Aureliano Becucci

Exercise Doppler Echocardiography Identifies Preclinic Asymptomatic Pulmonary Hypertension in Systemic Sclerosis

Abstract:  In systemic sclerosis (SSc), the involvement of the interstitium or vascular system of the lung may lead to pulmonary arterial hypertension (PAH). PAH is often asymptomatic or oligosymptomatic in early SSc and, when it becomes symptomatic, pulmonary vascular system is already damaged. Exercise echocardiography (ex‐echo), measuring pulmonary artery pressure (PAP) during exercise and allowing to differentiate physiologic from altered PAP responses, may identify subclinical PAH. Our aims were (a) to evaluate by ex‐echo the change of PAP in patients with SSc without lung involvement; and (b) to correlate PAP during exercise (ex‐PAP) values to clinical and biohumoral parameters of PAH. Twenty‐seven patients with limited SSc (lSSc) without interstitial lung involvement were studied. Patients underwent rest and exercise two‐dimensional and Doppler echocardiography by supine cycloergometer. Systolic PAP was calculated using the maximum systolic velocity of the tricuspid regurgitant jet at rest and during exercise values of systolic PAP exceeding 40 mmHg at ex‐echo were considered as abnormal, and biohumoral markers potentially related to PAH were assessed. Eighteen of 27 SSc patients presented an ex‐PAP >40 mmHg, while in 9 of 27 patients ex‐PAP values remained <40 mmHg (48.8 ± 4.5 mmHg versus 36.2 ± 3.1 mmHg; P < 0.001). Other echocardiographic and ergometric parameters, clinical tests, and biohumoral markers were not different in the two groups. Ex‐PAP significantly correlated with D‐dimer (P= 0.0125; r2= 0.2029). Ex‐echo identifies a cluster of SSc patients with subclinical PAH that may develop PAH. This group should be followed up and may be considered for specific therapies to prevent disease evolution.

Melatonin is a safe and effective treatment for chronic pulmonary and extrapulmonary sarcoidosis

Abstract:   Chronic sarcoidosis (CS) is often unresponsive to usual treatments. Melatonin, an immunoregulatory drug, was employed in CS patients in whom usual treatments were ineffective or induced severe side effects. Melatonin was given for 2 yr (20 mg/day in the first year, 10 mg/day in the second year) to 18 CS patients. Pulmonary function tests, chest X rays, pulmonary computed tomography, Ga67 scintigraphy and angiotensin‐converting enzyme (ACE) were assayed at baseline and in the follow‐up. Normalization of ACE, improvement of pulmonary parameters and resolution of skin involvement were found in the patients given melatonin. After 24 months of melatonin therapy, hylar adenopathy completely resolved in eight patients and parenchymal lesions were markedly improved in all patients; in the five patients with reduced diffusion capacity of the lung for carbon monoxide, the values normalized after 6 months of therapy and remained stable until month 24. After 24 months, Ga67 pulmonary and extra‐pulmonary uptake was totally normalized in seven patients and, at month 12 months, ACE was normalized in six patients in which the values were high at the baseline. Skin lesions, present in three patients, completely disappeared at month 24 months. No side effects were experienced and no disease relapse was observed during melatonin treatment. Melatonin may be an effective and safe therapy for CS when other treatments fail or cause side effects.

Response of Some Haemocoagulatory and Haemorheological Variables to Maximal Exercise in Sedentary and Active Subjects

The purpose of this study was to evaluate how physical conditioning is associated with haemostatic and rheological responses to strenuous exercise. A total of 25 males, divided into two groups differing in exercise fitness (14 sedentary and 11 active), underwent exercise testing on a bicycle ergometer with an initial 25 W workload increasing by the same amount every 3 min. The following variables were evaluated before and after the test: platelet count and aggregability, plasma fibrinogen, fibrinolytic degradation products, viscometry and micro-haematocrit. Significant differences in baseline values between the two groups were found only for blood viscosity. Irrespective of the group, significantly increased values were demonstrated for all the variables, except platelet aggregability and fibrinogen levels, in response to strenuous exercise. It is concluded that the possible protective effect of exercise against cardiovascular disease does not seem to be related to changes in the haemorheological and haemostatic measures evaluated.

Low incidence of cardiac hypertrophy in essential hypertensives with no retinal changes

120 subjects, 90 hypertensives and 30 age-matched controls, were evaluated by fundoscopy and echocardiography to assess the degree of target organ involvement. The hypertensive patients were divided into 3 groups (mild, moderate, severe hypertension) according to their diastolic blood pressure levels. No significant difference was demonstrated in left ventricular mass among the 3 groups. Moreover, no relationship was demonstrated between the degree of hypertension and the severity of fundoscopic changes. Our findings indicate that patients with no retinal changes show a low probability of left ventricular hypertrophy and that patients with left ventricular hypertrophy show a high probability of retinal involvement. Our data indicate that fundoscopy is more sensitive than echocardiography in the recognition of the hypertensive disease.

Effect of age on mean heart rate and heart rate variability

Age-related changes in heart rate and in its variability might prove to be a suitable parameter to evaluate the physiological course of advancing age in human beings. We demonstrated higher mean heart rate values and increased heart rate variability in younger adult subjects. A significant direct relationship was demonstrated by linear regression equation between age and the product between mean heart rate and heart rate variability. We conclude that the analysis of these parameters may help assess the aging process of human beings.

An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest

We describe a case of more than 5 h cardiac arrest in a 60-year-old patient who underwent general anesthesia for a urologic operation. Before extubation, the patient suddenly developed ventricular fibrillation, pulseless ventricular tachycardia and asystole which was immediately treated by advanced life support (ALS) measures. Thirty minutes later seizures developed and were controlled by 200 mg of thiopentone and 10 mg of diazepam. A pattern of ventricular tachycardia, coarse ventricular fibrillation and asystole lasted for nearly 120 min. Termination of resuscitation maneuvers was considered, but long-term life support was continued for 5 h. After this time, peripheral pulses, with a supraventricular tachycardia-like rhythm and regular spontaneous breathing reappeared. Seven hours later, the patient had a Glasgow Coma Scale (GCS) of 5, dilated unresponsive, absence of pupils, and a systolic arterial pressure of 100 mmHg. He was then transferred to intensive care unit (ICU). The morning after, the patient was awake, responded to simple orders, breathing spontaneously, and free from sensomotor deficit. He was, therefore, extubated. Subsequently, other episodes of transitory ST-line upper wave followed by ventricular fibrillation appeared, suggesting Prinzmetal angina. This was successfully treated by percutaneous coronary angioplasty. The first electroencephalogram recorded the day after cardiac arrest showed a mild widespread background slowing. An electroencephalogram 6 days later showed a return to alpha rhythm with only mild theta-wave abnormalities. Four weeks after the first cardiac arrest the patient was discharged. This is an exceptional experience compared with the others reported. We believe that all the efforts must not be given up when such an event occurs during anesthesia and there are optimal conditions for resuscitation maneuvers.

Ventricular Late Potentials in the Assessment of Mitoxantrone Cardiotoxicity

Sixteen female patients underwent signal-averaged electrocardiography and radionuclide angiography for the assessment of the resting left ventricular ejection fraction in the course of chemotherapy with mitoxantrone (MTX) for advanced breast cancer. Nine patients had received prior cardiotoxic treatments. Our findings indicate that patients treated with MTX may develop late potentials.

Effect of aging on heart rate: a chronobiological study

Abstract A group of 39 males divided into three groups according to age and with no clinical or instrumental signs of cardiovascular disease was studied by continuous 24‐h electrocardiogram recording. All the subjects were under the same sleep‐wakefulness cycle and meals schedule. Single cosinor analysis demonstrated significant circadian rhythms in heart rate for all the subjects. Multiple regression analysis revealed the existence of a significant inverse relationship between age and mesor and amplitude of the rhythm. Analysis of variance and extended Tukey test demonstrated significantly different mesors and amplitudes among the three different groups of ages. We conclude that aging is characterized by a progressive decrease in mesor and amplitude of the circadian rhythm in heart rate.

Chronobiological analysis of plasma concentrations of atrial natriuretic peptide in patients with moderate essential hypertension and in normal subjects

Abstract A group of hormones with potent diuretic/natriuretic activity, vasorelaxing properties and aldosterone secretion inhibiting action, are synthesized within the myocytes of cardiac atria and secreted by the stimulation of atrial stretch receptor. They are frequently elevated in hypertensives and may show a circadian rhythmicity in normal subjects. In the present study, to investigate the circadian pattern of ANF, we measured its plasma concentrations in a group of 12 healthy subjects and in a group of 10 patients with mild essential hypertension. None of the 10 hypertensives and of the 12 normotensives showed a significant circadian rhythm of ANF plasma concentrations. Also, we did not demonstrate a significant group rhythm for the two populations studied. Furthermore, no difference was seen in ANF plasma levels between mild hypertensives and healthy control subjects.

Erratum to “An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest”

Erratum Erratum to ‘‘An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest’’ [Resuscitation 48 (2001) 175–180] Lea Poala Fabbri *, Maria Nucera , Aureliano Becucci , Antonello Grippo , Francesco Venneri , Vismara Merciai , Sergio Boncinelli a a Department of Pathophysiology, Unit of Anaesthesiology and Intensi e care, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. b Department of Internal Medicine, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. c Department of Neurological Sciences, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. Received 1 February 2000; received in revised form 22 August 2000; accepted 22 August 2000 www.elsevier.com/locate/resuscitation