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Purpose: To characterize patients with APS and to propose a new approach for their follow-up. Query ID="Q1" Text="Please check the given names and familynames." Methods: Monocentric observational retrospective study enrolling patients referred to the Outpatients clinic of the Units of Endocrinology, Diabetology, Gastroenterology, Rheumatology and Clinical Immunology of our Hospital for Autoimmune diseases. Results: Among 9852 patients, 1174 (11.9%) [869 (73.9%) female] were diagnosed with APS. In 254 subjects, the diagnosis was made at first clinical evaluation (Group 1), all the other patients were diagnosed with a mean latency of 11.3 ± 10.6 years (Group 2). Group 1 and 2 were comparable for age at diagnosis (35.7 ± 16.3 vs. 40.4 ± 16.6 yrs, p = .698), but different in male/female ratio (81/173 vs 226/696, p = .019). In Group 2, 50% of patients developed the syndrome within 8 years of follow-up. A significant difference was found after subdividing the first clinical manifestation into the different outpatient clinic to which they referred (8.7 ± 8.0 vs. 13.4 ± 11.6 vs. 19.8 ± 8.7 vs. 7.4 ± 8.1 for endocrine, diabetic, rheumatologic, and gastroenterological diseases, respectively, p < .001). Conclusions: We described a large series of patients affected by APS according to splitters and lumpers. We propose a flowchart tailored for each specialist outpatient clinic taking care of the patients. Finally, we recommend regular reproductive system assessment due to the non-negligible risk of developing premature ovarian failure.

Duplex stainless steels have very good properties including good ductility, moderate toughness and good stress corrosion cracking resistance. These properties can be severely affected by the precipitation of sigma (s) and chi (?) phases, in particular ductility and toughness. The effect of cold deformation on the isothermal transformation kinetics of UNS S32205 steel was investigated. The steel was cold rolled up to 64 % reduction in thickness and annealed at 850 °C from 10 min up to 4320 min (3 days). Microstructural characterization used light optical and scanning electron microscopy, energy dispersive spectroscopy, and magnetic measurements. Formation of intermetallics is much faster in the cold-rolled samples. After 4320 min, samples show the same amounts of each phase for all rolling strains. Results have been validated by thermodynamic calculations.

Percutaneous ethanol injection (PEI) is an effective treatment for autonomously functioning thyroid nodules (AFTNs). The aims of this study were to assess: (1) the ultrasound (US) and colour-coded duplex sonography (CCDS) baseline and post-therapy patterns of AFTN, and (2) the contribution of CCDS in determining the efficacy and optimum duration of PEI. Forty AFTNs were evaluated by US and CCDS before, during and 6 and 12 months after PEI. Four grades of increasing vascularity were arbitrarily identified at CCDS (0-1-2-3). These data were compared with thyroid scintiscan and hormonal findings. All nodules showed a striking volume decrease. After treatment a hypoechoic pattern and blurred outlines on US were associated with a higher percentage volume reduction. Soon after PEI a reduction in the vascularity score was noticed in 29 of 40 of AFTNs. Pre- and post-treatment vascular score distributions were significantly different. It is concluded that a vascular score decrease to grade 0–1 at the end of PEI is an index of successful treatment.

Ultrasound-guided ethanol injection (PEI) is an effective treatment of autonomously functioning thyroid nodules (AFTN) but little is known about the tissue lesions induced by alcohol. We report morphological changes of an AFTN which was removed after successful PEI treatment. At histological evaluation, the adenoma showed multiple areas of coagulative necrosis with eosinophilic ghost follicles, hemorrhages, small vessel thrombosis and a wedge-shaped hemorrhagic infarction. The peripheral adenomatous tissue and the surrounding thyroid parenchyma were free of regressive changes and/or lympho-monocytic inflammatory reactions. Enzyme histochemistry confirmed the hyperfunctioning character of the lesion and showed reduction of succinic dehydrogenase and cytochrome-c-oxydase activity in the viable tissue surrounding the central necrotic areas. By electron microscopy, the hyperfunctioning follicular epithelium showed submicroscopical alterations of the adenomatous cells surrounding the areas of coagulative necrosis. These results suggest that control of hyperthyroidism, after PEI, is due to: a) directly induced, irreversible damage (coagulative necrosis and vascular thrombosis with hemorrhagic infarction) in the central areas of the lesion; b) potentially reversible damage (reduction of intracellular enzyme activity and ultrastructural changes) in the peripheral areas.

The aim of this work was to study the vascularization of hepatocellular carcinoma (HCC) by means of dynamic CT and to demonstrate the existence of optimal temporal windows for visualization of HCC in order to develop new protocols for helical CT of the liver. We studied, by means of dynamic CT, 42 histologically proved HCCs in 30 patients after injecting contrast medium (100 ml, 3 ml/s). We performed a time–density analysis of the aorta, liver, portal vein, spleen and lesion. We identified three temporal curves of attenuation of the neoplastic tissue. Curve 1 was three-phasic: hyperattenuation, isoattenuation and hypoattenuation; curve 2 was two-phasic: hyperattenuation and isoattenuation; curve 3 was two-phasic: isoattenuation and hypoattenuation. Thirty-two lesions were homogeneous (curve 1 in 22 cases, 68.7 %; curve 2 in 7 cases, 21.8 %; curve 3 in 3 cases, 9.4 %), whereas 10 lesions were non-homogeneous. Two optimal temporal windows were identified: the first, with predominantly hyperattenuating lesions (range 29–65 s, 90.4 % sensitivity); the second, with predominantly hypoattenuating lesions (range 132.1–360 s, 76.1 %). There is an interposed time range of reduced visualization (range 62–127 s, 54.7 %) in which lesions are isoattenuating. Combined CT study during the first and second temporal windows improves the detection of HCCs especially for homogeneous and small lesions. The intermediate isoattenuation time range does not increase lesion detection rate.