Contrast-enhanced sonography was found to be more sensitive than sonography and almost as sensitive as CT in the detection of traumatic abdominal solid organ injuries. It can therefore be proposed as a useful tool in the assessment of blunt abdominal trauma.

One of the most striking reported symptoms in CoViD-19 is loss of smell and taste. The frequency of these impairments and their specificity as a potential central nervous system function biomarker are of great interest as a diagnostic clue for CoViD-19 infection as opposed to other similar symptomatologic diseases and because of their implication in viral pathogenesis. Here severe CoViD-19 was investigated by comparing self-report vs. testing of smell and taste, thus the objective severity of olfactory impairment and their possible correlation with other symptoms. Because a significant discrepancy between smell and taste testing vs. self-report results (p < 0.001) emerges in our result, we performed a statistical analysis highlighting disagreement among normosmia (p < 0.05), hyposmia, severe hyposmia, and anosmia (p < 0.001) and, in hypogeusia and severe hypogeusia, while no differences are observed in normogeusia and ageusia. Therefore, we analyzed the olfactory threshold by an objective test revealing the distribution of hyposmic (34%), severe hyposmic (48%), and anosmic (13%) patients in severe CoViD-19. In severe CoViD-19 patients, taste is lost in 4.3% of normosmic individuals, 31.9% of hyposmic individuals, 46.8% of severe hyposmic individuals, and 17% of anosmic individuals. Moreover, 95% of 100 CoViD-19 patients objectively tested were affected by smell dysfunction, while 47% were affected by taste dysfunction. Furthermore, analysis by objective testing also highlighted that the severity of smell dysfunction in CoViD-19 subjects did not correlate with age and sex. In conclusion, we report by objective testing that the majority of CoViD-19 patients report severe anosmia, that most of the subjects have olfactory impairment rather than taste impairment, and, finally, that the olfactory impairment correlate with symptom onset and hospitalization (p < 0.05). Patients who exhibit severe olfactory impairment had been hospitalized for about a week from symptom onset; double time has taken place in subjects with normosmia. Our results may be limited by the relatively small number of study participants, but these suggest by objective testing that hyposmia, severe hyposmia, and anosmia may relate directly to infection severity and neurological damage. The smell test assessment could be a potential screening symptom that might contribute to the decision to test suspected cases or guide quarantine instructions, further therapeutic approach, and evaluation of neurological damage.

Objective. To compare parameters of muscle energy metabolism in patients with fibromyalgia syndrome (FMS) and sedentary controls.Methods. Thirteen female FMS patients and 13 female sedentary controls underwent a standardized clinical assessment (including dolorimeter measurements of the upper trapezius and tibialis anterior muscles) and a standardized aerobic fitness test including measurement of maximum oxygen uptake (VOzmax). Phosphorus (3'P) magnetic resonance spectroscopy studies of the upper trapezius and tibialis anterior muscles were then performed in FMS patients and controls, at rest and during and following a musclefatiguing exercise protocol.Results. FMS patients and controls had similar levels of VOZmax and of maximum voluntary contraction (MVC) of the upper trapezius and tibialis anterior muscles. After controlling for VOZmax and MVC, measurements of phosphocreatine (PCr), inorganic phosphate (Pi), and intracellular pH in these muscles were not significantly different in FMS patients versus sedentary controls either at rest, during exercise, or during recovery. In the patients with FMS, no correlation was Submitted for publication May 25, 1993; accepted in revised form October 19, 1993. found between overall or local pain severity and the principal muscle metabolic parameter, PCr/Pi. Inverse correlations between dolorimeter scores at 2 muscle sites and tibialis anterior PCr/P, were found both in patients and in controls.Conclusion. This study demonstrates that under the conditions studied, muscle energy metabolism in FMS is no different than that in sedentary controls.These findings do not support the hypothesis that detectable defects in muscle energy metabolism occur in FMS.Fibromyalgia syndrome (FMS) is a common chronic musculoskeletal pain syndrome which has been recently defined in a multicenter study (l), although its cause remains unknown (2). A number of studies using invasive and noninvasive techniques have suggested that patients with FMS have abnormalities in muscle energy metabolism (3-8). Several histologic studies appeared to demonstrate histopathologic changes consistent with tissue anoxia, including "moth-eaten" and "ragged-red' ' muscle fibers at the sites of tenderness (4-6). More recent studies appeared to confirm these findings, with the demonstration of local hypoxia and reduced high-energy phosphate levels at sites of tenderness, compared with normal controls (7,8). It has also been recently recognized, however, that patients with FMS are relatively deconditioned when compared with normal subjects (9). Furthermore, increases in high-energy phosphate levels in skeletal muscle may occur in response to physical training (10). It is therefore possible that studies demonstrating lower levels of high-energy phosphate compounds in muscles of FMS patients compared with normal controls reflect only a disuse effect. Nevertheless, no studies of muscle metabolism in FMS to date have taken into account the level of deconditioning in study subjects.

Caracasanamide, one of the hypotensive agents isolated from Verbesina caracasana, is a mixture of (Z)-1a and (E)-1b forms of 1-[(3,4-dimethoxycinnamoyl)amino]-4- [(3-methyl-2-butenyl)-guanidino]butane. The structure of (E)-caracasanamide (1b) was confirmed by high-yielding synthesis starting from N,N'-bis(tert-butoxycarbonyl)-S-methylisothiourea. The water-soluble Z-form of 1a, assayed by i.v. route in anesthetized rats at doses ranging from 50 to 1600 micrograms/kg body weight, was found to decrease blood pressure, to increase cardiac inotropism, respiratory frequency, and tidal volume, and to induce a very slight and not significant tachycardia. Higher doses determined respiratory depression and, in some cases, consequent cardiac arrest. The compound was shown to affect cardiovascular function by acting at the vascular level in inducing arterial vasodilation, by determining sympathetic hypotone through central neurogenic mechanisms, and by interacting with the cardiac beta 1-adrenoreceptors. The respiratory effects were independent of the cardiovascular ones. In lowering blood pressure, the compound was more potent than guanethidine and not less potent than reserpine and papaverine. (Z)-Caracasanamide may therefore be useful in the treatment of arterial hypertension of moderate degree.