[The influence of Cytoflavin therapy on the cerebral hemodynamics in patients with various stages of hypertensive disease]. / Vliianie terapii preparatom tsitoflavin na sostoianie tserebral'noi gemodinamiki pri razlichnykh stadiiakh gipertonicheskoi bolezni.

AIM: To study an influence of cytoflavin therapy on the cerebral hemodynamics in patients with various stages of hypertensive disease (HD). MATERIAL AND METHODS: One hundred and forty patients with HD, I-III stages, were randomized into 2 groups: patients of group 1 received complex treatment (antihypertensive therapy and cytoflavin), patients of group 2 were treated with antihypertensive therapy. The control group consisted of 30 healthy people. The changes in cerebral hemodynamics using the algorithm of the complex ultrasound study of cerebral vascular system were assessed. RESULTS: Disturbances of hemodynamics at all structural/functional levels of cerebral vascular system were found in all HD stages. There were a decrease in the blood flow through the common carotid, inner carotid, spinal and middle cerebral arteries, reactivity of veins of Rosenthal, blood flow through veins of Rosenthal and inner jugular veins and an increase of blood flow through spinal veins. The hemodynamic study showed that in group 1 there was the increase of blood flow through common carotid, inner carotid, middle cerebral arteries in stage I and through spinal arteries in stage I-II of HD; improvement of the reactivity of veins of Rosenthal, restoration of blood flow parameters through the veins of Rosenthal and inner jugular veins to control values, the decrease in blood flow velocity through the spinal veins in all HD stages. CONCLUSION: HD is accompanied by the damage of all structural/functional levels of cerebral vascular system. The use of cytoflavin in the complex therapy of HD exerts a positive influence on the cerebral hemodynamics reducing the severity of arterial insufficiency in the initial stages of disease, improving microcirculation and venous hemodynamics in all HD stages.

Cold storage of Acartia tonsa eggs: a practical use in ecotoxicological studies.

The calanoid copepod Acartia tonsa has been recommended as a marine organism for ecotoxicological tests due to its wide distribution, short life cycle and high productivity. This species is used in acute and chronic toxicity tests to assess water and sediment quality; egg hatching success and the survival of the first larval stages are considered endpoints. Toxicity test protocols require a large number of organisms and an appropriate culture system. Eggs stored under conditions that delay hatching could ensure sufficient quantities of biological materials for ecotoxicological tests. In the current study early-spawned eggs were stored at 3 °C (±1) up to 240 days and their hatching success was evaluated on a monthly basis. Our results showed that the percentage of hatching success for eggs stored for 30 days was >80 % and decreased by about 8 % for every 20 days of storage, up to 120 days. A further increase of time in cold storage brought about a significant reduction, in statistical term, of hatching success compared with the control group (43.69 ± 22.19 %). Almost 50 % of eggs hatched or died during the cold storage period, with more than 80 % lost after periods longer than 150 days. To verify the suitability of stored eggs for toxicity test, 48 h acute tests were performed using nickel chloride as a referent toxicant. Eggs stored for 30, 60, 90 and 120 days gave EC50 values ranging from 0.130 to 0.221 mg L(-1), similar to the value recorded for early-spawned eggs, suggesting that these eggs can be used for ecotoxicological tests. Our results open new possibilities for a wider use of the Mediterranean strain of A. tonsa copepod for ecotoxicological tests.

Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP)-2013.

Primary lymphedema can be managed effectively as a form of chronic lymphedema by a sequenced and targeted treatment and management program based around a combination of Decongestive Lymphatic Therapy (DLT) with compression therapy, when the latter is desired as an adjunct to DLT. Treatment in the maintenance phase should include compression garments, self-management, including self-massage, meticulous personal hygiene and skin care, in addition to lymphtransport-promoting excercises and activities, and, if desired, pneumatic compression therapy applied in the home. When conservative treatment fails, or gives sub-optimal outcomes, the management of primary lymphedema can be improved, where appropriate, with the proper addition of surgical interventions, either reconstructive or ablative. These two surgical therapies can be more effective when fully integrated with manual lymphatic drainage (MLD)-based DLT postoperatively. Compliance with a long-term commitment to MLD/DLT and particularly compression postoperatively is a critical factor in determining the success of any new treatment strategy involving either reconstructive or palliative surgery. The future of management of primary lymphedema has never been brighter with the new prospect of gene-and perhaps stem-cell oriented management.

Sustainability evaluation of Sicily's lemon and orange production: an energy, economic and environmental analysis.

The island of Sicily has a long standing tradition in citrus growing. We evaluated the sustainability of orange and lemon orchards, under organic and conventional farming, using an energy, environmental and economic analysis of the whole production cycle by using a life cycle assessment approach. These orchard systems differ only in terms of a few of the inputs used and the duration of the various agricultural operations. The quantity of energy consumption in the production cycle was calculated by multiplying the quantity of inputs used by the energy conversion factors drawn from the literature. The production costs were calculated considering all internal costs, including equipment, materials, wages, and costs of working capital. The performance of the two systems (organic and conventional), was compared over a period of fifty years. The results, based on unit surface area (ha) production, prove the stronger sustainability of the organic over the conventional system, both in terms of energy consumption and environmental impact, especially for lemons. The sustainability of organic systems is mainly due to the use of environmentally friendly crop inputs (fertilizers, not use of synthetic products, etc.). In terms of production costs, the conventional management systems were more expensive, and both systems were heavily influenced by wages. In terms of kg of final product, the organic production system showed better environmental and energy performances.

Treatment of chronic venous disease with flavonoids: recommendations for treatment and further studies.

OBJECTIVES: A variety of studies have suggested that flavonoids are effective for the treatment of CVD. However, many questions remain about their mechanism of action and when, how, and for what signs and symptoms they should be used. METHOD: A panel of experts in CVD met in Budapest, Hungary in December 2011 to discuss the current state of knowledge of CVD and the role of flavonoids in its treatment. The discussion was based on a literature search in the current databases. The goals of this paper are recommendations for further studies on the use of flavonoids in the treatment of CVD. RESULTS: There is good evidence to recommend the use of flavonoids in the treatment of CVD. However, because of the poor quality of some older clinical trials, inadequate reporting, and insufficient information, much work is still needed to firmly establish their clinical efficacy and to determine when and how they should be employed. In particular, long-term randomized, placebo-controlled, double-blind studies are needed to establish the efficacy and safety of flavonoids. Additional studies are also needed to establish their mechanism of action, pharmacokinetics, toxicity, and cost-effectiveness. CONCLUSIONS: Aside from good evidence for the use of flavonoids in CVD further studies are indicated to establish long term treatment in this indication.

Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program.

AIM: The Vein Consult Program is an international, observational, prospective survey aiming to collect global epidemiological data on chronic venous disorders (CVD) based on the CEAP classification, and to identify CVD management worldwide. The survey was organized within the framework of ordinary consultations, with general practitioners (GPs) properly trained on the use of the CEAP classification. METHODS: Screening for CVD was to be performed by enrolling in the survey all consecutive outpatients >18 years whatever the reason for consultation, to record patient's data and classify them according to the CEAP, from the stage C0s to C6. The program enrolled 6232 GPs 91545 subjects were analysed. Their mean age was 50.6±16.9 years, younger patients being in the Middle East and older ones in Europe, and the proportion of women was higher than that of men. RESULTS: The worldwide prevalence of CVD was 83.6%: 63.9% of the subjects ranging C1 to C6, and 19.7% being C0s subjects. C0s patients were more frequently men whatever the age and the geographical zone. C1-C3 appeared to be more frequent among women whatever the country but the rate of severe stages (C4-C6) did not differ between men and women. GPs consider CVD subjects as patients eligible to specialist referral beginning from C2 but some geographical disparities were observed. CONCLUSION: The VCP survey provides reliable results on CVD global epidemiology and shows that CVD affects a significant part of the populations worldwide, underlining the importance of adequate screening for CVD and training of both GPs and specialist physicians.

Microphthalmia due to congenital varicella infection: a case report.

The authors report the clinical case of a newborn affected by congenital varicella syndrome, occurred about the 12th gestational week, with ophthalmic involvement. The ocular anomalies consisted in right microphthalmia, with lens opacities and atrophic chorioretinitis, without any involvement of other pathologies. The ophthalmic lesions and the sierological data confirmed that the infection occurred during the first weeks of gestation. Although the manifestation limited to the eyes is extremely rare, the authors point out the necessity of an appropriate prevention to avoid irreversible involvements of important organs.

Ophthalmological manifestations in segmental neurofibromatosis type 1.

AIMS: To study the ophthalmological manifestations in individuals with the typical features of neurofibromatosis type 1 (NF1) circumscribed to one or more body segments, usually referred to as segmental NF1. METHODS: Visual acuity and colour tests, visual field examination, slit lamp biomicroscopy of the anterior segment, and a detailed examination of the retina by indirect ophthalmoscopy were performed at diagnosis and follow up in 72 consecutive subjects (29 males, 43 females; aged 1-64 years; mean age 14.6 years) seen at the university departments of paediatrics in Catania and Rome, Italy, during years 1990-2003, who had in restricted body areas: (1) typical pigmentary manifestations of NF1 (cafe au lait spots and freckling) only (n = 48); (2) NF1 pigmentary manifestations and neurofibromas alone (n = 2); (3) neurofibromas only (n = 15); and (4) plexiform neurofibromas only (n = 7). RESULTS: None of the 72 patients had Lisch nodules in the iris irrespective of age at eye examination or hypertelorism (a "minor" NF1 feature) and none developed typical associated ophthalmological NF1 complications. An additional child had an isolated optic pathways glioma (OPG), which behaved both biologically and radiographically as an NF1 associated OPG. CONCLUSIONS: This represents the first systematic study reporting on eye involvement in the largest series of individuals at different ages having segmental NF1. As one of the postulated mechanisms to explain segmental NF1 is somatic mosaicism for the NF1 gene (so far demonstrated only in two patients) the present findings could be explained either by the fact that the eye is too far from the mutated area with NF1 lesions in most cases or by the NF1 (or other "predisposing" or "cooperating") gene mutation restricted to too few cellular clones or to tissues embryologically different from the eye.

The incidence of venous disease in Brazil based on the CEAP classification.

BACKGROUND: Venous disease presents an extremely complex problem with various clinical manifestations. This is an epidemiological study of venous disease as it occurs in an area of Brazil. For the first time in Brazil the CEAP classification is used. METHODS: A total of 2104 people, were randomly recruited at the registration desks of the General Policlinic Department of the University Hospital and public health centers. The "C" of the CEAP classification was used to classify the clinical features of the venous diseases. The subjects were categorized according to sex and age. In addition, women were also subdivided according to number of their pregnancies. RESULTS: In the age group of females aged 14 to 22, we found 46.42% without symptoms and obvious veins (CEAP 0A/0A). Only 12.29% were symptomatic, and 41.25% of all patients in this group presented with visible veins or telangiectasias, though without symptoms. In the age group of women ranging from 23 to 48, 66.47% had had up to 3 pregnancies. In this group 10.43% were (CEAP 0A/0A). Those who had symptoms with prominent veins totaled 37.53% and those who presented with prominent veins without symptoms, 51.83%. In the female group over 48 years of age, only 4.67% were (CEAP 0A/0A). The majority (62.79%) had symptoms and prominent veins. In the male group, the greater part (65.54%) was (CEAP 0A/0A). Only 13.97% were considered symptomatic with some kind of prominent veins. CONCLUSIONS: This large epidemiological study is the first in Brazil to validate the CEAP classification as an important tool in the epidemiology of venous pathology: a method allowing an objective approach to venous disease. The data in this study were similar to those of western countries. Venous disease was found to be much more frequent in females than males. Age and number of pregnancies are important factors in the development of the disease. Over 50% of young women presented with visible veins in their legs but were without symptoms and this was considered a purely esthetic problem.

Netilmicin: in vitro activity, time-kill evaluation and postantibiotic effect on microorganisms isolated from ocular infections.

The in vitro activity of netilmicin and other antibiotics against ocular gram-positive and gram-negative microorganisms was evaluated. Netilmicin showed excellent activity against all the tested microorganisms, with more than 90% susceptibility. Many gentamicin- and tobramycin-resistant strains were still susceptible to netilmicin, although the minimum inhibitory concentration values of netilmicin were higher than those for the fully susceptible strains. In time-kill studies, netilmicin showed bactericidal activity within 1 h against Pseudomonas aeruginosa and Staphylococcus aureus. Moreover, netilmicin showed a postantibiotic effect of 2.4 h against P. aeruginosa and 1.5 h against S. aureus. These values were longer than those showed by ofloxacin, i.e. 2.1 and 1.4 h, respectively.

Effects of nicergoline on the retinal and cortical electrophysiological responses in glaucoma patients: a preliminary open study.

PURPOSE: The retinal dysfunction and the delayed visual cortex responses shown by patients affected by glaucoma can be objectively assessed by Pattern Electroretinogram (PERG) and Visual Evoked Potentials (VEP) recordings. The present study aims to evaluate the effects of nicergoline on the retinal function and on the visual cortical responses in glaucoma patients. METHODS: Sixty patients (mean age 44.6+/-3.7) with open angle glaucoma were enrolled. The patients were divided into two groups: NG Group, where 30 patients were treated with nicergoline (Cebran((R)), 2 cps day) for 30 days; and CG Group, where 30 patients were not treated. Simultaneous recordings of PERG and VEP were performed in NG patients at the baseline, at 30 days after treatment with nicergoline (day 30), and at 45 days from the end of the treatment (day 75). PERG and VEP were recorded in CG patients at the baseline and after 30 and 75 days. The visual stimulus for recording PERGs and VEPs was a checkerboard whose elements subtended a visual arc of 60' and 15' with a 70% contrast, and alternated at a frequency of 2 Hz. RESULTS: At the baseline none of the electrophysiological parameters observed in NG Group patients differed (P>0.05) from those of CG Group patients. At days 30 and 75, in CG Group patients the values of the PERG and VEP parameters were unmodified (P>0.05) with respect to the baseline. In NG Group patients, the 30-day treatment period with nicergoline induced a significant (P<0.01) improvement of the PERG and VEP parameters. At day 75 all the electrophysiological parameters of NG Group did not differ significantly (P>0.05) from those at the baseline. CONCLUSION: Treatment with nicergoline induces an improvement of the retinal function and of the visual cortical responses in patients affected by glaucoma. This effect disappears within 45 days after the suspension of the treatment.

[Incidence of ROP (Retinopathy of Prematurity) in hypoxemic neonates: case contribution]. / Incidenza della ROP nei neonati ipossiemici: contributo casistico.

In this retrospective study the Authors correlated the hypoxia with the severity of retinopathy of prematurity (ROP) in a population of 683 outborn preterm infants (bw < 2500 g and gestational age < 38 weeks). They excluded all cases with specific pathological conditions. Among neonates with the same gestational age the incidence of ROP was higher (p < .05) in those with hypoxia (pH < 7.25, tcPO2 < 50 mmHg). These data suggest that hypoxia plays a role in the pathogenesis of ROP.

Training in colposcopy: experience with a videocolposcopy test.

The authors evaluate the results of a videocolposcopy test (330 total cases, 12 cases of histologically confirmed CIN2 or more severe lesions) taken by 9 accredited and 17 unaccredited colposcopists during 1995. Seven of 9 accredited and 4 of 13 unaccredited colposcopists reached the requested standard (sensitivity > 90%, biopsy rate < 60%). Performance was definitely better when the test was not blind to the cytologic report (4 of 13 reached the requested standard) with respect to blind reading (none of 17). The study confirmed that colposcopy at unaccredited practices is poorly accurate. Colposcopic assessment of patients with abnormal smears should be centralized in accredited practices, which should undergo periodic quality control to guarantee screening efficacy. Tape-recorded videocolposcopy tests are a good, simple, practical and inexpensive method for interobserver quality control of colposcopic performance.

SHORT syndrome: a new case with probable autosomal dominant inheritance.

A further case of SHORT syndrome is reported. This 9-year-old Italian boy was short of stature and had partial lipodystrophy, minor facial anomalies, mild hyperextensibility of joints, ocular depression, Rieger anomaly, delay in speech development and in dental eruption. The father and sister showed a striking similarity to the propositus. Moreover, the sister had bilateral and symmetrical lens opacities, which have not been reported previously in affected subjects or their relatives. A variable expression of an autosomal dominant gene can be considered in the present family.

Carbohydrate deficient glycoprotein syndrome type I: ophthalmic aspects in four Sicilian patients.

Four patients with carbohydrate deficient glycoprotein (CDG) syndrome type I underwent ophthalmic examination. All of them had retinitis pigmentosa with extinguished scotopic electroretinogram. The importance of CDG syndromes as one of the metabolic causes of retinal dystrophy with 'bony spicule' pigment is stressed.

[Variations of blood bilirubin levels in the newborn with and without retinopathy of prematurity (ROP)]. / Variazioni dei livelli bilirubinemici nei neonati con e senza retinopatia della prematurità (ROP).

Retinopathy of prematurity (ROP) is a multifactorial disease where production of free radicals is a pathogenic factor. Bilirubin is regarded today as the most powerful antioxidant substance "in vitro". To test such effect "in vivo" we studied 219 premature infants, admitted to our Neonatal Intensive Case Unit from April 1991 to October 1992, evaluating their serum bilirubin levels from day two to seven and mean bilirubin level of first week for each child. We also calculated the mean rate of daily increase of bilirubin. Our results show that bilirubin parameters considered are higher in neonates which will develop ROP of every stage than in the control ones. These results therefore do not support the concept that bilirubin could have a role in the prevention of ROP.