Quantitative evaluation of left ventricular shape in anterior aneurysm

The purpose of the study was to analyze left ventricular (LV) shape in post-infarction anterior aneurysm by utilizing quantitative analysis of wall curvature. Forty-one patients (39 men, 2 women; mean age 56 years) subjected to surgical intervention for LV aneurysm complicating an anterior myocardial infarct were retrospectively evaluated. In all patients the presence of resectable aneurysmal tissue had been confirmed by direct surgical examination. Patients with inferior myocardial infarction and patients who had undergone percutaneous transluminal coronary angioplasty (PTCA) or bypass surgery were excluded. Pre-intervention ventriculograms (RAO projection) were analyzed. LV wall motion was studied by applying the centerline method. Regional curvature of end-diastolic and end-systolic outlines was calculated at 90 equidistant points from aortic corner (point 1) to mitral plane (point 90). Patients with LV anterior aneurysm show a typical pattern of alterations in wall curvature, which is characterized by a shifting of the angiographic apex (the point with the greatest curvature) towards the mitral plane, and by a sharp shift of curvature values at the antero-basal and infero-apical regions, marking the borders of the sac. These hinge points closely correspond to the external limits of wall motion abnormalities. Significant correlations were found between degree of regional curvature alterations and severity of global LV dysfunction, as indicated by decrease of ejection fraction and increase of end-systolic volume. In conclusion, quantitative evaluation of LV shape by means of wall curvature analysis allows recognition of the characteristic morphologic changes of the aneurysm, i.e., wall expansion and deformation. The alterations of regional curvature correlate with the extent of wall motion abnormalities and the severity of global LV dysfunction. © 1993 Wiley-Liss, Inc.     

Implementation and application of real-time motion analysis based on passive markers

A method for real-time motion analysis based on passive markers is presented. An opto-electronic automatic motion analyser was used as hardware platform and the real-time operation was based on the interfacing between two levels of the system architecture. True real-time acquisition, processing and representation of two-dimensional and three-dimensional kinematics data were implemented through a newly conceived data acquisition procedure and high speed optimisation of the kinematics data processing. The method allows one to operate the motion analysis system in real-time; even when the data elaboration unit is required to perform other processing functions, the only consequence is a decrease in system sampling rate. The maximum number of processed and ploted markers in three dimensions at the highest system sampling rate (100 Hz) turned out to be suitable for the implementation of analytical and visual kinematics biofeedback. An example of the achievable level of complexity in terms of marker disposition model and graphic representation is reported by describing a demonstration of the real-time representation of human face movements. A clinical application of the method for patient position definition and control at radiotherapy units is presented.     

Electrophysiological and cognitive effects of lumbar myelography with iopamidol: comparison with diagnostic lumbar puncture

To assess the influence of contrast medium on cortical function, we studied 20 patients undergoing lumbar myelography with iopamidol and 10 patients undergoing diagnostic lumbar puncture (controls). The examinations performed before and 6 and 24 h after myelography (or lumbar puncture) included a neuropsychological battery and an electrophysiological evaluation. In the patients cranial CT was performed thrice to assess passage of contrast medium from the cerebrospinal fluid into the brain. Neither patients nor controls had significantly different scores on neuropsychological testing after the diagnostic examinations. A transient slowing of basal EEG activity could be detected in 2 patients and 3 controls 6 h after the lumbar puncture. In 3 patients CT showed a transient increase in density of the brain. None of the parameters studied was significantly affected by myelography with iopamidol. CT findings support the hypothesis of early clearance of iopamidol from brain tissue, explaining its low neurotoxicity.     

Vitamin D and multiple sclerosis: an update

Vitamin D and its biologically active metabolite, 1-alpha,25dihydroxyvitamin D3 [1,25(OH)2D3], which is produced in the dermal skin layer after exposure to ultraviolet (UV) radiation, play a central role in calcium metabolism and bone homeostasis; besides this “classical” function, they hold also other important activities, such as the regulation and differentiation of normal and tumoral cellular proliferation, and a powerful immunomodulatory activity. The relationship between vitamin D and multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system (CNS) with multifactorial pathogenesis, involves various aspects, including first of all the presence of an altered bone metabolism in subjects affected by the disease. On the basis of epidemiological data of prevalence, vitamin D and sunlight exposure may play a protective role in MS development. Nevertheless, the possible disease-modifying effect of a supplementation with vitamin D and its analogues requires further investigation, as current evidence does not support its recommendation in the specific treatment of the disease.     

Randomized Trial Comparing Nicotinamide and Nicotinamide Plus Cyclosporin in Recent Onset Insulin-dependent Diabetes (IMDIAB 1)

A 1-year open randomized controlled multicentre trial was carried out on 90 patients with recent onset (< 4 weeks) insulin-dependent diabetes (IDDM) to compare the effect of nicotinamide (NCT) with the combination NCT and low dose cyclosporin (CyA) on clinical remission and optimization of metabolic control during the first year from diagnosis. Three groups of patients were randomly assigned to receive for 12 months either NCT 25 mg kg^?1 day^?1 (n = 30) or NCT 25 mg kg^?1 day^?1 + CyA 5 mg kg^?1 day^?1 (n = 30), the latter adjusted to maintain 12 whole blood trough levels of 83 nmol l^?1; a third group of patients (n = 30) receiving insulin only acted as a control group for spontaneous remission and metabolic control. Clinical remission (i.e. suspension of insulin therapy with normal metabolic parameters for more than 2 weeks according to the International Diabetes Immunotherapy Group) was achieved at 3 months in 6/30 NCT treated patients and in 1/30 NCT + CyA treated patient (p = 0.05); no remission was observed in control patients. At 6 months the number of patients achieving remission in each group was 4/29, 3/27, and 1/29, respectively (p = NS). One year after diagnosis 4/27 NCT treated, 2/25 NCT+ CyA treated but 0/28 of the control patients were in remission (NCT vs control p = 0.05). Clinical remission lasted longer (7 ± 3 SD months) in NCT treated patients than in NCT+ CyA treated or control patients (p < 0.02). In patients who did not show clinical remission, there were no significant differences in the integrated measures of metabolic control (HbA₁ and C peptide) between the two groups; however, NCT+ CyA treated patients only required significantly less insulin at 12 months compared to control patients (p < 0.02). Side-effects were not observed in patients receiving NCT and were minimal in those treated with the combination of NCT+ CyA. We conclude that nicotinamide alone is a safe and effective adjunct to insulin in the early phase of IDDM to increase the rate of clinical remission and to improve integrated parameters of metabolic control.     

Hormones and immunological capacity: II. Reconstitution of antibody production in hormonally deficient mice by somatotropic hormone, thyrotropic hormone and thyroxin

Hypopituitary dwarf mice are immunologically deficient. This deficiency can be overcome by injection of somatotropic hormone and thyroxin. Antibody formation in hormonally reconstituted mice as measured by the number of plaque-forming cells against sheep erythrocytes equals or surpasses that of normal mice. The number of nucleated spleen cells is increased in both normal and dward mice after treatment with hormones. The hypotrophic thymus and peripheral lymphoid tissue of dwarf mice can be reconstituted to normal by treatment with somatotropic hormone and thyroxin.

Anti-somatotropic hormone and anti-thyrotropic hormone antisera produce suppression of antibody formation. These effects can be reversed by somatotropic hormone and thyrotropic hormone. The anti-hormone antisera produce an involution of thymus and other lymphatic organs. A parallelism exists between involution of the lymphoid tissue, neutralization of circulating somatotropic hormone and depression of antibody production.

These results stress the importance of the thymus—hypophysis relationship for cell differentiation with particular reference to the maturation of the immunological capacity.