Emergency department triage performance timing. A regional multicenter descriptive study in Italy.

Objectives: We explored the time employed by nurses to perform the ED triage process in the clinical setting. Moreover, we assessed the influences on triage timing performance exerted by variables related to nurses, local EDs' features, and by interruptions.

Methods: This is a multicenter prospective descriptive-explorative study performed in 11 EDs of the Tuscany region (Italy), using a 5 tier triage system.

Evidence of impaired coronary flow reserve and elevated microvascular resistances in a case of recurrent left apical ballooning.

A 56-year old man was admitted for precordial pain associated with dyspnea and evidence of myocardial ischemia on ECG and cardiac ultrasound. His previous history included an episode of left apical ballooning five years before. At angiography, no evidence of significant epicardial coronary artery disease was manifest.

Very late thrombosis in a bare metal stent: an under-recognized problem.

Recent publications have emphasized the concept that restenosis of a bare metal stent is not as clinically benign as previously believed. A case of very late (seven years) thrombosis after implantation of a bare metal stent is described. While doubts on the long-term safety of drug-eluting stents are debated, registry data and clinical reports suggest that the long-term safety of coronary bare metal stent implantation should also be reconsidered.

The "slow coronary flow" phenomenon: evidence of preserved coronary flow reserve despite increased resting microvascular resistances.

Introduction: The expression "slow coronary flow phenomenon" (SCFP) indicates a slow progression of the contrast seen at the coronary angiography in the absence of epicardial stenosis and/or of other conditions associated with decreased coronary flow velocity. While microvascular abnormalities are suspected to underlie the mechanism of SCFP, they have never been directly demonstrated.

Methods And Results: Fifteen anginal patients with a positive stress test and no evidence of epicardial lesions (obstructive coronary artery disease, coronary ectasia, or coronary spasm) were enrolled.

Non-Q-wave myocardial infarction associated with three-vessel thrombosis.

Acute coronary syndromes have been traditionally considered the consequence of the rupture of a single plaque. Recent evidence has suggested that this is not the case, and intravascular ultrasound studies have demonstrated that an average of two to three ruptured plaques are present in patients admitted to hospital for unstable angina or infarction. We present a case of three-vessel occlusive thrombosis causing non-Q-wave myocardial infarction treated successfully with IIb-IIIa inhibitors.

Correlation analysis between different parameters of conduit artery and microvascular vasodilation.

Impaired endothelial responsiveness to specific vasodilator stimuli has been used as a surrogate marker of cardiovascular risk. Multiple methods allow testing endothelial responses in both microvessels and conduit arteries, but it is still unclear whether there is a relationship in endothelial function between these two different vascular beds. Twenty-five healthy young non smoking male volunteers (age range 24-45) were enrolled.

The effect of ischemia and reperfusion on microvascular function: a human in vivo comparative study with conduit arteries.

Although microvascular dysfunction is of critical importance in the pathophysiology of myocardial ischemic syndromes, no study has investigated whether there are differences in the sensitivity to ischemia and reperfusion injury between microvessels and conduit arteries. Ten healthy young nonsmoking male volunteers (age range 24-45) were enrolled. Parameters measured included radial (conduit) artery (endothelium-dependent) flow-mediated dilation, microvascular cutaneous reactive hyperemia (using laser Doppler) and acetylcholine-induced microvascular vasodilation (laser Doppler iontophoresis).

Magnesium profile in autism.

The aim of the present study was to determine and compare plasma and erythrocyte concentrations of magnesium in 12 autistic children (10 boys, 2 girls), 17 children with other autistic spectrum disorders (14 boys, 3 girls), 5 girls with classic Rett syndrome, and 14 normal children (7 boys, 7 girls) of the same age. No differences in intracellular Mg were found between controls and pathological subjects; however, autistic children and children with other autistic spectrum disorders had significantly lower plasma concentrations of Mg than normal subjects (p=0.013 and p=0.

Sildenafil prevents endothelial dysfunction induced by ischemia and reperfusion via opening of adenosine triphosphate-sensitive potassium channels: a human in vivo study.

Background: Animal studies have demonstrated that administration of sildenafil can limit myocardial damage induced by prolonged ischemia, an effect that appears to be mediated by opening of adenosine triphosphate-sensitive potassium (K(ATP)) channels. No study has investigated whether sildenafil can also prevent the impairment in endothelium-dependent vasodilatation induced by ischemia-reperfusion (IR) in humans.

Methods And Results: In a double-blind, placebo-controlled, crossover design, 10 healthy male volunteers (25 to 45 years old) were randomized to oral sildenafil (50 mg) or placebo.