Observation of high-energy neutrinos from the Galactic plane

The origin of high-energy cosmic rays, atomic nuclei that continuously impact Earth's atmosphere, is unknown. Because of deflection by interstellar magnetic fields, cosmic rays produced within the Milky Way arrive at Earth from random directions. However, cosmic rays interact with matter near their sources and during propagation, which produces high-energy neutrinos. We searched for neutrino emission using machine learning techniques applied to 10 years of data from the IceCube Neutrino Observatory. By comparing diffuse emission models to a background-only hypothesis, we identified neutrino emission from the Galactic plane at the 4.5σ level of significance. The signal is consistent with diffuse emission of neutrinos from the Milky Way but could also arise from a population of unresolved point sources.

Evidence for neutrino emission from the nearby active galaxy NGC 1068

A supermassive black hole, obscured by cosmic dust, powers the nearby active galaxy NGC 1068. Neutrinos, which rarely interact with matter, could provide information on the galaxy’s active core. We searched for neutrino emission from astrophysical objects using data recorded with the IceCube neutrino detector between 2011 and 2020. The positions of 110 known gamma-ray sources were individually searched for neutrino detections above atmospheric and cosmic backgrounds. We found that NGC 1068 has an excess of 79 − 20 + 22 neutrinos at tera–electron volt energies, with a global significance of 4.2σ, which we interpret as associated with the active galaxy. The flux of high-energy neutrinos that we measured from NGC 1068 is more than an order of magnitude higher than the upper limit on emissions of tera–electron volt gamma rays from this source.

Search for Unstable Sterile Neutrinos with the IceCube Neutrino Observatory

We present a search for an unstable sterile neutrino by looking for a resonant signal in eight years of atmospheric ν_{μ} data collected from 2011 to 2019 at the IceCube Neutrino Observatory. Both the (stable) three-neutrino and the 3+1 sterile neutrino models are disfavored relative to the unstable sterile neutrino model, though with p values of 2.8% and 0.81%, respectively, we do not observe evidence for 3+1 neutrinos with neutrino decay. The best-fit parameters for the sterile neutrino with decay model from this study are Δm_{41}^{2}=6.7_{-2.5}^{+3.9}  eV^{2}, sin^{2}2θ_{24}=0.33_{-0.17}^{+0.20}, and g^{2}=2.5π±1.5π, where g is the decay-mediating coupling. The preferred regions of the 3+1+decay model from short-baseline oscillation searches are excluded at 90% C.L.

Strong Constraints on Neutrino Nonstandard Interactions from TeV-Scale ν_{μ} Disappearance at IceCube

We report a search for nonstandard neutrino interactions (NSI) using eight years of TeV-scale atmospheric muon neutrino data from the IceCube Neutrino Observatory. By reconstructing incident energies and zenith angles for atmospheric neutrino events, this analysis presents unified confidence intervals for the NSI parameter ε_{μτ}. The best-fit value is consistent with no NSI at a p value of 25.2%. With a 90% confidence interval of -0.0041≤ε_{μτ}≤0.0031 along the real axis and similar strength in the complex plane, this result is the strongest constraint on any NSI parameter from any oscillation channel to date.

Search for Relativistic Magnetic Monopoles with Eight Years of IceCube Data

We present an all-sky 90% confidence level upper limit on the cosmic flux of relativistic magnetic monopoles using 2886 days of IceCube data. The analysis was optimized for monopole speeds between 0.750c and 0.995c, without any explicit restriction on the monopole mass. We constrain the flux of relativistic cosmic magnetic monopoles to a level below 2.0×10^{-19}  cm^{-2} s^{-1} sr^{-1} over the majority of the targeted speed range. This result constitutes the most strict upper limit to date for magnetic monopoles with β≳0.8 and up to β∼0.995 and fills the gap between existing limits on the cosmic flux of nonrelativistic and ultrarelativistic magnetic monopoles.

The relevance of MRI blood-sensitive sequences in the diagnostic assessment of late-onset epilepsy

OBJECTIVE

Sporadic cerebral amyloid angiopathy (CAA) is a degenerative brain small vessel disease of ageing resulting from progressive amyloid deposition in small arteries and arterioles of the cortex and leptomeninges. CAA may be diagnosed by the mean of Boston criteria, particularly with the use of the blood-sensitive T2* MRI sequences (GRE and SWI). Epileptic seizures have rarely been reported in CAA.

PATIENTS AND METHODS

We describe two patients with late-onset unprovoked seizures due to CAA. A short literature review on this topic is presented.

RESULTS

In our two patients with late-onset unprovoked seizures as the first manifestation of CAA, only GRE and SWI sequences lead to a correct diagnosis. In literature, only 15 patients with CAA presenting with seizures have been reported. In these subjects, data on seizures semiology and prognosis are scarce.

CONCLUSIONS

Our report highlights the importance to perform blood-sensitive sequences in all subjects with LOE of otherwise unknown etiology, not to miss a diagnosis of CAA.

eV-Scale Sterile Neutrino Search Using Eight Years of Atmospheric Muon Neutrino Data from the IceCube Neutrino Observatory

The results of a 3+1 sterile neutrino search using eight years of data from the IceCube Neutrino Observatory are presented. A total of 305 735 muon neutrino events are analyzed in reconstructed energy-zenith space to test for signatures of a matter-enhanced oscillation that would occur given a sterile neutrino state with a mass-squared differences between 0.01 and 100  eV^{2}. The best-fit point is found to be at sin^{2}(2θ_{24})=0.10 and Δm_{41}^{2}=4.5  eV^{2}, which is consistent with the no sterile neutrino hypothesis with a p value of 8.0%.

Characteristics of the Diffuse Astrophysical Electron and Tau Neutrino Flux with Six Years of IceCube High Energy Cascade Data

We report on the first measurement of the astrophysical neutrino flux using particle showers (cascades) in IceCube data from 2010-2015. Assuming standard oscillations, the astrophysical neutrinos in this dedicated cascade sample are dominated (∼90%) by electron and tau flavors. The flux, observed in the sensitive energy range from 16 TeV to 2.6 PeV, is consistent with a single power-law model as expected from Fermi-type acceleration of high energy particles at astrophysical sources. We find the flux spectral index to be γ=2.53±0.07 and a flux normalization for each neutrino flavor of ϕ_{astro}=1.66_{-0.27}^{+0.25} at E_{0}=100  TeV, in agreement with IceCube's complementary muon neutrino results and with all-neutrino flavor fit results. In the measured energy range we reject spectral indices γ≤2.28 at ≥3σ significance level. Because of high neutrino energy resolution and low atmospheric neutrino backgrounds, this analysis provides the most detailed characterization of the neutrino flux at energies below ∼100  TeV compared to previous IceCube results. Results from fits assuming more complex neutrino flux models suggest a flux softening at high energies and a flux hardening at low energies (p value ≥0.06). The sizable and smooth flux measured below ∼100  TeV remains a puzzle. In order to not violate the isotropic diffuse gamma-ray background as measured by the Fermi Large Area Telescope, it suggests the existence of astrophysical neutrino sources characterized by dense environments which are opaque to gamma rays.

Time-Integrated Neutrino Source Searches with 10 Years of IceCube Data

This Letter presents the results from pointlike neutrino source searches using ten years of IceCube data collected between April 6, 2008 and July 10, 2018. We evaluate the significance of an astrophysical signal from a pointlike source looking for an excess of clustered neutrino events with energies typically above ∼1  TeV among the background of atmospheric muons and neutrinos. We perform a full-sky scan, a search within a selected source catalog, a catalog population study, and three stacked Galactic catalog searches. The most significant point in the northern hemisphere from scanning the sky is coincident with the Seyfert II galaxy NGC 1068, which was included in the source catalog search. The excess at the coordinates of NGC 1068 is inconsistent with background expectations at the level of 2.9σ after accounting for statistical trials from the entire catalog. The combination of this result along with excesses observed at the coordinates of three other sources, including TXS 0506+056, suggests that, collectively, correlations with sources in the northern catalog are inconsistent with background at 3.3σ significance. The southern catalog is consistent with background. These results, all based on searches for a cumulative neutrino signal integrated over the 10 years of available data, motivate further study of these and similar sources, including time-dependent analyses, multimessenger correlations, and the possibility of stronger evidence with coming upgrades to the detector.

Recent Borexino results and perspectives of the SOX measurement

Borexino is a liquid scintillator detector sited underground in the Laboratori Nazionali del Gran Sasso (Italy). Its physics program, until the end of this year, is focussed on the study of solar neutrinos, in particular from the Beryllium, pp, pep and CNO fusion reactions. Knowing the reaction chains in the sun provides insights towards physics disciplines such as astrophysics (star physics, star formation, etc.), astroparticle and particle physics. Phase II started in 2011 and its aim is to improve the phase I results, in particular the measurements of the neutrino fluxes from the pep and CNO processes. By the end of this year, data taking from the sun will be over and a new project is scheduled to launch: Short distance Oscillation with boreXino (SOX), which uses a Cerium source for neutrinos (100÷150 kCi of activity) and aims to confirm or rule out the presence of sterile neutrinos. This particle is hypothesised to justify the reactor, Gallium and LSND anomalies found and can reject extensions to the standard model. The work presented is a summary of the solar neutrino results achieved so far, which lead not only to a precise study of the processes in the sun, but also to more Standard Model oriented measurements (such as the stability of the charge, i.e. the life time of the electron). Furthermore, the perspectives of the SOX program are discussed showing the experiment sensitivity to a fourth neutrino state covering almost entirely 3σ of the preferred region of the anomalous neutrino experiments, and additional applications of the detector such as the study of geo-neutrinos.

Interaction between DRD2 variation and sound environment on mood and emotion-related brain activity

Sounds, like music and noise, are capable of reliably affecting individuals' mood and emotions. However, these effects are highly variable across individuals. A putative source of variability is genetic background. Here we explored the interaction between a functional polymorphism of the dopamine D2 receptor gene (DRD2 rs1076560, G>T, previously associated with the relative expression of D2S/L isoforms) and sound environment on mood and emotion-related brain activity. Thirty-eight healthy subjects were genotyped for DRD2 rs1076560 (G/G=26; G/T=12) and underwent functional magnetic resonance imaging (fMRI) during performance of an implicit emotion-processing task while listening to music or noise. Individual variation in mood induction was assessed before and after the task. Results showed mood improvement after music exposure in DRD2GG subjects and mood deterioration after noise exposure in GT subjects. Moreover, the music, as opposed to noise environment, decreased the striatal activity of GT subjects as well as the prefrontal activity of GG subjects while processing emotional faces. These findings suggest that genetic variability of dopamine receptors affects sound environment modulations of mood and emotion processing.

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8±0.7(stat)±6.7(syst)  MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principles calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.

Search for patterns by combining cosmic-ray energy and arrival directions at the Pierre Auger Observatory

Energy-dependent patterns in the arrival directions of cosmic rays are searched for using data of the Pierre Auger Observatory. We investigate local regions around the highest-energy cosmic rays with [Formula: see text] eV by analyzing cosmic rays with energies above [Formula: see text] eV arriving within an angular separation of approximately 15[Formula: see text]. We characterize the energy distributions inside these regions by two independent methods, one searching for angular dependence of energy-energy correlations and one searching for collimation of energy along the local system of principal axes of the energy distribution. No significant patterns are found with this analysis. The comparison of these measurements with astrophysical scenarios can therefore be used to obtain constraints on related model parameters such as strength of cosmic-ray deflection and density of point sources.

Quasi real time in vivo dosimetry for VMAT

PURPOSE

Results about the feasibility of a method for quasi real time in vivo dosimetry (IVD) at the isocenter point for volumetric modulated arc therapy (VMAT) are here reported. The method is based on correlations between the EPID signal and the dose on the beam central axis. Moreover, the γ-analysis of EPID images was adopted to verify off-axis reproducibility of fractionated plan delivery.

METHODS

An algorithm to reconstruct in vivo the isocenter dose, D(iso), for RapidArc treatments has been developed. 20 VMAT plans, optimized with two opposite arcs, for prostate, pancreas, and head treatments have been delivered by a Varian linac both to a conic PMMA phantom with elliptical section and to patients. The ratios R between reconstructed D(iso) and the planned doses were determined for phantom and patient irradiations adopting an acceptance criterion of ±5%. In total, 40 phantom checks and 400 patient checks were analyzed. Moreover, 3% and 3 mm criteria were adopted for portal image γ-analysis to assess patient irradiation reproducibility.

RESULTS

The average ratio R, between reconstructed and planned doses for the PMMA phantom irradiations was equal to 1.007 ± 0.024. When the IVD method was applied to the 20 patients, the average R ratio was equal to 1.003 ± 0.017 and 96% of the tests were within the acceptance criteria. The portal image γ-analysis supplied 88% of the tests within the pass rates γ(mean) ≤ 0.4 and P(γ<1) ≥ 98%. All the warnings were understood comparing the CT and the cone beam CT images and in one case a patient's setup error was detected and corrected for the successive fractions.

CONCLUSIONS

This preliminary experience suggests that the method is able to detect dosimetric errors in quasi real time at the end of the therapy session. The authors intend to extend this procedure to other pathologies with the integration of in-room imaging verification by cone beam CT.

Real-time dose reconstruction for wedged photon beams: a generalized procedure

A practical and accurate generalized procedure to reconstruct the isocenter dose Diso for 3D conformal radiotherapy (3DCRT) has been developed for X‐ray open beams supplied by linacs of different manufacturers and equipped with aSi electronic portal imaging devices (aSi EPIDs). This paper reports an extension of the method, to be applied at the wedged X‐ray beams characterized by the wedge attenuation factor WAF.

Using water‐equivalent solid phantoms (SPs) of different thicknesses, w, and photon square fields of sizes, L, the generalized midplane doses D0(WAF,w/2,L) and generalized transit signals st0(WAF,w,L) by 38 beams of six different linacs were determined. The generalized data were fitted by surface equations and used together with the information of the ‘record & verify’ network of the centers. In this manner, for every beam, the Diso reconstruction was obtained in about 25 seconds after the treatment.

To test the in vivo dosimetric procedure, six pelvic treatments that used conformed wedged beams were carried out with three linacs of different manufacturers. For every beam, the comparison between the reconstructed Diso and the Diso,TPS computed by the TPS, resulted in an acceptable tolerance level of ±5%, estimated for this kind of treatment.

Generally the in vivo dosimetry methods that use EPIDs require: (i) a special effort for the dosimetric commissioning with SPs of different thicknesses, and (ii) extra time for the analysis of the EPID signals. The proposed procedure simplifies the commissioning step and supplies for Varian, Elekta, and Siemens linacs equipped with the aSi EPIDs a quasi‐real time in vivo dosimetry for open and wedged 3DCRT fields.

PACS number: 87.53Xd

Large idiopathic unilateral adrenal hematoma in a young woman

This is a case report on a young woman with a large idiopathic unilateral adrenal hematoma (AH). Only few cases of AH which were not associated with any trauma, previous surgery, coagulative or any other systemic disorders have been described. The mass was discovered by abdominal ultrasound which was performed for a recent flank pain. Magnetic resonance imaging (MRI) confirmed the presence of a 13-cm sized lesion in the right hemi-abdomen; T1 and T2 weighed imaging was compatible with subacute-to-chronic adrenal hematoma. The lesion dislocated the liver and right kidney. Positron emission tomography (PET) did not show any significant radiotracer uptake by the mass. Serum cortisol, aldosterone, renin activity and DHEA-S were normal. Urinary catecholamines and free cortisol excretion were within the normal range too. The lesion was removed by transabdominal laparoscopic adrenalectomy without any complication. The histological exam confirmed a large subacute- to-chronic organized AH. In conclusion, in the absence of known risk factors, differential diagnosis of a large AH may not be easy. The possibility of an underlying pheochromocytoma, malignant adrenal or metastatic tumor must always be considered. In our patient, computed tomography (CT) scan and MRI suggested the presence of a large subacute-to-chronic AH, and PET excluded metabolic activity of the mass. Laparoscopic adrenalectomy can be the surgical treatment of choice in organized symptomatic AH. The correct diagnosis, early recognition and treatment of complications including adrenal insufficiency may decrease patient morbidity and mortality.

[Minilaparoscopy and open laparoscopy: prevention of laparoscopic complications]

BACKGROUND

The study aimed to compare laparoscopy, open-laparoscopy and mini-laparoscopy and to correlate the results of each technique with the respective percentages of laparotomic conversion.

METHODS

A total of 101 laparoscopies were performed between November 1997 and April 1999: 18.8% were diagnostic and 81.2% operative. The latter included 54 traditional laparoscopies (65.9%), 18 open-laparoscopies (21.9%) and 10 minilaparoscopies (12.2%).

RESULTS

Laparotomic conversion was required in 5.5% of laparoscopies. No laparotomic conversion was necessary for the open-laparoscoples and for mini-laparoscopies.

CONCLUSIONS

The possibility of resorting to open-laparoscopy and mini-laparoscopy may represent a valid tool when the patient has previously undergone laparoscopic or laparotomic surgery, with the supposition of pelvo-abdominal adherences that would increase the risk of traditional laparoscopy.

[Role of capacitation in intrauterine insemination as a treatment of male infertility]

BACKGROUND

Although FIVET and ICSI efficacy and efficiency are continuously increasing, intrauterine insemination (IUI) is a very used technique for many different types of sterility. It is also used in male sterility for its cost/benefit positive rate. Pregnancies frequency obtained after IUI in male factor infertility cases, with or without ovarian stimulation, shows the value of this work.

METHODS

We evaluated 149 insemination cycles in 34 couples with a male infertility diagnosis confirmed after at least 2 semen analysis, according to OMS criteria. All the 34 patients had at least one Fallopian tube open and some spontaneous ovulatory cycle to enter in this study. The patients without biochemical pregnancy signs after 6 intrauterine insemination cycles were induced to multiple ovulations through oral administration of 50 mg of Clomifene citrate from the 5th to the 9th cycle-day or through intramuscular administration of 75 I.U. of FSH from the 5th cycle-day. A luteal support with 200 mg of vaginal progesterone, 2 times for day, was reserved for all the patients with endometrium <8 mm or with low progesterone serum levels (<20 nmol/l).

RESULTS

All patients made 149 IUI cycles, with a total medium pregnancy rate for cycle of 6.0% and for patient of 26.4%. We didn't observe statistically significant differences related to spermatozoa total number for ml in native sperm, in terms of pregnancy rate in men with 100-150 millions of spermatozoa. We observed a lower pregnancy rate in men with less than 5 millions moving spermatozoa. Under 1 million of total spermatozoa, pregnancy rate is very low (2.3%): it is established for higher values, obtaining the best results between 10 and 20 millions of total spermatozoa (10.5%) and a little reduction over 20 millions (8.3%).

CONCLUSIONS

The evaluation of spermatozoa total number and also their motility does not present any prognostical significance as to the pregnancy rate in intrauterine insemination for male factor infertility.

[Cure of female sterility. Treatment of hydrosalpinx]

BACKGROUND

The aim of this study was to show how a laparoscopic salpingectomy can positively modify infertile patients pregnancy rate after a diagnosis of hydrosalpinx, obtaining, through successive assisted procreation programs, a pregnancy rate equal to the pregnancy rate obtained in good conditions.

METHODS

A group of 19 women under infertility treatment was evaluated: of these women, 11 were included less than three times in an assisted procreation program and 8 were included three or more times in these programs, for a total of 41 cycles of assisted reproduction: all these cycles were characterized by a negative result. All 19 patients were treated by diagnostic-operative laparoscopy: a salpingectomy was carried out after a hydrosalpinx in all these cases.

RESULTS

All patients were treated with 2 assisted reproduction cycles, which were made with a variable range of time from 3 to 6 months after laparoscopic surgery, totalizing 38 cycles. At present, 4 pregnancies have been obtained (pregnancy rate = 22%): this value is comparable to the values obtained in the best assisted reproduction programs.

CONCLUSIONS

Many studies showed that hydrosglpinx presence reduces very much FIVET procedures. There are many cases showing that the hydrosalpinx become worse, if it has not been preventively treated, during assisted reproduction programs. Moreover complications during FIVET programs in the presence of hydrosalpinx are observed. Even if this study is based on data related to a small number of patients, it's clear that surgical treatment of severe tubarian pathology can give the best results where an assisted reproduction program will be surely unsuccessful.

[Ureaplasma urealyticum vaginosis and premature rupture of membranes. What is its role?]

BACKGROUND

The aim of this study was to evaluate a correlation between PROM and genital infections.

METHODS

A total of 308 vaginal swabs were made in randomized study group composed by 184 pregnant women aged between 26 and 32 years with an extreme age of 19 (one) and 40 years (one). Three vaginal swabs and one cervical swab (searching for Chlamydia) were made for every patient. Sixteen patients were excluded during this study, because they decided to have their babies in other hospitals. Therefore, the patients totally included in the study were 166: 109 at the first pregnancy, 33 at the second pregnancy and 5 at the third pregnancy. No one of them had any spontaneous abortion in the past. All possible other factor which ca be considered responsible and/or inductive of premature ruptures, such as cervical incontinence, cigarette smoke and coitus were excluded.

RESULTS

280 vaginal swabs were made in this study: 134 were positive, with a global positivity percentage of 47.85%. Premature rupture of membranes (PROM) was observed in 38 cases with an incidence of 23.03%: 26 were PROM and 12 were pPROM. The extreme pPROMs occurred, respectively, at the 21st and at 34th gestational week; 29 of the 38 cases of PROM, were associated with positive cultures. The results obtained show an evident correlation between PROM and Ureaplasma urealyticum vaginosis: this fact is improved by the high incidence percentage of this mycobacter in pregnant women and also by an absolute predomination of Ureplasma urealyticum in PROM cases (72.41%).

CONCLUSIONS

These data obtained confirm the importance of this microorganism in PROM genesis, according to some recent studies. It is suggested that Ureaplasma urealyticum infection can contribute to a premature start of labour.

Biohumoral parameters and bone mineral content in the identification of high risk subjects for postmenopausal osteoporosis

BACKGROUND

The aim of this study was to evaluate the possibility of identifying women with a high risk of postmenopausal osteoporosis by using computerised bone mineral analysis (CBMA) associated with markers of bone turnover in order to provide a valid and reliable screening test.

METHODS

A total of 925 patients were evaluated, 252 of whom had already undergone a preliminary densitometric test six months earlier and were diagnosed as fast bone losers. 225 of them (89%) also showed altered bone turnover markers. CBMA was negative in the remaining 673 patients but 13 patients showed altered bone turnover markers and three of the latter then showed a positive CBMA 18 months later. The 673 patients who, after six months of study, were not fast bone losers were monitored over time.

RESULTS

It emerges from these results that fast bone losers are characterised by higher levels of hydroxyprolinuria and calcium, lower levels of oestrone and estradiol, and reduced body weight compared to healthy subjects.

CONCLUSIONS

This simplified method enabled 79% of the fast bone losers to be identified, whereas densitometry identified 87.5% of the high-risk subjects. The main advantage of our simplified method compared to the measurement of bone mineral content is that it identifies the majority of fast bone losers in the initial postmenopausal period, before a substantial reduction in BMC has taken place.

[Partial hydatidiform mmole at the 17th week of pregnancy]

A 36-year-old woman, at the 17th week +5 days gestational age, who was already admitted to the nephrology department for gestational hypertension, proteinuria and legs oedema, was admitted to our Institute. About three weeks before her admission to the nephrology dept., the patient presented heart palpitations and exertional dyspnoea related to the first evidence of the legs oedema, weight gain (about 5 kg during only one month) and normal blood pressure values. During the following days, an antihypertensive therapy was made, but hypertensive crisis and strong headache were also persistent. Vulvar oedema was observed, the uterus was moderately contracted and its dimensions were similar to an uterus at the 21st week; beta-hCG serum values were more than 500,000 IU/lt. An echography confirmed the diagnostic suspicion of hydatidiform the presence of a fetus developed as much as the gestational time. beta-hCG serum values increased to 1,200,000 IU/lt; the molar abortion induction was made thru prostaglandins: fetal extrusion occurred after three hours. The placenta was instrumentally extracted and it showed evident hydatidiform moles a uterine curettage. Patient temperature was very high (39 degrees C) in the immediate postoperative period and three hematologic pockets were transfused. After a week, we made a second elective uterine curettage with the extraction of a little quantity of gestational material; the patient was still hospitalised for ten days: during this time there was a progressive decrease of the beta-hCG serum values (last value at discharge: 7,200 IU/lt). The patient had also positive beta-hCG serum values after about one year.

[Biochemical markers of bone remodeling in the prevention of postmenopausal osteoporosis]

Normal bone mass is one of the principal factors in the prevention of osteoporosis for women in advanced age. Therefore, it is necessary to have efficacious serum and urinary markers available to screen the bone development and the bone resorption. Even if we are also far from identifying an ideal marker, the measurement of some substances such as pyridinoline (Pyr) and deoxypyridinoline (D-Pyr) seems to be a first progress for efficacious and rather simple techniques.

[Pregnancy today. Randomized study of the emotional state of the woman and her partner]

BACKGROUND

Pregnancy is a remarkable ground for studying the biopsychosocial perspective of psychosomatics, because there is a close correlation between biological conditions, that quickly change in time, and emotional implications that are this result of women psychological structure, her psychosexual maturation degree and her social and environment past and present influences.

METHODS

Through a questionnaire including some general data and a more specific section to evaluate psychic and emotional factors of the pregnant and her partner during pregnancy, we interviewed 100 pregnant women beginning from the 32nd pregnancy week; all women attended the psychoprophylactic lessons for childbirth, they were between 20 and 41 years old and the 87% was primipara and the 13% was multipara.

RESULTS AND CONCLUSIONS

This study showed that even if pregnancy is more and more planned and desired, anxiety and fears follow the joy and the happiness of having child, both in man and in woman. Thus, pregnancy and birth, seem to be, also today, too much medicated to the detriment of the "naturalness" of the event: in fact, woman uptake more drugs and there is an increased need to have a good medical assistance not for real obstetrical problems but only to make up for intense anxiety.

Ultrasound diagnostic criteria in breast disease

The Kasumi-Kamio parameters (margins, peripheral echoes, internal echoes, posterior echoes, lateral shadow cones) and the ratio between the longitudinal and transverse diameter of the breast lump form the basis for a list of standardised diagnostic criteria on which to base an analysis of breast disease that assesses the specificity and sensitivity of ultrasonography as a valid, reliable initial step in the diagnosis of breast tumours. The study was based on a series of 129 tumour cases and produced correct diagnosis in 89.28% of benign, 83.33% of malignant cases.

[Anencephaly associated with uterine rupture during induced abortion. A clinical case]

A 32 year old woman, at the 23rd week + 3 days gestational age, was admitted to our institute for a therapeutic abortion decided because of an ultrasonographic diagnosis of anencephaly. This woman had already had a cesarean section caused by acute fetal stress during labor in 1992. We decided for a labor induction with prostaglandin analogues: we used gemeprost vaginal tablets and after injectable sulproste. During this treatment we observed increasing abdominal pain, slight genital haemorrhage, vanishing HFR, an elevated reduction of haemoglobin (7 g): so, we thought of a uterine rupture. During the intervention, we observed a conspicuous haemoperitonei caused by a complete yielding of the old hysterotomic suture at the cervix border; the placenta and its adnexals get out from the uterine breach and the fetus fluctuated in the abdominal cavity, also enclosed in his unruptured amniotic fluid. Post-intervention course was satisfactory and we discharged the patient during the 7th admission day. Our personal experience shows the importance of a careful monitoring of maternal and fetal conditions during labor induction, particularly in those cases in which a woman was already submitted to a hysterotomy, and especially when the use of different types of prostaglandin drugs may be necessary.

[Estrogen-progestin contraception and biohumoral response of new markers of the atheroma risk. Behavior of lipoprotein(a) and apolipoproteins A and B]

A homogeneous group of 45 patients, aged between 19 and 37 years was considered in relationship to metabolic response during oral contraceptive use. A free endocrinological-metabolic pathology control group, formed by 30 patients, aged between 22 and 35, who were not treated with any therapy in the six months before, was also considered. We also considered any other factors like smoking, height, and weight in all women of our study. Study-trial was comprehensive of a 12 months follow-up, with some periods of study at 0, +6, +12 months. Metabolic responses of lipoprotein(a) and apolipoprotein A and B during the different follow-up steps were determined. Total and fractionated cholesterol and triglycerides were also determined. Positive correlations were shown between Lipo(a) and Apo B and also between total cholesterol and LDL. Negative correlations were shown between Lipo(a) vs HDL and Apo A. Lipoprotein(a) was determined by the ELISA technique and turbidimetric technique. The aim of our study was to verify the importance of the new markers of atheroma risk; even if the oral estrogen-progestin contraception little interferes with this biohumoral marker synthesis, it improves atheroma risk protection through the lipidic metabolism complexity.

[Lipoprotein(a) and the cardiovascular risk during estrogen-progestin replacement therapy in postmenopause]

A homogeneous group of 37 patients, aged between 52 and 61 years was considered in relationship to the metabolic response during hormonal replacement therapy (HRT). A free endocrinological-metabolic pathology control group, formed by 40 patients, who were not treated with any therapy, was also considered. Study-trial was comprehensive of a 123 months follow-up, with some periods of study at 0, +6, +12 months. Metabolic responses of lipoprotein(a) and apolipoprotein A and B during the different follow-up steps were determined. Total and fractioned cholesterol and triglycerides were also determined. Significant correlations were shown between Lipo(a) and Apo B and also between Lipo(a) and LDL in both groups considered Lipoprotein(a) was determined by ELISA methodic and turbidimetric methodic. The aim of our study was to verify the importance of the new markers of the atheromatous risk. The reduction of lipoproteins middle value observed in the HRT group shows a little, but however present, estrogens action to the Lipo(a) itself. This fact testifies to the benefit of the use of HRT in post-menopause also as reg ards an evaluated cardiovascular risk inhibition.

[Bacterial vaginosis and premature membrane rupture: an open study. Preliminary data]

We tried to identify a correlation between bacterial vaginosis and PROM with the aim of proposing a future screening for pregnant women at risk for premature rupture of membranes. We made two vaginal bacteriological tests on women pregnant at 24th and 34th week, and we repeated the same test when it proved positive for infection after therapy. We did 375 tests and our study group was composed of 249 pregnant women, aged between 24 and 35. We also evaluated some variable factors as ultrasonographic gestational age redetermination, number pregnancies of oral contraceptives or IUD use, presence of risk factors presence (recurrent abortion, previous PROM, glucose metabolism alteration, immunosuppression, condylomatosis). 171 tests proved positive (total positivity percentage: 47.2%). The most common micro-organism was Ureaplasma urealyticum (49.1%) that was related to PROM in 66.7%. This result contracts with affirmations of some England authors who think that Ureaplasma hasn't an important role in PROM. This fact, if related to the other data we obtained with our study, actually current, shows a strict correlation between PROM and bacterial vaginosis, but also a different distribution of vaginal infections in our country in comparison with English countries.

Surgical management and follow-up of medullary thyroid carcinoma

Between 1977 and 1990 we operated on 33 patients with medullary thyroid carcinoma. We performed total thyroidectomy in 31 patients and central node dissection and/or lateral modified node dissection in 21 patients (63.3%). Two patients underwent radiotherapy after subtotal resection and tracheostomy. No perioperative death occurred. Twenty-five patients were followed (mean follow-up, 63.8 months) and 8 others were unavailable for follow-up. Three patients (1 with multiple endocrine neoplasia type IIB, 2 sporadic with distant metastases) died of their disease at 12, 18 and 36 months after initial operation. Of the remaining 22 patients, 4 with stage II disease were normocalcitoninemic even with pentagastrin stimulation, following total thyroidectomy and bilateral modified neck dissection and central node dissection. Eighteen other patients continued to have elevated calcitonin levels postoperatively. Only 10 patients with known cervical metastatic disease were reoperated upon. We performed extensive node dissection in all. In addition we resected recurrent tumor from the thyroid bed in 4 patients. Despite these extensive reoperations no patient became normocalcitoninemic. At the completion of the study (December 1991), 22 of the 25 patients followed were alive: 4 patients with normal calcitonin levels, baseline and after pentagastrin stimulation, and 18 with persistent mildly elevated calcitonin levels but no other evidence of disease. Our experience supports a very aggressive surgical approach at the time of the first operation for patients with medullary thyroid carcinoma. A lesser operation usually resulted in residual medullary thyroid carcinoma in the neck. We demonstrate the difficulty of achieving a cure by reoperation once the tumor becomes demonstrable by localization studies.

Thyroperoxidase immunodetection for the diagnosis of malignancy on fine-needle aspiration of thyroid nodules

We have previously demonstrated that in 95.6% of malignant thyroid tumors the enzyme thyroid peroxidase (TPO) presents antigenic changes detectable by a monoclonal antibody termed MoAb47. The aim of this study was to investigate the interest of TPO immunodetection for the diagnosis of malignancy on fine-needle aspiration biopsy (FNAB) of thyroid nodules. The study was performed on 300 patients. Slides of FNAB aspirate were air-dried and stained by anti-TPO-MoAb47. According to the percentage of TPO-positive epithelial cells, patients were divided into two groups: benign (> 80%) and malignant (< 80%). In 279 cases additional slides were available for Giemsa stain and standard cytology. All the patients were operated on, and the final diagnosis was recorded as benign in 248 cases (183 macrofollicular nodules, 23 microfollicular adenomas, 18 atypical adenomas, 11 oncocytomas, 11 thyroiditis, 2 Graves' disease) and malignant in 52 cases (44 papillary carcinomas and 8 follicular carcinomas). Samples from 215 of 248 benign nodules yielded 80% to 100% TPO-positive cells, whereas samples from all malignant tumors yielded less than 80% positive cells. The sensitivity of TPO staining for diagnosis of malignancy was thus 100%, its specificity 86.7%, and its overall accuracy 89%. With conventional cytology, sensitivity, specificity, and accuracy were 91.6%, 79.2%, and 81.0%, respectively. We conclude from this study that TPO staining with MoAb47 should become an essential adjunct in the preoperative cytologic diagnosis of thyroid nodules.

Choledochal cysts in adults: a case report

We examined a case of choledochal cyst in an adult having congenital dilatation of the bile duct classified, according to Todani's, as type I and treated by excision with hepatic-jejunostomy Roux-en Y. This procedure is recommended as the best treatment for eliminating pancreatitis by pancreaticobiliary disconnection and thus for reducing the risk of malignancy.

Maternal and embryonal/fetal beta-endorphin concentrations during the first trimester of pregnancy

In this study, we have determined the beta-endorphin concentrations in the plasma of 11 cases during the first 3 months of pregnancy, as well as the corresponding products of conception, collected by hysterosuction, during the course of voluntary abortion. The purpose of this study is to compare the values obtained by the analysis of maternal plasma and the material collected by hysterosuction. The beta-endorphin concentrations were obtained by radioimmunologic methods using a kit which allows a separation from beta-lipotropin. The specimens obtained by hysterosuction (8 +/- 1.7 pmol/l) showed significantly higher levels of beta-endorphin than those observed in the maternal plasma (2.6 +/- 0.3 pmol/l). Thus, already in the earliest gestational period, the data are consistent with a feto-placental origin for this opioid peptide.