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Ensuring high levels of adherence to highly active anti-retroviral therapy (HAART) is a priority in treating people living with AIDS. This study reports the rates of adherence of patients served by DREAM (Drug Resource Enhancement against AIDS and Malnutrition) in the city of Matola, Mozambique. DREAM, an innovative programme tailored for Africa, was implemented by the Community of Sant'Egidio in August 2001. DREAM provides patients with anti-retroviral drugs and laboratory tests at no charge, and is based on a particular strategy of health education and organization of services designed for a population that is predominantly poor and has a low level of formal education. This study analyzes the adherence of 154 patients over a period of 6 months. In evaluating adherence, two indicators were used: (1) the percentage of appointments kept for check-ups, tests and the collection of medicine, and (2) the overall change in the patients' blood chemistry over the 6-month period. Of the 154 patients, 127 (82.5%) kept more than 90% of their appointments. Adherence to the programme was further confirmed by a relevant increase of hemoglobin levels and CD4 counts, and a significant decrease in the viral loads among the 154 patients.

Using fluorescent microlymphography, we examined the morphology andfunctional characteristics of the microlymph-vascular network in 36 subjects including 9 patients with "compressible" lymphedema (Group I), 14 with minimally compressible lymphedema (Group II), 9 with noncompressible lymphedema (Group III), and 4 healthy individuals. As lymphedema progressedfrom early to advanced stages (Group I-III), an increasingly greater lymphatic capillary density and diameter were depicted and eventually fibrosis/sclerosis with lymphangiectasia, fragmentation and a gradual decrease in the number of microlymphatics. Concomitantly, there was a prolongation in transport and disappearance of fluorescent dye and a progressive increase in endolymphatic and interstitial hydrostatic pressures.

The atherosclerotic disease is a very important problem for the health in the advanced countries. The Rose's questionnaire was utilised for diagnosing the intermittent claudication but the current diagnostic method is the ankle-arm blood pressure ratio (Winsor's index). The incidence of intermittent claudication is 0.4% to 14.4%, utilising the Rose's questionnaire and 4.2% to 35% using the Winsor's index. The main risk factor for the peripheral arteriopathies is the smoke followed by the hypertension and the diabetic disease. The dyslipidemic and coagulative diseases are important risk factors in some populations. The main cause of death is the myocardial infarction. The risk increases when it is present a cerebral or coronary arterial pathologies.

The authors report a clinical and ultrastructural study on a group of patients with angiomegaly, a vascular disorder characterized by elongated and distended blood vessels affecting the arterial (arteriomegaly) and/or venous system (venomegaly). The arterial group, drawn from a large arteriographic series, focuses on a comparison between atherosclerotic arteriopathy and arteriomegaly. The venous group, drawn from a large ultrasound series of vein disorders, is made up of patients with venomegaly. Venomegaly gives rise to few or no symptoms and it appears to be less frequent than arteriomegaly but as the latter proved to be associated in the majority of cases studied. Based on ultrastructural findings, the chief abnormality of angiomegaly seems to lie in a specific alteration of the elastic component of the vessel wall. We found slightly osmiophil amorphous elastic material neighbouring the basement membrane of the myocytes of the vessel walls. In the superficial parts of these myocytes occurred a great number of pinocytotic vesicles indicating for a rich creation of the new elastic material. Middle or highly osmiophil thick elastic fibers with irregular side protrusions were also found among myocytes remembering the moth-eaten picture. Results from a large ultrasonographic study on patients' relatives suggest an inheritability of this vascular disorder.

Mondor's disease is a rare pathology which is characterized from a superficial thrombophlebitis more frequently of a vein on the anterolateral thoraco-abdominal wall. The world literature reported about 500 cases which have been compared to 22 cases which represent our personal case-report. The most frequent etiological causes are represented by post-traumatic and infective events. The most important symptom is pain. The prognosis of the singol phlebitis focus is always favourable.

The data's from National Statistic Institute referring to all Italians hospitalized during 1988 are: 37,312 patient due venous diseases, 2.03 p. cent of all hospitalized patients. Varicose veins diseases are more represented in female (10,948 f. and 4,476 m.). A regional study shows an increase in the north of Italy. The medium amount of days in hospital per patient is reduced in the last years at 11 day (from 18 d). The days in hospital in phlebophatic patients were 409,568 (20,522,122 d. for all diseases) during 1988. The expenses for hospital charges due to venous diseases were estimated in 163,827,000,000 of Italian liras, 136,522,500 US. dollar. Other report consider the factory working as the most important in the scale of job inducing phlebophaties. The first seems to be textile industries, at the second place the food factory, the last are builders. In 1974 were lost 2,300,000 working days. We suppose that increasing of private angiological assistance and having a poor public assistance in Italy the patients undergone to hospitals are reducing (81,599 with venous diseases in 1974 and 37,312 in 1988).

The ultrastructure of the v. colica sinistra in a case of generalized vasomegaly in man was examined. Elastic material was found in three forms: as a lightly osmiophil amorphous material bordering on myocytes, as a highly osmiophil elastic membrane, and as highly osmiophil slim elastic fibres of different orientation in the tunica media and adventitia. The slightly osmiophil elastic material is assumed to be newly formed by pinocytotic activity of the myocytes. The highly osmiophil elastic material indicates its impairment. No typical atherosclerotic changes were found in the examined vein. Based on a comparison with previous findings in the case of vasomegaly of the a. mesenterica inferior, the authors conclude that the venomegaly phenomenon is connected with degenerative changes in the elastic material of the vessel wall.

We use from some years the doppler method for noninvasive meas urements of venous pressure and about seven years ago we communicated the early results.1-3 We have confirmed the reliability and sensitivity of the method carrying on our clinical work. Now we report the results of a more extensive observation.

The AA. have carried out a complete review of the world literature on Mondor phlebitis of the last 50 years (214 cases) pointing out the clinic and epidemiologic characteristics and those of a possible aetiogenesis. 11 personal cases, detailed characteristics of which are given, have been presented. The female sex is the most affected (63,3%) and the most frequent aetiopatogenetic factors are: accidental or surgical traumas (35,7%), muscular stresses (6,3%, centres of infection (4,3%, concomitant mammary pathology (2,4%). The most common symptom is pain (51%) with or without tension sensation (28,9%). The histologic aspect relevant to the biopsy, shows the characteristics of thrombophlebitis non specific, almost always without periphlebitis. The cases presented by the AA. are characterized by the high incidence of relapses (45,4% against 5% of the total cases in the world) as well as by the occasional positivity of the specific serum-agglutination for the Rickettsia Q18 (2 cases out of 11) and the reduction of some immunologic tests (1 cases out of 11). This latter data are leading to two aetiopatogenetic hypothesis: the infective and immunitary one.

A serologic study using the direct seroagglutinate method described by Babudieri and Zardi was carried out in 31 patients affected by Buerger's disease, to determine the positive antibody reaction level against rickettsial disease. In 41.9% of the cases there was a positive test for R. burnetii, in 6.4% a positive test for R. mooserii, and in one a positive test for R. conorii. The results lead us to believe that these pathogenic agents are largely responsible for the development of thromboangiitis obliterans.

With reference to the measuring method suggested, we report the pressure indices noted in surgery, in order to compare them with those of non-surgical methods, using the Doppler. We also define some parameters for recording the measurements; failure to observe these might result in inaccuracy of the instrumental findings. We have to consider the index of maximum pressure to be attained using the pneumatic cuff, the lenght of time of compression, and the place at which the measurement is taken.

Taking into consideration a previous work, where we experimented the pharmacological action of different products of nitrite retard and from which resulted the absolute superiority of isosorbide dinitrate, we considered interesting to repeat the experimentation with a new form of isosorbide dinitrate characterized by an action duration more prolonged in the time owing to the particular freeing of the active principle. In 20 patients free from peripheral vasculopathy it was enregistered the rheogram with derivation back-feet-big toe in base condition and at 1st, 3rd, 5th and 10th hour from the administration of Nitrosorbide Retard 20 mg. The product action, put in evidence by the appearance of the typical pulse by nitrite, begins the first hour, it reaches the maximum at the 5th hour on average and it clearly lasts until the 10th hour. Therefore it is demonstrated the practical usefulness of this product in the daily clinical medicine considered its characteristics of action rapidity, duration and steadfastness.

Specific seroagglutination tests were performed in 70 patients with Buerger's disease to detect possible antibodies to rickettsia, the test being repeated in 8 cases after activation by doxycycline administration over 10 days. In 21 patients a Weil-Felix test was also carried out. Tests were assessed as positive in 44 cases (62.8%): 18 times for Rickettsia Q. 18, 14 times for Rickettsia Mooseri, 13 times for Rickettsia Burnetii, 5 times for Rickettsia Conorii and 3 times for Rickettsia Prowazekii. After activation by doxycycline the antibody titre was increased 5 times, unchanged 3 times and reduced once. The Weil-Felix gave positive results in 3 of the 21 cases (14.28%), the reaction being positive to Rickettsia Prowazekii. These findings provide supplementary arguments for a possible pathogenic role of rickettsial infection in Buerger's disease.

We have established a serologic study with method of direct microagglutination described by Babudieri and Zardi, by 31 patients affected from a Buerger's disease, to determine the positivity of antibody title which desposes on rickettsiosis infection. Positivities have been confirmed for the Rickettsia Burnetii from 41,9% of cases, for R. Mooseri from 6,4% and for the R. Conori only from one case. Since the positivity varies in the normal population from the 0.7% to 1.1% the data related appears very significant for a possible rickettsiosis etiology of the Buerger's disease.

A study was carried out in 127 patients (94 males and 33 females) presenting with arteriosclerosis (88 patients) or diabetic vasculopathy (39 patients) in different stages of severity (Fontaine) to assess the effectiveness and tolerance of treatment with high doses of pentoxifylline. Patients received a daily dosage of 2200 mg, given as 800 mg orally and 300 mg by intravenous infusion in saline twice daily, for a mean period of 15.8 days. Relevant clinical parameters were assessed and measurements made of biological and laboratory indices before and after treatment. The results showed that intermittent claudication was improved in 52.4% of the arteriosclerotic and 50% of the diabetic patients Stage II disease, pain at rest disappeared in 64% and 78% of patients in Stage III, respectively, and trophic lesions in Stage IV patients were reduced or became less clearly marked in 47% and 44%, respectively. Arterial blood pressure, recorded on the tibial arteries using Doppler ultrasound, showed a mean increase of 18%, but no significant changes in blood flow were evident from rheographic examination. Whole blood erythrocyte filtration time was reduced by a mean of 8%. The main changes in the biological indices after treatment were decreases in haematocrit, mean corpuscular volume and blood fibrinogen values, but these were not statistically significant. The other variables showed little if any change. Side-effects initially reported by the patients consisted of headache, nausea, sweating, pruritus and general malaise, and were mainly associated with the infusion time and regressed in most cases when this was extended.

Weight bearing on the paretic lower extremity and transfer of weight from one lower extremity to the other are important goals of stroke rehabilitation. Improvements in these limb loading and weight transfer abilities have been shown to relate to improved performance of many functional activities. Unfortunately, valid and practical clinical measures of paretic lower extremity loading and weight transfer have not been identified. The purpose of this study was to quantitatively assess, through center of foot pressure (CoP) analysis of quiet upright stance control, recovery of paretic limb loading as a measure of weight transfer in early stroke subjects, testing the effectiveness of a targeted rehabilitation intervention based on audiovisual biofeedback. Thirty-seven adults with lower extremity motor impairment following unilateral, non-cerebellar stroke, were Biofeedback rehabilitation of posture and weightbearing distribution in stroke: a center of foot pressure analysis tested twice, at an interval of at least one month post stroke and following rehabilitation intervention aimed at correcting their asymmetrical weight bearing. The intervention was performed with (Study Group, SG) or without (Control Group, CG) a postural audio-visual biofeedback approach. Indices of postural stability and of balance control asymmetry were estimated by acquiring the movements of the CoP during quiet upright stance condition with or without visual input (eyes open, EO and eyes closed, EC). Clinical scales were also administered. Both the CG and the SG subjects showed improved control in upright stance posture as documented by significant improvements in the scale scores and indices of stability during both the EO and the EC condition. Only the SG showed a significantly reduced CoP index of asymmetry. The CoP index of asymmetry, correlating with clinical motor scales, is a valid measure of paretic limb loading during stroke recovery. Postural audio-visual biofeedback represented the more effective approach for reducing weight loading asymmetry of the lower limbs in stroke.