Objective: Glomerular filtration rate (GFR) measured through 99mtechnetium-diethyltriamine pentacetic acid (99mTc-DTPA) renal scintigraphy (rsGFR) was compared to that estimated (eGFR) from 24-h creatinine clearance (CrCl_24 h) and using both the Cockcroft-Gault (CG) formula and the Modification of Diet in Renal Disease (MDRD) formula. Design and Method: In 200 normoalbuminuric (<30 mg/24 h), normocreatininaemic, non-diabetic, hypertensive patients (HTs) age 55–75 years without a history of coronary or cerebrovascular diseases, the Bland-Altman method was used to assess the agreement between rsGFR and eGFR, separately in subjects with low (<60) and normal (≥60 ml/min/1.73m2) rsGFR. The span between −1.96 and +1.96 standard deviations of mean difference (bias) was calculated and used for this purpose. Results: The Bland-Altman analysis (Figure, panel A) showed that the smallest span between rsGFR and eGFR was evident for ClCr_24 h values (26.8 ml/ min/1.73m2), while higher values were detected with the CG and MDRD formulas (40.60 and 42.4 ml/min/1.73m2, respectively). The same results were observed for low rsGFR (Figure, panel B), where a smaller span was found for ClCr_24 h (21.2 ml/min/1.73m2), while CG and MDRD methods gave greater results (30.4 and 31.8 ml/min/1.73m2 respectively); no differences were found between genders. The degree of agreement for eGFR estimated with the CG and MDRD formulas was wider than that derived from ClCr_24 h, reflecting a greater between-methods variability and a considerable discrepancy of rsGFR values in the former than in the latter. Conclusions: In normocreatininemic HTs, ClCr_24 h measurement should be preferred to estimate GFR, while CG and MDRD formulas are of limited efficacy.

This review describes the therapeutic approach of endocrine arterial hypertension in clinical practice. In mineralocorticoid-related hypertension, adrenalectomy is the treatment of choice for aldosterone-producing adenomas and monolateral primary aldosteronism, whereas pharmacologic blood pressure (BP) control is indicated for the other forms of primary aldosteronism such as bilateral adrenal hyperplasia. Spironolactone is the drug of choice, but intolerable side effects limit its use; amiloride or eplerenone are a valid alternative. If BP remains uncontrolled, angiotensin converting enzyme inhibitors (ACE-I), angiotensin II receptor antagonists (AII-RA) and calcium channel blockers (CCB) may be added. Hypertension accompanying Cushing's syndrome can be approached with surgery, but antihypertensive treatment both pre- and postoperative is required as well. Eplerenone, AII-RA and ACE-I are indicated, while peroxisome proliferator activated receptor upsilon agonists may help for the insulin resistance syndrome. Drugs that suppress steroidogenesis should be used with care because of their serious side effects. Subjects with catecholamine-dependent hypertension due to a neuroendocrine neoplasm need to undergo preoperative alpha-adrenergic blockade with phenoxybenzamine or doxazozine. When adequate alpha-adrenergic blockade is achieved, beta-adrenergic blockade with low dose propranolol may be added. If target BP is not achieved, CCB and/or metyrosine are indicated. Laparoscopic adrenalectomy is the procedure of choice for solitary intra-adrenal neoplasms <8 cm. Acute hypertensive crises that may occur before or during surgery should be treated intravenously with sodium nitroprusside, phentolamine, nicardipine or labetalol. For malignant neoplasms, chemo- and radiopharmaceutical therapy may be considered.

Introduction.Over the last decade the genetic component of the cardiovascular risk (CV) has particularly been evaluated in young adults; on the contrary, only few studies have had elderly population as main target.Aim.The ROVIGO study is aimed at identifying the prevalence and distribution of CV risk factors in the elderly from the general population of Rovigo (see figure), and to clarify if they depend on genetic or environmental modifiable risk factors.

Endocrine arterial hypertension (EAH) a condition in which hormone excess results in clinically significant hypertension is a rare cause of hypertension. However in the last years its prevalence has increased, mostly due to the improvement of diagnostic work-up. In clinical practice, hypertensive subjects with suspicion of EAH currently undergo hormonal screening of the renin-aldosterone and catecholamines and glucocorticoids excess. This paper reviews current understanding for earlier recognition of the main forms of EAH and discusses screening laboratory methods and localization techniques that have enhanced the clinician's ability to make the diagnosis of EAH. Primary aldosteronism (PA) has recently been recognised as the most frequent cause of EAH. The aldosterone to renin ratio (ARR) is a highly recommended screening test for PA. When ARR is increased, confirmatory tests as saline infusion or fludrocortisone suppression are required. Differential diagnosis of PA requires adrenal gland imaging by computed tomography (CT) or magnetic resonance imaging (MRI), biochemical testing of the aldosterone response to posture, and selective adrenal venous sampling to differentiate unilateral aldosterone-producing adenoma from bilateral hyperplasia. Hypertension is frequently found in endogenous Cushing's Syndrome (CS). Twenty-four-hour urinary free cortisol measurement is the gold standard for the diagnosis of CS, but it must be confirmed by the overnight dexamethasone suppression test. CT and MRI are the primary imaging studies to perform, while scintigraphy is a useful confirmatory method. The most specific and sensitive diagnostic test for catecholamine-producing neoplasms is determination of urinary metanephrine levels; the neoplasms can be located by CT, MRI and metaiodo-benzylguanidine scintigraphy.

Introduction: It is known that the metabolic syndrome (MS), i.e. a condition characterised by a cluster of alterations in glucose metabolism, lipid metabolism and blood pressure, is more common in subjects with HIV infection than in HIV negative individuals This has been ascribed to use of anti-retroviral therapy.Methods: To compare the prevalence of MS in HIV patients with that from a sample of a general Italian population.1263 HIV patients aged more than 18 were recruited in 18 centres for Infectious Diseases in Northern and Central Italy.Controls were 2051 subjects aged 25 to 74 years representative of a town in the Milan province.MS was diagnosed by the ATP criteria, i.e. at least 3 out of 5 abnormalities among a fasting glucose (>110 mg/dl), a low HDL cholesterol (< 40 mg/dl) a high plasma triglycerides level (>150 mg/dl) an increased waist circumference 88 cm) and a blood pressure > 130/85 mmHg.Results: Prevalence of MS in HIV group was 20.8% whereas in the control group it was only 15.8% (P<0,05) HIV patients was accounted for by a much more common occurrence of an impaired fasting glucose, increased plasma triglycerides and reduced HDL-cholesterol whereas the blood pressure and abdominal obesity components of MS were similar or lower in HIV patients than in controls.MS prevalence was similar in HIV patients treated with anti-retroviral drugs and in those never treated. Conclusions:The prevalence of MS is greater in HIV patients compared to general population, due to a greater prevalence of lipid and glucose abnormalities.Prevalence of MS and its components is similar in treated and untreated HIV patients.

The relationship between serum uric acid (SUA) and risk of coronary heart disease (CHD) mortality remains controversial, particularly in diabetic subjects. The aim of the present study is to evaluate whether SUA independently predicts CHD mortality in non-insulin-dependent elderly people from the general population and to investigate the interactions between SUA and other risk factors. Five hundred and eighty-one subjects aged ≥65 years with non-insulin-dependent diabetes mellitus were prospectively studied in the frame of the CArdiovascular STudy in the ELderly (CASTEL). Historical and clinical data, blood tests and 12-year fatal events were recorded. SUA as a continuous item was divided into tertiles and, for each tertile, adjusted relative risk (RR) with 95% confidence intervals (CI) was derived from multivariate Cox analysis. CHD mortality was predicted by SUA in a J-shaped manner. Mortality rate was 7.9% (RR 1.28, CI 1.05–1.72), 6.0% (reference tertile) and 12.1% (RR 1.76, CI 1.18–2.27) in the increasing tertiles of SUA, respectively, without any difference between genders. In diabetic elderly subjects, SUA independently predicts the risk of CHD mortality in a J-shaped manner.

The classification of arterial hypertension (HT) to define metabolic syndrome (MS) is unclear in that different cutoffs of blood pressure (BP) have been proposed. We evaluated the categorization of HT most qualified to define MS in relationship with coronary heart disease (CHD) mortality at a population level. A total of 3257 subjects aged ⩾65 years were followed up for 12 years. MS was defined according to the criteria of the National Education Cholesterol Program using three different categories of HT: MS-1 (systolic blood pressure (SBP) ⩾130 and diastolic blood pressure (DBP) ⩾85 mm Hg), MS-2 (SBP ⩾130 or DBP ⩾85 mm Hg) and MS-3 (pulse pressure (PP) ⩾75 mm Hg in men and ⩾80 mm Hg in women). Gender-specific adjusted hazard ratio (HR) with 95% confidence intervals (CI) for CHD mortality was derived from Cox analysis in the three MS groups, both including and excluding antihypertensive treatment. In women with MS untreated for HT, the risk of CHD mortality was always significantly higher than in those without MS, independent of categorization; the HR of MS was 1.73 (CI 1.12–2.67) using MS-1, 1.75 (CI 1.10–2.83) using MS-2 and 2.39 (CI 3.71–1.31) using MS-3. In women with MS treated for HT, the HR of CHD mortality was significantly increased only in the MS-3 group (1.92, CI 1.1–2.88). MS did not predict CHD in men. In conclusion, MS can predict CHD mortality in elderly women with untreated HT but not in those with treated HT; in the latter, PP is the most predictive BP value.

or sexual abuse is an increasingly serious problem in our society. The detrimental effects of childhood abuse have long-term consequences affecting an individual's physical and mental health.',2 Identifying and intervening with child victims of abuse can, however, be very difficult owing to their immature verbal expression, fear of revealing family secrets, or confusion about the meaning of abusive acts. One way to circumvent these obstacles to diagnosing and treating abuse is through child artwork. Children can "safely" ex-

The results of 50 latissimus dorsi myocutaneous flaps are presented. The majority of reconstructions were assessed by the patients as excellent or good. There were few major complications and these were more common in patients having delayed reconstruction.

A patient with Von Hippel disease is described. The Von Hippel syndrome is a genetic disease characterized by a retinal angiomatosis and multiple tumors (renal and pancreatic sites are common). The pheochromocytoma is-on the contrary-very uncommon and the association with 2 pheochromocytomas has probably never been reported. In our case, a double pheochromocytoma (the first in 1973, the second in 1986) was present, in conjunction with a thyroid tumor and with an anomalous renal vein (circumaortic ring). The clinical picture was characterized by a severe hypertension and a fourth stage retinopathy. A correct diagnosis was established only 10 years after the clinical exordium. The thyroidectomy and the ablation of both the pheochromocytomas were necessary.

A genetically determined alteration of the cell membrane sodium metabolism may play a role in the pathogenesis of essential hypertension. The most consistent finding in patients with essential hypertension is an increased red blood cell Li/Na exchange (countertransport). It is genetically determined but it is also associated to potentially confounding variables (body weight, race, age and so on). The present study investigates the relationship between red cell Li/Na countertransport and various potentially confounding variables in a random sample of the population. It shows that this membrane cation transport system is increased in males compared to females and significantly correlated to body mass index in males and to blood pressure, alcohol consumption and, negatively, to urinary calcium excretion in females. Since body weight and alcohol consumption are correlated to blood pressure in several epidemiological studies, it can be hypothesized that they influence blood pressure control through an alteration of the cell membrane sodium transport.

A genetically determined alteration of the cell membrane sodium metabolism may play a role in the pathogenesis of essential hypertension. The most consistent finding in patients with essential hypertension is an increased red blood cell Li/Na exchange (countertransport). It is genetically determined but it is also associated to potentially confounding variables (body weight, race, age and so on). The present study investigates the relationship between red cell Li/Na countertransport and various potentially confounding variables in a random sample of the population. It shows that this membrane cation transport system is increased in males compared to females and significantly correlated to body mass index in males and to blood pressure, alcohol consumption and, negatively, to urinary calcium excretion in females. Since body weight and alcohol consumption are correlated to blood pressure in several epidemiological studies, it can be hypothesized that they influence blood pressure control through an alteration of the cell membrane sodium transport.

An increase in intra-erythrocytic sodium (IENa) content has been proposed as a genetic marker of essential hypertension. Intra-erythrocytic sodium was studied using hypotonic lysis and flame photometry after four washings with isotonic MgCl2 in 240 normotensive subjects (aged 10-45 years) on a free diet with (F+, 121 patients) or without (F-, 119 patients) hypertensive parents, recruited from a random sample of the general population. Systolic blood pressure was significantly higher in males F+ than in males F- (130 +/- 2 versus 125 +/- 2 mmHg, mean +/- s.e.m., P < 0.05), while IENa did not differ. In contrast, intra-erythrocytic potassium content (IEK) was significantly lower and red cell sodium potassium (Na:K) ratio significantly higher in F+ than F-. This might reflect decreased NaK pump activity, or increased membrane permeability to cations which causes increased K leakage. No differences in blood pressure, IENa or IEK showed in female F+ versus F-. It is concluded that IENa is not a genetic marker of hypertension, and that it is probably influenced by exogenous factors. Being associated with differences in blood pressure, the abnormalities of IEK and Na:K ratio might be pathogenetically linked to an early increase in blood pressure.