A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction.

PURPOSE: The aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous semitendinosus-gracilis tendons on the same MRI used for ACL rupture diagnosis. METHODS: The study included 92 patients, with a median age of 31 years (IQR 26-41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study. RESULTS: Overall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76-91%), with κ = 0.797 which corresponds to a level of agreement defined as "Strong". Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found. CONCLUSION: This study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis. LEVEL OF EVIDENCE: IV.

Technique and protocols for cardiothoracic time-resolved contrast-enhanced magnetic resonance angiography sequences: a systematic review.

AIM: To review contrast medium administration protocols used for cardiothoracic applications of time-resolved, contrast-enhanced magnetic resonance angiography (MRA) sequences. MATERIALS AND METHODS: A systematic search of the literature (Medline/EMBASE) was performed to identify articles utilising time-resolved MRA sequences, focusing on type of sequence, adopted technical parameters, contrast agent (CA) issues, and acquisition workflow. Study design, year of publication, population, magnetic field strength, type, dose, and injection parameters of CA, as well as technical parameters of time-resolved MRA sequences were extracted. RESULTS: Of 117 retrieved articles, 16 matched the inclusion criteria. The study design was prospective in 9/16 (56%) articles, and study population ranged from 5 to 185 patients, for a total of 506 patients who underwent cardiothoracic time-resolved MRA. Magnetic field strength was 1.5 T in 13/16 (81%), and 3 T in 3/16 (19%) articles. The administered CA was gadobutrol (Gadovist) in 6/16 (37%) articles, gadopentetate dimeglumine (Magnevist) in 5/16 (31%), gadobenate dimeglumine (MultiHance) in 2/16 (13%), gadodiamide (Omniscan) in 2/16 (13%), gadofosveset trisodium (Ablavar, previously Vasovist) in 1/16 (6%). CA showed highly variable doses among studies: fixed amount or based on patient body weight (0.02-0.2 mmol/kg) and was injected with a flow rate ranging 1-5 ml/s. Sequences were TWIST in 13/16 (81%), TRICKS in 2/16 (13%), and CENTRA 1/16 articles (6%). CONCLUSION: Time-resolved MRA sequences were adopted in different clinical settings with a large spectrum of technical approaches, mostly in association with different CA dose, type, and injection method. Further studies in relation to specific clinical indications are warranted to provide a common standardised acquisition protocol.

Burden of focal cryoablation versus brachytherapy versus active surveillance in the treatment of very low-risk prostate cancer: a preliminary head-to-head comprehensive assessment.

Focal cryoablation (FC), brachytherapy (B) and active surveillance (AS) were offered to patients diagnosed with very low-risk prostate cancer (VLRPC) in an equal access protocol. Comprehensive validated self-report questionnaires accessed patients' erectile (IIEF-5) and voiding (IPSS) functions, Beck scales measured anxiety (BAI), hopelessness (BHS) and depression (BDI), SF-36 reflected patients' quality of life added to the emotional thermometers including five visual analogue scales (distress, anxiety, depression, anger and need for help). Kruskal-Wallis or ANOVA tests and Spearman's correlations were obtained among groups and studied variables. Thirty patients were included, median follow-up 18 months (15-21). Those on AS (n = 11) were older, presented higher hopelessness (BHS) and lower general health perceptions (SF-36) scores than patients opting for FC (n = 10) and B (n = 9), P = 0.0014, P = 0.0268 and P = 0.0168 respectively. Patients on B had higher IPSS scores compared to those under FC and AC, P = 0.0223. For all 30 included patients, Spearman's correlation (rs ) was very strong between BHS and general health perceptions (rs  = -0.800, P < 0.0001), and weak/moderate between age and BHS (rs  = 0.405, P = 0.026) and age and general health perceptions (rs  = -0.564, P = 0.001). The sample power was >60%. To be considered in patients' counselling and care, current study supports the hypothesis that even VLRPC when untreated undermines psychosocial domains.

Possible KIR-driven genetic pressure on the genesis and maintenance of specific HLA-A,B haplotypes as functional genetic blocks.

The HLA genomic structure underlines the permanence of fixed haplotypes transmitted in blocks as allelic combinations. One of the most discussed concerns is how and why such a strong linkage between HLA alleles has been maintained for so long. We hypothesized a possible KIR-driven pressure in the genesis of specific HLA-A,B haplotypes. Certain HLA-A and -B molecules are ligands for the same KIR receptors through the Bw4 binding motif spanning residues 77-83 in the α1 domain. We analyzed the HLA-A and -B genomic types of 9897 Caucasian people (3533 newborns and 6364 adults) subdividing them according to the presence/absence of the HLA-B Bw4 serological epitope. For each HLA-B Bw4- and Bw6-cross-reactive group, we evaluated the presence/absence of HLA-A ligands for KIR3DL1 (HLA-A*23, HLA-A*24, HLA-A*32) and KIR3DL2 (HLA-A*03, HLA-A*11). The frequency of HLA-A KIR ligands significantly increased moving from the HLA-B Bw4/Bw4 to the HLA-B Bw4/Bw6 and the HLA-B Bw6/Bw6 groups among both newborns and adults (P<0.0001). Here, we suggest that, when the HLA-B KIR-ligand motif is lacking, the HLA-A KIR-ligand might have a vicarious role in controlling the natural killer cell-mediated innate immune response. Basing upon this compensatory function in the engagement of KIR receptors, we hypothesize that specific HLA-A,B ancestral haplotypes were generated.

Effects of aliskiren on QT duration and dispersion in hypertensive patients with type 2 diabetes mellitus.

AIM: To evaluate the effect of aliskiren compared to amlodipine on QT duration and dispersion in hypertensive patients with type 2 diabetes. METHODS: A total of 170 outpatients aged 50-75 years with mild to moderate hypertension (SBP >130 and <180 mmHg and DBP >80 and <100 mmHg) and type 2 diabetes were randomly treated with aliskiren 300 mg or amlodipine 10 mg, both given once daily for 24 weeks, according to a prospective, open label, blinded-end point, parallel group design. At the end of the placebo run-in, and after 12, and 24 weeks of treatment blood pressure (BP) measurements (by mercury sphygmomanometer, Korotkoff I and V), plasma biochemistry and a standard 12-lead surface ECG were evaluated. RESULTS: Both aliskiren and amlodipine significantly reduced systolic blood pressure (SBP)/diastolic blood pressure (DBP) values (-27.2/-14.3 mmHg, p < 0.001 vs. placebo and -27.8/-14.2 mmHg, p < 0.001 vs. placebo, respectively), with no statistical difference between the two drugs. Aliskiren, but not amlodipine, significantly reduced maximum QT interval (QTmax) (-14 ms at 12 weeks and -17 ms at 24 weeks, both p < 0.05 vs. placebo) and corrected QT max (QTc max) (-26 ms and -31 ms, p < 0.01) as well as the dispersion of both QT (-11 ms and -13 ms, p < 0.01) and QTc (-18 ms and -19 ms, p < 0.01). CONCLUSIONS: Despite similar BP lowering effect, aliskiren, but not amlodipine, reduced QT duration and dispersion, which might be related to the ability of aliskiren to interfere with mechanisms underlying myocardial electrical instability in the heart of diabetic hypertensive patients.

[Organizational and management companies models]. / Modelli di organizzazione e gestione aziendale.

With the legislative decree 81/08 and s.m.i. it's explicitly defined a model of management and corporate organization that can contribute to prevent security risks in work environments. The realization of the model is not obligatory, but desirable because the result of its implementation is a decrease of company's risks and costs for safety. Our study group has developed the structure of an organizational and management model for corporate safety and the tools necessary for its realization. The realization of a model is structured in various phases: initial exam, safety policy, planification, implementation, monitoring, system retest and improvement. Such a model, in continuous evolution, is based on the responsibilities of the different corporate figures through an accurate analysis of the measured risks and the measures adopted.

[Protection of working woman's health]. / Tutela della salute della donna lavoratrice.

INTRODUCTION: In the past the role of women was mainly that of wife and mother, over the centuries, this role has changed: women assert themselves in every social field and workplace. OBJECTIVES: Analyze the history of women's work, from prehistory to the present day highlighting the evolution of women's role over the centuries. Identify which may be the different occupational stressors, in particular the organizational and psycho-social ones, to which is submitted a working woman. MATERIALS AND METHODS: The authors have analyzed the most relevant data from literature, in particular on the issue of mental health. RESULTS: Provide the main forms of prevention that have to be implemented. DISCUSSION: The main challenge for women today, is to balance work outside the home and housework. This added to job stressors, may interfere with the psychological and physical wellbeing of the worker.

Management of patients with suspected or confirmed COVID-19, in the radiology department.

OBJECTIVES: From December 2019, a novel coronavirus disease named COVID-19 was reported in China. Within 3 months, the World Health Organization defined COVID-19 as a pandemic, with more than 370,000 cases and 16,000 deaths worldwide. In consideration of the crucial role of diagnostic testing during COVID-19, the aim of this technical note was to provide a complete synthesis of approaches implemented for the management of suspected or confirmed COVID-19 patients. KEY FINDINGS: The planning of a robust plan to prevent the transmission of the virus to patients and department staff members should be fundamental in each radiology service. Moreover, the speed of spread and the incidence of the pandemic make it necessary to optimize the use of personal protective devices and dedicated COVID-19 equipment, given the limited availability of supplies. CONCLUSION: In the management of radiographic and CT imaging, staff should take special precautions to limit contamination between patients and other patients or professionals. IMPLICATIONS FOR PRACTICE: An isolated imaging room should be dedicated to suspected or confirmed COVID-19 cases, including radiography and CT scanners. This paper will provide guidance concerning disposable protective gear to be utilized, as well as on the cleaning and sanitation of radiology room and equipment.

[Educational campaign targeting high school smokers]. / Intervento educativo rivolto a giovani fumatori della scuola secondaria di secondo grado.

The problem of smoking among young people continues to be a major health problem. In this study, high school students from the provinces of Rimini and Ravenna were invited to take the carbon monoxide test, in order to investigate the main reasons behind their smoking behaviour and to analyse attitudes towards changing the habit. The initiative involved 288 students: 56% males and 44% females aged between 14 and 20. The average daily consumption of cigarettes was 7.9 for the 14-17 age range, and 8.5 for the older group; the average age of starting smoking was 14.6 years. The consumption was seen to rise in both sexes at the weekend among those who smoked more than 10 cigarettes a day. The main reasons for smoking were relaxation and pleasure; the females were more addicted to cigarettes and to the rituals surrounding the habit. Although the students were aware of the risks involved in smoking, only 15% intended to quit. This confirms that awareness of the dangers alone is not sufficient to break the habit. Once again the school environment appears to be the most suitable place to meet young people in order to establish and assess their needs, and to set up programs of health promotion and education.

[Scientific evidence in occupational health: meta-analytical study of the burnout syndrome]. / L'evidenza scientifica in medicina del lavoro: studio meta-analitico sulla sindrome del burnout.

BACKGROUND: According to scientific literature, burnout can be described as a multi-dimensional syndrome with three fundamental dimensions: emotional exhaustion, depersonalization and reduced personal accomplishment. OBJECTIVES: Since attention for this phenomenon is increasing, with a large number of articles published in scientific journals in recent years, we set out to evaluate the scientific evidence on this topic by applying the meta-analytical method. METHODS: All comparative studies performed on burnout were identified and examined in order to compute the Effect Size of the results. Forty studies complied with the inclusion criteria of this analysis for a total of 2,031 burnout cases versus 1,950 controls. RESULTS: Our results revealed a significant disparity in the methods of selecting subjects with burnout. This problem emphasizes the lack of a standardized definition of burnout as a univocal clinical entity and, consequently, the lack of a unanimously agreed procedure for the identification of patients to be included in this diagnostic category. CONCLUSIONS: The wide heterogeneity between studies thus considerably reduces the possibility of comparing them and generalizing the results.

[Assessment of the cancerogenic risk in schools]. / Valutazione del rischio cancerogeno nelle scuole.

The aim of the study is to verify the presence of the carcinogenic risk for teachers, technical assistants and students in 96 secondary schools, providing suggestions for its assessment. Since the analysis of the national and international scientific literature does not reveal data on the evaluation of the carcinogenic risk nor in schools nor in similar environments, the authors gave importance to the preliminary phase of the risk assessment that is to say the inspections aimed to detect the possible presence of risk agents and to identify the possible exposed subjects. The evaluation of the exposition through the execution of environmental and biological monitoring has to be performed, according to the authors opinion, only after this indispensable preliminary phase. The carcinogenic risk has been ascertained in relation to the presence of substances used for didactical means (fuels, mineral oils, reagents, enamels and pitch, ceramic mixtures and metallic alloys) or produced during practical activities (hard wood dusts, Polycyclic Aromatic Hydrocarbons (PAHs) deriving from high temperatures cooking), analyzing the tasks implying their use and identifying the exposed subjects. The presence of carcinogenic agents has been found out in 54 on 96 schools. In order to preserve the health status of the exposed workers in schools, it is necessary the adoption of the suitable measures of prevention and protection similarly to what is established for all the work places, even before the eventual environmental monitoring.

[Night workers and plasmatic cortisol]. / Lavoratori notturni e cortisolo plasmatico.

The aim of the study is to evaluate whether occupational exposure to night work could cause alterations in the levels of plasmatic cortisol. The interest toward this argument arises form several studies in scientific literature referring the presence of an alteration in the synthesis and release of cortisol in workers exposed to night work. We studied a population of workers employed in night security service and monitoring service of alarm systems in different museums compared to a control group not performing shift-work and/or night work. The exposed and control subjects were compared by age, length of service, smoking habit (n. cigarettes per day), habitual consumption of alcoholic drinks (n. glass of wine/beer per day). We evaluated the levels of plasmatic cortisol on 50 workers exposed to night work, all males of whom 30 smokers and 20 non-smokers and on 50 controls of whom 30 smokers and 20 non-smokers.

Mutant p53 protein in serum could be used as a molecular marker in human breast cancer.

p53 wild-type is a tumor suppressor gene involved in DNA gene transcription or DNA repair mechanisms. When damage to DNA is unrepairable, p53 induces programmed cell death (apoptosis). The mutant p53 gene is the most frequent molecular alteration in human cancer, including breast cancer. Here, we analyzed the genetic alterations in p53 oncogene expression in 55 patients with breast cancer at different stages and in 8 normal women. We measured by ELISA assay the serum levels of p53 mutant protein and p53 antibodies. Immunohistochemistry and RT-PCR using specific p53 primers as well as mutation detection by DNA sequencing were also evaluated in breast tumor tissue. Serological p53 antibody analysis detected 0/8 (0%), 0/4 (0%) and 9/55 (16.36%) positive cases in normal women, in patients with benign breast disease and in breast carcinoma, respectively. We found positive p53 mutant in the sera of 0/8 (0.0%) normal women, 0/4 (0%) with benign breast disease and 29/55 (52.72%) with breast carcinoma. Immunohistochemistry evaluation was positive in 29/55 (52.73%) with mammary carcinoma and 0/4 (0%) with benign breast disease. A very good correlation between p53 mutant protein detected in serum and p53 accumulation by immunohistochemistry (83.3% positive in both assays) was found in this study. These data suggest that detection of mutated p53 could be a useful serological marker for diagnostic purposes.

Plasma 17-alpha-OH-progesterone in female workers exposed to urban pollutants.

The aim of this study is to evaluate whether occupational exposure to urban pollutants could cause alteration in plasma 17-alpha-OH-P levels in female workers. After excluding the subjects with the principal confounding factors, traffic police and controls were matched by age, working life, age of menarche, menstrual cycle day, BMI, drinking habits, habitual consumption of soy and Italian coffee. 68 traffic police and 82 controls (7th day; follicular phase of the ovarian cycle), 37 traffic police and 20 controls (21st day; lutheal phase of the ovarian cycle) were included in the study and matched for the above mentioned variables. In follicular and lutheal phase of ovarian cycle, 17-alpha-OH-P mean levels and the distribution of 17-alpha-OH-P values were significantly higher in traffic police vs. controls. A higher instance of mental health disorders in traffic police vs. controls was found, although the difference was not significant. Considering that the potential confounding effect of extraneous factors was controlled by restricting the study population and by matching traffic police vs. controls on the above mentioned variables, our results suggest that occupational exposure to urban pollutants may alter plasma 17-alpha-OH-P concentrations. 17-alpha-OH-P could be used in an occupational setting as an early biomarker of exposure to urban pollutants, valuable for a group, even before the onset of related pathologies.

The therapeutic role of thalidomide in inflammatory bowel disease.

Recent clinical experience with the use of thalidomide in inflammatory bowel disease is the focus of this article. Although widely used in Crohn's disease, thalidomide therapy in patients with ulcerative colitis, children with Crohn's disease, as well as patients with Crohn's disease associated with upper gastrointestinal and genital tract involvement have been occasionally reported.

Anxiety, musculoskeletal and visual disorders in video display terminal workers.

AIM: The increase in the working population assigned to video display terminals (VDT) has led to ever growing attention to reports on health effects. We studied musculoskeletal and visual disorders and levels of anxiety in 2 groups of VDT operators with different tasks, in order to evaluate if they could be influenced by organizational and intrinsically working factors. METHODS: The study included 190 VDT operators, subdivided into 2 groups (A and B) on the basis of tasks performed and average hours/ week spent at VDT (25 vs 36), and 190 controls not assigned to VDT. Ocular and musculoskeletal subjective symptoms and objective findings were assessed for all subjects, and the State-Trait Anxiety Inventory (STAI) test was administered. RESULTS: For VDT operators of the 2 groups, the relationship between ocular and musculoskeletal symptoms and findings, working life (P=0.0001) and number of hours spent at the VDT (symptoms P=0.001 and P=0.0001; findings P=0.002 and P=0.007), was significant. Group B VDT operators showed significantly higher state anxiety (S-anxiety) levels vs those in Group A and controls (P=0.001); trait anxiety (T-anxiety) was significantly higher in Group B and controls vs Group A (P=0.001 and P=0.03). CONCLUSIONS: Our results confirm the literature data about musculoskeletal and visual disorders and, as for anxiety, seem to denote a higher relevance of factors related to labor organization vs VDT use per se.

Magnitude of the equilibrium isotope effect on carbon-tritium bond synthesis.

The exchange of tritium from 3HOH into the methyl group of pyruvate catalyzed by 6-phospho-2-keto-3-deoxygluconate aldolase (6-phospho-2-keto-3-deoxy-D-gluconate D-glyceraldehyde-3-phosphate-lyase, EC 4.1.2.14) of Pseudomonas putida shows an equilibrium isotope effect of 0.78. From this value and the deuterium effect on the fumarase equilibrium (Thomson, J.F. (1960) Arch. Biochem. Biophys. 90, 1), one can calculate by use of the relative fractionation factors of Hartshorn and Shiner (Hartshorn, S.R. and Shiner, Jr., V.J. (1972) J. Am. Chem. Soc. 94, 9002), fractionation factors for transfer of deuterium or tritium from water to a number of organic molecules of interest.

Rationale and use of corticosteroids in chronic obstructive pulmonary disease.

Several studies of corticosteroid efficacy in patients with COPD performed in the last decade have had stronger study designs and larger patient populations than most of the previously reported investigations. These studies have provided evidence of the objective benefit of corticosteroid therapy on pulmonary function in clinically stable COPD patients. These positive results are due to a relatively marked beneficial effect of corticosteroids in a minority of the subjects studied rather than a modest effect in the majority of subjects. A controlled randomized trial of intravenous corticosteroid administration in patients with COPD and acute respiratory failure admitted to the hospital showed improvement in pulmonary function from 12 hours following initial administration through the remainder of the 3 days of the study in the treatment group as compared to the control group. A greater percentage of patients showed a beneficial response to corticosteroids in this study of patients with acute exacerbations as compared to most of the studies of clinically stable COPD patients with beneficial effects. This suggests the possibility that some patients may show a beneficial response to corticosteroids during an acute exacerbation although they have not shown a response when clinically stable. The response to inhaled corticosteroids in patients with COPD has not been studied as extensively as the response to oral corticosteroids. However, some studies have shown a beneficial response to inhaled corticosteroids, primarily but not exclusively, in individuals who have also shown a positive response to oral agents. Generally, the response in terms of improved pulmonary function has been less striking with the inhaled agent as compared to the oral drug, although higher relative doses of the oral drugs usually were studied. Several limitations of the currently available studies are evident. Most of the studies deal with the effects in clinically stable outpatients with COPD and no studies have dealt with maintenance therapy in patients who have responded to a 1 to 2 week course of 30 mg of prednisone or greater. Data on the efficacy of inhaled corticosteroids in COPD patients are limited. No studies have investigated the role of corticosteroids in acute exacerbations in outpatients with COPD. Recommendations are given regarding use of corticosteroids in patients with COPD. A trial of corticosteroids is recommended at some point during a patient's course, while clinically stable. If a beneficial response is obtained in terms of improvement in airflow obstruction, then clinical judgment must be used regarding whether maintenance therapy is continued and, if so, at what dose and by what route.(ABSTRACT TRUNCATED AT 400 WORDS)

Neoadjuvant chemotherapy for osteosarcoma of the extremities with synchronous lung metastases: treatment with cisplatin, adriamycin and high dose of methotrexate and ifosfamide.

We report on the clinical course and outcome of 28 patients, treated at The Istituti Ortopedici Rizzoli between 1995 and 1997 for osteosarcoma of the extremities metastatic to the lung at presentation. The treatment for these patients was the following: primary chemotherapy with cisplatin, adriamycin and high dose of methotrexate and ifosfamide followed by simultaneous resection of primary and metastatic lesions (when feasible), and further chemotherapy. After primary chemotherapy, lung metastases disappeared in 6 patients, whereas metastases in 3 remained surgically unresectable. These 9 patients received surgical treatment of the primary tumor only. In the remaining 19 patients, after chemotherapy, a simultaneous resection of the primary and metastatic tumor was performed. The resection of metastatic lesions was complete in 18 cases and incomplete in one. Three of the 4 patients who did not achieve a tumor-free status died in a few months and one is still alive with uncontrolled disease. With a median follow-up of 32 months (19-43) of the 24 patients who achieved remission, 12 (55%) remained continuously free of disease, 11 relapsed with new metastases and 1 died of chemotherapy-related toxicity. The 2-year DFS and OS were 36% and 53% respectively. These results are much worse than those achieved in 114 contemporary patients with localised disease (2-year DFS: 81%) treated in the same period and they are superimposible to the results achieved in 23 patients previously treated with the same protocol, but with standard dose of ifosfamide (2-year DFS: 32%). However, it must be underlined that, as regards prognosis, patients with metastatic disease at presentation are a hetero-geneous group. The DFS was significantly higher for patients with only one or two metastatic lesions than for patients with 3 or more lesions (2 year DFS: 78% vs. 28%). In 12 of the 19 patients who had a complete simultaneous resection of the primary and metastatic tumor, a strong correlation between the degree of necrosis of the primary and metastatic lesions was found. We conclude that in patients with osteosarcoma of the extremity with lung metastases at presentation: a) the combination of aggressive chemotherapy with simultaneous resection of primary and metastatic tumors works very well only for those patients who present with one or two metastatic nodules whereas for patients with 3 or more pulmonary metastases the prognosis is very poor; b) within the 4-drug regimen used in this study, the increment of ifosfamide dose from 10 g/m2 to 15 g/m2 for cycle does not improve prognosis; c) the strong correlation found between the histologic response of the primary tumor and metastases supports the strategy, largely used nowadays in the neoadjuvant treatment of osteosarcoma, of tailoring postoperative chemo-therapy on the basis of the primary tumor histologic response to preoperative chemotherapy.

Use of a new transdermal delivery system for estrogen replacement therapy in postmenopausal women.

This study reports on the use of a new transdermal delivery system for estrogen replacement therapy. This was a 12 week open multicenter trial using patches that delivered 0.05 mg/24 hour of 17 beta-estradiol applied twice weekly, every 72 hours, with one week interval after each 3 weeks. Results indicate an overall significant improvement on climacteric complaints with a highly significant and time-related reduction in the two most frequent symptoms: hot flushes and night sweating. Neither local nor systemic side effects were prevalent. By the end of treatment mean plasma levels of estradiol and FSH were 50.6 pg/ml and 46.8 mIU/ml, respectively. It is concluded that this new system of transdermal estrogen replacement therapy significantly reduces the main postmenopausal symptoms, produces adequate plasma estradiol levels and allows good compliance to treatment.