An immunohistochemically positive E-cadherin status is not always predictive for a good prognosis in human breast cancer.

BACKGROUND: in primary breast cancers dichotomic classification of E-cadherin expression, according to an arbitrary cutoff, may be inadequate and lead to loss of prognostic significance or contrasting prognostic indications. We aimed to assess the prognostic value of high and low E-cadherin levels in a consecutive case series (204 cases) of unilateral node-negative non-lobular breast cancer patients with a 8-year median follow-up and that did not receive any adjuvant therapy after surgery. METHODS: expression of E-cadherin was investigated by immunohistochemistry and assessed according to conventional score (0, 1+, 2+, 3+). Multiple correspondence analysis was used to visualise associations of both categorical and continuous variables. The impact of E-cadherin expression on patients outcome was evaluated in terms of event-free survival curves by the Kaplan-Meier method and proportional hazard Cox model. RESULTS: respect to intermediate E-cadherin expression values (2+), high (3+) or low (0 to 1+) E-cadherin expression levels had a negative prognostic impact. In fact, both patients with a low-to-nil (score 0 to 1+) expression level of E-cadherin and patients with a high E-cadherin expression level (score 3+) demonstrated an increased risk of failure (respectively, hazard ratio (HR)=1.71, confidence interval (CI)=0.72-4.06 and HR=4.22, CI=1.406-12.66) and an interesting association with young age. CONCLUSIONS: the findings support the evidence that high expression values of E-cadherin are not predictive for a good prognosis and may help to explain conflicting evidence on the prognostic impact of E-cadherin in breast cancer when assessed on dichotomic basis.

Severe spontaneous arterial thrombotic manifestations in patients with inherited hypo- and afibrinogenemia.

We report two novel cases of severe arterial thrombotic episodes occurring in two women with severe hypofibrinogenemia, not linked to the administration of replacement therapy. The first patient had sudden acute occlusion of the anterior branch of left renal artery with infarction of the antero-lateral region of the upper part of the left kidney during treatment with combined oestrogen-progestogen started 16 years before for recurrent haemoperitoneum caused by bleeding at ovulation. The second patient showed recurrent arterial thrombosis of lower limbs over 2 years, which eventually led to amputation of affected limbs. Thrombotic events in patients with inherited severe hypofibrinogenemia are rather frequent, may be severe and not associated with the use of replacement therapy.

Biology, prognosis and response to therapy of breast carcinomas according to HER2 score.

BACKGROUND: The standardization of the HER2 score and recent changes in therapeutic modalities points to the need for a reevaluation of the role of HER2 in recently diagnosed breast carcinoma. PATIENTS AND METHODS: A multicenter, retrospective study of 1794 primary breast carcinomas diagnosed in Italy in 2000/2001 and scored in HER2 four categories according to immunohistochemistry was conducted. RESULTS: Ductal histotype, vascular invasion, grade, MIB1 positivity, estrogen and progesterone receptor expression differed significantly in HER2 3+ tumors compared with the other categories. HER2 2+ tumors almost showed values intermediate between those of the negative and the 3+ subgroups. The characteristics of HER2 1+ tumors were found to be in between those of HER2 0 and 2+ tumors. With a median follow-up of 54 months, HER2 3+ status was associated with higher relapse rates in node-positive and node-negative subgroups, while HER2 2+ only in node positive. Analysis of relapses according to type of therapy provided evidence of responsiveness of HER2-positive tumors to chemotherapy, especially taxanes. CONCLUSIONS: The present prognostic significance of HER2 is correlated to receptor expression level and points to the need to consider HER2 2+ and HER2 3+ tumors as distinct diseases with different outcomes and specific features.

Outbreak of acute bovine viral diarrhea in Brazilian beef cattle: clinicopathological findings and molecular characterization of a wild-type BVDV strain subtype 1b.

When first described in 1946, bovine viral diarrhea (BVD) was characterized as an acute transmissible disease associated with severe leucopenia, high fever, depression, diarrhea, gastrointestinal erosions, and hemorrhages. Recently the severe acute form has been related only to some hypervirulent BVDV-2 strains. This article reports the detection of BVDV-1b associated with an acute and fatal outbreak of BVD in a Brazilian beef cattle herd. Depression, anorexia, watery diarrhea, sialorrhea, and weakness were observed in six steers. One of these animals was evaluated for laboratorial, clinical, and pathological alterations. Laboratory findings were non-specific; clinically, the animal was weak, with dehydration and erosive oral lesions. Pathological alterations were predominant at the tongue, esophagus, and rumen. A RT-PCR assay using primers to partially amplify the 5' untranslated region (5'UTR) of the BVDV genome was performed and identified BVDV in all clinical samples analyzed. Phylogenetic analysis of BVDV derived from lymph node revealed that this strain was clustered within the BVDV subtype 1b. This differentiating was only possible to be performed by molecular characterization since both clinical presentation and pathologic findings were similar to BVDV-2 infection.

Papillomaviruses in ruminants: An update.

Papillomaviruses (PVs) are complex viruses which infect the skin or mucosae of a broad range of amniotes worldwide. They cause benign or malignant lesions depending on environmental factors, virus oncogenicity and the location of infection. Bovine papillomaviruses (BPVs) are the second most studied PVs beyond human PVs. In the past few years, genetic characterization of animal PVs has increased due to the availability of new techniques, which simplified the sequencing of entire genomes. Therefore, this review aims to provide an update of the current epidemiology, classification and genome features of ruminant PVs (mainly BPVs) affecting animals worldwide. The review also aimed to clarify the key differences between the high-risk Delta papillomaviruses and the seemingly low-risk Xi, Epsilon, Dyoxi and Dyokappapillomavirus as well as the recently described PVs BPV18, 19, 21 and PpuPV1 that belongs to an unclassified genus.

Fauna flebotomínica e soroprevalência para leishmaniose visceral canina em área urbana na região Centro-Oeste do Brasil / [Phlebotomine fauna and seroprevalence for canine visceral leishmaniasis in urban area from Central-West region of Brazil]

A leishmaniose visceral americana (LVA) é uma zoonose de transmissão vetorial na qual o cão tem papel importante na epidemiologia da doença. No Brasil, a elevada prevalência da infecção em cães está diretamente correlacionada com o aumento no risco de ocorrência de casos de LVA. O objetivo deste estudo foi investigar a fauna flebotomínica e verificar a soroprevalência da leishmaniose visceral canina (LVC) na localidade Pedra 90, no município de Cuiabá. Para o levantamento entomológico, armadilhas CDC foram utilizadas de agosto de 2014 a julho de 2015. Na avaliação sorológica dos cães, o teste imunocromatográfico DPP LVC foi utilizado para a triagem das amostras, enquanto o ensaio imunoenzimático (EIE) para o diagnóstico da LVC (Bio-Manguinhos) foi empregado como teste confirmatório. O trabalho vem acrescentar à fauna flebotomínica do município de Cuiabá as espécies Lu. andersoni, Lu. braziliensis, Lu. bourrouli e Lu. scaffi, não registradas em publicações anteriores. Além disso, entre as espécies de flebotomíneos com importância médica, Lu. cruzi, Lu. flaviscutellata e Lu. whitmani foram capturadas. No inquérito canino, a prevalência de LVC observada na localidade Pedra 90 foi de 1,14%, indicando que a região pode ser considerada como área de transmissão.(AU)

American visceral leishmaniasis (AVL) is a vector-borne zoonosis in which the dog has an important role in the epidemiology of the disease. In Brazil, a high prevalence of canine infection is directly correlated with an increased risk of occurrence of AVL. The aim of this study was to investigate the phlebotomine fauna and seroprevalence of canine visceral leishmaniasis in Pedra 90 region of Cuiabá municipality. For the entomological survey, CDC traps were used from August 2014 to July 2015. In the serological evaluation of dogs, the immunochromatographic test DPP LVC was employed for screening the samples while enzyme-linked immunosorbent assay (Bio-Manguinhos) was used as a confirmatory assay. The previously unreported phlebotomine species Lu. andersoni, Lu. braziliensis, Lu. bourrouli, and Lu. scaffi were added to the phlebotomine fauna of Cuiabá. In addition, the medically important phlebotomine species Lu. cruzi, Lu. flaviscutellata, and Lu. whitmani were identified. The canine survey revealed the prevalence of 1.14% for canine visceral leishmaniasis in the Pedra 90 region, the region being considered a transmission area.(AU)

NIDDM as unfavorable factor to the postinfarctual ventricular function in the elderly: echocardiography study.

BACKGROUND: Aging and diabetes mellitus have been recognized as strong predictors of heart failure in patients with acute myocardial infarction. The aim of this study was to assess, by echocardiography, the influence of aging and non-insulin-dependent diabetes mellitus on the changes of left ventricular parietal kinesis in patients with acute myocardial infarction over the 6 months after hospitalization. METHODS: The study population consisted of 82 patients (42 male, 40 female) aged 70 years, consecutively admitted to coronary care unit with acute myocardial infarction from January 1991 to May 1993. They were divided into two groups: group 1 comprised 36 patients with non-insulin-dependent diabetes mellitus, aged 78.8 +/- 6.02 years, 17 men and 19 women; group 2 comprised 46 patients without diabetes aged 78.7 +/- 6.9 years, 25 men and 21 women. Echocardiography was performed at admission to the unit (T0), at discharge (T1), and after 6 months of follow-up (T2). The echocardiographic wall motion score index was calculated by considering the number of akinetic and dyskinetic left ventricular wall segments. Fatal and non-fatal incidents of heart failure were also considered and a multivariate analysis was applied to identify the clinical and instrumental parameters that were independent predictors of wall motion score index changes and heart failure events. RESULTS: At T1 the two groups were comparable in localization of acute myocardial infarction, previous myocardial infarction, creatinine kinase serum peak, ECG score and wall motion score index. A statistically significant reduction in akinesia (P < 0.001) was observed in group 2 at T1 and T2, but was not seen in group 1. At T2 the difference in wall motion score index between the groups became significant (P < 0.05). The occurrence of heart failure was significantly higher in group 1 than in group 2 either during hospitalization (P < 0.03) or during follow-up (P < 0.004). The multivariate analysis identified non-insulin-dependent diabetes mellitus as an independent predictor of lacking recovery in LV kinesis (P < 0.01) and of heart failure development (P < 0.001). CONCLUSION: In elderly patients with non-insulin-dependent diabetes mellitus lack of recovery in wall motion score index after acute myocardial infarction seems to be an important factor, with a higher heart failure prevalence adversely affecting the in-hospital and long-term outcome. Non-insulin-dependent diabetes mellitus appears to be an important factor related to this unfavorable outcome.

Prior myocardial infarction and prognostic outcome in patients with unstable angina in a postdischarge follow-up.

The authors investigated how a previous myocardial infarction (MI) affects the prognosis of unstable angina pectoris in patients with maintained or slightly reduced left ventricular performance. From January 1991 to August 1993, 131 patients hospitalized with the diagnosis of Braunwald's class II-III unstable angina and ejection fraction > 40% were included. The enrolled patients were divided into two groups: (1) group I: unstable angina with prior MI (n = 70, 49 men, 21 women, aged between fifty-one and eighty years, mean: 65.7 +/- 8.5 years, Braunwald's class III: 71.4%), (2) group II: unstable angina with previous infarction (n = 61, 31 men, 30 women, aged between forty-nine and eighty, mean: 66.3 +/- 7.9 years, Braunwald's class III: 83.6%). The follow-up varied between six and twenty-four months. The frequency of major cardiovascular events (deaths, MI, reinfarction, heart failure, and recurrent unstable angina) and the number of revascularization procedures (percutaneous transluminal coronary angioplasty [PTCA] and coronary artery bypass grafting [CABG]) established during follow-up were evaluated. Hospitalization was 10.1 +/- 2.9 days in group I and 8.6 +/- 2.6 days in group II (P < 0.01). The duration of the follow-up was comparable between the two groups. Based upon predischarge noninvasive evaluation, patients in both groups were selected to undergo coronary and ventricular angiography: 38 of 70 (55.7%) in group I and 39 of 61 (62.3%) in group II; among them, 52.9% in group I and 24.6% in group II (P < 0.05) were submitted to coronary revascularization, while the others received medical treatments: 33 of 70 in group I and 46 of 61 in group II (P < 0.05). In the subset of patients submitted to angiography, the severity of coronary disease did not differ between the groups, and group I showed a statistically lower ejection fraction than group II (P < 0.005). The frequency of major cardiovascular events demonstrated a mortality rate of 2.9% in group I and 1.6% in group II. Acute MI/reinfarction accounted for 2.9% of the cases in group I and 3.3% in group II. Heart failure was present in 2.9% of group I. Recurrence of unstable angina was diagnosed in 11.4% of group I and 6.5% of group II. CABG and PTCA were performed, respectively in 7.1% and 5.7% in group I and in 6.6% and 4.9% in group II. During follow-up 75.7% of patients in group I and 80.3% in group II were asymptomatic. No significant differences in the frequency of cardiovascular events were reported between the two groups. As result of more aggressive therapeutic approaches following the detection of residual ischemia in patients with prior infarction, the authors conclude that the prognosis of unstable angina in the group with previous infarction does not seem to differ from that of unstable angina in the absence of prior necrosis in patients whose left ventricular function is maintained or slightly decreased.

Sudden cardiac death rate in an area characterized by high incidence of coronary artery disease and low hardness of drinking water.

From January 1992 to January 1993 the incidence of sudden cardiac death among the population of the Media Valle del Serchio area (Tuscany, Italy), composed of a population of 35,000, was found to be twice that of the European average; 32 cases have been reported over this period in that area (9 per 10,000 in the examined year), with a male/female (M/F) ratio of 2.5:1 (23 M, 9 F). In Italy the mean incidence of sudden death was calculated as 6/10,000 and in Europe 5/10,000. In the examined population hypertension was the coronary risk factor present most frequently (87%). A previous diagnosis of coronary artery disease was documented in 21 cases (66%); 5 of these exhibited previous myocardial infarction and 3 previous myocardial infarction associated with left ventricular heart failure. In 7 subjects no previous cardiovascular disorders were discovered. Prodromal symptoms had been reported in 20 cases (62%), which included chest pain in 8 and dyspnea in 8. In the examined geographic area a high prevalence of coronary artery disease was verified through the records of the Public Health Service, which documents the main causes of mortality in Tuscany, and through the hospitalization data and the services provided for ischemic heart disease at the local coronary care unit compared with the national average. Moreover, research was accomplished on physical and chemical properties of drinking water in the same area, and this revealed a very low total hardness due to the paucity of calcium and magnesium salts.(ABSTRACT TRUNCATED AT 250 WORDS)

Left ventricular size and function in patients with noninsulin-dependent diabetes and postinfarction total or subtotal coronary occlusions.

The aim of this study was to establish the effects of postinfarction total or subtotal coronary occlusion on left ventricular remodeling in patients with noninsulin-dependent diabetes (NIDD) compared with the effects in postinfarct nondiabetic patients. The authors selected 100 patients submitted to coronary angiography between 1 and 5 weeks after acute myocardial infarction (T0: 20.5+/-15.4 days) and classified into three groups: G1: NIDD with coronary occlusion/subocclusion (n=24), G2: controls with coronary occlusion/subocclusion (n=43), G3: controls without coronary occlusion/subocclusion (n=33). At time zero (T0) the following parameters were evaluated: end-systolic and end-diastolic volume indexes (ESVi, EDVi), ejection fraction (EF), echocardiographic wall motion score index (WMI), presence of left ventricular aneurysm, and triple-vessel coronary disease. The frequencies of major cardiovascular events were recorded during follow-up. Significantly greater ESVi and EDVi were noted in G2 compared with G3 (P<0.0001), while no significant differences were observed between NIDD patients and controls. Although left ventricular global and segmental dysfunctions were increased in diabetics, controls with coronary occlusion/subocclusion presented more pronounced EF reduction (P<0.0001 G2 vs G3) and higher elevation in WMI (P<0.005 G2 vs G3). Cardiac events during follow-up were elevated in G1 and G2, particularly as regards the occurrence of congestive heart failure. The authors conclude that NIDD seems to influence in a positive way left ventricular remodeling associated with postinfarct total or subtotal coronary occlusion.

Effect of atenolol and ramipril on regression of left ventricular hypertrophy: comparative echocardiographic assessment.

Left ventricular hypertrophy (LVH) dramatically worsens hypertensive illness. Because the genesis of LVH appears to be multifactorial, antihypertensive treatment should aim to reduce not only pressor values but also the hypertrophic ventricular mass. This result can be obtained only when drugs able to act on both pathogenetic factors are used. To evaluate the effectiveness of antihypertensive therapy on regression of LVH, 21 patients with stage 2 essential hypertension were treated for a year with either atenolol (120 mg/d orally), a cardioselective beta-blocker without intrinsic sympathomimetic activity, or ramipril (5 mg/d orally), an angiotensin-converting enzyme inhibitor with high tissue activity. Both treatments produced significant control of hypertension and regression of LVH. No statistically significant difference between treatments was noted, except for heart rate, which was substantially unchanged by ramipril but significantly decreased by atenolol. Both drugs were well tolerated. Atenolol and ramipril have a major role in the long-term treatment of hypertension and in the regression of hypertension-associated LVH.

[Effects of physical activity on the cardiovascular autonomic function in the aged]. / Effetti della attività fisica sulla funzione autonomica cardiovascolare nell'anziano.

The objective of this trial was to evaluate whether cardiovascular vagal-sympathetic relationship, which is expected to be decreased in the elderly, can be modified by physical activity performed in advanced age. Cardiovascular autonomic function, as assessed by heart rate and arterial blood pressure during lying to standing, deep breathing, handgrip isometric stress test and Valsalva manoeuver, was estimated through Ewing's test in 10 sedentary healthy elderly subjects (mean age 68 +/- 3.1) compared to 10 long-distance runners of the same age (mean age 69 +/- 4.6). The endurance athletes, suitable for competition, had been practicing sport activity for a long time. Moreover in order to evaluate the influence of physical activity on cardiovascular response to exertion in the elderly all subjects were submitted to maximal electrocardiographic exercise test on a cycloergometer (multistage program with 30 watt x 3 min. steps). Heart rate, arterial systolic and diastolic blood pressure were recorded; double product was calculated at baseline; furthermore, total and maximal watts were recorded. For each of the parameters, Student's "t" test for independent observations was used in order to evaluate statistical differences among the two groups. Our data exhibited better results in cardiovascular reflex response due to parasympathetic (Valsalva and deep breathing test) neurovegetative modulation in the trained subjects with respect to the sedentary controls: Valsalva ratio (VR) = 2.04 +/- 0.44 vs 1.40 +/- 0.18 p < 0.001); deep breathing test (FC) = 23.6 +/- 6.2 vs 15.1 +/- 2.5 p < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiovascular effects of amitriptyline in therapeutic dosages. Echocardiographic study]. / Effetti cardiovascolari dell'amitriptilina a dosaggi terapeutici. Studio ecocardiografico.

The authors studied the cardiovascular effects of amitriptyline at therapeutic plasma concentrations in 15 depressed patients (6 M. 9 F.) without cardiovascular disease both before treatment and after six months of therapy. The cardiovascular effects were evaluated by means of electrocardiographic and 2D-echocardiographic examinations in basal conditions and after hand-grip stress test. The effects of isometric hand-grip exercise (IHG) on left ventricular size and performance were studied non invasively in all patients at rest and after 3 min. of IHG at 30% of maximum contraction. Left ventricular internal diameter was measured at end-diastole and end-systole on LV echograms, and blood pressure was measured by sphygmomanometer. Our data confirmed the depressant effect of amitriptyline even on healthy myocardium, an effect that becomes manifest only at handgrip stress with a significant reduction of ejection fraction (form 70.6 to 66.4%; p < 0.001), while ECG and arterial blood pressure did not change throughout the study. This goes to show that treatment with tricyclic antidepressants always has a latent depressant effect on myocardial contractility that becomes clinically evident under stress, as well as in subjects with heart disease and in the elderly. Hence the need to monitor left ventricular function, as well as ECG and blood pressure, and to exercise great caution in prescribing tricyclic antidepressants to subjects with a history of myocardial failure.

[Effects of rehabilitation on cardiovascular autonomic function in ischemic cardiopathy]. / Effetti della riabilitazione sulla funzione autonomica cardiovascolare nella cardiopatia ischemica.

METHODS: Twenty patients with uncomplicated myocardial infarction randomized in two groups (group 1 and 2) of ten patients were investigated. Only group 1 trained four months according to a protocol of rehabilitation, whereas patients of group 2 followed their usual activity (control group). The autonomic cardiovascular function was estimated by Ewing's tests, that evaluate the variations of heart rate and blood pressure during deep breathing. RESULTS: Our data showed an increase of parasympathetic tone in group 1 (Valsalva ratio 1.55 +/- 0.28 vs 1.36 +/- 0.28, p < 0.01; variation in heart rate during deep breathing 17.3 +/- 4.6 vs 13.3 +/- 4.2). The sympathetic activity tests showed no significant difference after training. On the other hand, group 2 showed no significant difference in sympathetic and parasympathetic activity. CONCLUSIONS: In patients with uncomplicated myocardial infarction physical training increases the parasympathetic activity; as shown in the literature, such an increase can have clinical and prognostic importance, since improves cardiac performance and reduces the risk of sudden death from arrhythmic events.

[Locally advanced cancer of the breast (LACB) and identification of estrogen receptors with monoclonal antibodies]. / Considerações sobre o câncer localmente avançado de mama (CLAM) acrescidas de identificação dos receptores de estrogênios usando anticorpos monoclonais.

The effects of therapy in locally advanced breast cancer submitted to combined conventional telecobalt therapy plus chemotherapy with cyclophosphamide and 5-fluorouracil were studied in 49 patients. Associated to radical mastectomy in operable cases. Local tumor control was achieved in 86.7%. There were no local recurrences in those submitted to surgery but they reached 21.7% in inoperable patients who received only radiation therapy and chemotherapy. The median follow-up time for dead patients was 29.5 months and for living patients 79.3 months. The index of complete responses was 24.5% and the median disease free interval was 22.9 months. The overall survival rate, between three and five years, was 32.7%. Estrogen receptors were identified by using immunohistochemical assay ER-ICA and monoclonal antibody H222-SP gamma, Abbott. There were no differences in the complete response index, disease free interval and survival rates, among ER-positive and ER-negative patients, explained by the far advanced stage of the disease. ER-positivity was significantly correlated with histological features of the tumors: cell differentiation, presence of elastosis, absence of lymphocytic infiltration and absence of tumor necrosis.

Epilepsy and occupational accidents in Brazil: a national statistics study / Epilepsia e acidentes de trabalho no Brasil: um estudo das estatísticas nacionais

Epilepsy may restrict the patient's daily life. It causes lower quality of life and increased risk for work-related accidents (WRA). The aim of this study is to analyze the implantation of the Epidemiologic and Technical Security System Nexus (ETSSN) and WRA patterns among patients with epilepsy. Data regarding WRA, between 1999 and 2008, on the historical database of WRA Infolog Statistical Yearbook from Brazilian Ministry of Social Security were reviewed. There was a significant increase of reported cases during the ten year period, mainly after the establishment of the ETSSN. The increased granted benefits evidenced the epidemiologic association between epilepsy and WRA. ETSSN possibly raised the registration of occupational accidents and granted benefits. However, the real number of WRA may remain underestimated due to informal economy and house workers' accidents which are usually not included in the official statistics in Brazil.

A epilepsia pode restringir o cotidiano do paciente, levando a comprometimento da qualidade de vida e risco aumentado de sofrer acidentes. O objetivo deste trabalho é analisar o impacto do Nexo Técnico Epidemiológico Previdenciário (NTEP) sobre os acidentes de trabalho envolvendo pacientes com epilepsia. Pesquisando as estatísticas de acidentes de trabalho, ocorridos entre 1999 a 2008, na Base de Dados Históricos do Anuário Estatístico de Acidentes de Trabalho do Ministério da Previdência Social, observou-se aumento no número de acidentes de trabalho neste período de dez anos. Houve um aumento significativo no número de casos registrados, intensificado após a instituição do NTEP. O aumento de benefícios concedidos pela Previdência Social possivelmente se deve à aceitação do vínculo entre epilepsia e acidentes de trabalho sem necessidade de demonstração individualizada. Entretanto, grande parte dos acidentes pode não constar das estatísticas por acontecer na economia informal ou entre trabalhadores domésticos.

Prevalence of superficial mycoses in the Aosta Valley region of Italy from 1984 to 1989.

This report represents the results of the culture tests for fungi carried out in the Aosta Valley region of Italy from 1984 to 1989. The pathological material consisted of cutaneous scales, hair and nails. It was possible to identify 91.8% of the isolates: out of these, 36.1% were dermatophytes, 21% were Aspergillus spp, 15.6% Deuteromycetes, 15% yeasts and 4.1% members of the family Mucoraceae. The resulting data indicate that Microsporum canis was the most wide-spread species (73.7%) among the isolated dermatophytes and keratinophilic fungi (Trichophyton rubrum, T. mentagrophytes, Epidermophyton floccosum and Scopulariopsis brevicaulis): 87.5% were isolated from hair and 65.9% from the glabrous skin. The high prevalence of M. canis as the cause of dermatomycoses is discussed. Lastly the use made of the Regional Hospital's Mycology Department by health workers is discussed.

[The effect of physical exercise on the response to exertion in the elderly]. / Influenza dell'esercizio fisico sulla risposta allo sforzo nell'anziano.

BACKGROUND: A decrease in adaptation to exertion has been observed as age progresses. Although this decline may also be affected by factors such as health conditions and age, physical inactivity related to sedentary behaviour plays a dominant role. METHODS: In order to evaluate the influence of physical activity on cardiovascular response to exertion in the elderly, 4 groups of 22 subjects each were submitted to maximal electrocardiographic exercise test on a cycloergometer (multistage program with 30 Watts x 3 min. steps). All subjects were male. The composition of the groups was as follows: 1) veteran long distance runners (mean age: 71 +/- 5.4); 2) sedentary veterans (mean age: 69.8 +/- 3.9); 3) young long distance runners (mean age: 25.4 +/- 4.3); 4) sedentary young adults (mean age: 25.8 +/- 3.9). The endurance athletes, well fitted to competition, had been practicing sport activity for at least 3 years. RESULTS: Heart rate, arterial systolic and diastolic blood pressure were recorded; mean blood pressure and double product were calculated at baseline and at the climax of the stress test; furthermore, total and maximal watts were recorded. For each of the parameters, Student's t test for non-paired observations were used to evaluate statistical differences amongst the four groups. The most interesting result arises in the comparison between veteran long distance runners and sedentary young adults: between the two groups no statistically significant differences in workload, expressed as total watts (1649.55 +/- 296.32 vs 1650.00 +/- 446.32; p = NS) and maximal watts (175.91 +/- 19.19 vs 173.18 +/- 24.38; p = N.S.), were observed. On the contrary, highly significant differences in both total (p < 0.01) and maximal (p < 0.01) watts were noticed by comparing long distance runners and sedentary subjects of the same age. CONCLUSIONS: These data support the hypothesis that the progressive reduction in physical activity, which is usually observed in aging, is the major determinant of exercise deconditioning in the elderly.

[Analysis of variations in cardiac performance induced by tilt and hand-grip in athletes and in untrained subjects]. / Analisi delle variazioni del rèndimento cardiaco indotte dal tilt e dall'hand-grip in atleti ed in soggetti non allenati.

The aim of the present study is to analyze variations of external cardiac work and of indices of myocardial oxygen consumption induced by upright tilting and hand-grip in volley-ball athletes (group A) in comparison with a group of normal subjects (group N). For this purpose we have used impedance cardiography, a simple, reproducible and non invasive technique, which is very reliable in evaluating both systolic time intervals and hemodynamic parameters such as stroke volume and cardiac output. No significant differences, of external cardiac work, double and triple product were observed between group A and N upon upright tilting. Hand-grip test, on the other hand, can differentiate the myocardial behaviour of trained people from that of the control group. The double product was significantly reduced in group A in comparison with group N (P less than 0.001 and the end of the test, P less than 0.05 after 30", P less than 0.001 after 1' and 3"). The triple product was significantly reduced in group A in comparison with group N at the end of the test (P less than 0.005). External cardiac work was always higher in group A in comparison with group N (P less than 0.02, at the stop P less than 0.05 after 30", P less than 0.01 after 1', P less than 0.0001 after 3'). Therefore in volleyball athletes the myocardium exhibits better mechanical performance than in normal subjects.