A telemonitoring platform for the investigation of blood pressure profiles in pacemaker patients.

Rate responsive pacemakers (PM) use different strategies to adapt the patient paced rate, with the aim of having the best hemodynamic performance in response to internal or external conditions. Closed-loop stimulation (CLS) uses intracardiac impedance as a sensor principle. The evaluation of impact of different pacing modalities and technologies on the blood pressure (BP) profiles is mainly investigated in short-term laboratory settings, mainly due to the need of reliable daily-based BP values. The impact of CLS pacing on systemic blood pressure (BP) has been studied on short term basis, but data on long term effects are scarse. This study present a telemedicine platform designed for evaluating the effect of the rate responsive technology on daily systolic and diastolic BP data. BP and pacemaker data were collected daily from fourteen patients during a 3 month period. The total number of monitoring days was 1277 (91 day/patient), for a total number of 4455 BP measures. On average 3.5 measure/day/patient were received). The analysis of the BP data showed that CLS pacing results in diastolic pressure closer to the normal values than accelerometer-based pacing, which were associated to lower diastolic pressures.

Physiological effects of a lung-recruiting strategy applied during one-lung ventilation.

BACKGROUND: One-lung ventilation (OLV) affects respiratory mechanics and ventilation/perfusion matching, reducing functional residual capacity of the ventilated lung. While the application of a lung-recruiting manoeuvre (RM) on the ventilated lung has been shown to improve oxygenation, data regarding the impact of RM on respiratory mechanics are not available. METHODS: Thirteen patients undergoing lung resection in lateral decubitus were studied. During OLV, a lung-recruiting strategy consisting in a RM lasting 1 min followed by the application of positive end-expiratory pressure 5 cmH(2)O was applied to the ventilated lung. Haemodynamics, gas exchange and respiratory mechanics parameters were recorded on two-lung ventilation (TLV(baseline)), OLV before and 20 min after the RM (OLV(pre-RM), OLV(post-RM), respectively) and TLV(end). Haemodynamics parameters were also recorded during the RM. RESULTS: The PaO(2)/FiO(2) ratio was 358+/-126 on TLV(baseline); it decreased to 235+/-113 on OLV(pre-RM) (P<0.01) increased to 351+/-120 on OLV(post-RM) (P<0.01 vs. OLV(pre-RM)), and remain stable thereafter. During the RM, CI decreased from 3.04+/-0.7 l/m(2) OLV(pre-RM) to 2.4+/-0.6 l/m(2) (P<0.05), and returned to baseline on OLV(post-RM) (3.1+/-0.7 l/m(2), NS vs. OLV(pre-RM)). The RM resulted in alveolar recruitment and caused a significant decrease in static elastance of the dependent lung (16.6+/-8.9 cmH(2)O/ml OLV(post-RM) vs. 22.3+/-8.1 cmH(2)O/ml OLV(pre-RM)) (P<0.01). CONCLUSIONS: During OLV in lateral decubitus for thoracic surgery, application to the dependent lung a recruiting strategy significantly recruits the dependent lung, improving arterial oxygenation and respiratory mechanics until the end of surgery. However, the transient haemodynamic derangement occurring during the RM should be taken into account.

Blockade of CRF(1) or V(1b) receptors reverses stress-induced suppression of neurogenesis in a mouse model of depression.

Repeated exposure to stress is known to induce structural remodelling and reduction of neurogenesis in the dentate gyrus. Corticotrophin-releasing factor (CRF) and vasopressin (AVP) are key regulators of the stress response via activation of CRF(1) and V(1b) receptors, respectively. The blockade of these receptors has been proposed as an innovative approach for the treatment of affective disorders. The present study aimed at determining whether the CRF(1) receptor antagonist SSR125543A, the V(1b) receptor antagonist SSR149415, and the clinically effective antidepressant fluoxetine may influence newborn cell proliferation and differentiation in the dentate gyrus of mice subjected to the chronic mild stress (CMS) procedure, a model of depression with predictive validity. Repeated administration of SSR125543A (30 mg/kg i.p.), SSR149415 (30 mg/kg i.p.), and fluoxetine (10 mg/kg i.p.) for 28 days, starting 3 weeks after the beginning of the stress procedure, significantly reversed the reduction of cell proliferation produced by CMS, an effect which was paralleled by a marked improvement of the physical state of the coat of stressed mice. Moreover, mice subjected to stress exhibited a 53% reduction of granule cell neurogenesis 30 days after the end of the 7-week stress period, an effect which was prevented by all drug treatments. Collectively, these results point to an important role of CRF and AVP in the regulation of dentate neurogenesis, and suggest that CRF(1) and V(1b) receptor antagonists may affect plasticity changes in the hippocampal formation, as do clinically effective antidepressants.

Pregnancy in Cushing's disease shortly after treatment by gamma-knife radiosurgery.

Gamma-knife radiosurgery (GKR) is considered as a possible treatment for patients affected by unsuccessfully surgically treated pituitary adenoma or not suitable for surgery. The disadvantages of this technique seem to be the length of time to the onset of remission, which is known to be at least of 6 months, and the possible adverse effects. We report here a case of a 13-yr-old female patient with Cushing's disease (CD) due to ACTH-secreting pituitary adenoma. After a complete clinical remission obtained by a transsphenoidal surgery, at the age of 18, the patient had a recurrence of ACTH-dependent hypercortisolism, and a second transsphenoidal surgery was performed. In April 1999, a second recurrence of CD was diagnosed and the patient underwent GKR on a small pituitary mass, on the left side of the sella. In June 1999 amenorrhoea appeared, and in August 1999 pregnancy occurred. Although during the pregnancy the disease activity was still high, the fetus's growth was normal and in February 2000 a normal male infant was delivered. The baby and the mother did not show any biochemical signs or clinical symptoms of hypo- or hypercortisolism. This case is interesting, since GKR exerted a very rapid effect and turned to be safe even if performed shortly before pregnancy. Moreover, in spite of the still high disease activity, the pregnancy had a normal course and the fetus did not have any cortisol secretion abnormalities.

Sympathetic activity and blood pressure pattern in autosomal dominant polycystic kidney disease hypertensives.

To study the potential role of sympathetic activity in the pathogenesis of arterial hypertension associated with autosomal dominant polycystic kidney disease (ADPKD) and to analyze its relationship with 24-hour blood pressure pattern, plasma catecholamines and 24-hour ambulatory blood pressure monitoring were evaluated in 30 ADPKD hypertensive patients (of which 17 without and 13 with renal failure) and in 50 essential hypertensives. The groups were matched for sex, body mass index, known duration of hypertension, and clinic blood pressure. Plasma catecholamines, determined in resting position, were higher in ADPKD patients without renal failure than in essential hypertensives. Nighttime diastolic blood pressure was higher and the percentage day-night difference in mean blood pressure was lower in hypertensives with ADPKD compared to patients with essential hypertension. Blood pressure was significantly correlated with plasma noradrenaline in ADPKD patients, independently of renal function. No significant differences were observed between ADPKD patients with and without renal failure, with respect to plasma catecholamines, 24-hour daytime and nighttime ambulatory blood pressures and the percentage day-night difference in mean blood pressure.

Factor V Leiden, C > T MTHFR polymorphism and genetic susceptibility to preeclampsia.

We performed a case-controlled study to investigate whether the FV Leiden mutation and the C > T677 polymorphism of the 5, 10 methylene tetrahydrofolate reductase (MTHFR) are associated with the occurrence of preeclampsia in 96 otherwise healthy preeclamptic women and 129 parous women as controls. FV Leiden carriers were 10 (10.5%) in cases and 3 (2.3%) in controls (OR: 4.9, 95% CI: 1.3-18.3). MTHFR TT homozygotes were 28 (29.8%) in cases and 24 (18.6%) in the control group (OR: 1.8, 95% CI 1.0-3.5). No difference in any of the polymorphisms was found between proteinuric (n = 45) and non-proteinuric (n = 51) patients. Moreover, MTHFR polymorphism does not affect the association between FV Leiden and preeclampsia. In conclusion, FV Leiden mutation and MTHFR TT genotype are associated with the occurrence of preeclampsia, suggesting that, during pregnancy, women carrying these gene variants are prone to develop such a complication.

Factor V Leiden is associated with repeated and recurrent unexplained fetal losses.

Activated protein C resistance (APCR) is responsible for most cases of familial thrombosis. The factor V missense mutation Arg506 > Gln (FV Leiden) has been recognized as the commonest cause of this condition. Recently, it has been suggested that APCR is associated with second trimester fetal loss. We investigated the distribution of FV Leiden in a sample (n = 43) of Caucasian women with a history of two or more unexplained fetal losses. A group (n = 118) of parous women with uneventful pregnancies from the same ethnical background served as control. We found the mutation in 7 cases (16.28%) and 5 controls (4.24%; p = 0.011). A statistically significant difference between women with only early fetal loss vs those with late events (p = 0.04) was observed. Our data demonstrate a strong association between FV Leiden and fetal loss. Furthermore, they indicate that late events are more common in these patients.

[Allergic contact dermatitis to nickel: modification of receptor expression on peripheral lymphocytes of women after oral provocation tests (preliminary data)]. / Dermatite allergica da contatto a nichel: modificazioni delle espressioni recettoriali dei linfociti periferici in donne dopo test di provocazione per via orale (dati preliminari)

Blood lymphocyte subset evaluation was performed before after oral challenge with 10 mg of Ni, in 9 healthy women and in 15 allergic to Ni. Following challenge, 7 allergic showed a flare up of eczema and/or urticaria. In the controls, CD4+ lymphocytes were modified 24 hours after Ni challenge: CD4+/CD44RO- "virgin" cells were reduced while CD4+/CD45RO+ "memory" cells increased. The allergic women, not sensitive to oral Ni, showed an increase of B lymphocytes after the test. On the contrary, the oral Ni reacting patients presented a reduction of monocytes 4 hours after Ni ingestion and marked reduction (ranging from 20 to 50%) of T and B lymphocytes after 24 hours. These significant T and B lymphocytes changes suggest a migration of the cells in peripheral tissues, likely skin and GUT mucosa.

Effects of captopril and ticlopidine, alone or in combination, in hypertensive patients with intermittent claudication.

Twenty four male hypertensive patients suffering also from peripheral obstructive arterial disease were randomly subdivided in two groups and after a period of farmacological wash-out of one month Group I was treated with Captopril (C 50 mg bid) or Ticlopidine (T 250 mg bid) for three months and then with the association C plus T for three months again. After placebo administration for one month, patients were further treated with C plus T at low doses (25 mg bid and respectively 250 mg daily). In the first part of the study, patients of Group II received an inverse sequence of the drugs (before Ticlopidine 250 mg bid and then Captopril 50 bid). In both groups of patients C induced a significant decrease of blood pressure and an increase of PFWD, TWD, and WI. T did not modify blood pressure but slightly increased PFWD, TWD, and WI. The improvement was more evident during administration of C plus T, whereas placebo administration induced a trend toward baseline values. Finally, the chronic administration of C plus T for twelve months induced a further improvement of all considered parameters. In conclusion, chronic administration of C plus T may be useful in the treatment of hypertensive patients suffering from intermittent claudication, improving significantly PFWD and TWD.

[Early gastric cancer]. / Early gastric cancer.

The authors perform a retrospective analysis of 46 cases of EGC referred to the Surgical Division of Carrara Civic Hospital during the period 1980-1990 who subsequently underwent surgery. Data relating to age, symptomatology and endoscopic examinations were analysed in order to evaluate the real diagnostic penetration of the method in association with tumour biopsy, site, macroscopic aspect, possible lymph node involvement and the histology of lesions. The most frequent form of surgery in this series was subtotal gastrectomy and the 5- and 10-year survival rates, calculated using an actuarial method, were compared with data reported in the literature. The authors conclude by emphasising the need to improve the frequency of diagnosis of gastric cancer at an "early" stage and affirm that gastric resection associated with lymphoadenectomy of 1st and 2nd level lymph nodes is a sufficiently radical operation and less punitive for the patient compared to total gastrectomy given that the 5- and 10-year survival rates are comparable.

[Immuno-histopathologic changes in the gastrointestinal mucosa in patients with nickel contact allergy]. / Modificazioni immuno-istopatologiche della mucosa gastro-intestinale in pazienti con allergia da contatto al Nichel.

The study concerns the histological and immunohistochemical findings of the gastrointestinal mucosa of 20 patients (group A) suffering from contact allergic dermatitis (CAD) to Ni, with symptom recrudescence due to food ingested Ni. Results were compared with those observed in 20 patients suffering from CAD to Ni (group B), without sensitivity to food ingested Ni, and in 20 normal subjects (controls). The sensitivity to food ingested Ni, as suggested by history, was demonstrated by placebo-controlled oral-Ni challenge. The biopsies for histological and immunohistochemical study were performed during endoscopy and obtained from the antrum and from the duodenal mucosa. In the biopsies obtained from 16 of group A patients there was evidence of inflammatory infiltrate of lymphocytes and plasma cells with oedema and vasodilation in the lamina propria. Slight flattening of the villi and enlongation of the crypts were concomitant. These findings were light in the 4 patients of group A and in 11 of group B and instead were absent in the remaining group B patients and in the controls. Immunohistochemically, lymphocytes in the lamina propria were prevalently CD20 + (B cells) and CD4 + (Th cells), some were CD45RO + (memory) and finally few CD8 + (Tc/s cells). CD45RO + cells was found in cluster in patients of group A and in 4 of group B, whereas in the others were isolated. Since some studies have shown that immunological pattern of skin reaction to Ni is characterized by increased CD45RO + cells, it may be hypothesized that in patients suffering from CAD to Ni, the sensitivity to food-ingested Ni may be induced by a type IV immunological reaction in the gut.

[Magnetic resonance in the study of aseptic necrosis of the femur head]. / La Risonanza Magnetica nello studio dell'osteonecrosi asettica della testa del femore.

Avascular necrosis (AVN) of the femoral head is a common clinical problem due to the frequent use of corticosteroids and to the high incidence of hip fractures from osteoporosis and traumas. In order to demonstrate MR diagnostic capabilities, 31 patients (62 hips) were studied with MR imaging, CT, and conventional radiology. The patients had already been diagnosed as having AVN of the femoral head, or the condition was clinically suspected. MR staging of the disease was compared with CT staging and with plain radiographs. The authors suggest new MR staging method and adapt the radiographic classification developed by Ficat, Arlet, and Lecestre. The results of this comparative study demonstrate MR imaging to be most appropriate in the patients with equivocal/negative radiological/CT findings. On the contrary, MR imaging is unnecessary when AVN has already been diagnosed by means of other imaging modalities, because in these advanced cases MR diagnostic contribution either equals or is inferior to that of CT and conventional radiology.

Risk factors of female cancers in Ragusa population (Sicily)--1. Endometrium and cervix uteri cancers.

A case-control study on breast, cervix and endometrium cancer cases registered in Ragusa between January 1, 1983 and June 30, 1985 has been conducted. Information on risk factors has been obtained by means of a structured questionnaire. Risk factors for endometrium cancer were: few children (1-2 vs greater than 4 OR 15.18, 95%CL 1.96-117.64), oestrogenic treatment (OR 2.20, 95%CL 1.05-4.90), obesity (Quetelet index greater than 30 vs less than 22 OR 10.42, 95%CL 1.30-83.86), family history (OR 2.87, 95% CL 1.05-7.83). Risk factors for cervix uteri cancer were: multiple abortions (greater than 2 vs 0 OR 9.87, 95%CL 1.46-66.66), no contraception (OR 8.33, 95%CL 2.38-25.00), younger age of mother at birth (OR 6.89, 95%CL 1.71-27.70). Age at menarche, age at menopause and years of fertile life were not found to be related to either endometrium or cervix uteri cancer. The existence of influencing differences (ancestry, environment, lifestyle) has been postulated.