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New diagnostic and therapeutic aspects of the essential thrombocythemia are summarized. A series of 14 patients with essential thrombocythemia is reported.

Background and aim Dyslipidemia is one of the main risk factors for atherosclerosis, usually the underlying cause of cardiovascular diseases which are the major cause of morbidity and mortality in developed countries. The aim of this study was to assess the effects and the advantages of a combined dietary supplementation with PUFA n-3, vitamin E, niacin and γ-oryzanol on lipid profile, inflammatory status and oxidative balance. Methods and results Fifty-seven dyslipidemic volunteers were randomly assigned to receive: placebo (group A, 19 subjects); PUFA n-3 and vitamin E (group B, 18 subjects); the same as B plus γ-oryzanol and niacin (group C, 20 subjects). Lipid profile, reactive oxygen species (ROS), total antioxidant capacity (TAC), vitamin E, interleukin 1-β (IL1-β), tumor necrosis factor (TNF-α) and thromboxane B 2 (TXB 2 ) were determined at baseline (T0) and after four months (T1). All dyslipidemic subjects showed, at baseline, oxidative stress and, after four months, all biochemical markers improved significantly in groups treated with dietary supplementation. Particularly in group C all lipid patterns improved significantly. Conclusions Our findings demonstrate that the strategy of combining different compounds, which protect each other and act together at different levels of the lipid chain production, improves lipid profile, inflammatory and oxidative status, allowing us to reduce the dose of each compound under the threshold of its side effects.

To date we lack official data on tipology of Diagnosis Related Groups (DRGs) and their quality in Italian Respiratory Intermediate Care Units (RICUs).The objective of the study was to collect data on the activity of 26 Italian RICUs and to evaluate the quality of the DRGs generated.The primary and secondary diseases, the procedures carried out and their coding using the ICD9 system (valid Italy until 2000) were collected from the discharge forms of patients admitted to RICUs. To obtain the DRG, these codes were automatically recoded in the ICD9-CM classification system by Grouper 10. Afterwards, the same diseases and procedures were directly processed by the ICD9-CM classification system. Finally, in order to evaluate the quality of care, the DRGs generated by the ICD9 classification system were compared to DRGs generated by the ICD9-CM classification system.The average weight of the patients cared for in an Italian RICU was 2.05 using the ICD9 classification system and 2.53 using the ICD9-CM classification system. Some non-complicated DRGs (80-97) or non specific DRGs (101-102) were set to zero; others, like DRG 87 appear due to the ability of the ICD9-CM classification system to recognise and accept the fifth digit of the Respiratory Failure code (518.81). The difference in terms of DRG scores generated by the two codification systems was 360.5 DRG points in favour of ICD9-CM. More than 1 million Euro of reimbursements have been lost, as the average national reimbursement for each DRG score is Euro 2,943.80.Severe pulmonary diseases determined the case mix of patients cared for in the Italian RICUs during the observed period. The Italian RICUs offer high quality assistance and are characterised by high mean weight per treated patient. However, the activity has been under-estimated due to the low sensitivity of the ICD9 classification system used in the recognition of the real disease and in the correct generation of relative DRG. The ICD9 classification system penalised the recognition of respiratory failure in particular.

40 subjects who had a transitory ischemic cerebral attack were treated with Mesoglycan and controlled for two consecutive years. Only four patients showed relapse of ischemic cerebral attacks. There was also noted a positive effect on the patients' quality of life, examined using psycometric scales.

A dysfunction of dopaminergic systems with reduction of active dopamine, is well-known in cerebral involution. Twenty patients with mild-moderate pathological cerebral involution of atrophic and/or vascular origin, were treated with Selegiline (L-deprenyl), a monoamino-oxidase B inhibitor (10 mg/die for six months). Compared with a control group, Selegiline treated patients showed a statistically significant improvement in cognitive and behaviour capacities. At the end of investigation, "Mini Mental State" showed an improvement of 26.5% in Selegiline group and of 3.7% in control group (P0.01). "Echelle Clinique d'Aptitudes Intellectuelles" showed an improvement of 29.4% and of 10.8% respectively (P0.01). Selegiline treatment has shortened significantly the reaction times and has improved mnesic capacities. No side effects were observed during the study.

30 patients, affected by chronic ethylic hepatopathy, were treated with 450 mg/daily of ursodeoxycholic acid (UDCA): after six months, a significant decrease of serum hepatic enzymes was noted. The addition of silymarin (400 mg/daily) to UDCA in other 30 patients, induced a further improvement of hepatic function.

The effects of Citicoline were investigated in 40 patients with pathological cerebral involution of atrophic origin. The dose was 1000 mg/die by parenteral injection for 4 weeks; 20 patients, after a wash-out of a week, received another cycle of Citicoline at the same doses for other 4 weeks. Citicoline treatment has shortened significantly the reaction times and has improved cognitive and behaviour capacities, evaluated according to the "Clifton test" and "Green Relatives Stress Scale". Better results were obtained in patients who received two cycles of therapy. No side effects were observed during the study.

Static mouth pressure during maximal inspiratory efforts is commonly used to evaluate inspiratory muscle strength. However, maximal inspiratory pressure (MIP) presents some potential limitations likely to be overcome by the measure of mouth pressure during a maximal sniff maneuver in patients with respiratory muscle weakness. The aim of the present study was to assess whether mouth pressure during sniff maneuver (Pmosn) is a better index of inspiratory muscle strength than MIP in patients with neurologic and neuromuscular diseases (NNMD) with and without inspiratory muscle weakness.Both MIP and Pmosn were measured in 30 patients affected by various types of NNMD and in 41 control subjects. Pmosn was measured with a 5-cm latex balloon-catheter system, the balloon being held in the oral cavity with the lips closed.In control subjects, MIP was either similar (in female subjects) or higher (in male subjects) than Pmosn, the variation coefficients for the two tests being similar both in male subjects (19.3% vs 19.1% for MIP and Pmosn, respectively) and in female subjects (27.5% vs 26.2%, respectively). There was no difference in the Pmosn/MIP ratios observed in the different diseases (one-way analysis of variance, F = 0.29, p = 0.91). In control subjects, a significant inverse relationship between Pmosn/MIP ratio and MIP (r = - 0.66, p0.00001) was found, ie, the lower the MIP, the higher the Pmosn/MIP ratio, suggesting an increasing difficulty in performing MIP as MIP values decreased. The majority of patients were between the prediction limits of the regression calculated for control subjects. At variance, patients with Duchenne dystrophy and low MIP were under the prediction limits of the regression calculated for control subjects, indicating a lower-than-expected PMOSN.In patients with NNMD, irrespective of the etiology, we found the following: (1) Pmosn does not overcome the limitations of MIP measurement; (2) the two maneuvers are not interchangeable, but rather complement one another in the assessment of inspiratory muscle strength; (3) Pmosn may underestimate muscle strength as assessed by MIP in patients with NNMD with inspiratory muscle weakness; and (4) in patients with low MIP, the lower-than-expected Pmosn/MIP ratio confirms inspiratory muscle weakness.

Whether or not short-term negative pressure ventilation (NPV) improves respiratory function by decreasing the drive to the respiratory muscles in hypercapnic chronic obstructive pulmonary disease (COPD) patients remains to be defined. In six severely obstructed hypercapnic COPD patients (Group A) with grade IV dyspnoea (modified Medical Research Council (MRC) dyspnoea scale), we evaluated pulmonary volumes, arterial blood gases, the pattern of breathing (tidal volume (VT) and respiratory frequency (Rf)) and the neuromuscular respiratory drive (NMRD), before and immediately after a 7 day period with the iron lung (IL). NMRD was assessed by expressing mouth occlusion pressure (P0.1) recorded during quiet breathing as a percentage of maximal P0.1 recorded during exogenous CO2 stimulation (P0.1 max,CO2). A group of six hypercapnic, less dyspnoeic (grade II to III) COPD patients (Group B), with similar mechanical characteristics, and another less obstructed historically normocapnic control group (Group C) were also considered. Before IL, in Group A VT was lower than in C, and P0.1 (%P0.1 max,CO2) was greater than in Group B and C. After a 7 day period with IL, VT increased, Rf decreased, and arterial blood gases and dyspnoea grade improved; P0.1 (%P0.1 max,CO2) significantly decreased remaining, however, greater than in Group C. In Group A the time course of arterial carbon dioxide tension (Pa,CO2) and P0.1 (%P0.1 max,CO2) were significantly related to each other. These data seem to indicate that IL is effective in improving respiratory function and symptoms in chronic hypercapnic severely dyspnoeic COPD patients. The observation that these effects were associated with a decrease in NMRD reflects an improved efficiency of the respiratory system. After IL, respiratory function in Group A was similar or even better than that in Group B. This study also considers the possibility of putting severely dyspnoeic hypercapnic COPD patients into an IL trial before starting a traditional rehabilitation programme.

The difficulty of clinical and biochemical diagnosis of insulinoma lies in the extreme variability of both clinical symptoms and glycaemia/insulinaemia levels, so that neither parameter is a totally reliable diagnostic indicator. The possibility of introducing a third parameter, the non-esterified fatty acid (FFA) level, to enhance the reliability of insulinoma diagnosis was therefore investigated. The behaviour of glucose, insulin and plasmatic FFA levels and the correlation of the three parameters were studied in 4 patients whose suspected insulinomas were later surgically confirmed. The tests applied were as follows: 24 hour fast followed by endovenous glucose, oral glucose administration, tolbutamide stimulus test, adrenaline and glucagon tests. The results revealed anomalies in insulinaemia and glycaemia behaviour such as have already, in part, been described in organic hyperinsulinism, e.g. the discrepancy between insulin and glucose levels after prolonged fasting. It was also clear that the parameters examined still leave much room for uncertainly in the biochemical diagnosis of insulinomas. Numerous anomalies were also observed in the behaviour of plasmatic FFA. For example lipid mobilisation was often reduced in conditions that normally stimulate it (fasting, the administration of catecholamines). Equally the prolonged blockage of lipid mobilisation was encountered in the presence of factors that normally reduce lipolysis (endovenous glucose). On the basis of these results it is suggested that a combined assessment of glucose and plasmatic FFA levels may be a more sensitive diagnostic indicator of insulinoma than the insulin/glucose ratio commonly reported in the literature. The mechanism behind the lipid mobilisation anomalies of insulinomas is also discussed in the light of its apparent connection with the glucose/insulin interaction characteristic of the condition.

We studied in agar growth behaviour of bone marrow granulocyte-macrophage progenitor cells (CFU-GM) in 16 patients with marrow failure in order to discriminate patients with cells inhibiting granulopoiesis both in bone marrow and peripheral blood. Our experimental design was based on: a) agar culture of bone marrow cells before and after treatment with antilymphocyte globulin (AGL); b) agar co-culture of marrow cells with autologous lymphocytes from peripheral blood. ALG treatment of marrow cells determined CFU-GM growth increase in 4 out of 10 patients; in the same patients co-culture with autologous lymphocytes showed a significant inhibition of CFU-GM growth. The growth enhancement induced by ALG treatment "in vitro" associated with growth inhibition in the coculture suggests the existence of a lymphocyte population suppressing the granulopoiesis both in bone marrow and peripheral blood. With this work we propose an experimental model in order to discriminate marrow failure based on cell-mediated suppression of CFU-GM growth in patient susceptible of immunosuppressive therapy with ALG.