A simplified regimen of targeted antifungal prophylaxis in liver transplant recipients: A single-center experience.

BACKGROUND: Invasive fungal infection (IFI) is a severe complication of liver transplantation burdened by high mortality. Guidelines recommend targeted rather than universal antifungal prophylaxis based on tiers of risk. METHODS: We aimed to evaluate IFI incidence, risk factors, and outcome after implementation of a simplified two-tiered targeted prophylaxis regimen based on a single broad-spectrum antifungal drug (amphotericin B). Patients presenting 1 or more risk factors according to literature were administered prophylaxis. Prospectively collected data on all adult patients transplanted in Turin from January 2011 to December 2015 were reviewed. RESULTS: Patients re-transplanted before postoperative day 7 were considered once, yielding a study cohort of 581 cases. Prophylaxis was administered to 299 (51.4%) patients; adherence to protocol was 94.1%. Sixteen patients developed 18 IFIs for an overall rate of 2.8%. All IFI cases were in targeted prophylaxis group; none of the non-prophylaxis group developed IFI. Most cases (81.3%) presented within 30 days after transplantation during prophylaxis; predominant pathogens were molds (94.4%). Only 1 case of candidemia was observed. One-year mortality in IFI patients was 33.3% vs 6.4% in patients without IFI (P = .001); IFI attributable mortality was 6.3%. At multivariate analysis, significant risk factors for IFI were renal replacement therapy (OR = 8.1) and re-operation (OR = 5.2). CONCLUSIONS: The implementation of a simplified targeted prophylaxis regimen appeared to be safe and applicable and was associated with low IFI incidence and mortality. Association of IFI with re-operation and renal replacement therapy calls for further studies to identify optimal prophylaxis in this subset of patients.

Polarized Raman mapping and phase-transition by CW excitation for fast purely optical characterization of VO2 thin films.

Vanadium dioxide has attracted much interest due to the drastic change of the electrical and optical properties it exhibits during the transition from the semiconductor state to the metallic state, which takes place at a critical temperature of about 68 °C. Much study has been especially devoted to developing advanced fabrication methodologies to improve the performance of VO2 thin films for phase-change applications in optical devices. Films structural and morphological characterisation is normally performed with expensive and time consuming equipment, as x-ray diffractometers, electron microscopes and atomic force microscopes. Here we propose a purely optical approach which combines Polarized Raman Mapping and Phase-Transition by Continuous Wave Optical Excitation (PTCWE) to acquire through two simple measurements structural, morphological and thermal behaviour information on polycrystalline VO2 thin films. The combination of the two techniques allows to reconstruct a complete picture of the properties of the films in a fast and effective manner, and also to unveil an interesting stepped appearance of the hysteresis cycles probably induced by the progressive stabilization of rutile metallic domains embedded in the semiconducting monoclinic matrix.

The effects of a multimodal training program on burnout syndrome in gynecologic oncology nurses and on the multidisciplinary psychosocial care of gynecologic cancer patients: an Italian experience.

OBJECTIVE: In cancer care, the burden of psycho-emotional elements involved on the patient-healthcare provider relationship cannot be ignored. The aim of this work is to have an impact on the level of burnout experienced by European Institute of Oncology (IEO) gynecologic oncology nurses (N = 14) and on quality of multidisciplinary team work. METHOD: We designed a 12 session multimodal training program consisting of a 1.5 hour theoretical lesson on a specific issue related to gynecologic cancer patient care, 20 minute projection of a short film, and 1.75 hours of role-playing exercises and experiential exchanges. The Link Burnout Questionnaire (Santinello, 2007) was administered before and after the completion of the intervention. We also monitored the number of patients referred to the Psycho-oncology Service as an indicator of the efficacy of the multidisciplinary approach. RESULTS: After the completion of the program, the general level of burnout significantly diminished (p = 0.02); in particular, a significant decrease was observed in the "personal inefficacy" subscale (p = 0.01). The number of patients referred to the Psycho-oncology Service increased by 50%. SIGNIFICANCE OF RESULTS: Nurses are in the first line of those seeing patients through the entire course of the disease. For this reason, they are at a particularly high risk of developing work-related distress. Structured training programs can be a valid answer to work-related distress, and feeling part of a multidisciplinary team helps in providing patients with better psychosocial care.

Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality?

We investigated the influence of nipple areolar complex (NAC) sparing in mastectomy, on patient satisfaction with cosmetic results, body-image, sexuality and psychological well-being. We developed a specific questionnaire and compared two groups of women who underwent radical mastectomy with immediate breast reconstruction (IBR). Between 2004 and 2006, 310 women with NAC preservation and 143 patients with successive NAC reconstruction were mailed the questionnaire at follow-up 1 year after definitive complete breast reconstruction surgery. 256 questionnaires was available. Our results showed significant differences in favour of the NAC sparing group regarding body image (difficulty in looking at themselves naked and being seen naked by their partners after surgery, P = 0.001 and P = 0.003, respectively); regarding satisfaction with the appearance of the nipple (P < .0001) and with the sensitivity of the nipple (P = 0.001); regarding the feeling of mutilation (P = 0.003). NAC sparing in mastectomy has a positive impact on patient satisfaction, body image and psychological adjustment.

MBL2 and MASP2 gene polymorphisms in patients with hepatocellular carcinoma.

The pathogenesis of hepatocellular carcinoma (HCC) is not fully understood, but the majority of patients with HCC are associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Mannan-binding lectin (MBL) is a collectin that can act directly as opsonine or activate MBL-associated serine proteases (MASPs) thus initiating the antibody-independent pathway of the complement system. In our study, we analysed two MBL2 and MASP2 functional polymorphisms (MBL2 allele A/0 and MASP2 D120G) as well as MASP2 polymorphism (Y371D) responsible for an amino acidic change in the protein in 215 HCC patients (HBV-infected, HCV-infected, HBV/HCV co-infected and patients with HCC with no viral infection) and 164 healthy controls to give new insights regarding the role of these two molecules in HCC and viral infection pathogenesis. No significant association was found between MBL2 or MASP2 alleles or genotypes, neither comparing the total patients with HCC and healthy controls nor between the different groups of HCC subjects divided for type of viral infection. Also, dividing the total HCC patients group into low MBL producer (A0 and 00 genotypes) and normal producer (AA genotype) and comparing MASP2 polymorphisms in these two groups, no significant differences were found. Our data do not seem to suggest a role for MBL2 and MASP2 polymorphisms in HCC susceptibility either for HBV-HCV infection-dependent HCC or for HCC raised as a consequence of exposure to different risk factors.

Anterolateral adipofascial turnover flap of the leg: Anatomical study.

AIM: The aim of this study is to clearly define the vascularisation of the lateral paratibial septum of the leg, defining the basis for a vertical pedicled adipofascial flap harvested from the anterolateral aspect of the leg to cover pretibial soft tissue defects. MATERIALS AND METHODS: Twelve cadaver legs (eight fixed with formalin and four fresh) were dissected. The vessels running into the lateral paratibial septum were identified. The number of vessels were noted and evaluated at the lateral border of the proximal, middle and distal thirds of the leg. In addition, an angiographic study was performed on two limbs to confirm the connection between tibialis anterior artery and the overlaying fascia through these septal vessels. RESULTS: All the specimens had periosteo-septal vessels running in the lateral aspect of the tibia. The average number was 6.6. The distribution was constant in all the thirds of the leg. CONCLUSION: These data are useful to propose the harvesting technique for adipofascial flap with vertical pedicle as a suitable reconstructive option to cover pretibial soft tissue defects.

Simultaneous Liver-Kidney Transplantation in Adults: A Single-center Experience Comparing Results With Isolated Liver Transplantation.

BACKGROUND: After introduction of the Model for End-Stage Liver Disease (MELD) score in 2002, a worldwide increasing number of simultaneous liver-kidney transplantations (SLKTx) has been observed. However, organ shortage puts into question the allocation of 2 grafts to 1 recipient. This retrospective, single-center study compared SLKTx results with isolated liver transplantation (LTx). METHODS: Between 1995 and 2013, 37 SLKTx were performed in adult recipients. Every SLKTx was matched by donor age (±5 years) and transplantation date with 2 LTx (n = 74). Pretransplant, intraoperative, and post-transplant variables were collected; liver graft and patient survivals were calculated. RESULTS: As expected, donor age was similar in the 2 groups (median, 39.7 years), whereas serum creatinine level, glomerular filtration rate, and MELD and D-MELD (donor age*MELD) scores were significantly higher in the SLKTx group. SLKTx had longer waiting list time (P = .0034) as well as higher surgical difficulty, testified by more blood transfusions (P = .0083), increased use of classic caval reconstruction (P = .0024), and more frequent need of abdominal packing for bleeding control (P = .0003). In addition, duration of hospital stay (P < .0001), second-look surgery (P = .0082), post-transplant dialysis (P < .0001), and post-transplant infections (P = .04) were significantly greater in SLKTx group. Acute rejection episodes involving the liver were significantly less in SLKTx than in LTx (14% vs 41%; P = .0045). Liver graft and patient survival at 10 years after transplantation was similar in the 2 groups (liver graft: SLKTx, 80% vs LTx, 77% [P = .85]; patient: SLKTx, 86% vs LTx, 79% [P = .56]). CONCLUSIONS: Despite being technically challenging, SLKTx provided excellent long-term results and was shown to be an effective use of liver grafts.

Fluoroapatite glass-ceramic coatings on alumina: structural, mechanical and biological characterisation.

The aim of this work was to realise bioactive coatings on full density alpha-alumina substrates. An SiO2-CaO-based glass (SC) and an SiO2-Al2O3-P2O5-K2O-CaO-F--based glass-ceramic (SAF) were used for this purpose. Specifically, SAF is a fluoroapatite containing glass-ceramic and previous studies have shown that it is a highly bioactive biomaterial. Furthermore, these fluoroapatite crystals possess a needle-shaped morphology which mimics that of hydroxylapatite found in human hard tissues, particularly in teeth. SAF is a very viscous glass-ceramic and for this reason an intermediate, less viscous, SC layer was interposed in direct contact with alumina aiming to obtain a good coating adhesion. Moreover, this intermediate layer strongly lowers the Al3+ diffusion and thus minimises both compositional changes in the SAF outer layer and the risk of detrimental modifications of the nature of the crystalline phases. A complete characterisation of the coated samples was performed by means of X-ray diffraction, optical and scanning microscopy. Coating adhesion on alumina was tested by comparative shear tests while biocompatibility was investigated on alumina. bulk SAF and on the realised coatings. For this purpose, cytotoxicity, adhesion and proliferation of human osteoblast-like cells were cultured onto the three materials. Results showed that the interposition of the SC layer was successful in allowing a good softening and spreading of the SAF outer layer and in avoiding the crystallisation of undesired crystalline phases maintaining the good bioactive properties of the bulk one. In vitro results on the coatings showed osteoblast-like cell behaviour similar to bulk fluoroapatite glass-ceramic and better respect to alumina substrates, being a promising index of bone material integration and of its in vivo possible applications.

Isoelectric focusing and quantitative estimation of cerebrospinal fluid and serum IgG in idiopathic polyneuropathy.

Isoelectric focusing and quantitative estimation of serum and CSF IgG were performed in 85 patients with idiopathic polyneuropathy (IP), subdivided according to the clinical course (acute, subacute, recurrent, chronic). Acute IP very frequently had an increase of oligoclonal and/or polyclonal serum IgG during the progressive phase and blood-CSF barrier damage accompanied by polyclonal IgG intrathecal synthesis during the stationary phase. Polyclonal IgG intrathecal synthesis was also present in several not acute IP and seemed to forecast unfavorable course. Oligoclonal IgG synthesis occurs very rarely within CSF but is a frequent finding in serum of patients with IP. Abnormalities of the IgG serum pattern are neither specific for any clinical course of IP nor of prognostic value. The possible significance of such findings is discussed.

Immunocytochemical determination of estrogen and progesterone receptors on 219 fine-needle aspirates of breast cancer. A prospective study.

Fine needle aspirates from breast carcinomas of 219 patients were examined cytologically and for the determination of estrogen receptors (ER) and, in 145 of these cases, of progesterone receptors (PR), with the immunocytochemical technique. The traditional biochemical method was also followed for the post-surgical examination of the excised tumour for the determination of the ER and PR contents. In 149 of the 219 cases involving the determination of the ER, and in 112 of those where the PR was determined, the results were compared with those obtained using the biochemical method. Assuming the biochemical technique to be reliable, we obtained the following results with the immunocytochemical method for the ER: 84 true positives, 54 true negatives, 6 false negatives, 5 false positives, 93.3% sensitivity, 91.5% specificity, 94.3% positive predictive value, 90% negative predictive value, 92.6% accuracy, coefficient of correlation 0.83, p = 0.000006. For the PR, we obtained: 42 true positives, 60 true negatives, 6 false positives, 4 false negatives, 91.3% sensitivity, 90.9% specificity, 87.5% positive predictive value, 93.7% negative predictive value, 91.07% accuracy, coefficient of correlation of 0.83, p = 0.000001. Excluding those patients who underwent neoadjuvant treatment, the ER showed 94.3% sensitivity, 98.1% specificity, 98.8% positive predictive value, 91.5% negative predictive value and 95.8% accuracy, and the PR gave 93.3% sensitivity, 93.7% specificity, 91.3% positive predictive value, 95.2 negative predictive value and 93.7% accuracy.

Immunocytochemical determination of estrogen and progesterone receptors and flow cytometric DNA analysis of breast cancer on fine needle aspirates.

A prospective study was performed on a series of 42 patients with breast carcinoma. Immunocytochemical determination of receptors for estrogens (ER) and progesterone (PR) and flow cytometric DNA analysis (DNA-ploidy and the S-phase fraction) were performed on material obtained from fine-needle aspirates (FNA). The patients underwent subsequent surgery, and the same parameters were determined on the surgical samples. The correlation between the biochemical and the immunocytochemical methods gave for ER, r = 0.853, p < 10 (-6) and for PR, r = 0.830, p < 1.6 (-6). In addition, comparisons of FNA's with the surgical samples showed significant relationships for the DNA index (r = 0.96, p < 0.000001) and for the S-phase fraction (r = 0.88, p < 0.000001).

Current indications and limits of pancreatic islet transplantation in diabetic nephropathy.

Insulin-dependent diabetes mellitus (IDDM) is a disease caused by a progressive autoimmune destruction of the insulin-producing beta-cells within the pancreas. A major task of diabetes research consists in developing new forms of treatment to delay or prevent the development of the chronic complications associated with the disease. Islet transplantation could become an attractive alternative to whole organ transplantation, since it is a simpler and safer procedure. However, the requirement for long-term immunosuppression has limited the indication of islet transplantation to patients receiving a simultaneous kidney transplant or already bearing one. While the majority of recipients of islet allografts did not become insulin independent, the field has witnessed significant progress and the long-term results in patients with even partial graft function are comparable or better than those achievable with intensive insulin therapy. Recent trials of donor bone marrow infusions combined with solid organ transplants are in progress to determine whether donor-specific tolerance can be achieved with the potential to expand the future indications of islet transplantation in diabetes.

Hypertensive pneumocephalus and nasal fistula in ventriculo-peritoneal shunt: case report and review of literature.

A case of hypertensive endoventricular pneumocephalus associated with rhinoliquorrea raised after about 2 years from the application of ventriculo-peritoneal shunt for hydrocephalus by stenosis of aqueduct is presented. The causes of such complication and diagnostic possibilities to point out the fistula by CT and ventricular cisternography are to talk over. Even the indication of external CSF drainage or to the repairing treatment will be discussed. Finally, literature is reviewed.

A rare case of ceruminous tumor of the cerebellopontine angle.

In this case report we describe the development in the cerebellopontine angle of a very rare tumor, ceruminous adenoma. In the few cases described in the literature this tumor occurred in the external acoustic meatus. In four cases it developed in the cerebellopontine angle by infiltration of the petrous bone or by subcutaneous spread. In the present case no connection was found between the cerebellopontine angle and the external acoustic meatus. The most likely pathogenetic hypothesis in this case is that of a tumor of dysembryogenetic origin.

[The pathology of self-destruction. Personal experience. Clinico-statistical aspects]. / Patologia anticonservativa. Esperienza personale. Considerazioni clinico-statistiche.

Personal experience of 165 cases of attempted suicide observed at the resuscitation centre of the Biella Hospital in the period 1983-1987 is reported. The patients are examined from the point of view of their personal status, job, previous pathologies with particular regard to depressive anxiety syndromes. Particularly noteworthy is the high incidence of mortality among patients who had tried suicide previously.

[Experience with regard to the use of plasmapheresis in pathologies of resuscitative importance]. / Esperienza riguardo all'uso della plasmaferesi in patologie di interesse rianimatorio.

After a report on the basic techniques and clinical significance of plasmapheresis, personal experience of the application of the technique on 6 patients with various pathologies is described. The overall results were satisfactory.

[Intra-arterial chemotherapy in the treatment of liver metastases of colorectal cancer]. / La chemioterapia intrarteriosa nel trattamento delle metastasi epatiche da cancro del colon-retto.

AIM: The authors evaluate the value of hepatic intrarterial chemotherapy (HAC) as an alternative treatment for hepatic metastases from colo-rectum cancer unsuited to radical surgery. METHODS: This study evaluates the physiopathological and pharmacodynamic bases for this type of treatment, the correct procedure for patient staging and selection, the surgical technique used to insert the infusional system, surgical complications and those linked to endoarterial treatment, the evaluation of response and the results. Complications correlated to the infusional system were evaluated in a total of 1223 patients in 10 non-randomised studies and 7 randomised studies taken from the literature. Complications correlated to chemotherapy were analysed in a total of 777 patients from 8 randomised studies and 7 randomised using FUDR. Special emphasis was placed on the possible association of locoregional and systemic treatment in order to prevent extrahepatic progression, the main cause of death in patients undergoing a single cycle of HAC. RESULTS: By comparing locoregional and systemic treatment taken from a number of randomised and non-randomised studies, the results were evaluated in terms of objective response and survival. CONCLUSIONS: There was no proportional increase in survival rates compared to systemic treatment only, in spite of the large proportion of objective responses achieved using locoregional treatment alone.

[Surgery and rehabilitation of flexor tendons injuries in zone 1 and 2]. / Chirurgia e riabilitazione delle lesioni dei tendini flessori in zona 1 e 2.

BACKGROUND: Prevention of adhesions that restrain tendon gliding is based on early mobilization techniques. Such approach, anyway, does not guarantee positive outcomes. METHODS: Seventy-five patients for a total number of 98 flexors tendons have been treated at the University Hospital of Messina between December 1993 and January 2000. Twenty-five patients, for a total number of 26 tendons, have been seen at follow-up. Seventeen lesions involved zone 2 and 9 involved zone 1. The modified Kessler suture has been generally used. All the repairs have been followed by an adequate early mobilization protocol, according to Kleinert (passive extension/active flexion) in nine patients and according to Risitano and Savage (active extension/active flexion) in 16. RESULTS: Minimum follow-up was 12 months. We present results with an assessment performed according to Strickland and to Elliot for lesion in zone 1 and according to Strickland and using Total Active Motion of the finger for lesions in zone 2. CONCLUSIONS: The suturing technique and mobilization protocol did not affect results, but we made some considerations about respective advantages and disadvantages of either method.

[The role of needle aspiration biopsy in the diagnosis of parotid masses]. / Il ruolo della citologia per agoaspirazione nella diagnostica delle neoformazioni della parotide.

The aim of this work is to assess the list of fine needle aspiration in the diagnosis of lesions of the parotid. Thirty-nine patients suffering from parotid pathology were subjected to cytology examination through fine needle aspiration. Thirty seven patients subjected to surgical operation have a histological comparison. We have proved the validity of the technique considering the sensibility, specificity and the accuracy. We didn't have FN we only had 1 FP that could be a suspect cytology. We had a 100% sensibility, a 75% specificity and 97.29% accuracy.

[Scrotal angiomyofibroblastoma. Report of a case]. / Angiomiofibroblastoma a localizzazione scrotale. Report di un caso.

OBJECTIVE: The authors report their experience about the treatment of a rare case of scrotal angiomyofibroblastoma (AMF). DESIGN: Report of 1 cases; evaluation of effectiveness of surgical treatment. SETTING: Operative Unit of General and Thoracic Surgery, Department of Surgical, Anatomical and Oncological Disciplines. Policlinico, University of Palermo. INTERVENTIONS: The patient was submitted to curative and radical surgery. RESULTS: Resolution of the pathology. Follow up (6 months) negative. CONCLUSIONS: The AMF's treatment is surgical and localized. Is important the complete preoperative evaluation.