Carotid artery wall hypertrophy in children with metabolic syndrome.

Preclinical vascular changes (increased stiffness and/or wall thickness) have been observed in children with known metabolic risk factors. Aim of the present study was to evaluate different carotid parameters, representative of vascular health, in children with and without metabolic syndrome (MS). We studied 38 children with MS (mean age 9.6+/-2.6 years; range 6-14 years) and 45 healthy age-matched subjects. Children who met three or more of the following criteria qualified as having the MS: fasting glucose >110 mg dl(-1), fasting triglyceride concentration >100 mg dl(-1), fasting high-density lipoprotein cholesterol concentration <50 mg dl(-1) for females or <45 mg dl(-1) for the males, waist circumference >75th percentile for age and gender and systolic or diastolic blood pressure >90th percentile for age, gender and height. Carotid B-mode ultrasound examinations were performed and intima-media thickness and diameters were measured in all subjects. Arterial geometry was further characterized by calculation of carotid cross-sectional area. Carotid intima-media thickness and lumen diameters were increased in children with MS as compared to children without MS. Moreover, carotid cross-sectional area was significantly higher in the group of children with MS 9.83+/-1.86 mm(2) [mean+/-s.d.] compared with the control group: 7.77+/-1.72 mm(2), P<0.001, even after adjustment for age, gender and height. Carotid hypertrophy is already detectable in children with MS. High-resolution B-mode ultrasound could provide a valuable tool for the cardiovascular risk stratification of children.

Longitudinal study on thyroid function in patients with thalassemia major.

UNLABELLED: Primary hypothyroidism is one of the most frequent complications observed in patients suffering from thalassemia. We investigated thyroid function in a group of patients attending the Pediatric Department of Cardarelli Hospital in order to determine in how many patients thyroid function worsened during a 12 year-period of follow up. PATIENTS AND MEASUREMENTS: Fifty patients with beta-thalassemia major (27 females and 23 males), mean age 25.7+/-1.4 years, were re-evaluated according to the criteria of Faglia et al. Thyroid dysfunction was defined as follows: overt hypothyroidism (low FT4 and increased TSH levels >10 microU/ml); compensated hypothyroidism (normal FT4, TSH 5-10 microU/ml, and abnormal TRH test); subclinical hypothyroidism (normal FT4, basal TSH 0-5 microU/ml, abnormal TRH test). Correlation with hematological, biochemical and growth parameters was evaluated. RESULTS: Ten out of 50 patients evaluated in a previous study had moved to other centers, and four patients had died from cardiac problems. Thus, 36 patients completed a 12 year-period of follow-up. In 25% of the patients the degree of thyroid dysfunction worsened with different degrees of severity. The prevalence of overt hypothyroidism had risen to 13.9% from 8.4%. No cases of secondary hypothyroidism were observed, and anti-thyroglobulin and anti-thyroperoxidase (TPO) antibody titers were negative in all patients. Five (28%) out of 17 patients with normal thyroid function previously (one female, four male) showed an exaggerated TSH response to a TRH test, with normal serum levels of FT4, and they were classified as having subclinical hypothyroidism; while another patient died of cardiac complications. Four out of twelve patients with previous subclinical hypothyroidism showed worsening with a different degree of severity: two females changed to compensated hypothyroidism, and two males to overt hypothyroidism. Furthermore, two out of six patients with compensated hypothyroidism and one out of four patients with overt hypothyroidism died of cardiac failure. In all patients there was no correlation between serum ferritin levels, blood transfusion, pretransfusion Hb levels and worsening of thyroid function. Echographic data showed features of dishomogeneity of the parenchyma with different degrees of severity in accordance with the criteria of Sostre and Reyes. The highest score was observed in all patients with overt and compensated hypothyroidism. CONCLUSIONS: A slow worsening of thyroid function was observed in 25% of the studied patients and only two of them developed overt hypothyroidism. The echographic pattern seems to be strongly predictive of thyroid dysfunction.

Effects of losartan and chlorthalidone on blood pressure and renal vascular resistance index in non-diabetic patients with essential hypertension and normal renal function.

Antihypertensive drugs can differ in target organ protection despite similar blood pressure (BP) control. We compared the effects of losartan (L) and chlorthalidone (C) on renal vascular resistance index (RVRI) in 194 grade I to II, non-diabetic hypertensive patients with increased RVRI (>0.68 m/s by echo-Doppler) but normal renal function. Patients were randomly allocated to C 25 mg/d or L 50 mg/d according to a single blind, PROBE study design. After 4 weeks of treatment, 92 patients (48 L/44 C) with BP <140/90 mm Hg were enrolled in the long-term phase of the study. After 12 months a normalization of RVRI was observed in 47 of 48 patients treated with L (97.5%) and only in 14 of 44 of those treated with C (25.8%) despite no differences in BP control. Patients whose RVRI remained elevated during C therapy underwent a 2-week washout period and then were treated with L 50 mg/d for 12 additional months. After that period 28 of 30 (95%) of patients who were nonresponders to C showed a normalization of RVRI despite no differences in BP control. In conclusion, our data suggest that treatment with L can improve renal hemodynamic and exert a protective renal effect beyond BP control in patients with hypertension.

Tumour uptake of 57-cobalt-bleomycin in patients with breast cancer.

17 patients with breast carcinoma were studied with 57-cobalt-bleomycin scintigraphy. Scans showed increased tumour uptake in all patients. Results expressed as percentage of the injected dose (ID) normalised by the size of the tumour region (% ID/pixel) showed higher tumour uptake in patients with T3-T4 breast carcinomas (n = 5) than in patients with T1-T2 breast cancer (n = 12) (8.4 +/- 0.55 x 10(-3) vs. 5.25 +/- 1.71 x 10(-3)% ID/pixel, respectively, P < 0.05). An inverse correlation between tumour uptake of 57-cobalt-bleomycin and progesterone receptor concentration was also found in all tumours tested (r = -0.60, P < 0.05, n = 10) and was confirmed in the group of patients with T2 breast carcinomas (r = -0.89, P < 0.05, n = 6). We conclude that a quantitative analysis of 57-cobalt-bleomycin uptake can give additional information suitable for the presurgical characterisation of a tumour.

Phase analysis of radionuclide angiography in acute myocardial infarction.

Standard deviation of the histogram of left ventricular phase distribution (SDP-LV) obtained by radionuclide angiography (RNA) was studied in 75 acute myocardial infarction (AMI) patients, 37 with anterior or anteroseptal (Group A) and 38 with inferior, inferolateral or posterior necrosis (Group I). In order to evaluate sensitivity, specificity and accuracy of SDP-LV compared to ejection fraction (EF) and peak filling rate (PFR), 16 controls and 29 patients with coronary artery disease with normal kinesis proved by angiography were studied. Patients were also compared according to normal or abnormal EF and PFR. Sensitivity of PFR was better than those of EF and PFR (86.6% vs 38.7% and 70.6%, respectively). Specificity of SDP-LV was 89.6%, better than that of PFR (58.6%), but just less than that of EF (93.1%). The accuracy of SDP-LV turned out to be better than those of EF and PFR (87.5% vs 53.8% and 67.3%, respectively). Ejection fraction correlated with SDP-LV in the total study population (r = -0.54, P less than 0.001), and in Groups A (r = -0.44, P less than 0.01) and I (r = -0.43, P less than 0.05); SDP-LV correlated with PFR in the total population (r = -0.35, P less than 0.05), but not in Group A or I. Mean SDP-LV was higher in Group A than I and in patients with lower EF; no difference was found among patients with different PFR values.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnosis of ischemic cardiopathy in hypertensive patients. Comparison of radioisotopic technics]. / Diagnosi di cardiopatia ischemica in pazienti ipertesi. Confronto tra tecniche radioisotopiche.

Exercise radionuclide ventriculography (ERV) is considered a superior non-invasive screening test for coronary artery disease (CAD). ERV showed, however, a low specificity in hypertensive patients (H). The diagnostic accuracy of ERV and thallium-201 myocardial scintigraphy (M) was evaluated in 23 patients (H) with chest pain and positive ECG-stress test. All patients underwent ERV and M, randomly, in different days. Finally, they all underwent coronary angiography: CAD was diagnosed in case of luminal narrowing greater than or equal to 70% in 1 major coronary artery at least. Eleven patients had severe CAD. ERV was considered positive for CAD in presence of ex-induced abnormality of wall motion and/or in case of ex-induced ejection fraction increase less than or equal to 5% respect to the basal values. M was considered positive for CAD when perfusion defects were observed in early images only. ERV showed low diagnostic accuracy. On the contrary M had both sensibility and specificity, and a high positive and negative predictive value in the diagnosis of CAD. M is thus suggested as the non-invasive methodology of choice in hypertensive patients with suspected CAD.

Diagnostic approach to hepatic hemangiomas detected by ultrasound.

Eighty cases of hepatic hemangioma were studied using ultrasound. In one group consisting of 28 subjects a final diagnosis of hepatic hemangioma was supported by arteriography (21 cases) or surgery (7 cases). In the remaining 52 cases, the diagnosis was uncertain and the normal clinical and biochemical findings with the ultrasound follow-up studies at intervals of 3, 6 and 12 months, made a diagnosis of hemangioma highly probable. Twenty-nine cases (9 cases of the first group and 20 of the second) were also evaluated by Tc-99m colloid and in vivo Tc-99m-labelled red blood cell scintigraphy. On the basis of ultrasound appearance and internal structure, hemangiomas may be divided into three groups: hyperechoic pattern (of which there were 16 cases in our study), cystic or anechoic pattern (5 cases), and complex pattern (7 cases). Fifty-two cases of uncertain diagnosis showed hyperechoic focal lesions with rounded, well-defined margins and no clinical or biological abnormalities. Differentiation from malignant forms must be approached according to the specific ultrasound pattern observed and the presence or absence of symptoms. Only in cases of hyperechoic, well-defined lesions detected in asymptomatic patients may a reliable diagnosis of hemangioma be made. The use of in vivo Tc-99m-labeled red blood cell scintigraphy (Tc-99m RBC scintigraphy) is useful in hyperechoic and cystic forms having a diameter greater than 3 cm. Complex forms invariably require additional studies, using complementary procedures (angiography, angio-CT) to confirm diagnosis.