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Knowledge of axillary lymph node status is a key aid to staging and prognosis and it represents a guideline for adjuvant therapy in breast cancer. Despite the morbidity it causes, complete axillary dissection was long the mainstay of treatment. Sentinel lymph node biopsy has proved so reliable in the evaluation of node involvement that axillary node dissection is now generally performed when sentinel node biopsy tests negative.In this 3-phase study, 50 patients were enrolled to evaluate the learning curve of sentinel node biopsy (phase 1, September 1997-January 1998); 256 patients (age range 27-81 years) with infiltrative breast cancer (T3 cm, clinical N0) underwent level 1 lymph node dissection when the sentinel node tested negative at histopathology (phase 2, February 1998-March 2001); 221 patients with T3 cm underwent dissection of the sentinel node when it tested negative for metastasis (phase 3, April 2001-March 2005).The sentinel node was preoperatively detected in 98.6% of cases after peritumoral and intradermic injection of the radionuclide tracer and intraoperatively in 99% (90% with radio-guided surgery, 10% with vital staining). The sentinel node was positive in 15% of patients with T1 and metastatic in 65%.Our results are in line with the published data; therefore, the study will go forward to examine the role of the micrometastasis in the sentinel node and of in-transit tumoral cells.

Distance technologies have been advocated as a means of providing education and training to working professionals. Our data suggest that distance learning can move beyond downstream lectures to more comprehensive, educationally effective activities that enable students to apply instructional content and receive feedback from peers.

The Authors report their experience about 127 ductal carcinoma in situ (DCIS) of the breast. Guidelines for surgical treatment are: radiological or clinical diagnosis, tumor's extension, histological classification, grading and margin status. At the present the Authors prefer breast conserving surgery with tumor margin's study. They report their experience in the last seven years about sentinel node biopsy. Radiotherapy and endocrine therapy are indicated for selected patients; local recurrence after DCIS therapy is 8,1% on a 6,1 years follow-up.

Breast-conserving surgery is the treatment of choice for the breast cancer T3 cm. The local recurrence is a problem of diagnosis and consequent treatment. We enrolled, from 1987 to 2004, 1504 breast cancer. In 803 (53.4%) tumor with T3 cm we performed conserving surgery. The sentinel lymph node (SN) technique induce to limit the axillary dissection in patients T1a-b to the SN only if non metastatic and located to the first level, the dissection of the 1st level of the axilla in patients T1c-T23 cm and SN negative, complete axillary dissection in patients with metastatic SN or located to the 2nd level. Our percentage of local recurrence in the follow-up was 3.5% at 5 years and 6% at 10 years.

New models of care are proposed to reduce the costs of traditional hospitalization and to improve the utilization of resources in surgery. Day surgery is widely employed in breast surgery. In this study we report the conversion rate and causes in ordinary hospitalization and we identify some contraindications related to breast surgery in day surgery.A cohort study was performed on 306 patients operated on between July 1999 and December 2001 for breast lesions with uncertain interpretation at the clinical and/or instrumental examination. Those patients who lived at a distance of less than 50 km from the hospital, had a telephone, a suitable house, direct family support and, if necessary, could benefit from home health care in addition to hospitalization, were considered as eligible to day surgery. The kind of anesthesia and hospital admission were established after clinical, psycho-emotional, and socio-familiar evaluation of the patients by the surgeon and the anesthetist.A total of 250 excisional biopsies and 56 biopsies with a Mammotome were performed. Surgery was performed under local anesthesia in 278 patients and general anesthesia in 28 subjects. Observation exceeding 24 hours was only necessary in 10 patients reporting hypotension syndrome and anxiety. The conversion rate in ordinary hospitalization was 0.3%. Postoperative morbidity was 1%.Day surgery is an effective model of care in breast surgery for diagnostic and therapeutic purposes without axillary dissection. A good selection of patients, perfect interdisciplinary collaboration, and an efficient structural organization are necessary to control the complication and conversion rates of traditional hospitalization.

In the last 15 years, a rapid evolution occurred from the traditional hernioplasties toward prosthetic techniques, in Italy. Outpatient procedures under local anaesthesia are now most commonly performed. We report our experience with a personal modification of the sutureless mesh repair, called "held in mesh repair". From 1990 to 2003 we treated 3,520 cases of primary hernia with the "held in mesh repair". 2,370 patients were affected by a unilateral hernia and 575 by a bilateral one. Local anaesthesia was used in 92% of the cases, loco-regional in 6% and general in 2%. Sixteen (0.4%) hernias recurred after 2 years, while two further recurrences (total 0.5%) were observed after 3 years; three femoral pseudo-relapses (0.08%) occurred before the first postoperative year. An overall incidence of 1.3% of major complications were observed. One mortality case (0.02%) occurred 3 days after the operation for cardiovascular complications. The favourable results of the "held in mesh repair" and the simplicity of the procedure suggest that it can be considered a safe and reliable technique for most primary inguinal hernias.

We describe a laparoscopic hemisplenectomy that was performed to treat a 21-year-old patient with a large splenic pseudocyst located in the upper splenic pole. The diagnosis was made by computed tomography and ultrasound, and surgery was performed with ultrasound scalpel, clips, and fibrin glue. Surgery lasted 70 min and did not require blood transfusions. The patient was discharged on postoperative day 3, and at 28-month follow-up there were no sequelae or recurrences. The laparoscopic approach is a valid alternative to laparotomy because the integrated magnified view enables the surgical team to perform surgery in a much shorter time and with greater hemostatic accuracy than the traditional technique.

Molti studi hanno dimostrato la affidabilità della tecnica del linfonodo sentinella (SN) nella valutazione del parametro N nel cancro mammario tanto da indurre a limitare la dissezione ascellare alla biopsia del solo SN (SNB) in caso questo sia negativo. Dopo un periodo di messa a punto della tecnica di identificazione, biopsia ed esame istologico del SN (ottobre 97- gennaio 98) sempre seguita dalla dissezione completa dei tre livelli dell’ascella (ALND), abbiamo intrapreso uno studio per valutare la affidabilità di una dissezione limitata al solo I livello dell’ascella (FLND) in donne con T

The PHENIX detector is designed to perform a broad study of A-A, p-A, and p-p collisions to investigate nuclear matter under extreme conditions. A wide variety of probes, sensitive to all timescales, are used to study systematic variations with species and energy as well as to measure the spin structure of the nucleon. Designing for the needs of the heavy-ion and polarized-proton programs has produced a detector with unparalleled capabilities. PHENIX measures electron and muon pairs, photons, and hadrons with excellent energy and momentum resolution. The detector consists of a large number of subsystems that are discussed in other papers in this volume. The overall design parameters of the detector are presented. (C) 2002 Elsevier Science B.V. All rights reserved.

Consensus doesn't exist about the intraoperative cholangiography specially if is need in every one laparoscopic cholecystectomy either exclusively in case of anatomical doubts or suspect of injures or stones of the common duct. We have considered 450 patient subjected to laparoscopic cholecystectomy during 1992-2000. Patients suspicious to be affected by common duct lithiasis (28 cases) are subjected to ERCP with cleaning of the biliary tree. In 18 patients (4%) it has been necessary the laparotomic conversion; 176 patients (39%) have been subjected to intraoperative cholangiography, selected on anatomical regional disposition or anamnesis and biochemical and instrumental results (history of jaundice or gallstones pancreatitis, abnormal serum level of the biliary stasis biochemistry, common bile duct major of 8 mm, michrolitiasis of the gallbladder). In 7 cases (4%) we have discovered common bile duct stones. We don't attempt intraoperative cholangiography in every one laparoscopic cholecystectomy, but only in cases where we suspect presence of common bile duct stones either iatrogenic injuries or when we retain it necessary to clarify the regional anatomy. Unlikely just in patients where would be more useful, causes major risk of intra- and post-operative complications, it is very difficult, often impossible, to attempt the intraoperative cholangiography. Routinary employing of the intraoperative cholangiography could be useful just for a little number of patients, while selective employing reduce 60% the X-ray. Collaboration with the radiologist is able to reduce the mistaken on the interpretation of the radiograms.

The high mortality rates (20-30%) still occurring in some forms of acute pancreatitis demands adequate clinical and instrumental protocols in order to establish the most suitable therapeutic option to employ. The use of laparoscopic surgery can reduce hospital stay and time for functional recovery.The study enrolled 73 patients referring for acute biliary pancreatitis in whom staging with clinical, laboratory and instrumental criteria was performed. According to Ranson classification 63 patients (86.3%) had a mild-moderate acute biliary pancreatitis, 10 (13.6%) a severe one. In the first group laparoscopic cholecystectomy with retrograde cholangiography was performed within seven days of admission, in the second group surgical procedure followed medical treatment between eight and 30 days after the onset of the disease. No preoperative ERCP was performed.The rate of main biliary tract calculosis was 8.2% in group A: six cases all treated through laparoscopy. Two switches (2.7%) due to intolerance to the pneumoperitoneum, eight major postoperative complications (10.9%), and two deaths (2.7%) occurred and a mean hospital stay of 7.4 days was observed in group A versus 8.2 days in group B.The management suggested in this study for mild-moderate acute biliary pancreatitis showed consistent results with those of the recent literature, as far as morbidity (6.3%) and mortality (1.5%) are concerned. A higher number of severe biliary pancreatitis (10 cases) should be observed to assess the role of ERCP with endoscopic sphincterotomy rather than laparoscopic or combined treatment.

The reduced incidence of gastric cancer, due to a better patients surveillance and more accurate understanding of prophylactic measure, has allowed a detection of early stages as well as cancers with different origin cells. Either the difficulty of differential diagnosis or the various surgical and integrated approaches, make these neoplasm hard to enroll in standard treatment protocols. Our experience consists of 5 clinical cases with four different histology: lymphoma, leiomioma, carcinoid and gastrinoma. A rare case of secondary involvement of the stomach by an adrenal adenocarcinoma is also described. Lymphomas benefit of the surgical therapy only in early stages (IE, IIE), eventually associated to chemio- and radiotherapy, in relationship with local diffusion of the disease; gastric resection is more supported than gastrectomy. Polychemotherapy, with or without radiotherapy, is used for advanced stages (IIIE and IVE), leaving to surgery the role of controlling hemorrhagic or occlusion compliances. GIST have a different therapeutic approach: surgery represents the only choice since chemio- and radiotherapy have no benefits for the biological characteristics of such neoplasm. Surgery is the ideal choice for the carcinoids with some indications for chemio radiotherapy in the palliative surgery or in the relapsing. We emphasize the rarity of the secondary gastric neoplasm coming from the suprarenal glands. We analyze our diagnostic and therapeutic protocols, comparing them with the current literature.

Limbs phlebostatic ulcers are in many cases associated with perforator reflux veins often caused by post-thromboflebitis syndrome. The origin operation consisting in perforating vein interruption, described by Linton in 1938, allowed high quality exposition of these vessels and gave successful therapeutic results only affected by complications which prolonged hospitalisation. The most unfavorable prognostic factor was the need of performing an incision in skin sites affected by dermo-hypodermic degeneration induced by phlebopathy which inhibits post-surgery cicatrization. The therapeutic importance of reflux perforator vein interruption induced vascular surgeons to improve various procedures not affected by post-surgery complications and able to excise as much incontinent vessels as possible.By video-surgery and new surgery tools nowadays available, the Subfascial Endoscopic Perforating Veins Surgery (SEPS) was established as a feasible and valuable method. At present, there are many surgical techniques differing from each other for the tools and the subneurotic compartement from which the perforating veins start. The results obtained from 45 SEPS procedures performed on 45 patients presenting lymphodermatosclerosis or venous ulcers caused by chronic venous insufficiency have been retrospectively evaluated.Thirty-six patients reached ulcer healing within 4 weeks after the operation; 7 ulcers healed over a 2 month time, while for 2 patients no clinical improvement has been recorded yet.SEPS is a valid alternative to the Linton procedure and provides remarkable advantages both in economic and clinical terms since it yields a more rapid lesions healing of small incisions which makes it one of the most minimally invasive surgical technique.

Chronic venous insufficiency is a recurrent pathology, but affected patients often undergo clinical observation at a most severe and clearly symptomatic stage of the disease. In this late stage, therapy can only relieve symptoms of the disease which often lead to disability. In the clinical course of chronic venous insufficiency, phlebostatic ulceration constitutes a recurrent finding and it is responsible of compromising patients quality of life. The role of perforating veins, made refluxive by various pathogenic noxa, in the genesis of ulcerative lesions has been known since long time. For many years the interest in perforating veins surgery has been limited because of the several negative consequences of the operations. The possibility of modifying the hemodynamics of perforating veins compartment without causing post-operation complications by video-supported surgery, led to the debate on the role of these vessels in the chronic venous insufficiency. The phlebostasis non-invasive diagnosis uses imaging techniques consisting in tests which mostly are cheap, simple and easy to perform, thus representing the best early approach to the patient. It is widely thought that even though complex examinations are available, most precious information can be obtained by only two examinations: color-Doppler ultrasonography and, limitedly, plethysmography. By these diagnostic directions it is possible to better identify the site and the hemodynamic origin of the venous insufficiency.

Nowadays oncologic surgery is defining new criteria in the treatment of rectal cancer: preservation of sfincterial function, ultra-low resections with distal margin at only 2 cm distally to the tumor, role of mesorectum as preferential site of lymphatic diffusion, preservation of lombo-aortic and pelvic nerves. Laparoscopy is showing good results in bowel surgery so as previously got on biliary tract: less visceral manipulation, less stimulation of immunologic system, less pain, early resumption of peristalsis and food intake, better recovery, less hospital stay. We experimented on pig ultra-low laparoscopic resection of the rectum, with preservation of sfincterial function, and mechanical anastomosis at the upper edge of the sfincterial ring. The evaluation of surgical technique, post-operative supervision, and follow-up instrumental control (anal manometry, endo-rectal ultrasonography, sfincterial electtromanometry, Rx barium enema) show technical feasibility and confirm a better recovery with regular defecatory function.

We previously demonstrated that lymphoscintigraphy could be used to study pulmonary lymphatic flow. Radiocolloids, high-molecular-weight proteins tagged with radioactive markers, are injected percutaneously in the periphery of the lung. These molecules enter the lymph, are transported via lymphatic channels, and concentrate in the tributary hilar and mediastinal lymph nodes, where they can be visualized by nuclear scan. The goal of this study was to determine whether pulmonary lymphoscintigraphy could be used to detect allograft rejection after lung transplantation. Thirteen mongrel dogs underwent left lung allotransplantation. Cyclosporine 15 mg/kg per day and azathioprine 1 mg/kg per day were given orally for postoperative immunosuppression. Lymphoscintigraphic studies were obtained 1 week after the operation and then at weekly intervals. In five dogs (group A), immunosuppression was continued until the animal died or was put to death 6 weeks later. Lymphoscintigraphy demonstrated reestablishment of lymphatic drainage between the lung graft and the mediastinum in all the animals 2 to 4 weeks after transplantation. In eight dogs (group B), immunosuppression was discontinued after reestablishment of graft lymphatic drainage was documented by two consecutive lymphoscintigraphic studies. The dogs continued to be studied with weekly scans. In group B, lymphatic drainage from the lung graft to the mediastinum disappeared 1 to 4 weeks after immunosuppression was stopped. Rejection was diagnosed clinically and confirmed histologically with open lung biopsies and/or autopsies in all animals. This study shows that canine allograft lung rejection is associated with disappearance of lymphatic drainage from lung graft to mediastinum, which can be documented by pulmonary lymphoscintigraphy, a minimally invasive technique that can be easily repeated. Pulmonary lymphoscintigraphy may be useful for early detection of lung allograft rejection.

The technique of pulmonary lymphoscintigraphy was used to evaluate pulmonary lymphatic flow and to assess reestablishment of lymphatic drainage after lung transplantation. A first group of six control dogs underwent percutaneous transthoracic injection of a radiocolloid into the periphery of the left upper and lower lobes. Radiocolloids are large molecules tagged with radioisotopes that are absorbed only through lymph and are concentrated in tributary lymph nodes. Twenty-four hours after injection the dogs underwent scintigraphic studies of the chest and upper part of the abdomen. Mediastinal lymph nodes were visualized in all animals. A second group of four dogs underwent partial reimplantation of the native left lung, with interruption of all lymphatic connections between the lung and mediastinum. Lymphoscintigraphic studies of the left lung were obtained on the third postoperative day and then weekly for 4 weeks. Three of the four dogs in this group did not have visible mediastinal nodes 3 days after the operation. Nodes were visualized in all animals at 1 week and at all following studies. A third group of five dogs were subjected to left lung allotransplantation by means of standard surgical techniques, as well as immunosuppression. The animals were studied with radiocolloid injections and lung lymphoscintigraphy at weekly intervals for 6 weeks. Mediastinal nodes were visualized for the first time 2 to 4 weeks after the operation and at every subsequent study. We conclude that lung lymphoscintigraphy is a reliable technique for the study of pulmonary lymphatic flow. This experiment demonstrates that lymphatic drainage after lung transplantation is reestablished as early as the second postoperative week.

It has been shown previously that skeletal muscle ventricles fashioned from canine latissimus dorsi muscle can function as effective blood pumps. We describe four dogs that have been reported on before but have now had skeletal muscle ventricles functioning as effective aortic diastolic counterpulsators for 191 to 836 days. One dog remains well with a skeletal muscle ventricle that has been pumping in circulation for 194 days; there has been no evidence of thrombus in the skeletal muscle ventricle cavity or thromboembolism. None of the three dogs that died had evidence of peripheral embolization, although two of those dogs had thrombus within the cavity of the skeletal muscle ventricle. This study proves that skeletal muscle ventricles can function long-term in the circulation and maintain diastolic pressure augmentation beyond 2 years. To the best of our knowledge, the dog whose skeletal muscle ventricle pumped in circulation for 836 days represents the longest living laboratory animal or human with a functioning heart assist device.

We analyze the parameters present in the Morse potential and van Zandt potential to describe the hydrogen bonds in DNA using the quasicontinuum model applied to the low-frequency vibrational modes.

Since 1979, a total of 17 patients with Wiskott-Aldrich syndrome have undergone allogeneic bone marrow transplantation at Memorial Sloan-Kettering Cancer Center. Eleven patients received marrow from either human leukocyte antigen (HLA) genotypically identical siblings (nine patients) or an HLA phenotypically identical parent (two patients). Six patients received marrow grafts from HLA-disparate parents. Cytoreduction was accomplished with busulfan and cyclophosphamide for the HLA-identical recipients and total-body irradiation followed by high-dose cytarabine therapy in the mismatched recipients. All 11 recipients of HLA-identical marrow had successful grafts, and 10 of 11 are alive and well 28 to 145 months after transplantation. One patient died 10 months after transplantation of chronic graft-versus-host disease and interstitial pneumonitis caused by cytomegalovirus. Only one of the six mismatched graft recipients survives, 52+ months after transplantation; the other patients have died of extensive chronic graft-versus-host disease (one patient), lymphoma (three patients), or progressive pancytopenia accompanying Candida sepsis (one patient). thus bone marrow transplantation represents the treatment of choice in patients with Wiskott-Aldrich syndrome who have an HLA-identical donor. However, our approach for patients lacking a histocompatible family donor requires modifications to overcome allogeneic resistance and decrease the posttransplantation immunoincompetence in these patients.

The authors stop onto make use of the colon smooth musculature to resolve the question of medical and surgical methods used until now to improve the continence of colostomies. Owing to the experiences and co-operating with some other research centers, the authors refer about the experiment performed on the rabbit, where a small leaf of intestine serous-muscular tissue was employed to perform a continence system on colostomy. The analysis of manometric results obtained from check animals in different post-operatory periods (3-7-14-21 days) pointed out a moderate reaction of neosphincterial function, while the histological results prove a favorable histological development without to change the muscular tunica fibrous tissue. The easy application, harmless of employed methods and undoubted comfort for the patient stand for valid indications in the development to come of this method.

From 1974 through 1989, 36 patients with arteriovenous malformations were treated in the neuroradiological unit of the Santobono Children's Hospital, in Naples, 7 of these patients were younger than 3 years of age. During such a time-span, dramatic improvements in diagnostic work-up were jelded by introduction of CT-scan and MRI; better angiographic techniques, progress in anaesthesia drugs, equipment and procedures and more rational surgical modalities. Anaesthesia must be tailored in each patient with special consideration of the clinical and neurological conditions of the patients as well of the neuroradiological procedure, specifically, with minimal side effects on cardiovascular and respiratory functions as well on intracranial pressure. The present paper discuss of equipment for cardiovascular assistance and drugs to be employed in the various steps of the diagnostic work-up of such patients.

Eighty-seven consecutive children and young adults with acute nonlymphocytic leukemia (ANLL) were treated uniformly with induction chemotherapy based on daunorubicin and cytarabine (ara-C), with the addition of etoposide (VP-16) and azacytidine (5-Az) for refractory patients. Of the 65 patients who entered complete remission, 42 were eligible for assessment of response to intensive chemotherapy consisting of four pairs of drugs administered in sequential fashion. Nineteen others with available histocompatibility locus antigen (HLA)-compatible donors were assigned to receive allogeneic bone marrow transplants within 16 weeks from their dates of complete remission. Durations of continuous complete remission (CCR) in the two groups were not significantly different at a median follow-up time of 6 years (P = .30 by log-rank analysis). Kaplan-Meier estimates of CCR probabilities (+/- SE) at 6 years were 43% +/- 13% (transplantation) and 31% +/- 7% (sequential chemotherapy). Postremission failures in the sequential chemotherapy group resulted from bone marrow relapse in 23 of 29 patients (79%), whereas in the transplantation group, failures were equally divided between marrow relapse and transplantation-related complications of graft-versus-host disease (GVHD) or infection due to the immunosuppressive effects of ablative chemotherapy. Comparison of hematologic remission curves indicated a significant advantage for marrow transplantation in terms of systemic leukemia control (P = .06). Thus, in programs of intensive chemotherapy of the type described here, allogeneic marrow transplantation should be seriously considered as alternative therapy for patients in first remission who have an HLA-matched sibling donor, provided that effective methods for control of transplant-related complications are available.

Of 220 patients operated for gastric cancer, 74 with subtotal gastrectomy and 145 with total gastrectomy (60 with lymphadenectomy), the results and indications for total gastrectomy extended with lymphadenectomy are analysed. The importance of lymph node emptying in relation to the possibility of breakdown of the lymphnode chains with R2 metastasis is particularly stressed. Analysis of perioperative mortality and long-term survival indicates results that are close to the data reported by Japanese schools.

Steiner nel 1968 iniziò ad applicare la radiochirurgia stereotassica nel trattamento delle malformazioni artero-venose mediante l'erogazione di una singola alta dose di radiazioni concentrata sul bersaglio. Le lesioni suscettibili di tale trattamento non potevano avere diametro superiore a mm. 18. Il progresso tecnologico che si è avuto nell'ultimo decennio con la possibilità di predisposizione dell'acceleratore lineare alla metodica stereotassica e l'utilizzazione di caschi non invasivi, ha reso possibile l'inserimento di questo tipo di radioterapia nel protocollo terapeutico di lesioni encefaliche neoplastiche di differente neura. La radioresistenza della maggioranza di questi processi espansivi limita l'efficacia biologica della radioterapia convenzionale a dosi frazionate, in quanto con questa metodica non è possibile erogare dosi superiori a 60 Gy senza produrre danni notevoli al tessuto cerebrale sano. Viceversa, l'utilizzo di un sistema stereotassico non invasivo e l'impiego di più isocentri consente attualmente l'erogazione di più dosi singole meno elevate, permettendo così l'aggressione di lesioni piuttosto estese e geometricamente complesse. In questo lavoro viene presentata la nostra esperienza nell'applicazione della radioterapia stereotassica, iniziata nel giugno 1991, e vengono poste alcune considerazioni sui vantaggi e sui limiti attuali di questa metodica.

I recenti progressi nella tecnologia Spect hanno prodotto un evidente aumento della sensibilità e della risoluzione dei sistemi di acquisizione ed elaborazione consentendo una estensione della applicazione della metodica a svariate patologie, particolarmente a quelle di pertinenza neurologica. In età pediatrica la Spect ha, negli ultimi anni, fornito ulteriori informazioni nello studio delle epilessie. Noi abbiamo iniziato da alcuni mesi ad applicare la metodica nello studio di patologie del SNC della prima età pediatrica. In questo lavoro vengono presentati i risultati preliminari e viene posta una iniziale verifica se i dati Spect, correlati con gli altri dati strumentali, possano essere utili nell'iter diagnostico di queste patologie.

Expressing the generalised zeta function Sigma n omega n-s in terms of the 'partition function' Sigma ne- alpha omega (n), alpha the authors show in this paper why they obtain the same answer for for the Casimir effect (in many physical situations) if they use, alternatively, the analytic continuation procedure for the zeta function or take the first derivative of the above partition function and make alpha to 0+ with the neglect of all pole terms in alpha =O.

Sediment samples collected from the Central Adriatic Sea were leached at room temperature with phthalate buffers of pH 3 and 6 and with 0.5M HCl. The leaching was aimed at estimating the mobilization of elements under different pH conditions. The buffers were used to simulate the bioavailability of elements to benthic fishes and invertebrates. The leach results were compared to total concentrations obtained by digesting samples with 65% HNO3 at 120 C for 8 h.

T HE EVOLUTION of bone marrow transplantation (BMT) from purely experimental therapy for patients in leukemic relapse to the indicated treatment for certain malignancies and congenital disorders has been a result of multiple factors.‘.2 Major strides in the field of immunobiology have provided the basis for a more rational clinical approach to bone marrow transplant candidates.” In particular, further understanding of the major histocompatibility complex (MHC), which encompasses the genes for human leukocyte antigens (HLA), has improved our ability to select an appropriate marrow donor.3 As increasing numbers of institutions are offering bone marrow transplants as a treatment option, various issues pertinent to the role of the donor are arising. These issues, which may affect the recipient’s clinical course as well as the donor’s well being, are discussed.

Δ 2,2′ -Bi- (2H-1,4-benzothiazine) ( 4 ), the parent ring system of a group of amino-acid pigments (trichosiderins) from red hair and feathers, has been synthesized by a simple and novel method involving air oxidation of 2H-1,4-benzothiazine, generated in situ by treatment of 1-( o -aminophenylthio)-2,2-diethoxyethane ( 1 ). This procedure yields only the yellow trans -isomer 4 , which in solution exhibits marked photochromism, being reversibly converted into the red unstable cis -form 5 on brief irradiation with sunlight.

The effects of heparin were studied in a group of 42 patients with preinfarction angina (PA) and acute myocardial infarction (AMI) whose plasma fibrinogen was increased. Plasma fibrinogen was measured by the turbidimetric method in timol turbidimetric units. Statistically significant results proved that heparin reduces the plasma fibrinogen progressively over a treatment period of 6 weeks. During the first three weeks a dose of 1 cc (50 mg or 5000 IU) was given by intravenous injection at 6-h intervals, this was followed by a dose of 2 cc (100 mg or 10,000 IU) given by subcutaneous injection at 12-h intervals for a further three weeks. Hyperfibrinogenemia is perhaps one of the most important factors in the thrombophilic syndrome, and at the same time it is one of the fundamental physiopathological alterations observed in AMI and PA. Because heparin reduces hyperfibrinogenemia it has a beneficial effect in these diseases.

Lo studio, condotto all'interno della Scuola di Restauro dei Monumenti di Napoli, diretta dal prof. R. Di Stefano, riguarda l'analisi degli impianti univeristari presenti nel centro antico della città e ospitati, in molti casi, in antichi conventi: attraverso un'analisi accurata dei caratteri storici e funzionali di tali complessi, se ne prospetta il recupero e la valorizzazione.

A clinical trial using iopamidol, a non-ionic contrast medium, in various iodine concentrations (300, 200 and 150 mg I/ml), was carried out in 947 children, aged between 1 day and 14 years, who underwent various neuroradiologic procedures: computed tomography (CT) cisternography (n = 307), CT ventriculography (n = 203), CT myelography (n = 153), and conventional myelography (n = 284). No significant variation in vital signs and neurologic status was recorded during and up to 72 hours after the examination. Psychic agitation was the major effect registered, being clearly related to the type of procedure used. A significant reduction of untoward side effects (about 50%) was observed using the lower concentrations of the medium. Iopamidol 150 mg and 200 mg represented the optimal concentration for CT enhancement, these concentrations reducing artifacts; the 300 mg I/ml concentration gave best results in conventional radiology. It seems that the lower concentrations of iopamidol (200 and 150 mg I/ml) can be usefully employed in pediatric neuroradiology, with preserved contrast and dramatically reduced untoward reactions.

The diagnostic features of CT images of the spine are constantly influenced by some limitations of the method because of the peculiar configuration of the human spine. Recent generations of CT scanners greatly improve the results but with the second generation (Acta 0200 FS Pfizer Scanner) we have been able to develop a modified scan reconstruction method to maintain the quality of our spinal images, thanks to the very flexible software of our CT scanner.

SICKLE-CELL anemia affects 1 in 600 of the U.S. black population and accounts for 80,000 deaths annually throughout the world.1 , 2 Current therapy is designed to prevent sickle-cell crises, but supportive care remains the only treatment available once they occur. Attempts to alter the expression of hemoglobin genes in β-thalassemia and sickle-cell anemia with the use of azacytidine have produced only transient effects.3 This report describes the conversion of sickle-cell anemia to sickle-cell trait by marrow transplantation (done for treatment of leukemia) in a child with both sickle-cell anemia and acute myeloblastic leukemia. It raises the possibility of using marrow transplantation . . .

A rare case of migration of a distal catheter from a ventriculo-atrial shunt into the right atrium is presented. The employed surgical procedure for the removal of the foreign body from the heart is briefly discussed.

Extracranial congenital arteriovenous malformations are often associated with dural and/or cerebral malformations. One case is presented. The angiography of the common carotid artery revealed no evidence of abnormal vessels into the internal or external carotid territory. The injection of contrast medium into an enlarged epicranial vein showed the extracranial malformation, well opacified; the phlebography revealed also a small dural malformation draining in the superior sagittal sinus. The Authors outline the importance of complete angiographic study in all the cases of extracranial vascular malformations even if the carotid angiography is apparently normal.

A number of annoying and frequent disturbances caused by an increase in intestinal meteorism have aroused the interest of students since the last century. Aerophagy, abdominal distension, flatulence represent the commonest aspects of this frequent gastroenterological pathology. The new diagnostic approaches have made it possible to classify the principal mechanisms involved in the production and elimination of intestinal gases. It has thus been possible to study with greater precision the composition of gaseous content and the origin and removal of intestinal gases. It is possible to demonstrate an increase in intestinal gas in various conditions, not only in relation to concomitant organic factors but also following surgery and disease situations triggered by functional or reflex mechanisms. Basic diagnosis is important because if correctly classified these pathological conditions can be resolved with simple therapeutic aids.