Value of Doppler ultrasound scans in deciding whether to treat infantile haemangioma with oral propranolol.

BACKGROUND: Oral propranolol (Pr) must be administered until the end of the proliferation phase of infantile haemangioma (IH). This phase may be difficult to assess, particularly where a deep component is involved. Doppler ultrasound scans (DUS), which identify vascular activity (VA), could assist the clinician in making the correct therapeutic decision (CTD). PATIENTS AND METHODS: All children with IH treated with Pr for at least 3 months and up to the age of 9 months, and who also underwent DUS, were enrolled in this retrospective, single-centre, observational study. The quality of DUS as a binary diagnostic test for IH proliferation was assessed, together with its value in deciding whether to discontinue Pr (at the end of the presumed proliferation phase) or resume this drug (in the case of suspected recurrence). RESULTS: A total of 29 children were enrolled and 45 DUS were performed. Thirty-nine (87%) DUS were of high quality (80% sensitivity, 95% specificity) and made a major, moderate, or minimal contribution to the CTD in respectively 20%, 60% and 7% of cases. DISCUSSION: DUS proved to be a high-value tool. They were essential in some cases of IH, mainly periocular and localised forms, and those involving deep components, in which the question of discontinuing Pr arose (age>1 year) and where clinical examination had not been sufficient to make the CTD. Furthermore, in the vast majority of cases, they provide a helpful examination and complement clinical findings in terms of patient follow-up and reaching a CTD. CONCLUSION: DUS is an effective and complementary tool to clinical investigation.

Factors associated with delayed referral for infantile hemangioma necessitating propranolol.

BACKGROUND: Oral propranolol is the gold standard to treat infantile hemangiomas. There is better efficacy and a lower risk of sequelae if therapy is started before the end of the growth phase, but most children are referred too late. Herein, we report the first study to investigate the delay and its associated factors when referring infants with infantile hemangiomas that need propranolol therapy. OBJECTIVES: The primary objective was to determine the delay in referral (time between age at referral [first phone contact] and the optimal age for referral (fixed at 75 days). The second objective was to determine the impact of weighted factors associated with delayed referral assessed by logistic regression performed on two subgroups (referral ≤75 vs. >75 days). METHODS: Monocentric, retrospective, observational study included infants with infantile hemangiomas treated with oral propranolol between August 2014 and May 2017. RESULTS: Eighty-two children (83% females) were included. Before referral, 81 (99%) children had seen another physician (a paediatrician in 67% of cases). Median age at referral was 99 days [2-478] and 63% phoned after 75 days. Median age at the first visit was 111 days [2-515], and median age when propranolol was started was 128 days [32-541]. After adjustment, in multivariate analyses, location on the lips (OR (CI 95%): 4.21[1.19-14.89]) and superficial hemangioma (OR (CI 95%): 4.19 [1.55-11.34]) emerged as the most significant factors to influence referral before 75 days. CONCLUSIONS: This study adds to our understanding regarding delayed referral and has identified targets for future information campaigns.

Active State Organization of Spontaneous Behavioral Patterns.

We report the development and validation of a principled analytical approach to reveal the manner in which diverse mouse home cage behaviors are organized. We define and automate detection of two mutually-exclusive low-dimensional spatiotemporal units of behavior: "Active" and "Inactive" States. Analyses of these features using a large multimodal 16-strain behavioral dataset provide a series of novel insights into how feeding, drinking, and movement behaviors are coordinately expressed in Mus Musculus. Moreover, we find that patterns of Active State expression are exquisitely sensitive to strain, and classical supervised machine learning incorporating these features provides 99% cross-validated accuracy in genotyping animals using behavioral data alone. Altogether, these findings advance understanding of the organization of spontaneous behavior and provide a high-throughput phenotyping strategy with wide applicability to behavioral neuroscience and animal models of disease.

The coupling of RP-HPLC and ESI-MS in the study of small peptides and proteins secreted in vitro by human salivary glands that are soluble in acidic solution.

The aim of this study was the development of a method based on the coupling of RP-HPLC and ESI-MS for identifying and quantifying proteins and peptides secreted by human salivary glands in vitro. Salivary gland specimens, obtained from informed patients undergoing surgical resection, were incubated in an optimized medium. Incubation media of glandular specimens, selected on the basis of cytomorphological and ultrastructural analysis, were investigated by HPLC-MS. Several salivary peptides/proteins, previously recognized in human whole saliva, were searched for along the chromatogram by the selected ion monitoring (SIM) strategy. Analysis of the incubation media of parotid glands revealed the presence of basic PRPs PC, PD, PH, IB-1, II-2, and acidic PRP-1 and PRP-3 in all of the investigated samples. Basic PRPs PB and PA, acidic PRPs, and cystatins SN and S1 were detected in all of the incubation media of submandibular glands, whereas histatin 1 was detected in only one sample. Moreover, the method allowed detection of some post-translational derivatives of known salivary proteins, as well as of several previously unidentified small peptides. The present method represents a sensitive and powerful instrument to detect peptides and proteins secreted by human salivary glands in vitro.

Colposcopy, cytology and HPV-DNA testing in HIV-positive and HIV-negative women.

In this study we examined the incidence of colposcopic-colpocytologic findings and analyzed Human Papilloma Virus (HPV)-DNA testing by Polymerase Chain Reaction (PCR) in 104 Human Immunodeficiency Virus (HIV) serous positive women (Group 1) and 218 HIV-negative women (control Groups 2 and 3). The aim of the study was to evaluate the most appropriate and efficacious diagnostic methods for screening programs for cervical cancer in HIV-positive women. For Group 1 we also considered the value of CD4+ T-lymphocytes and morphologic and molecular follow-up from 3 to 6 months. The results showed that the abnormal transformation zone (ANTZ) was present in 66.3% of the cases in Group 1 compared with 31.4% in control-Group 2 (p<0.001), and with 58.93% of the cases in control-Group 3 (p=0.257); intraepithelial squamous lesions (SIL) were found in 50% vs 5.66% (p<0.001) and vs 56.25% of the cases (p=0.433), respectively. In 28.85% of the HIV-positive patients the first cytological screening exam was not evaluable due to inflammation but in 56.67% of the cases colposcopy revealed ANTZ. The subsequent colpocytological checkup after therapy showed 10 cases (30%) of low risk squamous intraepithelial lesions (LSIL) and two cases (6.6%) of high risk squamous intraepithelial lesions (HSIL). HPV-DNA testing by PCR was positive in 53.8% of the cases in Group 1, in 6.6% in control-Group 2 and in 42% in control-Group 3. In HIV-positive patients multiple HPV genotypes were simultaneously present in 21.43% of the cases and high risk genotypes were present in 70% of the cases of HSIL. In Group 1, 36.61% of the cases had lesions of the lower genital tract. The value of CD4+ T-lympocytes was <200 cells/ml in 30% of the cases of HSIL. Our data, like those of other Authors, confirm a high incidence of HSIL, abnormal colposcopic findings, and HPV infections in HIV-positive women with respect to control-Group 2, while there was not much difference between Group 1 and control-Group 3. Such frequency again suggests that an integrated morphological diagnostic approach with colposcopy-colpocytology in the screening of immunosuppressed subjects would be worthwhile.

Pars interarticularis fenestration in the treatment of foraminal lumbar disc herniation: a further surgical approach.

OBJECTIVE: A new surgical approach to foraminal disc herniation is proposed. METHODS: The procedure was performed in 28 patients during a span of 3 years. The herniation was purely foraminal in 18 patients and mainly foraminal with a definite extraforaminal component in the other 10 patients. Surgical treatment was offered only after 6 weeks of therapy with anti-inflammatory drugs and strict bed rest had proved to be ineffective. SURGICAL TECHNIQUE: To unroof the foraminal compartment, an ovoid fenestration (10 x 5 mm) is cut, with its major longitudinal axis at the level of the pars interarticularis, just medially and slightly off-center under the lateral isthmic notch, i.e., below the pedicle projection. This fenestration exposes the foraminal root compressed by the herniated disc, which can be easily removed. RESULTS: Treatment was successful in all patients, with swift remission of pain and only mild postoperative discomfort. All patients resumed their occupations as usual within 10 to 30 days after the operation, according to type of work. Mean follow-up is 24 months (range, 12-36 mo), without any return of pain. CONCLUSION: We propose pars interarticularis fenestration because it spares, with minimal bone removal, the facet joints and the anatomic continuity of the pars interarticularis, yet properly exposes the foraminal compartment both medially and laterally and thereby permits optimal removal of the disc herniation.

Iatrogenic spinopelvic cerebro-spinal fluid fistula. Case report.

Perineurial cysts usually affect the lumbosacral spinal nerve roots, but sometimes they can erode the sacrum and reach the retroperitoneal space. In such cases misdiagnosis can lead to an improper treatment and cause serious complications. A presacral mass was diagnosed in a young woman during routine ultrasound investigation, and an exploratory laparotomy was performed. A large, fluid-containing cyst was found and marsupialized into the pelvis. After operation the patient experienced headache, vomiting and VI cranial nerve palsy whenever she stood up. By radiculography a iatrogenic spinopelvic cerebro-spinal fluid fistula was diagnosed, which required further surgery to be repaired. The presence of a giant perineurial cyst in the pelvis in unusual but must be considered in the differential diagnosis of presacral masses; the exceptionally rare case reported in this paper is exemplar of the harmful complications that an incautious procedure can determine.

Risk factors for complicating infections after cesarean section.

In this study of 906 women who underwent Cesarean Section without the use of an antibiotic prophylactic it has been confirmed that age, labour in course and the premature rupture of the membrane are clinical parameters that are statistically significant for unspecified fever/endometritis or for infections of the wound and that hemoglobin and hematocrit values below 9 gr/dl and at 35% post-operation are significant for infections of the wound. 13.2% women had complicating infections of which 1.3% were infections of the wound, 0.6% were endometritis, 7.2% were unspecified fever and 4.1% were urinary infections. The Authors show that preventive measures in some areas could be as effective as chemoprophylaxis.

Colposcopy, colpocytology and the vaginal ecosystem. Oncological, bacteriological and hormonal evaluation in a series of 400 women.

The Authors retrospectively considered colpocytological and colposcopic findings in a series of 400 women, aged 16 to 83 years, presenting for the first time at the Oncological Gynaecology Unit of the Institute of Gynaecology and Obstetrics of Padua University between 1991 and 1992. In addition to oncological evaluation, the bacteriological profile and hormone status of cytological samples were formulated in all cases. The most common oncological finding was a cell morphology within normal limits (67%), followed by reactive and reparative changes (19%) and low-grade squamous intraepithelial lesions (SIL, 12%). Histological findings correlated well with the cytological diagnosis, though low-grade SIL was over-estimated. As for the bacteriological profile, a mixed flora was most frequent (56.7%) followed, especially in fertile age, by Döderlein's bacillus (20%) and vaginosis (15.5%). Colposcopy most frequently revealed ectopia and/or a normal transformation zone (50.7%) and dystrophic mucosa (21%). An abnormal transformation zone was more common among women with a moderate-to-abundant flora. Fifteen male partners were also checked: cellular changes typical of human papilloma virus infection were found in 40% and colposcopic findings compatible with said virus were observed in 26.6% of cases. These results confirm that colpocytology provides a complete and simultaneous evaluation not only of cell morphology, but also of the bacterial population and hormones in the vaginal ecosystem. It is therefore the method of choice in screening for cervical and vaginal neoplasms and an effective means for simultaneously evaluating vaginal flora and hormone status.

Endometrial cytology for the prevention and early diagnosis of endometrial neoplasias.

One hundred and forty women, aged between 46 and 70 years, were submitted to periodic colpocytologic, colposcopic and cytologic endometrial checking. None of the patients had been treated by estrogenic therapy. We evaluated the possible morphologic modifications of the endometrium over time by periodic cytologic checks, personalized on the basis of the anamnestic and actual risks of the patients. From the data it was noted that the endometrium in pre- and in post-menopause may present changes in the absence of substitutive therapies. In fact in women in post-menopause we found 33% of atrophic endometria at first check, going down to 22.3% at the second, while the incidence of hyperplasia increased slightly. At the second check we always diagnosed 2 cases (2.6%) presenting atypia, confirmed by subsequent curettage. At the third check an increase was observed of atrophic endometria (41.8%) and a reduction of focal hyperplasia (4%). Among women in pre-menopause there was a high incidence of endometria with focal hyperplasia, 37.5% at the first check, 40.6% at the second and 39.6% at the third; hyperplasia in 11.5% of cases at first check, 12.5% at the second and 6.3% at the third; presence of atypia in 1.5% of cases at the second check and 3.2% at the third. Curettages subsequently confirmed diagnosis in these last three patients. In the cases where small fragments of endometrial tissue appeared in the cytological sample we found good agreement between histologic and cytologic diagnoses; the latter slightly overestimated focal hyperplasia and diffuse hyperplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Vulvar invasive and intraepithelial neoplasia. Comparison of some epidemiological and clinical data.

We have compared some of the epidemiological and clinical data of 45 patients affected by Vulvar Intraepithelial Neoplasia (VIN) and of 42 patients affected by Invasive Vulvar Neoplasia who came to our observation between 1986 and 1991. We have evaluated and compared the average age in the two groups of patients, their vulvoscopic pictures and the symptomatology referred at the time of the patients' diagnosis.

Colposcopic pictures of Abnormal Transformation Zone (ANTZ): colpocytological and histological findings.

The Authors have examined the correlation between the colposcopic pictures of the Abnormal Transformation Zone (ANTZ), in its varying degrees, and the colpocytological and histological examinations in order to seek a better definition of the indications of carrying out aimed biopsies. From our results a good agreement has been observed from the colpocytological and histological examination and the colposcopic pictures of the ANTZ. In patients with colposcopic images of ANTZ G2 the colpocytological examination diagnosed a CIN 3 in 80.6% of cases, invasive carcinoma in 6.4%, and in histologic examination CIN 3 in 71% and microinvasive carcinoma in 10.7%. Instead in the ANTZ G1, CIN 3 was revealed colpocytologically in 7.9% of the cases and histologically in 7.3%. Among these last, in half of the cases, the focuses of CIN 3 were present at the level of third inferior of the cervical canal. Finally, in ANTZ G0 there was cytological evidence in 6.6% of cases of CIN 3 with a histological correspondence of 3.9%. In particular the focuses of CIN 3, small and limited, had resulted from biopsies carried out on some glandular openings not clearly attributable to ANTZ G1. With regard to the opportuneness of carrying out aimed biopsies, mandatory in the cases of ANTZ G2, we feel it would be useful to carry them out also for ANTZ G1, above all if alterations are diagnosed at the colpocytologic examinations, and in ANTZ G0 if colpocytological alterations are present. Therefore integrating colposcopic and colpocytologic examinations and aiming the biopsies would seem to lead to good diagnostic reliability and adequate successive personalized treatment.

Vulvar intraepithelial neoplasia. Epidemiological and clinical study of 45 cases.

We observed 45 cases of Vulvar Intraepithelial Neoplasia (VIN) histologically diagnosed which came to our observation between 1986 and 1991. The average age of the patients and the grade of the VIN lesions were evaluated. We also examined the eventual association with Papillomavirus infection, with non-neoplastic epithelial disorders in the adjacent areas and with intraepithelial neoplasias of the cervix and/or the vagina (CIN and/or VAIN). These data were studied in relation to the vulvoscopic pictures and symptomatology presented by the patients at the moment of diagnosis.

Risk of progression in low grade squamous intraepithelial lesions.

In order to evaluate the evolution of the low grade dysplasia using colpocytologic follow-up, 150 women, enrolled in this study, were submitted to yearly colpocytologic control for a period of four years. The rate of progression toward more severe forms was very low; three cases (2.14%) in the first year, one case (0.7%) in the second and two cases (2.32%) in the fourth. Eighty-eight per cent of the patients had cytologic signs of Human Papilloma Virus infection detected in cytologic and histologic examination.

Cytological patterns of primary malignant uterine fibrous histiocytoma. A case report.

The Authors have reported the cytological patterns of malignant primitive uterine fibrous histiocytoma of a 57 year old woman. The endometrial cytological sampling was performed by an aspiration technique using a feeding-tube; a necrotic-haemorrhagic background filled with hymphocytes and polymorphonuclear leukocytes, and a mixture of highly anaplastic histiocytic and fibroblastic type cells, associated with undifferentiated small round cells, has been described. The result of the histological examination performed on the surgical specimen was the following: polymorphic malignant neoplasia characterized by spindle-like and giant plurinucleated cells, phagocytosis features, endoluminal polypoid growth, wide infiltration of the miometrium two thirds deep, vascular space invasion of the uterine wall and the hilus of the ovaries. The histological features and immunohistochemical analysis were consistent with malignant fibrous histiocytoma in the pleomorphic variety.