Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology最新文献

Background: The aim of this study was to assess the 10-year cardiovascular risk categories using risk chart, recently set up by the National Institute of Health in the population examined by the Cardiovascular Epidemiologic Observatory.

Methods: 3745 men and 3664 women aged 40-69 years were classified into five risk categories (< 5 %; 5-10%; 10-15%; 15-20%; > or = 20%) taking into account age, smoking habit, history of diabetes, systolic blood pressure, serum cholesterol and excluding those already under treatment for hypertension and hypercholesterolaemia or experienced a previous major cardiovascular event (1937 persons: 955 men, 982 women).

Results: Proportion of people estimated at risk in 10 years > or = 20% is minimal in the youngest age range, increases in adulthood, duplicates in smokers and is higher in diabetics. In non-diabetic men that proportion varies between 3.4% in non-smokers and 5.6% in smokers. All women at risk are already under specific treatment.

Conclusions: Cardiovascular Epidemiologic Observatory data allowed to assess the expected proportion of individuals at risk in 10 years > or = 20%. Besides attention to high-risk individuals, preventive measures supporting a healthier lifestyle in the general population must be adopted, considering that it will produce the greatest number of events.

The May-Hegglin anomaly (MHA) is a rare autosomal dominant platelet disorder characterized by thrombocytopenia, giant platelets and leukocyte inclusion bodies. Many patients affected by the MHA have a marked hemorrhagic tendency, a well known contraindication to thrombolytic and anticoagulant therapies. We report a case of a 56-year-old woman with the MHA, referred to our department with an evolving acute ST-elevation myocardial infarction. The patient underwent urgent coronary angiography revealing the acute occlusion of the distal left anterior descending coronary artery, treated with a thrombus aspiration system. In view of the absence of residual stenosis, no balloon dilation and stent deployment were performed. No antiaggregant and anticoagulant therapy was administered. The procedure has been successful, the hospital course was uneventful and the patient was discharged 5 days later. At a 30-day follow-up the patient was asymptomatic and in a good hemodynamic state. To the best of our knowledge, this report is the first description of managing a myocardial infarction in a patient affected by the MHA in the reperfusion era.

The continuous spread of e-mail determines an ever-increasing use of this tool for information exchange in healthcare. In spite of that, the frequency and quality of on-line communication between the physician and the patient are still scarce. Beyond analyzing the causes that make difficult the adoption of e-mail in healthcare, and beyond explaining the potential advantages, this paper focus on how this type of communication may influence the patient-physician relationship. More specifically two different types of patient-physician relationship have to be distinguished: type A is characterized by the absence of a preexisting face-to-face interaction, whereas type B is characterized by the presence of a preexisting contractual relationship. The management of e-mail messages needs attention and requirements that are different in the two cases. In type A relationship, there apply some principles different from the guidelines prepared by the American Medical Association that refer to type B interaction. The authors describe and comment the principles and guidelines that apply to the two types of patient-physician relationships. The aim of this work was to help physicians to manage and treat e-mail communication with the patient in a suitable way.

Background: No assessment has been made up today concerning clinical features, coronary artery flow and mid-term prognosis between acute non-ST-elevation myocardial infarction (NSTEMI) patients without epicardial coronary disease and those with epicardial coronary artery stenosis > 50% of at least one vessel.

Methods: We evaluated consecutive NSTEMI patients who had undergone coronary angiography within the first 48 hours of infarction. We examined their age, sex, smoking habits, the incidence of diabetes, dyslipidemia, hypertension, and left ventricular ejection fraction. The coronary blood flow was assessed according to the conventional TIMI flow grade and with the TIMI frame count (TFC).

Results: From October 1, 2001 to December 31, 2003, 50 patients out of 996 with NSTEMI (20 males, 30 females, mean age 60 +/- 13 years), showed normal coronary arteries (5%). This subset of patients was compared with 50 NSTEMI patients with coronary stenosis. Patients of the first group were younger and more frequently female with respect to NSTEMI patients with coronary stenosis. The differences between the two groups with respect to diabetes, hypertension, dyslipidemia incidence and ejection fraction (52 vs 47%) were not statistically significant. With the corrected TFC (cTFC) method we found a slow flow in at least one coronary vessel in a high percentage of NSTEMI patients with normal coronary arteries. When we compared normal vessels between the two groups, we found a higher cTFC in NSTEMI patients with normal coronary arteries than in NSTEMI patients with coronary stenosis. After a 16 +/- 8 months of follow-up we observed 8 events in the normal vessel group and 10 in the coronary stenosis group (p = NS).

Conclusions: The possible hypothesis of microvessel dysfunction as a pathogenesis of a slow flow in NSTEMI patients with normal coronary arteries is strong. Further studies are warranted to investigate microvessel disease and characteristics and possible causes of abnormalities. A larger perspective study with a longer follow-up is needed as well to evaluate the prognosis in this subset of patients.

To write a paper and to succeed in getting it published in a highly renowned scientific journal represent the last but not the least of the difficulties that a researcher has to face before being able to consider a given research project fully accomplished. While writing a manuscript, it is important to put a consistent effort in designing its structure, paying attention to a few technical guidelines. It is worth keeping in mind, however, that the editorial success of a manuscript is related not only to the writer skills and experience but also to the attention previously dedicated to the design and conduction of the research project from which data are derived. On the other hand, the probability for a well designed and carefully performed study (yielding data relevant from a clinical viewpoint), to have its results accepted for publication in an important journal is very low if they are poorly summarized in a low quality paper. In the light of these considerations, the aim of this concise review was to provide the researcher with a few simple tips on how to prepare a scientific article, ranging from its early drafting to its final publication. We have also dealt in some detail with the problems related to the selection of the journal and manuscript format, with the procedures related to manuscript submission, and with the approach to follow in order to prepare a proper answering to the reviewers' and editors' comments.

We shall focus on infective endocarditis due to Enterococcus spp and Staphylococcus aureus, both able to develop resistance to antibiotics with different mechanisms. Vancomycin-resistant strains produce some of the most challenging nososocomial infections. Enterococci develop resistance practically to all classes of antibiotics. Vancomycin-resistant strains, in the '90s, passed from 2% to more than 25%. Five types of vancomycin-resistance were reported (from van A to van E), linked to the presence of certain classes of genes regulating the production of abnormal precursors of peptidoglycan which inhibit the action of vancomycin. Staphylococcus aureus is a fearful organism whose infections can reach a mortality rate of 80%. In 1943, as soon as penicillin G was introduced into therapy, Staphylococcus strains producers of beta-lactamase were identified. After beta-lactamase-resistant penicillins were introduced into therapy, methicillin-resistant Staphylococcus strains appeared in the '60s. In 1996 the first strain of methicillin-resistant and vancomycin-resistant Staphylococcus aureus was isolated. In 2001, in Japan, the first case of infective endocarditis due to Staphylococcus aureus resistant to methicillin and non-responsive to vancomycin was described. The resistance is connected to an increased synthesis of the cell wall, which thickens reducing the activity of vancomycin.

The prevalence of infective endocarditis with negative blood cultures varies in the different series from 5 to 25%. There are certain explanations of negative blood culture endocarditis: previous incorrect antibiotic therapy before obtaining blood samples (antibiotic treatment inhibits the growth of germs, and therefore bacteremia, without sterilizing the vegetations); infective endocarditis due to fastidious microorganism, that is of difficult cultivation and identification; infective endocarditis due to cell-dependent organism (e.g. Coxiella burnetii); infective endocarditis due to fungi; non-infectious involvement of the endocardium (at times with vegetations) during the course of certain disease. We underline three etiologies (Coxiella burnetii, Bartonella species and Whipple's disease bacterium) because their study have constituted the stimulus for the introduction into clinical evaluation of patients with suspected infective endocarditis of different diagnostic approaches, based on a correct sequential application of blood cultures, serodiagnosis and molecular microbiology.

Background: Pacemaker pocket erosion is still a relevant clinical problem as it may be the cause of septicemias and/or endocarditis with consequent poor prognosis. The true incidence of this complication is rather variable in the various series of cases reported in the literature ranging between 0.9 and 5% when early infective complications are included.

Methods: In order to evaluate the real incidence of this complication we performed a retrospective analysis on the data coming from all the pacemaker implanting centers in Piedmont. Data collection forms were completed for each patient presenting this kind of complication from 1996 through 1998; the follow-up lasted for at least 36 months.

Results: In the 21 centers (81% of all implanting centers in Piedmont) in which completed data were collected, 7793 pacemaker and 289 automatic cardioverter-defibrillator (ICD) implants were performed. During the follow-up 100 cases of pacemaker pocket erosion were observed with a total incidence of 1.28% (range 0-3.1%); no cases of ICD pocket erosion were reported. Diabete mellitus was the most frequent associated disease (25% of patients), about 30% of patients were taking antiplatelet drugs. The kind of surgical procedure performed to resolve the problem was different in the various centers according to personal experience and to the various evaluations performed by each physician.

Conclusions: Our study demonstrates that the overall incidence of late pacemaker pocket erosion in our region is absolutely acceptable even in spite of relevant differences in the various implanting centers. A system of continuous monitoring with the data collection of all the performed procedures would be extremely useful to constantly check the quality level both locally and regionally.

Background: The contribution of conventional factors (hypertension, dyslipidemia, diabetes mellitus and smoke) to the risk of development of atherosclerotic cardiovascular disease is known. Nurses have a strong role in helping patients improve their risk profile, and change their lifestyle. Behaviors and beliefs of the nurses (and physicians as well) are relevant to their "reliability" as models and educators.

Methods: A questionnaire was administered to a cohort of 98 students attending the last course-year in a school of nursing, and to a cohort of 84 nurses working in a cardiovascular department, to investigate their awareness of their own risk factors, their lifestyle, and their attitudes as to the primary prevention of cardiovascular disease.

Results: Among heritable risk factors, hypertension ranked first in the awareness of both students and nurses, but the risk inherent in a family history of sudden death and early myocardial infarction was recognized only by 36% of subjects. Smokers were more frequent among students than among nurses (40 vs 25%); in both cohorts the misconception was common among smokers, that "light" cigarettes or smoking "no more than 5-10 cigarettes per day" is not harmful (15 and 30% of responders, respectively). The knowledge of upper normal limits for blood pressure, plasma cholesterol and triglycerides was often poor in both cohorts.

Conclusions: The knowledge and awareness of risk factors and harmful life habits should be improved by stressing their importance to the nurse students with a high priority during the school, and to the practicing nurses during postgraduate courses. This may be especially important for smoking. On the whole, however, our data suggest that the majority of the interviewed subjects, especially among the nurses, have a lifestyle that is a credible model for our patients.