[Electroclinical evaluation of the effectiveness of a new benzodiazepine, Ro 5-4023].
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Biomedical subjects
Publications and source records attributed to W Liboni.
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We report the first case of recurrent ifosfamide-related neurotoxicity in the same patient following two distinct administrations of the drug at different doses and schedules and with a long interval between the two episodes. Remarkably, the first event was characterized by confusion and hallucinations, while the second, 29 months later, was characterized by partial and generalized seizures. Between the two episodes the patient had received high-dose cyclophosphamide, an oxazophoshorine agent closely related to ifosfamide, without any neurological side effects. We briefly discuss the diagnosis and management of ifosfamide-related encephalopathy.
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The Doppler technique has only been used in neurological practice to evidence local vessel pathology such as occlusion or stenosis. Both common carotid artery and internal jugular vein flows can change not only because of pathological processes of the vessels but also because of impedance of their distribution territory. In this report we analyze the relationship between flow velocity, one of the parameters of blood flow, and intracranial impedance variations which occur in cerebral concussion, tumors and acute vascular cerebral pathology. During our observations we noticed that the diastolic wave of the velocity curve of the common carotid artery is a very important signal of the flow variations in the internal carotid artery and, in turn, of variations in cerebral flow. We studied the behaviour of the common carotid artery velocity curve in our patients both during clinical disease development and during the action of mannitol in the acute phases of the disease. We found that the ultrasonic patterns during antiedema action were similar to the ones obtained during the recovery period. We were able to note some differences and some similarities of the curve morphology in relation to generalized or focal causes of cerebral edema. This may be very important considering that at present no non-invasive and therefore repeatable technique is available for monitoring cerebral blood flow in intracranial hypertension.
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The Authors, after briefly reviewing the literature on chemotherapy of malignant gliomas, present their own experience on forty-four patients with such tumors. All of them had been previously operated and irradiated. The clinical course was controlled by various parameters which are described. Results obtained in glioblastomas, anaplastic astrocytomas and malignant oligodendrogliomas are discussed. BCNU and CCNU seem to be beneficial not only in prolonging survival time but also in improving its quality: the average survival time of treated patients is 9.2 +/- 9.8 against 6.7 +/- 3.4 of controls. These values however are not statistically significant. In 15 out of 31 patients, who died at varying intervals after chemoterapy, an autopsy was performed. The morphology of the tumors was compared with that of previous biopsies. No specific alterations to be referred to chemotherapy were found. The side effects are described in detail and particular attention is focused on toxicity (blood and liver) whose main effect is the lowering of platelets and white cells. However, this and the epatic alterations did not reach values requiring interruption of chemotherapy. Other drugs have been used such as MeCCNU, VM 26 and Procarbazine. The number of patients, treated with each of them, is low for a definite conclusion; even if VM 26 and Procarbazine seem to offer the best effects.
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