Lipid profile assessed in the family pediatrician's office: the COLIBRI'- SIMPeF study.

There is limited information on the prevalence of dyslipidemia in the Italian pediatric population. Aim of the study was to evaluate total cholesterol, high-density lipoprotein (HDL)-cholesterol and triglyceride levels, and associated factors in a large sample of Italian children, applying a micro-sampling procedure in the family pediatrician's office. In a population of 1910 children (50.2% males, age 7-11 years), 27.6% was overweight or obese and 28.3% had at least one parent with referred hypercholesterolemia. Total cholesterol and triglyceride levels were elevated in 4.5% and 23.5% of the subjects, respectively, while HDL cholesterol was below 40 mg/dl in 3.3%. Male gender (OR 1.58, 95% CI 1.01-2.49) and positive family history (OR 2.13, 95% CI 1.36-3.32) were independent predictors of hypercholesterolemia, while BMI z-score was associated with low HDL cholesterol (OR 1.46, 95% CI 1.13-1.88) and high levels of triglycerides (OR 1.39, 95% CI 1.26-1.55).Conclusion: The prevalence of dyslipidemia in our sample is worthy of attention. The study suggests the opportunity and feasibility to check for the presence of dyslipidemia at the family pediatrician's office. Familiarity is associated with high cholesterol levels, regardless of the children's weight class, while weight excess identifies subjects with the typical lipid profile of metabolic syndrome. What is Known: • Few data are available on the lipid profile in Italian children. • Early treatment of hypercholesterolemia is effective in reducing cardiovascular events later in life; there is no agreement on how to screen for dyslipidemia in childhood, however. What is New: • In a large sample of Italian children, familiarity doubles the risk of hypercholesterolemia, while increased BMI is associated with low HDL cholesterol levels and hypertriglyceridemia. • The pediatrician may perform an assessment of plasma lipids in his office as a first step to diagnose familial hypercholesterolemia.

SARS-CoV-2 pandemia in Lombardy: the impact on family Paediatricians.

As health care workers (HCWs) who care for children, who usually demonstrate milder symptoms than adults, family paediatricians have an increased risk of exposure to coronavirus. In April 2020, the Sindacato Medici Pediatri di Famiglia (SIMPeF), provided its members with rapid tests to detect antibodies against SARS-CoV-2; 1240 individuals, including 377 paediatricians, 108 staff members of pediatric clinics, and 755 cohabitant relatives of paediatricians, were tested in Lombardy, the most affected Italian region. The global prevalence of IgG antibodies in these individuals was 20.7%, which is higher than that of the general population and other HCWs. More than 70% of subjects with IgG antibodies presented symptoms, and 4.9% needed hospitalization. In addition, 64.2% of the study participants reported close contacts with a suspected case of COVID-19, while 72.9% of the family paediatricians reported occupational exposure to the disease. The initiative of the SIMPeF has been useful in assessing the impact of the COVID-19 pandemic on paediatric settings, as well as in raising paediatricians' awareness of the spreading of coronavirus.

Elderly and very elderly patients with hepatocellular carcinoma. Strategy for a first line treatment.

AIM: Health-status of elderly patients with hepatocellular carcinoma (HCC) may limit surgical approach; other options are thus auspicable. METHODS: The authors reviewed 98 selected patients, aged 65 to 90 years, with 149 HCC treated between 2002 and 2011. According to the extent of malignancy, health status and treatment, patients were divided into 3 groups. Sixty-one, submitted to major and minor curative resections, were in group A and B while group C included 37 patients, unsuitable for high-risk procedures and percutaneous ablation, submitted to intraoperative-radiofrequency ablation (IRFA) alone or combined with minor resections. Assessment of safety and therapeutic efficacy of this managment was evaluated. RESULTS: A postoperative mortality rate of 1,02% and an overall survival rate at 5 years of 62.3% were observed. Indeeed matched post-operative morbidity and mortality rates of A, B, C groups were 45%, 8%, 16.21% (p < 0.004) and 9 %, 0%, 0% (p= 0.112 ) respectively. 3 years overall-survival was not statistically different (p= 0.585). However 5 years survival rate and disease-free-survival rate were significantly higher in patients of group A and B (p= 0.003; p< 0.001). CONCLUSION: Treatment strategies to minimize treatment-related morbidity and mortality have resulted satisfactory for early and late outcomes of an heterogeneous group of elderly patients with HCC.

Robotic adrenalectomy: technical aspects, early results and learning curve.

BACKGROUND: Adrenal surgery is undergoing continuous evolution, and robotic technology may extend indications for a minimally invasive approach to adrenalectomy. METHODS: Thirty robot-assisted unilateral transperitoneal adrenalectomy procedures have been performed at our Department over the last 5 years. The presence of bilateral lesions and vascular involvement were the only contra-indications for a minimally invasive approach. Several patients presented with significant co-morbidities: BMI > 35 kg/m(2) (20%); ASA score III-IV (58.7%); and moderate to severe impaired respiratory function (36.6%). In addition, 40% of patients had undergone previous abdominal surgery. RESULTS: Two patients presented with intra-operative complications (6.6%) and only one patient required conversion to an open procedure (3.3%). None of the patients required intraoperative transfusions. Hospital morbidity was 10% but no mortality was recorded. The mean hospital stay was 5.2 ± 2.2 days. The mean size of the resected adrenal mass was 5.1 ± 2.4 cm. A significant reduction in operative times was found with gaining experience. CONCLUSIONS: Thanks to robotic technology, some subpopulations of patients with clinical or oncological contra-indications to laparoscopic treatment may be addressed with minimally invasive treatment.

Low correspondence between K-ras mutations in pancreatic cancer tissue and detection of K-ras mutations in circulating DNA.

OBJECTIVE: K-ras is the most frequently mutated gene in pancreatic cancer; reported rates range from 70% to 90%. The aim of this study was to evaluate the correspondence between K-ras mutations in pancreatic cancer tissue and in circulating DNA and the value of K-ras mutations as serological marker. METHODS: The research was conducted in 30 patients with pancreatic cancer in whom both plasma and neoplastic tissues were available. Such research was extended to circulating DNA isolated from 40 patients with chronic pancreatitis. Mutations in codon 12 were examined by mutant allele-specific amplification method and by direct sequencing. Serum values of routinely used tumor markers such as carbohydrate antigen (Ca) 19.9, carcinoembryonic antigen, Ca 50, and Ca 242 have been tested in all the patients enrolled in this study. RESULTS: K-ras mutations were detected in 70% of neoplastic tissue samples, but no mutated DNA resulted in circulating DNA samples. The 60% of patients with tissue K-ras mutation showed elevation of some tumor markers among Ca 19.9, carcinoembryonic antigen, Ca 50, and Ca 242. As a whole, these last showed low sensitivity (20%-56.67%) and specificity (56.67%-77.5%) when compared with chronic pancreatitis. CONCLUSION: Over the years, there has been no change in the direction of an earlier diagnosis by serological markers, and also, these data indicate that K-ras mutation in serum is an unsatisfactory method for the detection in patients with pancreatic cancer as well as in patients with high risk of progression toward neoplastic pancreatic disease.

Surgical treatment of pancreatic head carcinoma in elderly patients.

HYPOTHESIS: The treatment of cancer in elderly patients has become a global clinical issue, considering the increasingly longer life expectancy. Three quarters of patients with pancreatic adenocarcinoma are older than 60 years. Surgical resection is the only chance of cure, and early outcome of pancreaticoduodenectomy in elderly patients is comparable with that obtained in a younger population. DESIGN: During an 11-year period, 166 patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. Clinical and demographic factors were evaluated by univariate and multivariate analyses to test their effect on early outcome. SETTING: State university medical school tertiary care center. PATIENTS: One hundred sixty-six patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. They were divided into 2 groups according to age (group A for patients older than 70 years, group B for patients younger than 70 years). INTERVENTION: Pancreaticoduodenectomy was performed using a Whipple procedure. An end-to-end pancreaticojejunostomy was constructed. Lymphadenectomy was carried out along the hepatoduodenal ligament, common hepatic artery, vena cava, superior mesenteric vein, and along the right side of the superior mesenteric artery. Four abdominal drainage sites were routinely used. MAIN OUTCOME MEASURES: The postoperative hospital stay was calculated and morbidity and mortality were assessed. RESULTS: Significantly higher operative morbidity and mortality were observed in group A (group A, 49.1% vs group B, 45.8% and 10.5% vs 3.7%, respectively). Underlying comorbid conditions in group B patients influenced postoperative morbidity but not mortality. Rate and nature of surgical complications were indicated as causes of significant higher mortality in group B patients. CONCLUSIONS: An aggressive surgical approach is justified for elderly patients with pancreatic adenocarcinoma. However, surgical complications that lead to reoperation are responsible for a high mortality in elderly patients. In addition to general causes, such as concomitant disorders, reduced functional reserve, poor tolerance to stress, and the texture of the pancreatic remnant, there are specific prognostic factors affecting pancreaticojejunostomy leakage and related mortality.

Treatment of giant intramuscular hemangioma: a multistep approach in three patients.

BACKGROUND: Giant intramuscular hemangioma (GIH) is a rare, progressively enlarging benign tumor, characterized by variable presentation and usually initially diagnosed in childhood. Large volume, rapid enlargement and particular radiologic imaging create suspicion of malignancy. Radiologic investigations and needle or small excisional biopsy are not always reliable for an accurate diagnosis; therefore, histology on a large surgical specimen is often requested. The timing and modality of treatment of these tumors is a matter of debate. PATIENTS AND METHODS: Data on 3 patients with GIH of the upper trunk and neck are reported. Associated vascular anomalies were found in all patients. All 3 patients had surgery because of the effect of the growth on their function, the severe symptoms and suspicion of malignancy. RESULTS: A one-step excision of an enormous tumor was carried out in one patient, who died from severe postoperative complications. A second patient was successfully treated by a multistep surgical and multidisciplinary approach. An uneventful removal of part of the tumor was performed on the third patient, who is currently in follow-up for completion of treatment. CONCLUSION: Surgery remains the most effective mode of treatment for GIH and often results in permanent cure. The authors suggest performing the surgical removal of these tumors at first diagnosis, when their smaller size requires less demanding procedures, presents lower rates of morbidity and offers a better chance of complete excision.