P22 USE OF THE LIFE–VEST IN PATIENTS WITH HIGH ARRHYTHMIC RISK: EXPERIENCE OF A SPOKE CENTER IN THE COVID–19 PERIOD

Background

Patients with newly found dilated heart disease have a high risk of sudden death. During the COVID period, the follow–up of these patients was difficult due to the limitation of access to the hospital and the impossibility of performing tests with high decision–making power (cardiac MRI) at third–level hospitals.

Purpose

To evaluate the use of the Life–Vest in patients with newly found dilated heart disease as a protection system for early discharge and the related cost/benefit ratio in relation to an early ICD implant.

Methods

In the COVID period, a Life–Vest was applied to 18 patients with newly found dilated heart disease (4 post ischemic and 16 without coronary artery disease), to monitoring ventricular arrhythmias and to protect them against any life–threatening ventricular tachycardias. These patients showed an high arrhythmic risk for ventricular tachycardias, (VT found on monitoring) and an unfavorable echocardiographic aspect. Each week, the patient‘s telemetry was remotely viewed and a telephone assessment was performed for clinical conditions. A control echocardiogram was performed at 30 days to evaluate the FE and the possible continuation of monitoring.

Results

Of the 18 patients (mean age 59 years) analyzed, 5 (28%) underwent ICD implantation for persistent severe reduction in FE during 3 months after diagnosis and 13 (72%) normalized FE (duration average follow–up 50 days); there are no significant differences between the postischemic and non–postischemic DCM groups. The cost of renting the Life–Vest is about 4000 euros for 40 days and the average cost for an ICD implant, considering the device and the costs related to the days of hospitalization and use of human resources/advanced technological support, amounts to about 20700 euros. Considering these data, we observed a saving of approximately 261900 euros for 18 observed patients. To this saving must be added the costs related to the reduction of the days of hospitalization (average 5 days) and the costs to any future replacement of the ICD.

Conclusion

In patients with newly found dilated heart disease at high arrhythmic risk, the use of the Life–Vest reduces the days of hospitalization, allows patients to be discharged safely and generates substantial savings for the National Health System.

Epidemiological and clinical features of prosthetic joint infections caused by gram-negative bacteria

OBJECTIVE

To review the clinical literature focusing on epidemiology, clinical presentation and outcomes of prosthetic joint infections (PJIs) due to gram-negative bacteria (GNB) and to report the experience of a multicentric cohort.

PATIENTS AND METHODS

A retrospective, observational, cohort study was performed in three Italian hospitals. All consecutive PJIs caused by GNB over a 12-year period (from May 2007 to March 2018) were enrolled. Epidemiological, clinical, microbiological and therapeutic features were described. Factors related to treatment failure (defined as the occurrence of death, amputation or starting long-term antimicrobial suppression therapy) were analysed with a Cox regression model.

RESULTS

A total of 82 PJIs due to GNB (42.7% men; median age 73 years) were studied. The implants included 65 (79.3%) hip, 16 (19.5%) knee and one (1.2%) shoulder. An early PJI was diagnosed in 16.2% of patients, a delayed PJI in 29.4% and a late PJI in 54.4%. The most common isolated organisms were Escherichia coli (21.7%) and Pseudomonas spp. (20.9%). 13.4% of the isolates were carbapenem-resistant bacteria (CRB). In 53.8% of cases a two-stage exchange arthroplasty was performed and in 32.5% a Girdlestone excision arthroplasty. The average therapeutic failure occurred in 17.7% of cases. The therapeutic failure rate of the two-stage was 10%. PJI due to CRB was identified as a potential risk factor for failure (aHR 4.90; IC 95%, 0.96-25.08; p=0.05). The therapeutic failure rate in the CRB group was 50%.

CONCLUSIONS

The treatment with the two-stage procedure for PJIs caused by GNB seems to be associated with a low rate of failure, while PJI due to CRB seems to be related to the worst outcome.

TD-UAPO diffracted field evaluation for penetrable wedges with acute apex angle

This study deals with the time domain (TD) diffraction phenomenon related to a penetrable acute-angled dielectric wedge. The transient diffracted field originated by an arbitrary function plane wave is evaluated via a convolution integral involving the TD diffraction coefficients, which are determined here in closed form, starting from the knowledge of the frequency domain counterparts. In particular, the inverse Laplace transform is applied to the uniform Asymptotic physical optics diffraction coefficients valid for the internal region of the wedge and the surrounding space. Diffraction by penetrable wedges in the TD framework is a challenging problem from the analytical point of view, and no other expressions are available in closed form for the diffraction coefficients associated with the considered problem.

Diffraction by 90° penetrable wedges with finite conductivity

This study concerns the diffraction problem relevant to a plane wave normally incident with respect to a 90° wedge. A penetrable material with finite conductivity forms the structure. A high-frequency solution is here obtained by adopting a physical optics approximation for the equivalent electric and magnetic surface currents involved in the radiation integrals used to represent the fields scattered in the inner region of the wedge and the surrounding space. Uniform asymptotic evaluations of such integrals lead to closed form expressions for the diffraction coefficient in terms of the transition function of the uniform theory of diffraction and the Fresnel coefficients for the reflection and transmission mechanisms. No limitation exists on the loss tangent of the medium. Comparisons with numerical tools assess the effectiveness of the proposed solutions for the field diffracted in the inner and outer regions.

[Chronic osteomyelitis due to Pseudomonas aeruginosa: treatment with elastomeric infusor in an outpatient setting]

Chronic bacterial osteomyelitis requires long-term antibiotic treatment (at least 6-8 weeks). After in-hospital management, patients are usually discharged and treated in outpatient settings. However, when the aetiology is represented by Gram-negative microorganisms, outpatient treatment could be difficult. Beta-lactam administration by means of an elastomeric infusor may represent an attractive approach. We report two cases of osteomyelitis due to Pseudomonas aeruginosa successfully treated with continuous ceftazidime administration via an elastomeric infusor in outpatient settings. In both cases the patients were free from clinical and laboratory signs of osteomyelitis at the end of treatment and after 12 months follow-up.

Plane-wave diffraction by an obtuse-angled dielectric wedge

Uniform high-frequency solutions in closed form are derived for the diffraction of a plane wave normally impacting on a penetrable wedge having an obtuse apex angle and arbitrary dielectric permittivity. The approach used here takes advantage of a physical optics approximation for the electric and magnetic equivalent surface currents in the scattering integrals related to the inner region of the wedge and the surrounding space. Numerical tests and comparisons with finite-difference time-domain results demonstrate the accuracy and effectiveness of the proposed solutions.

Etiology of prosthetic joint infections in a tertiary care centre in Italy

Prosthetic joint infections (PJIs) represent a severe complication in orthopaedics. Coagulase-negative staphylococci (CoNS) and Staphylococcus aureus represent the most frequent cause, but Gram-negatives have also been reported. With a view to describing the aetiology of PJIs diagnosed from January 2005 to September 2007 at S. Corona Hospital in Pietra Ligure, Italy, we conducted retrospective analysis of pathogens isolated from PJIs by means of surgical specimens, needle aspirates or swabs of fistula (3 samples). During the study period 228 PJIs were described and 141 (62%) were microbiologically documented and evaluated. Early and delayed infections represented 45% of episodes, while late infections were observed in 55%. The aetiology was mono-microbial in 84% of cases, and polymicrobial in 16%. CoNS and S. aureus were the most frequently isolated pathogens. In early and delayed infections methicillin resistant CoNS were 30% and 24%, respectively, while in late infections they were 17%. Methicillin-resistant S. aureus was isolated in 13% of early, 22% of delayed and 15% of late infections. Gram-negatives were described in 16% of episodes without differences being found in the three groups. In our report staphylococci represented the most frequent cause of PJIs. Methicillin-resistant strains were more frequently isolated in early and delayed infections, but their frequency in late episodes was not negligible. Polymicrobial infections and Gram-negative infections were also frequent.

[Air quality control systems: heating, ventilating, and air conditioning (HVAC)]

After a brief illustration of the principal layout schemes of Heating, Ventilating, and Air Conditioning (HVAC), the first part of this paper summarizes the standards, both voluntary and compulsory, regulating HVAC facilities design and installation with regard to the question of Indoor Air Quality (IAQ). The paper then examines the problem of ventilation systems maintenance and the essential hygienistic requirements in whose absence HVAC facilities may become a risk factor for people working or living in the building. Lastly, the paper deals with HVAC design strategies and methods, which aim not only to satisfy comfort and air quality requirements, but also to ensure easy and effective maintenance procedures.

[Criteria for assessing severely hot environments: from the WBGT index to the PHS (predicted heat strain) model]

BACKGROUND

The present study deals with the main methods for assessment of hot environments: i.e., WBGT, SWreq and PHS. It is stressed how the WBGT index, which is strictly empirical, although a very practical tool for the assessment of the hot environments, can only be used for a rough evaluation of heat stress, and especially for a not very high metabolic rate (M<175 W/m2). On the contrary, the SWreq method, which is based on both subject-environment heat exchange and the effect of clothing, allows a better assessment of the work situation with a general reduction of the exposure limits with respect to WBGT, especially in non-uniform environments (ta not equal to tr). However, it should be noted that application of SWreq is required by the ISO standard 7243 when the WBGT limit values are exceeded.

METHODS

In this study interest was extensively focused on the "Predicted Heat Strain" method, highlighting via a special software the differences in heat stress assessment related to this new approach, which will be adopted by the ISO in the next revision of standard 7933.

RESULTS

The PHS method, unlike SWreq, allows the prediction of the time-response of the main physiological variables of interest (i.e., skin temperature, core temperature and sweat rate). Moreover thanks to better modelling of heat exchanges, the PHS method allows account to be taken of both movement and clothing effects, resulting in even more reduced exposure.

[Treatment of surface water]

The present paper describes the most important treatment processes to be used for water for human consumption. Advantages and disadvantages of alternative disinfectants are discussed and a critical assessment of the problem associated to disinfection byproducts is included.

The effects of a diode laser (810 nm) on pigmented guinea-pig skin

Various types of lasers, such as the Q-switched ruby laser and the Alexandrite laser, cause selective damage to cutaneous pigmented cells and are currently used in the therapy of pigmented lesions. The aim of this study was to evaluate the effects of a diode laser at a wavelength of 810 nm on pigmented guinea-pig skin. The diode laser was supplied by OcuLight Iris Medical Instruments, Inc. and was used to deliver 0.15, 0.2, 0.3, 0.4, 0.5, 1 and 1.5 J/cm2 laser beams in micropulses of 100 micros. The study was carried out on albino and black-spotted guinea pigs (GP). After irradiation, punch biopsies were taken and analysed by light and electron microscopy. Albino animals developed just a few signs of cutaneous injury. This mostly consisted of spongiotic disarray, after the highest doses were administered (>1 J/cm2). In the black skin of spotted GPs alterations appeared at 0.15 J/cm2 and included melanosome damage and, at doses higher than 0.3 J/cm2, also melanocyte damage. These observations demonstrate that the diode laser at 810 nm selectively affects pigmented structures and that the cellular targets of diode laser radiation are the melanosomes. The diode laser specificity for melanin may provide a biological basis for the treatment of pigmented superficial cutaneous lesions.

[Myocardial metabolism of calcium in heart failure: from physiology to new therapeutic perspectives]

Development of heart failure is associated with an impairment of intracellular calcium handling. The precise mechanisms involved are still obscure. When membrane depolarization occurs, a small amount of extracellular calcium enters the intracellular milieu through the L-type channels. Such "trigger" calcium acts on specific receptors of the sarcoplasmic reticulum, that, in turn, according to the so-called calcium entry-calcium release mechanism, allows the release of a larger amount of calcium from the sarcoplasmic reticulum. Removal of calcium from the cytosol is the key event of the diastolic phase. Calcium removal from cytosol occurs through specific membrane pumps. Recent therapeutic approaches involving gene targeting of calcium pumps have yielded promising results. Specifically, increased levels of SERCA 2 in the myocardium have shown to enhance cardiac contractility under normal circumstances and in experimental heart failure. Future research is needed to confirm these findings in human heart failure.

Cardiovascular effects of short-term growth hormone hypersecretion

Many studies have shown that acromegaly has relevant effects on cardiovascular system, but few data are available regarding the effects of short-term acromegaly on heart morphology and function. These data would help to clarify the natural history of acromegalic disease and could provide new insight into the mechanisms of GH action on the human heart. Therefore, we studied by Doppler echocardiography a group of 10 young subjects strictly selected as having short-term (<5 yr) uncomplicated acromegaly. The results of this study have shown that shortterm acromegaly is characterized by significantly increased left ventricular mass (P<0.005), with normal relative wall thickness, associated with Doppler indices of diastolic function in the normal range. Furthermore, stroke index and cardiac index were significantly enhanced in the patient group (P<0.01 and P<0.001, respectively), whereas systemic vascular resistance was significantly reduced (P<0.001). In conclusion, our study shows that short-term acromegaly significantly affects the heart, but, at variance with long-term disease, it is characterized by increased left ventricular mass, with eccentric remodeling and normal diastolic function. Moreover, short-term acromegaly induces a high cardiac output state with reduction of systemic vascular resistance.

Prevalence of HNPCC in a series of consecutive patients on the first endoscopic diagnosis of colorectal cancer: a multicenter study. The Italian Collaborative Group

BACKGROUND AND STUDY AIMS

It is difficult to measure the prevalence of hereditary non-polyposis colorectal cancer (HNPCC) in geographical areas that do not have tumor registers, as is the case in the present study, and it was therefore decided to assess the prevalence in Italy using different methods.

PATIENTS AND METHODS

The pedigree was established for 485 of 501 colorectal cancer patients diagnosed with colorectal carcinomas. Patients were included consecutively in 13 gastroenterology centers; they had not taken part in prevention examinations. Information was collected regarding the neoplastic pathology observed in the families, confirmed in 90% of cases among 3515 first-degree relatives and in 79.5% of cases among 7068 second-degree relatives.

RESULTS

In the 3515 first-degree relatives (1002 parents, 1560 siblings and 953 children), 61 colorectal carcinomas, 29 carcinomas in the digestive tract outside the colon, and 99 carcinomas in other locations were reported. Only five of the 485 patients (1%) satisfied the Amsterdam criteria (three cancers, two of which were in first-degree relatives in different generations and one in a relative younger than 50). When broadening the criteria that we are proposing (satisfying only two of the three Amsterdam criteria), the prevalence would increase to 3% (15 cases).

CONCLUSIONS

Modifying the criteria makes it easier to identify new mutations or confirm the existence of those already known, as well as allowing preventative treatment in relatives who are apparently healthy.

[Effects of chronic subclinical hyperthyroidism from levothyroxine on cardiac morphology and function]

BACKGROUND

Thyroid hormones greatly affect the cardiovascular system. Although the effects of overt hyperthyroidism on the cardiovascular system have been diffusely studied, only in the last years the effects of subclinical hyperthyroidism on the heart have been investigated. Subclinical hyperthyroidism is a symptomatic or asymptomatic condition with an absent response of thyrotropin (TSH) to thyrotropin-releasing hormone in the presence of normal serum levels of thyroid hormones for the general population, though supraoptimal for the individual. The more frequent causes of endogenous subclinical hyperthyroidism are multinodular goiter, toxic, adenoma and Graves's disease, whereas the exogenous causes are induced by levothyroxine (LT4) therapy used to suppress TSH in patients with nontoxic goiter and differentiated thyroid cancer. This paper reports our experience derived from the study of 60 patients with subclinical hyperthyroidism due to TSH-suppressive therapy with LT4 compared to normal subjects.

METHODS

Patients (9 males and 51 females, mean age 39 +/- 10 years) were studied by complete Doppler echocardiography, standard and 24 hour ECG Holter monitoring, exercise test with cycloergometer, and radionuclide ventriculography at rest and during fixed workload (75 W).

RESULTS

Holter monitoring showed a significant increase in mean 24 hour heart rate (80 +/- 10 vs 70 +/- 9 b/min, p < 0.001) and supraventricular arrhythmias (42 vs 12 patients, p < 0.003). Echocardiography showed an increase in left ventricular mass index (94 +/- 13 vs 80 +/- 18 g/m2, p < 0.001) due to increased septal and posterior wall thickness. At rest, echocardiographic indices of systolic function (fractional shortening and mean corrected velocity of circumferential fiber shortening) were higher in patients than in controls (fractional shortening 40 +/- 6 vs 34 +/- 4%, p < 0.001; mean corrected velocity of circumferential fiber shortening 1.23 +/- 0.17 vs 1.05 +/- 0.14 circ/s, p < 0.001), while the Doppler indices of diastolic function were significantly impaired as documented by the reduced E/A ratio (1.18 +/- 0.3 vs 1.8 +/- 0.5, p < 0.001) and the prolonged isovolumic relaxation time (94 +/- 13 vs 78 +/- 12 ms, p < 0.001). Exercise tolerance was also significantly impaired in patients with subclinical hyperthyroidism: maximal exercise time (6.4 +/- 0.7 vs 9.4 +/- 1.4 min, p < 0.001) and peak workload (81 +/- 11 vs 121 +/- 17 W, p < 0.001) were significantly reduced and radionuclide ventriculography showed a decrease in ejection fraction during exercise (from 62 +/- 7 to 53 +/- 8%, p < 0.002).

CONCLUSIONS

Persistent subclinical hyperthyroidism by TSH-suppressive doses of LT4 significantly affects heart morphology and function. Thus, we suggest that a complete suppression of TSH must be recommended only in patients with differentiated thyroid cancer, while in patients with begin thyroid disease it could be sufficient to maintain subnormal TSH levels.

[Carotid atherosclerosis and thrombotic stroke. Diagnostic and therapeutic perspectives]

Carotid atherosclerotic lesions can be studied with color-Doppler ultrasonography vascular systems. Ultrasonography of the carotid plaques at major risk for the development of cerebrovascular ischemic events showed the following characteristics: irregular surface, degree of stenosis > 70%, intimal hemorrhage and ulceration. The plaques with these ultrasonography patterns have to be considered for surgical approach (TEA). The other patients with carotid atherosclerotic lesions will be initially treated with diet and changes of life style to obtain the correction of cardiovascular risk factors (i.e. hypertension, hypercholesterolemia, diabetes). Furthermore, medical therapy with antithrombotic agents will be instituted which, used with good results also in acute cerebral stroke, proved to be effective in the reduction of vascular events in patients with extracranial atherosclerotic plaques. However, it has not been clarified if the positive effect of antiaggregation therapy in carotid atherosclerosis is due to the inhibition of the progression and plaque growth or if other hemorheological factors are involved.

Thirty hours' evaluation of UVB-induced erythema by chromometry and microflowmetry

BACKGROUND

Individual UVB photosensitivity is usually investigated by determining the minimal erythemal dose (MED). Nevertheless, factors such as room light intensity and subjective experience of the observer can influence the erythema perception and, therefore, the MED assessment.

OBJECTIVE

To evaluate the relationship between the clinical and the chromometric and microflowmetric analyses of the UVB-induced erythema in 2 healthy volunteers.

METHODS

A bank of 6 fluorescent mercury vapor tubes (Philips TL 12/20 W) was utilized as a source of UVB light. Three skin areas (4 cm2), from the dorsal region of each subject, were irradiated with 3 different UVB doses corresponding to: (1) MED; (2) 0.7 MED, and (3) 1.3 MED.

RESULTS

(1) both microflowmetric and chromometric parameters reached a maximum peak 10-12 h after irradiation and maintained high values also 30 h after irradiation; (2) both microflowmetric and chromometric values were directly related to the UVB doses; (3) in some cases the microflowmetric values started to increase when the chromatic changes were still undetectable.

CONCLUSION

These preliminary data confirm that the visual determination of MED performed 24 h after irradiation is a correct procedure. Nevertheless, the microflowmetric may precede the chromatic changes suggesting that vasodilatation follows irradiation without a latent period.

Phaeomelanin versus eumelanin as a chemical indicator of ultraviolet sensitivity in fair-skinned subjects at high risk for melanoma: a pilot study

It is now generally agreed that solar exposure is a major external factor in the causation of cutaneous melanoma in light skinned populations with red hair and a marked susceptibility to the acute effects of ultraviolet (UV) radiation. In the present study, we investigated the existence of a possible relationship between hair melanin composition and minimal erythema dose (MED), as an indicator of UV sensitivity, in a group of 15 healthy red-haired subjects aged 20-46 years. In spite of comparable skin and hair colour, marked variations were observed in the MED values as well as in the hair melanin composition. Phaeomelanin levels varied in the range 0.026-0.53% w/w and were generally comparable to or higher than eumelanin levels (0.042-0.17% w/w). No significant relationship was found between MED values and phaeomelanin, eumelanin or total melanin (eumelanin plus phaeomelanin) content. Notably, however, a gross positive correlation was found between the eumelanin/phaeomelanin ratio and the MED values. These results would suggest that a high UV sensitivity is associated with high phaeomelanin and low eumelanin levels, and point to the eumelanin/phaeomelanin ratio as a novel chemical parameter that could be used for predicting individuals at high risk for skin cancer and melanoma.

The acute effect of smoking on cutaneous microcirculation blood flow in habitual smokers and nonsmokers

BACKGROUND

Smoking is known to be a primary cause of chronic harmful effects on the vascular system. It also induces some acute effects on the coronary circulation and on the ophthalmic artery.

OBJECTIVE

The aim of our study was to assess the effect of smoking a single cigarette on cutaneous blood flow in habitual smokers as well as in nonsmokers.

METHODS

A laser Doppler flowmeter was used to perform measurements of cutaneous microcirculation. Flowmetric data were recorded (i) before smoking, (ii) inhaling from an unlighted cigarette, (iii) during cigarette smoking, (iv) 2 and (v) 5 min after smoking.

RESULTS

We could show that smoking a single cigarette acts on the cutaneous microcirculation reducing blood flow in both groups of subjects (38.1% reduction in smokers and 28.1% reduction in nonsmokers; p <0.01). Interestingly, the recovery phase is faster in nonsmoker subjects than in smoker ones; in fact, the recovery is complete 2 and 5 min after cigarette smoking in nonsmokers and in smokers, respectively.

CONCLUSION

Smoking a single cigarette decreases the cutaneous blood flow in habitual smoker as well as in nonsmoker subjects. Moreover, the slower recovery phase of smokers suggests that their microcirculation become inured to smoke.

[Bacterial infections in HIV patients]

AIM OF THE STUDY AND METHODS

Retrospective analysis of bacterial infections occurring in 400 admissions of HIV-positive patients in the Infectious Diseases Unit of the Azienda Ospedale Santa Corona, Pietra Ligure (SV), from January 1994 to September 1996.

RESULTS

56 episodes were documented (14% of admissions): 24 (43%) hospital acquired (11 sepsis, 5 pneumonias, 6 urinary-tract infections, 1 infection of a prosthetic device) and 32 (57%) community-acquired (9 sepsis, 13 pneumonias [6 with bacteremia] 9 urinary-tract infections, 1 endocarditis). At time of diagnosis mean absolute CD4-lymphocyte count was 106/cmm (95% Cl 62-150) and mean neutrophil count was 4.690/cmm (95% Cl 3.466-5.914); 11 patients had a central venous catheter, 9 a vesical catheter and 7 severe skin lesions. Methicillin-resistant S. aureus (11/24, 46%) and Pseudomonas (8/24, 33%) were the most frequently isolated pathogens in hospital infections, while the majority of community acquired episodes were due to S. pneumoniae (10/32, 31%). In six episodes (11%) the patient died because of the bacterial infection.

CONCLUSIONS

Bacterial infections are quite frequent in this cohort of HIV-infected patients. Methicillin-resistant S. aureus and Pseudomonas represented the major cause of hospital acquired infections, while S. pneumoniae represented the major cause of community acquired episodes.

Spinal cord involvement and systemic lupus erythematosus: clinical and magnetic resonance findings in 5 patients

We report the clinical, magnetic resonance imaging (MRI) and laboratory findings in 5 patients with clinical spinal cord involvement with an acute or subacute course; in two of the patients the myelitic episode preceded, in one it was concomitant to, and in two it followed the diagnosis of systemic lupus erythematosus (SLE). The marked clinical and MRI heterogeneity detected in our patients suggests that various factors may be implied in the pathogenesis of spinal cord involvement in SLE. The possibility of a future evolution to SLE should be kept in mind in women presenting spinal cord involvement with no other explanation, and should be assessed by means of extensive and repeated clinical and laboratory evaluations.

A simple cryo-technique for the treatment of cutaneous soft fibromas

OBJECTIVE

We propose a simple cryo-technique for the treatment of cutaneous soft fibromas.

METHODS

This method, useful for fibromas larger than 4-5 mm in diameter, allows the freezing of the only soft fibroma without affecting the surrounding skin.

RESULTS

The technique shows the following advantages: it is simple to perform, it avoids local anesthesia, and it can be used in pacemaker holders.

CONCLUSION

The cosmetic results are very good.

[Churg-Strauss syndrome: is it a rare disease?]

We describe four patients with Churg-Strauss syndrome admitted to the hospital in 1988. Some clinical and histological features of particular relief are present in these cases. All patients had been treated with corticosteroids and they are now in remission. Our work suggests that Churg-Strauss syndrome is not a rare disease and that an early diagnosis and appropriate therapy may influence favourably at least long term survival.

[Gigantic fibroadenoma of the breast in an adolescent. Description of a clinical case]

A case of giant fibroadenoma in a girl of 14 is reported. This case emerged from an examination of about 380 patients observed at the Senology Clinic of the S. Maria di Loreto Hospital (USL 44) in the last 3 years. A statistical contribution is made to the study of breast pathologies in pubertal age and stress is laid on the importance of mass screening among adolescents.

Detection of the traversability of surfaces by crawling and walking infants

In four studies we investigated the perception of the affordance for traversal of a supporting surface. The surface presented was either rigid or deformable, and this property was specified either optically, haptically, or both. In Experiment 1A, crawling and walking infants were presented with two surfaces in succession: a standard surface that both looked and felt rigid and a deforming surface that both looked and felt nonrigid. Latency to initiate locomotion, duration of visual and haptic exploration, and displacement activity were coded from videotapes. Compared with the standard, the deforming surface elicited longer latency, more exploratory behavior, and more displacement in walkers, but not in crawlers, suggesting that typical mode of locomotion influences perceived traversability. These findings were replicated in Experiment 1B, in which the infant was presented with a dual walkway, forcing a choice between the two surfaces. Experiments 2, 3A and B, and 4A and B investigated the use of optical and haptic information in detecting traversability of rigid and nonrigid surfaces. Patterns of exploration varied with the information presented and differed for crawlers and walkers in the case of a deformable surface, as an affordance theory would predict.

Visual-field asymmetries in letter recognition: evidence for asymmetry in early visual registration

Two experiments on visual-field differences in tachistoscopic letter recognition are described. In the first, a bright pre-exposure field with a black fixation point was used, and the conventionally expected dominance of the right visual field was found. However, a large number of "blank" trials were observed, in which subjects completely failed to detect the presence of the flashed target. These "blanks" were themselves significantly asymmetric between visual fields, suggesting that asymmetry in early stimulus registration may play an unsuspected role in typical measures of cerebral asymmetry in recognition accuracy. This was confirmed in a second experiment in which use of dark pre-exposure fields eliminated "blanks" and led to higher over-all accuracy, with no visual-field differences. Implications for interpretation of laterality data with normal subjects are discussed.