Wrist median nerve motor conduction after end range repeated flexion and extension passive movements in Carpal Tunnel Syndrome. Pilot study.

Carpal Tunnel Syndrome (CTS) can be due to a variety of different pathological conditions. These etiological and epidemiological differences may explain the non-homogeneous response to ordinary conservative therapeutical options observed in this syndrome. The aim of our study was to investigate on the possibility of identifying different sub-groups of patients among conservatively treatable CTS with different susceptibility to physiotherapeutic treatments. We decided to utilize an objective approach measuring some median motor nerve function parameters. Short term variations of Compound Motor Action Potential (CMAP) from the thenar eminence were compared in two groups of 55 hands (CTS patients and normal controls) after performance of two different types of end range passive movement. We found a different distribution of CMAP amplitude modifications within a sub-group of patients that suddenly improved more than the controls after two series of 10 end range passive flexions or after two series of ten end range passive extensions. Amplitude changes proved to be much more useful than latency variation studies in the provocative test neurophysiological approach. The method we propose appears to be useful for better surgical indication and/or for improvement of conservative therapeutic choice.

[Is a monthly biochemical check-up useful more than 2 years after kidney transplantation?]. / E utile un controllo biochimico mensile dopo il secondo anno di trapianto?

Over the course of the years many transplantation centres have altered their pattern of periodical check-ups in patients with stable renal function, in some cases considerably prolonging the intervals. Peripheral centres, which are attended by patients after kidney transplantation, must reconcile the follow-up requirements made by various reference centres. The authors carried out a retrospective evaluation of 39 patients who, at 30-6-1992, had had kidney transplants for more than two years, taking into consideration a series of hematochemical tests indicative of the main functional alterations (creatininemia, hepatic enzymes, hemochrome, cyclosporin assay). In the 31 patients receiving monthly check-ups after the second year, changes in cyclosporinemia were on average significantly more frequent in comparison to variations in other parameters. This finding, together with the need for a careful control of transplant patients, would appear to confirm the value of monthly check-ups. However, the positive experience of some centres which begin to space out periodical check-ups at an early stage and report good organ survival, opposes the previous affirmation. Lastly, it emerges from this study that patients undergoing frequent controls even after the second year of transplantation have significantly lower organ survival.

Prevalence of HCV antibodies in a uraemic population undergoing maintenance dialysis therapy and in the staff members of the dialysis unit.

We studied, by both 1st and 2nd generation assay, the prevalence rate of HCVAb in a population of 141 dialysis patients, 37 transplanted patients and 55 staff members. From this study emerges a higher sensitivity of the 2nd generation HCVAb test (15.38 versus 36.79% of positive responses, respectively), and a significant positive correlation between lengths of dialysis period. We have not found a significant difference between HCVAb-positive and -negative patients in relation to the blood transfusions. None of the 21 CAPD patients (home dialysis) resulted positive, even if transfused. Two nurses were positive. In our experience, the environmental factor seems more important. Since the isolation of the positive patients is an effective but not feasible measure, it is necessary to improve the operating management of the hemodialysis sessions, avoiding any contact between patients via material (instrumentation, monitors) and teaching the staff members to use severe preventive standards with all hemodialysis patients.

[Remarks on a clinical case of partial carbamyl phosphate synthetase deficiency]. / Osservazioni su un caso clinico di deficit parziale di carbamil-fosfato-sintetasi.

A preliminary undiagnosed case of partial carbamyl-phosphate-synthetase deficiency in a 14 year old patient is described. This extremely rare metabolic disorder is unlikely to produce clinical symptoms at such an advanced age. Details are given of the clinical picture, the diagnosis (by liver biopsy and post mortem liver examination) and the attempts at treatment.

Echotomography in arteriovenous fistulae.

We employed Echotomography (by 2.25-5MHz probes) as a quick procedure to measure the vessel diameter at definite points to detect aneurysms and their evolution, to evaluate the arteriovenous fistula (AVF) characteristics, to detect haematoma, thrombi, and collateral vessels. Echotomography is a non-invasive technique which may be performed repetitively even immediately after AVF surgery. It was most valuable in the examination of proximal AVF and internal shunts (autologous venous and bovine carotid grafts). Echotomography has proved to be accurate in studying the initial morphological and functional evaluation and follow-up of AVF.

[Study of serum ferritin in a population of 3-month-old breast feeding children]. / Valutazione della ferritina serica in una popolazione di lattanti al seno all'età di tre mesi.

The evaluation of serum ferritin level in a population of 30 three months old babies is made by the Authors following a radioimmunological method. The reckoned average values reflect exactly the wellknown elements of iron kinetics during the first months of life. The Authors underline that those values show how complete is breast-feeding; moreover they emphasize the importance of a referring value which, together with those already known in subjects of different ages, allows on early diagnosis of syndromes due to iron decrease and subsequent check-up after therapeutic trial.

Dopamine and cerebral cortical blood flow in the rat.

Dopamine topically applied to the cerebral cortex (1--20 micrograms/ml) or administered i.v. (0.5--64 micrograms/kg/min) has no effects on cerebral cortical blood flow in the rat.

[Early effect of Crotalus durissus terrificus venom on kidney circulation]. / Efecto precoz del veneno de Crotalus durissus terrificus sobre la circulación renal.

Local blood flow was measured in renal cortex (1 mm below cortical surface) by means of the hydrogen clearance method in urethanized rats. Recording of blood pressure from femoral artery was performed. Crotalus durissus terrificus venom injection (one mg/kg i.v.) significantly decreased cortical blood flow at 10 min, without a significant arterial pressure modification. Posterior injection of mannitol 200 mg induced a significant increase in cortical blood flow, although initial values were not reached. Electron microscopy showed thromboses in the glomerular capillaries 35 minutes after venom injection. It is suggested that the precocious effect of this venom on renal cortical blood flow may be instrumental in the development of the renal acute insufficiency induced by Crotalus durissus terrificus venom.

Efecto precoz del veneno de Crotalus durissus terrificus sobre la circulación renal. / [Early effect of Crotalus durissus terrificus venom on kidney circulation]

Local blood flow was measured in renal cortex (1 mm below cortical surface) by means of the hydrogen clearance method in urethanized rats. Recording of blood pressure from femoral artery was performed. Crotalus durissus terrificus venom injection (one mg/kg i.v.) significantly decreased cortical blood flow at 10 min, without a significant arterial pressure modification. Posterior injection of mannitol 200 mg induced a significant increase in cortical blood flow, although initial values were not reached. Electron microscopy showed thromboses in the glomerular capillaries 35 minutes after venom injection. It is suggested that the precocious effect of this venom on renal cortical blood flow may be instrumental in the development of the renal acute insufficiency induced by Crotalus durissus terrificus venom.

Efecto precoz del veneno de Crotalus durissus terrificus sobre la circulación renal / [Early effect of Crotalus durissus terrificus venom on kidney circulation]

Local blood flow was measured in renal cortex (1 mm below cortical surface) by means of the hydrogen clearance method in urethanized rats. Recording of blood pressure from femoral artery was performed. Crotalus durissus terrificus venom injection (one mg/kg i.v.) significantly decreased cortical blood flow at 10 min, without a significant arterial pressure modification. Posterior injection of mannitol 200 mg induced a significant increase in cortical blood flow, although initial values were not reached. Electron microscopy showed thromboses in the glomerular capillaries 35 minutes after venom injection. It is suggested that the precocious effect of this venom on renal cortical blood flow may be instrumental in the development of the renal acute insufficiency induced by Crotalus durissus terrificus venom.

On the mechanism of the amphetamine induced vasodilation at the rat's cerebral cortex.

Cerebral cortical blood flow was measured with the hydrogen clearance technique. It was found that the increase in CoBF induced by amphetamine is blocked by atropine or chlorpromazine.

[Attempt to solve technical problems involved in the re-utilization of coil filters for hemodialysis]. / Tentativo di soluzione ai problemi tecnici relativi al riuso dei filtri coil per emodialisi

The problem of the reutilization of coil filters in haemodialysis is discussed. The methodologies in current use are examined and the technical risks and inconveniences that limit any real economic advantage are pointed out. On the basis of these observations, a system of reutilization is proposed which does not call for any direct handling of the filter nor any special techniques for eliminating risks of transmitting infection, and cuts to the minimum extra work involving the use of hospital staff. The proposed equipment is illustrated in detail. It consists of a small accessory individual monitor which has opened the way to the concept of "weekly dialyser". Attention is called to the need for further research into the physiopathology of the regenerated membrane, particularly in relation to the type of filter, the number of reutilizations, and the behaviour of ultrafiltration and the various solutes.

[Avoidance of renal cortical blood flow autoregulation induced by NaCl not attributable to plasma asmolarity changes (author's transl)]. / Anulacion de la autorregulacion de flujo sanguineo cortical renal inducida por el ClNa no atribuible al aumento de osmolaridad.

Experiments were conducted on rats to investigate the acute effects on renal cortical blood flow and cortical autoregulation caused by intravenous administration of hypertonic solutions of sodium chloride or glucose. Local blood flow was measured in renal cortex (at 1 mm below cortical surface) by means of the hydrogen clearance method in urethanized rats. Recording of blood pressure from femoral artery was performed. In control group, renal cortical vascular resistance (R.C.V.R.)--arterial pressure relationships demonstrated typical autoregulation. An increase in plasma osmolarity of approximately 5.90%, induced by glucose, did not affect autoregulation. An increase in plasma osmolarity of approximately 4.43%, induced by NaCl, avoided autoregulation and the resistance-arterial pressure relationships became passive in appearance. In addition, NaCl administration was associated with an increase in cortical blood flow. It is suggested that in the presence of a low increment in plasma osmolarity, the sodium ion rather than the osmolarity itself, is the factor that influences cortical blood flow autoregulation in the rat.

[Impairment of renal cortical blood flow autoregulation induced by reserpine, guanethidine or propranolol (author's transl)]. / Alteracion de la autorregulacion del flujo sanguineo cortical renal inducida por guanetidina, reserpina o propranolol.

Local blood flow was measured in renal cortex (at 1 mm below cortical surface) by means of the hydrogen clearance method in urethanized rats. Recording of blood pressure from femoral artery was performed. The blood flow autoregulation was studied by plotting renal cortical vascular resistance (R.C.V.R.) as a function of arterial pressure in all the experimental conditions. R.C.V.R. was calculated as arterial pressure/blood flow ratio. In control animals R.C.V.R. was linearly correlated to arterial pressure; this implies the existence of autoregulation in the studied zone. In animals pretreated with guanethidine or propranolol, and in animals injected with propranolol immediately before the experiment, the increase of arterial pressure was not followed by an increase in R.C.V.R.; this implies that autoregulation was absent. In animals pretreated with reserpine the increase of arterial pressure was not followed by a significant increase in R.C.V.R., although a tendency to increase was detected. It is suggested that the impairment of autoregulation induced by guanethidine, propranolol or reserpine may be due to an inhibition of renin release. The results obtained with guanethidine and reserpine may be partially attributable to a decrease in adrenergic activity on the vascular smooth muscle of the studied zone, although other mechanisms cannot be discarded.

Anulacion de la autorregulacion de flujo sanguineo cortical renal inducida por el ClNa no atribuible al aumento de osmolaridad. / [Avoidance of renal cortical blood flow autoregulation induced by NaCl not attributable to plasma asmolarity changes (authors transl)]

Experiments were conducted on rats to investigate the acute effects on renal cortical blood flow and cortical autoregulation caused by intravenous administration of hypertonic solutions of sodium chloride or glucose. Local blood flow was measured in renal cortex (at 1 mm below cortical surface) by means of the hydrogen clearance method in urethanized rats. Recording of blood pressure from femoral artery was performed. In control group, renal cortical vascular resistance (R.C.V.R.)--arterial pressure relationships demonstrated typical autoregulation. An increase in plasma osmolarity of approximately 5.90

, induced by glucose, did not affect autoregulation. An increase in plasma osmolarity of approximately 4.43

, induced by NaCl, avoided autoregulation and the resistance-arterial pressure relationships became passive in appearance. In addition, NaCl administration was associated with an increase in cortical blood flow. It is suggested that in the presence of a low increment in plasma osmolarity, the sodium ion rather than the osmolarity itself, is the factor that influences cortical blood flow autoregulation in the rat.

Alteracion de la autorregulacion del flujo sanguineo cortical renal inducida por guanetidina, reserpina o propranolol. / [Impairment of renal cortical blood flow autoregulation induced by reserpine, guanethidine or propranolol (authors transl)]

Local blood flow was measured in renal cortex (at 1 mm below cortical surface) by means of the hydrogen clearance method in urethanized rats. Recording of blood pressure from femoral artery was performed. The blood flow autoregulation was studied by plotting renal cortical vascular resistance (R.C.V.R.) as a function of arterial pressure in all the experimental conditions. R.C.V.R. was calculated as arterial pressure/blood flow ratio. In control animals R.C.V.R. was linearly correlated to arterial pressure; this implies the existence of autoregulation in the studied zone. In animals pretreated with guanethidine or propranolol, and in animals injected with propranolol immediately before the experiment, the increase of arterial pressure was not followed by an increase in R.C.V.R.; this implies that autoregulation was absent. In animals pretreated with reserpine the increase of arterial pressure was not followed by a significant increase in R.C.V.R., although a tendency to increase was detected. It is suggested that the impairment of autoregulation induced by guanethidine, propranolol or reserpine may be due to an inhibition of renin release. The results obtained with guanethidine and reserpine may be partially attributable to a decrease in adrenergic activity on the vascular smooth muscle of the studied zone, although other mechanisms cannot be discarded.