Use of pivagabine in the management of hospitalization distress in children.

A double-blind, placebo-controlled study was performed in order to evaluate the efficacy of pivagabine (4-[(2,2-dimethyl-1-oxopropyl)amino]butanoic acid, CAS 69542-93-4, Tonerg) on "distress" in children hospitalized for acute disorders. Ninety children (43 boys and 47 girls) aged between 2 and 13 years were randomly distributed into two groups of equal size. The first group was treated with 450-900 mg/d of pivagabine by oral route, whereas the second group was given identical quantities of placebo. Treatment was continued for 21 days, with a medical examination after 7 days and another at its termination. Diurnal behaviour, motor activity, attention, sleep disturbances (insomnia) and sleep characteristics and behaviour upon awakening were assessed during treatment by means of a semiquantitative rating scale. Pivagabine induced significantly greater improvement in all the items listed above as compared to the control group. In many cases complete remission of the symptoms of "distress" was recorded. The results obtained therefore confirm the hypothesis that pivagabine acts by intervening on the biochemical mechanisms that regulate the CNS adjustment response to stress. It is likely that the intervention consists in the inhibition of the release of hypothalamic corticotropin releasing factor.

[The surgery of pulmonary metastases. The surgical indications and technical aspects of lung resections for metastases]. / La chirurgia delle metastasi polmonari. Indicazioni operatorie e aspetti tecnici delle resezioni polmonari per metastasi.

Surgery for pulmonary metastases is an accepted method of treatment for many kinds of malignant neoplasms, because of favorable results in five-year and ten-year survival. At present several technical aspects are being debate (operative indications, method of thoracic access, procedure of lung resection, approach of bilateral lesions), with the aim of improving the number of patients undergoing radical excision of all pulmonary metastatic foci. The present paper summarizes a recent experience (1989-1992) in the treatment of pulmonary metastases in 55 patients, with special reference to tactical and technical problems related to metastasectomies. The primary tumor was an osteogenic sarcoma in 28 cases (51%), other musculoskeletal and soft tissue sarcoma in 20 (36%), and epithelial neoplasms in 7 (13%). In 47 patients (85%) the discovery of pulmonary metastases was metachronous regarding primary malignancy, with a range of between 3 months and 17 years; in the other 8, lung disease was simultaneous with diagnosis of neoplasm. All patients underwent preoperative standard chest X-ray, thoracic computerized tomography and lung function assessment; the radical control of primary neoplasm and the absence of any extrapulmonary metastases were required for thoracotomy. Pulmonary nodules were single in 21 patients (38%), multiple ipsilateral in 16 (29) and bilateral in 18 (33%). The thoracic approach was a muscle-sparing thoracotomy (axillary vertical thoracotomy) in 51 patients, other thoracotomies in 3 and a median sternotomy in 1 patient. The operative procedures were 19 single wedge resections (35%), 27 multiple wedge resections (49%), 1 lobectomy (2%), 1 lingulectomy (2%) and finally 7 exploratory thoracotomies (12%) for different reasons. In patients with bilateral disease, a bilateral synchronous thoracotomy and multiple wedge resection was performed 13 times, while staged thoracotomy was necessary in 2 and a median sternotomy was preferred in 1 case; 2 patients received a monolateral axillary exploratory thoracotomy. A total of 186 lung nodules were excised, but only in 161 (86%) the histologic examination confirm the metastasis. There was no operative mortality and the postoperative complications were few. Based on this experience, the authors believe that every neoplastic patient with pulmonary metastases, certain or suspected, should be considered for thoracotomy, since metastasectomy is a very safe procedure today.(ABSTRACT TRUNCATED AT 400 WORDS)

[Axillary thoracotomy: a simple and conservative approach to the thoracic cavity]. / La toracotomia ascellare: un accesso semplice e conservativo al cavo toracico.

Morelli and Di Paola's thoracotomy allows to approach the pleural space with the only osteo-muscular sparing without any section of chest wall structures. With this kind of approach that we have been employing since twenty years, we report our experience about 82 cases recently operated on for both pulmonary and mediastinal disease. Unlike who don't consider this approach to allow adequate exposure of all endothoracic anatomic structures, it is our opinion that this thoracotomy not only allows every kind of operation in thoracic surgery, but is easy to perform and fast to repair. Moreover, postoperative pain is decreased, functional recovery is improved and patient can frequently be discharged earlier from the hospital with a very satisfactory aesthetic result.

[Adenocarcinoma of the distal ileal loop: a rare disease at the typical site for Crohn's disease]. / L'adenocarcinoma dell'ultima ansa ileale: una malattia rara nella sede tipica del morbo di Crohn.

The authors report their recent experience in the treatment of two patients respectively affected by Crohn's disease and adenocarcinoma of the terminal ileum. Although with some differences, they presented with radiological, pathological and gross morphological findings quite similar so that the authors concluded for a different clinical stage of Crohn's disease in both cases. Frozen-section examination carried out in one of the two cases, established the correct diagnosis and indicated a wide resection instead of a very limited one. An extremely rare case of primitive adenocarcinoma of the terminal ileum is presented and the literature is reviewed. Features which could help the differential diagnosis between malignant lesions and regional enteritis are therefore focused.

Clinical results of lumbar sympathectomy alone or as a complement of direct arterial surgery.

Six hundred and eighty patients underwent conservative surgery for chronic obliterative arterial disease of the lower limbs during a 15 year period ranging from 1960 to 1974. Two hundred and fifty-three lumbar sympathectomy were performed in 240 patients, 339 patients had direct surgery and in 133 cases lumbar sympathectomy was added to direct surgery. From this experience the authors conclude: 1. Lumbar sympathectomy has a low mortality rate (3 deaths or 1.18%) and no important after effects: in particular no sexual problems are reported. 2. Lumbar sympathectomy for intermittent claudication seems to be useful since it apparently improves symptoms and prognosis of the operated leg. 3. Lumbar sympathectomy for rest pains or necrosis can be useful in 1/3 of the patients with proximal arterial lesions and in 2/3 of the patients with only peripheral lesions. 4. Lumbar sympathectomy should always be added to direct arterial surgery above the inguinal ligament since it improves the patency rate of arterial reconstruction without increasing the operative risk.