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It has been found that three alkaline Immobilines (out of seven weak acids and bases used to generate immobilized pH gradients), having pK values of 6.2, 7.0 and 9.3, act as cross-linking agents, aggregating and precipitating out of solution ferritin and other large macromolecules (e.g., from serum and tissue extracts) present in body fluids and human biopsies. All the acidic Immobilines (pK 3.6, 4.4 and 4.6) and the basic species of pK 8.5 appear to be unreactive. The three precipitin Immobilines mimic cationic detergents, acting on the basis of two different principles at the opposite extremes, by ionic interaction at one end and by hydrophobic bonding at the other end of the molecule. The ionic type of interaction was clearly demonstrated, owing to its sensitivity to pH extremes and to progressively increasing ionic strength. The hydrophobic interaction in the region of the double bond (Immobilines are N-substituted acrylamido acids and bases) was deduced on the basis of the following observations: (a) oxidation of the double bond with introduction of a vicinal diol totally inhibited ferritin aggregation; (b) addition of SH groups to the double bond increased protein precipitation and (c) the protein-Immobiline aggregates were found to be sensitive to alkyl-substituted ureas (especially ethyl- and propylurea), which are known to bind to hydrophobic regions of proteins, and insensitive to urea, which is known to split only hydrogen bonds. Interestingly, neutral and zwitterionic detergents were unable to split the Immobiline-ferritin complexes, suggesting that their large micelles could not have access to the tightly packed Immobiline cross-linking region.

Percutaneous fine-needle aspiration biopsy of solid adrenal masses was performed under real-time sonographic guidance in 18 patients. Cellular material was aspirated in all cases. Cytologic examinations were correct in 11 metastatic deposits, three primary adrenal adenocarcinomas, and one pheochromocytoma. One subsequently proven primary adenocarcinoma was not diagnosed. In two cases of adenoma, normal adrenal cells were aspirated. Percutaneous aspiration of adrenal masses is recommended when the precise nature of the lesions is clinically required. The simplicity and speed of fine-needle aspiration biopsy under sonographic control and its high diagnostic accuracy and safety suggest its use as a routine procedure in the management of patients with adrenal masses well depicted by sonography.

A 49 year old woman with syphilis of recent onset was repeatedly admitted to the hospital on account of recurrent dyspnoea and hemoptysis. The symptoms and radiological signs indicated the presence of a "cardiac lung". The ECG disclosed right ventricular overload which was confirmed by echocardiography. The left heart was normal, not only on echocardiography but also on cardiac catheterization, which documented severe pulmonary hypertension, partly precapillary, partly postcapillary. The presence of chronic lung congestion in the absence of pathological findings pertaining to the left heart lead to the diagnosis of pulmonary venous occlusive disease. However, pulmonary angiography showed notable and widespread arterial amputations which are not present in this syndrome. Autopsy provided the correct diagnosis: sclerosing mediastinitis localized at the hilum with prevalent involvement of both arterial and venous pulmonary vessels.

The uncommon observation of alternation of the first heart sound in intensity, associated with mechanical and electric alternans is reported in a patient with cardiac tamponade due to large hemorrhagic pericardial effusion. Following pericardiocentesis and removal of 400 millilitres of fluid, all alternation phenomena disappeared. The combination of three alternation phenomena may be a helpful physical diagnostic sign of cardiac tamponade. The possible mechanisms of the "alternans" are discussed. It is suggested that variations in ventricular filling and emptying are the relevant pathogenetic factors.

The apparent diffusion coefficients of proteins in carrier ampholyte isoelectric focusing (CA-IEF) and in immobilized pH gradients (IPGs) are strongly dependent on the amount of buffering ions present in the system. However, whereas in CA-IEF increased levels of ampholytes facilitate diffusion, in IPGs they strongly quench it. It is concluded that a protein in an IPG matrix is isoelectric but not isoionic, in the sense that it forms a salt with the surrounding ions bound to the polyacrylamide matrix. This salt formation is beneficial as it greatly increases protein solubility at the pI. It is suggested that, when performing zymograms in situ, the IPG gel should contain at least twice the standard amount of Immobiline, so as to keep sharp enzyme bands even with prolonged incubation periods.

A novel method is described for casting immobilized pH gradients in polyacrylamide gel rods of small diameter (2 mm), based on the principle of rotational centrifugation. The tubes are filled vertically with equal volumes of dense and light solution (250 microliter each) titrated to the extremes of the desired pH gradient, and then tilted at 2.5 degrees to the level. After 5 min at rest, to allow for sliding of the two menisci to equilibrium position, the glass tubes are rotated for 3 min at 180 rpm, followed by an additional 3 min at 180 rpm by reversing the sense of rotation. A homogeneous linear gradient is thus produced. The rotating platform is then raised to 90 degrees and the gels allowed to polymerize under standard conditions. Formation of linear and reproducible pH gradients is ensured by using stabilizing density gradients of low viscosity (0-5% glycerol, having a maximal ratio viscosity/density of 1.1).

Within the multicentre trial of the Italian Group for the Study of Streptokinase in Infarct (G.I.S.S.I.), a particular study was planned for the analysis of plasma creatine kinase curves (CK). Serial measurements of total plasma CK from 11,806 pts (5.905 treated with Streptokinase (SK) and 5,901 control pts (C)) were evaluated by the compartment method (Fig. 7), which is commonly used in pharmacological studies. By this method, the plasma enzyme curve is interpreted on the basis of the following kinetic parameters: the fractional rate of input (Ki) and of disappearance (Kd) of enzyme into and from the blood; the plasma cumulative CK activity (Dp); the time interval between the onset of symptoms and the beginning of the ascending CK curve (To); the time from To to the peak CK (Tp). The Dp/Ki ratio was employed for the estimate of myocardial infarct size. From the available data, acceptable CK curves could be derived in 7,632 cases (3,568 treated with SK, 4,064 control pts.). Compared with control group (Fig. 1--Tab. I) the SK treated pts presented increased Ki and Kd values and reduced To, (p greater than 0.001), Dp/Ki (p greater than 0.05). The earlier SK treatment was started, the higher difference (Fig. 2) was observed between the two groups (SK and C). No significant difference was found between the two groups (SK and C) with regard to sex (Fig. 3), age, history of previous myocardial infarct, re-infarction, early post-infarction angina. Statistically significant similar differences of the above parameters between SK and C groups, were also found when various infarct locations were considered, with the only exception of not-Q infarct (Fig. 4). In the cases complicated by pericarditis (Tab. II, Fig. 5), independently of treatment, reduced reperfusion related indexes and increased Dp/Ki ratio were observed. Severe left ventricular impairment (Killip class 4) tends to reduce (Tab. III) the differences in enzyme parameters between the two groups (SK and C). The patients who died (18 hours after the onset of symptoms) exhibited as the only significant difference compared to survivors the infarct-size related CK parameters (Dp/Ki), independently from the treatment. The mathematical model used in this study proved to be easily feasible and useful for the evaluation of the effect of the treatment in acute myocardial infarct.(ABSTRACT TRUNCATED AT 400 WORDS)

The classification of benign stenosis of Vater's ampulla is explained and reference is made to 5 years' experience in this field. The preoperative diagnosis of this condition is discussed and an account is given of the results obtained and the postoperative course. Attention is drawn to the very low incidence of postoperative pancreatitis with respect to the surgical methods employed. This incidence is evaluated in the conclusions reached.

Intraventricular conduction disturbances (IVD) were found in 181 (21,9%) out of 828 patients with acute myocardial infarction. Isolated RBBB was present in 6,3% of cases; both RBBB and LAH or LPH in 3,4%; isolated LAH in 5,8%; LBBB in 3%; suspect blocks of the three brances [RBBB+LAH+first degree atrio-ventricular block (AVB), or LBBB+first degree AVB] in 2,9% of cases. The severe mortality (41%) during hospitalisation of patients with IVB seems to be due to the haemodynamic impairement: cardiogrnic shock was observed in 20% of these patiens and acute pulmonary oedema in 18%. Transient or permanent complete AVB occurred during hospitalisation in 24,3% of these patients. The occurrence of complete AVB was higher (54%) in patients in whom suspect block of three branches was present. It was found that the progression of IVD to complete AVB increased the mortality rate to 48%. The short term prognosis of patients with IVD does not seem to be improved by prophilactic electrical stimulation, but the rate of deaths for asystolia is reduced. The mortality rate after one year of patients discharged from hospital was 25%; suspect three branches IVD died suddenly and 2 progressed to complete AVB. In the author's opinion the implantation of permanent electrical stimulation is indicated in patients showing IVD of the three branches assessed using His bundle electrgram during the acute phase of myocardial infarction.

We have studied bone marrow CFU-GM growth behaviour in agar in 7 patients with smouldering Leukemia (SL) in order to test prognostic value of CFU-GM assay to identify patients at high risk of progression to acute nonlymphocytic leukemia (AnLL). By means of the criterion of "topographic scoring at two sequential times", we have estimated bone marrow CFU-GM percentage distribution spectrum, a parameter independent of aggregate absolute number. Basing on our growth data, we have distinguished SL with low colony growth and SL with high cluster growth without colonies. If evaluated quantitatively, these data are not correlated with clinical evolution; if evaluated qualitatively, as percentage distribution spectrum, they are correlated with rapid progression to AnLL. With this work we show that bone marrow CFU-GM distribution spectrum is a suitable parameter to study the disorder of granulocytic line in SL.