Qualitative profile of degummed guar (Cyamopsis tetragonoloba L.) seeds grown in a Mediterranean area for use as animal feed.

Guar (Cyamopsis tetragonoloba L.) is an interesting summer legume multipurpose crop used for the extraction of seed gum, due to its galactomannan content, and the high-protein by-product, (germ and hull) used for animal feed. The aim of this study was to assess qualitative traits of degummed seeds, named guar meal, of six guar varieties from India, South Africa and USA, grown in a Mediterranean environment (Sicily, Southern Italy), in order to explore their suitability for livestock, and comparing them with the marketed Indian products of guar meals, Churi and Korma. After harvest, seeds were manually degummed and proximate composition was analysed using the official method of analyses, total phenols and tannins by UV spectrophotometry and fatty acids by GC-FID. Qualitative profile of degummed guar seeds (DGS) was significantly (p < .05) influenced by the genotype. Among DGS, Matador showed a high (p < .05) content of protein (518 g/kg), lipids (59.4 g/kg) and the lowest (p < .05) NDF level (181 g/kg) compared to the other varieties. Total phenol content of DGS showed similar values among varieties (2.57 mg gallic acid/g, on average) and with those of guar meal Korma 50%-53% (2.89 mg gallic acid/g) and Korma 56%-58% (2.94 mg gallic acid/g). Tannins were below the instrumental limit of quantification (1.5 mg/g of catechin equivalents) in DGS, as well as in the marketed products. Fatty acid composition was significantly influenced (p < .05) by the genotype. Matador showed the significant highest content of polyunsaturated fatty acids (PUFA) of the n6 series (45.2 g/100 g), whereas India showed the significant (p < .05) highest content of PUFA of the n3 series (3.55 g/100 g), and the significant (p < .05) highest level of n3/n6 PUFA ratio (0.08), and the best (p < .05) Atherogenic Index (0.19) and Thrombogenic Index (0.46). This study shows the interesting nutritional characteristics of degummed guar seeds, underlining that, if the future of the guar gum industries depends largely on the utilization of guar seed meal, this product can be considered a valuable feed resource and a way to increase the income of guar production.

A rare case of malignant diaphragmatic hemangiopericytoma in a patient with pleural effusion.

This paper reports a case of primary malignant diaphragmatic hemangiopericytoma in a 30-year-old male patient operated on for a diaphragmatic mass. The tumour was discovered on a TC scanning performed to explain the etiology of an exudative pleural effusion in a patient admitted for dyspnea, fever and thoracic pain. Given the rarity of this disease, the histological and pathological features of hemangiopericytoma are discussed in the light of the new classification system for soft tissue and bone tumours, as well as its currently accepted therapeutical guidelines.

Late outcome and perioperative complications for surgery of locally recurrent bronchogenic carcinoma.

AIM: Many doubts involve a 2(nd) surgical approach for local relapse of non small cell lung cancer (NSCLC) since iterative resections represent a well-recognized treatment in second primary lung cancer (SPLC). METHODS: The medical reports of patients who underwent surgical resection, between 1988 and 2002, were reviewed. All patients submitted to 2(nd) operation were examined according to Martini and Melamed criteria to distinguish between local recurrence and second primary lung cancer. RESULTS: Complete resection for NSCLC was performed in 1 386 patients. Nineteen patients were submitted to surgery for local recurrence (17 men and 2 women) and mean age at the time of 1(st) operation was 61 years (range 41-78 years). The 1(st) operation consisted of lobectomy in 15 cases, anatomical segmentectomy in 2 and wedge resection in 2. The 2(nd) pulmonary resection was completion pneumonectomy in 16 cases, completion lobectomy in 2, wedge resection in 1. Major complications occurred in 26% and overall hospital mortality was 5%. Five-year survival after 2(nd) intervention was 31% and median survival 27 months. Survival was better when the time between 1(st) resection and cancer relapse was longer than 14 months and when recurrence was intrapulmonary. CONCLUSIONS: A new malignant lesion can be operated if it is solitary and intrapulmonary, if accurate staging is negative and if the patient is able to go through 2(nd) surgery from cardiopulmonary evaluation.

Ichthyosis and neutral lipid storage disease.

A boy with a lipid storage disease characterized by lamellar ichthyosis, cataracts, hepatosplenomegaly, and leukocyte vacuoles has been identified in a Sicilian family. This patient shows all the characteristics of ichthyosis and neutral lipid storage disease (Chanarin-Dorfman syndrome). Family data confirm an autosomal recessive inheritance; the heterozygotes may be detected by the presence of vacuoles in circulating eosinophils.

Assessing the prognostic value of the extent of mediastinal lymph node infiltration in surgically-treated non-small cell lung cancer (NSCLC).

Although there have been several attempts in dividing N2 patients into several subgroups on the basis of different prognoses, the correct treatment for these patients is still a moot point. Even multimodal treatment, which is the most common therapy used, does not result in a consistent outcome. The aim of our study is to assess the prognostic value of the extent of mediastinal lymph node infiltration in surgically treated non-small cell lung cancer (NSCLC). From January 1990 to December 1997, 682 patients underwent surgery for NSCLC at the Thoracic Surgery Unit, University Hospital of Siena, 87 of which (12%) had mediastinal involvement. Studies on the number of lymph node stations show that those with one station involved tend to have a better 5-year survival rate with respect to the others. We studied the number of lymph node stations by using a new critique based on the percentage of lymph node infiltration. The percentage is obtained from a ratio of the number of involved nodes to the total number of nodes removed. The result was an improved 5-year survival ratio in patients with lymph node infiltration, lower than 50% with respect to the others, and the difference was significant (P=0.0001). It appears that surgery may be the most suitable option for treating those N2 patients that we consider to be in 'early N2 phase', in view of long term survival. Although an invasive technique like mediastinoscopy seems to be the appropriate indicator in selecting N2 patients, it does not allow the calculation of the ratio a priori.

Studies of the neutropenia in kala-azar: results in two patients.

Two patients with kala-azar were studied, one with DF32P (diisopropylfluorophosphate) and one with 51CR (chromate), in an attempt to elucidate the mechanisms producing neutropenia in this disease. The granulocyte half-life was found to be reduced in both patients, with pooling and probable destruction occurring in the spleen and, to a lesser extent, in the liver. Bone marrow neutrophil reserve, estimated by the response to intravenous hydrocortisone hemisuccinate, was found to be markedly reduced in both patients. An enlarged marginal granulocyte pool in one patient indicated that the neutropenia may also be due to altered intravascular granulocyte distribution.

Leukokinetic studies in Mediterranean kala azar.

Two patients with acute Kala Azar were studied with DF32P (diisopropylfluorophosphate) and three patients with 51Cr (chromate) in an attempt to delineate the mechanism producing neutropenia in this disease. The granulocyte life span was found to be reduced in all the patients with exception of one who was studied during Glucantim treatment. The surface radioactivity counts showed that the reduced granulocyte life span was due to pooling and probable destruction of granulocytes in the spleen and to a lesser degree in the liver. Bone marrow neutrophil reserve, evaluated by the response to the intravenous hydrocortisone hemisuccinate, was found to be markedly reduced in all patients. An enlarged marginal granulocyte pool indicated also that the neutropenia may be due to altered intravascular granulocyte distribution.

Predicting prostate biopsy outcome by findings at digital rectal examination, transrectal ultrasonography, PSA, PSA density and free-to-total PSA ratio in a population-based screening setting.

The study offers a retrospective analysis of the positive predictive value (PPV) of several variables, i.e. digital rectal examination (DRE), transrectal ultrasonography (TRUS), PSA value, PSA density (PSAD), and free/total PSA ratio (F/T), for the histologic outcome of 179 prostate biopsies performed within a population-based screening trial. The ratio of spared benign biopsies to missed cancers (SBB/MC) if biopsy results had been decided on the basis of single variables was also evaluated. PPV was 82.9% for DRE, 56.3% for TRUS, 26.6% for PSA (cutoff > or =4 ng/mL), 47.4% for PSA (cutoff > or =10 ng/mL), 42.0% for PSAD (cutoff 0.15), 59.2% for PSAD (cutoff 0.20), 34.9% for F/T (cutoff 0.20) and 40.0% for F/T (cutoff 0.15). SBB/MC was 121/23 for DRE, 96/12 for TRUS, 11/10 for PSA (cutoff > or =4 ng/mL), 107/34 for PSA (cutoff > or =10 ng/mL), 87/23 for PSAD (cutoff 0.15), 109/26 for PSAD (cutoff 0.20), 45/8 for F/T (cutoff 0.20) and 70/14 for F/T (cutoff 0.15). Multivariate analysis of the association with biopsy outcome showed the highest odds ratio for TRUS (13.24, 95% CI=4.4-30.7), and considerably lower values for DRE (4.17, 95% CI=2.0-8-9), PSAD (cutoff 0.20: 3.24, 95% CI=-1.8-5.7) and F/T (cutoff <0.15: 3.16, 95% CI=1.7-1.8). None of the possible variable combinations was clinically useful: the highest PPV (83.3%) was obtained with a combination of suspicious DRE/TRUS, PSAD >0.20 and F/T <0.15, which nevertheless missed 20 of 52 cancers.

Serum biochemical markers of bone turnover in healthy infants and children.

Serum osteocalcin (OC), bone alkaline phosphatase (BAP), carboxyterminal propeptide of type I procollagen (PICP), carboxyterminal telopeptide of type I collagen (ICTP), parathyroid hormone (PTH) and 1,25 dihydroxyvitamin D [1,25(OH)2D] were measured in 241 normal infants and children (134 males and 107 females aged 1.9 months-14 years, 1.8 months-12 years, respectively). Regarding the analysis of data for children above 2 yrs, we chose data with the following normalization: data/body surface x standard body surface, to eliminate biological variations not exclusively related to chronological age. The increase in serum OC occurred at the expected age of growth spurts in both sexes: in the first year of life OC values (mean +/- SD) were 82.6 +/- 34.3 and 60.2 +/- 32.9 OC ng/ml in males and females, respectively; during puberty, peak values occurred at the age of 10-12 yrs in girls (76.6 +/- 25.8) and at the age of 12-14 yrs in boys (113 +/- 48.3). Furthermore, significant positive correlations with age were found for males from 2 to 14 yrs (p < 0.00001) and for females from 2 to 12 yrs (p < 0.001). Elevated levels of BAP occurred in the first year, 70.4 +/- 28.2 and 71.8 +/- 28.5, and in the second year, 69.4 +/- 26.7 and 67.4 +/- 33.8 ng/ml, for males and females, respectively. For children older than 2 yrs, a positive correlation with age (p < 0.01) was found for females only, with a peak value of 67.2 +/- 13.9 at the age of 10-12 yrs. For ages 2-14 yrs the reference values (mean +/- 2SD) were 15.5 - 90.3 and 17.2 - 95.2 ng/ml for males and females, respectively. The highest PICP levels (1354 +/- 680 ng/ml in males and 1041 +/- 766 in females) were observed in infants less than 1 year of age, decreasing by about 60% at the age of 2. There was no significant change in serum PICP for children older than 2 yrs with values covering a range (mean +/- 2SD) of 52 - 544 and 18 - 546 ng/ml in males and females, respectively. Similarly, the highest ICTP values were seen in infants younger than 1 year (29.7 +/- 11.7 and 29.5 +/- 20.1 ng/ml in males and females, respectively). In the ages from 2 to 14 yrs there did not seem to be any systematic age-correlated changes, with values covering a range (mean +/- 2SD) of 6.06 - 24.5 in boys and 6.84 - 22.9 ng/ml in girls. Serum PTH concentrations (mean +/- SD) in infancy were 27.2 +/- 19.3 pg/ml for males and 25.8 +/- 10.8 for females. Normal ranges (mean +/- 2SD) in the older group were 5.77 - 53.1 and 6.71 - 57.3 pg/ml for males and females, respectively. Serum 1,25(OH)2D presented values of 47.3 +/- 28.1 and 38.7 +/- 18.2 pg/ml under 2 yrs for males and females, respectively. The ranges (mean +/- 2SD) in children above 2 yrs were 9.5 - 101 pg/ml in boys and 10.9 - 88.4 in girls. The results of this study contribute to the establishment of reference values in normal children for these biochemical assays; these reference values are needed when the above biological markers will be applied in the monitoring of metabolic bone diseases.

The diagnosis value of beta 2-microglobulin and immunoglobulins in primary Sjögren's syndrome.

Salivary and serum concentrations of beta 2-microglobulin, salivary levels of the immunoglobulins, and salivary flow (as measured by a gravimetric method) were assessed in 34 patients and 11 controls. Of the 34 study patients, 16 had a primary form of Sjögren's syndrome (pSS) and 18 had sicca syndrome. The salivary and serum concentrations of beta 2-microglobulin and salivary levels of IgA and IgG were much higher in the patients with pSS than in controls or those with sicca syndrome (p < 0.001). Similarly, the salivary IgM levels of patients with pSS were higher (although at a lower degree of statistical significance) as compared to those of patients with sicca syndrome (p < 0.01) or controls (p < 0.05). No correlation was observed among the salivary flow and the salivary IgG and IgM levels, while there was a negative relationship (p < 0.01 with salivary IgA levels in all 45 patients considered as a whole. In 12 patients with pSS, the coefficient of correlation between the salivary gland biopsy focus score and the salivary (but not serum) concentration of beta 2-microglobulin was highly significant (p < 0.001). A similar relationship was observed with the IgG (p < 0.001) and IgM (p < 0.05) levels, but not IgA. In the diagnosis of pSS, the salivary IgA level demonstrates high sensitivity and low specificity. In contrast, serum and salivary concentrations of beta 2-microglobulin, salivary IgG, and to a lesser degree, salivary IgM have high specificity and positive predictive value.(ABSTRACT TRUNCATED AT 250 WORDS)

Which treatment in pericardial effusion?

BACKGROUND: Pericardiocentesis, pleuro-pericardial window, subxiphoid pericardial drainage and pericardioscopy: which methodology to treat pericardial effusion? Each of these surgical treatments can be effective, depending on clinical factors and history of the patients. We considered pericardial effusions during 5 years. METHODS: We reviewed 64 cases: 14 acute pericardial effusions (5 patients with cardiac tamponade), 39 subacute, 11 chronic. Epidemiology and aetiology: 8 cases were between 20 and 25 years old (all affected by lymphoma), 56 were distributed in every age, especially over 60, and of these 45 were neoplastic and 11 non- neoplastic. Non-neoplastic cases were connectivitis (3 patients), uncertain origin effusion (7 patients), tubercular (1 patient). In neoplastic effusions we found lymphoma (at older age) in 7, small cell lung cancer in 6, NSCLC in 12, mesothelioma in 2, breast cancer in 7. RESULTS: Acute pericardial effusions with cardiac tamponade underwent echo-guided pericardiocentesis. In 43 we had a subxiphoid pericardial drainage, among these cases we performed 4 pericardioscopies. We created a pleuro-pericardial window on VATS in 13, on thoracotomy in 4 for technical reasons. CONCLUSIONS: Pericardiocentesis is to be preferred in acute pericardial effusion with cardiac tamponade to avoid general anaesthesia. Pleuro-pericardial window on VATS is better in chronic pericardial effusion (for infective or systemic disease) and in recurrence, after performing subxiphoid drainage. Subxiphoid drainage is suitable for all neoplastic patients, and in case of unknown aetiology in order to perform a pericardioscopy.

Comparison between segmentectomy and larger resection of stage IA non-small cell lung carcinoma.

AIM: Stage IA non small cell lung carcinoma (NSCLC) represents early cancer and is best treated by surgery. The frequency of recurrence and new primary cancer varies from one report to another while the role of sublobar resection is still debated. METHODS: We retrospectively reviewed 121 consecutive patients with pathological stage IA after radical surgery. RESULTS: In stage IA NSCLC 1-, 3-, 5-year survival rates were 89%, 76% and 66%. Nearly half of the deaths were unrelated to the original cancer. From statistical analysis we did not find any factor indicative of a better prognosis. We did not find any difference in survival between histologic types. Segmentectomy did not show a worse survival rate compared with larger resection. CONCLUSION: Survival is neither influenced by the type of resection nor by the histologic types in stage IA. However, we noticed a high incidence of local recurrence, segmentectomy could be a viable choice in patients with cardiopulmonary impairment.

Serum HBV DNA and intrahepatic hepatitis B core antigen (HBcAg) in chronic hepatitis B virus infection: correlation with infectivity and liver histology.

In this study we investigated the HBeAg/anti HBeAg status, the liver histological features, the intrahepatic localization of HBcAg, and the presence of serum HBV DNA in a group of 79 HBsAg-positive patients. We found a close relationship between the presence of HBV DNA and intrahepatic HBcAg in HBeAg-positive patients. Among the 56 anti-HBeAg-positive patients considered, 13 (23.2%) showed the presence of intrahepatic HBcAg and serum HBV DNA. In this group of patients, active viral replication was associated with a chronic inflammatory liver disease and particularly with CAH. Furthermore, a prevalent cytoplasmic localization of HBcAg was found in 66.6% of patients affected by CAH, showing that this peculiar distribution of HBcAg seems to be associated with a poor prognosis.

[Tumor markers in the diagnosis of pancreatic cancer]. / I marcatori tumorali nella diagnosi del carcinoma pancreatico.

The difficulty in an early diagnosis of pancreatic cancer is in the absence of early symptoms due to lower limit of detection of the actual imaging techniques. Clinical symptoms like weight loss, abdominal pain and jaundice indicate an advanced cancer stage. Today 50% of pancreatic tumors are diagnosed in advanced metastatic stage and only 20-30% show resectable cancer. Ultrasound and determination of a mucine like antigen as CA 19-9, CA 50 and CA 195 seem to allow an earlier diagnosis with a higher rate of resective surgery and a prolonged survival for these patients. The mucines are high molecular weight glycoproteins consistent of a backbone protein to which oligosaccarides are attached. The linkage of carbohydrate to the peptide is termed O-glycosidic and involves the hydroxylic groups of serine or threonine with N-acetylglucosamine. Only the backbone proteins are genetically determined (genes MUC). The gangliosides are the same or derivative of Lewis antigen. CA 19-9, CA 50 and CA 195 are assays directed to different epitopes probably present on the same mucinous antigen. These epitopes are not present in different mucines as CA 15-3, CA 125 and TAG 72. Recently other two mucines are emploied CA 242 and CAM 17.1 but they are not better than CA 19-9. The use of a "triplet" of tumor markers as CA 19-9, CA 125 and CEA is the best diagnostic tool for cancer of pancreas in an "integrated" use with ultrasonographic evaluation of the lesion. CA 19-9 permits differential diagnosis from neuroendocrine tumor or pancreatitis, the values of CA 125 and CEA are useful in the evaluation of the stage, resectability and prognosis of pancreatic cancer. The recent use of CA19-9 for the evaluation of radiochemotherapy in preoperative management of the patient is a mode of a well known application of tumor markers in a kinetic evaluation of the tumor for the radicality of therapy, follow-up, recurrence and the effectiveness of the palliative therapy.

Villous adenoma of the bladder.

Villous adenomas of the bladder are rare tumors and up to now they have not been seen to undergo malignant transformation. We report a case of villous adenoma of the bladder with areas of adenocarcinoma in a 72-year-old man. We describe all the morphological, histochemical and immunohistochemical features characterizing this tumor. We recommend adequate pathological sampling and a thorough follow-up of patients with villous adenoma. The prognosis and the behaviour of these adenomatous papillary lesions, morphologically similar to colonic adenomas, in the bladder is unclear. We report a case with focal area of adenocarcinoma and review the literature.

[Our experience with the use of ranitidine in the prevention of gastroduodenal damage caused by antiblastic polychemotherapy]. / Nostra esperienza sull'impiego della ranitidina nella prevenzione dei danni gastroduodenali da polichemioterapia antiblastica.

BACKGROUND AND AIM: Prevention of the adverse effects of antiblastic chemotherapy on the upper digestive tract through the administration of ranitidine. METHODS: A heterogeneous group of patients suffering from neoplastic pathologies was monitored between 1984 and 1998 (204 males and 152 females); patients were aged between 36 and 80 years old and they were all treated with antineoplastic polychemotherapy. Preventive therapy with ranitidine at a dose of 300 mg/die per os in a single evening bolus was continued throughout the entire period of antiblastic treatment, varying between a minimum of six months and one year or more. The study was performed at the Outpatient clinic for Surgical Oncology and Clinical Therapy at the General Surgery Department of Valdichiana Senese, Local Health Unit 7, Siena. It took the form of a clinical and instrumental follow-up using esophagogastroduodenoscopy at the time of enrollment and subsequently 3, 6 and 12 months thereafter as required. RESULTS: Ranitidine was found useful as a means of significantly reducing the gastrolesive effects of antiblastic drugs which, as has been extensively shown by the literature, can lead to the suspension of treatment owing to intolerance and even death. In this study ranitidine reduced the lesive effects on the upper digestive tract in 78% of the cases studied compared to 22% in non-responders. CONCLUSIONS: The action of ranitidine made antiblastic treatment more acceptable by mitigating or even blocking the adverse effects on the stomach and duodenum, thus leading to an improved quality of life for these cancer patients.

Ranitidine in the prevention of gastroduodenal damage during antiblastic polychemotherapy.

BACKGROUND: The authors report their personal experience of the use of ranitidine in the prevention of gastroduodenal damage induced by antiblastic drugs during antiblastic polychemotherapy. METHODS: A heterogeneous group of cancer patients was monitored from January 1984 to December 1999 (293 males and 204 females), aged between 36 and 80 years old, a11 of whom were undergoing antineoplastic polychemotherapy. Preventive treatment with ranitidine at a dose of 300 mg/die per os in a single evening bolus continued through the entire period of antiblastic treatment ranging from a minimum of six months to one year or more. The study was carried out in the General Surgery Department of Valdichiana Senese, Local Health Unit 7 in Siena and in the Department of Surgical Oncology at the University of Catania. The study consisted of a clinical and instrumental follow-up using esophagogastroduodenoscopy at the time patients were enrolled and at 3, 6 and 12 months, or at the end of treatment if longer. RESULTS: Ranitidine was useful and could significantly reduce the harmful gastric effects of antiblastic drugs, as has been extensively shown by the literature. These drugs can lead to the suspension of treatment owing to intolerance or even death. In this study ranitidine reduced the damaging effects on the upper digestive tract in respectively 78% of the cases treated compared to 22% of non-responders. CONCLUSIONS: The action of ranitidine made antiblastic treatment more acceptable by mitigating or even blocking the damaging effects on the stomach and duodenum, leading to an improved quality of life for cancer patients.

[Salivary and serum beta 2-microglobulin in the diagnosis of primary Sjögren's syndrome]. / La beta 2-microglobulina salivare e sierica nella diagnostica della sindrome di Sjögren primitiva.

beta 2-microglobulin (beta 2m) serum and salivary levels and total protein salivary levels were determined in 15 patients with primary Sjögren's syndrome (pSS), 14 patients with sicca syndrome and 11 healthy subjects. beta 2m serum and salivary levels were higher (p < 0.005) in the patients with pSS than in the healthy subjects and in the patients with sicca syndrome. The bioptic focus scores of minor salivary glands were correlated to beta 2m salivary levels with a high significance (p < 0.001) but were not correlated to beta 2m serum levels. The assessment of beta 2m serum and salivary levels is a non-invasive clinical investigation, which may be easily repeated. It is a very sensitive and highly specific test for the diagnosis of pSS. It may be therefore a useful mean to follow the natural course of pSS and to evaluate the effects of therapy.

Renal resistive index and left ventricular hypertrophy in essential hypertension: a close link.

The aim of this study was to evaluate renal Doppler resistive index in patients with mild to moderate essential hypertension (EH) and to correlate its changes with the presence of left ventricular hypertrophy assessed by echocardiography. Twenty-eight EH patients (19 males, 9 females, mean age 56.2 +/- 8.6 years) and 13 normotensive subjects (7 males, 6 females, mean age 57.6 +/- 7.9 years) were studied; all patients underwent a complete echocardiographic study (M-mode, two-dimensional and Doppler) and a color Doppler echography of renal and intrarenal arteries. After the renal Doppler waveform was obtained, resistive index was calculated by peak systolic velocity (S) and lowest diastolic velocity (D) with the formula S-D/S. EH patients were divided into two subgroups on the basis of left ventricular mass (LVM): Group EH1 with normal LVM (15 patients) and Group EH2 with increased LVM (13 patients). All patients evidenced normal renal morphology and function and received no therapy throughout the entire observation period. Renal resistive index was significantly higher in EH patients than in controls; however, the maximum difference was observed between normotensive subjects and the EH patients with increased LVM (p < 0.00001). At univariate analysis, significant correlations were found between renal resistive index and age, body mass index, left ventricular relative wall thickness and LVM. However, when multiple regression analysis was used, only age (p < 0.01) and LVM (p < 0.05) remained significant predictors of resistive index. In conclusion, our data show that in EH patients resistive index, which is considered an expression of arterial impedance, is well correlated with the presence of left ventricular hypertrophy, presently considered the best index of the severity of hypertensive disease. This correlation may be the expression of the involvement of two target organs in hypertension.

[Video laparoscopic cholecystectomy in situ viscerum inversus totalis]. / Videolaparocolecistectomia in situ viscerum inversus totalis.

Situs viscerum inversus totalis is a rare condition with a genetic predisposition that is autosomal recessive. We present a case in an elderly patient with transposition of the viscera and cholelithiasis, who was successfully treated with laparoscopic cholecystectomy. This paper further expands the application of this technique and shows that they can be safely and effectively applied in the setting of situs viscerum inversus totalis, although attention must be paid to the details of left-right reversal.