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With the aim of investigating the functional result of the coronary angioplasty (PTCA) and verifying the predictive value of the exercise test for detecting restenosis, 165 patients who underwent successful PTCA were evaluated through exercise stress tests performed 10, 75 and 165 days after PTCA and through coronary angiography performed 5 to 6 months after PTCA. The percentage of negative tests and the rate-pressure product (RPP) increased significantly with respect to the tests performed before PTCA, both in patients with single-vessel and those with multivessel disease. Maximal ST segment depression and ST/HR were significantly reduced only in patients with complete revascularization. The percentage of positive tests 10 days after PTCA was lower in patients with single-vessel than in those with multivessel disease (2.5% versus 10.8%) and, of the latter, in patients with complete rather than incomplete revascularization (0% versus 13.5%). In patients with complete revascularization, the mean exercise time rose significantly (703 s versus 538 s). The percentage of positive tests increased progressively with time, in accordance with probable increasing restenosis. In comparison with the results of angiography, sensitivity of the exercise stress test proved to be poor (59%), especially in patients with single-vessel disease (45%), while the specificity was very high (98%). The predictive value of a negative test was 77% in patients with multi-vessel and 87% in patients with single-vessel disease. The predictive value of a positive test was over 90% in both groups of patients.

Left ventricular thrombosis (LVT) is a frequent complication after acute anterior myocardial infarction (AMI). The purpose of this study is to evaluate whether streptokinase (SK) therapy prevents LVT, and whether this effect is due to the preservation of left ventricular function or to the fibrinolytic action of the drug. Sixty-five patients who underwent a left ventricular angiography within 2 months after a first AMI were studied. Twenty-eight patients (SK group) received SK 1,500,000 U i.v. administered over 60 min within 6 h from the onset of symptoms. A lower incidence of LVT was found in the SK group (p = 0.0003). We divided patients into two classes according to the value of akinetic-dyskinetic area (AD): the first group with a lower value of AD, the second group with a higher value of AD. In both groups, a reduced incidence of LVT was associated with SK therapy (p = 0.014, p = 0.015, respectively). Early infusion of SK during AMI seems to prevent the development of LVT, with an effect partly independent from its action on infarct size for small to large myocardial infarction.

This study has been carried out with the aim of assessing the incidence and other features of Infective Endocarditis in the region Veneto (Italy) in the years 1975-84, with particular regard to the patients admitted to the hospitals in Verona. Of the 692 patients admitted in hospitals of Veneto, 629 were resident in the region (an incidence equal to 1.6/100,000 inhabitants per year). The age range was from 8 to 72 (55 +/- 9). All social classes were affected, although retired, disabled and unemployed subjects were in the majority. The average stay in hospitals was 27.6 days. In 7.6% of the cases surgical therapy was required; the over-all mortality rate was 10%. Of the 80 patients admitted to the hospitals in Verona, 79% were suffering from pre-existing cardiopathy (40% rheumatic heart disease, 25% valvular prosthesis, 7.5% congenital heart disease, 5% prolapsing mitral valve, 1.2% obstructive hypertrophic cardiomyopathy); 54% of the cases had been exposed to bacteriological infections in the preceding months: bronchopulmonary, oropharyngeal, genitourinary or gall bladder infections processes or oral surgery or heart surgery or drug addiction. Only in 19% of these cases a correct antibiotic prophylaxis had been carried out. The responsible germ was identified in 50 patients (67% of the cases in which blood cultures had been performed): Streptococcus in 22%, Staphylococcus in 20%, Gram-negative in 12%, Corynebacterium in 4%, polymicrobial associations in 9% of the cases. These data stress the need for an improvement in antibiotic drug regimen (both in prophylaxis and treatment) and the diffusion of norms of hygiene aimed to the reduction of skin and mucous sources of bacteremia and interpersonal transmission of infections disease.

The concept that acute myocardial infarction is a dynamic event and that different interventions can modify the extent of the necrosis, has led to renewed interest in early pharmacological and surgical treatments designed to reduce the ischemic injury. To evaluate the effects of different pharmacological interventions aimed to reduce the extent of necrosis, we studied 166 patients (138 male and 28 female, mean age of 59.4 +/- 11.3 years) admitted within 6 h after chest pain and treated with a single therapy during the first 72 h. Enzymatic infarct size (IS) was calculated by serial creatine kinase isoenzyme MB determinations using a compartmental model. Six groups of patients were evaluated: 33 patients were treated only with antiplatelet drugs, 38 with anticoagulants, 34 with intravenous thrombolytic therapy, 20 with calcium channel blockers, 25 with nitrates, and 16 with beta-blockers. Estimated IS (gEq/m2) and elimination constant (Kd, U/L/h) did not differ in the six groups, but patients treated with streptokinase had higher release constant (Ka, U/L/h) and shorter time to peak CK-MB value. Early treatment (less than or equal to 2 h after chest pain) had a favourable effect on the enzymatic IS only in patients treated with calcium channel blockers (p less than 0.005).

In a random trial on 40 patients undergoing extraction of the third lower molar 0.125 mg of triazolam were administered sublingually to 20 patients and placebo (lactulose solution 66.7%) to 20 patients. The sedative and amnesic effect rapidly appeared after triazolam while the anxiolytic effect was less pronounced. The recovery of psychomotor functions measured by standard psychomotor tests occurred rapidly and all patients were discharged after about 120 min from the end of the surgery. The judgment of the surgeon was positive as far as the anxiolytic and relaxing effects of triazolam was concerned. The patients treated with triazolam moreover appreciated the sedation induced by the drug. No cardiocirculatory complication was observed and the patients showed a considerable stability from the circulatory stand point. The results show that triazolam may represent a safe alternative to the use of other anxiolytic and sedative drugs in the minor surgery of the oral cavity.