Alessandro Siciliano

Worsening of rosacea in patients treated with dihydropyridine calcium channel blockers: a clinical observation.

Worsening of rosacea in patients treated with dihydropyridine calcium channel blockers: a clinical observation

Rapid ultrasound score as an indicator of atherosclerosis’ clinical manifestations in a population of hypertensives:

OBJECTIVE Flow-mediated dilatation (FMD) of brachial artery, renal resistive index (RRI), retina resistive index of central artery (RRICA) and carotid intima-media thickness (IMT) have been used for ultrasound assessment of cardiovascular risk as good surrogate markers of pre-clinical atherosclerosis. We investigated the interrelationship of these four parameters and examined whether an integrated score is a good indicator of atherosclerotic disease in hypertensives. METHODS One-hundred fifty-two consecutive subjects were enrolled in this study between April 2004 and April 2005. Each patient underwent cerebral computed tomography, coronarography, carotid, renal, central retinal and femoral arteries Doppler ultrasonographic evaluation. Statistical analysis was performed using ANOVA, Fisher test, Pearson correlation and stepwise regression analyses. RESULTS FMD, RRICA, IMT and RRI were significantly correlated with each other. In multiple regression analysis age, pulse pressure, hypertension duration were independently related with the four parameters. Eighty-one findings of total atherosclerotic disease (ADAD were recorded overall (15 cerebrovascular disease, 20 coronary heart disease or myocardial infarction, 22 carotid plaques and 24 low limb plaques). Using an integrated score we were able to divide the population into three scoring bands. In the lowest band we classified 87 patients with 16% of total AD; in the intermediate 40 patients with 30% of total AD, in the highest 25 patients with 54% of total AD. Differences between groups were significant (p<0.05). CONCLUSION A potential benefit of these integrated, low-cost and easy-to-detect parameters, is the stratification of patients with atherosclerotic risk. This method may prove useful in discovering those with atherosclerosis in a pre-clinical stage for whom therapy initiated before complications could reduce the risk for a cerebro-cardio-vascular event.

When chewing gum is more than just a bad habit.

In November, 2008 a 13-year-old boy (weight 45 kg, height 160 cm) was taken by his parents to the emergency department. His parents reported that after school the boy had been agitated and aggressive, in contrast with his normal mood. He denied feeling stressed or having used drugs or stimulants. He complained of abdominal discomfort, increased diuresis, dysuria, and prickling sensations in his legs. On examination, he was restless, with sinus tachycardia (147 beats per min [bpm] on electrocardiogram [ECG]), tachypnoea (25 breaths per min), and raised blood pressure (145/90 mm Hg). Chest radiography and laboratory blood test results were normal. Toxicological screen was negative for cocaine, heroin, and amphetamine. Psychiatric consultation was unremarkable. Our patient’s condition improved overnight without any treatment and he was discharged the following morning. At discharge he was noted to have sinus bradycardia (40 bpm).Later that day, his mother returned to the emergency unit with two empty packets of stimulant (“energy”) chewing gum that she had found in her son’s bag; he had admitted consuming the confectionery at school. The chewing gum contained 160 mg caff eine per packet (0·57% caff eine per gum pellet) and non-specifi ed amounts of guarana,

Which is the correct management of patients with asymptomatic severe calcific aortic stenosis after symptomatic spontaneous calcium cerebral embolism

Elective surgery cannot be recommended in every patient with asymptomatic severe aortic stenosis, and predictors identifying high-risk patients need to be identified. In guidelines we read that elective surgery, at the asymptomatic stage, can only be recommended in selected patients, at low operative risk (see guidelines of European Society of Cardiology and American Heart Association), but we have not read any reference to patients with severe calcific aortic stenosis after symptomatic spontaneous calcium cerebral embolism. Because cardioembolic stroke is associated with poor prognosis compared to other stroke subtypes, in patients with asymptomatic severe aortic stenosis and spontaneous calcific embolic stroke valve replacement appears to offer the best hope of avoiding a recidivation of stroke and should be considered in most cases. On the contrary, is it still correct to consider as asymptomatic patients with severe aortic stenosis and cerebral thromboembolism from a calcified aortic valve?

Routine evaluation of abdominal aorta diameter at the end of transthoracic echocardiography in hypertensive patients. Why not

Patients managed by cardiologists for any cardiovascular disease should be considered at a higher risk for abdominal aortic aneurysm (AAA) because several risk factors (smoking, hypertension and so on) are common to AAAs and other cardiovascular diseases. The detection of AAA not only prevents rupture, but on the other hand, the presence of AAA is a clinical form of atherosclerotic disease and carries a risk for major coronary events equal to that of established coronary heart disease (CHD) [more than 20% per 10 years (i.e. more than 20 of 100 such individuals will develop CHD or have a recurrent CHD event within 10 years)] that constitutes a marker of cardiovascular disease with a related need of reinforced secondary prevention intervention.

A new character on the scene of cardiorenal syndrome

Arterial stiffness has a strong influence onthe kidney because of the distinctive structureof the renal microcirculation. Certain tissues,such as the brain, heart, skin and skeletalmuscle tissues, contain precapillary arteriolesand metarterioles that disperse the majorityof the mean and pulsatile energy content ofthe advancing pressure and flow waveformbefore it reaches the capillary. In contrast,glomerular capillaries are located betweenafferent and efferent arterioles. Because effer-ent arteriolar resistance is physiologicallygreater than afferent resistance, the meanand pulsatile pressures in the glomerulusare relatively elevated. This high hydrostaticpressure ensures the maintenance of anelevated glomerular filtration fraction, whichis normally B20% of renal plasma flow,but exposes the glomerular capillary topotentially harmful pulsatile pressures ifarterial stiffness and pulse pressure are high.Moreover, the myogenic tone of the afferentarteriole is influenced by pressure pulsatility.

ASSOCIATION BETWEEN CAROTID ARTERY STIFFNESS ESTIMATED WITH E-TRACKING AND DIASTOLIC DYSFUNCTION ASSESSED WITH TDI IN 105 PATIENTS WITH MASKED HYPERTENSION: PP.31.237

A normal blood pressure in the clinic or office but an elevated blood pressure out of the clinic is defined as masked hypertension. It may occurs in as many 10% of the general population. Increased arterial stiffness directly increase end-diastolic left ventricular pressure and compromise myocardial relaxation properties. Thanks to our study we can evaluate the role of carotid artery stiffness parameters on diastolic function in patients with masked hypertension. Methods: Observing 105 consecutive patients with masked hypertension (proved by 24 H- ambulatory blood pressure monitoring), we have noticed that diastolic early (E’) and late (A’) velocities were recorded by pulse wave tissue. Doppler imaging of the lateral mitral anulus in the apical 4- chamber view and carotid artery stiffness parameters were valued by e-tracking on the left carotid with ALOKA a 10 ultrasound system. Pulse wawe velocity (PWV), elastic pressure (Ep) and stiffness parameter (ß) were measured. Results: Pwv (m/s) 8+/-2, Ep (Kpa) 134+/-23, ß 12+/-2, normalized for age, were increased when compared with healthy subjects. Stiffness parameters correlate significantly with Tissue Doppler imaging diastolic parameters in particularly with E’ pwv (r = 0.68, p < 0.05), Ep (r = 0.60, p < 0.05) and ß (r = 0.68, p < 0.01). Conclusion: patients with masked hypertension increased arterial stiffness and abnormal left ventricular diastolic function (particularly with E’), was associated with arterial stiffness, expression of a greater contribution of atrial contraction to left ventricular filling for increased left ventricular end-diastolic pressure due to an high afterload.