Quality of neurology residency programmes: an Italian survey.

In recent years there has been a growing interest in medical and particularly neurological education and how this should be related to the needs for patient care. To evaluate neurological training in Italy, we conducted a survey of the residency programmes aimed at different aspects of training. The survey was conducted in the 38 neurological Italian teaching hospitals and 27 of these answered. Six of the 27 centres organized all of the scheduled teaching courses. The quality of courses was considered 'not sufficient' in 11 schools and 'good' in 12. Seminars were regularly performed in 18 centres but in 60% of these the number was <1 per week. Questionnaires to evaluate the quality of teaching were lacking in all centres. Regarding the procedures performed by each resident there was a large variation between the different schools. A regular rotation of each resident in the neurophysiology services was performed in 14 schools. Ward and out patient activity varied widely and details are given. We conclude that there is marked heterogeneity in training programmes between different centres. Some important activities such as seminars and rotation in neurophysiology are performed poorly.

Pilot trial of albuterol in spinal muscular atrophy.

The aim of this pilot study was to evaluate the effect of albuterol in children with spinal muscular atrophy (SMA). Thirteen patients (five with SMA II and eight with SMA III) were given oral albuterol for 6 months. There was a significant increase in myometry, forced vital capacity, and lean body mass between the baseline and the 6-month assessments (p < 0.05). Albuterol may have a beneficial effect in patients with SMA without causing any significant adverse effects. Larger randomized, placebo-controlled trials are needed to confirm this observation.

Dietary protein intake and nutritional status in patients with renal transplant.

BACKGROUND: Uremic patients on regular dialysis treatment (RDT) obtain and maintain with difficulty an adequate nutritional status. Successful kidney transplantation allows remarkable rehabilitation of patients with end-stage renal disease previously on RDT. However, information concerning the role of dietary protein restriction in the treatment of patients with chronic transplant rejection is scarce. PATIENTS AND METHODS: The role of dietary protein restriction in the treatment of patients with chronic transplant rejection was studied over 10 years in 42 patients with a kidney transplant to examine longterm renal and nutritional responses to dietary protein on graft renal function. In these patients, renal function was checked monthly, clinical evaluation and anthropometric measurements studied, nutritional status and all patients' diets were recorded. RESULTS: In 18 of these patients, biochemical signs of renal failure were found. A diet with 35 Kcal/kg and 0.7 - 0.8 grams of protein/Kg was instituted. Renal function studied every six months for 10 years showed improvement or stabilization. The low protein diet was associated with a significant reduction in 24-hour urinary protein excretion, without any change in blood pressure. Protein restriction was not associated with changes in serum protein. CONCLUSIONS: Our long-term study suggests that moderate protein intake may improve the course of chronic rejection and that restriction in protein intake may be a useful strategy in slowing the progression of renal disease in chronic rejection.

n-3 fatty acids do not enhance LDL susceptibility to oxidation in hypertriacylglycerolemic hemodialyzed subjects.

Recent data suggest that treatment with n-3 fatty acids could enhance the susceptibility of plasma low-density-lipoprotein (LDL) to oxidation. Twelve hypertriacylglycerolemic, hemodialyzed patients were treated with 2.5 g n-3 fatty acids/d for 2 mo. Treatment was then withdrawn for 2 mo (washout phase). Plasma total cholesterol and LDL cholesterol increased significantly (9% and 28%) and plasma triacylglycerols decreased significantly after the n-3 phase compared with baseline and washout values. LDL susceptibility to oxidation was tested by oxidation of LDL particles with 2,2'-azobis (2-amidinopropane) dihydrochloride (AAPH). No significant changes were observed for the lag phase and the peroxidation rate. The vitamin E content of LDL also did not change significantly. The results thus suggest that a daily dosage of 2.5 g n-3 fatty acids does not enhance LDL susceptibility to oxidation, while retaining its hypotriacylglycerolemic effect.

Recombinant tissue plasminogen activator (rt-PA) as first-line therapy for declotting of haemodialysis access.

One of the most common complication in haemodialysis patients is thrombosis of the arteriovenous fistula (AVF). Thirty-five patients with a total of 42 thromboses of the angioaccess were infused via a small needle: (i) into the feeding artery (50% of the cases); (ii) into a AVF venous segment of the arteriovenous fistula (42.8%); (iii) directly into the thrombus (7.1%), by rt-PA. After an initial pulse of 5-10 mg, according to body weight, the drug was continuously infused by a pump with the speed automatically programmed in 30 Brescia-Cimino autologous AV fistulae and 12 polytetrafluoroethylene (PTFE) grafts. A complete thrombolysis with return of bruit and thrill was obtained in 71.4% of the cases using a mean drug dose of 21 mg and an infusion time of 3.8 h. All the successful cases underwent haemodialysis via AVF on the same day. No bleeding occurred at remote sites. Local bleeding occurred in 16% of the cases; in no case was it so severe as to require the suspension of the therapy or blood transfusions. The median cumulative duration of patency after thrombolysis was 32.4 months. Respectively 21, 12 and two patients had a functioning angioaccess after 3.6, 32.4 and 36 months from the lytic approach. Failure of the treatment was not related to the patients' gender or age, AVF age, route of administration of the drug, type of vessel (natural or artificial), or delay between the discovery of the fistula occlusion and the start of the therapy. In unsuccessful cases an organic lesion of the vessels was documented by angiography or echo colour Doppler. In summary, rt-PA local infusion provides a useful means of preservation of AV fistulae and may be used as the therapy of first choice in dialysis patients without active bleeding or high bleeding risk.