Minerva cardioangiologica
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Minerva cardioangiologica · Dec 1996
[The role of spinal cord electric stimulation in critical ischemia of the extremity].
The aim of this study is to evaluate, through a retrospective analysis of our experience, the effectiveness of spinal cord stimulation (SCS) in conservative treatment of critical limb ischaemia. During a 7-year period, at our Institution, SCS has been performed in 35 patients affected by severe lower limb ischaemia with angiographic multilevel distal lesions; femoro-distal bypass was not advisable or had failed due to poor outflow conditions. Basing upon clinical criteria (regression of rest pain, claudicatio and ischaemic lesions, limb salvage and need of amputation) the results of therapy were distinguished in "good,", "satisfactory" and "poor". ⋯ SCS has been reported to reduce ischaemic pain and improve ulcer healing and microcirculation in ischaemic limbs. Our experience and recent studies have provided strong evidence that SCS reduces tissue loss and improves limb salvage rate in inoperable patients. A prospective randomised study will be helpful in defining if SCS should represent an efficacious and alternative procedure to bypass in the treatment planning of critical leg ischaemia.
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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.
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Unstable angina implies high risk of myocardial infarction and sudden death. Increased levels of cytoplasmatic enzymes and proteins (creatine phosphokinase, MB creatine phosphokinase troponin T, etc.) were described in unstable angina, providing information about incoming major coronary events. Cardiac troponin I (cTn-I) is a structural protein inhibiting the actinomyosine ATPase; it is only found in myocardial cells. Serum titration of cTn-I has been recently introduced into clinical practice as a sensitive and specific marker of myocardial cellular necrosis. ⋯ CTn-I is a sensitive and specific marker of myocardial necrosis. It is not found in patients with unstable angina; therefore it has no role as a prognostic marker of major coronary events.
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Atherosclerosis is a polydistrectual disease. The patients with peripheral, carotid or aortoiliac pathology suffer frequently from coronary disease; so, a careful evaluation of operative risk is indispensable related to the anatomic district that we intend submit to surgery. In this work we separately explore the risk related to peripheral revasculations, aortic surgery and carotid surgery following the current literature and our experience.
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Minerva cardioangiologica · Mar 1996
Randomized Controlled Trial Comparative Study Clinical Trial[A comparison between propafenone and hydroquinidine perorally in the treatment of recent-onset atrial fibrillation].
The aim of this study was to assess the effectiveness of propafenone and quinidine to restore sinus rhythm in patients with paroxysmal atrial fibrillation. Eighty consecutive patients with recent onset atrial fibrillation were randomized to one of the following oral treatments: a) propafenone 450 mg as single dose followed by 300 mg t.i.d.; b) hydroquinidine 900 mg/24 hours + digoxin if necessary. Drugs were given for a maximum of three days and withdrawn at the restoration of sinus rhythm. ⋯ The two groups did not differ from each other with respect to left atrial size, age and presence of organic heart disease, and kind of cardiopathies between the two groups. Sinus rhythm was restored in 39 patients of group 1 (93%) and 36 of group 2 (95%). In conclusion, oral propafenone is as effective as quinidine in the treatment of paroxysmal atrial fibrillation.