Atrial fibrillation: Epigenetic aspects and role of sodium-glucose cotransporter 2 inhibitors.

Atrial fibrillation (AF) is the most frequent arrhythmia and is associated with substantial morbidity and mortality. Pathophysiological aspects consist in the activation of pro-fibrotic signaling and Ca2+ handling abnormalities at atrial level. Structural and electrical remodeling creates a substrate for AF by triggering conduction abnormalities and cardiac arrhythmias. The care of AF patients focuses predominantly on anticoagulation, symptoms control and the management of risk factors and comorbidities. The goal of AF therapy points to restore sinus rhythm, re-establish atrioventricular synchrony and improve atrial contribution to the stroke volume. New layer of information to better comprehend AF pathophysiology, and identify targets for novel pharmacological interventions consists of the epigenetic phenomena including, among others, DNA methylation, histone modifications and noncoding RNAs. Moreover, the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in diabetic and non-diabetic patients at cardiovascular risk as well as emerging evidence on the ability of SGLT2i to modify epigenetic signature in cardiovascular diseases provide a solid background to investigate a possible role of this drug class in the onset and progression of AF. In this review, following a summary of pathophysiology and management, epigenetic mechanisms in AF and the potential of sodium-glucose SGLT2i in AF patients are discussed.

Intact intracranial breast prosthesis: a 28-year CT follow-up after treatment of late hemispherectomy complications.

Anatomical hemispherectomy has had excellent results in treating drug-resistant seizures of infantile hemiplegia. This technique of hemispherectomy consists in the removal of a whole hemisphere, with or without the basal ganglia, the end result being a large cavity left at the end of the operation. The technique, however, is considered to be weighted by important complications, in particular intracranial hemorrhages due to vessels tearing secondary to dislodgement of the remaining hemisphere. Several techniques have been consequently proposed to reduce the volume of the residual hemicranial cavity. An alternative measure is the filling of the cavity itself. We have demonstrated that this type of procedure can be carried out using a silicone breast prosthesis. In this report, we demonstrate also that such an implant can have a surprisingly long duration in its unusual location.

MRI appearances of benign uterine disease.

Benign uterine disease is a common entity affecting women of all ages. Ultrasound has historically been the predominant imaging method used in the evaluation of benign gynaecological disease, magnetic resonance imaging (MRI) being reserved for use in the staging of malignant uterine and cervical disease. MRI is now increasingly used in the diagnosis of benign uterine disease as well as a tool for problem-solving in cases of diagnostic dilemma. It allows detailed assessment of benign conditions, such as endometrial lesions, leiomyomas, and adenomyosis, and can be helpful in the stratification of patients to different treatment modalities, including surgical resection, uterine artery embolization, and medical therapies. In this article, we review the MRI findings in the common benign uterine diseases.

Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound.

PURPOSE: This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI). MATERIALS AND METHODS: Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up. RESULTS: Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered. CONCLUSIONS: Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.

[The value of the calcitonin test in Paget's disease of bone]. / Importanza del test alla calcitonina nella malattia ossea di Paget.

Five untreated patients with Paget's disease and one who had been unsuccessfully treated with porcine calcitonin for 2 years were given 20 mg/kg/day disodic ethydronate. Alkaline phosphatase and urinary hydroxyproline values were examined and the progress of the calcitonin test was followed. In addition to being of great importance and in line with the other two parameters in following the course of the disease, this test was found to be an excellent pointer to the moment when no further response is being obtained from treatment with calcitonin.

[Neoplasms of the tongue. An analysis of cases]. / Neoplasie della lingua. Analisi di una casistica.

The authors study a group of 295 patients treated for tongue neoplasms at the Istituto di Oncologia di Torino. They point out the influence of many factors on survival particularly referring to tumour size, lymph nodes metastases and tumour stage at the time of first treatment.

[Carcinoma of the tonsil. Case contributions]. / Il carcinoma della tonsilla. Contributo casistico.

The authors study a group of 25 patients treated for tonsillar carcinomas mainly in stage IV at the Istituto di Oncologia di Torino. The most part of the deaths are in the first 2 years after treatment, mainly due to distant metastases; a good stabilization of survival follows, obtained by radiation therapy alone or associated with surgery and/or chemotherapy.

[Carcinoma of the palate. Clinical cases]. / Il carcinoma del palato. Contributo casistico.

The paper reports a series of 29 patients treated for advanced neoplasias of the palate at the Oncology Institute in Turin. The study confirms the proportional deterioration of the survival rate in correlation with the advanced stage of the carcinoma. The majority of deaths due to insufficient control occur during the second year following treatment but, after this period, the survival rate tends to stabilise around 40%.

[Neoplasms of the floor of the mouth. Case reports]. / Neoplasie del pavimento orale. Contributo casistico.

The authors study a group of 61 patients treated for floor of the mouth neoplasms at the Istituto di Oncologia di Torino. They confirm a high incidence of deaths in the first 2 years after treatment in patients T greater than 2 N+, and better survival in patients with stage I-II tumours. The survival does not tend to fall between 5 and 10 years after treatment.