A polysorbate-based non-ionic surfactant can modulate loading and release of beta-lactoglobulin entrapped in multiphase poly(DL-lactide-co-glycolide) microspheres

PURPOSE

The goal of the present paper was to investigate the role of a surfactant, Tween 20, in the modulation of the entrapment and release of beta-lactoglobulin (BLG) from poly (DL-lactide-co-glycolide) microspheres.

METHODS

Poly(DL-lactide-co-glycolide) microspheres containing BLG were prepared by a water-in-oil-in-water emulsion solvent procedure. Tween 20 was used as a surfactant in the internal aqueous phase of the primary emulsion. BLG entrapment efficiency and burst release were determined. Displacement of BLG from microsphere surface was followed by confocal microscopy observations and zeta potential measurements, whereas morphological changes were observed by freeze-fracture electron microscopy.

RESULTS

Tween 20 was shown to increase 2.8 fold the encapsulation efficiency of BLG without any modification of the stability of the first emulsion and the viscosity of the internal aqueous phase. In fact, Tween 20 was shown to be responsible for removing the BLG molecules that were adsorbed on the particle surface or very close to the surface as shown by confocal microscopy and zeta potential measurements. Tween 20 reduced the number of aqueous channels between the internal aqueous droplets as well as those communications with the external medium. Thus, the more dense structure of BLG microspheres could explain the decrease of the burst release.

CONCLUSIONS

These results constitute a step forward in the improvement of existing technology in controlling protein encapsulation and delivery from microspheres prepared by the multiple emulsion solvent evaporation method.

Evidence that both area V1 and extrastriate visual cortex contribute to symmetry perception

Bilateral symmetry is common in nature and most animals seem able to perceive it. Many species use judgements of symmetry in various behaviours, including mate selection [1-3]. Originally, however, symmetry perception may have developed as a tool for generating object-centered, rather than viewer-centered, descriptions of objects, facilitating recognition irrespective of position or orientation [4]. There is evidence that the visual system treats the orientation of axes-of-symmetry in the same way it treats in orientation of luminance-defined contours [5], suggesting that axes-of-symmetry act as 'processing tokens' [6]. We have investigated the characteristics of neural mechanisms giving rise to the perceived orientation of axes-of-symmetry. We induced tilt aftereffects with symmetrical dot patterns, eliciting perceived angle expansion and contraction effects like those usually observed with luminance-defined contours [7,8]. Induction of aftereffects during binocular rivalry resulted in a reduction of the magnitude of these effects, consistent with the aftereffects being mediated in extrastriate visual cortex, probably between visual areas V2 and MT [9]. In a second experiment in which the aftereffects were induced monocularly, their magnitudes were measured in the unadapted eye. Contraction effects transferred completely, suggesting that they are mediated by binocular cells. Expansion effects did not transfer completely, consistent with their having a monocular component. These data suggest that information about the orientation of axes-of-symmetry may be available as early as area V1, but that processing continues in extrastriate cortex.

Changing the pH of the external aqueous phase may modulate protein entrapment and delivery from poly(lactide-co-glycolide) microspheres prepared by a w/o/w solvent evaporation method

The milk model protein, beta lactoglobulin (BLG), was encapsulated into microspheres prepared by a multiple emulsion/solvent evaporation method. The effect of the pH of the outer aqueous phase on protein encapsulation and release as well as on microsphere morphology has been investigated. At all tested pH values, the encapsulation efficiency was shown to decrease with increasing the initial amount of BLG. This was correlated with the reduced stability of the primary emulsion as the initial BLG increased. In addition, reducing the solubility of BLG in the external aqueous phase by decreasing the pH to the isoelectric point of BLG (pI 5.2) resulted in an improved protein encapsulation. Moreover, it was shown that combining pH modification and optimal stability of the first emulsion yielded microspheres with a high encapsulation efficiency. However, release kinetic studies revealed that a significant burst release was observed with microspheres loaded with large amounts of BLG, especially when prepared in a medium at pH 5.2. This burst effect was attributed to morphology changes in the microsphere surface which was characterized by the presence of pores or channels able to accelerate the release of BLG. These pores were assumed to result from the presence of large amounts of protein molecules on the microsphere surface, that aggregate during microsphere formation at pH 5.2. Indeed, single adsorption experiments have shown that BLG had a higher affinity for the particle surface when the pH was close to the pI. Thus, reducing the solubility of a protein in the external aqueous phase allows the product of microspheres with a better encapsulation efficiency, although this benefit is provided by a strong adsorption of the protein on microsphere surface.

Gender differences in motivational style: a comparison of measures and curriculum area

BACKGROUND

Gender has long been implicated in school-based performance with gender differences varying across curriculum domains. Motivational differences have often been cited as a possible cause. However, evidence for the pattern of motivational difference between the genders is unclear.

AIMS

This study compares the motivational responses of girls and boys in the curriculum areas of mathematics and English. Two different measures of motivation are employed.

SAMPLES

The sample consists of all pupils from years 7, 9 and 11 in two secondary schools in Northern England. A total of 435 yr 7, 389 yr 9 and 357 yr 11 students was available.

METHODS

Students completed two assessments of motivation, one based on self-report measures of goal strength and the other on performance over four tasks. Some school performance data were also available.

RESULTS

The two motivation measures produce different patterns of results. The task-based measure shows no gender based differences while the other indicates a pattern of differences broadly suggestive of an advantage for girls.

CONCLUSIONS

Future exploration of gender effects in motivation needs to give careful consideration to the type of motivation under consideration. Univariate models are unlikely to be adequate.

Understanding the uninsured dilemma. A necessity for managed care survival

As we approach 2000, health care cost, quality and access continue to be highly debated issues within managed care and the health care delivery system. Of these, perhaps there is no single issue more contested among consumers than the average cost of health care. Factors affecting the cost of health care are many. However, the uninsured population is one of the most visible and difficult to predict. Leaders in managed care have extensively studied this problem for several years; however, there continues to be no consensus on the best way to capture the nearly 42 million uninsured, reprogram scarce health care resources or provide access into the health care delivery system for everyone while maintaining existing quality, cost containment measures and administration. This paper outlines the scope and impact of the uninsured in managed care and profiles initiatives in controlling the population.

General and cardiac toxicity of doxorubicin-loaded gelatin nanoparticles

General and cardiac toxicity of doxorubicin loaded gelatin nanoparticles cross-linked by glutaraldheyde were investigated in healthy rats. The rats were treated with free doxorubicin (DXR), unloaded nanoparticles (UNp), physical mixture of doxorubicin and unloaded nanoparticles (DRX/UNp), and DXR-loaded nanoparticles (DXR-Np). Each group of animals received the same dose of DXR (3 mg/kg) via i.p. once a week. Both electrocardiogram (ECG) parameters and body weight were measured 24 h before each administration. Rats treated with UNp behaved as controls. DXR/UNp provoked the same toxic effects as free DXR. On the contrary, DXR-Np resulted more toxic since significant variations of both the body weight and the ECG parameters were observed during the first week of treatment. In addition, the rats treated with DXR-Np died between the 3rd and the 5th day after the 2nd administration. These results demonstrate that, in these experimental conditions, the couplage of DXR to nanoparticles enhanced the cardiotoxicity of the drug. Since DXR was linked to the protein matrix of nanoparticles via glutaraldehyde, the high toxicity of DXR-loaded nanoparticles could be due to the covalent binding of the drug to the carrier.

Chemotherapeutic induction of long-term remission in metastatic medulloblastoma

The treatment of extraneural metastatic medulloblastoma is mainly a domain of chemotherapy. Although previous results were promising, the overall poor prognosis high relapse rates and the still unknown ideal combination of chemotherapeutic agents leave many questions open. In this study, the effectiveness of previously used chemotherapeutic agents for the treatment of metastatic medulloblastoma is reviewed, and the effectiveness and complexity of emerging new treatment strategies including high-dose chemotherapy with bone marrow and peripheral blood stem-cell transplantation are discussed. Furthermore, we describe a case of bone-metastasized recurrent medulloblastoma with the longest remission ever reported (120 months) after regimens containing doxorubicine, vincristine, cyclophosphamide (ACO-protocol) [1, 2] and methotrexate. When relapse with bone and bone marrow infiltration occurred, a second chemotherapeutically induced complete remission was achieved. High-dose-chemotherapy with autologous peripheral blood stem-cell transplantation was used as a consolidating regimen. Complete remission has persisted for over 15 months now.

[The influence of exertion on the incidence and course of diabetes mellitus]

Regular physical activity brings some benefits for patients with diabetes: it decreases insulin resistance, improves glycaemic tolerance and the state of the cardiovascular system, regulates blood lipid profiles and increases the fibrinolytic activity of plasma. All these factors improves the quality of life and professional rehabilitation of diabetic patients. Taking into consideration all contraindications kinesis therapy, together with diet and pharmacological treatment should be recommended as an important factor in the management of diabetes mellitus, especially NIDDM.

Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis

PURPOSE

This study was designed to evaluate the frequency of microscopic distal intramural spread in rectal adenocarcinoma and its correlation to other histopathologic prognostic factors.

METHODS

We examined 55 patients with adenocarcinomas of the lower one-third of the rectum and measured the extent of distal intramural spread in the submucosa and/or muscular layer in comparison with Dukes Stage, diameter of tumor, distance of distal margin of resection from tumor, depth of infiltration into perirectal adipose tissue, nodal status, neoplastic infiltration of lymphatic vessels, blood vessels, and nervous branches.

RESULTS

Distal intramural spread was found in 40 percent of patients, 77 percent of whom had advanced tumors with nodal metastases. Distal intramural spread appeared to be strictly related to tumor size (superior to 40 mm), infiltration of the perirectal adipose tissue, multiple positive lymph nodes, presence of neoplastic emboli in the intramural lymphatic vessels, and neoplastic invasion of the nervous branches. Local recurrence occurred in one Dukes Stage B patient with a positive distal margin of resection and in four patients with a negative distal margin of resection: three Dukes Stage C and one Dukes Stage B patients with neoplastic involvement of the circumferential margin of resection of the mesorectum.

CONCLUSION

These preliminary data suggest that distal intramural spread may carry little importance in determining local recurrence of rectal adenocarcinoma.

Total rectal resection, mesorectum excision, and coloendoanal anastomosis: a therapeutic option for the treatment of low rectal cancer

BACKGROUND

There is recent and sporadic evidence indicating that patients with very low rectal cancer may be treated via a sphincter-saving procedure, obviating the need for abdominoperineal resection and definitive colostomy. This study confirms these findings.

METHODS

From March 1990 to October 1994, 79 patients affected with primary low rectal cancers were submitted for total rectal resection, mesorectum excision, and coloendoanal anastomosis. All lesions were located within 8 cm of the anal verge (within 6 cm in 64 cases).

RESULTS

Eight patients relapsed at the pelvic level, and one patient only at the paraanastomotic site. Postoperative morbidity attributable to the procedure was low. A perfect continence was documented in 66% of cases after colostomy closure, and many patients (63%) had one or two bowel movements a day. Sixty-two patients of this series are alive, 49 without actual evidence of disease. Follow-up ranged from 2 to 56 months (median 23).

CONCLUSIONS

The clinical and pathological data derived from this study suggest that radical mesorectum excision more than a large clearance margin of resection remains the most important factor in reducing the incidence of local relapse after low rectal cancer surgery and that total rectal resection and coloendoanal anastomosis is a suitable and safe option to traditional, demolitive surgical techniques.

The influence of 2-hydroxypropyl-beta-cyclodextrin on the haemolysis induced by bile acids

Cyclodextrins improve the water-solubility of drugs and can mask their haemolytic effect in parenteral use. Because the mechanism by which bile acids induce haemolysis is poorly understood, it has been investigated in the presence of 2-hydroxypropyl-beta-cyclodextrin (HP-beta-CyD). The haemolytic effect of 1.8 mM solutions of cholic acid, chenodeoxycholic acid (CDCA), deoxycholic acid and ursodeoxycholic acid (UDCA) in isotonic buffer at pH 7.4 was investigated at 37 degrees C in the presence of HP-beta-CyD at concentrations from 0.18 to 32 mM. No haemolytic effect was evident for cholic acid and UDCA. The haemolytic effect of the other bile acids was reduced by addition of HP-beta-CyD and was prevented at a molar ratio of 1:1 owing to complex formation. An HP-beta-CyD:bile acid molar ratio greater than 5:1 had a different effect on the erythrocyte membrane, irrespective of the identity of the bile acid; the effect was in accordance with the complexion affinities. In the absence of HP-beta-CyD, the haemolytic effect of CDCA and deoxycholic acid appeared related to their capacity to form a surface monolayer and to solubilize the components of the erythrocyte membrane. The haemolytic effect observed after complexation of the bile acids appeared to be solely the effect of HP-beta-CyD, which was able to form a reversible inclusion complex with lipophilic components of the erythrocyte membranes at concentrations higher than 12 mM.

Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm

BACKGROUND

The question of whether manual dissection when searching for metastatic lymph nodes from rectal cancer (less than 5 mm) is a reliable method remains controversial.

METHODS

We examined 50 consecutive cases of primary adenocarcinoma of the rectum treated with a sphincter-sparing total rectum resection, total mesorectum excision, and coloanal anastomosis. We used a manual method for the detection of lymph nodes.

RESULTS

One thousand seven hundred ninety-three lymph nodes were found (mean, 36 per patient). One hundred seventy-four contained metastases. Seventy-nine (45.4%) of the affected lymph nodes were less than 5 mm in greatest dimension. The percentage of metastases to small lymph nodes was similar to the percentage reported by Kotanagi (50%), but lower than the report of Herrera (78%), who used a clearing technique to search for regional lymph nodes.

CONCLUSIONS

A median 17 months follow-up in these patients demonstrated that metastases in small lymph nodes are important in the accurate staging of rectal tumors and that a manual method of searching for small lymph nodes is reliable.

[The 3rd national workshop on defecography: the functional radiology of (neo) rectal ampullae (ileal reservoir, colo-anal anastomosis, continent perineal colostomy)]

A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).

DNA aneuploidy, increased proliferation and nuclear area of plasma cells in monoclonal gammopathy of undetermined significance and multiple myeloma

DNA cytometric and morphometric parameters of plasma cells were determined in 73 multiple myelomas (MMs), 31 monoclonal gammopathies of undetermined significance (MGUS), 11 reactive plasmacytoses (RPs) and 33 cases of normal bone marrow (NBM) using a TV-based static cytometer combined with a computerized relocation stage. Neoplastic transformation was defined by either an aneuploid DNA profile, an increased proliferative fraction or an increased mean nuclear area of plasma cells. Using threshold values defined by mean values and variations of NBM and RP, 67/73 MMs were correctly classified as malignant (sensitivity, 92%), whereas all NBMs and RPs were classified as benign (specificity, 100%). In MGUS, cytometric parameters of malignancy were detected in 19/31 cases (61%). Six of these cases developed MM after a median time of 4.9 years (mean follow-up, 9.3 years). Another three cases with MGUS developed MMs without previous cytometric plasma cell aberrations. Cytometric data from repeated measurements in MGUS progressing to MM exhibited perfect consistency over time concerning the presence or absence of cytometrically detected neoplastic transformation. Cytometric aberrations seem to be frequently associated with neoplastic growth in monoclonal plasma cell proliferations but do not predict clinically malignant behavior.

DNA-image cytometry and clinical staging systems in multiple myeloma

Clinical and hematological parameters, and three derived major staging systems were compared with DNA-cytometric parameters in 73 patients with newly diagnosed multiple myeloma (MM) and correlated in univariate analysis with survival to assess their predictive value. Regarding diagnostic validity, a multi-parameter system including STL, 5cER, PRF and MNA correctly classified 92% of MM as malignant (sensitivity 92%) at a 100% specificity. Regarding prognosis, the most powerful single clinical parameter was serum creatinine (p < 0.001, median survival [ms] 51 vs. 14 months) followed by platelet count (p < 0.01, ms 67 vs. 11 months). Mean nuclear area of plasma cells was the only cytometric parameter with prognostic relevance (p < 0.05, ms 43 vs. 14 months). Neither the original Salmon-Durie staging (p < 0.05 for I vs. II, p > 0.05 for II vs. III) nor the revised Salmon-Durie staging by Cavo et al were able to discriminate three patient groups at statistically significant levels. Only the staging system proposed by the British Medical Research Council (MRC) was found to be able to predict survival for all three groups significantly (p = 0.01 for A vs. B, p < 0.01 for B vs. C; ms A/B/C = 68/37/14 months, respectively).

Prevalence of behaviour problems among 9- to 12-year-old pupils on the island of St. Helena, South Atlantic: preliminary findings

The Rutter Behaviour Questionnaire was used to assess prevalence rates of behaviour problems in 9- to 12-year-old pupils (N = 402) in St. Helena, South Atlantic. The prevalence rate for this enquiry (6.9%) is among the lowest found in the literature for studies using this questionnaire with similarly aged samples.

Total rectal resection and colo-anal anastomosis with colonic reservoir for low rectal cancer

From March 1990 to December 1992, 47 patients with primary or recurrent low rectal cancer underwent total rectal resection and a coloendoanal anastomosis. Rectal resection was extended downward to the ano-rectal junction. The restorative technique included a colo-endoanal anastomosis between the dentate line and a J-shaped colic reservoir. All lesions were located within 7 cm of the anal verge (within 6 cm in 33 primary cases). Macroscopic and histological radicality was documented in all cases. Pelvic recurrence occurred in six patients and was para-anastomotic in one case. Post-operative morbidity was low. Perfect continence was documented in 36 patients and 72 of the cases had one or two bowel movements a day. All but four patients are alive at a follow-up ranging from 6 to 40 months (median 20 months). This approach is a safe option to conventional total rectal excision with permanent colostomy for lower third rectal carcinoma.

Prevalence of sexual dysfunction in male cancer patients treated with rectal excision and coloanal anastomosis

Impotency due to parasympathetic nerve injury is one of the most feared consequences of rectal cancer surgery. Sexual relationships make a significant contribution to the quality of life for almost everybody. Rectal excision and coloanal anastomosis (CAA) is a new surgical procedure for low rectal tumor with little data regarding the prevalence of sexual impairment as yet. We have examined the sexual life of 21 male patients who have undergone CAA by means a self-administered questionnaire. Only two patients reported reactive impotency. On the other hand 17 out of 21 patients had no ejaculation after undergoing surgery. According to our data it appears that CAA results in surgery a low degree of sexual impairment (impotency). Both sexual dysfunction and quality of life investigations should be integrated with oncological results when reporting data about colorectal surgery.

New perspective in the treatment of low rectal cancer: total rectal resection and coloendoanal anastomosis

PURPOSE

Presently abdominoperineal resection still remains the most diffuse modality of treatment of low rectal cancer. However, a new surgical approach is now available to avoid such a demolitive surgery and a definitive colostomy.

METHODS

From March 1990 to March 1993, 58 total rectal resections were performed in 55 patients affected with primary or recurring cancers of the low rectum. As a restorative procedure, a colic J-shaped pouch and a handsewn pouch-endoanal anastomosis was adopted. All of the primary lesions were within 7 cm of the anal verge; in 74 percent the distal tumor margin was located less than 6 cm from the cutaneous edge.

RESULTS

Histologic clearance of the rectum cut edge was documented in all cases. Seven patients relapsed locally from 7 to 14 months after surgery and in 3 more cases distant metastases were documented. Postoperative morbidity is low. After colostomy closure in 78 percent of patients, perfect continence was achieved and in 74 percent less than two bowel movements a day were recorded. Fifty patients are presently alive, 46 without evidence of disease. The follow-up ranged from 2 to 37 (median, 13) months.

CONCLUSION

This experience, along with data obtained from last year's literature, indicates that a conservative surgical procedure, such as total rectal resection and coloendoanal anastomosis, can be considered a feasible and radical option for treatment of low rectal cancer.

Total rectal resection and colo-anal anastomosis for low rectal tumours: comparative results in a group of young and old patients

Rectal cancer incidence is increasing among the elderly who are more often considered for palliation rather than for surgical cure. Moreover, sphincter-sparing surgery is often avoided when treating the elderly. We report our experience on a consecutive series of 38 subjects, suffering from a lower third rectal tumour with a median distance of 5.6 cm from the anal verge (7 Dukes' A, 6 Dukes' B, 17 Dukes' C, 3 Dukes' D, 3 anastomotic recurrences and 2 large villous adenomas). All subjects were prospectively collected in a 2-year period and treated with total resection and colo-anal hand-sewn anastomosis on a J colic reservoir. 20 patients younger than 65 years and 18 over 65 years were matched for surgical complications, late morbidity, oncological and functional results but no statistical difference was found. Our hope is that a conservative approach in treating the low rectal tumours will progressively be accepted for elderly patients.

Total rectal resection, colo-endoanal anastomosis and colic reservoir for cancer of the lower third of the rectum

The treatment of low rectal cancer is still a widely debated topic in surgical oncology. From March 1990 to August 1991, 18 patients with tumors sited in the lower third of the rectum underwent a total rectal resection extended to the ano-rectal junction. As restorative procedure, a colic J-shaped pouch and a handsewn pouch-endoanal anastomosis was adopted. All the lesions were less than 8 cm from the anal verge; in 94.5% the distal tumor margin was located within 6.5 cm of the cutaneous edge. Histological clearance of the rectum cut edge was documented in all cases. Only one patient (Dukes C) relapsed four months later at the para-anastomotic level. No mortality or major complications related to surgical procedure were found. In 13 patients perfect continence was achieved and in 12 cases less than two bowel movements a day were recorded. No one complained of severe sexual dysfunction. All patients are still alive. The follow up ranged from 6 to 22 months (median: 12). This experience together with data obtained from last years' literature indicate that a conservative surgical procedure, as total rectal resection and colo-anal anastomosis, can be considered a feasible and radical option for treatment of low rectal cancer.

Comparison of long-term survival of 1986 consecutive patients with breast cancer treated at the National Cancer Institute of Milano, Italy (1971 to 1972 and 1977 to 1978)

Long-term survival of 1986 consecutive patients with infiltrating duct carcinoma of the breast treated at the National Cancer Institute of Milano (Italy) in two periods of time (1971 to 1972 and 1977 to 1978) was comparatively evaluated to verify if the evolving concepts in the management of breast cancer had an impact on survival. The authors found that 10-year survival of our patients increased from 59.4% of the first period of time to 65% of the second (P = 0.005). Both node-negative (N-) and node-positive (N+) patients had an improvement of survival rates at 10 years of the same magnitude: 6.8% and 5.9% respectively. Taking into consideration both the maximum diameter of the primary tumor and the status of axillary nodes it was found that in (1) both N- and N+ patients with a primary tumor of no more than 2 cm in greatest diameter, the improvement of survival was not statistically significant; and (2) both N- and N+ patients with a primary greater than 2 cm in maximum diameter had a better chance of survival in the second time period.

[Administration of cytostatic drugs by intra-arterial route. Theoretical basis]

The Authors discuss the theoretical principles of the intra-arterial administration route of antineoplastic drug in the treatment of primaries or metastatic diseases.

Resectable breast cancer: axillary dissection sparing pectoralis muscles and nerves

In breast cancer surgery, axillary dissection is currently considered an essential step. Nevertheless, procedures commonly used include the resection of the pectoralis minor muscle and/or pectoralis nerves. Since 1984 we have performed axillary dissection by sparing both the pectoralis muscles and their nerves. In this paper we present the surgical technique. The comparison of the two groups with clinical N0 N1a assessment, the former of 103 patients submitted to this kind of surgical procedure, the latter (108 women) treated by resection of the pectoralis minor muscle, showed that the mean number of dissected lymph nodes in both procedures was superimposable.

A possible new tool for clinical diagnosis of melanoma: the computer

The analysis of cutaneous melanoma images by two coupled computers (IBM 7350/4361) was carried out on twenty color slides. Each color slide was digitized with a spatial reduction of 25 X 25 microns. Classic technics of digital image analysis and new algorithms were used to improve the contrast on the full image or a portion of it, contrast a skin lesion with statistical information deduced from another lesion, evaluate the shape of the lesion, the roughness of the surface, and the transition region from the lesion to the normal skin, and analyze a lesion from the chromatic point of view. The theoretical reasons of interest are to have an objective method that is easy to standardize and reliably repeatable and to be able to analyze details not perceivable by the human eye. If the same technic are used in the evaluation of histologic characteristics of the lesions, a chance of making much more sophisticated clinicopathologic correlations will be available. The system needs to be improved at the technical level so that the response time of acquisition of the digitized images is shortened by the use of a digital television camera and the development of new computer programs to be run on a small computer. Evaluation of the system's sensitivity and specificity and an adequate clinical trial are needed.