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BACKGROUND: In primary care risk stratification, automated algorithms do not consider the same factors as providers. The process of adjudication, in which providers review and adjust algorithm-derived risk scores, may improve the prediction of adverse outcomes. OBJECTIVE: We assessed the patient factors that influenced provider adjudication behavior and evaluated the performance of an adjudicated risk model against a commercial algorithm. DESIGN: (1) Structured interviews with primary care providers (PCP) and multivariable regression analysis and (2) receiver operating characteristic curves (ROC) with sensitivity analyses. PARTICIPANTS: Primary care patients aged 18 years and older with an adjudicated risk score. APPROACH AND MAIN MEASURES: (1) Themes from structured interviews and discrete variables associated with provider adjudication behavior; (2) comparison of concordance statistics and sensitivities between risk models. KEY RESULTS: 47,940 patients were adjudicated by PCPs in 2018. Interviews revealed that, in adjudication, providers consider disease severity, presence of self-management skills, behavioral health, and whether a risk score is actionable. Provider up-scoring from the algorithmic risk score was significantly associated with patient male sex (OR 1.24, CI 1.15–1.34), age > 65 (OR 2.55, CI 2.24–2.91), Black race (1.26, CI 1.02–1.55), polypharmacy >10 medications (OR 4.87, CI 4.27–5.56), a positive depression screen (OR 1.57, CI 1.43–1.72), and hemoglobin A1c >9 (OR 1.89, CI 1.52–2.33). Overall, the adjudicated risk model performed better than the commercial algorithm for all outcomes: ED visits (c-statistic 0.689 vs. 0.684, p

Immune Check-Point Inhibitors (CPIs) have improved long-term patients’ outcomes in several advanced cancers. Diabetes mellitus induced by CPIs (CPI-DM) is considered the second most frequent endocrine CPIs’ side effects with a variable prevalence up to 2%. The aim of our study was to identify CPI-DM characteristics and differences from the classical form of diabetes. Therefore, we conducted a structured Pubmed® search collecting publications dated from January 2015 to December 2019. A total of 642 citations were identified and 121 publications met our study criteria. We analyzed 200 case reports, including our 3 cases under publication. The majority of CPI-DM occurred with anti-Programmed cell Death-1 in monotherapy or in combination, although few cases with Programmed cell Death Ligand-1 and Cytotoxic T Lymphocyte Antigen 4 were reported. Generally, CPI-DM arose early (an average of 9weeks after CPIs starting), but also after the end of CPIs treatment. In all patients, CPI-DM has an acute onset and in 67.5% of cases diabetic ketoacidosis occurs. C-peptide levels were usually and permanently compromised, requiring lifelong insulin therapy. Moreover, autoimmunity and genetic profile was not always helpful. In particular, anti-glutamic acid decarboxylase (anti-GAD) antibodies and Human Leukocyte Antigen (HLA) DR4 were present in only 43.0% and 51.3% of cases respectively. In 51.0% of subjects a mild exocrine impairment coexisted. In short, though CPI-DM has similarities to type 1 diabetes mellitus, it represents a new, largely unknown, clinical entity. In addition, as CPI-DM is a relative frequent side-effect under CPI, a close monitoring of the glucose levels and early signs and symptoms of diabetes in patients affected by neoplasm is recommended.

BackgroundAlthough there are some controversies regarding whole pelvic radiation therapy (WPRT) due to its gastrointestinal and hematologic toxicities, it is considered for patients with gynecological, rectal, and prostate cancer. To effectively spare organs-at-risk (OAR) doses using multi-leaf collimator (MLC)’s optimal segments, potential dosimetric benefits in volumetric modulated arc therapy (VMAT) using a half-beam technique (HF) were investigated for WPRT.MethodsWhile the size of a fully opened field (FF) was decided to entirely include a planning target volume in all beam’s eye view across arc angles, the HF was designed to use half the FF from the isocenter for dose optimization. The left or the right half of the FF was alternatively opened in VMAT-HF using a pair of arcs rotating clockwise and counterclockwise. Dosimetric benefits of VMAT-HF, presented with dose conformity, homogeneity, and dose–volume parameters in terms of modulation complex score, were compared to VMAT optimized using the FF (VMAT-FF). Consequent normal tissue complication probability (NTCP) by reducing the irradiated volumes was evaluated as well as dose–volume parameters with statistical analysis for OAR. Moreover, beam-on time and MLC position precision were analyzed with log files to assess plan deliverability and clinical applicability of VMAT-HF as compared to VMAT-FF.ResultsWhile VMAT-HF used 60%–70% less intensity modulation complexity than VMAT-FF, it showed superior dose conformity. The small intestine and colon in VMAT-HF showed a noticeable reduction in the irradiated volumes of up to 35% and 15%, respectively, at an intermediate dose of 20–45 Gy. The small intestine showed statistically significant dose sparing at the volumes that received a dose from 15 to 45 Gy. Such a dose reduction for the small intestine and colon in VMAT-HF presented a significant NTCP reduction from that in VMAT-FF. Without sacrificing the beam delivery efficiency, VMAT-HF achieved effective OAR dose reduction in dose–volume histograms.ConclusionsVMAT-HF led to deliver conformal doses with effective gastrointestinal-OAR dose sparing despite using less modulation complexity. The dose of VMAT-HF was delivered with the same beam-on time with VMAT-FF but precise MLC leaf motions. The VMAT-HF potentially can play a valuable role in reducing OAR toxicities associated with WPRT.

Merkel cell carcinoma is a rare (∼ 2000 cases/year in the USA) but aggressive neuroendocrine neoplasm of the skin. In 2008, the Merkel cell polyomavirus (MCPyV) was found to be clonally integrated in approximately 80% of Merkel cell carcinomas. The remaining 20% have large numbers of UV-associated mutations. Importantly, both the UV-induced neoantigens in virus-negative Merkel cell carcinoma and the Merkel cell polyomavirus oncogenes that are required for virus-positive tumor growth are highly immunogenic. Indeed, antigen-specific T cells detected in patients are frequently "dysfunctional/exhausted," and the inhibitory ligand PD-L1 is often expressed by Merkel cell carcinoma cells. These data led to point our attention on the quantity and the quality of the immune response in Merkel cell carcinoma. Here, we found CD8+ lymphocytes are the only singly evaluated lymphocyte subclass that strongly influenced overall survival and disease-specific survival in Merkel cell carcinoma. In addition, we highlighted as Merkel cell polyomavirus is a strong prognostic factor and as it prompts a host immune response involving various lymphocyte subclasses (CD3, CD8, FoxP3, and PD-L1 positive) in MCC. For this reason, we proposed a novel eye-based "immunoscore" model, obtained by tumor infiltrating lymphocytes subtyping (CD3, CD8, FoxP3, and PD-L1) that could provide additional prognostic information in Merkel cell carcinoma.

Epidemiological studies have reported inconsistent findings for the association between B vitamins and breast cancer (BC) risk. We investigated the relationship between biomarkers of folate and vit ...

Introduction Although Hispanic women have lower rates of breast cancer compared to non-Hispanic whites (NHW), breast cancer remains the leading cause of cancer death among Hispanic women . Some studies suggest that Hispanic women have lower rates of breast cancer screening compared to NHW women, primarily due to lack of health insurance and socioeconomic disadvantages . This study aims to understand the demographic characteristics of Hispanic women in the U.S. who access and utilize the Avon Breast Health Outreach Program (BHOP), and how Hispanic women's mammography history differs by nativity. Avon BHOP supports community-based organizations to conduct education and outreach to over 50,000 low-income and uninsured women each year, linking them to routine breast cancer screening and care. Methods This study analyzed 2014 Client Intake Forms (CIF) for all women aged 40 and older, who were served by BHOP for the first time (∼16,000 women). Descriptive analysis was conducted to summarize their demographic and breast health information, comparing Hispanics with NHW. Multivariate logistic regression was performed to examine the relationship between ethnicity and nativity and having a mammogram in the last two years. Lastly, a sub-analysis among foreign-born (FB) Hispanics only was conducted to assess how the length of time living in the U.S. (number of years) impacts the likelihood of having a mammogram in the last two years. Results Of the first time clients served through BHOP in 2014, 10.4% were US-born Hispanics, 45.2% were FB-Hispanics, and 44.4% were NHW. The majority of FB-Hispanic women were from Mexico (66.2%). FB-Hispanics are less likely to have insurance as compared to US-born Hispanic women (19.7% vs. 39.3%), and less likely to have a high school degree (34.3% vs. 44.8%). After controlling for demographic and socioeconomic variables, FB-Hispanics had significantly greater odds of having a mammogram in the past two years compared to US-born Hispanics (OR=1.6, 95% CI, 1.3-1.9), and NHW women (OR=1.4, 95% CI, 1.2-1.6). FB-Hispanics living in the U.S. for 5+ years had a 1.7 greater odds of having a mammogram in the past 2 years, as compared to recent immigrants living in the U.S. for less than one year (OR=1.7 ;95% CI, 1.1 – 2.7). Discussion In 2014, the percentage of BHOP Hispanic women aged 40+, reporting a mammogram in the last two years (41.1%) was lower than the overall U.S. Hispanic rate (61.4%) , suggesting confirmation that BHOP serves vulnerable and underserved populations, as it aims to do. This study also demonstrates how screening behaviors differ among Hispanic women served through BHOP, with FB-Hispanics having higher mammography utilization rates as compared to their US-born counterparts, with variation seen by the number of years living in the U.S. In conclusion, it is critical to view Hispanics as a heterogeneous group in order to best address their clinical needs. Specifically, the results point to how U.S.-born Hispanic BHOP clients may be at particularly high risk for low breast cancer screening. Citation Format: Gates-Ferris K, Senter L, Aliaga M, Hurlbert M, Ricci C. The effect of Hispanic nativity and ethnicity on mammography use through the Avon breast health outreach program. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-06.

As the UN Agenda 2030 recognizes heritage protection in several goals, this research was focused on the improvement of the graffiti removal from stones. The cleaning of two graffiti paints with different composition (an alkyd- and an acrylic&ndash, based paints) from two stones (gneiss and travertine) was performed considering a synergistic approach based on the combination of a low-toxic solvent ternary mixture, followed by an Nd:YAG laser. The different concentrations of the low-toxic solvents were based on the triangular Teas graph, keeping similar Hansen solubility of the products commonly used in conservation of cultural heritage: methyl ethyl ketone (MEK) and n-butyl acetate. The n-butyl acetate was replaced by mixture A (51% ethyl alcohol/11% acetone/38% isooctane) and MEK by mixture B (7%/13%/80%). Regardless of the graffiti composition, the gneiss was satisfactorily cleaned with the mixture A, while for the travertine, the best results were achieved by the mixture B. Then, surfaces treated with the mixtures were irradiated with a QS Nd:YAG laser working at 532 nm. The cleaning evaluation was performed by stereomicroscopy, color spectrophotometry, roughness measurements, reflectance measurements, and scanning electron microscopy. As result, regardless on the stone and the graffiti paints, it was confirmed the enhancement of cleaning of the mixtures followed by the Nd:YAG laser. However, it is crucial to identify previously the concentrations of the chemical products that allow the best performance considering the graffiti-stone interaction, on the one hand, and the optimal laser&rsquo, s parameters, on the other hand.

The surgical experience of the sub-occipital approach for treatment of pineal gland and pineal region tumors is reported. This approach was originally proposed by Jamieson and modified by Lapras who by changing the shape of the bone flap obtained the elevation of the occipital lobe which consequently resulted in a better exposition of this deep region. The reason why this approach became the basis for their treatment is particularly related to the personal experience of Lapras who reported his fantastic experience of surgery in this deep area and demonstrated the advantages of the sub-occipital transtentorial approach. Material Out of 277 patients operated from 1982 to 2012 in Lyon for a pineal tumor, 233 were treated by a sub-occipital approach: 153 males, 125 females, 75 patients of pediatric age. The majority of patients were operated on in a sitting position which represents a surgical specialty of the anesthesiological school of Lyon. Results Complete tumor removal was possible in 135 patients (58%) and partial in 60 patients (26%). For 38 patients, it was not possible to establish the quality of surgical resection. The incidence of hemianopsia decreased to less that 2% of cases while the incidence of severe pneumocephaly which requires a prolonged intensive care hospitalization was less than 4% of cases. Mortality related to this surgical approach in the Lyonnais school series was 0% during this period. Conclusion In our experience the sub-occipital transtentorial approach seems to us the best approach for pineal tumors because it permits a large exposition of the pineal region favoring the removal of the tumor with a lateral extension and also for tumors extending low into the posterior cranial fossa. In fact, this is our preferred approach because it has been used in a large majority of cases. However, surgeons have to be familiar with other possible approaches to obtain the best result in terms of removal and also to decrease the rate of sequelae to improve the quality of life of these patients.

The infratentorial supracerebellar approach is most widely used for pineal tumors. We report our own experience and technical considerations using this approach. Material From 1982 to 2010, we operated on 232 patients with pineal region tumors. Of these, 201 patients were operated on using a suboccipital transtentorial approach while 31 patients were operated on using a supracerebellar infratentorial approach. The median age of the patients ranged between 8 months and 74 years. There were 19 children and 12 adults. All patients presented with elevated intracranial pressure. There were 6 pinealocytomas, 3 papillary tumors, 7 germinomas, 2 benign teratomas, 4 pineal cysts and 9 gliomas. Adjuvant post-surgical therapy consisted of chemo-radiotherapy in 4 patients, 2 with germinomas and 2 with a grade II/III gliomas. Radiotherapy was performed in the other twelve patients (5 germinomas and 7 gliomas). Results and complications All patients are still alive at a median follow-up of eight years. Twelve of the 19 children are attending normal school classes for their age, 5 are attending classes for special needs children and 2 are not yet of school age at the last follow-up. Seven of the 12 adults are working normally, three are working part-time at the same job and two have retired but are able to lead a normal life. Postoperative complications included symptomatic diffuse cerebellar edema (one patient) completely resolved with a mild residual cerebellar syndrome; double vision secondary to IV nerve palsy (one patient); transitory Parinaud's syndrome (2 patients) and cerebellar gait (2 patients) nearly completely recovered at respectively six and twelve months. Conclusion The supracerebellar infratentorial approach seems to be a safe and effective choice in the treatment of pineal region tumors. In our experience, it permits complete tumor resections with acceptable morbidity and all neurosurgeons should master this approach in order to adapt their surgical choice according to size, extent and the relationship of the lesion with the surrounding anatomical structures.

Within the neu_ART project, funded by Regione Piemonte (Italy), a team of specialists in different scientific fields coming from Istituto Nazionale di Fisica Nucleare (INFN), Physics Department of University of Torino and Centro Conservazione e Restauro (CCR) “La Venaria Reale” has developed a new digital X-ray apparatus expressly designed for painted canvas and panels up to about 3 m × 4 m. Compared to all other systems scanning time is faster, the procedure to obtain the whole radiography is easier and images are available in real time. This apparatus has been widely tested on artworks restored at CCR “La Venaria Reale”, allowing to study and optimize the operating parameters and to evaluate its performance, thanks to the feedback provided by professionals involved in the activities of conservation. Supported by the results presented in this work, restorers had the possibility to investigate the materials characteristics and to plan the operating strategy in advance: indeed, radiographs revealed areas with losses of paint, repainted areas, canvas damages, hidden pictures, writings and previous restorations. The X-Ray system for Digital Radiography is integrated in a more complex apparatus that can be used also for computed tomography of voluminous objects up to 2.5 m in height and 2 m in width, making the apparatus developed in the neu_ART project a unique and comprehensive tool at conservators' disposal.

Giulia Fiorini,1 Angelo Zullo,2 Luigi Gatta,3 Valentina Castelli,1 Chiara Ricci,3 Francesca Cassol,4 Dino Vaira11Department of Clinical Medicine, University of Bologna, Italy; 2Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy; 3Versilia Hospital, Lido di Camaiore, Italy; 4School of Gastroenterology, University of Ferrera, Ferrera, ItalyAbstract: Helicobacter pylori infection remains widespread internationally, with a definite morbidity and mortality. The efficacy of standard 7–14 day triple therapies is decreasing, mainly due to increasing primary bacterial resistance to antibiotics. Currently, the most effective treatments are either the sequential regimen or the concomitant therapy. Different patents have been registered showing high bactericidal effects in vitro, some of which are active against clarithromycin- and metronidazole-resistant strains, even at low pH values. Among these novel molecules, benzimidazole-derivatives, polycyclic compounds, pyloricidin, and arylthiazole analogues seem to be the more promising. The identification of essential genes for either bacterial colonization or growth represents a route for potential target therapies in the near future.Keywords: Helicobacter pylori therapy, new antibiotic agents

Background: Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health disparities in breast cancer screening related to multiple socioeconomic factors, including stigma and discrimination. Since 2001, the Avon Breast Health Outreach Program (Avon BHOP) has granted almost $60 million to 240+ organizations to promote breast cancer screening. Avon BHOP beneficiaries collect a standardized set of de-identified, self-reported client level health and demographic data to ensure that programs reach their target population. Prior to 2011, no data on client gender or sexual orientation were collected. Methods: From 2009–2010, the Avon BHOP conducted a review of the standard confidential client intake form (CIF), last revised in 2006. Based on stakeholder input, including the Avon Foundation for Women and Avon BHOP beneficiaries, the CIF was updated in 2011 to incorporate variables for gender and sexual orientation. Proposed revisions were presented to current beneficiaries in June 2010 for feedback. Although the CIF has historically included many sensitive elements such as race/ethnicity and income, several programs expressed concern that clients or program staff would be uncomfortable addressing questions on gender and sexual orientation in particular. In response, the Avon BHOP Coordinating Center provided standard language that programs could use to help ease the concerns of staff and clients that incorporated three key messages: 1) the same form is used for all clients and programs funded by the Avon BHOP to help ensure funds are reaching clients in need; 2) all responses are kept confidential; and 3) clients may skip any question they are not comfortable answering. Results: Preliminary CIF data for January-March 2011 were analyzed for 20,672 clients from 109 programs. Overall, 96.6% (n=19,966) indicated female gender; 0.5% (n=101) self-reported gender as follows: 75 male, 8 transgender, 12 “other”, and 6 “unknown”; and 2.9% (n=605) did not respond to this question. For sexual orientation, 77.7% (n=16,067) of clients selected “heterosexual”. Of the remaining 22.3% (n=4,606), 175 (0.8%) selected “lesbian, gay or bisexual”, 431 (2.1%) selected “other”, 1045 (5.1%) selected “unknown”, and 2,954 (14.3%) did not respond to this question. By program, the non-response rate ranged from 0% to 40.2% for gender, and from 0% to 81.9% for sexual orientation. Discussion: Avon BHOP programs were able to collect sensitive information on client gender and sexual orientation during the first three months during which this information was requested. Despite concerns expressed among staff, overall response rates were high and rates of “unknown” (which may indicate that a staff person did not ask a client to complete the question) were low. Beneficiaries receive a quarterly summary of their own CIF data, which allows program staff to review client responses and ensure that client needs are met in a culturally sensitive manner. The Avon BHOP is committed to supporting diversity among funded programs; requesting data on client gender and sexual orientation may help improve services for LGBT clients by giving them a voice and reducing stigma. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-14.

As part of the EuroLifeNet program we measured personal exposure to PM2.5 in 90 pupils attending three schools in Milan, over a three-week period spanning November and December 2006, using a portable light-scattering nephelometer. The primary aim was to investigate the relationship between personal exposure to PM2.5 and background measurements obtained from a fixed monitoring station. Pearson’s correlation coefficient between sampled daily mean exposures and reference values from background station varied from 0.64 to 0.75, with an overall value of 0.63, indicating good agreement. We also estimated that about 40% of the variability in the mean daily personal exposure at the three schools was due to variability in background exposure, the remaining 60% due to between-subject differences in exposures or to other sources of error.

Many authors have tested puppies' behavior early to detect adult behavioral disorders. Our pilot study aims to investigate puppies' reactivity toward tolerance of new situations and the consistency of behavior between puppy and adult dog. Seven tests (tunnel, direct looking, sudden noise, retrieving buster-ball, problem solving, bowl removal, and approaching) were used to evaluate the reactivity of 32 German shepherd dogs at 5, 7, and 9 months of age. Among these dogs, 17 were chosen by physical and behavioral traits to continue the training program up to adulthood (choice group) and administered the same tests at the age of 2 years. Through the observation of behaviors, the tests aim to assess sociality, exploratory and retrieving tendency, learning ability, playing aptitude, and tendency toward offensive aggression. The behaviors were ranked by degree of reactivity, and ranks were used as scores. The effects of gender and group on the 5- to 9-month reactivity profiles of all the puppies were estimated with a repeated-measures model. In the choice group, the behavior changes from 9 to 24 months and their dependence on gender were estimated with an analogous model. All puppies became more self-confident between 5 and 9 months. At 9 months, behavior was slightly better in males and in the choice group. Between 9 and 24 months, self-confidence, attentiveness, and ability to solve problems and retrieve objects improved, whereas playfulness decrease. Behaviors at 9 and 24 months showed very low variability, which indicated their very high similarity.

Summary Background Helicobacter pylori resistance to antibiotics is increasing worldwide, and it reduces the efficacy of therapy. Aim To assess current primary antibiotic resistance in H. pylori strains isolated in Italy. Methods Between June 2004 and June 2006, H. pylori strains were isolated consecutively in the two participating centres (Bologna, northern Italy; Rome, central Italy) from patients never previously treated for the infection. Isolated strains were tested for primary clarithromycin, metronidazole and levofloxacin resistance using as break point the minimal inhibitory concentration ≥1, ≥8 and ≥1 mg/L for the three antibiotics, respectively. Results Overall, 255 H. pylori strains were evaluated. The resistance rate was 16.9% for clarithromycin, 29.4% for metronidazole and 19.1% for levofloxacin. Clarithromycin resistance was significantly higher in non-ulcer dyspepsia than in peptic ulcer patients (19.1% vs. 0%, P = 0.02), metronidazole resistance was higher in foreign than Italian patients (50% vs. 22.9%, P = 0.0004) and levofloxacin resistance was higher in old than younger patients (28.4% vs. 14.4%, P = 0.048). Levofloxacin resistance was also more frequent in those strains with either clarithromycin or metronidazole resistance. Conclusion A very high rate of primary resistance towards the tested antibiotics was detected in our study.

People with severe mental disorders and a history of violence are often seen as a difficult-to-manage segment of the population. In addition, this group is usually characterized by a high risk of crime recidivism, and poor compliance with community and aftercare programs. To investigate a sample of male patients living in Residential Facilities (RFs) with a history of violent behavior against people and to compare their characteristics with those of never-violent residents; to analyze the associations between aggressive behaviors in the last two years and a history of previous violence; and, to assess the predictors of aggressive behaviors. This study is part of a prospective observational cohort study which involved 23 RFs in Northern Italy. A comprehensive set of sociodemographic, clinical, and treatment-related information was gathered, and standardized assessments were administered to each participant. Also a detailed assessment of aggressive behaviors in the past two years was carried out. The study involved 268 males: 81 violent and 187 never-violent. Compared to never-violent patients, violent patients were younger, with a higher proportion of personality disorders, and have displayed an increased number of aggressive behaviors in the last two years. The presence of a history of violent behavior in the past significantly increases the probability of committing aggressive acts in the future.

Based on the size differences found between haploid and diploid pollen produced by diploid and tetraploid rose cultivars, respectively, 2n pollen producers were identified in a population of 53 diploid hybrids from a cross between a dihaploid rose, derived from the haploidization of a tetraploid modern cultivar and the diploid species R. wichuraiana. Frequency of 2n pollen producers was estimated in 2002, 2003 and 2004. Highly variable frequencies were found i) within population; ii) during years of observation (between years and between different months in the same year). The variation of 2n pollen production could be related to environmental fluctuations. A cytological analysis of male meiosis was carried out in 10 hybrids randomly chosen. Among meiotic abnormalities leading to 2n pollen formation, triads (containing a 2n microspore at one pole and two n microspores at the other) resulting from abnormal spindle geometry were frequently observed. The mode of 2n pollen formation is genetically equivalent to a First Division Restitution (FDR) mechanism. FDR 2n pollen transmits a high percentage of the heterozygosity from the diploid parent – 2n pollen producer-to the tetraploid offspring.

Resume La chirurgie represente la premiere etape du traitement des oligodendrogliomes (OLG) supratentoriels de l’adulte. Mais le role de l’exerese chirurgicale sur le pronostic, le meilleur moment de la chirurgie dans l’histoire naturelle des OLG, la meilleure strategie d’exerese demeurent debattues et les courbes de survie apres exerese varient beaucoup d’une etude a l’autre. La confusion qui regne encore sur l’identification et la classification des OLG expliquent en partie ces divergences de resultats. Premiere des techniques chirurgicales, la biopsie –– chirurgicale ou stereotaxique –– permet de confirmer un diagnostic pose sur l’imagerie, d’examiner l’extension de l’infiltration tumorale par rapport aux limites des anomalies d’imagerie et de realiser les examens de biologie moleculaire actuels. Elle peut etre le seul geste chirurgical chez des patients porteurs d’une tumeur profonde sans effet de masse important, ou en prealable a une exerese ou lorsqu’une confirmation histologique est demandee avant une surveillance radio-clinique. Dans les autres cas, c’est l’exerese tumorale qui est indiquee. Mais il n’a pas ete montre que son moment dans l’evolution de la tumeur avait une influence sur la survie, en dehors des tumeurs evolutives responsables de signes deficitaires et d’une hypertension intracrânienne qui requierent une exerese chirurgicale rapide a defaut d’etre large. La surveillance clinique et en imagerie d’une tumeur dont l’aspect est celui d’un OLG de grade A est donc justifiee et l’exerese peut etre decidee a tout moment ulterieur. Au plan technique, la tendance actuelle est celle d’une exerese maximale possible, dans le respect des zones cerebrales fonctionnelles puisqu’une exerese complete au plan carcinologique n’est qu’exceptionnellement possible. Toutefois, les resultats contradictoires ne permettent pas d’affirmer qu’une exerese large ou complete sur l’imagerie soit associee a une survie significativement plus longue. Dans l’optique d’une exerese maximale possible et de respect des regions cerebrales fonctionnelles, l’utilisation des outils chirurgicaux actuels –– instruments de neuronavigation, imageurs operatoires, techniques de stimulation corticale per-operatoire, est d’une aide precieuse au chirurgien.

Resume Introduction Les oligodendrogliomes cerebraux voient leur incidence augmenter car ils sont mieux connus et reconnus, notamment grâce a l’evolution des classifications. L’etude d’une serie homogene de ces tumeurs classees selon le grading de l’Hopital Sainte-Anne en A et B a pour objet de connaitre leur histoire avec ou sans traitement, d’etudier le role de ceux-ci et d’apprehender le pronostic et les facteurs qui y sont associes. Materiel et methodes Une serie retrospective de 318 oligodendrogliomes (OLG) de l’adulte pris en charge a l’Hopital Sainte-Anne a Paris (SA) et a l’Hopital Neurologique a Lyon (L), entre 1984 et 2003, est presentee et analysee. Elle se repartit en 182 OLG de grade A qui ont pu etre regroupes entre SA et L et 136 OLG de grade B dont il n’a ete retenu que 98 obtenir une serie homogene de tumeurs. Pour les A, l’âge de diagnostic va de 21 a 70 ans (moyenne : 41 ans), le sex-ratio est de 1,28, alors que pour les B, l’âge de diagnostic va de 12 a 75 ans (moyenne : 45,5 ans) avec un sex-ratio de 1,58. Le mode principal de revelation etait l’epilepsie (91,5% pour les A et 76% pour les B), suivi d’une hypertension intracrânienne (7,9 % pour les A et 14,6 % pour les B) et d’un deficit neurologique (5,1 % pour les A et 17,7 % pour les B). Les topographies preferentielles etaient les regions frontale, insulaire et centrale pour les A comme pour les B. La taille moyenne des tumeurs etait de 55 mm pour les A et de 62 mm pour les B. Il a ete note 20 % de calcifications dans les A et 48,5 % dans les B. Aucune tumeur ne prenait le contraste en imagerie dans les A (par definition), et tous les B, sauf 7, le prenaient en scanner et/ou en IRM. Tous les patients ont ete operes avec soit une biopsie (47,2 % dans les A et 53 % dans les B), soit une exerese qui etait limitee (26,4 % dans les A et 19,4 % dans les B) ou large (36,3 % dans les A et 37,8 % dans les B). Les patients ont eu deux interventions dans 56 cas et trois interventions dans 12cas. Une radiotherapie a ete realisee dans 76,9 % des A et 91,4 % des B. Elle a ete precoce apres l’intervention dans 71 % des cas dans les A et 82,7 % dans les B. La chimiotherapie a ete realisee chez 36 % des A lorsqu’ils se transformaient en B ou en cas d’echec de la radiotherapie, et chez 67,5 % des B. Parmi les A, 38 % sont passes en B au cours de leur evolution dans un delai moyen de 51 mois sur un suivi median de 78 mois. Resultats La mediane de survie etait de 136 mois pour les A et de 52 mois pour les B. La survie a 5, 10 et 15 ans etait respectivement de 75,5 %, 51 % et 22,4 % pour les A et de 45,2 %, 31,3 % et 0 % pour les B. Apres analyse univariee puis multivariee, la survie des A etait associee a l’âge au diagnostic, la taille de la tumeur, l’exerese large et la reponse a la radiotherapie (RT). La survie des B etait liee a l’âge au diagnostic, l’exerese large et le caractere circonscrit de la tumeur. Conclusions La confrontation des resultats de cette serie aux series publiees retrouve de nombreux parametres pronostiques. Ceci permet egalement de montrer que les OLG sont des tumeurs heterogenes y compris dans chacun des grades A et B, qui doivent faire evoluer vers un traitement adapte voire cible pour chacun des patients, notamment en ce qui concerne la radiotherapie et la chimiotherapie post-operatoire.

Summary Background : Current guidelines recommend non-invasive testing and treatment of young dyspeptic patients without alarm symptoms. Aim : To evaluate the accuracy of a new rapid immunochromatographic stool test to diagnose Helicobacter pylori infection before and after treatment compared with a gold standard. Methods : Prospective, single-blind study, performed in a tertiary care hospital. A total of 303 consecutive dyspeptic patients underwent endoscopy with multiple biopsies. Infected patients were offered a treatment and invited to come back 4–6 weeks after the end of therapy to repeat the endoscopy. Patients were also asked to provide a stool sample before and after therapy. Results : About 149 patients were H. pylori infected. The sensitivity and specificity before treatment were 91.3 and 93.5%; after treatment 92 and 100%. The likelihood ratios were robust enough to produce significant changes from pretest to post-test probability both in pre-treatment (LR+ = 14, LR− = 0.093) and post-treatment (LR+ = 19.6, LR− = 0.095). Conclusions : The novel immunochromatographic stool test is fast, easy to perform and provides good differentiation between positive and negative results. It might become a rapid near patients test easily performed in the doctor office.

Introduction: X-ray computed tomography (CT) is now used in the cultural heritage field because it is non-invasive and it can give a large amount of information on the inner structure of the object under study. Until recently mainly medical CT scanners or micro-CT setups have been used, limiting the analysis to relatively small artworks or requiring multiple acquisition and difficult image-joining for objects larger than detector dimensions. Results: To overcome the limitations of ordinary CT devices, a facility for the X-ray tomography of large size artefacts has recently been designed and installed in a protected area of the Fondazione Centro Conservazione e Restauro “La Venaria Reale”, a Centre for Preservation and Restoration. This facility, based on a X-ray source, a linear X-ray detector and a high precision mechanical system, has been and will be used to gather information on materials, manufacturing techniques and conservative conditions of artworks undergoing the restoration process. In this paper the results of the tomography of the first analyzed large artistic object are presented, giving an idea of the wealth of information obtained from the CT scan. The presented artwork is the writing cabinet called “doppio corpo”, a masterpiece of furniture more than 3 m high, inlaid for Savoy Residences by Pietro Piffetti, the most famous cabinet-maker in Piedmont in the XVIII century. The artwork is now housed in the Quirinale Palace, the official residence of the Italian President in Rome. Conclusions: The CT analysis permitted us to obtain valuable information about the conservative conditions, the presence of previous interventions, the distribution of various materials and the dimensions and arrangement of several wooden pieces, thus allowing for interesting hypotheses about the building technique of this masterpiece.

Six hundred and ninety three male inmates from three penitentiaries, two (A and B) maximum-security systems and one (C) minimum-security facility, located in Campinas, State of São Paulo, Brazil were studied for the presence of human immunodeficiency virus (HIV) antibodies, using a cross-sectional design. The search for anti-HIV antibodies in 693 samples of sera collected was carried out by two serological tests: (a) the Microparticle enzyme immunoassay-HIV-1 and HIV-2 (MEIA) (Abbott Laboratories) and (b) the Western Blot-HIV-1 (WB) (Cambridge Biotech Corporation) to confirm positive results with MEIA. Sera reactivity for HIV antibodies was 14.4%. The highest frequency of anti-HIV antibodies was found in the A and B maximum-security prisons: 17% and 21.5%, respectively. In prison C, the frequency of reagents was 10.9%. Seventy three inmates, initially negative in the MEIA test, were checked again five and seven months later. Three of them, all from the maximum-security facilities, became reactive in the MEIA test, with confirmation in the WB, suggesting that serological conversion had occurred after imprisonment.

The concurret use of smoking and oral contraceptives affects the hemostatic balance, thereby inducing a thrombophilic state. In order to clarify the effects of this association on the hemostatic system, the possible changes in the markers of activation of coagulation (thrombin-antithrombin III complexes and prothrombin fragment F1+2) were evaluated in 35 women given a third-generation oral contraceptive for 6 months; 13 of these women (37.1%) were mild or moderate smokers. No differences were found in basal levels of the coagulation and fibrinolytic parameters between smokers and non-smokers. During oral contraceptive administration, both F1+2 fragment and thrombin-antithrombin III complex concentrations significantly increased both in smokers and in non-smokers (p0.01). Fibrinogen plasma levels increased in both groups (p0.01). Antithrombin III activity was reduced in both groups during treatment, but the difference was significant only in smokers (p0.05). Although the sample size of smokers was too small to draw definitive conclusions, present results appeared to confirm previous data about the effect of the concurrent use of smoking and oral contraceptives on antithrombin III levels, but did not demonstrate any additional effect of moderate smoking on the activation of the clotting system induced by this oral contraceptive preparation.

Plusieurs facteurs antigeniques de colonisation (CFA) et facteurs presumes de colonisation (PCF) ont ete decrits chez des souches de Escherichia coli enterotoxinogenes (ETEC). Toutefois, il existe encore de nombreuses souches d'ETEC, isolees chez des patients diarrheiques, qui ne presentent aucun de ces antigenes. Etudiant 87 ETECs isolees au Bresil chez des enfants atteints de diarrhee, nous avons selectionne deux souches appartenant au type serologique O2 :H1 et qui sont capables de s'agglutiner en presence de D-mannose et de cellules sanguines humaines ou de bovins, poulets, hamsters, moutons et chevaux. L'hemaglutination resistante au D-mannose (MRHA), les reactions serologiques specifiques et les ultrastructures fimbrillaires ont pu etre observees chez les souches cultivees a 37°C, mais non chez celles cultivees a 16°C. L'analyse, par SDS-PAGE (sodium dodecyl sulphate/polyacrylamide gel electrophoresis), de la fraction fimbrillaire purifiee a revele une bande de 32,5 kDa. Les tests d'hybridation utilisant la sonde LT (toxine thermolabile) ont identifie la codification de l'enterotoxine sur un seul plasmide a environ 34MDa. Par ailleurs, chez les souches isolees sur le critere LT, le phenotype fimbrie a ete confirme. Les caracteres specifiques des fimbrilles decrites correspondent a un nouveau facteur presume de colonisation des ETECs, et le code propose est PCF02.

Of the twenty-two sulphonamides and three commonly used dihydrofolate reductase inhibitors investigated for reverse phase separation in previous studies, the recoveries of five representative drugs from the stationary phase have been examined. Sulphanilamide, sulfisomindine, sulphaquinoxaline, diaveridine and pyrimethamine were chosen. Peak areas off the analytical column were compared with those obtained by substitution with stainless steel tubing. After careful correction for flow rate differences where necessary, 100% recoveries were indicated. As a further check, Maloprim tablets were assayed for pyrimethamine and the analysed results were found to be (99.1 ± 2.9)%. Limits of detection (LOD) for aqueous standards varied from 0.67 (for sulphanilic acid) - 0.03 μg ml/−1 (diaveridine). The linear dynamic range extended from the LOD for each drug to

The neu_ART project aims at developing state of the art transmission imaging and computed tomography techniques, applied to art objects, by using neutrons as well as more conventional X-rays. In this paper a facility for digital X-ray radiography of large area paintings on canvas or wooden panels and for the X-ray tomography of large size wooden artifacts, recently installed in a protected area, is presented. The results of a K-edge radiography facility that will soon be installed in the same area are also shown.

Gastroesophageal reflux disease is the most common gastrointestinal diagnosis recorded during visits to outpatient clinics. The spectrum of injury includes esophagitis, stricture, the development of columnar metaplasia in place of the normal squamous epithelium (Barrett’s esophagus), and adenocarcinoma. Barrett’s esophagus is a premalignant lesion detected in the majority of patients with esophageal and gastroesophageal adenocarcinoma. The incidence of these cancers has been increasing in the United States and they are associated with a low rate of survival (5-year survival rate, 15–20%). When symptoms of gastroesophageal reflux disease are typical and the patient responds to therapy, no diagnostic tests are necessary to verify the diagnosis. Endoscopy is the primary test in patients whose condition is resistant to empirical therapy but its yield in this setting is low because of the poor correlation between symptoms attributed to the condition and endoscopic features of the disease. Clinical experience suggests that lifestyle modifications may be beneficial for gastroesophageal reflux disease although trials of the clinical efficacy of dietary or behavioral changes are lacking. Abundant data from randomized trials show benefits of inhibiting gastric acid secretion and suggest that proton-pump inhibitors are superior to H2-blockers and that both are superior to placebo. In patients with Barrett’s esophagus, antireflux interventions are intended to control symptoms of reflux and promote healing of the esophageal mucosa. If a patient has symptoms refractory to proton-pump inhibitors or cannot tolerate such therapy, antireflux surgery, most commonly Nissen fundoplication, may be an alternative management approach. In patients with high-grade dysplasia, endoscopic therapies or surgical resection must be considered.

Two patients affected by severe Alzheimer's disease (AD) were investigated by MRI and image-guided 31P MRS. In one case, 1H MRS was additionally performed. In both cases the diagnosis of AD was confirmed, post mortem, by the pathologist. The spectral parameters of the 31P MR spectra were estimated by fitting the 31P MR signals in the time domain. Our 31P MRS results suggest that it is possible to detect the membrane catabolism, as indexed with the level of PDE resonances visible in in vivo 31P MRS, at least in severe AD cases. The 1H spectrum from AD brain showed a marked decrease of NAA signal respect to choline.

Fifteen patients with right ventricular dysplasia were investigated by T1-weighted spin- and gradient-echo pulse sequences, using a protocol that enabled both a subjective analysis of myocardial signal intensity and a quantitative/qualitative analysis of right and left ventricular function. In 8 patients, 3 investigators independently recognized abnormally hyperintense areas in the anatomic sites usually affected by the disease. In 7 of these patients, these areas showed an overlap with a-dyskinetic areas imaged by both magnetic resonance imaging (MRI) and echocardiography. In 1 patient who underwent a cardiac transplant, MRI of the explanted heart showed an excellent correlation between the distribution of the lesions and the in vivo/in vitro features. The data were compared with those from an equivalent sample of patients affected by dilated cardiomyopathy. In the latter patients, no focal hyperintensities were attributed to any anatomic sites in the right ventricule, and no focal a-dyskinetic foci were observed. Furthermore, the 2 groups of patients were significantly different in regard to dimensional and functional quantitative parameters. The results suggest that MRI is useful in integrating echocardiographic data and can be helpful in diagnosing this disease in late stages.

SUMMARYA population of 488 HBsAg carrier individuals, from central Italy, classified on the basis of biochemical, clinical and histological parameters, was analysed for the presence of HBV-DNA in serum and its relationship with HBeAg/anti-HBe markers. The prevalence of HBV-DNA was 32·8% in chronic patients with biopsy-proven liver disease, and 20 and 4·3% respectively in asymptomatic carriers with and without altered ALT levels. The values in chronic patients were correlated with the histological activity.Concordance of HBV-DNA presence and HBeAg positivity was observed in only 61·4% of cases. However HBV-DNA prevalence in sera of anti-HBe positive individuals was very low in asymptomatic carriers with normal ALT levels (2·5%). Higher values were observed in anti-HBe positive chronic patients (15·8%) and in carriers occasionally found with changes in ALT without any other clinical sign of illness (16·7%). These data would indicate that HBV-DNA is the serological marker which is most closely related to liver disease.

The characteristics of the 31P MR spectra from a large central volume in the brain of 47 healthy adults (aged 25–85 years) were assessed. Spectral parameters were estimated by means of a time‐domain fitting technique. Statistical uncertainties of the estimates were determined by means of the Cramer‐Rao theory and minimized by introducing a priori knowledge into the fitting procedure. Age‐dependency of the spectral parameters was assessed by means of linear regression. Significant differences between individuals were established for some parameters. A significant age‐dependency (p⩽0.001) of ca 20% over the age range considered was found for the intensity of the phosphocreatine resonance line. Copyright © 1993 John Wiley & Sons, Ltd.

The authors evaluated the degree of fatty infiltration of the liver in subjects with diffuse liver steatosis using image-guided 1H localized MR spectroscopy and correlated the magnetic resonance (MR)-determined fat fraction with the computed tomography (CT) liver/spleen density ratio and histologic evaluation.MR measurements were performed at 1.5 T by applying a double-spin-echo localization sequence. Twenty-six patients underwent MR and CT examinations and ultrasound (US)-guided biopsy. Additionally, three healthy volunteers underwent MR examination. Steatosis severity was estimated using 1) the ratio between fat and total MR signal areas; 2) the ratio between liver and spleen CT number; and 3) histologic score.The linear correlation between MR fat/fat-plus-water signal ratio and CT liver/spleen density values ratio is statistically significant. Both techniques correlate well with histologic score. No significant correlation exists between water or fat T2 values and the severity of steatosis.1H MR spectroscopy allows a noninvasive estimate of the hepatic fat content.

Literature has shown that immunosuppression observed in systemic mycosis can be related to damage in primary lymphoid organs. We have studied the immunopathological alterations induced experimentally by Paracoccidioides brasiliensis in these organs. In this work, thymic alterations induced in BALB/c mice during acute and chronic stages of infection are described. It was observed that P. brasiliensis is able to invade the thymic microenvironment, inducing severe atrophy characterized by degeneration of the cortical area, organ weight decrease, loss of corticomedullary delimitation and increase in histiocyte number. Occurrence of polymorphonuclear infiltration in the subcapsular area was also observed. Our results demonstrate that P. brasiliensis induces profound thymic atrophy and raises the question of whether this could be a fungal strategy to achieve successful establishment in the host over the long term.

¶ Objective. Report our experience with 27 tentorial meningiomas (TM) surgically treated between 1985 and 1998. Methods. The records of 27 patients with TMs were retrospectively reviewed for clinical presentation, neuroradiological evaluation, surgical treatment and long-term outcome. The extent of tumor resection was scored according to the Simpson's grading for tumor removal. Long-term results were evaluated according to the Glasgow Outcome Score (GOS). Results. The average age was 53 years. Female predominance was 74%. The most common complaints at presentation were headaches (51%), gait ataxia (33%), memory disturbances (30%) and hypo-acousia (30%). A classification of TMs into 5 subgroups according to tumor site is proposed on the basis of imaging studies. A cerebrospinal fluid shunt was established prior to direct approach in 7 patients and as the sole procedure in one inoperable patient. Twenty-seven direct approaches were undertaken in 26 patients, including 17 infratentorial and 10 supratentorial approaches. Total tumor removal was achieved in 20 patients (77%) and subtotal removal in 6 (23%). Fifteen patients (55%) experienced 22 postoperative complications. One patient died three months after a subtotal resection (mortality=3,7%). With a mean follow-up of 54 months, all 26 survivors are currently alive with 23 having resumed their normal activities and 3 needing assistance. Five of 6 patients with subtotal resection survived and were followed for a period ranging from 72 to 132 months: none showed residual tumor progression and no re-operation was considered. An additional patient experienced a «true» recurrence 6 years after total removal, with no tumor progression 2 years after his recurrence was recognized. Discussion. The best surgical approach to TMs is still a controversial matter. The advantages and drawbacks of conventional versus transbasal approaches are reviewed. Our experience suggests that subtotal removal can be associated with long recurrence-free intervals and preserved quality of life. TMs located at the tentorial edge carried a definitely worse prognosis than peripheral forms.

The aim of this study was to hormonally induce lactation in prepubertal, nulliparous, and male goats both transgenic and non-transgenic. Analysis of milk quality, recombinant protein expression levels, total amount of recombinant protein produced, and the affect on long-term reproductive capability was assessed. Fifty-one goats (Saanen, Alpine, and Toggenburg), male and non-pregnant females, 2-31 months of age, either non-transgenic or transgenic were evaluated with a total of 10 transgenes (constructs) represented. Animals were given estradiol (0.25 mg/kg, i.m.) and progesterone (0.75 mg/kg, i.m.) on days 1, 3, 5, 7, 9, 11 and 13, while prednisilone (0.4 mg/kg, i.m.) was administered on days 14-16 with mammary massage occurring daily from day 5 onward. Forty of 51 animals, (36 of 38 females and 4 of 13 males) produced milk with total volumes in the 30-day experiment, ranging from 20 microl to 530 mls per day, or approximately 500 microl to 6.8 liters total. Milk composition was analyzed for various parameters (total protein, fat content, total solids and somatic cell count) with no significant differences found between induced and natural milk. Expression levels of recombinant proteins from transgenic animals that were analyzed during the induced lactation, and subsequently during normal lactations, were found to have no significant differences. Total amount of recombinant protein produced was evaluated at different expression levels with no statistical significance seen. While over 90% of the females placed in the regimen became pregnant, there was a correlation between increased age at time of induction and an increase in number of breedings, or reproductive cycles needed to establish a pregnancy after induction. For males, 100% placed in the regimen settled females after hormonal induction of lactation. Semen quality was evaluated prior to, during, and after hormonal treatments. Semen volume and sperm number did not differ; however, for a small percentage of males, there was a decrease in sperm and post thaw motility after hormonal treatments. These levels returned to normal within 4-5 weeks. Subsequent natural lactations showed total milk volumes within breed standards. These findings indicate that hormonal induction of lactation in the caprine species is a viable alternative to pregnancy for initiating lactation and milk production, does not adversely impact reproductive performance long-term, and can benefit the early assessment of recombinant proteins produced in a transgenic founder program.

SummaryBecause of the association of oral contraceptives (OC) and cigarette smoking with an increased thrombotic risk, we evaluated thromboxane (TX) and prostacyclin urinary (u) metabolites, as in vivo indices of platelet-vessel wall interactions, in women assigned to third generation OC. Twenty-eight women (15 smokers) underwent a 6-month trial of 30 μg ethinylestradiol plus 0.150 mg desogestrel. Cotinine plasma levels were elevated only in persons classified as smokers and serum TXB2 determination confirmed the absence of cyclooxygenase inhibition throughout the study. u-TXB2 and 11-dehydro-TXB2 were higher in smokers than in non-smokers. OC decreased u-11-dehydro-TXB2 both in smokers (from (pg/μmol creatinine) 35.1 ± 6.9 to 15.8 ± 2.8; P Thus, the OC regimen used here improves – if anything – platelet vessel wall interactions as assessed by prostanoid production in vivo. The prothrombotic tendency associated with the use of OC in smokers does not appear to be mediated by changes in platelet-vessel wall interactions.

Among patients with enchondromatosis, those with Ollier's disease are usually considered to be at a lower risk for extra-osseous malignancy than those with Maffucci's disease. However, several reports suggest that Ollier's disease may also be associated with gliomas. We report here the youngest patient in the literature (16 years) to be detected with a brain tumor and Ollier's disease. This is also the first case with diffuse brain stem involvement. Thus, counselling of patients with Ollier's disease may become more difficult than initially thought.

The purpose of the present study is to evaluate retrospectively the effects of several intra-operative manipulations on the results of foramen magnum decompression (FMD) in patients having syringomyelia associated with type I Chiari malformation. Seventy-five patients having syringomyelia associated with Chiari I malformation were operated on between 1975 and 1996. This population was grouped into 4 subgroups according to the surgical protocol: group I = 42 patients with FMD alone; group II = 16 patients with FMD and third ventricle shunting; group III = 9 patients with FMD and syringosubarachnoid shunting (SSS); group IV = 8 patients with FMD and cerebellar tonsils resection. Pre- and postsurgical magnetic resonance imaging (MRI) studies were analyzed (and compared). Nine patients were lost to follow-up. The results were evaluated in the 66 remaining patients (mean follow-up: 52 months), using the Bidzinski's outcome scale (ref). Two patients (3%) died postoperatively, 31 (47%) had very good results (after additional surgery in 7), 16 (24.2%) had good results (after additional surgery in 7) and 17 (25.7%) had poor results despite further surgery in 9. A total of 27 reoperations were undertaken after primary FMD in 23 patients (35%). Thirty-nine patients (59%) had both pre- and postsurgical MRI evaluation. In 28 (72%) the syrinx had markedly decreased whereas it had remained stable in 11 (28%). Clinical results were not significantly different between the patients of groups I, II and III. Very good or good results were obtained in 24 patients (64.8%) of group I (after additional surgery in 10), in 8 (61.5%) of group II (after additional surgery in 1) and in 7 (87.5%) of group III (after additional surgery in 3). Results in group IV were as follows: 7 patients (87%) had very good results and one had a good result. With a mean follow-up of 28 months, no patient required additional surgery. Postsurgical MRI syrinx reduction was observed in all 8 patients either in the early postoperative course or on delayed followup. It is suggested that tonsils resection might enhance the results of FMD in individuals having Chiari I-related syringomyelia.

Some viruses of the families Retroviridae, such as Human T Lymphotropic Virus (HTLV); Herpesviridae as the Cytomegalovirus (CMV) and Hepadnaviridae such as the Hepatitis B Virus (HBV) are liable to be co-transmitted with the Human Immunodeficiency Virus (HIV). Since prisoners are exposed to several and important risk factors involved in the transmission of HIV and the above mentioned viruses, male inmates from the penitentiary complex of Campinas, SP, Brazil, including HIV + and HIV - ones, were examined for the presence of HTLV-I and/or II antibodies; IgG and IgM anti-CMV antibodies, and the research of the superficial hepatitis B antigen (HBsAg). The presence of anti-HTLV-I and/or II was determined by the Western Blot (WB) technique, whereas IgG and IgM anti-CMV and the search of HBsAg were carried out by the Microparticle Enzyme Immunoassay (MEIA-Abbott Lab).With regard to anti-HTLV-I and/or II, 58.3% (14/24-Number of positive reactions/number of sera examined) were reactive among the anti-HIV positive sera. Conversely, only 12.5% (3/24) among the HIV- negative sera showed positive reactions to HTLV-I and/or II antibodies. When looking for IgG anti-CMV percentages of 97.7% (43/44) and 95% (38/40) were obtained for anti-HIV positive and negative sera, respectively. As to IgM anti-CMV antibodies 11.36% (5/44) and 2.5% (1/40) of reactive sera were found for anti-HIV positive and negative, respectively. The HBsAg was found in 12.8% (5/39) of the sera which were anti-HIV positive.Alguns vírus das famílias Retroviridae, tais como, o Vírus do Linfoma Humano de Células T ( HTLV); Herpesviridae, tais como o Vírus Citomegálico (CMV) e da Hepatite B (HBV) podem ser co-transmitidos com o Vírus da Imunodeficiência Adquirida (HIV). Uma vez que prisioneiros estão expostos a diversos fatores de risco envolvidos na transmissão do HIV e dos vírus acima mencionados, prisioneiros do sexo masculino do Complexo Penitenciário de Campinas, SP, Brasil, incluindo aqueles que eram HIV+ e HIV-, foram examinados para a presença de anticorpos anti- HTLV-I/II; anticorpos IgG e IgM anti-vírus citomegálico e a presença do antígeno de superfície do HBV (HbsAg). A presença de anti- HTLV-I/II foi determinada pela técnica de Western Blot, enquanto IgG e IgM anti-CMV e a pesquisa do HbsAg foram feitas por ensaio Imunoenzimático (MEIA-Abbott Lab). Com relação à pesquisa de anti-HTLV-I/II, 58,3% (14/24- número de positivos/número total de soros examinados) foram reagentes entre os soros HIV+. Contrariamente, apenas 12,5% (3/24) entre os soros HIV- mostraram reações positivas para anti- HTLV-I/II. Porcentagens de 97,7% (43/44) e 95% (38/40) foram obtidas, respectivamente para os soros anti-HIV+ e anti-HIV-, em relação à pesquisa de IgG anti-CMV. No que concerne à IgM anti-CMV 11,36% (5/44) e 2,5% (1/40) foram os achados para os soros anti-HIV+ e anti-HIV-, respectivamente. A presença do HbsAg foi encontrada em 12,8% (5/39) dos soros que eram HIV+.

16 splenic grafts and 24 accessory spleens were evaluated with ultrasound, colour Doppler and power Doppler imaging, in order to compare the features of splenic grafts and accessory spleens. 12 splenic grafts (11 surgically implanted, 1 islet of splenosis) were detected in eight patients following splenectomy 6-12 months previously. Four of the surgically implanted splenic grafts were found in three patients following splenectomy 16-18 days previously. 21 accessory spleens were incidentally detected in 20 subjects who had not been operated upon, whereas three enlarged accessory spleens were found in 10 patients who underwent splenectomy 6-12 months previously. The size, shape, rim features, echogenicity, acoustic enhancement and vascularization of the splenic grafts and accessory spleens were evaluated. The splenic grafts were oval with lobulated margins, an inhomogeneous pattern in 36% and acoustic enhancement in 64%. Multiple feeding vessels arising from the surrounding tissue entered the periphery of 10 splenic grafts in the eight patients operated on 6-12 months previously, whereas no vascular signals were detected in the four splenic grafts of the three patients operated on 16-18 days ago. Accessory spleens were round with smooth echogenic margins and a vascular hilum arising from the splenic vessels. In conclusion colour Doppler and power Doppler allow differentiation between accessory spleens and splenic grafts basing on their shape and vascular supply.

A23-year-old man was admitted to the hospital with severe heart failure and cachexia. Ventricular arrhythmias and progressive heart failure (predominantly right heart) had been observed in the previous 3 years. Physical examination was unremarkable except for a widely split second heart sound, a systolic left precordial lift, third and fourth heart sounds, and signs of increased venous pressure. Chest radiography showed significant cardiomegaly. The ECG was characterized by right atrial enlargement, low QRS voltages, wide complexes in the right precordial leads (epsilon waves?), and negative T waves. Nonsustained ventricular tachycardia with polymorphic configuration was observed at ambulatory ECG monitoring. The echocardiogram (Figure 1⇓) disclosed severe right ventricular enlargement, with aneurysm at the level of the outflow, severe depression …