Transient left ventricular apical ballooning: A unifying pathophysiologic theory at the edge of Prinzmetal angina.

Introduction: Takotsubo or ampulla transient left ventricular apical ballooning (LVAB) cardiomyopathy has been described as a clinical syndrome characterized by the sudden onset of chest pain, cardiac failure, ischemic changes on electrocardiography, and apical severe myocardial dysfunction in the presence of "normal" coronary arteries on angiography. All features last from a few days to a few weeks.

Methods And Results: On the basis of previous knowledge and in light of our recent experience with acetylcholine testing in this condition, the cases of four patients are described and preliminary but sound arguments are given to support the theory that LVAB is caused by severe, sustained spasm of many or all of the coronary vessels.

Single coronary artery with prepulmonic coursing left main coronary artery manifesting as prinzmetal's angina.

We report the case of a 32-year-old man who presented at the emergency department with severe chest pressure, left arm pain, and dizziness. These symptoms were described as intermittent, occurring after exercise and at rest. He had undergone several stress tests during the past 8 years, but no objective evidence of ischemia was produced.

Infection with chikungunya virus in Italy: an outbreak in a temperate region.

Background: Chikungunya virus (CHIKV), which is transmitted by Aedes spp mosquitoes, has recently caused several outbreaks on islands in the Indian Ocean and on the Indian subcontinent. We report on an outbreak in Italy.

Methods: After reports of a large number of cases of febrile illness of unknown origin in two contiguous villages in northeastern Italy, an outbreak investigation was done to identify the primary source of infection and modes of transmission.

The "1st septal unit" in hypertrophic obstructive cardiomyopathy: a newly recognized anatomo-functional entity, identified during recent alcohol septal ablation experience.

In hypertrophic obstructive cardiomyopathy, selective and asymmetric hypertrophy results in a stenotic subaortic channel, which is further narrowed by a Venturi effect (suctioning of the anterior leaflet, manifested by systolic anterior motion of the mitral valve). Better understanding of these essential pathophysiologic mechanisms has led to the definition of a new anatomo-functional entity, the 1st septal unit, which consists of the basal interventricular septal hypertrophy and its related septal arterial branches. As an alternative to surgical myomectomy, alcohol septal ablation is an effective method of reducing subaortic stenosis and improving mitral valve function.

Newer concepts for imaging anomalous aortic origin of the coronary arteries in adults.

Of the different kinds of coronary anomalies observed in adults, anomalous origin of a coronary artery from the opposite sinus of Valsalva with an "interarterial" course (ACAOS) entails a high risk of clinical consequences related to the intramural course of the ectopic coronary artery. We review current imaging modalities for differentiating this condition from generally benign coronary anomalies and for quantifying the severity of individual cases. For identifying ACAOS, noninvasive modalities (echocardiography, computed tomographic angiography, and coronary magnetic resonance angiography) are preferred: the favored modalities are transthoracic echocardiography in children and multidetector computed tomography in adults.

Skeletal involvement in infants with neuroblastoma a quality control attempt.

Aims And Background: In 1994, French authors hypothesized that positive skeletal mlBG spots in infants with stage 4 neuroblastoma were not prognostically unfavorable unless associated to abnormal standard X-ray or CT findings. In 1999, the European Infant Neuroblastoma Study adopted this definition, indeed reducing the number of patients candidate to chemotherapy. Such an approach requires high quality scans and standardized procedures.

Coronary artery anomalies: an entity in search of an identity.

Coronary artery anomalies (CAAs) are a diverse group of congenital disorders whose manifestations and pathophysiological mechanisms are highly variable. The subject of CAAs is undergoing profound evolutionary changes related to the definition, morphogenesis, clinical presentation, diagnostic workup, prognosis, and treatment of these anomalies. To understand the clinical impact of CAAs, the fundamental challenge is the firm establishment, for a particular type of CAA, of a mechanism capable of interference with the coronary artery's function, which is to provide adequate blood flow to the dependent myocardium.

Successful ablation of atrioventricular node reentry tachycardia in a patient with crisscross heart and situs inversus levocardia.

Crisscross heart is a complex congenital anomaly that is rarely seen in the absence of important associated structural defects. We describe a 41-year-old woman with recurrent dizziness and tachycardia but no previous cardiovascular symptoms. Narrow-QRS tachycardia was detected, and magnetic resonance imaging showed situs inversus levocardia with a circulatory pattern typical of crisscross heart.

High dose pulsatile dexamethasone therapy in children with opsoclonus-myoclonus syndrome.

Opsoclonus-myoclonus syndrome (OMS) is a rare movement disorder characterized by chaotic eye movements, myoclonus, and ataxia associated with severe irritability. Different treatment modalities including steroids and cyclophosphamide have been tried in the past often with significant side effects and variable success. Here we present 11 children, diagnosed with OMS between 1999 and 2005 and treated with high dose dexamethasone pulses.

[A girl in the mirror].

We report a case of situs ambiguous associated with particular vascular anomalies resulting in secondary arterial hypertension. Renal ultrasonography performed in this case has oriented diagnosis.

[Ultrasound investigation in Apulo-Lucano renal echography study group of the Italian Society of Nephrology: a cognitive report].

The number of ultrasonography expert consultant Nephrologists is more and more increasing thanks to the contribution that this methodology has brought in both clinical and treatment fields. Up to now, a database of the ultrasonography benefits, as well as the main criteria for the interpretation of the urinary tract echographic examination has not been compiled, yet. We have therefore drawn up and distributed a questionnaire to the consultant nephrologists of the urinary tract echography study group (Apulo-Lucano division).

Daughter, you broke my heart: accidental thrombosis at a muscular bridge.

We report the case of a 59-year-old trained runner, who sustained an acute myocardial infarction, with residual effort angina, following extreme exertion while experiencing severe anxiety. Coronary angiography revealed that this patient had a myocardial bridge at the mid-left anterior descending artery, and an occlusive clot had developed at the proximal end of the muscular bridge. We discuss the possible relationships between the various circumstances of this sudden event.

In vitro inhibitory activity of boropinic acid against Helicobacter pylori.

In this study, we assessed in vitro minimum inhibitory concentration (MIC) values of some natural geranyloxycoumarins, geranyloxy- and isopentenyloxy acids against growth of Helicobacter pylori. Boropinic acid, active principle isolated from Boronia pinnata (Fam. Rutaceae), was seen to be the most effective compound with a MIC value of 1.

Symptomatic anomalous origination of the left coronary artery from the opposite sinus of valsalva. Clinical presentations, diagnosis, and surgical repair.

Anomalous origination of a coronary artery can have serious, even fatal, consequences. Intravascular ultrasonography has recently provided new insights into anomalous coronary artery origination from the opposite sinus of Valsalva. On the basis of these insights, we describe 3 typical forms of this anomaly with left coronary artery involvement, including clinical presentations, diagnostic methods (particularly intravascular ultrasonography), and details of surgical treatment.

Hospitalization rate due to measles in an area of the South East of Italy during an outbreak in the years 2002-2003.

Aim: Usually measles is not severe, but serious complications can occur and thus hospitalization is needed. The aim of this study was to assess the reasons of hospitalizations of the persons affected by measles and the severity of disease as a result of measles infection.

Methods: During an outbreak from 2002 to 2003 in the province of Taranto, 73 hospitalized persons affected by measles were evaluated.

Monitoring of the medical radiological exposures of the population of the Emilia-Romagna Region.

Purpose: The Italian Decree of Law 187/2000 provides for many fulfilments relevant to justification and optimisation of medical exposures that can complicate the daily work of radiology departments if considered as mere legal requirements. On the contrary, this law should be regarded as a good opportunity to analyse and optimise working practices. To this end, the Emilia- Romagna Region carried out an initial assessment of medical exposures to its population in 2001 followed by a second survey taking into account new dosimetric evaluations.

Neuroblastoma in adolescents: the Italian experience.

Background: Neuroblastoma (NB) occurs rarely during adolescence, and information is scarce on its characteristics and clinical course in this age group.

Methods: Patients with NB who were included in the Italian Neuroblastoma Registry were considered for the current study. The clinical characteristics and survival of adolescents (age at diagnosis between 10 yrs and 18 yrs) were compared with those of children (ages 1-9 yrs).