Effects of olive mill wastewater physico-chemical treatments on polyphenol abatement and Italian ryegrass (Lolium multiflorum Lam.) germinability

Direct spreading on agricultural lands may represent an environmentally friendly disposal method and a possible use of water and nutrients from olive mill wastewaters (OMWs). However, the agronomic use of OMWs is limited, among others by polyphenols, which exert phytotoxic effects. Activated charcoal (AC) has been recognized as a very effective agent for polyphenol abatement, as it enables an irreversible process of phenol adsorption. Addition of calcium hydroxide (Ca(OH)2) has also been described as a cheap and effective method in polyphenols abatement. However, the effects of Ca(OH)2 addition to OMW on seed germination are unclear. In this paper, the effects of AC and/or Ca(OH)2 on OMW polyphenols abatement, and Lolium multiflorum seed germination have been investigated. The highest polyphenols removal, approximately 95%, was observed when 80 g L(-1) of AC was added to OMWs (the maximum dose in this investigation). The addition of Ca(OH)2 not only improved the effectiveness of the AC treatment but also resulted in a significant rise in Lolium seed germination at the highest AC doses (60 and 80 g L(-1)). Considering the high salinity (7300 μS cm(-1)) of these wastewaters, low quantities of Ca(OH)2 may also exert a protective effect on soil structure counteracting the sodium-induced dispersion through the binding action of calcium cation on clays and organic matter.

Diet and pancreatic cancer: many questions with few certainties

BACKGROUND, OBJECTIVES: Pancreatic cancer ranks fourth for cancer mortality for men and women in the United States. This is a particularly devastating cancer since the case-fatality proportion approaches 90% within 12 months following diagnosis. Therefore, understanding the etiology and identifying the risk factors are essential for the primary prevention of this deadly disease. Of the few potentially modifiable risk factors that have been identified, cigarette smoking, history of diabetes mellitus, and obesity seem to be among the most consistent, but the effect of dietary factors is still unclear. The aim of our study is to review of the literature examining the potential role of carbohydrates, fatty acids, meat, fruit and vegetables, alcohol.

DISCUSSION

Although large prospective cohort studies with questionnaire based analyses will continue to have much to offer in defining predisposing factors for difficult diseases, such as pancreatic cancer, unfortunately dietary questionnaires do not reflect the bioavailability of the nutrients from various foods, the level of absorption from the digestive tract, or individual differences in metabolism.

CONCLUSIONS

Greater use of participant-derived biological samples, banked plasma, germline DNA, and tumour tissue samples may help to the understanding of pancreatic cancer pathogenesis.

[Biliary tract carcinoma. Case report]

Carcinoma of the main biliary way is a condition that often leads to a fatal outcome owing to the rapid growth and late onset of the symptoms. The importance of a correct, timely diagnosis is stressed, with reference to a clinical case in which even CT scanning did not confirm either the presence of the neoformation or the dilation of the intra and extrahepatic bile ways. The usefulness of humoral markers for the diagnosis of the disease in its preclinical phase in the interests of surgical treatment that is as radical as possible is underlined.

Solid-phase synthesis of cyclic analogues related to the hypoglycaemic peptide hGH(6-13): comparison of two i-->i + 4 lactam cyclization procedures

The use of 1,3-diisopropylcarbodiimide (DIC) for the synthesis of cyclic analogues of the hypoglycaemic peptide fragment derived from the N-terminus of human growth hormone (hGH), namely hGH[6-13], is described. Different strategies were examined to achieve improved yields for the on resin side-chain to side-chain cyclization of the corresponding linear peptides containing reverse beta-turn motifs. When compared with the more reactive Castro's reagent, the results confirm that DIC in the presence of HOBt can be successfully employed to minimize the formation of intermolecular oligomeric byproducts associated with the preparation of cyclic hGH[6-14] peptide analogues based on an i-->(i + 4)Lys-->Glu or Glu-->Lys cyclization strategy.

[The thyroidectomized follow-up]

Thyroid neoplasties are largely benign, and only 1% of all over malignant neoplasties with clinical diagnosis regard the thyroid. The histologic characteristics of the thyroid neoplasties assume fundamental importance both in diagnosis and in therapy. The authors underline the importance of the surgical treatment of malignant neoplasties of the thyroid with the problems connected to the choice of the entity of the demolition of the organ and the post-operative thyrohyoid residue and the importance of the correct follow-up for few patients, consenting to optmize the available resources.

Solid-Phase synthesis of a dendritic peptide related to a retinoblastoma protein fragment utilizing a combined boc- and fmoc-chemistry approach

Dendritic peptides, often presented as multiple antigen peptides (MAPs), are widely used in immunological-based fields of research, although their synthesis can be extremely challenging. In this paper, a tetrameric dendritic MAP-like presentation of the retinoblastoma protein [649-654] sequence (4RB(649-654)) has been prepared using solid-phase peptide synthesis (SPPS) methods. During the synthesis of this dendritic molecule, numerous modifications to the synthetic protocols were examined. These modifications included the introduction of a combination Boc- and Fmoc-chemistry approach and also the use of 1,8-diazabicyclo[5.4.0]-undec-7-ene as a Fmoc-deprotection agent. The use in combination of Boc- and Fmoc-based synthetic strategies resulted in the production of the desired peptide molecule, 4RB(649-654), in high purity and acceptable yields following purification by reversed phase HPLC.

[Pseudomyxoma peritonei with appendiceal and ovarian mucinous cystadenoma. A case report. Correlations with synchronous or metachronous colorectal carcinomas]

Mucocele is a rare pathology which is difficult to diagnose prior to surgery. The clinical symptoms are aspecific. Diagnosis is generally made at the time of surgery. Explorative laparoscopy is not advised owing to the possibility of encouraging metastatic diffusion. Surgery associated with ex tempore freezer tests must be carried out with the greatest caution to avoid rupture of organs and the spread of mucin. Appendectomy and removal of the adnexa is recommended in benign forms, with or without omentectomy. Omentectomy is necessary together with hystero-adnexectomy and right hemicolectomy in malignant forms, as well as lymph node cleaning and removal of all mucin in pseudomyxoma peritonei.

[Early gastric cancer. The therapeutic options]

The best therapeutic treatments for early gastric cancer are evaluated. Due to the difficulty of preoperative and intraoperative staging, it's reasonable to consider early gastric cancer as a composite disease; while some mucous localizations can benefit of minor therapeutic treatments, the submucous cancer must be treated as the parietal gastric cancer.

Solid phase synthesis of cyclic peptides: model studies involving i-(i+4) side chain-to-side chain cyclisation

Conditions for the synthesis of i-(i + 4) side chain-to-side chain head-to-tail Lys-->Glu and Glu-->Lys linked cyclic peptides related to hypoglycaemic analogues of human growth hormone hGH [6-13] have been examined. The success of the cyclisation reaction with the corresponding resin-bound, partially protected linear peptides was found to be both reagent as well as sequence dependent, with competing inter-chain oligomerisation predominating in some cases. The results also indicated that protection with the bulky Fmoc group of the amino acid residues immediately adjacent to the side chain-deprotected Lys and Glu residues, which participate in the cyclisation reaction, enhanced the rate of lactam formation.

Intensive training and cardiac autonomic control in high level athletes

PURPOSE

We aimed to evaluate in a longitudinal study the effect of intensive training on cardiac autonomic control in athletes using 24-h heart rate variability analysis.

METHODS

Time and frequency domain measures of heart rate variability were calculated from 24-h Holter monitoring in 15 high level bicyclists (mean age 21 +/- 4 yr) after 1 month of detraining and after 5 months of vigorous training. At the same times echocardiographic left ventricular mass and dimensions and maximal oxygen consumption (VO2max) were assessed.

RESULTS

In detrained athletes, VO2max values, left ventricular mass and dimensions, and time and frequency domain measures of vagal modulation of heart rate were higher than in a group of untrained subjects of similar age while heart rate and the low-to-high frequency ratio were lower, indicating an enhanced vagal modulation of heart rate in athletes as compared with that in control subjects. After 5 months of vigorous training, left ventricular mass and dimensions and VO2max increased in athletes, while heart rate decreased further. In contrast, no changes were detectable in time and frequency domain measures of heart rate variability over the entire 24-h and in both waking and sleeping hours.

CONCLUSIONS

This study demonstrates that an increased cardiac vagal control is detectable in detrained athletes; however, after intensive training, despite a significant decrease in heart rate, time and frequency domain measures of heart rate variability reflecting cardiac vagal control remain unchanged. Thus, other mechanisms than changes in cardiac autonomic control could be involved in determining the profound bradycardia of athletes.

Twenty-four-hour blood pressure monitoring during treatment with extended-release felodipine versus slow-release nifedipine in elderly patients with mild to moderate hypertension: a randomized, double-blind, cross-over study

OBJECTIVE

This double-blind, placebo-controlled randomized study was designed to compare the antihypertensive effect and tolerability of extended-release felodipine and slow-release nifedipine retard in elderly hypertensive patients.

METHODS

Thirty patients of both sexes (mean age 71 years) with mild to moderate essential hypertension were recruited from our hypertension outpatient clinic. After a 2-week placebo period, felodipine extended-release (felodipine ER), 10 mg once daily, nifedipine slow-release retard (nifedipine SR), 20 mg twice daily or placebo were administered to each patient for 2 weeks according to a 3 x 3 latin-square design. At the end of each treatment period, the patients underwent 24-h noninvasive blood pressure monitoring.

RESULTS

All of the patients completed the trial and no serious adverse experience was reported. In comparison with placebo, felodipine and nifedipine decreased mean 24-h diastolic blood pressure by 6.7 and 4.3 mmHg, respectively, with no significant difference between the two drugs. Mean 24-h systolic blood pressure also decreased after felodipine and nifedipine, with no difference between the two drugs. Both drugs reduced blood pressure variability, lowering the 24-h mean standard deviation of mean hourly blood pressure values. The trough:peak ratio for felodipine was 80% for systolic and 75% for diastolic blood pressure.

CONCLUSION

Felodipine ER once daily lowers blood pressure in elderly hypertensives and is as effective as nifedipine SR twice daily. The high trough:peak ratio suggests that the dose and the between-dose interval of felodipine provides adequate therapeutic coverage.

[Heredity and colorectal cancer]

The authors underline the role of inheritance in colorectal cancer and reporting the genealogical study of two families with high incidence of colorectal cancers personally observed. They thought that the genetic endowment (oncogenes, suppressor genes, microsatellite instability, protein-kinase C) was implicated directly in the genesis of disease.

[The laparoscopic approach to the polycystic liver and adnexal cysts]

Having re-examined the nosographic data acquired on the subject of hepatic polycystosis and uterine adnexal cysts, the authors report the results of their experience. On the basis of the evaluation of these results (no laparotomic conversion, no postoperative complications, reduced hospital stay), which are comparable to those reported in the literature, the authors conclude that the modern technology may be used to advantage in all cases where laparoscopic surgery is not difficult, does not require numerous tests and does not entail a high risk of complications.

[The utility of isolating the recurrent nerve and parathyroids in the prevention of complications in thyroid surgery. The role of the superior laryngeal nerve and C cells]

The authors emphasize systematic isolation of the recurrent nerve and of the parathyroids, to prevent complications in surgery of the thyroid. Moreover they try to underline the significance of the superior laryngeal nerve and the role of parafollicular cells (today unknown) for a rational and modern therapy of the non-neoplastic diseases of the thyroid.

[Ileal and axillary metastasis of primary unknown site melanoma. Clinical case]

The incidence of Cutaneous Melanoma is 4-5% of all the tumors of the skin. This incidence increases several folds in the last years. Metastases of Melanoma involve lungs, skin, soft tissue, liver, bone, brain, but in 20-30% of the patients involve gastrointestinal (GI) tract. In 60-70% of the cases GI metastases involve small bowel, in 15-20% stomach, in 10-20% large bowel, in 5% esophagus. In 8% of the patients the primary cutaneous melanoma is not known. The prognosis of the patients with metastatic melanoma is poor with an average survival of 5 months. One patient male, 51 years old, underwent surgery for metastases from melanoma in the lymph nodes of the right axilla and in the gastrointestinal tract (ileum). An ileo-ileo anastomosis and a lymphoadenectomy of the nodes of the right axilla were performed. After a first chemotherapy with DTIC (800 mg/m2) + a-IFN(3MU three times every week) and another with CDDP (30 mg/m2 day 1-3), DTIC (250 mg/m2 day 1-3) and VDS (2.5 mg/m2 day 1) with no response, the patient was treated with chemo-immunotherapy sec. Bernengo, slightly modified: CDDP 75 mg/m2; IL-2 18 MU (9MU b.d.) day 3-6 and 17-21; a-IFN 5MU three times every week. This therapy had a partial response of short-course (three months) and the patient died 15 months after surgery. The authors hope that immunotherapy and genetic therapy improve the survival of the patients with metastatic melanoma in the next years.

[Primary lymphoma of the small intestine. A clinical case report and review of the literature]

The authors present a case of small bowel primitive lymphoma found in a 66-years-old female. After having briefly reviewed the literature they direct their attention to the clinical-instrumental diagnostic difficulties of this neoplasm which is often discovered only when it has already invaded various organs. Therefore surgical therapy is not always radical. This fact in addition to the fatally rapid postoperative course led the authors to discuss the problems involved in a correct treatment of this pathology.

[Low ileorectal anastomosis in the surgery of ulcerative rectocolitis]

The authors report their experience of 23 patients with ulcerative colitis treated with surgery from 1991 to 1994. At admission 8 patients had a high-grade illness, 10 patients had a middle-grade illness, 5 patients had a toxic megacolon. All the patients were treated with systemic medical management (mesalazine + methylprednisolone) and topical medical management with rectal steroid (methylprednisolone) and rectal mesalazine by enema, and with nutritional support (Total Parenteral Nutrition). The 5 patients with toxic megacolon, after 48 hours of unsuccessful medical management, underwent surgery with deferred urgency; the other 18 patients underwent surgery after one-four months. The authors prefer the ileorectal anastomosis (IRA), since the rectal lesions are more susceptible to topical therapy. A single-stage IRA was performed in 17 patients. A sigmoid resection has been employed in the first stage in the 18th patient with a local development of the disease in the sigma; a following relapse of the lesions required a total colectomy with a low ileorectal anastomosis. A first-stage subtotal colectomy with ileostomy and Hartmann closure of the rectum with low ileorectal anastomosis at a later date was performed in the 5 patients with toxic megacolon. One of these, 18 years old, died after a heart failure. After surgery, as soon as the patients start moving their bowels all of these had again a systemic therapy with mesalazine for a short period and after they had a topical therapy with mesalazine + methylprednisolone by enema, for a long period. The average postoperative period of admission was 16.3 days. The functional results have been encouraging with an average of 1.6 bowel movements daily and an average of 0.4 nocturnal bowel movements. All the patients had a normal anal sphincter function with an acceptable stool frequency. In male patients there no urinary or sexual defects. In one case of these, there was a low grade of dysplasia, revealed by endoscopic biopsy. The authors conclude that today surgical treatment of ulcerative colitis is not well established.

Comparison of verapamil versus felodipine on heart rate variability after acute myocardial infarction

A depressed heart rate variability (HRV) is a powerful predictor of poor outcome in myocardial infarction patients. The beneficial effect of specific interventions on its recovery has been reported, but data concerning calcium antagonists are scarce. We evaluated the effect of a phenylalkylamine derivative, verapamil, and a dihydropyridine derivative, felodipine, on time- and frequency-domain measurements of HRV by 24-hour Holter monitoring in 60 patients with acute myocardial infarction (AMI). After a first Holter recording (65 +/- 8 hours from the onset of symptoms), patients were randomly assigned to continue standard treatment or to also receive verapamil retard (120 mg 3 times daily) or felodipine extended-release (10 mg/day). Holter recording was repeated after 7 days. After verapamil, mean RR interval increased from 823 +/- 92 to 907 +/- 95 ms and the SD of all normal RR (NN) intervals (SDNN) from 99 +/- 24 to 120 +/- 30 ms (p < 0.01); the root mean square successive difference (r-MSSD) and the percent of differences between adjacent NN intervals > 50 ms (pNN50) also increased (p < 0.01). After felodipine, only SDNN increased (p < 0.01). Regarding frequency-domain measurements, after receiving verapamil, very low frequency, low- and high-frequency powers increased (p < 0.01), whereas the low- to high-frequency ratio decreased (p < 0.01). After receiving felodipine, very low-frequency power increased (p < 0.01), whereas low- and high-frequency powers and the low- to high-frequency ratio remained unchanged. This study demonstrates that verapamil, but not felodipine, improves HRV in the early phase after AMI.

[Peritoneal mesothelioma. A case report]

Peritoneal mesothelioma is a rare neoplasm (annual incidence: 1-2 cases per million in the general population) and forms about 10% of all mesotheliomas. The authors report a case of malignant mesothelioma of the peritoneum in a male, 61 years old. After laparotomy the patient was treated with intraperitoneal administration of cisplatin (40 mg/m2 day 1-2-3-29-30-31) and intravenous administration of mitomycin C (10 mg/m2 day 1). The renal toxicity was avoided with the GSH and with prehydration before and after administration of the cisplatin. The bone marrow toxicity was avoided with the subcutaneous administration of G-CSF (300 mg three times each week) and erythropoietin (10.000 U three times a week). After the first cycle, with the reduction of the ascites, the cisplatin was administered intravenously too. After six cycles of chemotherapy (18 months after laparotomy) the patient is alive and he has a performance status of 1 (ECOG/WHO). The chemotherapy with cisplatin and mitomycin C must be preferred to the anthracycline in all the patient with cardiologic involvement. The cisplatin administered by intracavitary route give a quick response with less systemic toxicity. A review of the literature confirms the rarity of this pathology, linked epidemiologically with exposure to asbestos, and the difficulty of the preoperative diagnosis: in fact cytologic assay and ultrasonographic and TC scan always don't permit to discover a mesothelioma. The laparotomy and the laparoscopy are useful in the P.M. for the possibility of the biopsies and the apposition of the catheters for intracavitary therapy. The response of peritoneal mesothelioma to treatment is poor. The median survival after the appearance of the symptom is less than 18 months.

The effects of thymopentin on the development of SLE-like syndrome in the MRL/lpr-lpr mouse

Thymopentin (TP-5) is a synthetic pentapeptide that corresponds to the active 32-36 amino acid sequence of the thymic hormone thymopoietin, of which it retains all the immunomodulatory properties. In this study, we have evaluated the effects of long term prophylactic treatment with TP-5 on the clinical, immunological and histological parameters of the SLE-like syndrome that spontaneously occurs in MRL/lpr-lpr (MRL-lpr) mice. TP-5, administered (s.c.) to these mice at the doses of 1, 10 and 100 mg/kg, was given daily, five times a week, from the 9th to the 26th weeks of life. The prophylactic treatment with TP-5 prolonged in a clear dose-dependent fashion the lifespan of MRL-lpr mice as compared with PBS-treated control mice, and the effect reached statistical significance at the doses of 10 and 100 mg/kg. In parallel ex vivo studies, this clinical effect was associated with multiple profound modifications of the immune system including: (i) the reduction of the spontaneous and Con A-induced release of interleukin-4 (IL-4); (ii) the increased secretion of interferon-gamma (IFN-gamma) and IL-6 upon polyclonal mitogenic stimulation, and (iii) the amelioration of the defective Con A-induced lymphoproliferative response. In contrast, although the drug diminished the severity of proteinuria in MRL-lpr mice, it neither reduced histological signs of lupus nephritis nor diminished the serum titres of anti-native DNA and anti-histone autoantibodies. These results indicate that TP-5 displayed powerful immunodulatory activities in a well known model of human SLE.

The effect of cefepime on some immune parameters in vitro: lack of interference with mitogen-induced lymphoproliferation, immunoglobulin synthesis, IFN-gamma and IL-2 secretion and IL-2 receptor expression

The possible interference of the novel antibiotic cefepime (CPE) with some functions of the immune system was investigated in vitro. Peripheral blood mononuclear cells (PBMC) cultured in the presence of drug concentrations ranging from 25 to 100 micrograms/ml normally maintained their responsiveness to polyclonal (PHA, Con A, PWM) mitogenic stimulation in regard to proliferative response, IgM and IgG synthesis and IFN-gamma and IL-2 secretory capacity. Moreover, PHA-induced expression of IL-2 receptors was comparable in PBMCs cultured in the presence or absence of CPE. Taken together, these data suggest that CPE does not interfere, at this specific level, with T- and B-cell mediated functions in vitro.

Effects of sustained training on left ventricular structure and function in top level rowers

The effects of vigorous training on left ventricular structure and function were evaluated in 15 top level rowers using electrocardiography, Doppler echocardiography and radionuclide angiography. All subjects were studied after 1 month of deconditioning and again after 5 months of vigorous training. After training there was an increase in the ventricular hypertrophy voltage criteria proposed by Sokolow-Lyon and by Friedman but not in that proposed by Casale; T wave amplitude in leads V5 and V6 increased in nine subjects, was unchanged in one and decreased in five; the mean values were also unchanged. Training induced a significant increase in left ventricular end-diastolic and end-systolic diameter and in left ventricular mass index, while peak systolic stress and mean wall stress index decreased. No change was detected after training in the mean values of Doppler echocardiographic and radionuclide angiographic data; nevertheless a significant relationship was found between changes in T wave height in V5 or V6 and in peak filling rate, and between changes in T wave height and ejection fraction. Our study confirms that the effect of vigorous training on left ventricular mass and dimensions does not include changes in mean values of systolic and diastolic function. The relationship between change in T wave amplitude and in peak filling rate values suggests that some metabolic or neurohumoral derangement occurs in the subset of athletes with T wave flattening, that is responsible for the slight reduction in peak filling rate and ejection fraction.

[Preliminary results of a bacteriologic and immunologic study in patients subjected to colorectal surgery]

This study examines patients undergoing colorectal surgery for carcinoma, bacteriological data in faecal and systemic immunological data; these patients before surgery received short-term chemoprophylaxis with ceftriaxone (2 g e.v.) and thymopentina (1 phial/day for 15 days) and after surgery thymopentina (1 phial for three time a week). With these data the authors try to create immunomodulation and antibiotic chemoprophylaxis protocol for the reduction of the septic complications due to intestinal bacterial flora and immunological defence reduction.

Effect of a broad-spectrum cephalosporin on the oral and intestinal microflora in patients undergoing colorectal surgery

The influence of ceftriaxone on oral and intestinal flora was investigated in 10 patients undergoing colorectal surgery. Ceftriaxone was given intravenously in one 2g dose before anesthesia. Saliva and feces samples were collected and analyzed on day 0, 3, 5, 14 and 28 after drug administration. All specimens were cultured quantitatively for aerobic and anaerobic microorganisms; representative colonies of each morphologic type of organism cultured were identified. The oral aerobic flora was somewhat affected by the administration of ceftriaxone. In all patients the number of Streptococci, Staphylococci and Neisseria decreased during the 5 days after ceftriaxone administration. No significant changes in the number of anaerobic commensal occurred. The oral microflora of all patients after 14 days had returned to normal. The aerobic fecal flora was considerably affected: in all patients enterobacteria were eliminated or strongly suppressed. Only minor changes in the number of aerobic gram-positive bacteria were observed, and the anaerobic intestinal flora showed only minor alterations. On day 28 the intestinal flora were normalized in all respects. No new colonizing microorganisms were isolated during the investigation period and no colonization with ceftriaxone-resistant bacteria was observed. No postoperative infection occurred and no adverse effects were registered.

[Cardiac changes induced by deconditioning in athletes: an echocardiographic and electrocardiographic study]

The relationships between echocardiographic and electrocardiographic variations and the sensibility of three different electrocardiographic criteria of left ventricular (LV) hypertrophy were assessed during deconditioning in 18 top-level oarsmen (mean age 23 +/- 4 years). After seven months of training and on the 7th and 21st deconditioning days the oarsmen underwent clinical examination, electrocardiogram (ECG) and echocardiogram with Doppler evaluation. The following ECG measurements were obtained: heart rate (HR), QTc, QRS and T waves axes, QRS and T wave angular gradients, R, S and T wave amplitude and T wave area. Moreover, the sums of S wave in lead V1 plus R wave in lead V5 or V6, of S wave in lead V1 or V2 plus R wave in lead V5 or V6, and of R wave in lead aVL plus S wave in lead V3 were calculated as indices of left ventricular hypertrophy. The following echocardiographic parameters were also analyzed: intraventricular septal (IVST) and posterior wall thickness (PWT), LV internal diameter (LVID), left ventricular mass (LVM) and volumes, LV endocardial/epicardial diastolic surface area ratio, peak systolic meridional wall stress (PSS), end-systolic stress (ESS) and mean systolic wall stress (MWSI), LV ejection fraction (EF) and total peripheral resistances (TPR); early (E) and late (A) transmitral peak flow velocity, E/A ratio. Systolic blood pressure was reduced after 3 deconditioning weeks, while diastolic blood pressure and HR were unchanged. Left ventricular mass and end-systolic volume were reduced after 1 week, while LV end-diastolic volume only after 3 weeks; therefore, EF improved at the end of the first week when TPR were lower. End-systolic stress always remained unchanged; PSS increased at 1 week and then returned to previous values. In addition, the endocardial-epicardial area ratio increased after 1 week and then returned to starting values after 3 weeks. Doppler parameters were in the normal range and remained unchanged during the study. Amplitudes of R wave in aVL, V5, V6 and of S wave in V2 did not change, while S wave amplitude in V1 and V3 decreased after three weeks and one week, respectively. The most sensible criterion for LV hypertrophy was the sum of S wave in V1 or V2 plus R wave in V5 or V6 (range from 33.3% to 22.2%); the sum of S in V1 plus R in V5 or V6 performed better than the sum of R in aVL plus S in V3.(ABSTRACT TRUNCATED AT 400 WORDS)

Aztreonam versus gentamicin for short-term prophylaxis in biliary and gastric surgery

Short-term antibiotic prophylaxis was studied in 80 patients undergoing biliary or gastric surgery. The patients were randomized to receive 1 g of aztreonam or 80 mg of gentamicin intravenously 30 minutes before surgery and 8 and 16 hours after surgery. Of samples taken from the abdominal cavity for bacteriologic study, 53% were culture positive. Wound infections developed in two (4.5%) of 44 patients receiving aztreonam and in seven (19.4%) of 36 patients treated with gentamicin. Staphylococcus epidermidis and Enterobacter species were isolated from sites of wound infection in the aztreonam group; Escherichia coli (two isolates), Pseudomonas aeruginosa (two isolates), Enterobacter species, Klebsiella species, Enterococcus faecalis, and Aeromonas hydrophila were isolated from the gentamicin group. Our data indicate that aztreonam is safe and effective for the prevention of infections following biliary and gastric surgery.

[Surgical chemoprophylaxis with ceftriaxone]

Ceftriaxone is a cephalosporin of third generation. It is characterized by a broad spectrum, a long half-life and a good capacity of diffusion in tissue. We have studied 67 patients. Age ratio was 44 years. 25 patients did not receive short term prophylaxis; 42 patients did (2 gr iv of ceftriaxone one hour before the operation). In clean surgery, only patients immunodepressed or malnourished received chemoprophylaxis. Patients who received 2 gr iv of ceftriaxone one hour before incision, received antibiotic therapy only on the appearance of septic complications.

RESULTS

two patients submitted to chemoprophylaxis (4.8%) showed complications (cystitis and bronchial pneumonia). In the control group antibiotic therapy was undertaken only if septic complication appeared. 19 patients (76%) did not showed any complications. 6 patients (24%) showed surgical wound infection, acute pharyngo-tracheitis, cystitis. Finally, wound infections were limited exclusively to the control group. The ratio of respiratory infections was not statistically significant in the two groups; cystitis resulted more frequent in the control group than in the prophylaxis group. Prophylaxis with 2 gr single dose of ceftriaxone intravenously is effective in reducing the influence of infective complications in clean/contaminated surgery and clean risk surgery.

[Staplers in surgery: state of the art]

After a review of the technical development and application of staplers from their introduction to the present day, the indications to the use of this instrument in all gastroenterological areas from the oesophagus to the rectum as well as in chest, gynaecological and urological surgery specified. The advantages offered by staplers in the creation of intestinal anastomoses are undeniable, but these instruments must be considered alternatives to traditional surgery, the techniques of which should be well known to all surgeons. In certain areas (gastric, ileal and colonic resections etc.), the now widespread return to single thread manual stitches sheds a new light on staplers and reflects the fact that an anastomosis can be performed just as quickly by hand but will be softer and less rigid than a stapled one. It is only in oesophageal and lower rectal surgery that staplers offer a significant advantage, solving problems where hand suturing cannot.

Radiologic anatomy of the genital venous system in female patients with varicocele

The diagnosis of varicocele in a female patient is difficult clinically. Until recently, only celioscopy and uterine phlebography were helpful. We have developed a new method for diagnosis of the pelvic varicocele using retrograde phlebography of the ovarian and iliac veins. Thirty-three women with pelvic pains and disorders of the menstrual cycle have been studied. In 15 patients, an insufficiency of the left ovarian vein was revealed. In three of the patients, an analogous insufficiency of the right ovarian vein was also recognized, along with chronic bilateral stasis in the pampiniform plexes. An insufficiency of the left iliac vein was present in seven of the patients without ovarian varicocele. The average age of the women without ovarian reflux was lower (22.5 years) than that of women with reflux (36.6 years) (p less than 0.01). In this last group of patients, the number of pregnancies was greater (30 children) than in the group without reflux (two children) (chi-square = 12.75; p less than 0.001). This indicates how parity plays an important role in the determination of the appearance of a varicocele. We conclude that the diagnosis of pelvic varicocele may be made by a new diagnostic method represented by retrograde phlebography of the ovarian and iliac veins. The use of it in patients with chronic pelvic pains and disorders of the menstrual cycle of unknown nature can be done routinely.

[Ischemic coronary artery disease in menopause]

Women show a lower incidence of Coronary Artery Disease (CAD) and probably a better prognosis than men. However better survival rate of women tended to be obscured because they were more likely to have histories of hypertension and diabetes and to be older than men. In this paper, incidence, clinical presentation, and prognosis of CAD in women are examined. Furthermore the conflicting reports concerning the effect of estrogen use on morbidity from CAD are reported. Finally the syndrome of angina with a normal coronary arteriogram, sometimes referred to as "Syndrome X" is analyzed.

Short-term antimicrobial prophylaxis in surgery. The state of the art

The authors pointed out that contamination may be exogenous, as a result of invasive diagnostic techniques, patient preparation, surgery, catheter insertion and wound dressing, or endogenous, especially in patients with specific risk factors (age, metabolic disorder, malnutrition, immunodeficiency) and aspecific risk factors (anesthesia, blood transfusion, surgery). Pharmacologic prophylaxis of infection may be unspecific (artificial nutrients, anticoagulants, immunomodulators) or specific (antibiotics). Prophylaxis is indicated in clean-contaminated and contaminated surgery; antibiotic chemoprophylaxis is also indicated in risk patients and permanent prosthesis surgery. The authors emphasized that antibiotics are no substitution for careful surgery.

[Diagnostic value of pan-cavography in obstructed central venous return of intrinsic causes]

The authors, after having analyzed the clinical patterns and the causes producing cava syndrome, propose a sequential diagnostic approach to it, whose course makes use of radiological procedures more or less invasive, and of endoscopic and histobioptic techniques. Among radiological investigations pan-cavography has allowed the authors to formulate the diagnosis of limited venous return because of intrinsic causes, conferring so an aetiological connotation and a physiopathological correlation indispensable for a correct and rapid therapy of the uncommon "intrinsic cava syndrome" of two patients, suffering respectively from "idiopathic thrombosis of superior vena cava, concerning also the beginning of inferior vena cava" and from "Fiedler cardiomyopathy".

[Intestinal subocclusion caused by lymphoma of the small intestine]

Primitive gastrointestinal lymphomas constitute a rare pathological event, may involve any part of the gastrointestinal tube, and normally belong to the non-hodgkin variety. They do not present characteristic symptoms as compared with what can be found in other gastrointestinal lesions whether neoplastic or inflammatory. Radiologically and endoscopically they do not evidence any particular aspects, so that they can be confused with other diseases (gastroduodenal ulcer, benign tumours, epithelial malignant tumours). For such primitive forms, radical surgical treatment constitutes the first treatment and undoubtedly the fundamental form, with which radiotherapy and chemotherapy may be associated. In addition to a review of the literature, the Authors examine a case of intestinal lymphoma complicated by a picture of subocclusion.