[Insulin therapy and parenteral nutrition in intensive care: practical aspects]. / Insulinothérapie et nutrition parentérale en soins intensifs: aspects pratiques.

Critically ill patients are hypercatabolic due to stress and inflammation. This condition induces hyperglycemia. Muscle wasting is intense during critical illness. Its prevention is essential. This is possible by early and appropriate nutritional support. Preserving the function of the gastrointestinal tract with enteral nutrition is the gold standard. However, when targeted protein-caloric intake is not met through enteral nutrition within the first three days in the intensive care unit (ICU), supplemental parenteral nutrition is administered to reduce morbidity and mortality. In addition, in order to limit metabolic imbalance and reduce mortality, glycemic control using insulin therapy is mandatory. This article reviews the current understanding of parenteral nutrition and insulin therapy in ICU patients, and provides the decision model applied in our institution.

[Refeeding syndrome: practical issues]. / Syndrome de renutrition inappropriée: aspects pratiques.

The refeeding syndrome is frequent and potentially deadly, still it is underdiagnosed. It is defined by clinical and biological manifestations that are seen upon refeeding of malnourished patients. It is the consequence of the transition from catabolism to anabolism. Ions intracellular shift caused by insulin and B1 vitamin deficiency are fundamental in the development of this syndrome. Riskconditions are well summarized by the NICE criteria. To avoid refeeding syndrome, it is fundamental to find and correct any electrolytic deficiency and to give thiamine before starting a slow and progressive oral, enteral or parenteral refeeding.

Cannabaceae pollen in the atmosphere of Brianza, Northen Italy.

AIM: We have noted several patients suffering for rhinitis and/or asthma symptoms in the summer months without positive skin tests for pollens blossoming in the corresponding season. So we tried to determine the pollination pattern of pollens usually not tested, because no company produces the corrisponding extract. METHODS: We determined airborne pollination by means of a volumetric pollen trap for five years from 2001 to 2005. RESULTS: We found, in addition to well-known aeroallergens, a significant percentage of Cannabaceae from the end of July to mid September with the highest concentration in 2004 (140 gr/m3). DISCUSSION: The potential allergenicity of Cannabis pollen was supported in the United States, where they found some patients with rhinitis or asthma during the pollen seasons and positive prick test for Cannabis, but the clinical significance of Cannabaceae pollen as an aeroallergen in Europe is still undefined.

[Acute and chronic cardiac decompensation: is vasodilator therapy useful?]. / Scompenso cardiaco acuto e cronico: è utile la terapia con vasodilatatori?

Systemic vasodilators represent a new approach in the treatment of the acute and chronic heart failure, as they reduce the afterload acting on the aortic impedance and/or the venous return to the heart. Vasodilators have been classified as venodilators (nitrates), which reduce left ventricular filling pressure and relieve pulmonary congestion; arteriolar dilators (hydralazine, phentolamine) which enhance cardiac output; and balanced vasodilator (nitroprusside, prazosin), which dilate both resistance and capacitance vessels. While nitroprusside and phentolamine are used in the treatment of the acute myocardial infarction, nitrates, hydralazine and prazosin are used in the long term treatment of the chronic congestive heart failure. Presumably, the renin-angiotensin system plays an important role in increasing peripheric vascular resistance in congestive heart failure. For this reason the inhibitors of the angiotensin-converting enzyme, such as captopril and teprotide, are also used. The treatment with vasodilators, recommended to patients with severe heart failure, is not an alternative to that with digitalis and diuretics: such a combination may in fact result as a very useful one.

[Arterial hypertension in perimenopausal women; tolerability of etozolin]. / Ipertensione arteriosa in donne in età perimenopausale; indagine di tollerabilità dell'etozolina.

Twenty women aged 45-55 years with mild-moderate hypertension were treated for 12 months with etozolin, a new loop diuretic. All patients concluded the study; resting systolic pressure was reduced from 164 +/- 3 to 145 +/- 3 mmHg; diastolic blood pressure dropped from 103 +/- 2 mmHg to 90 +/- 1 mmHg. No changes of blood glucose, blood nitrogen, serum Na+, K+, creatinine, cholesterol, triglycerides were observed, nor serious adverse reaction appeared. In conclusion, etozolin is a safe and effective antihypertensive agent in a selection of hypertensive patients highly sensitive to pharmacological side effects.

Meaning of early polyomavirus-BK replication post kidney transplant.

Polyomavirus BK (BKV) infection is ubiquitous in the human population. Under immunosuppression, BKV can undergo reactivation resulting in viral replication. What really happens in the early hours posttransplantation is not clearly defined; the meaning of early viremia and viruria is not clear. BKV viremia is considered a marker of infection. The aim of our study was to investigate the prevalence of early BKV infection in kidney transplant patients, to evaluate the relationship to infections at 3 and 6 months and the association with recipient, donor, and graft features. We enrolled 36 kidney transplanted patients from May 2006 to April 2007. BKV load was measured on plasma and urine samples by Q-PCR at 12 hours (T(0)/early) as well as 3 (T(3)) and 6 (T(6)) months thereafter. A high percentage of BKV infections were detectable in the first hours after transplantation (33.3%), which remained unchanged to month 6 post transplantation. Moreover, patients who were positive at T(0) had a high probability of remaining positive thereafter. The number of copies in plasma samples tended to increase at 3 months and to decrease thereafter, whereas the urine viral load tended to steadily increase. Among BKV-positive patients, we identified 2 groups according to viremic state at T(0): 9 patients (group A); who were already positive and remained so to T(6) 5 and 3 patients who turned positive at 3 or at 6 months, respectively (group B). Group A included 75% of positive patients at T(0) and 90% of positive patients at either T(3) or T(6) (P = .007). The most important contribution of our study was to highlight the presence of BKV infection in renal transplant recipients from the first hours posttransplantation. This condition seemed to be the most important risk factor for persistent infection in the first 6 months.

[Systolic times adjustment during pregnancy and puerperium (author's transl)]. / Modificazione dei tempi sistolici durante la gravidanza e il puerperio.

During pregnancy and the post partum period important cardiovascular adjustments take place, which for ethical views need a non invasive approach. In the present work we studied the alterations of the Systolic Time Intervals in both supine and lateral decubitus during each trimester and at the fifth day and fifth week after delivery. In the first part of pregnancy a significant reduction of the preejection time (PE) and PE/EVS with an increase of the left ventricular ejection time (EVS) become evident. In the second part the picture reverses to a significantly reduced EVS and increased PE and PE/EVS. This picture even if decreasing, is present in the post partum period. The first part of pregnancy is characterized by a hyperkinetic condition; in the second one the position of the woman becomes important, and the reduction of the EVS is at least partially due to an impaired venous return (compression of the vena cava by the gravid uterus). The persistence of altered systolic time intervals in the post partum (increased PE/EVS) suggest an impaired myocardial performance.