Probiotics in the gastrointestinal diseases of the elderly.

Changes of the gut microflora in elderly appear to involve a reduction in numbers of healthy bacteria (lactobacilli and bifidobacteria) and an increase in numbers of potentially pathogenic species. These changes are generally described as gastrointestinal disorders and infections. This review analyses benefits of probiotics in old people, with particular interesting for the latest researches relevant to elderly people, e.g. trials examining enteric infections, antibiotic-associated diarrhea and Clostridium difficile associated diarrhea, functional bowel problems (constipation and irritable bowel syndrome), inflammatory bowel diseases, stimulation of the immune system and prevention of cancer. A growing number of researches indicates that some probiotic strains may help to maintain the health in old people, suggesting both health and cost-saving benefits in offering fermented dairy products. These benefits include: establishment of balanced intestinal microflora; improving colonization resistance and or prevention of diarrhea; reduction of fecal enzymes; reduction of serum cholesterol; reduction of potential mutagenes; reduction of lactose intolerance; synthesis of vitamins; predigestion of proteins.

[Angiotensin II antagonists: new therapeutic perspectives]. / Antagonisti dell'angiotensina II: nuove prospettive terapeutiche.

First experimental data regarding potential effects of renin-angiotensin-aldosterone system modulation and their usefulness in clinical management of cardiovascular diseases have been reported more than 30 years ago. The two principals pharmacologic innovations are represented by the solid established angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers, lately introduced and not enough tested in well-conducted trials; in particular, it's very interesting the hypothesis of their impact in clinical practice not only in case of angiotensin converting enzyme inhibitors intolerance but as first choice or associated therapy in the treatment of heart failure, a very complex physiopathologic condition in which renin-angiotensin-aldosterone system plays an important role and so its both enzymatic and receptorial inhibition could be particularly useful. With this review we present an up to date of knowledges, completed trials results and ongoing trials perspectives, to redefine actual indications and to profile main future develops of this drugs.

Blood lipid changes in hypertensive, dyslipidemic patients under long term quinapril treatment.

OBJECTIVE: The present study aimed at verifying Quinapril effects on both pressure and lipid profile in 15 patients (5 M, 10 F), aged 45 to 80 years (63 +/- 9), complaining for mild to moderate hypertension and dyslipidemia (total cholesterol > 200 mg/dl and triglycerides > 200 mg/dl). No relevant associated disease was present, including diabetes mellitus not any lipid lowering drugs were given. METHOD: After a wash-out period of one week, all patients, who had been hypertensive for 2 to 120 months (33 +/- 11), were given Quinapril 20 mg orally once a day for 6 months and kept on a low lipid diet from before treatment to the end of the study. Lipid profile we assessed at three-month intervals. RESULTS: Blood pressure, monitored at two-week intervals, significantly decreased on the 1st month (p < 0.001), and kept lower thereafter. Mean total cholesterol, triglycerides and low density lipoprotein cholesterol levels, after 6 months of therapy, were reduced by 44 mg/dl (p < 0.001), 29 mg/dl (p < 0.001) and 39 mg/dl (p < 0.002) respectively. CONCLUSIONS: Our results seen indicate that Quinapril antihypertensive effects are accompanied by a significant improvement of the lipid profile.

[Cutaneous microcirculation and diabetic disease. A functional and flowmetry study in subjects with diabetes mellitus type 2]. / Microcircolo cutaneo e malattia diabetica. Studio funzionale e flussimetrico in soggetti affetti da diabete mellito di tipo II.

Laser-Doppler single fingertip skin blood flow has been evaluated in 41 euglycemic type II diabetic patients under basal conditions and after dynamic testing (both ischemia and thermal stress). The same subjects have also undergone tests for the assessment of the degree of autonomic nervous system (ANS) dysfunction. The results have been compared to those obtained in 38 age-matched healthy subjects. In diabetic patients: baseline flow levels were much higher; the post-ischemic flow increase was less evident; a shorter hyperemic phase followed ischemia; a longer latency period was noticed, during thermal stress, together with a lower and slower hyperemic peak level. According to the results of ANS dynamic tests, diabetic subjects were divided into 3 groups: Group 1 (subjects with negative results); Group 2 (subjects with only one positive result); Group 3 (subjects with more than one positive test). Microcirculation disturbances were more often found in Group 3. These results show that a correlation exists between diabetic microangiopathy and ANS dysfunction. They also support the hypothesis, already pointed out by other research groups, of a similar mechanism causing diabetic neurologic and vascular complications.

[The incidence and clinical significance of the echocardiographic finding of false chordae tendineae]. / Frequenza e significato clinico del rilievo ecocardiografico di false corde tendinee.

The presence of false tendons (FT) with M-mode and 2-D echocardiography in a consecutive series of 916 patients (520 men--396 women) with a wide age range (9-83 y) was investigated, and a possible correlation with heart systolic murmurs and/or heart arrhythmias evaluated. The problems that FT cause in differential diagnosis with other intraventricular structures were also considered. FT were observed in 53 subjects (5.8%), 30 men--23 women, and in an additional 51 cases (96%) in the left ventricular cavity. A clear prevalence of FT was observed during childhood and adolescence (26.1%), with the preferential location at the top of the ventricular chamber. No relevant correlation between FT and heart systolic murmurs and/or cardiac rhythm disorders was found. Although our results show that FT constitute an occasional finding, with no anatomic or functional relevance, they should always be held in due consideration in case of diagnostic uncertainty with other pathological structures, in particular intracavitary thrombi.

[Relation between the blood potassium and blood glucose responses and electrocardiographic changes, specifically the T wave, during the oral glucose tolerance test]. / Rapporto fra tipo di risposta kaliemica e glicemica e modificazioni elettrocardiografiche, interessanti l'onda T, in corso di "test" di tolleranza al glucosio per via orale.

As previously showed by the Authors, serum K+ levels significantly decrease during OGTT. Moreover, two possible patterns were separated: a) monophasic decrease ("M" type curve) causing a mild but continuous down-slope, possibly physiologically more relevant, and b) polyphasic decrease ("O" type curve) causing a sharp down-slope followed by a rebound to normal K+ levels. In 10 of 12 M type subjects (83%) electrocardiographic changes were shown after OGTT, comparative to only 9 out of 16 O type subjects. The Authors believe this to be suggestive of a heavier impact of kaliemic changes on to myocardial function in M type curves. The hypothesis needs further analysis.

[Influence of blood potassium variations on changes in electrocardiographic patterns during oral glucose tolerance test]. / Influenza delle variazioni kaliemiche sulle modificazioni eletrocardiografiche rilevate in corso di "test" di tolleranza al glucosio per via orale.

In 45 apparently healthy subjects an OGTT was performed and glucose, insulin, potassium and sodium were measured at fixed intervals. A standard EKG was recorded at the beginning and at the end of the trial. K+ levels steadily decreased reaching their lowest value 60 to 120 min after insulin peak. Na+ levels did not change. In those subjects whose final EKG showed some worsening, the ratio final to initial K+ levels, unlike glucose levels, significantly decreased (p less than 0,01). The hypothesis is given that many clinical pictures of coronary heart disease, so often encountered during OGTTs, may depend on K+, rather than glucose, unbalance.