Studio delle biforcazioni carotidee extracraniche

Sono stati studiati 51 pazienti affetti da disturbi di circolo cerebrale nel territorio carotideo con TC a strato sottile della regione cervicale e con angiografia convenzionale (AGF) dei tronchi epiaortici. I risultati TC sono stati confrontati con quelli AGF e, in 18 casi, anche con i reperti operatori. In tutti i 102 casi studiati la TC è stata in grado di dimostrare la biforcazione carotidea e la morfologia delle sue pareti. La TC si è rivelata più sensibile della AGF nell'evidenziare la morfologia delle placche e le lesioni ulcerative offrendo l'opportunità di una obiettiva misurazione del grado di stenosi luminale, grazie alla dimostrazione dei vasi sul piano assiale.

Studio TC delle biforcazioni carotidee

Per verificare le possibilità diagnostiche della TC nella definizione della patologia dei vasi del collo e per mettere a punto un protocollo di studio di agevole impiego clinico in grado di fornire risultati costanti e diagnosticamente validi sono stati valutati 132 pazienti affetti da disturbi cerebrovascolari, candidati all'intervento di tromboendoarteriectomia.

Lo studio della regione cervicale è stato effettuato utilizzando un pacchetto di scansioni rapide a strato sottile eseguite durante infusione e.v. di mezzo di contrasto (circa 100 ml) a goccia ravvicinata.

Nel presente contributo viene descritta la metodica di studio utilizzata ed analizzati e commentati i risultati ottenuti. Viene sottolineata l'importanza della TC nel dimostrare direttamente sul piano assiale le placche ateromasiche, la loro composizione e morfologia.

Viene anche sottolineata l'accuratezza della TC nell'individuare le ulcerazioni nelle placche e nel valutare il grado di stenosi vascolare. Infine vengono commentate le caratteristiche tecniche della metodica proposta sottolineandone la maneggevolezza nella pratica clinica.

SEPIVAC: a community-based study of stroke incidence in Umbria, Italy

The SEPIVAC study is a community-based epidemiological survey of incidence and outcome of acute cerebrovascular disease in the Sixth Local Health Unit, Umbria, Italy (population 49,218). The study was carried out from 1 September 1986 to 31 August 1989. There were 375 patients who were registered with a first ever stroke, with a crude rate of 2.54 (95% confidence limits 2.29-2.81) per 1000 per year; the rate adjusted to the European population is 1.55 (CL 1.36-1.77). The age adjusted relative risk for males is 1.35 (CL 1.10-1.66). Up to 15% of the patients were not admitted to hospital during the acute phase of their disease. At least 286 (76.3%, CL 72-80.6) of the cases were due to cerebral ischaemia; in 56 of these (19.6%, CL 15-24.2) a clinical diagnosis of lacunar ischaemia was made. The 30 day case fatality rate was 20.3% (CL 16.2-24.3); between one and six months 7.5% (CL 5-10.6) of patients died.

A community-based study of incidence, risk factors and outcome of transient ischaemic attacks in Umbria, Italy: the SEPIVAC study

The SEPIVAC study is a community-based epidemiological survey of incidence and outcome of transient ischaemic attacks (TIAs) and strokes in the territory of the 6th Local Health Unit, Umbria, Italy, where 49,218 people live, from 1 September 1986 to 31 August 1989. All cases were registered with the study either by notification from general practitioners (GPs) or by a check of hospital admission within the study area and in the two hospitals of Perugia. There were 94 incident cases of TIAs (45 males, 49 females), thus giving a crude rate of 0.64 per 1000 per year [95% conficence intervals (CI) 0.52/0.78]. The rate adjusted to the European population is 0.42 (CI 0.33/0.54). Mean age was 69.4 years, and females were significantly older than males. The weighted relative risk for males was 1.19 (CI 0.79/1.79). Thirty-one patients were treated at home by their GPs. Females had hypertension more frequently than males, whereas males smoked more frequently; we did not find any other statistically significant difference in the distribution of risk factors. Twelve patients out of 58 who had CT had an infarct, and 29 out of 54 submitted to Doppler ultrasonography had carotid stenosis. At 1 month, 4 patients had suffered an ischaemic stroke, 1 of whom died. At 6 months, 3 further strokes and 2 further deaths (1 due to myocardial infarction) had occurred.

Prognostic value of the dense middle cerebral artery sign in patients with acute ischemic stroke

The presence of a dense appearance of the horizontal part of the middle cerebral artery (the "dense middle cerebral artery sign") was looked for on CT scans taken on admission in 90 consecutive patients with ischemic stroke in the carotid artery distribution. The outcome of the 14 patients with the sign was poorer than that of 76 patients without the sign (Odds ratio 4.3). We suggest that this sign could be a useful prognostic variable in the acute phase of an ischemic stroke.

Effect of sleep on cerebral DNA synthesized during shuttle-box avoidance training

Female Wistar rats weighing 200 g were implanted with cortical electrodes and two intraventricular cannulae. Five days later they were given 3H-thymidine and exposed to shuttle-box training for four hours. They were then left free to sleep in the following three hours during which their EEG activity was recorded. In comparison with control animals (C), learning (L) and non-learning (NL) rats exhibited an increase in SS. In comparison to the EEG recording made the previous day, all animal groups displayed an increase in SS, but only NL rats suffered a decrease in PS(%). The specific radioactivity of DNA measured in several brain regions was tendentially lower in NL rats, but significance was achieved only in the cerebellum in the comparison between NL rats and C rats. No change occurred in liver. More marked and significant decrements in the DNA specific radioactivity of all brain regions were observed in the subgroup of NL rats displaying relatively high values of PS time in comparison to the analogous subgroups of C and L animals. Comparable decrements were present with regard to the subgroup of NL rats endowed with relatively low PS time. Less widespread and more limited changes were observed in the concentration of acid-soluble radioactivity. In addition, several significant correlations were detected by Spearman's analysis among behavioral, biochemical and sleep parameters. The results are consistent with the interpretation that the selective decrease in brain radioactive DNA observed in NL rats reflects a loss of DNA synthesized during the training period. The loss is related to the amount of post-training PS and is associated to a lengthening of the mean duration of PS episodes. It may be concluded that the loss of newly-synthesized brain DNA reflects the elimination of molecules associated with neural information devoid of adaptive value.

Radiculography with reduced amounts of contrast medium

Because of the frequency and seriousness of side effects observed after radiculography, due to, among the other things, the amount of contrast medium, the authors describe a method that gives diagnostically satisfactory results using a low dose of contrast and a tangent-beam technique. Among 106 patients undergoing radiculography with a tangent-beam technique and Iopamidol, only 4 developed mild side effects, namely headache in three cases and headache with nausea in one.

[Effect of sleep on cerebral DNA synthesized during learning]

Female Wistar rats weighing 200 g were implanted with cortical electrodes and with an intraventricular cannula. Five days later they were injected with 3H-thymidine and subjected to a two-way active avoidance session lasting four hours. During the following three hours they were left free to sleep while their EEG activity was being recorded. Biochemical analyses carried out in different brain regions and in liver indicated that the concentration of cerebral radioactive DNA was markedly lower in non-learning rats as compared to learning animal and to the control group. An increase in synchronized sleep and in paradoxical sleep was observed in learning animals, whereas non-learning rats exhibited an increment of synchronized sleep only. On the basis of these results and of previous data obtained with rats analyzed soon after the training session, it is concluded that the effect observed in non-learning animals stems from a loss of radioactive DNA synthesized during training. Such a loss takes place in the following resting period and is to be related to the variations of sleep pattern recorded. The process of DNA degradation might reflect the elimination of molecules associated with neural information non longer usable for adaptive aims.

[Sacroradiculo graphic and myelographic investigations with iopamidol: study of 610 examinations (author's transl)]

610 sacrorodiculographic and myelographic examinations were carried out injecting at lumbar level Iopamidol at 200, 300 and 370 mg I/ml concentrations. Immediate and early complications have been noticed in 18,52% of cases, i.e. sensation of pain during contrast injection, headache, nausea, vomit, neck stiffness, photophobia, epilepsy. In sacrorodiculographic examinations, side effects especially occurred by using 370 mg I/ml concentrations; in lumbar and thoracic myelographies, incidence of complications did not statistically differ by uing 300 or 370 mg I/ml concentrations. Side effects have occurred most frequently in cervical myelographies carried out with 370 mg I/ml concentration. Analysis of complications as well as radiographic results suggest to use Iopamidol at 300 mg I/ml concentration in sacrorodiculographics, in lower thoracic myelographies and in studies of narrowed, stenosed or obstructed canals; Iopamidol at 370 mg I/ml concentration may be used in upper thoracic studies and cervical myelographies.

L-dopa plus dopa-decarboxylase inhibitor. Sleep organization in Parkinson's syndrome before and after treatment

Sixty-four all-night sleep polygraphic recordings have been carried out in patients affected by Parkinson's syndrome, before and after treatment with an association of l-dopa plus a peripheral dopa-decarboxylase inhibitor. Without any drug, parkinsonian patients showed sleep disruption with frequent awakenings, reduction of total sleeping time and lessening of REM stage rather than slow sleep. Treatment with l-dopa plus inhibitor appeared to be able to restore good night sleep organization with a noteworthy increase in the REM stage.

Clinical pharmacology as an approach to the study of biochemical sleep mechanisms: the action of L-dopa

The authors have attempted to confirm, on the basis of clinicopharmacological research, the action of dopa on sleep stages and sleep organization; this was then well studied in laboratory researches. They have recorded patients suffering from Parkinson''s disease before and after treatment with <i>L</i>-dopa, at various quantities of drug, throughout the night and during spontaneous sleep. In the basic night records they found a decrease in the IV and REM stages, and an increase of wakefulness. After average doses of <i>L</i>-dopa (about 3 g) a decrease in wakefulness, a slight increase in slow sleep stages and a sharp rise in REM stage can be seen; moreover, the number of awakenings and the period for falling asleep are reduced. A higher dosage of the drug (about 5 g) causes the alterations and the disturbances of the basic night recordings to reappear.