Multicenter evaluation of mepindolol and of mepindolol plus hydrochlorothiazide in essential hypertension.

The effect on systolic (SAP) and diastolic (DAP) arterial blood pressure of 5 mg mepindolol daily vs 12.5 mg hydrochlorothiazide daily vs 5 mg mepindolol plus 12.5 mg hydrochlorothiazide daily was evaluated in this multicenter study. After a 2-week washout period with placebo, 138 patients with mild to moderate essential hypertension (WHO Class I and II), homogeneous for age and blood pressure values, were randomly allocated to one of the three treatment groups. Arterial blood pressure and heart rate were obtained at the beginning and at the end of the washout placebo period, and after 2, 4, and 6 weeks of active treatment. At the beginning and at the end of the study, all patients underwent a thorough clinical and laboratory evaluation, including blood chemistry, electrocardiogram, and chest roentgenogram. A trend toward normalization of blood pressure was defined as a lowering of DAP to 90 mmHg or at least a 10-mmHg decrease from the control value. Statistical analysis was performed on all the data. After 6 weeks of treatment, SAP and DAP values were significantly reduced in 67% of the patients in all groups. In 71% of patients on mepindolol plus hydrochlorothiazide a particularly more marked decrease in DAP was observed. Mepindolol was well tolerated: side effects were generally mild and inconsequential. The results show that mepindolol, given as a single oral dose of 5 mg, is an effective agent in the treatment of mild to moderate essential hypertension. Because of its efficacy, the advantage of single daily administration, and lack of important side effects, it can increase compliance to therapy. Moreover the association of mepindolol plus hydrochlorothiazide appears to be safe and effective.

[Value of metabolic studies in diagnosis of ischemic cardiopathy]. / Valore dello studio metabolico nella diagnostica della cardiopatia ischemica.

10 patients with documented heart disease were undergone to atrial pacing (AP) combined to metabolic study. A negative lactate utilization (-%L) noticed in SC (coronary synus) represents a sure proof of a subordinate pacing ischaemia. As the negative lactate utilization is absent a significative reduction of %L during AP or its persistence in recovery and a rise of L/P are further parameters of a subordinate pacing ischaemia. The Authors consider the usefulness of combining a metabolic study to AP in assessing the RC (coronary reserve).

[Effects of nifedipine on lactate metabolism in ischemic cardiopathy. Evaluation by atrial pacing]. / Effetti della nifedipina sul metabolismo del lattato nella cardiopatia ischemica. Valutazione mediante atrial pacing.

10 patients with documented ischaemic heart disease were undergone to atrial pacing (AP) before and after administration of nifedipine. The lactate utilization (%L), ischaemic ST, angor were tested in the same conditions before and after the drug. Six patients presented negative lactate utilization (-%L) during AP before the drug and four had decreased %L during recovery. -%L was removed by the drug, in those without -%L nifedipine is able to provocate the same paradoxically. Nevertheless angor disappears n all cases while the ischaemic ST is irregulary eliminated. Paradoxical -%L after nifedipine was not assumed as result of damage of the coronary flow, as ischaemic ST and angor disappear. Probably this is the sign of byochemical block of piruvate-deydrogenasy due to the Ca++ antagonist action of nifedipine. Nifedipine favorable action was explained by the increased %L in patients with low %L during recovery time, that is expression of a increased aerobic metabolism.

[Clinical significance of a prolonged sinus-node recovery time as the only pathological finding: follow-up]. / Significato clinico di un tempo di recupero del nodo del seno allungato come unico dato patologico: follow-up.

The Authors report their experience related to clinical follow-up (F.U.) study of a 12 patients group who showed a prolonged sinus node recovery time (SNRT) as the only pathologic datum. F.U. study appears extremely useful for clinical arrangement of these patients. In 6 patients a gastric ulcer was associated, which is considered a morbid equivalent of vagotonia. Therefore SNRT could be a false positive. In 3 patients following controls allow to document an initial ischemic cardiopathy. Tachicardic phase of S.S.S. was documented in 3 patients.

[Vectorcardiographic evolution after a valve replacement operation]. / Evoluzione vettorcardiografica dopo intervento di sostituzione valvolare.

The vectorcardiograms of 35 patients with valvular heart disease were recorded before and after prosthetic valve replacement. The spatial magnitude of the 40 msec and maximum QRS vectors were decreased postoperatively in patients with mitral insufficiency aortic stenosis and aortic insufficiency. 9 patients were studied postoperatively by right heart catheterization.

[Malfunction of disc prostheses. Echocardiographic study of 5 cases (author's transl)]. / Malfunzionamento di protesi a disco. Studio ecocardiografico di cinque casi.

78 patients who underwent disc prostheses replacement, 36 in mitral area, 58 in aortic area were studied by echocardiography. The Authors found 5 cases of malfunction, 3 in mitral area and 2 in aortic area. Regarding mitral malfunctions in 1 case a valve thrombosis was found; in 2 cases there was a partial leak. Regarding aortic malfunctions there was paravalvular leak. In mitral area malfunctions the Authors found alterations of the disc morphology during diastolic opening time associated with alteration of opening time. An increased diastolic closure velocity in 2 cases of paraprosthetic leak was found. A diagnostic element in the case with thrombosis was variability of maximal disc escursion during the same recording, because opening time variability never got over 10 m. seconds. In aortic area malfunctions the Authors found a constant fluttering of anterior mitral leaflet, a sinergic septal motion with the posterior wall and in 1 case the presence of disc opening before the first component of the first sound. The Authors underline the importance of simultaneous eco-phonocardiographic examination and the check-ups for the time to be.

[Electrophysiological evaluation of the aberrant pathways of intraventricular conduction obtained by means of premature atrial stimulation]. / Valutazione elettrofisiologica delle aberranze della conduzione intraventricolare ottenute mediante stimolazione atriale prematura.

12 patients with normal QRS either in basal condition or during atrial pacing, undergone on single premature atrial stimulation, showed several types of intraventricular aberrancies. These have been revalued with atrial premature stimulation introduced over a progressively increasing frequency of fixed atrial stimulation (extrastimulus method), sometimes after atropine. In 9 cases it was possible to eliminate completely the above mentioned aberrancies, having thus a clear reduction of the refractory periods regarding their responsible structures. In 3 cases this was not possible, owing to a less significant reduction of the refractory periods. Such fenomenon is considered as the only parameter able to identify probable initial organic facts of the His-Purkinje system.

[Transitory malfunction of an L-Kaster mitral prosthesis. Echocardiographic and polygraphic study]. / Malfunzionamento transitorio di una L-Kaster in sede mitralica Studio ecocardiografico e poligrafico

An unusual instance of transient prosthesis breakdown in a 29-yr-old woman with two L-Kaster disk prostheses for mitro-aortic defect is reported. The ECHO and polygraphic traces observed during and after breakdown are examined. It is considered that the breakdown which occurred in one prostheis only, was attributable to a small, internal thrombosis with embolism of the right lower extremity.

[Rapid atrial stimulation in therapy of atrial flutter]. / La stimolazione atriale rapida nella terapia del flutter atriale

Personal experience in 12 cases of atrial flutter treated with various types of atrial electrostimulation is reported. In 6 cases the sinusal rhythm was obtained immediately. In the remaining cases sinusal rhythm was also obtained with atrial fibrillation from a minimum of 2 minutes to a maximum of 48 hours.

[Recording of the potential of the bundle of His through the veins of the arm]. / Registrazione del potenziale del fascio di His per le vene del braccio

A new technique for recording His bundle and right branch potential through the veins of the arm instead of by the femoral route is described. Recordings were carried out in 70 patients. In 10, His potential was recorded simultaneously by the femoral and brachial routes. Potentials proved to be similar as regards morphology and duration; A-V conduction time proved identical while there were slight variations in His node conduction time since the atriogram revealed varying intrinsic deflexions. It is thus possible to confirm that the recording of His potential by the brachial route offers various advantages: 1) it takes less time than the femoral route; 2) it is an excellent alternative if, for various reasons, the patient cannot be examined by the femoral route; 3) His potential can be monitored more easily because of the greater stability of the catheter and the provisional electrosimulation using the same catheter when necessary; 4) contemporaneous recording of right branch and His bundle potential is possible in association with the femoral technique with better results than those obtained using multipolar catheters; 5) it is without complications: i.e. the phlebitis, phlebothrombosis, a-v fistula, and pulmonary emboly which, however rarely, may occur when using the femoral route.

[Evaluation of the parameters concerning the method for determination of the sinus node recovery time. Personal experience (author's transl)]. / Valutazione dei parametri relativi alla metodica di esecuzione del tempo di recupero del nodo del seno. Esperienza personale

On the basis of the personal experience of 36 patients with sick sinus syndrome, the role of length, seat, frequency of atrial stimulation (AS) on the duration of correct sinus node recovery time (CSNRT) were examined. The length of AS has little importance for values over 2 minutes. In 2 cases the CSNRT were pathological only if the position had been changed from the lateral wall of the right atrium to the middle right atrium. The frequency of AS is very important for the duration of pathological and maximal CSNRT. Therefore it is better to give every patient the major range of frequencies of AS as for a correct quantitative determination of sinus dysfunction so as not to lose some falsely negative results.