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Objective: The aim of this study was to conduct a systematic review with meta-analysis to analyze the effect of resistance training variables prescription on resting systolic (SBP) and diastolic blood pressure (DBP) and muscle strength changes. Methods: The search was conducted in the PubMed, Web of Science, and SPORTDiscus databases until August 2020 for randomized controlled trials with non-exercising control group. Results: In total, 36 studies qualified for inclusion in this meta-analysis. Eleven studies included users of antihypertensive medication, while the remaining 25 studies were conducted with non-users of antihypertensive medication. Resistance training only reduced SBP (−0.56 [−0.77 to −0.35]; P

Objective: This study aimed to verify the effect of resistance training performed with single (SET1) or three sets (SET3) on muscle strength and resting blood pressure (BP) of individuals with hypertension. BP was also assessed during knee extension exercise with submaximal load before and after training. Methods: Thirty-eight patients with hypertension were randomly assigned to a control group (CON: n = 12; 55.6 ± 3.2 years; 65.3 ± 9.3 kg; 163.5 ± 8.6 cm), SET1 group (n = 14; 58.1 ± 2.0 years; 65.4 ± 8.7 kg; 162.4 ± 11.1 cm) or SET3 group (n = 12; 57.9 ± 2.4 years; 66.3 ± 11.4 kg; 161.6 ± 7.5 cm). The training was conducted for 12 weeks (3 d.w−1; 4 exercises; 12–15 repetitions; moderate intensity). Results: No differences were found in pre-training values for BP and strength between groups. After training, SET3 showed lower values than CON for resting systolic (121.3 ± 8.0 vs 129.3 ± 10.3 mmHg; P = .01) and diastolic BP (73.5 ± 6.0 vs 79.5 ± 7.4 mmHg; P = .02). Muscle strength in bench-press and knee extension exercises increased in SET1 (48.1 ± 6.3 and 71.3 ± 12.2 kg, respectively) and SET3 (50.2 ± 7.8 and 75.2 ± 9.6 kg, respectively) in relation to CON (39.3 ± 5.1 and 62.4 ± 9.9 kg) (P

FUNDAMENTO: A obesidade está ligada à hipertensão arterial (HA) na infância. Entretanto, o papel da gordura como preditor de HA em adolescentes permanece desconhecido. OBJETIVO: Investigar a associação entre obesidade geral e abdominal com HA e identificar a sensibilidade e especificidade desses indicadores para detectar HA em adolescentes. MÉTODOS: A amostra consistiu em 1.021 adolescentes com idade de 10-17 anos. Os indivíduos foram classificados como normal, sobrepeso/obesidade, de acordo com as medidas do IMC, e como não-obeso com obesidade abdominal, de acordo com as medidas da circunferência da cintura (CC). A pressão arterial sistólica (PAS) e diastólica (PAD) foi avaliada através de um dispositivo oscilométrico. Regressão logística e curvas ROC foram usadas na análise estatística. RESULTADOS: A prevalência geral de HA foi 11,8% (13,4% em meninos e 10,2% em meninas). A prevalência de HA em meninos e meninas com sobrepeso/obesidade foi 10% e 11,1%, respectivamente. A prevalência de HA em meninos com obesidade abdominal foi 28,6%. Para ambos os sexos, o odds ratio (OR) para HA foi mais alto na obesidade abdominal do que no sobrepeso/obesidade geral (4,09 [OR IC95% = 2,57-6,51]) versus 1,83 [OR IC95% = 1,83-4,30]). O OR para HA foi mais alto quando sobrepeso/obesidade geral e obesidade abdominal estavam agrupados (OR = 4,35 [OR IC95% = 2,68 -7,05]), do que quando identificados como sobrepeso/obesidade geral ou obesidade abdominal apenas (OR = 1,32 [OR IC95% = 0,65- 2,68]). Entretanto, ambos os tipos de obesidade apresentavam baixo poder preditivo na detecção de HA. CONCLUSÃO: Obesidade geral e obesidade abdominal foram associadas com HA; entretanto, a sensibilidade e especificidade dessas variáveis na detecção de HA são baixas em adolescentes brasileiros.

FUNDAMENTO: Apesar de os estudos demonstrarem a ocorrência da hipotensão pós-exercício (HPE) em exercícios resistidos, ainda não há consenso sobre um protocolo ideal. OBJETIVO: Avaliar os efeitos de diferentes intervalos de recuperação (IR) entre séries de exercício resistido (ER) na pressão arterial (PA) pós-exercício. MÉTODOS: Dezesseis homens jovens sedentários e não hipertensos realizaram, de forma contrabalanceada três protocolos de ER com 1 (P1), 2 (P2) e 3 (P3) minutos de IR entre as séries, e um protocolo controle (CON). Os protocolos de ER consistiram em três séries de oito repetições em seis exercícios. As cargas utilizadas na 1ª, 2ª e 3ª série dos exercícios foram respectivamente 80, 70 e 60% de 1 repetição máxima (1RM). As medidas foram realizadas em repouso (REP), 15 (T15), 30 (T30), 45 (T45), 60 (T60), 75 (T75) e 90 (T90) minutos após a sessão. Foi realizada uma análise de variância fatorial (ANOVA) com post hoc LSD. RESULTADOS: Não foi encontrada alteração significativa na PA sistólica após os protocolos. Foi encontrado um aumento significativo da PA diastólica, após o CON, nos momentos T45 e T90. Ocorreu redução significativa na PA diastólica após P1 e P3, com duração de 30 e 15 minutos respectivamente. Não foram encontradas diferenças significativas nas respostas da PA sistólica e diastólica entre os protocolos com diferentes IR. CONCLUSÃO: Parece que o IR não influencia a redução da PA sistólica após uma sessão de ER. No entanto, foi encontrada uma queda na PA diastólica (P1 e P3) com duração de até 30 minutos.FUNDAMENTO: A pesar de que los estudios demuestran la aparición de hipotensión post-ejercicio (HPE) en Ejercicios de Resistencia, aún no existe consenso sobre un protocolo ideal. OBJETIVO: Evaluar los efectos de diferentes intervalos de recuperación (IR) entre series de ejercicios de resistencia (ER) en la presión arterial (PA) post-ejercicio. MÉTODOS: Dieciséis hombres jóvenes sedentarios y no hipertensos realizaron, de forma contrabalanceada, tres protocolos de ER con 1 (P1), 2 (P2) y 3 (P3) min de IR entre las series, y un protocolo control (CON). Los protocolos de ER consistieron en tres series de ocho repeticiones en seis ejercicios. Las cargas utilizadas en la 1ª, 2ª y 3ª serie de los ejercicios fueron respectivamente 80, 70 y 60% de 1RM. Las mediciones fueron realizadas en reposo (REP), 15 (T15), 30 (T30), 45 (T45), 60 (T60), 75 (T75) y 90 (T90) min luego de la sesión. Se realizó un análisis de varianza factorial (ANOVA) con post hoc LSD. RESULTADOS: No se halló alteración significativa en la PA sistólica luego de los protocolos. Se encontró un aumento significativo de la PA diastólica, luego del CON, en los momentos T45 y T90. Ocurrió una reducción significativa en la PA diastólica luego de P1 y P3, con una duración de 30 y 15 min respectivamente. No se hallaron diferencias significativas en las respuestas de la PA sistólica y diastólica entre los protocolos con diferentes IR. CONCLUSIÓN: Parece que el IR no tiene influencia sobre la reducción de la PA sistólica luego de una sesión de ER. Sin embargo, se encontró una caída en la PA diastólica (P1 y P3) con duración de hasta 30 min.BACKGROUND: Although studies have demonstrated the occurrence of postexercise hypotension (PEH) in resistance exercises, there is still no consensus on an ideal protocol. OBJECTIVE: To evaluate the effects of different rest intervals (RI) between resistance exercise (RE) sets on postexercise blood pressure (BP). METHODS: Sixteen sedentary non-hypertensive young men performed three RE protocols with RI of 1 (P1), 2 (2) and 3 (P3) minutes between the sets, as well as a control protocol (CON), in a counterbalanced manner. The RE protocols consisted of three sets of eight repetitions in six exercises. The loads used in the 1st, 2nd, and 3rd exercise sets were 80%, 70% and 60% of one repetition maximum (1RM), respectively. Measurements were taken at rest (RES), 15 (T15), 30 (T30), 45 (T45), 60 (T60), 75 (T75), and 90 (T90) minutes after the session. Factorial analysis of variance (Anova) was carried out, followed by post hoc LSD. RESULTS: No significant change was found in systolic BP after the protocols. A significant increase in diastolic BP was verified after CON at timepoints T45 and T90. Significant reduction in diastolic BP occurred after P1 and P3, with duration of 30 and 15 minutes, respectively. No significant differences were found in the systolic and diastolic BP responses between the protocols with different RI. CONCLUSION: RI does not seem to influence systolic BP reduction after an RE session. However, reductions in diastolic BP (P1 and P3) lasting up to 30 minutes were observed.

OBJETIVOS: Avaliar a acurácia de três pontos de corte na determinação da pressão arterial elevada em adolescentes, dada a forte relação entre o excesso de peso e valores elevados de pressão arterial. MÉTODOS: Participaram do estudo 1.021 adolescentes de ambos os sexos, selecionados de maneira aleatória nas escolas públicas e particulares de Londrina (PR). O peso corporal foi aferido por meio de balança digital, e a estatura, por um estadiômetro portátil com extensão máxima de 2 metros. A pressão arterial foi avaliada através de um aparelho automático. A capacidade do índice de massa corporal de detectar a pressão arterial elevada foi averiguada por meio da curva ROC e seus parâmetros (sensibilidade, especificidade e área sob a curva). RESULTADOS: Os pontos de corte da proposta nacional apresentaram maior acurácia (masculino: 0,636±0,038; feminino: 0,585±0,043) quando comparados aos pontos de corte das propostas internacional (masculino: 0,594±0,040; feminino: 0,570±0,044) e norte-americana (masculino: 0,612±0,039; feminino: 0,578±0,044). CONCLUSÃO: A proposta nacional foi a que apresentou melhor acurácia na indicação de valores elevados de pressão arterial.OBJECTIVES: To evaluate the accuracy of three different cutoff points for the detection of high blood pressure in adolescents, given the strong relationship between overweight and high blood pressure levels. METHODS: A total of 1,021 adolescents of both sexes were enrolled in the study, selected at random from public and private schools in Londrina, Brazil. Their body weight was measured using a digital balance, and their height with a portable stadiometer with a maximum extension of 2 meters. Arterial blood pressure was measured using an automatic apparatus. The capacity of body mass index to detect high blood pressure was gauged using ROC curves and their parameters (sensitivity, specificity, and area under the curve). RESULTS: The cutoff points proposed in a Brazilian standard exhibited greater accuracy (males: 0.636±0.038; females: 0.585±0.043) than the cutoff points proposed in an international (males: 0.594±0.040; females: 0.570±0.044) and a North-American standard (males: 0.612±0.039; females: 0.578±0.044). CONCLUSIONS: The Brazilian proposal offered greatest accuracy for indicating high blood pressure levels.

O objetivo desse estudo foi verificar o efeito da natação sobre as alterações morfológicas cardíacas e hemodinâmicas de ratos com hipertensão induzida por L-NAME. Quarenta ratos Wistar foram divididos nos grupos: controle sedentário (CS), controle treinado (CT), sedentário com L-NAME (LS) e treinado com L-NAME (LT). Os animais treinados realizaram natação por até 60 min durante quatro semanas. Os animais dos grupos L-NAME receberam 20 mg.kg-1 também durante quatro semanas. O grupo LS apresentou maiores valores de PAM (136,6±5,1 mmHg) comparado ao CS (107,1±1,8 mmHg). O grupo LT apresentou reduções na PAM comparado ao LS (121,2±1,4 e 136,6±5,1 mmHg, respectivamente). Por outro lado, os LT ainda permaneceram hipertensos comparados ao CT (121,0±1,4 e 107,1±1,8 mmHg, respectivamente). Em relação à FC, houve bradicardia de repouso para os animais treinados. Os grupos CS e CT não apresentaram alterações no peso relativo e absoluto do coração. Houve aumento do peso absoluto do coração para o grupo LS comparado ao CS e também se observou aumento para o peso relativo e absoluto do coração para o grupo LT comparado ao CT. A análise histológica demonstrou que o treinamento físico pode reduzir a quantidade de lesões provocadas pela administração crônica de LNAME. Conclui-se que a natação foi eficiente em reduzir a PAM de animais hipertensos, mas não reduziu em animais normotensos. Adicionalmente, o treinamento físico não promoveu hipertrofia cardíaca, mas a administração de L-NAME aumentou o peso absoluto e relativo do coração em animais sedentários e treinados.

Introdução e objetivos: O sistema renina angiotensina (SRA) apresenta importante função na homeostase do sistema cardiovascular, e a ativação da via clássica resulta na formação de angiotensina II, que leva ao aumento da pressão arterial (PA). No entanto, novos estudos tem evidenciado a ativação da via da angiotensina (1-7), a qual apresenta respostas contrárias a Angiotensina II e consequentemente reduz a PA. Considerando que o exercício físico interfere nas repostas cardiovasculares, este estudo teve o propósito de revisar a literatura quanto a possível relação do treinamento físico com o SRA. Métodos: o trabalho foi dividido em sessões de estudos que envolveram animais e estudos com seres humanos. A busca destes estudos foi realizada na base Medline e os principais critérios foram amostras com animais ou seres humanos e artigos publicados em inglês. Depois de aplicados os critérios de inclusão e exclusão, foram encontrados 12 artigos envolvendo animais e oito envolvendo seres humanos. Resultados: Os estudos demonstraram que existe uma relação entre o treinamento físico e o SRA, sendo que as respostas cardiovasculares observadas após o exercício físico pode apresentar alguma relação com o SRA. Além disso, estudos com seres humanos demonstraram que polimorfismos em alguns genes do SRA podem ser determinantes para as respostas cardiovasculares encontradas após o exercício físico. Considerações finais: Tendo em vista as recentes investigações que relacionam as respostas cardiovasculares após o exercício físico com o SRA, esta relaçação parece ser importante ao considerar os mecanismos responsáveis por promover determinadas respostas cardiovasculares após o exercício físico como a hipotensão.

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, accounting for over 9 million deaths annually. The prevalence of CAD continues to rise, driven by ageing and the increasing prevalence of risk factors such as hypertension, diabetes, and obesity. Current clinical guidelines emphasize the importance of functional tests in the diagnostic pathway, particularly for assessing the presence and severity of ischemia. While recommended tests are valuable, they may not fully capture the complex physiological responses to exercise or provide the necessary detail to tailor personalized treatment plans. Cardiopulmonary exercise testing (CPET) offers a comprehensive assessment of the cardiovascular, pulmonary, and muscular systems under stress, potentially addressing these gaps and providing a more precise understanding of CAD, particularly in settings where traditional diagnostics may be insufficient. By enabling more personalized and precise treatment strategies, CPET could play a central role in the future of CAD management. This narrative review examines the current evidence supporting the use of CPET in CAD diagnosis and management and explores the potential for integrating CPET into existing clinical guidelines, considering its diagnostic and prognostic capabilities, cost-effectiveness, and the challenges associated with its adoption.

Background : A knee injury in an athlete leads to periods of forced exercise interruption. Myocardial work (MW) assessed by echocardiographic and cardiopulmonary exercise testing (CPET) are two essential methods for evaluating athletes during the period following injury. However, compared to pre-surgery evaluations, the variations in cardiovascular parameters and functional capacity assessed by these methods after surgery remain unclear. Methods : We evaluated 22 non-professional athletes aged 18-52, involved in prevalently aerobic or alternate aerobic/anaerobic sports activities, who were affected by a knee pathology requiring surgical treatment. The evaluation was performed at rest using transthoracic echocardiography, including MW assessment, and during exercise using CPET. Each athlete underwent the following two evaluations: the first before surgery and the second after surgery (specifically at the end of the deconditioning period). Results : Resting heart rate (HR) increased significantly (from 63.3 ± 10.85 to 71.2 ± 12.52 beats per minute, p = 0.041), while resting diastolic and systolic blood pressure, forced vital capacity, and forced expiratory volume in the first second did not show significant changes. Regarding the echocardiographic data, global longitudinal strain decreased from -18.9 ± 1.8 to -19.3 ± 1.75; however, this reduction was not statistically significant ( p = 0.161). However, the global work efficiency (GWE) increased significantly (from 93.0% ± 2.9 to 94.8% ± 2.6, p = 0.006) and global wasted work (GWW) reduced significantly (from 141.4 ± 74.07 to 98.0 ± 50.9, p = 0.007). Additionally, the patients were able to perform maximal CPET at both pre- and post-surgery evaluations, as demonstrated by the peak respiratory exchange ratio and HR. However, the improved myocardial contractility (increased GWE and decreased GWW) observed at rest did not translate into significant changes in exercise parameters, such as peak oxygen consumption and the mean ventilation/carbon dioxide slope. Conclusions : After surgery, the athletes were more deconditioned (as indicated by a higher resting HR) but exhibited better resting myocardial contractility (increased GWE and reduced GWW). Interestingly, no significant changes in exercise capacity parameters, as evaluated by CPET, were found after surgery, suggesting that the improved myocardial contractility was offset by a greater degree of muscular deconditioning.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, and its incidence has grown within several years, quickly becoming the third leading cause of mortality. The disease is characterized by alveolar destruction, air-trapping, and chronic inflammation due to persistent exposure to a large spectrum of harmful particles. The diagnosis of COPD is made by demonstration of persistent and not fully reversible airflow limitation, and different phenotypes may be recognized based on pathophysiological, clinical, and radiological features. However, COPD is a systemic disease with effects involving several organs. For example, mechanical and functional alterations secondary to COPD involve heart function. Indeed, cardiovascular diseases are highly prevalent in patients affected by COPD and represent the primary cause of mortality in such patients. An electrocardiogram is a simple and cheap test that gives much information about the heart status of COPD patients. Consequently, variations from "normality" can be appreciated in these patients, with the most frequent abnormalities being P-wave, QRS axis, and ventricular repolarization abnormalities, in addition to conduction alterations and a vast number of arrhythmias. As a result, ECG should be routinely performed as a valuable tool to recognize alterations due to COPD (i.e., mechanical and functional) and possible associated heart diseases. This review aims to describe the typical ECG features in most COPD patients and to provide a systematic summary that can be used in clinical practice., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Chronic obstructive pulmonary disease (COPD) is a significant preventable and treatable clinical disorder defined by a persistent, typically progressive airflow obstruction. This disease has a significant negative impact on mortality and morbidity worldwide. However, the complex interaction between the heart and lungs is usually underestimated, necessitating more attention to improve clinical outcomes and prognosis. Indeed, COPD significantly impacts ventricular function, right and left chamber architecture, tricuspid valve functionality, and pulmonary blood vessels. Accordingly, more emphasis should be paid to their diagnosis since cardiac alterations may occur very early before COPD progresses and generate pulmonary hypertension (PH). Echocardiography enables a quick, noninvasive, portable, and accurate assessment of such changes. Indeed, recent advancements in imaging technology have improved the characterization of the heart chambers and made it possible to investigate the association between a few cardiac function indexes and clinical and functional aspects of COPD. This review aims to describe the intricate relation between COPD and heart changes and provide basic and advanced echocardiographic methods to detect early right ventricular and left ventricular morphologic alterations and early systolic and diastolic dysfunction. In addition, it is crucial to comprehend the clinical and prognostic significance of functional tricuspid regurgitation in COPD and PH and the currently available transcatheter therapeutic approaches for its treatment. Moreover, it is also essential to assess noninvasively PH and pulmonary resistance in patients with COPD by applying new echocardiographic parameters. In conclusion, echocardiography should be used more frequently in assessing patients with COPD because it may aid in discovering previously unrecognized heart abnormalities and selecting the most appropriate treatment to improve the patient's symptoms, quality of life, and survival., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Cardiovascular adaptations in elite athletes involve both ventricular and atrial changes. Nowadays, limited research exists on right ventricular (RV) remodeling, particularly in female athletes and across different types of exercise training., Methods: Our study evaluated 370 athletes (61% males) participated at 2020 Tokyo and 2022 Beijing Olympic Games. Athletes were categorized according to main type of exercise into isometric and isotonic. Comprehensive echocardiographic assessments were conducted to analyze RV morpho-functional parameters, comparing genders and different sporting exercise., Results: Significant differences in RV parameters were observed based on exercise type and gender. Isotonic athletes showed greater RV remodeling with larger RV outflow tract (15.1 ± 2.1 vs. 14.5 ± 1.7 mm, p < .0001) end-diastolic and end-systolic area (respectively, 24.6 ± 5.5 vs. 21.7 ± 5 mm, p < .000 and 11.7 ± 3.2 vs. 10.1 ± 2.8 mm, p < .0001) and right atrium size (11.7 ± 3.2 vs. 10.2 ± 2.3 mm 2 , p = .0001). Functional parameters, such as TDI velocities, were similar between groups. Males showed larger RV area and right atrium size (p < .0001) and lower RV TDI velocities with reduced E' (15.4 ± 2.9 vs. 16.1 ± 3.2 m/s in females, p = .031), resulting in lower E'/A' ratio (1.69 ± .6 vs. 1.84 ± .6 m/s, p = .021), while S' was lower females (14.6 ± 2.3 vs. 14.1 ± 2.4 m/s, p = .041). RV TDI velocities were similar in isotonic and isometric both in male and females., Conclusions: In elite athletes, RV morphological changes are influenced by exercise modality but do not translate into functional differences. Female athletes present distinct RV functional profiles, with lower S' velocities and a higher E'/A' ratio. Functional RV TDI parameters are not affected by the typology of exercise practiced., (© 2023 Wiley Periodicals LLC.)

Ligamentous atresia of the left side of a double arch distal to the left subclavian artery is a rare form of vascular ring, which can easily be confused, on transthoracic echocardiography, with the right-sided aortic arch when there is mirror-imaged branching. Because of its rapid acquisition, computed tomographic angiography with three-dimensional reconstruction has now become the modality of choice for accurate diagnosis of the various forms of double aortic arch. It can be performed without sedation in any age group, including neonates. It provides excellent visualisation of the aortic arch and its branching pattern, thus permitting accurate diagnosis and surgical planning. We present a case series of six children with this rare vascular ring assessed using CT, highlighting their outcomes.

Fanconi anemia (FA) is a genome instability syndrome characterized by bone marrow failure and cellular hypersensitivity to DNA cross-linking agents. In response to DNA damage, the FA pathway is activated through the cooperation of 16 FA proteins. A central player in the pathway is a multisubunit E3 ubiquitin ligase complex or the FA core complex, which monoubiquitinates its substrates FANCD2 and FANCI. FANCE, a subunit of the FA core complex, plays an essential role by promoting the integrity of the complex and by directly recognizing FANCD2. To delineate its role in substrate ubiquitination from the core complex assembly, we analyzed a series of mutations within FANCE. We report that a phenylalanine located at the highly conserved extreme C terminus, referred to as Phe-522, is a critical residue for mediating the monoubiquitination of the FANCD2-FANCI complex. Using the FANCE mutant that specifically disrupts the FANCE-FANCD2 interaction as a tool, we found that the interaction-deficient mutant conferred cellular sensitivity in reconstituted FANCE-deficient cells to a similar degree as FANCE null cells, suggesting the significance of the FANCE-FANCD2 interaction in promoting cisplatin resistance. Intriguingly, ectopic expression of the FANCE C terminus fragment alone in FA normal cells disrupts DNA repair, consolidating the importance of the FANCE-FANCD2 interaction in the DNA cross-link repair.

Background: Many international guidelines address appropriateness, prescribing variability and drug-related expenditure in primary dyspepsia management., Aims: To evaluate the impact on general practitioner (GP) practice and healthcare costs of a participatory intervention to modify primary dyspepsia and Helicobacter pylori (Hp) infection management, by standardised implementation of an international guideline in the local setting, through a prospective, controlled before-and-after study., Methods: Primary dyspepsia management was monitored in the Local Health District of Padua; 63 of all 354 local GPs (total patient population: 82,284) took part in a primary-care improvement programme. Measured variables were: mean prescribed gastroscopies/1,000 registered patients, mean expenditure/1,000 registered patients for antisecretories (H(2) blockers) and proton pump inhibitors (PPIs), inter-GP prescribing variability and adherence to guidelines, analysed through prospectively filled-out reports on GP consultations for dyspepsia. A 3-month pre-survey period was compared with a 6-month intervention period following implementation of an agreed guideline., Results: Compared to non-participating GPs, intervention yielded a 30 and 26.4% reduction in H(2)-blocker and PPI expenditure, respectively. Application of the guideline led to an upward trend in endoscopy prescriptions, coupled with a 7% increase in appropriate referrals. Intra-group variability marginally decreased; guideline compliance rose slightly., Conclusions: Participatory intervention can reduce prescribing variability among GPs and inappropriate esophagogastroduodenoscopies, lowering related costs. Results may not have been spectacular, but in view of the number of patients involved, they may have an important impact on Local Health District expenditure., (Copyright (c) 2005 S. Karger AG, Basel.)

Purpose: Capecitabine is an oral fluoropyrimidine converted to fluourouracil (FU) preferentially in tumor tissue. It has proven clinical activity against colorectal cancer when used as first-line therapy. The objectives of this study were to assess the safety and efficacy of capecitabine in patients with metastatic colorectal carcinoma who progressed despite previous FU therapy., Patients and Methods: According to the group sequential analysis design of this study, accrual would stop if no responses were observed in the first 20 patients treated. If one or more objective responses were confirmed, the trial would be expanded. Patients received capecitabine 1,250 mg/m(2) twice a day for 14 days, every 3 weeks. Tumor lesions were assessed every 6 weeks, and patients were followed for survival every 3 months after completing treatment., Results: Twenty-three patients were enrolled onto the study; 22 fulfilled all the eligibility criteria. No objective responses were observed among the 22 eligible patients; 11 patients (50%) had stable disease for a median duration of 141 days (range, 88-289 days). The Kaplan-Meier estimate of median time to disease progression was 64 days (95% CI, 41 to 134 days). The median survival time estimate was 389 days (95% CI, 267 to 637 days). The most frequent treatment-related adverse events were hand-foot syndrome, diarrhea, and nausea or vomiting. There were no grade 4 toxicities and no treatment-related deaths., Conclusion: Single-agent capecitabine in patients with metastatic colorectal carcinoma refractory to FU showed no objective responses and clinical benefit that was, at best, modest. The use of capecitabine in combination with other treatments in this patient population is under investigation.

Intragastric prosthesis (Lap-Band, BioEnterics Co., Carpinteria, CA, U.S.A.) migration is one of the major long-term complications of laparoscopic adjustable silicone gastric banding. The causes, clinical signs, timing, and overall incidence of band entrapment have not been prospectively investigated in a large series. The purpose of this study was to assess prospectively the incidence of Lap-Band intragastric migration and to establish the safety and effectiveness of minimally invasive band removal. Between January 1996 and June 2000, 148 consecutive patients enrolled in a multidisciplinary bariatric program underwent laparoscopic adjustable silicone gastric banding. In the follow-up treatment, gastrointestinal endoscopy was performed routinely. One hundred twenty-three patients with a minimum follow-up period of 12 months were entered into the study group. Eleven (9.2%) patients had long-term major complications. Intragastric band migration was observed in nine (7.5%) patients. The diagnosis was established by routine endoscopy between 10 and 41 months after surgery. Five erosions occurred in the first 30 cases (learning curve period). In six patients, the band was removed by an intragastric endoscopic-assisted approach avoiding laparotomy. The remaining three patients are under endoscopic surveillance. The results of this study show that routine upper gastrointestinal endoscopy can discover asymptomatic band migrations early. Band erosion did not require emergency treatment and can be removed safely by a minimally invasive approach.

Background: The majority of patients with cystic fibrosis today reach adulthood. During adolescence, however, many ask themselves questions regarding their possible future realisation., Aims: The aim of this study, which was performed using the Rorschach test, was to identify areas of particular problems in a group of CF adolescents monitored by the Pneumology Division of Regina Margherita Children's Hospital in Turin: 26 subjects aged between 14 and 18, including 11 females and 15 males., Methods: The analysis of the test was based on the use of thought, interior resources, instincts and interpersonal relations. The type of intimate resonance was also taken into account and, lastly, a study of the contents was performed using a self-representation grid., Results: The results obtained show a dishomogeneous profile of the development and quality of intellectual processes faced with the intensity of anxiety, mainly loss anxiety, linked to the disease, even if unrelated to its severity. The integration of emotive and instinctual aspects is difficult: mental development towards adult life appears to be impeded by the predominance of regressive modalities., Conclusions: On the basis of the study performed, it is possible to hypothesise the need for psychological help aimed at achieving a more evolved psychic organisation, possible as part of an overall management programme by the medical and nursing team.

The Ehlers-Danlos syndrome, type IV, i.e. the arterial and ecchymotic variety, has a severe prognosis and may represent a threat to life in that it predisposes to spontaneous rupture of the intestine and large vessels. The authors report a case in which spontaneous rupture of the colon and thoracic aorta occurred in short succession. Description of the syndrome and its many variants is preceded by a brief explanatory note on the formation and composition of collagen and its different types. The authors stress the important surgical implications of the syndrome the special risks deriving from elective surgery. Serious consequences may also derive from pregnancy trauma and from acts such as arteriography, endotracheal intubation, endoscopy and other invasive procedures. After examining the cases reported in literature (Sacks, Barabas, Beighton Sykes), they point out that, contrary to what is generally believed, the syndrome is not rare and cases, sporadic or familial, of recurrent episodes of spontaneous rupture of the intestine and large vessels or peripheral arteries are frequent. The authors come to the following conclusions: rupture of the aorta may occur spontaneously or after minimal trauma in subjects with EDS type IV and the cases complicated by spontaneous colon perforation would take advantage from definitive colostomy, considering the high incidence of recurrent perforations when intestinal continuity is restored.