BACKGROUND: Isolated office (IO) hypertension is a benign condition according to some researchers, whereas others believe it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this study is to compare morphofunctional characteristics of the left ventricle (LV) in IO hypertensive subjects, normotensive subjects (hereafter, hypertensives and normotensives), and never-treated sustained hypertensives. The 3 groups were matched not only by age, sex, and body mass index but also by clinic blood pressure (BP) (IO hypertensives and sustained hypertensives) and daytime BP (IO hypertensives and normotensives). METHODS: We enrolled 42 IO hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP < or = 130/80 mm Hg), 42 sustained hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP > or = 140 and/or 90 mm Hg) and 42 normotensives (clinic BP < 135 and/or 85 mm Hg and daytime BP < or = 130/80 mm Hg). Left ventricular morphologic features and function were assessed using digitized M-mode echocardiography. RESULTS: Compared with normotensives, IO hypertensives had significantly thicker LV walls, increased LV mass, reduced diastolic function, increased prevalence of LV hypertrophy, and preclinical diastolic dysfunction. Sustained hypertensives, compared with IO hypertensives, had significantly thicker LV wall, higher LV mass, and lower diastolic function, whereas the prevalence of LV hypertrophy and preclinical diastolic dysfunction was greater than in IO hypertensives, but the difference did not reach statistical significance (P = .29). CONCLUSIONS: Comparing matched BP groups, IO hypertensives have LV morphofunctional characteristics considerably different from normotensives and qualitatively similar to sustained hypertensives. Therefore, our results support the hypothesis that IO hypertension should not be considered as simply a benign condition.

Adult↗

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Clinical feasibility of echocardiographic automated border detection in monitoring left ventricular response to acute changes of preload in normal subjects.

Echocardiographic automated border detection (ABD) provides an instantaneous measurement of left ventricular (LV) volume and its rate of change. We tested the clinical feasibility of ABD in monitoring on-line LV response to acute changes in preload. We examined 20 healthy males in the supine position, with legs elevated, back in the supine position, 5 min after the inflation of blood pressure cuffs at the root of the four limbs, 5 min after the deflation of cuffs. End-diastolic and end-systolic LV volumes significantly increased with elevated legs and decreased during cuff inflation; ejection fraction remained unchanged. Peak filling and peak emptying rates did not change with elevated legs and increased significantly during cuff inflation. The values of LV parameters were stable in the three resting conditions, demonstrating a good reproducibility of the ABD technique. Our results demonstrate that ABD may be useful in clinical practice for monitoring on-line small acute changes in LV volume and function.

Adult↗

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Primary gastric non-Hodgkin's lymphoma in a population-based registry.

BACKGROUND: The incidence of primary gastric non-Hodgkin's lymphoma (NHL) appears to have increased worldwide in recent years, and this seems to be confirmed by large-sample population studies. METHODS AND RESULTS: We derived our data from the Lombardy Cancer Registry, which provides the incidence of cancer in the province of Varese, Northern Italy. From 1978 to 1987 we identified 3261 cases of gastric neoplasms, 119 of which were gastric NHL: 32 (1.87%) from 1978 to 1982, and 87 (5.32%) from 1983 to 1987. The difference in the age and sex standardized incidence trend between these two time periods was statistically significant (p < 0.001). The overall survival rate of the 112 evaluable patients was 54% at 5 years and 45% at 10 years. A multivariate analysis was performed. Age (p < 0.0005), clinical stage (p < 0.04) and therapy (p < 0.0005) were found to be significant prognostic factors for survival. CONCLUSIONS: This study stresses the utility of prospective randomized clinical trials that could indicate the optimal management of patients with primary gastric lymphoma.

Adult↗

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Thyroid hormone and thyrotropin regulate intracellular free calcium concentrations in human polymorphonuclear leukocytes: in vivo and in vitro studies.

Intracellular free calcium concentrations (Ca++i) were studied in polymorphonuclear leukocytes (PMNs) from 13 athyreotic patients who had been previously treated by total thyroidectomy and radioiodine therapy for differentiated thyroid carcinoma, and from age- and sex-matched euthyroid healthy controls. Patients were studied twice, when hypothyroid (visit 1) and after restoration of euthyroidism by L-T4 TSH-suppressive therapy (visit 2). PMNs from patients at visit 1 had significantly lower resting (Ca++)i levels compared to both visit 2 and controls. Values at visit 2 did not differ from those of the controls. Stimulus-induced (Ca++)i rise was also significantly blunted at visit 1 and normalized at visit 2, possibly through a differential contribution of distinct intracellular Ca++ stores, as suggested by the response pattern to the chemotactic agent, N-formyl-Met-Leu-Phe (fMLP), to the selective SERCA pump inhibitor, thapsigargine, and to the mitochondrial uncoupler, carbonyl cyanide p-trifluoromethoxyphenyl-hydrazone (FCCP). In vitro treatment of PMNs from healthy subjects with high TSH concentrations impaired intracellular Ca++ store function. Both resting (Ca++)i levels and fMLP-induced (Ca++)i rise increased in the presence either of low-concentration TSH or of T4, but effects of TSH and T4 were not additive. T3, rT3, and TRIAC had no effect. In conclusion, this study provides evidence for a direct relationship between thyroid status and (Ca++)i homeostasis in human PMNs, mainly related to direct actions of TSH and T4 on these cells.

Adult↗

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Premonitory symptoms in migraine without aura: a clinical investigation.

Thirty-three out of 100 patients affected by migraine without aura, reported premonitory symptoms in at least 50% of attacks and were considered to be affected by complete or premonitory common migraine. This group had a greater positive familiarity for migraine, a lower mean age of onset, and a higher average number of trigger factors compared with other patients. These three differences were statistically significant; hence we hypothesized that patients with migraine attacks generally preceded by premonitory symptoms have a stronger constitutional migraine trait with a premature weakening of their antinociceptive adaptation systems to the environment and to stressful events.

Adult↗

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Prognosis in Hodgkin's disease: verification of a new predictive equation.

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Blood Sedimentation↗

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Abdominal migraine in adults. Case reports.

The association between headache and gastrointestinal symptoms is typical of migraine and useful for diagnosis. Diagnosis is difficult when migraine consists only of gastrointestinal symptoms without headache. In such a situation differential diagnosis is very widespread, sometimes implying diagnostic and therapeutic delays with unpleasant consequences for the patient and embarrassment for the physician. We report on the troubled clinical history of three adults with abdominal equivalents.

Abdominal Pain↗

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The transient global amnesia-migraine connection. Case report.

Transient global amnesia is described in two patients suffering from classical and common migraine, respectively. These cases are peculiar in that the amnesic attack was part of the aura in one patient, while it behaved like an accompanying symptom in the other. The close temporal relation between the attacks of transient global amnesia and migraine strengthens the hypothesis of an etiologic role of migraine. The nature of this mechanism could be the cerebral blood flow changes or the neural perturbation which characterize migraine attacks.

Adult↗

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Mitral valve prolapse in systemic lupus erythematosus.

Despite a low incidence of clinical manifestations, autopsy data suggest endocardial and myocardial disease in about 50% of patients with systemic lupus erythematosus. To investigate whether mitral valve prolapse can be considered a clinical manifestation of cardiac involvement in systemic lupus erythematosus, we carried out an echocardiographic study in 51 affected subjects and 102 normals matched for age and sex. Prevalence of mitral valve prolapse was 25% in patients with systemic lupus erythematosus and 9% in healthy controls with a statistically significant difference (p less than 0.01). Neither pericardial effusion nor prolonged (more than 12 months) treatment with corticosteroids were associated with higher prevalence of mitral valve prolapse. Libman-Sacks verrucae on the mitral valve apparatus as well as focal myocardial scars affecting the papillary muscles and adjacent myocardium could be responsible for the development of the valvular dysfunction. We suggest that mitral valve prolapse can be considered a manifestation of cardiac involvement in patients with systemic lupus erythematosus.

Adolescent↗

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Mitral valve prolapse and transitory cerebral ischemia. Report on 8 cases.

Non-complicated mitral valve prolapse (MVP) may cause transitory ischemic attacks (TIA) of a probable micro-embolic nature, especially in young people. This study presents 119 cases of TIA, 41 occurring in patients under 45 years of age. All of the 119 patients were given a brain CT scan and associated risk factors such as dislipidemia, diabetes, arterial hypertension, polycythemia were corrected. In addition, 115 patients underwent an angiography. The 41 patients under 45 were given an echocardiogram. The 8 patients who were found to have mitral valve prolapse were submitted to a 24-hour continuous monitoring of the ECG (Holter test) and only 4 patients were given an angiography. On the basis of the results obtained the Authors propose: (1) to use CT scan and electrocardiograms to study youthful patients who have had one or more events of TIA, (2) not to give them an angiography if they suffer from MVP, (3) to conduct the Holter test on these patients and, (4) to establish a therapy using blood-platelet anti-aggregants. The use of anti-coagulants is debatable, even in cases with recurring events.

Adolescent↗

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