[A semirigid corset in the treatment of lumbar disc arthrosis. Physiopathology, indications, limitations and counterindications. A clinical contribution].
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Biomedical subjects
Publications and source records attributed to D Fiore.
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The authors present their first results with the treatment of hemifacial spasm by controlled percutaneous thermocoagulation of the facial nerve. Seven patients have been treated to date with good immediate results on the movements, although a slight paresis of the homolateral facial musculature, aesthetically acceptable, persists after treatment. A long-term follow-up at more than 10 months was achieved in only 3 patients, who showed a complete regression of the spasm with partial disappearance of the facial hemiparesis.
The authors describe percutaneous radiofrequency (rf) thermocoagulation of the sphenopalatine ganglion used to treat seven patients with sphenopalatine ganglion neuralgia. The procedure was effective in relieving pain, without significant side-effects. All the patients have actually been free of pain during a follow-up of 6-28 months. The surgical technique and the rationale for its use are pointed out.
Twenty-nine prostatic cancer patients were evaluated for staging purpose by Magnetic Resonance (MR). MR findings were correlated with the pathologic examination in 18/29 patients who underwent radical prostatectomy. Four MR staging parameters were evaluated individually: periprostatic fat; periprostatic venous plexus; seminal vesicles and pelvic adenopathy. MR correctly staged 16/18 patients, with one case of overstaging and one case of understaging. The diagnostic accuracy of MR in differentiating intracapsular stage B from extracapsular stage C was 87%, with a sensitivity of 90% and a specificity of 87%. MR and CT results agreed in 4 of the 7 operated patients who were examined with both techniques; in 3 cases there was disagreement, and MR was correct.
Subcutaneous and visceral fat distribution as related to sex, age, and overweight was studied in 130 subjects and 10 women with Cushing's disease. Fat depots were evaluated by computed tomography at one thoracic and one abdominal level. Adipose tissue (density range - 50 to 250 Hansfield units) was highlighted and the fat areas were measured by a laser planimeter. The ratio between subcutaneous and visceral fat areas (S:V ratio) was assumed as an index. Ratios of both nonobese and obese groups were significantly higher in females than in males. Ratios decreased markedly over age 60. There was a significant inverse correlation between age and S:V ratios in females (r = 0.65; p less than 0.001) and in males (r = 0.61; p less than 0.001). Statistically significant correlations were found between S:V ratios at thoracic and abdominal levels. In Cushing's patients, the S:V ratio at the abdominal level was significantly lower than in controls matched for age, sex, and body mass index.
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A high-pressure liquid chromatographic method has been developed that allows for the simultaneous analysis of dacarbazine (DTIC), 5-aminoimidazole-4-carboxamide (AIC), and 2-azahypoxanthine (2-AZA) in plasma or urine. Plasma samples were prepared by ultrafiltration, whereas urine samples were filtered and diluted for analysis. Chromatography was done with a C18 mu Bondapak column along with gradient elution of the drugs. The mobile phase consisted of 100% 0.5 M sodium acetate (pH 7.0) and 25% acetonitrile in 0.05 M sodium acetate (pH 5.5) with detection at 280 nm. Linearity was observed up to 500 micrograms/ml for DTIC and up to 53 micrograms/ml for AIC and 2-AZA. The assay methodology was reproducible, with a lower limit of detection of 5.0, 0.5, and 0.5 micrograms/ml for DTIC, AIC, and 2-AZA, respectively. Interday and intraday coefficients of variation ranged between 4 to 14% and 2 to 16%, respectively. The analytical method was applied to the analysis of plasma and urine samples resulting from the isolation perfusion chemotherapy of an extremity with 57 mg of DTIC per kg in a patient with melanoma.
We report on two patients with an asymmetrical expansion of fat tissue. At computed tomography, lipomatous tissue proved to be superficially located in one patient and both subcutaneously and deeply located in the second. Signs and symptoms of a peripheral neuropathy were observed in both patients, who were otherwise asymptomatic. The lipolytic activity in post-heparin plasma was normal in both patients. The fat cell size of lipomatous tissue, obtained in one patient by percutaneous needle biopsy, was higher than that of contralateral, uninvolved adipose tissue. The adipose tissue lipoprotein lipase activity in lipomatous tissue was higher than that in normal tissue. High density lipoprotein (HDL), HDL2 and HDL3 cholesterol values were elevated in both patients but not exceeding 1 standard deviation the values of age and sex matched controls. Isoprenaline-stimulated lipid mobilization was similar in lipomatous and in control tissue.
Magnetic Resonance (MR) cross sectional images of the normal mediastinum are presented and discussed. In normal subjects most mediastinal structures visible on Computed Tomography (CT) are also visible using MR. The primary advantages of MR over CT in the evaluation of mediastinum are the greater soft tissues contrast resolution, the multiplanar (axial, coronal and sagittal) display of the mediastinal anatomy and its ability to distinguish vascular from nonvascular structures without injection of contrast media.
During phenytoin therapy, a male patient showed hypertermia, myalgias and mediastinal and abdominal lymphadenopathy. Despite the impossibility of histological diagnosis, he was treated with antiblastic polychemotherapy with little benefit. Another female patient on the same therapy showed splenomegaly with pancytopenia. The spleen and some abdominal lymph nodes were removed; they revealed a pattern of tubercular-like gigantocellular-epithelioid chronic flogosis. As in the first patient, the suspension of therapy gave a disease-free period. A third female patient on diphenylhydantoin therapy undervent some hemolytic crysis and, finally, SLE with cardiac involvement. We point out the complexity of the pathogenesis of hydantoinic immunologic syndromes, the polymorphism of the clinical patterns and the difficulty to make a correct diagnosis, mostly on presence exclusively deep involvement.
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The technique of liver arterialization with the left gastric artery after portocaval shunt in the rat is described. The operation was carried out with three different modalities, and the best results were obtained when suturing was carried out after enlargement of the arterial caliber (0.4-0.5 mm external diameter), advantage of a vessel bifurcation. Eighty percent of the anastomosis were patent without any anticoagulant treatment 1 month after surgery. Preliminary results show the positive effect of liver arterialization compared to treatment with portocaval shunt alone.
As mezlocillin has been shown to display nonlinear pharmacokinetics in single-dose evaluations, we evaluated a crossover trial in patients with renal dysfunction the impact on serum clearance of fixed-dose versus fixed-interval administration of identical daily doses of the drug. In four patients with creatinine clearances of 0.00 to 1.78 liters/h per 1.73 m2, equal serum clearances were observed when the calculated daily total dose of mezlocillin was given either as a fixed dose of 5,000 mg at various intervals or every 4 h at various doses. We found that repetitive large daily doses that are equivalent to 30 g/day in patients with normal renal function can be administered to patients with impaired renal function as a reduced dose every 4 h instead of prolonging the dosing interval, as suggested by Mangione et al. (Antimicrob. Agents Chemother. 21:428-435, 1982). The observed serum clearances were equal for the two schedules, probably owing to the degree of continuing saturation of the nonlinear clearance mechanisms of mezlocillin.
A rapid, sensitive, and specific method of analysis for mezlocillin in serum and urine by high-pressure liquid chromatography is described. A solid-phase extraction column was used to remove interfering substances from samples before chromatography. Quantitation included the use of an internal standard, nafcillin. Mezlocillin was chromatographed with a phosphate buffer-acetonitrile (73:27) mobile phase and a C-18 reverse-phase column and detected at a wavelength of 220 nm. The assay had a sensitivity of 1.6 micrograms/ml and a linearity of up to 600 micrograms/ml and 16 mg/ml in serum and urine, respectively, with only 0.1 ml of sample. The interday and intraday coefficients of variation for replicate analyses of spiked serum and urine specimens were less than 6.5%.
A case of bilateral Castleman tumors in the posterior mediastinum is described. Computed tomography proved to be an accurate, noninvasive method of investigation since it identified not only a large mass but also a smaller mass, which was not visible on standard chest X-ray film. Complete surgical excision was possible. The high attenuation values of both masses demonstrated the hypervascularity of the lesion.
Two cases of von Recklinghausen neurofibromatosis (VRN) with thoracic and abdominal involvement are described. Computed tomography demonstrated the typical lesions of this disease: meningoceles, neurofibromas, and skeletal alterations. In both cases lesion morphology and location were similar and characteristic, in particular in the pelvic region. Computed tomography findings in generalized VRN are sufficiently characteristic to be considered diagnostic for this disease.
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