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Gastric metastasis by solid tumor cancer is a rare event. Concomitant metastases to other organs are frequent, so that this condition is often associated to a poor prognosis. Upper gastrointestinal bleeding and anemia are the most common presenting symptoms. We present the case of a 81 years old women previously treated for cervix carcinoma showing later a stomach metastasis. The patient is alive and disease free 39 months after salvage gastrectomy. A radical surgery in selected patients could be useful for symptom palliation and prolonged survival.

Malignancies of the parotid gland are relatively uncommon, accounting for only 3-6% of all head and neck cancers. Most of them are primary neoplasms, metastases are uncommon. Renal cell carcinoma (RCC) represents 3% of adult malignancies, the clear cell type comprises up to 70% of all RCC. RCC has an unpredictable behavior and the unique potential to metastasize to nearly every organ in the body. Though not as frequent, metastatic RCC to the head and neck has been identified in the thyroid, salivary glands, skull base, sinuses, pharynx, tonsils, tongue, lip and skin. Metastasis to the parotid gland is very rare. Here, we report the case of a clear cell type RCC metastatic to the parotid gland and mimicking a primary clear cell oncocytoma. Differential diagnoses and a brief review of the literature are added.

From corrosion protection to embrittlement and lubrication, the presence of phosphorus at iron surfaces is critical for a range of processes and applications. However, phosphorus adsorption on iron has never been studied experimentally or theoretically. Here P chemisorption on the most stable surface of iron is analyzed by means of density functional theory. The most stable adsorption geometry and coverage are identified, and the changes induced by P adsorption on the structural and electronic properties of the metal are discussed. A systematic comparison among P, S, N, and O uncovers a peculiar behavior of the P and S species: attractive adatom–adatom interactions at high coverage lead to the formation of two-dimensional overlayers that reduce the metal reactivity and work function. This effect is important in iron embrittlement and for the functionality of P- and S-containing additives included in lubricant oils.

The European Conference on Infections in Leukemia (ECIL) provides recommendations for diagnostic strategies and prophylactic, pre-emptive or targeted therapy strategies for various types of infection in patients with hematologic malignancies or hematopoietic stem cell transplantation recipients. Meetings are held every two years since 2005 and evidence-based recommendations are elaborated after evaluation of the literature and discussion among specialists of nearly all European countries. In this manuscript, the ECIL group presents the 2015-update of the recommendations for the targeted treatment of invasive candidiasis, aspergillosis and mucormycosis. Current data now allow a very strong recommendation in favor of echinocandins for first-line therapy of candidemia irrespective of the underlying predisposing factors. Anidulafungin has been given the same grading as the other echinocandins for hemato-oncological patients. The beneficial role of catheter removal in candidemia is strengthened. Aspergillus guidelines now recommend the use of either voriconazole or isavuconazole for first-line treatment of invasive aspergillosis, while first-line combination antifungal therapy is not routinely recommended. As only few new data were published since the last ECIL guidelines, no major changes were made to mucormycosis recommendations. © 2017 Ferrata Storti Foundation.

Background:Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG) QT-prolonging properties are combined is generally supposed but not well studied. Based on available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT) classification defines the risk of QT prolongation for exposure to single drugs. We aimed to investigate how combining AZCERT drug categories impacts QT duration and how relative drug exposure affects the extent of pharmacodynamic drug–drug interactions.Methods:In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other QTc-prolonging risk factors. We concurrently considered administered drug doses and pharmacokinetic interactions modulating drug clearance to calculate individual weights of relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we estimated individual drug exposure with these drugs and included this information as weights in weighted regression analyses.Results:Drugs attributing a ‘known’ risk for clinical consequences were associated with the largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with 95% confidence intervals for ‘known’ risk drugs + 0.93 ms (–8.88;10.75)]. Estimates for the ‘conditional’ risk class increased upon refinement with relative drug exposure and co-administration of a ‘known’ risk drug as a further risk factor.Conclusions:These observations indicate that indiscriminate combinations of QTc-prolonging drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation caused by drug combinations strongly depends on the nature of the combination partners and individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also for the risk prediction of combination therapies with QT-prolonging drugs.

Using the plasma model for the metal dielectric function we have calculated the electromagnetic fluctuation induced forces on a free standing metallic film in vacuum as a function of the film size and the plasma frequency. The force for unit area is attractive and for a given film thickness it shows an intensity maximum at a specific plasma value, which cannot be predicted on the basis of a non retarded description of the electromagnetic interaction. If the film is deposited on a substrate or interacts with a plate, both the sign and the value of the force are modified. It is shown that the force can change sign from attraction to repulsion upon changing the substrate plasma frequency. A detailed comparison between the force on the film boundaries and the force between film and substrate indicates that, for 50-100 nm thick films, they are comparable when film-substrate distance is of the order of the film thickness.

Leptin is an adipocyte-derived signal factor (167 amino acid protein) encoded by the ob gene in chromosome 7q31 that regulates eating behaviour via central neuroendocrine mechanisms. It has been shown that serum leptin levels correlate with weight and percentage body fat in normal and obese individuals, but the exact correlation between leptin and body weight in anorexic and bulimic patients has not yet been clarified. We investigated leptin levels in the serum of 58 female subjects aged 15-36 years: 10 with bulimia nervosa (BN); 12 with anorexia nervosa (AN); 12 overweight controls (not BN); 12 weight-reduced controls (not AN); and 12 normal weight controls. The aim of the study was to evaluate the possible correlations between leptin levels and the body mass index (BMI) in all five groups. Our results showed that the serum leptin levels of the bulimic patients were similar to those of the healthy controls, with a positive correlation between leptin and BMI. Although bulimic patients have very bad nutritional behaviour, their leptin levels do not appear altered. Serum leptin was significantly (p

We performed self-consistent linear muffin-tin orbital atomic sphere approximation calculations of the electronic structure of the 1{times}1 YBa{sub 2}Cu{sub 3}O{sub 7}/PrBa{sub 2}Cu{sub 3}O{sub 7} (YBCO/PBCO) superlattice, based on the local-spin-density approximation with on-site Coulomb correlation. From our results, we can exclude that the experimentally observed depression of the critical temperature is originated intrinsically by a modification of the electronic structure of the CuO{sub 2} planes. We find that the charge transfer between YBCO and PBCO layers is one order lower than the value required to explain the strong depression of both the critical temperature {ital T}{sub {ital c}}(onset) and the zero-resistance transition temperature {ital T}{sup 0}{sub {ital c}}, within the hole-filling model. {copyright} {ital 1996 The American Physical Society.}

Electronic structure calculations based on the local-spin-density approximation (LSDA) fail to reproduce the antiferromagnetic ground state of PrBa{sub 2}Cu{sub 3}O{sub 7} (PBCO). We have performed linear muffin-tin orbital--atomic sphere approximation calculations, based on the local-spin-density approximation with on-site Coulomb correlation applied to Cu(1) and Cu(2) 3{ital d} states. We have found that inclusion of the on-site Coulomb interaction modifies qualitatively the electronic structure of PBCO with respect to the LSDA results, and gives Cu spin moments in good agreement with the experimental values. The Cu(2) upper Hubbard band lies about 1 eV above the Fermi energy, indicating a Cu{sup II} oxidation state. On the other hand, the Cu(1) upper Hubbard band is located across the Fermi level, which implies an intermediate oxidation state for the Cu(1) ion, between Cu{sup I} and Cu{sup II}. The metallic character of the CuO chains is preserved, in agreement with optical reflectivity [K. Takenaka {ital et} {ital al}., Phys. Rev. B 46, 5833 (1992)] and positron annihilation experiments [L. Hoffmann {ital et} {ital al}., Phys. Rev. Lett. 71, 4047 (1993)]. These results support the view of an extrinsic origin of the insulating character of PrBa{sub 2}Cu{sub 3}O{sub 7}.

Charge transfer effects in YBa2Cu3O7/PrBa2Cu3O7 superlattices have been proposed by many authors as the origin of the experimentally observed strong depression of the critical temperature. We performed self-consistent LMTO-ASA calculations and found that no remarkable change in the electronic structure of the superconducting CuO2 planes occurs in the studied structures, when the PBCO layer thickness is varied. The observed depression of the critical temperature does not seem to be originated intrinsically by a severe modification of the electronic structure or by the hole-filling mechanism.

We demonstrate that the Hubbard correlation among Ni $3d$ electrons is able to reproduce the insulating character of NiO, the correct value of the gap, the orbital character of the valence band edge, and the presence of satellite structures. We have determined the quasiparticle spectra starting from the complex single particle band structure of NiO and including the on-site Hubbard repulsion according to a recently developed three-body scattering theory which allows us to treat highly correlated and highly hybridized systems. The calculated quasiparticle band structure is in excellent agreement with photoemission data.

The interaction with a metal of a two-level particle having two electrons in the triplet configuration has been studied using a time-dependent Newns-Anderson Hamiltonian under the assumption that the intra-atomic Coulomb repulsion terms are large compared to the matrix elements of the metal-particle interaction potential. Using perturbation theory explicit expressions of the transitions amplitudes for the processing occurring to second order in the interaction potential have been derived, thus allowing for the calculation of the spectral function up to fourth order. Results for a model system are presented that emphasize the importance of correlation terms in the various processes.

The total cross section for the double photoionization process is calculated for the first elements of the He isoelectronic series using the dipole approximation and highly correlated forms for the initial state wavefunction. The final state is approximated by a symmetrized product of Coulomb scattering wavefunctions. This allows the establishment of simple trends in the magnitude of the cross section and the importance of the angular correlations of the initial state. It is suggested that the double photoionization can be used as a tool for measuring excess charges on atoms in various chemical environments.

We present results of first principle calculations of the Casimir force between Si films of nanometric size, which show that it depends significantly upon the configuration of the surface atoms, and give evidence of the importance of surface states., to be published on J.Phys.A

YBa 2 Cu 3 O 7 has a complex structure, which allows for six different basal-plane surfaces. For each of them we have calculated the local density of states in the outermost crystal layers using a tight-binding method, and found that surface states with dangling-bond character are present. The surfaces obtained by cutting the bond between in-plane copper ions and axial oxygen atoms appear to be electrostatically stable, the charge distribution in the outermost planes closely resembling the bulk one

The satellite structure of ${\mathrm{YBa}}_{2}$${\mathrm{Cu}}_{3}$${\mathrm{O}}_{7}$ compound is calculated starting from an accurate description of the bulk band structure and evaluating the self-energy effects arising from the intra-atomic Coulomb repulsion on the copper and oxygen sites. A continuum of satellites of ${\mathit{d}}^{8}$ character originating from the highly hybridized Cu-O bands is found between 8 and 13 eV binding energy. Comparison with the experimental data allows one to explain the behavior of the Cu satellites in resonant photoemission and provides indications about the intrinsic character of the satellite at 9 eV.

We have investigated the role of the quantum size effects in the evaluation of the force caused by electromagnetic vacuum fluctuations between ultra-thin films, using the dielectric tensor derived from the particle in a box model. Comparison with the results obtained by adopting a continuum dielectric model shows that, for film thicknesses of 1-10 nm, the electron confinement causes changes in the force intensity with respect to the isotropic plasma model which range from 40% to few percent depending upon the film electron density and the film separation. The calculated force shows quantum size oscillations, which can be significant for film separation distances of several nanometers. The role of electron confinement in reducing the large distance Casimir force is discussed. Copyright (C) EPLA, 2008.

Thin metal films are subject to the pressure caused by the zero point oscillations of the electromagnetic field, which depends upon the film optical properties and, in case of deposition onto a substrate, upon the substrate reflectivity. It has been suggested that this force may be relevant in determining the stability of deposited pseudomorphic films with respect to buckling or island formation. We present a detailed analysis of its behaviour as a function of the optical parameters and of the film thickness and we illustrate the conditions under which it may play some role. For free standing films it turns out that the film stabilization is basically due to the surface stress, which largely overwhelms the vacuum force. For epilayers on metal substrate the vacuum force may be important, and we give stability diagrams and critical thicknesses for several cases, illustrating how the flat surface growth may depend upon the film parameters. The importance of including retardation effects into the theory for a realistic determination of the stability conditions is also discussed.

We study the influence of the electromagnetic vacuum force on the behaviour of a model device based on materials, like germanium tellurides, that undergo fast and reversible metal-insulator transitions on passing from the crystalline to the amorphous phase. The calculations are performed at finite temperature and fully accounting for the behaviour of the material dielectric functions. The results show that the transition can be exploited to extend the distance and energy ranges under which the device can be operated without undergoing stiction phenomena. We discuss the approximation involved in adopting the Casimir expression in simulating nano- and micro-devices at finite temperature. Copyright (C) EPLA, 2008

The behaviour of the hole number in YBCO systems as a function of the oxygen deficiency x is studied theoretically by calculating the density of electron states for several different superstructures formed by periodic arrangements of the oxygen vacancies. The characteristic features of the electronic properties for chain copper sites with different coordination are pointed out and their relevance in determining the number of carriers for oxygen planes is illustrated. It is shown that the curve of the hole number as a function of x shows plateaus and jumps similar to those found in the T c versus x curves if the de-oxygenation process takes place by forming fragmented chains. Structures formed by filled and empty chains only give a smooth hole behaviour as a function of the composition. The results of the numerical calculations can be understood by a simple model giving the Fermi energy shift in terms of the concentrations of Cu(1) sites with different coordination.

We have performed a systematic theoretical study of the effects of de-oxygenation on the plane hole numbers in YBa2Cu3O7 − x compounds, by calculating the total and partial densities of electronic states for several different orthorhombic structures corresponding to various forms of vacancy orderings. We show that as x increases the Fermi energy Ef moves upwards and the density of states at Ef decreases. The movement of the Fermi energy depends upon the type of structure under consideration and for structures having fragmented chains Ef remains constant over a large interval of compositions. This behaviour leads to plateaus in the hole number versus x curve which can be related to the behaviour of the critical temperature.

We present the results of theoretical calculations of the surface electronic structure of YBa 2 Cu 3 C 7 assuming different crystal terminations. Through a detailed analysis of the distribution of the valence charge near the surface we show that hole distribution may be significantly modified at the surface, due to the band narrowing and to the presence of surface states. The role of these modifications in determining the shape of the one-hole spectra is discussed.

We discuss the $2p$ and $3s$ line shape in NiO and MnO photoemission, and we show that the main features of all the spectra for both systems are reproduced within an unique theoretical scheme that takes into account the dynamics of the created photohole, together with the detailed band structure of the compounds. The solid state bonding and the antiferromagnetic order are found to deeply influence the characteristics of core level spectra; in particular, the large difference in the spin unbalance of MnO and NiO explains the different response of the two compounds to the creation of a core hole.

Two hundred eighty nine pT1a/pT1b (less thanor = 1 cm in diameter) mammary carcinomas were selected from a series of 2077 consecutive cases of breast carcinoma. When compared with carcinomas of a larger size, they were significantly associated with a lower histological grade (SBR), a lower growth fraction (Ki-67 antigen in less than 20% of neoplastic cells) and a lower number of positive cases (more than 10% of neoplastic cells) as far as p53, c-erbB-2 oncoproteins and EGF-R, as detected by immunohistochemical methods, are concerned. Moreover, a significantly higher number of estrogen and progesterone receptors positive cases (more than 10% of positive cells), and a higher frequency of "other" histotypes with a favourable prognosis, was detected. No difference between pT1a and pT1b cases was noted so that "1 cm size" only stratifies a class with a better prognosis. It is possible that small cases, although invasive, did not undergone sufficient mytotic cycles to produce the sequence of genetic changes that characterize the "no return" phase of breast cancer. A 17% of pT1a and pT1b cases displayed lymph node metastases (mean 26 lymph node/case examined): the number is so high that cautions about simple lumpectomies and about sentinel lymphadenectomy, even in cases of small cancers, are necessary, until a larger number of studies will become available.

This study investigated the efficacy and safety of citalopram in the treatment of eating disorders. Eighteen female patients gave their informed consent to enrollment in the trial: twelve with bulimia nervosa, six with anorexia nervosa according to the DSM IV criteria. They received individual systemic psychotherapy and took 20 mg/day citalopram for 8 weeks. At the beginning and end of the trial, their BMI, body fat and lean mass were checked and they completed the Eating Disorder Inventory and Binge Scale. The results showed that citalopram is effective and safe in the treatment of eating disorders: binge eating episodes and mean scores in three EDI subscales (bulimia, ineffectiveness and interoceptive awareness) significantly decreased in the bulimic patients, and mean scores in the EDI body dissatisfaction subscale significantly decreased in the anorexic patients.

The proliferative activity has been evaluated in 55 cases of seminoma and 36 cases of non-seminomatous germ cell tumors of the testis (NSGCT) in clinical stage I from patients alive and well within 5 years, by a semi-quantitative image analysis method of determination of the percent MIB-1 positive nuclear areas, using a Leica Quantimet 500+ analyzer. Significant differences of growth fraction have been detected between classical seminomas and seminomas showing more than 3 mitoses/1HPF (anaplastic seminoma)-mean of MIB-1 positivity in classic seminoma 23.8%, versus 43.9% in anaplastic seminoma; confirming this value of cut-off in distinguishing two classes of cases with different growth fractions, but without any difference as far as prognosis is concerned. The non seminoma- germ cell tumours (NSGCT) in toto display a growth fraction significantly higher than that of seminomas (mean value of MIB-1 positivity: 26.3% in seminoma versus 40.4% in NSGCT), but absolute values of positivity as high as those obtained by others by subjective evaluation have not been observed. A higher growth fraction in NSGCT is positively correlated with an embryonal carcinoma component as high as 80% of the tumor mass and/or with vascular invasion, but not with different histotypes. The proliferative activity doesn't stratify subgroups with different prognosis within the two groups of germinal tumours of the testis (seminomas and NSGCT) in our cases of clinical stage I testicular tumours.

Workload measurement is one of the most reliable tools in perspective payment systems, to evaluate clerk and technical personnel needs in a Surgical Pathology Department. In 1992 Italian Government began a full-comprehensive modification of financial support in National Health Care System, and during the last four years Public Hospitals and Local Health Units modified their financial organization with the introduction of workload measurement for the personnel needs. We propose a synthetic method for the workload measurement in Surgical Pathology Departments, similar to that proposed for perspective payment of surgical pathology services. The method is reliable and simple representing the full performance to obtain pathological report.

It is shown that electron correlation among Cu d -electrons explains the photoemission data of CuGeO 3 and is responsible for the insulating behaviour and of the observed complex satellite structures. The analysis and interpretation of the experiments require the use of a multi-band Hamiltonian which explicitly includes both on site electron correlation and a detailed description of the single-particle band states.

Autistic children undergoing therapeutic programs, which adopt in our service (USL 3 CT) different theoretical approaches, sometimes show a marked reduction in motor activities, a lowering of tone of voice, physical expression of sadness. We observe that animation is absent in the scene they may draw and colours are no longer used in their drawings. Sleep disturbance may appear or reappearance of enuresis. Many authors consider these symptoms as signs of depression. These changes, even though they create new problems in therapeutic management, are, in our opinion, a very important index of the unblocking of autistic withdrawal and beginning of development of those emotional, relational and cognitive components which seem to be frozen in autistic children and inhibit the birth of the mind, according to the U. Frith Theory. We report in this paper the psychoanalytic, cognitive, systemic, biological viewpoint on the occurrence of depression in infantile autism. We submit three cases of patients being treated in our service with the cognitive-behavioural oriented educational program and pharmacological therapy and discuss the multidimensional approach. The temporary occurrence of depression symptoms may be an index of a change within the resisting autistic balance, which may have a biological basis, but indicates the disorganization of the autistic child's mind in view of further development.

A case of jejunal-ileal metastasis from a left leg malignant schwannoma in a 73 year old woman is described. The patient was affected by progressive anemization without signs of bleeding. A colonoscopy performed during hospitalization revealed an ulcerative lesion at the ileo-colonic junction which at histologic examination was suspected for sarcomatous proliferation arising in peripheral nerve tissue. At operation multiple ileal resections of numerous polypoid formations were performed. Histological examination of polypoid masses revealed the presence of malignant proliferation of spindle cells consistent with a malignant schwannoma. Differential diagnoses are discussed with a review of the literature.

In this work we aimed to verify the main hypotheses of the pyramidical model where the presence in schizophrenia of four distinct but no coexclusive syndromes (positive, negative, depressive, excited) is described. The test was done by applying the PANSS (the Positive and Negative Syndrome scale) on 30 patients with a schizophrenia diagnosis according to the DSMIIIR. The PANSS was administered to 12 women and 18 men aged between 20 and 42 years old. The statistical analysis of data was done using Kendall's test and Sperman's test. The first test we checked if the four syndromes were statically independent and mutually exclusive, or if there was probability of association between them. The result proves that the four syndromes are statistically independent but not coexclusive though. Though Sperman's test we wanted to find out if there was a complete independence between positive and negative syndromes and between the latter and the depressive syndrome or if there was a probability of association between them. The results point out that the positive syndrome is independent of the negative syndrome and the latter is independent of the depressive syndrome. However, there is a significant level of association between the depressive syndrome and the negative syndrome.

We present the results of theoretical calculations of the electronic structure of the Sb/GaAs(110) interface in the submonolayer coverage regime performed in the full ab initio self‐consistent pseudopotential scheme. Different structural models for the edges of the extended Sb islands have been considered and their equilibrium geometry has been determined by total energy minimization. The single particle band structure shows interface states arising mainly from the incomplete bonding of the Sb adatoms at the terrace edge to the substrate, which fall within the optical gap. Distinct features are associated to different island terminations. The interface turns out to be metallic in all the considered cases with a partially occupied peak at the Fermi level. We have also studied the effect of including explicitly the on‐site Hubbard electron‐electron correlation in the calculation of the quasiparticle spectrum, obtaining the observed semiconducting interface when the Coulomb interaction parameter U is larger than 3 eV. The interface states within the optical band gap can be present also at higher coverages when some disorder exists, evidentiating a general mechanism for the Fermi level pinning at this interface.

Peroxisome proliferator-activated receptor gamma (PPARgamma), a member of the nuclear receptor superfamily, is expressed predominantly in adipose tissue. Forced expression of the two isoforms of this receptor, PPARgamma1 and PPARgamma2, in fibroblasts initiates a transcriptional cascade that leads to the development of adipocyte phenotype. Using the yeast two-hybrid system and GAL4-PPARgamma as bait to screen mouse liver cDNA library, we isolated a mouse steroid receptor coactivator (mSRC-1) involved in nuclear hormone receptor transcriptional activity as a mPPARgamma interactive protein. mSRC-1 cDNA we isolated contains an open reading frame of 1447 amino acids and encodes a new member of the basic helix-loop-helix-PAS domain family. We show that the binding of mSRC-1 to mPPARgamma is ligand independent and coexpression of mSRC-1 with mPPARgamma increases the transcriptional activity of mPPARgamma in the presence of mPPARgamma ligand. We have identified the presence of two putative mPPARgamma binding sites in the mSRC-1, one between residues 620 and 789, and the second between residues 1231 and 1447. These two regions exhibit different degrees of binding affinity for mPPARgamma. We also show that mSRC-1 exhibits its own constitutive transcriptional activity in the yeast as well as in mammalian cells. These results suggest that mSRC-1 interacts with PPARgamma and plays a role in the PPARgamma-mediated signaling pathway.

Owing to the complexity of their structure, YBa 2 Cu 3 O 7− x systems can have several different terminations of the crystal. Even considering basal plane surfaces only, six possible terminations are found for an ideal truncation of the crystal, having different electronic properties. The characterization of the real surfaces produced by fracturing sintered materials, by cleaving a mono-crystal or by growing a thin film is a very difficult task, due to the occurrence of processes such as contaminant segregation, oxygen loss from the external planes and surface reconstruction. Here we review the experimental work on this subject and critically compare the outcomes of different spectroscopical experiments. The data are discussed in the light of the available theoretical results for the surface band structure of the ideal basal plane surfaces. The role of the surface in determining a non-superconducting surface phase is illustrated. Possible morphological and structural models for the observed surfaces are presented.

The main objective of the pharmacotherapy of schizophrenia has been, and still is, to obtain optimal therapeutic efficacy, which is seconded by the aim to restrict as far as possible the sometimes severe collateral effects which are acknowledged as being the major drawback to the regular use of neuroleptic agents. Tight from the start, some "atypical neuroleptics" were identified as being of interest for this reason; these included Clothiapine and Clozapine, a more recently discovered drug which is not yet commercially available in Italy. Both of these neuroleptics have been found to offer extremely interesting advantages. The authors now report data referring to the clinical use of these drugs during 1989-1990 in addition to those published in the literature on this subject.

The attention given to the spiritual dimension in the "helping professions" practice represents a major step for a coherent approach toward the ethical aspects in the resolving individual and familial conflicts; furthermore they can be used as a key in understanding dysfunctional relationship. Psychiatry interest for religion and mysticism must be considered within a wider framework of cultural changes of our society, from which neither religion, understood as a system of faith, nor medicine, as an answer to human suffering could remain indifferent. The evaluation of this aspect prevents the occurrence of "burn-out" syndrome in the "helping professions" workers, because it would give them the opportunity to a greater spiritual growth with expression of empathy, respect and better understanding of help request from their patients.

Families with handicapped member seem to follow the same five stages (rejection and isolation, anger, dealing with the problem, depression, acceptance) of Kubler-Ross grief elaboration theory while dealing with the narcissistic wound of a handicapped child. Some of these families show a block in one of the stages. The effort of psychotherapy is to remove the block and let them reach the last stage. In this paper families under systemic psychotherapeutic treatment are analyzed, who had in common the birth of a child with low or modest invalidating signs and psychotic or autistic features. The families structure did not show the characteristics of a psychotic family. Nevertheless either one or both parents ignored the evidence of their child disease and they built a "disease-incongrous" wait around the child, trying to push away the painful reality. The authors explain the importance of this approach for the improvement of the autistic traits.

The authors have focused their attention on "pathological" mechanisms which appear a long time before the onset of any psychotic symptom. It seems particularly interesting to find out, using clinical observations, if and how family relationships in their temporal dimension, present a particular organization from the beginning of their histories. The authors consider the possibilities of single out the presence of "early indicators of pathology" in families with a psychotic member. This was carried out by a questionnaire articulated in two sessions: the first section was in relation to the periods before and after the birth of children and the second in relation to the children's school period. The questionnaire was given to 15 families. The results seem to confirm the families difficulties in relation to the period before the onset of the symptoms in the patient.