P3746Temporal patterns of premature atrial contractions predict atrial fibrillation occurrence in bradycardia patients continuously monitored through pacemaker diagnostics

Background

The frequency of premature atrial complexes (PACs) has been indirectly related with atrial fibrillation (AF) occurrence and adverse outcomes.

Objective

To evaluate whether temporal patterns of PACs are directly associated with AF onset in pacemaker patients with continuous monitoring of the atrial rhythm.

Methods

Overall, 193 pacemaker patients (49% female, 72±9 years old), enrolled in a national registry, were analyzed. Frequency of daily PACs was measured in a 14-day initial observation period, during which patients were in sinus rhythm. In the following period, temporal occurrence and frequency of daily PACs and eventual onset of AF were derived by pacemaker diagnostics.

Results

In the run-in period, median PACs frequency was 614 PACs/day (interquartile range=70–3056). Subsequently, in a median follow-up of 6 months, AF occurred in 109 patients, in particular in 37/96 (38.5%) patients with a PAC rate<614 PACs/day and in 72/97 (74.2%) patients with PAC rate≥614 PACs/day (p<0.001). In patients with AF occurrence, the number of daily PACs, normalized by dividing for the average of PACs in 10 preceding days, progressively increased in the 5–6 days preceding AF (Figure). Cox Model predictive analysis showed that the risk of AF was significantly higher in patients with a relative increase of the daily PACs higher than 30% compared with PACs average number in 10 preceding days (hazard ratio (95% confidence interval) = 3.67 (2.40–5.59), p<0.001).

PACs changes daily trend before AF

Conclusion

PACs frequency increases in the 5–6 days preceding AF onset. A relative increase of the daily PACs is significantly associated with the risk of AF occurrence.

Signatures of Enhanced Superconducting Phase Coherence in Optimally Doped Bi_{2}Sr_{2}Y_{0.08}Ca_{0.92}Cu_{2}O_{8+δ} Driven by Midinfrared Pulse Excitations

Optimally doped cuprate are characterized by the presence of superconducting fluctuations in a relatively large temperature region above the critical transition temperature. We reveal here that the effect of thermal disorder, which decreases the condensate phase coherence at equilibrium, can be dynamically contrasted by photoexcitation with ultrashort midinfrared pulses. In particular, our findings reveal that light pulses with photon energy comparable to the amplitude of the superconducting gap and polarized in plane along the copper-copper direction can dynamically enhance the optical response associated with the onset of superconductivity. We propose that this effect can be rationalized by an effective d-wave BCS model, which reveals that midinfrared pulses result in a transient increase of the phase coherence.

Abstract P4-14-01: Estrogen levels in premenopausal patients (pts) with hormone-receptor positive (HR+) early breast cancer (BC) receiving adjuvant triptorelin (Trip) plus exemestane (E) or tamoxifen (T) in the SOFT trial: SOFT-EST substudy final analysis

Background: Optimal endocrine therapy for premenopausal pts with early HR+ BC may depend on complete estrogen suppression with GnRH analog, which is crucial when using concurrent aromatase inhibitors (AIs). SOFT-EST is a prospective substudy of the phase 3 SOFT trial aiming to describe estradiol (E2), estrone (E1) and estrone sulphate (E1S) during the first 4 years (y) of monthly Trip+E/T and to assess if there were suboptimally estrogen suppressed (SES) pts in the E+Trip group. Secondary objectives included associations of baseline (BL) factors with SES, early SES with later SES, and SES with disease-free survival (DFS; exploratory objective).

Methods: Patients from select centers who consented and enrolled in SOFT, selected Trip as ovarian function suppression method, and were randomized to E+Trip or T+Trip were eligible for SOFT-EST until the accrual goal (120 pts: 90 E+Trip; 30 T+Trip). Prem status for SOFT eligibility was based on local E2. Blood sampling timepoints were 0, 3, 6, 12, 18, 24, 36 & 48 months (m) until Trip stopped. Serum estrogens were measured centrally by high specificity/sensitivity GC/MSMS and were not available during the study. For 4y analyses, SES was defined as E2 levels &gt;2.72 pg/mL in ≥2 post-BL samples (E2 levels not consistent with postmenopausal (PM) status on AIs [Smith IE, JCO 2006]), or vaginal bleeding &gt;3m after Trip start, or pregnancy. We explored 2 additional cutoffs: &gt;10 pg/mL (clearly inconsistent with PM status on AIs) and &gt;20 pg/mL (inconsistent with GnRH analog-related PM status). The analysis is intention-to-treat based on E/T assignment; as-treated analyses are forthcoming.

Results: From Mar 2009 to Jan 2011,109 pts (E/T=83/26) started Trip and had ≥2 samples drawn. In pts assigned E+Trip, median reductions from BL in E1, E2 and E1S were &gt;95% at all timepoints and significantly lower than in T+Trip. Post-BL E2 geometric mean ranged 0.8-1.3 pg/mL in E+Trip and 16.5-18.3 pg/mL in T+Trip. 21 (25%), 11 (13%) and 6 (7%) pts assigned to E+Trip had E2&gt;2.72, &gt;10, and &gt;20 pg/mL in ≥2 post BL samples or vaginal bleeding (n=3), respectively. Early SES [(≥1 E2 value &gt;2.72 pg/mL or vaginal bleeding in the firsty] predicted later SES [≥1 E2 value &gt;2.72 or vaginal bleeding thereafter (n=1); p&lt;0.001]. BL factors related to SES were higher E2, lower FSH and lower LH values (p=0.02, p&lt;0.01, p&lt;0.01 respectively). 12m FSH levels were not related to SES. In pts assigned E+Trip, after 6y median follow-up, DFS events were seen in 0 of 21 pts with SES vs 5 of 62 pts without SES.

Conclusions: Most pts on E+Trip had a profound E2 drop consistent with postmenopausal status on AI, but &gt;20% assigned to E+Trip had ≥2 E2 values &gt;2.72 pg/mL and 4% had vaginal bleeding, with those having higher E2, lower FSH/LH at BL being at higher risk. SES at 12m predicted subsequent SES. Few DFS events limit the ability to assess clinical relevance of SES with disease outcomes.

BL characteristicsN-109Prior chemo60 (55%)Amenorrhea39 (36%)Age &lt;35y8 (7%) Median (range)Age, y44 (25-53)BMI, kg/m224 (22-28)Estrogen (pg/mL) E252 (7-119)E141 (24-70)E1S894 (304-1320)FSH/LH (IU/L) FSH15 (7-47)LH11 (6-26)

Citation Format: Bellet M, Gray K, Francis P, Láng I, Ciruelos E, Lluch A, Ángel Climent M, Catalán G, Avella A, Bohn U, González-Martin A, Zaman K, Ferrer R, Azaro A, Rajasekaran A, De la Peña L, Fleming G, Regan MM. Estrogen levels in premenopausal patients (pts) with hormone-receptor positive (HR+) early breast cancer (BC) receiving adjuvant triptorelin (Trip) plus exemestane (E) or tamoxifen (T) in the SOFT trial: SOFT-EST substudy final analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-14-01.

Measuring Incompatible Observables by Exploiting Sequential Weak Values

One of the most intriguing aspects of quantum mechanics is the impossibility of measuring at the same time observables corresponding to noncommuting operators, because of quantum uncertainty. This impossibility can be partially relaxed when considering joint or sequential weak value evaluation. Indeed, weak value measurements have been a real breakthrough in the quantum measurement framework that is of the utmost interest from both a fundamental and an applicative point of view. In this Letter, we show how we realized for the first time a sequential weak value evaluation of two incompatible observables using a genuine single-photon experiment. These (sometimes anomalous) sequential weak values revealed the single-operator weak values, as well as the local correlation between them.

Experiment Investigating the Connection between Weak Values and Contextuality

Weak value measurements have recently given rise to a great amount of interest in both the possibility of measurement amplification and the chance for further quantum mechanics foundations investigation. In particular, a question emerged about weak values being proof of the incompatibility between quantum mechanics and noncontextual hidden variables theories (NCHVTs). A test to provide a conclusive answer to this question was given by Pusey [Phys. Rev. Lett. 113, 200401 (2014)], where a theorem was derived showing the NCHVT incompatibility with the observation of anomalous weak values under specific conditions. In this Letter we realize this proposal, clearly pointing out the connection between weak values and the contextual nature of quantum mechanics.

Absolute calibration of an EMCCD camera by quantum correlation, linking photon counting to the analog regime

We show how the same setup and procedure, exploiting spatially multimode quantum correlations, allows the absolute calibration of an electron-multiplying charge-coupled (EMCCD) camera from the analog regime down to the single-photon-counting level, just by adjusting the brightness of the quantum source. At the single-photon level, an EMCCD can be operated as an on-off detector, where quantum efficiency depends on the discriminating threshold. We develop a simple model to explain the connection of the two different regimes demonstrating that the efficiency estimated in the analog (bright) regime allows us to accurately predict the detector behavior in the photocounting regime and vice versa. This work establishes a bridge between two regions of the optical measurements that up to now have been based on completely different standards, detectors, and measurement techniques.

Positive operator-valued measure reconstruction of a beam-splitter tree-based photon-number-resolving detector

Here we present a reconstruction of the positive operator-value measurement of a photon-number-resolving detector comprised of three 50∶50 beam-splitters in a tree configuration, terminated with four single-photon avalanche detectors. The four detectors' outputs are processed by an electronic board that discriminates detected photon number states from 0 to 4 and implements a "smart counting" routine to compensate for dead time issues at high count rates.

Abstract P3-12-08: Incidence, predictive factors and outcome of brain metastases (BM) in a single institution cohort of breast cancer patients

Background: The aim of the study was to determine the cumulative incidence of BM, predictive factors of BM, and survival from diagnosis of BM in a cohort of breast cancer patients in a single institution.

Patients and Methods: We collected data from a cohort of 793 breast cancer patients between January 2000 and December 2005 in our institution. Variables recorded include age at diagnosis, hormonal receptor status (HRS), human epidermal growth factor receptor 2 status (HER2), histological grade, T stage and N stage. We analyzed the 5 and 10-year cumulative incidence of BM. Time to detection of BM and survival from BM were estimated using Kaplan-Meier method. Cox regression model was used to analyze the variables associated with time to BM

Results: With a median follow-up of 100 months, 49 patients went on to develop BM. The overall 5 and 10 year cumulative incidence of BM were 4.9% and 8.2% respectively. The table shows the 5 and 10 year cumulative incidence and hazard ratio (HR) of the predictive factors for the development of BM in the univariable analysis.

Self consistent, absolute calibration technique for photon number resolving detectors

Well characterized photon number resolving detectors are a requirement for many applications ranging from quantum information and quantum metrology to the foundations of quantum mechanics. This prompts the necessity for reliable calibration techniques at the single photon level. In this paper we propose an innovative absolute calibration technique for photon number resolving detectors, using a pulsed heralded photon source based on parametric down conversion. The technique, being absolute, does not require reference standards and is independent upon the performances of the heralding detector. The method provides the results of quantum efficiency for the heralded detector as a function of detected photon numbers. Furthermore, we prove its validity by performing the calibration of a Transition Edge Sensor based detector, a real photon number resolving detector that has recently demonstrated its effectiveness in various quantum information protocols.

Radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia: selective approach to the slow pathway via the superior vena cava

Selective radiofrequency catheter ablation of the slow atrioventricular nodal pathway is currently considered the first-line therapy for patients suffering from recurrent symptomatic atrioventricular nodal reentry tachycardia. In most cases slow pathway conduction may be selectively eliminated or modified by the application of radiofrequency current at the posterior portion of Koch's triangle. The ablation site is usually targeted by careful mapping of this area performed using an ablation catheter advanced via the inferior vena cava approach. In this report we describe 2 cases in which the conventional approach to the target site was either impossible owing to the presence of an atresic inferior vena cava (case 1), or contraindicated in view of a history of common femoral vein thrombosis, subsequently extended up to the inferior vena cava (case 2). In both patients a superior vena cava approach was utilized and the slow pathway was successfully ablated. In case of arrhythmias necessitating slow pathway mapping and ablation, such an approach may be considered as a feasible and safe alternative whenever, owing to the presence of anomalies and/or diseases of the inferior vena cava, the conventional approach cannot be employed.

Two-scale analysis of the SU(N) kondo model

We show how to resolve coherent low-energy features embedded in a broad high-energy background by use of a fully self-consistent calculation for composite particle operators. The method generalizes the formulation of Roth, which linearizes the dynamics of composite operators at any energy scale. Self-consistent equations are derived and analyzed in the case of the single-impurity SU(N) Kondo model.

Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries

Slow flow of dye in epicardial coronary arteries is not an infrequent finding in patients during routine coronary angiography. Whether this pattern of flow can be reversed by nitroglycerin or dipyridamole and whether this angiographic finding is associated with histopathological abnormalities is unknown. We hypothesized that this abnormality could be associated with small vessel disease of the heart, since the epicardial arteries are usually widely patent. Thus, out of the patients undergoing heart catheterization at our institution during the past 5 years, 10 (7%) presented with chest pain, normal epicardial coronary arteries, and abnormal coronary progression of dye. Rest electrocardiogram (ECG), exercise test, echocardiographic examination, and left ventricular angiogram were normal. Coronary angiography showed slow flow of dye on a total of 20 main coronary vessels, that was not reversed by intracoronary nitroglycerin administration. Six of them underwent dipyridamole intravenous infusion that normalized dye run-off in all affected vessels, for a total of 9 main coronary vessels. Histopathological examination (light and electron microscope) of left ventricular endomyocardial biopsies showed thickening of vessel walls with luminal size reduction, mitochondrial abnormalities, and glycogen content reduction. Normal and pathological zones often coexisted in the same specimen. Thus. In some patients with slow coronary flow and patent coronary arteries, functional obstruction of microvessels seems to be implicated, as it is relieved by dipyridamole infusion. Patchy histopathological abnormalities suggestive of small vessel disease are also detectable and could contribute to increase flow resistance.

Angina and normal epicardial coronary arteries: radionuclide features and pathophysiological implications at long-term follow-up

BACKGROUND

The aim of this study was to identify specific characteristics associated with modifications of symptoms and to evaluate the presence of a pathophysiological link between radionuclide abnormalities and delayed run-off of coronary contrast dye in patients with angina and normal coronary arteries.

METHODS

We followed up 53 patients (21 men and 32 women, mean age: 52 +/- 10 years) with angina and angiographically normal epicardial coronary arteries, 21 of whom (40%) displayed a pattern of slow contrast dye run-off from coronary vessels, on visual assessment using a semiquantitative empirical score. Exercise tests showed ECG abnormalities in 29 patients (55%).

RESULTS

All patients were alive 92 +/- 44 months after catheterization (140 +/- 79 months after beginning of symptoms). However, 30 patients (57%), who reported worsening or no change of symptoms, presented with a non-significant higher prevalence of conduction abnormalities at rest ECG (27 versus 17%), pathological exercise tests (57 versus 52%), and delayed run-off (47 versus 30%). Regional left ventricular function and perfusion were then simultaneously assessed at rest and peak exercise with 99mTc-sestamibi. Exercise-induced radionuclide abnormalities were detected in 27 patients (51%), who also presented with a non-significant higher prevalence of pathological exercise tests (63 versus 43%) and no improvement of symptoms (63 versus 46%). However, exercise-induced functional and perfusional abnormalities were simultaneously present in 29 out of 42 (69%) coronary territories supplied by vessels with delayed run-off, versus 21 out of 117 (17%) normal territories (P = 0.00032).

CONCLUSIONS

Despite a good prognosis, some patients with angina and normal coronary arteries presented no improvement of symptoms at follow-up, and had functional and perfusional abnormalities in coronary territories supplied by vessels showing delayed contrast dye run-off.

Recombinant alpha-2a interferon treatment in patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC): clinical and immunological evaluation

We evaluated clinical efficacy and tolerability of recombinant alpha 2a interferon (IFN), in a group of 16 patients with AIDS and ARC, including 3 children. All patients were followed up monthly for clinical and immunological studies. The frequency of oportunistic infections (OI) in AIDS, and the following symptoms in all patients were studied: fever, night sweats, fatigue, diarrhoea, weight loss. Immunological parameters (CD3+, CD4+, CD8+ lymphocytes, skin tests to recall antigens, NK activity, lymphoproliferative response to PHA) were also evaluated. Adult patients were treated with 3-6 million IU of r-alpha 2a IFN daily im for 3 months and the 3 times weekly up to 12 months. Pediatric cases were treated with lower doses of 0.5-1.5 million IU using the same time schedule. We observed clinical improvement and reduction of severe infections in 10/15 evaluable patients (4/4 ARC and 6/11 AIDS). Immunological parameters were transiently improved in one third of cases. We observed only mild side effects in r-alpha IFN treatment. We suggest therapy with r-alpha 2a IFN at low dosage should be tried in patients with AIDS for its beneficial effects on OI development.

[Relations between ACE inhibition with captopril and atrial natriuretic factor during an acute hemodynamic study]

Aim of this study was to evaluate if captopril treatment may directly alter the trial natriuretic factor (ANF) concentration. Six patients (2 male and 4 female) aged 53 +/- 11 years, with mitral stenosis, and atrial fibrillation, underwent cardiac catheterization in our Institution. The following parameters were evaluated: heart rate, right atrial and pulmonary capillary wedge pressure, aortic and pulmonary pressure, cardiac index, pulmonary and systemic resistances and ANF concentration in coronary sinus, pulmonary, artery, aorta, peripheral vein. All these parameters were measured before and 30 and 60 min after captopril administration (50 mg orally). No hemodynamic changes occurred after captopril administration. No changes in ANF concentration occurred in comparison with baseline levels, after 30 and 60 min in coronary sinus (199.8 +/- 151.5 vs 181.9 +/- 102.5 fmol/ml; 178.4 +/- 95.2 vs 181.9 +/- 102.5 fmol/ml), in pulmonary artery (58.3 +/- 36.6 vs 51.4 +/- 48.8 fmol/ml; 35.5 +/- 16.9 vs 51.4 +/- 48.8 fmol/ml), in aorta (29.7 +/- 22.7 vs 37.5 +/- 26.3 fmol/ml; 25.2 +/- 9.8 vs 37.5 +/- 26.3 fmol/ml); and in peripheral vein (14.6 +/- 7.9 vs 17.3 +/- 9.7 fmol/ml; 16.2 +/- 12.2 vs 17.3 +/- 9.7 fmol/ml). In conclusion our data show that, providing no hemodynamic changes occur, captopril administration does not alter ANF concentration.

[Primary pulmonary hypertension: a retrospective study of 13 patients]

Twenty-four patients (9M and 15F, mean age 28 years) with primary pulmonary hypertension underwent cardiac catheterization in our institution from 1955 to 1989. The prevalence of the disease in our population was lower (0.2%) than that reported by other Authors (1%). Thirteen of these patients (4 M and 9 F, mean age 32 years) evaluated between January 1979 and December 1989, were followed. Five were alive after 52 +/- 30 months (Group A) while 8 died after 11 +/- 9 months (Group B). In Group B mean pulmonary pressure was significantly higher than in Group A (66.7 +/- 17.2 vs 41.2 +/- 19.0 mmHg, p less than 0.05, respectively). Cardiac index and systolic volume index were lower in Group B than in Group A (2.07 +/- 0.85 vs 3.72 +/- 1.32 l/min/m2, p less than 0.01 and 24.43 +/- 10.25 vs 41.08 +/- 16.97 ml/m2, p less than 0.05, respectively). Pulmonary resistance index and systemic resistance index were higher in Group B than in Group A (3039 +/- 1519 vs 1181 +/- 1236 dyne x s x cm-5/m2, p less than 0.01; 4277 +/- 1794 vs 2309 +/- 1238 dyne x s x cm-5/m2, p less than 0.01). One patient underwent repeated cardiac catheterization after 2 years. This patient showed a deterioration of the hemodynamic parameters, consistent with the worsening of the clinical conditions. In conclusion, in our population of patients with primary pulmonary hypertension, an increase in pulmonary artery pressure and pulmonary resistances, as well as a decrease in cardiac index, are associated with a reduced life expectancy. On the other hand, right atrial pressure does not affect mortality.

[The role of therapy with a Ca++ antagonists (nifedipine) in the long-term prognosis of hypertensive patients with previous myocardial infarction]

One hundred and twenty-two patients suffering from slight or moderate essential arterial hypertension with a previous history of myocardial infarction were selected for inclusion in this study. Patients were divided into two groups of 61 according to the type of anti-hypertensive therapy received. Patients in group 1 received nifedipine (30 mg p.d.), while patients in group 2 were treated using other anti-hypertensive therapy (diuretics, alpha-methyldopa, clonidine, indapamide). At the end of the follow-up period, which lasted 5 years, a statistically significant improvement in the following factors was observed in group 1 in comparison to the control group: (a) an improved response of both SBP (p less than 0.001) and DBP (p less than 0.001) levels to anti-hypertensive therapy; (b) a more significant diminution in the thickness of the interventricular septum (p less than 0.001) and the posterior wall of the left ventricle (p less than 0.001) assessed using ultrasonography; (c) a reduced number of cases of post-infarction angina (p less than 0.05); (d) fewer cases of recurrent infarction (p less than 0.05); (e) fewer deaths as a result of re-infarction (p less than 0.01). These results confirm that the vascular and cardioprotective effects of nifedipine give a good long-term outcome in hypertensive patients with a previous history of myocardial infarction.

[Winging effect in interatrial defect after transseptal mitral valvuloplasty: an anatomical study]

In the balloon catheters the redundancy of the deflated balloon produces 2 or 3 sort of thin wings. The presence of wings can reduce the catheter "pushability" or, in certain conditions, can determine tissue lesion (winging effect). Simulating a transeptal valvuloplasty of the mitral valve by technique of the 2 balloon in human fresh heart, we studied the winging effect over the interatrial septum in 12 hearts; in the first 6 the atrial septum was dilated with a 6 mm balloon (Group A), in the second 6 the atrial septum was dilated with a 10 mm balloon (Group B). The procedure was completed introducing consecutively 2 bigger balloons (15 + 20 mm). We suppose that the winging effect of the 2 bigger balloons (15 + 20 mm) could counter balance the theoretical advantage of a small balloon (6 mm). The atrial septal defect (ASD) after septal dilatation was 5.0 +/- 0.59 mm x 1.56 +/- 0.25 mm (long axis x short axis) in Group A and 6.53 +/- 0.35 x 2.16 +/- 0.39 mm in Group B (p less than 0.01). The final ASD (after introducing the 2 bigger balloons) was 7.04 +/- 1.06 x 2.36 +/- 0.57 mm in Group A and 7.03 +/- 0.18 x 2.16 +/- 0.32 mm in Group B (NS). Our data show that the winging effect can determine biological negative effects.

Role of Ca++ antagonists (nifedipine) in the long-term prognosis of hypertensive patients with previous history of myocardial infarction

One hundred and twenty-two patients suffering from slight or moderate essential arterial hypertension with a previous history of myocardial infarction were selected for inclusion in this study. Patients were divided into two groups of 61 according to the type of anti-hypertensive therapy received. Patients in Group 1 received nifedipine (30 mg p.d.), while patients in Group 2 were treated using other anti-hypertensive therapy (diuretics, alpha-methyldopa, clonidine, indapamide). At the end of the follow-up period, which lasted 5 years, a statistically significant improvement in the following factors was observed in Group 1 in comparison to the control group: (a) an improved response of both SBP (p less than 0.001) and DBP (p less than 0.001) levels to anti-hypertensive therapy; (b) a more significant diminution in the thickness of the interventricular septum (p less than 0.001) and the posterior wall of the left ventricle (p less than 0.001) assessed using ultrasonography; (c) a reduced number of cases of post-infarction angina (p less than 0.05); (d) fewer cases of recurrent infarction (p less than 0.05); (e) fewer deaths as a result of re-infarction (p less than 0.01). These results confirm that the vascular and cardioprotective effects of nifedipine give a good long-term outcome in hypertensive patients with a previous history of myocardial infarction.

Intrarticular methotrexate in the therapy of rheumatoid arthritis

Five patients with oligoarticular rheumatoid arthritis were treated with intra-articular injections of methotrexate and orgotein in the knee joints. The employed dose of the antimetabolite was very low and orgotein was simultaneously administered to prevent local tissues from cytolysis-related damage. Clinical results were fairly good and support the hypothesis that methotrexate may be used intra-articularly as an immunosuppressor rather than at the heavily toxic doses required for a cytostatic effect.

Chemotherapy versus chemotherapy plus hormonotherapy in postmenopausal advanced breast cancer patients. A randomized trial

One hundred seventeen postmenopausal advanced breast cancer patients previously untreated with chemotherapy were randomized to receive: cyclophosphamide, methotrexate, and 5-fluorouracil (CMF), CMF and tamoxifen (TMX), and CMF and medroxyprogesterone (MAP). Treatments B and C induced a greater proportion of responses than treatment A. No effect was identified on the number of complete responses. After treatment failure, patients from groups A and C received Adriamycin (doxorubicin) (ADX) vincristine (VCR), and TMX and patients from group B received ADM, VCR, and MAP. No differences were found between the branches in the response rates to the second protocol. Responders to both treatments had a longer survival experience than nonresponders or responders to only one of the treatments. Survival was independent of the treatment group.

Echocardiographic evaluation with hemodynamic correlation of the left ventricle in mitral stenosis

The value of echocardiographic measurement of left ventricle volume and ejection fraction and of mitral valve area in patients with mitral stenosis has been assessed. All patients referred because of mitral stenosis have been studied by M-mode and two-dimensional echocardiography, by right and left heart catheterization, ventriculography and selective coronary angiography. Patients with other congenital or acquired heart disease or with coronary artery disease were excluded from this study. The selection lead to a series of 39 pts, all with a typical history of Rheumatic Fever: all these pts were divided in three groups according to the degree of mitral stenosis, classified as "mild", if valvular area was greater than 1.8 cm2 (8 pts), "moderate" between 1-1.8 cm2 (15 pts) and "severe" if valvular areas was less than 1 cm2 (16 pts). In all groups echocardiography underestimated left ventricular volumes as well as stroke volumes. Statistical correlation has not been excellent: the best result was again obtained in the calculation of ejection fraction (r = 0.91, P less than 0.001), confirming our previous results in a group of patients with mitral regurgitation. Cross-sectional two-dimensional echocardiography has confirmed, furthermore, as a sensitive and suitable procedure in assessing the mitral valve area (r = 0,87 P less than 0.001); at our experience echocardiography under-estimate mitral area in the cases of severe mitral stenosis.

[The value of continued dynamic electrocardiography in the sick sinus syndrome]

An assessment was made of the usefulness of continuous dynamic ECG (CDE) in diagnosis of the sick sinus syndrome (SSS). It was found that CDE has the following advantages: ready repeatability; control of patients during such physiological activities as sleep; recording of the possibly fleeting and intermittent pathological episodes that characterise SSS. The conclusion is drawn that CDE is the soundest technique for the investigation of SSS, whereas electrophysiological examination, albeit complementary, could be limited to cases whose interpretation proves more difficult.