Fast retreat of Zachariæ Isstrøm, northeast Greenland.

After 8 years of decay of its ice shelf, Zachariæ Isstrøm, a major glacier of northeast Greenland that holds a 0.5-meter sea-level rise equivalent, entered a phase of accelerated retreat in fall 2012. The acceleration rate of its ice velocity tripled, melting of its residual ice shelf and thinning of its grounded portion doubled, and calving is now occurring at its grounding line. Warmer air and ocean temperatures have caused the glacier to detach from a stabilizing sill and retreat rapidly along a downward-sloping, marine-based bed. Its equal-ice-volume neighbor, Nioghalvfjerdsfjorden, is also melting rapidly but retreating slowly along an upward-sloping bed. The destabilization of this marine-based sector will increase sea-level rise from the Greenland Ice Sheet for decades to come.

Dosimetría en tomografía computada / Dosimetry in computed tomography

La cantidad de estudios de tomografía computada (TC) que se llevan a cabo por año en el mundo crece de manera exponencial, fundamentalmente por la incorporación de la tomografía computada multicorte (TCMC) que permite la realización de estudios en pocos segundos. Sin embargo, a pesar del beneficio diagnóstico que tienen los pacientes, la dosis de radiación recibida con este tipo de prácticas es una preocupación en la comunidad profesional, debido a que es necesario disminuirla tanto como sea razonablemente posible. El presente artículo describe las principales unidades dosimétricas utilizadas en la tomografía computada, con el fin de poder trabajar con ellas de manera sencilla, utilizando los valores de los equipos modernos y los de referencia conocidos internacionalmente...

Haemophilia Experiences, Results and Opportunities (HERO) Study: influence of haemophilia on interpersonal relationships as reported by adults with haemophilia and parents of children with haemophilia.

Evidence delineating the effects of haemophilia on interpersonal relationships is sparse and largely outdated, failing to reflect the impact of current treatment strategies. HERO (Haemophilia Experiences, Results and Opportunities) was commenced to garner a more comprehensive understanding of psychosocial issues facing persons with haemophilia (PWH). This article describes the findings of the quantitative HERO survey relating to the influence of haemophilia on interpersonal relationships of adult PWH, and parents/caregivers of children with haemophilia. Separate questionnaires were completed by adult PWH and parents of minor children from 10 countries, including satisfaction with support from partners, family, friends and other social contacts; disclosure of haemophilia and carrier status and family dynamics. A total of 675 PWH and 561 parents completed the survey. Over half of PWH (57%) and parents (84%) were married. Most PWH were satisfied with support from partners (94%), family (90%) and friends (85%), with lower percentages reported among those with inhibitors. Most parents were likewise satisfied with support from partners (88%) and family (83%). Whereas PWH were reticent to disclose their diagnosis beyond family and friends, parents were more likely to share their son's diagnosis, and most were satisfied with the support from their son's peers (74%), teachers (83%) and other adults in supervisory roles (85%). PWH and parents surveyed were satisfied overall with the support they received from partners, family, friends and social contacts. Relationships are affected by haemophilia in various ways, and particularly affected in terms of disease burden, age and social life.

Bradykinin B2 receptors increase hippocampal excitability and susceptibility to seizures in mice.

Bradykinin (BK) and its receptors (B1 and B2) may exert a role in the pathophysiology of certain CNS diseases, including epilepsy. In healthy tissues, B2 receptors are constitutively and widely expressed and B1 receptors are absent or expressed at very low levels, but both receptors, particularly B1, are up-regulated under many pathological conditions. Available data support the notion that up-regulation of B1 receptors in brain areas like the amygdala, hippocampus and entorhinal cortex favors the development and maintenance of an epileptic condition. The role of B2 receptors, instead, is still unclear. In this study, we used two different models to investigate the susceptibility to seizures of B1 knockout (KO) and B2 KO mice. We found that B1 KO are more susceptible to seizures compared with wild-type (WT) mice, and that this may depend on B2 receptors, in that (i) B2 receptors are overexpressed in limbic areas of B1 KO mice, including the hippocampus and the piriform cortex; (ii) hippocampal slices prepared from B1 KO mice are more excitable than those prepared from WT controls, and this phenomenon is B2 receptor-dependent, being abolished by B2 antagonists; (iii) kainate seizure severity is attenuated by pretreatment with a non-peptide B2 antagonist in WT and (more effectively) in B1 KO mice. These data highlight the possibility that B2 receptors may have a role in the responsiveness to epileptogenic insults and/or in the early period of epileptogenesis, that is, in the onset of the molecular and cellular events that lead to the transformation of a normal brain into an epileptic one.

Optimización Interdisciplinaria de Protocolos en Tomografía Computada a partir de la modificación del mA y del control del ruido en la imagen / Interdisciplinary optimization of CT Protocols by modificating mAand controlling image noise

Objetivo: A partir de la determinación de las dosis en los protocolos habitualmente utilizados en estudios de tomografía computada en una institución, se modificaron la menor cantidad de parámetros radiológicos posibles para bajar las dosis impartidas, sin perder la calidad de la imagen. Materiales y métodos: Para la determinación de las dosis en un tomógrafo General Electric Hi Speed - 120kV Helicoidal, se realizaron mediciones utilizando una cámara de ionización tipo lápiz, un dosímetro, fantomas craneal y abdominal de PMMAde 16 cm y 32 cm de diámetro respectivamente, y un fantoma de agua. Con estos elementos se midieron las dosis habitualmente utilizadas y el ruido correspondiente en cada uno de los estudios. Se trabajó con el grupo de técnicos ymédicos de la institución con el objetivo de disminuir la dosis de cada uno de los protocolos utilizados, manteniendo imágenes con calidad diagnóstica. Resultados: Si bien las dosis de los protocolos utilizados por la institución antes de realizado este estudio se encontraban dentro de los rangos reconocidos internacionalmente, se establecieron nuevos protocolos y se pudieron reducir las dosis entre un 20% a un 30%, sin perder calidad ni presentar inconvenientes para el diagnóstico al grupo médico que trabaja en la institución. Conclusiones: Es fundamental realizar actividades de optimización de protocolos en tomografía computada con el objetivo de disminuir la dosis que reciben los pacientes, modificando apropiadamente los parámetros de los protocolos sin perder calidad diagnóstica ni afectar la actividad médica. Esta tarea debe llevarse a cabo en forma interdisciplinaria.

Purpose: To determine the dose frequently used in computed tomography and to modify radiological parameters in order to optimize each protocol according to the dose administered. Materials and Methods: To determine the dose, measurements were made using a pencil ionization chamber, a dosemeter, a 16 cm PMMAhead phantom and a 32 cm abdominal phantom, and a water phantom. AGeneral Electric Hi Speed - Helical 120kV CT scanner was used. The doses usually administered and the noise in each of the studies were measured using these instruments. Agroup of technicians and radiologists at the institution have sought to reduce the dose of each protocol, while maintaining high quality diagnostic images. Results: Although the protocols previously carried out at the institution did not include large doses, the new doses currently used in all protocols could be reduced by 30% on average. Diagnostic quality was not neglected and the slight increase in noise level was harmless to the group of radiologists. Conclusion: CT protocol optimization is essential to reduce the dose administered to the patient. Neither diagnostic quality nor medical activity should be altered by changes in the technique, which must be carried out by a multidisciplinary team.

Epithelial-cell apoptosis and proliferation in Helicobacter pylori-related chronic gastritis.

BACKGROUND: Several studies have shown that Helicobacter pylori infection is associated with enhanced gastric epithelial-cell proliferation, which is thought to be involved in its apparent carcinogenicity. This hyperproliferation is believed to be related to the inflammatory effects of the bacterium. The role of Helicobacter pylori in gastric epithelial apoptosis, however, is less clear. AIM: We attempted to identify the effect of Helicobacter pylori infection on apoptosis in the gastric epithelium and its possible relation to epithelial-cell proliferation and mucosal inflammation. PATIENTS AND METHODS: We studied cell proliferation (via bromodeoxyuridine labelling), apoptosis (using in situ TdT-mediated dUTP-biotin nick end labelling of DNA strand breaks) and mononuclear and polymorphonuclear cell infiltrates (computer-assisted image analysis) in gastric antral biopsies obtained from 37 gastritis patients (20 Helicobacter pylori-positive, 17 Helicobacter pylori-negative). RESULTS: Helicobacter pylori-positives displayed significantly enhanced proliferation within the gastric epithelium that was positively correlated with both acute and chronic inflammatory-cell densities. Apoptotic indexes were similar in both groups and showed no correlation with any of the parameters under consideration. CONCLUSIONS: Enhanced epithelial cell proliferation and an altered distribution of cycling cells within the gastric glands are a common feature of chronic superficial gastritis caused by Helicobacter pylori. In vivo immunohistochemically detected apoptosis of gastric epithelial cells does not seem to be affected by Helicobacter pylori infection. Further study is needed to clarify the effect of this infection on programmed cell death within gastric glands.

[Differential diagnostic problems in metastatic ovarian tumors of intestinal origin. Description of a clinical case]. / Problemi diagnostici differenziali dei tumori ovarici metastatici di origine intestinale. Descrizione di un caso clinico.

The authors report the case of a patient undergoing gynecological surgery to the presence of a right ovarian mass with a maximum of diameter of 23 cm which was found to be a secondary tumour. Histologically analysis showed that this mass was the metastasis of a tumour of intestinal origin, a finding that was then confirmed by flow cytometry. The authors draw attention to the need for patients with suspected ovarian tumour to undergo preoperative diagnostic tests to evaluate the possibility of neoplastic pathology in the gastrointestinal tract in order to optimise surgery and antiblastic treatment.

Neuroimágenes en pseudomeningoceles cervicales postraumáticos / Brachial plexus injuries (pseudomeningocele): CT and MR imaging findings

Los pseudomeningoceles postraumáticos de topografía cervical son la consecuencia de lesiones por tracción del plexo braquial. Se analiza el valor diagnóstico de la mielografía mielotomografía computada, y de la resonancia magnética en 4 casos de pseudomeningoceles postraumáticos. En el estadío agudo se detectó extravasación pararraquídea de contraste intratecal. En el estadio subagudo crónico se observaron pseudomeningoceles ubicados entre C5 y C8. Los partos distócicos y los accidentes de la vía pública resultan las causas más frecuentes de lesiones por tracción del plexo braquial. El daño puede ocurrir en el trayecto extravertebral de las raíces nerviosas (lesión postganglionar), o por avulsión de las emergencias radiculares a nivel medular (lesión preganglionar). Es posible observar arrancamiento radicular sin pseudomeningocele o viceversa. Las neuroimágenes permiten evaluar extensión y topografía de las lesiones traumáticas del plexo braquial con gran utilidad desde el punto de vista pronóstico y terapéutico (AU)

Neuroimágenes en pseudomeningoceles cervicales postraumáticos / Brachial plexus injuries (pseudomeningocele): CT and MR imaging findings

Los pseudomeningoceles postraumáticos de topografía cervical son la consecuencia de lesiones por tracción del plexo braquial. Se analiza el valor diagnóstico de la mielografía mielotomografía computada, y de la resonancia magnética en 4 casos de pseudomeningoceles postraumáticos. En el estadío agudo se detectó extravasación pararraquídea de contraste intratecal. En el estadio subagudo crónico se observaron pseudomeningoceles ubicados entre C5 y C8. Los partos distócicos y los accidentes de la vía pública resultan las causas más frecuentes de lesiones por tracción del plexo braquial. El daño puede ocurrir en el trayecto extravertebral de las raíces nerviosas (lesión postganglionar), o por avulsión de las emergencias radiculares a nivel medular (lesión preganglionar). Es posible observar arrancamiento radicular sin pseudomeningocele o viceversa. Las neuroimágenes permiten evaluar extensión y topografía de las lesiones traumáticas del plexo braquial con gran utilidad desde el punto de vista pronóstico y terapéutico

Transcranial magnetic stimulation in partial epilepsy: drug-induced changes of motor excitability.

Single-pulse transcranial magnetic stimulation (s-TMS) with recording of motor evoked potentials (MEPs) from thenar muscles of both hands was performed on 84 patients with cryptogenic partial epilepsy and 50 healthy controls. We analyzed the cortical latency (CL), central conduction time (CCT), and threshold intensity (TI) required to elicit liminal MEPs at rest. In the patients, CL and CCT were normal, but TI was significantly higher than in the controls. Of the 84 patients, 65 were taking one or more antiepileptic drugs and 19 were untreated. The untreated patients had a significantly lower TI than the treated patients. In the treated patients, the TI increase paralleled the number of drugs taken. Additionally, in 2 subgroups of patients undergoing major modifications of antiepileptic treatment, TI dropped after partial withdrawal of medication and increased following the commencement of therapy. The results suggest that anticonvulsants depress the excitability of human motor pathways in epileptic subjects.

A double-blind, placebo-controlled, pilot trial of thymosin alpha 1 for the treatment of chronic hepatitis C.

A randomized, double-blind, placebo-controlled trial was performed to evaluate the efficacy and safety of thymosin alpha 1 (alpha 1) in treating chronic hepatitis C. Nineteen Italian patients with chronic active hepatitis C, proven by biopsy were randomly assigned to receive a six month course of thymosin alpha 1 (900 micrograms/m2 of body surface area twice weekly) or a placebo. All had HCV-RNA in their serum (by PCR), with serum ALT levels more than double the upper limit of the normal range for at least six months before enrollment. After treatment, patients were followed for an additional six months. All patients completed the trial. One patient treated with thymosin alpha 1, but no patient in the placebo group, normalized serum ALT levels by the end of the treatment. This patient, however, relapsed at the sixth month of the follow up. Overall, there were no significant changes in mean serum ALT levels in either group during the treatment or follow-up period. No patient cleared HCV-RNA. No side effects were reported except for local discomfort at the injection sites, reported by some patients treated with thymosin alpha 1. In conclusion, this regimen of thymosin alpha 1 is not effective in the treatment of chronic hepatitis C.

[Metastatic malignant melanoma of the ovary]. / Melanoma maligno metastatico dell'ovaio.

We report 2 cases of ovarian metastases of malignant melanoma arisen 4 and 6 years after the removal of the primitive epithelial neoplasia. In both cases the ovarian neoplasia was unilateral. Both the macroscopic and the histological aspects of the malignant melanoma were examined. From both cases it was clear that it was a solid neoplasia with histological aspect of wide epithelioid cells with abundant cytoplasm and intracytoplasmatic melanotic pigment. The immunohistochemical results supported positivity for protein S100, vimentine and HMB45, negativity for cytokeratine.

[A mucinous ovarian tumor with foci of anaplastic carcinoma]. / Tumore ovarico mucinoso con foci di carcinoma anaplastico.

One ovarian mucinous cystic tumor that contained a mural solid nodule of anaplastic carcinoma is described in a 35-year-old woman. The epithelial elements consisted of invasive well differentiated mucinous carcinoma. The anaplastic nodule showed some similarities with the cells described in sarcoma and sarcoma-like mural nodules. In favor of a diagnosis of anaplastic carcinoma there are poor circumscription of the nodules, vascular invasion and absence of a prominent inflammatory reaction.

[Epithelial changes associated with invasive epidermoid carcinoma of the vulva]. / Alterazioni epiteliali associate al carcinoma epidermoide invasivo della vulva.

The frequency and meaning of epithelial alterations adjacent to a vulvar invasive carcinoma are examined. In the period from 1986 to 1989, 37 cases of vulvar invasive carcinoma were observed in the Bergamo Hospital (Anatomopathology Institute of Bergamo) in women aged between 54-95 years operated for vulvectomy. The vulvar epithelium adjacent to the invasive carcinoma was studied in order to determine the frequency and the type of associated lesions. Two lesions seem to be meaningfully correlated to the vulvar carcinoma: the lichen sclerosus in 59% of cases and the VIN3 of differentiated type in 35%. The identification of these epithelial lesions can serve to select the cases with increased risk to develop invasive carcinoma.

[Blue nevus of the uterine cervix]. / Il nevo blu della cervice uterina.

Seven cases of blue nevus of the endocervix were examined macroscopically and histologically. The endocervical blue nevus is a rare lesion which can be incidentally found in surgical pieces after hysterectomy in middle-aged women. It looks like a blue-blackish little lesion, located superficially in the submucosa of the endocervix. The immunohistochemical results are positive for Protein S100 of the nevus cells. Due of its localization in the cervical duct the lesion can be hardly identified through colposcopy. Histogenetical hypotheses are finally discussed.

[Diagnosis and treatment of myasthenia gravis. Experience 1974-1992]. / Diagnostico y tratamiento de la myasthenia gravis. Experiencia 1974-1992.

Between 1974 and 1992, 118 patients with Myasthenia gravis (MG) were studied in our Hospital; 92 patients, followed up for longer than 6 months, were surveyed for therapeutical results. Patients were categorized according to Osserman criteria; 22 belonged to group I; 77 to group II; 4 to group III and 15 to group IV. MG predominated in females, the ratio was 1.87:1.0. This predominance was more obvious in patients below 35 years of age (2.68:1.0) than above (1.18:1.0). The greatest prevalence was found at the 3rd decade of life. The assessment of the diagnostic test is as follows: 1) edrophonium test was positive in 97% of 93 patients; 2) supramaximal repetitive stimulation performed in 3 different nerves yielded positive results in 83% of 118 patients. It is worth noting that the test was positive in 92% of patients with generalized MG while only 48% of those with ocular MG displayed positive results; 3) sera antiacetycholine receptor antibodies (ACRA) quantification produced positive results in 88% of the patients with generalized MG and in 33% of ocular MG. Altogether the positivity of this test was 83%; 4) passive transfer of patients sera (25 generalized and 2 ocular MG forms) to mice and measurement of mepp's amplitude in the phrenic-diaphragm in vitro preparation yielded positive results in 100% of the tested cases. Once the diagnosis was achieved, the characteristics of the thymus were studied combining pneumomediastinography and linear tomography (PT) in 60 patients. Thorax Computed tomography (CT) was performed in 51 patients. Of those patients who underwent thymectomy, the coherence between radiological and histological diagnosis for PT was 100% while for CT just 60%. More recently 14 patients were studied by combining both procedures. Reliability of this technique is currently under study. Therapeutical assessment was carried out adscribing patients to 5 different groups according to their response after treatment withdrawal; group 2: Improved, neither symptoms nor signs; group 1: Remission, neither symptoms nor signs while on medication or minimal disability without medication; group 3: Unchanged while on medication; group 4: Worse, patients with more severe or frequent signs and symptoms despite being on treatment, group 5: Death, patients who died due to respiratory failure. Groups 1 and 2 were considered successful while 3, 4 and 5 as unsuccessful. Treatment was based on the administration of anticholinesterase drugs (piridostigmine, neostigmine) in 113 patients. Of these, 35 received those drugs as the only medication of whom 39% obtained successful results. Steroids (methylprednisone) were administered to 75 patients, in 40 cases combined with anticholinesterase drugs.(ABSTRACT TRUNCATED AT 400 WORDS)