[The priority status in the treatment of the multiply injured].
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Biomedical subjects
Publications and source records attributed to G Basile.
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The RAD51 gene of Saccharomyces cerevisiae is required both for recombination and for the repair of DNA damage caused by X rays. Here we report the sequence and transcriptional regulation of this gene. The RAD51 protein shares significant homology (approximately 50%) over a 70-amino-acid with the RAD57 protein (J.A. Kans and R.K. Mortimer, Gene 105:139-140, 1991), the product of another yeast recombinational repair gene, and also moderate (approximately 27%), but potentially significant, homology with the bacterial RecA protein. The homologies cover a region that encodes a putative nucleotide binding site of the RAD51 protein. Sequences upstream of the coding region for RAD51 protein share homology with the damage response sequence element of RAD54, an upstream activating sequence required for damage regulation of the RAD54 transcript, and also contain two sites for restriction enzyme MluI; the presence of MluI restriction sites has been associated with cell cycle regulation. A 1.6-kb transcript corresponding to RAD51 was observed, and levels of this transcript increased rapidly after exposure to relatively low doses of X-rays. Additionally, RAD51 transcript levels were found to that of a group of genes involved primarily in DNA synthesis and replication which are thought to be coordinately cell cycle regulated. Cells arrested in early G1 were still capable of increasing levels of RAD51 transcript after irradiation, indicating that increased RAD51 transcript levels after X-ray exposure are not solely due to an X-ray-induced cessation of the cell cycle at a period when the level of RAD51 expression is normally high.
Primitive synovial chondromatosis of the hip is quite rare. Through the presentation of four new cases, the authors discuss the pathologic and clinical features of this disease and evaluate the performance of imaging studies, emphasizing the value of CT scan for confirmation of radiographic findings. The indication for surgical treatment is analyzed for each stage of the disease.
The rise in the mean age and the increase in diabetes have frawn the surgeon's attention to gangrene of the lower limb which requires a multidisciplinary approach (doctor, surgeon, prosthesis specialist). Contrary to the concept of high thigh amputation, the possibility of carrying out a lumbar sympathectomy has encouraged the idea of a more distal amputation with conservation of physiological joints and an early recovery of function thus enabling patients who would otherwise have been condemned to permanent invalidity to return to social life.
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Postphlebitic syndrome of the lower limbs is a consequence of chronic varices or the outcome of TVP leading to edema, eczema, stasis ulcers, etc. In these cases surgical treatment takes the form of ligating the perforating varices using a subfascial route according to Linton's technique, together with stripping the great and small saphenous vein. There are cases, however, in which the extent of cutaneous involvement does not allow a "safety incision" to be made. Felder's operation, using posterior surgical aggression in that area of the skin which generally remains healthy, therefore allows an easier ligation of the perforating varices and quicker cutaneous healing.
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From 1970 to 1980 144 cases of breast cancer were diagnosed in this Department. Patient's age varied between 25 and 83 years with an average age of 51.5 years. 49 (42.98%) patients were in fertile age and 65 patients (57.01%) were in menopause. The incidence of cancer increased after 41 years and the maximal incidence was between 51 and 55 years. Married (117; 81.45%) and pluriparous (75; 65.78%) women prevailed. In the pluriparous the average parity was 4, and 35 (30.70%) pluriparous had greater than or equal to 4 siblings. In 38 cases (27.08%) the patient was nulliparous. In 100 cases (69.64%) diagnosis was made without evident cutaneous alteration. Left and right breasts were affected in 73 (50.69%) and 68 cases (48.21%) respectively. Cancer was bilateral in 3 cases (2.08%). The most frequent cancer localization was ESQ (70 cases; 48.61%). 1st stage was diagnosed in 64 cases (44.44%), 2nd stage in 57 cases (39.58%) and 3rd stage in 23 cases (15.97%). The 5 year survival rate after operation was 86.79% (46 cases), 48.97% (24 cases) and 26.31% (5 cases) in patients at 1st, 2nd and 3rd stage respectively. 13, 8 and 4 patients were lost at follow-up.
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Software was developed on a personal computer for a quantitative study of some ultrastructural aspects of sympathetic ganglia (the neuronal cell body, the surrounding satellite cell layer and the nearby capillaries). A low-cost digitizer, originally designed for teaching, semiprofessional graphics applications and games, was utilized to sample areas and distances on electron micrographs. The processing program derives stereologic parameters from the crude data stored in the memory. Further algorithms then assess the mean thickness and the volume densities of the satellite cell layer, endothelial basal lamina and endothelial layer.
We present 5 cases with angiographically absent pulmonary artery: 4 with absence of right pulmonary artery and 1 with absence of the left. We excluded cases of atresia of pulmonary artery, ventricular septal defect and major aorto-pulmonary collaterals. We excluded also cases of anomalous origin of a pulmonary artery from the aorta. Surgical inspection in 3 patients demonstrated total absence of pulmonary main branch (1 case), with intraoperative death, and presence of the hilar portion of the pulmonary artery (2 cases), with successful palliative procedure. It is supportive of efforts to identify as early in life as is feasible the absent vessel, for surgical purposes. In fact the early surgical procedure will ensure development of the vessel and normal lung growth, and will decrease the risk of the following intracardiac repair, when needful.
201 cases of hydatid cysts observed in 1964-1984 are analysed. This is followed by a report on 100 cases of hepatic cysts with details of the patients' sex, age, symptoms and occupation. Finally the surgical treatment adopted in response to the site and dimensions of the cysts is described in detail.
An ultrastructural and stereologic study was performed on sympathetic ganglia collected at surgery from eight diabetic patients, seven age-matched non-diabetics and six subjects with glucose intolerance. All patients underwent surgery because of arteriosclerosis obliterans. Volume density (Vv) and mean thickness (tau) of the satellite cell layer were found to be significantly higher in diabetics (P less than .001 and P less than .002, respectively) than in the other two groups, between which no difference was found. Vv and tau of the endothelial basal lamina were found to be increased in the diabetic and glucose-intolerance groups at a low level of significance (P less than .05). Satellite cells are thought to exhibit a close similarity to Schwann cells. Ultrastructurally, cytoplasmic edema, increase of subcellular organelles and lipid inclusions were consistently observed in satellite cells from diabetic patients. The results suggest that there may be a metabolic impairment of these cells in diabetes.
Increased urinary excretion of free amino acids is a sign which requires determination of the underlying cause. Physiological aspects of tubular transport with emphasis on the role played by transport proteins or carriers are briefly discussed. Subsequently we present a resumptive classification. In prerenal hyperaminoaciduria the urinary excretion of amino acids just reflects the error in amino acid metabolism. Depending on tubular reabsorption of the amino acid involved in the metabolic error three types can be distinguished: the overflow, the competitive and the non-threshold hyperaminoacidurias. Renal hyperaminoaciduria can either be specific for individual or group-related amino acids, or generalized involving all amino acids. With the exception of classical cystinuria the various hyperaminoacidurias have more theoretical than clinical importance. Generalized hyperaminoaciduria is always a symptom of severe tubular disturbance which can be produced by various metabolic diseases, intoxications or deficiency states. Finally we present our experience in the treatment of cystinuria with mercaptopropionyl-glycine.