Search for Lepton Number and Flavor Violation in K

Searches for the lepton number violating K^{+}→π^{-}µ^{+}e^{+} decay and the lepton flavor violating K^{+}→π^{+}µ^{-}e^{+} and π^{0}→µ^{-}e^{+} decays are reported using data collected by the NA62 experiment at CERN in 2017-2018. No evidence for these decays is found and upper limits of the branching ratios are obtained at 90% confidence level: B(K^{+}→π^{-}µ^{+}e^{+})<4.2×10^{-11}, B(K^{+}→π^{+}µ^{-}e^{+})<6.6×10^{-11} and B(π^{0}→µ^{-}e^{+})<3.2×10^{-10}. These results improve by 1 order of magnitude over previous results for these decay modes.

Detection of a novel allergen in raw tomato.

The study reports a case of "pure" tomato allergy in an adult female. The responsible allergen was partially characterized by immunoblot analysis, pepsin digestion, and heating. It had a molecular weight of about 9 kDa and was heat-labile and pepsin-resistant, thus confirming the clinical history. Unfortunately, due to the failure of both 2-dimensional electrophoresis analysis and N-terminal sequencing experiments, it was not possible to characterize the protein further. Based on a comparison with currently known tomato allergens, this seems to be a novel allergen protein.

[The topical therapy of ulcerative colitis. A multicenter study with beclomethasone dipropionate foam]. / Terapia topica della colite ulcerosa. Studio multicentrico con beclometasone dipropionato schiuma.

BACKGROUND AND AIMS: The use of steroids was recently extended to the various forms of ulcerative rectocolitis by the introduction of topical formulations, above all steroids with an hepatic "first pass" devoid of systemic interference. The aim of this study was to evaluate the efficacy and tolerability of Beclomethasone dipropionate (BDP) in a rectal foam formulation, in the treatment of patients suffering from ulcerative colitis. METHODS: The experimental protocol took the form of a 28-day open prospective trial using BDP rectal foam in patients suffering from ulcerative colitis. Endoscopic, histological, clinical and tolerability parameters were evaluated. The centres taking part in the trial collected data for 60 cases out of a total of 80 patients enrolled in the study, of both sexes and aged between 20 and 81 years old, suffering from proctosigmoiditis (46.7%) and ulcerative rectocolitis (53.3%). RESULTS: Endoscopic parameters showed an improvement after 28 days of treatment in 74.5% of patients; a clinical improvement was achieved in 65.2% of cases. In percentage terms of the mean value of all the improved parameters, histological parameters were altered in 56.9% of patients. With regard to tolerability 82% of patients judged the treatment to be good/excellent. CONCLUSIONS: In conclusion, in line with recent reports regarding other pharmaceutical forms of BDP, including the use of rectal foam, these data confirm the efficacy and tolerability of this molecule and emphasise the validity of its use in the treatment of ulcerative colitis and proctosigmoiditis.

Role of oesophageal manometry in clinical practice.

The present study evaluates the role of oesophageal manometry in clinical practice. Over 5 years, 347 consecutive patients were evaluated in our oesophageal laboratory. The reasons for referral were: dysphagia (11.5%), gastro-oesophageal reflux disease (GORD) (46.7%), non-cardiac chest pain (28.5%), connective tissue disease (6.9%) and other symptomatology (6.3%). Patients were classified into the following five groups according to the referral diagnosis: dysphagia (40 patients), gastro-oesophageal reflux disease (GORD) (162 patients), non-cardiac chest pain (99 patients), connective tissue disease (24 patients) and other symptomatology (22 patients). Abnormalities in oesophageal motility were detected in 90% of patients with dysphagia, in 40.1% of patients with GORD, in 47.5% of subjects with non-cardiac chest pain, in 45.8% of patients with connective tissue disease and in 18.2% of subjects with other symptomatology. The high prevalence of abnormalities in the dysphagia group was statistically significant (p < 0.001), and the range of 95% confidence intervals (0.81-0.99) suggests that the value found may be a reasonably good estimate of percentage of anomalies detectable in the dysphagia patient population. In the dysphagia group, the initial diagnosis was confirmed in 40% of patients and changed in 52.5%; in only 7.5% of cases were the manometry results not relevant for determining an appropriate diagnosis. Manometry substantially contributed to patients receiving the correct treatment in 82.5% of cases (p < 0.001 among all groups). In the GORD group and in the non-cardiac chest pain group, the results of manometry were not relevant for confirming or changing a diagnosis in 59.8% and 53.5% of cases respectively; nevertheless, in both groups, on the basis of manometry results, the treatment was changed in 42.5% of patients (p < 0.01 vs. other symptomatology group). In conclusion, on the basis of the present data, we can emphasize the usefulness of oesophageal manometry assessment in patients with dysphagia or non-cardiac chest pain, with negative routine examinations, and also in patients with refractory GORD who have been considered for antireflux surgery.

Long-term efficacy of endoscopic stenting in patients with stricture of the biliary anastomosis after orthotopic liver transplantation.

BACKGROUND AND STUDY AIMS: The choledocho-choledochostomy (CCS) stricture is one of the most frequent complications occurring after liver transplantation. Endoscopic retrograde cholangiography (ERCP) is the most sensitive method used to define the presence and narrowness of the stricture. Endoscopic stenting of the strictured anastomosis could provide an effective alternative to the surgical intervention. PATIENTS AND METHOD: ERCP was performed in 36 of 210 patients with liver transplantation and acute cholestasis or jaundice: in 15 cases biliary anastomotic stricture was found. These patients were endoscopically treated by long-term stenting of the common bile duct (CBD) (1 year) and followed up for more than 12 months after stent removal. RESULTS: In all cases the stenting procedure resolved the biliary obstruction syndrome within 7 days. At the end of the stenting period the CCS was dilated enough to allow adequate bile flow and absence of cholestasis. Moreover, in most patients (10) the anastomosis was kept patient for more than 1 year after stent removal, whereas only two patients had stricture recurrence and needed endoscopic restenting. Four patients dropped out of the study, respectively because of liver rejection (two), acute liver failure (one) and myocardial infarction (one). One patient who developed a stone of the transplanted CBD underwent surgical intervention. CONCLUSIONS: According to our data, the endoscopic stenting of the CBD might be considered as the first choice procedure in the setting of the biliary anastomotic strictures occurring after liver transplantation. It has proved to be safe and effective, avoiding the need for more invasive surgery, which in any case should be considered for nonresponsive patients.

The effect of endoscopic sclerotherapy of esophageal varices on the development of gastric varices.

BACKGROUND AND STUDY AIMS: The effect of sclerotherapy of esophageal varices on the development of gastric varices is a controversial question. The aim of the present study was to evaluate prospectively the presence and development of gastric varices as a consequence of esophageal variceal sclerotherapy. PATIENTS AND METHODS: We prospectively studied 227 patients, all of whom had liver cirrhosis at the time of the first bleeding episode due to esophageal varices. All patients were treated with emergency endoscopic sclerotherapy, and further courses of sclerotherapy to eradicate the varices were given at seven-day intervals for three sessions, and then every fifteen days until eradication was complete. At the time of inclusion in the study, patients were divided in two groups: group A, with initial gastric varices, and group B, without any gastric varices initially. RESULTS: Group A included 138 patients (60.8%), in 99 of whom (71.7%) disappearance of the gastric varices was observed. In 63 cases (63.6%) the varices were eliminated during the sclerotherapy treatment, before the eradication of esophageal varices; in 36 cases (36.4%), the gastric varices disappeared after the eradication of the esophageal varices. Group B included 89 patients (32.9%); in 78 of them (87.6%), no appearance of gastric varices was observed, while in 11 (12.4%), gastric varices appeared. CONCLUSION: From these data, it can be concluded that sclerotherapy of esophageal varices cannot be a determinant factor either for the appearance of gastric varices or for their subsequent risk of bleeding.

Non-bleeding visible vessel treatment: perendoscopic injection therapy versus omeprazole infusion.

BACKGROUND: The non-bleeding visible vessel in a peptic ulcer is the highest risk factor for a bleeding recurrence among not actively bleeding lesions. Perendoscopic injection of sclerosing compounds is usually used as prophylaxis against rebleeding. METHODS: Forty-two patients with visible vessels in a peptic ulcer at an emergency endoscopic procedure have been studied: 21 patients underwent prophylactic perendoscopic hemostasis, and 21 patients were infused with omeprazole intravenously. RESULTS: Eight patients (19%), four in each group, had early rebleedings (within 48 h after the enrollment). There was no significant difference between the two types of treatment. At the endoscopic control after 48 h there were significantly more lesions with higher risk of rebleeding (Forrest IIa and IIb) in the group treated with perendoscopic hemostasis. CONCLUSIONS: Our data suggest that omeprazole infusion is a valid alternative to injection treatment of non-bleeding visible vessels.

Endoscopic treatment of anastomotic biliary stenosis in patients with orthotopic liver transplantation.

The choledocho-choledochostomy stricture is one of the most frequent complications occurring after liver transplantation. Today endoscopic retrograde cholangiopancreatography may be considered one of the most common methodologic approaches for the diagnosis; at the same time it provides an effective treatment of the stenosis, avoiding more invasive surgery. Biliary flow through a strictured anastomosis definitely improves after endoscopic stenting which, in most cases, resolves the biliary obstruction syndrome; moreover, the stent could allow restoration of the anatomical and functional integrity of the common bile duct. We have successfully treated eight liver transplanted patients with biliary anastomotic stenosis by endoscopic stenting of the common bile duct or by balloon dilation (one patient). The stents were replaced every 3 to 4 months and then removed after 1 year of follow-up. We observed one patient with acute cholangitis due to the clogging of the prosthetic device.

The use of a long-acting somatostatin analogue (octreotide) for prophylaxis of acute pancreatitis after endoscopic sphincterotomy.

Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). In addition, serum pancreatic enzymes increase without clinical symptoms in about 40-50% of patients undergoing these endoscopic procedures. We evaluated the potential of octreotide, a long-acting somatostatin analogue, to prevent these complications in patients who underwent EST for choledocholithiasis. 151 patients were randomly allocated to two groups (A and B). Group A was given 0.1 mg of octreotide subcutaneously 120 and 30 min before EST and four hours after; group B was given a placebo. Serum amylases (normal range 20-220 IU/l) were measured before premedication and 4, 24, and 48 hours after the end of endoscopy. After EST, the increase in the mean serum amylase was greater in the control group, but the difference was statistically significant only at the 48-hour measurement. There were five cases of acute pancreatitis in each group, with a trend (but not statistically significant) toward less severe pancreatitis in the treated group. In the control group, one patient with acute pancreatitis died. In conclusion, octreotide does not seem to prevent acute post-EST pancreatitis.

Prophylactic sclerotherapy in high-risk cirrhotics selected by endoscopic criteria. A multicenter randomized controlled trial.

Controlled trials of sclerotherapy for the prevention of the first variceal hemorrhage in cirrhotics have given conflicting results. In the present study, 106 cirrhotics were randomized to sclerotherapy (55 patients) or control group (51 patients). Admission criteria were no history of previous variceal bleeding and the presence of high-risk varices, i.e., a variceal score less than or equal to 0 according to Beppu et al. Sclerotherapy sessions were performed at time zero, 7 days, 30 days, and then monthly until eradication. Follow-up endoscopies were performed at 6-month intervals thereafter. Control patients underwent repeat endoscopy at 6-month intervals. Bleeding episodes were treated by sclerotherapy in both groups, whenever possible. Mean follow-up was 24 months. Analysis of the results was performed by the intention-to-treat method. Variceal bleeding occurred in 19 sclerotherapy patients (34.5%) and in 17 controls (35.4%, P = NS). Overall mortality was 34.5% in sclerotherapy patients and 50% in controls (P = NS). Seven of the 19 sclerotherapy patients (36.8%) and 11 of the 17 controls (64.7%) who bled died of hemorrhage (P less than 0.05, log-linear model). It is concluded that prophylactic sclerotherapy does not reduce the incidence of first variceal bleeding in cirrhotics. However, there seems to be a trend toward a lower bleeding-related mortality in sclerotherapy patients than in controls.

Comparison between ranitidine 150 mg b.d. and ranitidine 300 mg nocte in the treatment of duodenal ulcer.

A multicenter trial was undertaken to assess the clinical usefulness of a single night-time dose of ranitidine in the short-term healing of duodenal ulcer. 384 patients with endoscopically diagnosed duodenal ulcer were randomly allocated to treatment with ranitidine either 150 mg b.d. or 300 mg as a single night-time dose for four weeks. The patients not healed after four weeks were again treated for four weeks. Of the 356 patients who completed the study, according to the protocol, 148 of 176 (84.1%) recovered on ranitidine 150 mg b.d. and 147 of 180 (81.7%) recovered on 300 mg nocte after four weeks. The healing rates increased to 95.8% and 94.8% respectively after four more weeks. Ulcer symptoms were rapidly reduced with no significant differences between the two treatment groups. There were no unwanted effects in either group and no significant abnormal biochemical or hematological changes. The results of this study support the hypothesis that ranitidine 300 mg given as one night-time dose and ranitidine 150 mg b.d. are equally effective. Ranitidine 300 mg once daily in a clinical practice may be advantageous to the patient.

Intracerebral mass lesions in patients affected by AIDS.

"Toxoplasma gondii" cerebral abscess is a common opportunistic infection in patients affected by AIDS. Making a reliable diagnosis of acute cerebral toxoplasmosis is difficult in AIDS patients because of the lack of specificity of serological data and neuroradiological findings. Brain biopsy is the only procedure which enables a reliable diagnosis to be made a trial of specific medical therapy for toxoplasmosis in patients affected by AIDS and intracranial mass lesion can be advisable before performing brain biopsy. The authors report the cases of three patients affected by AIDS and cerebral toxoplasmosis. Tissue diagnosis was made in the first patient from autopsy material while a presumptive diagnosis was made in the other two cases since specific medical therapy resulted in a dramatic improvement of the neurological status. Despite the good possibilities in the treatment of this complication AIDS, however, carries a poor prognosis.