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INTRODUCTION: Non-Alcoholic Fatty Liver Disease (NAFLD) is related to unhealthy habits, mainly to unfavorable dietary profiles. MTHFR gene encodes MethyleneTetraHydroFolate Reductase, a regulatory enzyme whose polymorphisms are associated with hyperhomocysteine-mia. Among polymorphisms, C677T, a thermolabile form, but not A1298C, thermostable, was associated with fatty liver and insulin resistance. AIM: to investigate if NAFLD, in subjects referred for nutritional assessment and counselling, has any difference of prevalence and severity when associated with isolated MTHFR A1298C polymorphism and hyperhomocysteinemia. PATIENTS AND METHODS: 94 subjects, age 55.65±15.43 years, BMI 27.88±5.17 kg/m², 26 with MTHFR Wild type genotype (1298AA) and 68 with MTHFRA1298C single polymorphism were studied: of them, 35 were homozygous (MTHFR1298CC), 33 were heterozygous (MHTFR 1298AC). Insulin resistance was assessed by HOMA-IR, NAFLD by UltraSound Brigh-Liver-Score (BLS). RESULTS: MTHFR subgroups (wild and A1298C single polymorphism) were not different for age, gender, dietary profile and BMI. In NAFLD, MTHFR 1298AC (heterozygous) vs. homozygous wild geno- type (MTHFR 1298AA) patients had more severe NAFLD (BLS: 1.12±1.14 vs. 0.54±0.76, p < 0.029), greater insulin resistance (HOMA 3.20±2.35 vs. 2.12±1.12; p < 0.036), higher AST and gammaGT. CONCLUSIONS: MTHFR1298AC gene heterozygous polymorphisms can be weakly predictive for NAFLD severity. This mutation occurs frequently in populations with low prevalence of overall mortality and of atherosclerosis-associated disease: it could have maintained and maintain its persistence by an heterozygosis advantage mechanism, within significant adherence to healthy nutritional profiles. Interactions of nutrition, genetics and health are a part of the aging process throughout the life span and a greater consideration to the genetic characteristics of populations and individuals is warranted. [ABSTRACT FROM AUTHOR]

Aim: Although it is commonly believed that a strong causal link exists between psychological stress and hypertension, as well with other factors, such as obesity, just what kind of empirical evidence supports this assumption is still controversial. The aim of the study is to investigate if perceived stress have any interference with intrarenal resistance and hence with mechanisms related to Essential Hypertension (EH) and if Anxiety, Depression, Self efficacy and Illness Perception can account for perceived stress., Patients and Methods: Obesity, insulin resistance (HOMA), Doppler Renal Resistive Index (RRI) and glomerular filtration rate (GFR) are studied along with Psychological Stress Measure (PSM), Illness Perception Questionnaire (IPQ-R), Generalized Self-Efficacy scale (GSE) and Hospital Anxiety and Depression Scale (HADS) in 119 hypertensive patients referred for stable lasting EH, and 150 normal controls. Lower salt/lower calories Mediterranean diet, physical activity increase and smoking withdrawal counseling were provided., Results: By Odds Ratios, higher risk of EH is associated with greater perceived stress, older age, lower GFR, obesity, greater RRI and insulin resistance. By Multiple Linear Regression the most significant variable that accounts for higher RRI are abdominal obesity and arterial pulse pressure; the only significant independent psychological variable that accounts for abdominal obesity are PSM and identity IPQ subscale. Self-Efficacy anxiety and Illness perception subscales (IPQr), accounts significantly for 62.0% of the variance to PSM, with possible effects on RRI and on the pathophysiological hypertension cascade., Conclusion: Worst identity and treatment control perceptions of EH, and a lower self-efficacy are the main psychological factors accounting for a greater stress. Interventions aimed to reduce perceived stress can be warranted in EH.

Aims: The study is aimed at investigating if perceived stress in Stable Atrial Fibrillation (AF) has any gender-associated feature and relationships with lifestyle indicators and education level, and which relationship self efficacy, anxiety and depression and illness perception have, if any., Patients and Methods: 88 consecutive patients referred for stable AF are studied by Psychological Stress Measure (PSM) test, Illness Perception Questionnaire (IPQ-R), Generalized Self-Efficacy scale (GSE) and Hospital Anxiety and Depression Scale (HADS). Mediterranean diet, physical activity increase and smoking withdrawal counseling were provided., Results: AF patients have higher PSM associated with gender (women), older age, anxiety and depression. Higher GSE, greater Adherence to Mediterranean Diet profile and coffee habits (greater coffee users) are associated with a reduced hazard of perceived stress. By multiple linear regression, PSM is explained by Anxiety and IPQr (statistically significant are emotional representation and illness coherence subscales), which account for 92.2% of the variance (p<0.0001)., Conclusion: Our results outline that psychological stress is greater in women in comparison with men. Illness perceptions are important in the context of perceived stress in AF. This effect appears to be modulated by greater self-efficacy and by Adherence to Mediterranean Diet profile, that when higher, are associated with a reduced hazard of perceived stress. We suggest that therapeutic interventions on illness perceptions can be warranted in order to achieve a lower psychological distress in AF patients.

Objective: Pain visual analog scales (VAS) have been validated for clinical use in fibromyalgia (FM) and rheumatoid arthritis (RA) patients. There are potential limitations, however, not only considering their use as a continuous measurement, but also with regard to the influence of personal illness perceptions, habitual physical activity and other life-style features. The aim of the study was to ascertain whether different illness perception, physical activity and clinical and laboratory characteristics can predict the severity of perceived pain assessed by VAS., Materials and Methods: This is an observational comparative study of forty consecutive out-patients, 20 of them with fibromyalgia and 20 with rheumatoid arthritis, treated by medical and physical therapy. Patients were assessed also by Pain VAS, Health Assessment Questionnaire (HAQ) disability index, Ritchie index, Baecke questionnaire for physical activity, Illness Perception Questionnaire (IPQr) and SF36., Results: Pain VAS is explained differently by some of the studied variables: in the total group HAQ and Ritchie index explain 29.8% of the variance; in the RA patients number of joints with pain and Ritchie index explain 52.7% of the variance; in FM patients total SF36 score and IPQr personal control dimension explains 44.7% of the variance. No definite role of anxiety and/or depression was found as predictor of perceived pain and disability., Conclusion: Pain perception and complaint are explained by belief in FM patients: This seems to suggest the need for a more articulated cognitive approach; addressing both diagnostic and therapeutic interventions to anxiety/depression issues is not supported by our results.

Psychological stress has been implicated as a cause of several psychosomatic disorders, but also as a factor that can unfavourably influence many diseases including diabetes mellitus. Measure of psychological stress in diabetes was performed by Psychological Stress Measure (PSM), a validated instrument, designed using 49 items drawn from descriptors generated by focus groups on stress. Clinical and psychological framework was assessed in a cohort of 100 type 2 diabetic patients (30 m, 70 f), aged 66.99 +/- 13.68 years considering disease grade, complications and level of instruction. Three other questionnaires were administered concurrently to all patients: Sickness Impact Profile (SIP), Functional Living Index (FLI) and SF-36 QOL. ANOVA statistical testing and Spearman correlation matrix were used also vs socio-cultural and clinical profile. Gender, obesity, diet compliance, smoking do not affect PSM response. Hypertensive patients and those with family history of diabetes show lower PSM scores, according to a sort of moderator effect on stress of concurrent and/or previous experience with chronic disease. Neuromuscular ailments are more prevalent in women; men vs women experience severe limitations of their working capacities and relational possibilities, with severe discomfort. In the whole, higher scores of PSM (greater stress p < 0.01) and lower scores of FLI (fair well-being perception; p < 0.01) are reciprocally related inside any school instruction level. Despite the great reciprocal association of the PSM vs FLI and SIP, no significant correlation is found between PSM vs SF-36 QOL. Socio-cultural elements interfere, and particularly instruction level quantified as school grades achieved, with the manner of living their disease. Interventions on psychological distress of type 2 diabetes mellitus patients is warranted, specially in the groups with lower levels of instruction which may need an attentive strategy for achieving a satisfactory coping with this disease.

Different clinical features of diabetic patients and type of complications are certainly a critical components of the global individual perception of quality of life (qol); but also personal socio-cultural characteristics interfere concurrently. Qol in diabetes was assessed considering disease grade, complications and level of instruction in a population of 100 diabetic patients (30 m, 70 f), aged 66.99 +/- 13.68 years. Two questionnaires were administered to all patients; Sickness Impact Profile (SIP) and Functional Living Index (FLI). SIP is an index of psycho-social, physical and motor functionality; FLI derives from a scale devised for cancer patients and adapted to diabetic patients. Both were analysed by Spearman correlation test, and assayed vs. sociocultural profile and clinical symptoms. Neuro-muscular ailments were more prevalent in women; men experience severe limitations of working capacities an relational possibilities, with severe discomfort. In the whole, higher scores of SIP (greater disability p: ns) and lower score for FLI (scant well-being perception r = 0.29: p<0.01) are related with lower school instruction level. Global QOL score is related as well with degree of instruction (r = 0.22: p<0.03). So QOL is altered during chronic diseases: however, in diabetes, qol impairment does not seem related with severity, treatment features and complications of diabetes. Socio-cultural elements, and particularly instruction level quantified as school grades achieved, interfere with the manner of living diabetic disease.

Unlabelled: Aim of the study was to ascertain if a common cultural feeling of young people toward health, disease, physician's role and doctor-patient relationship, is present, and if under- and post-graduate students concepts and opinions modify during their stay in a School of Medicine. The study (1999-2001) was performed by anonymous questionnaires with 75 students (m = 28; f = 47) of the State School of Medicine, tested at the 3rd year, and with 73 students (m = 29; f = 44) tested at the 5th year of course; moreover with 71 (m = 30, f = 41) postgraduate residents at the 3rd year of specialty (Internal Medicine, Cardiology and Surgery). A group of 76 (m = 33; f = 43) students of the last year of a high school was also tested as reference group., Results: Interference of medical under- and post-graduate school curricula on thoughts of youngsters toward health, disease, physician's role and doctor-patient relationship appears quite limited. Dissimilar way of thinking of medical vs. non-medical students was confined to some aspects concerning patient's possibility of healing, physician's role, behavior and function in chronic diseases. In the whole, our results suggest a trend, growing with the age of students, toward a more authoritarian and less "participative" approach with the patient: less confident relationship and more conflictual and antagonistic behaviors are widely considered and accepted. A general perspective with the construct of an authoritarian concept of health is superimposed as a net of rules and conditions on feelings' background of youngsters: postgraduate students regard themselves (and are perceived by younger students) as the guardians of an "healthy" system founded on scientific, economical and sociological grounds, as a work pointing to effectiveness, more than as a science with the target of efficacy., Conclusion: Impact of curricular studies of Medicine on youngsters is complex, but seems to modify only some and limited aspects of previously acquired thoughts and feelings on health and disease.

Circulatory effects of parathyroid hormone (PTH) were reported in experimental animal models, also in liver portal system. We devised to study non invasively relationship between plasmatic iPTH and portal blood flow rate in humans. The study was done in a group of healthy post-menopausal women aged 52.0 +/- 5.2 years (range 47-65), not treated with hormone therapy, with different body mass index. Women were studied by echocolor-doppler and by clinical and biochemical assays of common laboratory test and of iPTH, insulin and prolactin (RIA). A positive correlation between iPTH and mean portal flow rate was observed in the overall group. Women with BMI < 25 showed a more marked correlation between these two parameters, not observed in women with BMI > 25, with slight-moderate overweight. In this last group an inverse correlation between blood pressure and iPTH was observed. From these preliminary results, as previously observed in chronic disease, relationship among iPTH, regional flows and nutritional state can be operating also in physiological conditions.

Anaemia commonly occurs in cancer patients on chemotherapy, often necessitating blood transfusion, and, in most recent years, treatment with human recombinant cythropoietin (rHuEPO). However, several extra-hematological effects were reported for EPO, and multi-organ physiological effects on development and repair of tissues are described both on nerves and muscles. Moreover, EPO is presently used in oncological patients with the goal of preventing or limiting anemia secondary to chemotherapy. Ten patients with advanced lung cancer and without neurological impairment assessed by Siegal score and without severe anemia, were studied. Patients (age 56.2 +/- 8.3 years) were random assigned to two groups of 5 patients each: the control group and the EPO treated group. In both groups, at the end of the study, hemoglobin concentration was not different (above 9 mg/dl). In EPO treated group neurological score was 4.00 +/- 1.87, significantly lower (p < 0.004) in comparison with untreated group (score 9.20 +/- 4.32). From these preliminary data we suggest that EPO treatment in cancer patients can exert also a limiting effect on cisplatin peripheral neurotoxicity.

Both overweight and insulin resistance predispose to atherosclerosis and cardiovascular diseases, independently of other risk factors. We studied the relationship between insulin resistance and heart function and dimension in 39 patients with different degrees of obesity. Twenty-six women and 13 men with body mass index (BMI) ranging 26.1-41 kg/m2 (mean +/- SD = 33.9 +/- 3.8), without diabetes, hypertension and heart, liver or kidney diseases were studied. Patients were subdivided into 2 groups, 25 with overweight or grade I obesity (group A) and 14 with severe (grade II or III) obesity (group B). Insulin sensitivity was evaluated by the Insulin Tolerance Test (ITT), performed after an overnight fast and K(ITT) was calculated. Echocardiographic measurements were also assessed. Between the two groups no significant difference was observed for either K(ITT) (group A, K(ITT) = 5.47 +/- 1.30; group B, K(ITT) = 4.57 +/- 1.53) or the ejection fraction (EF%) (group A, 71.40 +/- 6.63; group B, 69.86 +/- 7.43). No correlation was observed between BMI and both the EF% and other echocardiographic measurements. In patients with mild obesity (group A) a significant negative correlation between EF% and KITT (r = -0.62,p < 0.001) was observed. In mild obesity, therefore, cardiac function changes occur in relation to the level of insulin resistance but these changes are not related to mass and/or volume changes. The cause(s) of this relationship is not clear, but most likely involves metabolic or endocrine factors. The increased EF% in moderately obese patients that are insulin-resistant may provide an initial compensatory mechanism but may also contribute to a late cardiac damage.

Left ventricular function is impaired in long-term maintenance dialysis as a consequence of several inter-related conditions. Aim of the study was to assess if different degree of malnutrition can affect diastolic and systolic function of dialysis patients. Bio-electrical whole-body multifrequency impedance analysis (BIA) allows a dynamic assessment of body composition according to a multi-compartment model. This allows an assessment of lean (FFM) and fat mass (FAT), metabolically active cell mass (BCM) and a BIA Nutritional Index (NI). We studied 73 patients (53 M, 20 F), aged 54.41 +/- 3.1 yrs, on maintenance bicarbonate dialysis since 57.3 +/- 61.8 mths, by BIA, performed before and after a dialysis. I-PTH and serum albumin are correlated (r = -0.55, p < 0.001); the same trend is shown by I-PTH vs fat free mass (r = -0.47, p < 0.001) and vs NI (r = -0.51, p < 0.001). Ejection fraction (EF) is correlated with age (r = -0.50, p < 0.001) and with I-PTH (r = -0.59, p < 0.001). Moreover, albumin and EF are closely related (r = 0.36, p < 0.01), as well as EF vs FFM (r = 0.47, p < 0.001), and EF vs NI (r = 0.37, p < 0.01). A/E ratio, assumed as index of left ventricular diastolic function, shows a correlation vs albumin (r = -0.33, p < 0.01), BCM (r = -0.34, p < 0.01) and NI (r = -0.40, p < 0.01), but not with I-PTH. Malnutrition, defined both by BIA measurements and lower serum albumin, could exert unfavourable effects on left ventricular systolic and diastolic function of patients on long-term haemodialysis, even independently by hyperparathyroidism.

Psychophysiological relationship in menopausal women was explored by the comparison of stress level and resistance to stress and related symptoms: socio-economic and cultural variables and willingness to participate into a specific therapeutic program were taken into account. One hundred women, aged 44-59 years (54.2 +/- 5.64), that consecutively were referred to an out-patient menopausal Clinic, were studied by a questionnaire that evaluates quality of life (qol) derived and adapted from the Sickness Impact Profile and the Functional Living Test; moreover the test MSP (psychological stress measurement), translated from the original and adapted to Italy, was used. Psychological complaints of women examined are minimal: adaptation tests are substantially normal, and stress index measurements are even lower in comparison with a gender and age matched population group. Our results suggest that after a short period of psychological tension at the onset of climaterium, women acquire a positive, stable status, well different from stereotypes and prejudices around psychological disturbance associated with menopause. Minimal relevance of perceived disturbance seems the reason that limits the women's need and request for a specific therapy. Menopausal depression seems more related to life changes than to hormonal alterations. Reduced physical fitness, increased risk of parental death, difficulty to cope with new roles, apart the care of adult sons or daughters. A critical point is socio-economic level and the possibility to maintain a satisfying work. Contextual conditions, and specially degree of instruction, type of role change inside the family and number of sons, appears the most evident and relevant variables that mediate psychophysical conditions and perceived quality of life.

Secondary hyperparathyroidism is a frequent condition of dialysis patients. Endocrine derangements, with disturbance of calcium metabolism are complex, involving bone, heart (left ventricular hypertrophy-dilatation), bone marrow (anemia and erythropoietin resistance), muscle (increase of body fat mass) and insulin resistance. Aim of the study was to assess how these conditions are inter-correlated in the same patients. 45 patients (m 20, f 25; years 61.8 +/- 11.6) in maintenance bicarbonate three-weekly hemodialysis since > 3 years were studied. Cardiac function was assessed by echocardiography (EF%: left ventricular ejection fraction), which showed an inverse correlation both with parathormone (iPTH vs EF%: r = -0.64; p < 0.001) and with erythropoietin (rHu-EPO vs EF%: r = -0.62; p < 0.001). This suggests the possibility of a multi-endocrine resistance in dialysis patients with chronic renal failure, secondary to the degree of malnutrition. Lower lean mass is correlated with hyperparathyroidism (iPTH vs fat mass%: r = 0.37; p < 0.01), with lower left ventricular systolic function (EF% vs fat mass%: r = -0.41; p < 0.005) and with rHu-EPO resistance. Moreover, patients with higher iPTH show a hypercatabolic disposition, assessed as protein catabolic rate (PCR/kg vs iPTH r = 0.54; p < 0.001). This pattern can be a consequence of chronic renal failure, but bio-compatibility of materials can be involved as well.

Introduction: Hemodialysis has a major influence on the quality of life of chronic renal failure patients. Great attention is currently paid to the development of supporting programmes for this patient group. Aim of this study was to evaluate the quality of life in maintenance dialysis and to research the influence of various factors related to treatment and ESRD on quality of life, taking into account also the level of school instruction., Patients and Methods: Reduced functional abilities, as measured by the Sickness Impact Profile (SIP), and Functional Living Test (FLT), derived by Karnofsky Activity Scale were assessed; Hospital Anxiety and Depression Scale (HAD) and semistructured interviews, including a clinical grading of symptoms were considered vs. age, duration of dialysis, level of school instruction. The study was performed with 40 hemodialysis patients, aged 57.4 +/- 14.9 years (range 22-79), treated since at least three years., Results: Significant (P < 0.05) independent correlates with higher SIP scores (greater disability) and Functional Living Test were lower educational level, and the score of Hospital Anxiety and Depression Scale (HAD). No correlation was found for any of the three scales vs. age and vs. dialytic age; no gender difference was observed., Discussion: A greater care in considering Quality of Life questionnaires is warranted, especially for the severe interference of instruction level of patients on results. QALY (Quality Adjusted Life Years), used as a tool for decision-making in clinical and political subsets, can include critical bias that invalidate conclusion.

Background: Hemodialysis patients are a clinical circulatory model whose main feature is discontinuous fluid removal. Extracorporeal treatment in chronic renal failure exerts blood-volume and circulatory changes with effects on post-dialysis blood pressure (BP). We investigated if pre-dialysis body fluid disposition and body composition, assessed as lean and fat mass, have different relationship with blood pressure., Methods: Bio-electrical whole-body multifrequency impedance analysis (BIA) enables dynamic assessment of body composition according to a multi-compartment model: extracellular (ECW) and total body water (TBW), lean (FFM) and fat (FAT) mass. We studied 73 patients (53 males, 20 females), mean age 54.4 +/- 13.1 years, on maintenance bicarbonate dialysis for 57.3 +/- 61.8 months. BIA was performed at the start and at the end of three consecutive dialysis sessions; blood pressure was monitored non-invasively throughout dialysis. Twenty-one patients (HP) were hypertensive (systolic BP 183.63 +/- 26.88 mmHg) and on pharmacological treatment, while 52 patients (NP) were normotensive (systolic BP 131.68 +/- 12.63 mmHg)., Results: Pre-dialysis assessment of blood pressure (BP) and body compartment in HP showed inverse relationships between systolic BP and percentage of total body water (r = -057, p < 0.001) and between BP vs lean mass/fat mass ratio (r = -0.68, p < 0.001). A high positive correlation was observed between systolic BP and percentage of fat mass (r = 0.73, p < 0.001). At the end of dialysis session, a strong relationship was observed between systolic BP and extracellular water (r = 0.77, p < 0.001). BP changes with dialysis do not show any special correlation with body compartment changes. No significant or overly weak correlations were observed in normotensive patients., Conclusions: Arterial hypertension of maintenance hemodialysis patients shows a strong relationship with the percentage of body fat and with FFM/FAT ratio, i.e. with the adiposity of diseased malnourished patients. Moreover, as suggested by the relationship between ECW and BP, present only at the end of dialysis, expansion of the extracellular water compartment or in other words, the degree of adequacy of water filtration during dialysis, seems to be an important condition in determining post-dialysis BP levels in hypertensive patients. The increase in BP during the interdialysis period is not closely interrelated with the degree of body hydration, but there is strong evidence that it is connected with the effects of malnutrition, including the increase in body lipids. This condition is multifactorial and can be a consequence of nutritional behavior, as well as of kidney disease and dialysis itself, with metabolic derangement also associated with protein and I-carnitine deficiency.

Nifedipine is a Ca-antagonist drug that reduces contractility of vascular smooth muscle, and is used in the treatment of arterial hypertension and of stable and vasospastic angina. Aim of this study is to evaluate long-term effect of nifedipine on distribution of body fluid compartment, assessed by BIA (Bio-Impedance Analysis), and on cardiac function, in hypertensive patients on dialysis. Two groups of hypertensive patients were compared: a) a first group of nine patients (5 Male, 4 Female; age 62.67 +/- 10.39) treated with nifedipine (30 mg/day) for one year; b) a control group of sixteen dialysis patients (9 Male, 7 Female; age 56.31 +/- 14.44), previously hypertensive, with normal blood pressure without anti-hypertensive drugs for three months or more. By BIA, extracellular water percentage (ECW%) is higher in nifedipine-treated patients (p < 0.001) in comparison with the control group before dialysis; no other difference is present. The intradialytical variations (before dialysis vs. the end of dialysis) of body fluid compartments are a significant decrease of total body water % (52.33 +/- 2.89 vs. 48.72 +/- 3.35, p < 0.001), ECW% (40.97 +/- 2.2 vs. 37.56 +/- 3.47, p < 0.005), Left Ventricular End-Diastolic Volume (81.1 +/- 14.6 vs. 63.4 +/- 21.66 ml/m2, p < 0.003), Cardiac Output (3.35 +/- 0.71 vs. 2.51 +/- 0.76 l/min/m2, p < 0.04) and Stroke Volume (45.76 +/- 10.21 vs. 34.34 +/- 9.98 ml/m2, p < 0.02) in nifedipine-treated patients. Our findings suggest that nifedipine induces intermittent and prolonged expansion of extra-cellular volume. This condition, in patients otherwise without clinical and echocardiographic signs of heart failure, can be potentially detrimental for cardiac function on long-term nifedipine treatment.

Purpose: To evaluate the effect of long-term levocarnitine supplementation on nutritional state of patients in maintenance dialysis., Patients and Methods: We studied by multifrequency-BIA (bioelectric impedance analysis) two groups of patients in maintenance bicarbonate hemodialysis for at least 4 years, comparable with respect to gender and age, and without liver disease, diabetes and malignancy. One group (25 patients) was treated with levocarnitine (1g/die) for three years or more; the control group (35 patients) never received this agent., Results: Long-term levocarnitine supplementation was associated with higher serum levels of total protein and albumin in comparison to the control group. These effects were not associated with an increase in body fat mass and/or in total body water content, which are potentially detrimental conditions, especially considering the reported frequent association with circulatory and blood pressure alterations., Conclusions: Levocarnitine is able to improve the nutritional state, and this is associated with higher protein catabolism rate, i.e. with a higher protein intake, without detrimental effects on dialysis efficacy and adequacy.

Hyperparathyroidism of hemodialysis patients is associated with osteo-dystrophy, impairment of cardiac function, of peripheral nerve conduction, of response to r-HuEPO and with decrease of lean body mass. Primary hyperparathyroidism of post-menopausal women is associated with increased fat mass (FM). The study investigated if gender varies relationship between i-PTH, and body composition, assessed by multifrequency bio-electrical impedance analysis (BIA), cardiac function, assessed by echocardiography, and anemia, in long-term hemodialysis patients. Seventy patients on long-term bicarbonate dialysis, 34 male and 36 post-menopausal female, were studied. i-PTH RIA, multifrequency BIA and Kt/V were assessed at three months intervals. i-PTH (345.88 +/- 199.58 vs. 224.26 +/- 161.62 pg/ml, p < 0.01) and FM% (39.13 +/- 10.42 vs. 30.95 +/- 5.88, p < 0.001) were both significantly higher in women vs men; BMI was not significantly different. In the total group of patients (r = 0.572, p < 0.001) and in women (r = 0.68, p < 0.001) a positive correlation was found between i-PTH and FM%, and reciprocally an inverse negative correlation with free fat mass (FFM) was observed. No significant relationship was observed in men. Decrease of blood pressure measurements and increase of left ventricular Ejection Fraction, in the comparison of beginning and end of three dialysis sessions, were significantly greater in women. Reduced FFM of women on dialysis could have also some relationship with a more close long-term adherence to dietary protein restriction. Hyperparathyroidism in chronic renal failure patients could share liability of bone structural abnormalities, cardiac function impairment, excitable tissue disease, and anemia. However, malnutrition, and its consequent relative decrease of lean mass, resulting from kidney disease and, possibly, from nutritional behavioral modifications, could be responsible of the multi-organ involvement of hyperparathyroidism in end-stage renal disease.

Circulatory adaptation to hemodialysis (HD) depends on several inter-related factors, due to the particular patient and to technical procedures. The cardiac effects of nutritional status and the improvement that erythropoietin (r-HuEPO) treatment, through the reduction of anemia, can determine, were reported; r-HuEPO requirements are quite different, in different patients, while achieving similar haemoglobin end-point. Thirty-four patients on r-HuEPO and 11 patients not treated, all in hemodialysis, were studied by echocardiography at beginning and at the end of 3 consecutive dialysis sessions. Ejection fraction increased with hemodialysis in all patients of the control group. A slight and not significant decrease of ejection fraction was observed, as average, in the r-HuEPO treated patients. But, more in detail, 20 patients on r-HuEPO showed a worsening of systolic function with hemodialysis; in the other 14 patients on r-HuEPO, as in not treated control patients, systolic function improved. A significant difference between the two sub-groups on r-HuEPO was the higher drug dose requirement, associated with a slightly lower haemoglobin concentration, both observed in patients with decreased ejection fraction after hemodialysis. Moreover, a close relationship between higher r-HuEPO requirements and worsening of systolic function was observed. This trend is not associated with adequacy of dialysis and malnutrition. Patients with higher r-HuEPO requirement share a worse cardiac adaptation to hemodialysis and slightly lower haemoglobin levels.

Hepatic encephalopathy in liver cirrhosis is due to several factors, including amino acid imbalance and hyperammonemia. Lactitol [correction of lactilol], a non adsorbable disaccharide, improves hepatic encephalopathy increasing bowel movements, modifying colonic bacteria and pH, and reducing blood ammonium. Ten patients with liver cirrhosis and longstanding stable hepatic encephalopathy were treated, after a period of drugs wash-out, with lactitol. A significant improvement of hepatic encephalopathy was observed, with a significant decrease of blood ammonium, related with the increase of stool frequency/day. Atrial natriuretic peptide decreased as well. Moreover, an increase of the ratio of plasma aliphatic amino acids (valine, leucine and isoleucine)/aromatic amino acid (tyrosine and phenylalanine) was observed. Lactitol is an effective drug in the treatment of chronic hepatic encephalopathy; its mechanism of action involves not only a decrease of blood ammonium but also modifications of the degree of plasma amino acid imbalance, and fluid and circulatory adjustments.

Aim of the study was to assess possible differences in ANP levels between patients with congestive heart failure (CHF) with and without chronic atrial fibrillation (AF). We studied 12 patients with chronic AF and 17 patients with sinus rhythm (SR), (m 16, f 13, years 67.7 +/- 8.6), with CHF, not hypertensive, without valvular or congenital heart disease, NYHA class II-III, by ANP RIA and echocardiography. Left atrial (LA/m2) dimensions were significantly higher in patients with AF, and ANP was also more increased in AF. Significant linear correlations between heart rate and ANP, ANP and LV shortening fraction and ANP and A/E ratio, assessed by Doppler trans-mitral flow, were observed in SR but not in AF patients. A significant correlation between ANP and left ventricular mass g/m2 was observed only in AF. Higher ANP levels seem associated with left ventricular enlargement, assessed as left ventricular mass, in AF patients; in SR patients, higher ANP levels are associated with depressed systolic function and with decreased left ventricular compliance. Rate dependent ANP incretion seems blunted in chronic AF; neurogenic heart rate control and/or coordinated atrial systoles may be ANP modulators in sinus rhythm CHF.

20 patients (18 m., 2 f., age 64.8 +/- 6.3 years), with chronic pulmonary heart disease (CPHD) secondary to chronic obstructive pulmonary disease and/or arterial hypertension were studied in comparison with a control group of subjects, age and sex matched, with normal respiratory function tests and without heart disease. CPHD patients did not show any difference of left ventricle (LV) systolic function, assessed by echocardiography, in comparison with the control group. However, among CPHD patients, significant correlations were found between lower arterial pH and cardiac output/m2 and between spirometric tests of bronchial obstruction and echocardiographic parameters of LV function. These results confirm that LV function in CPHD is maintained if other pathologic conditions are absent. On the other hand, correlations between echocardiography and spirometry and blood gas analysis strengthen the functional interdependence concept between left and right heart chambers.

Negative U wave is usually observed in ischemic heart disease, left ventricular hypertrophy and in chronic cor pulmonale, sometimes in association with electrolytic imbalance or toxic effects of drugs. We assessed by ECG and echocardiography 559 patients with longstanding arterial hypertension. Negative U wave was significantly more frequent in patients with increased left ventricular mass and/or with congestive heart failure, particularly in the middle-age hypertension group. Negative U wave appears to be an ECG sign closely associated with the anatomical evolution toward hypertensive heart disease with hypertrophy and/or congestive heart failure.

We describe a patient with congenital left ventricular diverticulum as an isolated lesion. The patient was asymptomatic until adult life and the diagnosis was apparent on cross-sectional echocardiography. The finding was confirmed by cardiac catheterisation.

Gilbert's syndrome is a frequent clinical condition with indirect hyperbilirubinemia, with controversial pathogenesis, nosography, and diagnostic criteria. Reliability of diagnostic test (caloric intake restriction and phenobarbital induction), as well as bilirubin modifications after physical exercise, were assessed in 7 patients with the disease. Phenobarbital induction appears to be the most suitable and reliable test for clinical non-invasive diagnosis of Gilbert's syndrome.

EKG is not considered a sensitive procedure for diagnosis of chronic pulmonary heart disease (CPHD). We performed a correlative study between EKG signs and spirometry in chronic obstructive pulmonary disease (COPD). Fifty-six consecutive in-patients (M 52, F 4, age 59.1 +/- 13.1 yrs) with COPD and echocardiographic/roentgenologic signs of right ventricular enlargement were studied. An EKG score system (0-6) was developed considering: 1) AQRS greater than or equal to 90 degrees; 2) P waves greater than or equal to 2.5 mm; 3) R wave V1 greater than or equal to 7 mm or R/S V1 greater than or equal to 1; 4) R/S V5 less than or equal to 1; 5) RV strain pattern; 6) RBBB. Significant (p less than 0.01) linear correlations were observed between: a) AQRS vs FEV1 (r = -0.59); b) AQRS vs FEV1/FVC% (r = -0.61); c) R/S V5 vs FEV1, (r = +0.38); d) EKG score vs FEV1 (r = -0.42); e) EKG score vs FEV1/FVC% (r = -0.40). Significant relationship between EKG score and spirometry suggests that this criterium can be useful for a more reliable ecg diagnosis of CPHD.