[Laparoscopic surgery: from clinic to legal medicine]

The laparoscopic technique introduced a new way of operating but inevitably causing new problems for the surgeon. After a comprehensive review of the history and the evolution of laparoscopic surgery from its beginning, the technical aspects of minimally invasive surgery and its fields of application are described. The close dependence on instruments and technology is emphasized. A detailed analysis of the advantages and limitations of laparoscopy is made with emphasis on the importance of a risk-benefit evaluation by the health care provider. Of key importance is to obtain a detailed and clear informed consent. The medico legal aspects of intraoperative complications and the liability of the surgical team in case of patients' injury or death are examined. However, it is always necessary to consider if the potential complications are predictable and/or preventable in accordance to the parameters of negligence, imprudence and lack of knowledge. The same criteria have to be applied to assure compliance with the preventive sanitary rules and that the conversion to laparotomy has been promptly carried out.

Evaluation of communicative and functional abilities in Wolf-Hirshhorn syndrome

BACKGROUND

Wolf-Hirschhorn syndrome (WHS) is a genetic condition characterized by many clinical disorders, learning difficulties, dysphagia, neuromotor deficits and communicative deficits. Up until now, no studies in the literature have described the development of communicative and functional abilities in subjects with WHS.

METHOD

In the present study of 11 patients with WHS, a descriptive analysis was made of several abilities and three groups of patients were identified on the basis of the severity of their functional deficit.

RESULTS

A non-homogeneous picture of impairment emerged in various areas of development. Overall, the neuromotor abilities of these patients were more adequate than their abilities related to autonomy in personal life, alimentary function, and cognitive and communicative-linguistic aspects.

CONCLUSION

Based on the identification of specific patterns of communicative and functional impairment in subjects with WHS, rehabilitative intervention strategies can be planned to increase their communicative opportunities, and possibilities for active and autonomous participation in various life contexts (e.g. home, school and the social environment).

Expression of growth factor receptors in unilineage differentiation culture of purified hematopoietic progenitors

We have evaluated the expression of growth factor receptors (GFRs) on early hematopoietic progenitor cells (HPCs) purified from human adult peripheral blood and induced in liquid suspension culture to unilineage differentiation/maturation through the erythroid (E), granulocytic (G), megakaryocytic (Mk), or monocytic (Mo) lineage. The receptors for basic fibroblast GF (bFGF), erythropoietin (Epo), thrombopoietin (Tpo), and macrophage colony-stimulating factor (MCSF) have been only assayed at mRNA level; the majority of GFRs have been evaluated by both mRNA and protein analyses: the expression patterns were consistent at both levels. In quiescent HPCs the receptors for early-acting [flt3 ligand (FL), c-kit ligand (KL), bFGF, interleukin-6 (IL-6)] and multilineage [IL-3, granulocyte-macrophage CSF (GM-CSF)] HGFs are expressed at significant levels but with different patterns, eg, kit and flt3 are detected on a majority and minority of HPCs, respectively, whereas IL-3Rs and GM-CSFRs are present on almost all HPCs. In the four differentiation pathways, expression of early-acting receptors shows a progressive decrease, more rapidly for bFGFR-1 and flt3 than for c-kit; furthermore, c-kit is more slowly downmodulated in the E and Mk than the G and Mo lineages. As a partial exception, IL-6Rs are still detected through the early or late stages of maturation in the Mk and Mo lineages, respectively. IL-3R expression is progressively and rapidly downmodulated in both E and Mk pathways, whereas it moderately decreases in the Mo lineage and is sustained in the G series. The expression of GM-CSFR is gradually downmodulated in all differentiation pathways, ie, the receptor density markedly decreases but late erythroblasts are still partially GM-CSFR+ and terminal G, Mk and Mo cells are essentially GM-CSFR+. Expression of receptors for late-acting cytokines is lineage-specific. Thus, EpoR, G-CSFR, TpoR, and M-CSFR exhibit a gradual induction followed by a sustained expression in the E, G, MK, and Mo lineages, respectively. In the other differentiation pathways the expression of these receptors is either absent or initially low and there-after suppressed. These observations are compatible with the following multi-step model. (1) The early-acting GFRs are expressed on quiescent HPCs with different patterns, whereas the multilineage GFRs are present on > or = 90% to 95% HPCs. (2) Multilineage GFs, potentiated by early-acting HGFs, trigger HPCs into cycling. HPC proliferation/differentiation is followed by declining expression of the early-acting GFRs and in part of multilineage GFRs (see above). (3) Multilineage GFs trigger the expression of the unilineage GFRs (see Testa U, et al: Blood 81:1442, 1993). Interaction of each unilineage GF with its receptor leads to sustained expression of the receptor (possibly via transcription factors activating the receptor promoter) and thus mediates differentiation/maturation through the pertinent lineage.

A murine monoclonal antibody strictly reactive with human peripheral blood monocytes

We have produced and characterized a novel murine monoclonal antibody (LAM7) of IgG1 isotype which appears specific for peripheral blood monocytes (PBM) on the basis of histochemical and functional studies. By indirect immunofluorescence, including FACS analysis, the antibody reacts with 90 +/- 6% of PBM and with monocytic leukemias, while it is totally unreactive with B and T lymphocytes, platelets, granulocytes, peripheral macrophages, dendritic cells, large granular lymphocytes, and nonmonocytic leukemias. The antigen-presenting capacity of peripheral blood mononuclear cells is abolished by treatment with MoAb LAM7 in an antiglobulin-complement-mediated cytotoxicity test, and restored by addition of purified PBM. The progressive disappearance of the antigen recognized by LAM7 from PBM within approximately 3 days in culture, and its absence from both bone marrow precursors and tissue macrophages, define it as a line-specific and stage-specific differentiation.