Intrarenal arteriosclerosis and impairment of kidney function in NIDDM subjects.

It is currently under debate whether the pathogenesis of end-stage renal failure in non-insulin-dependent diabetes mellitus (NIDDM) is a consequence of microangiopathy alone. The aim of this study was to investigate intrarenal arteriosclerosis and its correlation with kidney function in NIDDM. In 36 diabetic subjects, and in 10 age- and sex-matched healthy control subjects we measured kidney volume and resistive index of the interlobar arteries by duplex Doppler ultrasonography. Clinical and metabolic parameters, renal function and vascular sequelae of the disease were also evaluated. In diabetic subjects resistive index (median 0.72, range 0.54-0.79) was higher than in control subjects (median 0.62, range 0.57-0.66) (2p < 0.002). Kidney volume and resistive index correlated with age (p < 0.004), body mass index (p < 0.001), mean blood pressure (p < 0.001), total and LDL cholesterol (p < 0.01) and creatinine clearance (p < 0.001 and < 0.01, respectively). Kidney volume also correlated with HbA1 (p < 0.01) and resistive index with uric acid (p < 0.01). Lower body macroangiopathy was associated with increased resistive index and reduced kidney volume (2p < 0.05), while upper body macroangiopathy and microangiopathy were not. Our data suggest that macroangiopathy rather than microangiopathy is mainly responsible for impairment of kidney function in NIDDM. The resistive index of interlobar arteries seems to be a reliable marker of intrarenal arteriosclerosis and can be used as a non-invasive, easily available parameter of its evolution.

Basal synthesis of heat shock protein 70 increases with age in rat kidneys.

The heat shock protein (HSP) system is a mechanism of cell defense induced by stress, constitutively expressed during basal conditions and essential to the maintenance of cellular integrity. Acutely induced HSP synthesis decreases with aging, but the effect of age on the basal expression of HSP70 has not been specifically addressed so far. The aim of this work is to study the age-dependent basal concentrations of HSP70 mRNA in rat kidneys. In 8 young (2-3 months), 6 adult (6-11 months) and 6 old male Wistar rats (22-27 months), steady-state concentrations of HSP70 and gamma-actin mRNA and of rRNA were measured. Pentosidine was measured by HPLC. The basal, unstimulated HSP70 mRNA is increased in young and old rats compared with adult subjects [young: 182% of adult levels (100-299), old: 167% of adults (142-209); p < 0.005]. The amount of pentosidine increases with age (young: 0.6 +/- 0.1; adult: 1.65 +/- 0.15; old: 2.3 +/- 0.3 pmol/mg of protein; p < 0.0001). It seems likely that different mechanisms are responsible for the increased HSP70 basal synthesis in both the young and old animals. The prevalence of anabolic activity can trigger the increased basal production of HSP70 in young rats. The accumulation of posttranslational modified proteins, documented by pentosidine, can chronically enhance HSP70 synthesis in aged animals. The suppression of the synthesis of other proteins accompanying HSP-selective production might contribute to the impairment of specific cell functions in aging.

[Prevention of gastroesophageal reflux. Validity of hemifundoplication according to Cor-Casolo (experimental study)]. / La prevenzione del reflusso gastro-esofageo. Validità dell'emifundoplicatio sec. Dor-Casolo (studio sperimentale).

After a short preface about the main antireflux techniques employed in the treatment and prevention of gastro-oesophageal reflux, the problems involved in the iatrogenous gastro-oesophageal reflux are stated. As no unanimous opinion exists till now in literature about the importance and incidence of reflux after the operation of extramucous cardiomyotomy according to Heller, used in the treatment of achalasia, and after the Parietal Cell Vagotomy, employed in the treatment of duodenal ulcer, an experimental protocol was set up. An experimental research was performed on 16 dogs, subdivided into 3 groups: in the first group (6 dogs) extramucous cardiomyotomy according to Heller and antireflux procedure (antero-lateral hemifundoplication according to Dor-Casolo) were performed; in the second group (6 dogs) Parietal Cell Vagotomy + extramucous cardiomyotomy according to Heller + antero-lateral hemifundoplication according to Dor-Casolo were performed; in the third group (control) the only extramucous cardiomyotomy according to Heller was performed. In the research, articulated in two stages (1st time - operation; 2nd time - remote checking) the following was effected: pressure gauge test; pH-metric test; gastro-oesophageal scintigraphic test with Tc99m; histopathologic test. The experimental results obtained, elaborated by computer, demonstrated: that extramucous cardiomyotomy according to Heller causes serious oesophagitic phenomena, and therefore it should be joined to antireflux procedure; that Parietal Cell Vagotomy (P.C.V.) causes a significant decrease in the tone of L.E.S. (Lower Oesophageal Sphincter); that antero-lateral hemifundoplication according to Dor-Casolo (210 degrees) is effective in its antireflux action even after long time.