The prevalence of SMI was 17% and angiographic coronary disease was found in 13% of middle-aged subjects with new-onset Type 2 diabetes without other cardiovascular risk factors. This prevalence is similar to that observed in studies of subjects with long duration diabetes who have additional cardiovascular risk factors.

A dipyridamole-echocardiographic test (DET) was carried out to find out how safe and useful it was in predicting clinical outcome and in identifying patients at risk. The test was performed in 107 asymptomatic patients early (5 to 8 days) after a first acute uncomplicated myocardial infarction managed with thrombolytic therapy. All patients were followed up for a mean of 15 months and 94 underwent coronary angiography. The test was considered positive if transient asynergy of contraction was newly detected either in the infarct and adjacent areas or in the remote zones; two subsets were studied, according to the dose of dipyridamole (0.56 or 0.84 mg.kg-1) needed to induce ischaemia. The test was accomplished satisfactorily in 96% of patients. Intra-inter-observer agreements were 88% and 91% respectively. The test also proved safe at the high infusion dose. During the follow-up period, two patients died, one experienced re-infarction and 12 (12%) developed recurrence of angina. DET was abnormal in 32 patients (adjacent and remote asynergy in 28 and four patients respectively): 18 had a critical and two a non-critical stenosis in the infarct-related vessel, and nine had an occluded artery with collateral distal flow. Multivessel disease was present in 11 patients considered positive, four in the remote and seven in the adjacent zones. However, 20 patients with negative DET results had multivessel disease. Of the positive DET patients, seven had angina. There were eight total events in the 71 negative DET patients, five of whom had multivessel disease. Abnormality was more pronounced in positive DET patients, but did not influence the outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

INTRODUCTION Plasma cell disorders are a group of diseases characterized by the proliferation of a plasma cell clone which produces a monoclonal protein (M protein). The most common type is Monoclonal Gammopathies of Undetermined Significance (MGUS), followed by multiple myeloma (MM) and Waldenstrom’s Macroglobulinemia (WM). In particular, the frequency of MGUS increases with age and its rate of progression is approximately 1% per year. Because of the high prevalence and the different fields of clinical practice in which these patients are followed, it could be of great interest to know the epidemiology of these diseases out of the Hematology Units. AIM OF THE STUDY to describe the frequency and the progression risk of plasma cell disorders in a General Hospital during more than a twenty-year period. METHODS We retrospectively reviewed the medical records of patients with diagnosis of MGUS, MM or WM seen at our center from 1984 through 2006. Statistical analysis were performed using GraphPad Prism 4 (GraphPad Software, Inc.). RESULTS The study included 102 patients: 78 affected by MGUS (76%), 14 by MM (14%) and 10 by WM (10%). Patients’ clinical features are summarized in the Table. Median follow-up was 48 months (range:12–280). Among the 89 patients with a first diagnosis of MGUS, malignant transformation occurred in 11 patients (7 MM and 4 WM). The median time from diagnosis of MGUS to diagnosis of a lymphoplasma cell proliferative disorder was 60 months (range 12–196). Median time to progression (TTP) was 167 months, as shown in Figure. The cumulative probability of progression was 13.5% at 5 years and 29.2% at 10 years. The amount of serum M protein at diagnosis was a significant predictor of progression. CONCLUSIONS MGUS are very common in clinical practice, accounting in our study for more than 75% of plasma cell disorders. The premalignant nature of this condition is comfirmed by the rate of transformation in lymphoplasma cell proliferative disorders (50% of MM and 40% of WM, in this study). Even if our results may be biased by the short follow-up period, the only significant predictor of progression was the size of serum M protein at presentation. Table: Patients’ characteristics Characteristics MGUS MM WM Gender male/female 41/37 4/10 7/3 Age at diagnosis median (range) 69 yrs (30–91) 72 yrs (51–90) 75 yrs (67–85) Serum M protein median (range) 1.26 g/dl (0.17–2.92) 3.85 g/dl (0.62–8.10) 3.20 g/dl (2.22–4.9) Isotype IgG 46 8 - IgA 14 6 - IgM 15 - 10 biclonal 3 - - Immunoparesis yes/no 20/58 14/0 10/0 BJ proteinuria pos/neg 11/67 11/3 1/9 Figure Figure

IntroductionCoronary artery aneurism (CAA) is a rare condition, characterized by a dilatation of 1.5 times the diameter of an adjacent normal coronary vessel. Finding of a giant CAA is a very uncommon event. We present a case of incidental finding of an asymptomatic giant aneurism affecting the circumflex coronary artery; then we discuss epidemiology, etiology and clinical approach, referring to published literature data. Case ReportA 74-year-old woman presented at hospital with fever and uncontrolled hypertension. Over the past years, she had suffered from chronic obstructive pulmonary disease (COPD) and hypertension that had not been further investigated. While blood specimens showed no significant findings (mild inflammation), chest radiograms revealed the presence of a pulmonary mass and a transthoracic echocardiography revealed an anechogenic interatrial lesion, that measured 56 mm, with apparent internal flow (Figure 1). Chest computed tomography (CT) with radiopaque contrast showed a solid lesion in the superior left pulmonary lobe, while the cardiac angiographic multi-slice CT showed a markedly ectatic and winding circumflex artery (maximum diameter: 8 mm), with a saccular aneurysm placed between the medium and the distal third of the vessel, just after a marginal branch emergence. The aneurysm measured 6.4×5.5 cm and presented nor endoluminal thrombosis neither parietal calcifications. The distal branch of circumflex artery overflowed into the extremely dilated and winding Giant aneurysm of circumflex coronary artery in asymptomatic patient ABSTRACTWe report a case of a 74-year-old woman who presented to the hospital for fever and uncontrolled hypertension. We found, incidentally, a giant aneurysm of the circumflex coronary artery measuring 6.4×5.5 cm. We show suggestive computed tomographic scan images, multi-slice reconstructions and a review of the epidemiology, diagnosis and treatment of this condition. Contributions: AB was involved with review of the literature, diagnostic process and drafting of the manuscript; OP, CDF, GF, GB and GPV were involved with radiological and ultrasound analysis and drafting; GM, PF and CP were involved in the diagnostic process and drafting.Conflict of interest: the authors declare no conflict of interest.