Comparison of "IN-REC-SUR-E" and LISA in preterm neonates with respiratory distress syndrome: a randomized controlled trial (IN-REC-LISA trial).

BACKGROUND: Surfactant is a well-established therapy for preterm neonates affected by respiratory distress syndrome (RDS). The goals of different methods of surfactant administration are to reduce the duration of mechanical ventilation and the severity of bronchopulmonary dysplasia (BPD); however, the optimal administration method remains unknown. This study compares the effectiveness of the INtubate-RECruit-SURfactant-Extubate (IN-REC-SUR-E) technique with the less-invasive surfactant administration (LISA) technique, in increasing BPD-free survival of preterm infants. This is an international unblinded multicenter randomized controlled study in which preterm infants will be randomized into two groups to receive IN-REC-SUR-E or LISA surfactant administration. METHODS: In this study, 382 infants born at 24+0-27+6 weeks' gestation, not intubated in the delivery room and failing nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV) during the first 24 h of life, will be randomized 1:1 to receive IN-REC-SUR-E or LISA surfactant administration. The primary outcome is a composite outcome of death or BPD at 36 weeks' postmenstrual age. The secondary outcomes are BPD at 36 weeks' postmenstrual age; death; pulse oximetry/fraction of inspired oxygen; severe intraventricular hemorrhage; pneumothorax; duration of respiratory support and oxygen therapy; pulmonary hemorrhage; patent ductus arteriosus undergoing treatment; percentage of infants receiving more doses of surfactant; periventricular leukomalacia, severe retinopathy of prematurity, necrotizing enterocolitis, sepsis; total in-hospital stay; systemic postnatal steroids; neurodevelopmental outcomes; and respiratory function testing at 24 months of age. Randomization will be centrally provided using both stratification and permuted blocks with random block sizes and block order. Stratification factors will include center and gestational age (24+0 to 25+6 weeks or 26+0 to 27+6 weeks). Analyses will be conducted in both intention-to-treat and per-protocol populations, utilizing a log-binomial regression model that corrects for stratification factors to estimate the adjusted relative risk (RR). DISCUSSION: This trial is designed to provide robust data on the best method of surfactant administration in spontaneously breathing preterm infants born at 24+0-27+6 weeks' gestation affected by RDS and failing nCPAP or NIPPV during the first 24 h of life, comparing IN-REC-SUR-E to LISA technique, in increasing BPD-free survival at 36 weeks' postmenstrual age of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT05711966. Registered on February 3, 2023.

Pilot randomized experimental study evaluating isopropyl alcohol and ultraviolet-C radiation in the disinfection of healthcare workers' smartphones.

BACKGROUND: Smartphones in medical settings pose infection risks due to harbouring pathogenic bacteria. AIM: This pilot study assessed the effectiveness duration of sanitization methods, focusing on 70% isopropyl alcohol wipes and ultraviolet-C (UVC) boxes, aiming to obtain preliminary data on the reduction in total bacterial load 3 h post-sanitization. METHODS: A randomized monocentric trial with two intervention arms (wipes and UVC boxes) was designed. As participants, healthcare workers from three wards at Fondazione Policlinico Universitario 'A. Gemelli' IRCCS Hospital were recruited, stratified by ward, and block randomized within each ward to control confounders. FINDINGS: Seventy-one healthcare workers, mostly nurses (62%) were included in the study. Initial bacterial load reduction was significant with both disinfection techniques, but after 3 h both methods showed increased bacterial levels, with wipes displaying potentially higher residual efficacy (P=0.056). To adequately size a trial (89% power, significance level 0.05) for assessing the residual efficacy of alcohol-impregnated wipes compared with UVC boxes at 3 h post-sanitization, 503 professionals per group were required. CONCLUSION: This study highlights the necessity for guidelines on hospital smartphone sanitization and educational initiatives for healthcare workers and patients. Further studies, adequately sized, are necessary to determine optimal sanitization intervals and assess pathogen transmission risks.

Intra-articular Hymovis injection for managing hip OA in active sportsmen. A 24-month observational retrospective clinical investigation.

BACKGROUND: Hip Osteoarthitis (OA) risk is sport-specific and depends on frequency, intensity, and type of mechanic stress the hip is subjected to. This retrospective observational study aims to investigate the safety and performance of Hymovis (HYADD-4) injection, a hexadecyl (C-16) HA-derivative, when used to manage symptomatic hip OA in active middle-aged sportsmen over a 24-month observation period. METHODS: The retrospective analysis included clinical records of active sportsmen, aged between 40 and 65 years, and suffering from symptomatic Kellgren-Lawrence grade II to III hip OA, treated with two (24 mg/3 ml) Hymovis injections, two weeks apart, every 3-4 months, for two years. When available, data on MRI examination were included in the analysis as well as Heidelberg Sports Activity Score (HAS) and Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaires. RESULTS: Thirty patients (56.4 ± 7.3 years) were included in the study, sixteen cyclists and 14 tennis players. For all patients, HAS and most HAGOS scores improved significantly (p < 0.05) at the first control visit (4 months) and further improved over time. For all other scores an important clinical benefit was experienced by more than 50% of participants. No adverse events were recorded. CONCLUSION: Treatment of hip OA in active sportsmen with Hymovis seems a safe and effective approach for the management of OA symptoms, by potentially protecting cartilage and subchondral bone from further damage.

Gemelli decision tree Algorithm to Predict the need for home monitoring or hospitalization of confirmed and unconfirmed COVID-19 patients (GAP-Covid19): preliminary results from a retrospective cohort study.

OBJECTIVE: To develop a deep learning-based decision tree for the primary care setting, to stratify adult patients with confirmed and unconfirmed coronavirus disease 2019 (COVID-19), and to predict the need for hospitalization or home monitoring. PATIENTS AND METHODS: We performed a retrospective cohort study on data from patients admitted to a COVID hospital in Rome, Italy, between 5 March 2020 and 5 June 2020. A confirmed case was defined as a patient with a positive nasopharyngeal RT-PCR test result, while an unconfirmed case had negative results on repeated swabs. Patients' medical history and clinical, laboratory and radiological findings were collected, and the dataset was used to train a predictive model for COVID-19 severity. RESULTS: Data of 198 patients were included in the study. Twenty-eight (14.14%) had mild disease, 62 (31.31%) had moderate disease, 64 (32.32%) had severe disease, and 44 (22.22%) had critical disease. The G2 value assessed the contribution of each collected value to decision tree building. On this basis, SpO2 (%) with a cut point at 92 was chosen for the optimal first split. Therefore, the decision tree was built using values maximizing G2 and LogWorth. After the tree was built, the correspondence between inputs and outcomes was validated. CONCLUSIONS: We developed a machine learning-based tool that is easy to understand and apply. It provides good discrimination in stratifying confirmed and unconfirmed COVID-19 patients with different prognoses in every context. Our tool might allow general practitioners visiting patients at home to decide whether the patient needs to be hospitalized.

Clinical and radiographic assessment of implant-supported rehabilitation of partial and complete edentulism: a 2 to 8 years clinical follow-up.

OBJECTIVE: The aim of this study was to find out the rates of survival and success of implant rehabilitation, and the influence of some risk indicators on the medium- and long-term prognosis. PATIENTS AND METHODS: Of the 102 patients eligible for this study rehabilitated with dental implants during the years 2009-2015, 75 patients with 156 implants of different implant systems placed and loaded by the same team were recalled. For each subject, pocket-probing depth, bleeding on probing, plaque buildup, mobility of the fixtures, and the presence/absence of prosthetic complications were recorded. Radiographic evaluation was based on the analysis of bone levels around the fixtures, as shown by intraoral radiographs. RESULTS: The average follow-up was 4.4 years, ranging from 1.5 to 7.8 years. One hundred and fifty-four of the implants survived, while two implants failed; 98.8% of the prostheses survived, while 75.9% were successful. Success was achieved in 90.4% of implants and in 80% of patients. The sample showed average radiographic bone resorption of 1.09 mm. The average pocket probing depth was 2.79 mm. Bleeding on probing was found in 18% of all sites, and 59.6% of implants showed bleeding on probing in at least one site. Mucositis was found in 90% of patients, and peri-implantitis was found in 16% of patients. CONCLUSIONS: The rates of success and survival showed the reliability of implant therapy. Plaque accumulation, smoking and upper jaw location, seem to increase the risk of failure of implant-supported rehabilitation.

Prevalence, molecular characterization, and clinical relevance of sensitization to Anisakis simplex in children with sensitization and/or allergy to Dermatophagoides pteronyssinus.

SUMMARY: Prevalence of the Anisakis Simplex's (AS) sensitization in children sensitized to Dermatophagoides pteronissynus (DP) is not known, neither it is to which percentage it might be due to cross-reactivity. The primary objective of the present retrospective cross-sectional study is to evaluate the prevalence of sensitization to AS in children sensitized or allergic to DP. Secondary outcomes were the prevalence of cross-reactivity and clinical relevance of the condition. The prevalence of sensitization to AS differs significantly among patients sensitized and not to DP (13.43% vs. 3.80%; p=0.019). The higher prevalence is mainly due to cross-reactivity with Der p10 (OR=8.86; 95% CI=4.33-40.74; p=0.0001). Currently, the sensitization to AS seems to have no clinical relevance in the pediatric population.

Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium.

BACKGROUND: This study evaluated whether demographics, pre-diagnosis lifestyle habits and clinical data are associated with the overall survival (OS) and head and neck cancer (HNC)-specific survival in patients with HNC. PATIENTS AND METHODS: We conducted a pooled analysis, including 4759 HNC patients from five studies within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Cox proportional hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated including terms reported significantly associated with the survival in the univariate analysis. RESULTS: Five-year OS was 51.4% for all HNC sites combined: 50.3% for oral cavity, 41.1% for oropharynx, 35.0% for hypopharynx and 63.9% for larynx. When we considered HNC-specific survival, 5-year survival rates were 57.4% for all HNC combined: 54.6% for oral cavity, 45.4% for oropharynx, 37.1% for hypopharynx and 72.3% for larynx. Older ages at diagnosis and advanced tumour staging were unfavourable predictors of OS and HNC-specific survival. In laryngeal cancer, low educational level was an unfavourable prognostic factor for OS (HR = 2.54, 95% CI 1.01-6.38, for high school or lower versus college graduate), and status and intensity of alcohol drinking were prognostic factors both of the OS (current drinkers HR = 1.73, 95% CI 1.16-2.58) and HNC-specific survival (current drinkers HR = 2.11, 95% CI 1.22-3.66). In oropharyngeal cancer, smoking status was an independent prognostic factors for OS. Smoking intensity (>20 cigarettes/day HR = 1.41, 95% CI 1.03-1.92) was also an independent prognostic factor for OS in patients with cancer of the oral cavity. CONCLUSIONS: OS and HNC-specific survival differ among HNC sites. Pre-diagnosis cigarette smoking is a prognostic factor of the OS for patients with cancer of the oral cavity and oropharynx, whereas pre-diagnosis alcohol drinking is a prognostic factor of OS and HNC-specific survival for patients with cancer of the larynx. Low educational level is an unfavourable prognostic factor for OS in laryngeal cancer patients.

Prognostic factors in head and neck cancer: a 10-year retrospective analysis in a single-institution in Italy.

This study was undertaken to evaluate the association between demographics, lifestyle habits, and clinical data and overall survival (OS), recurrence and second primary cancer (SPC) in patients with first primary head and neck cancer (HNC). We retrospectively reviewed data from 482 patients treated at the "Agostino Gemelli" Teaching Hospital, Rome, between 2002-2012 for primary HNC. Individual parameters were evaluated for association with specific outcomes such as OS, cancer recurrence and second primary cancer (SPC) appearance using hazard ratios (HR) and 95% confidence intervals (CIs). Five-year OS was 60.6% for all HNC cases, 49.0% for oral cavity, 54.8% for oropharynx, 50.0% for hypopharynx and 63.4% for larynx. Predictors of OS were older age (HR = 1.04; 95% CI: 1.02-1.05) and advanced tumour stage (HR = 2.00; 95% CI: 1.41-2.84). The risk of recurrence was associated with drinking 8-14 drinks per week (HR = 1.73; 95% CI: 1.00-2.97). The risk of developing SPC increased with advanced tumour stage (HR = 2.75; 95% CI: 1.39-5.44) and with smoking for more than 40 years (HR = 3.68; 95% CI: 1.10-12.30). OS differed among HNC sites. Increasing age was an unfavourable predictor of HNC OS. Tumour stage was a prognostic factor both for OS and for risk of developing SPC. Alcohol and tobacco consumption were prognostic factors for recurrence and SPC, respectively.

Current state of genomic policies in healthcare among EU member states: results of a survey of chief medical officers.

Background: A need for a governance of genomics in healthcare among European Union (EU) countries arose during an international meeting of experts on public health genomics (PHG). We have conducted a survey on existing national genomic policies in healthcare among Chief Medical Officers (CMOs) of the 28 EU member states, plus Norway. Methods: A questionnaire was sent to CMOs after a meeting on the policy implications of PHG held during the Italian presidency of the Council of EU in 2014. The survey was closed in November 2015. Results: CMOs response rate was 65.5% (19/29). Twelve (63.2%) reported that their countries had a policy for genomics in healthcare in place, and 15 (78.9%) reported that public funding existed. Public research facilities for the development of such policies were documented in 13 (68.4%) countries, and 15 (83.3%) had working groups devoted to policy development. National agencies carrying out Health Technology Assessment of genomic-based technologies were present in nine countries (50%). Sixteen (88.9%) countries reported having agencies dealing with ethical issues related to genomic technologies. About 55% of countries disclosed the lack of information campaigns aimed at citizens, and 44.4% reported they had a legal framework for direct-to-consumer genetic tests. Conclusion: Belgium, France, Italy, Spain and UK documented the presence of a policy on genomics in healthcare. While many caveats are necessary because of the methodology, results suggest a need for a co-ordinated effort to foster development and harmonization of dedicated policies across EU to responsibly integrate genomics policies into existing health systems.

Enrichment for Northern European-derived multiple sclerosis risk alleles in Sardinia.

BACKGROUND: The list of genomic loci associated with multiple sclerosis (MS) susceptibility outside the major histocompatibility complex (MHC) in patients of Northern European (NE) ancestry has increased to 103. Despite the extraordinarily high MS prevalence in the isolated Sardinian population, the contribution of genetic risk factors to MS in Sardinia is largely not understood. OBJECTIVE: The objective of this paper is to examine the relevance of non-MHC MS susceptibility variants in Sardinia. METHODS: We examined a log-additive MS-specific genetic burden score (MSGB) using 110 NE-derived risk alleles in a dataset of 75 Sardinian cases, 346 Sardinian controls and 177 cases and 1967 controls from the United States (US). RESULTS: Sardinian cases demonstrate a heavier non-MHC MSGB load than Sardinian controls and US cases (p = 2E-06, p = 1E-06, respectively). Furthermore, Sardinian controls carry a heavier burden than US controls (p = 2E-14). Our results confirm the limited ability of the 110-SNP MSGB to predict disease status in Sardinia (AUROC = 0.629). CONCLUSIONS: Risk alleles discovered in samples of NE ancestry are relevant to MS in Sardinia. Our results suggest a general enrichment of MS susceptibility alleles in Sardinians, encouraging the pursuit of further studies of MS in this population.

Localización y frecuencia de placas ateromatosas intracraneales en pacientes mayores de 40 años / Location and frequency of intracranial atheromatous plaques in patients over 40 years

Si bien la ateromatosis intracraneal (AIC) es una entidad frecuente, está subvalorada en la práctica clínica. Los avances tecnológicos en los diferentes métodos radiológicos y especialmente el advenimiento de la tomografía computada multicorte (TCMC) han mejorado la precisión diagnóstica de esta patología. OBJETIVOS: Demostrar la utilidad de la TCMC en el diagnóstico de la AIC y determinar la frecuencia y localización de las placas ateromatosas, así como su distribución etaria y genérica. MATERIALES Y MÉTODOS: Se estudió retrospectivamente a 280 pacientes (140 mujeres y 140 hombres) entre octubre de 2011 y marzo de 2012. Todos eran mayores de 40 años y contaron con una TCMC de cerebro sin contraste, realizada con un tomógrafo Toshiba Aquilion de 16 filas de detectores. Se evaluaron solamente placas cálcicas (considerándose así a aquellas cuya densidad superaba las 80 unidades Hounsfield). RESULTADOS: Se encontró AIC en un 65% de los pacientes examinados, con una incidencia no significativa en el sexo masculino (relación: 1,16/1). Los vasos más comprometidos, en orden de frecuencia, fueron el sifón carotídeo y la arteria vertebral en su segmento V4. CONCLUSIÓN: La ateromatosis es una de las causas frecuentes de ictus cerebral. La TCMC es el método de elección para determinar la localización y frecuencia de las calcificaciones intracraneales de manera no invasiva. Al igual que el score de calcio, la determinación del calcio a nivel de las arterias permitiría establecer el riesgo que tiene el paciente de desarrollar complicaciones vasculares, en este caso en el territorio cerebral.

Even though intracranial atheromatosis (IA) is a frequent entity, it is undervalued in clinical practice. The technological advances in different radiological methods and especially multislice computed tomography (MSCT) have improved the diagnostic accuracy of this pathology. OBJECTIVES: To prove the multislice computed tomography usefulness in intracranial atheromatosis diagnostic, and establish the frequency and location of atheromatous plaques, and also the age and gender distribution. MATERIALS AND METHODS: Two hundred and eighty patients (140 male and 140 female) were studied retrospectively, between October 2011 and March 2012. All of them were more than 40 years old and counted with a brain MSCT without contrast, made it with a Toshiba Aquilion 16 multidetector computer tomograph. Calcium plaques were only evaluated (considering calcium plaques those whose density was over 80 Hounsfield units). RESULTS: It was showed the presence of IA in 65% of the examined patients, being the male gender the mostly affected in a 1.16:1, non significant relation. The most affected vessels in frequency order were carotid siphon and vertebral artery in their V4 segment. CONCLUSION: The atheromatosis is one of the frequent causes of cerebral stroke. The MSCT is the selected method to determine the location and frequency of the intracranial calcification in a noninvasive way. In the same way as the calcium score, determining the level of calcium in the arteries allows to determine the risk that the patient has of developing vascular complications, in this case in the cerebral territory.

Localización y frecuencia de placas ateromatosas intracraneales en pacientes mayores de 40 años

Si bien la ateromatosis intracraneal (AIC) es una entidad frecuente, está subvalorada en la práctica clínica. Los avances tecnológicos en los diferentes métodos radiológicos y especialmente el advenimiento de la tomografía computada multicorte (TCMC) han mejorado la precisión diagnóstica de esta patología. Objetivos: Demostrar la utilidad de la TCMC en el diagnóstico de la AIC y determinar la frecuencia y localización de las placas ateromatosas, así como su distribución etaria y genérica. Materiales y métodos: Se estudió retrospectivamente a 280 pacientes (140 mujeres y 140 hombres) entre octubre de 2011 y marzo de 2012. Todos eran mayores de 40 años y contaron con una TCMC de cerebro sin contraste, realizada con un tomógrafo Toshiba Aquilion de 16 filas de detectores. Se evaluaron solamente placas cálcicas (considerándose así a aquellas cuya densidad superaba las 80 unidades Hounsfield). Resultados: Se encontró AIC en un 65% de los pacientes examinados, con una incidencia no significativa en el sexo masculino (relación: 1,16/1). Los vasos más comprometidos, en orden de frecuencia, fueron el sifón carotídeo y la arteria vertebral en su segmento V4. Conclusión: La ateromatosis es una de las causas frecuentes de ictus cerebral. La TCMC es el método de elección para determinar la localización y frecuencia de las calcificaciones intracraneales de manera no invasiva. Al igual que el score de calcio, la determinación del calcio a nivel de las arterias permitiría establecer el riesgo que tiene el paciente de desarrollar complicaciones vasculares, en este caso en el territorio cerebral.(AU)

Even though intracranial atheromatosis (IA) is a frequent entity, it is undervalued in clinical practice. The technological advances in different radiological methods and especially multislice computed tomography (MSCT) have improved the diagnostic accuracy of this pathology. Objectives: To prove the multislice computed tomography usefulness in intracranial atheromatosis diagnostic, and establish the frequency and location of atheromatous plaques, and also the age and gender distribution. Materials and methods: Two hundred and eighty patients (140 male and 140 female) were studied retrospectively, between October 2011 and March 2012. All of them were more than 40 years old and counted with a brain MSCT without contrast, made it with a Toshiba Aquilion 16 multidetector computer tomograph. Calcium plaques were only evaluated (considering calcium plaques those whose density was over 80 Hounsfield units). Results: It was showed the presence of IA in 65% of the examined patients, being the male gender the mostly affected in a 1.16:1, non significant relation. The most affected vessels in frequency order were carotid siphon and vertebral artery in their V4 segment. Conclusion: The atheromatosis is one of the frequent causes of cerebral stroke. The MSCT is the selected method to determine the location and frequency of the intracranial calcification in a noninvasive way. In the same way as the calcium score, determining the level of calcium in the arteries allows to determine the risk that the patient has of developing vascular complications, in this case in the cerebral territory.(AU)

A framework for risk assessment and decision-making strategies in dangerous good transportation.

The risk from dangerous goods transport by road and strategies for selecting road load/routes are faced in this paper, by developing an original site-oriented framework of general applicability at local level. A realistic evaluation of the frequency must take into account on one side inherent factors (e.g. tunnels, rail bridges, bend radii, slope, characteristics of neighborhood, etc.) on the other side factors correlated to the traffic conditions (e.g. dangerous goods trucks, etc.). Field data were collected on the selected highway, by systematic investigation, providing input data for a database reporting tendencies and intrinsic parameter/site-oriented statistics. The developed technique was applied to a pilot area, considering both the individual risk and societal risk and making reference to flammable and explosive scenarios. In this way, a risk assessment, sensitive to route features and population exposed, is proposed, so that the overall uncertainties in risk analysis can be lowered.

Theoretical and experimental investigation into the explosive boiling potential of thermally stratified liquid-liquid systems.

The occurrence of a rapid phase transition, or so-called explosive boiling, when a cold volatile liquid comes into contact with a hot liquid or hot surface is a potential hazard in industry. This study was focused on the explosive boiling potential of thermally stratified liquid-liquid systems that result from a runaway reaction. The experimental runs were performed on both a non-reacting and a reacting system. The experimental results showed that under the analysed conditions, the cold phase was superheated but did not evaporate explosively, as the limits of superheat of the phase were not achieved. The response of the cold phase appeared to be completely controlled by the interface temperature between the hot and the cold phase. In general, based on the order of magnitude of temperature differences that result from a runaway reaction in a multi-phasic system and the fact that the system is pressurised by its own vapour pressure, the occurrence of explosive boiling under runaway conditions appears unlikely for these type of systems.

Occupational injuries in Italy: risk factors and long term trend (1951-98).

OBJECTIVES: Trends in the rates of total injuries and fatal accidents in the different sectors of Italian industries were explored during the period 1951-98. Causes and dynamics of injury were also studied for setting priorities for improving safety standards. METHODS: Data on occupational injuries from the National Organisation for Labour Injury Insurance were combined with data from the State Statistics Institute to highlight the interaction between the injury frequency index trend and the production cycle-that is, the evolution of industrial production throughout the years. Multiple regression with log transformed rates was adopted to model the trends of occupational fatalities for each industrial group. RESULTS: The ratios between the linked indices of injury frequency and industrial production showed a good correlation over the whole period. A general decline in injuries was found across all sectors, with values ranging from 79.86% in the energy group to 23.32% in the textile group. In analysing fatalities, the trend seemed to be more clearly decreasing than the trend of total injuries, including temporary and permanent disabilities; the fatalities showed an exponential decrease according to multiple regression, with an annual decline equal to 4.42%. CONCLUSIONS: The overall probability of industrial fatal accidents in Italy tended to decrease exponentially by year. The most effective actions in preventing injuries were directed towards fatal accidents. By analysing the rates of fatal accident in the different sectors, appropriate targets and priorities for increased strategies to prevent injuries can be suggested. The analysis of the dynamics and the material causes of injuries showed that still more consideration should be given to human and organisational factors.

Hemangiopericytoma of the greater omentum: US and CT appearance.

The US, Doppler and CT appearances in a patient with hemangiopericytoma of the greater omentum are presented. Ultrasound revealed a solid mass with heterogeneous echo pattern, well-defined margins and marked vascularity with low impedance flow (mean resistive index 0.42). The tumour was mobile. It was detected below the left kidney at the first US examination and had migrated into the pelvis 14 days later. At CT the tumour demonstrated strong but brief peripheral enhancement and a central hypodense scar.

A new approach in the evaluation of gonadotropins for the diagnosis of polycystic ovary syndrome.

The new immunometric methods using monoclonal antibodies to detect gonadotropins revealed a reduction in the absolute values of these hormones, especially LH, due to a decrease in cross-reaction between gonadotropin subunits. Therefore, reference values of the LH/FSH ratio and their diagnostic significance in the polycystic ovary syndrome (PCOS) need to be defined again. We evaluated the LH/-FSH ratio in basal conditions and after administration of GnRH (100 micrograms as i.v. bolus) in seventy patients with PCOS employing an immunoenzymatic method. In PCOS patients the LH/FSH ratio was greater than 1 in 70% when evaluated on a single sample and in 88% when evaluated on a pooled serum from four samples every 30 minutes; in the control group the ratio was always lower than 1. The LH/-FSH ratio evaluated on the peak values in response to GnRH was greater than 2 in all patients and lower than 2 in the control group. Our results indicate that the LH/FSH ratio is still an important diagnostic tool in PCOS, especially when evaluated on the peak values in response to GnRH, even if its reference values are lower using these new monoclonal methods.

Naltrexone must not be considered a real therapy in functional hypothalamic amenorrhea. The results of a double blind controlled study.

Endogenous opioids exert a tonic inhibitory control on GnRH pulsatility at the hypothalamic level and it must be responsible for some hypogonadotropic hypogonadic syndromes such as functional hypothalamic amenorrhea (FHA). We treated 22 patients suffering from FHA with an oral anti-opioid drug, Naltrexone Hydrochloridrate (NH), 50 mg once a day or placebo, in a double blind controlled study. Six patients exhibited a regular resumption of their menstrual cycles (4 on placebo and only 2 on NH). There was an increase of 17BE2 in 3 of these 6 patients; progesterone levels did not change at all. Gynaecological echography demonstrated folliculogenesis in 4 of these 6 patients (only 1 on NH). The results show that NH is not a real therapy in patients suffering from FHA. Furthermore placebo, useful to the resumption of menstrual bleeding in 4 patients, underlines the importance of psychosomatic effects in the therapeutic management of FHA.