Intrathecal baclofen therapy in patients with severe spasticity.

Spasticity has been described as "a motor disorder, characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex as one component of the upper motor neuron syndrome". In patients with complete spinal cord lesions, severe untreatable spasticity can make movement, sitting and hygiene difficult or impossible while it may alter gait and personal care in patients with partial lesions. From a clinical point of view, it is useful to distinguish spinal cord spasticity from supraspinal spasticity. Traditionally, the Ashworth scale is the most widely used to quantify the tone of single muscles. In order to quantify hypereflexia, the Reflex Scale is also used. In the spinal spasticity which is characterized by spasms, the Spasm Frequency Scale is useful in order to monitor their frequency. Initially, management of spasticity is based on non-invasive treatments that later become more invasive. The first approach. the conservative treatment, usually includes elimination of the nociceptive stimuli, rehabilitative therapy (physical and occupational), orthopaedic prostheses and plaster corsets. These treatments, do not resolve spasticity in about 33% of cases. In these severe cases, more invasive procedures such as muscle infiltrations with botulin toxin and intrathecal baclofen infusion can be used.

Lymph node micrometastases in patients with early gastric cancer: experience with 139 patients.

BACKGROUND: Although lymph node metastases in patients with early gastric cancer (EGC) is an important prognostic factor, the prognostic relevance of lymph node micrometastases is still uncertain. METHODS: The authors studied 1488 lymph nodes, which were histologically confirmed as pN0, dissected from 139 patients who were treated for EGC between 1976-1994. Micrometastases were defined as a single or small cluster of neoplastic cells identifiable only by immunohistochemical methods. RESULTS: Lymph node micrometastases was observed in 24 of the 139 patients (17%). No significant correlation was observed between micrometastases and other clinicopathological characteristics. Analysis of overall survival showed no significant difference between the micrometastases positive and negative groups. CONCLUSION: The results of our study show that the presence of lymph node micrometastases in EGC does not have an influence on patient prognosis.

[Indications and results of conservative treatment of closed trauma of the liver]. / Indicazioni e risultati del trattamento conservativo dei traumi chiusi del fegato.

During the last years, a marked change toward a more conservative approach in the treatment of abdominal trauma especially liver blunt trauma has been noted. The rationale for a conservative management is to avoid the operation or whenever this is not possible, to perform less extensive surgical resections. This approach, initially used in handling splenic trauma, is justified by the finding of spontaneous haemostasis in about half of liver injuries at the time of laparotomy. Moreover, the finding of an haemoperitoneum without signs of circulatory instability is not an absolute indication to laparotomy. In conclusion, the importance of CT and Ultrasonography in the selection of patients suitable for nonoperative treatment as well as in follow up studies is emphasized.

[Gastric volvulus. A clinical therapeutic contribution]. / Il volvolo gastrico. Contributo clinico-terapeutico.

Gastric volvulus is an infrequent event and few clinical cases are an important experience. Diagnosis, both clinical and radiological, is not difficult if you think of gastric volvulus; abdomen X-ray is often sufficient to clear up diagnostic doubts. First diagnosis can be quickly confirmed by X-ray examination of digestive organs that provides us with further information: contemporaneous ulcerative of neoplastic lesions, characteristics of bowels whirling round. Endoscopic and manometric evaluation must be performed only in recurrent or chronic cases, when there's no symptom of clinical urgency. Authors describe their experience of three cases observed in the last ten years and underline the importance of deciding and performing the surgical treatment quickly to avoid serious complications, in all doubtful cases. It is important to carry out an operation compared to the pathogenesis of volvulus: generally gastropexy is sufficient while radical operations are executed only in cae of gastric necrosis or in the presence of gastric neoplasms or ulcerative lesions.

An efficient method for culturing human breast carcinoma to evaluate antiblastic drug activity in vitro: experience on 136 primary cancers and on 116 recurrences.

The feasibility of techniques developed for isolating and culturing human mammary epithelial cells of malignant origin was confirmed in 136 primary breast cancers, 116 hypodermal metastases, and 8 metastatic lymph nodes. In 115 (84%) primary breast cancers and in 81 (70%) hypodermal recurrences we observed a good in vitro cellular proliferation. These proliferating cells, at the second passage, were used for a clonal assay suitable for quantitating drug sensitivity. With this clonal assay median cloning efficiencies of 14% and 6% were obtained respectively in primaries and in skin recurrences. We examined the in vitro response to different drugs and confirmed the test's ability to detect heterogeneity in response to same drugs (doxorubicin, 4'-epidoxorubicin, vinblastine, cis platinum, and idarubicinol) among the different breast carcinoma cultures as well as heterogeneity among subpopulations within a single carcinoma.

[Epidermoid cyst of the spleen. Presentation of a case]. / Cisti epidermoidale della milza. Presentazione di un caso.

Cystic lesions of the spleen are unusual. They are classified essentially as: parasitic or nonparasitic, based on their etiology, and true or pseudo based on the presence or absence of lining epithelium. The pathogenesis of true cysts is unknown and numerous hypotheses are given by different Authors. After a short review of the literature, the Authors describe the clinical and pathological data of a case of epithelial (epidermoid) splenic cyst occurs in a 12-year-old woman. The Authors put forward some personal observations on pathogenesis, still doubtful, by means of histochemical and immunohistochemical study.

Ossified epidural hematoma. Report of a case with epilepsy.

A case of post-traumatic ossified epidural hematoma associated to epileptic seizures is reported. After surgical treatment complete recovery was obtained.