Biomedical subjects
Publications and source records attributed to R Noto.
The author reports twelve cases of difficult tracheal intubation, sometimes in acrobatic conditions, in victims of railway accidents. The position of the patient, the circumstances of the accident and the importance of the ventilatory distress, make tracheal intubation essential "in situ". The success of this act depends on the qualification of the medical and para-medical personnel, the technique proposed and the choice of material used.
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In diabetics, even in those without complications and/or alterations of lipid metabolism, higher levels of cupremia were found than in the controls; these increased levels were not correlated with the duration of the disease and the cupremia was more evident in the older patients and in those with complications. However, the increases were not dissimilar from those found in non-diabetic arteriosclerosis. Our findings favor the hypothesis that after some years and by affecting fatty acid metabolism, higher levels of cupremia enhance the appearance of diabetic vasculopathy.
A case of hypoglycemic hemiparesis in a fifteen-year-old girl with insulin dependent diabetes mellitus (IDDM) is described. The initial presentation included left facial paresis and muscular weakness of the left upper and lower extremities, associated with a blood glucose level of 31 mg/dL. The patient recovered completely after a glucose infusion. Her neurological examination became normal within 24 hours and remained so for a follow-up period of 6 months. Hypoglycemic hemiparesis is rarely described in children and adolescents.
Pectin shares with many other polysaccharides an intrinsic chemical and physical complexity. The widespread industrial applications have made it one of the most studied polysaccharides. This work presents a theoretical model of poly(galacturonic acid), the major constituent of pectin, suitable to study its structural and dynamical properties. In particular, the effects of solvent and charge status are studied. The dynamics is shown to be severely affected by the presence of charged groups on each residue, making the charged chain much more rigid than the uncharged one. A key structural property for a semirigid polymer, the asymptotic persistence length, is calculated for relatively short charged and uncharged chains in molecular water solvent using a new method. The influence of charge on structural properties of poly(galacturonic acid) is shown to be strong and solvent-dependent. In fact, a large difference is found between continuum solvent adiabatic map calculations and molecular dynamics with explicit solvent, with the latter showing a much larger persistence length.
Changes in the metabolic hormonal balance during the climacteric and menopause, especially surgically induced menopause, increase the risk of acute cerebrocardiovascular complications. This major risk may be linked to changes in blood pressure. In this study we performed twenty-four ambulatory blood pressure monitoring in climacteric (C), menopausal (PM), and surgically induced menopausal women (SM) to determine mean diurnal and nocturnal systodiastolic levels and percentage peaks, as variations in the pressure profile may be linked to organ damage. Our results showed that the entire series presented mainly diastolic increments (mDBP: HPM = 104.4 +/- 5.1; HSM = 106.3 +/- 2.9; HC = 100.2 +/- 3.1), and that this rise was greater in surgically induced menopausal women. In addition, these subjects presented the highest diastolic and systolic pressure peaks (HSM 37/42 versus HPM 35/36 and HC 29/31) also during the night (nocturnal peak: HSM 15/19 versus HPM 10/12 and HC 5/15). Non dippers seem more exposed to cerebrocardiovascular disease. Our results revealed that climacteric patients affected by arterial hypertension (mSBP = 162.2 +/- 4.1; mDBP = 100.2 +/- 3.1; 24 h systolic peak % = 24, diastolic peak % = 24) during the climacteric presented the same levels as observed in conclaimed menopause (mSBP 165.2 +/- 5.5; mDBP = 104.2 +/- 5.1; 24 h systolic peak % = 28, diastolic peak % = 29). Therefore, 24 h blood pressure monitoring is able to show that the pressure changes in hypertensive climacteric and menopausal women and could detect women who are at a greater risk of organ damage.
Thrombosis of the abdominal veins is a rare clinical condition which can be assimilated with the more frequent localization of deep venous thrombosis of the lower limbs. In the last few years great attention has been paid to possible risk factors for thrombosis of the abdominal veins. Two risk factors that have been identified are the presence of internal diseases and congenital and/or acquired abnormalities of haemostasis. The authors describe 3 clinical cases (splenic and portal thrombosis due to congenital thrombophilia, Budd-Chiari syndrome, portal cavernoma consequent to ovarian neoplasia) with different etiopathogenesis to show how this apparently rare condition is today more frequently encountered and easier to recognize. In the presence of thrombosis of major venous structures the search and the identification of intrinsic internal risk factors and of congenital and acquired thrombophilic disorders remains of great importance. Screening for thrombophilia includes blood C and S proteins, AT III, homocysteine, Leiden mutation of the factor V gene, G20210A mutation of the prothrombin gene, antiphospholipid antibodies. The presence of one or more of these risk factors allows the identification of the cases of portal thrombosis (EHPVO) responsible for about 10% of all the cases of portal hypertension, without cirrhosis or other hepatic lesions. The primary diagnostic procedure however remains color-Doppler ultrasonography which represents the most simple and the cheapest diagnostic investigation for the study of the portal and suprahepatic vein system, but it's strictly operator dependent.
Hyperhomocysteinemia is widely recognised as an emerging risk factor of endothelial dysfunction and vascular damage. In this study we wanted to verify if it, when associated to arterial hypertension--traditional risk factor--represents a higher added risk of organ damage during menopause, which is a condition connected to a higher incidence of cerebrovascular diseases. A survey of 30 postmenopausal women with similar characteristics (BMI, age, absence of relevant pathologies such as diabetes, metabolic disorders and absence of smoking) was selected (menopause had occurred from 12 to 16 months at the moment of observation). At the moment of the observation they had not gone through any continuous pharmacological therapy. They were subdivided into 3 groups: normotensive; hypertensive (with 2nd degree hypertension: mild to moderate) without organ damage; hypertensive with organ damage (TIA, ischaemic heart disease, etc.). The carotid IMT, measured with ultrasound method, was considered as an organ damage parameter. 43% of the patients had high levels of homocysteine (> 15 micromol/l), which are levels considered at risk in other surveys. The highest levels of homocysteine were recorded in hypertensive women with episodes of acute cerebrovascular damage (micromol/l = 24.3 +/- 8.9). In this group, a positive correlation (r = 0.7) was obtained between homocysteine levels and carotid IMT. The possible coexistence of hyperhomocysteinemia and arterial hypertension, even though without particularly high values for both of them, in menopause may represent a dangerous association responsible for a significant organ damage and, therefore, for acute cerebrovascular events.
Homocysteine levels have been determined with Chromatography on HPLC column, between the 20th and the 24th week of pregnancy, in women with analogous characteristics (a) normotensive, (b) with pregnancy-induced hypertension (PIH), low (LR), medium (MR), high risk (HR). The group they belonged to was confirmed after natural or caesarean delivery. All the patients were submitted to 24 hour blood pressure monitoring for the evaluation of further pressure risk parameters: mean arterial pressure (MAP), non dippers, percentages of pressure peaks. Homocysteine levels in normotensive pregnant women (5.8 +/- 1.7 microM) were low. Significant high levels of homocysteine were present proportionally to the risk degree of PIH. Higher levels of homocysteine statistically significant were present in non dippers of all groups (MR p < 0.05; HR p < 0.01). A direct correlation between plasmatic homocisteine levels and pressure profiles was found out in non dippers (r = 0.56, r = 0.55, r = 0.50 respectively) and in dippers (r = 0.7, r = 0.75, r = 0.60 respectively), and also between levels of homocysteine, MAP value, and pathological percentages of systolic and diastolic nocturnal peaks. In pregnant women presenting preeclampsia afterwards, high levels of homocysteine were not different from mean values present in high risk PIH pregnant women (13.3 +/- 1.9 vs. 16.4 +/- 1.7 microM). High levels of homocysteine early determined in the second trimester of PIH pregnancies seem to be associated to a pregnancy higher risk, coexisting with dangerous pressure profiles. High levels confirm a pregnant woman to belong to a higher or lower risk degree of vascular damage, but in the same group context high levels of homocisteine do not allow to identify those pregnant women who will develop eclampsia.
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