Reliability of the international spinal cord injury bowel function basic and extended data sets.

STUDY DESIGN: This study was designed as an international validation study. OBJECTIVE: The objective of this study was to assess the inter-rater reliability of the International Spinal Cord Injury Bowel Function Basic and Extended Data Sets. SETTING: Three European spinal cord injury centers. METHODS: In total, 73 subjects with spinal cord injury and a history of bowel dysfunction, out of which 77% were men and median age of the subjects was 49 years (range 20-81), were studied. The inter-rater reliability was estimated by having two raters complete both data sets on the same subject. First and second tests were separated by 14 days. Cohen's kappa was computed as a measure of agreement between raters. RESULTS: Inter-rater reliability assessed by kappa statistics was very good (≥0.81) in 5 items, good (0.61-0.80) in 11 items, moderate (0.41-0.60) in 20 items, fair (0.21-0.40) in 11 and poor (<0.20) in 5 items. CONCLUSION: Most items within the International Spinal Cord Injury Bowel Function Data sets have acceptable inter-rater reliability and are useful tools for data collection in international clinical practice and research. However, minor adjustments are recommended.

Performance and fat quality of heavy pigs fed maize differing in linoleic acid content.

Maize shows wide differences in linoleic acid due both to total lipid content and to fatty acid profile. Therefore, diets containing the same high maize percentage (up to 55%) can differ in linoleic acid content and lead to subcutaneous fats of differing suitability for raw ham curing. Two trials were performed on heavy pigs; in the first, 60 pigs (body weight 48.7+/-5.1 kg) were fed three diets made using three maize batches differing in linoleic acid due to different total lipid content, in the second trial, 40 pigs (live weight 70.4+/-3.4 kg) were fed two diets made using two maize batches differing in linoleic acid due to their fatty acid profile. Pigs were slaughtered at 170 kg of live weight. In both trials, the growth and slaughtering performance did not differ. In the first trial the three diets lead to a different content of linoleic acid both in subcutaneous (low linoleic vs medium linoleic vs high linoleic P0.01) and intramuscular fat (low linoleic vs high linoleic P0.05). In the second trial different linoleic acid content was observed for subcutaneous fat (P0.01) but not for intramuscular fat. To formulate diets for heavy pigs, it is crucial to know the linoleic acid content of the maize used, because differences of only 0.3% can lead to significant differences in fatty acids composition of depot fats.

Use of pure glycerol in fattening heavy pigs.

Eighty Italian Duroc×Italian Large White pigs (BW 42.6±3.37kg) were used to determine the effects of pure glycerol on growth performance and meat quality of heavy pigs. Pigs were divided into five groups receiving 0% (control), 5% or 10% during the growing and finishing phases (42.6-160kg BW) (G+F5,G+F10) or 5% or 10% during the finishing period (100-160kg BW) (FIN5,FIN10) of pure glycerol in substitution for maize meal (on a dry matter basis). The pigs were slaughtered at approximately 160kg BW. The growth performance of pigs fed 5% glycerol did not differ from controls regardless of feeding duration, whereas those fed 10% glycerol showed reduced growth and poorer feed:gain ratio. Fat quality and meat suitability for raw ham curing were not affected by dietary treatment. Differences were not consistent enough to draw any conclusion about the effects of feeding glycerol on sensory characteristics.

Effect of feeding partially hydrogenated lard on trans-fatty acid content of muscle and backfat of heavy pigs.

The incorporation of fat in diets for heavy pigs may be necessary in order to increase their energy intake in the finishing period. Lard may be a good lipid source but it contains 10-13% of linoleic acid, which makes the subcutaneous fat less suitable for long term curing of raw ham. Partial hydrogenation of lard decreases linoleic acid content, but increases trans-fatty acid content. This trial involved two groups of pigs of 114kg live weight, fed for the last two months before slaughter with diets containing 3% lard (L) or 3% partially hydrogenated lard (PHL). The PHL contained about 10% trans-fatty acids and 2.5% linoleic acid. Rearing performance and carcass characteristics were unaffected by treatment. The group fed PHL showed a lower percentage of linoleic acid in the backfat (PHL 12.28% vs. L 13.04%) and a higher percentage of C18:1 trans-fatty acids both in backfat (0.5% vs. 0.06%) and in intramuscular fat (0.2% vs. 0.04%).

Tachyphylactic properties of angiotensin II analogs with bulky and hydrophobic substituents at the N-terminus.

Tachyphylaxis, defined as the acute loss of response of some smooth muscles upon repeated stimulations with angiotensin II (Ang II), has been shown to be dependent mainly on the N-terminal region of the ligand. To further study the structural requirements for the induction of tachyphylaxis we have synthesized Ang II analogs containing the bulky and very lipophilic substituents 9-fluorenylmethyloxycarbonyl (Fmoc) and 9-fluorenylmethyl ester (OFm) at the alpha-amino (Nalpha-Fmoc-Ang II) or the beta-carboxyl ([Asp(OFm)1]-Ang II) groups of the Asp1 residue, respectively. In binding assays with Chinese hamster ovary cells transfected with the AT1 Ang II receptor, Nalpha-Fmoc-Ang II bound with high affinity, whereas [Asp(OFm)1]-Ang II showed lower affinity. In biological assays, these two analogs were full agonists and showed 30 and 3%, respectively, of the Ang II potency in contracting the guinea-pig ileum smooth muscle. The two analogs induced tachyphylaxis, in spite of the lack of a free amino group in Nalpha-Fmoc-Ang II. Thus, analogs with Fmoc- or OFm-type groups coupled to the Asp1 residue, whether at the amino or carboxyl functions, induce tachyphylaxis through an unreported mechanism. Based in these findings and those available from the literature, an alternate molecular interaction mode between Ang II N-terminal portion and the AT1 receptor is proposed to explain the tachyphylactic phenomenon.

Effect of age at slaughter on carcass traits and meat quality of Italian heavy pigs.

Barrows and gilts (n = 128) from four breed crosses were used to investigate the effect of age at slaughter on carcass traits, proteolytic enzyme activity, and meat and fat quality. Pigs were blocked by breed cross into four blocks, and within blocks, one pen (eight barrows and eight gilts) was assigned randomly to be slaughtered at either 8 or 10 mo of age. Pigs were fed a corn-barley-soybean meal finisher diet from 104 +/- 2.5 d of age (37.7 +/- 0.33 kg BW) to the appropriate slaughter age. Carcasses from older (10 mo) pigs had lower (P < 0.01) muscularity indexes and lean cut yields than those of younger (8 mo) pigs, but dressing percentage and longissimus muscle area increased (P < 0.01) with age. Older pigs produced a redder (P < 0.01) and darker (P < 0.05) semimembranosus, with lower (P < 0.01) ultimate pH and cathepsin B and B + L activities, as well as higher (P < 0.01) aminopeptidase hydrolyzing activity than younger pigs. Moreover, the longissimus muscle of pigs slaughtered at 10 mo of age had lower (P < 0.01) drip and cooking loss percentages than that from pigs slaughtered at 8 mo of age. Ham subcutaneous fat from 10-mo-old pigs had greater (P < 0.05) percentages of oleic acid and lower (P < 0.01) proportions of moisture, linoleic, and linolenic acids than subcutaneous fat from pigs slaughtered at 8 mo of age. Results from this study indicate that fresh hams from pigs slaughtered at 10 mo of age would be more suitable for the production of high-quality, Italian, dry-cured hams.

Fmoc-POAC: [(9-fluorenylmethyloxycarbonyl)-2,2,5,5-tetramethylpyrrolidine-N-oxyl-3-amino-4-carboxylic acid]: a novel protected spin labeled beta-amino acid for peptide and protein chemistry.

The stable free radical 2,2,6,6-tetramethylpiperidine-N-oxyl-4-amino-4-carboxylic acid (TOAC) is the only spin labeled amino acid that has been used to date to successfully label peptide sequences for structural studies. However, severe difficulty in coupling the subsequent amino acid has been the most serious shortcoming of this paramagnetic marker. This problem stems from the low nucleophilicity of TOAC's amine group towards the acylation reaction during peptide chain elongation. The present report introduces the alternative beta-amino acid 2,2,5,5-tetramethylpyrrolidine-N-oxyl-3-amino-4-carboxylic acid (POAC), potentially useful in peptide and protein chemistry. Investigations aimed at addressing the stereochemistry of this cyclic molecule through X-ray diffraction measurements of crystalline and bulk samples revealed that it consists only of the trans conformer. The 9-fluorenylmethyloxycarbonyl group (Fmoc) was chosen for temporary protection of the POAC amine function, allowing insertion of the probe at any position in a peptide sequence. The vasoactive octapeptide angiotensin II (All, DRVYIHPF) was synthesized by replacing Pro7 with POAC. The reaction of Fmoc-POAC with the peptidyl-resin occurred smoothly, and the coupling of the subsequent amino acid showed a much faster reaction when compared with TOAC. POAC7-AII was obtained in good yield, demonstrating that, in addition to TOAC, POAC is a convenient amino acid for the synthesis of spin labeled peptide analogues. The present findings open the possibility of a wide range of chemical and biological applications for this novel beta-amino acid derivative, including structural investigations involving its differentiated bend-inducing characteristics.

[Acute diverticulitis of the right colon. Report of 3 cases]. / La diverticolite acuta del colon destro. Descrizione di tre casi.

Three cases of acute diverticulitis of the right colon are described and a review of the international literature about this rare disease is made. Diverticulitis of the ascending colon is an uncommon disease which mimics appendicitis or perforated neoplasm. The correct diagnosis is rarely made, but can be suggested by signs and symptoms and confirmed by the barium enema. It should be treated conservatively, like left-colon diverticulitis. Isolated diverticula can be managed by simple excision and primary closure. Local resection may be necessary if the involved area is too large. Right hemicolectomy is performed when carcinoma is strongly suspected.

[Surgical treatment of parathyroid hyperplasia]. / Il trattamento chirurgico dell'iperplasia delle paratiroidi.

BACKGROUND: To review a series of 11 patients affected by hyperplasia of parathyroid glands and to discuss diagnostic and therapeutic tools. METHODS: A series of 11 patients out of 44 (= 25%) with primary hyperparathyroidism has been retrospectively reviewed. They underwent surgery in I surgical Department of OORR of Bergamo. All 11 patients were submitted to ultrasound and computed tomography examination before surgery, without any localisation of hyperplastic or adenomatous tissue. An exploring cervicotomy was performed with subtotal parathyroidectomy after the anatomopathological result of hyperplasia. RESULTS: No adverse effects related to surgery were observed. All patients could be considered as cured with a median follow-up of 36 months. CONCLUSIONS: Among hyperparathyroidism, hyperplasia is an underhand form and even if the laboratory diagnosis is simple, the imaging techniques cannot always localise the pathologic tissue. Personal experience shows the role of subtotal parathyroidectomy (removal of 3 parathyroid glands and a half of the last one) confirmed by the absence of adverse effects or relapse with a median follow-up of 36 months.

[Multifocal carcinoid of the stomach]. / Il carcinoide multifocale dello stomaco.

Carcinoid tumors are among the most frequently reported neuroendocrine neoplasms of the gastroenteropancreatic system. They occur more commonly as benign diseases but malignant ones can also be found. Gastric carcinoid is an uncommon pathology which accusin 2% of the carcinoid tumors of various districts and 0.5% of the gastric carcinomas. The authors report a case of gastric malignant multifocal carcinoid, diagnosed in a 63 year-old female patient. Diagnosis was confirmed at histologic analysis of the operating piece. The aim of this paper has been to review the frequency, prognosis and treatment of this neoplasm in the literature.

[Epidemiological behavior of perforated peptic ulcer before and after the introduction of the antisecretory drug therapy. Our experience]. / Il comportamento epidemiologico dell'ulcera peptica perforata prima e dopo l'introduzione della terapia medica antisecretiva.

The diagnostic iter and treatment of peptic ulcer have evolved considerably over the past 20 years. The capillary spread of endoscopy has permitted secure and precise diagnoses to be made, in terms of both the site and size of the anatomic lesion, on the one hand, and on the other, the introduction of antisecretory drugs has led to the resolution of the majority of ulcers, so much so that the ulcer is no longer managed using strictly surgical methods but is now treated medically and only emergency cases, such as perforations, undergo surgery. Complications, such as digestive hemorrhage, penetration and stenosis, may lead to the need for surgery. In particular, perforation seems to be the only complication which has not been significantly influenced by the introduction of antisecretory therapy, the point that its status as a "complication" has been questioned leading to the suspicion of its nosological autonomy. The authors review the series of ulcer patients admitted to hospital during the period 1968 to 1991, paying special attention to the correlation with the use of antisecretory drugs which were introduced during the period 1978-1981, the trend of ulcer complications over the entire period, the duration of symptoms and the epidemiology of peptic and perforated ulcers.

[Diagnostic findings and the surgical treatment of liver metastases: our experience]. / Orientamenti diagnostici e trattamento chirurgico delle metastasi epatiche: nostra esperienza.

The authors report their 10 year experience of 32 consecutive hepatic resections for metastases. All patients were preoperatively evaluated with US and CT, however, in 9 cases the diagnosis was obtained at laparotomy. In the first years there were no codified criteria for indications to surgery, while recently these were restricted, because of more favourable prognostic evaluations, to the metastases from colorectal carcinoma, endocrine or carcinoid tumours, digestive system neoplasms invading adjacent liver (in this case usually with palliative goal). The low mortality and morbidity registered explain the safety and efficacy of this procedure, also taking into account the fact that currently surgery is the only effective procedure with curative purpose. Criteria for patients selection, particularly in case of colorectal cancer, are referred and discussed and consequently prognostic factors are proposed: hepatic involvement extent, stage of primary tumour, absence of extrahepatic metastases, disease free interval between resection of primary tumour and hepatic resection for metachronous metastases.

Hyponatremic hypertensive syndrome and massive proteinuria in a patient with renin-producing leiomyosarcoma.

We report a case of renin-producing leiomyosarcoma associated with the hyponatremic hypertensive syndrome and nephrotic-range proteinuria. Extremely high levels of active renin and, to a greater extent, of prorenin were found in plasma and tumor tissue. Immunohistochemical and in situ hybridization studies demonstrated that the neoplastic cells were the source of renin production. The hyponatremic hypertensive syndrome and proteinuria promptly responded to treatment with angiotensin-converting enzyme inhibitors, suggesting an angiotensin II dependency of these disorders. After removal of the leiomyosarcoma, plasma concentration of active renin, but not of prorenin, normalized and the hypertension, proteinuria, and electrolyte abnormalities disappeared. However, 5 months after operation, the patient presented once again with hypertension, hypokalemia, proteinuria, and markedly increased plasma levels of both active renin and prorenin that heralded the relapse of neoplastic disease.

[Surgical treatment of liver trauma: our experience]. / Il trattamento chirurgico dei traumi epatici: nostra esperienza.

The Authors report their ten-year experience in the surgical treatment of liver injuries. Thirty-five patients underwent emergency laparotomy for hepatic trauma: 14 showed associated injuries, mostly of the spleen, while 21 had isolated liver lesions. Emergency surgical operation was performed for those patients with hypovolemic shock due to massive haemoperitoneum, while for all stabilized patients a preoperative ultrasonography or a computerized tomography was diagnostic. With a correct diagnosis, nowadays possible thanks to the overmentioned radiologic means, a group of patients was not treated by laparotomy, but strictly monitorized. For the patients who underwent laparotomy, good results with a low mortality rate were obtained using a surgical conservative treatment.

[The diagnostic and therapeutic problems of endocrine tumors of the digestive system: our experience]. / Problematiche di diagnosi e terapia dei tumori endocrini dell'apparato digerente: la nostra esperienza.

The authors experience in the surgical treatment of endocrine tumours of the digestive tract is reported. Particularly, they emphasize that in spite of the several syndromes associated with these neoplasms, diagnostic and therapeutic concepts herein analyzed are similar.

[Quandrantectomy in the conservative treatment of breast carcinoma]. / La quadrantectomia nel trattamento conservativo del carcinoma della mammella.

Two years after the first evaluation, the authors review the results of quadrantectomy in the conservative treatment of breast carcinoma. Local control of the disease by quadrantectomy with axillary lymphadenectomy and radiotherapy has been more difficult in the T2 patients (4 local relapses out of 41 patients) compared T1 patients (3 local relapses out of 52 patients). Nodal involvement appears to be not crucial for the prognosis (7 patients out of 10 with remote metastases were N- at the time of surgery).

[Primary malignant lymphoma of the parotid gland. Report of a case]. / I linfomi maligni primitivi della parotide. A proposito di un caso.

Primary malignant lymphoma of the parotid gland is often correlated, in literature data, with inflammatory autoimmunological disease of the salivary gland. Finding of blasticlymphoid cells in myoepithelial scialoadenitic areas in a case of parotid disease is described by the Authors. Needle may be useful in detecting these high radio-chemosensitive neoplasms to reduce the occurrence of complications of total parotidectomy.