Association of mitral annulus calcification, aortic valve calcification with carotid intima media thickness

Background

Mitral annular calcification (MAC) and aortic annular calcification (AVC) may represent a manifestation of generalized atherosclerosis in the elederly. Alterations in vascular structure, as indexed by the intima media thickness (IMT), are also recognized as independent predictors of adverse cardiovascular outcomes.

Aim

To examine the relationship between the degree of calcification at mitral and/or aortic valve annulus and large artery structure (thickness).

Methods

We evaluated 102 consecutive patients who underwent transthoracic echocardiography and carotid artery echoDoppler for various indications; variables measured were: systemic blood pressure (BP), pulse pressure (PP=SBP-DBP), body mass index (BMI), fasting glucose, total, HDL, LDL chlolesterol, triglycerides, cIMT. The patients were divided according to a grading of valvular/annular lesions independent scores based on acoustic densitometry: 1 = annular/valvular sclerosis/calcification absence; 2 = annular/valvular sclerosis; 3 = annular calcification; 4 = annular-valvular calcification; 5 = valvular calcification with no recognition of the leaflets.

Results

Patient score was the highest observed for either valvular/annulus. Mean cIMT increased linearly with increasing valvular calcification score, ranging from 3.9 ± 0.48 mm in controls to 12.9 ± 1.8 mm in those subjects scored 5 (p < 0.0001). In the first to fourth quartile of cIMT values the respective maximal percentual of score were: score 1: 76.1%, score 2: 70.1%, score 4: 54.3% and score 5: 69.5% (p > 0.0001).

Conclusion

MAC and AVC score can identify subgroups of patients with different cIMT values which indicate different incidence and prevalence of systemic artery diseases. This data may confirm MAC-AVC as a useful important diagnostic parameter of systemic atherosclerotic disease.

Aortic Ectasia with Hemiazygos Vein Dilatation: A Mimicker of Aortic Dissection

Infrahepatic interruption of the inferior vena cava (IVC) is a rare but well-documented finding. In this condition, the IVC between renal and hepatic vein is absent and the hepatic veins directly empty into the right atrium; because of the enlargement of the azygos-hemiazygos vein system, this condition could mimic aortic pathology. We will describe a case of aortic arch enlargement with dilatation of hemiazygos vein, which was initially misdiagnosed by two-dimensional transesophageal echocardiography (TEE) as aortic dissection. TEE-Doppler identified the real condition, which was confirmed by computed tomography.

[Angiotensin II antagonists: new therapeutic perspectives]

First experimental data regarding potential effects of renin-angiotensin-aldosterone system modulation and their usefulness in clinical management of cardiovascular diseases have been reported more than 30 years ago. The two principals pharmacologic innovations are represented by the solid established angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers, lately introduced and not enough tested in well-conducted trials; in particular, it's very interesting the hypothesis of their impact in clinical practice not only in case of angiotensin converting enzyme inhibitors intolerance but as first choice or associated therapy in the treatment of heart failure, a very complex physiopathologic condition in which renin-angiotensin-aldosterone system plays an important role and so its both enzymatic and receptorial inhibition could be particularly useful. With this review we present an up to date of knowledges, completed trials results and ongoing trials perspectives, to redefine actual indications and to profile main future develops of this drugs.

[Testicular seminoma in stages I and II non-bulky. 16 years' experience]

From June 1977 through June 1993, ninety-five patients with testicular seminoma were treated in our center. This paper reports on 67 assessable patients--52 with stage I and 15 with non-bulky stage II disease. Median follow-up is 8 years (range: 4-16 years). Postorchiectomy radiotherapy consisted in 30 Gy (1.5 Gy/day) precautionary treatment to ipsilateral hemipelvis and paraaortic nodes (stage I) or 40-45 Gy to the same area plus 25.5-30 Gy prophylactic irradiation to mediastinum and supraclavicular fossae (stage II). Ten-year actuarial survival is 100%-96.8% +/- 2.2 considering deaths from other diseases. Ten-year disease-free survival is 95.3% +/- 2.6. The 3 relapsed patients were rescued with chemotherapy or radiotherapy (1 and 2 cases, respectively). Acute side-effects were nausea (30% of cases) and vomiting (18%) which disappeared after oral antiemetics. Late toxicity-asymptomatic osteolysis of the ipsilateral pubic region--was observed in 1 patient only (1.5%) who received cobalt therapy to inguinal canal and hemiscrotum (40.5 Gy in 27 fractions). The current diagnostic and therapeutic approaches to testicular seminoma are discussed. In stage I the conventional treatment is low-dose (20-25 Gy) subdiaphragmatic radiotherapy and a policy of surveillance is justified only for clinical trials. In non-bulky stage II disease lumboaortic and hemipelvic irradiation (36-40 Gy) is the treatment of choice whereas precautionary irradiation should not be given to the mediastinum. If abdominal CT scans show nodal metastases, chest CT is necessary for staging instead of chest X-ray films. When abdominal CT findings are negative or questionable, bi-pedal lymphography must be performed. Residual testis US should be the routine examination for the early diagnosis of metachronous contralateral seminoma. The semen should be tested for further storage and sexual functions should be accurately analyzed to distinguish between organic and psychologic causes. Although limited, our experience demonstrates the good prognosis of this condition and the optimal tolerance in testicular seminoma patients even with a radiotherapy regimen which is now considered suboptimal, though it was the standard about 10 years ago.

[Fluorouracil and high-dose folinic acid in the treatment of advanced colorectal carcinoma]

Forty-five consecutive patients with advanced colorectal cancer were treated with 5-fluorouracil and high dose folinic acid. Among 43 evaluable patients there were 7 objective responses for an overall response rate of 16%. Toxicity was generally mild and rapidly reversible. Compared to those reported with 5-fluorouracil alone, these results failed to demonstrate an increase in response rate in the treatment of advanced colorectal cancer with the combination of 5-fluorouracil and folinic acid.

[Aztreonam and oxacillin in the treatment of febrile neutropenic patients with solid tumors]

22 consecutive febrile episodes in 21 neutropenic (PMN less than 1000/mmc) cancer patients, were treated with aztreonam and oxacillin. Nineteen patients were severely neutropenic (PMN less than 500/mmc). Cure was obtained in 86% of the febrile episodes, including 6/7 bacteriologically documented gram negative infections. No major side effects were observed. These results seem to indicate that aztreonam is effective as empiric treatment of gram negative infections in neutropenic patients. However, it must be used in combination with another antibiotic to ensure gram positive coverage.

[Serological assay of measles and rubella immunity in a sample of infantile population in palermo (author's transl)]

The antibodies to measles and rubella viruses were titrated in a sample of infantile population in Palermo in 1978. Measles antibodies were investigated in 900 children aged 0-15 years by the HI test; rubella antibodies in 120 girls aged 12-14 years by the hemolysis-in-gel test. A "saturation" level of immunity against measles virus as can be found in the adult population appeared to be attained at the age of 12-13 years. At this age however, about 28% of the girls were still not immunized against rubella virus.