[Reconstructive and non-reconstructive procedures in the treatment of the threatened limb]. / Procedure ricostruttive e non ricostruttive nel trattamento dell'arto critico.

Limb threatening ischemia is an acute step in the chronic course of peripheral arterial obstructive disease that requires some form of intervention. The objective of this study is to prove that reconstructive surgery as well as non reconstructive approaches are associated with positive results. Ours is a retrospective analysis of a ten year experience in the treatment of limb threatening ischemia. In the period 1983-93, 139 patients under-went 164 procedures. 67% of patients were diabetics. Early in the observation period the therapeutic strategy was non reconstructive, the procedure of choice was sympathectomy. Later vascular reconstructions have been recognized as the procedures of choice. In the cases not amenable to reconstructive procedures according to our group criteria (absence of a tibial vessel in continuity with a patent pedal arch), we have employed procedures such as prostanoid infusion; thrombolysis and epidural spinal cord stimulation. Reconstructive procedures have been associated with a decrease in the number of major amputations. Alternative procedures, employed in patients not amenable to reconstruction have proven worthwhile in terms of limb salvage even if this trend is limited to a short period of observation.

Control of DNA replication and cell proliferation in eukaryotes by aphidicolin.

The mycotoxin aphidicolin specifically inhibits nuclear DNA synthesis in eukaryotic cells by intereacting with the replicative DNA polymerase alpha. The drug does not bind directly to DNA nor does it interfere with RNA, protein and nucleic acid precursor synthesis. Aphidicolin offers a new tool for analyzing the mechanism of DNA replication and repair in eukaryotes and for studying the role of eukaryotic DNA polymerases. The drug might also be valuable therapeutically for controlling excessive cell proliferation without adverse effects upon non-multiplying cells. We describe here how to synchronize DNA synthesis in human cells by a double block with aphidicolin and the properties of two human cell lines resistant to the drug.

[Unusual complication of arterial hypertension: Martorell's ulcer]. / Rara complicanza dell'ipertensione arteriosa: l'ulcera di Martorell.

Eight cases of Martorell's ulcer observed in the last ten years are presented. Discussion of the aetiopathogenesis, and the clinical, anatomo-pathological, physiopathological, and therapeutic aspects of this form leads to the conclusion that it appears in hypertensive subjects, usually women, between the middle and inferior third of the leg, on the anterolateral surface. The limb is free from nervous, venous, and arterial lesions. Ulceration is typical of hypertensive arteriolitis. Drug and local antiseptic management normally gives the best results. In the case of severe lesions, Thiersch grafts can be usefully employed.

[Sarcomas of the small intestine]. / I sarcomi del tenue

Four cases of sarcoma of the small intestine (2 leiomyosarcoma, 1 fibrosarcoma, and 1 Hodgkin's disease) are described. In each case, diagnosis was the outcome of surgery: emergency operation for acute abdomen in three cases (2 mechanical ileus, 1 perforation); exploratory laparotomy for recurrent haemorrhage following negative X-ray examination per os and clyster of the digestive tract on a number of occasions. The relevant literature is surveyed. Attention is drawn to the different anatomopathological and clinical forms, and to the difficulty of diagnosis.