Biomedical subjects
Publications and source records attributed to A Nappo.
A 4-month-old infant dying suddenly is diagnosed as sudden infant death syndrome (SIDS). Important modifications of the cardiac conduction system were found, consisting of conspicuous accessory atrioventricular (AV) pathways of Mahaim and Kent type, which can be regarded as arrhythmogenic in nature.
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56 cases of lacunar stroke were reviewed retrospectively. The patients showed a clinic picture which could be classified within nine of the lacunar syndromes recognized by Fisher. The localization of the lacunes was considered with respect to the clinical symptoms and the characteristics of the EEG and the TC and their different correlations were examined. The EEGrafic patterns of the lacunar strokes with normal TC were compared with those showing an altered one. Our study suggests that the absence of EEGrafic alterations may be a useful characteristic for the diagnosis of lacunar stroke, even when TC is normal. No significant correlations were found between the alterations of the EEG and the dimensions and/or localizations of the lacunes, as well as between the type of EEG (localized-wide-spread) and the size (large-small) of the lacunar infarcts.
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Cardiac metastatic malignant melanoma. Secondary tumors frequently involve the heart, but the main data about incidence, rate and localization into the specialized myocardium are poor and fragmentary. Post-mortem examination of the conduction system of arrhythmic hearts was studied in two cases of malignant melanoma. In the first case signed by AV block and fibrillation, metastases involved the myocardium over atrioventricular (AV) node and the left and right bundle branch (L and RBB). The second case had not arrhythmias in the clinical picture, but a large metastatic mass involved the junctions between sinoatrial (SA) node and myocardium of the crista terminalis, the junctions between atrium and AV node and the left branch.
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Involvement of the cardiovascular system in patients affected by acromegaly is an important factor in morbidity and mortality. The diagnosis in these subjects is acromegalic cardiomyopathy with cardiac decompensation, arrhythmias and sudden death. The pathologic substrate has rarely been described. The present study reports the findings in a case of sudden death in a 54-year-old man, affected by acromegaly. Subsequent diagnostic investigation revealed the characteristic aspects of acromegalic cardiomyopathy in the common myocardium and the presence of hyperacute myocardial infarct of the antero-septal wall of the left ventricle. Examination of conduction tissue revealed slight fibrolipomatosis and dispersion of the atrio-ventricular node (AVN), which extended to the His bundle and bifurcation. The right branch was prematurely intramural with sclerosis and lipomatosis. This location in atrio-ventricular conduction system has seldom been reported in the literature and if so, with different lesions from those found in the case we investigated. The results of microscopic examination convalidate the hypothesis of electrical instability in the heart, as confirmed by the subject's history of ventricular extrasystoles, left branch block and attacks of angina after effort. Death was correlated to hyperacute myocardial infarction of the anteroseptal wall of the left ventricle, in a subject with history of angina, affected by acromegalic cardiomegaly and electric instability. In this case, sudden death could also be considered arrhythmogenic in relation to the additional workload by persistent hormonal stimulation.