[Clinical experience with alpha blockers and calcium antagonists in the perioperative treatment of pheochromocytoma]. / Esperienza clinica con alpha-bloccanti e calcioantagonisti nel trattamento perioperatorio del feocromocitoma.

This study aims to value the efficacy of the association between alpha-blockers and calcium channel-blockers, administered per os, in the reduction of preoperative preparation in patients with phaeochromocytoma and the calcium channel-blockers utility when are administered e.v. in the control of development of arterial paroxysmal hypertension during surgical manipulations. The trial had been conducted on 5 patients which have undergone the operation, before the operation we administered per os nifedipine and phonoxybenzamine for 8 days and during the operation we administered diltiazem e.v. The association between alpha-blockers and calcium-blockers per os, has reduced the preparation stage and has controlled the pressure parameters during the preoperative treatment. When we utilized diltiazem during the operation, we haven't note a good hemodynamic stability; these results are opposed to Tokioka's. Calcium channel-blockers and alpha-blockers seem to be a good therapy in the preoperative preparation of patients with phaeochromocytomas and they seem to be able to take fastly the standard of preoperative preparation.

Short-term preoperative treatment in a case of pheochromocytoma.

The authors show the case of a young drug addict patient with chronic hepatitis affected by pheochromocytoma, owing to his conditions, which was prepared preoperatively with a short term phenoxybenzamine i.v. We had no complications in the perioperative period. Our opinion is that it is possible, when necessary, to administer a short term therapy but this preparation isn't be considered a standard therapeutic program.

[Treatment of pheochromocytoma in children. Experience with 3 clinical cases]. / Trattamento del feocromocitoma in età pediatrica. Esperienza in tre casi clinici.

The authors report their own experience in three cases of paediatric phaeochromocytoma. Before surgery the patients received alpha-adrenergic blocking drugs; two of them also received calcium channels blocking drugs and in one of them was employed a beta-adrenergic blocking drug too. Before surgery the patients received blood and plasma expandera infusions for two weeks. Hypertension during surgery was treated with phentolamine infusion. The employment of an invasive haemodynamic monitoring was very important. The authors believe that such management, already employed in adult patients, is the best choice in paediatric patients too.

Balancing dental service requirements and supplies: the economic evidence.

A conceptual model of the market for dental services is described. The model is based on principles of demand and production theory and the applications of those principles to the dental industry. The model highlights the significance of relevant economic indicators which are discussed to create an awareness of and, when possible, explain the challenges awaiting dentistry in the decades to come. It is concluded that, while dental service expenditures per dentist are likely to increase, larger portions of the population may not be able to afford dental care if prices of dental services continue to increase faster than individual budgets.

Balancing dental service requirements and supplies: epidemiologic and demographic evidence.

As a counterpoint to negative interpretations of recent trends, this article presents a positive picture of dentistry in the 1990s and 21st century. Reported trends show large increases in older dentate adults who are retaining more of their natural dentition, new diagnosis and treatment technologies, increased incidence of dental caries in older adults, increased awareness of periodontal diseases, greater interest in esthetic dentistry, and generally higher expectations for health and fitness in our society. All of these factors point to a greater need for adult dental services. Therefore, in the next 30 years, the dental profession should be prepared to provide increased amounts of diagnostic, preventive, adult operative, fixed prosthodontic, and endodontic and orthodontic services. Declines in need should be expected in children's operative dentistry, extractions, and complete dentures.

[Difference between arterial pressure in clino- and orthostatism. A method for evaluating preparation for pheochromocytoma intervention]. / Differenza tra la pressione arteriosa in clino ed ortostatismo. Un metodo per la valutazione della preparazione all'intervento di feocromocitoma.

Four patients with pheochromocytoma underwent pre-surgical treatment with phenoxybenzamine and volemic expansion. The postural hypotension was evaluated by daily monitoring of the arterial pressure and heart rate in clino orthostatism. The patients underwent surgery and hemodynamic monitoring by Swan-Ganz catheter when postural hypotension was at the lowest level. Hemodynamic data were: elevated cardiac output, normal systemic vascular resistance and filling pressure. These results confirm that the orthostatic hypotension reduction is a valid indication to evaluate the effectiveness of the treatment period with phenoxybenzamine and volemic expansion.

Ultrastructural study of human adrenal pheochromocytoma by open needle biopsy.

Samples from eight cases of human adrenal pheochromocytoma were obtained using open needle biopsy and processed for electron microscopy. The good tissue preservation and the absence of mechanical damage allowed the confirmation of already described features of this differentiated tumor or of new findings. The presence of catecholamine granules in the pericapillar spaces and in the lumen of fenestrated capillaries was documented together with that of amyelinated nerve fibers surrounded by Schwann cells or in close contact with chromaffin cells.

[Criteria of evaluation of hemorrhagic portal hypertension and surgical indications]. / Criteri di valutazione nell'iperteso portale emorragico e indicazioni chirurgiche

Massive, active bleeding of the oesophageal varices in cirrhotics requires immediate, comprehensive and continuing appraisal of determining risk parameters (liver function and morphology, hyperdynamic syndrome, renal function, dynamic angiography of the splanchnic circulation). When survival is linked with stopping the haemorrhage, indications must not be looked at restrictively and operation has to be fast. Minor surgical measures aimed at temporary control of the haemorrhage are not satisfactory. Side-to-side portacaval anastomosis is effective in terms of reducing portal pressure and controlling the haemorrhage. Mesenterico-caval shunt with H-dacron graft interposition is sufficient dynamically and has less effect on porto-hepatic flow. Long-term results with this technique requires further study.