Rehabilitation protocol after simultaneous anterior cruciate ligament reconstruction and high tibial osteotomy: introducing the concept of the individualized approach

Postoperative rehabilitation after simultaneous anterior cruciate ligament reconstruction and opening wedge high tibial osteotomy is a complex concept. Different osteotomy techniques, extremely selected patients, high expectations in returning to previous sport activities, and the different individual physical profile and performances make traditional chronological criteria impractical and unfeasible. This study presents a novel rehabilitation in which functional objective criteria are considered the key factors for standardizing a 4-step protocol. Each step is "individualized", based on the patient's response to the healing processes and to the different training phases, allowing for a safe return to sports competitions. This definitively implies a strict collaboration between patient, surgeon, physician and physiotherapists, as well as thorough and detailed patient education. Due to the high versatility of these new rehabilitation concepts, the application of the "individualized" steps described in this study may be broadened to include different sports medicine knee injuries that may benefit from a specific, detailed and carefully patient-centered rehabilitation project.

Comparing different approaches in robotic-assisted surgery for unicompartmental knee arthroplasty: outcomes at a short-term follow-up of MAKO versus NAVIO system

The popularity of unicompartmental knee arthroplasty (UKA) continues to grow among orthopaedic surgeons and robotic surgery may be helpful in obtaining a precise placement of the prosthetic components, thanks to the meticulous intra-operative computer study for simulating the prosthetic positioning. This may lead to longer implant survivorship as well as a reduction in intermediate and long-term prosthetic complications, despite the initial greater costs than those of manual UKA. In this preliminary study, from January 2017 and October 2017, 18 patients underwent UKA with MAKO robotic system assistance and 10 patients received UKA with NAVIO robotic system assistance. The two groups were homogeneous by age, BMI, degree of osteoarthritis involvement, and postoperative program. Patients were followed both clinically (Numeric Rating Scale NRS and Knee Injury Osteoarthritis Outcome Scores KOOS) and radiographically. At the end term follow up (2 years), no significant difference was observed for NRS and KOOS as well as for clinical parameters as an active range of motion. A significant discrepancy was detected regarding the duration of the surgery and time of using the robotic system, that appeared to be longer in the NAVIO group than that of MAKO group, likely due to the specific technical aspects that characterize these two different robotic systems. The main finding of this study is that favorable clinical and radiographical results may be obtained using a robotic approach (MAKO or NAVIO) for UKA positioning at a short follow up. Due to the lack of significant clinical differences observed between the two groups of patients at end term follow up, the "concept" of a robotic approach, more than a specific patented system, may be considered the key element for improving UKA technique and it is likely that in the near future the choice of a single specific robotic system will still be a "surgeon's preference". The results of the study add scientific evidence regarding the effective improvement of UKA results using different robotic approaches. They also show possible economic sustainability of this therapeutic strategy related to the optimal patients' performance obtained at short term follow up, suggesting that the robotic assistance may really become a key element for better long-term survivorship of unicompartmental knee arthroplasty.

Proximate, fatty acids and metals in edible marine bivalves from Italian market: Beneficial and risk for consumers health

Seafood is recognized as a healthy food choice due to high contents of essential nutrients, including polyunsaturated fatty acids (PUFAs) of the n-3 family. However, seafood is often contaminated by toxic compounds, which have adverse effects on human health. The aim of this study was to provide information about the percentage of edible part, condition index and the benefit and risk for human consumers health associated to the consumption of eight bivalve species (Flexopecten glaber, Mimachlamys varia, Modiolus barbatus, Mytilus galloprovincialis, Ostrea edulis, Ruditapes philippinarum, Solen marginatus and Venus verrucosa) of high commercial value, purchased from Taranto local fish markets. High percentage of edibility and condition index were found in all analysed species. The relatively high protein content, low levels of lipid and high percentage of healthy n-3 PUFAs make M. varia, O. edulis, S. marginatus, M. galloprovincialis, M. barbatus more suitable for benefit to consumers. Provisional tolerable weekly intake and hazard index calculated on the basis of trace metals in edible tissues, indicated specific recommendations for a responsible daily consumption of shellfish. For the most part of studied species, the estimated balance between beneficial and risk for consumers recommend a daily portion (RDP) lesser of 60 g/person/day than M. galloprovincialis, O. edulis and R. philippinarum (≥60 g/person/day). Careful risk-benefit considerations should promote seafood consumption while minimizing exposure to toxic contaminants.

Effects of PCB-126 on aryl hydrocarbon receptor, ubiquitin and p53 expression levels in Sparus aurata

The aim of the present study is to determine if Ahr ligands as PCB-126, a dioxin-like, might contribute to inhibition of the tumor suppressor p53 by promoting its degradation through proteasome-ubiquitin system (UPS). The findings show, in the presence of PCB-126, a significant increase of p53 immunoreactivity in fish compared to the control. Subsequently, there is a decrease of p53 immunoreactivity at 24h which is maintained even at 72h. At the same time there is a slight decrease of ubiquitin immunoreactivity to 12h compared to the control and a marked decrease to 24 and 72h. The induction of ubiquitin expression is resulted very marked in the control and preserved at 12h. It's very important to underline as in our study we demonstrate a marked decrease of ubiquitin and p53 immunoreactivity at 24h and 72h. AHR activation, by ligands as PCB-126, increases p53 ubiquitation inhibiting its expression, in addition it decreases the free ubiquitin promoting disruption of Ub homeostasis; this is the first report that establishes a relationship between AhR, increases p53 ubiquitation, and reduction of free ubiquitin. Our result emphasize the need to deeply the role of this receptor in UPS regulation as potential therapeutic target for cancer treatment.

Exposure of sea bream (Sparus aurata) to toxic concentrations of benzo[a]pyrene: possible human health effect

Polycyclic aromatic hydrocarbons (PAHs) can accumulate in the food chain, due to their lipophilic properties. Fish can accumulate contaminants including PAHs and frequent consumption of such contaminated fish can pose risk to human health. The aim of this study was to clarify if acute exposure of sea bream (Sparus aurata, a fish species of great economic importance in the Atlantic and Mediterranean areas) to a PAH, benzo[a]pyrene (B[a]P), at a dose that can induce CYP1A and pathological changes in fish gills, liver and muscle, can induce accumulation in muscle. We investigated the cytotoxic effects (as changes in cell viability, DNA laddering and glutathione content) of in vitro exposure of human peripheral blood mononuclear cells (PBMCs) to organic extracts obtained from muscle of sea breams previously exposed via water to B[a]P (2mg/l, for 12, 24 and 72 h). At this level of exposure, B[a]P caused morphological changes, inflammatory response and CYP1A induction not only in sea bream gills and liver but also in muscle; furthermore, in fish muscle we observed a substantial B[a]P accumulation, which may be associated with the increased CYP1A activity in liver and especially in muscle. However, when PBMCs were exposed to organic extracts obtained from sea bream muscle contaminated with B[a]P, a toxic, although modest effect was revealed, consisting in a significant decrease in cell glutathione levels without alterations in cell viability and DNA laddering. This suggests that consumption of sea breams from B[a]P contaminated waters might represent a risk for human health.

Organization, achievement and results of a pelvis surgery center

INTRODUCTION

Pelvic fractures are not frequent, yet severe injuries, often associated to other lesions. Well defined diagnostic and therapeutic procedures are lacking, and their economical assessment is inadequate. The goal of this study is to propose the organization of a multidisciplinary center that can develop diagnosis, treatment, and follow up protocols.

MATERIALS AND METHODS

25 patients were treated from August 2008 to July 2010, 5 women and 20 men, average age 34.5 years. Twenty patients had acetabular fractures (8 posterior wall fractures, 2 anterior column fractures and 10 mixed fractures, Judet and Letournel). Five patients suffered from diastasis symphisis pubis (three patients with a CAP type I, and 2 with a CAP type II, Young-Burgess).

RESULTS

Average delay between trauma and operation was 15.6 days. Average hospital stay after surgery was 45 days. Five had excellent results, 15 were good, and 4 presented poor results. One patient deceased. Four patients underwent hip arthroplasty 1 year after surgery.

DISCUSSION

It was essential to identify the collaborating units. The center aims at a uniform and rapid treatment for patients with lesions which are treated differently depending on the department of hospitalization and on the surgeon's experience. The target is to avoid treatment delays, costs and complications. The DRG evaluation grants the highest value to pelvis surgery. This should be followed by dedicated structures that can become reference centers.

CONCLUSION

The results can be improved, but considering this is not well known context both clinically and economically, they can be seen positively.

Genistein aglycone improves skin repair in an incisional model of wound healing: a comparison with raloxifene and oestradiol in ovariectomized rats

BACKGROUND AND PURPOSE

Oestrogen loss at menopause is frequently related to poor wound healing. Genistein has been tested in anti-ageing cosmetic preparations with interesting results on skin health. Here, we investigated the effects of the genistein aglycones, given systemically, in an incisional model of wound healing, compared to systemic oestradiol and raloxifene.

EXPERIMENTAL APPROACH

Six months after ovariectomy (OVX), rats were randomly assigned to groups of 12 animals each and treated daily with genistein aglycone (1 and 10 mg kg(-1) s.c.), raloxifene hydrochloride (0.05 and 0.5 mg kg(-1) s.c.) or 17-alpha-ethinyl oestradiol (0.003 and 0.03 mg kg(-1) s.c.) for 12 weeks. Untreated OVX and sham OVX rats were used as controls. Then, 14 or 7 days before the end of the experiment, an incisional wound healing procedure was performed and skin specimens were collected to evaluate molecular, histological and functional measurements.

KEY RESULTS

Seven and fourteen days after wounding, samples from OVX rats showed a decrease in transforming growth factor-beta1, tissue transglutaminase 2 and vascular endothelial growth factor compared to samples from sham OVX rats. Oestradiol, raloxifene and genistein all significantly modified this decrease, but the lowest genistein dose exerted a greater effect than the other treatments. Moreover, the lowest dose of genistein was the most effective in improving skin healing and wound tensile strength.

CONCLUSIONS AND IMPLICATIONS

Genistein aglycone might be an alternative therapy for the management of skin wound healing.

Protective effects of IRFI-042 in monensin induced neurotoxicity in chicks

Monensin, a well known ionophore antibiotic, may cause severe damage in neuronal cells by altering Na+/K+-ATPase and Ca2+-ATPase. We investigated whether IRFI-042, a synthetic analogue of vitamin E, may block lipid peroxidation in neuronal cells and protect against monensin neurotoxicity in chicks. Monensin toxicity was induced in chicks by once-daily administration (150 mg/kg by oral gavages), for 8 days. Sham animals received a saline solution and were used as controls. All animals were randomized to receive either IRFI-042 (20 mg/kg) or its vehicle. Survival rate, brain lipid peroxidation, mRNA for neuronal and inducible nitric oxide synthases (nNOS and iNOS) and brain histological evaluations, including immunohistochemical expression of nNOS and iNOS were performed. Monensin administration decreased survival rate, induced behavioural changes, increased brain lipid peroxidation, reduced brain nNOS mRNA and immunostaining and enhanced iNOS mRNA and immunostaining in the brain in chicks. IRFI-042 significantly improved the survival rate and counteracted monensin-induced changes in chick brains. Our data suggest that monensin is responsible of neurotoxicity in chicks by inducing oxidative stress/lipid peroxidation and that IRFI-042 might represent a useful pharmacological approach to protect against the neuronal damage induced by this monovalent carboxylic ionophorous polyether antibiotic.

Organochlorine pesticides and PCBs in wild boars from Calabria (Italy)

At present, there are no specific studies on the evaluation of environmental toxicological risks in Calabria (south of Italy) and on the presence of contaminants in the fauna of this region. The aim of the present research was to investigate the levels of contamination by OC pesticides and PCBs in some organs and tissues of wild boars (utilized as 'biological indicator') from various areas of Calabria. Quantitative determinations of organochlorines were carried out using GC-ECD and confirmed with GC-MS in 154 samples from wild boars (heart, liver, lung, kidney, muscle tissue and spleen) during the hunting season from 2000 to 2002. The results indicate the low residual levels of DDE in 8 samples and DDT in 4 samples and PCBs residues (Aroclor 1232) below the detection limits were found. Therefore, these results show that the Calabria region is not at contamination risk from organochlorines and moreover is free from health problems for the consumer of boar meat.

Levels of "toxic" and "essential" metals in samples of bovine milk from various dairy farms in Calabria, Italy

The aim of this research was to evaluate the possible contamination by heavy metals of milk from cows bred on various farms in Calabria. The concentrations of heavy metals were determined in 40 samples of bovine milk from the various dairy farms. Each sample, homogenized and powdered, was mineralized in a microwave oven. Quantitative analyses of Cd, Cr, Cu, Pb and Se were performed using an atomic absorption spectrophotometer with graphite furnace; As was analyzed by hot vapor generation technique and Zn with the flame method. As regards toxic heavy metals, highest values are those of As (g.m. 37.90 microg/kg w.w.) and Pb (g.m. 1.32 microg/kg w.w.), while lowest concentrations are those of Cd (g.m. 0.02 microg/kg w.w). With regard to essential metals, Zn (g.m. 2016 microg/kg w.w) and Se (g.m. 13.24 microg/kg w.w.) showed the highest concentrations, followed by Cr (g.m. 2.03 microg/kg w.w.) and Cu (g.m. 1.98 microg/kg w.w.). Further investigations of the levels of heavy metals (As) in a greater number of milk samples from various zones of Calabria are necessary, both to examine this problem from the clinical epidemiological point of view and to identify the possible causes of milk contamination.

Effects of monensin on Na+/K(+)-ATPase and Ca(++)-AtPase activities in chick skeletal muscle and myocardium after subacute treatment

Chicks were treated at 2 weeks of age with 4,15, 40, 100 and 150 mg/kg of monensin, an ionophore used for its anticoccidial and growth-promoting properties. In the present immunohistochemical study, the expressions and distribution of Na+/K(+)-ATPase and Ca(++)-ATPase were studied in myocardium and skeletal muscles (pectoral and quadriceps femoris). We detected an increase of Na+/K(+)-ATPase immunostaining with prominent staining of the sarcolemma and a slight increase of Ca(+)-ATPase with prominent staining of the sarcoplasma.

Effectiveness and kinetic behaviour of tilmicosin in the treatment of respiratory infections in sheep

Nineteen sheep which were anorexic, pyrexic, coughing, dyspnoeic and had a nasal discharge and symptomatic thoracic sounds on auscultation, received a single subcutaneous dose of 10 mg/kg bodyweight of tilmicosin. The clinical signs were eliminated within four to six days. The kinetic profiles of the drug after a single subcutaneous injection were compared in five healthy sheep and five infected sheep. More of the drug was absorbed by the infected animals and its concentration remained higher for significantly longer. The drug was well tolerated and no local or systemic side effects were observed.

Reduction of carbon tetrachloride-induced rat liver injury by IRFI 042, a novel dual vitamin E-like antioxidant

Carbon tetrachloride (CCl4 )-induced hepatotoxicity is likely the result of a CCl4 -induced free radical production which causes membrane lipid peroxidation and activation of transcription factors regulating both the TNF-alpha gene and the early-immediate genes involved in tissue regeneration. IRFI 042 is a novel vitamin E-like compound having a masked sulphydryl group in the aliphatic side chain. We studied the effect of IRFI 042 on CCl4 -induced liver injury. Liver damage was induced in male rats by an intraperitoneal injection of CCl4 (1 ml/kg in vegetal oil). Serum alanine aminotransferase (ALT) activity, liver malondialdehyde (MAL), hydroxyl radical formation (OH*), calculated indirectly by a trapping agent, hepatic reduced glutathione (GSH) concentration, plasma TNF-alpha, liver histology and hepatic mRNA levels for TNF-alpha were evaluated 48 h after CCl4 administration. Hepatic vitamin E (VE) levels were evaluated, in a separate group of animals, 2 h after CCl4 injection. A control group with vitamin E (100 mg/kg) was also treated in order to evaluate the differences versus the analogue treated groups. Intraperitoneal injection of carbon tetrachloride produced a marked increase in serum ALT activity (CCl4 = 404.61 +/- 10.33 U/L; Controls= 28.54 +/- 4.25 U/L), liver MAL (CCl4 = 0.67 +/- 0.16 nmol/mg protein; Controls= 0.13 +/- 0.06 nmol/mg protein), OH(7) levels assayed as 2,3-DHBA (CCl4 = 8.73 +/- 1.46 microM; Controls= 0.45 +/- 0.15 microM) and 2,5-DHBA (CCl4 = 24.61 +/- 3.32 microM; Controls= 2.75 +/- 0.93 microM), induced a severe depletion of GSH (CCl4 = 3.26 +/- 1.85 micromol/g protein; Controls= 17.82 +/- 3.13 micromol/g protein) and a marked decrease in VE levels (CCl4 = 5.67 +/- 1.22 nmol/g tissue; Controls= 13.47 +/- 3.21 nmol/g tissue), caused liver necrosis, increased plasma TNF-alpha levels (CCl4 = 57.36 +/- 13.24 IU/ml; Controls= 7.26 +/- 2.31 IU/ml) and enhanced hepatic mRNA for TNF-alpha (CCl4 = 19.22 +/- 4.38 a.u.; Controls= 0.76 +/- 0.36 a.u.). IRFI 042 (100 mg/kg, 30 min after CCl4 injection) blunted liver MAL (0.32 +/- 0.17 nmol/mg protein), decreased the serum levels of ALT (128.71 +/- 13.23 U/L), and restored the hepatic concentrations of VE (9.52 +/- 3.21 nmol/g tissue), inhibited OH* production (2,3-DHBA= 3.54 +/- 1.31 microM; 2,5-DHBA= 7.37 +/- 2.46 microM), restored the endogenous antioxidant GSH (12.77 +/- 3.73 mmol/g protein) and improved histology. Furthermore IRFI 042 treatment suppressed plasma TNF-alpha concentrations (31.47 +/- 18.25 IU/ml) and hepatic TNF-alpha mRNA levels (11.65 +/- 3.21 a.u.). The acute treatment with vitamin E failed to exert any protective effect against CCl4 -induced hepatotoxicity. These investigations suggest that IRFI 042 treatment may be of benefit during free radical-mediated liver injury.

Transrectal Ultrasonography in the Diagnosis of Prostatic Carcinoma: Our Study on 365 Patients

To evaluate the usefulness of transrectal ultrasound associated with needle biopsy of the prostate, 365 patients, with age ranging between 50 and 80 years, were studied for a total of 412 biopsies; the ultrasound exam was performed when the clinical or the prostate specific antigen findings were pathological. Our experience confirms the high sensitivity and specificity of transrectal ultrasonography in detecting prostate cancer. It is our opinion that all the patients with positive or negative digital rectal examination but altered prostatic specific antigen or clinical exam should undergo transrectal ultrasonography associated with needle biopsy. The elevated operability of the studied patients shows the capability of ultrasound to detect the pathology in the early stages and its value in screening diagnosis should therefore be considered.

[Gastric pH changes during and after extracorporeal circulation. What is its clinical meaning?]

OBJECTIVE

To determine the relationship between gastric pH (pHm) and several other indices of blood perfusion in patients undergoing cardiopulmonary bypass (CPB). To evaluate the importance of pHm as a prognostic index for elective cardiac surgery.

DESIGN

Prospectives study.

SETTING

Cardiac surgery ICU of a Regional Hospital in Italy.

PATIENTS

Nineteen patients were sequentially studies in a 4-month period.

METHOD

Before anesthetic induction, a pH probe incorporated in the tip of a nasogastric tube (GrapHprobe SH, GrapHometer, Zinetics Medical, USA) was inserted in the stomach. Results, collected during the CPB and in the postoperative period until 1 hour after extubation, were compared to the peripheral tissue perfusion and oxygenation data (transcutaneous: PtcO2), hemodynamic variations (Swan-Ganz catheter), pharyngeal temperature, and blood gases.

RESULTS

No significant variations of pHm were reported during the study. Significant relations were found only after surgery between pHm and PaO2 (p < 0.001), hemoglobin (p < 0.001), and blood pH (p < 0.05). No statistical correlations were reported between pHm and hemodynamic variations.

CONCLUSIONS

Although a significant variation of peripheral and pulmonary vascular resistance and transcutaneous oxygenation was reported throughout the study, no correlations were found to pHm. At present it is not possible to confirm the importance of pHm as a prognostic index for elective cardiac patients, even though it is necessary to examine whether the additional data of pHm variation could be considered a true marker of visceral perfusion.

Total parenteral nutrition in patients with intra-aortic balloon counterpulsation

The effects of total parenteral nutrition (TPN) were studied in nine of 19 patients with intra-aortic balloon pumping TPN (c. 27 kcal/kg/day) was begun 3 hours after the start of pumping. The non-protein caloric source was composed of hypertonic dextrose and fat emulsion (60% and 40%). The nitrogen intake was 1 g/150-200 kcal/day. The ten control patients received 5% dextrose in corresponding volume/hour. Hemodynamic studies were performed before and 24, 48 and 72 hours after the start of counterpulsation. The predicted and the observed resting energy expenditure were recorded in both patient groups during counter-pulsation. Systemic and pulmonary vascular resistance differed significantly between the groups. Cardiac function improved in both groups. In the TPN group the measured resting energy expenditure increased by 33% more than predicted on day 2 and by 56% on day 3 and in the controls the figures were 31% and 40%--all rises significant. Total parenteral nutrition with low fat content thus alters the hemodynamic equilibrium without clinically significant effects in patients undergoing intra-aortic balloon pumping. These patients are hypermetabolic and should receive artificial nutrition as soon as possible.

Evidence for a role of nitric oxide in hypovolemic hemorrhagic shock

Hypovolemic hemorrhagic shock was induced in rats by intermittently withdrawing blood from an iliac catheter for 20 min until mean arterial blood pressure (MAP) decreased to 30 mm Hg. Survival rate, survival time, plasma myocardial depressant factor (MDF) activity, MAP, and microscopic gastric alterations were then evaluated. NG-nitro-L-arginine methyl-ester (L-NAME), a selective inhibitor of nitric oxide (NO) production from L-arginine, was injected intravenously (i.v.) after the bleeding was discontinued. Untreated hemorrhagic shocked rats died in 27 +/- 3.3 min, had enhanced plasma activity of MDF, and exhibited hemorrhagic infiltrates in gastric fundus mucosa. L-NAME (5 and 10 mg/kg) significantly increased survival rate and time, blunted the increase in plasma MDF activity, and protected against the gastric lesions induced by hemorrhagic hypovolemic shock. All these protective effects were reversed by a bolus of L-arginine (30 mg/kg/i.v.), given 2 min after administration of L-NAME. Our findings suggest that NO production plays an important role in the pathophysiology of hemorrhagic shock.

The value of computed tomography in the diagnosis of soft-tissue swellings of the hand

Twenty patients with palpable swellings of the hand were investigated by computed tomography. The results, when compared with the pathological findings, lead us to consider this a technique of considerable value in the assessment of this kind of disease. The importance of angiography and, occasionally of magnetic resonance imaging, are also stressed.

The Value of Computed Tomography in the Diagnosis of Soft-Tissue Swellings of the Hand

Twenty patients with palpable swellings of the hand were investigated by computed tomography. The results, when compared with the pathological findings, lead us to consider this a technique of considerable value in the assessment of this kind of disease. The importance of angiography and, occasionally of magnetic resonance imaging, are also stressed.

Fatal progression of Behçet's disease after cardiac surgery

The authors describe a patient affected with Behçet's disease who developed, after cardiac surgery, acute clinical manifestations of the syndrome and died of a generalized infection. They also discuss the clinical aspects, the particular clinical course, and the therapy of the disease.

[Noninvasive hemodynamic (bioimpedance) evaluation during short anesthesia with propofol]

The hemodynamic effects of propofol (3 mg/kg) during anesthetic management of 10 patients undergoing minor urologic procedures were evaluated by noninvasive thoracic electrical bioimpedance method. Cardiac output, cardiac index, systolic and diastolic arterial blood pressures and EVI/TFI (an index of myocardial function) decreased significantly in ten minutes from starting of propofol injection, while the heart rate remained unchanged.

Behavioural and electrocortical changes induced by paraquat after injection in specific areas of the brain of the rat

The behavioural and electrocortical effects of paraquat were studied after its administration into the substantia nigra, pars compacta, an area where dopamine-(DA) containing cell bodies are present, into the caudate nucleus, where DA-containing nerve endings of the DA nigro-striatal system project, into the locus coeruleus, an area containing noradrenaline cell-bodies and into the n. raphe dorsalis or into the n. raphe medianus, two nuclei containing serotonin (5-HT) cell bodies. The intraventricular administration of paraquat (10 and 50 micrograms) produced an intense pattern of behavioural stimulation and an increase in locomotor activity, circling and the wet-dog syndrome. This symptomatology was accompanied by desynchronization of the electrocorticogram (ECoG) and the appearance of bilateral high voltage epileptogenic spikes, culminating in clonic convulsions. The infusion of paraquat into the s. nigra produced contralateral head and neck deviation, behavioural and motor stimulation, these effects being observed also with smaller doses (1 and 5 micrograms), than those used intraventricularly. The ECoG activity was desynchronized and characterized by high voltage spike discharges. A similar behavioural, postural and ECoG pattern was also observed after infusion of paraquat into the caudate nucleus (10, 25 and 50 micrograms). In addition, paraquat, infused into the locus coeruleus or into the raphe nuclei (5 and 10 micrograms), produced circling, escape responses, jumping and clonic convulsions accompanied by ECoG desynchronization and epileptic phenomena. In conclusion, the present experiments showed that paraquat was able to produce central neurotoxicological effects which did not seem to be specific, at least for the doses used, for the DA nigro-striatal system.

Muscle CT, biopsy and EMG in diagnosis of neuromuscular diseases

The diagnostic value of EMG and muscle biopsy has been compared with muscle CT in 53 patients with neuromuscular diseases. CT concordance with clinical diagnosis was found in 62% of myopathies and was highest in Duchenne PMD and scapulo-peroneal myopathy and very low in metabolic and inflammatory myopathies. In neurogenic diseases muscle CT agreed with clinical diagnosis in 63% of patients: the highest concordance was found in acquired polyneuropathies.

CT and the diagnosis of myopathies. Preliminary findings in 42 cases

A total of 42 patients with myopathies underwent CT scans in order to study the relationship between CT images and clinical findings. CT is a valuable diagnostic aid to distinguish primary from neurogenic myopathies, to facilitate directed biopsy and finally to classify the disease according to the degree and extent of the muscular lesion.

Estrone conversion rates by human endometrial cancer cell lines

Studies on estrone metabolism by long term human endometrial cancer HEC-1A and Ishikawa cell lines are reported. These cell lines grow well in epithelial mono or plurilayer form, as previously reported. Ishikawa cells appear to be estrogen responsive whereas HEC-1A appear non responsive. In our experience Ishikawa cells show high affinity--low capacity estrogen binding sites in both soluble and nuclear fractions of the same range of ZR 75-1 and of MCF7, but HEC-1A cytosols gave Kd values in the order of 10(-8)-10(-9). These values are probably more representative of estrogen receptors of low affinity-high capacity (site II) and this is in agreement with previous results regarding their poor response to estrogens. These two different endometrial cancer cell lines exhibit at the same time, common and quite dissimilar metabolic patterns of estrogens. In fact, metabolic conversion studies carried out after 24th incubation at not far from physiological concentrations by using high pressure liquid chromatography in reverse phase mode plus "on line" radioactive detection showed: Both these well established cell lines are fast growing in culture with sufficient morphological or biochemical stability, at least during a limited number of passages and appear a useful material for studies on steroid metabolism. In both, estradiol (E2) and estrone (E1) were most part of converted products (more than 95%); negligible amounts of other radio-metabolites were observed. Quite different conversion rates of E1 to E2 have been shown by HEC-1A cells (6 times or more), with respect to Ishikawa.

[Computerized tomography in the assessment of soft-tissue neoplasms. Observations in 124 cases]

In order to evaluate the role of Computed Tomography (CT) in prediction of nature, staging and follow-up of soft-tissue tumors, the authors examined by CT 124 patients with soft tissue neoplasms who later underwent surgery (116 cases) or fine needle biopsy (8 cases). Comparison between CT and surgical or anatomical results showed that CT was able to correctly predict the benignancy or malignancy of the masses in 76% of cases but it was very seldom able to allow an histological prediction. On the contrary CT was found to be a very useful tool for pre-therapeutic staging and follow-up of the tumors, because it gave many diagnostic information which influenced therapeutic choices and strategies.

Arteriographic and tomodensitometric pictures in three cases of popliteal artery entrapment

CT could be an effective diagnostic modality of "popliteal artery entrapment". The authors present three cases of this pathology, studied with CT and arteriography.

[Computerized tomography in the study of myelopathy in cervical spondylosis]

This study involved 107 patients selected according to symptoms and signs of myelopathy due to cervical spondylosis. All patients were examined by high resolution CT without intravenous or intrathecal contrast enhancement. Diagnostic accuracy of CT is discussed with regard to idiopathic and degenerative cervical spinal stenosis. Emphasis is placed on CT findings of ossification of posterior longitudinal ligament. The authors conclude that plain CT may be a reliable method for diagnosing cervical spondylothic myelopathy. Nevertheless the authors stress how intrathecal contrast enhanced CT is far superior to plain CT in the selection of a definitive anterior or lateral surgical approach without a delay.

Metrizamide-enhanced computed tomography of intracranial arachnoid cysts

Between July 1981 and August 1983 the authors studied 21 patients with intracranial arachnoid cysts using metrizamide-enhanced CT. With this method we are able to determine the degree of communication between the cysts and the surrounding subarachnoid space as well as to assess the evolving character of some of these lesions. This information will allow a more rational choice of surgical treatment.

[The use of computerized tomography in recurrences of rectal tumors]

The authors refer the results of CT studies of 33 patients who underwent surgical resection of the rectum for cancer. In 20 of these cases there was only a suspicion of recurrence; in 13 recurrence had been already clinically or instrumentally demonstrated. In the latter group (13 patients) CT clearly showed the presence of a pelvic mass and of muscular infiltration; in 8 cases pelvic organs and in 7 cases pelvic bones were involved; the mass had liquid density features in 3 patients. In 12 of the 20 cases in which cancer recurrence was suspected, CT demonstrated the presence of a pelvic mass. Compared to the former group infiltration of pelvic organs and bones was less frequent. Granulation tissue, fibrous tissue, abscess formation and surgical removal of epiploon placed into the pelvis may all be causes of false positivity. In order to reduce the rate of wrong diagnosis it is useful a post-operative evaluation of the pelvis as soon as it has recovered from surgery.