Mueller maneuver and LV function in coronary artery disease

Decreasing pleural pressure impedes the ejection of blood from the left ventricle (LV), may lead to decreased LV compliance because of interdependence effects and leads to increased transmural LV systolic and diastolic pressure. Previous work from this laboratory has shown that patients with coronary artery disease (CAD) often develop akinetic segments of the LV wall during the Mueller maneuver. In the presence of increased LV transmural pressure regional akinesis could be caused either by the development of regional ischemia or by mechanical inhibition of motion of an area of nonfunctional myocardium as would be caused by previous myocardial infarction (MI). The present study was designed to distinguish between these two mechanisms by determining if the presence of CAD alone is sufficient to lead to regional akinesis or if prior MI is necessary. We used first pass radionuclide ventriculography (RVG) in the 30 degrees LAD supine position to measure LV ejection fraction (EF), end-diastolic (EDV) and end-systolic (ESV) volumes, heart rate and to assess regional wall motion during the Mueller maneuver. This was done in four groups of subjects: 13 normal subjects, 25 patients with CAD but no prior MI, 13 patients with prior nontransmural MI and 36 patients with prior transmural MI. All subjects had angina pectoris and underwent contrast coronary arteriography. Most also underwent routine contrast left ventriculography as well. There were no significant differences among the three patient groups as regards medications, extent and severity of CAD, and response to routine exercise tolerance testing. EF decreased significantly in the three patient groups (4%-9%, p less than 0.01) but not in the normals during the Mueller maneuver. Heart rate increased (5-10 bpm, p less than 0.05) in the normals and in patient groups 2 and 4. EDV decrease in all four subject groups (8%-10%, p less than 0.01), while ESV remained unchanged. Akinesis of the LV wall developed during the Mueller maneuver only in one group-2 patient, but did so in 17/36 patients with prior transmural MI (group 4, p less than 0.001). One-half of the akinetic LV wall segments seen during the Mueller maneuver on RVG were not seen on routine contrast ventriculography. We tested the effects of posture (supine versus upright) on the response to the Mueller maneuver in six normal subjects and found no changes in the response of EDV and ESV to the Mueller maneuver.(ABSTRACT TRUNCATED AT 400 WORDS)

[Rare neoplastic and common pathologies of the thyroid]

Observation of three cases of rare thyroid pathology (medullary carcinoma, thyroid lymphoma, De Quervain's subacute thyroiditis) triggers a discussion of the need to take due account of such rare pathologies in preoperative differential diagnosis in order to avoid giving the wrong treatment. The fact that extemporary histological examination is no help in such situations is also discussed.

[Unilateral pulmonary edema due to rapid re-expansion in pneumothorax]

A case of unilateral pulmonary oedema (UPO) caused by rapid re-expansion after drainage of a spontaneous pneumothorax is reported. If acute respiratory failure is noted at the moment of re-expansion the condition can be brought within safe limits by careful clinical observation and if necessary the use of assisted respiration.

[Endoscopic excision of a pin implanted in the 3d portion of the duodenum]

The Authors, while presenting a case of endoscopic extraction of a foreign body fixed in the duodenum, underline the value of operative endoscopy, which, going beyond the limits of a exclusively diagnostic technique, is intended as a first choice therapeutic procedure to be always carried out, leaving to surgery the treatment of the most complicated cases and those where the endoscopic attempt fails.

[A case of primary intestinal lymphoma]

The authors examine primary small bowel tumours, dealing at some length with problems of a diagnostic and clinical nature. The difficulties often encountered in reaching an early diagnosis and the feasibility of radical surgery frequently prove to be factors conditioning prognosis. The importance is then stressed of thorough evaluation of those vague symptoms which may be the only manifestation of this disease.

[24-hour pH measurement and Holter ECG monitoring in studying patients with angina-like chest pain. Our experience]

Preliminary experience with the combined use of 24 pH-metering and Holter ECG monitoring in the differential diagnosis of angina-like-pain (ALP) is reported. Twenty patients aged 24-65 (15 females and 5 males) all with angina-like-pain were studied. The aim of the study was to differentiate between oesophageal and cardiac causes of the various types of chest pain and to investigate the possibility of their coexistence. 50% of the ALP patients with a negative non-invasive cardiological report presented a pathological gastroesophageal reflux. In 5% of the cases simultaneous coronary insufficiency and pathological gastro-oesophageal reflux was noted. The importance of performing both Holter recordings and pH-metering before subjecting patients to coronarography is therefore emphasised.

[A case of vascular leiomyosarcoma of the superficial soft tissues]

The authors report a case of vascular leiomyosarcoma of the superficial soft tissues, and point out its epidemiologic (rareness of the report), biologic (high degree of malignancy, trend to local relapse and remote conversion into metastases), histopathologic aspects. They consider significant as to prognostic value the appraisal of the "mitotic index" and the opportunity of a radical intervention, followed by radiotherapy. They, moreover, think it useful, in consideration of the frequency of the relapses, to perform a periodic checking of the patient.

[Protocols for the diagnostic verification of lymph node toxoplasmosis]

The protocol we have fixed for the diagnosis of lymphonodal toxoplasmosis includes a precise succession of tests: 1) specific repeated serological tests (I.H.A.T., I.F.A.T., IgM--I.F.A.T. on total serum and on pure IgM fraction); 2) lymphonodal biopsy for histological examination and biological test (isolation procedure in mouse). We have evaluated the effectiveness of our protocol in 20 cases that we observed during 1980.

[Current clinical aspects of leptospirosis]

Leptospirosis is still endemic in the Po valley. It has an extremely protean clinical picture. In a series of 79 cases diagnosed at Pavia in the period 1970-79 hepatonephritic forms were the most common (29.1%), followed by febrile or pseudo-influenza forms (25.3%), hepatitis (20.2%), nephritis (17.8%), and meningitis (7.6%). Febrile hepatonephritis was always accompanied by the most severe pictures. Timely antibiotic management with penicillin or ampicillin, and above all the early use of peritoneal dialysis (carried in 10 subjects) enable a final cure to be obtained even in these cases. The only death in that series did not appear to be ascribable to the disease itself.

[Importation of malaria to Lombardy. II - Analysis of hospitalized cases]

Among 210 cases of imported malaria, officially notified in Lombardy from 1976 to 1980, we have selected 142 hospitalized patients and, about these, we got detailed informations on the stay in malaria endemic areas, on chemoprophylaxis and on their principal clinical data. We have found statistically significant correlations between P. falciparum infection and all the most frequent values in every class of epidemiological parameters considered, particularly with provenience from tropical African countries, touristic motivation, stay less than 30 days in winter season, onset of the illness within 20 days after the return in Italy, diagnostic lag shorter than 10 days after the onset and fever remission 2 or more days after starting specific treatment. There is also a tight correlation between these clinical parameters and the absence of individual chemoprophylaxis. The definition of these factors of risk is particularly useful to plan out some programs of prevention that should managed by regional Centers.

[Importation of malaria to Lombardy. I - Analysis of reported cases]

The comparative analysis of the cases of imported malaria in Lombardy and in Italy during 1976-1980, shows that the prevalent factors of risk are, in both, the male sex, the young age, the stay in endemic areas of tropical Africa where P. falciparum is greatly prevalent. The only very significant difference is represented by the prevalence of touristic motivation of the stay among the cases of Lombardy. The efficacy of prophylaxis against these factors of risk allowed to note, in the two last years considered (1979-1980), a sharp reduction of the annual number of cases in opposition to the trend of European cases of malaria.

[Post-transfusion malaria after imported malaria]

A case of falciparum malaria transmitted by a whole blood transfusion from a donor affected by imported malaria is reported. As an increased number of cases of transfusion malaria is reported in Europe during the past ten years, the authors emphasize the importance of screening blood donors by the I.F.A. test to identify carriers. They also discuss some related diagnostic and therapeutic problems.

A new complement fixation test for toxoplasmosis. Comparison with other serological methods

A new complement fixation test for toxoplasmosis has been compared with the classical test indirect immunofluorescence test (IFAT) and indirect haemoagglutination test (IHAT). Neither false positive or negative results were obtained with LBCF-H100-TTE. Notably these values correlate well with IFA titers. Furthermore LBCF-H100-TTE shows the highest titers in acute cases and its time course is practically superimposable to IFAT. The differences obtained performing these different tests on the preferential detection of different antigen antibodies systems by these 3 tests are discussed.

Increased radiation resistance of vegetative Bacillus pumilus

A 4.5-fold increase in vegetative cell radiation resistance of Bacillus pumilus E601, the internationally recognized biological standard for irradiation sterilization, was obtained by the repeated passage of resistant survivors through successive sublethal doses of (60)Co irradiation. This increase in resistance was accompanied by a corresponding increase in spore resistance through the seventh irradiation passage. By the fifteenth passage, the ability for spore formation was lost. Other effects noted by the successive irradiation dosages included loss of motility and pellicle formation, and changes in the Gram reaction, cell morphology, and colonial morphology. Increased resistance was also accompanied by an increased nutritional requirement for specific amino acids. Radiation resistance was not transferred from vegetative cells to spores.