[Economic impact of etanercept and adalimumab biosimilars on hospitals scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products]. / Évaluation de l'impact économique des biosimilaires d'étanercept et d'adalimumab à l'échelle des établissements adhérents au groupement de commandes PharmAlp'Ain.

OBJECTIVES: To evaluate the economic impact of future prescriptions of etanercept and adalimumab biosimilars at the territorial scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products. METHODS: Determination of the number and status of patients (naive or in continuation of treatment) from the National Database "Datamart de Consommation Inter-Régimes" of health insurance, concerned by a dispensation in a pharmacy of etanercept or adalimumab in 2015. Calculation of potential savings in case of biosimilar requirements according to 3 hypotheses: 63% (rate observed in a previous study) of initiations are treated with biosimiliaries and the others by princeps (H1); all initiations under biosimilars and continuation therapy with the princeps (H2) or all patients are treated with biosimilars (H3). RESULTS: The annual savings are estimated at 237,000 € with the H1 hypothesis. In the case of H2, the expected savings would be 376,200 € per year. In the case of H3, savings for the community could reach almost 1,282,800 € per year. CONCLUSION: The arrival of biosimilars allows significant savings for medicines market. According to the French recommendations in 2016, the expected savings are between the H1 and H2 hypothesis. The rate of penetration of biosimilars depends on many factors such as the involvement of health professionals, patient adherence, or health authority recommendations.

[MacLeod's syndrome: nosographic framework in the area of diffuse diseases of the lung. Contribution of radiographic and radioisotope studies]. / La sindrome di MacLeod: inquadramento nosografico nell'ambito delle malattie diffuse del polmone. Contributo delle indagini radiografiche e radioisotopiche.

The paper examines the clinical and etiopathogenetic aspects of MacLeod's syndrome. MacLeod's syndrome, more accurately known as unilateral bullous pneumodystrophy, forms part of the diffuse or localised hyperdiaphanies of the pulmonary parenchyma. Standard chest examination, inhalation and exhalation chest X-rays and stratigraphic control are useful instruments for the etiopathogenetic study of the syndrome. More specific tests include perfusion and ventilation scintigraphy, in addition to bronchography and angiopneumography.

[The contribution of radiographic and radioisotope findings to the study of multiple sclerosis with special reference to the problems of false-positive scintigraphy reports]. / Contributo delle indagini radiografiche e radioisotopiche allo studio della sclerosi multipla con particolare riguardo al problema dei falsi positivi scintigrafici.

The diagnostic value of radiographic and radioisotopic examinations in multiple sclerosis is noted. Multiple sclerosis is clinically diagnosed. If invasive and possibly dangerous examinations are to be avoided, only computerised axial tomography can often clarify differential diagnosis from other forms causing subtentorial hypercaptation and especially from tentorial meningitis.

[Quality control of hospital care or medical audit: non-juridical guarantee of quality]. / Controllo di qualità delle cure ospedaliere o medical audit: garanzia di qualità non tribunale.

After defining the meaning of "medical audit", i.e. control and guarantee of the quality of hospital treatment with absolutely no judgment connotation or idea of something that interferes in any way with the physician's professional freedom, aspects of the medical audit are summarised on the basis of American and Dutch experience. It is pointed out that the technical and medical aspects should be the initial considerations.

[The rights of the hospitalized patient. A medico-social problem of major importance]. / I diritti del malato in ospedale. Un problema medico sociale di grande interesse.

Recently many Italian regions take care of the patient's rights and some regions have made regional laws of patients rights in hospital that had been made by international associations. In the latest times also syndicate of hospital's doctors began to take care of this problem and an important symposium on patient's rights was made in Gardone in September 1980. It has been discussed about patient's right and why these rights are sometimes forgotten by those who work in hospitals.

[Practical radiological problems in the service to non-collaborating patients]. / Problemi pratici di radiologia nelle prestazioni a soggetti non collaboranti.

The difficulty of radiographies, radioisotopical examination and radiotherapeutic treatments made on patients who are not able to understand doctor's instruction is pointed out. Particular stress is laid on organization, anesthesiological, and protection problems.

[Radiographic diagnostic problems in cancer of the gastric stump in subjects gastrectomized for ulcer over 10 years earlier]. / Problemi di diagnostica radiografica del cancro del moncone gastrico in soggetti gastroresecati per ulcera da più di dieci anni.

On the basis of some observed cases the histological, clinical and radiological aspects of carcinoma of the gastric stump are described in detail. The condition is comparatively rare, but once it occurs, recurrences are fairly frequent and given the high mortality rate it requires prompt diagnosis. Double contrast examination of the digestive tract is a useful additional technique for this purpose.

[Principal complications in radiographic studies]. / Principali complicanze delle indagini radiografiche.

After an introductory review of ion radiation sickness and the problem of accidents with contrast media, the main complications in urography, cholecystocholangiography, bronchography, lymphography and computerised axial tomography are listed. The comparative frequency of such complications is deduced from a study of the literature.

[Iatrogenic risks. Medicolegal and organizational problems concerning the performance of radiographic examinations with intravenous administration of contrast media]. / Rischi jatrogeni. Problemi medico legali e organizzativi relativi all'esecuzione di esami radiografici con mezzo di contrasto per via endovenosa.

The forensic medicine and organizational aspects of doing X-rays with i.v. contrast medium are discussed. Special attention is paid to the pathogenetic and clinicotherapeutic aspects of X-ray and contrast medium induced accidents together with the organizational problems posed by these problems in small hospitals without anaesthesia and resuscitation departments.

[Clinical and radiological diagnosis considerations on 2 cases of achalasia]. / Considerazioni cliniche e di diagnostica radiologica su due casi di acalasia.

Two cases of achalasia of the lower third of the oesophagus are presented. Leucoplakia was encountered in one of the cases. The clinical, aetiopathogenic and x-ray diagnostic aspects of achalasia are described in relation to the possibility that it may be associated with neoplasia or pre-cancerous alterations. In both the above cases, early dysphagia was encountered.

[Anatomopathological, clinical, radiological diagnostic and therapeutic aspects of intraluminal duodenal diverticulum]. / Aspetti anatomopatologici, clinici, di diagnostica radiologica e terapeutici del diverticolo intraluminale del duodeno.

Anatomopathological, clinical, therapeutical aspects of intraluminal duodenal diverticulum are analyzed. This is an illness of which are described in all literature of world about 47 to 70 cases. On intraluminal duodenal diverticulum is described with x rays examinations. The diagnosis of this illness is made by radiological and endoscopical examinations. The clinical symptoms are very poor, but many illness of duodenum, pancreas, cholecystis are associated with this.

[Radiographic diagnosis in the early recognition and evaluation of incapacitating sequelae of advanced rheumatoid arthritis]. / Diagnostica radiografica nella diagnosi precoce e nella valutazione dei postumi invalidanti di artrite reumatoide avanzata.

Two observed cases of rheumatoid arthritis, one at an initial, the other at a very advanced stage, form the basis for a detailed report on the radiographic signs of the disease. Particular emphasis is placed on the possibilities offered by the various radiographic techniques for the evaluation of the sequelae of rheumatoid arthritis and for the early diagnosis of the disease.

[Nephrobronchial fistula]. / La fistola nefrobronchiale.

Nephrobronchial fistula is a rare pathology both in absolute terms and in relation to the complications of renal inflammatory processes. Clinical symptoms may be varied but pulmonary complications, which may mask renal symptoms, are generally predominant; cough, hemoptysis and the expectoration of calculi are rarely found. Occasionally, as in the case reported here, the most evident sign is an infective process due to the contemporaneous fistulization of subcutaneous tissues. Instrumental diagnosis is based on chest and abdomen X-ray, fistulography, retrograde pyelography and abdominal CT. CAT may be useful above all in the study of pararenal abscesses.

[The legislative requirements for radioprotection in dental offices equipped with apparatus for dental radiodiagnosis and orthopantomography]. / Adempimenti legislativi di radioprotezione per gli studi odontoiatrici dotati di apparecchiature per radiodiagnostica dentale e ortopantomografia.

The paper summarises the new legislation which is expected to be introduced concerning the use of dental radiodiagnostic and orthopantomographic equipment. The above modifications are partly the responsibility of the employer responsible for the dental practice, the qualified expert and, if present, the authorized doctor. A summary is given of the development of Italian regulations which are being brought into line with EEC standards.

Comparative pharmacokinetic study of chewable and conventional carbamazepine in children.

Fifteen children (7 boys and 8 girls) with generalized tonic-clonic seizures (GTCS) and partial seizures with elementary or complex symptomatology, treated with carbamazepine (CBZ) alone (n = 7) or in combination with either phenobarbital (PB, n = 6) or clobazam (CLB, n = 2) given for at least 3 months at stable individualized doses and regimens, entered an open, within-patient, change-over study of consecutive periods, each lasting 2 weeks. During period 1, conventional CBZ was given; during period 2, a chewable CBZ formulation was substituted for conventional CBZ and given at the same total daily dosage with the same schedule as in period 1. Blood samples for measuring plasma concentration of both total CBZ and CBZ-10,11 epoxide (CBZ-E) were taken on the last day of each period. No significant difference between the two periods was noted in the mean +/- SD of Cmax, Css mean, and area under the curve (AUC) of total CBZ and CBZ-E. The two different CBZ formulations, administered at the same total daily dosage, can be considered bioequivalent.

Induction of ethinylestradiol and levonorgestrel metabolism by oxcarbazepine in healthy women.

PURPOSE: To evaluate the effect of oxcarbazepine (OCBZ) on the pharmacokinetic profile of steroid oral contraceptives. METHODS: Twenty-two healthy women aged 18-44 years were recruited, and 16 of them completed the study. By using a randomized double-blind crossover design, each woman was studied in two different menstrual cycles, during which placebo or OCBZ (maintenance dosage, 1,200 mg/day) was given in randomized sequence for 26 consecutive days with a washout of at least one cycle in between. A steroid oral contraceptive containing 50 microg ethinylestradiol (EE) and 250 microg levonorgestrel (LN) was taken for the first 21 days of each cycle. Plasma concentrations of EE and LN were measured by gas chromatography-mass spectrometry in samples collected at regular intervals on days 21-23 of each cycle. RESULTS: Compared with placebo, areas under the plasma concentration curves (AUC(0-24h, geometric means) decreased by 47% for both EE (from 1,677 to 886 pg.h/ml; p < 0.01) and LN (from 137 to 73 ng.h/ml; p < 0.01), during OCBZ treatment. Peak plasma EE concentrations decreased from 180 pg/ml during the placebo cycle to 117 pg/ml during the OCBZ cycle (p < 0.01), whereas peak plasma LN concentrations decreased from 10.2 to 7.7 ng/ml (p < 0.01). The half-lives of EE and LN also decreased from 13.6 to 7.9 h (p < 0.01) and from 28.8 to 15.8 h, respectively (p < 0.01). CONCLUSIONS: OCBZ reduces plasma concentrations of the estrogen and progestagen components of steroid oral contraceptives, presumably by stimulating their CYP3A-mediated metabolism in the liver or gastrointestinal tract or both. Because this may lead to a decreased efficacy of the contraceptive pill, women treated with OCBZ should receive preferentially a high-dosage contraceptive and should be monitored for signs of reduced hormonal cover.