A 16-year-old girl had been undergoing intensive chemotherapy (ALL 2009) for Early T -cell precursor acute lymphoblastic leukemia (ETP). At 22:00 of the 26th day of induc-tion phase IA, she was found to have developed febrile neutropenia. After blood cul-tures were obtained, empirical therapy with ceftriaxone and amikacin was initiated, according to internal protocol. Clinical condition improved and she remained afebrile for 24 hours. The following day, at 04:00, she suddenly developed a cough with hemoptysis. At this time, fibrinogen was 167 mg/dL, and platelets 35000/uL. A chest X-ray showed thickening in the middle of the right lower zone, and a chest CT scan showed a nodule with central hypodense area (necrotic-colliquative evolution of the infiltrate). In spite of supplementation with platelets, red blood cells, plasma, fibrino-gen, antithrombin, and activated factor VII, the patient's clinical condition worsened rapidly and the pulmonary hemorrhage became uncontrollable. She died at 12:00. Blood cultures yielded a strain of Pseudomonas aeruginosa, with reduced sensitivity to antibiotics.
Aspergillosis is the most frequent infectious cause of massive pulmonary hemorrhage in pediatric leukemias, while bacterial pneumonia or TBC are by far less frequent. As-pergillus requires the presence of neutrophils to cause hemoptysis or cavitation, while bacteria (Gram-positive or -negative) can cause pulmonary necrosis also in patients with neutropenia.
According to current literature, sentinel lymph node identification technique is a sim-ple procedure that allows predicting the location of the axillary lymph nodes without under-staging neoplastic disease.
In clinical practice, the radio-guided surgery has been spreading also to diagnose the occult malignancy, giving space to the nuclear method for those injuries that, with a lot of difficulties for all the team's specialists, were detected using a guide-wire.
Currently the Radio-guided Occult Lesion Localization (ROLL) has become the choice procedure for all small lesions. Therefore, dedicated centers for study and treatment of breast disease use ROLL and Sentinel Node and Occult Lesion Localization (SNOLL) to resolve in a single surgery both breast disease and axillary nodal spread.
For this reason, the authors intend to prove, through this work, the idea that this method should be applied routinely in the current clinical practice of all operative units
The high incidence of HIV, especially in sub-Saharan African countries, and the in-crease of life expectancy due to effectiveness antiretroviral therapies, have led to an increase of patients undergoing surgery interventions. To date there is still no defini-tive data on role, outcome and management of HIV positive surgical subjects. This paper reviews the more recent literature about HIV infection, highlighting the main pathologies treated by thoracic, abdominal and orthopedic surgery, without forgetting about other surgery branches. Particular attention was paid to Mozambique, a devel-oping country with one of the highest levels of HIV incidence.
This is a retrospective cohort study with the aim of evaluating fluconazole efficacy in preventing invasive fungal infections in very low birth weight newborns, in our NICU setting. Neonates weighing less than 1500g at birth, born between January 2013 and Decem-ber 2014, were enrolled in the study. The primary aim was to assess the prevalence of fungal infections. The secondary aim was to identify newborns with a higher risk of invasive fungal infections as well as the incidence of complications after invasive fungal infection. 59 newborns were included in the study. Routine fluconazole prophylaxis at the dose of 3mg/kg i.v. every 72 hours was administered to 47/59 (79,7%). The overall pro-portion of invasive fungal infections was 17%, with no significant difference between neonates who underwent fluconazole prophylaxis (19,1%) and those who did not (8,3%) (p = 0,4). Candida parapsilosis was the most common isolated strain (90%). Lower gestational age, lower birth weight, surgery interventions and delayed initiation of enteral feeding were associated with invasive fungal infections. All septic newborns developed complications: bronchopulmonary dysplasia, retinopa-thy of prematurity and periventricular leukomalacia. None died due to Candida infec-tion. Our findings do not appear to support routine fluconazole prophylaxis in very-low-birth-weight infants.
THE MANAGEMENT OF PIN-CARE IN EXTERNAL FIXATION TECHNIQUE: POVIDONEIODINE VERSUS SODIUM HYPOCHLORITE 0,05% (AMUKINA-MED®) MEDICATIONS.Written by Michele Bisaccia et al.
Purpose: Currently, there is no universal approach to pin-site care for preventing infection. The medication of these pins is essential for obtaining good external fixation results. The purpose of this study is to evaluate the results obtained after pins were medicated with two different disinfectants: povidone-iodine (10%) and sodium hypochlorite 0,05% (Amukina-med®).
Methods: 237 pins of 40 patients treated with Hoffmann II external fixation have been analyzed in our study. The average age was 41.3 (ranging from 19-71). All pins were inserted by hand pre-drilling together with continuous irrigation with cold saline to reduce the risk of thermal necrosis. Patients were divided into 2 groups consisting of 20 patients each: in group A, 109 pins were medicated with povidone-iodine and in group B, 128 pins were medicated with sodium hypochlorite 0,05%.
Results: 24 pins (22%) medicated with povidone-iodine became infected, as well as 13 pins (10,1%) medicated with sodium hypochlorite. A few pins mobilized: 13 in group A and 6 in group B. In all cases, infections were resolved with oral antibiotic therapy.
Conclusions: Our study showed that medication with sodium hypochlorite 0,05% reduced the per-centage of pin-tract infection and mobilization with respect to povidone-iodine, dem-onstrated by significant statistical evidence (Chi-square's test: p<0.05).
Historically, only the energy storage function had been attributed to adipose tissue. However, recent studies have shown that it is also able to secrete several substances which act in a paracrine or endocrine manner, contributing to the maintenance of or-ganism’s homeostasis. It has been reported that the visceral fat has distinctive secret-ing characteristics. Based on previous scientific observations, here we shall describe the possible functional role of epiploic appendages. The epiploic appendages may play an important role in the metabolic regulation and/or in immune defense through the secretion of specific factors, such as leptin and some inflammatory cytokines. Leptin has been seen to be involved both in the regulation of hunger signals, in coordination with the hypothalamus, and in complex immune defense processes. The exact under-standing of the behavior of this hormone could play a key role in understanding the functions ascribed to the epiploic appendages.
Introduction: Thoracic splenosis is an acquired rare condition, resulting from het-erotopic autotransplantation of splenic parenchyma into chest, usually after traumatic spleen and diaphragm rupture. Methods and Results: This paper describes the thoracic splenosis, as an incidental di-agnosis and asymptomatic condition, 34 years after a thoracoabdominal trauma in a patient who underwent radiological investigations due to a 15 kg weight loss in the previous four months: the only abnormalities found were thoraco-parapericardial and abdominal nodules of splenosis. Discussion: Thoracic splenosis is a rare condition, usually following a thoracoabdomi-nal trauma with concomitant lesions of the spleen and diaphragm, which allow tho-racic implantation of splenic tissue. Patients are generally asymptomatic, and the con-dition is discovered incidentally during radiological investigations, which allow certain diagnosis without using invasive methods. Excision of splenosis should be considered for symptomatic patients or unconfirmed diagnosis. Conclusions: Thoracic splenosis is a rare condition. Imaging investigations allow to diagnose the condition, and excision of splenosis is not suggested for asymptomatic patients
Fatty liver diseases are a spectrum of liver pathologies characterized by abnormal hepatocellular accumulations of lipids. This condition may occur in both adults and children, particularly those who are obese or have insulin resistance or following abuse of alcohol consumption. They are classified in Non-Alcoholic Fatty Liver Disease (NAFLD) and Alcoholic Fatty Liver Disease (AFLD). Steatohepatitis is a specific pattern of injury within the spectrum of NAFLD and this pattern is associated with fibrotic pro-gression and cirrhosis. The role of oxidative stress in liver steatosis production and its progression to inflammation leading to steatohepatitis has been discussed in relation to alterations in metabolic and pro-inflammatory pathway. One of the main enzymes responsible for antioxidant activity in the presence of liver damage is the Heme Oxy-genase-1(HO-1).The products of the HO-1-catalyzed reaction, particularly carbon monoxide (CO) and biliverdin/bilirubin have been shown to exert protective effects in several organs against oxidative and other noxious stimuli. In this context, it is inter-esting to note that induction of HO-1 expression contributes to protection against liver damage in various experimental models. The focus of this review is on the significance of targeted induction of HO-1 as a potential therapeutic strategy to protect the liver against fatty liver diseases.
For the benefit of medical students, in this paper we examine the somatotopic organi-zation of the spinal cord, which shows a similar organization in mammalians. The dor-sal horn is comprised of sensory nuclei with deutoneurons; the lateral horn contains preganglionic visceral motoneurons; the ventral horn is subdivided into a medial col-umn innervating the paravertebral muscles, a central column, C3-C6, innervating the diaphragm, and a lateral column innervating the limb muscles. In the lateral column of the ventral horn, the dorsal motoneuron groups innervate the intrinsc arm muscles; the dorsal posterior motoneuron groups innervate hand muscles; the lateroventral motoneuron groups innervate the shoulder. Furthermore, the rostral and caudal moto-neuron groups innervate the proximal and the distal muscles, respectively. In cat spi-nal cord, the medial columns 1-2 innervate the paravertebral muscles, and columns 3-6 are divisible into groups, each innervating specific muscle groups. In human spinal cord, 11 motor columns have been identified: column 1 is located in the medial part and columns 2-11 in the lateral part of the ventral horn. Columns 1-2 extend to S3, while columns 3-8 are confined to the cervical and T1 segments, and columns 9-11 are situated in the lumbosacral segments.
Diabetes Mellitus is regarded as an independent risk factor for cardiovascular disease and is highly prevalent in the Asian Indian community in South Africa. Poor control of blood glucose is associated with an increased risk for coronary artery disease (CAD). We determined the glycaemic control profile in a sample of known diabetic subjects from the Phoenix Lifestyle project cohort, and examined the relationship between gly-caemic control and other biochemical parameters.
This is the first study in the Asian Indian community in Phoenix that determined the relationship between glycaemic control in diabetic subjects and other cardiovascular risk factors. Our study shows that significant dyslipidemia is present in the majority of diabetics with poor glycemic control, as well as in subjects with HBA1c levels demon-strative of good control. Atherogenic dyslipidemia in diabetic subjects is a substrate for the premature development of CAD in diabetes.
Methods: Color Doppler imaging of arterial and venous blood flow was performed on 78 patients with normal tension glaucoma (NTG), 80 patients with high-pressure glau-coma (HPG) and 60 control subjects. The statistical analysis included the calculation of the correlation between clinical data and ocular blood flow parameters, as well as Pearson’s correlation coefficient. The threshold P value for statistical significance was 0.05.
Results: Ocular blood flow (both arterial and venous) was significantly reduced in NTG and HTG, compared to the control group. While the arterial blood flow reduction was more significant in HTG than in NTG, a decrease in venous blood flow had a higher in-cidence in NTG. In contrast to the control group, POAG patients showed a correlation between clinical data and venous blood flow. The correlation was higher in NTG pa-tients.
Pilonidal sinus disease is a complex condition that causes both discomfort and embar-rassment to sufferers. Direct cost through absence from work is high. Controversy still exists regarding the best surgical technique for its treatment in terms of minimizing disease recurrence and patient discomfort. Thus, we conducted this study to evaluate the results of rhomboid excision and Limberg flap reconstruction in the surgical treat-ment of pilonidal sinus disease. This prospective study included 81 patients who had pilonidal sinus and were treated by the rhomboid excision and Limberg flap. The mean follow–up was 18 months and all patients were satisfied with the procedure. There were lower complication rates, minimal discomfort, patients discharged in 2-3 days and only two recurrences. The authors recommend the Limberg Flap procedure for pilonidal sinus disease. It is effective, with short hospitalization, low recurrence rate and shorter time off work.
Distal radius fractures are the most common fractures of the upper limbs and repre-sent 17% of all fractures treated in emergency medicine. The purpose of the present study is to evaluate the correlation between the clinical and radiographic outcomes obtained with surgical osteosynthesis using volar plates for the treatment of articular fractures of the wrist. We evaluated a series of 50 consecutive patients from January 2010 to December 2013 who had undergone surgery, aged 24 to 75, for distal meta-epiphyseal fractures of the radius, with or without distal ulnar involvement. All pa-tients were evaluated clinically and radiographically, pre-operatively and post-operatively. For the clinical evaluation, the DASH score and Mayo Wrist clinical rating scale were used. After one year, the range of movement of the wrist was very satis-factory, and the mean grip strength was 77.5% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 18 and the Mayo Modified Wrist Score was 82.5. Complex articular distal radius fractures, like those of other sites, needed an appropriate surgical treatment and the fixation with the volar LCP system demonstrated its validity for the stabilization of these fractures, the articular surface reconstruction and prompt mobilization. All the clinical results were related to the pa-tients’ age, the functional needs, the physiotherapy and the individual recovery