Relation between carotid artery atherosclerosis and time on dialysis. A non-invasive study in vivo.

Patients undergoing maintenance hemodialysis have a high cardiovascular mortality but there are conflicting reports in the literature regarding the possibility of an accelerated atherosclerotic process in these patients. The aim of this study was to assess, in vivo, the extent of atherosclerotic lesions in the common carotid arteries and in the aorta of patients undergoing hemodialysis and their relation to clinical variables and risk factors. An ultrasonic system was employed to measure intimal-medial thickness in the carotid arteries and compliance in the aortic iliac axis. A positive significant relation emerged between carotid intimal-medial thickness and the length of time on dialysis (p < or = 0.001). Furthermore there was a significant correlation between intimal-medial thickness and LDL cholesterol (p < or = 0.001). No correlation was found between aortic-iliac compliance and the clinical variables considered. Non-invasive examination of the peripheral arteries with ultrasound could be a useful technique in the follow-up of patients on dialytic treatment; it could aid in the identification of the patients who are at increased vascular risk.

The independent effect of habitual cigarette and coffee consumption on blood pressure.

The authors investigated the possible relation between habitual cigarette and coffee consumption and blood pressure (BP) levels in 7506 men and 2095 women. The study population were managers and employees examined in northern Italy between 1986-1988. In particular, the hypothesis of a substantial independence between smoking-BP and coffee-BP was tested. BP levels were corrected for age, body mass index, physical activity, and alcohol consumption by analysis of covariance. Significantly, smoking was inversely related to BP, both in men (SBP, P < 0.001, DBP, P < 0.001) and women (SBP, P = 0.001, DBP, P = 0.012). In particular, the BP of non-smoking men, SBP/DBP, was 131.0/83.5, whereas in male smokers up to and over 20 cigarette/day, BP was 128.1/82.0 and 128.1/82.1 respectively. Coffee consumption was related to BP levels in men (SBP, P < 0.001; DBP, P = 0.009), but not in women (SBP, P = 0.320; DBP, P = 0.982). BP in male subjects was 131.3/83.5 in non-drinkers, 130.7/83.3 in those drinking 1-3 cups/day, 128.4/82.6 and 127.2/81.8 in drinkers of 4-5 and over 5 cups/day, respectively. No significant interactions were demonstrated, thus the relationship between habitual smoking and coffee consumption with BP appears to agree with an additive model.

Iron and ferritin in Italian subjects.

We studied the iron status of 400 Italian subjects, 200 men and 200 women, equally distributed in four 10-year age groups between 20 and 60 years. The frequency of iron deficiency was elevated in women of childbearing age. On average 13% of the women in the three younger age groups showed low serum ferritin levels and 16-18% a low transferrin saturation index. Only 6% of the women over 50 were iron deficient. Signs of iron deficiency were never observed in more than 2% of the men in the age groups under 50, with the percentage rising slightly in the men over 50. In the women an inverse correlation was found between serum ferritin levels and number of births [log ferritin (ng/ml) vs number of births, b +/- SE (b): -0.252 +/- 0.088] and between serum ferritin and duration of menstruation [log ferritin (ng/ml) vs duration of menstruation (days), b +/- SE (b): -0.160 +/- 0.065]. Furthermore, hemoglobin levels were 0.700 (+/- 0.248, SE) g/dl lower in the women with 'abundant menstrual flow', and hemoglobin levels correlated inversely with number of births [hemoglobin (g/dl) vs number of births, b +/- SE (b): -0.354 +/- 0.115]. Our study showed an elevated frequency of iron deficiency in women of reproductive age. The number of births and abundance of menstrual flow were both important factors in predisposing younger women to developing iron deficiency.

Coffee and cholesterol, an Italian study.

In the present study, conducted in northern Italy between 1986 and 1989, the authors investigated the possible association between coffee consumption and serum cholesterol levels in 8,983 subjects, 7,432 men and 1,551 women, managers and employees aged 18-65 years, who were examined during a program of preventive medicine upon an agreement between various companies and the Centro Diagnostico Italiano. Analysis of covariance was used to compare the serum cholesterol levels of the subjects subdivided according to coffee consumption, along with age, body mass index, alcohol consumption, cigarette smoking, and physical activity. An important relation was demonstrated between coffee intake and cholesterol, particularly in the men, the differences in serum cholesterol in the coffee users compared with the nonusers being 6.1 +/- 1.4 (standard error) mg/dl for consumers of 1-3 cups/day (3.4 +/- 1.4 mg/dl after adjustment for age, body mass index, alcohol and cigarette consumption, and physical activity), 9.9 +/- 1.6 mg/dl for those drinking 4-5 cups/day (5.8 +/- 1.6 mg/dl after adjustment), and 14.8 +/- 2.0 mg/dl for those drinking over 5 cups/day (9.6 +/- 2.0 mg/dl after adjustment). This relation remained substantially unvaried when nonsmokers and smokers were analyzed separately. It has been suggested that it is coffee prepared by boiling rather than other methods that has a hypercholesterolemic effect. Our observations demonstrate an interesting relation between coffee and cholesterol, even though the coffee drunk in Italy is mainly filtered and nonboiled. However, our finding is not necessarily in disagreement with the above hypothesis since, when coffee is prepared in the Italian way (with the mocha method), ground coffee is preheated by steam and more importantly, the water passes through the ground coffee at a higher temperature than with the other brewing methods.

Body mass index and liver enzyme activity in serum.

The association between body mass index (BMI) and serum liver enzyme activity [gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)] was studied in 3167 subjects, 2373 men and 794 women. The subjects were managers and employees, ages 18-64 years, who were examined during a program of preventive medicine. Analysis of covariance was used to compare the serum liver enzyme activities (expressed as natural logarithms) of the subjects, who were subdivided according to BMI, while also considering age, alcohol and cigarette consumption, and physical activity. In men, the percentage increase in the geometric mean of liver enzyme activity of the obese subjects (BMI greater than 30 kg/m2) compared with that of the normal subjects (BMI less than or equal to 25 kg/m2) was 47.7% (P less than 0.001) for GGT, 55.3% (P less than 0.001) for ALT, and 19.7% (P less than 0.001) for AST; in women, the increase was 63.2% (P less than 0.01) for GGT, 58.4% (P less than 0.001) for ALT, and 7.3% (P greater than 0.05) for AST. Thus, our observations demonstrate a relation between BMI and serum liver enzyme activity.

Association between habitual coffee consumption and blood pressure levels.

The relationship between habitual coffee consumption and blood pressure was investigated in 9601 subjects (7506 men and 2095 women) who were office managers and employees, aged 18-65 years. Those who drank coffee had lower blood pressure levels than those who did not and the mean blood pressure levels decreased with increasing coffee consumption. In the men, blood pressure (systolic/diastolic) was highest in the non-coffee drinkers (130.0/83.0 mmHg) and lowest in those drinking greater than 5 cups/day (126.0/81.3 mmHg). Mean differences (+/- s.e.m.) corrected by analysis of covariance for age and body mass index (kg/m2) were: systolic -4.0 +/- 0.7 mmHg, P less than 0.0001; diastolic -1.7 +/- 0.5 mmHg, P less than 0.001. In the women, blood pressure ranged from 121.1/77.4 mmHg in the non-coffee drinkers to 117.7/76.2 mmHg in those drinking greater than 5 cups/day (mean +/- s.e.m. systolic difference -3.4 +/- 1.4 mmHg, P less than 0.05; diastolic -1.2 +/- 0.9 mmHg, P greater than 0.05). These observations were confirmed after correction for physical activity, and cigarette and alcohol consumption (for age and body mass index). In the men, blood pressure ranged from 130.8/83.1 mmHg in non-coffee drinkers to 127.5/81.9 mmHg in those drinking greater than 5 cups/day, with the effect of classification by coffee consumption being very important (analysis of covariance: systolic F = 12.17, 3 degrees of freedom at numerator, P less than 0.0001; diastolic F = 3.56, 3 degrees of freedom at numerator, P = 0.0135).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of cigarette smoking and coffee consumption on apolipoprotein B levels.

Apolipoprotein B levels were studied in relation to cigarette smoking, coffee and alcohol consumption, physical activity, age and body mass index in 253 men aged 21-61 years. The mean apolipoprotein B level was 7.3 +/- 3.2 mg/dl and was higher for smokers compared with non-smokers. Considering the smokers of over 20 cigarettes/day and the non-smokers, this difference reached 12.6 +/- 4.3 mg/dl. A significant increase of 7.2 +/- 3.5 mg/dl in apolipoprotein B levels was observed in the subjects who drank over 3 cups of coffee/day compared with the remaining subjects, but the increase was only 4.3 +/- 3.7 mg/dl when we made a correction for cigarette consumption. Furthermore, for cigarette smoking and coffee consumption, there is apparently an interactive effect with BMI and/or age (vs apolipoprotein B levels). However, with a stepwise selection among explicative variables [age, BMI, smoking (yes/no) and coffee consumption (less than or equal to 3, greater than 3 cups/day)] and all their interactions of first order, only the interaction between BMI and smoking (BMI*smoking: b +/- ES (b) = 0.3029 +/- 0.0303), and age and BMI (age*BMI), are significantly and positively related to serum levels of apolipoprotein B. Thus cigarette smoking, interacting with high BMI, appear related to higher apolipoprotein B levels.

[Afterload changes in diabetic dysautonomia evaluated using echocardiography]. / Alterazioni del post carico nella disautonomia diabetica valutate ecocardiograficamente.

We have studied echocardiographic morpho-functional alterations in 34 male subjects with diabetes, aged 31-73 years, with and without autonomic nervous system failure. The subjects are grouped following the tests "deep breathing", "Valsalva manoeuver", "lying to standing" and "active standing" in: D-I (10 normal subjects); D-II (16 subjects with parasympathetic failure); D-III (8 subjects with orthosympathetic failure). The D-III subjects showed significantly lower parietal systolic stress (PSS) compared to normal subjects, 115.6 +/- 17.4 vs 163.1 +/- 13.1 10(3) dynes/cm2 (mean +/- 1SD), and significantly lower end isovolumetric systolic stress, 67.8 +/- 7.8 vs 98.6 +/- 7.1 10(3) dynes/cm2 ("afterload" indexes). In D-III group, the subjects with noradrenaline levels greater than 300 pg/ml, with an hypothetical peripheral resistance to noradrenaline (or receptor "down regulation"), showed higher blood pressure levels and higher parietal stress (PSS: 141.3 +/- 25.3 vs 98.5 +/- 20.7 10(3) dynes/cm2; EISS: 74.1 +/- 17.8 vs 63.6 +/- 8.6 10(3) dynes/cm2). Thus, cardiovascular signs of autonomic failure, like the stress index variation, related to a modification of the afterload, may be observable in diabetic patients.

Alcohol consumption and blood pressure. An Italian study.

We studied the relationship between alcohol consumption and arterial pressure in 1,190 subjects of both sexes aged between 18 and 63 years who were examined during the course of a program of preventive medicine organized by Centro Diagnostico Italiano. In 711 subjects who were not requested to alter their usual alcohol consumption we found a significant relationship between alcohol consumption and systolic arterial pressure, b + SE(b), 4.6 +/- 2.1 mmHg/100 g ethanol/day. In particular, males who were heavy drinkers (greater than or equal to 50 g ethanol/day) presented significantly higher systolic pressure levels than the other men, d +/- SE(d), 3.7 +/- 1.6 mmHg, whereas no significant differences were observed among the various classes of women subdivided according to alcohol intake (only 4.6% of the women consumed greater than 50 g ethanol/day). On the other hand, in 479 subjects who were requested to abstain from alcohol consumption during the three days preceding the examination, no significant relation was found between alcohol intake and arterial pressure. The difference between the systolic pressure levels of the male heavy drinkers and those of the male moderate and non-drinkers was only 0.1 mmHg. Excessive alcohol consumption, in this case, mainly in the form of wine, was therefore associated with higher systolic pressure levels. However, it seems that abstaining from alcohol for even a brief period may modify this relation considerably.

Coffee consumption and blood pressure: an Italian study.

The relation between habitual coffee consumption and blood pressure was studied in 500 Italian subjects, males and females, aged 18-62 years. After allowing for sex, age and weight, the pressure levels showed a significant decrease with increasing coffee consumption. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were respectively 130.4 +/- 1.8 (SE) mmHg and 81.5 +/- 1.1 mmHg for non-coffee drinkers, 129.4 +/- 1.4 and 82.2 +/- 0.9 mmHg for 1 cup per day, 128.4 +/- 0.8 and 81.4 +/- 0.5 mmHg for 2-3 cups per day, 124.9 +/- 1.1 and 78.8 +/- 0.7 mmHg for 4-6 cups per day, and 124.1 +/- 2.5 and 78.7 +/- 1.6 mmHg for more than 6 cups of coffee daily (analysis of covariance: SBP F = 3.46, 4 df, P less than 0.01; DBP F = 3.46, 4 df, P less than 0.01). Even after correcting pressure levels for habitual alcohol intake and cigarette smoking, we observed a mean reduction in SBP and DBP of 0.80 mmHg and 0.48 mmHg respectively per cup per day.

Combined chemotherapy for unresectable carcinoma of the lung: a randomized trial.

A selected case file of 32 patients with carcinoma of the lung which had passed the stage of surgical cure was randomized in 3 arms and treated with different schedules: regimen A, adriamycin plus cyclophosphamide; regimen B, the BACON combination, slightly modified; regimen CVP, cyclophosphamide plus vincristine plus prednisone. Response rate and survival curves were analyzed. Statistical evaluation showed a significant increase in survival of B versus A, but not versus CVP, while other factors such as the initial performance status and the response rate seemed to have a marked influence on survival time. No significant correlation was observed with different histiotypes within each regimen. All three regimens compare favorably with patients who received only supportive treatment.

Primary carcinoma of the colon and hyperlipemia: a paraneoplastic syndrome.

The human counterpart of the association of hyperlipidemia with cancer is rare, as compared with the relative frequency of the syndrome in experimental animals. A case is presented of adenocarcinoma of the colon with a non casual relationship between the presence and the progression of the tumor and hyperlipemia. Surgical resection and antiblastic chemotherapy moreover seemed to influence the metabolic anomaly.

The long Q-T syndrome.

Recent clinical and experimental data on the long Q-T syndrome (LQTS) are presented and discussed. The pathogenesis of LQTS is dependent on an imbalance between various components of the cardiac sympathetic innervation. A congenital decreased activity through the right cardiac sympathetic nerves seems to be the more likely pathogenetic mechanism for the majority of cases. Other forms of sympathetic imbalance, including left or even right hyperactivity, are, however, possible in isolated cases. Beta-blockers, at full blocking dose, represent the therapy of choice and are greatly effective in reducing the mortality (from 73 per cent to 6 per cent). If syncopal attacks are not eliminated by the medical therapy, the the ablation of the left stellate ganglion along with the first thoracic ganglia is the most rational and specific therapy. The possiblity for the correctly diagnosed and treated patients to escape an otherwise impending death calls urgently for diffusion of the knowledge about the long Q-T syndrome.