The direct surgical management of lesions of the high internal carotid artery.

The diagnosis and surgical management of non-penetrating high cervical internal carotid injuries continues to be a major problem. The increased incidence of these lesions is due to the escalation of motor vehicular trauma involving multi-system injuries as seen in our Trauma Unit. Carotid angiographic studies are necessary for diagnosis when there is an index of suspicion at time of injury. There have been varied opinions concerning the best treatment due to the difficulty of direct access to the para-mandibular, para-antantoxial segment of the internal carotid artery. Two cases of post-traumatic aneurysms have been discussed and an innovative surgical technique is demonstrated with excellent results. This technique can be utilized in other lesions of the high carotid artery such as intimal flaw and/or dissection of this vessel. The primary indications for surgical intervention are propagation of emboli originating in the aneurysmal sac and intolerance of head noise to the patients (not seen in our patients).

[Prognostic significance of thallium-201 scintigraphy in patients with previous myocardial infarct]. / Valore prognostico della scintigrafia con tallio-201 nei pazienti con pregresso infarto miocardico.

With the purpose of ascertaining the predictive value of residual myocardial ischemia, in stable clinical conditions at a distance after myocardial infarction, on the incidence of late cardiac events, we evaluated 55 patients 24.2 +/- 11.4 months after myocardial infarction with thallium-201 stress test imaging. All patients were either asymptomatic or with stable effort angina pectoris, well controlled with medical treatment. In the next follow-up period, whose duration has been 22.4 +/- 14.4 months, the incidence of unfavourable cardiac events, like unstable angina, reinfarction, coronary bypass surgery, sudden cardiac death has been monitored. Thirty-one patients (56.4%) presented a reversible perfusion defect (RPD) in one or more myocardial segments; 17 of these 31 showed cardiac events during follow-up. Only 2 patients of the remaining 24 without RPD had cardiac events, with a significant difference (p less than 0.01). The patients with RPD only in peri-infarct areas had a relatively smaller number of cardiac events, with respect to those patients with RPD also or only in distant areas. Fifteen of 21 patients with RPD in 2 or more segments manifested cardiac events, compared to 2 of 10 patients with RPD in only one segment (p less than 0.01). In 10/55 patients, increased lung uptake of thallium-201 activity was observed; 8 of them presented cardiac events (p less than 0.01). This analysis confirms the high predicting value of thallium-201 RPD imaging on the incidence of cardiac events in patients controlled at a distance after myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Myocarditis in legionellosis. A case report]. / Miocardite in corso di legionellosi. Descrizione di un caso.

Cardiac involvement during Legionnaires' disease has been rarely described; few cases of myocarditis, pericarditis and endocarditis were reported. We describe a case of myocarditis associated to pneumonia, with high antibody title suggesting a disease due to Legionella pneumophila. The patient had severe myocardial damage, with overt heart failure and important ECG and Doppler-echocardiographic abnormalities, without associated multiorgan involvement.

[Female gender and acute myocardial infarction: what role does it play in the early and late prognosis]. / Sesso femminile ed infarto miocardico acuto: quale ruolo nella prognosi a breve e medio termine?

The primary purpose of this study is to examine the influence of the female gender on the early and 1-year post-discharge prognosis after acute myocardial infarction (AMI). Moreover, the therapeutic approaches are compared between the two sexes during the early phase of AMI. We performed a retrospective cohort study of 341 patients, 219 men and 122 women, consecutively admitted to the coronary care unit with AMI. Among the baseline characteristics, the age greater than 70 years, the systemic hypertension and the diabetes mellitus are more represented in women; on the contrary cigarette smoking is prevalent in the male gender. The analysis of laboratory and clinical parameters does not show any statistic differences between the two sexes, except the ejection fraction and the coronary reperfusion. The first turns out to be lower in the females and the second one is more often observed in the males. As for the intra-hospital complications, the cardiogenic shock is prevalent in the female gender, the early mortality gets to 26% in women and 11% in men (p < 0.01). The late mortality during the follow-up does not present any difference between the two sexes. From our data, we conclude that transmural AMI, cardiogenic shock, ventricular fibrillation and 2-3 degree atrio-ventricular blocks are significantly bound to a higher early mortality in women. In them the atrial fibrillation is the only predictor of 1-year mortality. Finally, thrombolysis, beta-blockers and significantly aspirin and heparin (p < 0.05), are less used in the female patients, while diuretics and digoxin are more employed.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of age on early and late mortality after an acute myocardial infarct]. / Influenza dell'età sulla mortalità precoce e tardiva dopo infarto miocardico acuto.

The purpose of this study is to define the importance of age as predictor of early and late mortality following acute myocardial infarction (AMI). At the same time, effects coming from the use of various therapeutic approaches are considered. We have studied 341 patients, 188 aged < 70 years and 153 > or = 70 years, consecutively admitted to the coronary care unit with diagnosis of AMI. Our findings show that age > or = 70 years, female gender, cardiogenic shock, ventricular fibrillation and early post-infarction angina are significantly connected to higher intra-hospital mortality. As for predictors of 1-year mortality, they turned out to be the age > or = 70 years, indirect signs of more extensive infarction as previous necrosis, acute heart failure, cardiogenic shock, new bundle branch blocks and pre-discharging lower ventricular ejection fraction. In patients aged > or = 70 years, especially in ultra eighty-year old men, thrombolysis, heparin, beta-blockers and aspirin are significantly less employed. All drugs used in the early hours of AMI turned out to be bound to beneficial effects with reduced mortality, except diuretics and antiarrhythmics. The only drugs correlated with an improved 1 year survival are betablockers, aspirin and thrombolysis. On the contrary, the use of diuretics and digoxin is limited to patients with a greater clinical dysfunction. These drugs are associated to a higher late mortality. The present study confirms the finding that elderly patients with AMI who are submitted to less aggressive therapeutic approaches and are more frequently represented by women, have a higher mortality.

Blunt traumatic rupture of the right atrium and the right superior pulmonary vein.

Blunt trauma to the chest may produce a spectrum of cardiac lesions extending from asymptomatic myocardial contusion to rapidly fatal cardiac rupture. A case is discussed in which a patient with signs of cardiac tamponade after blunt trauma was found to have a rupture of the atrium. During repair of the cardiac injury, an unusual tear of the right superior pulmonary vein was also discovered. Both injuries were successfully repaired and the patient recovered.