Liposomes and micellar dispersions for delivery of benzoheterocyclic derivatives of distamycin A

In this article we describe the production and characterization of specialized delivery systems for some distamycin derivatives (DD), namely liposomes and micellar dispersions. All the formulations were designed to increase the solubility of DD in an aqueous environment and to reduce the possible toxicity problems related to the administration of these drugs. For instance, liposomes were prepared by reverse phase evaporation technique followed by extrusion through polycarbonate filters, then characterized in terms of dimensions, morphology, and encapsulation efficacy. The analysis of their in vitro antiproliferative activity on cultured human and mouse leukemic cells demonstrated that liposomes and micellar dispersions containing DD exert quite different effects. These effects were compared with those shown by the free drug depending on type of drug and also cell line used.

Selective activation of 5-HT2C receptors stimulates GABA-ergic function in the rat substantia nigra pars reticulata: A combined in vivo electrophysiological and neurochemical study

In vivo electrophysiology and microdialysis were used to investigate the physiological role of 5-HT(2C) receptors in the control of substantia nigra pars reticulata (SNr) function. Extracellular single-unit recordings were performed from putative GABA-containing neurons in the SNr of anesthetized rats, and local GABA release was studied by in vivo microdialysis in the SNr of awake freely-moving rats. Systemic administration of the selective 5-HT(2C) receptor agonist (S)-2-(chloro-5-fluoro-indol-1-yl)-1-methylethylamine 1:1 C(4)H(4)O(4) (RO 60-0175) caused a dose-dependent excitation of about 30% of the SNr neurons recorded. However, the remaining neurons were either inhibited or unaffected by systemic RO 60-0175, in similar proportion. Local application of RO 60-0175 by microiontophoresis caused excitation in the majority of SNr neurons tested (48%), whereas a group of neurons was inhibited (16%) or unaffected (36%). Both the excitatory and the inhibitory effects of systemic and microiontophoretic RO 60-0175 were completely prevented by pretreatment with SB 243213 [5-methyl-1-({2-[(2-methyl-3-pyridyl)oxy]-5-pyridyl}carbamoyl)-6-trifluoromethylindoline], a selective and potent 5-HT(2C) receptor antagonist. Consistent with these electrophysiological data, both systemic and intranigral administration of RO 60-0175 and m-chlorophenylpiperazine (mCPP), a non-selective 5-HT(2C) agonist, markedly increased extracellular GABA levels in the SNr. The stimulatory effect of systemic and local RO 60-0175 on GABA release was completely prevented by systemic administration of SB 243213, whereas local application of SB 243213 into the SNr only partially blocked RO 60-0175-induced GABA release. It is concluded that selective activation of 5-HT(2C) receptors stimulates GABA-ergic function in the SNr, and the clinical relevance of these data is discussed.

Inhibition of glycogen synthase kinase-3beta attenuates the development of carrageenan-induced lung injury in mice

BACKGROUND AND PURPOSE

Glycogen synthase kinase-3 (GSK-3) is a ubiquitous serine-threonine protein kinase that participates in a multitude of cellular processes and has recently been implicated in the pathophysiology of a number of diseases. The aim of this study was to investigate the effects of GSK-3beta inhibition in a model of acute inflammation. Here, we have investigated the effects of TDZD-8, a potent and selective GSK-3beta inhibitor, in a mouse model of carrageenan-induced pleurisy.

EXPERIMENTAL APPROACH

Injection of carrageenan into the pleural cavity of mice elicited an acute inflammatory response characterized by: accumulation of fluid containing a large number of neutrophils (PMNs) in the pleural cavity, infiltration of PMNs in lung tissues and subsequent lipid peroxidation, and increased production of nitrite/nitrate (NOx), prostaglandin E2 (PGE2), tumour necrosis factor-alpha, (TNF-alpha) and interleukin-1beta (IL-1beta). Furthermore, carrageenan induced an upregulation of the adhesion molecules ICAM-1 and P-selectin, iNOS, COX-2 as well as nitrotyrosine as determined by immunohistochemical analysis of lung tissues.

KEY RESULTS

Administration of TDZD-8 (1, 3 or 10 mg kg(-1), i.p.), 30 min prior to injection of carrageenan, caused a dose-dependent reduction in all the parameters of inflammation measured.

CONCLUSIONS AND IMPLICATIONS

Thus, based on these findings we propose that inhibitors of the activity of GSK-3beta, such as TDZD-8, may be useful in the treatment of various inflammatory diseases.

[The treatment of acute recurrent pharyngotonsillitis]

AIM OF THE STUDY

In paediatric patients, recurrent febrile pharyngo-tonsillitis is usually due to chronic inflammation of the tonsils and/or adenoids: these episodes are often associated with other clinical manifestations (respiratory obstruction of naso-pharyngeal origin; auricular inflammation, especially effusive otitis media and acute otitis media; streptococcal beta-haemolytic Group A (SBEGA) infection, causing a distant disorder of varying severity and which may, therefore, give rise to serious pathological conditions). A retrospective multicentric investigation has, therefore, been carried out in order not only to further elaborate findings emerging from earlier studies, performed in other countries, in which random methods were used, but also to focus on: 1. the possible association of these clinical manifestations with recurrent febrile pharyngo-tonsillar inflammation in relation to frequency of the condition; 2. results obtained with adenoidectomy or with adeno-tonsillectomy, referring to the overall clinical outcome of the pathological condition, bearing in mind data emerging from the control groups, submitted to strict follow-up, associated with any medical treatment deemed necessary.

MATERIAL AND METHODS

The study population comprised 692 patients (394 male, 298 female), age range 2-11 years and with a minimum follow-up of 2 years. Considering the clinical manifestations emerging from the case history, the following two investigations were carried out: 1. the first, on 501 patients, all previously submitted to adeno-tonsillectomy in whom the recurrent febrile pharyngo-tonsillar inflammation had occurred, respectively > 4 or < or = 4 episodes during the last 12 months; 2. the second, on 455 patients in whom recurrent febrile pharyngo-tonsillar inflammation, in the 12 months prior to the beginning of the study, had been < or = 4 episodes: in 264 cases, adeno-tonsillectomy was carried out; in 144, adenoidectomy; 47 children were studied as controls and, therefore, submitted to watchful waiting. The results obtained were statistically analysed by chi2 and Fisher test: a "p" value of < 0.05 was considered statistically significant.

RESULTS

The first investigation showed that all symptomatological manifestations considered were resolved following adeno-tonsillectomy, in a significantly high percentage of cases (recurrent febrile pharyngo-tonsillar in flammation: 91.8%; naso-pharyngeal respiratory obstruction: 92.2%; pathological ASO titre: 69.8%; distant disorders probably due to SBEGA: 76%; effusive otitis media: 76%; acute recurrent otitis media: 87.5%). The most interesting clinical findings obtained can be summarized as follows: naso-pharyngeal respiratory obstruction is a frequent finding; the incidence is statistically higher in cases in which recurrent febrile pharyngo-tonsillar inflammation is less frequent (p < 0.05): in these patients, this is an important pathological manifestation indicating the need for surgery; the higher incidence is associated with at significant finding of pathological auricular processes; the percentages of recovery for naso-pharyngeal respiratory obstruction are statistically greater in the group of patients in whom the recurrent febrile pharyngo-tonsillar inflammation is more frequent: an identical result is found in patients with the effusive form of otitis media and in those with recurrent acute otitis media; a pathological ASO titre is more frequently found, the difference being statistically significant (p < 0.05), in the group of patients with more frequent recurrent febrile pharyngo-tonsillar inflammation, albeit this factor does not affect the percentage of recovery; also the favourable evolution and recovery of clinical distant manifestations, related to streptococcal beta-haemolytic Group A infection, are correlated with the return to normal of the ASO titre. The second investigation demonstrated the efficacy of surgical treatment, adeno-tonsillectomy and adenoidectomy, in all the clinical manifestations studied, the possibility of achieving resolution of recurrent febrile pharyngo-tonsillar inflammation even in the control subjects submitted to medical treatment, but also the lack of success, in the latter, as far as concerns naso-pharygeal respiratory obstruction, the pathological ASO titre and the inflammatory auricular processes.

CONCLUSIONS

The present investigations confirm previous observations emerging from randomized clinical studies, regarding the possibility to achieve valid prevention of recurrent febrile pharyngo-tonsillar inflammation, also in a large percentage of control patients submitted to watchful waiting; these investigations, however, also demonstrated that, in the control group, the percentage of subjects in whom recovery of other symptoms was achieved was very low compared to that in the groups submitted to surgery. In other words, clearly emerges as far as concerns the overall symptomatological picture of the patients, the efficacy of the surgical treatment, but also the lack of success of the medical treatments in all clinical manifestations associated with recurrent febrile inflammations. Therefore, it is necessary to select and advise the most suitable treatment strategy, not in relation to the Guidelines elaborated on the basis of results emerging from statistical research, that, due to the intrinsic methodology limits cannot be applied to all cases in an acritical fashion, but in relationship to the specific clinical picture of each individual patient.

[Acute recurrent pharyngotonsillitis and otitis media]

BACKGROUND

In the more recent randomized clinical studies, the surgical procedures adopted (adenoidectomy and adeno-tonsillectomy) for the treatment of the effusive and the acute recurrent forms of otitis media have generally shown a relatively modest and not persistent efficacy. It should be pointed out, however, that the cases studied displayed no clinical elements suggesting the existence of any aetio-pathogenic relationship between the auricular inflammation and a possible pathological disorder localized in the tonsils and/or adenoids.

AIM OF THE STUDY

The present investigation aimed to establish: a) the frequency with which the two forms of tympanic inflammation, under study, were detected in children with recurrent febrile pharyngo-tonsillar inflammation, also considering the possible presence of naso-pharyngeal respiratory obstruction and the severity of these two pathological manifestations; b) in relationship to these parameters, what might be the outcome with respect to the pathological auricular processes following surgical treatment of the pharyngeal disorder (adeno-tonsillectomy or adenoidectomy) vs. watchful waiting, c) the possible advantages offered by ventilation tube, inserted during surgical treatment, in the prevention of the two forms of otitis media studied.

MATERIAL AND METHODS

This retrospective multi-centre investigation involved 678 subjects (388 male, 290 female), age range 2 - 11 years: all subjects were followed-up for a minimum period of 2 years. Patients in this study population were submitted to 3 groups of investigations: a) in the first (487 children submitted to adeno-tonsillectomy), the study population was subdivided into 2 groups according to the frequency of the complaints of febrile pharyngo-tonsillar inflammation reported during the previous 12 months (> 4 or < or = 4); b) in the second (443 children with recurrent febrile pharyngo-tonsillar inflammation during the previous 12 months < or = 4), three groups of cases were compared; in the 1st (252 cases), patients were submitted to adeno-tonsillectomy; in the 2nd (144 subjects), adenoidectomy was carried out; in the 3rd (47 cases), the watchful waiting approach was adopted; c) in the third (193 cases, with both pathological auricular manifestations), patients were submitted to adeno-tonsillectomy (119 cases) or to adenoidectomy 74 cases); during surgery, ventilation tube was applied bilaterally in 61 cases, while 132 patients formed the control group. The results obtained were statistically analysed by chi2 and Fisher test: a "p" value of < 0.05 was considered statistically significant.

RESULTS

The first investigation showed: a) the incidence of cases with auricular disorders was greater in the group presenting recurrent febrile pharyngo-tonsillar inflammation < or = 4 (effusive otitis media: p < 0.05); in this group, the presence of cases with naso-pharyngeal respiratory obstruction was statistically greater (p < 0.05); b) the number of cases in which the pathological auricular process was resolved following adeno-tonsillectomy, appeared high (effusive otitis media: 136/179 = 76%; acute recurrent otitis media: 189/216 = 87.5%), not unlike the percentage of patients with positive results on recurrent febrile pharyngo-tonsillar inflammation and on naso-pharyngeal respiratory obstruction (91.6% and 92.4%, respectively); c) the percentages of recovery, for auricular disorders, were significantly higher in the group presenting more frequent recurrent febrile pharyngo-tonsillar inflammation, i.e. > 4 (p < 0.05); in this group, also the incidence of cases, in which the naso-pharyngeal respiratory obstruction was resolved, was greater. The second investigation demonstrated, in the groups in which surgical treatment was carried out, compared to controls: a) a significantly greater percentage of cases achieving recovery, for both parameters (p < 0.05); as far as concerns the effusive form of otitis media, a total of 72 (67.3%) subjects were cured following adeno-tonsillectomy; 67 (81.7%), following adenoidectomy; in acute recurrent otitis media, the subjects achieving recovery were; for adeno-tonsillectomy, 97 (82.2%); for adenoidectomy; 85 (81.7%); b) in the subjects in whom, following surgical treatment, the inflammatory auricular disorder was resolved, it was generally found that recovery had been achieved not only for the recurrent febrile pharyngo-tonsillar inflammation but also for the naso-pharyngeal respiratory obstruction; c) in the controls, the results appeared to be significantly less satisfactory (< 0.001); together with the lack of success in the watchful waiting approach, as far as concerns auricular disorders, we found, likewise, a significant lack of efficacy (p < 0.001) of this treatment in the management of naso-pharyngeal respiratory obstruction (5/35 cases cured: 14.3%). The third investigation showed that the application of the ventilation tube during adeno-tonsillectomy or adenoidectomy did not lead to any improvement in the results; indeed, the percent recovery of the pathological tympanic processes was significantly greater (p < 0.05) in those subjects in whom transtympanic drainage had not been adopted.

CONCLUSIONS

The results of these investigations reveal a clear relationship between the naso-pharyngeal respiratory obstruction and the pathological auricular processes in subjects with episodes of recurrent febrile pharyngo-tonsillar inflammation. These results also demonstrate that adeno-tonsillectomy and/or adenoidectomy are able to resolve the auricular inflammatory manifestations in a very large percentage of cases. These data are apparently in contrast with those described in recent reports related to randomised investigations. In effect, the two groups of investigations had different aims: the studies carried out according to a randomised approach were performed on study populations in which the findings of pathological auricular manifestations were not linked by the demonstration of a correlation with possible adenoid or adeno-tonsillar inflammation; the present study, on the other hand, was performed on patients in whom the auricular disorder was part of the clinical picture of recurrent febrile pharyngo-tonsillar inflammation. Therefore we believe that each of these study methods has precise possibilities, but also limitations; thus, one should not exclude the other, but rather be integrated.

Cationic liposomes as potential carriers for ocular administration of peptides with anti-herpetic activity

In the present study the preparation, characterization and activity of cationic liposomes containing the secretory form of herpes simplex virus type 1 (HSV-1) glycoprotein B (gB1s) or two related polylysine rich peptides, namely DTK1 and DTK2, were described. The immunotherapeutic potential of these HSV antigens containing liposomes was examined with a rabbit ocular model of HSV-1 infection. Our study indicates that the liposomes (i) are able to encapsulate quantitatively gB1s and around 30% the DTK peptides, (ii) are characterized by dimensions compatible with ocular applications and (iii) can release the peptide comparably to the free solution. In addition, neutralization studies demonstrated that an anti-DTK specific polyclonal antiserum can inhibit HSV-1 infection, indicating that such peptides could be a good immunogen/antigen in an anti-HSV vaccine formulation. Although the vaccination protocol did not induce protection against the eye disease, a significative protection against a lethal ocular challenge was detectable together with the absence of reactivation episodes from latency on the survived animals. In this respect, the use of cationic liposomes coupled to gB1s and DTK peptides, as a local ocular vaccine, could represent an interesting approach in order to obtain a possible efficacy in protecting animals against a subsequent HSV-1 ocular challenge.

Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy

OBJECTIVE

To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy.

METHODS

Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper.

RESULTS

The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms.

CONCLUSIONS

This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.

Regional changes in the metabolite profile after long-term hypoxia-ischemia in brains of young and aged rats: a quantitative proton MRS study

Quantitative proton magnetic resonance spectroscopy (MRS) was used to determine region-specific metabolic changes in young and aged animals subjected to a long-term hypoxic-ischemic injury. Focal ischemia, which was studied as an experimental stroke model, was induced in 3- and 24-month-old rats by unilateral common carotid artery occlusion associated with 24 h of hypoxia. Eight metabolites were quantified from extracts in three different brain regions (hippocampus, frontoparietal and occipital cortices) from both the ipsilateral and contralateral sides. Our findings showed significant differences in lactate and myo-inositol concentration values in the hippocampus of the aged rats as compared to the same area of the young adult group under normoxic conditions. After hypoxia-ischemia (HI), the most relevant changes in metabolite concentrations were found in the hippocampal region of both young and aged groups as compared to their age-matched controls. Of the three brain areas under investigation, the hippocampus proved to be particularly susceptible to the prolonged hypoxia-ischemia perturbation. The effects were more evident in the aged animals.

Liposomes containing distamycins: preparation, characterization and antiproliferative activity

This article describes the production and characterization of two liposome formulations containing antitumor drugs, namely distamycin A (Dist) and a new alkyl derivative of distamycin A (C16-Dist). Egg-PC/cholesterol liposomes (4:1 mol/mol) were prepared by reverse phase evaporation technique followed by extrusion through polycarbonate filters. The encapsulation efficiency was found to be almost complete for C16-Dist (99.8%), while native distamycin A showed a lower yield (19.0%). The in vitro antiproliferative activity of the distamycins-containing liposomes determined on human leukaemic K562 cells, was 11-fold and 8-fold higher for native and alkyl derivative distamycin A, respectively, compared with that of the corresponding free drugs. Liposomal formulations show an increase in the activity and specificity of distamycins in experimental antitumor therapy.

Surveillance of post-operative infections and management of antibiotic surgical prophylaxis in an Italian region

The aim of the study was to evaluate the incidence of post-surgical infections and to assess management of antibiotic surgical prophylaxis. The survey was carried out by means of a questionnaire in order to obtain diverse information such as demographics, length of pre- and post-operative hospitalization, type of surgery, intervention duration, possible antibiotic prophylaxis and onset of post-surgical infections also monitored by post-discharge ambulatory controls. Four General Surgery and five Obstetrics and Gynecology Departments in Campania (southern Italy) participated in the study, which was carried out from December 2001-January 2002. Overall, 410 questionnaires were collected, referring to as many patients; antibiotic prophylaxis was performed in 385 (93.9%) patients. Antibiotic prophylaxis was generally managed not according to the general principles suggested by the international guidelines either for timing, for its duration or for the route of administration. Substantial differences were also noted in patient selection and antibiotic choice. Surgical site infections were recorded in 0.9% of patients undergoing clean surgery and in 3.6% of patients undergoing clean-contaminated surgery. Distant infections occurred in 1.5% in clean-contaminated surgery. The results of the present study suggest the need for continuous and accurate monitoring of post-surgical infections and the need to adopt appropriate guidelines to improve the management of surgical prophylaxis.

Amphiphilic association systems for Amphotericin B delivery

The present study describes the production and characterization of amphiphilic association systems for Amphotericin B (AMB). In particular, three different classes of microemulsions and different monoglyceride-water systems were produced. Formulations were characterized for macroscopic aspect, pH, rheology, mean size and size distribution, both in the absence and in the presence of AMB. AMB solubility was investigated in the different formulations by HPLC studies. The formulations increased AMB solubility up to 20-fold with respect to the single oil and aqueous phases employed for microemulsion production.AMB diffusion studies from two microemulsions taken as models were performed in a Franz cell system using a nylon membrane. The physical and chemical stability of AMB-containing amphiphilic association systems were investigated for three months after production. For physical stability studies both the macroscopic aspect, droplet mean size and dimensional distribution were analysed. For chemical stability studies, the AMB content of the formulations was quantified by HPLC analysis. Microemulsions and monoglyceride-water systems were free from phase separation for up to three months and in some cases the AMB content was unchanged even after three months.

Aminated polysaccharide microspheres as DNA delivery systems

This article describes the production and characterization of cationic microparticles based on pullulan and starch for the delivery of nucleic acids. The microparticles were prepared by chemically cross-linkinking of a polymer solution dispersed in organic phase, followed by amination with N, N-diethyl-2-chloroethyl amine hydrochloride, or N-glycidyl-N,N-dimethyl-N-methylammonium chloride. The association of desoxyribonucleotide (DNA) with positively charged microparticles was determined. The association capacity and the affinity of microspheres for DNA were investigated as a function of type of polysaccharide, content and basicity of the amino groups. It was found that the both types of carriers synthetized display a high affinity for defibrotide due to the high porosity of polysaccharide microspheres (PMs). The in vitro release kinetics from microspheres showed an initial fast release of DNA (30 min) followed by slower release rate over 14 days. DNA release was influenced by the ionic strength of the receiving fluid. In addition, DNA release was slightly more rapid from pullulan than from starch complexes. DNA stability studies were performed by agarose gel, indicating no degradation even after 14 days. All the produced cationic microspheres were able to quantitatively load DNA. The release of DNA from PMs was strongly affected by the ionic strength of the receiving fluid. Finally, agarose gel electrophoresis of DNA released from microspheres indicated that no DNA degradation occurs even after 14 days of release from PMs.

[Correlation between chronic obstructive bronchial disease and colonic anastomosis dehiscence in the elderly]

BACKGROUND

Anastomotic leakage remains a major complication after large bowel surgery. Chronic obstructive pulmonary disease is frequent disease in the elderly.

AIMS

The authors want to analyze the correlation between systemic tissue hypoxia, resulting from chronic obstructive pulmonary disease and anastomotic leakage in large bowel surgery in a group of patients over 65 years.

PATIENTS AND METHODS

In the period 1979-2001 at our surgical Department, 590 patients underwent colorectal surgery; 211 elderly patients (> 65 years) with large bowel anastomosis were selected. In 29/211 (13.7%) chronic obstructive pulmonary disease was diagnosed. The group of patients affected by chronic obstructive pulmonary disease was defined as group A; the other, as group B. The incidence of anastomotic leakage in patients with and without chronic obstructive pulmonary disease was evaluated.

RESULTS

The overall incidence of anastomotic leakage was 5.6% (12/211); a difference in the incidence of anastomotic leakage was found in the group A vs. B: 7/29 (24.1 %) in the group A were affected by dehiscence vs. 5/182 (2.7%) of group B. This difference was statistically significant (p = 0.001).

CONCLUSIONS

Chronic obstructive pulmonary disease can be a factor increasing the risk of anastomotic leakage. The elderly patient is often affected by chronic obstructive pulmonary disease and consequently show an higher risk of colonic anastomotic failure than younger patients.

Sacral nerve neuromodulation improves physical, psychological and social quality of life in patients with fecal incontinence

There are several therapeutic options for fecal incontinence but often they do not achieve good results in the long run. This study dealt with sacral nerve modulation, a new therapeutic option. Twenty-one patients underwent pudendal nerve evaluation (PNE) at our institution. Nine patients were affected by both fecal and urinary incontinence, 3 had fecal incontinence and anal pain, 5 had fecal incontinence and pelvic floor dyssynergia, and 4 had isolated fecal incontinence. They underwent morphological, functional and psychological tests prior to PNE, showing no sphincter rupture, almost normal anal pressures, impaired rectal sensation and deficient psychological pattern. All patients underwent at least two nerve evaluations. Four of 21 patients (19%) were selected to receive a permanent sacral electrode, as PNE seemed to have improved their symptoms by >75%. A median follow-up of 15 months (range, 6-24 months) showed that this method decreases weekly episodes of incontinence and increases maximal squeeze pressure. We demonstrated an increase in basal pressure in 3 of 4 patients (all with isolated fecal incontinence). Rectal sensation threshold decreased in three patients; urge threshold decreased in two patients and increased in two patients, but in each patient we got a stabilization. We evaluated the quality of life by applying the Short Form Health Survey test (SF-36). All 4 patients showed a significant increase in the scores of physical, emotional and social role functioning after the permanent implant. In conclusion, sacral nerve modulation may improve physical, physiological and social quality of life in selected groups of incontinent patients without gross sphincter lesions and with impaired rectal sensation.

Serotonin/dopamine interaction--focus on 5-HT2C receptor, a new target of psychotropic drugs

Several hypotheses regarding physiopathology of major psychiatric diseases exist. Attention has been focused on cerebral monoaminergic systems, the dysfunction of which is thought to underlie various aspects of their symptomatology. There are reports describing the involvement of serotonergic and dopaminergic systems in the mechanism of action of psychotropic drugs. This article reviews current knowledge on interaction between 5-hydroxytryptamine (5-HT), acting at 5-HT2C receptors in the central dopamine (DA) systems. Since 90s, a growing body of behavioural, neurochemical and electrophysiological evidence from animal studies have demonstrated a clear role for 5-HT2C receptors in modulation of activity of dopamine neurones. This evidence has led to the suggestion that drugs acting on 5-HT2C receptors have potential as novel antipsychotic and antidepressant agents and may also be used in the treatment of other neuropsychiatric disorders such as Parkinson's disease and psychoactive substance abuse.

Perineal pilonidal sinus. Case report

Pilonidal sinus is a very common disease and its most frequent location is in the presacral area. Other locations are extremely rare. We describe the case of a 28-year-old white man, a baker by profession, with a swelling around the right side of the anus, pain with burning, itching and seropurulent secretion which had been present for 7 months. A physical examination demonstrated the presence of multiple cutaneous fistulas. A fistulography and the endoscopy demonstrated the absence of fistulas-in-ano. Moreover, MRI confirmed the diagnosis of a perianal mass not communicating with the anal canal. Surgical exploration revealed the presence of hair and an excision of the mass with fistulas was performed. Healing was rapid and uncomplicated. Perineal pilonidal sinus with foreign body inflammatory reaction was the histological diagnosis.

Microsurgical treatment of varicocele in outpatients using the subinguinal approach

BACKGROUND

The aim of this study is to analyze the results of a group of patients who underwent subinguinal microsurgical varicocelectomy using local anaesthesia in one-day-surgery.

METHODS

From 1997 to 1998 150 patients were selected from the whole group of patients who underwent surgical treatment for varicocele. The varicocele was always on the left side and the mean age was 27.1 years (range: 16-43). The diagnosis was based on clinical features (testicular pain or scrotal sensation), physical examination and Doppler ultrasound. Where there was infertility with abnormal semen analysis and/or patient's intolerance to the symptoms, surgery was suggested. The patients underwent varicocelectomy by sub-inguinal approach using local anaesthesia. The microsurgical technique of dissection was performed.

RESULTS

All operations were performed on an outpatient basis (post-operative stay: 3-7 hours) and the operating time was 20 to 45 minutes. Follow-up was performed by physical examination, doppler ultrasound and semen analysis. Immediate and long-term complications were: 7 (4.7%) transient pain, 3 (2.0%) ecchymosis, 1 (0.7%) transient hydroceles and 1 (0.7%) permanent hydroceles, 2 (1.3%) palpable recurrence, 2(1.3%) doppler recurrence and 1 (0.7%) long-term recurrence, 0 testicular atrophy. 120/150 (80%) patients showed an improvement of semen analysis and 19/41 (46.3%) patients with infertility achieved a pregnancy with the partner.

CONCLUSIONS

Microsurgical treatment of varicocele in outpatients by subinguinal approach is a safe and reliable procedure. It is performed in local anaesthesia, preserves the lymphatics, spermatic artery and vas and in our experience showed an improvement of semen analysis and pregnancy rates with minimal morbidity.

Thrombin and PAR-1 activating peptide increase iNOS expression in cytokine-stimulated C6 glioma cells

Thrombin (THR) plays a key role in the brain under physiological and pathological conditions. Several of the biological activities of thrombin have been shown to be mainly driven through activation of protease-activated receptor-1 (PAR-1)-type thrombin receptor. Here we have studied the effect of THR and PAR-1-activating peptide (PAR1-AP), SFLLRN, on cytokine-induced expression of inducible nitric oxide (iNOS), a prominent marker of astroglial activation using the rat C6 glioma cells. In this cell line, THR (1-10 U/mL) and PAR1-AP (1-100 microM) induced a significant concentration-dependent increase both of IFN-gamma- (250 U/mL) or TNF-alpha- (500 U/mL) induced NO release. The observed increase of NO production was related to an enhancement of iNOS expression as measured in cell lysates prepared from different treatments by using SDS-PAGE followed by western blot analysis. The effect of THR, but not that of PAR1-AP, was significantly inhibited by hirulog(TM) (60 microg/mL), a specific and stochiometric THR inhibitor or by cathepsin-G (40 mU/mL), an inhibitor of PAR-1. In conclusion our data suggest a role for THR through activation of PAR-1 in the induction of astroglial iNOS, and further support the hypothesis that THR may function as an important pathophysiological modulator of the inflammatory response.

Pectin-based microspheres: a preformulatory study

This paper reports on (a) the production of pectin microspheres and (b) the influence of different experimental parameters and ionic crosslinking on morphological and dimensional characteristics of pectin microspheres. Morphological and dimensional characteristics of pectin were analyzed as a function of the type of pectin, the dispersing phase, the stirring speed, and the emulsifying agent. Crosslinking by calcium chloride and the encapsulation of antibiotics (i.e., metronidazol and tetracycline) gave particles morphologically similar to empty particles but with slower swelling kinetic.

m-Chlorophenylpiperazine excites non-dopaminergic neurons in the rat substantia nigra and ventral tegmental area by activating serotonin-2C receptors

In vivo electrophysiological techniques were used to study the effect of m-chlorophenylpiperazine, a non-selective serotonin-2C receptor agonist, on the activity of non-dopaminergic neurons in the substantia nigra pars reticulata and the ventral tegmental area of anesthetized rats. Intravenous administration of m-chlorophenylpiperazine (5-320 microg/kg) caused a dose-dependent increase in the basal firing rate of a subpopulation of nigral neurons which do not respond to a footpinch stimulus [P(0) neurons], whereas it did not affect the activity of neurons which are responsive to the footpinch [P(+) neurons]. However, m-chlorophenylpiperazine (5-320 microg/kg) excited all non-dopaminergic neurons sampled in the ventral tegmental area. Moreover, microiontophoretic application of m-chlorophenylpiperazine (10-40 nA) caused an excitation of P(0) nigral and ventral tegmental area neurons. Pretreatment with the selective serotonin-2C receptor antagonist SB 242084 (200 microg/kg, i.v.) completely blocked the excitatory effect of i.v. m-chlorophenylpiperazine (5-320 microg/kg), both in the substantia nigra pars reticulata and in the ventral tegmental area. It is concluded that stimulation of serotonin-2C receptors by m-chlorophenylpiperazine activates non-dopaminergic (presumably GABA-containing) neurons in the substantia nigra pars reticulata and ventral tegmental area.

Adult-onset familial laryngeal abductor paralysis, cerebellar ataxia, and pure motor neuropathy

Two brothers presented with late-onset cerebellar ataxia and severe dysphonia. Brain MRI showed vermian and hemispheric cerebellar atrophy. Laringofiberscopy revealed laryngeal abductor paralysis in both patients. Neurophysiologic studies showed a pure motor neuropathy. The combined findings and the molecular analysis suggest a new familial disorder. Inheritance is most likely autosomal recessive, but X-linked transmission is also possible.

Acrylic microspheres for oral controlled release of the biguanide buformin

Spherical microparticles based on methacrylic acid-methyl methacrylate copolymer have been developed. The method chosen for the preparation of such microparticles was suspension radical copolymerization of acrylic comonomers in the presence of the ethyleneglycol dimethacrylate as crosslinking agent. The microparticles obtained were characterised by inverse size exclusion chromatography, scanning electron microscopy, swelling degree and exchange capacity. The porous volume of the microspheres ranged from 0.086 ml/g for the microparticles produced by a methacrylic acid/methyl methacrylate ratio of 1/3 and a 10% degree of crosslinking, to 8.57 ml/g for the microparticles produced by a methacrylic acid/methyl methacrylate ratio of 3/1 and 2% degree of crosslinking (in 0.1 N NaCl in phosphate buffer pH 7.4). Also the pore diameter of the swollen microparticles ranged from a few to 120 A. Buformin tosylate - a classical hypoglycaemic drug - was included in the polymer network of the microparticles during the polymerization process. Due to the water solubility of the drug and its low solubility in the organic phase, the entrapment yield did not exceed 15%. However the amount of encapsulated drug as well as the drug released from the microparticles, was dependent on the methacrylic acid/methyl methacrylate ratio, the degree of crosslinking and solvent/comonomers ratio.

Role of 5-HT(2C) receptors in the control of central dopamine function

Substantial evidence suggests that the functional status of the mesocorticolimbic dopamine (DA) system originating in the ventral tegmental area is under a phasic and tonic inhibitory control by the 5-HT system that acts by stimulating 5-HT(2C) receptor subtypes. Indeed, electrophysiological and biochemical data demonstrate that 5-HT(2C) receptor agonists decrease, whereas 5-HT(2C) receptor antagonists enhance, mesocorticolimbic DA function. However, 5-HT(2C) receptors do not appear to play a relevant role in the control of the nigrostriatal DA system originating in the substantia nigra pars compacta. In this article, the role of 5-HT(2C) receptors in the control of brain DA function will be reviewed, and the search for new therapies for neuropsychiatric disorders, such as depression, schizophrenia and drug addiction, based on these findings will be discussed.