Platelet‑to‑lymphocyte ratio, neutrophil‑to‑lymphocyte ratio and monocyte‑to‑HDL cholesterol ratio as markers of peripheral artery disease in elderly patients

Solid evidence underlines the pivotal role played by inflammation regarding atherosclerosis. Peripheral artery disease (PAD) is one of atherosclerotic cardiovascular diseases (CVDs), it is highly frequently diagnosed in older individuals. In the present study we carried out an investigation on the association between platelet‑to‑lymphocytes ratio (PLR), neutrophil‑to‑lymphocyte ratio (NLR), monocyte‑to‑HDL cholesterol ratio (MHR) with PAD as favourable markers. We identified 300 subjects aged over 70 years, without any concomitant CVDs. The PLR, NLR and MHR were assessed from peripheral venous blood routinely drawn in the ward during hospitalization. Patients were divided in groups according to ankle brachial index (ABI) value (>0.9; 0.9‑0.99; 1‑1.4; >1.4). Higher PLR (P=0.007), NLR (P=0.0001) and MHR (P=0.0001) were associated with <0.9 ABI. Patients with a >1.4 ABI showed NLR values higher compared to >0.9l ABI (P<0.01). Univariate linear regression analysis demonstrated the direct correlation between increase in PLR (P=0.0023)and MHR (P<0.0001) with the decrease in ABI value. In multivariate linear regression analysis including main cardiovascular risk factors we found that PLR, NLR and MHR were independently associated with lower ABI (P=0.0011). Results show and suggest that the elevated PLR, NLR and MHR are related to PAD evaluated with ABI measurement. PLR and MHR seem to be more reliable markers than NLR in PAD. NLR seems to be more related to incompressibility of arterial wall. It is hypothesized that these three indexes may play a role as simple and repetitive markers of PAD.

Microbiological Etiology of Chronic Skin Lesions in Type 2 Diabetic Subjects

INTRODUCTION

Skin lesions represent lesions that result in loss of tissues and their joints and often this cutaneous process is a primary or secondary consequence of structural changes in the same skin surface. Type 2 diabetic subjects developing chronic skin lesions in the lower limbs in the western world are steadily increasing. We conducted a study on the etiologic incidence of chronic skin lesions in type II diabetic subjects in the lower limbs compared to subjects with chronic skin lesions (controls).

MATERIALS AND METHODS

Thirty subjects (group "A") with Chronic Skin Lesions (CSL controls) (19 F-11M, mean age 67.5±7.2) in the lower limbs were admitted to our study according to a randomization scheme and compared a thirty (group "B") type II diabetic patients (18F-12M, mean age 73.5±4.9) with chronic skin lesions (CSL). These two groups "A" and "B" have been studied and compared on the basis of infectious etiology responsible for the infectious skin process.

RESULT

In the subjects of the "A" group we found a positive bacteriological colony test of 9 examinations corresponding to the total 30.0%. In the group called "B" we obtained a colony test positive of 12 subjects over 30 corresponding to 40.0% of the examinations. For the number of bacterial species identified in the "A" group we obtained 7 monomicrobial and 2 poly microbial bacteriological tests, while in the "B" group we observed 3 mono microbial and 9 poly microbial tests. All bacteriological isolates showed "in vitro" sensitivity to satisfactory aminoglycosides with MICs range of 0.78- 1.56mg/L.

CONCLUSIONS

Data from this study show a different etiology among diabetic subjects than nondiabetic subjects. In fact, in the "B" group, more poly microbial bacteriological findings are found in positive culture studies with subjects in group "A". This phenomenon confirms an alteration of the skin microbiome of diabetic subjects with modification of the "opportunistic role" of some species of the skin bacterial flora.

Effects of vildagliptin, a DPP-4 inhibitor, in elderly diabetic patients with mild cognitive impairment

INTRODUCTION

There is an unclear association between type 2 diabetes and mild cognitive impairment in the elderly. Both diseases are more prevalent in the older adults compared to the younger counterpart. Some anti-diabetic drugs seem to influence positively the evolution of mild cognitive impairment. This retrospective study investigated the effect of vildagliptin, an inhibitor of the enzyme dipeptidyl peptidase-4 (DPP-4), on the cognitive functioning of elderly diabetic patients with mild cognitive impairment (MCI) documented at mini mental state examination (MMSE).

METHODS

We included 60 diabetic elderly people which were divided in 2 groups: Group A, 30 patients with HbA₁c (glycated hemoglobin) ≤7.5% and treated with metformin, and Group B, 30 patients with HbA₁c >7.5%, and treated with metformin plus vildagliptin. We collected data on MMSE, fasting plasma glucose (FPG) and HbA₁c at baseline and after 180 ± 10 days from the beginning of treatment.

RESULTS

The two groups exhibited significantly different values in FPG (P < 0.05) and HbA₁c (P < 0.01) at baseline, and in MMSE score (P < 0.001) after treatment. The intragroup comparison showed a significant (P < 0.05) reduction in MMSE score in group A, and in HbA1c (P = 0.01) in group B.

CONCLUSION

Vildagliptin in addition to metformin resulted in the maintenance of MMSE score, showing a protecting role on cognitive functioning compared to the metformin only group.

Hypothyroidism as a Predictor of Surgical Outcomes in the Elderly

There is a high prevalence of hypothyroidism in the elderly population, mainly among women. The most important cause is autoimmune thyroiditis, but also iodine deficiency, radioiodine ablation, and surgery may be responsible for hypothyroidism in elderly hospitalized patients. Thyroid-related symptoms are sometimes comparable to physiological manifestations of the aging process, and hypothyroidism may be related with many symptoms which can be present in critical patients, such as cognitive impairment, cardiovascular, gastrointestinal, and hematological alterations, and eventually myxedema coma which is a severe and life-threatening condition in older adults. Adequate thyroid hormone levels are required to achieve optimal outcomes from any kind of surgical intervention. However, only few randomized clinical trials investigated the association between non-thyroidal illness (or low-T3 syndrome), and adverse surgical outcomes, so far. The goal of this review is to discuss the role of thyroid function as a predictor of surgical outcomes in the elderly.

Can laparoscopic cholecystectomy be safety performed in the elderly?

AIM

To assess the suitability of laparoscopic cholecystectomy in elderly patients, although early reports have questioned the efficacy of this procedure in that patient group.

MATERIAL OF STUDY

Retrospective study evaluating the medical records of the elderly patients who underwent laparoscopic cholecystectomy in our surgical unit. Data included age and gender, American Society of Anesthesiologists (ASA) score, comorbid illness, prior abdominal surgery, presentation, operative time, conversion rate, postoperative morbidity, and mortality rates and length of hospital stay.

RESULTS

Fifty consecutive patients age 70 or older who underwent laparoscopic cholecystectomy were studied Postoperative complications occurred in five patients.

DISCUSSION

Many Studies have shown that the incidence of complicated gallstone disease in the elderly is higher when compared with that of younger patients and gallbladder disease is particularly virulent in the elderly, with high rate of acute cholecystitis, biliary tract disease, increased morbidity, and prolonged hospital stay. This poor outcome has been attributed to the presence of severe co-morbid factors associated with the aging process. Compared to open cholecystectomy, laparoscopic cholecystectomy may cause less postoperative depression of respiratory function and cell-mediated immunity. In our study perioperative mortality rate was 0%.

CONCLUSIONS

Laparoscopic cholecystectomy in elderly patients is a relatively safe procedure that can be accomplished with acceptable low morbidity. In this series of geriatric patients, there was no evidence of any increased risk for conversion to an open cholecystectomy, delayed recovery, or prolonged hospitalization.

Therapeutic options for elderly diabetic subjects: open label, randomized clinical trial of insulin glargine added to oral antidiabetic drugs versus increased dosage of oral antidiabetic drugs

Glycemic control in elderly persons with type 2 diabetes mellitus (T2DM) is challenging because they are more likely to have other age-associated medical conditions and to experience hypoglycemia during intensive therapy. A best therapeutic strategy for these patients has not yet been defined. We investigated the efficacy and safety of adding once-daily insulin glargine to patients' current oral antidiabetic drugs (OAD) regimen, compared to increasing the OAD doses. The study enrolled patients aged 65 years or more, with poor glycemic control. Patients were randomized to two groups and entered a 3-week titration period in which their actual therapy was adjusted to meet the study's glycemic goals, by either adding insulin glargine to current therapy (group A, 27 patients) or increasing current OAD dosages (group B, 28 patients). Thereafter, therapies were continued unchanged for a 24-week observation period. The mean therapeutic dosage of insulin glargine in group A was 14.9 IU/day (SD = 5.0 IU/day). During the observation period, mean levels of glycosylated hemoglobin (HbA1c) reduced by 1.5% in group A and 0.6% in group B (P = 0.381). An HbA1c level <7.0% was achieved by five patients in each group. Mean fasting blood glucose levels reduced by 29 and 15% in groups A and B, respectively (P = 0.029). Group A had fewer total hypoglycemic events (23 vs. 79, P = 0.030) and fewer patients experiencing any such event (9 vs. 17, P = 0.045). Neither a serious hypoglycemic event nor other adverse event occurred. These results suggest that, compared to increasing OAD dosage, the addition of insulin glargine to current OAD therapy is as effective but safer in terms of the risk for hypoglycemia in elderly patients with T2DM.

Probing membrane protein orientation and structure using fast magic-angle-spinning solid-state NMR

One and two-dimensional solid-state NMR experiments are discussed that permit probing local structure and overall molecular conformation of membrane-embedded polypeptides under Magic Angle Spinning. The functional dependence of a series of anisotropic recoupling schemes is analyzed using theoretical and numerical methods. These studies lead to the construction of a set of polarization dephasing or transfer units that probe local backbone conformation and overall molecular orientation within the same NMR experiment. Experimental results are shown for a randomly oriented peptide and for two model membrane-peptides reconstituted into lipid bilayers and oriented on polymer films according to a method proposed by Bechinger et al.

The prevalence of various arrhythmias in normotensive and hypertensive elderly patients

The prevalence of the most frequent arrhythmias was studied in a geriatric day hospital. Patients older than 65 years have been considered, of them 118 were normotensive and 56 hypertensive subjects. Comparison of the two groups revealed no statistically significant difference either in the frequency of occurrence or in the type of arrhythmias. Dividing the hypertensive patients in the Lown's classes, only those of class 3 or over displayed a considerably higher frequency of arrhythmias than the normotensive subjects. The results demonstrate the age-dependent increase of the prevalence of arrhythmias in general, and the increased occurrence of complex ventricular types in the hypertensive subjects.

L-carnitine decreases severity and type of fatigue induced by interferon-alpha in the treatment of patients with hepatitis C

BACKGROUND

Hepatitis C virus (HCV) is one of the major agents of chronic hepatitis and liver disease worldwide. Infection with HCV leads to chronic hepatitis in about 80% of the cases. The most used treatment is based on interferon (IFN)-alpha, which is effective in less than 50% of patients; however, a high proportion of responders may relapse after interferon withdrawal. Fatigue is a common complaint in patients with liver disease. The aim of our study was to evaluate the efficacy of carnitine on IFN-induced fatigue in subjects with chronic hepatitis C.

PATIENTS AND METHODS

We studied 50 patients (30 males and 20 females) with chronic hepatitis C. Chronic hepatitis was diagnosed by determination of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels (at least 2-fold upper normal values for 1 year). Our study series was divided into two groups and matched as to number, age, sex, as well as grade and duration of disease. Group 1, composed of 25 patients, was treated with leucocytic IFN-alpha at a dosage of 3 million IU thrice a week; group 2 (25 patients) was treated with the same protocol as group 1, but was also administered carnitine 2 g per os daily. Patients' response was evaluated on the basis of serum levels of AST and ALT as well as liver functions; fatigue was evaluated by Wessely and Powell scores. All patients studied were tested before treatment and then 1, 3 and 6 months after the beginning of IFN administration.

RESULTS

The difference of physical fatigue between the two groups after 1 month of therapy was significant (p < 0.01) for patients treated with carnitine. This significance continued at the end of month 3 (p < 0.01). With reference to mental fatigue, the comparison between the two groups showed a significant difference for group 2 after 1 month (p < 0.01). Finally, with respect to the fatigue severity, the comparison between the two groups showed that after 1 and 3 months of therapy, fatigue was significantly less severe in group 2 than group 1 (p < 0.0005).

CONCLUSIONS

If we take into account baseline values of mental and physical fatigue as well as the severity of this symptom in our study series, one observes that therapy with IFN alone induces fatigue in the majority of cases after 1 and 3 months, while at month 6, the values decrease. In contrast, patients treated with IFN + carnitine show a marked and early significant reduction of fatigue levels. These data suggest that the greater energetic substrate utilised by group 2 patients may in some way provide a better response of the patients to this side-effect. Abnormalities of neurotransmission concerning serotonine seem involved in the genesis of depression and fatigue. In addition, depression and fatigue commonly occur together, and the former is the most commonly observed symptom in patients with chronic fatigue syndrome.

[Behaviour of free radicals in Alzheimer's disease]

BACKGROUND

The objective of this study is to evaluate the oxidative stress status in patients affected by Alzheimer's disease, considering the role played by the free radicals in the progression and determination of this disease.

METHODS

We have studied 13 patients aged between 65 and 84 years and diagnosed with Alzheimer's disease on the basis of Brain CT scan or MRI results, PTEA (uditive mapped slow potential waves), EEG analysis, evaluation questionnaire (MMSE, ADAS), free radicals levels.

RESULTS

This study proved the presence of an oxidative stress status in all patients studied, showing an interaction between the disease and oxidative status. A reduction of the free radicals levels after therapy with determinable anti radicals has also been observed.

CONCLUSIONS

The existence between Alzheimer's disease and oxidative stress has already been demonstrated. This study is a contribution to this orientation. Further studies are suggested on the preventive effects, but particularly to demonstrate if the use of antioxidants may be able to decrease or stop the evolution of this disease.

Bioavailability and antioxidant activity of some food supplements in men and women using the D-Roms test as a marker of oxidative stress

Most antioxidants show contradictory behaviors because in the biological environment, for unpredictable reasons, they can become prooxidants. Recently, a new simple method to monitor oxidative stress in serum was developed. This test detects the derivatives of reactive oxygen metabolites (D-Roms). Hydroperoxides are converted into radicals that oxidize N,N-diethyl-para-phenylendiamine and that can be detected through spectrophotometric procedures as U.CARR. (Carratelli units). One U.CARR. corresponds to 0.8 mg/L hydrogen peroxide. In normal subjects U.CARR. values range from 250 to 300. Values outside this range indicate a modification of the prooxidant/antioxidant ratio. On the basis of this method, we tested three different formulas of antioxidants (F1, F2, F3) in 14 apparently healthy volunteers (11 men and 3 women). Formula 1 was composed of 5 mg zinc, 48 microg selenium, 400 microg vitamin A (as retinol acetate), 50 microg beta-carotene, 15 mg vitamin E (as dl-alpha-tocopheryl acetate) and 10 mg L-cysteine. Formula 2 was composed of 30 mg bioflavonoids from citrus, 30 mg vitamin C (as L-ascorbic acid), 10 mg coenzyme Q(10) and 1 mg vitamin B-6 (as pyridoxine hydrochloride). Formula 3 was composed of Formula 1 plus Formula 2. Each formula was prepared in dry capsules (formulation D1, D2, D3) or in a fluid form (formulation P1, P2, P3). Each formulation was administered for 1 wk in a crossover design. A 15% deviation of U.CARR. levels was chosen as the cut-off value for a significant change in oxidative stress. Formulas F1 and F3 reduced mean U.CARR. levels in most of the treated subjects (t test, P < 0.05), whereas F2 was not active. Fluid formulations were more active than dry formulations (chi(2) test, P < 0.05). In some cases, a slight increase in oxidative stress was detected. These minimal increases were not related to any particular antioxidant formula. In one subject only, the administration of the dry formulation (D1), increased oxidative stress to a level that reached the cut-off value. In conclusion, when antioxidants are taken in combination at low dosages they reduce oxidative stress, and little relevant prooxidant activity is detectable.

A method for evaluating the thermal threshold in patients with Raynaud's syndrome living in temperate areas. A report of three cases

BACKGROUND

The concept of "thermal threshold" in Raynaud's syndrome was theorized in 1990 by Pratesi as the ambient temperature below which an attack of vasospasm is more likely to be provoked, though so far it has not yet been proved to be a reality. Our preliminary report of two cases, whose attacks were compared with the daily maximum temperatures, showed results suggestive of the existence of this parameter.

METHODS

We asked a third female patient with Raynaud's syndrome of the hands and feet to keep note of the time, days and modalities of the phenomena, for at least three months including the summer. Data of six and five months from Cases 1 and 2 respectively, not including the times at onset, were reconsidered. The data available from all cases were compared to the true daily mean temperature. The data of the new Case 3 were also compared with the hourly temperatures on each day over the period of study. All calculations referred to the estimated temperature to be expected from the difference in altitude between the weather stations and the usual and temporary residences.

RESULTS

The mean thermal threshold was 17.166 degrees C in the less severe Case 1 and 28.438 degrees C in Case 2 (complicated by gangrene). In Case 3, the mean and hourly thresholds were 26.740 and 26.807 degrees C for the hands, and 25.092 and 23.807 degrees C for the feet, respectively.

CONCLUSIONS

This report is suggestive, although not conclusively, of the existence of a thermal threshold, which is higher in the more severe cases. Further research is required.

Secondary chemical shifts in immobilized peptides and proteins: a qualitative basis for structure refinement under magic angle spinning

Resonance assignments recently obtained on immobilized polypeptides and a membrane protein aggregate under Magic Angle Spinning are compared to random coil values in the liquid state. The resulting chemical shift differences (secondary chemical shifts) are evaluated in light of the backbone torsion angle psi previously reported using X-ray crystallography. In all cases, a remarkable correlation is found suggesting that the concept of secondary chemical shifts, well established in the liquid state, can be of similar importance in the context of multiple-labelled polypeptides studied under MAS conditions.

[Treatment of chronic arterial occlusive disease of the lower limbs with propionyl-1-carnitine in elderly patients]

BACKGROUND

Atherosclerosis is the most common pathology affecting the arterial system in elderly patients and arterial occlusive disease of the lower limbs represents one of the most severe complications. Intermittent claudication is the clinical expression of the ischemia underlying this arterial disease. Patients suffering from this complication present altered homeostasis of carnitine that results, by means of various mechanisms, in an alteration of the oxidative processes and damages the oxidative phosphorylation of the skeletal muscle. The effects of treatment with propionyl-l-carnitine (PLC) in a group of elderly patients with intermittent claudication (IC) are studied.

METHODS

39 elderly patients with IC were enrolled in an open study. The diagnosis was made using arterial colour ultrasonography of the lower limbs and patients were asked to perform the treadmill test. All patients received 300 mg i.v. PLC a day for 2 weeks and 1 g twice a day per os for 18 weeks. Patients presenting heart, respiratory or other problems restricting physical exercise were excluded from the study.

RESULTS

After 5 months of treatment an improvement was obtained in the distance after which IC appeared (from 213+/-8 m to 357+/-13 m) and the maximum distance covered (from 307+/-12 m to 549+/-23 m).

CONCLUSIONS

The results of this study allowed us to evaluate the efficacy of this drug on the severely disabling pain affecting the quality of life of patients, thus enabling the maximum distance covered by these patients to be increased. Moreover, the drug was well tolerated (only two patients reported slight collateral effects ascribed to the drug) and safe to use. It represents a valid conservative, non-surgical treatment which can be administered to all patients with intermittent claudication.

Enteral nutrition in patients with chronic neurological diseases

BACKGROUND

Malnutrition is commonly considered an important risk factor that can produce a negative influence on the prognosis of patients with chronic neurological diseases. The reduced caloric or proteic intake due to the motor or cognitive dysfunction, the hypercatabolic state due to infections, the abnormal gastrointestinal motility are the main mechanisms responsible for a state of malnutrition.

METHODS

Between January and December 1999 fourteen patients with chronic neurological diseases were treated. Ten of them had had a stroke, four due to Amyotrophic Lateral Sclerosis (ALS). After the evaluation of nutritional status the patients received enteral nutrition (EN) by placement of a nasointestinal feeding tube or a Bengmark tube. Glycaemia, blood urea nitrogen, serum creatinine, electrolytes, glycosuria, glutamic-oxalacetic and glutamic pyruvic transaminase were monitored in all patients. Polymeric enteral feeding was administered by an infusion pump. Standard nourished patients (7/14) received a 30 Kcal/kg/day support, the undernourished ones (6 low, 1 moderate malnutrition) received a 35-40 Kcal/kg/day support.

RESULTS

The complete caloric supply was reached in three-four days. Both of the groups received continuous feeding infusion during hospitalization. For the patients who continued the nutritional support at home (3/14) refeeding was performed only during night-time. In the patients with stroke the optimal/standard weight was reached within one month. In these patients oral nutrition was started within 45 days of treatment taking into account the restored swallowing function. In the patients with ALS the improvement of nutritional standards was reached within the first month and complete restoration within the second/third month.

CONCLUSIONS

On the basis of our experience enteral nutrition represents an effective refeeding procedure in patients with chronic neurological diseases.

Treatment of arterial hypertension in the elderly with diltiazem vs ramipril

BACKGROUND

Around 40% of the elderly population suffer from arterial hypertension. An effective antihypertensive treatment is therefore required. Calcium antagonists are used to treat hypertension because, owing to their mechanism of action, they can provoke systemic, as well as coronary vasodilatation. In this study the authors aimed to evaluate the activity and tolerability of diltiazem compared to ramipril in a group of elderly patients suffering from essential arterial hypertension.

METHODS

A controlled single-blind study was performed in which patients were randomly assigned to one of two groups, A and B, consisting of 25 patients each, treated respectively with 300 mg sustained-release diltiazem or 5 mg ramipril in a single daily dose. The study lasted 6 months and evaluated systolic and diastolic pressure and heart rate.

RESULTS

The evolution was positive in all patients in Group A and most patients in Group B, with the normalisation of both systolic and diastolic values. Heart rate showed a more persistent fall in Group A, but this was expected owing to the mechanism of action of diltiazem. No patient in Group A had to suspend treatment, whereas one patient in Group B had to interrupt therapy following the onset of a persistent cough.

CONCLUSIONS

Both treatments resulted in similar changes in systolic and diastolic arterial blood pressure. In the light of these results, it can be affirmed that, at an oral dose of 300 mg/day, sustained-release diltiazem was found to be effective and well tolerated in the treatment of mild to moderate essential arterial hypertension in the aged.

Helicobacter pylori eradication in elderly patients

BACKGROUND

The elderly population is rising constantly in industrialised countries. Accord-ing to ISTAT, within the next 15 years the number of over-80-year-olds in Italy will top 2.6 million. In the elderly, the incidence of peptic ulcer tends to increase with age. An important etiological role has recently been attributed to helicobacter pylori (HP) which has been identified as a risk factor for the various forms of gastric cancer.

METHODS

The study was carried out in 57 patients (45 with HP+ duodenal ulcer and 12 with HP+ gastric ulcer). Diagnosis was made on the basis of endoscopic tests, histological tests and urea breath test. Patients were treated orally with clarithromycin 500 mg twice a day for 14 days), amoxycillin (1 g twice a day for 14 days) and omeprazole (20 mg once a day for 30 days).

RESULTS

The results showed an eradication of HP in 89% of duodenal ulcer patients and 83.3% of peptic ulcer patients.

CONCLUSIONS

The treatment protocol used in this study achieved percentages of eradication that are comparable to those reported by other authors using different protocols; the percentages were sufficiently high for the protocol to be regarded as efficacious and well tolerated by patients. In fact, the scarce incidence of undesirable effects and excellent patient compliance are of particular interest in view of the fact that elderly patients have a higher risk of side-effects.

About a case of familial adenomatous polyposis

The authors present a case of FAP, familial adenomatous polyposis. This condition comprises 3 different syndromes characterized by the development of numerous polyps in the colon. Other different expressions of the same genetic anomaly are: familial adenomatous polyposis coli, Gardner's syndrome and Turcot's syndrome. The main risk for these pathologies consists in the frequent cancer outcome, which usually occurs between the 4th and the 5th decade of life and, however, after about 12 years from the first diagnosis. The patient came to the authors' observation in the surgery room of the department of geriatrics, in the university of Catania, where patients from South Italy and Sicily are treated. He had a severe anemic condition and poor general health. At the time of the diagnosis the patient, 56 years old, was subjected to endoscopic investigations which showed extensive polyposis of the entire colon and of the stomach, later on typified as ''Familial polyposis''. He was then subjected to total colectomy and gastric polypectomy. Besides, the patient and his direct family members (4 children and 2 sisters) were also genetically screened. The results proved that the patient and 3 of his children presented a genetic mutation located in connection with one of the two alleles of the APC gene. The potentially cancerous evolution makes it necessary to perform a genetic screening of all direct relatives of patients affected by FAP in order to both uncover the genetic anomaly responsible for this pathology and to prevent cancer, which is the natural outcome of this disease.

[Spectral analysis of EEG signals in Alzheimer's disease]

Alzheimer's disease (AD) represents the most frequent cause of senile dementia in Western countries. The disease has a slow onset and gradual progress. Over the past few years considerable importance has been attributed to the diagnostic techniques of brain imaging able to highlight morphological and functional images. EEG mapping is one of the most widely used methods.

METHODS

The authors evaluated the characteristics of EEG mapping in relation to frequency and amplitude in a group of elderly patients with AD and in a group of healthy elderly control subjects. The former group consisted of 10 patients with AD aged between 65 and 83 years old. The control group included 10 healthy subjects who were matched for age and sex.

RESULTS

The spectral analysis of EEG signals relating to frequency and amplitude showed a slowing down of underlying activity in AD patients, with a frequency between 1 and 4 c/sec, amplitudes below 5 microW and no arrest reaction. In healthy subjects spectral analysis showed a signal percentage colocated at a frequency of between 8 and 13 c/sec in relation to frequency.

CONCLUSIONS

In view of these results, the authors recommend the use of EEG mapping to complete the diagnosis of Alzheimer's disease in the aged.

[Study of mapped slow auditory evoked potentials in Alzheimer's disease]

BACKGROUND

Alzheimer's disease affects around 500,000 persons in Italy and its diagnosis remains essentially clinical. Our aim was to contribute to the diagnosis of Alzheimer's disease by mapping auditory evoked potentials (AEP). Evoked potentials represent the electric response of the CNS to an external stimulus and can be represented as a sequence of waves. Brain mapping allows a chromotopogram to be compiled showing chromatic maps.

METHODS

A group of 12 patients were studied aged between 68 and 84 years old who were referred to our attention at the Department of Geriatrics and Gerontology at Catania University and the A.O. Cannizzaro, Geriatrics Unit. All patients completed an assessment form (MM-SE, ADAS) and underwent brain NMR and AEP.

RESULTS

These tests enabled us to identify two types of patients (Group A and Group B) based on the responses shown. The overall evaluation of results revealed that patients with Alzheimer-type dementia present an anomalous cortical neurogenic response to mapped AEP, and that patients in Group A showed anomalous wave morphology, latency and localisation and asymmetric impregnation. The data gathered in this study did not confirm any specific characteristics of AEP given that similar anomalies are found in metabolic dysfunction syndromes and demyelination pathologies.

CONCLUSIONS

However, while it does not constitute a specific technique for screening against Alzheimer's disease, the mapping of AEP may contribute to the diagnosis of this disease.

Treatment of arterial hypertension in the elderly using enalapril

BACKGROUND

Arterial pressure increases with age and is the most common chronic disease in the elderly, men and women alike. At present arterial hypertension is considered a social disease as it poses great health, economic and social problems.

METHODS

A group of 50 patients of both sexes, between 66 and 83 years of age, suffering from essential arterial hypertension and treated with Enalapril administered at doses varying from 10 to 20 mg/day, for a period of 18 months, has been studied.

RESULTS AND CONCLUSIONS

The results of this study showed that blood pressure values of almost all the patients treated normalised and left ventricular hypertrophy decreased in all patients with this complication.

Advantages and disadvantages in the therapy with different types of interferon for chronic hepatitis C in the elderly patient

BACKGROUND

HCV-related hepatitis is a pathology on the increase, and it is especially affecting patients above 60 years old. The only treatment for this disease is therapy with different types of interferon. In this paper the authors compare two of their experiences relative to the treatment of HCV-related chronic hepatitis in the elderly using two types of interferon: recombinant interferon alpha and interferon beta, in order to evaluate their efficacy and side effects.

METHODS

The authors studied and compared two groups of elderly patients from Sicily and Calabria receiving medical care in the department of Geriatrics of the University of Catania. The first group consisted of 20 patients with an age ranging between 60 and 69 years, treated with recombinant interferon alpha; the second group consisted of 26 patients aged between 60 and 75 years treated with interferon beta.

RESULTS

After an evaluation of the results, the authors argue that recombinant interferon alpha is preferable since the remission percentage is higher (75%). However, the interferon beta therapy proves to be almost without side-effects.

CONCLUSIONS

Finally, the authors conclude that even in cases where there could be a possible higher exposure to side-effects linked to the use of recombinant interferon alpha, still, the risk/benefit ratio suggests that recombinant interferon alpha 2b should be used for the treatment of hepatitis in elderly patients, in the light of the results obtained.

[Edema and skin ulcers of the lower limbs as a collateral effect of nifedipine. A clinical case report]

Nifedipine, as most calcium-antagonist drugs, is widely used for the treatment of angina pectoris and primary hypertension. Among its side effects, edema of lower limbs may expose patients to traumatic ulcers which become chronic. A case with painful ulcers and remarkable swelling of the ankles is reported. In this case, misdiagnosed as chronic venous insufficiency, good results were obtained with topical treatment and discontinuation of nifedipine. Leg ulcers and edema resolved in four months after ten years of disease history.

[The determination of the thermal threshold in subjects with Raynaud's disease. A preliminary report of 2 clinical cases]

BACKGROUND

The onset of Raynaud's phenomenon is mainly provoked by cold stimuli which, in patients affected by Raynaud's disease, are milder than those able to provoke the same phenomenon in healthy subjects. Therefore, it is reasonable to theorize the existence of a "thermal threshold", below which it is more likely for a Raynaud's phenomenon to be provoked. The aim of this investigation is to determine whether a thermal threshold in Raynaud's disease exists and if it can be used as a practical tool for preventing the complications of Raynaud's disease (digital gangrene and ulcers), whose onset is strictly related to the frequency of the phenomena.

METHODS

Two patients affected, respectively, by slight Raynaud's phenomenon secondary to peripheral neuropathy (Case 1), by severe Raynaud's phenomenon associated with mixed connective tissue disease (Case 2), were asked to write a note about the phenomena and the days of their onset, within a period of three months. Afterwards, all data were related to the daily ground maximum temperature occurred in the period of study.

RESULTS AND CONCLUSIONS

These preliminary results show an interesting correlation between this new parameter and the clinical data, the thermal threshold being higher in more severe cases. It was equal to 22 degrees C in the patient affected by slight phenomenon (Case 1), and equal to 27 degrees C in the severe phenomenon (Case 2). This method for evaluating the thermal threshold in these two cases of Raynaud's disease (the greater the figure, the more severe the case) allowed both the clinical assessment of the pathology and the prevention of secondary complications.

[Correlation between clinical-instrumental pattern in venous pathology (capillaroscopic classification of the medial peri-malleolar area)]

BACKGROUND

The high incidence of chronic venous insufficiency makes it quite an ordinary topic in the outpatients departments of vascular units. Furthermore, due to the discrepancy between symptoms and Doppler c.w reports, it is necessary to face this problem with the help of very sensitive instrumental methods. Therefore, the main aim of this article is to find out which method, among those used in the outpatients department of phlebology, is sensitive enough to establish a relationship between clinical and instrumental patterns in venous diseases.

METHODS

Fifty-one subjects were studied: 44 affected by venous disease and 7 healthy subjects. All patients underwent clinical examination followed by classification by Widmer criteria, Doppler c.w., infrared photoplethysmography and capillaroscopy of the medial malleolus.

RESULTS AND CONCLUSIONS

Capillaroscopy demonstrated to have the highest sensitivity, allowing to find out pathological alterations in subjects complaining of symptoms and with normal Doppler c.w. findings. Furthermore, the findings of venular networks (pathological) in the malleoli of healthy subjects, made it necessary to modify the current capillaroscopic classification (based upon three types of pictures: normal, reticular and halo formations), into a new extended version based on five steps, with three types of reticular sub-classes, in which the different gauge of the venules is satisfactorily related to the symptoms referred by the patients.

Helicobacter pylori-positive functional dyspepsia in elderly patients: comparison of two treatments

The association of Helicobacter pylori and functional dyspepsia is not well defined. The role of H. pylori on dyspeptic symptoms is still controversial. The aim of this study is to confirm the efficacy of H. pylori eradication by two different commonly used treatment regimens, as well as to examine the improvement of the dyspeptic symptoms by eradicating H. pylori. H. pylori functional dyspepsia is prevalent in people over 60 years old. In this age group we treated 126 patients with bismuth plus metronidazole and amoxicillin (group A, 67 patients) versus omeprazole plus amoxicillin (group B, 59 patients). Results were statistically analyzed utilizing the Wilcoxon signed-rank test, McNemer test and chi-square test; P < 0.05 was considered significant. Two months after the end of therapy we observed an eradication rate of 66.1% in group A vs 64.3% in group B. All treated patients showed improvement in symptomatology. Although there was no significant difference between patients in whom H. pylori was or was not eradicated within the respective groups, when examining all H. pylori-positive patients versus H. pylori-negative posttreatment patients, there was a significant reduction (P < 0.05) in all four symptoms of functional dyspepsia measured. In conclusion, we suggest that patients treated with H. pylori-eradicating therapeutic regimens have an improvement in functional dyspepsia symptoms. We shall prefer the dual therapy as compared to the triple therapy. We believe that eradicating treatment to eradicate H. pylori in the elderly patients with H. pylori-related functional dyspepsia will reduce health care costs by reducing the number of subsequent visits.

[Treatment of postmenopausal osteoporosis with etidronate]

BACKGROUND

Osteoporosis is a widespread social disease as it is considered to be the most common pathology affecting bone metabolism in the elderly. A group of patients suffering from post-menopausal osteoporosis have been treated with etidronate.

METHODS

This controlled study was performed on 32 post-menopausal women aged between 53 and 66 suffering from post-menopausal osteoporosis, treated at the Department of Geriatrics of the University of Catania where patients mainly come from Sicily and Southern Italy. The diagnosis was made after clinical examination and humoral tests as well as computerised total body bone densitometry. Patients were treated according to an intermittent cyclic scheme which consisted in the administration of 400 mg etidronate per day for 14 days and 500 mg calcium carbonate per day for the following 76 days. This treatment had to be repeated for one year. Patients in the placebo group were not treated.

RESULTS

The results of the study showed a significant increase of total body bone mineral density +5.6% (p = 0.009), with a considerable improvement of clinical symptoms. No significant variation was detected in the control group.

CONCLUSIONS

On the basis of the results obtained, the conclusion is drawn that the intermittent cyclic treatment with etidronate is effective, well tolerated and with good compliance. Moreover, this drug proved to have no side effects.

Different types of interferon for the therapy of HCV chronic active hepatitis in the elderly patient

HCV correlated hepatitis is a pathology on the increase, and it is especially affecting patients above 60 years old. The only treatment for this disease is therapy with different types of interferon. The authors take into examination three of their previous studies on treatment of HCV correlated chronic hepatitis in the elderly using different types of interferon: recombinant interferon alpha, interferon beta, and lymphoblastoid interferon, in order to evaluate which one, among the three, should be the best for the treatment of this pathology in the elderly. The data show that recombinant interferon alpha is preferable since the remission percentage is higher (75%), compared to beta (53.8%) and lymphoblastoid interferon (60%). As far as the relevant side-effects in elderly patients are concerned, beta-interferon therapy is almost with no side-effects. Even in cases where there could be a possible higher exposure to side-effects linked to the use of recombinant interferon alpha, still, the risk/benefit ratio suggests that this particular drug should be used for treating this pathology in elderly patients.

Clinical evaluation of the efficacy of pivagabine in the treatment of mood and adjustment disorders

Depression and distress have in common hypercortisolism, a high turn-over of cerebral monoamines and a wide clinical variability. Results of a clinical open trial with pivagabine (4-[(2,2-dimethyl-1-oxopropyl) amino]butanoic acid, CAS 69542-93-4, Tonerg) on 22 young patients affected by dysthymic disorders and on 38 older patients affected by adjustment disorders following different stressors (mourning, retirement and recovery in institutions of assistance) are reported. Oral treatment with 1800 mg pivagabine lasting 30 days showed in both groups a significant improvement of the psychic state with variations from 50 to 80% of the criteria reported in the Hamilton Rating Scale for Depression (HDRS) and for anxiety (HARS) and in the Self-rating Anxiety Scale (SAS). Good tolerance of the drug and the complete absence of serious side effects considerably contributed to the clinical success.

Treatment of chronic hepatitis C with lymphoblastoid interferon alpha in elderly patients

One hundred patients with severe Chronic C Hepatitis, > 60 years of age and a life expectancy > 10 yrs were randomised to receive a course of lymphoblastoid a-IFN or a non specific support therapy as control. Patients randomised to IFN (no. 50) were treated with 3MU i.m. every two days for 2 months and then with 6MU i.m. every second two days for additional 10 months. All patients were followed-up for 12 months at the end of treatment. At the end of treatment, 30/50 patients in the IFN group showed a complete remission with normalisation of ALT and AST values (60%). Partial remission occurred in 11 patients (22%) whose transaminase values improved but did not normalise. No response was seen in 9 cases (18%) who showed similar pre- and post- treatment transaminase levels. On the contrary, normalisation of ALT-AST was observed in just two patients assigned to the non-specific therapy, whereas pre- and post-treatment values were similar in the remaining 48 patients. In patients receiving IFN a marked histological improvement was observed at the end of therapy in 22 responders (73.3%) and in 6 partial or non responders (30%) treated with IFN. No histological improvement was observed in control patients. At the end of the 12-month follow-up (24 months from the beginning of the study), 12 responders relapsed (40%) showing levels of transaminase which returned to the pre-treatment values within the second month from the IFN discontinuation. Therefore 18 out of 50 patients (36%) showed a long-term response to lymphoblastoid interferon. Lymphoblastoid a-IFN is an effective and safe therapy in elderly patients whose life expectancy justify its use and generates responses which are similar to those observed in younger subjects.

Preliminary results of beta-interferon treatment in the elderly

The authors studied 26 patients presenting with chronic hepatitis C who were diagnosed by clinical and histological tests. Thirteen patients were treated with beta-interferon (3 x 10(6) IM for 2 months and consecutive 6 x 10(6) IM for 10 months) every second evening, while the remaining 13 received aspecific treatment. Our results revealed normalization of transaminase accompanied by marked improvement of their clinical and histological pictures in 54 percent of the patients on beta-interferon. All the patients treated with beta-interferon were followed up for a 12-month drug-free period, after which the disease reappeared in 57 percent of the responders.

[Treatment with an aldose reductase inhibitor in peripheral neuropathy in elderly diabetic patients]

Diabetic neuropathy (DN) is one of the most frequent and severe long-term complications in elderly diabetes. Most scientists believe that onset of chronic complications in diabetics is due to prolonged glycometabolic imbalance. Recently aldose reductase inhibitors (ARI) have been used in the treatment of DN. We studied 100 elderly subjects affected by diabetes mellitus who were treated with tolrestat, an ARI, for a year and a control group who received a placebo. All subjects underwent the following examinations at the start of treatment and then at 8, 24, 42 and 52 weeks: 1. electromyography of the lower and upper limbs', 2. biotensiometric evaluation of the vibratory perception threshold (VPT), 3. glycosylated hemoglobin, 4. hourly glycemic profile, azotemia, creatininemia, hemochrome, cholesterol, triglycerides, bilirubin, electrolytes, protidogram, urine. The patients on tolrestat showed: increased nerve conduction velocity (mean values 2.3 m/sec) of the ulnar nerve; increased nerve conduction velocity (mean values 3.9 m/sec) of the peroneal nerve; reduced VPT at the right and left first toe (mean values 5 and 7 volts respectively); reduced VPT at the right and left malleoli (mean values 10 and 8 volts respectively). The authors recommend prompt, long term ARI treatment be initiated before the onset of evident signs of neuropathy in elderly subjects.

Effects of treatment with Simvastatin in elderly patients with primary hypercholesterolemia

Atherosclerosis and its complications are the main cause of death and disability in affluent nations, especially in the elderly population. Lipids and lipoproteins play an important role in its pathogenesis. The authors treated a group of elderly patients with Simvastatin (20 mg/day for 1 year), a HMG CoA reductase inhibitor and observed a significant reduction in total cholesterol (p < 0.001). LDL (p < 0.001) and beta apolipoproteins (p < 0.05). They also achieved regression of the atherosclerotic plaque in 5 patients and arrested the atherosclerotic process in 8. The authors intend to conduct further studies in this field to better define the action of Simvastin on the atherosclerotic plaque.

Treatment of chronic hepatitis C with recombinant interferon alpha 2b

The authors studied 70 patients affected by chronic hepatitis C where diagnosis had been made by clinical and histological tests. Intramuscular recombinant alpha 2b interferon (3 x 10(6)) was administered to 35 patients every second evening for 6 months, whereas the other 35 received aspecific treatment. Our results revealed normalization of transaminase in 57% of the patients, with distinct improvement of their clinical and histological pictures. All patients on interferon were followed up for a six-month drug free period, after which the disease reappeared in 50% of the responders.