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Treatment of oximes and semicarbazones of saturated and α,β-unsaturated ketones and aldehydes with trimethylchlorosilane-dimethyl sulphoxide in dry acetonitrile affords the corresponding carbonyl compounds in excellent yields under mild conditions.

α-Chlorodimethylacetals are hydrolysed in a mixture of acetic acid and aq. HCl (3.5 M) to α-chloroaldehydes in excellent yields. On replacing HCl by HBr the same procedure is applied to α-bromodimethylacetals.

Thioethers are transformed by manganese(IV) oxide-trimethylchlorosilane in CH3OH in high yields to sulphoxides, exclusively.

A novel method to prepare β-chloroalkyl suifides from alkenes and Me2S-SO2Cl2-Me2SO is described, methanesulfenyl chloride being suggested as intermediate.

A community-based programme to ensure prompt and adequate treatment of presumptive episodes of clinical malaria in children has been established in a rural province of Burkina Faso. The implementation strategy was based on training a core group of mothers in every village and supplying community health workers with essential antimalarial drugs specially packed in age-specific bags containing a full course of treatment. Drugs were sold under a cost-recovery scheme. The programme was run in 1994 by the national malaria control centre (CNLP), and in 1995 it was devolved to the provincial health team (PHT). Knowledge and awareness of malaria increased with the intervention. Drug consumption by age group was compatible with the distribution of disease, and no major problem of misuse emerged. The actual implementation costs of the intervention were US$ 0·06 per child living in the province. An evaluation of the impact of the intervention on the severity of malaria, using routine data from the health information system and taking as an indicator the proportion of malaria cases which were recorded as severe in health centres, was performed. In 1994, when the intervention was implemented on a provincial scale by CNLP, this proportion was lower than the average of the 4 preceding years (3·7% vs. 4·9%). In 1995, when the programme was implemented by the PHT, the proportion of severe cases was lower in health centres achieving a programme coverage of =50% in their catchment area compared with the others (4·2% vs. 6·1%). Our experience shows that a low-cost, community-based intervention aimed at providing children with prompt and adequate treatment of presumptive episodes of clinical malaria is feasible, and suggests that it may lead to a reduction in the morbidity from severe malaria.

N-alkyl-2,2-dihaloamides were efficiently prepared by amino-de-alkoxylation of methyl 2,2-dihalocarboxylates, at room temperature without solvents and promoters. Excellent yields of anilides were obtained after addition of AlCl3.

Two cases of 5-fluorouracil cardiotoxicity, resulting in one patient in myocardial infarction, are described. A review of the literature confirms that cardiotoxicity is a rare but genuine complication of 5-fluorouracil treatment; the cardiotoxic effect seems to range from mild angina without persistent electrocardiographic changes to severe myocardial infarction. No factors predictive of this complication were identified. The authors therefore feel it is advisable to stop 5-fluorouracil treatment when precordial pain occurs, even if the ECG (after angina) is normal, since angina can in some cases result in myocardial infarction.

The Kharasch addition of methyl 2,2-dichlorocarboxylates to 1-alkenes is promoted by ferrocene in DMF at 100°C, affording 1:1 adducts in satisfactory yields.

Spirometric tests and CO transfer tests were systematically employed before, during, after the therapy and in the follow-up of 33 patients affected by non seminomatous testicular tumors treated with 4-5 Einhorn courses (PVB). The aim was to demonstrate possible bleomycin-induced pulmonary toxicity and its relationship with the cumulative dose of the drug. Our patients, who never had clinical or radiological signs of pulmonary toxicity, did not show significant change in the functional respiratory tests throughout therapy, except for 6 patients who had a reduction in CO transfer of about 30 % after the 2nd or 3rd course which persisted up to the end and during the follow-up. We did not find any correlation of such a reduction with predisposing factors.

Acute cardiac herniation with incarceration following pulmonectomy is a very rare occurrence, often with disastrous results. In this communication we report a case and review the literature.

Four cyclopentanoid monoterpenes were isolated from Teucrium marum; they are the two [(A) and (B)] C2-epimers of a-(2-formyl-3-methylcyclopentyl)acrylaldehyde and two new [(C) and (D)] isomeric unsaturated lactones. Structures were established by spectral (u.v., i.r., N.M.R., m.s.) evidence and chemical transformations.

The transfer factor of the lung for carbon monoxide (TLCO) and the respiratory response to moderate exercise were determined in 16 patients with pulmonary metastasis pretreated with bleomycin who underwent pulmonary partial resection. The results of pulmonary function tests were related to histologic findings. No significant correlation was found between pulmonary morphologic changes and the TLCO: this questions the usefulness of TLCO as a predictive method for detecting subclinical bleomycin pulmonary toxicity. No significant correlation was found between morphologic findings and cumulative dose of bleomycin: this confirms the limit of a dose limitation strategy. In contrast, evaluation of pulmonary response to exercise seemed to improve the sensitivity of monitoring such patients for clinical evidence of latent pulmonary toxicity; however, it seems that critical morphologic changes must occur before pulmonary performance begins to deteriorate.

This paper presents the possible contribution of multi-temporal Landsat Thematic Mapper (TM) data to the assessment of land-use modifications in the most important portion of the metropolitan area of Milan where rapid transformations, starting from urban areas and then gradually extending to rural areas, took place. The study area corresponds to the so-called 'Great Milan' which includes a protected area, the 'South Milan Agricultural Park', where a widespread conflict between agricultural and-urban land use has arisen. Park realisation will contribute improving agricultural activities and creating a belt for environment protection around the city. Digital thematic maps, digitizing Istituto Geografico Militare dTtalia cartography of 1888-90 and 1945-50, were extracted. Normalized Difference Vegetation Indices (NDVI) were produced from three Landsat-5 Thematic Mapper images of 1984, January, June and August, and a Multi-temporal Colour NDVI Composition (MCNC) output was produced. Maximum Likelihood Classification for land use mapping was applied both on MCNC data jointly with band 5 of June, and on 12 April 1990 Landsat TM image. Classification accuracy was assessed and results summarized. An historical analysis of land-use changes from XIX century up to today was performed by comparison of different surface classes from historical (1888-90 and 1945-50) and satellite (1984 and 1990) thematic maps. Results confirm the useful contribution of satellite remote sensing studying land-use/land-cover modifications in areas affected by phenomena of agriculture rapid transformation and residential or industrial development.

Methyl 2,2-dihalocarboxylates add easily to carbonyl compounds in fair to good yields through the intermediate formation of 2-haloester enolates; the reaction is promoted by zinc, following a "Barbier" type procedure.

Treatment of p-tosylhydrazones of saturated and α,β-unsaturated ketones and aldehydes with trimethylchlorosilane-dimethyl sulphoxide in dry acetonitrile affords the corresponding carbonyl compounds in excellent yields under mild conditions.

Chlorination of alkenes was achieved in high yields by MnO2-MnCl2-Acetyl Chloride in dimethylformamide. A Mn(III) intermediate and a ligand-transfer process are suggested.

Methyl 3-oxo-cis-cycloundec-1-enecarboxylate (3) and the corresponding Δ3-isomers, methyl 10-oxo-cis- and 10-oxo-trans-cycloundec-1-enecarboxylates (5) and (4), were synthesized. Equilibration using 1,5-diazabicyclo [4.3.0]non-5-ene as a basic catalyst gave very different results in comparison with those reported for analogous systems with 7–10 membered ring.

2-Chloro acid methyl esters were prepared in good yields treating 2-chloro aldehyde dimethyl acetals with trichloroisocyanuric acid in DMF. Aldehyde dimethyl acetals with the 2-halogen on a tertiary carbon atom were poorly reactive and could be oxidized effeciently only after their transformation into 1,3-dioxolanes.

Methyl 2,2-dichloro or 2-bromo-2-chloro carboxylates were obtained in excellent yields by oxidation–chlorination of 2-(1-haloalkyl)-4-methyl-1,3-dioxolanes with trichloroisocyanuric acid.

Dermatofibrosarcoma protuberans is a rare cutaneous malignant tumor associated with a high cure rate but with a high incidence of local recurrence. Because of its tentacle-like subcutaneous infiltrating pattern that extends far beyond the clinically visible skin lesion, a wide resection margin is recommended. Hence, its localization to the head-and-neck regions, although rare, represents a real challenge for both the oncologic surgeon and the reconstructive surgeon, who aim to achieve a radical resection of the tumor with the best possible aesthetic outcome.

A case of intrathoracic pheochromocytoma in a child 3 years old with hirsutism, physical and mental underdevelopment, increased urinary corticoids output and some others unusual clinical features is described. The case is particularly interesting not only for the rarety of the localization, but for the even more rare association between medullary and cortical hyperfunction. The latter has been described in few cases, but never in an extradrenal pheochromocytoma. The patient has been diagnosed preoperatively, operated upon successfully and followed up for about 2 years; particular attention has been put in the ECG which preoperatively showed signs of marked left ventricular hypertrophy and postoperatively an increasing of the signs, which disappeared only after several months. Likewise the catecolamines output which was very high at the beginning has remained over normal even several months after removal of the tumor. Conversely disappearance of the physical signs and improuvement in the general conditions has been dramatic soon after the operation. In regard of the pathogenesis of the syndrome, the authors describe the two main interpretations: a) stimulation of the cortical by the hyperadrenalinaemia through the hypophysis and b) association of cortical and medullary hyperfunction in the same tumor. They think the latter one is the more probable.

Parry-Romberg syndrome is a disease characterized by progressive hemifacial atrophy. Multiple surgical procedures have been used to improve the facial volume and contours of patients with this disease, including alloplastic, silicone, or collagen implants; lipofilling; and pedicled or free-flap transplants. The present case describes the successful application of lipostructure to treat a woman with Parry-Romberg syndrome affecting the left side of her face.

3-Benzylimino-2-pyrrolidinones can be prepared in good yield by heating 3-chloro-4-chloromethyl-2-pyrrolidinones, benzylamine and NaI in THF at 80°C. An endo-dehydrohalogenation followed by a SN 2′substitution on the intermediate allyl chloride, and finally a shift of the exo-double bond to Δ 3with attendant tautomerization, appears to be the most probable reaction mechanism.

Heart rate (HR) is an important prognostic factor in patients affected by chronic heart failure (CHF); ivabradine has been demonstrated to significantly reduce nonfatal myocardial infarction and hospitalization rate for acute heart failure and to improve left ventricular (LV) reverse remodeling, quality of life, exercise capacity, and arterial elastance (Ea) in these patients. We aimed at evaluating the short‐term effects of ivabradine on ventricular‐arterial coupling (VAC), aortic stiffness, and endothelial function in stable patients with CHF. We evaluated 30 consecutive CHFpatients (LVEF≤ 35%, NYHAclass II) with sinus rhythm and HR≥ 70 bpm on optimized pharmacological therapy. All of them underwent both transthoracic echocardiogram to assess aortic elastic properties (aortic distensibility, AD; aortic stiffness index, ASI; systolic aortic strain, SAS) and VAC, and peripheral arterial tonometry to measure endothelial function. Therapy with ivabradine 5 mg bid was added and each patient was evaluated with the same examinations after 4 months. At the baseline, 73% of patients had impaired VACand 63% endothelial dysfunction. After 4 months, there was a significant improvement in the VACvalue (ΔVAC−0.10 ± 0.18, P =.021), mainly linked to Ea (ΔEa −0.40 ± 0.23 mm Hg/mL;P =.003). All the parameters of aortic elasticity underwent significant improvement (ΔAD1.82 ± 1.43 cm² × dyn−¹, P =.004; ΔASI−4.73 ± 6.07, P =.033; ΔSAS−7.98 ± 4.37%, P =.003). Lastly, we also noted a significant improvement of endothelial function (Δ RHI0.35 ± 0.35; P <.001). At follow‐up 40% of patients had impaired VAC(P =.018) and 33% endothelial dysfunction (P =.038). In patients with CHFadding ivabradine on top to the standard optimized medical therapy, when indicated, seems to improve endothelial function, aortic properties, and VAC.

Duane syndrome is a congenital disorder of eye movement characterized by partial or absent development of the sixth cranial nerve nucleus andor the sixth nerve itself. Patients often undergo procedures, both surgical and nonsurgical, to correct ocular misalignment and improve the resulting visual problems. We present a case report of a 49-year-old woman with left-sided Duane syndrome who underwent aesthetic surgical correction of enophthalmos.

3-Aza-2-oxo-bicyclo[3.1.0]hexanes, which are opened to 2,3-methano-γ-aminobutyric acids, are obtained in very high yields by a two step procedure from N-protected- N-allyl-α-Br-amides.

The halogen atom transfer radical addition (HATRA) of methyl 2-Br-2-Cl-carboxylates to alkenes is obtained in good yields by catalytic amounts of iron filings in dimethylformamide/1,2-dichloroethane at 80°C under argon.

A healthy young woman with recurrent spontaneous abortion and septate uterus underwent hysteroscopic metroplasty with intracavitary instillation of 1350 mL of 10 dextran 40 in normal saline. After the operation, the patient developed acute hypervolemic pulmonary edema and severe coagulopathy due to temporary impairment of platelet function. Fluid overload, which could have been caused by the hyperosmolar properties of dextran, worsened progressively as fluids were drawn from the interstitial space and urine output was reduced. The use of a dilute and/or low-molecular-weight dextran solution to distend the uterine cavity during operative hysteroscopy is not without risk of complications.

Herpes zoster (HZ) incidence is higher in patients with hematologic malignancies (HM) (25-100 cases/1000 person-years) than in the general population (3-5 cases/1000 person-years). This immunocompromised population can experience significant morbidity and occasional mortality from complications associated with reactivation of the varicella-zoster virus (VZV). In general, there is limited data in the literature regarding the effect of anti-CD20 monoclonal antibodies, used in treatment of HM patients, on vaccine-related cell-mediated immune response. Due to the potential negative impact of anti-CD20 monoclonal antibodies on vaccine immunogenicity and efficacy, HM patients receiving anti-CD20 monoclonal antibodies have been excluded from prior inactivated VZV vaccine (inactivated-ZV) studies. This study evaluated the safety and immunogenicity of inactivated-ZV in HM patients receiving anti-CD20 monoclonal antibody therapy.This was an open label, single arm, multicenter Phase I study of a 4-dose inactivated-ZV regimen (∼30 days between each dose) in patients ≥18 years old with HM receiving anti-CD20 monoclonal antibodies either as a single agent or in a combination chemotherapy regimen and not likely to undergo HCT (n=80). Blood samples were collected at baseline prior to dose 1 and 28 days postdose 4 to measure VZV-specific T-cell responses using interferon-gamma enzyme-linked immunospot (IFN-γ ELISPOT). The primary hypothesis was that inactivated-ZV would elicit significant VZV-specific immune responses at ∼28 days postdose 4, with the statistical criterion being that the lower bound of the two-sided 90% confidence interval (CI) on the geometric fold rise (GMFR) be >1.0. All vaccinated patients were evaluated for adverse events (AE), including VZV-like rashes, through 28 days postdose 4.The 4-dose inactivated-ZV regimen elicited a statistically significant VZV-specific immune response measured by IFN-γ ELISPOT at 28 days postdose 4 in the per-protocol population (GMFR = 4.34 [90% CI: 3.01, 6.24], p-value <0.001). As the lower bound of the 2-sided 90% CI for GMFR was >1.0, the pre-specified primary immunogenicity success criterion was met.Overall, 85% (68/80) of patients reported ≥1 AEs, 44% (35/80) reported ≥1 injection-site AEs, and 74% (59/80) reported ≥1 systemic AEs. The most common injection-site AEs were pain (32%), erythema (31%), and swelling (26%). The most common systemic AEs were pyrexia (25%) and diarrhea (14%). Twelve patients (15%) experienced serious AEs, including one event determined by the investigator to be vaccine-related (convulsion: day 8 postdose 1). One patient experienced a fatal serious AE (Richter’s transformation to Hodgkin’s disease; day 34 postdose 1) assessed as not vaccine-related by the investigator. In general, the frequencies of AEs did not increase with subsequent doses of vaccine. No inactivated-ZV recipient had a rash that was PCR positive for VZV vaccine strain.In adults with HM receiving anti-CD20 monoclonal antibodies, inactivated-ZV was well tolerated and elicited statistically significant VZV-specific T-cell responses ∼28 days postdose 4.McNeil: Merck: investigator Other, Research Funding. Betts:Merck: investigator Other, Research Funding. Lawrence:Merck: investigator Other, Research Funding. Velardi:Merck: investigator Other, Research Funding. Kimby:Merck: investigator Other, Research Funding. Pagnoni:Merck: Employment, Equity Ownership. Stek:Merck: Employment, Equity Ownership. Zhao:Merck: Employment, Equity Ownership. Chan:Merck: Employment, Equity Ownership. Lee:Merck: Employment, Equity Ownership. Parrino:Merck: Employment, Equity Ownership.

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Pulse pressure is related to vascular compliance and to ageing. In the present study we evaluated the pattern of blood pressure, using a 24-h ambulatory BP recording, in 1929 patients with essential hypertension, divided into twelve groups on the basis of the age: group I, aged from 16 to 20 years (20 M - 15 F); group II, from 21 to 25 (27 M - 21 F); group III, from 26 to 30 (49 M - 35 F), group IV, from 31 to 35 (69 M - 43 F); group V, from 35 to 40 (104 M - 72 F); Group VI, from 41 to 45 (110 M - 102 F); Group VII, from 46 to 50 (151 M-125 F); Group VIII, from 51 to 55 (158 M-161 F); Group IX, from 56 to 60 (115 M-117 F); Group X, from 61 to 65 (86 M-106 F); Group XI, from 66 to 70 (53 M - 98 F); Group XII, from 71 to 75 (31 M - 61 F). All hypertensives, with no evidence of secondary hypertension, were recuited in about ten years and all of them did a 24-hour ambulatory BP monitoring (A&D TM 2420, model 6). In younger pulse pressure was progressively reducing from adolescence to juvenile age (always higher in males compared to females, p<0.0005). With increasing age, pulse pressure reached an early steady state in the middle-aged hypertensives, then was progressively increasing in both genders (p<0.05-0.0005). These findings accounted for a significantly higher pulse pressure values recorded in males and seem to describe an age-related curve with a U-pattern profile in males (higher values in both juvenile and elderly age) and a J-pattern profile in females (with higher values in the elderly).

Prognostic value of blunted BP night-time reduction might be useful in hypertensive evaluation. In the present study we evaluated pattern and profiles of 24-h ambulatory systolic BP recording, with regard to similarities and differences during afternoon (“siesta”) and night-time periods in six groups of age of untreated hypertensives: group I, from 35 to 40 years (104 males - 72 females); group II (110 M - 102 F) 41 to 45 years, group III (151 M-125 F) 46 to 50 years, group IV (86 M-106 F) 61 to 65 years, group V (53 M - 98 F) 66 to 70 years, group VI (31 M - 61 F) 71 to 75 years. All patients were uncomplicated and with no previous cardiovascular events and they carried out 24-h ambulatory BP monitoring. Nocturnal systolic BP fall into three younger group of patients was always greater compared to the afternoon in both males and females, whereas into three elderly groups nocturnal systolic BP fall was blunted and with values comparable to that observed during siesta period in both males and females. (See Figure)