Safe implementation of thrombolysis in stroke-monitoring study in Italy.

BACKGROUND AND PURPOSE: The safe implementation of thrombolysis in stroke-monitoring (SITS-MOST) study was an unique opportunity to test in Italy, where only few centres were expert in thrombolytic treatment before, safety and efficacy of i.v. alteplase within 3 h of ischaemic stroke outside the setting of clinical trials. METHODS: In Italy to participate in the study the clinical centres had to possess organizational and structural characteristics certified by Regional Health Authorities. RESULTS: Seventy-one centres were activated, 56 (79%) treated patients of which 41 (73%) had never used thrombolysis before the study. Globally, 586 patients were included. Baseline median National Institute of Health Stroke Scale of Italian patients was 13 vs. 12 in other European centres (P = 0.0001). Symptomatic intracerebral haemorrhage as per the NINDS/Cochrane definition, mortality and independence (modified Rankin Scale 0-2) rates at 3 months occurred respectively in 6.7% (95% CI: 4.8-9.1), 11.7% (9.2-14.6) and 51.6% (47.4-55.7) of Italian patients compared with 7.3% (6.7-8.0) (P = 0.56), 11.2% (10.4-12.1) (P = 0.75) and 55.1% (53.8-56.4) (P = 0.09) in the European patients and in 8.6% (40/65; 6.3-11.6), 17.3% (14.1-21.1) and 50.1% (44.5-54.7) of the patients treated in the pooled randomized controlled trials. CONCLUSIONS: The SITS-MOST study showed that in Italy i.v. alteplase is safe and effective in routine clinical use also in non-expert centres.

[Risk stratification in patients with a first myocardial infarct based on simple clinico-instrumental variables]. / Stratificazione del rischio in pazienti con primo infarto miocardico in base ad alcune semplici variabili clinico-strumentali.

UNLABELLED: It is an acknowledged fact that the prognosis for patients with a first myocardial infarction depends mainly on the degree of residual left ventricle function. We wanted to evaluate the importance that certain simple clinical and instrumental variables can have in stratifying post-infarction cardiovascular risk with particular emphasis on chronic obstructive lung disease (COLD). We selected 97 out of the 512 patients treated in the coronary intensive care unit (CICU) from February 1, 1988 to October 31, 1990 according to the following criteria: First myocardial infarction; no cardiogenic shock; no serious concomitant diseases with considered negative prognosis within 6 months. The following variables were considered for all the patients: age; sex; positive family history for ischemic heart disease; history of diabetes mellitus; arterial hypertension; previous cerebrovascular incident; history of obstructive arteriopathy of the lower limbs, of angor and COLD. The following tests were performed on all the patients: echocardiogram prior to discharge form the CICU; angiocardioscintigraphy with Tc-99 between the 20th and 30th day following the acute event; bicycle ergometer stress test on the 30th day. END POINTS: general mortality; cardiac mortality; non-fatal reinfarction; residual angina at 3 months. All the patients were treated with aspirin (325 mg/die) and/or heparin (12,500 units subcutaneously). All 97 patients were monitored for a mean follow-up time of 19.8 months. General mortality was 2.08% (for reinfarction) 24 (24.7%) non-fatal cardiac events.(ABSTRACT TRUNCATED AT 250 WORDS)

[Dissection of the epiaortic vessels: an emergency pathology as the cause of focal cerebral ischemia. The evaluation of a case load of 7 patients]. / Dissezione dei vasi epiaortici: una patologia emergente come causa di ischemia cerebrale focale. Valutazione di una casistica di 7 pazienti.

Dissection of the epiaortic vessels is an emerging cause of focal cerebral ischemia, especially in young patients. Non-invasive diagnostic devices (ultrasound, nuclear magnetic resonance) have greatly improved the ability to suspect and identify it. We report our clinical experience with 5 patients affected by carotid artery dissection and 2 patients affected by vertebral artery dissection. Vessel dissection generally occurred spontaneously; it was preceded by head or cervical trauma in 2 cases. Arterial hypertension was commonly associated, and headache was always present together with other focal neurological signs. Clinical suspicion was confirmed by ultrasound duplex scanning: although never conclusive, it always showed typical Doppler patterns. Nuclear magnetic resonance has become an acknowledged means of definitive diagnosis although angiography remains the gold standard. In any case, diagnosis requires clinical suspicion and the accurate correlation of clinical data and instrumental results. Therapy consisted in anticoagulant and antiplatelet drugs. The clinical course of our patients was favorable in all cases, and no recurrences were recorded.

[Spontaneous staphylococcal abscess of psoas muscle]. / Ascesso stafilococcico spontaneo del muscolo psoas.

An abscess of the psoas muscle is a rare occurrence and pathogenetic interpretation usually proves difficult. Abscessing of the psoas may be due either to direct diffusion of infections of adjacent structure or to hematogenous spread. However, not uncommonly, a "spontaneous" abscess occurs, which cannot be correlated to other sites of infections or sepsis. The Authors describe two cases of abscesses of the psoas muscle following Staphylococcus aureus sepsis of unknown origin.

[Platelet aggregation inhibitory therapy in chronic arterial occlusive disease of the lower limbs: results of short-term clinico-instrumental study with indobufen]. / La terapia antiaggregante piastrinica nelle arteriopatie obliteranti croniche degli arti inferiori: risultati di uno studio clinico-strumentale a breve termin con indobufene.

Aim of our study was to evaluate the effectiveness of indobufen in the treatment of II degree stage lower limb occlusive arterial disease. Forty patients were randomly assigned to the iIndobufen (400 mg/die) treatment group or the no treatment control group (20 patients each). Doppler pressure measurement (Winsor index) and subjective symptomatology were evaluated at the time of enrollment and after one month. A significant improvement (p less than 0.01) was noted only in the treated group. We conclude that indobufen may be of therapeutic value in the treatment of peripheral occlusive arterial disease.

[The nimodipine therapy of acute focal cerebral ischemia (minor stroke). A clinical study with an assessment of regional cerebral blood flow by SPECT]. / Terapia con nimodipina dell'ischemia cerebrale acuta a focolaio (minor stroke). Studio clinico con valutazione del flusso cerebrale regionale tramite SPECT.

Aim of the study is the evaluation of therapeutic effectiveness of nimodipine in acute focal cerebral ischaemia. Thirty patients affected by minor ischaemic stroke divided in two randomized groups have been studied consecutively: all the patients were treated with standard therapy, nimodipine was delivered in addition only to the patients of the first group. Both clinical evaluation using Mathew scale, modified by Gelmers, and flowmetric evaluation with SPECT were performed at different times. The results haven't shown any significant statistical difference in the effectiveness of the therapy between the two groups even if a positive clinical trend was evidenced in the group treated with nimodipine. The flowmetric study has shown the poor homogeneity of the groups from a physiopathological point of view not-with-standing the two groups were similar for the clinical severity, sex, age and vascular risk factors. We conclude that is advisable to carry out further trials in which the comparison study groups are more numerous and balanced also from a physiopathological point of view.

Wilson's disease, a reversible dementia: case report.

A case of advanced Wilson's disease with clear dementing features is presented. Neuropsychological evaluation before treatment revealed intellectual deterioration particularly in memory and performance tasks. The patient was treated with Penicillamine, a copper-chelating agent, for 7 months, with notable improvement in her dementia and in her motor signs. A second battery of neuropsychological tests demonstrated the improvement in the mental aspects. These findings support the concept of Wilson's disease being a reversible dementia.

Severe dementia associated with neurocysticercosis.

A severe case of dementia associated with a parenchymous miliar neurocysticercosis in a 15-year-old girl is described. Although there was general cerebral involvement, EEG, neurological and neuropsychological examinations showed a marked decrease in right hemisphere activity. Treatment with Praziquantel reduced the patient's intellectual deterioration, but hydrocephalus developed.

[Clinical diagnosis of pulmonary embolism: validity of a score system and its correlation with therapeutic choices in a case series of 51 patients]. / Diagnosi clinica di embolia polmonare. Validità del sistema a punteggio e sua correlazione con le scelte terapeutiche in una casistica di 51 pazienti.

The Authors have used, on a group of 51 patients, a score-system for the clinical diagnosis of pulmonary embolism. This system is based on clinical examination of the patients and utilizes a different value for each sign and symptom: each sign and symptom correspond to a positive number. Every patients was also undergone instrumental tests to confirm the diagnosis (i.e.: perfusion lung scanning and venous doppler) according to previously defined diagnostic program. A good relationship between the instrumental diagnosis and clinical probability was found with above mentioned score-system. The AA believe that this score-system is valid and that it can be used in elaborating diagnostic decision, particularly in those cases in which the diagnosis is not established by the instrumental tests and in which is not possible to perform pulmonary angiography.

[The patient with carotid reversible cerebral ischemic attack. Clinico-instrumental pathogenetic diagnosis]. / Il paziente con attacco ischemico cerebrale reversible (RIA) carotideo. Diagnosi patogenetica clinico-strumentale.

Reversible ischemic attacks (RIA) in the carotid territory may be caused by different pathogenetic diseases (atheroembolism, cardioembolism, lacunar infarcts, hemodynamics crisis); peculiar therapeutic treatment has to be related to each pathophysiologic evidence. A pathogenetical and diagnostical approach based on clinical and instrumental data is suggested by the Authors; by this way it was possible to obtain a right pathogenetic diagnosis in 82% of a 144 patients series affected by carotid RIA.

Topography of the hemi-inattention syndrome.

The hemi-inattention syndrome was studied in 15 right-handed adults, 12 men and 3 women. One patient had a pontic-mesencephalic lesion, 3 had right hemisphere damage, 7 had left-hemisphere lesion and 4 had bilateral lesions. All lesions were confirmed by CT-scan. Different criteria of hemi-inattention were used. All patients presented extinction, inattention and in 13 visuomotor akinesia; 5 of the left and all of the right and bilateral lesion patients presented spatial neglect. CT-scans were superimposed. The posterior parietal region was the most important in producing contralateral hemi-inattention. Results are discussed with relation to the literature and the educational factor and cerebral asymmetry are discussed with regard to hemi-inattention.

The effect of morphine and naloxone administration on plasma oxytocin concentrations in the first stage of labour.

OBJECTIVE: We investigated the effect of an opiate (morphine) and an opiate antagonist (naloxone) on the maternal secretion of oxytocin in the first stage of labour. DESIGN: Patients were randomized to receive either morphine 5 mg (n = 9), naloxone 1.2 mg (n = 10) or sterile water (n = 9) which was injected intravenously. PATIENTS: Healthy women in the first stage of labour between 3 and 6 cm dilated with no prior analgesia or oxytocin administration were recruited for the study. MEASUREMENTS: Peripheral maternal oxytocin levels were measured by radioimmunoassay for 15 minutes before and 15 minutes after administration of the assigned substance. Sampling was at 2.5 minute intervals. RESULTS: Significant reduction in the mean oxytocin concentration was found in the patients who received morphine (-2.62 pmol/l/sample) but no change was found in the naloxone group (+0.57 pmol/l/sample) when compared with controls (+0.64 pmol/l/sample). CONCLUSION: Maternal oxytocin secretion is inhibited by exogenous opiates in the first stage of labour while an effect of opiate antagonism was not demonstrated.

Incidence of stroke in young adults in Florence, Italy.

A population-based study specifically addressing stroke in young adults (aged 15-44 years) was conducted in Florence, Italy, from 1983 to 1985. We identified 47 cases of first stroke by means of a daily check of the medical facilities of the city and nearby towns and a review of death certificates. Patients were assessed by a neurologist shortly after the onset of the stroke, and computed tomography or autopsy was performed in 96%. The average annual incidence rate for all stroke (cases per 100,000 population per year) was 9.0 (95% confidence interval 5.8-13.4) for males and 8.7 (95% confidence interval 5.5-13.0) for females. The average annual incidence rates for the pathologic types of stroke were 3.4 for cerebral infarction, 3.2 for subarachnoid hemorrhage, and 1.9 for intracerebral hemorrhage. The case-fatality ratio was 23.4% at 1 month. Among patients with ischemic strokes, atherosclerosis and cardiac disease accounted for 50% of the cases. Based on angiography or autopsy findings, aneurysm or arteriovenous malformation were demonstrated in 88% of the patients with subarachnoid hemorrhage. In 50% of the patients with intracerebral hemorrhage, no cause of bleeding was detected. Our study may supply information about stroke pathologic types in an unselected series of young adults.