24-hour leg and forearm haemodynamics in transected spinal cord subjects.

OBJECTIVE: A circadian rhythm of blood pressure has been demonstrated both in subjects who are physically active during the day and in those confined to bed. The study of the circadian rhythm of arterial flow and peripheral resistance, on the other hand, is limited to pioneer experiments. This paper is aimed at demonstrating that leg peripheral resistance has circadian fluctuations which are modulated by spinal neural traffic. METHODS: Eleven normal (able-bodied) human subjects and 11 patients with spinal transection due to spinal cord injury (SCI) were studied. They were confined to bed for 24 h. Blood pressure and heart rate were monitored every 15 min with an automatic device and leg flow with an automatic strain-gauge plethysmograph synchronised to the pressurometer. Peripheral resistance was calculated at the same intervals. RESULTS: In able-bodied subjects leg resistance was significantly higher during waking hours (when the sympathetic system is more activated) than during sleep, while in subjects with spinal cord injury no difference was detected between day-time and night-time. CONCLUSIONS: The circadian rhythm is controlled by adrenergic fibres transmitted via the spinal cord.

Lack of effect of vitamin B-6 supplementation on the lipoprotein profile of post-menopausal chronic hemodialysis patients.

This study was designed to analyze the effect of vitamin B-6 supplementation on the lipoprotein profile of chronic hemodialysis patients. Individuals on chronic hemodialysis experience an acceleration of atherosclerosis, which is often accompanied by abnormal lipid metabolism. Although total plasma cholesterol is usually normal, high-density-lipoprotein (HDL) cholesterol is often low. Recently, it has been suggested that the development of atherosclerotic lesions in chronic hemodialysis patients may be the result of a decreased plasma concentration of pyridoxal 5'-phosphate (PLP) and concomitant alterations in plasma amino acid and/or lipoprotein profiles. All subjects in this study were supplemented with 0.97 mmol (200 mg) pyridoxine hydrochloride per day for 28 days; then, concentrations of PLP, total cholesterol, and lipoprotein cholesterol fractions were determined in the plasma. No significant difference was noted in PLP concentration between Group 1 (five post-menopausal women with a history of atherosclerosis who were undergoing maintenance hemodialysis therapy) and Group 2 (six subjects who were non-symptomatic). However, both groups had significant increases in PLP concentrations between the pre- and post-supplementation periods (p less than .01). In contrast, there was a statistically significant difference in total plasma cholesterol and very-low-density- and low-density-lipoprotein (VLDL and LDL) cholesterol concentrations between groups, but no significant changes in total cholesterol or VLDL and LDL cholesterol content were found during vitamin B-6 supplementation. No statistically significant differences in HDL, HDL2, and HDL3 cholesterol concentrations were observed between Group 1 and Group 2 subjects or within either group during vitamin B-6 supplementation.

A prospective, parallel, double-blind comparison of iodixanol and iohexol in extremity phlebography.

RATIONALE AND OBJECTIVES: A two-center, prospective, double-blind study was conducted to compare the performance parameters (efficacy, safety, and injection-associated discomfort) of iohexol with those of the new, isosmolar contrast medium iodixanol in extremity phlebography. METHODS: Ninety-nine patients from two centers, for whom venography was clinically indicated, were blindly randomized into two groups, iohexol at 300 mg I/ml (IOH 300) or iodixanol at 270 mg I/ml (IOD-270). Patient vital signs and reports of adverse events were recorded for a minimum of 1 hr and monitored until the outcome was known. Any discomfort associated with the injection was also recorded. Laboratory measures included urinalysis, creatinine levels in serum and blood urea nitrogen. RESULTS: Both contrast media provided good or excellent visualization in nearly all patients (100% of patients in the IOD-270 group and 96% in the IOH-300 group). The incidence of adverse reactions was low in both groups (8.5% in the IOD-270 group and 10% in the IOH-300 group). Injection associated discomfort lasting less than 4 min occurred in nine patients, four in the IOD-270 group and five in the IOH-300 group. Although clinically relevant changes in vital signs occurred in more than half the patients, most were judged to be anxiety related. Review of laboratory data revealed no evidence of toxicity for either agent. There was no statistically significant difference between the two agents with regard to any of these observed parameters. CONCLUSION: The data support the conclusion that both IOD-270 and IOH-300 are safe and effective agents when used for adult phlebography and are associated with little injection-site discomfort.

Determination of heroin by means of the pitch of induced cholesteric mesophases.

A method is described for the determination of chromatographic fractions of heroin and strychnine in the mug and sub-mug range by measurement of the pitch and handedness of their induced cholesteric mesophases in MBBA and Phase IV, respectively.

[Splenectomy for hematologic disease. Mini-invasive versus traditional technique]. / La splenectomia per malattie ematologiche. Tecnica mininvasiva e tradizionale.

BACKGROUND: This study aimed to compare the safety, efficacy and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with hematologic disorders. EXPERIMENTAL DESIGN: prospective study; SETTING: II Department of Surgery, Santa Maria Nuova Hospital, Reggio Emilia and III Department of Surgery, Santo Spirito Hospital Pescara; PATIENTS: 48 consecutive adult patients underwent splenectomy; 30 patients under-went LS and 18 OS. Perioperative characteristics, outcomes, complications and costs were comparatively analyzed. RESULTS: Mean age was 35.3 years in the LS group, and 40.8 in the OS group. Mean spleen size was 11.7 cm in the LS group and 15.2 cm in the OS group. Accessory spleens were found in 5 patients in the LS group and in 4 patients in the OS group; 4 conversions to laparotomy occurred in the LS group. A total of 4 complications occurred in 3 patients of the LS; 9 complications occurred in 5 patients of OS group. Mean surgical time was 141.5 minutes for LS and 89.7 minutes for OS (p<0.005). Mean postsurgical stay was 5.8 days in the LS group and 8.5 days in the OS group (p<0.005). Response rates were similar in both groups. CONCLUSIONS: LS is comparable to OS in terms of efficacy and safety and it is associated with a shorter hospital stay. LS should become the technique of choice for treatment of intractable benign hematologic disease.

Ventricular evoked response in patients with hypertrophic obstructive cardiomyopathy treated with DDD pacing.

OBJECTIVE: To assess the changes in ventricular evoked responses (VER) produced by the decrease in left ventricular outflow tract gradient (LVOTG) in patients with hypertrophic obstructive cardiomyopathy (HOCM) treated with dual-chamber (DDD) pacing. METHODS: A pulse generator Physios CTM (Biotronik, Germany) was implanted in 9 patients with severe drug-refractory HOCM. After implantation, the following conditions were assessed: 1) Baseline evaluation: different AV delay (ranging from 150 ms to 50 ms) were sequentially programmed during 5 to 10 minutes, and the LVOTG (as determined by Doppler echocardiography) and VER recorded; 2) standard evaluation, when the best AV delay (resulting in the lowest LVOTG) programmed at the initial evaluation was maintained so that its effect on VER and LVOTG could be assessed during each chronic pacing evaluation. RESULTS: LVOTG decreased after DDD pacing, with a mean value of 59 +/- 24 mmHg after dual chamber pacemaker, which was significantly less than the gradient before pacing (98 + 22 mmHg). An AV delay > 100 ms produced a significantly lower decrease in VER depolarization duration (VERDD) when compared to an AV delay < or = 100 ms. Linear regression analyses showed a significant correlation between the LVOTG values and the magnitude of VER (r = 0.69; p < 0.05) in the 9 studied patients. CONCLUSION: The telemetry obtained intramyocardial electrogram is a sensitive means to assess left ventricular dynamics in patients with HOCM treated with DDD pacing.

[Poland syndrome associated with Moebius syndrome]. / Sindrome di Poland associata ad una sindrome di Moebius.

We present a case of a girl with Poland's Syndrome (absence of pectoral muscle and syndactyly) associated with Moebius Syndrome. More abnormalities, especially visceral, may be associated with it and therefore the clinician must know and identify them as soon as possible. We underline the importance of a precocious correction of the hand's abnormalities in order to avoid changes in the corporal pattern otherwise not correctible later. A retard in surgical treatment will produce a failure like in our patient.

[Ileal occlusion associated with ascites following delivery]. / Association d'occlusion iléale et ascite après l'accouchement.

An ascite complicated an acute ileal obstruction in the immediate post-partum period. The basal hormonal condition and a pharmacological treatment with synthetic oxytocin have to be considered as important etiological factors.

[Influence of transcutaneous stimulation (TENS) of the posterior tibial nerve on various cysto-manometric parameters in patients with neurologic bladder. Initial data on 6 patients]. / Influenze della stimolazione transcutanea (TENS) del tibiale posteriore su alcuni parametri cistomanometrici in pazienti con vescica neurologica. Primi dati su sei pazienti.

The authors report about their first study of the detrusor activity modifications induced by electrical stimulation of the posterior tibial nerve in six patients with neurogenic bladder. The results suggest that this new application inhibit detrusor activity.

[Therapy of shock]. / Terapia dello shock.

Shock therapy is a problem which readily leads to considerations of a practical nature. Routine clinical experience is the basis for all evaluations of results. Drugs, doses, therapeutical tactics are of value only in so far as experience has successfully made use of them.

Modification of respiratory function parameters in patients with severe Parkinson's disease.

Respiratory dysfunction remains one of the most common causes of death in patients with complicated Parkinson's disease (PD). The aim of this study was to investigate pulmonary function in fluctuating PD patients during "on" and "off" states of the disease. We studied 12 fluctuating, non-smoking PD patients (H&Y stages 3-5) without a history of lung or cardiovascular disease; all patients underwent Hoehn and Yahr scale (H&Y) and Unified Parkinson Disease Rating Scale (UPDRS items 18-31) to evaluate extrapyramidal impairment, as well as pulmonary function tests (PFT) and arterial blood gas analyses to assess respiratory function. All evaluations were performed during a stable on state of disease and in an off state produced by 12 hours of therapy withdrawal. A restrictive pattern of flow-volume loop was observed both in on and off states of disease. In the off state, we found a significant worsening in both FEV1 and FVC; the FEV1/FVC ratio was unmodified. These results suggest a restrictive pattern of flow-volume loop in these patients.

Primary lymphoma of the spleen. Report of a case with diagnosis by fine-needle guided biopsy.

Primary splenic lymphoma is a relatively infrequent disease; the diagnosis of this entity is currently made with splenectomy. In a 52-year-old female with left upper quadrant abdominal pain, ultrasound showed a normal-sized spleen with an internal hypoechoic focal lesion. Ultrasonically-guided fine-needle aspiration and tissue core biopsy of the splenic lesion showed non-Hodgkin's lymphoma (NHL). At the time of presentation there was no evidence of involvement of lymph nodes, bone marrow or any other organ. A diagnosis of primary splenic non-Hodgkin's lymphoma was made and the patient underwent laparotomy with splenectomy. Histologic examination of the spleen confirmed the diagnosis: low-grade NHL confined to the spleen. The patient is well and in complete remission seven months after diagnosis. The purpose of this paper is to report a rare occurrence of primary splenic lymphoma and to demonstrate the possibility of making this diagnosis by percutaneous guided biopsy.