[Hyponatremia: etiopathogenetic observations in the personal experiences]. / L'iponatremia : rilievi etiopatogenetici in esperienze personali.

AIM: Hyponatremia, an electrolyte disturbance, can be due to loss of solutes or to an increase of ''free'' water concentration, predominantly caused by excessive antidiuretic hormone (ADH) secretion. When acute, hyponatremia is threatening, because it can cause cell swelling and severe neuromuscular symptoms (central pontine myelinolysis). METHODS: In a sample of 220 subjects with hyponatremia (123 males, 97 females) aged from 47 to 83, hospitalized in the Department of Clinic Medicines and Emergent Pathologies, from 2000 till today, age, serum and urinary sodium concentration, urine specific gravity, signs, symptoms and causes of electrolyte disturbance were evaluated. Student's t-test was applied for parametric spread data, Mann-Whitney Test for no parametric spread data, ANOVA test for statistic comparison between groups. RESULTS: Hyponatremia due to an increase of ''free'' water prevails in respect to hyponatremia due to loss of solutes (55.9% vs 44%). In the first case the prevalent causes are: decompensated hepatic cirrhosis (37.3%), heart failure (31.7%), glucosate solutions at 5% (17.8%) and drugs that can potentially increase ADH secretion (antidepressants, etc.) (13%), especially in elderly people. In the second case chronic diarrhea, vomiting (40%, 32.9%) and diuretic-induced hypernatriuresis (18.5%) prevail. Laboratory results follow the grade of efficient volemia, registering statistically significant differences between the two variants of hyponatremia. CONCLUSION: Different diagnosis and adequate treatment are essential when hyponatremia is acute. Particular attention must be reserved to elderly people with hyponatremia, in which the mechanisms of ''free'' water clearance are inefficient and such hypotonic glucosate solutions as medicines that increase ADH secretion (psychodrugs) must be administered with caution and under clinical control.

[Management of uncomplicated arterial hypertension in pregnancy]. / Management clinico-terapeutico dell'ipertensione arteriosa non complicatanella donna in gravidanza.

In the management of uncomplicated arterial hypertension in pregnancy, blood pressure (BP) values of pregnant women should be treated in order to reduce risks of both maternal and fetal complications. To reduce these risks, it is necessary to monitor BP, some hematochemical parameters and albuminuria, to try to prevent more serious clinical complications. Moreover, repeated measurements of BP, as well as frequent ambulatory blood pressure monitoring (ABPM) over 24 h are necessary. In the treatment of hypertension in pregnancy, if there are no high risks, it is possible to try a non pharmacological antihypertensive therapy consisting of a suitable diet, reduction of weight, abolition of some lifestyles (smoking, excessive alcohol consumption and heavy physical exercises). If these measures are not sufficient or the risk is high, a pharmacological therapy with neither toxic nor teratogenic drugs for the fetus will be administered in order to normalize BP without reducing perfusion of the uterus/placenta. Only in case of severe hypertension, a more aggressive pharmacological treatment should be carried out and, if necessary, hospitalization. The drugs suggested in these cases are those which have already been recognised as presenting low side effects. Antihypertensive drugs used in pregnancy can be classified as: suitable (methyldopa, clonidine, long acting calcioantagonists); cautiously used (alpha-blockers, beta-betablockers); contraindicated (ACE-inhibitors, sartans, short acting calcioantagonists). Hyper-tensive crises should be treated with an injection therapy (clonidine, labetalol), with hospital admission if necessary, or if preeclampsia or eclampsia may occur.

[Clinical approach in hypertensive elderly patients]. / Considerazioni sull'approccio clinico di pazienti anziani ipertesi.

Hypertension in the elderly represents a cardiovascular risk factor which increases due to ageing and to the raise of blood pressure (BP) values. The occurrence of hypertension depends on an interaction between genes and environment. An available antihypertensive therapy causes a reduction in the incidence of cardiovascular events. An antihypertensive therapy in the elderly must take into account: in these subjects BP might be spontaneously lower over 30 mmHg in 24 hours; people normally have a postprandial BP reduction; sudden raises or falls of pressure cause cerebral hypoperfusion; some adverse vents of hypertensive drugs worsen their quality of life, not reducing myocardial hypertrophy; possible electrolytic troubles might worsen a congestive heart failure; drastic diets cause a raise in the incidence of colorectal tumours; a high heart rate increases the risk of sudden death; a chronic NSAID intake might cause or aggravate a hypertensive state; a reduction of natrium chlorure and lipides in the diet might cause a BP fall. In short, the BP reduction should be gradual in the hypertensive elderly in order to avoid the occurrence of cardiovascular events, diets should be balanced, rich in fibres and vitamins to avoid colorectal tumours. Besides, NSAID must be used by these patients for a short time and all therapeutic interventions should improve their quality of life.

[Severe myogenic pain in an unfit subject after intensive and prolonged abdominal muscle exercise]. / Marcata sofferenza miogena in un soggetto non allenato dopo intenso e prolungato esercizio fisico di flesso-estensione dei muscoli addominali.

The authors report the case of an unfit patient who, following intensive and prolonged physical exercise involving the abdominal muscles, presented a massive and diffuse subcutaneous edema (abdomen, scrotum, chest and face) together with abdominal and thoracic pain which increased in response to finger pressure. In addition, this was accompanied by a marked increase in CK, CK-MB and LDH, and TGO and TGP. Chest or heart pathologies were excluded by monitoring ECG and other clinical parameters, like heart rate and blood pressure, and by performing a chest X-ray. Muscular ultrasonography confirmed the massive subcutaneous edema and abdominal MR showed a slight edema in the suprasacral region, as well as confirming the subcutaneous edema. Hematological data gradually reduced and returned to normal after a week. Edema and pain also regressed gradually: the former finally disappeared after one week and the latter after five days. The authors conclude that clinical and laboratory findings were particularly severe because the subject was unfit and subcutaneous edema was larger than the free liquid in the abdominal cavity because the latter was absorbed by the peritoneum which acted as a dialysing membrane.

[Clinical and laboratory findings concerning at first dietary and afterwards cimetidine treatment of acute intermittent porphyria]. / Rilievi clinici-laboratoristici nel trattamento prima dietetico e dopo con cimetidina della porfiria acuta intermittente.

Clinical symptoms and laboratory findings were assessed in three women with acute intermittent porphyria. After 15 days of pharmacologic washout and free diet (time 0), the patients were give a well balanced normocaloric diet for 7 days (time 1), followed by 7 days of high carbohydrate normocaloric diet (time 2); on days 15 to 21 (time 3) well balanced normocaloric diet was given, and finally on days 22 to 28 (time 4) to the well balanced normocaloric diet cimetidine (0.4 g twice daily) was added. On days 3, 5, and 7 of times 1-4 the following porphyrin precursors were determined: ALA, PBG, total uroporphyrin, total coproporphyrin, and total porphyrin. At times 1 and 3, high values were found while levels dropped to normal during times 2 and 4. During times 1 and 3, patients complained of headache, insomnia and anxiety; during time 2, all patients complained of anxiety and only one suffered from insomnia. Finally, during time 4, all patients had only slight anxiety. Untoward effects of cimetidine were not observed in any of the patients.

[Captopril versus placebo in the prevention of hemicrania without aura. A randomized double-blind study]. / Captopril versus placebo nella profilassi dell'emicrania senz'aura. Studio in doppio cieco randomizzato.

Endogenous opioids are known to be involved in the pathophysiology of idiopathic headache. In fact, decreased levels of enkephalin (E) or endorphin (BE) during headache attacks might be a marker of an altered pain-inhibiting system of central neurotransmission or could be secondary to alterations of brain circulation that often occur during the headache crisis. Recently, captopril (C) has been shown to be apt to restore the availability of endogenous opioids, to improve cerebral blood flow via the inhibition of both the cerebral and systemic renin-angiotensin system or of catecholamine release. It has also been reported to be able to restore the nociceptive-antinociceptive balance through an increase of serum kinin (K) or prostaglandin (Pr) levels. In the present study, the efficacy of C in reducing the frequency (F), duration (D), or severity (S) of headache paroxysm were investigated in a double blind trial vs. placebo (P). Twenty-six subjects (5 males and 21 females; mean age 37 +/- 11 years) suffering from idiopathic headache at least for one year have been allocated to treatment with C (25 mg three times/day) or P according to a double-blind randomized protocol for 4 months. The effects of C or P have been evaluated with Migraine Index Correct, related to changes in F, D or S of headache attacks. Our results indicate that C is effective in reducing F, D or S in subjects with idiopathic headache.

[Study of the thyroid function in a representative sample of the population of 3 islands of the Eolian archipelago: Filicudi, Alicudi and Panarea]. / Studio della funzione tiroidea in un campione rappresentativo della popolazione di tre isole dell'arcipelago eoliano: Filicudi, Alicudi e Panarea.

The thyroid function has been subject of study on a casual and significant sample consisting of 189 individuals living in Filicudi, Alicudi and Panarea, the smallest of the inhabited islands in the Eolian archipelago. The prevalence of palpable thyroid (group 1) has resulted to be of 26.45% while the one of the visible goitre (group 2) has resulted of 5.29%. The T3 has resulted significantly lower, in the subjects with thyroid of group 2, than in the ones with thyroid of the group 0 or 1 (p less than 0.02). In the subject who are over sixty years old the circulating fT3 has resulted significantly lower and the T3 significantly more elevated than in the people who are in their twenties. Seven cases of thyrotoxicosis have been ascertained. These data show an unexpected frequency of hypertrofic thyroid in a population among which the jodic deficiency hasn't reason to be; the presence of thyrotoxicosis could be connected with the prevalence of the goitre.