Effects of fluconazole in the prophylaxis of oropharyngeal candidiasis in patients undergoing radiotherapy for head and neck tumour: results from a double-blind placebo-controlled trial.

Fluconazole is recommended in the prophylaxis of oropharyngeal candidiasis (OPC) in patients undergoing radiotherapy for head-neck tumours; however, the actual effectiveness of fluconazole in this setting remains unclear. Adult patients with cervico-cephalic carcinoma submitted to radical or adjuvant radiotherapy were randomized to 100 mg fluconazole (n = 138) or matched placebo (n = 132) oral suspension once daily from the sixth session of radiotherapy up to the end of treatment. The final analysis of the investigation showed a higher rate of the OPC outbreak-free survival in the fluconazole compared with placebo (P = 0.008 in the log-rank test). The mean time (95% CI) to OPC outbreak was 56 (53-59) days in the fluconazole group and 47 (43-51) days with placebo. The mean duration of radiotherapy was 43.5 and 39.9 days, respectively in the two groups (P = 0.027). Adverse effects were reported in 70.3% of patients in the fluconazole group and in 67.4% with placebo. The results showed prophylaxis with fluconazole given in irradiated patients with head-neck tumours significantly reduces the rate and the time to development of OPC compared with placebo.

[Case-control study of hemo-lymphopoietic neoplasms and exposure to pesticides in western Liguria]. / Studio caso-controllo sulle neoplasie del sistema emolinfopoietico ed esposizione a fitofarmaci nel ponente ligure.

The association between hematolymphopoietic cancers and occupational exposures to pesticides is being examined in a population based case-control study. 228 cases diagnose aged 20-74 years and 140 controls between 1/1/1990-31/12/1993 were eligible for the study in the west Liguria area. 163 cases and 109 controls were interviewed regarding use of pesticides and other possible risk factors and confounding variables. Expert agronomists assessed the job exposure to pesticides using the informations from questionnaires and the job-matrices.

[Immediate results of percutaneous mitral valvuloplasty using Inoue catheter. Personal experience in the first 15 cases]. / Risultati immediati della valvuloplastica mitralica percutanea con catetere di Inoue. Esperienza personale nei primi 15 casi.

Mitral valvuloplasty with an Inoue balloon catheter was performed at our institution in 15 patients affected by mitral stenosis. All were severely symptomatic (class NYHA III or IV). Transthoracic and transesophageal echocardiography showed a mitral score less than 10 (Wilkins criteria). Patients with thrombi in the left atrium and those with important mitral regurgitation were excluded. The mitral valve area increased from 0.98 +/- 0.2 to 1.89 +/- 0.4 cm2 and the transvalvular gradient decreased from 18.2 +/- 7.5 to 6.7 +/- 3.7 mmHg. There was a small increase of the mitral regurgitation. Two complications occurred during the procedure: the first was a haemopericardium, which was percutaneously drained, and the other a rupture of the anterior mitral leaflet with acute, severe mitral regurgitation necessitating urgent surgical correction. Applying the criteria of Herrmann, the results were optimal in 11 and suboptimal in 3 cases.

[Transesophageal echocardiography in the diagnosis of cor triatriatum in the adult]. / L'ecocardiografia transesofagea nella diagnosi di cor triatriatum nell'adulto.

Cor triatriatum (CT) is a rare congenital defect, surgically correctable, and sometimes difficult to diagnose by cardiac catheterization. This report describes three young patients with this particular defect, one of whom was sent to us because of signs of right ventricular failure. The diagnosis of CT was made by transesophageal echocardiography and confirmed by cardiac catheterization and surgical data. The other two cases underwent cardiac catheterization and cardiac surgery during infancy for other congenital defects. The diagnosis of CT was made only during post-operative controls by transthoracic echocardiography. In these two cases transesophageal echocardiography provided the most valuable information about the morphological features of the membrane and the mitral valve, and about the flow between the two left atrial chambers.

Congenital hypothyroidism and pericardial effusion.

A group of infants, affected by congenital hypothyroidism diagnosed through the neonatal screening program, was investigated with echocardiography to detect the presence of pericardial effusion. We studied the relationship between the effusion and the etiology of hypothyroidism, established through thyroid scintiscanning. Our data show a high prevalence of effusion in hypothyroid patients, without other clinical signs of cardiac involvement as well as a relationship between the etiology of hypothyroidism and the presence of effusion. This seems to be much more frequent in those forms which can imply a more severe hormonal defect, particularly during fetal life (agenesis/dyshormonogenesis). Furthermore, the high prevalence of pericardial effusion suggests to start the L-T4 replacement therapy with lower dosages as commonly advised, in order to avoid a cardiac involvement.

[The isovolumetric index: a new index of left ventricular function]. / L'indice isovolumetrico: un nuovo indice di funzione ventricolare sinistra.

The isovolumic index (IVI%), a new parameter of left ventricular function defined as (isovolumic contraction + isovolumic relaxation time)/left ventricular ejection time, is easily obtained from a routine echocardiogram. By simultaneous recordings of an electrocardiogram, a carotid arterial pulse tracing and the mitral valve echocardiogram, we calculated the IVI% as (time from R wave to MV opening-LVET)/LVET %. 90 normal subjects, mean age 38.32 +/- 11.8 years (range 20-60), underwent an echocardiographic study in order to calculate this index. The value of the IV% was 39.75% +/- 6.82 (range 21.4%-52.3%). The index was heart rate independent and showed a weak positive correlation with age (y = 32.4 + 0.19x; r = 0.33; p less than 0.01). The intraobserver and interobserver variability were 2.6% and 3.6%. The methodologic aspects of the calculation of the IVI% are discussed.

[Clinical and instrumental study of familial congenital myasthenia]. / Contributo clinico e strumentale alla conoscenza della miastenia congenita familiare.

Congenital familial myasthenia occurred in two male brothers, born from non affected mother. The diagnosis was based on anamnestic and clinical data, on electromyographic features, and on the effect of specific therapy. The differential diagnosis and the classification of congenital familial myasthenia are discussed. This type of disease represent 1% of all cases of myasthenia, but--excluding the "transferred" myasthenia to the newborn by affected mother--the percentage raises to 3--4%. The possibility of identifying two distinct formes of familial myasthenia is emphasized, the first with "early onset" where the symptoms become evident before two years of age, the second "late onset" clinically evident later in life seems doubtful that the two forms of the disease might be due to the same underlying pathological condition.