[Off-label use of intravitreal bevacizumab for severe retinopathy of prematurity]. / Uso off-label de bevacizumab intravítreo en retinopatía del prematuro severa.

OBJECTIVE: To examine the quality of evidence and the variability in the off-label use of intravitreal bevacizumab for retinopathy of prematurity (ROP). METHODS: A wide review of the literature was performed using Pubmed, Medline, and Cochrane database, using the words vascular endothelial growth factor (VEGF), retinopathy of prematurity, treatment and bevacizumab. RESULTS: Case reports, case series, reviews, one sistematic review and one randomized controlled trial were found on the use of intravitreal bevacizumab in severe ROP, as monotherapy or combined with láser and/or vitrectomy. CONCLUSIONS: The results shown on the use of intravitreal bevacizumab in ROP stage 3+ in zone I or in aggressive posterior ROP are promising. However, uncertainty remains regarding its maximum tolerable dose in the neonatal group, its ocular and systemic safety profile, or its efficacy and bioactivity in a developing child. This report found no significant differences in the recurrence rates of ROP stage 3+ in zone II in patients treated with intravitreal bevacizumab monotherapy in comparison to láser, although the latter is the best option due to long-term safety and efficacy. The use of intravitreal bevacizumab is not indicated in stages 1 and 2 of ROP as the risk of severe visual loss is low and VEFG is necessary for normal retinal vessel development. On the other hand, the use of intravitreal bevacizumab would be contraindicated in stages 4 and 5 because the retinal detachment is accelerated.

DC magnetic susceptibility and neutron powder diffraction analysis of the perovskite-type compounds LaYbO3 and LaHoO3.

Magnetization measurements and neutron powder diffraction analyses followed by Rietveld refinement have been carried out in order to investigate the magnetic structures of LaYbO3 and LaHoO3. Both compounds exhibit a negative thermal expansion along the a and b axes. In LaYbO3 Yb(3+) spins order at 2.4 K according to a FyGz-type structure, belonging to the Pn'ma' magnetic space group. Conversely, LaHoO3 is paramagnetic down to 1.5 K.

Structural, microstructural and magnetic properties of (La(1-x)Ca(x))MnO3 nanoparticles.

The crystal and magnetic structures of 10 and 20 nm sized (La1-xCax)MnO3 (x = 0.37, 0.50, 0.75) have been investigated between 5 and 300 K by means of Rietveld refinement of neutron powder diffraction data, coupled with transmission electron microscope observation and magnetization measurements. TEM observation reveals that nanoparticles are strongly affected by strain fields, probably originating from surface pressure. Irrespective of the composition, charge and orbital orderings are suppressed and Fz and Cy spin orderings coexist at low temperature; Cy and Fz orderings likely occur within the strained regions of the nanoparticles and in the matrix respectively. Moreover Gz and Az orderings are sometimes observed, and are likely to be taking place at the border of the strained regions.

Neutron powder diffraction investigation on the crystal and magnetic structure of (Ho(0.50+x)Ca(0.50-x))(Mn(1-x)Cr(x))O3.

The crystal and magnetic structure of (Ho(0.50+x)Ca(0.50-x))(Mn(1-x)Cr(x))O(3) (x = 0.00, 0.01, 0.02, 0.03) has been investigated between 5 and 300 K by means of neutron powder diffraction followed by Rietveld refinement and dc magnetic measurements. During cooling an orthorhombic to monoclinic phase transition occurs on account of the charge and orbital ordering taking place in the Mn sub-lattice; at low temperature phase separation takes place and the main monoclinic phase coexists with a secondary orthorhombic phase, whose amount slightly increases with the increase of Cr content. Cr(3+) is not involved in orbital ordering or superexchange interactions. The charge and magnetic ordering are decoupled: the Mn moments order according to a CE-type structure in all samples.

Ultrasound-guided liver resection: Early experience in a district general hospital.

INTRODUCTION: Intraoperative ultrasonography (IOUS) is the gold standard for tumor staging and operative decision making in liver surgery. Providing dynamic information on tumor-vessel relationships and distribution of intrahepatic veins, IOUS is also an important support for guiding the resection. Few authors report an extensive use of IOUS-guidance as a safe and effective approach. The aim of this study is to investigate the short-term results of an early experience of ultrasound (US) guided liver resection. METHODS: From December 2005 to December 2007 an extensive use of IOUS-guided resection was applied in 11 consecutive patients (8 males and 3 females; median age 74 years). Perioperative data were collected prospectively to assess the influence of this approach on mortality, morbidity and early recurrence. RESULTS: Four patients had hepatocellular carcinoma, 4 liver metastases, 1 peripheral cholangiocarcinoma, 1 hemangioma and 1 inflammatory pseudotumor. A median of 1 (range: 1-4) nodule per patient was resected. Median lesion size was 44 mm. Liver procedures included: 3 wedge resections, 3 subsegmentectomies, 4 segmentectomies and 3 bisegmentectomies. Median blood loss was 235 ml. Median surgical margin in cancer patients was 5 mm (range: 1-12). An average of 1 unit of blood transfusion was administered in 5 patients. Median postoperative hospital stay was 9 days. There was no mortality. Major complications occurred in 1 patient and minor complications in 5 patients. During a median follow-up of 14 months no recurrences were observed. CONCLUSIONS: In this study, use of IOUS-guided liver resection performed in a district general hospital proved to be a safe and effective approach in terms of short-term outcome.

Aspectos epidemiológicos, clínicos y micológicos de la histoplasmosis en pacientes HIV positivos / Epidemiologic, Clinical and Mycological aspects of patients with aids related to histoplasmosis

Se evaluaron retrospectivamente aspectos epidemiológicos, clínicos y micológicos de 15 pacientes con histoplasmosis asociada al SIDA internados en la Sala 11 del Hospital Muñiz, durante un período de 5 años. La mayor parte de los pacientes habitaban al momento de la internación o habían nacido dentro del área endémica de la histoplasmosis, en localidades del Gran Buenos Aires o en la ciudad de Buenos Aires. Fiebre, disminución del peso corporal, tos con expectoración y lesiones mucocutáneas fueron los hallazgos clínicos más frecuentes, seguidos por adenomegalias, sudoración, diarrea, dolor abdominal, cefalea y disnea. La radiografía de tórax reveló infiltrados pulmonares, en su mayoría con distribución bilateral y la ecografía abdominal evidenció la presencia de hepato y esplenomegalia. La microscopía del material obtenido por escarificación de las lesiones cutáneomucosas y los hemocultivos por el método de lisis-centrifugación permitieron el diagnóstico micológico de la casi totalidad de los casos

[A splenic autograft in posttraumatic splenectomies]. / Autoimpianto splenico nelle splenectomie post-traumatiche.

BACKGROUND AND AIMS: The authors report their experience regarding the use of autologous splenic transplantation in post-traumatic splenectomy unable to be treated using conservative surgery. After reviewing the international literature on the subject, they report a retrospective survey of cases treated from January 1992 to December 1996. METHODS: Owing to the particular logistic location of the hospital in an area with a high density of industry and at the crossroad of major road and rail routes, a total of 56 patients were admitted to the Emergency Ward suffering from abdominal trauma in 4 years. The patients included in this study could not be treated using conservative surgery: the study group included 15 patients aged between 14 and 76 years old. The surgical technique consisted of the graft of sections of splenic pulp in omental pockets, subsequently marked using metal clips. In order to evaluate splenic immunological function a complete hemochromocytometric examination was performed in each patient at the same time as emergency preoperative tests consisting of peripheral blood strip and pitted cells (PC) assay. This was followed by postoperative evaluations at weekly intervals, including platelet count, Howell-Jolly bodies assay (HJb), immunoglobulin M assay and hepatosplenic scintigraphy using erythrocytes marked with 99m-Technetium pertechnetate (99mTc). RESULTS: An adequate functional recovery of splenic tissue was achieved in all patients with partial recovery of hemocatheretic and immunological function. CONCLUSIONS: The authors' clinical experience confirmed the data inferred from animal experiments: the simplicity of the preparation technique and the autologous transplantation of splenic pulp in the absence of major complications confirms the possibility of applying this method in all splenectomies performed under emergency conditions.

Surgical treatment of abdominal aortic aneurysm in association with horseshoe kidney. Three case reports and a review of technique.

Horseshoe kidney is a rare congenital anomaly that can create various technical problems during surgery for repair of abdominal aortic aneurysm. The diagnosis of this anomaly should be confirmed preoperatively in order to plan surgical strategy. Nowadays, in more than 90% of all cases, ultrasonography, contrast computerized tomography, urography, and angiography are the best instrumental methods of detecting this anomaly in association with abdominal aortic aneurysm. The transperitoneal approach assures the best exposure of the kidney, the ureters, the aneurysm, and both iliac vessels, but the renal isthmus can pose a problem in reimplanting aberrant renal arteries. When it is known preoperatively that renal revascularization should be performed, the left extraperitoneal approach is a better choice. In any event, the coexistence of horseshoe kidney and abdominal aortic aneurysm does not preclude the treatment of the latter. In elective surgery of abdominal aortic aneurysm, the morbidity and mortality rates in the presence of horseshoe kidney are much the same as those in the presence of normal kidneys. The best results in this kind of surgery are obtained by adapting one's surgical technique to each anatomical variant that is encountered.

[Primary lung Kaposi sarcoma associated to AIDS in a heterosexual drug addict man]. / Sarcoma de Kaposi pulmonar primario asociado a SIDA en un varón heterosexual drogadicto.

A case of lung Kaposi sarcoma (KS) in the absence of cutaneomucosal lesions was observed in a 30-year-old heterosexual male with AIDS and a history of intravenous drug addiction. Both chest X-ray and CT scanning disclosed a diffuse nodular pattern in lungs, whereas endoscopy failed to demonstrate endobronchial damage. Cytological examination of the sample taken by transthoracic lung puncture proved compatible with primary KS, a rare neoplasia in heterosexual male drug addicts with AIDS. A year following the diagnosis of KS, the patient died of respiratory failure.

[Probable HIV transmission by female homosexual contact]. / Probable transmision de HIV por contacto homosexual femenino.

Here we report a case of HIV infection in a lesbian lacking other risk factors. She had sought advice for asthenia and unexplained weight loss. The physical examination disclosed oropharyngeal candidiasis and generalized lymphoadenopathies. The patient defined herself as an active sexual partner and denied having any heterosexual intercourse whatsoever. Particle agglutination test proved positive for anti-HIV, as well as two consecutive ELISA assays, confirmed by Western blot. Since there was no history of blood transfusions or intravenous drug addiction, it may be concluded that HIV transmission was most likely due to female homosexual practices.

Sarcoma de Kaposi/Sida en pacientes de sexo femenino: consideraciones a proposito de cinco casos / Kaposi's sarcoma in female sex patients considerations apropos of five cases

Se relatan cinco casos de sarcoma de Kaposi Sida en pacientes de sexo femenino. Se destaca que todas tuvieron lesiones en las mucosas accesibles; que dichas lesiones a veces precedieron a las cutaneas, que en ningno de los casos el contagio de Sida fue transfusional o por inyeccion de productos de sangre, y que en la mayoria de los casos el sarcoma de Kaposi aparece cuando el deterioro inmunologico ya es muy marcado, preanunciando un rapido desenlace fatal. Esto ultimo, en contraste con lo que sucede en el sexo masculino

Modifications of the Poggendorff effect as a function of random dot textures between the verticals.

In the present research, we investigated the modification of the strength of the Poggendorff illusion as a function of different densities of random dot textures filling the space between the verticals. The results of Experiment 1 show that the illusory effect is a nonlinear function of the texture parameter r, the ratio of black pixels to white and black pixels, with a minimum for r = 0.5, approximately, and a maximum for r = 0 and r = 1. The results may be interpreted by an analytical model of perceptual space dynamics, in which the effect depends on the amount of interaction between points of different light intensity. A computer simulation performed by applying the analytical model to different values of r shows a good agreement between the predictions and the experimental data. To test the hypothesis underlying the model, a second experiment was carried out to measure the magnitude of the expansion of the space between the verticals as a function of the parameter r. The results are consistent with the hypothesis of the model. The overall data are discussed in terms of their implications on various theories proposed for the Poggendorff illusion.

Stereokinetic effects with sharp and fuzzy illusory contours.

A black, 8-shaped pattern, whose centre of gravity is in the centre of a rotating disc, appears to split into two black discs rotating with phenomenal independent motion, orientation stability, and sliding of one on the other. The type of observed movement, the order of overlapping, and the extent of the stereokinetic depth in relation to the contour type and different dimensions of the pattern were investigated. The experimental data show that a fuzzy contour facilitates the stereokinetic effect. Furthermore, the extent of the stereokinetic depth has been found to be greater in case of fuzzy contour and vertical orientation of the pattern. These results are in contrast with the models in which this effect is considered as a problem of minimisation of distances or velocities. A vector model of the observed movement and an interpretation of the overlapping based on an energy approach are proposed. A tentative explanation of the stereokinetic depth for our patterns is put forward.

[The use of a total parenteral nutrition solution in major gastrointestinal surgery]. / L'impiego di una soluzione nutritiva completa in chirurgia gastrointestinale maggiore.

This study evaluates the efficacy and tolerance of a complete preparation for TPN, "Trive 1000" consisting of an emulsion of lipids, amino acids and sorbitol, balanced in the substratum with a caloric water ratio of 1 cal/1 ml. The preparation offers sterility and simplicities of use guarantee. 20 patients, subjected to major digestive surgery, were treated. The valuation of the product has been effected through nourishing index of common use and by checking of side effects. The results confirm the handling and the tolerance of "Trive 1000" although in hepatic and nephropathic patients the solution must be used with caution.

The orientation of a parallel-line texture between the verticals can modify the strength of the Poggendorff illusion.

In the present experiments, we attempted to evaluate the modification of the strength of the Poggendorff illusion as a function of the different orientation of a parallel-line texture filling the space between the vertical lines. In Experiment 1, the standard version of the Poggendorff configuration was tested against four different parallel-line textures oriented at 0 degrees, 45 degrees, 90 degrees, and 135 degrees with respect to the obliques. The results showed that the illusory effect was a linear function of the progressive discrepancy between the angle of the lines of the texture and that of the obliques. In Experiment 2, we tested the same textures used in Experiment 1 after the elimination of the two vertical lines. The data obtained approximated a linear function, as in the previous experiment, but the alignment errors were consistently lower. The statistical analysis performed on the data of all eight experimental conditions shows that both factors--texture and presence/absence of verticals--were significant, but most of the effect was due to the texture factor. The results may be interpreted through the "perceptual compromise hypothesis," originally proposed for the bisection forms of the Poggendorff illusion, but with important modifications. The data are also discussed in terms of their implications for other theories proposed for the Poggendorff illusion.

Surgical infections surveillance: results of a six-month incidence study in two Italian hospitals.

In a six-month incidence study of surgical wound infections (SWI) in two Italian hospitals, 1,019 surgical patients, in three general surgery wards, and 433 surgical patients in one orthopedics ward were studied. For the SWI surveillance, the DANOP-DATA system was used: this microcomputer program was developed by Danish authors and tested in a European multicenter study coordinated by the World Health Organization in 1989. Two Italian hospitals participated in the multicenter study. The overall infection rate was 1.2 per 100 operations in orthopedics and 4.9/100 in general surgery. The risk of infection increased with age (RR = 2.06; 95% CL = 1.20-3.53), wound class (RR = 3.38; 95% CL = 1.97-5.8), length of pre-operative stay (RR = 2.71; 95% CL = 1.54-4.74), and duration of operation (RR = 2.59; 95% CL = 1.48-4.54). The infection rates ranged from 3.7 to 7.3/100 among the three general surgery wards; this variability by ward was only partially explained by differences in the age distribution of in-patients, wound class, duration of operation and length of pre-operative stay. When all these risk factors were simultaneously taken into account using a logistic regression model, the odds radio, comparing one of the three general surgical wards with the other two, was still 2.29 (95% CL = 1.23-4.26). The observed variability can be attributed to differences, among the participating wards, in the case-mix of patients treated and/or to differences in the quality of infection control programs implemented.

Effects of tryptophan depletion on Poggendorff illusion, corner Poggendorff illusion, and attention.

The effects of a tryptophan-free amino acid mixture on Poggendorff illusion, corner Poggendorff illusion, and attention were investigated with 12 male subjects who ingested either a balanced amino acid mixture or a tryptophan-free mixture, the latter known to cause a marked depletion of brain tryptophan and serotonin. No significant difference between the two mixtures on the perceptual illusions was found.

[Picotamide monohydrate prophylaxis of deep venous thrombosis in patients undergoing general surgery. Clinical experience]. / Profilassi con picotamide monoidrata della trombosi venosa profonda in pazienti sottoposti ad interventi di chirurgia generale. Esperienza clinica.

The authors report their experience with the use of picotamide monohydrate for the prophylaxis of lower limb deep vein thrombosis in patients submitted to general surgery. Thirty-two patients were treated with the drug starting with 1200 mg daily three days before surgery and tapering to 900 mg daily in the postoperative period. The efficacy of the drug was found to be comparable to that of other currently used treatments and was not beset by a significant incidence of side effects.