Observational prospective study comparing mucoactive and antibiotic treament in the management of acute cough from upper respiratory tract infections.

AIM: Since the efficacy of antibiotics in the management of cough from upper respiratory tract infections (URTI) is unclear, we conducted an observational study to evaluate the efficacy of antibiotic compared to symptomatic treatment in adults with productive cough from URTI in a real life setting. METHODS: One-hundred and 50 subjects presenting to five general practice ambulatories with productive cough due to URTI were included in the study. According to the physician judgment, patients were treated with either oral antibiotics (group A, 50 patients), a mucoactive syrup (sobrerol: group S, 50 patients) as symptomatic treatment, or both sobrerol and oral antibiotics (group SA, 50 patients). Cough severity was assessed daily with a diary, by means of a validated verbal category-descriptive (VCD) Scale. RESULTS: In every treatment group cough severity decreased over time (P<0.001); however, during the first week of treatment patients in groups S and SA experienced significantly lower VCD score values in comparison to Group A (P=0.045 and P=0.010, respectively). On the other hand, the VCD score was never significantly different between the two groups that received symptomatic treatment at any of the 4 weeks of the study, suggesting that the effect observed was due to the action of the mucoactive syrup. CONCLUSION: Our data confirm the lack of efficacy of antibiotics in the management of productive cough in URTI and suggest that symptomatic treatment should be preferred to antibiotics in acute cough from URTI.

Antitussive activity of iodo-resiniferatoxin in guinea pigs.

BACKGROUND: Iodo-resiniferatoxin (I-RTX) has recently been described as an ultra potent antagonist of the transient receptor potential vanilloid-1 (TRPV1). METHODS: The ability of I-RTX to inhibit cough induced by inhalation of two putative TRPV1 stimulants (capsaicin and citric acid) was tested in non-anaesthetised guinea pigs. RESULTS: Pretreatment with I-RTX either intraperitoneally (0.03-0.3 micromol/kg) or by aerosol (0.1-3 microM) reduced the number of coughs produced by inhalation of citric acid (0.25 M) and capsaicin (30 microM) in a dose dependent manner. Capsazepine (CPZ) also reduced citric acid and capsaicin induced cough, but the activity of I-RTX was 10-100 times more potent than CPZ in all the experimental conditions tested. CONCLUSIONS: I-RTX is a novel and potent antitussive drug which inhibits cough mediated by agents possibly acting via TRPV1 activation.

SPET imaging of intracranial tumours with 99Tcm-sestamibi.

Single photon emission tomography (SPET) employing 99Tcm-sestamibi (MIBI) injected intravenously was performed in 27 patients for pre-surgical evaluation of intraparenchymal brain tumours. A computerized tomography (CT) scan was performed in 26 patients, magnetic resonance imaging (MRI) in 8 patients and digital subtraction angiography (DSA) in 14 patients. Visual analysis of the SPET scans was performed using a 4-point scale relating to background activity, to evaluate MIBI uptake in the tumour. The vascular supply and the cellular component were also evaluated using DSA and CT scans. In normal controls, MIBI uptake was observed in the scalp, in the choroid plexus and in the pituitary gland, but never in normal parenchyma. Among the astrocytoma group of patients, a trend between MIBI uptake and grade of tumour was noted. MIBI uptake in meningiomas depends primarily on the vascular supply. Our results support the hypothesis that vascular supply, integrity of the blood-brain barrier, the degree of malignancy of the neoplasm and the viability of the tumour cells may be related to MIBI uptake.

[Efficacy and safety of the use of levodropropizine in patients with chronic interstitial lung diseases]. / Efficacia e sicurezza di impiego di levodropropizina in pazienti affetti da pneumopatie interstiziali croniche.

Efficacy and tolerability of an antitussive drug, levodropropizine, in 21 adult patients with interstitial lung disorders was evaluated in this study. Levodropropizine dosage was 60 mg t.i.d. for four days of therapy. The authors evaluated the effectiveness of the antitussive therapy and, on the other hand, the tolerability of levodropropizine in these patients, monitoring PaO2, PaCO2 and pH values. The changes in cough frequency (34.1 +/- 5.6 20.4 +/- 5.4 mean +/- d.s. before and after treatment) and the overall efficacy judgment as reported by the doctor indicate a decrease in cough as confirmed by the significance of Kruskal-Wallis test (p less than 0.05). Furthermore the tolerability has been excellent, because the PaO2, PaCo2 ad pH values before and after treatment were unchanged (PaO2 mmHg: basal 71 +/- 16.6, after treatment 73.8 +/- 14.2; PaCO2 mmHg: basal 36.6 +/- 5, after treatment 36.6 +/- 4.6; pH basal 7.4 +/- 0.03, after treatment 7.4 +/- 0.02).

[Clinical and immunologic test of the activity of a polymicrobial vaccine in patients with chronic bronchitis during a flare-up]. / Verifica clinica ed immunologica dell'attività di un vaccino polimicrobico in pazienti affetti da bronchite cronica in fase di riacutizzazione.

The authors evaluated the effect of an orally administered polymicrobial vaccine in a group of chronic bronchitis patients in order to assess its efficacy in preventing recurrent infections and as adjuvants during minor acute episodes. Compared to the control group, vaccinated patients had 1) a reduced number of flare-ups, and these were less severe and symptoms were improved; II) lymphocyte phenotype was not altered in any of the patients but nevertheless the response to skin tests for delayed sensitivity was improved in the vaccinated patients only; III) more rapid symptomatic improvement of flare-ups. The authors stress the improvement of cell-mediated lymphocyte function as a result of vaccination, probably due to macrophage activation and with resulting improvement of the clinical course of the bronchial disorder.

[Exogenous lipid pneumonia. Clinico-radiologic characteristics]. / Polmoniti lipidiche esogene. Caratteristiche clinico-radiologiche.

Exogenous lipid pneumonia (ELP) is caused by the aspiration of animal, vegetal or, more often, mineral oils. Even though it may also be acute, ELP is most frequently a chronic disease, affecting people with predisposing factors, such as neuromuscular disorders, structural abnormalities and so on; very often exogenous lipid pneumonia is found in tracheotomized patients. The pathology of lipid pneumonia is a chronic inflammatory process evolving in foreign-body-like reaction, and eventually in "end-stage lung" condition. Clinically, most patients are asymptomatic; few cases only present with cough, dyspnea and chest pain. Eight cases of ELP, studied over the past 3 years, are described in this paper. All the patients were examined by chest radiographs and standard tomograms; 3 patients underwent CT. X-ray features were mono/bilateral consolidation of the lower zones, with air bronchogram and variable reduction in volume. CT density was not specific for fat tissue. In all cases the diagnosis was confirmed at biopsy. In 5 patients, followed for at least one year, clinical-radiological features showed no change. Thus, complications of ELP (especially malignant evolution) could be excluded. The authors conclude that lipid pneumonia must be considered in differential diagnosis of patients with history of usage of oils and compatible X-ray findings. The usefulness of an accurate follow-up is stressed.

[Transbronchial needle aspiration of mediastinal masses during fiber-bronchoscopy]. / Agoaspirazione transbronchiale di masse mediastiniche in corso di fibrobroncoscopia.

The authors present their own experience in the diagnosis of thoracic adenopathies and mediastinal masses by transbronchial needle aspiration (Wang needle). The diagnostic usefulness and safety of the method is stressed. Radiology plays an important role in choosing biopsy site (by CT), in monitoring the procedure by fluoroscopy and looking for complications following completion of the examination.

[Multicenter study of the immunostimulating activity of a bacterial lysate]. / Studio multicentrico sull'attività immunostimolante di un lisato batterico.

The Authors report the results obtained within a multicentrical trial, weighing the immunostimolant effect of bacterial lysate on 157 patients. The drug (bacterial lysate) has induced an immunitary reaction, making significantly higher either the salivary IgA values or the serum IgA, IgG and IgM values. Also excellent tolerability is peculiar to this new immunostimolant.