Efficacy of estradiol or GnRH in combination with progesterone intravaginal devices to control the follicular wave dynamics and resulting fertility in lactating dairy cows.

This study was conducted to compare efficacy of treatments with EB or GnRH and different quantities of exogenous progesterone (P4) for synchronization of time of ovulation on follicular growth and pregnancy in lactating dairy cows. In Experiment 1, 40 cows were treated with EB or GnRH and 1.9 or 3.0 g of P4 via progesterone-containing intravaginal devices (IVPD; D0), two doses of PGF2α on D7, GnRH on D9, and TAI on D10. In Experiment 2, 1,440 cows were treated with EB or GnRH and 1 g IVPD on D0, cloprostenol, eCG and EB on D7. Cows in estrus by 48 h were AIDE, and non-estrous cows were administered GnRH and TAI 60 h after IVPD removal. Non-estrous cows were AIDE 72 h after IVPD removal. In Experiment 1, P4 was greater on D7 for cows treated with GnRH than those treated with EB. The dominant follicle was larger for cows treated with GnRH than those treated with EB. In Experiment 2, for estrous cows, pregnancy per AI was greater in cows AI at 48 h compared to 60 h after IVPD removal for cows treated with GnRH, and greater with AI at 60 h after IVPD removal compared to 48 h in EB-treated cows. In non-estrous cows, there was no effect on pregnancy. In conclusion, treatment with GnRH compared with EB resulted in increased P4 regardless of amount of exogenous P4, and there were differential proportions of estrous cows pregnant depending on time of AI after IVPD removal.

[Loco-regional block in ophthalmic surgery: single drug or drug combination with hyaluronidase? Randomized prospective study]. / Blocchi loco-regionali in oculistica: monofarmacologici o miscela con jaluronidasi? Studio prospettico randomizzato.

UNLABELLED: The aim of this study is the comparison between the use of bupivacaine alone and a mixture of bupivacaine, mepivacaine and hyaluronidase in both retrobulbar and peribulbar blockades for eye surgery. Three hundred ninety-nine consecutive adult patients scheduled for cataract surgery with regional anaesthesia were included in this prospective, randomized and partially blind study. Peribulbar blockade was performed on 199 patients (group P). Ninety-nine of them received a mixture of local anaesthetics and hyaluronidase (sub-group M), while 100 received bupivacaine alone (sub-group B). Retrobulbar blockade was performed on 200 patients (group R): 100 of them received the mixture with hyaluronidase (sub-group M), while 100 received bupivacaine (sub-group B). The interval between anaesthesia and motor blockade (onset time), the presence of residual ocular movements, the need of further anaesthesia, the quality of anaesthesia, the ocular tone, the length of anaesthesia and possible complications were registered. RESULTS: Retrobulbar blockade has the only advantage of a shorter onset time, while peribulbar blockade shows a longer anaesthetic effect. Mixture with hyaluronidase (the sub-group M) has a shorter onset time, a lesser need of further anaesthesia, fewer residual ocular movements and a better quality of anaesthesia. CONCLUSIONS: Local anaesthetics mixture with hyaluronidase associated with peribulbar blockade presents the advantages of rapidity, duration and better quality without the risks of retrobulbar blockade side effects.

[Efficacy and tolerability of felodipine and nifedipine in stable angina refractory to beta-blocker therapy]. / Efficacia e tollerabilità della felodipina e della nifedipina nell'angina stabile refrattaria a terapia beta-bloccante.

BACKGROUND: Medical therapy of stable angina contemplates beta-blockers as a first line. The combination of dihydropyridines with beta-blocking drugs enhances the effectiveness of both single therapies. Nifedipine, in the usual formulation (AR), is burdened by an unsatisfactory tolerability, and this is the main reason to study new dihydropyridines. AIM: To compare efficacy and tolerability of felodipine ER 10 mg o.d. with that of nifedipine AR 20 mg b.d. in patients with stable angina pectoris refractory to beta-blocker therapy. PATIENTS AND METHODS: Of 15 initial patients, 14 were entirely evaluable for the study, the design of which was double blind, double dummy, random cross over and placebo controlled. All patients showed reproducible threshold of ischemia at exercise testing. In constancy of beta-blocker therapy, they were given placebos for 2 weeks, then one of the active drugs with a placebo of the other one for 4 weeks, followed by the cross-over period of 4 weeks. Efficacy and tolerability of treatments were evaluated by clinical observation and rest and exercise radionuclide angiography. At the end of each individual study, it was decided blindly if and which of the 2 drugs seemed preferable, considering symptoms, undesired collateral effects and the results of exercise procedures. RESULTS: The efficacy on angina of the 2 active treatments was not different. More patients suffered undesired side effects on nifedipine than on felodipine. Left ventricular ejection fraction (LVEF) at rest was 65.3 +/- 4.3% (s.e.) on placebo, 64.6 +/- 2.6% on felodipine and 67.5 +/- 2.5% on nifedipine (p n.s.). A significant reduction in resting LV function (that is, a decrease of LVEF > or = 5%) was observed in 2 patients on felodipine and 3 on nifedipine, but in both groups other 3 patients showed improvement in LVEF. During exercise, LVEF decreased 6.1 +/- 2.0% on placebo and 3.3 +/- 3.2% on nifedipine, while it increased 1.0 +/- 2.6% on felodipine (p < 0.01 vs. placebo). At the end of the study, felodipine was blindly judged superior to nifedipine in 10 patients, nifedipine was superior in 1 case, in the other 3 there was no clear difference (p < 0.02). CONCLUSIONS: In 14 patients with stable angina refractory to beta-blockers, the addition of felodipine or nifedipine has similar antiischemic effects. However, felodipine showed better results in LVEF response to exercise and less side effects, and this leaded to a more frequent blind choice of felodipine versus nifedipine to add to beta-blocker therapy.

[Urapidil and dopamine in severe heart failure. A clinical case]. / Urapidil e dopamina nello scompenso cardiaco grave. Caso clinico.

The Authors report their experience with a new vasodilator drug (Urapidil) employed in the management of serious cardiac failure, in a patient who previously didn't respond in a satisfactory manner to a therapy with Dopamine alone. After several days of continuous treatment, the patient was discharged, without any sign of toxic or metabolic reactions.

Comparison of nutritional status after total or subtotal gastrectomy.

Forty-four disease-free patients were evaluated a mean of three years after total gastrectomy (TG) or subtotal gastrectomy (SG) for cancer. The investigation encompassed nutritional assessment by standard anthropometric and biochemical indices; evaluation of the nutritional intake based on 24 h recall and of appetite status on a visual analogue scale; and anamnestic analysis of postcibal symptoms and syndromes. Body weight had declined progressively until the 15th postoperative month after both TG and SG. Weight loss, as well as the general nutritional status index (actual body weight/usual body weight +/- actual body weight/desirable body weight + measured arm muscle circumference/reference arm muscle circumference x 33), had dropped more significantly in patients undergoing TG than those having SG (p less than 0.05). The principal body compartment change was observed in the fat content which was severely depleted, whereas the somatic proteins were relatively spared and the visceral proteins and remaining biochemical variables were in the normal range. Protein intake was not significantly different in the two groups, but caloric intake was significantly lower and the number of meals significantly higher after TG (p less than 0.05). These data suggest that malnutrition after TG is relatively mild and that this operation causes only a limited impairment of the nutritional state, and spares most of the nutritional variables of clinical interest in comparison with SG. These findings argue in favor of TG when clinically indicated without excessive concern about postoperative nutrition.

Predictability of deterioration in marginally malnourished cancer patients during hospitalisation.

One hundred and twenty-six cancer patients admitted consecutively to the Istituto Nazionale Tumori, Milan, were examined. Within 48 h of hospital admission and again after one week, each patient underwent a nutritional assessment including standard anthropometric and biochemical indices (weight loss, serum proteins, serum albumin, total iron binding capacity (TIBC), cholinesterase (CHE) and lymphocyte count). Calorie and protein intake were also calculated. Each patient was classified with respect to a threshold of normality for each variable (< 10% for weight loss, > 6 g/dL for serum proteins, 3.4 g/dL for serum albumin, >/= 250 mmg/dL for TIBC, >/= 1900 mU/dL for CHE, >/= 1500/nm for total lymphocytes count and 90% Recommended Dietary Allowances (RDA) for nutritional intake). The Mann-Whitney test was performed to assess the statistical significance of the variation between all the nutritional variables at admission and after 7 days of hospitalisation. The relative risk of developing malnutrition regarding a nutritional index after 7 days of hospitalisation was then calculated with reference to each nutritional variable at admission. The significance was tested by the chi square test. The analysis showed that patients who developed deterioration of a nutritional index during hospitalisation had, at admission, worse values of the variable which subsequently deteriorated. In particular, low levels of serum albumin and total iron binding capacity were the variables associated with the higher number of nutritional indices which deteriorated after 7 days of hospitalisation. These were followed by low values of cholinesterase, body weight, serum proteins and lymphocytes. No significant relationship was found between change of a nutritional variable and protein and calorie intake. The risk of developing relevant weight loss (relative risk (RR) = 3.52), hypoalbuminemia (RR = 2.38) and hypoproteinemia (RR = 2.6) during hospitalisation was significantly higher when CHE was below 1900 mU/mL at admission.

Anorexia in cancer patients: prevalence and impact on the nutritional status.

One hundred and eightysix cancer patients with different types, site and stage of disease, consecutively admitted to the Istituto Nazionale Tumori, Milan, were examined. The purpose of the study was to assess the prevalence of subjective anorexia and to determine whether some nutrition-related indices are different within homogeneous categories of cancer patients, anorectic and non-anorectic. Anorexia was measured on the basis of an appetite score, evaluated with a visual analogue rating scale. Nutritional intake was evaluated by a computerised programme of the habitual food consumption. Nutritional assessment included anthropometric evaluations (triceps skinfold, arm circumference, arm muscle circumference) and biochemical indices (serum albumin, and total iron binding capacity). A nutritional index was then calculated: GNS = P + I + M x 100, where P: actual weight/premorbid weight; I: actual weight/ideal weight; M: actual arm muscle mass circumference/ideal arm muscle mass circumference. The evaluation of the data showed that: (1) The prevalence of subjective anorexia ranged from 1 3 to 2 5 of the patients depending on the type and site of tumour, and stage of disease. (2) Most of the nutritional-related variables were significantly worse in anorectic compared with non-anorectic patients. (3) Within groups of patients with different tumour location, but homogeneous for the presence or absence of subjective anorexia, there is no difference with respect to nutritional indices; except for patients with cancer of the oesophagus and stomach who were always more depleted. (4) Anorexia did not seem to influence the nutritional status in patients with cancer at an early stage (except in cancer of oesophagus and stomach) but it was associated to malnutrition as the disease progressed to more advanced stages.

Impact of hospitalization on the nutritional status of cancer patients.

This study was undertaken to examine the influence of hospitalization on the nutritional status of cancer patients. We examined 126 patients consecutively admitted to the Istituto Nazionale Tumori of Milan. At admission, all patients underwent standard evaluations, including actual weight, percentage weight loss, arm circumference, triceps skinfold, serum proteins, serum albumin, total iron binding capacity, cholinesterase and peripheral lymphocytes. Finally, from all patients a 24-h dietary recall was obtained, in order to calculate calorie and protein intake. All the patients underwent another evaluation after 1 week of hospitalization; after 2 weeks only 37 of them were evaluated again, since some were operated, some were treated with radio-chemotherapy, some were discharged or had died. Results showed that after one week of hospitalization some variables were significantly altered, such as arm circumference in male patients, serum proteins, cholinesterase, total iron binding capacity, peripheral lymphocytes, calorie and protein intake. A significant weight loss was seen after 2 weeks. The reduced calorie and protein assumption was correlated with depletion of some of the nutritional variables (body weight, arm circumference in males, total iron binding capacity, serum albumin, cholinesterase, lymphocytes). Our data show that hospitalization plays an important role in deterioration of nutritional status in our patient population, and this problem is generally overlooked by the clinicians primarily involved in the care of cancer patients.

Hospital malnutrition: incidence and prospective evaluation of general medical patients during hospitalization.

The incidence of malnutrition and the effect of hospitalization was evaluated in 100 consecutive admissions to the Clinical Pathology R Department of the University of Genoa. Nutritional deficiencies were evaluated at the time of admission and discharge from the Hospital, among patients hospitalized 2 weeks or longer, using the following nutrition-related parameters: body fat, muscle proteins, weigh, rate of weight loss plasma proteins level, vitamin B12 and folic acid plasma level, plasma iron and ferritin. We also considered the nutritional alterations in malnourished patients with relation to appetite decrease and to pathological status. At the admission to the hospital, the findings showed a high incidence (79%) of alterations in some nutritional parameters. In patients with nutritional impairments we observed a worsening of most of the nutritional parameters during hospitalization, especially in patients with severe appetite decrease and those affected by sepsis, neoplastic, gastric and renal diseases.