Efficacy of safety catheter devices in the prevention of occupational needlestick injuries: applied research in the Liguria Region (Italy).

Healthcare workers who use or may be exposed to needles are at risk of needlestick injuries, which can lead to serious infections by bloodborne pathogens. These injuries can be avoided by eliminating the unnecessary use of needles and using safety devices. The present study was aimed at evaluating the impact of a safety-engineered device, with passive fully automatic needlestick protection, on the rate of needlestick injuries among healthcare workers. The setting of the study was a network of five public healthcare institutions situated in a Northern Italian Region. Data on the type of device, the number of employees and the number of catheter devices used per year were collected through regular meetings with healthcare workers over a period of five years. The most notable result of this study was the huge risk reduction associated with safety devices. Indeed, the risk of needlestick injuries due to conventional devices was found to be 25-fold higher than that observed for safety devices. However, it is noteworthy that a considerable part of this excess can be explained by the different background number of devices used. Moreover, descriptive analysis suggested that individuals with a poor/moderate training level had a lower risk than those with good/high training, though the difference was not statistically significant. In conclusion, there is convincing evidence of a causal connection between the introduction of safety devices and the reduction in needlestick injuries. This consideration should prompt the introduction of safety devices into daily clinical practice.

Occupational Medicine and Hygiene: applied research in Italy.

The goal of Occupational Medicine and Hygiene is that of ensuring safety, health and well-being at workplaces, mainly assessing and preventing existing occupational risks. Scientific research in this field can provide useful arguments and further evidence upon which effective, efficient and sustainable policies and preventive measures have to be chosen and applied by the occupational physician in work-life. This paper summarizes four original studies, conducted in different professional settings across Italy, focusing on critical items, such as stress and violence, biological risks and sleep hygiene. The knowledge obtained can be useful to orientate proper preventive programs aimed at improving workplace health.

How to interpret reduced forced expiratory volume in 1 s (FEV1)/vital capacity ratio with normal FEV1.

The aim of the present study was to determine whether the combination of low forced expiratory volume in 1 s (FEV(1))/vital capacity (VC) ratio with normal FEV(1) represents a physiological variant or a sign of early airflow obstruction. We studied 40 subjects presenting with low FEV(1)/VC, but FEV(1) within the range of normality predicted by European Respiratory Society reference equations, and 10 healthy controls. All subjects completed two questionnaires and underwent comprehensive pulmonary function testing, which included methacholine challenge and single-breath nitrogen wash-out. According to the questionnaires, the subjects were assigned to three groups, i.e. rhinitis (n = 8), bronchial asthma (n = 13) and chronic obstructive pulmonary disease (COPD; n = 12). Subjects with negative responses to questionnaires were assigned to an asymptomatic group (n = 7). Airway hyperresponsiveness was found in four subjects of the rhinitis group, all of the asthma group, and 10 of the COPD group; in the last two groups, it was associated with signs of increased airway closure and gas trapping. Bronchodilator response to salbutamol was positive in only a few individuals across groups. In the asymptomatic group, no significant functional changes were observed, possibly suggesting dysanaptic lung growth. In subjects with low FEV(1)/VC and normal FEV(1), questionnaires on respiratory symptoms together with additional pulmonary function tests may help to clarify the nature of this pattern of lung function.

Alterations in the autonomic control of heart rate variability in patients with anorexia or bulimia nervosa: correlations between sympathovagal activity, clinical features, and leptin levels.

Changes in body composition, hormone secretions, and heart function with increased risk of sudden death occur in eating disorders. In this observational clinical study, we evaluated sympathovagal modulation of heart rate variability (HRV) and cardiovascular changes in response to lying-to-standing in patients with anorexia (AN) or bulimia nervosa (BN) to analyze: a) differences in autonomic activity between AN, BN, and healthy subjects; b) relationships between autonomic and cardiovascular parameters, clinical data and leptin levels in patients with eating disorders. HRV, assessed by power spectral analysis of R-R intervals, blood pressure (BP) and heart rate (HR) were studied by tilt-table test in 34 patients with AN, 16 with BN and 30 healthy controls. Autonomic and cardiovascular findings were correlated with clinical data, and serum leptin levels. Leptin levels were lowered in AN vs BN and healthy subjects (p<0.0001), but both AN and BN patients showed unbalanced sympathovagal control of HRV due to relative sympathetic failure, prevalent vagal activity, impaired sympathetic activation after tilting, independently from their actual body weight and leptin levels. No significant correlations were obtained between HRV data vs clinical data, BP and HR findings, and leptin levels in eating disorders. Body mass indices (BMI) (p<0.02), and leptin levels (p<0.04) correlated directly with BP values. Our data showed alterations of sympathovagal control of HRV in eating disorders. These changes were unrelated to body weight and BMI, diagnosis of AN or BN, and leptin levels despite the reported effects of leptin on the sympathetic activity.

99mTc-HMPAO regional cerebral blood flow and quantitative electroencephalography in Alzheimer's disease: a correlative study.

UNLABELLED: In this study the neuropsychological status of patients with Alzheimer's disease (AD) was correlated with quantitative electroencephalography (qEEG) and regional cerebral blood flow (rCBF) both in the cortex and in deep gray matter structures. METHODS: Forty-three outpatients (mean age 72.4 +/- 7.5 y) with probable AD underwent 99mTc-hexamethyl propyleneamine oxime SPECT with a brain-dedicated gamma camera and qEEG (relative values) within 1 mo. Preliminary factorial analysis with promax rotation identified four qEEG bands (2-5.5, 6-7.5, 8-11.5 and 12-22.5 Hz, with no distinction as to topography) and six SPECT regions (the two thalami together, the two parietal cortices together, the right temporal cortex, the right hippocampus, the left hippocampus and the remaining cortical areas together) as the variables with highest statistical power. All these variables and the Mini-Mental Status Examination score (MMSE, a sensitive marker of neuropsychological deficit) were processed by a final factorial analysis and multivariate analysis of variance. RESULTS: Both the 2-5.5 Hz and the 8-11.5 Hz powers were correlated with the perfusion level in the parietal regions of interest (ROls) (P = 0.0009), whereas the 2-5.5 Hz power was correlated with the right hippocampal perfusion level (P = 0.007). The MMSE score was significantly correlated with the perfusion level, both in the right (P = 0.006) and in the left (P = 0.004) hippocampal ROls and in the parietal ROls (P = 0.01); moreover, it was correlated with both the 2-5.5 Hz (P = 0.0005) and the 8-11.5 Hz (P = 0.004) power. CONCLUSION: rCBF (bilateral parietal perfusion) and qEEG (especially the slowest frequencies, i.e., 2-5.5 Hz) are confirmed to be good descriptors of AD severity. It is especially noteworthy that bilateral hippocampal CBF was the perfusional index best correlated with the MMSE as well as being significantly correlated to qEEG. Hippocampal SPECT imaging appears to be a promising index to improve characterization of AD in respect to other forms of primary degenerative dementia and may be proposed as a marker for evaluating the effects of pharmacotherapy of AD at the neuronal level.

Semen analysis following allogeneic bone marrow transplantation. Additional data for evidence-based counselling.

Knowledge of the impact of different conditioning regimens used in bone marrow transplantation on spermatogenesis is important in pre-BMT counselling for three reasons: (1) Most young patients who have not had children are concerned with their subsequent fertility; (2) For a number of diseases there are competing therapeutic options that may affect spermatogenesis more or less seriously; (3) Since spontaneous recovery of spermatogenesis is rare, it would be necessary to offer cryopreservation as soon as possible after diagnosis and prior to any treatment. This retrospective study evaluates 99 semen samples obtained in 64 patients who underwent BMT between 1982 and 1996. Recovery of spermatogenesis was observed in 90% of patients conditioned with cyclophosphamide (CY), in 50% of patients with CY plus busulphan (BU) or thiotepa and in 17% of patients with CY plus total body irradiation (TBI) or thoracoabdominal irradiation (TAI). Sperm quality following CY was within the normal range (WHO) in the majority of patients, whereas it was consistently severely impaired in patients who received irradiation or two alkylating agents. Following CY, spermatogenesis recovery was observed in 60% of patients tested 1 year post transplant and it was accomplished within the third year in 80% of cases. Following CY + TBI/TAI recovery of spermatogenesis never occurred before the 4th year post transplant and was demonstrated as late as 9 years in one patient who was azoospermic 1 year earlier. No statistical correlation between age and recovery of spermatogenesis could be demonstrated. The overall high incidence of azoospermia (70.3%) supports the indication for semen cryopreservation in young patients undergoing BMT. These results have implications for semen sample timing before and after BMT and underline a need to collect further data through prospective multi-center studies.

EEG spectral profile to stage Alzheimer's disease.

OBJECTIVE: The present study was undertaken to investigate whether a synoptic parameter of quantitative EEG (qEEG), such as the power spectral profile, may be used as a simple marker to stage Alzheimer's disease (AD) in the clinical setting. METHODS: To this purpose, the qEEG spectral profile was examined in 48 patients (mean age: 73 years) with probable (NINCDS-ADRDA criteria) AD, who were divided into 4 groups, according to the Global Deterioration Scale (GDS; score: 3-6). The spectral profile of each patient was expressed by the relative power of seven frequency bands (2-3.5, 4-5.5, 6-7.5, 8-9.5, 10-11.5, 12-13.5, 14-22.5 Hz). Mean values in each of the four GDS groups as well as in a control group of 18 healthy elderly subjects underwent multivariate analysis of variance. RESULTS: A normally shaped but shifted-to-the left spectral profile was found in GDS 3 group, whereas a reduced background rhythm with various increase in slow activity power characterized both GDS 4 and 5 groups. Finally, an 'exponential asymptotic' profile with the highest power in the lowest frequencies was the hallmark of GDS 6 group. Overall, the 4-5.5 Hz and the 10-11.5 Hz band powers showed the highest statistical significance in differentiating the patient groups between one another and from controls (P < 0.0001). CONCLUSIONS: These data show that spectral profile is a very simple parameter which can be used to stage the disease on a pathophysiological basis.

Timing of disease progression by quantitative EEG in Alzheimer' s patients.

This prospective study was planned to assess whether quantitative EEG (qEEG) can give an estimate of the timing of achievement of three endpoints (loss of activities of daily living, incontinence, and death) in 72 consecutive patients (53 females, 19 males; mean age, 70.8) affected with probable Alzheimer's disease, as defined according to the NINCDS-ADRDA criteria. Power-weighted, log-transformed relative values of the four conventional EEG bands were considered in a central-posterior temporal region for each hemisphere. The hypothesis was tested by the lifereg procedure of the Statistical Analysis System package (first significance level accepted, P < or = 0.01). Because patients were in different stages of the disease, the statistical analysis was performed in the entire group as well as in the subgroup of 41 patients (mean age, 69.6) with mild dementia (scoring 3 or 4 on the global deterioration scale). In the whole group, the loss of activities of daily living was predicted by delta power in either side (P = 0.01), incontinence was predicted by alpha power in the right side (P < 0.01), whereas the statistical significance was not reached for death (P < 0.05). In the subgroup of mild demented patients, the loss of activities of daily living was predicted by delta power in the left side (P = 0.01), incontinence by both delta (P < 0.01) and alpha (P < 0.001) power in the right side, and death was not significantly predicted (P = 0.08). Quantitative EEG is a low-cost, discomfort-free technique which may be used to obtain information on the timing of disease evolution. The results showed in mild Alzheimer's disease appear especially interesting to attempt a prediction of the future time course of the disease from its beginning.

Effects of valproate, phenobarbital, and carbamazepine on sex steroid setup in women with epilepsy.

Serum levels of sex-hormones, sex-hormone binding globulin, gonadotropin, and prolactin were evaluated during the follicular and the luteal phases in 65 women with epilepsy and in 20 healthy controls. Twenty-one patients were treated with sodium valproate (VPA), 21 with phenobarbital (PB), and 23 with carbamazepine (CBZ). VPA does not stimulate liver microsome enzymes, whereas PB and CBZ do. Patients on VPA therapy showed higher body weight and body mass index, but no significant differences in hirsutism score, or in ovary volume or polycystic ovary prevalence (at ultrasound examination). Estradiol levels were lower in all patient groups than in healthy controls in the follicular but not in the luteal phases. VPA affected luteal progesterone surge in 63.6% of cases. This effect was significantly lower in the CBZ and PB groups. Furthermore, increases in testosterone and delta 4-androstenedione levels and in free androgen index, along with a higher luteinizing hormone-follicle-stimulating hormone ratio in the luteal phase, were observed in women treated with VPA. Although sex-hormone binding globulin levels were higher in CBZ and PB than in VPA-treated patients, the differences were not significant because of the wide dispersion of the carrier protein levels. Inducer antiepileptic drugs decreased dehydroepiandrosterone sulfate levels, which remained unchanged during VPA treatment. No significant differences occurred in basal gonadotropin and prolactin levels.

[Analysis of risk factors in patients operated for abdominal aortic aneurysm]. / Analisi dei fattori di rischio in pazienti operati per aneurisma dell'aorta addominale.

BACKGROUND: The incidence of the associated risk factors on the early results of elective repair of abdominal aortic aneurysms has been evaluated in a series of 270 consecutive patients. Clinical, hematological and instrumental data concerning cardiovascular, pulmonary and metabolic diseases have been collected for each patient, as well as the type and the results of the surgical procedure. METHODS: The graft was straight aortic in 82 cases (30.3%), aorto-bisiliac in 130 (48.1%) and aorto-bifemoral in 58 cases (21.6%); the 237 uneventful patients (87.8%) have been discharged 8 days after the operation (mean) and 24 (8.9%) underwent to coronary-aortic bypass graft (CABG) previously. RESULTS: Postoperative complications have been observed in 33 patients (12.2%): 24.3% pulmonary, 21.2% cardiac and 15.1% renal and among these 13 patients died (4.8% of the complete series and 39.4% of those with complications) because of pulmonary (38.4%), cardiac (30.7%) and renal causes (23.3%) mainly. Despite the complications occurred mainly in patients with associated risk factors, the multivariate analysis has shown that only the chronic obstructive pulmonary disease (COPD) plays a fundamental role (p < 0.005). On the contrary, among the patients died not one single risk factor reached statistical significance, although the COPD was close (p = 0.1). CONCLUSIONS: These data underline the need of a careful evaluation and treatment of associated diseases in patients undergoing elective repair for an AAA; namely a screening for asymptomatic coronary artery disease, since the CABG can significantly reduce morbility and mortality rates, and for COPD. In addition a more careful monitoring of patients with long clamping time could reduce the possible related renal complications. Up to now, since the surgical procedures is already standardized, the precise diagnosis and treatment of associated risk factors represent the winning strategy for the achievement of better results.

[Acute myocardial infarction in elderly subjects. Significance of risk factors and method of presenting the clinical picture in the analysis of a cohort at a coronary care unit]. / Infarto miocardico acuto nel soggetto anziano. Significato dei fattori di rischio e modalità di presentazione del quadro clinico nell'analisi di una casistica di una Unità Coronarica.

Acute myocardial infarction in the elderly shows epidemiological and clinical features different from those observed in the same pathology in the young-adult subject. In this study, the authors compare literature data with their experience of 309 subjects aged greater than or equal to 65 years vs. 268 controls. All these patients were hospitalized for acute myocardial infarction in an Intensive Care Unit. Risk factors, symptomatology at onset, lesion site and survival in the Intensive Care Unit were examined. Our study establishes that cardiologists need special diagnostic accuracy to evaluate coronary artery disease in old patients.

[Acute myocardial infarction in the aged patient: comparison between the male and female sexes]. / Infarto del miocardo acuto nel soggetto anziano: confronto fra sesso maschile e femminile.

The authors evaluate old patients of both sexes with acute myocardial infarction. They study coronary risk factors, symptomatology onset, infarction site, complications and survival in Intensive Care Unit. The elderly women show significant features in comparison with the male as the particular predictive value of diabetes and hypertension and the greater atypia of clinical findings. The unforeseeable development of coronary artery disease in the female is confirmed also in the elderly.

[An epidemiological study of a group of workers employed in the maintenance of a sewer network and of urban waste water treatment plants]. / Studio epidemiologico su un gruppo di operatori addetti alla manutenzione della rete fognaria e degli impianti di depurazione delle acque reflue urbane.

The paper reports the results of a study on occupational risks of a group of sewage workers of the city of Genoa vs. a control group of nonexposed subjects; the first group was divided into three subgroups according to the job characteristics. After bibliographical research on the topic, a specific questionnaire was used to analyse individual symptoms. Clinical examinations, blood and respiratory tests were also performed. The statistical analysis was performed by evaluating F test for differences between parametric measures and the relative risk for non-parametric findings. The relative risk of alterations in respiratory function (both instrumental and clinical findings) was increased among the water treatment workers. The average platelets count in the exposed workers appeared to be significantly reduced compared to non-exposed subjects although both were within the normal limits. There was non evidence of an increased prevalence of positive A hepatitis markers in the exposed workers.

Effects of recombinant human thyrotropin on heart rate variability and blood pressure in patients on l-thyroxine-suppressive therapy for differentiated thyroid carcinoma.

BACKGROUND: Recombinant human thyrotropin (rhTSH) is now currently used for the follow-up of patients with differentiated thyroid carcinoma (DTC) after total thyroid ablation. Side effects after rhTSH could involve the autonomic system and TSH receptors are possibly expressed in the heart and coronary arteries. METHODS: Heart rate variability (HRV), studied by power spectral analysis of low (LF) and high frequency (HF) powers, blood pressure (BP) and their responses to orthostatism were investigated before and 3, 6, 9 days after the first of two administrations of rhTSH on alternate days in 11 patients on chronic l-thyroxine (l-T4) suppressive therapy for DTC and in 31 healthy controls. RESULTS: A transient asymptomatic decrease in systolic and mean BP was observed during the rhTSH test, but rhTSH did not modify sympathovagal control of HRV and the lying to standing responses. Decreased LF power and LF/(LF + HF) and LF/HF ratios in DTC patients versus healthy controls indicated a sympathetic failure ascribed to the TSH-suppressive therapy with l-T4 rather than to direct effects of rhTSH. CONCLUSIONS: These findings allowed us to confirm the cardiovascular safety of rhTSH and the absence of its effects on sympathovagal control of HRV when used in the follow-up of patients with normal heart function after thyroid ablation for DTC.

[Dimensions of the proximal thoracic aorta from childhood to adult age: reference values for two-dimensional echocardiography. Ligurian Group of SIEC (Italian Society of Echocardiography)]. / Dimensioni della radice aortica nell'infanzia e nell'età adulta: limiti di riferimento per l'ecocardiografia bidimensionale. Gruppo Ligure Della SIEC.

BACKGROUND: Two-dimensional echocardiography (2-DE) represents the main tool for detecting and monitoring abnormalities of proximal thoracic aorta. However, previous studies performed to assess the reference values of aortic diameters using this technique are few and, often, involve a small number of subjects. Furthermore, such a study has not been performed on an Italian population. METHODS: To assess the reference values and the growth curves of the dimensions of the proximal thoracic aorta in an Italian population, we measured aortic diameters at the level of the anulus, of the sinuses of Valsalva and of the supraaortic ridge, by using 2-DE, in 134 healthy volunteers (78 males, 56 females), aged 35 +/- 16 years (range 5-76). Sex, age, weight, height, body surface area (BSA), heart rate, systolic and diastolic blood pressure were analyzed as determinants of proximal thoracic aorta diameters. In addition, to compare the specificity of the reference values, we have obtained with those provided by literature, we studied another independent group of 23 healthy volunteers, aged 32 +/- 15 years (range 11-65). RESULTS: In our study population, mean values and range of aortic 2-DE diameters were 2.1 +/- 0.3 cm (range 1.3-2.9) at the level of the anulus, 2.6 +/- 0.4 cm (range 1.7-3.7) at the level of the sinuses of Valsalva and 2.4 +/- 0.4 cm (range 1.5-3.4) at the level of the supraaortic ridge. At multivariate regression analysis, sex and age emerged as the only independent determinants of the aortic root diameters (r2 = 0.35, 0.43, and 0.52 for aortic diameter at the level of anulus, sinuses of Valsalva, and supraaortic ridge, respectively). On average, aortic root dimensions at the level of the anulus, of the sinuses of Valsalva and of the supraaortic ridge in females were 1.5 mm, 2.8 mm, and 1 mm, respectively, smaller than those of males of comparable age, height and weight. The growth curves showed that proximal thoracic aorta increases in size in the first 30 years of life; thereafter, it remains relatively constant in size up to 55 years, after which the proximal thoracic aorta tends to enlarge gradually. The ratios of sinuses of Valsalva to annular diameter and of supraaortic ridge to annular diameter (1.27 +/- 0.17 and 1.17 +/- 0.16, respectively) were found to be indexes of aortic root dimension independent of sex and age. No correlation was found between aortic root dimensions and systolic blood pressure. M-mode echocardiography systematically overestimated 2-DE aortic diameters at the level of the anulus, as well as at the level of the sinuses of Valsalva and of the supraaortic ridge (+0.8 +/- 0.04 cm, +0.2 +/- 0.04 cm, and +0.4 +/- 0.04 cm, respectively, p < 0.0001 for all). In the control population, our reference values demonstrated a specificity significantly higher than that of the main reference values reported in literature (97 +/- 2% versus 62 +/- 4%, p < 0.0001). CONCLUSIONS: Our study provides a prospectic, systematic and detailed analysis of 2-DE proximal thoracic aorta diameters in a wide group of healthy Italian subjects. Our data show that: 1) 2-DE aortic root dimensions are influenced by sex and age but not by body size or blood pressure; 2) the ratios of sinuses of Valsalva to annular diameter and of supraaortic ridge to annular diameter are indexes of aortic root dimension which are independent of age and sex; 3) M-mode diameter systematically overestimates 2-DE diameters of the aortic root; and 4) Italian population based reference values showed higher specificity than values provided by literature.

Glucose infusion test: a new screening test for vascular access recirculation.

BACKGROUND: Vascular access recirculation is an important cause of diminished dialysis efficiency. We propose a new screening test based on glucose infusion as a tracer for recirculation. METHODS: The glucose infusion test (GIT) protocol comprises a basal blood sample (A) from the arterial port, a 5 mL bolus of 20% glucose into the venous chamber (time 0), followed by a second sample (B) in four seconds (from 13 to 17 s with QB 300 mL/min) from the same port. The blood glucose level is determined at the bedside on A and B with a reflectance photometer (CV 1.8%). Interpretation of the test is straightforward: If B = A, there is no recirculation, whereas if B > A, recirculation can be calculated from the regression equation: 0.046 x (B - A) + 0.07, obtained from in vitro tests reproducing artificial recirculation at 0, 5, and 10%. To validate this new method in vivo, we compared GIT and the urea test on 39 hemodialysis patients, obtaining a good correlation (r = 0.93). The two tests were considered positive (recirculation present) when the lower 95% confidence intervals were more than zero. RESULTS: Our patients were divided into two groups: those with (22 out of 39, mean recirculation 11.8%) or without recirculation (17 out of 39, mean 0.06%). The urea test did not recognize 7 out of 22 patients because they had a small recirculation below the urea test limit of detection. CONCLUSIONS: GIT was more sensitive (detection limit 0.3%), simpler, and immediate in showing the results than the urea test. It is an accurate and low-cost technique for screening and follow-up of vascular access in a dialysis unit.

Hippocampal perfusion and pituitary-adrenal axis in Alzheimer's disease.

The hippocampus is involved in Alzheimer's disease (AD) and regulates the hypothalamus-pituitary-adrenal axis (HPAA). Enhanced cortisol secretion has been reported in AD. Increased cortisol levels affect hippocampal neuron survival and potentiate beta-amyloid toxicity. Conversely, dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are believed to antagonize noxious glucocorticoid effects and exert a neuroprotective activity. The present study was aimed at investigating possible correlations between hippocampus perfusion - evaluated by SPECT - and HPAA function in AD. Fourteen patients with AD and 12 healthy age-matched controls were studied by (99m)Tc-HMPAO high-resolution brain SPECT. Plasma adrenocorticotropin, cortisol, and DHEAS levels were determined at 2.00, 8.00, 14.00, 20.00 h in all subjects and their mean values were computed. Cortisol/DHEAS ratios (C/Dr) were also calculated. Bilateral impairment of SPECT hippocampal perfusion was observed in AD patients as compared to controls. Mean cortisol levels were significantly increased and DHEAS titers were lowered in patients with AD, as compared with controls. C/Dr was also significantly higher in patients. Using a stepwise procedure for dependent SPECT variables, the variance of hippocampal perfusional data was accounted for by mean basal DHEAS levels. Moreover, hippocampal SPECT data correlated directly with mean DHEAS levels, and inversely with C/Dr. These data show a relationship between hippocampal perfusion and HPAA function in AD. Decreased DHEAS, rather than enhanced cortisol levels, appears to be correlated with changes of hippocampal perfusion in dementia.

Evidence of cerebral hypoperfusion in scleroderma patients.

OBJECTIVES: To investigate regional cerebral blood flow by (99m)Tc-hexamethylpropylenamineoxime (HMPAO) single photon emission computed tomography (SPECT) in a series of 40 patients (mean age 58.5+/-11.5 yr) affected by systemic sclerosis (SSc) in comparison with age-matched healthy controls. METHODS: Subjects affected by concomitant severe pathologies that might interfere with the interpretation of the SPECT results were excluded. SPECT findings were correlated with the severity of peripheral microvascular involvement, as assessed by nailfold videocapillaroscopy (NVC). Whenever possible, patients underwent magnetic resonance imaging (MRI) of the brain. RESULTS: Twenty-one SSc patients (52%) showed hypoperfusion in two or more regions of interest (ROIs) at the SPECT analysis. MRI was available in 14 of these patients, and was shown to be altered in eight of them (57%). One patient with both abnormal SPECT and abnormal MRI was affected by mild cognitive impairment. Transcranial Doppler sonography was normal in all but one of these patients with hypoperfusion. Nineteen patients exhibited a normal brain SPECT scan, but the MRI was shown to be altered in 3/12 of them (25%). No significant differences were found between the group of SSc patients showing hypoperfusion and those showing a normal SPECT scan regarding age, the duration of disease, the presence of vascular risk factors or damage of other organs typically involved in the disease, and the severity of peripheral microvascular involvement (NVC). CONCLUSIONS: Focal or diffuse cerebral hypoperfusion was found in more than half of the neurologically asymptomatic SSc patients studied, paralleling the incidence of altered brain MRI. The hypoperfusion was not linked to ageing and possibly reflects the cerebral location of the microangiopathic process characterizing the disease.

Usefulness of transdermal clonidine in hypertensive patients undergoing minor surgical operations.

Transdermal clonidine (TTSC) treatment was evaluated in 29 patients with mild to moderate hypertension scheduled for minor surgery. Two weeks before the scheduled operation, patients underwent 24-h ambulatory blood-pressure monitoring (ABPM) to evaluate the efficacy of previous oral antihypertensive treatment, which was then substituted with TTSC, 0.1 mg/day. After 1 week, the efficacy of TTSC was clinically assessed, and the dose increased to 0.2 mg/day if needed. ABPM was repeated 2 days before the scheduled operation and 2 days after surgery. The 24-h blood pressure (BP) and heart rate (HR) profiles were smoothed by Fourier analysis. Three patients withdrew for adverse events and one for inefficacy after dose adjustment, TTSC being effective in the remaining 25 patients. Two patients who completed treatment lacked postsurgical ABPM recording. In the 23 patients with all ABPM recordings, average 24-h BP and HR obtained preoperatively during TTSC treatment were slightly reduced compared with values recorded during previous oral therapy. BP changes after surgery were negligible, whereas HR showed a moderate increase. Minor adverse events occurred in four (14%) of 29 patients. Our results demonstrate that TTSC provides adequate BP control in patients with mild to moderate hypertension undergoing minor surgery.