'My wig has been my journey's companion': perceived effects of an aesthetic care programme for Italian women suffering from chemotherapy-induced alopecia.

This study explored the perceived effects of an aesthetic care/wig programme for Italian women suffering from chemotherapy-induced alopecia. Despite advances in the treatment of many side effects of chemotherapy, alopecia remains difficult to resolve. Literature suggests that patients' reactions to alopecia and camouflaging strategies depend on their gender, individual characteristics, social context, and culture. A qualitative study was designed involving 20 patients from Sicily (Italy), who participated in an aesthetic care programme. Data were collected through semi-structured interviews, and an Interpretative Phenomenological Analysis was conducted on transcriptions. Our findings showed that, even if expected, alopecia is experienced as a traumatic event that challenges a woman's femininity, as reported by many other enquiries. Diverging from other studies, the wig is perceived as very helpful, since it camouflages baldness and reduces the 'sick aspect' related to alopecia. Patients consider their wig to be a 'friend', and it appears that through the aesthetic care programme they received support they otherwise would not have sought. We conclude that aesthetic care/wig programmes can help women affected by alopecia to cope with cancer 'stigma', especially in those rural contexts where psychosocial programmes are not frequently embraced by patients due to environmental and cultural barriers.

[Clinical guidelines for the management of gastrointestinal stromal tumors]. / Raccomandazioni cliniche per la diagnosi, la terapia ed il follow-up dei tumori stromali gastrointestinali.

Treatment of gastrointestinal stromal tumors (GIST) has been revolutioned by the recently discovered molecular mechanism responsible for the oncogenesis of this disease. In addition, due to the rapid progress at molecular and clinical level observed in the last few years, there is a need to review the current state of the art in order to delineate appropriate guidelines for the optimal management of these tumors. A panel of experts from several specialities, including medical oncology, surgery, pathology, molecular biology and imaging, were invited to participate in a meeting to present and discuss a number of pre-selected questions, and to achieve a consensus according to the categories of the National Comprehensive Cancer Network (NCCN) and the Standard Options Recommandations (SOR) of the French Federation of Cancer Centers. Generally, consensus points were from categories 2A of the NCCN and B2 of the SOR. Conventional histologic examination with immunohistochemistry for CD117, CD34, SMA, S-100 and desmin is considered standard. Molecular analysis for the identification of KIT and PDGFRA mutation may be indicated in CD117-negative GIST. Complete tumor resection with negative margins is the optimal surgical treatment. Adjuvant imatinib should be considered an experimental approach. Neoadjuvant imatinib is also experimental, although its use may be justified in unresectable or marginally resectable GIST. Imatinib should be started in metastatic or recurrent disease, and should be continued until progressive disease or drug intolerance. In these cases, sunitinib can be used. The optimal criteria for the assessment and monitoring of GIST undergoing imatinib therapy are not well known, but they should include reduction in tumor size and disease stabilization, as well as reduction of tumor density on CT scan and metabolic activity on PET scan.

Ranitidine and somatostatin. Their effects on bleeding from the upper gastrointestinal tract.

In a randomized, double-blind placebo-controlled clinical trial, the effect of ranitidine was compared with the effect of somatostatin in the control of massive gastrointestinal tract bleeding. Ninety-six patients completed the study. Rates of continuing bleeding and death, incidence of surgery, and blood transfusion requirements were not significantly different in the three treatment groups. Eighteen of the 96 patients presented with a visible vessel at endoscopy. In this group the percent of patients with continuing bleeding, mean transfusion requirements, and mortality were significantly higher than in patients without a visible vessel. Seven patients with a visible vessel underwent surgery and six survived; 11 patients underwent conservative measures and eight died. Ranitidine and somatostatin do not seem to alter the clinical course of patients with upper gastrointestinal tract hemorrhage.

Intraoperative assessment of mitral valve function.

Clinical, echocardiographic, hemodynamic, and angiographic data can usually assess the preoperative status of the mitral valve quite accurately. However, there is need for an intraoperative method to observe the dynamic function of the mitral valve, particularly after an open commissurotomy, or to determine the efficacy of a valvoplasty. Our experience with more than 250 mitral annuloplasties has led to the development of a safe method for direct observation of the mitral closure mechanism using the left ventricular vent and a slight modification of the usual cardiopulmonary circuit.

Drug-induced modulation of carcinoembryonic antigen (CEA) expression in neoplastic cells from a patient with rectal cancer.

Treatment with 5-fluorouracil (5-FU) or recombinant interferon-gamma (IFN), alone or in combination, was found to increase carcinoembryonic antigen (CEA) expression in several carcinoma cell lines. In this study we examined the in vitro effect of these agents on CEA expression of tumor cells, obtained from a patient operated for rectal cancer. The results showed that exposure of cancer cells to 5-FU or to IFN resulted in increased CEA levels in terms of percentage of CEA-positive cells and mean fluorescence values, as indicated by FACS analysis. However, drug combination did not induce CEA expression higher than that provided by single agents alone. Treatment with 5-FU or with IFN produced a reduction of the total number of viable cells. Moreover, Western blot analysis revealed that exposure of cancer cells to each drug was followed by a substantial increase of the total cellular CEA content. On the contrary, 5-FU in combination with IFN did not increase the expression of the antigen more than that obtained by single agents. Noteworthy, exposure of CEA-negative cells from adjacent normal rectal tissue to both agents alone or in combination, did not result in CEA induction. In conclusion, the present results suggest new approaches aimed at (a) increasing the sensitivity of diagnostic procedures based on detection of CEA-positive tumor cells; (b) facilitating the recognition of CEA-positive cancer cells by immune responses induced by anti-CEA peptide vaccines.

Treatment of gram-positive surgical sepsis: role of the oxazolidinones.

Surgical sepsis is still too frequent (the thirteenth cause of death in the U.S.) with an estimated cost of 5-10 billion dollars. Since the early 1990s antibiotic resistance has become a serious public health problem, with a relevant increase in nosocomial gram-positive infections. The oxazolidinones, a new class of antibiotics acting on bacterial synthesis at a very early stage, were first commercialized in 1987, and linezolid was the first antibiotic in this class registered for clinical use. This new molecule has been shown to be effective in a variety of aerobic and anaerobic infections (both nosocomial and community-acquired), especially those due to gram-positive agents. Linezolid has complete bioavailability in parenteral and oral administration, is well tolerated and shows little toxicity, thus favoring a shortened hospital stay, improving the patient's quality of life and reducing social costs. Oxazolidinones may be considered the first choice in the treatment of resistant gram-positive infections.

Monitoring of antimicrobial prophylaxis in general surgery.

The incidence of infections in general surgery is related to different factors. Cost-benefit analysis of antimicrobic prophylaxis is positive, even though incorrect use may be even dangerous (development of resistance and/or superinfections, for instance). The authors report data on a study concerning a total of 316 patients divided into two series, who had antimicrobic prophylaxis before a surgical operation. 274 patients out of 316 (or 86.7%) had an ultra-short (one-shot-only) or short (<24 hours) prophylaxis, 42 (13.3%) standard (>24 hours). The operations performed were classified following class of contamination, i.e. I (clean), II (potentially contaminated), III (contaminated). Antibiotics used were ceftizoxime, cefepime, ceftriaxone, piperacillin and gentamicin in combination. A total of 16 postoperative infections was observed (5%); 11 of these 16 belonged to class III operations. Escherichia coli and Staphylococcus aureus were isolated in most of the infected wounds. The data confirm what is reported in the literature. The authors conclude that a preoperative single-shot 3rd or 4th generation cephalosporin reduces the incidence of wound infections in clean and clean-contaminated surgery.

Immunochemotherapy of advanced colorectal cancer with alpha-interferon and 5-fluorouracil. 1. Toxicological studies.

Twelve patients with advanced colorectal cancer were subjected to alternating cycles of treatment with low immunomodulating doses of recombinant alpha-interferon (alpha IFN) + 5-fluorouracil (5FU) or with 5FU alone. Hematological, biochemical and physical evaluation of the patients showed that alpha IFN + 5FU cycles were well tolerated like 5FU alone, except for modest and transient fever following alpha IFN administration. At hematological nadir (day 15-18 of each cycle) lymphocytopenia and granulocytopenia were more pronounced during alpha IFN + 5FU than 5FU cycles. No difference was found for platelet nadir. At the beginning of each cycle complete leukocyte recovery was observed in all cases. Platelet recovery was also complete, although counts were higher after alpha IFN + 5FU than after 5FU alone. Clinical results showed 1 complete remission, 1 partial remission, 5 stable disease and 5 progressive disease. These data point out that low doses of alpha IFN can be safely associated with 5FU. However further studies are required to establish the possible therapeutic value of alpha IFN-mediated immunomodulation for immunochemotherapy of colorectal cancer.

Effects of intravenous erythromycin lactobionate in respiratory infections.

The antibiotic erythromycin lactobionate given intravenously acts almost exclusively on Gram-positive bacteria. Even at high plasma and tissue concentrations there is an almost total absence of side-effects. It could be considered, therefore, as first choice in the treatment of patients with infectious respiratory diseases. Most of the 40 patients admitted to the present study were elderly and all had either acute or chronic and becoming acute respiratory disease. Their clinical symptoms and levels of phlogosis improved on treatment with erythromycin lactobionate without any interruption of therapy due to side-effects and toxicity. The absence of unfavourable pharmacological interactions further enhances the usefulness of the drug. In view of the excellent response to monotherapy with erythromycin lactobionate and the few groups of resistant bacteria found in those cases when it was possible to check, it was not considered necessary to investigate any synergistic association with other antibiotics. It can be concluded, therefore, that therapy with erythromycin lactobionate in patients with infective respiratory disease is favourable and patients show excellent tolerability.

[The value of echotomographic data in mesenteric cysts]. / Il significato dei rilievi ecotomografici nelle cisti del mesentere.

The Authors report a case of chylous mesenteric cyst of great size in an adult patient. They stress the diagnostic value of roentgen and sonographic findings that are determinant for a correct preoperative diagnosis. Sonography is the most important diagnostic tool; it leads to identification and localization of the mass; moreover it gives other important information about its physic composition. The various pathology that have a similar sonographic relief are discussed and differential diagnostic characters are referred.

[The Denver peritoneojugular shunt. Current indications]. / Shunt peritoneo-giugulare sec. Denver. Attuale indicazione.

Personal experience of 31 patients suffering from intractable ascites due to advanced liver cirrhosis between 1978 and 1987 is reported. Seventeen patients were selected for a peritoneojugular shunt: in 3 patients the Le Veen shunt was performed and in 14 the Denver shunt was preferred. The high postoperative morbidity and mortality due to liver failure, DIC, hepatorenal syndrome, bleeding, sepsis and cerebral thrombosis is pointed out. Careful selection of patients to be submitted to this surgical procedure is essential because of the high morbidity due to ascites reinfusion. DIC has to be diagnosed as soon as possible and, when severe, the prompt interruption of the peritoneojugular shunt is mandatory.

[Lymphovenous anastomosis in severe ascites]. / L'anastomosi linfovenosa nell'ascite difficile.

The authors dealt with 37 patients suffering from advanced liver cirrhosis with ascites. Eighteen patients out of them underwent Denver peritoneum-jugular shunt as a first choice procedure, the other 19 patients underwent lymphovenous anastomosis. The extremely advanced hepatic damage and the general conditions of these patients discouraged us to perform a portocaval shunt. In the 19 patients who underwent lymphovenous anastomosis we had no mortality rate. Two patients showed post-operative complications: 1 patient complained which hoarseness regressed in 5 months and the other patient suffered from a spleno-mesenteric-portal thrombosis with digestive hemorrhage from gastro-esophageal varices. In 6 patients out of 19 who underwent lymphovenous anastomosis, we did not obtain any immediate positive effects on ascites. In 4 patients, after 3 months, the ascites came back ingravescent and in the other 9 patients the positive effects on ascites were still evident after 1 year. Despite failure to obtain very comforting results, they suggest to employ this technique at any rate, as the first procedure, to make ascites more "manageable", because of its safety.

[Rupture of the transplanted kidney]. / La rottura del rene post-trapianto.

Five cases of kidney grafts followed by rupture are described. The explanation of the syndrome accompanying such an occurrence is deduced from personal observations as well as from literature data. As a matter of fact, the aetiopathology of this syndrome cannot be with an isolated cause, for several multifactorial immunological and non-immunological components may be involved.

[Arteriovenous fistulas for hemodialysis. Experience in 366 cases]. / Fistole artero-venose per emodialisi. Esperienza su 366 casi.

The surgical techniques adopted in performing 366 a-v fistulas for hemodialysis in 346 patients over ten years' experience are presented. A survey of the results obtained is then made as well as the evaluation of the same, based upon functional and clinical parameters. The technical details sometimes adopted, the occlusions and the principles drawn out for personal experience in this field are described.