Mental and physical effects of energy drinks consumption in an Italian young people group: a pilot study.

INTRODUCTION: The primary consumers of energy drinks were athletes, to combat fatigue, but in reality, thanks to their fast expansion and economic growth, young adults and teenagers represent the new target market. Consumption of energy drinks by both recreational and competitive athletes has increased dramatically in recent years, though they are often unaware of what is being ingested, believing to improve their physical and psychological performance. The literature shows contradictions about the capacity of energy drinks to enhance psychophysical results. In relation to probable adverse effects induced by the irregular consumption of energy drinks, which in several cases are not so clear, we decided to investigate the possible relationship between the intake of energy drinks and the presence of mental and physical stress in young people and athletes. METHODS: Two experimental sessions, separated at least by 1 week, according to a randomized cross-over design, following this protocol were conducted: in the first session a mental and physical stress was conducted without the consumption of energy drinks, the second after energy drinks consumption. BAI (Beck Anxiety Inventory) and BDI (Beck Depression Inventory II) test have been used to test the mental stress, and a "cycle ergometer test" to test the physical stress. RESULTS: BAI and BDI tests results showed that before the consumption of energy drinks, subjects are considered in the range of "minimal level of anxiety", (10 and 60 percentiles) and do not report a level of depression. After the energy drinks consumption, a "mild level of anxiety" has been recorded, and the BDI showed a case with a pathological profile. The physical test recorded a small increase in the maximum heart rate was verified with the intake of an energetic beverage. CONCLUSIONS: The stimulating effect of Energy Drinks EDs on nervous system and cardiovascular system, must be checked and studied in deeper detail, because it may represent a risk for the health of young athletes.

Relationship of visceral fat distribution to angiographically assessed coronary artery disease: results in subjects with or without diabetes or impaired glucose tolerance.

BACKGROUND AND AIM: To evaluate the relationship between the degree of coronary artery disease (CAD) and the amount of visceral fat deposition in a mixed population of CAD patients with or without diabetes or impaired glucose tolerance (IGT), and with different body weights. METHODS AND RESULTS: A total of 55 patients undergoing coronary angiography (43 men and 12 women with a mean age of 58.9 +/- 1.1 years, range 37-70, and a mean body mass index [BMI] of 27.9 +/- 0.4, range 21.3-38.7) were studied in order to establish whether the coronary damage exclusively depends on intra-abdominal adipose tissue per se, or may be influenced by the coexistence of diabetes or IGT. Twenty-one subjects were non-diabetic, 13 had type 2 diabetes, and 21 IGT. Hypertension was found in 47% and dyslipidemia in 55%; 69% were smokers. The angiographic evaluation of CAD was made using the method of Gensini, and computed tomography (CT) was used to estimate the amount of visceral adipose tissue (VAT) based on a single scan at L4 level. Clinical, anthropometric, biochemical and hormonal variables, as well as smoking and alcohol consumption were determined. In the study population as a whole, the coronary score did not correlate with VAT, but only with smoking. However, both univariate and multivariate regression analysis showed that CAD significantly correlated with VAT in the non-diabetic patients, particularly in those with VAT of > 130 cm2. This correlation did not appear in the diabetic or IGT patients, nor when the group of patients with VAT > 130 cm2 was extended to include diabetic or IGT patients. No relationship was found between CAD and BMI or the other considered variables. CONCLUSIONS: In a mixed population of CAD patients with or without diabetes, CAD correlates with VAT only in the absence of diabetes or IGT, and especially when VAT exceeds 130 cm2 at an L4 CT scan, regardless of weight or obesity. Diabetes or IGT therefore seem to contribute towards the development of CAD regardless of the amount of VAT.

[Spontaneous coronary dissection as a cause of acute myocardial infarct: description of a case and review of the literature]. / La dissecazione coronarica spontanea quale causa di infarto miocardico acuto: descrizione di un caso e revisione della letteratura.

Spontaneous coronary artery dissection is a rare cause of acute myocardial ischemia or death that is generally not detected until an autopsy is performed. It occurs in relatively young people and particularly in females. To date, its prognosis and treatment are not well defined. We describe our experience with one patient with acute myocardial infarction due to spontaneous dissection of the right coronary artery, which was treated successfully through direct coronary angioplasty. A 48-year-old man, heavy smoker, was admitted to our CCU for an acute inferior myocardial infarction with right ventricle involvement, which was complicated by the onset of cardiogenic shock (severe arterial hypotension, cold, pale and clammy skin, decrease in mental alertness, marked bradycardia due to a complete atrioventricular block). Since systemic thrombolysis was contraindicated (syncope followed by cranial trauma at the onset of symptoms), the patient underwent urgent coronary angiography that showed a proximal right coronary subocclusion with a filling defect and oblique linear density indicating possible dissection. Primary angioplasty was successfully attempted and a good distal flow was achieved (TIMI 3), but coronary artery dissection became more evident, with a double lumen extending over the distal segment just to the crux. Coronary stenting was not performed because optimum anticoagulant therapy was contra-indicated due to cranial trauma. Standard medical therapy was started after the procedure and coronary angiography, which was repeated before the patient was released from hospital, showed complete healing of the right coronary artery without any signs of dissection. The patient remained asymptomatic at a six-month follow-up check, with a negative exercise test. In our opinion, coronary angioplasty is a suitable therapeutic option in the treatment of spontaneous coronary dissection. More extensive experience is needed in order to standardize the most suitable therapeutic procedure in this rare cause of myocardial ischemia.

Prolonged streptokinase infusion in patients with unstable angina: results of a randomized, placebo-controlled clinical trial.

BACKGROUND: The purpose of this study was to assess the efficacy both of prolonged (48 h) and of short-duration (1 h) administrations of streptokinase in patients with unstable angina. In unstable angina, thrombosis is a dynamic process that waxes and wanes for hours and even days. The majority of previous studies have investigated the efficacy of short-duration thrombolytic regimens. METHODS: One hundred patients with acute unstable angina were randomly allocated to receive placebo, 1,500,000 U streptokinase during 1 h or 250,000 U streptokinase during 1 h and then a prolonged infusion of 100,000 U for the next 48 h. All of the treatments included intravenous heparin administration for 72 h. RESULTS: No death occurred in the study population. One of 34 patients treated with placebo (2.9%), three of 33 treated with streptokinase during 1 h (9.0%) and three of 33 treated with streptokinase during 48 h (9.0%) had a myocardial infarction. Refractory angina occurred in nine, three and seven patients receiving placebo, streptokinase during 1 h and streptokinase during 48 h, respectively. Kaplan-Meier analysis showed that the total probability for a patient to be free of cumulative events did not differ among the three groups of patients (NS). Fourteen patients (41%) receiving placebo, 15 patients (45%) receiving streptokinase during 1 h and 14 patients (42%) receiving streptokinase during 48 h had ischaemic episodes detected by Holter monitoring during the first 72 h after hospital admission (NS). Two patients receiving streptokinase during 48 h required blood transfusion, and a greater incidence of minor bleeding (P < 0.05) and adverse events (P < 0.02) was observed in patients receiving prolonged streptokinase administration than in those receiving streptokinase during 1 h or placebo. CONCLUSIONS: In patients with acute unstable angina, the administration of two different regimens of streptokinase significantly reduces the probability neither of developing cardiac events during hospitalization nor of ischaemia detected by Holter monitoring in the early phase after hospital admission. Although the sample size of the study provided sufficient power to exclude only a large difference in effect size, it did allow us to detect a significantly higher incidence of bleeding in the group of patients treated with prolonged streptokinase infusion.

Variable response to atrial pacing after intravenous propranolol in patients with stable exertional angina.

The effect of propranolol administration on regional coronary haemodynamics were investigated in 14 patients with stable exertional angina and isolated left anterior descending artery disease. Thermodilution was used to measure great cardiac vein flow (GCVF) and anterior regional coronary resistance (ARCR) under control conditions, at peak atrial pacing, after i.v. propranolol administration (0.1 mg kg-1) and at the peak of repeated atrial pacing. Propranolol did not change peak pacing heart rate, systolic blood pressure or double product. Peak pacing GCVF decreased slightly but non-significantly after drug administration from 84 +/- 20 to 79 +/- 24 ml min-1, while ARCR increased, but again non-significantly, from 1.36 +/- 0.44 to 1.45 +/- 0.45. Analysis of individual patient responses revealed that propranolol prolonged peak pacing time and hence peak pacing heart rate (from 126 +/- 24 to 140 +/- 23 beats min-1, P less than 0.05) in five patients. In such patients, peak pacing systolic blood pressure was lower than the pre-propranolol atrial pacing (145 +/- 35 vs 165 +/- 33, P less than 0.001) so that double product remained unchanged. Moreover, peak pacing ARCR did not change after propranolol (pre-propranolol 1.47 +/- 0.46, after propranolol 1.40 +/- 0.56 mmHg.ml-1.min, P = ns) while it increased significantly in the nine patients who did not improve after the drug (before propranolol 1.30 +/- 0.44, after propranolol 1.48 +/- 0.41 mmHg.ml-1.min, P less than 0.02). These data suggest that the response to atrial pacing after i.v. propranolol administration is variable as some patients tolerate higher heart rates while others do not.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term survival and risk stratification in patients with angina at rest undergoing medical treatment.

In order to determine those factors which influence long-term prognosis in patients with angina at rest associated with transient ST-segment changes, 217 patients undergoing medical treatment were followed for a mean of 39 months. All patients underwent coronary arteriography. Univariate analysis identified 12 variables significantly related to prognosis. These were disease of the left main coronary artery; the number of diseased vessels; left ventricular end-diastolic pressure; ejection fraction; baseline electrocardiogram; presence of prior myocardial infarction; ST-segment depression and ventricular arrhythmias during pain; disease of the proximal anterior descending coronary artery; crescendo angina; hypertension; and age. Use of the Cox regression model for survival analysis revealed only 3 variables which were independent predictors of prognosis. They were disease of the left main coronary artery; the number of diseased vessels and left ventricular end-diastolic pressure. The model allowed stratification of patients into 3 groups. Survival at 3 years was 98% in the low risk group; 82% in the intermediate risk group; and 58% in the high risk group. These data indicate that disease of the left main coronary artery, the number of diseased vessels and left ventricular end-diastolic pressure are the independent predictors of prognosis in angina at rest. These variables may allow stratification of patients into groups having different long-term survivals.

[Relationship between morphology of restenosis and clinical aspects in patients who had undergone coronary angioplasty]. / Relazione tra morfologia della restenosi e quadro clinico in pazienti sottoposti ad angioplastica coronarica.

Although restenosis after percutaneous transluminal coronary angioplasty (PTCA) may have morphologic characteristics which are not similar to the original stenosis, it is unknown if a different morphology is also associated with a different clinical presentation. Eleven consecutive patients with angina and single vessel disease had a recurrence of symptoms and restenosis within 6 months of successful PTCA. Seven patients (group I) complained of spontaneous angina before PTCA and had a positive hyperventilation test, while 4 patients complained of exercise-induced angina and had a negative hyperventilation test (group II). In group I restenosis was associated with the same clinical presentation as before PTCA and the hyperventilation test was positive in 6 patients. The angiographic morphology of restenosis was changed in 4 patients. In group II restenosis occurred with the same clinical presentation as before PTCA, the hyperventilation test was negative in 3 patients while the angiographic morphology of restenosis was unchanged in only 1 patient. Although morphology of restenosis is different from the original stenosis, clinical presentation associated with restenosis is generally the same as before PTCA. The response to vasoactive stimuli is independent from the morphology of the lesion.

Clinical significance of mitral regurgitation in patients with recent myocardial infarction.

The prognostic implications of the presence of mitral regurgitation (MR) in patients with recent myocardial infarction has not been clarified yet. In March 1983, we undertook a prospective study in patients surviving a first episode of acute myocardial infarction. Over a 4-year period, 266 patients entered the study. Left ventriculography documented the presence of MR in 51 patients, while 215 did not have angiographic evidence of MR. The presence of MR was associated with larger infarcts, as shown by greater values of peak CK (P less than 0.05) and by the prevalence of Q-wave vs non-Q-wave infarctions (P less than 0.05). Transient left ventricular failure during hospitalization was more frequent in patients with MR (P less than 0.05), while the occurrence of early post-infarction angina was similar in the two groups of patients. No difference was found in the extent of coronary disease, yet patients with MR had higher values of left ventricular end diastolic pressure (LVEDP) (P less than 0.005) and a lower ejection fraction (EF) (P less than 0.001). Patients with MR had a reduced exercise capacity (P less than 0.005), but signs of myocardial ischaemia were similarly distributed in the two groups. Patients with anterior infarcts and MR had higher left ventricular volumes than patients without MR, while no difference was found between patients with and patients without MR and inferior infarction, suggesting that left ventricular dilatation may play an important role in the pathogenesis of MR in patients with anterior but not in those with inferior infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Unstable angina.

Patients with unstable angina, defined as resting chest pain associated with transient repolarization changes on the electrocardiogram, represent a high risk subset among the clinical manifestations of ischemic heart disease. Pathogenetic mechanisms include coronary spasm and vasoconstriction, coronary thrombosis and platelet aggregation. Early prognosis is related to the degree of activity of the disease while long-term outcome depends on the extent of the coronary disease and the degree of left ventricular dysfunction. Medical treatment should include the combination of beta-blockers, nitrates and calcium antagonists as well as the use of heparin and aspirin. Despite such an aggressive treatment, attacks of resting chest pain persist in almost 30 per cent of patients. In these cases emergency revascularization may be achieved by either coronary angioplasty or bypass surgery. The latter operation may result in improved survival in patients with impaired left ventricular function and triple vessel disease.

[Pneumomediastinum or mediastinal emphysema. Case contribution and classification]. / Pneumomediastino o enfisema mediastinico. Contributo casistico e classificativo.

Five cases of pneumomediastinum with different aetiology are reported. The pathogenetic problems are examined and a new classification with physiopathologic criteria proposed.