[Cerebral vasospasm caused by subarachnoid hemorrhage].

Vasospasm is one of the most frequent complications of subarachnoid hemorrhage (SAH) and causes high mortality rates and serious neurologic deficits, resulting in invalidity. Diagnosis is based on precise clinical criteria (onset between the 3rd and the 8th day after the SAH) and is confirmed by angiographic examination. The etiology certainly involves many factors, though the identification of the primary cause (conductive to morpho-structural alterations of the artery walls) seems to be troublesome.

Lung function abnormalities in different connective tissue diseases.

Lung volumes, forced expiratory flow-volume curves, diffusing capacity indexes, and arterial blood gases were measured in 72 non-smoking patients with various connective tissue diseases (13 with rheumatoid arthritis, 17 with systemic lupus erythematosus, 25 with progressive systemic sclerosis, 10 with primary Sjögren's syndrome, 4 with polymyositis, and 3 with mixed connective tissue disease). Small airways disease and a diffusion capacity impairment were the most frequent and marked functional abnormalities in the whole group, and were often present in asymptomatic patients. Different lung function defects seemed to be present in each disease group.

Arachidonate metabolites and vasospasm after subarachnoid haemorrhage.

A wide literature exists about the pathogenesis of cerebral arterial spasm following subarachnoid haemorrhage: several compounds have been identified in human cerebrospinal fluid as possible vasoactive agents involved in the biochemical mechanism of vasospasm onset. Many experimental evidences exist for a major involvement of arachidonate metabolites. The present work represents a review of experimental data supporting the hypothesis of cerebral arterial spasm as a result of an imbalanced vascular regulatory mechanism involving arachidonate metabolites.

Total gastrectomy in the treatment of adenocarcinoma of the cardia. Review of the results in 73 resected patients.

Between January 1, 1971, and December 31, 1978, 73 patients with adenocarcinoma of the cardia were treated by total gastrectomy with distal esophagectomy. The continuity of the alimentary tract was restored by esophagojejunostomy using a Roux-Y procedure in 32 patients and jejunal loop interposition in 41 patients. The early postoperative mortality rate was 18 percent.

Prostaglandin D2 monitoring in human CSF after subarachnoid hemorrhage: the possible role of prostaglandin D2 in the genesis of cerebral vasospasm.

Experimental and clinical studies indicate that cerebral vasospasm following subarachnoid hemorrhage (SAH) may be caused by changed biochemical properties of the endothelium and vascular smooth muscle cell exposed to vasoactive substances synthetized by cerebral arteries and released in clotted blood. Many compounds have been identified in CSF from SAH patients: Thromboxanes A2 and B2, Prostaglandins F2 alpha, E2 and D2 are the major prostanoids incriminated in the causation of cerebral arterial spasm. We have monitored the CSF PGD2 concentrations with serial lumbar punctures at different intervals from the hemorrhage in 16 patients admitted for SAH: PGD2 was measured with radioimmunoassay as its 9-methoxy derivative.

Selected ion monitoring technique for the evaluation of sterols in cerebrospinal fluid: a new approach to desmosterol test for central nervous system tumors.

The desmosterol test for the diagnosis of central nervous system (CNS) tumors is proposed in a simplified form. The procedure is based upon the analysis of sterol profile in cerebrospinal fluid (CSF) by selected ion monitoring (SIM) technique. Applied to 55 patients with tumoral and non tumoral CNS disease, the new test detects average levels of CSF desmosterol in tumor bearing patients that are tenfold higher than in the absence of CNS neoplasia.

Extradural haematoma of the posterior fossa: a report of eight cases and a review of the literature.

The authors review the literature and present 8 cases of extradural haematoma of the posterior fossa operated from 1979 to 1985 at the Neurosurgical Clinic of the University of Pavia. Emphasis is placed on the importance of an early diagnosis of the symptoms which are often ignored due to the absence of specific clinical signs. The authors recognize a substantial improvement in results because of the recent introduction of CT scanning facilities which permit an early and precise diagnosis of this traumatic pathology.

Prostacyclin and vasospasm in subarachnoid hemorrhage from ruptured intracranial aneurysm. A preliminary clinical study.

Experimental and clinical observations suggest the importance of arachidonate metabolites in the genesis of symptomatic cerebral vasospasm after subarachnoid hemorrhage. Prostacyclin (PG12) has a well demonstrated vasodilator action. The authors monitored CSF prostacyclin concentration in 12 consecutive cases of subarachnoid hemorrhage with the purpose of correlating the prostacyclin concentration trend with the clinical course and the risk for vasospasm.

The assessment of gas exchange by automated analysis of O2 and CO2 alveolar to arterial differences.

A computer program to measure breath by breath alveolar pressure (PA) and alveolar to arterial difference (AaD) for O2 and CO2, by a mass-spectrometer has been implemented. The program allows the determination of alveolar gas by different methods: 1. Bohr's equation (BE); 2.

Respiratory effects in relation to estimated tar exposure from current and cumulative cigarette consumption.

Relationships between estimated "tar" exposure from current and past cigarette consumption, were related to respiratory symptoms and function during the seventh survey (1981-1983) of the Tucson epidemiologic study of airways obstructive diseases. Smokers (n = 582; 280 males and 302 females) and exsmokers (n = 621; 345 males and 276 females), answered detailed questions on current and past smoking, and performed flow-volume maneuvers. Cough and phlegm were significantly associated with estimated "tar" exposure from current cigarette consumption.

Cisternal and lumbar CSF concentration of arachidonate metabolites in vasospasm following subarachnoid hemorrhage from ruptured aneurysm: biochemical and clinical considerations.

Two representative cases of subarachnoid hemorrhage in which prostaglandin D2 (PGD2) and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), stable metabolite of prostacyclin (PGI2), were monitored with serial lumbar punctures and detected in cisternal CSF during operations for aneurysm, are reported. In the case with demonstrated arterial vasospasm, prostaglandin D2 has a concentration trend with characteristic peak related to vasospasm; the synthesis of prostacyclin appears inhibited after the hemorrhage. In the patient without radiologic evidence of vasospasm, arachidonate metabolite concentration trend appears in a steady-state.

Reference equations for the single-breath diffusing capacity. A cross-sectional analysis and effect of body size and age.

A longitudinal study was implemented in an unpolluted rural area of northern Italy (near Venice), before the start of the operation of a large oil-burning thermoelectric power plant, in order to investigate the effects of the future exposure to air pollution and to elucidate the natural history of obstructive airways diseases. During the first cross-sectional survey, a sample of the general population (n=3,300, 8 to 64 yr of age) performed several lung function tests, and information on risk factors and on the presence of respiratory symptoms were obtained by a standardized questionnaire. There were 712 subjects who were classified as normal on the basis of rigid criteria and who were able to perform satisfactorily a single-breath CO diffusing capacity (DLCOsb) test.

Peripheral PICA aneurysm. Case report.

One case of aneurysm of the right distal posterior inferior cerebellar artery (PICA), arising from the telo-velo tonsillary segment, is reported; the patient, a 73 years-old woman, was successfully treated by clipping procedure. Few similar cases are reported in literature. Among all intracranial aneurysms, PICA aneurysms account for 0.

[Possibilities and limits of neurosurgery in the management of cerebral ischemia].

Surgical treatment of occlusive cerebrovascular diseases is based on the theory that improved cerebral blood flow in the occluded areas can potentially limit the degree of ischaemic damage. This, it is thought, will at least partially normalise neuron metabolism. The two commonly used surgical techniques are carotid endarterectomy and extracranial-intracranial anastomosis.

[Protocol of combined surgical and polychemico-immunoradiologic therapy of stage T2N2MO lung cancer].

Preliminary data on the use of a combined surgical-polychemical-immunoradiotherapy protocol in the treatment of 13 T2N2M0 lung cancer patients are reported. The results are compared with those obtained in a 13 patient control group, homogenous by histotype, stage and surgical treatment who were given no other therapy. At 24 months the average survival rate in the first group was 61.

[Clinical aspects and surgical therapy of cerebral metastases].

Authors describe clinical presentation, signs and symptoms and diagnostic procedures in case of metastatic brain tumors. Incidence and different pathological aspects are considered. Surgical treatment is discussed in its limits and indications.

[Clinical aspects and surgical therapy of cerebral gliomas].

The Authors describe the clinical symptoms of malignant brain tumors emphasizing the relationship to raised intracranial pressure and to their different localizations. Problems involved in surgical therapy are described stating the limits and aims of conventional oncologic neurosurgery. The need for adequate pre and post-operative support therapy is discussed including peritumoral brain edema therapy.

Therapeutic strategy for central nervous system tumors: present status, criticism and potential.

Surgery, radiotherapy, chemotherapy and immunotherapy represent the combined therapeutic approach to malignant brain tumors. Surgery plays an important role in the treatment of malignant gliomas to ensure a correct diagnosis and to make room within the confines of the skull. Surgery must provide low mortality, low morbidity and at the same time, the most thorough removal possible of the tumor, while respecting the normal brain tissue surrounding the tumor.

[Cardial achalasia and emotional stress. Considerations on 47 clinical cases].

Reference is made to personal experience of psycholability is most patients with cardiac achalasia in presenting the results of a preliminary study of the relation between psychic trauma and the onset of this affection, in which a retrospective investigation was made of 47 clinical records prepared for surgical purposes, and hence poorly oriented. It was found that 16 patients (34%) spontaneously reported that dysphagia was closely related to a psychic trauma in terms of time. While no aetiopathogenetic theories can be founded on this observation, it suggests that the question can be usefully examined further by means of more specific psychological investigations that are more appropriate for employment in subsequent cases, the aim being to determine whether the trauma in question triggers the disease, or is simply a sign revealing the presence of an already existing condition.

Radio-chemo-immunotherapy (CCNU plus levamisole) for treatment of metastatic brain tumors. A pilot study.

Thirty-one patients with metastatic brain tumors were treated with Radiotherapy (RT) and CCNU or with RT, CCNU and Levamisole (LMS) in a randomized clinical trial. Twenty-seven were evaluable. All patients were submitted to whole brain radiation (50 +/- 5 Gy) and CCNU (130 mg/m2 p.