Coronary angiographic findings were compared in patients who presented with acute myocardial infarction (AMI, n = 75), unstable angina pectoris (UAP, n = 36), or stable angina pectoris (SAP, n = 36) ...for ≥2 years without evidence of any previous acute event and with an angiogram within 2 years of the initial symptoms. Angiograms were evaluated blindly for severity, extent (depending on the percentage of each coronary segment showing atherosclerosis), and pattern (discrete, <3 loci of narrowings involving <50% of any segment; diffuse, anything exceeding this). Patients in the SAP group had more narrowed arteries (2.4 ± 0.7 vs 1.3 ± 0.6 p <0.021 and 1.4 ± 0.6 p <0.021), more stenoses (6.0 ± 3.3 vs 2.1 ± 1.5 p <0.01 and 2.6 ± 1.7 <0.05) and occlusions (1.3 ± 1.1 vs 0.7 ± 0.6 p = 0.05 and 0.3 ± 0.5 p <0.02), and a greater extent index (0.9 ± 0.5 vs 0.5 ± 0.3 p <0.02 and 0.5 ± 0.3 p <0.02) than those in the AMI and UAP groups. Furthermore, a discrete pattern was less prevalent in patients with UAP than in those with SAP or AMI (3% vs 40% <0.02 and 25% p <0.05, respectively). In conclusion, patients who present with acute coronary syndromes have less extensive atherosclerosis than those who present with chronic stable angina. Therefore, in the former group, coronary atherosclerosis appears to be more susceptible to ischemic stimuli responsible for acute coronary syndromes. Conversely, whether acute ischemic stimuli result in AMI or in UAP does not appear to depend on the severity of coronary atherosclerosis.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SBCE, SBJE, UL, UM, UPCLJ, UPUK
In the current era of pharmacologic and mechanical reperfusion therapy, several studies have consistently shown that patients with myocardial infarction preceded by angina have smaller infarcts and a ...better in-hospital outcome after thrombolytic therapy than patients without preinfarction angina. At least three mechanisms may explain these differences between infarctions that are preceded by angina and those that are not: coronary collaterals, reperfusion rate, and ischemic preconditioning. Collaterals alone do not seem to explain the beneficial effects of preinfarction angina, although it is difficult to completely rule out their role in the clinical setting. The possibility that preinfarction angina is not protective per se, but rather is a predictor of a more rapid coronary reperfusion is attractive; however, it should be addressed by further clinical studies. Finally, it is likely that the beneficial effects of preinfarction angina are related to ischemic preconditioning. Although a direct demonstration of this hypothesis is still lacking, clinical features of preinfarction angina, which is characterized by anginal attacks preceding acute myocardial infarction, are very similar to those of ischemic preconditioning, in which brief ischemic episodes precede a prolonged ischemic period. Indeed, the demonstration of ischemic preconditioning in different clinical models of ischemia and reperfusion and the identification of some of its mediators suggest that in patients at high risk of myocardial infarction drugs known to block this endogenous form of protection should be used with caution, while drugs known to elicit preconditioning might have a relevant therapeutic role. However, the optimal timing, administration, and dosage for preconditioning-mimetic drugs in the appropriate clinical setting are still under debate and warrant further investigation.
The influence of several kinds of synthetic zeolite as mineral admixtures on the workability and performance strength of mortars cement and concrete has been investigated. In the first series of ...experiments zeolites have been used to replace 10% of cement in the preparation of mortars. The second series of experiments have regarded the preparation of high performance concrete. In order to evaluate the influence of alkali cations, two different forms of zeolite A have been used with one sodium (NaA or 4A) and the other with calcium (CaA or 5A) and also to evaluate the filling effects of particles zeolites 4A and 5A with different crystals sizes have been used. Furthermore we have used three types of cement with a different content of clinker: CEM I 42.5R, CEM II/A-S 42.5 R and CEM III/A-S 42.5 N. Every prepared sample has been water-cured at 20°C for 2, 7 and 28 days. The results of samples (mortars and concrete) made with zeolites were compared with those obtained with silica fume, usual fine material used in the preparation of high performance strength concrete.
Drug craving is an irresistible urge that compels drug-seeking behavior, and which often accounts for relapse among treated cocaine users. A cocaine craving scale that has proven reliable and ...practical in clinical treatment research with cocaine-using subjects is presented. It assesses intensity, frequency, and duration of this entirely subjective phenomenon. Data from 234 scales completed by 35 patients in treatment showed that craving for cocaine was of variable intensity, experienced relatively few times per day (zero to two), and of short duration (< 20 minutes). Internal consistency among the three scales was robust, shown by a standardized item α of .826. The use of this scale should allow for each component of craving to be studied separately.
To evalutate whether Holter electrocardiographic monitoring may improve the detection of ST-segment depression in patients with anginal chest pain and normal coronary arteries, we performed ...symptom-limited exercise testing and 24-hour Holter monitoring in a group of 38 such patients (27 women, age 54 ± 8 years). Patients were divided into 2 groups: group X1 included 28 patients with and group X2 10 patients without significant ST-segment depression during exercise testing. There were no significant differences between the 2 groups in age, gender, characteristics of chest pain, exercise duration, heart rate (HR), and blood pressure at peak exercise, but anginal pain during exercise testing was reported by 10 patients of group X1 (36%) and 9 of group X2 (90%) (p <0.01). Episodes of ST-segment depression on Holter monitoring were found in 17 patients of group X1 (61%) and in 5 patients of group X2 (50%) (p = NS). There were no differences between the 2 groups in daily number of ST episodes (3.6 ± 4 vs 2.8 ± 5 episodes per patient), symptomatic episodes (8% vs 18%), and duration of the episodes. On average, HR increased significantly, in a similar way, from 15 minutes before ST-segment depression to 1-mm ST in both groups, and its value at the onset of ischemia was similar in the 2 groups (102 ± 22 vs 109 ± 18 beats/min, p = NS). Finally, HR at 1-mm ST during Holter monitoring was significantly lower than that observed at 1-mm ST during exercise testing (127 ± 16 beats/min, p ≤0.01) in group X1, and it was also lower than that observed at peak exercise (136 ± 22 beats/min, p ≤0.01) in group X2. In conclusion, Holter monitoring can significantly increase the detection of ST-segment depression in patients with anginal pain and normal coronary arteries, indicating a cardiac, although not necessarily ischemic, origin of the pain. Indeed, 50% of our patients with negative symptom-limited exercise testing showed spontaneous ST changes, compatible with transient myocardial ischemia, during daily activities. Differences in the response of coronary microvascular tone to exercise testing and to stimuli operating during daily life are likely to play a significant role in determining these findings.
To assess the health-related quality of life (HRQoL) in young diabetic patients.
We studied 30 consecutive (16 male, 14 female; mean age 15.8 years) out-patients affected by Type 1 diabetes mellitus ...(T1DM). We used validated clinical, metabolic (HbA1c) and patient-oriented (Short Form-36) measurements.
Patient-oriented physical scores were significantly related to several clinical and habit features (daily glycaemia and number of insulin administration, dosage of HbA1c, number of snacks). Interestingly, the number of snacks is associated with better social functioning; furthermore, the mother's educational level is related with physical and mental aspects of the patient's quality of life.
The patient-oriented measure provides an important perspective of the severity of the disease and suggests new interpretations to conventional biological measurements. This multidimensional study shows that HRQoL is influenced by the metabolic picture. During adolescence a "constant attendance" of the disease, through strict self-control and the high number of therapy administrations, can deteriorate the patient's quality of life. Interestingly, this study indicates the mother's crucial role in the management of the disease during adolescence: the higher the mother's educational level the better the patient's HRQoL probably because she is able to help the child to manage and accept the disease.
Inflammation has been shown to play a pivotal role in ischemic heart disease, in particular unstable angina. The instability that characterizes this syndrome is related to the waxing and waning of ...ischemic stimuli, especially thrombotic ones. Angiographically and autoptically the severity of the atherosclerotic background in unstable angina does not differ from that in chronic stable angina, but in the former mural thrombi are often found and coronary atherosclerotic plaques are characterized by an inflammatory infiltrate, mostly consisting of activated lymphocytes, macrophages and mast-cells. In addition to these local findings, systemic evidence also suggests the importance of the role of inflammation in unstable angina as platelets, neutrophils and monocytes are activated, and elevated levels of serum markers of inflammation, e.g. C-Reactive Protein, have been consistently found. CRP has been demonstrated to be a reliable marker of prognosis in coronary heart disease. The consequenses of inflammation are a disruption in the dynamic balance between antithrombotic and prothrombotic activities, an altered extracellular matrix metabolism, hyper-reactivity of cells such as monocytes and smooth muscle cells, all important features of unstable angina. These findings have important prognostic implications, since markers of inflammation are associated to a worse prognosis, and may also have therapeutic implications in the near future
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVES
This study assessed the algesic activity of bradykinin (BK) in humans and the effects of acetylsalicylate on muscular and cardiac BK-induced pain.
BACKGROUND
Bradykinin is released by the ...ischemic myocardium and may be involved in the genesis of ischemic pain.
METHODS
Increasing doses of BK (from 30 to 960 ng/min) were randomly infused, for periods of 2 min each, into the iliac artery of 10 patients. The same protocol was repeated 30 min after the IV administration of 1 g of acetylsalicylate. In eight other patients with coronary artery disease, the same increasing doses of BK, for periods of 2 min each, were infused into the left coronary artery. The same protocol was repeated 30 min after the IV administration of 1 g of acetylsalicylate. Time to pain onset and maximal pain severity were obtained.
RESULTS
Before acetylsalicylate administration, all patients experienced pain during intra-iliac infusion of BK. After acetylsalicylate, eight patients did not experience any pain during BK infusion (p = 0.0014), and in the two remaining patients, time to pain onset and maximal pain severity were similar to those recorded before acetylsalicylate. Before acetylsalicylate administration, all patients experienced pain similar to their habitual angina during intracoronary BK infusion. After acetylsalicylate, six patients did not experience any pain during BK infusion (p = 0.0098), whereas in the two remaining patients time to pain onset and maximal pain severity were similar to those recorded before acetylsalicylate.
CONCLUSIONS
Intra-iliac infusion of BK causes muscular pain, and its intracoronary infusion in patients with coronary artery disease causes cardiac pain, which is similar to their habitual angina. The BK-induced pain is abolished or reduced by acetylsalicylate, thus suggesting that acetylsalicylate-sensitive mediators, such as prostaglandins, are involved in its pathogenesis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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