Use of amyloid PET/CT with 18F-Florbetaben in the management of patients with Alzheimer's disease.

INTRODUCTION AND AIM: Amyloid PET/CT is an "in vivo" imaging that may radically change management of Alzheimer's disease (AD) thanks to its ability to identify AD at the earliest stage. A diagnosis of dementia is currently made in terms of probability and is based on clinical evaluation (neuropsycological tests) as well as on the results of morphological imaging investigations (MRI) that can be supported by biohumoral (CSF analysis), and functional imaging only in the case of uncertain diagnosis of disease. The present study aimed to evaluate the role of amyloid PET/CT in the management of patients with suspicion of AD, through comparison with instrumental and clinical evaluation. METHODS: 38 consecutive patients with suspicion of AD (23 female, 15 male; median age 63 years old, range 46-72), who performed 18F-florbetaben PET/CT, were retrospectively reviewed. All of them performed a previous instrumental evaluation. A subgroup of patients (24/38) were evaluated with Mini Mental State Examination (MMSE). Cohen's K test was used as a measure of agreement between previous instrumental examinations/clinical evaluation and beta-amyloid PET results. RESULTS: Twenty-five/38 (65.8%) amyloid PET/CT scans resulted positive for amyloid deposition. Among the four target regions, precuneus was the most frequently involved. Previous instrumental evaluation was: MRI in 26/38 patients (24/26 positive for atrophy), CT in 9/38 (8/9 positive for atrophy), perfusion SPECT in 12/38 (8/12 areas of hypo-perfusion), 18F-FDG PET/CT in 2/38 (1/2 hypometabolism in frontal cortex). The agreement between previous instrumental examinations and beta-amyloid PET results was low (K= 0.084). In the subgroup of 24/38 patients, MMSE was scored positive (MMSE<24) in 14/24 (58.4%) and negative (MMSE>24) in 10/24 (41.6%). The agreement between clinical evaluation (MMSE) and beta-amyloid PET results was fair (K= 0.217). CONCLUSION: The low agreement between amyloid PET/CT and previous clinical and instrumental assessments that we found in our study suggests that the amyloid PET/CT provides additional and early information. To perform an early and differential diagnosis of AD could have a great impact on the patient's management and cost of care in order to perform the correct therapeutic interventions and to allow family members to manage adequately the patient's demanding care.

Impact of pre-treatment variables on the completion of 223radium-dichloride therapy in mCRPC patients with bone metastases.

INTRODUCTION: Radium-223 dichloride (223Ra) is an alpha-particle-emitter radiopharmaceutical, approved for metastatic castration-resistant prostate cancer (mCRPC) patients with symptomatic bone metastases and no visceral involvement. Its administration is based on a schedule of intravenous injection (55kBq/kg) every four weeks for up to six cycles. Because the biological effectiveness of 223Ra-therapy is dose-dependent, the main goal is to complete the entire treatment to achieve a better patient outcome. This study aims to identify potential pre-treatment variables that could impact on 223Ra-treatment completion and then be used to improve the clinical and supportive management of mCRPC patients. MATERIALS AND METHODS: 30 consecutive mCRPC patients (mean age 77 years old), who were admitted for Ra223-therapy at our Department from February 2016 to October 2018, were enrolled for the analysis. The population was grouped as patients who completed 223Ra-therapy (group Ra223-C) and patients who do not (group 223Ra-U). For each group, we analyzed the effects of potential pre-treatment variables (age, Gleason Score, tumor burden, "Time From Diagnosis To 223Ra therapy", type and number of previous treatments, hemoglobin level, Alkaline Phosphatase, Prostate Specific Antigen and pain) on the Ra223-therapy completion. Statistical analysis was performed to evaluate the association between the completion of 223Ra therapy and the variables examined. RESULTS: 16/30 (53%) patients were 223Ra-C, conversely 14/30 (47%) patients were 223Ra-U because of an early interrupted treatment. A statistically significant association was found only with tumor burden: 68.7% of patients who completed 223-therapy had less than 20 bone metastases (χ2=4.821, p=0.028). CONCLUSION: Our preliminary analysis demonstrates that the high tumor burden represents the most important pre-treatment factor that could affect treatment completion and that needs to be considered before starting 223Ra-therapy to achieve a better outcome in mCRPC patients.

Biofilms on tuff stones at historical sites: identification and removal by nonthermal effects of radiofrequencies.

A methodology aiming at identifying and removing biofilms from cultural heritage was applied to stones from tuff walls in historical sites. Identification of phototrophic encrusting microorganisms was carried out by optical and electron microscopy, as well as by molecular techniques (DNA analyses and denaturing gradient gel electrophoresis (DGGE)). In all sites, the examination of microbial components of biofilms resulted in the identification of 17 species belonging to Cyanobacteria, Rhodophyta, Bacillariophyta and Chlorophyta, with Cyanobacteria being the dominant components in all biofilms. In order to remove the biofilms, an innovative technique based on the use of nonthermal effects of radiofrequencies was adopted. The source of the electromagnetic fields was a signal generator connected to a horn antenna through an amplifier to provide the power boost required to generate the target field amplitude. Seven days after exposure to radiofrequency electromagnetic field, about 50 % reduction of biofilm was observed; after 14 days, biofilm extension was reduced by about 90 %. DGGE analyses performed after 14 days confirmed these visual inspections. Also, DGGE analyses carried out before and 14 days after treatments showed that 12 out of 17 identified species disappeared. A complete visual disappearance of biofilms was observed a month after the beginning of treatments. DGGE repeated at this time confirmed the total disappearance of biofilm-forming species. Treated stones, when transferred back to their original sites, did not show any microorganism re-growing after 6 months. No alteration in the color and structural consistency of tuff substrata was observed after radiofrequency treatments.

Development of a chemiluminescent ELISA and a colloidal gold-based LFIA for TNT detection.

To identify the explosive used in a terrorist attack, or to obtain an early sign of environmental pollution it is important to use simple and rapid assays able to detect analytes at low levels, possibly on-site. This is particularly true for TNT (2,4,6-trinitrotoluene), one of the most employed explosives in the 20th century and at the same time, because of its toxicity, a well known pollutant. In this work we describe the development of an indirect competitive ELISA with chemiluminescent detection (CL-ELISA) and of a lateral-flow immunoassay (LFIA) based on colloidal gold nanoparticle labels. A commercially available monoclonal antibody was used and 13 specially synthesized conjugates were tested. We optimized the assay by determining the optimal concentration of monoclonal antibody and conjugates and the influence of various non-specific factors such as: tolerance to organic solvents at different concentrations, the washing and competitive step time, and the cross-reactivity with related compounds. The sensitivity and reproducibility of the CL-ELISA were good (LOD and IC(50) values in the ng mL(-1) range, and CV value about 7%). It has been applied to real samples of various materials involved in a controlled explosion of an "improvised explosive device". Three extraction procedures were tested on these samples, all employing methanol as the solvent. The lateral flow immunoassay (LFIA), developed by using the same immunoreagents, reached a detection limit of 1 microg mL(-1) when tested on the same samples analysed by CL-ELISA.

[A surgical emergency: iatrogenic lesion of the spleen. Case report and review of the literature]. / Un'emergenza chirurgica: la lesione iatrogena della milza. Caso clinico e review della letteratura.

The spleen is an organ often injured during surgical procedures. Iatrogenic lesions belong frequently to a low grade and can be treated with a conservative therapy. The surgeon may avoid the splenectomy by using new haemostatic agents as the patch of fibrinogen and thrombin in fixed combination.

Serial recordings of auditory brainstem responses in severe head injury: relationship between test timing and prognostic power.

ABRs have proved to be very accurate prognostic indicators in severe head injury, even when predictions are based on single ABR recordings. In this study we submitted 30 severely head-injured patients to serial ABR recordings (during the clinical course of posttraumatic coma) in order to verify whether the ABR prognostic power may depend on test timing in relation to the injury. 15 patients (50%) died, 5 (16.7%) remained vegetative, 2 (6.6%) severely disabled and 8 (26.7%) recovered. All recovered patients had normal ABR throughout clinical course, while severely disabled and vegetative patients showed at least transently ABR abnormalities (namely, an interpeak latency of waves V-I greater than 4.48 ms). Among dead patients, 8 showed steady and 3 transient ABR abnormalities during the clinical course, while 2 of 3 patients with normal ABR dead from extracranial complications. ABRs were significantly related to the outcome at any time, but gave more accurate prognostic indications on days 3-6 after the injury. The use of serial ABR recordings appeared to improve the outcome predictions in comparison with single ABR tests. Finally our result confirm the previously reported existance of a breakpoint between reversible brainstem dysfunction and irreversible brainstem damage defined by an IPL V-I of about 4.50 ms.

Reliability in diagnosis of brain death.

OBJECTIVE: To compare some of the confirmatory investigations of brain death with clinical criteria in order to achieve the most sensitive and accurate diagnosis of brain death. DESIGN: All patients with isolated brain lesions and Glasgow Coma Scale (GCS) = 3 were subjected to neurological examination after ruling out hypothermia, metabolic disorders and drug intoxications and diagnosed as clinically brain-dead when the brainstem reflexes were absent and the apnea test positive. PATIENTS: 15 patients with clinical diagnosis of brain death entered this study. MEASUREMENTS AND RESULTS: The patients were submitted to the following investigations: electroencephalogram (EEG), transcranial Doppler (TCD) of the middle cerebral arteries (MCA), cerebral blood flow measurements with the i.v. Xe-133 method (CBF) and selective cerebral angiography (CA). EEG was isoelectric in 8 patients while the remaining 7 patients showed persistence of electrical activity. TCD was compatible with intracranial circulatory arrest in 18 MCA districts, compatible with normal flow in 2 and undetectable in 10 out of 30 districts insonated. In CBF examinations, however, all the patients showed a characteristic "plateau" of the desaturation curves lasting through the whole investigation and suggestive of absent cortical flow. CA showed circulatory arrest in both carotid and vertebral arteries. CONCLUSIONS: Our study suggests that cerebral angiography and CBF studies are the most reliable investigations whereas the role of EEG and TCD remains to be determined because of the presence of false negatives and positives.

Platinum(II) complexes containing iminoethers: a trans platinum antitumour agent.

The biological activity of cis and trans complexes of formula [PtCl2(HN = C(OMe)Me)2] has been investigated. The iminoether ligands can have either E or Z configuration about the C = N double bond, therefore EE, EZ and ZZ isomers are obtainable. Substitution of iminoether with EE configuration for amine leads to unexpectedly high antitumor activity for the complex with trans geometry which turns out to be more active than the cis congener in the P388 leukaemia system. The same trans-EE complex shows an activity comparable to that of cisplatin in reducing the primary tumour mass and lung metastases in mice bearing Lewis lung carcinoma, thus representing a trans platinum complex active on both limphoproliferative and solid metastasizing murine tumours. Also the cytotoxicity, the inhibition of DNA synthesis and the mutagenic activity, which are greater for the cis- with respect to the trans-isomer in the amine complexes, are instead greater for the trans- than for the cis- isomer in the case of iminoether compounds. Binding to calf thymus DNA is slower for iminoether complexes than it is for amine complexes, however after 24 h reaction time the level of binding is similar for both types of complexes. Trans-EE, like trans-DDP, does not give the DNA conformational alterations (terbium fluorescence) typical of antitumour-active cis- platinum compounds, but, under strictly analogous experimental conditions, shows a greatly reduced DNA interstrand cross-linking ability (heat denaturation/renaturation assay) with respect to either trans-DDP or cis-EE and cis-DDP. The data in hand point to a new trans platinum antitumour complex with a mechanism of action different from that of cis-DDP and classical analogues.

[Medullary carcinoma of the thyroid. A clinical case]. / Il carcinoma midollare della tiroide. Caso clinico.

A case of medullary thyroid carcinoma is reported. Moreover, the main peculiarity, the correct diagnostic approach and the therapeutic indication of this rare pathology are described.

[Our experience in vascular surgery in male impotence of venous nature]. / La nostra esperienza chirurgica vascolare della impotenza maschile di natura venosa.

A case series of 226 male patients, aged between 19 and 65 years, in whom a "venous-leakage" was probably the cause of impotence is reported. The Authors describe the complex diagnostic iter, the principles of medical and surgical treatments and the results. Finally the clinical conditions considered essentially proposing a surgical treatment are announced.

[Biliary complications during videolaparoscopic cholecystectomy. Remarks on methodology and indications in the training period]. / Le complicanze biliari in corso di colecistectomia videolaparoscopica. Riflessioni sulla metodica e sulle indicazioni nella fase di apprendimento.

In our study we have considered the activity of a surgeon working in our Surgery Department during his laparoscopic training period. We focus our attention on a date related to the same complications checked in 27 cases of cholelithiasis operated by the same surgeon. We have observed three cases of biliary cholelithiasis fistulas, all of them during the three last operations. The examination of the above mentioned cases considers the clinical post-surgery situation and the therapeutic standards we adopted to work out the complications. Now we can precisely state, according to our experience, the particular directions for the videolaparoscopic training period. In addition we can propose one simple mathematical formula to value the IRL (Laparoscopic Risk Index) concerning three variables: the experience of the surgeon; the instruments condition; the clinical situation of the patient. The relation of these three factors turned in numbers suggests the chance of success of a videolaparoscopic operation. We conclude our study mentioning the gasless videolaparoscopic technique that seems to have a large indication, according to the same Surgery School. This technique is particulary indicated on those classes of patients in which the CO2 insufflation into abdominal cavity and the increase of endocavity pressure can represent a contraindication to the videolaparoscopic approach: in this case the surgeon will follow the surgical indication to solve the clinical situation, as happens in war surgery.

[Hemorrhoid disease. Physiopathology, etiopathology and surgical approach]. / La malattia emorroidaria. Riflessioni fisiopatologiche ed etiopatologiche in funzione dell'approccio chirurgico.

The authors report a number of cases of hemorrhoid disease and describe the therapeutic iter followed with particular reference to the surgical approach used. After a description of the physiopathological aspects linked to the disease, bearing in mind the use of electromanometry and electromyography in diagnosis, the authors underline the contemporary presence of varices in the lower limbs and hemorrhoid disease, as well as the frequent finding of hemorrhoids in a syndrome of portal hypertension. They then affirm how it is impossible to establish the causes of this pathology with any certainty and how a single standardised treatment plan is untenable. The authors then indicate the guidelines used to choose the most appropriate form of surgery rather than pharmacological treatment, based on the ideal cases and conditions for surgery. The ultimate goals of surgery are also outlined. The study compares four possible surgical techniques, providing synthetic information regarding their adaptability to the various cases treated and the characteristics of their use. This means that, once decided, surgery must successfully resolve the patient's problems. In conclusion, once hemorrhoid disease has been diagnosed, it is important to intervene with appropriate medical treatment to control the evolution of the pathology; if this is not sufficient, surgery becomes an inevitable choice.

[Gynaecological pelvic mass. Emergency clinical assessment]. / Le tumefazioni ginecologiche dello scavo pelvico. Atteggiamento clinico in urgenza.

BACKGROUND: The authors report the gynaecological pathology of surgical interest occurring in an Emergency Department in the first half of 2000 and occasionally found during an operation in women who presented a pelvic mass or abdominal pain. METHODS: Six women, average age of 50 years, reached the Emergency Department: five of them were operated with an emergency procedure. RESULTS: Of the 6 cases, 1 patient was affected by uterine mass, 1 by uterine-ovarian mass and 3 by ovarian mass; in one patient, affected by ovarian tumour, another intervention was necessary for intestinal metastasis. CONCLUSIONS: The authors have considered the clinical aspect of the abdominal masses, the age of the patients, the diagnostic laboratory and instrumental implications, the surgical approach and the histological result, referring to literature. Their contribution is related to the need for an appropriate surgical approach in emergency where it may, sometimes, solve or, at least, stabilize an uncertain clinical case, thanks to the implicit basic knowledge of multidisciplinary surgical technique.

[Combined complex surgical procedures: cardiovascular and general surgery]. / Gli interventi chirurgici complessi combinati: chirurgia cardiaca e chirurgia generale.

BACKGROUND: Aim of the paper is to evaluate the surgical indication in patients with cardiac and concomitant pathology. METHODS: In this study, are examined ten combined surgical sessions performed from 1992 at 1999, in patients affected by both cardiac and neoplastic disease with surgical indication. Eight men and two women, mean age 59.4 (range 50-68 years), eight affected by thoracic or abdominal tumour, one affected by hypersplenism and one by pulmonary cystic dysplasia with recurring pneumothorax. Anatomic resection and in two patient wedge-resection were performed except one woman who was splenectomized and one man who underwent atypical resection and pulmonary decortication. All subjects required extracorporeal circulation. RESULTS: No peri-operative deaths were observed and mean survival was 34 months (range 6-72 months). Moreover, there were no hemorrhages due to coagulation values of extracorporeal circulation. This approach proved useful both from the economic point of view and hospitalization time. CONCLUSIONS: According to personal experience this can be considered a successful therapeutic choice in selected patients. These observations suggest further considerations on combined operations surgery risk and mortality-morbidity appears to be reduced by a better myocardial revascularization.

[Traumatic tearing of the mesentery: immediate or deferred emergency surgery]. / Le lacerazioni traumatiche dei mesi: scelta chirurgica in urgenza immediata o differita.

We have considered a 1 year first-aid survey and focused a 6 checked mesentery vascular traumatic tearing cases. We have valued some hypotheses on pathogenic mechanism assumptions about these vascular injuries in abdomen trauma. Among these, we have focused our attention on the relationship between visceral stretching from alimentary bolus and abdominal vascular trauma. During diagnosis, we valued the importance of abdominal sounding, of echotomography and Computerized Tomography; the first one seems to be remarkable for reliability and quickness of accomplishment. In one case we have performed laparoscopic diagnostic-therapeutic approach. We suggested some standards for surgery choice related to injury amount. Monitoring is particularly important for those patients it can performed by invasive or image means seen that the unacknowledged endo-abdominal injury increases mortality by about 5-65%.

[Tracheobronchial ruptures in closed thoracic trauma]. / Le rotture tracheo-bronchiali nei traumi toracici chiusi.

Authors refer about their experience on five cases of thoracic trauma. Following a review of international literature, they analyze the clinical, diagnostic and therapeutic aspects of this kind of injuries.

[CT pulmonary density mapping: surgical utility]. / Mappe TAC di isodensità polmonare: significato chirurgico.

BACKGROUND: The present paper considers the technique of CT scan maps of pulmonary isodensity, examining lung density differences as a function of the type of disease and considering their significance for the purposes of refined, useful diagnosis in a surgical context. METHODS. The method is used to examine 3 groups of subjects selected on a clinical/anamnestic basis and a further group already admitted for surgery. For each patient we obtained 2 thoracic density scans during the phase of maximum inspiration and expiration. On each scan we constructed 50 isodensity maps, the equivalent of more than 2500 measurements: the preliminary standard was represented by 100 wide windows to produce total "illumination" of the pulmonary fields. The isodensity windows were then codified differently. Subsequently, the density scans were analysed with the technique of scalar decomposition. RESULTS: The CT scan maps of lung isodensity proved useful for certain lung diseases in which early diagnosis, topographic extent of the pathology and the refined definition of the pathological picture provide important solutions as regards the indication and planning of surgical treatment and for the evaluation of the operative risk and prognosis. CONCLUSIONS: We consider that the technique is rapidly performed, not complex and inexpensive and is able to supply detailed information on the lung parenchyma such as to be used not only as a routine technique but also in emergencies.

[Rupture of the urinary bladder caused by trivial trauma. Case report]. / Lo scoppio della vescica repleta da trauma banale. Contributo clinico.

The urinary bladder occupies the deep pelvic cavity and is well protected from the bacin: this is the reason why it can rarely be traumatized. Anyway it could suffer traumas, which can cause extraperitoneal and intraperitoneal ruptures. A classification of traumas that can injure the urinary bladder and the treatments of these lesions are presented. A clinical case personal observed regarding a 78 year-old female patient is described. An accidental fall and direct trauma in the hypogastrium caused a rupture of her urinary bladder. In this case, the patient was anuric, though the macrohematuria and microhematuria can be present in the 85% of the urinary bladder lesions. This is an interesting case since it deals with a urinary bladder wall rupture, due to a trivial trauma on the bladder.

Ribosomal DNA analysis as a tool for the identification of Cannabis sativa L. specimens of forensic interest.

A method is described for the identification of Cannabis sativa L., comparing the sequence of the nuclear ribosomal DNA Internal Transcribed Spacer II (ITS2) of an unknown sample with a known predetermined consensus sequence of Cannabis. Hemp ITS2 varied very little among cultivars, but was consistently different from that of hops (Humulus lupulus L.), which belongs to the only other genus of family Cannabinaceae.

[Hemorrhoids: epidemiology and correlation with chronic constipation]. / Malattia emorroidaria: inquadramento epidemiologico e correlazione con la stipsi cronica.

Following a review of international literature, AA report main results and refer their opinion about the correlation of hemorrhoidal disease with constipation, considering some variants as well as age, sex, breed, social-economic condition and geographic distribution in USA, England and Wales. Epidemiologically ten millions of people, in USA, are affected by hemorrhoidal disease; the incidence rate is 4.4% with an age distribution that shows a prevalence between 45-65 years old subject while constipation has an exponential increase with aging. Hemorrhoidal disease is significantly influenced by sex and geographic distribution that is in white breed more than in black, in social high class and in men more than women. In black breed constipation and hemorrhoidal disease present especially in lower social classes. Based on these results hemorrhoidal disease shows on epidemiological pattern that differ from constipation's one. Many questions are still present about correlations between hemorrhoidal disease and chronic constipation regarding etiopathogenesis. Only future case-control studies will solve the problem.