[Solitary primary cerebral echinococcosis. Report of a case]. / Echinococcosi cerebrale primaria solitaria. Descrizione di un caso.

INTRODUCTION AND AIMS: Echinococcosis is a widespread parasitic disease caused by Echinococcus granulosus. Hydatid cysts are mainly diagnosed in adults except for primary cerebral localisation which is electively observed in childhood owing to the early manifestation of signs and/or symptoms of the space-occupying mass. In July 1995 P.N., a 55-year-old woman, was referred to our attention. She complained of intense asthenia, cephalea not responding to NSAIDs and paroxysms of tremor. RESULTS: The anamnesis revealed close relationships with dogs since infancy and an attack of pleurisy of unknown etiology. The objective examination was negative except for an increased volume of the right-hand thyroid lobe. Hematochemical tests showed relative eosinophilia, a significant positivity of anti-thyroglobulin antibodies and antiperoxidase with normal thyroid function indices. Thyroid scan showed a multinodular goitre. Confirmation of eosinophilia suggested the performance of a parasitological examination of feces with negative results. ECG and EEG were normal. Persistent cephalea led to the performance of an encephalic CAT which revealed a cystic formation in the rolandic region, subsequently confirmed by encephalic MNR. The positivity of the Ghedini-Weinberg test led to the diagnosis of cerebral echinococcosis. Chest X-ray and hepatic scan excluded hydatid localisation in these organs. CONCLUSIONS: The case was diagnosed as solitary primary cerebral echinococcosis. Medical follow-up was commenced with albendazole for six months, after which a control encephalic CAT showed the unchanged size of the cysts. The patient consequently underwent surgical exeresis.

Left ventricular performance after intravenous infusion of captopril in patients with congestive heart failure.

BACKGROUND: Although oral administration of captopril, an angiotensin-converting enzyme inhibitor, is effective for the treatment of congestive heart failure (CHF), the effect of its intravenous (iv) administration is not well known. METHODS AND RESULTS: Ten patients (age range 48-72 years), with CHF belonging to the second and third NYHA class, were given an iv bolus of 25 mg of captopril. Before and 30 minutes after the infusion of captopril, a number of parameters of the left ventricular function were evaluated by echocardiography IREX 3 M-B Mode. Eight patients showed a significant improvement of left ventricular performance indices. In fact, the ejection fraction (13.8%, p < 0.05), the cardiac output (24%, p < 0.001), the circumferential shortness fraction (29.9%, p < 0.05), and the fraction shortening (16.0%, p < 0.005) increased significantly, whereas the end-systolic diameter (21%, p < 0.001), the endsystolic stress (23.8%, p < 0.01) and the left ventricle ejection time (4.8%, p < 0.05) decreased significantly. Systolic and diastolic blood pressure values also underwent a significant reduction by 17% and 11% (p < 0.01 and p < 0.05 respectively). No evident correlation between the improvement of the left ventricular function and the basal renin rates was noticed. CONCLUSIONS: A significant improvement of parietal kinesis was observed especially in those segments which showed movement abnormalities (hypokinesia and akinesia) and in many cases this was detected by M-B Mode echocardiography. Our findings may be the result of the following factors: 1) reduction of parietal stress; 2) increased district coronary flow; 3) inhibition of tissue renin-angiotensin-aldosterone system; and 4) "scavenging" action exerted by the SH group of captopril.

[Role of MB-mode transthoracic echography in the early diagnosis of acute pulmonary embolism]. / Ruolo dell'ecografia transtoracica M-B mode nella diagnosi precoce di embolia polmonare acuta.

The aim of the present study was to evaluate whether transthoracic ecocardiography M-B mode was a sensitive and/or specific test for the early diagnosis of acute pulmonary embolism (PEA). For this purpose, we studied 7 patients with PEA as a complication of: deep leg venous thrombosis (3 cases), complicated bone fractures (2 cases), meniscectomy (1 case) and postpartum (1 case). The patients (3 males and 4 females), mean age of 46 +/- 7 years, did not have any previous earlier heart and/or pulmonary diseases. The diagnosis of PEA was made on the basis of clinical criteria, ecg and laboratory tests. Ecocardiography was performed using an IREX 3 M-B mode equipment; the measurements for the calculation of the indexes were made utilizing a short axis parasternal window. The parameters studied were: RVEDD/LVEDD ratio, LVDI Okubo index and the TR grade. Data were analyzed employing the paired Student's t test. In all patients was observed a statistically significant enlargement on the right heart cavities; while only in 3 of them was it possible to observe a slight reduction of the left ventricular cavities. In conclusion, the ecocardiographic exam was is a sensitive test for the diagnosis of PEA. Particularly, the RVEDD/LVEDD ratio gave an early and quantitative indication of the obstruction severity. Indeed, the morphological alteration of the right cavities became evident when the embolic obstruction was of at least 30%. Hence, we suggest that the standard ecocardiography M-B. mode may be regarded has a rapid diagnostic tool for the diagnosis of PEA.

[Review of the pathogenetic problem of hereditary ataxia]. / Revisione del problema patogenetico delle eredoatassie.

In the inherited ataxias, a heterogeneous group of relatively rare and progressive neurological disorders, abnormalities in pyruvate metabolism have been described. Pyruvate is involved in the glycolitic pathway as an important step, and utilized in the Krebs cycle, the main energy source in the brain. Furthermore, pyruvate and other intermediates in the Krebs cycle, can also serve as a precursors of amino acids for which a role as a neurotransmitter has been shown. The explanation of the basic biochemistry may serve as a basis for a more steady knowledge of the clinical and pathological findings of such diseases.