[Show abstract][Hide abstract] ABSTRACT: Little is known about the potential progression of hypertensive patients towards isolated systolic hypertension (ISH) and about the phenotypes associated with the development of this condition. Aim of this study was to detect predictors of evolution towards ISH in patients with initial systolic-diastolic hypertension. We selected 7801 hypertensive patients free of prevalent cardiovascular (CV) diseases or severe chronic kidney disease and with at least 6-month follow-up from the Campania Salute Network. During 55±44 months of follow-up, incidence of ISH was 21%. Patients with ISH at the follow-up were significantly older (P<0.0001), had longer duration of hypertension, higher prevalence of diabetes and were more likely to be women (all P<0.0001). They exhibited higher baseline left ventricular mass index (LVMi), arterial stiffness (pulse pressure/stroke index), relative wall thickness (RWT) and carotid intima-media thickness (IMT; all P<0.001). Independent predictors of incident ISH were older age (odds ratio (OR)=1.14/5 years), female gender (OR=1.30), higher baseline systolic blood pressure (OR=1.03/5 mm Hg), lower diastolic blood pressure (OR=0.89/5 mm Hg), longer duration of hypertension (OR=1.08/5 months), higher LVMi (OR=1.02/5 g m(-2.7)), arterial stiffness (OR=2.01), RWT (OR=1.02), IMT (OR=1.19 mm(-1); all P<0.0001), independently of antihypertensive treatment, obesity, diabetes and fasting glucose (P>0.05). Our findings suggest that ISH is a sign of aggravation of the atherosclerotic disease already evident by the target organ damage. Great efforts should be paid to prevent this evolution and prompt aggressive therapy for arterial hypertension should be issued before the onset of target organ damage, to reduce global CV risk.Journal of Human Hypertension advance online publication, 10 September 2015; doi:10.1038/jhh.2015.91.
Journal of human hypertension 09/2015; DOI:10.1038/jhh.2015.91 · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and aims:
The ESC/ESH guidelines for arterial hypertension recommend using statins for patients with high cardiovascular (CV) risk for both secondary and primary prevention. A recent meta-analysis, combining previous studies on statins, concluded that they are associated with a 9% increased risk of incident type 2 diabetes mellitus (DM). There is no information on whether statins increase incidence of DM in primary prevention.
Method and results:
We evaluated risk of incident DM in relation to statin prescription in 4750 hypertensive, non-diabetic outpatients (age 58.57 ± 9.0 yrs, 42.3% women), from the CampaniaSalute Network, without chronic kidney disease more than grade 3, free of prevalent CV disease and with at least 12 months of follow-up. DM was defined according to ADA criteria. At the end of follow-up period (55.78 ± 42.5 months), 676 patients (14%) were on statins. These patients were older (62.54 ± 7.3 vs 57.91 ± 9.1 yrs; p < 0.0001), more often female (49% vs 41.2%; p = 0.0001), with higher initial total cholesterol (217.93 ± 44.3 vs 205.29 ± 36.6 mg/dl), non-HDL cholesterol (167.16 ± 44.5 vs 155.18 ± 36.7 mg/dl) and triglycerides (150.69 ± 85.2 vs 130.98 ± 72.0 mg/dl; all p < 0.0001) than patients no taking statins, without other differences in clinical and laboratory characteristics. At the end of follow-up, prevalence of DM was 18.1% among patients on statins and 7.2% among those without lipid-lowering therapy (p < 0.0001). However, incident DM was 10.2% in patients on statins and 8.7% in those free of statin therapy (NS).
In real-life outpatient environment, statin prescription for primary prevention is not associated with increased risk of incident DM.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND AND AIMS: Metabolic syndrome (MetS) is a complex condition characterized by different phenotypes, according to the combinations of risk factors and is associated with cardiovascular abnormalities. Whether control of MetS components by treatment produces improvement in the associated cardiovascular abnormalities is unknown. We investigated whether partial control of components of MetS was associated with less echocardiographic abnormalities than the complete presentation of MetS based on measured components. METHODS AND RESULTS: We evaluated markers of echocardiographic preclinical cardiovascular disease in MetS (ATP III) defined by measured components or by history of treatment, in 1421 African-American and 1195 Caucasian non-diabetic HyperGEN participants, without prevalent cardiovascular disease or serum creatinine >2 mg/dL. Of 2616 subjects, 512 subjects had MetS by measured components and 328 by history. Hypertension was found in 16% of participants without MetS, 6% of those with MetS by history and 42% of those with MetS by measured components. Obesity and central fat distribution had similar prevalence in both MetS groups (both p < 0.0001 vs. No-MetS). Blood pressure was similar in MetS by history and No-MetS, and lower than in MetS by measured components (p < 0.0001). LV mass and midwall shortening, left atrial (LA) dimension and LA systolic force were similarly abnormal in both MetS groups (all p < 0.0001 vs. No-MetS) without difference between them. CONCLUSIONS: There is a little impact of control by treatment of single components of MetS (namely hypertension) on echocardiographic abnormalities. Lower blood pressure in participants with MetS by history was not associated with substantially reduced alterations in cardiac geometry and function.
[Show abstract][Hide abstract] ABSTRACT: Objective: Recent studies indicate an association of serum phosphate levels with blood pressure in hypertensive patients. A growing body of evidence suggests that white coat hypertension (WCH) is associated with target organ damage. Furthermore, metabolic syndrome (MS) and non-dipping pattern are also associated with increased cardiovascular risk. The purpose of this study was to explore the nocturnal blood pressure fall in WCH patients according to their serum phosphate, calcium levels and MS components. Design and Methods: The study comprised 2600 patients with WCH who attended our outpatient clinics. All patients underwent repeated office blood pressure measurements, 24-h ambulatory blood pressure monitoring, full clinical and laboratory evaluation. The diagnosis of MS was made according to the Adult Treatment Panel III criteria. Dipping pattern was defined as ‘dippers’ with nocturnal systolic blood pressure (NSBP) fall greater than or equal to 10% but less than 20%,‘non-dippers’ with NSBP fall greater than or equal to 0% but less than 10%, ‘extreme dippers’ with NSBP fall greater than or equal to 20%, and ‘reverse dippers’ with NSBP increase. Results: ‘Extreme dippers’ were 413, ‘dippers’ 1337, ‘non-dippers’ 734 and ‘reverse dippers’ 116. ‘Reverse dippers’ presented with significantly lower levels of serum phosphate, while ‘extreme dippers’ had significantly higher levels (3.39 ± 3.29 vs 3.58 ± 3.52 mg/dl, p < 0.0001). Grouping the patients according to the number of MS components, the main observation was the inverse relationship of serum phosphate to MS components (3.53 ± 0.36 to 3.50 ± 0.38 to 3.49 ± 0.38 to 3.44 ± 0.36 to 3.35 ± 0.31 mg/dl, p = 0.003). Conclusions: WCH patients with low phosphate levels appear to have impaired metabolic profile and higher incidence of non dipping profile. This observation may be important for the stratification of cardiovascular risk in WCH patients.
Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000378879.35061.d1 · 4.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Hypertension and renal dysfunction are associated with increased arterial stiffness. Arterial stiffness is a marker of cardiovascular disease and predictor of cardiovascular risk. We assessed the relationship between renal function and arterial stiffness in never-treated hypertensives. Design and Method: We enrolled 388 consecutive essential hypertensives (mean age 52 ± 12 years), who had no established cardiovascular disease. Arterial elastic properties were evaluated with carotid-femoral pulse wave velocity (PWV). Renal function was evaluated with blood creatinine and estimated glomerular filtration rate, measured by the simplified Modification of Diet in Renal Disease (MDRD) formula and the Cockcroft-Gault formula. Results: In multivariable regression analysis PWV significantly correlated with blood creatinine levels (p < 0.05, adjusted R2 of model = 0.224) and estimated GFR by the Cockroft-Gault formula (p = 0.05, adjusted R2 of model = 0.222), as well as by the MDRD formula (p < 0.05, adjusted R2 of model = 0.223). (Figure) The abovementioned correlations were independent of age, sex, body-mass index and mean blood pressure. Conclusions: This is the first study in never-treated hypertensives that shows a weak but significant relationship between the degree of GFR loss and arterial stiffness, even in individuals with GFR values within the normal renal function range.
Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000379479.30327.3f · 4.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We reported the use of the mucosal layer of preputial skin to give extra length to penile flaps on vaginal introitus and labia minora reconstruction in children with congenital adrenal hyperplasia.
Since November 1999, 14 patients (average age 16 months, range 6 months-4 years) have undergone early one-stage reconstruction of external genitalia. All patients were classified according to Prader's classification (from III to V degree) with clitoral size of 3 +/- 1.5 cm. The perineal sagittal approach is followed by careful dissection and partial mobilisation of the urogenital sinus. Subcutaneous reduction clitoroplasty has been performed. The mucosal layer of the prepuce, developed as an extended flap on the end of the phallic shaft skin used for labia minora, is ideally placed for reconstruction of the vestibulae and distal vagina.
The vagina was calibrated, the main vaginal calibre was 10 Hegar (range 6-14). With one exception, the urethral meatus was situated in the vestibulae and easily accessible. One distal vaginal stenosis was observed in a case with high confluence. No urinary incontinence was noted. The appearance of external genitalia was very satisfactory.
The described genitoplasty provides a good cosmetic appearance. As most of our patients have not yet reached the age of sexual activity and child bearing, the functional results of this operation will need longer-term evaluation.
World Journal of Urology 08/2008; 26(5):517-20. DOI:10.1007/s00345-008-0298-4 · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The presentation of congenital diaphragmatic hernia (CDH) at birth may fall outside the typical features (cyanosis, tachypnea and respiratory failure), manifesting, instead, also with others pictures that make the diagnosis difficult or even impossible. We report a case of CDH presenting as a pneumothorax and a perforative peritonitis due to an antenatal gastric perforation.
Pediatric Surgery International 04/2008; 24(3):365-9. DOI:10.1007/s00383-007-2000-0 · 1.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of the current analysis was to evaluate the outcome of patients enrolled at the National Cancer Institute of Naples between 1997 and 2000, who underwent breast-conserving surgery. Between January 1997 and December 2000, 946 patients had been diagnosed with T1 or T2 (<3 cm) breast carcinoma. At the time of the present analysis (31-12-2005), all patients had been followed for >5 years. A Cox proportional hazards model was performed. Overall, 7-year Locoregional Relapse-free survival (LRFS) and Distant Relapse-free Survival (DRFS) rates were 95.9% and 88.4%, respectively. Seven-year DRFS was 91.2% and 79.3% in T1 and T2 stage, respectively (p<0.0001). Multivariate Cox analysis indicated that number of positive lymph-nodes and hormone receptor status were significantly associated with prognosis. Our findings confirm that early diagnosed breast cancer, treated with breast-conserving surgery, is associated with a very good prognosis in patients referred to an Institution which may be considered as representative of similar Cancer Institutes of Southern Italy. The risk of local relapse was found to be very low (4%), although a longer follow-up is needed to draw definitive conclusions.
[Show abstract][Hide abstract] ABSTRACT: Thymic cysts are rare embryonic remnants along the course of thymic migration in the neck or the anterior mediastinum which may result in cervical masses in children, often misdiagnosed. We present the experience gained by three European tertiary care medical centers in the treatment of thymic cysts as well as the current data on the embryology, clinical presentation, diagnosis and management of thymic cysts. A retrospective study was carried out in nine patients with thymic cysts during the period 1986-2002 at the departments of Pediatric Surgery of Children's University Hospital "Federico II" and "Santobono" Pediatric Hospital of Naples in Italy and "Aghia Sophia" Children's Hospital of Athens in Greece. All cases were asymptomatic, appearing mainly as masses resembling branchial cyst or lymphatic malformation. Laboratory and imaging investigations were not useful for preoperative diagnosis. In one case the mass extended into the mediastinum. The histological findings of thymic tissue and Hassal's corpuscles in the cystic wall were diagnostic. In all cases, surgery was successful and uneventful. Surgical excision was accomplished by dissection of the cystic masses from the jugular vein, carotid artery and vagus nerve and from the sternocleidomastoid muscle. The presence of a normal thymus in the mediastinum must be documented preoperatively in order to avoid the risk of total thymectomy. If a cervical thymic cyst extends into the normal thymus, attempts should be made to preserve the thymus, especially in younger patients. Thymic cysts should always be included in the differential diagnosis of lateral cervical masses, especially in children.
Pediatric Surgery International 01/2008; 23(12):1219-25. DOI:10.1007/s00383-006-1822-5 · 1.00 Impact Factor