[Association between carotid lesions evaluated by Doppler color echocardiography and cardiovascular risk factors in the elderly. Preliminary results]. / Associazione tra lesioni carotidee valutate mediante eco color-Doppler e fattori di rischio cardiovascolari, in una casistica di soggetti in età geriatrica. Risultati preliminari.

BACKGROUND: The valuation of the extracranial carotid by echo color-Doppler takes on an extraordinary importance for the prevention of cerebral ictus at geriatric age. In this "naturalistic" study a population of old people (> 65 yrs) of Cagliari's province was considered in order to: 1) discriminate the lesions of the carotid that are imputed to atherosclerotic disease by anatomic changes of the arterial wall caused by aging; 2) study relations between lesions of the carotid and cardiovascular risk factors. METHODS: The carotids of 50 old subjects were studied by echo color-Doppler and the lesion classified in different classes of severity, according to the hemodynamic standard, comparing them with the presence of the most important cardiovascular risk factors. Hypercholesterolemia was the most frequent risk factor (76%), followed by hypertension (62%), over-weight (54%) and smoking (42%). Moreover a diffused intima-media thickening (IMT) was constant in all the subjects with values > 0.75 mm; athero-sclerotic plaques were even present in 39 subjects which only in 4 cases could be considered at risk of cerebral ischemia. RESULTS: A significant correlation between the severity of the lesions and levels of total cholesterol and LDL cholesterol for the male sex emerged, while for smoking only a trend of correlation has been obtained. CONCLUSIONS: Considering this experience it is suggested that in old subjects the presence of a diffused IMT with values > 0.75 mm must be considered as a marker of aging of the arterial wall of the carotid and not as a cardiovascular risk factor as reported in the literature for the middleaged.

Prevalence of peripheral arterial occlusive disease and associated risk factors in a sample of southern Sardinian population.

We studied a sample of adult population over 20 years old of Donori (totally 2049 inhabitants), a small town near Cagliari, South Sardinia, to: (1) Evaluate the prevalence of peripheral arterial occlusive disease of lower limbs (PAOD) diagnosed by standard questionnaire and US CW Doppler examination and associated risk factors in South Sardinia. (2) Compare the reliability of these two diagnostic methods. Our study included the answers to a standard anamnestic questionnaire (according to the WHO recommendations), physical examination and CW Doppler study of the lower limb arteries, the determination of the arterial systolic and diastolic pressure, ankle/arm pressure ratio, Body Mass Index, blood glucose, total and HDL-cholesterol, triglycerides and fibrinogen (the hematochemical examination only on 50% of the sample). The surveyed sample was of 577 subjects (37.96% of 1520, the eligible subjects over 20 years old), 237 males and 340 females. An arteriopathy was diagnosed by means of CW Doppler in 27 subjects, 20 M and 7 F. The overall prevalence of PAOD was 4.67% of the sample (2.06% of females, 8.43% of males). Prevalence steadily increased with age, and, surprisingly, the disease was not absent in young people (2 cases within males with age < or = 40 years). Conversely only 18.5% of PAOD patients were symptomatic. The overall prevalence of associated risk factors was: diabetes 3.6%, hypercholesterolaemia 59.1%, smoking 21.3%, arterial hypertension 21.6%, obesity 17.9%, hypertriglyceridaemia 9.3%, hyperfibrinogenaemia 4.67%. Among the males a significant correlation has been found, among the values of BMI vs age and total cholesterol, age vs total cholesterol, systolic blood pressure, diastolic pressure, fibrinogenaemia. Among the females, the systolic and diastolic pressure, BMI, total cholesterol, LDL-cholesterol, triglycerides and fibrinogen are significantly correlated with age; BMI correlates with systolic and diastolic blood pressure, fibrinogen; a nearly significant correlation has been found between BMI and triglycerides.

[Relation between changes in the microcirculation in the capillaries supplying the toenails and the degree of chronic venous insufficiency]. / Le alterazioni del microcircolo nutritizio della plica ungueale dei piedi sono correlate al grado dell'insufficienza venosa cronica.

Chronic venous insufficiency (CVI) is characterised by stasis which may lead to an imbalance in the cutaneous microcirculation resulting in a wide spectrum of complications. The use of capillaroscopy on the toenail folds of patients with CVI allows the morphological and microhemorrheological aspects of microcirculatory disorders to be studied. The aim of this study was to clarify the correlation between the extent of abnormalities of the nutritional capillary and the degree of severity of CVI according to Widmer's classification. Capillaroscopy of the toenail fold was used to study 100 patients suffering from essential varicose disease (EVD) and post-thrombotic syndrome (PTS) with CVI of various degrees, giving a total of 110 limbs grouped as follows: 30 limbs at stage 0; 49 at stage 1; 20 at stage 2 and 12 at stage 3. In addition, a further 30 limbs of normal subject without a family history of varicose disease were included in the study. All patients and control subjects were examined clinically and using ultrasound c.w. Doppler and eco-color-Doppler of the lower limbs. The results highlighted a progressive deterioration of the capillaroscopic conditions in relation to the severity of CVI. In particular, during stage 1 microcirculatory alterations found in patients with primary varicose syndromes appeared to be more severe than those with PTS. This apparent contradiction may be attributed to the unique topography of this hemodynamic disorders since the subpapillary circulation in EVD is topographically in direct continuity with the site of venous hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlations among capillaroscopic abnormalities, digital flow and immunologic findings in patients with isolated Raynaud's phenomenon. Can laser Doppler flowmetry help identify a secondary Raynaud phenomenon?

Thirty subjects with a diagnosis of isolated Raynaud's phenomenon, according to anamnestic and objective criteria, were cross-evaluated by various methods: laser Doppler flowmetry (LDF) during a standardized cold and rewarming test, nailfold capillaroscopy, immunological and other laboratory parameters, to assess the diagnostic and prognostic significance of each method. Correlations were also assessed among disease duration, capillaroscopic pattern score, quantitative digital flow values and laboratory parameters. Nearly 30% of patients showed immunologic abnormalities (ANA positivity at variable titres, ENA, hypocomplementemia, immunocomplexes); 16% of patients had a pathologic capillaroscopic pattern, not well correlated with immunologic findings; a characteristic cold stop reaction of digital flow (partial or total) was detected in 86% of the subjects; in ANA+ pts., ANA titers were positively correlated with the intensity and length of stop reaction (Trec). A significant correlation between digital flow parameters and the capillaroscopic score was also found in each considered group. Our results outline the relevance of LDF, during a standardized thermic test, to evaluate apparently primary RP, because even if a definite scleroderma-like capillaroscopic pattern is absent, this flowmetric method may detect potentially secondary RP patients.

[Hypothalamo-pituitary-adrenal function in liver cirrhosis of viral etiology]. / Studio della funzione ipotalamo-ipofiso-surrenalica nella cirrosi epatica di origine virale.

With the aim of evaluating the glucocorticoid function and the role of the adrenal gland in hypogonadism and feminization of cirrhotic patients, we examined 11 patients with virus-induced liver cirrhosis and 8 normal subjects as controls. In each subject serum levels of cortisol (C), progesterone (P), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS), delta 4-androstenedione (A), estrone (E1), testosterone (T), luteinizing hormone (LH) were assayed in basal conditions and after adrenocorticotropic hormone (ACTH) stimulation. Serum levels of ACTH, C, E1, estradiol (E2), T were assayed in basal condition and after dexamethasone suppression test. Moreover, a circadian study of ACTH, C and corticosteroid-binding globulin (CBG) was performed, with blood samples drawn at 8:00 and 20:00 on two consecutive days. Our results demonstrate that in cirrhosis: 1) normal levels of C, when metabolism is altered and CBG levels are reduced, are maintained by inhibition of ACTH secretion; 2) circadian rhythmicity of the pituitary-adrenal axis is well preserved; 3) in non-alcoholic cirrhosis, too, there is a reduction of androgens (T, DHEA, DHEAS, A) and a rise of estrogens (E2 and, more markedly, E1) and P; 4) in cirrhotic men E1 is mainly of adrenal origin and contributes, through negative feedback on LH secretion, to low levels of T.

Serum and urine ferritin in patients with transitional cell carcinoma of the bladder.

Erythrocyte, serum and urine ferritin concentrations were evaluated in 20 patients suffering from transitional cell carcinoma of the urinary bladder and in 20 healthy men. No clinical or biochemical signs of liver disorders, chronic inflammatory states or infections were present in both the patients and the controls. Our results showed no significant difference in the erythrocyte ferritin concentration in both groups. On the contrary there was a statistically significant difference in mean serum (p less than 0.05) and urine (p less than 0.01) ferritin concentration between the two groups. The mean serum ferritin concentration in the patients was 102.23 +/- 63.38 ng/ml while it was 258.41 + 250.68 ng/ml in normal subjects. The mean urine ferritin concentration was 6.30 +/- 5.35 ng/ml in normal subjects and 22.66 +/- 25.59 ng/ml in patients with bladder cancer. Our data seem to demonstrate that the assessment of the ferritin either in the serum or preferably, in the urine, could become an interesting tumoral marker for bladder cancer.

Evaluation of non-invasive haemodynamic parameters in patients with intermittent claudication subjected to physical training.

In a group of 26 patients, all smokers (mean age 56.9 +/- 8 years), with intermittent claudication due to arterial obliterative disease. We investigated some of the haemodynamic, haematologic and clinical parameters before and after a 3 months physical training program. During the training period, none of the patients were given vasoactive, anticoagulant, antiaggregant or other drugs which could affect blood lipid. Patients were instructed to walk for a minimum period of 1 hour daily, in addition to normal everyday activities. Statistically significant differences of claudication pain distance were obtained: 177 +/- 88 m vs 107 +/- 40 m, +65% (p less than 0.001); maximal walking distance: 456 +/- 205 m vs 250 +/- 138 m, +82% (p less than 0.0001) determined during treadmill test at 2 mph up 12% and t/2 peak flow: 30 +/- 11.6 sec vs 46.3 +/- 32.3 sec (p less than 0.02), determinated with plethysmographic venous occlusion strain-gauges studies. An important, but not significant decrease of fibrinogen was obtained: 302 +/- 60 mg% vs 328 +/- 57 (p = 0.06), whereas no statistically significant differences were found for the more important haemodynamic parameters: (1) Widsor index determinated before (60 +/- 14% vs 58 +/- 15%) and after (26 +/- 17% vs 26 +/- 17%) treadmill-test with Doppler ultrasound; (2) peak-flow (10.5 +/- 2 ml/100/min vs 10.2 +/- 3); (3) time to peak-flow (17 +/- 10.5 sec vs 19.3 +/- 12.1). We also didn't find any significant differences in total cholesterol (227 +/- 53 mg% vs 228 +/- 48) and haematocrit (43.6 +/- 3.5% vs 43.5 +/- 3.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Peripheral red blood cell survival invariance during pefloxacin treatment in subjects with glucose-6-phosphate dehydrogenase deficiency.

In order to evaluate the possible damaging effect of pefloxacin on erythrocytes in subjects with G-6-PD deficiency, a trial on red-cell survival was carried out using a 51Cr-labelled peripheral red blood cell technique. Eight men, aged 52 to 64 years, with osteoarthrosis and G-6-PD deficiency (Mediterranean type) were treated with 800 mg/day pefloxacin. Pefloxacin did not modify red cell survival in the subjects under study. In all subjects erythrocyte GSH levels were investigated in baseline conditions and also after incubation with increasing doses of pefloxacin. No significant change in erythrocyte GSH levels was observed after incubation with therapeutic doses of pefloxacin.

[Laser Doppler flowmetry. Principles and clinical applications in vascular acro-syndromes]. / La flussimetria Doppler laser. Principi ed applicazioni cliniche nelle acrosindromi vascolari.

Twenty-seven subjects with vasospastic diseases: 13 primary and 5 secondary Raynaud phenomenon (RP), 3 primary RP treated with raubasin 60 mg/day, 6 acrocyanosis and 9 normal subjects were studied in a standardized experimental set (thermostatic chamber), recording cutaneous digital micro-vascular reactions to cold and heat exposure by laser Doppler flowmetry, a relatively new method for the objective and reliable assessment of blood flow in the cutaneous microvasculature. The data suggest that patients with vasospastic disease have a defect in local microvascular flow regulation, that is revealed by low temperature exposure. The major difference between primary and secondary RF was recovery time (stop reaction) after cold test, that is easily recorded by this instrumental set. The morphology of the recording and the flow recovery time of acrocyanosis were found to be similar to those of secondary RF.

A case of classical Kaposi's sarcoma in B-cell chronic lymphocytic leukemia (B-CLL).

We report a case of classical Kaposi's sarcoma (KS) in a patient affected by B-cell chronic lymphocytic leukemia for 2 years and who had not received any antiblastic treatment. At the ultrastructural analysis the leukemic cell showed rather immature features, and the immunologic phenotype (absence of detectable cytoplasmic Ig, and expression only of the DR, B2 and IgD lambda molecules on the surface membrane) proved its intermediate level of maturity, its monoclonality and relative rarity. The patient presented a complex immunologic deficiency, revealed not only by the monoclonality of the B lymphocytes and their low degree of maturity, but also by the almost total absence of T helper lymphocytes, by the high reduction in NK activity, by the very scarce proliferative response to the polyclonal mitogens PHA, ConA and PWM, and by a complete anergy to the skin test of delayed reactivity. The search for antibodies against the viruses EBV, CMV, HTLV-I and HTLV-III in the serum was negative. At the HLA typing, the patient was DR5, as are most classical KS and/or B-CLL patients. The data are discussed in relation to documented non-casual association between B-CLL and KS. We stress that immunosuppression may play an important role in the pathogenesis of both diseases and the possibility of their being conditioned by common genetic HLA-associated factors of predisposition.