Acta bio-medica de L'Ateneo parmense : organo della Societa di medicina e scienze naturali di Parma最新文献

Twenty-four hour BP and heart rate measurements were carried out in fourteen newly diagnosed-, and in twenty-eight diabetics with 5-13 years of duration; and in eight healthy control children. Mean arterial BP rose at night in five-, fell slightly (less than 10%) in five- and fall markedly (more than 10%) in eighteen diabetics with longer duration of the disease. The diurnal-nocturnal difference of mean arterial pressure was significantly lower in the groups with nocturnal BP rise and slight nocturnal BP fall, compared to the control group (< 0.001; p < 0.01, respectively). The diurnal-nocturnal differences of heart rates were significantly lower in diabetics with relative "nocturnal hypertension" compared to the control group (p < 0.05). The presence of subclinical signs of diabetic autonomic neuropathy was significantly higher in patients with nocturnal BP rise and slight nocturnal BP fall compared to patients with marked nocturnal BP fall and newly diagnosed diabetics (chi squared p = 0.02 and p = 0.01, respectively). In conclusion, the prevalence of autonomic symptoms in diabetic children could be related to change in diurnal/nocturnal arterial BP, however longitudinal studies of ABPM are needed to define, whether patients with abnormal BP profiles are candidates for the development of diabetic vascular disease.

The authors describe the technique applied in their first case of laparoscopic splenectomy, in a patient with idiopathic thrombocytopenic purpura. Different technical approaches adopted by other surgeons are referred and discussed. The laparoscopic approach to splenectomy seems safe and allows the patients to re return to normal activity sooner than the "open" technique. Laparoscopy should be considered in patients who require splenectomy for benign disease.

Early identification of severity is one of the most important problems in acute pancreatitis, both for decision-making and classification. Predictive criteria show a wide range of accuracy: clinical examination (on admission: 76-85%); single laboratory data (PCR: 68-98%, C3-C4: 63-72%); multifactorial scoring systems (Ranson: 65-82%, Imrie: 78-95%); diagnostic peritoneal lavage (72-90%); CT features (52-81%). In 1982 we started a prospective evaluation of the prognostic performances of a bayesian statistical model for the prediction of severe vs mild pancreatis and death vs survival, which uses the outcome-related patterns of several variables, assuming their independence, analysed on a data of 44 patients. The performances have been calculated prospectively by comparing the expected vs actual results on 88 further patients (accuracy, sensitivity and specificity, respectively, in the prediction of severe pancreatitis: 92%, 92%, 93%; in the prediction of death: 95%, 97%, 87%). Moreover, the model can represent classes of risk by combining prediction of death + severe pancreatitis (DSP), survival + severe pancreatitis (SSP) and survival + mild pancreatitis (SMP) (accuracy, sensitivity and specificity, respectively, in the prediction of DSP: 97%, 83%, 100%; in the prediction of SSP: 95%, 87%, 97%; in the prediction of SMP: 95%, 97%, 90%). Our model enables clinicians dealing with other population to re-determine different variables or integrate them with new information, whenever available. It seems to be transferable and adaptable, even with a probable further increase of the performances, without compromising the objectivity of the predictive judgement and the homogeneity of the classes of risk.

The microvascular basement membrane thickness were investigated by electron microscope within skeletal muscle of 17 untreated patients with primary hyperlipoproteinemia. The average of minimal basement membrane thickness of hyperlipidemic patients were significantly different (p < 0.001) from that of the controls (127 +/- 44.6 nm vs 39.9 +/- 12.4 nm). In conclusion, hyperlipoproteinemia without diabetes mellitus might contribute to the damage of the capillary vessel wall.

Dementia in parkinsonian patients is estimated to 10-40%. Several factors may take part in the development of cognitive impairment: i/ defective function of subcortico-cortical pathways including the mesocorticolimbic dopamine deficiency with cell loss in medial substantia nigra, the degeneration of noradrenergic, serotonergic and cholinergic systems ii/ cortical and limbic Alzheimer pathology iii/ cortical Lewy bodies iv/ vascular alterations. Using HMPAO SPECT we distinguished three main types of hypoperfusion in Parkinson patients with dementia: i/ predominantly frontal lobe type ii/ posterior ("Alzheimer-like") type iii/ multiple small vascular defects. Neuropsychological investigation was based on the use of MMSE, word pair, digit span, verbal fluency, Lurija's tapping tests. In addition CURS and Hachinski's score were also applied. Selegiline (JumexR) therapy was introduced and the patients were followed for at least 60 days. Selegiline improved significantly the MMSE values and verbal fluency in the "frontal lobe" type further the memory functions in "Alzheimer-like" patients. The mechanism is still not clarified, the increased dopaminergic tone should be taken into account.

We performed gravity cavernosometry and radio-fluoro-graphic cavernosography with pharmacological intracavernous injection in 15 patients with erectile dysfunction. On the basis of cavernosographyc findings, in the 15 patients leak sites visualized included deep dorsal vein in all 15 patients leak sites visualized included deep dorsal vein in all 15 patients (100%), cavernous veins in 7 (46,6%), glans in 4 (26,6%) and corpus spongiosum in 3 (20%). Aberrant veins documented in 4 patients (26,6%): communicating with the saphenous vein in 2 (13,3%), with scrotal veins and femoral vein in 1 (6,6%). Deep dorsal vein leakage as the only venous site was find in 2 patients (13.3%), 9 (60%) had leakage through 2 venous sites, 3 (20%) had leakage through 3 venous sites and 1 (6,6%) had leakage through 4 venous sites. Correlations among hemodynamic and radiographic observations allowed the identification of 2 types of cavernosometric findings. While type I developed an high intracavernous pressure during gravity infusion, an high intracavernous pressure was not observed in type 2. The FCG by the digital radio-fluoro-graphic digital system permit the possibility of sottraction and rielaboration of images and reduces examination and radiation time. The gravity FCM is simple, not expensive and respect the physiological intracavernous pressure.

We report our experience on 63 patients submitted to kidney stone surgery, between january '88 and june '94, at the Division of Urology, in Parma (Italy). Nowadays percutaneous lithotripsy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) permit the resolution of lithiasic disease in more than 90% of the cases; in fact, the incidence of open surgery in only about 1-12%. At the present, the role of traditional surgery is also directed to resolution of damages of endourological and extracorporeal failures, as post-traumatic events. We want to emphasize, as now, that essential surgical approach to kidney surgery is lacking in the aim of young urologists training.

Particular interest was given to 61 cases of aneurysm and all possible risks and failures of the surgical procedures were discussed. The importance of how diagnostic, technical and instrumental investigations greatly improved therapy was emphasized. The largest group of patients investigated statistically was composed of patients suffering from acute aortic dissection. Emphasis was put on how modern diagnostic technology resulted in a faster and safe procedure, keeping in mind, however, that many severe cases were still unsuccessful. With regard to traumatic lesions of the aorta, typical of young patients, the importance of a complete clinical and surgical approach was stressed in order to treat the visceral and scheletral lesions that are often present.

We report a case of a 74 old man presenting unstable angina and history of previous myocardial infarction. Coronary angiography showed significant stenoses of the left main and right coronary arteries and saccular aneurysm of the left anterior descending coronary artery. The patient underwent surgical treatment consisting in coronary artery bypass grafts and aneurysm resection. This procedure appears indicated, in author's opinion, when coronary aneurysm is saccular as in the described case.