Effect of conditioning horses every third day at v10 on measures of fitness.

This study examined the effect of exercising horses five times per fortnight with two bouts of 5 min duration at their v(10) with 2 days between consecutive exercise sessions. Five Anglo-Arabian horses were treadmill-conditioned for 6 weeks. A standardized exercise test (SET) was performed at the beginning of the conditioning period (CP) to determine the blood lactate-running speed (BLRS) and the heart rate-running speed (HRRS) relationship and the SET was repeated every 2 weeks. After each SET, the BLRS relation was used to calculate the horse's speed (v = velocity), which produced a blood lactate concentration (LA) of 10 mmol/l (v(10) ) and 4 mmol/l (v(4) ). From the HRRS was calculated the speed at which the horses had a heart rate of 180 b/min (v(180) ). Each horse was then conditioned for the next 2 weeks five times at its individual v(10) for two 5-min bouts. Exercise speed was individually adapted to the new v(10) every 2 weeks. In addition, horses were submitted to another SET prescription to determine the peak oxygen consumption (VO(2 peak) ) before, after 3 weeks and at the end of CP. The v(4) of horses increased during the CP (p < 0.05). v(180) did not change (p > 0.05). VO(2 peak) increased in the first 3 weeks of CP (p < 0.05) and levelled off afterwards (p > 0.05). The conclusion drawn was that exercising horses five times per fortnight at their v(10) for two 5-min bouts with 2 days between consecutive exercise sessions improved v(4) and VO(2 peak) but not v(180).

Pattern of recurrence after surgery in adenocarcinoma of the gastro-oesophageal junction.

AIMS: This study reports mode, timing and predictive factors of recurrence after curative surgery for cardia cancer. METHODS: A prospective study in a series of 92 curatively (R0) resected patients from 1988 to 2002. RESULTS: The 5-year recurrence rate was 71%. Lymph node involvement was the only predictor of recurrence. No patients with more than 6 metastatic nodes were free from relapse 2 years after surgery. Locoregional, peritoneal and haematogenous relapses showed a similar median recurrence time (12, 10 and 12 months, respectively), 80% occurred within 24 months. CONCLUSIONS: Few patients can be cured by surgery, lymph nodal involvement is the only predictor of recurrence.

High-dose chemotherapy in small-cell lung cancer.

Small cell lung cancer (SCLC) is highly sensitive both to radiotherapy and chemotherapy. Given its high chemo sensitivity, even two decades ago, SCLC was one of the first malignancies deemed suitable for maximising the dose and dose intensity with the support of autologous bone marrow (ABMT). On the whole, results were disappointing and the procedure was practically abandoned. Nowadays some interest is again emerging due to improvements in supportive care, such as the availability of hematopoietic growth factors and the peripheral blood progenitor cells (PBPC). Data of 505 patients included in 26 studies were reviewed. About two thirds of these patients had LD (limited disease). Late intensification protocols were used in 311 patients who, however, represented only the 30% of the population initially given conventional chemotherapy. Of the patients not achieving complete remission (CR) after induction, high-dose induced a CR in 39% of the cases. The use of early intensification was reported in 8 studies including 194 patients. The CR rate was 51.5%. Overall, the probability of achieving the CR was 2-3 times higher in LD than in ED (extensive disease). Relapses occurred at the site of the primary in more than half of the cases, showing that the course of the disease was not modified by the use of high-dose chemotherapy. Toxic deaths occurred in 7% of the treated patients, without difference in the two treatment methods. Though the schedules were too variable to draw firm conclusions, the ICE (ifosfamide, carboplatin, etoposide) and the CBP (cyclophosphamide, cisplatin, carmustine) regimens apparently provided better results, with a 2-year survival rate of 30-50% in the LD subset. An european multicenter randomized trial is ongoing. At the present time high-dose chemotherapy is still to be considered experimental treatment, since major problems such as the selection of the patients, doses and timing of chemotherapy and radiotherapy remain unsolved.

Immunocytochemical detection of estrogen receptors by staining with monoclonal antibodies on cytologic specimens of human breast cancer.

A study was undertaken to test the possibility of determining the estrogen receptor (ER) content in human breast cancers by staining with commercial specific monoclonal antibodies (MAbs) on cytologic specimens (touch imprints and fine needle aspirates). The aspirates were suspended in a cell culture medium and cytocentrifuged onto slides to preserve their morphologic characteristics and to allow a proper immunocytochemical staining for ERs. MAb staining for ER was also performed on the respective surgical samples. The staining of cytologic samples for ER showed 100% specificity and 95% sensitivity in comparison to the staining of the histologic samples. Moreover, comparison of the percentage of stained cells in the cytologic specimens to the ER content in the respective surgical specimens, as assayed by the dextran-coated charcoal method, showed the MAb staining of cytologic samples to have 94% specificity and 100% sensitivity. These results support the reliability of MAb staining for ERs in cytologic samples and suggest that it could be the assay of choice in particular clinical settings in the evaluation of primary and recurrent breast cancers.

Primary cultures of human hypertrophic prostate tissue in WAJC 404 medium: a study of cell morphology and kinetics.

222 biopsy fragments of human hypertrophic prostate tissue were cultured in WAJC 404 serum-free medium for three weeks. Growth halos were examined after 7, 14 and 21 days of culture by optical and scanning electron microscopy. Colonies formed of two concentric areas showed in the inner halo elementary pseudo-lobular morphological units similar to the prostate structure. The cell morphological patterns of the halo turned out to be four in number. Every cell pattern was defined morphologically, morphometrically and phenotypically. Results indicate that all morphological differences must be attributed to the various phases of cell life, as all cell types were positive to cytokeratin. The nonconstant display of PSAP and PSA showed a moderate tendency to cell differentiation in WAJC 404 medium. Cell kinetics were also studied and revealed a decrease in proliferation after 14 days of culture. Primary cultures from biopsy fragments of human hypertrophic prostate tissue may be used as an experimental model up to the 14th day of culture.

[Stable contrast B-scan in thyroid diagnosis]. / Il B-scan stabile contrastato nella diagnostica tiroidea.

A new technique of bidimensional reproduction (B-Scan) is proposed. This is based on successive impressions on the same photogram of the same sections carried out at different amplification and on different frequencies. Frequency and amplification variations are based on constant A-Scan control for the bidimensional detection of echoes which at low frequency and weak amplification are not memorized.

[Indications and limitations of ultrasonic investigation in abdominal pathology]. / Indicazioni e limiti dell'indagine ultrasonica nella patologia addominale

Investigation of the abdomen by ultrasounds must now be included among routine tools in abdominal diseases. All abdominal organs, with the exception of the intestine with its gas content, are open to investigation with this technique which combines harmlessness and rapidity with its unique possibility of making differential diagnosis possible in structures with different tissue constitution. The limitations are to be sought more in the examiner's interpretational capacities and in the apparatu's limited resolution power rather than in the technique proper.

[Ultrasonic diagnosis of aneurysms of the abdominal aorta]. / La diagnostica ultrasonica degli aneurismi dell'aorta addominale

The principles of ultrasound diagnosis are briefly explained and the technique of the examination is described with particular reference to the measures taken to ensure the exact measurement of diameters. The modalities for the echographic presentation of the normal and aneurysmatic aorta is illustrated, together with the respective pictures. It is suggested that echography be employed both as a preliminary technique and as a supplement to angiography, which is not itself particularly applicable in the case of aneurysms. Above all, it can be considered as the sole and resolutive examination on account of the findings it offers.

[Echography in the diagnosis of kidney diseases]. / L'ecografia nella diagnosi delle malattie renali.

Nephrosonography has become a useful diagnostic tool in assessing renal disease. Parenchymal structure can be viewed by stable B-scan or A-scan and, even better, on the grey scale. The principles of applying ultrasounds and for examining results are described together with percutaneous renal punction and nephrostomy guided by ultrasounds. Current applications of echography in congenital and adult diseases are outlined and it is pointed out that the method is simple, non-invasive and precise in differentiating solid from cystic lesions, for appraising solid structures and establishing whether a mass is renal or extrarenal. Experience obtained in evaluating renal lesions and the most typical pictures of these lesions are presented. It is concluded that nephrosonography, independently of renal function, is an excellent method for investigating the kidney, has numerous advantages and is free from danger.

[Contrast of the grey scale and stable B-scan in the ultrasonic visualization of the thyroid gland]. / Scala dei grigi e B-scan stabile contrastato nella visualizzazione ultrasonica della tiroide.

Thyroid echography can be profitably performed with the stable contrasted B-scan and the gray scale. Both methods are based on the possibility of recording weak echoes from structures inside the gland and so differentiate almost all lesions in a reliable manner. The echo-structural patterns permit the following distinctions to be drawn: uniform distribution of echoes in the normal, hypoplastic and hyperplastic-hypertrophic thyroid. Calcified areas in goitre give distinct, strong echoes, whereas in colloid-cystic goitre there are weak echoes mixed with small empty areas due the cysts. Cystic lesions, too, have empty areas that are well defined, with reinforcement of the posterior wall. In adenoma, there is a uniform, solid area, in which the echoes are evenly distributed internally and the borders are well defined with respect to the unimpaired parenchyma. In acute thyroiditis, the presence of oedema and areas of fibrosis offer sufficiently indicative signs. In tumours, the most typical features are the irregularity of the walls, the distinct attenuation of the beam and the presence of a few, irregular internal echoes. These pictures are almost always peculiar to each situations and thus make echographical investigation of thyroid not only useful, but also indispensable.

[Echographic possibilities in surgical lesions of infancy]. / Le possibilità dell'ecografia nelle lesioni chirurgiche dell'infanzia.

The possibilities of applying ultrasound diagnosis techniques to the morphological and structural study of the soft tissues in infant surgical pathology have been examined. The technique's objective features mean that it is reliable in between 98 and 100% of cases of solid and cystic lesion identification and differentiation. In the further differentiation of solid lesions, such diagnostic accuracy may be limited by the operator's subjective experience and, objectively, by the dimensions of the lesions. Possibilities for application include thyroid, thoracic and abdominal pathology in preoperative diagnosis, postoperative control and in the monitoring of antineoplastic chemo- and radiotherapy. The peculiar features of the technique, i.e. its harmlessness and thus easy repeatibility, atraumaticity, and time and cost economy, are considered and it is concluded that it can be usefully employed on an extensive basis in the various field of infant surgical pathology, in view of the fact that other investigations always present some degree of risk and danger.

[Tumors of the head of the pancreas. Echographic diagnosis]. / I tumori della testa del pancreas Diagnosi ecografica

The diagnostic possibilities in cancer of the head of the pancreas offered by radiography, angiography, isotopic and endoscopic investigations (with respective accuracy percentages) are examined and a new technique based on the use of ultrasounds is presented. Echography exploits the different structures of tissues by reflecting the ultrasound beam which strikes them in a different way, providing a bidimensional tomographic picture of the surface explored with echostructural profiles and characteristics of the organs. The personal series, together with pictures and percentages of correct diagnosis, is presented. It is concluded that the technique is one of the most suitable for exploring the pancreatic region.

[Scope and limitations of the surgical treatment of diabetes]. / Possibilità e limiti del trattamento chirurgico del diabete.

A brief account is given of the current knowledge, experiments, and clinical findings concerning the surgical management of diabetes. The aim of all treatments, from conventional pancreas transplant to the sophisticated transplantation of islets and foetal pancreas, and a subject with its own special features, namely intestinal by-pass, is to relieve the patient from insulin management, which, while it increases his survival, does not defend him from possibly fatal vascular complications. Though far from providing a final solution, each of the topics dealt with provides an example of the way research and clinical practice continue to offer reasons for the experimentation of new therapeutic techniques.

[Echography in the diagnosis of aneurysms of the abdominal aorta]. / L'ecografia nella diagnosi degli aneurismi dell'aorta addominale.

The principles of echography and its technique are briefly explanded, and 8 personal cases examined for suspected aneurysm of the abdominal aorta are presented. Correct and accurate diagnosis was obtained in cases. In 1 case, aortography was also performed, though its findings were less clear. It is felt that the applications of echography can usefully be extended to the screening, diagnosis and control of this form.

[Current status in transplantation of the endocrine pancreas in the treatment of diabetes mellitus 2. Transplantation of fetal pancreas]. / Stato attuale del trapianto di pancreas endocrino nel trattamento del diabete mellito. 2) Il trapianto di pancreas fetale.

The latest findings support hypotheses that diabetes complications are secondary to metabolic control which current insulin therapy is unable to render constant. Surgical attempts to transplant the pancreas and Langerhans islets in the treatment of diabetes mellitus are reviewed and special attention paid to the use of the foetal pancreas which has proved particularly suitable in preventing microangiopathic complication. Comments are based on a careful review of the literature, made in the light of personal experience.

[Cytologic diagnosis of stomach neoplasms]. / Contributo alla diagnosi citologica delle neoplasie gastriche

Personal experience in the cytological diagnosis of gastric neoplasis acquired in a series of 104 patients is presented. Three false positives were detected in 29 cases of supposed malignancy and 11 false negatives in 75 patients with tumours thought to be benign. Cytology often proved the determining factor in the planning of surgery, while in some instances it also gave an indication of the histological type involved.

[New prospects offered by echography in the diagnosis of carcinoma of the gallbladder]. / Nuove prospettive offerte dall'ecografia nella diagnosi del carcinoma della colecisti.

Experience in diagnosing several cases of primary carcinoma of the cholecyst echographically in reported. The most important ultrasonic characteristics in relation to staging of the lesion are reviewed. It is seen that echographic features always correlate with surgical findings, confirming the diagnostic accuracy of the method which permits morphofunctional as well as structural evaluation. At this time echography seems to be the most rational tool for efficient diagnosis, a step forward in ensuring timely surgery and the improvement of long term prospects for the condition.

[Echography in renal tumors]. / L'ecografia nei tumori renali.

Echography is highly important today for the identification and differentiation of renal diseases. It also enable target biopsy of identified lesions to be carried out, thus making for precise histological diagnosis. Indications and results of echography in the diagnosis of 97 cases of suspect masses of renal origin consisting of cysts, hydropyonephrosis, tumours, multicystic and polycystic kidneys are considered. Overall diagnostic accuracy was 92.7%. The features pointing to differential diagnosis of individual lesions and the method of examination, based on the use A and B Scan with grey scale are described. It is concluded that, with their high diagnostic accuracy and non-invasivity, scanning techniques represent an indespensable tool for the diagnosis of renal masses.

[Clinical and instrumental study program of nodular diseases of the thyroid]. / Programma di studio clinico-strumentale delle affezioni nodulari della tiroide.

Authors have passed from a combined clinical and radioisotopic analysis to an integrated polyinstrumental approach by adding thermography and above all echography. In order to achieve the purpose Authors have confronted in retrospective a "clinico-radioisotopic group" of 103 cases, from 1965 to 1975, and an "integrated polyinstrumental group" of 53 cases, since 1976. Comparing the "clinico-radioisotopic method" with "polyinstrumental approach" the main results could be summarized as follows: the diagnostic specificity improved in benign lesions from 77% to 96%, however in malignant lesions it remained about the same (63%). Considering these results the Authors have subdivided thyroid nodules, mainly based on echography, in two distinct categories with the following orientation: I. Solitary Thyroid Nodule: a) definitely cystic -- demonstrated by echography; b) "cold" -- by conventional scintygraphy; c) "negative" -- by thermography; d) non uptake of tumor seeking radiopharmaceutical. The control, therapy and surveilance of these cases should be limited to needle aspiration of the cystic cavity followed, of course, by citologic examination. This aspirations is both diagnostic and possibly therapeutic. II. Solitary Thyroid Nodule: a) definite solid -- echography; b) "cold" -- convential scintygraphy; c) "positive" --thermography (possibly "negative"); d) non uptake of tumor seeking radiopharmaceutical. Here the therapeutic orientation is clearly surgical.

[Ultrasonically-guided percutaneous nephrostomy]. / La nefrostomia percutanea guidata dagli ultrasuoni.

Ultrasonically-guided percutaneous nephrostomy using Seldinger's technique is the most accurate and reliable procedure for pelvic catheterisation in obstruction-induced hydronephrosis. The procedure is straightforward and independent of renal function. Post-renal uraemia may thus be measured and corrected; hydropyonephrosis drained prior to surgical operation of choice. Injection of contrast media may identify an anatomo-pathological situation which cannot be defined with i.v. or retrograde pyelography.