Combined HPLC-DAD-MS, HPLC-MS(n) and NMR spectroscopy for quality control of plant extracts: the case of a commercial blend sold as dietary supplement.

The efficiency of 1D and 2D NMR spectroscopy along with HPLC-DAD-MS analyses in characterising the content of a dietary supplement is demonstrated. Experiments directly performed on a lyophilised sample of a commercial product gave details on the quality control of the product. The lack of the marker constituents of some of the declared plant species (Crataegus oxyacantha, Olea europea, Capsella bursa-pastoris and Fumaria officinalis) and the presence of banned adulterants, responsible for the strong antihypertensive effect of the supplement were established. The analyses proved the presence of indole alkaloids belonging to the group of Rauwolfia sp., such as ajmaline, reserpine and yohimbine. Quantitative HPLC analysis showed that the content of reserpine in the product was in the therapeutic range and therefore responsible for the collapses of the patients.

Anesthesia and myotonic dystrophy (Steinert's syndrome). The role of total intravenous anesthesia with propofol, cisatracurium and remifentanyl. Case report.

Anesthesia for patients with Steinert's syndrome (myotonic dystrophy, MD) is a challenge for the anaesthetist. MD is a multisystemic disease and the neuromuscular symptoms can be associated with sleep apnea, endocrine disorders (diabetes, hypogonadism, hypothyroidism), cardiac, gastroenteric or cognitive disorders (mental deficiency, attention disorders). The diagnosis is facilitated when one or more of these symptoms are associated with the neuromuscular symptoms; however, the latter are not always present at the onset, which makes the diagnosis of MD a difficult and often late one. The choice of drugs and the choice of anesthesia in these patients can be very challenging for many reasons. A myotonic crisis can be triggered by several factors including hypothermia, shivering and mechanical or electrical stimulation. These patients are very sensitive to the usual anesthetics such as hypnotics and paralyzing agents (both depolarizing and nondepolarizing). The following case report describes pathophysiological considerations and a technique for anaesthesia during thoracic surgery that has been able to assure hemodynamic peroperative stability, early extubation and prolonged respiratory autonomy in a patient affected by this genetic disorder.

[Cardiac rhythm disorder in infection caused by cytomegalovirus in patients with kidney transplant]. / Turbe del ritmo cardiaco in corso di infezione da citomegalovirus nei trapianti di rene.

A higher incidence of arrhythmias was observed in 16 renal allograft recipients infected with Cytomegalovirus (CMV), as compared to 26 patients who were transplanted during the same period and did not contract the infection (43.7% vs. 3.8%; p less than 0.01). There was a highly significant difference in the incidence of sinus tachycardia (37.5% infected vs. 0% not infected; p less than 0.005), while the incidences of atrial fibrillation and ventricular ectopic beats were not significantly different. The arrhythmias always appeared in the early phases of the infection and disappeared after a certain period, lasting from one week to months. It is proposed that arrhythmias arising during CMV infection may be due to a myocardial CMV involvement.

[Thin-needle aspiration cytology of palpable lymph nodes. Analysis of 702 consecutive cases]. / La citologia per aspirazione con ago sottile di linfonodi palpabili. Analisi di 702 casi consecutivi.

Seven-hundred-two needle aspirates were taken from palpable lymph nodes between january 1982 and june 1987. Cytohistological correlation in about 70% of the preparations showed that the technique is capable of detecting neoplastic cells in 99% of metastases and in 90% of lymphoma cases. Certain technical aspects of smear preparation are pointed out with a view to reducing the percentage of inadequate samples (14% in the present series) and the position of the technique among other diagnostic procedures is discussed, with evaluation of advantages and limitations.

Fournier's gangrene following a perianal abscess.

Fournier's disease is an uncommon form of gas gangrene involving the scrotum and perineum. Described by Fournier as an idiopathic condition, it must be recognized as a synergistic gangrene secondary, in most cases, to a focus of perianal infection. Urinary tract infection and local trauma follow as possible causal factors. Five cases complicating a perianal abscess observed in a period of 11 years have been treated with urgent aggressive surgical debridement and intensive care support. Full-thickness skin grafts were required in three patients. Hospital mortality occurred in one case. Although combination antibiotic therapy and correct postoperative wound management are potentially successful, the mainstay of treatment is complete excision of all necrotic tissue. Colostomy and urinary diversion are not mandatory. Treatment with hyperbaric oxygen is controversial.

[Prognostic factors in thromboembolectomy with the Fogarty catheter for acute ischemia of the limbs]. / Fattori prognostici nella tromboembolectomia con catetere di Fogarty per ischemia acuta degli arti.

The Authors describe the results obtained in 181 patients treated with thromboembolectomy by Fogarty catheter for acute limb ischaemia. Data were analyzed with the help of a set of computer programs for statistical computations, and some highly significant prognostic factors were determined: ischaemia duration and severity cause a substantial increase of both death and amputation probability; associate diseases or thrombosis are significant factors for amputation; occlusion level for death. The patients whose limb was saved without the pulse being present were characterized by ASO or thrombosis.