235 research outputs found
Low-pressure receptor activity and exaggerated natriuresis in essential hypertension
No full textLow-pressure receptor activity and exaggerated natriuresis in essential hypertension.
Coruzzi P, Novarini A, Biggi A, Lazzeroni E, Musiari L, Ravanetti C, Tagliavini S, Borghetti A.
Abstract
Urinary sodium excretion, central hemodynamics, and mean arterial pressure (MAP) were studied in 7 normal subjects and 19 hypertensive patients during both central hypervolemia by water immersion to the neck (NI) and extracellular volume expansion by i.v. saline infusion. During 2-hour NI, 12 out of the 19 hypertensives exhibited a significant fall in MAP (p less than 0.001). Exaggerated natriuresis did not occur in these patients (ns). In the remaining 7 hypertensive patients in whom, during NI, MAP was unchanged, exaggerated natriuresis was found (p less than 0.001). During saline infusion, MAP was either unchanged or increased and exaggerated natriuresis was found in all hypertensive patients (p less than 0.001) previously submitted to NI. Our findings suggest that a high MAP is a major determinant of exaggerated natriuresis in arterial hypertension
Disparate renal responses to Arginine.HCl in patients with Type 1 Diabetes or Essential Hypertension: role of tubuloglomerular feedback
No full textAbstract
Ten control (C), 10 essential hypertensive (HT) and 9 type 1 diabetic (OM) subjects underwent renal hemodynamic studies of 3-hours infusion of 0.012 mmol.kg.min-1 L-arginine (ARG) buffered with equimolecular HCl.
Mean Arterial Pressure, identical at baseline (8) in C and OM and -, 35% higher in HT (0.001), declined at the 3rd hour by 3.2% (0.001) in HT only. Glomerular Filtration Rate (GFR), identical at B in C and HT and 34% higher in DM (O.001), did not change in C and declined by 5.7 and 4.6% (0.001) in OM and HT. Renal blood flow, higher at B by 11% (0.02)
in DM and lower by 9% (ns) in HT, rose by 23% in C (0.001) and to a significantly lesser extent (0.001 vs C) in both HT (+13%) and OM (+J 1%). Sodium excretion, identical in C, HT and OM at B, rose equally in C and HT (+95% and +103%, respectively) and much more in OM (+213%, 0.'001 vs both C and HT). Absolute Proximal Reabsorption (APR, GFR-clearance of exogenous lithium). slightly elevated at B in HT (13%, 0.05 vs C) and: much higher in DM (44%, 0.001), fell equally in C and HT (-15 and -19%, respectively) and much more in DM (-25%, '0.001 vs both C and HT). Renal hemodynamic response to. ARG.HCl is blunled similarly in HT and DM, with less vasodilation and decreased GFR, but tubular response is similar to C in HT and much more pronounced in DM. During ARG.HCI renal hemodynamic changes have been shown to be largely, modulated by an activation of tubuloglomerular feedbac (TGF) depending, on the natriuretic _ properties of buffering anion HCI (Biggi A et at, J Hypertens, 2007).
Thus, the blunted vasodilatation in HT indicates an altered renal hemo-dynamic response to a normally activated TGF, while in DM, who show high GFR and APR with a deactivated TGF at S, an increased inhibition in tubular reabsorption during ARG.HCI. leading to both an exaggerated distal solute delivery and an abnormally activated TGF, seems to be responsible of the blunted renal vasodilation
CT-EVALUATION OF MEDIASTINAL LYMPHNODES IN NON-SMALL CELL LUNG CANCER
No full textFor several years the distinction between normal and pathologic lymphnodes was based on the dimensional criteria (radiological diameter more than 1 cm). Computed tomography is valuable for the assessment of hilar and mediastinal lymphnodes. The aim of this study is to report the specificity and the sensitivity of CT in the evaluation of mediastinal lymphnodes in non-small cell lung cancer and to identify the indications for the preoperatory mediastinoscopy. The CT showed low sensitivity and high specificity for the assessment of mediastinal lymphnodes
Purpura fulminans in a 16-year-old girl: clinical and ethical aspects
No full textPurpura fulminans (PF) is a severe clinical disorder mostly characterized by progressive vascular collapse and disseminated intravascular coagulopathy (DIC). The most frequent presentation is following meningococcal infection. PF leads to serious complications including multiple organ failure (MOF) until death in 3-12% of cases. However, a number of disabilities have been reported. We report a case of a young girl with septic shock, high fever, purple rash on the legs and buttocks. Clinical and laboratory tests confirmed N. meningitidis infection. Medical treatment included antibiotics and pain killers. Surgical treatments included multiple escharectomies, skin grafts and the amputation of the distal phalanx of the right foot. Psychological support was guaranteed. After 75 days of hospital stay, the patient was discharged with an acceptable aesthetic and functional result. The possibility to conduct extensive surgical treatments, although life-saving, constituted a decision of strong ethical criticality, but in this case the patient has understood the importance of the proposed treatments. PF represents a challenging issue in clinical practice, both for the medical assessment, both for the surgical treatment. Younger patients require more care for the acceptance and sharing of the therapeutic process. Even the cases earlier treated may have residual disabilities. A multidisciplinary team can optimize and improve the quality of life of minors. Psychological support and a very intensive rehabilitation are necessary for the integration back into society. Good communication between healthcare professionals and young people is essential
Purpura fulminans in a 16-year-old girl: Clinical and ethical aspects
No full textPurpura fulminans (PF) is a severe clinical disorder mostly characterized by progressive vascular collapse and disseminated intravascular coagulopathy (DIC). The most frequent presentation is following meningococcal infection. PF leads to serious complications including multiple organ failure (MOF) until death in 3-12% of cases. However, a number of disabilities have been reported. We report a case of a young girl with septic shock, high fever, purple rash on the legs and buttocks. Clinical and laboratory tests confirmed N. meningitidis infection. Medical treatment included antibiotics and pain killers. Surgical treatments included multiple escharectomies, skin grafts and the amputation of the distal phalanx of the right foot. Psychological support was guaranteed. After 75 days of hospital stay, the patient was discharged with an acceptable aesthetic and functional result. The possibility to conduct extensive surgical treatments, although life-saving, constituted a decision of strong ethical criticality, but in this case the patient has understood the importance of the proposed treatments. PF represents a challenging issue in clinical practice, both for the medical assessment, both for the surgical treatment. Younger patients require more care for the acceptance and sharing of the therapeutic process. Even the cases earlier treated may have residual disabilities. A multidisciplinary team can optimize and improve the quality of life of minors. Psychological support and a very intensive rehabilitation are necessary for the integration back into society. Good communication between healthcare professionals and young people is essential
I santuari gesuati
No full textIl saggio costituisce la premessa storica al contributo successivo, dedicato al ricettario gesuato del 1562 da Marco Biffi, e descrive il contesto in cui fu prodotto quel manoscritto, che è il più importante codice farmacologico dei gesuati, cioè il convento di San Girolamo a Lucca. Si indaga l’identità degli autori del codice, che viene sommariamente descritto, e si sottolinea l’importanza degli studi scientifici e della pratica distillatoria e farmacologica tra i gesuati
Tibial tubercle osteotomy (TTO) in total knee arthroplasty, is it worth it? A review of the literature
No full textIntroduction: Tibial tubercle osteotomy (TTO) is a well-established extensile approach to improve joint visualization and implant removal. Despite this, TTO is a challenging technique with a long learning curve and potential pitfalls. Complications are not infrequent, even if performing the correct surgical steps. Aim of this paper is to review the current literature about TTO, its safeness and reliability, and finally the complications rate. Materials and methods: We performed a systematic review of the available English literature, considering the outcomes and the complications of TTO. The combinations of keyword were “tibial tubercle osteotomy”, “total knee arthroplasty”, “total knee revision”, “outcomes”, “complication” and “surgical approach”. Results: From the starting 322 papers available, 26 manuscripts were finally included. Most of the papers show significant improvements in clinical outcomes, both in primary and in revision procedures. Radiographic fragment healing is close to 100%. Related complications can range from 3.8–20%. Conclusion: TTO may be necessary to correct pathological tuberosity position or patella tracking. However, TTO is a challenging technique to improve the surgical approach during total knee arthroplasty. A strict surgical technique can lead to better results and to minimize complications. However, it is not clear if the improved outcome can outweigh the longer surgery and the higher risk of pitfalls
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