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The advent of biological therapies represented the beginning of a new era in the therapy of Rheumatoid Arthritis (RA), as demonstrated in several studies, but still many questions about their safety, especially in long term use, and correct administration time remain unanswered. Once remission is achieved, the orientation of clinicians regarding the maintenance of biological therapy or the switch to another immunosuppressive therapy is still uncertain. In our previous study 21 patients affected by RA who reached remission by the use of a combined therapy of anti-TNF drugs and methotrexate (MTX) underwent CyA-MTX combination therapy for maintaining remission state and were evaluated during a 6-month follow-up. The present study aims to investigate these data by a longer follow-up (12 months) and on a larger population. Fifty-three RA patients, with a disease duration of less than 3 years and DAS28

With thermogravimetric analysis (TGA) it is possible to have an estimation of vegetable oil resistance to oxidation, having a measure of weight gain percent (∆%) due to oxygen caption of oil sample during the oxidation, and of initial and final oxidation temperatures ( Ti and Tf ). The following samples were examined: extra-virgin olive oil, olive oil, sunflower seed oil, soybean oil, maize oil, peanut oil, rapeseed oil, grape seed oil, hazelnut oil, rice oil and four different kinds of oils for frying. An assessment of data obtained so far makes it possible to point out some interesting outcomes. With regard to weight gain percent, the peanut, rice and extra-virgin olive oils showed the lowest values, whereas the highest one has been detected for one of the oils for frying. As concerns the initial oxidation temperature the rice oil has displayed the maximum value, whereas the same oil for frying above said the minimum. The experimental approach and analytical method developed in this study appear adequate for the purpose, and compared to older techniques offers definite advantages. © 2004 Elsevier B.V. All rights reserved.

A 14-yr-old White male was referred to the Urology Unit of the G. Gaslini Institute because of a post-traumatic urethral stenosis (arising from a bicycle accident) that, during the previous 18 months, had required repeated endoscopic urethral dilation manoeuvres at the patient's local hospital. Apart from the urethral stenosis, the patient had been in excellent health until 2 months before admission, when slowly progressive exertional dyspnoea, associated with nonproductive cough and right-sided posterior chest pain, developed. On admission, the patient appeared in good clinical condition. Decreased percussion and auscultatory sounds were noted over the middle and lower portions of the right hemithorax. A summary of the results of the blood tests performed on admission is shown in table 1⇓. View this table: Table 1 Results of blood tests performed on admission Chest radiography (fig. 1⇓) and high-resolution computed tomography (HRCT) (fig. 2⇓) were performed. Fig. 1.— Chest radiograph. Fig. 2.— High-resolution computed tomography of the chest at two different window settings: a) “parenchymal”; and b) “soft tissue”. Thoracocentesis was performed and 500 mL haemorrhagic pleural fluid aspirated. Pleural fluid analysis did not show any cytological changes suggesting malignancies, amylase levels were within the normal range and microbiological evaluation results were negative for bacteria, fungi, mycoplasmata, mycobacteria and viruses. Plasma d‐dimer levels were slightly elevated but ultrasonography of the deep venous system did not show signs of thrombosis in the legs, penis or pelvis. Echocardiographic evaluation did not demonstrate any right ventricular dysfunction. Ultrasonographic examinations showed that there were no abnormalities of the abdominal organs and no peritoneal effusion and ruled out the presence of testicular or thyroid tumours. Fibreoptic bronchoscopy was then performed and did not reveal any airway abnormalities. Bronchoalveolar lavage analysis was nondiagnostic (no siderocytes suggestive of pulmonary haemorrhage, acid-fast bacilli, bacteria, viruses, fungi or malignant cells were identified in the epithelial lining fluid or lavage fluid …

Objectives. To determine whether tumour necrosis factor (TNF)-� blockers may reduce carotid intima-media thickness (cIMT) in patients with active rheumatoid arthritis (RA) steadily responsive to such therapy. Methods. From 287 consecutive RA patients attending our out-patient clinic and diagnosed on the basis of the American College of Rheumatology (ACR) criteria, 49 without traditional cardiovascular risk factors and meeting the requirements for TNF-� blockers therapy were selected. Among them, 39 actually started TNF-� blockers, but only 30, who reached at least a response on the ACR 20% improvement criteria at 14 weeks, maintained during the whole year of treatment, were finally considered (group A). The remaining 10/49, homogeneous for age, sex, traditional cardiovascular risk factors, socioeconomic status, disease activity and duration, who did not consent to TNF-�-blocker administration, were used as controls (group B). Disease activity score in 44 joints (DAS44), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were evaluated before starting the study, and 3, 6, 12 months thereafter; cIMT was measured by ultrasound before and 12 months thereafter only. Results. Patients in group A showed a very significant cIMT reduction (P

Esophageal atresia without fistula is a rather uncommon malformation (about 8% of all esophageal atresias); its surgical correction is sometimes difficult because of the long gap between the two pouches. When a delayed anastomosis cannot be performed, it is necessary to perform a colon interposition. In one patient operated with retrosternal esophageal-colon-plasty a second operation was needed to correct a symptomatic reflux causing dysphasia and severe aspiration pneumonia. The distal end of the colon was tapered around a chest tube; then a submucosal gastric tunnel was prepared, and the tapered colon was pulled through it and anastomosed to the gastric lumen. The child showed no evidence of gastrocolic reflux in the three years following the operation and is today healthy. Radiologic and scintigraphic examinations, performed ten months after the operation, showed the good canalization of the interposed colon and the continence of the antireflux anastomosis.

Out of the 29 cases of fetal urinary tract anomalies detected by sonography, the authors report on the 17 cases with potentially correctable malformations. A critical analysis of the diagnostic contribution offered by the radiologic and sonographic studies is presented. The role of ultrasound examination in the choice of a suitable investigation strategy is emphasized, underlining the importance of an accurate approach to avoid diagnostic errors and unuseful procedures. The indications for fetal and neonatal antegrade pyelography are discussed.

The quantity variations of glycosaminoglycans (GAGS) in urothelial samples from patients with malformations presenting infectious, obstructive or lithiasis signs have been investigated. They showed a highly significant deficiency in GAGS in patients with recurrent infections of the urinary ways, a more limited deficiency in sufferers from lithiasis and values within the normal range in patients with obstructive malformations.

AA. report a case history about a 3 month old female baby affected by bilateral pyelo-ureteric obstruction by fungus ball, presented as urine ascites because of fissure in renal pelvis and successfully treated by surgery. In spite of disobstruction and subsequent medical treatment, the obstruction relapsed and a second operation was necessary. This time a bilateral nephrostomy was done allowing irrigation with anti-candida drugs. This case has to be considered unusual because of the age of the patient, the clinical presentation as ascites, the bilateral affection, the tendency to relapse after disobstruction, and the successful treatment after the second operation.

The authors describe their experience on the surgical treatment of ureterocele in the pediatric age. The anatomic and clinical features which condition the choice between various therapeutic solutions are presented. All problems concerning any kind of different surgical approach are discussed, stressing the importance of the endovesical radical treatment.

The authors, with the support of a large case report, point out several varieties of the standard urethrography of a normal urethra and the correlations between macroscopic anatomy, radiologic anatomy and physiology. They stress the importance of a good knowledge of the urethral anatomy and of the urethrographic physiology in order to avoid considering as pathologic a really normal radiologic finding.