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Besides the increasing costs of health technologies and the epidemic and demographic transactions, the causes of the current inadequacy of resources in the health field are also to be ascribed to people changed expectations toward nursing and medicine. Such aspects have put in a critical position the working of the health services, which are incapable of facing the escalating and relentless health expenses. The evidence-based approach to the clinical practice and the following output of guidelines as a solution to the rationing of health services, may, in someone opinion, make headway towards the control of expenditure because it allows a synergy between optimal and basic principles. The reasoned use of the resources does not only presuppose that nurses can decide, as far as the patient is concerned, what is strictly necessary and at the same time most effective to the fulfillment of the nursing needs which have been pinpointed; nurses should also commit themselves to organise for the best, according to their level of responsibility, the scenario where clinic decisions are taken and to affect the guidance processes of the strategic choices of the institution they are part of. Nurses, as other professional do, have to honour also a commission which implies, on different levels, to take on an executive function, a teamwork function, an active and responsible cooperation in the working of health service. A superficial and cursory use of the guidelines as an allocation of resources might, on the other hand, raise objections in the name of ethics: health cannot be treated as a commodity, nor can health be subjected to market laws of supply and demand. The degree of legitimation of a health policy must therefore derive from the degree of harmonization and coherence between an evidence element and a social and cultural context where both have to be put a test.

Ultrasonography (US) plays a major role in the study of the anterior and lateral abdominal wall. Our experience refers to 150 patients examined over a 5-year period, who were divided into two groups according to disease etiology: 72 patients suffered from iatrogenic and 78 from non-iatrogenic conditions. The first group was mainly composed of alterations caused by anticoagulation therapy, e.g., hematomas, and recent or previous surgery, i.e., 19 incisional hernias and 19 inflammatory-abscess processes. The second group included above all 32 cases of abdominal wall hernia, 18 neoplasms, 13 traumas with abdominal wall involvement only and 12 inflammatory processes. US yielded valuable pieces of information to diagnose iatrogenic conditions, even for small or non-relevant conditions. Moreover, US allowed non-iatrogenic conditions to be located and identified, accurately demonstrating abdominal wall layers involvement. US was also very useful in the patients whose physical examination is of no use or difficult, e.g., in the patients with much pain and trauma or obese patients. CT was used in selected cases only, as a complement to US, when a more detailed spatial assessment of wide or deep lesions was necessary.

This study was aimed at studying the normal morphology of the main extrapelvic trunk of the sciatic nerve, its average size and its anatomo-topographic relationships by means of high resolution US. The involvement of the sciatic nerve in traumas was also investigated. The lower gluteal region and the posterior aspect of both thighs were examined in 30 healthy subjects and in 11 patients with recent or previous traumas. The sciatic nerve is clearly demonstrated, on US images, between the biceps femoris muscle and the semimembranosus and semitendinosus muscles. The average dorsoventral diameter of the nerve is 6.4 mm at the upper third and 4.8 mm at the middle third of the thigh, while its average transverse diameter is 11.8 mm at the middle third of the thigh. In traumas, US demonstrated compression and displacement of the sciatic nerve in 6 recent hematomas and in 2 hypertrophic ossei calli of the femoral diaphysis. In 2 osteomyelitis cases with a posterior thigh fistula, US showed sciatic nerve involvement by the phlogistic process. Moreover, US allowed an old thick thrombosis of a satellite vein of the sciatic nerve to be depicted. In conclusion, the present study has demonstrated that US not only clearly depicts the sciatic nerve but also provides accurate information on its involvement in recent or previous traumas.

Sonography is currently considered a very useful technique for the study of inflammatory-abscess conditions in superficial soft tissues. The authors report their experience with US in the study of 22 patients. In 15 of them a comparison was made with X-ray findings, in 4 with fistulographic and in 2 with CT results. US allows the abscesses to be evaluated in both their morphological structure and anatomical topography. US has proven especially useful in correctly evaluating both complete and incomplete fistulas, as well as in revealing foreign bodies. The US pattern of an abscess often confirms clinical diagnosis for it supplies further and more accurate information. Moreover, US sometimes allows an abscess to be demonstrated even when the latter was missed at clinics. However, the differential diagnosis with malignant neoplasm is difficult and sometimes a decision can be made only by means of other diagnostic imaging modalities.

The therapeutic effectiveness and the tolerability of a collagenase-chloramphenicol ointment were studied on a group of 20 patients (mean age 73.4 +/- 13.6 years, range 25-88 years) with lower limb ulcerations of various origin. The ointment proved capable of favourably influencing the debridment and the healing process of these lesions. Statistically significant improvements were observed after days of treatment for debridment, inflammation and granulation, after eight days for the lesion size and after ten days for epithelization. Tolerability was very good.

This study was undertaken to assess the risk of developing complete heart block during general anesthesia in patients with bundle branch block. His bundle electrograms were recorded during sinus rhythm and after atrail pacing in 11 patients (5 LBBB, 2 RBBB, 3 RBBB and LAH, 1 RBBB and LBH) before and after administration of Pentothal 0.20 g e.v., Succinylcholine 1 mg/kg e.v., and breathing of fluothane 1%or Ethrane. Minimal effects on sinus functions and A-V node conduction was observed during anesthesia; Fluothane only increased slightly AH intervals (+11%). Both Fluothane and Ethrane effects on HV conduction was insignificant. In 9 patients HV intervals increased of 5% after Succinylcholine; 2 patients developed a complete heart block distal to his after the drug. Possible causes of the complete heart block are discussed and a direct effect of Succinylcholine is hypothesized.

Gastric polyps are benign tumors which have been less uncommonly detected in recent years, due to the refinement of both radiologic and endoscopic investigations. From 1981 through 1985 gastric polyps were detected in 102 patients (1.9%) out of 5368 radiologic examinations. In the same period, 98 cases (3.3%) were detected out of 2942 endoscopic examinations. The comparison of data in these two series shows a superimposition. Despite an increased percentage of endoscopic findings (to some extent due to previous radiologic reports), the authors assert the diagnostic efficacy of double contrast radiologic investigation as a first approach to benign polypous lesions of the stomach. As far as histology is concerned, a clear prevalence is shown of hyperplastic versus adenomatous polyps (90 and 8 cases respectively).

The value of US in the diagnosis of the alimentary tract diseases is discussed on the basis of a personal series of 116 cases, including 58 lesions detected by US as first investigation. The findings observed are: signet ring; pseudokidney or cockade; tram lines; solid mass; pseudokidney + solid mass. The value of the method is stressed in the staging of malignancies, in the evaluation of palpable masses, in the correct interpretation of some phlogistic diseases and in the follow up. Finally, emphasis is given to its high possibility of topographic definition. US are more and more employed in the diagnosis of abdominal diseases. Concerning the alimentary tract they still remain an investigation complementary to radiology and endoscopy. But the author's opinion is that, when employed a first investigation, one should not exclude the systematic detection of any possible unknown lesion of the alimentary tract: a good example are the 32 positive cases (24 neoplastic) in the present report.

The US findings are reported of 91 cases of abdominal lymphadenopathy examined by either histological or instrumental check-up, or follow-up. Adenopathies were classified according to etiology, which was lymphomatous or leukemic in 19 cases, metastatic in 56, and reactive or inflammatory in 16. Lymph node involvement was most frequent in porta hepatis, periportal and peri-aortocaval locations. US findings allowed a diagnostic approach to be planned based on number, size and morphology of adenomegalies, as well as on the involved lymph nodes. In the porta hepatis and periportal areas, adenomegalies were most often due to neoplastic metastases of the alimentary canal, and to inflammatory-reactive disorders. Adenopathies in the peri-aortocaval area were most often due to systemic and to severe neoplastic metastases having their primary location even out of the alimentary canal.

The nuclear DNA content of neoplastic cell was measured in 30 cases of carcinomas of the human breast. The normal lymphocyte was used as a reference for the DNA value corresponding to a diploid number of chromosomes. Samples from the same cases were embedded in paraffin and stained with haematoxylin and eosin. The nuclear DNA content is compared with the histological malignancy grading following Bloom and Richardson.

Two cases of breast carcinoma observed four years after breast biopsy for fibrocystic mastopathy are presented. These two cases have been subjected to microspectrophotometric measurement of cell DNA as an objective test for the evaluation of risk in breast fibrocystic disease. Tissue specimens of the two carcinoma cases showed in some lesions aneuploid DNA, while control groups always showed a typical diploid situation. This technique is suggested when epithelial proliferative pictures in adenose-cystic mastopathy seem to reach serious histopathological levels.

Accessory spleens mean autonomous masses of normal splenic tissue that can occasionally be found, and cause problems in differential diagnosis. Scintigraphy and angiography allow a correct diagnosis in oversized splenic nodules. On the other hand, echography is presently given a basic diagnostic value. The authors report their experience on 5 accessory spleen cases, fix the necessary standards for ultrasonic diagnostic value of this investigation and its present importance in the particular field of accessory spleens.