[Carotenodermia: an erroneous diagnosis of jaundice]. / Carotenodermia: un'errata diagnosi di ittero.

Carotenoids are essential pigments in vegetal photosynthetic processes, but they also have important biological functions in animal physiology: beta carotene in particular represents provitamin A. The accumulation of carotenoids in a man results in a cutaneous hyperpigmentation very similar to jaundice: usually this happens in vegetarian subjects after an excessive food eating. In the described case, a situation similar to jaundice appeared in a 56 years old man affected by psychic disorders, his diet consisted for several years almost exclusively of eggs (an average of 27 eggs a day). As this type of food is very rich in carotenoids (especially lutein giving to yolk the characteristic colour), it is inevitable that, in addition to hypercholesterolemia, a consistent amount of carotenodermia is present. This recalls the possible antiaterogenal action of carotenoids.

Target organ damage and ambulatory blood pressure in stage I hypertension. The Hypertension and Ambulatory Recording Venetia Study.

According to recent international guidelines the decision on whether to treat young subjects during the early phase of hypertension should be based not only on their office blood pressure but also on their ambulatory blood pressure and whether target organ damage has occurred. Few data on the prevalence of hypertensive complications in young subjects with mild hypertension are available. In the Hypertension and Ambulatory Recording Venetia Study (HARVEST), a multicenter trial conducted in northeast Italy, the percentage of young borderline-to-mild hypertensive subjects with echocardiographic left ventricular hypertrophy was 4.5% and the percentage with concentric remodeling was 4%. Clear differences in cardiac size and geometric adjustment to ambulatory systolic pressure between the two sexes were found. The impact of blood pressure on the walls of the left ventricle and on the left ventricular mass was remarkable in women but weak in men. The assessment of left ventricular systolic function confirmed that many young mild hypertensive subjects have an increased ejective performance. The left ventricular contractility evaluated by midwall measurement was, however, found to be depressed in 9.2% of the HARVEST participants. Their left ventricular diastolic function was similar to that of 50 normotensive controls. The prevalence of microalbuminuria [albumin excretion rate (AER) > 30 mg/24 h) was 6.1%, only slightly higher than that found by other authors among normotensive subjects and much lower than that observed among patients with more severe hypertension. For our stage I hypertensives, however, the AER was correlated to the 24 h blood pressure with high statistical significance, whereas we found no relationship between the AER and left ventricular mass index either for all of the subjects taken together or for the men and women considered separately. The results suggest that renal and cardiac involvement do not occur in parallel during the initial phase of hypertension.

Prevalence and clinical correlates of microalbuminuria in stage I hypertension. Results from the Hypertension and Ambulatory Recording Venetia Study (HARVEST Study).

The objective of the present study was to examine the association between albumin excretion rate (AER) and office and ambulatory blood pressures (BP), and other recognized cardiovascular risk factors in stage I hypertension. The study was carried out in 870 never-treated 18- to 45-year-old hypertensives (628 men, 242 women). Office and ambulatory BP, 24-h urinary collection for AER assessment, and echocardiographic left ventricular mass (n = 587) were obtained. AER was similar in men and women (12.3 v 12.5 mg/24 h) and was unrelated to age and body mass index. In 85.2% of the subjects, AER was < 16 mg/24 h, in 8.3% it was between 16 and 29 mg/24 h (borderline microalbuminuria), and in 6.1% it was >or= 30 mg/24 h (overt microalbuminuria). Office systolic BP was not different in the three groups, whereas 24-h systolic BP was higher in the subjects with microalbuminuria than in those with normal AER (P < .0001) and was similar in the two microalbuminuric groups. Office and 24-h diastolic BPs were higher in the subjects with overt microalbuminuria than in those with normal AER. Left ventricular mass was correlated to systolic (P < .0001) and diastolic (P = .01) 24-h BP, but was unrelated to AER. Family history for hypertension, smoking, coffee and alcohol intake, and physical activity habits did not influence AER. In a logistic regression analysis, 24-h systolic BP emerged as the only determinant of microalbuminuria (P < .0001). In conclusion, these results indicate that borderline levels of microalbuminuria may also be clinically relevant in stage I hypertension. Overweight and lifestyle factors do not appear to influence AER in these patients. Finally, the lack of correlation between AER and left ventricular mass suggests that renal and cardiac involvement do not occur in a parallel fashion in the initial phase of hypertension.

[Diagnostic aspects of spontaneous bacterial peritonitis in hepatic cirrhosis with ascites]. / Aspetti diagnostici della peritonite spontanea batterica nella cirrosi epatica con ascite.

Spontaneous bacterial peritonitis (SBP) is a severe complication appearing in 8-22% of hepatic cirrhosis with ascitic decompensation. The authors describe 6 cases of SBP in hepatic cirrhosis. SBP diagnosis has been confirmed by isolation of the aetiological agents in the ascitic fluid, and PMN count above 250/ml in 12% of the studies cases. SBP diffusion and the high mortality risk justify the examine of the ascitic fluid also in asymptomatic patients.

Interactive effect of cigarettes and coffee on daytime systolic blood pressure in patients with mild essential hypertension. HARVEST Study Group (Italy). Hypertension Ambulatory Recording VEnetia STudy.

OBJECTIVE: To test the hypothesis that moderate smoking (fewer than 20 cigarettes/day) and coffee consumption have an interactive effect on ambulatory blood pressure. DESIGN: A case-control study. SETTING: Patients in the multicentre Hypertension Ambulatory Venetia Study, northeastern Italy. SUBJECTS: Six hundred and forty-three men and 244 women with borderline-to-mild status (non-smokers versus smokers) and their habitual consumption of coffee (0, 1-3, or 4+ cups/day). MAIN OUTCOME MEASURES: Office blood pressure, ambulatory blood pressure, urinary adrenaline and noradrenaline levels according to smoking status, coffee consumption and their interaction. RESULTS: In the men, daytime systolic blood pressure (SBP) was significantly higher in the smokers than in the non-smokers and in the coffee drinkers than in the others. Moreover, two-way analysis of covariance revealed a significant interaction between smoking status and coffee consumption: the daytime SBP in smokers who drank 4+ cups/day of coffee was 6.0 mmHg higher than that of non-smokers who abstained from coffee. Conversely, office blood pressure was lower in the smokers than in the non-smokers and was similar in the coffee drinkers and the others. Coffee consumption had a significant effect on urinary adrenaline. Similar results were obtained in the women. CONCLUSIONS: In contrast with what is shown by office blood pressure measurement, moderate smokers and coffee drinkers with mild hypertension have significantly higher daytime SBP levels than non-smokers and those who do not drink coffee. Cigarettes and coffee have an interactive effect on daytime SBP in young patients, with mild essential hypertension.

[Therapeutic use of metadoxine in chronic alcoholism. Double blind study of patients in a department of general medicine]. / Uso terapeutico della metadoxina nell'alcolismo cronico. Studio clinico in doppio cieco su pazienti ricoverati in un reparto di Medicina Generale.

Sixty patients, recognized as chronic alcoholics on the grounds of the case history and with a score above 11 of the Munich Alcoholism Test (MALT) have been treated with metadoxine or placebo for thirty days according to a double blind randomized design. In the group treated with active drug there has been a significant reduction higher than in the controls of the scores relating to the abstinence symptomatology, in particular regarding the neuropsychic residual symptomatology (anxiety, depression, insomnia) after the first week of treatment, a reduced requirement of benzodiazepines and/or neuroleptics, and a significant decrement higher than in the controls of the score of MALT at the end of treatment. Furthermore, metadoxine seems to make easy the maintenance of abstinence, at least at short term.

[Correlations between laboratory and ultrasonic diagnosis and needle biopsy in chronic hepatitis and alcoholic cirrhosis]. / Correlazioni fra diagnosi laboratoristica, ecografia e agobiopsia di epatite cronica e cirrosi alcoolica.

A report is presented on patients admitted to hospital with chronic hepatitis or alcoholic cirrhosis of the liver and subjected to diagnostic laboratory tests, ultrasound scans and needle biopsies both non-surgical and during laparoscopy. The laboratory findings were compared with the results of ultrasound scans and biopsies. It was concluded that the diagnostic accuracy of ultrasound scans is sufficient, when backed by anamnestic clinical and laboratory data, to obviate the need for liver biopsy in cases of chronic hepatitis and alcoholic cirrhosis. Nor is biopsy required for differential diagnosis between the two conditions but should be reserved for the setting of diagnostic uncertainty about cancer-cirrhosis, or the presence of hepatoma, liver metastases, ascites or other oedematous forms. It is concluded that the undoubled diagnostic accuracy of biopsy does not compensate for the risk entailed especially for patients of this type.