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The new phase of study and revision of the Palaeolithic art of the Cova de les Meravelles, as well as the advances made in the field of 3D documentation in recent years, have motivated a new documentation campaign on the main panel full of tiny engraved motifs. The difficulties involved in acquiring and processing data executed using fine and thin engraving techniques indoors, have been solved through a multi-light photogrammetric survey, photographing the main panel surface with five lighting directions, and applying principal component analysis (PCA). This procedure has allowed us to obtain a large corpus of two and three-dimensional data and to improve the documentation base produced 17 years ago after its discovery. In this paper, we present the procedure followed, the enhanced engraving results in the new documentation campaign, its most significant contributions to the complex archaeological survey, and the limits we have found along the procedure.

Anticyclic citrullinated peptide (anti-CCP) antibodies are highly specific for the diagnosis of rheumatoid arthritis (RA). The clinical distinction between RA and psoriatic arthritis (PsA) is often difficult to establish; therefore, the presence of rheumatoid factor (RF) and anti-CCP antibodies could be useful. Seven percent to 40% of patients with longstanding psoriasis will develop PsA at some point. Therefore, it is important to study the positivity of these antibodies in these two interrelated populations.

While not the only form of reactive arthrits, Reiter's syndrome is the eponym given to a form of reactive arthritis associated with with the classice triad of conjuntivitis, urethritis, and inflammatory arthritis. Although in popular use, the term Reiter's syndrome has become clouded, not only because of the variable pathophysiology of reactive arthritis, but also because of Reiter's own past as an early member of the Nazi party and his prominent role in the German health system during the Thrid Reich, including involvement with involuntary medical procedures and experiments in Nazi concentration camps. As is often the case, the eponym attached to the syndrome does not honor the original describers of the disease, although doubtless Reiter's account remains the classic description. We offer a brief historical review of the disease, and complete it with a translation into English of Reiter's original publication.

Endometriosis is often a perplexing medical condition for both the physician and the patient. Accordingly, development of treatment strategies based on the needs of the individual patient is highly desirable. Although endometriosis has been part of the clinical practice for almost a century, many questions remain relating to the relationship between endometriosis and infertility as well as endometriosis and pelvic pain. Endometriosis is a disease of reproductive-age women, and it is now well recognized that a genetic susceptibility appears probable. The prevalence in the general population has never been clearly established. Factors to consider in management include the age and reproductive desires of the patient, the stage of the disease, and, most importantly, the symptoms. Therapeutic options include no treatment, medical therapy, surgery, or combination therapy. Oral contraceptives, androgenic agents, progestins, and gonadotropin releasing hormone (GnRH) analogs have all been used successfully, although at the present time, the latter preparations are the most popular medical therapy for endometriosis. Leuprolide acetate, goserelin acetate, and nafarelin acetate are all effective agents. Surgical therapy is appropriate, especially for advanced stages of the disease. Laparoscopy is an effective surgical approach with the goal of excision of visible endometriosis in a hemostatic fashion. Since endometriosis is a chronic condition, it is not uncommon for recurrences to occur. While endometriosis remains an enigmatic disease, the introduction of new pharmacologic agents, such as GnRH analogs and newer endoscopic methods of surgical treatment, have facilitated and improved the overall management of this disease.

Advancements in instrumentation and the introduction of new media for uterine distention have enhanced the potential of hysteroscopy as a diagnostic technique. In a 10month period at the University of Minnesota, hysteroscopy was performed in 110 patients with suspected uterine pathology. Paracervical block anesthesia was used in 70 ambulatory patients and the remainder were investigated under general anesthesia because of concomitant laparoscopy or planned surgical intervention. Both dextran 30 per cent and 5 per cent dextrose in water were used for uterine distention. Hysteroscopic abnormalities were found in 70 per cent of the patients examined. These findings included endometrial polyps (32 patients), 12 intrauterine foreign bodies, submucous myomas (10 patients), developmental anomalies and cesarean section scar defects (7 patients), and 16 patients with miscellaneous pathologic conditions, including one patient with adenocarcinoma of the endometrium. In 33 patients the hysteroscopic findings were normal. In several patients intrauterine devices were removed under hysteroscopic control. There were no complications related directly to hysteroscopic observation.

To investigate the thermal effects of electrical power and waveform on uterine tissue in vitro, using the gynecologic resectoscope with a 2.5-mm roller-bar electrode.

Laparoscopic tubal sterilization has been rapidly gaining acceptance as a nonpuerperal method of permanent fertility control. A number of problems have nonetheless been associated with this technique. For example, tubal destruction often exceeds that necessary for tubal occlusion, increasing the danger of thermal injuries and possibly such dysfunctional disorders as abnormal uterine bleeding and dysmenorrhea. Furthermore, excessive destruction precludes any possibility of later tubal reconstruction.

Endometrial and tubal causes of female infertility have been sought with the use of endometrial biopsy, the Rubin test, hysterosalpingography, and laparoscopy. Hysteroscopy, used as an adjunct to these methods, can increase their effectiveness in evaluating uterine or tubal factors that may account directly or indirectly for reproductive failure. Hysteroscopy was included in the diagnostic evaluation of 142 patients with a diagnosis of primary or secondary infertility. In 62% visually recognizable abnormalities were found, such as intrauterine adhesions, endometrial polyps, submucous leiomyomas, and uterine septa, that could explain the infertilitiy. In 31.7% of 63 patients who had an abnormal hysterosalpingogram, hysteroscopy demonstrated a normal uterine cavity. Even though hysteroscopy is useful as a diagnostic and therapeutic adjunct to traditional methods for evaluation of uterine factors in infertility, it does not replace or excude them. Rather, it complements the procedures, particularly when abnormal hysterosalpingograms have been obtained, when intrauterine adhesions are suspected, or when there is abnormal uterine bleeding. Performed concomitantly with laparoscopy, hysteroscopy becomes the most effective technique for evaluation of the uterine and tubal conditions that may play a role in female infertility.

Objective:To assess the impact of subchronic and moderate hypercortisolism on the secretary endometrium of the cynomolgus monkey.Methods:Osmotic pumps containing hydrocortisone phosphate (HP) were implanted subcutaneously in each monkey on the first day of the menstrual cycle; each monkey also received pumps containing saline in another cycle. Blood was obtained three times per week and urine was collected daily for hormone analyses. Endometriectomy was performed 13 ± 1 days after the serum estradiol (E2) peak in each study cycle.Results:Infusion of HP elevated serum cortisol levels by an average of 70%. Mean serum progesterone (P) levels were decreased by 50% during the secretory phase of HP-treatment cycles by comparison with self-control cycles (P < .01); as a result, the mean endometrial glycogen concentration was reduced by 30% (P < .05) and the activity of 17β-hydroxysteroid dehydrogenase was decreased by 70% (P < .05). Serum E2 levels were not consistently elevated by HP treatment, but cytosolic estrogen receptor levels of the endometrium were decreased by 50% (P < .01), indicating increased estrogenic stimulation. Histologic development of the secretory endometrium was retarded, but the length of the secretory phase was not affected by the treatment.Conclusion:A moderate elevation of serum cortisol levels over one menstrual cycle consistently produced a reduction in serum P and a hypoprogestogenic-hyperestrogenic response of the secretory endometrium in the cynomolgus monkey.

Hysteroscopy has added a new dimension to the management of patients with common clinical problems, increasing the accuracy of diagnosis and serving as an adjunct in treatment of intrauterine conditions. This report summarizes the hysteroscopic experience with 320 selected patients, 104 in the reproductive age group with abnormal uterine bleeding, 91 who underwent hysteroscopy for location and retrieval of intrauterine contraceptive devices, 36 with primary or secondary infertility, 36 with postmenopausal bleeding, and 15 with uterine leiomyomas. Paracervical block anesthesia was used successfully in 214 patients. General anesthesia was used in the remainder because of planned additional surgical intervention. Uterine distention was achieved with D5W in 270 patients, with dextran 32% in 30 patients, and with CO2gas insufflation in 20 patients. In 71.6 per cent of the patients, visually recognizable or pathologically suspicious intrauterine abnormalities were found. This study further demonstrated the utility of hysteroscopy in diagnosis of endometrial polyps, uterine submucous leiomyomas, uterine malformations, and intrauterine adhesions. Hysteroscopy was also helpful in taking directed biopsies of selected areas of the endometrium in patients with adenomatous hyperplasia and early adenocarcinoma of the endometrium and helpful in removal of intrauterine foreign bodies and evaluation of the recently pregnant uterus when there was a question of persistent pregnancy. Hysteroscopy is a safe ambulatory procedure that is appealing to both patient and gynecologist in its economy and simplicity.

This review discusses advances in hysteroscopy in the past decade, including the introduction of small-caliber endoscopes, microhysteroscopy, the flexible steerable hysteroscope, and the use of video systems in monitoring hysteroscopic evaluations. Media for uterine distension are reviewed and possible complications of the use of dextran 70 are discussed. Hysteroscopy is superior to curettage for evaluating abnormal uterine bleeding. Hysteroscopy can be used as an adjunct to hysterosalpingography, endometrial biopsy, and laparoscopy in evaluating infertility, and in detecting and treating intrauterine adhesions. The method has also been applied to the division of uterine septa, the removal of submucous leiomyomas, and tubal cannulation both for treating tubal obstruction at the cornual areas and in conjunction with new reproductive technologies. The use of the microcolpohysteroscope to tailor the size and extension of a cervical conization is described. Finally, hysteroscopy permits evaluation of the extension and involvement of the endocervical canal in patients with endometrial neoplasia and offers an important guide in staging and planning treatment for this condition.

Three experiments studied the effectiveness of ketamine acting as an aversive unconditioned stimulus (UCS) in a conditioned flavor aversion procedure. In Experiment 1a, three conditioning trials where sucrose was paired with ketamine produced a weak but significant aversion to sucrose; Experiment 1b showed that this effect was not due to a reduced consumption of sucrose caused by ketamine-induced neophobia. In Experiment 2, acquisition of an aversion to sucrose paired with lithium chloride (LiCl) injections was retarded by prior repeated exposure to LiCl but not to ketamine. These results are not consistent with an interpretation of previous results, showing that ketamine impairs the acquisition of flavor aversions based on LiCl-induced illness, as an example of the UCS preexposure effect.

While uterotubal chromopertubations were performed early in the 1970s with the introduction of hysteroscopy, cornual cannulation was extended and adapted to fluoroscopy. The disadvantages of fluoroscopy include the difficulty in ruling out tubal spasm, inability to evaluate distal tubal disease, and other pelvic abnormalities.

Over the Sea of Odysseus and of Columbus with sunrise-gilded sails, a ship with a saint aboard voyaged toward America. He was an island saint, with the compass of his heart pointing north, his vision directed toward the America which on the planisphere was still depicted as surrounded by seamonsters and dotted with Indian cities where men lived in misery, naked in a Paradise wherein the wolf of Gubbio had taken refuge.