Behaviour disorder caused by Cushing's syndrome in an older person.

An 81-year-old woman was hospitalised for behavioural disorders that had been progressively emerging over a period of few weeks. The symptoms appeared to worsen over time. A diagnosis of vascular dementia, complicated by psychosis, was initially hypothesised. The inefficacy of the antipsychotic/benzodiazepine medications used, along with the presence of hypertension, hypokalaemia and metabolic alkalosis (resistant to pharmacological attempts of correction), as well as the hirsutism and the development of several infections, led us to consider Cushing's syndrome. Endocrinological analysis suggested ectopic adrenocorticotropic hormone (ACTH) secretion. Although endogenous Cushing's syndrome is rare in older people, it should always be considered among the differential diagnosis of behavioural disorders.

Visualization of cleavage furrow proteins in fixed dividing spermatocytes.

Cytokinesis separates the cytoplasmic organelles and the duplicated genome into two daughter cells at the end of cell division. In animal cell cytokinesis, assembly and constriction of the contractile apparatus must be finely coordinated with plasma membrane remodeling and vesicle trafficking at the cleavage furrow. Accurate control of these events during cell cleavage is a fundamental task in all organisms and is also essential for maintaining ploidy and preventing neoplastic transformation. Drosophila male meiosis provides a well-suited cell system for exploring the molecular mechanisms underlying cytokinesis, combining the powerful tools of Drosophila genetics with unique cytological characteristics. Remarkably the large size of male meiotic cells highly facilitates cytological analysis of cytokinesis. Here we describe the main procedures that we use for fixing and visualizing cleavage furrow proteins in male meiotic cells. Moreover, we detail our protocol to detect protein interactions in fixed dividing spermatocytes by applying in situ proximity ligation assay.

A randomised, double-blind, vehicle-controlled study to evaluate the efficacy and safety of MAS063D (Atopiclair) in the treatment of mild to moderate atopic dermatitis.

MAS063D (Atopiclair is a hydrolipidic cream that has been developed for the management of atopic dermatitis (AD). The putative active ingredients of MAS063D are hyaluronic acid, telmesteine, Vitis vinifera, glycyrrhetinic acid. A five-week study in 30 adult patients with mild to moderate AD showed that MAS063D offered significant benefits over a vehicle-only control. MAS063D improved the total body area affected (17.2% --> 13.2%, p < 0.001), itch score (2.7 --> 1.3 on a 10-point scale, p = 0.001) and EASI score (28.3 --> 24.3, p = 0.024) after 22 days treatment compared to baseline. The patients' opinion of MAS063D (patient's view of itch control, and view of study substance) was rated by participating patients as significantly better than control (p = 0.008, p = 0.042 respectively). Based on these preliminary results in a small scale study, it is suggested that MAS063D is a possible new treatment option for improving signs and symptoms in adults with mild to moderate AD.

Interferon alpha-2B and ribavirin in combination for patients with chronic hepatitis C who failed to respond to, or relapsed after, interferon alpha therapy: a randomized trial.

PURPOSE: To assess the efficacy of interferon alpha-2b and ribavirin in combination in the treatment of patients with chronic hepatitis C who had either failed to respond to therapy with interferon alpha (nonresponders), or who had relapsed after interferon therapy (relapsers). SUBJECTS AND METHODS: Four hundred patients with chronic hepatitis C (200 nonresponders and 200 relapsers) were randomly assigned in equal numbers to receive either subcutaneous administration of recombinant interferon alpha-2b (3 million units three times per week) and ribavirin (1,000 to 1,200 mg/daily orally) or interferon alpha-2b alone (6 million units three times per week). Both ribavirin and interferon alpha-2b were given for 24 weeks. The patients were then followed for an additional 24 weeks. RESULTS: At the end of the treatment period, normalization of serum alanine aminotransferase levels and absence of hepatitis C virus RNA were seen in 21% of nonresponders and in 39% of relapsers who were treated with interferon alpha-2b and ribavirin, compared with 5% of nonresponders (P = 0.001) and 9% of relapsers treated with interferon alpha-2b alone (P <0.001). At the end of follow-up, 14% of nonresponders and 30% of relapsers treated with the combination therapy had a sustained response, compared with 1% of nonresponders (P = 0.001) and 5% of relapsers treated with interferon alpha alone (P <0.001). CONCLUSIONS: A 24-week course of treatment with interferon alpha-2b and ribavirin offers a chance of sustained response, whereas retreatment with interferon alpha-2b alone does not give satisfactory results. The role of long-term therapy in inducing prolonged remission remains to be explored.

Treatment of anxiety with ketazolam in elderly patients.

In a multicenter, double-blind trial, 63 elderly patients who had experienced a generalized anxiety disorder for at least one month were randomly assigned to receive 15 mg of ketazolam (n = 31) or placebo (n = 32) daily for 15 days. At the end of this period, if their total scores on the Hamilton Anxiety Rating Scale had decreased by at least 25%, treatment was continued unchanged for a further 15 days. Patients who did not respond to treatment were given an additional 15 mg of ketazolam daily. During the initial 15 days, 83% of the ketazolam-treated patients and 43% of the placebo patients responded to treatment (P < 0.01). During the second 15-day period, the anxiety scores of the ketazolam-treated patients continued to decline significantly, whereas the placebo patients showed no improvement. According to the investigators' assessments of severity of anxiety and patients' ratings of treatment effectiveness, ketazolam was significantly superior to placebo.

Iopamidol and metrizamide in cervical myelography: side effects, EEG, and CSF changes.

Two nonionic contrast media, iopamidol and metrizamide (Amipaque), were used for cervical myelography (C1-C2 puncture) in 95 consecutive patients. Both contrast media gave excellent radiographic results. Headache and vagal symptoms were similar in both groups, whereas metrizamide produced more electroencephalographic changes and epileptic seizures. Meningeal irritation occurred in both groups and was severe in three cases. Cerebrospinal fluid showed protein and cellular changes of inflammatory type in both groups. Iopamidol is considered to be the more suitable contrast medium for cervical myelography despite its slight neurotoxicity.

Outcome of liver disease in a large cohort of histologically proven chronic hepatitis C: influence of HCV genotype.

OBJECTIVE: To assess the influence of hepatitis C virus (HCV) genotypes on the clinical outcome of liver disease, we analysed 2,307 patients. RESULTS: The most frequently represented genotypes were 1b (40%) and 2 (28.1%). Patients with these genotypes had a median age higher than patients with other genotypes (P< 0.01). The overall survival of subjects with genotype 1b was poorer than the survival of patients with other genotypes (P< 0.01). Liver cirrhosis was found in 280 patients (12.1%), and type 1b was the most represented isolate among them (P< 0.01). Sixty-two patients (22%) developed hepatocellular carcinoma (HCC) during a follow-up of 1481.8 cumulative years (estimated crude incidence rate, 4.1 cases per 100 person-years for all cirrhotics; 5.9 cases for genotype 1a; 4.5 cases for genotype 1b; and 2.8 cases for genotypes non-1). Considering the whole population of 2,307 patients, only genotype 1b was associated significantly with both cirrhosis and the development of HCC. One hundred and nineteen cirrhotic patients underwent treatment with interferon in uncontrolled studies. Interferon therapy was associated with both better survival (P< 0.01) and a lower cumulative hazard for HCC (P< 0.01). CONCLUSIONS: Genotype 1b was associated with a poorer prognosis, probably because it leads to cirrhosis and consequently to HCC development. However, our data did not confirm genotype 1b as an independent risk factor for HCC in liver cirrhosis, which plays a major role in carcinogenesis. Interferon should be considered as a useful strategy in cirrhosis for improvement of survival and reduction of HCC risk.

Carotid percutaneous angioplasty.

Clinical benefit from treatment of symptomatic severe carotid stenoses has been demonstrated recently. The safety profile of endarterectomy, however, justifies the development of alternative techniques as percutaneous transluminal angioplasty (PTA), at least in mild to moderate stenoses. Early results and follow-up data from our series of 44 carotid stenoses treated by PTA are reviewed in this paper, in comparison with other reports from literature. PTA may be beneficial as a therapy of symptomatic internal carotid stenoses, provided its cost/effectiveness has been evaluated by a valid method.

Relationship between Monro's foramen and cranial breadth: a method for a more accurate echo-encephalographic examination.

A pneumoencephalographic study to localize the position of Monro's foramen in the skull cavity is reported. This has to be done by evaluating the place of Monro's foramen in both vertical and horizontal plane. A method to perform more accurate ultrasonic examinations is described.

Adjuvant therapy with essential fatty acids (EFAs) for primary liver tumors: some hypotheses.

Hepatocarcinoma is responsible for approximately 1 million deaths annually. It is usually discovered at an advanced stage and, if inoperable, has a poor prognosis. New therapies combining chemotherapy, hyperthermia, radiotherapy and immunomodulators have been recently attempted with various levels of success. Once the tumor is detected at an early stage, some possibilities of cure seem to emerge either by intratumoral percutaneous injection (PEI) of alcohol or by chemoembolization and interstitial hyperthermia. When the tumor volume is more than 5 cm, these therapies are less successful and radiotherapy can be used. All the techniques described have some limits; PEI, for instance, does not achieve a complete eradication of lesions > 3 cm and a non-homogenous alcohol distribution within the tumor leads to areas of necrosis. Radiotherapy, even if effective, is limited by dose-related radiation hepatitis. Another important limiting factor is the incomplete response to therapy and tumor recurrence. Essential fatty acids, especially gamma linolenic acid (GLA) and eicosapentaenoic acid (EPA) are discussed here for their ability to control primary tumor proliferation and increase response to chemotherapy, radiotherapy and hyperthermic treatment, thanks to their effects on cellular membranes (increased lipoperoxidation and modification of tumor stroma).

Alcoholic abstinence syndrome: short-term treatment with metadoxine.

The effects of metadoxine (pyrrolidone carboxylate of pyridoxine), a compound with central benzodiazepine-like properties, were evaluated in two groups of chronic alcoholics (inpatients) presenting a mild withdrawal syndrome. According to a double-blind study design 20 patients received metadoxine 900 mg twice daily eluted in 500 ml of saline infusion, while 20 (the control group) were given 500 ml of saline infusion twice daily with equivalent doses of pyridoxine (40 mg/die) every morning over a 10-day period. The results indicate that metadoxine treatment was able to control alcohol abstinence, thus allowing a reduction in the needs for standard benzodiazepine therapy. The central activity of gamma-aminobutyric acid of this compound might play a crucial role in the clinical effects demonstrated.

Psychological distress in geriatric and adult medical in-patients.

Psychological distress was evaluated in two groups of medical in-patients, one composed of geriatric subjects (178), the other of adults (201). The instrument used for this purpose was the SCL-90. The predominant pattern of emotional response among the geriatric patients was depression; although this pattern was also present among the adult patients, reactions of an anxious type were more common in these subjects. Women of both groups of patients scored significantly higher than men on many of the subscales of the SCL-90. No significant differences emerged in relation to the type of organic disease among the adult patients, while among the geriatric patients, subjects with disorders of the CNS, muscular-skeletal system and blood scored significantly higher than those with other diseases.

Flumazenil for hepatic coma in patients with liver cirrhosis: an Italian multicentre double-blind, placebo-controlled, crossover study.

Several factors suggest that endogenous benzodiazepines and gamma-amino-butyric acid may be involved in pathophysiology of hepatic encephalopathy (HE). Contrasting opinions exist on the therapeutic efficacy of flumazenil in the treatment of HE. This study was planned to assess the efficacy of flumazenil by a double-blind, placebo-controlled, crossover design in a large and selected population of cirrhotic patients in stage 4a HE admitted to intensive care units over a 4-year period. Out of 236 patients selected for the study, 132 received flumazenil, whereas 131 patients received placebo. Improvement of the neurological score was documented in 31 patients (23%) of flumazenil group and in two patients (1.5%) of placebo group (p < 0.001) during the first study period, whereas during the crossover period, improvement of the neurological score was documented in seven patients (5.3%) of the flumazenil group and in none of the placebo group (p = 0.022). Improvements in EEG tracings were observed in 44 patients (33.3%) of flumazenil group and in five patients (3.8%) of placebo group (p < 0.001) during the first study period; during the crossover period, improvements in EEG tracings were observed in 10 patients (7.5%) of the flumazenil group and in two patients (1.5%) of the placebo group (p = 0.040). The presence of benzodiazepines was detected in the serum of three responders and in two non-responders. The presence of diazepam and NN-desmethyl diazepam was documented in two responders; prior intake of synthetic diazepam was later confirmed in these patients. The results of our study suggest that flumazenil is beneficial only in a selected subset of cirrhotic patients with severe HE; the applicability of this treatment to unselected patients with hepatic coma or to cirrhotic patients with less severe HE still remains to be determined.

Diltiazem cold cardioplegia in coronary artery surgery: effects on myocardial function and ischemia.

This study was undertaken to evaluate the myocardial preservation obtained by adding a calcium channel blocker, diltiazem (200 mcg/kg of body weight) to cold potassium cardioplegia in 24 patients with coronary artery disease who underwent myocardial revascularization, and were randomly divided into a treated Group D and a Control Group C. No significant differences were noted between the groups in cardiac electrical arrest and recovery time, recovery rhythm, mechanical function recovery, inotropic support, stroke index, or cardiac index. After cardiopulmonary bypass, the stroke index decreased by 13.1% in Group D and by 20.7% in Group C; cardiac index increased in both--18.6% and 14.0%, respectively--but the results were possibly from compensatory heart rate increases. Peripheral deltaP/deltat and endocardial viability ratios decreased in both groups. Coronary sinus enzymes and serum CK were slightly lower in the treated group. Serum CK-MB, however, was significantly higher in the Control Group. Electrocardiographic ischemic changes occurred in four patients, all in Group C (p =.046). Hyperkinetic arrhythmias occurred in five of the controls, but in none of the treated patients (p =.018). One perioperative myocardial infarction was diagnosed in the Control Group. These data suggest that diltiazem has no negative side effects on hemodynamics or cardiac rhythm and does not reduce impairment of myocardial function due to ischemia, but it does decrease the incidence of ischemic lesions in patients undergoing coronary artery bypass procedures.

Virtual colonoscopy.

Computed axial colonography, usually called virtual colonoscopy, is a new diagnostic method potentially useful for investigating polyps and tumors of the colon and rectum. It uses spiral axial tomography data to build up images similar to those given by conventional colonoscopy, offering advantages in that it causes no adverse reactions, and is accepted well by patients, who do not need to be sedated. Reports to date show its sensitivity and specificity vary in identifying polyps in the colon, and there are still many problems with the new method, such as its cost, its learning curve, the identification of flat lesions, and detection of extracolonic abnormalities. There is a pressing need to establish the accuracy and cost-effectiveness of virtual colonoscopy as a screening method for colorectal tumors, and for post-polypectomy surveillance.

[Neoplasms of the male breast. Case report and review of the literature]. / Le neoplasie della mammella maschile. Contributo casistico e revisione della letteratura.

Fourteen cases of breast cancer in males observed between 1950 and 1974 at the Busto Arsizio Hospital Surgery Divsion are presnted. The literature is reviewed and attention is given to the incidence of this form, its symptoms and treatments, and to the length of survival after surgical management.

[Stenosis of hepatic artery associated with portal vein anomaly and splenomegaly: a haemodynamic evaluation (author's transl)]. / Associazione di stenosi dell'arteria epatica e di anomalie della vena porta con splenomegalia: studio della situazione emodinamica.

The authors describe one case of stenosis of the common hepatic artery associated with splenomegaly. After commenting on the rarity and peculiarity of such an occurrence, they explain the decisive role of selective celiac tripod arteriography not only for precise diagnostic definition of the case but also in terms of formulating an appropriate therapeutic program. The study of this case includes a detailed exploration of the hemodynomic situation created by the anomaly in the hepatosplenic district, and an equally detailed study of the associated blood picture changes.

[Variations of hematic viscosity due to water-electrolyte disorders induced by muscular stress]. / Le variazioni della viscosita' ematica in rapporto a perturbazioni idroelettrolitiche indotte da stress muscolare.

In view of the increasingly widespread tendency of common people to undertake sports activities without adequate athletic preparation, and in consideration of certain cardiovascular alterations detected in subjects cultivating athletic activities of some magnitude for a number of years, the authors set out to explore the effects of severe muscular activity on circulation. More precicely, they measured blood and plasma viscosity at rest and after 50 minutes of intense athletic activity, competitive or otherwise, at the same time looking for possible changes of volemia, blood lipid composition, and hemodynamic parameters. Trained subjects, even if no longer very young, showed viscosity values in the lower range of normal, with no increase following muscular exertion; and likewise no changes of circulating blood volumes. Untrained subjects, conversely, showed more significant increase of both said values, albeit not beyond the limits of norm. The definitely if not dramatically different behavior of the two groups of subjects (trained versus untrained) brings out the value of this simple test. The authors discuss the factors and mechanisms that may be responsible for the observed changes: namely the loss of water and associated changes of electrolyte and protein concentrations, the alterations of blood pH, the changes of paO2, and the increased velocity of blood flow.

[The behavior of blood viscosity in polyglobulism]. / Il comportamento della viscosita' plasmatica nelle poliglobulie.

In polyglobulic subjects we have found a variable reduction of plasmatic viscosity, with an increase of total viscosity. If the increase of Ht is the first cause of the increase of total viscosity, it is less simple to find the cause of plasmatic viscosity decrease; to this end we have analysed direct and indirect factors (coagulation factors, proteinous and lipidic components). We haven't found any significant qualitative alterations. It is proposed the importance of the interventions of basic proteins of polication type. To this end it has been studied the connection between plasmatic viscosity and ESR, being both influenced by the same factors, but in a contrary way and with variable results. Then the role of plasmatic viscosity in these subjects, in substitution of ESR, is significant.

[Variations of hematic and plasmatic viscosity as a function of flow velocity, analyzed by means of an experimental model]. / Variazioni della viscosita' ematica e plasmatica in funzione della velocita' di flusso, analizzate mediante modello sperimentale.

The authors have determined the hematic and plasmatic viscosity in 60 sound subjects, 30 men and 30 women respectively, at different values of cut drop, corresponding to the values that can be found at different levels of circulatory system. These subjects had value of Ht, total protidemy, cholesterolemy and trigliceryds, included in normal limits. For these determinations, made at constant temperature, they have used Well-Brookfield with a divergent angle of 0,8 degrees. In this way they could determinate the normality limits of hematic and plasmatic viscosity, in men and women, in connection with the physiologic modifications of flux speed. It has been confirmed the tixotropo behaviour of blood, whose viscosity increases exponentially for lessenings of cut drop and we have put this fact in touch with genesis of thrombosis. They haven't shown any expressive difference in the behaviour of the curves of two undergroups; the curve of middle values is higher for men, and it seems that this difference is owing to Ht. esclusively. In the end they have considered the curves of subjects that had values of viscosity different from normality; in this way they have found three different curves, in pathologic conditions.