To investigate the pathogenesis of myocardial infarction we undertook a systematic study of patients with angina at rest, a syndrome known to evolve frequently into infarction. Among 187 consecutive patients, 37 had infarction, all in the area that showed electrocardiographic changes during angina. In all 76 patients who underwent hemodynamic monitoring, 201thallium myocardial scintigraphy or angiography during angina, a vasospastic origin of the attacks was documented. In six patients with infarction shortly after these studies and in two in whom the infarction developed during hemodynamic monitoring or during angiography the onset of infarction was indistinguishable from the onset of anginal attacks. One patient in whom spasm was observed at the onset of infarction died six hours later; at post-mortem examination, a fresh laminar thrombus was found at the site of the spasm. After infarction, complete thrombotic occlusion of the branch shown to undergo vasospasm was documented in two patients by angiography.

No abstract

To evaluate hyaluronidase's effect in reducing post-infarction myocardial necrosis, we randomized 91 patients with anterior infarction to control (45) or to hyaluronidase-treatment (46) groups. A 35-lead precordial electrocardiogram was recorded on admission and seven days later. Hyaluronidase was administered intravenously after the first electrocardiogram and every six hours for 48 hours. QRS-complex changes were analyzed to assess the drug's effect. Precordial sites with ST-segment elevation (larger than or equal to 0.15 mV) on the initial electrocardiogram that retained an R wave were considered vulnerable for the development of electrocardiographic signs of necrosis. The sum of R-wave voltages of vulnerable sites fell more in the control group than in the hyaluronidase group (70.9 +/- 3.6 per cent [+/- 1 S.E.M.] vs 54.2 +/- 5.0 per cent P less than 0.01). Q waves appeared in 59.3 +/- 4.9 per cent of the vulnerable sites in control versus 46.4 +/- 4.9 per cent in hyaluronidase-treated patients (P less than 0.05). Thus, hyaluronidase reduced the frequency of electrocardiographic signs of myocardial necrosis.

Background: Before starting a molecular screening program for breast cancer risk and in order to develop ad hoc educational strategies, a population survey in Apulia, Italy, was performed to gather information on women's awareness of breast cancer genetics and their attitude toward genetic testing for breast cancer risk. Patients and methods: A consecutive series of 677 healthy women with or without a family history of breast cancer, who attended the outpatient clinics of Lega Italiana per la Lotta contro i Tumori in Bari, Italy, for preventive visits, were asked to complete a 20-item questionnaire on socio-demographics, risk perception, psychological characteristics and interest in genetic testing for breast cancer predisposing genes. Results: Most women (77%) reported knowing something about the genetics of breast cancer; only 7% of the women were not interested at all in genetic testing. These figures were not significantly different for women with or without a family history of breast cancer. The two most frequently cited reasons for being interested in genetic testing, accounting for more than 50% of collected responses, were 'to learn about your children's risk' and 'to help advance research'. On multiple logistic regression analysis, only older age [odds ratio (OR) 1.9; 95% confidence interval (CI) 1.3-2.9] was associated with women's knowledge of genetic testing. Moreover, marital status (OR 4.0; 95% CI 1.1-14.6) and thinking of cancer (OR 2.2; 95% CI 1.0 -4.7) independently predicted the interest in having genetic testing. Conclusions: Southern Italian women seem highly interested in genetic testing for breast cancer risk. However, their expectations mainly regard their concerns about their children or their altruistic need to help research rather than the idea of a direct clinical benefit. The great interest of the women in genetic testing probably reflects their inappropriate knowledge of the information that genetic testing can provide for breast cancer risk analysis.

ziato un "trend" estremamente rapido: gli ultrasessantacinquenni erano il 15% nel 1992 ed il 13% nel 1982 (1). Ciò significa che in Italia una donna su cinque ed un uomo su sette hanno oggi più di 65 anni di età. Inoltre, gli ultra-ottantenni sono più di 400.000 (il 4% della popolazione) ma supereranno il milione di individui nei prossimi quarant'anni giungendo a costituire l'11% della popolazione nel 2045 (1). Il 70% delle morti registrate nel nostro Paese si collocano nella fascia di età compresa tra i 70 ed i 94 anni, ma l'emergere di una quinta età sembrerebbe confermato dal fatto che circa il 4% dei decessi in Italia (circa 25.000) avviene oltre i 90 anni (2). L'analisi dell'indice di vecchiaia rivela che in Italia si contano 143,1 anziani oltre i 65 anni ogni 100 giovani al di sotto dei 15 anni di età, con alcune differenze tra Nord (155,6), Centro (151,8) e Sud (91,5) ed una tendenza alla diminuzione delle INTRODUZIONE L a composizione della popolazione italiana ha subito profondi cambiamenti negli ultimi cinquant'anni più di altri Paesi industrializzati. Il calo delle nascite ed il progressivo invecchiamento della popolazione italiana sono quantificabili attraverso l'analisi dei dati demografici ISTAT (1). Dal 1950 la speranza di vita alla nascita nel nostro Paese è aumentata di 4 mesi all'anno e si attesta attualmente a 77,9 per gli uomini e 84,4 per le donne (1). Il 20% degli italiani, pari ad oltre 10 milioni di cittadini, ha già superato i 65 anni di età e la crescita di questa fascia di popolazione ha eviden- Reumatismo, 2010; 62(2)