[Ultrasonics in the monitoring of portasystemic anastomoses]

Mortality due to recurrent variceal esophageal bleeding secondary to portosystemic shunt thrombosis is high. Early diagnosis of shunt thrombosis is therefore necessary. For these reasons, patients who have undergone a portal diversion must be controlled periodically. To this end, frequent controls, using reliable, riskless and inexpensive methods are needed. In this work, 34 patients who underwent different types of portal systemic shunts were studied by ultrasonography. Diagnosis by ultrasonography (confirmed by radiography showing esophageal varices and sometimes by arteriography) was positive with direct vision of the anastomosis in 65 p. 100 of cases and with indirect signs of patency or thrombosis of the anastomosis in 32 p. 100 of cases. This method failed to conclude in 3 p. 100 of our cases.

Appearance of esophageal peristalsis in treated idiopathic achalasia

The authors studied 22 patients with severe dysphagia, and follow-up studies showed the appearance of some esophageal peristalsis for the first time in three of these patients after Heller myotomy. Comparison of pre- and postoperative clinical, radiological, and manometric data of these three subjects and the data of the other 19 patients showed no statistically significant differences between the two groups of patients either before or after cardiomyotomy except for the unusual appearance of esophageal peristalsis after surgery. According to these results it is not possible to predict which patients will develop peristalsis after cardiomyotomy. The different motor pattern observed after surgery might suggest the existence of a different pathogenesis underlying the esophageal motor disorders in these two groups of patients.

Thrombosis, recurrent abortions and intrauterine foetal death in a patient with lupus anticoagulant

The authors describe a case report of a patient suffering from thrombosis and recurrent abortions. Routine coagulation screening was abnormal and investigation showed the presence of a circulating anticoagulant. High titres of anticardiolipin antibodies were demonstrated. Antinuclear antibodies were slightly positive and antinative DNA antibodies were present. Lupus anticoagulant activity and anticardiolipin antibodies seem to be strong markers of a thrombotic tendency.

A case of suspected teratogenic holoprosencephaly

A case of holoprosencephaly is reported in which the mother was prescribed high doses of oestroprogestins during the first 5 months of the pregnancy. Investigation of the family failed to reveal any sign of physical abnormality. A normal karyotype was detected in the proband. The authors suggest that this case may shed some light on the normal and abnormal way in which embryonic fields develop.

Diagnostic accuracy of serum cationic trypsinogen estimation for pancreatic diseases

Serum immunoreactive trypsinogen (IT) levels were measured in 479 normal controls and in 604 patients (510 with nonpancreatic diseases and 94 with pancreatic diseases) in order to evaluate the distribution of IT values in the control population and the accuracy of the assay in the diagnosis of pancreatic diseases. It concentrations were normally distributed in the healthy population; children showed mean IT values significantly lower than adults. The sensitivity, specificity, and predictive value of a positive and negative result in diagnosing acute or chronic pancreatitis were evaluated vs normals and vs normals plus all patients. With an IT value higher than 80 ng/ml, the likelihood that a patient is not affected by acute pancreatitis is less than 5%. An IT value lower than 9 ng/ml detected 44% of chronic pancreatitis and was related to a 52% probability of such a condition. The 48% false positive results also include patients with pancreatic tumor (31% of cases), so that the chance of finding reduced IT levels in subjects without pancreatic damage drops to 17%. In view of the low prevalence of pancreatic diseases, IT assay should not be taken into consideration as a diagnostic screening test in the general population and its use should be limited to a hospitalized population.

8-epiloganic acid and 7-beta-hydroxy-8-epiiridodial glucoside

Two new iridoid glucosides, isolated from Linaria cymbalaria (Scrophulariaceae), are 8-epiloganic acid ( 1) and 7-beta-hydroxy-8-epiiridodial glucoside ( 2). Partial synthesis of 2 from 8-epiloganin ( 3) has been performed.

Iridoids in equatorial and tropical flora

The leaves of Tecoma chrysantha Jacq. a tree of the tropics, contain together with 6-epiaucubin ( 1), a less polar iridoid 2. Chemical and spectroscopical data demonstrated that 2 contains a residue of 1 esterified by 8-hydroxy-2,6-dimethyl-2,6-octadienoic acid ( 3), a rare monoterpenic product.

6-O-beta-glucopyranosylaucubin, a new iridoid from Odontites verna

Fourteen iridoid glycosides have been isolated from Odontites verna ssp. serotina (Scrophulariaceae). In this paper the isolation of 6-O-beta-glucopyranosylaucubin is described; its structure and configuration has been demonstrated mainly by the aid of the (1)H- and (13)-C-NMR spectroscopy. The existence of a gamma glycosylation shift is showed.

Effect of somatostatin on lower esophageal sphincter (les) pressure and serum gastrin in normal and achalasic subjects

Serum gastrin and lower esophageal sphincter (LES) responses to somatostatin infusion were evaluated in ten normal subjects and in nine achalasic patients in order to determine evidence of hormonal (presumably gastrin)control of LES pressure. After somatostatin infusion, a significant decrease of serum gastrin was observed in normal subjects at 30 min (81.6 +/- 3.2 versus 40.0 +/- 4.7 pg/ml; p less than 0.01) and a rapid increase of LES pressure was also observed (26.0 +/- 1.3 versus 34.1 +/- 1.6 mmHg; p less than 0.01). In achalasia no change was observed in serum gastrin concentration after somatostatin infusion. LES pressure at 20 min however significantly decreased (45.8 +/- 7.6 versus 31.6 +/- 2.3 mmHg; p less than 0.05). Endogenous gastrin is not a major control factor for LES pressure in either normal or achalasic subjects.

[Surgical treatment of biliary lithiasis associated with acquired valvulopathy]

Personal experience in the treatment of acquired valvulopathies and biliary calculosis in one operating stage is reported. After examination the risk factors determining onset of bile calculosis in valvulopathic patients, the surgical techniques adopted and the special advantages obtained by associating the two operations at the same session are illustrated.

Iridoids, XXIX - Sinuatol (6-O-alpha-L-rhamnopyranosylaucubin) from Verbascum sinuatum

From the aerial part of Verbascum sinuatum L. a new iridoid diglycoside III has been isolated and its structure elucidated as 6-0-alphaL-rhamnopyranosylaucubin.

Inhalation of a radioactively labeled monodisperse aerosol in rats for the assessment of regional deposition and clearance

Unanesthesized male Sprague-Dawley rats, averaging 261 g of weight (s.d. = 9 g), were exposed to a radioactively (198Au) labeled monodisperse carnauba wax aerosol, whose AMMD was 0.54 micrometers with a sigma g of 1.1, to determined the alveolar deposition and clearance of particles. Results indicate that 74% of the initial lung burden is cleared in phase one with a T/2 of 11 hours. The remaining 26%, conventionally considered to be the alveolar deposit, is cleared with a T22 of 320 hours. Excised lungs from serial sacrifices have also been measured. The retention curve resulting form the pooled lung data per each day compared well with the curve of the whole animals counted in vivo.

Bleomycin in combination chemotherapy of metastatic Wilms tumor: a late recurrent case, refractory to conventional therapy

A patient with a late recurrence (13 years) of Wilms tumor is presented. After relapse with conventional chemotherapy, an objective partial remission was obtained with bleomycin, vinblastine, cyclophosphamide, and cis-platinum. Stable disease was noted when bleomycin was withheld. Bleomycin in this combination appeared to effect a good response, and further studies of chemotherapy of Wilms tumor should include bleomycin in combination with other active agents.