Coronary surgery with minimum access and cardiopulmonary bypass]

From October 1997 to March 1998 we operated on seven patients with minimal incision, cardiopulmonary by-pass with femoral cannulation and antegrade blood cardioplegic arrest using the "endoclamp" (Heartport Inc.). The seven patients with isolated severe lesions of the left anterior descending underwent a left internal thoracic artery graft under direct vision. Three had saphenous vein coronary bypass grafts performed to the diagonal (2) and obtuse marginal branches of the left coronary artery. The median cardiopulmonary bypass duration was 75 minutes (30-230) and the aortic occlusion time was 33 minutes (10-117). No major complications occurred and only two minor ones were noted. The median intensive care unit stay was 2 days (1 to 4) and the total hospital stay was 6.5 days (3 to 13). All the patients are in NYHA FC I, without treatment and a follow up of 3 to 6 months after the surgery. With this method of myocardial revascularization with minimal incision and cardiopulmonary bypass the sternotomy-related complications can be avoided, the intensive care unit and hospital stay can be reduced with better convalescence for the selected patients. We believe that this technique is a valid option for an increasing number of patients.     

In vitro culture facilitates the selection of healthy spermatids for assisted reproduction

OBJECTIVE: To evaluate the potential usefulness of in vitro culture of germ cells for distinguishing between healthy and apoptotic spermatids. DESIGN: Prospective study. SETTING: Private assisted reproduction laboratories and a university department. PATIENT(S): Men with secretory azoospermia who were candidates for assisted reproductive treatment. INTERVENTION(S): Testicular biopsy samples were cultured in the presence of FSH and testosterone for 48 hours. Germ cell apoptosis before and after culture was evaluated by terminal deoxyribonucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling. MAIN OUTCOME MEASURE(S): The percentage of germ cells at different stages of spermatogenesis that showed apoptosis-related DNA damage. RESULT(S): In fresh samples, high levels of apoptosis were detected at those stages of spermatogenesis at which major developmental blocks occurred, with a maximum at the most advanced stage detected. In contrast, apoptotic cells were considerably less well represented at the most advanced stage after culture. CONCLUSION(S): In addition to the previously described facilitation of spermatid recognition and the progression of cytoplasmic maturation, in vitro culture of germ cells is useful to overcome the danger of inadvertent use of apoptotic spermatids for assisted reproduction.     

Intratumor flowmetry in endometrial carcinoma. Correlation with the tumor stage

BACKGROUND: To assess the value of intra-tumoral (endometrial) flow as detected by color Doppler ultrasound in relationship with negative prognostic factors in patients with endometrial carcinoma. METHODS: Fifty-three patients with a previous histological diagnosis of endometrial carcinoma were included in the study. Transvaginal ultrasound with pulsed color Doppler was performed in order to record resistance indexes and vascular density (defined as "high" if > or = 3 vascular spaces were detectable for any given area). All cases were classified according to FIGO after surgery and histology. Prognostic bad factors were considered: FIGO stage (> I), tumor grade (> 1), myometrial invasion (> 50%) involvement of vascular spaces and lymph node metastasis. RESULTS: Both resistance indexes and vascular density in the endometrium related well to more prognostic signs. No relationship was found for lymph node metastasis, probably justified by the small number of positive nodes (2/27). DISCUSSION: Color Doppler ultrasound seems to be a promising technique in pre-surgical staging of endometrial carcinoma. Detection of vascular spaces rather than low resistance indexes is, in personal experience, more significantly related to advanced disease. It is hypothesized that long term follow-up of these patients can show a predictive value of Doppler ultrasound on the outcome of the disease.     

Background to Eusoma guidelines and statements

The European Society of Mastology (Eusoma) is committed in writing and diffusing guidelines on Breast Cancer, aiming at harmonising the quality of Breast Cancer care throughout Europe. To achieve this Eusoma organises scientific meetings, "workshops" or "Consensus meeting", inviting European experts from the different disciplines involved in the multidisciplinary management of Breast Cancer patients, to give their contribution in drafting "guidelines" or "consensus statements". In this regard Eusoma Executive Committee members found it appropriate to define the rules to organise its scientific meetings and to write the documents resulting from these meetings, i.e guidelines or statements. This will guarantee an homogeneity in the meeting organisations and in drawing up the scientific documents.     

The management of lobular carcinoma in situ (LCIS). Is LCIS the same as ductal carcinoma in situ (DCIS)?

Lobular carcinoma in situ was first described over 60 years ago. Despite the long history, it continues to pose significant difficulties in screening, diagnosis, management and treatment. This is partly due its multi-focal and bilateral presentation, an incomplete understanding of its biology and natural history and perpetuation of misconceptions gathered over the last decades. In this review, the working group on behalf of EUSOMA has attempted to summarise the current thinking and management of this interesting lesion.     

Refinement of the benzodiazepine receptor site topology by structure-activity relationships of new N-(heteroarylmethyl)indol-3-ylglyoxylamides

N-(heteroarylmethyl)indol-3-ylglyoxylamides (1-26) were synthesized and evaluated as ligands of the benzodiazepine receptor (BzR) to probe the hydrogen bonding properties of the so-called S(1) site of the BzR by means of suitable heterocyclic side chains. SARs were developed in light of our hypothesis of binding modes A and B. Pyrrole and furan derivatives adopting mode A (2, 8, 10, 20, 22) turned out to be more potent (K(i) values < 35 nM) than their analogues lacking hydrogen bonding heterocyclic side chains. These data suggest that the most potent indoles interact with a hydrogen bond acceptor/donor (HBA/D) group located within the S(1) site of the BzR. Compounds 1, 2, 8, 19, 20, and 22, tested at recombinant rat alpha(1)beta(2)gamma(2), alpha(2)beta(2)gamma(2), and alpha(5)beta(3)gamma(2) BzRs, elicited selectivity for the alpha(1)beta(2)gamma(2) isoform. On the basis of published mutagenesis studies and the present SARs, we speculate that the S(1) HBA/D group might be identified as the hydroxyl of alpha(1)-Tyr209 or of other neighboring amino acids.     

Third Italian national survey on knowledge, attitudes, and sexual behaviour in relation to HIV/AIDS risk and the role of health education campaigns

AIM: The survey, supported by the National Health Institute (ISS), investigates on sources of information for HIV/AIDS and sexual behaviour of the Italian general population. METHODS: The survey was carried out in four different Italian provinces with different geographical, social, and epidemiological patterns of HIV/AIDS: Bari, Milan, Parma, and Perugia. A self-administered questionnaire was used to interview a sample of 2000 people, aged 18-49 years, chosen using a quota-sampling, considering age, sex, and level of education. RESULTS: A total of 1985 persons filled in the questionnaire. Among them, 73.2% reported Ministry of Health as their main source of information and 76.7% TV/radio advertising as their main means of information. Sexually active subjects, experiencing occasional sexual intercourse, were 22.4%; of them 34.6% did not refer a systematic use of condom. Among sexually active people, half (45.7%) reported as irrelevant their risk of infection, 6.9% as high. Being male (OR = 6.175) and having the first sexual intercourse before 18 years (OR = 2.076) were significantly associated with sexual behaviour at risk (males having unsafe sexual intercourses with prostitutes or during partners' menstrual period; both sexes having unsafe occasional sexual intercourses or anal sex), while living in Northern Italy (OR = 0.672) was significantly protective. Subjects with sexual behaviour at risk were about 40%. CONCLUSIONS: The need for further education campaigns, and their consequent evaluations, is relevant. Monitoring sexual behaviour of general population, focusing on risk behaviour rather than risk groups, is fundamental nowadays in preventing HIV.