Thirty four children, 3-5 year old, of 3 nursery schools, with emotional inhibition or temper tantrums detected by the nursery staff, were investigated on difficulties in pregnancy or delivery, by specifically asking their mothers. Compared to a matched control group, the mothers of probands reported more anxious pregnancies (.025), more somatic disturbed pregnancies (.005), experienced more foetal hypermotivity (.05), and their deliveries were more anomalous (.005). The vital conditions of their new-borns were affected by more distress (.025). Since there is an increasing amount of literature stressing on one hand on relationships between pregnancy and delivery difficulties and future biopsychological and social maladjustment, and on the other hand on childhood antecedents of adult mental diseases, an early detection and a correct causality are the first steps to right therapeutic interventions.

Blood-Brain Barrier↗

PubMedDate not supplied

[Hemostatic-vascular interactions in the pathogenesis and the treatment of adult respiratory distress syndrome].

The complex pathophysiologic alterations occurring in adult respiratory distress syndrome (ARDS) result from the interaction of various humoral and cellular mediators. In this review we examine the events that lead to acute pulmonary injury as discussed in the recent literature as well as the correlations among humoral systems and cell activation involved in the pathogenesis of ARDS. We also consider the mechanisms inducing the appearance of adhesive molecules (ELAM-1 and ICAM-1) on the surface of endothelial cells, the importance of complement and clotting activation, and the role of monocyte-macrophages, platelets and neutrophils. The complexity of alterations among the different mediators involved in the pathogenesis of ARDS is underscored by experimental results demonstrating how the pharmacologic blockade of each system cannot completely prevent the development of lung damage. Understanding of the complex processes involved in the pathogenesis of ARDS provides new prospects for its treatment, such as inhalational nitric oxide and aerosolised prostacyclin. The most promising approach involves the use of monoclonal antibodies which may enable the selective inhibition of different mediators and endotoxins.

Humans↗

PubMedDate not supplied

[Transcranial Doppler in the diagnosis of brain death].

The delay in the diagnosis of brain death represents a cause of deficiency of organs for transplant. In this prospective study we evaluate the role of Doppler sonography, to investigate typical velocimetric profiles of brain death, and to evaluate the delay between finding the typical profiles and diagnosis expressed according to law. In this ongoing study, we evaluated 32 patients affected from serious primitive intracranial diseases (Glasgow Coma Scale < or = 7). Of the 32 patients examined, 18 underwent or still remained in brain death. All the patients showed typical profiles, classified in 3 fundamental types. Start of monitoring, according to the current law, showed a delay from 12 to 27 hours. The authors conclude that Transcranial Doppler and Doppler c.w. represent an early and sensitive technique, rightly to include in the procedure of the diagnosis of brain death.

Adolescent↗

PubMedDate not supplied

[Meningeal carcinomatosis from pulmonary adenocarcinoma: two clinical cases with review of the literature].

The case of a 68-year-old woman with lung adenocarcinoma complicated by apparently isolated widespread meningeal metastasis is described. Meningeal carcinomatosis is a rare complication of solid neoplasms. In fact, it occurs in less than 2% of lung carcinoma which is the most frequent cause of this syndrome. Although computed tomography and nuclear magnetic resonance may aid the diagnosis of this condition, only the cytological demonstration of neoplastic cells in the cerebrospinal fluid directly establishes it. In this patient, the onset of symptoms due to meningeal carcinomatosis complicated the course of a diagnosed lung adenocarcinoma with the acute onset of a confusional state and extended meningeal dissemination without clinical or instrumental findings of metastasis in other areas of the body. Acute confusional state is seldom the initial symptom of meningeal carcinomatosis. Nevertheless, in the neoplastic patient, this possibility must be taken into account after the most common causes of acute confusion have been excluded. Even when modern diagnostic imaging techniques are utilized, diagnosis must be confirmed by cytological examination of the cerebrospinal fluid.

Adenocarcinoma↗