Assessment on Practicing Correct Body Posture and Determinant Analyses in a Large Population of a Metropolitan Area

An incorrect posture can generate stress of the spine and can be the cause of musculoskeletal disorders. Considering the extensive use of the computer, which worsens posture disorders, among workers, is important to analyze the phenomenon in order to reduce his impact on industry. The aim of this study is to assess determinants regarding posture in a large population of a metropolitan area. A total of 1177 questionnaires was analyzed. The majority of sample showed good knowledge and attitude regarding correct posture; most of the sample, 70.4% was aware of the definition of posture and 68.7% feel that not enough attention is paid at posture at workplace. Despite the good predisposition, only 2.8% of the sample consult a specialist for posture. The multiple linear regression analysis shows that those who have higher knowledge and best attitudes will consequently have good behaviors in maintaining a correct posture. Furthermore, age and education resulted main drivers of correct posture in any model considered. The results enlighten the necessity of conducting further studies to analyze attitudes of the general population and suggest improving educational and training programs to the enrichment of knowledge and to correct posture behaviors.

Imaging of Violence Against the Elderly and the Women

Emergency department assessment is a critical opportunity to identify elder abuse and violence against women, which represent a growing problem, requiring the attention of health care systems. Elder abuse is most frequently perpetrated by family members because of the higher levels of stress, burnout, and financial problems affecting the caregivers that can even lead to deadly consequences. Intimate partner violence is defined as physical, sexual, or psychological harm caused to another by a current or former partner or spouse, and can range from a single acute hit to chronic battering, varying in frequency and severity. Radiologists have a critical role in detecting those injury findings suggestive of abuse and violence. When appropriate, additional information about the social circumstances in which an injury took place, linked with imaging findings, may also be helpful in diagnosing abuse. The purpose of this article is to highlight the role of diagnostic imaging in the detection of lesions compatible with domestic abuse in elderly patients and women, and to allow the recognition of the alterations most frequently associated with this type of violence.

TENS effects on salivary stress markers: A pilot study

Transcutaneous electrical nerve stimulation (TENS) is extensively used as pain relief through endorphins release. Moreover, recent findings showed a role in the activation of the autonomic nervous system (ANS); it was evidenced by modification in the heart rate variability and ANS-related marker. The objective of this pilot study is to evaluate salivary alpha amylase (sAA) as a marker of stress in two groups of healthy subjects, one receiving ultra-low frequency transcutaneous electrical nerve stimulation (ULF-TENS) and one without stimulation. Sixty healthy people were enrolled. The test group consisted of 30 participants (15 men, 15 women). The control group consisted of 30 participants (15 men, 15 women). Statistical analysis showed that sAA levels were statistically different between men and women independently from TENS; we hypothesize that treatment could influence sAA levels because it is thought to activate μ opioid receptors. The results of this study seem to indicate that the analysis of sAA, through a non-invasive saliva sample, could be an efficient aid for understanding the functions of the autonomic nervous system.

Acute abdominal pain in childhood and adolescence: assessing the impact of sonography on diagnosis and treatment

PURPOSE

To assess the impact of ultrasonography on defining the diagnostic and therapeutic pathways for pediatric patients admitted to the emergency department for acute abdominal pain.

METHODS

We performed a retrospective study of all patients aged <16 years with acute abdominal pain who underwent ultrasound examination at our Diagnostic Imaging Department from October 2010 to March 2012. We investigated for each patient the pathway following ultrasound examination and definitive diagnosis. The impact of ultrasonography was defined based on the frequency with which the information resulting from this examination confirmed or denied the diagnostic suspicion made by the emergency physician on the basis of clinical and laboratory findings.

RESULTS

In 497/729 patients (69 %), ultrasound examination did not determine variations in the diagnostic and therapeutic pathways, either because it confirmed the outcome of clinical examination and laboratory tests, or because, even addressing in the opposite direction to these, the emergency physician did not consider its result because of being particularly alarmed or sufficiently reassured by clinical examination and laboratory tests. In the remaining 232/729 cases (31 %), ultrasound examination determined an increase or a reduction of the provided care and attention (subsequently proved justified in the vast majority of cases) in spite of what was initially assessed based on clinical examination and laboratory tests.

CONCLUSIONS

The results of our retrospective study demonstrated that ultrasonography was a valuable tool in the management of pediatric patients with acute abdominal pain together with clinical examination and laboratory tests.

[Petit's lumbar hernia: about a case]

The authors are surgeons of Moscati Hospital in Aversa (CE)-Italy, and one of them is a Radiologist in the same hospital; they describe a rare case of lumbar hernia, the Petits hernia and describe the anatomical aspects of parietals hernias. Subsequently they describe the diagnostics aspects and then the surgicals treatments. In this case-report the authors describe the surgical operation to use one prolene-net to close the parietal breach. The most important aspect, that the authors emphsasize, is the absolute importance of careful clinic examination to diagnose it. This work is completed with some pictures that show it; some pictures are made in operatory-room during the surgical treatment and some of them are TC images.

Expression and purification of full-length human Bax alpha

Bax is a proapoptotic ion channel forming protein of the Bcl-2 family. In cells the protein is found in the cytosol and in the mitochondria membrane where it presumably is involved during apoptosis in disruption of the mitochondrial membrane potential and release of cytochrome c. The protein has a hydrophobic domain at the C-terminus, which renders it a limited solubility. Thus, all studies on recombinant Bax has so far been performed on C-terminal truncated protein. We have expressed and purified the full-length human Bax alpha. The protein was expressed with a His tag at the N-terminus and purified by affinity chromatography on Ni-NTA-agarose followed by ion-exchange chromatography on Q-Sepharose. The protein was more than 98% pure on SDS-PAGE and in the presence of 1% (w/v) octyl glucoside it could be concentrated up to 0.5 mg/ml. Full-length Bax was 25-fold more efficient, compared to C-terminal truncated Bax, in forming ion channels and trigger carboxyfluorescein release from liposomes.

Bax-induced cytochrome C release from mitochondria is independent of the permeability transition pore but highly dependent on Mg2+ ions

Bcl-2 family members either promote or repress programmed cell death. Bax, a death-promoting member, is a pore-forming, mitochondria-associated protein whose mechanism of action is still unknown. During apoptosis, cytochrome C is released from the mitochondria into the cytosol where it binds to APAF-1, a mammalian homologue of Ced-4, and participates in the activation of caspases. The release of cytochrome C has been postulated to be a consequence of the opening of the mitochondrial permeability transition pore (PTP). We now report that Bax is sufficient to trigger the release of cytochrome C from isolated mitochondria. This pathway is distinct from the previously described calcium-inducible, cyclosporin A-sensitive PTP. Rather, the cytochrome C release induced by Bax is facilitated by Mg2+ and cannot be blocked by PTP inhibitors. These results strongly suggest the existence of two distinct mechanisms leading to cytochrome C release: one stimulated by calcium and inhibited by cyclosporin A, the other Bax dependent, Mg2+ sensitive but cyclosporin insensitive.

Inhibition of Bax channel-forming activity by Bcl-2

Proteins of the Bcl-2 family are intracellular membrane-associated proteins that regulate programmed cell death (apoptosis) either positively or negatively by as yet unknown mechanisms. Bax, a pro-apoptotic member of the Bcl-2 family, was shown to form channels in lipid membranes. Bax triggered the release of liposome-encapsulated carboxyfluorescein at both neutral and acidic pH. At physiological pH, release could be blocked by Bcl-2. Bcl-2, in contrast, triggered carboxyfluorescein release at acidic pH only. In planar lipid bilayers, Bax formed pH- and voltage-dependent ion-conducting channels. Thus, the pro-apoptotic effects of Bax may be elicited through an intrinsic pore-forming activity that can be antagonized by Bcl-2.

Pairs of surface molecules involved in human IgE regulation: CD23-CD21 and CD40-CD40L

At least two cell-derived signals have been shown to be necessary for the induction of immunoglobulin isotype switching in B-cells. The first signal is given by either of the soluble lymphokines, interleukin (IL)-4 or IL-13, which induce germline epsilon transcript expression, but this alone is insufficient to trigger secretion of immunoglobulin E (IgE). The second signal is provided by a physical interaction between B-cells and activated T-cells, basophils and mast cells, and it has been shown that the CD40/CD40 ligand (CD40L) pairing is crucial for mediating IgE synthesis. In hyper-immunoglobulin M1 (HIGM1) syndrome, which is characterized by greatly decreased levels of immunoglobulin G, A and E (IgG, IgA and IgE), there are mutations in the CD40L resulting in a completely non-functional extracellular domain. The CD40L is, therefore, playing a central role in immunoglobulin isotype switching. Amongst the numerous pairs of surface adhesion molecules, the CD23-CD21 pair seems to play a key role in the generation of IgE. The CD23 molecule is positively and negatively regulated by factors which increase or decrease IgE production, respectively. Antibodies to CD23 have been shown to inhibit IL-4-induced human IgE production in vitro and to inhibit antigen-specific IgE responses in a rat model, in an isotype selective manner. CD23 interacts with CD21 on B-cells, preferentially driving IgE production. CD23 recognizes two main epitopes on the CD21 molecule. One region consists of short consensus repeat (SCR) sequences 1-2 and the other of SCR 5-8. In the latter region, Asn 370 and 295 are critical in the interaction with the lectin CD23. Therefore, a restricted number of cytokines and surface molecules seems to selectively regulate human immunoglobulin E synthesis.

Prognostic value of Holter monitoring in asymptomatic elderly subjects with sinus rhythm

Elderly people, even if asymptomatic and in apparently good cardiovascular condition, have a high incidence of cardiovascular events. Prognostic markers by noninvasive procedures would therefore be desirable. The aim of this study was to evaluate the prognostic usefulness of Holter monitoring in this setting. Holter findings in 50 asymptomatic elderly subjects with sinus rhythm were correlated with major clinical cardiovascular events occurring during a 5-year follow-up period (16% incidence). No significant association was found with any baseline arrhythmia category, even complex arrhythmias such as unsustained ventricular tachycardia, which had a 10% baseline prevalence. On the other hand, cardiovascular events were correlated (P < .01) with the presence of silent ST-segment depression (8% baseline prevalence), which seems to have an unfavorable clinical significance, in elderly, as well as younger, people. Holter monitoring, because of the benignity of high-prevalence findings and the very low incidence of unfavorable events, has an overall limited prognostic usefulness in asymptomatic elderly subjects with sinus rhythm. In a cost-conscious medical environment, its use seems to be justified only in selected cases.

CD40 ligand is functionally expressed on human eosinophils

CD40 ligand (CD40L), a surface molecule which can be expressed by T cells, mast cells and basophils, has been shown to be involved in the control of B cell proliferation, immunoglobulin class switching as well as in the activation of monocytes and T cells. We demonstrate that CD40L can also be expressed constitutively by eosinophils from an hypereosinophilic patient or, upon activation, by the eosinophilic cell line EOL-3 and normal blood eosinophils. Eosinophils were able to induce, in conjunction with IL-4, CD40L-dependent B cell proliferation in vitro. These results suggest that CD40L could play a role in the inflammatory processes during which eosinophil infiltration and activation are observed.

T cell clones from an X-linked hyper-immunoglobulin (IgM) patient induce IgE synthesis in vitro despite expression of nonfunctional CD40 ligand

The induction of immunoglobulin E (IgE) switching in B cells requires at least two signals. The first is given by either of the soluble lymphokines interleukin 4 (IL-4) or IL-13, whereas the second is contact dependent. It has been widely reported that a second signal can be provided by the CD40 ligand (CD40L) expressed on the surface of T cells, mast cells, and basophils. A defect in the CD40L has been shown recently to be responsible for the lack of IgE, IgA, and IgG, characteristic of the childhood X-linked immunodeficiency, hyper IgM syndrome (HIGM1). IgE can however be detected in the serum of some HIGM1 patients. In this study, we isolated T cell clones and lines using phytohemagglutinin (PHA) and allergen, respectively, from the peripheral blood of one such patient who expressed a truncated form of CD40L, and investigated their ability to induce IgE switching in highly purified, normal tonsillar B cells in vitro. Unexpectedly, 4 of 12 PHA clones tested induced contact-dependent IgE synthesis in the presence of exogenous IL-4. These clones were also shown to strongly upregulated IL-4-induced germline epsilon RNA and formed dense aggregates with B cells. Of the four helper clones, three were CD8+, of which two were characteristic of the T helper cell 2 (Th2) subtype. Two allergen-specific HIGM1 T cell lines, both of the Th0 subtype, could also drive IgE synthesis when prestimulated using specific allergen. All clones and lines were negative for surface expression of CD40L, and the mutated form of CD40L was confirmed for a representative clone by RNase protection assay and sequencing. The IgE helper activity could not be attributed to membrane tumor necrosis factor alpha (TNF-alpha) although it was strongly expressed on activated clones, and the addition of neutralizing anti-TNF-alpha antibody did not abrogate IgE synthesis. These results therefore suggest the involvement of T cell surface molecules other than CD40L in the induction of IgE synthesis, and that these molecules may also be implicated in other aspects of T-B cell interactions.

Similar CD40 ligand expression on EL-4 thymoma cell lines with widely different helper activity for B lymphocytes

A mutagenized subclone of the murine EL-4 thymoma (clone B5) is approximately 30 times more potent than parental EL-4 cells in stimulating proliferation and Ig secretion of murine or human B cells by direct cell contact in the presence of appropriate cytokines. In this study we found that CD40 ligand (CD40L) expression was constitutive and very similar on EL-4 B5 and parental EL-4 cells according to Northern blot and flow cytometry. Activation with phorbol 12-myristate 13-acetate (PMA) alone, PMA and ionomycin, interleukin-1 (IL-1) or human T-cell supernatant did not lead to significant CD40L up-regulation. A receptor-binding assay with soluble CD40 did not reveal different ligand affinities. However, murine and human soluble CD40-IgFc fusion proteins inhibited human B-cell stimulation by EL-4 B5 cells in the presence of human T-cell supernatant. Inhibition was 96% when soluble CD40 was added on day 0 of culture and progressively decreased when the CD40 was added subsequently. Ig secretion by cytoplasmic Ig-positive cells was no longer inhibited. These findings imply that, although CD40 ligand is necessary for B-cell activation by EL-4B5 cells, additional molecule(s) must be responsible for the increased helper activity of the EL-4 B5 clone.

Receptors for IgE

Following advances during the past 5 years in our understanding of the molecular structure of receptors for IgE, progress has been made in elucidating the structure and function of IgE receptors and the signalling events through these receptors. IgE is not the only ligand for some of these receptors, leading to their having unexpected and interesting biological activities.

Induction of human IgE synthesis in B cells by mast cells and basophils

Immunoglobulin E (IgE) is central to the induction of allergic diseases through its binding to the high-affinity receptor (Fc epsilon R1) on mast cells and basophils. Crosslinking by allergens of the bound IgE leads to the release of various inflammatory mediators. IgE production by B cells requires a physical interaction with T cells, involving a number of surface adhesion molecules, as well as the soluble factors interleukin-4 (IL-4) and IL-13 (ref. 5) produced by T cells, basophils and mast cells. Here we report that, in the presence of IL-4, mast and basophilic cell lines can provide the cell contact signals that are required for IgE synthesis. The human cell lines HMC-1 (mast) and KU812 (basophilic) both express the ligand for CD40 (CD40L) which is shown to be responsible for the IgE production. Moreover, freshly isolated purified human lung mast cells and blood basophils are also shown to express CD40L and to induce IgE production. This evidence suggests that mast cells and basophils may therefore play a key role in allergy not only by producing inflammatory mediators, but also by directly regulating IgE production independently of T cells.

Induction by anti-CD40 antibody or soluble CD40 ligand and cytokines of IgG, IgA and IgE production by B cells from patients with X-linked hyper IgM syndrome

We studied the ability of B lymphocytes from patients with X-linked hyper IgM syndrome (HIGM1) to be activated via the CD40 membrane receptor. HIGM1 is caused by a CD40 ligand gene mutation, leading to defective expression on the membrane of activated T lymphocytes. We found that triggering of B cells by an anti-CD40 monoclonal antibody or the soluble CD40 ligand plus interleukin (IL)-4 or IL-10 led to B cell proliferation and/or differentiation towards IgG, IgA and IgE secretion. This was reflected by transcription of C gamma, alpha and epsilon membrane isotype expression and IgG, IgA and IgE production. These results confirm the integrity of B cells in patients with the HIGM1 immunodeficiency and open up new therapeutic possibilities.

Human CD40-ligand: molecular cloning, cellular distribution and regulation of expression by factors controlling IgE production

Here we report the cloning of the cDNA for human CD40-Ligand (CD40-L) from a CD4-positive T cell clone. The deduced amino acid sequence predicts a type II membrane protein of 261 amino acids. Northern blot and FACS analysis of PBMNC revealed that the human CD40-L can be detected on T cells and is absent from B cells and monocytes. The human CD40-L is expressed on both CD4- and CD8-positive T cells, (CD45R0+) and (CD45RA+) subsets. We observed that IL-4, an inducer of IgE production, upregulated CD40-L mRNA level while IFN gamma, an inhibitor of IgE synthesis, reduced the expression of CD40-L mRNA. These data suggest a the correlation between human CD40-L expression and IgE production.

Atrial fibrillation and infarct area extent in ischemic stroke. A clinical and neuroradiological study in 104 patients

The extent of infarct area (IA) on CT-scan in 104 patients with ischemic stroke (IS) was compared with the presence of atrial fibrillation (AF) and other risk factors (hypertension, dyslipidemia, alcohol abuse). Infarct size was also compared with biological and clinical parameters in acute stage (6-12 h) (blood glucose level, systolic and diastolic arterial pressure, haematocrit, consciousness, clinical picture) and with clinical outcome. Among risk factors, only AF showed a significant correlation with IA extension (p less than .0009). IA correlated also with consciousness (p = .0017), clinical picture (p = .0145) and with clinical outcome (p less than 10(-6). Patients with AF showed a more severe clinical outcome with respect to patients without risk factors. It could be hypothesized that patients with AF have a reduced capacity for increasing or sustaining cerebral blood flow in the acute phase of IS.

Monoclonal antibodies reacting with the interleukin 1 receptor define a multi-molecular complex

By sequential immunization with a variety of different interleukin (IL) 1 receptor (IL 1R)-bearing cells and by generating a large number of clones from a single fusion experiment, we have managed to produce two monoclonal antibodies which react with the lymphocyte IL 1R. The antibodies also react with the mouse fibroblast line, 3T3, but we have not yet defined their reactivity with cells carrying low-affinity receptors. Immunoprecipitation allows the IL 1R to be isolated from EL4 6.1 cell membrane preparations and shows that the IL 1R exists as a complex. The antibodies clearly interfere with IL 1 responses both in vitro and in vivo. These are the first anti-mouse IL 1R antibodies to be described which clearly and profoundly affect the immune response.

A urine inhibitor of interleukin 1 activity affects both interleukin 1 alpha and 1 beta but not tumor necrosis factor alpha

Urine from monocytic leukemia and other febrile patients contains an inhibitor of interleukin 1 (IL-1), as measured by prostaglandin E2 and collagenase production by human fibroblasts and synovial cells. With the use of recombinant IL-1, the IL-1 inhibitor was partially purified by using ammonium sulfate precipitation, anion-exchange, and gel filtration chromatographies. IL-1 inhibitory activity elutes with an 18,000 to 25,000 apparent molecular size. The same fractions also inhibit IL-1 assayed by the proliferation of murine thymocytes and human fibroblasts. Both forms of human recombinant IL-1, IL-1 alpha and IL-1 beta, which show only 26% homology, but nevertheless bind to the same receptor, are affected by this natural inhibitor to the same extent. In contrast, human recombinant tumor necrosis factor, which shares some of the biologic activities of IL-1, is not inhibited by the urinary IL-1 inhibitor. This study shows that the various biologic activities of both forms of human recombinant IL-1 are inhibited by a partially purified natural urine-derived factor.

A urine inhibitor of interleukin 1 activity affects both interleukin 1 alpha and 1 beta but not tumor necrosis factor alpha

Urine from monocytic leukemia and other febrile patients contains an inhibitor of interleukin 1 (IL-1), as measured by prostaglandin E2 and collagenase production by human fibroblasts and synovial cells. With the use of recombinant IL-1, the IL-1 inhibitor was partially purified by using ammonium sulfate precipitation, anion-exchange, and gel filtration chromatographies. IL-1 inhibitory activity elutes with an 18,000 to 25,000 apparent molecular size. The same fractions also inhibit IL-1 assayed by the proliferation of murine thymocytes and human fibroblasts. Both forms of human recombinant IL-1, IL-1 alpha and IL-1 beta, which show only 26% homology, but nevertheless bind to the same receptor, are affected by this natural inhibitor to the same extent. In contrast, human recombinant tumor necrosis factor, which shares some of the biologic activities of IL-1, is not inhibited by the urinary IL-1 inhibitor. This study shows that the various biologic activities of both forms of human recombinant IL-1 are inhibited by a partially purified natural urine-derived factor.

The utilization of the Rorschach test in a case-controlled study

The Rorschach test was administered to 58 children of normal intelligence aged 7-14 years with a history of common migraine of at least 12 months and to a group of controls matched for age, sex, and IQ. The Rorschach test was scored blindly. The migraine group was characterized by marked intellectual inhibition with poor school performance and low response rates; inhibition of psychomotor activity and aggressiveness, shown by content analysis and by the presence of kinesthetic shock; inhibition of affect (ratio M/sum C); ineffective use of mechanisms of defence against anxiety (F-); prevalence of phobic features and massive use of repression, indicated by the high rejection rate and shock at red colour. The differences from the controls were significant at the 0.01 level with regard to all items in the preadolescent age group and with regard to all items except kinesthetic shock in the migraine group as a whole. There was thus a definite difference between the migraine group and the controls, a difference that might depend on impairment of ego function and on recurrent experience of pain.

[Systemic arterial hypertension in chronic alcoholics. Role of the abstinence syndrome]

A significantly positive association (p less than 0.001) has been shown between so called "minor" ethanol withdrawal-syndrome and raised systolic and diastolic blood pressure values in 328 hospitalized chronic alcoholics. In a subgroup of patients with clinical and histological findings of alcoholic hepatic cirrhosis, this association was absent (p greater than 0.5). In chronic alcoholics with several hospital admissions, a nearly constant relationship of "minor" ethanol withdrawal-syndrome to systolic and diastolic hypertension has been shown. Mild or early abstinence states in alcoholics - which may pass off undetected or misinterpreted in outpatient clinic examination - are possibly responsible for the positive association between hypertension and alcoholism reported by others in several epidemiologic studies. Therefore, high blood pressure values in a chronic alcoholic patient - even if detected on several occasions - need special clinical considerations and we think they do not mean alcohol-induced hypertension. From another point of view, high blood pressure values may give a hint for detection of hidden alcoholism.

[Biochemical indicators in chronic alcoholism. Comparison between the enzymes glutamate dehydrogenase and gamma glutamyl transferase]

Serum concentrations of glutamate dehydrogenase (GDH) and gamma-glutamyl-transpeptidase (GGT) have been determined in 93 chronic alcoholics regularly taking at least 150 g of alcohol daily, and in 35 healthy teetotal subjects. Both these enzymes were increased in the alcoholic group (P less than 0.001). The incidence of "false negatives" (alcoholics with normal enzymes) may be considered equal (25 and 29% respectively) while "false positives" (teetotal subjects with increased enzymes) were less frequent for glutamate-dehydrogenase (17 against 37%). In 20% of alcoholics one enzyme was normal while the other was increased; the serum increase of these two enzymes probably indicates different hepatic lesions. The search for a reliable biochemical marker of hepatocyte necrosis cannot be considered concluded; hystologic examination is still necessary to assess alcohol-related hepatic necrosis. Our study has shown that glutamate-dehydrogenase has an equal sensibility to gamma-glutamyltranspeptidase but a higher specificity as an indicator of alcohol abuse.

[Radiologic projection on the sagittal plane as a diagnostic parameter in primary lung neoplasms]

A study was carried out to evaluate the importance of location of radiological densities on lateral protection of X-ray films of the chest, as a valuable sign for the clinical diagnosis of primary neoplasms of the lung. Clinical case records of 100 patients with pneumonitis, 61 patients with active pulmonary tuberculosis and 58 cases with primary pulmonary neoplasms -- in which diagnosis was verified by hystological examination of biopsies performed during bronchoscopy or by autoptic control -- were reviewed. Radiological location in anterior or central-anterior planes was observed in only 14 per cent of patients with pneumonitis while in 86 per cent the location was in posterior or central-posterior planes. Only 10 per cent of patients with active pulmonary tuberculosis had their densities situated on anterior or central-anterior planes of the chest X-ray while in the remaining 90 per cent of cases the location was in central-posterior or posterior planes of the radiogram. In 74 per cent of patients with primary lung neoplasms we observed that radiological densities were located in the anterior or central-anterior planes; only in 26 per cent of patients the radiological location was in the posterior or central-posterior planes. Since in most instances of primary lung neoplasms the initial diagnostic approach is roentgenographic, it seems of particular importance in differential diagnosis to consider as neoplastic those lesions located in the anterior planes of an X-ray film taken in lateral projection until proven otherwise. This radiological aspect implies the opportunity to perform a bronchoscopic and hystological evaluation even in those patients in which clinical aspects should seem less suggestive of primary lung neoplasm. A posterior location does not exclude -- according to our data -- the neoplastic origin of a density but this radiological criterion does seem to justify a less aggressive diagnostic approach in all those patients which present contraindications or refuse invasive procedures.

[Macrocytosis and anemia in chronic alcoholism. Correlation with the results of hepatic needle biopsy]

Clinical and laboratory observations were made on 220 chronic alcoholics, regularly taking at least 150 g of alcohol daily. Haematological data concerning white blood cells, platelets and red cells counts, mean corpuscolar volume, hemoglobin and serum iron in these patients were compared with control values obtained from 150 healthy teetotal subjects. Hematological changes in chronic alcoholics were correlated with histological liver damages in transcutaneous needle-biopsies. No statistical differences were evident for white cells and platelets counts and for serum iron content; however, in chronic alcoholics, serum iron content showed a great dispersion around the mean. Mean corpuscolar volume (MCV) was significantly increased (P less than 0,001) in chronic alcoholics (even in those with a normal liver biopsy) but there was no significant difference in the degree and the incidence of macrocytosis between patients showing normal liver appearances or fatty changes only, and those showing more severe damage, i.e, acute alcoholic hepatitis (with or without steatosis), central hyaline-sclerosing necrosis and or hepatofibrosis, cirrhosis and hepatocarcinoma. No significant difference was seen between male and female alcoholics. Macrocytosis may be considered as an early marker for alcoholism but it does not correlate with the type of histological liver damage. Hemoglobin levels were significantly reduced in chronic alcoholics (P less than 0,01): the degree and incidence of anemia were more severe in those patients with advanced liver diseases and in female alcoholics. There is no statistically significant correlation between macrocytosis and anemia.

[Current status and problems of tuberculosis. 10 years of experience in a general medicine department]

One hundred and seventeen cases of tuberculous disease who came to the Authors' observation in 10 years are described. Some cases are illustrated in details just to point out the complexity and the different guises of clinical presentation and to underscore the importance of an high index of suspicion for tuberculosis in patients who are admitted to a ward of internal medicine. In 71 patients with active, progressive tuberculous disease, the diagnosis was confirmed by bacteriological findings in 29 cases and by bioptical and hystological data in 5 cases; in the remaining 37 cases only clinical and radiological criteria were met but the diagnosis was confirmed by the improvement which was observed after antimycobacterial therapy. Many difficulties have been met in the differential diagnosis between pulmonary tuberculosis and bronchogenic carcinoma in those cases with anamnestic and radiological data of previous pulmonary tuberculosis. When the radiological site of lesions was in the posterior segments of the lung, tuberculosis was the most probable diagnosis, while bronchogenic carcinoma is most oftenly localized in the anterior segments; only in 5 cases of the Author's series the above mentioned criterion was not satisfied. In 46 cases with clinical signs of inactive tuberculous disease which had not been adequately treated with chemotherapy, isoniazid was given only to those patients with a high risk of reactivation (silicosis, diabetes, chronic alcholism, gastric resection, prolonged steroid therapy). Two cases of isoniazid hepatitis were observed among patients treated by the Authors.