Alpha-Lipoic Acid and Antioxidant Diet Help to Improve Endothelial Dysfunction in Adolescents with Type 1 Diabetes: A Pilot Trial.

After evaluating the prevalence of early endothelial dysfunction, as measured by means of reactive hyperemia in adolescents with type 1 diabetes, we started a 6-month, double-blind, randomized trial to test the efficacy of an antioxidant diet (± alpha-lipoic acid supplementation) to improve endothelial dysfunction. Seventy-one children and adolescents, ages 17 ± 3.9 yrs, with type 1 diabetes since 9.

Duplicated left pulmonary artery: an unknown disease? Three case reports and review of the literature.

We report three cases of an abnormal finding of duplicated left pulmonary artery: two of these occurring in children with Kabuki syndrome and configuring the setting of a pseudo-pulmonary sling without any clinical or cardiac cross-sectional evidence of tracheal compression. The other case instead represents duplicated left pulmonary artery with pulmonary sling caused by the retro-tracheal course of the lower left pulmonary artery associated with "Christmas Tree" arrangement of the tracheo-bronchial system. In both patients with pseudo-pulmonary sling and Kabuki syndrome, the abnormal finding was incidental during echocardiographic examination and neither of the patients required surgical repair for the condition.

Sudden arrhythmic death syndrome: diagnostic yield of comprehensive clinical evaluation of pediatric first-degree relatives.

Aims: Sudden arrhythmic death syndrome (SADS) is most often caused by heritable cardiac diseases. Studies in adults have identified evidence of inherited cardiovascular diseases in up to 53% of families, but data on the prevalence of familial disease in children are scarce. The aim of this study was to evaluate the yield of clinical screening in pediatric first-degree relatives of victims of SADS using a systematic and comprehensive protocol.

Corneal anesthesia following application of 0.4% oxybuprocaine hydrochloride ophthalmic solution to normal feline eyes.

Objective: To evaluate the loss and recovery of corneal sensitivity after instillation of 0.4% oxybuprocaine hydrochloride solution in the normal feline eye.

Animal Studied: Eighteen European shorthair cats free of ocular disease

Procedures: Baseline corneal touch threshold (CTT) readings were obtained bilaterally with a Cochet-Bonnet aesthesiometer prior to treatment.

Serotonin reuptake inhibitors in pregnancy: can genes help us in predicting neonatal adverse outcome?

Lots has been written on use of SSRI during pregnancy and possible short and long term negative outcomes on neonates. the literature so far has described a various field of peripartum illness related to SSRI exposure during foetal life, such as increased incidence of low birth weight, respiratory distress, persistent pulmonary hypertension, poor feeding, and neurobehavioural disease. We know that different degrees of outcomes are possible, and not all the newborns exposed to SSRIs during pregnancy definitely will develop a negative outcome.

Self-reported weight and height: implications for left ventricular hypertrophy detection. An Italian multi-center study.

We examined the difference between self-reported and measured body size values and their impact on detection of left ventricular hypertrophy (LVH) by echocardiographic LV mass indexation. A total of 1963 subjects referred by their practitioners for routine echocardiographic examination to nine outpatient echocardiographic laboratories across Italy were included in the study. Left ventricular hypertrophy was defined according to two gender- specific criteria as: A) Left ventricular mass (LVM) index ≥49 g/h(2.

Left ventricular hypertrophy detection and body mass index in essential hypertension.

Background And Aim: Weight and height are two major determinants of left ventricular mass (LVM); the anthropometric parameter to which LVM should be normalized remains, however, debated. In a population of hypertensives, we compared the prevalence of left ventricular hypertrophy (LVH) defined by two indexation criteria of LVM in different subgroups of body mass index (BMI).

Methods: A total of 4468 essential hypertensives included in the Evaluation of Target Organ Damage in Hypertension (ETODH), were divided in four groups according to BMI thresholds: lean (BMI<20 kg/m(2), 4.

Nocturnal nondipping and left ventricular hypertrophy in hypertension: an updated review.

The classification of hypertensive subjects according to circadian blood pressure (BP) variations (i.e., dipping vs nondipping) is a useful means for reliable individual risk stratification and effective therapeutic decision-making.

Left ventricular geometry, ambulatory blood pressure and extra-cardiac organ damage in untreated essential hypertension.

Background And Aim: Limited information is available on the association between left ventricular (LV) geometric patterns defined according to updated criteria and blood pressure (BP) levels and extra-cardiac organ damage (OD) in human hypertension. Thus, in untreated essential hypertensives we assessed the relationship between LV geometry, ambulatory BP and markers of vascular and renal OD.

Methods: A total of 669 hypertensives were categorized in four groups according to LV geometric patterns defined by two sets of sex-specific criteria (i.

Impaired midwall mechanics and biventricular hypertrophy in essential hypertension.

Objective: Impaired left ventricular (LV) mechanics in human hypertension are strongly related to LV hypertrophy (LVH). In the present study, we investigated the relationship between LV mid-wall fractional shortening (MWS) and biventricular hypertrophy in uncomplicated essential hypertensives.

Methods: A total of 328 hypertensive patients categorized in tertiles of MWS were considered for the analysis.

Improving cardiovascular risk stratification in essential hypertensive patients by indexing left ventricular mass to height(2.7).

Aim: Clinical abnormalities associated with left ventricular hypertrophy (LVH) only defined by left ventricular mass (LVM) indexed to height(2.7) are still undefined. We investigated the prevalence, clinical correlates and extracardiac organ damage of such a cardiac phenotype in essential hypertensive patients.

Prevalence and clinical correlates of right ventricular hypertrophy in essential hypertension.

Aim: Right ventricular hypertrophy (RVH) has been reported to be a component of cardiac damage in systemic hypertension; this evidence, however, is based on small studies and major determinants of biventricular hypertrophy are still undefined. Thus, the prevalence and clinical correlates of RVH have been investigated in essential hypertension.

Methods: A total of 330 untreated and treated uncomplicated essential hypertensives consecutively attending a hospital out-patient hypertension clinic were considered for the analysis.

Retinal changes and cardiac remodelling in systemic hypertension.

The clinical value of left ventricular hypertrophy (LVH), a cardinal manifestation of hypertensive organ damage, in predicting cardiovascular (CV) events, independently of blood pressure (BP) and other accompanying risk factors, has been widely documented and its role in CV stratification indisputability recognized. Although the examination of the fundus oculi provides a unique opportunity to evaluate retinal microvascular abnormalities, which may mirror systemic arteriolar damage due to high BP, no consistent evidence exists, on the prognostic value of mild degrees of retinopathy, encompassing the vast majority of uncomplicated hypertensive subjects. Personal and literature data indicate that: (1) there is a tight association between advanced retinopathy and LVH suggesting the existence of a parallel involvement of retinal tree and cardiac damage in severe untreated or poorly controlled hypertension; (2) in contrast, a firm conclusion about the relationship between early or nonspecific retinal changes (narrowing or arteriovenous crossing) and cardiac damage is not allowed by the majority of the studies; (3) future investigations, based on computer-assisted methods, are further required to document the relation between initial retinal changes with organ damage and more importantly to test their predictive value for clinical outcomes.

Is retinal arteriolar-venular ratio associated with cardiac and extracardiac organ damage in essential hypertension?

Aim: Whether retinal microvascular disease is associated with markers of cardiac and extracardiac organ damage in human hypertension is still unclear. We examined the relationship between retinal arteriolar-venular ratio (AVR) and left ventricular hypertrophy, carotid atherosclerosis and microalbuminuria in essential hypertension.

Methods: A total of 386 untreated and treated uncomplicated essential hypertensive individuals (mean age 56 +/- 13 years) consecutively attending our hospital outpatient hypertension clinic were considered for the analysis.

Left and right ventricular structural changes in obese hypertensives.

Aim: Obesity is known to be independently related to left ventricular (LV) hypertrophy (LVH); however, in human hypertension the association of obesity with right ventricular hypertrophy (RVH) is still unsettled. We investigated the relationship of obesity with RVH and biventricular hypertrophy in essential hypertension.

Methods: A cohort of untreated and treated uncomplicated essential hypertensives consecutively attending a hospital outpatient hypertension clinic, categorized in three groups according to body mass index (BMI) thresholds (<25, 25-29.

Effects of antihypertensive drugs on carotid intima-media thickness: Focus on angiotensin II receptor blockers. A review of randomized, controlled trials.

Carotid intima-media thickness (IMT) and plaques have been shown to have a strong continuous relationship with cardiovascular (CV) morbidity and mortality; therefore, carotid atherosclerosis, as assessed by ultrasonography, can be regarded as a reliable surrogate end-point for therapeutic interventions. In this survey, we report the results of 16 double blind, randomized, controlled studies comparing: 1) antihypertensive drugs versus placebo/no treatment (five trials including 3,215 patients); 2) different active antihypertensive drug regimens (five trials including 4,662 patients); 3) angiotensin-II receptor blockers (ARBs) versus other antihypertensive agents (six trials including 841 patients). Our main findings can be summarized as follows: I) Long-term antihypertensive treatment has a blunting effect on carotid IMT progression, regardless of types of drugs.

Body mass index, nocturnal fall in blood pressure and organ damage in untreated essential hypertensive patients.

Aim: We sought to investigate the relationship between body mass index (BMI) and parameters derived from 48-h ambulatory blood pressure monitoring (ABPM) as well as organ damage in human hypertension.

Methods: A total of 658 consecutive outpatients with grade 1 and 2 hypertension, never treated with antihypertensive medications underwent the following procedures: (i) routine examination, (ii) 24-h urine collection for microalbuminuria, (iii) ABPM over two 24-h periods within 4 weeks, (iv) echocardiography and (v) carotid ultrasonography. Each patient was classified as lean (BMI<25 kg/m2) or overweight/obese (> or =25 kg/m2) and according to the consistency of the dipping or nondipping status in the first and second ABPM period, as dipper (DD), nondipper and variable dipper.

Metabolic syndrome and multiple organ damage in essential hypertension.

Aim: We investigated the prevalence of the metabolic syndrome (MS) in hypertensive patients categorized according to the number of markers of organ damage (OD) in order to assess the value of a systematic search for cardiac and extra-cardiac OD in the MS setting.

Methods: A total of 3119 untreated and treated essential hypertensives included in the Evaluation of Target Organ Damage in Hypertension (ETODH), an observational registry of hypertension-related OD, were considered for this analysis. All patients underwent extensive investigation for left ventricular hypertrophy (LVH) or LV concentric remodeling (cardiac OD), carotid plaques and/or intima-media thickening (vascular OD) and microalbuminuria (MA) and/or increased serum creatinine (renal OD).

Studies on left ventricular hypertrophy regression in arterial hypertension: a clear message for the clinician?

Background: Evidence-based medicine should provide clear and unbiased information to clinicians. We conducted an analysis on published randomized trials evaluating the effects of antihypertensive therapy on left ventricular (LV) morphology assessed by echocardiography to investigate (i) the consistency of criteria used for definition of LV hypertrophy (LVH) and (ii) the consistency of the way LVH regression and blood pressure (BP) control were reported.

Methods: Studies identified by a PubMed search were eligible for inclusion in the analysis, if they fulfilled the following criteria: (i) publication in a peer-reviewed journal within the last 12 years; (ii) double blind, randomized, controlled, parallel-group design; (iii) numerosity of at least 50 adult hypertensive subjects; (iv) follow-up duration of at least 6 months; (v) comparison between single-drugs or association regimens; (vi) LV mass (LVM) or wall thickness measured by echocardiography.