Attitudes of Italian Infertile Women Toward Ethical and Regulatory Limits of Medically Assisted Procreation (MAP).

Objective: Outline the views of Italian women, with fertility problems, on Medically Assisted Procreation. Methods: We have collected the opinions of 448 infertile women. The items used in the questionnaire were created with a qualitative method based on the Medically Assisted Procreation's most important bioethics issues and on the basis of the limits imposed by Law. The questions of the first part of the questionnaire were open; in the second part was closed ("Yes/No"); for each method they were asked whether they would introduce a legal limit to prohibit it. The tests have been standardized with test-retest method. Results: We found that much of the disputes that have, over time, been made to Law 40 of 2004 by Italian Courts, are shared by patients with infertility problems. Italian women do not share the legal limit for Medically Assisted Procreation in over 43 women, heterologous in-semination with seed donation and egg donation. Moreover, our sample show that Italian women do not share legal limit to pre-implantation genetic diagnosis and cryopreservation of embryos. Moreover, it emerges that many Italian infertile patients disagree with the Medically Assisted Procreation for homosexual couples. Conclusion: It will be important, in the event of a legislative reform in Italy on the Medically Assisted Procreation, also consider the point of view of women with infertility problems.

Tethered cord syndrome.

AIM: Tethered cord syndrome (TCS) is a stretch-induced disorder of the spinal cord. Tethering is due to an inelastic structure anchoring the caudal end of the spinal cord as a short and thick filum terminale. Spinal dysraphism is occasionally associated,but the etiological relationship between these disorders remain unclear. Other anomalies may be concurrently found as hydromielia and Arnold-Chiari malformation. METHODS: The authors analysed neuroradiological findings in 5 children and 9 patients of 20-24 years of age; there were four male and ten female. The criteria for inclusion were neurological disturbances (disorders!) localizable to the level of the conus and evidence for spinal dysraphism. The purpose of this study was to make the precise diagnosis and make also precise planning for therapy, conservative or surgical treatment. RESULTS: The age of diagnosis of TCS varies from under 1 year to 14 years and is very rarely as late as adulthood. TCS can present late and insidiously with progressive gait disturbances, atrophy of various muscle groups or the entire limb, loss of reflexes,loss of sensation in the sacral dermatomes, sphincter disturbances, gait abnormality and pain in the gluteal, perianal and other pelvic areas. The diagnosis involves standard X-RAY examination, CT and CT-Mielography but MRI is now a diagnostic method of choice. Surgical untethering of the cord is recommended. The associated pain responds best to surgical treatment; ambulation and bladder function may improve as well. CONCLUSIONS: However sphincter dysfunction often remains a permanent problem. Given the potential for rapid deterioration with incomplete neurological recovery, even prophilactic surgery seems advisable. The patient need to be followed up, if not operated upon.

2-thiouracil is a selective inhibitor of neuronal nitric oxide synthase antagonising tetrahydrobiopterin-dependent enzyme activation and dimerisation.

2-thiouracil (TU), an established antithyroid drug and melanoma-seeker, was found to selectively inhibit neuronal nitric oxide synthase (nNOS) in a competitive manner (K(i)=20 microM), being inactive on the other NOS isoforms. The drug apparently interfered with the substrate- and tetrahydrobiopterin (BH(4))-binding to the enzyme. It caused a 60% inhibition of H(2)O(2) production in the absence of L-arginine and BH(4), and antagonised BH(4)-induced dimerisation of nNOS, but did not affect cytochrome c reduction. These results open new perspectives in the understanding of the antithyroid action of TU and provide a new lead structure for the development of selective nNOS inhibitors to elucidate the interdependence of the substrate and pteridine sites and to modulate pathologically aberrant NO formation.

Treatment of cerebral arteriovenous malformations with a combination of preoperative embolization and surgery.

Forty-nine patients with cerebral arteriovenous malformations (AVMs) were treated with preoperative embolization followed by resection using a microsurgical approach. In 27 patients, the AVM was located in an eloquent area; in 32 patients, the volume of the AVM was over 20 cm3. Preoperatively, flow-directed embolization was performed in 10 patients (28 procedures), selective embolization with threads was performed in 35 patients (46 procedures), and a combination of flow-directed and selective embolization was performed in 4 patients (12 procedures). The percentage of reduction of the AVM volume averaged 36% after embolization. Five minor complications (transient neurological deficits, in 2 cases associated with ischemic areas on the CT scan) were observed after embolization. The interval between the last embolization and surgery was as follows: within 10 days in 7 patients; between 11 and 20 days in 3 patients; between 21 and 30 days in 10 patients; between 31 and 60 days in 11 patients; and 2 months later in 18 patients. The efficacy of this combined treatment (embolization plus surgery) was evaluated by the incidence of hyperemic complications and the clinical outcome. Hyperemic complications occurred more frequently in patients with an AVM volume greater than 20 cm3. When compared with flow-directed embolization, selective embolization was linked with decreased bleeding during surgery; postoperatively, the incidence of cerebral edema was also lower. Clinical outcome was better after selective embolization, with no occurrence of major deficits and no mortality. When the percentage of reduction of the AVM volume after embolization was 40% or more, the incidence of intraoperative hyperemic complications was lower; moreover, new permanent deficits were never observed in patients with this volume reduction. A retrospective clinical comparison of two groups of patients with similar AVM volumes (greater than 20 cm3)--those given combined treatment (n = 32) versus those treated by direct surgery alone (n = 27)--showed that intraoperative bleeding appeared to decrease in patients treated by embolization; the incidence of postoperative hyperemic complications was not different in the two groups. New major deficits and deaths were less frequent in patients treated by embolization (P = 0.05 for the incidence of major deficits); postoperative epilepsy was also less common in these patients. In conclusion, combined treatment with selective preoperative embolization and direct surgery may help the neurosurgeon in the treatment of large, high-flow AVMs, reducing the risks connected with their surgical removal.

The relevance of anatomic and hemodynamic factors to a classification of cerebral arteriovenous malformations.

Potential prognostic anatomic and hemodynamic factors were evaluated in 248 patients with cerebral arteriovenous malformations (AVMs), all treated by direct microsurgical removal. The size of each AVM was calculated by its volume, obtained by the multiplication of the three AVM diameters by 0.52. A surgical classification of AVM location (in 11 groups) is proposed. Types of feeders and of drainage were classified as superficial or deep; the extent of the drainage system was classified according to a four-degree scale. The mean flow velocity in the main AVM feeder, detected using transcranial Doppler ultrasonography, was used as an indirect measure of AVM shunt flow in a small number of patients (n = 29). AVM volume was a very important prognostic factor: the incidence of hyperemic complications and the morbidity and mortality rate were significantly higher when the volume of the lesion was greater than 20 cm3 (P less than 0.0001 for hyperemic complications; P less than 0.001 for permanent morbidity and mortality). The incidence of hyperemic complications and the morbidity rate were higher in AVMs in rolandic, inferior limbic, and insular locations than in AVMs in other locations. As for other anatomic factors: a) the presence of deep feeders significantly increased the incidence of hyperemic complications, as well as the morbidity and mortality rate; b) the presence of deep drainage significantly increased permanent morbidity only; c) the extension of the venous system was significantly related to the development of hyperemic complications, and to morbidity and mortality. Transcranial Doppler examination showed that mean flow velocities greater than 120 cm/s in the main feeder were associated with a significantly higher rate of postoperative hematomas and transient deficits. A classification of cerebral AVMs that takes into account AVM volume and location, the type of feeders, the extent of the drainage system, and the main feeder flow velocity is suggested.

ADS-12: an automated programmable 12-tablet dissolution testing system.

A novel computerized automated system is described which conforms to the basic requirements set forth in the compendia for testing the dissolution characteristics of solid dosage forms. This modular system can test 12 tablets simultaneously. It can maintain sink conditions at all times and can handle any chemistry amenable to an automatic analyzer. Dissolution, sampling, chemistry, and readout are all accomplished simultaneously, reducing the complete test time for 12 tablets to the dissolution time itself.

Computerized automated system for determining dissolution rate profiles for solid dosage forms.

A unique automated system was developed for the measurement of dissolution rates of tablets and capsules. This system, which adheres to principles set forth in the compendia, can test six dosage forms simultaneously. It is modular in form and capable of maintaining sink conditions, and it can handle any type of chemistry amenable to an automatic analyzer. In addition to the usual dissolution apparatus, the system includes a 12-channel combination sampling and solvent addition pump, a sequence control module, pertinent automated analyzer components, a spectrophotometer or fluorometer, an optional recorder, a specially designed digitizing system, and a teletype equipped with a paper tape punch reader and acoustic coupler. Each dissolution flask is automatically sampled every 6 min. Standards may be run either before or after the samples. Since dissolution, sampling, chemistry, and readout are all accomplished simultaneously, the complete test time is essentially reduced to the dissolution time itself. At the completion of sample dissolution, raw dissolution profile data are on the punched paper tape ready for computer processing via a time-sharing system. Developed software provides for the printout of a complete test report in less than 15 min.

Semiautomated system for high-pressure liquid chromatographic determination of dissolution rate of fludrocortisone acetate tablets.

A new semiautomated high-pressure liquid chromatographic (HPLC) system is described to determine the dissolution rate of fludrocortisone acetate tablets. The system uses a miniaturized dissolution basket and shaft assembly having the same geometry as that given in USP XIX. This reduced size permits use of smaller volumes of dissolution medium, allowing most very low dose oral solid dosage forms to be handled. The USP dissolution kettle was also replaced with a new miniaturized vessel that continuously filters the sample solution before it enters the flow system. Volumes of dissolution medium as small as 15 ml can be accommodated, depending on the sensitivity of the assay employed and the solubility of the drug substance under study. The concentration of fludrocortisone acetate in solution was monitored by a new HPLC system employing a reversed-phase column compatible with the aqueous dissolution medium used. A comparative dissolution study of different lots was made using different basket rotation speeds.

Small arterial anastomoses: experimental models applicable to microneurosurgical practice.

Four main models of vascular microsurgical anastomoses in rabbits are described with reference to revascularization procedures in man. Some technical expedients designed to improve the patency rate, are outlined. This preliminary report emphasizes the value of laboratory training to achieve successful results with microneurosurgical treatment of cerebral ischemia.

Cerebral pan-angiography in rabbit. Technical note.

An open technique of cerebral four-vessel angiography via femoral artery "in vivo" of the rabbit is described. This method allows a good visualization of extracranial and intracranial circulation without direct damage to the cerebral vessels.

Kinking and coiling of the internal carotid artery: Clinical-statistical observations and surgical perspectives.

The incidence of kinking and coiling of the internal carotid artery in an unselected series of 1,010 angiographies is reported. The angiographies of patients with cerebrovascular insufficiency and those of patients with other brain diseases were separately reviewed. On the basis of a statistical comparison, the finding of kinks and coils appears significantly higher in "vascular" than in "non-vascular" patients. The greater difference concerns age subgroups up to 50 years. These data give support to the assumption that both kinking and coiling of the internal carotid artery may play a role in determining cerebral ischemic attacks. Surgical experience concerns a series of 19 patients operated by various corrective procedures, including resection of the internal carotid artery and end-to-end anastomosis. It is felt that surgery, performed in appropriately selected cases, can afford significant benefits to cerebrovascular patients, especially those presenting recurrent ischemic episodes.

Ceftazidime in the treatment of infective complications of spinal cord lesions.

The use and the abuse of the antibiotics are certainly a subject of great concern, particularly for the increasing incidence of multiresistant bacteria. Since these resistant organisms may be sensitive to cephalosporin, we have tested the effectiveness of a new cephalosporin, ceftazidime, in the treatment of resistant infection in spinal cord injured patients. A randomized study of ceftazidime versus amikacin was carried out on twenty patients. The preliminary results are presented.

Spinal ossifying arachnoiditis. Case report.

A case of low dorsal spinal cord compression, due to ossifying arachnoiditis, is reported. Its relationship with a venous malformation overlying the dorsal surface of the spinal cord is mentioned. The literature is reviewed and possible etiopathogenetic factors favouring this rare condition are discussed in the light of few similar reports. The value of surgical treatment is stressed.

The significance of microcirculatory modifications in traumatic lesions of the spinal cord. A preliminary, morphological study on experimentally induced spinal cord traumas.

The authors have studied the histological modifications in rabbit spinal cords after injury by a 20 g weight dropping from a 10 cm height. The animals were sacrificed at various time intervals from trauma (after 30', 60', 90', 2 h, 3 h, 4 h, 5 h, 6 h). The traumatized spinal cords are characterized by edema, regressive alterations of neurons as well as of glia and of fibres, and by microcentres of myelinolysis. The prominent and very precocious presence of edema is very likely one of the main factors causing regressive alterations in the cells present in myelinolysis centres.

Valuation of some biological parameters in acute spinal cord trauma: experimental study in rabbits.

The authors investigated the formation of edema consequent to Spinal Cord Injury in rabbits. The goal of this project was to study the accumulation of Water, Sodium, Potassium and Ferrum in traumatized cords in the early time after the acute injury. To this aim a spinal cord trauma was induced in forty unselected animals using the weight-drop method; Water content was measured by wet and dry weight method; Sodium, Potassium and Ferrum content were measured by atomic absorbance spectrophotometry. These parameters were recorded at various time from the cord trauma (30 minutes up to 14 days). The results are presented and discussed with a particular view to the relationships between biological variation and time from the injury.

Antibiotic prophylaxis in clean neurosurgery.

Two regimens of antibiotic prophylaxis are in use at our institution. These protocols consist in perioperative administration of a single dose of amoxicillin-clavulanic acid of 2.2 g at induction and 8 h later and irrigation of the surgical wound with rifamycin before closure. In cases of dirty surgery, placement of external shunts or foreign bodies, we administer vancomycin 1.5 g/die and ceftazidime 6 g/die for 72 h. A retrospective study of all the clean operations we performed in the last 2 years yielded a total of 793 consecutive procedures with three postoperative wound infections. These results are in agreement with the majority of series reported in literature, although different prophylactic protocols are applied and in some cases no prophylactic antibiotics are administered at all. The use of these agents in clean neurosurgery remains, as a matter of fact, controversial. In order to further investigate this issue we took three or more intraoperative samples for culture in 40 clean cases. Only in 2% of these samples were cultures positive. Although lacking statistical significance, these results are interesting indications of the appropriateness of antimicrobial prophylaxis in clean neurosurgery and invite further investigation in that direction.

Pontine hematomas.

Pontine hematomas are very rare lesions that in the past were found at postmortem examination rather than diagnosed from the clinical presentation. The advent of computed tomography allowed more frequent identification of those lesions which has shown a more favorable prognosis than formerly thought. Three patients suffering from intrapontine hematomas, revealed by computed tomography, are discussed. The etiopathogenesis, location, and clinical features of this lesion are discussed in an attempt to establish general criteria from adequate management. All 3 patients (2 treated conservatively and 1 by surgical evacuation) had a successful outcome. Repeat CT scans gave evidence of resolution of this lesion in all patients.

Giant serpentine aneurysms: a separate entity.

Giant intracranial aneurysms containing a tortuous vascular channel appear, to some extent, different from other giant aneurysms. Their particular features are outlined in the present report which concerns a case of a small fusiform aneurysm of the posterior temporal branch of the middle cerebral artery evolving over five years into a giant serpentine aneurysm. Successful and complete removal of this lesion was achieved.

Arteriovenous shunts between dural branches of the carotid artery and the cavernous sinus.

Three cases with dural arteriovenous shunts of the cavernous sinus are reported. The clinical signs usually were mild and included frontal headache, dilated conjunctival veins, exophthalmos, bruit, and oculomotor nerve palsy. Arterial contributions to the fistulae arose from meningeal branches of the internal and external carotid arteries. The precise diagnosis was made by selective angiography supplemented by subtraction and magnification techniques. The distal occlusion of the feeding arteries close to the shunt offers advantages when compared with conventional vessel ligation because of a more effective exclusion of vascular abnormalities from the circulation.