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Main text At its meeting in October 2014, the EURAMET TC for Length, decided upon a key comparison on the calibration of diameter gauges, named EURAMET.L-K4.2015. Twenty National Metrology Institutes and one Designated Institute from Europe, Asia and South America participated in this comparison, which was carried out in two parallel groups. Twelve laboratories from EURAMET participated in group 1, while ten laboratories from EURAMET and two laboratories from GULFMET and SIM participated in group 2. To provide the link three laboratories, CEM, INRIM and METAS, participated in both groups and in the key comparison CCL-K4.2015. Two sets of gauges consisting of two rings, two plugs and a sphere were circulated in parallel in the two groups, the circulation started in November 2016 and completed in February 2018. The reference value (KCRV) was calculated on a gauge-per-gauge basis as the weighted mean of the submitted results of the diameter, roundness and straightness measurements. With group 1, inconsistent results (En> 1) gave a number of 5 out of 60 independent results for diameter and 7 out of 77 for roundness, while with group 2 a number of 6 out of 59 for diameter. These numbers are reflected in the comparison with reference values, while it is worth noting that with the two plugs of 100 mm diameter a decrement of 2 inconsistent results is achieved by introducing an uncertainty contribution related to the apparent change of length of these gauges. Furthermore, the KCRV was calculated by linking the two groups for the diameter of all the twin gauges and for the roundness of the twin spheres. When compared to those calculated independently for each group, minor changes of the KCRVs and associated uncertainties are observed from linking the groups. Consistency checks are satisfied for most of the gauges with the exception of the plugs 100 mm, which suffer from an apparent change in length during the circulation. With the linking, inconsistent results gave a number of 12 out of 119 independent results for the diameter and 1 out of 21 for roundness of the sphere. The comparison results help to support the calibration and measurement capabilities (CMCs) of the laboratories, while recommendations and actions were agreed with those having inconsistent results. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database https://www.bipm.org/kcdb/. The final report has been peer-reviewed and approved for publication by the CCL, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Resume Les fractures de fatigue sont des pathologies frequentes. Cependant, le retard diagnostique de ces lesions n’est pas rare, source de complications potentielles. Nous rapportons le cas d’un patient marathonien ayant presente une fracture de fatigue du col du femur avec un tableau clinique initial atypique.

Background In chronic inflammatory rheumatic diseases, comorbidities such as cardiovascular diseases and infections are more frequently observed than in general population and are suboptimally prevented, screened and managed.1–4 A nurse-led programme demonstrated the short-term benefit on management of comorbidities in rheumatoid arthritis patients.5 EULAR recently published points to consider for reporting, screening, and preventing specific comorbidities in chronic inflammatory rheumatic diseases in daily practice. Objectives Our objective was to screen and report comorbidities in chronic inflammatory rheumatic diseases patients in daily practice according to recent EULAR guidelines. Methods We included patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis from November 2016 to November 2017 in a retrospective monocentric study in the rheumatology department of the Grenoble Alpes Teaching Hospital. Data regarding comorbidities were collected in a standardised multidisciplinary consultation with a rheumatologist, a specialised nurse and a hospital pharmacist, according to EULAR and French Society of Rheumatology guidelines. Data concerning cardiovascular diseases, infectious comorbidities, cancer screening, and osteoporosis were collected. Data about the rheumatic disease including treatment and disease activity were recorded. Adherence was analysed in consultation by the pharmacist. Recommendations were notified to the patients, his general practitioner, and rheumatologist on a standardised letter. Data were analysed as mean/SD if appropriate and percentage. Results We included 101 patients, 43 patients had rheumatoid arthritis, 45 had spondyloarthritis, and 13 were diagnosed with psoriatic arthritis. The mean age was 49,6 years old.14,9 50 patients were followed in the hospital, 39 were followed by private practitioners and 12 were followed by both. All patients were treated with bDMARDS. In average, patients received 2,3 (SD 1,6) different biologic treatments. In our total population, 55,5% had influenza vaccination >1 year ago, 42,6% had an appointment to the dermatologist >1 year ago, 25% of the women between 50 and 75 years old had a mammography >2 years ago and 27,3% of women>50 years old with FRAX above threshold were not treated for osteoporosis. Moreover, 60,5% of patients with rheumatoid arthritis had a Heart Score >1% and 45,6% in the total population. Conclusions Our monocentric study confirmed that comorbidities are frequent and suboptimally prevented and managed according to the EULAR point to consider. An evaluation of the efficiency of our standardised consultation and intervention is necessary. References [1] Baillet A, et al. Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: a EULAR initiative. Ann Rheum Dis. 2016, 75(6):965–73 [2] Dougados M, et al. COMORA. Ann Rheum Dis. 2014, 73(1):62–8 [3] Gossec L, et al. Collection and management of selected comorbidities and their risk factors in chronic inflammatory rheumatic diseases in daily practice in France. Joint Bone Spine. 2016, 3(5):501–9 [4] Molto A, et al. ASAS-COMOSPA study. Ann Rheum Dis. 2016, 75(6):1016–23 [5] Dougados M, et al. COMEDRA. Ann Rheum Dis. 2015, 74(9):1725–33 Acknowledgements M. Clay Disclosure of Interest None declared

New World thrushes in the genus Catharus are small, insectivorous or omnivorous birds that have been used to explore several important questions in avian evolution, including the evolution of seasonal migration and plumage variation. Within Catharus, members of a clade of obligate long-distance migrants (C. fuscescens, C. minimus, and C. bicknelli) have also been used in the development of heteropatric speciation theory, a divergence process in which migratory lineages (which might occur in allopatry or sympatry during portions of their annual cycle) diverge despite low levels of gene flow. However, research on Catharus relationships has thus far been restricted to the use of small genetic datasets, which provide limited resolution of both phylogenetic and demographic histories. We used a large, multi-locus dataset from loci containing ultraconserved elements (UCEs) to study the demographic histories of the migratory C. fuscescens-minimus-bicknelli clade and to resolve the phylogeny of the migratory species of Catharus. Our dataset included more than 2000 loci and over 1700 variable genotyped sites, and analyses supported our prediction of divergence with gene flow in the fully migratory clade, with significant gene flow among all three species. Our phylogeny of the genus differs from past work in its placement of C. ustulatus, and further analyses suggest historic gene flow throughout the genus, producing genetically reticulate (or network) phylogenies. This raises questions about trait origins and suggests that seasonal migration and the resulting migratory condition of heteropatry is likely to promote hybridization not only during pairwise divergence and speciation, but also among non-sisters.

Introduction/Background We present a documented observation showing the existence of a biased representation of verticality in PD, resulting in a severe retropulsion and recurrent falls, and a camptocormia likely compensatory. A specific rehabilitation led to a spectacular result. Material and method A 68-year-old patient with Parkinson's disease fall backward 3 times a day. He presented an important camptocormia. There were no spinal muscular amyotrophy neither spinal canal stenosis on the lumbar tomography. The Postural vertical (PV) was tilted backward at −9° (normal for this age = −1.1° ± 1.4°). Our interpretation was that retropulsion was due to a backward tilt of the internal model of verticality, which led to recurrent falls. Camptocormia was mainly compensatory. The patient underwent an intensive rehabilitation program of 15 days including: erectus spinae muscles strengthening, realization of postural exercises thanks to mirror. A modulation of the internal model of verticality was undertaken on the basis of theoretical arguments (synthesis of graviceptive vestibular and somatosensory information) and on experimental studies: 30° forward tilted posture on a tilt table, bodyweight support walking, vibration of tibialis anterior's tendons. PV measurements before and after these technics confirmed the relevance of this approach. Results After 2 weeks the results were spectacular ( Table 1 ): posture spontaneously more upright (35 mm gain in C7 position), attenuated retropulsion (objectively assessed using the BDS), and normalization of PV = 0.1°. At discharge the patient was instructed to daily perform the exercises taught. Reviewed at M2 and M6, he was very satisfied with a dramatic reduction of fall frequency and the feeling to stand better. Conclusion This observation brings a new insight about the nature of some postural disorders in PD, and suggests the interest of a novel rehabilitation dedicated to the sense of upright.

BACKGROUND The optimal therapeutic approach for patients with Hodgkin's disease (HD) and human immunodeficiency virus (HIV) infection is unknown. In an attempt to improve the results obtained with standard chemotherapy and to decrease the occurrence of opportunistic infections (OI) during chemotherapy and follow-up observed in a previous experience, the authors designed a prospective combined antineoplastic and antiretroviral approach. METHODS Between March 1989 and March 1992, 17 consecutive previously untreated patients (median age, 30 years) with HD and HIV infection were enrolled. They had Stage III and IV or Stage I and II disease with adverse prognostic factors. The median CD4+ cell count was 184/microliters. Patients were stratified in two groups and treated accordingly. Group A was made up of patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of less than 3 and without OI. These patients received epirubicin 70 mg/m2 intravenously on day 1, bleomycin 10 mg/m2 IV on day 1, and vinblastine 6 mg/m2 IV on day 1 (regimen EBV). Group B was made up of patients with PS of 3 or greater or previous OI who had received a 50% reduced dose of epirubicin and vinblastine and a full dose of bleomycin. Courses were repeated every 21 days for six cycles. Zidovudine was given at the dose of 500 mg/day from the beginning of chemotherapy in Group B and after the third cycle in Group A. RESULTS Overall, 14 of 17 (82%) patients had an objective response and 9 of 17 (53%) achieved a complete remission (CR) of disease for a median duration of 20 months. Toxicity was moderate with Grade 3-4 leukopenia in eight patients and Grade 3 thrombocytopenia in one patient. Thirteen of 17 patients received zidovudine as planned with a median duration of 9 months. Only one patient had OI during or after chemotherapy (median follow-up, 11 months). No worsening of HIV markers during the combined therapy was seen, with the median CD4+ cell count before and after therapy being 184/microliters and 203/microliters, respectively. The median survival time was 11 months, with an actuarial survival rate of 48% at 36 months. The median survival time for the nine patients with CR has not been reached at the time of this analysis. CONCLUSIONS These results revealed the feasibility and the activity of the combination of EBV regimen and zidovudine. Objective response rate seems similar to those previously observed in patients receiving standard chemotherapy, but only one patient had OI, and this compares favorably with the 16 OI observed in 28 patients treated with standard chemotherapy (6% versus 57%) in the authors' previous experience. Thus, it seems that the addition of antiretroviral therapy to the EBV regimen decreased the occurrence of OI during chemotherapy or follow-up.

En esta investigación nos interrogamos por las formas de participación de la cultura material en los procesos de construcción de identidades sociales en la segunda mitad del primer milenio de la era en el Valle de Ambato –Catamarca, Argentina-. Este interrogante se vincula a problemáticas mayores, que desde hace al menos 30 años el Proyecto Arqueológico Ambato viene desarrollando en la zona, relacionadas con el surgimiento en el valle -alrededor del cuarto o quinto siglo del primer milenio- de relaciones sociales con mayor grado de exclusión que las formas organizativas anteriores. Estas nuevas relaciones habrían producido la institucionalización de desigualdades sociales inéditas para la región y la época. Concretamente, en este contexto, nos interesa dilucidar las formas específicas en que la cultura material participó en la constitución, legitimación y reproducción de la identidades sociales surgidas como parte del proceso de transformación social mencionado. El interés de focalizarnos en la participación de la cultura material en los procesos de construcción de identidades responde a la inquietud de que la misma no sólo conforma el registro visible con el que trabajamos los arqueólogos, sino que puede ser considerada un elemento activo –y podríamos plantear un “agente” más- de dicho proceso. Esta posición nos permite marcar ciertas limitaciones, pero también retomar los aportes del lugar históricamente ocupado por la cultura material en las investigaciones que se abocaron a estudiar los procesos de cambio señalados en el Valle de Ambato. La misma fue considerada como reflejo de la influencia de pueblos evolucionados de los Andes Centrales o como indicadora de procesos locales de cambios. Por otro lado, dentro de un panorama teórico más general, nos permite discutir aquellas posiciones esencialistas, materialistas y constructivistas de la constitución de las identidades y su relación con las cosas, en las que los objetos y sujetos quedaron ubicados en laderas opuestas, permitiéndonos establecer ciertos puentes entre ambos. En este sentido, extraemos a los objetos de aquellos marcos según los cuales éstos se transforman en espejos de esencias reificadas –la cultura en las posiciones normativas-; de aquellos donde éstos adquieren sentido sólo en relación al plexo funcional donde participan, siendo sólo productos de necesidades de los individuos que los preceden –posiciones materialistas vinculadas a la Nueva Arqueología- y de aquellos enfoques que pretenden encontrar al sujeto detrás del artefacto, siendo este último solo producto de un red intersubjetiva de significados -visiones constructivistas-. Retomando la serie de investigaciones producidas recientemente en el Valle de Ambato donde la cultura material fue adquiriendo cada vez más un rol activo, planteamos una posición alternativa donde sujetos y objetos se coproducen activamente en el tiempo. Así, a nivel metodológico realizamos una inversión de perspectiva: los objetos son analizados como si fueran personas con particulares trayectorias biográficas y los sujetos se analizan como si fueran artefactos, haciendo énfasis en la producción del cuerpo. Ambas perspectivas por sí solas resultan insuficientes para comprender los procesos de construcción de identidades sociales y su vinculación con la cultura material, por lo que finalmente, estas dos perspectivas invertidas son imbricadas construyendo una serie de cartografías donde se observan los encuentros, conjunciones y diseminaciones de estas biografías y los sujetos a los cuales dichos objetos se vincularon. Un conjunto de objetos son los protagonistas de las biografías que reconstruimos: vasijas de cerámica. Objetos que se mueven por distintas manos y contextos y de esta forma acumulan determinadas historias y diferentes significados sociales. Así, al ir delineando las trayectorias biográficas reconstruidas de estas vasijas iremos transitando por diferentes espacios, escalas y contextos a lo largo de toda la temporalidad señalada. Las trayectorias biográficas trazadas de estos objetos, son entrecruzadas con las formas materiales en que las personas fueron producidas. Particularmente hacemos hincapié en el cuerpo como ámbito de acción central, tanto en un sentido genético (socialización) como crónico (práctica cotidiana) de la subjetivación. Las cartografías reconstruidas nos marcan las sendas seguidas por estos objetos y sujetos en el espacio social del Valle de Ambato a lo largo de la temporalidad abarcada, y de esta forma nos permiten mostrar de qué manera en el valle las múltiples agencias — humanas y no humanas— continuamente se constituyeron unas a otras en redes de percepción y acción, haceres y saberes, representaciones y prácticas. Por otro lado el análisis de las cartografías reconstruidas en el largo término nos permite comprender de qué forma las mismas lograron producirse y reproducirse a lo largo de al menos siete siglos., Facultad de Ciencias Naturales y Museo

purpose: An increased risk of high-grade non-Hodgkin's lymphoma is observed in patients who are seropositive for human immunodeficiency virus (HIV). Treatment of such patients is complicated by their underlying acquired immunodeficiency syndrome (AIDS). Intensive strategies such as those used in non-HIV-related lymphoma may be poorly tolerated. However, patients without severe AIDS may derive significant benefits from such an approach. In a prospective multicenter study, treatment outcomes were assessed in 141 cases of HIV-seropositive lymphomas submitted to aggressive chemotherapy. patients and methods: Adult patients with lymphoma with a performance status less than 3 and no active opportunistic infection were consecutively treated with three cycles of doxorubicin 75 mg/m2, cyclophosphamide 1,200 mg/m2, vindesine 2 mg/m2 for 2 days, bleomycin 10 mg for 2 days, and prednisolone 60 mg/m2 for 5 days (ACVB). This treatment was followed by a consolidation phase of high-dose methotrexate plus leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH84). Central nervous system prophylaxis with intrathecal methotrexate was routinely used. Zidovudine maintenance therapy was started after chemotherapy. Ninety-three patients had high-grade lymphomas (59 Burkitt's type) and 48 had intermediate-grade lymphomas. Disseminated stage III-IV was present in 86 patients, meningeal involvement in 29, and bone marrow infiltration in 30; 62 patients had more than 2 extranodal localizations. Lactate dehydrogenase levels were above the normal value in 95 cases. The median CD4-positive lymphocyte count was 227 X 106/L. results: Eighty-nine patients (63%) achieved complete remission (CR) and 19 (13%) partial remission, whereas 13 did not respond and 20 (14%) died during the course of ACVB, 8 of them from progressive disease. With a median follow-up of 28 months, median survival and disease-free survival were 9 and 16 months, respectively. Median survival for nonresponders was 5 months; 23 patients died of opportunistic infections while in persistent CR. In multivariate analysis, four factors were strongly associated with shorter survival: (1) CD4 count less than 100 × 106/L, (2) performance status greater than 1, (3) immunoblastic lymphoma, and (4) prior AIDS. In the absence of all risk factors, the probability of survival at 2 years was 50%. conclusion: In a selected group of HIV-related lymphomas, intensive chemotherapy with LNH84 is feasible and yields a high CR rate. Survival is short due to death from HIV-related infections; however, in a subgroup of patients without adverse prognostic factors, long-term remission was observed.

Ninety-two cases of Hodgkin's disease (HD) in patients with HIV infection have been collected by the Italian Cooperative Group on AIDS and Tumors (G.I.C.A.T.). In accordance with the epidemiology of HIV infection in Italy, 82% were intravenous drug users (IVDU), 8% homosexual men, 5% IVDU+homosexuals and 5% heterosexuals. At diagnosis of HD, 16% had AIDS, 20% AIDS related complex (ARC), 33% persistent generalized lymphadenopathy (PGL) and 31% were asymptomatic. Fifty-three percent of the patients had stage IV disease and 70% mixed cellularity and lymphocytic depletion. Forty-six patients were treated with MOPP or MOPP [symbol: see text] ABVD +/- radiotherapy (zidovudine was not given) with complete remission (CR) in 54% and partial remission (PR) in 46% of the patients. Fifty-six percent of these patients developed opportunistic infections (OI) during therapy or follow-up. Sixteen patients were treated with epirubicin, bleomycin and vinblastine (EBV) and concomitant zidovudine, with CR in 44% and PR in 38%. However, only one of these patients developed OI during therapy or follow-up. The clinico-pathological features and natural history of HD in HIV setting are peculiar and quite distinct from those observed in HD in the general population. Better combined chemotherapy and antiretroviral therapy is needed in order to ameliorate the CR rate and decrease the OI in patients with HIV infection and HD.

Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, NovaraDear Sir,Kaposi’s sarcoma-associated herpesvirus/human herpesvirus8 (KSHV/HHV-8) is involved in the pathogenesis of Kaposi’ssarcoma (KS) and 2 lymphoproliferative diseases, primaryeffusion lymphoma (PEL) and the plasmablastic variant ofmulticentric Castleman’s disease (MCD). PEL is defined as aliquid-phase lymphoma harboring monoclonal rearrangementsof immunoglobulin (Ig) variable genes or, more rarely, of T-cell receptor (TCR) genes. As a rule, these elements are usedfor PEL diagnosis together with the demonstration of HHV-8infection of the tumor clone. However, as pointed out by Bou-langer and colleagues in the 1 July 2005 issue of the Interna-tional Journal of Cancer

The Inter-American Metrology System (SIM) has carried out a key comparison of diameter measurements. The artifacts studied were four ring gages and four plug gages. The measurand was a specified diameter of each gauge at 20 °C and corrected to zero force. This report presents results obtained by the individual participants and an analysis of the results and their uncertainties. The results are in good agreement with one another, well within the range expected based on the measurement uncertainties claimed by the participants. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCL, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

A parallel sensing scheme for multi-level non-volatile memories (ML NVM) is presented. A single comparison step is used to achieve high sensing speed. To this purpose, a high-speed low-voltage current comparator is used. Experimental evaluations on a 0.6-/spl mu/m EPROM test chip demonstrated the feasibility of 4-level-cell NV MLMs from the sensing standpoint. A read throughput of 12 MB/s is achieved with the proposed 4-level-cell memory architecture. Multi-level storage is achieved by using a program-verified scheme to obtain tight cell threshold voltage distribution. Overall sensing area overhead for a 32-Mbit chip is in the range of 1%.

The aim of this paper was to examine the present situation of adolescents admission for respiratory emergency, management of these patients, identify strategies for the best therapeutic options and better collaboration.We have gathered data of adolescent patients who were referred to the Emergency Unit of "G. Gaslini" Children's Hospital, and "San Martino" Hospital in Genoa and to the Intensive Care Unit of both Hospitals and to the Emergency Service 118 in Liguria district. Respiratory emergency in adolescence is a rare condition and it is usually due to a poor control of respiratory chronic diseases, i.e. respiratory distress in patients with asthma.We found that there is an increased number of respiratory emergencies because of psychological problems, drugs addiction, multiple trauma; in other words, we had an increased number of admissions due to behavioural problems. Temporary in-patients care has been showed to be the best therapeutic option after the admission in the Emergency Unit.In conclusion, adolescent patients need to be hospitalized, but appropriate spaces and structures need to be found either in pediatric or adult Hospitals and qualified personnel must be trained.

Multicentric Castleman's disease (MCD) and primary effusion lymphoma (PEL) are two B-cell lymphoproliferative diseases associated with Kaposi's sarcoma-associated herpes virus/human herpesvirus-8 (KSHV/HHV-8). Although MCD is considered a prelymphoma state, it is not known whether a pathogenetic link exists between MCD and PEL. This paper reports the clinico-pathological features of four cases of PEL (two pericardial, one pleural, and one peritoneal) developing in the context of HIV-associated MCD. Effusions, lymph nodes, spleen, and additional tissues from three autopsies were examined for morphology/immunophenotype, search for HHV-8 DNA, and assessment of immunoglobulin heavy chain gene (IgH) configuration using polymerase chain reaction (PCR)-based techniques. MCD and PEL samples contained HHV-8 DNA. Clonal IgH rearrangements were detected only in PEL, whereas MCD tissues were polyclonal. Light-chain immunostaining confirmed B-cell clonality in PEL (two lambda, one kappa, one not tested) and polyclonality in MCD. The autopsies revealed different morphological variants of visceral KS and multi-organ atypical infiltrates exhibiting immunoblastic/plasmablastic features reminiscent of PEL morphology, with a restriction of lambda-positive cells. In two cases, using microdissection and IgH PCR analysis, multiple/discrete bands were found in the infiltrates, compatible with polyclonality/oligoclonality. The case showing an oligoclonal IgH ladder contained a rearrangement of identical junctional size to the PEL clone; however, further analysis with PEL-derived clonotypic primers and sequencing of PCR products showed no amplification and nucleotide diversity, respectively, indicating that the two B-cell populations examined were clonally unrelated. These data show that MCD and PEL may co-exist in HIV-infected patients, suggesting a relevant association between these two HHV-8-related disorders. Although a definite clonal relationship between MCD and PEL was not demonstrated, it is hypothesized that in some MCD cases, within expanded polyclonal B-cell populations secondary to HHV-8 infection, clonal expansions may occur that localize into a body cavity, i.e. PEL.

There is very little experience reported in the literature on the treatment of patients with relapsed or resistant human immunodeficiency virus-related non-Hodgkin's lymphoma (HIV-NHL). We performed a prospective study to evaluate the feasibility and activity of a second-line chemotherapy regimen consisting of etoposide, mitoxantrone, and prednimustine (VMP) in this setting.Twenty-one patients were consecutively treated. Thirteen patients were resistant to primary chemotherapy and 8 patients had relapsed after their first complete remission (CR). Etoposide and prednimustine were both given orally at doses of 80 mg/m2 daily for 5 days, and mitoxantrone was given intravenously at a dose of 10 mg/m2 on Day 1; the cycles were repeated every 3 weeks.Nineteen of 21 patients were evaluable for response. The median number of cycles administered was 2 (range, 1-5). A CR occurred in 5 of 19 patients (26%; exact 95% confidence interval; 9-51%). Four of these CRs were observed in the 7 evaluable relapsed patients. Of 45 cycles evaluable for toxicity, severe neutropenia (500/microL) occurred in 19 (42%) cycles and severe thrombocytopenia (25,000/microL) in 6 (13%) cycles. One toxic death occurred due to sepsis during neutropenia. The overall median survival was 2 months (range,1-13 months); the median survival time for the 5 patients with CR (13 months; range, 6-13 months) was statistically significantly longer than that observed in patients without CR (2 months; range,1-7 months).Although the overall prognosis of patients with resistant or relapsed HIV-NHL is very poor, palliative therapy with VMP can be effective and relatively safe in the latter group. Prolonged survival has been observed in some patients who had relapsed after initial chemotherapy.

We report the clinical experience in 451 patients with HIV related non-Hodgkin's lymphoma (HIV-NHL) observed within the Italian Cooperative Group on AIDS and Tumors (GICAT: Gruppo Italiano Cooperativo AIDS e Tumori), a significant number of them being treated at the Aviano Cancer Center (ACC). High grade histology according to the Working Formulation, stages III-IV and B symptoms were detected in the majority of patients. The median survival was 6 months. Based on the Cox model, three factors appeared to influence survival: advanced stage, treatment received and failure to obtain complete remission (CR). In another study aimed at comparing between chemotherapy with or without G-CSF it was shown that G-CSF significantly reduced white blood cells (WBC) nadir duration, the mean delays between cycles, the mean hospitalization time for toxicity per patient treated, without increasing significantly the overall costs. Furthermore, of 77 GICAT patients treated at the ACC with (group A) or without (group B) long-lasting CR, performance status and the mean CD4+ cell count at time of NHL diagnosis were the only parameters of statistical relevance. Based on our data HIV related NHLs are highly aggressive malignancies which are associated with a poor prognosis per se, and because of the underlying HIV infection. Long-term survivals and possible cures can, nonetheless, be obtained in a subgroup of patients, who have a better performance status and a less advanced immune dysfunction related to HIV infection.

A case of intravenous catheter-related cutaneous aspergillosis and Aspergillus fumigatus fungemia in an HIV-positive patient with Burkitt-cell acute lymphocytic leukemia is reported. The patient developed pulmonary aspergillosis with a rapidly fatal outcome despite recovery from neutropenia and improvement of the underlying malignancy. The unusual severity and rapid spread of the infection, despite normal neutrophil count and prompt antifungal therapy, suggest that HIV-related immunocompromise might play a role in the impairment of host defences against Aspergillus infection. Thus catheter-related cutaneous aspergillosis could lead to a severe deep-seated infection in HIV-positive patients.

Summary Fusarium is an ubiquitous fungus commonly found in soil and on plants. Human infection usually occurs as a result of inoculation of the organism through the body surface, thus causing skin infection, onychomycosis, keratitis, endophthalmitis and arthritis. Dissemination may occur in subjects with underlying immunodeficiency. Among immunocompromised hosts, Fusarium sp. is an emerging pathogen in neutropenic patients. To our knowledge, since 1973, when the first disseminated fusariosis in a child with acute leukemia was reported, about 80 new cases have been reported, mainly occurring in patients with haematologic malignancies. Specific portals of entry are not well understood, nevertheless the respiratory tract, colonised gastrointestinal tract, onychomycosis, disrupted skin barrier and central venous catheter have been reported as entry sites of deep seated Fusarium infections. Fever, positive blood cultures, severe myalgias, disseminated ecthyma gangrenosum-like skin lesions, ocular symptoms and multiple-organ-system involvement are distinctive features in most cases of disseminated fusariosis. The prognosis is very poor with death generally following despite antifungal therapy, unless an increase in the white blood cell count occurs. All available antifungal drugs show a low activity against the various species of Fusarium . Nevertheless, amphotericin B seems to have the highest in vitro activity and, even if it does not appear to be effective in persistently neutropenic patients, it should be currently considered to be the treatment of choice.

The case of an adolescent male with short stature and partial growth hormone deficiency who developed a slipped capital femoral epiphysis during the treatment with recombinant growth hormone is reported in this paper. Our patient started GH therapy with recombinant growth hormone at the dose of 15 U/m2/week administered subcutaneously three times a week. After 6 months of GH therapy there was a satisfactory response to the therapy and his growth velocity improved significantly. Unfortunately the patient had pain of the left hip which was exacerbated by walking. The diagnosis of slipped capital femoral epiphysis was confirmed radiographically and treated surgically with internal fixation of the epiphysis with the use of Moore's pins. Treatment with GH was discontinued. After one year there was the complete resolution of the disease and the adolescent was able to return at his usual way of life. Slipped capital femoral epiphysis is a disease in which the anatomic relationship between the femoral head and neck changes by disruption of the epiphyseal plate. This condition can occur only before the epiphyseal plate closes. Patients vary in age from newborn infant to teenager, nevertheless slipped capital femoral epiphysis is probably the most common hip disease during adolescence, and is often associated with endocrine imbalance including growth hormone deficiency. The aetiology of slipped capital femoral epiphysis is still unknown although many theories have been proposed.(ABSTRACT TRUNCATED AT 250 WORDS)

The optimal therapeutic approach for patients with Hodgkin's disease (HD) and human immunodeficiency virus (HIV) infection is unknown. In an attempt to improve the results obtained with standard chemotherapy and to decrease the occurrence of opportunistic infections (OI) during chemotherapy and follow-up observed in a previous experience, the authors designed a prospective combined antineoplastic and antiretroviral approach.Between March 1989 and March 1992, 17 consecutive previously untreated patients (median age, 30 years) with HD and HIV infection were enrolled. They had Stage III and IV or Stage I and II disease with adverse prognostic factors. The median CD4+ cell count was 184/microliters. Patients were stratified in two groups and treated accordingly. Group A was made up of patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of less than 3 and without OI. These patients received epirubicin 70 mg/m2 intravenously on day 1, bleomycin 10 mg/m2 IV on day 1, and vinblastine 6 mg/m2 IV on day 1 (regimen EBV). Group B was made up of patients with PS of 3 or greater or previous OI who had received a 50% reduced dose of epirubicin and vinblastine and a full dose of bleomycin. Courses were repeated every 21 days for six cycles. Zidovudine was given at the dose of 500 mg/day from the beginning of chemotherapy in Group B and after the third cycle in Group A.Overall, 14 of 17 (82%) patients had an objective response and 9 of 17 (53%) achieved a complete remission (CR) of disease for a median duration of 20 months. Toxicity was moderate with Grade 3-4 leukopenia in eight patients and Grade 3 thrombocytopenia in one patient. Thirteen of 17 patients received zidovudine as planned with a median duration of 9 months. Only one patient had OI during or after chemotherapy (median follow-up, 11 months). No worsening of HIV markers during the combined therapy was seen, with the median CD4+ cell count before and after therapy being 184/microliters and 203/microliters, respectively. The median survival time was 11 months, with an actuarial survival rate of 48% at 36 months. The median survival time for the nine patients with CR has not been reached at the time of this analysis.These results revealed the feasibility and the activity of the combination of EBV regimen and zidovudine. Objective response rate seems similar to those previously observed in patients receiving standard chemotherapy, but only one patient had OI, and this compares favorably with the 16 OI observed in 28 patients treated with standard chemotherapy (6% versus 57%) in the authors' previous experience. Thus, it seems that the addition of antiretroviral therapy to the EBV regimen decreased the occurrence of OI during chemotherapy or follow-up.

Self-assessment measures of sexual maturation continue to be used to classify pubertal development even though their reliability remains in question. This study examined the accuracy of self-assessment measures by early adolescents in one setting, during a day hospital. Standardized figure drawings depicting Tanner's sexual maturation stages were shown to early adolescents, and subjects were asked to rate their own pubertal development. Physical examination by physicians was used to corroborate sexual maturation. Participating in this study were 50 males (10-17 age) and 50 females (9-16 age). A small concordance rate between physical examination and self-assessment has been reported: 14% in males, 16% in females. There was a tendency for subjects males (48%) to overestimate their sexual development at later stages. A great part of the females (40%) answered exactly, with a shift to underestimation (36%) for breast stage and (54%) for pubic hair stage. So, in our experience, the small concordance between physical examination and self-assessment of pubertal maturation can't be used like a not controlled test.

Noonan syndrome was first described over 20 years ago by Noonan and Ehmke. They defined a specific group of nine patients with valvular pulmonary stenosis who, in addition, had short stature, mild mental retardation, hypertelorism and unusual facies. The incidence of Noonan syndrome has been estimated to be between 1 in 1000 and 1 in 2500 live births. The primary biochemical defect in Noonan's syndrome is unknown. We analyzed 9 patients (5 males and 4 females) in an age range of 6 months to 10 years and 3 months with Noonan syndrome. Patients were diagnosed as having the syndrome if they had characteristic facies and a normal karyotype, plus one of the following signs: cardiac defects, short stature or undescended testes. All patients have ocular anomalies (epicanthal folds, ptosis of eyelids, hypertelorism, downslanting palpebral fissures and ocular proptosis). Congenital heart malformations are present in 8 patients and the more frequent cardiopath is pulmonary valve stenosis due to a dysplastic or thickened valve. Short stature is present in 6 patients and 3 of them are actually on treatment with rhGH. A moderate-mild mental retardation is present in 6 patients. Case n. 9 had a syringomyelia and tethered cord. These malformations are rarely reported in Noonan's syndrome.

An increased risk of high-grade non-Hodgkin's lymphoma is observed in patients who are seropositive for human immunodeficiency virus (HIV). Treatment of such patients is complicated by their underlying acquired immunodeficiency syndrome (AIDS). Intensive strategies such as those used in non-HIV-related lymphoma may be poorly tolerated. However, patients without severe AIDS may derive significant benefits from such an approach. In a prospective multicenter study, treatment outcomes were assessed in 141 cases of HIV-seropositive lymphomas submitted to aggressive chemotherapy.Adult patients with lymphoma with a performance status less than 3 and no active opportunistic infection were consecutively treated with three cycles of doxorubicin 75 mg/m2, cyclophosphamide 1,200 mg/m2, vindesine 2 mg/m2 for 2 days, bleomycin 10 mg for 2 days, and prednisolone 60 mg/m2 for 5 days (ACVB). This treatment was followed by a consolidation phase of high-dose methotrexate plus leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH84). Central nervous system prophylaxis with intrathecal methotrexate was routinely used. Zidovudine maintenance therapy was started after chemotherapy. Ninety-three patients had high-grade lymphomas (59 Burkitt's type) and 48 had intermediate-grade lymphomas. Disseminated stage III-IV was present in 86 patients, meningeal involvement in 29, and bone marrow infiltration in 30; 62 patients had more than 2 extranodal localizations. Lactate dehydrogenase levels were above the normal value in 95 cases. The median CD4-positive lymphocyte count was 227 x 10(6)/L.Eighty-nine patients (63%) achieved complete remission (CR) and 19 (13%) partial remission, whereas 13 did not respond and 20 (14%) died during the course of ACVB, 8 of them from progressive disease. With a median follow-up of 28 months, median survival and disease-free survival were 9 and 16 months, respectively. Median survival for nonresponders was 5 months; 23 patients died of opportunistic infections while in persistent CR. In multivariate analysis, four factors were strongly associated with shorter survival: (1) CD4 count less than 100 x 10(6)/L, (2) performance status greater than 1, (3) immunoblastic lymphoma, and (4) prior AIDS. In the absence of all risk factors, the probability of survival at 2 years was 50%.In a selected group of HIV-related lymphomas, intensive chemotherapy with LNH84 is feasible and yields a high CR rate. Survival is short due to death from HIV-related infections; however, in a subgroup of patients without adverse prognostic factors, long-term remission was observed.

Ninety-two cases of Hodgkin's disease (HD) in patients with HIV infection have been collected by the Italian Cooperative Group on AIDS and Tumors (G.I.C.A.T.). In accordance with the epidemiology of HIV infection in Italy, 82% were intravenous drug users (IVDU), 8% homosexual men, 5% IVDU+homosexuals and 5% heterosexuals. At diagnosis of HD, 16% had AIDS, 20% AIDS related complex (ARC), 33% persistent generalized lymphadenopathy (PGL) and 31% were asymptomatic. Fifty-three percent of the patients had stage IV disease and 70% mixed cellularity and lymphocytic depletion. Forty-six patients were treated with MOPP or MOPP [symbol: see text] ABVD +/- radiotherapy (zidovudine was not given) with complete remission (CR) in 54% and partial remission (PR) in 46% of the patients. Fifty-six percent of these patients developed opportunistic infections (OI) during therapy or follow-up. Sixteen patients were treated with epirubicin, bleomycin and vinblastine (EBV) and concomitant zidovudine, with CR in 44% and PR in 38%. However, only one of these patients developed OI during therapy or follow-up. The clinico-pathological features and natural history of HD in HIV setting are peculiar and quite distinct from those observed in HD in the general population. Better combined chemotherapy and antiretroviral therapy is needed in order to ameliorate the CR rate and decrease the OI in patients with HIV infection and HD.

The histologic and clinical features of 71 cases of peripheral T-cell lymphoma (PTCL) have been studied. All patients were HTLV-1 negative. The T-cell phenotype was demonstrated by immunohistochemistry on cryostat sections (41 cases) and paraffin-embedded sections (30 cases). All cases were histologically classified according to the updated Kiel classification of non-Hodgkin's lymphoma (low and high-grade) and according to a Working Formulation (WF)-based classification (predominantly small cells, mixed small and large cells, and predominantly large cells). Most cases were in the high-grade group according to both classifications. The prognostic value of these two classifications was comparatively assessed. The analysis of the actuarial survival curves showed that, by using the updated Kiel classification, low-grade PTCL had a survival probability higher than high-grade PTCL although the difference was not statistically significant. Similar results were obtained when the WF-based classification was applied: furthermore, actuarial survival curves of mixed small and large cell PTCL, and of large cell PTCL were rather similar, thus indicating that differentiating these two categories has a limited prognostic value.

Many cases of 7q deletion associated with mental retardation and multiple malformations have been described, nevertheless it is quite different to recognize common features among these infants. In this paper the cases of two female infants with uncommon facial features and 7q deletion are described. We also try to recognize the phenotypic features of this chromosomal disorder.