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Purpose: To review the cyclosporine therapy indications and evaluate determine the incidence of cyclosporine blood levels outside the therapeutic range in patients under treatment, to evaluate the practical utility of the drug monitoring., Patients and Methods: The blood concentration of monoclonal cyclosporine was monitored in 225 patients by FPIA method, using the trough concentration., Results: 58% of patients had a drug blood level within the therapeutic range, 26% and 16% of them had respectively, a value below and down this range. After correcting the drug dosage, 75% and 68% of the patients of the two subgroups had a cyclosporine blood value within the therapeutic range., Conclusions: Cyclosporine is increasingly used in transplant recipients as well as in patients with other immunological diseases. Since the number of patients, with inappropriate serum levels of cyclosporine is high, therapeutic monitoring of blood levels of the drug are of paramount importance.

After a short introduction about the current role of digitalis in the treatment of the supraventrical arrhythmias and about the factors that make often problematic the achievement of an optimal posology of the drug, the results relative to more recent 340 digoxinaemia determinations in patients of Policlinico in Palermo or in outpatients are presented. Just the 43.8% of the patients had a digoxinaemia value in the range considered therapeutic; just 45 patients (32.1%), out of the 140 in which the digoxinaemia had been monitored for, at least, 5 days, were in the therapeutic range at the first determination; the 47.8% of the patients were underdosed and the 38.8% of them showed higher values than the therapeutic range. Determination 5 or more days later showed digoxinaemia values in the therapeutic range in 112 patients (80%). According to the reported results, it may be presumed that the posology correction effectuated by the physician on these patients might have been driven by the digoxinaemia values, whose determination must be considered an unavoidable guide to the digitalis treatment.

Clinical symptoms and laboratory findings were assessed in three women with acute intermittent porphyria. After 15 days of pharmacologic washout and free diet (time 0), the patients were give a well balanced normocaloric diet for 7 days (time 1), followed by 7 days of high carbohydrate normocaloric diet (time 2); on days 15 to 21 (time 3) well balanced normocaloric diet was given, and finally on days 22 to 28 (time 4) to the well balanced normocaloric diet cimetidine (0.4 g twice daily) was added. On days 3, 5, and 7 of times 1-4 the following porphyrin precursors were determined: ALA, PBG, total uroporphyrin, total coproporphyrin, and total porphyrin. At times 1 and 3, high values were found while levels dropped to normal during times 2 and 4. During times 1 and 3, patients complained of headache, insomnia and anxiety; during time 2, all patients complained of anxiety and only one suffered from insomnia. Finally, during time 4, all patients had only slight anxiety. Untoward effects of cimetidine were not observed in any of the patients.

Non-Meckel's diverticula of the small bowel are a rare occurrence. They may be divided into true diverticula and pseudodiverticula. In general they are diagnosed intraoperatively following the onset of secondary complications. The authors describe a case which was brought to their attention.

Unlabelled: The aim of our study was to seek out a possible different reactiveness to cardiovascular stimulation tests among normotensives with and without positive family history of essential hypertension. We have studied about 200 inhabitants of Ustica and 49 medicine students, all normotensives according to the World Health Organization and the Joint National Committee criteria. In an isolated room and in a supine position, blood pressure (BP) and heart rate were measured every 30 s for 15 min with an automatic sphygmomanometer. Averages of last 4 measurements were considered baseline values. Then we have carried out mental stress (MS), handgrip and active orthostatism test (AO) in the inhabitants of Ustica; cold pressor test and AO in students. Patients were divided in 2 groups, genetics and controls, on the basis of a positive family history of essential hypertension. The 2 groups, in every sample, were similar for sex, age, body mass index and alimentary and life habits., Results: a preliminary estimation of Ustica sample showed a different prevalence of positive history between hypertensives and normotensives (63.9% vs 46.61%; p less than 0.05) and no difference between hypertensive and borderline patients (63.9% vs 64.2%); BP and heart rate were slightly higher in controls; there was no statistical difference between genetics and controls., Conclusions: our results can be explained in various ways: pressor dysregulation in candidates for hypertension may be masked in a large group of normotensives; exaggerated pressor response do not exist in genetics or this pressor dysregulation is impossible to find out with the cardiovascular stimulation tests we have used; other mechanisms are responsible for genetic hypertension.

We studied 45 hypertensive subjects to evaluate the usefulness of captopril test for identifying renal artery stenosis and small congenital kidney with the hypoplasia of the renal artery. In 18 hypertensives with hippuran renogram indicating renovascular disease, and in 27 essential hypertensives, the plasma renin activity (PRA) responses to an oral test dose (50 mg) of captopril were studied. A 60-minute post captopril PRA increase of 150% (or 400% if baseline PRA less than 3 ng/ml/h) was considered as positive. Digital venous angiography was performed in all cases. In the group of 18 subjects small congenital kidney in 7, and renal artery stenosis in 11 subjects were detected by angiography. Captopril test resulted negative in all patients with small congenital kidney (mean PRA% increase 58). The test identified 7 of the 11 renal artery stenoses (mean PRA% increase 477), sensitivity and specificity were 64% and 100% respectively. In the essential hypertensives-group, mean PRA% increase was 122; there were three false positives, and both sensitivity and specificity were 88%. This study demonstrates that the PRA response to oral captopril test is a useful screening test for distinguishing small congenital kidney from renal artery stenosis and for identifying the latter in hypertensive patients.

a group of 120 patients suffering from E.A.H. divided into three age Plasma renal flow was reduced on average in all three groups. It is t this fact could support the hypothesis that the change in renal per y a pathogenic role in E.A.H. ss F1/hlp F2/que F3/ext F4/can F5/nxt F6/ins F7/up F8/dwn F9/fin

Liposarcoma of the spermatic cord is a rare tumour, usually well differentiated, that generally resembles a lipoma and undergoes a slow, progressive enlargement. Most patients with liposarcoma do not experience any recurrence after local excision. Due to the rare occurrence of this tumour it seems appropriate to document one case that came to our observation in recent years.

Research has been carried out into the effects of a new vasoactive substance, buflomedil hydrochloride, on two groups of patients suffering from cerebrovascular insufficiency and obliterating arteriopathy at the lower extremities. Ten clinical parameters were assessed in the first group of patients (insomnia, headache, vertigo, tinnitus, asthenia, shaking, changes in reflexes, anorexia, memory disturbances, problems of concentration and character disturbances); in the second group, the muscular flow of the gastrocnemius as measured by the muscular clearance of NaI131 at rest, during standard exercise conditions, during ten minutes following exercise and in the post-ischaemic phase. The results can be considered satisfactory in both groups, especially after prolonged treatment and in the early stage of the disease. Drug tolerance was very good.

After looking at the possible physiopathological role of renal ptosis in the pathogenesis of arterial hypertension and urinary inflammation, the results of an epidemiological study carried out on about 600 reno-scintigraphic investigations are reported. The study demonstrated the high frequency of the condition in males and its frequent association with monolateral changes in the renographic curve. The second part of the paper assesses the reversibility of renal ptosis and the renographic change in 13 patients in passing from the sitting to Trendelenburg's position. The results show that the change in flow, which may be the cause of the renographic change in the ptosic kidney, is reversible in many patients as it disappears or reduces as the kidney position is corrected. In other patients in whom this does not occur, it can be presumed that the reduction in flow has an organic genesis, namely fibromuscular dysplasia of the renal artery which, as the literature shows, may be looked on as a complication of ptosis.

Cutaneous leiomyosarcoma is a rare tumour arising in dermis or subcutaneous tissue. Diagnosis is usually made by microscopic examination on the basis of marked cellular atypia and mitoses. We report one case of leiomyosarcoma of the gluteus with precocious lung metastases in a 65-year-old female.

It is generally admitted that alteration to the blood coagulation system, particularly the creation of fibrin from fibrinogen may play a pathogenetic role in the complex mechanism that characterises rheumatic diseases of the connective tissue. A study was therefore conducted to see whether accelerated fibrinogen turnover could be demonstrated in such patients. To this end the clearance of fibrinogen marked with I131 was assessed in 25 patients in various stages of connectivitis and 10 controls was measured. The results showed a distinct acceleration in fibrinogen turnover only in patients with highly active rheumatoid arthritis. In contrast patients with rheumatoid arthritis in the regressive phase or with stable progressive systemic sclerosis showed values similar to the control subjects. Finally the possible explanations for this behaviour are examined and the clinical interest of the technique employed is assessed.

Certain physiopathological features that differentiate essential arterial hypertension in normal weight and obese patients are recalled. The results of a retrospective study carried out in 293 hypertensive patients admitted to the Clinic in recent years are reported with a view to evaluating the prevalence of certain parameters (ischaemic cardiopathy, left ventricular hypertrophy, renal, vasculo-cerebral and retinal impairment) in patients subdivided into two groups: normal weight and obese. The study showed in the first group a higher prevalence of signs of ischaemic cardiopathy; in the second a higher prevalence of left ventricular hypertrophy. This difference is accentuated in the subgroup of smokers as regards ischaemic cardiopathy and in non-smokers as regards left ventricular hypertrophy. The possible explanations for this different behaviour are discussed.

A brief account of the physiopathology of proteinuria is followed by a description of the diagnostic routine to be followed in such cases, with particular reference to the electrophoretic study of urinary proteins. In many cases, this simple method gives information on a par with that offered by biopsy, especially insofar as the planning of treatment is concerned. Several clinical cases are cited by way of illustration.

A clinico-endoscopic study has been carried out in a group of 22 patients treated with 1 g of naproxene + 2 g of rosaprostol compared in a blind situation with another group of 19 patients treated with a similar dose of naproxene + placebo in order to evaluate the cytoprotective action of rosaprostol. Analysis of the results showed a high correlation between intake of rosaprostol and low onset of algico-dyspeptic disturbances and mucosal lesions of some gravity, although the problem of the monitoring of patients undergoing long-term treatment with NSAID remains unsolved.