Refinements in microvascular repair of extended oromaxillofacial defects with radial forearm free flap

The radial forearm free flap (RFFF) is one of the most widely used and versatile fasciocutaneous free flaps in head and neck reconstruction because of its qualities--the consistent vascular anatomy; the thin and pliable nature; the minimal hair presence; and the possibility of harvesting and transferring it as a composite tissue flap, with bone, tendon, and nerve. The RFFF provides a method of single-stage reconstruction of wide residual defects after excision of advanced cancer (T3-T4) in the head and neck region. We present our ten-year experience with RFFF and the good results obtained with some refinements, which allowed us to verify the efficacy of the oral competence using the palmaris gracilis tendon as a sling. We also present the possibility of harvesting long segments of radius (up to 18 cm), and the discovery that use of antithrombotic or anticoagulant therapy is not necessary for the flap survival. This treatment does not guarantee a complete recovery, but it can improve the quality of the patient's life.

Status of malaria vectors in Italy

About 30 yr after malaria eradication, surveys to assess the presence and abundance of anopheline vectors were carried out in central and southern Italy and in the islands of Sardinia and Sicily from 1992 to 1994. Anopheles labranchiae Falleroni was present in scattered foci in all regions, except for Tuscany, where it breeds almost exclusively in rice fields (Grosseto Province). Most common breeding sites were rivers and streams, followed by ponds and ground pools. The highest adult density was found in Tuscany near rice fields and along the west coast of Calabria. Anophelines in Grosseto were abundant at human bait, with peaks of > 200 landings per human per night and vectorial capacity between 7.3 and 26 for Plasmodium falciparum and between 8.3 and 32.5 for Plasmodium vivax. Anopheles sacharovi Favre, a former malaria vector in Puglia and Sardinia, was not found in these regions. The other vector in southern Italy, Anopheles superpictus Grassi, was found at low densities on the western and eastern coasts of Calabria. All anopheline populations were fully susceptible to deltamethrin, malathion, and DDT but showed reduced susceptibility to permethrin and propoxur. These data are discussed in the light of a possible reintroduction of malaria into Italy.

A variant of the Nijmegen breakage syndrome with unusual cytogenetic features and intermediate cellular radiosensitivity

We report the first Italian case of Nijmegen breakage syndrome (NBS). The proband is an immunodeficient, microcephalic, 11 year old boy with a "bird-like" face. He developed a T cell rich B cell lymphoma. Spontaneous chromosomal instability was detected in T and B lymphocytes and fibroblasts; chromosomes 7 and 14 were only sporadically involved in the rearrangements and no clonal abnormality was present. The patient appeared to be sensitive both to ionising radiation and to bleomycin, although his sensitivity did not reach the level of AT reference cells. After bleomycin treatment, inhibition of DNA synthesis was low when compared with normal cells, but higher than observed in an AT reference strain. Moreover, cell cycle analysis, after drug exposure, showed a progressive reduction in the percentage of S phase cells, but the G1 arrest, found in normal cells, was not observed. On clinical evaluation our patient shares features with NBS subjects, but cytogenetic and cell biological data do not completely overlap with those reported in Nijmegen breakage syndrome. The ethnic origin of our patient might account for these differences, as expression of different allelic forms at the NBS locus.

Late results of breast reconstruction with free TRAM flaps: a prospective multicentric study

When the free TRAM flap was introduced for breast reconstruction, it was supposed to have many advantages over the pedicled TRAM flap: good perfusion of all four zones, better mobility and easier shaping of the breast, lower incidence of abdominal-wall complications, and less restrictive selection of patients. However, we have experienced several complications after free TRAM flaps in our practice, including fat necrosis, partial and complete flap necrosis, abdominal-wall weakness, and hernias. In order to evaluate the incidence and types of complications, as well as the influence of preoperative risk factors (chemotherapy, radiotherapy, overweight, smoking habits, and abdominal scars), on complications, a multicentric prospective study including Bern (Switzerland), Leuven (Belgium), Stuttgart (Germany), and Verona (Italy) was designed. In 111 consecutive patients, operated on over a period of 18 months, 123 flaps were done; 99 flaps were unilateral and 24 bilateral, and 36 were used for primary and 87 for late reconstruction. There was no preoperative selection of patients. The follow-up period was from 8 to 24 months (average 19 months). A two-team operating approach was used. All four zones were always included in the flap, and the end-to-end anastomoses were done to the thoracodorsal, the circumflex scapular, or the internal mammary arteries. The total number of fat and flap necroses was 24 (19.5 percent), 6 (5 percent) minor and 4 (3 percent) major fat necroses, 2 (1.6 percent) minor and 6 (5 percent) major flap necroses, and 6 (5 percent) total flap necroses. Twenty-two (20 percent) patients had abdominal-wall complications. The results of this study show that the complication rate of free TRAM flaps is considerable. Preoperative risk factors did not play a major role in the development of complications and should not be considered as contraindications for free TRAM flap surgery. All total flap failures resulted from impaired arterial inflow to the flap, and the choice of recipient vessel did not influence the outcome. The incidence of total flap failures might be reduced by good postoperative flap monitoring and early revision of the anastomosis. Partial fat and flap necroses might be prevented by removing the fat under the scarpa fascia in zones 4 and 3 or by reducing zone 4. Sparingly harvesting the rectus muscle and its sheath as well as the use of mesh in the rectus sheath repair may reduce the abdominal-wall complications.

[Amalgam and the toxicological risks of mercury. A review of the argument]

The employment of dental amalgam in the area of conservative dentistry, in spite of representing an excellent therapeutic solution, is today undergoing criticism more frequently than before because of the potential toxicity of mercury regarding hyman health and environmental salubrity. Mercury is a metal having the tendency to evaporate at ambient temperature and it is just the inhalation of its vapor the most common form of exposure to mercury for man. The absorption may also may also occur through food ingestion or accidental swallowing of metal particles coming from dental amalgam fillings. Mercury poisoning usually turns out to be a chronic process which causes its major toxic effects at the expense of digestive, excretory and neurocentral apparatuses. Several authors have studied mercury exposure on the working places, including in their investigation persons operating in the dentistry departments: they found high levels of mercury existing both in tissues and in biological fluids in people affected by exposure, frequently accompanied by symptoms of chronic intoxication. More recent studies, however, do not fully confirm such conclusions and exclude that coming into contact with mercury vapor on the working place may be in connection with an increase of mortality. Exposure to mercury from amalgam for the most part occurs through ingestion of amalgam particles abraded from restored surfaces, inhalation of vapors generated during dental restorative procedures and deglutition of saliva into which corrosion products have dissolved.(ABSTRACT TRUNCATED AT 250 WORDS)

Biocontrol of postharvest diseases of apple using Bacillus spp. isolated from stored apples

Ninety-five bacterial isolates were recovered from 38 of 77 apples that had been stored at 1 °C for 6–7 months. The highest number of bacteria were recovered in nutrient, dextrose, and V8 juice broths, respectively. The bacteria were screened as biocontrol agents on cultivar Red Delicious apples primarily for control of blue mold caused by Penicillium expansum. Three bacteria effective against P. expansum were also tested against Botrytis cinerea for control of gray mold. Ten, four, and five isolates significantly reduced blue mold decay when apples were stored at 5, 10, and 20 °C. Two isolates tested against gray mold decay significantly reduced decay at 5 and 10 °C and one isolate was effective at 20 °C. Thirty-six isolates that had been selected for identification by the Biolog Microstation™ System were Gram positive and contained endospores, and 30 of these were positively identified as Bacillus spp. Further testing of 15 isolates that were effective biocontrol agents identified 7 as Bacillus subtilis on the basis of 15 microbiological tests used for determining species within the genus Bacillus.Key words: endophytic, bacteria, biocontrol, postharvest.

Sustained remission of immune-mediated red cell aplasia in a child after intravenous administration of gamma globulin

A 4-year-old white boy with immune-mediated red cell aplasia and severe anemia was given high intravenous doses of gamma-globulin. The therapy was well tolerated and followed by complete resolution of the inhibition of erythropoiesis with no recurrence of disease. Eight months after discontinuation of treatment, the patient has a normal complete blood cell count.

Ribosomal RNA genes in mosquitoes: localization by fluorescence in situ hybridization (FISH)

Fluorescence in situ hybridization (FISH) was used to localize the 18S-28S ribosomal RNA gene clusters on the chromosomes of 15 mosquito species belonging to the Anophelinae and Culicinae subfamilies. In the genus Anopheles the rRNA genes are localized on the heterochromatic arm of both sex chromosomes. The association between rRNA genes and sex determining chromosomes also applies to the homomorphic karyotype of Culicinae mosquitoes, at least in those cases in which localization of the sex locus/loci has been determined. In these species ribosomal genes are often found within or adjacent to heterochromatic regions (C bands). Differences in the location of rRNA genes among and within genera suggest the occurrence of several chromosomal rearrangements during the evolution of mosquitoes.

Ultrastructural findings of congenital dyserythropoietic sickle cell beta thal-associated anemia

The ultrastructural findings of erythroblasts and reticulocytes in one case of congenital dyserythropoiethic anemia (CDA) associated with a haemoglobinopathy, sickle cell beta thalassemia minor (Type V CDA), is described. The observations can be summarized as follows: 1) A lot of large breaks are present in the erythroblast nuclear envelope. 2) Nuclear membrane evaginations are filled with dense loose chromatin. 3) Electron-transparent areas (moth eaten chromatin) are evident in dense chromatin. 4) Electron-dense granular material, related to altered haemoglobin chain storage, is evident in the nucleus and in the cytoplasm. 5) Iron deposits are present in mitochondrial matrix. 6) Myelinic figures are present in reticulocyte cytoplasm. For the first time the ultrastructural findings in this type of associated CDA are described and related to the double origin of clinical symptoms.

Inter- and intraspecific heterochromatin variation detected by restriction endonuclease digestion in two sibling species of the Anopheles maculipennis complex

The sibling species Anopheles atroparvus and Anopheles labranchiae are cytogenetically almost indistinguishable. The chromosome complement (2n = 6) consists of two pairs of autosomes and two heteromorphic sex chromosomes with largely homologous heterochromatic long arms. Treatment of chromosome preparations with the restriction endonucleases, Alu I, Hae III, Mbo I, Hpa II, revealed species-specific differences of the sex chromosome banding pattern. These differences involved both amount and location of digested heterochromatin. Heterochromatin heterogeneity and a high level of intraspecific polymorphism, undetected with standard banding techniques, were observed in both species. Quantitative heterochromatin differences between the sex chromosomes did not inhibit their pairing and chiasmata formation. The endonuclease Msp I, which cleaves the same target sequence as Hpa II, did not digest heterochromatic as well as euchromatic regions in both species: inhibition of cleavage by methylation of the target sequence or limited access of the enzyme to the target could be involved in this response.

Experimental studies on the maintenance of Toscana and Arbia viruses (Bunyaviridae: Phlebovirus)

Transovarial transmission (TOT) of Toscana (TOS) and Arbia (ARB) viruses in a laboratory colony of Phlebotomus perniciosus is reported. Toscana and ARB viruses were maintained in P. perniciosus females, initially infected by intrathoracic inoculation, for 2 and 3 consecutive generations respectively. TOT was demonstrated in F1 (75%) and F2 (67%) generation adults for TOS and F1 (47%), F2 (37%), and F3 (34%) generation adults for ARB virus. The progressive decline of virus infection rates in each generation suggests that these agents cannot be maintained indefinitely by TOT. No infection was observed in F1 progeny after female parents were fed through membranes with either virus. Transovarially infected females were able to transmit TOS virus by bite to a susceptible vertebrate. Venereal infection of P. perniciosus females mated to males transovarially infected with TOS virus was seen.

Study of the bone pathology in early mucolipidosis II (I-cell disease)

Histological examination of the bones obtained on autopsy of a 5-month-old child with mucolipidosis II (I-cell disease) revealed inhibition of the growth plate calcification with defective vascular invasion and signs of hyperparathyroidism. These findings are the chondro-osseous basis of the early radiological ricket-like appearance of bones in the neonatal period or soon thereafter. Whether the early skeletal abnormalities of mucolipidosis II result from a primary enzymatic defect of cartilage and bone cells or from factors controlling bone metabolism deserves further study.

Mucolipidosis II: correlation between radiological features and histopathology of the bones

Twelve cases of Mucolipidosis II (I-cell disease) with a wide range of severity of skeletal involvement were studied. Pathological findings in two cases provided helpful information in understanding the radiographic features of dysostosis multiplex. Inhibition of the growth plate cartilage calcification and rickets-like lesions were observed in the metaphyses. Enhanced subperiosteal remodelling and paratrabecular fibrosis were also evident in the diaphyses. High levels of parathormone were found in one case. This finding supports the hypothesis that bone lesions may be secondary, at least in part, to damage in such viscera as the kidney and/or the liver and that they are mediated by vitamin D and parathormone.

Bilateral extensive skin necrosis of the lower limbs following prolonged epidural blockade

Skin necrosis has not been described as a complication following epidural sympathetic blockade. We report a case of bilateral extensive skin necrosis of the lower limbs after a 48-hour lumbar epidural blockade in a 71-year-old patient with right hemiplegia and mitral valve regurgitation, without any preoperative clinical evidence of peripheral vascular disease or diabetes, who underwent transurethral prostatectomy.

[Isoflurane pollution in operating rooms]

In three operating rooms of a Sardinian hospital, the Authors have measured the air levels of isoflurane using static samplers. Anaesthetic mean daily concentrations ranged from 3.5 to 41.5 ppm in room A, from 4.1 to 24.4 ppm in room B, from 9.5 to 30.4 ppm in room C above all depending on the length and the number of surgical operations. The Authors emphasize the need of suitable prevention measures.

Restriction endonuclease digestion and chromosome banding in the mosquito, Culiseta longiareolata (Diptera: Culicidae)

Fixed chromosomes of the mosquito, Culiseta longiareolata (2n = 6) were treated in situ with nine restriction endonucleases and stained with ethidium bromide or Giemsa. All the heterochromatic regions were apparently protected from digestion by all enzymes except Mbo I. This enzyme selectively digested one of the three types of heterochromatin present in the species. Staining with the fluorochrome quinacrine after enzyme treatment produced a standard Q-banding pattern or a Hoechst 33258-like pattern, depending on the enzyme. These results confirmed: (a) the presence of three types of heterochromatic containing different DNA fractions in the chromosomes of this species, (b) restriction enzymes accessibility to the DNA of heterochromatin regions, and (c) the selective cleavage of particular DNA fractions without DNA removal. Moreover, quinacrine staining after enzyme digestion proved useful in detecting differential activity among enzymes which produced the same banding pattern with standard dyes.