CT and arteriography in cerebral ischemia. A preliminary note

Sixty patients with cerebral ischemia were studied by both CT and angiography. The results are: 1. Thrombosis of the internal carotid artery: CT shows a hypodensity lateral to the frontal horn. 2. Thrombosis of the middle cerebral artery: the hypodensity occupies the convexity of the frontal, parietal, and temporal lobes. 3. In thrombosis of the posterior cerebral artery there is an occipital hypodensity, while in thrombosis of the vertebral artery the hypodensity occupies a cerebellar hemisphere. 4. Circulatory disturbances without occlusion of the major cerebral vessels: there is a disproportion between the serious CT lesion and paucity of the angiographic findings.

Postoperative CT changes

An analysis is made of 36 cases of severe postoperative changes, some of which are undoubtedly of iatrogenic origin. CT has considerably improved the possibilities of postoperative control. By this means it is easy to check the result of the operation. Moreover the neuroradiologist can verify the quality (indication and technique) of the work of his surgical colleagues in the same way that the neurosurgeon can verify the neuroradiologist's work in the operating theater. This will result in a better knowledge of each other and, even more important, in better care of the patient.

Acute viral hepatitis in Italy. Results of a collaborative study

The etiological and clinical aspects of viral hepatitis were evaluated by a retrospective survey of patients hospitalized in 1972, 1973 and 1974 in 12 specialized medical centers scattered throughout Italy. The data refer to 2788 patients suffering from acute viral hepatitis who were hospitalized during the initial 10 days of jaundice. The majority of patients (90%) had not been treated with steroids. For each case, the clinical and biochemical data were recorded, coded, computerized and statistically analyzed. In our patient population viral hepatitis was more frequent among younger patients. We observed a high frequency of HBsAg positive hepatitis (40.7%) which was seldom associated to a history of parenteral exposure and showed an irregular geographical distribution. HBsAg positive hepatitis was similarly distributed between males and females. It was more frequent in patients older than 30 (60%) than in children (18-23%) and younger patients (42%). In our series, the frequency of HBsAg hepatitis found in surgeons (81.8%) and nursing personnel (66.3%), but not in physicians (41.2%), was greater than that of the entire sample due to their exposure to blood.

Clearance of viable Calmette-Guèrin bacillus by the in vitro isolated and perfused rat liver

Liver efficiency in clearing circulating BCG (Clamette-Guèrin bacillus) was studied using the isolated rat liver. Bacteria were added to the perfusate at a concentration of 1 X 10(6) cells/ml, and the medium was then sampled at subsequent intervals for 6 hours in 2 perfusions and for 1 hour in 7 perfusions. At the end of all perfusions, liver and bile samples were obtained and used for viable bacterial counts. For each perfusion the bactericidal activity which might have been exerted by serum present in the perfusate was also investigated. About 95% of BCG disappeared from the perfusate after 6 hours of perfusions, and 90% after 1 hour. Recovery of viable bacteria in the liver at 60 minutes averaged 80% of the inoculum. Recovery in bile was negligible. Control experiments indicated that extrahepatic factors in possible reduction of bacterial concentration in the perfusate did not interfere with hepatic removal, per se.

Computerized tomography and encephalography

This preliminary paper compares encephalography and computed tomography as regards the duration of the examinations, the technical difficulties and their diagnostic values. Some examples are reported to demonstrate the complementary importance of the two techniques.

[Distribution of HBs-(Australia) antigen in progressive systemic scleroderma and other connective tissue disorders]

Of 173 patients, mostly suffering from collagen diseases and rheumatoid disease, the HBs antigen (HBsAg) was present in 1.73%. This figure is no higher than that observed among blood donors from the same area (Naples and surroundings). One HBsAg positive patient suffered from chronic active hepatitis and rheumatoid arthritis; another from chronic active hepatitis and a secondary type of reticuloendotheliosis; the third was one of seven patients with psoriatic arthritis. HBsAg was not found in any of 48 patients with other collagen diseases, including 22 patients with Progressive Systemic Sclerosis. These data do not support the hypothesis based on observations of polyarteritis nodosa that HBsAg plays an ethiopathogenetic role in collagen diseases with serious vasculitis.

Two cases of glomus tumour treated by unusual embolization

Two cases of glomus tumour treated by the catheterization technique are reported. In the first case, after it was found impossible to catheterize the external carotid artery by the femoral route, the external carotid was punctured directly, became spasmodic and the catheter could not be introduced, so the inner wall of the external carotid was eroded by manipulating the tip of the metallic guide. This resulted in complete occlusion of the artery 1 cm above the bifurcation of the common carotid. The second case was first treated by embolization of the ascending pharyngeal artery, but with only transitory improvement, so, after 2 months, additional embolization was performed via the vertebral artery, which was followed by immediate and lasting improvement.

[Homologous and heterologous antibody response induced in man by anti-influenza vaccine containing A/England/42/72 and b/Massachusetts/71]

In november 1973, 43 subjects living in a home for aged were given one dose of influenza vaccine, containing A/England/42/72 and B/Massachusetts/71. After 4 and 20 weeks, sera were tested for antibody contentto the homologous and to A/port Chalmers/1/73 viruses by haemoagglutination inhibition technique. Control group included 23 untreated subjects. The satisfactory increase in the anti-A/England/42/72 antibodies induced by vaccine indicated a good antigenic potency of the A component. The satisfactory cross-reacting response suggests that the "drift" in antigenic content between A England/42/72 and A/Port Chalmers/1/73 was moderate. On the contrary the increase in anti-B/Massachusetts/71 antibodies after vaccination was observed only in a limited number of cases. Twelve subjects (9 treated and 3 controls) experienced upper respiratory tract infections which appeared to be not related to infuenza viruses.

Post mortem investigation of the vertebrabasilar system

The shape, origin, termination and number of the main arteries of the vertebrobasilar system have been analysed in 30 anatomic specimens by dissection of the injected vessels and by radiography. Five projections are described for identifying the different regions of the brain stem and cerebellum through the appearance of the arteries. A technique is proposed for obtaining a 'true' a.p. view of the vessels in vertebral angiography in patients.

Spontaneous displacement of air after encephalography

In some cases it has been observed that after encephalography air seems to be displaced from one part of the ventricular system to another without movements of the head. This apparently occurs in spite of the law of upward displacement of gases in fluids.

Hemostatic abnormalities in chronic aggressive hepatitis and liver cirrhosis

Hemostatic defects of chronic aggressive hepatitis (CAH), 25 cases, and of liver cirrhosis, 20 cases, were investigated. The following assays were performed: liver function tests, thromboelastogram, prothrombin time (PT), partial thromboplastin time (PTT), factors I, II, V, X, XIII, euglobulin lysis time, fibrinogen degradation products (FDP), platelet count, morphology and agglutinability. High incidence of hemostatic defects was present in both groups. Thromboelastogram, PTT, prothrombin and qualitative platelet abnormalities were most common. On the whole, severity of hemostatic alterations in cirrhosis was more pronounced than that found in CAH, FDPs were increased in more than 50% of the CAH cases and only in a few cirrhotic patients. Bleeding occurred more frequently in cirrhosis (55%) than in CAH (4%) and, within the cirrhotic patients' group, it was associated with a more severe thrombocytopenia.

[Hemostatic changes in the course of different chronic hepatopathies]

The following tests were performed in 15 cases of chronic aggressive hepatitis (CAH), 12 of cirrhosis, and 8 of other forms of chronic disease: liver function, thromboelastogram, prothrombin time (PT), partial thromboplastin time (PTT), determination of factors I, II, V, X and XIII, euglobulin and FDP lysis, and platelet count, shape and agglutinability. At least one haemostasis alteration was observed in nearly every case, the most common being in the thromboelastogram, PTT, prothrombin, and platelet shape and agglutinability. Defects were most marked in cirrhosis and comparison with CAH was significant in the case of PT and factor V. Fibrinolysis was increased in 60% of the CAH group and rarely elsewhere. Haemorrhage was noted in 7 cases of cirrhosis and 1 of CAH. On each occasion, it was more dependent on the serious nature of the disease, rather than defective haemostasis.

[Value of a low-calorie diet in the diagnosis of Gilbert's syndrome]

Reduction of the calorie intake to 400 per day was employed in clinching the diagnosis in a case of Gilbert's disease admitted in the course of remission. This diet, in fact, results in a marked increase in serum bilirubin concentration. The non-conjugated form, in fact, reached values 5 times greater than those observed initially, within 24 hr after commencing the diet. Unlike other cases reported in the literature, this increase occurred in spite of an initially normal blood bilirubin level.