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Insulating electrodes, also known as capacitive electrodes, allow acquiring biopotentials without galvanic contact with the body. They operate with displacement currents instead of real charge currents, and the electrolytic electrode-skin interface is replaced by a dielectric film. The use of insulating electrodes is not the end of electrode interface problems but the beginning of new ones: coupling capacitances are of the order of pF calling for ultra-high input impedance amplifiers and careful biasing, guarding and shielding techniques. In this work, the general requirements of front ends for capacitive electrodes are presented and the different contributions to the overall noise are discussed and estimated. This analysis yields that noise bounds depend on features of the available devices as current and voltage noise, but the final noise level also depends on parasitic capacitances, requiring a careful shield and printed circuit design. When the dielectric layer is placed on the skin, the present-day amplifiers allow achieving noise levels similar to those provided by wet electrodes. Furthermore, capacitive electrode technology allows acquiring high quality ECG signals through thin clothes. A prototype front end for capacitive electrodes was built and tested. ECG signals were acquired with these electrodes in direct contact with the skin and also through cotton clothes 350 µm thick. They were compared with simultaneously acquired signals by means of wet electrodes and no significant differences were observed between both output signals.

Recent studies on handwriting production and neuropsychological data have suggested that orthographic representations are multilevel structures that encode information on letter identity and order, but also on intermediate-grained processing units such as syllables and morphemes. This study on handwriting production examined whether orthographic representations also include a graphemic-processing level. French adults wrote words containing an embedded one-, two-, or three-letter grapheme (e.g., a in clavier, ai in prairie, ain in plainte) on a digitizer. The results for letter duration revealed that the timing of movement processing depends on grapheme length (e.g., the duration of a for one-letter graphemes was shorter than that for two-letter graphemes, which, in turn, was shorter than that for three-letter graphemes). Two- and three-letter graphemes start to be processed before we start to write them. The results therefore revealed that orthographic representations also encode information on grapheme complexity.

We investigated the use of language-specific intonational cues to word segmentation in French. Participants listened to phonemically identical sequences such as /selafi/, C'est la fiche/l'affiche "It's the sheet/poster." We modified the f0 of the first vowel /a/ of the natural consonant-initial production la fiche, so that it was equal to that of the natural vowel-initial production l'affiche (resynth-consonant-equal condition), higher (resynth-consonant-higher condition), or lower (resynth-consonant-lower condition). In a two-alternative forced choice task (Experiment 1), increasing the f0 in the /a/ of la fiche increased the percentage of vowel-initial (affiche) responses. In Experiment 2, participants made visual lexical decisions to vowel-initial targets (affiche) following both the natural consonant-initial production (la fiche) and the resynth-consonant-equal version. Facilitation was found only for the resynth-consonant-equal condition, suggesting that raising the f0 allowed online activation of vowel-initial targets. The recognition system seems to exploit intonational information to guide segmentation toward the beginning of content words.

A novel scheme and a digital approach to the Driven Right Leg Circuit (DRL) are presented. It presents an ultra high common mode (CM) reduction of power line interference (higher than 80dB) without endangering stability. This improves by 40-50dB the CM reduction provided by a classical analog DRL, retaining the same stability criterion. The improvement comes from the inclusion of a high Q resonator in parallel with the common mode amplifier. It provides a large gain at power line frequency (50/60 Hz) whereas it does not significantly affect the open loop gain for high frequencies. The proposed scheme can be thought as an analog circuit, but the accuracy required, mainly in the resonator frequency response, leads to a digital implementation. In this way, component ageing and thermal fluctuation problems are avoided, as well as the need for manual adjusting. A prototype of the proposed DRL circuit was built and tested in laboratory conditions showing an open-loop gain of 74dB at 50Hz. It was also tested by acquiring real EEG signals.

Cystic fibrosis (CF; MIM# 219700) is the most frequent recessive disease in Caucasian patients. However, immigration from the Middle East and Africa to Europe is revealing different CFTR mutations. Here, we have described an 875+1G-->A mutation, found for the first time in a homozygous state in an 8 yr old boy. He was the child of a couple of Egyptian first level cousins, both carriers of the mutation. The functional test revealed the 875+1G-->A to be a severe mutation, leading to defective protein function as detected by nasal potential difference (NPD) measurements.

Objective: To determine the genetic cause of primary amenorrhea in a 46,XY woman., Design: Case report., Setting: Centre of Gynecological Endocrinology and Cytogenetics and Molecular Genetics Laboratory of university medical school., Patient(s): A 19-year-old woman referred for primary amenorrhea., Intervention(s): Clinical, endocrinologic, and ultrasonographic investigation and SRY mutation analysis., Main Outcome Measure(s): Hormone profile (LH, FSH, PRL, leptin, E(2), 17alpha-hydroxyprogesterone, 3alpha-androstanediol glucuronide), ultrasonographic evaluation, clinical follow-up., Result(s): A new SRY sporadic mutation due to a single nucleotide insertion at codon 13 position 38 (38-39insA) was found in a 46,XY woman with sex reversal. This mutation determined a frameshift of the reading frame sequence and a protein truncation at codon 16. Clinical and endocrinologic data are reported., Conclusion(s): This is a new rare case of a single nucleotide insertion affecting the SRY gene in 46,XY females with sex reversal. This new mutation should be considered in genetic counseling.

This study investigates whether children's production and recognition of obligatory liaison sequences in French depend on the singular/plural orientation of nouns. Certain nouns occur more frequently in the plural (e.g., arbre "tree"), whereas others are found more often in the singular (e.g., arc-en-ciel "rainbow"). In the input, children more frequently encounter these plural-oriented nouns after determiners that indicate plurality (e.g., les,des "the", deux "two") and that are often associated with a /z/ liaison (e.g., deux arbres [døzarbr] "two trees"). In Experiment 1, 122 children (3 years 2 months to 6 years 3 months of age) were asked to produce nominal phrases with either /z/ liaisons (i.e., in plural contexts such as deux ours [døzurs] "two bears") or /n/ liaisons (i.e., in singular contexts such as un ours [oe nurs] "one bear"). We found correlations between the plural orientation of the nouns and (a) the probability that they will be preceded by an incorrect /z/ liaison in the singular context and (b) the probability that they will be preceded by a correct /z/ liaison in the plural context. This result was, however, restricted to the younger children. In Experiment 2, 20 children (5 years 5 months to 6 years 3 months of age) were asked to monitor target words in auditorily presented sentences. The results showed shorter reaction times for singular-oriented nouns when preceded by a singular determiner than when preceded by a plural determiner. Conversely, plural-oriented nouns were responded to faster when preceded by a plural determiner than when preceded by a singular determiner. Results are discussed within the framework of a two-stage model of liaison acquisition recently proposed by Chevrot, Chabanal, and Dugua (Journal of French Language Studies,17 [2007] 103-128) as well as by Chevrot, Dugua, and Fayol (Journal of Child Language [in press]).

CSF-1, by binding to its high-affinity receptor CSF-1R, sustains the survival and proliferation of monocyte/macrophages, which are central cells of innate immunity and inflammation. The MAPK ERK5 (also known as big MAPK-1, BMK1, or MAPK7) is a 98-kDa molecule sharing high homology with ERK1/2. ERK5 is activated by oxidative stress or growth factor stimulation. This study was undertaken to characterize ERK5 involvement in macrophage signaling that is elicited by CSF-1. Exposure to the CSF-1 of primary human macrophages or murine macrophage cell lines, as well as murine fibroblasts expressing ectopic CSF-1R, resulted in a rapid and sustained increase of ERK5 phosphorylation on activation-specific residues. In the BAC1.2F5 macrophage cell line, ERK5 was also activated by another mitogen, GM-CSF, while macrophage activators such as LPS or IFN-gamma and a number of nonproliferative cytokines failed. Src family kinases were found to link the activation of CSF-1R to that of ERK5, whereas protein kinase C or the serine phosphatases PP1 and PP2A seem not to be involved in the process. Treatment of macrophages with ERK5-specific small interfering RNA markedly reduced CSF-1-induced DNA synthesis and total c-Jun phosphorylation and expression, while increasing the expression of the cyclin-dependent kinase inhibitor p27. Following CSF-1 treatment, the active form of ERK5 rapidly translocated from cytosol to nucleus. Taken together, the results reported in this study show that ERK5 is indispensable for optimal CSF-1-induced proliferation and indicate a novel target for its control.

We analysed the in vitro effects of a new hydroxamate derivative, ITF2357, on AML cells. ITF2357 potently induced histone acetylation. ITF2357 0.1 microM blocked proliferation and induced apoptosis in AML1/ETO-positive Kasumi-1 cells, while AML1/ETO-negative HL60, THP1 and NB4 cell lines were sensitive only to 1 microM ITF2357. Apoptosis was induced by 0.1 microM ITF2357 in AML1/ETO-positive primary blasts and U937-A/E cells induced to express AML1/ETO, but not in U937-A/E cells non-expressing AML1/ETO. In Kasumi-1 cells 0.1 microM ITF2357 induced AML1/ETO degradation through a caspase-dependent mechanism. ITF2357 0.1 microM also determined DNMT1 efflux from, and p300 influx to, the nucleus. Moreover, 0.1 microM ITF2357 determined local H4 acetylation and release of DNMT1, HDAC1 and AML1/ETO, paralleled by recruitment of p300 to the IL-3 gene promoter. ITF2357 treatment, however, did not induce re-expression of IL-3 gene. Accordingly, the methylation level of IL-3 promoter, as well as of several other genes, was unmodified. In conclusion, ITF2357 emerged as an anti-leukaemic agent very potent on AML cells, and on AML1/ETO-positive cells in particular. More relevantly, clearly emerged from our results that ITF2357 could be an ideal agent to treat AML subtypes presenting AML1/ETO fusion protein which determine HDAC involvement in leukaemogenesis.

In a crossmodal priming experiment, visual targets (e.g. RENARD, 'fox') were auditorily primed by either an intact [see text] 'the fox' or reduced form [see text] 'the fox' of the word. When schwa deletion gave rise to an initial cluster that respected the phonotactic constraints of French (e.g. [lapluz] 'the lawn' in which /pl/ is a legal word beginning in French), there was a processing cost for the targets primed by the reduced form of the word compared to intact primes (e.g. [see text] 'the lawn'). However, when schwa deletion produced an initial cluster that violated the phonotactic constraints of French (e.g. [see text], where /Rn/ is not allowed as a word beginning), there was no penalty for targets primed by reduced compared to intact forms of the word. Assuming that listeners change their phonemic percept when confronted with phonotactically illegal sequences (Segui, Frauenfelder, & Hallé, 2001), phonotactic constraints may help to restore the deleted schwa in sequences like le renard [see text] in French.

The French language has a grammatical gender system in which all nouns are assigned either a masculine or a feminine gender. Nouns provide two types of gender cues that can potentially guide gender attribution: morphophonological cues carried by endings and semantic cues (natural gender). The first goal of this study was to describe the acquisition of the probabilistic system based on phonological oppositions on word endings by French-speaking children. The second goal was to explore the extent to which this system affects categorization. In the study, 3- to 9-year-olds assigned gender categorization to invented nouns whose endings were typically masculine, typically feminine, or neutral. Two response conditions were used. In the determiner condition, children indicated the gender class by orally providing the determiner un or une marked for gender. In the picture condition, responses were given by pointing to the picture of a Martian-like female or male person that would be best called by each spoken pseudoword. Results indicated that as young as 3 years, children associated the determiner corresponding to the ending bias at greater than chance levels. Ending-consistent performance increased from 3 to 9 years of age. Moreover, from 4 years of age onward, sensitivity to endings affected categorization. Starting at that age, pictures were selected according to endings at greater than chance levels. This effect also increased with age. The discussion deals with the mechanisms of language acquisition and the relation between language and cognition.

The semaphorin family of guidance molecules plays a role in many aspects of neural development, and more recently semaphorins have been implicated to contribute to the failure of injured CNS neurons to regenerate. While semaphorin expression patterns after neural injury are partially understood, little is known about the expression of their signal transducing transmembrane receptors, the plexins. Therefore, in this study, we compared the expression patterns of all class A plexins (Plxn-A1, A2, A3, A4) in mouse CNS (rubrospinal) and peripheral nervous system (PNS)-projecting (facial) motoneurons for up to two weeks following axonal injury. Using in situ hybridization, immunohistochemistry, and Western blot analysis, in rubrospinal neurons, Plxn-A1 mRNA and protein and Plxn-A4 expression did not change as a result of injury while Plxn-A2 mRNA increased and Plxn-A3 mRNA was undetectable. In facial motoneurons, Plxn-A1, -A3 and -A4 mRNA expression increased, Plxn-A2 mRNA decreased while Plxn-A1 protein expression did not change following injury. We demonstrate that with the exception of the absence of Plxn-A3 mRNA in rubrospinal neurons, both injured rubrospinal (CNS) and facial (PNS) neurons maintain expression of all plexin A family members tested. Hence, there are distinct expression patterns of the individual plexin-A family members suggesting that regenerating rubrospinal and facial motoneurons have a differential ability to transduce semaphorin signals.

Imatinib is the first molecular targeted therapy that has shown clinical success, but imatinib acquired resistance, although a rare event, is critical during the therapy of chronic myelogenous leukaemia (CML). With the aim of better understanding the molecular mechanisms accompanying acquisition of resistance to this drug, a comparative proteomic approach was undertaken on CML cell lines LAMA 84 S (imatinib sensitive) and LAMA 84 R (imatinib resistant). Forty-four differentially expressed proteins were identified and categorized into five main functional classes: (I) heat shock proteins and chaperones; (II) nucleic acid interacting proteins (binding/synthesis/stability); (III) structural proteins, (IV) cell signaling, and (V) metabolic enzymes. Several heat shock proteins known to complex Bcr-Abl were overexpressed in imatinib resistant cells, showing a possible involvement of these proteins in the mechanism of resistance. HnRNPs also resulted in being up-regulated in imatinib resistant cells. These proteins have been shown to be strongly and directly related to Bcr-Abl activity. To our knowledge, this is the first direct proteomic comparison of imatinib sensitive/resistant CML cell lines.

We present a forward problem formulation for computing biopotentials measured with dry or capacitive electrodes. This formulation is not quasistatic and has mixed boundary conditions. Our results show that simple approximations to the measurements based on capacitive coupling are adequate in most situations. We study the range of validity and errors committed in the EEG forward and inverse problems when using this approximation.

Lexical decision latencies to word targets presented either visually or auditorily were faster when directly preceded by a briefly presented (53-ms) pattern-masked visual prime that was the same word as the target (repetition primes), compared with different word primes. Primes that were pseudohomophones of target words did not significantly influence target processing compared with unrelated primes (Experiments 1-2) but did produce robust priming effects with slightly longer prime exposures (67 ms) in Experiment 3. Like repetition priming, these pseudohomophone priming effects did not interact with target modality. Experiments 4 and 5 replicated this general pattern of effects while introducing a different measure of prime visibility and an orthographic priming condition. Results are interpreted within the framework of a bimodal interactive activation model., (((c) 2003 APA, all rights reserved))

In three experiments, we examined the effects of phonological resyllabification processes on the perception of French speech. Enchainment involves the resyllabification of a word-final consonant across a syllable boundary (e.g., in chaque avion, the /k/ crosses the syllable boundary to become syllable initial). Liaison involves a further process of realization of a latent consonant, alongside resyllabification (e.g., the /t/ in petit avion). If the syllable is a dominant unit of perception in French (Mehler, Dommergues, Frauenfelder, & Segui, 1981), these processes should cause problems for recognition of the following word. A cross-modal priming experiment showed no cost attached to either type of resyllabification in terms of reduced activation of the following word. Furthermore, word- and sequence-monitoring experiments again showed no cost and suggested that the recognition of vowel-initial words may be facilitated when they are preceded by a word that had undergone resyllabification through enchainment or liaison. We examine the sources of information that could underpin facilitation and propose a refinement of the syllable's role in the perception of French speech.

Muscle fibre conduction velocity is an important measurement in electrophysiology, both in the research laboratory and in clinical practice. It is usually measured by placing electrodes spaced at known distances and estimating the transit time of the action potential. The problem, common to all methods, is the estimation of this time delay. Several measurement procedures, in the time and frequency domains, have been proposed. Time-domain strategies usually require two acquisition channels, whereas some frequency-domain methods can be implemented using a single one. The method described operates in the time domain, making use of the autocorrelation function of the difference signal obtained from two needle electrodes and only one acquisition channel. Experimental results were obtained from the electromyogram of two biceps muscles (two adult male subjects, nine records each) under voluntary contraction, yielding an average of 3.58 m s(-1) (SD=0.04 m s(-1)) and 3.37m s(-1) (SD=0.03 m s(-1)), respectively. Several tests showed that the proposed method works properly with electromyogram records as short as 0.3 s.

Although therapeutic thinking and practice have entered their second century, most practitioners remain largely uncertain as to what data to trust, including "what works" and, "why it works." If anything, practitioners' reliance on ever-increasing numbers of theoretical models and either vague or contradictory research findings as primary guidelines to their practice has added to the confusion. What can the practitioner trust? This paper puts forward the "dangerous proposal" that it is of primary value for clinical professionals to place their trust on an often overlooked variable: the clients' statements about their therapy and their relationship to and with their therapist. It is argued that through the clarification of this variable will emerge a better understanding of the nonspecific variables of the therapeutic relationship itself and, as significantly, of the encompassing interrelational realms of discourse evident in all therapeutic models.

A three op-amps instrumentation amplifier (I.A) with active dc suppression is presented. dc suppression is achieved by means of a controlled floating source at the input stage, to compensate electrode and op-amps offset voltages. This isolated floating source is built around an optical-isolated device using a general-purpose optocoupler, working as a photovoltaic generator. The proposed circuit has many interesting characteristics regarding simplicity and cost, while preserving common mode rejection ratio (CMRR) and high input impedance characteristics of the classic three op-amps I.A. As an example, a biopotential amplifier with a gain of 80 dB, a lower cutoff frequency of 0.1 Hz, and a dc input range of +/- 8 mV was built and tested. Using general-purpose op-amps, a CMRR of 105 was achieved without trimmings.

Biopotential measurements are very sensitive to electromagnetic interference (EMI). EMI gets into the acquisition system by many ways, both as differential and common mode signals, driven-right-leg circuits (DRL) are widely used to reduce common mode interference. This paper reports an improvement on the classic DRL. The proposed circuit uses a transconductance amplifier to drive the patient's body. This configuration has some interesting properties, which provide an extended bandwidth for high-frequency EMI rejection (such as fluorescent lights interference). The improvement is around 20 dB for frequencies of few kilohertz and the circuit is easy to compensate for stability. A comparative analysis against a typical DRL is presented, the results obtained have been experimentally tested.

A literature review of the initial attempt to correlate tumor size in NSCLC with the expectancy of survival is presented starting from the 60s. The larger size was connected with an increased risk of metastatic diffusion. In the 70s resulted evident the relationship between tumor size and lymph node involvement so affecting survival. In the context of the TNM Staging System (Mountain 1986) size appeared a well assessed factor of prognosis and is recognised to play a major role in Stage I where the subsets T1N0 and T2N0 showed a consistent difference in survival across the 3 cm cut-off. The peculiar relation between largest size and mediastinal lymph node metastases is discussed as well as the proposal to allocate T2 descriptor within the range 3-5 cm. Finally, series of clinical observations from Japanese experience about small sized T1N0 tumors are presented and discussed.

The rationale of the Staging System of Lung Cancer is discussed from his presentation (Mountain, 1985) to the recent revision and proposals of new classifications. Survival rates offered a strong statistical support to the latest revision in 1997. Stage Group have become 7 out of Stage 0 (Tis). In the New Lymph Node Map, station 4 is confirmed as mediastinal (N2). The improved definition of Stage Grouping requires a golden standard of staging and a worldwide consensus on the surgical approach to mediastinal lymphadenectomy. IASLC, the International Association for the Study of Lung Cancer, is now moving to collect a new largest database with the aim to offer the next expected Revision.

Will Rogers phenomenon affects survival statistics applied to clinical research and could determine a misreading of results. Stage migration due to new methods of diagnostic imaging and staging invasive procedures could improve actuarial survival in each stage. TNM System is impaired when survival rates come from different inhomogeneous countries, regions and eras. Randomized trials suffer this fallacious phenomenon when staging depends on the different treatments which are to be evaluated.

Years of debates couldn't solve the discussion between the NSCLC assessment founded on CT scan and mediastinoscopy as in the Western countries and the refined extensive bronchoscopy, CT imaging and exploratory thoracotomy as practiced in Japan. Recently, the clinical onset of combined therapy protocols, the recognised value of the intrathoracic staging (also in the West) and survival rates in the earlier N2 disease moved towards change this steady situation. The role of complete resection in N2 NSCLC is therefore debated from the preoperative assessment to survival results in resected cases. Accuracy of CT scan and cervical mediastinoscopy is discussed also in the light of neoadjuvant therapy. The clinical value of intrathoracic staging is improved by Japanese experiences while a rationale assessment of Complete/Incomplete Resections is defined. Moreover, technical details of intraoperative recognition are cleared.

The Elderly Services of USL 3 "Genovese" together with the team for Continuing Education designed and implemented a survey on the elderly clients referred to the home care and nursing home services. The aim of the study was to describe the frequency, distribution and severity of pressure ulcers. The data were collected during a period of seven months: from 1st November 1997 to 31st May 1998. One thousand seven hundred and twenty nine clients were observed; 705 (41%) had single or multiple pressure ulcers. Patients with multiple pressure ulcers accounted for 42% of the total. The sacrum was the most affected site (43% of the patients with a single ulcer and 33% with multiple ulcers). Patients with severe pressure ulcers (stages 3 degrees and 4 degrees NPUAP classification) accounted for 42% of the total. Pressure sores were observed in 15% of "at no risk" patients and in 40% of those at low risk (Norton Scale score). The study highlighted a lack of documentation (90% patients) on treatments performed in the hospital and prescribed at discharge for the pressure sores. These findings reflects possibly the fact that this aspect of care is unduly disregarded by nursing personnel, and that a goal-oriented retraining, underlining also the need of appropriate documentation, is warranted.

Such a novel surgical project is supported by a large basic knowledge on molecular biology of solid tumours progression as well as the already assessed clinical experience in the parallel field of surgery for lung, brain and liver metastases. While pathology and the clinical work up have for a long time pointed out the steady rate of adrenal metastatic involvement from lung cancer (from 25 to 28% of all cases at the autopsy and, on clinical grounds, the most important site of extrapulmonary tumour spread just after the first one represented by the mediastinal lymphatic groups), the surgical approach to the problem is still very limited and the few operated cases previously reported in world literature (summing up to a total of 21) are not truly homogeneous and even largely scattered in time. The Authors report on their personal contribution in this field with four consecutive cases who underwent surgery during the last five years. The most important clinical features together with the initial remarkable result obtained in one patient who is still free of disease more than 3 years after the sequential radical resection of the primary lung tumour and the metastatic ipsilateral adrenal gland, are presented. In the light of this preliminary positive experience, the Authors are planning a sound clinical research based on the combined resection of those NSC Lung Cancers which appear surgically resectable but already included in an unresectable Stage IV Disease only because of the contemporary adrenal metastases (M1). An adjuvant chemotherapy in usually added.

Preceded by an international overview on the surgical approach to the peripheral higher stage NSCLC, the cumulative clinical experience from ten Italian University Departments and Teaching Hospitals, is analyzed in the light of the corresponding international contributions. Accordingly, the clinical records of 470 patients affected by such Stage III tumors and surgically treated, were collected and retrospectively reviewed. 43 out of 120 patients belonging to the group of apical invasive Pancoast's tumour underwent an en-bloc chest-wall resection, while an extrapleural dissection was performed in the remaining 77. Combined segmentectomy was prevalent (54%), while lobectomy/bilobectomy was performed in 38%, wedge resection in 5% and pneumonectomy in 3% of all cases respectively. Preoperative high-voltage radiation was given in 70% of them; while adjuvant RT was requested in 17% of cases, mainly because of N1-2 status. Actuarial 5-year survival was 14% with a range of 0% in N2 cases to 21% in NO-1 ones. When considering surgical modes, the en-bloc chest-wall resection had a 5-year survival of 20% while the more limited extrapleural dissection yield only a 9% survival. Compared with the international experience the 14% 5-year survival is standing at the bottom of the scale. On the other hand, 350 patients belong to the other two main groups of peripheral tumors taken in consideration: the ones which, even apical, are yet lying anteriorly far enough from the costo-vertebral angle (apical non Pancoast tumor), and the other ones which are lower placed along the thoracic cage. The majority of these patients (213) were treated by an extrapleural dissection, while the remaining minority (123) received an en-bloc chest-wall resection with 1-2 ribs resected in 46%, 3 ribs in 38% and 4 ribs or more in 16%, respectively. Combined lobectomy/bilobectomy was prevalent (64%), while pneumonectomy was performed in 16%, more limited resections in 16% and exploration alone in 4% respectively. 5-year survival was 18% ranging from 0% in N2 patients to 23% in the NO-1 ones. The extrapleural dissection had a 5-year survival rate of 24.5%, while the en-bloc chest-wall resection yield a lower rate of 15.6%. This overall survival can be indeed considered nearer the international one, even if both surgical approach and the related 5-year survival rates are in full discordance with the compared international references.

The TNM System as originally proposed by Denoix in 1946, provides a consistent, reproducible description of the anatomic extent of disease in cancer patients at a specific time in the life history of the cancer. C.F. Mountain first adapted this classification to lung cancer in 1973 on behalf of AJCC. In 1986 he presented the "New Intl. Staging System for Lung Cancers" mainly based on a 13 yr experience of the previous one, which was accepted world-wide through a round of international consensus meetings held in 1985. Clinical Staging is the best estimate of disease extent made prior to the institution of any therapy; Surgical-pathological Staging is the classification of disease extent as determined from pathological examination of resected specimens. Accordingly, once the diagnosis is made, it is necessary to stage accurately the tumour determining the size and location of the tumour (T status), the presence or absence of lymphnode involvement (N status), and whether the tumour is metastatic to distant sites (M status). Moreover the uniform staging criteria for lung cancer will assure for each patient the better selection of treatment, the evaluation of operability, the need for adjuvant therapy, as well as the estimation of prognosis. Equally important is the resultant ability to compare the outcome of treatment protocols from different centres. More recently C.F. Mountain has added to the Staging System a new standard logic or "convention" for classifying infrequently observed presentations of lung cancer with which the standard rules of Staging System itself don't fit. These conventions are based on empiric expectation for treatment selection and survival that are similar to those for the Staging definitions, which are based on actuarialsurvival data. Many different types of tumour such as multiple masses, synchronous multiple primitives, discontinuous tumour foci in visceral or parietal pleura as well neoplastic involvement of various mediastinal structures, could be now staged with a major benefit for their treatment protocols. In conclusion the Staging System represents today a standard clinical methodology which basically helps in a better clinical approach to lung cancer even if it cannot fully cover and consider all the innumerable manifestations of the tumor. Therefore, if it is true that in the near future the new molecular predictors of prognosis are expected to measure more deeply the extent of disease, for the present time the International Staging System still continues to act as the best common method for measuring prognosis.

Between 1978 and 1994, 55 patients (53 men and 2 women) with a mean age of 62 years underwent an extended lobectomy to the main bronchus, with bronchial re-anastomosis, for bronchogenic tumours located around the lobar orifice. There were 32 upper sleeve lobectomies (58%) with a wedge resection of carina in one instance, 7 lower mono/bilobectomies with an upper lobe "turn up" re-anastomosis (13%) and 16 upper wedge lobectomies (29%). Squamous cell carcinoma was predominant (32 patients, 58%), while the adenocarcinoma was present in 16%, adenosquamous in 5%, microcitoma in 9%, carcinoid in 4% and a well differentiated neuro-endocrine carcinoma in 2%. The indication for the bronchoplastic procedure was judged to be when the FEV, value was about -25% of the normal; in a few patients still in good respiratory condition, an elective indication was also admitted. Postoperative staging was: Stage 0 in 1 patient, Stage I in 7 patients; Stage II in 10 patients; Stage III A in 31 patients; Stage III B in 5 patients and Stage IV in 1 patient. Follow-up was completed with a mean extension of 40 months (range 3 months-16 years). There was no operative mortality in Stages I and II as well as in Stages III B and IV, while it was 9% in Stage III A patients. Survival rates according to the stage were as following: 66% 5 and 10 year for Stage I disease; 56% 5 year and 45% 10 year for Stage II disease; 7% 4 year for Stage III A. None of 5 patients belonging to Stage III B has survived for more than 18 months (mean 7). Some single survivals are mentioned because of their special clinical features. Besides stressing the absolute value of survival rates obtained in Stage I and II disease, the Author also point out the clinical role of these advanced surgical techniques in improving both the survival length and the quality of life, when applied for the treatment of more advanced Stage III A.

A fluorocarbonate emulsion was infused into 30 rabbits after the removal of varying amounts of blood. Parameters relating to the transport of respiratory gases and the fundamental features of the macrocirculation were monitored. The animals were sacrificed after 6 or 24 hr and the histological changes in the main parenchymas were assessed. The material injected displayed low toxicity, a good ability to act as a vehicle for oxygen and carbon dioxide, and no tendency to alter the macrocirculation. Numerous problems remain, however, with regard to the stability of fluorocarbonates over the course of time and the effect of their uptake by tissues.

A series of experiments was carried out to determine histological damages in rabbit's lung, liver, kidney and brain after oxygenated alveolar lavage (L.A.O.).

The nosological polymorphism of peripheral arterial obstruction (A.O.P.) continuously requires new surgical techniques of vascular repair. This led the AA. to develop a new composed aorto-popliteal by-pass. It consists of a proximal (aorto-femoral) synthetic segment (Dacron D.V.) which is distally anastomozed to a biological (Meadox-Dardik Biograft) femoral-popliteal segment. Indications for aorto-popliteal by-pass, technical problems, patient selection and results are here discussed.

Certain fluorinated carbonate compounds can carry O2 and CO2 in a physiological manner. This faculty was exploited in the elaboration of an experimental intra-alveolar oxygenating washing protocol employing such compounds as intrapulmonary oxygenating liquids conveyed by transtracheal flooding of the alveoli in 20 rabbits. AP, PaP, CVP and EP were monitored in accordance with a 35' protocol, during which the positive oxygenation and negative emptying phases of the washing process were repeated at an average 2 cycles/min. A respiratory exchange capable of keeping all the animals alive until the recommencement of spontaneous ventilation was noted, along with only slight changes in lung structure. Once an in-depth study is made of certain fundamental phenomena related to structure and lung function, it is felt that this washing method can be used clinically for the treatment of hypoxaemic situations in which normal alveocapillary exchange is impeded by extraneous material, as in desquamative interstitial pneumonia, pulmonary alveolar proteinosis, etc.

The authors have experimented a fluorocarbon compound (FC 43) in form of a stable emulsion (20%), in the presence of a suitable surfactant agent (Pluronic F 68: 2,5%), as an hematic substitute. The animals (fifteen rabbits) underwent substitution of 50% of the total hematic volume with same volumes of the emulsion and thereafter have been examined for a period of twenty-four hours. During the time of observation there were no changes on: 1) acid-base equilibrium; 2) respiratory homeostasis and 3) major circulatory parameters.

Fluorocarbonates are organic compounds capable of carrying oxygen and surrendering it to tissues by means of biological sound modalities. Experimentation of an emulsion consisting of perfluorotripropylamine and perfluorodecaline (Fluosol DA 20%) as a blood substitute is reported. Acute (Ht less than 1%) and chronic morphological (Ht = 15%) studies were performed on rats, and a semi-acute biochemical and morphological protocol (Ht = 21%) was experimented in pigs. The first signs of altered cerebral electrical activity occurred at Ht = 2% in the acute experiments, and death due to respiratory arrest took pace at Ht = 0.5%. In the semiacute and chronic experiments, widespread infiltration of fluorocarbonic micelles was noted on histological and electron microscope lung and liver preparations.

The fate of two different kinds of new small arterial substitutes, porous and nonporous, has been compared, particularly with regard to the structure of the luminal surface. Twenty-eight weavenit Dacron pyrolytic carbon coated grafts and 28 glutaraldehyde-tanned human umbilical vein segments were implanted into the carotid arteries of dogs. Grafts were removed at intervals, from ten to 120 days after implantation, and examined by scanning electron microscopy. The cumulative patency rate was 96.4 per cent for Dacron and 85.7 per cent for umbilical vein grafts. Ten days after implantation, the Dacron grafts were uniformly covered by a thin thrombus layer, while the umbilical vein grafts showed a thin network of fibrin on the central portion of the luminal surface of the graft and thrombotic deposits at the anastomoses. Thirty days after implantation, both types of prostheses showed the development of a thin fibrous tissue layer on the inner surface. Finally, at 120 days, an endothelial lining was observed.