Influenza like Illness (ILI): prescribing behaviour of 83 sentry doctors in Lazio region in the period 2001-2002. Is it adherent to Italian ILI guidelines?

To describe different doctors' attitudes in drug prescribing in case of influenza-Like-Illness during 2001-2002 influenza season in Lazio region, with regard to consumption and expenditure and its adherence to Italian Guidelines on ILI Management. Prospective study aimed to assess doctors' behaviour in prescribing in respect with the following events: (a) ILI and subsequent controls after diagnosis, (b) complications, (c) adverse events to influenza vaccine. 7,629 subjects, have been identified and only 17% presents one or more comorbidities. There are totally 7,766 cases of ILI: 23% are complicated and out of the remaining 77%, only 14% presents comorbidities. Almost all elderly people have been vaccinated. Antibiotics were prescribed to complicated cases (82%) with comorbidities (55%); 1,075 patients (12%) had second or third contact with doctors in a period longer than 7 days and about 65% of them received antibiotics in case of acute bronchitis; children received mainly ibuprofen and paracetamol for fever control; acetylsalicylic acid in children group has been delivered only in 1% of cases. Overall, doctors' attitude in prescribing is generally coherent with Italian Guidelines on ILI even though a high variability still persists.

Evaluation of anterior pituitary function in patients with posttraumatic diabetes insipidus.

Serum LH, FSH, TSH, PRL, GH, and cortisol were measured in 10 patients with posttraumatic diabetes insipidus both basally and after a combined insulin-induced hypoglycemia, LRH and TRH test. Two patients did not show hormonal abnormalities, while 8 patients had deficiencies of 1 or more hormones. The most frequent abnormality was GH deficiency (50%), followed by TSH (40%), ACTH (30%), FSH (30%0, and LH (20%). These results indicate that anterior pituitary dysfunction frequently accompanies posttraumatic diabetes insipidus.

Photodynamic therapy of malignant brain tumors: clinical results of, difficulties with, questions about, and future prospects for the neurosurgical applications.

Photodynamic therapy (PDT) has been applied in a variety of oncological fields with good results. In neurosurgery, the clinical series are limited and the number of treated patients is not statistically significant. This work examines the results of PDT performed in our clinic and discusses some difficulties and causes of failure of this method in neurosurgical patients. Eight patients with malignant brain tumors underwent PDT. All had been treated previously by operation and radiation therapy and one patient had also received chemotherapy. At 24 hours after the i.v. injection of hematoporphyrin (5 mg/kg body weight), the tumor was removed as radically as possible and the residual tumor bed was exposed to either 630-nm light from an argon-dye laser or 600- to 680-nm light isolated from the emission of a quartz-halogen lamp. The type of sensitizer, the irradiation methods, and the peculiarities of glial tumors are examined as possible causes of failure. The longer survivals of some patients with glial tumors treated by PDT may make this treatment suitable when traditional therapies fail.

Variations of prolactin content in human cerebrospinal fluid after metoclopramide and morphine.

Serum and cerebrospinal fluid (CSF) prolactin (PRL) concentrations were determined in fourteen patients of both sexes suffering from hydrocephalus, in basal conditions and after i.m. administration of 10 mg metoclopramide or 10 mg morphine. A significant increase in both serum and CSF hormone values was found after administration of both drugs. Serum and CSF PRL values after metoclopramide administration increased earlier and to a greater extent than after morphine. Furthermore, the metoclopramide induced CSF PRL increase immediately followed the serum peak, whereas after morphine administration an evident delay in the CSF hormone peak with respect to the serum increase was found. These data suggest that PRL entry in the CSF compartment is subject to a controlling mechanism which acts at the blood/brain barrier.

Diurnal beta-endorphin changes in human cerebrospinal fluid.

Plasma and cerebrospinal fluid (CSF) beta-endorphin levels were determined by a RIA method in seven hydrocephalic male patients. The samples were simultaneously collected every two hours from 8 AM to 12 midnight and every hour from 1 AM to 7 AM. In both plasma and CSF beta-endorphin levels showed significant time-related variations during the 24 hour period. These results suggest the existence of diurnal CSF beta-endorphin variations analogous to those observed in plasma.

Modified Holter Rickham reservoir: a device percutaneous photodynamic treatment of cystic malignant brain tumors.

A modified Holter Rickham reservoir which permit the percutaneous photodynamic treatment of cystic malignant brain tumors, is described. Through this device it is possible to introduce in the tumoral cyst both the photosensitizer drug and the optical fibers, carriers of the light in order to induce the photodynamic process. This treatment, if necessary, can be repeated over and over again, simply through a skin perforation.

The CO2 laser beam in the surgical treatment of cerebral tumours.

Several cases of supratentorial gliomas and meningiomas were operated on since May 1977 with the help of CO2 laser infrared beam, generated by the Sharplan 791 He unit, with an adjustable output up to 50 Watts. Defocused laser beam has been found to be useful in direct attack on the tumour, through a vaporization of the neoplastic tissue. So the tumour could be progressively excavate with a loss of blood comparatively lower than with classical method. Haemostasis was quite good on diffuse capillary bleeding, but not on arterial or venous haemorragies, where the use of electrocoagulation was necessary. Extirpation especially, of meningiomas, was easier and less traumatic with the laser beam, and the destruction of infiltrating glial tumours was facilitated too.

Traumatic subdural hygromas: a report of 70 surgically treated cases.

The Authors present 70 cases of traumatic subdural hygromas, classified into acute, subacute and chronic, according to the interval between injury and the appearance of symptoms. The acute cases were 22.9% of our series. Criteria for surgical treatment were established by means of CT scan serial investigations. Pathogenesis, clinical aspects and results are discussed. Mortality rate was 17.1%.

Fast attempts at the photodynamic treatment of human gliomas.

Photodynamic therapy is based on the capacity of certain substances to preferentially stain neoplastic tissues in respect to healthy tissues, and on the property of such substances to produce cytotoxic agents when excited by light of an appropriate wavelength. The authors demonstrate the first attempts to photoradiant therapy in the treatment of human gliomas utilizing a hematoporphyrin derivative injected i.v. as a sensitizing drug. A He Ne Laser (632,8 nm) was used in order to trigger the photodynamic process. Immediately after surgical removal of the glioma the residual tumoral bed was exposed to the action of the Laser in order to provoke necrosis of the remaining neoplastic cells. Necrosis even if partial of the residual tumor was effected. Better and more definite results may be obtained in the future utilizing a Laser connected with fiber optics consenting an in-depth light penetration.

Pituitary hormone concentrations in cerebrospinal fluid in patients with prolactin and growth hormone-secreting tumors.

GH, PRL, LH, FSH and TSH were measured in serum and in cerebrospinal fluid (CSF) in 16 patients with chromophobe adenomas, in 8 with acromegaly and in 18 subjects with neurological diseases without endocrine troubles. Elevated mean GH and PRL levels in serum and in CSF were found in patients with chromophobe adenomas and with acromegaly. No constant correlation was observed between serum and CSF values. The highest hormonal levels in CSF were usually observed in adenomas with suprasellar extension, but this finding was inconstant. The determination of hormonal levels in CSF does not seem to supply any reliable information about the characteristics of pituitary tumors.

Changes of CSF prolactin induced by metoclopramide in man.

A sharp increase in serum and CSF prolactin (PRL) values after acute metoclopramide (10 mg i.m.) administration was found in six male patients without endocrine diseases. Peak values occurred simultaneously in serum and in CSF. This finding suggests the possibility that CSF PRL content depends also on the retrograde transport from pituitary gland.

Vertex epidural hematomas.

Fourteen cases of vertex epidural hematomas encountered in patients admitted over a 12-year period (1964-1976) at the University of Genoa Neurosurgical Clinic are presented. Special emphasis is put on the large number of cases (nine) without a free interval. Clinical and neuroradiological findings, treatment and results are reported. A clinical classification of this traumatic pathology according to the epidural hematoma classification of Pecker et al is proposed.

[Management of vaccination practices in adults: the influenza vaccination campaign in Lazio region, Italy]. / Modelli organizzativi di profilassi vaccinale nell'adulto: l'esperienza della campagna di vaccinazione antinfluenzale nella regione Lazio.

This paper focuses on key issues of the organizational model of the influenza vaccination campaign in Lazio region, Italy, started during the 1999-2000 season. The following crucial features of the model are emphasized: a strong support given by Regional Health Agency; a high level of commitment of local health authorities; a considerable involvement of general practitioners; the appropriation of economical incentives related to different levels of coverage; an "ad hoc " information system. The model resulted in a remarkable increase of the number of vaccinations among elderly population (from about 420,000 in the 2000-2001 vaccination campaign to about 560,000 in the successive campaign) and of the correspondent levels of coverage (from 45.7% in the 2000-2001 vaccination campaign to 59.2% in the successive campaign). Nevertheless, further efforts should be provided to better identify population at risk, and to reach the most disadvantaged groups. Moreover, actions are to be performed to assess health and economic benefits of vaccination campaign, in order to improve the efficiency of health care planning programs.

Regression of syringomyelia after removal of a posterior fossa epidermoid tumour.

The case is reported of a 49-year-old man with a giant infratentorial extradural epidermoid tumour, with cervical syringomyelia and hydrocephalus, and partial protrusion of the cerebellar tonsils through the foramen magnum. The patient complained of symptoms of raised intracranial pressure and was admitted to our Department, where ventriculoperitoneal shunting and total removal of the epidermoid tumour were performed. One year later, MR imaging demonstrated collapse of the cervical syringomyelia.