The drugs currently under investigation in the prevention of recurrent gastrointestinal bleeding in cirrhosis are likely to decrease the portal pressure by means of a primary reduction of portal blood flow. The hemodynamic effects of beta-blocking agents and vasodilatory drugs were noninvasively measured in eight patients with cirrhosis by means of pulsed echo-doppler equipment. Portal caliber, blood velocity and flow were recorded hourly after a single dose of propranolol (40 mg p.o.) or atenolol (100 mg p.o.), and every 5 min after treatment with isosorbide dinitrate (5 mg sublingually). The drugs were administered at random with an interval of 2 days or more. The portal caliber decreased after atenolol, but did not change after propranolol and isosorbide. The blood velocity decreased by 29 +/- 2% 3 hr after propranolol, by 26 +/- 2% 3 hr after atenolol and by 31 +/- 3% 15 min after isosorbide. The portal blood flow decreased by 0.29 +/- 0.03 liters per min after propranolol, by 0.34 +/- 0.06 after atenolol and by 0.26 +/- 0.03 after isosorbide, without any difference among the various treatments. beta-blockers and vasodilatory drugs have comparable effects on portal blood flow. beta 1-selective and nonselective beta-blockers are similarly effective in keeping with the hypothesis that changes in portal blood flow are mainly due to the block of beta 1-receptors.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Galactose elimination capacity and liver volume in aging man.

The galactose elimination capacity, a measure of the functional liver cell mass, and liver volume were measured in 50 normal subjects of five different age groups (less than 50, 51 to 60, 61 to 70, 71 to 80 and greater than 81 years). The volume of the liver was evaluated by ultrasonography. All subjects had normal routine liver function tests and no history of liver disease. Galactose elimination progressively decreased from 3.05 +/- 0.58 (S.D.) mmoles per min in younger subjects to 1.83 +/- 0.24 mmoles per min in subjects over 81 (p less than 0.00003), without any change in the apparent volume of distribution of the sugar. Similarly, the estimated volume of the liver decreased from 110 +/- 14 units to 75 +/- 13 units with increasing age (p less than 0.0002). Both galactose elimination capacity and the estimated liver volume inversely correlated with age (r = -0.728 and r = -0.579, respectively) whereas a positive correlation was observed between galactose elimination and the estimated liver volume (r = 0.520). Part correlation analysis confirmed that age, when entered in a multiple regression already containing body weight and estimated liver volume as independent variables, had a significant effect on liver function, whereas no significant independent effect of liver volume was present. Both age and body weight had a significant independent effect on the estimated liver volume. The maximum functional capacity of the liver, measured by galactose elimination, is reduced in the elderly. Although several factors may play a role, our data suggest that aging is associated with a slight decline in the intrinsic metabolic activity of the hepatic parenchyma.

Adult↗

PubMedDate not supplied

Echo-Doppler measurement of splanchnic blood flow in control and cirrhotic subjects.

Blood flow in the splanchnic veins was studied in cirrhotics and matched controls by means of a system that combines a mechanical sector scanner with a pulsed Doppler. The measurements were validated in an in vitro model. Echo-doppler studies could be carried out reproducibly in only approximately two-thirds of cases because of poor echo transmission or incomplete cooperation. Portal blood velocity was significantly reduced in cirrhotics (10.5 +/- 0.6 cm/s versus 16.0 +/- 0.5 in controls; p less than 0.001), but portal blood flow was normal because of enlarged portal caliber. A complete hemodynamic evaluation of the splenic and superior mesenteric veins was possible in only a few subjects. In selected patients the technique may prove relevant in the study of hemodynamic effects of drugs and surgery on portal blood flow.

Adult↗

PubMedDate not supplied

Recent experience in the management of meningeal hemangiopericytomas.

Although the histogenesis of meningeal hemangiopericytomas (HMP) remains controversial, both biological and clinical evidence seems to identify these neoplasms as a separate entity with respect to meningiomas. In order to assess the current prognosis of HMP we reviewed our personal experience limited to the last decade (1986-1995): during this period 7 patients (4M, 3F) were treated by surgery alone or surgery combined with postoperative radiotherapy. In spite of meticulous attempts at radical resection, the tumors recurred in all but two cases with a mean interval of 85 months, and a total of 18 operations were performed (2.57/patient; range 1-4). Massive intratumoral hemorrhage determined acute deterioration and required emergency surgery in two cases while in one patient diffuse visceral metastases were discovered at autopsy. Five patients are still alive at follow-up but only 2 of them are in good neurological conditions and without evidence of disease. These results are similar to those reported in other series. In view of our results we conclude that intracranial hemangiopericytomas still have a dismal prognosis. Advances in neuroimaging, neuroanesthesia, microneurosurgery and adjuvant therapy do not seem to have significantly affected the recurrence rate, quality of life and mortality.

Adult↗

PubMedDate not supplied

Pseudohypoaldosteronism: report of a case presenting as failure to thrive.

We report a 2 month-old infant referred for failure to thrive. At birth, weight was 3820 g and length 52 cm. After physiologic weight loss, the patient showed no further weight gain for the next two months. On admittance (age 2 mo), weight was 3340 g and length 53 cm; the infant had severe dystrophy, generalized hypotonia and dehydration; blood chemistry showed hyponatremia, hyperkalemia and hypochloremia. A salt losing syndrome of adrenal origin was hypothesized. However, rehydration and hydrocortisone administration failed to correct hyponatremia and hyperkalemia. Endocrine assessment showed high levels of aldosterone and plasma renin activity, suggesting pseudohypoaldosteronism. Oral sodium chloride supplementation normalized electrolyte balance and the patient showed progressive weight gain and catch-up growth, confirming the diagnosis.

Administration, Oral↗

PubMedDate not supplied

[Colloid cysts in the 3rd ventricle: a microsurgical series and new perspectives].

Colloid cysts are rare benign CNS lesions (0.5-2% of tumors), mostly located within the third ventricle. Although sometimes asymptomatic they may cause life-threatening complications and sudden death and therefore require active treatment in the vast majority of cases. Microsurgical removal warrants excellent radicality at low morbidity/mortality rates but emerging neuroendoscopic techniques have been applied successfully worldwide although longer follow-up of these patients is needed. We present out personal microsurgical series from last decade and discuss the results in the light of current knowledge and preliminary neuroendoscopic experiences.

Brain Diseases↗

PubMedDate not supplied

[Antonio Pacchioni (1665-1726): pioneer studies on the dura mater].

Clustering of arachnoid villi along the sagittal sinus gives rise to the so-called "Pacchionian Granulations". These structures were originally described in 1705 by Antonio Pacchioni, an Italian scientist. Born in Reggio Emilia in 1665, he graduated in Medicine in his hometown and later moved to Rome were he built up a successful career by dedicating to medical practice as well as to research and teaching. He became friend and often collaborated with some of the leading scientists of his age: Lancisi, Malpighi and Morgagni among the others. Moreover he carefully followed research developments in Europe as testified by frequent quoting of foreign authors in his works. He devoted himself to the elucidation of structure and function of Dura Mater, often by using new techniques of maceration of anatomic specimens in various fluids. Among Pacchioni's works, the "Dissertatio epistolaris de glandulis conglobatis Durae Meningis humanae" (1705) is particularly well known and contains the first description of arachnoidal granulations. He compared Dura to cardiac muscle and attributed to its "glandulae" (glands) the faculty of secreting lymph for lubrification of the sliding movements between meninges and brain during contractions. He died in Rome in 1726. Three centuries after Pacchioni's death fine structure of arachnoid villi hasn't been fully elucidated; moreover many questions on mechanisms underlying CSF absorption remain unanswered.

Aged↗

PubMedDate not supplied

[The inhalational therapy of respiratory pathology].

The inhalation of aerosolized drugs for therapeutic purpose has been used for many years in respiratory diseases as asthma, chronic bronchitis, cystic fibrosis. Therapeutic aerosols have the advantages to deliver active substances directly to the site of disease, without systemic side effects, to produce a more rapid clinical response, to avoid barriers to the absorption of drugs such as the gastrointestinal tract. We review the mechanisms and the site of lung deposition and the range of devices that can provide an effective aerosol such as metered dose-inhaler and spacers. Besides drugs as cromolyn, beta-2-agonists and topical steroids, recently new inhalation therapies were proposed using antiviral drugs (interferon), pentamidine for Pneumocystis carinii in immunocompromised host, inhalation of attenuated virus (measles) for active immunization. However there is a need for further work in this area.

Administration, Inhalation↗

PubMedDate not supplied

[Neurosurgery in Rome: 1880-1970].

Among many factors contributing to the birth of Neurosurgery, the "awareness of feasibility" of neurosurgical procedures is especially significant. June 1st, 1885 is the arbitrary birthdate of Neurosurgery in Rome: Francesco Durante, Professor of Surgery at the Royal University, successfully resects an olfactory groove meningioma, arising admiration worldwide. Roberto Alessandri succeeds Durante in 1919. In roman hospitals outstanding surgeons perform from time to time neurosurgical procedures, sometimes with satisfactory results: Paolo Postempski, Cesare Antonucci, Guido Egidi and Raffaele Bastianelli, first director of the "Regina Elena" Cancer Institute (IRE) (April 1933) and friend of Harvey Cushing. Angelo Chiasserini sr. is however the first roman surgeon constantly committed to Neurosurgery and founder of the first neurosurgical unit in Italy, in 1937; also, from 1941 to 1944 he directs a neurosurgical service at the "Celio" military hospital of Rome, to which patients from the various battle theatres are referred. While Mario Margottini and Piero Frugoni follow Bastianelli's steps at the IRE, the roman neurosurgeons Felice Visalli and Libero Ugelli serve in the Army, during the greek-albanian conflict and in Russia, respectively. In May 1955 Beniamino Guidetti, an Olivecrona pupil, is called at "La Sapienza" University of Rome and elevates the neurosurgical clinic at the highest standards. The other main neurosurgical pole is founded in 1958 at the San Camillo Hospital: within both institutions modern neurosurgical teams are formed along with neuroradiological and neuroanesthesiological staffs.

History, 19th Century↗

PubMedDate not supplied

[Surgery of lumbar disk hernia: historical perspective].

Although the clinical picture of discogenic sciatica is well known already in the ancient world, it is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice. The work of the American Authors was however based on the knowledge acquired during the previous centuries starting with Domenico Cotugno, who first suggested the neurogenic nature of sciatica (1764) and later with the neurologists of the french school Valleix, Lasègue, Dejerine, Sicard who elucidated the semeiology and debated in detail the etiopathogenesis of the condition. The german pathologists Schmorl and Andrae (1927-29) are to be credited for their contribution to the pathology of intervertebral disc, recognizing the frequency and degenerative (not neoplastic) nature of nucleus pulposus herniation. Surgery of disc herniation starts with Oppenheim and Krause (1909). Mixter and Barr used laminectomy and a transdural route although a more limited approach to the spinal canal had already been proposed by the italian Bonomo (1902), unknown to many. Love, of the Mayo Clinic (1937-39) introduced the extradural/interlaminar approach while Caspar and Yasargil (1977) applied the concepts of microsurgery to the procedure. The latest advances are represented by percutaneous and endoscopic techniques.

Animals↗