[An implant-prosthetic solution to a Class III case]

When the surgeon operates a patient, he must be in a state of absolute serenity with regard to law and his own conscience. This aim can be achieved only when the patient is completely conscious of the type of operation which will be performed, as well as of all possible consequences which may occur afterwards. The balanced occlusion, in restaurations by total subperiosteal technique of serious cases of edentulism of maxillae, seems to be the only possible solution for the duration in time of the two sub-structures.

[Carney's triad. Apropos of a case of recurrent gastric leiomyosarcoma and bilateral pulmonary chondroma]

Carney's triad is a rare syndrome characterized by gastric leiomyosarcoma, functioning extra-adrenal paraganglioma, and pulmonary chondroma. Twenty-seven cases are reported in literature: the most commonly observed neoplasm is gastric leiomyosarcoma (26/27) followed by lung tumor (22/27), and gastric paraganglioma (15/27). Three patients bearing a gastric leiomyosarcoma developed liver metastases, and 6 had a local recurrence after some years. The occurrence of paraganglioma makes the prognosis worse: 4 deaths from local infiltration, metastases or severe hypertension. The triad only occurred in 9/27 cases, mostly young female patients. A common embryologic origin is difficult to assess. The case of a young female patient with recurrent gastric leiomyosarcoma (12 years later) and bilateral pulmonary chondroma is described. It is important that patients with any of the three tumors be periodically examined.

Pattern of emotional control and psychological reactions to breast cancer: a preliminary report

To investigate the relationship between suppression of negative feelings and psychological reaction to cancer, a series of breast cancer patients were studied preoperatively ( n = 35), a week after mastectomy ( n = 32) and six months later ( n = 12). A general pattern of emotional control, as measured by the Courtauld Emotional Control Scale, showed less correlation with anxiety (Symptom Questionnaire Anxiety scale) before breast lump biopsy and more with depressive symptoms (SQ Depression scale) after mastectomy, especially 6 mo. later. Six months after surgery hostility (SQ Hostility scale), inability to express feelings to others, a tendency to perceive the somatic effects of the illness, and less preoccupation about the disease (Illness Behavior Questionnaire) were also associated with emotional repression. These preliminary results suggest further examination of the tendency to inhibit behavioral discharge of emotions which may be a factor in favoring psychological difficulties after diagnosis of cancer.

[Idiopathic juvenile osteoporosis]

Four cases (3 males and 1 female) of idiopathic juvenile osteoporosis, a rare form of bone demineralization, are described. The pathogenesis is unknown. The males showed osteoporosis at X-ray while in the female osteoporosis was only identified by computerized bone densitometry. The age of onset of the disease is perpuberal, but in one case it appeared in a small child. Biochemical data were in the normal range, only 1.25 (OH) 2D was reduced in two patients.

Isolated HLA-B27 associated Achilles tendinitis

The case of a 37 year old man with a longstanding HLA-B27 associated bilateral Achilles tendinitis without seronegative spondyloarthropathy is reported. This case suggests that heel enthesopathy may for a long time be the only clinical manifestation of the HLA-B27 associated disease process.

[Urinary tract infections in a general medicine department. Comments on cases collected over 3 years]

Urinary infections often complicate the clinical course of hospitalised patients especially those with immunological diseases or under antibiotic treatment for other infectious pathologies. Urethral catheterisation is also a well known cause of such infections. The problem of urinary infections was examined in a general medical division. Over a three year period (1982-84), 384 urinary tract infections (UTI) with one infecting organism and 21 UTI with two bacterial species in urine cultures were found. UTI was more often found to be caused by gram negative than gram positive bacilli in both catheterised and non-catheterised patients and E. Coli accounted for most infections. Pseudomonas, Serratia and Acinetobacter were only found in catheterised patients and Enterobacter cloacae almost exclusively so. Among gram-positive bacilli, Enterococcus was the most common. Staphylococcus aureus was rare but created major pathogenetic and therapeutic problems. The results are discussed with particular reference to the high incidence of Escherichia coli and the significance of the different distribution of Pseudomonas, Serratia, Acinetobacter and Enterobacter cloacae between catheterised and non-catheterised patients. Finally the pathogenic and therapeutic problems of UTI caused by more than one germ are considered.

In vitro study of the sensitivity of 1030 hospital-isolated bacterial strains to aztreonam

The antibacterial activity in vitro of aztreonam is compared with other antibiotics on 1,030 strains isolated from pathological specimens. Its spectrum is very large, with special regard to Gram-negative bacteria. Of particular interest appears the sensitivity to aztreonam of otherwise multiresistant strains of Pseudomonas aeruginosa and Proteus rettgeri.

[Bacteriuria. Bacteriological diagnosis and sensitivity to chemotherapeutic agents]

In a brief introduction, methods for collecting urine and diagnosis criteria are reviewed. Data relative to a study of about 10,000 samples of urine from patients admitted to various departments of the Milan Ca' Granda Hospital in 1975 are then reported. The frequencies of the various species of bacteria isolated in cases of bacteriuria are reported. Those occurring most frequently were Proteus (40.7%) of whose four species, Proteus mirabilis and Proteus rettgeri cover almost all cases, and Escherichia coli (26.1%). As for individual isolated microrganisms, the sensitivity to 13 chemotherapeutic agents was tested. E. coli, Klebsiella and Enterococcus demonstrated a high degree of sensitivity with respect to the majority of antibiotics considered.