Emotions in labour: Italian obstetricians' experiences of presence during childbirth.

OBJECTIVE: The present study represents a qualitative research aimed to explore the obstetricians' psychological experiences of birth. BACKGROUND: During labour the role of obstetricians assumes a fundamental importance in hospitalised childbirth. However, literature analysis has shown that the psychological side of birth has been investigated only considering the woman's and midwife's points of view. The obstetricians' psychological experiences have not been considered enough and only a few studies at a quantitative level have been performed. METHODS: Seven focus groups for a total of 72 obstetricians were conducted in hospital contexts in Italy. The qualitative methodology of grounded theory was adopted. FINDINGS: The results were divided into three different core themes: obstetricians' approaches to delivery, critical aspects about relationships in the delivery room, and obstetricians' feelings and emotions in the delivery room. Each theme was subdivided into different subthemes. CONCLUSION: The results highlight different ways obstetricians approach their profession, the complex and multifaceted relationship with the woman and the extraordinary variety of feelings and emotions, which enrich, but also may complicate, life in the delivery room. Further studies could provide more details to help researchers to develop new and more effective strategies to support obstetricians' training and work.

[Global eradication of dracunculiasis is a reality nowadays].

Global efforts to eradicate dracunculiasis have continued to progress with only 542 cases reported in 2012 versus almost 1 million cases in the 1980s when the initiative was launched. The disease is still endemic, but in only four countries: South Sudan (541 cases), Chad (10 cases), Mali (4 cases), and Ethiopia (4 cases). The International Commission for the Certification of Dracunculiasis Eradication declared that 180 countries were free of the disease by 2013. Dracunculiasis was first eradicated in the former USSR in 1931 when its last case was registered due to the successful implementation of a package of appropriate measures (case detection and management, vector control, and health education, including water filtration from open water sources and behavioral changes). These approaches were actively taken into account when developing the global strategy for dracunculiasis. The World Health Organization has set a goal to eradicate the disease by 2015. However, despite the fact that the global situation looks very optimistic, the time for completing the program will be most likely postponed due to a few operational challenges remaining in the still endemic countries, in South Sudan in particular.

Myocarditis mimicking an acute coronary syndrome: a case related to Salmonella enteritis.

Infective myocarditis is most commonly due to a viral infection; occasionally it has been related to bacteria. Gastrointestinal infections associated with myocarditis have only rarely been described in young people, and the pathogenesis is unclear. We report a case of myocarditis mimicking an acute coronary syndrome (ACS) in a patient hospitalized for fever and diarrhoea. Salmonella enteritidis was isolated from stool, and no other pathogens were found. The coronary angiography was normal, and there were not other coronary artery risk factors, other than hypertension. The patient was treated with ciprofloxacin, acetylsalicylate acid, and ramipril with rapid clinical improvement and normalization of cardiac abnormalities. Final diagnosis of Salmonella enteritis and related myocarditis was made based on clinical, laboratory, ECG and echocardiographical findings.

Occipital intermittent rhythmic delta activity only following eye closure in atypical CNS Salmonellosis.

OBJECTIVE: A statement recently published on the base of a large retrospective analysis, report that the occipital intermittent rhythmic delta activity (OIRDA) "is associated with epilepsy but not acute encephalopathy" [Gullapalli and Fountain. J Clin Neurophysiol 2003;20:35-41]. Our aim is to report, the exception from a child with an intermittent fever, in which the finding of an occipital intermittent rhythmic delta activity (OIRDA) following the eye closure in the EEG recording was the first clinical sign addressing to a CNS involvement. METHODS: To review the record from a five-year-old girl with a normal basal electroencephalogram and OIRDA that only appeared following eye closure. RESULTS: We found OIRDA associated with atypical CNS Salmonellosis. Brain MRI and CSF examination confirmed an acute encephalopathy, which was due to Salmonella infection. The only symptoms of the infection were episodes of nightly fever that had lasted for four weeks, sometimes associated with headache and vomiting. Both OIRDA only induced by eye closing and other symptoms disappeared after starting antimicrobial therapy. CONCLUSIONS: OIRDA only following eye closure is a non-specific abnormality and the present findings, based on a single case, merely indicate that intracranial infection is among the possible causes. SIGNIFICANCE: The new clinical association is certainly worth recording, as the presence of this electrophysiological sign may provoke clinicians to then delve further into a diagnostic work up.

Unusual cases of cervical nerves schwannomas: phrenic and vagus nerve involvement.

Benign neurogenic tumors (neurilemmoma) arising from the cervical phrenic or vagus nerve are relatively rare. These lesions are benign, asymptomatic and incidentally found. We describe two cases considering different surgical techniques adopted. In the case of phrenic nerve schwannoma we performed a total excision of the tumor including the maternal nerve fiber to prevent tumor recurrence, also in regard to the already present hemidiaphragm palsy. On the other hand in second case, in which the vagus nerve was involved, we proposed a microsurgical approach by monitoring nerve function in order to minimize nerve damage.

Malignant fibrous histiocytoma of the pharynx.

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life, but is relatively uncommon in the head and neck region. That region has been reported to be the origin of malignant fibrous histiocytoma in 3-10% of cases. Only one case of the tumor occurring in the pharynx has been reported. Histologically it is sometimes hard to distinguish this tumor from some sarcomas and pleomorphic carcinomas. The treatment of choice is a large surgical resection, while radiotherapy and chemotherapy are reserved for recurrences. The authors present a case of oropharyngeal malignant fibrous histiocytoma. The patient complained dysphagia and dyslalia progressively worsening in six months. Pharyngo-laryngoscopy revealed a mass of the left lateral wall of oro and hypopharynx. CT scan examination showed a capsuled mass which displaced but not involved the neck neurovascular structures; there was no evidence of linphonodal involvement. Transoral surgical excision of the mass was performed with the preservation of speech and swallowing. For more than 1 year postoperatively, there has been no evidence of the disease or metastasis.

Schwannoma of the tongue: one case report.

The schwannomas are nervous tissue tumours that arise from Schwann cells; they are uncommon in peripheral nerves and rare in the tongue. After, a review of the literature, we present a case of schwannoma which arose in the ventral part of the body of the tongue. The tumour presented as a slowly growing mass producing few symptoms. The diagnosis of schwannoma is usually made post-operatively by histological identification although modern imaging techniques can provide useful indications. The treatment is exclusively surgical and usually enucleation of the mass is uncomplicated. There are no reports of malignant transformation.

[Benign hemangiopericytoma of the bladder: description of a case and review of the literature]. / Emangiopericitoma benigno della vescica: descrizione di un caso e revisione della letteratura.

Hemangiopericytoma (HPC) of the viscera is very rare and only six of these tumors arising in the urinary bladder have been previously reported. The differentiation of HPC from other neoplasms with prominent vascular pattern may be a diagnostic problem. The difficulty is further enhanced by the lack of distinctive immunohistochemical features of this tumor. Here is presented a case of benign HPC occurring in the right lateral wall of the bladder of a 37-year-old woman. The mass is completely transurethrally resected. Histologically, the tumor is characterized by a monomorphic population of polygonal or spindle-shaped cells packed around branching vascular channels, with "staghorn" configuration. There are no foci of necrosis or hemorrhage. The mitotic count is 2 per 10 HPF. Immunohistochemically, the tumor cells react with anti-bodies against Vimentin. Cytokeratin, Actin HHF35, S-100, CD 34, Factor VIII-related antigen are not expressed within the lesion. Ultrastructurally, the tumor cells surround endothelium-lined vascular channels. There are pinocytotic vesicles on the cell borders. The cells are separated from one another by deposits of basal lamina-like material and collagen. On the basis of clinical, histological, immunohistochemical and ultrastructural observations, we believe that the case reported is a primary benign HPC of the bladder. There is no evidence of recurrence or metastasis 32 months later.

Chlamydia pneumoniae antibodies and angiographically demonstrated coronary artery disease in a sample population from Italy.

Recent reports suggest an association between Chlamydia pneumoniae and chronic coronary heart disease. This case-control study investigates the relationship between the presence of immunoglobin G (IgG) and immunoglobin A (IgA) when measured by means of microimmunofluorescence (MIF) and angiographically diagnosed coronary disease. Cases (n = 150) were angiography patients with at least one coronary artery lesion occupying at least 50% of the luminal diameter. Controls (n = 49) were angiography patients with no detectable signs of coronary artery disease and patients (n = 56) without signs or symptoms of coronary disease and with normal ECG results. No significant differences were revealed between the seroprevalence of IgG and IaA and geometric mean titers (GMT) as measured in cases and controls. When cases were compared with controls whose angiographic results were normal, after adjusting for established risk factors (cholesterol, smoking, hypertension, diabetes, age, gender and family history), the estimated risk of coronary artery disease was 0.79 (95% confidence interval (C.I.), 0.31-1.99) for the presence of IgG and was 0.94 (95 C.I., 0.37-2.39) for IgA. When cases were compared with controls with normal ECG results, the adjusted odds ratio (O.R.) for coronary artery disease was 1.17 (95%, C.I., 0.52-2.62) for the presence of IgG and 0.82 195% C.I., 0.36-1.86) for the presence of IgA. These results do not support an association between C. pneumoniae infection and coronary disease.

Prognostic value of clinicopathologic characteristics including neuroectodermal differentiation in osseous Ewing's sarcoma family of tumors in children.

AIMS AND BACKGROUND: The aim of the present study was to determine the relationship between clinico-pathologic parameters, including neuroectodermal differentiation, and their impact on survival in a series of pediatric patients with osseous tumors of the Ewing's sarcoma family admitted to the Pediatric Department of the Istituto Nazionale Tumori of Milan. METHODS: Seventy-three patients were enrolled. The variables analyzed were sex, age, site of primary tumor, serum lactate dehydrogenase (LDH) level at diagnosis, involvement of periosseous soft tissues by primary tumor, presence of metastatic disease, status of disease after the treatment plan, as well as the presence of mitoses, morphologic and immunocytochemical neural markers, and neuroendocrine markers in the primary tumor. RESULTS: Neural and neuroendocrine markers were not significantly associated with any of the other parameters. In the univariate analysis, significant risk factors related to unfavorable outcome were elevated LDH, metastatic disease, lack of complete remission after treatment, presence of mitoses and of morphological neural markers; immunocytochemical neural and neuroendocrine markers lacked prognostic value. In the multivariate analysis, only LDH levels and the status of disease following the treatment were retained. CONCLUSIONS: LDH level at diagnosis might be a useful marker to identify different risk levels; neuroectodermal differentiation might have no clear-cut impact on the clinical management of osseous Ewing's sarcoma family of tumors.

Differentiation in paediatric peripheral primitive neuroectodermal tumours of bone. A critical contribution to its assessment.

Differentiation was studied in 73 paediatric peripheral primitive neurorectodermal tumours (pPNETs) of bone observed during 1974 through 1992. The presence of rosettes, pseudorosettes, and/or a rosette-like arrangement of tumour cells (the morphological neural marker, MNM) occurred in 29% of these cases. NSE and N-CAM were expressed by nearly all tumours; synaptophysin was present in 30% of cases, not significantly associated with the MNM status. Neuroendocrine (NE) markers were present in 25% (chromogranin B, secretogranin II) to 40% (chromogranin A, 7B2 protein) of cases. Focal expression of cytokeratins, S100 protein and/or desmin was also noted in a minority of cases. In univariate statistical analysis, only the presence of MNM conferred a significantly higher (about twofold) risk of death than its absence. This study demonstrates the occurrence of at least one immunocytochemical N and/or NE differentiation marker in all pPNETs of bone and a focal expression of cytokeratins, S100 protein and/or desmin in a minority of cases. Synaptophysin and MNM were present each in less than 1/3 of the cases, and no association was noted between them. Statistical analyses highlighted the prognostic role of MNM per se and discourage the sole use of immunocytochemistry in the assessment of neuroectodermal differentiation for prognostic purposes in paediatric pPNETs of bone.

[Proposal for a semiqualitative evaluation method for AgNORs (rap score)]. / Proposta di un metodo di valutazione semiquantitativa delle AgNORs (rap score).

Nucleolar Organiser Regions (NORs) can be stained in paraffin embedded specimens by a simple silver technique: the black dots formed, called AgNORs, have usually been counted only by eye with "careful focusing", a time-consuming and subjective method. Therefore we propose a new semiquantitative approach based on three patterns of AgNORs configuration of increasing malignancy as previously described by Crocker et al: 1) AgNORs fully aggregated to form a solitary argyrophil structure (pattern RESTING: -R-); 2) AgNORs lying within nucleolus and nucleoplasm (Pattern ACTIVATED: -A-); 3) Numerous small AgNORs distributed through the nucleoplasm, without nucleolar structures (Pattern PROLIFERATING: -P-). We assigned a numerical value to each pattern: R = 1; A = 2; P = 3. These values are multiplied by the relative rate in 100 cells. Eventually we obtain a score (range 100-300): this method shows significant correlation (r = 0.8363: regression equation) compared to the usual count obtained "by eye", tested on a sample of 150 breast cancer. Further studies are under way to validate this method which may represent a cheap and useful tool in AgNORs evaluation.