[Surgical tactics for treatment of thyroid gland diseases from an oncologic standpoint]. Analyzing the 30-year experience of a hospital, the authors come to a conclusion that the incidence of thyroid carcinoma among 10034 patients operated on has grown by 2.1 times. The number of thyroid cases grew mostly at the expense of a higher incidence of carcinomas of goiter-changed thyroid. The risk of appearance of malignant growth foci is virtually the same in different thyroid diseases and makes up 3%, as evidenced by the data of studies of the macro- and micro-preparations of the thyroid of 2930 patients with various thyroid conditions. This fact is explained by the effects of the same etiopathogenic factors studied in 595 patients with nodular tumors of the thyroid, though the incidence of these factors varies and is related to the nosologic entity. Prolonged follow-up and conservative therapy of thyroid patients are unjustified.


[Lipid peroxidation and antioxidant enzymatic defense in patients with newly detected insulin-dependent diabetes mellitus]. Studies of lipid peroxidation and antioxidant enzymic defense in red cell membranes in 23 patients with newly detected insulin-dependent diabetes mellitus have revealed a statistically significant (2-fold) elevation of malonic dialdehyde lipid peroxidation products and a trend to a rise in the levels of lipid peroxides. This is parallelled by a certain overstrain of the cellular antioxidant defense system. The authors discuss the usefulness of administering antioxidant therapy at the onset of the disease in order to prevent the toxic injury of beta-cells and vascular endothelium cells by lipid peroxidation products.


[Use of the lipolytic drug mevacor in the treatment of patients with diabetes mellitus]. Stable compensation of diabetes mellitus, including normolipidemia, underlies the therapy of diabetic angiopathies. Mevacor represents a nonactive lactone form of a certain hydroxy acid, a potent inhibitor of endogenous synthesis of cholesterol, conducive to blood cholesterol reduction. The aim of the present study was the assessment of the efficacy of this drug in therapy of patients with diabetes mellitus. Ten patients were administered mevacor in a dose of 20 mg for a month. Such therapy was conducive to a significant reduction of the levels of cholesterol, LNP cholesterol, triglycerides, and cholesterol/LVP ratio. It also promoted a reduction of the content of lipid peroxidation products in the blood, these products being an active factor of vessel destruction. The levels of hydroperoxides, blood serum and red cell malonic dialdehyde, and superoxide dismutase were also reduced. These results necessitate addition of mevacor to a complex of therapy for diabetes to normalize lipid metabolism.


[Formulas for estimating the RD parameter in the algorithm of statistical regulation of glycemia with a biostator]. An analytical approach to the estimation of the RD parameter for this algorithm has been developed; up to the latest time this parameter was chosen by the investigators by the 'try and miss' technique, based on the scientist's intuition. Three interactive formulae for the calculation of the RD parameter were derived, differing by the degree of the parameter modulation in the iterative procedure of the search for the precise value. The method for estimation of glucose utilization rate was adapted for the clamp method results obtained with a biostator; this method was for the first time used in the semiautomated glycemia regulation, that may improve the accuracy of glucose tolerance estimation.


[Disorder of neuroendocrine regulation of sexual behavior of male rats with streptozotocin-induced diabetes]. The present paper presents studies of the sexual behavior characteristics and the associated changes of LH releasing factor and of sex hormone receptor concentrations in hypothalamic regions involved in the regulation of sexual behavior activity and hypophyseal gonadotropic function (the anterior preoptic and mediobasal regions) of rats with streptozotocin-induced diabetes. The activities of both motivational and copulative components of sex behavior of such rats were found reduced. These changes were parallelled by LH-RH reduction in the median eminence and in the synaptosomal fraction of the anterior preoptic and mediobasal regions. An increased concentration of estradiol nuclear receptors was found in the anterior preoptic region, that may be responsible for the male feminization in diabetes and for weaker male sexual activity parameters. Blood levels of LH and FSH in experimental rats were virtually the same as in the reference animals, whereas prolactin and testosterone levels were reduced in the presence of elevated estradiol content. The majority of the detected hormonal shifts and sexual behavior characteristics normalized after compensatory insulin therapy. The authors come to a conclusion on the neuroendocrine disorders at the level of the CNS in animals with experimental diabetes during the formation of the motivational and copulative components of sexual behavior.


[Role of cytoplasmic proteins in the process of thyroxine stimulation of protein phosphorylation in rat liver and brain]. The role of thyroxin and thyroxin action modulator (cytoplasmic protein mediating some hormonal effects on the mitochondria and nucleus) in rat liver and brain protein phosphorylation was studied in experiments. In the liver, an organ sensitive to thyroid hormones, the modulator was found to stimulate the activity of specific protein kinases contributing to protein phosphorylation, and co-incubation of physiologic concentrations of T4 with the modulator enhanced the stimulatory effect. In the brain change of the thyroid status did not change the protein kinase activation. Incubation of T4 and thyroxin effect modulator did not change the enzymic activity either.


[Effect of protein content in rat diet on water-soluble vitamin metabolism in streptozotocin-induced diabetes]. Water-soluble group B vitamins metabolism was studied over the course of streptozotocin-induced diabetes mellitus in rats fed semisynthetic isocaloric diets containing 18 and 50% of protein. A high-protein diet in diabetes mellitus does not influence riboflavin metabolism disordered in this disease but reduced 4-pyridoxyl acid excretion to the level characteristic of healthy animals. The observed trend to an increase of liver nicotinamide coenzymes levels and of 1-methylnicotinamide urinary excretion reflects increased niacin synthesis from the diet protein tryptophan, for niacin level is reduced in diabetes.


[Free radical processes in the pathogenesis of alloxan diabetes]. Presents the results of studies of carbohydrate and peroxide metabolism, of antioxidant content in rats with alloxan diabetes under various levels of alimentary antioxidant consumption. Alloxan administration was found to result in biochemical and morphologic shifts characteristic of diabetes mellitus. The development of these changes runs against the background of enhanced free-radical processes. Simulation of alloxan diabetes in deficiency of alimentary antioxidants is conducive to the development of alloxan diabetes. The authors discuss the contribution of free-radical processes to the pathogenesis of alloxan diabetes and come to a conclusion on the usefulness of including antioxidant drugs in to a complex of therapeutic measures in this condition.


[Evaluation of antimicrobial drugs and atmospheres for the isolation of Campylobacter fetus subspp. from the bovine genital tract]. Growth of 3 reference bovine C. fetus strains in media with and without antibiotics and bacteriostats active against the most common contaminant bacteria in the bovine genital tract was evaluated. In addition, 2 regional bovine C. fetus strains and 1 reference C. sputorum biovar bubulus strain were used in some experiments. Reference strain C. fetus subsp. venerealis was completely inhibited by polymyxin (> or = 0.25 IU/ml) whereas the other C. fetus strains were not inhibited. In Shepler's medium supplemented with rifampicin (10 micrograms/ml) subsp. fetus, was the only one to grow. When rifampicin was used at 5 micrograms/ml together with a reduced dose of the other Shepler's antibiotics, especially polymyxin B (0.85 IU/ml), subsp. venerealis was able to grow; nevertheless even at such a reduced dose, rifampicin was inhibitory for the biotype intermedius. It was demonstrated that triclosan (Irgasan) could be very useful at < or = 10 micrograms/ml in media with added blood, < or = 6 micrograms/ml in brucella broth and < or = 3 micrograms/ml in Mueller-Hinton broth for isolation of all subspecies of C. fetus. The sensitivity of C. fetus to 5-fluorouracil was variable: subsp. fetus was resistant (up to 800 micrograms/ml) whereas subspp. venerealis and biotype intermedius grew slowly or sometimes did not grow at all in concentrations of 6.25 micrograms/ml onwards. Fosfomycin was inhibitory to all C. fetus strains at > or = 50 micrograms/ml. C. sputorum biovar. bubulus was less inhibited than C. fetus with triclosan grew up to more than 100 micrograms/ml, with 5-fluorouracil up to 100 micrograms/ml and with fosfomycin up to 50 micrograms/ml. Growth of C. fetus subspp. was compared in different microaerophilic atmospheres contained in anaerobic jars (Oxoid HP 11) without palladium catalyzer. Growth with nitrogen or hydrogen was similar. When jars were replaced by 15 x 13 cm cylindrical cans without valves or gas measurement devices only pure hydrogen supported satisfactory growth of all C. fetus subspp. and C. sputorum biovar. bubulus strains. The candle system, a commercial nitrogen rich gas mixture and pure carbonic anhydride prepared in these cans failed to enable these strains to grow. C. fetus subsp. fetus was more aero-tolerant than subsp. venerealis and its biotype intermedius and was able to grow, although very weakly, with only carbonic anhydride added to an aerobic atmosphere. The growth obtained using a commercial gas generating microaerophilic kit (Oxoid BR-56) was comparable to the one achieved with the hydrogen rich atmosphere prepared in our laboratory.


[Effect of glucose and lactose on the utilization of citrate by Lactobacillus casei subsp. rhamnosus ATCC 7469]. The utilization of citrate by Lactobacillus casei subsp. rhamnosus ATCC 7469 in a complex medium containing glucose, lactose or citrate was investigated, as an approach to the question of the transport of this acid and the possible relationship with the production of flavour compounds (diacetyl and acetoin). This lactobacillus uses citrate as an energy source in the absence of carbohydrates. External pH and growth increases when citrate is added to complex medium. The presence of citrate does not affect glucose uptake. L. casei ATCC 7469 possibly uses a transport system for citrate utilization, and citrate uptake seems to be under glucose or lactose control. Lactose only inhibits the entrance of citrate at high concentration while the utilization of this acid was negatively regulated by low glucose concentration.


[Prevalence in Tucumán of Chlamydia trachomatis and Ureaplasma urealyticum in sexually active women]. A group of 298 sexually active women who consulted for cervicitis, sterility or infertility were studied to detect the prevalence of Chlamydia trachomatis and Ureaplasma urealyticum and also to correlate the presence of these pathogens with tube damage. Chlamydial antigens were detected with a fluorescent commercial reagent with specific monoclonal antibodies. The isolation of U. urealyticum was made following the Shepard and Lunceford (19) techniques. In all samples of endocervical canal, we observed a higher incidence of chlamydial antigens (42.8%) with respect to U. urealyticum (5.7%). In peritoneal liquid the values were 38.8% and 5.5%, respectively. In the group of infertile women, we observed a higher incidence of C. trachomatis (49.5%), with 31.7% in the sterile group and 53.2% in those women with cervicitis without failures in reproduction. The frequency of U. urealyticum was 11.1%, 6.1% and 4%, respectively. According to the results obtained we can postulate that there is no correlation between infections produced by C. trachomatis and U. urealyticum and failures in reproduction.


[Numerical taxonomy of the genus Desulfovibrio by group analysis]. The Desulfovibrio genus has a particular interest because it includes the microorganisms connected with the corrosion produced microbiologically. The taxonomy of the genus shows disadvantages due to its metabolical and physiological characteristics. In this paper, 14 strains of the Desulfovibrio type were studied from the metabolical point of view. Numeric taxonomy was carried out according to the Group Analysis method, using and comparing the change possibilities of the method. The Consensus Method was also applied. The results obtained indicate a low metabolic activity of the strains with regard to the number of compounds which can be used as energy source. The taxonomic method showed a better structure with more clear divisions, corresponding to Simple Matching coefficient (which coincides with other symmetric coefficients and with the distance coefficient) with average bond (UPGMA). It is estimated that the present classification will vary in time with new strains with different metabolic characteristics. The two groups of bacteria correspond to those with more and less degrading ability.


Mutant vasopressin precursor producing cells of the homozygous Brattleboro rat as a model for co-expression of neuropeptides. The homozygous Brattleboro rat (di/di) synthesizes a VP precursor with an abnormal C terminus, which is not transported from the rough endoplasmic reticulum to the Golgi apparatus. In addition, the phenotypic expression of co-existing peptides is differentially disturbed. Ang II and 7B2 are two of the peptides which are not detectable, whereas other peptides (e.g. galanin) are clearly expressed in mutant VP cells. During postnatal life a small but increasing number of solitary post-mitotic VP neurons of the di/di rat undergoes a switch to a heterozygous phenotype. At the same time Ang II and 7B2 show up again in these heterozygous cells, which suggests that for the expression of 7B2, but not for that of other peptides (e.g. galanin), a normal VP precursor is required. A possible underlying mechanism (i.e. the existence of several domains on the endoplasmic reticulum involved in the translocation of sets of neuropeptides) for this differential phenotypic expression of co-existing peptides is discussed.


[Analysis of principal coordinates and factorial correspondence analysis applied to the taxonomy of type strains of Desulfovibrio]. Bacterial taxonomy using mathematical methods can be carried out with different techniques. Two techniques are used in this paper: analysis of principal coordinates and factor analysis of correspondences. The first one allows 2 and 3 dimension graphs of bacteria, thus showing their relationship considering proximity. The second one gives new data because it is an analysis which allows to connect bacteria to the reactions which identify them. In order to carry out these analyses 14 strains of the Desulfovibrio genus were studied, thus obtaining a classification consistent with other numeric method (group analysis with Simple Matching coefficient of average bond) to which it adds new information.


Relationships among the FMRFamide-like peptides. The nuclear family of FaRPs (comprising those peptides that are, on compelling evidence, homologous) appears to be restricted to the protostome invertebrate phyla: i.e. Mollusca, Arthropoda, Annelida and Nematoda. Neither the origin nor the range of the family has been definitively established. That is, no genuine homologs have been demonstrated yet in the flatworms (though not for lack of trying), and neither the pseudocoelomate phyla related to the nematodes, nor the coelomate relatives of the annelids have been examined. The extended family of FaRPs (including peptides with little consistent sequence similarity beyond a penultimate Arg and an amidated hydrophobic residue at the C-terminal) exists in all phyla. Such a superfamily was probably first proposed by Morris et al. (1982), whose sequencing of SCPB suggested to them a class of peptides, "... the key unit for biological activity being Phe-A-Arg-B-amide (where A and B are also hydrophobic amino acids)." The ubiquity of the convergent FaRPs could reflect a conserved family of complementary heptahelical receptors requiring the arginyl residue for binding (Price and Greenberg, 1989). But another selective advantage would be the protection provided by a penultimate Arg against certain deamidating peptidases, found so far in yeast and mammals (Jackman et al., 1990).


Neuropeptide gene expression in transgenic animals. Transgenic animal techniques offer today's neuroscientist the ability to experimentally manipulate neurosecretory systems with a precision undreamt of by our predecessors. The range of techniques now available, building as it does on our growing knowledge of physiological systems at the inter- and intercellular level, allows us to critically define molecular lesions and ask about their consequences to the whole organism. Neuroscientist should grasp the opportunities afforded by these recent developments.


Residence time distribution of diazepam in the isolated perfused rat liver. Analysis with the axial dispersion model. The application of the axial dispersion model to diazepam hepatic elimination was evaluated using data obtained for impulse-response experiments with diazepam in the single-pass isolated perfused rat liver preparation. The transient form of the two-compartment dispersion model was applied to the output concentration versus time profile of diazepam after bolus input of a radiolabelled tracer into the hepatic portal vein (n = 4), providing DN and CLint estimates of 0.251 +/- 0.093 and 135 +/- 59 ml min-1, respectively. In contrast, the one-compartment form of the axial dispersion model, which assumes instantaneous transversal distribution of substance to the accessible spaces within the liver, could not adequately describe the residence time distribution (RTD) of diazepam. Furthermore, the magnitude of DN, a stochastic parameter which characterizes the axial spreading of solutes during transit through the liver, is similar to that determined for non-eliminated substances such as erythrocytes, albumin, sucrose and water. These findings suggest that the dispersion of diazepam in the perfused rat liver is determined primarily by the architecture of the hepatic microvasculature.


Potential induction of osteogenesis by systemic administration of bovine bone proteins. This study shows, apparently for the first time, that the administration of bone derived proteins (putative bone growth factors) obtained from bovine demineralized maxillaries has a direct effect on osteogenesis, affecting significantly some markers of bone formation such as lactate dehydrogenase activity and serum osteocalcin. Also, collagen deposition and bone protein turnover were markedly increased by the treatment, which may have important biological and clinical applications.


Analysis by digital simulation of the peripheral and renal resistance in hypovolemic hypotension. A haemorrhage was simulated and analysis of dynamic behaviour of renal resistance, renal nervous activity and peripheral resistances were processed, with the aim of studying the paradoxical behaviour of renal resistance as opposed to peripheral resistances and the increase of sympathetic activity in hypovolemic shock situations using both non-linear models of the renal blood flow and arterial pressure and body fluids. The following conclusions can be made after comparing the results obtained by simulation with data related to animal experimentation models: the model is useful for its use in the analysis of nervous activity, resistance and renal flow in hypovolemic shock situations in humans and the control structure it puts forward can explain the paradoxical behaviour of renal vascular resistance as opposed to the peripheral resistances and the increase in the renal nervous activity in the aforementioned circumstances.


Biological characterization of a formulated allergoid from Dermatophagoides pteronyssinus. A comparative study between the biological properties of the allergen Dermatophagoides pteronyssinus (Dp) and its formulated allergoid (DpHCHO) was performed. After immunizing rats with Dp or DpHCHO the serum level time course of IgE and IgG was determined by passive cutaneous anaphylaxis (PCA) and indirect-ELISA, respectively. The avidity for IgE (PCA and PCA-inhibition) or IgG (indirect ELISA and ELISA inhibition) and the ability to induce anaphylactic shock were also determined. Serum IgE pattern differs between Dp and DpHCHO while IgG levels were greater after DpHCHO. The allergoid has lost the ability to bind IgE while its avidity for IgG falls 5-6 times. The allergoid, but not the allergen, fails to induce anaphylactic shock. A schedule for assaying the biological characteristics of allergoids is presented.


Unilateral ovariectomy, flutamide treatment and HCG reverse the anovulatory action of antiprogesterone RU486 in rat. Administration of antiprogesterone RU486 (4 mg/day) from estrus through proestrus to cyclic rats blocked ovulation. Moreover, RU486 increased basal serum concentrations of LH, PRL, testosterone and estradiol, while it decreased basal serum concentration of FSH. Both unilateral ovariectomy and antiandrogen flutamide treatment, as well as an ovulatory injection of HCG in the proestrus afternoon partially reversed, the ovulatory blockade of RU486. These results indicate that both the decreased FSH concentration and the increased testosterone concentration, as well as the reduced ovulatory LH release are responsible for the anovulatory effects of RU486.


Comparative determinations of low-density-lipoprotein-cholesterol. Two different methods for low-density-lipoprotein-cholesterol (LDL-C) determination were comparatively used. The heparin-sodium citrate (pH 5.12) precipitation method gave similar LDL-C results to the ones given by the Friedewald et al. formula (3.2 vs 3.3 mmol/l) in 187 men. Values obtained using both methods show a very high and significant correlation (r > 0.9; p < 0.001). However, LDL-C values obtained with the precipitation method were 15% higher in hypertriglyceridemics (triglycerides (Tg) > or = 2.3 mmol/l). A paired-comparison between data obtained by both methods indicates a clear serum Tg-values influence, because LDL-C values obtained by the precipitation method were significantly more frequently higher (p < 0.05 or p < 0.01) than LDL-C values obtained using the Friedewald's formula in hypertriglyceridemic men (Tg > or = 1.7 mmol/l or Tg > or = 2.3 mmol/l respectively). When a 3.9 mmol/l LDL-C level break was chosen, Friedewald's formula gave 13% false hypercholesterolemics. The influence of Tg was again significant in men with both, hypercholesterolemia and hypertriglyceridemia, while LDL-C values obtained by the precipitation method were significantly more frequently higher (p < 0.01).


[Regional distribution of brain aminopeptidases in the rat]. Soluble and membrane-bound aminopeptidase activities in eleven regions of the rat brain were assayed using L-leucine-2-naphthylamide as a substrate. In addition, two metabolic enzymatic activities were compared: lactate dehydrogenase and aspartate aminotransferase. All enzymatic activities showed significant regional differences when the data were analyzed statistically. Soluble aminopeptidase and aspartate aminotransferase activities were significantly lower in cortical than in subcortical areas. Membrane-bound aminopeptidase activity levels were higher in cortical areas. Lactate dehydrogenase activities did no differ between cortical areas and the rest of the zones studied. However, while no wide regional differences were found for the other enzymatic activities, membrane-bound aminopeptidase varied markedly across brain regions: a 5-fold difference was observed between zones. The differential distribution of this enzymatic activity is consistent with the hypothesis that it is responsible for the enzymatic inactivation of some neuroactive peptides.


Effect of maternal food restriction on the evolution of pregnancy in the rat. The present work analyzes the role of food and water intake, nitrogen balance, and in vivo D-glucose intestinal absorption in body weight gain during the second half of pregnancy in malnourished mother rats. Our results indicate that nitrogen balance and intestinal absorption of D-glucose were not changed as a result of food restriction, but important negative correlations between water intake and micturition and weight gain and micturition were found in experimental mothers. The retention of water seems to be one of the most important factor influencing body weight gain in malnourished mother rats in the second half of pregnancy.


Effects of hyperprolactinemia on prolactin and LH pulsatile pattern in female rats. Prolactin (PRL) and luteinizing hormone (LH) secretions are very closely-related. To further understand these mechanisms, the pulsatile secretion pattern of both hormones in experimentally-induced hyperprolactinemia has been studied in adult female rats. Hyperprolactinemia was induced by the transplanting of two pituitary glands. Nine days after the transplant operation, rats were bled (75 or 100 microliters/7 min for 3 h). Serum samples were analyzed for prolactin and LH values by RIA. Hyperprolactinemia modifies pulsatile PRL secretion by increasing the absolute amplitude and duration of the peaks together with a decrease in their frequency. Also, the mean values of the hormone during the whole studied period were increased. Hyperprolactinemia was followed by an increase in the mean values of LH and in the absolute amplitude of the peaks. All these results suggest that hyperprolactinemia induced by pituitary grafting in adult female rats, is followed by a significant change in prolactin and LH pulsatility, which may explain, to some extent, the effects of hyperprolactinemia on reproduction.


[The antitoxic action of xenogeneic spleen in treating the suppurative-septic complications in surgery]. The article presents results of using hemoperfusion through the swine spleen and infusions of the xenosplenic perfusate in treatment of purulent peritonitis and various suppurative complications in 109 patients. A positive effect was noted (20% reduction of lethality, 1.5-3.5 times shorter period of treatment).


[The role of determining the level of middle molecules in patients in the diagnosis and treatment of suppurative-inflammatory complications after operations on the liver and pancreas]. Investigations of the level of medium-mass molecules were performed in blood plasma of 52 patients in dynamics after different operations on the liver and pancreas. Significant elevation of the level of medium-mass molecules was noted in patients with pyo-inflammatory complications. The inverse relationship between the level of medium-mass molecules and the prognostic coefficient value (the ratio of the general plasma protein to the general protein of wound discharge) was revealed. The indicators of the prognostic coefficient value decreased when the level of the medium-size molecules elevated against the background of purulent complications. These data allowed to estimate the severity of purulent complications and degree of intoxication which helped to determine the correct method of treatment of patients and to timely detect pyo-inflammatory complications.


[An active individualized treatment procedure for patients with bleeding stomach and duodenal ulcers]. Individual methods of treatment of patients with ulcer bleedings are described. At the period from 1987 to 1990 170 patients were operated upon. Lethality was 3.1%.


[The effect of the type of operation and of combined pathology on the treatment results in patients with chronic disorders of duodenal patency]. The work presents results of surgical treatment of 38 patients with chronic disturbance of duodenal patency. It was established that operations aimed at the improvement of the passage of food through the duodenum, gave unsatisfactory results in remote period in 30% of cases. Operations are recommended aimed at the improvement of the passage of contents of the duodenum in combination with operations excluding the duodenum from the passage of food. Surgical correction of coexistent diseases of the digestive system is recommended.


[Aspiration-lavage treatment in suture incompetence of the duodenal anastomoses and stump following gastric resection]. An analysis of results of 26 patients has been made who had incompetent sutures of anastomoses and stump of the duodenum at the nearest postoperative period after gastric resection. In 14 patients (main group) aspiration-lavage method of drainage was used, in 12 patients (control group) other methods of treatment of incompetent sutures were employed. The advantage of the aspiration-lavage method of treatment over other methods is shown.


[Simultaneous operations in the surgical treatment of cancer of the esophagus and cardia]. In the clinic one-stage operations for cancer of the esophagus of different localizations and cardia were performed on 63 patients. The substitution of the removed esophagus was fulfilled with an isoperistaltic tube made from the greater curvature of the stomach with anastomosis on the neck or in the pleural cavity. After intrapleural plasty lethality was 21%, after total one with extracavital esophagogastroanastomoses--14%. For prevention of ischemic complications an intraoperative assessment of viability of the transplant was performed with the help of microphotoplethysmography. The authors have shown the advantage of endolymphatic route of administration of cytostatic in 25 patients as compared with the intravenous one.


[The use of decompressive endoscopic operations in the complicated course of cholelithiasis]. The article is based on an analysis of observation of 853 patients with complicated forms of cholelithiasis. The average age of patients was 73.5 years, two thirds of them had critical coexistent diseases. The system of treatment proposed by the authors allowed achievement of good results (lethality is less than 5%) while the methods of treatment generally accepted in surgical practice is followed by higher lethality achieving 40%. The work analyzes errors and complications of endoscopic decompressing operations and gives recommendations for their prevention.


[The current problems of relaparotomy].

[The current problems of relaparotomy]. Relaparotomy was performed in 252 of 23,232 (1.08%) patients operated upon. The most frequent cause of relaparotomy is purulent complications. These patients have immunodeficient states due to different causes (duration of the disease, old age, diabetes mellitus, toxemia, anemia, extension of the injuries, irrational administration of antibiotics). Due to it, anaerobic neclostridial infection is widely used. Its participation in the purulent process in the abdominal cavity achieves 80-90%. For prevention and treatment of purulent complications of great importance is the modern and adequate struggle against intoxication and hypoxia, correction of immunodepression, purposeful antimicrobial therapy. Problems in determination of indications for relaparotomy are emphasized and the necessity to perform it in earlier terms.


[The indications for the use and the technical characteristics of gastric resection by Roux's method]. Based on findings of general diagnosis in 62 patients the authors have determined indications for using Roux resection of the stomach which was used as primary operation in 22 patients and repeated operation--in 40 patients. Main indications for Roux resection were chronic disturbance of duodenal patency, chronic pancreatitis, afferent loop syndrome, reflux-gastritis. The work describes technical peculiarities of the Roux resection of the stomach with necessary observation of 6 pathogenetically substantiated rules. Results of Roux resection of the stomach are good, no evacuatory disorders of the gastric stump were noted.


[The physiological aspects of the efficacy of reconstructive operations in arteriosclerosis obliterans of the lower extremities]. Reconstructive operations in the aorto-iliac and femoro-popliteal segments were performed on 281 patients with obliterating atherosclerosis. An attentive examination of the patients in the nearest postoperative period and within the first 5 years has shown different efficiency of the operation in different patients. Favorable changes took place in regional hemodynamics, while disturbances retained in microcirculation and function of the extremity. Another cause of insufficient efficiency of the interventions was an initial stable suppression of tissue respiration and oxygen utilization in the extremity tissues. The dynamics was positive during a year followed after that by new symptoms of progressing disease.


[False aneurysms of the vascular anastomoses after reconstructive operations on the aorta and arteries of the lower extremities]. The authors have performed an analysis of examination and surgical treatment of false aneurysms of vascular anastomoses (34) in 29 patients after reconstructive operations on the aorto-iliac and femoro-popliteal segments. This late complication was found to develop in 3.3% of the patients operated upon. In 66.5% of them the aneurysms had complicated the clinical course. Multifactorial genesis of false aneurysms was confirmed. The first place among etiological factors belongs to infection. Reconstructive operations with resection of the aneurysm and restoration of blood flow were performed on 27 patients. Good results were obtained in 25 of them, reamputation of the femur and shin was made in 2 patients. The authors insist on early diagnosis and active surgical treatment of false aneurysms of anastomoses.


[The surgical restoration of the function of the knee joint in patients with severe refractory posttraumatic contractures]. Results of operative treatment of 100 patients with long-standing persistent contractures of the knee joint and partial defects of condyles of joint ends were studied. The treatment used allowed to obtain favorable results in majority of the patients and to return working ability to the patients. The application of perosseous apparatuses and allotransplantation make the potentialities of reconstructive surgery of the knee joint much wider.


[The replantation of the thumb in avulsive amputations]. A comparative assessment of results of operations was made in 2 groups of patients with abruption of the first finger. An analysis of immediate and long-term results of operations has shown advantages of the method of replantation with heterotopic revascularization of the replanted first finger and reinnervation by means of plasty of the palmar digital nerve.


[Acute intestinal obstruction as a problem in emergency surgery]. An experience with treatment of acute ileus is presented. Operations were performed on 499 patients. Postoperative lethality from small intestine obstruction was 12.5%, from the colon obstruction--32.4%. The methods of treatment of different forms of intestinal ileus are described.


[The intestinal suture under conditions of disordered blood supply]. Under conditions of disturbed blood supply, irrespective of the method of anastomosing, the trophicity of tissues in the zone of suture is sharply disturbed. These alterations are especially pronounced after using multi-row suture when healing develops very unfavorably. In hypoxia of tissues a one-row everting suture made by the author's method with a removal of mucosa and preservation of submucosa provides more favorable conditions for healing of the wound in the place of anastomosis. The method of intestinal suture is described.


[The efficacy of the conservative treatment of patients with acute appendicitis on board ships at sea]. Under study was efficiency of conservative treatment of 247 patients with acute appendicitis on ships in the sea depending on the age of patients, clinical manifestations of the disease, volume of medicamentous therapy and time of taking medical advice. It was established that conservative treatment is most effective if started within the first 6 hs from the beginning of the disease and antibiotics were used in combination with spasmolytics, antihistamines and sulfanilamides. Patients treated conservatively had pronounced inclinations to delimiting the inflammatory process in the abdominal cavity.


[Diagnostic and therapeutic laparoscopy in acute cholecystitis in middle and old age]. Laparoscopic decompression of the gallbladder in elderly and senile patients having acute cholecystitis and in patients with severe coexistent diseases allows arresting the acute inflammatory process in the gallbladder, reducing the amount of forced operations which are extremely dangerous for this contingent of patients. Sanitation of the gallbladder with the electrolytic silver solution and irradiation of the bladder mucosa with laser is highly effective. Microcholecystostoma performed with a catheter having a diameter not less than 2.5 mm maintains adequate decompression of bile ducts and allows performing complete examination of them.


[The functional assessment of the late results of surgical treatment in lung cancer]. Results of a complex clinico-functional examination of 48 patients after resection for lung cancer 8-10 years ago are presented. The satisfactory pumping function of the heart was revealed with practically normal volumes of the cardiac output. Among patients subjected to resection of a lobe of the lung two groups were determined: with relatively satisfactory parameters of the function of external respiration and blood circulation and with a pronounced degree of strain of the functioning of these systems.


[The clinico-functional assessment and work capacity of patients undergoing repeated operations on the mitral valve]. A complex of examinations (ECG, echocardiographic and X-ray evaluations of heart volumes and cavities, treadmill-test) was performed in 82 patients before and after reoperations on the mitral valve. The type of recorrection was found to be associated with the degree of positive dynamics of the results. The data obtained contradicted to hyperdiagnoses of primary medical-labor examination commission establishing the II group of invalidism in 86 +/- 4% (M +/- m) of the examined patients. As a result of an analysis of all the data obtained the number of such patients was reduced up to 34 +/- 5%. A new approach to solving the problem of medical-labor examination was shown to be necessary for patients reoperated for mitral disease of the heart.


[Variants in the distribution of the vertical reflux of blood through the pelvic veins and the routes for its transmission to the veins of the lower extremities in patients with varicose veins]. An analysis of complex clinical and phlebographic examinations of 60 patients with the varicose disease has been made. Twelve variants of ways of spreading vertical reflux of blood along the pelvic veins have been established and two ways of its transmission to the lower extremity veins: a direct way of reflux from the iliac to femoral vein and an indirect ways of reflux--from tributaries of the iliac vein to those of the femoral vein. To eliminate the direct reflux the operative correction is necessary of the valve of the common femoral vein located inferior to the inguinal ligament. For patients with the indirect way of reflux ligation of the injured communicating veins of the gluteal area and femur, dissection of the varicose external labial veins are indicated.


[The surgical treatment of Dupuytren's contracture]. Treatment of 129 patients with palmar fibromatosis was performed; all the men were from 20 to 63 years old. In 56 patients (1st main group) operation of aponeurectomy was performed with the help of an ultrasonic scalpel (USS), in 53 patients (2nd main group) the operation was made with the help of the microsurgical technique (MST), 30 patients (a control group) were operated upon by usual methods. The use of USS and MST were followed by excellent (92.6%), good (2.1%) and satisfactory (5.3%) long-term results.


[Traumatic disease in wounded patients]. Results of clinico-physiological, pathobiochemical, immunological and hemocoagulative studies performed at the postshock period in 186 patients with battle wounds have shown their coincidence with data obtained in critical mechanical trauma of peace-time. A conclusion is made that critical gunshot wounds are followed by trauma disease having main regularities similar to those in a critical mechanical trauma of peace-time. One can speak only about specific features of battle injuries, but to distinguish "wound disease" as an independent clinical form is thought to be illegal.


[The use of the "internal autotransfusion" method in complex shock-control measures at the prehospital stage]. Fifty-three patients with traumatic shock were injected 200-400 ml of a 10% solution of sodium chloride in combination with 100 ml of the 40% solution of glucose. The continuous, for 1-2 h, elevation of arterial pressure, increased minute blood circulation volume, cardiac index, stroke volume were noted. At the same time base deficiency in blood was growing. So, in the last 5 patients the infusion therapy at the prehospital stage was completed by injecting 200 ml of 3% sodium solution and the acid-base state in them was thus leveled. When using the "internal autotransfusion" lethality was reliably less than in patients who were treated by routine (polyglucon, gelatinole) infusion therapy.


[A procedure for infusion-transfusion therapy and autohemodilution in severe trauma and shock (apropos the article by B. N. Salamatin et al., The use of the "internal autotransfusion" method in complex shock-control measures at the prehospital stage)]. The infusion of hypertonic solution is thought by the authors to be effective due to its reflectory action for treatment of patients who are in the state of anaphylactic and cardiogenic shock. This method seems to be expedient for massive blood loss under conditions of prehospital medical aid to victims with very low level of arterial pressure, with craniocerebral trauma and critical trauma of the chest.


[The use of external fixation apparatus in injuries to the hand bones]. An analysis of experimental studying the stability of osteosynthesis and clinical application of apparatuses of external fixation in 282 patients with fractures and sequellae of traumas of the bones and joints of the hand is presented. Main conditions influencing stability of fixation of the hand bones were determined. A universal complex of details is recommended which allows to make the optimum construction of the device as applied to the specific kind of trauma. It was proved that choice of the individual construction of the apparatus considerably widened the scope of using the method of external fixation and improved results of the treatment.


[The pathogenetic and clinical grounds for the advantages of nondrug procedures in the preoperative preparation of patients with diffuse toxic goiter]. An analysis of 615 patients operated upon for diffuse toxic goiter is presented. In 148 of them (24%) preoperative preparation was made with the help of nonmedicamental methods (extracorporal hemosorption, hyperbaric oxygenation (HBO), plasmapheresis). The state of euthyroidism was controlled according to their clinical symptoms and was verified by radioimmunological studies of triiodothyronine (T3), thyroxin (T4), thyrotropine (TTG). Indicators of corticosteroid hormones, thyrostimulating antibodies, antigenic HLA structure and antioxidative activity of different media of blood were also determined. The estimation of the data obtained as compared with results of morphological examinations allowed a conclusion that the above nonmedicamental methods in patients with diffuse toxic goiter are pathogenetically substantiated. Clinical expedience of their use is obvious. No lethal outcomes or complications resulted from using hemosorption and HBO. Single complications took place resulting immediately from catheterization of large venous vessels. Long-term results from 3 to 9 years have shown that recurrences of the disease in patients given nonmedicamental preoperative preparation were met much more rarely as compared with patients who obtained routine preparation (1.4% and 5.4 correspondingly).


[Intraoperative changes in the peripheral circulation with different methods for reconstructing the arteries of the extremities]. An examination of 192 patients with obliterating atherosclerosis of lower extremities was made who had different reconstructive operation. Intraoperative measurements of oxygen strain in the foot skin and rheography of the shin have shown that temporary compression of large arteries when making vascular anastomoses cause ischemia of extremities, whose degree and duration is dependent on the technique of the technique of the intervention. Advantages of the method of transprosthetic aortotomy such as less duration and lower degree of ischemia were shown. The possibility was revealed to prognose nearest results of treatment for changing regional hemodynamics and oxygenation of tissues at the moment of termination of the operation.


[Current problems in the diagnosis and surgical treatment of rare developmental defects of the lungs]. The author analyzes questions of diagnosis and surgical treatment of 168 patients with rare malformations of the lungs which made up 5.6% of the general amount of patients with surgical nonspecific diseases of the lungs and 36.1% among all defects of development of the lungs. It was established that diagnostics of rare defects of development of the lungs might be of full value but when using a complex of roentgenological, bronchiological and functional methods of examination. Surgical treatment of rare defects of the lung development is indicated to 86.1% of the patients and must be performed till the progressing of secondary alterations, when disturbances of ventilation and oxygenation are observed, there is blood flow shunt disturbances of hemodynamics of the pulmonary circus of blood circulation.


[The effect of temporary endobronchial occlusion on pulmonary gas exchange in the treatment of pyopneumothorax]. An estimation of changes of main hemodynamic, biochemical and laboratory indicators and the function of external ventilation was fulfilled when performing temporary endobronchial occlusion at the level of lobular and main bronchi in 37 patients with pneumothorax. Favorable changes were established in the systems of blood circulation and external ventilation in occlusion of lobular bronchi. Grounds are given for the necessity of intensive anti-inflammatory treatment, oxygenation and maintenance of cardiodynamics in occlusion of the main bronchus.


[The prognostic assessment of the reversibility of myocardial dysfunction in patients with ischemic heart disease after aortocoronary bypass]. Forty-six patients with ischemic heart disease with considerable dysfunction of the myocardium were subjected before operation of aortocoronary shunting to veloergometry with calculation of indices of the central hemodynamics by the method of tetrapolar rheoplethysmography, echocardioscopy before and after taking nitroglycerin. Close interrelation was noted between the increase of the stroke volume during veloergometry, increased fraction of output after taking nitroglycerin and improved contractile capacity of the myocardium after aortocoronary shunting.


[The hemostatic effect of vagotomy in acute gastroduodenal ulcers complicated by massive hemorrhage]. The clinico-experimental investigation has shown high efficiency of the bilateral subdiaphragmatic truncal vagotomy in treatment of patients with acute gastroduodenal ulcers complicated by massive hemorrhage. The haemostatic effect of the operation is related to the inhibited acid gastric secretion, proteolytic activity of the intragastric content as well as to the activation of serotonin-containing cells and increased tonus of the sympathetic nervous system, which is responsible for gastric vessel spasm, shortens time of bleeding, increases the amount of thrombocytes and their aggregation. When vagotomy with interventions draining the stomach is not possible, suturing (dissection) of bleeding acute ulcers is recommended in combination with prolonged novocain blockade of vagus nerves.


[The digestive activity of the chymus in the gastric stump in postgastrectomy peptic ulcers]. Forty-two patients with postgastroresection peptic ulcers of the zone of gastrojejunal anastomoses were examined. The cause of the appearance of the ulcers was the action of aggressive content of the gastric stump on the jejunum in the area of anastomosis. "Vagal" peptic ulcers were found by the gastrocepin test. After operations reducing the stump acidity healing of all the ulcers was noted. In achlorhydria of the stump the digestion in it is realized due to reflux at the expense of pancreas proteinases.


[The preoperative morphological diagnosis of hepatobiliary and pancreatoduodenal cancer]. Morphological investigations at the preoperative stage were performed in 94 patients. The morphological diagnosis was made on the basis of findings of duodenal biopsies, cytological investigations of the bile and aspirate from the Vater's papilla ampulla, endocholedochal and percutaneous biopsies with the express cytological monitoring. Recommendations are given on the programs of preoperative morphological diagnosis of carcinoma of Vater's papilla.


[The procurement of demineralized cranial transplants and their clinical use]. Demineralized cranial transplants of allogenic origin when transplanted to 49 neurosurgical patients with defects of the skull cap of not more than 50 cm2 area gave positive results by liquidating the corresponding symptoms. High bioplastic quality of such transplants allow them to be recommended for wide use in clinics.


[Microsurgical autotransplantation in gunshot wounds of the extremities and their sequelae]. An experience with treatment of 108 patients with extensive deep defects of extremity tissues was generalized. Such wounds made up 42.3% of the total number of patients with wounds of extremities. The introduction of microsurgical autotransplantation of tissues allowed to shorten the terms of medical and social rehabilitation, to reduce invalidism of the patients and to lower the cost of treatment.


[The use of photomodified blood in oncology]. Under study was the influence of different regimens of blood photomodification on the course of the tumor process. Experiments were carried out on 460 syngeneic mice with a model of Lewis adenocarcinoma of lungs and melanoma B 16. It was established that the influence of APMB on the course of the tumor process is dose-dependent and when specially selected the regimen of APMB may have an antitumoral effect. The transfusion of the photomodified donor blood may facilitate the suppression of antitumoral immune reaction of the recipient organism.


[Quantum hemotherapy in the treatment of chronic postembolic pulmonary hypertension]. Based on studying 34 patients, the authors made a conclusion that transfusion of UVI autoblood improves the pulmonary blood circulation, increases blood oxygenation and deformability of erythrocytes, decreases blood viscosity.


[An immunoelectron microscopic study on the development of the antibody-producing cells in the guinea pig popliteal lymph nodes]. The pre-embedding immunoelectron microscopic method was used to study the development of antibody-producing cells in the guinea pig popliteal lymph nodes of 2, 3, 5, 8 and 10 days after a second challenge with horseradish peroxidase. The results indicated that the antibody activity was located in the perinuclear space, the endoplasmic reticulum and Golgi complex. According to the cellular developmental stages and the characteristics of distribution of the antibody activity, the antibody-producing cells (APC) were divided into four types: (1) Type I cells (lymphocytes) exhibited many positive granules throughout the cytoplasm; (2) Type II cells (proplasmacytes) contained many positive granules and positive short bars, some of them were parallel; (3) Type III cells (proplasmacytes) contained numerous parallel positive lamellae in cytoplasm; (4) the parallel lamellae in cytoplasm of type IV cells (plasmacytes) were arranged into a network-endoplasmic reticulum. According to the kinetic change from granules, short bars to parallel lamellae and the network, the results indicated the developmental course of AFC from lymphocytes, proplasmacytes to plasmacytes.


[The production of IL-2, IL-6 in relation to the functional development of NK cells in human fetal spleens]. The production of IL-2, IL-6 by fetal splenic mononuclear cells (FSMC) and relationship between them and the ontogenetic development of natural killer cell function were studied in human fetal spleens. As a results, before 20 weeks of gestation, both IL-2 and NK cell activities were not measured, but IL-6 was done. It was found that IL-2, IL-6 and NK cell activities were increased with the gestational age, and shown that there were linear positive correlation between the activities of three ones above (r > 0.86). Before the birth, the induced IL-2 activity was the same as adult levels (p > 0.05), although both IL-6 production and NK activity in fetal spleens were significantly lower than that in adults (p < 0.01). Lastly, the production of IL-2, IL-6 in relation to the functional development of NK cells during the embryonic development was discussed.


[The role of p53 gene in the switch of U937 leukemic cells from growth into differentiation]. The expression of p53 gene has been found to be regulated during the induction of differentiation of U937 leukemic cells into mature macrophages by recombinant human granulocyte- macrophage colony stimulating factors (rhGM-CSF) We showed here that the increased expression of p53 seemed to be necessary for the differentiation of U937 cells induced by rh-GM-CSF. The inhibition of p53 expression by a p53 antisense oligodeoxynucleotide lead to the significant decrease of formation of mature macrophages from U 937 cells in the presence of rhGM-CSF. By contrast, the p53 sense oligodeoxynucleotide had no any effect. Furthermore, we have analysed the growth of U937 cells in the presence or absence of rhGM-CSF. The results showed that rhGM-CSF dramatically inhibited the growth of U 937 cells in the cultures. At the same time, the antisense inhibition experiment demonstrated that the inhibition of p53 expression partially diminished the growth-inhibitory effect of rhGM-CSF on U 937 cells. These results suggested that the p53 was required for the initiation of rhGM-CSF-induced differentiation of U 937 cells on one hand, and the inhibition of cell growth on the other hand. Thus we deduce that the increased expression of p53 induced by rhGM-CSF may be a coupling event of switch of U 937 cells from growth into differentiation.


[Effect of gossypol on the proliferation of rat prostate cells studies in vivo and in vitro]. The effect of gossypol on prostate cells of rat was studied both in vitro and in vivo. For in vivo study, mature male Sprague Dawley rats were given gossypol orally, 5 mg/day, 5 times a week for one month. Then the prostates were examined histologically. By adding gossypol to the culture system directly, NbE-1 cells were used in vitro study. Several parameters, including histological structure, cell growth, DNA synthesis and mitotic cycle of cells were measured by different methods. The prostate size and weight in experimental rats decreased and significant differences between acini in controls and gossypol treated animals were noted. Acini of control prostate were full of protruding folds constituted by columnar epithelial cells, whereas, the most of the acini in treated animals were composing of cubic or square epithelial cells and epithelial folds were rarely seen. Thus, acini with normal appearance were about 14% less than that in controls. In the in vitro experiments, both cell proliferation and DNA synthesis decreased from 0 to 80% and from 0 to 90% respectively, when the concentrations of gossypol were increased from 0 to 20 micrograms/ml. It seems that 10 micrograms/ml of gossypol could cause the most significant inhibition in these two cellular functions. The cell mitotic assay showed that in treated groups, the cell number of S phase was decreased from 43 to 31%, this fact indicated that the inhibition on cell proliferation caused by gossypol might be due to preventing cells to enter S phase. Besides, inhibition effect on the proliferation of prostatic epithelial cells was dosage dependent and related to the duration of treatment.


[The distribution and changes of lectin receptors in developing mouse cornea]. Using ConA-HRP and RCAI-HRP as probes, the distribution and changes of glycosides in mouse cornea were studied during pre- and postnatal development. Mannose residues were distributed mainly in stroma and endothelium, sialic acid residues in epithelium and galactose residues in both epithelium and stroma. Mannose residues in stroma showed an increased density toward endothelium before and after birth. Sialic acid and galactose residues were concentrated gradually at the corneal epithelial surface in accompanied with the development of cornea. The embryonic day 13 was the starting day to synthesize glycoconjugates from fibroblasts of mouse cornea.


[The synaptic architecture of propriospinal neurons in cultured mouse spinal cord]. An electron microscopic analysis of the synaptic architecture in propriospinal neurons of cultured fetal mouse spinal cord has been undertaken. The size of the perikarya in the cultured spinal cord represents a range from small- to medium sized neurons, which form many synapses each other. There are many axo-dendritic and axo-somatic synapses in the culture but direct dendro-dendritic apposition is rarely seen. Four morphological types of synaptic boutons, S, F, M and G are classified according to criteria used by previous investigators. The ultrastructural details available suggest that the propriospinal neurons receive synaptic input from propriospinal fibers through simple synapses. It may indicate that their impulses can be controlled only postsynaptically.


[Role of beta-carotene in the prevention of genotoxic damage in patients undergoing radiotherapy. Monitoring by the micronucleus test in exfoliative cells of the oral cavity]. Radiotherapic treatment of patients with carcinoma usually causes genotoxis damage. This has been studied recently using the test of micronuclei in esfoliated cells. This test presents methodologic advantages in compared with the classic citogenetic analysis and as it is carried out on esfolieted cells from the oral cavity it faithfully reflects the genotoxic damage undergone by the cells of the basal layer of the epitelium. The preliminary result obtained so far have confirmed the anticlastogenic activity of beta-carotene in fact, the frequence of micronuclei in esfolieted cells from the oral cavity in patients undergoing radiotherapy or undergoing treatment with beta-carotene is inferior to that of patients undergoing treatment with beta-carotene is inferior to that of patients undergoing radiotherapy without the subministration of carotenoids. Treatment with carotenoids does not influence the therapeutic efficiency of radiotherapy treatment. Therefore, the results seem to confirm that indirect ossidaction processes are involved in the mechanism of the clastogenic action of radiotherapia. The carotenoids seem to be able to contrast validly this undesirable effect without interfering with the desirable therapeutic effect.


[Bovine costal cartilage as material for otologic reconstruction: anatomo-functional results]. The Authors present their experience in using bovine cartilage as otological material reconstruction. Cartilage of the ribs is to collect from selected bred cattle and is first placed in an antibiotic solution for 3 days and then in a 70% ethyl alcohol in which it is stored for 20 days before being utilized. One hundred-nineteen cartilage heterografts have been implanted in the middle ear since January 1989. We report the results of 86 cases which were included in a followed study for at least 12 months. Bovine cartilage was used in 47 canal up techniques, 28 canal down techniques and 11 anatomic and functional rehabilitation of old radical cavities. The result prove most encouraging. In 74 cases we observed good anatomical results characterized by a new, intact eardrum with no sign of inflammation or a cavity lined with normal epithelium. No extrusion was found. Removal of cartilage implanted after a year enabled us observe the high tolerance of the graft and to carry out further histological examination. The histological findings indicated normal and intact cartilagineous matrix, lined with fibrous tissue and mucosa with no evidence of condrocytes. In cases in which the heterografts were utilized for ossiculoplasty, the post-operative air-bone gap was 11.1 dB and the mean hearing gain was 26.3 dB. Moreover, bovine cartilage is easily obtainable and available in pieces of sizes necessary for specific purposes in otologic surgery. Cartilage heterografts might well be a good alternative to autologous and homologous cartilage grafts.


[Cell kinetic analysis and treatment planning in epidermoid tumors of the head and neck]. Cell kinetic parameters were evaluated using the method based on in vivo incorporation of Bromodeoxyuridine (BrdU) and flow cytometric (FCM) analysis in 30 human epidermoid head and neck tumors from oropharynx, oral cavity, rhinopharynx, larynx and lips. BrdU was injected four/six hours before the obtainment of multiple bioptic samples from the tumor tissues. The flow cytometric method was carried out on 70% ethanol fixed cell suspensions based on established protocol for the simultaneous evaluation of DNA content and BrdU uptake using anti-BrdU monoclonal antibodies. We have evaluated the following FCM parameters: DNA ploidy, the degree of DNA aneuploidy (DNA index), Labelling Index (LI), duration of s-phase (Ts) and tumor potential doubling time (Tpot). LI values ranged from 1.5 to 20% with a median value of 10%. The median LI of DNA diploid tumors was 5.4% compared to 14% in DNA aneuploid tumors. Ts values ranged from 8 to 11, the median value being 10 hours. Tpot values ranged from 2 days to 16 days, the median Tpot being 5 days. The large heterogeneity of all these parameters indicates that these tumors may have a different degree of biologic aggressiveness (9). Tpot values did not correlate with DNA ploidy nor with lymph node metastasis status. Tpot values did not correlate in a statistically significant manner with degree of differentiation although shorter Tpot were more frequently observed in moderate or poorly differentiated tumors. Our study shows that the FCM-BrdU technique in vivo is feasible in a clinical setting to evaluate the proliferative behaviour of head and neck tumors, before any specific therapeutic decision is taken after surgery is performed. It is likely that tumors with more aggressive biological behavior, as indicated by LI > 15%, DNA aneuploidy and Tpot < 5 days, may benefit from more aggressive therapies such as accelerated regimeus of radiotherapy and/or other multimodal therapies in respect to tumors with slow growth rate (LI < 15%), DNA diploidy and Tpot > 5 days. So far, however, it still remains to be demonstrated from randomized clinical trials if the knowledge of such individualized cell Kinetic parameters really can help to choose the most effective therapy for every individual patient.


Conduction velocity of antigravity muscle action potentials. The conduction velocity of the impulses along the muscle fibers is one of the parameters of the extraterritorial potentials of the motor units allowing for the evaluation of the functional state of the muscles. There are no data about the conduction velocities of antigravity muscleaction potentials. In this paper we offer a method for measuring conduction velocity of potentials of single MUs and the averaged potentials of the interference electromiogram (IEMG) lead-off by surface electrodes from mm. sternocleidomastoideus, trapezius, deltoideus (caput laterale) and vastus medialis. The measured mean values of the conduction velocity of antigravity muscles potentials can be used for testing the functional state of the muscles.


4-Aminopyridine and tetraethylammonium-induced changes in action potentials of unmyelinated axons. The effects of different concentrations of 4-aminopyridine (4-AP) and tetraethylammonium (TEA) on the intra- and extracellular action potentials (ICAPs, ECAPs) of unmyelinated axons of Lumbricus terrestris were studied. The results showed different sensitivity of the axons to both potassium current blockers (4-AP and TEA), added to the medium. 4-AP led to spontaneous and single stimulus- evoked repetitive activity, manifested as a slow "burst" action potential propagation like "plateau" ICAP with oscillations. The ICAP duration of the TEA-treated axons increased mainly at the expense of the repolarization phase which reflected the increased duration of the ECAP recorded at long radial distances. The amplitude of the ICAPs after treatment with both blockers was decreased to 20% as compared to the controls (untreated axons) and ECAPs decreased to 40% in the TEA-treated axons. The conduction velocity (CV) of the action potentials was not significantly changed. The calculated total ionic current during the action potential upon TEA treatment was decreased and the duration of the outward phase was prolonged.


[Cystic parotid lesions in HIV infection]. The appearance of parotid lesions of cystic aspect with a HIV's infections has been described in the past by foreign Authors above all coming from USA and from Africa. Similar cases has been recorded in France but only among children. The Authors report a casuistry constituted by five male sex's and white race's subjects, everyone HIV positive, suffering from mono or bilateral benign lymphoepithelial cysts. Every patient under examination presented a positive history because of the use of intravenous drug. Four of the five subjects underwent a surgical treatment of parotidectomy. Echotomography, CT and RM scanning seem to be the more sensitive diagnostic techniques. The peculiar histopathologic aspects allow us to differentiate these lesions both from the classical benign lymphoepithelial cysts and from the Warthin's tumor. The increase of the signalling of these cases seems to be connected with the progressive diffusion of the infection and with major survival of the patients thanks to chemotherapy. The majority of the Authors is agreed to recommend the surgical treatment for the possible malignant degeneration of this kind of forms. A careful clinical and diagnostic analysis of every patient with parotid swelling, above all if at risk for HIV's infection, is strictly necessary.


Investigation of antiischemic properties and mechanism of action of azacrown ether derivative. The influence of the azacrown ether derivative benzylaza-15-crown-5 on myocardial tolerance to ischemia and on the functional state of the zone of myocardial ischemia during coronary artery occlusion was investigated in experiments on anaesthetized open-chest cats. The compound tested produced a dose-dependent antiischemic effect and prevented the development of myocardial ischemia. In experiments on isolated guinea-pig papillary muscle benzylaza-15-crown-5 inhibited the first and second components of the isoproterenol-induced muscle contraction. The compound decreased the maximal contraction force and had no effect on the cardiac cycle duration and on the time necessary for reaching maximal tension. It is suggested that the protective effect of benzylaza-15-crown-5 during myocardial ischemia is mediated through the inhibition of calcium release from the sarcoplasmic reticulum.


[Analysis of the cellular infiltrate and epithelial class I and II molecular expression in edematous type nasal polyps]. Although in the last few years histopathological, immunohistochemical and immunological studies on nasal polyps have been carried out by several Authors, the etiology of these formations still remains unknown. Nasal polyps have a very characteristic structure and have been classified in three histologic types: edematous, glandular and fibrous. In the present report, 11 nasal polyps of edematous type, representing 61% of total number of collected polyps, were studied employing immunohistochemical methods. All the examined polyps were similar in histology and positivity pattern for HLA molecule expression. The edematous core appeared infiltrated (149 cells/mm.2) mainly by eosinophils (> 90%), whereas the peripheral subepithelial connective tissue contained cellular clusters (416 cells/mm2.) made up of different subsets of hematic cells (30.8% were monocytes-macrophages and 48.6% were lymphocytes largely represented by CD4+ cells). On the contrary, mast cells were quite rare (on the average 1.7 cells/mm2.) and located near T cell clusters. The epithelial positivity for HLA-DR and HLA-A,B,C molecules showed a characteristic discontinuous pattern. In the same patient, controlateral nasal mucosa showed a histological structure very similar to that of polyps. The above data suggest that the presence of polyps is the result of an inflammatory process brought about by a complex array of cellular and humoral components.


Stance does interfere with movement related brain potentials. Movements of the upper limb are well known to be preceded by electromyographic activity in leg and trunk muscles known as postural preadjustment. Brain potentials preceding the actual commencement of voluntary displacement were also described. The relationship between the occurrence of these two electrophysiological phenomena was investigated by performing two types of movement in three different body positions. Healthy subjects were free standing, sitting and standing with backsupport. When fast forward arm elevation was executed, the preceding Bereitschaftspotential was higher in amplitude at 500 msec before EMG onset and alongside midline scalp leads during sitting. The amplitude at 150 msec, immediately preceding movement, did not show significant differences related to body positions and there was no contralateral dominance. When index finger flexion was performed, it did not yield differences in the Bereitschaftspotential between sitting and standing positions. These findings suggest the existence of two separate stages of the preparatory process and an influence of the muscle mass involved in the stance perturbation during voluntary movement.


[Interaction between continuous and impulse noise: anatomic and functional evaluation in relation to the intensity of the exposure]. Interaction between continuous and impulse noise was studied. One group of chinchillas was exposed to octave band of noise of 0.5 kHz 95 dB SPL intensity. Three groups were exposed to impulse noises of 113, 119 and 125 prak SPL emitted at 1 imp/sec, 1 imp/4 sec and 1 imp/16 sec respectively. Three groups were exposed to noise created by a combination of above continuous and impulse noises. All exposures lasted for 5 days. Hearing thresholds were measured in 35 animals using auditory evoked potentials. The combined continuous and impulse noises showed equal energy contents, but the groups exposed to 119 and 125 dB impulse noise intensities developed an exacerbation of PTS and cell hair loss. Therefore, the critical level, under which the damage associated with noise exposure is related to the total noise energy (Equal Energy Hypothesis) was reduced when impulse noise was added to continuous noise.


[Open rhinoplasty: indications and limits of a controversial method]. As Aufricht has said, rhinoplasty is "... an easy operation to do, but it is hard to get good results". As it clearly observed in ENT rhinoplasties which deal with severe and combined defects of the nose which result in functional impairment. The aim of this study was to analyse complications in a personal series of open rhinoplasties as well as those in literature in order to standardize different surgical approaches possible in correcting various nasal deformities, divided according to a personal classification. Other than the classical intramucosal technique (following Roe, Joseph and Weir), the more conservative extramucosal operation (described by Jost and Aiach) and the more aggressive external approach are available to the surgeon. Intramucosal rhinoplasty is still the most dependable and widely used technique. However open rhinoplasty which brings about complications in less than 10% of the procedures, offers clear-cut advantages if employed following precise indications. In our experience, the main indications for open rhinoplasty are: severely crooked nose, above all of the II and III arch: crooked nose with saddle deformity; asymetrical defects (including those due to a cleft lip); 50% of the secondary rhinoplasties (excluding minor procedures).


Veterinary drug surveillance.

Veterinary drug surveillance. The possible adverse effects of the application of veterinary drugs are considered with special reference to their illegal use or misuse in the different categories of animals (pet, sporting, food-producing). The risks of unacceptable drug residues in animals and their products, the environment and man are taken into consideration. The need is stressed for proper veterinary surveillance by previous assessment of priorities such as animals' health status, economic aspects, quality of food of animal origin, safeguard of the environment.


Veterinary pharmacovigilance in the European context. Pharmacovigilance (or pharmaco-surveillance) is the surveillance of adverse drug reactions (ADRs) which are noxious and of unintended reactions which occur at doses normally used in animals in accordance with the terms of the marketing authorization. From this definition, the scope of veterinary pharmacovigilance should be clearly defined, especially with regard to associated problems of lack of efficacy, resistance, effects in man, residues, etc. Priorities should be established concerning adverse effects in animals in order to set up an operational system. Methodological tools are being developed such as causality assessment, thesaurus, data banks, alert systems. The situation of veterinary pharmacovigilance in countries is very different. The existing systems are based on two different conceptions: a pharmacovigilance of the administrative type, made by authorities; a pharmacovigilace of the interactive type, made in veterinary universities, linked with the authorities. In industry, the importance of pharmacovigilance is increasing; collaborations have been set up but should certainly be developed. Finally, the sensitization of the veterinary practitioners, which play a key-role in the system of spontaneous reporting of ADRs, is to be developed in many ways: interaction during or after the report, publication of data, concrete actions, improvement of side-effect warnings and prevention, etc. Veterinary pharmacovigilance should be a very interesting area of cooperation between the field, universities, industry and regulation authorities.


The role of multigeneration studies in safety assessment of residues of veterinary drugs and additives. Multigeneration studies investigate the impact of a chemical on the reproductive function of laboratory rodents following continuous exposure of several (usually 3) generations. Such tests detects the presence of effects sensitively and efficiently; however, it may be necessary to add satellite groups to the basic protocol and/or to undertake more specific studies in order to investigate the nature of the effects observed. The possible enhancement of the chemical's impact along the generations and the use of apical endpoints (fertility, pup mean weight and survival, etc.) make multigeneration tests apt to reveal the cumulative action of minor, detrimental hits. Therefore, they appear especially important in the safety assessment of chemicals not expected to be markedly toxic, like many veterinary drugs or feed additives. The present paper reviews the role played by the data drawn from multigeneration studies in the toxicological evaluation of six compounds, namely: a) a synthetic anabolic steroid with hormonal (antigonadotropic) activity, trenbolone acetate; b) a colouring additive with some cumulative toxicity, canthaxanthin; c) a lipophyllic drug with effects on neuron transmission, ivermectin; d) a teratogenic benzimidazole, albendazole; e) a genotoxic molecule, olaquindox; f) a drug with male reproductive toxicity, closantel. Finally, the endpoints evaluated in the multigeneration studies might be utilized also in field studies aimed at evaluating the long-term reproductive impact of chemicals in farm species.


Veterinary primary health care in Italy. The role of Veterinary Services in the field of primary health care according to the principles expressed by the World Health Organization is described. In more details, the contribution that Veterinary Services can give in Italy at local level to promote programmes of primary health care is considered, especially in the field of veterinary urban and rural hygiene, hygiene of food of animal origin and health education.


Intersectoral collaboration in animal and human health. A review is made of the health fields where collaboration between veterinarians and physicians and with other professions is most needed. The main obstacles encountered in this collaboration are recognized in institutional and attitudinal factors such as the type of administration in which veterinary services are located, economic interests, isolated spheres of activity of both veterinarians and physicians, reactions of the public to Veterinary Public Health action, insufficient fund allocation, etc. Control of echinococcosis/hydatidosis and brucellosis is given as an example of fruitful intersectoral collaboration supported by health institutions at local and international levels. It is stressed that the need for intersectoral collaboration is being increasingly and universally accepted with the active involvement of concerned organizations at all levels.


The state of food hygiene and foodborne diseases: requirements for the future. The current world situation of foodborne diseases is reviewed with an analysis of the factors responsible for their occurrence in both developed and developing countries. Strategies to solve the problems associated with food hygiene are also reviewed with special attention to the most recent approaches identified and worked out by the main institutions concerned. Specific suggestions are given for more effective planning and implementation of future global food hygiene programmes.


Hazard analysis critical control point (HACCP) in public catering services: a modified method, combined to bacteriologic assay. During 1990 and 1991 the Veterinary and Public Health Services of USL 35 of Ravenna carried out a research programme aimed at the control of food-borne diseases in the sector of public catering services, in collaboration with the Public Health Laboratory (Presidio Multizonale di Prevenzione). The objectives were: obtaining sure information about health hazards in public catering services; checking structural characteristics and equipment of workrooms in restaurants, hotels and refectories; verifying food preparation and preservation methods; promoting health education to increase employees' awareness of hygiene-related problems. The first objective, evaluation of the level of the control of the workrooms exerted on the food contamination hazard by pathogenic or potentially pathogenic organisms, was carried out by allotting specific scores to several characteristics of laboratories or workers' habits, as suggested by the "Hazard Analysis Critical Control Point" (HACCP) method for butcher's shops and fish markets. Five hundred ninety-eight public catering service units have been inspected in restaurants, hotels, school-refectories, factories, hospitals and social houses; 2,097 bacteriological examinations by agar-contact plates and swabs were carried out; 118 preserved-food temperatures were measured, especially in deep-frozen and cooked food; 70 food specimens were tested to search for Salmonella spp. and Staphylococcus aureus and measure Total Aerobic Mesophilic Weight. The presence of Enterobacteriaceae and Escherichia coli was also tested.


Animals as hosts of zoonoses.

Animals as hosts of zoonoses. The different aspects of the host/parasite relationships are taken into consideration along with the factors that can affect their behavioural patterns. Special attention has been given to the conditions which are involved in the development and establishment of the host/parasite association with an account of the various forms of this coexistence, such as proper parasitism, mutualism, commensalism and symbiosis. The rules which must be complied with to secure the survival of parasites and the perpetuation and completion of the parasitic life cycles are described. The special role of man as a host of zoonotic agents and the main approaches to zoonoses control are considered.


Echinococcosis/hydatidosis: socio-economic consequences and economic analyses of control programmes. A review is made of the socio-economic consequences of echinococcosis/hydatidosis and of the methods of economic analysis of control programmes. The main costs and benefits (both financial and social) which should be taken into consideration in evaluating health action are also examined.


A study of factors influencing intestinal parasites in dogs. Coprological examinations were made on 686 owned dogs (23% of the total number of the registered dogs) in a semiurban area of the province of Bologna including the small towns of S. Agata, S. Giovanni in Persiceto, Sala Bolognese and Crevalcore. The results of the coprological tests were evaluated in association with the data obtained from the owners about the origin and the use or function of the animals, veterinary assistance, diet, cohabitation with other dogs, and the presence of gastrointestinal conditions. Prevalence rates were 7.0% for ascarids, 3.6% for tapeworms, 7.1% for coccidia, 2.8% for hookworms, 28.6% for whipworms. On the whole, the animals positive for gastrointestinal parasites were 37.5% of those examined. Multiple linear regression analysis indicated that the presence of gastrointestinal parasites in general was influenced by the use of the animals, veterinary assistance, age, anthelminthic treatments and cohabitation with other dogs. The presence of ascarids appeared to be influenced by age and veterinary assistance; that of cestodes by veterinary assistance; that of coccidia by cohabitation with other dogs; that of whipworms by function, treatments, veterinary assistance and age. None of the variables considered in the analysis could explain the presence of hookworms. Factor analysis grouped the variables considered into 5 factors: the first was associated with veterinary assistance; the second with the animal's function and the presence of whipworms, hookworms and tapeworms; the third with cohabitation, origin and presence of coccidia; the fourth with the presence of fresh meat (cooked, raw or frozen) in the diet, age and positivity for ascarids; the fifth with sex and the presence of gastroenteric conditions.


Evaluation of the size of stray dog population and of related problems in Emilia-Romagna. An investigation was carried out on the diffusion of stray dog populations in Emilia-Romagna by submitting a questionnaire/interview. 30 gamekeeper officers and 21 public veterinarians of Bologna and Forlì provinces were interviewed. The data collected were compared with the official data of the Health Council of the Emilia-Romagna Region. Statistical analysis confirmed a correlation between number of biting dogs and inhabitants of the province; number of captured dogs and registered dogs; number of biting dogs and owned dogs, and the existence of factors favouring dog straying in mountain areas.


Dog-transmitted zoonoses: a serological survey in the province of Bologna. Eight hundred and two sera of owned dogs from four small towns north-west of Bologna were examined for the presence of antibodies against Coxiella burnetii and Leishmania infantum. At the same time, 149 sera of 69 dog owners from the same area were tested for the presence of antibodies to Q fever, leishmaniasis, echinococcosis/hydatidosis and toxocarosis. Of the 802 dog sera, 7 (0.87%) were positive for Q fever. Of the 69 dog owners, 24 (35%) were positive for Q fever, 4 (6%) for echinococcosis/hydatidosis and 3 (4%) for toxocarosis. Some epidemiological evaluations are made on the possible role played by the dog in spreading the zoonoses considered, at least in the area examined.


Bovine spongiform encephalopathy: an overview. Bovine spongiform encephalopathy (BSE), a novel disease of cattle first described in 1986, has now reached epidemic proportion in Great Britain with about 500 cases a week. The clinical, epidemiological, and pathological characteristics of BSE are described. Moreover, the etiopathogenetic mechanisms of spongiform encephalopathies are reviewed. Legislative measures to prevent the spread of BSE in Italy and in other EEC countries and to minimize the theoretical risk to man are reported.


Intersectoral cooperation training: a tool for health personnel development. The present paper describes some training experiences for improving intersectoral collaboration in the public health sector, between Medical and Veterinary personnel, working at the same level, local or regional, but in different preventive Services. It stresses that intersectoral collaboration is an important resource in public health planning and in developing health system as well as a real tool for health personnel development.


The control of human brucellosis in the Campania region: an updating of knowledge and results obtained by the third year of the programme activities. A control programme for brucellosis in Campania was started in 1988, in the province of Caserta, and implied different actions at the regional and provincial levels. The section of the work described here regards the updating of the results obtained during the third year of the project activity. The action performed included experimentation of data sheets in the province of Caserta to gain information on the factors conditioning brucellosis, gathering and analysis of ISTAT data on the size of livestock population as an actual or potential source of infection for man, epidemiological surveillance of human cases, census of dairies, and public health measures taken by the Regional Council. The results show that improvement of human brucellosis surveillance is in progress, whereas the programme implementation has provided a clearer picture of the situation with better understanding of the factors affecting the disease occurrence. Such problems posed by the project management as difficult maintenance of sufficient collaboration between veterinarians and physicians, scarce participation of local and regional administrations, resistance opposed by some categories, and reduced availability of financial resources are also discussed.


Mortality rates among psychiatric patients, during and after the "psychiatric reform", in the area of Rome (Italy). The issue of supposedly high mortality rates among psychiatric patients discharged from mental hospitals after the implementation in Italy of Law 180 is controversial. We have studied a cohort of 1858 long-term psychiatric inpatients of Public Mental Hospitals in the area of Rome (Italy), followed up for 9 years during and after the implementation of Law 180. As expected, age adjusted mortality rates were higher than those observed in the general population living in the study area, and death rates among patients with "organic mental disorders" were higher than those among patients with "functional disorders". No difference in death rates was observed between the group of discharged patients and that of patients not yet discharged.


[Anopheles in Italy: distribution on rice lands in the provinces of Grosseto and Siena]. The Laboratory of Parasitology of Istituto Superiore di Sanità acts as a coordinating centre for anophelism data collection in Italy, and collaborates with the health local authorities. This specific investigation takes into consideration several areas in the provinces of Grosseto and Siena, focusing attention on the rice fields, which are today the most important anopheline breeding sites in Maremma. The records collected in collaboration with the Department of Environmental Zoology (USL 28 Grosseto), show a high density of A. labranchiae, the potential malaria vector, in the coastal areas of Grosseto province, and a decreased susceptibility to some insecticides. Among the other anopheline species found, only A. atroparvus (the species most present on the inland hills of the provinces of Grosseto and Siena) show a remarkable density.


[National Register of congenital hypothyroidism]. The results of five years activity of the National Register of children with Congenital Hypothyroidism (NRCH) have been evaluated. NRCH was established in Italy in 1987, as a pilot project of Health Ministry. All Italian Centers in charge of the screening, treatment and follow-up of CH are involved in the program. The results have provided further epidemiological informations about CH in Italy and have evidenced some aspects in the screening organization which had to be improved. Discussion of Register data in annual meetings has recently allowed to obtain an improvement especially for the beginning of treatment and the used dose of therapy.


Prevalence of mental disorders in Tuscany: a community study in Lari (Pisa). A number of population studies of mental disorders has been carried out using standardized diagnostic tools. We performed a study of this type in the small town of Lari (Pisa) with the objectives of estimating the prevalence of mental disorders, including "minor" disorders, and of comparing our estimates with similar studies carried out in UK and Greece using identical methods (PSE-IX and CATEGO). The prevalence of individuals with mental disorders in our study population was 15.4% similar to that observed in Greece (16%) and higher than that observed in London (10%). Prevalence of "obsessive neurosis" was higher in London as compared to Lari and Athens, while the opposite was true for "generalized anxiety".


[Somatomedins/insulin-like growth factors (IGFs): chemical and functional characteristics]. The insulin-like growth factors constitute a family of peptides which have structural homology with proinsulin, and which possess broad anabolic and mitogenic action in wide variety of tissues. The two main forms of IGFs in serum of adults are insulin-like growth factor I (IGFI) and insulin-like growth factor II (IGFII). IGFI appears to be the major growth factor involved in postnatal growth and is believed to mediate most (if not all) of the growth promoting effects of growth hormone (GH). IGFII may be involved in embryonic and fetal growth. It is the aim of this article to present an account of recent advances in the understanding of the origins, functions, and clinical significance of these peptides. Particularly the role of IGFs in fetal growth during normal and diabetic pregnancies.


[Immunogenicity of a recombinant vaccine against viral hepatitis B]. The introduction in Italy of recombinant DNA hepatitis B vaccines has allowed to plan out a very important programme of vaccination; in Italy the compulsory vaccination against hepatitis B virus begun from 1991. Because of the reduction of vaccine cost, the screening for serum markers of HBV infection is needless. On the contrary, the test of antiHBs titres after the vaccination is important in order to take into account a booster vaccine dose and to carry out revaccination strategies. In this study, we analyzed 419 subjects vaccinated with Engerix-B; the immune response was correlated with private and behaviour data.


[Evaluation of work styles using the clinical case method at the departments of mental health in the region of Campania]. In the present study, designed after the Australian "Quality Assurance Project", the same 9 clinical "vignettes" relative to 3 schizophrenia cases, 3 depressives and 3 neurosis were read by 48 psychiatrists of the Campania Region (Italy). For each case, the psychiatrists were requested to give their opinions on best place of treatment, psycoactive drugs, psychotherapy, etc. A remarkable variability among psychiatrists was observed, regarding not only psycotherapy but drug therapy as well.


[Models and strategies for the control of air pollution in large urban areas]. In the attempt to define the characteristics of a global approach to the problem of atmospheric pollution, the mathematical and statisticals tools currently available are presented which will allow the rationalization of both the study and the management of reduction policy. An example of a possible application of this approach is given, which presents the results obtained by modelling the data on "conventional" pollutants furnished by the experimental sampling station set up at the Istituto Superiore di Sanità (ISS) in Rome. Since the suggested approach may not do without an integrated management of date, a hypothesis for an information system is outlined as well.


[Territorial distribution of mortality from malignant tumors of the pleura in Italy]. Mortality from malignant pleural neoplasms in Italy, 1980-87, was studied in order to detect areas at risk. The number of observed deaths occurring in each of the 8000 Italian municipalities was contrasted to the expected figure obtained from regional and/or national rates; whenever a significant increase, based on at least three observed cases, was detected, the municipality was included in the study. The main findings in Piedmont concern the city of Casale Monferrato, where an important asbestos cement factory is located, and some areas characterized by the presence of the textile industry. Genoa and other harbours of the northwestern coast, where important shipyards are located, were detected. In Lombardy an increased in risk concerning women was observed in several municipalities. Major increases in risk were seen in Venice. Trieste and Monfalcone, where important shipyards are located. In Tuscany, the highest risk was reported in Leghorn and surrounding areas; naval industry and chemical industries should be considered. In southern Italy, several cities with industrial harbours were shown to be at risk.


[Hemangioma of the petrous bone. Diagnosis and treatment]. Hemangiomas of the temporal bone are benign, vascular and are tumors. The diagnosis is in most cases made during the operation because the symptoms are non conclusive. Two cases were recently observed: one simulating a Meniere disease while the tumor was developed close to the jugular bulb and the endolymphatic sac; the second invaded the geniculate area and the petrous apex and was revealed by a progressive facial palsy.


[Neuroendocrine giant-cell epithelioma. Description of a clinical case and review of the literature]. Neuroendocrine tumors are rare neoplasms of the larynx and hypopharynx. This tumors are divided in paragangliomas (usually benign, although malignant case have been reported), large cell neuroendocrine carcinoma, described in this case as a primary pharyngo-laryngeal locate, and small cell neuroendocrine carcinoma (characterized by early and diffuse metastatic disease, and best treated by radiotherapy and chemotherapy). Through the international literature, the authors reviewed the characteristics of the large cell neuroendocrine tumors and their management.


[Anatomical limits of endonasal ethmoidectomy]. Constant anatomic boundaries of the lateral mass of the ethnoid are described, based on data from microdissections, endoscopic examinations, computed tomography imaging and histology in 12 subjects. As with surgical progression, identification of these boundaries follows the lateral orbital and superior craniofrontal surfaces. The "starred groove formation", ethmoidal roof lamina and ethmoidosphenoidal recesses are the safety beacons for endonasal ethmoidectomy under endoscopic control.


[Asthma and polyposis. Efficacy and adverse effect of endonasal ethmoidectomy. Results apropos of 70 patients]. The authors report the efficacy and adverse effects of intranasal ethmoidectomy in 70 patients with asthma and persistent severe symptoms from nasosinal polyposis despite repeated prior treatment. The efficacy was defined according to the evolution of symptoms and endoscopic findings. Adverse effects were evaluated according to subjective clinical and therapeutic data in all 70 patients. In addition, 25 patients had complete pre and post-operative pulmonary function tests. The results confirm that intranasal micro-surgery does not increase the severity of asthma. On the other hand, no significant improvement in bronchial function was noted after ethmoidectomy. Finally, the authors emphasize the poorer results obtained in Widal's disease and the importance, after the failure of medical treatment, of using of sufficiently extensive surgical procedure in order to decrease the incidence of recurrences.


[Is facial nerve visible on magnetic resonance imaging?]. The internal architecture of the parotid gland was studied by nuclear magnetic resonance (NMR) imaging, particular attention being paid to the intra-parotid portion of the facial nerve. Currently available apparatuses provide high resolution images of previously poorly elucidated anatomic details. Certain authors consider that images in the axial plane in T1 allow direct visualization of the facial nerve and its branches in the form of low frequency linear signals within the gland. The present study, based on radio-anatomic correlations and date determined in a healthy volunteer, demonstrated that these structures correspond in fact to segments of the excretory canal tree, the facial nerve and its branches being invisible on NMR imaging. It is not possible, therefore, to determine the location of a parotid tumor in relation to these nerve elements using this imaging technique.