Effects of insulin therapy optimization with sensor augmented pumps on glycemic control and body composition in people with cystic fibrosis-related diabetes.

Objective: Cystic fibrosis (CF)-related diabetes (CFRD) resulting from partial-to-complete insulin deficiency occurs in 40-50% of adults with CF. In people with CFRD, poor glycemic control leads to a catabolic state that may aggravate CF-induced nutritional impairment and loss of muscle mass. Sensor augmented pump (SAP) therapy may improve glycemic control as compared to multiple daily injection (MDI) therapy. Research design and methods: This non-randomized clinical trial was aimed at evaluating the effects of insulin therapy optimization with SAP therapy, combined with a structured educational program, on glycemic control and body composition in individuals with insulin-requiring CFRD. Of 46 participants who were offered to switch from MDI to SAP therapy, 20 accepted and 26 continued the MDI therapy. Baseline demographic and clinical characteristics were balanced between groups using a propensity score-based overlap weighting procedure and weighted mixed-effects regression models were used to estimate changes in study outcomes. Results: After 24 months changes in HbA1c were: -1.1% (-12.1 mmol/mol) (95% CI: -1.5; -0.8) and -0.1% (-1 mmol/mol) (95% CI: -0.5; 0.3) in the SAP and MDI therapy group, respectively, with a between-group difference of -1.0 (-10 mmol/mol) (-1.5; -0.5). SAP therapy was also associated with a decrease in mean glucose (between group difference: -32 mg/dL; 95% CI: -44; -20) and an increase in TIR (between group difference: 19.3%; 95% CI 13.9; 24.7) and in fat-free mass (between group difference: +5.5 Kg, 95% CI: 3.2; 7.8). Conclusion: Therapy optimization with SAP led to a significant improvement in glycemic control, which was associated with an increase in fat-free mass.

Villoglandular papillary adenocarcinoma of the uterine cervix: report of a case.

Villoglandular papillary adenocarcinoma is a recently described form of adenocarcinoma of the uterine cervix, which apparently affects young women and seems to have a favorable course with an excellent prognosis. We report on a case of villoglandular papillary adenocarcinoma in a 26-year-old woman. The patient was treated by conization alone and is disease free after a 40-month follow-up.

[Audit of histopathology activities at the pathology departments of 7 general hospitals. 2. Response time]. / Audit dell'attività istopatologica nei servizi di sette ospedali generali. 2. Tempi di risposta.

A retrospective analysis of 1,000 consecutive cases was conducted in each histopathology lab of seven general hospitals. The collected information included the date of specimen withdrawal (six labs only), receipt in the laboratory, and reporting. Time intervals between withdrawal and receipt. Two labs, received 3/4 of cases the same day, while the others had a very low prevalence of receipt. All labs but one, received 80-90% of cases within 48 hours. In one lab, 17% of cases arrived five days after from the withdrawal. Time intervals between receipt and reporting. The mean observed in the seven labs ranged from 3.1 to 6.1 days. Two labs were able to report within 24 hours, but this occurred only in 6% of their cases. The reporting prevalence within three days ranged between 5 and 64%, with a mean for the seven labs of 37%. The reporting prevalence within 6 days was about 95% (four labs), 60-70% (two labs) and 20% (one lab). All labs but one reported 95-100% of cases within ten days. Time intervals between withdrawal and reporting. Our labs were not able to report within 24 hours from the withdrawal (frozen sections excluded). The reporting prevalence within 2-3 days was about 35-40% (three labs), 16% (one lab), 2% (two labs), and within six days it was about 90% (three labs), and 61%, 38% and 14% (the remaining). These latter reported 95% of their cases within twenty days. The turnaround times we found are unsatisfactory. Probably, there are many sources of delay, and these are multifactorial. However, a major factor involved in these delays seems to be related to poor arrangements in the allocation and managing of human resources.

Ki-67 scores and AgNor counts in transitional cell carcinoma of the bladder: apparent lack of prognostic value.

The cellular proliferative state of 18 incident cases of transitional cell carcinomas of the bladder treated with transurethral resection was blindly determined by two independent observers using Ki-67 monoclonal antibody and silver stain for nucleolar organizer regions (AgNORs). Ki-67 scores were significantly related to histological grade (WHO) (rs = 0.65, p < 0.01) and clinical stage (UICC) (rs = 0.46, p < 0.05). However, the follow-up analysis over a six year period did not demonstrate significant relationship between Ki-67 values and survival. AgNOR counting did not show significant association with any of the variables under study. The results of this investigation and the review of the pertinent literature suggest that the assessment of cell proliferation of bladder carcinoma by means of Ki-67 and AgNOR techniques is far from having immediate direct influence on patient management.

[Chorioangioma (placental hemangioma): anatomo-pathologic identification and possible clinical relevance]. / Corioangioma (emangioma placentare): identificazione anatomo-patologica e possibile rilevanza clinica.

Chorioangioma (Placental hemangioma): Anatomo-pathological identification and possible clinical importance. Chorioangioma is found in about 1% of all placentas. However, many small tumours are missed in routine examination or easily mistaken for infarcts. Cases of large chorioangiomas may be related with a number of feto-maternal pathological conditions. Here we report a case of chorioangioma with a brief review on the possible several complications related to its occurrence.

Liposarcoma of the thyroid gland. Fine-needle aspiration cytology, immunohistology, and ultrastructure.

A 56-year-old woman presented with a rapidly growing tumoral mass of the thyroid. In fine-needle aspirates, neoplastic cells were interpreted as undifferentiated (anaplastic) carcinoma. In contrast, histologic examination of tissue samples revealed a tumor with features suggestive of myxoid liposarcoma. The non-epithelial nature was confirmed by immunohistochemical and electron microscopic evaluation. Immunostains for vimentin and S-100 protein were positive, whereas no reactivity was obtained for epithelial markers. Ultrastructurally, the tumor consisted of poorly differentiated mesenchymal cells and lipoblastic elements in various stages of differentiation. Review of the literature reveals only one previous report of thyroid liposarcoma, the diagnosis of which was based on conventional light microscopic studies.

[Tumor grading in urinary cytology. A study of the cytohistological relationship with evaluation of the kappa statistic for concordance]. / Il grading tumorale in citologia urinaria. Studio della correlazione cito-istologica con valutazione del kappa statistico per la concordanza.

In order to verify both usefulness and reliability of cytologic grading evaluated on urinary sediment, we designed a study to test the ability to distinguish consistently between different degrees of neoplastic abnormalities of urothelial cells from voided urine, in relation to the histologic findings of bladder biopsies performed after cytologic reading. Kappa measures were calculated in 112 cytohistologic pairs representative of first disease detection (A) and in 35 pairs representative of disease recurrence (B). Cytology was able to correctly identify a cancer in 70.5% and 80.0% of group A and group B lesions, respectively. Unweighted kappa values of both groups A and B were poor (0.298 and 0.324 respectively). When we considered the weighted kappa, values suggesting fair agreement were obtained (0.576 and 0.500). Our data confirm that urinary cytology shows a good sensitivity in detecting bladder cancer, but it does not seem to give reliable results for the assessment of the tumor grading.

[Correlation between histological grading and cell growth fraction in bladder tumors]. / Correlazione tra grading istologico e frazione di crescita nei carcinomi vescicali.

30 carcinomas and 1 papilloma of bladder were studied by immunohistochemical method with a monoclonal antibody Ki-67 (Dako-PC) reacting with a nuclear antigen present in cells of the mitotic phases G1, S, G2 and M. Authors would like determine the growth ratio (correlation between the number of cells in mitotic cycle and the total number of cells) of the neoplastic cell populations to compare it to the grading of themselves established by traditional parameters. It was shown, as in other carcinoma type, that the down grading correspondent with augmentation of cell growth fraction. It is of interest to verify that among carcinoma of different grading there are values partially corresponding for the growth fraction. This confirm what are going to demonstrate all those studies by means of flow cytometry and image analysis: grading of neoplasias as now fixed, doesn't give a satisfactory index for prognosis.

[Paraneoplastic syndrome of disseminated intravascular coagulation in cardial carcinoma with multiple metastases]. / Sindrome paraneoplastica di coagulazione intravascolare disseminata in carcinoma cardiale con metastasi multiple.

A case of paraneoplastic DIC syndrome (asymptomatic carcinoma of the gastric fundus with multiple metastases) is described. Initially, differential diagnosis hesitated before thrombotic thrombocytopenic purpura (Moschowitz' syndrome), given the presence of grave microangiopathic haemolytic anaemia as a major symptom. The main characteristics of Moschowitz' syndrome and the most frequent causes of DIC are described in the discussion.