This brief commentary is focused on the experimental procedures employed in the evaluation of both cognitive and balance impairments of aging patients. This is an important ergonomic issue that might be used for research purposes. In fact, the corrected assessment of impairments during aging may favor the development of new integrated ergonomic strategies to ameliorate ADL together with the reduction of environmental risks.
Background: Hepatorenal syndrome (HRS) is a functional acute renal failure occurring in patients with advanced liver disease: the etiology of HRS is still unknown, but a role in its development and maintaining is played by the atrial natriuretic peptide-renin-aldosterone system. Aim of the study was to investigate the circulating plasma levels of the atrial natriuretic peptide (pANP), plasma renin activity (PRA) and plasma aldosterone (pA) in a group of HRS patients, compared to healthy controls.
Methods: Venous blood samples were drawn at 8:00 am in 36 healthy controls and in 20 patients with HRS following liver cirrhosis for the radioimmunoassay measurement of the circulating pANP, PRA and pA levels. The mean values of each variable were compared between the two groups by the "t" test; linear regression analysis was used to correlate the values of pANP and PRA, pANP and pA, and PRA and pA in the two groups.
Results: HRS patient presented significant (p < 0.05) higher levels of pANP, PRA and pA than controls. Significant (p < 0.001) relations were found in healthy subjects between pANP and PRA (r = -0.78), pANP and pA (r = -0.68), and PRA and pA (r = 0.71), whereas the HRS group have only a significant (p < 0.001) positive relation between pANP and PRA (r = 0.67).
Conclusions: These data indicate that HRS is not due to a deficiency in circulating pANP. The elevated pANP levels in HRS may suggest a renal insensitivity to its natriuretic effects, and the derangement in the relationships and function in the atrial natriuretic peptide-renin-aldosterone system could be considered an important pathophysiologic mechanism in the hydro-electrolyte unbalance of HRS.
The authors report two cases of a particular type of migraine with aura, known as familial hemiplegic migraine (FHM). According to the International Headache Society (IHS) diagnostic criteria, the FHM can be diagnosed with the exception of organic causes, in a patient with migraine with aura including emiparesis of anything severity and with an end occurring a member of the family with similarity in the attach pattern. The two clinical cases reported clearly show these features and they can be considered exemplary for this type of pathology. This rare type of migraine has an unknown etiology, it seems to depend on a decreases of cerebral blood flow originative on the occipital lobe, over the subsequentially spreading anteriory region temporal and parietal lobe. The hypoperfusion with the next following neural ischemia is related to the variation of blood flow and/or "the spreading depression" supported by Leao and Olesen recently. We wanted to show these two cases so that the psychiatrist, the pediatrician, and the neurologist can be able to refer parents to the right approach, considering possibility of a pathology rare but benign; this is the FHM.
The authors valued the incidence and clinical therapeutic aspects of Haemophilus influenzae type b (Hib) meningitis in children. They report a retrospective study, in children, with diagnosis of acute purulent meningitis, from January 1982 to December 1994, aged between 1 month and 14 years. Particular attention was direct to Haemophilus influenzae type b meningitis (20 cases). The incidence rate of Hib meningitis in the overall cases (89) was 22.47% (20), while among children younger than 5 years Hib was the most frequently pathogen isolated (20/58-34.47%). In 1/4 of cases, particularly in children younger than 1 years, exordium was aspecific and unclear. At admission culture and examination of Cerebrospinal Fluid (CFS) have been done. CFS was cultured on blood agar and chocolate plates. A latex agglutination test was used for rapid detection of the bacterial antigens. In some cases we looked for bacterial antigens in urine. 20% of children had complications and 10% had sequelae (1 years of follow-up). We didn't have any dead. Antibiotic treatment was principally with Ampicillin, Cephalosporin and Chloramphenicol. The results of this study confirm the Hib gravity and suggest that the administration of conjugate vaccine against Hib to all living in Italy is justified.
Objectives: To evaluate the incidence of bacterial colonization in the throat and in urines of children admitted to a paediatric ward in the year 1994. To test the sensitivity of isolates on the most common antibiotics used in therapy.
Methods: The investigation was carried out on a group of 270 children (125 male and 145 female), aged between 3 months and 12 years, hospitalized with feverish infectious pathology in the department of infectious and Tropical Diseases of the University "La Sapienza" of Rome. The cultures of the throat swabs and on urines were performed on the admission of the children before the beginning of the therapy.
Results: The throat-swab cultures showed pathogenous microrganisms in 232 samples (85.9%) with a slight prevalence of Gram-negative bacteria (122) with respect to Gram-positive (110) and saprophytic microbial flora (38). The urine cultures proved to be positive in 81 cases (30%) with a prevalence of Gram-negative (56) above Gram-positive isolates (25).
Conclusions: The two/thirds of paediatric patients hospitalized in an Infectious Diseases Department appeared to be colonized in the upper respiratory tract, whereas in about 10% of them a marked bacteriuria was clearly evident, often in the absence of specific symptoms. A few isolates either from the throat or from urines, showed resistance to the common antibacterial agents.
In order to define the relationship, if any, between serum uric acid and insulin pattern in different types of diabetes mellitus, 4 groups of subjects (controls, and affected by type 1 and type 2 diabetes mellitus, with and without obesity) were considered. In each group, successively cleared of the long-term and complicated diabetic patients, serum and urinary uric acid and insulin secretion (serum C-peptide values) were determined. Serum uric acid and C-peptide values were higher in type 2 obese diabetic subjects vs the other groups of patients and controls (p < 0.001). No difference was found, on the contrary, between creatinine clearance and urinary excretion of uric acid among the groups. Moreover, serum uric acid values were in positive correlation (p < 0.02) with serum C-peptide values considering, among the diabetic subjects, only those with duration of diabetes less than 5 years and without micro-macrovascular complications. In conclusion, these data lead to presume that diabetic patients with short duration of disease and without complications show a different serum uric acid pattern, strictly related to beta-cellular secretion.
Arterial hypertension is a common finding in climacteric women even though the role of reduced estrogen levels in promoting this condition remains unclear. The purpose of the present survey was to evaluate the effects of hormone replacement therapy in hypertensive postmenopausal women. 180 patients were studied; they had been postmenopausal for 12-18 months and afflicted with mild or moderate essential arterial hypertension for less than 2 years. Patients were randomly divided into two groups and treated with progestin-estrogen therapy (group I, 96 patients) or with antihypertensive drugs (group II, 84 patients). Fourty-one cases in group I (42.7%) responded adequately to hormone therapy with persistent normalization of blood pressure levels; antihypertensive drugs were effective in 61 patients in group II (72.5%). The 23 unresponsive patients in group II were subsequently treated with progestin-estrogen therapy and a normalization of pressure values was achieved in 10 of these (43.5%). These results suggest that hormonal treatment determines, in at least one third of the cases, a significant reduction in blood pressure values. Moreover, hormone replacement may be effective even in patients that have not responded to antihypertensive drugs.
Acute idiopathic pseudo-obstruction of the colon, or Ogilvie's syndrome, is a rather unfrequent condition. Although it has been associated to a variety of pathological conditions, the etiology is still unknown. The authors refer upon a case of Ogilvie's syndrome observed by them and, confronting the data that emerged reviewing the literature with their experience, they retain that if the conservative therapy fails, and in absence of perforations or ischemic lesions, the treatment to prefer is the positioning of a cecostomy tube in local anesthesia. For elderly patients with unsufficiently good general conditions who present a recurrent acute pseudo-obstruction of the colon, it is advisable to confection a definitive cecostomy.
Three hundred and seventy subjects (217 women and 153 men) affected by essential hypertension of moderate or severe degree were studied. Their age ranged from 28 to 57 years, with a mean of 47 years. 251 patients had a normal electrocardiogram (ECG) and 119 patients an abnormal ECG: 78 with T wave abnormalities, 4 with Q-S segment abnormalities, 9 with left bundle branch block and 28 with left ventricular hypertrophy. Control group was composed by 45 non hypertensive subjects matched for age and sex. Glucose and insulin concentrations, before and after the oral glucose intake, were higher in patients with essential hypertension than in control group. The hypertensive patients with abnormal ECG were found to have higher plasma insulin response, high triglyceride plasma levels, total cholesterol and LDL cholesterol concentrations, associated with a significant increase in the total cholesterol/HDL cholesterol ratio.
The secondary drug failure is a well known phenomenon in the development of type 2 diabetes mellitus, but an exact definition of this situation is still lacking. The aim of this research was to evaluate the beta-cell reserve in non obese diabetic patients in relation to the metabolic control and the duration of disease. The main aim was to identify values of postprandial plasma C-peptide that can characterize the patients requiring insulin treatment. A daily profile was performed in 135 non obese diabetic patients, within 20% of their ideal body weight. The mean diurnal values (m) and the mean post-prandial increases (delta mpp) of plasma glucose (G), insulin (IRI) and C-peptide (CP) were assessed. Fourty-four patients showed good (NwD-GC: G-m = 138 +/- 3.2 mg/dl) and 91 poor metabolic control (NwD-SF: G-m = 210 +/- 4.8 mg/dl), according to the G-m lower or higher than 150 mg/dl. Beta-cell reserve (CP-delta mpp: 0.70 +/- 0.03 vs 1.39 +/- 0.04 ng/ml) and C-peptide/insulin molar ratio (CP/IRA-delta mpp: 2.36 +/- 0.06 vs 2.80 +/- 0.06) were significantly lower (p < 0.001) in NwD-SF than in NwD-GC. NwD-GC and NwD-SF were respectively divided into three subgroups, according to the duration of disease. A progressive reduction of CP-delta mpp and an increase in SF prevalence, from the first to the third decade of diabetes duration, was observed. In both NwD-Gc and NwD-SF the duration of disease inversely correlated with CP-delta mpp (NwD-GC: y = 1.59-0.019X, p < 0.001; NwD-SF: y = 1.01-0.023X, p < 0.001). The analysis of the two regression lines showed that patients with CP-delta values lower than 1.0 ng/ml require insulin treatment. In conclusion the duration of diabetes and the progressive reduction of beta-cell reserve represent the major pathogenetic factors in secondary failure.
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