Primary stenting for renal fibromuscular-dysplastic stenosis: a case report.

Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic vascular disease that has been reported in renal and internal carotid arteries and in almost every arterial bed, primarily affecting young to middle-aged people, mainly female individuals. These patients may be asymptomatic or may present with hypertension. A 29 year-old hypertensive woman was referred for a renal color Doppler ultrasound (CDU) scan because of a suspicion of renovascular hypertension and we revealed the presence of three separate stenosis on the right renal artery. Digital selective angiography (DSA) and percutaneous transluminal angioplasty (PTA) were performed but an incomplete dilation of the vessel was obtained. Because of the suboptimal result, it was decided to stent the lesions during two different procedures. Percutaneous transluminal renal angioplasty is the primary treatment of renal FMD, but should not be excluded primary stent implantation as an alternative technique to surgical revascularization.

Circadian rhythm of sinoatrial conduction time assessed by 24 hours ECG monitoring.

SACT was evaluated in 50 subjects during 24 hours ECG monitoring. All of these subjects presented frequent atrial beats with no evidence of bradyarrhythmias. SACT was measured in accordance with Strauss' formula (SACT = P2P3 - P1P1/2). Twenty-four hours recording were divided in to 4 time intervals, 6 hour each, starting 7 o'clock. The SACT is higher during nighttime than during daytime. The phenomenon is, presumably, attributable to predominance of the para-sympathetic tone during the night.

Experimental study on the correlation between cardiac function and ovarian hormones.

Results of the study of cardiac function carried out on young women during various phases of the menstrual cycle were correlated to those obtained after acute administration of progesterone. In all cases systolic time intervals reveals a reduction of mechanical systole and of preejection. Direct action progesterone on cardiac function by an unknown mechanism was confirmed.

Cardiovascular effects induced by progesterone administration.

The Authors have studied cardiovascular effects induced by progesterone administration. The results obtained in the present investigation reveal a significant reduction in O-S2 and PEP in the absence of modifications in the values of the other parameters of systolic time intervals. The results confirm the hypothesis that progesterone exerts an adrenergic effect upon cardiac function.

Day-time changes for pituitary-thyroid hormones denote a rhythmic structure not detectable in elderly subjects.

The day-time concentrations of TSH, T3, T4, FT3 and FT4 were investigated in clinically healthy volunteers, 20 young individuals, aged from 20 to 27 years, and 12 elderly subjects, aged from 70 to 81 years. Nocturnal sampling was purposely avoided in order to eliminate the interindividual differences in sleep patterns. The day-time series were analysed by means of cosinor analysis to interpolate the best-fitting sinusoidal wave that covers the day-night period. The reconstruction of the circadian sinusoidal wave was validated for TSH, T3, T4, FT3 and FT4 in young subjects, and, with limitation, for T4 in elderly individuals. The findings suggest that the day time patterns of TSH, T3, FT4 and FT3 in elderly subjects are characterized by a dyschronism that is not detectable in young subjects. The investigation of the day-time concentrations is suggested as a cost-effective tool for exploring the circadian cycle of the pituitary-thyroid hormones in aged people.

[Penile ultrasonography. Characteristic velocimetric feature in the maximal erection phase in healthy subjects]. / Eco color-Doppler penieno. Caratteristico aspetto velocimetrico nella fase di massima erezione in soggetti sani.

BACKGROUND: A peculiar finding from penis eco color-Doppler, detected in healty subjects with erection dysfunction, is described. METHODS: 385 patients with erection dysfunction were studied, by using duplex scan with color Doppler, 85 of these patients normal Regiscan test were chosen and patients with Induratio penis plastica or hormonal disorder were excluded. RESULTS: A "reverse" flow during the entire diastolic phase was detected in 58 normal patients (68%) with age < of 41 years. CONCLUSIONS: In the evaluation of healthy subjects with erection dysfunction, the presence of a complete "reverse" diastolic flow is indicative of a venous reflux block, that may represent an important pathogenetic mechanism in this specific setting.

[Arterial hypertension in pregnancy: evaluation of renal damage through the study of NAG urinary activity]. / Ipertensione arteriosa in gravidanza: valutazione del danno renale attraverso lo studio dell'attività NAG-urinaria.

NAG-urinary activity was assessed in order to study the renal effects of arterial hypertension in pregnant women. The results obtained showed that there were no significant differences between mean levels of enzymuria in control subjects and normotensive pregnant women. On the contrary, significant differences were found between these two groups and hypertensive pregnant women (above all if arterial hypertension predated pregnancy). The paper stresses the usefulness of this method, which is reliable and non-invasive, for an accurate assessment of the extent of renal damage caused by arterial hypertension during the course of pregnancy.

[Monolateral autoimmune exophthalmos in an euthyroid woman]. / Esoftalmo monolaterale autoimmune in donna eutiroidea.

So-called "endocrine" ophthalmopathy may arise even in the absence of thyroid disorders since although these two nosographic and clinical conditions are both linked to closely inter-related organ-specific auto-immune responses, they may also present independently. After a review of the two clinical conditions, the case of an autoimmune ophthalmopathy unaccompanied, at least during a long observation period, by demonstrable functional thyroid alterations is reported. The case was also unusual because only one eye was affected.

[Psychonephrological considerations on the diet in chronic renal insufficiency]. / Considerazioni di psiconefrologia sulla dieta nella insufficienza renale cronica.

Some psychonephrological remarks on the reactions of 36 patients with chronic renal failure with respect to diet in predialysis and dialytic phase are presented.

[Control of weight gain between dialyses in patients undergoing periodic hemodialysis. Psychological aspects]. / Controllo dell'aumento di peso interdialitico in pazienti in emodialisi periodica. Aspetti psicologici.

Some patients undergoing periodic hemodialysis have complained that between one treatment session and the next they suffer form thirst and have serious problems in maintaining their interdialytic weight gain within the limits indicated by the medical team. Weight gain may usually be explained by psychological factors: they may be more or less acute depending on the situation in which the patient finds himself. On the basis of the present study, the Authors affirm that the lack of interdialytic weight control may be easily improved by providing the patient with psychological support capable of optimising his general level of adaptation, and that this can lead to excellent results with regard to specific problems which otherwise detract from the wellbeing of the patient and hamper the work of the medical team.

[Enzymuria in chronic nephropathies. Diagnosis by the urinary enzyme method in chronic nephropathies]. / Aspetti delle enzimurie nelle nefropatie croniche. La diagnosi col metodo delle enzimurie nelle nefropatie croniche.

A simple empirical method based on linear relation-ships between certain types of enzymuria (NAG, LDH, GRS, Isoenzymes I and V of total dehydrogenase lactate) has been used in a series of 80 patients presenting chronic nephropathy [40 interstitial nephropathy (IN) and 40 glomerulonephritis (GN)]. Diagnosis made on the basis of the results obtained in each case was identical to that based on clinical findings (in the absence of enzymuria determinations). This method, if confirmed on a larger number of statistically significant data, might be useful to obtain a differential diagnosis between I.N. and G.N. only assaying these few enzymurias. Prefixed relationships could be employed on a larger group of patients with other diseases studied for comparative purposes. Furthermore, this method appears to be fast and unexpensive.

[Changes in erythrocyte catalase activity in subjects with respiratory insufficiency]. / Variazioni dell'attività catalasica eritrocitaria in soggetti affetti da insufficienza respiratoria.

The behaviour of catalase activity was studied in patients with respiratory insufficiency and the results assessed in the light of a theory that attributes a completely new teleological function to this substance.

[Normal values of the urinary activity of 4 enzymes]. / I valori normali dell'attività urinaria di 4 enzimi.

The urinary activity of 4 enzymes (NAG, GLU, GAL, GRS) was investigated in 105 healthy subjects in order to evaluate the variability of standard levels and establish the degree of such variations in relation to sex, age, weight and height. The results obtained demonstrate that these enzymurias do vary in relation to the parameters examined. Age and sex produced the most pronounced variations though height and body weight also appeared to have some influence. The study of variations in standard levels is of value in the interpretation of pathological enzymurias.

[Environmental contamination by iodine-131 and cancer of the thyroid gland]. / Contaminazione ambientale da iodio-131 e cancro della tiroide.

The biological effects of cosmic rays and ionising radiations on man are described. Particular attention is paid to the consequences of the environmental pollution caused by the Chernobyl accident and the relationship between I131 radiation and thyroid tumours is analysed.

[Urinary NAG activity and diabetic microangiopathy]. / Attività NAG-urinaria e microangiopatia diabetica.

The behaviour of urinary NAG was monitored in diabetic patients some of whom presented more or less severe vascular alterations. The results showed a relationship between urinary NAG levels and the severity of the vascular condition (in fact the greatest NAG activity was found in patients with overt kidney damage). NAG may therefore reveal the existence of a vascular nephropathy that is still too slight to be identified by the standard non-invasive clinical examinations.

[Partial and multiple correlations between 4 types of enzymuria in 2 groups of chronic nephropathic patients]. / Aspetti di correlazione parziale e multipla tra quattro enzimurie in due gruppi di nefropatici cronici.

The urinary activity of four enzymes (NAG, GLU, GRS and GAL) was studied in two groups of patients suffering respectively from interstitial nephritis and chronic glomerulonephritis with the aim of further investigating enzyme variability through the theory of partial and multiple correlation. This study permitted the effects of two enzymes on the known correlations between the remaining two enzyme types to be studied. It was established that very stable relationships exist between each enzyme and the group composed of the remaining three. In particular, in patients with interstizial nephritis, correlations with GAL were all highly significant even if the effect of the other two enzymes was ignored. Similarly, correlations with GRS were strongly significant in patients with chronic glomerulonephritis. In the two groups studied, each enzyme appears to have a highly stable relationship with the other three. Accurate estimates may probably be achieved for GAL and GRS in both groups and for NAG in the glomerulonephritis sufferers. This is further evidence that the enzyme procedure may be used to differentiate between interstitial and glomerular nephritis.

[Behavior of certain forms of enzymuria in subjects treated with pipemidic acid]. / Considerazioni sul comportamento di alcune enzimurie in soggetti trattati con acido pipemidico.

Three groups of subjects (I with infections of the lower urinary ways; II with chronic pyelonephritis; III healthy controls) were treated with pipemidic acid for 10 consecutive days and the behaviour of their urinary NAG and AAP was studied. It was discovered that the healthy group and the patients with infections of the lower urinary ways showed no significant variations in the urinary activity of the two enzymes following the administration of pipemidic acid. However there was a distinct reduction in both enzymes in patients with chronic pyelonephritis who presented demonstrable bacterial sensitivity to the drug. Apart from the fact that it produces no nephrotoxic effects at least in the doses used and for the treatment period adopted, the drug is therefore considered to reduce renal inflammation that is beneficial to individuals with chronic interstitial nephropathy.

[A comparison between the urinary and serum NAG activity in subjects with chronic nephropathies and essential arterial hypertension]. / Confronto tra le attività urinaria e sierica del NAG in soggetti affetti da nefropatie croniche e da ipertensione arteriosa essenziale.

Various substances can interfere with the urinary activity of N-acetyl-beta-D-glycosaminidase (NAG), particularly certain bacteria that exert inhibitory or enhancing effects on the enzyme. Clearly, all this constitutes a limitation on the use of the technique. For these reasons, in patients suffering from interstitial and glomerular nephropathies and essential arterial hypertension a comparative study was carried out between the activity of urinary and serum NAG to establish if the latter produces more reliable results than the former. The results of urinary NAG activity confirm that there is no significant difference between healthy subjects and those with essential arterial hypertension; on the other hand, nephropathic patients present significantly higher urinary enzyme activity than healthy controls. On the other hand, evaluation of serum NAG does not seem to provide any practical aid as it does not highlight any difference between measurements carried out in healthy subjects and those carried out in hypertensive patients or those suffering from interstitial or glomerular nephropathy.

[Changes in urinary NAG activity in patients with climacteric syndrome treated with estrogens]. / Variazioni dell'attività NAG-urinaria in pazienti con sindrome climaterica trattate con estrogeni.

The behaviour of urinary NAG activity was studied in patients during menopause, some of whom were given estrogen therapy due to severe vasomotor symptoms (hot flushes etc.). One group of these patients revealed slightly higher than normal blood pressure. A second group had slight arterial hypertension and pancreatic diabetes. The third group consisted of apparently healthy menopausal women. The significant increase in enzymuria in the first two groups suggests that blood pressure should be carefully checked before starting estrogen therapy. Furthermore this treatment should be given very cautiously and under constant surveillance in the presence of slight hypertension. In patients with diabetes or more severe hypertension, estrogens should never be given.

[Use of ultrafiltration in refractory cardiac decompensation]. / Impiego dell'ultrafiltrazione nello scompenso cardiaco refrattario.

Traditional therapy for heart failure (diuretics, digitalic compound, vasodilators, inodilatory ACE-inhibitors) cannot arrest the progressive overloading of the circulatory system so that it is inevitable that a refractory stage to all forms of treatment will be reached when more specialised techniques, such as heart transplant and ultrafiltration will be needed. The paper reports the results obtained in 13 patients in ultrafiltration treatment for refractory heart failure: in the majority of these, a marked improvement in general conditions (edema, dyspnea) was recorded together with a regression from class 5 to class 3 NYHA in 5 patients, and to class 2 for others. The ultrafiltration method in spite of not altering the prognosis which remains negative in these patients, allow those waiting for heart transplant to survive and may improve their chances of surviving heart surgery.