[Usefulness of ultrasonographic techniques in catheterization of the internal jugular vein in patients with chronic heart failure].

Background: The right internal jugular vein as a route for right heart catheterization and continuous infusion of drugs is increasingly used in patients with heart failure. Although this approach has several advantages, a small but definite number of unsuccessful vein punctures and/or of complications have been reported. This prospective study was designed to evaluate the usefulness of ultrasound techniques for cannulating internal jugular vein in a series of 310 consecutive patients with chronic heart failure.

Perchloroethylene exposure can induce colour vision loss.

We evaluated colour vision in 35 dry-cleaners exposed to perchloroethylene (PCE) and in a paired number of controls matched for sex, age, alcohol consumption and cigarette smoking. A subclinical colour vision loss, mainly in the blue-yellow range, was present in dry-cleaners. This effect was related to PCE exposure levels, and appeared at environmental concentrations of the solvent well below the current exposure limits for exposed workers.

Scopolamine improves autonomic balance in advanced congestive heart failure.

Background: Sympathetic hyperactivity and parasympathetic withdrawal in patients with congestive heart failure correlate closely with disease severity and overall survival. The modulating effects of drugs on the autonomic dysfunction may contribute to improve survival. Low-dose scopolamine has a vagomimetic effect in normal subjects and patients after acute myocardial infarction.

Multiple CT imaging in pressure sores.

In patients affected by pressure sores, bones can be reached easily by the infection. This suggested a new way for a more precise diagnostic evaluation, looking at the most recent technological knowledge, which can offer a better evaluation of single lesions for a better planning of surgical operations. The possibility of performing multiple imaging under a CT guide, as well as a simple technique for contrast permanence within the sore, led the authors to demonstrate the validity of modern CT scanning as a main diagnostic method.

Can power spectral analysis of heart rate variability identify a high risk subgroup of congestive heart failure patients with excessive sympathetic activation? A pilot study before and after heart transplantation.

Background And Objectives: Autonomic dysfunction seems to be involved in the progression and prognosis of severe congestive heart failure. Parasympathetic activity can still be abnormal 4-8 weeks after haemodynamic improvement by heart transplantation. To identify patients in heart failure with a more pronounced neural derangement and to analyse the changes in sympathetic and parasympathetic activity soon after heart transplantation, spectral indices of heart rate variability were assessed in 30 patients in severe heart failure and in 13 patients after heart transplantation; a group of 15 age-matched subjects served as controls.

[Multicenter study on exercise-induced silent myocardial ischemia: clinical, anamnestic and ergometric parameters in 4389 patients with proven ischemic cardiopathy].

Aim Of The Study: In order to evaluate the incidence and clinical significance of myocardial ischemia during exercise testing (ExT) in patients (pts) with proven ischemic heart disease (Stable Effort Angina = SEA, Myocardial Infarction = MI, PTCA or CABG) 73 ergometric laboratories participated in a multicenter prospective study (SMISS) coordinated by the Italian Working Group on Cardiac Rehabilitation. Here we report the clinical and ergometric parameters.

Methods: Over a period of six months 4,389 consecutive pts were enrolled in the study after performing a maximal limited ExT (25 watts x 3') after drug withdrawal.

The time constants of motor and sensory peripheral nerve fibers measured with the method of latent addition.

The time constants of motor and sensory fibers in the human ulnar, median and tibial nerves were determined using the method of latent addition. Two square-wave stimuli were applied: the first one was subthreshold and the second, at various delays relative to the first, was adjusted to achieve threshold activation. Strength-delay curves were obtained, from which the time constant was determined using a mathematical model.

[Nasal pressure support ventilation (NPSV) in a case of Pneumocystis carinii pneumonia in single-lung transplantation].

In patients who underwent lung transplantation one of the primary determinants of patient survival is infection. Contributing factors in the development of pneumonia include immunosuppression and alterations in the natural lung defense mechanism induced by transplantation. We describe a case of a Pneumocystis carinii pneumonia occurring in the recipient of single lung transplantation for interstitial lung disease four months after surgery.

Acute effect of corticosteroids on respiratory mechanics in mechanically ventilated patients with chronic airflow obstruction and acute respiratory failure.

We assessed the short-term effect of steroids on respiratory mechanics in eight mechanically ventilated patients with chronic airflow obstruction (CAO) and hypercapnic respiratory failure. Airflow (V), airway pressure (Paw), and changes in pulmonary volume were measured using a conventional ventilator. End-expiratory and end-inspiratory airway occlusions were performed to assess intrinsic PEEP (PEEPi), static compliance of total respiratory system (Cstrs), maximum inspiratory resistance (Rrsmax), and minimum inspiratory resistance (Rrsmin).

Evoked potentials in inherited ataxias: a multimodal electrophysiological study.

A multimodal electrophysiological study, including median nerve somatosensory evoked potentials (SSEPs), motor cortical stimulation (CS) and brainstem evoked potentials (BAEPs), was performed on 34 patients with hereditary ataxias (HAs): 15 with Friedreich's disease (FD), 10 with early onset cerebellar ataxia (EOCA), and 9 with autosomal dominant cerebellar ataxia (ADCA). A higher incidence of abnormal central motor conduction was observed in FD than in EOCA patients, but was never observed in ADCA. A relationship between central motor conduction abnormalities and disease duration and clinical impairment was found only in FD patients.

Effect of angiotensin converting enzyme inhibition with quinaprilat on the ischaemic and reperfused myocardium.

We assessed whether the local inhibition of myocardial converting enzyme by quinaprilat and captopril reduces the functional and metabolic damage caused by ischaemia and reperfusion. Quinaprilat and captopril were either subcutaneously injected (0.3 mg/kg once daily for 5-6 days) in the rabbit before isolation of the heart or delivered to the isolated hearts in the perfusate (10(-6) M) 60 min before ischaemia.

Effects of granulocyte-macrophage colony-stimulating factor and interleukin-3 on small cell lung cancer cells.

Nonhematopoietic malignant cells may express receptors for hematopoietic growth factors and respond to these peptides. The aim of the present study was to investigate whether small cell lung cancer (SCLC) cells may be stimulated to proliferate by hematopoietic growth factors such as granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-3 (IL-3), which are currently used in clinical trials in combination with cytotoxic chemotherapy. We studied two SCLC cell lines, H69 and N417.

Electromotive administration of guanethidine for treatment of reflex sympathetic dystrophy: a pilot study in eight patients.

Persistent neuropathic pain is associated with diagnostic and therapeutic challenges that may be very difficult to resolve. This report describes eight patients with incapacitating, posttraumatic neuropathic pain characteristic of reflex sympathetic dystrophy (RSD) who were treated by electromotive administration of guanethidine into affected areas of skin. Following 1-5 treatments, six patients experienced complete resolution of all superficial symptoms of hyperalgesia, pain, pallor, coolness, and sweating of the affected areas.

[Are nitrates to be recommended in acute myocardial infarct? Towards a conclusive answer].

The early administration of nitrates in acute myocardial infarction (AMI) may lower myocardial oxygen demand and increase blood supply to the ischemic myocardium. Actually, nitrates are the drugs most largely used in AMI patients, but no definite proof of their clinical benefits had been reported before GISSI 3 and ISIS 4. Only a meta-analysis of several trials carried out before the thrombolytic era showed that intravenous nitrates and probably oral nitrates can reduce mortality when given early to patients with myocardial infarction.

[Heart failure unit: 1 year experience].

Many factors such as aging and pharmacologic and surgical progress contribute to the growing of organizational problems of health care for patients with severe chronic heart failure. Since March 16, 1992, in the Medical Center of Montescano, an experimental model (Heart Failure Unit) of health assistance has been in development, taking into account the assistance and observational needs of such patients. During the first year of activity, 173 patients were treated in the Unit, for a total of 307 admissions.

Principles of digital sampling of a physiologic signal.

The practice of clinical neurophysiology requires fast, reliable and accurate assessment of a variety of biologic signals. Appropriate filters and rates of analog-to-digital sampling must be used to avoid distorting the signal. Using principles of sampling theory and examples, we describe the frequency content of signals encountered in clinical neurophysiology laboratories, offer guidelines for band-limiting frequencies, and give rules for determining minimal sampling frequencies.

[Standardization of the values of the concentration of exogenous substances in the urine and expired air].

Workplace pollutants, inhaled by exposed people, can be subsequently excreted by the kidney as biotransformed or by the lung as parent substances. In both cases the concentration values need to be corrected to a given hydration level (the urinary metabolites) or to a value adjusting the effects of respiratory manoeuvres and those of the mixing between alveolar and dead space air (the volatile substances eliminated through the respiratory tract). The classical methods of standardization of urinary values lie in expressing the data as a value adjusted to a constant specific gravity of urine (1.

[The echographic diagnosis of neurogenic paraosteoarthropathies in myelosis patients].

To assess the role of the ultrasonic imaging evaluation of articular lesions suspected to be the initial presentation of heterotopic ossifications (HO) 59 consecutive spinal cord injured patients were studied. 32 out of 59 patients showed clinical signs of local inflammation in one of the articular sites of the upper or lower limbs, sonographic scans proved to be diagnostic of HO in 7 out of those 32 patients before a their radiographic findings. Serial sonographic examinations were performed utilising a 7.

[An ergonomic analysis of 5 technics for moving patients]].

Nursing personnel and physical therapists refer to the lifting and moving of patients as the most important determinant of occupationally related low-back pain. This study was conducted in 12 nurses and 12 patients, to compare three methods of transferring patients from bed to wheelchair; (I) manual lifting, (II) an assistive device-a walking belt (with both one- and two-person transfers) and (III) a mechanical hoist. After completion of a given transfer, nurses were asked to rate the physical stress and how secure they felt the method was.

[Physical workload demands: the combined use of 2 evaluation programs].

A computerized methodology is presented for the "on-site" evaluation of work-related physical activities in industrial plant workers. Subjects were videotaped during the activities while heart rate and subjective perception of effort were monitored. The videorecordings were then analyzed with two appropriate software, in order to identify activities at high risk for musculoskeletal injuries ("Vision 3000" program, Promatek Ltd.