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This paper investigates the ceramide composition of the psoriatic scale compared with that of normal human SC. A method was optimalized, based on TLC separation followed by densitometry, allowing the provision of good resolution and quantification of ceramide fractions from both normal and pathological specimens. Seven ceramide fractions were isolated and submitted to compositional analysis. The obtained results suggested a revisitation of previous ceramide designation. Therefore a simple classification is suggested, based on grouping ceramides carrying structural similarities under common codes. According to these rules, ceramides were grouped into five classes designated as: (1) Cer[EOS], which contains ester-linked fatty acids, omega-OH fatty acids and sphingosines; (2) Cer[NS], which contains non-OH fatty acids and sphingosines; (3) Cer[NP], which contains non-OH fatty acids and phytosphingosines; (4) Cer[AS], which contains alpha-OH fatty acids and sphingosines; (5) Cer[AP], which contains alpha-OH fatty acids and phytosphingosines. Analysis of ceramides from the psoriatic scale, compared to those from normal human SC, resulted in an impairment of the Cer[EOS] content as well as of the ceramides containing phytosphingosine, with concurrent increase in ceramides containing sphingosine, being the total amount maintained identical. Since one of the suggested pathways for phytosphingosine biosynthesis involves the water addition to the corresponding sphingosine double bond, we can speculate that the observed alteration is due to a deranged water bioavailability, associated with psoriasis.

In allergic rhinoconjunctivitis not only the nasal mucosa but also the conjunctiva and, in severe cases, the cornea are affected by reactive phenomena. This pathological process is often encountered in clinical practice, its incidence ranging from 10% to 30% of the whole population, as reported by many authors. Up to now, the pathogenetic mechanisms of allergic reactivity are not completely understood. In our opinion this is due to insufficient standardization of the diagnostic procedures; even the clinical picture of such a pathological process seems to be insufficient, especially with regard to the analogies between the nasal and conjunctival pathologies. To a great extent this depends on the different clinical pictures both in otorhinolaryngology and ophthalmology. Our study has been carried out on 98 patients suffering from rhinoconjunctivitis, and presents an accurate documentation with regard to the existence of analogies in reactivity at the immunoallergic level, in both the nose and conjunctiva. These are evident when we refer not only to specific routine allergological tests but, mainly, to local examinations. The evaluation of the selected data enables us to formulate a single classification of allergic rhinoconjunctivitis, taking into account the common reactive phenomena.

A study was carried out on 110 patients with various diseases related to chronic inflammation of the tonsils and to hypertrophic adenoids. Sixty-two of these patients underwent adenotonsillectomy, while the others were followed clinically and, where necessary, given medical treatment. At the first observation the patients were between the ages of 2 and 12 (mean age 6.1 years). At the start of the present study the patients ages ranged from 10 to 22 (mean age 17 years). Clinical follow-up was carried out on the patients 2 and 7 years after the first observation and/or adenotonsillectomy. The patients were divided into homogeneous groups according to the severity of symptoms. The A.A. evaluated changes of the following clinical parameters: annual frequency of inflammatory pharyngotonsillar episodes, nasal respiratory obstruction, sore throat, otologic pathology. Evaluations were carried out statistically in each group. After more than 7 years from surgery, the significant reduction of various diseases related to chronic inflammation of the tonsils and to hypertrophic adenoids, in accordance with the findings after 2 years from surgery, underline the effectiveness of adenotonsillectomy in correctly selected candidates.

In a previously reported study on the anti-photoageing effects of topical tretinoin, the following regimen produced good patient compliance: 0.01% for 1 month, 0.025% for 1 month; and 0.05% for 4 months. The majority of patients (60/89) enrolled in the initial study continued to apply the cream to the face, and a further 140 patients were enrolled for a long-term study (mean duration 2 years). The prolonged study showed that 91.4% of patients used tretinoin in an attempt to slow down skin aging, and 8.6% sought subjective skin benefits. Of the 163 patients who completed the study, 58.8% sought an improvement of wrinkles, 30.1% skin trophism and 14.7% reduced pigmentation. The product was used throughout the year by 66.9% of patients, but 8.0% stopped using it during the summer. A daytime moisturizing cream was required by 77.9% of patients, and 82.8% used a sunscreen in the summer. Tretinoin was applied to other areas of the body by 63.8% of patients.

Esophageal voice obtained through logopedic treatment and speech produced by electronic prostheses is the principal means of verbal communication of laryngectomized patients. Several factors condition the success of logopedic rehabilitation: entity of hypopharyngeal surgical exeresis and scar repairing modalities; rehabilitation technique employed; patient's skill in controlling pharyngo-esophageal tract and articulation organs; patient motivation. A previous study executed by our School reported that only the 20% of the patients who did not practise logopedic therapy employed the laryngophone. Reduced use of electronic prosthesis depends on three factors: acoustic products of poor quality; evidence of anatomic and functional impairment pointed out by laryngophone use; limitation of manual activity during phonation. Electronic prostheses have a precise indication in the following cases: immediately after surgery; in case of logopedic treatment failure and when tracheo-esophageal prosthesis are contraindicated; when the esophageal voice has an insufficient volume or in noisy environments. Finally indicative criteria to introduce patients to the most suitable rehabilitation modality are reported.

The Authors show their original technique for the differential diagnosis of cochlear and retrocochlear hearing loss which employs ipsilateral masking of the A.B.R. in order to define the difference in V wave latency between a standard technique (clicks at 21 pps without noise) and a sensitized technique (clicks at 21 pps with noise at S/N of +40). This difference in latency has been named Sensitizing Latency Difference (SLD). Sixty normal subjects, 85 patients with cochlear hearing loss and 6 with retrocochlear hearing loss, were studied. The obtained data showed a SLD value: in normal hearing of: a) 0.31 msec. (+/- 0.14 SD) from 18 to 40 years old; b) 0.36 msec. (+/- 0.26 SD) from 41 to 60 years old; c) 0.48 msec. (+/- 0.21 SD) over 60 years old; in patients with cochlear hearing loss 0.12 msec. (+/- 0.14 SD) in 2 subjects affected by retrocochlear hearing loss a value superior to 1.5 msec. in the other 4 cases the V waves disappeared during recording of the sensitized test. A differential value of 1 msec. between cochlear and retrocochlear hearing loss was established by the Authors who with this value correctly identified all the patients with retrocochlear hearing loss and 97.8% of the subjects with cochlear hearing loss. An incorrect diagnosis of the hearing loss origin (false positives) was made in 2.2% of the patients with cochlear hearing loss. In conclusion, the Authors feel that the SLD evaluation, in consideration of its large clinical utility and of the high reliability of obtained data, is a particularly useful test in making a differential diagnosis between cochlear and retrocochlear hearing loss.

The present work evaluates the results obtained in a group of 360 patients with laryngeal-glottic tumors (classification T1/T2-N0-M0) who, in the last 10 years, have undergone direct microlaryngoscopy surgery employing a CO2 Laser. In the T1 glottic carcinomas the neoplasm was limited to the vocal cord on one side or it involved the anterior commissure and, most likely, the vocal cord on the opposite side; in T2 glottic tumors the extension reached the hypoglottic region and/or the Morgagni ventricle and the false vocal cords on one or both sides but without compromising laryngeal motility. The five year healing rate for the T1 tumors proved to be 84.7% while it was 74% for the T2 forms. In 36 cases complications were found which can be broken down as follows: - limited local recurrences (13 patients) requiring subsequent direct microlaryngoscopy; - regional lymph node metastases (6 patients) without reproduction of the primary neoplasm; in general (5 of the 6 cases) these patients underwent lateral neck dissection; - spreading of the neoplastic process (17 cases) which made total laryngectomy with lateral neck dissection necessary; this procedure was performed in 15 cases. When these subsequent surgical procedures are also taken into account the percentage healing rises to 94.3% for T1 glottic tumors and to 84.9% for T2. Detailed analysis of the case study, comparison with the data found in the relative literature regarding patients treated with traditional techniques, a series of observations on the advantages and disadvantages inherent to the techniques employed have all led to the conclusion that the use of a CO2 laser in the treatment of laryngeal tumors gives excellent results in terms of prognosis. Moreover, this technique offers significant advantages over the traditional methods and constitutes a reliable technique for partial laryngectomies as long as the indications are accurately applied and the proper techniques used.

By making use of a twenty-four hour Holter monitoring, it as been possible to compute the acute cardiotoxicity of the cyclophosphamide + mitoxantrone + 5-fluorouracil (CNF) association in twenty oncologic patients (pts) each of whom being immune from organic cardiopathy emerging clinically and at their first cycle of chemotherapy. The following parameters have been computed: meaningful changes in the heart frequency; premature atrial and ventricular depolarizations, both as a first appearance and as a clear growth in the number; the ST dislocation entity; malignant ventricular arrhythmias. The administration of CNF at the doses of: 600 mg/m2 of cyclophosphamide, 12 mg/m2 of mitoxantrone and 600 mg/m2 of 5-fluorouracil , has caused a meaningful increase in the heart frequency on 6 pts (30%), an increase of premature atrial depolarization on 4 pts (20%) with an appearance ex novo on 2 pts (10%), an increase of premature ventricular depolarization, without any passing to superior Lown classes, on 2 pts (10%) with an appearance ex novo on 3 pts (15%). Although the results in the study point out a frequency percentage of simple hyperkinetic arrhythmias equal to the 55%, the lack of more serious hyperkinetic arrhythmias and of intense disorders of ventricular repolarization testified to a synergic effect as a determining factor on the acute cardiotoxicity of the previously discussed association, in our opinion.

An open clinical study was undertaken to evaluate the anti-photoageing efficacy of topical tretinoin. A length of cream of approximately 1 cm was applied to the face daily in the evening for 6 months: during month 1 of therapy 0.01% tretinoin cream was administered; 0.025% was given during month 2; and 0.05% was given in months 3-6. The clinical symptoms of photoageing (coarse wrinkling, fine wrinkling, skin thinning, mottled hyperpigmentation, laxity and xerosis) were evaluated before and after therapy. A total of 19.1% of patients withdrew from the study; only 5.6% were for treatment-related reasons. At the end of the treatment period all the clinical parameters, except xerosis, were improved. The amount of improvement varied, but only 4.2% of patients failed to show any improvement. Tolerability was excellent in 51.4% of patients, good in 44.4% and fair in 4.2%, and compliance was excellent in 47.0% of patients, good in 48.5% and fair in 4.5%. Tolerability and compliance were improved by applying the same amount of cream each day but increasing the concentration of tretinoin over the 6-month period. Silicone skin replicas of the same area of skin taken before and after treatment, analysed by scanning electron microscopy, profilometry and computer image analysis, showed a decrease in the width of wrinkles, and an improvement in skin texture and follicle density.

Though currently conservative surgical procedures have an ever-growing importance in breast cancer treatment, there is still place for radical surgery. The Authors describe radical techniques and their indications. The surgeon must know how to choose the proper radical technique, when it is not possible to perform a conservative surgical procedure.

Five females with duplication of the short arm of one chromosome 9 are reported, one tetrasomic and four trisomic for 9p. The tetrasomy is due to an isochromosome 9p while the trisomies are due in one case to an intrachromosomal duplication present in lymphocytes but not in fibroblasts, two are secondary to translocations with chromosomes 22 and 13 respectively, and one is a mosaic with a cell line with an additional deleted chromosome 9 present in lymphocytes and fibroblasts. This analysis indicates that duplications 9p may result in impairment of ovarian function. The phenotypic differences between trisomy and tetrasomy 9p are discussed.

The effect of anti-rubella vaccination on lymphocyte proliferation kinetics in vitro and on SCE frequency was studied in three young women. The studies were carried out by taking blood samples before vaccination (day 0) and subsequently on days 7, 14, 28 and 42. The mitotic index (MI) shows a decrease at day 14 and 28 followed at day 42 by an increase above day 0 levels. The average cell cycle (ACC) shows a decrease at day 14 followed by an increase at day 28. Complex variations were also found in the percentage distribution of cells in the various division classes. The SCE frequency showed variations inverse to the MI. The whole picture seems to indicate the existence of changes in the lymphocyte population which can be correlated with immune response.

The study of skin reliefs attracted the attention of dermatologists because it may reflect development, assembly and functional activity of the stratum corneum--and therefore of the entire epidermis. Psoriasis is characterized by a deep alteration of surface texture: and this can be related to the severity of the disease. In this work we studied, by means of skin profilometry, the roughness parameters that better describe the distinctive features of psoriatic skin topography and the modification of psoriatic surface after topical therapy. For this purpose we analyzed psoriatic skin reliefs using silicone rubber replicas both before therapy and after coal-tar topical application. A statistically significant difference between uninvolved and psoriatic skin for Ra- but not for Rz- values was observed in replicas made before therapy. After therapy, replicas showed no significant difference either for Ra or for Rz values. The profilometric analysis of psoriatic skin can be considered a useful method to characterize psoriatic plaque and the improvement obtained by topical therapy.

A sample of 87 couples addressed to cyto-genetic analysis after the occurrence of one or more spontaneous abortions was studied. Reciprocal translocations were found in three couples. In reviewing the literature, the data were broken down and reassembled in order to estimate the translocation frequency in homogeneous samples. The conclusions of this re-examination is that for those couples with a history of frequent spontaneous abortions, a cytogenetic investigation is advisable, even if there have been no cases of still-borns or malformed children.