Analysis of Aortic Remodeling and Stiffness in Patients with Obstructive Sleep Apnea Syndrome: Preliminary Results.

Obstructive sleep apnea (OSA) is a well-known risk factor for cardiovascular diseases. Several studies have shown that OSA is associated with vessel remodeling, but few studies have examined aorta. AIM: to analyse aortic remodelling in OSA. METHODS: Thirty consecutive OSA patients (22 males and 8 females, aged 58.5 ± 13.2 years) were studied. All patients underwent a morning blood gas analysis, a full cardiorespiratory evaluation, including nocturnal polygraphy and echocardiography, that assessed aortic root diameter (ARD) and aortic stiffness index (ASI). Patients were grouped as follows: Group 1, non-severe OSA (Apnea-Hypopnea Index; AHI <30, 14 patients); Group 2, severe OSA (AHI ≥30, 16 patients). RESULTS: No difference was found between the groups in ARD as absolute value (Group 1, 33.64 ± 0.91 mm; Group 2, 33.64 ± 1.02, p = ns) and as normalized value for the body surface area - ARDi (Group 1, 16.72 ± 0.63 mm/m2; Group 2, 16.09 ± 0.44, p = ns). Moreover, no difference was found in the ASI (Group 1, 14.04 ± 2.26; Group 2, 13.41 ± 2.22, p = ns). Considering all OSA patients, AHI showed an inverse correlation with ARDi (p = 0.018) and ASI (p = 0.0449). Moreover, the ASI showed a direct correlation with ARDi (p = 0.01) and morning PaO2 (p = 0.0349) as well as an inverse correlation with the oxygen desaturation index (ODI, p = 0.031) and total time with apnea and hypopnea (p = 0.039). CONCLUSION: No difference was found between severe and non-severe OSA in ARD. Surprisingly, the data show that the severity of OSA correlates inversely with the ASI and ARDi. The relation between PaO2 and stiffness might be explained by a feedback mechanism that tries to overcome the reduction of aortic elasticity due to night desaturation. These findings need to be investigated in further studies with a larger study population.

Intravesical chemo-immunotherapy in non muscle invasive bladder cancer.

Non-Muscle-Invasive-Bladder-Cancer represents 75-85% of the new bladder cancer cases per year. Trans-uretral vesical resection is the milestone for diagnosis and therapy. After primary treatment, recurrence is frequent depending on the presence of several established risk factors: multiplicity, T dimension, prior recurrence. In some patients disease progress to an advanced stage. Adjuvant chemo-immunotherapy has been widely used depending on the risk category assigned on the basis of the risk factors for recurrence. In low risk categories a one shot treatment with chemotherapy is considered the standard treatment without any maintenance therapy. In intermediate risk patients, adjuvant induction therapy and maintenance chemotherapy or immunotherapy for at least one year is recommended. In high risk patients adjuvant induction and maintenance immunotherapy until 3 years is considered the best strategy. In this review data on the different drugs used in this setting will be discussed.

Cloning of a gar (Lepisosteus osseus) GH cDNA: trends in actinopterygian GH structure.

A cDNA containing the sequence of GH was cloned and sequenced from a pituitary cDNA library for the holostean fish Lepisosteus osseus (common name: gar). The gar GH cDNA contained an open reading frame of 633 nucleotides and a 3' untranslated region (including the terminal codon TAG) of 1058 nucleotides. The overall length of the gar GH cDNA including leader sequence, signal sequence, hormone sequence and 3' untranslated region was 1713 nucleotides. Thus, the gar GH cDNA is the largest vertebrate GH cDNA yet cloned. A comparison of GH sequences from ancient (holostean fishes-gar and bowfin; one chondrostean fish-the Russian sturgeon) and more modern (27 species of teleosts) members of class Actinopterygii indicate that members of this class have maintained many of the invariant residues deemed necessary for GH folding motifs (intramolecular relationships) observed in mammals.

Multicenter assessment of the QuietTrak ambulatory blood pressure recorder according to the 1992 AAMI guidelines.

To clinically evaluate the QuietTrak ambulatory blood pressure (BP) recorder (Tycos-Welch-Allyn, Arden, NC), we assessed the device according to the performance criteria set out by the 1992 Association for the Advancement of Medical Instrumentation (AAMI) guidelines. The QuietTrak is a portable, noninvasive recorder that uses an auscultatory measuring system. As recommended in the 1992 AAMI guidelines, a large, heterogeneous population was recruited for the study using three clinic sites to assess accuracy and clinical performance. In addition, observer agreement and the effects of age, arm circumference, heart rate, posture, and blood pressure level on the observer-device differences were analyzed. There were 1098 simultaneous, same arm BP measurements performed in 122 subjects by the QuietTrak recorder versus two skilled clinicians per site using a teaching stethoscope and 24-h blood pressure recordings performed in 46 subjects to assess reliability of the monitor. The differences in observers for all sites were 0.7/-0.5 +/- 3.8/3.5 mm Hg with 89% of the BPs within 5 mm Hg. The mean difference between observer average and the device (all positions) was 0.3/-1.5 +/- 5.0/7.5 mm Hg. The agreement between the QuietTrak and mercury column determinations was within 10 mm Hg for 92 to 94% of systolic readings and 91 to 93% of diastolic readings, depending on the posture. The limits of agreement (2 standard deviations about the mean difference) between observers and the device for systolic BP tended to be lower for the sitting position (-11 to 10 mm Hg) compared to supine (-14 to 13 mm Hg) and standing (-14 to 14 mm Hg) positions.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation and biological activity of [Trp5]bradykinin from the plasma of the phylogenetically ancient fish, the bowfin and the longnosed gar.

The holostean fish occupy an important position in vertebrate phylogeny as extant representatives of a ancient group of ray-finned fish with evolutionary connections to present-day teleosts. Incubation of heat-denatured plasma from the bowfin Amia calva with trypsin generated bradykinin-like immunoreactivity. The primary structure of bowfin bradykinin was established as Ala-Pro-Pro-Gly-Trp-Ser-Pro-Phe-Arg. This amino acid sequence contains one amino acid substitution (Phe5 --> Trp) compared with mammalian bradykinin. The same peptide was generated in heat-denatured plasma from the longnosed gar Lepisosteus osseus. Treatment of plasma from either the bowfin or gar with glass beads under conditions previously shown to activate Factor XII in the plasma of mammals and reptiles did not generate bradykinin. Bolus injections of synthetic bowfin bradykinin (0.1, 0.3, and 1.0 nmol/kg) into the bulbus arteriosus of unanesthetized bowfin resulted in an immediate fall in arterial blood pressure of 5-10 min duration that was followed by a dose-dependent rise in pressure that was sustained for 30-60 min. There was no change in heart rate following bradykinin administration. The data suggest that the kallikrein-kinin system may predate the appearance of teleosts and may play a role in cardiovascular regulation in holosteans.

Detection of N-acetylated forms of alpha-MSH and beta-endorphin in the intermediate pituitary of the holostean fishes, Lepisosteus spatula, Lepisosteus osseus, and Amia calva.

Acid extracts of the intermediate pituitaries of the gars, L. spatula and L. osseus, were fractionated by Sephadex G-50 column chromatography and analyzed by radioimmunoassay. This procedure revealed that immunoreactive forms of N-acetylated beta-endorphin- and alpha-MSH-sized material were present in equimolar amounts and represented the major end products of the POMC biosynthetic pathway in these species. Cation-exchange chromatography indicated that multiple N-acetylated forms of beta-endorphin were present in the intermediate pituitaries of the two species of gar, and that these forms differed in their net positive charge and in their apparent molecular weight. Reversed-phase HPLC analysis of the alpha-MSH-related material indicated that up to 90% of the total MSH in the pituitary of the gar was N-acetylated. Furthermore, the predominant form of alpha-MSH in both species of gar was N,O-diacetyl-ACTH(1-13)-NH2. Nearly identical results were obtained following the analysis of alpha-MSH-related peptides in the intermediate pituitary of the bowfin, A. calva. The pattern of posttranslational processing of POMC observed in the intermediate pituitaries of holostean fishes is very similar to the processing events observed in lungfishes, turtles, and mammals; hence, the processing of POMC has been remarkably conserved during vertebrate evolution.

The corpuscles of Stannius in arawana (Osteoglossum bicirrhosum), an ancient teleost.

The corpuscles of Stannius of arawana (Osteoglossum bicirrhosum), an ancient teleost, were examined by routine light and electron microscopy and following their immunoreactivity to salmon and trout stanniocalcin antisera. Periodic acid-Schiff positive cells of the corpuscles of Stannius had a follicular arrangement and demonstrated a strong immunohistochemical reaction with both stanniocalcin antisera. Fine structural analysis of the paired, posteriorly located, and perirenal ovoid glands revealed two morphologically distinct cell types the basal laminae of which were ramified by nerve terminals. Immunocytochemistry demonstrated that osmiophilic secretory granules in both cell types were immunoreactive to the stanniocalcin antisera. When extracts of arawana corpuscles of Stannius were subjected to sodium dodecyl sulphate electrophoresis and Western blot analysis a diffuse molecular weight band was evident ( approximately 68 kDa) in the non-reduced condition. In all cases, immunoreactivity was abolished by preabsorption of the antisera with salmon stanniocalcin or with a crude extract of arawana corpuscles of Stannius. The corpuscles of Stannius of arawana are similar to those in more recent teleosts with respect to cell structure and their anatomical distribution but their stanniocalcin is more similar in molecular weight to that present in at least one other non-teleost actinopterygian (the gar) which has an ancient lineage.

Grading scores and survivorship functions in liver cirrhosis: a comparative statistical analysis of various predictive models.

In a group of followed-up liver cirrhotics we evaluated the reliability of prognostic estimates predicted on the basis of a previously described multivariate statistical model (MSM). In the same subjects we also compared theoretical survival estimates obtained by fitting some other liver cirrhosis grading scores (Child-Turcotte's, McCormick's and Orrego's) to prognostic purposes. No statistical difference between actual and MSM-estimated survivorship functions was found (employing a life-table method with Logrank test), thus confirming the prognostic reliability of this multivariate classification model. Such a global and prognosis-correlated index may be recommendable both for comparing different groups of patients, and for assessing treatment effectiveness. Or results also substantially confirm the other investigated classificative methods such as reliable liver cirrhosis severity indexes, although their use for prognostic purposes seems to be less suitable.

Prognostic significance of clinical and laboratory parameters in liver cirrhosis. A multivariate statistical approach.

Successive clinical and laboratory data of 73 cirrhotics, who died during a follow-up period, were evaluated. The relationships between the actual survival time and 22 potentially prognostic variables were studied by means of the log-rank test and the likelihood ratio test. Seven variables (presence of ascites, hepatic encephalopathy and oesophageal varices; serum albumin, total bilirubin, gamma-globulin percentage and cholesterol) showed a strict correlation with survival time, and were included in a multiple regression model in order to compute the specific "prognostic weight" of each parameter. Results show that the parameters directly related to liver cell biosynthesis or indicating a structural liver damage should be considered more reliable for predicting theoretical survival in patients with liver cirrhosis.

[Role of crural inguinal lymphadenectomy and dynamic sentinel lymph node biopsy in lymph node staging in squamous-cell carcinoma of the penis. Our experience]. / Ruolo della linfoadenectomia inguino crurale e della biopsia dinamica del linfonodo sentinella nella stadiazione linfonodale del carcinoma a cellule squamose del pene. Nostra esperienza.

PURPOSE: We determine the value of dynamic sentinel node biopsy for staging squamous cell carcinoma of the penis. MATERIALS AND METHODS: During a period of 2 years 17 patients with penile cancer was performed after lymphoscintigraphy pre and intraoperatively with gamma ray detection probe at biopsy of the sentinel node with the aid of perilesional administered patent blue dye. After 20 days regional lymph node dissection was performed in all patients. RESULTS: Sentinel node metastasis was found in 5 patients; in one case lymphoscintigraphy not visualized sentinel node. All negative node biopsy was confirmed with the regional lymph node dissection. No major complication did occur after sentinel node biopsy. CONCLUSIONS: Occult lymph node metastases can be detected by dynamic sentinel node biopsy including preoperative lymphoscintigraphy, vital dye and gamma ray detection probe with a sensitivity of 78%, predictive negative value of 100% and with low morbidity.

[Hypereosinophilic syndrome and renal insufficiency]. / Sindrome ipereosinofila e insufficienza renale.

Hypereosinophilic syndrome is a pathological condition whose etiology is still unclear. Having been introduced for the first time Hardy and Anderson in 1968, the term is used to indicate hypereosinophilia which does not accompany those pathologies with which it is more commonly associated. This paper reports the case of a patient affected by hypereosinophilic syndrome associated with kidney insufficiency. This association with a clinical picture of eosinophilic interstitial nephritis has rarely been described in the past. The Authors discuss the possibility of a possible evolution towards renal insufficiency, probably caused by the successive appearance of arteriolar glomerulitis with vasculitis, leading to the dysfunction of a growing number of nephrons.

[Polyarteritis nodosa and pulmonary neoplasms. Report of a clinical case]. / Poliarterite nodosa e neoplasia polmonare. Descrizione di un caso clinico.

A case of rare association between PAN and cancer is presented. The tumour was a bronchogenic carcinoma (large cell type) diagnosed about 14 years after the beginning of PAN, that in this case had a very long course increasingly affecting the principal arteries of the legs.

[Coronary atherosclerosis: a long natural history]. / L'athérosclérose coronaire: une longue histoire naturelle.

In this paper we have tried to explain the natural history of atherosclerosis as a condition marked by intimal vessel expansion tending to the endoluminal proliferation until to the obliteration of the lumen because of the presence of atheroma with fixed stenosis. During the course of the life, the various histologic alterations are responsible of the different ischaemic syndromes, ranging from instable vasospastic angina, to chronic ischaemia caused by fixed stenosis, until to myocardial infarction. Besides, we have outlined that in the young (< 40 years old), the most frequent and important event is the vasospasm owed by the fibromuscular proliferation that could cause an infarction with "intact" coronary arteries. On the other side, in the elderly, are observed specially degenerative atherosclerotic lesions with fixed stenosis and consequent thrombosis, cracking of the plaque as cause of acute myocardial infarction.

[Hepatic psittacosis: a case of liver abnormality diagnosed by ultrasonography]. / Psittacose hépatique: un cas avec anomalie échographique du foie.

Psittacosis marked by liver and spleen involvement and minimal pericarditis was observed in an 18-year-old patient hospitalized for fever of 1 month duration. At admission, there was no other clinical manifestation and the chest X-ray showed no sign of pulmonary involvement. Liver tests revealed cholestasis. Ultrasonography of the abdomen revealed multiple nodular formations in the liver and spleen, images confirmed on computed tomography. Liver biopsy showed granulomatous with hyperplasia of the Kupffer cells surrounded by healthy tissue. Complement fixation to psittacosis antigen was positive and increased significantly over a 15-day interval. Treatment with tetracycline led to rapid remission of the fever and normalization of the liver tests and hepatic images. Liver involvement in psittacosis is not uncommon, but this is apparently the first case reporting echographic anomalies. The absence of pulmonary involvement has been reported earlier in a few cases. The diagnosis is usually suggested on the basis of epidemiologic criteria and confirmed by complement fixation.

[Prokinetic drugs in digestive disorders]. / I procinetici in patologia digestiva.

In this paper the authors review the main prokinetic drugs analyzing their pharmacological properties, therapeutic indications and adverse effects. In addition, some more recently introduced substances are taken into consideration which, although they were not initially used for digestive tract dyskinesias, can nevertheless be used in certain conditions. From this point of view, calcium blocking agents employed in spastic conditions of the esophagus and the new antiserotoninergic drugs for treatment of anticancer chemotherapy-induced vomiting are of particular interest.

[Physiopathologic aspects of non-ulcerous dyspepsia. Considerations of a new diagnostic method]. / Aspetti fisiopatologici della dispepsia non ulcerosa. Considerazioni per una nuova strategia diagnostica.

The above study is an analysis of different dyspeptic syndromes outlining their pathophysiology and clinical features. On this basis, the authors suggest a diagnostic strategy, stressing the importance of certain elements such as age at onset, duration and variability of symptoms. This allows to evaluate the indications for endoscopy or biopsy, or to decide that it is sufficient to continue observation while reassuring the patient that the dyspeptic condition is benign.

[Role of Helicobacter pylori in digestive disease in AIDS]. / Ruolo dell'Helicobacter pylori nella patologia digestiva in corso di AIDS.

The frequent combination of chronic antral gastritis with the presence of Helicobacter pylori has been known for ten years. On the basis of studies carried out so far, Helicobacter gastritis is very infrequent in patients suffering from AIDS with digestive pathology. Our study of 317 patients with AIDS confirms the low incidence of this disorder which leads to the conclusion that the treatments intended to combat HIV are apt to modify the physico-chemical conditions of the stomach thus impeding Helicobacter colonization.

[Excess of histamine as a possible cause of cardiac arrhythmias]. / L'iperistaminemia come causa possibile di aritmie cardiache.

In this paper we outline the importance or the histamine in the genesis of cardiac arrhythmias. Such an event can verify not only in patients with allergic diseases especially versus specific substances (antibiotics and anesthetics), but also after endoscopy of surgery which make free a large amount of histamine. For this reason, we outline the possible evenience anaphilaxis after coronarography or cardiac surgery with extracorporeal circulation. Therefore it is always very important to modulate the histamine tone to avoid arrhythmias which can be serious.

[The physiopathological aspects of sudden cardiac death]. / Aspetti fisiopatologici della morte improvvisa cardiaca.

In this paper we have tried to clarify the pathophysiological aspects of sudden cardiac death. On a clinical basis, beside the arrhythmias and the coronaropathies, the other functional and/or organic alterations such as myocardiopathies, congenital malformations, myocarditis, primitive or secondary neoplasms and neurophysiological alterations are described as cause of sudden cardiac death.

[Aortic dissection: new diagnostic and therapeutic trends]. / La dissecazione aortica: nuovi orientamenti sulla diagnosi e sul trattamento.

The aortic dissection is a relatively infrequent, but very serious event, that needs to be always considered when a thoracic pain with symptoms of ischemia belongs to the origin of the dissection without signs of myocardial infarction. The most simple and commonly accepted classification, includes two variants, according to the Stanford University (A and B). This aspect is very important in order to the treatment which must be preceded by a suitable pharmacological approach followed in any case by the surgery. We outline the importance of the fast diagnostic knowledge and of the therapeutic choice in order to reduce the mortality that is still very high.