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Copyright of SCENARIO: Official Italian Journal of ANIARTI is the property of ANIARTI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Perfusion CT is a relatively new technique that allows rapid qualitative and quantitative evaluation of cerebral perfusion by generating maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). This technique can guide the decision to perform intra-arterial thrombolysis, intravenous thrombolysis, or other treatment. The CT perfusion data can positively identify patients with non-haemorrhagic stroke in the presence of a normal conventional CT, provide an indication as to prognosis and potentially select those patients for whom thrombolysis is appropriate. Perfusion CT can be readily incorporated into the conventional CT assessment of patients with stroke, adding less than 5 min to the imaging time, thus a complete imaging evaluation is achievable using widely available equipment whilst avoiding the need to move the patient to another imaging device. The Author with this paper underlines technical principles and clinical applications of perfusion CT. [ABSTRACT FROM AUTHOR]

Cardiogenic shock (CS) is a life-threatening condition that occurs in response to reduced cardiac output, in the presence of adequate intravascular volume, and results in tissue hypoxia. CS can occur as a result of several etiologies but the most common is acute myocardial infarction. Despite the introduction of emergency revascularization for CS complicating acute myocardial infarction, mortality still remains exceptionally high, particularly in patients with refractory CS. The diagnosis of CS is sometimes challenging and it is based on clinical, hemodynamic, and biochemical signs. A multidisciplinary technical platform as well as specialized and experienced medical teams are crucial to treat this group of patients.We briefly summarize the main aspects of diagnosis, etiology and pathophysiology with a particular focus on macro- and microhemodynamic parameters that are essential for the diagnosis and treatment of this patient population.

Purpose: The aim of this study was to validate a 64-row multidetector computed tomography (64-MDCT) acquisition protocol with biphasic administration of contrast medium for comprehensive assessment of the coronary and systemic arterial tree in a single examination., Materials and Methods: The scanning protocol comprised two acquisitions: an electrocardiograph (ECG)-gated scan at the level of the heart, followed by a total-body, low-dose scan of the systemic arterial circulation. Twenty patients were evaluated using two different strategies for contrast administration. In ten patients, the delay between the two acquisitions was set at 40 s, whereas in the remaining patients, it varied between 45 s and 65 s. For both strategies, the degree of systemic arterial opacification and the attenuation gradient between arterial and venous structures were quantitatively assessed at six extracoronary locations. Two observers evaluated in consensus the presence or absence of atherosclerosis and the degree of stenosis of arterial segments., Results: Three hundred coronary segments were analysed. Arterial-wall changes were depicted in 155 (51%) segments, and in 35 (23%), the degree of stenosis was > 50%. Of the 640 extracoronary arterial segments, 250 (39%) presented atherosclerotic wall alterations, in 50 (20%), the degree of stenosis was > 50% and five were affected by aneurysmal dilatation. The magnitude of arterial opacification values and attenuation gradients between arterial and venous structures were significantly higher in patients scanned with the 40-s fixed-delay strategy., Conclusions: Whole-body CT angiography with biphasic administration of contrast agent and fixed scan delay has been shown to be a feasible and reproducible technique. Comprehensive data on the global atherosclerotic burden potentially offer important therapeutic options for subclinical, high-risk segments.

Background: In this study the circadian skin flux pattern was evaluated in 10 normal reference subjects and in 35 patients (mean age 68 +/- 11) subdivided in groups (10 with intermittent claudication (200-400 m of walking distance), 10 diabetics with claudication, 7 patients with rest pain and 8 with localised gangrene)., Methods: A laser Doppler flowmeter was used to monitor skin flux for 24 hours. In patients with intermittent claudication the circadian pattern was comparable to normal subjects. In diabetics the daily curve showed several irregular peaks mostly dissociated from activity or rest., Results: In patients with critical ischaemia severe alterations of the circadian pattern were observed (the daily curve was flattened and dissociated from activity or rest) particularly in gangrene. PGE1 alpha-ciclodestrina treatment (60 micrograms/day) partially restored the circadian pattern and increased the average values of the 24-hour curve. In rest pain and gangrene the infusion of PGE1 alpha-ciclodestrina in the late evening increased the average night flux (which tended to fall to very low levels causing pain) and prevented or abolished night rest pain.

Padua University was the place of the scientific revolution not only for astronomy and mechanics with Galilei, but also and most of all for medicine. Here the traditional Aristotelianism created the favourable conditions for the discovery of blood circulation by W. Harvey, because of the strict connection established by Aristotle between medicine and philosophy of nature, the importance attributed to empirical observation, carefully and systematically pursuited, the primacy of the heart among other body organs and the attention payed to the function of various organs. The defect of these conditions was the cause of some Descartes' errors concerning blood circulation, which were avoided by Harvey.

In diabetics, vascular examination may consider great and medium arteries and microcirculation. The aim of this study is correlation between stenosis in carotid and femoral bifurcation, ultrasound biopsy, and laser-Doppler measurements of distal microcirculation in diabetics. During a six month period, we have examined 90 diabetics in the diabetological service of the Civita Castellana Hospital (Viterbo, Italy), asymptomatic for any vascular distal, cerebral or coronary disease. Subjects were 49 +/- 20 years old with 15 +/- 5 years of diabetes; glycosilate haemoglobin was 7% (mean). 70% of diabetics (62% type I, 38% type II) had an altered veno-arteriolar reflex and 30% of these an ultrasound biopsy value of more than 25. These data demonstrate that most diabetic subjects develop an early, preclinical neuropathy that is directly proportional to the arterial wall condition.

In order to evaluate post-embolic pulmonary gas exchange responses to exercise, we studied 7 patients who had previously suffered from an acute pulmonary embolism but were presently free from clinical and functional signs of cardiorespiratory diseases. Patients came to the laboratory on two occasions, 30 and 120 days following the episode of acute embolism, respectively, and performed an incremental ramp exercise test up to the maximum attainable workload. On both occasions, the dead volume/tidal volume (VD/VT) ratio at rest increased. During the first exercise test performed 30 days after the acute pulmonary embolism, mean VD/VT decreased from a resting value of 62.5% to 38.6% at the maximum workload. During the second exercise test, VD/VT decreased, at the same workload, from 71.3% to 35.5%. There was no significant difference in exercise-related VD/VT decrease between the two exercise tests. The results suggest that in patients who have suffered from an acute pulmonary embolism, a considerable pulmonary blood flow redistribution may occur during incremental ramp exercise performed 30 and 120 days after the acute event.

This work was aimed at comparing magnetic resonance angiography (MRA) with and without ECG gating in the study of peripheral vessels. Ten volunteers, mean age 27.8 years, were examined with MRA of the femoral, popliteal and tibial segments. MRA was performed with a 1.5-T superconductive magnet, a transmit head coil and the TOF 2D technique. In all cases MRA was performed without cardiac gating and with different times of trigger delay (0, 20, 40, 70 and 200 ms). When comparing the different acquisitions, the number of vessels and the signal-to-noise (S/N) ratio were calculated. In the femoral segment, MRA without cardiac gating showed a mean of 7.7 vessels with 2.79 S/N ratio; MRA with 0 ms of trigger delay showed a mean of 13.1 vessels with 1.51 S/N ratio; MRA with 20 ms trigger delay showed a mean of 13.1 vessels with 1.52 S/N ratio; MRA with 40 ms trigger delay showed a mean of 13.2 vessels with 1.52 S/N ratio; MRA with 70 ms trigger delay showed a mean of 13.5 vessels with 1.50 S/N ratio; finally, MRA with 200 ms trigger delay showed a mean of 13.4 vessels with 1.50 S/N ratio. In the popliteal segment, the corresponding values were 6.4 vessels and 2.51 S/N ratio, 11.4 vessels with 1.54 S/N ratio, 11.3 vessels and 1.54 S/N ratio, 11.6 vessels and 1.52 S/N ratio, 11.8 vessels and 1.52 S/N ratio and, finally, 11.9 vessels and 1.52 S/N ratio. In the tibial segment, the corresponding values were 8.5 vessels and 1.84 S/N ratio, 14.4 vessels and 1.14 S/N ratio, 14.5 vessels and 1.17 S/N ratio, 14.5 vessels and 1.14 S/N ratio, 14.3 vessels and 1.17 S/N ratio and, finally, 14.5 vessels and 1.19 S/N ratio. To conclude, MRA with cardiac gating better visualized peripheral vessels whatever the trigger delay.

Cardiovascular responses to isometric muscular exercise were evaluated during sauna. Nine healthy men aged 26 to 46 underwent testing during 5-6 saunas with one week interval between sessions. Each sauna included 2-6 heatings of 8-15 minutes (80-85 degrees C, humidity 15%) followed by complete cooling. Cardiovascular response during handgrip (45 seconds) were measured before sauna, after the first interval and 25 minutes after the end of sauna treatment.

Resting skin flow (RF) and the venoarteriolar response (VAR) were studied in 40 patients with diabetic microangiopathy and neuropathy, in 40 diabetes with microangiopathy and in 30 normal subjects using laser-Doppler flowmetry. In patients with microangiopathy and neuropathy RF was increased and the VAR was impaired to a greater extent than in patients without neuropathy. We evaluated the microangiopathy index (VAR/RF) that was lower in diabetics without neuropathy and even lower in those with neuropathy than in normals We also evaluated the VAR with different postural changes.

Seventy-four uremic patients in chronic hemodialysis were studied by X-ray of the thorax before and after the same dialysis. Radiological signs and variables (originally proposed by Milne) related to hemodynamics of pulmonary and systemic circulation were evaluated in relation to fluid subtraction. The study demonstrated the high sensitivity and the clinical value of thoracic radiography in the follow-up of these patients and particularly in the evaluation of fluid overload.