[Infrared photocoagulation, cryosurgery and laser surgery in hemorrhoidal disease]. / Fotocoagulazione all'infrarosso, criochirurgia e laser chirurgia nella malattia emorroidaria.

The non invasive treatment of hemorrhoidal disease has the best indications for I and II degree symptomatic piles and only in few cases of III and IV degree. Authors report their practice with infra-red-coagulation, cryosurgery and laser surgery, discussing indications, controindications and describing in detail their technique. About laser surgery they emphasize that this procedure is a formal hemorrhoidectomy, and laser acts as a scissor or a blaude.

Clinical and biochemical evidence of skeletal muscle involvement in galactose-1-phosphate uridyl transferase deficiency.

An 8-year-old boy with galactose-1-phosphate uridyl transferase (GALT) deficiency presented with hypotonia, muscle hypotrophy, hepatomegaly, bilateral cataract and mild mental retardation. Two brothers showed a GALT activity consistent with a homozygotic condition and both parents were found to be heterozygotes for this defect. Histological and ultrastructural examination of muscle biopsy specimens showed several necrotic fibres. GALT activity was undetectable in skeletal muscle and muscle tissue cultures; myotubes converted galactose to CO2 at a lower rate than controls. Galactose-1-phosphate was increased in the patient's red cells and muscle tissue. GALT deficiency, not previously described in muscle, may be of pathogenic relevance in determining the myopathic features present in GALT deficiency syndrome.

New basic esters of 2-phenyl-3-methyl-4-oxo-4H-1-benzopyran-8-carboxylic acid endowed with spasmolytic properties. Synthesis and pharmacological-pharmacokinetic evaluation.

In order to obtain new analogs of flavoxate endowed with higher stability and possibly higher potency, a new series of basic esters of 2-phenyl-3-methyl-4-oxo-4H-1-benzopyran-8-carboxylic acid (MFCA) has been prepared and investigated. Derivatives in which the structure of flavoxate was modified by branching and lengthening of the estereal alkyl chain were synthesized, together with the conformationally restricted N-piperidinyl derivatives. Esters containing in their structure various alicyclic tertiary amines which are present in natural or synthetic drugs endowed with spasmolytic properties, mainly of anticholinergic nature, were also prepared. The stability in aqueous solution, acute toxicity in mouse, and in vitro spasmolytic properties of the new compounds were investigated in comparison with flavoxate. Based on the results obtained from this screening procedure, 3 compounds were selected for further investigation. In this phase, further pharmacological and stability testing as well as preliminary animal pharmacokinetic investigations were carried out. The obtained results suggested the choice of 1,1-dimethyl-2-(1-piperidinyl)ethyl 2-phenyl-3-methyl-4-oxo-4H-1-benzopyran-8-carboxylate HCl (Rec 151 2053, terflavoxate, CAS 86433-39-8) as a candidate for preclinical development. The deeper pharmacological characterization of this compound, carried out mainly in comparison with flavoxate, terodiline, and oxybutynin confirmed its good spasmolytic activity.

[Evolution of the bacteria responsible for surgical infection. n 8-year study in our department]. / Evoluzione dei batteri responsabili della sepsi chirurgica. Un'indagine di 8 anni nel nostro reparto.

Since 1981 we monitored all the bacteria strains isolated from patients bearing a surgical infection and hospitalized in our department. We also tested the susceptibility of the isolated strains to different antibiotics. The observed results at three different intervals (1981, 1984, 1987-1988) reveal an increase in Gram+strains. Among the tested antibiotics Imipenem and Amikacin showed the highest antibacterial activity in recent years (1987-1988).

Surgery for severe idiopathic constipation: a report of personal experience

Discute-se protocolo para estudo de tratamento de constipacao idiopatica severa (CIS); 108 pacientes foram assim classificados: 58 com constipacao colica cronica, 30 com transito lento, quatro com megacolon idiopatico, 24 com sindrome de intestino irritavel, 45 com constipacao retal, 21 com obstrucao intestinal baixa, 12 com megareto e 12 com hipertonia do esfincter anal interno, alem de cinco casos de formas mistas. Em sete pacientes com CIS colica (cinco com transito lento e dois com megacolon idiopatico) foi indicado tratamento cirurgico, com realizacao de colectomia subtotal e anastomose ileo-retal. Todos esses doentes evoluiram satisfatoriamente no pos-operatorio...

Hemorrhoidectomy according to Milligan-Morgan: ligature and excision technique.

The author notes of the fundamental principles and particularly the techniques of hemorrhoidectomy according to Milligan-Morgan, adopted with full satisfaction in more than 1,000 cases of third and fourth degree hemorrhoids. Correct indication and a precise, accurate technique based upon the high ligature of the vascular peduncle and on the preservation of the muco-skin bridges, are the essential conditions for the radicality of the intervention in 97% of the cases and for a minimum incidence of morbility. The modifications by Arnous based upon a posterior sphincterectomy with anoplasty in those cases with sphincteric hypertone, and upon the revision of the muco-skin bridges make this technique feasible even in the most complicated cases.

[Results of the use of topical diosmin (venosmine) in the treatment of acute hemorrhoid pathology]. / Risultati dell'uso della diosmina (venosmine) per applicazione topica nel trattamento della patologia acuta emorroidaria.

There is still much discussion about the pharmacological treatment of certain symptoms caused by haemorrhoids and their complications. In 1986 topical treatment with Diosmina ointment was used on 50 patients (33 males, 17 females) with grade 1, 2, 3 or 4 haemorrhoids featuring strangulation and thrombosis. Patients who had previously been given other treatment were excluded from the study. The efficacy of the treatment was assessed by a simple method previously used by others which involves scoring (0-3) the major symptoms of the condition (bleeding, oedema, erythema, pain, itching) according to severity. The drug was most effective on oedema and erythema, producing 75% and 73% improvements as assessed in three consecutive weekly visits. These results confirm the value of Diosmina in the topical treatment of acute haemorrhoids. In particular the treatment is very well tolerated and produces no unwanted side effects if properly used.

Pharmacological activities of the main metabolite of flavoxate 3-methylflavone-8-carboxylic acid.

The pharmacological properties of 3-methylflavone-8-carboxylic acid (MFCA), the main metabolite of flavoxate, have been studied in vitro and in vivo. MFCA did not display antispasmodic activity on isolated organs contractions induced by histamine, acetylcholine or CaCl2, nor did it exhibit significant affinity for the rat brain alpha- and beta-adrenergic, serotoninic, muscarinic, D2, opiate and Ca2+ receptors. However, it showed a remarkable phosphodiesterase (PDE) inhibiting activity. Moreover in vivo studies indicate an interesting activity of MFCA which inhibited the rat urinary bladder voiding contractions, increased bladder volume capacity and decreased micturition pressure in the rat cystometric recordings. The activity of MFCA in the two in vivo experimental models, probably related to cAMP-PDE inhibitory properties, suggests that flavoxate's therapeutical potential might be partially sustained by its main metabolite.

1-(2-pyridinyl)piperazine derivatives with antianaphylactic, antibronchospastic, and mast cell stabilizing activities.

New 1-(2-pyridinyl)piperazine derivatives were synthesized and tested as inhibitors of the reaginic passive cutaneous anaphylaxis in the rat (PCA), of the histamine-induced bronchospasm in the guinea pig, and of the rat mesenteric mast cell degranulation induced by compound 48/80. On the basis of test results, a series of N-(substituted phenyl)-omega-[4-(2-pyridinyl)-1-piperazinyl]alkanamides was prepared. The nature of substituents at the anilide ring strongly influenced mast cell stabilizing activity, whereas it was less determining in the case of the other two tests. No clear correlation between the most common physicochemical parameters (pi, sigma, Vw volume) of substituents and activity could be detected. With regard to the position of substituents at the anilide ring, the rank order of potency, in the PCA and bronchoconstriction tests, was para greater than meta greater than ortho. Introduction of substituents in the 1-(2-pyridinyl)piperazinyl moiety of the N-(substituted phenyl)propanamide derivatives hardly affected activity, or the effect was deleterious. Some of the new compounds exhibited a simultaneous remarkable activity in all the three assays employed.

Determination of denzimol, a new anticonvulsant agent, and its main metabolite in biological material by gas chromatography and high-performance liquid chromatography.

Two methods, using gas chromatography (GC) and high-performance liquid chromatography (HPLC), were developed in order to investigate the pharmacokinetics of denzimol hydrochloride, N-[beta-[4-(beta-phenylethyl)phenyl]-beta-hydroxyethyl] imidazole hydrochloride, which is a new anticonvulsant drug, and of its main metabolite, N-[beta-[4-(beta-phenyl-beta(alpha)-hydroxyethyl)phenyl] -beta-hydroxyethyl]-imidazole (referred to as M2), in humans. Both methods involve the use of a homologue of denzimol as an internal standard. The GC method is more sensitive (sensitivity limit 2.5 ng/ml for denzimol and 15 ng/ml for M2) and was utilized for the determination of denzimol and M2 in plasma. The GC method is specific, precise (relative standard deviations are 3.26, 2.12 and 1.72% at 10, 100 and 1000 ng/ml for denzimol and 6.45, 4.17 and 3.38% at 50, 500 and 1000 ng/ml for M2) and accurate (mean recovery +/- S.D. is 102.58 +/- 4.10% for denzimol and 99.72 +/- 7.75% for M2). The HPLC method is very simple and quick to perform. This method has a sensitivity limit of 0.5 micrograms/ml for denzimol and 1 microgram/ml for M2, and allows the determination of both compounds in urine with high selectivity, reproducibility (relative standard deviations are 2.05, 3.50 and 1.02% for denzimol and 2.78, 2.80 and 1.73% for M2, at concentrations of 15, 35 and 70 micrograms/ml) and accuracy (mean recovery +/- S.D. is 103.57 +/- 2.97% for denzimol and 95.91 +/- 1.59% for M2). The common anticonvulsants, when present in plasma, do not interfere with the monitoring of denzimol levels.

[Subphrenic abscess. Importance of its pathology and ever present diagnostic and therapeutic problems]. / Gli ascessi subfrenici. Interesse di una patologia dalle problematiche diagnostiche e terapeutiche sempre attuali.

Even today subphrenic abscesses constitute a major problem for the surgeons who are at times their involuntary cause. These abscesses are characterised by a high mortality rate and difficulty of treatment. A careful review of the literature and a fortunately modest experience form the basis for an assessment of what has been achieved and what problems still remain with particular reference to new diagnostic and therapeutic techniques.