Vendors' handling practices of edible long-horned grasshoppers (Ruspolia differens) products and implications on microbial safety.

Edible grasshopper, Ruspolia ruspolia, has nutritional and cherished cultural and economic importance to people from diverse cultures, particularly in over 20 African countries. It is consumed at home or commercially traded as sautéed, deep-fried, or boiled products. However, there is limited information on the hygiene practices of the vendors and the implications on the microbial safety of the final product. This research aimed at assessing the food safety knowledge, handling practices and shelf life of edible long-horned grasshopper products among vendors and the microbial safety of ready-to-eat products sold in 12 different markets in Uganda. Samples of raw, deep-fried and boiled grasshoppers were randomly collected from 74 vendors (62% street and 38% market vendors) and subjected to microbial analysis. Over 85% of the vendors surveyed had no public health food handler's certificate and >95% had limited post-harvest handling knowledge. Total aerobic bacteria (7.30-10.49 Log10 cfu/g), Enterobacteriaceae (5.53-8.56 Log10 cfu/g), yeasts and molds (4.96-6.01 Log10 cfu/g) total counts were significantly high and above the acceptable Codex Alimentarius Commission and Food Safety Authority of Ireland (FSAI) limits for ready-to-eat food products. Eight key pathogenic bacteria responsible for foodborne diseases were detected and these isolates were characterized as Bacillus cereus, Hafnia alvei, Serratia marcescens, Staphylococcus aureus, S. xylosus, S. scuiri, S. haemolyticus, and Pseudomonas aeruginosa. Findings from this study highlight the urgent need to create local and national food safety policies for the edible grasshopper "nsenene" subsector to regulate and guide street and market vending along the value chain, to prevent the transmission of foodborne diseases to consumers.

Burnout syndrome and associated factors among university teaching staff in Cameroon: Effect of the practice of sport and physical activities and leisures.

OBJECTIVES: This study aimed to evaluate the epidemiology of burnout syndrome among university teaching staff in Cameroon; and to establish if the practice of physical activities and leisures could have preventive effect. METHODS: A cross-sectional study using a self-administered questionnaire on socio-demographic characteristics, socio-professional conditions, Maslach Burnout Inventory-Educator Survey (MBI-ES) to evaluate burnout syndrome, and Ricci-Gagnon metrics to assess level of physical activities practice among grades of teaching staff, in the various faculties of the University of Douala, Cameroon. RESULTS: Three hundreds and three teaching staff members aged 43±7 years were included (69% males). The prevalence of burnout syndrome was 68%, distributed within the three dimensions as follows: emotional exhaustion (15.2%), depersonalization (32.1%) and loss of personal accomplishment (22.1%), with 57% low level, 38% moderate and 6% severe. Burnout affected respectively 55.4% lecturers, 38.3% senior lecturers and 6.3% professors. Burnout was significantly associated with poor working conditions (P=0.0001), unsatisfactory salary (P=0.0001), part time teaching in private university institutions (P=0.027), sensation of strenuous job (P=0.002), conflict with colleagues (P=0.028), sedentariness (P=0.007). Sport and physical activities showed significant protective effect against burnout (P=0.004), the same with leisures (P=0.016). CONCLUSION: The prevalence burnout syndrome is high among university teaching staff in Cameroon. The practice of sport and physical activities and leisures has a protective effect against burnout syndrome.

[Burnout syndrome among generalist medical doctors of Douala region (Cameroon): Can physical activities be a protective factor?] / Syndrome de burnout chez les médecins généralistes de la région de Douala (Cameroun) : les activités physiques peuvent-elles être un facteur protecteur ?

BACKGROUND: This study aimed to evaluate and document the importance of Burnout syndrome among generalist medical doctors (GMD) since no investigation have been carried in Cameroon. METHODS: Cross-sectional study including 85 GMD using a self-administered questionnaire on socio-demographic characteristics, socioprofessional conditions, Maslach Burnout Inventory - Human Services Survey (MBI-HSS) to evaluate burnout, and Ricci-Gagnon physical activities level metrics. RESULTS: 77 GMD (90.6 %) reported having never heard about burnout. Mean age was 29 years (range 24-42 years). The MBI-HSS revealed that 36 GMD (42.4 %) were victims of burnout, with 27 (31.8 %) at a low level, 8 (9.4 %) moderate and one (1.2 %) severe. Burnout was associated with distance from home to job place (p ⟨ 0.05), strenuous job (p = 0.04), number of children in charge (p = 0.007), number of hospital attended (p = 0.003), number of hours of labor per day (p = 0.0001), conflicts with the hierarchy (p = 0.01), number of guards per month (p = 0.01). Physical activities practice did not showed significant preventive effect on burnout (p = 0.3) (Odds-ratio = 1.45, IC 95 % 0.6, 3.45). CONCLUSIONS: Burnout syndrome is not well known among GMD in Douala, though having a high prevalence. Various socio-demographic and socio-professional factors are associated and contribute to increase the level of affect. Burnout seems to be a vicious somato-psycho-somatic disorder. This study did not found a protective or preventive effect of physical activities on burnout.

BUT: Le but de cette étude était d'évaluer et documenter l'importance du syndrome de burnout parmi les médecins généralistes (MG), dans un contexte d'une absence totale de données sur cette affection au Cameroun. METHODES: Etude transversale incluant 85 médecins généralistes, à l'aide d'un questionnaire auto-administré sur les caractéristiques sociodémographiques, les conditions socioprofessionnelles, le Maslach Burnout Inventory - Human Services Survey (MBI-HSS) pour évaluer le burnout et le questionnaire de Ricci-Gagnon pour déterminer le niveau des activités physiques. RESULTATS: 77 MG (90,6 %) ont déclaré n'avoir jamais entendu parler du burnout. L'âge variait de 24 à 42 ans. Le MBI-HSS a révélé que 36 (42,4 %) étaient victimes du burnout, dont 27 (31,8 %) à un niveau faible, 8 (9,4 %) modéré et 1 (1,2 %) sévère. Le burnout était associé à la distance domicile-lieu de travail (p ⟨ 0,05), à la charge du travail (p = 0,04), au nombre d'enfants à charge (p = 0,007), au nombre d'hôpitaux de consultation (p = 0,003), au nombre d'heures de travail par jour (p = 0,0001), aux conflits avec la hiérarchie (p = 0,01), au nombre de gardes par mois (p = 0,01). La pratique des activités physiques n'a pas montré un effet préventif significatif sur le burnout (p = 0,3) (odds-ratio = 1,45, IC 95 % 0,6, 3,45). CONCLUSIONS: Bien qu'ayant une prévalence élevée, le burnout n'est pas bien connu parmi les MG à Douala. Divers facteurs sociodémographiques et socio-professionnels sont associés et contribuent à augmenter le niveau de l'affection. Le burnout semble être un trouble somato-psycho-somatique vicieux.

Daily survival and human blood index of major malaria vectors associated with oil palm cultivation in Cameroon and their role in malaria transmission.

OBJECTIVE: To describe the daily survival rate, biting habits, feeding behaviour, sporozoite and entomological inoculation rates of Anopheles species and their relative contribution to Plasmodium falciparum transmission in large-scale oil palm-growing zones in Cameroon. METHODS: Entomological surveys by employing human-landing catches, both indoors and outdoors, two nights per month for 12 months from October 2004. RESULTS: A total of 2485 Anopheles were collected and four species recorded: An. funestus, An. hancocki, An. gambiae s.s. and An. nili. There was substantial indoors to outdoors variation and seasonality in the distribution of the Anopheles population. All four species showed similar nocturnal biting patterns and were sympatrically involved in malaria transmission simultaneously or replacing each other seasonally. Their constant presence throughout the year and longevity suggest that transmission can occur at any time if parasite reservoirs are present in the area. The circumsporozoite protein rates were 5.8%, 6.3%, 8.4% and 4.1%; mean anthropophilic rates were 97.1%, 94.5%, 73.9% and 77.6%, respectively, for An. funestus, An. gambiae s.l, An. nili and An. hancocki. The annual entomological inoculation rate was 1077 infectious bites per person. Of those An. gambiae specimens testing positive for P. falciparum sporozoites, 69.01% were M form and 30.99% were S form. CONCLUSION: Any vector control strategy intending to significantly reduce the malaria burden in the palm estate will have to take into account entomological heterogeneity in addition to ecological and socio-economic multiplicity.

Early acid perception in NERD.

Heartburn is the hallmark of gastroesophageal reflux disease. The hypothesis tested in this study is that the time of onset of this symptom may play a role in the development of mucosal lesions. During endoscopy of 61 patients complaining of heartburn and nine control subjects, gastric fluid was aspirated using a catheter introduced through the operative channel, and blindly instilled onto the esophageal mucosa before withdrawing the endoscope. Saline was used as control. Evocated symptoms and endoscopic lesions were recorded. Thirty-seven patients did not present esophageal lesions (nonerosive reflux disease [NERD]); 24 presented esophagitis (ERD). Instillation of gastric fluid on the esophageal mucosa elicited heartburn in 46% of patients with NERD, 8.3% with ERD, and 11.1% of controls. Symptoms lasted throughout the procedure but were no longer present when the gastroscope was withdrawn. The NERD value was significantly higher than that of ERD (P= 0.02) and controls (P= 0.02), while no difference was found between ERD and controls. Saline did not induce symptoms either in controls or patients. NERD patients show an early response to gastric fluid instillation much more frequently than ERD and controls. It is hypothesized that the early onset of symptoms in NERD patients may be a possibility to avoid the progress of mucosal lesions by claiming an earlier medical care.

Ecological transition from natural forest to tea plantations: effect on the dynamics of malaria vectors in the highlands of Cameroon.

From October 2002 to September 2003, an entomological survey was carried out in a rural forested fringed village in the highlands of Mount Cameroon region to determine the temporal dynamics of the anopheline population and the intensity of malaria transmission. A total of 2387 Anopheles spp. were collected, with A. funestus predominating (59.9%), followed by A. hancocki (24.4%) and A. gambiae s.l. (15.7%). Considerable differences were observed in the nocturnal biting cycles of parous mosquitoes, with peak activity in the latter part of the night. PCR revealed that all specimens of the A. funestus group were A. funestus s.s. and all specimens from the A. gambiae complex were A. gambiae s.s. of the S molecular form. Plasmodium falciparum sporozoite rates of 17.3% and 8.5% were recorded for A. funestus and A. hancocki, respectively, with an anthropophilic rate of 96.3%. A strong positive correlation (r=0.996) was found between the human-biting rate and the entomological inoculation rate (EIR). Malaria transmission was very high and perennial, with an estimated annual EIR of 460.1 infective bites per person per year. These results confirm that in high agricultural activity areas, A. funestus can be by far the major malaria vector responsible for malaria transmission.

Multidetector computed tomography in the diagnosis and management of renal trauma.

Renal injuries fall within the broad and complex subject of retroperitoneal trauma. Although their computed tomography (CT) features have been known for a while, the timing, diagnostic approach and management are still debated. In addition, some areas of uncertainty remain regarding timing, indications and imaging modalities to be used in the follow-up of these patients. The purpose of this paper is to review the impact of CT on the management of renal trauma, stressing the importance of this technique and the role of the radiologist in the timing of decisions. Finally, we discuss the diagnostic approach to the follow-up of renal trauma.

Climate change and altitudinal structuring of malaria vectors in south-western Cameroon: their relation to malaria transmission.

An entomological survey was conducted in Cameroon between October 2004 and September 2005, in nine localities targeted for malaria vector control based on adult productivity and variability. Mosquitoes were collected by human-landing catches (HLCs) and pyrethrum spray catches. A total of 12 500 anophelines were collected and dissected: Anopheles gambiae s.l. (56.86%), An. funestus s.l. (32.57%), An. hancocki (9.38%), and An. nili (1.18%). Applying PCR revealed that specimens of the An. funestus group were An. funestus s.s. and An. gambiae complex were mostly An. melas and An. gambiae s.s. of the M and S molecular forms with the M forms being the most predominant. The natural distribution patterns of Anopheles species were largely determined by altitude with some species having unique environmental tolerance limits. A human blood index (HBI) of 99.05% was recorded. Mean probability of daily survival of the malaria vectors was 0.92, with annual mean life expectancy of 21.9 days and the expectation of infective life was long with a mean of 7.4 days. The high survival rates suggest a high vector potential for the species. This information enhances the development of a more focused and informed vector control intervention.

Is early endoscopic retrograde cholangiopancreatography useful in the management of acute biliary pancreatitis? A meta-analysis of randomized controlled trials.

AIMS: To compare early endoscopic retrograde cholangiopancreatography with conservative management for the treatment of acute biliary pancreatitis: a meta-analysis of prospective randomized trials. METHOD: Pertinent studies were selected from the Medline, Embase, and the Cochrane Library Databases, references from published articles and reviews. Conventional meta-analysis according to DerSimonian and Laird method was used for the pooling of the results. The rate difference (95% CI) and the number needed to treat were used as a measure of the therapeutic effect. RESULTS: Five prospective randomized trials including 702 patients were selected. Overall complications and mortality rates were 31% and 6%, respectively. In predicted severe pancreatitis the pooled rate difference for complications in early endoscopic retrograde cholangiopancreatography was 38.5% (95% CI -53% to -23.9%); p < 0.0001; number needed to treat = 3. In predicted mild pancreatitis the pooled rate difference for complications in early endoscopic retrograde cholangiopancreatography was 1.8% (95% CI -5.6% to 9.3%); p = 0.6. No mortality was observed in predicted mild pancreatitis. In predicted severe pancreatitis the pooled rate difference for mortality in the early endoscopic retrograde cholangiopancreatography group was 4.3% (95% CI -16% to 7.5%); p < 0.24. CONCLUSIONS: Early endoscopic retrograde cholangiopancreatography reduces pancreatits-related complications in patients with predicted severe pancreatitis although mortality rate is not affected. In predicted mild pancreatitis early endoscopic retrograde cholangiopancreatography has no advantage compared to conservative management.

Assessment of inflammatory activity in Crohn's disease by means of dynamic contrast-enhanced MRI.

PURPOSE: Our aim was to perform a dynamic study of contrast enhancement of the intestinal wall in patients with Crohn's disease to quantitatively assess local inflammatory activity. MATERIALS AND METHODS: We studied a population of 50 patients with histologically proven Crohn's disease. Magnetic resonance imaging (MRI) was performed using a 1.5-T magnet with a phased-array coil and acquisition of T2-weighted single-shot fast spin echo (SSFSE) half Fourier sequences before intravenous administration of gadolinium, and T1-weighted fast spoiled gradient (FSPGR) fat-saturated sequences before and after contrast administration. Before the examination, patents received oral polyethylene glycol (PEG) (1,000 ml for adults; 10 ml/Kg of body weight for children). Regions of interest (ROI) were placed on the normal and diseased intestinal wall to assess signal intensity and rate of increase in contrast enhancement over time. Data were compared with the Crohn's Disease Activity Index (CDAI). RESULTS: The diseased bowel wall showed early and intense uptake of contrast that increases over time until a plateau is reached. In patients in the remission phase after treatment, signal intensity was only slightly higher in diseased bowel loops than in healthy loops. There was a significant correlation between the peak of contrast uptake and CDAI. CONCLUSIONS: Dynamic MRI is a good technique for quantifying local inflammatory activity of bowel wall in patients with Crohn's disease.

A QSAR for the mutagenic potencies of twelve 2-amino-trimethylimidazopyridine isomers: structural, quantum chemical, and hydropathic factors.

An isomeric series of heterocyclic amines related to one found in heated muscle meats was investigated for properties that predict their measured mutagenic potency. Eleven of the 12 possible 2-amino-trimethylimidazopyridine (TMIP) isomers were tested for mutagenic potency in the Ames/Salmonella test with bacterial strain TA98, and resulted in a 600-fold range in potency. Structural, quantum chemical, and hydropathic data were calculated on the parent molecules and the corresponding nitrenium ions of all of the tested isomers to establish models for predicting the potency of the unknown isomer. The principal determinants of higher mutagenic potency in these amines are: (1) a small dipole moment, (2) the combination of b-face ring fusion and N3-methyl group, (3) a lower calculated energy of the pi electron system, (4) a smaller energy gap between the amine HOMO and LUMO orbitals (Pearson "softness"), and (5) a more stable nitrenium ion. Based on predicted potency from the average of six regression models, the isomer not yet synthesized and tested is expected to have a mutagenic potency of 0.77 revertants/microg in tester strain TA98, which is near the low end of the potency range of the isomers.

Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation.

BACKGROUND: Echocardiographic parameters for predicting cardioversion outcome in patients with non-valvular atrial fibrillation are not accurately defined. OBJECTIVE: To evaluate the role of left atrial appendage flow velocity detected by transoesophageal echocardiography for prediction of cardioversion outcome in patients with non-valvular atrial fibrillation enrolled in a prospective. multicentre, international study. METHODS: Four hundred and eight patients (257 males, mean age: 66 +/- 10 years) with non-valvular atrial fibrillation lasting more than 48 h but less than 1 year underwent transthoracic echocardiography and transoesophageal echocardiography before either electrical (n=324) or pharmacological (n=84) cardioversion. RESULTS: Cardioversion was successful in restoring sinus rhythm in 328 (80%) and unsuccessful in 80 patients (20%). Mean left atrial appendage peak emptying flow velocity was significantly higher in patients with successful than in those with unsuccessful cardioversion (32.4 +/- 17.7 vs 23.5 +/- 13.6 cm x s(-1); P<0.0001). At multivariate logistic regression analysis, three parameters proved to be independent predictors of cardioversion success: the atrial fibrillation duration <2 weeks (P=0.011, OR=4.9, CI 95%=1.9-12.7), the mean left atrial appendage flow velocity >31 cm x s(-1) (P=0.0013, OR=2.8, CI 95%=1.5-5.4) and the left atrial diameter <47 mm (P=0.093, OR=2.0, CI 95%=1.2-3.4). These independent predictors of cardioversion success outperformed other univariate predictors such as left ventricular end-diastolic diameter <58 mm, ejection fraction >56% and the absence of left atrial spontaneous echo contrast. CONCLUSION: In patients with non-valvular atrial fibrillation, measurement of the left atrial appendage flow velocity profile by transoesophageal echocardiography before cardioversion provides valuable information for prediction of cardioversion outcome.

Simultaneous peripubertal onset of multireactive autoimmune diseases with an unusual long-lasting remission of type 1 diabetes mellitus.

Although it is well known that patients with type 1 diabetes mellitus are susceptible to other autoimmune diseases, the simultaneous occurrence of clustered distinct autoimmune diseases is uncommon. We report a 16-year-old girl, previously diagnosed as having coeliac disease and IgA deficiency, who at 13 years of age developed a clustering of distinct autoimmune diseases, including type 1 diabetes mellitus, rheumatoid arthritis (RA) and euthyroid autoimmune thyroiditis, eventually resulting in a simultaneous long-term remission. The clinical picture was associated with a functional immunodeficiency characterized by a defect in proliferative responses to T cell predominant mitogens and a normal response to the B cell predominant mitogen. In addition, the T cell activation markers HLA-DR, IL-2 receptor and transferrin receptor) were not upregulated. The clinical course of this immunodeficiency paralleled the outcome of the autoimmune diseases. After the abrupt onset, spontaneous clinical remission of both diabetes mellitus and RA was observed. Insulin was first reduced in dose and then discontinued completely at 15 months, in the presence of normal C peptide secretion and normal metabolic control (HbA1c 5.8%). Anti-glutamate decarboxylase (GAD65) and anti-IA-2 antibodies remained persistently high. During the remission phase a normalization of the functional immune defect was observed. The gradual resolution of the multisystemic diseases as well as the normalization of immune function in our patient is unusual. This case may be of considerable value in furthering our knowledge of the immunological mechanisms implicated in these rare multireactive syndromes.

Formation of the mutagen IFP in model systems and detection in restaurant meats.

Mixtures of the free amino acids, creatine and glucose, were dry-heated to model the potential formation of heterocyclic amines in meats. The formation of the mutagenic amine IFP (determined to be 2-amino-(1,6-dimethylfuro[3,2-e]imidazo[4,5-b])pyridine) was investigated by varying heating time, heating temperature, and precursors. With an optimized mixture of glutamine, creatine, and glucose, heated at 200 degrees C for 60 min, 2 mg of IFP was purified for studies to define its structure. Trideuteriomethyl-IFP was made from trideuteriomethylcreatinine in the model system for use in LC-MS detection of IFP in foods. Analysis of well-done meats purchased from restaurants showed about half to contain IFP at levels from 1.4 to 46 ng/g of cooked meat, demonstrating human exposure to this mutagen.

Transesophageal echocardiographic evidence of more pronounced left atrial stunning after chemical (propafenone) rather than electrical attempts at cardioversion from atrial fibrillation.

We studied left atrial function in 55 patients undergoing electrical (n = 23) or chemical (intravenous administration of propafenone, n = 32) attempts at cardioversion from atrial fibrillation. Chemical attempts at cardioversion revealed a significant increase in spontaneous echo contrast and a significant decrease in left atrial appendage Doppler flow, even in patients who did not have successful conversion to sinus rhythm.

Heterocyclic amine formation and the impact of structure on their mutagenicity.

The occurrence and formation of heterocyclic amines in foods is discussed in light of the consistent finding of a new class of imidazopyridines. In addition, a quantitative structure-activity relationship will be presented correlating the potency of these imidazopyridines to predicted chemical properties. Although no strong linear correlation is found between the potency and the chemical properties, a low dipole moment is found to be a qualitative predictor of high mutagenic potency.

[Anticoagulation and electrical cardioversion of chronic atrial fibrillation: proposal for an abbreviated protocol]. / Anticoagulazione e cardioversione elettrica della fibrillazione atriale cronica: proposta di un protocollo abbreviato.

BACKGROUND: Several weeks of prophylactic anticoagulation are routinely prescribed before and after electrical cardioversion of atrial fibrillation. Recent studies have supported the use of transesophageal echocardiography to guide early cardioversion: patients in whom no thrombus is observed are treated with heparin followed by one month of warfarin therapy after the procedure. This kind of treatment requires hospital admission during heparin infusion, because of the need for monitoring partial thromboplastin time. AIM OF THE STUDY: To evaluate if a short at-home treatment (three days) with warfarin is sufficient to reach a good level of anticoagulation, in order to permit safe electrical cardioversion in day-hospital for patients who show no thrombi on transesophageal echocardiography. METHODS: One hundred twenty-four patients with atrial fibrillation, who were candidates for cardioversion, were treated with warfarin: 10 mg the first and second day, 5 mg the third day in group A patients (n = 79); 15 mg the first day, 10 mg the second and third day in group B patients (n = 45). On the fourth day, INR value was measured and if it was < 2, warfarin therapy was prolonged until patients reached a good level of anticoagulation. Transesophageal echocardiography was performed when the INR was > or = 2, and patients were cardioverted with DC shock if there were no thrombi. The patients were discharged on the same day of the procedure, and warfarin therapy was continued for 4 weeks there-after. If a thrombus was detected, patients repeated transesophageal echocardiography after 6 weeks of warfarin therapy, and were cardioverted if the thrombus disappeared. Otherwise, cardioversion was deferred and they received prolonged warfarin treatment. If there was poor visualization of the left atrial appendage, patients received conventional warfarin therapy for 3 weeks before and 4 weeks after electrical cardioversion. RESULTS: Mean INR value after three days of warfarin treatment was 2.41 in group A patients and 3.02 in group B patients. Twenty-one patients from group A and 3 patients from group B required anticoagulant therapy for a mean of 3.3 and 5.1 days, respectively, before reaching a good level of anticoagulation (INR value > or = 2). Eight patients reverted spontaneously to sinus rhythm before transesophageal echocardiography. Eighteen thrombi (15.5%) were identified on the transesophageal echocardiography, all of which were in the left atrial appendage. In 11 cases, thrombus disappeared after 6 weeks of warfarin therapy. In 7 patients (6%), the atrial appendage was not sufficiently visualized. Electrical cardioversion was performed on 109 patients and was successful in 88 (80.7%). None of them experienced a clinical thromboembolic event. CONCLUSIONS: In the majority of patients in atrial fibrillation, a short at-home warfarin treatment is sufficient to reach a good level of anticoagulation in order to permit safe electrical cardioversion in a day-hospital situation. Larger initial doses can achieve even better results. This treatment algorithm minimizes the anticoagulation period, hospital stay, overall duration of atrial fibrillation and the time required for the mechanical function of the left atrium to return.

[Natriuretic peptides and the heart. Critical review and application]. / Peptidi natriuretici e cuore. Revisione critica ed applicazioni.

This paper deals with a literature survey on natriuretic peptides (NP) and their clinical use in prognostic stratification and therapy of arterial hypertension and cardiac failure. After a brief historical introduction, the phylogenesis of NP is analyzed and the reasons of their preservation in the evolution are emphasized. The biochemistry of the NP is then treated, and the structure, synthesis, mechanism of cellular action and systems of regulation are analyzed. Subsequently, the authors have analyzed the physiology of the NP as well as their hemodynamic and biohumoral effects and actions on the central nervous system. A literature review on the significance of NP in arterial hypertension, on their usefulness as indicators of damage and on their therapeutic practice is then made. In particular, the possible future applications in the prevention of atherosclerotic damage are analyzed. The significance of NP and of their metabolites in heart failure and the prognostic implication of these peptides particularly in ischemic heart failure are then discussed. The most important papers on this topic are described. Finally the studies on the use of NP in the therapy of heart failure are analyzed and a guide on research of this topic is defined.

[Angiographic findings in arrhythmogenic dysplasia of the right ventricle]. / L'aspetto angiografico della displasia aritmogena del ventricolo destro.

Arrhythmogenic right ventricular dysplasia is characterized by fibrous and adipose replacement of the right ventricular myocardium and recurrent ventricular arrhythmias of left bundle branch block morphologic pattern. Sometimes the diagnosis is difficult because not all the clinical and instrumental findings are present and the separation between arrhythmogenic right ventricular dysplasia and other right ventricular cardiopathies is uncertain. In such cases the angiographic appearance of the right ventricle has been considered the "gold standard". To assess the diagnostic value of right ventricular morphology in identifying arrhythmogenic right ventricular dysplasia, we compared the angiographic findings of 8 patients with arrhythmogenic right ventricular dysplasia, 10 with biventricular dilated cardiomyopathy and 10 with Ebstein's anomaly. The following aspects were considered: deep fissuring of the anterior or inferior wall, outflow tract enlargement, contrast persistence in the right ventricle during the levophase, regional wall motion abnormalities including aneurysmal formations and tricuspid regurgitation. Aneurysmal formations of the right ventricle were found only in arrhythmogenic right ventricular dysplasia whereas the other angiographic findings were common to all the above mentioned diseases. Right ventricular angiography is an important adjunct to the clinical and instrumental diagnosis of arrhythmogenic right ventricular dysplasia, but most of its angiographic features are common to other diseases which cause right ventricular dilatation.