Work capacity of the upper limbs after mastectomy.

Cancer patients are now more often long-term survivors and their needs for returning to social and productive activities have become a primary focus of intervention. The purpose of the present study was to propose an objective evaluation test for predicting endurance capacity in breast cancer patients after surgery, in order to optimize return to work or previous daily activities, and for monitoring changes during rehabilitation. Twenty female patients (mean age: 44 +/- 5), who underwent radical breast surgery 2 months before being referred to our Unit, participated in the study. In addition to the measures of the circumferences in the arm-forearm and manual muscle strength test, we performed the following functional evaluations: 0-100 Constant scale for shoulder function; instrumental evaluation of daily/occupational upper limb activities (Lido WorkSET). We monitored the mechanical parameters, the perception of effort, pain or discomfort, and the range of movement while performing a 3-minute steady daily/occupational task chosen by the subject. Patients were asked to perform the 3-minute test at three different intensities ("moderate", "somewhat hard", "hard") until the perception of fatigue, pain or discomfort was rated > 3 on the 10 point Borg's scale. The 'power-duration' product (Watt x min) defined by the three tests (see Fig. 1) represented the individual tolerable work load, since subjective indicators of pain/discomfort remained within tolerable limits during the exertion. On this basis, patients were encouraged to return to levels of daily physical activities compatible with the individual tolerable work load. The second evaluation, although no statistical analysis was performed, confirmed that the "guided" daily activity in a 2-month period increased patients' capacities and "trust" in their physical capacity.

[Evaluation of the capacity of work using upper limbs after radical latero-cervical surgery]. / La valutazione della capacità lavorativa con gli arti superiori dopo intervento di svuotamento latero-cervicale.

Evaluation of arm work capacity after radical neck surgery. The aim of this paper is to describe an approach for the assessment of work capacity in patients who underwent radical neck surgery, including those treated with radiation therapy. Nine male patients, who underwent radical neck surgery 2 months before being referred to our Unit, participated in the study. In addition to manual muscle strength test, we performed the following functional evaluations: 0-100 Constant scale for shoulder function; maximal shoulder strength in adduction/abduction and intrarotation/extrarotation; instrumental. We measured maximal isokinetic strength (10 repetitions) with a computerized dynamometer (Lido WorkSET) set at 100 degrees/sec. During the rehabilitation phase, the patients' mechanical parameters, the perception of effort, pain or discomfort, and the range of movement were monitored while performing daily/occupational task individually chosen on the simulator (Lido WorkSET) under isotonic conditions. On this basis, patients were encouraged to return to levels of daily physical activities compatible with the individual tolerable work load. The second evaluation at 2 month confirmed that the integrated rehabilitation protocol successfully increased patients' capacities and "trust" in their physical capacity. According to the literature, the use of isokinetic and isotonic exercise programs appears to decrease shoulder rehabilitation time. In our experience an excellent compliance has been noted. One of the advantages of the method proposed is to provide quantitative reports of the functional capacity and therefore to facilitate return-to-work of patients who underwent radical neck surgery.

Clinical pharmacokinetics of ibopamine on different diseases and conditions.

The pharmacokinetics of ibopamine was studied after single dose and after single and multiple dosing. The studies after single dose were conducted in normal subjects (NS) and in patients with congestive heart failure (CHF) of NYHA functional classes II, III and IV, in patients with chronic renal impairment (CRI), with hepatic cirrhosis (HC) and in elderly patients. Furthermore, ibopamine-quinidine pharmacokinetic interaction and the effects of food on plasma kinetics were evaluated in NS. The studies after single and multiple dosing were conducted in CHF patients. The effects were also studied of chronic oral ibopamine treatment on the pharmacokinetics of digoxin after chronic oral dosing and of treatment with digoxin on ibopamine pharmacokinetics. Ibopamine appears to be rapidly and extensively absorbed, quickly hydrolyzed to epinine and then excreted mainly through the kidneys either after being sulpho-conjugated or oxidized to homovanillic acid and 3,4-dihydroxyphenylacetic acid. Epinine is thought to be the therapeutically active moiety of the drug. In patients with CHF epinine pharmacokinetics does not depend on the NYHA functional class, and it falls within the same area as that in NS; the pharmacokinetics of epinine does not vary during the repeated administration of the drug for one month. In patients with CHF the pharmacokinetic data do not suggest the need to adjust the dose according to the NYHA functional class. In patients with CRI the pharmacokinetics of epinine does not vary with the degree of renal impairment. In HC patients AUC and Cmax of epinine seem to be higher than in NS; in these patients a higher amount of epinine is excreted into urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Viminol analgesic activity in elderly patients with chronic pain: a controlled evaluation, using self-rating questionnaires.

The analgesic effects of single oral doses of viminol (70 mg), of viminol (70 mg) combined with chlordiazepoxide (10 mg) and of chlordiazepoxide (10 mg) were compared in 41 outpatients with chronic pain mostly due to neoplasms. Alone, or combined with chlordiazepoxide, viminol proved significantly more effective than chlordiazepoxide; No difference in analgestic effect was observed between viminol combined with chlordiazepoxide and viminol alone. The use of self-administered questionnaires was found particularly convenient for study of analgesics in outpatients.

Blood level of cimetidine in relation to age.

The blood level versus time curve for unchanged cimetidine after a 200 mg oral dose has been determined in 20 apparently healthy subjects, ranging from 22 to 84 years of age. A significant relationship between the area under the curve (AUC) and age was found (r = 0.81; P less than 0.001). The peak concentrations of cimetidine were significantly inversely related to body weight (r = -0.71; P less than 0.001). The age-related increase in bioavailability of oral cimetidine, as measured by AUC, was probably due to decreased total clearance of the drug, which resulted from the opposed changes (by themselves not significant) of distribution volume towards a decrease and of half-life towards an increase with age. Reduction in the standard oral dose of cimetidine by one third to one half should be feasible in the elderly without loss of efficacy, and it may be advisable in order to obviate extreme individual responses that may occur in this population.

Relative bioavailability of fosfomycin and of trometamol after administration of single dose by oral route of fosfomycin trometamol in fasting conditions and after a meal.

The pharmacokinetics of fosfomycin and trometamol after single oral dose of fosfomycin trometamol (Z 1282) was studied in healthy volunteers in fasting conditions and immediately after standard meal. The dose was of 1.876 g (equivalent to 1.0 g of fosfomycin). The parameters considered were: serum apparent elimination half-life (t1/2), maximum serum concentration (Cmax), time to Cmax (tmax), area under the curve of the serum concentrations from time 0 (zero) to infinity (AUC0-infinity) and urinary recovery in the first 48 h. The results confirm that fosfomycin trometamol allows high bioavailability of fosfomycin. The absorption and elimination rates of fosfomycin and trometamol in the serum were similar. A statistically significant difference was found between the Cmax values of fosfomycin in the 2 experimental conditions. Means +/- SE of Cmax (micrograms/ml) were 12.1 +/- 0.6 in fasting conditions and 7.8 +/- 1.6 after a meal. Urinary recovery of the antibiotic was high in both experimental conditions. The fraction of the dose recovered (the dose being taken as equal to 1) was on the average 0.58 in the first condition and 0.52 in the second. Urinary recoveries of trometamol in the 2 different conditions were similar.

Viminol R2 analgesic activity in patients with postoperative pain: comparison with pentazocine.

The analgesic activity of Viminol R2 was compared to that of Pentazocine and placebo in a double-blind, "between subjects" study involving 42 patients with postoperative pain randomly assigned to 3 groups of 14 patients each and treated with a single intravenous dose of Viminol R2 10 mg, Pentazocine 30 mg or placebo. Pain relief scores were recorded over a 2 h period after treatment. The analgesic activity of Viminol R2 and Pentazocine was significantly greater than that of placebo both in terms of time-course of action and frequency of classes of satisfactory analgesia. No statistically significant differences were found between Viminol R2 and Pentazocine. No side effects were observed in any patients treated with Viminol R2.

Blood levels of cimetidine in patients with liver cirrhosis.

Blood concentrations and pharmacokinetic parameters of cimetidine were studied in 16 patients with liver cirrhosis and in 8 apparently healthy subjects. The drug was administered orally as a single dose of 200 mg. Four patients of both groups were treated with cimetidine orally and intravenously. No statistically significant difference was observed between pharmacokinetic parameters of cimetidine obtained from control subjects and those from patients with liver cirrhosis. The pharmacokinetic parameters of cimetidine in patients with liver cirrhosis did not significantly differ from those of normal patients even if separately calculated with respect to serum albumin and total serum bilirubin.

Use of N-acetylcysteine in the management of coronary artery diseases.

Thrombolysis after acute myocardial infarction may lead to a number of adverse effects (reperfusion injury) such as myocardial stunning, arrhythmias and even myocardial damage and extension of the infarct size. Some recent clinical studies have demonstrated that the intravenous infusion of N-acetylcysteine during thrombolysis was associated with a decrease in infarct size and better preservation of left ventricular function, probably due to antioxidant and free radical scavenger properties of N-acetylcysteine. Short- and long-term studies indicated that also in patients with unstable angina pectoris and threat of infarct, the intravenous or oral administration of N-acetylcysteine in association with nitroglycerin is highly effective in decreasing the risk of worsening, mainly by preventing the occurrence of acute myocardial infarction.

[Recent progress in the stimulation of the histiocyte system and the anti-infection defences. Research into the effect of stanozolol treatment on the phagocyte activity of human macrophages]. / Recenti progressi nella stimolazione del sistema istiocitario e delle difese anti-infettive. Ricerche sugli effetti del trattamento con stanozololo sull'attivltà fagocitaria del macrofagi umani.

A group of patients was treated with stanozolol. A modified version of Roebuck's skin window technique was used to obtain macrophages. These were then fixed in vitro with a suspension of Paracolonbacter aerogenoides. Comparison with a group of control subjects showed that the macrophages from the treated patients appeared to take up and destroy germs more effectively and that this could be potentiated by prior opsonisation with serum from the treated subjects. These results are seen as an expression of functional activation of the macrophages and an increase in serum opsonin content.