Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality

The aim of the study was to determine the incidence of psychological distress among expectant women carrying fetuses with prenatal diagnosed abnormalities and their partners. A 2-year retrospective medical chart review was completed of 1032 expectant mothers carrying fetuses with a confirmed anomaly, and 788 expectant fathers, who completed the CFDT Mental Health Screening Tool. Furthermore, 19.3 % of women and 13.1 % of men reported significant post-traumatic stress symptoms, and 14 % of men and 23 % of women scored positive for a major depressive disorder. Higher risk was noted among expectant parents of younger age and minority racial/ethnic status, and women with post-college level education and current or prior use of antidepressant medications. Heightened distress was noted within fetal diagnostic subgroups including neck masses, sacrococcygeal teratomas, neurological defects, and miscellaneous diagnoses. Incorporating screening tools into prenatal practice can help clinicians better identify the potential risk for psychological distress among expectant parents within high-risk fetal settings.

In silico study of structural and geometrical requirements of natural sesquiterpene lactones with trypanocidal activity

Chagas' disease, caused by the intracellular protozoan Trypanosoma cruzi, is one of the most serious health problems throughout South America. Despite the progress that has been made in the study of its biochemistry and physiology, more efficient chemotherapies to control this parasitic infection are still lacking. In this paper we report the trypanocidal and cytotoxic activities of a series of sesquiterpene lactones, isolated from Asteraceae medicinal plants. The significant trypanocidal activity and high selectivity indexes found for many of the compounds evaluated, prompted us to undertake a quantitative structure-activity relationship study. A model using 3D molecular descriptors allowed us to set up a high correlation of the observed activity and the atomic spatial arrangement of these sesquiterpene lactones closely related to steric parameters.

Trypanocidal Activity of Smallanthus sonchifolius: Identification of Active Sesquiterpene Lactones by Bioassay-Guided Fractionation

In order to find novel plant-derived biologically active compounds against Trypanosoma cruzi, we isolated, from the organic extract of Smallanthus sonchifolius, the sesquiterpene lactones enhydrin (1), uvedalin (2), and polymatin B (3) by bioassay-guided fractionation technique. These compounds showed a significant trypanocidal activity against the epimastigote forms of the parasite with IC50 values of 0.84  μ M (1), 1.09  μ M (2), and 4.90  μ M (3). After a 24 h treatment with 10  μ g/mL of enhydrin or uvedalin, parasites were not able to recover their replication rate. Compounds 1 and 2 showed IC50 values of 33.4  μ M and 25.0  μ M against T. cruzi trypomastigotes, while polymatin B was not active. When the three compounds were tested against the intracellular forms of T. cruzi, they were able to inhibit the amastigote replication with IC50 of 5.17  μ M, 3.34  μ M, and 9.02  μ M for 1, 2, and 3, respectively. The cytotoxicity of the compounds was evaluated in Vero cells obtaining CC50 values of 46.5  μ M (1), 46.8  μ M (2), and 147.3  μ M (3) and the selectivity index calculated. According to these results, enhydrin and uvedalin might have potentials as agents against Chagas disease and could serve as lead molecules to develop new drugs.

Early versus delayed laparoscopic cholecystectomy for acute cholecystitis

AIM

Laparoscopic cholecystectomy, currently the gold standard treatment for cholelithiasis, has been extended to treating acute cholecystitis as well. However, operation timing remains controversial. The aim of this retrospective study was to compare our data on the timing of surgery for early and delayed laparoscopic cholecystectomy for acute cholecystitis.

METHODS

From January 1, 2006 to December 31, 2010, 508 laparoscopic cholecystectomy procedures were performed, 149 of which for acute cholecystitis: 122 operations were defined as early (performed within 72 hours of symptom onset) and 27 as delayed (72 hours to 9 days from symptom onset).

RESULTS

There were no statistically significant differences in operating time, conversion or complications rates between early and delayed procedures. The total length of hospital stay was longer for patients who had undergone a delayed procedure. The success rates were similar irrespective of the surgeon's level of experience.

CONCLUSION

Patients operated on for acute cholelithiasis between 72 hours and up to 9 days after symptom onset may benefit similarly as from an earlier operation. Delayed laparoscopic cholecystectomy for acute cholelithiasis is a feasible and safe procedure that compares favorably with early laparoscopic cholecystectomy.

Intrapartum sonography for occiput posterior detection in early low dose combined spinal epidural analgesia by sufentanil and ropivacaine

AIM

To evaluate the incidence of occiput posterior position in labour with and without combined spinal epidural analgesia (CSE) by low dose of sufentanyl and ropivacaine.

MATERIAL AND METHODS

This study focused on 132 women subdivided in two groups, patients in spontaneous and in labour analgesia, administered by a low dose CSE by sufentanyl and ropivacaine; all women were evaluated by digital examinations and ultrasound till delivery. All data were collected and analyzed by an independent reviewer.

RESULTS

In the second stage, 79 were persistent occiput posterior position (POPP) fetuses and 36 were translated from anterior to posterior position (TAPP) fetuses. Specifically, in spontaneous labour on 25 women in anterior position, there were 17 TAPP and in CSE analgesia on 28 women in anterior, there were 19 in TAPP, without significant differences. The number of asynclitisms was higher in the POPP group (84%) respect to the TAPP group (75%), so as the rate of caesarean section (67% versus 52.7%).

CONCLUSIONS

The labour with low dose of ropivacaine and sufentanyl does not increase the occiput posterior position during fetal descent, leading to a POPP. Finally, since in the occiput anterior presentation labour analgesia significantly lengthens time to delivery, in the occiput posterior position this is significantly increased, with a prolonged second stage of labour and reduced time of descent of fetal head in obstetric pelvis.

[Occipito-posterior fetal head position, maternal and neonatal outcome]

The purpose of this review is to summarize the available evidence on occipito-posterior fetal head position and maternal and neonatal outcome. The occipito-posterior fetal head position is the most common malposition, but there are not so many data about it in literature. Its incidence is ranging from 1.8% by Fitzpatrick, to 4.6% and 5.5% by Yancey and Sizer, to 6% by Ponkey. Only two trials studied the occipito-posterior associated factors. There are lower incidence of premature rupture of membrane, arterial hypertension pregnancy-induced, induced labour, increased of episiotomy, instrumental delivery and a decreased of vaginal birth without a difference in neonatal Apgar, and with a neonatal bigger weight. The occipito-posterior fetal head position persistence compared to anterior position, has a statistically significant association with low maternal stature, previous cesarean section, longer first and second stage of labour, oxytocin augmentation, epidural analgesia, instrumental vaginal delivery, chorion-amniositis, vaginal perineal injures, loss of blood and post partum infections. A highest incidence of occipito-posterior fetal head position may depend by nulliparity, malnutrition with pelvic deformity, pelvic immaturity in the teenager and anterior placenta. Epidural analgesia is a risk factor for fetal head malposition. The majority of occipito-posterior fetal head positions is not due to a malrotation, but to a persistence in this position of the fetal head. In fact, this persistence leads to a failure of the fetal head rotation. The prolonged second stage is often the result of occipito-posterior fetal head position and instrumental delivery is required. The traditional vaginal examination is not useful for the determination of fetal head position, so and instrumental method is needed, such as ultrasound, for a correct evaluation of fetal head position, particularly if a vaginal instrumental delivery is necessary. This is recommended by the Canadian Society of Obstetrics and Gynecology. The evaluation of fetal head position is important in the prediction of labour induction.

Anti-inflammatory activity of flavonoids from Eupatorium arnottianum

Three anti-inflammatory compounds: nepetin, jaceosidin and hispidulin have been isolated and identified from Eupatorium arnottianum Griseb. dichloromethane extract. Nepetin reduced the TPA mouse ear edema by 46.9% and jaceosidin by 23.2% (1mg/ear). Both compounds inhibited the NF kappaB induction by 91 and 77%, respectively. Furthermore phytochemical analysis of the ethanol extract has led to the identification of eriodictyol, hyperoside, rutin, caffeic and chlorogenic acids. All these compounds are reported for the first time in this species. The finding of topical antiinflammatory activity exerted by Eupatorium arnottianum extract and the identification of active principles could support the use of this plant for the treatment of inflammatory affections.

In vitro evaluation of trypanocidal activity in plants used in Argentine traditional medicine

Thirty-two organic and aqueous extracts, belonging to 12 Argentine medicinal plants were tested for their in vitro trypanocidal activity on epimastigote forms of Trypanosoma cruzi. Among the selected species, the organic extracts of Ambrosia scabra, Ambrosia tenuifolia, Baccharis spicata, Eupatorium buniifolium, Lippia integrifolia, Mulinum spinosum and Satureja parvifolia, and the aqueous extracts of E. buniifolium, L. integrifolia, M. spinosum and S. parvifolia showed trypanocidal activity with a percentage of growth inhibition higher than 70% at a concentration of 100 microg/ml.

Comparison of sequential combined spinal-epidural anesthesia and spinal anesthesia for cesarean section

AIM

The aim of our study was to prove that by using sequential combined spinal-epidural (CSE) anesthesia it is possible to overcome the limits connected to the use of spinal anesthesia (SA) alone for elective cesarean section.

METHODS

We examined 100 women submitted to cesarean section; SA was administered to 50 patients and sequential CSE technique to the other 50. In every woman before execution of the anesthesia we infused 500 mL of a plasma expander and a previous administration of 5 mg of ephedrine. The CSE was executed at the L1-L2 intervertebral space, administering in spinal anesthesia 5 mg of levobupivacaine with 5 _g of sufentanil, and in peridural anesthesia 10-12 mL of levobupivacaine 0.25% according to the patient's height. The peridural catheter for postoperative analgesia was then positioned. In the group of women submitted only to SA, 7.5-8 mg of levobupivacaine was injected, according to the patient's height, in the L1-L2 intervertebral space, with 5 _g of sufentanil. We considered the following adverse effects: hypotension; bradycardia; vomiting; intraoperative discomfort and motor block.

RESULTS

The results obtained showed that, with a P < or = 0.05, the incidence of motor block (P < 0.001), discomfort (P < 0.001) and hypotension (P = 0.021) in the SA group is greater than in the CSE group. The difference in the incidence of vomiting (P = 0.147) and bradycardia (P = 0.067) between the 2 groups is not statistically significant.

CONCLUSIONS

In our opinion sequential CSE can be considered an important step forward in the regional anesthesia used for elective cesarean section.

1,3-dihydroxy-5-(tridec-4',7'-dienyl)benzene: a new cytotoxic compound from Lithraea molleoides

A dichloromethane extract from the leaves of Lithraea molleoides (Anacardiaceae), an argentine medicinal plant, showed cytotoxicity on human hepatocellular carcinoma cell line. Bioassay guided fractionation of this extract led to the isolation of a new active 5-alkyl resorcinol: 1,3-dihydroxy-5-(tridec-4',7'-dienyl)benzene. Chemical structure was established based on spectroscopic data (UV, IR, MS, 1H-NMR, 13C-NMR, COSY). This compound presented cytotoxic activity on 3 human tumoral cell lines: hepatocellular carcinoma cell line-Hep G2 (IC50 +/- SD of 68 +/- 2 microM), mucoepidermoid pulmonary carcinoma cell line-H292 (IC50 +/- SD of 63 +/- 5 microM) and mammary gland adenocarcinoma cell line -MCF7 (IC50 +/- SD of 147 +/- 5).

Antinociceptive activity of Eupatorium buniifolium aqueous extract

The antinociceptive properties of the aqueous extract of Eupatorium buniifolium aerial parts were investigated in chemical and thermal models of nociception in mice. Oral doses of 250 and 500 mg/kg produced an inhibition of 42.3% and 73.9%, respectively, of the abdominal writhes induced by acetic acid in mice. This antinociceptive effect was not reversed by pretreatment with naloxone. In the formalin test, the administration of 500 and 1000 mg/kg p.o. had no effects in the first phase (0-5 min) but produced a dose-dependent analgesic effect on the second phase (15-30 min) with inhibitions of the licking time of 38.9% and 57.3%, respectively. In the hot plate test, no effect was seen at the dose of 500 mg/kg p.o.

Two ellagitannins from the leaves ofTerminalia triflorawith inhibitory activity on HIV-1 reverse transcriptase

The bioassay- guided fractionation of the aqueous extract of Terminalia triflora leaves afforded punicalin and 2-O-galloylpunicalin, isolated for the first time from this species. These compounds showed inhibitory activity on HIV-1 reverse transcriptase in a dose-dependent manner. Punicalin showed an IC(50) of 0.11 microg/ml (0.14 microM) and 2-O-galloylpunicalin an IC(50) of 0.10 microg/ml (0.11 microM).

Immunomodulating properties of Argentine plants with ethnomedicinal use

Five Argentine medicinal plants selected according to folk traditional or ethnomedical use, references and primary pharmacological screening; were chosen to elucidate their immunomodulating properties. Dichloromethane, methanolic and aqueous extracts of the aerial parts of Achyrocline flaccida (A. flaccida), Eupatorium arnottianum (E. arnottianum) and Eupatorioum buniifolium (E. buniifolium), leaves of Lithraea molleoides (L. molleoides) and leaves and stems of Phyllanthus sellowianus (P. sellowianus) were analyzed to disclose their effects on murine normal and tumor cell growth as well as on complement hemolytic activity. Modulation of cell growth was evaluated by tritiated thymidine incorporation while inhibition of complement activity was measured on both classical and alternative complement pathways (CP and AP respectively). The results obtained show that most of the extracts exerted inhibitory effect on tumor as well as on mitogen activated normal spleen cell growth. On tumor cells, IC50 ranged between 1-75 microg/ml for most of the extracts with the exception of dichloromethane of L. molleoides and P. sellowianus which required concentrations higher than 100 microg/ml to produce the effect. On mitogenic activated splenocytes, IC50 ranged between < 1 to 85 microg/ml with the exception of methanolic extract of E. buniifolium or P. sellowianus which were not effective on ConA or LPS stimulated splenocytes respectively. Only E. buniifolium was active on murine normal splenocytes proliferation (IC50 0.5-1.5 microg/ml). Finally, one (7%) of 15 extracts showed inhibition of complement activity on CP and 6 extracts (40%) presented moderate activity on CP. The dichloromethane extract of E. arnottianum was the most active (IC50 5 microg/ml), although remarkable effect was also obtained with dichloromethane and methanolic extracts of P. sellowianus (IC50 11.2 and 17.3 microg/ml respectively). Besides, 2 extracts (13%), dichloromethane extract of E. arnottianum and aqueous extract of P. sellowianus, showed moderate inhibition on AP.

In vitro antiplasmodial activity of extracts of Argentinian plants

Fifteen extracts from nine selected Argentine medicinal plants were tested for their antiplasmodial activity in vitro by assessing their ability to inhibit the uptake of [3H]-hypoxanthine into the Plasmodium falciparum K1 pyrimethamine/chloroquine resistant strain. The methanol extract of Satureja parvifolia showed good antiplasmodial activity (IC(50) 3 microg/ml). Inhibition of the growth of P. falciparum was also observed with aqueous extracts of Buddleja globosa and S. parvifolia.

Phenolic compounds with anti-inflammatory activity from Eupatorium buniifolium

Anti-inflammatory activity was detected in the CH(2)Cl(2) extract of the aerial parts of Eupatorium buniifolium using the TPA-mouse ear model. Three compounds isolated from this extract, by bioassay-guided fractionation, significantly inhibited the inflammatory response. The compounds were identified as 5,7,5'-trihydroxy-3,6,2',4'-tetramethoxyflavone (1), scopoletin (2) and centaureidin (3) which inhibited the edema by 67.3 %, 59.8 % and 49.7 %, respectively, at a dose of 1 mg/ear.

[Simultaneous meningitis caused by Candida and tuberculosis as manifestation of AIDS]

Opportunistic germs meningoencephalitis plays an important role within neurologic pathology in aids. Treponema pallidum and Mycobacterium tuberculosis among bacteries, Cryptococcus neoformans in fungus group, Toxoplasma gondii in protozoos group and Papovavirus JC in virus one are the most frequently implicated germs. Sometimes infections are mixed. We present a simultaneous meningitis case produced by Candida albicans and Mycobacterium tuberculosis that coursed with neutrophilic pleocytosis in CSF and normal glucose CSF levels, consisting the clinical debut of aids. Repeated CSF examinations are the diagnostic clue owing, as in our case, instauration of early treatment. Present case of simultaneous tuberculous and candidiasic meningitis is the first one described in a HIV positive patient.

Antimicrobial activity of Argentine plants used in the treatment of infectious diseases. Isolation of active compounds from Sebastiania brasiliensis

Different extracts of Sebastiania brasiliensis, Sebastiania klotszchiana, Polygonum punctatum, Lithraea molleoides and Myrcianthes cisplatensis, all plants growing in Entre Ríos Province and traditionally used as antiseptics, were tested against a set of Gram positive and Gram negative bacteria and fungi. All the species, with the exception of M. cisplatensis, presented activity against some of the microorganisms tested. A 50% hydroalcoholic extract of S. brasiliensis was selected for bioguided fractionation. Two antimicrobial compounds identified as methylgallate (MIC 128 microg/ml) and protocatechuic acid (MIC 128 microg/ml) were isolated apart from quercetin, kaempferol, quercitrin and gallic acid.

First cyclotide from Hybanthus (Violaceae)

Hypa A, a novel macrocyclic polypeptide containing 30 amino acid residues, has been isolated from the n-butanol extract of the Argentine plant Hybanthus parviflorus. The sequence, cyclo-(SCVYIPCTITALLGCSCKNKVCYNGIPCAE), was determined by automated Edman degradation, quantitative amino acid analysis and nanospray MS/MS(2). Three intramolecular disulfide bridges stabilize the cyclic peptide backbone of hypa A. Using these structural features to classify the peptide as a cyclotide, we extended the distribution of that substance class to a new genus, and now propose a uniform nomenclature for cyclotides.

Minor head injuries: one year experience according to the new Italian guideline

BACKGROUND

The data concerning a consecutive series of 4,536 adult patients suffering from minor head injuries treated at the Department of Neurosurgery over a period of one year are reported.

METHOD

The patients' age, sex and the circumstances of the injury have been taken into consideration. The patients, according to the new method, were divided into four groups. Group 0 (3,864 patients) included all patients with Glasgow Coma Scale (GCS) score 15. They did not present any clinical features such as loss of consciousness (LOC), post-traumatic amnesia (PTA), headache or vomiting. No risk factors (RF) such as coagulopaties, alcoholism, drug abuse, epilepsy, previous neurological treatment or disabled elderly patients were detected. Group 1 (600 patients) included patients with GCS score 15. The patients presented one or more clinical features (LOC, PTA, headache, vomiting). No RF were presented. Group 2 (24 patients) included patients with GCS score 14 with or without clinical features (LOC, PTA, headache, vomiting) and with or without RF. Group 0-1R (48 patients) included patients with GCS score 15 with or without clinical features (LOC, PTA, headache, vomiting). All of them presented RF. The presence of focal neurological signs, open injury and GCS score < or = 13 were considered criteria for exclusion.

FINDINGS

All the patients from groups 1, 0-1R, 2 and 187 patients from group 0 underwent CT scan for a total of 859 exams which are analyzed and discussed. 458 patients were admitted and are divided as follows: 216 from group 0, 192 from group 1, 26 from group 0-1R and all the 24 belonging to group 2. Six patients were treated surgically (3 extradural haematomas, 2 lobe contusions, 1 acute subdural haematoma) and one of them (0.02% of the total) died (extradural haematoma). The patients who were not admitted were sent home with an information sheet after at least a six hour observation period.

INTERPRETATION

The authors draw the conclusion that they have evaluated the applicability and efficacy of guidelines, developed by the study group on head injury of the Italian Society of Neurosurgery. A critical part of our guidelines is not only to identify all the intracranial lesions, but to identify patients harbouring relevant intracranial mass before clinical deterioration.

Antinociceptive effect of some Argentine medicinal species of Eupatorium

Eupatorium laevigatum, E. arnottianum and E. subhastatum, plants used in Argentine folk medicine for the treatment of inflammation and pain related problems, were evaluated for analgesic activity. The infusions of these species (500 mg/kg, p.o.) produced a reduction in the number of stretches of 46.6%, 41.5% and 35.6% respectively, in the acetic acid induced writhing test. This antinociceptive effect of the infusions was not reversed by pretreatment with naloxone. The infusions studied did not produce antinociceptive effects when assayed in the hot plate test. These results suggest that the analgesic activity is exerted by a mechanism unrelated to interaction with opioid systems.

Biological and chemical characterization of the fraction with antiherpetic activity from Achyrocline flaccida

The in vitro antiviral activity demonstrated by aqueous extract (AE) of Achyrocline flaccida on herpes simplex virus type-1 is exerted early during the viral replication, essentially during the viral adsorption to host cells. A bioguided purification process of the AE indicated that negatively charged polysaccharides were responsible for this antiviral activity.

Argentine plant extracts active against polymerase and ribonuclease H activities of HIV-1 reverse transcriptase

Lipophilic and hydrophilic extracts of four Argentine plants (Gamochaeta simplicaulis Cabr. 1, Achyrocline flaccida Wein. D. C. 2, Eupatorium buniifolium H. et A. 3, and Phyllanthus sellowianus Muell. Arg. 4) were examined in vitro for their ability to inhibit the polymerase and ribonuclease H (RNase H) activities of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase (RT) (wild and Y181C mutant types). The active extracts were also examined as inhibitors of viral replication in HLT4LacZ-1IIIB cell cultures, evaluating their cytotoxicity in parallel. Infusions 2I and 4I, among the crude extracts, showed the highest activity. These extracts were refractioned into four fractions; 2I4 and 4I4 were active as inhibitors of DNA-polymerase (wild and Y181C types) and RNase H activities. These fractions were potent as inhibitors of viral replication and were not cytotoxic. Refractionation of 2I4 yielded five new fractions, two of which, 2I4-4 and 2I4-5, showed notable activity. Refractionation of 4I4 yielded for new fractions; of these, 4I4-3 and 4I4-4 were active. The marked biological activity found in the infusion of A. flaccida and P. sellowianus makes them sufficiently attractive to be considered in the combined chemotherapy of the disease.

Antiviral activity in Argentine medicinal plants

In an ethnopharmacological screening of selected medicinal plants used in Argentina for the treatment of infectious diseases, aqueous extracts of five species were assayed in vitro to detect antiviral activity against herpes simplex virus type 1 (HSV-1), respiratory syncytial virus (RSV) and adenovirus serotype 7 (ADV-7). Polygonum punctatum, Lithraea molleoides, Sebastiania brasiliensis and Sebastiania klotzschiana but not Myrcianthes cisplatensis showed in vitro antiherpetic activity with 50% effective dose (ED50) ranging from 39 to 169 microg/ml. P. punctatum, L. molleoides and M. cisplatensis showed antiviral activity against RSV with ED50 ranging from 78 to 120 microg/ml. None of the extracts had antiviral activity against ADV-7. The differences between their maximal non cytotoxic concentration and their antiviral activity values were high enough to justify further analysis.

Cervical myelopathy caused by median disc herniation: analysis of the complications following anterior discectomy with and without Fusion Report of 90 cases

Between 1980 and 1992 about 400 patients underwent anterior cervical discectomy with or without intersomatic fusion at the Department of Neurosurgery of CTO Hospital (Rome) and Nuovo Pellegrini Hospital (Naples). Among them 90 patients were selected (50 from CTO and 40 from Nuovo Pellegrini Hospital). Clinical evaluation of postoperative results were assessed according to Odom's grading system and postoperative complications were discussed. No difference was observed in patients who underwent anterior cervical discectomy with and without fusion; however, postoperative complications were frequently observed in patients who underwent fusion. In conclusion, we consider the anterior microdiscectomy as the treatment of choice for the removal of soft disc herniations with or without osteophytosis even at two level disc. If cervical myelopathy is expression of one or more disc herniations, maybe calcified and associated with marked osteoarthrosic degenerative phenomena, we favour the evacuation of the herniated disc and the removal of osteophytes with Cloward's or Smith-Robinson's techniques.

Cavernous angioma of the diencephalon

A case of cavernous angioma of the diencephalon presenting with subarachnoid hemorrhage in a 19 years old woman is reported. Pertinent literature is reviewed. Clinical data, Computerized Tomography (CT) and pre and post operative Magnetic Resonance (MR) imaging are presented and discussed. The problems of diagnosis and treatment of cavernous angiomas localized in critical areas of the brain are also discussed.

The role of early postoperative CT scan following surgery for herniated lumbar disc

40 patients underwent lumbosacral microdiscectomy in a 12 months period covering the years 1988-1989 in our center. For the purpose of the present study, we considered the 30 cases who underwent CT control of the operated interspaces and of the adjacent vertebral endplates. This was routinely carried out on the 3rd post-operative day. The present study failed to show correlations between early post-operative CT data and subsequent clinical results in this unselected series of patients. In fact an image suggesting persistent disc herniation was as a rule observed in spite of satisfactory clinical results, and other CT findings that have been considered of clinical significance, such as intraspinal air and low attenuation of disc space, were commonly observed in patients with an uncomplicated post-operative course. The present study suggests that early post-operative CT appears to be of no value in the management of potential early complications of low-back surgery. The introduction of MRI appears to offer other possibilities in the evaluation and management of failed back surgery syndrome (FBSS).

Lumbar root compression by a gas-containing cyst in the extradural space. Case report

The case report describes a patient with acute sciatica of three months duration, resulting from lumbar root compression by a gas containing cyst in the extradura space. This condition is related to vacuum disc phenomenon, because the gas appears to have originated from within the adjacent disc space.

Postoperative CSF problems after spinal and lumbar surgery. General review

Although the dura is frequently traumatized in surgery, and during lumbar punctures, it is surprising that the "CSF problem" is a rare complication in the surgical treatment for herniated intervertebral disc (0.1%); and exceptionally rare at cervical or dorsal level. In the upright position the CSF pressure at the site of the potential leak is greater in the lumbar region, lumbar operations are more frequently performed than cervical, and, perhaps, also because cervical operations are performed by fewer surgeons with greater specific experience. The purpose of this work is to describe the etiopathology, the symptomatology, the diagnosis and treatment of early and delayed CSF problems.

Alexithymia and breast cancer. Survey of 200 women undergoing mammography

The Schalling Sifneos Personality Scale (SSPS) and the Middlesex Hospital Questionnaire (MHQ) have been used in 381 women just before mammography at the Breast Center of the Radiology Institute, University of Bari (Italy). Of the 200 women who accepted to complete the questionnaires 13 were found positive for cancer. Student's t test comparison of the mean SSPS and MHQ scores of the positive for cancer with the negative showed that women with breast cancer have more pronounced alexithymic but not neurotic traits. Our findings suggest that patients with cancer may have something in common with those suffering from so-called psychosomatic pathologies who have a constrained imagination and fantasy and difficulty in verbalizing their emotions. Thus, this study indicates a relationship between alexithymia and cancer.

Chlordiazepoxide facilitates erections and inhibits seminal emission in rats

Two experiments have been conducted to clarify the effects of the benzodiazepine chlordiazepoxide (CDP) on the different components of male rat sexual behavior. In the first experiment the effects on penile erectile reflexes (PR) of two doses (10 and 30 mg/kg, IP) of CDP were compared with those of vehicle, no-treatment and baseline pre-test in a repeated measures design. In the second experiment the different components of male sexual behavior - PR, mating behavior and spontaneous seminal emission SSE) - were extensively studied after vehicle, 3 and 30 mg/kg CDP treatments. CDP was found to increase significantly the percentage of rats showing penile reflexes, enhance the number of erections per test and shorten the latency to onset of reflexes. It lowered the percentage of animals displaying seminal emission during the PR test. In the mating behavior test, CDP abolished copulatory (and other) behavior at 30 mg/kg. It decreased the number of animals achieving ejaculation at the subataxic 3 mg/kg dose level. In the SSE 3-day test, CDP significantly reduced the weight and the number of plugs of seminal material emitted by the CDP-injected animals. The possible involvement of the serotonergic system in determining the dose-dependent increase in erections and decrease in seminal emission following CDP treatments is discussed. Clinical implications are also briefly considered.

Stimulation of spinal serotonergic receptors facilitates seminal emission and suppresses penile erectile reflexes

Penile erection and ejaculation are produced by spinal reflexes subject to tonic control from the brain. This study examines the possible involvement of serotonergic transmission in the supraspinal modulation of such reflexes. The effects of two drugs which facilitate serotonergic transmission by different mechanisms, namely the direct receptor agonist, 5-methoxy-N,N'-dimethyltryptamine (5-MeODMT), and the reuptake inhibitor, zimelidine, were compared in intact and spinal rats. Results show that serotonergic stimulation in intact rats by either drug produces a dose-related increase in the incidence of seminal emission as well as a definite decrease of the display of erectile responses. In the spinal animals 5-MeODMT treatment reproduced both effects. By contrast, zimelidine, which needs functional nerve endings to exert its agonistic action, was ineffective in the spinal rats. This is interpreted to exclude a peripheral mechanism for the effects of the serotonin agonists on penile reflexes of intact animals and makes a strong case for a spinal site of action. We postulate the existence of serotonergic receptors located in the lower segments of the spinal cord which, when stimulated, trigger seminal emission and suppress erection.