Extended transsphenoidal microsurgical approach for diaphragma sellae and tuberculum meningiomas.

Diaphragma sellae meningiomas represent a difficult challenge for neurosurgeons; they are generally operated on by a transcranial approach. Some authors reported transsphenoidal surgery in selected cases, but without accurately focusing the surgical technique that should be necessary for removing the typical hard fibrous tissue of the meningioma, that is not aspirable, by this approach. We present the surgical technique and the useful instrumentarium for removing a diaphragma sellae meningioma through an extended microsurgical transsphenoidal approach.

Phenotypic features and secretory pattern of alveolar macrophages in atopic asthmatic patients.

The aim of this study was to evaluate by cytofluorimetry, the phenotype and the activation of alveolar macrophages (CD14; CD33; CD44; CD54; CD23; HLA-DR) and, by radioimmunoassay, the "in vivo and in vitro" macrophage secretory pattern (IL-1 alpha; IL-1 beta; IL6; IL8; PGE2; PGD-1 alpha; TXB2; LTB4) in atopic patients with mild asthma in intercritical phase and with bronchial hyperreactivity (PD20 FEV1 = 377 +/- 262.8 micrograms). In asthmatic patients we have demonstrated that the number of cells recovered in BALF expressing the phenotypic features (CD14; CD33; HLA-DR; CD23; CD44; CD54) was larger than in control subjects. By analysing the culture medium of unstimulated and LPS-stimulated alveolar macrophages from asthmatic and normals we have demonstrated a greater production of IL-1 beta (p = 0.005) and IL-8 (p = 0.005) in the first group than in one second, as confirmed by a Wilcoxon test. Concerning the secretory pattern in BALF of asthmatic patients we obtained similar results, showing a significant IL-1 beta (p = 0.005) and IL-8 (p = 0.002) increase suggesting a persistent cellular activation. On the contrary we could not show any significant increase of IL-1 alpha (p = 0.31) and IL-6 (p = 0.22). The cellular activation was confirmed by increased levels of different chemical mediators such as TXB2 (p = 0.005); LTB4 (p = 0.004); PGE2 (p = 0.007); PGF-1 alpha (p = 0.008) which were recovered from BALF of asthmatic patients compared to normal subjects. In conclusion alveolar macrophages play an important role in the pathogenesis of asthma because of the presence of cytokines and mediators in BALF and in the supernatant of alveolar macrophage cultures.

Levodropropizine in the premedication to fibrebronchoscopy.

The aim of the study was to evaluate the efficacy of cough-preventing treatment with levodropropizine, a drug inhibiting peripheral cough reflexes, in patients undergoing bronchial endoscopy. Sixteen patients, aged 37-73 years, suffering from chronic obstructive lung disease in the hypersecretory phase, were included in the study. The experiment was designed as double blind with double observer, controlled versus placebo. As comparative efficacy parameters were considered the number of anaesthetic boluses (lidocaine at 2%) administered during and immediately after the manoeuvre. The number of coughs during and 10 min after bronchoscopy was registered on a magnetic tape and read by a blinded observer thereafter. Levodropropizine was given as oral drops (20 each time, equal to 60 mg active drug) 12 h and 1 h before bronchoscopy. Data analysis was performed by descriptive statistical tests and by the non-parametric Wilcoxon test for paired samples. Levodropropizine treatment significantly reduced the number of anaesthetic enemas (p less than 0.01), and presented an excellent tolerability and safety profile.

Pefloxacin in lower respiratory tract infections.

To determine the efficacy and safety of pefloxacin in the treatment of lower respiratory tract infections, a multicentre trial involving four departments of respiratory diseases was performed. One hundred and eight patients were admitted to the study: most of them were affected with exacerbations of chronic bronchitis or with pneumonia complicating lung cancer. Isolation and identification of responsible microorganisms from bronchial secretions was possible in 78 patients. Seven patients were withdrawn, one for worsening of the underlying disease and six for early side-effects. Thus, of 108 patients recruited, 101 completed the course of therapy (pefloxacin 400 mg bd for 5-14 days) and could be submitted to final evaluation. Of these 43 (42.6%) were cured and 48 (47.5%) showed improvement. Eradication of responsible microorganisms was achieved in 70 (90.9%) of 77 patients microbiologically evaluated. Side-effects of moderate severity were observed in 12 patients (gastrointestinal disturbances in 11 and dyspnoea in one); these did not necessitate discontinuation of therapy.

Equinococosis hidatidica pulmonar. / Pulmonary hydatid echinococcosis

Se presentan 43 casos de quistes hidatidicos de pulmon intervenidos en el Hospital Zonal de Esquel desde el 1o. de julio de 1977 hasta el 31 de diciembre de 1981. La incidencia de la localizacion pulmonar con respecto al total fue del 33%. Se destaca la importancia del examen catastral radiologico y seroinmunologico. Se recomiendan las tecnicas quirurgicas conservadoras que tratan la periquistica. Se comunican 2 casos poco frecuentes: 1 quiste hidatidico de pleura parietal y un quiste multivesicular del pulmon

[Serum levels of GPI, AAT and CEA in primary lung neoplasms and chronic bronchopneumopathies]. / I livelli sierici di GPI, A1AT e CEA nelle neoplasie polmonari primitive e nelle broncopneumopatie croniche.

The Authors have tested serum levels of alpha-1-antitrypsin (A1AT), phosphohexose-isomerase (GPI) and carcinoembryonic antigen (CEA) in 133 patients affected with primary lung cancer, not treated with any drug, and in 183 patients affected with not neoplastic lung diseases or healthy, to control the utility of these markers in the early diagnosis of lung cancer. In many patients all the tests have been made at the same time. The three tumoral markers have been also examined in connection with the histological kinds of lung cancer. Results show that is suitable to test GIP and A1AT at the same time because they are percentually more pathological; serum levels of CEA, that are not very elevated in the pathological cases, seem in correlation with the histological kind of cancer.