RESUMEN
BACKGROUND AND AIMS: Evidence shows that aldosterone excess is crucial for the development of cardiac and metabolic complications. Among the possible pathogenetic elements of the metabolic syndrome, adiponectin and its polymorphisms seem to confer a genetic risk for metabolic alterations and type 2 diabetes. Aims of the study were to investigate whether metabolic syndrome represents a common feature in patients with primary aldosteronism (PA) compared with essential hypertensives (EH) and to study the impact of two common adiponectin gene variants on the parameters of metabolic syndrome. METHODS AND RESULTS: Metabolic syndrome was defined according to ATPIII criteria. Eighty-nine patients with PA and 164 matched EH were studied. In all patients with PA and in 135 EH two single nucleotide polymorphisms of the adiponectin gene, T45G and G276T, were detected. Patients with PA displayed a higher prevalence of metabolic syndrome compared with EH (45% vs. 30%, p<0.05). In patients with PA, genotypes 45T/G+G/G were associated with significantly lower values of waist circumference, HOMA-IR and serum aldosterone. In both PA patients and EH, the 276T/T genotype was associated with significantly worse metabolic profile and a higher risk for the metabolic syndrome (OR=1.5 for PA and OR=1.3 for EH). CONCLUSIONS: Our data confirm a higher prevalence of metabolic syndrome among patients with PA compared with matched EH. Genetic analysis of T45G and G276T adiponectin gene polymorphisms showed that, while the genotypes 45G/G+G/T seemed to have a protective role on the metabolic complications, the genotype 276T/T defined PA and EH patients with a worse metabolic profile.
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Hiperaldosteronismo/genética , Hipertensión/genética , Síndrome Metabólico/genética , Polimorfismo de Nucleótido Simple , Adiponectina/sangre , Adiponectina/genética , Aldosterona/sangre , Biomarcadores/sangre , Glucemia/genética , Glucemia/metabolismo , Distribución de Chi-Cuadrado , Estudios Transversales , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Humanos , Hiperaldosteronismo/sangre , Hiperaldosteronismo/epidemiología , Hiperaldosteronismo/fisiopatología , Hipertensión/sangre , Hipertensión/epidemiología , Hipertensión/fisiopatología , Insulina/sangre , Resistencia a la Insulina/genética , Italia/epidemiología , Síndrome Metabólico/sangre , Síndrome Metabólico/epidemiología , Síndrome Metabólico/fisiopatología , Oportunidad Relativa , Fenotipo , Prevalencia , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Circunferencia de la CinturaRESUMEN
BACKGROUND: The increased survival due to the introduction of effective antineoplastic regimens has caused a modification of the natural history of numerous malignancies. Follow-up of neoplastic patients often includes the evaluation of masses in various body sites by fine needle cytology (FNC) in order to rule out cancer recurrence. Besides primary neoplasms, the breast can host a number of metastases: these rarely do have a typical presentation, so FNC is requested for their cytomorphological assessment. PATIENTS AND METHODS: This report describes nine consecutive cases in which a cytopathological diagnosis of metastasis to the breast was carried out on FNC samples. RESULTS: Primary sites were identified on cytomorphological and immunocytochemical bases and were represented by the ovary (three cases), melanoma (two cases), endocervix (one case), endometrium (one case), lung (one case) and prostate (one case). CONCLUSION: The cytopathological diagnosis of metastatic neoplasms to the breast is not always straightforward, especially in the absence of a clinical history of cancer. The usage of improved cytopathological criteria combined with immunocytochemistry may be of great diagnostic help in the identification of breast metastases.
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Biopsia con Aguja Fina , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/secundario , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundario , Adulto , Anciano , Neoplasias de la Mama Masculina/diagnóstico , Neoplasias de la Mama Masculina/secundario , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/secundario , Cistadenocarcinoma Seroso/diagnóstico , Cistadenocarcinoma Seroso/secundario , Neoplasias Endometriales/patología , Femenino , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/patología , Masculino , Melanoma/diagnóstico , Melanoma/secundario , Persona de Mediana Edad , Neoplasias Ováricas/patología , Valor Predictivo de las Pruebas , Neoplasias de la Próstata/patología , Neoplasias del Cuello Uterino/patologíaRESUMEN
OBJECTIVE: The temporal response to endoventriculoplasty (EVP) has not been well defined. We have evaluated the long-term clinical and functional results of this technique. METHODS: From 1988 to 1997, 121 patients underwent aneurysmectomy by EVP associated with myocardial revascularization for anteroapical left ventricular postinfarction aneurysm. Among these, 39 patients (43%) underwent early post-operative cardiac catheterization (within 3 months maximum), and were available to be revaluated after a mean follow-up time of 56+/-28 months, by means of a new hemodynamic study. Left ventricular silhouettes were analyzed by means of a special software. RESULTS: The mean New York Heart Association functional class decreased from 2.5+/-0.9 to 1.6+/-0.8 (P<0.001) late postoperatively. The global ejection fraction improved early postoperatively from 43+/-13 to 61+/-13% (P<0.001), and late postoperatively slightly decreased to 42+/-13% (ns) versus preoperative values. Left ventricular end diastolic pressure early postoperatively fell from 16.8+/-7 to 15.7+/-6.7 (ns), and late postoperatively increased to 21.6+/-8.8 (ns) versus preoperative values. Pulmonary artery pressure rose early postoperatively from 31.5+/-6.4 to 32.1+/-6.7 (ns), and late postoperatively to 34.9+/-8.9 (ns). The global contractility score decreased early postoperatively from 42.3+/-9.6 to 28.4+/-13.6 (P<0.001); the global late postoperative contractily was 35+/-14 (ns) versus preoperative values. Patients who benefit most from the operation were those with a normal postoperative contraction pattern, where ejection fraction improved respectively early postoperatively from 43+/-13 to 63+/-11% (P<0.001), and late postoperatively to 49+/-10% (P<0.001) versus preoperative values. Occlusion or critical stenosis of bypass grafts occurred in 10 patients (25.6%). There were no significant differences in hemodynamic data and hypokinesis score changes between patients with patent or occluded bypass graft, and between patients with mono or multivessel disease. The operative mortality was 6.3%, and 8.8% needed intraaortic balloon counterpulsation. The actuarial survival rates at 5 and 7 years were 73+/-6 and 61+/-6%. The mean follow-up period was 68 months (with 112 months maximum). CONCLUSIONS: We conclude that, in our patients group, EVP of left ventricular aneurysm associated with coronary grafting improves clinical status after operation. We registered a trend for a mild hemodynamic worsening, irrespective of coronary artery disease except in those patients who had shown a normal postoperative contraction pattern.
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Procedimientos Quirúrgicos Cardíacos , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos , Infarto del Miocardio/complicaciones , Adulto , Anciano , Angiografía Coronaria , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/etiología , Ventrículos Cardíacos/cirugía , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica , Resultado del Tratamiento , UltrasonografíaRESUMEN
Cardiac papillary fibroelastomas are rare cardiac tumors and have been considered a 'benign' incidental finding that may have significant clinical manifestations. In this paper we report two cases of mitral valve fibroelastoma: one was discovered by chance with transthoracic echocardiography in a young healthy man, the other was an intraoperative incidental finding in a middle aged man with a recent history of acute myocardial infarction. The mitral valve was repaired in both cases after excising the tumor. The patients did well and remain asymptomatic. A literature review was compiled which comprises previous case reports of 34 patients with mitral valve papillary fibroelastomas. Most were asymptomatic, but when symptoms occurred, they could be disabling, such as stroke, cardiac heart failure, myocardial infarction, and sudden death. Papillary fibroelastoma is amenable to simple surgical excision or in addition to mitral valve repair or replacement. Recurrence has not been reported.
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Procedimientos Quirúrgicos Cardíacos , Fibroma/cirugía , Neoplasias Cardíacas/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Músculos Papilares/patología , Adulto , Puente Cardiopulmonar , Ecocardiografía Transesofágica , Fibroma/complicaciones , Fibroma/diagnóstico , Estudios de Seguimiento , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Músculos Papilares/diagnóstico por imagenRESUMEN
In this study are considered the short-middle term results of anterior mitral leaflet prolapse repair obtained by means of a personal operative technique: chordal shortening and free edge remodeling. In our institution since 1993 34 consecutive patients with degenerative myxomatous mitral regurgitation, (mean age 63.3 years, range 25 to 83 years), underwent surgery. Before the operation 22 patients (64.7%) were in NYHA functional class III or IV. Mitral insufficiency, evaluated by echocardiogram, was severe in all patients; a prolapse of only anterior leaflet was present in 10 patients, both leaflets prolapsed in the others. Patients with chordal rupture of anterior mitral leaflet were excluded. Anterior mitral leaflet prolapse repair was performed with two continuous sutures including the free edge as well as the chordae for a variable length (2 mm up to 5 mm) depending on the degree of the elongation. A concomitant posterior leaflet quadrangular resection was performed in 24 patients (70.5%), and the procedure was almost always completed by a posterior suture annuloplasty reinforced by a glutaraldehyde-tanned strip of autologous pericardium. There were no perioperative deaths. The postoperative course was uneventful in all cases, and there were no hospital deaths. Postoperative echocardiographic evaluation showed satisfactory valve function. The mean valvular regurgitation before surgical procedure was 3.67 +/- 0.4, after repair 0.30 +/- 0.5 (p < 0.01). Follow-up was completed in all patients (mean 16.5 months) with no late deaths. One patient required early reoperation for recurrent mitral regurgitation resulting for a recurring anterior leaflet prolapse. We conclude that this technique is a safe, effective and easy procedure for the repair of anterior mitral leaflet prolapse without rupture. Nevertheless, a larger number of patients and a longer follow-up are required to confirm our results.
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Cuerdas Tendinosas/cirugía , Prolapso de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Técnicas de Sutura , Adulto , Anciano , Puente Cardiopulmonar , Cuerdas Tendinosas/diagnóstico por imagen , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/diagnóstico por imagenRESUMEN
This is a selected series of 28 patients with myxomatous mitral regurgitation that underwent correction of the anterior leaflet prolapse caused by chordal elongation by means of a running suture involving the chordal-cusp junction. Postoperative echocardiograms showed correction of anterior leaflet prolapse and mitral regurgitation in all patients. This technique is effective and easy to perform, and increases the number of options for restoring mitral valvular function.
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Prolapso de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Ecocardiografía Transesofágica , Humanos , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Prolapso de la Válvula Mitral/diagnóstico por imagenRESUMEN
OBJECTIVE: A prospective angiographic study was undertaken to investigate, with an objective analysis, the global and regional wall response to myocardial revascularization. METHODS: Thirty-one patients (30 men and 1 woman, mean age, 61 years) with a left ventricular ejection fraction of less than 0.30 were admitted to our institution between 1992 and 1995 for two- or three-vessel coronary artery disease requiring myocardial revascularization. All patients underwent isolated coronary artery bypass grafting and were studied 3 months later with angiography. Preoperative and postoperative wall motion were analyzed using special software that computed a segmental left ventricular ejection fraction, generating a segmental score. Computerized analysis allowed us to distinguish patients with diffuse hypokinesis and a symmetric contraction pattern from patients with akinesis involving at least two segments and an asymmetric contraction pattern. RESULTS: There were no operative deaths and no patient required intraaortic balloon counterpulsation. One patient had postoperative enzymatic evidence of myocardial infarction. Postoperative angiography showed a graft patency rate of 84%. Global analysis showed a small but significant rise in the left ventricular ejection fraction (0.25 +/- 0.51 to 0.31 +/- 0.70, p < 0.001) and a fall in the left ventricular end-diastolic pressure (23.7 +/- 10 to 16.5 +/- 9 mm Hg, p < 0.01). Mean scores always have been lower after the operation than before it, with the best results obtained for the apex and the worst for the anterobasal segment. The group with a symmetric contraction pattern showed a trend toward a better hemodynamic response than the group with an asymmetric contraction pattern. Regression analysis revealed two important predictors of segmental functional improvement: (1) the absence of an echocardiographic scar, and (2) the presence of a collateral circulation. CONCLUSIONS: Coronary artery bypass grafting produced a small but substantial improvement in patients with ischemic cardiomyopathy. The greater benefit occurred in patients with a symmetric contraction pattern. The absence of an echocardiographic scar and the presence of a collateral circulation predicted segmental functional improvement.
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Puente de Arteria Coronaria , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/cirugía , Anciano , Circulación Colateral , Angiografía Coronaria , Ecocardiografía , Femenino , Insuficiencia Cardíaca/fisiopatología , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico , Grado de Desobstrucción VascularRESUMEN
Mitral annuloplasty has always been a target for the cardiac surgeon, even before the era of open heart surgery. We describe here commisural annuloplasty, annular reduction with rings, and supported annular reduction without rings, which are, at the present time, the three types of annuloplasties employed. The increasing incidence of mitral valve surgery for degenerative disease suggests reconstructive surgery with autologous patients tissue as the gold standard.
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Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Ecocardiografía , Fluoroscopía , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico , Politetrafluoroetileno , Diseño de PrótesisRESUMEN
A case of iatrogenic aortic insufficiency due to laceration of the aortic right coronary leaflet at the time of diagnostic heart catheterization is presented. The situation was remedied by repairing the lacerated leaflet.
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Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/lesiones , Cateterismo Cardíaco/efectos adversos , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Ecocardiografía Transesofágica , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana EdadRESUMEN
Since September 1985 to June 1994, 252 patients (70 years and older) underwent coronary artery bypass grafting isolated or combined with other surgical procedures. Mean age was 73 +/- 4.3 years (range: 70-84). Associated non-cardiac diseases were present in 131 patients (52%). Concomitant surgical procedures were performed in 34 patients (13.5%). Myocardial revascularization was accomplished under emergency conditions in 18.1% of patients. Overall operative mortality was 5.5% (n = 14). Isolated coronary artery bypass grafting operative mortality was 3.9% (n = 10). In-hospital death rate was higher (11.7%; n = 4) for coronary artery bypass grafting associated with other procedures. During the same period, the overall mortality rate for patients younger than 70 years was 3.4% (p = NS). The 30-days in-hospital mortality was significantly higher for emergency procedures (8.7%) than for elective surgery (4.9%) (p = 0.01). Multivariate stepwise logistic regression analysis identified concomitant diseases as independently significant risk factor. Morbidity was 36.1% (n = 91). Mean intensive care unit stay was 2.8 +/- 2.2 days vs 2.1 +/- 1.2 days for patients < 70 years (p = 0.01). Total charges per case for surgical treatment were 15% higher for elderly patients. Follow up ranged from 1 to 108 months, averaging 32 months. Long-term survival was 92%, 78% and 58% at 1, 5 and 10 years from operation. With current techniques, cardiac surgery is performed in the elderly with acceptable mortality and morbidity and with slightly increased average costs.
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Revascularización Miocárdica , Anciano , Anciano de 80 o más Años , Angina Inestable/mortalidad , Angina Inestable/cirugía , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/cirugía , Femenino , Humanos , Italia/epidemiología , Masculino , Análisis Multivariante , Infarto del Miocardio/mortalidad , Infarto del Miocardio/cirugía , Revascularización Miocárdica/métodos , Revascularización Miocárdica/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Factores de RiesgoRESUMEN
Endothelial damage of human saphenous vein (HSV) during the preparation for bypass grafting could affect graft patency. Improving the preservation of HSV could provide a longer and better patency of coronary artery bypass grafts. An electron microscopic comparative analysis of the effects of three different preservatives on HSV morphology was carried on in order to determine the best method to prevent or minimize possible endothelial damage. Distal segments of HSVs were harvested from 15 patients with a "no-touch" technique. Each segment was divided into seven specimens after a low pressure distension with saline solution. The first of them was fixed immediately after harvesting with 2.5% glutaraldehyde solution, for basal evaluation. Three were fixed after 30 min and three after 5 h preservation at 4 degrees C in a) autologous, oxygenated, and heparinized blood (AOHB), b) heparinized saline solution with papaverine (HSSP) and c) University of Wisconsin solution (UWS). The specimens preserved in AOHB showed marked endothelial cell detachment and endothelial cell loss after both preservation times (30 min and 5 h). The specimens preserved in HSSP for 30 min showed no alteration in endothelium in 12 cases, while a partial endothelial detachment with intracellular edema was present in the last 3 cases; all 5 h specimens showed only a few remnants of endothelial cells. The specimens preserved in UWS for 30 min showed a morphology comparable to specimens preserved in the saline solution for the same time; in the 5 h specimens a well preserved endothelium was found in 11 cases and partial endothelial detachment and subendothelial edema in the other 4.(ABSTRACT TRUNCATED AT 250 WORDS)
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Soluciones Preservantes de Órganos , Preservación de Órganos/métodos , Vena Safena , Adenosina , Alopurinol , Sangre , Puente de Arteria Coronaria , Endotelio Vascular/patología , Glutatión , Heparina , Humanos , Inmersión , Insulina , Oxígeno , Papaverina , Rafinosa , Vena Safena/patología , Vena Safena/cirugía , Cloruro de Sodio , SolucionesRESUMEN
We have examined the effects of oxygen free radicals, generated by xenobiotics administration, ischaemia-reperfusion or sepsis, on the healing of skin or intestinal wounds in rats. We found that 5 days after operation there was a significant decrease in the wound breaking strength in rats treated with phenazine methosulfate, zymosan, ischaemia-reperfusion or retroperitoneal infection. These changes were specifically prevented by administration of superoxide-dismutase (SOD), aprotinin and (in some models) allopurinol. On the contrary, none of these measures was effective when a local trauma caused the decrease in breaking strength. Our results suggest that oxygen free radicals mediate the inhibition of wound healing following ischaemia-reperfusion and sepsis.
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Aprotinina/uso terapéutico , Oxígeno/metabolismo , Superóxido Dismutasa/uso terapéutico , Cicatrización de Heridas/efectos de los fármacos , Alopurinol/uso terapéutico , Animales , Femenino , Radicales Libres , Metosulfato de Metilfenazonio/farmacología , Ratas , Ratas Endogámicas , Xenobióticos/farmacología , Zimosan/farmacologíaRESUMEN
We have retrospectively investigated the time of the onset of acute myocardial infarction in 2046 patients admitted to six coronary care units in a two-year period. A significantly reduced number of patients (P less than 0.01) showed the beginning of acute myocardial infarction during the 0 to 6 a.m. period, while, during the remaining periods, no difference in frequency distribution was observed. Our results suggest that an impending myocardial infarction is more likely to occur at certain times of the day than others, suggesting a period of relative protection from onset.