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To describe different doctors' attitudes in drug prescribing in case of influenza-Like-Illness during 2001-2002 influenza season in Lazio region, with regard to consumption and expenditure and its adherence to Italian Guidelines on ILI Management. Prospective study aimed to assess doctors' behaviour in prescribing in respect with the following events: (a) ILI and subsequent controls after diagnosis, (b) complications, (c) adverse events to influenza vaccine. 7,629 subjects, have been identified and only 17% presents one or more comorbidities. There are totally 7,766 cases of ILI: 23% are complicated and out of the remaining 77%, only 14% presents comorbidities. Almost all elderly people have been vaccinated. Antibiotics were prescribed to complicated cases (82%) with comorbidities (55%); 1,075 patients (12%) had second or third contact with doctors in a period longer than 7 days and about 65% of them received antibiotics in case of acute bronchitis; children received mainly ibuprofen and paracetamol for fever control; acetylsalicylic acid in children group has been delivered only in 1% of cases. Overall, doctors' attitude in prescribing is generally coherent with Italian Guidelines on ILI even though a high variability still persists.

This paper focuses on key issues of the organizational model of the influenza vaccination campaign in Lazio region, Italy, started during the 1999-2000 season. The following crucial features of the model are emphasized: a strong support given by Regional Health Agency; a high level of commitment of local health authorities; a considerable involvement of general practitioners; the appropriation of economical incentives related to different levels of coverage; an "ad hoc " information system. The model resulted in a remarkable increase of the number of vaccinations among elderly population (from about 420,000 in the 2000-2001 vaccination campaign to about 560,000 in the successive campaign) and of the correspondent levels of coverage (from 45.7% in the 2000-2001 vaccination campaign to 59.2% in the successive campaign). Nevertheless, further efforts should be provided to better identify population at risk, and to reach the most disadvantaged groups. Moreover, actions are to be performed to assess health and economic benefits of vaccination campaign, in order to improve the efficiency of health care planning programs.

The case is reported of a 49-year-old man with a giant infratentorial extradural epidermoid tumour, with cervical syringomyelia and hydrocephalus, and partial protrusion of the cerebellar tonsils through the foramen magnum. The patient complained of symptoms of raised intracranial pressure and was admitted to our Department, where ventriculoperitoneal shunting and total removal of the epidermoid tumour were performed. One year later, MR imaging demonstrated collapse of the cervical syringomyelia.

The six-month follow-up of 83 surgically treated cases for intracerebral hematoma (ICH) was examined in relation to some clinical and computer-tomographic parameters (age, sex, accompanying diseases, clinical features, localization, ventricular involvement, time elapsed between stroke and surgery). Clinical and laboratory pre-requisites for admittance to the study were: 1) ICH with subcortical major component greater than 3 cm. in diameter, 2) a Glasgow Coma Scale (GCS) score at/or superior than 5, 3) any evidence of trauma, aneurysm, A-V malformation and tumor and 4) surgery not later than 96 hrs. after onset of bleeding. The role of the clinical picture and the ventricular involvement of ICH was strinkingly significant on both mortality as well as recovery rates while sex, some accompanying diseases and left localization influenced the recovery rate. Time elapsed between bleeding and surgery was not considered an objective parameter due to the variability of some organizatory and human factors. Age was an uninfluential factor.

This report concerns 23 patients, the majority of whom are suffering from low back and chest pain caused by chest, urological or gynaecological cancer. These patients were treated with subarachnoid buprenorphine, administered in a single bolus or by slow infusion from micropumps, at a daily dose adapted to patients need (0.06-0.15 mg). The painful symptomatology was successfully controlled in all the cases treated, allowing the patients to live a virtually normal life. In no cases was respiratory depression or tolerance observed.

Somatostatin concentration was determined in plasma and in cerebrospinal fluid during a 24-h period in 7 male patients suffering from hydrocephalus of differing aetiologies. Blood and ventricular cerebrospinal fluid samples were taken every 2 h during the day (08.00–22.00 h) and every hour during the night (24.00–07.00 h). Simultaneously, plasma growth hormone levels were also evaluated. Plasma SRIH levels showed significant circadian variations with highest values in the daytime and lowest values during the night. Cerebrospinal fluid SRIH did not show any significant time-related circadian changes. Plasma GH levels showed the well-known circadian pattern in the majority of patients. No significant correlation was found between the plasma GH and plasma or cerebrospinal fluid SRIH values recorded during the 24-h period. Results suggest that peripheral SRIH does not play any major role in the control of the 24-h GH secretory pattern in man.

Two cases of isodense epidermoid tumours are described. Both lesions, which did not enhance after contrast infusion, were located in the orbital cavity. The possible pathophysiological basis for this unusual appearance on the CT scan are discussed.

Serum and cerebrospinal fluid (CSF) prolactin (PRL) concentrations were determined in fourteen patients of both sexes suffering from hydrocephalus, in basal conditions and after i.m. administration of 10 mg metoclopramide or 10 mg morphine. A significant increase in both serum and CSF hormone values was found after administration of both drugs. Serum and CSF PRL values after metoclopramide administration increased earlier and to a greater extent than after morphine. Furthermore, the metoclopramide induced CSF PRL increase immediately followed the serum peak, whereas after morphine administration an evident delay in the CSF hormone peak with respect to the serum increase was found. These data suggest that PRL entry in the CSF compartment is subject to a controlling mechanism which acts at the blood/brain barrier.

After reviewing the literature the authors report the case of a woman with a chromophobe pituitary adenoma. The only abnormal physical sign was a CSF rhinorrhoea.

Photodynamic therapy is based on the production of a cytotoxic factor by porphyrins, particularly hematoporphyrin (HP), when exposed to light of a suitable wavelength and intensity. The uptake of HP is notably large in tissues with a high mitotic index. Although cholesteatomas are not malignant tumors, our working hypothesis was that their high lipid content might result in their exhibiting a remarkable affinity to HP, which is normally carried in the blood by lipoproteins. Cholesteatomas were induced in rabbits using the Tübingen procedure (closure of the auditory canal by sutures). Animals were killed 30-40 days later at intervals of 1, 3, 6, 12, and 24 h following intravenous HP administration (5 mg/kg). Specimens were divided into two portions, one for histological examination and the other for biochemical study. The latter revealed that HP accumulates in experimental cholesteatomas, with a maximum uptake after 3 h. The level then gradually decreases, although at a lower rate than in the liver, but remains considerably high even after 24 h. These results suggest that the photodynamic treatment of cholesteatomas should be feasible in our animal model, although such treatment is still speculative in man.

The authors describe the principal tests employed in clinical evaluation of anterior pituitary function.

Photodynamic therapy is based on the capacity of certain substances to preferentially stain neoplastic tissues in respect to healthy tissues, and on the property of such substances to produce cytotoxic agents when excited by light of an appropriate wavelength. The authors demonstrate the first attempts to photoradiant therapy in the treatment of human gliomas utilizing a hematoporphyrin derivative injected i.v. as a sensitizing drug. A He Ne Laser (632,8 nm) was used in order to trigger the photodynamic process. Immediately after surgical removal of the glioma the residual tumoral bed was exposed to the action of the Laser in order to provoke necrosis of the remaining neoplastic cells. Necrosis even if partial of the residual tumor was effected. Better and more definite results may be obtained in the future utilizing a Laser connected with fiber optics consenting an in-depth light penetration.

Several cases of supratentorial gliomas and meningiomas were operated on since May 1977 with the help of CO2 laser infrared beam, generated by the Sharplan 791 He unit, with an adjustable output up to 50 Watts. Defocused laser beam has been found to be useful in direct attack on the tumour, through a vaporization of the neoplastic tissue. So the tumour could be progressively excavate with a loss of blood comparatively lower than with classical method. Haemostasis was quite good on diffuse capillary bleeding, but not on arterial or venous haemorragies, where the use of electrocoagulation was necessary. Extirpation especially, of meningiomas, was easier and less traumatic with the laser beam, and the destruction of infiltrating glial tumours was facilitated too.

GH, PRL, LH, FSH and TSH were measured in serum and in cerebrospinal fluid (CSF) in 16 patients with chromophobe adenomas, in 8 with acromegaly and in 18 subjects with neurological diseases without endocrine troubles. Elevated mean GH and PRL levels in serum and in CSF were found in patients with chromophobe adenomas and with acromegaly. No constant correlation was observed between serum and CSF values. The highest hormonal levels in CSF were usually observed in adenomas with suprasellar extension, but this finding was inconstant. The determination of hormonal levels in CSF does not seem to supply any reliable information about the characteristics of pituitary tumors.

The Authors present 70 cases of traumatic subdural hygromas, classified into acute, subacute and chronic, according to the interval between injury and the appearance of symptoms. The acute cases were 22.9% of our series. Criteria for surgical treatment were established by means of CT scan serial investigations. Pathogenesis, clinical aspects and results are discussed. Mortality rate was 17.1%.

Somatostatin concentration was determined in plasma and in cerebrospinal fluid during a 24-h period in 7 male patients suffering from hydrocephalus of differing aetiologies. Blood and ventricular cerebrospinal fluid samples were taken every 2 h during the day (08.00-22.00 h) and every hour during the night (24.00-07.00 h). Simultaneously, plasma growth hormone levels were also evaluated. Plasma SRIH levels showed significant circadian variations with highest values in the daytime and lowest values during the night. Cerebrospinal fluid SRIH did not show any significant time-related circadian changes. Plasma GH levels showed the well-known circadian pattern in the majority of patients. No significant correlation was found between the plasma GH and plasma or cerebrospinal fluid SRIH values recorded during the 24-h period. Results suggest that peripheral SRIH does not play any major role in the control of the 24-h GH secretory pattern in man.

In a previous project on haematoporphyrin (HP) uptake by experimentally induced cholesteatoma of the rabbit, it was shown that HP concentration was remarkably high in the cholesteatoma, with a peak at three hours after intravenous administration of the drug. On the basis of these results an attempt was made to destroy the matrix of cholesteatoma by means of photodynamic therapy.

Fourteen cases of vertex epidural hematomas encountered in patients admitted over a 12-year period (1964-1976) at the University of Genoa Neurosurgical Clinic are presented. Special emphasis is put on the large number of cases (nine) without a free interval. Clinical and neuroradiological findings, treatment and results are reported. A clinical classification of this traumatic pathology according to the epidural hematoma classification of Pecker et al is proposed.

The indications and the results of different surgical procedures for the management of intracranial abscesses are dealt in a cooperative study. Two series, amounting 68 patients altogether, collected in epidemiologically homogeneous areas with high percentage of rural population without adequate medical control, are appraised. Due to the high rate of chronic lesions, particularly in the pre-CT scan era (1968-1975), radical excision was required in 70.6% of cases. Overall postoperative mortality was 14.7%: 7.3% during the hospital stay, mostly due to pyrogenic ventriculitis in patients with large deep located abscesses, and 7.4% for different complications, both intra- and extracerebral, at home or other institutions several months after surgery. 29% of patients recovered completely and 45.6% have only minor disability, only 10.3% remained severely crippled and dependent. The results of the surgery, both in terms of operative mortality and functional recovery seem to depend on the neuropathological background rather than on the kind of therapeutic procedure implemented. Even though it must be acknowledged that at present conservative and minor surgical procedures are more often successfully used, radical excision still appears to keep far from negligible indications.

The arginine vasopressin (AVP) concentrations were determined in plasma and in cerebrospinal fluid (CSF) during a 24-hour period in 7 male patients suffering from hydrocephalus of differing etiologies. Blood and ventricular CSF samples were simultaneously collected every 2 h during the day (08.00-22.00) and every hour during the night (24.00-07.00). In both plasma and CSF, the AVP levels did not show significant time-related circadian variations. No significant correlation was found between the plasma and CSF AVP values during the 24-hour period. The data obtained indicate the absence of the plasma and CSF AVP circadian rhythm in hydrocephalic patients and suggest that in these patients, and possibly in healthy humans, physiological stimuli which are able to induce variations in the plasma AVP concentration during daily life do not alter the CSF AVP content.

Plasma and cerebrospinal fluid (CSF) beta-endorphin levels were determined by a RIA method in seven hydrocephalic male patients. The samples were simultaneously collected every two hours from 8 AM to 12 midnight and every hour from 1 AM to 7 AM. In both plasma and CSF beta-endorphin levels showed significant time-related variations during the 24 hour period. These results suggest the existence of diurnal CSF beta-endorphin variations analogous to those observed in plasma.

A modified Holter Rickham reservoir which permit the percutaneous photodynamic treatment of cystic malignant brain tumors, is described. Through this device it is possible to introduce in the tumoral cyst both the photosensitizer drug and the optical fibers, carriers of the light in order to induce the photodynamic process. This treatment, if necessary, can be repeated over and over again, simply through a skin perforation.

In normal subjects somatostatin cannot modify the plasma levels of prolactin when they are in a normal range or when they are pharmacologically increased. In the case of pituitary adenoma (prolactinic or eosinophilic), the response of prolactin to somatostatin varies widely. In some patients there is a marked decrease of the prolactin levels while in others no modification is observed.

SUMMARY Eight adult male patients suffering from hydrocephalus of differing aetiologies were investigated in order to detect the existence of diurnal variations of prolactin (PRL) concentration in human cerebrospinal fluid (CSF). Blood and ventricular CSF samples were taken every 2 h during the day (0800–2200 h) and every hour during the night (2300–0700 h). CSF mean PRL levels showed significant nyctohemeral variations with low levels (2·1 ± 0·3 ng/ml) during day-time and higher levels at night (3·3 ± 0·1 ng/ml), similar to that observed in serum (PRL values: 16·4 ± 5·2 and 24·8 ± 4·3 ng/ml during day and night periods respectively). The presence of a 24 h CSF PRL secretory profile similar to that in serum was shown in six patients with normal 24 h mean PRL values and normal diurnal changes in serum. In two patients with an altered serum 24 h secretory pattern no significant nyctohemeral variations in CSF PRL levels were found. Present data show the existence in man of nyctohemeral variations in CSF PRL content related to the 24 h changes of PRL levels in serum.

A sharp increase in serum and CSF prolactin (PRL) values after acute metoclopramide (10 mg i.m.) administration was found in six male patients without endocrine diseases. Peak values occurred simultaneously in serum and in CSF. This finding suggests the possibility that CSF PRL content depends also on the retrograde transport from pituitary gland.