Search

Our aims were to develop a noninvasive predictive tool to identify cirrhotic patients with esophageal varices and to evaluate whether portal Doppler ultrasonographic parameters may improve the value of other predictors. One hundred forty-three consecutive compensated cirrhotic patients underwent upper gastrointestinal endoscopy. Fourteen clinical, biochemical, ultrasonographic, and Doppler ultrasonographic parameters of each patient were also recorded. Esophageal varices were detected in 63 of the 143 patients examined (44%; 95% confidence interval [CI] 36.2-52.6). Medium and large esophageal varices were observed in 28 subjects (44%; 95% CI 31.4-58.4). Using stepwise logistic regression, presence of esophageal varices was independently predicted by prothrombin activity less than 70% (odds ratio [OR]: 5.83; 95% CI: 2.6-12.8), ultrasonographic portal vein diameter greater than 13 mm (OR: 2.92; 95% CI: 1.3-6.4), and platelet count less than 100 x 10(9)/L (OR: 2.83; 95% CI: 1.27-6.28). Variables included in the model were used to generate a simple incremental rule to evaluate each individual patient. The discriminating ability of the prediction rule was relevant (area under the curve: 0.80) and did not change by replacing ultrasonographic portal vein diameter with congestion index of portal vein. We concluded that compensated cirrhotic patients should be screened by upper gastrointestinal endoscopy when prothrombin activity less than 70%, platelet count less than 100 x 10(9)/L, and ultrasonographic portal vein diameter greater than 13 mm are observed, whereas those without any of these predictors should not undergo endoscopy. The contribution provided by portal Doppler ultrasonographic parameters does not appear of practical utility.

Portal hypertensive gastropathy (PHG) is frequently found among patients with hepatic cirrhosis and at present the only way to detect and follow PHG is via endoscopy.To assess gastric and intestinal permeability and investigate its relationship to endoscopic findings and indices of portal hypertension and hepatic function.Thirty-one non-diabetic patients with hepatic cirrhosis and PHG (PHG+) were studied and compared with 17 cirrhotic patients without PHG (PHG-). All patients underwent endoscopy for the assessment of PHG and Helicobacter pylori status, ultrasound determination of the diameters of spleen and portal vein, and, subsequently, an oral load of sucrose, lactulose, and mannitol. Sugar concentrations were determined in 6-h urine specimens and expressed as a percentage of the orally administered dose or as lactulose/mannitol ratio.The urinary sucrose excretion was significantly elevated in patients with PHG compared to those without (PHG+, 0.20% +/- 0.03; PHG-, 0.07% +/- 0.01; P0.001). No difference was found for the small intestinal probes lactulose and mannitol. Gastric sucrose permeability correlated positively with the endoscopic lesion score (P0.001), but not with other parameters of portal hypertension or hepatic function. H. pylori status did not influence gastric permeability. The sensitivity of this test reached 100% for PHG scores2.Gastric permeability to sucrose is increased in patients with PHG, independently of the presence of H. pylori. Sucrose permeability may be useful for the follow-up of patients with PHG.

Thanks to the manipulation of hormone composition in the medium it has been possible to attribute morphogenic fonction to specific hormones and to separate spatially and in time the different hormone-dependent steps which are present in the morphogenic process (Christianson and Warnick 1988; Fambrini et al. 1996). By contrast, the role of the photomorphogenic pigments (if any) in the discrete steps characterizing the process of morphogenesis in vitro is still an open question despite a number of studies showing that light quantity, quality and duration influence both shoot and root formation (Hughes, 1981; Lercari et al. 1986; Economou and Read, 1987; Marcenaro et al, 1994). In the present paper we investigated the photocontrol of shoot regeneration from hypocotyl expiants of an au mutant of tomato and its isogenic wild type. The au mutant used in this study was isolated from tissue cultures as a result of somaclonal variation (Lipucci di Paola et al., 1988). The etiolated seedling of au mutant lacks spectrophotometrically detectable phytochrome, as a consequence of a excision in chromophore synthesis (Terry and Kendrick, 1996). In tomato plants at least five phytochrome genes are expressed (Hauser et al., 1997).

Lateral meniscal cysts are usually small asymptomatic lesions, and to find a large cyst with extensive bony changes arising from this cyst is exceedingly rare. These changes are usually erosive defects of the tibia. Dull pain with an associated mass are classical findings. A 47-year-old man developed a symptomatic lateral meniscal cyst that eroded a large part of the lateral tibial plateau. Arthroscopy and arthrotomy with cyst excision was required in this case and led to the amelioration of his symptoms.

A retrospective study of imaging-directed percutaneous fine-needle aspiration cytology of focal renal lesions was performed. The objectives were to determine the efficacy and safety of renal aspiration biopsy in establishing the diagnosis of renal cell carcinoma and avoiding nephrectomy in patients with a renal mass and disseminated metastases or with a renal mass and relative contraindications to nephrectomy.Between September 1987 and September 1991, 55 consecutive patients had 57 imaging-directed renal aspiration biopsies at our institution. We examined the medical records, pathology reports, imaging studies, and follow-up information of the 23 patients who had the procedure because of disseminated metastases (10 patients) or relative contraindications to nephrectomy (13 patients). Preliminary diagnoses were based on the cytopathology, and final diagnoses were based on the surgical pathology (six patients) or clinical course over more than 6 months (17 patients).Cytopathologic findings were true-positive in 12 patients, true-negative in eight, false-negative in three, and false-positive in none. The sensitivity was 80%, the specificity was 100%, and the accuracy was 87%. Of the 10 patients with a renal mass and disseminated metastases, aspiration cytology failed to show malignancy in only one. None of these patients had surgery, and all died within 1 year. Of the 13 patients with relative contraindications to surgery, seven were treated without surgery. The cytologic diagnosis was renal cell carcinoma in two of the seven, and these two patients have since died. Cytopathology was negative for renal cell carcinoma in five of the seven, and subsequent imaging studies in these patients have shown no renal mass enlargement or metastases 2-3 years after biopsy (three patients) or the patients have died of severe heart disease (two patients). Nephrectomy was performed in the remaining six patients, and no evidence of disease had been found 2-4 years after removal of two oncocytomas and four renal cell carcinomas. There were no significant complications.Percutaneous renal aspiration biopsy cytology is accurate, safe, and useful in establishing the diagnosis of renal cell carcinoma in patients with disseminated metastases or relative contraindications to surgery.

Our aims were to develop a noninvasive predictive tool to identify cirrhotic patients with esophageal varices and to evaluate whether portal Doppler ultrasonographic parameters may improve the value of other predictors. One hundred forty-three consecutive compensated cirrhotic patients underwent upper gastrointestinal endoscopy. Fourteen clinical, biochemical, ultrasonographic, and Doppler ultrasonographic parameters of each patient were also recorded. Esophageal varices were detected in 63 of the 143 patients examined (44%; 95% confidence interval [CI] 36.2-52.6). Medium and large esophageal varices were observed in 28 subjects (44%; 95% CI 31.4-58.4). Using stepwise logistic regression, presence of esophageal varices was independently predicted by prothrombin activity less than 70% (odds ratio [OR]: 5.83; 95% CI: 2.6-12.8), ultrasonographic portal vein diameter greater than 13 mm (OR: 2.92; 95% CI: 1.3-6.4), and platelet count less than 100 3 109/L (OR: 2.83; 95% CI: 1.27-6.28). Variables included in the model were used to generate a simple incremental rule to evaluate each individual patient. The discriminating ability of the prediction rule was relevant (area under the curve: 0.80) and did not change by replacing ultrasonographic portal vein diameter with congestion index of portal vein. We concluded that compensated cirrhotic patients should be screened by upper gastrointestinal endoscopy when prothrombin activity less than 70%, platelet count less than 100 3 109/L, and ultrasonographic portal vein diameter greater than13 mm are observed, whereas those without any of these predictors should not undergo endoscopy. The contribution provided by portal Doppler ultrasonographic parameters does not appear of practical utility. (HEPATOLOGY 2001;33:333-338.)

The authors report their experience in the reconstruction of the anterior cruciate ligament using the Leeds-Keio ligament in 12 patients, 7 by open arthrotomy and 5 by an arthroscopic technique. The biological evolution of the new ligament was studied macroscopically and histologically in the first 6 cases treated by open arthrotomy. Arthroscopic monitoring and biopsy was carried out 4 to 10 months after operation. In 5 cases the new ligament appeared to be intact and histologically vital, with proliferation of new tissue along the new ligament. There were broken filaments of dacron hanging from the intercondylar cavity in only one case. The first macroscopic, histological and ultrastructural results show that despite a few limitations the Leeds-Keio ligament has the features required for replacement of the anterior cruciate ligament, although it will be necessary to wait 4 or 5 years before fully evaluating the durability and function of the ligament and the best operative method.

Niceforo Alfredo. A propos de quelques comparaisons entre les moyennes anthropométriques obtenues sur les sujets appartenant à des classes sociales différentes. In: Bulletins et Mémoires de la Société d'anthropologie de Paris, VI° Série. Tome 1, 1910. pp. 443-451.

Niceforo Alfredo. Contribution à l'etude de l'indice céphalique en Suisse. In: Bulletins et Mémoires de la Société d'anthropologie de Paris, V° Série. Tome 5, 1904. pp. 493-495.