Luciano Ricci

Chronobiological aspects of acute cerebrovascular diseases

The study was aimed at further investigating the circadian and circannual patterns of stroke onset. Study design and type of participants: 977 strokes (475 in men and 502 in women) concerning 926 subjects (457 men and 469 women) admitted to Ferrara Hospital in two calendar years (1990–1991), were prospectively investigated. The strokes were classified as based on cerebral infarction (CI), transient ischemic attack (TIA) and cerebral hemorrhage (CH: subarachnoid and intracerebral hemorrhage). Two statistical models of analysis were used. The assessment of circadian and circannual periodicity was performed utilizing the single cosinor method. A separate analysis was performed after distribution of events into 6‐hour intervals, and chi‐square test for fit was applied to the number of observed versus expected cases. The majority of strokes occurred in the morning between 7 a.m. and noon (35% of cases) and the hypothesis of a uniform distribution of the time onset was rejected on the basis of the chi‐square for all subtypes of stroke. A circadian rhythm was found for CI and TIA with acrophase at the 11.56 and 12.41 respectively. Also a circannual periodicity was found for CI with a prevalent peak in October. The spectral analysis detected a circadian cycle for CH having a period of 4 h, and a circannual cycle for TIA with a period of 4 months. This study confirms that stroke is a high‐chronorisk disease, with specific circadian and circannual rhythms. This is very important for a better understanding and control of the underlying factors and in terms of prevention.

Circadian variation in the onset of acute myocardial infarction : lack of an effect due to age and sex

The circadian patterns in the onset of symptoms of acute myocardial infarction were assessed in a prospective study involving 450 patients. Analysis of the data in the 424 patients in whom the time of onset was known did not show any statistically significant circadian rhythms, either for the group as a whole or for subgroups divided according to sex, age group (< 60, 60 − 69, 70 − 79 and ≥ 80 years old), or the presence or absence of diabetes mellitus. The frequency of onset of symptoms was highest in the morning (06.01 − 12.00 h) for the group as a whole (29.2%). Patients aged < 70 and ≥ 80 years old showed a peak in the morning, whereas patients aged 70 − 79 years old showed a peak in the afternoon (12.01 − 18.00 h).

A 49-year-old woman with dyspnoea, palpitations and syncope

Pulmonary hypertension is rarely described in association with Sjögrens syndrome. The authors report the case of a patient in which pulmonary hypertension was the inaugural clinical manifestation of primary Sjögrens syndrome. Clinical assessment, differential diagnosis, etiopathological implications, and therapeutic approach are discussed.

Variations in serum ion levels in acute myocardial ischemia: Possible insights for diagnosis and therapy

Abstract Variations in serum levels of calcium (Ca 2+ ), sodium (Na + ), potassium (K + ), chloride (Cl − ), phosphorus (HPO 4 2− , H 2 PO 4 − ), and magnesium (Mg 2+ ) ions during acute myocardial ischemia were analyzed in 55 patients with acute myocardial infarction (AMI), 60 patients with episodes of angina (EA), and 76 patients with noncardiac chest pain (NCP). Serum levels of Na + , phosphorus ions, and Mg 2+ were lower in patients with AMI and EA than in patients with NCP; patients in the AMI and EA groups had lower serum levels of Ca 2 and Cl − compared with the NCP group. A significant negative correlation was found between creatine phosphokinase and Na + , phosphorus ion, and Mg 2+ levels.