ACE inhibition reduces glomerulosclerosis and regenerates glomerular tissue in a model of progressive renal disease

Today angiotensin II inhibition is primarily used to slow the rate of progression of kidney diseases. There is evidence that these therapies can induce a partial regression of glomerular lesions. However, we do not know yet the extent of sclerotic lesion regression and whether new glomerular tissue is formed to help support the renal function. We used male Munich Wistar Fromter (MWF) rats, an experimental model for progressive kidney disease, to quantify kidney structural lesions upon angiotensin-converting enzyme (ACE) inhibition therapy. Animals were studied at 50 weeks of age, when renal function and structure are severely altered, and after a 10-week observation period, without or with treatment with lisinopril (80 mg/l in drinking water). A group of untreated Wistar rats was used as controls. With age, proteinuria, and serum creatinine worsen, but lisinopril almost normalized proteinuria and stabilized serum creatinine. Serial section analysis of whole glomerular tufts showed that at baseline, glomerulosclerosis affected the entire glomerular population, and that these changes further increased with age. Lisinopril significantly reduced incidence and extent of glomerulosclerosis, with the presence of glomerular tufts not affected by sclerosis (23% of glomeruli). Glomerular volume was not significantly affected by treatment, and glomerular mass spared from sclerosis increased from 46.9 to 65.5% upon treatment, indicating consistent regeneration of glomerular tissue. Lisinopril normalized baseline glomerular transforming growth factor-beta and alpha-smooth muscle actin overexpression, and prevented worsening of interstitial changes. Hence, ACE inhibition, which is widely used in human kidney disease, may not only halt the progression of renal failure, but also actually induce the regeneration of new renal tissue.

[Work capacity of housewives with complete laceration of the rotator cuff]

OBJECTIVE

The aim of the this study is to evaluate the work capacity of housewives with full thickness tear of the rotatory cuff (FTTRC).

METHODS

Twenty-five subjects have been studied. The FTTRC was located un the right shoulder in 16 cases, in the left shoulder in 5 cases and was bilateral in 4 patients. All patients were female; the average age was 72.4 +/- 4 (range 62-81). The Assessments were made using the Constant Scale, the Groningen Activity Restriction Scale and the Simon's Test.

RESULTS

The result of this study confirmed that none of the housewives was able to carry out the houseworks quite independently and with no effort. 16% of the patients did the houseworks with great effort while 84% was helped in making some activities. Help is necessary for the usual housework and heavy domestic works (washing glasses, using vacuum cleaner to clean the floor). Patient's relatives provided help in 76.2% of cases while 23.8% were assisted by maid. Help was occasional in 33.3% of cases, continuous in 52.3% and full in 14.4% of patients. Disability resulting from FTTRC is heavier in subjects where electrical household appliances are not used (p < 0.05) and in subjects who feel deep pain (p < 0.05). The active movements of shoulder, local shoulder pain and level of use of upper limbs do not affect domestic works.

CONCLUSIONS

These study showed that FTTRC reduces work capacity of house wives. These disease is more preventing heavy domestic works.

[Walking recovery in stroke patients with femoral fracture]

The aims of this study were: 1) to evaluated the degree of walking of hemiplegic patients after femur fracture, 2) to evaluate if the neurological damage interferes with the recovery of walking. We studied 51 hemiplegic patients with femur fracture. All patients could walk without any help before the fracture. At the end of the rehabilitation period we had the following results: 5.8% of patients regained full walking independence; 37.2% walked with a cane; 43.1% with a quadripod; 9.8% walked with assistance; 3.9% remained unable to walk. 50.9% of them regained their prefracture functions. 96.1% returned directly to their own home, the remaining 3.9% were admitted to Geriatric hospitals. To address the second aim, we divided the same patients into two groups of 20 patients each (A = mild impairment; B = severe impairment) according to Mathew's scale. At the end of treatment, 95% of group A and 75% of group B regained full walking independence.

IN CONCLUSION

1) the femur fracture did not influence the recovery of walking in stroke patients, 2) patients with mild neurological impairment had enhanced recovery of walking.

Respiratory muscle function and exercise capacity in multiple sclerosis

Patients with multiple sclerosis (MS) show a poor exercise tolerance. A reduction in respiratory muscle strength has also been reported. The purpose of this study was to evaluate whether reduction in exercise tolerance was related to respiratory muscle dysfunction. Twenty four multiple sclerosis patients (mean +/- SD age: 48 +/- 9 yrs, duration of illness 12.2 +/- 6 yrs, severity of illness as assessed by Expanded Disability Scale Score (EDSS) 5.3 +/- 2), underwent detailed evaluation of lung function tests, arterial blood gas analysis, respiratory muscle strength and endurance, and exercise test on an arm ergometer. Sixteen of the 24 patients were able to perform the exercise test (Group I), whilst the other eight were not (group II). Arterial blood gases and lung function tests were normal for both groups. Respiratory muscle strength as assessed both by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) was significantly reduced (MIP 18-76 cmH2O; MEP 16-82 cmH2O) compared to predicted values. Inspiratory muscle endurance time was significantly reduced in Group II in comparison to Group I (247 +/- 148 vs 397 +/- 154 s, respectively). Both MIP and MEP were significantly related to inspiratory muscle endurance time. Endurance time, MIP and MEP were inversely significantly related to duration of illness, whilst only endurance time was significantly related to Expanded Disability Scale Score.(ABSTRACT TRUNCATED AT 250 WORDS)

[Motor inhibition and disinhibition in hemiplegics with global aphasia: rehabilitative implications]

Motor behaviour of 18 complete aphasic-hemiplegic patients have been studied. Among these patients an attitude of motor inhibition has been noticed, prevalently characterized by motor slowing and stopping. It has also been noticed an attitude of motor disinhibition, characterized by motor restlessness and ineffective bustle.