Effect of gamma-aminobutyric acid on growth hormone and prolactin secretion in man: influence of pimozide and domperidone.

To investigate the possibility that GH release induced by gamma-aminobutyric acid (GABA) in man is mediated by a dopaminergic mechanism(s), we evaluated the effect of two antidopaminergic compounds, pimozide and domperidone, on the plasma GH response to acute GABA administration (5 g, orally). Only the former compound can freely cross the blood-brain barrier. In 9 normal volunteers, GABA caused a significant increase of plasma GH levels (P < 0.0001 vs. GH levels in a group of 14 controls). In these subjects, pimozide (6 mg/day, orally, for 4 days) significantly blunted the GH elevation induced by GABA (P < 0.01). Unlike pimozide, in 8 additional subjects, domperidone (4 mg injected iv immediately before GABA administration) did not influence the GABA-induced GH response. GABA did not alter either baseline or pimozide-stimulated plasma PRL levels. Likewise, it did not significantly modify the brisk PRL rise after domperidone injection. These findings are consistent with the hypothesis that GABA-stimulated GH secretion is mediated via dopamine release at a suprapituitary level. With regard to PRL secretion, no GABA-dopamine interactions are readily apparent.

Comparison of nimesulide and diclofenac in the prevention and treatment of painful inflammatory postoperative complications of general surgery.

In a double-blind study, 40 patients scheduled for saphenectomy or inguinal hernioplasty were randomly assigned to treatment with nimesulide (200mg 3 times daily) or diclofenac (100mg 3 times daily) administered rectally. Therapy with either drug resulted in significantly less pain, oedema and hyperaemia, and resolution of mild fever. No adverse reactions attributable to treatment were observed.

Intrathoracic intercostal nerve block with phenol in open chest surgery. A randomized study with statistical evaluation of respiratory parameters.

Seventy-three patients who underwent thoracic surgery were randomly selected for intraoperative intercostal nerve block using phenol (32 block and 41 control subjects). The patients were divided into three groups: pneumonectomies, lobectomies and explorative thoracotomies and evaluated by pain level, respiratory function parameters (VT, IRV, ERV, VC) and blood-gas analysis, both six and 24 hrs after surgery. The patients who had intraoperative nerve block using phenol enjoyed a more comfortable postoperative period. In particular, respiratory parameters were statistically better.

Inhibition by phospholipid liposomes of the prolactin and cortisol response to insulin hypoglycemia in man.

This study was designed to further investigate the purported dopaminergic activity of phospholipid liposomes (PL) prepared from bovine cerebral extracts, and to obtain further indications about their pituitary or suprapituitary site of action. In eight normal subjects, we have studied the effects of PL administration (250 mg as IV bolus plus additional 250 mg infused IV over a 60-min period), compared to placebo, on the prolactin (PRL), cortisol and growth hormone (GH) response to an insulin tolerance test (ITT). In eight additional subjects, the effects of PL on the PRL and TSH response to TRH were evaluated. PL medication blunted the PRL and cortisol response in the ITT: significant differences, with respect to placebo administration, were observed between mean peak PRL values (51.9 +/- 13.63 SEM vs 83.4 +/- 26.35 ng/ml, P less than 0.05) and mean cortisol values at 120 min time (20.9 +/- 0.67 vs 26.7 +/- 2.46 micrograms/dl, P less than 0.05). In contrast, PL administration did not modify the ITT-related GH rise or the PRL and TSH release in response to TRH. These findings favour the view that PL are endowed with intrinsic biological activity which is dopamine-mediated, and point to the hypothalamus as their primary site of action.

Trazodone for deafferentation pain. Comparison with amitriptyline.

We report a clinical multicentre experience with antidepressant agents (trazodone and amitriptyline) in the treatment of chronic pain due to deafferentation. Forty five patients were admitted to the study; most of them with oncological peripheral nerve lesions. Almost all of them were already being treated with NSAID in association with weak or strong opioids. A random double blind study was performed: 23 patients were treated with trazodone, 22 with amitriptyline. In the assessment of results, pain intensity, hours of sleep, hours standing and lying, side effects, mood, anxiety and weakness were all taken into consideration. The therapeutic analgesic efficacy of the two drugs proved to be similar.

Trimethoprim-sulfamethoxazole-induced aseptic meningitis: case report and literature review.

Aseptic meningitis is a rare adverse drug reaction, reported with non-steroidal anti-inflammatory agents (NSAIDs) and with miscellaneous drugs such as trimethoprim-sulfamethoxazole (TMP-SMX). The most common clinical findings reported are fever, headache, stiffness and altered level of consciousness. We report a case of aseptic meningitis related to TMP-SMX ingestion that caused severe derangements of the patient's vital signs, requiring Intensive Care Unit admittance. The prompt diagnosis and discontinuation of the drug resulted in complete recovery. We examine the case according to the literature on this topic. We conclude that, since the signs and symptoms of this unusual drug reaction may mimic those of central nervous system infection, the clinician should consider this etiology when he is faced with a patient with suspected meningoencephalitis, especially if the latter has already been treated at home with unknown drugs. Further studies should investigate the pathogenetic mechanism of TMP-SMX-induced aseptic meningitis.

[A case of angioimmunoblastic lymphadenopathy with dysproteinemia]. / Su un caso di linfoadenopatia angioimmunoblastica con disprotidemia.

A case of angioimmunoblastic lymphoadenopathy is presented. It is very interesting because of its rarity (slightly more than 200 cases in the literature) and because presents some distinguishing features: it arises from a Salk antipolio vaccination, the age at beginning is extremely early (7 years old), the survival time is quite long (more than ten years).

[Preoperative parathyroid ultrasonography. 45 recent verified cases]. / Ultrasonographie parathyroïdienne préopératoire. Quarante-cinq cas vérifiés récents.

In a series of 45 patients operated upon for primary hyperparathyroidism, a total of 167 parathyroid glands were confirmed. Thirty out of the 43 parathyroid masses potentially accessible to ultrasounds were correctly identified by preoperative cervical ultrasonography. There were 124 true negative results, including one retro-oesophageal mass and one mediastinal mass, 1 false-positive result and 11 false-negative results, giving the method a sensitivity of 73% and a specificity of 99%. Sensitivity increases with the experience of the operator. The main factors that reduce sensitivity are change of apparatus, old age of the patient, small masses (less than 500 mg) and coexistence of a thyroid disease (22% of the cases). The ease with which parathyroid masses can be correctly identified is independent from plasma calcium and parathyroid hormone values.

[The use of CT in oncologic radiotherapy (author's transl)]. / Ruolo della TC nella radioterapia dei tumori profondi.

The authors report their three-years experience on the use of CT in oncologic radiotherapy. They present 10 typical cases, using both brain and total body CT, in order to show the main relationships between CT and radiotherapy of deep tumors: 1) more careful oncologic diagnosis; 2) correct geometric approach to treatment planning; 3) good control of treatment, conforming the target-volume to the reduction in size of the tumor; 4) post-radiotherapeutic follow-up.

[Lysine acetylsalicylate in the treatment of postoperative pain in obstetric and gynecological surgery]. / L'acetilsalicilato di lisina nel trattamento del dolore post-operatorio in chirurgia ostetrica e ginecologica.

The analgesic activity of acetylsalicylate of lysine (ASL) was evaluated in postoperative pain. Acetylsalicylate of lysine was administered i.v. to 345 patients submitted to obstetrical and gynaecological surgery. Excellent results were obtained in 77.4% of the cases and no severe side-effects were observed.

A case of repeated reversible cerebrovascular attacks caused by two hemorrhagic lesions.

A case of repeated reversible cerebrovascular deficit proved on computerized tomography to be hemorrhagic in origin. It would seem advisable to await the outcome of CT before classifying a case of cerebrovascular disease even though the clinical features point to ischemia as the cause.

[Preanesthesia in elderly patients undergoing subarachnoid anesthesia: chlordesmethyldiazepam versus diazepam]. / La preanestesia nei soggetti anziani sottoposti ad anestesia sub-aracnoidea: clordemetildiazepam vs diazepam.

Forty patients over 65 undergoing subarachnoid anesthesia with bupivacaine 0.50% (5 mg) and fentanyl (0.1 mg) were subdivided into two equal groups: one was premedicated with atropine and chlordesmethyldiazepam (0.03 mg/kg-1) and the other with atropine and diazepam (0.015 mg/Kg-1). A statistically significant difference was found in the group treated with diazepam which required an increase for anesthetic drugs during surgery. The authors suggest a probable synergic or an enhanced effect between intramuscular chlordesmethyldiazepam and opiates in spinal anesthesia.

Prolonged treatment of chronic C hepatitis by means of medium-high doses of recombinant alpha-2b interferon: an open study to evaluate response and long-term relapse.

Thirty-six patients with hepatitis C virus-RNA positive chronic hepatitis were studied to evaluate whether recombinant alpha-2b interferon, in medium-high doses, (6-9 MU 3 times/week) over a long period (12-18 months), was more effective in reducing or normalizing alanine aminotransferase values, and in reducing the relapsing percentage than the historical trials. At the end of the 12th and 18th month of treatment, mean alanine aminotransferase values were significantly reduced; the level of complete responses was 36.1%, at the end of the 12th month, and 19.4% at the end of the 18th month (intention to treat). These results were no better than comparable findings in the literature. At the end of the first follow-up (12th month), percent complete responses fell to 15.5%, with a relapse rate of 14.3%. At the end of the second follow-up (24th month), percent complete responses fell further to 11.1% (all 4 patients with a 24 months sustained response showed absence of viraemia), with a relapse rate of 42.9%; even these percentages were judged unsatisfactory. In conclusion, no significant advantage was obtained by prolonging interferon treatment and/or using higher dosages. However, the possible virus clearance in all the long-term responders seems to justify further investigation in terms of cost-benefit analysis.

Liver cell dysplasia is a major risk factor for hepatocellular carcinoma in cirrhosis: a prospective study.

BACKGROUND/AIMS: In humans, the role of liver cell dysplasia as a preneoplastic lesion is still debated. A prospective, long-term, multicenter study was performed to establish whether liver cell dysplasia in cirrhosis is associated with an increased risk for hepatocellular carcinoma (HCC). METHODS: A cohort of 307 consecutive patients in whom liver cirrhosis was diagnosed by histology was investigated for development of HCC at 6-month intervals by ultrasonography and determination of alpha-fetoprotein levels. RESULTS: At enrollment, liver cell dysplasia was found in 75 patients (24%) and in 53% (P < 0.01) of those positive for hepatitis B surface antigen (HBsAg). After a mean follow-up of 46 months, HCC was detected in 45 cases, and it was significantly more frequent in patients with liver cell dysplasia (P < 0.01) and HBsAg-serum positivity (P < 0.01). Multivariate analysis showed that liver cell dysplasia was the most important risk factor correlated with HCC development. HBsAg positivity and age over 60 years were also independent risk factors for HCC. CONCLUSIONS: These results indicate that liver cell dysplasia is a major risk factor for HCC, and it should be looked for carefully by pathologists in liver biopsy specimens to identify patients requiring more intensive observation.

Cerebrospinal fluid and plasma concentrations of SRIH, beta-endorphin, CRH, NPY and GHRH in obese and normal weight subjects.

Numerous hypothalamic peptides are involved in the control of eating behaviour. We assessed plasma and cerebrospinal fluid (CSF) levels of SRIH, beta-endorphin (beta-EP), CRH, NPY and GHRH in a group of massively obese patients and in normal weight subjects. In the obese patients, CSF SRIH and beta-EP levels were significantly reduced and increased, respectively, compared with controls (20.6 +/- 2.62, mean +/- s.e.m., vs 34.5 +/- 2.14 pg/ml, P < 0.05, for SRIH and 111.2 +/- 5.00 vs 80.4 +/- 5.32 pg/ml, P < 0.001, for beta-EP). Considering the data of obese and control subjects altogether, SRIH and beta-EP concentrations correlated negatively and positively, respectively, with BMI values (r = -0.641, P < 0.005 and r = 0.518, P < 0.05). No significant differences were observed in CSF levels of CRH, NPY and GHRH between obese and normal weight subjects, though GHRH levels were close to the assay sensitivity. CSF concentrations of CRH were positively correlated with those of SRIH in obese patients (r = 0.60, P < 0.05) and with those of NPY both in obese (r = 0.69, P < 0.02) and in control subjects (r = 0.83, P < 0.005). Plasma levels of SRIH, beta-EP, NPY and GHRH did not differ significantly in the two groups of subjects; plasma CRH was undetectable. Our results argue against the hypothesis of an enhanced SRIH tone as the cause of impaired GH secretion in obese patients, a primary defect in GHRH or GH release seems more likely. Moreover, they emphasise the importance of an increased tone of endogenous opioids in the pathophysiology of human obesity.