Enalapril: a new angiotensin-converting enzyme inhibitor in chronic heart failure: acute and chronic hemodynamic evaluations.

Hemodynamic effects of the new oral angiotensin-converting enzyme inhibitor, enalapril, were evaluated acutely in 15 patients with chronic heart failure and in 7 patients after 4 weeks of maintenance therapy. Initial hemodynamic effects were characterized by a significant increase in cardiac index (from 2.1 +/- 0.7 to 2.6 +/- 0.7 liters/min per m2) and a decrease in pulmonary capillary wedge pressure (from 30 +/- 6 to 24 +/- 7 mm Hg), right atrial pressure (from 14 +/- 5 to 11 +/- 4 mm Hg), mean arterial pressure (from 96 +/- 16 to 80 +/- 17 mm Hg) and systemic vascular resistance (from 1,820 +/- 480 to 1,200 +/- 410 dynes . s . cm-5) without any significant change in heart rate, pulmonary artery pressure and pulmonary vascular resistance. During maintenance therapy, the dose of diuretic drugs had to be increased because of systemic venous hypertension. Repeat hemodynamic study showed that after chronic therapy, cardiac index (2.1 +/- 0.7 vs. 3.0 +/- 0.08 liters/min per m2) and stroke volume index (24 +/- 10 vs. 36 +/- 7 ml/m2) remained elevated and pulmonary capillary wedge pressure was lower than control (30 +/- 6 vs. 16 +/- 6 mm Hg), indicating sustained improvement in left ventricular performance. Plasma renin activity increased and plasma norepinephrine levels decreased after enalapril therapy and these humoral changes persisted during maintenance therapy. All patients receiving chronic therapy had symptomatic improvement. Significant hypotension, which occurred in five patients at the initiation of therapy, appears to be the major side effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Quality-of-life assessment in a home care program for advanced cancer patients: a study using the Symptom Distress Scale.

Quality-of-life assessment in advanced cancer patients should include the study of physical function, psychological status, social interactions, and symptoms. "Symptom distress" relates to the degree of discomfort caused by specific symptoms. A Symptom Distress Scale, which has been developed by McCorkle and Young, is a self-rating instrument that evaluates 13 symptoms. In the present study, the Italian version of the Symptom Distress Scale (SDS) was used to assess the quality of life in advanced cancer patients. The internal consistency of this version was found to be good (Cronbach's coefficient alpha = 0.78). A sample group of 43 patients treated in a home care program was asked to fill out the SDS on a weekly basis. The scores showed a reduction in symptom distress, which was primarily due to improvement in pain, nausea, and bowel pattern. Home care was less effective in improving concentration and, more generally, psychological aspects. This study confirms the validity of a quality-of-life monitoring system that uses a patient self-rating symptom assessment instrument.

Nursing care planning for terminally ill cancer patients receiving home care.

Nursing home care for terminally ill cancer patients was organized according to nursing care plans that were based on diagnoses as recommended by the North American Nursing Diagnosis Association (NANDA). This study was carried out among a sample of 40 patients receiving home health care for a period of 1 to 19 weeks. More than 697 nursing diagnoses were identified in the study. The most frequently recorded nursing diagnoses were anxiety, constipation, and diminished food intake. Fifteen of the 40 patients in the study were able to complete a weekly self-report of their symptoms. The patients' own descriptions of their symptoms were then compared with their symptoms as identified by nursing staff. There was a congruence in 63% of reported instances. Although nurses' assessments were not always in agreement with the symptoms reported by the patients, agreement was more frequently found with somatic symptoms than with psychological ones. One conclusion is that nursing plans should incorporate multidimensional methods for assessing patients' real needs.

The Trabucco technique in the treatment of inguinal hernias; A six-year experience.

BACKGROUND: The introduction of both polypropylene prosthesis and the new tension-free methods for the treatment of inguinal hernias, induced us to choose the Trabucco technique since August 1994. METHODS: Up to April 2001 983 inguinal hernia repairs were carried out in 825 patients, 948 with the Trabucco technique. RESULTS: Minor complications (hematoma, seroma, inguino-crural pain) were 42 (5.1%) with no wound infections. There were 3 relapses (0.36%), one treated in an other hospital and the other two were surgically treated because of the small dimension of the hernia and they were not troublesome for the patients, although they were strictly controlled. CONCLUSIONS: In spite of the limited follow-up period, there is satisfaction for the short-term period outcomes which showed the superiority of the Trabucco method compared with the traditional techniques both as to hospitalization and good recovery and to the early relapse.

[Carcinoid of the appendix. Clinical report of 3 cases and diagnostic and therapeutic considerations]. / Il carcinoide dell'appendice. Osservazione clinica di 3 casi e considerazioni diagnostiche e terapeutiche.

The Authors report three cases of carcinoid of the appendix and discuss the difficult preoperative diagnosis and the different therapeutic options available. Over the period from January 1994 to December 1999, in the Surgery Unit of Penne Hospital, 424 appendicectomies were performed in 182 males and 242 females (age: 12-86 years; mean age: 39.9 years). In three cases the histological response was positive for carcinoid of the appendix. No postoperative mortality or morbility were reported. The authors analyze the biological peculiarities and the prognostic factors associated with appendiceal carcinoid tumours, such as tumour size and the lymphatic or vascular infiltration of the mesoappendix (and the corresponding more aggressive surgical treatments) and recommend an appropriate postoperative follow-up since synchronous or metachronous bowel carcinomas are likely to occur. Pharmacological therapy has also made important progress, with the possibility of administering compounds capable of interfering with tumour development and neoplastic growth.

Development of gestalt-reading processes in children: assessment using the Boder test.

According to Boder, there are two processes involved in reading: visual-gestalt and analytic-phonetic. The gestalt process is activated for known words, forming part of the child's "sight vocabulary", and it enables him/her to recognize words even when they are exposed for a very short time. The analytic-phonetic process involves the auditory channel when the words are not part of the "sight vocabulary" and require a spelling process. At first, neither the English version nor the Italian adaptation of the Boder test included a control of word exposition time (ET) and reading time (RT). Both parameters are necessary for a check of the gestalt and phonetic processes. The aim of this paper was the assessment of minimum ET for the words belonging to the "sight vocabulary" and of RT for a word read through a gestalt process. Seventy-five primary schoolchildren from the first to the fifth class were presented with 100 meaningful words (MF) and 100 meaningless (ML) words, using ETs ranging from 150 to 650 ms. The results showed that, at the age of 7 years, the gestalt process was completely developed. Of MF words, 95% were correctly read and it did not change significantly with longer ETs. The RT for MF words did not change with different ETs and remained stable after the age of 7 years. Finally, the RT for ML words was always longer than the RT for MF words, and the difference was significant in 8-, 9- and 10-year-old children.