Olfactory event-related potentials: a new approach for the evaluation of olfaction in nasopharyngeal carcinoma patients treated with chemo-radiotherapy.

OBJECTIVE: Olfactory dysfunction is a possible side effect of chemo-radiotherapy performed in patients affected by nasopharyngeal carcinoma. Self-rating measurements and olfactory event-related potentials were used and compared in order to evaluate the impact of this treatment on the olfactory system. METHODS: Nine patients underwent subjective evaluation of olfactory function (using visual analogue scales for olfactory symptoms and quality of life, and a six-item Hyposmia Rating Scale), and a quantitative and objective measurement (olfactory event-related potentials). RESULTS: Spearman's rank correlation analyses highlighted significant relationships between the clinical scales and olfactory event-related potentials. Inter-group analyses showed significant differences in the latency and in the amplitude of olfactory event-related potentials between patients and controls. CONCLUSION: Taking into account the small sample size and the lack of pre-treatment assessment, olfactory event-related potentials seemed to allow a more objective diagnosis of unilateral and bilateral olfactory loss. Moreover, olfactory event-related potentials and subjective scales results were concordant.

[Proctologic day-surgery. Results of 2000 surgical interventions]. / Chirurgia proctologica in day-surgery. Risultati di 2000 interventi chirurgici.

The aim of the study was the evaluate of results of 2000 surgical operations for ano-rectal disease performed in the day-surgery setting (7-24 hours hospital stay) with improvement of both cost effectiveness and patient comfort. From January 1980 to December 1998, 2000 patients underwent surgical operations: 1011 for haemorrhoids; 708 for anal fissure; 172 for fistula in ano; 80 for pylonidal disease; and 45 for anal stenosis. 97.6% of patients were operated on with loco-regional anaesthesia; the others with narcosis and peripheral anaesthesia. The hospital-stay was 24 hours in 697 patients (34.5%), while 1319 (65.5%) operated on under loco-regional anaesthesia were hospitalised for 7-10 hours. Three patients (0.2%) developed acute hemorrhage after hemorroidectomy during the immediate postoperative period. They underwent reintervention under general anaesthesia with a hospital stay of 7 days. Four patients (0.6%) with perianal abscess after internal sphincterotomy underwent incision 10 days after the operation. Two patients with perianal hematoma after sphincterotomy prolonged the hospital stay for three days. In 1048 patients (51.9%) clinical recovery was observed at first follow-up (7 days); 48% had recovered at the 2nd follow-up (14 days). In 1608 patients (98%) anatomical recovery was observed at the follow-up three months after surgery. Patient satisfaction 6 month after operation was high in 79%; good in 27%; low in 1%. These results seems confirm the feasibility of proctological day surgery in almost all patients, with both a considerably cost reduction and enhanced patient comfort and compliance.

[Simultaneous bilateral pneumothorax. Case report]. / Presentazione di un caso di pneumotorace a contemporanea insorgenza bilaterale.

A case report of a 44 year-old white man admitted to the surgical unit for a bilateral simultaneous pneumothorax is presented. The pneumothorax occurred on day one after a surgical operation for discal hernia; in the past the patient already presented a right spontaneous pneumothorax at 32 years of age and a left pneumothorax at 37 years of age, both treated with a pleural drainage. A thoracic drain was bilaterally positioned with a good result only in the right side. The persistence of the left pneumothorax induced the authors to perform a postero-lateral thoracotomy bullae excision and pleurectomy with a good postoperative course. After a few months a new right pneumothorax occurred and the patient was treated with a right postero-lateral thoracotomy, bullae resection and pleurectomy. On the basis of the case reported, the authors consider the different opportunities in the treatment of spontaneous pneumothorax in relation to the present knowledges and technologies. Surgical procedure is to be preferred in case of persistence of pneumothorax despite a pleural drain and in case of pneumothorax in high risk subjects. Even if thoracoscopy seems to give better results regarding postoperative pain, it is not always possible with such a method to perform a careful pleurectomy neither to obtain it in all cases (above all in secondary pneumothorax). Every case must then be carefully studied to choose the best treatment at present available.

[The role of the absolute value and "density" of the prostate-specific antigen estimated echographically in the selection of patients to undergo a biopsy in suspected prostatic carcinoma. A comparison between PSA, palpation and echography in 95 patients undergoing echo-guided endorectal prostatic biopsy]. / Ruolo del valore assoluto e della "densità" dell'antigene prostatico specifico, valutata ecograficamente, nella selezione dei pazienti da sottoporre a biopsia nel sospetto di carcinoma prostatico. Confronto tra PSA, palpazione ed ecografia in 95 pazienti sottoposti a biopsia prostatica endorettale ecoguidata.

We retrospectively reviewed the findings relative to 95 patients with known prostate specific antigen (PSA) values who had undergone digital rectal examination, transrectal US and US-guided biopsy for suspected prostate carcinoma. Histology (48 adenocarcinomas, 26 BPHs, 12 inflammations and 9 negatives) was compared with results from rectal examination, prostate US, PSA values and "density" (PSA/prostatic volume, as measured with US). PSA values < 4 ng/ml exhibited 90% negative predictive value and PSA > 10 ng/ml 70.8% positive predictive value. In the intermediate range (4-9.9 ng/ml) the positive predictive value of PSA was 44.4% and its negative predictive value was 55.5%. PSA density did not affect predictive values in the two groups with PSA < 4 and > 10 ng/ml, while in the intermediate 4-9.9 ng/ml group, positive predictive value raised to 62.5% and negative predictive value to 81.8%, thus increasing the specificity of PSA values and US findings. Our results suggest that PSA should be the examination of choice in the patients with prostatic disease. Follow-up with PSA dosage after one year may be suggested when PSA < 4 ng/ml. PSA density can be helpful in patients with PSA values ranging 4-9.9 ng/ml; biopsy should be performed when the index > 0.15, while follow-up at 6 months should be performed when the index < 0.15. PSA values > 10 ng/ml require further evaluation with rectal examinations, prostate US and US-guided biopsy. Random biopsies are suggested when PSA values are > 20 ng/ml.

Correlation between amniotic levels of alpha-MSH, ACTH and beta-endorphin in late gestation and labour in normal and complicated pregnancies.

alpha-MSH, ACTH and beta-endorphin were measured by radioimmunoassay in samples of amniotic fluid collected from the 32nd to the 38th gestational week and at labour from normal pregnancies and pregnancies complicated by gestosis. In normal pregnancies, the concentration of alpha-MSH, ACTH and beta-endorphin remained relatively constant during the last 7 gestational weeks, but increased at labour above the values of the 38th week by 88, 143 and 96%, respectively. A positive correlation between beta-endorphin and alpha-MSH (r = 0.92) or ACTH (r = 0.76) levels was found when labour values were considered in the regression analysis. In contrast, when labour values were excluded, only a poor positive correlation between beta-endorphin and alpha-MSH (r = 0.52) was found. In complicated pregnancies, alpha-MSH and ACTH concentrations were similar to those found in normal pregnancies: on the other hand, the level of beta-endorphin, was found to be 130% higher than normal. As in normal pregnancies, alpha-MSH, ACTH and beta-endorphin levels increased at labour, but only by 46, 44 and 23%, respectively. In contrast to in normal pregnancies, the correlation between beta-endorphin and alpha-MSH or ACTH was not significantly modified by labour values. The present results confirm and extend previous studies showing that beta-endorphin may be considered a marker of fetal distress and that the fetal pituitary is capable of reacting to stressful stimuli in normal and suffering fetuses.

Plasma alpha-melanocyte-stimulating hormone during the menstrual cycle in women.

alpha-Melanocyte-stimulating hormone (alpha-MSH) and adrenocorticotropin (ACTH) immunoreactivity (IR) was measured in the blood of 22 healthy women with normal ovulatory process in the early and late follicular (near to ovulation) phases and in the early luteal phase of the menstrual cycle. Plasma alpha-MSH IR ranged from undetectable values to 81.3 pg/ml, the highest levels being found in the late follicular phase (15.52 +/- 4.16 pg/ml). In contrast, plasma ACTH IR was always detectable (range: 18.5-63.2 pg/ml), but its concentration did not differ significantly between the 3 phases of the menstrual cycle. High-pressure liquid chromatography fractionation of Sep pak C18-purified alpha-MSH IR revealed in all 3 phases the presence of 3 major peaks of alpha-MSH IR, coeluting with desacetyl-alpha-MSH, alpha-MSH and diacetyl-alpha-MSH, respectively. The most abundant peak always coeluted with authentic desacetyl-alpha-MSH, and the ratio between this deacetylated and the other 2 acetylated forms was similar in the 2 follicular phases (1:1.25 and 1:1.16 in the early and late phase, respectively), but significantly different in the luteal phase (1:0.48). The fluctuations in plasma concentration of the above MSH-related peptides suggest that different rates of alpha-MSH acetylation and release take place in the pituitary gland depending on the phase of the menstrual cycle.

Des-acetyl-alpha-MSH and not alpha-MSH is the major form of alpha-MSH in amniotic fluid.

Immunoreactive alpha-melanocyte stimulating hormone (IR-alpha-MSH)-like activity was measured by radioimmunoassay (RIA) in at term pregnancy amniotic fluid prior and after adsorption on a Sep-pak C18 cartridge. alpha-MSH activity was 3-4 times lower after Sep-pak purification but, unlike the levels of IR-alpha-MSH in the fluid analyzed in toto, increased linearly with the volume of fluid analyzed. Furthermore, fractionation by high pressure liquid chromatography (HPLC) revealed that IR-alpha-MSH recovered from the Sep-pak was due to several peptides rather than to a single peptide. The most abundant of them (50% of total activity) behaved like authentic des-acetyl-alpha-MSH. Since des-acetyl-alpha-MSH is also the most abundant alpha-MSH-like peptide in the fetal pituitary gland, the present results suggest that the fetal pituitary is a main source of des-acetyl-alpha-MSH in the amniotic fluid.

Effect of thyrotropin-releasing hormone in pituitary-thyroid system function infertile women after surgical castration.

The Authors evaluate the effect of surgical castration on thyroid function of fertile women, and the response of TSH to TRH before and 30 days after castration.

Haematological and obstetric aspects of antenatal diagnosis of beta-thalassaemia: experience with 200 cases.

The results of 200 antenatal diagnoses in pregnancies at risk for homozygous beta-thalassaemia, carried out on fetal blood samples obtained by placental aspiration in the second trimester, are described. Globin chain synthesis in the fetuses was measured by means of 3H-leucine incorporation and separation of the chains on carboxy-methyl-cellulose columns. Fetal red cell enrichment was performed by NH4Cl-NH4HCO3 differential lysis of maternal cells or anti-i differential agglutination. Sufficient fetal blood for analysis was obtained in 97.5% of the cases. The overall fetal loss rate was 6.5%, but it declined from 10% in the first consecutive 100 cases to 3% in the last 100 cases. Fetal loss was the result of early or late intrauterine death or spontaneous abortion. Forty-two homozygous fetuses had no beta-chain synthesis and one had a very low beta/gamma ratio (0.005). Of the pregnancies, 37 were terminated at parental request and four aborted spontaneously. Absence of beta-chain radioactivity was confirmed in 12 abortuses with suitable cord blood samples for analysis. Two pregnancies with homozygous fetuses were not terminated, as one member of each couple was a devout Catholic. As expected, both infants developed Cooley's anaemia. Follow-up of the 146 infants, diagnosed in utero as non-homozygotes, showed cerebral palsy in one and a small cutaneous needle injury in three. None of these developed homozygous beta-thalassaemia. Even beta-thalassaemia trait with a beta/gamma ratio of 0.046 +/- 0.012 can be distinguished from normal, showing a beta/gamma ratio of 0.086 +/- 0.019 with a high degree of certainty.

Variations of plasma CEA levels in gynecologic malignancies: incidence, significance and changes occurring in response to therapy.

Serial carcinoembryonic antigen (CEA) radioimmunoassay were performed on 84 patients with primary gynecologic malignancies using the double antibody method. A positive correlation between the marker levels and tumor stage was found in the subjects with invasive disease: the incidence of positive values is appreciably higher in the advanced stages of malignancies. The surgical resection normalized the pretreatment elevated levels: fluctuating CEA values were observed during chemio or radiotherapy. The findings of this investigation support the theory of the limited usefulness of the CEA levels as a diagnostic test in patients with gynecologic cancer. The determination would appear to be helpful only in case with an elevated plasma values at the time of diagnosis. The CEA test seems to indicate that serial plasma assays can be of large interest in the follow-up of this women and for the second-look surgery, chemio and radiant therapy.

Decrease in human plasma prolactin levels by oral prostaglandin E2 in early puerperium.

Eight milligrams of prostaglandin E2 (PGE2; 2 mg every 30 min) were given orally to 12 puerperal women on day 4 after delivery. Plasma levels of prolactin showed a significant decrease in comparison with basal levels and with those of controls sampled over a similar period. The same dose of PGE2 was ineffective in modifying the plasma prolactin levels in four puerperal women on day 30 after delivery and in four non-pregnant women with normal levels of prolactin. It is suggested that a PGE2-induced decrease in prolactin could be mediated by hypothalamic dopaminergic neurones.

[Clinical significance of a prolonged sinus-node recovery time as the only pathological finding: follow-up]. / Significato clinico di un tempo di recupero del nodo del seno allungato come unico dato patologico: follow-up.

The Authors report their experience related to clinical follow-up (F.U.) study of a 12 patients group who showed a prolonged sinus node recovery time (SNRT) as the only pathologic datum. F.U. study appears extremely useful for clinical arrangement of these patients. In 6 patients a gastric ulcer was associated, which is considered a morbid equivalent of vagotonia. Therefore SNRT could be a false positive. In 3 patients following controls allow to document an initial ischemic cardiopathy. Tachicardic phase of S.S.S. was documented in 3 patients.

Prenatal diagnosis of beta thalassaemia by fetal red cell enrichment with NH4-Cl-NH4HCO3 differential lysis of maternal cells.

Prenatal diagnosis with globin chain synthesis analysis on fetal red blood cells concentrated by NH4Cl-NH4HCO3 differential lysis of maternal cells (Orskov lysis) was carried out in 27 pregnancies at risk for beta thalassaemia and one at risk for sickle cell beta0 thalassaemia. The beta/gamma globin chain synthesis ratio was also determined after anti-i-differential agglutination (12 cases), in almost pure fetal samples (sic cases) and by extrapolation (one case). Differential lysis permitted the study of samples drawn by placental aspiration containing as little as 3.2% fetal red blood cells. There was no consistent difference between the beta/gamma ratios observed after differentail lysis and those determined after the use of the other approaches. A presumptive diagnosis of homozygous beta thalassaemia was made in nine cases. All but one of these pregnancies was terminated. The absence of beta chain synthesis was confirmed by the study of fetal blood after abortion in four cases with suitable samples. Of the remaining pregnancies, six proceeded to term and non-homozygous infants were delivered. The others are still in progress. No fetal loss occurred. Orskov lysis seems to be a very reliable method for prenatal diagnosis of beta chain abnormalities. Moreover it can minimize the number and duration of placental aspirations required and thus the risk to the fetus.

[Malfunction of disc prostheses. Echocardiographic study of 5 cases (author's transl)]. / Malfunzionamento di protesi a disco. Studio ecocardiografico di cinque casi.

78 patients who underwent disc prostheses replacement, 36 in mitral area, 58 in aortic area were studied by echocardiography. The Authors found 5 cases of malfunction, 3 in mitral area and 2 in aortic area. Regarding mitral malfunctions in 1 case a valve thrombosis was found; in 2 cases there was a partial leak. Regarding aortic malfunctions there was paravalvular leak. In mitral area malfunctions the Authors found alterations of the disc morphology during diastolic opening time associated with alteration of opening time. An increased diastolic closure velocity in 2 cases of paraprosthetic leak was found. A diagnostic element in the case with thrombosis was variability of maximal disc escursion during the same recording, because opening time variability never got over 10 m. seconds. In aortic area malfunctions the Authors found a constant fluttering of anterior mitral leaflet, a sinergic septal motion with the posterior wall and in 1 case the presence of disc opening before the first component of the first sound. The Authors underline the importance of simultaneous eco-phonocardiographic examination and the check-ups for the time to be.

Prenatal diagnosis of beta thalassemia: experience with 133 cases and the effect of fetal blood sampling on child development.

Prenatal diagnosis was attempted in 133 pregnancies at risk for beta thalassemia (132 cases) or sickle-cell beta 0 thalassemia (1 case). Of these, 76 couples requested diagnosis because they already had children affected with homozygote beta thalassemia (72 cases) or beta+ thalassemia (4 cases). The others were probably at risk for beta 0 thalassemia since this is by far the predominant thalassemia type in Sardinia. Sufficient fetal blood for analysis was obtained by placental aspiration at 18--24 weeks gestation in 130 cases. Ten fetal losses occurred. The pregnancies were followed and no relevant complications were seen. Of the newborns delivered, 45 were followed from birth with particular attention to congenital malformation, neurological, growth, and maturity assessement. No major adverse effect of placentocentesis on child growth and development was observed. Placental samples were analyzed by globin chain synthesis analysis on carboxylmethylcellulose columns. When the placental samples contained more than 20% maternal red cells, fetal red cell enrichment was carried out by anti-i (53 cases) or anti-AB (2 cases) differential agglutination or NH4Cl-NH4HCO3 differential lysis of maternal cells (17 cases). Of the 130 cases, 32 fetuses had no beta-chain radioactivity and one had a beta/gamma ratio of 0.005. These were presumed to be homozygous and all but one were electively aborted. Absence of beta-chain radioactivity was confirmed in 10 abortuses with suitable cord blood samples. A total of 91 infants have been born and are nonhomozygous. Genotype assessment at 6 months after birth in 33 infants showed that there was only a slight overlap between the ranges of normal (0.095 +/- 0.016) and heterozygous (0.05 +/- 0.01) fetal beta/gamma globin chain synthesis ratios.

[Induction of therapeutic abortion with intravenous administration of prostaglandin F 2-alpha]. / Induzione dell'aborto terapeutico con prostaglandina F2 alpha per via endovenosa.

PIP: 24 women, aged 22-41, with parity 0-4, and between the 8-24 week of pregnancy, underwent therapeutic termination of pregnancy by intravenous injection of prostaglandin F2 alpha. There were 23 complete abortions in a relatively short time. No serious complications were observed, although most patients suffered from nausea, vomiting, and diarrhea. This technique proved to be much safer and effective than other techniques previously experimented.^ieng