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Background: In patients with essential arterial hypertension (EAH) the left heart ventricular hypertrophy (LVH) causes structural and functional alterations of the coronary vessels that can alter the coronary blood flow reserve. The aim of this study is to evaluate in hypertensive patients with or without LVH versus normotensive subjects, the blood flow and the coronary vasodilatation capability and the coronary blood flow reserve in basal conditions and during dipiridamole i.v. infusion., Methods: Eighty patients have been selected by ECG, echo color Doppler, transesophageal echocardiography: 50 were hypertensive patients with and without LVH, from mild to moderate to severe and 30 were normotensive subjects. The enrolled patients underwent a first transesophageal echocardiography, before and during infusion of 0.86 mg/kg of dipiridamole in growing doses, 0.56 in four minutes followed after three minutes by 0.30 mg/kg. The observation lasted 18 months, and no patients left the study., Results: The coronary resistances in hypertensive patients were significintally reduced during dipiridamole infusion, maintaining their level higher compared to the normal controls. The reduced coronary vasodilatation capability in hypertensive subjects could be due to an increase of the basal vessel tone and/or a reduced compliance of the coronary resistances. The coronary blood flow reserve is significantly reduced in all hypertensive studied, included those without LVH. It is suggested that this is secondary to increase of the coronary blood flow and tone., Conclusions: In conclusion essential arterial hypertension is the cause of early anatomical and functional coronary alterations leading hypertensive subjects to risk for coronary events before LVH.

Histiocytic Necrotising Lymphadenitis by Kikuchi-Fujimoto (NHL) is a rare disease of unknown etiopathogenesis, characterized by cervical lymphadenomegaly, fever and asthenia. It has a good prognosis with a complete functional recovery of the affected lymph nodes. In 1998 a 28 year-old patient (A. G.) was admitted in the Department of Internal Medicine, Garibaldi Hospital, Catania for fever, asthenia and cervical lymphadenopathy. Hemato-chemical tests performed during hospitalization showed only relative leukopenia and a significant increase of ESR. An initial cervical lymph node biopsy made the diagnosis of Hodgkin's lymphoma. However, the favourable clinical course and the normalization of the previous altered hematochemical tests, induced to perform a second lymph node biopsy which led to diagnosis of NHL. The patient was given antibiotics and anti-inflammatory drugs for ten days with a complete healing which persisted at a twelve-month follow-up. The conclusion is drawn that NHL of unknown etiopathogenesis and with a good prognosis is more frequent than what revealed by the data in the literature because of its insidious and aspecific clinical presentation.

Myelodysplastic syndromes (MDS) are diseases typical of the adult age, characterized by a clonal alteration of the totipotent staminal cell which causes an inefficient hemopoiesis, reduction of bone marrow cell number, increased bone marrow cell destruction, dysplasia of at least two of the three hemopoietic cell lines and by the tendency to evolve towards acute myeloid leukemia (AML). In patients with MSD, particularly in the advanced primary form, single or multiple chromosomal abnormalities can be found frequently, which may show up and/or modify themselves in any moment of the disease (multistep pathogenetic hypothesis) and whose severity influences significantly the prognosis of MSD patients. In November 1998, a 22 year old female patient (C. C.) was admitted to the Department of Internal medicine of the Garibaldi Hospital, Catania for anemia of unknown origin. The normalities of the hematochemical tests and of other instrumental examinations, induces to perform an osteo-medullary biopsy which revealed the presence of a typical MSD, refractory anemia with excess of blasts type. This disease in its primary form is rare in youth and has a high tendency to evolve in AML. The good clinical conditions of the patient, the absence of chromosomal abnormalities, the normal levels of HbF, the short time interval of the initial diagnosis induced to proceed to bone marrow transplantation, that, as shown by the data reported in the international literature, may give her a good quoad vitam prognosis.

Introduction and Aims: Echinococcosis is a widespread parasitic disease caused by Echinococcus granulosus. Hydatid cysts are mainly diagnosed in adults except for primary cerebral localisation which is electively observed in childhood owing to the early manifestation of signs and/or symptoms of the space-occupying mass. In July 1995 P.N., a 55-year-old woman, was referred to our attention. She complained of intense asthenia, cephalea not responding to NSAIDs and paroxysms of tremor., Results: The anamnesis revealed close relationships with dogs since infancy and an attack of pleurisy of unknown etiology. The objective examination was negative except for an increased volume of the right-hand thyroid lobe. Hematochemical tests showed relative eosinophilia, a significant positivity of anti-thyroglobulin antibodies and antiperoxidase with normal thyroid function indices. Thyroid scan showed a multinodular goitre. Confirmation of eosinophilia suggested the performance of a parasitological examination of feces with negative results. ECG and EEG were normal. Persistent cephalea led to the performance of an encephalic CAT which revealed a cystic formation in the rolandic region, subsequently confirmed by encephalic MNR. The positivity of the Ghedini-Weinberg test led to the diagnosis of cerebral echinococcosis. Chest X-ray and hepatic scan excluded hydatid localisation in these organs., Conclusions: The case was diagnosed as solitary primary cerebral echinococcosis. Medical follow-up was commenced with albendazole for six months, after which a control encephalic CAT showed the unchanged size of the cysts. The patient consequently underwent surgical exeresis.

We report the case of a female patient who came to our observation for a severe enterorrhage. Following colonoscopic examination and color-Doppler M-B Mode echocardiography we made the following diagnosis: "angiodysplasia of the right colon in females with aortic stenosis". It was possible to ascertain whether there were similar lesions in other parts of the gastro-intestinal tract because the patient opposed firmly. In agreement with other authors, we believe that colonoscopic examination is the appropriate method to diagnose gastro-intestinal angiodysplasia. The advanced age and the clinical conditions of the patient did not allow surgical treatment, so we treated her with antihaemorrhagic drugs and elevated doses of ascorbic acid (4 g/die). The disappearance of enterorrhagies, the rapid clinical recovery and the normalization of red blood cell (RBC) count allowed us to discontinue antihaemorrhagic treatment and to continue the administration of elevated doses of ascorbic acid. Eight days later, the patient was discharged in good clinical condition and ascorbic acid was prescribed to be continued at home. A good clinical and haemodynamic balance was observed at the six-month follow-up. In conclusion we think that the clinical case we observed, characterized by the association angiodysplasia of the right colon-aortic stenosis, may be included in the diction Heyde's syndrome. In aging patients with severe concomitant diseases, ineligible for surgical interventions, the enterorrhage caused by a non complicated angiodysplastic lesion of the gastro-intestinal tract may benefit from the acute administration of ascorbic acid as the therapeutic agent of first choice capable to loose and/or stop the haemorragic complication and, in chronic administration, to reduce the number of relapses.

Background: Although oral administration of captopril, an angiotensin-converting enzyme inhibitor, is effective for the treatment of congestive heart failure (CHF), the effect of its intravenous (iv) administration is not well known., Methods and Results: Ten patients (age range 48-72 years), with CHF belonging to the second and third NYHA class, were given an iv bolus of 25 mg of captopril. Before and 30 minutes after the infusion of captopril, a number of parameters of the left ventricular function were evaluated by echocardiography IREX 3 M-B Mode. Eight patients showed a significant improvement of left ventricular performance indices. In fact, the ejection fraction (13.8%, p < 0.05), the cardiac output (24%, p < 0.001), the circumferential shortness fraction (29.9%, p < 0.05), and the fraction shortening (16.0%, p < 0.005) increased significantly, whereas the end-systolic diameter (21%, p < 0.001), the endsystolic stress (23.8%, p < 0.01) and the left ventricle ejection time (4.8%, p < 0.05) decreased significantly. Systolic and diastolic blood pressure values also underwent a significant reduction by 17% and 11% (p < 0.01 and p < 0.05 respectively). No evident correlation between the improvement of the left ventricular function and the basal renin rates was noticed., Conclusions: A significant improvement of parietal kinesis was observed especially in those segments which showed movement abnormalities (hypokinesia and akinesia) and in many cases this was detected by M-B Mode echocardiography. Our findings may be the result of the following factors: 1) reduction of parietal stress; 2) increased district coronary flow; 3) inhibition of tissue renin-angiotensin-aldosterone system; and 4) "scavenging" action exerted by the SH group of captopril.

The aim of the present study was to evaluate whether transthoracic ecocardiography M-B mode was a sensitive and/or specific test for the early diagnosis of acute pulmonary embolism (PEA). For this purpose, we studied 7 patients with PEA as a complication of: deep leg venous thrombosis (3 cases), complicated bone fractures (2 cases), meniscectomy (1 case) and postpartum (1 case). The patients (3 males and 4 females), mean age of 46 +/- 7 years, did not have any previous earlier heart and/or pulmonary diseases. The diagnosis of PEA was made on the basis of clinical criteria, ecg and laboratory tests. Ecocardiography was performed using an IREX 3 M-B mode equipment; the measurements for the calculation of the indexes were made utilizing a short axis parasternal window. The parameters studied were: RVEDD/LVEDD ratio, LVDI Okubo index and the TR grade. Data were analyzed employing the paired Student's t test. In all patients was observed a statistically significant enlargement on the right heart cavities; while only in 3 of them was it possible to observe a slight reduction of the left ventricular cavities. In conclusion, the ecocardiographic exam was is a sensitive test for the diagnosis of PEA. Particularly, the RVEDD/LVEDD ratio gave an early and quantitative indication of the obstruction severity. Indeed, the morphological alteration of the right cavities became evident when the embolic obstruction was of at least 30%. Hence, we suggest that the standard ecocardiography M-B. mode may be regarded has a rapid diagnostic tool for the diagnosis of PEA.