[Indications and results of transcatheter fibrinolysis in acute arterial occlusions]

The authors' experience is reported on intravascular fibrinolytic therapy with urokinase in acute arterial obstructions. Thirty-eight patients were treated, from 1983 to 1986, for acute thrombosis and/or thromboembolization, 22 of which developed on an atherosclerotic lesion, and 10 on a surgical stenotic by-pass graft. A complete vascular recanalization has been obtained, at the end of the procedure, in 69.4% of the cases, 77.7% had a definite final clinical improvement. The results correspond to the medium statistical level of the various casuistics analyzed for comparison. Surgery has been performed on 27.7% of the patients. Complications have been observed in 8% of the cases. IAF technique is of greatest value in the treatment of those lesions; better results have been obtained with intra-thrombus injection of the drug (as emphasized by many authors) in association with PTA and surgery. A close cooperation between interventional radiology, vascular surgery and angiology is therefore necessary in this field.

Fatty acid pattern of red blood cell membranes and risk of ischemic brain infarction: a case-control study

The fatty acid composition of red blood cell membranes (which reflects dietary fat intake) was studied in 28 male patients with recent (less than 3 days) ischemic stroke and 56 matched controls. Fifteen fatty acids were measured by means of chromatographic analysis. Percentages of linoleic, 22:5, and 22:6 acids were significantly lower in red blood cell membranes of stroke patients than in those of matched controls. The results suggest that a low unsaturated fatty acid diet could be an independent risk factor for ischemic brain infarction.

Effects of acute benzodiazepine administration on growth hormone, prolactin and cortisol release after moderate insulin-induced hypoglycemia in normal women

Benzodiazepines are known to affect pituitary hormone release, and it has recently been hypothesized that the adenohypophysial hormone response to stress may be modified by previous benzodiazepine treatment. We investigated, therefore, whether a single dose of triazolam, a short-acting benzodiazepine, and flurazepam, a long-acting one, could influence the response of prolactin (PRL), growth hormone (GH) and cortisol to a mild hypoglycemic stress in young healthy volunteers. Neither triazolam nor flurazepam pretreatment resulted in a significant effect on the pituitary response to hypoglycemic stimulus. The GH, PRL and cortisol peaks after both benzodiazepines were similar to those observed after placebo. Our results seem to exclude, therefore, any relevant effect of acute benzodiazepine administration on the neuroendocrine response to mild stress.

Value of CT scanning in outpatients: preliminary report on a controlled study

A series of 100 consecutive new outpatients attending the neuroradiology service for a cranial CT scan between 1 October and 24 December 1984 were analyzed. On the day of the investigation each patient was examined by a neurologist, who gave his opinion on the value of a CT scan. The neurologist's ratings were then compared with the CT reports. More than 2/3 of the requests for CT were useless and could have been avoided by thorough clinical evaluation of the patients and full awareness of what CT scanning can contribute to diagnosis and treatment.

[Digital subtraction angiography (DSA) of the renal-adrenal area. Methods of use and indications]

Our experience on 371 patients studied with DSA for reno-adrenal pathology in the last two years is reported. The purpose of this study was the evaluation of real possibilities of DSA in comparison with conventional angiography, particularly to specify diagnostic space of venous versus arterial approach in this region of interest. In our experience, DSA by venous approach is indicated only as a screening method for nefrovascular hypertension or post-surgery, post-PTA and post-embolization controls; in all other cases, DSA by arterial approach is preferable for its superior diagnostic accuracy and lesser pharmacological invasivity, in comparison both with venous DSA and conventional angiography.

[Digital panangiography. Possibilities of digital angiography in estimating multifocal atheromatous vascular diseases]

Results obtained on 431 patients studied during thirty months (February '83-June '85) with DSA-whole body angiography are reported. On the basis of statistic evaluation, PAN-DSA certainly appears the best choice, especially with combined use of 150 mgI/ml and 300 mgI/ml contrast medium. A highly significant incidence of athero-sclerotic lesions found on target-territories, even in the presence of monofocal symptoms, suggests global radiological study (PAN-DSA) as indicated whenever diffuse vascular pathology is suspected.

[Comparative results in the carotid region. Venous or arterial digital angiography?]

A comparative evaluation between Digital Venous (DV) and Arterial (DA) studies of carotid arteries has been carried out in our institution in the last two years. DV study, in our experience, only in fourty percent of the cases shows good details (i.e. of true diagnostic value); this rate decreases to fifteen-twenty of intracranial sector, while DA offers optimal results in eighty percent and more of the patients. DV studies, highly invasive on a pharmacological point of view, based on the contrast medium amount, must be reserved only to surgical follow-up studies and patients with femoral/brachial bilateral occlusion, that involves technical impossibility for arterial catheterization.

[Combination of oxybutynin chloride (Ditropan) with intermittent catheterization in the treatment of neurogenic bladder in childhood: results on continence]

Nowadays Intermittent Catheterization (I.C.) is considered the treatment of choice in patients with neurogenic bladder dysfunction, because of its easy handling and good results. Renal function preservation, urinary tract infections prevention and continence can be achieved by this method. In particular, I.C. per sè improves continence quality in many cases, but, in the majority of them the best results can be obtained by drug therapy addition, having in mind a more direct action on to detrusor compliance and/or bladder neck tone. Oxybutynin Chloride (Ditropan)(-) is the first choice drug, even in childhood, in cases of neurogenic bladder dysfunction, for its anticholinergic, antispastic and analgesic properties. From 1978, 48 children with neurogenic bladder have been treated by I.C. Out of them, 27 have had drug therapy (Oxybutynin Chloride-Ditropan) in addition to I.C., according to indications of clinical, radiologic and urodynamics findings. Results on continence are discussed.

[Circulating immune complexes in patients with lymphoproliferative and myeloproliferative diseases]

Circulating immune complexes have been studied with a competitive immune-enzymatic method on 9 controls, on 34 patients with lymphoproliferative disease (41.6 +/- 26.8) and in those with myeloproliferative disease (62.1 +/- 30) have been found significantly higher than in controls (20.3 +/- 14.1). The percentage of incidence of circulating immune complexes with values greater than 35 (normal value greater than 35) is found to be 58.8% in lymphoproliferative disease and 77.7% in myeloproliferative disease. Higher values of circulating immune complexes have been observed in patients with a depressed count of circulating monocytes, of lymphocytes with a dot-like alpha-naphthyl-acetate-esterase reaction and of nitroblue tetrazolium positive granulocytes, suggesting that circulating immune complexes can modulate cellular immune response as blocking factors.

[Measuring venous pressure with the Doppler technic statistical data]

With reference to the measuring method suggested, we report the pressure indices noted in surgery, in order to compare them with those of non-surgical methods, using the Doppler. We also define some parameters for recording the measurements; failure to observe these might result in inaccuracy of the instrumental findings. We have to consider the index of maximum pressure to be attained using the pneumatic cuff, the lenght of time of compression, and the place at which the measurement is taken.

Noninvasive venous pressure measurements in different venous diseases. A new case collection

We use from some years the doppler method for noninvasive measurements of venous pressure and about seven years ago we communicated the early results. We have confirmed the reliability and sensitivity of the method carrying on our clinical work. Now we report the results of a more extensive observation.

Sustained haemodynamic and clinical effects of captopril in long-term treatment of severe chronic congestive heart failure

1 The angiotensin-converting-enzyme inhibitor captopril is known to produce beneficial haemodynamic effects in patients with chronic congestive heart failure. 2 Twelve patients with chronic congestive heart failure were conventionally treated with digitalis and diuretic therapy plus oral captopril (75-150 mg/day), and 14 patients were used as a control group. 3 There was no improvement in functional and haemodynamic values in the controls, but the patients treated with captopril showed a significant functional improvement (increase of exercise time and improvement in New York Heart Association functional class), a definitive decrease in systemic vascular resistance (20%), and a significant increase in the cardiac index and ejection fraction (18% and 28% respectively).

[Catheterization of the ureter after anti-reflux reimplantation using the Cohen technic]

Cohen's ureteroneocystostomy is largely employed by many pediatric urologists, the only substantial criticism being the impossibility of endoscopic ureteral catheterization after this procedure. A method is described, based on the use of a catheter needle introduced on the filled bladder suprapubically, in a lateral position, opposite to the side of the ureter concerned. Adequate ureteral catheter is introduced on the venous catheter, using a common endoscopic rubber tip to maintain water tightness. Under endoscopic vision the ureteral catheter is easily inserted in the ureteral meatus and introduced in the ureter.

[Parkinson's disease and am-otrophic lateral sclerosis (case report) (author's transl)]

A 68 years old man affected by parkinson's disease for four years suddenly developed symptoms of a motor neuron disease. He also had a defect of his visual-spatial ability with an intra cerebral calcifications in right parieto-temporo-occipital region. The AA. discuss the nosological aspects of this case and do not accept the possibility of a chance occurrence of the two systemic degenerative diseases and favour a unification of nuerological abiotrophic diseases.