Duplex-Doppler ultrasonography in the evaluation of cirrhotic patients with portal hypertension and in the analysis of their response to drugs

Sixteen patients (15 males, aged 48-70) affected by liver cirrhosis and oesophageal varices were subjected to duplex-Doppler ultrasonographic study (DDUS). Four patients (three with a portal thrombosis and one with a hepatofugal portal flow) were excluded from the subsequent pharmacological test. The twelve remaining patients took part in a double blind cross-over study that evaluated the variations of heart rate (HR), mean systemic arterial pressure (SAP), portal vein diameter (PVD), maximal and mean portal flow velocity (PFV) after the administration of either 40 mg of propranolol or placebo per os, on two consecutive days. Propranolol caused no significant variation in mean SAP and in PVD, whereas it reduced the HR from 67.7 +/- 8.0 to 58.4 +/- 7.0 beats/min (mean +/- s.d.; P less than 0.001); the maxPFV dropped from 18.2 +/- 5.4 to 14.0 +/- 3.7 cm/s (P less than 0.001) and the meanPFV dropped from 15.3 +/- 4.1 to 13.2 +/- 3.1 cm/s (P less than 0.005). No significant variation was observed with placebo. After propranolol administration eight patients exhibited a significant maxPFV decrease, whereas the other four patients exhibited only a drop in HR, suggesting either drug inefficacy, inappropriate dosage or inadequate duration of treatment. DDUS is the only non-invasive method for the examination of the portal vein system.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment with GnRH agonists before myomectomy and the risk of short-term myoma recurrence

Summary. Twenty-four women with symptomatic multiple uterine myomas were allocated randomly to treatment with buserelin, 1200μg/day intranasally, for 3 months followed by myomectomy ( n = 8) or to immediate myomectomy ( n = 16). Pre-operative treatment with buserelin reduced the mean uterine volume from 432 (SD 165) to 242 (SD 82) ml ( P < 0.01) but intra-operative blood loss and postoperative morbidity were not significantly less in this group. Six months after operation, pelvic examination was normal in all the patients. However, ultrasonography with transvaginal probe demonstrated the presence of myomas of < 1.5 cm in five women (63%) treated pre-operatively with the analogue and in two women (13%) who underwent immediate surgery (P < 0.05). Induction of a period of hypo-oestrogenism before myomectomy seems to favour short-term recurrence of uterine myomas, limiting the efficacy of surgery.     

Stress vulnerability and the effects of moderate daily stress on sleep polysomnography and subjective sleepiness

The purpose of this study was to investigate if and how sleep physiology is affected by naturally occurring high work stress and identify individual differences in the response of sleep to stress. Probable upcoming stress levels were estimated through weekly web questionnaire ratings. Based on the modified FIRST‐scale (Ford insomnia response to stress) participants were grouped into high (n = 9) or low (n = 19) sensitivity to stress related sleep disturbances (Drake et al., 2004). Sleep was recorded in 28 teachers with polysomnography, sleep diaries and actigraphs during one high stress and one low stress condition in the participants home. EEG showed a decrease in sleep efficiency during the high stress condition. Significant interactions between group and condition were seen for REM sleep, arousals and stage transitions. The sensitive group had an increase in arousals and stage transitions during the high stress condition and a decrease in REM, whereas the opposite was seen in the resilient group. Diary ratings during the high stress condition showed higher bedtime stress and lower ratings on the awakening index (insufficient sleep and difficulties awakening). Ratings also showed lower cognitive function and preoccupation with work thoughts in the evening. KSS ratings of sleepiness increased during stress for the sensitive group. Saliva samples of cortisol showed no effect of stress. It was concluded that moderate daily stress is associated with a moderate negative effect on sleep sleep efficiency and fragmentation. A slightly stronger effect was seen in the sensitive group.     

Safety and Long‐Term Outcome of Modified Intracardiac Echocardiography‐Assisted “No‐Balloon” Sizing Technique for Transcatheter Closure of Ostium Secundum Atrial Septal Defect

Background: The need for sizing the secundum atrial septal defect (ASD) with the balloon sizing technique is still debated at least in adult patients. We sought to prospectively evaluate the effectiveness of intracardiac echocardiography (ICE)‐aided sizing technique for transcatheter closure of secundum ASD, without using a balloon sizing. Methods: In a prospective 5‐year registry, we enrolled 81 patients (mean age 48 ± 13.7 years, 54 females) who had been referred to three different centers for catheter‐based closure of secundum ASD. Eligible patients underwent ICE study and closure attempt. In a preliminary group of 21 patients, sizing balloon was performed under ICE guidance to assess the value of rim thickness necessary for device anchorage. In the remaining 60 patients, the retrieved value of the rim thickness was measured on ICE and used as key points to measure the defect and select the device. Results: In the preliminary group of patients, the value of thickness at point of initial deflection by the balloon was 1.23 ± 0.1 mm. ASD diameter in the study group was measured at the point of rim with at least 1.2 mm and the mean ASD diameter was 26.2 ± 10.1 mm. Rates of procedural success, predischarge occlusion, and major complications rate were 100%, 93.3%, and 0%, respectively. On mean follow‐up of 5.4 ± 1.8 years, the occlusion rate was 98.7% with no long‐term complications. Conclusions: Our novel ICE‐sizing technique appears to be safe and effective in adult patients, thus eventually minimizing overestimation, costs, and potential complications of balloon sizing. (J Interven Cardiol 2012;25:628–634)     

CLINICO-IMMUNOLOGIC CORRELATIONS IN PEMPHIGUS AND BULLOUS PEMPHIGOID

Specific immunopathologic data can be found in 95% of patients with pemphigus vulgaris and in 70% of patients with bullous pemphigoid. Antibodies in pemphigus vulgaris can belong to different classes of immunoglobulins and can be destroyed by immunosuppression. Twenty percent of the pemphigus patients had differing results suggesting early recurrence of disease. In patients with bullous pemphigoid, there is great variability in anti-basal zone antibodies. When the disease clears, there is still a wide range of immunologic patterns.