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(2004). Complete vaginal obstruction caused by chronic graft-versus-host disease after haematopoietic stem cell transplantation: diagnosis and treatment. Journal of Obstetrics and Gynaecology: Vol. 24, No. 5, pp. 591-595.

To assess the feasibility, safety and efficacy of thrombolysis in the Emergency Room of a Rural Hospital with no Coronary Care Unit, and subsequent transfer to the Coronary Care Unit of a City Hospital.Prospective study, controlled with two parallel groups of consecutive patients (Group 1: Rural Hospital, Group 2: CCU Ravenna) and administration of Anistreplase 30 intravenous unit.Rural Emergency Rooms which transmitted the electrocardiogram by cardiotelephone to the Ravenna Coronary Care Unit (average distance 35 km; range: 17-50 km).280 (Group 1: 102 patients, Group 2: 178 patients) with suspected acute myocardial infarction and with no contra-indications to fibrinolysis, within 6 h of onset of symptoms.time saving, accuracy of diagnosis, adverse events, left ventricular function and survival.the median pain to needle time was 90' in Group 1 and 165' in Group 2 (P0.001). Accuracy of diagnosis for acute myocardial infarction was 91% and 100%, respectively. Complications were rare and none occurred during transfer. The creatine phosphokinase peak of Group 1 was lower than Group 2 (1389 vs. 2186 IU/l; P0.001). The echocardiographic Wall Motion Abnormality Score Index of Group 1 was lower than Group 2 (3.571 vs. 5.589; P0.001). Mortality at 35 days in Group 1 was 7.5% vs. 10.7% in Group 2 (-30%; P = n.s.).The Emergency Room physician, in close collaboration with the cardiologist, supplied a very high standard of pre-Coronary Care Unit diagnosis and therapy. Administration of Anistreplase in the rural Emergency Room brought about a significant reduction of pain to needle time, a significant improvement in left ventricular function and a reduction in mortality.

Cardiovascular prevention has been developed in the last eight years producing an ever increasing amount of data requiring frequent updating. Studies using angiography to determine change in coronary obstruction have indicated progression, stabilization, or regression of coronary lesions associated with changes in plasma lipids and lipoproteins. Moreover, the guidelines on arterial hypertension published in 2007 listed the risk factors affecting prognosis but even by 2009 an update modified not only the list of risks, but even the philosophy behind the thought process which introduced as essential element in the prognosis of hypertension the ascertained existence of a damaged organ. Thus, the documentation of atherosclerotic vascular disease (plaques) and the quantification of its extension in the arterial tree became a determinant in the definition of cardiovascular risk. Magnetic Resonance (MRI) and coronary computed tomography (coro CT) applied to the heart and large vessels are the most promising methods.

Percutaneous transluminal coronary angioplasty (PTCA) is an established technique in the management of patients with angina pectoris or acute myocardial infarction. One of the major problems related to PTCA is myocardial ischemia following balloon catheter occlusion of the coronary artery. A new device utilized in an attempt to counteract myocardial ischemia is the perfusion balloon catheter which allows passive transmission of pulsatile blood flow to the distal myocardial bed. Our purpose was to compare immediate results following traditional PTCA and autoperfusion balloon PTCA in two groups randomly assigned to receive one of the two treatments (total patients n. = 158). The results show that coronary angioplasty was successfully performed in 98.87% of patients treated with autoperfusion PTCA and in 97.10% of those treated with conventional PTCA. In the autoperfusion PTCA group we observed a lower incidence (statistically significant) of ST elevation and of minor complications. We conclude that autoperfusion balloon catheter angioplasty may be recommended for its immediate success rate with good patient tolerance and lower incidence of in-hospital complications.

During the short while of 5 years, between 1984 and 1985, two large clinical trials have been performed in Italy concerning fibrinolytic therapy in Acute Myocardial Infarction: GISSI 1 and GISSI 2. They made possible to evaluate the evolution of demographic and clinical features, the in-hospital mortality rate, and the causes of death of a huge number of patients admitted to CCU throughout the whole country. Out of 31,826 patients with acute myocardial infarction admitted to 176 CCU participating to the GISSI 1 16.9% were 75 years old and 24.7% were females; 21.8% and 26.4% were the percentages in the 38,086 patients admitted to the 223 CCU participating in the GISSI 2. Despite the higher prevalence of the two demographic characteristic with the worse prognosis, the in-hospital mortality rates were respectively 12.2% in the GISSI 1 and 10.0% in the GISSI 2 studies, with a statistically significant decrease (RR 0.84; C.L. 0.80-0.88). The significant decrease in the in-hospital mortality concerns also the patients populations selected according to the same criteria of inclusion in the two trials (within 6 hours from the onset of symptoms and with only ST elevation at the ECG of admission) and to the treatment with fibrinolytic drug (SK or rtPA). As a matter of fact 468 patients died of the 4,696 (10.0%) treated with SK in the GISSI 1 against 1,092 patients of 12,381 (8.8%) enrolled in the GISSI 2 and treated with SK or rtPA (RR 0.87; L.C. 0.78-0.98). The reduction of in-hospital mortality may be explained by some differences in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Some ECG criteria and the radiologic method of Westcott are evaluated against echocardiography in the left atrial enlargement. ECG shows generally a very good sensitivity (72%); particularly when the diameter is more than 5 cm. The radiologic findings show significant correlative indexes in normal and in softly enlarged atria. In atria greater than or equal to 5 cm the method is not so precise; the reasons are discussed on an anatomical basis. We acknowledge an important place to the ECG described criteria and to the Westcott method in the depistage of the left atrium enlargement.