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Introduction. Background The aim of the paper is related to our experience defining the diagnostic accuracy of breast elastosonography. Objective. The aim of our study is therefore to define the diagnostic accuracy of breast elastosonography in the differential diagnosis of nodular breast neoformations to improve the characterization of the solid lesion and reduce the number of needle aspiration unnecessary for benign formations. Material and methods. A total of 88 patients were enrolled, who came to the Department with an ultrasound diagnosis of a breast lesion. Each lesion was subjected to mammography and B-mode ultrasonography with an evaluation of size, echogenicity, and vascularization presence or absence. The use of the ultrasound machine and the respective probe has made it possible to make the measurements. All nodules were subjected to ultrasound-guided FNAC. These data were compared with the results of elastosonographic examination. Results. FNAC results were as follows: CIN 1 in 18 nodules, CIN 2 in 22 nodules, CIN 3 in 36 nodules, CIN 4 in 6 nodules, and CIN 5 in 6 nodules. The sensitivity and specificity of elastosonography found in our case series reported values in line with data reported in the literature, confirming the method's high reliability. Conclusions. The elastosonography could become a complementary technique to mammography and ultrasonography in the future, reducing the costs and risks of additional examinations. Therefore, we believe it is essential to contribute with this additional finding to increasingly accredit this pathway and reduce the discomfort to patients of more invasive methods. [ABSTRACT FROM AUTHOR]

This study explored the relationships between self-esteem level and self-esteem variability at work with parameters of diurnal cortisol rhythm, using intensive longitudinal data collected during two consecutive working days from N = 166 workers. Participants self-reported measures of sex, height, weight, self-esteem, neuroticism, and negative events at T0. Then, they answered a single item of self-esteem 4 times per day. Self-esteem variability was assessed by means of the relative variability index approach proposed by Mestdagh et al. (2018). Further, participants collected salivary samples at specific time points for analysis of diurnal cortisol patterns. Self-esteem average levels and a specific form of self-esteem variability were associated with diurnal cortisol parameters. In particular, results showed a relationship between low self-esteem and blunted cortisol awakening response, specifically when low self-esteem levels were stable over time. Moreover, self-esteem variability predicted a lower diurnal cortisol decline and a smaller magnitude of overall cortisol production. Present findings highlight the neuroendocrine correlates of self-esteem level and variation at work, suggesting potential pathways by which short-term variability in self-esteem states may impact hypothalamic-pituitary-adrenal axis functioning and long-term workers' health and well-being., Competing Interests: Conflict of interest The authors declare they have no conflict of interest to disclose., (Copyright © 2022 Elsevier B.V. All rights reserved.)

In order to predict the effects of climate change on polar ecosystems, disentangling mechanisms of nutrient transfer in food webs is crucial. We investigated sources of nutrients in tundra lakes, tracing their transfer through the food web and relating the observed patterns to runoff, snow coverage, and the presence of migratory geese in lake catchments. C and N content (elemental and isotopic) of several food web components including Lepidurus arcticus (Notostraca, at the top of the lake food webs) in 18 shallow Arctic lakes was compared. Terrestrial productivity and geese abundance were key biotic factors that interacted with abiotic variables (snow coverage, lake and catchment size) in determining the amount and origin of nutrient inputs, affecting the trophic interactions among aquatic species, food chain length and nutrient flow in Arctic lake food webs. Decreasing snow coverage, increasing abundance and expansion of the geese's range are expected across the Arctic due to climate warming. By relating nutrient inputs and food web structure to snow coverage, vegetation and geese, this study contributes to our mechanistic understanding of the cascade effects of climate change in tundra ecosystems, and may help predict the response of lakes to changes in nutrient inputs at lower latitudes., (© 2022. The Author(s).)

Background: Ultrasound-guided percutaneous liver biopsy is a standard procedure, but it might be burdened with serious adverse events, mainly hemorrhagic. Literature lacks recent studies taking into account new ultrasound machines, more sensitive to tiny vessels and the evolution of the bioptic technique, including ultrasound guidance in all instances. Hence, the primary aim of this study was to evaluate complication rates of ultrasound-guided percutaneous liver biopsy in a recent population. Secondary aims were to evaluate if the experience of operator is a determinant of risk of complication and to identify other potential risk factors., Methods: We evaluated 800 procedures carried out in one hospital in the period 2010-2018., Results: Complication rate resulted in 4%, with the occurrence of moderate hemorrhagic complications in 0.75%. No cases of severe events or death were registered. A higher risk of bleeding was found to be associated with less experienced operators, while the need to perform multiple needle insertions increased the probability of adverse events., Conclusion: The present findings confirmed ultrasound-guided percutaneous liver biopsy to be a substantially safe procedure with a low risk of overall adverse events and bleeding in particular, especially when performed by expert operators., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Background The aim of the paper is related to our experience defining the diagnostic accuracy of breast elastosonog-raphy., Objective: The aim of our study is therefore to define the diagnostic accuracy of breast elastosonography in the differential diagnosis of nodular breast neoformations to improve the characterization of the solid lesion and reduce the number of needle aspiration unnecessary for benign formations., Material and Methods: A total of 88 patients were enrolled, who came to the Department with an ultrasound diagnosis of a breast lesion. Each lesion was subjected to mammography and B-mode ultrasonogra-phy with an evaluation of size, echogenicity, and vascularization pres-ence or absence. The use of the ultrasound machine and the respective probe has made it possible to make the measurements. All nodules were subjected to ultrasound-guided FNAC. These data were compared with the results of elastosonographic examination., Results: FNAC results were as follows: CIN 1 in 18 nodules, CIN 2 in 22 nodules, CIN 3 in 36 nodules, CIN 4 in 6 nodules, and CIN 5 in 6 nodules. The sensitivity and specificity of elastosonography found in our case series reported values in line with data reported in the literature, confirming the method's high reliability., Conclusions: The elastosonography could become a complemen-tary technique to mammography and ultrasonography in the future, reducing the costs and risks of additional examinations. Therefore, we believe it is essential to contribute with this additional finding to increasingly accredit this pathway and reduce the discomfort to patients of more invasive methods.

(1) Background: The study aims to identify which imaging parameters are necessary for a new correct surgical approach in the study of choanal atresia, and which anatomical findings are essential for correct planning of endoscopic treatment in choanal atresia. (2) Methods: In this retrospective study, 19 patients with choanal atresia had high-resolution multiplanar imaging (14 cases aged ≤1 year and 5 cases aged 1 to 3 years) and 35 patients in the control group similarly distributed by age. Fourteen variables, the most relevant from a surgical point of view, were selected and measured. A comparison was made between the averages of the study group and the different control groups, either directly observed or selected from the literature, using Pearson's correlation. (3) Results: In 14 out of 26 cases, the differences were statistically significant. There was a correlation between the structures assessed, such as choanal height, rostrum height, and age. (4) Conclusions: Thanks to volumetric reformatting, this work identified and provided the clinician with useful information that helped choose the correct surgical approach. Furthermore, it focused on which imaging parameters are necessary to improve the planning of the surgical correction of choanal atresia.

Obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) are in terms of nosography different pathologies, however they share a stress-related physio-pathogenetic component, not yet explored in depth. Therefore, the aim of the present study was to ascertain whether OSA and CSC share a common profile, specifically in cortisol production focusing on the cortisol awake response (CAR), the area under curve (AUC CAR ) and the SLOPE CAR compared with healthy matched controls. Furthermore, standardized self-administered questionnaires were used to identify mental health status related to depression, anxiety and subjective stress perception levels in the study populations. The results showed hypothalamus-pituitary-adrenal (HPA) axis activity anomalies, represented by a flattening CAR in the OSA group and a statistically significant increase in cortisol production in CSC patients at awakening. This disarrangement of the HPA axis activity associated with elevated distress and mental health scores, and its presence in both patients with OSA and patients with CSC, might represent the shared path explaining the stress-related component in these diseases. Further research is needed to investigate the psycho-neuro-endocrinological aspects of OSA and CSC to determine whether psychoeducation on effective stress coping strategies might be of value in improving the quality of life of OSA and CSC patients.

It has been hypothesized that the occurrence of central serous chorioretinopathy (CSC) might be associated with stress. Therefore, our purpose was to investigate the diurnal trajectories of salivary cortisol and α-amylase (α-Amy) - markers of hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) system activity, respectively - and psychological profiles in idiopathic acute CSC. This cross-sectional observational case-control study, which included self-reported psychometric questionnaires, was formally approved by the Ethics Committee. Written informed consent was obtained from all participants. Home diurnal saliva collection was scheduled at several timepoints: at awakening, 30 and 60 min later, and at approximately 13:00 h and 20:00 h. Twenty consecutive male subjects with first-episode CSC attending the outpatient clinic of the Retina Medical Service at the Bietti Foundation were enrolled in the study. Twenty age-matched subjects were recruited as controls. After their initial enrollment, 3 subjects per group were excluded. The production of cortisol and α-Amy and the scores on the negative subscale of the Positive/Negative Affect Schedule, the Daily Hassles and Stress Scale and the Beck Depression Inventory were higher in the CSC group than in the control group. To estimate the diurnal trends in the production of salivary cortisol and α-Amy, an equation was derived for each group of the study population. The equations describing the interpolated regression lines gave salivary cortisol and salivary α-Amy slopes that were determined to be significantly different by Student's t-test (cortisol: t = 3.533, p < .001; α-Amy: t = 2.382, p = .018). Furthermore, the area under the curve with respect to the ground (AUC G ) was calculated to summarize repeated salivary biomarker measurements from 07:00 h to 08:00 h for assessment of the cortisol awakening response (CAR) and the α-Amy awakening response (AR). The diurnal cortisol AUC G and diurnal α-Amy AUC G were calculated from 07:00 h to 20:00 h. The CAR AUC G values of the CSC patients were significantly higher than those of the controls. No differences between the two groups were detected for the α-Amy AR AUC G . The present study adds novel information to the growing body of data suggesting that abnormal diurnal activity of the HPA axis and the SAM system is associated with CSC in susceptible individuals, providing ophthalmologists with a new chronobiological approach for these patients.

Background: Although antitumor necrosis factor alfa (TNFα) agents are widely used to treat patients with inflammatory bowel diseases (IBD) - both Crohn's disease (CD) and ulcerative colitis (UC) - there is still some uncertainty in the cell type expressing TNFα in human ileo-colonic segments., Aims: We investigated the immunohistochemical (IHC) expression of TNFα in the ileo-colonic segments of patients with both active CD and UC, to establish its anatomic and cellular localization in the inflamed sites. Our aim was to identify patients potentially resistant to anti TNFα agents., Patients and Methods: Ileo-colonic slides of complete histological mapping of patients with CD and UC before any treatment was started were obtained, and serial sections assessed for TNFα expression, together with IHC markers for lymphocytes, macrophages, and plasma cells., Results: TNFα was expressed in almost all inflamed segments of IBD patients, albeit with different strength, and was present, in addition to lymphocytes and, to a lesser extent, to macrophages, in plasma cells, where it had a strong positivity, as also demonstrated by colocalization of specific IHC staining. The expression of TNFα was mostly focal in CD patients and more diffuse in UC patients, likely due to the different patterns of inflammation (transmural and mucosal) of the two entities., Conclusions: In IBD, TNFα is strongly expressed also in plasma cells, and it is easily evidenced by conventional IHC techniques. It remains to be established whether this observation might be useful in future to establish in routine biopsy samples whether patients may be responsive to treatments toward this cytokine., (Copyright © 2018. Published by Elsevier Inc.)

The presence and accumulation of plastic waste into the marine environment are well known environmental issues. Microplastics (MPs) end up in sea waters and, due to their hydrophobicity and high surface/volume ratio, POPs tend to sorb and accumulate to their surface. The supralittoral amphipod Talitrus saltator (T. saltator) was selected to study the role of MPs in the transfer of organic pollutants and to investigate if ingested MPs could either transfer contaminants to biota or clean it adsorbing pollutants taken from the diet. T. saltator is an established POPs (Persistent Organic Pollutants) biomonitor in coastal environments and it is able to swallow microplastics in natural condition. Two laboratory experiments were performed and T. saltator was exposed to a labelled polybrominated diphenyl ether ( 13 C-labelled BDE-47) to investigate the opposite gradient role of MPs. X Ray Micro-CT (Micro-Computed Tomography) analyses were also performed on sandhopper samples to evaluate the uptake of MPs via digestive tract. The results showed that MPs ingestion could whether transfer and remove contaminants from T. saltator, indicating a partial balance among positive and negative effects. This study has underlined MP potential double role demonstrating that MP can act both as a carrier and scavenger for the bioaccumulation of organic pollutants (i.e. PBDEs), suggesting that chemicals leaching from MPs could have a limited impact to biota., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: The vestibular acute stress induces reversible alert-like reactions that involve the sympathetic adrenal-medullar system and hypothalamic-pituitary-adrenal axis responses. The present study aimed to evaluate salivary α-amylase and salivary cortisol production in relation with cardiovascular reactivity induced by acute stress in healthy subjects., Material and Methods: Forty-eight young healthy male volunteers were examined under basal conditions and at various times after reaching the maximal nystagmic reaction following air caloric vestibular test. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at the same time as measurement of the salivary α-amylase and salivary cortisol. At the end of the caloric vestibular test session, perceived stress scale questionnaires were administered to measure the self-perceived stress impact induced by the task, and individual scores were compared with those measured on the enrollment day., Results: Following caloric vestibular test-evoked vertigo, salivary α-amylase and cortisol showed distinct trends in their production after acute stress: Student's t-test was used to compare the α-amylase vs cortisol slopes of the respective interpolated regression lines, and the difference was significant (t = -3.283; p<0.001); an increase in salivary cortisol production corresponded with a decrease in the salivary α-amylase concentration. In addition, salivary biomarker modifications were associated with consistent changes in the heart rate, systolic blood pressure and mean arterial pressure., Conclusions: Using the air caloric vestibular test task as a stressor, the present study demonstrated a connection between the acute hormonal stress response to vestibular stimulation and cardiovascular output. However, further research is needed before we can define the potential importance of the consistent cardiovascular activity changes evoked by vestibular stimulation and the possible functional consequences for cardiovascular regulation and orthostatic tolerance in humans.

Animals that use astronomical cues to orientate must make continuous adjustment to account for temporal changes in azimuth caused by Earth's rotation. For example, the Monarch butterfly possesses a time-compensated sun compass dependent upon a circadian clock in the antennae. The amphipod Talitrus saltator possesses both a sun compass and a moon compass. We reasoned that the time-compensated compass mechanism that enables solar orientation of T. saltator is located in the antennae, as is the case for Monarch butterflies. We examined activity rhythms and orientation of sandhoppers with antennae surgically removed, or unilaterally occluded with black paint. Removing or painting the antennae did not affect daily activity rhythms or competence to orientate using the sun. However, when tested at night these animals were unable to orientate correctly to the moon. We subsequently measured circadian gene expression in the antennae and brain of T. saltator and show the clock genes period and cryptochrome 2 are rhythmically expressed in both tissues, reminiscent of other arthropods known to possess antennal clocks. Together, our behavioural and molecular data suggest that, T. saltator has anatomically discrete lunar and solar orientation apparatus; a sun compass, likely located in the brain and a moon compass in the antennae.

Objective: The purpose of this study was to examine the longitudinal relationship between Positivity (POS), defined as a stable disposition to view at experience under a positive outlook, and physical and psychological functioning in a sample of cancer patients immediately after diagnosis and one year later., Methods: A total of 110 patients (40% males) with pulmonary, colorectal and breast cancer, aged 30-75 (M age = 59.62; SD = 10.33), have been prospectively enrolled between 2012 and 2013, at the S. Andrea Hospital in Rome. All patients were previously aware of their diagnosis. A follow-up one year after diagnosis was conducted. We used structural equation modeling in order to analyse the specific effects of POS on functioning impairment from diagnosis to follow up., Results: POS was associated with less functioning impairment both at diagnosis and follow-up assessments. Furthermore, POS level at diagnosis continued to be associated with less functioning impairment one year later, after controlling for its stability., Conclusions: Patients with higher level of POS tended to report less symptoms associated with negative affect such as anxiety and despondency and to preserve their habitual relationships and social roles. POS may act as a basic disposition that sustains patients' efforts to deal efficaciously with severe illness, by complying with medical treatment and using cognitive strategies that enable individuals to cope with concurrent and prospective challenges of illness.

Introduction: Eye fixations can be distributed in three ways: randomly, in clusters, and regularly. However, there is always a continuum among these types, because these spatial patterns are the result of a process evolving over time. The focus of the present work was to study the changes over time observed in the Nearest Neighbor Index (NNI), an index derived from the spatial distribution of eye fixations that has been reported to be sensitive to variations in mental workload. Of particular interest are periodic changes in the ultradian timescale (an ultradian rhythm is a recurrent period or cycle repeated throughout a 24-h circadian day)., Methods: Data from a previously reported experiment were further analyzed using temporal spectral analysis, which is one of the most commonly used techniques for studying measurements collected at regularly spaced intervals of time., Results: An ultradian rhythm with a periodicity between 2 and 15 min was found, which is compatible with results obtained by analyzing reaction times in prolonged vigilance tasks., Discussion: The identification of a periodicity in the allocation of mental resources should be considered in the design of automation support that is dynamically matched to mental workload.

We investigated behavioural responses (locomotor activity and substrate selection) of the amphipod Talitrus saltator after laboratory exposure to different concentrations of Hg, Cu and Cd. Locomotor activity, measured with a microwave radar device, was assessed in animals exposed to contaminated sand and in sandhoppers previously kept for 48 h in contaminated seawater and tested in clean sand. The contents of Hg, Cu and Cd in T. saltator tissues were measured at the end of pre-exposure to contaminated seawater and after 7 days of exposure to contaminated sand. Substrate selection tests were carried out in a binary choice arena. Tests in contaminated sand showed that sandhopper locomotor activity varied in a dose-dependent manner in the presence of Cu and Hg (at lower Hg concentration they were more active during daytime) but did not show significant changes in Cd-exposed animals except for disappearance of the typical circadian activity pattern. Pre-exposure to trace metals in seawater induced a significant decrease of movements for all metals, although the effects varied according to the toxicity of the metal. Trace metals analyses showed that tissue concentrations of Hg, Cu and Cd were related to their concentrations in the test medium. Substrate selection tests showed avoidance of contaminated sand only when sandhoppers were tested in the presence of both concentrations of Hg and at the higher concentration of Cu. In conclusion, locomotor activity and avoidance behaviour of T. saltator could be used as behavioural biomarkers of trace metals exposure.

Objectives: Because the cortisol awakening response (CAR) has received increasing attention as a useful index of adrenocortical activity, the primary objective of this study was to investigate the presence of an awakening response for various salivary biomarkers of adrenocortical activity, including dehydroepiandrosterone-sulphate (DHEA-S), which acts as a cortisol antagonist, and α-amylase, which is a predictor of circulating catecholamine activity. Salivary biological indicators are considered to be valuable markers of hypothalamus-pituitary-adrenal (HPA) axis diurnal activity., Methods: In an attempt to overcome problems associated with non-adherence to the requested sampling protocol, only young, healthy males with a physiological CAR value (defined as a 50% increase in salivary cortisol within 30 min after waking) were included in the study (67 out of 102 who initially enrolled met this criterion)., Results: Our results suggested that, as is already known for cortisol, DHEA-S and α-amylase have significant awakening responses. In addition, daily profile of salivary cortisol, α-amylase and DHEA-S fluctuations were analysed. Significant correlations were found between salivary cortisol, DHEA-S and α-amylase levels. The results showed that cortisol and DHEA-S concentrations were inversely correlated with α-amylase levels., Conclusion: This correlation confirmed the distinctiveness of the two regulatory systems: salivary cortisol and DHEA-S concentrations reflect the activity of the HPA axis, whereas α-amylase activity is more closely related to sympathetic activity. In addition, the present study emphasizes the potential value of saliva collection (which is both easy and stress-free) in monitoring changes of adrenal function, confirming that multiple sampling (especially within 1 h after awakening) is necessary to reliably characterise biomarker activity when investigating neuroendocrine changes under various conditions.

The sandhopper Talitrus saltator has an endogenous activity rhythm with a circadian periodicity. It is well known for its ability to compensate for the apparent movement of the sun during its migrations along the sea-land axis of the beach. Both chronometric mechanisms are entrained by the natural LD photoperiod. Using actographic recordings and tests of solar orientation of individuals kept under an LD 12:12 clock-shifted cycle, after 1-13 days of treatment, we demonstrate that the timing mechanism of activity rhythm and the chronometric mechanism underlying the sun compass are the same.

It was recently reported that the circadian clock machinery controls plasma levels of factor (F) VII, the serine protease triggering blood coagulation. Here, by exploiting the mouse model, this study showed that variations of photoperiod (i.e., winter or summer conditions or simulated chronic jetlag conditions) have a strong impact on plasma FVII activity levels. Under conditions mimicking summer or winter photoperiods, FVII activity showed a clear 24 h rhythmicity. Interestingly, mean daily FVII activity levels were significantly reduced in mice exposed to summer photoperiods. Behavioral activity rhythms under both photoperiods were synchronized to LD cycles, and the amount of activity per 24 h was comparable. The authors also investigated the influence of chronic jetlag (CJL) on the FVII activity rhythms, which can be easily mimicked in mice through continuous abrupt shifts in the lighting schedule. The exposure of mice to simulated CJL of either consecutive westward or consecutive westward and eastward flights for 15 days did not abolish the behavioral activity rhythms but was associated with a period significantly different from 24 h. Intriguingly, both types of CJL exerted a strong influence on FVII activity rhythms, which were virtually suppressed. Moreover, the mean daily FVII activity was significantly lower in the CJL than in the winter photoperiod condition. Taken together, these findings in mice provide novel insights into the modulation of FVII activity levels, which might have implications for human pathophysiology.

Background: The general or spontaneous motor activity of animals is a useful parameter in chronobiology. Modified motion detectors can be used to monitor locomotor activity rhythms. We modified a commercial microwave-based detection device and validated the device by recording circadian and ultradian rhythms., Methods: Movements were detected by microwave radar based on the Doppler effect. The equipment was designed to detect and record simultaneously 12 animals in separate cages. Radars were positioned at the bottom of aluminium bulkheads. Animal cages were positioned above the bulkheads. The radars were connected to a computer through a digital I/O board., Results: The apparatus was evaluated by several tests. The first test showed the ability of the apparatus to detect the exact frequency of the standard moving object. The second test demonstrated the stability over time of the sensitivity of the radars. The third was performed by simultaneous observations of video-recording of a mouse and radar signals. We found that the radars are particularly sensitive to activities that involve a displacement of the whole body, as compared to movement of only a part of the body. In the fourth test, we recorded the locomotor activity of Balb/c mice. The results were in agreement with published studies., Conclusion: Radar detectors can provide automatic monitoring of an animal's locomotor activity in its home cage without perturbing the pattern of its normal behaviour or initiating the spurt of exploration occasioned by transfer to a novel environment. Recording inside breeding cages enables long-term studies with uninterrupted monitoring. The use of electromagnetic waves allows contactless detection and freedom from interference of external stimuli.

Modified motion detectors can be used to monitor locomotor activity and measure endogenous rhythms. Although these devices can help monitor insects in their home cages, the small size of the animals requires a very short wavelength detector. We modified a commercial microwave-based detection device, connected the detector's output to the digital input of a computer, and validated the device by recording circadian and ultradian rhythms. Periplaneta americana were housed in individual cages, and their activity was monitored at 18 degrees C and subsequently at 28 degrees C in constant darkness. Time series were analyzed by a discrete Fourier transform and a chi-square periodogram. Q10 values and the circadian free-running period confirmed the data reported in the literature, validating the apparatus. Moreover, the spectral analysis and periodogram revealed the presence of ultradian rhythmicity in the range of 1-8 h.

The possibility of an intraventricular pressure gradient in patients with aortic stenosis is well known: this entity is associated with a high risk of postoperative complications. The authors carried out a Doppler echocardiographic study of flow in the left ventricle in 51 patients who had recently undergone valve replacement for severe aortic stenosis (valve area < 0.75 cm2). Before surgery, only one patient had significant acceleration of intraventricular systolic flow attaining 3.8 m/s (maximum pressure gradient of 60 mmHg). After surgery, maximum intraventricular systolic velocities of over 2.5 m/s with a typical end systolic peak were observed in 8 patients under basal conditions (gradients of 30 to 115 mmHg), and in 7 others after inhalation of amyl nitrite. Pulsed spectral and color Doppler flow mapping showed that the highest velocities were located at the mitral papillary muscle level. In addition, these patients had significant reduction in cavity size. Only one patient had systolic anterior motion of the anterior mitral leaflet with septal contact. Left ventricular dimensions were measured by TM echocardiography. High intraventricular velocities seemed to be significantly related to the smallest ventricular dimensions, the thickest ventricular walls and the smallest preoperative aortic valve surface area. The highest intraventricular pressure gradients-disappeared with betablocker therapy (4 cases), after correction of hypovolemia (1 case), after drainage of large pericardial effusions (2 cases) or spontaneously (1 case). This study confirms the relatively high prevalence of dynamic intraventricular gradients after surgical cure of aortic stenosis and the value of Doppler echocardiography for the avoidance of certain drugs (inotropic agents, vasodilators, diuretics), which could aggravate the hemodynamic abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)