Radium isotopes in Estonian groundwater: measurements, analytical correlations, population dose and a proposal for a monitoring strategy.

In some areas of Estonia, groundwater contains a significant number of natural radionuclides, especially radium isotopes, which may cause radiation protection concern depending on the geological structure of the aquifer. Indeed, the parametric value of 0.1 mSv y⁻¹ for the total indicative dose established by European Directive 98/83/EC, adopted as a limit value in Estonian national legislation, is often exceeded. A Twinning Project between Estonia and Italy was carried out within the framework of the Estonian Transition Facility Programme, sponsored by the European Union. Its aims were to assess the radiological situation of Estonian groundwater and related health consequences. The first step was a study of Estonian aqueducts and the population served by them, and a thorough analysis of the radiological database for drinking water, from which the relevant effective doses for the population were obtained. Particular attention was devoted to doses to children and infants. Correlations between the chemical parameters were investigated, in order to suggest the best possible analytical approach. Lastly, a monitoring strategy, i.e. sampling points and sampling frequencies, was proposed.

Clinical and haemostatic effects of intravenous prostaglandin E1 therapy in patients with peripheral arterial occlusive disease.

BACKGROUND: In this study the action of an antiaggregatory prostaglandin, PGE1, was studied in a group of patients with peripheral arterial occlusive disease (PAOD). METHODS: In 16 patients with PAOD Fontaine stage IIb and III the clinical and haemostatic effects of the endovenous administration of 60 micrograms/die of alprostadil-PGE1 for four weeks, were evaluated. Before and after pharmacological treatment, were evaluated the clinical symptoms (claudicatio intermittens and rest pain) and the following haemostatic parameters: plasma thrombomodulin (TM), beta-thromboglobulin (beta-TG), D-dimer (DD), tissue-type plasminogen activator (t-PA) and plasminogen activator-inhibitor (PAI-1). RESULTS: No significant difference in plasma TM, t-PA and PAI-1 levels was observed after the treatment. On the other hand the patients showed plasma levels of beta-TG and DD significantly decreased at the end of the treatment. From the clinical point of view both claudicatio intermittens and rest pain satisfactorily improved in all patients. CONCLUSIONS: This data confirmed the therapeutic efficacy of PGE1 in the treatment of PAOD patients.

Haemostatic effects of iloprost in patients with lower limb ischemia.

The aim of this study was to investigate the haemostatic effects of iloprost, a stable analogue of prostacyclin, in patients with peripheral arterial disease. In a group of 13 patients with obliterative arteriopathies of the lower limbs the plasma levels of thrombomodulin (TM), betathromboglobulin (beta-TG), D-dimer (DD) and plasminogen activator-inhibitor (pAI-1) were measured, and compared to the values obtained from 10 healthy volunteers. All the parameters were found to be significantly higher in vasculopathic patients. These haemostatic evaluations were carried out after 4 weeks of treatment with iloprost up to 2 ng/kg/min, 6 hours infusion per day. During and at the end of treatment a clinical improvement was recorded. The patients also showed a significant decrease in plasma beta-TG and DD at the end of treatment. These data suggest that iloprost exerts clinical improvement, in who may have a part the decrease of platelet activation and of fibrin turnover.

Haemostatic parameters in patients with primitive venous hypertension.

In twenty patients with primitive venous hypertension and in ten healthy subjects we have determined the plasmatic levels of: Thrombomodulin (TM), beta-Thromboglobulin (beta-TG), D-Dimer (DD), the tissue activator of the plasminogen (t-PA) and the inhibitor of the activator of the plasminogen (PAI-1). The levels of the parameter we studied have shown in the patients a significant difference of beta-TG (p < 0.01) and PAI-1 (p < 0.01) compared to the controls, whereas there was no significant difference in the other parameters we studied. Our data underline, in patients with primitive venous hypertension, the importance that the activation of the platelets and the reduction of the potential fibrinolytic can assume, together with the stasis, regarding the onset of thrombotic complications.

Haemostatic changes in patients with deep vein thrombosis.

Thrombomodulin (TM), beta-thromboglobulin (beta-TG), D-dimer (DD), tissue-type plasminogen-activator (t-PA), plasminogen activator-inhibitor (PAI-1) and quantitative determination of functional protein S (PS) were measured using ELISA procedures in the plasma of 16 untreated patients with newly-diagnosed deep vein thrombosis in the leg and in 10 healthy volunteers. No significant difference in plasma TM, t-PA and PS levels was observed among the controls and patients with deep vein thrombosis. These patients, on the other hand, showed plasma DD, beta-TG and PAI-1 levels significantly higher than the control subjects. These data show that in patients with deep vein thrombosis a hypercoagulable state is a common occurrence.

Effects of medium-term antihypertensive therapy on haemostatic parameters in patients with essential hypertension.

This study assessed the effects of the angiotensin-converting enzyme (ACE) inhibitor cilazapril on the main haemostatic variables in 22 patients, of either sex, with newly diagnosed uncomplicated essential hypertension. In the patients and in 10 control subjects, plasma levels of thrombomodulin, beta-thromboglobulin, D-dimer, tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) had previously been measured. Only the levels of t-PA and PAI-1 were found to be higher than in controls. All these haemostatic evaluations were carried out after 6 and 12 months of treatment with an ACE inhibitor, cilazapril, 5 mg/day. This treatment significantly lowered the mean arterial pressure in the whole group from 133 to 106 mm Hg (after 6 months) and to 105 mm Hg (after 12 months), p < 0.05. No significant difference in any haemostatic parameters was observed after 6 and 12 months of treatment. The present study confirmed that treatment with cilazapril for 12 months lowers daytime ambulatory mean arterial pressure in patients with essential hypertension, without any significant increase in the tendency of blood to clot.

Leukaemoid reaction with megakaryocytic features in newborns with Down's syndrome.

A leukaemoid reaction was observed in 3 newborns with Down's syndrome. Thrombocytopenia was present in 2, requiring platelets transfusions in 1, and red cell transfusions were necessary in 2 patients. Blast cells characterization by specific monoclonal antibodies showed a prevalence of megakaryoblasts in all 3 cases. This feature was confirmed in 2 of them by the demonstration of platelet peroxidase (PPO) activity under transmission electron microscopy (TEM). A spontaneous remission of the leukaemoid picture was observed after 2-3 months. However, in 1 case a relapse of the myeloproliferative disorder with the same features of the blast cell population was diagnosed after 16 months. Chemotherapy with low-dose Ara-C, started because of a relevant clinical involvement, induced a complete remission.

[Long-term evaluation of immunosuppressive therapy in childhood idiopathic pulmonary hemosiderosis]. / Valutazione a lungo termine della terapia immunosoppressiva nella emosiderosi polmonare idiopatica dell'infanzia.

Idiopathic pulmonary hemosiderosis (IPM) is a rare disease of unknown etiology, whose diagnostic, prognostic and therapeutic approach is still open to discussion. In this paper the authors report a study regarding three cases of IPH initially detected in 13, 11 and 7 year-old children. The patients were treated with cyclophosphamide and prednisone according to different cycles depending on the clinical stage in the disease. All three patients are still alive after 10, 6 and 5 years since initial diagnosis. This therapeutic protocol therefore seems to be effective in preventing the progression of IPH and in maintaining the patients in an asymptomatic condition.

[Clinical evaluation of a new factor VIII concentrate in hemophilic children]. / Valutazione clinica di un nuovo concentrato di fattore VIII in bambini emofilici.

Studies of in vivo recovery, longevity and dose response of factor VIII following infusions of a new factor VIII concentrate (Koate, Cutter Laboratories) yielded results similar to those reported using other sources of factor VIII. Koate has been demonstrated to be clinically effective in classic hemophilia. This preparation was produced by refinements of the methods first described by Hershgold, Pool and Pappenhagen in 1966. By these procedures a high purity factor VIII concentrate is obtained being some 65 to 170 fold purified. This factor VIII concentrate was clinically evaluated in 11 hemophilic children (one of them with 7 Bethesda Units inhibitor) who received a total of 13 separate infusions. Biologic half-life values determined in two subjects resulted 12 and 9,5 hours comparing favorably with those previously reported. Initial 50% disappearance averaged 5,4 and 4,8 hours respectively. In vivo recovery of the infused factor VIII activity averaged 98 +/- 12,75%. Dose response measurements showed that 1 unit/Kg gave an in vivo increase in circulating activity of 1,97 +/- 0,93%.

[Average number of bleeding episodes in hemophilic children of different ages in "on demand" therapy]. / Incidenza media di episodi emorragici nelle varie età del bambino emofilico in terapia "on demand".

We have studied the number of important bleeds in our patients with respect to the age group in order to find criteria for putting the hemophilic child on an effective continuous prophylactic regime as early as possible. The bleeding sites are shown in the Tables. 48 children with severe hemophilia were studied. We observed an increase in bleeds with an increase in age. This increase in bleeds and their recurrence in preferential sites in a high percentage (48%) of these children indicate a higher exposure to trauma in part, and a gradual incipience of an arthro-miopathy as well. To avoid this occurring we propose beginning prophylactic treatment as early as possible.

[Comparative study of 3 different prophylactic programs in hemophiliac children]. / Studio comparativo su 3 differenti programmi di profilassi in bambini emofilici.

Prophylaxis continues to be an area for discussion in the therapy of the hemophilic child. In fact, standard parameters are still not used in the evaluation of the efficacy of this treatment. At the Milan University Pediatric Clinic we have begun three different prophylactic programs with 52 children with ages ranging from 12 months to 14 years 7 months. We have evaluated the efficacy of these regimes comparing the data obtained in the 12 months following the start of the program with those obtained in the 12 months prior to it. Our data, even though they pertain to a limited number of children, show that continuous prophylaxis is truly efficacious if it is begun early before the onset of an arthopathy. Therapeutic prophylaxis however for the stabilizing of a target joint is usually better accepted by the children and their parents. The high cost of the prophylactic programs can nevertheless be justified by the better quality of life of the patients.