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Extensive bone defects caused by bone tumor resection, osteomyelitis, congenital pseudoarthrosis, post-traumatic bone loss, or femoral head necrosis, require large bone grafts. Such large defects usually are not amenable to conventional, nonvascularized cancellous grafts. By using vascularized bone grafts that do not undergo creeping substitution, that heal rapidly and are not depending on the surrounding tissue, better, safer, and faster results can be obtained. To compare recoveries after vascularized grafts with those after conventional, nonvascularized grafts, experiments were carried out in a rabbit model. They demonstrated good viability and better and faster healing of the microvascular grafts, using radiography, scintigraphy, light microscopy of bone osteocytes and vessels, and tetracycline double-labeling evaluation techniques.

Aneurysms in the hand are infrequent and aneurysms of the proper digital arteries are particularly rare, only 11 cases having been reported in the literature. The authors describe the case of a patient operated on for two traumatic false aneurysms of the ulnar digital arteries of the middle and ring fingers. Arterial aneurysms should be carefully evaluated to exclude other lesions such as cysts, abscesses, neuromas. The choice between ligation and resection or reconstruction of the vessel should be based on pre-operative and intra-operative evaluation of circulation.

The selectivity of procaterol for beta 2-adrenoceptors vs beta 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, LTC4 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 TXA2. Procaterol (0, 3-3 micrograms/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 TXA2. The possibility that the adenylate-cyclase-stimulating properties of procaterol may explain its antiasthmatic activity is discussed.

Inflammatory process of the airways has been claimed to be relevant to the development of bronchial hyperreactivity in different experimental models. We investigated the consequences of pleural inflammation induced in the guinea-pigs by croton oil injection into the pleural space. Croton oil injection was followed by the development of an inflammatory reaction localized to the pleura as shown by recovery of inflammatory exudate from the pleural cavity of treated animals. An increased number of white cells was observed in the pleural fluid of treated animals as compared to control. Moreover, the croton oil induced inflammation was characterized by development of pulmonary hyperreactivity which involved both airway and vascular smooth muscles. We also studied this phenomenon in an animal model of asthma, such as the actively sensitized guinea-pigs. Polymorphonuclear leukocyte and particularly eosinophil recruitment was increased in this experimental condition and a different trend in the development of the hyperreactive phenomenon was observed. Our data support the relationship between inflammatory process within the pleural space and increased reactivity of pulmonary tissues. The possible involvement of different classes of white cells in this phenomenon has also been discussed.

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.

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.

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.

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.

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.

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.