Abstract The vagus nerve is an important component of the efferent arm of the baroreflex. Blood pressure levels as well as baroreflex control of circulation are significantly different in male and ...female spontaneously hypertensive rats (SHR). We proposed to investigate the morphometric differences between genders using the vagus nerve of SHR. Adult animals (20 weeks old) were anesthetized and had their arterial pressure (AP) and heart rate (HR) recorded by a computerized system. The rats were then systemically perfused with a fixative solution and had their cervical vagi nerves prepared for light microscopy. Proximal and distal segments of the left and right vagi nerves were evaluated for morphometric parameters including fascicle area and diameter, myelinated fiber number, density, area and diameter. Comparisons were made between sides and segments on the same gender as well as between genders. Differences were considered significant when p < 0.05. Male SHR had significantly higher AP and HR. Morphometric data showed no differences between the same levels of both sides and between segments on the same side for male and female rats. In addition, no significant morphometric differences were observed when genders were compared. This is the first description of vagus nerve morphometry in SHR indicating that gender differences in AP and HR cannot be attributed to dissimilarities in vagal innervation of the heart. These data provide a morphological basis for further studies involving functional investigations of the efferent arm of the baroreflex in hypertension.
The objective of the present study was to compare the morphology of the unmyelinated fibers in the aortic depressor nerves (ADN) of spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY). ...In anesthetized rats, the ADN was identified by its spontaneous activity synchronous with the arterial pulses. Thin sections of the proximal and distal segments of the ADN were analyzed by electron microscopy, and a morphometric study of the unmyelinated fibers and Schwann cells was performed. The proximal segments of WKY and SHR ADN contain an average of 335 +/- 68 and 130 +/- 14 unmyelinated fibers, respectively (P < 0.05), and the distal segments contain an average of 337 +/- 46 and 242 +/- 77 unmyelinated fibers, respectively (P < 0.05). The distribution of the diameters of unmyelinated fibers was unimodal for both strains, with the histogram from the SHR significantly shifted to the left. Because the unmyelinated fibers play a role in the tonic inhibition of the medullary vasomotor centers, especially in the presence of hypertension, the morphological differences observed in the ADN from SHR may account, at least in part, for the blunted baroreflex of SHR.
Male Wistar rats were inoculated intraperitoneally with approximately 2 x 10(6) Trypanosoma cruzi Y strain blood forms. On days 7, 50, and 185 after inoculation, the animals were killed, and the ...right cervical vagus nerve was dissected, postfixed in 1% osmium tetroxide, and embedded in epoxy resin (Araldite). Semi-thin transverse sections were stained with 1% toluidine blue, examined by light microscopy, and photographed. An image analysis system was used to measure the area and diameter of each nerve and each fiber visible on the photomicrographs. Inoculated animals killed on days 7 and 185 after inoculation did not present morphologic or morphometric alterations of the vagus nerve. Inoculated animals killed on day 50 after inoculation presented several degrees of structural disorders in the myelin sheaths compared with control animals. The morphometric data demonstrated that the diameter of the myelinated fibers was generally increased in inoculated animals killed on day 50 after inoculation. These results suggest that experimental Chagas' disease in rats causes myelin damage and axonal swelling of the myelinated fibers of the vagus nerve, and that this injury to the vagus nerve may be important for a better understanding of the pathogenic mechanisms of the cardiac and digestive alterations caused by T. cruzi.
Cysticercosis is the most frequent parasitosis of the nervous system and nowadays it is widespread through the world. Despite the development of anticysticercal drugs (praziquantel and albendazole), ...their efficacy is more marked in cases with parenchymal active cysts and they do not prevent complications such as hydrocephalus. Thus, many patients with neurocysticercosis require surgical intervention, generally of palliative nature, but that may occasionally produce a cure. The clinical outcome of 180 patients with cerebral cysticercosis who underwent surgical treatment form 1970 to 1993 was analyzed. Surgical treatment was performed to control increased ICP in 177 patients and due to local compression of cranial nerves or brainstem in five. Some patients had more than one surgical procedure, totalizing 287 interventions. Increased intracranial pressure (ICP) was caused by hydrocephalus in 91%, by intracranial mass lesion (tumoral form) in 6.2% and by pseudotumor cerebri (pseudotumoral form) in 2.8% of the case. Based on the pathophysiological mechanisms of intracranial hypertension identified through conventional CT-scan, ventriculography, cysternotomography, ventriculotomography and MRI, different surgical approaches were indicated. Patients with tumoral form were submitted to direct approach and cyst removal and generally they had benefits from this procedure. Patients with pseudotumoral form whose clinical treatment failure underwent decompressive craniectomies and had a poor outcome (40% of good results). Direct removal of ventricular/cisternal cysts and/or ventriculoatrial/peritoneal shunting (VA/VPS) was performed in patients with hydrocephalus. Removal of free ventricular cysts in patients who had no ependimitis/arachnoiditis generally allowed a good outcome. Patients with adherent cysts and inflammatory process needed a VA/VPS posteriorly and the outcome was not so good. One hundred thirty-two patients were submitted to VA/VPS (109 as the first procedure and 23 after another surgical treatment). The VA/VPS was effective to control increased ICP, despite many complications observed mainly during the two first postoperative years. After this period the surviving patients generally had a better outcome. The patients submitted to cyst removal due to local compression of cranial nerves/brainstem generally had good results. Based on the experience acquired with the management of these patients we present our recent policy for the treatment of patients with neurocisticercosis.
To compare pain relief and motor impairment of 0.25% levobupivacaine with either an equivalent (0.25%) or equipotent (0.4%) concentration of ropivacaine for continuous interscalene block after open ...shoulder surgery.
Seventy-two adult patients scheduled for elective major shoulder surgery received an interscalene injection of mepivacaine 1.5% 30 mL followed by 24 h patient-controlled interscalene analgesia (basal infusion rate: 5 mL h-1; incremental bolus: 2 mL; lockout period: 10 min; maximum boluses per hour: 4) with either 0.25% levobupivacaine (n = 24), 0.25% ropivacaine (n = 24) or 0.4% ropivacaine (n = 24). A blinded observer recorded the evolution of pain relief and recovery of motor block during the first 24 h. Motor function was assessed as the maximum pressure developed while squeezing a sphygmomanometer cuff with the blocked hand. The reduction from preoperative values was considered as an index of motor impairment.
No differences were reported among the three groups in the quality of postoperative analgesia. The number of incremental patient-controlled interscalene analgesia doses, total volume of local anaesthetic infused during the 24-h patient-controlled interscalene analgesia, and number of rescue ketoprofen analgesia were higher in the ropivacaine 0.25% group than in the other two groups (P = 0.0005). The hand strength recovered to >or=90% of baseline values within the first 24 h of infusion in all groups, without differences among the three groups.
When providing patient-controlled interscalene analgesia after open shoulder surgery 0.25% levobupivacaine and 0.4% ropivacaine performed equally in terms of pain relief, motor block and number of patient-controlled boluses required, while patients receiving 0.25% ropivacaine needed significantly more boluses and rescue analgesia to control their pain.
The aim of this study was the evaluation of the impact of service screening programmes on breast cancer mortality in five regions of Italy. We conducted a matched case-control study with four ...controls for each case. Cases were defined as breast cancer deaths occurred not later than 31 December 2002. Controls were sampled from the local municipality list and matched by date of birth. Screening histories were assessed by the local, computerised, screening database and subjects were classified as either invited or not-yet-invited and as either screened or unscreened. There were a total of 1750 breast cancer deaths within the 50 to 74-year-old breast cancer cases and a total of 7000 controls. The logistic conditional estimate of the cumulative odds ratios comparing invited with not-yet-invited women was 0.75 (95% CI: 0.62-0.92). Restricting the analyses to invited women, the odds ratio of screened to never-respondent women corrected for self-selection bias was 0.55 (95% CI: 0.36-0.85). The introduction of breast cancer screening programmes in Italy is associated with a reduction in breast cancer mortality attributable to the additional impact of service screening over and above the background access to mammography.
BackgroundXiapex (active ingredient: collagenase Clostridium histolyticum), is a novel, innovative and expensive drug under observation from the Italian Medicine Agency (AIFA). Its dispensation is ...authorised only in highly specialised hospitals, such as this hospital, where it has been given to patients with Dupuytren disease since 4 December 2014. By law the drug is allowed to be given 3 times on the same palmar fascia for 4 weeks.PurposeTo monitor Xiapex utilisation pattern (drug prescribing pattern, tolerability and efficacy study) over a 10 month period of marketing.Material and methodsFrom the AIFA database the eligibility criteria for Xiapex treatment were obtained:the joint involved in the treatment (metacarpophalangeal (MP) or proximal interphalageal (PIP));degree of contracture (between 20 and 50 for MP; between 15 and 40 for PIP);prior surgical intervention (only aponeurotomy or fasciotomy); andother concomitant disease (diabetes, hypercholesterolaemia, tabagism, alcoholism, epilepsy cirrhosis or HIV).Personal and clinical data of all 24 patients (pz) were available from the doctor records as well as data on tolerability and efficacy of the drug after 4 weeks of treatment.ResultsPatient age ranged from 40 to 90 years. 4 were women and 20 were men.5 pz presented other disease: 2 diabetes, 2 hypercholesterolaemia, 1 tabagism.22 pz had MP contracture as the main issue. In particular, 11 pz had a contracture score of 30, 2 pz a score of 35, 7 pz a score of 40 and 2 pz a score of 50.2 pz were affected by the PIP contracture as the main issue. In particular, 1 pz had a score of 35 and the other a score of 40.Only 2 pz had previous fasciotomy.All 24 pz were treated once and this treatment was sufficient to resolve the Dupuytren’s contracture (specifically the remaining residual delta of muscolar contraction was trascurable).Only minor, modest and short side effects were observed, such as skin rush at the armpit, light skin abrasions and ecchymosis.ConclusionThese preliminary results show that clinically different patients, but within the AIFA criteria, benefit from the treatment with very few side effects in all patients.No conflict of interest.
We present the main results of the 2011-2012 survey of the Italian screening programmes for colorectal cancer carried out by the National centre for screening monitoring (Osservatorio nazionale ...screening, ONS) on behalf of the Ministry of Health. By the end of 2012, 112 programmes were active, of which 11 had been activated during 2012 and 4 during 2011. The national theoretical extension increased from 66% of Italians aged 50-69 years residing in areas covered by organized screening programmes in 2010 to 73.7% in 2012. The majority of programmes employ the fecal immunochemical test (FIT), while some have adopted flexible sigmoidoscopy (FS) once in a lifetime and FIT for non-responders to FS. Overall, about 7,744,000 subjects were invited to undergo FIT, 53.1% of those to be invited within the two years. The adjusted attendance rate was 47.1%and 3,531,937 subjects were screened. Large differences in the attendance rate were observed among regions. Positivity rate of FIT programmes was 5.2% at first screening (range: 1.0-12.4%) and 4.0% at repeat screening (range: 3.4-6.4%). The average attendance rate to total colonoscopy (TC) was 81.2% and in two regions (Molise and Campania) it was lower than 70%. Completion rate for total colonoscopy (TC) was 91%. Among the 1,316,327 subjects attending screening for the first time, the detection rate (DR) per 1,000 screened subjects was 2.0 for invasive cancer and 9.1 ‰ for advanced adenomas (AA, adenomas with a diameter ≥1 cm, with villous/tubulo-villous type or high-grade dysplasia). As expected, the corresponding figures in the 2,215,610 subjects at repeat screening were lower (1.0‰ and 6.8‰ for invasive cancer and AA, respectively). Many programmes reported some difficulties in guaranteeing TC in the appropriate time frame to FIT+ subjects: in 15% of cases the waiting time was longer than two months. Ten programmes in 2011 and eight in 2012 employed FS as the screening test: 24,549 subjects were screened in the two years, with an attendance rate of 24.5%. Overall, 85.9% of FSs were classified as complete. Overall, TC referral rate was 9.8% and the DR per 1,000 screened subjects was 3.0 and 48.2 for invasive cancer and AA, respectively.
BackgroundAntibiotic preventive care in a surgical hospital is very important: the main cause of surgical infections is the endogenous bacteria flora of patients. For this reason, in 2009, a ...multidisciplinary team defined the new guideline (LG) providing: one single shot of cefazolina 2 g, replaced by clindamicyn 600 mg in allergic patients; and the administration of prophylaxis from 30 to 60 min before the incision. The team also identified indicators to monitor the correct prevention of hospital infections: comply with LG, timing respect , and use of hydroalcoholic solution for hand-washing, defined correctly by OMS between 10 to 20 litres for 1,000 days of hospitalisation.PurposeIndicators were monitored to verify the accuracy of prevention measures and on the basis of obtained results, a programme was possible for improving interventions.Material and methodsIn order to verify LG adherence of prophylaxis, antibiotics prescription has been controlled in a sample of 189 medical records. Timing administration registered by the operating theatre programme had been verified and the consumption of hydroalcoholic solution for hand-washing has been controlled according to the pharmacy management programme for 2016.ResultsMedical records indicate an adherence of nearly 100% to LG: in 189 medical records only two resulted in not complying with prophylaxis continuation up to patient discharge. Timing administration was respected only in 65% of cases: 5% received cefazolina after 60 min and the other 30% received it before 30 min. Gel consumption for handwashing was 23 litres gel/100 hospitalisation days.ConclusionAdherence to prophylaxis has been achieved, therefore only periodic monitoring is to be continued. The use of hydroalcoholic solution for hand-washing is slightly higher than the OMS guideline and to make sure that hand-washing is carried out in the correct way, dedicated timers will be mounted on faucets. Timing administration, on the contrary, is still poor, so that is why there will be a meeting with anaesthesiologists in order to decide future strategy.No conflict of interest
Reports on the morphology of the baroreceptor terminal of spontaneously hypertensive rats (SHR) did not demonstrate any difference when compared to the axonal terminal of normotensive rats. Although ...several studies reporting baroreceptor terminal and blood vessel wall morphology have been carried out to better understand the baroreceptor function and resetting to hypertensive levels, there are no reports examining the morphology of the fibers of the aortic depressor nerve (ADN) in hypertensive models. Therefore, the objective of the present study was to investigate the morphological aspects of SHR ADN compared to Wistar–Kyoto (WKY) rats. Before the morphologic study, the nerves were isolated and the pressure–nerve activity curve was determined for each ADN. SHR exhibited an increase in the threshold pressure for baroreceptor activation, a rightward shift in the pressure–nerve activity curve with decreases in slope and maximum activity. Semithin (0.3 to 0.5 μm thick) sections of the proximal (close to the nodose ganglion) and distal (close to the aortic arch) segments of the ADN were analyzed by light microscopy. A morphometric study of the nerve fascicles and myelinated fibers was performed. Comparison between proximal and distal segments of the two strains revealed that the ADN of WKY rats were consistently larger. All morphometric parameters studied in myelinated fibers and their respective axons were smaller in SHR. The area of the myelin sheath was comparatively larger in WKY rats. These data show morphologic differences between the ADN of SHR and WKY rats, which may explain, at least in part, the decreased slope and maximum activity of the pressure–nerve activity curve observed with the baroreceptor resetting in SHR.
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