Ferdinando Pentimone

Tortuosity, kinking, and coiling of the carotid artery : Expression of atherosclerosis or aging?

The etiology of carotid abnormalities is both congenital than acquired. The aim of this study was to clarify the role of aging and atherosclerosis in the acquired cases, and the role of these abnormalities in hemodynamic alterations and neurologic symptoms. Over a 1-year period the authors studied all the subjects undergoing carotid exami nation by continuous-wave and color-coded Doppler sonography at an Angiology Unit. They evaluated neurologic symptoms; risk factors for atherosclerosis; number, sites, and kinds of carotid abnormalities; atherosclerotic lesions; stenosis; hemodynamic alterations of the carotid; and other localizations of atherosclerotic diseases. There were 469 subjects: 272 (58%) with abnormalities (group 1) and 197 (42%) without abnormalities (group 2). The total number of abnormalities was 479 (104 tortu osities, 262 kinkings, and 113 coilings). The abnormalities were more prevalent in the elderly (P<0.001) and in women (P< 0.001). In group 1 they found significant preva lences of hyperlipemia (P<0.001), hypertension (P<0.01), chronic cigarette smoking (P<0.01), and ischemic heart disease (P<0.05). (continued on next page) Carotid atherosclerotic lesions were more prevalent in group 1 than in group 2 (P<0.001); among the patients with atherosclerotic carotid lesions, those in group 1 were older than those in group 2 (P<0.001). Tortuosity seemed to be associated with fewer hemodynamic alterations. The authors conclude that atherosclerosis, hypertension, and aging may play an important role in producing carotid abnormalities. The aging seemed more important than atherosclerosis. Only a prospective study of patients with carotid abnormalities and no atherosclerotic lesion will clarify the role of hemodynamics and neurologic symptomatology.

Heart rate variability and left ventricular diastolic function in anorexia nervosa

PURPOSEnTo investigate the cardiac effects of starvation in a group of adolescents with anorexia nervosa (AN).nnnMETHODSnTwenty-five patients with AN (range 13-20 years), compared with 25 age-matched thin and 25 age-matched control women with body mass index > 20 Kg/m(2), underwent a complete clinical evaluation, including echocardiogram and 24-hour electrocardiogram monitoring to evaluate heart rate variability (HRV) indices.nnnRESULTSnCompared to both thin and control women, patients with AN had greater HRV time domain indices (SDNN: 246.5 +/- 32.4 vs. 170.4 +/- 24 ms and vs. 181 +/- 21.2 ms, p <.001), and in the frequency domain a lower LF/HF ratio (4.2 +/- 1.3 vs. 6.7 +/- 1.2 and vs. 6.8 +/- 1.3 ms, p <.001). AN patients showed reduced left ventricular mass with normal systolic function and typical diastolic patterns, characterized by a lower peak velocity transmitral flow in late diastole (peak A: 35.9 +/- 8.5 vs. 45.2 +/- 7.3 cm/sec and vs. 46.6 +/- 6.3 cm/sec, p <.01), a comparable peak velocity in early diastole (peak E: 92.7 +/- 12.1 vs. 83 +/- 6.2 and vs. 86.8 +/- 9.1 cm/sec, ns) and, subsequently, a greater E/A ratio (2.8 +/- 0.7 vs. 1.8 +/- 0.3 and vs. 1.9 +/- .5, p <.01) than thinness and control groups. Moreover, SDNN was also positively related to E/A ratio (r =.54, p <.01).nnnCONCLUSIONSnOur findings demonstrate a cardiovascular vagal hyperactivity in AN, which appears to influence the ventricular diastolic dynamics. HRV and diastolic function analysis may represent useful tools in monitoring anorexia-induced cardiac modifications.

The use of recombinant interferon Alfa-2b in elderly patients with anti-HCV-positive chronic active hepatitis

Objective: To compare efficacy and tolerance of recombinant interferon alfa‐2b in the treatment of anti‐HCV‐positive chronic active hepatitis (CAH) in subjects aged 65 years and above with those less than 65.

Endothelium-dependent and endothelium-independent skin vasoreactivity in the elderly

Background and aims: It was demonstrated that endothelium-dependent vasoreactivity, an aspect of endothelial functioning, is impaired in coronary and brachial arteries, and in skeletal muscle resistance vessels of elderly people. However, little data is available about the influence of aging per se on the endothelial function of the skin microcirculation. The aim of the present study was to evaluate the endothelial function and intrinsic vasodilatory capacity of the skin microcirculation in elderly people with a low atherosclerosis risk profile. Methods: Using laser Doppler flowmetry, we measured the cutaneous hyperemic responses following local iontophoresis delivery of an endothelium-dependent vasodilator, acetylcholine (ACh), and an endothelium-independent vasodilator, sodium nitroprusside (SNP), in 15 subjects older than 65 years and in 15 subjects younger than 50 years. Exclusion criteria were diabetes, hyperlipidemia, smoking, arterial hypertension and cardiovascular diseases. Results: Skin maximal hyperemic responses induced both by ACh and by SNP delivery did not differ between the younger and the older groups. Cutaneous blood flow progressively increased in response to the 8 ACh delivery steps, both in the older and younger groups; however, the dose-response curve following ACh delivery was significantly lower in the former (p<0.001). Conclusions: While these results should be viewed as preliminary due to the small sample size, they suggest that aging in itself is associated with a mild endothelium dysfunction in the skin microcirculation, whereas its overall vasodilatory capacity is preserved.

Age-Related Modifications in the Regulation of the Hypothalamic-Pituitary-Thyroid Axis

We studied the hypothalamic-pituitary-thyroid function in two groups of healthy elderly subjects: group A (n = 23, age range 65-80 years), and group B (n = 11, age range 81-92 years), and in 32 controls, aged 20-60. A TRH test for TSH and prolactin was performed in all subjects, while the TSH circadian modulation was evaluated in elderly subjects only. Group B showed significantly lower fT3 and TSH, and higher fT4 levels with respect to controls (fT3: 4.4 +/- 0.2 vs. 5.2 +/- 0.2 pmol/l, p < 0.05; fT4: 13.1 +/- 0.9 vs. 11.4 +/- 0.4 pmol/l, p < 0.05; TSH: 1.07 +/- 0.21 vs. 1.46 +/- 0.13 mIU/l, p < 0.05). Morning TSH showed an inverse correlation with age (r = -0.42; p < 0.02) among the 34 elderly subjects, but not among controls. Evidence for TSH circadian modulation was found only in group A (nighttime TSH: 1.60 +/- 0.17, vs. daytime: 1.25 +/- 0.13 mIU/l, p < 0.001). The TRH-stimulated TSH peak was reduced among all elderly subjects with respect to controls (A: 6.26 +/- 0.64 mIU/l, p = 0.01; B: 5.02 +/- 0.58 mIU/l, p < 0.01). The maximal PRL response was also blunted (A: 25.7 +/- 2.6 micrograms/l, B: 27.7 +/- 5.2 micrograms/l, p < 0.0005). In conclusion, a resetting of the pituitary threshold of the TSH feedback suppression, along with complex alterations in peripheral thyroid hormone levels, may progressively develop in older people, becoming apparent only with extreme senescence. Moreover, the TSH nocturnal surge may be lost with increasing age, thus providing evidence also for hypothalamic dysfunction.

Ultrasonic tissue characterization of the myocardium in anorexia nervosa

Aim: To determine the systodiastolic variations in the integrated backscatter (IBS) signal of the myocardium in patients with anorexia nervosa. Methods: 25 young women (aged 22.4 ± 4.3 y) with overt anorexia nervosa, compared with 25 age‐matched thin and 25 age‐matched control women with body mass index >20 kg m−2, underwent either conventional two‐dimensional echocardiography or analysis of IBS cyclic variations. Results: Compared with thin and control subjects, anorectic patients showed reduced left ventricular mass (LVM: 82.9 ± 17.1 vs 119.9 ± 13.8 and vs 126.12 ± 16.4 g, p < 0.0001; LVM indexed 21.4 ± 3.3 vs 29.4 ± 2.5 and vs 31.2 ± 3.1 g m−2.7, p < 0.0001), and IBS cyclic variations (septum: –0.49 ± 2.18 vs 6.86 ± 1.3 and vs 6.61 ± 1.74 dB, p < 0.0001; posterior wall: 2.77 ± 2.12 vs 7.15 ± 2.12 and vs 7.48 ± 2.23 dB, p < 0.01).

Takayasu's Arteritis: Low Corticosteroid Dosage and Pregnancy—A Case Report:

The authors describe a case of Takayasus arteritis in a twenty-five-year-old Italian woman, characterized by • nonspecific symptoms (weakness, arthralgias, fever) and elevated erythrocyte sedimentation rate • early onset of these symptoms at the age of about twenty-three years • early diagnosis, only eighteen months after the onset of symptomatology • absence of progression of the disease under corticosteroid therapy with a follow-up of three years • uneventful pregnancy ending in cesarean section and birth of a baby without maternal and neonatal complications.

Ultrasonic backscatter of the carotid wall in young and older athletes

Objectives.u2002 The aim of this study was to evaluate the effects of habitual exercise on the age‐related changes of carotid wall composition defining its acoustic reflectivity by the quantitative approach of integrated backscatter (IBS) analysis.

Unusual Takayasu's Arteritis: Case Report

Takayasus disease, a condition with unusual clinical symptoms and peculiar radiologic manifestations is described. The clinical and physiopathological implications are discussed together with a literary review.

Bilateral perinephric fluid accumulation : an unusual manifestation of pulmonary hypertension : a case report

This is the case report of a forty-seven-year-old man with an ostium secun dum atrial septal defect and a very high grade of pulmonary hypertension, associated with a large bilateral perinephric fluid accumulation. The fluid accu mulation was remarkably reduced after eleven phlebotomies over a twelve- month period. A pathogenetic relation with the Eisenmengers syndrome is discussed. No previous report of this association has been found in a survey of the literature.