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Pubertal breast maturation is usually evaluated according to Tanner stages; however, this morphological appraisal is not strictly related to actual glandular growth. In 48 normal pubertal girls with breast development from B, to B4, comparison of data regarding Tanner's stages, mammary dimensions, breast echo-structures, and serum and urinary estrogen levels were studied. Ultrasonography allows an accurate morphostructural study of the developing breast, so that a new ultrasonographic grading of mammary growth emerged that was closely related to growing estrogen levels.

Conservative surgery represents the standard care for patients with early breast cancer. The aim of this review was to discuss the extension of conservative surgery in controversial fields such as after primary chemotherapy for large tumours or the possibility to repeat conservative surgery for a local reappearance. The project of a conservative approach to breast cancers continues with sentinel node biopsy which is worldwide performed more and more frequently. In our institute sentinel node biopsy is the standard procedure in the axillary staging of breast cancer even in those clinical scenarios which were previously considered either controversial or a contraindication such as in multicentric breast cancer, during pregnancy, in intra-ductal neoplasias, after primary chemotherapy, and male breast cancer. This conservative approach is completed by the possibility to deliver a partial breast irradiation and to provide patients with more personalized adjuvant treatments tailored on the biological features of the tumour.

We present the case of an intraperitoneal IUD incidentally noted on lumbar spine X-rays and confirmed by CT. This was secondary to asymptomatic uterine perforation occurred at the time of insertion 17 years before.

Bile duct strictures may be malignant or benign. In the absence of previous biliary surgery a precise preoperative diagnosis is often difficult, in particular when a tumor mass is absent in the preoperative radiologic findings.A review of 179 patients observed between 1982 and 2001 by the same surgical team with a preoperative diagnosis of malignant stricture of the biliary tree. A surgical procedure was performed in 153 of these cases.The presence of a malignant stricture was confirmed by final pathologic examination in 32 of 38 cases (96%) in which a curative resection was performed. A final diagnosis of inflammatory stricture secondary to choledocholithiasis was made in 3 of the remaining 6 cases (4%), along with one case each of sclerosing cholangitis, granular cell tumor and Mirizzi's syndrome, respectively.Precise preoperative evaluation of biliary structures can be very difficult when a tumor mass is absent. Despite the use of invasive procedures and new techniques such as magnetic resonance cholangiopancreatography, a false-positive rate of 4% may be expected. However, whenever a malignancy is not definitely excluded, biliary strictures should be treated as a cholangiocarcinoma.

A 48-year-old woman who underwent emergency cardiac surgery for removal of a thrombus partially occluding the mitral valve, developed pulmonary hypertension right ventricular failure and systemic hypotension, in the immediate postoperative period, a clinical condition not well controlled by high doses of epinephrine and dobutamine. The addition of a continuous infusion of norepinephrine in incremental dosages, caused the rise in cardiac index accompanied before by the reduction in the pulmonary pressure and the stability in the systemic pressure, than by the further reduction in the pulmonary pressure and the increase in the systemic pressure. The conclusion is drawn that norepinephrine is useful in the treatment of right ventricular failure which follows a condition of acute pulmonary hypertension, because the improvement of cardiac performance established without adverse effects on the pulmonary pressures whose values on the contrary progressively declined.

Increase in lung size has been described in acromegalic patients, but data on respiratory muscle function and control of breathing are relatively scarce. Lung volumes, arterial blood gas tensions, and respiratory muscle strength and activation during chemical stimulation were investigated in a group of 10 patients with acromegaly, and compared with age- and sex-matched normal controls. Inspiratory muscle force was evaluated by measuring pleural (Ppl,sn) and transdiaphragmatic (Pdi,sn) pressures during maximal sniffs. Dynamic pleural pressure swing (Ppl,sw) was expressed both as absolute value and as percentage of Ppl,sn. Expiratory muscle force was assessed in terms of maximal expiratory pressure (MEP). In 8 of the 10 patients, ventilatory and respiratory muscle responses to hyperoxic progressive hypercapnia and to isocapnic progressive hypoxia were also evaluated. Large lungs, defined as total lung capacity (TLC) greater than predicted (above 95% confidence limits), were found in five patients. Inspiratory or expiratory muscle force was below normal limits in all but three patients. During unstimulated tidal breathing, respiratory frequency (fR) and mean inspiratory flow (tidal volume/inspiratory time (VT/tI)) were greater, while inspiratory time (tI) was shorter than in controls. Minute ventilation (V'E) and mean inspiratory flow response slopes to hypercapnia were normal In contrast, four patients had reduced delta(VT/tI)/arterial oxygen saturation (Sa,O2) and three had reduced deltaV'E/Sa,O2. Ppl,sw(%Ppl,sn) response slopes to increasing end-tidal carbon dioxide tension (PET,CO2) and decreasing Sa,O2 did not differ from the responses of the normal subjects, suggesting normal central chemoresponsiveness. At a PET,CO2 of 8 kPa or an Sa,O2 of 80%, patients had greater fR and lower tI compared with controls. Pdi,sn and Ppl,sn related both to deltaV'E/deltaSa,O2 (r=0.729 and r=0.776, respectively) and delta(VT/tI)/deltaSa,O2 (r=0.860 and r=0.90, respectively). Pdi,sn also related both to deltaV'E/deltaPET,CO2 (r=0.8) and delta(VT/tI)/deltaPET,CO2 (r=0.76). In conclusion, the data suggest the relative independence of pneumomegaly and respiratory muscle strength. Peripheral (muscular) factors appear to modulate a normal central motor output to give a more rapid pattern of breathing.

Generalized cross-covariances describe the linear relationships between spatial variables observed at different locations. They are invariant under translation of the locations for any intrinsic processes, they determine the cokriging predictors without additional assumptions and they are unique up to linear functions. If the model is stationary, that is if the variograms are bounded, they correspond to the stationary cross-covariances. Under some symmetry condition they are equal to minus the usual cross-variogram. We present a method to estimate these generalized cross-covariances from data observed at arbitrary sampling locations. In particular we do not require that all variables are observed at the same points. For fitting a linear coregionalization model we combine this new method with a standard algorithm which ensures positive definite coregionalization matrices. We study the behavior of the method both by computing variances exactly and by simulating from various models., Mathematical Geology, 29 (6), ISSN:1874-8961, ISSN:0882-8121, ISSN:1874-8953, ISSN:1573-8868

In surgery for achalasia, the length of the myotomy and the opportunity of associating an antireflux procedure are still debated. Prospective and comparative studies on different techniques are few. The aims of this work is to compare the long term results of three different techniques successively adopted by the same surgical group.Between January 1955 and December 1991, 185 achalasic patients were submitted to myotomy by using in temporal sequence three different techniques. The first technique utilized (1955-1972) was a long esophagogastric abdominal myotomy (83 patients), secondly (1973-1978) a limited transthoracic myotomy (30 patients) and at last (1979-1991) a long esophagogastric abdominal myotomy associated to the Dor gastroplasty (72 patients). Since 1972, patients were prospectively followed up according to a protocol which included a clinical interview, x-rays, manometry and endoscopy at given dates. Post-operative esophagogastric transit and gastro-esophageal reflux were assessed to verify the therapeutical outcome. Results obtained with the three different techniques were analyzed and compared by using the actuarial Kaplan-Meier curves.The mean follow up was 193.3 months for the patient group that underwent abdominal myotomy (62/83 patients), 137.3 months for the thoracic myotomy group (30/30 patients) and 86.9 months for the abdominal myotomy plus Dor gastroplasty group (69/72 patients). Long-term results in the abdominal myotomy and in the thoracic myotomy groups were respectively poor in 51.6% and in 46.6% of patients. Major causes of failure were insufficient myotomy (6.5%), periesophageal scarring (9.6%) and reflux esophagitis (22.6%) for the abdominal myotomy group; insufficient myotomy (20%) and reflux esophagitis (23%) for the thoracic myotomy group. In the abdominal myotomy plus Dor gastroplasty group long-term results were excellent or good in 87% of patients and poor in 13%. Reflux esophagitis (10% of cases) was the principal cause of failure.The comparison of the actuarial curves shows a significantly better long term outcome for the abdominal myotomy plus Dor antireflux procedure than for the abdominal myotomy (p = 0.01) and for the thoracic myotomy (p = 0.002) techniques.

To evaluate the usefulness of the urinary estrone-3-glucuronide (EI-3-G) in the monitoring of the ovarian function in girls, we studied 11 girls with idiopathic central precocious puberty (ICPP) treated with LHRH analogs (LHRHa) for 2-5 years. Plasma LH, FSH, 17-beta-Estradiol (E2) levels, early morning urine (EMU) E1-3-G concentrations, were assessed before and 3, 6, 12 months after the onset of treatment. As expected, mean basal plasma LH, FSH and E2 concentrations, as well as mean basal EMU E1-3-G levels were significantly (p0.01) higher in patients studied than in normal, age matched, prepubertal controls. Three out of the 11 sexually advanced girls showed undetectable (15 pg/ml) basal plasma E2 values. On the contrary, in each patient studied, individual basal E1-3-G levels were higher than in normal age-matched prepubertal girls. LHRHa treatment significantly suppressed both basal and peak stimulated plasma gonadotropins, plasma E2 and EMU E1-3-G. However, while serum E2 levels were below the assay detection limit, not allowing to assess the degree of gonadal suppression, E1-3-G urinary concentrations were detectable in each subject treated, in the range of the normal prepubertal values. EMU E1-3-G determination seems to be a very sensitive and reliable approach to the monitoring of the effectiveness of LHRHa treatment in sexually advanced girls, allowing to detect very low estrogen concentrations and to achieve the desired ovarian suppression.

The authors report a 39-year-old man who developed a phalangeal osteomyelitis of the right thumb in consequence of nail biting. Cultures grew Staphylococcus aureus. Treatment with intravenous teicoplamine 400 mg/day for 3 weeks resulted in complete cure of infection.

In order to evaluate the effects of low-dosage, 6–12 months course of oxandrolone treatment in constitutional delay of growth, we compared the growth responses on treatment, the pattern of sexual development and pubertal growth events, up to final stature of 11 prepubertal boys, aged 10.6–14.1 yr, with those of 11 prepubertal, age-matched untreated controls. Treatment caused a significant increase of height velocity, from 4 to 9 cm/yr, and a significant acceleration of bone maturation, without affecting the timing of onset of puberty, the progression of sexual development or the onset of pubertal growth spurt. On the other hand, oxandrolone induced an earlier skeletal growth arrest but did not affect the expected final height. Treated boys showed an adult stature not significantly different from that of control subjects. Our data suggest that 6 months-1 year, low dosage oxandrolone treatment in constitutionally delayed growth has no significant effect on the pattern of pubertal growth, nor on the rate of sexual maturation or on final height.

The resorption of edentulous alveolar crests has been correlated to a variety of factors which may be briefly summarised as anatomic, metabolic, functional and prosthetic factors. With regard to functional factors, some researchers have found that some psychological aspects in edentulous subjects may be indicative of a parafunctional damaging habit leading to consequent alterations of the physical characteristics of forces applied to the bone. The aim of this study was to evaluate whether alveolar crest resorption in edentulous subjects was correlated to aspects of their psychological status, such as trait anxiety and the presence of psychosomatic symptoms. A group of 70 totally edentulous subjects were examined and trait anxiety and the presence of psychosomatic symptoms were evaluated. The orthopantomographies of the 70 subjects were then analysed in order to assess the degree of edentulous crest resorption. The present study showed the absence of statistically significant correlations between edentulous crest resorption and trait anxiety and between edentulous crest resorption and the presence of psychosomatic symptoms. These results appear to indicate that "anxious" subjects might not have parafunctional habits or that the latter play a minor role in the process of edentulous mandibular crest resorption.

(2001). Sentinel Node Biopsy in Male Breast Cancer: Future Standard Treatment? The European Journal of Surgery: Vol. 167, No. 6, pp. 461-462.

In this work is presented a finite volume full 3-D Navier-Stokes solver suitable for turbulent turbomachinery computations. The code is applied to the analysis of the secondary flow patterns in a transonic turbine cascade at three different isentropic outlet Mach numbers; namely 0.50, 1.02, 1.38. Detailed measurements obtained in four planes downstream of the trailing edge allow for comparison of losses, flow angles, vorticity and hence for a deep evaluation of the accuracy of the numerical results. Moreover the code is used to gain insight into the formation and the evolution of secondary flows inside the blade passage, into the generation of losses and into characteristic feature of these flows hard to detect experimentally. All the above mentioned aspects are examined and discussed as well as the influence of compressibility, giving thus a precise picture of secondary flows in the transonic regime.Copyright © 1992 by ASME

Conservative treatment of ureteral stenoses has been possible since the evolution in materials and methods available. We report our experience in 49 cases of ureteral stenoses (1 case with bilateral lesion). The etiology was as follows: 3 cases of tuberculous strictures, 10 late complications of endourological treatment of ureteral stones, 16 stenoses of ureteroenteric anastomoses or bladder reimplantation, 16 after radical pelvic surgery, 5 after external beam radiation therapy. Forty-two cases were treated with balloon dilation or by means of a coaxial dilator; in 7 cases a cold-knife treatment was performed. All patients had a ureteral stent for 40 days. The results were evaluated by IVP, sonography and DTPA renal scan, 6 to 20 months after stent removal. Overall success rate was 56%: it was lower than the 100% rate obtained in a 13 patients group surgically treated. In selected cases of ureteral stenoses, endourological approach should be the first choice treatment because of low morbidity and reduced hospitalization time.

Assessment of continuous cardiac output using the arterial pulse wave (APCO) is currently available only with standard radial artery catheterization (Vigileo System, FloTrac™, Edwards Lifesciences, Irvine, CA, USA) [1,2]. Many of the studies available in the literature have compared APCO versus intermittent cardiac output (ICO) obtained with a pulmonary artery catheter (Intellicath, Edwards Lifesciences, Irvine, CA, USA) in patients undergoing cardiac surgery [3]. The aim of this study was to assess the bias and level of agreement between the APCO and ICO in patients undergoing major vascular surgery.

Cardiogenic shock remains the leading cause of death in patients hospitalized for myocardial infarction, acute valvular disease and after cardiac surgery. Levosimendan (LS) is a new inodilator that has been shown to improve hemodynamic function in patients with decompensated systolic heart failure without increased myocardial oxygen consumption. The aim of this study was to evaluate the use of LS as rescue medication in patients with low ejection fraction (EF) that are not responders to conventional therapy.

Introduction The aim of this study was to investigate the haemodynamic changes that follow the appearance of pruritus during vancomycin administration.

We observed that the administration of vancomycin (V) is sometimes accompanied by pruritus, a clinical sign which appears a few minutes after the beginning of V infusion and lasts soon after V administration has been stopped. Generally it is not associated with a cutaneous rash. The aim of this study was to evaluate the hemodynamic behaviour which follows the appearance of pruritus.

To select the best tracer for use in a competitive immunoassay, we conjugated human somatomedin C (SmC) to various chemiluminescent compounds via two different synthetic pathways. Naphthylhydrazides and arylhydrazides, used as the labels, were incorporated via their imidate or their succinimide esters. Conjugating the carboxy terminal of (amino ethyl)ethyl-isoluminol to SmC via a succinimide linkage supplied the most sensitive detection limit and the most immunoreactive conjugate. We developed an immunoassay based on the use of this conjugate, and evaluated dextran-coated charcoal, second-antibody precipitation, and solid-phase immunoprecipitation for separating bound and free label. This chemiluminescent method has a detection limit of 16 pg per tube, and it is accurate and precise. Correlation studies with a conventional radioimmunoassay (x) for SmC gave the following regression equation: y = 0.66x + 3.76 (r = 0.953, n = 30); the slight discrepancies between the two methods are probably ascribable to the use of different antibodies. We thus propose this chemiluminescence immunoassay as an inexpensive and sensitive alternative to radioimmunoassay for measuring SmC in serum or in extracts of serum.

The determination of the concentration of estrone-3-glucuronide and pregnanediol-3 alpha-glucuronide has been performed by a chemiluminescent immunoassay in early morning urine samples of 14 normal menstruating women and 11 women affected by luteal phase defect. The early morning urine samples were daily collected for an entire menstrual cycle. We have employed a timed and measured volume collection procedure as correction factor. The integrated values of the hormonal data in definite time intervals were used to create a nomogram. By means of this method, it was possible to completely separate normal from luteal insufficiency subjects and to distinguish two different types of luteal phase defects. Moreover, the same approach was applied to the study of the role and the frequency of luteal phase defect in 15 patients affected by habitual abortion and in 17 premenopausal women who had undergone quadrantectomy for T1a No Mo breast cancer. A luteal phase defect was detected in nine of the aborting patients (60%) and in eight women affected by breast cancer (47%). Finally estrone-3-glucuronide was measured in early morning urine samples of 96 prepubertal and pubertal girls in different pubertal stages and in one patient affected by precocious puberty, before and during an agonist GnRH treatment. The urinary test of ovarian function seems to be suitable for diagnostic purposes and for clinical studies.

Les auteurs decrivent un cas de syndrome de Behcet dont les signes marquants etaient des ulcerations buccales, genitales, des lesions cutanees et des atteintes du tractus digestif. Les ulceres furent observes au niveau de l’œsophage, de l’ileon terminal et du rectum. Une legere amelioration spontanee des lesions intestinales a pu etre observee. Le traitement par la Salazopyrine et les steroides a permis d’obtenir et de maintenir une remission tant des symptomes gastrointestinaux que des lesions extra-digestives.

Cortisol, androstenedione, testosterone, dehydroepiandrosterone sulphate (DHAS) and free dehydroepiandrosterone (DHA) were measured in plasma of ten women affected by amenorrhoea with hyperprolactinaemia and eleven women affected by secondary hypothalamic amenorrhoea; twelve normal women at the second day of the menstrual cycle were used as controls. All subjects were hospitalized and 17-ketosteroids, 17OH-corticosteroids and total dehydroepiandrosterone were also measured in urine. Plasma DHAS was increased in all subjects affected by amenorrhoea with hyperprolactinaemia, while plasma DHA and urinary DHA were significantly increased in this group in comparison to other groups. Plasma cortisol, androstenedione and testosterone and urinary 17-oxosteroids and 17OH-corticosteroids were not significantly differnt in the three groups. In subjects affected by amenorrhoea with hyperprolactinaemia treated with bromocriptine a clear decrease of DHAS correlating with a decrease of plasma prolactin was observed. Since in wome DHAS sems to be almost exclusively secreted by the adrenal gland and most of the circulating DHA is dervied from adrenal secretion, these data suggest that human prolactin can stimulate DHAS production by the adrenal cortex.

SUMMARY Plasma dehydroepiandrosterone sulphate (DHEAS), cortisol (F) and prolactin (PRL) were measured in seventeen premenopausal women with primary hypothyroidism and in fifteen normal premenopausal women. Significantly lower (P < 0·001) DHEAS levels were found in hypothyroid women while F and PRL were in the range of normal controls. No significant relation was found between DHEAS and total thyroxine (T4) and TSH. Our results support the hypothesis that DHEAS secretion is impaired in some women with primary hypothyroidism.

Fibroendoscopic and histobioptic study of the distal oesophageal mucosa has been carried out in a series of patients suffering from gastro-oesophageal regurgitation. The regurgitation condition was verified and its extent established by means of anamnestic, spot-fluorographic and manometric-pHmetric investigations. On the basis of the analysis of relations between the extent of the oesophagitis assessed on the basis of endoscopy and that arising out of microscopic examination of the biopsy, it is concluded that there is no complete correspondence between the two techniques insofar as endoscopy can give false positive or false negative results. On the basis of these results and of those of functional investigations, histology is considered desirable even when the oesophageal mucosa is normal, if there are clinical and/or laboratory signs of gastro-oesophageal regurgitation.

The effects of Amiodarone (1000-1400 mg/week, for a period ranging from 3 to 24 months) on thyroid gland function were studied in 45 patients with heart disease, using a new method of free thyroid hormone assay. Forty-four untreated patients and 11 normal subjects were used as controls. In treated patients the prevalence of dysthyroidism was 22,2% (15,6% hypothyroidism and 6,6% hyperthyroidism); the onset of dysthyroidism ranged from 20 days to 2 years after the beginning of treatment. In control patients the prevalence of dysthyroidism was 4,4% (2,2% hypothyroidism and 2,2% hyperthyroidism). In patients with hypothyroidism (TSH greater than 7 microunits/ml) T4 levels were generally low, while T3, fT4 and fT3 levels were normal. In treated patients with hyperthyroidism (fT3 greater than 5,3 pg/ml and fT4 greater than 16 pg/ml) T4 values were high, while T3 concentrations were in the normal range. In Amiodarone-treated euthyroid patients, mean T4, fT4 and rT3 values were significantly (p less than 0,01) higher than those of control subjects; TSH levels were normal in all the groups studied. These data suggest that Amiodarone can exert both a direct effect on the thyroid gland and the peripheral metabolism of thyroid hormones. The action on the thyroid gland is suggested by the high prevalence of dysthyroidism in Amiodarone-treated patients and by the high levels of T4 and fT4 observed in patients who did not show dysthyroidism. The action on the peripheral hormonal metabolism seems to be proved by the high levels of rT3 and by the prolongation of QTc interval.

Testosterone, progesterone, 17 alpha-hydroxyprogesterone, and 20 alpha-dihydroprogesterone have been measured in the spermatic and peripheral venous blood of 17 prepubertal boys undergoing surgery for undescended testis or inguinal hernia repair. Mean (+/-SE) spermatic testosterone and progesterone (538 +/- 212 and 704 +/- 110 pg/ml, respectively) were significantly higher (P less than 0.005) than peripheral levels (91 +/- 11 and 419 +/- 71 pg/ml, respectively). No significant spermatic-peripheral gradient was found for 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone. These in vivo studies demonstrate that the secretory pattern of the prepubertal testis is different from the adult testis.

An explicit multistage finite volume method for the solution of the compressible Navier Stokes equations has been applied to resolve the transonic flow through a double throat nozzle. The accuracy and robustness of the method are shown by the accurate predictions of: extent of recirculation regions; effects of the Reynolds number on the shock structure; the viscous-inviscid interaction. The dependency of the solution upon grid refinement and wall boundary condition is also studied.

The authors report on their clinical experience with the use of Whitaker test in 38 patients (27 men, 5 women; age 3 months-66 years). Clinical applications of ureteral pressure-flow test are extensively reviewed. A standardized method with simultaneous recording of bladder pressure and combined video-pressure-flow study are basic points to be considered in order to obtain more objective data.