Disección aórtica crónica tipo A en un paciente con obesidad mórbida y preeclampsia / Type A chronic aortic dissection with obesity and preeclampsia

La disección aórtica es una dolencia potencialmente letal, con una incidencia en la gestante hasta 100 veces superior comparada con la de la población adulta. Suele presentarse con un cortejo típico caracterizado por dolor torácico. Presentamos el caso de una mujer de 37 años con antecedente gestacional y obesidad mórbida, diagnosticada de disección aórtica crónica tipo A por un hallazgo radiológico documentado a los 10 meses posparto (AU)

Aortic dissection is a potentially lethal disease whose incidence in pregnant women can be up to 100 times that of the remaining adult population. In most cases, it presents as typical chest pain. We report the case of a 37yo obese woman diagnosed with chronic type A aortic dissection documented by a radiological finding 10 months after delivery (AU)

Type A chronic aortic dissection with obesity and preeclampsia. / Disección aórtica crónica tipo A en un paciente con obesidad mórbida y preeclampsia.

Aortic dissection is a potentially lethal disease whose incidence in pregnant women can be up to 100 times that of the remaining adult population. In most cases, it presents as typical chest pain. We report the case of a 37yo obese woman diagnosed with chronic type A aortic dissection documented by a radiological finding 10 months after delivery.

Adjustable Velcro Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial.

OBJECTIVE/BACKGROUND: The objective of this study was to compare the efficacy and comfort of inelastic bandages (IBs) and adjustable Velcro compression devices (AVCDs) in reducing venous leg edema in the initial treatment phase. METHODS: Forty legs from 36 patients with untreated venous edema (C3EpsAsdPr) were randomized to two groups. Patients in the first group received IBs (n = 20) and those in the second AVCDs (n = 20). Both compression devices were left on the leg day and night, and were renewed after 1 day. Patients in the AVCD group were asked to re-adjust the device as needed when it felt loose. Leg volume was calculated using the truncated cone formula at baseline (T0), after 1 day (T1) and after 7 days (T7). The interface pressure of the two compression devices was measured by an air filled probe, and the static stiffness index calculated after applying compression at T0 and T1, and just before removal of compression on T1 and T7. Patient comfort with regard to the two compression systems was assessed by grading signs and symptoms using a visual analog scale. RESULTS: At T1, the median percent volume reduction was 13% for the IB group versus 19% for the AVCD group; at T7 it was 19% versus 26%, respectively (p < .001). The pressure of the IBs was significantly higher compared with the AVCDs at T0 (63 vs. 43 mmHg) but dropped by > 50% over time, while it remained unchanged with AVCDs owing to the periodic readjustment by the patient. Comfort was reported to be similar with the two compression devices. CONCLUSION: Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance therapy, but also in the initial decongestive treatment phase of patients with venous leg edema.

In vitro fermentation characteristics of different carbohydrate sources in two dog breeds (German shepherd and Neapolitan mastiff).

Few studies have been published on the normal intestinal biota of canines unlike the wealth of information regarding livestock animal species. The in vitro gas production technique (IVGPT) including measurements of accumulating gas during fermentation and end-product determinations allows obtaining a complete picture of microbial activity kinetics. The aim of this study was to study the in vitro fermentation characteristics of different carbohydrate sources using inocula from two dog breeds (German Shepherd and Neapolitan mastiff). Faeces sampled from rectum of two GS and NM adult dogs, fed the same dry food, were used as inocula. The samples, diluted and filtered, were incubated at 39 degrees C under anaerobic condition with nine substrates different for carbohydrate composition (rice, corn, potato, spelt, pure cellulose, beet pulp, wheat bran, inulin and fructo-oligosaccharide). Gas production was recorded 17 times using a manual pressure transducer. After 48 h, the fermentation was stopped and fermenting liquor was analysed for pH and volatile fatty acids (VFA). Organic matter digestibility (OMD) was calculated as difference after burning the residuals. OMD, gas production and end-products were significantly correlated with chemical composition of substrates, in particular carbohydrate fractions (total dietary fibre and starch), confirming the effectiveness of the IVGPT in evaluating dog feeds. Concerning the comparison between breeds significant differences (p < 0.01) were found for OMD, gas production, fermentation kinetic parameters and end-products, suggesting a different pathway of fermentation and consequently, a different anaerobic population.

Role of PET/CT in the detection of liver metastases from colorectal cancer.

PURPOSE: The aim of this study was to compare the diagnostic accuracy of 2-[fluorine-18] fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) and computed tomography (CT) with PET/CT in the detection of liver metastases during tumour staging in patients suffering from colorectal carcinoma for the purposes of correct surgical planning and follow-up. MATERIALS AND METHODS: A total of 467 patients underwent a PET/CT scan using an iodinated contrast medium. We compared images obtained by the single PET scan, the single CT scan and by the fusion of the two procedures (PET/CT). The final diagnosis was obtained by histological examination and/or by the follow-up of all patients, including those who did not undergo surgery or biopsy. RESULTS: The PET scan had 94.05% sensitivity, 91.60% specificity and 93.36% accuracy; the CT scan had 91.07% sensitivity, 95.42% specificity and 92.29% accuracy. The combined procedures (PET/CT) had the following values: sensitivity 97.92%, specificity 97.71% and accuracy 97.86%. CONCLUSIONS: This study indicates that PET/CT is very useful in staging and restaging patients suffering from colorectal cancer. It was particularly useful when recurrences could not be visualised either clinically or by imaging despite increasing tumour markers, as it guaranteed an earlier diagnosis. PET/CT not only provides high diagnostic performance in terms of sensitivity and specificity, enabling modification of patient treatment, but it is also a unique, high-profile procedure that can produce cost savings.

A model to assess the use of caecal and faecal inocula to study fermentability of nutrients in rabbit.

An in vitro gas production trial was conducted using 10 Hyla rabbits to evaluate the use of caecal and faecal inocula in fermentability studies. Caecal content (CI) and hard faeces (FI) were used as inocula. Six legume and six cereal concentrates were used as substrates. Gas production was recorded 19 times at 2-24 h intervals throughout fermentation (120 h). The fermentation characteristics (degraded organic matter, OMd; potential gas production, A; volatile fatty acid, VFA; ammonia, NH(3)) were measured by testing the inoculum and substrate (legumes vs. cereals). The inocula were different (p < 0.01) in OMd (818.2 vs. 799.4 g/kg OM for CI and FI respectively), A (255.0 vs. 267.1 ml/g OM), total VFA (67.3 vs. 53.2 mmol/g OM) and NH(3) content (21.2 vs. 19.8 mmol/l). Moreover, the significant differences in the (acetate + propionate)/butyrate ratio (5.02 vs. 4.09 for CI and FI respectively, p < 0.01) and in the branched chain proportion (isobutyrate + isovaleriate)/total VFA (0.044 vs. 0.031, p < 0.01) indicate that the inocula differed in fermenting legumes or cereals, but the equations for estimating caecal fermentation characteristics from those of faeces showed R(2) values from 0.673 to 0.975 (p < or = 0.01). Our results confirm that in vitro fermentation characteristics of faeces were highly related to those of caecal content.

Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature.

PURPOSE: The authors sought to evaluate indications, technical feasibility and clinical efficacy of computed tomography (CT)-guided pudendal nerve infiltration in patients with chronic anoperineal pain by reviewing the role of the CT technique in their personal experience and in the recent interventional literature. MATERIALS AND METHODS: Twenty-eight women, mean age 50 years, and with a diagnosis of pudendal neuralgia on the basis of clinical and electromyographic criteria were enrolled in the study. CT-guided pudendal nerve injections were performed during three consecutive sessions held 2 weeks apart. In each session, patients received two percutaneous injections: one in the ischial spine, and the other in the pudendal (Alcock's) canal. RESULTS: One patient dropped out of the study after the first session. At clinical assessment, 24h h after treatment, 21/27 patients reported significant pain relief. At follow-up at 3, 6, 9 and 12 months, 24/27 patients reported a>or=20% improvement in the Quality of Life (QOL) index. CONCLUSIONS: In pudendal nerve entrapment, CT-guided perineural injection in the anatomical sites of nerve impingement is a safe and reproducible treatment with a clinical efficacy of 92% at 12 months.

Influence of pasture on fatty acid profile of goat milk.

The effect of pasture on the fatty acid profile of milk was evaluated using 30 pluriparous goats, which were divided into two homogeneous groups (H and P) of 15 goats each after kidding. Group H (control) goats were housed in a stall and received alfalfa hay, while group P was led to pasture. The goats of both the groups received the same concentrate. Average milk yield did not differ statistically between the groups. The goats of the P group had significantly higher fat content in milk than those of group H (53.7 vs. 61.5 g/day, p < 0.01), while lactose content was significantly higher for group H (66.2 and 61.4 g/day, for groups H and P, respectively, p < 0.05). Among milk fatty acids, pasture significantly affected the percentages of C18:1 cis9, C18:1 trans11, octadecadienoic acid, mono-unsaturated fatty acid and polyunsaturated fatty acid. Pasture highly influenced the c9 t11 conjugated linoleic acid (CLA) (0.778 and 0.513 g/100 g of fat, for group P and H, respectively, p < 0.01), t10 c12 CLA (0.046 vs. 0.029 g/100 g of fat: p < 0.01, for group P and H, respectively, p < 0.01) and SigmaCLA (0.84 vs. 0.56 g/100 g of fat for group P and H, respectively, p < 0.01) concentrations of milk.

Use of faeces as an alternative inoculum to caecal content to study in vitro feed digestibility in domesticated ostriches (Struthio camelus var. domesticus).

1. In order to find an alternative source of inoculum to caecal content for studying the in vitro feed digestibility in domesticated ostriches (Struthio camelus var. domesticus), caecal content and faeces of 4 male birds were used as inocula for an in vitro gas production trial. 2. About 1 g of each of 5 substrates (maize silage, CS; alfalfa hay, AH; barley, BG; soybean meal, SM; beet pulp, BP) was weighed, in quadruplicate per inoculum, in 120 ml flasks; 75 ml of anaerobic medium and 4 ml of reducing solution were added and flasks were kept at 39 degrees C. Caecal content and faeces were diluted respectively 1 : 2 (CI) and 1 : 4 (FI) with an anaerobic medium and were injected into the respective flasks (10 ml). 3. Gas production was recorded 22 times up to 120 h of incubation and fermentation characteristics (for instance, degraded organic matter, OMd; potential gas production, A; maximum fermentation rate, Rmax; time at which it is reached, Tmax; pH; volatile fatty acid, VFA; ammonia) were studied for each inoculum and substrate. 4. CI and FI showed significant differences in Tmax (16.37 vs 18.47 h, respectively), propionic (16.47 vs 12.07 mmoles/l) and butyric acid (6.50 vs 7.98 mmoles/l) and ammonia concentration (17.18 vs 19.95 mmoles/l). The substrates, according to their chemical composition, showed different fermentation characteristics. However, the regression equations able to estimate some fermentation characteristics of the caecum from those of faeces were statistically significant and showed R2-values ranging from 0.87 to 0.99. 5. The differences in fermentation pathways of the two inocula did not appear to influence the rate and extent of OM digestion. Faecal fermentation predicted rates and extent of OM digestion by caecal fermentation in ostriches; consequently, the faeces could be considered as an alternative to caecal content to study feed digestibility in the species, although there is a need to undertake further research.

Use of two different dietary energy and protein contents to define nutritive requirements of lactating buffalo cows.

Two total mixed rations, differing in energy and protein concentrations (diet A: 6.1 MJ/kg DM of NE(l), 112.5 g/kg DM of metabolizable protein, MP, and 101.7 g of protein digestible at the intestinal level, PDI, vs. diet B: 6.4 MJ, 95.1 g of MP, 78.9 g of PDI) were administered ad libitum for 1 year to two groups of 12 buffaloes in which the partial monthly turnover of animals allowed the lactation stage to be maintained close to 160 days. The diets were formulated to obtain, with a daily intake of about 15.5 kg of DM, a balanced energy supply but an excess of protein (diet A); the opposite occurred with diet B. The average dry matter intake recorded during the trial was 14.5 kg for diet A and 15.0 kg for diet B. Milk production was similar for both groups (7.94 kg vs. 7.95 kg). The diet with a higher protein concentration brought about a significant increase in protein, casein and non-protein nitrogen contents in the milk. A significant increase in milk fat percentage was observed when the animals were fed the diet with a higher energy concentration. The serum urea concentration (8.62 mm/l) of buffaloes fed diet A was outside the physiological range for lactating buffaloes. The energy and protein conversion efficiencies for milk production were more favourable when their supplies were balanced: 3.58 MJ of NE(l)/kg of FPCM for diet A; 2.50 g of MP or 2.07 g of PDI/g of protein milk for diet B. Moreover, when the requirements were satisfied, greater energy or protein supplies failed to induce significant changes in milk yield and quality. Finally, regarding the great differences between estimated MP requirements and those recorded during the trial, the authors suggest that the equations used in the CPM-Dairy software, formulated for dairy cows, are not applicable in buffaloes.

Solitary pulmonary nodules: morphological and metabolic characterisation by FDG-PET-MDCT.

PURPOSE: This study was done to analyse the additional morphological and functional information provided by the integration of [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography ([18F]-FDG-PET) with contrast-enhanced multidetector computed tomography (MDCT) in the characterisation of indeterminate solitary pulmonary nodules (SPNs). MATERIALS AND METHODS: Fifty-six SPNs, previously classified as indeterminate, were evaluated using a Discovery ST16 PET/CT system (GE Medical Systems) with nonionic iodinated contrast material and [18F]-FDG as a positron emitter. Images were evaluated on a dedicated workstation. Semiquantitative parameters of [18F]-FDG uptake and morphological, volumetric and densitometric parameters before and after contrast administration were analysed. Results were correlated with the histological and follow-up findings. RESULTS: Twenty-six SPNs were malignant and 30 were benign. Malignant lesions at both PET/CT and histology had a mean diameter of 1.8+/-1.2 cm, a volume doubling time (DT) of 222 days, a mean standardized uptake value (SUV) of 4.7 versus 1.08 in benign lesions and a mean postcontrast enhancement of 44.8 HU as opposed to 4.8 HU in benign nodules. Malignant lesions had a significantly shorter doubling time and significantly greater postcontrast enhancement compared with benign nodules. Based on the SUV and using a cut-off value of >2.5, PET/CT had a sensitivity of 76.9%, specificity of 100%, diagnostic accuracy of 89.2%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 83.3%. Based on doubling time (cut off<400 days), it had a sensitivity of 76.9%, specificity of 93.3%, accuracy of 85.7%, PPV of 90.9% and NPV of 82.3%. Based on postcontrast enhancement (cut off>15 HU), it had a sensitivity of 92.3%, specificity of 100%, accuracy of 96.4%, PPV of 100% and NPV of 93.7%. CONCLUSION: PET/CT allows accurate analysis of anatomical/morphological and metabolic/functional correlations of SPN, providing useful data for identifying and locating the disease, for differentiating between malignant and benign nodules and for establishing the aggressiveness and degree of vascularity of pulmonary lesions. Therefore, partly in view of the considerable reduction in time and cost of the single examinations, we believe that PET/CT will gain an increasingly dominant role in the diagnostic and therapeutic approach to lung cancer, especially in the preclinical phase.

[From the bad to the worse]. / Piove sul bagnato.

A sixty-five year old man, who had the left kidney removed for neoplasm, was admitted to evaluate a renal mass on the right side. Ultrasonography and TC scan were suggestive of neoplasm. A lower pole kidney ablation was made, otherwise a radical nephrectomy would have forced him into chronic dialysis. One month later the patient complained of a gross hematuria and asthenia. A new ultrasonography examination was made and was very helpful to get the right diagnosis.

Involvement of purinergic nerves in the NANC inhibitory junction potentials in pigeon oesophageal smooth muscle.

1. Electrical field stimulation (EFS) (0.5 ms in train of 2-32 Hz for 300 ms) in smooth muscle of pigeon oesophagus, in the presence of atropine (1 microm) and guanethidine (1 microm), elicited an inhibitory response consisting of a transient hyperpolarization (inhibitory junction potential, IJP) associated with muscle relaxation. 2. Sodium nitroprusside (SNP, 100 microm) induced hyperpolarization correlated to mechanical relaxation. 3. The nitric oxide (NO) synthase inhibitor N(omega)-nitro-l-arginine (from 0.1 to 100 microm) caused a concentration-dependent reduction of electromechanical response to EFS indicating a role for NO in this response. 4. Apamin (1 microm) reduced both IJP and relaxation to EFS but was without effect on the response to SNP indicating a role for purines, which are also blocked by apamin. 5. Adenosine, AMP, ADP and ATP (all from 1 microm to 1 mm) application caused transient hyperpolarization and muscular relaxation with the following order of potency: adenosine > AMP > ADP > ATP. 6. Inhibitory responses evoked by purines are TTX (1 microm) insensitive but they were inhibited by apamin. This indicates that a purine component for the non-adrenergic non-cholinergic (NANC) response exists but the purine receptor site is not located on the neurone. 7. Overall these results suggest that NANC inhibitory response elicited by EFS presents two different components apamin-sensitive, probably purines-mediated and apamin-insensitive probably NO-mediated as apamin only partially block the response to EFS.

Cardiovascular risk markers in hemodialysis patients.

Cardiovascular events are the main cause of death in hemodialysis patients. Nevertheless, acute myocardial infarction may be misdiagnosed in uremic patients, because typical markers have a high rate of false positivity. A recent two-year prospective study showed that predialytic high serum concentrations of troponin T and CK-MB mass were associated with high mortality, cardiac mortality, myocardial infarction and unstable angina (MACEs). We studied 16 uremic patients (13 M; 3 W) on standard HD and 6 patients (4 M; 2 W) on on-line HDF, who had been taking folic acid for at least three months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. Anthropometric parameters, pre and post-dialytic pH, HCO3 and electrolytes did not differ between the two groups. Kt/V and URR% were lower in conventional HD vs on-line HDF (p < 0.04; p < 0.04). ORR% was strongly elevated in on-line HDF compared with HD (p < 0.005). In conventional HD, ORR% was directly correlated with Kt/V and URR% (r = 0.49, p < 0.04; r = 0.48, p < 0.04, respectively). Even in on-line HDF ORR% was directly correlated with Kt/V and URR% (r = 0.79, p < 0.04; r = 0.76, p < 0.05, respectively). Troponin I and CK-MB mass were not significantly different in pre vs post-dialysis, both in standard HD and on-line HDF. Nevertheless, in standard HD postdialytic troponin I correlated with serum sodium concentration (r = 0.93, p < 0.000), potassium (r = 0.67, p < 0.004) and serum chlorine (r = 0.92, p < 0.92, p < 0.000). CK-MB mass showed a correlation with serum chlorine (r = 0.49, p < 0.05). Postdialytic CK-MB mass correlated with serum potassium in on-line HDF (r = 0.83, p < 0.03). Our data suggest that hemodialytic treatments, both standard HD and on-line HDF, do not modify serum troponin I and CK-MB mass. Consequently, we can use these parameters for the diagnostic approach in acute or chronic ischemic heart disease in hemodialysis patients.

[Cardiovascular risk markers in hemodialysis]. / Marcatori di rischio cardiovascolare in emodialisi.

PURPOSE: Although maintenance dialysis prevents death from uremia, patient survival remains an important issue. Cardiovascular (CV) events have been considered the main cause of death in hemodialysis (HD) patients. Some authors demonstrated an expected remaining life span of < or =2 yrs in HD patients who had a myocardial infarction. Therefore, it is very important to appraise risk factors and to adopt the correct diagnostic approach to match therapy. Nevertheless, acute myocardial infarction can be misdiagnosed in uremic patients, because typical markers have high false positivity rates. It has been estimated, for example, that 29% of HD patients have elevated serum troponin T concentrations, but do not have evidence of myocardial injury. Troponin T is more frequently elevated than troponin I among asymptomatic patients with renal insufficiency and this could be due to the relatively higher levels of an unbound cytosolic pool of troponin T and its higher molecular weight. Neither the common cardiac markers (LDH, LDH 1, CPK, CK-MB) are sensitive or specific as in the general population, but a recent 2-yr observational study showed that pre-dialytic high serum concentrations of troponin T and CK-MB mass were associated with complete mortality, cardiac mortality, myocardial infarction and unstable angina (MACEs). In our study, we evaluated how dialysis influenced serum troponin I and CK-MB mass, and then we assessed serum homocysteine (Hcy), an additional CV risk factor in uremic patients. METHODS: We studied 17 uremic patients (13 males, four females) on standard HD and six patients (four males, two females) on on-line hemodiafiltration (HDF), who were taking folic acid for at least 3 months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. We performed arterial gas-analysis, Na+, K+, Ca++, Mg++, Cl-, P, serum albumin, creatinine (Cr), urea, total homocysteine (tHcy), red blood count (RBC), troponin I and CK-MB mass, both pre and post-dialysis. We assessed urea reduction rate percentage (URR%), Kt/V, Hcy percentage reduction ratio (ORR%), and anthropometric parameters. RESULTS: Anthropometric parameters, pre- and post-dialytic pH, HCO3 and electrolytes did not differ between the two groups, Kt/V and URR%. Even in on-line HDF, ORR% directly correlated with KtV and URR% (r=0.79, p<0.04; r=0.76, p<0.05, respectively). Troponin I and CK-MB mass were not significantly different in pre- vs post-dialysis, both on standard HD and on-line HDF. Nevertheless, in standard HD, post-dialytic troponin I correlated with serum sodium concentration (r=0.93, p<0.000), potassium (r=0.67, p<0.004) and serum chlorine (r=0.92, p<0.92, p<0.000). CK-MB mass showed a correlation with serum chlorine (r=0.49, p<0.05). Post-dialytic CK-MB mass correlated with serum potassium for on-line HDF (r=0.83, p<0.03). CONCLUSIONS: Our study suggests the probability that dialytic adequacy improves CV outcome causing a reduction in the concentration of homocysteinemia and it demonstrates that convective treatments (on-line HDF) are best in reaching this end-point. Our data suggests that hemodialytic treatments, both standard HD and on-line HDF did not modify serum troponin I and CK-MB mass. We can use these parameters as a diagnostic approach in acute or chronic cardiac ischemic disease in HD patients, because they are not influenced by the hemodialytic procedure. This allows the selection of high risk patients, and offers them on-line treatment as the best suitable therapeutic option.

[Risk of arrhythmias in hemodialysis patients vs healthy people]. / Rischio aritmologico in pazienti emodializzati vs soggetti normali.

PURPOSE: Hemodialysis (HD) patients present an elevated risk of ventricular arrhythmias and sudden death. This risk is correlated with QTc dispersion, assessed as the difference between maximum and minimum QT recorded on 12 leads. Our study aimed to estimate the difference between QT, QTc, QT dispersion and QTc in HD patients on standard HD and online hemodiafiltration (HDF) in pre- and post-dialysis vs. normal controls. METHODS: Nineteen uremic patients on standard HD (13 males, six females) and nine patients (six males, three females) treated with on-line HDF were studied. Seven normal subjects were the control group, matched for age and sex. No one was taking drugs that could interfere with electrocardiographic morphology and QT value. Basal anthropometric parameters were taken and simultaneous 12-lead electrocardiograms (ECGs) were recorded before and 30 min after HD. Serum concentration of creatinine (Cr), urea and electrolytes (Na, K, Mg, Ca, Pi) were monitored before and 30 min after HD, in the short interval section. QT interval was measured according to the Bazett formula, in the presence of different heart rates: QTc=QT/RR(0.5) (heart rate corrected QT interval). RESULTS: Anthropometric parameters were similar among the groups. Before dialysis, standard HD patients had lower calcium and higher potassium than the controls (Student's t-test): (p<0.01, p<0.004). ECGs in the two groups did not show essential differences. After dialysis calcium was higher and magnesium lower in HD patients than in controls: (p<0.0006, p<0.000); QT and QTc dispersion was higher in HD patients than in controls: (p<0.01, p<0.04). Before dialysis on-line HDF patients had lower magnesium (p<0.01) than controls; while there were no electrocardiographic differences between them. In the post-dialytic phase, calcium was higher and phosphates, magnesium and potassium were lower than in controls: (p<0.001, p<0.01, p<0.002, p<0.01); QT and QTc dispersion was higher in HD patients (p<0.03, ns). Controls did not demonstrate any correlation between electrolyte and electrocardiographic parameters; while QTc dispersion and phosphates positively and directly correlated in uremic standard HD patients after dialysis (r=0.48, p<0.02), and then QTc dispersion correlated negatively to Ca/P ratio (r=-0.63, p<0.003).

Lipid microparticles as sustained release system for a GnRH antagonist (Antide).

Lipid microparticles (LMs) as a sustained release system for a gonadotropin release hormone (GnRH) antagonist (Antide) were prepared and evaluated. Antide loaded microparticles (Antide-LMs) were obtained by a cryogenic micronization process starting from two different monoglycerides (glyceryl monobehenate and glyceryl monostearate) and using two different incorporation methods (co-melting and solvent evaporation). Antide-LMs, 2% (w/w) loading, were characterized for drug incorporation by RP-HPLC, particle size by laser diffractometry and surface morphology by scanning electron microscopy. In vitro peptide release and in vitro biological activity were also studied. Serum Antide and testosterone levels, as pharmacodynamic marker, were assessed following subcutaneous administration in rats. Antide-LMs showed a mean diameter of approximately 30 micro m and variable Antide release depending on lipid matrix and incorporation method. In vivo experiments demonstrated that detectable Antide plasma levels were present, in the case of Antide-LMs based on Compritol E ATO obtained by co-melting procedure, for at least 30 days after dosing. Testosterone levels were consistent with prolonged pharmacokinetic profiles. In vitro release of Antide from LMs correlated well with the in vivo release. In conclusion, LMs can sustain the release of Antide for at least 1 month. The levels of the initial 'burst' and the extent of the pharmacodynamic effect can be influenced by the lipid characteristics and by process conditions.