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BackgroundNo clear-cut guidelines exist about the use of imaging procedures for the diagnosis of idiopathic inflammatory myopathies (IIM). Similarly, conflicting, and scanty data exist about Power Doppler Ultrasonography (PDUS) in this subset of patients. In this regard, we recently proposed (1) a 0-3 grey scale (GS) and Power Doppler (PD) score in a cohort of patients affected by IIM, evidencing a positive, statistically significant, correlation for PD and oedema and disease activity.ObjectivesThe aim of this study was to assess the diagnostic accuracy of our score in IIM patients compared to a control group.MethodsWe prospectively collected, since July 2020 to December 2021, all patients evaluated in Vasculitis and Myositis clinic, Rheumatology Unit, University of Siena, with a recent diagnosis of IIM, as well as patients with a previous, definite diagnosis of IIM and evaluated during follow-up or referred from other centres for a second opinion. As control group, we collected all patients affected by amyopathic dermatomyositis (DM) or who underwent myositis immunoblot or muscle biopsy for proximal limbs weakness but eventually received a diagnosis other than IIM. All patients underwent US examination of both thighs in axial and longitudinal scans.ResultsForty-five IIM patients (11 anti-synthetase syndrome, 20 DM, 12 PM, 2 scleromyositis) and twenty-six controls were included. During the observational period, 7, 8, 1 and 1 patients underwent PDUS twice, three, four and five times, respectivelyAssessing area under the receiver operating characteristic (AUROC) curve analysis, IIM patients and control group were distinguished according to PD sum, Oedema sum, atrophy sum and CRP values (Figure 1a). The best cut-off value for PD sum values was 0.5 (70.2% SE and 83.3% SP), for Oedema sum 1.5 (74.5% SE and 79.2% SP), atrophy sum 0.5 (63.4% SE and 65.4% SP) and CRP was 0.22 mg/dL (61.5% SE and 75% SP).Figure 1.Stratifying IIM population into two groups according to disease activity (PhGA≥2), AUROC curve analysis allow to distinguish these groups according to PD and oedema sum and CRP values (Figure 1b) and the best cut-off values was 1.5 (69.6% SE and 76.9% SP), 2.5 (52.2% SE and 92.3% SP) and 0.55 mg/dL (66.7% SE and 88.9% SP), respectively.Testing the IIM group versus control as dependent variable by logistic regression, with PD sum, oedema sum, atrophy sum, CRP, CPK and myoglobin as independent variables, the AUROC was 0.976. From the probability associated with the Chi-square tests, the Type II analysis showed the variable that most influences the IIM diagnosis was PD sum and oedema sum (p=0.017 and p=0.013, respectively) (Figure 1c).ConclusionGS and PDUS have proven an overall good diagnostic accuracy in distinguishing between IIM and myositis mimicker. In particular, even low values of PD (sum 1.5) display a good sensitivity and specificity and, together with oedema, elevated CRP values and myositis-specific and associated antibodies, may be considered a reliable tool for a definite diagnosis of IIM.References[1]Conticini E, Falsetti P, Al Khayyat SG et al. A novel grey scale and Power Doppler ultrasonographic score for idiopathic inflammatory myopathies: Siena Myositis Ultrasound Grading Scale. Rheumatology (Oxford). 2021 Dec 24;61(1):185-194.Disclosure of InterestsNone declared

Four-hundred and forty-two F4+ pathogenic Escherichia coli were isolated in a period of 10 years (2002-2011), from pigs that were suffering from diarrhoea belonging to Italian swine herds. The strains were analysed for their susceptibility to 12 antimicrobials using the disc diffusion method. During the study period, a statistically significant proportion of isolates resistant to enrofloxacin (14.5-89.3%), marbofloxacin (5.4-60.7%), flumequine (49.1-92.9%), danofloxacin (21.6-80%), florfenicol (9.8-64.3%), thiamphenicol (50-92%) and cefquinome (3.8-44%) was recorded. An increase in resistance (not statistically significant) to gentamicin (63.6-85.7%), apramycin (61.8-82.1%), trimethoprim-sulphamethoxazole (75-89.3%), tetracycline (97-100%) and erythromycin (92.4-100%) was also observed. Based on antimicrobial multiresistance, the strains were collected into three groups: I. resistant to 2-5 antimicrobials; II. resistant to 6-8 antimicrobials; III. resistant to 9-12 antimicrobials. The number of isolates belonging to the first group showed a statistically significant decrease (P 0.05; R(2) = 0.896; r = -0.9608), while the isolates belonging to the second and third groups showed a statistically significant increase in resistance (P 0.05; R(2) = 0.753; r = 0.8890 and P 0.05; R(2) = 0.727; r = 0.8701, respectively) over the period of study. The results of this study suggest the need for continued monitoring of the development of resistance.

The TCR repertoire of CD8+ T cells specific for Moloney murine leukemia virus (M-MuLV)-associated Ags has been investigated in vitro and in vivo. Analysis of a large panel of established CD8+ CTL clones specific for M-MuLV indicated an overwhelming bias for V beta4 in BALB/c mice and for V beta5.2 in C57BL/6 mice. These V beta biases were already detectable in mixed lymphocyte:tumor cell cultures established from virus-immune spleen cells. Furthermore, direct ex vivo analysis of PBL from BALB/c or C57BL/6 mice immunized with syngeneic M-MuLV-infected tumor cells revealed a dramatic increase in CD8+ cells expressing V beta4 or V beta5.2, respectively. M-MuLV-specific CD8+ cells with an activated (CD62L-) phenotype persisted in blood of immunized mice for at least 2 mo, and exhibited decreased TCR and CD8 levels compared with their naive counterparts. In C57BL/6 mice, most M-MuLV-specific CD8+ CTL clones and immune PBL coexpressed V alpha3.2 in association with V beta5.2. Moreover, these V beta5.2+ V alpha3.2+ cells were shown to recognize the recently described H-2Db-restricted epitope (CCLCLTVFL) encoded in the leader sequence of the M-MuLV gag polyprotein. Collectively, our data demonstrate a highly restricted TCR repertoire in the CD8+ T cell response to M-MuLV-associated Ags in vivo, and suggest the potential utility of flow-microfluorometric analysis of V beta and V alpha expression in the diagnosis and monitoring of viral infections.

To determine the prevalence of morphologic bowel lesions in patients with inflammatory rheumatic diseases and to better define the interactions between intestinal and articular pathology, 177 patients [39 with reactive arthritis (ReA), 40 with psoriatic arthritis (PsA), 23 with ankylosing spondylitis (AS), 21 with undifferentiated spondyloarthropathy (USpA) and 54 with rheumatoid arthritis (RA)] underwent ileocolonoscopy followed by multiple biopsies of the large bowel and the ileum and ileocecal valve. Biopsies were then examined with light and electron microscopy. During the endoscopic examination various degrees of gut inflammation were observed in 13% of ReA, 5% of PsA, 26% of AS, 14% of USpA and 11% of RA patients. At the histological examination those percentages were respectively 51%, 45%, 48%, 38%, and 15%, and at the electron microscopic examination 76%, 53%, 90%, 60%, and 50%. Our results show that an involvement of the gut is a factor in a large percentage of patients with spondyloarthropathy and, to a lesser extent, with RA. The involvement of the intestine in RA manifests itself mainly in ultrastructural lesions, thus this involvement is not so obvious as in the spondyloarthropathies; however, it could nonetheless play an important role in the etiopathogenesis of this disease.

B-cell-type chronic lymphocytic leukemia (B-CLL) patients have immunological abnormalities of both B and T lymphocytes. Since T cell defects might depend upon a defective accessory function of neoplastic B lymphocytes, we analyzed the ability of peripheral blood B cells of seven B-CLL patients to stimulate allogenic normal T cells in mixed lymphocyte reaction (MLR) and to present tetanus toxoid (TT) to autologous T cells. In both systems, neoplastic B lymphocytes show a defective antigen-presenting function, which is more evident with disease progression. Such a defect cannot be ascribed to a decreased MHC class II molecule expression nor to an abnormal IL-1β production, but it can be partially accounted for by a low B7 expression. Pretreatment of neoplastic B cells with interleukin-4 (IL-4) restores primary MLR, but has little effect on the response to TT. The effect of IL-4 is not mediated by quantitative modifications of class II and B7 molecule expression or of IL-1β production.

Thirty-six cases of abdominal aortic aneurysms rupturing into the vena cava and two iliac aneurysms rupturing into iliac veins are reported. This group represents 10% of the total number of observed ruptured abdominal aortic aneurysms (388). Such a condition is therefore quite rare but should be considered positively because the reported mortality rate is less than with ruptured aneurysms in general. Nevertheless, a spontaneous aorto-caval fistula is responsible for a critical haemodynamic deterioration and sudden worsening of the general condition of the patient and therefore prompt surgical repair is mandatory. The overall mortality rate in our series was 21 % (8 cases).

The aim of this study was to evaluate the ability of ultrasound (US) to measure the parietal thickness of varicose veins.In a blind in vitro analysis, 28 great saphenous veins, obtained after stripping surgery from 28 patients with chronic venous insufficiency, were examined with a digital US scanner ATL-HDI5000, linear 5-1 to 2-MHz broadband probe, compound imaging technique and analogic-digital zooming. We obtained one to three progressive measurements for each vein wall (total 67 parietal thicknesses). The samples, fixed in formalin, were sent to the pathology laboratory: sections were obtained at the same level of the sonographic planes, and images were obtained by digital camera mounted on an optical microscope. Measurements obtained at histology were considered as the gold standard. K-statistic was applied to compare sonographic and histologic measurements.Considering only the hypoechoic wall portion, 29/29 (100%) diagnoses of hypotrophy (K=0.91), 19/22 (86%) diagnoses of normotrophy (K=0,47) and 12/16 (75%) diagnoses of hypertrophy (K=0.7) were obtained by sonography.In our preliminary experience, the in vitro study of varicose veins allows precise, at least morphological, detection of hypotrophic walls. If these preliminary data are confirmed in vivo, sonography could be used to discriminate patients eligible for conservative treatment instead of surgery.

This open phase IV multicentre trial was carried out to evaluate the efficacy and tolerability of amtolmethin guacyl in patients with acute osteoarthritis in at least one of the following locations: knee, hip, vertebral column. Amtolmethin guacyl is a drug belonging to the NSAID class whose action is comparable to that of other active ingredients belonging to the same class, but it is particularly interesting that a low incidence of collateral effects involving the gastric mucosa, equal to around 5%, has been reported in all clinical trials. It has been demonstrated that amtolmethin guacyl provokes an increased production of nitric oxide (NO), an important mediator of the gastric mucosa defence system through the induction of the nitric oxide synthetase (NOS) enzyme.A total of 41 centres took part in the trial and an overall population of 388 patients were recruited. The protocol specified that the drug should be taken for one month at a dose of 1200 mg/die (2 tablets b.i.d.) for 3 days and 600 mg/die (1 tablet) for the remaining 27 days. At screening, after 7 days (T1) and at the end of treatment (T2), the parameters of efficacy were evaluated using a semiquantitative scale for the following symptoms: spontaneous pain and pain on movement, joint function and swelling. All patients were asked to keep a daily diary to evaluate gastric tolerability, whereas overall tolerability was evaluated by recording adverse effects and determining the common laboratory parameters. The statistical analysis was calculated both according to intention to treat (379 patients) and by protocol (372 patients), using Friedman's test to analyse the 4 scales of signs and symptoms (basal visit vs T1 vs T2).A statistically significant difference (p0.01) was found in both analyses for all 4 parameters examined between the basal evaluation and the two evaluations during and post-treatment.The analysis of vital parameters, laboratory parameters and adverse effects confirmed the good tolerability of the product.

Calcium ions have a key role in the physiology of muscular contraction: changes in calcium ion concentration may be involved in the pathogenesis of fibromyalgia. Although, since the plasmatic level of calcium in fibromyalgia patients is always in the normal range, it seemed interesting to evaluate the intracellular calcium concentration. The study was carried out on two groups of subjects: 70 affected by fibromyalgia and 40 healthy controls. The results obtained show that in fibromyalgia patients the intracellular calcium concentration is significantly reduced in comparison to that of healthy controls: the reduced intracellular calcium concentration seems to be a peculiar characteristic of fibromyalgia patients and may be potentially responsible for muscular hypertonus. The effective role of this anomaly in the physiopathology of fibromyalgia and the potential role of drugs active on the calcium homeostasis are still to be confirmed.

We analysed the role of dosage, route and frequency of administration of clinical grade interferon-beta (IFN-beta) preparations in inducing anti-IFN-beta antibodies (IFN-beta-Abs) in 5 groups of relapsing-remitting multiple sclerosis (RRMS) patients who were respectively treated as follows: 1) weekly intramuscular (i.m.) injections of 30 mg of recombinant IFN-beta1a (Avonex), 2) subcutis (s.c.) injections of 250 mg IFN-beta1b (Betaferon) every other day, 3) weekly i.m. injections of 250 mg IFN-beta1b (Betaferon), 4) s.c. injections of 22 mg of IFN-beta1a (Rebif) three times a week, and 5) i.m. injections of 22 mg of IFN-beta1a (Rebif) twice a week. IFN-beta-Abs were determined by ELISA. IFN-beta1b was more immunogenic than IFN-beta1a not only when administered s.c. every other day, but also when administered i.m. at a lower weekly dose; i.m. injection, however, significantly delayed the appearance, and induced lower serum levels of IFN-beta-Abs. In patients treated with s.c. IFN-beta1b, Ab levels peaked 3 to 9 months after therapy initiation, and then slowly, but progressively, declined to pre-therapy levels that in some patients were reached after three years. Patients treated with i.m. or s.c. IFN-beta1a only rarely developed IFN-beta-Abs, and then at very low titers. Overall, the i.m. weekly administration of IFN-beta1a was the less immunogenic treatment. In IFN-beta1b-treated patients, a wash-out period of two/three months was sufficient to bring the IFN-beta-Ab levels below the cut-off. Our findings suggest that the immunogenicity of IFN-beta1a is low, regardless of the route of administration and the dosage, while that of IFN-beta1b is high, and is significantly, but not completely reduced by i.m. administration. As IFN-beta-Abs are cross-reactive, a wash-out period is suggested when the preparation is changed from IFN-beta1b to IFN-beta1a in order to maintain the clinical benefits of the therapy.

Calcium and magnesium ions play a key role in the physiology of muscular contraction: changes in calcium ions concentration may be involved in the pathogenesis of fibromyalgia. Since the plasmatic levels of calcium and magnesium in fibromyalgia patients is always in the normal range, it seemed interesting to evaluate the intracellular calcium and magnesium concentration.The study was carried out on two groups of subjects: 100 affected by fibromyalgia and 40 healthy controls.The results obtained show that in fibromyalgia patients the intracellular calcium and magnesium concentration seems to be a peculiar characteristics of fibromyalgia patients and may be potentially responsible for muscular hypertonus.It is still to be confirmed the effective role of this anomaly in the pathophysiology of fibromyalgia and the potential role of drugs active on calcium homeostatis.

Substance P (SP), a neurotransmitter stored within the afferent nociceptive fibers, is likely to be involved in the pathogenesis of musculoskeletal pain. We investigated SP immunoreactive (SP-ir) nerve fibers in the upper trapezius of patients with fibromyalgia (FM) and myofascial pain syndrome (MPS) by immunochemistry.Trapezius muscle obtained from tender points of 9 women with primary FM, from trigger points of 9 women with regional myofascial pain, and from 9 control women were immunostained with anti-SP sera. Quantitative evaluation was performed by computerized image analysis.No significant differences in the number of SP-ir areas were detected between groups (one way ANOVA: p = 0.2); in contrast, mean optical density (OD) of SP-ir showed a significant difference comparing the groups (one way ANOVA: p0.0001). Mean OD of the immunostaining for SP was statistically greater in trapezius muscle of patients with MPS (0.594 +/- 0.096) compared to specimens from patients with FM (0.436 +/- 0.140) (p0.05) and controls (0.314 +/- 0.105) (p0.05); mean OD of immunostaining for SP was greater in FM specimens than in controls (p0.05).Our results point to a peripheral hyperactivity of the peptidergic nervous system in FM as well as in MPS. These findings support the notion of pathogenetic involvement of the afferent nervous system in the development and perception of myofascial pain.

interferon beta (IFN-beta) reduces relapse rate and disease progression in patients with the relapsing-remitting form of multiple sclerosis (RRMS). IFN-beta may act by upregulating the expression of anti-inflammatory components of the immune system.To determine whether weekly intramuscular (i.m.) injection of IFN-beta1a had a short- or long-term effect on the expression of naturally occurring soluble factors that play an immunosuppressive role within the cytokine network.serum levels of interleukin-1 receptor antagonist (IL-1Ra), soluble tumor necrosis factor alpha receptor type I and type II (sTNF-alphaRI and sTNF-alphaRII), and soluble E-selectin (sE-Sel) were followed over time in ten patients with RRMS who were treated with weekly i.m. injections of 30 mg (= 6 MU) of IFN-beta1a. Patient sera were sampled before, and 24, 48, 72, 96, and 168 hours after the first IFN-beta1a injection (short-term), and then at 1, 3, 6, 9 and 12 months after therapy initiation (long-term); highly sensitive, commercially available ELISA tests were used.serum levels of IL-1Ra, sTNF-alphaRI and sTNF-alphaRII, but not sE-Sel were significantly increased in both short- and long-term follow-up. Interestingly, IL-1Ra, sTNF-alphaRI and sTNF-alphaRII behaviors were completely different, suggesting that these naturally occurring immunoregulatory factors were differentially affected by IFN-beta1a.our study demonstrates that weekly i.m. injection of 30 mg of IFN-beta1a induces the expression of soluble mediators that may suppress the activities of pro-inflammatory cytokines such as IL-1 and TNF-alpha.

To report the results of a multicenter safety trial of percutaneous carotid stenting performed by vascular surgeons.Symptomatic or asymptomatic patientsor = 65 years of age with internal carotid artery (ICA) stenosesor = 70% andor = 2-cm long were eligible for enrollment. The procedures were performed in an operating room with the choice of anesthesia and the percutaneous access site at the discretion of the surgeon. Only Palmaz stents were used.From January 1, 1996 to December 31, 1997, 99 patients (74 men, mean age 70 years, range 51 to 94) were enrolled in the study. More than half (57 of 99 patients) were asymptomatic. The direct cervical approach was used predominantly (97%). Three (3%) cases were converted to surgery for inability to access the artery or deploy the stent (technical success 97%). No perioperative death or myocardial infarction was reported. Six (6%) procedural complications included 1 reversible arterial spasm, 2 dissections, 1 cervical hematoma, and 2 residual stenoses. One neurological event reversed within 7 days (1% minor stroke rate) and 4 (4%) transient ischemic attacks resolved within 24 hours. One (1%) asymptomatic early occlusion occurred 2 days postoperatively. No neurological event was observed in the 1- to 24-month follow-up (mean 13 months). Two (2%) patients died of nonprocedurally related causes. No stent compression was seen, but 1 asymptomatic occlusion and 3 asymptomatic, non-flow-limiting restenoses (240%, 1 at 60%) were found within 1 year (3% restenosis rate on an intention-to-treat basis). Patency was 98% at 1 year.The results of this trial support the contention that carotid stenting of short ICA lesions can be performed with a low neurological complication rate.

The therapy of fibromyalgia (SF), with pharmacological and non pharmacological treatments, is not always effective and the benefits obtained can be unsteady or non-lasting. The aim of this study was to evaluate the effect of a pure copper wire sheet ("Telo Cypro") used as bedsheet, on sleep quality as well as spontaneous and provoked pain.The study was double-blind, with two parallel groups, versus placebo. Forty patients with fibromyalgia were enrolled, thirty-eight females and two males, with a mean age of 48.8 years and without any current pharmacological treatment.The results obtained show how the use of "Telo Cypro" is extremely beneficial in subjects with fibromyalgia, in reducing painful symptomatology at the tender point level and improving sleep quality, with a positive effect on the patients' cenesthesia at awakening.In conclusion, the use of "Telo Cypro" can be a valid help in the treatment of fibromyalgia.

This study assessed the analgesic action of tramadol compared with placebo in patients suffering from fibromyalgia syndrome. Twelve patients (11 females, one male) were treated according to a double-blind crossover experimental design. Each patient, after signing informed consent, was randomly allocated to either tramadol (100 mg ampul in 100 ml given intravenously in 15 min doses) or placebo for a single dose treatment. At the second visit, patients crossed over to the other drug for a further single dose treatment. There was a wash-out period of 1 week. Nine patients completed the study, while in three cases (two tramadol, one placebo) the study was discontinued due to the onset of side effects. The assessment of efficacy, carried out at the baseline and 15 min and 2 hours after administration of each dose, involved the use of a visual analog scale (VAS 100 mm) for spontaneous pain and pressure dolorimetry (kg/cm2) at 12 "symptomatic" tender points and nine "control" tender points for fibromyalgic pain. During the first treatment cycle effective control of spontaneous pain was achieved with tramadol, which determined a reduction of 20.6% while with the placebo spontaneous pain increased by 19.8%. With pressure dolorimetry there were no clinically important differences observed after either active treatment or placebo. The contrasting results found in the present study could be a stimulus for the organization of new projects, which may lead to the identification of an optimal therapeutic approach for fibromyalgic patients, also using tramadol for long periods.

Although the routine use of a patch for closure of the arteriotomy after carotid endarterectomy is still debated, patch angioplasty is frequently used to avoid residual stenosis and to lower the incidence of later restenosis. Several materials are widely used for carotid patching, notably, autologous vein, Dacron and polytetrafluorethylene (PTFE). During recent years a heterologous stabilized graft made from bovine pericardium has been introduced. This paper reports the authors' experience of 52 carotid endarterectomies in which a patch of bovine pericardium was used to close the arteriotomy. The patients were followed with colour-duplex scanning over 12-30 months. This biograft did not require preclotting and proved to be easy to suture. Follow-up did not uncover any complications related to graft use. Although this is a preliminary report, it is concluded that bovine pericardium is a promising material for carotid patch angioplasty.

Outpatient surgery of varices of the lower limbs is currently considered a viable alternative to traditional surgery with hospitalization. This paper reports the experience of 4 university groups (Padua, Modena, Verona, Milan), where outpatient treatment has been used since 1987. From June 1987 to June 1992, 2,568 lower limb varices were treated in this way. Different techniques of anaesthesia were used (local infiltration, combined local and general, general, subarachnoid). In all cases, crossectomy was combined with short or long saphenous stripping. There were no intra- or perioperative deaths, and only limited morbidity. Postoperative hospitalization was required in only 2 cases: for hemorrhaging of the inguinal wound in one case, and headache 2 days after spinal anaesthesia in the other. In 2 separate samples of 100 patients, 88 and 89 indicated satisfaction with the surgical treatment. In conclusion, outpatient surgery of varices can be based on the same techniques as in-patients treatment. The risks of surgery and anaesthesia in specialised centres are very limited, with scope for a variety of anaesthetic techniques according to facilities available. Patients satisfaction is high.

Fibromyalgia syndrome (FS) is a frequently seen extra-articular rheumatism of unknown etiology. Some authors have suggested a direct role of the immune system in the pathogenesis of the disease while others have found an increased prevalence of some HLA DR and B antigens. The aim of our study was to verify the possible association between HLA and FS in Italian patients with no clinical or immunological evidence of chronic rheumatic inflammatory diseases. Ninety-two consecutive Italian patients were evaluated: 86 were typed for HLA A-B-C antigens and 74 for HLA DR antigens. The study was performed by standard NIH microlymphocytotoxicity technique and by NIH prolonged technique on B lymphocyte purified preparations. There was no statistically significant difference between any HLA A-B-C and DR antigens in the patients compared with the controls. We conclude that in the pathogenesis of FS there is no clear cut evidence of immunologic or genetic involvement.

Fibromyalgia syndrome is a form of extraarticular rheumatism of unknown origin; its diagnosis is fundamentally based on clinical and anamnestic findings, on characteristics of pain and on number and sites of tender points, very painful areas to palpation. At present there is no laboratory or instrumental test available for a more objective diagnosis. The Authors verified the utility of telethermography for fibromyalgia syndrome diagnosis to point out a possible specific pattern; in particular the tender points were studied, even to find some analogy to myofascial syndromes trigger points, which appear as hot spot to telethermography. The telethermographic patterns of 156 patients with fibromyalgia syndrome have been compared with tender point maps obtained from same subjects and with telethermographic data of patients affected by spine osteoarthritis and normal controls. The patients with fibromyalgia syndrome showed a non specific hyperthermic pattern, corresponding to painful muscular areas, comparable with pattern of osteoarthritic patients. This phenomenon can be interpreted as a greater thermic emission by hypertonic muscles. Therefore, telethermography in fibromyalgia syndrome cannot represent a basic diagnostic tool but can support the clinical diagnosis and play an important role in the follow-up of patients.

The possibility of increasing the resistance of a synthetic vascular graft to intraoperative or immediate postoperative bacterial contamination justifies the interest in methods such as antibiotic bonding or antibiotic soaking. On the basis of this experience and with the aim of testing the efficacy of such a graft, a multicentre experimental study on sheep to compare the susceptibility to infection of Dacron Gelseal grafts (control) versus rifampicin-bonded Dacron Gelseal grafts (treated) following the intravenous infusion of 10(7)-10(8) cells Staphylococcus aureus was conducted. The grafts were implanted in both common carotid arteries of sheep. In a group of 11 animals (group A), a treated and a control graft were implanted in the same animal. In a group of four sheep (group B), only treated or control grafts were implanted in each animal. In group A, 36% of (four of 11) the treated grafts became infected versus 54% (six of 11) of the control prostheses. In group B, none of the treated grafts was infected by the inoculated pathogen, which, by contrast, infected 75% (three of four) of the controls. These observations confirm the recent interest aroused by the possibility of pretreating gelatin-coated Dacron grafts with rifampicin in the prevention of early graft infection.

Large veins LMS is a rare slow growing malignant tumor originating from smooth muscle cells of the media. The authors report a case of LMS of the left common iliac vein propagating to the Inferior Vena Cava that presented with a left femoral-iliac deep thrombophlebitis. CT scan showed an uneven solid mass approximately 5 cm large within the left side of the pelvis. The mass displaced the left iliac artery and compressed the left iliac vein without a significant cleavage surface between the mass itself and the vascular structures. Location was next to the spine, medially and anteriorily to the psoas muscle. A thrombosis could be noticed within the distal segment of the inferior Vena Cava and within the proximal segment of the left iliac vein. US scan with fine needle biopsy of the mass didn't yield significant information. At surgical exploration a neoplastic mass involving and blocking the left iliac vein was found. Veinotomy performed on the iliac vein and on the distal segment of the Inferior Vena Cava but without infiltration of the vein walls. Surgical treatment consisted of asportation of the neoplastic mass, resection of the left iliac vein and thrombectomy of the Inferior Vena Cava. Histologic examination of the operated specimen revealed a mixoid LMS with vascular origin without involvement of the surrounding lymph nodes. Absence of clinical and radiological signs of relapse eight months after surgery makes further surgical and complementary (drug- and radiotherapy) treatments currently unnecessary.

To help fibromyalgia syndrome's diagnosis, the authors propose the use of Back Pain Classification Scale (BPCS), verbal test for pain analysis, able to distinguish between organic and functional disease. Two-hundred patients suspected for fibromyalgia and forty controls completed the questionnaire and so it was possible correctly to distinguish patients with organic disease from those affected by fibromyalgia. The authors conclude that BPCS can represent a useful tool for fibromyalgia diagnosis.

The most suitable treatment for intraluminal carotid thrombi remains still a much debated question. Some authors have reported a lower morbidity in patients treated with anticoagulant or antiplatelet therapy; on the other side, urgent or delayed surgery is burdened with a high risk of perioperative stroke. Over 11 years (october 1981-november 1992) 602 surgical revascularizations on epi-aortic vessels have been performed at Vascular Surgery Unit of Udine Regional Hospital. Only 2 cases of intraluminal carotid thrombi were observed: both fulfilled the angiographic requirements for endovasal filling defect, surrounded by contrast medium, adherent to posterior wall and extending to distal internal carotid artery. First patient suffered a TIA 20 days before surgery, the second one a previous major stroke contralateral to the thrombus. The former was given preoperatively a medical anticoagulant treatment (warfarin). At operation we discovered a nearly complete resolution of the thrombus: only its adherent base was still present. Therefore we performed a routine endarterectomy and a PTFE patch angioplasty. The latter case reported had no preliminary medical treatment; a thrombus extending from carotid bulbus to external and internal carotid was detected and then removed without any distal embolization. Arteriotomy was closed by Dacron Velour patch angioplasty. No perioperative stroke occurred in both cases: our second patient showed a partial resolution of his motility deficit. According to our limited experience, delayed surgical treatment of intraluminal carotid thrombi seems not to be affected with higher risk of perioperative stroke than prophylactic carotid endarterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult mice injected with Moloney murine leukemia virus (M-MuLV) 1 day after a short term treatment with anti-CD4 mAb developed T cell lymphomas, or sarcomas when rechallenged with Moloney murine sarcoma virus (M-MSV). Neoplastic development was correlated with virus spread, as thymic and peripheral T and B lymphocytes promptly expressed M-MuLV-induced Ag after virus introduction; no virus-specific CTL generation was detected in MLTC. This failure, which was selective for M-MuLV-induced Ag, persisted throughout the life span of the mice, and was not sustained by suppressor cell activity. The frequencies of splenic virus-specific CTL precursor varied in relation to time after virus injection; in the first postinjection month, frequencies were similar to those in nonimmune control mice, while at 4 mo post-virus exposure, they showed a striking reduction. These findings indicate that a transient functional impairment of CD4+ cells at the time of retrovirus injection provided the appropriate milieu for tolerance induction in both the peripheral mature and intrathymic T cell compartments.

Plasma lipids and lipoproteins, glucose, uric acid, and haemocoagulative parameters were studied in a group of 22 elderly hospitalized patients with arteriosclerotic dementia, and compared with those of a control group of a similar age. No significant differences were found in lipids, lipoproteins, glucose, or uric acid but the fibrinogen level was significantly raised in the group with arteriosclerotic dementia. A comparison of the metabolic parameters of the dementia patients with those of a group of subjects with peripheral occlusive arteriosclerosis showed, on the other hand, that this latter group had significantly raised plasma triglycerides as well as a significantly higher incidence of the Fredrickson phenotypes of hyperlipoproteinaemia. These findings indicate that the common laboratory parameters used to evaluate arteriosclerosis are not adequate to point out any pathogenic mechanism for arteriosclerotic dementia, and research should therefore be focused in other directions.

SUMMARY Specific sensitization against H-2 determinants was effected by immunizing allogeneic mice with spleen and lymph node cells in H-2 congenic combinations. Lymph nodes from the sensitized and non-sensitized mice were respectively cultured together with H-2 syngeneic tumour cell lines. The growth and viability of the tumour cells was subsequently measured by the amount of radiothymidine incorporation. If the tumour cells incorporated less isotope when cultured with the immune cells than with the normal cells this was termed ‘cytostasis’. To identify the H-2 genes controlling the sensitization phase in the cytostasis assay, we studied the effect on different transplantable tumour target cells of lymphoid cells from mice sensitized against different congenic spleen cells. The results suggest that the cytostasis assay can measure an in vitro specific response to H-2-incompatible sensitizing antigens, and that I-B incompatibility, together with K and/or D, is essential to produce effectors. Furthermore, H-2 allogeneic sensitization could induce cytostasis even against tumour cells syngeneic for the H-2 halotype of the responder strain. The implications of these findings are discussed.

Accessory cell activity of spleen cells from M-MuLV neonatally injected (tolerant) mice was studied to evaluate their ability to take part in in vitro CTL generation against tumor-associated antigens induced by M-MSV. In contrast with accessory cell activity in normal spleen cells, spleen cells from M-MuLV-tolerant mice are unable to reconstitute the in vitro virus-specific CTL generation of M-MSV immune, Ia-depleted spleen cells. A selective defect seems to characterize M-MuLV-tolerant mice as their spleens constitute a good source of accessory cells for alloantigen CTL generation.

Lipoprotein compositional studies were carried out in 20 patients with atherosclerotic peripheral vascular disease. Twelve of these patients were normolipidemic, the other eight, hypertriglyceridemic. Ten normolipidemic and 10 hypertriglyceridemic age-matched subjects were used as controls. High density lipoprotein cholesterol levels were markedly reduced in the hypertriglyceridemic subjects, both with (35.1 +/- 5.0 mg/dl) and without (36.2 +/- 11.7 mg/dl) peripheral vascular disease, as compared to the normolipidemic patients (47.0 +/- 6.3 mg/dl) and controls (48.1 +/- 10.0 mg/dl). A decreased relative content of apo C-11 in very low density lipoproteins in the hypertriglyceridemic subjects, as compared to the normolipidemics, was detected by isoelectric focusing. Hypertriglyceridemia in patients with peripheral vascular disease shows a typical Type IV lipoprotein and apoprotein profile. Apoprotein B levels in very and low density lipoproteins were determined by electroimmunodiffusion and selective precipitation with tetramethylurea (r = 0.981 between the two methods). All the patients with peripheral vascular disease showed an increased apo B content in very low density lipoproteins vascular disease showed an increased apo B content in very low density lipoproteins (VLDL) as compared to controls (apo B cholesterol in VLDL = 0.341 +/- 0.124 for peripheral vascular disease patients and 0.236 +/- 0.086 for controls, p less than 0.001). A significant correlation between VLDL cholesterol and apo b levels was detected both in peripheral vascular disease patients and in controls; however, two distinct populations could be clearly separated (slopes of the regression lines: peripheral vascular disease patients = 0.350; controls = 0.215, p less than 0.001). The data suggest a possible discriminatory power of VLDL-apo B levels in patients with peripheral vascular disease independent from other lipoprotein and lipid parameters.

A case of aneurysm of the hepatic artery associated with aneurysm of the abdominal artery in fissuration is discussed. The indications, possibilities and limits of exclusion or removal of the aneurysm without reconstructing the main artery axis in the treatment of cases involving the hepatic artery are examined in the hight of the reported case and modern views concerning the physiopathology of the hepatic circulation.

The effect of a supernatant (SN-A) obtained from PMA-stimulated IL-2 producing EL-4 cells on cytotoxic cell induction in thymocyte and splenocyte cultures was evaluated. SN-A, but not recombinant IL-2 alone, induced cytotoxic cell differentiation in thymus cell cultures, thus indicating that factors distinct from IL-2 are required for effector cell generation. INF-gamma takes part in the process, and Ia+ accessory cell presence is also strictly required in thymus cultures for lymphokine-induced cytotoxic cell generation. Cytotoxic activity in thymocyte cultures was due only to Thy 1+ Lyt 2+ cells having a broad spectrum of target cell specificity, while in spleen cell cultures an effector population with NK activity was also generated.

A large number of surgical procedures aimed at revascularizing the popliteal and infrapopliteal arteries has been reported in patients affected by rest pain or gangrene of the extremities as well as intermittent claudication. In consideration of the high incidence of early and late unsuccessful results following this type of surgery as reported in the literature, we believe that peripheral reconstructions should be restricted to those patients presenting a clinical picture of such severity that major amputation is unavoidable in the short run. In these patients our choice of the appropriate surgical procedure is strictly related to the patency or not of the popliteal artery. The role of the above knee femoropopliteal bypass is discussed. A series of patients that we have operated upon according to these criteria is analyzed. The low number of cases in our group of patients and the high rate of postoperative failures reflect our policy on this matter.

The relationship between mean pulmonary artery pressure (PAP) and alveolar pressures, at varying tidal volumes and opposing variable pressure to expiratory flow, was studied in 14 healthy dogs at the end of inspiration and at the end of expiration. Pulmonary blood flow was also studied in 4 dogs. Through the analysis of multiple regression, the equations which show the relation between PAP, tracheal pressure and tidal volume during phases of zero flow were obtained. Our study shows that the co-relation between PAP and tracheal pressure is always highly significant and that, in our experimental conditions, the parameter having the greatest influence on PAP is tracheal pressure, while tidal volume is negligible.

Human iliac arteries, obtained at surgery, were examined at SEM. The ultrastructural aspects has evidenced pathological pictures, quite unexpected. The material observed resulted very adapt for scanning electron microscope.