[Listeria monocytogenes meningitis. Description of a clinically significant case]. / Meningite da listeria monocytogenes. Descrizione di un caso clinico significativo.

Meningitis caused by Listeria monocytogenes is a rare affection: it develops from close contagion as professional illness (veterinarians, butchers) or in newborns by infected mothers; in indirect way for ingestion of contaminated food in subjects at high risk: elderly, immunosuppressed patients, alcoholics, diabetics. Clinically it is not diversified from the other bacterial meningitises. In this paper we present a case of Listeria monocytogenes meningitis in an adult female, without a sure occasion of infection and in absence of the factors of typical risk.

Pharmacological profile of dextrorphan.

Dextrorphan (CAS 125-73-5) is the active metabolite of the antitussive agent dextromethorphan (CAS 125-71-3). The activity of dextromethorphan, its specific pharmacology, acute toxicity and general pharmacology in respect to the central nervous system were investigated in comparison to dextromethorphan. The studies showed that dextrorphan exerts an antitussive activity comparable to the one of dextromethorphan, but a better tolerability and a lower toxicity. These results suggest to use dextrorphan instead of its precursor dextromethorphan in therapy.

Dextrorphan and dextromethorphan: comparative antitussive effects on guinea pigs.

Dextromethorphan, after administration, is rapidly and extensively transformed into dextrorphan. The aim of this study was to compare the cough-suppressing activity of 6, 12, 24, 48 mg/kg, i.p., of dextrorphan (dextro rotatory isomer of racemorphan) with that of dextromethorphan, using the model of citric acid-induced coughing in the unanaesthetized, unrestrained guinea pig. A significant dose-effect relationship of dextrorphan in reducing citric acid-induced cough was observed. This effect was comparable with that of dextromethorphan. However, at 48 mg/kg, i.p., dextromethorphan had a toxic effect while dextrorphan did not. Because dextrorphan is the major metabolite of dextromethorphan and has antitussive activity comparable to that of dextromethorphan, clinical use of dextrorphan is suggested.

Comparative pharmacokinetics of oral dextromethorphan and dextrorphan in the rabbit.

The pharmacokinetics of dextromethorphan (CAS 125-71-3) and its metabolite dextrorphan (CAS 125-73-5) was compared. The drugs were administered orally at the same molar dose of 0.085 mmol/kg. Plasma levels of dextromethorphan, dextrorphan, and metabolites 3-hydroxymorphinan and 3-methoxymorphinan were determined by HPLC with fluorimetric detection. Dextromethorphan was rapidly and extensively metabolized and the plasma profiles of dextrorphan, administered directly or as metabolite of dextromethorphan, were similar. The concentrations of 3-hydroxymorphinan were higher after dextromethorphan than dextrorphan. 3-Methoxymorphinan was detectable only 60 and 120 min after dextromethorphan. This work proposes the therapeutic use of dextrorphan instead of its precursor dextromethorphan.

Effects of metoxibutropate, ibuprofen and guaiacol on the gastrointestinal system.

In previous studies we have shown that ibuprofen, guaiacol and the guaiacol ester of ibuprofen (I.N.N. metoxibutropate) are able to inhibit in-vitro prostaglandin synthesis. In the present study we have evaluated the effect of ibuprofen, guaiacol and metoxibutropate on the gastrointestinal system. Oral treatment with equimolar increasing doses of the three drugs produced a progressive inhibition of prostaglandin biosynthesis in the intestinal tract, without any effect on the rate of intestinal propulsion. Further studies evaluated the gastric tolerance of a molar dose of ibuprofen causing ulceration in 50% of the animals. After single and repeated administration of guaiacol and of the guaiacol ester of ibuprofen, the percentage of animals with gastric damage was very low and the index of ulceration seemed rather moderate. Our results show that although guaiacol is able to inhibit prostaglandin biosynthesis like a classic NSAID, it does not induce gastric damage. For these reasons it is justified to combine guaiacol with ibuprofen in order to reduce gastric erosions induced by a classic antiinflammatory drug.

Pharmacokinetic study of neostigmine after intranasal and intravenous administration in the guinea pig.

It is well known that the nasal route may be an effective alternative to the administration of drugs poorly absorbed via oral administration. Thus an investigation of neostigmine bioavailability after nasal administration was undertaken. The neostigmine kinetic profiles after nasal and intravenous administration in the guinea pig have been compared, and results indicate good nasal absorption of neostigmine. At the same dose, no significant differences have been noticed between the two administration routes, as the area under the curve and the bioavailability index is close to 100%. Moreover nasal administration shows a longer plasmatic elimination compared with the i.v. route (t1/2 beta e.n. = 160.04 min; t1/2 beta i.v. = 23.35 min). Nasal absorption is observed to be dose-related. The present results suggest that nasal administration of neostigmine may be an effective clinical means in Myasthenia gravis therapy.

[Rheumatoid arthritis with cervical localization. Description of a case with neurological symptomatology and review of the literature]. / L'artrite reumatoide a localizzazione cervicale. Descrizione di un caso con sintomatologia neurologica e revisione della letteratura.

A case of a patient with rheumatoid arthritis with a cranio-cervical junction involvement is presented. Medullary compression was present and was partially invalidating. Radiological and CT scan signs are explained and their relationship with a clinical symptomatology is discussed. The importance of radiological monitoring is emphasised in order to avoid dangerous neurological complications.

[Risk factors and sensitivity to certain antibiotics in hospital urinary infections]. / Fattori di rischio e sensibilità ad alcuni chemioantibiotici nelle infezioni urinarie ospedaliere.

Urinary infections contracted in hospital are one of the most important health problems. The present paper looks at 549 hospitalised patients and 548 subjects referred to the laboratory for routine tests over a period of 6 months. The results showed a higher number of hospital infections in the Medicine Department and this number was directly proportional to certain risk factors such as the presence of a catheter at home, the greater age of patients and a poorer physical condition. The strains most frequently isolated were E. coli and Pseudomonas spp although percentages were different between out-patients and hospitalised patients. The infections in question might be reduced and, at least partially, controlled by means of stricter hygiene on the part of personnel and by a moderate use of vesical catheterism.

[Erythrocyte indices in smokers and heroin addicts]. / Indici eritrocitari in fumatori ed eroinomani.

Red blood cells values of 100 male heroin addicts, 100 male smokers and 100 normal men, all of like age, have been examined. Nearly all of the heroin addicts are heavy cigarette smokers. The GRC/mm3, Hb g%, Ht%, MCHC and MCV values did not show significant statistical differences between the three groups, except the MCV in the average appeared 2,8 mu3 higher in the smokers, than the normal non smokers. In heroin addicts there did not appear any variation related to abnormalities in liver function and dependency life time. The differences between the results of our studies and the literature are determined from a longer exposition to the damage caused from heroin and smoke.

[Achalasia caused by infiltrating carcinoma of the esophagus. Clinical case and physiopathological considerations]. / Acalasia secondaria a carcinoma infiltrante l'esofago. Caso clinico e considerazioni fisiopatologiche.

A case of symptomatic esophageal achalasia due to a slowly growing neoplastic infiltration of the esophageal wall by a mammary indifferentiated carcinoma operated ten years before is presented. At admission, the clinical history and the endoscopic appearance of the esophageal lumen and mucosa led to the diagnosis of idiopathic achalasia, while the esophageal manometry showed a rather long high pressure zone (6--8 cm), which did not relax with deglutition. Barium study confirmed the length of the achalasic tract. Only thoracotomy permitted a correct diagnosis. On the basis of this case achalasia is thus considered as a syndrome which can be either idiopathic or secondary to Trypanosoma cruzi, high troncular vagotomy, benign or malignant tumor infiltrating the esophageal wall. The difficult diagnosis of some cases from the clinical point of view is underlined. Stress is laid on the necessity that all findings (history, radiology, endoscopy, manometry) be carefully evaluated to reach a preoperative diagnosis.