(99m)Tc-DTPA scintigraphy assesses the absence of glomerular filtration rate impairment of Aliskiren in high-risk hypertensive subjects. A 12-month follow-up study.

AIM: Glomerular filtration rate (GFR) is commonly calculated using the modification of diet in renal disease (MDRD) and Cockroft-Gault (CG) formulas and recently by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) algorithm and not directly measured, so that the real impact of antihypertensive therapy on GFR could not be well defined. In this study, the effect of Aliskiren on the GFR measured by radionuclide clearance of 99mTc-diethylene triamine penta-acetic acid (DTPA) was investigated. METHODS: In 106 hypertensive subjects (53% men) aged 61.9±12.7 years with uncontrolled blood pressure (BP) receiving at least 2 antihypertensive medications, Aliskiren was added once-daily at a dose of 150-300 mg for 12 months. Clinic BP measurements were taken at every follow-up visit (1st, 6th and 12th month), while 24-hours ambulatory BP and GFR (in mL/min/1.73 m2) were evaluated at baseline and at the end of the follow-up. Analysis of variance for repeated measures of BP, GFR and microalbuminuria was provided. RESULTS: With the use of Aliskiren a significant reduction of BP and microalbuminuria was found (P<0.0001). Only in male population, a significant reduction in GFR calculated with CKD-EPI (82.4±15 vs. 78.6±18.2, P<0.01) and CG (81.6±29.5 vs. 74.2±28.4, P<0.0001) formulas was observed. This impairment of GFR was not found either with MDRD formula (70.5±19.6 vs. 68.3±23.4) or by radionuclide clearance (62.4±18.6 vs. 61.4±20.5). CONCLUSION: This study seems to demonstrate that the efficacy on BP control of Aliskiren is not accompanied by an impairment of GFR. In order to evaluate the effect of Aliskiren on GFR scintigraphy technique or MDRD formula resulted to be the most accurate methods.

Safety and long-term results of patent foramen ovale transcatheter closure in patients with thrombophilia.

AIM: Trials on transcatheter closure of patent foramen ovale (PFO) in different settings attempted to exclude patients with thrombophilia for the risk of device thrombosis. Authors sought to retrospectively evaluate safety and results of transcatheter PFO closure in patients with confirmed coagulation abnormalities. METHODS: Between December 2006 and December 2008, 30 out of 98 consecutive patients (mean age 40+/-10.9 years, 23 females) referred to Rovigo General Hospital for transcatheter closure had coagulation abnormalities including mutations of factor V Leiden, factors X, VIII, protein C, S, MHFTR factors, and antiphospholipid and anticardiolipin antibodies, hyperhomocisteinimia. All patients underwent preoperative transesophageal echo and brain magnetic resonance imaging, and intra-cardiac echo-guided transcatheter PFO closure. RESULTS: Success rate was 100%; there was no difference in occlusion and complications rates between patients with and without thrombophilia: in particular no device thrombosis or recurrent cerebral ischemia or stroke were observed during the follow-up. Patients with thrombophilia had a higher incidence of atrial septal aneurysm, migraine with aura and deep venous thrombosis in the previous medical history compared to patients without. CONCLUSIONS: Despite its small sample, this study suggests that patients with coagulation abnormalities should not be excluded from the trial; they have potentially a higher risk of stroke through a PFO compared to other patients, and transcatheter closure is as safe and effective as in general population with almost no additional therapy rather than aspirin.

[Presence of a monoclonal component IgG lambda in a 17-day-old newborn with omphalitis caused by Staphylococcus aureus]. / Presenza di una componente monoclonale IgG lambda in un neonato di 17 giorni affetto da onfalite da Staphylococcus aureus.

Monoclonal components are usually found in elderly patients. They are rarely noted in children, both because of their slight presence, and because the very low concentration makes it difficult to single them out. This report is about the identification of a transitory IgG lambda monoclonal component in a 17 day old baby suffering from aureus Staphylococcus. Electrophoresis was carried out with automatic equipment on cellulose acetate; immunofixation with a manual method on agarose gel; the quantitative doses of the immunoglobulins, reactive protein C and alpha 1-acid glycoprotein with nephelometric technique, the erythrocyte sedimentation rate with automatic equipment. The importance of singling out monoclonal components in children must be emphasized, inasmuch as it may be a sign of an immunological disorder, usually benign and transitory, but sometimes extremely serious.

[Smoking and acute cerebrovascular disorders of the ischemic type]. / Abitudine al fumo e vasculopatie cerebrali acute di tipo ischemico.

In order to define the relationships between cigarette smoking and occurrence of cerebrovascular disease, a retrospective study was undertaken regarding smoking habits of 187 patients (129 men and 58 women) with cerebral infarct of non-embolic origin and 85 patients (40 men and 45 women) with TIA (transient ischemic attacks). Each patient was matched with a control subject, of the same sex and age group, who showed no signs or symptoms of cerebrovascular disease. Results show a statistically significant association between smoking habits and cerebral infarcts only in male subjects who smoked more than 20 cigarettes a day.