The psychopathological trajectories to delusion in Schizophrenia: the affective and schizotypal pathways

Introduction

Delusions are a key feature of schizophrenia psychopathology. From a phenomenological approach, Jaspers (1913) differentiates between “primary” or true schizophrenic delusions, defined as an unmediated phenomenon that cannot be understood in terms of prior psychological origin or motivation, and “secondary” delusions, understandable from the patient’s mood state or personality. Primary delusions have been considered the hallmark of reality distorsion dimension in schizophrenia, disregarding a possible affective patwhay to delusional belief.

Objectives

The present study was aimed at elucidating the psychopathological trajectories to delusion in schizophrenia through the investigation of both affective and schizotypal trait dispositions.

Methods

Seventy-eight participants affected by schizophrenia were administered the Peters Delusional Inventory (PDI), the Positive and Negative Affective Scale (PANAS), the Experience of Shame Scale (ESS), the Referential Thinking Scale (REF), the Magical Ideation Scale (MIS) and the Perceptual Aberration Scale (PAS).

Results

The severity of delusional ideation (PDI) was positively related to both affective (PANAS positive dimension, ESS) and schizotypal traits (MIS, PAS and REF). Moreover, referential thinking (REF) mediated the relationship between “magical ideation” (MIS) and delusions severity (Fig. 1), whereas experience of shame (ESS) was a moderating factor in the between referential thinking and delusion severity (Fig. 2).

Conclusions

The study findings suggest that in schizophrenia patients, severity of delusions is underpinned by an intertwining of both affective and schizotypal pathways.

Disclosure

No significant relationships.

Bilateral Cancer of the Breast

The authors reviewed a series of 2311 primary breast cancers followed-up from 1 to 11 years after radical mastectomy. Twenty-eight simultaneous and 40 metachronous contralateral breast cancers were observed in the study period with an average annual incidence rate of 4.5%. Younger age and histologic evidence of lobular carcinoma at first cancer diagnosis was significantly associated with contralateral cancer, whereas first cancer stage did not seem to be a risk factor. Contralateral metachronous cancer significantly worsened the expected prognosis, which was not true for simultaneous bilateral cancers. The possible reasons for this negative prognostic influence of a second breast cancer and the role of preventive measures such as contralateral mastectomy are discussed. At the present time, an accurate annual clinicomammographic follow-up seems to be the most advisable course of action.

Intraoperative Fall in Plasma Levels of Intact Parathyroid Hormone in Patients Undergoing Parathyroid Adenomectomy

Intraoperative measurement of intact parathyroid hormone (PTH) can be used to evaluate the success of parathyroid surgery in primary hyperparathyroidism associated with parathyroid adenoma. To evaluate this approach we used a modified immunoradiometric assay (IRMA) to study the kinetic patterns of circulating PTH disappearance in 13 patients undergoing adenomectomy for single adenoma. The rapid and the standard assay for PTH measurement in plasma were used and compared. The two methods showed a highly significant correlation (r=0.995; p<0.0001).

We reported a decrease in PTH to 18.2±2.30 (mean±SEM) from baseline values at 15 minutes after successful parathyroid adenomectomy in the 13 patients. The biphasic pattern of serum PTH clearance was calculated in 8 of the studied patients with a fast phase showing a half-life (T1/2) of 3.99 (SEM 0.464) minutes and a slow phase with a T1/2 of 91.0 (SEM 33.6) minutes. Half the amount of the basal values was reached between 4 and 9 minutes.

Our study concludes that the modified IRMA for intraoperative measurement is feasible, reliable and sufficiently precise for low hormone values. Since it may yield information on the half-life of PTH in the circulation, it may play a role in the surgical guidance for total exeresis of hyperfunctioning tissue

European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases: report of the European Union Parliament Summit (29 March 2017)

On March 29, 2017, a European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases (CRD) was organized by the European Forum for Research and Education in Allergy and Airway Diseases. The event took place in the European Parliament of Brussels and was hosted by MEP David Borrelli and MEP Sirpa Pietikainen. The aim of the Summit was to correspond to the needs of the European Commission and of patients suffering from CRD to join forces in Europe for the prevention and self-management. Delegates of the European Rhinologic Society, European Respiratory Society, European Academy of Allergy and Clinical Immunology, European Academy of Paediatrics, and European Patients Organization EFA all lectured on their vision and action plan to join forces in achieving adequate prevention and self-management of CRD in the context of Precision Medicine. Recent data highlight the preventive capacity of education on optimal care pathways for CRD. Self-management and patient empowerment can be achieved by novel educational on-line materials and by novel mobile health tools enabling patients and doctors to monitor and optimally treat CRDs based on the level of control. This report summarizes the contributions of the representatives of different European academic stakeholders in the field of CRD.

The pre-launch characterization of SIMBIO-SYS/VIHI imaging spectrometer for the BepiColombo mission to Mercury. II. Spectral calibrations

The Visible and near Infrared Hyperspectral Imager (VIHI) is the VIS-IR spectrometer with imaging capabilities aboard the ESA BepiColombo mission to Mercury. In this second paper, we report the instrument spectral characterization derived by the calibration campaign carried out before spacecraft integration. Complementary measurements concerning radiometric and linearity responses, as well as geometric performances, are described in Paper I [G. Filacchione et al., Rev. Sci. Instrum. 88, 094502 (2017)]. We have verified the VIHI spectral range, spectral dispersion, spectral response function, and spectral uniformity along the whole slit. Instrumental defects and optical aberrations due to smiling and keystone effects have been evaluated, and they are lower than the design requirement (<1/3 pixel). The instrumental response is uniform along the whole slit, while spectral dispersion is well represented by a second order curve, rather than to be constant along the spectral dimension.

European symposium on the awareness of allergy: report of the promotional campaign in the European Parliament (26-28 April 2016)

From 26 to 28 of April 2016, an allergy awareness campaign was organized by the European Academy of Allergy and Clinical Immunology and the European Federation of Allergy and Airway Diseases Patients Associations in the European Parliament in Brussels, with support of the European Parliament's Interest group on Allergy and Asthma and was co-hosted by the Members of the European Parliament David Borrelli, Sirpa Pietikainen and Nessa Childers. Skin prick tests (SPTs) were performed to gain attention for the increasing prevalence of allergic airway diseases in Europe. Since more than 30% of the total European population suffers from airway allergies and asthma, reaching a higher level of awareness and elaboration of an active prevention plan is mandatory. Of the 406 individuals undergoing SPT in the European Parliament, 211 participants (52%) reported to have suffered from an allergy in the past, with allergic symptoms being present in the nose and eyes (40% and 36%, respectively), the skin (27%), lower airways (14%) and the gut (8%). Of the 381 SPT with reliable results, cutaneous hypersensitivity was found in 201 (53%) participants. Of those with positive SPT (n = 201), 70 participants (35%) were monosensitized while 131 participants (65%) were polysensitized. The positive skin reactions were found mostly for grass pollen (n = 108), followed by Dermatophagoides pteronyssinus (n = 105), Dermatophagoides farina (n = 96) and birch pollen (n = 85). Of note, 54 individuals (14% of the total tested population) without reported allergy or allergic symptoms showed a positive SPT without clinical relevance. This report summarizes the main idea and goals of the symposium: chronic airway diseases are a major and growing health problem in Europe. Therefore, a joint preventive action plan needs to be developed for a better health status of European citizens.

European Symposium on Precision Medicine in Allergy and Airways Diseases: Report of the European Union Parliament Symposium (October 14, 2015)

The European Academy of Allergy and Clinical Immunology (EAACI), the European Rhinologic Society (ERS), and the European Medical Association (EMA) organized, on October 14, 2015, a symposium in the European Parliament in Brussels on Precision Medicine in Allergy and Airways Diseases, hosted by MEP David Borrelli, and with active participation of the EU Commissioner for Health and Food Safety Vytenis Andriukaitis, MEP Sirpa Pietikainen, Chair of the European Parliament Interest Group on Allergy and Asthma, the European Respiratory Society (ERS), the European Federations of Allergy and Airways Diseases Patients Associations (EFA), the Global Allergy and Asthma European Network (Ga2len), Allergic Rhinitis and Its Impact on Asthma (ARIA), and the Respiratory Effectiveness Group (REG). The socioeconomic impact of allergies and chronic airways diseases cannot be underestimated, as they represent the most frequently diagnosed chronic noncommunicable diseases in the EU; 30% of the total European population is suffering from allergies and asthma, and more than half are deprived from adequate diagnosis and treatment. Precision medicine represents a novel approach, embracing four key features: personalized care based on molecular, immunologic, and functional endotyping of the disease, with participation of the patient in the decision-making process of therapeutic actions, and considering predictive and preventive aspects of the treatment. Implementation of precision medicine into clinical practice may help to achieve the arrest of the epidemic of allergies and chronic airways diseases. Participants underscored the need for optimal patient care in Europe, supporting joint action plans for disease prevention, patient empowerment, and cost-effective treatment strategies.

European symposium on precision medicine in allergy and airways diseases: report of the European Union parliament symposium (October 14, 2015)

On 14 October 2015, the European Academy of Allergy and Clinical Immunology (EAACI), the European Rhinologic Society (ERS) and the European Medical Association (EMA) organized a symposium in the European Parliament in Brussels on Precision Medicine in Allergy and Airways Diseases, hosted by MEP David Borrelli and with active participation of the European Respiratory Society (ERS), the European Federations of Allergy and Airways Diseases Patients Associations (EFA), the Global Allergy and Asthma European Network (Ga2len), Allergic Rhinitis and Its Impact on Asthma (ARIA) and the Respiratory Effectiveness Group (REG). MEP Sirpa Pietikainen, Chair of the European Parliament Interest Group on Allergy and Asthma, underlined the importance of the need for a better diagnostic and therapeutic approach for patients with Allergies and Chronic Airways Diseases, and encouraged a joint initiative to control the epidemic of Allergy and Asthma in Europe. The socio-economic impact of allergies and chronic airways diseases cannot be underestimated, as they represent the most frequently diagnosed chronic non-communicable diseases in the EU. Despite the fact that 30% of the total European population is nowadays suffering from allergies and asthma, more than half of these patients are deprived from adequate diagnosis and treatment. Precision Medicine represents a novel approach in medicine, embracing 4 key features: personalized care based on molecular, immunologic and functional endotyping of the disease, with participation of the patient in the decision making process of therapeutic actions, and taking into account predictive and preventive aspects of the treatment. Implementation of Precision Medicine into clinical practice may help to achieve the arrest of the Epidemic of Allergies and Chronic Airways Diseases. This report summarizes the key messages delivered during the symposium by the speakers, including the EU Commissioner for Health and Food Safety Vitenys Andriukaitis. The Commissioner underscored the need for optimal patient care in Europe, supporting joint action plans for disease prevention, patient empowerment and cost-effective treatment strategies leading to a better health status of European citizens.

European symposium on precision medicine in allergy and airways diseases: report of the European Union parliament symposium (October 14, 2015)

On 14 October 2015, the European Academy of Allergy and Clinical Immunology (EAACI), the European Rhinologic Society (ERS) and the European Medical Association (EMA) organized a symposium in the European Parliament in Brussels on Precision Medicine in Allergy and Airways Diseases, hosted by MEP David Borrelli and with active participation of the European Respiratory Society (ERS), the European Federations of Allergy and Airways Diseases Patients Associations (EFA), the Global Allergy and Asthma European Network (Ga2len), Allergic Rhinitis and Its Impact on Asthma (ARIA) and the Respiratory Effectiveness Group (REG). MEP Sirpa Pietikainen, Chair of the European Parliament Interest Group on Allergy and Asthma, underlined the importance of the need for a better diagnostic and therapeutic approach for patients with Allergies and Chronic Airways Diseases, and encouraged a joint initiative to control the epidemic of Allergy and Asthma in Europe. The socio-economic impact of allergies and chronic airways diseases cannot be underestimated, as they represent the most frequently diagnosed chronic non-communicable diseases in the EU. Despite the fact that 30% of the total European population is nowadays suffering from allergies and asthma, more than half of these patients are deprived from adequate diagnosis and treatment. Precision Medicine represents a novel approach in medicine, embracing 4 key features: personalized care based on molecular, immunologic and functional endotyping of the disease, with participation of the patient in the decision making process of therapeutic actions, and taking into account predictive and preventive aspects of the treatment. Implementation of Precision Medicine into clinical practice may help to achieve the arrest of the Epidemic of Allergies and Chronic Airways Diseases. This report summarizes the key messages delivered during the symposium by the speakers, including the EU Commissioner for Health and Food Safety Vitenys Andriukaitis. The Commissioner underscored the need for optimal patient care in Europe, supporting joint action plans for disease prevention, patient empowerment and cost-effective treatment strategies leading to a better health status of European citizens.

Antidepressant discontinuation in bipolar depression: a Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) randomized clinical trial of long-term effectiveness and safety

OBJECTIVE

To assess long-term effectiveness and safety of randomized antidepressant discontinuation after acute recovery from bipolar depression.

METHOD

In the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, conducted between 2000 and 2007, 70 patients with DSM-IV-diagnosed bipolar disorder (72.5% non-rapid cycling, 70% type I) with acute major depression, initially responding to treatment with antidepressants plus mood stabilizers, and euthymic for 2 months, were openly randomly assigned to antidepressant continuation versus discontinuation for 1-3 years. Mood stabilizers were continued in both groups.

RESULTS

The primary outcome was mean change on the depressive subscale of the STEP-BD Clinical Monitoring Form. Antidepressant continuation trended toward less severe depressive symptoms (mean difference in DSM-IV depression criteria = -1.84 [95% CI, -0.08 to 3.77]) and mildly delayed depressive episode relapse (HR = 2.13 [1.00-4.56]), without increased manic symptoms (mean difference in DSM-IV mania criteria = +0.23 [-0.73 to 1.20]). No benefits in prevalence or severity of new depressive or manic episodes, or overall time in remission, occurred. Type II bipolar disorder did not predict enhanced antidepressant response, but rapid-cycling course predicted 3 times more depressive episodes with antidepressant continuation (rapid cycling = 1.29 vs non-rapid cycling = 0.42 episodes/year, P = .04).

CONCLUSIONS

This first randomized discontinuation study with modern antidepressants showed no statistically significant symptomatic benefit with those agents in the long-term treatment of bipolar disorder, along with neither robust depressive episode prevention benefit nor enhanced remission rates. Trends toward mild benefits, however, were found in subjects who continued antidepressants. This study also found, similar to studies of tricyclic antidepressants, that rapid-cycling patients had worsened outcomes with modern antidepressant continuation.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00012558.

Preparation and structural analysis of carbon-supported Co core/Pt shell electrocatalysts using electroless deposition methods

Cobalt core/platinum shell nanoparticles were prepared by the electroless deposition (ED) of Pt on carbon-supported cobalt catalyst (Co/C) and verified by HRTEM images. For a 2.0 wt % Co/C core, the ED technique permitted the Pt loading to be adjusted to obtain a series of bimetallic compositions with varying numbers of monolayers (ML). The tendency for corrosion of Co and the electrochemical (i.e., oxygen reduction reaction (ORR)) activity of the structures were measured. The results from temperature-programmed reduction (TPR) analysis suggest that a single Pt ML coverage is formed at a Pt weight loading between 0.5 and 0.7% on the 2.0% Co/C. HRTEM analysis indicates that the continuity of the Pt shell on the Co core depends on the precursor Co particle size, where "large" Co particles (>10 nm) favor noncontinuous, three-dimensional Pt structures and "small" Co particles (<6 nm) favor layer-by-layer growth. For these larger core-shell particles, Co was observed to quickly corrode in 0.3 M H(2)SO(4). Surface area specific ORR activity, measured by chemisorption techniques, revealed that the Pt-Co/C catalysts performed better than a commercial Pt/C catalyst; however, on a Pt mass basis, only the lower Pt:Co atomic ratio Pt-Co/C catalysts outperformed the Pt/C catalyst.

Short term effects of air pollution on hospitalizations for cardiovascular diseases in eight French cities: the PSAS program

INTRODUCTION

Short term associations between air pollution indicators and hospitalizations for cardiovascular diseases have been suggested by epidemiological and clinical studies. The present study aims at estimating the association between particles with diameter <10 microm (PM(10)), nitrogen dioxide (NO(2)) and ozone and hospitalizations for cardiovascular diseases in eight French cities during the 1998-2003 period.

METHODS

The daily number of hospitalizations in each city was extracted from the French hospital information system (PMSI) for cardiovascular diseases, cardiac diseases, ischemic heart diseases and stroke. Excess relative risks (ERRs) of hospitalization associated with a 10 microg/m(3) increase in pollutant levels were estimated in each city by fitting a Poisson regression model, controlling for well-known confounding factors and temporal trends. City-specific results were then combined by inverse variance weighting.

RESULTS

Daily number of hospitalizations for cardiovascular diseases was associated with PM(10) levels (for a 10 microg/m(3) increase, ERR=0.8%, 95% CI: [0.2, 1.5]), with NO(2) (1.1%, [0.6, 1.6]) but not with ozone (0.1% [-0.2%, 0.5%]). Associations were stronger in people aged 65 years and over, and when only hospitalizations for ischemic heart diseases were considered. No association was found between strokes and air pollution levels.

DISCUSSION

Our study suggests that the ambient levels of air pollutants currently experienced in the eight French cities, which are close to European air quality guidelines, are yet linked to a short term increase of hospitalizations for cardiovascular diseases. These results are consistent with epidemiological and toxicological data on the cardiovascular effects of air pollution.

[Retrospective study of 266 patients with differentiated thyroid cancer. Current surgical options]

INTRODUCTION

Total thyroidectomy (TT) is considered to be more efficient and more widely used than conservative thyroidectomy (CT) in patients with differenziated thyroid cancer (DTC). Anyway recently CT has been reevaluated in the treatment of DTC sharing favorable prognostic factors, due to the introduction of mini-invasive neck surgery. Such technique are indeed more feasibly applicable to CT than to TT. In this retrospective study we report the results of these surgical approaches in a series of patients with DTC.

PATIENTS AND METHODS

Since 1985 up to 2002, 329 patients with thyroid neoplasm (134 female, aged between 13 and 88) underwent to surgery in our Department. Sixty-three were diagnosed as non-DTC and therefore excluded from this study. The remaining 266 were divided into two groups according with the surgical treatment: the I group (82 patients) underwent to CT, the II group (184 patients) had TT. Several clinical/pathological parameters were analyzed in comparison in the two groups.

RESULTS

60.3% of TT and 80.4% of CT had a single node presentation (p < 0.001 chi-square), whereas multinodular presentation was found in 28.4% of TT and in only case of CT. The mean size of the node was 2.9 +/- 0.8 cm in TT and 1.3 +/- 0.5 in CT (p = < 0.001 t-test). The follicular hystotype was more frequent in TT (37%) than in CT (13%) (p = 0.006 chi-square), whereas papillary form and capsule invading tumors were equally distributed. There was a lymphatic involvement in 20% of TT. Peri-operative mortality is absent; transitory and definitive recurrent nerve lesions were more frequent in TT then n CT (2.1% vs 1.2%); 2.2% of TT and no case in CT had hypoparatiroidism. Ten TT patients (5.5%) and 3 CT cancer (3.6%) died for thyroid cancer. Out of the latter 2 had a capsule-infiltrating form. Finally 4 CT patients had controlateral recurrence (4.8%): two of them had a follicular form and two a papillar one, with mean size of 2.5 cm.

CONCLUSIONS

Although TT is currently considered as the approach of choice for the oncologic accuracy and the correct follow-up, CT is having increasing application for low-risk patients in open and video-assisted surgery especially in the case of an incidental post-operative diagnosis of malignancy. The increasing use of modern technology such as high resolution ultrasounds and nuclear imaging (PET) will allow a more accurate follow-up of CT patients, with an early recognition of either lymphatic or local recurrences.

[Videolaparoscopic adrenalectomy in Conn syndrome. Analysis of 39 case observations]

The authors retrospectively analyse 39 patients affected by Conn's syndrome, which have been observed since 1985, and discuss the results of surgical approach using the new technologies. In particular, the introduction of laparoscopy, technique that has been applied almost exclusively since the last seven years, has revealed being the "gold standard" for the surgical treatment of this disease. The adrenal underlying lesions are indeed almost always monolateral, small in size and present very rarely malignancy in their biological behaviour. Furthermore, the authors, although lacking of personal experience, propose the possibility of a more conservative treatment of the adrenal lesions with a simple "enucleation", whose feasibility also in laparoscopy has recently been shown by some authors. Anyway, the Authors believe that this technique of a partial adrenalectomy could be chosen in selective cases of bilateral adenomas or hyperplasia or in those lesions which are placed in an easily accessible peripheral site.

[Surgical strategy in the treatment of adrenal cortex cancer. Expanded and repeated interventions]

AIM OF THE STUDY

To analyze our patients affected by adreno-cortical carcinoma (ACC) considering in particular the therapeutical approach in case of local recurrence or metastasis, and to compare our results with those from literature.

PATIENTS AND METHODS

Since 1975 up to 2001, 35 patients with ACC were observed, 27 female and 8 male, aged between 3 and 76 year. All patients were surgically treated, 3 out of which laparoscopically. Thirty patients underwent radical and 5 palliative surgery. Twenty-two patients had extended resections to surrounding infiltrated organs, such as spleen, pancreatic taIl, vena cava, left colon and liver. The intervention was always completed by regional lymphadenectomy. Adjuvant treatment was administered in 17 patients, 4 out of which were re-operated.

RESULTS

Only one patient died in the perioperative period for hyperacute adrenal failure. The survival rate was 85.7% at one year, 76.5% at two years, 70.8% at three and 28.3% at five years. Out of the 30 patients radically treated, only 3 are disease-free up to now. Local recurrence or metastatic disease was observed in 27 patients, out of which only 9 were eventually surgically treated, once or more times. All non-operated patients died between 1 and 6 months from the recurrence. The survival rate of the 9 re-operated patients was 51% at 2 years, and 22.1% at 5 years. Interestingly, one patient who has been re-operated three times, is still alive and disease-free after 7 years from the first recurrence. No significant difference was observed between Mitotane-treated and non-treated patients.

CONCLUSIONS

According with data from literature, we conclude that surgical therapy of recurring local or metastatic ACC is up to now the best treatment, independently from the original stage of the disease. Controversies still remain about the utility of adjuvant chemotherapy in the primary and the recurrent disease.

[Current indications of bilateral adrenalectomy in Cushing's syndrome: discussion of personal experience]

Since 1975 we have observed 68 patients with Cushing syndrome, 48 out of which with an ACTH-independent disease and 20 with an ACTH-dependent one, due to hypophisary adenoma. Out of the latter group of patients, which had a relapse of the disease after a previous trans-sfenoidal procedure, 16 underwent an open bilateral adrenalectomy and 4 a laparoscopic monolateral or bilateral adrenalectomy. Patients from the former group had an open or laparoscopic adrenalectomy, or a bilateral adrenalectomy in case of the rare bilateral diseases, as McCune-Albright syndrome. All patients had a complete healing, except for 2 patients affected by McCune-Albright syndrome who died for cardiopulmonary complications. We conclude that bilateral adrenalectomy plays a fundamental role in the treatment of Cushing disease, after the failure of the trans-sfenoidal procedures. This surgical therapy has been certainly improved by the introduction of the laparoscopic techniques, which allowed us to exert bilateral adrenalectomies in two times with a significant reduction of perioperative morbidity and mortality because of the less severe traumatism and the absence of addisonian complications.

The influence of new technologies on laparoscopic adrenalectomy: our personal experience with 91 patients

BACKGROUND

Laparoscopic adrenalectomy has proved to be the technique of choice for managing benign pathologies of the adrenals and isolated adrenal metastases, especially those arising from lung tumor, but the procedure should not be performed for primitive adrenal carcinoma. The Authors wanted to test the advantages of the Harmonic Scalpel in laparoscopic adrenalectomy.

METHODS

From April 1995 to April 2001, the authors investigated their series of laparoscopic adrenalectomies performed at the Careggi General Hospital, Division of General and Vascular Surgery, Florence, Italy. This study enrolled 91 patients with various adrenal pathologies. The transperitoneal approach was used, with the patient in a lateral position, as suggested by Gagner. Special care was taken to improve the surgical approach to the adrenals by the use of new technological devices such as the Harmonic Scalpel. The operative time required by the surgical procedure was computed by dividing the study into three periods: 1995-1997, 1998-1999, 2000-2001. The first period was necessary to complete the learning curve. In the second period, a steady state in surgical time was reached. During the third period, the Harmonic Scalpel was introduced. The differences between the three periods were tested using a nonparametric analysis (Mann-Whitney U test or Kruskal-Wallis test) as appropriate. A two-tailed p value of 0.05 or less was considered statistically significant. The authors investigated the cost of the operation performed in each of the two groups using, respectively, the conventional laparoscopic device (1998-1999) and the Harmonic Scalpel (2000-2001). The following expenses were considered: Harmonic Scalpel impulse generator and disposable shears, operating room cost per hour, and endoclip applier.

RESULTS

The 91 laparoscopic adrenalectomies were performed with these indications: 31 incidentalomas (26 adenomas and 5 cysts), 25 cases of Conn's disease, 18 cases of Cushing's disease, 9 pheochromocytomas, 2 myelolipomas, 5 metastases (from lung, kidney, and breast) and 1 primitive carcinoma diagnosed preoperatively. Considering the whole series (1995-2001), there was a significant trend of reduction in operative time (p = 0.0001). Moreover looking at the first period (1995-1997), in which the learning curve was completed, the mean surgical time was 148 min, as compared with 125 mm. For the second period (1998-1999) (p = 0.0002). This represents a significant reduction in operative time. The authors noted a further reduction in the operative time when surgery was performed with the Harmonic Scalpel (2000-2001) (92 min; p = 0.001). The reduction in operative time attributable to the Harmonic Scalpel was confirmed also by a multivariate analysis of covariance general linear models procedure (GLM), which accounts for several confounders: age, gender, site and size of tumors, and histology (p = 0.0001). The rate was 3.3% for morbidity, 1.1% for mortality, and 2.2% for conversion. There was no difference in complications between patients treated with conventional devices and those treated with the Harmonic Scalpel.

CONCLUSIONS

The laparoscopic approach has proved to be an extremely reliable procedure for benign pathologies and isolated metastases. There may yet be doubts about its use for the treatment of adrenal carcinomas preoperatively diagnosed. When surgery is performed using Harmonic Scalpel, operative time is significantly reduced and surgery is easier and less expensive. Infact use of the Harmonic Scalpel allowed the cost per operation to be reduced $70. Moreover, if surgery is performed using the nondisposable clip applier, the expenses are reduced $105.

Laparoscopic adrenalectomy. Personal experience in 78 patients

Laparoscopic adrenalectomy has proved to be the technique of choice for the treatment of benign pathologies of the adrenals and also for the treatment of isolated adrenal metastases, especially arising from lung tumor, but it shouldn't be performed for primitive adrenal carcinoma. The harmonic scalpel is very useful for laparoscopic adrenalectomy showing a significant reduction in operative time. The Authors retrospectively investigated 78 laparoscopic adrenalectomies performed from April 1995 to April 2000 using a transperitoneal approach with the patient on a lateral position as suggested by Gagner. Special care was taken to improve the surgical approach to the adrenals also by means of new technological devices as the Harmonic scalpel. The 78 laparoscopic adrenalectomies were performed in 70 cases for benign neoplasms: incidentalomas 24, Cushing's disease 16, Conn's disease 20, pheochromocytomas 9, myelolipoma 1. In the remaining 8 patients laparoscopic adrenalectomy was performed in 7 cases for isolated adrenal masses (5 metastases, 2 adenomas) in neoplastic patients, and in 1 patient for a preoperatively diagnosed adrenal carcinoma. Patients operated for functioning neoplasms had all remission or improvement of symptoms and humoral parameters; patients operated for isolated adrenal metastases showed this survival: 3 patients 3 years asymptomatic and disease free, 1 patient 18 months, and 3 patients are still alive and healthy after 6-12-15 months. A fast onset of local recurrence was seen in a patient operated for a preoperatively diagnosed adrenal carcinoma. We analyzed the operating time dividing the patients in three groups: a) 14 patients operated in the first semester of 1998 when we completed the training curve (average operative time 120.7 minutes); b) 14 patients operated from 1998-1999 (average operative time 118 minutes); c) the last 14 patients (operated from December 1999 to April 2000) where surgery was performed using the Harmonic scalpel (HS) (average operative time 94 minutes). The analysis of the average operative time comparing groups B and C using T-Student Test showed a significant reduction (p = 0.004). The morbility rate was 2.6%, mortality 1.3%, and a conversion rate of 2.6%. Laparoscopic approach results to be an extremely reliable procedure also for the treatment of incidentalomas up to 4-5 cm in which the incidence of adrenal carcinoma is about 13%. Doubts may yet result for the treatment of adrenal carcinomas preoperatively diagnosed. When laparoscopic adrenalectomy in performed using HS the operative time is significantly reduced and surgery is easier.

The importance of the unsuppressed glands in the study of intact parathyroid hormone disappearance after parathyroid adenomectomy

BACKGROUND

In the usual techniques for intraoperative intact parathyroid hormone (iPTH) monitoring for primary hyperparathyroidism, the normal glands are implicitly considered suppressed. On the contrary, we believe, as do other researchers, that they are not totally suppressed.

METHODS

For this reason, we considered the introduction of an infusion from the unsuppressed normal glands (UNG), described by an influx constant (IC (pg/ml per min)), into the formulation of a two-compartment model. For the blood compartment, we have: C(t)=A.exp(-at)+B.exp(-bt)+EV, where A+B+EV=iPTH concentration at zero time (clamping), EV (equilibrium value)=IC/k, 'a' and 'b' are reciprocals of the time constants of the two exponentials and k=rate constant of elimination from the blood. The experimental data were obtained using an IRMA standard method, collecting samples in 20 patients, during and following adenomectomy.

RESULTS

In spite of the variability among the patients, all fits were very good, thus confirming the importance of the UNG contribution to the shaping of the disappearance curve. For this reason, the relationship between the constant infusion from the UNG and the basal iPTH level at the induction of anaesthesia (BV), was studied.

CONCLUSIONS

The existence of a negative correlation, together with the determination of a regression curve (IC=6.5BV), not only confirmed our assumptions, but also revealed the theoretical possibility of a priori knowledge of the iPTH contribution from the UNG. Hence, there is a theoretical possibility of discriminating between this contribution and that of the remaining (if any) affected gland(s).

Adrenal masses in neoplastic patients: the role of laparoscopic procedure

BACKGROUND

The incidence of complications resulting from fine-needle biopsy of adrenal masses in patients already treated by radical procedures for primitive neoplasms of the lungs and kidneys substantiates our opinion concerning laparoscopy as both a diagnostic and therapeutic procedure.

METHODS

We performed 70 laparoscopic adrenalectomies from April 1995 to December 1999. In five patients, the adrenal mass appeared at follow-up evaluation in patients submitted to surgery for a spinocellular lung cancer. One patient underwent surgery for renal adenocarcinoma. In two patients, the adrenal mass was present already at the time primitive lung tumor was diagnosed, so adrenalectomy was performed at the first lung surgery in one patient and 2 weeks before lung surgery in the other patient. All the patients were placed in a lateral position for a transperitoneal approach. Right adrenal masses were present in seven patients, whereas one patient had an adrenal mass in a left location.

RESULTS

No laparotomy was required. The average surgical time was 160 min. (range, 115-120 min). No morbility or mortality occurred, and the average hospital stay was 4 days (range, 3-11 days). All the patients had a complete removal of their masses, which averaged 4.5 cm (range, 2.5-6 cm) in size. Histology confirmed the metastatic origin of the mass in five of seven patients with primary lung cancer, and in one patient with previous kidney cancer. At this writing, three patients were disease free and still alive respectively at 3, 5, and 18 months. Three patients died of brain metastases respectively at 16, 36, and 36 months. An adenoma was proved in the other two cases.

CONCLUSIONS

Laparoscopic adrenalectomy allows us to propose a much more aggressive approach to adrenal masses demonstrated at follow-up evaluation or in patients with primary lung or kidney cancer and no masses at other locations. Nevertheless a much larger study is required for definitive conclusions on a survival rate. We believe that a mini-invasive procedure such as laparoscopy may allow us to replace a rational surgical approach with a more certain pathologic diagnosis.

[The results of total thyroidectomy in Basedow's disease. The authors' personal experience of 180 cases]

The therapeutic guidelines of Basedow (Graves') disease are based on three different approaches: medical treatment with anti-thyroid drugs, radio-iodine therapy and surgery. This choice has increasing consensus for the great improvement of the techniques, which at the moment are practically free of mortality risks, and have very low morbidity incidence, as well as for its positive influence on the course of the Graves' ophthalmopathy. For authors' study 180 patients affected with Graves disease, who have undergone total thyroidectomy, were retrospectively enrolled. The results show that hyperthyroidism symptoms are almost completely cured in most of the subjects, with a very low rate of complications as related to nervous (ricorrential) and parathyroid gland function. Furthermore, total thyroidectomy has resulted to have a positive impact in the clinical course of Graves' ophthalmopathy, particularly regarding some aspects of the eyes involvement, which have a dramatic effect in the "quo ad valitudinem" prognosis of these patients.

Parathyroid glands: combination of (99m)Tc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules

PURPOSE

To determine the appropriate choice of imaging techniques for localization of nodular lesions of parathyroid glands.

MATERIALS AND METHODS

First, computed tomographic (CT), magnetic resonance (MR), ultrasonographic (US), and technetium 99m methoxyisobutyl-isonitrile (MIBI) scintigraphic images in 49 patients with primary hyperparathyroidism were retrospectively evaluated. A single-blind, prospective study that included 16 patients with primary hyperparathyroidism was then conducted. MR, US, scintigraphic, and color Doppler US images of the neck were obtained and analyzed.

RESULTS

In the retrospective study, CT, MR imaging, and US had low sensitivity (13%, 17%, and 27%, respectively) and specificity (39%, 65%, and 65%, respectively). Scintigraphy had 57% sensitivity and 85% specificity. In the prospective study, the use of latest-generation MR and US equipment and the participation of experienced operators led to improved sensitivity and specificity for these techniques. The combination of US and scintigraphy resulted in improved sensitivity (96%), specificity (83%), and positive and negative predictive values (88% and 94%, respectively), relative to the results obtained with either method alone. Doppler US was of little help in the setting of small glands.

CONCLUSIONS

The combination of (99m)Tc MIBI scintigraphy and US performed by well-trained operators with up-to-date instruments appeared to be the best diagnostic tool for the preoperative diagnosis of parathyroid disease.

Adjustable gastric banding: advantages and disadvantages

BACKGROUND

Adjustable gastric banding has many advantages in the treatment of severe obesity.

METHODS

The authors report their experience with open and laparoscopic adjustable gastric banding in the treatment of severe obesity.

RESULTS

This procedure presents some risks and complications, which are described.

CONCLUSIONS

Patients must be well informed about the procedure and accept a strict behavioral therapeutic pattern. Follow-up requires strict surveillance. When the band necessitates increase of pressure, follow-up must be very close in order to avoid a complication that may invalidate this procedure.

[New issues in surgery of adrenal pheochromocytoma]

The adrenal pheochromocytoma still arouses great interest among the experts. The Authors give here a report of a study carried out on the personal case history of 32 patients and the concerning literature. A correct clinical and diagnostic approach is important to detect, at a preoperative level, the benign forms from the malignant ones (10-15% of cases according to literature) and the polyendocrine syndromes (21% of our series). Video-laparoscopy technique is recommended in pheochromocytomas surgery, mainly in asymptomatic and incidental forms and in all benign symptomatic forms less than 5 cm in size. At least, uni- or bilateral adrenalectomy associated with total thyroidectomy is also suggested in case of a polyendocrine syndrome.

Portal thrombosis. A rare complication of laparoscopic splenectomy

Portal thrombosis is a rare complication of splenectomy. We performed 12 laparoscopic splenectomies and observed this complication only in one patient with idiopathic thrombocytopenia (ITP). The right branch of the portal vein presented a partial thrombosis, while the left branch was completely obstructed by thrombi. Abdominal ultrasonography and an ultrasound doppler exam allowed us to diagnose this event and a retrograde angiography performed afterward confirmed our diagnosis. A 48-h intravenous heparin treatment was promptly begun, followed by anticoagulant drugs (dicumarol). The patient was dismissed 5 days afterward, presenting a steady-state ultrasound doppler pattern and a complete normalization of liver parameters. An ultrasound doppler exam performed 1 month after anticoagulant therapy showed a complete resolution of portal thrombosis. We believe that early diagnosis of this rare complication, prompt beginning of anticoagulant therapy, and care in surgical procedures may reduce patient life-threatening risks and assure complete remission.

Periprosthesis sepsis: an undesirable complication of silicone gastric banding

BACKGROUND

Gastric banding is a very satisfactory procedure for the treatment of morbid obesity. The significant incidence of skin suppuration in these patients makes the laparoscopic approach a suitable technique. Regardless of this, in some cases, suppuration can still rarely result.

METHODS AND RESULTS

In four patients the authors observed diffusion of suppuration in both directions along the catheter which connects the port to the band, necessitating band removal and thus invalidating the procedure.

CONCLUSIONS

Suppuration of port location is an undesirable complication that must be avoided because it may contaminate the entire device system. This complication must be carefully evaluated for a correct diagnosis and an eventual removal of the band.

Adjustable silicone gastric banding: complications in a personal series

BACKGROUND

Morbid obesity is a very severe pathology, deriving partly from a psychological disturbance of nutritional behavior. Besides a behavioral therapeutic approach, surgery appears to be necessary to resolve associated diseases by causing a satisfactory weight loss. Adjustable gastric banding is a less-invasive, potentially reversible procedure that guarantees an optimal quality of life.

METHODS

The authors have performed Kuzmak's gastric banding since 1992, with the lap-band approach since 1995; 183 patients were submitted to surgery, and 68 of these were operated by the laparoscopic approach. Average body mass index was 45.5 kg/m2. The complications were always under control and have decreased since the introduction of the recent lap-band.

RESULTS

Gastric banding is still a very young procedure and it is difficult to state definitive results yet. Preliminary results, according to our experience are satisfactory in terms of weight loss, without metabolic changes and without mortality.

CONCLUSIONS

Our experience is encouraging if patient selection is accurate and rigid.

Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma

BACKGROUND

Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series.

METHODS

One hundred eighty-eight cases of ACC were collected in a national registry. A complete follow-up was obtained in 179 cases. At initial diagnosis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a mean disease-free interval of 21.7 months.

RESULTS

Adjuvant chemotherapy was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 +/- 14.9 months) than in nonreoperated cases (3.2 +/- 2.9 months). Five-year actuarial survival in reoperated patients is significantly better than in nonreoperated patients (49.7% versus 8.3%, respectively).

CONCLUSIONS

Although the prognosis of this tumor is still poor, surgery is the only effective therapy; reoperation allows survival comparable to that observed in patients without recurrent disease. An aggressive strategy for recurrent ACC is advisable until prospective studies demonstrate a real effectiveness for chemotherapy.

[Indications for hepatic resection: personal experience]

The Authors, before examining their case history, which includes 103 major and minor hepatic resections performed during the last decade, briefly show the surgical technique concerning hepatic ischaemia and the new technologies proposed to reduce the hematic loss during hepatic resections. The constant adoption of these techniques and the careful evaluation of some parameters concerning hepatic functionality allowed to decrease postoperative complications and mortality, which currently is around 5-10%. These data are confirmed by the Authors experience.

Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicentre randomised study

After curative resection for gastric adenocarcinoma, 103 patients, all with positive nodes, were randomised so that 48 received adjuvant chemotherapy of epidoxorubicin (EPI) 75 mg m-2 on day 1, leucovorin (LV) 200 mg m-2 on days 1-3 and 5-fluorouracil (5-FU) 450 mg m-2 on days 1-3, every 21 days for 7 months, whereas the remaining 55 did not. During the first year of observation, 21 control patients (38%) and five treated patients had recurrences. After a follow-up period of 36 months, 12 of the treated patients (25%) and only seven controls (13%) were still alive. At that point, the median survival was 13.6 months for the 55 untreated patients and 20.4 months for the 48 treated patients, a significant difference. We found a survival advantage for patients treated with the EPI-LV-5-FU regimen and a consistent delay in the appearance of recurrent or metastatic cancer. Acute toxicity was mild and treatment was well accepted by all patients. There was no long-term toxicity or any cardiac toxicity. We conclude that this particular chemotherapy, administered shortly after gastric resection, improves survival rate in node-positive gastric cancer patients, even although final assessment of this particular adjuvant approach must await completion of the trial.

Functional and structural recovery of myotubes from mice with muscular dysgenesis after co-culture with normal, non-myoblastic cells

Muscular dysgenesis is a mutation which is characterized by paralysis of skeletal muscle cells. Excitation-contraction coupling is deficient and muscle cells display atypical ultrastructure. In vitro, mutant myotubes recover a normal phenotype when co-cultured with spinal cord cells from normal animals or with normal fibroblasts. We have shown that other types of cells, eg certain glial cells present in the spinal cord or in other tissues, have this capacity. In contrast, intervention of neurons in the recovery does not appear likely. Very different types of non-myoblastic cells, then, are capable of restoring contractile activity of dysgenic myotubes in vitro, suggesting that a non-specific mechanism is involved in the phenotypic reversion of affected muscle cells. The restoration process seems to imply a close relationship between myotubes and normal glial cells.

Intra-arterial hepatic chemotherapy with 5-fluorouracil and 5-methyltetrahydrofolate in the treatment of unresectable liver metastases from colorectal cancer

Treatment of patients with hepatic metastases from colorectal cancer using hepatic artery fluorodeoxyuridine (FUDR) has been reported to induce high remission rates but also a high incidence of limiting hepatobiliary toxicity. In an attempt to obviate the limiting FUDR toxic effects, a phase I-II study was undertaken to establish the efficacy and tolerability of intra-hepatic 5-fluorouracil (5-FU) when given in combination with 5-methyltetrahydrofolate. Patients with colorectal liver metastases (n = 17) received escalating doses of 5-FU as a 1 h infusion with a fixed dose (100 mg/m2) of intra-hepatic 5-methyltetrahydrofolate (4 h infusion) once a week. Dose limiting toxicity was hepatic and gastrointestinal (diarrhea) and occurred at doses > or = 350 mg/m2 5-FU. Other adverse effects included nausea/vomiting and cutaneous toxicity. One patient achieved a complete response and 2 a partial response (mean duration = 9 months) while 11 had stable disease. Patients with complete or partial responses had a mean survival of 17 months, while patients with stable disease survived 13 months and those with disease progression 5.5 months on average. These results suggest that this is a well tolerated regimen although with efficacy at the lower level of the range observed with fluoropyrimidines.

Urinary MHPG and clinical symptoms in patients with unipolar depression

The relationship between levels of urinary 3-methoxy-4-hydroxyphenylglycol (MHPG) and symptom scores on the Hamilton Rating Scale for Depression was examined in 31 patients with unipolar depression. Patients with either low MHPG or high MHPG showed significant sleep disturbance in the form of early morning awakening. Patients with mid-range or high MHPG showed decreased work and activities. Endogenomorphy factor scores represented a blend of these findings.

Epidoxorubicin and high dose leucovorin plus 5-fluorouracil in advanced gastric cancer: a phase II study

We conducted a multicentric phase II study on advanced gastric cancer to determine the efficacy and toxicity of treatment with epidoxorubicin (EPI) plus high doses of leucovorin (LV) and 5-fluorouracil (5-FU). Thirty-seven patients with measurable disease were enrolled into the trial and treated with EPI 75 mg/m2 on day 1 and LV 200 mg/m2 plus 5-FU 450 mg/m2 from day 1 to 3, the cycle being repeated every 3-4 weeks from a median of five cycles per patients. The response rate was 49% in 35 evaluable patients, with two complete remissions and 15 partial responses. Median response duration was 12.4 months; median survival for responding patients was 17.3 months, which was significantly longer than 8.7 months for non-responding patients. General toxicity was usually mild, myelotoxicity was moderate and there was no evidence of cardiac toxicity. These results show that EPI-LV-5-FU is an effective regimen for advanced gastric carcinoma. The efficacy of this combination should now be tested as an adjuvant therapy in resectable gastric cancer.

Fine needle aspiration cytology of parathyroid adenoma. A review of seven cases

The value of fine needle aspiration (FNA) cytology in the diagnosis of parathyroid adenomas was demonstrated by a cytohistologic review of seven cases. The cytologic patterns, which were characterized by numerous, mostly isolated epithelial cells and naked nuclei showing anisokaryosis and multiple nucleoli, were consistent with the histologic findings in this neoplasm, which should be considered in the differential (FNA) diagnosis of masses in the neck region. The only diagnostic problem is its differentiation from follicular thyroid neoplasms.

Effects of TSH on cAMP levels and thyroid hormone release in human thyroid 'autonomous' nodules: relationship with iodothyronine and iodine content in thyroglobulin

The effect of TSH on the adenylate cyclase-cAMP system and in vitro iodothyronine release, together with the iodothyronine and iodine content of 19s thyroglobulin, were studied in seven clinically euthyroid patients with autonomous thyroid nodules. Basal cAMP and cGMP content together with phosphodiesterase and protein-kinase activities were normal in nodular, and suppressed in extranodular tissue. TSH-dependent cAMP accumulation was reduced in nodular tissue, but normal in the suppressed extranodular tissue. In vitro TSH-dependent iodothyronine release from nodular and extranodular tissue was absent. Thyroxine and iodine content of thyroglobulin extracted from nodular tissue was reduced, while triiodothyronine content was normal but with a low T4/T3 ratio. In extranodular tissue T3, T4 and iodine contents were reduced. In conclusion, autonomous thyroid nodules produced a poorly iodinated thyroglobulin leading to preferential T3 secretion with increased circulating free thyroid hormones even in clinically euthyroid patients.

Thyroxine and triiodothyronine levels in thyroid vein blood and in thyroid tissue of patients with autonomous adenomas

Thyroxine (T4) and triiodothyronine (T3) concentrations were measured in peripheral and thyroid vein blood and in nodular and extranodular thyroid tissue from twenty-four patients with autonomous thyroid nodules (AFTN); fifteen of these patients showed clinical signs of hyperthyroidism and nine were euthyroid. Thirteen patients with solitary non-functioning thyroid adenomas who were clinically euthyroid, served as controls; samples of thyroid vein blood and normal thyroid tissue being obtained from the contralateral lobe. T4 (189.4 +/- 27.2 nmol/l) and T3 (7.05 +/- 2.03 nmol/l) concentrations were significantly higher in the thyroid vein blood of patients with AFTN compared with controls (T4 = 119 +/- 9.1 nmol/l, P less than 0.05; T3 = 2.3 +/- 0.21 nmol/l, P less than 0.01) whereas peripheral levels in the two groups were similar. The T3 concentrations (10.56 +/- 4.12 nmol/g wet tissue) in autonomously-functioning thyroid nodular tissue were significantly higher than those of extranodular (1.9 +/- 0.62 nmol/g wet tissue, P less than 0.01) and normal thyroid tissue (2.63 +/- 0.43 nmol/g wet tissue, P less than 0.05). The T4 levels were not different in the tissues examined. The concentrations of T4 and T3 in thyroid vein blood did not show any significant correlation with the hormone levels in thyroid tissue.

Spermatic and peripheral oestradiol levels in patients affected by azoospermia due to seminiferous tubular damage

Plasma levels of testosterone, androstenedione and oestradiol were determined in the spermatic venous blood of both testes of 17 patient affected by azoospermia due to tubular damage (Group I). The results were compared with those found in 5 patients affected by azoospermia of obstructive origin and 5 patients with an inguinal hernia (Group II). Mean spermatic levels of testosterone and androstenedione were not significantly different in the two groups, while the mean (+/- SE) oestradiol spermatic level was significantly higher in patients of Group I (5.02 +/- 0.75 nM/l vs. 2.20 +/- 0.365 nM/l; P less than 0.05). Moreover, while the testosterone/androstenedione and the androstenedione/oestradiol ratios were not significantly different in the two groups, the mean (+/- SE) testosterone/oestradiol ratio was significantly lower in patients of Group I (552.71 +/- 80.94 vs. 939.86 +/- 129.45; P less than 0.025). Peripheral testosterone and androstenedione mean levels were not significantly different between the two groups while the mean peripheral oestradiol level (+/- SE) was significantly higher in Group I (0.107 +/- 0.021 nM/l vs. 0.038 +/- 0.05 nM/l; P less than 0.025). Peripheral oestradiol was not significantly related to peripheral FSH, nor to spermatic oestradiol in both groups. These results suggest the possibility that oestradiol may be involved in the pathogenesis of some cases of male infertility.