Prevalence of myocarditis at autopsy in Turin, Italy

OBJECTIVE: To evaluate the prevalence of myocarditis in a general hospital in Turin, Italy. DESIGN: We retrospectively reviewed 17162 postmortem records from autopsies routinely performed at San Giovanni Battista General Hospital, Turin, between 1965 and 1994. RESULTS: Applying the so-called Dallas criteria, myocarditis was histologically found in 91 cases (0.53%, 95% CI 0.4 to 0.7). The prevalence increased, reaching a peak between 1985 and 1994 (1.2%, 95% CI 0.9 to 1.6). The disease was found more frequently in patients from 20 to 39 years of age, with no difference between males and females. The present data were compared to those of a previous study, performed in 1985 and 1993 to 1994, in which we had prospectively taken into account 605 autopsies (not comprised in the present retrospective study) with standardized myocardial sampling for histological examination: a 5.1% prevalence was found (nearly five times as high as that retrospectively detected in the same period). CONCLUSIONS: If a standardized method of myocardial samples for microscopic examination is not followed, it is possible that myocarditis is overlooked in an unsuspected number of cases.     

The blood supporting of nipple-areolar (NAC) complex performing for mammaplasties

In case of mammaplasties the blood support of the nipple-areolar complex is one of the most important. The authors give a comprehensive clinical summary of the operating technics which are suitable to correct mastoptosis and breast hypertrophy (or macromastia). After mentioning the anatomy, blood and nerve supply of breast, following the classifying of mastoptosis and breast hypertrophy. Summarizing of the historical development of operating methods, which resulting in modern solutions, and adding Hungarian-related data. The widely used mastopexies and reduction mammaplasties will be analyzed, with demonstration of transposition of NAC using different kind of dermo-glandular flaps, e.g.: Skoog-, Pitanguy-, McKissock-, Str?mbeck-, Robbins-, Regnault- and other's method. After discussing the possible postoperative complications, authors underline the necessity of detailed analysis and exact planning in varied clinical cases for achieving wanted functional and aesthetic result. Attaching importance to have more perfect operating techniques.     

Interaction of nonionic polymers at a clay interface

The structure and dynamics at the interface of swelling clays (smectites) are crucial to such diverse applications as drilling for oil, cosmetics, paints, water treatment, or chemical reactions. From our previous NMR studies on clay suspensions, we have shown how the orientation of interfacial molecules is affected by the clay structure1, by the nature of counterions 2, or by the composition of the liquid phase3. These results have been mainly obtained from the analysis of residual quadrupolar splittings of nuclei from interfacial species. In this work, we report our studies on a clay montmorillonite suspended in aqueous solutions of non ionic polymers. The polymer perturbs the structure within the interfacial region as deduced from the variations of the splittings of water quadrupolar nuclei and of sodium-23 relaxation parameters in terms of the polymer concentration. Proton self-diffusion coefficients and carbon-13 relaxation times are measured to describe the influence of the clay on the polymer mobility. The dependence of the polymer nature on these parameters is also investigated.     

Central pontine myelinolysis at autopsy; a twelve year retrospective analysis

Central pontine myelinolysis (CPM) was first described in 1959 and only later was associated with a rapid, sustained rise in serum sodium from a hyponatremic baseline. This discovery in 1981 led to modifications in recommendations for clinical treatment of hyponatremia. Our interest has been in tracking the incidence of CPM found at autopsy by year to see whether changes in medical treatment in hyponatremia have resulted in a decrease in CPM over time. Clinically asymptomatic CPM found at autopsy has always been at least as frequent as cases diagnosed premortem and serves as a reasonable indicator for the incidence of the disease. In over 3,000 autopsies, on most of which the brain was examined macroscopically and microscopically by the same neuropathologist, we have discovered 15 cases of asymptomatic, small pontine CPM. Of these 15, 6 were active lesions and 9 were remote; in the active group, 5 of the 6 cases were associated with a rapid, sustained rise in serum sodium during the appropriate time period. The incidence of asymptomatic CPM has remained steady over the 13-year time period. In contrast, we have encountered no cases of CPM diagnosed premortem that have come to autopsy in the same time period. These cases emphasize that CPM still occurs, but most often as an asymptomatic disorder with small, midline pontine lesions. When small active CPM is found, it still is associated with a rapid sustained rise in serum sodium.     

Histologic and biologic patterns of microscopic pancreatic ductal adenocarcinomas detected incidentally at autopsy

BACKGROUND: The major clinical problems with pancreatic carcinoma are its silent course and late, fatal clinical manifestation. The results of treatments of small pancreatic carcinomas (<2 cm in greatest dimension) have led to the assumption that the detection of these cancers at earlier stages would lead to better survival and possible cure. Currently, there is no information about the histologic and biologic patterns of early stage pancreatic carcinoma, and the available data on incidentally detected tumors are fragmentary. The authors observed two incidental microscopic pancreatic ductal adenocarcinomas in female patients who died of advanced gastric carcinoma (Case 1) and renal carcinoma (Case 2). METHODS: The pancreatic lesions were examined histologically in serial sections and immunocytochemically for islet cells. Microdissection was performed so that the lesions could be examined for c-Ki-ras mutation. RESULTS: In Case 1, the pancreatic lesion was composed of cystic and solid components. The cystic component consisted of four small cysts compatible with a mucinous cystic tumor and showed no invasion. The solid component was a well-differentiated adenocarcinoma that occupied a 4 x 2 mm area. In Case 2, the pancreatic lesion contained two small, separate cysts, one of which was surrounded by two apparently separate, invasive adenocarcinomas 2.6 x 0.7 mm and 1.2 x 0.5 mm in greatest dimension. There was invasion of pancreatic islets and perineural spaces in both cases; and in Case 2, there was invasion of peripancreatic fatty tissue. In both cases, the epithelia of the cystic components and tumors showed mutation of the c-Ki-ras oncogene at codon 12, with GGT-to-GAT transition. CONCLUSIONS. Pancreatic carcinoma seems to occur under occult circumstances and maintain a silent course. Even in its early developmental stage, the cancer is invasive, primarily affects islets and nerves, and exhibits mutation of the c-Ki-ras oncogene. These findings call for urgency in the development of preventive modalities.     

The use of osteotomes for sinus augmentation at the time of implant placement

The placement of endosseous dental implants is often hampered by the loss of alveolar bone. In the posterior maxilla, the presence of the maxillary sinus and less-dense bone present additional obstacles to successful implant placement. Existing methods of subantral augmentation require extensive surgical manipulation, often including a second surgical site for harvesting autogenous bone. The development of surgical osteotomes has facilitated the placement of implants in areas of minimal alveolar bone height in the posterior maxilla. This article describes the osteotome technique for sinus augmentation at the time of implant placement and presents a short-term evaluation of 34 implants placed in 18 patients.     

Local anesthesia in breast augmentation

The Authors report their experience in the application of local anesthesia during breast prosthesis implantation.     

Stress Distribution at PTFE Interface in Cylindrical Bearing

Two analytical methods capable of evaluating stresses at the curved polytetrafluoroethylene (PTFE) metal sliding interface in a cylindrical bearing subjected to combined vertical and horizontal loads are described. One method is based on a finite-element approach incorporating contact elements to model the sliding PTFE∕metal interface, while the other, referred to as the displacement method, is based on an approach that assumes all displacement in the bearing under load is confined to the PTFE. Both methods are shown to give similar results. Basic equations for the displacement method are derived assuming a bilinear stress-displacement relationship for the PTFE, and this method is used to produce design curves for cylindrical bearings, based on criteria relating to prevention of separation of the interface and limitation of maximum stress level in the PTFE under service load. The displacement model shows that the common design practice of assuming linear elastic material behavior and a plane surface is conservative. The design charts presented in this paper provide an effective tool for taking advantage of the extra horizontal load resistance resulting from the bilinear behavior of the PTFE and the curved interface of the bearing.     

Epidemiologic autopsy of Binswanger's disease

BACKGROUND: Binswanger's disease is the most substantial part of the continuum of ischemic vascular dementia (IVD). IVD is the second most frequent cause of dementia in industrialised countries. The frequency of IVD generally, and of the Binswanger's disease especially, is due to the method of statistical data collection, in the Czech republic not known. METHODS AND RESULTS: The crude rate of Binswanger's disease diagnosed histologically among the autopsies of 132 men and 212 woman aged 60-99 yr. performed at Thomayer's University Hospital from 1. 7. 1995 to 1. 7. 1996 by use of by principle of "epidemiologic" autopsy was estimated at 7.9%. This is about a half of the crude rate of Alzheimer's disease found in the same cohort. By estimating of histological "ischemic score", which is independent on clinical data, it is possible to diagnose the Binswanger's disease with high probability. CONCLUSIONS: The sensitivity and specificity of clinical diagnosis IVD generally and of BN in particular is low. IVD/BN is one of the most frequent and consequential ailment in higher age groups. IVD/BN is preventable and curable at earlier stages of development. Knowledge and precise and timely diagnosis of IVD/BN is fundamentally important for patients.     

Coordination of the Batch Distribution at the Blast-Furnace Mouth and the Gas-Flux Distribution in the Hearth

Coordinated parameter selection of the batch charged at the top of the blast furnace and the blast injected in the hearth is evaluated as a means of improving furnace performance.     

29Si CP/MAS NMR of phosphorus-bearing organosilicon compounds

While liquid-state 29Si NMR of phosphorus-bearing organosilicon compounds with more than one phosphorus per molecule can take advantage of the presence of J-coupling nJ(31P29Si) for purposes of structural assignment from J-coupling patterns, conventional 29Si CP/MAS spectra of such molecular solids do not reveal structural details in a straightforward manner. For such compounds it is necessary to obtain 29Si CP/MAS spectra under conditions of simultaneous 1H- and 31P-high power decoupling in order to derive reliable 29Si chemical shift information. 29Si CP/MAS NMR spectra, obtained with and without 31P high power decoupling during the acquisition time, of several organosilicon compounds containing SixPy (x = 1-10, y = 1-10) moieties are reported.     

Periosteal augmentation of the acetabulum

The periosteum in children and especially infants has significant osteogenic potential. To determine the efficacy of periosteal flaps to assist in improving acetabular coverage in children with acetabular dysplasia, a series of experiments were designed using young rabbits. Three groups of five rabbits each had periosteal flaps fashioned and brought down from the anterolateral aspect of the innominate bone superior to the acetabulum and sutured to the capsule of the hip. The study was designed to examine the effects of the periosteal cambium layer in the formation of new bone to augment the acetabulum and to determine the effects of a periosteal flap plus cancellous bone graft. A control group of five rabbits underwent a sham operation of an open arthrotomy of the hip. Radiographic and histologic examination at 12 weeks revealed augmentation of the acetabulum with periosteal flaps that resulted in an average improvement of the acetabular index of 3.5 degrees and 6.6 degrees, without and with bone graft, respectively. New bone formation from the rim of the acetabulum averaged 3.9 mm with periosteal flaps alone and 4.6 mm with bone graft added. Periosteal augmentation of the acetabulum in conjunction with established procedures for augmenting acetabular coverage would appear to be a useful procedure for improving coverage of the femoral head in children with acetabular dysplasia.     

Buspirone augmentation of antidepressant therapy

Thirty outpatients meeting DSM-III-R or DSM-IV criteria for major depression, single or recurrent episode, and failing to respond to an adequate trial of an antidepressant (>6 weeks at recommended dosage) received buspirone (20-30 mg/day) for 4 or 5 weeks in addition to their existing antidepressant. Of the 22 patients who had buspirone added to their selective serotonin reuptake inhibitor antidepressant regimen (fluoxetine, paroxetine, or citalopram), 59% (13/22) showed complete or partial remission of their depressive symptomatology. Similarly, 63% (5/8) of patients treated with buspirone in addition to clomipramine showed complete or partial remission. The mean score on the Clinical Global Impressions Scale fell by 64% (from 4.7 to 1.7; p < 0.0001) in treatment responders (complete and partial). No serious side effects were observed during combination therapy. Seventy-nine percent (11/14) of initial responders (both complete and partial) who remained on augmentation therapy for at least 4 months were symptom-free at follow-up. Buspirone augmentation may produce marked clinical improvement in depressed patients who are initially unresponsive to standard antidepressant therapy.     

Maxillary sinus augmentation: histomorphometric analysis of graft materials for maxillary sinus floor augmentation

OBJECTIVE: To compare efficacy and tolerance of recombinant interferon alfa-2b in the treatment of anti-HCV-positive chronic active hepatitis (CAH) in subjects aged 65 years and above with those less than 65. DESIGN: A randomized controlled trial. SETTING: Outpatients in two hospitals. PATIENTS: 65 consecutive outpatients with anti-HCV-positive CAH for 1 to 30 years, having basal aminotransferase levels at least twice the normal value. Those 65 and over were randomized to an interferon group (A, n = 22) or a no-treatment group (B, n = 22). All those under 65 received interferon (group C, n = 21). INTERVENTION: Interferon at a dose of 3 mU 3 times a week for a 6-month period. A normalization of serum aminotransferase levels was considered a positive response to therapy. RESULTS: Response to therapy was positive in 62% of the treated elderly compared to 57% of the adults (P = 0.85). The two groups of responders showed a common highly significant reduction of aminotransferase (P < 0.001). Side effects were similar in elderly and young. Two untreated elderly showed spontaneous normalization of aminotransferase. CONCLUSION: Interferon in anti-HCV-positive CAH is useful in the elderly, allowing normalization of aminotransferase, improvement of the histology and remission of the disease in 62% of the cases. Side effects seem to be independent of age. Further studies are required to assess both duration of remission and usefulness of cyclic therapy in previous responders.