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OBJECTIVE. We investigated whether the combination of an angiotensin-converting enzyme inhibitor and an angiotensin II type 1 receptor antagonist offers better control of proteinuria and cardiovascular parameters without causing adverse side effects. METHODS. We enrolled 10 children (mean age: 12.3 [+ or -] 4.06 years) with proteinuria resulting from chronic renal diseases of various causes. The study consisted of 2 phases, 3 months each, for an overall 6-month observation time. During phase 1 (3 months), each child was assigned randomly to treatment with either an angiotensin-converting enzyme inhibitor or an angiotensin II type 1 receptor antagonist alone. During phase 2, each child was advanced to combination therapy with the addition of an angiotensin II type 1 receptor antagonist or an angiotensin-converting enzyme inhibitor, respectively. Renal function tests, echocardiography, and 24-hour ambulatory blood pressure monitoring were performed at the beginning of the study (time 0), at 3 months (time 1), and at 6 months (time 2). RESULTS. At time 2, proteinuria (change: -80.21 [+ or -] 10.75%), interventricular septum index (change: -13.63 [+ or -] 18.64%), posterior wall of the left ventricle index (change: -30.71 [+ or -] 20.32%), and left ventricular mass index (change: -28.33 [+ or -] 24.44%) were reduced significantly, compared with time 0 and time 1. No untoward side effects were detected during the study. CONCLUSIONS. In the short term, the combination of angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists for children with proteinuria of renal origin reduced proteinuria significantly, compared with baseline or either drug alone. Furthermore, echocardiographic studies gave evidence of reduction of left ventricular hypertrophy. Additional studies are needed to evaluate long-term results. KEYWORDS. chronic kidney disease, proteinuria, left ventricular hypertrophy, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonist., Riccardo Lubrano, MD, Francesca Soscia, MD, Marco Elli, MD, Flavia Ventriglia, MD, Claudia Raggi, MD, Elisabetta Travasso, MD, Simona Scateni, MD, Valeria Di Maio, MD, Paolo Versacci, MD, Raffaele Masciangelo, [...]

Objective: To assess computed tomography with volume rendering (CT-VR) as a tool to evaluate parenchymal hyperinflation before and after bronchoscopic lung volume reduction (BLVR) in patients with advanced stage emphysema., Materials and Methods: Between March 2006 and October 2007, we have prospectively studied pre- and postoperatively by spiral multislice CT scan and functional tests seven patients (six male, one female; age range 51-77 years, mean 64) with advanced stage heterogeneous emphysema who underwent BLVR using the Emphasys one-way valves (Emphasys, Redwood City, CA, USA). CT parameters considered were: the volume of the 'target' lobe and of the entire treated lung, the diameters (antero-posterior and cranio-caudal) of the treated hemithorax and the emphysematous parenchyma rate with respect to the normal parenchyma rate of the treated lobe. Lung parenchyma has been classified as emphysematous if the density was in the -1024/-900 Hounsfield units (HU) range and as normal if the density was in the -900/-200 HU range. Preoperative radiological data were compared with postoperative data and plotted against spirometric data observed 1 month after treatment., Results: Overall, 24 valves have been implanted in the 7 patients. Valves have been placed in the right upper lobe in two patients, in the left upper lobe in four and in both the left upper lobe and the right lower lobe in one. Volume reduction as a proportion of the 'target' lobe and of the entire lung has been observed in all patients with significant differences between mean preoperative and postoperative values [p=0.016 (target lobe); p=0.031 (lung)]. Lobar volume reduction ranged between 1.3% and 53.7% of preoperative values. Volume reduction of the entire lung ranged between 3.1% and 16.8%. Thoracic diameters decreased in all patients after treatment with significant mean differences [p=0.007 (antero-posterior); p=0.004 (cranio-caudal)]. FEV1 increased in six of seven patients with significant mean differences (p=0.025). The higher volume reduction rate has been observed in the three patients showing the better FEV1 improvement. Emphysematous lung parenchyma rate decreased postoperatively in six of seven patients with mean differences being not significant (p=0.17)., Conclusions: CT-VR is an excellent tool to confirm the efficacy of BLVR in reducing parenchymal hyperinflation. Functional advantages are proportional to the volume reduction as measured by CT-VR.

The aim of this study was to evaluate the influence of three variables--protease inhibitors, stavudine, and the length of combined therapy--on body habitus changes, metabolic effects and bone mineral density in HIV patients treated with highly active antiretroviral therapy (HAART). The onset of possible cardiovascular involvement was considered. Forty HIV patients (29 men and 11 women, mean age 39.13 +/- 7.82 years, range 28-61 years) treated with HAART for 12-43 months were evaluated for fat, lean, bone tissues, immunohematological and cardiovascular alterations. The differences in fat/lean tissues and bone mineral density were evaluated at dual-energy X-ray absorptiometry (DEXA). Serum lipids and the CD4/CD8 T-cell counts were recorded. ECGs were taken every 6 months; color Doppler echocardiography and color Doppler ultrasounds of the carotid vessels were performed in close chronological sequence with the second DEXA. Statistical analyses included: Student's t-test, Wilcoxon test, and single-multiple regression analysis. Thirteen patients presented with fat loss, 7 fat accumulation, and 20 a combined form of both. The changes in the single body districts showed that the decrease in the limb fat is to be attributed to protease inhibitors, while none of the three variables was responsible for the decrease in the upper limb fat. The trunk weight increase was not significant. The decrease in the lean mass of the upper limbs is to be attributed to protease inhibitors, while none of the three variables was responsible for the increase in the lean mass of the upper and lower limbs. The decrease in bone mineral density was not significant. No treatment-related cardiovascular lesions were observed. In HIV patients treated with HAART for 12-43 months, the decrease in lower limb fat was due to protease inhibitors. Neither osteopenia nor cardiovascular diseases were observed during follow-up.

More than 10 years after its appearance in clinical practice, laparoscopic cholecystectomy can now be considered the standard operation for gallstone disease. However, some aspects of this operation are still debated. The need to perform routine antibiotic prophylaxis in order to reduce the incidence of infectious complications is still a matter of controversy. International guidelines do not recommend its routine use. The evidence for this, however, is rather limited, because there are no randomized trials with a sufficient number of cases to avoid a type II error. The authors, on behalf of the Lap Group Roma, introduce the protocol of a multicenter prospective randomized controlled clinical trial designed to find a definitive answer to this problem.

Purpose: Colorectal cancer (CRC) is one of the major health problems of the Western world and the proportion of elderly patients with CRC is growing. Raltitrexed ('Tomudex'), a specific thymidylate synthase inhibitor, has shown efficacy and manageable toxicity in elderly CRC patients. In this retrospective study, the tolerability of raltitrexed in patients with CRC was examined in relation to age., Patients and Methods: Toxicity parameters, graded according to World Health Organization criteria, were assessed in two patient groups: < 70 and > or = 70 years old. In total, 56% (50 out of 90) of patients treated with raltitrexed (3 mg/m2 as a 15-minute intravenous infusion every 3 weeks) were aged > 70 years (M:F 28:22; Eastern Cooperative Oncology Group performance status 0-1:2 38:12)., Results: Overall, 437 cycles of chemotherapy were administered and grade 3-4 toxicity was reported in < 10% of patients. There were no clinically significant differences between the two age groups, apart from grade 3-4 asthenia, which was reported by 6% and 0% of patients aged > or = 70 and < 70 years, respectively. This was in spite of a significantly lower calculated mean creatinine clearance in patients aged > or = 70 years compared with those patients < 70 years of age., Conclusion: The raltitrexed toxicity profile does not appear to be significantly influenced by age; however caution is recommended in the management of elderly patients, particularly in the presence of impaired renal function.