[Association of bronchogenic cyst of the pancreas and duplication cyst of the stomach]

One case of bronchogenic cyst of the pancreas associated to a true gastric cyst produced by duplication is described. Such congenital neoformations are extremely rare. The symptoms are highly variable. The diagnosis can be established only through the histopathological study of the surgical specimen.

SPECT, MRI and cognitive functions in multiple sclerosis

Seventeen patients with relapsing remitting multiple sclerosis (MS) and mild physical disability had neuropsychological testing, magnetic resonance imaging (MRI) and single photon emission computerised tomography (SPECT) using technetium 99m (99mTc) hexamethyl-propyleneamine oxime (HMPAO). Performance in verbal fluency, naming and memory testing appeared to be impaired in MS patients compared with 17 age-sex and education matched normal controls. Weighted periventricular and confluent lesion scores and the width of the third ventricle, proved to be the most sensitive MRI measures in differentiating more cognitively impaired patients from those who were relatively unimpaired. Ratios of regional to whole brain activity, measured by SPECT, showed significant reduction in the frontal lobes and in the left temporal lobe of MS patients. A relationship was found between left temporal abnormality in 99mTc-HMPAO uptake and deficit in verbal fluency and verbal memory. Finally, asymmetrical lobar activity indicated a predominant left rather than right temporo-parietal involvement.

24-month follow-up of multiple sclerosis patients treated with cyclophosphamide

15 patients with remitting-progressive multiple sclerosis received a course of intravenous cyclophosphamide followed by a booster dose every 60 days for 2 years. There were no severe short or medium term side effects. Half of the patients presented clinical stabilization and substantially unchanged Kurtzke rating at 2 year follow-up. Since the aim was stabilization only, our findings argue for continuation of the study in young patients with very short shift.

Matching of receptive fields in the association projections from SI to SII of cats

Anatomical and electrophysiological experiments were performed on cats to investigate the pattern of divergence and convergence in the association projections from the first (SI) to the second (SII) somatic sensory cortex and to ascertain whether diverging and converging fibre components from SI have receptive fields (RFs) matching those of target neurons in SII. In the first group of six cats, a single deposit of horseradish peroxidase (HRP) was iontophoretically placed (2-4 microA for 20 minutes) into an electrophysiologically identified site of the SII map: the digit (3 cats), forepaw (2 cats), and arm (1 cat) zones. The forelimb representation in ipsilateral SI was subsequently explored with microelectrodes and RFs from small clusters of neurons systematically mapped. Planar maps of this area were reconstructed with the aid of a computer from serial sections, to correlate on the tangential plane the topographical distribution of retrogradely labelled association neurons with the physiological map of the forelimb. Since diverging projections were observed from a zone of SI to multiple zones of SII, double-labelling experiments were carried out in a second group of three cats, in which two retrograde fluorescent dyes (diamidino yellow and fast blue) were injected by pressure into two different sites of the SII map, to ascertain whether SI sends diverging projections by branching axons. HRP injections in SII retrogradely labelled a discrete number of association neurons in SI. Their distribution area was several tens of times wider than that covered by the injection site. This suggests that a remarkable amount of divergence and convergence exists in the association projections from SI to SII. Despite the substantial difference in the extent of the injected and labelled areas, RFs of afferent and target neurons corresponded closely. Injections covering a small region within a single digit zone of SII labelled neurons throughout the entire representation of the same digit in SI, while neurons labelled in somatotopically inappropriate zones were rare. RFs mapped from several sites of the labelled region in SI were individually smaller than the RF mapped from the injection site in SII, but the overall size of afferent RFs encompassed that of target neurons. Divergence and convergence in the SI projections to SII zones representing more proximal portions of the forelimb may be even greater since HRP injections in the forepaw and arm zones of SII labelled a number of neurons also in the digit zone of SI, providing the RFs mapped from the injection sites were sufficiently wide to include the digits.(ABSTRACT TRUNCATED AT 400 WORDS)

[Acute distension followed by gastric rupture after an episode of bulimia. Apropos of a case]

The authors report a case of spontaneous gastric rupture due to acute distension following an episode of bulimia. A two stage surgical procedure was performed with a favorable outcome. The difficulty in the choice of therapy was confirmed in a review of the literature. A minor surgical intervention involving a lesser degree of trauma may be chosen, and after appropriate resuscitation, definitive surgery can be planned.

Serial study of gadolinium-DTPA MRI enhancement in multiple sclerosis

We performed serial baseline and gadolinium (Gd)-DTPA-enhanced MRI in 4 patients with definite multiple sclerosis. Studies were performed every month for a total of 4 scans. We obtained short TR/short TE sequences at 10 and 60 minutes after Gd-DTPA injection. All patients had multiple hyperintense lesions seen on baseline MRI with long TR/short and long TE. There was Gd-DTPA enhancement in new, enlarging, and preexisting lesions that were unchanged in size. The enhancing lesions were always seen on T2-weighted images. There was no difference in enhancement between the 10- and 60-minute studies. Six of 85 preexisting lesions enhanced whereas all new or enlarging lesions enhanced. Enhancement persisted in only 1/3 of the new or enlarging lesions, suggesting that MR enhancement is a transient phenomenon due to local temporary blood-brain barrier breakdown. Our data indicate that Gd-DTPA enhancement monitoring is more sensitive than unenhanced MRI for detecting disease activity in MS.

[Longitudinal comparison of methods of auditory evoked potentials in defined multiple sclerosis]

The object of the present paper was to evaluate the diagnostic accuracy of ABR using ipsilateral masking in patients suffering from multiple sclerosis. Fourteen patients were examined. Each patient with normal audiogram underwent two ABR recording sessions during a follow-up period of thirty months. The ABRs were recorded under two experimental conditions applying standard testing procedures and ipsilateral masking, respectively. In 5 patients magnetic resonance imaging was also available. The findings were compared with a control group, composed of 20 normal subjects. Standard ABR testing gave evidence of a pathological value in 50% of the cases while the ABRs proved to be altered in 64% under ipsilateral masking. The outcomes were less favourable than those obtained with somatosensory or visually evoked potentials. The conclusions drawn confirm the importance of ABR in the follow-up of multiple sclerosis. On the other hand, ipsilateral masking does not appear to provide any significant advantages due to poor amelioration of sensitivity and doubtful specificity of the observed alterations.

Callosal connections of the somatic sensory areas II and IV in the cat

The homotopic and heterotopic callosal connections in the forelimb representations of the second (SII) and fourth (SIV) somatic sensory areas of cats were investigated by means of the axonal transport of horseradish peroxidase (HRP) in conjunction with microelectrode recording. The tracer was injected in the electrophysiologically identified hand and/or digit zone of SII (six cats) or SIV (four cats). The homotopic area in the contralateral hemisphere was explored with microelectrodes in five animals (three injected in SII and two in SIV) to map neuronal receptive fields. The aim was to correlate in the same experimental case the topography of labelled callosal neurons with the physiological map of the forelimb. Labelled cells and recording sites were plotted on planar maps reconstructed with the aid of a computer from serial coronal sections from the anterior ectosylvian gyrus. After SII injections, labelled callosal neurons were observed throughout the forelimb representation in the contralateral area, but in the tangential plane their distribution was uneven. Each somatotopic zone composing the forelimb map, that is, the arm, hand, and digit zones, contained several subzones in which callosal neurons were either dense or rare. Microelectrode explorations showed that receptive fields mapped from callosal and relatively acallosal subzones representing the same body part were similar in extent and location. After SIV injections, labelled callosal neurons were observed throughout the forelimb and proximal body representation of the contralateral area. Although slight regional variations in the density of labelled cells were apparent, no subzones bare of callosal labelling were observed in SIV. In both SII and SIV, callosal neurons were concentrated mainly in layer III, but a significant number was also evident in the infragranular layers. After HRP injections in the digit zone of SII or SIV, labelled cell bodies were also observed in heterotopic areas of the contralateral hemisphere. Most of these neurons were clustered in the medial bank of the coronal sulcus and in two other heterotopic cortical regions lying, respectively, in the anterior suprasylvian sulcus and in the lateral branch of the ansate sulcus. Some callosal cells interconnecting SII and SIV were also labelled. The results show that the distal forelimb zones in SII and SIV are callosally connected with the respective homotopic zones and with several somatosensory fields located heterotopically in the contralateral hemisphere.

[Extrapyramidal type collateral effects of the administration of metoclopramide to children]

Metoclopramide (M.) is a neurolectic drug used with good results in digestive tracts disorders. Even in minimum doses Metoclopramide may cause side effects to children. The most frequent are: localized hypertonia, oculogyric fits, trismus, cervical, oral and lingual dyskinesias, tremors and agitations. Symptoms seem to be serious but it is sufficient to stop the cure that all signs fade away. Manufactures show three personal side-effects' remarks by M. and advise to administer the drug to children with more caution since they are very sensitive to the substance.

Multifactorial inheritance and recurrence risks of multiple sclerosis in Italian patients

This study is based on 166 patients with definite multiple sclerosis (MS) residing in different Italian regions and on 332 parents and 326 siblings. Seven patients had a first-degree relative with a definite diagnosis. The comparison with a population age-matched for specific frequency of MS showed an increase of the disease among relatives. The increase in MS frequency among sibs is compared with that expected under an autosomal dominant, autosomal recessive or multifactorial model. The multifactorial hypothesis appears to better fit the data. The heritability index is calculated for each combination of relative and affected patient sex and compared with estimates of other European and American countries. The recurrence risk rates for male and female relatives have been computed for the more frequent family situations. Our results support the hypothesis of a multifactorial model of inheritance and provide risk figures to be used in genetic counseling.

Quantitative assessment of blood-brain barrier permeability in multiple sclerosis using 68-Ga-EDTA and positron emission tomography

Fifteen patients with definite multiple sclerosis were examined with high volume delayed (HVD) CT scan and positron emission tomography (PET) using 68-Ga-EDTA as a tracer. The passage of 68-Ga-EDTA across the blood-brain barrier (BBB) was measured by using multiple graphical analysis. This method permits the simultaneous calculation of a blood to brain influx constant Ki (ml/g-1 min-1) and of the plasma volume Vp (ml/g-1). Focal areas of abnormal CT enhancement and pathological accumulation of 68-Ga-EDTA were visualised in four patients who were all examined during a clinical exacerbation of the disease. The mean Ki value measured in these areas was 12.5, SD 3.4 indicating a moderate but significant increase of BBB permeability compared with the value found in normal tissue (3.2, SD 0.9). No parallel increase in Vp values was found in these pathological areas. Quantitative data obtained with PET seems to provide further insight into the study of BBB function in multiple sclerosis.

Hepatic alterations in indomethacin-treated rabbits

Indomethacin was parenterally administered (6 mg/Kg/day) for 30 days to rabbits, to evaluate changes in serum biochemical parameters and any ultrastructural alterations induced by the drug at the hepatic level. An analysis of the results demonstrated that when the group of rabbits, a statistically significant increase in the serum ALT was found in the treated rabbits. Ultrastructural observations showed the following hepatocyte alterations: 1) minimum mitochondrial alterations 2) mild signs of cholestasis (pericanalicular osmophilic bodies) 3) Smooth endoplasmic reticulum hyperplasia. These findings suggest that indomethacin has the capacity to induce hepatic lesions in the rabbit and this is probably due to the surfactant mechanism.

Amikacin-induced liver toxicity: correlations between biochemical indexes and ultrastructural features in an experimental model

In previous studies, aminoglycosides (AG) as gentamicin (G), dibekacin (D), tobramycin (T), netilmicin (N) and Sysomicin (S) were proved to induce ultrastructural alterations in the liver of experimental animals. The aim of this studies is to investigate the effect of amikacin (AK) on rabbit liver which is commonly used in infections resistant to other AG; this was done studying both the common blood parameters and ultrastructural changes. The study was accomplished in 24 New-Zealand rabbits, twelve received 20 mg/kg AK every 12 hours for 2 weeks. Thereafter the animals were anesthesized and liver slices were obtained for transmission electron microscopy. As results obvious signs of primary and secondary microcholestasis associated to mitochondrial cristae detachment and phospholipid aggregations were noted; this last finding was less marked when compared to previous studies employing other AG. In the AK treated group, blood tests showed a significant increased in only Blood Urea Nitrogen (BUN) and an insignificant rise in AST levels. Our findings are consistent with an AK induced liver toxicity albeit less evident with respect to the other AG.

[Ultrastructural study of the liver in rabbits treated with diclofenac]

The existence of alterations of common indexes of hepatic function, and the case-reports of acute hepatitis after the use of diclofenac sodium are the rationale for this experimental study, in which 8 rabbits were given 15 mg/kg day of diclofenac, to check ultrastructural modifications with respect to a control group. The analysis showed the typical signs of primary and secondary microcholestasis, indicating the existence of liver distress. This finding, from a clinical standpoint, suggests caution in the administration of this drug, chiefly in the hepatopathic patients.

Sequential computed tomography and 123I-HIPDM scans in multiple sclerosis with large plaque. A case report

We report a case of acute multiple sclerosis in whom computed tomography (CT) scan suggested the presence of a large plaque. The anatomical and functional recovery of the brain tissue was followed by means of repeated CT scan and 123I-HIPDM studies. Single photon emission CT may be successfully employed to monitor the pathophysiological changes associated with the demyelinating process.

Retentive properties of a new post and core system

Fifty Flexi-Posts were cemented in extracted teeth and tested for tensile strength. The Flexi-Post was the most retentive post tested when compared with posts used in a similar study. The retention of the Flexi-Post became greater as the size of the post increased.

An interictal study of partial epilepsy using positron emission tomography and the oxygen - 15 inhalation technique

Data from ten patients with complex partial seizures who underwent positron emission tomography using the 15-0 inhalation technique are presented. Decreased flow and metabolism are noted in the hemisphere ipsilateral to the EEG focus, but, in patients with unilateral foci, bilateral changes in temporal cortex are detected. Other areas maximally affected include the basal ganglia, and the cerebellum. The possible role of anticonvulsant drugs in these findings is discussed.

Serial observations on the pathophysiology of acute stroke. The transition from ischaemia to infarction as reflected in regional oxygen extraction

Regional cerebral blood flow, fractional oxygen extraction and oxygen metabolism have been measured in 34 patients after acute nonhaemorrhagic cerebral hemispheric infarction. Nine cases showed elevated oxygen extraction in the region of the early infarct, and these were the patients studied earliest after the onset of stroke. The results of serial studies to follow the evolution of the pathophysiology of acute stroke in these 9 patients are presented. The elevated oxygen extraction within the early infarct showed a significant reduction over the week following the onset of stroke. The reason for this fall in the fractional use of available oxygen varied in individual cases, and at the extremes was associated with a marked reduction in oxygen metabolism with a further small fall in residual blood flow, or a return of flow without recovery of oxygen metabolism. The significance of oxygen extraction in terms of potential viability of the tissue is discussed. The finding of a lower oxygen extraction in subcortical grey and white matter compared to cortex within the first hours or days of a major stroke is considered indicative of an earlier change from ischaemia to infarction in the deep tissues, probably related to the anatomy of the microvasculature. The interpretation of the results in the light of knowledge accumulated from studies of ischaemia in animals is presented, and problems imposed on data analysis by current limitations in positron emission tomography are discussed.

Mitral valve prolapse as a risk factor for TIA. A study with echocardiography and dynamic ECG

The present study has been devoted to the analysis of 120 patients presenting with reversible focal cerebral ischemia without conventional signs of cardiopathy and/or relevant atherosclerotic disease. In 77% of the patients vascular risk factors, such as hypertension or hyperlipemia, were present. In 23% of the patients, no abnormal finding was discovered at clinical, hematochemical and cardiological examinations. In these patients a further cardiological evaluation was performed with echocardiography. Dynamic electrocardiography was performed in 52 patients. Echocardiography and dynamic electrocardiography revealed the occurrence of 6 cases of mitral valve prolapse (MVP), 2 cases of frequent premature ventricular beats, and 1 proximal atrial arrhythmia. All 6 cases of MVP were detected in the subgroups of patients without vascular risk factors. In our patients younger than 45 years, the relative frequency of MVP attains 21.5%. This study confirms that MVP has to be regarded as a risk factor for focal cerebral ischemia in young patients.

The combined use of radionuclide angiography and Doppler-sonography in the screening of carotid lesions

The aim of our research is to check if the combined use of radionuclide angiography and Doppler-sonography leads to correct screening of carotid lesions in the neck, independently from the indexes of reliability of the individual examinations. 125 cerebrovascular patients (for a total of 250 carotid studies) were investigated with radionuclide angiography and Doppler-sonography. 100 of these carotids were also angiographically investigated. On the basis combined angioscintigraphic and Doppler results, these patients have been classified in four groups. When both non-invasive examinations result negative, the angiography shows pathological arteries only in 22% of cases. When only radionuclide angiography is positive, the angiography shows pathological findings in 63% of cases: when only Doppler is positive, the angiography confirmation occurs in 72% of cases. Finally, when both non-invasive tests results positive, there is always arterial pathology in the angiography.

Measurement of regional cerebral blood flow and oxygen utilisation in patients with cerebral tumours using 15O and positron emission tomography: analytical techniques and preliminary results

Regional cerebral blood flow and oxygen utilisation have been studied in 8 patients with brain tumours using continuous inhalation of C15O2 and 15O2 and positron emission tomography. The methods used to analyse the regional cerebral pathophysiology are presented. A relative uncoupling between oxygen consumption and blood flow was observed in all tumours as indicated by a decreased regional fractional extraction of oxygen (rOER). This suggest that a major proportion of these tumours had sufficient blood supply to meet oxygen metabolic demand. A decrease of blood flow in grey matter was found both in the affected and contralateral hemispheres of the brain. Matched reductions of flow and oxygen utilisation were observed in oedematous tissue.

[Social unsuitability in the developmental age. Hypothesis for new structures helping social adjustment]

In this report the Authors analise, according to their different competences, from a psychiatric, psycho-sociological, and of judicial politics point of view, a case of neurosis of conflict during adolescence, with an anti-social development, regarding which it has been ascertained that the measures of restoration, which have been adopted, have failed their purpose. They have, as a matter of fact, paradoxically fixed the subject even more in his anti-social condition, not giving him the possibility of escaping the psycho-pathological destiny of negative sociopatic deviation. The Authors, in this report, reflect upon the meaning of the Institutes of restoration and punishment in the light of the new re-educational conceptions, pointing out their limits. They long for the institution of supplementary structures of little dimensions in the bosom of the family, well integrated with the school, the working milieu, and the local community and wish the structures of restoration for anti-social disadaptations to stop from being static Institutions far from the real social problems of a democratic life, in order to become centers of social democratic life and places of comparison, according to a dialectic method of knowledge, between subculture as deviation (which is not always negative) and the dominating culture with its needs and rules.