Biocatalytic Regioselective O-acylation of Sesquiterpene Lactones from Chicory: A Pathway to Novel Ester Derivatives

We report the first biocatalytic modification of sesquiterpene lactones (STLs) found in the chicory plants, specifically lactucin (Lc), 11β,13-dihydrolactucin (DHLc), lactucopicrin (Lp), and 11β,13-dihydrolactucopicrin (DHLp). The selective O-acylation of their primary alcohol group was carried out by the lipase B from Candida antarctica (CAL-B) using various aliphatic vinyl esters as acyl donors. Perillyl alcohol, a simpler monoterpenoid, served as a model to set up the desired O-acetylation reaction by comparing the use of acetic acid and vinyl acetate as acyl donors. Similar conditions were then applied to DHLc, where five novel ester chains were selectively introduced onto the primary alcohol group, with conversions going from >99 % (acetate and propionate) to 69 % (octanoate). The synthesis of the corresponding O-acetyl esters of Lc, Lp, and DHLp was also successfully achieved with near-quantitative conversion. Molecular docking simulations were then performed to elucidate the preferred enzyme-substrate binding modes in the acylation reactions with STLs, as well as to understand their interactions with crucial amino acid residues at the active site. Our methodology enables the selective O-acylation of the primary alcohol group in four different STLs, offering possibilities for synthesizing novel derivatives with significant potential applications in pharmaceuticals or as biocontrol agents.

Toxicological aspects of cannabinoid, pesticide and metal levels detected in light Cannabis inflorescences grown in Italy

Recently, the cultivation of light Cannabis, with a total THC content less than 0.6%, has been encouraged due to its industrial and therapeutic potential. This has increased the consumption of hemp for both smoking purposes and food preparation. Even so, Cannabis inflorescences are not subject to EU regulations and standards provided for food and tobacco products. A study was carried out on thirty-one inflorescences samples, collected in different Italian regions, in order to determine cannabinoids, pesticides and metals and to evaluate the exposure of consumers to contaminants and ensure a safe consumption. Contents of THC were always below 0.5%, while CBD ranged between 0.3 and 8.64%. The determination of 154 pesticides showed that 87% of the samples contained fungicides and insecticides in the range 0.01-185 μg/g. The most found are spinosad and cyprodinil. The concentration of metals ranged from 1 to more than 100 μg/g and As, Cd, Co, Cr, Hg, Cu, Mo, Ni and V exceeded the regulatory US limits for inhaled Cannabis products, while Pb exceeded them for both oral and inhaled products. These contaminants are intrinsically toxic and may affect public health. Actions are needed to establish regulatory measures and reduce the adverse effects caused by contaminants in Cannabis.

Depression, pathological dependence, and risky behaviour in adolescence

During adolescence, there is an increased chance of increased incidence of depression and the development of addictive/dependent behaviours such as pathological gambling, excessive Internet use and compulsive shopping, Here we present a psychoeducational approach in the schools of Pescara and Penne to identify and treat these problems.

Search for supersymmetry in events with three leptons and missing transverse momentum in √[s]=7 TeV pp collisions with the ATLAS detector

A search for the weak production of charginos and neutralinos decaying to a final state with three leptons (electrons or muons) and missing transverse momentum is presented. The analysis uses 2.06 fb(-1) of √[s]=7 TeV proton-proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with standard model expectations in two signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric and simplified models. For the simplified models, degenerate lightest chargino and next-to-lightest neutralino masses up to 300 GeV are excluded for mass differences from the lightest neutralino up to 300 GeV.

Search for lepton flavour violation in the eμ continuum with the ATLAS detector in [Formula: see text]pp collisions at the LHC

This paper presents a search for the t-channel exchange of an R-parity violating scalar top quark ([Formula: see text]) in the e±μ∓ continuum using 2.1 fb-1 of data collected by the ATLAS detector in [Formula: see text]pp collisions at the Large Hadron Collider. Data are found to be consistent with the expectation from the Standard Model backgrounds. Limits on R-parity-violating couplings at 95 % C.L. are calculated as a function of the scalar top mass ([Formula: see text]). The upper limits on the production cross section for pp→eμX, through the t-channel exchange of a scalar top quark, ranges from 170 fb for [Formula: see text] to 30 fb for [Formula: see text].

Contribution of volcanic ashes to the regional geochemical balance: the 2008 eruption of Chaitén volcano, Southern Chile

The environmental geochemical behaviour of the rhyolitic ashes from the 2008 eruption of Chaitén volcano, Southern Chile, has been studied. After the bulk characterisation, the potential contribution to the regional geochemical fluxes was examined using: i) single batch leaching tests to provide a rapid screening of the implied major and trace elements; and ii) column experiments to evaluate the temporal mobility of leached elements. The environmental concerns of these ashes are related to the fine grained component present in each sample (independent of distance from the source), in particular the presence of cristobalite, and the geochemical hazards posed by ash-water interaction. Leaching experiments show the fast dissolution of surface salts and aerosols, which dominate over glass dissolution during the first steps of the ash-water interaction. Chaitén ashes could transfer to the environment more than 1×10(10)g or 10,000 metric tonnes (mt) of Cl, S, Ca, Na, Si, and K; between 1000 and 10,000 mt of F, Mg, and Al; between 100 and 1000 mt of As, Pb, P, Fe, Sr, Zn, Mn, and Br; between 10 and 100 mt of Ba, Li, Ti, Ni, Nb, Cu, Rb, Zr, V, Mo, Co, and Sc; and less than 10 mt of Cr, Sb, Ce, Ga, Cs, and Y. These results show the fertilising potential of the ashes (e.g., providing Ca and Fe) but also the input of potentially toxic trace elements (e.g., F and As) in the regional geochemical mass balance. The Chaitén results evidence lower potentials for poisoning and fertilising than low silica ashes due to the lower contents released of practically all elements.

Measurement of the ZZ production cross section and limits on anomalous neutral triple gauge couplings in proton-proton collisions at sqrt[s] = 7 TeV with the ATLAS detector

A measurement of the ZZ production cross section in proton-proton collisions at sqrt[s] = 7 TeV using data corresponding to an integrated luminosity of 1.02 fb(-1) recorded by the ATLAS experiment at the LHC is presented. Twelve events containing two Z boson candidates decaying to electrons and/or muons are observed, with an expected background of 0.3 ± 0.3(stat)(-0.3)(+0.4)(syst) events. The cross section measured in a phase-space region with good detector acceptance and for dilepton masses within the range 66 to 116 GeV is σ(ZZ → ℓ+ ℓ- ℓ+ ℓ-)(fid) = 19.4(-5.2)(+6.3)(stat)(-0.7)(+0.9)(syst) ± 0.7(lumi) fb. The resulting total cross section for on-shell ZZ production, σ(ZZ)(tot) = 8.5(-2.3)(+2.7)(stat)(-0.3)(+0.4)(syst) ± 0.3(lumi) pb, is consistent with the standard model expectation of 6.5(-0.2)(+0.3) pb calculated at the next-to-leading order in QCD. Limits on anomalous neutral triple gauge boson couplings are derived.

Environmental geochemistry of ancient volcanic ashes

Volcanic ashes from the Puna and surrounding Andean areas in northern Argentina show that sometimes volcanic ash deposits are very well preserved (up to several million years) and can remain a potential hazard for the environment in a similar way as current deposits. Eight ashes have been characterized by SEM-EDX and DRX, and their potential released geochemical fluxes were examined by using water and nitric acid batches, which are analyzed by ICP-OES, ICP-MS and ISE (F). Results demonstrate that water batch system is better medium than nitric acid for this study. The high and fast reactivity of these ancient ashes is mainly associated with their high content in glass. The order of magnitude of released contents of implied elements is consistent among the samples, i.e., Al>B>Fe>Zn>F>P>Mn>Ba>Sr>Li>Ti>Rb>Cu>Ni>Sb>Pb>As>Cr>V. Ash-water interaction, although infrequent in arid regions such as the Puna Region in northern Argentina, introduces rapid changes in the geochemical fluxes of elements and pH and may constitute a potential hazard for the environment. In fact, many of these elements are included in the drinking water guidelines due to their potential toxicity and may constitute potential hazards for the environment and human health.

Mapping the intake of different elements in vegetal tissues by dual-energy X-ray imaging at DaPhine synchrotron light source

This article reports on the first utilization of the soft X-ray beamline at the DaPhine synchrotron light source for mapping the intake of different elements in plant tissues. As a test, the method of dual-energy X-ray microradiography was applied to the investigation of the natural sulfur content in dried leaf and root samples. Our ultimate goal was to monitor the pollutant lead and its intake, which was added in controlled doses to the hydroponic medium of laboratory-controlled samples of vegetal species. The results obtained by the nondestructive X-ray radiographic analysis are compared to the values of concentrations determined by a standard chemical analysis utilizing atomic absorption spectroscopy. From this comparison the validity of the X-ray detection of heavy metals in biological samples has been confirmed. The superposition of the dual energy results on the simple planar radiography shows the representation of the pollutant intake directly on the sample structures. It should be pointed out that this method, developed here for plant root and leaves could be applied to any biological sample of interest, but the preparation and observation conditions necessitate different strategies according to the type of sample under analysis.

Effect of morbid obesity on kinetic of desflurane: wash-in wash-out curves and recovery times

AIM

The aim of this paper was to compare wash-in and wash-out curves of desflurane in morbidly obese and nonobese patients.

METHODS

Fourteen patients (7 obese and 7 nonobese) were studied. In the nonobese patients, anaesthesia was started by administering 2 mg/kg propofol bolus and a target controlled effect site concentration of remifentanil set at 2.5 ng/mL. Obese patients were intubated using a flexible fiberoptic bronchoscopic technique facilitated by a target controlled effect site concentration of remifentanil set at 2.5 ng/mL. After endotracheal intubation, general anaesthesia was started by administering a 1.5 mg/kg propofol bolus dose. Ten minutes after induction of anaesthesia, 4% desflurane was administered for 30 min. Desflurane kinetics was determined by collecting end-tidal samples from first breaths at 1, 5, 10, 15, 20, 25 and 30 min. At last skin suture, the end-tidal concentration of desflurane was recorded from 5 consecutive breaths before their discontinuation, then the end-tidal samples of the inhalational agent were collected at 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5 and 5 min after terminating its administration. The period of time from discontinuation of desflurane to opening eyes, squeezing the observer's hand, extubation, stating the patients' name and providing date of birth was also recorded.

RESULTS

The FA/FI ratio was higher in the nonobese group from the 10th to the 15th min. Wash-out curves of desflurane and recovery times were similar.

CONCLUSION

Our results show that desflurane provides similar kinetic and recovery profiles in obese and nonobese patients.

[Neck pain and fever after peginterferon alpha-2a]

A 39-year-old woman presented to the emergency room with fever and tender swollen neck two days after the first injection of Peginterferon alpha-2a (Pegasys). She had been under Interferon therapy for melanoma over the last five months. Because of side effects Interferon alpha-2a (Roferon-A) was discontinued and she was given Peginterferon alpha-2a. On examination, she was unwell, febrile (38.8 degrees C) and her pulse was 110/min. Laboratory findings were as follow: erythrocyte sedimentation rate 85 mm/h, C-reactive protein 143 mg/L, white cell count of 11 x 10(9)/L (3.0-9.6), TSH 0.10 mU/L (0.27-4.20), fT4 24.2 pmol/L (12-22), fT3 5.5 pmol/L (2.8-7.1) antinuclear antibodies 1:80, antithyreoglobulin antibodies 212 IE/ml (< 100), thyreoglobulin 442 microg/L, anti-TPO normal and TSH receptor antibodies were negative. Ultrasonography revealed an enlarged, focally hypoechoic thyroid. We suspected she had a Peginterferon alpha-2a induced thyroiditis de Quervain and started a therapy with NSAR and thereafter with Prednison 20 mg. Her symptoms resolved within few days. Thyroiditis in association with Interferon alpha-2a have already been reported. Not known is, to our knowledge, an acute thyroiditis as a side effect of treatment with Peginterferon alpha-2a. Our case shows that also Peginterferon alpha-2a can induce an inflammation of the thyroid similar to de Quervain's thyroiditis.

[Exercise-induced left arm pain and thrombocytosis]

We describe the case of a 45-year-old male smoker who presented with an acute anterior wall myocardial infarction and a platelet count on admission of 1030000/mm3. Emergent coronary angiography revealead left anterior wall akinesia caused by a spontaneously resolved thrombosis of the left anterior descending artery with residual stenosis. Primary percutaneous coronary angioplasty and stenting were performed. Postangioplasty course was uneventful. He was diagnosed with essential thrombocythemia based on the findings of marked thrombocytosis of 1,030,000/mm3, splenomegaly and numerous clumping giant megakaryocytes on bone marrow biopsy. In addition to standard therapy with aspirin, heparin, betablocking agent, ACE-inhibitor and statine he received additional anti-platelet therapy with Clopidogrel. Cytoreductive therapy was not necessary.

[Spontaneous dissection of visceral blood vesssels--a rare cause of epigastric pain]

A 51 year-old man presented with acute abdominal pain in our emergency room. The first examination revealed no pathological findings except coprostasis and after an enteroclysis the patient was sent home without any complaints. During a recent episode of abdominal pain a computer tomography was performed, showing dissection of the superior mesenteric and the celiac artery. Without any signs of mesenteric ischemia additional examinations like laboratory studies, x-rays, and abdominal ultrasound might be normal and therefore not helpful for diagnosis. In patients presenting with persistent abdominal pain and unspecific clinical and laboratory findings rare causes of abdominal symptoms should be considered. Despite the rarity of visceral artery dissection, awareness of this pathology is crucial because of its possible lifethreatening complications. Appropriate diagnostic imaging tests may avoid postmortem diagnosis by the pathologist.

Exposure to Di(2-ethylhexyl)phthalate in humans during pregnancy. A preliminary report

BACKGROUND

Di(2-ethylhexyl)phthalate (DEHP), the most commonly used plasticizer, is a widespread ubiquitous environmental contaminant. The potential health hazards from exposure to DEHP and its main metabolite, mono(2-ethylhexyl)phthalate (MEHP), have been well documented. Exposure to DEHP and MEHP in humans at risk, such as pregnant women and human fetuses, has not been tested.

METHODS

Plasma DEHP and MEHP concentrations were measured in a total of 24 consecutive mother-infant pairs by high performance liquid chromatography. Associations between DEHP/MEHP and infant characteristics were tested using Fisher's exact test, unpaired t tests and univariate linear regression analysis.

RESULTS

Measurable DEHP and MEHP concentrations were found in 17/24 (70.8%) and 18/24 (75%) maternal plasmas, respectively, and in 11/25 (44%) and 18/25 (72.0%) cord samples, respectively. Either DEHP or MEHP were detectable in 21/24 (87.5%) maternal plasmas and 19/25 (76%) cord samples. The mean DEHP concentrations in maternal and cord plasmas were 1.15 +/- 0.81 and 2.05 +/- 1.47 microg/ml, respectively. The mean MEHP concentrations were 0.68 +/- 0.85 and 0.68 +/- 1.03 microg/ml, respectively. No significant correlations were found between maternal and cord blood DEHP, maternal and cord blood MEHP, maternal DEHP and cord blood MEHP, or maternal MEHP and cord blood DEHP plasma concentrations.

CONCLUSION

Although the effects of perinatal exposure to phthalates need further research, our findings: (i) confirm the high frequency of DEHP and/or MEHP exposure in human pregnancies; (ii) indicate that the exposure to these environmental contaminants begins during intrauterine life, and (iii) suggest that fetal exposure is closely related to the maternal exposure.

High plasma concentrations of di-(2-ethylhexyl)-phthalate in women with endometriosis

BACKGROUND

Emerging evidence suggests a potential role for ubiquitous environmental contaminants in the physiopathology of endometriosis. Di-(2-ethylhexyl)-phthalate (DEHP), the most commonly used plasticizer in flexible polyvinylchloride (PVC) formulations, is a widespread environmental contaminant with potentially adverse effects on fertility in animal models. In the present study, we tested the hypothesis that DEHP and/or and its main metabolite, mono-ethylhexyl phthalate (MEHP), play a role in the pathogenesis of endometriosis.

METHODS

Specimens of blood and peritoneal fluid were collected in a group of women with endometriosis (n = 55), and in age-matched control women (n = 24). Concentrations of DEHP and MEHP were measured in plasma and peritoneal fluid by using high performance liquid chromatography (HPLC). Differences between groups were tested using the Fisher's exact test, Wilcoxon-test, and Kruskal-Wallis analysis of variance.

RESULTS

Endometriotic women showed significantly higher plasma DEHP concentrations than controls (median 0.57 micro g/ml, interquartile range: 0.06-1.23; values range: 0-3.24 versus median 0.18 micro g/ml, interquartile range: 0-0.44; values range: 0-1.03; P = 0.0047) and 92.6% of them had detectable DEHP and /or MEHP in the peritoneal fluid. No significant differences in either the DEHP/MEHP plasma concentrations (P >/= 0.31) or DEHP/MEHP peritoneal fluid concentrations (P >/= 0.66) were observed in the endometriotic patients as a function of the disease stage at the time of diagnosis.

CONCLUSIONS

The present findings showed for the first time an association between DEHP plasma concentrations and endometriosis, suggesting a possible role for phthalate esters in the pathogenesis.

Nedocromil sodium in the prevention of exercise-induced bronchospasm in athletes with asthma

The aim of this study was to determine the efficacy of nedocromil sodium in the prevention of exercise-induced bronchospasm (EIB) in 13 top athletes affected by bronchial asthma. At a dose of 4 mg the drug significantly reduced the fall in FEV1 compared with placebo but not with respect to basal values. In 9 athletes, 4 mg nedocromil sodium produced a good protective effect and reduced the mean fall in FEV1 to 4% with respect to baseline values, while in the remaining 4 subjects, the protective effect was not satisfactory. In these 4 "non responders" 6 mg nedocromil was effective, and in 2 cases induced prolonged bronchodilatation. In conclusion, the effect of nedocromil sodium in the prevention of EIB may be dose-dependent in relation to the degree of bronchial hyperreactivity or to interference of other factors.

Nedocromil sodium inhibits the increase in airway reactivity induced by platelet activating factor in humans

To investigate the effect of nedocromil sodium on changes in airway reactivity to methacholine induced by platelet activating factor, we studied 12 nonasthmatic, nonatopic subjects (24 to 41 years) in a double-blind trial. The FEV1 and airflow at 30 percent of vital capacity from a partial forced expiration (V30p) were used to assess changes in airway caliber. Two concentration-response curves to doubling concentrations of MCh (from 0.3 mg/ml) were performed 48 h apart. The concentrations of MCh causing a 20 percent fall in FEV1 (PC20FEV1) or a 40 percent fall in V30p (PC40V30p) were calculated. After the first MCh challenge, subjects were matched by airway reactivity and randomly assigned to nedocromil sodium (two puffs qid 2 mg/puff) or placebo treatment. Two days after the second MCh challenge, PAF was inhaled, and changes in airway caliber were recorded. Administration of either nedocromil sodium or placebo was ended at this time and airway response to MCh was assessed two days after PAF. The two concentration-response curves to MCh obtained before PAF exposure were superimposable. The PAF caused a dose-related bronchoconstriction in both groups; the maximal fall in V30p was 27.6 +/- 6.6 percent (mean +/- SE) in the nedocromil sodium group and 37.4 +/- 4.6 percent in the placebo group. Two days after PAF, the PC20FEV1 did not change in subjects who received nedocromil sodium (4.86 vs 4.32 mg/ml; geometric mean), but it fell from 6.59 to 1.12 mg/ml (p less than 0.05) in placebo-treated subjects. These results indicate that nedocromil sodium inhibits PAF-induced increase in airway reactivity.

Nedocromil sodium: a review of clinical studies

Nedocromil sodium is a new compound for the long-term treatment of bronchial asthma. Its effect has been studied in prevention of bronchospasm induced by a variety of stimuli showing a broader spectrum of activity than SCG. Its clinical efficacy has been demonstrated in a number of trials involving patients regardless of asthma type.

Sodium cromoglycate: a review

Sodium cromoglycate is a drug widely used in the treatment of bronchial asthma. In vitro and animal models show that its effect is related to mast cell stabilization and to a direct action on inflammatory cells or the broncho-obstructive reflex. In man, sodium cromoglycate is able to prevent bronchoconstriction induced by a variety of stimuli including the 'late' reaction to allergen. It is also able to prevent the allergen-induced increase in hyperresponsiveness. Long-term therapeutic trials have confirmed its validity in the treatment of asthmatic patients.

Diagnosis and treatment of asthma across Europe

It is widely recognized that the mortality rate for asthma is at an unacceptably high level. Many physicians take the view that, if this situation is to be reversed, emphasis should be placed on the earlier and regular use of preventive therapies, which manage the fundamental pathophysiology of asthma, rather than merely treating symptoms. It, therefore, appears appropriate to reappraise sodium cromoglycate in terms of its role in normalizing respiratory function by its effect on inflammatory mediators and, thus, in improving the quality of life for asthmatics.

A double-blind group comparative study of nedocromil sodium in the treatment of seasonal allergic rhinitis

Thirty-eight patients with seasonal rhinitis due to grass pollen allergy took part in this double-blind study comparing 1% nedocromil sodium and placebo. Treatment was allocated by randomised coding sheet and consisted of 1% nedocromil sodium nasal spray or placebo given four times daily for four weeks during the peak pollen season. Highly significant (p less than 0.001) differences in favour of nedocromil sodium were seen for all signs and symptoms recorded at clinical assessments, and for diary card assessments of symptoms. In addition, time to effect and patient and clinician opinions of treatment significantly (p less than 0.001) favoured nedocromil sodium. Laboratory data on blood and urine samples taken before and after treatment showed no significant effects, and both treatments were well tolerated. Nedocromil sodium 1% nasal spray taken four times daily was shown to be an effective treatment for grass pollen rhinitis.

Prevention of non-specific bronchial hyperreactivity. Dose-dependent effect of sodium cromoglycate metered dose aerosol

The protective effect of different doses of sodium cromoglycate (4 mg, 12 mg and 20 mg) given as pressurized aerosol on fog-induced bronchoconstriction were investigated in three different groups of asthmatic patients. Premedication with the active drug was compared versus absence of premedication. The authors discuss their results by a statistical analysis of the FEV1 variations. Sodium cromoglycate effectively prevents fog-induced bronchoconstriction with a clear dose-dependent effect.

Lumbar disc herniation: diagnosis, surgical treatment, recurrence. A review of 872 operated cases

This review is based on 972 cases treated surgically for lumbar disc herniation between 1974 and 1984. The authors discuss several problems related to this condition. The importance of the history and clinical assessment are emphasized, as well as the role of instrumental tests such as radiculography and CT scan. The authors report what they believe to be the treatment of choice to avoid recurrence, based on an analysis of two groups of patients. The first group consisted of patients in whom lumbar and radicular pain persisted after operation. The second group consisted of patients in whom these symptoms recurred after an interval of complete relief. This analysis leads to the following conclusions: 1) clinical examination is pre-eminent; CT scan and radiculography are complementary to an accurate neurological examination; 2) hemilaminectomy is the operation of choice because it is sufficient to ensure accurate exploration of both root and disc; 3) most recurrences are due to errors in diagnosis or surgical technique.

Double-blind crossover trial to compare the activity of nedocromil sodium and placebo in antigen challenge

In a double-blind crossover placebo controlled study, the inhibitory effects of three different doses of nedocromil sodium on the immediate bronchoconstrictor response to antigen challenge were compared with a placebo. All the test treatments were inhaled three hours before challenge. Four asthmatic patients took part in the study and the test treatments were taken in a randomized order. All three doses of nedocromil sodium significantly reduced the bronchoconstrictor response and protected the patients against antigen challenge, compared with placebo. The highest dose of 2 mg was the most effective dose. All test doses of nedocromil sodium were safe and well tolerated by the patients.

The treatment of fractures of the acetabulum involving both anterior and posterior columns

Over a period of 20 years, 35 cases of fracture of the acetabulum involving both columns were treated by operation in our unit. These were followed up after a minimum of 8 to a maximum of 20 years. The Iselin approach, even when extended forwards by partial disinsertion of the gluteal muscles, allowed good reduction only when there was little or no displacement of the ilio-pubic column. In the other cases, it was necessary to use a combined anterior and posterior approach, or the Letournel approach, but the latter was reserved for cases with very severe displacement or comminution of the fragments when it is essential to have access and control of the iliac and acetabular complex in its entirety. The clinical and radiographic results of fractures involving both columns are not unlike those observed in other complex fractures of the pelvis: good reduction and osteosynthesis is synonymous with good function even in the long term.

Transverse fractures of the acetabulum

From a total case material of 356 fractures of the acetabulum we have been able to analyse in depth 188 fractures treated surgically--77 transverse, 21 T-fractures and 90 transverse associated with posterior rim fractures. These lesions, although sharing certain anatomical and radiographic features, have peculiar characteristics which are important to define for purposes of treatment. Posterior dislocation of the femoral head is frequently associated with posterior rim fractures and central dislocation with transverse and T-fractures. Traumatic arthritis as a late complication was studied with particular reference to the quality of reduction of the fracture. When this results in an irregular articular surface early arthritis is the usual outcome; when it results in an acetabular cavity wider than the diameter of the femoral head, arthritis is delayed usually for more than 10 years, and subsequently progresses very slowly.

The transtibio-fibular graft in the treatment of pseudarthrosis of the tibia with loss of bone substance

The transtibio-fibular graft is the treatment of choice in pseudarthrosis of the tibia with significant loss of bone, particularly in the presence of infection or potential infection. A personal series of 28 cases is reported. The method consists of stabilizing the pseudarthrosis, usually after radical surgical cleansing, by applying the grafts through healthy tissues from a postero-lateral approach. The authors stress that this operation is only called for when the amount of bone loss is substantial. In the less severe cases the operation restores sufficiently strong union to prevent future fatigue fractures, whilst even in cases of more extensive bone loss it still offers an excellent prospect of avoiding such possible future complications.

[Action of Trivé 1000 on hemostasis and hematocrit]

The action of lipids on haemostasis has already been shown. The authors study possible changes of haemostasis induced by the use of a substance: Trive 1000 containing 3.8 g of Soya oil and 0.3 g of Soya lecithin per 100 ml. Twenty patient received 1 litre per day over a period of ten days and were compared with 16 controls receiving glucose and amino acides without lipids. Studies of haemostasis included: overall coagulation by the thrombo-elastogram, P.R.P. (platelet rich plasma), estimation of the co-factors of the prothrombin complex, thrombin and reptilase times, platelet count, platelet stickiness using the method of HELLEM, platelet aggregation using the method of Born, plasminogen and plasmin activity by the pH STAT method, and P.D.F. levels. These examinations were carried out on the 1st, 3rd, 5th, 7th and 9th postoperative days. The results in the patients receiving Trive 1000 were as follows: no change in blood coagulation, progressive fall in platelet activity in the sense of hypoaggregability which was significant from the 5th day onwards only. There was no change in fibrinolysis. By contrast, there was anaemia, as determined on the basis of a fall in haematocrit, maximal on the 5th day and attributed by the authors to the haemolytic properties of triglycerides. In conclusion, Trive 1000 had no signifcant influence on haemostasis, apart from platelet hypoaggregability of moderate degree after prolonged treatment and perhaps haemolytic anaemia.