[Electrophysiologic diagnosis of carpal tunnel syndrome in patients with diabetes mellitus]. / Diagnosi elettrofisiologica di sindrome del tunnel carpale in corso di diabete mellito.

The authors evaluated 406 patients affected by carpal tunnel syndrome diagnosed by clinical and electromyographic data. Diabetes mellitus was recognized in 57 subjects. The others constituted the control group. The severity of the syndrome was similar in both groups. Also similar was the interval between onset and clinical diagnosis. Such parameters and the severity of the syndrome showed no modification with age in the diabetic group. In the control group, carpal tunnel syndrome was more pronounced in the aged patients, presumably for the longest latency of disease. Carpal tunnel syndrome onset was later in diabetic subjects compared the control. At lastly we found a prevalence of bilaterality in diabetics, and an M/F rate comparable in both groups, as described by other authors.

Phytohemagglutinin induced changes of membrane lipid packing, c-myc and c-myb encoded protein expression in human lymphocytes during aging.

Three parameters which signal different stages of cell activation were analyzed in lymphocytes from young and old subjects. Merocyanine 540 (MC-540) incorporation into the membrane lipid phase was used as a very early marker of activation and was measured after 1 h of phytohemagglutinin (PHA) stimulation. The proteins coded by c-myc and c-myb protooncogenes were determined by appropriate antibodies and were taken as markers of the G0/G1 and G1/S phase transition, respectively. The number of cells which increased the uptake of MC-540 following PHA stimulation did not differ when comparing young and old individuals. Both the number of the responding cells and the size of the response were decreased during aging when the presence of the c-myc protein was taken into account. A consistent decrease of the percentage of lymphocytes able to express the c-myb protein was observed in the cells from old donors as compared to those from the young ones, but the amount of detectable protein per cell remained unchanged. Our data suggest that the deficiency of responsiveness which accompanies aging is due to impairments at different points of the cell cycle. The very low number of cells expressing the c-myb protein is likely the result of step by step elimination of those cells not able to fulfill the requirements to progress along the cell cycle.

[Carpal tunnel syndrome secondary to repetitive microtrauma. The clinical and electromyographic aspects]. / Sindrome del tunnel carpale secondaria a microtrauma ripetuto. Aspetti clinici ed elettromiografici.

The authors describe 20 cases of carpal tunnel syndrome (cts), caused by repetitive microtrauma at work. The clinical and electromyographic data are compared with a control group (406 pt affected by non traumatic cts). In the control group, the syndrome appeared more frequently in the right side (mostly in men), in relation to the manual dominance. These data suggest that the importance of "physiological traumatism" is decisive in the pathogenesis of the syndrome. Patients affected by microtraumatic stc show a better EN-Graphic pattern versus the control group, likely imputable to a earlier diagnosis.

Clinical and electromyographic evidence of carpal tunnel syndrome in a hypertensive patient with chronic beta-blocker treatment.

We describe a case of carpal tunnel syndrome (CTS) in a hypertensive man on long term treatment with a beta-blocker, propranolol. The clinical and instrumental findings, including MRI at the wrist, excluded all other possible causes of CTS. The improvement in symptoms and electromyographic findings on discontinuation of the drug suggested that the CTS may have been related to the beta-blocker therapy.

Peripheral neuropathy and multiple myeloma in aging: a case report.

A 67-year-old man affected by moderate weight loss, acral paresthesia and plantar burning sensation was admitted to our department. Electromyographic (EMG) and electroneurographic (ENG) studies confirmed a peripheral, asymmetrical, motor-sensorial polyneuropathy (PPN). Hematological data and bone marrow biopsy discovered a non-secerning multiple myeloma (MM). All other probable causes of peripheral neuropathy could be excluded, and the possible relationship between nerve damage and neoplasia was confirmed. Furthermore, all possibilities of association of MM with PPn, namely the osteosclerotic variant, the Crow-Fukase syndrome, and the amyloid one have been evaluated. The only finding of osteolytic bone areas by radiology, the absence of organomegaly, diabetes mellitus, skin alterations, and of amyloid deposition in muscles and nerves, exclude the possible connection of the case to any of the listed possibilities. On the other hand, some clinical aspects differ, in part, to others described in the literature. In conclusion, the association between PPN and MM as the result of multiform clinical variants could be considered.

[Profile of thyroid hormones in aging: evaluation of a hospitalized elderly population]. / Profilo degli ormoni tiroidei nell'invecchiamento: valutazione su di una popolazione anziana ospedalizzata.

The aim of the study is to evaluate thyroid serum levels in a geriatric community to confirm the presence of a low T3 syndrome during normal ageing. The authors consider 413 subjects (125 male and 288 female) admitted to our Geriatric Division. The group affected by thyroid and extrathyroid disease (such us malnutrition, diabetes mellitus, renal failure, etc.) was withdrawn. In the selected patients (271) was operated a statistical evaluation to correlate the hormonal parameters (T3, T4, TSH, FT3, FT4) with age and sex. According to international literature, we confirm a progressive T4 and FT4 reduction (p less than 0.05) during ageing, both in male and in female. These data range within normal values. On the contrary, TSH shows no modifications with age and sex. Unlike all other parameters, T3 presents a more evident decrement with age, confirming a low T3 syndrome.

Biochemical effects of urapidil on red cell membrane ion transport systems in a population of elderly essential hypertensives.

The aim of our work was to verify the effect of urapidil on membrane ion transport systems. This was a randomized, double-blind, cross-over study which evaluated the clinical and biochemical effects of urapidil (30 mg twice daily in comparison with placebo) in a group of 10 elderly hypertensive patients (3 male, 7 female ranging from 68 to 90 years, mean age 79.2 +/- 7.6 years). For the evaluation in fresh erythrocytes of principal ion transport systems (cotransport Na+/K+, countertransport Na+/Li+, Na+/K+ ATPase pump. intracellular Na+ and K+) we used the nystatin technique. We found that urapidil activated the red cell membrane ions cotransport system (basal values: 83.7 +/- 50.3 mumol Na+ RBC 1-1.h-1, after 1 month of urapidil therapy: 181.5 +/- 89.3 mumol Na+ RBC 1-1.h-1) (P less than 0.01), without significant changes in the other biochemical parameters evaluated. Our data suggest that one of the mechanisms of the urapidil antihypertensive effect could involve an increase in the membrane sodium cotransport system.

[The problem of hypercholesterolemia in the aged]. / Il problema dell'ipercolesterolemia nell'anziano.

This paper deals with the problems of hypercholesterolaemia in the elderly. We have significant results that show an important relationship between serum cholesterol and cardiovascular diseases in the adult, but the same has not yet been definitely established for the elderly. After examination of the available data, the Authors suggest that--after a through clinical evaluation--the elderly should also be treated given that there are data to suggest and hypothesize the positive action of a hypolipemic diet until at least the age of seventy five years. The therapy, whenever possible, could be dietetic; but from relevant results obtained, used together with HMG-CoA reductase inhibitors, these drugs are a good therapeutic approach to the problem, also in the elderly. To support this opinion, the Authors show the results obtained with the use of Simvastatin in a group of old patients.

[Hypercholesterolemia in the aged: rational approach to the problem]. / Ipercolesterolemia nell'anziano: razionale approccio al problema.

While there are definite data showing the correlation between cholesterol level and cardiovascular disease in adults, so far we lack reliable evidence showing hypercholesterolemia to be an important risk factor in the elderly as well. Having examined all available data, the authors come to the conclusion that in elderly subjects, too, hypercholesterolemia should be treated after careful clinical evaluation of every individual case. Whenever possible therapy should be dietary but in light of recent results obtained with HMG-CoA reductase inhibitors which are effective and well tolerated also in the elderly, adequate pharmacological management should also be feasible in this type of patient.

Vasopressin, prolactin and growth hormone in Alzheimer's disease: their evaluation after metoclopramide stimulation.

Recent studies have shown that there is a relationship between an alteration of central neurotransmitters and the modification of some biohumoral parameters in Alzheimer's Disease (AD). In this study the authors evaluated, after metoclopramide (MTC) stimulation, the concentration curve of vasopressin (AVP), prolactin (PRL) and growth hormone (HGH) in the plasma of 34 subjects (20 males and 14 females, mean age 70.5+/-6.9 years; 17 were AD patients, the others constituted the control group). MTC increased AVP serum concentration in healthy (P <0.001), but not in AD patients. This result seemed to be due to the lack of 'procholinergic' action of the drug in the AD patients probably due to an alteration in their cholinergic pathways. The PRL response to MTC was reduced only in the AD female group (P <0.005), suggesting an alteration in dopaminergic control. Lastly, the HGH response in AD did not differ in the two groups, neither in basal conditions, nor after MTC stimulation. The absence of HGH response both in AD and in healthy subjects, demonstrated the ineffectiveness of MTC stimulation. We can conclude that AVP and PRL responses to MTC stimulation efficiently separated the two groups (AD and controls); the former test showing a higher discriminant power than the latter.