Human surface anatomy terminology for dermatology: a Delphi consensus from the International Skin Imaging Collaboration

BACKGROUND

There is no internationally vetted set of anatomic terms to describe human surface anatomy.

OBJECTIVE

To establish expert consensus on a standardized set of terms that describe clinically relevant human surface anatomy.

METHODS

We conducted a Delphi consensus on surface anatomy terminology between July 2017 and July 2019. The initial survey included 385 anatomic terms, organized in seven levels of hierarchy. If agreement exceeded the 75% established threshold, the term was considered 'accepted' and included in the final list. Terms added by the participants were passed on to the next round of consensus. Terms with <75% agreement were included in subsequent surveys along with alternative terms proposed by participants until agreement was reached on all terms.

RESULTS

The Delphi included 21 participants. We found consensus (≥75% agreement) on 361/385 (93.8%) terms and eliminated one term in the first round. Of 49 new terms suggested by participants, 45 were added via consensus. To adjust for a recently published International Classification of Diseases-Surface Topography list of terms, a third survey including 111 discrepant terms was sent to participants. Finally, a total of 513 terms reached agreement via the Delphi method.

CONCLUSIONS

We have established a set of 513 clinically relevant terms for denoting human surface anatomy, towards the use of standardized terminology in dermatologic documentation.

Tuning of polyurethane foam mechanical and thermal properties using ball-milled cellulose

Cystalline-Cc and ultra-milled Amorphous-Ca cellulose were used as reactive filler to tune the performances of composite polyurethane-cellulose-foams, PUC. The effect of Cc and Ca on chemo-physical and mechanical properties of PUC was analysed through FTIR, morphological analysis, thermal conductivity and compression measurements. FTIR results show that, both Cc and Ca react with isocyanate through the OH functional groups contributing to the formation of a tough cellulose-polyurethane network. Morphological observations show that the addition of both Cc and Ca induces a decrease of average cell-size compared to the pristine-PU, thus confirming that they act as nucleating agent. In addition, the better dispersion of the Ca in the polyol, with respect to Cc induces, a finer cell leading to a reduction of the thermal conductivity around 33 % (for the composite loaded with 20 %wt-Ca) with respect to pristine-PU. Finally, the addition of Ca highly reactive modifies the mechanical behaviour from rigid-brittle to semi-rigid.

Characterization of sustainable polyhydroxyls, produced from bio-based feedstock, and polyurethane and copolymer urethane-amide foams

This manuscript presents data related to the research article entitled "Synthesis and characterization of sustainable polyurethane foams based on polyhydroxyls with different terminal groups" (DOI: 10.1016/j.polymer.2018.06.077) [1]. We provide Supplementary data on the chemical properties, in terms of FTIR characterization, of polyhydroxyls produced starting from bio-based feedstock (biosuccinic acid and 1,4 butandiol) and thermal properties (glass transition temperature-Tg and thermal degradation behavior) of polyurethane and copolymer urethane-amide foams manufactured from the aforementioned polyhydroxyls. The FTIR characterization elucidates the chemical structure of polyhydroxyls and allows to make some hypothesis on their reaction routes with the isocyanate molecules. The thermal characterization revealed that the addition of bio-based polyhydroxyls to the sample formulations improves both the glass transition and degradation temperature of the foams. These foamed products exhibit potential performances to be applied as a substitute for conventional polyurethane foams.

Genotoxic and cytotoxic effects of ZnO nanoparticles for Dunaliella tertiolecta and comparison with SiO2 and TiO2 effects at population growth inhibition levels

The increasing use of oxide nanoparticles (NPs) in commercial products has intensified the potential release into the aquatic environment where algae represent the basis of the trophic chain. NP effects upon algae population growth were indeed already reported in literature, but the concurrent effects at cellular and genomic levels are still largely unexplored. Our work investigates the genotoxic (by COMET assay) and cytotoxic effects (by qualitative ROS production and cell viability) of ZnO nanoparticles toward marine microalgae Dunaliella tertiolecta. A comparison at defined population growth inhibition levels (i.e. 50% Effect Concentration, EC50, and No Observed Effect Concentration, NOEC) with SiO2 and TiO2 genotoxic effects and previously investigated cytotoxic effects (Manzo et al., 2015) was performed in order to elucidate the possible diverse mechanisms leading to algae growth inhibition. After 72h exposure, ZnO particles act firstly at the level of cell division inhibition (EC50: 2mg Zn/L) while the genotoxic action is evident only starting from 5mg Zn/L. This outcome could be ascribable mainly to the release of toxic ions from the aggregate of ZnO particle in the proximity of cell membrane. In the main, at EC50 and NOEC values for ZnO NPs showed the lowest cytotoxic and genotoxic effect with respect to TiO2 and SiO2. Based on Mutagenic Index (MI) the rank of toxicity is actually: TiO2>SiO2>ZnO with TiO2 and SiO2 that showed similar MI values at both NOEC and EC50 concentrations. The results presented herein suggest that up to TiO2 NOEC (7.5mg/L), the algae DNA repair mechanism is efficient and the DNA damage does not result in an evident algae population growth inhibition. A similar trend for SiO2, although at lower effect level with respect to TiO2, is observable. The comparison among all the tested nanomaterial toxicity patterns highlighted that the algae population growth inhibition occurred through pathways specific for each NP also related to their different physicochemical behaviors in seawater.

Dermoscopy of acral melanoma: a multicenter study on behalf of the international dermoscopy society

BACKGROUND

Most studies on dermoscopy of acral lesions were conducted in Asian populations. In this study, we analyzed these features in a predominantly Caucasian population.

OBJECTIVE

Estimate the prevalence of dermoscopic features in acral lesions, and assess their level of agreement between observers.

METHODS

In this retrospective multicenter study, 167 acral lesions (66 melanomas) were evaluated for 13 dermoscopic patterns by 26 physicians, via a secured Internet platform.

RESULTS

Parallel furrow pattern, bizarre pattern, and diffuse pigmentation with variable shades of brown had the highest prevalence. The agreement for lesion patterns between physicians was variable. Agreement was dependent on the level of diagnostic difficulty.

CONCLUSION

Lesions with a diameter >1 cm were more likely to be melanoma. We found as well that a benign pattern can be seen in parts of melanomas. For this reason one should evaluate an acral lesion for the presence of malignant patterns first.

Thermoplastic Foams from Zein and Gelatin

The aim of this study was to characterize the foaming of natural proteins as thermoplastic polymers. In particular, two proteins, one of vegetal origin, zein, and one of animal origin, gelatin, were processed to achieve thermoplastic polymers, and subsequently foamed by a gas foaming batch process. The effects of suitable plasticizing additives and melt-mixing process on the thermal and mechanical properties of the thermoplasticized proteins were evaluated to assess the thermoplastic characteristics of these materials. Furthermore, selected protein/plasticizers systems were foamed with mixtures of CO2 and N2 as blowing agents, in a batch foaming apparatus, at different temperatures, pressures and pressure drop rates, to evaluate the processing window and the final properties of the foams. Foams with densities of 0.1 g/cm3 and morphologies characterized by uniform distributions of cells with 10 μm diameters were obtained. Results indicated the suitability of zein and gelatin for being processed with classical thermoplastic processing technologies including melt mixing and foaming and their potentials as biodegradable polymers.

Agreement of dermatopathologists in the evaluation of clinically difficult melanocytic lesions: how golden is the 'gold standard'?

BACKGROUND

The 'gold standard' for the diagnosis of melanocytic lesions is dermatopathology. Although most of the diagnostic criteria are clearly defined, the interpretation of histopathology slides may be subject to interobserver variability.

OBJECTIVES

The aim of this study was to determine the variability among dermatopathologists in the interpretation of clinically difficult melanocytic lesions.

METHODS

This study used the database of MelaFind®, a computer-vision system for the diagnosis of melanoma. All lesions were surgically removed and sent for independent evaluation by four dermatopathologists. Agreement was calculated using kappa statistics.

RESULTS

A total of 1,249 pigmented melanocytic lesions were included. There was a substantial agreement among expert dermatopathologists: two-category kappa was 0.80 (melanoma vs. non-melanoma) and three-category kappa was 0.62 (malignant vs. borderline vs. benign melanocytic lesions). The agreement was significantly greater for patients ≥40 years (three-category kappa = 0.67) than for younger patients (kappa = 0.49). In addition, the agreement was significantly lower for patients with atypical mole syndrome (AMS) (kappa = 0.31) than for patients without AMS (kappa = 0.76).

LIMITATIONS

The data were limited by the inclusion/exclusion criteria of the MelaFind® study. This might represent a selection bias. The agreement was evaluated using kappa statistics. This is a standard method for evaluating agreement among pathologists, but might be considered controversial by some statisticians.

CONCLUSIONS

Expert dermatopathologists have a high level of agreement when diagnosing clinically difficult melanocytic lesions. However, even among expert dermatopathologists, the current 'gold standard' is not perfect. Our results indicate that lesions from younger patients and patients with AMS may be more problematic for the dermatopathologists, suggesting that improved diagnostic criteria are needed for such patients.

Design of porous polymeric scaffolds by gas foaming of heterogeneous blends

One of the challenges in tissue engineering scaffold design is the realization of structures with a pre-defined multi-scaled porous network. Along this line, this study aimed at the design of porous scaffolds with controlled porosity and pore size distribution from blends of poly(epsilon-caprolactone) (PCL) and thermoplastic gelatin (TG), a thermoplastic natural material obtained by de novo thermoplasticization of gelatin. PCL/TG blends with composition in the range from 40/60 to 60/40 (w/w) were prepared by melt mixing process. The multi-phase microstructures of these blends were analyzed by scanning electron microscopy and dynamic mechanical analysis. Furthermore, in order to prepare open porous scaffolds for cell culture and tissue replacement, the TG and PCL were selectively extracted from the blends by the appropriate combination of solvent and extraction parameters. Finally, with the proposed combination of gas foaming and selective polymer extraction technologies, PCL and TG porous materials with multi-scaled and highly interconnected porosities were designed as novel scaffolds for new-tissue regeneration.

The significance of multiple blue-grey dots (granularity) for the dermoscopic diagnosis of melanoma

BACKGROUND

The presence of multiple blue-grey dots (MBGD) is widely used by clinicians to decide if a pigmented lesion should be removed, but only little is known about their significance.

OBJECTIVES

To evaluate the significance of MBGD for the dermoscopic diagnosis of melanoma.

METHODS

In part 1 we retrospectively evaluated 340 pigmented lesions for the presence and morphological appearance of granularity. One hundred and seventy melanomas were included and matched with 170 benign and dysplastic naevi which were randomly chosen from our collection. In part 2, 3773 lesions were examined prospectively in at-risk patients: all lesions with granularity were recorded, surgically removed and subjected to histopathological examination.

RESULTS

In part 1, granularity was found in 26.5% of the benign lesions and 93.5% of melanomas. The presence of granularity, granularity at the periphery, irregularly distributed granularity and granularity in association with red and white colour were statistically highly significant for the diagnosis of melanoma (P < 0.001). In part 2, granularity was found in 1.08% of the 3773 lesions and more frequently in sun-damaged skin. Sensitivity for the diagnosis of melanoma was 85% and specificity 99%.

CONCLUSIONS

After the revision of many lesions with MBGD, we concluded that the term 'granularity' better describes this entity. Lesions with irregular granularity (periphery, irregularly distributed) should be removed especially if they are associated with red, blue or white colour. Lesions with a benign dermoscopy pattern which have granularity with a regular appearance and involving only a small portion of the lesion do not require surgical excision.

Dermoscopy of facial nonpigmented actinic keratosis

BACKGROUND

The accuracy of clinical diagnosis of nonpigmented, facial actinic keratosis (AK) is often suboptimal, even for experienced clinicians.

OBJECTIVES

To investigate the dermoscopic features of nonpigmented AK located on the head/neck that may assist the clinical diagnosis.

METHODS

Forty-one nonpigmented AKs on facial sites were examined by dermoscopy for any consistent underlying features. Lesions were gathered from skin cancer centres in Australia, Austria, Italy and the U.S.A. All cases were diagnosed histopathologically.

RESULTS

Four essential dermoscopic features were observed in facial AK: (i) erythema, revealing a marked pink-to-red 'pseudonetwork' surrounding the hair follicles (95%); (ii) white-to-yellow surface scale (85%); (iii) fine, linear-wavy vessels surrounding the hair follicles (81%); and (vi) hair follicle openings filled with yellowish keratotic plugs (66%) and/or surrounded by a white halo (100%). These features combined, in 95% of cases, to produce a peculiar 'strawberry' appearance.

CONCLUSIONS

A dermoscopic model of 'strawberry' pattern is presented, which may prove helpful in the in vivo diagnosis of nonpigmented, facial AK. A limitation of this study is the lack of testing of the specificity of the described dermoscopic criteria in differentiating nonpigmented AKs from other nonpigmented skin lesions at this site.

Impairment of coronary circulation by acute hyperhomocysteinaemia and reversal by antioxidant vitamins

OBJECTIVE

To evaluate the effect of acute hyperhomocysteinaemia with and without antioxidant vitamins pretreatment on coronary circulation and circulating chemokine levels.

DESIGN

Observer-blinded, randomized crossover study.

SETTING

This study was conducted at a university hospital and at a general hospital in Italy.

SUBJECTS

Sixteen healthy hospital staff volunteers (nine men, seven women), aged 26-40 years.

INTERVENTIONS

Subjects were given each three loads in random order at 1-week intervals: oral methionine, 100 mg kg(-1) in fruit juice; the same methionine load immediately following ingestion of antioxidant vitamin E, 800 IU, and ascorbic acid, 1000 mg; and methionine-free fruit juice (placebo).

MAIN OUTCOME MEASURES

Coronary flow velocity reserve (CFVR), assessed by noninvasive transthoracic Doppler echocardiography, blood pressure, heart rate, lipid and glucose, monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) parameters evaluated at baseline and 4 h following ingestion of the loads.

RESULTS

The oral methionine load increased plasma homocysteine from 12.8 +/- 1.8 to 33.3 +/- 3.4 micromol L(-1) at 4 h (P < 0.001). A similar increase was observed with same load plus vitamins (P < 0.001) but not with placebo (P = 0.14). Circulating MCP-1 and IL-8 levels rose after the methionine load (P < 0.001), but not after placebo or methionine plus vitamins. The methionine load significantly reduced CFVR (decrease, 26 +/- 8.2%; P < 0.001). The methionine load with ingestion of vitamins partially prevented the impairment of CFVR (decrease, 11 +/- 4%; P < 0.001).

CONCLUSION

Our data suggest that acute hyperhomocysteinaemia reduces CFVR and increases plasma MCP-1 and IL-8 levels in healthy subjects. Pretreatment with antioxidant vitamin E and ascorbic acid prevents the effects of hyperhomocysteinaemia, suggesting an oxidative mechanism.

[Dermatoscopy of pigmented lesions]

Dermoscopy is a simple to use in vivo method for the early diagnosis of malignant melanoma and the differential diagnosis of pigmented skin lesions. It has been shown to increase diagnostic accuracy over clinical visual inspection in the hands of an experienced physician. This paper is a review of the principles of Dermoscopy as well as recent technological developments.

Automatic differentiation of melanoma from melanocytic nevi with multispectral digital dermoscopy: a feasibility study

BACKGROUND

Differentiation of melanoma from melanocytic nevi is difficult even for skin cancer specialists. This motivates interest in computer-assisted analysis of lesion images.

OBJECTIVE

Our purpose was to offer fully automatic differentiation of melanoma from dysplastic and other melanocytic nevi through multispectral digital dermoscopy.

METHOD

At 4 clinical centers, images were taken of pigmented lesions suspected of being melanoma before biopsy. Ten gray-level (MelaFind) images of each lesion were acquired, each in a different portion of the visible and near-infrared spectrum. The images of 63 melanomas (33 invasive, 30 in situ) and 183 melanocytic nevi (of which 111 were dysplastic) were processed automatically through a computer expert system to separate melanomas from nevi. The expert system used either a linear or a nonlinear classifier. The "gold standard" for training and testing these classifiers was concordant diagnosis by two dermatopathologists.

RESULTS

On resubstitution, 100% sensitivity was achieved at 85% specificity with a 13-parameter linear classifier and 100%/73% with a 12-parameter nonlinear classifier. Under leave-one-out cross-validation, the linear classifier gave 100%/84% (sensitivity/specificity), whereas the nonlinear classifier gave 95%/68%. Infrared image features were significant, as were features based on wavelet analysis.

CONCLUSION

Automatic differentiation of invasive and in situ melanomas from melanocytic nevi is feasible, through multispectral digital dermoscopy.

Precision of automatic measurements of pigmented skin lesion parameters with a MelaFind(TM) multispectral digital dermoscope

The purpose of this study was to assess the precision of automatic computerized measurement of parameters that may be useful in the differentiation of malignant melanoma from benign pigmented skin lesions, and also to determine the feasibility of quantitative monitoring of skin lesions over time. Ten independent sequences of images were acquired with a MelaFind multispectral digital dermoscope for each of 12 benign or malignant pigmented skin lesions. The sequences of images were processed automatically to provide 10 independent measurements of the various parameters for each lesion. Parameters included lesion area, greatest 'diameter', perimeter, reflectance and asymmetry. The precision of each parameter determination was computed from the mean and standard deviation of the 10 measurements of that parameter. The relative errors in determining the lesion area, 'diameter' and perimeter were found to be 6%, 3% and 4%, respectively. Other lesion parameters that are used in differentiating melanomas from benign skin lesions were also analysed as a function of wavelength. In the blue band (about 430 nm) the relative error was about 7% for the mean lesion reflectance and about 7% for the asymmetry parameter. These results demonstrate the feasibility of using MelaFind for objective quantitative monitoring of changes in pigmented skin lesions over time. As suggested by some studies, such information is useful in the early detection of malignant melanoma. The results show that parameters obtained automatically from MelaFind images are sufficiently precise to allow pertinent parameters to be used to classify pigmented skin lesions.

Melanoma in a psoriatic plaque

This is the first reported case of a melanoma in a psoriatic plaque. The clinical, dermoscopic, and histologic features of this case are detailed. A review of the risk of melanoma among patients treated with psoralen-ultraviolet A is presented.

Spitz nevus: a case report

The case of a 2-mm Spitz nevus is reported. We comment on the case and describe the skin-surface microscopy features.

The actinic comedonal plaque

A case of actinic comedonal plaque is reported. We comment on the case as well as describe the skin surface microscopic features.

[A query system for the "SINTESI" database in scientific research and medical practice]

"SINTESI release 1.0" is an application for Windows that was designed to enable a practical approach to day-hospital evaluation and management of several metabolic and instrumental parameters. "SINTESI" provides electronic archives such as demographics, history, follow-up, laboratory, electrocardiogram, Doppler echocardiography, vascular echo-Doppler, Holter ECG, nuclear imaging, radiology, ergometric testing, ambulatory blood pressure monitoring, hemodynamics. We have improved the first release (1.0) with a new application that queries the database ("SINTESI release 2.0"). The new query application, developed in collaboration with experts of the Italian Group for the Study of Atherosclerosis and Metabolic Diseases, was designed with the central file displaying buttons that recall electronic archives, allowing to select the variables for the query. At the end of each operation, the user always returns to the central file, where it builds the query formula by "AND/OR" logic operators. Query formula and results can be recorded to be used whenever needed. The results of the query can be exported as DBF or ASCII files for analysis with statistical packages. This feature allows the use of the data bank for medical research.

Expression of Met/hepatocyte growth factor receptor gene and malignant behavior of musculoskeletal tumors

Overexpression of the hepatocyte growth factor receptor (Met/HGF receptor), a transmembrane tyrosine kinase encoded by the met proto-oncogene, has been associated with tumor progression in different human carcinomas. More recently, the Met/HGF receptor has also been described in tumor cell lines of mesenchymal origin, suggesting the existence of an autocrine loop that may contribute to the pathogenesis of sarcomas. In this study, we analyzed the expression of Met/HGF receptor by Western blotting and immunohistochemistry in frozen samples of 87 primary tumors of bone and soft tissues. Among benign tumors, overexpression was consistently found only in giant-cell tumor, a locally aggressive lesion that may also, although rarely, spread to the lung. Among malignant lesions, the presence of the Met/HGF receptor was detected in a relevant percentage of primaries and in almost all of the recurrences. The highest levels of Met/HGF receptor were found in osteosarcoma, a highly aggressive tumor that typically permeates the host bone and rapidly expands to the soft tissues. On the contrary, only low levels of Met/HGF receptor were found in chondrosarcoma, a slowly growing tumor that usually expands without massive destruction of the surrounding structures. These data indicate an association of Met/HGF expression with local aggressiveness in human mesenchymal tumors. The finding of Met/HGF receptor overexpression in all of the osteosarcomas suggests a role for the met proto-oncogene in the pathogenesis of this tumor.

[Absence of an association of the D allele of the ACE gene with arterial pressure in mild-moderate essential arterial hypertension]

To assess the relationship between the angiotensin converting enzyme (ACE) gene I/D polymorphism, blood pressure (BP) and family history of hypertension, 133 hypertensive subjects (mean age 50 +/- 9 years, 78 males, 55 females) were selected according to both casual supine BP > 140/90 mmHg and ambulatory BP > 134/88 mmHg. Drug treatment was discontinued 2 weeks before entering the study. Subjects with myocardial ischemia, as well as those with "white coat" hypertension, were excluded. The study population was subclassified according to age < or = 50 years. Polymerase chain reaction was used to detect the I/D polymorphism of the ACE gene, and the DD genotype was analysed twice. The frequencies of the I and D allele were 42 and 58%, and the distribution of the ID+ II and DD genotypes were 69 and 31% respectively. No significant relation was found among ACE genotypes (DD vs ID+ II) and casual systolic or diastolic BP as well as ambulatory BP, both in the whole study population and in the subpopulation < 50 years old. No difference was found also in the distribution of dippers and no dippers, as well as in the distribution of subjects with a positive family history in the whole sample and hypertensives < 50 years old.

Early abnormalities of cardiac function in non-insulin-dependent diabetes mellitus and impaired glucose tolerance

The aim of this study was to evaluate the role of diabetes and minor abnormalities of glucose homeostasis, such as impaired glucose tolerance, as determinants of cardiac function and structure in a working population. We studied a population-based sample of 64 telephone company employees (both sexes, mean age 58 years): 25 with normoglycemia, 15 with impaired glucose tolerance, and 24 with non-insulin-dependent diabetes mellitus (NIDDM) diagnosed by oral glucose tolerance test according to the recommendations of the World Health Organization. Subjects with myocardial ischemia were excluded. Left ventricular end-systolic dimension, indexed to body surface area, was greater in those with NIDDM (p < 0.05) and in those with impaired glucose tolerance (p < 0.05) with respect to normoglycemic persons. The ratio of the peak early diastolic velocity wave to the late diastolic wave was lower in those with NIDDM (p < 0.05) and in those with impaired glucose tolerance (p < 0.05) than in participants with normoglycemia. Body mass index and blood pressure were similar in the 3 groups. These results clearly indicate that early abnormalities of cardiac structure and function are observed not only in patients with NIDDM, but also in those with impaired glucose tolerance, independent of the confounding role of myocardial ischemia, body weight, and blood pressure.

[The SINTESI Project: software in cardiovascular prevention]

Coronary heart disease is the most important cause of mortality in adults. New approaches may reduce the cardiovascular risk in population. "SINTESI" is an original data base designed in collaboration with the Italian Group for the Study of Metabolism Disease and Atherosclerosis to improve the evaluation of the major risk factors in the population and to create a data bank for medical research. It runs in Windows. The software includes the following electronics archives: Demographics; History; Follow-up; ECG; Laboratory; Doppler-echocardiography; Stress test-ECT; Ambulatory blood pressure monitoring; Holter-ECG; Nuclear imaging; Vascular echo-Doppler; Hemodynamics; Radiology. We named the most important file "Main Working Area" (MWA). This displays all the most important information on the clinical status of the patients and represents the "console" for using the software. In fact, in MWA "buttons" are displayed to enter all the electronic archives. The software displays graphics and the flow-chart of clinical history. We implemented "routines" for automatic evaluation of several variables. We also simplify the statistical use of the data implementing functions for "query" that permit the management of data bank. The use of this software may facilitate the correct evaluation and stratification of the cardiovascular risk. In conclusion, "Progetto SINTESI" is an easy, synthetic organization of patient's clinical data and a complete data bank. It is our opinion that the use of this software may promote a standard way of collecting a large number of data to improve the stratification of cardiovascular risk.

Reduction of left ventricular mass by short-term antihypertensive treatment with isradipine: a double-blind comparison with enalapril

The aim of the present study was to evaluate the effect of dihydropyridine calcium antagonist isradipine on left ventricular (LV) structure and function in patients with essential hypertension. Cuff blood pressure and Doppler echocardiographic variables were assessed in 26 patients with mild to moderate hypertension (diastolic blood pressure range 95-110 mmHg) before and after 12 weeks of therapy with either isradipine 5 mg daily or enalapril 20 mg daily. The study was of double-blind, parallel design, with a placebo run-in period of 15 days. Three subjects withdrew from isradipine treatment because of flushing and 2 from enalapril treatment due to cough before completing the study. Both drugs significantly reduced cuff systolic and diastolic blood pressure (p < 0.001) without affecting heart rate. By virtue of the decrease in both septal wall (p < 0.01) and posterior wall thicknesses (p < 0.05), isradipine treatment produced a significant reduction in LV mass adjusted for height (p < 0.001) in comparison with placebo; also LV end-systolic dimension showed a slight decrease (p < 0.05). Enalapril induced a similar reduction in LV end-systolic dimension (p < 0.05) but the changes of wall thickness and LV mass did not reach statistical significance. In conclusion, our results indicate that isradipine treatment improves LV systolic function and causes a significant reduction in LV mass. This reduction is observed early in the course of antihypertensive treatment and is effective in both patients with and without LV hypertrophy.