[Indications and outcomes of epilepsy surgery in children]. / Indicaciones y resultados de la cirugia de la epilepsia en niños.

INTRODUCTION: One in every four children who suffer epilepsy will continue to seize despite all the current arsenal of anticonvulsant medications. Epilepsy surgery can be an effective treatment for many cases of pharmaco-resistant epilepsy. AIM: To review some of the most recent data regarding indication and results for epilepsy surgery in children. DEVELOPMENT: New analysis of neurophysiological data such as magnetoencephalography, dipole analysis and high frequency oscillations, plus functional neuroimaging and higher resolution MRI, have improved the prompt referral of potential candidates for surgery. An adequate selection of the surgical candidates will be fundamental in obtaining positive outcomes. Children, just like adults, can achieve seizure freedom or more than 90% seizure reduction in 85% of the cases of temporal lobe resections. Extratemporal epilepsy surgery is more challenging, and presents frequently in epilepsy surgery centres specialized in pediatric care. CONCLUSION: It is not mandatory for a patient to have an structural lesion evident on MRI in order to be considered a candidate for epilepsy surgery. In many cases a partial reduction of seizure activity can significantly improve the patient's and family's quality of life, and can have a sinergistic effect with other therapies which were no effective before surgery.

Indicaciones y resultados de la cirugía de la epilepsia en niños / Indications and outcomes of epilepsy surgery in children

Introducción. Uno de cada cuatro niños que sufren epilepsiacontinúa teniendo crisis a pesar del arsenal de medicamentosantiepilépticos del cual se dispone actualmente. La cirugía parala epilepsia es un tratamiento potencialmente efectivo en muchoscasos de epilepsia refractaria a fármacos. Objetivo. Revisaralgunos de los avances más recientes en cuanto a las indicacionesy resultados de la cirugía en casos de epilepsia. Desarrollo. Graciasal avance en técnicas neurofisiológicas de localización, comola magnetoencefalografía, el análisis de dipolo y de oscilacionesde alta frecuencia así como de neuroimágenes funcionales y demayor resolución espacial, se han beneficiado de este tratamientomás pacientes y en un menor plazo. La selección del paciente determinaen gran medida el porcentaje de éxito. Así como en losadultos, en la población pediátrica, la cirugía para tratar la epilepsia del lóbulo temporal tiene altos índices de éxito, con más del85% de los niños que resulta totalmente libre de crisis o con unareducción de las crisis en más del 90% de los casos. Los casos decirugía de epilepsia extratemporal son mas frecuentes en los niñosy presenta mayor dificultad de localización y abordaje neuroquirúrgico.Conclusión. No siempre se necesita hallar una lesión estructuralpor neuroimágenes para considerar a un paciente candidatoa cirugía, y, en muchos casos, una reducción parcial de lascrisis mejora la calidad de vida significativamente, validando laopción de realizar cirugía aun en los casos donde la probabilidadde permanecer totalmente libre de crisis sea muy baja

Introduction. One in every four children who suffer epilepsy will continue to seize despite all the current arsenal ofanticonvulsant medications. Epilepsy surgery can be an effective treatment for many cases of pharmaco-resistant epilepsy.Aim. To review some of the most recent data regarding indication and results for epilepsy surgery in children. Development.New analysis of neurophysiological data such as magnetoencephalography, dipole analysis and high frequency oscillations,plus functional neuroimaging and higher resolution MRI, have improved the prompt referral of potential candidates forsurgery. An adequate selection of the surgical candidates will be fundamental in obtaining positive outcomes. Children, justlike adults, can achieve seizure freedom or more than 90% seizure reduction in 85% of the cases of temporal lobe resections.Extratemporal epilepsy surgery is more challenging, and presents frequently in epilepsy surgery centres specialized inpediatric care. Conclusion. It is not mandatory for a patient to have an structural lesion evident on MRI in order to beconsidered a candidate for epilepsy surgery. In many cases a partial reduction of seizure activity can significantly improve thepatient’s and family’s quality of life, and can have a sinergistic effect with other therapies which were no effective beforesurgery

Neurocisticercosis en niños costarricenses: experiencia clínica e importancia de la vigilancia epidemiológica / Neurocysticercosis in Costa Rica children: clinical experience and the importance of epidemiological surveillance

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[Systematic biopsy with multiple samples per lobe in the diagnosis of prostatic carcinoma]. / Biopsia sistematica a prelievi multipli per lobo nella diagnosi di carcinoma della prostata.

A new fashion of prostate transperineal biopsy (seven cores from each lobe) is described, in order to evaluate a potential increase of prostate cancer detection rate. From June 1996 to PSA. April 1997, 247 patients underwent transperineal biopsy for an abnormal DRE and/or elevated In addition to apex, base and lateral peripheral samples, two more were obtained from middle-lateral peripheral zone and tow more from transition zone of each lobe of the prostate. In 14 patients (13.1%) carcinoma was detected in the additional samples only. This new biopsy fashion seems to be safe and more accurate than sextant biopsy for a significant percentage of cancer that otherwise would have been missed.

Autonomic nervous dysfunction in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA): possible pathogenic role of autoantibodies to autonomic nervous structures.

Autonomic nervous dysfunction has been previously reported in SLE, RA and systemic sclerosis, but the pathogenesis of such a complication is poorly understood. In the present study, four standard cardiovascular autonomic function tests were performed in 34 female patients with connective tissue diseases and in 25 healthy control subjects, and results expressed as cardiovascular (CV) test scores. Moreover, in each subject the presence of circulating complement-fixing autoantibodies directed against sympathetic and parasympathetic nervous structures, represented by superior cervical ganglia and vagus nerve, respectively, was simultaneously assessed by an indirect immunofluorescent complement-fixation technique, using rabbit tissue as substrate. None of the patients reported autonomic symptoms. However, an abnormal CV test score (> or = 5) was detected in 15% of the patients and in none of the healthy control subjects, approaching statistical significance (P = 0.07). No correlation was found between CV test results and disease duration, type of therapy or presence of conventional autoantibodies. One or two autoantibodies to autonomic nervous structures were detected in six patients (18%) and not in the control subjects (P < 0.05). Values of deep breathing test were significantly lower in autoantibody-positive patients compared with those amongst the control subjects (P < 0.05), and an abnormal CV test score was significantly associated with the presence of autoantibodies to autonomic nervous structures (P < 0.05). In conclusion, we confirm that autonomic nervous function can be impaired in patients with connective tissue diseases, and suggest that autoantibodies directed against autonomic nervous system structures may play a role in the pathogenesis of the autonomic dysfunction.

[Role of expectant therapy in prostatic carcinoma of low grade and staging]. / Ruolo della expectant therapy nel carcinoma della prostata di basso grado e stadio.

Low stage and grade prostate cancer can be treated by radical prostatectomy, radiotherapy and expectant therapy. Preoperative evaluation with biopsy is in many cases unreliable to pathological stage and grade. In this study we considered 31 patients with prostate cancer, evaluated with directed ultrasound guided biopsy (15) or with sextant biopsy (16). Sextant biopsy showed better results. Grading was confirmed by radical prostatectomy specimen in 62.5%. The role of expectant therapy is then discussed.

[Echo-guided biopsy of the transitional zone in the diagnosis of prostatic carcinoma]. / La biopsia ecoguidata della zona di transizione nella diagnosi di carcinoma prostatico.

Approximately 24% of prostate cancer originate in transition zone. To define the indications for transition zone biopsies from April 1994 to February 1996 we evaluated 112 men ranging in age from 56 to 84 years (mean 67.4). 94 patients presented elevated PSA levels and normal rectal examination (24 with negative prior systematic sextant biopsies). A group included 6 patients with palpable nodularity and normal PSA levels. A third group consisted of 12 men with sonographic abnormalities. Of the 112 patients evaluated 38 (34%) were found to have cancer on the prostate biopsies and 7 (18%) were positive only in sample of transition zone biopsies. We conclude that transition zone biopsies don't substantially improve the cancer detection rates in patients with palpable nodularity or sonographic abnormalities but are useful in patients with elevated PSA levels and/or negative prior systematic sextant biopsies.

[Preoperative staging of prostatic carcinoma: evaluation of the role of transrectal echography]. / Stadiazione preoperatoria del carcinoma prostatico: valutazione del ruolo dell'ecografia transrettale.

Radical Retropubic Prostatectomy (RRP) is the choice treatment for localized prostate cancer. Transrectal ultrasonography (TRUS) was used to predict local tumor extension in ninety-one patients prior RRP. In these patients 41% showed histologic evidence of extracapsular spread. These data suggest that ultrasonography is associated with considerable staging errors when used to evaluate men with clinically localized prostate cancer.

Compliance to longterm vasoactive intracavernous therapy.

From December 1986 to December 1991, 107 patients with organic impotence were advised to intracavernous pharmacological therapy with papaverine. Sixteen patients refused such treatment: 91 patients, after the determination of the therapeutical dose, underwent self injection. The follow up was 30-90 months. Thirty-seven patients (40.7%) withdraw the treatment within 3 months: 3 patients (3.3%) after losing the partner; 9 (9.9%) for intercurrent disease; 23 (25.3%) were unsatisfied for the therapy; 2 (2.2%) regained spontaneous erections. Complications were: local haematomas in 23 (42.6%); prolonged erections in 6 (11.1%); fibrotic changes of the corpora cavernosa in 9 patients (16.7%); liver enzymes changes in 2 (3.7%). The reasons for the low compliance to the intracavernous pharmacological therapy with papaverine were analysed.

Paroxetine in the treatment of premature ejaculation.

OBJECTIVE: To test the efficacy and the adverse effects of a new anti-depressant drug (paroxetine) in the treatment of premature ejaculation. PATIENTS AND METHODS: The study comprised 32 men (mean age 28 years) with premature ejaculation (14 of whom ejaculated before penetration) who were treated with paroxetine (20 mg orally each evening for 2 months). The study group excluded those with neurological and psychiatric disorders, urinary tract infections and drug or alcohol abuse. RESULTS: After about 14 days, the patients' symptoms improved and all patients reported a longer interval before ejaculation. The adverse effects were sleepiness in 19 patients (61%) and mild sensory confusion in 21 (68%), but only one had to withdraw from therapy. Three weeks after the end of therapy, the premature ejaculation recurred in 28 (90%) of the patients. CONCLUSIONS: These results indicate that paroxetine is an effective therapy for premature ejaculation. Further studies with different dosages are necessary to decrease the adverse effects and to prolong the efficacy.

[Crohn's disease in prolonged remission: should one augment protein-calorie intake as compared to healthy subjects?]. / Maladie de Crohn en rémission prolongée: faut-il augmenter l'apport protéino-calorique comparativement à la population saine?

The aim of our two year prospective study was to evaluate whether adult Crohn's disease patients in prolonged remission (CDAI < 150), in order to maintain their body weight as close as possible to the ideal one, need a protein-calorie intake higher than the predicted one and that of healthy controls. Twenty-four out of 49 Crohn's disease patients in clinical remission completed the two year prospective study, during which they were free to eat "ad libitum", in quantity and in quality. Twenty-three of the 24 patients (96%) maintained their body weight > 95% of the ideal one. As compared to predicted intakes, mean calories were -12.23% (= 272 +/- 91 Kcal/day) lower (P < 0.01), and proteins +40.6% (20.16 +/- 13.6 g/day; = 0.32 g/kg b.w./day) higher (p < 0.001). Protein-calorie intake and glycolipid ratio were comparable to those of healthy controls (p = n.s.). In the group of patients who had a relapse during the follow-up, 9 out of 25 were found to be underweight at the onset of the survey. Their protein-calorie intake was equivalent to that of subjects who completed the study. We conclude that adult Crohn's disease patients in prolonged remission maintain their ideal body weight by a protein-calorie intake comparable to that of healthy population and do not need a tailored regimen.

Advanced prostate cancer follow-up with prostate-specific antigen, prostatic acid phosphatase, osteocalcin and bone isoenzyme of alkaline phosphatase.

We report our experience in the follow-up of 63 patients with advanced prostate adenocarcinoma. We used prostate-specific antigen and prostatic acid phosphatase in 27 patients; in 36 patients we evaluated osteocalcin and bone isoenzyme of alkaline phosphatase, two markers of bone metabolism which seem to be good markers in the follow-up of patients with bone metastases.

[Ultrasonically guided biopsy of the prostate for the diagnosis of carcinoma]. / La biopsia ecoguidata della prostata per la diagnosi di carcinoma.

Echoguided biopsy of the prostate is a new method used in the diagnosis of carcinoma. False negatives, which range between 7% and 27% of transperineal biopsies, can be reduced to 11% using ultrasound control. In 50% of cases carcinoma are located in the hypoechogenic area, in 45% in mixed echogenic areas and in 5% in hyperechogenic areas. The diagnosis of carcinoma was performed in 40.7% of patients examined. In conclusion, this method is shown to be a valuable and advisable aid.

Study of mepartricin possible interactions with antilipemic drugs. Controlled clinical trials in patients with benign prostatic hyperplasia.

In order to more throughly study mepartricin pharmacodynamic characteristics, 2 groups of 15 patients with BPH and coexistent lipid metabolism disorders were studied in conformity with a sequential experimental design during which also systemic-acting (procetofen) and endoluminal-acting (cholestyramine) fat-lowering drugs were tried. The data obtained confirmed mepartricin specific effect on symptomatology and function in BPH and demonstrated the absence of positive and/or negative pharmacological interactions between the substance in question and the fat-lowering agents tried.

[Clinical characteristics of 153 patients with Crohn's disease. Presentation of a Turin case series]. / Caratteristiche cliniche di 153 pazienti affetti da malattia di Crohn. Presentazione di una casistica torinese.

This clinical and epidemiological retrospective study of 153 Italian Crohn's disease patients, surveyed between 1965 and 1988 took into account the following features: male to female ratio; region of origin; familiarity; age at onset; anatomical site of lesions; symptoms at onset; diagnostic delay; local and general complications; relapses; admissions; surgery and mortality rates. The clinical patterns of 67 patients surveyed between 1965 and 1977 (group A) were compared with those of 86 patients observed from 1978 to 1988 (group B). Overall results agreed with those of the literature, except for a male prevalence and a longer diagnostic delay. As compared to group A, group B showed: a) a higher number of females; b) a statistically significant increase (p less than 0.001) of patients from Southern Italy, thus supporting the hypothesis of a role of environmental factors in the onset of the disease; c) a reduced surgery rate, in agreement with the general trend of a more cautious surgical approach in Crohn's disease.