MULTISPECTRAL MICROSCOPY AND COMPUTERIZED IMAGE ANALYSIS: A METHOD TO OBTAIN MORE RELIABLE AND REPRODUCIBLE IMMUNOHISTOCHEMISTRY RESULTSWritten by Giovanni Francesco Spatola et al.
Intra-abdominal desmoplastic small round cell tumors are rare aggressive neoplasms, with a very poor prognosis, observed in young adults with a male predominance. Their etiology is unknown and the diagnosis is based on histopathology, immunohistochem-istry and cytogenetics. Histological analysis shows typically clusters of round cells separated by abundant desmoplastic stroma. These tumors exhibit a multi-marker im-munohistochemistry profile expressing the three embryonic lineages: epithelial, neural and mesenchymal. They are positive for desmin and cytokeratin and are characterized by a specific recurring translocation t (11: 22) (q12 - p13), which involves EWSR1 WT1 gene. They are usually fatal despite an aggressive multidisciplinary therapeutic approach. Hereby we report the case of a 39 year old man who presented with an in-tra-abdominal desmoplastic small round cell tumor. The diagnosis was made by radio-logical, histological and immunohistochemistry profile analyses of a CT scanguided bi-opsy. This article also includes a mini review of the literature.
Retropharyngeal abscesses (RPA) are rare in adults. We report a case of a healthy adult with RPA presenting with clinical symptoms of acute thyroiditis. A 37-yr-old female presented with a painful mass in the anterior region of the neck, sore throat, mild fever and dysphagy for liquids and solids. Neck emergency US dis-closed normal thyroid ventrally displaced by a huge retropharyngeal hypoechoic mass. Direct laryngoscopy revealed erythema of the posterior pharyngeal wall with bulges (8 cm) preventing the correct visualization of the glottic plane. CT confirmed the pres-ence of retropharyngeal abscess and laryngoscopic drainage was performed. The pa-tient was discharged on 11th post-operative day, in good condition. The high mortality rate of retropharyngeal abscess is related to its association with invasion of contiguous structures and mediastinum: once mediastinitis occurs, mortality reaches 50%, even with antibiotic therapy. CT is fundamental for the diagnosis, but in many cases, as our, ultrasonography of the neck may play a pivotal role as quickly as possible. Surgi-cal treatment (intraoral incision and drainage) is the better definitive and resolutive treatment. The clinical diagnosis of retropharyngeal abscess in adult can be difficult because of the lacking and non specificity of clinical presentation. It is recommended to collect accurate clinical history, careful examination of the head and neck and use of early ultrasound examination of the neck, which in real time can give precise indications to guide the diagnosis and therapy. The management of a retropharyngeal abscess depends on the patient’s clinical condi-tion, moving from conservative treatment with steroids and antibiotics to reanimation and aggressive surgical drainage.
Obesity is a multifaceted disorder stemming from an imbalance in the homeostasis of energy, which leads to an accumulation of excess energy as fat. It has become of in-creasing concern in the Iraqi population since 2003, when obesity was identified as a significant factor in relation to several diseases. The objective of this study is to inves-tigate the association between oxidative stress and obesity in blood serum of obese Iraqi men.
This study was conducted on two different groups with matching age ranges (25-35 years). The obese group consisted of thirty-six obese subjects with varying grades of obesity (BMI 40 ± 5 kg/m2). The control group included thirty-six non-obese subjects (BMI 25 ± 3 kg/m2). There are two parallel components to this study: The first in-volves Superoxide dismutase activity, catalase activity and total thiol group levels as a marker of antioxidants. The second involves the end product of lipid peroxidation (MDA) as a marker of oxidative stress.
When compared with the control group, SOD, CAT activity, and MDA were significantly increased, whereas TTG was significantly decreased. There is a balance between CAT activity compared with SOD activity and polyunsaturated fatty acids hydroxyl peroxide that play a vital role in the regulation of ROS and the body's defense system in obese men and in the human body in general.
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a dangerous complication of bisphosphonates, a class of pharmaceutical agents used in numerous bone disor-ders. No gold standard therapy exists, but recent literature suggests that, in advanced stages, the best results are achieved with aggressive debridement. In this paper, we report our experience of treatment of stage 3 BRONJ of the maxilla with extensive surgical debridement and reconstruction with a chimeric ALT-Vastus lateralis flap.
Five selected patients with stage 3 BRONJ underwent partial maxillectomy with dis-ease-free margins followed by immediate reconstruction with a chimeric ALT-Vastus lateralis free flap.
Only two patients experienced minor complications. All other patients healed unevent-fully within two weeks and donor site morbidity was minimal.
Our data suggest that aggressive debridement and reconstruction with a chimeric ALT-Vastus lateralis flap is an effective option for the treatment of stage III BRONJ of the maxilla.
This article presents the results of a study on how the formation of the traditional health culture is deeply rooted at the present stage. Unsustainable development of modern Russia and its regions, insufficient legal resources, information and financial support for the conservation of human health and society, public health, or protracted reforms contributed to a significant deterioration in the population’s health. The solu-tion to these problems requires a change in state policies in the health field. As a situation, we consider it to be fundamental to identify the level of Buryatia Buryats health culture, and ways to improve it. Thus, in the traditional culture regarding the Buryat unity of body, mind and soul to this day is an axiom. However, by analyzing how the culture of health is deeply rooted at the present stage, we cannot ignore the fact that there are contradictions. Only a comprehensive examination of the problem will help develop the right policies for the conservation and development of a health culture in the Republic of Buryatia.
RETROSPECTIVE STUDY ON THE COMPARISON OF OUT-OF-HOSPITAL AND IN-HOSPITAL SUDDEN CARDIOVASCULAR DEATHWritten by Giovanni Bartoloni et al.
A retrospective study of forensic autopsies was carried out in the time interval January 2007 to December 2012 at the Forensic Pathology Service, Catania, south Italy, with a reference population of 3 000 000 inhabitants. During the study period, 1346 forensic autopsies were performed, including 223 (16.57%) sudden/unexpected deaths. Among the latter, 116 fulfilled the criteria of out-of-hospital (Group A) and 107 were in-hospital (Group B) sudden/unexpected deaths with suspected medical malpractice and/or a professional liability claim.
In Group A, coronary artery disease was the most common cause of death (N=67; 57.65 %), followed by cardiomyopathies (N=19, 16.38%) and myocarditis (N= 6; 17%). In Group B, coronary artery disease (N=32, 29.91%), post-procedural or post-surgical complications (N=30, 28.04%), pulmonary thromboembolism (N= 17; 15.89%) and aortic dissection (N=7, 6.54%) were the main causes of death.
Milk thistle is a herbaceous plant and is part of the characteristic vegetation of all those lands that overlook the Mediterranean Sea. The plant is known for its use as a herbal medicine. This medicinal plant is known for its beneficial properties for the treatment of liver disorders and other diseases. Such effects are related to its ability to act as free radical scavenger as well as to the activation of antioxidant enzymatic system (i.e. heme oxygenase-1). The aim of the present review is to provide a tool for the clinicians in order to exploit the beneficial effects of milk thistle expecially for those conditions in which the modern pharmacology has not yet developed a success-fult strategy of treatment (i.e. Nonalcoholic Liver Disease).
NEOADJUVANT IMATINIB AND RADIOTHERAPY IN GASTROINTESTINAL STROMAL TUMOR OF THE RECTUM: A CASE REPORTWritten by Rocco Luca Emanuele Liardo et al.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Rectal localization is rare. The gold standard for treat-ment is: surgery and tyrosine kinase inhibitors (TKIs) for metastatic or unresectable disease.
We report a case of a 62 year-old woman who underwent a gastroenterology visit for abdominal pain, tenesmus and constipation. After GIST diagnosis and staging, the pa-tient started induction therapy with imatinib followed by concomitant radio and tar-geted therapy before a sphincter-saving anterior resection, with a regular postopera-tive course.
The rationale of neoadjuvant treatment is lesion downsizing for an easier surgery. In epithelial cancers treated through concomitant therapies, the goal is also to preserve the functional integrity of organs, lowering the risk for salvage therapies. Also in GISTs, there is a direct correlation between downsizing, downstaging and outcomes.
COMMUNICATION IN THE HEALTHCARE RELATIONSHIP: SOME ASPECTS OF PATIENTS’ PERSPECTIVES IN THE CONTEXT OF PERCEIVED QUALITY OF CARE IN THE VERONA UNIVERSITY HOSPITAL IN 2013Written by Valentina Mecchi et al.
INTRODUCTION: Medical practice should be carried out in a sensible and respectful manner. This study aimed to assess the levels of patient satisfaction regarding the right to be informed, listened to and involved in care decisions, with the intention of contributing to the implementation of a better quality of care..
METHOD: Between October 7th and November 3rd 2013, anonymous questionnaires were distributed to hospitalized patients.
RESULTS: 46.14% stated they had felt involved in decisions about their treatment, and 82.94% reported that they had been directly informed about their health or treat-ment to an appropriate extent. 85.13% of patients had felt they were being treated with respect and dignity at all times.
DISCUSSION: Quality of communication between physicians and patients positively influences outcomes. Measuring the perceived quality of care, in AOUI Verona, trig-gered an increasing awareness of these issues, a drive for improvement, productive involvement in the project and the active participation of service users.
CONSERVATIVE TREATMENT AND PERCUTANEOUS“K”WIRE FIXATION OF CHILDHOOD SUPRACONDYLAR HUMERUS FRACTURESWritten by Liborio Miccichè et al.
Supracondylar humeral fractures are frequent lesions during childhood. Treatment consists in a conservative approach for the compound and stable fractures; the unsta-ble fractures are treated with a closed reduction surgery using percutaneous K-wire fixation. The authors considered 62 cases of supracondylar humerus fractures in pa-tients between the ages of 2 and 11 years old, which occurred between 2000 and 2013. The surgical results were analyzed through post-operative X-ray examinations. The functional results were evaluated afterwards by observing the alteration of the elbow’s anatomical profile, the presence or absence of a vascular-nervous deficit, the pain management, the muscular strength (MRC scale) and any eventual functional limitation. The mean follow-up was 7 years. According to the authors’ experience, both the conservative treatment and the percutaneous "k" wire fixation guarantee good results and a low complication rate. For this reason, surgeon experience is cru-cial in relation to the fracture’s nosologic overview and to the osteosynthesis surgery abilities.
RESULTS: 16,725 participants (aged 18-64) met inclusion criteria; 44.28% of workers were overweight or obese (56.36% of males vs 27.24% of females, p<0.001). Ac-cording to the logistic regression analysis, female (OR 0.28, 95% CI 0.26-0.31) and highly educated workers (OR 0.70, 95% CI 0.65-0.75) showed less risk of being overweight/obese compared to male and less educated workers. Aging was associated with an elevated risk (those aged >64 yrs compared to younger colleagues: OR 4.02, 95% CI 2.91-5.58) as well as artisans compared to employees (OR 1.11, 95% CI 1.01-1.23) and shift-work compared to daytime-work (OR 1.14, 95% CI 1.03-1.26).
DISCUSSION: Our analysis in the Italian context is consistent with the existing knowl-edge, suggesting that overweight is significantly associated with shift work, even when controlling for important covariates, such as education, age, gender, civil status, BMI category.
Background: Hospital-acquired infections (HAIs) pose a significant clinical and eco-nomic burden worldwide. Surveillance has been associated with a reduction of HAI rates in Intensive Care Unit (ICU) patients, although the particular reasons for this decrease are still difficult to determine. The present study was conducted in order to report HAI surveillance data during an eight-year period in five ICUs in Catania.
Methods: A patient-based HAI surveillance was conducted in the framework of the first four surveys of the Italian Nosocomial Infections Surveillance in ICUs network (SPIN-UTI) of the GISIO-SItI. Each survey consisted in a six-months surveillance con-ducted in: 2006-2007; 2008-2009; 2010-2011 and 2012-2013. During the study pe-riod, HAI cumulative incidence, incidence density and mortality were calculated overall and for each survey.
Findings: From 2006 to 2013, a total of 2070 patients were admitted in the five par-ticipating ICUs and were included in the study. The cumulative incidences of infected patients in each survey were: 13.3, 17.0, 18.9 and 8.9 per 100 patients, respectively. Accordingly, the risk of ICU-acquired infections increased in the third survey compared with the first (RR: 1.43; 95%CI: 1.06-1.92) but it decreased in the fourth survey compared with the second (RR: 0.64; 95%CI: 0.47-0.86) and the third (RR: 0.57; 95%CI: 0.43-0.76). A similar trend was observed considering incidence of infections and incidence density. Although mortality did not show a significant trend between the four surveys, the risk of death increased for infected patients.
Conclusions: The patient-based cohort design allowed us to analyze HAI indicators during an eight-years period, in five ICUs in Catania. Particularly, the risk of ICU-acquired infections increased in the third survey compared with the first, whereas it decreased in the fourth survey compared with the second and the third surveys. Fur-thermore, mortality remained unchanged, however the risk of death significantly in-creased for infected patients, in each survey. Surveillance data are useful to support policymakers and leaders to make evidence-based decisions in the healthcare setting, to plan and improve programs, services and interventions for preventing, managing and treating HAIs.