Implantation of a novel insertable cardiac monitor: preliminary multicenter experience in Europe

BACKGROUND

The LUX-Dx™ is a novel insertable cardiac monitor (ICM) introduced into the European market since October 2022.

PURPOSE

The aim of this investigation was to provide a comprehensive description of the ICM implantation experience in Europe during its initial year of commercial use.

METHODS

The system comprises an incision tool and a single-piece insertion tool pre-loaded with the small ICM. The implantation procedure involves incision, creation of a device pocket, insertion of the ICM, verification of sensing, and incision closure. Patients receive a mobile device with a preloaded App, connecting to their ICM and transmitting data to the management system. Data collected at European centers were analyzed at the time of implantation and before patient discharge.

RESULTS

A total of 368 implantation procedures were conducted across 23 centers. Syncope (235, 64%) and cryptogenic stroke (34, 9%) were the most frequent indications for ICM. Most procedures (338, 92%) were performed in electrophysiology laboratories. All ICMs were successfully implanted in the left parasternal region, oriented at 45° in 323 (88%) patients. Repositioning was necessary after sensing verification in 9 (2%) patients. No procedural complications were reported, with a median time from skin incision to suture of 4 min (25th-75th percentiles 2-7). At implantation, the mean R-wave amplitude was 0.39 ± 0.30 mV and the P-wave visibility was 91 ± 20%. Sensing parameters remained stable until pre-discharge and were not influenced by patient characteristics or indications. Procedural times were fast, exhibited consistency across patient groups, and improved after an initial experience with the system. Operator Operator feedback on the system was positive. Patients reported very good ease of use of the App and low levels of discomfort after implantation.

CONCLUSIONS

LUX-Dx™ implantation appears efficient and straightforward, with favorable post-implantation sensing values and associated with positive feedback from operators and patients.

Acute kidney injury promotes development of papillary renal cell adenoma and carcinoma from renal progenitor cells

Acute tissue injury causes DNA damage and repair processes involving increased cell mitosis and polyploidization, leading to cell function alterations that may potentially drive cancer development. Here, we show that acute kidney injury (AKI) increased the risk for papillary renal cell carcinoma (pRCC) development and tumor relapse in humans as confirmed by data collected from several single-center and multicentric studies. Lineage tracing of tubular epithelial cells (TECs) after AKI induction and long-term follow-up in mice showed time-dependent onset of clonal papillary tumors in an adenoma-carcinoma sequence. Among AKI-related pathways, NOTCH1 overexpression in human pRCC associated with worse outcome and was specific for type 2 pRCC. Mice overexpressing NOTCH1 in TECs developed papillary adenomas and type 2 pRCCs, and AKI accelerated this process. Lineage tracing in mice identified single renal progenitors as the cell of origin of papillary tumors. Single-cell RNA sequencing showed that human renal progenitor transcriptome showed similarities to PT1, the putative cell of origin of human pRCC. Furthermore, NOTCH1 overexpression in cultured human renal progenitor cells induced tumor-like 3D growth. Thus, AKI can drive tumorigenesis from local tissue progenitor cells. In particular, we find that AKI promotes the development of pRCC from single progenitors through a classical adenoma-carcinoma sequence.

Surgical management of bilateral, upper and lower eyelid entropion in 27 Shar Pei dogs, using the Stades forced granulation procedure of the upper eyelid only

Aims: To evaluate the outcome of surgical management of entropion of the upper and lower eyelids in Shar Pei dogs which had previously undergone temporary palpebral tacking, using the Stades forced granulation procedure of the upper eyelid only.Methods: Medical records were retrospectively searched to identify Shar Pei dogs referred for bilateral entropion of both the lower and upper eyelids, and that were treated with the forced granulation procedure of the upper eyelid only. Dogs were included if they had previously undergone unsuccessful temporary palpebral tacking and had at least three follow-up examinations in the 30 days following surgery.Results: Twenty-seven Shar Pei dogs with a median age of 7.9 (min 4, max 24) months were included in the study. Before surgery, all dogs showed signs of severe ocular discomfort with bilateral keratitis and visual deficit due to blepharospasm, enophthalmos and protrusion of the third eyelid. In 13/54 eyes, keratitis was associated with a corneal ulcer. When re-examined 4 weeks after surgery, correction of the upper eyelid entropion and associated trichiasis resolved ocular signs in 50/54 eyes. Mild bilateral lower entropion remained in two dogs postoperatively, which underwent revision surgery with the Hotz-Celsus technique. There were no cases of long-term recurrence of entropion or ocular irritation in the 38 eyes (19 dogs) which were re-examined 1 year after surgery.Conclusion and clinical relevance: The forced granulation procedure performed on the upper eyelid only was effective for correction of entropion in the Shar Pei dogs included in this study. In our experience, it is preferable to operate on the upper eyelid alone, rather than attempting to correct upper and lower entropion during the same surgical operation. The dog can then be reassessed a few weeks later to determine whether the lower entropion is anatomical or secondary to the severe blepharospasm resulting from the painful ocular irritation.

The invasion of abandoned fields by a major alien tree filters understory plant traits in novel forest ecosystems

The abandonment of agricultural use is a common driver of spontaneous reforestation by alien trees. The N-fixing black locust (Robinia pseudoacacia L.) is a major alien invader of old fields in Europe. Here we show that canopy dominance by this tree may filter the frequency distribution of plant functional traits in the understory of secondary woodlands. Higher soil C/N ratio and available P are associated with black locust stands, while higher soil phenols associate with native tree stands. These environmental effects result in differences in understory flowering periods, reproduction types and life forms. Our findings emphasize the effect of a major alien tree on functional plant trait composition in the early stages of spontaneous reforestation of abandoned lands, implying the development of a novel forest ecosystem on a large geographical scale.

Thymoma: A Clinico-Pathologic Study Based on Newly Developed Morphologic Criteria

A retrospective study of 28 cases of thymoma classified according to Marino and Müller-Hermelink (cortical, medullary, mixed common, mixed with cortical predominance, mixed with medullary predominance thymoma) was undertaken to determine the existence of correlations between histology and clinical behavior. Cortical thymoma was observed in 11 cases (39.2%), mixed common thymoma in 9 (32.1%), mixed with cortical predominance in 5 (18%), and medullary thymoma in 3 (10.7%). In patients with cortical thymoma the tumor was always invasive (stages II and III according to Bergh), whereas medullary thymomas were noninvasive in 2 cases (stage I) and slightly invasive with a moderate infiltration of the capsule in the remaining case (stage II). Mixed common and mixed with cortical predominance thymomas displayed intermediate behavior. Twelve patients were affected by myasthenia gravis: 1 had medullary thymoma, 6 had mixed common thymoma, 3 had mixed thymoma with cortical predominance, and 2 had cortical thymoma. One patient with cortical thymoma had superior vena cava syndrome and 1 had erythroid hypoplasia; mixed common thymoma was associated with Cushing's syndrome in 1 patient. These data confirm previously reported observations (16) showing a higher degree of malignancy in patients with cortical thymoma.

Endocycle-related tubular cell hypertrophy and progenitor proliferation recover renal function after acute kidney injury

Acute kidney injury (AKI) is considered largely reversible based on the capacity of surviving tubular cells to dedifferentiate and replace lost cells via cell division. Here we show by tracking individual tubular cells in conditional Pax8/Confetti mice that kidney function is  recovered after AKI despite substantial tubular cell loss. Cell cycle and ploidy analysis upon AKI in conditional Pax8/FUCCI2aR mice and human biopsies identify endocycle-mediated hypertrophy of tubular cells. By contrast, a small subset of Pax2+ tubular progenitors enriches via higher stress resistance and clonal expansion and regenerates necrotic tubule segments, a process that can be enhanced by suitable drugs. Thus,  renal functional recovery upon AKI involves remnant tubular cell hypertrophy via endocycle and limited progenitor-driven regeneration that can be pharmacologically enhanced.

Carpal tunnel syndrome in HIV-positive patients coinfected with HCV

A wide range of rheumatic and peripheral nervous system disorders may develop in patients with HIV infection, leading to pain, sensory symptoms, and muscle weakness. Over the past three decades, the progress in management of HIV disease with anti-retroviral therapy (ART) has resulted in increased life expectancy for people living with HIV disease. With this new chronicity of the disease has a constellation of chronic musculoskeletal, orthopaedic and rheumatic manifestations has emerged, as potential complications of the disease itself and/or the results of ART treatment regimen and/or because of expected age-related symptoms/manifestations. The incidence of CTS in the general population is around 3.8% with clinical examination and, when electroneuromyography is used, it is 2.7%. In the HIV-positive population, the incidence is very close to that of the general population. The aim of this study was to evaluate the incidence of CTS and to identify factors influencing the development of CTS in HIV-infected patients attending our clinic. This syndrome has been associated with advanced HIV disease and the use of ART possibly due to an increased inflammatory state and the presence of concurrent HCV infection.

[The Cri du Chat syndrome: a study on the quality of care]

AIM

The Cri du Chat syndrome (SCdC / [OMIM #123450]) is a rare disease characterized by the deletion of the short arm of chromosome 5. The typical clinical features are the cat-like cry, microcephaly, a distinct facial phenotype and a severe psychomotor and mental retardation. The aim of this study was to provide an analysis on the data concerning the life quality and families assistance to whom have a child affected by Cri du Chat syndrome such as: the life's change of parents after the child's birth, the frequency of treatments, the collaboration between family and center of reference.

METHODS

We have also analyzed the improvement obtained, the type of school attended, the aide and the time spent at home in postprimary education. Through a questionnaire sent to 100 families, we have been picked up information on 76 patients.

RESULTS

These families have to adapt to the reality of a child with a rare genetic disorder for which there are no pharmacological or surgical therapies.

CONCLUSION

Therefore, it seems important to give information and tips for dealing with the disease and the early start of rehabilitation and educational therapy.

Humic substances induce lateral root formation and expression of the early auxin-responsive IAA19 gene and DR5 synthetic element in Arabidopsis

Humic substances (HS) have positive effects on plant physiology, but the molecular mechanisms underlying these events are only partially understood. HS exert auxin-like activity, but data supporting this hypothesis are under debate. To investigate the auxin-like activity of HS, we studied their biological effect on lateral root initiation in Arabidopsis thaliana. To this aim we characterised HS by means of DRIFT and (13)C CP/MAS NMR spectroscopy, and measured their endogenous content of IAA. We then utilised a combination of genetic and molecular approaches to unravel HS auxin activity in the initiation of lateral roots. The data obtained using specific inhibitors of auxin transport or action showed that HS induce lateral root formation mostly through their 'auxin activity'. These findings were further supported by the fact that HS used in this study activated the auxin synthetic reporter DR5::GUS and enhanced transcription of the early auxin responsive gene IAA19.

Endometrial carcinoma: intraoperative evaluation of myometrial invasion. A prospective study

AIM

The authors investigated the diagnostic value of intraoperative assessment of myometrial invasion in endometrial cancer patients. Following hysterectomy, the uterus was sectioned and macroscopically examined in order to assess the depth of myoinvasion, which was classified as <50% and >50%. In patients with macroscopic depth of invasion>30% and <50%, a frozen section of this area was carried out. The results of intraoperative evaluation were compared with the results of postoperative pathological examination. The agreement between methods was developed as generalized Kappa type statistic. Sensitivity, specificity, positive and negative predictive values for intraoperative only macro and macro/micro evaluation were calculated.

METHODS

Seventy eight consecutive patients (median age 64 years, range 43-92; median Body Mass Index [BMI] 30.5, range 21.9-46.7) who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (THBSO) were included in the study. Following intraoperative macroscopic evaluation, frozen section was carried out in 15 (19%) patients. The median time to obtain the results was 16 min for macroscopic evaluation, and 29 min for the macro/micro assessment.

RESULTS

Macroscopic only assessment correctly identified depth of myoinvasion in 91% of patients, while, when the frozen section was carried out, myoinvasion was correctly identified in 95% of patients. For macroscopic only and macro-micro assessment sensitivity and specificity were 76% and 98%, 86% and 98%, respectively.

CONCLUSION

These data suggest that the frozen section may improve, the diagnostic value of macroscopic only intraoperative assessment of myometrial invasion in selected patients.

First Report of Stemphylium vesicarium as Causal Agent of Wilting and Root Rotting of Radish Sprouts in Italy

A consistent contamination from a Stemphylium sp. was detected on radish (Raphanus sativus) seeds by a seed blotter test. Twenty-five percent of seed lots were contaminated. Stemphylium vesicarium (teleomorph Pleospora allii) was identified on the basis of morphological characters of conidia and conidiophores (4). Conidia were golden brown to dark drown, oblong to oval with one to four transverse and one to three longitudinal septa, constricted at one to three of the major transverse septa. Conidia dimensions ranged from 12 to 22 × 30 to 40 μm. Conidiophores were straight or occasionally one-branched with a swollen apex and one to four septate. Pseudothecia with asci and ascopores were observed on radish seeds. Asci were cylindrical to clavate with eight ascospores with up to six transverse septa and numerous longitudinal septa. Species identification was also confirmed after comparing the sequences of the internal transcribed spacer (ITS) region of rDNA and gpd (glyceraldehyde-3-phosphate dehydrogenase) (3) of four isolates with those of Stemphylium species already present in the NCBI database. Accessions Nos. AM 746020 to AM746023 and AM883174 to AM883177 were deposited for ITS and gpd, respectively. Artificial inoculations were carried out on radish seeds previously disinfected with 1% sodium hypochlorite for 10 min and then plated on S. vesicarium sporulating colonies grown on potato dextrose agar (PDA). The four sequenced isolates were tested for pathogenicity. Disinfected seeds were plated onto PDA only and used as a control. After 48 h of incubation, seeds were sown in sterilized soil in plastic plates. The emerging and the eventually dead plants were counted. Stem necrosis and root rotting developed on sprouts within the first week after sowing. On the surviving infected plantlets, wilting and death occurred on more than 70% of the plants within 4 weeks after sowing. Control plantlets obtained from disinfected seeds remained healthy. The fungus reisolated from wilted and dead plants was morphologically identical to the original isolates, thus confirming S. vesicarium as the causal agent. In Italy, this pathogen is common on asparagus (1), but it has also been reported on Allium spp., tomato, and pear. On European pear it is the causal agent of brown spot (2), a destructive disease in the Mediterranean area but also in the Netherlands and other continental European countries. On the basis of these results, seed contamination with S. vesicarium can represent a threat for the production of radish for sprout consumption. To our knowledge, this is the first report of S. vesicarium on radish plantlets in Italy. References: (1) F. Del Zan et al. L'informatore Agrario 11:95, 1989. (2) I. Llorente and E. Montesinos. Plant Dis. 90:1368, 2006. (3) B. M. Pryor and D. M. Bigelow. Mycologia 95:1141, 2003. (4) E. G. Simmons. Sydowia 38:284, 1985.

The auxin-like activity of humic substances is related to membrane interactions in carrot cell cultures

A detailed characterization of two humic fractions was performed: One with low relative molecular mass (LMr<3,500 Da) and one with high relative molecular mass (HMr>3,500 Da). Distinct (1)H NMR spectroscopic patterns were observed for the two fractions. HMr showed an aromatic proton region, an intense and broad region (3.0-5.0 ppm) attributed to sugar-like and polyether components, and an intense doublet at 1.33 ppm (identified as protons of the beta-CH(3) in lactate). In contrast, LMr did not show resonances due to aromatic protons and was characterized by a broad unresolved region, assigned to sugar-like components. The (13)C NMR spectra showed that the LMr humic fraction was richer in carboxylic and aliphatic C groups compared to HMr fraction. These substances were fluorescein-labeled [fluorescein isothiocyanate (FITC)], and their interaction with carrot cells in culture was monitored for 10 d, and compared to FITC-indole-3-acetic acid (IAA) to clarify their mechanisms of biological activity. After different incubation times, fluorescein staining of carrot cells and decrease of fluorescein concentration in the culture medium were evaluated. Fluorescent membrane staining was only present in IAA and the LMr humic fraction treated cell cultures. A consequential decrease of fluorescein concentration in the culture media was also observed. Pretreatment of carrot cells with unconjugated IAA or LMr humic fraction markedly reduced fluorescein staining of both FITC-IAA and FITC-LMr humic fraction. Blocking tests gave indirect evidence of possible binding of the LMr humic fraction to IAA cell membrane receptors. These results indicate that the two humic fractions behave differently. Only LMr humic fraction, like IAA, interacts with cellular membranes in carrot cell cultures.

Chemical and biological characterization of dissolved organic matter from silver fir and beech forest soils

Despite a growing attention to the dissolved organic matter (DOM) in terrestrial ecosystems and evidence of the fact that vegetation affects the quality of both undissolved and dissolved organic matter in soil, the role of DOM as a biological indicator is still poorly understood. In this work, the fertility of 59 sites, divided into eight key alliances of the order Fagetalia sylvaticae Pawl., was studied considering chemical and biological parameters such as soil DOM, hormone-like activity, low-molecular-weight (LMW) aliphatic and phenolic acids, and floristic data. Both non-parametric tests and principal component analysis (PCA) revealed differences between silver fir and beech forests and within each type of forest. There were also differences between neutrophilous and acidophilous types. What's more, PCA reveals the dominance of the auxin (IAA)-like activity, and of some phenolic acids in distinguishing the acidophilous beeches (ACI) form the other types, whereas the gibberellin (GA)-like activity is more relevant in neutrophilous conditions such as thermophilous (THE) and mesophilous (MESO) beeches and montane (MO), high montane (HMA), high montane (HMC) silver fir forests. The GA-like activity is also related to the succinic, fumaric, malonic, and l-malic acids in the MO, HMA and HMC silver fir forests. Moreover, the role of LMW aliphatic acids in mobilizing the hormone-like activity, which improves forest growth, is stressed. The growth of seedlings of Picea abies was influenced by the phenolic acid content. At concentrations between 1 and 100 microM, phenylacetic and protocatechuic acids inhibited root growth to the same extent as indoleacetic acid, while p-hydroxybenzoic acid had a stimulating effect comparable to that of gibberellic acid. The aliphatic and phenolic acids appear to be related to plant strategies that influence soil fertility affecting plant growth through rhizodeposition. The role of LMW aliphatic and phenolic acids as molecular markers of ecosystem function is noted.

Pancreas transplantation: problems and prospects in intensive care units

AIM

The aim of this study is to describe personal experience in the intensive management of patients with severe diabetes undergoing pancreas transplantation.

METHODS

Clinical records of subjects consecutively undergoing an isolated or combined pancreas transplant have been examinated.

RESULTS

During the considered period, 10 patients received an isolated pancreas transplant and 43 a simultaneous kidney-pancreas transplantation (SPKT), including 6 using a kidney from a living donor. The mean stay in the Intensive Care Unit (ICU) was 4.7 days: 52 patients (98.2%) were transferred to the Surgical Department, whereas one (1.8%) belonging to the SPKT group died with a non-functioning graft. Ten patients (18.6%) were re-admitted because of the onset of late complications, including one SPKT who died of sudden cardiac death with functioning grafts. Arterial hypertension appeared in 51% of the recipients, and 5.6% experienced at least one hypotensive episode. Cardiac rhythm alterations were diagnosed in 5 subjects (9.4%), and myocardial ischemia in 9 (17%).

CONCLUSIONS

Pancreas transplantation is a therapeutic option that can improve patients' quality of life by also slowing down the evolution of diabetes; however, it is important to bear in mind the associated risks. The best results are obtained in patients in whom the disease has not already seriously impaired the function of the various target organs.

Cardiac evaluation for simultaneous pancreas-kidney transplantation and incidence of cardiac perioperative complications: preliminary study

Type I diabetes mellitus (IDDM) is associated with an increased cardiovascular risk, and eligibility protocols for simultaneous pancreas-kidney transplantation (SPKT) are consequently accurate for preoperative cardiovascular assessment. According to our algorithm, coronary angiography in SPKT candidates is indicated for patients not only experiencing previous cardiac events or symptoms, but also those with long-standing diabetes (more than 25 years) and/or age over 45 years. Furthermore, a basal transthoracic echocardiographic exam (TTE) is performed to assess cardiac volumes, left ventricular mass, systolic function, and kinesis. The aims of this study were to evaluate perioperative cardiac morbidity and mortality in 18 SPKT-eligible patients, divided into two groups on the basis of the presence/absence of angiographically evident coronary artery disease (CAD), as well as to assess the impact of left ventricular hypertrophy (LVH) on cardiac complications. Cardiac intraoperative morbidity and mortality and postoperative mortality and major morbidity were absent; minor cardiac morbidity consisted only of silent ischemic ECG alterations, without significant differences between groups, although the incidence seemed to be higher in the CAD-positive population. LVH detected preoperatively by TTE exam also failed to correlate with the incidence of such complications. Selection of SPKT candidates by coronary angiography may have positive effects on perioperative cardiac morbidity and mortality. A larger sample size is needed to give the study statistical power. Medium- and long-term follow-up studies are warranted to evaluate the effects of preoperative selection on survival rates.

[Pharyngeal and laryngeal hamartoma: case report]

In this report a case of laryngeal hamartoma is presented. Macroscopically this lesion is quite similar to a tumor but is actually a malformation derived from an error in the development of a healthy organ. Histologically, the hamartoma is composed of a proportionally abnormal mixture of tissues as compared to what is normally present in its anatomic site. The lesion is extremely rare and usually appears in the head and neck district, spleen, pancreas, lung and liver. The diagnosis is essentially based on histological examination. The treatment of choice consists of surgery and periodic follow-up. Differential diagnosis must consider other rare neoplasms such as rhabdomyoma and teratoma.

Biological activity of soil organic matter mobilized by root exudates

In order to study the biological activity of soil organic matter mobilized by agrarian (Zea mays: cultivars Mytos and Samantha) and forest (Picea abies Karst. and Pinus sylvestris L.) root exudates, two different soils, an Eutric Cambisol (EC) and a Rendzic Leptosol (RL), were considered. Soil organic matter extracts were obtained by treating the soils with water (control) or plant root exudates. The extracts were characterized by hormone-like activities and gas chromatographic/mass spectrometric (GC/MS) measurements. Their effects on the nitrogen metabolism in maize seedlings were evaluated. The nitrogen organification in the maize seedlings has been greatly stimulated by all the organic acid extracts from the agrarian soil, while the extracts from the forest soil had no influence upon the metabolism; this indicated a probable link between the plant and the environment. The different biological activities of the extracts are discussed.

Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation

BACKGROUND

Circumferential radiofrequency ablation around pulmonary vein (PV) ostia has recently been described as a new anatomic approach for atrial fibrillation (AF).

METHODS AND RESULTS

We treated 251 consecutive patients with paroxysmal (n=179) or permanent (n=72) AF. Circular PV lesions were deployed transseptally during sinus rhythm (n=124) or AF (n=127) using 3D electroanatomic guidance. Procedures lasted 148+/-26 minutes. Among 980 lesions surrounding individual PVs (n=956) or 2 ipsilateral veins with close openings or common ostium (n=24), 75% were defined as complete by a bipolar electrogram amplitude <0.1 mV inside the lesion and a delay >30 ms across the line. The amount of low-voltage encircled area was 3594+/-449 mm(2), which accounted for 23+/-9% of the total left atrial (LA) map surface. Major complications (cardiac tamponade) occurred in 2 patients (0.8%). No PV stenoses were detected by transesophageal echocardiography. After 10.4+/-4.5 months, 152 patients with paroxysmal AF (85%) and 49 with permanent AF (68%) were AF-free. Patients with and without AF recurrence did not differ in age, AF duration, prevalence of heart disease, or ejection fraction, but the LA diameter was significantly higher (P<0.001) in permanent AF patients with recurrence. The proportion of PVs with complete lesions was similar between patients with and without recurrence, but the latter had larger low-voltage encircled areas after radiofrequency (expressed as percent of LA surface area; P<0.001).

CONCLUSIONS

Circumferential PV ablation is a safe and effective treatment for AF. Its success is likely due to both PV trigger isolation and electroanatomic remodeling of the area encompassing the PV ostia.

Soil organic matter mobilization by root exudates

In order to study the different soil organic matter mobilisation by agrarian (Zea mais: cultivars Paolo and Sandek) and forest (Picea abies Karst. and Pinus sylvestris L.) root exudates, three different soils (Dystric Spodic Cambisol--S1, Haplic Luvisol--S2 and Calcaric Cambisol--S3) have been considered. Treating the soils with water (control) or plant root exudates, soil organic matter extracts were obtained. The extracts were characterised by hormone-like activities and gas chromatographic/mass spectrometric (GC/MS) measurements. Water extract and plant root exudates exhibited no hormone-like activity, while the other soil-extracts were endowed with a different hormone-like behaviour. GC/MS data indicated that in the acid soils (S1) Sandek and Picea abies exudates showed a greater ability in extracting organic acid isomers (Cl4COOH, Cl5COOH and Cl7COOH), while in neutral soils (S3) all the exudates were active in separating organic acids. In intermediate conditions (S2), Picea abies and Pinus sylvestris exudates liberated C15COOH isomers, Paolo C11COOH isomers, while Sandek was not effective. The different role of plant root exudates in mobilising bio-molecules from the bulk of the soil is proposed.

Pharmacokinetics and tissue penetration of vancomycin in patients undergoing prosthetic mammary surgery

Vancomycin concentrations in periprosthetic breast tissues were evaluated in 24 women undergoing reconstructive surgery after mastectomy for breast cancer. Patients were given a single prophylactic dose of vancomycin (1 g iv) 1-8 h before surgery, and mean capsular and pericapsular tissue concentrations were measured by HPLC. Vancomycin was not detectable in the majority of patients belonging to the 1-3 h post-dose groups, whereas in the 4-8 h post-dose groups, mean capsular and pericapsular concentrations were as follows: at 4 h, 4.0 mg/kg and 5.9 mg/kg; at 6 h, 4.1 mg/kg and 4. 8 mg/kg; at 8 h, 5.9 mg/kg and 11.1 mg/kg, respectively. Vancomycin tissue concentrations thus were equal to or exceeded the breakpoint of 4 mg/L in most samples collected 4-8 h after dosing. In conclusion, our data suggest that appropriate timing of vancomycin prophylaxis should be considered to allow the maintenance of adequate tissue concentrations throughout the surgical procedure.

[Hürthle cell carcinoma and "insular" carcinoma: uncommon varieties of thyroid carcinoma]

The Hürthle cell carcinoma and "insular" carcinoma are two uncommon types of thyroid carcinoma. These neoplasms do not present accurate characteristics as to incidence, natural history, pathophysiology and therapies. Two cases are presented: the first was submitted to near-total thyroidectomy for Hürthle cell carcinoma, the second to total thyroidectomy for "insular" carcinoma with bone and lung metastases. Some literature previous studies on pathophysiology and natural history of both tumors are discussed. At the end, personal trend on the surgical treatment of these two thyroid neoplasms is presented: total thyroidectomy for CCh and "insular" carcinoma, and near-total thyroidectomy for Hürthle cell adenoma.

[Massive thrombosis of the superior mesenteric artery following splenectomy. A coincidence?]

Postsplenectomy thrombocytosis is a well recognised complication about which there is little published information. Therefore, postoperative complications of this effect have not been emphasised. An experience with a case of superior mesenteric artery thrombosis and small intestinal ischemia following splenectomy is reported. We reviewed the literature, but we wasn't able to find any case, whereas the association between splenectomy and mesenteric or portal vein thrombosis is well known. Pathogenesis of postsplenectomy thrombocytosis is poorly understood. Theories to explain it include removal of the splenic sequestration effect or removal of a regulatory humoral factor produced by the spleen. Both mechanisms could be operative at the same time, explaining the observation that some patients develop thrombocytosis related complications soon after surgery, while others after a longer time. The literature on the thromboembolic risk of postsplenectomy thrombocytosis is inconclusive and no studies have established whether patients with thrombocytosis following splenectomy should be treated with anticoagulants or antiplatelet medications in order to prevent thrombotic complications. Certainly, a recommendation for the routine use of these drugs cannot be made on the basis of one observation, but the need for controlled studies must be stressed.

Deterioration of protein fraction by Maillard reaction in dietetic milks

The development of the Maillard reaction in pasteurized, UHT and in-bottle sterilized dietetic milks was studied. In these products damage caused by heat treatments could increase as a result either of the addition of various ingredients or of manufacturing processes that alter their content of reducing carbohydrates. Protein damage was evaluated by measuring furosine by reversed-phase ion-paired HPLC. The levels of furosine detected made it possible to assess the amounts of biologically unavailable lysine. In all milks analysed blocked lysine values were < 340-350 mg/g total lysine, the level at which lysine becomes the limiting amino acid in milk. Pasteurized dietetic milks had levels of blocked lysine similar to that in ordinary pasteurized cows' milk. In some UHT and in-bottle sterilized dietetic milks their different composition resulted in an increase in the blocked lysine content. In some in-bottle sterilized milks, protein damage greatly reduces the beneficial effects of milk as a dietary supplement. Lactose-free milks, which are more susceptible to protein deterioration because of their higher content of reducing carbohydrates, were also analysed after storage at 20 degrees C and at < or = 4 degrees C. At the end of their recommended storage times, they contained limited amounts of blocked lysine only if they had been stored at < or = 4 degrees C.

[The involvement of the urinary tract in inguinal hernias]

The involvement of the organs of the urinary tract in an inguinal hernia represent a constant trap for the surgeon because the diagnosis of that pathology is very rare. The authors report two cases: 1) male, carrier of a voluminous bilateral inguinal hernia, that on the right, contains a diverticulum of the bladder. 2) male, with a bilateral inguinoscrotal hernia. Bilaterally the hernia contains the ureter. The hernias of the bladder properly called are very rare but the involvement of a small portion of the organ, often a diverticulum, in an inguinal hernia is more frequent and always associated with hypertrophy of the prostate. The relative symptoms to this interest seem to supply obvious indications but very rarely are interpreted in the right way. The hernias of ureter are rare too, some acquired, some, about a quarter, congenital. The case-history don't supply useful news for the diagnosis. In the most of the cases of involvement of the urinary tract organs in an inguinal hernia, we arrived at operative-room without knowing the hernia content. The structures of urinary tract usually are recognised by particular maneuvers but is not infrequent that, moreover unforeseen, they are accidentally damaged.

[Colo-uterine fistula, a complication of sigma diverticulitis]

The colo-uterine fistula is a rare complication of diverticular disease of the colon; the literature review has shown only few well studied cases. The fistula, among the complications of the sigma diverticulitis, is 20% of the observed cases; generally, the bladder is the most involved organ, but also the skin or gut can be interested. If we consider the aetiology of the colo=uterine fistula of the observed case, the presence of the sigma locked stenosis with an endocolic pressure increase, associated with a peridiverticulitis condition, seems to have a relevant rule. The clinical symptomatology is represented by vague abdominal pain localized in particular in the left iliac cavity and by emission of blood, purulent material and stools from the vagina. The diagnosis of colo-uterine fistula is not easily reached: barium enema, Fallopian tube endoscopy and colon endoscopy not always allow to visualize in a right manner the fistula and only the oral administration of non-absorbable substances to be searched in the vaginal tampon, clear each doubt. Regarding the therapy to be carried out, we think that, colic resection en bloc with the uterus is the treatment of choice, while, in emergency, the Hartman operation is the most suitable to avoid the beginning of septic complications.

Response of uncomplicated falciparum malaria to oral chloroquine and quinine in Burundi highlands

The in vivo response of falciparum malaria to oral chloroquine and quinine was evaluated in two identical hospital-based, comparative open trials carried out 2 years apart in the same seasonal period at a hospital located in the highlands of Northern Burundi. Children aged 0-14 with uncomplicated falciparum malaria were administered either chloroquine, at 25 mg/kg over 3 days, or quinine, at 10 mg/kg per 8 hourly for 5 days (alternate allocation) and treatment response was evaluated by the WHO 7-day test. In the first study (1992/1993) 472 patients qualified for analyses (211 in the chloroquine and 261 in the quinine group), as compared to 249 subjects in the second study (1994/1995). In each study, the response to quinine was significantly higher than that to chloroquine (P = 0.004 and < 0.001, respectively). While the response to quinine showed insignificant changes over time (95.8 vs. 92.9%), chloroquine was found to be significantly less effective in the second study as compared to the first (77.8 vs. 63.1%; OR (95% CI) 2.04 (1.21-3.43)). Such decline in chloroquine efficacy was attributable to the age group < 5 years of age, where response to chloroquine decreased from 72.9% in 1992/93 to 56% in 1994/1995. Uncontrolled chloroquine use, which spread after the onset in late 1993 of the still ongoing ethnic fighting, appears to be the most likely reason for such a decrease in chloroquine efficacy. Chloroquine resistance has long been known to be present in the hyperendemic lowlands of Burundi, but no data have so far been reported on the response to antimalarials in the highlands of the country. These findings should be considered when deciding on drug policies for the treatment of falciparum malaria in Burundi.

Trace elements in human scalp hair and soil in Irian Jaya

Pb, Cd, and Ni contents were determined in the scalp hair of the Asmat of Irian Jaya (Indonesian New Guinea) on 35 adult subjects. These data are presented together with those of Al, Ca, Ti, Fe, Cu, Zn and Sr, which were determined in previous research on the same group. Hair samples were analyzed by EDXRS and ICP. Trace elements were also determined in 12 soil samples from the same area by EDXRS (Al, Si, K, Ca, Fe) and ICP (Cu, Sr, Ti), and by AAS (Cd, Ni, Pb). When hair element levels are compared and discussed with those of other New Guinea populations, acculturated and nonacculturated tropical groups, populations from Western countries and from polluted areas, and "recommended levels" in the literature, they greatly exceed Western levels and generally fit those of other New Guinea populations, stressing the importance of common environment, subsistence, and behavior. The results of soil analyses are consistent with the presence of those elements in hair, and their quantitative distribution follows a common trend. Metal mobility in soil, patterns of absorption, and transfer from soil to plants and to humans are considered here.

[Diagnostic problems, pathogenetic hypothesis and therapeutic proposals in Ogilvie's syndrome. Review of 470 observations from the literature and presentation of 5 new cases]

The authors describe five cases of acute pseudo-obstruction of the colon: the first, alcoholic, treated with antidepressant drugs, with a long history of intestinal occlusions and explorative laparotomies, treated successfully by conservative therapy; the second, with meningitis, in which right colectomy for the presence of multiple perforations of the cecum was performed; the third with acute neurological problems of ischemic nature, died before any treatment was given; the fourth, with left hemicolectomy performed for cancer, in which transversostomy was performed after colonoscopy and medical treatment with prokynetic drugs had failed; the last one, in a young woman treated with anti-depressant and antipsychotic drugs, treated by conservative therapy. In reviewing 470 cases from the literature the most commonly associated disorders are found; 33 patients (7%) were diagnosed as idiopathic. Only 273 cases were available for detailed analysis of age, sex, mode of treatment, presence of perforation, mortality rate. The mortality rate was 17.6%. When comparing the different treatment procedures, surgery has a higher mortality rate (23.5%) than medical treatment or colonoscopy (12.1%) (p < 0.02). In this study the presence of perforation increased mortality from 15.1% to 29.9% (p < 0.03). The mortality rate for cecostomy is 15.3% vs 30.1% for other surgical procedures. Recently the syndrome pathogenesis is attributed to an autonomic imbalance, between the sympathetic and parasympathetic innervation of the colon: sympathetic prevalence due to sacral parasympathetic derangement, lead to inhibition of colonic peristalsis. The attention must be focused on early diagnosis and prompt treatment; for this purpose colonoscopy seams to be a safe method of establishing the diagnosis and carrying out treatment.

Intravenous immunoglobulin versus corticosteroid in treatment of Graves' ophthalmopathy

We compared the effectiveness of systemic corticosteroids with the use of high-dose intravenous immunoglobulin (IVIG) in the treatment of Graves' ophthalmopathy. This was performed as a prospective, nonrandomized study including a blinded ophthalmological and orbital computed tomographic (CT) evaluation. The two groups of patients were not significantly different in relation to sex composition, age distribution, duration of Graves' disease, and ophthalmopathy and previous hyperthyroidism. All patients were followed up by endocrinologic evaluation and blinded ophthalmological (before therapy = B, at the end of therapy = E, and 6 months after the end = 6M) and orbital CT (B and E) evaluations. Twenty-seven patients treated with IVIG were followed up after the end of treatment for an average of 21 months (range 12 to 48 months). Soft tissue involvement (NOSPECS) improved or disappeared in 32 of 35 (90%) patients treated with IVIG and in 25 of 27 (92.5%) patients treated with corticosteroids. Diplopia improved or disappeared in 22 of 29 (75%) patients treated with IVIG and in 16 of 20 (80%) patients treated with corticosteroids. The results observed by clinical evaluation were confirmed with orbital CT score in 30 IVIG patients and in the corticosteroid-treated patients; a significant reduction of extraocular muscle thickness was observed after treatment in both groups. Proptosis improved or disappeared in 20 of 31 (65%) patients treated with IVIG and in 15 of 24 (62%) patients treated with corticosteroids. Mean values of proptosis evaluated by Hertel's exophthalmometer showed a slight reduction both in IVIG as well as in corticosteroid-treated patients. It is interesting to observe that in 28 IVIG-treated patients in whom it was possible to evaluate soft tissue involvement, proptosis and diplopia in the period between the fifth and sixth month from the start of therapy, the most important part of the amelioration (if responders) was already obtained at that time. Responder patients were defined in relation to the decrease in the highest NOSPECS class or grade. Among IVIG-treated patients 26 of 34 (76%) responded; while in the corticosteroid group 18 of 27 (66%) responded to treatment. The prevalences of patients who responded to the treatments were not significantly different in the two groups (Chi-square). The initial values of the subjective eye score were similar in the two groups, and a significant reduction was observed in both. Major side effects requiring discontinuation of the corticosteroid therapy were observed in two patients with hemorrhagic gastritis and in one patient with manic-depressive psychosis. Among 15 patients submitted to the evaluation of bone mineral content before and after corti-costeroid therapy, 4 presented signs of osteoporosis and 3 a reduction of bone mineral content. Moderate and minor side effects were more frequently noted in steroid-treated patients than in the IVIG group. These data suggest that IVIG is safe and effective in reducing the eye changes in patients with Graves' ophthalmopathy.

The ParaSight-F rapid dipstick antigen capture assay for monitoring parasite clearance after drug treatment of Plasmodium falciparum malaria

Three methods for the detection of Plasmodium falciparum infection in peripheral blood were compared during antimalarial treatment and follow-up in 32 Burundian patients: dipstick antigen capture assay, standard (TBF) and prolonged thick blood film examination (PTBF) (3 x 5 min and 3 x 20 min examination respectively). Parasitaemia was determined daily by comparison with total white blood cell counts (determined by Coulter counter) until no parasite was detected on 2 consecutive days by PTBF. Cumulatively, 231 observations were made with each assay: 64 were negative and 167 positive by PTBF (59 had parasite counts < or = 100/microL). Compared to PTBF, the sensitivities of TBF and the dipstick assay were 1.0 for parasite counts > 100/microL and 0.458 and 0.966 respectively for counts < or = 100/microL. Overall, the dipstick assay was significantly more sensitive (0.988 vs. 0.808; P < 0.001) but less specific (P = 0.013) than TBF. The dipstick assay is of potential use for monitoring response to drug treatment and for detecting low parasitaemias.

Autonomic nervous system imbalance and left ventricular systolic dysfunction as potential candidates for arrhythmogenesis in Becker muscular dystrophy

We evaluated the arrhythmic profile in a population of 20 Becker muscular dystrophy (BMD) patients searching for possible correlations between the severity of the arrhythmic events, the cardiac autonomic balance (assessed by heart rate variability analysis in the time domain) and the degree of left ventricular systolic impairment. A population of 14 male healthy individuals served as the control group. BMD subjects exhibited lower values of SDNN (P=0.013), SDANN index (P=0.008) and 24-h mean heart rate (P=0.002). The total number of premature ventricular beats (totPVB) and the number of PVB out of 1000 heartbeats (PVB/1000) appeared also higher in BMD subjects (P=0.05 and P=0.046, respectively). No difference was found in terms of 24-h mean QTc and 24-h longest QT among the two groups. TotPVB and PVB/1000 were inversely related to both the ejection fraction (r= -0.620, P=0.004 and r= -0.517, P=0.019) and to the shortening fraction (r= -0.568, P=0.009 and r= -0.469, P=0.037). Twenty-four-h mean QTc was also inversely related to both the ejection fraction (r= -0.520, P=0.019) and the fractional shortening (r= -0.491, P=0.028). These data suggest that in BMD there is cardiac autonomic imbalance characterized by sympathetic predominance and an increased susceptibility to ventricular arrhythmias, even in the absence of overt cardiomyopathy. Furthermore, the severity of the arrhythmic profile in BMD appears closely related to the degree of left ventricular systolic dysfunction.

[Proposal for update of Bassini's procedure in the treatment of inguinal hernia under local anesthesia]

Inconvenience due to tension along the suture, a relative high recurrence rate, the availability of optimal prosthetic materials and the tendency to reduce hospital stay are the motivations which induced many surgeons to adopt alternative techniques instead of the traditional ones for inguinal hernia repair. Among these latter it is worthwhile to add a personal update of the Bassini's technique: the plasty tailored upon the polypropylene mesh performed in local anesthesia. Thanks to the use of the prosthetic mesh, the plasty is performed using only four stitches tied loosely without much high tension on the conjoined tendon. Such technical expedients reduced postoperative pain and give better warrant for the plasty and allow hernia repair in local anesthesia and on a daily basis.

[The electrophysiological bases of aberrant intraventricular conduction during atrial fibrillation]

Twenty-four hours electrocardiogram from 4 patients with chronic atrial fibrillation and intraventricular aberrant conduction were analyzed. Aim of the study was to evaluate the reliability of the Ashman's and Akthar's rules in electrocardiographic differential diagnosis between aberrancy and ectopy. We computed parameters related to 10 RR interval preceding the aberrant conduction (AB+ Group), normal complex QRS (AB-Group) and ectopic QRS (E Group): coupling interval (CI), preceding CI cycle (PCL1), preceding PCL1 cycle (PCL2), the difference between PCL1 an PCL2 (delta PCL1), the difference between CI an PCL1 (delta CI), the mean value (RR10) and the standard deviation (RR10SD) of the 10 QRS complexes preceding the end of the sequence. Specificity of Akthar's rule was 48.7% (range 45-50%), sensibility was 90.1% (range 75-100%). PCL2, delta PCL1 and RR10DS were significantly different between AB+ and AB- Group but not between AB+, AB- and E Group. In this work Akthar's rule showed a better reliability than Ashman's rule but specificity was low (probably related to concealed conduction in atrio-ventricular node). RR10DS, but not RR10, were significantly higher in AB+ Group than AB- Group suggesting that acceleration of the cycle length can provoke CVA by increasing the difference between the refractory period of His bundle branches. Aberrant ventricular conduction cannot be determined by a mathematical rule. In the differential diagnosis of wide QRS during atrial fibrillation only morphological analysis of QRS and the study of coupling interval and compensatory pause are helpful.

Micelle-like conformation of humic substances as revealed by size exclusion chromatography

To gain further insight into the macromolecular behaviour of humic substances we treated a humic material with simple organic compounds and followed the change in molecular size distribution. Monocarboxylic, dicarboxylic, and tricarboxylic acids shifted the humic absorbance from high to low molecular sizes in size exclusion chromatograms. Mineral acids, phenol, alcohols, were not able to produce the same shift and gave total absorbance at the column void volume as in the case of humic substances alone. Our results are evidence of the micellar behaviour of humic substances in solution and of the importance of hydrophobic bondings in holding humic molecules together. The organic acids enter in the interior of the humic micelle and alter its stereochemical hydrophobic arrangement. In alkaline conditions, the developed negative charges disrupt the apparent high molecular size configuration and disperse the humic material into small-size micelles. This macromolecular property, that we report for the first time, may be of great importance in understanding the biological activity and the overall environmental behaviour of humic substances.

Acute posterior dislocation of the shoulder: diagnosis

The authors describe the clinical and radiographic findings of posterior dislocation of the shoulder by examining 19 cases observed at the Rizzoli Orthopaedic Institute between 1981 and 1990; of the total number of cases, 16 were acute and 3 inveterate, equal to 1.7%. After analyzing the pathogenesis of the lesion, which was due to direct trauma, indirect trauma, or which occurred during an episode of convulsions, the authors call attention to the rareness of the lesion, and consequently the little amount of knowledge of the clinical and radiographic elements characterizing it. Three varieties are distinguished: subacromial (or retroglenoid), subglenoid, and subspinous. Finally, the results obtained with non-surgical treatment, which always allows for recovery of the joint relationships and complete functional recovery, are reported.

Use of a specific oral hyposensitization therapy to Dermatophagoides pteronyssinus in children with atopic dermatitis

The aim of the present study was to evaluate the efficacy of an oral specific hyposensitization therapy in children with atopic dermatitis and positive prick skin tests and/or RAST to Dermatophagoides pteronyssinus (D.pt.). A total of 60 patients, in three different clinical groups, were selected for a three years clinical trial. Group A: children with atopic dermatitis and allergic asthma and/or rhinitis; groups B and C: children with exclusively atopic dermatitis. Groups A and B received specific hyposensitization therapy. Group C was the control group. The clinical evaluation of the dermatological lesions, at the end of our study, didn't show any significant difference among the three groups. Moreover, the onset of respiratory symptoms between the two groups with exclusively atopic dermatitis was similar and not related to the positivity of prick skin tests and/or RAST to seasonal allergens. Our study suggests that specific hyposensitisation therapy with extracts of D.pt., although with no side effects, does not affect the natural history of atopic dermatitis.

An application of EDXRF on the study of barley seedlings growth on sewage sludge

An energy dispersive X-ray fluorescence method for trace element analysis in plants (leaves and roots) is presented. The method is characterized by the use of a secondary target excitation, thin specimen, and microwave acid digestion. The accuracy is about 10% and the sensitivity is in the range 10-50 ng/cm2. The analysis time (from dry sample to concentration data) is about 4 x 10(3) s. The effects of Cr in sewage sludge on barley seedling growth is presented.

[Adrenal myelolipoma. A case report and review of the literature]

Myelolipoma is a rare benign neoplasm of the adrenal gland, histologically characterized by the presence of mature fat cells and bone marrow elements. In the international literature were reported 126 cases of adrenal myelolipoma surgically treated. The indications to surgical removal of this tumor are the presence of large symptomatic tumours, high risk of spontaneous haemorrhage, and suspicion of malignant neoplasms. The authors present a case of adrenal myelolipoma, preoperatively identified with an abdominal MNR, and surgically removed.

The herniated lumbar intervertebral disc in children and adolescents. Long-term follow-up of 101 cases treated by surgery

The authors review 101 cases of herniated lumbar intervertebral disc in children and adolescents treated by surgery. The most significant etiologic and pathogenetic factors in this series were early onset of disc degeneration, congenital lumbosacral malformations, and repeated trauma. The main clinical symptom was pain, usually sciatica, while neurological symptoms were less common than they are in adults. In all patients diagnosed correctly with the aid of appropriate imaging studies (myelography, CT scan, MRI), discectomy by means of conservative hemilaminectomy achieved satisfactory results, except in two cases of concomitant spinal instability due to spondylolysis and in one case of recurrence.

The epidemiology of idiopathic scoliosis in the city of Bologna. A three-year review of positive cases

The authors report the results obtained in a review of all of the young patients who have been found to be affected with vertebral deformity in an epidemiological study conducted during the academic years 1983-84 and 1984-85. There is predilection for the female sex, which is also more vulnerable to the risk of progression. Menarchal age constitutes the most important period for the progression of the deformity. The most frequent type of curve observed is the double primary one, in particular, right thoracic and left lumbar, which proved to be that most vulnerable to angular progression. The cases which in a previous screening had been defined risk cases were followed-up, and thanks to early diagnosis and suitable treatment surgery was not required in any of these.

[Our experience in the surgical treatment of cysts and fistulas of the thyroglossal duct]

A clinical series of cysts and fistulas of the thyroglossal tract has been examined. Clinical aspects of this pathology and the results obtained with surgical treatment are compared with reported data.