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Although the diffusion of fertility behavior between different social strata in historical communities has received considerable attention in recent studies, the relationship between the diffusion of fertility behavior and the diffusion of people (migration) during the nineteenth century remains largely underexplored. Evidence from population registers compiled in the Historical Database of the Liège Region, covering the period of 1812 to 1900, reveals that migrant couples in Sart, Belgium, from 1850 to 1874 and from 1875 to 1899 had a reduced risk of conception. The incorporation of geographical mobility, as well as the migrant status of both husbands and wives, into this fertility research sheds light not only on the spread of ideas and behaviors but also on the possible reasons why the ideas and behaviors of immigrants might have been similar to, or different from, those of a native-born population.

A case is presented of a 27-year-old Caucasian woman that presented with an oval purplish patch with defined borders on her right cheek. It was swollen and tense, with a mottled surface due to scarring. Histologic examination indicated discoid lupus erythematosus and the patient was initially treated with medical therapy. The lesion relapse and cosmetic results convinced us to propose surgical option with aggressive medical treatment and follow up. In our patient, this combination therapy proved effective.

Compression sutures are a widely used surgical procedure to treat over-filtration blebs associated with corneal dellen, bleb-related dysesthesia, and hypotony. In the current clinical case, a severe complication of compression sutures for the treatment of over-filtering conjunctival bleb following trabeculectomy is described.

An overview is given on recent work towards new avermectin derivatives of extremely high insecticidal and acaricidal activity. These compounds were prepared from commercially available abamectin (avermectin B1) 1. For the synthesis, many novel entries have been opened up, making use of modern synthetic methods and applying them, for the first time, to the chemistry of avermectins. Several types of avermectin derivatives can be regarded as key innovations in the field. These are, in particular, 4''-deoxy-4''-(S)-amino avermectins 3, 4'-O-alkoxyalkyl avermectin monosaccharides 5, 4''-deoxy-4''-C-substituted 4''-amino avermectins 6 and 2''-substituted avermectins 7. 4''-Deoxy-4''-(S)-amino avermectins 3 were obtained by the consecutive application of the Staudinger and Aza-Wittig reaction. 4'-O-Alkoxyalkyl avermectin monosaccharides 5 were prepared by alkoxyalkylation of 5-O-protected avermectin monosaccharide. For the synthesis of 4''-deoxy-4''-C-substituted 4''-amino avermectins 6, several methods were used to construct the fully substituted 4''-carbon centre, such as a modified Strecker synthesis, the addition of organometallics to a 4''-sulfinimine and a modified Ugi approach. In order to prepare 2''-substituted avermectins 7, 5-O-protected avermectin monosaccharide was coupled with carbohydrate building blocks. An alternative synthesis involved the hitherto unknown enol ether chemistry of 4''-oxo-avermectin and the conjugate addition of a cuprate to an avermectin 2'',3''-en-4''-one. In addition, a number of other highly potent derivatives were synthesised. Examples are 4''-O-amino avermectins 8, as well as products arising from intramolecular rhodium catalysed amidations and carbene insertions. A radical cyclisation led to an intriguing rearrangement of the avermectin skeleton. Many of the new avermectins surpassed the activity of abamectin 1 against insects and mites.

Latanoprost is a prostaglandin F2-alpha isopropyl ester prodrug which is rapidly hydrolyzed by esterases in the cornea to the biologically active latanoprost acid. When latanoprost is topically administered into the eye, the cornea seems to act like as a slow-release depot to the anterior segment. One hour after administration maximum concentration is found in the iris, followed by the anterior chamber and the ciliary body. Despite extensive research, controversy remains about the real mechanism of action of this drug. Immunohistochemical data have shown that the intraocular pressure (IOP) reduction with topical prostaglandin F2-alpha is associated with a reduction of collagens within the uveoscleral outflow pathway. Evidence from several experimental and clinical studies suggests that latanoprost is a valuable addition first-line treatment alternatives for glaucoma, ocular hypertension and even angle-closure glaucoma. Strong points are its efficacy, which is demonstrated to be higher than that of brimonidine, dorzolamide and timolol with fewer systemic adverse effects; a convenient administration schedule; and the IOP-controlling pattern, which is relatively flat compared with timolol and dorzolamide, and enables better control in glaucoma progression, since large fluctuations may be associated with the risk of developing glaucoma in untreated ocular hypertensive subjects.

Purpose: To evaluate the effect of the timolol-dorzolamide fixed combination (TDFC) and latanoprost 0.005% on 24-hour intraocular pressure (IOP), systolic (SBP) and diastolic (DBP) blood pressure, and diastolic ocular perfusion pressure (DOPP) in patients with primary open-angle glaucoma (POAG)., Methods: This was an institutional, randomized clinical trial. After a 24-hour assessment without treatment, 27 previously untreated patients with POAG were randomized to 6 weeks' treatment with twice-daily TDFC (8 AM and 8 PM) followed by once-daily latanoprost 0.005% (8 PM), or vice versa. One eye was analyzed per patient. The mean values of IOP, DBP, SBP, and DOPP (difference between DBP and IOP) were recorded at each time point, and the 24-hour data are the mean values of each patient's measurements over the 24-hour period. The differences between the values of the first treatment period and the baseline and the second treatment period and washout were calculated and analyzed by means of an analysis of variance model that tested the effects of sequence and treatment., Results: Both treatments significantly reduced 24-hour IOP (P < 0.0001), but TDFC led to lower 24-hour pressure (mean +/- SD: 15.4 +/- 1.9 vs. 16.7 +/- 1.7 mm Hg; P = 0.004). Latanoprost did not lead to any significant reduction in mean 24-hour SBP and DBP (SBP: P = 0.952; DBP: P = 0.831), but TDFC did (SBP and DBP: P < 0.0001). Both treatments significantly increased 24-hour DOPP (P < 0.0001), with no difference between the two medications (P = 0.09)., Conclusions: In previously untreated patients with POAG, TDFC, and latanoprost equally enhanced 24-hour DOPP: the former by counteracting the decrease in DBP with a substantial reduction in IOP and the latter by not affecting DBP and significantly reducing IOP. (isrctn.org number, ISRCTN67123277.).

The glaucomatous disease is currently considered a disease involving ocular and visual brain structures. This new approach to glaucoma introduces the possibility of inducing an improvement by means of a pharmacological approach similar to that used in different degenerative brain disorders. In line with this hypothesis, we studied the effects of oral (1600 mg/die, Cebrolux, Tubilux Pharma, Pomezia, Rome, Italy) or intramuscular (1000 mg/die, Cebroton, Tubilux Pharma) cytidine-5'-diphosphocholine (citicoline) treatment on retinal function and neural conduction in the visual pathways of glaucoma patients with moderate visual defects. Improvement of retinal function (objectively evaluated by pattern electroretinogram recordings) and of neural conduction along visual pathways (objectively evaluated by visual evoked potential recordings) were observed in glaucoma patients after two 60-day periods of oral or intramuscular treatment with citicoline. However, partial regression of this improvement was detected after two 120-day periods of washout. This suggests that the beneficial effects observed are in part treatment-dependent. The extension of citicoline treatment up to a period of 8 years lead to the stabilization or improvement of the glaucomatous visual dysfunction. These results suggest potential neuroprotective effects of citicoline in the glaucomatous disease.

Levobetaxolol is a cardioselective beta-blocker that has been demonstrated to reduce intraocular pressure in patients affected with primary open-angle glaucoma and ocular hypertension. Levobetaxolol may be an effective neuroprotectant because of its great capacity to block sodium and calcium influx, which might confer a neuroprotective activity. Experimental and clinical studies have demonstrated the effects of levobetaxolol on ocular hemodynamics and visual field, and the pharmacologic differences between beta-blockers currently used for the treatment of elevated IOP have become of more than academic interest since a number of studies have shown improvements to various extents. Unlike the initially manufactured 0.5% ophthalmic solution, levobetaxolol is suspended in a different delivery vehicle in levobetaxolol ophthalmic suspension, to increase the ocular tolerance and allow a similarity of effect with a 2-fold reduced concentration (0.25%).

Two principal subunits of the marine algal toxin (-)-gymnodimine were synthesized. A trisubstituted tetrahydrofuran representing C10-C18 of the toxin was prepared via a highly stereoselective iodine-mediated cyclization of an acyclic alkene bearing a bis-2,6-dichlorobenzyl (DCB) ether. The formation of a cis-2,5-disubstituted tetrahydrofuran in this process conforms to a stereodirecting effect by the DCB group proposed by Bartlett and Rychnovsky. A cyclohexene subunit corresponding to the C1-C8, C19-C24 portion of gymnodimine was synthesized via Diels-Alder cycloaddition of a 1,2,3-trisubstituted diene to a symmetrical dienophile obtained from Meldrum's acid. Differentiation of carbonyl groups in the cycloadduct was made by an intramolecular reaction with a neighboring alcohol to form a gamma-lactone. Linkage of the two subunits at C18-C19 was accomplished by using a B-alkyl Suzuki coupling in which a borane prepared from the pendent alkenyl chain of the cyclohexene domain was reacted with the (E)-iodoalkene attached at C16 of the tetrahydrofuran sector. Subsequent transformations positioned functional groups in the coupled product for a future macrocyclization event that would close the 15-membered ring of gymnodimine.

Purpose: To compare the short-term effects of timolol 0.5%, brimonidine 0.2%, dorzolamide 2%, and latanoprost 0.005% on intraocular pressure (IOP), blood pressure (BP), and diastolic ocular perfusion pressure (DOPP), calculated as the difference between the diastolic blood pressure (DBP) and IOP., Methods: According to a 4 x 4 Latin squares design for repeated measures, 27 untreated patients and patients with newly diagnosed primary open-angle glaucoma (POAG) were treated with timolol 0.5% at 8 AM and 8 PM; brimonidine 0.2% at 8 AM and 8 PM; dorzolamide 2% at 8 AM, 2 PM, and 8 PM; and latanoprost 0.005% at 8 PM. The duration of each treatment course was 6-weeks, with a 4-week washout between each treatment. IOP and BP were measured at baseline and at the end of each treatment period. IOP was measured every 2 hours throughout a 24-hour period. Sitting IOP was measured from 8 AM to 10 PM by Goldmann applanation tonometry. Supine IOP was assessed from 12 to 6 AM by means of a handheld electronic tonometer (TonoPen XL; Mentor, Norwell, MA). BP monitoring was performed by means of an automated portable device (TM-2430; A & D Co., Saitama, Japan)., Results: All the drugs tested decreased the IOP significantly at all time points in comparison with baseline pressure. The mean 24-hour IOP after latanoprost administration (16.62+/-0.98 mm Hg) was significantly lower than that after timolol, brimonidine, or dorzolamide (P=0.0001). During the 24-hour period, brimonidine induced a significant decrease in systolic BP (SBP) and DBP at all time points when compared with baseline measurements and with those after administration of the other drugs (P<0.0001). Timolol caused a significant decrease in DBP and SBP at all the 24-hour time points when compared with the baseline and with the dorzolamide- and latanoprost-induced changes (P<0.0001). The mean 24-hour DOPPs were 50.7+/-5.9 mm Hg at baseline, 53+/-5.5 mm Hg with timolol, 46.2+/-5.4 mm Hg with brimonidine, 55.9+/-4.6 mm Hg with dorzolamide, and 56.4+/-4.9 mm Hg with latanoprost. Brimonidine induced a significant decrease in the mean 24-hour DOPP compared with that at baseline (P<0.0001), whereas dorzolamide and latanoprost induced a significant increase (P<0.0001)., Conclusions: Latanoprost seemed to induce a uniform reduction in IOP during the 24-hour period, although timolol was as effective as latanoprost during the daytime, and dorzolamide are as effective as latanoprost at night. SBP and DBP were significantly decreased by either timolol or brimonidine. In this study of patients with newly diagnosed POAG, only dorzolamide and latanoprost significantly increased mean 24-hour DOPP.

Purpose: To determine the proportion of patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH) who do not respond to latanoprost therapy., Methods: Three hundred forty consecutive patients with a new diagnosis of POAG or OH, or previously treated only with a beta-blocker and after an appropriate washout period, were treated with latanoprost for 1 month and then divided into three groups on the basis of the reduction in intraocular pressure (IOP): nonresponders (<15%), responders (> or =15% but <30%), and high-responders (> or =30%). To give a wide picture of the drug effect, eight different cut-off points were used to present data on distribution of mean IOP reductions. Only the nonresponders entered a randomized cross-over study investigating the efficacy of timolol, brimonidine, and pilocarpine., Results: IOP at baseline and after 1 month's latanoprost therapy was respectively 24.1+/-1.4 and 16.9+/-2.4 mm Hg, with a mean reduction in IOP of 29.9+/-4.2%. Nonresponders accounted for 4.1% of the patients and high-responders for 41.2%. The nonresponders showed a statistically significant reduction in IOP after brimonidine treatment (P=0.05), whereas the reduction after timolol and pilocarpine treatment was clinically relevant but not statistically significant., Conclusions: This multicenter prospective study found only 14 of 340 nonresponders to latanoprost. In the cross-over trial on nonresponders, IOP reduction reached statistical significance only after brimonidine, but their small number reduced its statistical power.

Purpose: Based on the known neurocristopathic etiology of type 1 neurofibromatosis (NF1) and the neuroectodermal embryologic derivation of the iridocorneal angle, we examined a sample of young patients affected with NF1 to see if they have evidence of underdevelopment of the angular region., Patients and Methods: We designed a case-controlled clinical study. Forty-two consecutive patients (42 eyes), 24 male and 18 female, affected with NF1 were recruited for the study. Forty-two eyes of 42 consecutive young patients (19 male and 23 female) served as a control group for the iridocorneal angle features studied. Indirect gonioscopy was performed by the means of a Goldmann lens. The intraocular pressure was measured with a Goldmann applanation tonometer. Photographs were taken of the anterior segment and of all the four quadrants of the iridocorneal angle to record the presence of abnormalities. The iridocorneal angle was graded according to the classification proposed by Spaeth. Evaluation of the angle also included the gonioscopic width of ciliary body band (CBB)., Results: In this study we found that 29 of 42 eyes (69%) of the NF1 group had mild anteriorization, even if within normal limits, of the iris insertion and abundant basal iris processes. The CBB was either invisible (54.84%) or very narrow (21.4%). Three NF1 patients had bilateral juvenile congenital glaucoma., Conclusions: It seems that patients affected with NF1 often have characteristic gonioscopic findings consistent with underdevelopment of the iridocorneal angle.

An azaspiro[5.5]undecadiene corresponding to a subunit of the shellfish toxin gymnodimine was synthesized by Diels-Alder cycloaddition. One member of the pair of stereoisomeric adducts was transformed to a spiroimine, which will serve as the core around which the macrocyclic portion of the toxin will be assembled. [structure: see text]

Objective: To evaluate the effect of Ginkgo biloba extract (GBE) on preexisting visual field damage in patients with normal tension glaucoma (NTG)., Design: Prospective, randomized, placebo-controlled, double-masked cross-over trial., Participants: Twenty-seven patients with bilateral visual field damage resulting from NTG., Intervention: Patients received 40 mg GBE, administered orally, three times daily for 4 weeks, followed by a wash-out period of 8 weeks, then 4 weeks of placebo treatment (identical capsules filled with 40 mg fructose). Other patients underwent the same regimen, but took the placebo first and the GBE last. Visual field tests, performed at baseline and at the end of each phase of the study, were evaluated for changes., Main Outcome Measures: Change in visual field and any ocular or systemic complications., Results: After GBE treatment, a significant improvement in visual fields indices was recorded: mean deviation (MD) at baseline versus MD after GBE treatment, 11.40 +/- 3.27 dB versus 8.78 +/- 2.56 dB (t = 8.86, P = 0.0001, chi-square test); corrected pattern standard deviation (CPSD) at baseline versus CPSD after GBE treatment, 10.93 +/- 2.12 dB versus 8.13 +/- 2.12 dB (t = 9.89, P = 0.0001, chi-square test). No significant changes were found in intraocular pressure, blood pressure, or heart rate after placebo or GBE treatment. Any ocular and systemic side effects were recorded for the duration of the trial., Conclusions: Ginkgo biloba extract administration appears to improve preexisting visual field damage in some patients with NTG.

Chiral Lewis acid catalysis has emerged as one of the premiere method to control stereochemistry. Much effort has gone into the design of superior ligands with increasing steric extension to shield distant reactive sites. We report here an alternative and complementary approach based on a "chiral relay". This strategy focuses on the improved design of achiral templates which may relay and amplify the stereochemistry from ligands. The essence of this strategy is that the chiral Lewis acid would effectively convert an achiral template into a chiral non-racemic template. This approach combines the advantages of enantioselective catalysis (substoichiometric amount of the chiral inducer) with the ones of chiral auxiliary control (efficient and predictable stereocontrol).

[reaction: see text] A new strategy to control the enantioselectivity of Lewis acid catalyzed reactions has been investigated. The use of N-acryloyl-1,3-benzoxazol-2-(3H)-ones substituted at position 4 leads to the formation of diastereomeric complexes as a result of the presence of a chiral axis. The stereochemical outcome of the reaction is controlled by the chiral catalyst and by the chiral axis, leading to high enantioselectivity improvements and, in one case, to an inversion of enantioselectivity.

Different dipeptide analogues containing an oxirane ring in the place of the peptidic bond were prepared starting from naturally occurring amino acids. N-Fmoc-amino aldehydes were transformed into the corresponding methoxyvinyl derivatives through a Wittig reaction, and the addition of PhSeCl gave a series of different alpha-phenylselenyl aldehydes. Mukajiama reaction with silylketene acetals gave an intermediate product that was finally transformed into the desired oxiranyl peptidomimetics. Following this strategy we were able to control three new contiguous stereocenters starting from the enantiomerically pure amino acid. The dipeptide analogues could be used in SPPS on a SASRIN resin as the final epoxides were relatively unstable under acidic conditions. Moreover the synthesis of the single dipeptide mimetics was carried out on solid phase to generate a small library of epoxy peptidomimetics. Some of the products prepared in this work resulted as time-dependent reversible inhibitors of cysteine protease.

Growth hormone releasing peptides (GHRPs) are synthetic molecules endowed with potent neuroendocrine activities mediated by specific receptors in the pituitary and in the central nervous system. GHRPs receptors have been reported even in perpheral tissues, particularly in the myocardium, where they probably mediate growth hormone (GH)-independent activities. We studied in humans the cardiac effects of hexarelin administration in 7 normal adults, in 7 severe GH-deficient patients, and in 12 patients with severe dilated cardiomyopathy. Left ventricular ejection fraction (LVEF), mean blood pressure (MBP), heart rate (HR), and GH levels were evaluated at baseline and every 15 min up to 60 min after acute 2.0 microg/kg iv hexarelin administration. Basal LVEF in dilated cardiomyopathy was impaired and lower (p < 0.001) than in GH deficiency, in turn lower (p< 0.001) than in normal subjects. Hexarelin signficantly (p < 0.05) increased LVEF in normal and in GH-deficient subjects, but not in dilated cardiomyopathy, without significant variations in MBP and HR. Hexeralin significantly (p < 0.05) increased GH levels in normal subjects and in dilated cardiomyopathy but not in GH deficiency. These findings suggest that, in humans, the acute administration of hexarelin exerts a GH-independent positive inotropic effect likely mediated by specific GHRPs myocardial receptors.

Objective: To review the literature regarding the safety and efficacy of epidural corticosteroid injections in the treatment of low back pain (LBP) of various etiologies., Data Sources: A MEDLINE search (1966-February 1999) of English-language literature pertaining to the use of epidural corticosteroids in LBP was performed. Additional literature was obtained from reference lists of pertinent articles identified through the search., Study Selection and Data Extraction: All articles were considered for the review. The clinical trials included are those that enrolled a larger patient population and were primarily controlled clinical trials. The authors selected pertinent information for further discussion., Data Synthesis: Nerve root compression and inflammation are thought to be factors contributing to LBP. Corticosteroids act to decrease inflammation and may be of benefit in relieving LBP, especially if administered directly to the affected area via the epidural route. However, data on the efficacy of various corticosteroid agents administered via this route are limited. In addition, there have been reports of significant adverse reactions, thought to be due primarily to the preservative components in the corticosteroid preparations. Therefore, the role of these agents in the therapy of LBP remains to be determined., Conclusions: Based on the studies reviewed, epidural corticosteroids may be an effective treatment for LBP. Their use is warranted in patients who have failed conservative therapy. Although they contain preservatives, it appears that these agents are relatively safe and do not cause significant neurotoxicities.

Objective: To evaluate the effect of ab-interno goniotrabeculotomy (AIGT) on the intraocular pressure (IOP) in adult patients with primary open-angle glaucoma (POAG), compared with the effects of mitomycin C trabeculectomy (MT)., Design: Prospective, randomized, clinical trial., Participants: Thirty-two eyes of 32 patients with medically uncontrolled POAG., Intervention: Standard limbus-based trabeculectomy with adjunct mitomycin C (0.3 mg/mL for 3 minutes) in 16 eyes of 16 patients; AIGT was performed in 16 eyes of 16 patients. The groups were matched for age, preoperative IOP, duration of preoperative antiglaucoma treatment, use of preoperative beta-blockers and parasympathomimetics, and use of beta-blockers in the fellow eye. The IOP (average of the two highest values measured in the diurnal curve, from 8 AM to 6 PM, every 2 hours) and complications were recorded 1, 3, 6, 12, 18, and 24 months after surgery., Main Outcome Measures: Identification of complications and IOP., Results: All patients were followed up for 24 months. More postoperative complications occurred in the MT group during the 2-year follow-up. One month after surgery, IOP was 10 +/- 1.46 mmHg (range, 8-13) in the MT group and 12.12 +/- 1.63 mmHg (range, 8-14) in the AIGT group (Student's t test, P = 0.001). Three months after surgery, IOP was 11.5 +/- 1.59 mmHg (range, 8-14) and 12.75 +/- 1.57 mmHg (range, 10-16) in the MT and AIGT groups, respectively (Student's t test, P = 0.033). From the 6th to the 24th postoperative month, no statistically significant difference in IOP was found between the two groups. At the end of follow-up, 14 of 16 eyes (87.5%) of the AIGT group and 13 of the 16 eyes (81.25%) of the MT group showed an IOP < or = 14 mmHg., Conclusion: Ab-interno goniotrabeculotomy appears to be a viable and safe surgical treatment for adult POAG. More extended follow-up, however, and a larger series of patients are needed to ascertain the actual effectiveness of this procedure in adult POAG.

Prophylactic cholecystectomy for asymptomatic gallstones is still controversial. Aim of the study was to assess whether the determination of serum acute phase proteins (APP) could be utilized as a criterion for cholecystectomy, as they are suggestive of the presence in the blood of cytokines released from the inflamed gallbladder wall, even when clinical signs are missing. In 75 cases of gallstones, free from other coexistent inflammatory processes, red cell sedimentation rate, plasmatic cortisol, immunoglobulin (IgA, IgG, IgM), electrophoresis of the proteins, CPR, fibrinogen, haptoglobin, alfa-1-antitrypsin and bile culture have been detected. The patients have been subdivided into two groups: patients with asymptomatic or mildly symptomatic disease and patients with a clear clinical pattern of acute cholecystitis. In the latter alfa-1-globulin, alfa-2-globulin, ESR, CPR and cortisol turned out to be significantly elevated, while in 20-30% of the former CPR, beta-globulin and cortisol were increased, too. The study demonstrates that among the patients with asymptomatic gallstones there is a population having PFA values higher than normal. This is suggestive of a cytokines activation which, when other inflammatory processes can be excluded, is likely due to gallbladder inflammation and surgery will likely be indicated.

Purpose/methods: Rubinstein-Taybi syndrome is a constellation of clinical findings characterized by mental and motor retardation, broad thumbs and broad first toes, marked growth retardation, microcrania, typical facies, high-arched palate, and cryptorchidism in males. Ocular and adnexal abnormalities are quite common and include antimongoloid slant of the palpebral fissures, epicanthal folds, congenital obstruction of the lacrimal excretory system, ptosis, strabismus, and severe ametropia. Macrocornea, microophthalmos, colobomas of the iris and of the optic nerve head, congenital cataract, and optic nerve atrophy have also been described. Congenital glaucoma is a rare complication. We examined a patient with Rubinstein-Taybi syndrome with bilateral congenital glaucoma., Results/conclusions: Examination of this patient revealed bilateral antimongoloid slants of the palpebral fissures, and bilateral congenital glaucoma. Gonioscopic examination revealed the iris to be inserted flatly into the trabecular meshwork. This case emphasizes the importance of detailed, complete ocular examinations in patients with Rubinstein-Taybi syndrome, and also highlights the occurrence of ocular abnormalities rarely associated with this disease.

Purpose: Color Doppler imaging (CDI) is a relatively new technique that allows quantification of blood flow velocity in orbital and ocular vasculature. Despite the numerous clinical studies that have used CDI, repeatability of this technique and agreement between observers have not been documented., Methods: The authors performed a prospective investigation of the repeatability and agreement between observers on ophthalmic artery blood flow velocity measurements in 35 patients (35 eyes)., Results: Results on the estimated error of measurement (variability between repeated readings on the same subject) indicate good repeatability of the measurements; in fact, the measurement variances were only 5.6% for the peak systolic velocity, 11.4% for the end diastolic velocity, and 6.2% for the mean envelope velocity. The statistical analysis of repeatability showed a very narrow 95% confidence interval for both observers. The measurement of agreement between the two observers demonstrated the existence of a good concordance of the measurements taken by each observer on each subject., Conclusions: Results suggest that CDI is a reliable tool for quantitative assessment of ophthalmic artery blood flow velocity.

Pneumoperitoneum in diagnostic or therapeutic laparoscopy can be achieved by an open or a closed technique. The authors, on the basis of their experience, compare both techniques, concluding that open method is safer, because of the lack of major complications observed in the closed method and with only few minor complications.

This study was performed to confirm the high sensitivity of CT during arterial portography (CTAP) versus US and dynamic CT in the diagnosis of liver metastases from colorectal cancer. Ninety patients with 108 colorectal cancers underwent US, dynamic CT and CTAP to investigate the presence of liver metastases. US depicted 39 metastases in 26 patients, dynamic CT 46 metastases in 29 patients and CTAP 54 lesions in 34 patients. CTAP detected 8 metastases missed at dynamic CT; 4 of them were < 1 cm in diameter, 3 ranged 1-2 cm and one metastasis > 2 cm in diameter. After preoperative investigations only 7 patients were considered for hepatic resection. At surgery, palpation and intraoperative US of the liver detected two more metastases in the same patients. Our experience, in agreement with recent studies, confirms CTAP as the most sensitive preoperative method in detecting liver metastases and its superiority to be most apparent in lesions < 1 cm in diameter. Therefore, we consider CTAP an essential imaging technique for planning the correct treatment of liver metastases.

The term endometriosis means the presence in an ectopic site of normal functioning endometrial tissue, the ectopic endometrial tissue, as the normal uterine mucosa, undergo hormonal stimulation and follow the proliferative and functional changes along the menstrual course; this evolution, characterize the clinical story of patients affected by endometriosis. Endometriosis is considered to be one of the most common gynecologic disorders, occurring in about 10% of women in fertile age. An involvement of adjacent organs such as the pelvic colon and rectum by endometriosis is not uncommon and may cause symptoms difficult to distinguish from malignant or inflammatory disease located in the pelvic region. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of a disease concerning both the surgeon and gynecologists. Our case concerns a 44 year old patient with two children and a negative previous clinical gynecological history; the patients reports the occurrence in the last two years of alterations of colic evacuation consisting in a period of constipation lasting 5-7 days. The patient reached us in emergency with a sub-occlusive state that has lasted for 5 days, in the last 12 hours the appearance of a violent trafictive pain referred to the lower abdomen configure the clinical picture of a acute abdomen. The patient underwent surgery and the laparotomy demonstrated the presence of a perforated tumours located at the recto-sigmoid junction. We proceed to perform an Hartman's resection and a right ovariectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Purpose/methods: A 35-year-old woman, who had undergone an uncomplicated Scopinaro-type biliopancreatic bypass for obesity nine years previously, was examined because of severe bilateral corneoconjunctival xerosis and markedly decreased vision. One month earlier she had had a bout of nonspecific enteritis. She was treated with intramuscular vitamin A., Results/discussion: After one month of therapy, the ocular xerosis had cleared completely and her vision had returned to normal. This case suggests that this kind of operation can cause instability of vitamin A absorption.

During the period between 1-1-1979 and 30-9-1992, 43 cases of hemorrhagic necrotic acute pancreatitis were referred to the authors' attention. Six patients were not operated, 12 underwent emergency surgery and laparotomy was postponed in 25 cases. The introduction of sophisticated diagnostic methods, such as Eco, CT, ERCP, intensive medical therapy and postoperative NPT have allowed a more rational surgical approach in terms of timing and extent to be adopted, operating on patients who are metabolically more stable. NPT is a useful tool in the latter postoperative stage. In the series of patients undergoing emergency laparotomy there was a mortality rate of 66%. The mortality rate fell to 16% in those patients in whom surgery was postponed.

This study was aimed at investigating the role of color-Doppler US in the assessment of orbital vasculature under normal conditions; the results were then applied to the flowmetric analysis of some vascular diseases of the orbit, i.e., retinitis pigmentosa, simple chronic glaucoma, low-tension glaucoma and carotid-cavernous fistulas. The study consisted of two phases: first, a group of 20 healthy volunteers was examined and then 39 patients were divided into 4 subgroups. The patients (18 men and 21 women, age range: 52-68 years) were further divided into 4 subgroups: 12 of them had retinitis pigmentosa, 15 simple chronic glaucoma, 8 low-tension glaucoma and 4 carotid-cavernous fistulas. Color-Doppler yielded useful pieces of information on the position of orbital vessels and flow direction, while pulsed Doppler allowed the measurement of several variables, i.e., time average velocity, protosystolic velocity, peak systolic velocity, mesodiastolic velocity, end diastolic velocity, resistive index and pulsatility index. The study of the 20 healthy volunteers yielded valuable information on the anatomy and flow patterns of some vessels, such as the ophthalmic artery, the central retinal artery, the lacrimal artery and the posterior ciliary arteries, all of them visible in 90-100% of patients; the central retinal vein, the superior ophthalmic vein and venae varicosae were demonstrated in about 10-30% of them. In the group of patients, the mean flow velocities of the examined arteries were significantly lower than those in the normal volunteers; in the patients with carotid-cavernous fistulas an ectasic superior ophthalmic vein was demonstrated, with its typical flow "arterialization" pattern. The results suggest that color-Doppler could play a mayor role in the study of ocular hemodynamics.

In the present study the relationship between intraocular pressure (IOP) and pulsatile ocular blood flow (POBF) in low tension glaucoma (LTG) has been investigated. The POBF was measured using the Ocular Blood Flow system of Langham in undisturbed eyes and repeated at IOP increments of about 5 and 10 mmHg in 20 patients affected with bilateral LTG and in 25 healthy subjects matched for age, IOP, refractive error, arterial blood pressure and heart rate. The POBFs were 740.1 (SD 58.83) and 667 (SD 108) microliters/minute (microliter/min) in the control and LTG groups, respectively and statistically significantly different. The POBFs at an IOP increased by 5 mmHg were 658.1 (SD 60.2) and 457.3 (SD 74.8) microliter/min in the control and LTG groups, respectively; in the control group the mean POBF at an IOP increment of 10 mmHg was 552.1 microliters/min (SD 66.9), and in the LTG group was 317.7 microliters/min (SD 85.2). Statistical analysis of the data showed a significant difference of POBFs in the two groups either at an IOP increment of 5 or 10 mmHg (p < 0.0001). The substantial decrease of POBF with increased IOP in LTG eyes compared with normals shows an altered response of the vascular system in LTG. These findings are probably consistent with a lack of the myogenic autoregulation in reply to IOP-induced modifications of the perfusion pressure.

Surgical avulsion of the iris was performed in 11 eyes of 11 patients affected with diabetic retinopathy, rubeosis of the iris and neovascular glaucoma that had been unsuccessfully treated otherwise. Nine eyes had extensive iris neovascularization, complicated cataract and vitreous haemorrhage, whereas the other two eyes were aphakic and had previously undergone vitrectomy, lensectomy and extensive laser photocoagulation. Prior to surgical avulsion of the iris, all eyes received topical and entheric hypotensive therapy. The intraocular pressure (IOP) ranged from 24 to 52 mmHg. Iris avulsion lowered the IOP in 9 of the 11 eyes treated (IOP range, 6-19 mmHg).

The exact mechanism of action of argon laser trabeculoplasty (ALT) has only been presumptively proposed. There are two hypotheses of action of ALT: the first is the mechanical theory and the second is centered on the possibility of laser-induced modifications of trabecular cells. The goal of our investigation was to verify if pilocarpine determines a decrease of intraocular pressure mainly by a mechanical stretching of the meshwork; if pilocarpine could lower intraocular pressure after ALT; and thus if the mechanism of action of laser treatment could mainly be attributable to a mechanical strain of the trabecular meshwork. Twenty-one patients affected with primary open angle glaucoma had been recruited for the study. Twenty-one eyes underwent trabeculoplasty. All the patients were followed for 6 months. Statistical analysis of the data revealed that pilocarpine was not able to induce a further decrease of intraocular pressure after trabeculoplasty. Moreover, the maximum decrease of intraocular pressure induced by pilocarpine before laser treatment was not statistically different from the tensional values after ALT. The results of the present investigation suggest that the mechanism of action of trabeculoplasty is probably attributable to a mechanical stretching of the trabecular meshwork and the results show the inefficacy of pilocarpine after laser treatment in the management of glaucomatous patients.

Successful management of vaginal aplasia in two patients with Rokitansky-Küster-Hauser syndrome by means of Vecchietti's technique is reported.

A personally observed case of biliary ileus triggers this description of its clinical features, blood chemical and diagnostic aspects and surgical treatment. Emphasis is placed on the importance of the preoperative rehydration and restoration of the electrolyte balance in patients with upper intestinal occlusion which reduces the risk involved in subsequent surgery.

Sixty-eight eyes presenting with congenital glaucoma and operated on by goniotomy, have been followed up for 1 to 10 years. Intra-ocular pressure was normalized in 91.18 p. cent of cases by one or more goniotomies with or without medical treatment. We have also analyzed the functional results of these operations.

Between January 1983 and July 31, 1988 at the 1st Division of General Surgery of Cuneo S. Croce Hospital, 57 patients (33 m, 24 f) were subjected to abdomino-perineal amputation for rectal A.D.K. A definitive colostomy was fashioned for all patients. Neostoma complications were encountered in 33% of cases. 91% of patients completed the rehabilitative programme and 40% saw satisfactory results as regards the regularisation of the alvus and return to social life.

On the basis of experience acquired through 11 cases of acute mesenteric infarction personally observed over a 10-year period (1-1-1978-31-12-1987) and on the basis of a review on the literature, the usefulness for the purposes of early diagnosis and consequent early treatment of monitoring the essential, typical biological and clinical parameters of patients at risk of acute mesenteric infarction are reported.

A series of 172 cases of acute pancreatitis encountered between 1-1-79 and 30-4-88, including 57 treated with somatostatin is presented. A comparison between the latter and the other cases treated with a variety of drugs (aprotinin, cimetidine, ranitidine) led to the following conclusions: 1) somatostatin significantly improves the clinical course of acute oedematous pancreatitis with circumscribed necrosis; 2) it makes no difference to the development of cases with diffuse necrosis and haemorrhage.

The treatment adopted in 11 cases of acute mesenteric infarction is described: 6 cases involved arterial occlusion due to embolism and 5 arterial occlusion due to thrombosis. Six explorative laparotomies, 4 intestinal resections and one embolectomy of the superior mesenteric artery were carried out. Mortality was 63%. Stress is therefore laid on the need for very early, etiopathogenetic accurate diagnosis so as to commence treatment during the phase of reversible ischaemic intestinal lesion, targeting treatment to the cause of the ischaemia. The problem of the postoperative treatment problem is then discussed with special regard to the treatment of shock, the prevention of recurrences and the short intestine syndrome.

The symptomatology and diagnostic procedure adopted in 11 cases of acute mesenteric infarction are examined. Stress is laid on the importance of early, aetiologically accurate diagnosis for the purpose of instituting profitable treatment. In order to comply with such needs it is essential to perform urgent selective arteriography and/or urgent laparoscopy which only with rare exceptions is carried out even in hospitals that should be better equipped.

The authors, after a short introduction of physiopathology, report on 17 patients who underwent a total (10 cases) or a subtotal (7 cases) gastrectomy for cancer at various times and then submitted to hemochromocytometric test and Schilling test modified by Katz and Bell. On the bases of information given by the tests, some clinical and therapeutic considerations are made.

The prognostic factors regarding colon-rectal cancers in the under-40s are examined. A personal series of 15 cases shows that the incidence of tumour recurrence is higher and the disease-free interval shorter than in patients not selected for age and that 5-year survival is much less. These results permit the hypothesis of greater aggressiveness in colorectal cancers in the young, something that justifies the severer prognosis by comparison with the elderly population.

The problem of obstructed emptying of the gastric stump after Billroth II operations in patients previously treated with H2 receptors is discussed. Statistical comparison using the Student's "t" test revealed a significant difference (t = 2.173) between those given and not given H2-antagonists and confirmed the existence of greater postoperative hypotonia in the gastric stumps of the former group. This clinical syndrome demands careful monitoring of the hydroelectrolytic balance and possibly the use of a double naso-gastric and nasojejunal tube as a precaution to ensure the delivery of the jejunal contents to the stomach. The gastrokinetic drugs metoclopramide and domperidone are also beneficial.