Isolated dissection of the superior mesenteric artery: conservative approach in a selected patient.

The authors present the case report of effective conservative treatment in a patient with spontaneous, self-limiting, non-atherosclerotic dissection of the superior mesenteric artery (SMA) without fixed obstruction of the vessel lumen and signs of intestinal ischemia. Treatment with both anti-coagulant and anti-hypertensive agents succeeded in limiting the progression of intimal dissection and in preventing the potential dramatic sequelae of this rare clinical condition. Conservative treatment of spontaneous SMA dissection may be an alternative to surgery, if residual blood flow is maintained.

A scale evaluating the emotivity and well-being of elderly (Italian acronym: SVEBA): analysis of psychometric characteristics.

The psychopathology in the aged is an increasing burden for the last decades of the life and a large source of expenditure. An early recognition and treatment could lead to reduce personal distress and improve prognosis. For the use in the general practitioner (GP) office and ward settings most of the short check-lists available are focused on depression symptoms. For this reason a 15 items check-list, oriented to cover a wider array of symptoms, has been designed for the Italian population in the '90 (called SVEBA abbreviated from its Italian name). This work intended to investigate the presence of symptomatological clusters in order to detect different profiles of symptoms in populations with different comorbidities, in 214 home-dwelling elderly, with a mean age 80.2 years, referred to the geriatric memory clinic. We used the Keiser-Meyer-Olkin and Bartlett tests to check for applicability of factorial analysis, then a principal axis factoring extraction method was applied. The analysis identified the following factors: the first, collected items related to lack of motivation and initiative The second is related to the perceived "locus of control". The third, collected items related to sleep disturbance. The fourth, included items related to somatic complaints and anxiety. In the structure of SVEBA index is possible to identify three main symptom profiles related to motivation, anxiety and somatic symptoms and sleep disturbances.

[Antihypertensive therapy and renoprotection: do we really need to block the renin-angiotension system?]. / Terapia antipertensiva e nefroprotezione: e' superfluo il blocco del sistema renina angiotensina?

Recent studies questioned the existence of a specific renoprotective effects of ACE-inhibitors (ACE-i) and angiotensin receptor blockers (ARBs) besides their blood pressure lowering effect. In the ALLHAT study patients were randomly assigned to receive chlorthalidone, amlodipine and lisinopril. Results showed that, even in patients with reduced GFR, neither lisinopril nor amlodipine was superior to chlorthalidone in reducing the rate of development of ESRD or a 50% or greater decrement in GFR. Because of inclusion criteria the ALLHAT population was selected as at low risk for renal outcomes. Moreover, over 50% of the patients who were randomized to lisinopril either never received the medication or received the lower possible dose. Casas et al selected RCT comparing ACE-i and ARBs with other regimens. They concluded that ACE-i and ARBs are not more renoprotective that can be explained by lowering of blood pressure (BP) in diabetic nephropathy, while in non diabetic kidney disease a blood pressure independent renoprotective effect is uncertain. They made a very heterogeneous selection of trials that was dominated by the ALLHAT study; the analysis was not based on individual patient data. The Benedict Study showed that in hypertensive, normoalbuminuric patients with type 2 diabetes, BP reduction and ACE-i therapy both independently may prevent microalbuminuria. ACE-i therapy is particularly effective when BP is poorly controlled. We conclude that the recommendation of the Guidelines to use ACE-i and/or ARBs as first-line antihypertensive drugs for renoprotection in patients with diabetic and non diabetic kidney disease is still valid.