EVAR and OPEN treatment of abdominal aortic aneurysm: What is the role of MMP-9 in the follow-up?

INTRODUCTION: The aim of our study is to verify the role of metalloproteinases in endovascular repair (EVAR) and OPEN surgery treatment for abdominal aortic aneurysm (AAA). Postoperatively, these enzymes could represent an important biomarker to adapt diagnostic tests and further investigations during follow-up. MATERIAL AND METHOD: From 2004 to 2008, 55 patients were considered with AAA. Of these, 33 patients (mean age: 70.1 years), (mean AAA diameter: 5.4cm) were treated with OPEN surgery (group A) and 22 (mean age: 74.1 years) (mean AAA diameter: 5.1cm) were treated with EVAR. In 17 of them, there were no signs of endoleak (group B1), while in 5 patients, a presence of endoleak (group B2) was detected. Plasma samples were collected in order to determine MMP-9 activity. Enzyme immunoassay was performed preoperatively at 1, 3, 6 and 12 months. Patients treated conventionally were clinically examined after 1 and 12 months by ultrasound. Patients undergoing EVAR treatment were clinically examined by CT scan after 1, 3, 6 and 12 months. The analysis was done by assessing the interaction over time of the MMP-9 value in B1 and B2 groups. RESULTS: The average values observed for MMP-9 were preoperatively and at 1, 3, 6 and 12 months, respectively: in group A 150.8ng/mL (SD=30.5), 252.5ng/mL (SD=25.2), 315.4ng/mL (SD=22.7), 295.3ng/mL (SD=26.8), 210.7ng/mL (SD=30.2); in group B1 105ng/mL (SD=10.8), 125.6ng/mL (SD=18), 85.8ng/mL (SD=19.9), 95ng/mL (SD=20.2), 80.4ng/mL (SD=15.6); in group B2 149ng/mL (29.2), 375.4ng/mL (SD=40.2), 215ng/mL (SD=35.9), 180ng/mL (SD=20.2), 175ng/mL (SD=33.4). The MMP-9 level was higher in group B2 compared to group B1 (P=0.01), suggesting a correlation with the presence of the endoleak. CONCLUSIONS: This preliminary study shows that MMP-9 may be a biomarker of the presence of endoleak. Other further investigations and larger series are needed to show that metalloproteases could play a role in the follow-up of EVAR treated patients.

Specific learning disorder in the primary epilepsies of childhood.

AIM: The aim of this study was to investigate the presence of learning disorders in children with idiopathic epilepsy. METHODS: The study enrolled 16 children with idiopathic epilepsy, 8 with absence and 8 with rolandic epilepsy. This was a standardized neuropsychological assessment with particular attention to learning performance (reading and writing skills/number processing). RESULTS: Fourteen out of 16 subjects resulted with a specific learning disability, although specific patterns have not been identified. CONCLUSION: The study confirms the higher incidence of learning disorder in children with epilepsy (in front of normal prevalence, 2-10%). The importance of complete neuropsychological evaluation in children with focal or generalized epilepsy was highlighted.

Endoparasites of chub (Leuciscus cephalus) in two rivers of the Abruzzo region of Italy.

The relationship between communities of chub endoparasites (Leuciscus cephalus) fished in the Orta and Pescara Rivers in the Abruzzo region of Italy, and the quality of the water in which they are caught, were studied in surveys designed to evaluate the feed quality of fish in the inland waters of the Abruzzo. Samples were taken monthly from October 2000 to September 2001 in the Orta River (Buscesi District) and the Pescara River (near the Villareia bridge); a total of 86 chub were caught. During periods of low and moderate flow in both rivers, benthonic macroinvertebrates were sampled at the fish sampling sites to classify the water quality using the extended biotic index (EBI) method. The Orta River was moderately polluted and the Pescara River slightly more polluted than the Orta. A parasitological study of the fish was conducted using conventional methods. A morphological study of the parasites led to the identification of seven species of endoparasites. Five of these (Allocreadium isoporum, Caryophyllaeus brachycollis, Caryophyllaeides fennica, Rhabdocona denudata and Pomphorhyncus laevis) were found at both sampling sites, while Acanthocephalus clavula was found only in the Pescara River and Neoechinorhynchus rutili was found only in the Orta River.

Cost-of-illness study in acromegalic patients in Italy.

INTRODUCTION: acromegalic therapeutic goals are directed at removing the tumor, preventing tumor re-growth and reducing long-term morbidity and mortality. In this scenario, the acromegalic patient needs a variety of health resources (diagnostic tests, surgery, radiotherapy, specialist visits and drugs) for his/her cure, in order to decrease/stop the progression of the disease and to cure the co-morbid diseases. Lack of epidemiological data has suggested performing an Italian retrospective study aiming to assess the health resource consumption that is caused by acromegalic cure and the relative co-morbidities, in order to estimate the amount of the direct costs of acromegalic patients. METHOD: a retrospective study was performed on a total of 134 patients (142 patients selected, 76 in Genoa and 66 in Turin) for a period of about 7 yr preceding the enrolment date. Only direct costs were evaluated by performing an analysis on the perspective of Italian Healthcare Service (SSN). RESULTS: the mean total direct costs for acromegaly cure ranged from 7,968.41 to 12,533.02 Euros/yr (p < 0.01; Mann Whitney Test), respectively, for Responders and Non-Responders. The cost driver was drug (SS analogs) for acromegalic cure. The co-morbidity conditions associated to acromegalic Non-Responder patients are clearly higher than those with well-controlled disease. CONCLUSION: the study supports the hypothesis that controlled patients drove a saving for SSN in comparison to poor control patients that use more health resources.

Academic models of clinical care for women: the National Centers of Excellence in Women's Health.

Between 1996 and 1999, 18 academic health centers were awarded the designation of National Center of Excellence (CoE) in Women's Health by the Office on Women's Health within the Department of Health and Human Services and were provided with seed monies to develop model clinical services for women. Although the model has evolved in various forms, core characteristics that each nationally designated CoE has adopted include comprehensive, women-friendly, women-focused, women-relevant, integrated, multidisciplinary care. The permanent success of these comprehensive clinical programs resides in the ability to garner support of leaders of the academic health centers who understand both the importance of multidisciplinary programs to the clinical care they provide women and the education they offer to the future providers of women's healthcare.

Sleep quality, estradiol levels, and behavioral factors in late reproductive age women.

OBJECTIVE: To estimate the prevalence of perceived poor sleep in women aged 35-49 years and to correlate sleep quality with levels of gonadal steroids and predictors of poor sleep. METHODS: A cohort of 218 black and 218 white women aged 35-47 years at enrollment (aged 37-49 at final follow-up) with regular menstrual cycles was identified through random digit dialing for a longitudinal study of ovarian aging correlates. Data obtained at four assessment periods, including enrollment, over a 2-year interval were collected between days 1 and 6 (mean = 3.9) of the menstrual cycle. The primary outcome measure was subjects' rating of sleep quality at each assessment period. Associations of sleep quality with hormone levels (estradiol, follicle-stimulating hormone, luteinizing hormone, testosterone, and dehydroepiandrosterone sulfate) and other clinical, behavioral, and demographic variables were examined in bivariable and multivariable analyses. RESULTS: Approximately 17% of subjects reported poor sleep at each assessment period. Significant independent associations with poor sleep included greater incidence of hot flashes (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.08, 2.12, P =.02), higher anxiety levels (OR 1.03; 95% CI 1.00, 1.06, P =.04), higher depression levels (OR 1.05; 95% CI 1.02, 1.07, P <.001), greater caffeine consumption (OR 1.25; 95% CI 1.04, 1.49, P =.02), and lower estradiol levels in women aged 45-49 (OR 0.53; 95% CI 0.34, 0.84, P =.006), after adjustment for current use of sleep medications. CONCLUSION: Both hormonal and behavioral factors were associated with sleep quality. Estradiol levels are an important factor in poor sleep reported by women in the 45-49 age group. Further evaluation of estrogen treatment for poor sleep of women 45 years and older is warranted.

Very early tracheal extubation without predetermined criteria in a liver transplant recipient population.

This study of all patients undergoing orthotopic liver transplantation (OLT) at our center between January 1997 and December 1999 evaluated the feasibility and safety of very early tracheal extubation without previous selection. Anesthetic management was the same in all cases, and tracheal extubation was performed on the basis of standardized criteria routinely adopted in operating rooms throughout the world, i.e., no residual curarization or anesthetic action, ability to swallow efficiently, and stable hemodynamics. One hundred sixty-nine patients underwent 181 OLTs during the study period. Tracheal extubation was performed within 3 hours of surgery in 115 cases, 8 hours in 19 cases, and 8 to 24 hours in 10 cases. In 36 cases, artificial ventilation was required for more than 24 hours or weaning was not possible. One patient died of primary graft nonfunction within 24 hours and was excluded from the analysis. The feasibility of early extubation was influenced by the amount of intraoperative transfused blood; efficacy of kidney, cardiac, and pulmonary function; and presence of encephalopathy (P <.001). No correlation was found with age or pre-OLT severity of hepatic disease, and the postoperative period was not compromised by early weaning. Very early extubation was feasible and safe in a large number of unselected transplant recipients, thus suggesting that the definition of early tracheal extubation should be changed from 8 to 3 hours after surgery.

Hot flashes in the late reproductive years: risk factors for Africa American and Caucasian women.

Hot flashes are a primary reason that midlife women seek medical care, but there is little information about the onset or the predictors of hot flashes in the years before the menopause. This study examines women's experience of hot flashes in the late reproductive years, comparing African American and Caucasian women, and identifies hormonal, behavioral, and environmental risk factors for hot flashes associated with ovarian aging. Data are from a population-based prospective cohort study of ovarian aging in women who were ages 35--47, in general good health, and had regular menstrual cycles at study enrollment. Hot flashes were assessed by subject report in a structured interview at the first follow-up period and correlated highly with previous prospective daily ratings of hot flashes (p = 0.0001). Blood samples were obtained in the first 6 days of the menstrual cycle in two consecutive cycles at enrollment and two consecutive cycles at follow-up. Predictor variables include hormone measures, structured interview, and standard questionnaire data. Thirty-one percent of the sample (n = 375) reported hot flashes (mean age 41 years). In bivariate analysis, more African American than Caucasian women reported hot flashes (38% vs. 25%, p = 0.01). Significant predictors of hot flashes in the final multivariable logistic regression model were higher follicle-stimulating hormone (FSH) levels (odds ratio [OR] 3.19), anxiety (OR 1.06), baseline menopausal symptoms (OR 4.91), alcohol use (OR 1.09), body mass index (BMI) (OR 1.04), and parity (OR 1.20). Race did not predict hot flashes after adjusting for these variables. Hot flashes commonly occur before observable menstrual irregularities in the perimenopause and are associated with both hormonal and behavioral factors. The association of hot flashes with increased body mass (BMI) challenges the current "thin" hypothesis and raises important questions about the role of BMI in hormone dynamics in the late reproductive years.

Occurrence of Thelazia lacrymalis (Nematoda, Spirurida, Thelaziidae) in native horses in Abruzzo region (central eastern Italy).

A survey on the prevalence of Thelazia spp. in Abruzzo region (Italy) in slaughtered native horses was conducted from August 29, 1997 to August 28, 1998. Both eyes from 128 eight-month to 11 year-old native animals were examined. 50 horses (39.06%) were found parasitized by Thelazia lacrymalis. 502 specimens (371 females, 88 males and 12 larvae) were collected. In the infected horses the numbers of T. lacrymalis ranged from 1 to 48, with a mean count burden of 3.92 per head (SD = 7.79). T. lacrymalis specimens were mainly in the excretory ducts of the Harderian gland, and also in the ducts of the lacrimal glands, free in the conjunctiva and behind the nictitancte. Gross examination showed a conjunctivitis, more frequently a follicular conjunctivitis, in the 58% of the infected horses.

Evaluation of growth hormone administration in patients with chronic heart failure secondary to coronary artery disease.

We have examined the effects of 6 months of treatment with growth hormone (GH) (0.02 U/kg/day) in 10 patients with chronic postischemic cardiac failure. Ten patients matched for age, body mass index, functional class, and ejection fraction served as a control group. In the GH group, 1 patient died and 2 were withdrawn from the study because of arrhythmia or worsening of heart failure. In the control group, 1 patient died and 1 patient was withdrawn from the study because of progressive heart failure. Among GH patients, those with an unfavorable outcome had a greater left ventricular end-diastolic diameter (79, 82, and 88 mm) on entry to the study than patients without adverse events (range 62 to 72 mm). At the end of the study, the seven GH patients reported a feeling of well-being and had a significant increase in their exercise test duration (462 +/- 121 vs 591 +/- 105 seconds, p <0.05). Low baseline insulin-like growth factor-I values were increased with GH treatment (189 +/- 52 vs 100 +/- 22 ng/ml, p <0.01). GH did not change left ventricular diameters or wall thickness. A trend toward decreased serum triglyceride levels and adipose body tissue associated with an increase in high-density lipoproteins was observed in the GH group. In conclusion, our present data support previous suggestions that GH treatment exerts some beneficial effects in patients with chronic, stabilized, moderately severe heart failure, but may have deleterious effects in patients with more severe heart failure.

Penn Health for Women: the evolution of a women's health program in an academic setting.

Penn Health for Women is an interdisciplinary model for women's health care created and implemented in an academic setting to provide comprehensive, integrated care to women of all ages and to establish a leadership position in women's health within the surrounding communities.

Characterization of spermidine binding to solubilized plasma membrane proteins from zucchini hypocotyls

In this work [14C]spermidine binding to total proteins solubilized from plasma membrane purified from zucchini (Cucurbita pepo L.) hypocotyls was investigated. Proteins were solubilized using octyl glucoside as a detergent. Specific polyamine binding was thermolabile, reversible, pH dependent with an optimum at pH 8.0, and had a Kd value of 5 &mgr;M, as determined by glass-fiber-filter assays. Sephadex G-25 M gel-filtration assays confirmed the presence of a spermidine-protein(s) complex with a specific binding activity. By sodium dodecyl sulfate-polyacrylamide gel electrophoresis and native polyacrylamide gel electrophoresis of collected fractions having the highest specific spermidine-binding activity, several protein bands (113, 75, 66, and 44 kD) were identified. The specificity of spermidine binding was examined by gel-filtration competition experiments performed using other polyamines and compounds structurally related to spermidine. Partial purification on Sephadex G-200 led to the identification of 66- and 44-kD protein bands, which may represent the putative spermidine-binding protein(s) on the plasmalemma.

Estrogen and the prevention and treatment of osteoporosis.

Osteoporosis is a systemic skeletal disease characterized by decreased bone mass and impaired structural integrity of remaining bone. Due to a decline in circulating estrogen, an acceleration of bone loss occurs after the menopause. Osteoclast activity is increased, leading to an imbalance of bone resorption over formation, resulting in a net loss of bone. Estrogen is an effective antiresorptive agent used in both the prevention and treatment of osteoporosis. Estrogen replacement effectively maintains bone mass and prevents fractures. Replacement therapy is most effective when it is initiated soon after the cessation of menses and is continued long term. Historically, there is a low compliance rate with long-term therapy in this country. The addition of a progestin to estrogen replacement is necessary for endometrial protection but negatively affects patient compliance. The identification of other significant medical benefits, such as the reduction of cardiovascular risk and possible amelioration of Alzheimer's dementia, affirm the cost-effectiveness of estrogen replacement and may increase its attractiveness to patients. Clarification of breast cancer risk and improvement of an individual's side effect profile through use of different regimens, hormonal preparations, and routes of administration may enhance compliance.

[Veno-venous crossover bypass according to Palma: our experience]. / Il bypass veno-venoso crossover sec. Palma: nostra esperienza.

Four cases of Palma's operation (veno-venous cross-over bypass) performed from 1986 through 1992 for occlusive venous disease are reported together with an extensive follow-up. After a synthetic review of the literature, the authors conclude that this operation should no more be considered an experimental procedure, even if a definite statement of its long-term usefulness (and therefore of the indication) is still lacking.

[Entrapment syndrome of the popliteal vein: results of the surgical treatment]. / La sindrome da intrappolamento della vena poplitea: risultati del trattamento chirurgico.

Entrapment of the popliteal vein has been rarely reported. Purpose of the present study was to evaluate the long-term results of vein decompression in the popliteal vein entrapment syndrome. Between August 1986 and June 1994, 35 patients (49 limbs) were operated on for popliteal vein entrapment syndrome at our Institution. There were 28 female and 7 male (mean age 44.5 +/- 13.5 years). Seven limbs had associated a popliteal artery entrapment syndrome. Twenty-three (49.6%) limbs presented with skin changes ascribed to venous disease. Preoperative diagnosis consisted on Doppler CW, Duplex Scan, venography and ambulatory venous pressure measurements. Surgical management consisted on the division of the anomalous structure causing entrapment. In 35 (71.4%) limbs subfascial ligation of perforating veins was associated. The patients were followed-up (mean 61 +/- 7 months) with venography and AVP. No deaths occurred and morbidity was 14.3%. Doppler CW and Duplex Scan were not accurate to diagnose the entrapment. Ambulatory venous pressure and venography accurately diagnosed the syndrome. Age and preoperative status did not affect long-term results (p = NS). Long-term operative success was negatively influenced by associated procedures for ligation of perforating veins (p < 0.03). Popliteal vein entrapment syndrome should be early diagnosed to prevent incompetence of perforating veins. Surgical treatment of cases not requiring ligation of perforating veins had a better long-term success rate. Treatment at later stages allows symptom amelioration but does not prevent the consequences of a long-standing chronic venous disease.

[Preoperative blood storage and intraoperative blood recovery in elective treatment of abdominal aorta aneurysm]. / Predesposito e recupero intraoperatorio di sangue nel trattamento elettivo degli aneurismi dell'aorta addominale.

We evaluated the efficiency and costs-effectiveness of blood predonation and intraoperative salvage in elective abdominal aortic aneurysm surgery. Between January 1992 and January 1994, 66 patients (59 male and 7 female, aged 69.9 +/- 0.8 years) who underwent elective surgical repair of an AAA were selected for the study. Thirty-six (54.5%) patients (Group 1) intra- and/or postoperatively received homologous blood whereas 30 (45.5%) patients (Group 2) received autologous blood predonation and intraoperative blood aspiration and reinfusion. The two groups were similar for demographic data, aneurysmal diameter and associated diseases and/or risk factors (p = NS). Operative mortality was comparable between the two groups (p = NS). The mean intraoperative blood loss was 803.4 +/- 104.5 ml in group 1 and 812.8 +/- 44.8 ml in group 2 (p = NS). Group 2 patients received intra- or postoperatively a mean of 0.8 +/- 0.2 units of homologous blood (p < 0.001). Aneurysmal diameter did not influence the transfusion requirement between the two groups (p = NS). The cost per unit of homologous banked blood was significantly higher (p < 0.01). Cumulative costs of the procedures did not show statistical differences between the two groups (p = NS). Aortic surgery is the ideal target for predonation and intraoperative blood salvage.

Insulin-like growth factor-I and angiographically documented coronary artery disease.

In conclusion, we have reported an association between low IGF-I concentrations and CAD in relatively young men. This observation raises the possibility that IGF-I deficiency could be part of the polymetabolic syndrome. Whether a subnormal IGF-I production is due to growth hormone secretory abnormalities or to other metabolic reasons (e.g., insulin resistance or fat distribution, or both) is still unknown.