Multiple hormonal and metabolic deficiency syndrome in chronic heart failure: rationale, design, and demographic characteristics of the T.O.S.CA. Registry.

Recent evidence supports the concept that progression of chronic heart failure (CHF) depends upon an imbalance of catabolic forces over the anabolic drive. In this regard, multiple hormonal deficiency syndrome (MHDS) significantly has impacts upon CHF progression, and is associated with a worse clinical status and increased mortality. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Therapy in Heart Failure) Registry (clinicaltrial.gov = NCT02335801) tests the hypothesis that anabolic deficiencies reduce survival in a large population of mild-to-moderate CHF patients. The T.O.S.CA. Registry is a prospective multicenter observational study coordinated by "Federico II" University of Naples, and involves 19 centers situated throughout Italy. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydroepiandrosterone , and insulin are measured at baseline and every year for a patient-average follow-up of 3 years. Subjects with CHF are divided into two groups: patients with one or no anabolic deficiency, and patients with two or more anabolic deficiencies at baseline. The primary endpoint is the composite of all-cause mortality and cardiovascular hospitalization. Secondary endpoints include the composite of all-cause mortality and hospitalization, the composite of cardiovascular mortality and cardiovascular hospitalization, and change of VO2 peak. Patient enrollment started in April 2013, and was completed in July 2017. Demographics and main clinical characteristics of enrolled patients are provided in this article. Detailed cross-sectional results will be available in late 2018. The T.O.S.CA. Registry represents the most robust prospective observational trial on MHDS in the field of CHF. The study findings will advance our knowledge with regard to the intimate mechanisms of CHF progression and hopefully pave the way for future randomized clinical trials of single or multiple hormonal replacement therapies in CHF.

Robotic antrum-pyloric resection with intracorporeal anastomosis in a young woman with ectopic pancreas pyloric stenosis.

INTRODUCTION: Ectopic pancreas is pancreatic tissue sited outside its normal location and lacking anatomic or vascular connection with eutopic pancreatic tissue. We present herein a successful robotic antrum-pyloric resection with intracorporeal Roux-en-Y reconstruction in a 24-year-old woman. PATIENT AND METHODS: The patient was admitted for recent worsening vomiting, intermittent epigastric pain, and hyporexia that arose some years previous. Endoscopic ultrasonography (EUS) findings suggested the presence of ectopic pancreas but did not exclude the possibility of gastrointestinal stromal tumor (GIST) or other pathogenesis. Totally robotic (three-arm da Vinci(®)) antrum-pyloric resection was decided. RESULTS: Final pathologic analysis revealed that the lesion comprised exocrine pancreas located in the submucosal layer. Patient was discharged on the 10th postoperative day. DISCUSSION: Robotic antrum-pyloric resection was decided considering its advantages over laparoscopy including stereoscopic vision, loss of tremor, and robotic arm endowrist. These instrumental benefits facilitate procedures such as knot-tying, suturing, organ manipulation, and tissue dissection. CONCLUSIONS: We show that subtotal gastrectomy for ectopic pancreas can be performed robotically and is a feasible and safe procedure.

[Comparison between lymphocytic infiltration in early spontaneous abortions and in elective abortions with signs of disruption at the chorio-decidual interface]. / Comparazione dell'infiltrato linfocitario in aborti spontanei precoci e in interruzioni volontarie di gravidanza con segni di sofferenza deciduo-coriale.

AIM: The aim of the study was to compare lymphocytic infiltrations in early spontaneous abortions with those with signs of disruption at the chorio-decidual interface in elective abortions. Determinations were performed on preparations received at the Anatomy-Pathology Services of Ospedale San Paolo, Savona (Italy) in 2005. METHODS: Immunohistochemistry studies were performed using antisera CD3, CD4 and CD14 with a DAB detection kit on a Ventana BenchMark automated slide staining system. The material was grouped into three classes: early spontaneous abortions (class 1); elective abortions with signs of disruption at the chorio-decidual interface (class 2); elective abortions without such signs (class 3). RESULTS: Preparations from classes 1 and 2 shared a similar picture of lymphocytic activation and the presence of macrophagic elements. The test results demonstrated that the proportion of the T cell population increased with the rise in CD8+ lymphocytes in both class 1 and class 2 preparations. CONCLUSION: The results indicate that T-cell-mediated immune activation may the cause or one of the causes of spontaneous abortion and that the effects of disruption at the chorio-decidual interface observed in elective abortion provide a clue to initial signs of loss of pregnancy. From the discovery of a population without evident signs of active abortion (elective abortion with a disturbed chorio-decidual interface) but with evidence of initial lymphocytic activation compared with that devoid of such signs (elective abortion) one can conjecture that lymphocytic activation is a major factor in the process leading to early spontaneous abortion.

[Splenic rupture in chronic pancreatitis. A clinical case. Observations]. / Rottura di milza in corso di pancreatite cronica. Caso clinico. Considerazioni.

The paper reports a case of splenic rupture during the course of chronic pancreatitis, an event rarely reported in the literature. The anatomical arrangement of organs and peripancreatic vessels is a predisposing factor for this complication. There are essentially three different but correlated pathogenetic hypotheses. The first refers to thrombosis of the splenic vein with portal hypertension documented by some researchers even in angiographical terms: during the course of chronic pancreatitis the spleen is sometimes palpable. Thrombosis and/or vascular compression make the spleen more fragile and its rupture more likely: this is particularly true during the course of calcific chronic pancreatitis and cases involving the tail. An enzymatic factor may also be responsible and this appears more clearly in pancreatitis with pseudocysts. In this case it is the direct action of pancreatic enzymes on the ileum or splenic parenchyma, which may also affect all organs surrounding the pancreas, which leads to hemorrhage or hematoma. Sometimes the cause of bleeding is a pseudoaneurysm of the splenic artery which is eroded by the contents of the pseudocysts themselves. There is also a mechanical hypothesis which some authors consider the sole possibility: in chronic pancreatitis the splenic compartment presents severe perisplenitis which fixes the spleen making it more vulnerable and even a mini-trauma will cause rupture. The patient is almost always an emaciated young alcoholic suffering from chronic pancreatic pathology.(ABSTRACT TRUNCATED AT 250 WORDS)

Wilms' tumor after treatment.

Sixty-one Wilms' tumors (WTs) from 59 patients who received preoperative therapy were studied. Twenty-seven WTs from 26 patients who did not receive preoperative treatment were also reviewed as controls. Marked and diffuse morphological changes occurred in treated cases. Necrosis affected mostly undifferentiated and replicating elements and was extensive, up to 90% of tumor mass. Minimal residual tumor, permitting recognition as Wilms', was always spared. Epithelial and rhabdomyoblastic components were more resistant to treatment; moreover, they appeared to be susceptible to differentiation and maturation. Necrosis and muscle cell differentiation seemed to have prognostic implications. Cases with extensive necrosis (greater than 90%) had a better outcome, although the difference was not statistically significant. The rhabdomyoblast/tumor mass ratio, after treatment, appears to carry prognostic meaning. Chemotherapy had no apparent effect on anaplasia.