Oxcarbazepine is effective and safe in the treatment of neuropathic pain: pooled analysis of seven clinical studies.

The results of 7 open-label clinical studies on oxcarbazepine (OXC) in different neuropathic pain conditions, sharing the same protocols, were pooled together in order to evaluate whether the results obtained in the individual trials were confirmed in the pooled analysis of this larger sample, providing more evidence for efficacy and tolerability of OXC in these conditions. Eligible patients (>18 years old) with a diagnosis of neuropathic pain were enrolled in seven open-label trials, consisting of a one-week prospective Screening Phase followed by an eight-week Treatment Phase. Treatment with OXC was initiated at 150 mg/day, and the daily dose was increased by 150 mg/day on a 2-3 day basis to the maximum tolerated dose over four weeks, up to 1800 mg/day. The primary outcome measure was the change in the actual pain rating assessed on the visual analogue scale (VAS) between the end of the Screening Phase and the end of the Treatment Phase. One hundred and thirty-six patients were enrolled in the trials. The mean VAS score dropped from 77.13 at the end of the Screening Phase to 38.41 at the end of the trial for a mean reduction of 50.2%. The percentage of responders (mean VAS score reduction > or = 50%) was 49.2%. OXC was well tolerated, with the most common adverse events consisting of vertigo, tremor, somnolence, hypotension and nausea. The results of this analysis suggest that OXC administered as monotherapy is an efficacious and safe option for the symptomatic treatment of pain associated with neuropathies.

Discussion on the design of a hip joint simulator.

Hip joint simulators were developed for predicting, by attempting to duplicate in vitro physiological loads and motion, the wear rate that total hip replacements are likely to show in vivo. From a theoretical point of view, loading and motion cycles of hip joints could be closely reproduced by three rotation actuators and three force actuators. However existing devices have been designed assuming that some of these degrees of freedom are negligible, in order to reduce the complexity of the equipment. The present study singles out some preliminary indications on the design choices regarding the spatial configuration of loading and motion actuators. The aim is to define theoretically a simplified simulator but still able to apply the most physiologically realistic loading cycle to the specimen.

Felodipine in chronic stable angina: a randomized, double-blind, placebo-controlled, crossover study.

To investigate the antianginal efficacy and tolerability of felodipine, a new dihydropyridine calcium antagonist, 20 patients with stable exertional angina, not completely controlled by beta-blocker monotherapy, entered a randomized, double-blind, placebo-controlled, crossover study. Patients on standard beta-blocker therapy, who had at least 3 weekly anginal episodes and a reproducible exercise test (stopped for angina and ECG signs of ischaemia) at the end of 2 weeks placebo treatment, were eligible for the study. They were randomized to one sequence of treatment: felodipine 5 mg twice daily for 2 weeks followed by placebo for a further 2 weeks, or vice versa. Beta-blocker treatment was unchanged throughout the study. A treadmill test was carried out at the end of each crossover period, 2-4 h after drug administration. The number of anginal attacks and nitroglycerin consumption was recorded on a diary card. At rest, felodipine significantly (P less than 0.05) reduced standing systolic but not diastolic blood pressure. Heart rate was not modified by the active treatment. At ischaemic threshold and at peak exercise, heart rate, systolic blood pressure and rate-pressure product remained unchanged. Exercise duration was increased by felodipine (P less than 0.01) and maximal ST change was reduced (P less than 0.01). Time to 1 mm ST depression was prolonged non-significantly by felodipine (basal 5.7 +/- 1.5, felodipine 7.4 +/- 2.0, placebo 6.6 +/- 1.5 min). The number of patients who stopped exercise due to angina and ST change was 20/20 at baseline, 16/20 with placebo and 10/20 with felodipine. Felodipine significantly reduced weekly anginal episodes (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Andersson's phenomenon in HLA-B27 negative ankylosing spondylitis]. / Fenomeno di andersson in spondilite anchilosante HLA-B27 negativa.

A computed tomography (CT) and conventional radiography study is reported in a case of HLA-B27 negative ankylosing spondylitis. The value of CT in comparison with conventional radiography in evaluation of anatomic alterations is determined.

Felodipine ER formulation in the treatment of mild hypertension: efficacy and tolerability vs placebo.

1. Felodipine is a new calcium-antagonist dihydropyridine derivative with a high degree of selectivity for smooth muscle of arteriolar resistance vessels, as opposed to cardiac cells. 2. In this double-blind, cross-over study the antihypertensive efficacy and tolerability of the new extended release (ER) formulation of felodipine 10 mg, once daily, in patients with mild essential hypertension was evaluated. After a 4-week single-blind placebo period 28 patients (15 males; mean age 48 +/- 12 years) were randomized to receive felodipine 10 mg ER once daily or placebo for 4 weeks and the alternative treatment for a further 4 weeks. Supine blood pressure and heart rate were measured in the out-patients department every 2 weeks, 22-24 h after the last drug administration. 3. Felodipine 10 mg ER induced a significant reduction in blood pressure in comparison with placebo (from 149 +/- 16/97 +/- 6 to 140 +/- 12/89 +/- 6 mm Hg). Heart rate remained unchanged. Seven patients dropped-out; five during felodipine ER administration and two during placebo. 4. A once daily dose of felodipine ER significantly reduces blood pressure in mild hypertensive patients 22-24 h after administration. It is well tolerated and the adverse events are related to its pharmacodynamic effects.

Hemodynamic interactions between diuretics and calcium antagonists in the treatment of hypertensive patients.

To investigate the hypotensive and hemodynamic effects of plain and extended-release (ER) formulations of felodipine added to a diuretic in the treatment of moderate essential hypertension, we studied 18 patients in a randomized, double-blind, cross-over study. Blood pressure (BP), heart rate (HR), hemodynamics (bioimpedance), foot volume (Archimedes' principle), and symptoms were evaluated after a 1-month placebo washout, after 1-month's treatment with a fixed combination of hydrochlorothiazide 50 mg plus amiloride 5 mg (HA), and then after felodipine 5 mg twice daily (F) or felodipine ER 10 mg daily (FER) (double-blind phase), each given for 2 weeks in a randomized sequence together with the diuretic. All measurements were performed at the end of the dosing interval. At baseline, supine SBP/DBP was 175.6 +/- 12.9/113.4 +/- 8.1 mmHg; HR was 77.3 +/- 7.0 beats/min; CO was 5.3 +/- 1.4 l/min; SVR was 2166 +/- 707 dynes sec. cm5, and foot volume was 433 +/- 195 ml (FV). HA induced a reduction (p less than 0.05) in BP; one patient had a DBP = 90 mmHg and was excluded from the combination study; eight patients had a DBP reduction of greater than or equal to 10 mmHg (responders), and their blood pressure was mainly reduced by a fall in SVR. HR, CO, and FV were unchanged. The addition of felodipine to a diuretic induced a further significant (p less than 0.001) reduction in BP with respect to HA alone, with no differences between F and FER. All patients had a DBP fall greater than 10 mmHg, which had no relationship to their response to the diuretic.(ABSTRACT TRUNCATED AT 250 WORDS)

[Male transsexualism and hormonal therapy: radiologic pictures of the breast]. / Transessualismo maschile e terapia ormonale: quadri radiologici mammari.

Often the male transsexual takes hormonal drugs, sometimes under medical prescription but most frequently by his personal choice. They wish to obtain a development of mammary gland and the disappearance of hair from facial skin. Prolonged hormonal and incorrect treatments, mainly for too high dosage and absence of association with progesterone, assumption of oestrogens, can cause the growth of mammary tumours. The Authors present the results of a clinical and radiological study on 15 patients, 12 in treated with hormonal drugs for two years and 3 without any therapy.

[Radiologic evaluation of ileal reservoirs. Our experience]. / Valutazione radiologica dei reservoirs ileali. Nostra esperienza.

A radiological investigation was performed in 25 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. Radiology was of great value in the demonstration of post-operative complications.

[Asymptomatic, right reno-ureteral calculi in a cake kidney]. / Calcolosi reno-ureterale destra asintomatica in "rene a focaccia".

The primary caudal site of the urogenital anlage in the embryo explains why certain positional anomalies occur during cranial migration and are the outcome of various associated factors. A case of ectopic fusion in the ileo-sacral site known as cake kidney whose peculiarity consists of totally asymptomatic right multiple reno-ureteral lithiasis identified by chance is reported.

[Radiological characteristics of primary hyperoxaluria with oxalosis]. / Caratteristiche radiologiche della iperossaluria primitiva con ossalosi.

Oxalosis is a rare disorder, in which there are widely and evenly spread deposits of oxalate crystals in the kidneys with progressive renal failure. An inborn error of metabolism is the cause of oxalosis. The incidence of this disease in boys and girls is practically equal. Most patients do not survive their 20th year. In our case there were changes in the skeleton and extensive deposits of oxalates in the kidneys.

[Role of computerized tomography in Poland syndrome]. / Il ruolo della tomografia computerizzata nella sindrome di Poland.

A morphological CT study in Poland syndrome is presented. The osteomuscular anomalies of the chest, which are not demonstrated by usual x-Ray, are well defined by CT scans. The usefulness of CT in postoperative controls of muscles transfers is stressed.

[A rare case of sirenomelia. Possibility of prenatal ultrasonic and radiologic diagnosis]. / Un raro caso di sirenomelia. Possibilità di diagnosi ecografica e radiologica prenatale.

A rare case of sirenomelia malformation in a fetus of 33 weeks is reported. Besides typical fusion of the lower extremities, important alterations of the urogenital system and large intestine are present. A review of the literature on the subject is presented. The usefulness of ultrasonography in the prenatal diagnosis of this malformation is then stressed.

[Nontraumatic lesions of the knee revealed by standard radiographic examination]. / Le lesioni non traumatiche del ginocchio evidenziabili all'esame radiografico standard.

Examination of a series of knee arthrographies and CAT scans reveals the importance of certain signs of "lesions" that are revealed by simple standard radiography.

[Fibromatosis of the mesenterium]. / Fibromatosi del mesentere.

A rare case of mesenteric fibromatosis observed in a 58 year old woman, repeatedly operated in the abdominal area, with a mesogastric-hypochondriac hard-elastic mass, is presented. Being the cause of the affection still unknown, an abnormal proliferation of fibrous tissue induced from chemical-physical injuries is considered at the basis of the clinical entity.

Jargonagraphia: clinical and neuropsychological correlates.

Jargonagraphia (i.e., fluent, unintelligible writing with abundant paragraphias and preserved mechanics of writing) is considered to be an infrequent symptom of Wernicke's aphasia. Six cases fulfilling the definition of jargonagraphia were found in a retrospective series of 1076 consecutive aphasics and the neuropyschological and clinical correlates of this phenomenon were analysed. Jargonagraphia was not qualitatively uniform, and its appearance seems to be conditioned by the interaction of an increased "impulse to write" with disrupted language mechanisms.

Subcortical aphasia: two clinical-CT scan correlation studies.

Two clinical-CT scan studies were undertaken in order to investigate the frequency and the characteristics of aphasia following strictly subcortical left hemisphere lesions. In Study 1, all patients whose CT scan, carried out within a given period, showed subcortical lesions in both hemispheres, were evaluated for presence and type of aphasia; conversely, in Study 2 the records of all patients referred to our Aphasia Unit for language evaluation within a given period, were examined for presence of subcortical lesions on the CT scan. In Study 1 aphasia was found in two out of six patients. In Study 2 stabilized, strictly subcortical lesions of the left hemisphere were found in six out of 250 patients referred to the Aphasia Unit; 4 out of 6 were aphasics. Closer scrutiny of the type of language disorder in the aphasics from both studies (N = 6) suggests the possibility of differentiating two types of defect: an atypical non fluent aphasia, sometimes associated with anterior capsular-putaminal lesions, and a mild fluent aphasia, sometimes associated with posterior capsular-putaminal lesions.