Peripheral neuropathy associated with hypereosinophilia.

Three patients with hypereosinophilia showed different forms of peripheral neuropathy: severe polyneuropathy of prevalently sensory type (case 1), mild sensory neuropathy (case 2), acute mononeuropathy of the median nerve with subclinical polyneuropathy (case 3). Hypereosinophilia was probably idiopathic, however the presence of atypical findings suggested transition to vasculitides or collagen disease. Sural nerve biopsy in cases 1 and 2 showed features of axonopathy in both, although of different severity, reflecting the variability of clinical involvement and, probably, heterogeneous pathogenic mechanisms. Peripheral nerve involvement associated with hypereosinophilia may be related to neurotoxicity of eosinophils, or to vascular damage.

[Cardiocirculatory adaptations during the initial phases of pregnancy. An echo-Doppler assessment]. / Adattamenti cardiocircolatori durante le fasi iniziali della gravidanza. Valutazione eco-Doppler.

During pregnancy the cardiovascular apparatus meets an important process of morphofunctional adjustment. However the very moment when this happens is not very well known. We observed thirty patients during the various GIFT phases (Gamete Intrafallopian Transfer) that consists in the intratubal transfer of male and female gametes and that represents also an ideal model for the study of pregnancy in the early phases. With echo-Doppler technique morphological and functional parameters of the left ventricle have been evaluated and at the same time estradiol and progesterone blood variations have been determined. In all the thirty patients to the increase of E2 corresponds a significative increment of telediastolic (Dd) and telesystolic (Ds) diameter and of systolic index (SI) and cardiac index (CI). At the same time a significant reduction of mean arterial pressure and of the index of a systemic vascular resistance has been observed. These data say that the systolic flow increment is not due to an increase of the ejection fraction but to an increase of the diastolic filling. The utilised mechanism has nothing to do with inotropism but to the preload reserve according Starling principle. The increase of the systolic output is the almost unique cause of the cardiac capacity increment because there is only a light increase of heart rate. Those patients in which GIFT gave a positive results, these variations are sustained while in the group of those patients not pregnant one can see a rapid return to basic values of the various parameters (except the presence of a significative Dd increment) together with the reduction of plasmatic E2. In conclusion our work results say that significative cardiovascular adjustments are evident from the earliest pregnancy phases and that these changes one can related to E2 plasmatic variations.

Noninvasive evaluation of cardiovascular hemodynamics during multiple follicular stimulation, late luteal phase and early pregnancy.

A noninvasive hemodynamic study in three moments of the gamete intrafallopian transfer (GIFT) cycle was carried out on 25 patients: before beginning multiple follicular stimulation (MFS) (study I); after rapid increase of serum estradiol (E2) (study II); and 12 days after GIFT (study III). In the 25 patients, the rapid increase in E2 proved to be combined with a significant increase in the left ventricular end diastolic dimension (LVEDD), the left ventricular end systolic dimension, the heart rate (HR), the systolic index, the cardiac index, and a significant reduction in the mean arterial pressure, in the systolic arterial pressure and in the systemic vascular resistence index. In the 14 pregnant patients in study III, all of the hemodynamic parameters studied proved to be significantly modified with respect to study I. In the 11 nonpregnant patients between Studies I and III were no significant cardiovascular modifications except for a significant increase in LVEDD in Study III. It is concluded that, during MFS, the rapid increase in E2 is combined with hemodynamic modifications and that, in pregnancy, the cardiovascular adaptation modifications occur in the very early stages.

Induction of ovulation for gamete intrafallopian transfer (GIFT) using a gonadotropin-releasing hormone agonist and "pure" FSH: results obtained in 30 normally menstruating women.

About 30% of the ovulation induction cycles in GIFT and FIVET programmes are cancelled due to an inadequate response of patients to gonadotropins and/or clomiphene citrate. GnRH agonist-gonadotropins and/or "pure" FSH combination has been successful in inducing ovulation in patients with a previous history of cycle cancellation and/or alterations in the menstrual cycles. In order to reduce the number of cycle cancellations and obtain more homogeneous oocytes, GnRH agonist-gonadotropins and/or "pure" FSH combination in all candidates for GIFT and FIVET has been recently hypothesised. The Authors report results obtained from GnRH agonist-"pure" FSH combination in 30 normally menstruating patients of the GIFT programme: in 93% of cases the harvested oocytes were preovulatory, in 27.6% of cycles and in 28.6% of the GIFTs respectively an ongoing pregnancy was obtained. While the results obtained must be considered preliminary, they nevertheless suggest that the use of a combination of GnRH-agonist "pure" FSH in all patients in the GIFT programme may be of real clinical validity.

The direct IgG-MAR test (mixed antiglobulin reaction test): results and correlations with seminal analysis in 1176 men from infertile couples.

The direct IgG mixed antiglobulin reaction (IgG-MAR) test was carried out as a screening test and as a routine test of semen analysis in 1176 male patients from infertile couples. We correlated the results of the IgG-MAR test with the semen analysis parameters. The test was only positive in 3.1% of the cases; other Authors describe incidences of much higher positive results than ours, for which reason we emphasize that our patients had not previously undergone any kind of preliminary section. The positive IgG-MAR test proved to correlate significantly both with the number and motility of the spermatozoa, while there appeared to be no correlation between its positiveness and the other parameters of the seminal liquid.

[Effect of blood levels of carboxyhemoglobin (COHb) on erythrocyte filtration time in young smokers]. / Influenza del tasso ematico di carbossiemoglobina (COHb) sul tempo di filtrazione eritrocitaria in giovani fumatori.

The effects of chronic exposure to carbon monoxide on some rheologic parameters (erythrocyte filtration time in particular) and on FEV1, and on FEF25-50 were studied in young smokers. A positive correlation among number of cigarettes day, COHb blood levels and erythrocyte filtration time was found. Packed red cell volume, fibrinogen concentration and platelet count were unaffected; no evidence of small-airway obstruction was observed. The alteration of erythrocyte deformability may be an early sign of hemorheological impairment which can progressively worse if high COHb blood levels are chronically maintained, with damaging effects on vessel function.

[Evaluation of age-related changes of erythrocyte filtration]. / Valutazione delle variazioni della filtrazione eritrocitaria in rapporto all'età.

In two groups of subjects (young and elderly), the red blood cell (RBC) deformability was examined determining the filtration time by means of two different methods (filtration of whole blood and filtration of RBC suspension with hematocrit adjusted at 20%, respectively). In addition, the DFE (Debit de filtration erythrocytaire), an indirect index of capillary blood flow, was mathematically derived. Since the filtration times appear to be positively correlated with age, it is conceivable that in the elderly, erythrocytes are less deformable than in the young, and that this change may impair both capillary blood flow and tissue oxygen delivery; this alteration is further emphasized when the relationship between whole blood filtration time and hematocrit is taken into account.