A cancer modifier role for parathyroid hormone-related protein.

The parathyroid hormone-related protein (PTHrP) gene (Pthlh) maps in the distal region of mouse chromosome 6 that contains a quantitative trait locus associated with genetic predisposition to skin tumorigenesis. Here, we report a genetic polymorphism located in the osteostatin encoding region of the Pthlh gene and that produces Thr/ Pro PTHrP variants. PthlhThr and PthlhPro alleles were significantly linked with resistance and susceptibility to skin carcinogenesis in phenotypically selected Car-R and Car-S outbred mice. Transfection of human NCI-H520 squamous cell carcinoma cells with the PthlhPro allele resulted in cells growing in clusters, tending to pile up, and growing at a significantly faster rate in nude mice than non-transfected and PthlhThr-transfected cells. These results point to the role of the Pthlh gene as a cancer modifier gene in skin tumorigenesis.

Cardiac and circulatory response to the intravenous administration of urapidil during general anaesthesia.

The authors have assessed the hypotensive response to the intravenous administration of urapidil bolus, during intra-operative hypertensive crises, in 42 patients undergoing general anaesthesia for surgery. Twenty-two of these patients underwent major vascular surgery and were monitored through catheters introduced into the radial and pulmonary arteries, to study the haemodynamic changes induced by urapidil. A significant reduction was observed in these values: systolic and diastolic arterial pressure, systolic and diastolic pulmonary pressure, pulmonary wedge pressure and systemic vascular resistance. A non-significant reduction was observed in central venous pressure and pulmonary vascular resistance. Heart rate and cardiac output remained unchanged. Systolic arterial pressure decreased 12% from the baseline in 81% of patients. The transient action of urapidil bolus in some cases (55%) suggests the need for urapidil infusion.

Technical and clinical problems in patients with simultaneous implantation of a cardiac pacemaker and spinal cord stimulator.

Spinal cord stimulators are used to relieve pain associated with peripheral ischemia and angina pectoris. In patients with both permanent pacemaker (PPM) and a spinal cord stimulator (SCS), electromagnetic signals from the SCS may inhibit the PPM. A bipolar PPM configuration is preferred to minimize myopotential or electromagnetic interference but patients have safely had unipolar devices implanted. We report ten patients (six males and four females; median age 73.3 years) with both a SCS and a PPM implanted between 1987-1991. Intermittent interference with one PPM (Ela Medical Model Opus 3001) was noted after an increase in the output voltage of the SCS for continued clinical efficacy. Inhibition was output voltage dependent, and reversion to the noise mode was frequency dependent. Sensitivity to both could be managed by changing the pacemaker sensitivity. Interference with pacemaker function occurred if the SCS output was set above a voltage and pulse duration which resulted in a product of these values above 1.9-2 mVs. Seven VVI, one VDD, and two DDD PPM had been implanted. In five patients both PPM and SCS were unipolar. In two patients the SCS was bipolar and the PPM unipolar, in two patients a bipolar PPM was associated with a bipolar SCS and with one patient, a unipolar SCS. Multiprogrammable and/or bipolar PPMs should be implanted in a patient with a SCS to allow reprogramming of the PPM and to minimize the risk of inter-device interference. Inhibition of the PPM may occur at different SCS stimulation frequencies. The frequency at which inhibition occurs varies with different models of implanted pacemaker.

[Epidural spinal cord stimulation in the treatment of refractory angina pectoris. Mechanisms of action, clinical results and current indications]. / La stimolazione spinale epidurale nel trattamento dell'angina pectoris refrattaria. Meccanismi d'azione, risultati clinici ed indicazioni attuali.

The spinal cord stimulation (SCS) is an antalgic technique which has been used since 1967 for the treatment of several painful syndromes. More recently it was employed in cardiology to treat refractory angina, not suitable for revascularization. Despite the fact that published results on this subject have reported small, non-homogeneous series, and that the mechanisms of action are not completely understood, we can affirm according to the analysis of the literature and our own experience that SCS causes improvement in quality of life, reduction in frequency of angina attacks and reduced consumption of rapid-action nitrates. There is also evidence that electrical stimulation has a definite anti-ischemic effect, as revealed by increased work capacity, improved lactate metabolism and reduced downward slope of ST segment at comparable maximum work load. In expert hands SCS implantation is associated with relatively low frequency of complications, whose incidence is greatly reduced if the main contraindications are respected, particularly in patients receiving anticoagulants or with an infection.

[Epidural electrostimulation in the treatment of refractory angina pectoris in elderly patients: preliminary results]. / L'elettrostimolazione epidurale nel trattamento dell'angina pectoris refrattaria nel paziente anziano: esperienza preliminare.

The spinal cord stimulation is an antalgic technique which has been used since 1967 for the treatment of several painful syndromes. More recently it was employed in the cardiology field to treat refractory angina, not suitable for revascularization. We applied spinal cord stimulation as alternative therapy in 7 clients older than 70 years who, for different reasons, could not undergo revascularization. We obtained good short- and long-term clinical results, without complications. On the basis of our preliminary experience with this technique in a small group of elderly patients and after a critical review of the literature, we conclude that spinal cord stimulation can be used without significant risks, in elderly patients with refractory angina pectoris.

Efficacy and safety of permanent cardiac DDD pacing with contemporaneous double spinal cord stimulation.

Spinal cord stimulation (SCS) is currently used to treat peripheral vascular disease (PVD) and refractory angina pectoris not amenable to revascularization. In a case of contemporaneous SCS implant and permanent cardiac pacemaker (PPM), if multipolar electrodes are used it is possible to avoid any interference between the systems. We describe the case of a patient with a DDD pacemaker, in whom two bipolar SCSs were implanted at different times: one to control refractory angina pectoris and the other for PVD. No interference between the three systems has been observed.

The interaction between alcohol, chlorpropamide and phenformin in a severe combined poisoning: case report.

A young non-diabetic woman ingested 2.5-3.7 g of chlorpropamide and 0.6-0.9 g of phenformin together with a large dose of alcohol, nitrofurantoin and promethazine in a suicidal attempt. She developed severe metabolic acidosis, hypokalemia, polyuria and prolonged hypoglycemia in the absence of typical hypoglycemic symptoms. These unusual clinical features were in part explained on the basis of the interactions between alcohol and the other drugs.

[Electroencephalographic changes during anesthesia with low-dose propofol]. / Modificazioni elettroencefalografiche in corso di anestesia con propofol a bassi dosaggi.

The electroencephalographic changes of 12 patients submitted to anaesthesia with low dosages of propofol (4-2 mg/kg/h + fentanyl) for peripheral vascular surgery have been studied. The standard induction dose of propofol was 2 mg/kg for all the patients. The EEG recording was carried out during the whole length of anaesthesia and the EEG changes were analysed during induction and maintenance phases. During surgical anaesthesia it was always easy to read EEG and also to detect eventual cerebral suffering. On the basis of our results we can suggest this anesthesiologic technique for surgery (for example: carotid surgery) requiring a continuous monitoring of the cerebral function during intra and postoperative phases.

[Evaluation of cardiac risk in patients undergoing major vascular surgery. Usefulness and limitations of transesophageal atrial pacing]. / Valutazione del rischio cardiaco in pazienti da sottoporre a chirurgia vascolare maggiore. Utilità e limiti del pacing atriale transesofageo.

Patients undergoing vascular surgery are at high risk of developing cardiac events in the perioperative period. The aim of the study was the evaluation of the predictive accuracy of transesophageal atrial pacing (TAP) in identifying patients at higher risk of developing major cardiac events (cardiac death, acute myocardial infarction, unstable angina, heart failure and sustained ventricular tachyarrhythmias). We studied 96 consecutive patients, 80 males and 16 females, median age 63, requiring arterial surgery (aortofemoral or aortoiliac bypass and thromboendoarterectomy, abdominal aneurysm resection and extracranial carotid thromboendoaterectomy). TAP was performed without cardioactive drugs in all patients, but one. After surgery CK and CKMB serial assessment and ECG recording were performed daily until the seventh postoperative day. Preoperatively all patients were admitted to the Intensive Care Unit and submitted to haemodynamic monitoring with Swan-Ganz catheter at least for 72 hours. Three patients did not undergo surgery because of severe ST depression during TAP. Thus, 93 patients (96.8% of the series) were the subject of this report. In the postoperative period only two events (2.1% of the patients) were recorded, one relapsing acute myocardial infarction and one ventricular fibrillation, both in patients with negative TAP. No death occurred. Our study shows a very low prevalence of major cardiac events.(ABSTRACT TRUNCATED AT 250 WORDS)