ACROMORFO study: gait analysis in a cohort of acromegalic patients.

PURPOSE: In acromegaly, skeletal complications resulted to be associated with low quality of life (QoL) and high risk of falls. The aim of the present study was to perform a quantitative assessment of movement through gait analysis technique in patients with acromegaly. STUDY POPULATION: Thirty-three acromegalic patients [9 with active disease (AD), 14 with controlled disease (CD) and 10 with disease remission (RD)] and 20 healthy subjects were enrolled for the study. MEASUREMENTS: Kinetic and kinematic data were collected with 3D-gait analysis. Kinematic data were processed to compute the Gait Profile Score (GPS), a parameter that summarizes the overall deviation of kinematic gait data relative to unaffected population. RESULTS: The acromegalic group showed longer stance phase duration (p < 0.0001) compared to controls. The GPS and several gait variable scores resulted to be statistically higher in the acromegalic group compared to healthy controls. GPS values were significantly higher in AD compared to CD (p < 0.05) and RD groups (p = 0.001). The AD group presented significantly higher values in terms of hip rotation and ankle dorsiflexion compared to CD and RD groups and with regard to the foot progression compared to RD. Interestingly, patients with RD exhibited a more physiological gait pattern. CONCLUSION: Acromegalic patients showed quantitative alterations of gait pattern, suggesting instability and increased risk of falls. Arthropathy, along with its associated abnormal joint loading, proprioceptive impairment and hyperkyphosis could be contributing factors. Disease control and remission appear to improve postural balance. A better knowledge on walking performance in acromegaly would help to develop specific rehabilitation programmes to reduce falls' risk and improve QoL.

Treatment of visceral leishmaniasis in Kenya by aminosidine alone or combined with sodium stibogluconate.

The treatment of leishmaniasis, as currently conducted in Kenya with sodium stibogluconate, is unsatisfactory as it is expensive, resistance and relapses may occur, and major adverse effects have been reported. Recently, aminosidine (paromomycin) sulphate has shown good antileishmanial activity on its own as well as synergism with pentavalent antimony, administered concurrently. The present study was designed to assess the effectiveness of parenteral aminosidine, alone or combined with sodium stibogluconate, in visceral leishmaniasis, compared to treatment by stibogluconate alone. 53 patients were allocated to the 3 therapeutic regimes. The presenting signs and symptoms of leishmaniasis were those commonly seen in the visceral form of the disease, particularly in Kenya. At termination, clinical cures were achieved in all 53 patients with no difference between treatment groups. Spleen aspirates revealed the best parasitological results in patients receiving the combined treatment, with only 13% failures (partial cures + relapses), as opposed to 21% failures with aminosidine alone and 45% with stibogluconate alone. Treatment with aminosidine alone was the cheapest and safest regime.

Comparative study of aminosidine, etophamide and nimorazole, alone or in combination, in the treatment of intestinal amoebiasis in Kenya.

417 patients suffering from intestinal amoebiasis were randomly allocated to 6 different treatment groups in a controlled study in 3 District Hospitals in Kenya. The patients received either aminosidine (A), etophamide (E), nimorazole (N), or the combinations NA, NE, EA. Treatment in all cases was given twice daily for 5 days. Before and after treatment, rectosigmoidoscopy was done in each patient, and stool examination with characterization of invasive (IF) and non invasive (NIF) forms of amoeba was done daily throughout treatment, and on Days 15, 30 and 60 of follow-up. Clinical cure was good after all the treatments, varying from 90 to 100%; parasitological cure at the end of treatment was 100% in the NA and EA treatments groups, and 98% in A group. The incidence of relapses was nil in the EA group, followed by 3% in NA and 6% in A groups. Anatomical cure (healing of ulcers) was 97.8% in the NA group, 95.5% in the N group and 88.5% in the A group. Drug tolerance was excellent or good after all the treatments, except that the EA combination produced diarrhoea in 76.5% of patients. Overall analysis of the findings, including tolerance of the various treatments, showed that aminosidine either alone or in combination with nimorazole gave the best results. Ulcers seen on rectosigmoidoscopy were more common in patients excreting invasive forms of amoebae in their stools.

Drug combinations in the treatment of malaria.

The knowledge of the plasmodium life-cycle is essential for the use of antimalarial drugs and their combinations. The antimalarial drugs currently available can act on one or more stages of parasitic development, but only on its proliferative phases. The combinations of drugs in the treatment of malaria aim at three distinct objectives: a) action on different stages of parasitic life-cycle; b) enhancement of antiparasitic activity; and c) prevention of drug resistance. In this regard, complementary, additive and potentiating combinations have been used, sometimes on an empiric basis. The potentiating combinations seem the most logical and effective, but some of them are not rational due to pharmacokinetic differences between the proposed components.

A multi-centre trial comparing a sulfamethopyrazine/trimethoprim combination with co-trimoxazole in respiratory tract infections.

A double-blind, multi-centre trial was carried out in 72 patients with acute or chronic infections of the lower respiratory tract to compare the efficacy and tolerance of a sulfamethopyrazine (200 mg)/trimethoprim (250 mg) combination with that of the established combination co-trimoxazole (400 mg sulphamethoxazole plus 80 mg trimethoprim). Patients received treatment for 10 days either with 2 capsules of co-trimoxazole twice daily or in the newer combination group with 2 capsules on Day 1 but then only 1 capsule daily for the remainder of the treatment period. The results of clinical, bacteriological and functional tests showed an excellent or good response in over 90% of patients in each group. There was no statistically significant difference in effectiveness of treatment with the once-daily sulfamethopyrazine/trimethoprim regime compared with co-trimoxazole given twice daily, and both treatments were well tolerated, with only a few mild side-effects, mainly gastro-intestinal ones, being reported.

[Disturbances of equilibrium in the aged]. / I disturbi dell'equilibrio nella terza età.

The occurrence during the last year of vestibular disorders, faints and drop attacks was investigated in 150 patients consecutively admitted to a geriatric hospital. The clinical features of these episodes were recorded by means of a proper questionnaire. True vertigo and/or feeling of unstable equilibrium were referred by 54,6% of the patients inquired into, whereas episodes interpretable as faints and drop attacks showed by far lower prevalences, respectively 13,3% and 6%. The Authors call attention to the difficulties in differential diagnosis among these three kinds of phenomena in the current practice.

[Juvenile cerebral infarct. Retrospective analysis of risk factors in 78 cases]. / L'infarto cerebrale giovanile. Analisi retrospettiva dei fattori di rischio in 78 casi.

THe records of 78 young adults, who had suffered cerebral infarction, were reviewed with regard to possible pathogenetic mechanisms. Atherosclerosis risk factors appeared to play a major role between the age of 40 and 50, especially in males. Non atherosclerotic factors of cerebral ischemia were found predominant among females under 40, owing to contribution of migraine, oral contraceptive use and pregnancy/puerperium. In 18% of the patients no etiology could be identified.

[Comparative study of the frequency of 6 primitive reflexes in a hospitalized population of aged patients]. / Studio comparativo della frequenza di 6 riflessi primitivi in una popolazione ospedalizzata di età geriatrica.

110 elderly patients, 57 with and 53 without acquired neurological lesions, were examined for the presence of the grasping, snout, sucking, palmomental, glabellar and bulldog reflexes. The results were statistically analyzed by means of the chi2 method. The percentages of the positive reflex responses, although not negligible in the neurologically healthy patients, turned out far higher in the patients with organic cerebral disorders. With the exception of the sucking and palmomental reflexes, these differences appeared statistically significant. As for the neurological diagnosis, diffuse lesions proved themselves more crucial than focal ones. The conclusion is drawn that primitive reflexes should be regarded abnormal only in the context of an overt cerebral pathology.