Ocular swabs on exhumed bodies: An alternative to the collection of "classical" tissue samples in forensic genetics.

We present the results obtained on DNA extracted from ocular (scleral/corneal) swabs collected from exhumed bodies at different times of burial. To our knowledge, there are no publications in the scientific forensic literature dealing with sclera/cornea as a source of DNA in the forensic laboratory. The obtained results demonstrate that cornea/sclera swabbing might be a promising alternative to the sampling of other tissues for DNA extraction even in highly putrefied bodies.

Carotid endarterectomy with contralateral carotid artery occlusion: is this a higher risk subgroup?

OBJECTIVE: to evaluate early and mid-term term results of carotid endarterectomy (CEA) in patient with and without contralateral carotid occlusion. METHODS: between 1996 and 1999, 1324 CEAs were performed. In 82 patients contralateral carotid artery occlusion was present (group I); 1242 patients had patent contralateral carotid (group II). All patients were operated under general anaesthesia, and selective shunting was based on somatosensory evoked potentials (SEPs). Ultrasonographic follow-up was performed at 1, 6 and 12 months and then once a year. Early results and follow-up data were analysed retrospectively. RESULTS: in group I there was a significantly higher incidence of SEPs reduction and shunt insertion; however, there were no differences in terms of perioperative complications. The cumulative stroke and death rate at 30 days in group 1 and group 2 were 2.4% vs 1.4% (p=n.s.), respectively. At a mean follow-up of 15 months there were no differences between the two groups in terms of cumulative symptom-free survival. CONCLUSIONS: the presence of contralateral carotid occlusion caused an increased use of shunt, but not in early complications rates.

Antibiotic prophylaxis in clean surgery: vascular surgery.

The commonest and most dangerous infective complication in vascular surgery is prosthetic graft infection. Despite the use of routine systemic antibiotic prophylaxis, graft infection occurs after 3-5% of all prosthetic vascular reconstructions. Infection is associated with a high rate of major morbidity and mortality, with significant time and cost implications. Management can be difficult and the outcome is often disappointing. Data from Italian Registry of Prosthetic Graft Infections show that the commonest site of infection is the aorto-femoral district and that involved bacteria are usually gram-positive in early and low-grade infections and gram-negative in late and high-grade infections. Results are poor, with a mortality rate of 15% for elective surgery and of 60% for emergency interventions. We report the results of a multicenter randomized controlled trial of rifampicin-bonded Dacron grafts in aorto-femoral surgery, in which our Department was involved. Data demonstrate a reduction in total early wound and graft infection rates, and 2-year results show a small, non-significant reduction in graft infection (1.7% in study group, 2.3% in control group). The same results were obtained in two other multicenter trials.

Duplex scanning exploration of the ophthalmic artery for the detection of the hemodynamically significant ICA stenosis.

BACKGROUND AND PURPOSE: The North American and the European Carotid Endarterectomy Trials demonstrated a significant benefit of surgery in preventing stroke for patients with symptomatic hemodynamically significant internal carotid artery (ICA) stenosis. Because the 3 angiographic methods of measuring carotid stenosis provide discrepant results, the indication for surgery depends on the method used for the evaluation of the angiogram. The goal of this study was to verify whether color duplex scanning of the ophthalmic artery alone might be reliable for detection of the extracranial hemodynamically significant ICA stenosis. METHODS: Three groups of patients (351 total patients) with transient ischemic attack or minor stroke referred for possible carotid endarterectomy were examined by means of color duplex scanning of the ICA, transcranial Doppler, color duplex scanning of the ophthalmic artery, and angiography of the ICA. RESULTS: In the first group (n=31) the comparison of findings from each method and the direct measurement of the residual lumen of plaque removed "en bloc" showed that the findings of the ophthalmic artery color duplex scanning, subdivided into 5 categories--NP (normal positive), LP (low positive), NF (no flow), REV (reverse flow), PP (pathological positive)--were associated with the best overall agreement (96.7%). The accuracy of the various categories of the ophthalmic artery color duplex scanning signals was studied in the second group of patients (n=200). The results pointed out that all but low positive categories were associated with high diagnostic accuracy. Finally, the results obtained in the third group (n=120) showed that a significant increase in the specificity of the low positive signal could be obtained by processing this signal in terms of pulsatility index and of transmission of pulsatility index. CONCLUSIONS: Our results suggest that the diagnostic capacity of color duplex scanning for the detection of ICA critical stenosis can be appropriately increased if it is performed also at the level of the ophthalmic artery and if the Doppler signals are processed on the basis of criteria we applied.

[Arteriovenous fistulas for hemodialysis: transposition of the cephalic veins, a personal experience]. / Fistole artero/venose per emodialisi. La trasposizione della vena cefalica nella nostra esperienza.

BACKGROUND: Vascular access for hemodialysis has remarkably developed during these years. Since 1966 we have the Brescia-Cimino fistula which is considered nowadays the best choice for angioaccess. The transposed cephalic vein is the "variant" which has been evaluated in a single stage surgical technique. METHODS: A prospective and randomized study regarding 23 patients submitted to operation for first fistula during 1998. With a median follow-up of 10 months, these fistulas have been studied with echocolordoppler in order to verify their primary patency, diameter and blood flow in artery, in vein and anastomosis. RESULTS: Fistulas have been patented in all cases (15 males e 8 females) and used for dialysis after 3 weeks. No early or late complications have been observed. Mean diameter has been 1.2 cm with mean velocity of 1.8 m/sec, in artery mean velocity 2.3 m/sec and in vein 1.1 m/sec. CONCLUSIONS: Increasing length of life even for high critical patients like these with chronic renal failure underlines the need of surgical strategies which may improve the quality to life. This technique of transposed cephalic vein has the same advantages of direct fistulas also for those patients in which we should have used prosthetic grafts.

[Classification of chronic hepatitis]. / In tema di classificazioni delle epatiti croniche.

After an examination of the classifications of chronic hepatitis put forward between 1968 and the present a critical review of the subject is presented. On the basis of personal experience and in the light of recent developments, another classification is proposed which together with morphological criteria, haematochemical evaluation and particularly, statistically processed immunological data would permit adequate monitoring of possible therapeutic treatments.

[Changes in blood sugar and blood insulin chronic liver diseases]. / Modificazioni glicemiche ed insulinemiche nelle epatopatie croniche.

Glycaemic and insulinaemic alterations in chronic hepatopathies have been investigated by means of endovenous glucose load curves. Calculation of the mathematical increment on the curves confirmed the presence of variations in glycaemia and insulinaemia. A critical evaluation of altered glucose tolerance compared to hyperinsulinism was also made.