Biomedical subjects
Publications and source records attributed to R Russo.
A case of idiopathic orthostatic hypotension (Shy-Drager syndrome) in a 50-year-old man is reported. The diagnosis was made after other possible causes of orthostatic hypotension had been excluded. The Authors emphasize the need for a correct diagnosis in order to adopt an adequate symptomatic therapy, and to avoid useless and often harmful treatments.
Cardiac valvular involvement in patients with rheumatoid arthritis is rare and seldom so severe as to require surgery. The present report is concerned with a case of rheumatoid aortic incompetence successfully treated by prosthetic valve replacement. As suggested by previous similar reports, surgery is the most effective therapy for clinically significant rheumatoid endocarditis.
From 1970 to 1979, 23 patients underwent isolated aortic valve replacement because of active infective endocarditis at our Institution. The main indications for open heart surgery were cardiac failure unresponsive to medical treatment, embolic episodes and septic status. Staphylococci and streptococci were the most frequent offending microorganisms, which could be identified either from blood or valve cultures in 65.2% of the cases. Operative and late mortality was low (4.3 and 4.5% respectively), and postoperative complications rare. The favorable results, probably related to early surgical treatment, and the low incidence of postoperative complication seem to warrant an aggressive approach in the active phases of infective endocarditis involving the aortic valve.
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A phonomechanocardiographic investigation has been carried out on 61 patients who had undergone mitral valve replacement with a Lillehei-Kaster prosthesis between May 1972 and April 1976 (Follow-up 48-96 months). All prostheses were considered to be well functioning according to clinical, electrocardiographic, radiological and laboratory findings. Based on the results of the present study the phonomechanocardiographic features of normal functioning Lillehei-Kaster mitral prostheses are the following: 1) a double or triple closing sound; 2) a small single or double opening sound recorded in 67.21% of our series. The opening sound, preceding the 0 point of the apexcardiogram of approximately 29.8 msec is most likely related to the beginning of the motion of the disc, whereas the opening sound coincident with or following the 0 point of the apexcardiogram is produced at the end of the opening movement of the disc; 3) the presence of meso or telediastolic clicks in patients with atrial fibrillation during longer diastolic periods or occasionally in patients with sinus rhythm, mild aortic regurgitation and or 1st. degree A-V block; 4) an apical diastolic rumble present in 68.85% of our cases, regardless of the size of the prosthesis, which does not necessarily indicate a prosthesis malfunction; 5) a systolic ejection murmur, recorded on the left upper sternal border in all our patients, is probably related to the turbulent blood flow around the prosthetic prongs which protrude into the left ventricular outflow tract.
The wide and persistent splitting of S2 is commonly considered the auscultatory hallmark of uncomplicated ostium secundum atrial septal defect (ASD). We have recently observed a 31-year-old female with a variable splitting of S2 and a 2/6 systolic murmur at the second left intercostal space, who showed incomplete right bundle branch block on the ECG and normal heart shadow with increased pulmonary vascular markings on the chest film. Cardiac catheterization revealed an isolated ostium secundum atrial septal defect with significant left-to-right shunt, normal pulmonary pressures and normal ventricular function. Subsequently the patient underwent closure with patch of the ASD without complications. We feel our case is of interest since it demonstrates that the absence of a wide and persistent splitting of S2 in adults does not exclude the diagnosis of uncomplicated "ostium secundum" ASD, when ECG and x-ray findings suggest the disease.
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Fifty-five patients were hospitalized in a Coronary Care Unit within the first 24 hours after onset of symptoms of an acute myocardial infarction. The sum of positive and negative ST-segment deflections of their twelve leads electrocardiograms (epsilon ST12) showed a maximum within the 3rd hour from the onset of symptoms. Thereafter, in the first 24 hours, there was a marked reduction in epsilon ST12, with a steep and significant fall within the 7th hour from symptoms. In the following nine days of this study, the patients showed 4 different epsilon ST trends, but there was no significant correlation with CPK curves, or with the kind of therapy the patients underwent. An irregular trend of epsilon ST12 or a secondary late rise (after 36 hours from symptoms) suggest an unfavorable prognosis (1 death in the epsilon ST-3 group, and 2 deaths + 1 ventricular fibrillation in the epsilon ST-4 group). No significant difference results between the patients treated with high doses Heparin plus Acetyl-Salicylic-Acid (A.S.A.), and the patients treated with A.S.A alone, though the first treatment seems to reduce the values of epsilon ST12 more rapidly; perhaps this behaviour is due to the use of antiplatelet drug A.S.A in both groups, and to the relatively small number of patients.
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The Authors have examined the PO2 and PCO2 of peripheral arterial blood in 10 hypertensive subjects before and after 20 mg of nifedipine administered by sublingual route. A PaO2 decrease and a light increase of PaCO2 were observed; this pattern, if considered together with the increase of CO2 and the decrease of pulmonary resistance, may be attributed to a greater perfusion of those districts having a low V/Q ratio.
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