Rheumatoid arthritis (RA) is an inflammatory chronic disease with an autoimmune pathogenesis and a complex multifactorial etiology. Various factors such as immunogenetic determinants, sex, age, and stress play an important role. The relationship between stress and RA is still unclear and undefined; however, various lines of research are developing in order to evaluate environmental, psychologic, and biologic stressors as predisposing factors. The aim of our study was to evaluate whether stress-related psychologic factors and personality disorders might be involved in the development of RA, by using a psychometric investigation-methodology in a series of patients. Fifteen in- and outpatients underwent a clinical interview and other specific psychometric tests. Macro- and microstressful life-events preceded RA onset in 86% of the cases. Sixty percent of the patients showed a correlation between flare-ups of the disease and appearance of microevents. Forty percent of the patients showed an obsessive-compulsive personality disorder (OCPD), 40% showed a borderline personality disorder (BPD), 7% showed a schizoid and a dependent disorder. Only 13% of the patients showed no personality disorders. Among the BPD group we also detected alexithymia. Our results should be considered as preliminary; on the other hand, the high prevalence of major life-events preceding the onset of RA and the presence of personality disorders support the role of the altered stress response system as an important pathogenetic factor and will be a matter of further studies.

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Carbon has been used to improve the thromboresistance of synthetic vascular prostheses, and for this pur pose, dacron grafts have been coated with carbon. Owing to the contradic tory results reported in the literature, a new kind of vascular conduit, ex clusively textured from carbon fi bers, has been developed. The pres ent research study was undertaken to compare carbon and expanded poly tetrafluoroethylene (e-PTFE) grafts when used as vascular substitutes. Fifty-six experimental animals were divided into four equal groups and underwent substitution of segments of infrarenal aorta or inferior vena cava (IVC), through use of either carbon or e-PTFE grafts. Prosthetic segments were removed fifteen sec onds, or sixty minutes, or seven, fif teen, thirty, sixty, or one hundred twenty days after implantation. Spec imens were examined by light and scanning electron microscopy. Cumu lative patency rates, calculated by the life-table method at 120 days after surgery, were 72% for aortic carbon grafts, 41 % for aortic e-PTFE grafts, and 0% for both carbon and e-PTFE grafts implanted on the IVC. Carbon conduits performed significantly bet ter than e-PTFE conduits when used as small-caliber arterial substitutes (p < 0.05). Fifteen seconds after blood contact, the inner surface of carbon prostheses, regardless of the implantation site, was covered with a thin proteinaceous layer, whereas e- PTFE grafts appeared almost com pletely free from hematic deposits. One hour after implantation, a red thrombus was found to overlay the luminal surface of both carbon and e- PTFE prostheses. This layer ap peared to be thicker on the e-PTFE grafts than on the carbon grafts and thicker on the venous grafts than on the arterial. The endothelialization process of the blood-prosthesis inter face seemed to be slightly more rapid on the carbon than on the e-PTFE aortic grafts. In conclusion, this new carbon graft would appear to possess promising specifications, making it suitable for small-caliber arterial (but not venous) replacement.

Perinatal infections are a serious and delicate problem for which great diagnostic care and accurate therapies are required. In some cases they are characterized by a dramatic onset, easy to diagnose at delivery, whereas in many other cases they are poorly symptomatic with medium and long term sequelae. In these other cases, further laboratory, mlcrobiological and instrumental investigations äs well äs blood tests are needed. With all these investigations, a correct diagnosis takes rather long with obvious disadvantages for the patient. Therefpre, more efforts should be made to reduce the time interval between diagnosis and beginning of therapy, for example through a rapid histological examination of the cord and membranes on frozen sections. However, with this method, by which a correct diagnosis can be obtained in a very short time, the cases to be examined must first be selected. After a long period of study and planning, during which the advantages and limits of this diagnostic tool have been examined, the following guidelines have been identified: 1) positive vaginal tampon during pregnancy for pathogenic agents infecting the phoetus; 2) untreated genital-urinary infection during pregnancy or for which no subsequent negative control is available after treatment; 3) any other infection risk factor present in individual cases; 4) prolonged rupture of the membranes (for morethan 24 hours) ; 5) pre-term delivery (before week 37) without any other known risk factors; 6) muddy and/or malodorous amniotic fluid; 7) skin rash at birth (pustules or macules/papules); 8) fever at birth; 9) mother's fever during labour and/or in the days preceding birth. From a practical point of view, because of the focal nature of funisitis and chorion amnionitis, the pathologist should be provided with a relatively long segment of the umbilical cord from which sections shall be cut at three different levels, äs well äs a fold of placental membrane to be examined throughout its length according to the 'Swiss roll' technique. The füll placenta will be sentlaterforthorough examination according tothe Standard protocol (see Pathologica 84,563-566,1992). The above protocol was rigorously applied with no interruptions to a case series from April to September 1993. In this period, 46 urgent examinations were conducted on a total of 680 newborns (i.e. 6.8%). 9 cases of chorion amnionitis were detected (19.6%), 5 of which with associated funisitis. These cases were referred to us based pn the following findings: -muddy or malodorous amniotic fluid (criterio n° 6): 4 cases -pre-term delivery (criterio n°5): 3 cases -prolonged rupture of the membranes (criterio n° 4): 1 case -fever at birth (criterio n°8): 1 case. All diagnoses made on frozen sections were later confirmed on embedded material specimens and on additional placenta specimens. Negative cases were also confirmed accordingly. The reliability of this technique is thus confirmed by these data. The 9 positive cases were confirmed by bacteriological examinations on the newborn and on the...

Dilatation and perforation of the prosthetic wall represent major problems limiting long-term function of biologic arterial substitutes. One case of multiple aneurysm formation and one of graft wall perforation, occurring nine and three years, respectively, after human umbilical vein (HUV) femoropopliteal reconstructions, are reported. Both grafts were well functioning. At microscopic examination, the aneurysmal HUV wall showed no degenerative changes, while appearing thinner with respect to the undilated zones (about one third). The HUV flow surface remained thromboresistant, except for the dilated areas. Partial endothelialization of the inner graft surface was documented. In conclusion, the risk of HUV graft dilatation and perforation increases when function is maintained for periods longer than three years from implantation. However, the umbilical vein retains over time its thromboresistant properties.