Plasma catecholamines in pre- and in postmenopausal women with mild to moderate essential hypertension.

The sympathetic nervous system (SNS) is thought to play an important role in the pathogenesis of essential hypertension and many studies have established a relationship between plasma levels of norepinephrine (NE) and epinephrine (E) and sympathetic nervous activity (SNA). Furthermore, it has been suggested that climacteric women are more exposed to psychosocial stress which can produce a transient rise in blood pressure (BP) and, with time, determine a hypertensive state. Plasma NE and E levels were measured at rest and after physiological stimulation (head-up tilt test) in 20 hypertensive (BP: 146 +/- 13/101 +/- 4 mm Hg) and in 20 normotensive women (BP: 132 +/- 7/85 +/- 4 mm Hg). Women in each of these two groups were further subdivided according to their climacteric status (10 premenopausal and 10 postmenopausal women). No difference in NE values at rest was found between groups and subgroups. During head-up tilt test, Ln NE plasma values increased in normotensive and hypertensive groups; the rise was significantly higher in hypertensive than in normotensive women (P < 0.01). In climacteric subgroups, Ln NE appeared markedly increased above resting levels in pre- and postmenopausal hypertensive women when their position was changed from supine to upright (P < 0.01). Since high plasma NE levels after stimulation (head-up tilt) are associated with sympathetic overactivity, we conclude that SNA is involved in the pathogenesis of essential hypertension in climacteric women.

Antibodies to cardiac conducting tissue in progressive systemic sclerosis.

Cardiac conducting tissue antibodies (CCTA) were detected, using indirect immunofluorescence, in 8 (25%) out of 32 sera from patients with progressive systemic sclerosis (PSS) and in 39 (35%) out of 110 with rheumatoid arthritis (RA). Conduction abnormalities, namely right bundle branch block, were present in 19 (59%) of the PSS patients and in 37 (32%) of the RA cases. No significant correlation was found between the prevalence of CCTA and conduction abnormalities in PSS patients, while this was present in RA patients (p less than 0.001). CCTA were always negative in 18 patients with systemic lupus erythematosus and were found in one out of 8 cases with Sjögren's syndrome, also positive for rheumatoid factor without clinical RA. These data suggest that CCTA are evoked when involvement of cardiac conducting tissue (as in RA) or working myocardium (as in PSS) is present. Whether CCTA should be mainly regarded as an expression of the immunological derangement underlying these pathological conditions or whether they are secondary to myocardial tissue damage, must still be clarified.

High blood pressure and 'ischaemic' ECG patterns in climacteric women.

A study to evaluate the prevalence of high blood pressure (HBP) and resting 'ischaemic' electrocardiogram (ECG) patterns in the climacteric was carried out in 494 outpatients aged up to 65 yr. The study group was made up of 91 pre-menopausal women, 235 natural post-menopausal women, 91 surgical post-menopausal women and 77 women of advanced reproductive age, who comprised the control group. High systolic and/or diastolic blood pressure values were seen in 26.6% of the overall climacteric group (C), i.e. in 23.1% of the pre-menopausal women (PM); 28.9% of the natural post-menopausal women (NMt); and 24.2% of the surgical post-menopausal women (SMt), these frequencies being statistically significant compared to that in the control group (K) (6.5%). 'Ischaemic' ECG patterns (according to the Minnesota Code definition) were observed in 20.3% of the C group, in 22.0% of the PM group and in 27.5% of the SMt group, these rates being statistically significant compared to that in the control group (9.1%). Minnesota Code 4:1 and 5: 1-2 patterns were present in 5.7%, and 4:2 and 5:3 patterns in 14.6% of the C group. A significant correlation was found between HBP (systolic and diastolic) and 'ischaemic' ECG patterns.

Non-invasive 24-hr monitoring of high blood pressure in climacteric outpatients.

Blood pressure (BP) monitoring was carried out over a period of 24 hr in 28 hypertensive women selected among the outpatients attending the Menopause Clinic at Bologna University. Seven (7) of the women (mean age 50 +/- 1 yr) were in the pre-menopause, 7 had undergone a natural menopause at 6 to 36 mth previously (mean age 52 +/- 4 yr) and a further 7 had had a natural menopause 37-120 months previously (mean age 56 +/- 5 yr). The control group was made up of 7 women in late fertile age (mean age 47 +/- 1 yr). It was found that: high blood pressure was not confirmed in all patients; there was a significant increase in systolic and diastolic BP values in natural post-menopause subjects (P less than 0.01) temporarily related to ovarian failure, but BP reached a steady state in elderly women when a new hormonal balance is established; 24-hr monitoring made it possible to identify a group of climacteric outpatients at higher cardiovascular risk whose suitability for antihypertensive treatment could thus be assessed.

Body mass index distribution in climacteric women.

Body Mass Index (BMI) was calculated in 2481 climacteric women selected from among the outpatients attending the Menopause Clinic at Bologna University in absence of hormonal replacement therapy and diseases that could cause weight gain. Analysis of variance of the W/H2 (weight/height squared) distribution in different age and climacteric situations demonstrates that the pre-menopause is a weight-gain inducing state and that ageing seems to cause a progressive increase in W/H2.

[Eosinophilic gastroenteritis simulating ascites (eosinophilic ascites). Presentation of a case and review of the literature]. / La gastroenterite eosinofila ad espressione esclusiva di ascite (ascite eosinofila). Presentazione di un caso e revisione della letteratura.

Eosinophilic gastroenteritis is an uncommon disorder of unknown etiology characterized by recurrent episodes of infiltration of the gastrointestinal wall with eosinophils and peripheral eosinophilia. The Authors report a patient in which ascites with eosinophilia in the ascitic fluid was the cardinal feature of the disease. A low E.S.R. in the acute phase of illness was found. Steroids are indicated in patients presenting obstructive symptoms or malabsorption. In our case the treatment was not necessary because of the spontaneous remission of the symptoms.

[Cardiological findings in acromegaly]. / Rilievi cardiologici nell'acromegalia.

Acromegaly involves cardiovascular complications mostly due to the presence of hypertension, diabetes and atherosclerosis. However the appearance of cardiac decompensation and arrhythmias in the absence of predisposing factors tends to support the hypothesis of a specific myocardiopathy caused by excess GH. In order to assess the existence and course of subclinical cardiac alterations, 8 acromegaly patients were examined: 4 males and 4 females aged 31-56 with GH levels of 24-70 ng/ml (M + CD X 47 +/- 16) and no cardiovascular symptoms. One of the patients had moderate hypertension and 2 reduced glucose tolerance. The basal ECG showed sporadic ventricular extrasystoles in 2 cases and alterations compatible with left ventricular hypertrophy in another, while the effort ECG produced an asymptomatic depression of the ST segment in the hypertensive patient. The chest X-ray was normal in all cases. The echocardiography study investigated: the thickness of the interventricular septum (IVS = 13.9 +/- 2.8 mm), the thickness of the posterior wall of the left ventricle (LPW = 10.6 +/- 2.9 mm), the septum/posterior wall ratio (IVS/LPW = 1.3 +/- 0.2 the diastolic diameter (DD = 15.4 +/- 11.4 mm), the fraction of shortening (FS = 39.1 +/- 14.5%), the ejection fraction (EF = 64.1 +/- 18.4%) and revealed asymmetrical septal hypertrophy in 3 cases, concentric hypertrophy in another two. In two cases the DD and EF were distinctly altered. The patients were re-examined 2-4 years after surgical or radiation treatment. GH levels (M +/- SD = 10.3 +/- 10.1 ng/ml) were normal in 4 cases and still high, though lower in another two. The remaining two patients had borderline GH levels with high Sm-C. The ECG and chest X-ray were unchanged while echocardiography revealed a significant deterioration in heart function as far as DD (56.4 +/- 10.8 mm, p less than 0.05) were concerned with frankly pathological results in 4 and 3 cases respectively. These data confirm the view that most acromegalic patients present subclinical abnormalities in cardiac function and that the evolution of these is slightly influenced by the reduction in GH and Sm-C. levels. In fact, while the persistence of high GH and Sm-C. levels may explain the progression of cardiac alterations in some cases, it does not in others. It is also emphasised that echocardiography appears to be the most sensitive non-invasive technique for the diagnosis and follow-up of cardiac involvement in acromegaly.

Left atrial size in paroxysmal atrial fibrillation: echocardiographic evaluation and follow-up.

Echocardiographic measurement of left atrial size was performed in 24 patients (13 males, 11 females, median age 56 years) with idiopathic paroxysmal atrial fibrillation (IPAF). A second measurement was done, after a mean period of 20 months. Our study showed that: (1) the patients with IPAF had normal-sized atria, the dimensions of which remained unmodified over a 20-month period; and (2) no correlation was found between the frequency of recurrent arrhythmic episodes and left atrial size. Since atrial enlargement, which is the known risk factor for embolic stroke, was not observed in our patients, we conclude that patients with IPAF do not need anticoagulant therapy.

Antibodies to cardiac conducting tissue and abnormalities of cardiac conduction in rheumatoid arthritis.

The prevalence of antibodies to cardiac conducting tissue and cardiac conduction electrocardiographic abnormalities were studied in 60 patients with rheumatoid arthritis (RA). Complete or incomplete right bundle branch block (RBBB) was found in 21 patients (35%). Antibodies to cardiac conducting tissue were found in 16 (76%) of the 21 with RBBB and in eight (21%) of the 39 without RBBB. Cardiac conducting tissue antibodies (CCTA) were found only in one of 42 patients with RBBB unrelated to RA and in two out of 60 normal subjects. This newly documented immunological abnormality is thus correlated with disorder of conducting tissue.

[Echopolycardiography in the detection of cardiac lesions in rheumatoid polyarthritis]. / Apport de l'échopolycardiographie au dépistage des lésions cardiaques dans la polyarthrite rhumatoïde.

In order to verify the extent and the frequency of cardiac complications in rheumatoid arthritis (RA), the authors performed mechanophonocardiographic studies and simultaneous mono- and bi-dimensional echocardiography in 28 patients with RA, 2 men and 26 women aged between 38 and 65 (mean = 51) (history of the disease ranging from 1 to 37 years). One case showed an increase in the PEP:LVET ratio on the polycardiogram and 18 cases showed echocardiographic alterations (64.3%), in particular: pericardial effusion in 6 cases (21.4%), thickening of the epicardium and the pericardium in 4 cases (14.3%), alterations in the mitral valve (reduction in the protodiastolic closing velocity of the anterior edge of the large mitral valve) in 10 cases (35.7%) and thickening of the interventricular septum in 5 cases (17.9%). These examinations are therefore good indicators of the cardiac complications of rheumatoid disease and allow a group of patients to be identified who would not otherwise be detectable. These patients can be followed up subsequently, in the light of the positive correlation between echocardiographic alterations and the duration and severity of the disease. The authors conclude that simultaneous mono-and bi-dimensional echocardiography represents the optimal investigation for defining the nature, the severity and the frequency of rheumatoid cardiac abnormalities.