Efficacy of topical treatment with aescin + essential phospholipids gel on capillary fragility

The aim of this efficacy study was to evaluate local capillary fragility with the vacuum suction chamber (VSC) in patients with chronic venous hypertension due to chronic venous disease. All included patients had important ankle edema due to venous hypertension because of a post-thrombotic syndrome. Severe, deep, venous incompetence was present. The VSC was applied onto the internal perimalleolar region. Negative pressure was applied for a variable period of 2, 4, 6, 8, and 10 minutes. The negative pressure in the plastic chamber (2 cm in diameter)-as previously described-was 50 mm Hg. A group of ten patients (mean age 56 years; SD 4; M:F = 5:5) were studied. The tests were repeated in steps of two tests on different days. Between the two tests, with the VSC applied in different skin areas of the perimalleolar region, an interval of at least 30 minutes was observed.     

Neuronal NOS activation during oxygen and glucose deprivation triggers cerebellar granule cell death in the later reoxygenation phase

The present study investigated the temporal relationship between neuronal nitric oxide synthase (nNOS) activity and expression and the development of neuronal damage occurring during anoxia and anoxia followed by reoxygenation. For this purpose, cerebellar granule cells were exposed to 2 hr of oxygen and glucose deprivation (OGD) and 24 hr of reoxygenation. To clarify the consequences of nNOS activity inhibition on neuronal survival, cerebellar granule cells were exposed to OGD, both in the absence of extracellular Na(+) ([Na(+)](e)), a condition that by reducing intracellular Ca(2+) ([Ca(2+)](I)) prevents Ca(2+)-dependent nNOS activation, and in the presence of selective and nonselective nNOS inhibitors, such as N(omega)-L-allyl-L-arginine (L-ALA), N(omega)-propyl-L-arginine (NPLA), and L-nitro-arginine-methyl-ester (L-NAME), respectively. The results demonstrated that the removal of [Na(+)](e) hampered the [Ca(2+)](i) increase and decreased expression and activity of nNOS. Similarly, the increase of free radical production present in cerebellar neurons, exposed previously to OGD and OGD/reoxygenation, was abolished completely in the absence of [Na(+)](e). Furthermore, the absence of [Na(+)](e) in cerebellar neurons exposed to 2 hr of OGD led to the improvement of mitochondrial activity and neuronal survival, both after the OGD phase and after 24 hr of reoxygenation. Finally, the exposure of cerebellar neurons to L-ALA (200 nM), and L-NAME (500 microM) was able to effectively reduce NO(*) production and caused an increase in mitochondrial oxidative activity and an improvement of neuronal survival not only during OGD, but also during reoxygenation. Similar results during OGD were obtained also with NPLA (5 nM), another selective nNOS inhibitor. These data suggest that the activation of nNOS is highly accountable for the neuronal damage occurring during the OGD and reoxygenation phases.     

Metastatic breast carcinoma to the vitreous

PURPOSE: To evaluate the clinical and pathologic findings in two patients with prior breast carcinoma who underwent diagnostic vitrectomy for vitreous opacities and preretinal membrane. METHODS: The clinical histories and ophthalmic findings in two patients were reviewed. Vitrectomy specimens from the patients were processed by cytospin and standard tissue techniques, stained with hematoxylin and eosin, and examined immunohistochemically for cytokeratins. The original breast carcinoma specimens were reviewed. RESULTS: The vitreous in both patients contained malignant cells with cytologic features consistent with metastatic carcinoma. Immunohistochemical stains were positive for cytokeratins in the cells. The cytologic findings in the vitreous cells resembled the primary breast carcinoma. CONCLUSIONS: Breast carcinoma may metastasize to the vitreous, most likely via the retina. The clinical manifestations include vitreous cell and preretinal membrane.     

Tele-echocardiography in paediatrics

Echocardiographic images can be transmitted over increasing distances with less cost and better quality thanks to advances in the field of telecommunications. This technological support can be used to detect heart defects in newborns and children in remote situations. The intent of this study was to confirm the feasibility and usefulness of telemedical communication for echocardiographic evaluation of paediatric cardiovascular disease. A total of 214 echocardiographs were performed in 194 children at a remote hospital by an experienced sonographer in paediatric echocardiography. These echocardiograms were transmitted to a distant tertiary care paediatric cardiology centre using a telemedicine link across three ISDN lines. There an experienced paediatric cardiologist interpreted the tele-echocardiograms. Tele-distant diagnoses were prospectively documented and compared with the diagnoses made subsequently on direct consultation and echocardiography. The quality of transmitted echocardiographic images was sufficient for evaluation except for one case. In 191 children (98%), the remote echocardiographic diagnosis was correct as confirmed by follow-up face to face consultations. Three cases were diagnosed incorrectly. CONCLUSION: our results confirm that accurate and rapid diagnosis can be provided by tele-echocardiography in neonates and children. This facilitates the appropriate care of these patients as expensive and potentially dangerous long-distance transfers can be avoided.     

Endocarditis abscess of the aortic annulus involving the left ventricular inferior wall and causing a moderate aortic systolic obstruction: diagnosis by transthoracic and transesophageal echocardiography

Abscesses are an important and potentially devastating complication of aortic valve endocarditis. The extension of the infectious process from the aortic valve to surrounding tissue can occur in different directions. This case report describes a 28-year-old man in whom the abscess of the aortic annulus was very large, causing a moderate aortic systolic obstruction, and also involved the left ventricular inferior wall. The diagnosis was provided by a combination of TTE and TEE examination and was confirmed by cardiac surgery.     

The safety and effectiveness of deferiprone in a large-scale, 3-year study in Italian patients

In 1997, the Italian Ministry of Health created a special programme for the controlled distribution of deferiprone to collect data and to evaluate its safety and effectiveness in long-term use. Five hundred and thirty-two thalassaemia patients from 86 treatment centres were enrolled in this programme. One hundred and eighty-seven patients (32%) experienced a total of 269 events that led to a temporary interruption or, in some cases, to a discontinuation of treatment. The incidence of agranulocytosis and milder neutropenias were 0.4/100 and 2.1/100 patient-years respectively. Neutropenia occurred predominantly in younger and non-splenectomized patients. Transient alanine transaminase increase, gastrointestinal discomfort and arthralgia were the other most commonly reported events. Ferritin levels showed a significant decrease in time after 3 years of therapy. This is the largest number of deferiprone-treated patients to have been reported to date. These data show that the drug was effective in reducing serum ferritin levels and the incidence of adverse events was not greater than the frequency reported in clinical trials.