Efficacy and safety of a soy-protein-formula for feeding babies with atopic dermatitis and cow's milk hypersensitivity

In this paper we report 21 infants with atopic dermatitis (AD) due to cow's milk (CM) hypersensitivity in 20/21 of whom a CM-free diet using as a CM-substitute a soy-protein formula improved the skin lesions, in addition to insuring a regular growth in all infants. Only one infant failed to complete the trial due to an absolute refusal of the soy protein formula. A possible secondary sensitization to soy was found in one infant, in whom dietary therapy alone was not effective. We conclude that soy-protein formulas represent an effective CM-substitute when CM must be eliminated from the diet of an infant with AD.

A simple method for localisation and removal of small subcortical brain tumours

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Cimaterol reduces cathepsin activities but has no anabolic effect in cultured myotubes

The effect of the beta-adrenergic agonist cimaterol on bovine and chicken primary myotubes was assessed. Cimaterol at 10-100 nM concentrations reduced cathepsin B benzyloxy-carbonyl-Arg-Arg-4-methyl-7-coumarylamide hydrolyzing activity, as well as benzyloxycarbonyl-Phe-Arg-4-methyl-7-coumarylamide hydrolysis, which is a substrate for both cathepsin B and cathepsin L. Maximum effect was observed after 6-16 h treatment. Cathepsin H Arg-4-methyl-7-coumarylamide hydrolyzing activity was low and not significantly affected by cimaterol treatment. Despite decreasing cathepsin activities, cimaterol also increased proteolysis rates but induced no detectable effect on protein synthesis rates. These observations suggest that beta-agonists, as a result of a direct action on muscle, can decrease cathepsin activities but that beta-agonist-induced muscle hypertrophy may not be due to a direct effect on muscle cells.

Value of magnetic resonance imaging in spontaneous extradural spinal hematoma due to vascular malformation: case report

A case of spinal cord compression due to spontaneous extradural spinal hematoma is reported. A spinal arteriovenous malformation was suspected on the basis of magnetic resonance imaging. Early surgical exploration allowed a complete neurological recovery. The vascular malformation was histopathologically confirmed. The role of magnetic resonance imaging in the evaluation of acute spinal cord compression syndromes is stressed.

Gene structure of mouse cathepsin B

The structure of a genomic DNA fragment encoding mouse cathepsin B was characterized. The genomic insert spans 15 kbp and contains 9 exons encoding the 339 amino acid residues of mouse preprocathepsin B. Intron break-points are not found at the junctions of the pre-peptide, pro-peptide and mature enzyme. Like other cysteine proteinase genes, the region around the cysteinyl active site is split by an intron, but in contrast with cathepsins L and H the intron break-point is located immediately after the active site.

Surgical treatment of 100 single brain metastases. Analysis of the results

The authors report their personal series of 100 consecutive surgically treated single brain metastases between 1981 and 1988. Patients selection was decided with respect to general and neurological conditions and to primary cancer development. Resection was mostly radical, postoperative mortality rate was 6% and neurological improvement was obtained in 73% of cases. Mean follow-up was 15 months (min. 12, max. 60). The overall median survival time was 13 months. The survival rate was studied with respect to age, lesion site, preoperative syndrome, primary cancer, cause of death and radiotherapy. On the base of their experience the Authors would stress that a better patients selection can further reduce the mortality rate.

[Failed dissolution of a gallstone by methyl tert-butyl ether: importance of predicting gallstone chemical composition]

In December 1986 we attempted direct chemical litholysis using methyl-tertiary-butyl-ether (MTBE) in a sixty-year-old man with severe ischemic heart disease who had suffered frequent episodes of biliary colic due to a radiolucent gallstone. MTBE was infused for a total of 17 hrs over a period of 5 days; however the gallstone diameter remained unchanged. The patient was subsequently cholecystomized and chemical analysis revealed that the gallstone was a pigment stone. The need for accurate prediction of gallstone composition before beginning an invasive, such as MTBE infusion, is emphasized.

Purification and properties of different isoforms of bovine cathepsin B

A rapid purification procedure is described for cathepsin B from bovine liver. After preparation of crude lysosomal extracts, the method only involves DEAE Zeta-Prep-Disk chromatography, gel filtration, and fast protein liquid chromatography on Mono-S column. Two active peaks (P1 and P2) of cathepsin B were distinguished. Both presented uncleaved (relative mass (Mr) 30,000) and cleaved (Mr 25,000 + Mr 5000) chains, but different isoforms as revealed by isoelectrofocusing. These two different populations of cathepsin B isoforms nevertheless exhibited similar enzymatic properties. Km and kcat were 114 microM and 52 s-1, and 125 microM and 75 s-1, for hydrolysis of Z-Arg-Arg-NMec by P1 and P2, respectively. Both were rapidly inhibited by low concentrations of E-64 or leupeptin, but were unaffected by cathepsin-L-specific inhibitor Z-Phe-Phe-CHN2.

[J-reservoir in the treatment of ulcero-hemorrhagic rectocolitis]

The Authors report their experience on ileal-anal anastomosis with a J-pouch. A videotape illustrates the surgical technique. At last functional results are shown.

Evaluation of new test (Phadiatop) for the screening of respiratory allergic disorders in children

The present study investigated the sensitivity, specificity, and predictive value of a new in vitro test, the Phadiatop, which detects the presence in serum of specific IgE to a balanced mixture of the most frequent inhalant allergens. Ninety-eight children (63 males, 35 females) 2-12 years old (median age = 6), suffering from rhinitis and/or conjunctivitis and/or asthma were studied. Our data show that Phadiatop has an 87% sensitivity, a 100% specificity, a 92% efficiency, a 100% positive predictive value, and an 86% negative predictive value. These results indicate that Phadiatop is very effective in diagnosing atopy (no false positive). However, a negative Phadiatop does not exclude the diagnosis of atopy.

Endoscopic approach to patients with portal hypertension: a complex diagnosis. A retrospective study based on 10 years' experience

We analyzed the endoscopic findings in 788 patients with esophageal and gastric varices who underwent upper gastrointestinal endoscopy between 1 January 1979 and 31 December 1988. Of these, 154 patients (19.6%) had gastric varices associated in various patterns with esophageal varices. Congestive gastropathy, occurring with esophageal and gastric varices (43.4%), was the most frequent pathology detected in our patients. Esophagitis was present in 15.8% of patients, but did not correlate with variceal bleeding. Endoscopy performed at 1 day to 1 week post-hemorrhage in 313 patients accurately identified the source of bleeding in only 57.2% of patients. This figure increased to 98.2% when we performed the examination within the first 24 h of hemorrhage. In this group varices were the source of hemorrhage in 72.3% of patients while the hemorrhage came from other sources, such as erosive gastritis, duodenal and gastric ulcer in 27.6% of patients.

Endoscopic dilation of colonic postoperative strictures

After the use of surgical staplers had become widespread, the number of colonic postoperative stenoses was observed to have increased. Nevertheless, the clinical relevance of this observation is minimal since only 2-5% of the patients complain of chronic constipation or obstruction symptoms. In such cases medical therapy is somewhat troublesome, and surgical treatment always implies a major operation. Endoscopic dilation has proved to be a reliable, simple, and safe therapeutic alternative. Forty-two patients with evidence of stenosis of either colocolic or colorectal anastomosis underwent mechanical or pneumatic dilation in our unit: 19 patients with a temporary diverting stoma were dilated before the colostomy was removed; in the remaining 23 cases, treatment was given according to the patients' symptoms or because it was not possible to pass the anastomosis with an endoscope. The overall failure rate was 2.4%, and no morbidity or mortality was found. When the percentages of patients successfully treated in one session alone were compared (76.9% versus 51.8%), balloon dilation was found to be more effective than bougienage. In our opinion, endoscopic dilation represents the mainstay of treatment of colonic anastomotic strictures, with surgery being reserved for the rare failures, when recurrence of cancer should be suspected.

Chronic encapsulated intracerebral haematoma: pathogenetic and diagnostic considerations

Two cases of chronic encapsulated intracerebral haematoma are reported. The patients presented with progressive neurological deficits. Computed tomography scan showed a roundish, intracerebral lesion, that revealed ring blush after contrast infusion, with mass effect. At operation a thick, fibrous, brownish capsule, containing clots in different states of formation, was removed. The hypothesis of capsule formation due to an exuberant proliferation of arachnoidal fibroblasts, is discussed. Differentiation between encapsulated intracerebral haematoma and other chronic intracerebral blood collections is considered mandatory for appropriate treatment.

[Case in point: allergy, intolerance or pseudoallergy to chocolate?]

Chocolate is traditionally considered as allergenic for predisposed subjects although many immunologic reactions are erroneously evaluated as allergic, due to misleading procedures. Therefore the term intolerance has been more properly employed. After summarizing the negative effects of chocolate, especially in children, we stress that the diagnosis of chocolate intolerance should be based upon reliable studies, including elimination/provocation tests in a double-blind fashion.

[Continuous localized EEG discharges during sleep in children]

Continuous generalized spike-and-wave complexes occurring during slow-sleep were first observed in some children by Patry et al. (1971). A general review of the reported cases was made by Tassinari et al. (1984). We have observed a new clinical-EEGraphic picture. Spikes and spike-and-wave complexes localized to one hemisphere were recorded during at least 85% non-REM sleep both in 3 quadriplegic and in 3 hemiplegic mentally retarded children, aged from 2 years and 10 months to 11 years (mean age: 5 years and 2 months). Cyclic organization of sleep was almost normal. Wake EEG showed an epileptic focus. Brain CT showed midline defect and brain atrophy in quadriplegic patients, and a wide temporal-parietal porencephalic cyst in hemiplegic patients. This EEGraphic pattern was associated with a more pronounced mental impairment: neuropsychological improvement was observed in 2 cases, when continuous sleep discharges disappeared. As aforesaid, this picture seems to be related either to hemispheric or to midline brain defects. In our cases, sleep phase organization could be examined, while continuous generalized discharges occurring during sleep do not allow such a study.

Intraventricular craniopharyngioma. Clinical and surgical considerations

The authors present two cases of craniopharyngioma wholly located within the cavity of the third ventricle. The rarity of this condition is outlined. In these cases the computed tomography is not always sufficient to determine the correct surgical approach; therefore the Authors stress the importance of the clinical findings.

"Primary" leptomeningeal dissemination of medulloblastoma. Report of an unusual case

The Authors report the case of a 5-year-old boy medulloblastoma presenting with "primary" widespread diffusion in the subarachnoid spaces of the posterior fossa without true mass lesion. The diagnosis, suspected first on the basis of the computed tomography (CT) findings, was confirmed by cytological examination of the cerebrospinal fluid (CSF) and by surgery. The Authors analyse the peculiar clinical features (rapid and severe deterioration of general conditions, hyperacute course of the illness and fatal issue) and the morphological aspects of the tumor (CT and surgical findings). To our knowledge no case of "primary" dissemination of medulloblastoma was previously reported.

Non-invasive assessment of left ventricular performance in patients with coronary artery disease after chronic diltiazem therapy

To evaluate the effects of diltiazem (240 mg/day) on the left ventricular function, we studied 13 patients with coronary artery disease (CAD). Comparison with placebo was made in a double-blind randomized crossover study. Both placebo and diltiazem were administered for 5 weeks. We assumed left ventricular systolic time intervals assessed by polycardiography as parameter of ventricular function. Diltiazem induced a significant decrease in pre-ejection period (p less than 0.01) as well as pre-ejection period/left ventricular ejection time ratio (p less than 0.01). Thus, our results suggest that diltiazem improves the contractile state of ischemic myocardium in CAD patients.

The lung and primary immunodeficiency

Primary immunodeficiences (ID), once considered to be very rare, are now increasingly recognized thanks to more knowledge in the immunological field and to the availability of more sophisticated diagnostic techniques. The respiratory tract and especially the lung are the most common targets of primary ID, and respiratory infections and/or failure are the most frequent causes of early death when the immune defect is not corrected with HLA-identical bone-marrow trans lant or, in few selected cases, with thymic extracts. Many patients with Ig deficiency are severely affected by chronic and recurrent respiratory infections, unfortunately leading to bronchiectasis in the majority of such patients. Today early i.v. gammaglobulin administration can prevent bronchiectasis, and this increases the chances of a better prognosis and of an improved quality of life as well.

In search of the moral foundation of nursing

This article is offered as an extension of the work of Yarling and McElmurry, who ostensibly discussed the moral foundations of nursing. They did not actually broach their intended topic, but they did offer important clues for further analysis. This presentation attempts to show how the moral foundation of nursing might be discerned by indicating both its linkage to the great moral ideas and certain confusions in current nursing ideology. It is claimed that the moral foundation of nursing--indeed, the moral inspiration at the heart of nursing practice--must come from a clearly developed understanding of the idea of nursing.

Dysphagia lusoria: proposal of a new treatment

Recent observation of one patient suffering from dysphagia lusoria has suggested critical review of treatment of the symptomatic aberrant right subclavian artery. Surgical correction of such an anomaly is difficult and may produce serious complications, and is not always successful. Endoscopic dilatation of the oesophageal stricture, even though it might only produce temporary relief of dysphagia, represents a valid therapeutical alternative because of its favourable cost/benefit ratio, low incidence of complications and patient acceptability.

[A rare cervico-facial teratoma in a newborn female infant]

The Authors report a case of a rare and very voluminous teratoma with uncommon location (the right cervico-facial region) and extracranial seat in a female newborn. The teratoma was excised in the 18th day of life. It showed cystic and solid lesions. The tissues were derived from the three germ layers and were prevalently mature; only a bit of them was represented by embryonic mesenchymal tissue. The baby, followed and checked up during all the first year of her life, showed a normal evolution and absence of recurrences.

[The case of little Hans: a prototype of family therapy?]

The clinical case of little Hans is the story of a five-year-old child's phobia; it was published by Freud in 1909 using material gathered from his supervision of the "analytical treatment" brought before the child's father. Freud put the case as a clinical confirmation of the relative theory of infantile sexuality and the existence of an infantile neurosis based on the castration complex and oedipal conflict. Freud also focused his attention on the development of the "theories" the child uses to understand the world: the analysis is constructed as the hermeneutics of the private conditions with which the mind develops omnipotent cognitive theories about external reality. In addition to the clinical material, the peculiar conditions of the setting opened up new avenues in psychoanalysis; the case of little Hans in particular is considered a prelude to infantile analysis. This work emphasizes how Han's cure is the result of a complex interaction involving the entire family nucleus and proposes a possible relational significance of the kind of therapeutical operation which develops through the father of little Hans.