[The general practitioner faced with the choice of hospitalization: an analysis of the data from the Follow-Up System computerized network]. / Il medico di medicina generale di fronte alla scelta del ricovero: analisi dei dati della Rete informatizzata "Follow-Up System".

The Project "Informatization of the General Practitioner" aimed at networking the work stations of a randomized set of 150 general practitioners equipped with the "Follow-Up System" software, for the collection of information related to the activity carried out, to be electronically transferred to a central unit was developed in the frame of the finalized Project of the National Research Council: "Prevention and Control of the Disease Factors". During the project activity, a study on prescribed hospitalizations was carried out. The contents of items regarding hospitalization diagnosis show that diagnoses concerning diseases included in chapter ICD-9: "Symptoms, signs and morbid conditions not well defined" represent 30.3% of the total; most of these undefined syndromes can be identified under the item "abdominal pain" with 18.2% of cases. Obviously in the case of appendicitis (12.1% of hospitalizations) the hospitalization carried out by the physician resulted to be necessary, in the case of biliary lithiasis (8 cases, 7.4%), the physician could have treated the patient without hospitalization. The interest of such data is to induce a sort of provocation in order to observe, within 8% of hospitalizations following abdominal pain, what rate of hospitalization could be avoided, giving the adequate support to the general practitioner in order to decide the behaviour to have.

A sentinel network of general practitioners for epidemiologic surveillance in Italy.

A Computer Network of General Practitioners (GP's) has been established connecting 110 general practitioners representing a statistically selected national sample, homogeneously distributed all over Italy. The purpose of the network is to increase the epidemiologic surveillance on the health status of the Italian community, to collect useful data on the routine activity of the GP's, to promote computer use among them, and to organize some "ad hoc" investigations on specific subjects (case-control studies). To this purpose, a specific software was developed both to meet the requirements of epidemiological research and to manage general practitioners' clinical files. A working prototype of health card using micro-computer technology is also being experimented on a subset of the GP's.

Effects of cisapride on parameters of oesophageal motility and on the prolonged intraoesophageal pH test in infants with gastro-oesophageal reflux disease.

The effect of cisapride, a new gastrointestinal prokinetic drug, on oesophageal motility and acid reflux was studied in 14 children with gastro-oesophageal reflux disease, receiving either placebo or cisapride 0.15 mg/kg intravenously. Cisapride significantly (p less than 0.01) increased the lower oesophageal sphincter pressure (+124%), the amplitude (+84%) and duration (+24%) of oesophageal peristaltic waves, whereas the placebo treatment did not produce any changes. Subsequently, all 14 children underwent 24 hour oesophageal pH-monitoring before and after four weeks of treatment with oral cisapride 0.2 mg/kg tid given in addition to postural therapy and thickened feedings. The 24 hour intraoesophageal pH recordings and symptomatic scores were compared with those of 10 control patients treated only by postural therapy and thickened feedings. When compared with baseline pH data, cisapride significantly reduced the oesophageal acid exposure time, the mean duration of each reflux episode, the duration of the longest reflux episode and the number of long lasting reflux episodes; the number of reflux episodes was not influenced. The effect of cisapride was marked and consistent during fasting and sleep periods. Oesophageal acid exposure was reduced more significantly in patients given cisapride (-61%) than in controls (-24%; p less than 0.001). Symptom improvement was greater after four weeks of cisapride treatment (score reduction: 61%) than after postural and dietary therapy alone (score reduction: 42%; p less than 0.01). No adverse effects occurred. These findings suggest that cisapride is a valuable drug in the management of gastro-oesophageal reflux disease in children.

Cisapride for gastro-oesophageal reflux and peptic oesophagitis.

Twenty children (age range 75 days-47 months) with reflux oesophagitis entered a random double blind trial in which they received either Cisapride (Janssen Pharmaceutical Ltd), a new prokinetic agent, or an identical placebo syrup. Diagnosis of gastro-oesophageal reflux was made by measurement of intraluminal oesophageal pH combined with manometry. Oesophagitis was assessed in all patients by histological examination of mucosal specimens taken during oesophagogastroduodenoscopy. Manometry, pH test, and endoscopy with biopsy examination were repeated at the end of the treatment period. Seventeen patients completed the trial, eight of whom were taking the drug and nine the placebo. Mean total clinical score and post-prandial reflux time (% of reflux) significantly improved in patients in the group given Cisapride but not in the group given placebo. Furthermore, there was a significant improvement of the histological oesophagitis score only in the children in the group given Cisapride, whereas placebo was ineffective. It is concluded that Cisapride is a useful agent both for the relief of symptoms of gastro-oesophageal reflux and for the healing of peptic oesophagitis in infancy.

Effect of cisapride on human fasting gallbladder volume: a real-time ultrasonographic study.

The effect of cisapride, a new non-antidopaminergic agent, on human gallbladder volume has been studied in nine normal subjects. In a double-blind crossover fashion, each subject was given a slow i.v. injection of cisapride and placebo after 12-h fasting. Gallbladder volume was monitored every 15 min for 90 min by real-time ultrasonography. After cisapride, gallbladder volume significantly diminished, with a mean reduction of 22.9 +/- 5%, observed 30 min after injection, whereas no significant changes were noted after placebo. A cholinergic mechanism is proposed to explain the effect of cisapride on gallbladder volume.

[Effect of azathioprine and inosiplex on rosette formation by lymphocytes from normal donors and from patients with neoplasia (author's transl)]. / Effetto dell'azatioprina e dell'inosiplex sulla formazione di rosette da parte dei linfociti di soggetti sani e di pazienti con neoplasie.

The effect of azathioprine and inosiplex on the capacity of peripheral blood lymphocytes to form E active rosettes has been studied in vitro on 25 healthy subjects and 63 cancer patients (27 with pulmonary cancer and 36 with cancer of the digestive tract). Azathioprine significantly inhibited the capacity of T cells obtained from normal donors to form rosettes (P less than 0.01). Similar results were registered in patients suffering from pulmonary cancer (P less than 0.01) or from digestive neoplasia (P less than 0.05). Inosiplex, a substance with antiviral and immunomodulating properties, increased the percentage of the E active rosettes forming cells of 18 subjects with lung carcinoma and 26 patients with cancer of the gastrointestinal apparatus. If lymphocytes of both normal donors and cancer patients were preincubated simultaneously with azathioprine and inosiplex, the latter had an inhibitory effect on the azathioprine dependent rosette inhibition and restored the percentage of the E active rosette forming cells to control values.

[Influence of antibiotics on leukocyte migration]. / Influenza degli antibiotici sulla migrazione leucocitaria.

Polymorphonuclear granulocytes play an important role in the immediate unspecific host response, and a depression of their functions can be found in many patients with severe or recurrent infections. Therefore administration of drugs causing such impairment in PMN function may be regarded as an additional risk for negative side effects to the patient. In our report the influence of 13 antibiotics--amphotericin B, ampicillin, tauglicolcillin, amoxicillin, cloxacillin, dicloxacillin, cephaloridine, cefalexin, cefuroxime, chloramphenicol, gentamicin, rifamycin, fosfomycin--on the granulocyte spontaneous and induced migration is investigated under in vitro experimental conditions. Human PMN preincubated with the antibiotics appropriately brought to the desired concentrations (therapeutic dose, 1/10 and 10X) in Hepes-Medium 199-water solution pH 7.2, were washed three times and tested for spontaneous and induced migration under agarose. Our experiments demonstrate that amphotericin B, cefalexin, cephaloridine, cefuroxime, chloramphenicol, dicloxacillin, gentamicin and rifamycin can inhibit in vitro human PMN chemotaxis and/or random migration. Inhibition of intracellular respiratory enzyme synthesis, presence of inactive metabolites of the drug, alterations of cyclic AMP and GMP or of the membrane bound divalent cations can be responsible of the phenomenon.