Proper names in the early stages of Alzheimer's disease

A short proper name retrieval test was found to discriminate between unselected subjects and age- and education- matched patients affected by Alzheimer's type dementia at a stage where the Mini-Mental State Examination could not detect a difference between these groups. The proper name retrieval task also compared favorably with the 3MS, a more sensitive, modified version of the MMSE. These findings suggest that proper name retrieval could be used to an advantage and become a routine component of short batteries for the early detection of Alzheimer's disease.

Optimal PPI-based triple therapy for the cure of Helicobacter pylori infection: a single center comparison of four 14-day schedules

BACKGROUND

Helicobacter pylori eradication is accomplished using a wide array of drugs combined in a multitude of dosage schedules. The aim of the present study was to define the best 14-day eradication schedule using a PPI plus either two antibiotics or one antibiotic and bismuth.

MATERIAL AND METHODS

For this study, 367 subjects (198 males, 169 females, age 22-87 years) with document H. pylori infection of the stomach were recruited from out-patients of the Gastroenterology Department of the Venezia Hospital. In all patients, H. pylori infection was identified by histology and the CLO-test. Patients were treated as follows: 1) PPI (P) plus clarithromycin (C) 250 mg plus amoxicillin (A) 1000 mg bid (P + C + A); 2) P plus C plus bismuth subcitrate (B) 120 mg qid (P + C + B); 3) P plus C plus tinidazole (T) 500 mg bid (P + C + T); and 4) P plus A plus T bid (P + A + T). After two months, an upper gastrointestinal endoscopy was repeated for end point histological evaluation and the CLO- test. Positivity of one of the two methods was considered sufficient to define H. pylori as "not eradicated".

STATISTICS

Chi-squared test and Fisher exact test.

RESULTS

Thirty-three subjects dropped out (six due to adverse events). P + C + B was proven significantly less effective than P + C + A, P + C + T and P + A + T, eradication rates being, respectively, 75.0%, 90.5%, 87.6%, 92.0%, (p = .005, per protocol analysis).

CONCLUSIONS

All PPI-based triple therapies tested in this study were effective in curing H. pylori infection; however, P + C + B resulted in rates too low (< 85%) to be recommended. P + C + A and P + A + T resulted in the high cure rates and thus may be considered the treatment of choice.

[Intestinal anastomosis with biodegradable ring]

The authors report their experience using biofragmentable anastomosis ring (BAR) in bowel anastomosis. Starting January 1993 to February 1994, 46 intestinal anastomoses were performed using BAR, and particularly 39 end-to-end colo-colostomies, 2 end-to-side colo-colostomies and 5 end-to-side ileo-colostomies. 35 patients were affected by colonic neoplasm, 5 patients by diverticular colonic complications- and 5 patients by several unusual bowel diseases. Four emergency operations were performed, while 42 patients had an accurate bowel preparation before surgery. In this series of patients one case of preoperative mortality is reported, due to massive pulmonary embolism. Instead several minor complications occurred in other patients, such as paroxysmal atrial fibrillation (one case), basal pleuritis (one case), hyperpyrexia (three cases), temporary subocclusion or delayed canalization (five cases). Only one patient suffered from intestinal occlusion induced by adhesions and a second laparotomy was required. Delayed canalization seems to be caused by the small size of the BAR employed (25 mm) or by inadequate intestinal preparation, that usually occurs in emergency operations. After surgery all patients were followed up and 18 of them were examined by coloscopy six months after surgery. No clinical problem connected with bowel anastomosis was reported and all anastomosis looked quite previous and resilient. No anastomotic stenosis was found. In our experience and from recent reviewed reports, BAR seems to be a rapid, effective and safe device for sutureless bowel anastomosis.

[Role of surgery in the treatment of acute hemorrhagic non-variceal lesions in the upper gastrointestinal tract]

From January 1993 to December 1994, out of 244 cases of upper gastrointestinal hemorrhage observed 25 patients underwent surgical treatment. Twenty-nine bleeding varices were excluded from this study. Early endoscopy revealed the source of bleeding almost in all cases (84%). All patients received, at the time of admission, medical treatment associated in 7 cases (28%) to endoscopic injection therapy. Emergency surgery indications were massive bleeding persistent bleeding, rebleeding and macroscopic findings of lesions. The aim of this report is to verify the respective roles of medical, endoscopic and surgical therapies in relation to the nature of the bleeding lesion and the entity of the hemorrhage. Results with regard to indication, clinical data, surgical technique were compared with literature data.

[Thyroid carcinoma in hyperthyroid syndromes]

The relationship between hyperthyroidism and carcinoma of the thyroid is still uncertain. The incidence of thyroid carcinoma ranges from 0.3 to 16.6%. Between 1984 and 1994 the Authors observed 9 patients affected with thyroid cancer and toxic nodular goiter (4 patients) or Basedow disease (2 patients) or scintigraphic evidence of single hyperfunctioning nodule (3 patients). Six out of the 9 cases were diagnosed as papillary cancer, while three as follicular cancer. A carcinoma was diagnosed before operation in only one case, while in the other 8 patients, the diagnosis was obtained by histological examination of the specimen. Four patients underwent subtotal thyroidectomy, while five patients underwent radical lobectomy. All patients are alive and in good health; the average follow-up was 48 months.

Carbohydrate-induced thermogenesis in liver cirrhosis: glucose vs. fructose

Reduced thermic response after a glucose load has been reported in liver cirrhosis. To determine the mechanism and the site of this phenomenon, the effects of glucose and fructose on energy expenditure (EE) were measured in seven well-nourished cirrhotic patients and in six healthy control subjects. EE and fuel utilization were measured via indirect calorimetry for 3 h after oral glucose or fructose administration (1 g/kg body wt). After a glucose load, plasma glucose and insulin concentrations were higher in cirrhotic patients than in control subjects (p < 0.05). During the glucose trial, the cumulative incremental changes in EE over the 3-h measurement period were lower (p < 0.01) in patients than in the control subjects (0.98 +/- 0.13 vs. 1.70 +/- 0.23 kJ.kg-1.3 h-1). After fructose ingestion, the cumulative changes in the EE of control subjects (1.76 +/- 0.24 kJ.kg-1.3 h-1) and cirrhotic patients (1.59 +/- 0.15 kJ.kg-1.3 h-1) were similar. In cirrhotic patients, the EE increase after fructose was higher than after glucose (p < 0.05). After glucose and fructose ingestion, no difference was observed between the carbohydrate oxidation in cirrhotic patients and that in control subjects, and lipid oxidation was suppressed to the same extent in both groups. We conclude that glucose-induced thermogenesis is impaired in liver cirrhosis, whereas fructose can normalize the thermic response. Because fructose is chiefly metabolized in the liver, these findings suggest that extrahepatic tissues are the site of defective thermogenesis in liver cirrhosis.

[Solitary ulcer of the rectum]

The authors review their five-year experience of solitary rectal ulcers. A revision of the most recent literature enables them to outline the characteristics of the disease with reference to its epidemiology, anatomopathology and clinical features. The discussion focuses on the problem of treatment which must be based on a thorough and in-depth knowledge of pathogenetic mechanisms. The paper outlines two theories, the hamortomatous one and the so-called mechanical theory involving the hinge valve, which are referred to by most researchers. The question of treatment is then discussed illustrating the possibility of resorting to surgical-type treatment which appears to be the most suitable for the definitive resolution of the problem. But since, at least in the light of the authors' personal experience; the majority of patients belong to an age group in which other pathologies are often present, the medical treatment option appears to be more rational. The re-education of the alvus achieved using suggestions not only of a dietary type but also regarding the behaviour and correct position to assume during defecation appears, at least theoretically, sufficient to obtain a marked improvement. The local application of therapeutical AIDS, if necessary strengthened by the action of drugs taken systemically, brings considerable further benefit to the patient who cannot and/or does not which to undergo surgery.

Helicobacter pylori infection, cigarette smoking and alcohol consumption. A histological and clinical study on 286 subjects

Helicobacter pylori (Hp) is connected with active/chronic gastritis, gastric gastric and duodenal ulcer. It is not known whether exogenous factors are involved in Hp infection. The aim of this prospective study, performed on 286 consecutive subjects undergoing upper gastrointestinal endoscopy, was to evaluate the influence of smoking and alcohol consumption on Hp infection. For each patient the following parameters were taken into account: sex, age, smoking (no, < 10, > 10 cig/day) and alcohol (no, < 40, > 40 g ethanol/day) intake, antiulcer therapy (no, H2-blockers, omeprazole, sucralfate), presence of gastric or duodenal ulcer (DU). At least two biopsies from both the antrum and the corpus were obtained for histological examination; the gastritis was classified and scored according to the Sydney system.

STATISTICS

chi-squared test (corrected), Fisher's exact test.

RESULTS

43 pts had Hp (27M, 16F; age 57.8 yrs, range 23-91), 47 Hp ++ (25M, 22F; age 61.1, range 19-86), 81 Hp + (48H, 33F; age 56, range 16-84), 115 Hp- (75M, 40F; age 57.8, range 19-84). Hp infection was found to be significantly correlated with presence of ulcer symptoms, gastritis, lymphoid follicles and, among DU patients, with active DU. The other parameters considered did not influence Hp infection. In conclusion smoking habits and alcohol consumption do not affect Hp infection of the stomach.

[Granulosa cell tumor of Abrikossof]

The authors report a case of Abrikossof's tumor that came under their observation. The reappraisal of the literature permits to review on this disorder that was unknown until few years ago. Electronic microscope and immunohistochemical study allowed to recognize the real origin of this tumor. It arises from peripheric nervous tissue particularly from Schwann's cells. This neoplasm must be considered as benign, especially when of small dimensions. In case of rapidly growing or larger than 8 cm forms a widely exeretic surgery and a careful follow-up, because of the possibility of finding tumors in other district of the body.

[Mondor syndrome. Etiopathogenesis and case report]

The Authors observed and report a case of Mondor's syndrome in a male. In the attempt to identify the real origin in this peculiar thrombophlebitis they reviewed the recent literature. It is apparently impossible to drawn definitive conclusions from the different studies on this subject. Anyway Mondor's syndrome looks suitable for inclusion in the group of jumping thrombophlebitis. Therefore the real cause of the venous accident should be a pathologic situation next to the venous branch where the thrombophlebitis has broken out.

[Tumors of the small intestine. Case reports and comments]

Tumours of the small intestine are extremely rare and have a particularly severe prognosis. The impossibility of making an early diagnosis due to the scarcity of precise symptoms during the early stages of the disease and the lack of safe instrumental tests limits the results of treatment which is essentially surgical. In order to contribute to the study of the disease and improve its prognosis, the authors report the cases which they have observed and review the literature.

Co-participation of thromboxane A2 and leukotriene C4 and D4 in mediating cyclosporine-induced acute renal failure

The relative role of thromboxane (TxA2) and sulfidopeptide leukotrienes C4 (LTC4) and D4 (LTD4) in the acute renal failure induced by cyclosporine was studied in the rats. Bolus i.v. administration of 20 mg/kg of CsA but not vehicle to adult male Sprague-Dawley rats resulted in a significant fall in glomerular filtration rate from 0.85 +/- 0.10 and renal plasma flow (RPF) 2.45 +/- 0.14 ml/min/100 g body wt to values at 20 min of 0.47 +/- 0.03 and 1.01 +/- 0.12 ml/min/100 g body wt (P less than 0.01), respectively, without a fall in mean arterial pressure. This hemodynamic effect was maintained for the following 40-min period. Pretreatment of rats with the TxA2 receptor antagonist GR32191 (3 mg/kg i.v.) allowed a partial but significant preservation of GFR (0.60 +/- 0.05 ml/min/100 g body wt) and RPF (1.55 +/- 0.12 ml/min/100 g body wt). In addition, the antagonism of endogenously produced LTC4 and LTD4 with the putative receptor antagonist L-649,923 (1 mg/kg i.v.) partially prevented the fall in GFR (0.65 +/- 0.07 ml/min/100 g body wt) and RPF (1.80 +/- 0.18 ml/min/100 g body wt) at 20 min after CsA injection. The combined administration of GR32191 and L-649,923 completely abolished the CsA-induced decline in GFR (0.80 +/- 0.09 ml/min/100 g body wt) and RPF (2.40 +/- 0.12 ml/min/100 g body wt). These findings suggest that TxA2 and LTC4/LTD4 participate in mediating renal function deterioration induced by acute CsA administration in the rat.

[Carcinoid tumor of the appendix]

The authors after briefly outlining the epidemiological and clinical characteristics of the appendiceal carcinoid, report a case observed by them. They discuss the problem concerning the prognosis of this particular tumoral form, and the prognosis which could be more severe than people generally think.

Brain M3 muscarinic receptors are involved in the ACTH-induced reversal of hemorrhagic shock

In an experimental model of bleeding-induced hemorrhagic shock causing the death of all saline-treated rats within 30 min, the intravenous injection of ACTH-(1-24) at the dose of 160 micrograms/kg induced a sustained reversal of the shock condition, with almost complete recovery of blood pressure, pulse amplitude, respiratory rate, heart rate, and 100% survival, at least for the 2 h of observation. This effect of ACTH-(1-24) was prevented by the intracerebroventricular injection of 4-DAMP (a highly selective antagonist for M1 and M3 muscarinic receptors), but unaffected by the intracerebroventricular injection of pirenzepine (a highly selective antagonist for M1 muscarinic receptors). These data indicate that an essential step in the complex mechanism of the ACTH-induced shock reversal may be the activation of brain M3 muscarinic receptors.

[Pilonidal sinus: our experience in the surgical treatment by closed method]

The A. describe the essential traits of the "sinus pilonidalis" disease and report the results obtained by surgical therapy and compared their data with literature data. The A. underline the goodness of the "closed method" particularly if a few special tricks are employed.

Ticlopidine prevents renal disease progression in rats with reduced renal mass

Functional and morphological studies were done in three groups of male Sprague-Dawley rats after removal of the right kidney and infarction of approximately five-sixths of the left. Group 1 received no specific therapy. Group 2 was treated with ticlopidine, 150 mg/kg per os, for 50 days starting 10 days after surgical ablation. Group 3 was given the thromboxane antagonist, GR 32191, 3 mg/kg b.i.d. orally for 50 days, like ticlopidine. Untreated Group 1 rats developed renal insufficiency, systemic hypertension, progressive proteinuria and glomerulosclerosis. In Group 2 treatment with ticlopidine was associated with less severe impairment of renal function. Proteinuria was significantly lower and animals were partially protected from the development of glomerulosclerosis. These animals had significantly prolonged skin bleeding time. In vitro ADP and arachidonic acid (AA)-induced platelet aggregation was inhibited. Systemic blood pressure was significantly lower than in controls. In Group 3 rats GR 32191 failed to influence progressive proteinuria and severity of glomerulosclerosis which were comparable to those in Group 1. Bleeding time was not prolonged, and in vitro platelet aggregation was inhibited only when AA was used as aggregating agent. Systemic blood pressure was not influenced. These studies suggest that a drug like ticlopidine, which has a broad spectrum of pharmacological actions on platelets and platelet-cell interactions, does retard the development of progressive renal injury when nephron number is reduced. Specific blocking of thromboxane A2 (TxA2) biological activity does not influence progressive renal disease in rats with remnant kidney.

Carcinoma of the gastric stump following partial gastrectomy (Billroth II operation) for benign gastroduodenal lesions. Preliminary results

A series of 110 patients out of 2,200, who had undergone Billroth II partial gastrectomy for benign lesions, between 1945 and 1980, was reviewed in order to perform clinical, biochemical and endoscopical examinations. In this group 9 patients (8.18%) showed gastric stump cancer and in 4 (3.63%) esophageal cancer was detected. The average time interval between previous operation and carcinoma diagnosis was of 28 years and 6 months. Eight patients out of 9 were males aging from 47 to 82, while the only woman was 65 (overall average: 63). The stump cancer presents at the same age and gives the same symptoms as primitive gastric carcinoma, but with worse results and prognosis. After having underlined some pathogenetic problems, the Authors show personal results and confirm the utility of an accurate endoscopical and clinical follow up especially for patients operated on since more than twenty years.

Extended operations for extracolic invasion by colon cancer

Out of 618 cases of colon cancer treated between 1976 and 1986, 25 had an unusual local invasion. They underwent radical surgery with total resection of one or more adjacent organs. This group is made of 17 female and 8 male patients, with an average age of 58 years. All the patients underwent resection of the colon with radical excision of the locally invaded organs. Only one case of postoperative death is recorded. Postoperative surgical complications were rare. This experience confirms that colic resection extended to adjacent organs invaded by the tumor gives a low risk of relapse and satisfying long term results in relatively young patients with good general conditions and without remote metastases.

[Dyspeptic syndrome in heart diseases]

Many investigations have ascertained the relation between dyspepsia and diseases or disorders of gastrointestinal tract; on the contrary, the topics concerning the dyspeptic syndrome during acute cardiac disorders are very few. For this reason, Authors studied the upper tract of digestive apparatus in some patients affected with congestive heart failure and ischemic heart disease. Data have showed alterations of motility in esophagus, stomach and duodenum in every patient and lesions of gastric mucous membrane in more than half of them.

Right hemisphere patients' judgements on emotions

A triadic comparison technique was used to assess brain-damaged patients' ability to judge the relatedness of a number of emotions, using either a pictorial or verbal material. Emotionally neutral material served as a control. Right hemisphere patients also differed from normals in processing emotions when presented with verbal material. It is suggested that central rather than only peripheral aspects in recognition of emotions are disturbed after injury to the right hemisphere.

Testicular biopsy of azoospermic men with vas deferens malformation using two different techniques

A morphological analysis was carried out on testicular biopsies of men with obstructive azoospermia as consequence of vas deferens malformations as compared with biopsies from fertile men. For each case the biopsies were processed with two different techniques: routine histological procedure, and semithin sections of specimens processed for electron microscopy. Four parameters were considered: tubular morphology, testicular biopsy score count (TBSC), tubular diameter, and germinal cell density. The data were quantified and analyzed by statistical tests. The biopsies of azoospermic men present a higher frequency of tubular sections with "tubular blockage," "sloughing" and cellular degeneration, lower values of TBSC, and lower germinal cell density. The results appear to be of relevant interest in relation to the existence of long-term testicular alteration following vasectomy.

The morphology of seminiferous tubules of human testicular biopsies. Analysis of the data obtained with two different techniques

Testicular biopsies of fertile men and of azoospermic patients for vas deferens agenesis were processed with two different techniques, i.e. routine histological procedure and semithin sections of electron microscopy preparations. Tubular morphology, testicular biopsy score count and tubular diameter were analyzed in comparison. The two techniques give rise to a different qualitative and quantitative evaluation of all tubular parameters considered. Otherwise they confirm the real existence of the so-called 'tubular blockage' situation with central tubular cellular mass and cell degeneration.

Noninvasive detection of insulation break

The electric current leak through an unsealed connector or insulation break can be a source of problems in cardiac pacing. This study describes a method of leak detection. The underdrive inhibition test--chest wall stimulation with external stimulator (ES)--was used for this purpose. Three cutaneous electrodes (CE) were applied: the first one above the indifferent electrode, the second one above the suspected leak location, and the third one above the active electrode. Two inhibition thresholds (IT) were measured: the first one connecting ES on first CE and second CE, and the second one connecting ES on first CE and third CE. The inhibition threshold is the value of ES output charge at which the inhibition of implanted pacemaker occurs. The relation between two ITs, not the absolute value, is significant for leak estimation. The former should be at least five times higher than the latter, if there is no current leak. During the two years of follow-up of 541 patients, 272 measurements were performed. In 52 cases the connector leak was found-both ITs were approximately equal. Twenty-seven cases were confirmed by surgery for EOL pacemaker replacement; the intrusion of body fluid was evident. Five operations were indicated because of the leak problem: two--muscle twitching, one--loss of capture, one-undersensing, and one--insulation break with lead fracture. The method, although approximate, is a reliable qualitative estimation of leak.

Antireflux ureterocystostomy at the vertex of the bladder

This is the first report on the technique and the results of an antireflux ureterocystostomy in the vault of the bladder. During the last 3 years, a total of 106 antireflux ureterocystostomies at the vertex of the urinary bladder has been performed. In 93 cases without another preceding antireflux operation, only 2 (2-1%) recurrent refluxes were found, whereas in 13 cases where an antireflux operation had been performed previously, 4 cases of recurrent reflux were seen, making a 30% rate of operative failure in this particular group. In all other cases the end result was excellent; the urine has become negative on culture and the dilatation of the ureter has subsided.