Brain natriuretic peptide as a cardiac marker of transient radiotherapy-related damage in left-sided breast cancer patients: A prospective study.

PURPOSE: Our study evaluated brain natriuretic peptide (BNP) changes over time after adjuvant radiotherapy (RT) in women with left-sided breast cancer investigating its correlation with heart dosimetric parameters. METHODS: Forty-three patients underwent clinical cardiac examination, electrocardiogram (ECG), echocardiography and BNP measurement before RT (T0) and 1 (T1), 6 (T6) and 12 months (T12) after. After T12 cardiac assessment was performed annually in each patient. Mean values and standard deviation (SD) of BNP, left ventricular ejection fraction (LVEF), V20, V25, V30, V45 and mean dose were calculated. Normalized BNP (BNPn) was calculated as follows: BNPnT1 = BNPT1/BNPT0, BNPnT6 = BNPT6/BNPT0, BNPnT12 = BNPT12/BNPT0. Absolute BNP and BNPn values were used for data analysis. RESULTS: Median follow-up from the end of RT to the last check-up was 87 months (range 37-120 months). Minimum follow-up was 74 months except for two patients, who died at respectively 37 and 47 months after RT. In all patients LVEF did not change significantly (p = 0.22) after RT. BNP increased significantly (p < 0.001), particularly 1 and 6 months after RT. It slightly decreased after 12 months. BNP did not correlate with V20, V25, V30, V45, mean dose and MHD. All BNPn correlated significantly (p < 0.05) with V20, V25, V30, V45, mean dose and MHD. Four patients had a cardiac event; in the only subject who developed myocardial infarction, V20, V25, V30 and V45 were the highest and BNP increased from T1 and persisted high even at T12. CONCLUSION: Our results confirm that BNP could be a useful minimally invasive marker of early RT related cardiac impairment.

Tratamiento mínimamente invasivo del hematoma subdural crónico del adulto. Resultados en 116 pacientes. Respuesta de los autores / Minimally invasive treatment of chronic subdural haematoma in adults. Results in 116 patients. Response by the authors

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[Minimally invasive treatment of chronic subdural hematoma in adults. Results in 116 patients]. / Tratamiento mínimamente invasivo del hematoma subdural crónico del adulto. Resultados en 116 pacientes.

INTRODUCTION: Chronic subdural hematoma in adults (CSDH) has a global crude incidence of 14.1/100,000 per year in our institution captive population. There is no single treatment protocol. In our hospital we choose a minimal invasive technique (trans-marrow puncture) without general anaesthesia due to the age of the population. A descriptive study of patients with CSDH and treatment results, including a laterality analysis, is presented. MATERIAL AND METHODS: We retrospectively searched patients with (CSDH) between January 1998 and May 2009. The diagnosis was made by neuroimaging techniques in all patients. The preferred treatment was trans-marrow puncture; exceptionally some patients were treated by burr holes or craniotomy. RESULTS: We found 127 patients. Age, gender, midline displacement, hospitalisation days, and number of procedures, were not a predictive factor of mortality in the first month. A slight majority (55%) of CSDH were on the left side, with no statistically significant difference. There were 6 (4.7%) deaths during hospitalisation. In our series cumulative mortality at six months was 11.8%. Markwalder scale at admission was not a predictive factor of statistically significant mortality. An 80% of the patients received trans-marrow puncture as single procedure was performed on 80% of the patients. CONCLUSIONS: The results of our study suggest that trans-marrow puncture is an acceptable procedure, with low mortality, and less hospitalisation days and complications. Mortality, associated mechanisms, age, gender, midline displacement are no different than in others previous publications. We found a higher frequency of hematomas to the left, as in other series. Meta-analysis studied need to be performed to determine more accurately the frequency of this dominance.

A pilot study to evaluate the effects of vardenafil on sexual distress in men with obesity.

There are no interventional studies on the impact of sexual distress (SD) in men with obesity. We investigated the effects of vardenafil (VAR) on SD in middle-aged (mean age 49 ± 8), healthy, obese men in the absence of premature ejaculation, ED or hypogonadism. After a 4-week run-in period, 20 men with high body mass index (BMI=40 ± 8) and SD at the Sexual Distress Esteem Questionnaire-Male (mean score 65 ± 20 AU) were randomized to receive either VAR 10 mg on demand (N=10) or matched-placebo (PLB, N=10). Primary endpoints were variations from baseline in the intravaginal ejaculatory latency time (IELT) measured by the stopwatch technique; secondary endpoints were variations from baseline in Self-Esteem and Relationship (SEAR) and Male Sexual Health Questionnaire-Ejaculatory domain (MSHQ-EjD) scores. VAR significantly improved IELT (P<0.0001), as well as SEAR (P<0.001) and MSHQ-EjD (P<0.005) scores, whereas no changes were observed after PLB. Interestingly, an inverse relationship between BMI and IELT was found in all the men studied (r(2)=0.37, P<0.001). SD in healthy obese men seems to be correlated mainly with inadequate ejaculatory control, especially in men with higher BMI. Our preliminary results suggest that treatment with VAR may improve ejaculatory control, thus ameliorating self-esteem and sexual performance in men with obesity.

[Is the international normalised ratio a prognostic factor of mortality in intracerebral haemorrhage?]. / ¿Es el cociente normalizado internacional un factor pronóstico de mortalidad en hemorragias intracerebrales?

BACKGROUND: Oral anticoagulant therapy (ACO) is considered an independent predictor of mortality in patients with intracerebral haemorrhage (ICH), with the role of the international normalised ratio (INR) being unclear. The aim of this work is to evaluate the relationship between ACO and the INR value and the ICH volume, and to determine the relationship between both variables and mortality. PATIENTS AND METHODS: Patients were retrospectively analysed using the Private Community Cerebrovascular Hospital Register (Registro Cerebrovascular del Hospital Privado de Comunidad), between December 2003 and May 2009. Volumes of the haematomas (dependent variable) were calculated from the first image performed, using the abc/2 method. Independent variables were age, gender, vascular risk factors, site of bleeding, intraventricular dump, clinical severity (Glasgow scale), time to image, antiplatelet drugs, and INR value on admission. An analysis of the relationship between all these variables and mortality was also performed. RESULTS: A total of 327 patients with HIC were identified (35 with ACO). Median volume was higher in the anticoagulated patients (55ml vs 24ml P<.05), with no statistically significant relationship between volume and the other variables. In the multivariate analysis, a statistically significant higher mortality associated to volume was observed, but not with anticoagulation. CONCLUSIONS: Oral anticoagulation was associated with a higher initial volume of the haematoma, with no correlation between the INR value and volume. The HIC volume was directly related to mortality, however, like the volume, the INR was not associated with increased mortality.

The laboratory assessment of partial androgen deficiency of the aging male.

The diagnosis of andropause, currently named partial androgen deficiency of the aging male (PADAM), by the International Society for the Study of Aging Male (ISSAM), is based on the presence of clinical symptoms together with a biochemical evidence of hypogonadism. Thus, the definition of specific diagnostic criteria, both as clinical manifestations and laboratory findings, is fundamental to identify those men for whom androgen replacement therapy should be warranted. Clinical manifestations suspected to be caused by androgen deficiency are numerous (decreased libido and erectile dysfunction, decreased muscle mass and strength, decreased bone mineral density, increased fat mass, depression, fatigue, irritability, etc) and, for these, the linkage to a real hypogonadal state must be confirmed on an individual basis. In this regard, the exact list of reproductive hormones to be evaluated, for screening or for diagnosis confirmation, together with eventual dynamic endocrine test (GnRH, hCG, clomiphene, etc) must be adjusted. Furthermore, the clinician must be aware of the methods and limits of androgen assays in order to be able to specifically select, where possible, those which are validated by comparison to a "gold standard" or accepted method of measurement.

Emerging pathologies in aquaculture: effects on production and food safety.

Infectious diseases represent a limiting factor for the further development of Italian aquaculture. The recent introduction and spreading of new pathogens, along with the global climatic change, has contributed to a considerable decrease in trout production. Emerging pathologies in rainbow trout culture include viral diseases, e.g. infectious haematopoietic necrosis (IHN), bacterial diseases, such as lactococcosis and visceral flavobacteriosis, and parasitical diseases, e.g. proliferative kidney disease (PKD). Higher mortality rates in trout fry and fingerlings are generally induced by visceral flavobacteriosis and IHN, while the main losses in large trout during the warm season are due to lactococcosis and PKD. Mariculture has at present a better sanitary status compared to trout culture, but a rapid dissemination of pathogens, including zoonosis agents, is envisaged also for seabass and seabream. Emerging pathologies in sea bass include VNN, pseudotuberculosis, streptococcosis and tuberculosis. Seabream is much more resistant and is mainly affected by novel Vibrio infections and enteromyxidiosis. A good sanitary management of fish farms is essential for avoiding or limiting losses caused by emerging pathologies. Transmission of zoonosis agents to man, through the consumption of cultured fish, is very remote in Italy. On the contrary, transmission of Streptococcus iniae, Vibrio vulnificus and Mycobacterium marinum by means of improper manipulation of infected fish, could represent a potential hazard for fish farmers and fish processors, as well as for people preparing fish meals.

Changes of lipocalin type prostaglandin D-synthase in the seminal plasma of subfertile man.

It was proposed that lipocalin type prostaglandin D synthase (L-PGD-S), a bifunctional protein both synthesizing PGD2 and transporting retinoids and other lipophilic ligands, could be involved in the development and the maturation of sperm. In the present study, the seminal plasma (SP) of 59 adult males was analyzed by standard WHO methods and immunoblotting, using a monospecific polyclonal antibody directed against L-PGD-S. Briefly, aliquots of SP (2.5 microl), were fractionated by polyacrylamide electrophoresis in the presence of sodium dodecyl sulfate, the blots were stained and densitometrically analyzed. To obtain quantitative data, the aliquot of SP was selected within the linear part of the dose/band intensity curve and a proper quality control was analyzed in all blots to normalize the intensity of the bands of different experiments. A significant reduction (p<0.05) of the L-PGD-S levels was observed in severe oligozoospermic patients compared to normozoospermic subjects and a significant correlation between L-PGD-S levels and sperm concentration was found, as reported by other authors. Further studies are warranted to evaluate the possible diagnostic and pharmacological applications of these observations.

Bahren types III and IVa testicular vein anomalies as a reason for failure in left idiopathic varicocele retrograde sclerotherapy. Ontogenic discussion and clinical implications.

Left testicular vein anatomy has received more attention due to the presence of competent or incompetent venous valves and bypassing anastomoses, which are involved in venographic diagnosis and embolisation of varicocele. The left gonadal vein develops, in both males and females, between the 5th and 7th intrauterine weeks, being derived from the distal or postrenal portion of the left subcardinal vein. The varicocele aetiologic hypothesis leads to ontogenetic disturbances in the development of the secondary venous system. Retrograde testicular venography shows the precise anatomy of the left pampiniform plexus, while anterograde testicular venography identifies the presence of the valve and possible continence. In the present case sclerotherapy could not be achieved due to testicular vein anomalies. Sclerotherapy versus surgical high ligature of the left testicular vein in cases of left idiopathic varicocele with testicular vein anomalies is discussed.

Aspirin inhibits androgen response to chorionic gonadotropin in humans.

Eicosanoids play an important role in the regulation of the hypothalamic-pituitary axis; less clear is their role in testicular steroidogenesis. To evaluate the involvement of cyclooxygenase metabolites, such as prostaglandins, in the regulation of human testicular steroidogenesis, we examined the effects of a prostaglandin-blocker, aspirin, on plasma testosterone, pregnenolone, progesterone, 17OH-progesterone, androstenedione, dehydroepiandrosterone, and 17beta-estradiol response to human chorionic gonadotropin (hCG) in normal male volunteers in a placebo-controlled, single-blinded study. To test the efficacy of aspirin, seminal prostaglandin E(2) levels were also determined. hCG stimulation increased peripheral levels of testosterone, 17OH-progesterone, androstenedione, dehydroepiandrosterone, and 17beta-estradiol, without affecting circulating pregnenolone and progesterone values. Aspirin significantly lowered seminal prostaglandin E(2) levels, whereas it did not modify steroid concentrations not exposed to exogenous hCG. Moreover, the drug significantly reduced the response of testosterone, 17OH-progesterone, androstenedione, and dehydroepiandrosterone to hCG, as assessed by the mean integrated area under the curve, whereas it did not influence 17beta-estradiol response. In conclusion, aspirin treatment inhibits androgen response to chorionic gonadotropin stimulation in normal humans. The action of aspirin is probably mediated via an effective arachidonate cyclooxygenase block.

Screening for coeliac disease: the meaning of low titers of anti-gliadin antibodies (AGA) in non-coeliac children.

Coeliac disease is diagnosed by means of jejunal biopsy, an invasive procedure. Anti-gliadin antibodies (AGA) have therefore been used in the first screening of the disease. On the other hand, low titers of AGA are widely detected also in normal subjects. In order to investigate if low levels of AGA could be correlated with laboratory and clinical data, we performed a study on 167 subjects with various illnesses, such as recurrent abdominal pain, failure to thrive, short stature, diarrhoea or constipation, cow-milk protein intolerance and/or food allergy, recurrent vomiting or previous gastroenteritis, all non coeliac conditions which have been associated with AGA presence. Seventy coeliac children, all biopsied, were selected as a control group. Among the 167 cases we found 60 subjects positive for AGA (35.9%), a high proportion as compared with the general population. Only 33/167 patients, all IgG and IgA AGA positive, fulfil our laboratory and clinical criteria to perform a 'confirming' biopsy. For the 134 residual cases (14 IgA, 13 only IgG AGA positive, 107 AGA negative) a diagnosis of coeliac disease has been excluded by clinical criteria (scoring). As a whole, the patients with coeliac disease had significantly higher levels of AGA of both IgG and IgA classes (p < 0.01). On the other hand, no significant difference emerged for all the anamnestic and laboratory parameters considered between AGA+ and AGA- non-coeliac subjects. However, laboratory parameters of IgG-AGA and/or IgA-AGA positive patients were similar to those of coeliac children for ion, Xylose, total IgA count. As no biopsied case showed mucosal atrophy, it is suggested that the presence of even low AGA levels in non-coeliac children may represent a highly sensitive index of intestinal alteration causing an increased permeability to macromolecules, but it is very unlikely that one could detect coeliac children by means of Ig-AGA among such illnesses and normal subjects. Strong clinical diagnosis and laboratory parameters are required to justify intestinal biopsies. In fact, the production of AGA seems to be a merely immunological phenomenon linked to an increased and probably transient permeability to macromolecules of the intestinal mucosa.

[Parameters for the assessment of inflammation of the anterior segment of the eye]. / Parametri per la valutazione delle flogosi del segmento anteriore dell'occhio.

The authors examine general aspects of the assessment and evaluation of inflammation of the anterior segment of the eye, stressing above all the importance of accurate history taking and correct diagnostic approach. The also define general features of inflammatory processes and analyse the main and most modern instrumental techniques that are essential for precise assessment of clinical parameters of inflammatory conditions of the anterior segment of the eye.

[Apropos of preventive ophthalmologic interventions in the child population of compulsory school age. Authors' experience]. / A proposito degli interventi sanitari oftalmologici di prevenzione nella scuola dell'obbligo. Una nostra esperienza.

The results are reported of work carried out during the last five years by the Center of Social Ophthalmology, director Prof. G. Scuderi, which is part of the II Division of the Ophthalmologic Clinic of Rome University "La Sapienza" with the object of trying out together with territorial units a model of preventive intervention acting as a filter for specialized university facilities. In other words, already existing facilities and medical personnel were to be used and trained for specific methods and techniques. From 1985 through 1990, 787 children selected by ophthalmologic screening by school doctors among the compulsory school population of the RM 3 and 5 districts were seen and submitted to periodic checks. This cohort included children aged 5 to 14 without significant differences in sex distribution and with prevalence of the 8 to 10 year olds. Each subject was submitted to complete eye examination including refractometry and orthoptics, color vision, biomicroscopic and ophthalmoscopic examination. The principal findings show that about 36% of subjects examined have a natural vision of 11/10 while the high percentage of ametropia observed was mainly represented by astigmatism and hypermetropy, albeit of minor intensity. Strabismus was found in 2.79% and implied marked visual deficit that was often refractory to any type of treatment. In addition, the prevalence was determined of other abnormalities concerning eye motility, color vision and pathologies involving anterior segment and eyeground. In their conclusion, the authors stress the rarity of organic ocular pathology in children (mostly represented by inflammatory changes of the adnexes and conjunctiva) whereas amblyopia was one of the main causes of visual deficit in children. They stress the importance of early therapeutic intervention in order to allow complete visual rehabilitation. The results of the clinical model for prevention were excellent so that it can even be proposed for large scale prevention of amblyopia.

Chronobiology of blood pressure in childhood: implications for tracking.

Chronobiology, in its methodological evolution, developed data series analyses paying particular attention to blood pressure (BP), because of the importance of this biorhythmic variable for assessing the risk of developing hypertension. An example of the potentiality of the chronobiologic procedures is given in the present report which deals with the inferential analysis of the BP 24-h patterns in 3-12 year-old children. By using the chronobiologic methodology, time-qualified standards for BP are calculated. Rhythmometric parameters for circadian rhythm of systolic and diastolic components of BP are also computed. Data presented are a tangible outcome for emphasizing the introduction of chronobiology in epidemiology and pediatrics in order to optimize the primary prevention and care of hypertension taking as reference the chronobiologic standards of BP.