Nailfold capillaroscopic changes in patients with idiopathic pulmonary arterial hypertension and systemic sclerosis-related pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) represents one of the main clinical expressions of the vascular changes in systemic sclerosis (SSc). Lung microvascular changes can play a role in the pathogenesis of idiopathic PAH (IPAH) also. The aim of this study is to investigate the presence of capillaroscopic abnormalities in patients with IPAH and to evaluate the differences in capillary nailfold changes between patients with IPAH and patients with SSc with and without PAH. METHODS: 39 SSc patients (19 with PAH - SSc-PAH and 20 without - SSc-noPAH), 21 subjects with IPAH and 20 healthy subjects were recruited. PAH was diagnosed by right heart catheterization. Nailfold videocapillaroscopy was performed (NVC) in all recruited subjects; capillary quantitative parameters (loops length and width, capillary density, neoangiogenesis) were evaluated and a semiquantitative scoring was used (normal, minor or major abnormalities for healthy controls and IPAH subjects and specific patterns - early, active and late - for SSc subjects) to define microvascular alterations. RESULTS: The presence of capillaroscopic abnormalities was detected in 38,1% subjects with IPAH; particularly, compared to healthy controls, capillary density was significantly lower (7,5±1,65loops/mm vs 9±1,37loops/mm p<0,05) and mean capillary width was significantly higher (21±13µm vs 17±3µm p<0,05). A more severe NVC pattern (active/late) was described. SSc-PAH patients compared to SSc-noPAH patients (73,2% vs 50% respectively, p<0,05), with a significantly lower capillary density (5,64±1,9loops/mm vs 6,5±1,3loops/mm p<0,05) and a significantly higher capillary width (55±7µm vs 35±8µm - p<0,05) and mean number of neoangiogenesis (N/mm) (1±0,33 vs 0,2±0,22 respectively p<0,05). CONCLUSIONS: These data, beyond to confirm the role of microvascular damage in SSc-related PAH, support the hypothesis of systemic microvascular involvement in IPAH also, which can be detected by NVC, although further studies are needed to establish whether the changes in the systemic microcirculation are causal or consequential to PAH.

[Diet, metformin and inositol in overweight and obese women with polycystic ovary syndrome: effects on body composition]. / Dieta, metformina e inositolo in donne sovrappeso e obese con sindrome dell'ovaio policistico: effetti sulla composizione corporea.

AIM: The aim of this study was to evaluate the effects of diet alone, and in association with metformin in monotherapy or in cotreatment with myoinositol (MYO) on menstrual irregularities, hirsutism, body weight and composition in overweight/obese women with polycystic ovary syndrome (PCOS). METHODS: Twenty-seven PCOS overweight/obese patients were randomly treated: nine with only diet (D); nine with diet and metformin 1000 mg/day continuously (D+M); nine with diet, metformin 500 mg/day and MYO 4 g/day plus 400 µg folic acid daily, continuously (D+M+I). Menstrual cycle, Ferriman-Gallwey score, body mass index (BMI), waist hip rate (WHR), body composition by BIA 101 of AKERN SRL, were measured on basal condition and at 3 months. RESULTS: Regularity of menstrual cycle was restored in a significantly number of patients of group D+M+I (P<0.05); Ferriman score was significantly improved by weight loss (P<0.05). Body weight, BMI, waist and hip circumferences decreased significantly in all groups without WHR modification; body weight loss significantly depended on adding metformin to diet. Fat mass (FM) kg and % was significantly reduced in groups D and D+M+I; fat free mass (FFM) kg was slightly reduced by diet (P<0.05) and correlated with Ferriman score. CONCLUSION: Body weight loss in obese PCOS patients improves symptoms and body composition; weight loss was dependent on adding metformin to diet; MYO was more effective in restoring regularity of menstrual cycle. Further investigation occurs to confirm metformin and MYO rule on body composition improvement, specially regarding FFM that is likewise FM correlated to cardiovascular risk.

Phosphorescent iridium-containing nanomicelles: synthesis, characterization and preliminary applications in nanomedical imaging.

Diagnostic nanomedicine constantly requires the development of novel contrast agents with intrinsic imaging capabilities. Phosphorescent Ir(iii)-complexes represent good candidates when delivered through polymeric nanoparticles. In this work, we propose a biocompatible nanoparticle made from an intrinsically phosphorescent copolymer, synthesized directly with an imaging tag present on its backbone. Polymeric nanoparticles can be obtained with the exact amount of phosphorescent moieties needed to maximize their output signal. Complete characterization and ex vivo studies confirmed that this nanosystem is suitable as a future diagnostic tool.

[Comparison between pre- and postnatal echographic screening of malformative uropathies]. / Confronto tra lo screening ecografico pre- e postnatale delle uropatie malformative.

AIM: The aim of this study has been to compare the validity of postnatal echographic screening in respect of prenatal echography in early diagnosis of malformative uropathies (MU). METHODS: In 6578 infants, who have been submitted to fetal echography, and to a postnatal screening of MU in our Neonatal Service of Echography (University of Messina), we have compared the diagnostic agreement of prenatal with postnatal echography. RESULTS: Our comparison demonstrates that, in respect of postnatal screening, only 35.71% of pyelectasies and 73.17% of hydronephrosis have been diagnosed by fetal echography, and, in particular, only 18.75% of no-dilated MU. CONCLUSIONS: These data confirm that, in our country, the postnatal screening of MU has still significance and suggest that, before excluding this screening, it is necessary to verify everywhere the validity of fetal echography.

[Brachial plexus paralysis: its incidence, predisposing factors and outcome]. / Paralisi del plesso brachiale: incidenza, fattori predisponenti ed esiti.

METHODS: We have studies, retrospectively, the risk factors, incidence and outcome of obstetric palsy in all infants delivered between January 1990 and December 1994 at the Obstetric and Gynecological Department and afferent to the Neonatological Division of the University of Messina. Twenty-eight of the 5556 live born full term infants (5/1000) were at birth diagnosed as having a brachial plexus paresis. Of these eight (1.6/1000) had persistent palsy. RESULTS: In about 40-50% of the infants with brachial plexus palsy the obstetric history was characterized by high birthweight, shoulder dystocia, and parity 1. The infants who recovered totally did so during the first 12 months of life. All infants had upper brachial plexus, or Erb's palsy, which is more favorable than entire brachial plexus palsy. At follow-up (15 months-5 years), all infants with persistent palsy were afflicted by varying degrees of arm function compromise. CONCLUSIONS: We stress that, in several cases, obstetric brachial plexus palsy results in life-long handicap, and that prevention, early diagnosis and therapy need to be the goals of the obstetrical and pediatric management.

[Diabetes and pregnancy. Maternal risk factors and neonatal morbidity]. / Diabete e gravidanza. Fattori di rischio materni e morbilità neonatale.

BACKGROUND: To verify in our population the incidence of infants of mother with insulin dependent diabetes mellitus (IDDM) or gestational diabetes (GD) and to evaluate the maternal characteristics influencing neonatal outcome. METHODS: The study was retrospectively performed on 6179 infants born between 1995 and 1998 at the Obstetric Clinic of the University of Messina and referred the Division of Neonatology. The following groups have been selected: group A (offsprings of IDDM mothers), group B (offsprings of DG mothers), group C and group D, controls, (2 infants of the same sex and gestational age born before and after the infants of group A and group B, respectively). The parameters analyzed were: diabetic familiarity, age, weight and body mass index (BMI) of the mothers, delivery, gestational age, weight at birth, neonatal outcome. RESULTS: The infants of IDDM mothers were 3% and the infants of GD mothers were 0.8%. Group A and group B present a significantly higher incidence of: diabetic familiarity, cesarean section, macrosomia, hypoglycemia, hypocalcemia, hyperbilirubinemia. The GD mothers had weight and BMI higher than IDDM mothers. The infant weight did not correlate with maternal weight and BMI. CONCLUSIONS: These data suggest that in our population GD is underestimated, metabolic control in pregnancy is insufficient, obstetric practices are too invasive, neonatal outcome is verosimely correlated only to metabolic control.

[Blood coagulation in 222 cases of solid malignant neoplasms]. / Assetto emocoagulativo in 222 casi di neoplasia maligna solida.

We have examined 222 patients with nonterminal solid malignant tumors in order to study the possible variations on the hemocoagulation system due to neoplasia. Only patients whose hemocoagulation system could be proven normal by test made before the malignant neoplasia appeared were taken into consideration. Our study was based on the following tests: platelet count, platelet adhesiveness and aggregation, prothrombin time, thrombin time, thrombotest, antithrombin 3, thrombin-coagulase, activity partial thromboplastin time, fibrinogen, reptilase time. Our study showed there was no relevant difference between the results tests of healthy people taken as points or reference and those of our patients. We did find however a slight but diffuse alteration of all, or almost all, the components of the hemostatic and coagulation system. These variations however were not significant enough to enable us to prove any connection between the neoplasia and the whole hemocoagulation system.

Red blood cell depletion of cord blood using hydroxyethylstarch double sedimentation: analysis of 40 cases.

Cord blood has been shown to successfully reconstitute haematopoiesis following allogeneic transplantation in a variety of disorders. A major drawback of cord blood has been the risk of transfusion reaction secondary to ABO incompatibility and reduction in the stem cell pool if cord blood is manipulated to remove red cells. We report our experience on red blood cell depletion of cord blood (CB) with hydroxyethylstarch (HES) double sedimentation. The nucleated and mononucleated cell recovery passed from 78.4% at 90 min to 92.9% at 180 min and from 85% at 90 min to 96% at 180 min, respectively. The overall recovery of CCD34+ cells and of haemopoietic progenitors (CFU-GM) was 90.5% and 83.8%, respectively. The data indicate that HES double sedimentation is a simple and effective technique for cord blood manipulation, but further studies are necessary to evaluate the clonogenic progenitor recovery after thawing.