Effects of 24-week Polarized Training vs. Threshold Training in Obese Male Adults

The combination of high volume of moderate-intensity continuous training with a low volume of high-intensity interval training improved body composition and physical capacities in individuals with obesity. However, polarized training (POL) has never been used in adult men with obesity. Thus, the purpose of this study was to investigate changes in body composition and physical capacities induced by a 24-week POL or threshold (THR) program in obese male adults. Twenty male patients (mean age 39.8±6.3 yrs; mean body mass index [BMI] 31.6±2.7 kg∙m-2) participated in this study (n: 10 POL, n: 10 THR). After 24-week, body mass (BM) and fat mass (FM) decreased by -3.20±3.10 kg (P<0.05) and -3.80±2.80 kg (P<0.05), respectively, similarly in both groups. Maximal oxygen uptake (  ̇VO2max) and   ̇VO2 at respiratory compensation point (RCP) increased in the POL group (+8.5±12.2 and+9.0±17.0%, P<0.05) and in the THR group (+4.24±8.64 and+4.0±6.70%, P<0.05), as well   ̇VO2 at gas exchange threshold (GET) increased similarly in both groups (+12.8±12.0%, P<0.05). POL and THR were equally effective in improving body composition and physical capacities in obese subjects. Future studies are needed to determine whether adherence to the training program can be improved by adding a running competition compared with a group without competition at the end of the training program.

Metabolic Syndrome and Heart Transplantation: An Underestimated Risk Factor?

Metabolic Syndrome (MetS), a multifactorial condition that increases the risk of cardio-vascular events, is frequent in Heart-transplant (HTx) candidates and worsens with immunosuppressive therapy. The aim of the study was to analyze the impact of MetS on long-term outcome of HTx patients. Since 2007, 349 HTx patients were enrolled. MetS was diagnosed if patients met revised NCEP-ATP III criteria before HTx, at 1, 5 and 10 years of follow-up. MetS was present in 35% of patients pre-HTx and 47% at 1 year follow-up. Five-year survival in patients with both pre-HTx (65% vs. 78%, p < 0.01) and 1 year follow-up MetS (78% vs 89%, p < 0.01) was worst. At the univariate analysis, risk factors for mortality were pre-HTx MetS (HR 1.86, p < 0.01), hypertension (HR 2.46, p < 0.01), hypertriglyceridemia (HR 1.50, p=0.03), chronic renal failure (HR 2.95, p < 0.01), MetS and diabetes at 1 year follow-up (HR 2.00, p < 0.01; HR 2.02, p < 0.01, respectively). MetS at 1 year follow-up determined a higher risk to develop Coronary allograft vasculopathy at 5 and 10 year follow-up (25% vs 14% and 44% vs 25%, p < 0.01). MetS is an important risk factor for both mortality and morbidity post-HTx, suggesting the need for a strict monitoring of metabolic disorders with a careful nutritional follow-up in HTx patients.

Improvement of adiponectin in relation to physical performance and body composition in young obese males subjected to twenty-four weeks of training programs

Obesity and related metabolic diseases represent a worldwide health problem. The main factor predisposing to obesity is an unhealthy lifestyle including the lack of physical activity. A pivotal role in the etio-pathogenesis of obesity is carried out by adipose tissue, an endocrine organ secreting several adipokines involved in numerous metabolic and inflammatory processes. Among these, of particular importance is adiponectin, an adipokine involved in the regulation of insulin sensibility and in anti-inflammatory processes. The aim of the study was to determine the effects of 24 weeks of two different training programs polarized (POL) and threshold training (THR) on body composition, physical capacities and adiponectin expression. Thirteen male obese subjects (BMI: 32.0 ± 3.0 kg m-2) followed 24 weeks of two different training programs, POL and THR, consisting of walking or running (or a combination of the two methods) in their normal living conditions. Before (T0) and after the end of the program (T1), the assessment of body composition was assessed by bioelectrical impedance and the concentration of salivary and serum adiponectin was analyzed by enzyme-linked immunosorbent assay and western blotting. Although the results obtained did not show significant differences between the two training programs, body mass and body mass index decreased by a mean of -4.46 ± 2.90 kg and 1.43 ± 0.92 kg m^-2 (P < 0.05). Fat mass decreased by -4.47 ± 2.78 kg (P < 0.05). V'O₂max increased by a mean of 0.20 ± 0.26 L min^-1 (P < 0.05) Also, we observed an increase in saliva and in serum of adiponectin concentrations at T1 compared to T0 by 4.72 ± 3.52 μg mL^-1 and 5.22 ± 4.74 ng mL^-1 (P < 0.05) respectively. Finally, we found significant correlations between Δ serum adiponectin and Δ Hip (R = -0.686, P = 0.001) and between Δ salivary adiponectin and ΔWaist (R = -0.678, P = 0.011). Our results suggest that a 24 weeks training program, independently from intensity and volume, induces an amelioration of body composition and fitness performance. These improvements are associated with an increase in total and HMW adiponectin expression in both saliva and in serum.

A dietary intervention study to reduce Metabolic Syndrome risks in heart-transplanted patients

Background

Since heart transplantation (HTx) has become the gold standard therapy in end-staged heart failure, many factors, including metabolic syndrome (MS), represent a burden in HTx patients. Considering key role of immunosuppressive therapy and its side effects on the appearance of MS, we focused on modifiable factors including adherence to Mediterranean Diet (MD) and improvement of dietary habits.

Methods

21 heart-transplanted patients were enrolled and randomized in a control group (CG; N 10) and an intervention group (IG; N 11). During two meetings (baseline, 6-month follow-up) were administered a validated Food Frequency Questionnaire (FFQ), to assess adherence to MD, and collected clinical and anthropometric parameters, IG were additionally requested to fill a food diary. IG received personalized advices, CG received standard recommendations. Comparison between IG and CG were analyzed, differences into the IG were also assessed.

Results

The prevalence of MS at baseline was 46% in IG and 20% in CG. During 6-month follow-up, significant lower blood pressure values were observed (median, 25th-75th: systolic 130, 120-130 IG vs 145, 130-147 CG; p = 0.004). Seven patients of IG underwent a 12-month meeting. In this group MD scores increased significantly (7 + 1.3 vs 4 + 1.5, p = 0.001). Furthermore, significant decrease of fat mass percentage (%) (23.3 + 6.3 vs 14.8 + 10.1, p = 0.014), increase of fat free mass % (76 + 6.3 vs 85.2 + 10.1, p = 0.014) and increase of body cell mass % (50.9 + 3.8 vs 53.4 + 3.4, p = 0.031) were observed. Dietary data in IG showed significant decrease of energy from saturated fatty acids % (13.0±2.1 vs 9.6±1.5, p = 0.001), sodium (mg) (2138±359 vs 1822±417, p = 0.045), and decreasing trend for cholesterol (mg) (219±82 vs 171±59, p = 0.082).

Conclusions

Dietary intervention based on MD perhaps can improve MS risks in heart-transplanted patients. Further investigations may be needed to assess the fundamental role of a structured nutritional follow-up in these patients.

Key messages

• Personalized nutritional advices based on the MD, compared to general recommendation, can significantly improve health and quality of life in heart-transplanted patients.

• A structured nutritional follow-up for heart-transplanted patients may be desirable to prevent risks of Metabolic Syndrome as a public health instrument in selected categories as these patients.

Are Dietary Patterns Related to Cognitive Performance in 7-Year-Old Children? Evidence from a Birth Cohort in Friuli Venezia Giulia, Italy

Research from different sources supports a link between nutrition and neurodevelopment, but evidence is still sparse regarding the relationship between a posteriori dietary patterns (DPs) and cognitive performance in school-aged children. Within the Northern Adriatic Cohort II, Friuli Venezia Giulia, Italy, 379 7-year-old children were cross-sectionally evaluated. Dietary patterns were identified through a principal component factor analysis based on 37 nutrients from children’s 3-day dietary records. The Wechsler Intelligence Scale of Children (WISC-IV) test provided measures of cognitive performance, including the full-scale intelligence quotient (FSIQ) and single index scores. Each DP was related to FSIQ or single index scores through multiple robust linear regression models. We identified five DPs named “Dairy Products”, “Plant-based Foods”, “Fats”, “Meat and Potatoes”, and “Seafood” (63% of variance explained). After adjustment, no significant relationship was observed with the FSIQ score; positive associations were found between the “Seafood” DP and Verbal Comprehension Index or Perceptual Reasoning Index. The “Meat and Potatoes” and “Dairy Products” DPs were inversely associated with the Verbal Comprehension Index and Processing Speed Index scores, respectively. In the absence of a relation with the overall FSIQ score, single DPs might influence specific cognitive functions, including verbal and reasoning abilities, as targeted by single indexes, in the expected direction.

C54 METABOLIC SYNDROME IN HEART TRANSPLANTATION: AN UNDERESTIMATED RISK FACTOR?

Background and Aims

Metabolic Syndrome (MS) is a multifactorial condition that increases the risk of cardio–vascular events, it’s frequent in Heart transplant (HTx) candidates and worsens with immunosuppressive therapy.

Aim of the study was to analyse the impact of MS on long–term outcome of HTx patients in our centre.

Methods

MS was defined through the presence of at least 3 of the following factors: Triglyceride ≥150mg/dl or drug treatment for hypertriglyceridemia HDL &lt;40mg/dl for men and &lt;50mg/dl for women Blood glucose ≥100mg/dl or diabetes mellitus Arterial pressure ≥130/80 or hypertensive drug treatment BMI&gt;30. In 349 HTx patients since 2007, mortality and morbidity predictors were evaluated.

Results

MS was present in 35% of patients pre–HTx and 47% within the first year of follow–up. Five–year survival in patients with pre–HTx MS was worst (65% vs 78%, p &lt; 0.01), as well as in those with MS in the first year of follow–up (78% vs 89%, p &lt; 0.01). At the univariate analysis, risk factors for mortality were recipient age (HR 1.07, 1.04–1.09, p &lt; 0.01), pre–HTx MS (HR 1.86, 1.29–2.69, p &lt; 0.01), pre–HTx hypertension (HR 2.46, 1.70–3.55, p &lt; 0.01), pre–HTx hypertriglyceridemia (HR 1.50, 1.04–2.18, p = 0.03), chronic renal failure (HR 2.95, 2.03–4.27, p &lt; 0.01), MS and diabetes at 1–year follow–up (HR 2.00, 1.25–3.19, p &lt; 0.01; HR 2.02, 1.27–3.23, p &lt; 0.01, respectively). The last two resulted also risk factors for CAV (HR 1.86, 1.16–2.99, p = 0.01; HR 1.67, 1.03–2.69, p = 0.04, respectively). MS at 1–year follow–up determined a significant higher risk to develop CAV at 5– and 10–year follow–up, compared to patients without MS (25% vs 14% and 44% vs 25%, p &lt; 0.01).

Conclusions

MS is an important risk factor for both mortality and morbidity post–HTx, suggesting the need for a strict monitoring of metabolic disorders with a careful nutritional follow–up in HTx patients.

Psychological and socio-educational correlates of energy drink consumption in children and adolescents: a systematic review

Energy drinks (EDs) are non-alcoholic beverages providing an extra boost in physical/cognitive performance and mood. Besides the physiological effects related to the high-caffeine content of EDs, long-term emotional, social, and behavioral effects have been recently receiving attention. However, a few systematic reviews have focused on the critical yet understudied periods of childhood and adolescence. We have undertaken a comprehensive systematic review of the evidence on any psychosocial correlates of ED consumption in 0-18-year-old subjects, as published up to April 1, 2021, in MEDLINE/PubMed, PsycINFO, and Cochrane Reviews and Central Register of Controlled Trials. Of the initial 789 records, 104 original articles were included in the systematic review. Seventy percent of them were published from 2016 onwards; among investigated topics, substance use ranked first, followed by psychological and socio-educational factors; the less investigated topic was risky behaviors. Taste and energy-seeking were the main drivers of consumption, which generally happened at home or during sport/recreational activities, without perception of health-related risks. Positive associations with ED consumption were found for sensation seeking, irritability/anger, and suicide ideation, plan, or attempts. Finally, participants with lower grades, a low parental monitoring, or bad influences from peers were more likely to consume EDs. Conclusion: With ~ 70% of papers published since the 2 comprehensive reviews on children/adolescents were carried out, an update of the literature with a broad focus is of great importance. Consumption of EDs by children/adolescents lies in the potential interplay between personality traits, school performance, and influences by family members and peers. What is Known: • Taste and energy-seeking are the main drivers of energy drink consumption, which mostly happened at home or in sport/recreational activities. What is New: • Perception of risks related to energy drinks is associated with a lower consumption, as based on cross-sectional studies. • As mostly based on cross-sectional studies: 1. energy drink consumption is related to sensation seeking, irritability/anger, and suicide ideation or attempts; 2. students with a lower school performance, low parental monitoring, or bad peer influence, are more likely to consume energy drinks.

Cerebral microemboli detected by transcranial doppler in patients treated with extracorporeal membrane oxygenation

INTRODUCTION

Cerebrovascular complications rate in patients treated with extracorporeal membrane oxygenation (ECMO) is about 7%. Ischemic stroke may be caused by solid or gaseous microemboli due to thrombosis within the circuit or cannula. Transcranial Doppler (TCD) is the only method able to detect microembolic signals (MES) in real time. The objective of this study was to detect possible MES by TCD in patients treated with veno-venous (VV) and veno-arterial (VA) ECMO and to test for a relation between the number of MES and the 6-month clinical outcome of these patients.

METHODS

This is a monocentric observational prospective study in patients consecutively admitted and treated with ECMO at our regional ECMO referral center in 18 months. TCD detection of MES was performed in patients upon initiation of treatment and then repeated during treatment.

RESULTS

Two hundred and forty-eight TCD monitoring were performed in 42 VV and 11 VA ECMO patients. MES were detected in 26.2% of VV ECMO patients and in 81.8% of VA ECMO patients (P < 0.001). In both subgroups of patients, no correlation was found between MES detection and extracorporeal flow velocities or aPTT values. In VA ECMO patients, an inverse correlation between left ventricular ejection fraction and MES grading was found (P = 0.037). In both groups, no clinical neurological impairments correlated to MES detection were found at 6 months follow-up.

CONCLUSIONS

MES were found in both ECMO configurations; independently from their pathophysiology, MES do not seem to influence clinical outcome. Multicenter studies are still required with more extensive cases to confirm these results.

Down syndrome, autoimmunity and T regulatory cells

Autoimmune diseases are more represented in Down syndrome (DS) individuals compared to chromosomally normal people. Natural T regulatory cells (nT(reg) ) have been considered to be primary in the role of controlling the intensity and targets of the immune response. We have investigated the phenotypical and functional alteration of nT(reg) in a group of DS people. The phenotypical characteristic of T(reg) cells of 29 DS was analysed and compared with an age-matched healthy control group. The inhibitory potential of CD4(+) CD25(high) CD127(low) T regulatory cells was evaluated on autologous CD4(+) CD25(-) T cell proliferation in response to activation with a mytogenic pan-stimulus (anti-CD2, anti-CD3 and anti-CD28 antibodies). The CD4(+) CD25(high) cells in the DS and control groups were 2·692±0·3808%, n=29 and 1·246±0·119, n=29%, respectively (P=0.0007), with a percentage of forkhead box protein 3 (FoxP3)-expressing cells of 79·21±3·376%, n=29 and 59·75±4·496%, respectively (P=0.0015). CD4(+) CD25(+) FoxP3(+) cells were increased in peripheral blood from DS subjects (DS mean 5·231±0·6065% n=29, control mean 3·076±0·3140% n=29). The majority of CD4(+) CD25(high) were CD127(low) and expressed a high percentage of FoxP3 (natural T(reg) phenotype). While the proliferative capacity of DS T cells was not altered significantly compared to normal individuals, a reduced inhibitory potential of T(reg) compared to healthy controls was clearly observed (mean healthy control inhibition in T(eff)  : T(reg) 1:1 co-culture: 58·9%±4·157%, n=10 versus mean DS inhibition in T(eff) :T(reg) 1:1 co-culture: 39·8±4·788%, n=10, P=0.0075; mean healthy control inhibition in T(eff)  : T(reg) 1:0·5 co-culture: 45·10±5·858%, n=10 versus DS inhibition in T(eff) : T(reg) 1:0·5 co-culture: 24·10±5·517%, n=10, P=0.0177). DS people present an over-expressed peripheral nT(reg) population with a defective inhibitory activity that may partially explain the increased frequency of autoimmune disease.

No association between chronic cerebrospinal venous insufficiency and pediatric-onset multiple sclerosis

OBJECTIVE

Chronic cerebrospinal venous insufficiency (CCSVI) was hypothesized to play a causative role in multiple sclerosis (MS). The assessment of pediatric-onset MS (POMS) may provide a unique window of opportunity to study hypothesized risk factors in close temporal association with the onset of the disease.

METHODS

Internal jugular veins, vertebral veins and intracranial veins were evaluated with extracranial and intracranial ultrasound in 15 POMS and 16 healthy controls. Assessor's blinding was maintained during the study. We considered subjects positive to CCSVI when at least two criteria were fulfilled.

RESULTS

CCSVI frequency was comparable between POMS and controls (p > 0.05). Clinical features were not significantly different between CCSVI-positive and CCSVI-negative patients.

CONCLUSIONS

Our findings add to previous data pointing against a causative role of CCSVI in MS.

Music and cerebral hemodynamics

Previous studies performed by positron emission tomography and Transcranial Doppler (TCD) found a different cerebral activation during musical stimuli in musicians compared to non-musicians. The aim of our study is to evaluate by means of TCD, possible different pattern of cerebral activation during the performance of different musical tasks in musicians, non-musicians and lyrical singers. Our findings show a left hemispheric activation in musicians and a right one in non-musicians. Preliminary data on lyrical singers' activation patterns need further confirmation with a larger population. These data could be related to a different approach to music listening in musicians (analytical) and non-musicians who are supposed to have an emotional approach to music.

[Complete section of the main bile duct during laparoscopic cholecystectomy. Surgical treatment]

Three cases of biliary tract serious lesions during videolaparoscopic cholecystectomy are reported. They were executed in other hospitals and presented big technical restoring difficulties, not easily resolvable. In 2 cases of lithiasic cholecystitis there was a complete damage of common biliary duct, in the third one there was a double main biliary duct binding with removal of a biliary tract segment. In all cases a biliary confluence-jejunal anastomosis with Roux en y loop was made up. In all cases the operation was difficult because of main bile duct fragility and modest expansion. In the third one the presence of a secondary biliary duct in gallbladder fossa not recognized but drained outside with a common drainage placed during the operation has prevented appearance of jaundice with dilatation of biliary ducts. It has heavily conditioned confluence-jejunal anastomosis with Roux en Y loop. In all cases tubes were left in the biliary duct for few months in order to calibrate it. In 2 patients postoperative course was characterized by the appearance of an external biliary fistula which has spontaneously disappeared. One year later both patients don't present any stenosis or cholangitis problem.

Iatrogenic injury in videolaparoscopic cholecystectomy: difficult surgical correction biliary tract

Two cases of biliary tract serious lesions during videolaparoscopic cholecystectomy are reported. In the first case of lithiasic cholecystitis there had been a complete damage of the common biliary duct; in the second case there had been a double main biliary duct binding with removal of a biliary tract segment. In both cases a biliary confluence-jejunal anastomosis with Roux-en-Y loop was made up. In the first one the operation was difficult because of the main bile duct's fragility and modest expansion. In the second one the presence of a secondary biliary duct in gallbladder fossa not recognized, but drained outside with a common drainage placed during the operation prevented appearance of jaundice with dilatation of biliary ducts. It was heavily conditioned performing confluence-jejunal anastomosis with Roux-en-Y loop. The post-operative course was characterized by appearance of an external biliary fistula which has spontaneously disappeared. One year later, neither of the two patients had any stenosis or cholangitis problems.

Retroperitoneal fibrosis: unusual localization

Six cases of retroperitoneal fibrosis, each with a different pathogenesis and unusual localization were observed from 1980 to 1996. Four patients had had previous surgery for a neoplasm, one patient had idiopathic retroperitoneal fibrosis, and the last patient was hardly classifiable due to the complexity of the clinical pattern. The mean survival in 3 patients with malignant retroperitoneal fibrosis was 7 months. Two patients treated with medical therapy are still alive and in good clinical condition. The aspecificity of the symptoms makes early diagnosis difficult. CT and NMR are essential procedures for differential diagnosis of abdominal masses. Histology differentiates benign from malignant retroperitoneal fibrosis. The choice between medical or surgical therapy depends on the general condition of each patient.

Sex-related differences in human cerebral hemodynamics

OBJECTIVES

To identify possible inter-hemispheric sex-related cerebral hemodynamic differences at rest, in healthy subjects by transcranial Doppler (TCD).

SUBJECTS AND METHODS

Mean flow velocity (MV) was recorded by TCD in 96 (48 males, 48 females) right-handed volunteers. Mean age was similar in males and females, distribution of age-groups by sex was similar, too.

RESULTS

Examining by sex MV values in each basal artery, left middle cerebral artery (MCA) showed a statistically significant difference (53.5+/-8.2 cm x s(-1) in males versus 58.5+/-10.4 cm x s(-1) in females, P=0.005, one-way ANOVA). Multiple regression models show a significant correlation between age and MV on each side, while sex correlates with MV on the left side.

CONCLUSION

A sex-dependent hemispheric difference in MV in the left MCA at rest (females>males) in the younger population subgroup was identified. These data support recent observations on anatomical differences between sexes, referring a proportionally larger Broca area in females compared to males.

Abnormal brain hemodynamic responses during passive orthostatic challenge in panic disorder

OBJECTIVE

Autonomic dysregulation and cerebral blood flow (CBF) abnormalities have been reported in patients with anxiety disorders and, more recently, in panic disorder. Variations in the middle cerebral artery velocity (measured by transcranial Doppler technique), heart rate, and blood pressure during a tilting-table test were used as nonanxiogenic procedures to explore these abnormalities.

METHOD

Mean flow velocity in the right middle cerebral artery, heart rate, and blood pressure were monitored at rest and during a 70 degrees tilting-table test. Three groups of patients were studied: 11 patients (eight women and three men; mean age = 31.1 years, SD = 8.0) with a diagnosis of panic disorder within 6 months of the onset of the disorder, nine asymptomatic patients (two men and seven women; mean age = 35.0, SD = 6.3) with a previous diagnosis of panic disorder who were in full remission of symptoms and had been drug free for at least 6 months, and 10 normal comparison subjects (two men and eight women; mean age = 31.1, SD = 5.2).

RESULTS

Both patients with acute panic disorder and patients with remitted panic disorder showed a significant percent reduction of right middle cerebral artery mean flow velocity compared with normal subjects following tilting to the upright position. No significant differences were observed for blood pressure and heart rate.

CONCLUSIONS

Patients with panic disorder, both during the acute phase of the illness and after clinical recovery, show an exaggerated drop in CBF during tilting. Since these findings are similar, although attenuated in intensity, to those which are observed in dysautonomic illnesses, one possible interpretation is that of panic disorder as a subclinical form of autonomic dysreactivity.

Technical limits in transcranial Doppler recording: inadequate acoustic windows

Transcranial Doppler (TCD) is a technique that evaluates blood flow velocity in intracranial vessels. It uses a 2-MHz probe and a Doppler signal analyzer. Absence of an acoustic window is a considerable problem for clinical utilization of TCD because cerebrovascular patients are frequently elderly. Previous reports suggest a higher prevalence of inadequate temporal acoustic window (TAW) in aged subjects and in females. A consecutive series of 624 subjects (376 males and 248 females, age range 2-86 y) were evaluated by standard TCD examination, to assess the contemporary absence of any signal corresponding to insonated basal arteries, defined as inadequate acoustic window. The rate of inadequate TAW was 8.2%, that of inadequate occipital acoustic window (OAW) was 9.0%. Prevalence of inadequate TAW was higher in females than in males, and OAW was higher in males than in females. Influence of aging on the presence of inadequate acoustic window is confirmed for temporal, but not for the occipital window. Different anatomical characteristics of the 2 regions could explain the different prevalence of TAW and OAW.

Instrumental treatment of recurrent lithiasis of biliary tract with stenosis of hepatico-jejunal anastomosis

The optimal treatment for recurrent stones of the biliary tract in patients previously treated by hepatic-jejunal anastomosis with Roux en Y loop is debated and the criteria are not fully defined. Age, cardiopulmonary diseases, diabetes, multiple previous surgery of the biliary tract, size, number, and type of stones are some of the factors to evaluate before choosing the most convenient approach. We present two high surgical risk patients with recurrent biliary tract stones previously treated with hepatic-jejunal anastomosis and Roux en Y loop, and treated successfully. Percutaneous lithotripsy was used and in one extracorporeal lithotripsy was associated. These techniques offered a good treatment for these patients, but we must consider the high cost of these procedures. The criteria to choose the best option should consider the risk factors and the cost effectiveness of the various possibilities.

The relevance of transcranial Doppler to ischemic stroke outcome

To assess the value of transcranial Doppler examination for the early prognosis of ischemic stroke, we examined 24 patients (15 males and 9 females, mean age 66.8 +/- 9.3 years) with hemispheric cerebral infarction, within 6 hours of stroke onset. Of these 24 patients, 22 were evaluated on the Canadian Neurological Scale, the Toronto Stroke Scale, and the Barthel Index on days 60 and 120. Mean flow velocity in the middle cerebral artery on the lesion side was measured and values outside the range 30 to 80 cm/sec were rated abnormal. Two of nine patients with normal flow velocity died compared to five of the 13 patients with abnormal values. Four of the seven remaining patients in the former group made a full recovery compared with none of the remaining eight patients in the latter group (P less than 0.05). Neurological and functional status measured on the scales used on days 60 and 120 were also significantly better in the group with normal flow velocity. Early transcranial Doppler may prove useful in predicting the outcome of hemispheric infarction in the acute phase of cerebral ischemia.

A study of the semeiological reliability of dorsalis pedis artery and posterior tibial artery in the diagnosis of lower limb arterial occlusive disease

Routine diagnosis of suspected occlusive arterial disease of the lower limbs are often based on the pulse absence at the dorsalis pedis artery. However many of these diagnoses are not confirmed after more thorough tests, and this fact arises the problem of the semeiological reliability of the above mentioned artery. Researches carried out by several authors in normal individuals on the dorsalis pedis artery yielded controversial results. Three hundred-sixty subjects free of occlusive arterial disease were then examined by means of clinical and Doppler investigation in order to assess the semeiological reliability of the dorsalis pedis artery in the diagnosis of occlusive arteriopathy of lower limbs, when compared to the posterior tibial one. The conclusion is drawn that a greater semeiological reliability must be attributed to the latter, due to its lesser "absence" incidence.

[Clinical use of percutaneous transhepatic biliary decompression]

Several interesting applications of P.T.C. with biliary drainage are described out of several years' experience with the technique. It was found to be extremely useful for precise preoperative diagnosis of biliary calculus and any associated pathologies. The information provided by biliary drainage is also obviously helpful in selecting the correct surgical approach to this condition.

[Rectocolic carcinoma associated with ovarian neoplasms. A clinical study and review of the literature]

Five cases of colorectal cancer associated with ovarian neoplasma are reported: three of them are multiple primary malignant lesions and the others are colorectal carcinoma with ovarian metastasis. Problems of its frequency are then discussed as well as and ethiopathogenesis in multiple primary malignant neoplasma and in ovarian metastasis.

[Use of thermo-mammographic and cholesteric methods in the early diagnosis of breast carcinoma]

In 1973, 600 women aged between 19 and 70 and belonging to various social strata were examined. Some came spontaneously without symptomatology, for the sole purpose of preventive screening, others presented various symptoms. Thermography was used on all patients. Complementary mammography was carried out on some of them while others were subjected to cutaneous application of a personally prepared cholesteric strip with various thermic range. An Eastman Kodak cholesteric mixture at 10% solution and with thermic range varying from 35 degrees to 39 degrees was used. Solutions with thermic excursion of 1 degree C were adopted. (This examination was carried out for scientific purposes as it is absolutely not yet part of diagnostic routine). A comparison was then made between the thermo mammographic and cholesteric methods in the early diagnosis of mammary carcinoma.