Relationship of aggregated intramembranous particles to water permeability in vasopressin-treated toad urinary bladder.

It has been previously demonstrated with freeze-fracture electron microscopy that vasopressin induces specific structural alterations of the luminal membrane of granular cells from toad urinary bladder in a dose-dependent fashion. These alterations consist of aggregated intramembranous particles and are observed both in the presence and absence of an osmotic gradient. We examined the effect of methohexital, a selective inhibitor of vasopressin-stimulated water flow, and the effect of phloretin, a selective inhibitor of urea permeability, on the structure of the granular cell luminal membrane. Methohexital treatment of the vasopressin-stimulated toad bladder reduced both the osmotic water flow and vasopressin-induced alterations of membrane structure to the same extent. Phloretin reduced urea permeability but not water flow or particle aggregation. Since neither agent affects vasopressin-stimulated sodium movement, these findings indicate that the phenomenon of particle aggregation is specifically related to vasopressin-induced water permeability and not to changes in urea or sodium permeability.

Brachial artery to brachial vein preserved vein allograft fistulas for hemodialysis.

Vein allografts were obtained from varicose vein patients in whom stripping and ligation was indicated. Proximal 30 cms of the long saphenous vein was removed and stored at -30 degrees C. A-V fistulas were constructed in the upper arm between brachial artery and the brachial or cephalic vein in dialysis patients. All these allograft vein recipients had major blood groups identical to the donors. Clinical experience over a two year period revealed a 100% long term patency. Complications including early graft thrombosis, superficial wound infection, hematoma formation and local edema were few and easily managed. Allograft rejection was not a problem in this series of patients. The large diameter grafts in upper arm position function well. They are convenient for the patient and preferred by dialysis personnel as a direct site for venepuncture. An initial experience suggests that preserved vein allografts may become the preferred material for arteriovenous fistulas.

Survey of delta infection in the Naples basin: a possible epidemiologic model for endemic areas.

The prevalences of delta co-infections and superinfections in 100 randomly selected subjects for each year from 1977 to 1982 and in all the subjects of subsequent years until April 1986, admitted to our Department with acute viral hepatitis B (AVHB), were evaluated and compared with the annual incidence of cases of AVHB reported in Naples during the same period. Moreover, anti-delta antibodies were determined in the sera of 25 consecutive cases of HBsAg-positive chronic active hepatitis and 25 consecutive cases of HBsAg-positive chronic active hepatitis and 25 consecutive cases of HBsAg-positive cirrhosis, respectively, for 1977, 1980, 1983 and 1986. Our data show a high, constant circulation of HDV and a decrease in its incidence in acute forms over the last 3 years, which coincides with the parallel lower incidence of AVHB, but which is not reflected in the delta prevalence in the chronic forms. They also indicate the possible existence of alternate cycles of increase and decrease in the infection, partly dissociated from HBV circulation, which present peculiar epidemiologic characteristics.

Feeding efficiency of premature neonates.

The purpose of this study was (a) to investigate the validity of the revised Neonatal Oral Motor Assessment Scale (NOMAS) in discriminating between efficient and inefficient feeders in a sample of high-risk premature neonates and (b) to identify significantly different oral motor behaviors in the two groups. The revised NOMAS rates normal and abnormal characteristics of nutritive and nonnutritive sucking. The 26 subjects were classified by the amount of liquid they consumed during the first 5 min of feeding. The findings demonstrated that both nutritive and nonnutritive sucking scores were higher in the efficient feeders than in the inefficient feeders and that the revised NOMAS scores accurately classified the two groups. Characteristics that were significantly associated with inefficient feeding were lack of rhythm, disorganization in jaw and tongue movements, and pauses of more than 6 sec. Often, these responses appeared to be related to respiratory patterns.

[Diagnosis of disseminated mycobacterial infection in AIDS patients by US-guided fine needle aspiration biopsy of lymphnodes and spleen]. / Diagnosi della micobatteriosi disseminata in pazienti con AIDS mediante agoaspirato ecoguidato con ago sottile dei linfonodi e della milza.

Our aim was to evaluate the efficacy of abdominal US and fine-needle aspiration biopsy (FNAB) in the diagnosis of disseminated mycobacteriosis (DM) in patients with Acquired Immunodeficiency Syndrome (AIDS). We reviewed the US and clinical records of 18 AIDS patients (12 males; 22-43 years) with DM studied with abdominal US. 18 patients underwent fine-needle aspiration biopsy of enlarged abdominal lymphnodes and 11 underwent FNAB of the spleen. All aspirates were studied with acid-fast stain for fast examination and cultures for isolation of mycobacteria. Abdominal US showed: enlarged abdominal lymphnodes (diameter range: 5-35 mm; mean 17 mm) splenomegaly (spleen diameter range: 14-22 cm; mean: 16.2 cm) and hepatomegaly (right hepatic lobe thickness range: 14.5-18.5 cm) in all patients; multiple splenic abscesses (diameter range: 3-20 mm) in 11 patients; small intestine wall thickening in 5 patients (maximum bowel wall thickness range: 7-15 mm); mild to moderate ascites in 8 patients; pleural effusion in 4 patients; hyperechogenicity of the kidney cortex in 5 patients; peritoneal abscesses in one and a retroperitoneal abscess in one patient. fast-acid-stain of spleen and/or lymphnode FNAB specimens allowed early diagnosis of mycobateriosis in 18/18 cases (100%). Cultures of lymphnode aspirates grew mycobacteria in 10/18 patients (56%). Spleen aspirates grew mycobacteria in 11/11 patients (100%) Blood cultures were positive in 6/18 patients (33%). Diagnosis of species was M. tuberculosis in 9 and M. avium in 6 patients. In 3/18 patients (17%) all cultures were negative. In conclusion, abdominal US features suggest DM in AIDS patients. Spleen and/or lymphnode FNAB allows a specific diagnosis in 100% of the patients.

[A-mode echography in surgery: a study of solitary thyroid nodules (author's transl)]. / L'ecografia A-mode in chirurgia. Studio dei noduli solitari della tiroide.

As part of their exploration of the possibilities afforded by A-mode ultrasonic investigation in several disorders of surgical interest, the authors report the results obtained in the study of solitary thyroid nodules. More precisely, after a brief explanation of ultrasonics, current apparatus for echography, and methods for echographic examination, they describe the semiological features exploited in A-mode echography: namely nodules with liquid content, mixed content, solid homogeneous content, and solid heterogeneous content. They conclude with considerations on the principles and indications of this diagnostic procedure in the light of their personal experience.

[A-mode echography in surgery. Study of nodular lesions of the breast]. / L'ecografia A-mode in chirurgia. Studio delle lesioni nodulari della mammella.

In the context of researches for studying the possibilities of ultrasonic A-mode research for a diagnosis of thyroid, mamma and abdominal organs affections, in this first part the authors make known the results obtained studying nodulary lesions. After a short notice about ultra-sounds, echoscopic apparati and methods for echoscopic research, they outline the semeiologic characters for echoscopic A-mode diagnostic and they stop on echoscopic obtained pictures: liquid crops, nodulary images with homogeneus echostructure scarcely ecogena and nodulary images with not homogeneus echostructure highly ecogena. Then they ended with some considerations about the principles and the indications of this method, in the light of personal experience.

[Klippel-Trenaunay syndrome]. / La sindrome di Klippel e Trenaunay.

The Klippel-Trenaunay syndrome is a rare congenital pathology which includes varices, hemangiomas and hypertrophy of limbs. The Authors report two cases and pay particular attention to the diagnostic and therapeutical protocols. Although these aspects are still open questions, the Authors conclude that conservative therapy is often sufficient while surgery is requested only in the severe forms.

Buckwheat achenes antioxidant profile modulates Aspergillus flavus growth and aflatoxin production.

Buckwheat (Fagopyrum spp.) is a "pseudo-cereal" of great interest in the production of healthy foods since its flour, derived from achenes, is enriched with bioactive compounds and, due to the absence of gluten, may be used in composition of celiac diets. Amongst buckwheat species, F. tataricum achenes possess a larger amount of the antioxidant flavenol rutin than the common buckwheat F. esculentum. Ongoing climate change may favor plant susceptibility to the attack by pathogenic, often mycotoxigenic, fungi with consequent increase of mycotoxins in previously unexploited feeds and foodstuffs. In particular, Aspergillus flavus, under suitable environmental conditions such as those currently occurring in Italy, may produce aflatoxin B1 (AFB1), the most carcinogenic compound of fungal origin which is classified by IARC as Category 1. In this study, the viable achenes of two buckwheat species, F. tataricum (var. Golden) and F. esculentum (var. Aelita) were inoculated with an AFB1-producing A. flavus NRRL 3357 to analyze their relative performances against fungal invasion and toxin contamination. Notably, we sought the existence of a correlation between the amount of tocols/flavonols in the achenes of buckwheat, infected and non-infected with A. flavus, and to analyze the ability of the pathogen to grow and produce toxin during achene infection. Results suggest that achenes of F. tataricum, the best producer of antioxidant compounds in this study, are less susceptible to A. flavus infection and consequently, but not proportionally, to mycotoxin contamination compared with F. esculentum. Moreover, rutin-derived quercetin appears to be more efficient in inhibiting aflatoxin biosynthesis than the parent compound.

Maxillary sinus augmentation procedures through equine-derived biomaterial or calvaria autologous bone: immunohistochemical evaluation of OPG/RANKL in humans.

Autologous bone is considered the gold standard for bone regeneration, even if different heterologous bone substitutes have been proposed to overcome the limits related to its use. The aim of this study was to analyze and to compare the molecular events switched on by autologous or heterologous bone graft insertion, focusing on TGFß1 expression and OPG/RANKL ratio, to analyze resorption process, and estimating graft vascularization, new bone tissue deposition and its mineralization, through VEGF, BSP and SPARC expression evaluation, respectively. Patients needing pre-prosthetic rehabilitation of the posterior maxilla were treated using an equine-derived biomaterial (Group 1) or calvaria autologous bone (Group 2), according to the morphology of the bone defect. Bone graft integration was evaluated on bone samples obtained from the treated areas at the moment of dental implant insertion, by morphological and immunohistochemical analyses for TGFß1, OPG, RANKL, VEGF, BSP, and SPARC expression. Morphological analysis shows the presence of biomaterial residual granules in Group 1, in parallel to a good integration between graft and host tissue. Moderate TGFß1 expression is seen in both Group 1 and Group 2. OPG/RANKL ratio appear higher in Group 1; VEGF expression appears very strong in Group 1 and strong in Group 2, while BSP and SPARC expression results weak in Group 1 and moderate in Group 2. Results reveal the good integration between both types of graft and the host tissue, even though autologous graft seems to produce a faster regenerative process, as evidenced by the different expression of the investigated molecules. According to these observations, the clinical use of heterologous particulate equine-derived biomaterial may ensure long-term predictability of implant-prosthetic rehabilitation, comparable to that obtained with autologous bone graft.

Percutaneous ethanol injection under sonographic guidance of hepatocellular carcinoma in compensated and decompensated cirrhotic patients.

Forty-six patients with cirrhosis and 75 biopsy-proved hepatocellular carcinoma (HCC) nodules underwent percutaneous ethanol injection (PEI) regardless of number (up to five) and size (mean diameter, 3.6 cm) of tumoral lesions and clinical severity of cirrhosis (11 patients in Child's class C were included). Ethanol was injected under sonographic guidance through 20 to 22 gauge needles so as to obtain homogeneous hyperechogenicity of lesions. A total of 271 PEI sessions were carried out, delivering 2 to 14 ml per session. All nodules but one decreased in size, and seven were no longer appreciable on sonography. Recurrence was detected in two patients. The 3 year survival rate of all cases was 86%. Child's classes A and B patients fared better (3 yr survival 100%); 2 year survival of subjects with HCC < or = 3 cm was 92%. Multifocality did not affect survival. Most patients experienced mild pain at the site of injection, but only two major complications were encountered: partial chemical thrombosis of the left portal vein and cholangitis. Both cases were managed conservatively. In conclusion, PEI seems to offer a safe and valuable tool for therapy of HCC, especially in patients with good functional liver reserve and small (< or = 3 cm) tumors.

[Percutaneous therapy of hydatid cyst of the liver with ultrasound-guided double puncture-aspiration and alcoholization]. / Trattamento percutaneo delle cisti idatidee del fegato con doppia puntura-aspirazione ed alcolizzazione ecoguidata.

Fourteen patients (9 females, 5 males; age range: 22-80 years) with 16 univesiculated hydatid cysts of the liver (O ranging 4.2-14 cm) underwent two sessions of puncture-aspiration-alcohol injection (D-PAI) under real-time US guidance at 3-day intervals. Two patients had postoperative recurrences. One patient was pregnant (9 weeks' gestation): her cyst doubled its volume over 2 months. One patient had HBV chronic hepatitis treated by means of interferon: also in this case the cyst doubled its volume. The remaining were high-risk patients for surgery or had refused operation. At US follow-up (ranging 4-24 months) 6 cysts exhibited complete reconstitution of liver parenchyma. In the extant patients two different US patterns were observed: 1) liquid areas with detached inner membranes (4 cysts); 2) solid inhomogeneous areas (6 cysts). In these cases the volume was reduced by 50-80%. No allergic complication occurred either during or after the procedure. Two patients only were affected with vomiting and fever, which resolved in a few hours. Our results indicate D-PAI of univesiculated hydatid cysts of the liver to be an effective alternative to surgery.

Ultrasound evaluation of uncomplicated and complicated acute viral hepatitis.

Seven hundred ninety-one consecutive patients with acute viral hepatitis, 17 of whom had liver failure, and 97 healthy volunteers were examined by ultrasound. No specific patterns were found in either the uncomplicated or the complicated forms. Only 19 subjects showed a typical "bright liver" pattern, which is correlated with significant vacuolar hepatocellular degeneration. The increased brightness and clear visualization of portal vein radicle walls, previously described in this disease, were detected in only 32.2% of the hepatitis patients but were also seen in 30.9% of the normal controls.

Cirrhosis: value of caudate to right lobe ratio in diagnosis with US.

To verify the value of ultrasound (US) in the diagnosis of cirrhosis, the ratio of transverse caudate lobe width to right lobe width (C/RL) was determined with US in 25 healthy subjects and 156 consecutive patients with either histologically proved acute viral, chronic persistent, or chronic active hepatitis or cirrhosis. The C/RL ratio had a sensitivity of 43%, a specificity of 100%, and an accuracy of 79% in cirrhosis. The sensitivity was very low in alcoholic cirrhosis, low in cryptogenic cirrhosis, and high in hepatitis B virus related cirrhosis. In spite of its fairly low overall sensitivity, the C/RL ratio is a useful measurement in assessing chronic liver disease because of its high specificity in cirrhosis.

Delta infection in the Naples area. Epidemiologic and clinical significance.

To define the epidemiologic and clinical significance of delta infection in the Naples area, we sought anti-delta antibodies in all cases of HBV-associated liver diseases, hospitalized in our department during 1983 (234 acute hepatitis, 9 of which fulminant; 51 chronic hepatitis; 32 cirrhosis; 19 hepatocarcinomas) and in randomly selected acute hepatitis over the previous 6 years. Delta agent in acute forms and IgM anti-HBc in delta-positive acute forms were also tested. The acute cases were controlled for at least 9 months after dismissal. Delta infection showed a high prevalence in the Naples area (20% of all acute cases in 1983; similar prevalences in previous years; high rate of coinfections, 81%; no peculiar modalities of circulation) and a high pathogenicity, as proved by the greater prevalence in fulminant cases (66.7%) and severe chronic forms. Moreover superinfection appears a more dangerous event than coinfection as regards the diseases becoming chronic (77.8% vs 2.5%).