[Acquired esophago-tracheo-bronchial fistulas (observations on a case)].
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Biomedical subjects
Publications and source records attributed to G Zaccara.
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Recent findings suggest that patients affected by Alzheimer's disease (AD) have evident alterations of smooth-pursuit ocular movements induced by a sinusoidal predictable target. For a better understanding of the possible modifications of this performance in patients with AD we evaluated, using a quantitative method, the smooth-Pursuit induced by ramps with constant, unpredictable velocities. Twelve patients with probable AD were studied. These patients were compared with twelve age matched healthy volunteers. Visual inspection of our recordings shows that AD patients have frequent, large saccades intrusions which in some cases appeared to disrupt smooth tracking, particularly for low target speeds. Furthermore, the smooth-pursuit eye velocity induced by target of high speed is significantly reduced in respect to that present in our control group. Some significant correlations between altered smooth-pursuit parameters and abnormal psychometric scores were noted.
Twenty consecutive patients with chronic partial seizures with onset before twenty years of age were investigated by means of 0.5 T MRI (20) and HM-PAO (19) in order to identify focal alterations amenable to surgical therapy. MRI evidentiated parenchymal lesions in 7 patients. Findings consistent with unilateral medial temporal sclerosis and cortico-subcortical parietal scars were found in two patients each. Small solid nodular lesions in the temporal lobe were observed in two patients. These and one additional patient with nodular partially cystic lesions in temporal lobe were administered a paramagnetic contrast agent (Gadolinium DPA) intravenously. In one case a contrast enhancement was observed. Histologic examination post surgery revealed a low grade glioma in one patient. HM-PAO SPECT examination showed area of abnormal captation in 9 of 19 patients. Aspects of EEG correlation with the MRI and SPECT findings are discussed. Our data supported the usefulness of magnetic resonance and SPECT imaging in the completion of pre-surgical assessment in this kind of patients.
Therapeutic efficacy of Nomifensine and Nortriptyline was compared with a double blind study on 29 patients suffering from several kinds of depression. The patients were admitted to the Institute of Nervous and Mental Diseases of the University of Florence. Drugs were administered according to a flexible dosage varying from 50 mg to 125 mg/day, subdivided in 2-3 doses. The experiment is referred to the first 15 days of treatment. In order to estimate the effect of the drugs, the Hamilton's scale for depression was used. This scale was administered before treatment and on the 5th, 10th, 15th, day of therapy. Scores of Hamilton's scale and of some "Clusters" were computerized. It was found that Nomifensine has an antidepressant effect comparable to that of Nortriptyline. No relevant differences were noted in the range of action of these drugs. No side-effects were detected in the doses employed.
Six epileptic patients are described to whom the addition of Valproic Acid (VPA) to a previously unsatisfactory antiepileptic treatment caused a toxic encephalopathy. This was characterized by alterations of the state of consciousness in all patients a few days after the beninning of the treatment with VPA. These ranged from a marked drowsiness to coma and were often associated with gastrointestinal and neurological (ataxia, asterixis) symptoms. In all cases very high blood ammonia values were found and the EEGs showed a diffuse slowing down of the activity. After the discontinuation of the drug the toxic symptoms quickly ceased and ammonia values returned to the normal values. It is hypothesized that the interference of VPA on the metabolism of ammonia could play an important role in the pathogenesis of the VPA-induced toxic encephalopathy.
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The Authors present and discuss the results obtained by assaying plasma DPH and PB in 123 patients chronically treated with antiepileptic drugs. The subjects examined were considered resistant to medical therapy and were all at their first laboratory control. The data obtained show: 1) the very poor correlation existing between the doses of drugs administered and their actual plasma levels; 2) the very high percentage of patients with DPH and PB plasma levels not in the therapeutic range of these drugs. The Authors discuss some of the most frequent errors in planning chronic therapy with DPH and barbiturates due to the lack of knowledge of drug blood levels.
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