Trimester-specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta-analysis.

OBJECTIVE: To assess the diagnostic accuracy of ultrasound for detecting placenta accreta spectrum (PAS) during the first trimester of pregnancy and compare it with the accuracy of second- and third-trimester ultrasound examination in pregnancies at risk for PAS. METHODS: PubMed, EMBASE and Web of Science databases were searched to identify relevant studies published from inception until 10 March 2023. Inclusion criteria were cohort, case-control or cross-sectional studies that evaluated the accuracy of ultrasound examination performed at < 14 weeks of gestation (first trimester) or ≥ 14 weeks of gestation (second/third trimester) for the diagnosis of PAS in pregnancies with clinical risk factors. The primary outcome was the diagnostic accuracy of sonography in detecting PAS in the first trimester, compared with the accuracy of ultrasound examination in the second and third trimesters. The secondary outcome was the diagnostic accuracy of each sonographic marker individually across the trimesters of pregnancy. The reference standard was PAS confirmed at pathological or surgical examination. The potential of ultrasound and different ultrasound signs to detect PAS was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio and positive and negative likelihood ratios. RESULTS: A total of 37 studies, including 5764 pregnancies at risk of PAS, with 1348 cases of confirmed PAS, were included in our analysis. The meta-analysis demonstrated that ultrasound had a sensitivity of 86% (95% CI, 78-92%) and specificity of 63% (95% CI, 55-70%) during the first trimester, and a sensitivity of 88% (95% CI, 84-91%) and specificity of 92% (95% CI, 85-96%) during the second/third trimester. Regarding sonographic markers examined in the first trimester, lower uterine hypervascularity exhibited the highest sensitivity (97% (95% CI, 19-100%)), and uterovesical interface irregularity demonstrated the highest specificity (99% (95% CI, 96-100%)). In the second/third trimester, loss of clear zone had the highest sensitivity (80% (95% CI, 72-86%)), and uterovesical interface irregularity exhibited the highest specificity (99% (95% CI, 97-100%)). CONCLUSIONS: First-trimester ultrasound examination has similar accuracy to second- and third-trimester ultrasound examinations for the diagnosis of PAS. Routine first-trimester ultrasound screening for patients at high risk of PAS may improve detection rates and allow earlier referral to tertiary care centers for pregnancy management. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Regulation of hepatic P-gp expression and activity by genistein in rats.

P-glycoprotein (P-gp) is an ABC transporter exhibiting high pharmacotoxicological relevance by extruding a wide range of cytotoxic compounds out of the cells. Previously, we demonstrated that the phytoestrogen genistein (GNT) modulates P-gp expression in hepatocellular carcinoma in vitro. Although several beneficial effects (e.g., antioxidant, antimutagenic, anticancer) have been attributed to GNT, the molecular mechanisms have not been totally elucidated. In the present work, we evaluated the effect of GNT on P-gp expression in rat liver, kidney and ileum. We found that GNT (5 mg/kg daily s.c. 3 days) increased hepatic P-gp expression and also Mdr1a (one of the genes encoding P-gp) mRNA levels. Renal and intestinal P-gp remained unchanged after GNT treatment. Hepatic P-gp activity measured with rhodamine-123 and digoxin, both well-known P-gp substrates, was also increased. In vitro experiments using hepatocyte primary cell culture demonstrated that inhibition of ER-α with ICI182/780 did not prevent Mdr1a mRNA up-regulation by GNT (10 µM). In contrast, Mdr1a induction was suppressed after pregnane X receptor (PXR) inhibition by sulforaphane and knockdown of this nuclear receptor. These findings were confirmed in vivo by using the PXR antagonist ketoconazole. In conclusion, we demonstrated the induction of hepatic P-gp expression and activity by GNT in vivo, with PXR being a likely mediator. This suggests that GNT, at concentrations observed in plasma of individuals consuming the phytoestrogen in the diet or through supplements, could affect the clearance of relevant P-gp substrates of therapeutic use as well as toxicity of environmental and food toxicants.

Isolation, characterization and determination of biotechnological potential of oil-degrading bacteria from Algerian centre coast.

AIMS: The Algerian coastline is exposed to several types of pollution, including hydrocarbons. The aim of this work was to isolate oil-degrading bacteria and to explore the intrinsic bioremediation potential of part of its contaminated harbour. METHODS AND RESULTS: A collection of 119 strains, capable to grow on mineral medium supplemented with hydrocarbons, were obtained from polluted sediment and seawater collected from Sidi Fredj harbour (Algiers). Twenty-three strains were selected for further studies. Sequencing of the 16S rRNA gene showed that most isolates belong to genera of hydrocarbonoclastic bacteria (Alcanivorax), generalist hydrocarbons degraders (Marinobacter, Pseudomonas, Gordonia, Halomonas, Erythrobacter and Brevibacterium) and other bacteria not known as hydrocarbon degraders (Xanthomarina) but were able to degrade hydrocarbons. Strains related to Marinobacter and Alcanivorax were frequently isolated from our samples and resulted the most effective in degrading crude oil. Screening of catabolic genes alkB and xylA revealed the presence of alkB gene in several bacterial strains; one isolate harboured both catabolic genes while other isolates carried none of the studied genes. However, they grew in the presence of crude oil implying the existence of other biodegradation pathways. CONCLUSIONS: The samples of seawater and sediment from the Algerian coast contain high level of hydrocarbon-degrading bacteria that could be interesting and useful for future bioremediation purposes. SIGNIFICANCE AND IMPACT OF THE STUDY: This investigation demonstrates the diversity of hydrocarbon-degrading bacteria from a marine-contaminated area in Algeria, and their variable biodegradation abilities.

Single-Incision Laparoscopic Cholecystectomy: our experience and review of literature.

AIM: After the revolution in the surgery of gallbladder stones represented by the laparoscopic cholecystectomy, we tried a new technique that further maximize the aesthetic results and that at the same time is of easy learning for young surgeons. PATIENTS AND METHODS: From January 2011 to December 2012 we performed at our department 320 cholecystectomy: 27 in laparotomy and 293 in laparoscopy. Of these, 88 underwent to Single Incision Laparoscopic Surgery (SILS), namely the Single Incision Laparoscopic Cholecystectomy (SILC), in recruited patients aged between 19-65 years; 56 patients were females and 32 were males. RESULTS: The laparoscopic cholecystectomy with the SILS methodology is a safe technique. Respect to multi-port Laparoscopic Cholecystectomy (LC), we have cosmetic advances. The pain is less in extraumbilical sites, and the major umbilical pain can be prevented by local anaesthesia. The times are slightly longer, especially at the beginning of training, but after a few of operations it is reduced to about one hour. We didn't found any other difference in vantage and advantage between the two technics, only a case of postoperative umbilical hernia in SILS. CONCLUSION: We found the SILS a safe and effective technique for the cholecystectomy.

Pediatric blunt renal trauma with wide fragments dislocation: successful organ saving management by internal stenting and percutaneous perirenal drain.

Children have an high risk of renal damage as a result of blunt trauma. Conservative management is always recommended for lower grades (I to III) but is rather controversial whenever high grade injuries (grade IV and V) are concerned. We describe a case of successful conservative management in grade IV renal injury occurred in a 9-years-old girl with blunt trauma.

Lymphoma of cheek: a case report.

Lymphoma of cheek is a rare ad uncommon disease, representing 2,5% of malignant lymphoma. The cause is unknown but there are a lot of risk factors such as Helicobacter pylori and Epstein Barr virus. Symptoms are aspecific and may be confused with otolaryngological benign diseases. We present a case of B cell lymphoma of the cheek, which presented with a history of a slowly growing swelling of 3 months duration, resistant to NSAIDs and antibiotic therapy. Biopsy of the mass led to diagnosis of lymphoma. Blood investigations, ultrasonography and CT scan helped to reach this result. This case report shows that an accurate clinical examination, a cytohistological and immune-histochemical diagnosis by fine-needle aspiration biopsy (FNAB) are fundamental to obtain a diagnosis and to decide therapy.

A large calcified retroperitoneal extraskeletal osteosarcoma with consequent bilateral hydronephrosis.

Extraskeletal osteosarcoma (ESOS) is a rare malignant mesenchymal neoplasm that accounts for less than 4% of all osteosarcomas and approximately 1-2% of all soft tissue sarcomas. The tumor is typically located in the deep soft tissues, without attachment to skeletal bones. Although ESOS has been found todevelop virtually in every organ, its most common locations are the limbs. In the case of abdominal or pelvic lesions the diagnosis can be very difficult, thus it necessarily requires confirmation after exploratory laparotomy and histopathology. Such tumors may reach enormous sizes before detection because the enlarging mass may not be associated with pain. ESOS may be one of the differential diagnoses to be considered in the case of calcified masses arising in retroperitoneal space. Here we describe a bulky, bilateral, metastatic ESOS arising from the retroperitoneum and causing obstructive uropathy with consequent hydronephrosis.

Intestinal lymphoma: a case report.

Primary intestinal lymphoma is rare representing about 0.5% of all colonic malignancies. It can be classified into two principal categories: follicular B cell lymphomas and intestinal T cell lymphomas. Other intestinal diseases are very important such as immunoproliferative small intestinal disease (IPSID), a prelymphomatous process, and MALT lymphomas, caused by infection of Helicobacter pylori (H. Pylori). We present a 79-year-old male patient which presented with abdominal pain in the upper parts of abdomen of four months' duration, colic timpanists, tenderness, distention, weight loss. Sometimes the abdominal pain decreased expelling diarrheal dejections. Histological and immune-histochemical tests on bioptic piece helped to reach the diagnosis of lymphoma but only after histological investigation on operative piece was made the diagnosis of B-cell lymphoma. This case report shows that an accurate diagnosis, the evaluation of the extension and the presence of particular infections and/or co morbidities (H. Pylori positive, age, performance status) are fundamental to decide the therapeutic protocol.

The neo-adjuvant treatment in gastrointestinal stromal tumor.

Gastrointestinal Stromal Tumor (GIST) is a rare intra-abdominal tumor, characterized by a specific histological and immunohistochemical pattern. These tumors affect with higher frequency stomach and small bowel and occur at a median age of 60 years with a slight male predominance. An early stage of GIST often don't cause any symptoms, so most GISTs are diagnosed in later stages of the disease. We report a case of GIST diagnosed only with clinical data and positron emission tomography (PET). We demonstrate the usefulness of neoadjuvant treatment with Imatinib mesylate, a newly developed tyrosine kinase receptor inhibitor. The neoadjuvant treatment with Imatinib reduced the mass size and vascularization, making possible a surgical approach.

Aggressive scalp carcinoma with intracranial extension: a multidisciplinary experience of 25 patients with long-term follow-up.

Malignant skin cancer of the scalp with skull invasion, dural infiltration and brain involvement is a uncommon lesion. This scenario is most often encountered in patients where initial scalp lesions are not appropriately diagnosed or their extent is underestimated by the patient and/or the doctor. Our study is a retrospective review of 25 patients treated using a multidisciplinary approach (combined plastic surgery/neurosurgery procedure and neuro-oncological management). After a mean follow-up of 7 years, 22 patients did not show local recurrence or distant metastases of their primary disease. Overall, these 22 patients had excellent quality of life; however, three patients died from causes not related to their primary pathology. To obtain a complete and definitive cure, prompt diagnosis of scalp cancers followed by appropriate multidisciplinary management is strongly advised.

[The use of dermic substitutes in the repair of cutaneous defect due to a phlebostatic wound]. / L'utilizzo di sostituti dermici nella riparazione del difetto cutaneo da ulcera flebostatica.

The use of dermic substitutes is a valid and effective choice in the treatment of the cutaneous defects with loss of substance. In our experience, the aesthetic and functional results of dermic substitutes is really positive and encouraging, with better tolerance by patients than the autologue grafts.

[Surgical treatment of abdominal trauma in pediatric age]. / Traumi chirurgici addominali in età pediatrica.

AIM OF THE STUDY: to value the appropriateness and the efficacy of non-operative treatment in children with blunt abdominal trauma. PATIENTS AND METHODS: in this research 14 children with abdominal trauma, secondary mostly to road accidents, were studied; 9 of these had single organ injury while 5 had multiple organ injuries. Spleen has been the most injured organ (9 children), followed by liver (5 cases) and kidney (2 cases). Five children were admitted at emergency department in hypovolemic conditions, promptly corrected by resuscitative measures. All patients underwent abdominal ultrasound and/or C.T. scans in order to detect any intraperitoneal free fluid or organic injuries. Six children (43%) were followed by non-operative treatment, while other eight underwent surgery. RESULTS: all children, those treated conservatively as well as those operated, were cured, without any important complication. DISCUSSION AND CONCLUSIONS: nowadays, with the great help of ultrasound and C.T. scans, is possible to treat 40-50% of children affected by abdominal trauma with non-operative measures, with return to normal functions by the injured organs. The surgical approach is today accomplished only in presence of severe injuries or haemodynamic instability resistant to resuscitative treatment. The majority of Authors in the literature agree on the usefulness of non-operative treatment, especially for children. Regarding surgical treatment, in the near future probably we'll see a larger application of laparoscopic techniques also in the field of abdominal traumatology.

[Castleman's disease: a case report]. / Malattia di castleman. Contributo clinico.

Castlemans disease (CD) was described from Benjamin Castleman in 1954. The disease today is enumerated among lymphoproliferative disorders and has unknown etiology, but a interleukin-6 (IL-6) dysregulation and a reaction to viral antigens (HHV8) especially in patients with immunodeficiency is suspected. It is observed in adult and young people, in male or female with equal frequency; the appearance in childhood is extremely rare. The disease shows various clinical and histological pictures, with a localized type (involvement of one lymph node group) described more frequently than the multicentric one. Histological examination distinguish a "hyaline-vascular type" that represents approximately the 91%, a plasma cell type" that represents approximately the 9% has an aggressive clinical outcome, and the "mixed types". Initial symptoms are nearly absent, but not for the plasma cell type. We describe the clinical case of a female patient 21 years old. She reached our observation in May 1999, referring us for pelvic pains and amenorrhoea from four years. During 1996 she underwent to a laparoscopy that diagnosed an endometrial cyst on left ovary. A year later a new retroperitoneal mass was discovered and a second laparoscopy was performed with a little partial excision of the tumor. In our Institute the us and the TC showed a retroperitoneal mass of 4.5 cm of diameter, next to the uterus and the iliac left vessels. The patient underwent surgical laparotomic excision and histological examination showed hyaline vascular type of CD. Three years after surgery the patient is still free of any symptoms.

[Breast carcinoma in pregnancy: a clinical case]. / Carcinoma della mammella in gravidanza: caso clinico.

Breast cancer is a rare, but frequently hidden pathology. A woman, 36 years old, during the early months of pregnancy found a little tumor in her right breast. A fine needle biopsy was negative for cancer. Despite this, the tumor rose and two months after delivery (the patient breast-fed her daughter for a month), she had pain in the right axillary region and the tumors involved all superior dials of the right breast. A Madden mastectomy was performed. The histopathological report was: ductal invasive breast cancer 3 of 19 lymph nodes involved, stage IIIA, TNM pT3N2M0, ER -, PgR +--. Chemotherapeutic regimens were: at first ADM 75 mg/m2 for 5 cycles, and after CMF 1-8 for 6 cycles. After six months the woman had a cutaneous recurrence in the scar of mastectomy, treated with surgery and RT. Thirteen months after, she had lung MTS and then brain MTS. The patient died thirty months after the mastectomy. The surgeons have to discover the women high-risk for the breast cancer before and during the pregnancy. Excisional biopsy is the diagnostic procedure of choice for breast lump during pregnancy. When a breast cancer develops during a pregnancy, the surgeon has to operate immediately the tumors. Chemotherapeutic regimens should be delayed until the second o third trimester or after delivery.

[The thyroidectomized follow-up]. / Il follow-up dei tiroidectomizzati.

Thyroid neoplasties are largely benign, and only 1% of all over malignant neoplasties with clinical diagnosis regard the thyroid. The histologic characteristics of the thyroid neoplasties assume fundamental importance both in diagnosis and in therapy. The authors underline the importance of the surgical treatment of malignant neoplasties of the thyroid with the problems connected to the choice of the entity of the demolition of the organ and the post-operative thyrohyoid residue and the importance of the correct follow-up for few patients, consenting to optmize the available resources.

Molecular basis of perinatal changes in UDP-glucuronosyltransferase activity in maternal rat liver.

The molecular basis of perinatal changes occurring in major UDP-glucuronosyltransferase (UGT) family 1 isoforms and in UGT2B1, a relevant isoform belonging to family 2, was analyzed in rat liver. Nonpregnant, pregnant (19-20 days of pregnancy), and two groups of postpartum animals corresponding to early and middle stages of lactation (2-4 and 10-12 days after delivery, respectively) were studied. UGT activity determined in UDP-N-acetylglucosamine-activated microsomes revealed that bilirubin, p-nitrophenol, and ethynylestradiol (17beta-OH and 3-OH) but not androsterone and estrone glucuronidation rates, were decreased in pregnant rats. Decreased enzyme activities returned to control values after delivery. p-Nitrophenol, androsterone, and estrone conjugation rate increased in postpartum rats. Western blot analysis performed with anti-peptide-specific (anti-1A1, 1A5, 1A6, and 2B1) antibodies revealed decreased levels of all family 1 isoforms and UGT2B1 during pregnancy. In postpartum animals, protein level recovered (1A5 and 2B1) or even increased (1A1 and 1A6) with respect to control rats. Northern blot analysis suggested that expression of UGT proteins is down-regulated at a post-translational level during pregnancy and that increased levels of 1A1 and 1A6 observed in postpartum rats were associated to increased mRNA. To establish whether prolactin is involved in up-regulation of UGT1A1 and 1A6 postpartum, ovariectomized rats were treated with 300 microg of ovine prolactin per day for 7 days. The data indicated that prolactin was able to increase expression of UGT1A6 (protein and mRNA) but not 1A1. Thus, prolactin is the likely mediator of the increased expression of UGT1A6 observed in maternal liver postpartum.

Quantitative and qualitative gender-related differences in jejunal glutathione S-transferase in the rat effect of testosterone administration.

Gender-related differences and the regulation by testosterone of glutathione S-transferase were studied in rat jejunum. We analyzed enzyme activity and the relative content of GST subunits. Four experimental groups of adult rats were studied: normal males, castrated males, castrated males injected with testosterone and normal females. Glutathione S-transferase activity was assayed using 1-chloro-2,4-dinitrobenzene and 1,2-dichloro-4-nitrobenzene as substrates. Differences in subunit composition among groups were evaluated by western blot analysis. The results demonstrated that 1-chloro-2,4-dinitrobenzene conjugation rate is higher in normal males than in normal females and castrated males. Testosterone administration to castrated males raised the activity up to the level observed in normal males. No significant difference in glutathione S-transferase activity towards 1,2-dichloro-4-nitrobenzene was observed among groups. Western blot analysis revealed that males and females differ in all subunits tested that is, rGSTA2, rGSTM1, rGSTM2 and rGSTP1, and that testosterone regulates the content of rGSTM1, rGSTM2 and rGSTP1. In conclusion, jejunal GST shows a gender-dependent regulation affecting both enzyme activity and subunit composition, and testosterone appears to be one of the factors involved.

Induction of phase II biotransformation reactions in rat jejunum during lactation. Possible involvement of prolactin.

The effect of lactation on UDP-glucuronosyltransferase (UGT) and Glutathione S-transferase (GST) activities was studied in jejunum from mother rats, 14 (LM14) and 21 (LM21) days after delivery. p-Nitrophenol glucuronidation rate was increased in LM14 and LM21 rats while conjugation of bilirubin and estrone was not affected and androsterone glucuronidation was decreased. Additional studies, including Western blotting and microsomal lipid analysis, revealed that the enhancement in p-nitrophenol UGT activity is most likely associated with an inductive process rather than with a modification in enzyme constraint. GST activity towards 1-chloro-2,4-dinitrobenzene (CDNB) was also increased in LM14 and LM21 while activity towards 1,2-dichloro-4-nitrobenzene (DCNB) was not affected. Western blotting revealed a significant increase in the cytosolic content of mu (rGSTM2) and pi (rGSTP1) class subunits in LM14 and LM21 groups, while the alpha class subunit rGSTA2 remained unchanged. To evaluate the potential modulatory role of prolactin on the same enzyme systems, ovariectomized rats were treated with ovine prolactin (oPRL) at doses of 100, 200 and 300 microg/100 g body wt. per day for 4 days. Hormone administration affected UGT activities towards p-nitrophenol and androsterone and GST activity towards CDNB in a way and magnitude consistent with those produced in lactating rats, while conjugation of estrone, bilirubin and DCNB were unchanged. Western blotting data were also consistent with those of lactating rats. These results indicate that UGT and GST activities are increased in rat jejunum during lactation, due to induction of some specific isoforms, and that prolactin is the likely mediator of these effects.

Prolactin increases the hepatic content of mu-class subunits of glutathione S-transferase in the rat.

Hepatic glutathione S-transferase (GST) activity is increased in postpartum female rats, a phenomenon that depends on the lactation stimulus. Here we evaluated the effect of prolactin (PRL) administration on hepatic enzyme activity and on the expression of the major subunits of the alpha- (rGSTA1, rGSTA2, rGSTA3) and mu-classes (rGSTM1, rGSTM2). A similar study was conducted in lactating (LM) and in nonlactating (NLM) mother rats 14 days after delivery and in virgin female rats (V). Ovine PRL (oPRL) was administered to ovariectomized rats at daily doses of 75, 150, 200, and 300 microg/100 g b.wt. (PRL1, PRL2, PRL3, and PRL4, respectively) for 4 consecutive days. GST activity was measured using 1-chloro-2,4-dinitrobenzene as substrate. The relative content of the different subunits was determined by Western blot. oPRL produced a dose-dependent increase in GST activity (60% at the highest dose). Subunit analysis performed in PRL2 and PRL4 revealed a substantial enhancement in rGSTM2 and to a lesser extent in rGSTM1, in response to oPRL. The effect was also dose-dependent. alpha-Class subunits were increased only slightly after hormone treatment. A 60% increase in GST activity was observed for LM relative to NLM and V. As was observed for PRL treatment, the increase was associated with changes in the expression of mu-class subunits whereas alpha-class subunits were not affected by lactation. Taken together these data would indicate a role of PRL in regulating GST activity postpartum via an increase in the content of mu-class subunits, particularly rGSTM2.

Enhancement of intestinal UDP-glucuronosyltranferase activity in partially hepatectomized rats.

To evaluate whether a temporary hepatic insufficiency may affect intestinal glucuronidation, we determined UDP-glucuronosyltransferase activity towards bilirubin and p-nitrophenol in rat jejunum and liver after partial hepatectomy. Enzyme assays were performed in native, and in UDP-N-acetylglucosamine- or palmitoyl lysophosphatidylcholine-activated microsomes at different times post-hepatectomy. Content of enzyme was analyzed by Western blot. Microsomal cholesterol/phospholipid ratio, phospholipid and total fatty acid classes were also determined to evaluate the possible influence on enzyme activity. The results show that while hepatic microsomes exhibited no change in UDP-glucuronosyltransferase activity (for both substrates) with respect to shams at any time of study, intestinal activities increased significantly 48 h after surgery, returning to sham values 96-h post-hepatectomy. Western blotting confirmed the increase (about 50% for both substrates 48-h post-hepatectomy) in intestinal UDP-glucuronosyltransferase activity. No variations were observed in hepatic and intestinal microsomal lipid composition in agreement with the absence of modification in the percent of activation by palmitoyl lysophosphatidylcholine. In conclusion, jejunum but not liver, was able to produce a compensatory increase in conjugation capacity during a transitory loss of hepatic mass. The phenomenon is associated to a modification in the amount of UDP-glucuronosyltransferase, rather than to changes in the characteristics of the enzyme environment.