Fungal Planet description sheets: 1478-1549

Novel species of fungi described in this study include those from various countries as follows: Australia, Aschersonia mackerrasiae on whitefly, Cladosporium corticola on bark of Melaleuca quinquenervia, Penicillium nudgee from soil under Melaleuca quinquenervia, Pseudocercospora blackwoodiae on leaf spot of Persoonia falcata, and Pseudocercospora dalyelliae on leaf spot of Senna alata. Bolivia, Aspicilia lutzoniana on fully submersed siliceous schist in high-mountain streams, and Niesslia parviseta on the lower part and apothecial discs of Erioderma barbellatum on a twig. Brazil, Cyathus bonsai on decaying wood, Geastrum albofibrosum from moist soil with leaf litter, Laetiporus pratigiensis on a trunk of a living unknown hardwood tree species, and Scytalidium synnematicum on dead twigs of unidentified plant. Bulgaria, Amanita abscondita on sandy soil in a plantation of Quercus suber. Canada, Penicillium acericola on dead bark of Acer saccharum, and Penicillium corticola on dead bark of Acer saccharum. China, Colletotrichum qingyuanense on fruit lesion of Capsicum annuum. Denmark, Helminthosphaeria leptospora on corticioid Neohypochnicium cremicolor. Ecuador (Galapagos), Phaeosphaeria scalesiae on Scalesia sp. Finland, Inocybe jacobssonii on calcareous soils in dry forests and park habitats. France, Cortinarius rufomyrrheus on sandy soil under Pinus pinaster, and Periconia neominutissima on leaves of Poaceae. India, Coprinopsis fragilis on decaying bark of logs, Filoboletus keralensis on unidentified woody substrate, Penicillium sankaranii from soil, Physisporinus tamilnaduensis on the trunk of Azadirachta indica, and Poronia nagaraholensis on elephant dung. Iran, Neosetophoma fici on infected leaves of Ficus elastica. Israel, Cnidariophoma eilatica (incl. Cnidariophoma gen. nov.) from Stylophora pistillata. Italy, Lyophyllum obscurum on acidic soil. Namibia, Aureobasidium faidherbiae on dead leaf of Faidherbia albida, and Aureobasidium welwitschiae on dead leaves of Welwitschia mirabilis. Netherlands, Gaeumannomycella caricigena on dead culms of Carex elongata, Houtenomyces caricicola (incl. Houtenomyces gen. nov.) on culms of Carex disticha, Neodacampia ulmea (incl. Neodacampia gen. nov.) on branch of Ulmus laevis, Niesslia phragmiticola on dead standing culms of Phragmites australis, Pseudopyricularia caricicola on culms of Carex disticha, and Rhodoveronaea nieuwwulvenica on dead bamboo sticks. Norway, Arrhenia similis half-buried and moss-covered pieces of rotting wood in grass-grown path. Pakistan, Mallocybe ahmadii on soil. Poland, Beskidomyces laricis (incl. Beskidomyces gen. nov.) from resin of Larix decidua ssp. polonica, Lapidomyces epipinicola from sooty mould community on Pinus nigra, and Leptographium granulatum from a gallery of Dendroctonus micans on Picea abies. Portugal, Geoglossum azoricum on mossy areas of laurel forest areas planted with Cryptomeria japonica, and Lunasporangiospora lusitanica from a biofilm covering a biodeteriorated limestone wall. Qatar, Alternaria halotolerans from hypersaline sea water, and Alternaria qatarensis from water sample collected from hypersaline lagoon. South Africa, Alfaria thamnochorti on culm of Thamnochortus fraternus, Knufia aloeicola on Aloe gariepensis, Muriseptatomyces restionacearum (incl. Muriseptatomyces gen. nov.) on culms of Restionaceae, Neocladosporium arctotis on nest of cases of bag worm moths (Lepidoptera, Psychidae) on Arctotis auriculata, Neodevriesia scadoxi on leaves of Scadoxus puniceus, Paraloratospora schoenoplecti on stems of Schoenoplectus lacustris, Tulasnella epidendrea from the roots of Epidendrum × obrienianum, and Xenoidriella cinnamomi (incl. Xenoidriella gen. nov.) on leaf of Cinnamomum camphora. South Korea, Lemonniera fraxinea on decaying leaves of Fraxinus sp. from pond. Spain, Atheniella lauri on the bark of fallen trees of Laurus nobilis, Halocryptovalsa endophytica from surface-sterilised, asymptomatic roots of Salicornia patula, Inocybe amygdaliolens on soil in mixed forest, Inocybe pityusarum on calcareous soil in mixed forest, Inocybe roseobulbipes on acidic soils, Neonectria borealis from roots of Vitis berlandieri × Vitis rupestris, Sympoventuria eucalyptorum on leaves of Eucalyptus sp., and Tuber conchae from soil. Sweden, Inocybe bidumensis on calcareous soil. Thailand, Cordyceps sandindaengensis on Lepidoptera pupa, buried in soil, Ophiocordyceps kuchinaraiensis on Coleoptera larva, buried in soil, and Samsoniella winandae on Lepidoptera pupa, buried in soil. Taiwan region (China), Neophaeosphaeria livistonae on dead leaf of Livistona rotundifolia. Türkiye, Melanogaster anatolicus on clay loamy soils. UK, Basingstokeomyces allii (incl. Basingstokeomyces gen. nov.) on leaves of Allium schoenoprasum. Ukraine, Xenosphaeropsis corni on recently dead stem of Cornus alba. USA, Nothotrichosporon aquaticum (incl. Nothotrichosporon gen. nov.) from water, and Periconia philadelphiana from swab of coil surface. Morphological and culture characteristics for these new taxa are supported by DNA barcodes. Citation: Crous PW, Osieck ER, Shivas RG, et al. 2023. Fungal Planet description sheets: 1478-1549. Persoonia 50: 158- 310. https://doi.org/10.3767/persoonia.2023.50.05.

Abstract 1251: Novel potential role of m6A-demethylase FTO (fat mass and obesity) protein in colorectal cancer

Colorectal cancer (CRC) is the one of the most frequent and deadly cancer worldwide. The regulation mediated by the N6methyladenosine (m6A) demethylase protein called FTO in CRC is quite controversial. As previously studied in obesity and food intake, currently is being linked to stemness, epithelial-mesenchymal transition, chemotherapy resistance and proliferation in colon cancer cells, however, its localization and function in the tumor microenvironment (TME) and how it connects with progression remains unclear. The aim of this study was to evaluate FTO protein in tumor and healthy corresponding tissue from 22 colorectal cancer patients with different histological TNM stages (hTNM) by immunohistochemistry and multiple immunofluorescence analysis; classifying the tumor and stromal FTO localization and associating this data with clinical and histopathological features. As for content, the frequency of FTO+ cells in stromal compartments increases in more invasive stages compared to non-tumor tissue and in tumors with low desmoplasia. Regarding to localization, FTO is mostly nuclear and present in the lamina propria cells in non-tumor tissues and in immune and fibro-immune compartments in the TME, such as T cells, cancer associated fibroblasts and macrophages. In tumor cells, the percentage of FTO+ cells increase in early carcinogenic stages (hTNM I vs healthy tissue) and in moderately differentiated tumors. In addition, nuclear FTO expression increases in normal T cells and fibroblasts with a particular pattern after exposure for 24h to a colon adenocarcinoma cell-derived conditioned media, suggesting FTO activity in the TME interaction following a paracrine signal. In conclusion, the increase of the FTO protein in both tumor and stroma from CRC suggests its participation mediating TME communication.

Citation Format: Glauben T. Landskron-Ramos, Antonia L. Domínguez-Beltrando, Mauricio Zambra-Rojas, Antonella Sanguineti, Gonzalo Vasquez, Marjorie De la Fuente, Daniela Simian, Silvana Valdebenito-Silva, Juan Saavedra, Solange Gouet, Ricardo Soto-Rifo, Daniela Sauma, Eliseo Eugenin, Mario Abedrapo, Marcela A. Hermoso, Marcela A. Hermoso. Novel potential role of m6A-demethylase FTO (fat mass and obesity) protein in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1251.

Major and trace elements in Boletus aereus and Clitopilus prunulus growing on volcanic and sedimentary soils of Sicily (Italy)

The aim of this study was to determine and compare the content of 28 elements (Ag, Al, As, Ba, Be, Bi, Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, Pb, Rb, Sb, Se, Sr, Tl, U, V and Zn) in fruiting bodies of Boletus aereus Bull. and Clitopilus prunulus P. Kumm collected from eleven unpolluted sites of Sicily (Italy) and, also to relate the abundance of chemical elements in soil with their concentration in mushrooms. Median concentrations of the most abundant elements in Boletus aereus ranged from 31,290 μg/g (K) to 107 μg/g (Zn) in caps and from 24,009 μg/g (K) to 57 μg/g (Zn) in stalks with the following abundance order: K > Na > Ca > Mg > Fe > Al > Rb > Zn. The same elements, in the whole fruiting body of Clitopilus prunulus samples, varied in the range 54,073-92 μg/g following the abundance order: K > Na > Mg > Ca > Fe > Al > Rb > Zn. Metal contents in Boletus aereus and in the whole fruiting body of Clitopilus prunulus, collected from the same sampling sites, showed statistically significant differences for most elements. In particular, Clitopilus prunulus contained around two to four times more Co, Cr, Fe, Mg, Mo, Pb, U and V than caps and stalks of Boletus aereus species which, in turn, was from two to four times more enriched in Cu, Se and Tl. Thus, the elemental content of Boletus aereus and Clitopilus prunulus appeared to be species-dependent. The distribution of chemical elements in Boletus aereus was not uniform throughout the whole fruiting body as most elements were significantly bioconcentrated in caps. Furthermore, the fruit bodies of Boletus aereus from the volcanic soil differed both in major and minor elements concentrations from those collected from sedimentary soils. Cadmium and lead concentrations were below the threshold limits for wild mushrooms proposed by EU Directives (2008 and 2015). The elemental content was not significantly influenced by soil pH.

The Lymphocytes Stimulation Induced DNA Release, a Phenomenon Similar to NETosis

The release of DNA into the extracellular milieu by neutrophil during a process called NETosis has been postulated as an additional source of autoantigens; a process believed to be important in the pathogenesis of some autoimmune disease, such as systemic lupus erythematosus (SLE). However, it is not established if the B and T cells undergo the release of DNA to the extracellular milleu, in response to different stimuli. In this study, it was observed that the treatment of B and T cells with PMA, ionomycin and the serum from patients with SLE induced the extracellular DNA presence in B and T cells. These findings suggest that the phenomenon were similar to those observed in neutrophil's Etosis; B and T cells also released their DNA into the extracellular milieu. The findings express that serum from patients with SLE and SLEDAI ≤ 8 triggers the release of extracellular DNA in neutrophils, B and T cells, that suggested the presence of soluble factors in the serum that favoured this phenomenon.

Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients

PURPOSE

To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS).

METHODS

Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014.

RESULTS

Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS.

CONCLUSIONS

Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.

A rare case of a double phytobezoar causing gastric and jejunum obstruction in an adult man: a case report

Background

Bezoars are an uncommon cause of mechanical intestinal occlusion. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Symptoms are classically indistinguishable from one another and from more common causes of intestinal occlusion, so it can be difficult to establish a correct diagnosis in order to apply the correct treatment. We present a rare case of two different phytobezoars causing intestinal occlusion (gastric and jejunal). We also describe the correct techniques for making a correct and fast diagnosis of occlusion caused by phytobezoars, and the possible conservative and operative treatments.

Case presentation

We present the case of a double phytobezoar that was surgically treated with a double enterotomy. Our patient was a 68-year-old Caucasian man with a medical history of hypertension, a previous open appendectomy, and open repair of a perforated gastric ulcer. He was admitted with a 5-day history of abdominal pain located in his upper quadrants along with vomiting. After a preoperative examination, he was taken to the operating room. He was discharged in a good clinical condition 11 days after surgical intervention. A physical examination at 6 months demonstrated our patient was in good health.

Conclusions

Diagnosing bezoars is difficult because of their rarity. However, they must be taken into consideration in a differential diagnosis because their treatment is not always surgical. In fact, it may be conservative in many cases and a correct diagnosis will guide towards the correct therapy.

Haemodynamic Correction of Varicose Veins (CHIVA): An Effective Treatment?

Objective:

Evaluation of the feasibility and utility of haemodynamic correction of primary varicose veins (French acronym: CHIVA).

Design:

Prospective, single patient group study.

Setting:

Department of Surgery, University of Ferrara, Italy (teaching hospital).

Patients:

Fifty-five patients with primary varicose veins and a normal deep venous system (ultrasonographic criteria) were studied.

Interventions:

Fifty-five haemodynamic corrections by the CHIVA method described by Franceschi were undertaken. Seven patients were treated for short saphenous vein varices (group A) while 48 patients were treated for long saphenous vein varices (group B).

Main outcome measures:

Clinical: presence of varices and reduction in symptoms. Duplex and continuous-wave Doppler detection of re-entry through the perforators and identification of recurrences or new sites of reflux. Postoperative ambulatory venous pressure and refilling time measurements. Patients were studied for 3 years following surgery.

Results:

In group A, 57% short saphenous vein occlusions with no re-entry through the gastrocnemius and soleal veins were recorded. In group B the long saphenous vein thrombosis rate was 10%. In this group 15% of the patients showed persistence of reflux instead of re-entry at the perforators. Early recurrences were also observed. Overall CHIVA gave excellent results in 78% of the patients. Statistically significant ambulatory venous pressure and refilling time changes were recorded ( p<0.001).

Conclusions:

CHIVA treatment is inadvisable for short saphenous vein varices. Long saphenous vein postoperative thrombosis is related to development of recurrences

Cytokine gene polymorphisms in Colombian patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) patients exhibit alterations in cytokine production that may be relevant to SLE pathogenesis. There is evidence that cytokine gene polymorphisms control cytokine production; thus, these polymorphisms may be associated with SLE or its clinical manifestations. To establish the association of tumor necrosis factor alpha (TNF-alpha), transforming growth factor (TGF) beta1, interleukin (IL)-10, and IL-6 gene polymorphisms in Colombian SLE patients and their clinical manifestations, 120 SLE patients and 102 healthy controls were studied. Single nucleotide polymorphisms were studied by sequence-specific primers polymerase chain reaction (SSP-PCR) at: TNFalpha-308 (G/A), TGFbeta1 codon 10 (C/T) and codon 25 (G/C), IL-10 -1082 (G/A), -819 (C/T) and -592 (C/A), and IL-6 + 174 (G/C). Human leukocyte antigen (HLA)-DRbeta1 was typed by SSP-PCR. SLE patients had increased frequency of allele C at TGFbeta1 codon 25 (P = 0.0001, odds ratio (OR): 4.25, 95% confidence interval (CI): 2.17-8.35) and allele A at TNFalpha-308 (P = 0.0004 OR: 3.9, 95% CI: 1.65-5.80) compared with healthy controls. There was higher frequency of GC genotype at TGFbeta1 codon 25 in SLE patients (P < 0.0001). Extended genotypic analysis showed that SLE patients have decreased frequency of TNFalphaLow/TGFbeta1High (0.50) compared with healthy controls (0.80) (P < 0.0001). No association was found between these polymorphisms and SLE clinical manifestations except for Sm and Ro autoantibodies that were associated with TNFalpha allele A. There is an association between TNFalpha-308A/TGFbeta1 codon 25C with SLE susceptibility in Colombian population. This association may result in a highly inflammatory response with a decrease regulatory function mediated by TNFalpha and TGFbeta1, respectively. The TNFalpha-308A/TGFbeta1 25C genotype may be one component of genetic susceptibility to SLE in Colombian population.

[PHS Repair in femoral hernia surgery]

BACKGROUND

Since December 2000 we began to treat femoral hernias, for the first time in emergency, placing the underlay mesh of a PHS 168; device in the properitoneal space using the same anterior way well known in plug technique repair. The technical description and short term effectiveness, safeness and comfort of our new femoral prosthetic repair are reported.

METHODS

Prospective analysis of 12 unselected consecutive female patients who underwent 12 PHS device femoral hernia repairs (6 in emergency with 2 intestinal resections and 6 in elective settings), performed from December 2000 to December 2001 at the Institute of General Surgery, University of Ferrara. Mean age was 61,7 (range 25-94) and mean follow-up was 6 months (from 1 to 11).

RESULTS

Mean hospital stay was 2.1 days (from 1 to 5). No recurrences or complications occurred. We report one (8.3%) 25 year old woman with moderate cruralgia which required analgesics assumption form more then 24 hours.

CONCLUSIONS

Although our report is not statistical significant (recent introduction of this new technique for a low incidence rate pathology) actually we perform PHS device femoral hernia repair systematically, both in elective and emergency surgery. This new procedure appears as a simple, safe, effectiveness and comfortable, anterior properitoneal "tension-free" repair of the myopectineal region (direct inguinal hernias prophylaxis).

[Inguinal hernia prosthetic repair through the anterior approach]

BACKGROUND

Aim of this study is to compare the Lichtenstein's, Rutkow's and PHS techniques of inguinal hernia repair in terms of therapeutical efficacy and grade of acceptability, expressed in function of the complications, compliance and performance status of the patients.

METHODS

The preliminary results of an ongoing prospective non-randomized study on the most frequently used techniques of inguinal hernia repair (PHS, Rutkow's, and Lichtenstein's) are reported. Sixty patients with primary inguinal hernia were divided into three homogeneous groups for age, gender, Gilbert's type of hernia, type of anesthesia, ASA class. The three groups underwent PHS, Rutkow's and Lichtenstein's inguinal hernia repairs, respectively. The end-points of the study were: operative time, intra- and postoperative pain, intra- and postoperative complications, patients compliance and performance status.

RESULTS

The mean operative time were 40', 41' and 36' minutes for the PHS, Rutkow's and Lichtenstein's procedures, respectively. One of patients of the PHS group, five of the Rutkow's and none of those undergoing Lichtenstein's repair needed mild intraoperative sedation. Mild postoperative pain was recorded in 5% of the patients undergoing PHS repair and 10% undergoing Rutkow's repair. No intraoperative complications, difference in compliance and performance status were detected in the three groups.

CONCLUSIONS

The conclusion is drawn that the PHS, Rutkow's and Lichtenstein's procedures for inguinal hernia repair are safe (no complications), effective and well accepted by the patients (85% of the patients expressed a very good judgement) although the Rutkow's repair seems more invasive. The appearance of a better trend, in patient's compliance and performance status when operated with the PHS technique, need to be confirmed in the future but, if it will be, this could became our first choice technique of repair for the medium and large hernia defect.

Correlation between serum levels of 17 beta-estradiol, progesterone and beta-human chorionic gonadotropin and the karyotype of first trimester anembryonic and embryonic pregnancies

We aimed at establishing the correlation between karyotype of anembryonic and embryonic first trimester pregnancies and serum levels of beta-hCG, 17beta-estradiol and progesterone. Chromosomal analyses were performed on products of conceptions lower than 12 weeks, using standard-banding protocols. Measurements of 17beta-estradiol and progesterone were carried out by immunoenzymatic assays and beta-hCG by radioimmunoanalysis (RIA). Chromosomal analyses among 11 spontaneous abortions revealed 6 (54,5%) to be normal and 5 (45,5%) abnormal; of these latter, 4 were anembryonic pregnancies (44,4% total frequency). Serum beta hCG and beta-estradiol average levels were lower in the anembryonic pregnancies but did not reveal significant differences with normal levels. Hormonal levels were correlated with karyotype results and it was found that average beta-hCG value was 3.8 times higher in cases with abnormal karyotype than in those in whom it was normal (p <0.05). Linear correlation analyses between hormonal measurements in anembryonic pregnancies were statistically significant (p <0.05). Correlations between beta-hCG and progesterone, beta-hCG and 17-beta estradiol, and the latter with progesterone, proved to be significant in the group with abnormal karyotype (p < 0.05). Anembryonic pregnancies present high frequency of chromosomal anomalies; such pregnancies with abnormal karyotype have a high serum level of beta-hCG; this condition increased the rate of abortion.

2'-O-[2-[N,N-(dialkyl)aminooxy]ethyl]-modified antisense oligonucleotides

[structure] Oligonucleotides with two novel modifications, 2'-O-¿2-[N, N-(dimethyl)aminooxy]ethyl¿ (2'-O-DMAOE) and 2'-O-¿2-[N, N-(diethyl)aminooxy]ethyl¿ (2'-O-DEAOE), have been synthesized. These modifications exhibit high binding affinity to target RNA (and not to DNA) and enhance the nuclease stability of oligonucleotides considerably with t(1/2) > 24 h as a phosphodiester.

[Short-stay surgery of inguino-crural hernia]

BACKGROUND

To evaluate the hospital stay, morbidity, and patients' compliance for short stay inguinal hernia repair.

METHODS

Retrospective analysis of 669 patients (594 men and 75 women) who underwent short stay inguinal hernia repair (706 inguinal and 45 femoral repairs) at the Institute of General Surgery, University of Ferrara. Mean age was 60.7 years (range, 18-84 years). The anesthesia was: loco-regional in 495 patients (74%) and general or epidural in 174 (26%).

RESULTS

Mean hospital stay was 1.2 days. Postoperative complications were: three scrotal hematomas, two ischemic orchitis, three prosthetic infections, one local anesthetic intolerance, and three high fever. Eighty-five percent of patients were satisfied of the surgical procedure in short hospital stay. Mean follow-up was 36 months.

CONCLUSIONS

Short hospital stay in inguinal hernia repair is safe, effective, and widely accepted by patients.

Association of HLA-DRB1*1602 and DRB1*1001 with Takayasu arteritis in Colombian mestizos as markers of Amerindian ancestry

We performed HLA Class I and Class II typing in 16 patients (15 women, one man) with a confirmed diagnosis of Takayasu arteritis. We did not find any of the previously described associations with HLA-B52, and/or HLA-DRB1*1301 alleles. However, in our patients, HLA-DRB1*1602 and HLA-DRB1*1001 were significantly increased. The association of Takayasu arteritis with Amerindian and Asian HLA-DRB1 alleles (DRB1*1602 and DRB1*1001) in the Colombian mestizo patients reported here, and with HLA-B*3906 previously reported in Mexicans, suggest the possibility that some HLA and disease associations are markers for ethnicity of a population carrying a disease gene which is present in an admixed population with the disease.

Lack of evidence of conserved lentiviral sequences in pigs with post weaning multisystemic wasting syndrome

In order to investigate the role of retroviruses in the recently described porcine postweaning multisystemic wasting syndrome (PMWS) serum and leukocytes were screened for reverse transcriptase (RT) activity, and tissues were examined for the presence of conserved lentiviral sequences using degenerate primers in a polymerase chain reaction (PCR). Serum and stimulated leukocytes from the blood and lymph nodes from pigs with PMWS, as well as from control pigs had RT activity that was detected by the sensitive Amp-RT assay. A 257-bp fragment was amplified from DNA from the blood and bone marrow of pigs with PMWS. This fragment was identical in size to conserved lentiviral sequences that were amplified from plasmids containing DNA from several lentiviruses. Cloning and sequencing of the fragment from affected pigs, however, did not reveal homology with the recognized lentiviruses. Together the results of these analyses suggest that the RT activity present in tissues from control and affected pigs is the result of endogenous retrovirus expression, and that a lentivirus is not a primary pathogen in PMWS.

Effects of vasoactive agents in healthy and diseased human saphenous veins

PURPOSE

Smooth muscle reactivity is one of the factors involved in the pathogenesis of varicose veins. We investigated the myotropic effects of the 3 main vasoconstrictor agents norepinephrine (NE), angiotensin II (Ang II), and endothelin-1 (ET-1) in isolated human saphenous veins.

METHODS

Human saphenous veins were collected from 23 patients with primary chronic venous insufficiency who underwent elective varicose vein resections and who were stratified into the following 3 groups: group 1, 7 patients in clinical class 2; group 2, 9 patients in clinical classes 3 and 4; and group 3, 7 patients in clinical classes 5 and 6. Moreover, 6 patients who underwent arterial bypass grafting procedures represented the control group. The tissues were suspended in organ baths that contained Krebs solution, and their mechanical responses were measured isometrically. The cumulative concentration-response curves to Ang II, NE, and ET-1 were performed at 90-minute intervals in each tissue.

RESULTS

In the control tissues, NE, Ang II, and ET-1 induced concentration-dependent contractions with apparent affinities (pEC50, the negative logarithm to base 10 of the molar concentration of the agonist, which produces the 50% of the maximal effect) and maximal effects (maximum effect, g of contraction) that were equal to 7.06 +/- 0.23, 8.53 +/- 0.34, 7.63 +/- 0.10, and 2.21 +/- 0.33, 1.65 +/- 0.31, 2.60 +/- 0.77, respectively. Two main findings were evident in comparison of varicose veins with control tissues. First, the maximum effect that was evoked by all of the stimulants was reduced progressively with the increasing severity of the disease, which raised the third group to statistical significance for both NE and Ang II (P <.05). Second, a marked reduction of Ang II apparent affinity was already evident in tissues that were taken from patients in an early stage of the disease (P <.05).

CONCLUSION

The demonstration of a significant reduction in Ang II and NE contractile activities and the important reduction of that of ET-1 in the diseased veins as compared with the control tissues extends the previous observations regarding the impairment of smooth muscle contractility in primary chronic venous insufficiency. Moreover, the dramatic reduction of Ang II affinity, which appears in an early stage of the disease, supports the hypothesis that such abnormality within the venous wall could play a role in the pathogenesis of primary varicose vein disease.

Saphenous vein sparing surgery: principles, techniques and results

OBJECTIVE

Evaluation of saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion, in terms of effectiveness and suitability for eventual bypass surgery.

EXPERIMENTAL DESIGN

Prospective evaluation of 421 operations for primary varicose veins, 64 external valve-plasties of the sapheno-femoral junction (EV-SFJ), (42 performed using the hand sewing technique and 22 using the Veno-cuff device), mean follow-up 52 months, and 357 hemodynamic correction of varicose veins (French acronymis CHIVA), mean follow-up 49 months. Moreover, a subgroup of 27 patients was operated on using the CHIVA technique in two steps, mean follow-up 18 months.

SETTING

Institute of General Surgery, University of Ferrara. Institutional practice, one-day surgery.

PATIENTS

Patients were selected using clinical and duplex scanning evaluations, and classified according to CEAP criteria. Patients with varicose veins due to sapheno-femoral reflux with duplex scanning evidence of mobile valve leaflets underwent EV-SFJ. The other patients were operated on using the hemodynamic correction technique.

INTERVENTIONS

EV-SFJ restores valve function correcting vein wall dilatation by applying an external prosthesis. CHIVA consists of selected ligatures of the superficial veins that allow superficial blood aspiration in the deep veins through the perforators as well as the preservation of saphenous drainage.

MEASURES

The outcome was evaluated with independent clinical and ultrasonographic examinations; pre and postoperative AVP and LRR-RT measurements were assessed in 125 cases. Data from self-assessment of the functional and cosmetic result of the patients of the CHIVA group were also obtained using a scoring system. Moreover, scanning the preserved long saphenous vein the rate of long saphenous vein suitable as arterial conduit following sparing surgery was also evaluated.

RESULTS

Overall long saphenous vein patency registered after EV-SFJ and CHIVA was 94%. Varicose veins recurrence rate was 12% and 11%, respectively. Postoperative AVP and LRR-RT improvement was statistically significant (p<0.001).

CONCLUSIONS

These two alternative procedures seem to be effective in varices treatment following the proposed indications and techniques. In addition, they appear able to preserve a more significant rate of saphenous veins suitable for eventual bypass surgery than high ligation and multiple cosmetic avulsion.

The extent of early viral replication is a critical determinant of the natural history of simian immunodeficiency virus infection

Different patterns of viral replication correlate with the natural history of disease progression in humans and macaques infected with human immunodeficiency virus type 1 (HIV-1) and simian immunodeficiency virus (SIV), respectively. However, the viral and host factors influencing these patterns of viral replication in vivo are poorly understood. We intensively studied viral replication in macaques receiving identical inocula of SIV. Marked differences in viral replication patterns were apparent within the first week following inoculation, a time prior to the development of measurable specific immune effector responses to viral antigens. Plasma viral RNA levels measured on day 7 postinoculation correlated with levels measured in the postacute phase of infection. Differences in the susceptibility of host cells from different animals to in vitro SIV infection correlated with the permissiveness of the animals for early in vivo viral replication and hence with the postacute set point level of plasma viremia. These results suggest that host factors that exert their effects prior to full development of specific immune responses are critical in establishing the in vivo viral replication pattern and associated clinical course in subjects infected with SIV and, by extension, with HIV-1.

[Hernia surgery with short hospitalization]

The hospital stay of 55 patients, 47 males and 8 females, admitted to hospital for surgical repair of inguinal (53 procedures) and crural (4 procedures) hernias was analyzed. The mean age was 60.7 years (range from 25 to 82 years), local anesthesia was the method of choice (55 procedures), it has suppressed post-anesthetic respiratory and urinary troubles. The mean hospital stay was 1.18 days. One superficial skin hematoma and 1 wound infection were found, local anesthetic intolerance occurred in 1 case, and low fever in three cases. Over 90 percent of patients were favourable to short stay surgery for hernia repair at 30 days follow-up. The authors conclude on the feasibility, acceptability, social benefits and usefulness of short stay and day care surgery for hernia repair.

Alternative saphenous vein sparing surgery for future grafting

OBJECTIVE

Evaluation of long saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion, in terms of effectiveness and suitability for eventual by-pass surgery.

EXPERIMENTAL DESIGN

Prospective evaluation of 125 operations for primary varicose veins, 52 external valve-plasties of the sapheno-femoral junction (EV-SFJ) (42 performed using the hand sewing technique and 10 using the Veno-cuff device), mean follow-up 45 months, and 73 hemodynamic correction of varicose veins (French acronyms: CHIVA), mean follow-up 30 months.

SETTING

Department of General Surgery, University of Ferrara. Institutional practice, one-day surgery.

PATIENTS

Patients were selected using clinical, Doppler cw, and duplex scanning evaluations. Patients with early varices due to sapheno-femoral reflux with duplex scanning evidence of mobile valve leaflets underwent EV-SFJ. The other patients were operated on using the hemodynamic correction technique. Both groups underwent preoperative ambulatory venous pressure (AVP) and light reflection rheography-refilling time (LRR-RT) measurements.

INTERVENTIONS

EV-SFJ restores valve function correcting vein wall dilitation by applying an external prosthesis. CHIVA consists of selected ligatures of the superficial veins that allow superficial blood aspiration in the deep veins through the perforators.

MEASURES

The outcome was evaluated with clinical and ultrasonographic examinations, AVP and LRR-RT measurements.

RESULTS

Long saphenous vein patency registered after EV-SFJ and CHIVA was 94.2% and 90.4%, respectively. Both treatments preserve the drainage function in the saphenous system. Varicose veins recurrence percentage rate was 9.6% and 10.9%, respectively.

CONCLUSIONS

Following the proposed selection criteria, these two alternative procedures seem to be more effective in varices treatment than high ligation and have the advantage of preserving saphenous veins suitable for eventual by-pass surgery.

No correlation between peritubal and mucosal adhesions in hydrosalpinges

OBJECTIVE

To correlate the presence and extent of peritubal and mucosal adhesions in hydrosalpinges.

DESIGN

Comparative study.

SETTING

Tertiary centers with experience in tubal microsurgery.

PATIENTS

Infertile women with complete distal tubal block.

INTERVENTION

Salpingoneostomy.

MAIN OUTCOME MEASURE

Presence and extent of adhesions.

RESULTS

Peritubal adhesions occur more frequently than mucosal adhesions in hydrosalpinges. Of 7 hydrosalpinges without peritubal adhesions, 1 showed mucosal adhesions but of 83 hydrosalpinges with peritubal adhesions, 31 (37%) showed no mucosal adhesions.

CONCLUSION

Accurate endoscopic assessment of the ampullary mucosa is recommended in hydrosalpinx to select the appropriate patient for surgery.

When CHIVA treatment could be video guided

BACKGROUND

Hemodynamic correction (CHIVA) is a conservative, ambulatory, and controversial varicose vein treatment. It consists of selected ligatures of the superficial venous system decided by means of preoperative duplex mapping.

OBJECTIVE

Prospective evaluation of 80 patients, operated on according to the CHIVA technique described by Claude Franceschi. Mean follow-up length was 30 months.

METHODS

Fifty-five consecutive patients were operated on after clinical, ultrasonographic, ambulatory venous pressure and light reflection rheography evaluations. After a 3-year follow-up, another 25 consecutive patients were selected applying some exclusion criteria that emerged in the first part of the study. This second series was operated on by means of intraoperative angioscopy. The same preoperative evaluations have been used to study the outcome in all patients.

RESULTS

CHIVA failed in the short saphenous vein territory varices and when the long saphenous vein and the insufficient perforating veins had a preoperative diameter greater than 10 and 4 mm, respectively. The procedure showed a long saphenous vein patency of 90.4% and registered a total recurrence rate of 18.7%.

CONCLUSIONS

CHIVA seems to be a more effective varicose vein treatment than high ligation and distal stab avulsion. It also preserves a higher rate of long saphenous veins, suitable for bypass surgery.

[Laparoscopic treatment of Mirizzi's syndrome]

The Mirizzi syndrome is an unusual benign obstructive jaundice due to extrinsic mechanical compression of the common hepatic duct by gallstone impacted within the neck or cystic duct of the gallbladder. This syndrome is described either as an acute form due only to extrinsic compression of the common bile duct (type I) or as a chronic form resulting in an erosive cholecysto-choledochal fistula (type II). Up to date, the syndrome remains a clinically and surgically challenging problem. The anatomic basic of the syndrome (an anomalous relationship between the cystic duct and the common hepatic duct) when associated with inflammation and interbiliary fistula predisposes to a critical situation to be clearly detected and contributes to technical difficulties when surgical management is performed. The operative diagnosis of Mirizzi syndrome remains elusive and requires careful scrutiny of the biliary tract imaging to recognize the diseased duct system and to facilitate the following operative procedures. The surgical treatment requires a skill and careful operative dissection of the duct system, cholecystectomy and a safe biliary exploration and stone clearance, avoiding any iatrogenic damage to common hepatic duct. Laparotomy is commonly advocated as the safer approach to the diseased biliary tract and it is still employed by most authors. The laparoscopic surgery has not yet entered as the first-choice procedure for this syndrome due to jaundice and acute inflammation considered by some as contraindication to mini-invasive treatment. This paper describes successful surgical management by laparoscopic techniques in two patients affected by Mirizzi type I and type II syndrome treated by cholecystectomy alone and cholecystectomy with choledochal fistula flap repair, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of PGE1 in severe ischemia of the lower extremities. Clinical study]

Lower limb critical ischemia is a clinical condition typical of patients with severe chronic obstructive arterial disease (Fontaine's IIIb and IV degree). This condition often leads to amputation of the limb involved. The authors present to the use PGE1 in 50 patients with Fontaine's IIIb-IV degree chronic obstructive arterial disease of lower limbs in which the indication of amputation was done. All the patients, admitted to the emergency ward, complain of rest pain and distal ulcers. The administration of PG5(1) was given as follows: 40 mg/bid/e.v./20 days. A 6 months long follow-up was installed with the instrumental evaluation of: Transcutaneous oxygen pressure; Distal blood perfusion with Doppler; cardiac pulse; blood pressure. Eighteen patients became to a Fontaine's II degree during the next 2 months after therapy, 25 patients came back to a severe claudicatio: of them 18 underwent successfully vascular surgery, 7 underwent amputation of the lower limb. In 7 patients the PGE1 did not influence the natural progression of the disease. Among the side-effects of therapy we can mention: headache (4%), erythema and pain of injected vein (8%), sick (4%). All the side effects were transient and never led to interruption of therapy.

[Video-assisted venous surgery]

The use of intraoperative angioscopy, till now utilized exclusively in arterial surgery, is now used also in venous surgery. From January 1992 54 patients underwent to video-guided venous surgery: 23 cases of external valvuloplasty of the sapheno-femoral junction (EV-SFJ), 25 cases of hemodynamic correction of varicose veins (French acronyms CHIVA), 5 cases of high ligation plus long saphenous vein intraoperative sclerotherapy (HL-IS) 1 case of sub-fascial perforators interruption (SPI), the only extraluminal videoguided procedure. We have used 3 different video-angioscopes: a 1 mm monofibroscopy let in a 6 Fr Fogarty catheter, a disposable 2,8 mm colangioscope and a 2,2 mm operative angioscope. For the perforators interruption we have utilised the thoracoscope. EV-SFJ: the angioscopy has confirmed the presence of normal valvular cusps in a dilated vein wall in 21 cases, so excluding 2 patients from the planned treatment. At the end of the operation the angioscope has verified the reapproach of valvular cusps. CHIVA: the angioscopy has allowed to identify the exact points of the superficial venous system which should be interrupted, according to the Franceschi's theory. This procedure can avoid the technical errors due to intraoperatory misleadings of the duplex mapping. HL-IS: consists of a classic high ligation followed by long saphenous vein intraoperative sclerotherapy. The angioscopy has allowed a complete deconnection of the long saphenous vein from tributaries and perforators. Furthermore has facilitate the proportional distribution of the sclerosing agent along the long saphenous vein. SPI: the videoassistance have permitted the identification of the insufficient perforating veins reducing their surgical exposures.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective study of tubal mucosal lesions and fertility in hydrosalpinges

The relationship of abnormalities of the Fallopian tubes in patients with tubal infertility due to hydrosalpinges and fertility outcome after salpingoneostomy was studied in a prospective multicentric project. Hydrosalpinges of infertile patients were evaluated macroscopically and microscopically at the time of salpingoneostomy and the results were analysed with regard to the fertility outcome. Peritubal adhesions, the diameter and the quality of the mucosa were scored at the time of surgery and biopsies from representative areas were evaluated by scanning electron and light microscopy in 50 patients with bilateral hydrosalpinges or a hydrosalpinx of a single tube. Analysis of the different factors for fertility outcome was performed using the Cox proportional hazards model. No intrauterine pregnancy occurred in the thick-walled hydrosalpinges group (n = 13). In the thin-walled hydrosalpinx group (n = 37), 15 intrauterine and two tubal pregnancies occurred. The aspect of the mucosa as evaluated by an operating microscope was the most important factor in determining the fertility outcome; > 50% abnormal mucosa was associated with an intrauterine pregnancy rate of 7% which increased significantly to 50 and 69% when the mucosa was > 50 and 75% normal respectively. The pregnancy rate was not influenced by the presence or extent of peritubal adhesions but small sized (< 1 cm) hydrosalpinx had a better prognosis than medium (1-2 cm) and large sized (> 2 cm) hydrosalpinx. When mucosal adhesions were present (n = 19), the intrauterine pregnancy rate was 22% which increased significantly to 58% when adhesions were absent (n = 18). Both tubal pregnancies occurred in tubes with mucosal adhesions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intimal hyperplasia following vascular procedure. An unresolved problem]

Many pathophysiological mechanisms have been postulated for the development of intimal hyperplasia following arterial reconstructions that can lead to restenosis. The central theme appears to be injury to the endothelial cell. A number of pharmacological therapies have been proposed for the control of intimal hyperplasia, but at the current time this is managed by surgical reconstruction. Modification of the hyperplastic response by the newer pharmacological therapies requires further experimental and clinical studies. The definition of specific factors responsible for particular cellular events in the injured artery will make the right pharmacological treatment possible.

[Deep venous thrombosis and surgery. Assessment of the main risk factors]

Deep venous thrombosis is a quite frequent pathology with a high degree of morbidity and death-rate. Two are the main problems of this disease: the risk of pulmonary embolism and outcome of a post-thrombotic syndrome, leading patients to infirmity. The patients max exposed to the risk of deep venous thrombosis are the surgical ones: the authors, with a retrospective study on 480 surgical patients, examine the risk factors mostly related with the onset of deep venous thrombosis. At the end they refer about connection between the risk factors studied and the clinical display of in surgical patients.

[Video-laparoscopic splenectomy: experience in 3 cases]

BACKGROUND

In selected cases the spleen can be removed:

METHODS

2 women and 1 men with immune thrombocytopenic purpura, with hypersplenism without splenomegaly, underwent splenectomy by laparoscopic means.

RESULTS

In 2 cases the splenectomy has been performed entirely by laparoscopic means. In 1 case the operation has been converted as we have not been able to control a venous bleeding from injured hilar spleen vessels.

DISCUSSION

No particular technical problems arose in the 2 cases entirely conducted by laparoscopic means. Care must be taken manipulating the hilar vessels as the veins are fragile and their bleeding is difficult to be controlled in laparoscopy. The laparoscopic splenectomy seems to offer less postoperative pain, shorter hospitalization and improved cosmesis according to our previous experience with open splenectomy.

CONCLUSIONS

The good result of the operations encourages the laparoscopic approach to splenectomy, in selected cases.

[Iatrogenic lesions of cranial nerves during endarterectomy of the carotid artery]

Cranial nerve injuries may result from carotid endarterectomy. In a retrospective study of 222 surgical procedures, from July 1982 through June 1990 only three cranial nerve injuries were documented (1.35%). In a prospective study of 79 carotid endarterectomies performed from July 1990 through June 1992, there were 11 nerve injuries (13.9%), fortunately most of them were temporary. We conclude that carotid endarterectomy is associated with a much higher incidence of local nerve injury than retrospective surveys would indicate.

Tender points or tender patients? The value of the psychiatric in-depth interview for assessing and understanding psychopathological aspects of fibromyalgia

Although the aetiology of fibromyalgia is still unexplained, evidence favouring the role of psychopathology is accumulating, at least in a subgroup of patients; however, the exact aetiological significance of psychopathology in this syndrome is difficult to assess. Various assessment strategies have both strengths and weaknesses. Two case reports are presented which illustrate the value of the psychiatric in-depth interview (including psychodynamic-biographical history taking) for assessing and understanding psychological/psychiatric aspects of fibromyalgia.

[Acute ischemia of the upper limb. Clinical case and general considerations]

The authors report a case of acute inveterate right subclavian artery obstruction. The leading role of US vascular investigation and the surgical technique adopted are pointed out. The personal findings are compared with those from the international references.

Isolated true atherosclerotic aneurysms of the superficial femoral artery. Case report and literature review

Isolated true atherosclerotic aneurysms of the superficial femoral artery are rare. We report an original case of superficial femoral artery aneurysm (SFAA) not associated with dilatation of the common femoral or popliteal artery. The review of the literature emphasizes the great latency of the disease and the high incidence of complication at presentation, as well as, echosonographic diagnostical advantages over angiography. After surgical treatment the prognosis is favourable. Early recognition and surgical repair are recommended for patients with aneurysms of the superficial femoral artery greater at least twice the normal vessel size. Elective surgical treatment is associated with little risk to the patients and avoids the need for operation in the setting of limb-threatening ischemia.

Is there a relationship between reflex sympathetic dystrophy and helplessness? Case reports and a hypothesis

Five case reports that illustrate the possible contribution of psychological factors in the etiopathogenesis of reflex sympathetic dystrophy (RSD) are presented. All five patients at the time of physical trauma were confronted with a significant loss that either accidentally coincided with the trauma, or was related to the experience of the trauma itself. The patients' reaction to the loss was invariably characterized by helplessness. A biopsychosocial hypothesis which considers the possible role of psychophysiological and behavioral aspects of helplessness in the precipitation, maintenance, and/or enhancement of RSD is outlined.

[Duplex scanner diagnosis of complete extracranial carotid artery obstruction: possibilities and limitations]

The authors enhance the current importance of the hemodynamic evaluation of the vascular carotid territory by means of Doppler-CV although the great development of the "real time" ultra sonographic imaging. Combined US/Doppler-CV technique is really useful in differential diagnosis of the severe obstructive disease of extracranial carotid arteries. The authors report the possibilities of pitfalls in diagnosis due to the limitation of devices employed or to the frequent anatomical variability featured by examination of severe obstruction of vascular carotid territory.

Etiopathogenesis of reflex sympathetic dystrophy: a review and biopsychosocial hypothesis

Reflex sympathetic dystrophy (RSD) is an enigmatic condition. Many clinicians, however, believe that psychological factors could contribute to the onset and persistence of the syndrome. In this article we critically review the evidence from psychometric and psychodynamic/biographical studies that suggests a role for such factors. An etiopathogenetic hypothesis based on the authors' clinical experience and the foregoing literature also encompasses elements of stress-coping theory, cognitive-behavioral views on chronic pain, and the psychobiological approach to sympathetic nervous system dysfunction. Implications of this model for future psychological research and the therapeutic treatment of RSD are discussed.

[Myointimal hyperplasia caused by vascular suture. A case report and general considerations]

Smooth muscle cell proliferation is a step of the repair process after vascular injury. A similar process occurs after percutaneous transluminal angioplasty and can lead to intimal hyperplasia and vascular restenosis. We have recently observed this process in an anastomotic restenosis after saphenous vein by-pass in the popliteal artery. We suppose that myointimal hyperplasia can also be an aspecific response to surgical intimal injury.

[Takayasu disease in the genesis of cerebrovascular insufficiency. Description and considerations of a clinical case]

The authors in explaining their limited clinical experience relative to one single case, describe the peculiarity of Takayasu's disease and its rare incidence in western populations. The case under observation because of its peculiar rarity had been underestimated and treated in a completely inappropriate manner. Important instrument in its diagnosis is the High Resolution echography which in determining the diagnosis favors and speeds up the diagnostic therapeutic iter.

[Aneurysm of the abdominal aorta and stenosis caused by compression of the celiac tripod in a young woman with tuberous sclerosis and previous mesoblastic nephroma]

Tuberous sclerosis, first described by Bourneville in 1880, is a syndrome characterized essentially by mental deterioration, seizures and cutaneous sebaceous adenoma; an association with malformative lesions of the kidney and cardiovascular apparatus has been documented. Recently a case of a young woman with tuberous sclerosis has come to our observation; she was also affected by abdominal aortal aneurysm and stenosis due to compression of the truncus coeliacus; previously she operative elsewhere for right nephrectomy for breakage of nephric right arterial aneurysm: the histological examination of the removed kidney manifested the presence of a mesoblastic nephroma and afterward tuberous sclerosis was diagnosed. The angiomyolipomatosis evidence confirmed the suspicion of a notable inclination to polydistrict malformations in tuberous sclerosis.

[Visceral aneurysmal arterial pathology]

In this paper the Authors report their experience on diagnostic and surgical procedures with respect to aneurysms of the visceral district. The clinical review during the last ten years of surgical activity in the Istituto di Clinica Chirurgica (Università di Ferrara) regards 13 patients with different visceral aneurysms. The study reports the different percentage of localization, the diagnostic approach, the surgical procedure performed and discussion of results obtained. Patients at risk for this disease are pointed out.

[Subrenal coarctation of the aorta. Presentation of a clinical case]

Coarctation of abdominal aorta constitutes a rare group of vascular abnormalities, including segmental stenoses and extended hypoplasia below the restriction. Usually hypertension is the only clinical evidence. The natural history of the surgically untreated disease foresees a decline of life expectancy; while surgical operation permit an almost complete "restitutio ad integrum". The Authors report a case of coarctation of the abdominal aorta come to their observation whose particularly was determined by the absence of high blood pressure, the aortic stenoses being located under the renal arteries.