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The Double Asteroid Redirection Test (DART) had an impact with Dimorphos (a satellite of the asteroid Didymos) on 26 September 20221. Ground-based observations showed that the Didymos system brightened by a factor of 8.3 after the impact because of ejecta, returning to the pre-impact brightness 23.7 days afterwards2. Hubble Space Telescope observations made from 15 minutes after impact to 18.5 days after, with a spatial resolution of 2.1 kilometres per pixel, showed a complex evolution of the ejecta3, consistent with other asteroid impact events. The momentum enhancement factor, determined using the measured binary period change4, ranges between 2.2 and 4.9, depending on the assumptions about the mass and density of Dimorphos5. Here we report observations from the LUKE and LEIA instruments on the LICIACube cube satellite, which was deployed 15 days in advance of the impact of DART. Data were taken from 71 seconds before the impact until 320 seconds afterwards. The ejecta plume was a cone with an aperture angle of 140 ± 4 degrees. The inner region of the plume was blue, becoming redder with increasing distance from Dimorphos. The ejecta plume exhibited a complex and inhomogeneous structure, characterized by filaments, dust grains and single or clustered boulders. The ejecta velocities ranged from a few tens of metres per second to about 500 metres per second.
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The gravity harmonics of a fluid, rotating planet can be decomposed into static components arising from solid-body rotation and dynamic components arising from flows. In the absence of internal dynamics, the gravity field is axially and hemispherically symmetric and is dominated by even zonal gravity harmonics J2n that are approximately proportional to qn, where q is the ratio between centrifugal acceleration and gravity at the planet's equator. Any asymmetry in the gravity field is attributed to differential rotation and deep atmospheric flows. The odd harmonics, J3, J5, J7, J9 and higher, are a measure of the depth of the winds in the different zones of the atmosphere. Here we report measurements of Jupiter's gravity harmonics (both even and odd) through precise Doppler tracking of the Juno spacecraft in its polar orbit around Jupiter. We find a north-south asymmetry, which is a signature of atmospheric and interior flows. Analysis of the harmonics, described in two accompanying papers, provides the vertical profile of the winds and precise constraints for the depth of Jupiter's dynamical atmosphere.
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INTRODUCTION: Alcohol is an important factor weighting towards global disease burden, premature death and Disability-Adjusted Life Years. This study examines the burden imposed on the Borgo Trento Verona Hospital Emergency Department (ED) Italy by patients with Acute Alcohol Intoxication (AAI). METHODS: A 6-year retrospective study was performed by reviewing medical records in all patients (≥ 16 years old) diagnosed with AAI. Clinical criteria for inclusion in the sample followed those defined in the "Alcohol Intoxication Symptoms" section of DSM-IV-TR. Ambiguous cases presenting traumas potentially related to AAI were confirmed positive using a Blood Alcohol Level (BAL) test before inclusion in the sample. Socio-demographic data, case history, timing of admission/discharge and outcome were collected for each patient. RESULTS: One thousand five hundred forty-seven patients (males:females = 6.6:1) were included in the study. With regard to marital status, the crude rate within the sample shows that single and married subjects have a significantly higher prevalence (p < 0.01). When demographic data of residents was taken into consideration, divorced/separated and single categories were significantly more represented (p < 0.05). The admissions appeared fairly constant throughout the week with a higher prevalence of patients aged between 25-55 years, and a significant peak of the youngest age class on weekends. Higher rates of admission were recorded during the late afternoon and night. The triage code of admission appeared uniformly distributed along the week, with the highest prevalence of green code (67.7%), followed by yellow one (25.8%). The analysis of clinical symptoms and BAL highlights that moderate clinical severity concerns almost 50%, and clinically critical severity the 6.6% of cases of access. Admissions rates of foreign patients resulted to be 3 times higher compared to those of natives when adjusted to demographic data. DISCUSSION: Social disadvantages such as foreign provenance and social difficulties as unemployment, low money intake, perception of loneliness, and dysfunction in family life were frequently identified in the sample. An exception was found within the youngest age group, where the AAI are mostly related to alcohol abuse during social outings over the weekend. EDs play a crucial role in helping patients with AAI, but prevention of alcohol abuse though implementation of social and sanitary health policies on all ages (but especially among the youngest) is essential.
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BACKGROUND: In the literature, chronic groin pain (i.e. lasting >3 months) occurs in about 10 % of patients who undergo inguinal hernioplasty with prosthesis; it is characterized by a broad range of symptoms, and is relative to individual perceptions of pain. In 2-5 % of cases, the painful symptomatology is so intense that it interferes with daily activities, and can be debilitating in 0.5-6 % of cases. The best known cause of inguinodynia is neuropathy, due to implication of one or more inguinal nerves (iliohypogastric, ilioinguinal, and genitofemoral nerves) into fibroblastic processes; or from nervous stimulation caused by prosthetic material on adjacent nervous trunks. Many therapeutic strategies have been proposed to treat chronic groin pain, including intra-operative prophylactic neurectomy. OBJECTIVE: The purpose of our study was to perform a comparative analysis between outcomes from wide resections of inguinal nerves versus those from simple nervous section (or minimal resection). PATIENTS AND METHODS: We considered 350 patients who had undergone inguinal prosthetic hernioplasty with Trabucco's technique between 2004 and 2010. Wide nervous resection (removal of nerve segments 3-8 cm in length) was performed in 180. The other 170 patients underwent simple section or minimal resection. All patients were checked 1 week, 1 month, and 1 year after surgery. RESULTS: Group 1: At 1-week follow-up, 63 patients (35 %) reported no pain, 113 (63 %) reported moderate pain, and 4 (2 %) intense pain; 1 month after the procedure, 152 patients (84.4 %) reported no pain, 25 (14 %) complained of moderate pain, and 3 (1.6 %) of severe pain; 1 year after surgery, only 1 patient (0.5 %) complained of constant pain. Group 2: At 1 week follow-up, 48 patients (28 %) reported no pain, 101 (59 %) reported moderate pain, and 21 (13 %) intense pain; 1 month after the procedure, 81 patients (47.6 %) had no pain, 72 (42.4 %) complained of moderate pain, and 17 (10 %) of severe pain; 1 year after surgery, 11 patients (6.5 %) had constant pain, and two of them were re-admitted for surgery. The lower incidence of chronic pain after long nervous resection is statistically significant (0.5 vs. 6.5 %; p = 0.006); the incidence of moderate pain 1 month after operation is also lower (14 vs. 42.4 %; p < 0.0001); patients who underwent a long resection experienced faster resolution of pain symptomatology, during a month. Also noteworthy is the lower incidence of intense pain in the short and medium term (after 1 week, 13 vs. 2 %, p = 0.0005; after 1 month, 10 vs. 1.6 %, p = 0.0018). CONCLUSIONS: The prophylactic wide resection of selected segments of inguinal nerves, despite the apparent paradox of greater tissue damage, appears more effective than simple section at preventing postoperative inguinodynia, given both the lower incidence and the faster resolution of painful symptomatology.
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Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Canal Inguinal/inervação , Canal Inguinal/cirurgia , Procedimentos Neurocirúrgicos , Dor Pós-Operatória/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Método Simples-CegoRESUMO
AIM: Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic gallstones disease. Despite surgeon's expertise and laparoscopic technical skills, at times conversion to open laparotomy is still required to carry out safely the surgical procedure. In such cases, we still pursue a minimally invasive approach based on a very short subcostal laparotomy supported by laparoscopic magnification of the reduced surgical field. We named the procedure Minimally Invasive Video-Assisted Cholecystectomy (MIVAC). In the setting of a truly minimal laparotomy, the implementation of a laparoscope makes the difference in terms of improving observation respect to naked eye, providing both details' magnification and deep field illumination. METHODS: Between 2003 and 2010, 1054 LC were performed at a single institution. Seventy-two LC were converted to open laparotomy (6.83%). Reasons for conversion included technical difficulties, aberrant biliary anatomy, dense scarring related to severe cholecystitis, biliary injuries and significant operative bleeding. Our primary endpoint was to evaluate the level of post-operative discomfort along with patient satisfaction from an aesthetic standpoint. RESULTS: Postoperative pain was comparable to LC while subcuticular running sutures ensured acceptable cosmetic results. Medium hospital stay was 24 hours. Both operative and recovery times were comparable to LC and postoperative liver function tests and routine labs did not differ significantly from the preoperative checks. CONCLUSION: The "so called" MIVAC approach appears to be a valid alternative to traditional open cholecystectomy whenever conversion to laparotomy becomes mandatory during the course of LC.
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Colecistectomia Laparoscópica , Conversão para Cirurgia Aberta , Cirurgia Vídeoassistida , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodosRESUMO
Retrospective study in a toxicological unit care (TUC) performed to know the epidemiology of acute intoxication (AI) in Verona (Italy) during years 2008-2009. All data regarding patients with a diagnosis of certain/suspected AI were collected and evaluated: some demographic information, the characteristics of the agent involved, the pattern of exposure, the triage at the admission to TUC and the outcome. 244 cases were analyzed: 45.9% males and 54.9% females, mean age respectively 45.1 and 43.9 years. The monthly distribution of admitted patients resulted fairly constant, except from a light rising prevalence in autumn, with a majority of yellow (45.9%) and green (43.4%) triage code. The pattern of exposure resulted: ingestion (82.7% of cases; age peaks: 18-34 and 35-51 years old; mostly due to food (as mushrooms), drinks, detergents, soap, pharmaceutical, drugs of abuse, caustics substances), contact (10.2% of cases; age peak 18-51) and inhalation (6.9% of cases). In 17.2% of cases the poisoning exposure was intentional. In 63.5% the patients were sent to their general practitioners (45.5% of the yellow and 81.1% of the green coded patients) and in 22.1% of cases they were admitted to clinical rooms (44.6% of the yellow coded patients). In most cases the triage code assigned to the studied patients resulted yellow and green. Considering that the seriousness of the symptoms can appear after several hours from the exposure to toxic substances, a quick and specific intervention to obtain the best therapeutical effectiveness is suitable, in order to save lives or to avoid irremediable health damages.
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Cuidados Críticos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Intoxicação/epidemiologia , Doença Aguda , Adulto , Distribuição por Idade , Cáusticos/intoxicação , Etanol/intoxicação , Feminino , Humanos , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Praguicidas/intoxicação , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Distribuição por Sexo , Tentativa de Suicídio/estatística & dados numéricos , Toxicologia/estatística & dados numéricos , Adulto JovemRESUMO
The interior structure of Saturn, the depth of its winds, and the mass and age of its rings constrain its formation and evolution. In the final phase of the Cassini mission, the spacecraft dived between the planet and its innermost ring, at altitudes of 2600 to 3900 kilometers above the cloud tops. During six of these crossings, a radio link with Earth was monitored to determine the gravitational field of the planet and the mass of its rings. We find that Saturn's gravity deviates from theoretical expectations and requires differential rotation of the atmosphere extending to a depth of at least 9000 kilometers. The total mass of the rings is (1.54 ± 0.49) × 1019 kilograms (0.41 ± 0.13 times that of the moon Mimas), indicating that the rings may have formed 107 to 108 years ago.
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This paper presents the design and the experimental results of a CMOS Automatic Control System (ACS) for the biasing of High-Electron-Mobility-Transistors (HEMT). The ACS is the first low-power mixed-signal Application-Specified-Integrated-Circuit (ASIC) able to automatically set and regulate the operating point of an off-chip 6 HEMT Low-Noise-Amplifiers (LNAs), hence it composes a two-chip system (the ACS+LNAs) to be used in the Large Scale Polarization Explorer (LSPE) stratospheric balloon for Cosmic Microwave Background (CMB) signal observation. The hereby presented ACS ASIC provides a reliable instrumentation for gradual and very stable LNAs characterization, switching-on, and operating point (<4 mV accuracy). Moreover, it simplifies the electronic instrumentation needed for biasing the LNAs, since it replaces several off-the-shelf and digital programmable device components. The ASIC prototype has been implemented in a CMOS 0.35 µm technology (12 mm2 area occupancy). It operates at 4 kHz clock frequency. The power consumption of one-channel ASIC (biasing one LNA) is 3.6 mW, whereas 30 mW are consumed by a single LNA device.
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BACKGROUND: Chronic post-operative inguinodynia occurs in about 10 % of patients undergoing inguinal hernioplasty with prosthesis; it is characterized by a broad pleomorphism of symptoms, including relative to individual variability of algic perception. Its intensity can also potentially jeopardize patient's work and social activities. The most notorious cause of inguinodynia is neuropathy, resulting from the involvement of one or more inguinal nerves (iliohypogastric, ilioinguinal and genitofemoral nerves) in fibroblastic processes, or from nervous stimulation, caused by prosthetic material on adjacent nervous trunks. The aim of our study was to provide a comparative analysis between outcomes of wide nerve resection vs. nerve sparing. PATIENTS AND METHODS: In our hospital, between 2000 and 2010, 600 patients underwent monolateral prosthetic inguinal hernia repair, using the original Trabucco technique. In 345 cases, to avoid chronic post-operative pain, we carried out intentional neurectomy, between 3 and 8 cm in length of either the main and/or peripheral branches of the iliohypogastric nerve, ilioinguinal nerve and the genital branch of the genitofemoral nerve, deemed at risk of entrapment because of the prosthetic material. In the control group, which included the other 255 patients, nerves were identified and spared. Follow-up was scheduled at 1 week, 1 month and 1 year after surgery. CASE: 1 week after the operation, 135 patients (39.1 %) did not show pain, 201 (58.3 %) reported moderate pain and 9 (2.6 %) showed intense pain; 1 month after the procedure, 300 patients (87 %) did not have pain, 39 (11.3 %) complained of moderate pain and 6 (1.7 %) demonstrated severe pain; 1 year after surgery, only two patients (0.6 %) complained of persistent pain. CONTROL: At the 1-week follow-up, 114 patients (44.7 %) did not show pain, 111 (43.5 %) reported moderate pain and 30 (11.8 %) intense pain; 1 month after the procedure, 183 patients (71.8 %) did not have pain, 45 (17.6 %) complained of moderate pain and 27 (10.6%) showed severe pain; 1 year after surgery, 11 patients (4.3 %) had persistent pain, and two of them were re-submitted to surgery. The lower incidence of chronic pain after nerve resection is statistically significant (0.6 vs. 4.3 % p = 0.0048); the incidence of moderate pain 1 month after the operation is also lower (11.3 vs. 17.6 % p = 0.0097). In addition, among patients subjected to nerve resection there is a faster resolution of algetic symptomatology, over the course of a month; also noteworthy is the lower incidence of intense pain in the short-and medium-term (after 1 week, 11.8 vs. 2.6 % p = 0.0006 ; after 1 month, 10.6 vs. 1.7 % p < 0.0001). CONCLUSIONS: Despite the apparent paradox of an higher tissue damage, elective neurectomy of selected segments of inguinal nerves, appears an effective technique in preventing chronic postherniorraphy pain, considering both the lower incidence and the faster resolution of painful symptomatology.
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Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Neuralgia/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Nervos Periféricos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Dor Crônica/prevenção & controle , Feminino , Virilha , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversos , Adulto JovemRESUMO
Effects of picotamide (900 mg in 3 oral administrations for 7 days) on ex vivo and in vivo platelet TxA2 production and on platelet aggregation were evaluated in 8 patients with peripheral arteriopathy and in 8 normal subjects. Picotamide significantly reduced ADP-induced platelet aggregation, but had no effect on that induced by arachidonic acid or the thromboxane analogue U46619. Though ex vivo platelet TxA2 production (TxB2 concentration after arachidonic-acid-induced aggregation) was reduced from 946 +/- 141 (mean +/- SD) to 285 +/- 91 ng/ml in controls and from 1515 +/- 673 to 732 +/- 420 ng/ml in patients with arteriopathy, there was no effect on urinary excretion of 2,3-dinor-TXB2 (in vivo indicator of platelet TxA2 production), or on in vivo PGI2 production (urinary excretion of 6-keto-PGF1 alpha and 2,3-dinor-6-keto-PGF1 alpha). In the same subjects, single-dose aspirin reduced ex vivo TxB2 production by at least 98% and 2,3-dinor-TxB2 excretion from 116.7 +/- 61.4 to 32.6 +/- 17.0 ng/g creatinine in control subjects, and from 156.3 +/- 66.1 to 59.1 +/- 19.2 ng/g creatinine in patients with peripheral arteriopathy. Our data suggest that inhibition of platelet TxA2 production in vivo may not be picotamide's main mechanism of action.
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Ácidos Ftálicos/farmacologia , Inibidores da Agregação Plaquetária , Tromboxano A2/biossíntese , Idoso , Arteriosclerose Obliterante/sangue , Arteriosclerose Obliterante/urina , Epoprostenol/urina , Humanos , Masculino , Pessoa de Meia-Idade , Tromboxano A2/sangue , Tromboxano A2/urinaRESUMO
A patient underwent a subtotal resection of the tracheobronchial carina for an obstructing endobronchial lesion. Preoperative biopsies of the lesion were not diagnostic. After resection, the histological examination of the specimen removed demonstrated an extramedullary plasmacytoma infiltrating the bronchial wall. Immunohistochemical studies showed monoclonality for kappa light chains. The postoperative course was uneventful and the screening for multiple myeloma was negative. No adjuvant treatment was given and the patient is currently alive and free of disease 63 months after the resection. Primary endobronchial plasmacytoma is a very rare disease: it is unclear which is the best treatment for endobronchial plasmacytoma. However, complete surgical resection has allowed a long-term survival, free of disease.
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Neoplasias Brônquicas , Plasmocitoma , Idoso , Neoplasias Brônquicas/metabolismo , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/cirurgia , Humanos , Cadeias Leves de Imunoglobulina/metabolismo , Imuno-Histoquímica , Masculino , Plasmocitoma/metabolismo , Plasmocitoma/patologia , Plasmocitoma/cirurgiaRESUMO
We report a case of benign multicystic mesothelial proliferation (the so-called multicystic peritoneal mesothelioma) arising multifocally in the abdomen of a 46-year-old white man. His anamnesis showed an 8-year history of intermittent pain in the right lower abdominal quadrant. Mucin stains, immunohistochemistry, and electron microscopy confirmed the mesothelial origin of the lesion. Review of the available literature allowed us to find another 85 reported cases of benign multicystic mesothelial proliferations of the peritoneum. Out of these cases, eighteen only occurred in men, the majority being reported in middle-aged women mostly with complaints of abdominal pain. Electron microscopy or immunohistochemistry are needed to make a differential diagnosis towards other multicystic lesions, such as peritoneal cystic lymphangioma. Although multicystic mesothelial proliferations of the peritoneum have often been regarded as benign neoplasms, the true nature--neoplastic or hyperplastic--of these lesions still remains greatly elusive. Therefore, we believe that the unbinding term benign multicystic mesothelial proliferation (first used with regard to the unique hitherto reported case arisen in the pleural cavity) should be considered at present more appropriate to indicate even these peritoneal lesions.
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Cistos/patologia , Mesotelioma/patologia , Neoplasias Peritoneais/patologia , Dor Abdominal , Actinas/análise , Cistos/ultraestrutura , Humanos , Imuno-Histoquímica , Queratinas/análise , Masculino , Mesotelioma/ultraestrutura , Pessoa de Meia-Idade , Neoplasias Peritoneais/ultraestruturaRESUMO
Intracellular platelet pH was studied by the BCECF fluorescent pH-sensitive intracellular indicator method in 52 patients with essential hypertension and 42 control subjects of similar age and sex. In 40 hypertensive patients studied by oral glucose tolerance test (standard OGTT) 23 presented with pathological blood glucose and plasma insulin values. Intracellular pH was on average higher in hypertensives (7.415 +/- 0.114, mean +/- SD) than in controls (7.348 +/- 0.109, P < 0.05), although there was a considerable overlap in values. In the group of hypertensive patients, no difference was observed between those with normal and those with pathological OGTT. There was also no significant correlation between intracellular pH and blood glucose, plasma insulin after OGTT, plasma cholesterol and triglycerides, age, BP or body mass index. These data are consistent with an anomaly of intraplatelet pH, perhaps owing to alteration of Na+/H+ exchange in essential hypertension, but do not indicate that this is related to a condition of hyper-insulinaemia or insulin resistance.
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Plaquetas/fisiologia , Glucose/metabolismo , Hipertensão/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hipertensão/metabolismo , Líquido Intracelular/fisiologia , Masculino , Pessoa de Meia-IdadeRESUMO
The effects of 14-day physical exercise or iloprost treatment (0.5-2 ng/Kg/min) on endogenous nitric oxide production and neutrophil adhesion were evaluated in 20 patients with peripheral arterial occlusive disease (Fontaine Stage II). Peripheral venous blood samples and 4-h urine samples were collected before, immediately after 14 days of therapy and 7-10 days after therapy in order to evaluate neutrophil adhesion, nitrite/nitrate and cGMP excretion rates. A longer pain free walking distance was observed after exercise, compared to iloprost (>500 m in 3/10 subjects). Urinary nitrite/nitrate, as well as cGMP concentrations, significantly increased after exercise. Nitrite/nitrate excretion rate inversely correlated to neutrophil adhesion. No variations were observed in these parameters in iloprost treated patients. The improvement in claudication and the transient increase in urinary nitrite/nitrate suggest a possible nitric oxide-dependent mechanism for the clinical efficacy of physical exercise. The results from the present and previous observations indicate that, besides pharmacological treatments, a regular aerobic exercise improves peripheral arterial occlusive disease.
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Arteriopatias Oclusivas/metabolismo , Arteriopatias Oclusivas/fisiopatologia , Terapia por Exercício , Óxido Nítrico/biossíntese , Doenças Vasculares Periféricas/metabolismo , Doenças Vasculares Periféricas/fisiopatologia , Idoso , Arteriopatias Oclusivas/terapia , Adesão Celular/efeitos dos fármacos , Humanos , Iloprosta/uso terapêutico , Infusões Intravenosas , Pessoa de Meia-Idade , Ativação de Neutrófilo/efeitos dos fármacos , Neutrófilos/efeitos dos fármacos , Nitratos/urina , Óxido Nítrico/metabolismo , Nitritos/urina , Doenças Vasculares Periféricas/terapia , Vasodilatadores/uso terapêuticoRESUMO
BACKGROUND: Bronchopulmonary manifestations of Crohn disease have been rarely described in children, including both subclinical pulmonary involvement and severe lung disease. CASE PRESENTATION: A 6.5-year-old girl is described with early recurrent bronchopulmonary symptoms both at presentation and in the quiescent phase of Crohn disease. Pulmonary function tests (lung volumes and flows, bronchial reactivity and carbon monoxide diffusing capacity) were normal. Bronchoalveolar cytology showed increased (30%) lymphocyte counts and bronchial biopsy revealed thickening of basal membrane and active chronic inflammation. CONCLUSIONS: Clinical and histological findings in our young patient suggest involvement of both distal and central airways in an early phase of lung disease. The pathogenesis of Crohn disease-associated lung disorders is discussed with reference to the available literature. A low threshold for pulmonary evaluation seems to be advisable in all children with CD.
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Broncopneumonia/etiologia , Doença de Crohn/complicações , Biópsia , Brônquios/patologia , Broncopneumonia/diagnóstico por imagem , Criança , Colo/patologia , Feminino , Humanos , Pulmão/diagnóstico por imagem , RadiografiaRESUMO
BACKGROUND: To assess the agreement between a new automatic device (FS-20D) using a cuff-oscillometric method to measure arterial blood pressure (BP) in the fingers and a standard mercury sphygmomanometer. METHODS: The blood pressure measurements were taken in a sequential order, in a sample of both normotensive subjects (n. 57) and slight to moderate hypertensive patients (n. 28) without vascular complications. RESULTS: The mean sphygmomanometer-monitor difference was 0.52 +/- 4.57 mmHg for systolic and 0.25 +/- 4.41 mmHg for diastolic values; the agreement limits were: SBP -8.6 divided by 9.6 mmHg, 95% CI: -0.5 divided by 1.5; DBP: -8.6 divided by 9.1 mmHg, 95% CI: -0.7 divided by 1.2. The grade of agreement between the monitor and the sphygmomanometer was "A" (British Hypertension Society) for both systolic and diastolic values (difference of readings < 5 mmHg: 82%; < 10 mmHg: 97% for systolic blood pressure, 98% of diastolic blood pressure). CONCLUSIONS: The monitor was proved to be reliable with a good level of precision and accuracy. The FS-20D monitor may be used in self-monitoring of blood pressure of patients with slight to moderate hypertension.
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Determinação da Pressão Arterial/métodos , Monitores de Pressão Arterial , Dedos/irrigação sanguínea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , EsfigmomanômetrosRESUMO
OBJECTIVE: To evaluate the modifications induced by chronic treatment with a new formulation of nicardipine (slow release) on the hemodynamic parameters in peripheral artery and left ventricle diastolic function. MATERIALS AND METHODS: Ten mild to moderate essential hypertensive male patients (mean age 42 years, range 32-54 years) received nicardipine slow release (40 mg b.i.d.) for six months. Peripheral hemodynamic and cardiac parameters were evaluated by duplex scanner, coupled with a plethysmographic method, basally (T0) and after 1 (T1) and 6 months' treatment (T2). RESULTS: Blood pressure showed a significant reduction after 1 month (mean blood pressure 109 +/- 2 vs 124 +/- 3 mmHg, M +/- SE, p < 0.001), which was maintained after 6 months (mean blood pressure 112 +/- 3 mmHg, p < 0.001), while heart rate showed only a slight, non-significant increase. There were highly significant changes in distensibility (0.29 +/- 0.02 vs 0.16 +/- 0.01 s2.cm-2, T2 vs T0, p < 0.001), characteristic impedance (55 +/- 3 vs 78 +/- 3 dyn.s.cm-5.10(2), T2 vs T0, p < 0.001) and local resistances (71 +/- 5 vs 118 +/- 4 mmHg.ml-1. s, T2 vs T0, p < 0.001) in the brachial artery, and also in left ventricle posterior wall diastolic thickness (10.2 +/- 0.4 vs 11.5 +/- 0.3 mm, T2 vs T0, p < 0.05), end diastolic volume (127 +/- 3 vs 109 +/- 3 ml, T2 vs T0, p < 0.01) and mass/volume index (1.21 +/- 0.03 vs 1.35 +/- 0.03, p < 0.05). CONCLUSIONS: The antihypertensive efficacy of nicardipine slow release, with only two daily administrations, allows the restoration of the dumping function of the large arteries, and the regression of the functional modifications affecting the left ventricular diastole.
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Antebraço/irrigação sanguínea , Hemodinâmica/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Nicardipino/administração & dosagem , Função Ventricular Esquerda/efeitos dos fármacos , Adulto , Preparações de Ação Retardada , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Iloprost therapy for severe peripheral obstructive arterial disease (POAD) has demonstrated to be effective in reducing the need for amputation. However the feasibility of a 28-day infusion regimen in less severe stages of the disease is poor due to the length in hospital stay. A randomized, controlled, parallel-group pilot study was carried out with the aim to evaluate clinical and circulatory effects of Iloprost, a stable prostacyclin analogue, administered with two different infusion schedules to patients with POAD at Leriche Fontaine stage III. METHODS: Twenty patients 16 males and 4 females, mean age 66 +/- 6 years) with objective signs of POAD, rest pain for at least two weeks and posterior tibial artery pressure > 50 mmHg, were randomized to either Iloprost i.v. infusion up to 2 ng/Kg/min for 6/h/day for 28 days (Group A) or to Iloprost i.v. infusion up to 1.5 ng/Kg/min for 16/h/day for 7 days (Group B). At baseline (before starting first infusion) after 7 days (for group B only, end of therapy) and after 28 days (end of therapy for Group A, end of study for Group B) the following parameters were evaluated: walking distance, rest pain and analgesic consumption, plethysmographyc parameters (first flow, peak flow and peak flow time) and laser Doppler parameters (rest flow, post ischemic flow). RESULTS: After 28 days, both Iloprost infusion schedules increased walking capacity (maximum walking distance/pain free walking distance +119/+84% +199/+85% respectively, for Group A and B respectively) reduced ischemic pain (-45% and -48% respectively for Group A and B) and analgesic consumption and improved plethysmographyc and laser Doppler parameters. Tolerability seemed to be better in Group B, suggesting that the lower dose and the shorter duration of the therapy period might result in reduced incidence of headache thus, in principle, increasing patient acceptability. CONCLUSIONS: The results of this pilot study, if confirmed by larger trials, could have important positive implications in terms of costs, patient comfort and management.
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Arteriopatias Oclusivas/tratamento farmacológico , Iloprosta/uso terapêutico , Doenças Vasculares Periféricas/tratamento farmacológico , Vasodilatadores/uso terapêutico , Idoso , Arteriopatias Oclusivas/fisiopatologia , Teste de Esforço , Feminino , Humanos , Iloprosta/efeitos adversos , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/fisiopatologia , Vasodilatadores/efeitos adversosRESUMO
In a randomized, placebo-controlled, crossover study, 15 ambulatory patients with Raynaud's phenomenon, treated for three weeks with ketanserin 80 mg/day and pentoxiphylline 1,200 mg/day, were evaluated by subjective symptom scores, daily frequency and duration of attacks, and photoplethysmography, at room temperature and after cold test. Reduced subjective symptoms and duration of attacks, together with improved cold test plethysmography, were significant only after ketanserin. All subjective symptom scores also improved after ketanserin but only for cyanosis and paresthesia after pentoxiphylline. Excellent results were obtained in 4 cases after ketanserin and in 1 case with pentoxiphylline. The authors discuss the greater importance of antivasospastic action over antiaggregating and hemorheologic effects in Raynaud's phenomenon therapy, as well as the pathogenetic role of serotonin.
Assuntos
Ketanserina/uso terapêutico , Pentoxifilina/uso terapêutico , Doença de Raynaud/tratamento farmacológico , Teobromina/análogos & derivados , Adulto , Ensaios Clínicos como Assunto , Feminino , Mãos/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Pletismografia , Distribuição Aleatória , Doença de Raynaud/fisiopatologia , Fluxo Sanguíneo Regional/efeitos dos fármacosRESUMO
After a two-week washout (WO) period with placebo 1 capsule/bid, 12 patients suffering from stable Raynaud's phenomenon were treated with ketanserin (K) 40 mg/bid for fifteen days. Blood pressure, heart rate, and laboratory parameters were evaluated at the end of each period. Patients used diary cards to record the number, duration, and intensity of attacks. Computerized thermometry of the fingers was evaluated at basal temperature after acclimatization, 23 degrees C for thirty minutes; after cold test, 10 degrees C for five minutes; and after thermal recovery, 23 degrees C for eighteen minutes. Results were analyzed statistically by use of Student's t-test for paired data (p less than 0.05). No marked changes were observed in the symptoms of the attacks, but K proved effective in significantly reducing the number and duration of daily attacks and in promoting their spontaneous regression. Thermometry revealed a parallel increase in temperatures, particularly basal and recovery values. The data suggest increased flow and decreased vasospasm following 5-HT2 receptor blockade.