Signal-averaged electrocardiography and echocardiography in the evaluation of myocardial involvement in progressive systemic sclerosis.

To assess the myocardial involvement in progressive systemic sclerosis we evaluated the presence of late potentials by signal-averaged electrocardiography (signal-averaged ECG) and the left ventricular function by M-mode, two dimensional and Doppler echocardiography. Fifteen outpatients, 7 with diffuse progressive systemic sclerosis and 8 with CREST syndrome variant, without clinical or electrocardiographic evidence of cardiac disease were studied and compared with 18 normal subjects. Late potentials occurred in 5 out of 15 progressive systemic sclerosis patients (33%) with a significant difference versus controls (P < 0.

Increased rate of thrombin generation in hepatitis C virus cirrhotic patients. Relationship to venous thrombosis.

Background: Venous thrombosis may complicate the clinical course of liver cirrhosis (LC), but the pathogenesis is still uncertain. We have previously demonstrated that antiphospholipid (aPL) antibodies were a risk factor for thrombosis. In the same study it was also evident that there was a higher prevalence of hepatitis C virus (HCV) infection in patients with thrombosis, and an association between anti-HCV positivity and aPL.

[A case of non-Hodgkin T-cell lymphoma with predominantly cutaneous manifestations].

There is a wealth of experiences concerning cancer and leukemia induced in human populations by radiation. The contribution of the nuclear industry to the radiation exposure of the general population is small, but there is the risk of catastrophic accidents causing a large number of deaths. The authors describe the case of a 48 year old black man accidentally exposed to the effects of radiations during the nuclear disaster of Chernobyl in 1986.

Association between low-grade disseminated intravascular coagulation and endotoxemia in patients with liver cirrhosis.

Background & Aims: Hyperfibrinolysis may complicate the clinical course of liver cirrhosis. The aim of this study was to evaluate if, in cirrhosis, hyperfibrinolysis is primary or secondary to intravascular clotting activation and if endotoxemia is associated with activation of clotting and/or the fibrinolytic system.

Methods: Clotting, fibrinolytic indexes, and endotoxemia were studied in 41 cirrhotic patients and 20 healthy subjects.

Prognostic value of clotting and fibrinolytic systems in a follow-up of 165 liver cirrhotic patients. CALC Group.

One hundred sixty-five patients with cirrhosis diagnosed by needle liver biopsy were followed for 2 years to evaluate the relation between clotting factors and survival. Patients with spontaneous bacterial peritonitis, hepatic carcinoma, and cholestatic liver diseases were excluded. Patients were classified as A (n = 34), B (n = 75), or C (n = 56) according to Child-Pugh criteria.

Prevalence of lupus anticoagulant in patients with cirrhosis: relationship with beta-2-glycoprotein I plasma levels.

We have previously demonstrated that patients with cirrhosis may be positive for lupus anticoagulant and anticardiolipin antibodies. The prevalence and clinical value of antiphospholipid antibodies in cirrhosis have never been described. Besides, it has not yet been determined if serum levels of beta-2-glycoprotein I, which is synthesized by the liver and mediates the interaction between cardiolipin and anticardiolipin antibodies affects lupus anticoagulant detectability in cirrhosis.

Hypercoagulability state in patients with chronic obstructive pulmonary disease. Chronic Obstructive Bronchitis and Haemostasis Group.

Since there is some clinical evidence that the clinical course of patients with chronic obstructive pulmonary disease (COPD) may be complicated by thrombosis in the pulmonary vessels, we studied whether a hypercoagulability state (HS) does occur in COPD. Plasma levels of prothrombin F1 + 2 fragment, a marker of thrombin generation, D-dimer, a marker of in vivo thrombin and plasmin activation, and fibrinogen were measured in 37 COPD patients and in 30 controls matched for sex and age. COPD patients had significantly higher values of F1 + 2 (p = 0.

[Relationship between blood fibrinogen and plasma lipoproteins in patients with hypercholesterolemia].

Objective: Subjects with risk factors of atherosclerotic cardiovascular disease showed frequently high plasma levels of fibrinogen. Nevertheless, the relationship between hyperfibrinogenemia and atherosclerotic risk factors is not yet well known. In particular, some studies showed a correlation between hyperlipoproteinemia and high plasma levels of fibrinogen, even if the mechanism(s) involved in the hyperfibrinogenemia associated with hyperlipoproteinemia is not completely clear.

[Calcium antagonists in the therapy of arterial hypertension in the aged].

A large number of epidemiologic and interventional studies go to show that acute cerebral and cardiac events and chronic organ injury are significantly less frequent in treated compared to untreated elderly hypertensives. These observations clearly show that hypertension in the elderly must be treated. As to water-electrolyte metabolism, activity of the renin-angiotensin-aldosterone axis as well as volemia are reduced in the elderly while extravascular liquid compartment and activity of the natriuretic atrial factor are both increased.

Bleeding time in patients with cirrhosis: relation with degree of liver failure and clotting abnormalities. C.A.L.C. Group. Coagulation Abnormalities in Cirrhosis Study Group.

Patients with cirrhosis suffer from a complex haemostatic disturbance, due to abnormalities in clotting and fibrinolytic system activation and in primary haemostasis. The latter is indicated by a prolongation of bleeding time, which is a reliable indicator of platelet function in vivo. To further assess the relationship between bleeding time, degree of liver failure and clotting abnormalities in patients with cirrhosis, bleeding time was investigated in a prospective study of 70 consecutive patients with cirrhosis diagnosed by liver-needle biopsy, of whom 19 belonged to Child-Pugh class A, 29 to B and 22 to C.

Apolipoproteins C-II and C-III in peripheral arterial disease.

Apolipoprotein (apo) C-II and apo C-III serum concentrations were investigated in 119 normotriglyceridemic male subjects with peripheral arterial disease (PAD) or coronary heart disease (CHD) or without clinical manifestations of atherosclerotic disease. All subjects included in the study had similar blood levels of total cholesterol (< 400 mg/dL). High-density lipoproteins cholesterol (HDL-C) subfractions and apo A-I serum levels were significantly lower in CHD patients, as were apo A-I/apo B and HDL-cholesterol/total cholesterol ratios.

Relationship between lipoprotein(a) levels in serum and some indices of protein synthesis in liver cirrhosis.

Recent research has demonstrated that the major site of apolipoprotein(a) synthesis, the characteristic protein of lipoprotein(a) (Lp(a)), is the liver and that patients affected by liver cirrhosis have low serum concentrations of Lp(a). Nevertheless, it is still not clear whether Lp(a) behaviour in these patients is related to reduced hepatic protein synthesis, or to decreased serum lipid levels or to both these conditions. In order to investigate further the behaviour of Lp(a) and, in particular, its relationship with some indices of blood lipids and coagulation, 30 patients affected by liver cirrhosis have been studied.

Association between prolonged bleeding time and gastrointestinal hemorrhage in 102 patients with liver cirrhosis: results of a retrospective study.

Background: Gastrointestinal bleeding is a frequent complication of liver cirrhosis (LC) and represents an important warning sign of imminent death. Platelet dysfunction is an abnormality occurring prevalently in severe liver failure, and could well predispose to bleeding.

Methods: One hundred and two patients with liver cirrhosis diagnosed by needle liver biopsy were studied.

[Effects of simvastatin on plasma lipoproteins].

The role of low density lipoprotein (LDL) cholesterol as well as of that transported by other lipoproteins, such as high density lipoprotein (HDL), in the pathogenesis of atherosclerotic disease has been pointed out by several studies. Nevertheless, recent researchers have suggested that cholesterol transported by other lipoproteins, e.g.

Chronic obstructive pulmonary disease. A possible correlation between platelet aggregation tests and respiratory indexes. ECOB Group.

It has been suggested that thrombotic events occurring in patients with chronic obstructive pulmonary disease could be partially due to abnormalities in blood coagulation and fibrinolysis, as well as to changes in platelet function. In the present study in vitro platelet aggregation, in addition to clotting activity, has been studied in 20 patients with chronic obstructive pulmonary disease and different degrees of alteration of blood gas analysis. The results obtained suggest that the presence of a condition of platelet hypoaggregability characterizes patients with marked hypercapnia and/or hypoxemia, whereas the improvement of respiratory indexes is followed by a trend to normalization, or, more often, to an increase of platelet activity.

[The behavior of the fibrinogen polymerization curve in hypercholesterolemic subjects].

Several epidemiological and clinical studies performed in subjects with risk factors for atherosclerotic cardiovascular events, have shown changes in plasma levels and/or activities of coagulation factors that could suggest a prothrombotic state. We studied the behaviour of the fibrinogen polymerization curve (FPC), a spectrophotometric technique evaluating the kinetics of fibrinogen transformation into fibrin, in 68 subjects with and without hypercholesterolemia. Significant differences were found between FPCs of subjects with serum cholesterol > 240 mg/dl and < or = 240 mg/dl respectively.

[The prevalence of arrhythmias in subjects over 80 years old. The prognostic role of anamnestic symptomatology and the therapeutic directions].

24-hour Holter monitoring was performed in 129 unselected subjects older than 80 years (69 women and 60 men) in order to evaluate arrhythmia incidence and to establish significance of symptoms; 56% patients had lipothymia and/or syncope, chest pain and palpitations, 44% were asymptomatic. All patients showed high incidence of hyperkinetic and hypokinetic arrhythmias; no significant differences between symptomatic and asymptomatic patients in arrhythmia incidence were seen. Moreover, no correlation could be seen of the symptoms reported by the patient to the incidence of any particular type of arrhythmia.

Hyperfibrinolysis resulting from clotting activation in patients with different degrees of cirrhosis. The CALC Group. Coagulation Abnormalities in Liver Cirrhosis.

This study explored the relationship between clotting activation and tissue plasminogen activator and its inhibitor in cirrhotic patients with different degrees of liver failure. Sixty-seven patients (40 men, 27 women; age = 31-77 yr) with cirrhosis diagnosed by liver biopsy were divided into three subgroups (A, B and C) on the basis of Child-Pugh classification. Tissue plasminogen activator antigen and activity, plasminogen activator inhibitor antigen and activity, fibrin/fibrinogen degradation products, and D-dimer were measured in each patient.

1-year survey of patients with advanced liver cirrhosis. Prognostic value of clinical and laboratory indexes identified by the Cox regression model.

The relation between coagulation indexes and survival rate was studied and analyzed in 46 patients with advanced liver cirrhosis (grade B and C Child-Pugh Classification), during a follow-up of 1 year. Twenty-four patients (52%) died of liver failure or fatal haemorrhage within 12 months of follow-up. Prothrombin activity, fibrinogen, fibrin(ogen) degradation products, prekallikrein and factor VII, serum bilirubin, and the degree of liver insufficiency, scored by Child-Pugh classification, proved to be significantly correlated with survival by univariate analysis.

High density lipoprotein cholesterol low serum level as the only risk factor in male patients with coronary heart disease.

Forty-three male patients with myocardial infarction, severe angiographic coronary lesions, high or normal low density lipoprotein (LDL) cholesterol serum levels, and without other risk factors for coronary heart disease were selected. In all patients high density lipoprotein (HDL) cholesterol and HDL-cholesterol/total cholesterol ratio were significantly lower than in the control group; in particular, the ratio was below 0.240 which was the median value of normal subjects.

Methods for detecting lupus anticoagulants and their relation to thrombosis and miscarriage in patients with systemic lupus erythematosus.

Aims: To examine the sensitivity and specificity to past thrombotic events of four different coagulation tests, which screen for lupus anticoagulant (LA), and of anticardiolipin antibodies in patients with systemic lupus erythematosus.

Methods: Fifty three consecutive patients with systemic lupus erythematosus were studied of whom three males and 21 females, aged 21-60 years, had a history of venous and arterial thrombosis, or miscarriage, or both. Activated partial thromboplastin time (aPTT), dilute Russell's viper venom time (dRVVT), kaolin clotting time (KCT), dilute aPTT and the circulating titre of anticardiolipin antibodies were investigated in the two groups of patients and in 20 healthy control subjects.

Hyperfibrinolysis increases the risk of gastrointestinal hemorrhage in patients with advanced cirrhosis.

Sixty-one patients with different degrees of liver failure, 23 with Child-Pugh class B and 38 with Child-Pugh class C, were studied and observed for 3 yr. Coagulation index analysis showed significantly lower values of prothrombin activity, more prolonged activated partial thromboplastin time, higher bilirubin and fibrinogen degradation products values in class C patients. Among all patients, 28 had fibrinogen degradation products values greater than 10 micrograms/ml, and in these patients a hyperfibrinolytic state was confirmed by higher values of circulating plasminogen activator antigen (17.