Recommended procedures and techniques for morphological studies of Eriophyoidea (Acari: Prostigmata).

Methods used for sample storage, specimen clearing, slide mounting, species illustration and morphometric description in alpha-taxonomic studies are essential for the Eriophyoidea. Eriophyoid mites are very tiny and delicate, for which truly permanent specimen slides currently cannot be prepared, resulting in eventual loss of material, including type specimens. Often, published descriptions and drawings have not achieved the required level of quality, and thus many relevant taxonomic details have been permanently lost or neglected. These shortcomings can make certain identifications impossible and cause significant confusion. Consequently, there is a considerable need for accurate and uniform descriptive and illustrative data for the Eriophyoidea. Based on their expertise on this topic, the authors provide guidelines and advices, assisted also by illustrations, of the main critical aspects in managing eriophyoid mites in order to supplement and improve techniques for handling and preparation of specimens, and for improving their taxonomic study. The effects of the short- and long-term preservation methods (i.e., fresh, dried and liquid preservative choices) on digesting the internal tissues of the mites are discussed. Clearing and mounting procedures are analyzed, and special tips are suggested for handling mites and designing tools needed during these steps. Methods for recovering specimens from unsuitable slides (i.e., undercleared and overcleared specimens) are proposed and described. Techniques and tricks to produce descriptive line drawings of good quality are highlighted, and the content to include in plates is stressed. Finally, detailed instructions for standardization of measurements are given.

Duplex scanning exploration of the ophthalmic artery for the detection of the hemodynamically significant ICA stenosis.

BACKGROUND AND PURPOSE: The North American and the European Carotid Endarterectomy Trials demonstrated a significant benefit of surgery in preventing stroke for patients with symptomatic hemodynamically significant internal carotid artery (ICA) stenosis. Because the 3 angiographic methods of measuring carotid stenosis provide discrepant results, the indication for surgery depends on the method used for the evaluation of the angiogram. The goal of this study was to verify whether color duplex scanning of the ophthalmic artery alone might be reliable for detection of the extracranial hemodynamically significant ICA stenosis. METHODS: Three groups of patients (351 total patients) with transient ischemic attack or minor stroke referred for possible carotid endarterectomy were examined by means of color duplex scanning of the ICA, transcranial Doppler, color duplex scanning of the ophthalmic artery, and angiography of the ICA. RESULTS: In the first group (n=31) the comparison of findings from each method and the direct measurement of the residual lumen of plaque removed "en bloc" showed that the findings of the ophthalmic artery color duplex scanning, subdivided into 5 categories--NP (normal positive), LP (low positive), NF (no flow), REV (reverse flow), PP (pathological positive)--were associated with the best overall agreement (96.7%). The accuracy of the various categories of the ophthalmic artery color duplex scanning signals was studied in the second group of patients (n=200). The results pointed out that all but low positive categories were associated with high diagnostic accuracy. Finally, the results obtained in the third group (n=120) showed that a significant increase in the specificity of the low positive signal could be obtained by processing this signal in terms of pulsatility index and of transmission of pulsatility index. CONCLUSIONS: Our results suggest that the diagnostic capacity of color duplex scanning for the detection of ICA critical stenosis can be appropriately increased if it is performed also at the level of the ophthalmic artery and if the Doppler signals are processed on the basis of criteria we applied.

Is there any relationship between cold-induced vasodilatation and vasomotion?

There are many analogies between cold-induced vasodilatation (CIV) and vasomotion (VM), but the demonstration of any relationship between these two microvascular homeostatic reactions is to date lacking. In a group of seven controls and seven patients with Raynaud phenomenon in the vasomotor stage of the disease, we studied, by means of laser Doppler fluxmetry, the fingertip flow at room temperature (15 min), during hand immersion into cold water (0-6 degreesC, 30 min), and at room temperature again (15 min). The Fourier spectral analysis of the laser Doppler signal revealed in both groups two different patterns of the fingertip flow oscillations: the first was characterized by continued oscillations with small amplitude and median frequency of 2-8 cycles/min occurring both at room temperature and during cold stimulation. The second was characterized by continued oscillations of high amplitude and median frequency of 1 cycle/4-6 min occurring during cold stimulation only. The first pattern of flow oscillations still occurred during the second. The high-frequency oscillations are similar to the waves of vasomotion and the low-frequency oscillations are similar to the waves of cold-induced vasodilatation. Because 90-98% of the fingertip flow passes through arteriolar-venular anastomosis (AVAs), our results suggest that the CIV flow oscillations may be an expression of the AVA's VM.

Routine ultrasound surveillance after carotid endarterectomy.

Ultrasounds (US) are employed in preoperative carotid disease diagnosis and in carotid endarterectomy (CEA) follow-up. The authors present their experience about postoperative modifications in CEA site with US evaluation with particular interest in restenosis. Clinical and instrumental examinations were performed at intervals 1, 3, 6, 12, and 24 months following surgery. Follow-up data were available on 189 CEAs. In 58 cases a primary closure was performed, whereas in the other 131 cases, a patch was applied. 15 restenosis (7.9%) were seen during the follow-up control period with 2 cases of haemodynamic restenosis (1%). Good results were recorded with PTFE patch angioplasty (restenosis 4.4%), instead of vein (restenosis 14.2%) and a biosynthetic material called Omniflow (restenosis 9.5%). A vein patch dilatation was encountered in 13 applications (30.9%). In conclusion the routine application of US after carotid endarterectomy allowed us to monitor the evolution of the repair processes and of the stenotic lesions from the very beginning.

Possible correlations of ocular blood flow parameters with intraocular pressure and visual-field alterations in glaucoma: a study by means of color Doppler imaging.

The authors evaluated, by means of color Doppler imaging, the blood flow of the ophthalmic artery, ciliary arteries and central retinal artery in normal and glaucomatous subjects. In normals they found that flow velocities of all considered vessels progressively decline while resistivity indices increase with advancing age. In glaucomatous subjects there was a statistically significant reduction of the mean systolic peak flow velocity of the ophthalmic artery in comparison with normals. Glaucomatous eyes with uncontrolled IOP and with visual-field worsening showed a statistically significant decrease in the end-diastolic flow velocities and an increase in the resistivity index values in ciliary arteries.

Color Doppler imaging in evaluation of optic nerve blood supply in normal and glaucomatous subjects.

The authors evaluate by means of Color Doppler Imaging (CDI) the blood flow in ophthalmic artery, posterior ciliary arteries and central retinal artery in a group of glaucomatous patients. The data obtained in this study show a statistically significant reduction of the mean systolic peak flow velocity in ophthalmic artery in glaucomas in comparison with controls. In Glaucomatous patients with uncontrolled IOP there was a reduction of end-diastolic flow velocities and a rise of resistivity index in ciliary arteries and central retinal artery.

[Defibrotide vs. calcium heparin in the prevention of deep vein thrombosis in gynecologic oncologic surgery]. / Defibrotide versus eparina calcica nella profilassi delle TVP in chirurgia ginecologica oncologica.

Eighty-one patients were submitted to gynaecological malignancy surgery in a randomized study aimed at the evaluation of the efficacy of defibrotide (40 patients) and calcium heparin (41 patients) in perioperative prophylaxis. They were randomly allocated to defibrotide group (400 mg bid im starting one day before surgery and continuing until the 7th postoperative day) or calcium heparin group (5000 IU bid sc starting two hours before surgery and continuing likewise for 7 days). No cases of DVT diagnosed by means of a Doppler CW were observed in either treatment group. Laboratory parameters have shown similar modifications in the two treatment groups. Three cases of bleeding were observed in the calcium heparin group while no cases of bleeding were detected in the defibrotide group. The results obtained suggest that defibrotide is at least as effective as calcium heparin in perioperative DVT prevention and that the former drug has a possibly better tolerability profile, due to a decisively lower tendency to bleeding.

Sonography of vertebral arteries in De Kleyn's position in subjects and in patients with vertebrobasilar transient ischemic attacks.

Two groups of subjects, matched for age, were studied. The first group consisted of 190 healthy subjects, the second, of 60 patients with vertebrobasilar transient ischemic attacks (TIAs), 22 of whom underwent angiography. After it was ascertained that the findings from continuous-wave (cw) Doppler of carotid and vertebral arteries, performed in the standard position, were normal, the examination was then done in De Kleyn's position, the velocity signal being detected at the mastoidal slopes. The abnormal findings were classified into two groups: "loss of diastolic velocity signal" and "absence of velocity signal." In the control group, changes of flow were detected in 6.31%, whereas in the group of patients abnormal Doppler parameters were detected in 33.33%. None of the patients who were submitted to angiography showed abnormal hemodynamic findings. The authors suggest that the detection of the velocity signal of the vertebral arteries in De Kleyn's position could be of help in revealing conditions that could cause, in time, signs and/or symptoms of vertebrobasilar insufficiency in subjects with possible asymptomatic anomalies of the circle of Willis.

Pachydermoperiostosis (primary hypertrophic osteoarthropathy): report of a case with evidence of endothelial and connective tissue involvement.

A case of pachydermoperiostosis characterised by the presence of finger clubbing, periostosis, sweating of hands and feet is described. Modifications of capillaroscopic pattern and of arteriovenous anastomoses are reported. The periungual border and finger tip tissue showed diffuse endothelial hyperplasia, hyalinosis, and sclerosis with packing of collagen fibres. Electron microscopy showed hypertrophic and activated endothelia (numerous and hypertrophic Golgi complexes, several Weibel-Palade bodies, vesicles of micropinocytosis, and glycogen particles), the basal membrane thickened and reduplicated, perivasal infiltrate in superficial derma, reticulation and segmentary reduplication of basal membrane in arteriovenous shunt. In the perineural connective tissue numerous Luse bodies (long spacing collagen) were evident. The data indicate that in the early phase of pachydermoperiostosis morphological endothelial and collagen fibre abnormalities are present, though there is a normal peripheral blood flow.

Arteriovenous anastomoses' function and Raynaud's phenomenon.

By intrabrachial artery injections of a bolus of human albumin microspheres labeled with 99mTc in patients with primary or secondary Raynaud's phenomenon (RP) and in a group of healthy volunteers, the authors developed a method of detecting the patency rate of arteriovenous anastomoses (AVA) in the hand, after local heat and cold stimulation, by quantifying the radioactivity of the lungs expressed as a percentage of an intravenously injected radionuclide dose. With strain gauge plethysmography, simultaneous changes in the digital total (DTF) flow were also measured. After exposure of fingers to cold, 25 of 26 subjects had a clear reduction in both DTF and the AVA patency rate (APR) in comparison with the corresponding heat values. The RP patients, in particular, showed a statistically significant reduction in DTF (P less than 0.001) and in APR (P less than 0.001). These results appear to be consistent with the onset of critically reduced patency of the AVA of the hand during the ischemic phase of RP.

Continuous-wave Doppler of vertebral arteries in noninvasive diagnosis and management of vertebro-basilar TIAs.

Continuous-wave Doppler and angiography of the vertebro-basilar system were used in 38 patients with vertebro-basilar transient ischemic attacks. 63 vertebral arteries were studied. Among 47 normal Doppler parameters, 46 were confirmed by angiography. The sonographic diagnostic procedure showed a very high negative predictive value (97.87%), while the positive predictive value was relatively low (56.25%). Data from literature were reviewed. The authors suggest that when Doppler of vertebral arteries is negative, there is a very low probability that a follow-up angiography will reveal pathologic conditions calling for a surgical approach.

A study of the semeiological reliability of dorsalis pedis artery and posterior tibial artery in the diagnosis of lower limb arterial occlusive disease.

Routine diagnosis of suspected occlusive arterial disease of the lower limbs are often based on the pulse absence at the dorsalis pedis artery. However many of these diagnoses are not confirmed after more thorough tests, and this fact arises the problem of the semeiological reliability of the above mentioned artery. Researches carried out by several authors in normal individuals on the dorsalis pedis artery yielded controversial results. Three hundred-sixty subjects free of occlusive arterial disease were then examined by means of clinical and Doppler investigation in order to assess the semeiological reliability of the dorsalis pedis artery in the diagnosis of occlusive arteriopathy of lower limbs, when compared to the posterior tibial one. The conclusion is drawn that a greater semeiological reliability must be attributed to the latter, due to its lesser "absence" incidence.

Effects of calcitonin on limb blood vessels in human obstructive arterial disease.

To check the possibility of a vasoactive effect of calcitonin in man, the authors treated ten hospitalized patients (seven males and three females, mean age 66.3 +/- 3.24), suffering from obstructive arterial disease in the lower extremities, with 100 units M.R.C. i.m. daily, for a period of 15 days. Five patients presented Raynaud's phenomenon. Treatment (B) led to an improvement of subjective symptomatology and to the disappearance of Raynaud's phenomenon in comparison with symptoms before treatment (A) and after a placebo period of 15 days (C). With respect to instrumental parameters, calcitonin induced: a) a slight increase of segmental plethysmography values (height/width ratio of curves) if compared with A (p less than 0.05) and more significantly if compared with C (p less than 0.01 and less than 0.0125, from right and left sides, respectively); b) a small change in venous-occlusion plethysmography values, if compared with A and C, both in basal conditions and after the "ischaemic test"; c) a significantly lesser reduction of digital photoelectric plethysmography values (height/width ratio of curves) after the "cold test" in comparison with A (p less than 0.01, both on the second and on the third fingers of the right hand), as well as with C (p less than 0.01 and p less than 0.025, on the second and on the third fingers, respectively). The present investigation points out the vasoactive influence of calcitonin in human obstructive disease. Results show the improvement in collateral limb circulation and, above all, in the amount of cutaneous flow. Little information is available on the mechanism of this effect, for which only hypotheses can at present be advanced.

Observations on changes in intermittent claudication after the administration of creatine phosphate.

A study was carried out in 13 patients with stabilized occlusive arterial disease to assess the effect of treatment with creatine phosphate (800 mg/day for 12 days) on walking distance to onset of disabling pain and on haemodynamic parameters (Winsor Index and calf arterial blood flow after ischaemia). Before treatment, patients had daily exercise for 12 days on a treadmill to plateau walking distance increase due to exercise. The results showed a further significant increase in walking distance after treatment, and a significant increase in peak reactive hyperaemia in all but 2 patients. The possible mechanisms of the effects of creatine phosphate are discussed.

Reliability of cerebral radioisotopic angiography and of directional Doppler C.W. in the diagnosis of cerebrovascular insufficiency.

The diagnostic value of radioisotopic cerebral angioscintigraphy (R.A.) and of Doppler CW (D.C.W.) techniques to identify stenosis of the internal carotid artery in its extracranial course was studied in 97 patients with ischaemic lesions (50 T.I.A. and 47 Complete Stroke). The results of R.A. and D.C.W. were compared with those of contrast carotid-angiography (C.A.). C.A. revealed stenosis above 50% or complete occlusion in 22% of cases, whereas D.C.W. and R.A. showed flow reduction in 27% and 48% of the cases respectively. In T.I.A., C.A. positivity went down to 8%; D.C.W. to 16%; and R.A. to 34%. In "Complete Stroke" positivity was 36% for C.A.; 41% for D.C.W.; and 62% for R.A. There was a high number of false positive findings with D.C.W. (8) but even more with R.A. (27). False negative findings occurred only in two cases with R.A. These data confirm the diagnostic value of these two noninvasive techniques to identify haemodynamically carotid stenosis. The use of both methods can reduce error due to false negativity. The rather marked frequency of false positivity, particularly with reference to R.A. doesn't affect the diagnostic value of the two methods.