The implantable cardioverter defibrillator in congestive heart failure patients in primary prevention: assessment of neuropsychological impact.

AIM: Cognitive impairment, anxiety and depression have been described in patients with congestive heart failure (CHF). The aim was to analyse the prevalence of cognitive impairment and anxiety-depression in an in-hospital CHF population before discharge attempting to correlate with the presence of an implantable cardioverter defibrillator (ICD). METHODS: All subjects underwent a mini mental state examination (MMSE), geriatric depression scale (GDS), hospital anxiety and depression scale test (HADS). RESULTS: Three-hundred and eighteen CHF patients (age 71.6 years, 195 males) were analysed. The mean New York Heart Association class (NYHA) was 2.9±0.8, left ventricular ejection fraction (LVEF) was 43.4±15.8%; brain natriuretic peptide (BNP) plasma level was 579.8±688.4 pg/mL. In 9.6% a pathological MMSE score emerged; a depression of mood in 18.2% and anxiety in 23.4% of patients were observed. An ICD was implanted in 43 (14.2%) CHF patients for primary prevention of cardiac sudden death. Patients in ICD group demonstrated a higher prevalence of renal impairment (creatinine 1.7±0.7 vs. 1.2±0.8 mg/dL; P=0.0001), lower LVEF (24.9±8.9 vs. 46.2±14.6% P=0.0001) and higher BNP (717.1±538 vs. 345.4±448.6 pg/ml; P=0.0001) but similar 6-minute walking test (338.6±81.3 vs. 345.3±114.9 m; P=0.8). An ICD intervention was registered in 9 (20.9%) patients. Although clinical parameters seemed to describe a sicker population in ICD implanted patients, from neuropsychological tests did not emerge any significant differences (P=NS for MMSE, GDS and HADS). CONCLUSION: ICD-implanted CHF patients for primary prevention did not reveal a worsening in anxiety and depression of mood demonstrating a similar cognitive performance in comparison with non-ICD implanted.

Psychopathology and treatment of night eating syndrome: a review.

The article reviews the international literature about psychopathological aspects and treatments of Night Eating Syndrome (NES). Studies were found using Medline; data from recent international books and conferences about ED are included, but single case descriptions are not included in the study. NES seems to be consistently related to mood disorders and anxiety. There is a low overlap between other eating disorders, including binge eating disorder (BED), and NES. The relationship between the syndrome and substance abuse is unclear and needs further study. Sleep architecture seems not to be severely altered among those with NES. A limited number of treatment studies for NES have been published or presented. Most of the literature focuses on pharmacological treatment, with fewer psychotherapeutic approaches reported at this time. Larger, multi-site treatment studies would serve to confirm the findings of this first wave of clinical trials.

A possible pathogenetic role of cationic proteins (CP) released by stored granulocytes in the development of pulmonary infiltrates after granulocyte transfusions.

The cationic protein (CP) content of polymorphonuclear neutrophils (PMN) prepared for transfusion is depleted after storage. The supernatants from these PMN have in vitro a PMN aggregating activity which is abolished by the preabsorption with a specific rabbit anti-human PMN CP serum. Furthermore, when the supernatants stored for few hours were injected into New Zealand White rabbits, a marked sequestration of PMN took place in the lung microvascular bed. It is suggested that PMN storage per se can cause the release of intracellular mediators of possible pathogenetic importance in the development of the pulmonary infiltrates observed after PMN transfusions.

[Current clinical use of radioisotopes in the study of platelet kinetics]. / Attualità sull'utilizzazione clinica delle indagini radioisotopiche nello studio della cinetica piastrinica.

Radioisotopic study of platelet kinetics can provide a preliminary orientation in the diagnosis of thrombocytopenia. A study of the platelet kinetics in thrombocytopenic and normal subjects using the Cr51 isologous platelet labelling technique and subsequent in vivo injection of the labelled platelets was conducted. The results obtained confirm the reliability and usefulness of the technique. The identification of the limitations involved and the recognition of their significance in processing data allows the hematologist and the general practitioner to allow the right amount of room for the study of platelet kinetics in the diagnosis of thrombocytopenia.

Plasma exchange in immune complex glomerulonephritis: clinical and immunological correlations.

22 patients with immune complex (IC) glomerulonephritis (GN) were treated with plasma exchange (PE), corticosteroids and immunosuppressors, in 4 cases also as a long treatment. We evaluated circulating IC and some neutrophils (PMN) functions such as phagocytosis, aggregation and platelet activating factor (PAF) release. In extracapillary GN improvement was observed in 3/9 patients, concomitantly with IC decrease: in 6/9 patients no renal amelioration occurred, despite IC decrease in two. In all Lupus Nephritis and mixed IgG/IgM cryoglobulinemia, IC were highly positive and the disappearance of IC in 5/6 Lupus Nephritis and 4/4 cryoglobulinemia heralded systemic and renal amelioration. PMN functions were hampered in acute Lupus Nephritis and mixed cryoglobulinemia, but constantly improved along with IC decrease and clinical amelioration. Thus in extracapillary GN the decrease of IC by PE may not eventuate in renal improvement. In Lupus Nephritis and cryoglobulinemia a better correlation exits between IC, PMN function and clinical course.