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Clinical picture and diagnostic methods in a patient with primary pericardial mesothelioma are described. Echocardiography shows an intrapericardial mass in direct continuity with left ventricular wall. Magnetic resonance imaging is essential to define mass dimension and extension and show cardiac wall and contiguous tissues infiltration. The histological characteristics are defined by using TAC-guided needle biopsy and needle aspiration.

Electrical ventricular activation was studied by means of electrocardiogram and vectorcardiogram in 62 patients, 55 women and 7 men, affected by systemic sclerosis of average disease duration of 10.3 years. 45% of the patients showed the "diffused form" of the disease and 55% the "limited form". The vectorcardiogram showed some alterations of the ventricular activation in 55% of the recorded cases. The previous electrocardiogram found only 18%. The alterations, which are more frequent in the diffuse form than in the limited one, are the presence of loss of forces in septal, lateral or inferior or combined areas and intraventricular conduction disorders as complete and incomplete right bundle branch block, left anterior subdivision block, left posterior subdivision block, or combination between incomplete right bundle branch block and left anterior or posterior subdivision block. The vectorcardiogram was more sensitive than the electrocardiogram in showing loss of forces, also in patients with the limited form of systemic sclerosis, when the electrocardiogram was normal. Moreover the vectorcardiogram is helpful to identify left posterior subdivision block. The vectorcardiographic investigation seems to be a useful complement of the electrocardiogram especially for the identification of cases with myocardial involvement that is clinically silent.

A sharp and unusually high increase in the serum of glutamic-oxalacetic and glutamic-pyruvic transaminase and of lactic-dehydrogenase accompanied the terminal events, acute pulmonary edema with cardiogenic shock, in 2 patients suffering from chronic congestive heart failure caused by dilatative myocardiopathy. Experimental and clinical data raises the possibility that the considerable enzymic increase may be due to the combined effect of chronic stasis and acute ischemia on the liver.

Prazosine and isosorbide dinitrate have been studied in 15 patients with acute myocardial infarction complicated by heart failure. Prazosine at the first hour had a reduction of 39% of pulmonary capillary wedge pressure (PCWP), of 23% of systemic vascular resistences index (SVRI), of 20% of mean arterial pressure (AP). Isosorbide dinitrate at the first hour in a group of 7 patients had a decrease of SVRI by 19%, the cardiac index (CI) augmented by 23%, the PCWP fell by 15%, while in a group of 5 patients the drug had an increase of SVRI by 15%, a fall of 40% of PCWP and a slight decrease of CI.

43 patients over 60 years of age underwent an aortocoronary bypass operation between 1974 and 1977. The observation period after surgery ranged from 4 to 7 years. Clinical results of this group were compared with the results of a group who presented with the same presurgical and surgical characteristics, randomly chosen between 212 patients under 60 years of age operated on in the same period. Surgical mortality was 16.2%, higher than that of the control group (5.5%); similar and very low is the late mortality in both groups (average follow-up on 5.3 years): 2.9% vs 5.5%. The effects on angina are favourable: 79.4% of elderly patients are free from angina and improvement in symptoms is present in all; left ventricular failure is rarely present (7.6%); congestive heart failure is absent. Moreover we pointed out the efficacy of the aortocoronary bypass on return to work. These results lead to a more favourable attitude towards operation in subset of patients showing serious symptoms of coronary heart disease in old age.

A case of idiopathic orthostatic hypotension (Shy-Drager syndrome) in a 50-year-old man is reported. The diagnosis was made after other possible causes of orthostatic hypotension had been excluded. The Authors emphasize the need for a correct diagnosis in order to adopt an adequate symptomatic therapy, and to avoid useless and often harmful treatments.