Recurrent pleural effusion as manifesting feature of primitive chest wall Hodgkin's disease.

Recurrent, cytologically benign pleural effusion was, for a long time, the only clinical manifestation of Hodgkin's disease involving the inner thoracic wall in the reported case. It is the first case reported in literature.

Use of Doppler flow velocity waveform analysis in detection of initial diabetic microangiopathy.

Doppler flow velocity waveform analysis (FVWFA), recorded from the dorsalis pedis artery (DPA) and the radial artery (RA), was performed on 36 women in attempting to detect an initial diabetic microangiopathy (DM). The study comprised two groups of women affected by non-insulin-dependent diabetes mellitus, 6 patients (pts) of reproductive age (1), 12 pts in menopause (II), and two groups of age-matched healthy controls (C) (III and IV). Clinical signs of initial DM were present in group I. All the examined pts were nonsmokers and normotensive and without cardiopathy, signs of diabetic macroangiopathy, collagen vascular disease and/or Raynaud's phenomenon, and renal failure. Four waveform dimensions capable of separating different degrees of peripheral obstructive arteriolar disease were determined on velocity tracing and the results used in a single best discriminant equation. The resultant discriminant score (DS), derived by FVWFA on DPA, showed a highly accurate rate of separating the young pts with DM from both C and the pts in menopause without DM. Furthermore, the resultant DS was statistically not different in groups II, III, and IV. In conclusion, FVWFA on DPA, in this experience, has proved to be an accurate and sensitive method in the detection of initial DM.

[Therapy of arterial hypertension associated with acute stroke. Current trends and problems]. / Terapia dell'ipertensione arteriosa associata all'ictus cerebrale in fase acuta. Orientamenti e problemi attuali.

Acute stroke may cause hypertension and actually available devices for non-invasive blood pressure monitoring make it possible to study short-term variability of pressure in this condition, in order to settle a more rational diagnostic and therapeutic approach. In our experience blood pressure variability has shown to be greater in thrombo-embolic, than haemorrhagic stroke. This outcome contributes to explain literature disagreement on benefits of antihypertensive therapy and suggests the need for blood pressure monitoring in every trial, that wants to evaluate with satisfactory reliability the antihypertensive treatment in ischaemic stroke. As to antihypertensive drugs to be used in stroke patients, we prefer antiadrenergics, because hypertension in this clinical condition is due to adrenergic overactivity. Our preliminary experience with a centrally acting antiadrenergic drug (clonidine) has shown its ability not only to reduce blood pressure, but also blood pressure variability in ischaemic stroke.

Pathologic sideroblastosis in myelodysplastic syndromes and acute nonlymphocytic leukemia.

To assess the incidence and the eventual prognostic relevance of pathologic sideroblastosis in myelodysplastic syndromes and acute nonlymphocytic leukemia, 5 acquired idiopathic sideroblastic anemias, 2 refractory anemias, 9 refractory anemias with excess of blasts, 10 acute nonlymphocytic leukemias were studied with regard to sideroblast type (ring or ferritin) and percentage. Pathologic sideroblastosis was commonly found in each subgroup, in some patients it appeared later in the course of the disease while in other reversed. In a successfully treated leukemic patient, pathologic sideroblastosis in otherwise normal bone marrow after therapeutic hypoplasia suggested clonal remission. Although the patient number was small, pathologic sideroblastosis seems to correlate with poor treatment response in leukemic patients. We conclude that systematic looking for pathologic sideroblastosis may have some biologic and clinical implications in myelodysplasia and acute leukemia.

[Abdominal lymph node tuberculosis: a diagnostic surprise]. / Tubercolosi linfonodale addominale. Una sorpresa diagnostica.

The case of a patient submitted to sonographic abdominal examination because of recent onset of fever, abdominal pain and weight loss, with the finding of multiple enlarged lymph nodes along great vessels, is reported. Because of the negativity of noninvasive procedures, the patient underwent laparatomy and biopsy. The histologic and bacteriologic diagnosis of tuberculous lymphnodes was unexpected, as the patient was unreactive to the tuberculin skin test and had no signs of active pulmonary tuberculosis. Although uncommon, tuberculosis must be included in the differential diagnosis of subdiaphragmatic lymphadenopathies even if symptoms of mycobacterial infection or other signs of the infections are not presented.

Asymmetric septal hypertrophy in uremic-normotensive patients on regular hemodialysis. An M-mode and two-dimensional echocardiographic study.

We have observed a high incidence (36.4%) of asymmetric septal hypertrophy (ASH), detected with the use of M-mode (MME) and two-dimensional echocardiography (2DE), in normotensive patients with chronic renal failure on maintenance hemodialysis without signs of cardiac diseases. ASH was detected by conventional MME in 11 cases and was confirmed with the use of 2DE in 8 cases showing a diagnostic concordance of 72.7% between the two methods. After dialysis the MME study of the left ventricular (LV) performance showed an evident impairment of cardiac index (CI) due to reduction of LV volume in addition to an abnormality of septal function. The presence of ASH does not impair the percentage of fractional shortening (FS%), the mean circumferential shortening (mean Vcf) and the ejection fraction (EF%), probably because of a compensatory performance of the LV posterior wall. Predialysis serum creatinine and fasting triglycerides have been found significantly higher in the group with ASH. ASH may be considered as a focal and early form of myocardial involvement in uremic patients on regular hemodialytic treatment.

Asymmetric septal hypertrophy and sympathetic overactivity in normotensive hemodialyzed patients.

Sympathetic activity has been evaluated in 23 chronic uremic normotensive patients on long-term hemodialysis. M-mode and bidimensional echocardiographic finding of asymmetric septal hypertrophy (ASH) was shown in seven (30.4%). Sympathetic function was assessed by determining arterial plasma norepinephrine (plasma NE) and epinephrine (plasma E) in supine and upright positions, both before and after dialysis. After dialysis standing caused a significant increase in plasma NE levels in the patients with ASH in comparison to the patients without ASH and the control group. A significant decrease in mean blood pressure (mBP) and a sharp heart rate (HR) increase were detected in the patients without ASH, whereas mBP and HR were unchanged in the patients with ASH. Predialysis serum creatinine and fasting triglycerides were found to be significantly higher in the group with ASH. These results suggest that sympathetic overactivity may play a role in the development of interventricular septum hypertrophy. This increased neurosympathetic responsiveness is probably related to the counteraction of the postural dialysis-induced hypotension.

Carotid artery atherosclerotic disease assessed by flow velocity wave form analysis in hemodialyzed normotensive and hypertensive patients.

Cerebrovascular accidents, often secondary to severe atherosclerotic disease, are very common in uremic patients on long-term hemodialysis. The aim of the present study is to assess asymptomatic carotid artery atherosclerotic disease (CAAD) in hemodialyzed normotensive and hypertensive patients in comparison with age-matched controls, by the use of Doppler ultrasound flow velocity wave form analysis (FVWFA), recorded from the common carotid artery. This study was performed on 47 subjects divided into four groups: 10 young and 10 middle-aged normals were considered in groups I and II, respectively, 5 young uremic normotensive, 6 young uremic hypertensive and 16 middle-aged uremic normotensive patients in groups III, IV and V, respectively. All the examined patients were nonsmokers, without diabetes or cardiopathy. The five wave form dimensions most capable of separating different degrees of atherosclerotic disease were determined on every common carotid tracing and used in a single best fit discriminant equation; the resultant discriminant score (DS) classified each carotid tracing and consequently every group's range. DS of groups I and III were not different, but significantly higher compared to the other three groups; besides DS was statistically not different in groups II, IV and V. In conclusion, FVWFA did not detect a different degree of CAAD between normotensive dialyzed patients and age-matched normals, whereas the blood pressure pharmacological control did not affect the velocity findings of advanced CAAD in young uremic hypertensive patients.

[Asymmetric hypertrophy of the intraventricular septum in normotensive patients with chronic uremia during hemodialysis therapy. M-mode echocardiographic study]. / Ipertrofia asimmetrica del setto interventricolare in pazienti uremici cronici normotesi in trattamento emodialitico. Studio ecocardiografico M-mode.

Cardiovascular complications are very common in uraemic patients on regular dialytic treatment and are often the cause of death. In these patients many echocardiographic studies have been carried out to establish the presence of cardiac alterations. In particular some M-mode echocardiographic investigating have shown a significant incidence of asymmetric septal hypertrophy (ASH), but often the patients had associated cardiomegaly or arterial hypertension. In the present paper M-mode echocardiogram and carotid pulse tracing were recorded after dialysis in 23 normotensive long-term hemodialyzed patients. The aim of the study was to detect the incidence of ASH and to assess the functional behaviour of the left ventricle in relation to the presence of the septal abnormality. ASH as ratio of interventricular septal to posterior wall thickness (IVS/PWT) of 1.3 or greater, without systolic anterior motion of anterior mitral leaflet (SAM), was found in 52.1% of patients. The group with ASH showed an obvious reduction of the cardiac index (CI), after dialysis, due to reduction of left ventricular size and to the abnormal septal function. CI was normal in patients without ASH. On the other hand the presence of ASH did not significantly influence the percentage of fractional shortening (FS%), the velocity of circumferential fiber shortening (Vcf) and the ejection fraction (EF%) which were similar in both groups of patients. A long-term echocardiographic follow-up of these patients may be important to outline the natural history of ASH and to evaluate its relation to chronic renal failure on hemodialytic treatment.

[Relation between asymmetrical hypertrophy of the interventricular septum and plasma levels of catecholamines in normotensive chronic uremic patients undergoing hemodialysis treatment]. / Relazione tra ipertrofia asimmetrica del setto interventricolare e concentrazione plasmatica di catecolamine in pazienti uremici cronici normotesi in trattamento emodialitico.

Sympathetic-adrenergic activity has been evaluated in 23 chronic uremic, normotensive patients on regular hemodialysis, 7 of which (30.4%) with M-mode and bidimensional echocardiographic finding of asymmetric septal hypertrophy. The sympathetic function has been assessed by measuring arterial plasma norepinephrine and epinephrine levels before and after postural activation, just before and after dialysis. After dialysis, standing caused a significant increase of plasma norepinephrine levels in patients with asymmetric septal hypertrophy in comparison with patients without asymmetric septal hypertrophy and with the control non uremic group. Moreover, a significant decrease in blood pressure and a sharp heart rate increase were noted in the patients without asymmetric septal hypertrophy, whereas mean blood pressure and heart rate were unchanged in the patients with asymmetric septal hypertrophy. These results suggest that increased plasma norepinephrine concentration may have a role in the development of interventricular septal hypertrophy.