Mitochondrial Cation Signalling in the Control of Inflammatory Processes

Mitochondria are the bioenergetic organelles responsible for the maintenance of cellular homeostasis and have also been found to be associated with inflammation. They are necessary to induce and maintain innate and adaptive immune cell responses, acting as signalling platforms and mediators in effector responses. These organelles are also known to play a pivotal role in cation homeostasis as well, which regulates the inflammatory responses through the modulation of these cation channels. In particular, this review focuses on mitochondrial Ca2+ and K+ fluxes in the regulation of inflammatory response. Nevertheless, this review aims to understand the interplay of these inflammation inducers and pathophysiological conditions. In detail, we discuss some examples of chronic inflammation such as lung, bowel, and metabolic inflammatory diseases caused by a persistent activation of the innate immune response due to a dysregulation of mitochondrial cation homeostasis.

S. aureus and IgE-mediated diseases: pilot or copilot? A narrative review

INTRODUCTION

S. aureus is a major opportunistic pathogen that has been implicated in the pathogenesis of several chronic inflammatory diseases including bronchial asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), chronic spontaneous urticaria (CSU), and atopic dermatitis. S. aureus can induce the production of both polyclonal and specific IgE that can elicit an inflammatory cascade.

AREAS COVERED

The link between the sensitization to S. aureus enterotoxins and the severity of several chronic inflammatory diseases is reviewed in detail, as well as its therapeutic implications.

EXPERT OPINION

An anti-IgE strategy to inhibit S. aureus enterotoxins would be a valid approach to treat several endotypes of severe asthma, CRSwNP and CSU in which IgE against S. aureus enterotoxins should represent, not only a marker of severity of the diseases but also a target of a treatment.

Health-related quality of life in patients with autoimmune hepatitis

BACKGROUND

Autoimmune hepatitis (AIH) is a rare chronic liver disease. Impaired health-related quality of life (HRQL) contributes to the overall disease burden. At current, only limited data related to the impact of treatment response on HRQL are available.

OBJECTIVE

The aim of the study was to determine the impact of biochemical remission on HRQL.

METHODS

Patients with AIH were prospectively enrolled between July 2018 and June 2019. A liver disease-specific tool, the chronic liver disease questionnaire (CLDQ) and the generic EQ-5D-5L were used to quantify HRQL. Treatment response was assessed biochemically by measurement of immunoglobulin G, ALT and AST. The cohort was divided into two groups according to their biochemical remission status in either complete vs. incomplete remission. Clinical as well as laboratory parameters and comorbidities were analysed using univariable and multivariable analysis to identify predictors of poor HRQL.

RESULTS

A total of 116 AIH patients were included (median age: 55; 77.6% female), of which 9.5% had liver cirrhosis. In this cohort, 38 (38.4%) showed a complete and 61 (61.6%) an incomplete biochemical remission at study entry. The HRQL was significantly higher in patients with a complete as compared to an incomplete biochemical remission (CLDQ overall score: 5.66 ± 1.15 vs. 5.10 ± 1.35; p = 0.03). In contrast, the generic EQ-5D-5L UI-value was not different between the groups. Multivariable analysis identified AST (p = 0.02) and an incomplete biochemical remission (p = 0.04) as independent predictors of reduced HRQL (CLDQ total value).

CONCLUSION

Patients with a complete biochemical remission had a significantly higher HRQL. Liver-related quality of life in patients living with AIH is dependent on the response to immunosuppressive treatment.

Geo-climatic heterogeneity in self-reported asthma, allergic rhinitis and chronic bronchitis in Italy

BACKGROUND

Several studies highlighted a great variability, both between and within countries, in the prevalence of asthma and chronic airways diseases.

AIM

To evaluate if geo-climatic variations can explain the heterogeneity in the prevalence of asthma and respiratory diseases in Italy.

METHODS

Between 2006 and 2010, a postal screening questionnaire on respiratory health was administered to 18,357 randomly selected subjects, aged 20-44, living in 7 centers in northern, central, and southern Italy. A random-effects meta-analysis was fitted to evaluate the between-centers heterogeneity in the prevalence of asthma, asthma-like symptoms, allergic rhinitis, and chronic bronchitis (CB). A principal component analysis (PCA) was performed to synthetize the geo-climatic information (annual mean temperature, range of temperature, annual rainfalls, global solar radiations, altitude, distance from the sea) of all the 110 Italian province capital towns. The associations between these geo-climatic components obtained with PCA and the prevalence of respiratory diseases were analyzed through meta-regression models.

RESULTS

10,464 (57%) subjects responded to the questionnaire. There was a significant between-centers heterogeneity in the prevalence of asthma (I(2)=59.5%, p=0.022) and CB (I(2)=60.5%, p=0.019), but not in that of asthma-like symptoms or allergic rhinitis. Two independent geo-climatic components explaining together about 80% of the overall geo-climatic variability were identified: the first principally summarized the climatic variables; the second the topographic ones. Variations in the prevalence of asthma across centers were significantly associated with differences in the climatic component (p=0.017), but not with differences in the topographic one.

CONCLUSIONS

Our findings suggest that climate play a role in determining the between-center heterogeneity in the prevalence of asthma in Italy, with higher prevalence in dry-hot Mediterranean climates, and lower in rainy-cold northern climates.

Juxtarenal aortic aneurysm with hostile neck anatomy: midterm results of minilaparotomy versus f-EVAR

AIM

The aim of this study was to compare the results of complex aneurysm (hostile neck anatomies) repair in high-risk patients with two minimally invasive techniques, fenestrated endografting (f-EVAR where EVAR stands for endovascular aneurysm repair) and minilaparotomy.

METHODS

All high-risk patients (N.=50, group 1) with hostile neck abdominal aortic aneurysms (AAAs) operated in the vascular surgery department of the "Policlinico Universitario G. Martino" of Messina (Italy) during a 5-year period (January 2006-December 2010) were cross-matched with 50 similar patients (group 2) treated in the Vascular Surgery Department of the "Hopital Cardiologique" University of Lille (France) with similar anatomies, comorbidities and risk factors. The patients in group 1 underwent open minilaparotomy surgery, and the patients in group 2 were treated with f-EVAR. The aim of our study was to compare perioperative complications, survival and reintervention rates.

RESULTS

Perioperative cardiac complications occurred in 5 patients (10%) in group 1, and 1 patient (2%) in group 2 (P<0.092). Renal impairment not requiring permanent hemodialysis was significantly higher in group 1 (14% vs. 2% P<0.027), as well as respiratory complications (32% vs. 2% P<0.0001). Five patients (10%) in group 1 underwent reintervention vs. 4 patients in group 2 (P<0.7268). There was no statistically significant difference for survival rates at 30 days (92% in group 1 and 96% in group 2; P=0.399); at six months (90% vs. 96%; P=0.239); at one year (90% vs. 96%; P=0.239); and at two years (84% vs. 94%; P=0.110). However, we observed statistically significant differences in survival rates at three years (74% vs. 94%; P<0.006); at four years (70% vs. 86%; P<0.005); and at five years (65% vs. 68%; P<0.003).

CONCLUSION

Our results showed that both techniques are effective in the treatment of AAA with hostile neck in high-risk patients. Although operative mortality rate was not statistically different, f-EVAR showed better results in terms of early complications and late survival.

The sensibility and specificity of cerebral oximetry, measured by INVOS - 4100, in patients undergoing carotid endarterectomy compared with awake testing

BACKGROUND

Selective shunting during carotid endarterectomy (CEA) is advocated to reduce shunt-related stroke. Cerebral monitoring is essential for temporary carotid shunting. Many techniques are available for cerebral monitoring; however, none is superior to monitoring the patient's neurological status (awake testing) while performing the procedure under local anesthesia (LA). Cerebral oximetry (CO) has previously been used to show the adequacy of cerebral circulation in patients undergoing CEA. This investigation was designed to compare the performance of the INVOS-4100 cerebral oximeter and the neurologic functions, by means of detecting cerebral ischemia induced by carotid cross-clamping, in patients undergoing CEA under LA, namely cervical plexus block.

METHODS

Patients scheduled for CEA under LA were included. Patients converted to general anesthesia (GA) or other types of operations other than CEA were excluded from this study. We enrolled 100 consecutive patients from January 2009 to December 2010. Bilateral regional cerebrovascular oxygen saturation (rSO(2)) was monitored in all patients, in addition to the awake testing. Changes in rSO(2) following carotid artery clamping were recorded. A drop greater than 20% was considered as an indicator of cerebral ischemia that might predict the need for carotid shunting. Patients were only shunted based on the awake testing.

RESULTS

Of the 100 patients undergoing CEA under LA, 9 showed a significant drop in rSO(2) (range: 22.6-32.8%, mean: 26.4%): only three of them required shunting, while the remaining 6 had no changes in consciousness after internal carotid artery (ICA) cross-clamping and it was not necessary to place a shunt (false positive). Compared to the preclamping values, a significant decrease in rSO(2) was found on the hemisphere of the operated side, while no significant change was observed contralaterally. Ninety-one patients had no significant changes of CO values: in 89 of them there was no consciousness deterioration, so we didn't place a shunt (true negative), but 2 patients showing a non-significant post-clamping decline in CO saturation (1.5% and 18.2%) required shunting based on the awake testing (2 false negative). In the current study, the median drop in rSO(2) was 19% (range: 1.5-26.4%) in the 5 patients that required shunting. This represents a sensitivity of 60% and a specificity of 25% for CO in comparison to the awake testing.

CONCLUSION

The results of this study suggest that the usefulness of CO in predicting cerebral ischemia is modest. Cerebral monitoring with INVOS-4100 has a high negative predictive value, but the positive predictive value is low.

Early and one-year results of infrainguinal bypass after failure of endovascular therapy

AIM

The aim of this study was to retrospectively compare early and one-year results of open surgery (OS) for critical limb ischemia (CLI) in patients who underwent primary surgery and in patients operated after a previous failure of endovascular treatment (EV).

METHODS

Between January 2004 and December 2007, 460 patients (304 males, 156 females) aged between 46 and 95 (average age 72) underwent OS or EV for CLI. We performed 273 EV (47%) and 307 OS (53%) procedures. In 98 patients (21.3%) the procedures were bilateral. EV procedures were intraluminal, subintimal or both, with selective stenting. OS procedures were distal bypass grafts. OS involved 34 dialysed patients, 159 patients with CLI non-dialysed and not previously submitted to EV treatment (group 1, control group) and 114 patients with failure of previous EV treatment (group 2), frequently performed in different and non surgical centers, 8% of EV failure in our series in this time. We retrospectively compared the early and one-year results in the last two groups of patients in terms of level of revascularization, primary patency, amputation and mortality.

RESULTS

By-pass grafts were autologous vein in 94% and PTFE in 6%. Revascularizations have been directed to the tibial or to the plantar arteries at the ankle or foot. Those directed to the plantars were respectively 54% (52% dorsalis pedis, 36% retromalleolar posterior tibial, 12% medial plantar artery) in the control group and 76% (66% dorsalis pedis, 18% retromalleolar posterior tibial, 16% medial plantar artery) in patients with previous failed PTA (P<0.001). Early primary patency, mortality and amputation free survival were respectively in the control group and in patients with previous failure of PTA: 93.7% vs. 76.3% (P<0.001), 2.5% vs. 3.5% (P>0.5), 95% vs. 93% (P>0.5). One-year primary patency, mortality and amputation free survival were respectively in the control group and patients with previous failure of PTA: 86.03% vs. 70.87% (P>0.25), 14.93% vs. 17.56% (P>0.5), 78.1% vs. 68.5% (P>0.1).

CONCLUSION

After failure of EV therapy, the subsequent open surgery was more distal and technically demanding. Its results were significantly worse when compared with standard CLI patients, with an increase rate of redo. Our data suggest that EV should not be attempted as the first choice in every patient affected by CLI, and we believe that OS still is the primary treatment for the most advanced clinical situations.

Detection of Pseudomonas syringae pv actinidiae in kiwifruit pollen samples

Presence of Pseudomonas syringae pv actinidiae (Psa) the causal agent of bacterial canker of kiwifruit in pollen samples collected from infected and non infected orchards in Italy and in New Zealand was determined by polymerase chain reaction (PCR) and by direct bacterial isolation Psa was isolated only from pollen samples collected in Italy including pollen collected from two uninfected orchards which the following year showed signs of infection Psa was also detected in pollen collected from male and female vines in an Italian infected orchard Pollen samples from Italy but not from New Zealand were collected with a vacuum device Psa could not be isolated from any of the 25 New Zealand pollen samples analysed This is the first report of Psa being associated with pollen There is currently no evidence that artificial pollination leads to increased infection or that pollen has been responsible for the introduction of Psa in a previously Psafree area

Use of FloSeal in the endovascular treatment of voluminous aneurysm of a lower gluteus artery

We suggest an alternative endovascular treatment for gluteal artery aneurysm using Floseal a matrix of bovine gel and thrombin component. A 70-year-old woman, presented with claudicatio of the lower left limb after 150 m walking and pain at the sciatic nerve irradiation. A pulsating and painful mass was present in the lower gluteal region. No history for previous trauma, nor for orthopedic surgery. The suspect of aneurysm of the left gluteal artery was confirmed by Color Doppler Ultrasound and by computed tomography (CT) showing a fusiform aneurysm in the lower gluteus artery. In order to rule out infective cause, blood coltures were taken. Compression of the sciatic nerve was confirmed by electromyography study. Patient was treated by endovascular treatment. We performed angiography, with a selective study of the lower left gluteus artery, and embolization of the aneurysm by an injection of FloSeal (hemostatic) and fibered platinum coil. At the discharge, we observed absence of pulsation in gluteus region and the complete resolution of clinical symptom. The Color Doppler Ultrasound scan showed a complete occlusion of the aneurysm. This case appears quite peculiar, for the absence of any pelvic trauma, orthopedic operations or previous penetrating lesions, responsible of vascular lesions as reported in literature. The large aneurysm dimensions made the embolization procedure quite difficult, and brought us to use FloSeal. The treatment we proposed may be useful in the treatment of peripheral aneurysms of great dimension, and may be an alternative to the more traditional ones.

Three aspartic acid residues of polygalacturonase-inhibiting protein (PGIP) from Phaseolus vulgaris are critical for inhibition of Fusarium phyllophilum PG

Polygalacturonase-inhibiting proteins (PGIPs) are plant cell wall proteins that specifically inhibit the activity of endopolygalacturonases (PGs) produced by fungi during the infection process. The interaction with PGIPs limits the destructive potential of PGs and may trigger plant defence responses through the release of elicitor active oligogalacturonides. In order to pinpoint the residues of PvPGIP2 from Phaseolus vulgaris involved in the interaction with PGs, we used site-directed mutagenesis to mutate the residues D131, D157 and D203, and tested for the inhibitory activity of the mutant proteins expressed in Pichia pastoris against Fusarium phyllophilum and Aspergillus niger PGs. Here, we report that mutation of these residues affects the inhibition capacity of PvPGIP2 against F. phyllophilum PG.

[The role of laparoscopic surgery in the treatment of occlusive and abdominal aortic aneurys. Review of the literature]

The objective of this systematic review of the literature is to evaluate whether a laparoscopic operation can be performed on patients with occlusive or abdominal aortic aneurysm as a minimally invasive and durable alternative. For this purpose, the literature was reviewed and laparoscopic surgery results were compared with those of conventional and endovascular surgery. All series were included, even when containing also one case. Operative and clamping times, mortality and morbidity and hospital stay were evaluated. Thirty-five studies were identified about conventional (4), minilaparotomy (4), endovascular (4), total (12) and video-assisted (11) laparoscopic surgery. Operative and clamping times were shorter for video-assisted procedures than total-laparoscopic procedures. The mortality rate ranged from 3% to 4.5% for conventional surgery, from 0% to 3% for endovascular surgery, from 0% to 6% for total-laparoscopic surgery and from 0% to 4.2% for video-assisted laparoscopic surgery. A variable morbidity was described for all techniques, with a higher incidence in total-laparoscopic surgery. Mean hospital stay was similar for laparoscopic surgery procedures. The learning curve of a surgical team performing laparoscopic surgery improves the

RESULTS

Laparoscopic abdominal aortic surgery is feasible and may offer good postoperative recovery with excellent mid-term patency. Shorter hospital stay and simple mid-term follow-up allow more comfort for the patient and probably monetary savings for the community. A steep learning curve is needed. For these reasons laparoscopic video-assisted technique can be considered a third means of treating severe occlusive and aortic aneurysm, but only new instruments for performing aortoprosthetic anastomoses can diffuse the total laparoscopic technique as a routine approach.

Endovascular repair in atypical traumatic rupture of thoracic aorta

INTRODUCTION

The traumatic rupture of thoracic aorta is a surgical emergency with high risk of morbidity and mortality.

CASE REPORT

We describe the case of an atypical rupture of retro-cardiac thoracic aorta with dissection of brachiocephalic trunk and spleen trauma occurred after a road accident. TC scan and perioperative angiography showed an atypical rupture of thoracic aorta.

CONCLUSION

A combined treatment, endovascular for retro-cardiac thoracic aorta and surgical for brachiocephalic artery, has been useful to diminish the hemodynamic and organ ischemic problems associated with open surgery.

Endovascular repair of aortic lesions associated to video-assisted thoracoscopy surgery after chest trauma

AIM

Trauma of the thoracic aorta for blunt trauma shows a very high incidence of mortality. Hospital mortality rate after aortic open surgery is between 15% and 30%. Endovascular management represents an alternative treatment Associated lesions are usually seen in those critical patients. Hemothorax may be present. The authors propose a combined treatment of endovascular repair for the aortic lesion and video-assisted thoracoscopy surgery (VATS) for the treatment of chest bleeding complications.

METHODS

The authors report a series of three patients with post-traumatic aortic lesion and hemothorax. In two patients endovascular procedure was first performed, followed by VATS, few days later, for retained hemothorax. In the third patient the two procedures were performed at the same time because of the patient's critical conditions.

RESULTS

There was technical success of stent-graft placement in all the treated cases. No postoperative mortality. No postoperative paraplegia. No VATS converted to thoracotomy. The postoperative follow-up time range between 10 and 19 months.

CONCLUSION

Considering the relatively short procedural time and minimally invasive approach of both techniques, the concomitant use of them may represent an alternative to standard open surgery in cases of thoracic aorta lesions associated with hemothorax. Those procedures may be performed sequentially or together in emergency cases with intra-thoracic more active bleeding to exclude or to treat intra thoracic bleeding.

Multi slice computed tomography in the study of pulmonary metastases

PURPOSE

This study was undertaken to assess the performance of 16-slice computed tomography (MSCT) using Multi-Planar Reformatting (MPR), Maximum Intensity Projection (MIP) and Volume Rendering (VR) reconstructions to study pulmonary metastases.

MATERIALS AND METHODS

CT studies of 32 patients with pulmonary metastases were retrospectively reviewed. Images were assessed for the following parameters: number, size, location, distribution of the nodules and the presence of the "mass-vessel sign". These parameters were evaluated by two observers on axial-source images and on MPR, MIP and VR reconstructions. Sensitivity of each reconstruction and interobserver agreement were calculated.

RESULTS

Two-dimensional (2D) axial images and MIP and VR reconstructions exhibited 100% sensitivity for lesions >10 mm. For nodules 6-10 mm, sensitivity was 49%-55% for the 2D images, 90% for MIP and 80%-85% for VR reconstructions. For metastasis <or= 5 mm, sensitivity was 22% for 2D images, 87%-89% for MIP and 55%-58% for VR reconstructions. Coronal and sagittal MPR, MIP and VR did not improve the detection rate compared with the corresponding axial images. MIP and VR provided overlapping results in detecting the "mass-vessel sign".

CONCLUSIONS

MIP are the most sensitive reconstructions for detecting small pulmonary nodules.

Surgical treatment of tumors involving the inferior vena cava. Personal experience

AIM

Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor that frequently produces non-specific symptoms. Surgical treatment is complex. In this review of our experience, we highlight replacement modalities of the vena cava or other vessels after complete tumor resection.

METHODS

During the last 20 years, we treated 12 patients (6 women and 6 men; age range, 38-72 years) with IVC leiomyosarcoma, all apparently free of distant metastases. Tumor location, graft patency, long-term survival and tumor recurrence were recorded. The tumor arose from the IVC in 8 patients; in 2 cases the intracaval mass reached the right atrium; in 4 patients the tumor arose from the femoroiliac axis. Surgical approach was by sternolaparotomy in 5 cases and by median xyphopubic access in 7. Extracorporeal circulation (ECC) was needed in 2 cases. All tumors were removed by en bloc resection. The IVC was directly sutured in 2 patients and patched in 4; no reconstruction was necessary in 2 patients; the IVC was replaced in the remaining cases. Four patients had an additional arteriovenous fistula. One patient underwent bifurcated Dacron graft replacement of the aortic carrefour involved by tumor.

RESULTS

Two patients died postoperatively. One patient developed late stenosis of the polytetrafluoroethylene (PTFE) graft, which was treated by stenting. The mean follow-up period was 35 months. The 4-year survival rate was 51% and survival free of recurrence was 63%.

CONCLUSION

Leiomyosarcoma of the IVC is an uncommon tumor that produces non-specific symptoms. In the absence of distant malignancy, an aggressive approach can obtain late survival free of recurrence.

Lung cancer and cardiovascular diseases: occurrence, comorbidity and surgical timing

AIM

The authors discuss tumor histological type, TNM staging and time of first occurrence of lung cancer, as well as related cardiovascular diseases, underlining type of treatment, surgical timing, surgical mortality, post-surgical complications and potentially additional therapies.

METHODS

A total of 189 patients underwent surgery for non-small cell lung cancer (NSCLC) (Stage I-II), 35 (17.5%) of which presented with surgically relevant concurrent cardiovascular disease (8 coronary artery disease, 4 carotid stenosis, 8 obstructing artery disease, 15 aortic aneurysm). In most cases, surgical timing provides for cardiovascular disease treatment completion first, followed by lung resection only afterwards. Alternatively, concomitant cardiovascular and lung cancer treatment averts the need for repeated surgery, even though the intraoperative complications rate is higher, as long as patients are hemodynamically stabile.

RESULTS

No remarkable surgical mortality was observed; stay in hospital ranged from 8 to 18 days. A 5-year follow-up was carried out in only 95/189 patients; 11/18 (61%) with concurrent cardiovascular disease and 46/77 (59%) with lung cancer alone are still alive.

CONCLUSIONS

In 17% of cases, surgical treatment by the simultaneous and the differentiated approach for cancer and cardiovascular disease proved essential; comorbidity as an identifier of the strong correlation between the two diseases had a major impact on prognosis.

Gastrointestinal stromal tumours: experience with multislice CT

PURPOSE

The aim of this study was to evaluate the possibilities of multislice computed tomography (MSCT) in the identification and characterisation of gastrointestinal stromal tumours (GISTs).

MATERIALS AND METHODS

MSCT images of 27 patients affected by GIST were analysed. MSCT scans were performed before and after contrast medium injection, and bowel distension was obtained with the administration of water, air or a diluted Gastrografin solution. Images were evaluated for presence and site of the tumour, origin and growth pattern relative to the bowel wall, density, relationship with adjacent structures and evidence of lymph nodes and metastases.

RESULTS

GISTs were located in the stomach in 18/27 patients, in the small bowel in seven, in the oesophagus in one and in the rectum in one. Tumour size ranged from 1.5 cm to 21 cm. An extramucosal origin was definitely established in 23/27 cases. In 15/27 cases, the lesions exhibited extramural growth, and in 17/27 cases, they were homogeneous after contrast medium injection. The borders were regular in 17 cases. Hepatic metastases were detected in 5/27 cases, and lymphadenomegaly was found in one case only.

CONCLUSIONS

Nowadays, MSCT can be considered an essential tool for the diagnosis of GISTs, as it enables one to detect the disease, define its relationships and search for possible metastases.

GC-MS characterisation and identification of natural terpenic resins employed in works of art

Natural resins were frequently employed in the past as adhesives or as components of oleo-resinous media in paintings. The identification of vegetable resins is still an open problem. The aim of this paper is to analyse by GC-MS some vegetable resins frequently employed in paintings, such as Venice turpentine, dammar, copal, elemi, in order to identify their main components in samples both raw and aged. Some molecules are proposed as chemical markers to identify these natural resins. Two samples scraped off from XV and XVII century paintings were used to test the reliability of proposed method.

[Bronchial arteries: anatomical and clinical studies and strategies in surgical approach]

One of the most important and controversial aspects of thoracic surgery is due to the topographical and surgical anatomy of the vascular structures involving the mediastinum. The knowledge of the so-called "vascular time", in fact, allows to face more complicated surgical situations, typical of the most specialistic thoracic surgery. The bronchial arteries represent a paradigm of what we have just stated. The study of their anatomy (number, position, origin, distribution and relationships with the mediastinal structures) is of relevant importance, not only for the interest the bronchial vascular tree arises in tracheo-bronchial surgery and in pulmonary transplantology, but also for the knowledge of the pathogenesis of some processes regarding pulmonary and pleural pathologies. The aim of this paper is to evaluate the real clinical interest of bronchial arteries, with an analytic study of the anatomy of vessels, and with the possibility to show the most frequent and characteristic anomalies involving the origin and course of these arteries.

[Combined video-thoracoscopic, surgical and endovascular treatment in a case of ascites and recurrent bilateral pleural effusion]

Among recurrent pleural effusions a role of remarkable importance is held by those combined with ascitis due to the difficulty of their treatment, even using widely tested techniques. The incidence of such pathology varies from 4% to 6% of patients suffering from cirrhotic pathology, reaching 10% in cases with advanced illnesses. Pleural effusions involve the right emithorax more frequently than the left one, but it can show up bilaterally too. Its etiopathogenesis is tied up to the direct passage of ascitic liquid into the chest and, during the past years, numerous theories have been described to explain this migration. The Authors report the case of a patient with interesting considerations for the diagnostic difficulties and the peculiarity of the treatment performed.

Characterisation of fresh and aged terpenic resins by micro-FTIR and GC-MS analyses of varnishes in XVI-XVII centuries paintings

Resinous materials, generally added to drying oils, were often employed as final protective films in paintings, both in tempera and oil techniques. Most of the resins used in fine arts come from exudates of plants. Natural resins are mainly composed by terpenoids. Among these resins, dammar, rosin, mastic, elemi gum, Venice turpentine were frequently employed in easel paintings. The aim of this work is the identification of natural resins in samples collected from works of art. In this paper we propose to use micro-FTIR spectrometry as a preliminary and non destructive technique to detect the presence of resinous materials in microsamples collected from paintings, followed by GC-MS analyses to obtain a precise identification of the resin. To reach this aim commercial resins, employed as standard, were analysed previously by micro-FTIR spectrometry and then analysed by GC-MS chromatography, searching characteristic chemical compounds used as "markers" of resins. The results obtained on standards allowed us to successfully analyse samples collected from two works of art: the "Portrait of a Young Gentleman", by Lorenzo Lotto (XVI century), and the "Madonna with the Infant Jesus and Saints": by Carlo Maratta (XVII secolo).

Primary aortoduodenal fistula including the afferent loop of a Billroth II anastomosis. A case report

Primary aortoenteric fistula is a very rare consequence of the evolution of an abdominal aortic aneurysm (AAA). The 3rd and 4th portion of the duodenum are involved in up to 80% of all cases. Frequently, gastrointestinal bleeding represents the first symptom, and diagnosis is difficult because of the aspecific clinical presentation and course, characterized by alternating remission and relapse; this is the reason why surgical treatment is usually delayed and therefore such events are managed as emergencies with a preoperative and intraoperative high death rate. We report the case of a 76-year-old man with a primary aortoduodenal fistula, who was submitted to gastric resection according to Billroth II 20 years before. This case could be interesting for its anatomical peculiarities favourable to the formation of the fistula.

Development of a new assay for the screening of hypochlorous acid scavengers based on reversed-phase high-performance liquid chromatography

A new assay for the screening of hypochlorite/hypochlorous acid (XOCl) scavengers, based on the reversed-phase high performance liquid chromatographic analysis of human serum albumin (HSA, 0.2% in 100 mM sodium phosphate, pH 7), before and after oxidation by XOCl (1.6 mM), was developed. XOCl induced a significant decrease of the area under the chromatographic peak of HSA at 280 nm due to the oxidation of the aromatic amino acids tryptophan and tyrosine, as suggested by the literature and by the chromatographic analyses and the electrochemical study performed here. The assay was validated by testing known XOCl scavengers such as ascorbic acid, cysteine, glutathione, S-methylglutathione and alpha-lipoic acid and other antioxidants such as carnosine and chlorogenic acid, which inhibited the oxidation of HSA. Quantitative activities were calculated using an original formula based on the changes of the area of the albumin peak. Electrochemical data collected here in a homogeneous medium showed that the anodic potentials of the antioxidants tested are less positive (ascorbic acid, chlorogenic acid and cysteine) or similar (alpha-lipoic acid) compared with those of the aromatic residues (tryptophan and tyrosine) of HSA oxidized by XOCl. However, as expected, carnosine, glutathione and S-methylglutathione were inactive at a glassy-carbon, gold or platinum electrode.

Characterisation of fatty acids in drying oils used in paintings on canvas by GC and GC-MS analysis

Of the various binding media used in paintings, this work examines drying oils. During the initial phase of polymerisation and the progressive ageing process, the fraction of unsaturated and polyunsaturated fatty acids undergoes various changes (reticulation, oxidation, etc.), that give rise to characteristic compounds. Within a broader research project, aimed at the characterisation of binding media, a preliminary study was made of the ageing process of linseed oil. In this regard, linseed oil was spread on a glass or canvas support and then dried in the open air. The ageing of the spread linseed oil was monitored by taking samples of the material at regular intervals. After the fatty acids had changed into methylesters, the samples were analysed by gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). The results obtained have been reported as a ratio between the areas of the chromatographic peaks of the different fatty acids found.

Effects of shivering prevention on haemodynamic and metabolic demands in hypothermic postoperative neurosurgical patients

We evaluated the haemodynamic and metabolic effects of prevention of shivering after prophylactic nefopam administration in neurosurgical patients undergoing craniotomy and mild systemic hypothermia (33-35 degrees C). Forty patients were enrolled in a randomised, double-blind study. Before extubation, patients received intravenously either nefopam 0.12 mg.kg-1 or an equal volume of saline 0.9%. Left ventricular systolic work index, oxygen consumption index and systemic lactate concentration were recorded before, immediately after and every 20 min for 2 h after extubation. Shivering appeared in two patients treated with nefopam and in all control patients (p < 0.001). Both left ventricular systolic work index and oxygen consumption index were similar in the two groups before extubation, increased after extubation, and further increased in control patients showing a statistical difference compared to patients treated with nefopam. Our results suggest that nefopam is effective in preventing postoperative shivering in patients undergoing neurosurgery and mild hypothermia and attenuates the haemodynamic effects of shivering during rewarming.

[Diabetic retinopathy in Martinique: results of a cross-sectional survey based on 771 patients]

INTRODUCTION

Because of the gravity of diabetic retinopathy in Martinique, a cross-sectional survey was conducted between March and September 1996 to estimate the prevalence of this complication on this island.

PATIENTS AND METHODS

Clinical data, obtained by examining and questioning 771 diabetic patients (recruited among the usual practice of the ophthalmologists), were analyzed using Epi-Info.

RESULTS

Some form of diabetic retinopathy was present in 42%. of the patients and 8.3% presented proliferative retinopathy. A total of 78% of the patients presented a non-insulin-dependent diabetes mellitus, essentially women. Medical supervision of the diabetes and its ophthalmologic complications proved to be insufficient. Principal risk factors found for the prevalence and severity of diabetic retinopathy were a long duration of diabetes, insulin-dependent type diabetes among women and the whole population, age among men, mode of treatment (insulin), and hypertension.

DISCUSSION

These results are higher than those usually reported in France. This can be explained by diet and racial factors: the population is mainly of African and Indian descent. Risk factors are the same as those already described in earlier studies. To improve these prevalences, strategies should include classic methods risk factors correction, patients education, increasing coordination between the different medical specialists), but should also take into account the particularities of this Caribbean population such as racial, economic, historical, and sociocultural factors.

[Intestinal angiodysplasia]

Intestinal angiodysplastic lesions represent one frequent source of gastro-enteric tract serious bleedings, endowed with present-day therapeutic implications. The Authors report a singular case of a bleeding of this kind. A selective arteriography analysis of the superior mesenteric artery immediately pointed out the necessity for a surgical intervention, which however has not proved being resolutive for recovery, because massive intestinal hemmorrhage recurrence occurred. The left gastric artery anomalous origin, being discovered in the first branch of the mesenteric artery, which was not recognized fully in advance, stressed, in fact, the need for a partial gastrectomy, firstly, and a full gastrectomy, subsequently. The post-surgery course got more serious for a small leak of the oesophageus-digiunal anastomosis and for a serious renal failure. NPT and haemodialysis helped to quickly solve those complications. Other hemorrhagic events have not occurred anymore, 5 years having passed since the surgical intervention.

[Treatment of bleeding esophageal varices: sclerotherapy or surgery?]

To evaluate therapeutic options to improve the prognosis of haemorrhage from oesophageal varices, a study was performed on 422 patients observed from 1983 to 1998. Patients were classified according Child-Campbell method after improvement of general conditions (class A: 7%; B: 68%; C: 25%). Thirty-two patients (7.8%) died during emergently pharmacologic treatment in the first 24 hours; 182 patients (44.6%) because of persistent haemorrhage underwent endoscopic sclerotherapy. In 164 (90.1%) bleeding stopped and 14 cases (7.6%) underwent emergency surgical treatment (9 splenectomies and splenorenal shunts, 5 mesenterico-caval shunts). Teu other patients (with rebleeding 3-7 days after sclerotherapy) underwent emergency surgical treatment (7 azygos-portal thoracotomic deconnections, 3 splenectomies and spleno-renal shunts). The rates of therapeutic success were respectively 80% for surgical treatment and 90% after sclerotherapy. Factors of prognostic improvement of these emergently disease are examined. The advantages of both endoscopic and surgical treatment are outlined.

Cardiovascular effects of intravenous propofol administered at two infusion rates: a transthoracic echocardiographic study

We assessed the haemodynamic changes after a propofol infusion at two rates in low-risk unpremedicated patients (ASA I-II). To determine contractility changes and loading conditions, we measured the ejection fraction, end-systolic quotient and fractional shortening on transthoracic echocardiograms. We studied 40 patients undergoing peripheral neurosurgical procedures under general anaesthesia induced by propofol alone (total dose 2.5 mg.kg-1). Patients were randomly assigned to receive propofol at an infusion rate of 10 mg.s-1; or 2 mg.s-1. Haemodynamic data were recorded simultaneously immediately before propofol infusion, at the end of infusion, and 5 and 10 min after the infusion ended. The higher infusion rate induced a larger decrease in mean arterial pressure than the lower infusion rate (- 20% vs. - 10% from baseline, p = 0.01). In both groups, global and segmental ventricular function remained unchanged throughout the study. In both groups, there were markedly reduced end-systolic quotients--presumably related to diminished afterload, and in the higher infusion-rate group a significant reduction in fractional shortening--presumably related principally to diminished preload.

[Thyroid surgery yesterday, today, tomorrow]

The Authors, after a bibliographic research on the matter, report the development of thyroid surgery, from the beginning at today.

[Surgical treatment of arterial hypertension: experience and results]

Hypertension is a wide spread disease. In a small percentage of cases (nephrosclerosis, renovascular hypertension, endocrine hypertension) surgical treatment could be resolutive. The Authors describe their experience of the last five years about the subject, emphasize the technical detail taken and the results achieved; they outline the necessity to give the indications for surgery in wise manner considering clinical, laboratory and instrumental findings.

[Thyroid surgery in assisted local anesthesia]

To evaluate the advantages of thyroidectomy under assisted local anesthesia, 35 cases operated on from January 1998 to February 1999 were reviewed. The patients were studied in ambulatory setting and adequately informed on the program of thyroid operation under local anesthesia. Multinodular goitre was present in all the cases. In 12 cases, it was intrathoracic. The morning of operation, all the patients underwent to pre-operative sedation and, in operative room, to local anesthesia with Mepivacaine 1% and adrenaline 1,200,000 U. The operations were performed with a mean of 30 cc of local anesthetic. During operation, in none case the conversion to general anesthesia was necessary. No mortality and morbility were registered. In the majority of cases, an analgesic was necessary meanly 4 hours after operation. The evening of operation in all the patient oral nutrition was restored. Twenty-nine patients were discharged from the hospital 48 hours after surgery. Eight days after operation, surgical recovery was evident in all the patients reviewed in the out patients setting. The advantages of thyroid surgery under assisted local anesthesia are outlined.

[Elective and emergency minimally invasive surgery in pleural diseases]

In the last years the video-assisted thoracic surgery (V.A.T.S.) assumed an important order for the diagnosis and treatment of the pleural disease. In this particular field, the procedure allows obtaining almost the same outcomes of traditional surgery and is very safety. V.A.T.S. reduces hospital time and trauma with a fast return to the working life. The Authors describe their experience and outline the diagnostic and therapeutic indications for the treatment of choice and emergency.