Intrafusal effects of botulinum toxin in post-stroke upper limb spasticity.

A previous study in subjects with focal dystonia suggested that the greater and longer-lasting effect induced by botulinum toxin type A (BoNT-A) on the tonic vibration reflex (TVR) than on the maximal M-wave (M-max) might be the physiological marker of the toxin's action at the level of intrafusal muscle fibres. With this approach, we investigated the possible effect of BoNT-A on fusimotor synapses in eight patients with post-stroke spasticity (four with no residual motor capacity before treatment and four with partially spared muscle strength and residual motor capacity). TVR and M-max were recorded from the wrist and finger flexor muscles before treatment and at 1, 4 and 7 months afterwards. The TVR reduction was greater than the M-max reduction and remained fairly constant over time only in the subjects with a residual motor capacity before the treatment. This pilot study suggests that some degree of strength and active movement is necessary for the action of BoNT-A on intrafusal fibres.

Rheologic changes in the synovial fluid of patients with gonarthritis induced by intraarticular infiltration of hyaluronic acid.

The aim of the present study was to evaluate possible changes in synovial fluid viscosity in gonarthritic patients treated with intraarticular infiltration of hyaluronic acid. Thirty patients with radiologically proven (Stage III Kellgren) serious gonarthrosis, local pain and functional limitation were enrolled. All patients had reported at least 4-5 episodes of hydrarthrosis during the previous 12 months. Therefore, two different phases of their illness could be observed: a relatively silent phase of hydrarthrosis and a symptomatic phase. According to the protocol, one sample of synovial fluid was collected for evaluation of baseline viscosity (pretreatment); immediately afterwards, intraarticular administration of high molecular weight sodium hyaluronate (one 20 mg vial/week for 3 weeks) was initiated. During the entire treatment period and for 3 weeks following the end of treatment, intraarticular synovial fluid samples (one sample per week for 3 treatment weeks followed by a further 3 weeks as control) were collected to perform rheologic assessment and viscosimetric analysis. The results of this preliminary study show that exogenous administration of high molecular weight sodium hyaluronate induced normalization of hyaluronic acid viscosity values in patients with high and low baseline hyaluronic acid viscosity values.

Red cell filterability and erythrocyte membrane microviscosity during ticlopidine treatment.

The effects of 10 days' treatment with 500 mg/day ticlopidine on the filterability of red blood cells in suspension and on the microviscosity of the red blood cell membrane was evaluated in 11 patients with vascular atherosclerosis. The results show ticlopidine to be effective in influencing the rheological measures of red cell filterability and membrane microviscosity: filterability was increased and microviscosity was decreased. Ticlopidine also decreased the extent of fluorescence polarization. These results are discussed regarding possible mechanisms of action of ticlopidine.

Vascular atherosclerotic disease: evaluation of the whole-blood filterability and red cell membrane microrheological pattern after intravenous administration of a single dose of pentoxifylline.

A study was carried out in 10 patients with vascular atherosclerotic disease to investigate the effects of a single dose of 300 mg pentoxifylline, given by intravenous infusion over 30 minutes, on various macrorheological and microrheological parameters. Measurements were made at baseline, at the end of the intravenous infusion and again 30 minutes later, of whole-blood filterability, erythrocyte membrane fluidity (using pyrene as probe) and transverse fluidity gradient (using fluorescent fatty acids as probes). The results showed that there was a significant variation in whole-blood filterability and the red cell membrane fluidity gradient after pentoxifylline. No difference, however, was noted for the membrane fluidity. These data suggest, therefore, that pentoxifylline plays a role in affecting the red cell membrane microrheological pattern.

Blood rheology changes during bezafibrate treatment.

To evaluate the effect of bezafibrate on the haemorheological pattern, 30 atherosclerotic non-diabetic patients were enlisted in a double-blind, comparative, parallel group trial with bezafibrate (600 mg daily) or placebo being randomly assigned. The 45-day treatment period was preceded by a three week pharmacological wash-out. Haemorheological parameters such as whole-blood, plasma and serum viscosity, haematocrit, fibrinogen, fibrinogen/albumin ratio and erythrocyte filterability were evaluated before and at the end of treatment. The results showed no change in haemorheological determinants in the placebo-treated group but a significant reduction in whole-blood viscosity, in haematocrit, in fibrinogen and fibrinogen/albumin ratio was observed in the bezafibrate treated patients. No variation was present in the plasma and serum viscosity and in the erythrocyte filterability.

[Blood filterability at various filtration pressures: a study conducted on normal and diabetic subjects]. / Filtrabilità ematica a diverse pressioni di filtrazione: studio condotto su soggetti normali e diabetici.

Using the Reid et al. technique we have evaluated the blood cellular volume (VBC: ml/min) obtained by changing the negative filtration pressure. From the obtained data it is evident that at the three different filtration pressure values (-20, -15 and -10 cm of H2O) the VBC does not distinguish normal from diabetic subjects. Only at the negative pressure of 20 cm of water did the VBC distinguish diabetics, who were subdivided by type and vascular complications. We have also evaluated the relationship between the values of VBC calculated at the pressures of -20 and -10 cm of water. From this study it emerged that the relationship between the two values present in normals is not different from that present in diabetics and in diabetics subdivided by type and vascular complications.

[Hemorrheological survey in a group with arteriosclerotic vascular disease treated with suloctidil]. / Rilievi emoreologici in un gruppo di vasculopatici aterosclerotici trattati con suloctidil.

In 17 patients affected by atherosclerotic vascular disease and showing in basal conditions a hyperviscosity state, we have monitored the main hemorheological determinants during treatment with Suloctidil. At the end of treatment carried out for 5 months the results showed that erythrocyte filterability was the only hemorheological determinant influenced. The possible causes of this action are therefore considered.

[Blood viscosity in diabetes mellitus (evaluation on the basis of high shear rates)]. / Viscosità ematica nel diabete mellito (valutazione a bassi ed alti shear rates).

In 45 diabetic patients (22 men and 23 women) subdivided in relation to type and vascular complications we have evaluated the blood viscosity at high and low shear rates. From the obtained results it is evident that only at low shear rates this hemorheological parameter distinguishes diabetic patients from normal subjects and diabetic patients without vascular complications from those with these complications. This result is present only because these shear rates are dependent on the influence of the erythrocyte aggregation which is altered in the diabetic disease.

[Behavior of plasma triglycerides and cholesterol in diabetic patients]. / Comportamento dei trigliceridi e del colesterolo plasmatici in pazienti diabetici.

34 diabetic patients (24 females and 10 males) were studied and hypertriglyceridemia was found only in females. Obesity seems to be the most important factor determining hypertriglyceridemia and hypercholesterolemia. No correlation was found between glycosylated haemoglobin and triglycerides or cholesterol levels. Only a little correlation was found between fasting plasma glucose and triglycerides levels.

[Study of behaviour of fibrinogen and of some glycoproteins in arteriosclerotic clinical situations (author's transl)]. / Comportamento del fibrinogeno e di alcune frazioni glicoproteiche in situazioni cliniche arteriosclerotiche.

The behaviour of fibrinogen, haptoglobin alpha 1-acid GP, ceruloplasmin, alpha 2-macroglobulin and alpha 2-HS in patients with acute myocardial infarction (in the initial stage and in the following two weeks), chronic ischaemic heart disease, chronic atherosclerotic vascular disease and hyperlipoproteinemia was evaluated. According to the obtained results the utility of their evaluation is evident and, especially for the chronic situations, some therapeutic considerations emerge.