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Surgical therapy of thyroid diseases utilizes a collar-shaped transverse cervicotomic access. However, this access can be insufficient for a complete execution of operating plan. The authors suggest sternum thoracic and laterocervical enlargement of the operative filed. These two enlargements present several advantages and don't expose the patient to greater postoperative complications. Moreover, the surgeon can operate with higher safety in controlling inferior instestinal peduncolar and recurrent nerve. In case of latero-cervical access a complete dissection of neck is also possible.

The authors report their experience in clinical and instrumental diagnosis of primary varicocele, with regard to bilateral and subclinical forms. 54 patients affected by varicocele were evaluated comparing the results of clinical examination with those coming from scrotal ultrasonography and Doppler flowmetry of spermatic cords. Bilateral varicocele was found in 26 cases (48.2%); subclinical varicocele, monolateral or bilateral, was evidenced in 25 cases (46.3%). On the basis of this study clinical examination seems not to be ideal for the diagnosis of varicocele, particularly in view of a surgical or percutaneous treatment aimed at complete resolution of venous spermatic reflux.

Varicose veins present a major health problem, causing chronic leg symptoms and disability to a large segment of population. The prevalence rate in adults shows great geographical variations and increases with age. Several authors reported that most cases of primary varicose veins are due to valvular incompetence of saphenofemoral junctions. On the base of close physiopathologic and hemodynamic relationships between primary varicose veins and primary varicocele we decided to evaluate the continence of saphenofemoral junctions in a selected group of young men affected by primary varicocele. MATERIALS AND METHODS. 42 patients were included in the study. The age ranged from 13 to 55 years; the mean age was 28 years. In all cases a clinical and instrumental (ultranosography. Doppler flowmetry) diagnosis of primary varicocele was performed. Bidirectional Doppler flowmetry was used to evaluate the continence of 84 saphenofemoral junctions. RESULTS. Among the group of studied 36 (85.7%) showed a monolateral or bilateral valvular incompetence of saphenofemoral junctions; in the remaining 6 patients (14.3%) there was no evidence of valvular insufficiency. In 84 saphenofemoral junctions studied 52 (61.9%) were found incompetent, 32 to the left side and 20 to the right side. Moreover 2 patients had clinically detectable varicose veins of the lower limbs and symptoms related to chronic venous insufficiency. DISCUSSION. Varicose veins are one of the most prevalent chronic conditions in industrialized countries and places a considerable demand on the health services. Since this pathology is potentially preventable it seems very important to select within populations asymptomatic groups in which there is an increasing risk of chronic venous insufficiency and to perform a clinical and instrumental assessment, based on non invasive techniques. In the past varicose veins were related to other diseases and among them some authors suggested primary varicocele, that is due to venous spermatic reflux and/or valvular incompetence; furthermore varicocele and varicose veins are often familiar. In our 42 patients affected by varicocele only 6 (14.3%) had no Doppler flowmetry evidence of incompetence of saphenofemoral junctions and more than half (61.9%) of the junctions were found incompetent. CONCLUSIONS. In our experience we found a considerable relationship between primary varicocele and venous incompetence of saphenofemoral junctions. Perhaps these patients must be considered a group with an increasing risk to develop primary varicose veins. So we suggest that clinical examination and instrumental assessment should be performed in young men affected by varicocele, in order to obtain a prevention of chronic venous insufficiency of the lower limbs. Nevertheless this retrospective study has to be further confirmed by longterm prospective studies.

It is well known that a number of chemotherapeutic agents are able to induce procoagulating activity not only in neoplastic cells but also in normal, monocyte/macrophage cells, and some of them, including cisplatin, even increase procoagulating activity of the factor already expressed, providing a further example of the possible co-participation of chemotherapy in the onset of thrombotic complications in cancer patients. Carboplatin is an analogue of cisplatin but differs strikingly in terms of its collateral effects, in particular being less oto- and nephrotoxic. To the authors' knowledge there are no data regarding the possible effect of carboplatin on lympho/monocyte procoagulating activity. This study shows that not only platin but also carboplatin is able to increment the levels of lympho/monocyte procoagulating activity in vitro, with a dose-dependent effect, and to synergize with bacterial endotoxin in increasing this leukocyte activity, although the synergic effect is significantly greater in the case of carboplatin. The importance of these findings at a practical and clinical and clinical level still remains to be defined, in particular in the light of the different pharmacokinetic behaviour of these two chemotherapeutic agents and in the context of those neoplastic diseases for which cisplatin and carboplatin treatment is most frequently used.

It is well known that a number of antineoplastic agents are able to induce procoagulant cellular activity and tissue factor not only in neoplastic cells but also in normal, monocyte/macrophage cells, and some of them, including adriamycin, even increase procoagulating activity of the factor already expressed, providing a further example of the possible co-participation of chemotherapy in the onset of thrombotic complication in cancer patient. Epirubicin is an analogue of adriamycin but differs strikingly in terms of its collateral effect, in particular being less cardiotoxic. To the authors' knowledge there are no data regarding the possible effect of epirubicin on lympho/monocyte procoagulant activity. This study shows that not only adriamycin but also epirubicin is able to increment the level of lympho/monocyte procoagulant activity "in vitro", with a dose-dependent effect, and to synergize with bacterial endotoxin in increasing this leukocyte activity, although the effect is significantly greater in the case of adriamycin. The importance of these findings at practical and clinical level remains to be defined, in particular in the length of the different pharmacokinetic behavior of these two chemotherapeutic agents and in the context of those neoplastic diseases for which adriamycin and Epirubicin treatment is most frequently used.

Among available drugs, omeprazole is the one that cures gastric acid secretion-related pathologies, including reflux oesophagitis which responds poorly to H2-receptor antagonists, most rapidly and efficaciously. This marked therapeutic action is thought to reflect the drug's capacity to adequately control parietal hydrochloric acid secretion. Our data suggest an omeprazole effect on human neutrophil function too. Neutrophils are more or less a constant, and often conspicuous anatomo-pathological component of the phlogistic processes associated with gastric acid secretion. A direct or indirect effect exerted by omeprazole on leukocyte function would be of great scientific-biological and therapeutic interest. Furthermore, it would contribute to marking the drug superior in terms of more rapid relief of the symptoms and range of therapeutic action.

The diverticulosis of jejunum ileum is an uncommon pathology, that is often revealed just from the complications which it presents. The clinical case reported by the Authors describes a woman who reached to admission for a serious condition of shock secondary to a jejunum bleeding diverticulosis and who underwent an intestinal resection. The patient was discharged home on IX p.o. day. From the review of literature results that the incidence of the diverticulosis of jejunum ileum consists of 0.1%-0.11% of all the gastrointestinal's diverticula and the predominance is for the female, especially in the middle age. The diverticulosis of jejunum ileum can be congenital or acquired; the first one came to the antimesenteric side of the intestines, the second one to the mesenteric side of the same. The diverticulosis is generally asymptomatic, but often produces many complications as the intestinal occlusion, secondary to a bridle, a volvulus, an invagination, also if the peritonitis caused by a diverticulosis's perforation represents the most frequent complication of them. Others rarest complications are the massive haemorrhage of diverticula, the stagnant loop syndrome, the malabsorption's syndrome due to lack of B12 vitamin and growth of bacteria within them, the diverticulitis caused by infection. The therapy of all complicated cases of jejunum ileum diverticula is necessarily the surgery only and exactly the intestinal resection.

Turbidimetric specific techniques (turbidity end-pot measurement after thrombin addition to the plasma) are widely used for fibrinogen determination. This paper describes a series of tests performed with the aim of establishing a fixed-time kinetic method based on the above mentioned technique. It is know that 1st order or pseudo 1st order reaction are the most valuable for the kinetic determination of substrates. However for this procedures, in contrast to end-point techniques, enzymes with the highest possible Michaelis constant are required. If the Michaelis constant values for the pair fibrinogen/thrombin determined in artificial systems have a molarity in the order of 10(-5)/l when the measurement is made on plasma, antithrombins which are powerful thrombin inhibitors, increase the Michaelis constant to a molarity of 10(-2)/l. For the thrombin in the reaction mixture we have adopted an activity of 1.6 National Institute of Health (NIH) units/100 microliter of plasma; this activity is sufficiently high to induce instantaneous start of fibrinogen polymerization, without affecting the 1st order kinetic. The preliminary studies which have been carried out to evaluate this technique have shown the following characteristics: a) it is both accurate and precise; b) it requires simple and fast operations; c) it may easily be automated with a productivity of about 200 tests/hour on micro centrifugal analyzer.

We have explored the changes of plasma concentrations of antithrombin III and fibrinogen in patients recovering from major abdominal and cardiac surgery. In one group of patients subjected to major abdominal surgery we detected a statistically significant reduction of antithrombin III in the second and third postoperative day, followed by return to normal values in the fourth or fifth day. Fibrinogen, instead, increased to as much as 180% of the preoperative value in the first four postoperative days and reverted slowly to preoperative values between the fourth and the eighth day. In another group of patients subjected to cardiac surgery procedures utilizing the heart-lung machine, however, we found no significant reductions of antithrombin III in the early postoperative period. These results suggest the possible influence of local tissue factors affecting the plasma levels of antithrombin III differently in the two types of surgery under discussion. The patients subjected to extracorporeal circulation, on the other hand, showed a depletion of plasma fibrinogen down to less than 30 or 40% of preoperative values. This may reflect activation of coagulation processes and the considerable sequestration of fibrin at some interfaces of the heart-lung machine.