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Marijuana consumption is growing up becoming very common especially between young people. 9-THC, the main psychoactive compound in cannabis, acts on the endocannabinoid system having different cardiovascular effects, including arrhythmias, acute coronary syndrome, and sudden cardiac death. We present the case of a young man from Gambia with no cardiovascular risk factors, marijuana consumer, presenting to the emergency department with ST-elevation myocardial infarction. At coronary angiography, thrombotic left anterior descending coronary artery subocclusion was documented. We also describe the association between acute coronary syndrome and cannabis abuse.

Caseous calcification of the mitral annulus is an uncommon variant of mitral annular calcification. It appears as a round echodense mass containing central areas of echolucencies resembling liquefaction and with no flow in the central zone on color Doppler. In most cases it involves the posterior mitral annulus region, particularly in female subjects. The pathogenesis remains unclear: hypercholesterolemia and the dissolution of lipid-rich macrophages may be implicated in liquefaction necrosis. Transthoracic and transesophageal echocardiography represents the most reliable technique for diagnosis, whereas cardiac magnetic resonance imaging is the choice in doubtful cases. We report the case of an 82-year-old female patient describing different aspects of this particular clinical condition.

Aim: Dyslipidemia is recognized as one of the major risk factors for cardiovascular diseases. This retrospective observational study was aimed to assess the effect of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in dyslipidemic patients with a lipid profile not well controlled by maximally tolerated statin therapy or intolerant to these lipid-lowering drugs. We enrolled 151 patients, of whom, 119 were taking evolocumab and 32 alirocumab., Results: Total cholesterol significantly decreased progressively until the fourth year; after 4 years there was a significant reduction (-125.5 mg/dl, -51.5%, P < 0.0001 vs baseline, and P < 0.05 vs 1 year and P < 0.05 vs 2 years) and -2.8 mg/dl (-2.3%) compared with the third year. Low-density lipoprotein-cholesterol (LDL-C) also decreased significantly until the fourth year. After 3 years, there was a significant reduction (-117.8 mg/dl, -71.5%, P < 0.0001 vs baseline, and P < 0.05 vs 1 year) and -13.9 mg/dl (-22.8%) compared with the second year; after 4 years there was a significant reduction (-121.4 mg/dl, -73.7%, P < 0.0001 vs baseline, and P < 0.05 vs 1 year and P < 0.05 vs 2 years) and -3.6 mg/dl (-7.7%) compared with the third year. High-density lipoprotein-cholesterol increased significantly only during the fourth year of detection. After 3 years, there was a nonsignificant increase (4.9 mg/dl, 10.0%, P = 0.061 vs baseline) and 1.6 mg/dl (3.1%) compared with the second year; after 4 years, there was a significant increase (5.2 mg/dl, 10.6%, P < 0.05 vs baseline) and 0.3 mg/dl (0.6%) compared with the third year. The value of Tg was significantly reduced progressively until the second year and then stabilized in the third and fourth years. After 3 years, the value of Tg stabilized (-48.6 mg/dl, -32.4%, P < 0.01 vs baseline, and P < 0.05 vs 1 year) and -4.8 mg/dl (-4.5%) compared with the second year; after 4 years (-46.4 mg/dl, -31.0%, P < 0.01 vs baseline, and P < 0.05 vs 1 year) there was a slight and nonsignificant increase of 2.2 mg/dl (2.2%) compared with the third year. Regarding adverse events, both drugs were well tolerated., Conclusions: We showed that PCSK9 inhibitors are well tolerated and provide long-term significant LDL-C lowering in individuals with hyperlipidemia., (Copyright © 2021 Italian Federation of Cardiology - I.F.C. All rights reserved.)

We report a COVID-19 case with acute heart and kidney failure in a healthy young male. Echocardiography showed severe systolic and diastolic left ventricle dysfunction, with diffuse myocardial thickening. Cardiac MRI showed aspects of focal myocarditis, and hypertensive cardiomyopathy. Renal biopsy demonstrated limited acute tubular injury, and hypertensive kidney disease. Coronary angiography excluded critical stenoses. Unlike what we initially suspected, myocardial inflammation had a limited extent in our patient; severe hypertension causing cardiomyopathy and multi-organ damage, not diagnosed before, was primarily responsible for severe illness. Correct diagnosis and guidelines-directed treatment allowed a favorable course.

Primary cardiac tumors are uncommon and primary liposarcoma of the pericardium is extremely rare. We describe the case of a 55-year-old Caucasian woman without significant medical history, who presented with 3weeks complain of dyspnea, peripheral edema, and gain weight. Echocardiography revealed a huge pericardial mass confirmed by computed tomography and by magnetic resonance. The lesion was primitive of the pericardium but the surgery was not able to cut it off because of the absence of cleavage planes. Histopathologic analysis detected a dedifferentiated liposarcoma. Mediastinum compression syndrome brought the patient to the exitus in a few days., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Intramyocardial bridge is defined as the segment of a major epicardial coronary artery that runs within the cardiac muscle wall (coronary tunneling). Usually, this kind of anatomic variant is asymptomatic but sometimes it may lead to acute coronary syndrome and/or arrhythmias, and more rarely to sudden cardiac death. Treatment for symptomatic patients is pharmacological, using beta-blockers.

The Kounis syndrome was first described in 1991 as'the allergic angina syndrome'which could progress to acute myocardial infarction which was named'allergic myocardial infarction. There are several causes underlying this syndrome including drugs, various conditions and a variety of environmental exposure factors such as animal stings. Hymenoptera stings can induce Kounis syndrome because hymenoptera venom contains allergenic proteins and peptides. The following case report describes a patient who experienced an anaphylactic shock associated with coronary artery ischaemia (inferior ST-segment elevation myocardial infarction) after a bumblebee sting.

Breast carcinoma is becoming a spread disease that needs a specif teraphy. Tamoxifen is the first line treatment in patients with positivity of expression of estrogen receptors. The risk of thromboembolism is high in patients treated with tamoxifene indipendent from the neoplastic disease. This work focuses the attention on tamoxifen mechanism of thrombosis.

We describe the case of a young female affected by a thymus teratoma coexisting with carcinoid tumor.

Boerhaave's syndrome is a very rare disease characterised by a spontaneous rupture of the oesophagus. It is often misdiagnosed and there is no consensus as to the best treatment. We describe a case of a 61 year-old man without significant previous medical history presenting in the emergency room with acute chest and back pain. Despite objective and laboratory tests negative for chest pain screening, computed tomography showed the presence of mediastinal air and pneumothorax consistent with oesophagus rupture. Urgent surgical intervention saved the patient.

Tobacco smoking and occupational exposure are the major factors responsible for chronic obstructive pulmonary disease (COPD) worldwide. The prevalence of this disease and its main risk factors were investigated in an area characterized by a high density of iron- and steelworking factories in North Italy. A total of 1,497 subjects (50% male) aged 40-59 yrs underwent an interview and a physical assessment, and 1,244 of them also underwent spirometry. The prevalences of COPD and asthma were 16.1 and 5.2% among males and 4.4 and 4.0% among females. COPD and respiratory symptoms were associated with both smoking and occupational exposure in males: the odds ratios for having been occupationally exposed among males were 2.3 (95% confidence interval 1.4-3.7) for COPD and 1.7 (1.2-2.6) for respiratory symptoms. No association was found between asthma and tobacco smoking or occupational exposure. The forced expiratory volume in one second and forced vital capacity were associated negatively with smoking and not associated with occupational exposure. In females, lesser effects of cigarette smoking on both self-reported respiratory diseases and lung function tests were found. The attributable risks of chronic obstructive pulmonary disease for smoking and occupational exposure among males were 52.9 and 8.8%, respectively, and 60.3% when considered together, whereas 18.8% of chronic obstructive pulmonary disease cases among females were attributable to smoking.

We performed a population survey in the Valle Sabbia mountain community, a highly industrialized area in the province of Brescia, in northern Italy, in order to estimate the prevalence of the main risk factors for coronary heart disease (CHD) among middle-aged men and women. A random sample of 1497 subjects (747 males) aged 40-59 were interviewed and underwent a physical examination. A blood sample was also taken to test total serum cholesterol. Personal histories of hypertension and CHD were given by 20.3 and 4.6% of men, and by 23 and 2.4% of women, respectively. A personal history of diabetes mellitus was reported by 5.2% of men and 4% of women. The mean values of systolic and diastolic blood pressure (SBP and DBP), total cholesterol, number of cigarettes smoked per day and BMI were, respectively: 135.1 and 84.1 mmHg, 219.2 mg/dl, 10.2 cig/day and 26.2 in men, and 136.8 and 83.9 mmHg, 214.3 mg/dl, 2.4 cig/day and 25.1 in women. Among men, 45.0% had SBP > or = 140 or DBP > or = 90, 32.3% had total cholesterol > or = 240 mg/dl, 29.3% were current smokers and 60.7% had a BMI higher than 25. Among women, 48.7% had SBP > or = 140 or DBP > or = 90, 26.0% had total cholesterol > or = 240 mg/dl, 16.8% were current smokers and 44.3% had a BMI higher than 25. When considering the prevalence of high SBP or DBP, high total cholesterol or cigarette smoking, 72.3% of men and 67.7% of women had at least one of the main risk factors for CHD, usually higher values of SBP or DBP, whereas 29.3% of men and 21.2% of women had two or more factors. Overall, prevalences of the most common CHD risk factors in this community were similar to those found in other surveys carried out in Italy in the last decade.

Objective: To evaluate the interrelationships between structural alterations in the carotid arteries and left ventricular geometric patterns in a middle-aged general population., Design and Methods: We studied 223 untreated subjects (106 females, 117 males; aged 48-64 years) living in a small town in Northern Italy (Vobarno, Brescia), using a cross-sectional design. The left ventricular mass index was assessed by echocardiography, while the intima-media thickness and the occurrence of plaque were evaluated by ultrasound. Blood pressure was determined by clinic measurements and by 24 h noninvasive ambulatory blood pressure monitoring., Results: According to the presence of left ventricular hypertrophy (left ventricular mass index > 50 g/m2.7 in males and > 47 g/m2.7 in females) or concentric left ventricular remodelling (normal left ventricular mass index and relative wall thickness > 0.42), the subjects were divided into four groups: 124 subjects with normal left ventricular geometry, 73 subjects with left ventricular hypertrophy (55 with eccentric and 18 with concentric hypertrophy) and 26 subjects with concentric remodelling. The common carotid intima-media thickness and cross-sectional area were significantly greater in the subjects with concentric left ventricular hypertrophy (analysis of variance, P< 0.05) than in those with normal left ventricular geometry. A significantly higher number of plaques was observed in subjects with concentric and eccentric left ventricular hypertrophy., Conclusions: In a general population of unselected middle-aged subjects, the presence of concentric left ventricular hypertrophy was associated with an increase in intima-media thickness and with the presence of plaque in the carotid arteries, possibly contributing to the worse prognosis observed in this group of patients.

The aim of our study was to evaluate whether initial changes of cardiovascular structure and/or function can be detected in young normotensive subjects with (F+) and without (F-) family history of hypertension. Thirty-two subjects (19 F+, 10 males and 9 females, age range 17-32 years; 13 F-, 6 males and 7 females, age range 19-33 years) were studied. In each subject 24 hours ambulatory blood pressure monitoring, a M-mode, 2d guided and pulsed doppler echocardiogram and postischemic forearm strain gauge plethysmography were performed. The two groups of subjects did not differ for causal systolic and diastolic BP and 24 hours systolic and diastolic ambulatory monitored blood pressure. No differences in LV end-diastolic and end-systolic diameters, as well as in LV wall thickness, and in LV mass index were observed. Systolic functional parameters were also similar in the two groups. In F+ subjects peak early filling velocity was reduced in respect to F- (p < 0.01), peak late filling velocity integral was increased (p < 0.05) and the ratio of peak E/peak A integrals was decreased (p < 0.05). No difference was observed for postischemic forearm blood flow and minimal vascular resistance, taken as an index of arteriolar structural changes as well as intima-media thickness of carotid arteries. In conclusion in this study F+ and F- had similar BP values, LV mass and min VR; differences previously observed in LV mass between F+ and F- may have been due to the presence of different basal levels of BP; in F+ LV diastolic filling, although still in the normal range, shifted early toward the pattern of LV filling usually observed in hypertensive patients.

The authors review their five-year experience of solitary rectal ulcers. A revision of the most recent literature enables them to outline the characteristics of the disease with reference to its epidemiology, anatomopathology and clinical features. The discussion focuses on the problem of treatment which must be based on a thorough and in-depth knowledge of pathogenetic mechanisms. The paper outlines two theories, the hamortomatous one and the so-called mechanical theory involving the hinge valve, which are referred to by most researchers. The question of treatment is then discussed illustrating the possibility of resorting to surgical-type treatment which appears to be the most suitable for the definitive resolution of the problem. But since, at least in the light of the authors' personal experience; the majority of patients belong to an age group in which other pathologies are often present, the medical treatment option appears to be more rational. The re-education of the alvus achieved using suggestions not only of a dietary type but also regarding the behaviour and correct position to assume during defecation appears, at least theoretically, sufficient to obtain a marked improvement. The local application of therapeutical AIDS, if necessary strengthened by the action of drugs taken systemically, brings considerable further benefit to the patient who cannot and/or does not which to undergo surgery.

The authors report a case of Abrikossof's tumor that came under their observation. The reappraisal of the literature permits to review on this disorder that was unknown until few years ago. Electronic microscope and immunohistochemical study allowed to recognize the real origin of this tumor. It arises from peripheric nervous tissue particularly from Schwann's cells. This neoplasm must be considered as benign, especially when of small dimensions. In case of rapidly growing or larger than 8 cm forms a widely exeretic surgery and a careful follow-up, because of the possibility of finding tumors in other district of the body.

Primary stones can probably form, although rarely, in the common bile duct. The authors report a series of six cases which they considered as primary common duct stone disease and, in order to get more precise information on this problem, they review the literature on the subject. This disease would be caused by the presence of a lithogenic bile which, with a chronic obstruction of the Vater's ampulla, could let lithiasic particles accumulate in the common bile duct. On the basis of this hypothesis and in order to perform a correct procedure that allows easy drainage of the bile to the intestine to the chronic use of litholytic drugs.

The Authors observed and report a case of Mondor's syndrome in a male. In the attempt to identify the real origin in this peculiar thrombophlebitis they reviewed the recent literature. It is apparently impossible to drawn definitive conclusions from the different studies on this subject. Anyway Mondor's syndrome looks suitable for inclusion in the group of jumping thrombophlebitis. Therefore the real cause of the venous accident should be a pathologic situation next to the venous branch where the thrombophlebitis has broken out.

Tumours of the small intestine are extremely rare and have a particularly severe prognosis. The impossibility of making an early diagnosis due to the scarcity of precise symptoms during the early stages of the disease and the lack of safe instrumental tests limits the results of treatment which is essentially surgical. In order to contribute to the study of the disease and improve its prognosis, the authors report the cases which they have observed and review the literature.

The authors after briefly outlining the epidemiological and clinical characteristics of the appendiceal carcinoid, report a case observed by them. They discuss the problem concerning the prognosis of this particular tumoral form, and the prognosis which could be more severe than people generally think.

The A. describe the essential traits of the "sinus pilonidalis" disease and report the results obtained by surgical therapy and compared their data with literature data. The A. underline the goodness of the "closed method" particularly if a few special tricks are employed.

Many investigations have ascertained the relation between dyspepsia and diseases or disorders of gastrointestinal tract; on the contrary, the topics concerning the dyspeptic syndrome during acute cardiac disorders are very few. For this reason, Authors studied the upper tract of digestive apparatus in some patients affected with congestive heart failure and ischemic heart disease. Data have showed alterations of motility in esophagus, stomach and duodenum in every patient and lesions of gastric mucous membrane in more than half of them.