[Physical exercise in the thromboembolism of the pulmonary artery]. / L'esercizio fisico nella tromboembolia dell'arteria polmonare.

In order to evaluate post-embolic pulmonary gas exchange responses to exercise, we studied 7 patients who had previously suffered from an acute pulmonary embolism but were presently free from clinical and functional signs of cardiorespiratory diseases. Patients came to the laboratory on two occasions, 30 and 120 days following the episode of acute embolism, respectively, and performed an incremental ramp exercise test up to the maximum attainable workload. On both occasions, the dead volume/tidal volume (VD/VT) ratio at rest increased. During the first exercise test performed 30 days after the acute pulmonary embolism, mean VD/VT decreased from a resting value of 62.5% to 38.6% at the maximum workload. During the second exercise test, VD/VT decreased, at the same workload, from 71.3% to 35.5%. There was no significant difference in exercise-related VD/VT decrease between the two exercise tests. The results suggest that in patients who have suffered from an acute pulmonary embolism, a considerable pulmonary blood flow redistribution may occur during incremental ramp exercise performed 30 and 120 days after the acute event.

Effects of low-dose captopril on renal hemodynamics and function in patients with cirrhosis of the liver.

BACKGROUND: In cirrhotic patients with ascites, captopril has deleterious effects on renal function, which have been referred to as captopril-induced arterial hypotension. The effects of this drug on renal function in cirrhosis were evaluated using low-dose captopril, thereby avoiding any change in arterial pressure. METHODS: In a randomized, double-blind, placebo controlled, cross-over trial, the effects of 12.5 mg captopril on renal plasma flow, glomerular filtration rate (measured by radioisotopic techniques), and sodium excretion in healthy controls and cirrhotic patients with and without ascites were determined. RESULTS: In healthy subjects, captopril only induced a significant, 18% increase in renal plasma flow. In contrast, glomerular filtration rate significantly decreased in patients with (from 108 +/- 7 to 78 +/- 9 mL/min) and without ascites (from 102 +/- 4 to 88 +/- 3 mL/min), whereas renal plasma flow did not change. Urinary sodium excretion also significantly decreased in ascitic patients (from 43.8 +/- 4.4 to 30.6 +/- 3.8 mumol/min). CONCLUSIONS: These data suggest that angiotensin II contributes to maintain renal hemodynamics in cirrhosis with and without ascites.

Clinical correlations of plasma angiotensin converting enzyme (ACE) activity in systemic sclerosis: a longitudinal study of plasma ACE level, endothelial injury and lung involvement.

Lung involvement was studied by perfusion scan, ventilation scan, pulmonary clearance rate of 99mTc DTPA and pulmonary function tests in 20 patients with systemic sclerosis (SSc). Decreased plasma angiotensin converting enzyme (ACE) activity and increased levels of von Willebrand Factor Antigen (vWF:Ag) were found in all patients with SSc. The relationship between ACE levels and lung involvement was not statistically significant, however levels of vWF:Ag correlated with parameters of lung vascular alterations. An inverse relationship between the reduced ACE levels and ESR was found. It is likely that ACE levels reflect the inflammatory aspect of the disease. Further studies of ACE synthesis, release and inhibition are needed to determine the mechanism of the observed decreased activity in SSc.

Arteriovenous anastomoses' function and Raynaud's phenomenon.

By intrabrachial artery injections of a bolus of human albumin microspheres labeled with 99mTc in patients with primary or secondary Raynaud's phenomenon (RP) and in a group of healthy volunteers, the authors developed a method of detecting the patency rate of arteriovenous anastomoses (AVA) in the hand, after local heat and cold stimulation, by quantifying the radioactivity of the lungs expressed as a percentage of an intravenously injected radionuclide dose. With strain gauge plethysmography, simultaneous changes in the digital total (DTF) flow were also measured. After exposure of fingers to cold, 25 of 26 subjects had a clear reduction in both DTF and the AVA patency rate (APR) in comparison with the corresponding heat values. The RP patients, in particular, showed a statistically significant reduction in DTF (P less than 0.001) and in APR (P less than 0.001). These results appear to be consistent with the onset of critically reduced patency of the AVA of the hand during the ischemic phase of RP.

[Gastroesophageal reflux of mixed type]. / Il reflusso gastro-esofageo di tipo misto.

Gastroesophageal reflux has been showed both clinically and experimentally to be especially damaging esophageal mucosal layer when the elements which make up reflux are gastric content and bilio-pancreatic juice.

Binding of low-molecular-weight heparin to aortic endothelium in rabbits.

The ability of a low-molecular-weight heparin to bind in vivo to the aortic endothelium in rabbits, compared with that of unfractionated extractive sodium heparin (UHEP), was investigated. For this purpose a low-molecular-weight heparin (LMWHEP) fraction (CY 216 A, 4,000-5,000 daltons) and an extractive UHEP (average 17,000 daltons) were labeled with 99m Tc and injected (0.2, 0.6, and 1.2 mg/kg) intravenously in groups of 6 rabbits. The binding to endothelium was then measured by counting the radioactivity of samples of abdominal aorta. Both heparins bound to endothelium with a fast, saturable, and reversible binding. No significant difference in the total bound radioactivity was found between the two heparins, suggesting that the investigated LMWHEP retains the ability to bind to the endothelium, contributing to its athrombogenic properties.

"Normal" pressure hydrocephalus in chronic inflammatory diseases: a clinical and laboratory study.

A review of the 21 cases of "normal" pressure hydrocephalus (N.P.H.) identified by means of radioisotope cisternography, seems to support the basic views of Adams et al. (1965) that a chronic inflammatory disease is an important cause of N.P.H. The clinical and laboratory date made it possible to identify a substantial number of cases affected by N.P.H. in the course of a chronic inflammatory disease; of particular interest were those affected by syphilis. In this connection it seems possible that the symptoms of classical neurosyphilis may be very similar to those often seen in patients with N.P.H.

[The problem of dissecting aneurysm of the aorta and its benign course]. / I'l problema dell'aneurisma dissecante dell'aorta ad evoluzione benigna

On the basis of a personal case, the clinical, diagnostic and therapeutic problems of variants of dissecting aneurysm of the aorta with benign course are discussed. The usefulness of cardio-aortic angioscintigraphy in the interests of early diagnosis of aneurysm and aortography by catheterism for specifying its location and extent, is pointed out. Spontaneous benign development would seem to be tied up with the affected area of the aorta, the modalities of dissection, and above all with the establishment of a distal return breach for blood flow into the aortic lumen. The predominant role of cystic medionecrosis in determining dissection is stressed and the usefulness of intensive pharmacological therapy based essentially on hypotensive and beta-blocking substances confirmed.