Effect of Recycling on the Mechanical Properties of 6000 Series Aluminum-Alloy Sheet

Sustainability is one of the biggest values of today and for the future of our society; a responsible usage of material in every sector is fundamental to achieving sustainability goals. Aluminum alloys are some of the most promising materials in terms of strength and weight, but their production implies the emission of a high amount of CO2. For that reason, the study and development of aluminum alloys with increasing scrap content play a central role in future applications. In the current study, two sheet-aluminum 6181 alloys with different scrap content were analyzed and compared with a 6181 alloy coming from primary production. The alloys were compared in terms of chemical composition, microstructure, tensile properties, and forming behaviors. The results showed that the alloys coming from secondary productions contained a higher amount of manganese, iron, and copper. The metallurgical and mechanical behaviors were very similar to those of the primary produced alloy. Nevertheless, a drop in formability was shown in the aluminum alloys containing a high scrap amount when stressed in a biaxial condition. The study demonstrated the viability of 6181 alloy production using a high scrap amount, highlighting the main difference with the same alloy coming from primary route production.

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Ultrasensitive Detection of Malachite Green Isothiocyanate Using Nanoporous Gold as SERS Substrate

In this article, a high-performance nanostructured substrate has been fabricated for the ultrasensitive detection of the organic pollutant, Malachite green isothiocyanate (MGITC), in aquatic systems via the Surface Enhanced Raman Spectroscopy (SERS) technique. The chemical dealloying approach has been used to synthesize a three-dimensional nanoporous gold substrate (NPG) consisting of pores and multigrained ligament structures along thickness. The formation of the framework in NPG-5h has been confirmed by SEM with an average ligament size of 65 nm at the narrower neck. Remarkable SERS performance has been achieved by utilizing the NPG-5h substrate for the detection of MGITC, showing a signal enhancement of 7.9 × 10⁹. The SERS substrate also demonstrated an impressively low-detection limit of 10^-16 M. The presence of numerous active sites, as well as plasmonic hotspots on the nanoporous surface, can be accredited to the signal amplification via the Localized Surface Plasmon Resonance (LSPR) phenomenon. As a result, SERS detection technology with the fabricated-NPG substrate not only proves to be a simple and effective approach for detecting malachite green but also provides a basis for in situ detection approach of toxic chemicals in aquatic ecosystems.

Electroless Cobalt Deposition on Dealloyed Nanoporous Gold Substrate: A Versatile Technique to Control Morphological and Magnetic Properties

The connection of multidisciplinary and versatile techniques capable of depositing and modeling thin films in multistep complex fabrication processes offers different perspectives and additional degrees of freedom in the realization of patterned magnetic materials whose peculiar physical properties meet the specific needs of several applications. In this work, a fast and cost-effective dealloying process is combined with a fast, low-cost, scalable electroless deposition technique to realize hybrid magnetic heterostructures. The gold nanoporous surface obtained by the dealloying of an Au₄₀Si₂₀Cu₂₈Ag₇Pd₅ ribbon is used as a nanostructured substrate for the electrodeposition of cobalt. In the first steps of the deposition, the Co atoms fill the gold pores and arrange themselves into a patterned thin film with harder magnetic properties; then they continue their growth into an upper layer with softer magnetic properties. The structural characterization of the hybrid magnetic heterostructures is performed using an X-ray diffraction technique and energy-dispersive X-ray spectroscopy, while the morphology of the samples as a function of the electrodeposition time is characterized by images taken in top and cross-section view using scanning electron microscopy. Then, the structural and morphologic features are correlated with the room-temperature magnetic properties deduced from an alternating-gradient magnetometer's measurements of the hysteresis loop and first order reversal curves.

Electrochemical Synthesis, Magnetic and Optical Characterisation of FePd Dense and Mesoporous Nanowires

Dense and mesoporous FePd nanowires (NWs) with 45 to 60 at.% Pd content were successfully fabricated by template- and micelle-assisted pulsed potentiostatic electrodeposition using nanoporous anodic alumina and polycarbonate templates of varying pore sizes. An FePd electrolyte was utilized for obtaining dense NWs while a block copolymer, P-123, was added to this electrolyte as the micelle-forming surfactant to produce mesoporous NWs. The structural and magnetic properties of the NWs were investigated by electron microscopy, X-ray diffraction, and vibrating sample magnetometry. The as-prepared NWs were single phase with a face-centered cubic structure exhibiting 3.1 µm to 7.1 µm of length. Mesoporous NWs revealed a core-shell structure where the porosity was only witnessed in the internal volume of the NW while the outer surface remained non-porous. Magnetic measurements revealed that the samples displayed a soft ferromagnetic behavior that depended on the shape anisotropy and the interwire dipolar interactions. The mesoporous core and dense shell structure of the NWs were seen to be slightly affecting the magnetic properties. Moreover, mesoporous NWs performed excellently as SERS substrates for the detection of 4,4'-bipyridine, showing a low detection limit of 10^-12 M. The signal enhancement can be attributed to the mesoporous morphology as well as the close proximity of the embedded NWs being conducive to localized surface plasmon resonance.

Rapid Fabrication of Fe and Pd Thin Films as SERS-Active Substrates via Dynamic Hydrogen Bubble Template Method

Fe and Pd thin film samples have been fabricated in a rapid fashion utilizing the versatile technique of dynamic hydrogen bubble template (DHBT) method via potentiostatic electrodeposition over a copper substrate. The morphology of the samples is dendritic, with the composition being directly proportional to the deposition time. All the samples have been tested as SERS substrates for the detection of Rhodamine 6G (R6G) dye. The samples perform very well, with the best performance shown by the Pd samples. The lowest detectable R6G concentration was found to be 10^-6 M (479 μgL^-1) by one of the Pd samples with the deposition time of 180 s. The highest enhancement of signals noticed in this sample can be attributed to its morphology, which is more nanostructured compared to other samples, which is extremely conducive to the phenomenon of localized surface plasmon resonance (LSPR). Overall, these samples are cheaper, easy to prepare with a rapid fabrication method, and show appreciable SERS performance.

Estimation of Nanoporous Au Young's Modulus from Serial Block Face-SEM 3D-Characterisation

Nanoporous Au has been subjected to serial block face-scanning electron microscopy (SBF-SEM) 3D-characterisation. Corresponding sections have been digitalized and used to evaluate the associated mechanical properties. Our investigation demonstrates that the sample is homogeneous and isotropic. The effective Young's modulus estimated by an analytical multiscale approach agrees remarkably well with the values stated in the literature.

Effect of the Substrate Crystallinity on Morphological and Magnetic Properties of Fe70Pd30 Nanoparticles Obtained by the Solid-State Dewetting

Advances in nanofabrication techniques are undoubtedly needed to obtain nanostructured magnetic materials with physical and chemical properties matching the pressing and relentless technological demands of sensors. Solid-state dewetting is known to be a low-cost and "top-down" nanofabrication technique able to induce a controlled morphological transformation of a continuous thin film into an ordered nanoparticle array. Here, magnetic Fe70Pd30 thin film with 30 nm thickness is deposited by the co-sputtering technique on a monocrystalline (MgO) or amorphous (Si3N4) substrate and, subsequently, annealed to promote the dewetting process. The different substrate properties are able to tune the activation thermal energy of the dewetting process, which can be tuned by depositing on substrates with different microstructures. In this way, it is possible to tailor the final morphology of FePd nanoparticles as observed by advanced microscopy techniques (SEM and AFM). The average size and height of the nanoparticles are in the ranges 150-300 nm and 150-200 nm, respectively. Moreover, the induced spatial confinement of magnetic materials in almost-spherical nanoparticles strongly affects the magnetic properties as observed by in-plane and out-of-plane hysteresis loops. Magnetization reversal in dewetted FePd nanoparticles is mainly characterized by a rotational mechanism leading to a slower approach to saturation and smaller value of the magnetic susceptibility than the as-deposited thin film.

Nanostructured Molybdenum Oxides from Aluminium-Based Intermetallic Compound: Synthesis and Application in Hydrogen Evolution Reaction

Characterized by a large surface area to volume ratio, nanostructured metal oxides possess unique chemical and physical properties with applications in electronics, catalysis, sensors, etc. In this study, Mo₃Al₈, an intermetallic compound, has been used as a precursor to obtain nanostructured molybdenum oxides. It was prepared into ribbons by arc-melting and melt-spinning techniques. Single and double-step free corrosion of the as-quenched material have been studied in 1 M KOH, 1 M HF and 1.25 M FeCl₃ at room temperature. In both cases, nanostructured molybdenum oxides were obtained on a surface layer a few microns thick. Two of the as-prepared samples were tested for their electrocatalytic capability for hydrogen evolution reaction (HER) in 0.5 M H₂SO₄ giving low onset potential (−50 mV, −45 mV), small Tafel slopes (92 mV dec⁻¹, 9 mV dec⁻¹) and high exchange current densities (0.08 mA cm⁻², 0.35 mA cm⁻² respectively). The proposed nanostructured molybdenum oxides are cost-effective and sustainable due to the cheap and abundant starting material used and the simple synthetic route, paving the way for their possible application as HER electrocatalysts.

A comparative study of the influence of the deposition technique (electrodeposition versus sputtering) on the properties of nanostructured Fe70Pd30 films

Sputtering and electrodeposition are among the most widespread techniques for metallic thin film deposition. Since these techniques operate under different principles, the resulting films typically show different microstructures even when the chemical composition is kept fixed. In this work, films of Fe₇₀Pd₃₀ were produced in a thickness range between 30 and 600 nm, using both electrodeposition and sputtering. The electrodeposited films were deposited under potentiostatic regime from an ammonia sulfosalicylic acid-based aqueous solution. Meanwhile, the sputtered films were deposited from a composite target in radio frequency regime. Both approaches were proven to yield high quality and homogenous films. However, their crystallographic structure was different. Although all films were polycrystalline and Fe and Pd formed a solid solution with a body-centered cubic structure, a palladium hydride phase was additionally detected in the electrodeposited films. The occurrence of this phase induced internal stress in the films, thereby influencing their magnetic properties. In particular, the thickest electrodeposited Fe₇₀Pd₃₀ films showed out-of-plane magnetic anisotropy, whereas the magnetization easy axis lied in the film plane for all the sputtered films. The domain pattern of the electrodeposited films was investigated by magnetic force microscopy. Finally, nanoindentation studies highlighted the high quality of both the sputtered and electrodeposited films, the former exhibiting higher reduced Young's modulus and Berkovich hardness values.

Structural and Magnetic Properties of FePd Thin Film Synthesized by Electrodeposition Method

Bimetallic nanomaterials in the form of thin film constituted by magnetic and noble elements show promising properties in different application fields such as catalysts and magnetic driven applications. In order to tailor the chemical and physical properties of these alloys to meet the applications requirements, it is of great importance scientific interest to study the interplay between properties and morphology, surface properties, microstructure, spatial confinement and magnetic features. In this manuscript, FePd thin films are prepared by electrodeposition which is a versatile and widely used technique. Compositional, morphological, surface and magnetic properties are described as a function of deposition time (i.e., film thickness). Chemical etching in hydrochloric acid was used to enhance the surface roughness and help decoupling crystalline grains with direct consequences on to the magnetic properties. X-ray diffraction, SEM/AFM images, contact angle and magnetic measurements have been carried out with the aim of providing a comprehensive characterisation of the fundamental properties of these bimetallic thin films.

Traumatic atlanto-axial rotatory subluxation after surgical correction of prominent ears: Case report and review of the literature

Corrective surgery of prominent ears may be justified for social or aesthetic reasons during childhood or adulthood. Post-operative complications occur in approximately 0 to 8.4% of cases. This case describes a rare atlanto-axoid rotatory subluxation after bilateral surgical correction of prominent ears under general anesthesia. Orthopedic treatment was done after two months of medical roaming outside of our center. The one-year post-operative clinic consultation and radiological exam were normal. Only the psychological impact of the episode remained. Traumatic atlanto-axial rotatory subluxation is a rare complication but should be considered after post-operative torticollis in order to aid with diagnosis and allow doctors to implement the appropriate course of treatment.

Effect of carrier tunneling on the structure of Si nanowires fabricated by metal assisted etching

The metal assisted etching mechanism for Si nanowire fabrication, triggered by doping type and level and coupled with choice of metal catalyst, is still very poorly understood. We explain the different etching rates and porosities of wires we observe based on extensive experimental data, using a new empirical model we have developed. We establish as a key parameter, the tunneling through the space charge region (SCR) which is the result of the reduction of the SCR width by level of the Si wafer doping in the presence of the opposite biases of the p- and n-type wafers. This improved understanding should permit the fabrication of high quality wires with predesigned structural characteristics, which hitherto has not been possible.

Magnetization reversal and microstructure in polycrystalline Fe50Pd50 dot arrays by self-assembling of polystyrene nanospheres

Nanoscale magnetic materials are the basis of emerging technologies to develop novel magnetoelectronic devices. Self-assembly of polystyrene nanospheres is here used to generate 2D hexagonal dot arrays on Fe50Pd50 thin films. This simple technique allows a wide-area patterning of a magnetic thin film. The role of disorder on functional magnetic properties with respect to conventional lithographic techniques is studied. Structural and magnetic characteristics have been investigated in arrays having different geometry (i.e. dot diameters, inter-dot distances and thickness). The interplay among microstructure and magnetization reversal is discussed. Magnetic measurements reveal a vortex domain configuration in all as-prepared films. The original domain structure changes drastically upon thermal annealing performed to promote the transformation of disordered A1 phase into the ordered, tetragonal L10 phase. First-order reversal magnetization curves have been measured to rule out the role of magnetic interaction among crystalline phases characterized by different magnetic coercivity.

[Pathomimia and plastic surgery, a case report]

Pathomimia is defined as a dummy pathology self-induced deliberately and is neither associated with mental confusion nor disturbance of consciousness. This article reports a case of pathomimia in plastic surgery. One of our patients had intentionally injected physiological saline solution into her breast implants in order to increase their volume. Implants removal was necessary because of severe local inflammatory signs. Psychiatric assessment revealed body dysmorphic disorder (BDD) developed on an hysterical personality, which explained the self-induced injuries. This nosologic entity must be promptly identified because it's diagnosis remains problematic and a multidisciplinary medical management is essential.

[Hereditary neuropathy with liability to pressure palsy (HNPP): a diagnostic trap]

The authors report two clinical cases of a rarely observed pathology in orthopedic surgery daily practice: hereditary neuropathy with liability to pressure palsy (HNPP), which leads to dysesthesiae, hypoesthesiae and regressive palsies. Onset, clinical signs and electromyographic abnormalities are described. Forensic consequences can occur in early postoperative period. Knowledge of this familial pathology allows precautionary measures at surgery and avoids unnecessary surgical revisions.

Radiation dose in cardiac CT angiography: protocols and image quality

This paper aims to evaluate the radiation dose exposure of patients submitted to cardiac computed tomography angiography. The effective dose was obtained from the product of dose-length product values and the conversion factor established in the European Working Group for Guidelines on Quality Criteria in CT. The image noise and contrast- and signal-to-noise ratios were obtained for all images. Sixty-four- and 256-slice CT angiographies were used in 211 (68.5 %) and 97 (31.5 %) patients, respectively. The calculated mean effective dose with prospective CT angiography was 6.0±1.0 mSv and the retrospective mode was 8.4±1.2 mSv. The mean image noise values were 38.5±9.5 and 21.4 ± 5.3 for prospective and retrospective modes, respectively. It was observed that the image noise increased by 44.4 % using a prospective mode. Prospective CT angiography reduces radiation dose by ∼29 % compared with the retrospective mode, while maintaining diagnostic image quality and the ability to assess obstructions in patients.

Operative files of legal medical emergency in Calabria: study team

In Calabria, a study team form legal medicine emergency (LME) formed to initiate a Crisis Unit (CU) able to manage and deal LME with complicated operations and roles, people and technical aspects involvement. First steps are planning, scene study and organization. Everything connecting the first and second emergency to have practicable application.

[Cornea donation consent by telephone]

BACKGROUND

The cornea donation process often runs into problems of obtaining family consent. A face-to-face interview is often not possible for logistical reasons. We carried out a prospective study on the effectiveness of telephone contact in obtaining donation consent.

MATERIAL AND METHODS

Consent was obtained by a single, non medical, hospital coordinator. He contacted families selected on good staff-family relations during the patient's stay. If a face-to-face interview was not possible, a telephone interview was conducted using a standardized procedure.

RESULTS

Over 21 months, 334 families were contacted, either in a face-to-face interview (142, 42.5%) or by telephone (192, 57.5%). Donation consent was obtained in 66.5% of cases, 106 times by telephone (47.7%) and 116 times in the face-to-face interview (52.3%). The acceptance rate was 55.2% by telephone and 81.6% face to face (p<0.001).

CONCLUSIONS

The telephone interview was an effective method for obtaining consent for cornea donation. Although the acceptance rate using this method is lower than the face-to-face interview, using the telephone should not be overlooked as this enabled procurement of nearly half the corneas in our hospital.

Cornea procurement from very old donors: post organ culture cornea outcome and recipient graft outcome

AIM

To study the suitability of corneas from very old donors for graft after banking and their clinical and endothelial outcomes in recipients.

METHODS

419 corneas stored in organ culture were divided into group 1, donors under 85 years (330 corneas) and group 2, "very old" donors aged 85 years and over (89 corneas). Endothelial cell density (ECD) before and after organ culture, discard rate before and after storage, and clinical and endothelial outcomes of the 196 penetrating keratoplasties (PKP) (158 in group 1 and 38 in group 2) were compared in a prospective longitudinal study.

RESULTS

Initial ECD was lower in group 2 than in group 1 and elimination for low ECD was more frequent in group 2 (respectively 38% v 20.2%, p=0.001). At the end of storage, because very old corneas lost fewer ECs than younger ones (respectively 4.2% v 9.5%, p=0.022), ECD was comparable between the two groups. The corneas of very old donors had a poorer macroscopic appearance at procurement and during surgery. Despite this, in grafted patients, overall graft survival in groups 1 and 2 (respectively 87.4% v 80.6%, p=0.197), visual acuity, and ECD did not differ at completion of the study (mean follow up 25 months).

CONCLUSION

This study suggests that endothelial cell count during banking ensures that functional and cellular results of PKPs are not dramatically influenced by very old donor age. Considering Europe's ageing population, the very elderly should not be deemed off limits for corneal procurement.

[Use of a pair of blood culture bottles for sterility testing of corneal organ culture media]

PURPOSE

To test the effectiveness and rapidity of a pair of blood culture bottles in the diagnosis of bacterial and fungal contamination of corneal organ culture media.

MATERIAL

and methods: Seven hundred and sixty one microbiological analysis of storage media (Inosol(R) and Exosol(R), Opsia, Toulouse, France), sampled in all phases of the organ culture at 31 degrees C of 410 consecutive corneas, were analyzed. Each medium was inoculated in a pair of Bactec Plus Aerobic/F(R) and Bactec Lytic/10 Anaerobic/F(R) blood bottles (Becton Dickinson, Cockeysville, MD) and placed in a Bactec 9240 incubator for 14 days at 37 degrees C and in a Sabouraud broth at 20 degrees C. Changes in color or turbidity of storage media were evaluated daily at the corneal bank. Recipients were screened after graft for signs of infection.

RESULTS

The overall contamination rate was 2.4% (18/761). Contamination was detected in less than 1 day in 78% (14/18) and in less than 2 days in 94% (17/18). Positivity of the microbiological controls of starting media preceded medium color changes in 10 out of 14 cases. Bactec blood bottles allowed detection of bacteria as well as Candida sp. yeasts.

DISCUSSION

The use of a pair of aerobic and anaerobic blood culture bottles is a simple, effective and rapid method for the diagnosis of a wide range of microbiological contaminations of organ-cultured corneas during banking.

CONCLUSION

The validation of this protocol will require a prospective study to compare it with the conventional microbiological method.

[Corneal harvesting from donors over 85 years of age: cornea outcome after banking and grafting]

PURPOSE

To study the suitability of corneas from very old donors for graft after organ culture and their clinical and endothelial outcomes in recipients after perforating keratoplasty.

METHODS

We stored 419 corneas at 31 degrees C for 13.1 +/- 4 days (mean +/- SD) and then divided them according to donor age: group 1, donors under 85 years of age (n=3 3 0, 79%, 16-84 years old), and group 2, donors over the age of 85 (n=8 9, 21%, 85-100 years old). Endothelial density at the time of harvest and before and after organ culture, rates of suitability for grafting, and clinical and endothelial outcomes of the 196 keratoplasty procedures were compared in a prospective longitudinal study of the 2 groups, with a mean follow-up of 25 months. The corneas were grafted with no pre-established policy on matching with the age of the receiver. Statistical analysis was carried out on SPSS 10.0: Chi(2), Student t test, and Kaplan Meier survival curves.

RESULTS

The average age of the donors was 72.1 +/- 16.7 years. The macroscopic aspect of the corneas was judged to be of slightly lower quality in group 2. No statistically significant difference was found in overall suitability for transplantation (group 1, 45% vs group 2, 54%, p=0.17) but elimination for low endothelial density was more frequent in group 2 (67% vs 39%, p=0.001). Cell density at the beginning of organ culture was lower in very old corneas than in younger corneas (respectively, 2116 +/- 368 vs 2 311 +/- 360 cell/mm(2), p=0.002) but no difference was apparent at the end of organ culture (respectively, 2 011 +/- 285 vs 2 090 +/- 296, p=0.12) because very old corneas lost fewer cells than younger ones (respectively, 5.6% vs 10.0%, p=0.001). There was no correlation between donor/receiver age (r=0. 337) but group 1 corneas were slightly more frequently allotted to receivers with normal endothelium (p=0.019). During surgery, the two groups did not differ in terms of the macroscopic aspect of the grafts. In the 196 grafted patients, and without age-matching, overall graft survival (86% vs 79%, p=0.275), visual acuity, and endothelial density (1 194 +/- 469 vs 1098 +/- 545 cells/mm(2), p=0.387) did not differ at the completion of the study.

DISCUSSION

The corneas from very old donors were macroscopically of poorer quality and had a lower cellular endothelial density at harvesting, but these differences disappeared after organ culture because of greater cell loss in corneas from younger donors. Selection by organ culture ensures that functional, anatomical, and cellular results are not influenced by very old donor age.

CONCLUSION

Considering the aging population in countries with a high standard of living, the techniques available for selecting corneas based on endothelial quality, and the increasing need for corneal grafts, the very old age should not be deemed off-limits for corneal harvesting.

In vivo cytogenetic studies of the genotoxic effects of polymethyl methacrylate employed in orthopaedics

Polymethyl methacrylate (PMMA) is a material employed as a cement in prosthesis that has been found to induce cytogenetic damage in human lymphocytes in vitro. This effect is particularly achieved before the 5th day of the exposition, while after this period no significant variations appeared. In the present study, results of cytogenetic tests in humans are reported. Sister chromatid exchange analysis and micronucleus tests have been performed on lymphocytes of patients who had undergone prosthesization with cemented prosthesis (group A) or with biological anchorage prosthesis, as control (group B). DNA damage was investigated before implantation and 5 d after surgery in both groups. Cytogenetic tests did not show any significant increase in the number of micronuclei and sister chromatid exchanges with respect to control values in patients with PMMA cemented prosthesis.

Therapy for hepatocellular-carcinoma (review)

Hepatocellular carcinoma remains one of the commonest malignant tumours in the world. It usually arises on a background of hepatic cirrhosis which limits the possibility of resection or transplantation. The literature contains few good randomised trials of therapy for this common tumour. This review discusses the role of surgery and liver transplantation together with recent developments in medical therapy, namely chemoembolisation, percutaneous ethanol injection and hormonal treatment, and arrives at a consensus as to the place of these treatments in the current management of hepatoma.

Epirubicin in hepatocellular carcinoma: pharmacokinetics and clinical activity

The pharmacokinetics and clinical activity of epirubicin were investigated in 16 patients with hepatocellular carcinoma (HCC) who received epirubicin at 75 mg/m2; the drug was given intravenously to 7 patients and via the hepatic artery to 9 patients (7 of whom also underwent embolisation). Lignocaine (1 mg/kg) was also given intravenously to 15 patients, and the metabolite monoethylglycinexylidide (MEGX) was measured as an indicator of liver function. Epirubicin clearance correlated with serum aspartate aminotransferase (AST), albumin and bilirubin values in patients treated intravenously or intraarterially. Although the route of administration did not affect the median total plasma clearance of epirubicin, early- and intermediate-phase clearance was higher following intraarterial administration. MEGX levels correlated with serum bilirubin levels but there was no correlation with albumin or AST values or epirubicin clearance. The rate of response to epirubicin was 3/13 (23%; 95% confidence interval, 8%-50%). Intravenous epirubicin was tolerated well, but intraarterial treatment was associated with significant morbidity. These data confirm that although current recommended dose adjustments are based primarily on serum bilirubin levels, altered epirubicin pharmacokinetics correlate more strongly with AST and albumin values than with serum bilirubin concentrations. However, at this dose and schedule, epirubicin has only modest activity against HCC.

Factors in the development of a liver transplantation programme: experience of 100 consecutive transplantations in Milan's Niguarda Hospital

From December 1985 to December 1990, 100 liver orthotopic transplantations (OLTX) were performed in 89 adults with cirrhosis and various other liver diseases; eight patients had two transplants and three of these had three transplants. Organ perfusion was done with Eurocollins in the first 30, then with UW solution. Immunosuppressants were a combination of cyclosporin A and steroids for the first 30 patients, and then a combination of antilymphocyte globulin, azathioprine, methylprednisolone and cyclosporin A. The OLTXs were examined as a whole and also divided into two groups, one for 1985-88 and one for 1989-90. The cumulative survival was 63% after 12 months, 40% after 36 and 42 months. It was poor for the patients who received transplants between 1985 and 1988, but for the second group, survival was improved to 78% after 12 and 18 months. For neoplastic patients, overall survival was 49% after 18 months and 23% after 36 and 42 months. In the second group it was markedly better (83% after 18 months). The recurrence rate for patients surviving more than three months was 17% for hepatocellular carcinoma and 50% for cholangiocarcinoma. Five patients (38%) out of 13 HBsAg-positives before the transplant and surviving more than three months had recurrent hepatitis-B virus. The remaining eight patients are HBsAg negative at present. The improved actuarial survival for the second group is accounted for by the better surgical and intensive care given now and the methodological differences.

Eradication of esophageal varices by endoscopic sclerotherapy: how much is enough?

To clarify if complete eradication of varices from the lower esophagus by endoscopic sclerotherapy is really essential to prevent rebleeding, or if reduction of varices below a certain size can be considered a sufficient result, we compared the fate of 72 patients in whom sclerotherapy was stopped after one of the following endoscopic endpoints was reached: complete eradication (15 patients, group 1), partial eradication with residual small white varices (32 patients, group 2), and partial eradication with residual small blue varices (25 patients, group 3). The incidence of variceal recurrences and recurrent bleeding over a median follow-up of 17 months after stopping sclerotherapy did not differ significantly in the three groups. Analysis of the time course of variceal recurrences showed that the recurrence-free interval was almost identical in group 1 and group 2 patients (13 and 14 months, respectively). Group 3 patients had a shorter recurrence-free interval (8.3 months), but the difference was not statistically significant. We conclude that sclerotherapy can be stopped safely when either complete eradication or reduction of varices to small white columns is obtained.

A case-referent study investigating the relationship between exposure to silica dust and lung cancer

A case-referent study was carried out to investigate the relationship between lung cancer and exposure to silica dust in an area where a relatively high proportion of the workforce was exposed to silica dust in the past. The cases were 309 lung cancer patients admitted at the Chest Department of the Central Belluno Hospital during the period 1973-1980, while the 309 controls were patients admitted at the same department for diseases other than lung cancer and bronchitis during the same period. Information on exposure to silica and smoking habits were collected from hospital records. The results show an elevated risk, supported by a clear dose-response, due to smoking. Exposure to silica also appears to increase the risk of lung cancer, but only in presence of silicosis. The risk estimates tend to increase both with amount of smoking and duration of exposure to silica, with the magnitude of the risk being, however, much smaller for the latter effect. No clear interaction appears to exist between the two factors. The limitations of the study and the problems in interpreting the results are discussed.