Relationship between plasma aldosterone levels and arterial stiffness parameters in hypertensive patients with subclinical vascular damage.

Purpose: Aldosterone plays important role in cardiovascular damage. Aim was to evaluate arterial subclinical damage through arterial stiffness parameters in patients with Essential Hypertension (EH) and Primary Aldosteronism (PA). Methods: From 2018 to 2019 we consecutively enrolled 82 subjects (37 males and 45 women), distinguished in two groups: 60 EH [systolic blood pressure (SBP) 143.4 ± 16.7 mmHg, diastolic blood pressure (DBP) 89.5 ± 12.1 mmHg] and 22 PA (SBP 149 ± 19.5 mmHg, DBP 92.7 ± 12.4 mmHg) [5 with aldosterone-secreting adrenal adenoma(APA), 17 with idiopathic aldosteronism(IHA)]; 40 matched normotensive subjects (NS) were enrolled (SBP 109.7 ± 6.2 mmHg, DBP 71.3 ± 9.7 mmHg). We used non-invasive applanation tonometer to acquire pressure waveform. Results: PA patients showed higher µ-Albuminuria (UAE) (65.7 ± 11.0mg/24 h) than EH and NS (21.5 ± 7.0 mg/24 h and 21.5 ± 7.0 mg/24 h, respectively); APA group showed increased levels of arterial stiffness index (11.7 ± 4.8 m/s; p < 0.02) compared to EH subjects (8.3 ± 3 m/s) and NS subjects (7.2 ± 1.7 m/s) as well as higher carotid intima-media thickness (c-IMT); APA patients showed significant reduction of subendocardial viability ratio (SEVR) and travel time of the reflected waves (TI) respect EH and NS. PA groups showed high percentage of augmented "worsening age" (60%), compared to EH (38%) and NS (37%). PAC was positively correlated with Arterial Stiffness Index. Performing multiple linear regression analysis (evaluating anthropometric and biochemical parameters), we found UAE as predictor of Augmentation Index, Arterial Stiffness Index and Travel Time of reflected waves in the enrolled population. Conclusion: PA patients showed higher cardiovascular subclinical damage respect to EH; UAE excretion had significant correlation with aldosterone, resulting best marker of subclinical vascular remodeling.

Reduction of the clinical severity of sickle cell/beta-thalassemia with hydroxyurea: the experience of a single center in Greece.

The use of hydroxyurea for the prevention of sickle cell crises in patients with homozygous HbS disease is now well established. The beneficial effects of this compound stem from (a) selective enrichment of red cells containing an increased amount of fetal hemoglobin, which inhibits HbS polymerization, and (b) a decrease of leukocytes, platelets, and reticulocytes, which significantly limits their adherence to the vascular wall. We report the results of a clinical trial of hydroxyurea on 55 Greek-origin patients with sickle cell/beta-thalassemia and 14 patients with homozygous HbS disease who have been treated with hydroxyurea for several years. Such patients have a higher probability to benefit from hydroxyurea therapy, since in addition to its antisickling effect, the increase of gamma-chain synthesis is expected to diminish the deleterious effects of the unbound alpha-globin chains. Selection of patients and monitoring throughout the whole trial were done by the same clinicians. Quantitative expression of the clinical condition was done using a system scoring several outcome parameters. For a period of 52 months prior to starting treatment, the total score of severity for 59 evaluable patients was 1182 points (3068 patient-weeks), while for the 12,018 patient-weeks of the trial this parameter fell to only 82 points. Other observations of interest include the significant improvement of a group of patients with hepatic cholestasis, the development of leg ulcers possibly related to the treatment, and the dramatic increase of hemoglobin F, often in association with an increase of the total hemoglobin levels as a result of decreased hemolysis.

Review article: the management of acute liver failure.

Acute liver failure (ALF) is a relatively uncommon but dramatic clinical syndrome with high mortality rates, in which a previously normal liver fails within days or weeks. Paracetamol overdose remains the major cause of ALF in the UK, while viral hepatitis is the commonest cause world-wide. Cerebral oedema is the leading cause of death in patients with ALF. Despite advances in intensive care and the development of new treatment modalities, ALF remains a condition of high mortality best managed in specialist centres. Orthotopic liver transplantation is the only new treatment modality that has made a significant impact in improving outcome. Bioartificial liver support systems and hepatocyte transplantation are new promising treatment options that may change the management of ALF in the future.

[Anatomico-functional changes in the right ventricle of the athlete]. / Modificazioni anatomo-funzionali del ventricolo destro nell'atleta.

The aim of this study was to compare the morpho-functional modifications of the right cardiac sections of the athlete's heart, with those of sedentary healthy control subjects. We studied 24 endurance athletes (mean age 28.17 +/- 7.28 years), 21 power athletes (mean age 25.86 +/- 4.96 years), and 20 sedentary healthy control subjects (mean age 33.22 +/- 6.67 years). We examined the right cavities by standard echocardiographic projections and the following parameters were evaluated: right ventricular longitudinal diameter; under tricuspid valve and medium ventricular transversal diameter immediately under the tricuspid plane and at medium ventricular level; right atrial transversal and longitudinal diameters. All parameters were corrected for body surface area. Our data showed that the right ventricle presents morphological adaptations to endurance exercise; modification is represented mainly by an increase in the mean transversal ventricular diameter with a consequent reduction in the transversal/longitudinal diameter ratio accompanied by modification of the ventricular geometry. In addition the data showed an increase in longitudinal and transversal diameters of the right atrium. On the contrary, the power athletes did not show statistical modification of the right ventricle and atrium. The different modifications of the right heart side diameter are probably due to the different hemodynamic loading, which is involved in the endurance and power training respectively.

Detection of left ventricular systolic and diastolic abnormalities in patients with coronary artery disease by color kinesis.

BACKGROUND: Color kinesis (CK) is a recently developed echocardiographic technique based on acoustic quantification that automatically tracks and displays endocardial motion in real time and has been used in initial studies to improve the evaluation of global and regional wall motion. HYPOTHESIS: For further validation of the use of CK for analysis of segmental ventricular dysfunction, we assessed its sensitivity and specificity for detection of regional systolic and diastolic wall motion abnormalities in patients with coronary artery disease (CAD). METHODS: Two-dimensional (2-D) echocardiography and CK were used to study 15 normal subjects and 63 patients with technically good quality echocardiographic tracings, who underwent coronary arteriography within 1 month of echocardiography. Significant (> 70% luminal diameter stenosis) CAD was present in 50 patients (79%). RESULTS: Color kinesis tracked endocardial motion accurately in 93% of left ventricular segments. Wall motion score, systolic segmental endocardial motion (SEM), and the time of systolic SEM (tSEM) and diastolic (tDEM) segmental endocardial motion were calculated. Intra- and interobserver variability were within narrow limits. SEM and tSEM were significantly lower and tDEM was significantly higher in the patient population than in the control group (p < 0.001). Comparison between CK and 2-D echocardiography showed a correlation coefficient of 0.81 between the two techniques. The score was identically graded in 74% of segments, with concordance of 82% in diagnosing segments as abnormal. Interobserver concordance was 86% for CK (r = 0.85) and 81% for 2-D echocardiography (r = 0.80). The sensitivity and specificity of systolic and diastolic CK parameters for the detection of CAD were 88 and 92% and 77 and 85%, respectively. The positive predictive values were 93 and 96%, respectively, the negative predictive values were 63 and 73%, respectively, and the overall accuracy was 86 and 91%, respectively. CONCLUSIONS: Our data suggest that CK is a feasible and sensitive technique for identifying regional systolic as well as diastolic wall motion abnormalities in patients with CAD.

Postanginal sepsis syndrome with metastatic lung abscess in a young man.

A postanginal Sepsis Syndrome with metastatic lung abscess caused by Fusobacterium necrophorumin a 25-year-old previously healthy man is described. The incomplete and ineffective antibiotic treatment at onset of angina ended progressively in septicaemia and metastatic infections in a 3-week time period. The early parenteral use of Metronidazole based only on the clinical picture, the Gram stain findings and the strict anaerobic feature of the blood isolate in parallel with the long-term antibiotic treatment were possibly the main reasons for the good outcome of this serious infection.

Relative risks of limb revascularization and amputation in the modern era.

A retrospective review of 266 patients undergoing infrainguinal revascularization for limb salvage and/or major amputation (transmetatarsal, below-knee or above-knee) from 1984 to 1990 was conducted to determine comprehensive procedure-specific 30-day operative morbidity and mortality rates. Some 211 patients underwent 295 infrainguinal vascular reconstructions (195 primary and 100 secondary reconstructions). There were 122 major amputations in 98 patients (29 above-knee, 70 below-knee and 23 transmetatarsal). Most amputations were performed in patients with unreconstructable vascular disease, including 39 patients (41 extremities) with failed infrainguinal reconstruction. Procedure-specific morbidity and mortality rates were 48 and 2% for primary revascularization, 35 and 2% for secondary revascularization and 37 and 4%, for amputation, respectively. The difference in mortality between revascularization and amputation approached but did not achieve statistical significance. Cardiac, graft and wound complications were the major causes of morbidity in all groups. Nine of the 12 deaths were of cardiac etiology. Revascularization can be performed in almost all patients with advanced limb ischemia, with a mortality rate equivalent to, or perhaps lower than, that of amputation. When limb amputation is required, it can be performed with a mortality rate remarkably lower than that described in the older literature.

Influence of age on venous physiologic parameters.

PURPOSE: The incidence of deep venous thrombosis increases significantly with age. Attempts to explain this association have failed to identify factors that could be contributory. We hypothesized that age-related changes in venous physiologic parameters might contribute to an increased risk of deep venous thrombosis. METHODS: Air plethysmography was used to measure a number of physiologic parameters in two sets of patients. Group A consisted of 17 subjects (33 limbs), age range 23 to 40 years. Group B consisted of 11 subjects (22 limbs), age range 60 to 83 years. No subject in either group had peripheral vascular disease or a history of deep venous thrombosis. Parameters measured were venous volume, venous filling index, ejection volume, ejection fraction, residual volume fraction, and outflow fraction. RESULTS: Venous volume and ejection fraction were significantly reduced in Group B compared with Group A. Residual volume fraction was significantly increased in Group B compared with Group A. There were no statistically significant differences in outflow fraction, venous filling index, or ejection fraction between the two groups. CONCLUSIONS: These results suggest that the efficiency of the calf muscle pump diminishes with increasing age, possibly contributing to the increased incidence of deep venous thrombosis in the elderly.

The use of transesophageal echocardiography in the evaluation of chest trauma.

Transesophageal echocardiography (TEE) has been used over the last 10 years (1982-1992) to study the heart and thoracic aorta. We set out to evaluate the diagnostic applications of TEE in patients with thoracic trauma. Specifically, TEE was performed on patients suspected of having either a cardiac contusion or an injury of the thoracic aorta. Fifty-eight patients admitted with thoracic trauma underwent TEE. Fifty of those patients suspected of having a cardiac contusion also underwent transthoracic echocardiography (TTE). The two diagnostic modalities were compared. In 21 of these patients a wide mediastinum was apparent on admission chest x-ray films. Nineteen of this latter group underwent thoracic angiography in addition to TEE. Two patients underwent post-mortem examination. Of the 50 patients undergoing both TEE and TTE, a cardiac contusion was detected by TEE in 26 patients. Transthoracic echocardiography detected only six contusions in this group. Of the 21 patients with a wide mediastinum, TEE detected three obvious aortic disruptions. These findings were confirmed in each case by angiography. In 16 cases TEE showed the aorta to be normal. This was confirmed on the angiogram in 14 cases and by autopsy in two cases. Transesophageal echocardiography revealed an aortic intimal irregularity distal to the left subclavian artery in two cases. The results of aortography were normal in these last two cases. As a diagnostic modality, TEE more accurately detected cardiac contusions than TTE (p less than 0.001) and was a very sensitive screening tool in the early evaluation of patients with a wide mediastinum.

Inhibitory effect of high oxygen pressure on potassium- induced activation of pyruvate dehydrogenase and glucose metabolism in rat brain slices.

The effects of high oxygen pressure on pyruvate dehydrogenase (pyruvate: lipoate oxidoreductase (decarboxylating and acceptor-acylating), EC 1.2.4.1) activity, tissue concentration of ATP, and CO2 production from glucose were studied in rat brain cortical slices. The increase in pyruvate dehydrogenase activity and the lowering of cellular ATP, occurring during potassium-induced depolarization at 1 atm of oxygen, were reversed by increasing the oxygen pressure to 5 atm. When brain slices were incubated at 1 atm oxygen with [U-14C]glucose, a high potassium medium approximately doubled the production of 14CO2. Oxygen at 5 atm abolished this potassium-dependent increase in 14CO2 production with no significant effect on glucose oxidation in normal Krebs-Ringer phosphate medium. Adding 4 atm helium to 1 atm oxygen did not interfere with the ability of potassium ions to activate pyruvate dehydrogenase, lower ATP, or increase glucose oxidation. The results show that toxic effects of hyperbaric oxygen, not manifest in "resting" tissue, may be revealed during stress such as potassium depolarization. The site of the toxic effects of oxygen is probably the cell membrane where excess oxygen appears to interfere with the action of the sodium pump, calcium transport or other processes stimulated by increased concentrations of extracellular potassium.