[Prolongation of the Q-T interval and hyperkinetic ventricular arrhythmias probably induced by terfenadine use in liver cirrhosis patients]

The authors describe the prolongation of Q-T interval and secondary appearance of ventricular sustained ectopic beats in a 57 years old cirrhotic female treated for 4 days with antihistaminic drug (terfenadine) 240 mg/die/os. The pro-arrhythmic properties of terfenadine may be due to the quinidine-like mechanism of the drug and is strictly linked to the direct effect of the drug on H1 histaminergic receptors, which cause the prolongation of the myocardial cells action potential.

[Alcoholic hepatopathy, deficiency pathology and serum transaminases. Presentation of 2 clinical cases]

The authors describe two cases of Vit B1 and B6 deficiency in alcoholics with malnutrition. In the first case serum levels of AST and ALT, initially below norm became higher after Vit B1 and Vit B6 intake; the second, with AST and ALT above norm in previous months, had AST and ALT with normal activity during the disease. The authors suggest that normal activity of AST and ALT during alcoholic hepatopathy could be related to a depletion of Vit B1 and Vit B6.

[Increase of liver enzymes during treatment of myocardial infarct using intravenous nitro-derivatives]

A transitory serum elevation of hepatocellular enzyme alanine-aminotransferase (ALT) and gamma GT is reported during i.v. treatment with nitroderivatives of acute myocardial infarction. authors have reviewed 144 case (105 males and 39 females) admitted to the emergency ward for acute myocardial infarction: of the 144 cases reviewed, 54 males and 16 females (48.6% of the total) presented a significative increase of ALT and gamma GT, up to the maximum value of 220 U/l, during the first week of continuous i.v. therapy with nitroderivatives. This elevation was transient, with return to normal values during the first month. The AA postulate that this increase is dose-dependent, linked to individual susceptibility and possibly due to the production of free oxygen radicals.

[A case of wet beriberi]

The AA. report a case of thymine acute deficiency in a 35 year old chronic alcoholic and malnourished male, who was admitted to the hospital because of high-output heart failure, peripheral polyneuropathy, cortico-cerebellar atrophy (associated with RMN), ataxia and peripheral edema. The diagnosis of wet Beri-beri combined with Wernicke-Korsakoff syndrome was made and appropriate therapy with pulse daily dose of parenteral thymine instituted. At the fifth day of therapy the cardio-circulatory hyperkinetic syndrome was markedly improved and after three weeks neurological damage was also alleviated. The AA. outline the importance of early diagnosis and treatment for this form of high-output heart failure, which has a poor prognosis and, if left untreated, can determine the death of the patient in a few days.

[Prolonged use of intravenous nitro derivatives in acute myocardial infarction (AMI)]

A retrospective survey is made on 166 cases of acute myocardial infarction, treated with intravenous nitro-derivatives for eight days of continuous therapy. This therapeutic modality appears to gain four goals: a reduction in mortality of patients, a faster return of ST tract on isoelectric guideline, fewer ventricular pump failures. In the authors' point of view, a delay in the downward return of ST tract towards the isoelectric guideline is an important but ominous prognostic sign in this group of patients. Therefore, this modality of treatment is suggested for all patients with AMI, wherever the myocardial coronary lesion is localized.