Growth hormone in inflammatory bowel disease.

Crohn's disease and ulcerative colitis are inflammatory diseases of the gastrointestinal tract characterized by chronic relapsing inflammation and catabolism. Growth hormone/insulin-like growth factor-I axis is important in inflammatory bowel disease, because of the effects on epithelial cell kinetics, collagen deposition and immunomodulation. The potential of growth hormone as a therapeutic option in inflammatory bowel disease has been proven in various clinical settings. Acquired growth hormone resistance in inflammatory bowel disease seems to be mediated by a combination of undernutrition and active inflammation. In particular, proinflammatory cytokines, such as TNF-a and interleukin-6, have been implicated as potential mediators of growth hormone resistance. The introduction of anti-TNF-alpha monoclonal antibodies has proven very efficacious in patients with inflammatory bowel disease. By reducing cytokines levels in inflammatory cells of intestinal mucosa, infliximab could interfere with cytokine-induced growth hormone resistance. Recent in vivo data have shown that acquired growth hormone resistance in patients with inflammatory bowel disease may be reversed after the administration of anti-TNF-alpha therapy.

Measuring Children's Suggestibility in Forensic Interviews.

According to the scientific literature, childrens' cognitive development is not complete until adolescence. Therefore, the problems inherent in children serving as witnesses are crucial. In preschool-aged children, false memories may be identified because of misinformation and insight bias. Additionally, they are susceptible of suggestions. The aim of this study was to verify the levels of suggestibility in children between three and 5 years of age. Ninety-two children were examined (44 male, 48 female; M = 4.5 years, SD = 9.62). We used the correlation coefficient (Pearson's r) and the averages variance by SPSS statistical program. The results concluded that: younger children are almost always more susceptible to suggestibility. The dimension of immediate recall was negatively correlates with that of total suggestibility (r = -0.357 p < 0.001). Social compliance and source monitoring errors contribute to patterns of suggestibility, because older children shift their answers more often (r = 0.394 p < 0.001). Younger children change their answers more times (r = -0.395 p < 0.001).

Cardiac biopsy in patients with "primary" atrial fibrillation. Histologic evidence of occult myocardial diseases.

Fourteen patients (ten men and four women; mean age, 37 years) with lone atrial fibrillation (AF) (1 to 18 months' duration) were evaluated by thyroid function tests, two-dimensional echocardiography, hemodynamics, coronary angiography, and left ventricular endomyocardial biopsy, because of unresponsiveness to the usual antiarrhythmic therapy. The results of the T3, T4, TSH, and TRH tests were normal in all patients; cardiac valves and ventricular and atrial sizes (left atrium less than 40 mm) were within the normal limits; also normal were LVEDP (less than or equal to 10 mm Hg) and EF (greater than 0.50). Histologic findings were abnormal in all cases, with three patients showing cardiomyopathic changes, three other patients showing active myocarditis (lymphocytic in two and eosinophilic in one), and eight patients with nonspecific necrosis or fibrosis or both. Steroids (prednisone; 50 mg/m2 of body surface area daily) used in addition to antiarrhythmic therapy in patients with eosinophilic and lymphocytic active myocarditis were able to cause reversion to sinus rhythm, while the other patients continued to have AF. This study documents that occult myocardial diseases (myocarditis, cardiomyopathy, and nonspecific necrosis or fibrosis) can underlie "primary" AF. The addition of steroids to antiarrhythmic therapy in patients with refractory AF and histologic evidence of active myocarditis seems to be useful in controlling the arrhythmia.

Abnormal blood pressure response to exercise in borderline hypertension. A two year follow-up study.

Twenty-eight men with borderline hypertension according to the World Health Organization criteria underwent maximal exercise testing, and then were followed for a two year period. The prevalence of abnormal blood pressure behavior during exercise was 53.58% (n = 15). During follow-up established hypertension developed in 63.33% (n = 10) of subjects with an abnormal blood pressure response to exercise, and only in 15% (n = 2) of subjects with normal blood pressure behavior. In predicting established hypertension development in a two year follow-up, maximal exercise testing has the following statistical values: sensitivity = 83.33%, specificity = 68.75%, accuracy = 75%, positive predictive value = 66.66%, negative predictive value = 84.61%.

Prevalence of left ventricular hypertrophy and cardiac arrhythmias in borderline hypertension.

Seventy-eight men with borderline hypertension according to the World Health Organization criteria underwent echocardiographic examination, followed by simultaneous ambulatory blood pressure and electrocardiographic monitorings for 24 h. The prevalence of echocardiographic left ventricular hypertrophy was 16.6% (13/78). Borderline hypertensives with left ventricular hypertrophy had more supraventricular (P less than .001) and ventricular ectopic beats (P less than .001) than normotensive controls and borderline hypertensives without cardiac involvement. Furthermore, ventricular ectopic activity was significantly related to left ventricular mass (r = 0.58, P less than .05) in borderline hypertensives showing echocardiographic evidence of left ventricular hypertrophy. Our findings suggest that noninvasive assessment of target organ status, including echocardiography, should be employed to optimize risk stratification in borderline hypertension.

Casual versus 24-hour ambulatory blood pressure recording in the evaluation of chronic administration of sustained-release verapamil.

Although ambulatory blood pressure monitoring has been used widely for the evaluation of antihypertensive treatment, little information is available regarding the comparison between this method and casual BP measurement during drug trials. In our study, we tested the efficacy of a new formulation of verapamil, 240 mg sustained-release tablets, and compared the degree of BP reduction as detected by casual (standard mercury manometer) and by 24-hour ambulatory recording (Spacelab ICR 5300). A statistically significant fall in casual BP was observed after verapamil with respect to placebo. Moreover, 24-hour, waking and sleeping ambulatory BPs were significantly reduced by verapamil. The mean BP reduction was similar for office (20.1/16.1 +/- 4.3/3.1 mmHg) and for day-time ambulatory monitoring (13.4/10.7 +/- 4.2/1.9 1.9 mmHg), but no correlation was found between BP fall recorded by the two techniques for individual subjects. This study suggests that sustained-release verapamil is an effective antihypertensive drug. Individual mean BP reduction outside the clinic may not be predicted from office readings and therefore ambulatory BP recording seems to provide a better basis for testing the efficacy of drugs.

Infliximab in the treatment of steroid-dependent ulcerative colitis.

BACKGROUND AND OBJECTIVES: Infliximab has proven efficacious in the treatment of Crohn's disease. Limited and contrasting data are available on effectiveness of anti-TNF alpha therapy in ulcerative colitis. We evaluated the efficacy of infliximab in the management of steroid-dependent ulcerative colitis. METHODS: We report preliminary data from a randomized, open-label, methylprednisolone-controlled trial of infliximab in the induction and maintenance of remission of patients with moderate to severe steroid-dependent ulcerative colitis. Twenty patients received either three infusion of infliximab (5 mg/kg) at 0, 2 and 6 weeks and thereafter every 8 weeks (group A) or methylprednisolone (0,7-1 mg/kg) daily for one week followed by a tapering regimen up to the minimal dose to maintain a symptom-free condition (group B). Clinical remission was defined as a DAI score less than 3. RESULTS: Ten patients in group A (DAI: 8.9+/-1.4) achieved remission after the first infusion (DAI: 1.6+/-0,7; p = 0.005) and steroids were progressively discontinued. At present (mean follow-up: 9.8+/-1.1 months), 9 out of 10 patients maintain clinical remission, while one patient relapsed at 3 months. Ten patients in group B (DAI: 8.7+/-1.4) reached clinical remission at one week (DAI: 1.9+/-0.3; p = 0.005). Eight out of 10 patients were maintained at a minimal steroid dosage without any relapse at 9.7+/-1.0 months follow-up. Two patients relapsed at 6 and 8 months, respectively. CONCLUSIONS: Infliximab seems to be as effective as steroids in the management of moderate to severe steroid-dependent ulcerative colitis. These preliminary data suggest the potential efficacy of repeated treatment with infliximab for short-term maintenance of remission and steroid withdrawal in glucocorticoid-dependent ulcerative colitis.

Target organ status and cardiovascular risk in borderline hypertension.

In order to assess the prevalence of target organ damage 78 men with borderline hypertension, according to the World Health Organization criteria, and 67 normotensive controls underwent echocardiographic, electrocardiographic and fundoscopic examination, followed by ambulatory blood pressure monitoring for 24 hours. Echocardiographic left ventricular hypertrophy was found in 13 borderline hypertensive subjects (16.6%), while no electrocardiographic or fundoscopic abnormalities could be detected. Our data suggest that noninvasive assessment of cardiovascular status, including echocardiography, allows recognition of a subset of borderline subjects with an increased risk for subsequent cardiac morbid events, thereby improving prognostic stratification.

[Semiological value of the electrocardiogram in pheochromocytoma]. / Valore semeiologico dell'elettrocardiogramma nel feocromocitoma.

ECG abnormalities of various types and extent were noted in subjects with pheochromocytoma. In the majority of cases, they regressed after surgical resection of the tumour. The underlying pathogenetic mechanisms are discussed in the light of the functional and organic cardiac and vascular alterations induced by the abnormal increase in catecholamines. Reference is also made to the literature in support of the diagnostic and prognostic soundness of ECG with regard to both pheochromocytoma and any heart involvement it may cause.

[Cardiovascular problems in heroin dependence]. / Problemi cardiovascolari nella farmacodipendenza da eroina.

The main cardiovascular problems caused by heroin addiction are examined, with particular emphasis on acute pulmonary oedema, the most dangerous and dramatic complication, of which the pathogenetic, clinical, diagnostic and therapeutic aspects are described.

[Hyperuricemia in essential hypertension. Considerations on some pathogenic aspects]. / L'iperuricemia nell'ipertensione essenziale. Considerazioni su alcuni aspetti patogenetici.

Hyperuricaemia was encountered in 29% of 55 subjects with essential hypertension, who had not been treated with anti-hypertensive drugs, as against a 10% incidence in a group with normal blood pressure. No relationship between hyperuricaemia and level of hypertension was found. The normal glomerular filtration, the frequent reduction in uric acid clearance and its correlation with uricaemia are held to be indicative of a tubular defect in the excretion of uric acid, as a cause of hyperuricaemia. The reduction in renal plasma flow and its significant correlation with uricaemia and uric acid clearance are considered probable causes of reduced renal excretion. In conclusion it is hypothesised that hypertension triggers renal haemodynamic disturbances and hence hyperuricaemia.

Prevalence of silent ST segment depression during long-term ambulatory electrocardiographic monitoring in asymptomatic diabetic patients with essential hypertension.

Thirty-five asymptomatic diabetic patients with non insulin-dependent diabetes and mild moderate essential hypertension (18 males and 17 females, mean age 60 +/- 6 years) underwent echocardiographic examination, followed by simultaneous ambulatory blood pressure and electrocardiographic monitorings. Three hundred and sixteen significant episodes of asymptomatic ST segment depression (at least 1 mm 80 msec after the J point, lasting more than 1 min) were recorded in 21 patients (60%) with a total duration of 5637 minutes. Patients with asymptomatic episodes of ST segment depression had significantly higher values of total cholesterol (p < 0.05), LDL cholesterol (p < 0.05), Glycosylated hemoglobin (p < 0.001), left ventricular mass index (p < 0.02), mean 24-hour systolic and diastolic ambulatory blood pressure (p < 0.001), systolic (p < 0.02) and diastolic (p < 0.01) ambulatory blood pressure variability and hypertensive peaks (p < 0.05), with respect to the rest of the study population. The number of ST segment depression episodes was significantly related to total cholesterol levels (r = 0.40, p < 0.05), LDL cholesterol levels (r = 0.36, p < 0.05) glycosylated hemoglobin levels (r = 0.50, p < 0.01), left ventricular mass index (r = 0.48, p < 0.01), ambulatory systolic (r = 0.43, p < 0.01) and diastolic (r = 0.51, p < 0.01) blood pressure variability and hypertensive peaks (r = 0.50, p < 0.01). Our data suggest that haemodynamic and metabolic factors could have a relevant role in high prevalence of SMI in asymptomatic diabetic patients with EH. The evidence of SMI in these patients warrants further diagnostic work-up and prognostic assessment.

[Ischemic hepatitis: case reports and a review of the literature]. / L'epatite ischemica: contributo casistico e revisione della letteratura.

Ischemic hepatitis represents a condition in which an acute circulatory failure determines a striking elevation of both serum transaminases and total bilirubin and a prolongation of prothrombin time. Such impairment of liver function tests is due to a haemodynamic hepatocyte injury, showing focal centrilobular necrosis as the specific pathologic correlate. In this paper the authors describe four different cases of ischemic hepatitis, in which an acute derangement of liver function tests occurred as a consequence either of myocardial failure or of systemic venous congestion. Finally, the authors review all current international literature concerning the various clinical, pathologic and therapeutic features of ischemic hepatitis.

[The relationship between high-density lipoproteins, thromboxane B2 and arteriosclerosis in a case of primary hypoalphalipoproteinemia]. / Rapporto tra lipoproteine ad alta densità, trombossano B2 ed arteriosclerosi in un caso di ipoalfalipoproteinemia primitiva.

Data in the literature suggest that cases of hypoalphalipoproteinemia involve an increase in thromboxane B2 (TXB2) together with an increased risk of atherosclerosis. A recent detailed examination of a 32-year-old man revealed clinical and biochemical features strongly indicative of that pathology. The case presented several unusual features: marked infiltration of the skin and mesenteric lymph nodes by histiocytic lipids with sufficient hyperplasia to induce acute intestinal occlusion combined with an in vivo TXB2 generation curve, subsequently inhibited by aspirin, that was comparable to the curves of the control subjects. Furthermore there were no signs of early atherosclerotic damage so that it was possible to postulate the hypothesis that despite the 50% drop in alpha-lipoprotein levels, they were still sufficient to ensure normal turnover of the other lipoproteins so that, however complex the clinical condition, it was an incomplete expression of a phenotype.

Left ventricular hypertrophy and diastolic dysfunction in alcohol-associated hypertension.

In order to assess left ventricular structure and diastolic function, 50 hypertensive male subjects, 25 with and 25 without a history of alcohol abuse, and 20 normotensive male controls underwent Doppler echocardiographic examination followed by ambulatory blood pressure monitoring for 24 hours. Left ventricular mass was significantly higher in alcoholic hypertensives in relation to non-alcoholic hypertensives (p < 0.05) and normotensive controls (p < 0.001). Moreover, Doppler parameters expressing left ventricular filling pattern were significantly worse in alcoholic than in non-alcoholic hypertensives (p < 0.01). Clinic and ambulatory blood pressure were similar in alcoholic and non-alcoholic hypertensives, while mean day-time heart rate was significantly higher in alcoholics (p < 0.01). Collected data suggest that non-hemodynamic factors are probably involved in the development of cardiovascular abnormalities in hypertensive alcoholics, and that echocardiography should be employed for risk-profile definition in alcohol-associated hypertension.

[Effect of somatostatin on peripheral circulation. Preliminary study]. / Action de la somatostatine sur la circulation périphérique. Etude préliminaire.

Somatostatin is a cyclic tetradecapeptide widely distributed in the human cells; it has many physiological effects. Synthetic somatostatin, actually employed in some clinical conditions, was administered intravenously to normal and arteriopathic subjects. Rheography and plethysmography of lower limbs were performed before, during and after administration. A marked improvement of blood flow and a reduction of heart rate was observed after somatostatin infusion. Some hypotheses about the mechanism of action of somatostatin are discussed, especially the action on the sympathetic nervous system or the calcium-antagonist effect on the blood vessels.

[Electrocardiographic changes in hypertensive emergencies. Their incidence and possible pathogenetic mechanisms]. / Le alterazioni elettrocardiografiche nelle emergenze ipertensive. Incidenza e possibili meccanismi patogenetici.

The aim of the study was to analyse electrocardiographic alterations in 30 patients with slight to moderate essential arterial hypertension during the course of hypertensive attacks (DAP greater than 115 mmHg). Standard hematochemical tests were performed in basal conditions, together with 24-h ECG monitoring and an echocardiogram to measure the left ventricular mass index. Echographic monitoring was carried out during hypertensive attacks and for 2 h after the return to basal pressure values. In basal conditions patients showed slight hypopotassemia (23%), left ventricular echographic involvement (57%), left ventricular hypertrophy with or without systolic strain (43%), and ventricular extrasystole (VE) classified as Lown's 1st and 2nd class (17%). During the course of hypertensive attacks, there was a significant increase in systolic strain, the appearance of anterolateral subendocardial ischemia (10%), left anterior hemiblock (3%), lateral subepicardial ischemia (3%), and a marked increase in VE (67%) which were complex in 40% of cases (Lown's classes 3, 4 and 5). A significant correlation was found between the left ventricular mass index and VE/h. The authors stress the multifactorial pathogenesis of echographic alterations and underline left ventricular involvement, acute hemodynamic strain and consequent alterations of coronary perfusion, hypopotassemia, and increased levels of circulating catecholamines.

[Sublingually administered captopril versus nifedipine in hypertension emergencies]. / Captopril versus nifedipina somministrati per via sublinguale nelle emergenze ipertensive.

Aim of the study was to assess the effectiveness and tolerability of sublingual captopril (SLC) versus sublingual nifedipine (SLN) in treating hypertensive emergencies. During hypertensive crises (systolic blood pressure exceeding 200 mmHg and diastolic blood pressure exceeding 115 mmHg) forty hypertensive patients received either 25 mg of SLC or 10 mg of SLN in a randomized single blind fashion. Blood pressure and heart rate were then controlled after 5, 10, 15, 20, 30, 45, 60, 120 min. and, in 18 cases, up to the 8th hour from the administration. Our results showed: 1) a satisfactory control of the hypertensive crises in 80% of patients treated with SLC with a significant blood pressure reduction after 10 min. (13/8 mmHg, p less than 0.02), while the maximum hypotensive effect was achieved after 30 min. (52/36 mmHg, p less than 0.001); SLN was able to reduce blood pressure in 90% of all the cases, with a significant reduction after 5 min. (15/11 mmHg, p less than 0.02) and hypotensive peak after 20 min (57/38 mmHg, p greater than 0.001); 2) no significant differences for hypotensive effectiveness between the two groups, but with SLC having a mildly delayed onset of action when compared to SLN; 3) antihypertensive effect lasting for about 6 hours in patients treated with SLC and blood pressure progressively raising after 4 hours in patients who received SLN; 4) a significant correlation between blood pressure reduction and blood pressure before drug administration in both groups; a significant correlation between pretreatment PRA and antihypertensive effect in the SLC group. We conclude that both drugs are effective and useful in treating hypertensive emergencies. Anyway we think that in severe forms SLN should be preferred for the shorter time preceding onset of action.

[Efficacy of the combination of nicardipine-enalapril and atenolol in severe hypertension secondary to chronic renal disease]. / Efficacité de l'association nicardipine-enalapril-aténolol dans l'hta sévère secondaire à une maladie rénale chronique.

The antihypertensive efficacy of combination therapy with N-E-A was evaluated during 6 months in 15 patients with hypertension associated with mild to moderate kidney failure. After 6 months a significant reduction of SBP and DBP (p < 0.001), with improvement of creatinine clearance and with no adverse effects on ECG, heart rate and routine laboratory tests test, was observed in 3 patients treated with N 20 mg x 2/d + E 10 mg/d + A 50 mg/d and in 8 patients treated with N 20 mg x 3 + E 10 mg x 2, + A 50 mg x 2. Four patients did not respond to this therapy.

[The efficacy and tolerance of heparin-calcium at low doses in postinfarct ischemic cardiopathy]. / Efficacia e tollerabilità dell'eparina calcica a basse dosi nella cardiopatia ischemica post-infartuale.

The above study was undertaken in order to evaluate the efficacy and tolerability of low dose calcium heparin for postinfarct ischemic heart disease (CIPI). In particular, the incidence was checked of: cardiovascular death, reinfarction, angina pectoris, TIA or RIND, stroke, arterial thromboembolism, venous thromboses, heart failure, complex ventricular arrhythmias, silent myocardial ischemia. Eighty patients with CIPI were divided into two groups similar for age, sex, physical features, cardiovascular risk factors, site of infarction, length of hospitalization, complications during hospitalization, clinical and instrumental findings at discharge, concomitant pathology. Upon discharge, patients were randomized into group 1 for traditional treatment and group 2 which in addition received 12,000 U calcium heparin s.c. every 24 h. After 12 months, during which patients were submitted to periodical laboratory and instrumental (standard and dynamic ECG, echoG) evaluation, group 2 had significantly fewer cardiovascular events than group 1 both as to overall number of events and as to number of events per individual patient. Especially, silent myocardial ischemia and ventricular arrhythmias were less frequent in group 2 patients and these two events, especially if coincident, are known to have severe prognostic implications. The efficacy of low-dose calcium heparin must be attributed to the enhancement of physiological antithrombotic mechanisms with compensation of blood clotting disorders that are fairly frequent in CIPI patients. Long-term s.c. administration was well tolerated.