REPERFUSION EDEMA: THE DEVIL IN THE MOISTURE. POST ACUTE TREATMENT AND REHABILITATION

The presentation discusse main topics for reperfusion injury - edema with therapeutic options

The non-invasive cardiovascular study of preclinical atherosclerosis: role in the screening of asymptomatic people at risk.

Cardiovascular diseases still represent the leading cause of death in developed countries and are largely related to atherosclerosis. Primary prevention is the most effective approach but requires the identification of asymptomatic people at increased risk to be submitted to preventive treatments. Currently, population screening is made using traditional cardiovascular risk factors model from the Framingham study. With this method, however, a relevant part of the population is classified as intermediate risk with unclear indication to an intensive treatment of risk factors. To better characterize these individuals, new risk indicators, both biochemical and instrumental have been proposed for use in screening. The most investigated non-invasive instrumental methods are the study of the pulse wave velocity, the analysis of endothelial function, the measure of the carotid intima-media thickness, the calculation of the ankle brachial index and the measurement of the coronary calcium score. Some of them, especially the coronary calcium score, showed strong correlations with the development of cardiovascular events and would seem to be able to significantly improve the prediction of the risk score when added to traditional risk factors, allowing the correct reclassification of subjects in intermediate risk in over 50% of cases. Nevertheless, methodological limits of standardization and repeatability and concerns on the complete harmlessness (in the case of coronary calcium), together with the lack of efficacy data from interventional studies, have so far made little spread their use

Sporotrichoid Mycobacterium marinum infection in an elderly woman

We describe the case of an elderly woman who acquired a Mycobacterium marinum infection following skin exposure to the bacteria through a small wound on her right ring finger, obtained while preparing fish. The resultant sporotrichoid nodules of the right hand and the distal forearm, refractory to the initial therapy with doxycycline and rifampicin, were successfully treated with oral regimen of clarithromycin

Modificazioni emodinamiche indotte da acetilcisteina in vasculopatici diabetici.

MODIFICAZIONI EMODINAMICHE INDOTTE DA ACETILCISTEINA IN VASCULOPATICI DIABETICI De Marchi S., Rigoni A., Prior M., Zecchetto S., Rulfo F., Arosio E. UO di Riabilitazione Vascolare, Policlinico di Verona, Università di Verona. Introduzione: essendo acetilcisteina (ACS) un composto con attività scavenger sui radicali liberi dell’ossigeno e coinvolto nella sintesi del glutatione abbiamo voluto valutare se sia in grado di migliorare alcuni parametri emodinamici in pazienti con elevato stress ossidativo come i diabetici vasculopatici. Materiali e metodi: abbiamo reclutato 12 pazienti diabetici maschi (età 58-76 aa) con angiopatia, in terapia con antidiabetici orali (glibenclamide e metformina da almeno 6 mesi) ed Hb glicosilata inferiore o uguale a 4,2 %, i pazienti presentavano anche ipertensione arteriosa stabile trattata con clonidina da almeno 3 mesi, non erano ammessi farmaci vasoattivi. Durante lo studio non era consentita l’assunzione di caffè (12 ore), nessuno dei pazienti era fumatore. Dopo 25 minuti di clinostatismo in una stanza a temperatura controllata (22±2 C°), è stato eseguito studio del microcircolo con laserdoppler alla mano sinistra ed all’avampiede (arto maggiormente affetto), in condizioni basali e dopo ischemia (3 minuti). Abbiamo inoltre misurato la vasodilatazione endotelio-dipendente con ecocolordoppler all’arteria brachiale e quindi calcolato la pulse wave velocity carotido-femorale (PWV) mediante due rilevatori pletismografici. PA e frequenza cardiaca sono stati monitorati. I tests sono stati ripetuti dopo 10 giorni di ACS 600 mg/die. Risultati: il flusso all’arteria brachiale a riposo è apparso immodificato dopo terapia, mentre si è registrato un incremento della vasodilatazione endotelio-mediata (14±3 vs 7±5% ; p<0,05). Non sono state rilevate modifiche dei parametri microcircolatori misurati alla mano prima e dopo il ciclo di ACS. Dopo trattamento si è rilevato un aumento del flusso microcircolatorio in corso di iperemia post-ischemica al piede (56,4±12,2 vs 31,1±11,3 UP; p<0,05), immodificato il flusso a riposo. La PWV si è ridotta dopo assunzione di ACS (5,9±1,9 vs 11,5±2,2 m/s; p<0,05). Abbiamo riscontrato un decremento ai limiti della significatività dei valori pressori diastolici dopo ACS, invariate pressione sistolica e frequenza cardiaca. Conclusioni: in soggetti affetti da angiopatia diabetica, ACS è in grado di incrementare la vasodilatazione endotelio dipendente; tale dato potrebbe essere dovuto ad un miglioramento della funzione endoteliale in relazione alle proprietà antiossidanti di ACS. Analogamente ACS potrebbe potenziare la risposta iperemica microcircolatoria con il controllo dell’iperossidazione da ischemia-riperfusione. Il miglioramento della PWV può essere attribuito ad una migliorata funzione endoteliale conseguente ad un ripristino del bilancio ossidoriduttivo. ACS può migliorare alcuni indici predittivi di morbilità e mortalità in pazienti diabetici

Early Hypertension Is Associated With Reduced Regional Cardiac Function, Insulin Resistance, Epicardial, and Visceral Fat

Mild-to-moderate hypertension is often associated with insulin resistance and visceral adiposity. Whether these metabolic abnormalities have an independent impact on regional cardiac function is not known. The goal of this study was to investigate the effects of increased blood pressure, insulin resistance, and ectopic fat accumulation on the changes in peak systolic circumferential strain. Thirty-five male subjects (age: 47±1 years; body mass index: 28.4±0.6 kg . m −2 ; mean±SEM) included 13 with normal blood pressure (BP: 113±5/67±2 mm Hg), 13 with prehypertension (BP: 130±1/76±2 mm Hg), and 9 newly diagnosed with essential hypertension (BP: 150±2/94±2 mm Hg) who underwent cardiac magnetic resonance tissue tagging (MRI) and MRI quantitation of abdominal visceral and epicardial fat. Glucose tolerance, on oral glucose tolerance test, and insulin resistance were assessed along with the serum lipid profile. All of the subjects had normal glucose tolerance, left- and right-ventricular volumes, and ejection fraction. Across the BP groups, left ventricular mass tended to increase, and circumferential shortening was progressively reduced at basal, midheart, and apical segments (on average, from −17.0±0.5% in normal blood pressure to −15.2±0.7% in prehypertension to −13.6±0.8% in those newly diagnosed with essential hypertension; P =0.004). Reduced circumferential strain was significantly associated with raised BP independent of age ( r =0.41; P =0.01) and with epicardial and visceral fat, serum triglycerides, and insulin resistance independent of age and BP. In conclusion, regional left ventricular function is already reduced at the early stages of hypertension despite the normal global cardiac function. Insulin resistance, dyslipidemia, and ectopic fat accumulation are associated with reduced regional systolic function

Clinical Study The Influence of the Coexpression of CD4 and CD8 in Cutaneous Lesions on Prognosis of Mycosis Fungoides: A Preliminary Study

Background. Although techniques of immunophenotyping have been successful in characterizing the cells in the cutaneous infiltrates of mycosis fungoides little evidence suggests that variations in the phenotypic characterization correlate with prognosis. Objectives. In a preliminary prospective, single-centre, study we correlated the T-cell phenotype in cutaneous biopsies with the progression of the disease to determine whether the coexpression of CD4 and CD8 has an impact on prognosis. Methods. Skin biopsy specimens from 30 newly diagnosed patients were stained with immunoperoxidase techniques to determine their phenotypic characteristics. After a median followup of 42 months patients were divided into two groups with stable and progressive disease. Results. Eighteen patients had the conventional CD4+CD8− T-cell phenotype. Ten patients showed the coexpression of CD4 and CD8 and had a slightly lower rate of progressive disease. Conclusions. The coexpression of CD4 and CD8 in cutaneous lesions is not rare and is associated with a slightly lower rate of progressive disease. Since double positive CD4/CD8 phenotype is rarely reported in mycosis fungoides the presence on conventional immunophenotyping of both CD may be due to a &quot;mixture&quot; of neoplastic cells and inflammatory CD8+ tumor infiltrating lymphocytes. Immunohistochemical study combined with confocal microscopy could clarify this issue

Von Willebrand Factor Antigen Predicts Response to Double Dose of Aspirin and Clopidogrel by PFA-100 in Patients Undergoing Primary Angioplasty for St Elevation Myocardial Infarction

Von Willebrand factor (VWF) is an emerging risk factor in acute coronary syndromes. Platelet Function Analyzer (PFA-100) with Collagen/Epinephrine (CEPI) is sensitive to functional alterations of VWF and also identifies patients with high on-treatment platelet reactivity (HPR). The objective of this study was to verify the effect of double dose (DD) of aspirin and clopidogrel on HPR detected by PFA-100 and its relation to VWF and to its regulatory metalloprotease ADAMTS-13. Between 2009 and 2011 we enrolled 116 consecutive patients with ST elevation myocardial infarction undergoing primary PCI with HPR at day 5 after PCI. Patients recruited were then randomized between a standard dose (SD, n=58) or DD of aspirin and clopidogrel (DD, n=58), maintained for 6 months follow-up. Blood samples for PFA-100, light transmittance aggregometry, and VWF/ADAMTS-13 analysis were collected after 5, 30, and 180 days (Times 0, 1, and 2). At Times 1 and 2 we observed a significantly higher CEPI closure times (CT) in DD as compared to SD (P<0.001). Delta of CEPI-CT (T1-T0) was significantly related to VWF (P<0.001) and inversely related to ADAMTS-13 (0.01). Responders had a significantly higher level of VWF at T0. Finally, in a multivariate model analysis, VWF and ADAMTS-13 in resulted significant predictors of CEPI-CT response (P=0.02). HRP detected by PFA-100 in acute myocardial infarction is reversible by DD of aspirin and clopidogrel; the response is predicted by basal levels of VWF and ADAMTS-13. PFA-100 may be a useful tool to risk stratification in acute coronary syndromes given its sensitivity to VWF

Treatment Decision-Making of Secondary Prevention After Venous Thromboembolism: Data From the Real-Life START2-POST-VTE Register

Patients with venous thromboembolism (VTE) should receive a decision on the duration of anticoagulant treatment (AT) that is often not easy to make. Sixteen Italian clinical centers included patients with recent VTE in the START2-POST-VTE register and reported the decisions taken on duration of AT in each patient and the reasons for them. At the moment of this report, 472 (66.9%) of the 705 patients included in the registry were told to stop AT in 59.3% and to extend it in 40.7% of patients. Anticoagulant treatment lasted 653 months in &gt;90% of patients and was extended in patients with proximal deep vein thrombosis because considered at high risk of recurrence or had thrombophilic abnormalities. d-dimer testing, assessment of residual thrombus, and patient preference were also indicated among the criteria influencing the decision. In conclusion, Italian doctors stuck to the minimum 3 months AT after VTE, while the secondary or unprovoked nature of the event was not seen as the prevalent factor influencing AT duration which instead was the result of a complex and multifactorial evaluation of each patient