Intravenous infusion of magnesium sulphate during subarachnoid anaesthesia in hip surgery and its effect on postoperative analgesia: our experience.

The treatment of degenerative hip joint disease involves modern operative techniques and the use of prosthetic devices individualized on each patient. Being a surgery of considerable importance, great attention is always given by the anaesthesiologist to postoperative analgesia. In general, our goal is to limit the doses of NSAIDs, known to be associated with haemostasis interference and alteration of gastrointestinal apparatus; component of our baseline analgesic protocols after arthroplasty is morphine given parenterally. In order to steadily improve analgesic techniques, which directly impact on patient outcome, we experimented the use of a continuous infusion of magnesium sulphate during subarachnoid anaesthesia. Magnesium sulphate is the drug of choice in case of eclampsia, and pre-eclampsia (for the risk of evolution in eclampsia). According to the most recent findings, this drug has also analgesic properties: its use as an adjunct to analgesia is based on a non-competitive antagonism towards the NMDA receptor and on the blocking of calcium channels: these properties prevent the mechanisms of central sensitization due to nociceptive stimulation of peripheral nerves.

18FDG uptake in sinonasal inverted papilloma detected by positron emission tomography/computed tomography.

Inverted papilloma (IP) is a benign but locally aggressive sinonasal tumour. Aggressive surgical treatment has thus been traditionally recommended because of the risk of transformation in squamous carcinoma. CT and MRI are used to evaluate bone destruction and soft-tissue extension before surgery but may be ineffective to differentiate an inverted papilloma from squamous cell carcinoma. In recent years, F-18 Fluorodeoxyglucose positron emission tomography ((18)FDG-PET) is widely used as diffuse imaging procedure for diagnosis and followup of malignancy affecting the head and neck district. To evaluate the utility of (18)FDG-PET/CT in the diagnosis of patients with suspicious lesions for IP, twelve patients with suspicious sinonasal inverted papilloma were selected for this study. (18)FDG-PET/CT imaging was performed, and standard uptake value (SUV) was calculated for each patient. SUV(max) was considered as the maximum value measured in the visualized lesions. Seven of the twelve cases exhibited uptake of (18)FFDG with an SUV(max) ranging from 1 to 8.1. Histopathologic diagnosis after surgery confirmed the diagnosis of IP in five cases; all these cases had an SUV(max) > 3. The five cases, which exhibited absence of (18)FDG uptake, had a histological diagnosis of absence of IP.

The usefulness of toluidine staining as a diagnostic tool for precancerous and cancerous oropharyngeal and oral cavity lesions.

Toluidine blue stain is used as a marker to differentiate lesions at high risk of progression in order to improve early diagnosis of oropharyngeal carcinomas. This study focused on 45 oral mucosal lesions in 32 patients (13 female, 19 male). In 9 cases, multiple biopsies were collected. Of the 45 lesions examined, 26 (57.0%) were defined clinically benign, while 19 (42.3%) were defined as suspected lesions (premalignant or malignant). According to the clinical examination, the sensitivity was 53% (16/30) and for toluidine blue staining 96.2% (26/27) (p = 0.0007). The specificity was 80% (12/15) for clinical examination and 77.7% (14/15) for toluidine blue staining (p = 0.79). In conclusion toluidine blue stain has been shown to be a reliable aid when clinical examination is unable to differentiate lesions at high risk of progression and then it improves early diagnosis for oral cavity and oropharyngeal cancer.

Mutations and polymorphisms in mitochondrial DNA in head and neck cancer cell lines.

Changes in mitochondrial DNA have been reported in cancer cells. Since little information exists regarding mt DNA mutations in head and neck, the present study focused on ten head and neck cancer cell lines in the attempt to detect alterations in the ND4 gene sequence. DNA was extracted from 10 head and neck squamous cell carcinoma lines from 9 patients. MtDNA sequences were compared in normal and tumour cell line DNA. In ten head and neck squamous cell carcinoma cell lines, 8 somatic mutations and 5 polymorphisms of the mitochondrial gene for ND4 were found. All 5 polymorphisms were silent. Of the 8 somatic mutations, 3 altered the amino acid sequence suggesting a possible effect on enzyme function. The mitochondrial mutations and polymorphisms found demonstrated that these can serve as clonal markers for individual cell lines and demonstrate that the mitochondrial genome remains stable in the cell lines during in vitro culture.

Ectopia lentis et pupillae with patchy depigmentation of the skin, hair and lashes: a new association.

We describe a case of a four year-old boy, with congenital ectopia lentis et pupillae, who developed patchy unilateral depigmentation of the skin, hair and lashes. The association between ectopia lentis et pupillae and transillumination of the iris is well documented in the literature, but it has never been reported with skin hypopigmentation.

Ocular pharmacokinetics of rufloxacin a new fluoroquinolone antibiotic.

Ocular pharmacokinetics of rufloxacin (MF 934), a new monofluorinated quinolone derivative, has been investigated in rabbits. A long half-life, good g.i. absorption and a higher tissue/plasma concentration than that of other quinolones, are its interesting pharmacokinetic properties. However, there is reason to believe that drug accumulation may occur in deep body compartments. We determined plasma, aqueous, and vitreous concentrations of the drug at 1, 4, 8, and 24h after a single 50 mg/kg i.v. administration of rufloxacin. Our data show that rufloxacin, administered by the i.v. route, rapidly reaches chemotherapeutically useful levels in aqueous and vitreous fluids. Although still present in plasma 8 hours after administration, it proved to be undetectable in ocular fluids, signifying that the depletion of the deep compartments occurs well in advance of the next invasion. Due to its antibacterial effectiveness and pharmacokinetic properties rufloxacin may take a relevant place among the quinolone derivatives in the treatment of ocular infections.

[Diagnosis of sensorineural hearing loss by ipsilateral masking of brain stem auditory evoked potentials]. / La diagnosi delle ipoacusie neurosensoriali mediante il mascheramento ipsilaterale dei potenziali evocate acustici del tronco encefalico.

The Authors show their original technique for the differential diagnosis of cochlear and retrocochlear hearing loss which employs ipsilateral masking of the A.B.R. in order to define the difference in V wave latency between a standard technique (clicks at 21 pps without noise) and a sensitized technique (clicks at 21 pps with noise at S/N of +40). This difference in latency has been named Sensitizing Latency Difference (SLD). Sixty normal subjects, 85 patients with cochlear hearing loss and 6 with retrocochlear hearing loss, were studied. The obtained data showed a SLD value: in normal hearing of: a) 0.31 msec. (+/- 0.14 SD) from 18 to 40 years old; b) 0.36 msec. (+/- 0.26 SD) from 41 to 60 years old; c) 0.48 msec. (+/- 0.21 SD) over 60 years old; in patients with cochlear hearing loss 0.12 msec. (+/- 0.14 SD) in 2 subjects affected by retrocochlear hearing loss a value superior to 1.5 msec. in the other 4 cases the V waves disappeared during recording of the sensitized test. A differential value of 1 msec. between cochlear and retrocochlear hearing loss was established by the Authors who with this value correctly identified all the patients with retrocochlear hearing loss and 97.8% of the subjects with cochlear hearing loss. An incorrect diagnosis of the hearing loss origin (false positives) was made in 2.2% of the patients with cochlear hearing loss. In conclusion, the Authors feel that the SLD evaluation, in consideration of its large clinical utility and of the high reliability of obtained data, is a particularly useful test in making a differential diagnosis between cochlear and retrocochlear hearing loss.

Narcolepsy and psychopathology. A case report.

The case of a 14-year-old girl presenting with the association of a clearcut narcoleptic syndrome and psychiatric disturbances is reported. Tricyclic anti-depressant drugs and hypnagogic hallucinations seem to play a precipitating role on delusional episodes in a predisposed subject with a positive psychiatric familial history.

Vascular compression from goiter as an unusual cause of cerebrovascular accident.

The unusual case of a patient with goiter and left faciobrachiocrural paresis due to right temporoparietal infarction is reported. Cerebral angioscintigram and arteriography showed a brachiocephalic and right subclavian stenosis secondary to compression by an extended thyroid nodule.

Skin and perivascular toxicity induced experimentally by doxorubicin.

Extravasation of antitumor drugs and particularly doxorubicin (DXR) can be followed by skin ulceration and slowly evolving perivascular necrosis. DXR lesions have some characteristics in common with those induced by ionizing radiation and, with respect to gross morphology, are reminiscent of skin lesions induced by necrotizing agents. Time course and histopathology of toxic phenomena induced by intradermal or perivascular injection of various doses of either DXR or caustic chemicals have been studied in hairy outbred and hairless inbred (MF1 hr/hr) mice. The latter strain has been found to be intrinsically more sensitive to DXR induced toxic effects, particularly as far as perivascular administration is concerned. Long lasting lesions and, in a few cases, systemic involvement have been observed. On the contrary, necrotic foci induced by caustic chemicals rapidly regressed in both strains. The perivascular administration model, which has not been previously investigated, appears to be representative of what happens in clinical conditions and can be of use for assessing either skin toxicity of antitumor compound or the protective effect of candidate antidotes.

Thrombolytic activity of defibrotide: a morphometric evaluation in experimental venous thrombosis.

We have studied the morphometric aspects of the thrombolytic activity of Defibrotide in experimental venous thrombosis induced by inserting a collagen-coated nylon thread into the femoral vein of rabbits. 24 hours after thrombus induction Defibrotide decreases the size of thrombi by a factor of 6; stimulation of fibrinolysis and inhibition of platelet and leucocyte recruitment are prominent. Size of the thrombus, extension of the fibrin net and platelet adhesion are also modified by Defibrotide in 7-day-old thrombi where granulation tissue has replaced the original coagulum.

Wakefulness and sleep autonomic dysfunction in diabetics.

Parasympathetic and sympathetic controls on cardiovascular systems were studied during wakefulness and sleep in 8 diabetic patients (3 IDDM and 5 NIDDM), in order to detect the presence of autonomic dysfunction. In particular, cardiovascular assessment during sleep allowed to detect minimal autonomic abnormalities in the absence of a documented pathology during wakefulness.

Paroxysmal electroencephalographic abnormalities genetically transmitted: one family description.

A 10-year-old girl came to our observation since a general rule-out electroencephalogram (EEG) had showed, in absence of any clinical manifestation, generalized and symmetrical 3 c/s spike-and-wave bursts, whose duration was longer than 3 s. The subject, only daughter born from her mother's first marriage, had no family history of neurological diseases; her physical and neuropsychological examinations were normal. A polysomnographic recording showed, during sleep, the same abnormalities observed during wakefulness. Also on this occasion, there were no related clinical manifestations. Subsequent recordings were performed on her 33-year-old mother and on two siblings, 3 and 2 years old, respectively, born from their mother's second marriage, all normal by physical and neuropsychological examinations, with no referral about clinical seizures. Among them, the 3-year-old sister showed asymptomatic left rolandic spikes, while the 2-year-old boy, whose EEG was firstly normal, displayed, 1 year later, a burst of generalized 3 c/s spike-and-wave paroxysmal activity on a 4-7 c/s background activity. The possible unitary genetic transmission of paroxysmal EEG abnormalities is discussed.

[Adhesive technology and preparations for composites in the anterior sector]. / Tecnología adhesiva y preparaciónes para composites en el sector anterior.

The authors analyzec the possibility of introducing modifications in the traditional cavity designs for Class 3, 4 and 5 restorations using present adhesive techniques for bonding reinforced composite resins to tooth tissues. The concepts followed by classic authors are reviewed, compared to the characteristics recommended for new preparations and bases for their use are considered. It is concluded that it is possible to use more conservative and smaller preparations.

Tecnología adhesiva y preparaciónes para composites en el sector anterior. / [Adhesive technology and preparations for composites in the anterior sector]

The authors analyzec the possibility of introducing modifications in the traditional cavity designs for Class 3, 4 and 5 restorations using present adhesive techniques for bonding reinforced composite resins to tooth tissues. The concepts followed by classic authors are reviewed, compared to the characteristics recommended for new preparations and bases for their use are considered. It is concluded that it is possible to use more conservative and smaller preparations.