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Study question Do different gonadotrophins for controlled-ovarian-stimulation (COS) affect metaphase-II (MII) oocyte competence? Summary answer Euploid blastocyst rate (EBR) per cohort of MII-oocytes, live-birth-rate (LBR) per first vitrified-warmed euploid single-embryo-transfer (SET) and cumulative-LBR are independent from the gonadotrophins used. What is known already Controlled-ovarian-stimulation (COS) is a cornerstone of IVF. Its purpose is maximizing ovarian reserve exploitation and obtaining ≥1 euploid blastocyst to transfer. Indeed, ovarian reserve decreases and blastocyst aneuploidy rates increase with increasing maternal age, making this task quite complicated in advanced maternal age. Old-fashioned studies suggested an association between COS and embryonic aneuploidy rates. Conversely, recent studies excluded an impact of COS dosage, duration, ovarian response, and ovulation trigger, on blastocyst aneuploidy rate. An aspect, though, needs more clarity: do different gonadotropins impact oocyte competence after COS, comprehensively defined as EBR per cohort of MII-oocytes? Study design, size, duration Out of 3169 PGT cycles with ³1 MII oocyte conducted between 2014-2018, we excluded (i)PGT-M/-SR, (ii)women Participants/materials, setting, methods Only GnRH-antagonist COS, ICSI with fresh MII-oocytes, single culture in continuous-media, trophectoderm biopsy without assisted-hatching, comprehensive-chromosome-testing to assess full-chromosome non-mosaic aneuploidies and vitrified-warmed euploid SET were conducted. Oocyte competence was comprehensively defined as EBR per cohort of MII-oocytes with all intermediate outcomes (fertilization, blastulation and euploidy). LBR per first vitrified-warmed euploid SET and cumulative-LBR per retrieval were also assessed. Generalized-linear-models and multivariate regressions were adopted to adjust the results for confounders. All cycles were concluded. Main results and the role of chance Patients using recFSH+recLH and recFSH+HMG (40.7 yr) were older than patients using recFSH-only or HMG-only (40 yr; ANOVA Limitations, reasons for caution The gonadotrophins were chosen based on patient compliance to their administration route and gynecologist judgement, and only qualitative outcomes were assessed. Therefore, randomized-controlled-trials and cost-effectiveness analysis investigating the efficiency in oocyte recruitment and cumulative-LBR per intention-to-treat are needed. Wider implications of the findings Different gonadotrophins might not affect MII-oocyte competence. This information is key since, in view of the optimization of follicle recruitment through personalized-COS, it allows more flexibility in the choice of the most suitable protocol. Therefore, gynecologists might ponder also features like patient reproductive history and compliance to different administration routes. Trial registration number none

BackgroundSystemic lupus erythematosus (SLE) often affects women in their childbearing years, and pregnancy may affect SLE disease activity during pregnancy and post-partum (1,2). Limited data assessing the likelihood and characteristics of SLE activity in an extended time period post-partum which may be relevant as patients may wish further pregnancies exist.ObjectivesTo assess predicting factors that might influence SLE disease activity in women in an extended follow-up period of 2 years after giving birth and clinical assessment every three months.MethodsThe study was design as an international retrospective, data-driven case collection study, enrolling 119 women with a first birth and with a strictly monitored follow-up period of 2 years.ResultsTable 1 shows pregnancy outcomes of all pregnancies. When considering disease manifestations, joint involvement was present in 80% of patients, acute cutaneous in 64%, haematological in 54%and renal in 41%; 75% of patients were positive for anti-dsDNA, 49% for anti-ENA and 37% for anti-Ro/SSA positive. The mean SLE disease activity index 2000(SLEDAI-2k) at diagnosis was 13.5±6.8 and at first birth was 2.8±4.4.Table 1.Pregnancy outcomes of all pregnancies and relative breastfeeding dataPregnancy CharacteristicsAll (214)%OutcomesLive births16979Miscarriages3717.3Stillbirths83.7Maternal and Foetal ComplicationsPrematurity3918.2Pre-eclampsia2310.7HELLP syndrome41.9Placental Infarction125.6Breastfeeding (all pregnancies)Any breastfeeding (n, %)10964.5*Exclusive breastfeeding (n, %)8751.5*Breastfeeding (after first birth)Any breastfeeding (n, %)8773.1**Any breastfeeding duration (months) (m±sd)10.29±10.04Exclusive breastfeeding*** (n, %)6252.1**Exclusive breastfeeding*** duration (months) (m±sd)6.07±6*Percentages are calculated considering viable babies (total= 169)**Percentages are calculated considering first birth (total= 119)***Exclusive breastfeeding was defined as feeding infants only breast milkAt follow-up, 51.3% of patients had at least one flare after a mean time after birth of 9±6.3 months(mean flare per patient 0.94±1.1). The most frequent flare manifestations were joint involvement(48%), followed by renal(33%), cutaneous(28%) and haematologic(20%).Patients with remission of disease(SLEDAI-2K=0; no clinical or laboratory manifestations of SLE) at conception had significantly lower rates of flares than those not in remission (18/49–37% vs. 43/70–61%;p=0.008) (Figure 1).Figure 1.Flare proportion: Survival Curve based on remission status at conception of the patients included in the study.Patients who experienced a flare during pregnancy (17 patients), when compared to those who did not, had higher rates of flares during follow-up (76% vs. 47%, respectively, p=0.019), lower time for first flare (4.4±2.3 months vs. 10.3±6.5, respectively, pRemission of disease and flares during pregnancy remained significantly associated with the development of flares during follow-up after multivariate analysis.ConclusionRemission at conception can influence SLE disease positively, even at long-term. Planned pregnancy counseling is fundamental when managing SLE patients.References[1]Tincani A, Nalli C, Khizroeva J, Bitsadze V, Lojacono A, Andreoli L, et al. Autoimmune diseases and pregnancy. Best Pract Res Clin Endocrinol Metab 2019;33.[2]Clowse MEB, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 2005;52:514–521.Disclosure of InterestsNone declared

The Mercury Orbiter Radio Science Experiment (MORE) of the ESA mission BepiColombo will provide an accurate estimation of Mercury’s gravity field and rotational state, improved tests of general relativity, and a novel deep space navigation system. The key experimental setup entails a highly stable, multi-frequency radio link in X and Ka band, enabling two-way range rate measurements of 3 micron/s at nearly all solar elongation angles. In addition, a high chip rate, pseudo-noise ranging system has already been tested at 1-2 cm accuracy. The tracking data will be used together with the measurements of the Italian Spring Accelerometer to provide a pseudo drag free environment for the data analysis. We summarize the existing literature published over the past years and report on the overall configuration of the experiment, its operations in cruise and at Mercury, and the expected scientific results.

BACKGROUND: Use of preventive therapy for migraine is often recommended for only 6-9 months, but no randomised, placebo-controlled trials have investigated migraine frequency after the end of prophylaxis. We assessed the effects of discontinuation of topiramate after a treatment period of 6 months. METHODS: 818 patients who have migraines were enrolled from 88 clinics in 21 countries. After a 4-8-week lead-in period, patients received topiramate in a 26-week open-label phase. Daily dose was increased from 25 mg to 100 mg in steps of 25 mg every week; the dose could be adjusted further in the range 50-200 mg/day, but was stable for the final 4 weeks. Patients were randomly assigned to continue this dose or switch to placebo for a 26-week double-blind phase. The primary endpoint was the difference in number of days with migraine during the last 4 weeks of the double-blind phase compared with the last 4 weeks of the open-label phase. Analysis was by intention to treat. This trial is registered with EudraCT, number 2005-000321-29. FINDINGS: 559 patients (68.3%) completed the open-label phase; 514 entered the double-blind phase and were assigned to topiramate (n=255) or placebo (n=259). The mean increase in number of migraine days was greater in the placebo group (1.19 days in 4 weeks, 95% CI 0.71 to 1.66; p

Este estudo tem o objetivo de analisar brevemente a alegoria, a personificação e a metáfora, do modo como se apresentam na obra de Charles d’Orléans, poeta francês do século XV. Para tanto, consideram-se a atitude alegórica desde sua origem na antiguidade clássica, os diversos tipos de alegoria e a tradição alegórica medieval na qual Charles d’Orléans se insere. Trata-se de uma tradição iniciada pelo Romance da Rosa, cujas raízes mergulham na obra de Alain de Lille. Além disso, faz-se um estudo sucinto do símbolo e da sinédoque, discutindo as visões de Curtius, Huizinga, Hansen, Eco, Greimas, Dubois, Lausberg e Ricoeur, entre outros.Palavras-chave: Idade Média, alegoria, personificação, metáfora, poesia.

Enhanced or pumped pork products represent a significant proportion (40 to 50%) of the commercially available pork cuts available to consumers at the retail level. In a previous study, pork loins containing viable Toxoplasma gondii tissue cysts were pumped with solutions containing 2% sodium chloride or 1.4% or higher potassium or sodium lactate and stored at 4 degrees C for 7 days. This treatment prevented transmission of T. gondii to cats. In the present study, enhanced pork loins were stored for 0, 8, 16, 24, 32, or 40 h at 4 degrees C and then fed to T. gondii-seronegative cats to determine how quickly the loss of tissue cyst viability occurred. In a second experiment, pork loins collected from pigs experimentally infected with T. gondii were stored at temperatures found in retail meat cases and then fed to T. gondii-seronegative cats to determine the effect of typical meat case storage temperatures on tissue cyst viability. In both experiments, cat feces were examined for 14 days after the infected meat meal to assess oocyst shedding. The results indicate that solutions containing 2% sodium chloride or 1.4% potassium or sodium lactate are effective within 8 h of injection for killing T. gondii tissue cysts in pork loins and that storage at meat case temperatures at or below 0 degrees C (32 degrees F) for 7 days also killed T. gondii tissue cysts in pork loins.

The Italian Space Agency (ASI Agenzia Spaziale Italiana) funded 27 scientific projects in the framework of COSMO-SkyMed (CSK) program. A subset of them focused on the improvements of the quality and quantity of information which can be extracted from X-SAR data if integrated with other independent techniques (GPS, data and imagery in other bands and wavelengths). The paper summarizes the results obtained from same of these projects and, in particular, regarding: - the use of GPS observations and Numerical Weather Models (NWM) to remove atmospheric artifacts from InSAR imagery so improving the CSK potentialities in the field of topographic mapping; - the integration of SAR data in X, L and C bands to improve snow cover monitoring and glaciers detection; - the use of X-SAR data to retrieve rain precipitation and its validation with C-band radar observations; - the improvements of the focusing techniques.

The use of the GPS radio occultation technique (GPS RO) for retrieving physical and chemical parameters of the Earth's atmosphere has been deeply and widely investigated over the last decade. The technique has proved to be particularly precise in retrieving temperature profiles with high vertical resolution ( h=h 250 K up to the stratopause) using the Hopfield dry atmosphere model [J. Geophys. Res. 74(18) (1969) 4487], in which ground pressure and temperature are the parameters to be estimated. In the second step humidity profiles are extracted by subtracting the dry refractivity given by the estimated Hopfield model from the values (wet + dry) retrieved by GPS RO. The refractivity profiles used in the work were retrieved from CHAMP GPS RO data [Geophys. Res. Lett. 28 (2001) 3263]. The humidity profiles obtained with the proposed technique have been compared and validated with profiles retrieved from radwinsonde observations (RAOB) over eight sites. The results are promising in that the new method seems to retrieve profiles comparable to those obtained using the method currently in use (TAO 11(1) (2000) 53).

A fronte di un evidente ritardo del nostro paese nel riutilizzo di rifiuti da costruzione e demolizione, il presente lavoro contribuisce ad una ampia verifica delle potenziali applicazioni di tali materiali per la realizzazione degli strati portanti della sovrastruttura stradale. La rilevanza dei risultati sperimentali è evidente considerando i significativi vantaggi economici e i benefici ambientali eventualmente perseguibili in un uso diffuso di tale materiale. Più nello specifico l'articolo sintetizza gli esiti di un'ampia campagna sperimentale sviluppata presso il laboratorio di strade dell’Università di Roma Tre. Verranno descritti metodi e materiali utilizzati per investigare la produzione di fino per effetto delle azioni meccaniche di costipamento operate sia sul materiale tal quale, sia sul materiale “corretto” con alcune frazioni granulometriche di inerti naturali: gli effetti indotti dai fenomeni di autocementazione sulle caratteristiche meccaniche del C&D “tal quale" e corretto, al variare dell’umidità di confezionamento; l’incremento delle resistenze meccaniche indotto dalla stabilizzazione con cemento al variare dell'umidità di costipamento, per il materiale tal quale e corretto, per tempi diversi di stagionatura. I risultati ottenuti pongono in evidenza come le azioni meccaniche del costipamento siano responsabili di una rilevante produzione di fino. ciò non consente un adeguato riscontro tra il C&D approvvigionato all'impianto e quello posto in opera. Peraltro si è osservato come l'usuale tecnica di correzione adottata attraverso la singolare sostituzione di una singola classe granulometrica non realizza un reale beneficio in quanto questa determina una frizione che in alcuni casi incrementa la produzione di fino e finissimo, Rispetto al contenuto d'acqua si è riscontrato che per basse umidità prevalgono i fenomeni di plasticizzazione in quanto nel medio periodo un apprezzabile in-cremento di resistenze si realizza solo se si in-nescano fenomeni di ce-mentazione. Tali processi risultano più evidenti quando, per il campione corretto granulometricamente. si verifica un minore assorbimento di acqua e si realizza un efficiente scheletro litico. Nel caso invece dell'aggiunta di un'adeguata percentuale di legante cementizio, si possono ottenere risultati di particolare interesse e presumibilmente compatibili con le qualità meccaniche richieste per gli strati di base della sovrastruttura stradale sempre che: si provveda alla correzione con materiali naturali atti a garantire l'affi-dabilità dello scheletro litico e si adotti un'umidità di confezionamento tale da garantire l'efficienza dei fenomeni di presa. In Italy there is a delay in employing the waste from construction and demolition. This study carries out checks on potential applications of these materials to realize load bearing layer of road pavement. The experimental results show very clearly big advantages, especially if we consider the big economic and environmental advantages using these materials. Specifically the article synthesize the results of a wide campaign developed in the laboratory of Roma Tre university. Will be described materials and methods to investigate the production of fine materials due to the mechanical actions of the machines for the compaction both on the row material and the corrected (adjusted) material adding fractions of natural aggregate the effects due to the setting on the C&D features, varying the humidity of confection; the increase of the mechanical characteristic due to the cement stabilization varying the humidity during compaction, for the row material and the corrected one, for different time of maturation. The result shows how the mechanical actions during the compaction, are responsible for a big production of fine material. Because of this effect there is a difference between the C&D at the production site and the layed down C&D.Moreover has been observed how the traditional technique for the correction of the material adopted by the substitution of a single granulometric class doesn't realize a real advantage because it helps the production of fine and very fine material. In respect with the water content has been observed that with a low humidity prevail plastic phenomena because at medium term there is a increase of resistence only if hydratation starts.

A suitable intake of vitamins and minerals both during preconceptional period and pregnancy is essential in reducing the incidence of adverse maternal and perinatal outcomes. This is more evident in developing countries, particularly during periods of famine, when women suffer from an inadequate intake of vitamins and minerals. Even in developed countries, however, most women's diet does not meet their increased needs for micronutrients. The association of different micronutrients in a single multivitamin preparation is consequently a useful, easy to take solution and with a good cost/benefit ratio, and can prevent some important obstetrics pathologies, as preterm delivery, fetal growth restriction and preeclampsia.

At the beginning of 2008 the Indian satellite OCEANSAT-2 will be launched. This satellite will carry on-board two payloads for ocean studies and the Italian Radio Occultation GPS receiver (ROSA) devoted to atmospheric studies. In the framework of thismission, the ROSA instrument will only be able to observe rising occultations collecting data both in Open-Loop and in Close-Loop modes. These data will be downloaded both to the Indian and the Italian receiving stations where they will be processed by the ROSA ground segment, completely developed by Italian universities and research centres. In particular, this ground segment will be implemented at a first level in an integrated computing infrastructure installed in Matera and mirrored at Hyderbad in India and, at a second level, on a distributed software and hardware infrastructure. This second infrastructure will perform the rapid and precise Orbit Determination and Prediction, the unambiguous bending and impact parameters profiles extraction, the ionospheric correction and the stratospheric initialization, the refractivity, pressure, temperature and humidity profile retrieval, the value added services for meteorology, climate and space weather applications. This will identify a prototype of distributed and Multimission Ground Processing Centre distributed through the various research centres and universities involved, connected through a Web-based GRID computing infrastructure. After a description of these two different implementations of the ROSA Ground Segment, this contribution will focus on the scientific activities carried on by the Italian institution involved in the project: - Physics Dept. of Universita' di ROMA: development of climatological indexes. These activity is based on the utilization of RO data for climatic study. The main work will be focused on tropopause temperature and height determination, large scale water vapour analysis, geopotential field retrieving for dynamic indexes, evaluation and comparisonof RO data with LIDAR profiles in stratosphere. ... ... ...

Tamoxifen, for many years the 'gold standard' in the adjuvant setting for the management of endocrine sensitive early breast cancer, is associated with an increased risk of endometrial cancer and other life-threatening events. Moreover, many women relapse during or after tamoxifen therapy due to the development of resistance. This provided the rationale for a switching trial with anastrozole, the updated results of which are reported here.This trial investigated the efficacy of switching to anastrozole for women already receiving tamoxifen. After 2-3 years of tamoxifen treatment, postmenopausal, node-positive, ER-positive patients were randomized to receive either anastrozole 1 mg/day or to continue tamoxifen, 20 mg/day, giving a total duration of 5-years treatment. The primary end point was disease-free survival and secondary endpoints were event-free survival, overall survival and safety.A total of 448 patients were enrolled. At a median follow-up time of 64 months (range 12-93), 63 events had been reported in the tamoxifen group compared with 39 in the anastrozole group [HR 0.57 (95% CI 0.38-0.85) P = 0.005]. Relapse-free and overall survival were also longer in the anastrozole group [HR 0.56 (95% CI 0.35-0.89) P = 0.01 and 0.56 (95% CI 0.28-1.15) P = 0.1]. However, the latter difference was not statistically significant. Overall more patients in the anastrozole group experienced at least one adverse event (209 versus 151: P = 0.000). However, numbers of patients experiencing serious adverse events were comparable (37 versus 40, respectively: P = 0.7).Switching to anastrozole after the first 2-3 years of treatment was confirmed to improve event-free and relapse-free survival of postmenopausal, node-positive, ER-positive early breast cancer patients already receiving adjuvant tamoxifen.

International audience; This work presents the first results of an experiment aiming to derive a high resolution Digital Terrain Model (DTM) by kinematic GPS surveying. The accuracy of the DTM depends on both the operational GPS precision and the density of GPS samples. The operational GPS precision, measured in the field, is about 10cm. A Monte Carlo analysis is performed to study the dependence of the DTM error on the sampling procedure. The outcome of this analysis is that the accuracy of the topographic reconstruction is less than 1m even in areas with a density of samples as low as one sample per 100m2, and becomes about 30cm in areas with at least one sample per 10m2. The kinematic GPS technique gives a means for a fast and accurate mapping of terrain surfaces with an extension of a few km2. Examples of application are the investigation of archaeological sites and the stability analysis of landslide prone areas.

The FOURIER mission (Adriani et al. 2001) has been selected by the Italian Space Agency, together with other 4 projects, for a feasibility study. Within the current year one of these will be selected to fly within the next 4 years. The primary goal of FOURIER is the development of a systematic and objective observational test of the predictive capabilities of climate models, as proposed by Goody (1998). This requires long-term climate benchmark observations that differ from those presently available. High accuracy, demonstrable with respect to international standards, is the primary requirement. Other important features follow from this requirement. At least two types of space measurement satisfy these criteria: refractivity retrieved by GPS microwave occultation data; and calibrated, resolved, thermal radiances. In Fourier mission it is foreseen to put on board both a GPS-GLONASS receiver and a spectral radiometer (the Planetary Fourier Spectrometer —PFS-) to perform just such a test. In the paper will be discussed how to compare and validate data which will be obtained with both instruments for the future mission. Essentially the “main drawback” is that: while the PFS points to nadir direction, GNSS occultations are retrieved just along Earth grazing directions. So only the occultations that occur along the spacecraft velocity direction are selected and benchmarking for calibration purposes.

Purpose of the study: Traumatic brain injury (TBI) results in white matter injury (WMI), evidenced by demyelination. WMI may originate from neuroinflammation and is associated with late emotional and cognitive disorders in patients. Experimental research focuses on brain lesions and neurological deficits occurring days after injury, occulting long-term consequences of TBI. The present study aims to evaluate the time-course of neuroinflammation, WMI and behavioral disorders related to anxiety, compulsiveness, depression, behavioral flexibility and spatial memory after TBI. Methods used: Three groups of male Swiss mice were studied: non-operated, sham-operated and traumatic brain injured mice. TBI was induced by a controlled cortical impact. Neuroinflammation was determined by microglia activation using CD11b immunostaining. The expression of myelin basic protein (MBP), a marker of myelination, was measured in the corpus callosum using Western blot (for all biomarkers evaluations n = 5−6/group). At 15 days, 1, 2 and 3 months, sensorimotor performances were determined with pole test and spontaneous locomotion with actimeter. Spatial learning and memory, and behavioral flexibility were assessed using Barnes maze: two weeks after TBI, mice were trained to find a target hole 3 trials/day during 4 days, followed by a probe test (i.e. in absence of target box) on the last day. At 1, 2 and 3 months, mice were trained to find a new target hole location as previously described. Compulsiveand anxiety-like behaviors using the marble-burying, the open field and the elevated plus maze tests and immobility/escape behavior in the forced swim test, more relevant to depression, were assessed 3 months postTBI (for all behavioral measurements: n = 9−12/group). Data were analyzed with one-way ANOVA. Results: Number of CD11b+ cells was increased from 24 h (P< 0.001) up to 7 days post-TBI (P< 0.001), showing neuroinflammation. MBP expression was decreased at 7 days and 3 months (P< 0.01) in ipsiand contralateral corpus callosum demonstrating acute and long-term bilateral WMI. Spontaneous locomotor activity, motor coordination performances, anxiety-like and despair-like behavioral measurements were undisturbed by TBI. Although, spatial learning performances were not disturbed at 2 weeks post-TBI, deficit was apparent when moving the target hole location 1, 2 and 3 months after TBI. While all mice discriminated the target zone correctly during the probe tests, latencies to find the new target hole, distances travelled and number of errors, were all significantly higher in injured mice during the first training day (P< 0.05), suggesting that TBI induces an early deficit in learning processes, behavioral adaptability and flexibility disorder. Conclusions: These data clearly demonstrate that TBI induces acute microglial activation that precedes acute and long term demyelination, suggesting the involvement of neuroinflammation in WMI. Moreover, the latter is associated with a reduction of flexibility and a spatial learning deficit, in the absence of sensorimotor and emotional states impairments, suggesting that changes in the escape behavior to the target hole, were related to behavioral flexibility rather than defense behavior. Behavioral evaluation is still ongoing until 12 months after TBI. This model will provide an overview of various late behavioral disorders and demyelination that could help to validate pharmacological strategies.

The long-term results of 36 patients operated of manual dilatation of the anus are presented. Chronic anal fissure or benign anal stricture have been treated by this procedure in the years '80s.Patients have been in part clinically examined and the other called up by phone interview. Average follow-up is 78 months.Nobody has been re-operated for the same cause, but 2 patients underwent sphincter sparing operation for rectal cancer. Twenty-five patients (72%) completely recovered, 5 (12.5%) complain sometimes from sudden anal pain and 3 (8%) report minor incontinence problems.These long-term results do not confirm disastrous conclusions reported by other authors in the literature, even if the incidence of continence disorders is higher than in anal sphincterotomies.

The authors report their experience with the giant prosthetic reinforcement of the visceral sac (Stoppa procedure), developed in the last 6 years operating 126 cases. Postoperative period was regular for two third of the patients, but only in 4 cases we can consider complication severe: 2 cases of preperitoneal haemorrhage with haematoma formation and subsequent recurrence; one sepsis of the preperitoneal space around the prosthesis, cured with drainage and conservative measures without recurrence, and then one peritonitis in a morbid obese individual. There was no mortality. 93.3% of the patients has been clinically controlled after over 6 months (average 27 months; range 6-67 months): 8 recurrences have been observed (3.6% of the hernias operated). 7 required reintervention. Therefore it is possible to affirm that 91% of the operated patients had good results.

The authors report their experience with Rives procedure, a prosthetic repair of groin hernias using preperitoneal sutured mesh by parainguinal access. This operation is not technically easy to perform and is usually done out of necessity in cases with higher risk of recurrence because of systemic factors of chronic abdominal high pressure and/or of local factors of risk, when there are contraindications to operations like Stoppa procedure. Our series report 38 patients operated upon on 5 years, with incidence of 5.8% overall hernias repaired in the same period. 33 are males, 5 females, with average age of 60.5 years. Mean time required for the operation is 94 minutes (range 55'-130'). About postoperative complications we complain of one testicular atrophy, but none infections. Follow-up range is 9-50 months (average 23.2 months) for 30 patients operated more than one year ago. All but one were revisited after almost 12 months. No recurrences were detected.

Squamous cell carcinoma of the gallbladder is a rare tumor with an ill-defined clinical course. We report a case of pure squamous carcinoma of the gallbladder with a rapidly fatal outcome. The tumor cells were positive for oncogenes P53, c-Erb B2 and Ki 67. This feature has no comparison with other reported cases of squamous carcinoma of the gallbladder but it is in accordance with oncogene expression in adenocarcinomas.

The authors describe a rare case of leiomyoma situated in the second duodenal portion near the Vater papillary diagnosed for over eight years. The preoperative investigation isn't able to explain certainly the characteristics and the anatomo-topographic relations of the lesion besides the anatomo-pathologic dates have left a border of uncertainty about the benignity of the lesion. These considerations, as agreed with the greater part of authors, show the necessity of early surgical treatment.

Fifty-eight solid breast masses in 57 patients were subjected to fine-needle aspiration biopsy, and the results of cytologic analysis and histologic diagnosis were compared. The sensitivity was 79.2%, specificity, 85.3%, and accuracy, 82.8%. These results are within the range of those in the medical literature. Fine-needle aspiration biopsy is a useful adjunct in the management of palpable breast masses in the community hospital setting. Our data, however, do not support its use alone as a screening tool. Excisional biopsy or close clinical follow-up remains essential for evaluation and management of palpable breast masses.

Approximately 10% of premenopausal women suffer from dysfunctional menometrorrhagia. The correct therapeutic approach to this pathology above all requires a precise diagnostic framework. For this purpose the doctor can employ a number of laboratory and instrumental tests, both invasive and non-invasive, in order to differentiate the dysfunctional forms from those supported by organic pathologies or non-gynecological diseases. Once the diagnostic iter has been completed, the choice of therapy can be directed towards surgical or medical treatment; the latter may be symptomatic or causal. This review focuses on the most commonly used treatments for dysfunctional menometrorrhagia in premenopausal women and proposes clinical protocols for a correct diagnostic and therapeutic approach.

Breast cancer is a major cause of death by cancer worldwide. It is a systemic disease and may recur decades after it has been initially diagnosed (1). It is associated with a high risk of metastasis (2). There is no doubt that breast tumours synthesize high levels of eicosanoids as compared to the normal tissue (3–6). Whether this increased synthesis occurs in response to certain physiological stimuli or in response to intracellular mediators unique to malignant cells or it is contributed by the non-tumerous surrounding cells resident in the tumour tissue in response to the mediators released by malignant cells, is still unknown. Honn et al (7,8) suggested that primary tumours or detached tumour cells may cause the disruption of systemic balance between prostacyclin (PGI2) and thromboxane (TXA2) in favour of TXA2. However, we did not find any alteration in the ratio of TXA2:PGl2 in plasma of patients with malignant or benign tumour of the breast (9). Nevertheless, the levels of PGI2 and TXA2 in plasma of breast cancer patients were significantly higher than in benign patients. Also, surgical removal of the primary tumour showed no decrease in levels of prostanoids in breast cancer patients (9) .

Since intravascular volume contraction is regarded as an important pathological feature in preeclampsia, it has been proposed that plasma volume expansion could be a therapeutic manoeuver that interrupts the pathogenetic chain of hypovolemia inducing increased vascular resistance. Furthermore, tissue perfusion should be improved and, if albumin is used as plasma expander agent, interstitial edema should also be reduced. We report the results observed in an open pilot study in ten preeclamptic patients treated with daily albumin infusions (0.4 to 1 g/kg) from 7 to 36 days. No acute effects were shown on blood pressure, and the need for antihypertensive therapies did not decrease in the following days. Serial evaluation after at least five or ten days of repeated albumin infusions did not show stable changes in electrolytes excretion, renal clearances, serum protein concentration and hematocrit value, nor in aldosterone, renin and atrial natriuretic peptide basal levels, while proteinuria tended to increase. Uteroplacental and fetoplacental blood flow acutely ameliorated in 3 cases only after albumin 1 g/Kg, but reached basal values again on the next day. The clinical implications are that daily albumin infusions with this schedule dosage do not lower blood pressure and that they are unable to induce stable changes in renal function, uteroplacental and fetoplacental resistance. No maternal complications were observed during the conservative management, but fetal mortality was high (6/10). Given the uncontrolled study, we cannot know whether similar results had been achieved by conventional therapy only.

Transhiatal blunt esophagectomy has been reported as a safe and effective procedure for the palliation of carcinoma of the esophagus. Avoidance of a thoracotomy eliminates the morbidity associated with this procedure, and creation of a cervical esophagogastric anastomosis avoids the catastrophic sequelae of an intrathoracic anastomotic leak. Moreover, use of the procedure for palliation does not preclude excellent 1-year survival rates. We report early results in five consecutive patients with esophageal carcinoma who underwent transhiatal blunt esophagectomy. Five patients had 22 complications, including one with a fascial dehiscence, pyloroplasty leak, and localized mediastinal abscess requiring a second laparotomy. One patient died in the hospital postoperatively of massive aspiration pneumonitis. Our results compare favorably with those reported in the literature. We believe that transhiatal blunt esophagectomy avoids the morbidity and mortality of a thoracotomy and an intrathoracic anastomosis, yet remains a major gastrointestinal operative procedure with all of its attendant risks.