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As we enter a new millennium, many are questioning the nature of the family and its future in a rapidly changing society. To put these issues in proper perspective, this article reviews the changes the family has undergone in the past and explores what this suggests about the future. First, a brief historical sketch of the American family over the past two centuries is presented. Next, the modern concept of the family as a functioning system is explored. Family systems not only evolve in structure through history, but each family also develops individually through its own family life cycle. These ideas are presented from a family therapy perspective in order to give the physician a more practical framework within which to view families seen in practice. Finally, some implications for the future of families in the next decade are discussed.

A prospective study was carried out to compare the value of ultrasound examination with conventional management in patients presenting with emergency surgical problems. During an 4 years period the authors followed 301 patients referred to the Ist Institute of Surgery of the University of Rome "La Sapienza". After immediate clinical evaluation one or more US examinations were performed in each patient following a standard protocol of study. Abdominal emergencies were the most frequent conditions, found in 75% of the cases and the acute abdomen due to trauma in 17.6% of the cases. The overall sensibility, specificity and accuracy of clinical examinations and US examinations were respectively of 88%, 33%, 70% and 95%, 94%, 95%. In 38 patients (12.7%), a diagnosis was made up by sonographic examination which had not been clinically expected (group A). The principal condition in this group was gynaecological pathology, found in 17 patients. In 161 patients (53.3%) sonography confirmed the first diagnosis clinically suspected (group B) and in 23 cases the second or third differential diagnosis (group D). Sonography made no contribution to the diagnosis in 77 cases (25,5%) and only in 2 cases was considered misleading. The result of this study demonstrate the usefulness of emergency ultrasonography in gynecological, gall bladder, pancreatic and vascular diseases. Moreover sonography must be considered the principal diagnostic tool in patients with trauma. In order to recognize gynecological diseases which can simulate appendicitis US examination must be considered necessary in young female patients. When appendicitis is suspected US is useful in children and in older patients too.

Significant signs of uremic osteodystrophy were found at Rx examination of the pelvis in 29 out of 72 uremic patients (40%) undergoing maintenance hemodialysis. It is therefore thought that Rx of the pelvis, although it is more significant for some signs (brown tumors, alterations of the trabecular structure, enlargement of Ward's triangle) than for others, such as subperiosteal resorption, should not be neglected in these patients.

The authors base their study on a retrospective evaluation of a personal series of patients and on a review of the literature on this topic. They focus their attention on surgical problems relating to the type of treatment of non-toxic multinodular goitre. On the basis of the data obtained, they underline that in this pathology total thyroidectomy is the most appropriate form of surgery and does not entail a higher morbidity in relation to more conservative resection.

B. F. Skinner saw behavior as a product of three levels of evolution. J. R. Kantor and Gregory Bateson noted similar relations. This article describes and applies basic evolutionary concepts to each level: (a) phylogenic, (b) ontogenic, and (c) cultural evolution. Each level is analyzed in terms of (a) units of selection, (b) variety of units required for the selection process, (c) selection pressures, (d) interactions among levels, and (e) implications for understanding and predicting behavior. Distinguishing between models of proximate and ultimate causation, as in biology, may help clarify research problems posed by, and facilitate better communication among, psychologists.

Some fluoroacylderivatives at the side chain NH2 of D-cycloserine were synthesized and evaluated in vitro for antimicrobial activity against bacteria and tubercular or non-tubercular mycobacteria. Against the used Gram-positive and Gram-negative strains only trifluoroacetamide 1 exhibited comparable MIC values and lower MBC values than those of parent antibiotic. Other fluoroacycloserines, inactive at all on these bacteria, were found to inhibit the growth of mycobacteria when tested in liquid media. The in vitro anti-Herpex Simplex virus type-2 (HSV-2) activity was also investigated on HEp-2 and Vero cells. The obtained results demonstrated an antiviral activity of the compounds 1 and 3 when tested on Vero cell-lines, whereas the same cycloserine is inactive.

The Authors report their experience about fifty patients affected with renovascular hypertension, treated by percutaneous transluminal angioplasty (PTA) for stenosis of main renal artery and now studied by Duplex-Scan and Color-doppler. Results, compared with arterial pressure measurements, renography and laboratory renal function evaluation, showed a sensibility of 84%, specificity of 90% and an accuracy of 87.5%. Advantages and limits of Duplex-scan in patients treated by PTA are briefly discussed.

In the present study the A. try to assess the usefulness of ultrasound in detecting blending risk in portal hypertension. Endoscopic and sonographic findings of 35 cirrhotic patients with esophageal varices were compared to a control group of 27 hepatopathy patients without portal hypertension, observed in the same department and in the same interval. The medium caliber of portal vein was 14.64 +/- 2.59 and 11.8 +/- 1.33 mm, respectively in the study and in the control group (p less than 0.01). Statistic correlations were also found in subgroups of patients with varices of different degrees. A portal vein greater than 16 mm was found in 10 of 11 patients with large varices; this pattern provides a sensitivity of 71.4% and a specificity of 94.1%. In our experience this echographic finding should represents a clear indication for close endoscopic follow-up, even in patients without previous bleeding from esophageal varices.

From February 1986 to March 1988 113 abdominal US exams were performed in emergency situation to evaluate the accuracy of this methodology: 13 were blunt traumas, 18 postoperative complications. A real-time scanner with a linear probe of 5 MHz was employed. The results were confirmed by surgical and/or clinical and instrumental evaluation. In 81% of the examinations, ultrasonography allowed a diagnosis to be made. Gallbladder and biliary pathologies were the most common findings. The results (sensibility 96%, specificity 88%, accuracy 95%) confirm the reliability of ultrasonography in abdominal emergencies, as shown in literature.

The results are reported of a clinical and radiological study of a group of athletes that investigated the often asymptomatic alterations found in the spinal area. In comparison with non-athletic controls the sportsmen revealed a significantly higher incidence in the pars intearticularis of the posterior apophysis in the lumbar region. Practitioners of sports requiring violent spasmodic effort also revealed spondylolysis and spondyloisthesis. The early appearance of lumbar degenerative arthritis in practitioners of sports requiring moderate but sustained effort was also statistically significant.

The authors report the results of a radiological evaluation of the foot in 18 patients affected with chronic renal insufficiency (CRI). After discussing the bone changes considered to be "typical" of renal osteodystrophy, they analyse the trabecular system, in which they distinguish three degrees of change. If these finer changes are taken into account a high incidence of bony alteration is observed in CRI (84%). The biomechanics and static stresses of the foot are discussed, based on the presupposition that the anatomofunctional features of this part of the skeletal system could influence the grade and progression of the bony alterations. However, no such association was observed, nor was there any correlation between the radiographic changes and the clinical symptomatology.

A retrospective analysis is reported of 131 symptomatic patients for gastro-esophageal reflux, comparing the radiological diagnosis to endoscopic, manometric and pH-metric results. A low incidence of x-ray examination is found. The role of radiology in gastro-esophageal reflux is considered and discussed.

Five cases (3M, 2F) of ureteral transitional cell carcinoma are reported. they have been observed in the last two years in a general surgical service. All the patients have been treated surgically. Gross hematuria was present in all the patients. Three cases had multicentric tumor sites. Three tumors were located in the distal ureter. Four cases showed a non functioning kidney at IVP. In two, because of obstruction, retrograde pyelography was unsuccessful. Ultrasound was able to demonstrate hydronephrosis. In the two cases submitted to angio-CT the spread of the tumor was correctly diagnosed. Frequency, etiology, clinical, diagnostic findings and surgical therapy as well have all been taken into account, based on the literature. Histopathologic aspects, grade and stage, are considered too. The authors emphasize the necessity to find and understand the cause of an unexplained hematuria, since ureteral carcinoma is not as rare as previously thought. Being grade and stage closely related to prognosis, the diagnostic delay must be reduced.

Intrarectal ultrasonography is a new imaging method used in the preoperative staging of rectal cancer. Twenty five patients with proven rectal cancer were submitted to preoperative intrarectal ultrasonography; 24 were resected. Real time scanner with a linear probe of 5 MHz was employed. Five sonographic structures corresponding to the five histological layers were evidenced. Ultrasound T staging was compared to pathology, using UICC classification. In all but two cases pathology corresponded to ultrasound T staging (accuracy 92%). Perirectal nodal involvement was also investigated. It is concluded that intrarectal ultrasonography will play a definite role in the preoperative staging as well as in programming treatment of rectal carcinoma.

The widespread use of abdominal aortic grafting procedures and increasing awareness of related complications suggests the need for a reliable and non-invasive diagnostic technique which will allow early detection of both occlusive and non-occlusive complications. Ultrasound is generally used with satisfactory results, but has several limitations, whereas MRI has shown great promise in the study of cardiovascular disease, being non-invasive, multiplanar and multiparametric. The present research aims to evaluate MRI in the follow-up of abdominal aortic grafts, attempting to define its significance as a screening procedure in non-selected patients. MRI is reliable in ascertaining the normality of the graft as well as the complications, these being partial or total thrombosis, pseudoaneurysms and perigraft collections. The data obtained are highly satisfactory and are almost always superior to those achieved with ultrasound and CT.

A retrospective study of 92 solitary pulmonary nodules of patients submitted to surgery is reported. The review was carried out only on chest X-rays performed prior to surgery. The radiographic signs concerning density, contour and margin were correlated with the benign or malignant nature of the lesions. 91.06% of the malignant nodules had a lobulated-umbilicated contour and ill-defined margins; 82.60% of the benign nodules had smooth contour and well-defined margins. Radiographically visible calcifications were found in 85% (6 cases) of the benign nodules, and in 15% (1 case) of the malignant ones. It is concluded that it is impossible to make a definite diagnosis of nature of SPN, due to the different types of tumor growth.

A case of adult type polycystic liver disease in a child is reported. The entire right hepatic lobe was involved whereas the left lobe was normal. Spleen, kidneys and pancreas did not show cystic alterations. Diagnostic examinations and histologic findings are illustrated. The patient underwent right hepatectomy. The adult and childhood types of congenital polycystic liver disease are discussed.

The Authors describe an experimental model that makes feasible to endoscopically approach a Roux-en Y hepatico-jejunostomy through a percutaneous transjejunal route. Potentials for its clinical application are briefly discussed.

Five cases of osteoid osteoma and five cases of osteoblastoma of the spine are reported. All the patients underwent surgery and the radiographic diagnosis was always histologically confirmed. Conventional radiographic technique using tomography constantly permitted the diagnosis. Computed tomography was primarily useful for spatial localization of the lesion. The authors evaluate the radiographic findings of the two lesions discussing the symptoms which are suspected for these pathologic conditions. Bone scintigraphy must precede radiological examination.

The results are reported of high energy Co60 radiotherapy treatment over a period of twenty years, of 120 patients suffering from metastatic monostotic osteolytic original tumours of the breast, prostate and bronchial tubes. A fair improvement was noted, subjectively in terms of relief of pain, and objectively in terms of recalcification of the osteolytic area in a significantly high percentage of the patients treated.