Leukoaraiosis is associated with functional impairment in older patients with Alzheimer's disease but not vascular dementia.

BACKGROUND: Leukoaraiosis (LA) is a common finding in older persons, and might be associated with reduced cognitive performance, gait abnormalities, and functional impairment. Although LA is more frequent in persons affected by dementia, scant data are available about its clinical consequences in this group of patients. OBJECTIVE: To study the association between presence of LA and functional performance in basic activities of daily living in a sample of older persons affected by dementia. DESIGN: We conducted a cross-sectional study on 214 patients; 77 affected by late onset Alzheimer's disease (LOAD), and 137 by vascular dementia (VD). Functional status was assessed using Barthel Index (BI). LA was assessed using computed tomography. RESULTS: In LOAD patients, LA (OR: 7.87; 1.26-48.94), and MMSE score (OR: 0.83; 0.71-0.98) were associated with the risk of severe disability, independent of age, gender, diabetes, hypertension, coronary heart disease, left ventricular hypertrophy, atrial fibrillation, and brain atrophy. In VD patients, MMSE score (OR: 0.77; 0.64-0.93), and CHD (OR: 7.41; 1.09-50.21), but not LA (OR: 2.07; 0.45-9.45) were associated with a severe functional impairment after multivariate adjustment. CONCLUSIONS: Our study suggests that LA might be associated with a worse functional status in basic activities of daily living in patients affected by LOAD but not VD. LA might act synergistically with cognitive and behavioural disturbances to the onset and progression of disability of these patients.

[Lipolysis and ketosis during swimming in thermal water]. / Lipolisi e chetosi nel nuoto in acqua termale.

Plasma free fatty acids, blood glucose, beta-hydroxybutyrate and acetoacetate variations were studied in rats during swimming. Rats were forced to swim for 30 min in thermal water (source of Abano Terme) at 35 degrees and in normal water at 25 degrees. During swimming in thermal water plasma free fatty acids were increased, the glycemia remained unaffected, the beta-hydroxybutyrate and acetoacetate decreased. The swim in normal water induced a sharp increase of plasma free fatty acids, a decrease of blood glucose, an increase of blood beta-hydroxybutyrate and a marked decrease of acetoacetate. From these data, some indications of clinical interest are presented and discussed.

Verapamil-induced changes in digoxin kinetics in cirrhosis.

The influence of a single low dose of verapamil (80 mg) on the serum levels of digoxin (single dose of 0.5 mg) was studied in 6 patients with hepatic cirrhosis and in 6 healthy volunteer controls. In the cirrhotic patients verapamil increased the peak serum level and the total AUC of digoxin by 98% and 32%, respectively. There was an associated 23% decrease in the renal digoxin clearance. In normal subjects only marginal alterations in digoxin kinetics were observed following verapamil administration. The results indicate that cirrhosis magnifies the influence of verapamil on digoxin kinetics.

[Diagnostic aspects and results of drug therapy in pulmonary thromboembolism]. / Aspetti diagnostici e risultati della terapia medica nella tromboembolia polmonare.

Out of a group of 28 patients examined for suspected pulmonary thromboembolism (PTE), the diagnosis was confirmed by angiopneumography in 18 cases. In these patients the symptoms and clinical, electrocardiographical, radiological and scintiphotographical findings corresponded with those reported in the literature. 9 patients were treated with Urokinase (UK) at the dosages recommended by the Food and Drug Administration (FDA), followed by full-dose heparin, and 9 were treated with heparin alone. All patients survived and were discharged undergoing warfarin treatment. Follow-up checks were made after 1 and 6 months. Most of the patients treated with UK showed signs of swift improvement (within 24 hours) in clinical and instrumental terms with no significant haemorrhagic complications. An improvement was also observed in patient treated with heparin alone after the first week of treatment. To conclude: a) clinical diagnosis of PTE is neither sensitive nor specific; b) standard blood tests, electrocardiogram, chest x-ray and lung perfusion scintiphotography display different degrees of sensitivity compared with angiopneumography but all have a poor specificity; c) thrombolytic treatment is safe and effective in selected cases; d) long-term clinical results do not depend on treatment given during the acute stage of the disease.

Do malfunctioning bioprosthetic heart valves represent a potential thrombogenic focus?

In vivo platelet reactivity, expressed by plasma concentration of beta-thromboglobulin (beta TG) and platelet factor 4 (PF4), was determined in 57 patients with bioprosthetic heart valves: 35 had well-functioning bioprostheses (WFBP), while 22 had documented malfunctioning bioprostheses (MFBP). beta TG and PF4 values in patients with WFBP were not significantly different from controls, even when these determinations were repeated at monthly intervals, whereas beta TG and PF4 concentration was significantly higher in patients with MFBP compared to both groups. There was a strong positive correlation between beta TG and PF4 in all subjects studied. Serum lactic dehydrogenase, indirect bilirubin level and reticulocyte count were significantly higher in patients with MFBP than in those with WFBP, but no correlation was found between platelet reactivity and rate of intravascular hemolysis. Our results suggest that there is an increased platelet release in vivo of the platelet-specific proteins in patients with MFBP not related to mechanical damage, and that bioprostheses, at least in a degenerative state, may represent a potential thrombogenic focus.

[Clinical and statistical evaluation of the hypotensive effectiveness of 3 therapeutic plans in essential hypertension]. / Valutazione clinico-statistica dell'efficacia ipotensiva di tre schemi terapeutici nell'ipertensione essenziale.

The analysis of variance and Student's "t" test were applied in an assessment of the hypotensive effectiveness of three hypotensive protocols: a) diazepam + amitryptiline; b) reserpine + chlorthalidone; c) all drugs in 57 and 32 patients with stabilised essential hypertension. Diazepam + amitryptiline proved effective, both alone and in protocol b).

[Ankylosing hemorrhagic arthropathy in a patient with Von Willebrand's disease (angiohemophilia A)]. / Artropatia emorragica anchilosante in paziente con malattia di Von Willebrand (angioemofilia A)

A case of von Willebrand's disease with unusual clinical manifestations is described. The disease was characterized by the presence of insistently recurring haemarthroses, starting from infancy, involving a number of joints, ending in ankylosis. Bleeding time was lengthened and the patient presented antihaemophilic globulin deficiency and decreased platelet adhesiveness.