What if the reward is not as yummy? Study of the effects of Successive Negative Contrast in domestic dogs in two different tasks

Successive Negative Contrast (SNC) occurs when there is a reduction in the quantity or quality of a reward that is expected according to the presence of contextual cues. This induces an emotional response of frustration that is similar to stress. While this phenomenon has been observed in several mammal species, findings in domestic dogs have been inconsistent, although this issue has strong relevance in dog training. The aim of this study was to assess the effects of Successive Negative Contrast in two responses that had already been studied in this species, but with an increase in the methodological rigor and variations in the experimental conditions to examine the generalizability of the phenomenon. To this end, experimental dogs experienced a pre-shift phase in which they received a high-value reward (liver), followed by a post-shift phase in which they obtained a low-value reward (dry dog food), and then a re-shift phase in which the high-value reward was available again. Control dogs received dry food in all phases. The results show a contrast effect on the behavior of following human pointing to obtain food (Study 1). On the contrary, there were no differences in problem solving behavior after the de- and re-evaluation of the reward during a non-social task (Study 2). The results support that Successive Negative Contrast is not a consistent phenomenon in pet dogs. It is possible that certain characteristics of dogs such as the great availability of high-value rewards in their daily lives could attenuate the effects of a reduction in incentive value.

Use of focus point for plane acquisition to improve reproducibility in fetal biometry

OBJECTIVE

To assess the reproducibility of ultrasound measurements of fetal biometry using a 'focus point' to assist the acquisition of the relevant plane.

METHODS

This was a study of 80 women with a singleton non-anomalous pregnancy who attended University College London Hospital, London, UK, between 18 and 37 weeks' gestation. Planes to measure head circumference (HC), abdominal circumference (AC) and femur length (FL) were obtained four times by two different sonographers with different levels of experience, who were blinded to one another; the first set of images was obtained with reference to a standard image, and the second set of images was obtained using the focus point technique. The focus point was defined as a unique fetal anatomical landmark in each plane (cavum septi pellucidi for HC, two-thirds of the umbilical vein for AC and one of the two extremities of the diaphysis for FL). Once identified, the focus point was maintained in view while the sonographer rotated the probe along three axes (x, y, z) to acquire the relevant plane. Sonographers were either in training or had > 3000 scans worth of experience. Intra- and interobserver reproducibility were assessed using Bland-Altman plots, and absolute values and percentages for mean difference and 95% limits of agreement (LoA) were reported.

RESULTS

Overall reproducibility was good, with all 95% LoA < 8%. Reproducibility was improved by use of the focus point compared with the standard technique for both intraobserver comparison (95% LoA, < 4% vs < 6%) and interobserver comparison (95% LoA, < 7% vs < 8%). These findings were independent of sonographer seniority and plane acquired.

CONCLUSIONS

Reproducibility of fetal biometry assessment is improved with use of the focus point for plane acquisition, regardless of sonographer experience. We propose that this method should be implemented in clinical practice and training programs in fetal biometry. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Still-face effect in domestic dogs: comparing untrained with trained and animal assisted interventions dogs

The still-face effect has been extensively studied in human infants and comprises the reduction in affiliative behaviors and increased stress that occurs after a sudden interruption of social interaction with a caregiver. Domestic dogs (Canis familiaris) are model candidates for showing this effect, as they form deep bonds with their owners and interspecific social interaction is reinforcing to them. The aim of these studies was to assess if companion dogs exhibit the still-face effect and whether prior experiences during ontogeny modulate this effect. To this end, Study 1 compared dogs with different levels of training (untrained, intermediate, and advanced), while Study 2 assessed dogs that participated in Animal Assisted Interventions (AAIs) and companion dogs (CDs). The procedure was carried out virtually and comprised three phases lasting 1 min: interaction, still-face (the owner turned suddenly indifferent), and reunion (the interaction was resumed). Dogs exhibited a decrease in proximity to and contact with the owner, as well as an increase in begging and stress behaviors during the still-face phase. Moreover, this was not observed in a control condition in which the interaction continued in the same way during all three phases, discarding alternative explanations for these changes. These results show that dogs experience a still-face effect in a similar way to infants, highlighting the value interspecific social interaction has for dogs. Nevertheless, the absence of differences according to their training level or participation in AAIs suggests this is a robust phenomenon, which appears to be less susceptible to the influences of ontogenetic experiences.

Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study

OBJECTIVE

To evaluate the performance of third-trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low-lying placenta or placenta previa.

METHODS

This was a prospective multicenter study of pregnant women aged ≥ 18 years who were diagnosed with low-lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at ≥ 26 + 0 weeks' gestation, between October 2014 and January 2019. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs on grayscale ultrasound: (1) obliteration of the hypoechogenic space between the uterus and the placenta; (2) interruption of the hyperechogenic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. Histopathological examinations were performed according to a predefined protocol, with pathologists blinded to the ultrasound findings. To assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprising the need for active management at delivery and histopathological confirmation of PAS was considered the reference standard. PAS was considered to be clinically significant if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation or uterine artery embolization. The diagnostic performance of each ultrasound sign for clinically significant PAS was evaluated in all women and in the subgroup who had at least one previous Cesarean section and anterior placenta. Post-test probability was assessed using Fagan nomograms.

RESULTS

A total of 568 women underwent transabdominal and transvaginal ultrasound examinations during the study period. Of these, 95 delivered in local hospitals, and placental pathology according to the study protocol was therefore not available. Among the 473 women for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%), comprising 36 cases of placenta accreta, 19 of placenta increta and 44 of placenta percreta. The median gestational age at the time of ultrasound assessment was 31.4 (interquartile range, 28.6-34.4) weeks. A normal hypoechogenic space between the uterus and the placenta reduced the post-test probability of clinically significant PAS from 21% to 5% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 9% in the subgroup with previous Cesarean section and anterior placenta. The absence of placental lacunae reduced the post-test probability of clinically significant PAS from 21% to 9% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 36% in the subgroup with previous Cesarean section and anterior placenta. When abnormal placental lacunae were seen on ultrasound, the post-test probability of clinically significant PAS increased from 21% to 59% in the whole cohort and from 62% to 78% in the subgroup with previous Cesarean section and anterior placenta. An interrupted hyperechogenic interface between the uterine serosa and bladder wall increased the post-test probability for clinically significant PAS from 21% to 85% in women with low-lying placenta or placenta previa and from 62% to 88% in the subgroup with previous Cesarean section and anterior placenta. When all three sonographic markers were present, the post-test probability for clinically significant PAS increased from 21% to 89% in the whole cohort and from 62% to 92% in the subgroup with previous Cesarean section and anterior placenta.

CONCLUSIONS

Grayscale ultrasound has good diagnostic performance to identify pregnancies at low risk of PAS in a high-risk population of women with low-lying placenta or placenta previa. Ultrasound may be safely used to guide management decisions and concentrate resources on patients with higher risk of clinically significant PAS. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Showing behavior in Animal Assisted Intervention and pet dogs

A dog's behavior can indicate the location of hidden food to a human who is unaware of its position. These behavioral patterns are known as showing behavior, which comprise gazing towards the target location and gaze alternation between the human and the target (i.e., hidden food). Although this ability has been extensively studied in pet dogs, research has not yet focused on dogs with other kinds of life experiences, such as dogs working in Animal Assisted Interventions (AAI). These dogs are exposed to novel environments under the guidance of their handlers and previous studies have highlighted the importance of gazing behavior in this population. Therefore, we evaluated AAI and pet dogs on a showing task. Results indicate that dogs overall engaged in showing behavior as they gazed more towards the baited pot and alternated their gaze more on showing trials than control ones. Contrary to our expectations, differences between AAI and pet dogs were minimal. However, owners of AAI dogs were more successful than owners of pet dogs in finding the hidden food in showing trials. This suggests they may be more skillful in reading their dogs' behavior, which can be crucial to ensure their welfare during AAI sessions.

Gazing as a help requesting behavior: a comparison of dogs participating in animal-assisted interventions and pet dogs

Dogs tend to gaze at humans when they are confronted with inaccessible food during an unsolvable task, which is often interpreted as a help requesting behavior. Dogs who participate in animal-assisted interventions (AAI) interact with many people during their lives and prior studies have emphasized the importance of gazing in their communication. We compared the behavior of AAI (n = 15) and pet (n = 16) dogs during an unsolvable task, using a container fixed to a wooden board with inaccessible food inside, while the owner and an unfamiliar woman stood facing each other at the sides of the board ignoring the dog. Results showed that AAI dogs spent significantly more time gazing and alternated their gaze more frequently between the container and the people than pet dogs. In addition, they spent more time in contact with the unfamiliar person. However, no significant differences were found in the time dogs of either group gazed towards the owner compared to the unfamiliar person, in the frequency of gaze alternation or in the time spent interacting with the apparatus. In line with prior studies, these results suggest that gazing may be a significant communicative response in AAI dogs, which could probably contribute to having a better coordination with their handler. A greater understanding of the characteristics of this population may aid the selection and training of AAI dogs, which is particularly relevant given the increased popularity of AAI nowadays.

Do dogs experience frustration? New contributions on successive negative contrast in domestic dogs (Canis familiaris)

An unexpected change in reward quantity or quality frequently elicits a sharp decrease of responses as well as a negative emotional state. This phenomenon is called successive negative contrast (SNC) and, although it has been observed in numerous mammals, results in dogs have been inconsistent. The aim of this study was to evaluate SNC in dogs, comparing the effects of rewards of different qualities in a non-social task carried out in the dogs' usual environment. Dogs were separated into two experimental groups that experienced a downshift from a high quality reward (liver or sausage) to a low quality one (dry food), as well as a control group that always received dry food. The task involved a dog toy with bone shaped pieces that had to be removed to get the food hidden underneath. When the reward changed from liver to dry food, dogs picked up significantly fewer bones than the control group. However, this effect was not observed with sausage. Results show SNC in dogs in a non-social task carried out in their home environment. Additionally, the importance of the discrepancy in the hedonic value of the rewards is highlighted.

How much and for how long does the neonatal myocardium suffer from mild perinatal asphyxia?

Cardiac troponins can be useful in monitoring cardiac injury following perinatal distress. We report here an increase of cardiac troponin I (cTnI) to 2.84 microg/l at 3 weeks (age-related median: 0.07 microg/l) followed by normalization in a newborn with an uneventful clinical course after resuscitation at birth. Serial echocardiographs showed normal cardiac function. Such a time course of cTnI, not previously reported, could be due to either a greater sensitivity of biochemical markers than of instrumental tools or birth asphyxia. Larger studies are needed

Long-term outcome after senning operation for transposition of the great arteries

BACKGROUND

The Senning operation for transposition of the great arteries (TGA) was first introduced by Senning in 1959 and was revived by Quaegebeur et al. in the late 1970s, thus becoming the intervention of choice for the correction of TGA in many centers.

HYPOTHESIS

The purpose of this study was to evaluate the long-term follow-up of a group of patients undergoing surgery with the Senning procedure for TGA.

METHODS

From November 1978 to November 1987, 73 consecutive patients underwent the Senning operation. The 70 survivors had an average follow-up of 19 years (16-25 years).

RESULTS

(1) Cardiac rhythm: with time there was a progressive decrease in stable sinus rhythm (60% after 20 years) and a progressive increase of supraventricular tachyarrhythmias requiring therapy (10% after 20 years). (2) Right ventricular function: 20% of the patients had reduced ejection fraction. (3) Late mortality: in the last 12 years of follow-up years there were two sudden deaths (2.8%). (4) Functional status: 80% of patients were in NYHA class I, 17% in class II, and 3% in class III.

CONCLUSIONS

Our results confirm that the patients who undergo the Senning procedure have a progressive loss of sinus rhythm, an increase in active arrhythmias, and other important adverse outcomes such as late sudden death and a decrease in right ventricular function; however, most patients (93% in our series) are alive and in good functional status.

[A neonatal case of congenital myotonic dystrophy]

Congenital myotonic dystrophy is a rare autosomal disease, caused by an increased number of cytosine-thymine-guanine (CTG) trinucleotide on chromosome 19q. In the neonatal period the most peculiar clinical features are arthrogryposis, hypotonia, facial diplegia, respiratory and feeding difficulties. Clinical and electrical myotonic discharges are difficult to elicit in the newborn. We report a case of congenital myotonic dystrophy in a female newly born presenting with hypotonia, diaphragmatic paralysis, facial diplegia, and contractures of hips, knees and ankles. The diagnosis was confirmed by genetical study on lymphocyte DNA.

[Neurologic outcome in infants surgically treated for congenital cardiopathy: preliminary data]

INTRODUCTION

Both surgical techniques for correction of congenital heart diseases (CHD) and intraoperatory neurologic protection improved during the last 20 years. Nevertheless cardiac surgery is still a risk for neurologic morbidity.

METHODS AND PATIENTS

Analysis of the postoperative neurologic status of infants younger than 6 months who underwent cardiac surgery from January 1998 to December 1999. We reviewed the EEG tracings, cranial ultrasound reports (CUS) and CT scans of 48 patients. Diagnoses were: ventricular septal defect = 15, Fallot (TOF) = 9, patent ductus arteriosus (PDA) = 5, coarctation of aorta = 4, atrio-ventricular septal defect = 4, transposition of great arteries (TGA) = 3, hypoplastic left heart syndrome = 2, pulmonary atresia = 2, total anomalous pulmonary veins drainage = 2, double outlet right ventricle = 1, cor triatriatum = 1. Mean age (range) at intervention was 54 days (2-150), 44 infants (91.7%) survived at follow-up: 23 EEG, 22 CUS and 2 CT were performed in the recent postoperative. Among survivors 5/44 had neurologic complications. EEG was altered in 4: two of them (1 TOF, 1 TGA) had pathologic CUS and CT as well (ischemic pattern in the former, atrophy in the latter). Finally a preterm newborn with PDA had mild abnormalities at CUS. After a mean follow-up of 16 +/- 6 months 3/5 patients had mild-to-moderate psychomotor delay and 2 recovered.

CONCLUSIONS

According to our preliminary data the prevalence of neurologic complications in infants who undergo cardiac surgery seems to be low. The pathological findings of the recent postoperative seem to recover up to normalization in some cases at mid-term follow-up. As expected, permanent complications effect more often complex CHD. Further follow-up studies to school age will be mandatory to check the very final results of cardiac surgery performed during early infancy.

[Positioning of umbilical vein catheter with ECG-guided technique: randomized study]

GOAL

To evaluate the effectiveness of electrocardiography-guided technique to aid in the correct positioning of umbilical vein catheters.

DESIGN

A prospective, randomized controlled study.

METHODS

Term and preterm newborns who required an umbilical venous catheter were managed by an ECG-guided technique (group A) or by a conventional method (group B). Correct positioning was defined by a chest-X-ray when the catheter tip was located above the diaphragm and outside the right atrium. For the ECG-guided technique we utilized a conductive device Vygocard (Medival, Padova) inserted in a 3-way stopcock connected with the catheter. The catheter was inserted under ECG observation until the appearance of a tall P-wave in lead III, which indicated the tip was within the right atrium. The catheter was then withdrawn until the P wave size returned to normal.

RESULTS

We enrolled 44 patients (16 F, 28 M). Median gestational age (GA) and birth weight (BW) were 34 weeks (range 26-41) and 2130 g. (590-3870), respectively. Sex distribution, GA, BW and Apgar scores were not different between patients in group A (n = 22) and group B (n = 22). Catheters could not be advanced till the estimated insertion depth in 11 patients (A = 5, B = 6). In the remaining 33 patients, correct tip placement was more frequent in group A (88%) compared with group B (50%) (p = 0.021 by Fisher's exact test). No side effects specific to the ECG-guided method were noted.

CONCLUSIONS

The ECG-guided technique seems to be a safe and effective method for the proper placement of umbilical vein catheters in newborns.

The role of surgery in the treatment of gastrointestinal lymphomas other than low-grade MALT lymphomas

BACKGROUND AND OBJECTIVE

A bias in clinical investigations on gastrointestinal lymphomas is the lack of testing the intention to treat as to resection, emergency conditions at presentation and selection brought about by the evaluation of feasibility of surgery.

DESIGN AND METHODS

A prospective study involved 154 patients with gastrointestinal nodular or high-grade MALT lymphomas, 111 with a gastric and 43 with an intestinal presentation. The decision to resect or treat conservatively was left to clinicians, on condition that it was previously defined for each patient.

RESULTS

Failure-free survival was significantly higher in the 106 resected patients than in the 48 unresected ones but did not differ according to either primary intention to treat or emergency surgery/elective treatment. Survival was similar in patients operated on by choice and in those because of an emergency. Intentionally unresected patients had a significantly better survival than those not undergoing surgery despite the initial intention, for a number of clinical reasons. Patients with gastric lymphoma survived longer than those with intestinal disease and prognostic factors were analyzed separately in the two groups. The best predictors of prognosis were performance status and serum lactic dehydrogenase level in gastric lymphomas, resection alone in intestinal ones.

INTERPRETATION AND CONCLUSIONS

The prognosis of gastric lymphomas depends on lymphoma-related factors and not on surgical treatment. The prognosis of intestinal ones is exclusively related to surgery. These data support the appropriateness of different clinical approaches to gastric and intestinal lymphomas.

[Nutrition in the first months of life with a new formula containing maltodextrins and enriched with long-chain fatty acids]

According to the recent acquisition about the biochemical properties of the carbohydrates contained in human milk, the addition of maltodextrins to infant formulas became recommended. We refer about the preliminary data of the first utilization of a new formula (Aptamil 1 "Nuova Formula") in which both maltodextrins and Long Chain Fatty Acids are added. Sixty-seven infants were enrolled to the study for the first 4 months of life. Forty-three of them (64%) completed the study and were grouped as follows: Group 1 = 15 subjects exclusively formula-fed (4F, 11M), Group 2 = 21 infants with mixed feeding (breast + formula), Group 3 = 7 cases in which Aptamil 1 "Nuova Formula" substituted another formula (4F, 3M). Auxologic parameters (weight, length, head circumference) were among the normal standard limits according to the percentile charts of the Boston Children's Medical Center. All infants enjoyed the taste of the milk we tested. The food regimen was changed in 4/67 (6%) infants because of alimentary intolerance suspicion but 2/4 infants were subsequently fed with soya milk formula and with an "hypoallergenic" milk respectively, the other 2 continued with another formula. The weight growth chart in infants of Group 1 tended to bend down a little bit between the 3rd and 4th month, reminding the breast-fed infants behavior. Considering the daily milk volume assumed by the same subjects, we found a statistical difference (p < or = 0.01) between the volumes of milk assumed in the 2nd and the 3rd month of life but from the 3rd to the 4th month there was no statistical difference in daily milk volumes. This resembles the breast-fed infants behavior as well. According to our preliminary results the new milk formula we tested seems a very good substitute when an infant can't be breast-fed for any reason.

[Dermatitis herpetiformis and latent celiac disease in two siblings]

The association between coeliac disease (CD) and dermatitis herpetiformis (DH) is well known. Moreover, this cutaneous disease may be the only sign of an otherwise asymptomatic CD. Subjects presenting with both CD and DH generally show an HLA pattern in which A1, B8, DR2, DR7, DQw2 are the most frequent antigens one can find. We report about 2 brothers presenting with DH, clinically asymptomatic, without antigliadin serum antibodies (AGA), but positive to the research of antiendomysial (EMA) ones. The biopsy performed by digestive endoscopy showed a complete atrophy of duodenal villi and the diagnosis of CD was confirmed according to the European Society for Pediatric Gastroenterology and Nutrition (ESPGAN) criteria. The diet without gluten caused the DH to recovery and the duodenal villi microscopic aspect to normalize as well. Both the brothers had the same HLA pattern: A1, B8, DR3-DR2, DQw2. Our clinical study suggests that it is very important, especially for the general practitioner, to recognize a DH and in every child presenting with a dermatitis like that it will be mandatory to perform a laboratory research of both AGA and EMA.

[Heart transplant: an emotional storm for the child and his family]

The purpose of the present study was a psychological analysis of the emotional state of a family awaiting heart transplantation. Current practice suggests that such emotional reaction is characterized by mixed and contradictory feelings which require further investigation. Subjects were 5 children waiting for transplant and 5 with previous transplant. Methods were: 1) open interview with children and parents; 2) projective drawing test for children (Corman family test, H.T.P., L.A.D.S., M.U.C.T., K.F.D.); 3) "palinomas" questionnaire which investigates: awareness of the illness, child relation with the food, feelings of competence and control, self-esteem and perception of the self. "Palinomas" was created in Italy by a hospital psychological team in order to give a chance to the child to talk about himself and to maintain control over the situation. The information we obtained by "palinomas" revealed to be very useful to understand the personality of the child through the main areas reported above. Within the limits of an introductory study, results indicate that family needs an active psychological support in order to develop a more positive attitude.

Ploidy and proliferative activity measurement by flow cytometry in non-Hodgkin's lymphomas. Do speculative aspects prevail over clinical ones?

Paraffin-embedded lymph node biopsies from 107 patients with newly diagnosed non-Hodgkin's lymphomas were examined for cell DNA content and proliferative activity (as percentage of S-phase cells) by means of flow cytometry. Patients were diagnosed between 1975 and 1985 and were homogeneously treated according to the grade of histologic malignancy. Cytofluorimetric data were studied with regard to their correlation with histology (classified and reviewed according to both Kiel and Working Formulation criteria), clinical stage, presence of constitutional symptoms, presence of bulky disease, sex, age, and the following laboratory data measured at diagnosis: erythrocyte sedimentation rate, hemoglobin, serum lactic dehydrogenase and serum albumin concentration. Aneuploidy was more frequent in the high grade malignant subtypes and in the miscellaneous group but showed no correlations with the other clinical parameters studied. Proliferative activity demonstrated a wide variation of data but a trend was evident toward higher proliferative values in the more severe histologic subtypes. The survival discrimination allowed by high- and low-grade malignant histology is exactly reproduced when highly and slowly proliferating lymphomas are considered (greater than or less than or equal to 12% of S-phase cells). These results, analyzed with those in the literature, suggest that measurements of ploidy and proliferative activity add little independent information to what is already provided by current histologic classifications, mainly as far as clinical evaluation and prognosis are concerned. Cytokinetic-aided therapeutic choices can be usefully proposed in a restricted number of cases. Improvement of the available lymphoma classifications through a better integration of ploidy and cytokinetic data with immunologic, genetic and histologic findings is still an object to be pursued in cytometric studies.

Increasing interdependency of prognosis- and therapy-related factors in Hodgkin's disease

Two subsequent series of patients with Hodgkin's disease (HD) treated according to different therapeutic plans were compared: the study made it possible to analyze the role played by therapy in influencing the individual importance of a group of well-known prognostic factors. Study 1 concerned 667 patients treated in the period 1971-1979 without special measures for mediastinal bulky disease and with four-drug chemotherapy regimens (MOPP, COPP, ABVD) for stage B or IV. Study 2 included 220 patients treated between 1980 and 1984 with combined sandwich chemoradiotherapy when mediastinal bulk was present, and with eight-drug alternating chemotherapy regimens for stages B or IV (MOPP/ABVD, CcVPP/ABVD). Distribution of epidemiologic and clinical characteristics as well as staging accuracy were comparable in the two series. Only sex, serum albumin at onset and success or failure in achieving complete remission showed the same ability to discriminate survival in both studies. Age, stage and histology retained a reduced role in Study 2, where it was found they could be handled as binary variables, i.e. more or less than 50 years of age, stage IV or other stages, lymphocyte depletion histotype or other types. The influence of B symptoms on survival was sharply decreased in patients treated with alternating chemotherapy regimens, whereas combined sandwich therapy showed a truly leveling effect on the role of mediastinal bulk, which has to be considered a very unfavorable factor with other treatments. In HD the evaluation of clinical findings with respect to their impact on prognosis is crucial for validating and graduating the staging process, and for matching the intensity of the therapy to the needs of the patient. The ongoing evolution in the roles of single prognostic factors due to therapy needs periodic reevaluation for proper adjustments of therapeutic strategies.

Preliminary report on activity and tolerability of epomediol, administered by intravenous infusion, in patients with chronic hepatopathies

The therapeutic activity and tolerability of epomediol were studied in 28 patients with chronic hepatopathies. Treatment was continued, parenterally, for 10 days (400-600 mg once daily by intravenous infusion). Clinical parameters (headache, right hypochondrial pain, bitter taste in the mouth, asthenia and nausea) and hepatic function (transaminase, alkaline phosphatase and gamma-glutamyl transpeptidase) showed significant improvements. Clinical and systemic tolerabilities of epomediol were satisfactory.

Hodgkin's disease prognosis: a directly predictive equation

586 patients with Hodgkin's disease diagnosed between 1970 and 1979 were staged and treated in the same way. Multivariate analysis was used to delineate the prognostic roles of several clinical features at diagnosis. A multiple regression analysis was applied to an exponential model for survival-time distribution, which proved to fit the data accurately. Several clinical characteristics were studied and those that could singly discriminate survival significantly were chosen as predictive variables for the multiple regression. These were: sex, age, stage, histological subtype, presence of constitutional symptoms, mediastinal mass, and erythrocyte sedimentation rate (ESR), and haemoglobin and serum albumin concentrations. ESR, stage, histological subtype, and age proved to be the best prognostic factors, while sex and albumin had minor value. The presence of symptoms, mediastinal bulk, and haemoglobin were not so important. A linear equation for the six variables was derived to calculate the estimated median survival time for any given patient. This equation was validated on an external group of 179 similar patients.

[Persistent supraventricular tachycardia in childhood]

Persistent or chronic supraventricular tachycardia is defined as the one occurring in more than 10% of cardiac rhythm during 24 hours. It may begin at any age, persisting months or years, and frequently it is discovered occasionally because it can be asymptomatic. The persistent supraventricular tachycardia (PSVT) represents 20-30% of all supraventricular tachycardias in pediatric age. The two main forms of PSVT are: atrial ectopic tachycardia, and persistent junctional reciprocating tachycardia (PJRT). The authors present 9 cases of children affected by PJRT seen from 1972 to 1985. They discuss the clinical course (mean follow up = 9.5 years), the pharmacologic treatment, the results obtained. They underline the particular resistance to conventional antiarrhythmic therapy of this form. On the other hand an antiarrhythmic treatment is recommended to avoid the risk of congestive heart failure. Nevertheless the prognosis is considered benign because in the majority of cases this type of arrhythmia disappears later on.

[Dilated cardiomyopathy due to primary carnitine deficiency]

A case of a 3 and a half years old girl with severe congestive heart failure, and typical picture of dilated cardiomyopathy is presented. The serum level of carnitine (17.2 micromoles/l, versus 44.1 +/- 12.2 micromoles/l, normal value for age) and the histologic and biochemical evaluation of quadriceps muscle tissue confirmed the diagnosis of primary deficit of carnitine. L-carnitine (2 gr. three times a day p.o.) was added to anti-congestive therapy. After 8 weeks of therapy, the general and cardiocirculatory conditions are much improved. The physiopathology of dilated cardiomyopathy due to deficit of carnitine are discussed. An early diagnosis, and an early substitutive therapy with L-carnitine dramatically improve the outcome of the disease.

Reevaluation of prognostic significance of symptoms in Hodgkin's disease

The prognostic value--at diagnosis--of fever, sweating and weight loss, which enter the Ann Arbor B category, and of pruritus, whose influence on survival is still debated, were systematically reevaluated in 635 patients with Hodgkin's disease, observed between 1972 and 1982. By means of multivariate analysis an intrinsic, more negative prognostic value was demonstrated for each of the following symptoms: fever over 38 degrees C, weight loss more than 10% of body weight in the 6 months before admission, and severe pruritus, which is defined as being generalized, causing multiple excoriations and resisting local and systemic antipruritics. Patients with the mild counterparts of these symptoms, as well as sweats, were found to have a survival rate quite comparable with that of fully asymptomatic patients. A rearrangement of the Ann Arbor B constitutional symptoms which would replace sweats with severe pruritus might be more correct and more suitable for better selecting the patients who require more aggressive therapy.

[A case of scleroderma with sclerodermic renal crisis and association with the Vogt-Koyanagi-Harada syndrome]

We report a case of scleroderma with "scleroderma renal crisis", (arterial hypertension, high plasma renin levels and impaired renal function) associated with a Vogt-Koyanagi-Harada syndrome which includes neurological, ophthalmic and cutaneous symptoms. This case is interesting not only because both syndromes are rare and have not previously been reported in association, but because it suggests a pathogenetic relationship between two autoimmune diseases.

Serum albumin in Hodgkin's disease

Serum albumin levels were measured by electrophoresis in 552 evaluable patients with Hodgkin's disease. Determinations were made on all patients at onset, on 224 after induction therapy and on 78 in relapse after remissions of variable length. At onset a discrete hypoalbuminemia was evident, inversely related to stage and more marked in symptomatic cases and elder patients. Little or no differences in albumin levels were found with relation to histologic subtypes, sex and presence of weight loss or hepatic damage. Posttherapeutic normalization of serum albumin occurred only after achievement of complete remission and failed after partial remission, while a new clear decrease became evident in relapse. On the basis of 799 albumin measurements during active disease and in remission, the albumin/alpha 2-globulin ratio demonstrated a clear and useful clinical advantage over either albumin or alpha 2-globulin fractions alone as indicator of active disease and relapse. If defective synthesis is the most accepted mechanism for hypoalbuminemia in Hodgkin's disease, these results suggest a casual factor somehow related to the tumoral mass.

Prognostic factors in non-Hodgkin's lymphomas

Prognostic factors were investigated in 67 patients with non-Hodgkin's lymphomas, homogeneously staged and treated (COP or CHOP according to low or high malignant histotype). A large number of parameters were scrutinized in order to recognize those exhibiting a prognostic value regarding length of survival. All the parameters that singly appeared to influence survival were entered into a multiple regression factor analysis. The erythrocyte sedimentation rate (ESR), higher or lower than 35 mm at the 1st h, better discriminated the groups of patients surviving or not at a given time. The histologic type, according to the Kiel classification of malignancy, was the second best prognosticator when a short-term prediction was requested (survival or death after no more than 2.5 years), but showed insufficient statistical weight for predicting longer survivals (greater than 4 years). Stage seemed to be the third best prognosticator for the first years of survival, but only the second best for longer survivals. Other parameters had very low prognostic importance when compared with those above. The results were substantially confirmed by 28 other patients, taken as controls. The importance that such a simple and easy test as ESR may be adequate with regard to prognosis is emphasized.