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The occurrence of beta-adrenoceptor desensitisation in clinical experience, after long term therapy with specific beta 2-agonists, is still an open question, even if this phenomenon is easily observed in different experimental models. Since the majority of these experiments have been performed in normal animals, we investigated the possible occurrence of beta-adrenoceptor desensitisation in the ovalbumin actively sensitised guinea-pig model of experimental asthma. The isoproterenol concentration-response curves performed in pilocarpine contracted guinea-pig trachea in vitro were shifted to the right by the beta-adrenoceptor desensitisation procedure, which was achieved by the in vitro administration of isoproterenol (10(-5) M x 2 times x 20 min each) both in normal and ovalbumin sensitised tissues. The same desensitisation procedure markedly affected epinephrine-relaxing capacity in both normal and ovalbumin actively sensitised guinea-pig tracheae. However, the ovalbumin sensitised tissue seemed to be more sensitive than normal to the specific beta 2-agonist procaterol; in parallel the beta 2-mediated relaxation was more impaired by isoproterenol-induced beta-adrenoceptor down regulation in ovalbumin sensitised trachea when compared to normal. Similar results have been obtained using salbutamol as the beta 2-adrenoceptor desensitising agent. The changes in beta-adrenoceptor reactivity between normal and ovalbumin sensitised guinea-pig tracheae seemed to depend on the active sensitisation process. No difference in the degree of beta-adrenoceptor down regulation was observed in passively ovalbumin sensitised guinea-pig trachea as compared to normal. These data suggest that, in this model of experimental asthma, beta-adrenoceptor reactivity is in some way modified and that this phenomenon might contribute to the genesis of asthma.

A follow-up of 78 patients with acromio-clavicular dislocation who have been operated on since 1956 is reported. The tendon of the short head of the biceps is transferred to the clavicle to obtain, and maintain, reduction. The site of transfer in the last 51 cases has been to a point on the clavicle immediately above the coracoid process. The acromio-clavicular joint is only opened when an obstruction to reduction is present. The functional results in this group of patients are very good.

The authors present the results of twenty-five tendon grafts performed between 1972 and 1982. The end results were evaluated according to these parameters: the pre-operative condition, the donor tendon, the level of the lesion, the age of the patient, and the time elapsed from injury to operation.

Immediate mobilisation after flexor tendon suture produces a conflict between the muscle force and resistance of the sutures. Sutures within the tendon after repair are weak and need contrived measures (e.g. wrist and metacarpophalangeal flexion, rubber bands etc.) to prevent dehiscence, while pull-out sutures do not allow mobilisation because of their anchorage. A new technique is presented which consists of a simple slip-knot suture which transmits the tension generated by the muscle to the distal tendon stump and its bony insertion, allowing immediate mobilisation. Results in ninety eight cases repaired by this technique during nine years are presented.

The study was performed on a group of 91 children with their first febrile convulsion whose parents were then instructed in the use of rectal diazepam in the event of a further seizure. later, the families were periodically recalled for interviews. The aim was to study the acceptance and cooperation of the families, the psychological attitude and the relation between the findings and parents' educational level. At the end of the follow-up, 80% of the 91 families showed good cooperation and psychological benefits. There was no relationship between the findings at the end of the follow-up and families' educational level. Even in the presence of a favorable psychological attitude, recurrences of febrile convulsions were still a frightening experience for many parents.

Die einzelnen Migraneformen werden unterschiedlich klassifiziert. Gestutzt auf die klinische Symptomatologie unterscheidet man im Kindesalter zwei Hauptformen: die einfache Migrane und die klassische Migrane. Nicht alle sind sich daruber einig, ob es sich um zwei unterschiedliche Krankheiten oder um zwei Abarten der gleichen Erkrankung handelt [1,2,3]. Wir haben in einer Population von Kindern mit idiopathischen Kopfwehformen versucht zu klaren, inwieweit aufgrund der klinischen Symptomatologie eine Einteilung in verschiedene Kopfwehformen moglich ist.

Previously, when part of a muscle and the terminal part of its nerve with its branches were removed through trauma, no technique for repair was available. A new technique for direct neurotization of denervated muscles is presented. This consists of the insertion of the distal stump of a nerve graft, divided into many small branches, directly into the muscle. Very good results were obtained in eight clinical cases of severely damaged muscles which were operated on according to this technique.

1 A threshold dose of Prostaglandin D2 (PGD2) (0.5 microgram/kg i.v.), which did not modify the basal values of airway resistance, potentiated the acetylcholine induced bronchospasm in anaesthetized guinea-pigs. 2 beta-adrenoreceptors blockade induced by propranolol enhanced the positive interaction between PGD2 and acetylcholine in the pulmonary dynamics. 3 Active sensitization of guinea-pigs by ovalbumin increased the pulmonary PGD2-acetylcholine interaction and the phenomenon was sustained during the time. 4 The inability of PGD2 to potentiate histamine-induced bronchoconstriction suggests a specificity for the interaction.

Immediate mobilization of flexor tendons repairs creates a conflict between muscle strength and suture solidity. Non removable sutures are brittle and require to prevent extension by means of either a cast in flexion of the wrist and of the metacarpo-phalangeal joints or a rubber band traction. Pull-out sutures do not permit early mobilization because of their anchorages. The authors present a new technique they have been using for the last five years. It consists in a simple solid slip-knot which tightening the tendon when the muscle pulls. This knot is fixed at the distal bone insertion of the tendon, which makes immediate mobilization possible. Sixty three patients have been treated with by this technique over the past five years. We have not encountered any rupture of the suture. The results, even in the least favorable cases have been considered as very good.

Fractures of the intercondylar tibial eminence are produced by a mechanism similar to that of rupture of the cruciate ligaments, in particular excessive internal rotation in varus and external rotation in valgus. When combined with other types of force there may be associated lesions of other structures, which naturally complicates the treatment and prognosis. Screw fixation is not considered satisfactory, both because of its difficulty when the posterior tuberosity is involved, the need for a second operation to remove the screw, the frequency with which the fragments break during or after the application of the screw, and the possibility that the screws may loosen. Fixation is performed by means of a metal wire transfixing the fracture, passed through two tunnels in the tibia, and anchored on the anterior surface of the tibia over a small metal plate, in order to prevent cutting through the bone under tension. It is important that the two small tunnels drilled in the tibia should exactly meet the fracture line.

To evaluate the antithrombotic effect of sulfinpyrazone on blood vessels (1-2 mm diameter) injured by microsurgical procedures, twenty male rabbits were chosen at random to receive sulfinpyrazone (10 mg/kg/die) or placebo three days prior to and on the morning of vascular microsurgery, which consisted of a complete transverse section, or a longitudinal section 1 cm long, of the femoral artery and vein, followed by interrupted suture. Scanning electron microscopy revealed consistently less fibrin and blood cell adhesion to the endothelial areas adjacent to the surgical trauma in the animals treated with sulfinpyrazone than in those treated with placebo. Our results agree with those reported in the literature, demonstrating the antithrombotic effects of sulfinpyrazone at the level of the vascular endothelium injured by various kinds of trauma and are sufficiently encouraging to justify testing this drug in the prevention of vascular thrombosis following microsurgical procedures in man.

In summary, this technique provides a number of well-differentiated sensory and voluntary motor fibers. This number is certainly less than that of a normal plexus but is much more and of much better quality than that of intercostal nerves. If we distribute these fibers to well-chosen branches of the brachial plexus, limiting the neurotization to few selective components, we have the possibility of a useful recovery of essential movements of the shoulder and elbow. Sensation to the hand will also recover to a certain extent. Subsequent palliative operations (as for instance different kinds of arthrodesis) can supply a limb that, although paralyzed and severely impaired, can still be useful.

The authors present the results of twenty-five tendon grafts performed between 1972 and 1982. The end results were evaluated according to these parameters: the pre-operative condition, the donor tendon, the level of the lesion, the age of the patient, and the time elapsed from injury to operation.

S-(+)-2-(4-Fluorophenyl)-alpha-methyl-5-benzoxazolacetic acid (flunoxaprofen, Priaxim is a new antiinflammatory compound, which in various biological systems interferes with the generation and release of arachidonic acid metabolites of the cyclo-oxygenase pathways without affecting the formation of 5- and 12-lipoxygenase products. Flunoxaprofen reduces the concentration of thromboxane (TX)B2 (ED50 = 35.4 mg/kg p.o.) and prostaglandin (PG)E2-like activity (ED50 = 39.9 mg/kg p.o.) in the inflammatory exudate of rats 8 h after implantation of sponges soaked with carrageenan, whereas the concentration of leukotriene (LT)B4 remains in the range of that of the untreated animals (3.1 ng/ml). Flunoxaprofen inhibits cell infiltration in the exudate and this suggests that LTB4 does not initiate cell recruitment but may represent a mechanism for amplifying the inflammatory response. Using human platelets challenged with collagen, flunoxaprofen only at higher concentration (10(-4) mol/l) reduces TXB2 formation without altering generation of 12-hydroxy-5,8,10,14-eicosatetraenoic acid. This suggests a low capacity of flunoxaprofen of affecting platelet aggregation regulated by arachidonic acid metabolites. Flunoxaprofen prevents pulmonary changes due to secondary release of TXA2 in the guinea-pig. In fact this drug prevents changes due to immunological reaction and antagonizes bronchoconstriction due to exogenous administration of histamine and LTC4.(ABSTRACT TRUNCATED AT 250 WORDS)

In order to avoid the risks of local and general complications encountered in replantations after long ("critical") periods of ischemia, or in cases of severe open fractures with crushed muscles, a so-called "muscle elementarization" technique has been devised. This technique consists of removing the muscular masses which have undergone prolonged ischemia with a priority for the least important muscles. In this manner, we believe that edema and the consequent risks of compartment syndromes as well as of life threatening complications can be reduced. Functional impairment is limited as well. Eleven cases of severe crushing or critical time limit ischemia replantation have been treated in this manner without any complications.

Tiaramide hydrochloride (THC) is a benzothiazoline derivative with a remarkable antianaphylactic activity: in anaesthetized guinea-pig it shows protecting effects against histamine (H)- and bradykinin (Bk)-induced bronchoconstriction, preventing increase of lung resistance and decrease of dynamic compliance. At the same time THC inhibits formation of circulating thromboxane A2 brought about by H and Bk. THC is also able to antagonize the contractions induced by CaCl2 on isolated guinea-pig tracheal spirals and its mode of action seems to be of the competitive type. Furthermore THC abolishes the "tonic" phase of K+-induced contractions of guinea-pig taenia coli which are dependent on inward movement of calcium, whereas the "phasic" component of the contractions is left unaltered. THC is a very weak inhibitor of 3'-5' cyclic adenosine monophosphate phosphodiesterase which is affected only at very high dosage (10(-2) M). The calcium antagonistic activity of THC may explain both its bronchodilating and antianaphylactic properties.

The trapeziometacarpal (TM) joint is often the site of painful arthrosis, particularly in women at the onset of the fourth decade. It is generally associated with capsuloligamentous laxity of the joint or with work requiring the repetitive use of the thumb and index finger and thus work which is typically done by women. It may also be of traumatic origin following joint fracture, but this is not discussed in the present paper. The treatment of this syndrome by stabilisation of the joint is described.

Denervation, provosed at the turn of the century and abandoned because of inconstant results, has again been taken up in principle, but with a notable change in technique. It is necessary to do a careful examination of the muscles that are to be denervated (of the median and ulnar nerves) and to determine the nature of the spasticity. The incision, longer than in the original technique, allows a better view of the median and ulnar nerves. The nerve branches to each muscle are thus easily identified, and by electric stimulation during the operation one judges how much denervation to subject the muscles to while taking into account the phenomenon of the take-over of the denervated muscles by the remaining nerve fibers. Part of the nerve branches are then sectioned under microscopic control near the muscle, taking care to cauterize the proximal stump. It may be necessary to do associated tenotomies or capsulotomies. This method gives good results if the technique and the contraindications, (athetosis, chorea and cerebral deficits) are respected. It must be emphasized that the results depend on the degree of denervation, which is hardly quantifiable, and is subject to the operator's experience.

The present evaluations of hand invalidity are based on parameters that can give correct assessment for amputations or for single stiffness, but these parameters are not able to evaluate the majority of lesions. A nerve lesion does not repair at 100% or at 0%; all degrees are possible. The same is true for vascular, tendon and muscular lesions. We studied a new global evaluation on a large number of patients and we compared it with the tables in use today. The assessed parameters are: the active and passive movement, ability of the hand, strength, duration of the effort or of the fatigue, trophism, sensibility, pain, aesthetics.

Leukotrienes (LTs) are released from human lung “in vitro” 1’2 and they exert a potent bronshocontracturating activity in normal and asthmatic subjects3, suggesting an important role for LTs in the allergic bronchoconstriction4. On the other hand anaphylactic shock is accompanied by increase in pulmonary vascular resistance5 and both specific antigen-challenge and LTs “in vitro” induce a vasoconstriction of pulmonary vessels of different animal species6,7. During anaphylactic reaction the vessels of the respiratory system release a considerable amount of LTD4 8,9 and its relative low pharmacological activity10 in this vascular tissue does not rule out a possible interaction with other chemical mediators. All these observations prompted us to investigate the ability of LTs to induce vascular hyperreactivity to other vasoactive compounds. In this regard LTs have been suggested to play a role in the pathogenesis of bronchial hyperreactivity11,12; in addition to this, Creese and Bach13 have shown in guinea-pig tracheal smooth muscle a clear cut potentiating action of LTD4 on histamine and acetylcholine induced contractions.

The bronchodilating activity of mequitazine (MQ) (10-[3- quinuclidynilmethyl ]-phenothiazine) has been investigated in the guinea-pig using various spasmogens such as acetylcholine, histamine and leukotriene-C4 (LTC4). Mequitazine showed a potent protecting activity versus bronchoconstriction induced by the above agonists and was also able to prevent their capacity to trigger activation of arachidonic acid metabolism and preferential formation of TXA2. The results obtained with the "in vivo" experiments correlate well with those obtained "in vitro" using guinea-pig perfused lungs, where LTC4 and histamine stimulate TXA2 formation and release in the pulmonary effluent. MQ demonstrated its efficacy in protecting passively sensitized guinea-pigs from antigen challenge; this protection is accompanied by a substantial reduction of circulating TXA2. The bronchodilating and antiallergic activity of MQ is likely due to a direct control of histamine and muscarinic receptors and to a diminished bioamplification via eicosanoid activation. In addition, the capacity of MQ to counteract the "in vitro" and "in vivo" effects of LTC4 adds interest to its therapeutic potential.

Patellectomy is performed by different surgeons for various conditions, e. g. patlar comminuted fractures, patellar chondromalacia, patellofemoral arthrosis. Some consider patellectomy a good operation, others think poorly of it and perform it only under very restricted situations.

The story of free microneurovascular muscle grafts is still at an early stage. Different muscles have been suggested and some of them have been tested (gracilis, rectus anterior, extensor digitorum brevis for example). However, when considering a muscle that can be applied to the forearm, it becomes evident that none of the proposed muscles are suitable, mainly because they do not correspond with the muscles in the forearm, the length of the muscle being disproportionate to that of the tendon. We therefore considered the tensor fasciae latae muscle as a potential muscle donor since it has a muscular venter of about 13-15 em and tendons of any desired length. We then conducted anatomic research on cadavers and electrophysiological research on patients who were undergoing hip surgery. The tensor muscle is extremely interesting since it is continuous with the Maissiat band, true tendon in the whole fascia lata, and so great in length that it allows arm grafting with the transmission of action to the hand from the forearm. This small band is wide, and it can be divided in such a way as to transmit the flexor (or extensor) action to the four fingers and, if necessary, even to the thumb. Anatomic research has proved that the muscular belly of the tensor muscle is on the average 14 em long, while the tendon can reach 45 em in tall persons. Vascularization is provided by an artery which originates in the lateral circumflex femoral artery and which has a diameter of 1.1-1. 3 millimeters, a more than reasonable size in microsurgery. The direction is medial-lateral. The vein or veins (2 comitantes) are tributaries of the lateral circumflex femoral vein which, when single, can reach 1.5-1.7 mm in diameter and, when

1 PGD2 dose dependently potentiated the parasympathetic-induced contraction in guinea-pig trachea in vitro. This phenomenon was much more evident in ovalbumin-sensitized guinea-pig trachea. 2 Indomethacin pretreatment enhanced the capacity of PGD2 to potentiate cholinergic-induced contraction in normal but not in ovalbumin-sensitized guinea-pig. 3 PGD2 shifted to the left the curve of the exogenous acetylcholine-induced contraction in guinea-pig trachea, indicating a postsynaptic site of action of PGD2. 4 These data suggest a role of PGD2 in the genesis of hyperreactivity of tracheal smooth muscles, particularly in a model of pulmonary anaphylaxis.

The Authors report their experience with 222 esophagoenteric anastomoses, performed in 211 cases for malignant neoplasms (middle and lower third) of the esophagus or stomach. Particularly, they have performed 4 Sujura operations, 31 esophagogastric, 4 esophagocolic, 183 esophagojejunal anastomoses utilizing SPTU, ILS and EEA circular stapler. GIA was used in the preparation of the stomach before esophagogastroplasty. Mortality rate of the manual period (1970-1980: 114 cases operated) was 14.5% versus 2.2% of the stapling period (1981-1987: 222 cases operated). From the technical point of view reasons of the superiority of stapled technique are discussed and summarized as follows: 1) space not favourable for handsewn anastomoses; 2) stapled technique allows the surgeon to save anastomoses vascularization; 3) the stapler performs the suture simultaneously so to reduce tensile strength on the anastomoses and the fragile esophageal wall especially; 4) stapled agraphes are fixed in three points vs. the two points of the handsewn stitches.

Bromelain, a proteolytic enzyme extracted from pineapple plants, was investigated for its capacity to interfere with arachidonic acid metabolism, since prostaglandins and other eicosanoids are well-known to be involved in the pathogenesis of inflammatory diseases. Bromelain was tested for its ability to interfere with eicosanoids generation in vivo in two experimentally-induced inflammatory reactions in the rat. Also antiplatelet aggregation activity of bromelain was studied in ex vivo rat platelets. The results seem to indicate an interference of bromelain with arachidonic acid cascade, which, however, deserves further investigation to be better assessed.

We report the data of 878 selected children between 1 month and 6 years, presenting a first episode of seizure with fever. Two-hundred-fifty-five children underwent lumbar puncture. In 7 cases the CSF findings showed a bacterial meningitis, in 14 cases a viral meningitis. In 598 of the 623 children who did not undergo LP, a bacterial meningitis could be excluded on the basis of the clinical course. The data show that the probability of finding a bacterial or viral meningitis is high in children under 6 months of age even if no significant neurological signs are found on examination performed shortly after the seizure. In our study, older children affected by bacterial meningitis were clinically identifiable. In children aged 6 months to 3 years without important neurological signs, a complex seizure has been found to be a significant discriminating factor between patients with and without viral meningitis.

It is known that a normally innervated muscle cannot be innervated by another nerve but that a denervated muscle has a spread sensitivity to acetylcholine and therefore can accept a new nerve.

In this paper the results of treatment in 19 cases of postactinic paralysis of the brachial plexus are reported. The surgical technique aimed at resolving this condition, which is serious and often extremely painful, involves neurolysis and a long, narrow free omental graft and removal of the clavicle; the donor vessels are the left gastroepiploic arteries and veins; the recipient vessels are those distant from the irradiated area (often in the neck, transverse and facial arteries, veins affluent to the external jugular).

Experiments in rats, introducing the proximal and distal stumps of tibial and sural nerves into a vein graft, showed by acetylcholinesterase and toluidine blue staining that sensory and motor fibers mix inside the vein graft, but that nevertheless they are able to select their distal targets correctly. The authors' hypothesis is that surface membrane antigens of Schwann cells might be responsible for this chemotactic phenomenon.

Pulmonary hyperreactivity is a common feature in asthma. In the present study we investigated the possible role of different mediators in the genesis of this phenomenon. In particular the ability of prostaglandin D2 (PGD2), substance P (SP) and bradykinin (BK) to potentiate acetylcholine (ACh)-induced bronchospasm was assessed in anaesthetized and mechanically ventilated guinea-pigs. Threshold doses of PGD2, SP and BK significantly enhanced ACh-induced bronchospasm in normal guinea-pigs, even if a different trend in the onset and duration of the phenomenon was observed. Ovalbumin (OA) active sensitization modified the ability of the three compounds tested to positively interact with ACh. Beta-adrenoceptor blockade due to propranolol treatment increased the positive interaction between the three compounds and ACh. The role of PGD2, SP and BK in the genesis of pulmonary hyperreactivity is proposed and the relevance of mediator-mediator interaction during adrenergic imbalance is discussed.

The aim of this study was to obtain precise data on muscular degeneration and regeneration after ischemia, with reference to reimplantation in human beings. Ischemia was induced in 386 rabbits in order to study the tolerance of muscle to various types of ischemic conditions and the capacity of muscle to regenerate in these conditions.

Summary The selectivity of procaterol for β 2 -adrenoceptors vs β 1 -adrenoceptors in animals has been already described. In these studies the ability of procaterol to protect guinea-pig against bronchoconstriction induced by various spasmogens such as histamine, LTC 4 and acetylcholine is demonstrated. The results obtained both in anaesthetized animals and in perfused lungs clearly show that procaterol antagonizes not only the direct effect of the bronchoconstrictors quoted above but also their ability to activate arachidonic acid metabolism and to augment the generation of TXA 2 . Procaterol (0,3-3 μg/Kg i.v.) is more potent than salbutamol in protecting passively sensitized guinea-pig from massive bronchoconstriction following antigen challenge: a phenomenon which is paralleled by an increment of the circulating TXA 2 . The possibility that the adenylate-cyclase-stimulating properties of procaterol may explain its antiasthmatic activity is discussed.