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.

Could an echo contrast agent be helpful in identifying renal artery stenosis?

BACKGROUND: Diagnosis of renal artery stenosis using echo color-Doppler is subjected to several limitations. The aim of this study was to examine if the routine use of a contrast agent could be helpful in identifying renal artery stenosis (RAS). METHODS: We analysed 35 patients affected by RAS using an echo color-Doppler coupled with a contrast agent. All patients presented arterial hypertension, with a good drugs control, and mean serum creatinine of 1.8 mg/dL. All patients previously underwent angiography. RAS was at the origin of the artery in 27 patients, at the intermediate tract in 8. All patients had already been submitted to a basal echo color-Doppler. RESULTS: The contrast agent determined a significant increase in the average colour signal in all the subjects, and a better evaluation of the spectral waveforms, if compared to the basal examination. CONCLUSIONS: The results obtained showed that the contrast agent doesn't improve the diagnosis of RAS, especially in vascular origin stenosis, while it shows a real advantage in the intermediate or distal stenosis which are better visualized.

Color-Doppler sonography in ophthalmology.

BACKGROUND: With the present study we considered ocular blood flow by the use of color Doppler ultrasound. We compared the most clinically important arteries of both eyes. We valued the central retinal artery, the posterior long ciliary arteries, the posterior brief ciliary arteries and the central retinal vein. METHODS: We submitted to an ecd examination of the ophthalmic arteries 50 patients, of whom 30 were healthy, 4 presented a pallor of the optic disk, 6 were affected by chronic simple glaucoma and 10 were affected by arterial hypertension. RESULTS: This study has allowed us to define the normal and pathologic anatomic findings at the ecd tracing therefore qualitative and quantitative standards of this examination, repeatable and comparable. CONCLUSIONS: Currently the different techniques used to study ocular blood flow, do not allow its exact detection, but only a morphological evaluation of the eye artero-venous system. Acquisition of morphological and velocimetric data, at the same time, allows a more exact evaluation of the pathology. Therefore the ecd is a simple rapid and non-invasive approach, useful in the acquisition of important data concerning diagnostic confirmation, prognosis, and above all pharmacological follow-up of many pathologies such as diabetes, glaucoma and arterial hypertension. The diagnosed vascular alterations are correlated to the degree retinopathy and to the effectiveness of the pharmacological treatment.

[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.

[Indirect diagnosis of aortic coarctation by Doppler color echography. Velocimetric and spectral aspects in one of our cases]. / Diagnosi indiretta di coartazione aortica mediante eco color-Doppler. Aspetti velocimetrici e spettrali in un caso di nostra osservazione.

OBJECTIVE: Description of a case report. PATIENTS: The case of a 55-years-old man with a previous history of hypertension, treated for several years with many antihypertensive drugs without improvement is described. RESULTS: The patient was affected with a unknown coarctation of the aorta. This disease, in fact, is an important cause of secondary hypertension. Adult patients, if asymptomatic, are most often diagnosed because of hypertension or murmur on a routine examination. This congenital disease can be demonstrated on suprasternal notch two-dimensional echocardiographic views along with increased Doppler flow velocity across the coarctation site. TC scan and aortography confirm the degree and nature of the aortic narrowing. CONCLUSIONS: In the case reported color Doppler ultrasonography demonstrated two peculiar aspects of the coarctation of the aorta: 1) detection of a stenotic flow in the abdominal aorta, abdominal and lower extremities arteries; 2) marked renal vasodilatation secondary to compensatory mechanisms that intervene in the renal flow reduction; this finding is detectable in the presence of bilateral stenosis of renal arteries as well as in the hypertensive forms of coarctation of the aorta.

Hypertension and menopausal syndrome: effects of hormone replacement therapy and antihypertensive drugs.

Arterial hypertension is a common finding in climacteric women even though the role of reduced estrogen levels in promoting this condition remains unclear. The purpose of the present survey was to evaluate the effects of hormone replacement therapy in hypertensive postmenopausal women. 180 patients were studied; they had been postmenopausal for 12-18 months and afflicted with mild or moderate essential arterial hypertension for less than 2 years. Patients were randomly divided into two groups and treated with progestin-estrogen therapy (group I, 96 patients) or with antihypertensive drugs (group II, 84 patients). Fourty-one cases in group I (42.7%) responded adequately to hormone therapy with persistent normalization of blood pressure levels; antihypertensive drugs were effective in 61 patients in group II (72.5%). The 23 unresponsive patients in group II were subsequently treated with progestin-estrogen therapy and a normalization of pressure values was achieved in 10 of these (43.5%). These results suggest that hormonal treatment determines, in at least one third of the cases, a significant reduction in blood pressure values. Moreover, hormone replacement may be effective even in patients that have not responded to antihypertensive drugs.

Hypertension and CHD: evidence of glucose and lipid metabolism involvement.

Three hundred and seventy subjects (217 women and 153 men) affected by essential hypertension of moderate or severe degree were studied. Their age ranged from 28 to 57 years, with a mean of 47 years. 251 patients had a normal electrocardiogram (ECG) and 119 patients an abnormal ECG: 78 with T wave abnormalities, 4 with Q-S segment abnormalities, 9 with left bundle branch block and 28 with left ventricular hypertrophy. Control group was composed by 45 non hypertensive subjects matched for age and sex. Glucose and insulin concentrations, before and after the oral glucose intake, were higher in patients with essential hypertension than in control group. The hypertensive patients with abnormal ECG were found to have higher plasma insulin response, high triglyceride plasma levels, total cholesterol and LDL cholesterol concentrations, associated with a significant increase in the total cholesterol/HDL cholesterol ratio.

[Hormonal markers of early-stage osteitis fibrosa in patients on hemodialysis]. / Indici ormonali di osteite fibrosa in fase iniziale nel paziente emodializzato.

The diagnosis of renal osteodystrophy is straightforward when the disease has reached an advanced stage and the pathology is extremely difficult to treat, whereas it is considerably more complex during the early stages. A study was carried out to assess the sensitivity of some biochemical, hormonal and instrumental markers in the early diagnosis of osteitis fibrosa in patients undergoing hemodialysis due to chronic renal insufficiency. Of these markers, the assay of whole molecule PTH appeared to be the most sensitive and specific biological marker.

[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.

[Mitral valve prolapse. Age and sex incidence, echocardiographic diagnosis and clinical and electrocardiographic correlations]. / Prolasso della mitrale. Incidenza per età e sesso, diagnosi ecocardiografica e correlazioni cliniche ed elettrocardiografiche.

The paper reports an electrocardiographic and M and B-mode echocardiographical study in 3682 non-selected patients among which a total of 241 were identified with mitral valve prolapse. In males the highest frequency was found during the second decade of life with a tendency to decrease with increasing age. In females, who were found to be the most severely affected (2:1 in relation to males), two peaks of incidence were observed during the third and fifth decade, with a greater frequency in the latter and a marked absence of cases in the fourth decade. Many echocardiographically diagnosed mitral prolapses were both clinically and electrocardiographically silent; moreover it was observed that the risks of this complication increased in parallel to the thinness and redundance of the mitralic flap affected by prolapse and the dilation of the valvular ring.

[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.

[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.

[The evaluation of urinary NAG activity in patients undergoing urography]. / Valutazione dell'attività NAG-urinaria in pazienti sottoposti ad urografia.

A study has been carried out to verify the nephrotoxic effect of hyperosmotic substances used as a contrast medium in radiology employing the enzymuria technique (NAG). The research was carried out in 202 patients, some of whom diabetic, suffering from various pathologies and subjected to perfusion urography by inoculating an iodate contrast medium (isopaque). The result showed that NAG urinary activity grows significant in the 24-36 hours subsequent to X-ray examination in both diabetics and nondiabetics although the increase is greater in the former. After 5-7 days, enzymuria returns to normal in nondiabetic patients but remains high in the diabetic.

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.

[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.

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.

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.

[Tumor markers in the early diagnosis of thyroid neoplasms]. / I markers tumorali nella diagnosi precoce delle neoplasie tiroidee.

Radioimmunological techniques were used to assay tumour markers in order to identify neoplasms in patients with thyroid nodules at the earliest possible stage. In the 7 patients with differentiated thyroid tumours, the marker findings were within normal limits. On the basis of these results it is concluded that at the present time these markers are of no value for the early diagnosis of thyroid tumours.