[Impaired lung function and anemia from large hiatal hernia: a case report]. / Alterazioni della funzione respiratoria ed anemia da voluminosa ernia iatale: descrizione di un caso.

We present the clinical case of a 54 years old man who accessed for dyspnea and severe anemia. After being transfused, he underwent to gastroscopy, which showed an erosive gastritis with large hiatal hernia. The hernia was surgically reduced with laparoscopic hiatoplastic and Nissen-Rossetti fundoplication. In conclusion, dyspnea is not merely a medical competence but also a surgical one.

[Non-traumatic chest pain. Work at the Chest Pain Unit of Umberto I Polyclinic in Rome]. / Dolore toracico non traumatico. Attività 2010 dell'Unità Operativa Semplice Chest Pain Unit del Policlinico Umberto I di Roma.

The aim of the Chest Pain Unit at Policlinico Umberto I in Rome was to implement simple diagnostic flow-charts in subjects with non-traumatic chest pain for an early identification of patients at high, intermediate and low risk of acute coronary syndrome (ACS). A total of 4.74% of all patients admitted to the Emergency Department were hospitalized in the Chest Pain Unit. 15.72% of them received a diagnosis of atypical chest pain with low risk of ACS; 26,42% were diagnosed of stable angina pectoris; 11.37% were affected by chronic coronary heart disease with medium risk of ACS and 12.83% were at high risk of acute coronary syndrome.

[Variation in the plasma concentration of B-type natriuretic peptide in emergent paroxysmal atrial fibrillation, in acute pulmonary embolism, in acute coronary syndrome and in dilated cardiomyopathy]. / Variazioni della concentrazione plasmatica del peptide natriuretico di tipo B in urgenza nella fibrillazione atriale parossistica, nell'edema polmonare acuto, nella sindrome coronarica acuta e nella cardiomiopatia dilatativa.

Our research is based on the critical evaluation of plasma concentration variation of B-type natriuretic peptide (BNP)--in emergency--in paroxysmal atrial fibrillation, acute pulmonary edema, acute coronary syndrome and dilated cardiomyopathy. The aim of our research was to assess if the BNP concentration variation may be useful in the diagnosis and therapy. Peptide synthesis takes place mainly in the ventricular myocardium. We selected 102 patients: 27 control subjects, and 75 admitted to the emergency and reception department for dyspnea and/or precordialgia and/or palpitations. At the beginning they were considered as one group only, and then they were divided into groups according to the diagnosis: 20 with paroxysmal atrial fibrillation with reversion to sinus rhythm in the first week; 20 with acute pulmonary edema; 22 with acute coronary syndrome without electrocardiographic ST-segment changes; 13 with compensated dilated cardiomyopathy. Our research assessed that the BNP activation and secretion are evident especially in patients with heart failure and remains at the high level until the administration of an effective therapy and then they reach a balance with values higher than the standards, while in the paroxysmal atrial fibrillation and in acute coronary syndrome they rise and come back to the standard levels or even at lower levels after the disease solution. For this reason, BNP reiterated measurements allow to assess treatment efficacy, even at home, and to optimize the therapy. The main limit of BNP diagnostic role is in the need of knowing in advance the specific values for each patient. The BNP concentration evaluation in the acute phase is necessary to differentiate patients with dyspnea due to heart failure from those with pulmonary pathologies, while the BNP assessment in the acute coronary syndrome predicted exitus or heart failure manifestations.