Efficacy and safety of 5% lidocaine-medicated plasters in localized pain with neuropathic and/or inflammatory characteristics: an observational, real-world study.

OBJECTIVE: Based on clinical study results, 5% lidocaine-medicated plaster (5% LMP) is currently recommended for the treatment of localized peripheral neuropathic pain, such as post-herpetic neuralgia (PHN). However, its effective action, as well as the high safety, have indeed led to its use in clinical practice for pain conditions with similar pathophysiological mechanisms. In this study, the efficacy and safety of 5% LMP were investigated in patients with localized pain with neuropathic and/or inflammatory characteristics, such as PHN, post-traumatic/surgical or musculoskeletal pain. PATIENTS AND METHODS: 503 patients with localized pain treated with 5% LMP were evaluated at baseline (T0), after 30 days (T30) and after 60 days (T60). The primary endpoint was number and proportion of 30% responders at T60, whereas secondary endpoints included number and proportion of 30% responders at T30, mean pain intensity, mean extension of the painful area, dynamic mechanical allodynia and quality of sleep. Evaluations were assessed in all patients and subgroups based on different clinical entities. Concomitant treatments and adverse reactions were also recorded. RESULTS: 72% and 90% of all patients responded to 5% LMP treatment at T30 and T60, respectively. Comparable results were also obtained in subgroups such as PHN patients (72% and 68% at T30 and T60, respectively), and musculoskeletal pain (73% and 83% at T30 and T60, respectively). The mean pain intensity, as well as the extension of the painful area, significantly decreased during the study, in all patients and each subgroup. In addition, secondary endpoints significantly improved at each time-point compared with baseline, in all groups. CONCLUSIONS: The effectiveness and safety of 5% LMP were shown in localized pain conditions such as neuropathic and, importantly, in musculoskeletal pain, a condition never investigated with this product. This field-practice study suggests that topical pain-reducing strategies such as 5% LMP could be effective in neuropathic and/or inflammatory, localized pain conditions.

Characterization of five tomato phospholipase D cDNAs: rapid and specific expression of LePLDbeta1 on elicitation with xylanase.

Phospholipase D (PLD, EC 3.1.4.4.) has been implicated in a variety of plant processes, including signalling. In Arabidopsis thaliana a PLD gene family has been described and individual members classified into alpha-, beta- and gamma-classes. Here we describe a second PLD gene family in tomato (Lycopersicon esculentum) that includes three alpha- and two beta-classes. Different expression patterns in plant organs were observed for each PLD. In testing a variety of stress treatments on tomato cell suspensions, PLDbeta1 mRNA was found to rapidly and specifically accumulate in response to the fungal elicitor xylanase. The greatest increase was found 2 h after treatment with 100 microg m1(-1) xylanase (ninefold). In vivo PLD activity increased nearly threefold over a 1.5 h period of treatment. When the elicitor was injected into tomato leaves, PLDbeta1 mRNA accumulation peaked at 2 h (threefold increase), before decreasing to background levels within 72 h. Mutant, non-active xylanase was as effective as the active enzyme in eliciting a response, suggesting that xylanase itself, and not the products resulting from its activity, functioned as an elicitor. When chitotetraose was used as elicitor, no PLDbeta1 mRNA accumulation was observed, thus it is not a general response to elicitation. Together these data show that PLD genes are differentially regulated, reflecting potential differences in cellular function. The possibility that PLDbeta1 is a signalling enzyme is discussed.

The hemostatic balance after plasma-exchange transfusion in myasthenia Gravis.

BACKGROUND: To study the effects of plasma-exchange on removal and recovery of haemostatic factors and inhibitors using albumin or PPS as replacement fluid. DESIGN: Prospective, noninterventional study. SETTING: Medical intensive care unit of a university hospital. PATIENTS: The study included 11 consecutive patients with Myasthenia Gravis, whose haemostatic parameters were normal before plasma-exchange. INTERVENTIONS: Plasma coagulative factors and inhibitors were studied before at the end of and 24 hours after each exchange. RESULTS: Immediately after exchange plasma coagulation factors and inhibitors evaluated were reduced, except for factor VIII; 24 hours later only fibrinogen was significantly decreased; D-Dimer was not found increased; the platelets, after exchange, were at normal levels. CONCLUSIONS: Our data show a parallel lowering of haemostatic factors and inhibitors after plasmapheresis using material devoid of coagulation factors as replacement, this explains the absence of hemorrhagic or thrombotic complications. So we think that careful monitoring of coagulation during plasma-exchange is not useful.

[Adaptation to effort myocardial ischemia]. / Adattamento all'ischemia miocardica da sforzo.

BACKGROUND: During PTCA it has been observed that in two sequential coronary occlusions, the second is characterized by less subjective anginal discomfort, less ST segment depression, less myocardial lactate production and lower mean pulmonary pressure than that recorded during the first inflation. The phenomenon is known as "cardiac adaptation to ischemia". PTCA, as a model for controlled, reversible myocardial ischemia must be viewed in a substantially different context from other models concerning different types of ischemia. The purpose of our investigation was to examine the hypothesis that phenomena similar to those observed during PTCA can occur during effort ischemia. METHODS: Six patients with stable effort ischemia, fixed ischemic threshold (bpm x mmHg variability less than 3200) and fixed recovery period (variability of time at ST on isoelectric line less than 1 min and variability of rate-pressure product at ST on isoelectric line less than 2000 bpm x mmHg) were studied. Our aim was to study the ischemic threshold (IT) and the recovery period in an exercise test performed a short time after an initial one. The programme consisted of: 1) exercise test at a fixed load (the load was predetermined by the level of ischemia reached in a previous multistage exercise test); 2) exercise test ending at ST decreases 1 mm; 3) recovery period; 4) 2nd exercise test similar to the first one and ending at ST decreases 1 mm, to be performed 3 minutes after the end of recovery period (that is, 3 minutes after ST on isoelectric line). In both exercise tests we registered rate-pressure product at ischemia (RPPI), time to ischemia (TI), rate-pressure product at ST on isoelectric line (rate-pressure product at normalization: RPPN) and time at ST on isoelectric line (time of normalization: TN). RESULTS: [table: see text] In all pts RPPI in the second exercise test was similar to RPPI registered in the first one, while RPPN in the second exercise test was higher than in the first. In the second exercise test, time to ST on isoelectric line was also shorter. CONCLUSIONS: We think that the shorter recovery period from myocardial ischemia in the second exercise test may be an expression of a "cardiac adaptation to ischemia", a phenomenon which has been previously observed during PTCA.

[Myocardial ischemia induced by exercise. Analysis of the recovery phase. Behavior of the rate-pressure normalization product in patients with fixed ischemic threshold and patients with variable ischemic threshold]. / Studio dell'ischemia miocardia indotta dallo sforzo. Analisi della fase di recupero. Comportamento del doppio prodotto di normalizzazione nei pazienti con soglia ischemica variabile e nei pazienti con soglia ischemica fissa.

Traditionally, in patients with exercise-induced myocardial ischemia we analyze the stress-test by studying the behaviour of double product at ischemia. We recognize the presence of a functional component in the reduction of coronary-flow reserve if the double product at ischemia (DPI) varies in 3 stress-tests i.e. more than 20% or more than 3200 mmHg b m'-1. Any analysis that relies exclusively on double product at ischemia is, of necessity, limited to the beginning of the ischemic phenomenon. To better understand the development of the whole event, we also considered the double product calculated when the ischemic electrocardiographic signal regressed (double product of normalization: DPN). More specifically, we set out to determine whether or not double product at ischemia behaviour in patients with variable ischemic threshold (i.e. double product at ischemia variation greater than 3200 mmHg b m'-1) differs from that of patients with fixed ischemic threshold (i.e. double product at ischemia variation less than b m'-1). We performed four multistage bicycle ergometer tests, without drugs, on 19 patients with chronic exertional anginal and exercise-induced ST depression. Patients were tested at the same time of day, within a 10 day period. In the second, third and fourth stress test double product at ischemia was calculated. On the basis of double product at ischemia values in three stress-tests, we distinguished two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Chronobiological study of ischemic attacks in angina pectoris at rest]. / Studio cronobiologico degli attacchi ischemici nell'angina a riposo.

The aims of this study were to determine if the hourly distribution of ischaemic episodes differed as regards ST segment elevation or ST segment depression during ischaemic attacks and differed as regards the degree of coronary atherosclerotic involvement. Twenty-four in-patient drug free subjects with angina at rest underwent ECG continuous Holter monitoring for periods varying from 24 to 168 hours. Four groups of patients were identified: group 1A: 6 patients with ST elevation and 0-1 vessel disease; group 1B: 6 patients with ST elevation and 2-3 vessel disease; group 2A: 3 patients with ST depression and 0-1 vessel disease; group 2B: 9 patients with ST depression and 2-3 vessel disease. During Holter monitoring, 301 ischaemic episodes were registered in group 1A during 576 hours; 173 episodes were registered in group 1B during 624 hours; 41 episodes were registered in group 2B during 528 hours. Using the single and population mean cosinor tests on the episodes of each group, considered as a whole, the following results were found: group 1A showed a circadian rhythm with acrophase at 4:03 a.m. (Fig. 2), group 1B showed a circadian rhythm with acrophase at 10:51 a.m. (Fig. 3), group 2A showed a circadian rhythm with acrophase at 11:15 p.m. (Fig. 5), while group 2B showed ultradian rhythms which lasted 7 and 13 hours (Fig. 6). The chronobiologic analysis of the distribution of the ischaemic attacks confirmed the existence of a circadian rhythm of ischaemic episodes in patients with ST elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Trinitroglycerin and controlled hypotension in microsurgery of the middle ear]. / Trinitroglicerina ed ipotensione controllata nella microchirurgia dell'orecchio medio.

A method to reduce blood pressure for helping middle ear peculiar surgery was evaluated in this study. TNT administered in slow intravenous drip, in association with NLA, permitted to obtain a quick and well controlled hypotension without the incidence of significant adverse reactions.

[Comparison of the effects of 2 anesthesiologic technics on hemostasis]. / Confronto degli effetti di due tecniche anestesiologiche sull'emostasi.

Results of hemocoagulation test in anesthesia performed upon 17 patients treated with Ethrane and 17 treated with NLA are reported in this paper. Normotest, Thrombotest and PTT are within normal limits. The two groups studied, however, showed a drop in the percentages of the Normotest and Thrombotest and a reduced PTT. Differences in base values (pre-operatory) and those on the first post-operatory day were calculated for each of the two groups of patients. No statistically significant variations were noted comparing these with the Student T test. Our results, as well as those of other authors, show that NLA and Ethrane do not clinically alter patient hemostasis. Considering that no significant bleeding was noted during surgery, we have arrived at the conclusion that these two anesthetic agents have a stabilizing effect on organic homeostasis, in emergency cases, thus protecting the hemostatic equilibrium.

[Drug therapy and enteral hyperalimentation in the prevention of stress ulcer in intensive therapy]. / Trattamento farmacologico ed alimentazione enterale nella prevenzione dell'ulcera da stress in terapia intensiva.

Stress ulcer is one of the risks to which patients undergoing intensive therapy are exposed. In an attempt to gain further knowledge on the ways and means of preventing this complication, a comparison was made of a selective treatment using drugs with a specific action on the gastric mucosa in a series of 20 cases. The clinical course was compared with that observed in 20 untreated patients. Drug management was associated with continuous and constant enteral alimentation to keep the activity of the digestive apparatus as physiological as possible.

[Paraquat poisoning. Clinical and anatomo-pathological aspects]. / Avvelenamento da Paraquat. Aspetti clinici ed anatomo-patologici.

Two cases of Paraquat poisoning of anticonservative origin are described. A brief account of the chemical composition and mechanism of action of Paraquat is followed by a discussion of the clinical and therapeutic features of the two cases. The anatomopathological findings obtained from lung specimens examined during necropsy are also described. Personal experience and the literature data are cited in an explanation of what is currently regarded as the most effective treatment protocol.

[Current treatment of tetanus patients in intensive therapy]. / Trattamento attuale del tetano in terapia intensiva.

A brief survey of recent criteria for evaluation of the seriousness of toxicity and infection in tetanus is followed by the examination of a series of cases of average severity. The method employed in their therapeutic management is described, and an account is given of its advantages and the possibility of complications. The mortality rate for the years 1974-1978 is also reported.