Are baseline frequencies of SCEs, CAs, and MN in human lymphocytes related to hematological values?

In the present study, the correlation among several hematic values and the baseline frequencies of sister chromatid exchanges (SCEs), chromosome aberrations (CAs), and micronucleus (MN) were evaluated in human peripheral blood lymphocytes from a group of 1429 volunteers. Donors were selected to be representative of the general population of people living in the city of Pisa (Italy). By the use of the principal component analysis (PCA), principal components (PCs) were extracted from the complex pattern of correlations intrinsic in the hematic values (for example such as those among hemoglobin content, hematocrit, and erythrocyte count), and were tested for correlation on SCE, CA and MN frequencies. The seven PCs extracted (among 20 hematic values) were either positively or negatively correlated with the three cytogenetic endpoints. However, after correction by independent confounding factors (such as the age), with the use of the coefficient of partial correlation (CPC) analysis, only one PC significantly held the correlation with MN frequencies. This PC had the main contribution from the correlation between the concentration of potassium and the activity of alkaline phosphatase. These variables are known to be markers for bone (calcium) metabolism and are negatively correlated with MN frequencies. Because MN can arise from aneuploidy, the hematic concentrations of calcium may be important for stabilizing the mitotic process in stimulated lymphocytes. Finally, our study shows that the analysis of the hematic values adds very little information and removes a meaningless part of variance of the total variability observed for SCEs, CAs and MN.

Subacute left ventricular free-wall rupture in early course of acute myocardial infarction. Clinical report of two cases and review of the literature.

Left ventricular free wall rupture (LVFWR) may complicate an acute myocardial infarction (AMI); its frequency ranges from 1 to 6 percent. In the era of coronary care units, LVFWR is the second cause of in-hospital death, after pump failure. The subacute presentation accounts for 2-3 percent of total hospital admissions for AMI. Heart rupture may not be suddenly fatal and sometimes there is enough time for surgical repair. Electromechanical dissociation is neither the only nor the main clinical presentation. More subtle symptoms occurring hours or days before the final event include unexplained hypotension and transient bradycardia and some ECG features such as persistent ST-segment elevation with T-waves failing to invert in the same leads. On echocardiographic subcostal view, pericardial effusion of more than 5-10 mm, with echo-dense masses overlying the heart independently of cardiac tamponade, is highly suggestive of heart rupture. If pericardiocentesis yields hemorrhagic fluid, surgical intervention is mandatory, providing both diagnostic confirmation and definitive treatment. Medical management strategies (prolonged bed rest, beta-blockade therapy) are still experimental but could become suitable for particular subsets of patients (elderly patients and patients at a high surgical risk). We report two cases of subacute LVFWR and review the currently available literature.

[Proteinuria in diabetic disease]. / La proteinuria nella malattia diabetica.

In 397 patients with primitive diabetes mellitus the authors evaluate the incidence of the disprotidemic pattern, behaviour of total utinary protein excretion/24/hours, renal function, glycosilated hemoglobin and oedema. This epidemiologic research shows that more attention must be placed on the evaluation of the plasma protein electrophoretic pattern and behaviour of plasma glycosilated hemoglobin. Clinical and physiopathological implications are discussed.

[Myocardial scintigraphy with thallium-201 in the evaluation of aortocoronary bypass patients]. / La scintigrafia miocardica con Tallio-201 nella valutazione dei pazienti operati di by-pass aorto-coronarico.

We have compared the results of 201-Thallium scintigraphy (201 TI Sc) and those of coronary angiography in 48 patients (Pts) at a mean time of 13 months after a coronary artery by-pass grafting operation (CABG). Forty-six pts were males and 2 females, with a mean age of 52 years (range 37-66). Eighteen pts (37%) had had a myocardial infarction (MI) before the operation, 4 (8%) had a perioperative and 3 (6%) a postoperative MI. Nineteen pts (40%) had angina, 9 (19%) atypical chest pain, 6 (12%) shortness of breath or easy fatigability and 14 (29%) had no symptoms. The overall CABG patency was 74% (left anterior descending: 73%, left circumflex: 71%, right coronary artery: 80%). The 201 TI was injected at peak exercise and its myocardial uptake was recorded immediately and after four hours at rest. The 201 TI Sc has shown a sensibility (SN), specificity (SP), positive predictive (PV-pos) and negative predictive value (PV-neg) of 86, 82, 64 and 94% respectively, compared to coronary angiography. In the single patient evaluation the 201 TI Sc has shown a SN, SP, PV-pos, PV-neg of 95, 85, 82 and 96% respectively versus 90, 82, 78 and 92% of the standard exercise test associated with a positive history for 1) residual angina and 2) peri or postoperative MI. The 201 TI Sc has not shown to be significantly superior to standard exercise testing and history in the evaluation of graft patency. However it allows a topographic localization of the disease which is not feasible with the latter techniques. The 201 TI Sc can better predict the patency rather than the occlusion of the grafts because there is a high number of false positives due to residual ungrafted native disease in the territory of a good functioning graft. The 201 TI scintigraphy can give a functional evaluation of borderline grafts stenoses beside the pure anatomic definition of angiography thanks to its capability to qualitatively assess the regional myocardial blood flow during stress.