[Regulatory problems regarding bone marrow transplantation from non-consanguinous donors]. / Problemi normativi riguardanti il trapianto di midollo osseo da donatore volontario non consanguineo.

The paper reports the normative rules and the Italian Ministry of Health administrative instructions concerning the bone marrow unrelated donor (MUD) search in the Italian Bone Marrow Donor Registry (IBMDR) and in international registries from the preliminary activation to a MUD bone marrow transplant (BMT), when a volunteer donor, perfectly compatible with a recipient lacking a HLA identical sibling, is found. The article describes all the expenses pertinent to the different stages of search and the documents necessary to obtain the reimbursement of these expenses. A very recent Ministry Decree establishing that all the search costs will be charged to the competent local sanitary authority is added.

[Advantages of the echographic staging of intestinal Crohn's disease. Correlations of echographic patterns and histological findings]. / Vantaggi della stadiazione ecografica del Morbo di Crohn intestinale. Correlazioni tra quadri ecografici e reperti istopatologici.

PURPOSE: Technical improvements in real-time scanners have revalued the importance of abdominal US for gastrointestinal (GI) tract studies, particularly to investigate chronic inflammatory disease. It is now possible to evaluate intestinal wall thickness accurately, to depict changes in the layers and to study bowel wall motility. Some authors proposed a US classification of Crohn disease into three stages. To investigate the usefulness of this US staging in clinical practice, US findings were compared with the corresponding histologic patterns of the full thickness of the bowel wall. MATERIAL AND METHODS: We examined 58 patients with radiography, endoscopy and US and classified them by Limberg's stage. We compared in vivo and in vitro US findings with the corresponding histologic pattern in seven Crohn patients submitted to ileocolic resection for complications. We performed the US studies with an Acuson 128 XP/10 and 5- or 7-MHz linear probes. RESULTS AND DISCUSSION: We found five Crohn 2 and two Crohn 3 cases. In Crohn 2, US showed moderate wall thickening and the presence of all five layers, with corresponding inflammatory infiltration, mainly in the submucosa, at histology. In Crohn 3, US showed marked wall thickening and no layers at all; no layers and wall necrosis areas were found at histology. In Crohn 2, correct drug treatment can stop or reduce intestinal wall lesion progression, which is not possible in Crohn 3 where fistulae and stenoses are likely to develop. CONCLUSIONS: We found the same patterns at abdominal US and histology of the surgical specimens: US accurately showed the characteristics and the extent of bowel wall inflammatory lesions. US is a simple and cost-effective method with no side-effects playing a major role in Crohn disease staging because it permits to study the bowel wall characteristics--an important piece of information for treatment planning.

Effect of low frequency pulsing electromagnetic fields on skin ulcers of venous origin in humans: a double-blind study.

The effect of an electromagnetic field on the healing of skin ulcers of venous origin in humans has been investigated in a double-blind study. Forty-four patients have been admitted to the study; one-half were exposed to active stimulators (experimental group) and the remaining to dummy stimulators (control group). The stimulation was scheduled to last a maximum of 90 days. The success rate was significantly higher in the experimental group both at day 90 (p less than 0.02) and in the follow-up period (p less than 0.005). The data suggest that the effect of the electromagnetic field lasts even when the stimulation is over. No ulcers worsened in the experimental group, while four worsened in the control group. Twenty-five percent of the patients in the experimental group and 50% in the control group experienced recurrence of the ulcer. It is concluded that stimulation with an electromagnetic field is a useful adjunctive therapy in the management of these patients.

Acenocoumarol and pentoxifylline in intermittent claudication. A controlled clinical study. The APIC Study Group.

The efficacy and safety of pentoxifylline (400 mg tid orally) and acenocoumarol, administered singly or in combination, in the treatment of intermittent claudication associated with chronic occlusive arterial disease were evaluated in a multi-center, randomized, factorial, blind clinical trial involving 146 patients. The response to treatment was assessed by measuring pain-free walking time on the treadmill and by Doppler ankle/arm systolic pressure ratio at rest and after treadmill. Both pentoxifylline and acenocoumarol were significantly more effective than placebo in increasing the proportion of patients who improved their performance on the treadmill after one year of treatment. Benefit from active treatment was also apparent from the results of Doppler examinations performed after physical exercise. No significant differences were observed in comparing the effect of one active drug versus the other or versus the combined treatment. Five major hemorrhagic complications were registered in anticoagulated patients, two fatal cerebral hemorrhages and one gastrointestinal bleeding occurring in the group treated with both active drugs. The investigators conclude that (1) pentoxifylline is effective and safe in the treatment of patients with intermittent claudication (2) the benefits of oral anticoagulant therapy are outweighed by the risk of serious bleeding, and (3) the risk of bleeding is probably increased by the combined treatment with pentoxifylline.