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The authors review the literature during the past ten years relating to the onset of retroperitoneal hemorrhage during heparin treatment. The phenomenon may be attributed to a thrombotic genesis involving the adrenal glands and may or may not be correlated to the presence of heparin-induced immune phenomena. The severity of the phenomenon is readily understood: given that the pathology is heparin-dependent, suspension of heparin treatment is the first main step to be taken; this is evidently a cause of risk in relation to the pathology that imposes the use of heparin. The rarity of this complication means that, according to the authors, it has been undervalued. They report three cases which were brought to their attention over the past three years. On the basis of their experience, the authors underline the importance of knowing the causes that are supposed to be responsible for the complication and the study of blood coagulative status. In order not to overlook the possible adrenal genesis of the phenomenon they also recommend a careful exploration of the adrenal glands when faced with a retroperitoneal hematoma in which the source of hemorrhage cannot be identified.

Unstimulated and pokeweed mitogen (PWM)-stimulated "in vitro" IgM synthesis by peripheral blood lymphocytes has been evaluated by an ELISA method in 33 patients with juvenile rheumatoid arthritis (JRA). Lymphocyte PWM responses were significantly reduced in patients with JRA compared with healthy controls. When patients were divided according to disease activity, a significant increase of stimulation index (ratio of IgM synthesis with over that without PWM) has been observed in patients with disease remission compared with those with active disease. These findings confirm the defect in PWM-induced IgM synthesis by peripheral blood lymphocytes of patients with JRA and suggest that these abnormalities may be related to disease activity.

No organism from the cradle lives germ-free or allergen-free. The modalities by which infections facilitate conditions of abnormal reactivity, in particular respiratory asthma and allergy to cow milk proteins, are examined. 216 asthmatic children and 50 infants with rotavirus enteritis have been considered. Infections, besides representing stimuli directly projected on the immune system, also constitute factors which more generally influence the way of reacting.

After an examination of the literature regarding the causes of lesions from rays, their most frequent sites, the diagnostic difficulties and the various types of treatment, the paper draws attention to the increase in such lesions in relation to the use of megavoltages, and the advisability of exploratory laparotomy in previously irradiated subjects even in cases apparently labelled as neoplastic relapses.

Following a review of the literature, 2 cases of angioimmunoblastic lymphadenopathy with dysproteinaemia are reported. Anatomo-pathological examination of the lymphonodes shows widespread change in the structure with vascular and lympho-immunoblastic proliferation and deposit of amorphous eosinophil substance. The most significant clinical and morphological aspects are reported and these are related to the therapeutic response. The effectiveness of cortisone therapy is shown by comparison of laboratory examination data at admittance and after three months.

Starting from one case of Gardner's syndrome of their own observation, and in light of Watne's results, the authors argue that in the syndrome just named--and in familial polyposis in a broader sense--genetic factors do not play a predominant role; rather, polyps seem to result from the prolonged action of noxious agents. At any rate, said action can be neutralized, and possibly prevented either with a surgical modification of the distal gut or by treatment with a chemical substance identified as ascorbic acid. In view of these considerations, the authors recommend preventive medical therapy.

A computerized database for patients with juvenile rheumatoid arthritis (JRA) is presented. The program has been developed using PRIST (Patient Record Information System Tool), a flexible tool specifically oriented to clinical data management. The database consists of three main sections: the fixed record devoted to anamnestic data, the periodic record collecting the clinical, laboratory and instrumental data and the balance record devoted to a periodic balance of the disease course. The major advantages of our database are: time saving data handling, elastic procedures and easy retrospective data collection.

Two cases of congenital cyst of the presacral space in the adult are presented. The unusualness of the lesion is stressed, and reference is made to the usefulness of a classification covering all retrorectal neoformations, including congenital forms. Attention is given to the manner of diagnosis. Variations in the surgical technique employed depend on the clinical and anatomical picture, and the potential inflammatory and degenerative aspects of the lesion. Emphasis is placed on the absolute need to section the sacrococcyx to prevent recurrences.

A case of hydatid cyst of the breast is reported. Stress is laid on its extreme rarity, the aspecificity of its symptomatology and the importance of considering this type of pathology in the differential diagnosis of cystic conditions of the breast.

Avascular necrosis (AN) of bone is a complication of systemic lupus erythematosus (SLE). In the present paper we describe two patients with SLE who presented an AN of femoral condyles 18 months and 2 years respectively after the diagnosis of the disease. In the second case, together with the destructive change of the symptomatic knee, X-ray films showed an initial involvement, still asymptomatic, of the contralateral knee.

The authors, on the basis of their experience on two cases of cardiac tamponade, and from the revision of literature, retain that immediate thoracotomy, followed by re-examination of the pericardial sac and myocardiorrhaphy, represents a treatment preferable to the evacuant pericardiocentesis, confining the latter only to diagnostic conditions and immediate decompression in cases which arrive in unequipped places.