[Anticardiolipin antibodies and early infarct of the myocardium]. / Anticorpi anticardiolipina ed infarto precoce del miocardio.

The relationship between anticardiolipin antibodies (aCL) and acute myocardial infarction (AMI) is still controversial. The purpose of this study was to investigate the prevalence of aCL in young patients (age < or = 45 years) with AMI; record the aCL titre during different days of disease; assess the relationship between aCL titres and in-hospital myocardial infarction complications. The aCL were measured in 108 consecutive patients and in 31 controls (ELISA method). High aCL levels (IgG or IgM) were found in 19/108 (17.6%) patients and 5/31 (16.1%) controls (NS); aCL titres were similar in different days after AMI and did not differ in controls and in patients with or without early myocardial infarction complications. In conclusion, the aCL levels are not elevated in AMI patients, do not change during the early stage of the disease and are not associated with in-hospital complications.

[Personal, familial and environmental factors influencing the inclination of smoking in adolescents: differences between sexes and between city and small-town dwellers]. / Fattori personali, familiari ed ambientali che influenzano la previsione di fumare degli adolescenti: differenze tra i sessi e tra grande e piccola città.

Smoking is a major health hazard. Most cigarette smokers start by the age of 18 years. The purpose of this study was to assess the prevalence of the intention to smoke among the students of a metropolitan compared to a non-metropolitan high school. The influence of age, sex, demographic and socio-economic variables, and the role of smoking models of family members and friends, were examined. Nine hundred forty-five students (529 males and 416 females; mean age 15.8 +/- 1.5 years) attending a high school in Naples and 442 students (223 males and 219 females; mean age 16.1 +/- 1.6 years) in Capua, a small town 40 Km distant from Naples, filled in an extensive questionnaire on smoking. The prevalence of intention to smoke was 10.4% in Naples and 9.3% in Capua. It was related to age (p < 0.01) in Naples, but not in Capua. The prevalence of smokers was 24.2% in Naples (males 21.6%, females 27.6%; p = 0.038) and 24.1% in Capua (males 29.2%, females 19%; p = 0.017). As expected, in both cities intention to smoke was associated (p < 0.001) with the strength of existing smoking habit. Students smoking over 21 cigarettes/week were more likely to continue than students smoking less 21 cigarettes/week, both in Naples and in Capua. More than half of smoking students, in both cities, were irresolute about their habit in the subsequent year. In Naples, intention to smoke of male students was associated with mother's (p = 0.02) and siblings' (p < 0.0001) smoking habit; in female students intention to smoke was associated with father's (p = 0.02), mother's (p < 0.001), parents' (p < 0.01) and siblings' smoking habit (p = 0.0002). In Capua an association was evident, in male students, between intention to smoke and paternal smoking habit (p = 0.04); in female students, intention to smoke was associated with siblings' smoking habit (p = 0.03). In Naples and in Capua, for both sexes, intention to smoke was related to smoking habits of the best friend of the same sex (p < 0.0005), the best friend of the opposite sex (p < 0.00005) and friends (p < 0.00001). Multivariate analysis showed, in Naples, an independent relation between adolescent intention to smoke and age (p = 0.01), smoking status of student (p < 0.0001) and friends' smoking habit (p = 0.01). In male students intention to smoke was associated with age (p = 0.003), smoking habit of student (p < 0.0001), mother's (p = 0.02) and friends' (p = 0.02), whereas in females it was associated with smoking behavior of student (p < 0.0001). In Capua student intention to smoke was related to the smoking status of the student (p < 0.0001) and of the best friend of the opposite sex (p < 0.04); in male as in female students, intention to smoke was associated with smoking habit of the student (p < 0.0001). In conclusion, prevalence of adolescents' intention to smoke is similar in two distinct populations of high school students of a city and a small town. Smoking is at higher prevalence among females in the city and among males in the small town. Intention to smoke increases with age, in the great city, and is related to student's existing habit and peer models. More than half of smoking students, in both cities, were irresolute about their habit in the subsequent year. This study has identified some variables associated with adolescents' intention to smoke; we feel that these findings may contribute to a better understanding of smoking behavior among adolescents and may have preventive implications.

[Family and friends who smoke: influence on adolescents]. / Familiari ed amici fumatori: influenza sugli adolescenti.

BACKGROUND: Smoking is the leading preventable cause of death. Most cigarette smokers take up the habit during adolescence. The purpose of this study was to assess the prevalence of cigarette smoking behavior among the students of a metropolitan high school as compared to those attending a non-metropolitan high school, examining age, sex and demographic and socioeconomic differences, as well as the influence of smoking models (family members and friends) on smoking behavior among adolescents. METHODS AND RESULTS: Nine hundred seventy-eight students (544 males, 434 females; mean age 15.8 +/- 1.5 years) attending a high school in the city of Naples and 467 students (235 males, 232 females; mean age 16 +/- 1.5 years) from a high school of Capua, a small town 40 kilometers away from Naples, filled out an extensive questionnaire on smoking. The prevalence of smokers was 24.2% (males 21.8%, females 28.2%; p = 0.02) in Naples and 23.8% in Capua (males 29.8%, females 19.2%; p < 0.001) and was related to age (p < 0.001) both in Naples and in Capua. In Naples, smoking behavior among male students was associated with smoking by sibling (p = 0.00005), whereas an association with father (p = 0.0003), mother (p = 0.00005), parental (p = 0.0002) and sibling (p = 0.00002) smoking was observed among females. In Capua, an association was evident only between smoking in female students and sibling smoking habits (p = 0.02). In both Naples and Capua, smoking status of the students was related to smoking habits of best friends of the same sex, best friends of the opposite sex and friends. Multivariate analysis showed an independent relationship in Naples between adolescent smoking behavior and smoking status of siblings (p = 0.01), best friends of the same sex (p < 0.001) and best friends of the opposite sex (p < 0.001). In males, smoking behavior was associated with the smoking behavior of best friends of the same (p < 0.001) and of the opposite sex (p = 0.01), whereas in females, it was linked with the smoking behavior of siblings (p = 0.05), mother (p < 0.05) and best friends of the same sex (p < 0.001). In Capua, student smoking was related to smoking among friends (p < 0.001) and this held true for both males (p = 0.05) and females (p < 0.0001). CONCLUSIONS: The prevalence of smoking habits among teenagers is similar in two distinct populations of high school students from a city and from a small town. Smoking showed a higher prevalence among females in the city and among males in the small town. It increases with age and is related to peer and family smoking models. This study has identified several variables associated with smoking status among adolescents. We thus feel that these findings may contribute to a better understanding of smoking behavior among teenagers and may have prevention implications.

[Evaluation of myocardial viability very early after acute myocardial infarction by ultra-low dose echo-dipyridamole test]. / Valutazione ultraprecoce della vitalità dopo infarto acuto del miocardio mediante test eco-dipiridamolo a dose ultrabassa.

BACKGROUND: After an acute myocardial infarction (AMI), stunned myocardium may cause a reversible left ventricular dysfunction. Dipyridamole echocardiography (0.56 mg*kg-1 over 4' e 0.84 mg*kg-1 over 10') can identify viable myocardium but can also induce ischaemia. AIM OF THE STUDY: To evaluate the usefulness of "Infra-low" dose dipyridamole echocardiography for identification of myocardial viability. METHOD AND RESULTS: Of thirty-four consecutive in-hospital patients, thirty (26 males; mean age 59 +/- 11 years) with AMI separately underwent (40 +/- 12 hours from symptoms onset): 1. a baseline resting echo (BASELINE); 2. a low dose dobutamine (DOB) echotest (5-10 mcg*kg-1*m-1 for 5') (DOB5, DOB10); 3. an "infra-low" dose dipyridamole echotest (0.28 mg*kg-1 over 4') (DIP). A pre-discharge resting echo was performed 7 days after admission (follow-up). No patient developed echocardiographic or electrocardiographic signs of ischaemia after DIP, while 4 patients developed ischaemia after DOB. The systolic blood pressure (112 +/- 18 mmHg) did not change after both DOB and DIP. The heart rate was unchanged after DIP (BASELINE = 73 +/- 18 bpm', DIP = 75 +/- 14 bpm'), while it increased after DOB (BASELINE 69 +/- 11 bpm'; DOB5 = 71 +/- 11 bpm', p = 0.02; DOB10 = 74 +/- 12 bpm', p = 0.001). Wall motion score index (WMSI), in a 16-segment model (from 1 = normal to 4 = diskinetic) (BASELINE = 1.64 +/- 0.3), improved after DIP (1.56 +/- 0.36, p < 0.05 vs BASELINE) and after DOB10 (1.50 +/- 0.36, p < 0.05 vs BASELINE) while did not change after DOB5 (1.59 +/- 0.35, p = n.s.). WMSI decreased at follow-up (1.53 +/- 0.31, p < 0.05 vs BASELINE); DIP and DOB10, but not DOB5, correctly predicted the WMSI decrease observed at follow-up. Results of DOB5, DOB10 and DIP were fully concordant in 118 segments (67%) (kappa = 0.54): 13 (7%) with concordant positivity and 105 (60%) with concordant negativity; 58 (33%) segments showed different results. At follow-up 54 (30%) of the 178 segments with baseline dysfunction, observed in 29 survivors, showed an improvement of grade 1 or more (viable). Two patients did not undergo DOB10; therefore, of the 168 segments with baseline dysfunction, in 27 survivors who underwent all tests, 54 (32%) showed an improvement of grade 1 or more (viable) e 114 (68%) showed no improvement (not viable). Of 25 DOB5 "responders" segments, 11 (44%) showed spontaneous recovery at follow-up (true-positive); of 153 "non responders" segments, 110 (72%) showed no spontaneous recovery at follow-up (true-negative). Of 61 DOB10 "responders" segments, 29 (47%) showed spontaneous recovery at follow-up (true positive); of 107 "non responders" segments, 82 (77%) showed no spontaneous recovery at follow-up (true-negative). Of 36 DIP "responders" segments, 19 (53%) showed spontaneous recovery at follow-up (true positive); of 142 "non responders" segments, 107 (75%) showed no spontaneous recovery at follow-up (true-negative). The sensitivity of DOB5, DIP and DOB10 for predicting short-term spontaneous recovery was 20, 35 and 53% (DOB10 vs DOB5: p < 0.001), respectively; specificity was 88, 86 and 71% (DOB5 vs DOB10: p = 0.002; DIP vs DOB10: p = 0.01); the positive value was 44, 52 and 47% (p = n.s.) and the negative predictive value was 72, 75 and 76% (p = n.s.) while the diagnostic accuracy was 67, 70 and 85% (p = n.s.). CONCLUSIONS: "Infra-low" dose dipyridamole echocardiography appears to be a hemodynamically neutral stress which does not modify either heart rate or blood pressure. It allows to explore selectively the viability of stunned myocardium, without eliciting ischaemia; it shows a good overall concordance with low-dose dobutamine and a low sensitivity but an excellent specificity for predicting spontaneous recovery early after AMI.

[Lipoprotein (a) and serum lipid levels young subjects with parents suffering from myocardial infarct]. / Livelli della lipoproteina (a) e dei lipidi sierici in giovani con familiarita per infarto del miocardio.

BACKGROUND: Elevated concentrations of lipoprotein (a) have been shown to increase the risk of coronary artery disease, especially in females, and have been found to be elevated in white US children with parental myocardial infarction. METHODS: To confirm the generality of this finding and to determine the influence of gender, we studied 143 children with parental myocardial infarction (cases), 71 males and 72 females, mean age 17 +/- 5 years, body mass index 22.1 +/- 3.8 and 102 controls, 50 males and 52 females, mean age 18 +/- 5 years, body mass index 23 +/- 4.3. RESULTS: The serum cholesterol and lipoprotein (a) levels were significantly higher, whereas the HDL level was significantly lower in cases than in controls; lipoprotein (a) levels > 30 md/dl were significantly more prevalent in cases than in controls. Among the males, serum HDL cholesterol was significantly lower in cases than in controls, whereas no significant differences were found in serum total cholesterol and in lipoprotein (a). Among the females, cases had lower HDL cholesterol level and higher serum total cholesterol and lipoprotein (a) levels in comparison to controls. CONCLUSION: Children with parental myocardial infarction, in particular the females, have a more unfavourable serum lipid profile than controls.

[Transient myocardial ischemia secondary to the use of cocaine-like anesthetic drug]. / Ischemia miocardica transitoria secondaria all'uso di farmaco anestetico cocaino-simile.

We describe the case of a 29-year-old male with a history of cocaine use who was hospitalized for a traumatic femur fracture. After spinal anesthesia with buprenorfin and bupivacain, he had electrocardiographic evidence of inferior myocardial ischemia. He was treated successfully with intravenous nitroglycerin. We conclude that not only cocaine addicts, but also subjects with a past history of cocaine use, may be at risk for transient myocardial ischemia when anesthetized with local cocaine-like anesthetics.

Right bundle branch block, persistent ST-segment elevation in V1-V3 and sudden cardiac death: always a distinct syndrome?

Right bundle branch block, persistent ST segment elevation in right precordial leads and sudden cardiac death, unexplainable by currently known disease, define a new distinct clinical and electrocardiographic syndrome. This report describe a patient with these features, whose physical examination, echocardiography, chest computed tomography and right ventricular angiography were normal. However, despite the negativity of these examinations, cardiac nuclear magnetic resonance allowed the identification of right ventricular dysplasia. Thus, right ventricular dysplasia should be considered in the differential diagnosis of the syndrome characterized by right bundle branch block, persistent ST segment elevation and sudden cardiac death.

[Proposed use of natural teeth for management of a prosthetic case]. / Proposta di utilizzazione di elementi dentari naturali per la risoluzione di un caso protesico.

Authors describe the case of a periodontopathic patient having seriously involved lower incisors. They used a splinting system consisting of a lingual metal bar using close healthy teeth as an anchor, and using previously extracted teeth of the patient to get a good aesthetical, psychological and functional result.

[Water absorption by denture base resins]. / L'asorbimento d'acqua da parte delle resine per basi protesiche.

In a review of the international literature about water absorption of denture base resins any effect on the physical properties of these polymers has been considered. The authors discuss the possibilities of controlling the final results on denture base function.

[The effects of subgingival irrigation with antimicrobial agents on periodontal disease]. / Gli effetti delle irrigazioni subgengivali con agenti antimicrobici nella malattia parodontale.

This report evaluates the role of local pharmacotherapy by subgingival irrigation to enhance clinical and microbiological periodontal status. This kind of chemical therapy is not a substitute to scaling and root planing, but possibly could increase its beneficial effects.

[Use of antibiotics during periodontal disease]. / L'uso degli antibiotici in corso di malattia parodontale.

Authors consider the possibility to use antibiotics to control periodontal disease. More used antibiotics are exposed systematically and topically administered.

[Chlorhexidine in the prevention of periodontal disease]. / La clorexidina nella prevenzione della malattia parodontale.

Authors considering microbiological and clinical characteristics of chlorhexidine pointing out its notable capacity to inhibit bacterial plaque formation and analyze possible collateral effects by its use.