Amelioration of the diagnostic possibilities of irrigraphy by a new index, I0

Irrigraphie (segmental impedance plethysmography) is a reliable non invasive method for the positive and topographic diagnosis of arterial occlusive disease and for its prognosis (5, 8, 9, 12, 13). The method is based on pulse volume recordings at six different positions of the leg (from 1 = proximal to 6 = distal). The amplitude of the signal is related to heart rate and to the basic impedance of the segment of the leg. The diagnosis of aorto-iliac disease is proposed when the upper extremity index (I1MS) over the lower extremity proximal index (I1) ratio (ITA) is increased (greater than 1.4), or when the I1 value is lower than 1.9. The diagnosis of femoro-popliteal disease is proposed when there is a significant drop between I1 and the above knee index I3. However in a recent study we found that I1 value drops when there is a severe femoro-popliteal lesion. In this case, irrigraphie proposes erroneously the diagnosis of aorto-iliac and femoro-popliteal diseases. In order to improve the method, we thought that a new electrod position (I0) over the iliac region would give to irrigraphie a more reliable topography diagnosis possibility. In this study 32 patients were analysed with angiography and irrigraphy, and divided into 3 groups: group I = isolated iliac disease (19); group F = isolated femoral diseases (22); group IF = ilio-femoral diseases (12). We observe from the ROC analysis, that I0 has a sensitivity of 84% and a specificity of 86%, when the iliac lesions are isolated whereas I1 and ITA give a lower specificity (52%). However, when aorto-iliac lesions are combined with femoro-popliteal lesions the irrigraphie is a little less sensitive (71%). In conclusion I0 index is more reliable for the topographical diagnosis of obstructive disease of the iliac artery than I1 index and we suggest to replace I1 by I0 whenever it is possible.     

Cholinergic processes in blood samples from patients with major psychiatric disorders

Cholinergic processes were measured in plasma and red blood cells (RBC) obtained from patients with mania, depression, and schizophrenia. RBC choline levels were elevated in manic patients, and lithium treatment led to a further increase. RBC choline transport was below normal in manic patients, and lithium treatment further reduced choline transport in addition to reducing the apparent affinity for choline. RBC acetylcholinesterase was low in depressed and schizophrenic patients, but not in manic patients, whereas plasma acetylcholinesterase was reduced only in depressed patients. Plasma nonspecific cholinesterase was below normal in all groups of patients. These results indicate unique patterns of differences from controls in the cholinergic system in blood samples from patients with different psychiatric illnesses.     

Relationship between acrosome reaction and in vitro fertilization of zona-free hamster eggs by bonnet monkey (Macaca radiata) spermatozoa

The relationship between acrosome reaction, as studied by FITC-RCA staining technique, and the penetration of bonnet monkey spermatozoa into zona-free hamster eggs was investigated. The acrosomes of unreacted spermatozoa fluoresced, whereas those of acrosome-reacted sperm did not fluoresce owing to decreased binding of the lectin. The percentage of acrosome-reacted sperm increased following 3 h of incubation in BWW medium. The assessment of acrosome reaction by the FITC-RCA staining technique correlates well with the in vitro fertilization of zona-free hamster eggs.     

Involvement of α-adrenergic receptors in the amnestic and anti-amnestic action of acth, β-endorphin and epinephrine

The post-training administration of ACTH_1–24 (0.2 μg/kg), human β-endorphin (1.0 μg/kg) or epinephrine HCI (5.0 μg/kg), intraperitoneally, caused retrograde amnesia for a step-down inhibitory avoidance task in rats, and their pre-testing administration reversed this effect. The concomitant administration of the α₂-adrenergic receptor blocker, yohimbine HCl (2.0 mg/kg), antagonized both the post-training amnestic and the pre-testing anti-amnestic effects of the three substances. The anti-amnestic effect of epinephrine, but not that of ACTH or β-endorphin, was also antagonized by the α₁-adrenergic receptor blocker, prazosin HCl (2.0 mg/kg). These findings suggest that α₂-adrenergic receptors are involved both in the amnestic and in the anti-amnestic effect of ACTH, β-endorphin and epinephrine at the doses used, and that, in the case of the antiamnestic effect of epinephrine, α₁ receptors also are involved. It seems likely that memory regulation by post-training and pre-testing ACTH and β-endorphin requires the concomitant activity of α₂-adrenergic mechanisms, either central or peripheral.     

Comparative Human Oral Clinical Pharmacology of Cefadroxil, Cephalexin, and Cephradine

At equivalent oral doses, cefadroxil has a longer serum half-life, slower urinary excretion rate, greater area under the serum level versus time curve than cephalexin or cephradine, and peak serum concentrations that are 75 to 80% those of cephalexin. The calculated, apparent in vivo volume of distribution of cefadroxil is greater than that of cephalexin. These properties infer greater persistence of cefadroxil in serum and urine and more prolonged in vivo bacterial exposure to cefadroxil than to cephalexin or cephradine. Neither cefadroxil nor cephalexin demonstrates drug accumulation on repeated administration. The serum levels achieved by cefadroxil are unaffected by food. The pharmacokinetic properties of cefadroxil are supportive of the development of clinical efficacy data which could indicate that cefadroxil could be administered at 12-h intervals.     

Experimental comparative study of surgical and needle biopsies of the testis.

Testis biopsy was performed on 78 rats in order to compare needle and surgical biopsies. The rats were autopsied 7, 15, 30, 60, and 90 days after biopsy. Both techniques provided tissue of equally good quality for histopathological examination and led to irreversible hypospermatogenesis of the biopsied and the contralateral testes.     

MRI in the early detection of breast cancer in women with high genetic risk

AIMS AND BACKGROUND: Women with BRCA1 or BRCA2 germline mutations have an elevated risk of developing breast and/or ovarian cancer. Because of the early onset of the disease, screening of this group of women should start at an earlier age than in the general population. The association of breast magnetic resonance imaging (BMRI) and ultrasonography (US) with mammography (MX) and clinical breast examination (CBE) in the regular surveillance of these individuals has been proposed and seems to improve the early detection of breast cancer. METHODS: Within a multicenter study started by the Istituto Superiore di Sanità (Rome), at the Istituto Nazionale Tumori of Milan (INT) we enrolled 116 women at high genetic risk for breast cancer; they were either BRCA1 or BRCA2 mutation carriers or had a strong family history of breast cancer. They underwent CBE, MX, US and BMRI once a year. RESULTS: Between June 2000 and April 2005, at INT 12 cancers were detected among the 116 screened individuals (10%). In this subgroup, 1 patient refused BMRI and in 2 cases US was not performed. With BMRI we found 11 cancers and 6 of them were detectable only by this technique. In these 6 cases, the size of the disease was less than 1 cm and MX was false negative due to irregularly nodular parenchyma in 4 cases and scar tissue or prosthesis in the other 2. US was not performed in 2 cases and was false negative in 4 cases. Three false positive results were found with BMRI: 1 case was considered suspect but related to hormonal influences; 1 case with the same pattern was sent for second-look US, which gave a negative result and BMRI review after 6 months showed normalization of the parenchyma; in the third case histology revealed the presence of adenosis. No false positive results were registered for MX. CONCLUSIONS: The aim of secondary prevention is the detection of cancer at its earliest stage. BMRI screening in women with BRCA1 or BRCA2 mutations or at high familiar risk appears to be highly sensitive and may detect mammographically occult disease. The accuracy of MR imaging is higher than that of conventional imaging but the technique is flawed by a lower specificity. In order to avoid unnecessary biopsies we believe that the combination of BMRI and conventional imaging can be very useful in screening women with a high genetic risk of breast cancer, especially with second-look evaluation by means of US when BMRI yields the only positive diagnostic result. Second-look US has been demonstrated to be of critical importance both in recognizing false positive BMRI results and in guiding biopsies, when necessary.     

Validity of self-reported smoking status among participants in a lung cancer screening trial.

Lung cancer remains a devastating disease associated with substantial morbidity and mortality. Recent research has suggested that lung cancer screening with spiral computed tomography scans might reduce lung cancer mortality. Studies of lung cancer screening have also suggested that significant numbers of participants quit smoking after screening. However, most have relied solely on self-reported smoking behavior, which may be less accurate among participants in lung cancer screening. To assess the validity of self-reported smoking status among participants in a lung cancer screening trial, this study compared self-reported smoking status against urinary cotinine levels. The sample included 55 consecutive participants enrolled in a randomized clinical trial comparing annual spiral computed tomography and chest X-ray for lung cancer screening. Participants were a mean of 59 years of age and predominantly Caucasian (96%) and male (55%). Self-reported smoking status was assessed before and after participants learned of the purpose of the biochemical verification study. Using urinary cotinine as the "gold standard," the sensitivity and specificity of self-reported smoking status were 91% and 95%, respectively (kappa = 0.85, P < 0.001, 95% confidence interval = 0.71-0.99). Total misclassification rate was 7%. However, three of the four misclassified participants reported concurrent use of nicotine replacement strategies. Eliminating these cases from the analysis revealed sensitivity of 100% and specificity of 95% (kappa = 0.96, P < 0.001, 95% confidence interval = 0.88-1.00). In conclusion, self-reported smoking status among participants in a lung cancer screening trial was highly consistent with urinary cotinine test results.     

Antidepressants and dizziness

Despite several evidences supporting a close relationship between dizziness and anxiety symptoms, the role of antidepressants in the treatment of such conditions remains poorly explored. The high prevalence of dizziness during serotonin reuptake inhibitors discontinuation syndrome and the few reports suggesting efficacy of antidepressants in treating some vestibular disorders justify a careful investigation. Neurophysiologic studies suggest possible focus of investigation on mechanisms of drug action. Psychophysiologic studies also suggest a possible role of antidepressant drugs in improving balance control and cognitive functioning. Controlled studies involving antidepressants with selective action in different neurotransmitters systems are necessary to elucidate the complex pathophysiologic mechanisms involving emotional and balance control. For future researches, special attention must be paid to the methodology of balance evaluation and the interaction between posture control and cognitive functioning.