Cerebral superb microvascular imaging in preterm neonates: in vivo evaluation of thalamic, striatal, and extrastriatal angioarchitecture.

PURPOSE: To explore the potential of superb microvascular imaging (SMI) in visualizing brain microvessels in preterm neonates of different gestational ages (GA). METHODS: In this retrospective, observational pilot study, 15 preterm newborns were equally divided into GA groups: extremely (GA < 28 weeks), very (28-31 weeks), and moderate to late (32-37 weeks) preterm. All patients underwent conventional transcranial ultrasounds during the first day of life following the American Institute of Ultrasound in Medicine practice guidelines. SMI was then performed; based on their SMI morphology and location, brain microvessels were classified as extrastriatal (cortical and medullary), striatal, or thalamic. Two examiners independently classified vessels as visible or invisible. To assess the association between vessel visibility and GA, binomial logistic regression analysis (separate for each microvessel group) was performed, taking visibility as a dependent variable and both examiners and GA as predictor variables. RESULTS: A statistically significant difference among GA groups was found in sex (P = 0.030), birth weight (P = 0.007), and Apgar score within 1 min after birth (P = 0.024). Microvascular visibility increased with GA for superficial vessels (P < 0.05 for both cortical and medullary), while striatal and thalamic vessels were visible in all neonates irrespective of their GA. CONCLUSIONS: SMI technology shows promise to assess brain microvasculature in preterm neonates, even potentially providing data on early brain development.

An observational study of powered wheelchair provision in Italy.

Powered wheelchairs are complex and expensive assistive devices that must be selected and configured on the basis of individual user needs, lifestyle, motivation, driving ability, and environment. Providing agencies often require evidence that their financial investment will lead to a successful outcome. The authors surveyed a sample of 79 users who had obtained powered wheelchairs from a Regional Health Service in Italy in the period 2008-2013. Follow-up interviews were conducted at the users' homes in order to collect information about wheelchair use, and its effectiveness, usefulness, and economic impact. The instruments used in the interviews included an introductory questionnaire, QUEST (Quebec User Evaluation of Satisfaction with Assistive Technology), PIADS (Psychosocial Impact of Assistive Devices Scale), FABS/M (Facilitators and Barriers Survey/Mobility), and SCAI (Siva Cost Analysis Instrument). The results indicated positive outcomes, especially in relation to user satisfaction and psychosocial impact. A number of barriers were identified in various settings that sometimes restrict user mobility, and suggest corrective actions. The provision of a powered wheelchair generated considerable savings in social costs for most users: an average of about $38,000 per person over a projected 5-year period was estimated by comparing the cost of the intervention with that of non-intervention.

Kaposi's sarcoma in a patient with focal glomerulosclerosis.

We report the clinical features and outcome af a patient who presented Kaposi's sarcoma following immunosuppressive therapy for FGS; Cyclophosphamide and steroids were administered; the patient recovered after three months treatment with i.v. vinblastine.

Relationship between changes in R wave voltage and cardiac volumes. A vectorcardiographic study during hemodialysis.

The effects of acute changes in cardiac volumes determined by hemodialysis on cardiac voltages were assessed in 18 chronically uremic patients by means of a vectorcardiographic and scalar Frank leads recording, immediately before, at the 90th and 180th minute, and immediately after hemodialysis. The following parameters were simultaneously monitored: body weight, systolic and diastolic blood pressure, heart rate, hematocrit and, in eight patients, echocardiographic systolic and diastolic diameters of the left ventricle. During hemodialysis all voltages considered except R wave in X lead increased significantly. They were inversely correlated with body weight, blood pressure, and systolic and diastolic diameters and directly with hematocrit (volemia-dependent parameters). The maximal vector on the left sagittal plane and the R wave amplitude in Z lead, representing left ventricular posterolateral wall activation, showed the greatest increase. When, at the end of hemodialysis, an amount of fluids ranging from 300 to 800 ml was restored, these cardiac voltages decreased paralleling the increase of left ventricular diameters. In conclusion, these results demonstrate that cardiac voltage and volumes are inversely related.

Echocardiographic evaluation of changes in cardiac performance induced by hemodialysis.

For the purpose of assessing the cardiovascular effects of hemodialysis (HD), M-mode echocardiography was performed 24 hours before and 2 hours after this procedure in 15 patients with chronic renal failure. The results, which include computer analysis of digitized interventricular septum (IVS) and left ventricular posterior wall (LVPW), show the following statistically significant changes after HD: reduction of end-diastolic and end-systolic internal diameters of the left ventricle (LVID), increase of mean velocity of circumferential fiber shortening, of peak rate of systolic and diastolic LVID variation, of systolic and diastolic LVPW movement, and of IVS movement in systole. These results demonstrate that after HD the left ventricle not only decreases in size but also its performance improves in both contraction and relaxation. These changes did not correlate with the reduction in body weight and arterial pressure following HD; hence HD seems to act on left ventricular function by reducing mainly afterload and, possibly, by modifying some humoral parameters. In conclusion, M-mode echocardiography, especially when utilized in conjunction with the computerized analysis of the recordings, is useful and reliable in monitoring hemodynamic changes occurring during the dialytic session.

Indomethacin and lysine acetylsalicylate in rats with autologous nephrotoxic serum nephritis. Biochemical and morphological studies.

The effects of indomethacin and lysine acetylsalicylate (L-ASA) were compared in rats in which autologous nephrotoxic serum nephritis had been induced. The aim of this study was to offer support to the hypothesis that indomethacin might reduce proteinuria through increased synthesis of glomerular basement membrane by the podocytes. Both drugs were injected intraperitoneally at the dosage of 4 mg/kg body weight daily during a 6-day period into 40 rats rendered nephritic by rabbit nephrotoxic serum injection. Rats treated with indomethacin showed a marked decrease of proteinuria (tested by the 3% sulfosalicylic aicd method) and a clear ultrastructural picture of hyperplasia and hypertrophy of podocytes. Rats given L-ASA showed only a slight correction of proteinuria and less specific ultrastructural modification. These observations suggest that indomethacin decreases proteinuria in nephritic rats not only through its anti-inflammatory activity, but possible also by a peculiar mechanism, namely an increase in podocytic basement membrane synthesis.