Posatirelin for the treatment of degenerative and vascular dementia: results of explanatory and pragmatic efficacy analyses.

In order to confirm the efficacy and safety of posatirelin (L-pyro-2-aminoadipyl-L-leucyl-L-prolinamide), a synthetic peptide having cholinergic, catecholaminergic and neurotrophic activities, a multicentre, double-blind, controlled study versus placebo was planned in elderly patients suffering from Alzheimer's disease and vascular dementia, according to National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria, respectively. The trial consisted of a 2-week run-in phase with placebo administered once a day orally, followed by a double-blind period of 3 months, with posatirelin or placebo administered once a day intramuscularly. Efficacy was assessed using the Gottfries-Bråne-Steen (GBS) Rating Scale (primary variable) and the Rey Memory Test (secondary variable). Laboratory tests, vital signs and adverse events were monitored. A total of 360 patients were randomized, the intent-to-treat sample (ITT) being made up of 357 patients and the per protocol sample (PP) of 260 patients. Both pragmatic and explanatory analyses showed significant differences between treatment groups in the GBS Rating Scale and the Rey Memory Test, with no difference in the two types of dementia. No difference between treatments was observed in safety variables, the incidence of adverse events in the posatirelin group being 7.3%. The study confirms previous results showing that treatment with posatirelin can improve cognitive and functional abilities of patients suffering from degenerative or vascular dementia.

Early diagnosis of deep vein thrombosis following total hip replacement using impedance plethysmography: advantages and limitations of this approach.

Early diagnosis of deep vein thrombosis (DVT) following total hip replacement is of fundamental importance given the particularly high incidence of thromboembolic complications and the limited effectiveness of available preventive measures. The authors report the results of postoperative monitoring of the lower limbs using impedance plethysmography (IPG). The validity of the computerized plethysmograph used in this study has been confirmed by previous clinical studies, in which this instrument demonstrated high sensitivity and specificity of diagnosis of deep vein thrombosis in the symptomatic patient. In the present study, however, the instrument is applied to a group of mostly asymptomatic patients, many of whom have non-occlusive DVT. One hundred thirty-two patients underwent IPG both one the day before surgery and on the seventh day after surgery. The postoperative IPG was positive in seven asymptomatic patients (5.3%). Proximal DVT was confirmed by phlebography in five patients (3.7%) and found to be absent in two patients (false positives: 1.5%), for a positive predictive value of 71%. IPG also found proximal DVT to be absent in three patients with postoperative signs and/or symptoms compatible with a thrombotic complication in the lower limbs. The character of the study did not permit collection of data as to IPG sensitivity in the asymptomatic patient, which is presumably quite lower than in the symptomatic patient. Therefore, phlebography remains the most reliable test for diagnosis of asymptomatic DVT. However, systematic monitoring by phlebography is not feasible for logistic, economic, and ethical reasons. Postoperative use of IPG may at least partially reduce the risks connected with thromboembolic complications.

[Echography in the diagnosis of breast cancer]. / L'ecografia nella diagnosi del cancro mammario.

Fifty-one patients with clinically palpable breast cancer were examined using small-parts echotomography. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of overall diagnosis were assessed in the two groups of patients: T1 (diameter less than 2 cm) and T2-T3-T4 (diameter greater than 2 cm). The frequency of the main echographic signs associated with breast cancer was also investigated. Diagnostic accuracy was found to be high in the T2-T3-T4 group (93%), but very low in the T1 group (71%). The study confirms the importance of ultrasound as an additional test in the study of breast cancer. However, this method becomes increasingly less sensitive and specific as the size of the tumour decreases.

[Diagnosis of breast carcinoma. Comparison of clinical, mammographic, echographic and cytological aspiration diagnosis in a group of 50 patients]. / Diagnosi del carcinoma mammario. Confronto tra esame clinico, mammografico, ecografico e citoaspirato in un gruppo di 50 pazienti.

The study assesses the sensitivity of clinical, mammographic, echographic and needle biopsy tests in a sample group of 50 women some of whom were examined and operated by the Surgical Division of Casalpusterlengo Hospital, whereas others were examined and operated at Crema Hospital. Data were compared with those from larger studies recently reported in the literature. Patients had a minimum age of 42 years and a mean age of 64.3 years; all were symptomatic. Clinical examination, mammography and echotomography showed an increased sensitivity in parallel with the increased size of tumour and the patient's age. The sensitivity of mammography in T1 cases was higher than that of clinical examination and ultrasound tests. Diagnosis was made on cytological grounds alone in 2% of cases, but was negative in 14% (benign/inadequate sample) in spite of the presence of a positive clinical examination and mammography. A 90.4% sensitivity rate was achieved using a combined clinical examination and mammography.

[The efficacy of echography in the diagnosis of gallbladder carcinoma]. / Utilità dell'ecografia nella diagnosi del carcinoma della colecisti.

The preoperative diagnosis of carcinoma of the gallbladder is very difficult because the clinical manifestations of this disease are nonspecific and often indistinguishable from those of cholecystitis. Radiography, including oral cholecystograms and i.v. cholangiograms, give aspecific findings. Ultrasound scans were performed on 13 gallbladder carcinomas: only "massive" cancer was diagnosed correctly, because sonography does not offer specific patterns for "infiltrating" and "fungating" carcinomas.

[Subarachnoid hemorrhage caused by cerebral arteriovenous malformations. Importance of neuroradiological studies]. / Emorragia subaracnoidea da rottura di MAV cerebrale. Apporto delle indagini neuroradiologiche.

The role of skull X-rays, CT scan with and without intravenous contrast enhancement, angiography, digital subtraction angiography and magnetic resonance imaging in the morphological and topographical evaluation of arteriovenous malformation are analyzed and discussed. The literature on this subject is critically reviewed. Venous angioma, cavernoma, dural fistula and arteriovenous malformation with no angiographical evidence, are examined with special attention.

Primary leiomyosarcoma of the lung in a girl.

Leiomyosarcoma of the lung is a type of tumour rarely found in childhood. It arises from smooth muscle either of bronchial or arterial walls, has a variable pattern of local growth, blood-borne metastatic spread with lymph nodes sparing and a clinical course characterized by fever, cough and worsening dyspnea. We report a case which occurred in a 14-year-old girl, reviewing all the other cases found in the literature.

[About three cases of median nerve compression inside the carpal tunnel (author's transl)]. / Trois cas rares de compression du nerf médian dans le canal carpien.

The authors report about three cases of median nerve compression inside the carpal tunnel; they were caused by tendons or anomalous muscular bellies of the Palmaris Longus. The first two cases consider the anomalies of the distal insertion of the muscle, the third a volume anomaly; the first two findings allow to recall the hypothesis of a common philogenetic origin of the palmar aponeurosis and the Palmaris Longus.

[Mondor's disease. Considerations on 5 cases]. / La malattia di Mondor. Considerazioni su chinque casi.

The clinical, anatomical, topographical and pathological features of Mondor's disease are described, and five personal cases are presented. Their aetiopathogenetic characteristics reflect the doubts expressed in the literature. Stress is laid on the benign nature of the disease, the possibility of treating it at the out-patient level, and the complete remission of both subjective and objective symptoms obtainable in the space of a few weeks.

[Morgagni-Larrey hernia (2 personal cases)]. / L'ernia di Morgagni-Larrey. (Due osservazioni personali).

Morgagni-Larrey hernia is a rare diaphragmatic form whose time of onset is almost impossible to determine. Its symptoms, if any, are not easy to interpret. A standing X-ray of the chest is the only way in which its presence may be suspected and diagnosis must be confirmed by the use of contrast media. Abdominal or thoracic surgery is mandatory, even in symptom-free cases. The choice of route will be determined by the facts of the case and the patient's age. The clinical picture observed in two personal cases and their treatment are described.