Development of an oral care guide for patients undergoing autologous stem cell transplantation.

Nurses identified oral mucositis as a recurring issue in clinical practice. To meet this challenge, a group of nurses took a leadership role in developing an oral care guide. The University Health Network Nursing Research Utilization Model and the Neuman Systems Model served as conceptual frameworks. A flowchart was developed to ensure a coordinated and continuous provision of oral care. Educational presentations were conducted to familiarize nurses and members of the multidisciplinary team of the practice changes. The introduction of the oral care regimen as primary prevention, plus systematic oral assessment and monitoring had the potential to reduce the occurrence and severity of oral mucositis in patients undergoing autologous stem cell transplantation.

Factors influencing the incidence and severity of oral mucositis in patients undergoing autologous stem cell transplantation.

This retrospective descriptive study documented the frequency of oral mucositis and examined the impact of certain variables in the development of oral mucositis in autologous stem cell transplants. Oral mucositis occurred in 90% of the patients, but 53.57% developed ulcerations. On average, oral mucositis started on day seven, lasted for six days and resolved on day 13 after the initiation of chemotherapy. Sodium bicarbonate mouthwash and mucositis mouthwash were commonly used interventions; 72.92% of the interventions were used as secondary prevention. Oral mucositis was significantly associated with diagnosis (lymphoma), chemotherapy (etoposide and melphalan), and level of prevention (secondary). Diagnosis (lymphoma), chemotherapy (etoposide and melphalan), serum creatinine (peak level), and level of prevention (secondary) were independent predictors of oral mucositis.

[Malignant tumors of the gastrointestinal autonomic nervous system (GAN tumors or plexosarcomas). Report of a case]. / I tumori maligni del sistema nervoso autonomo gastrointestinale (GAN tumors o plessosarcomi). Descrizione di un caso.

The plexosarcomas or gastrointestinal autonomic nerve tumors (GAN tumors) are very rare neoplasms originating from the gastrointestinal autonomic nervous system. They have been differentiated from the other gastrointestinal stromal tumors due to ultrastructural features showed by electronic microscopy. Their mesenteric localization rare than the gastric and intestinal localization, and it gives a very poor and specific clinical symptomatology. It's very difficult to make a correct diagnosis. The most important prognostic factors influencing the survival seem to be the tumor size and the mitotic activity. The authors describe a case of multiple Plexosarcomas occurred in a young patient one year after a surgical intervention for ileal resection to remove a benign schwannoma. This patient wasn't a carrier of multiple Neurofibromatosis. The diagnostic difficulties before surgical operation are stressed and the importance of surgery as the only diagnostic and therapeutic choice is underlined, even if local recurrences occurred in more than 50% of the treated cases.

[Nutcracker syndrome: a difficult case of recurrent gross hematuria]. / Sindrome di nutcracker: una macroematuria intermittente di difficile diagnosi.

BACKGROUND: The Nutcracker Syndrome (NS) is an uncommon clinical condition caused by compression and entrapment of the renal vein (LRV) as it passes through the angle between the superior mesenteric artery (SMA) and the aorta (meso-aortic angle). Intermittent macrohematuria, left peripelvic and gonadal vein varices and aspecific abdominal pain may be common manifestations of this syndrome. CASE-REPORT: A 15-year-old white boy developed recurrent macrohaematuria in June 2002. He had a history of upper respiratory infection prior the first episode of gross hematuria followed by 4 other episodes of macrohematuria 'sine causa'. Blood pressure and renal function were normal. Routine laboratory tests showed only an increase in serum LDH levels (901 IU/L) with negative Coombs' test, both direct and indirect, and absence of schistocytes in the blood smear. Renal ultrasonography showed normal kidneys while an intravenous pyelography showed a 'minus' in the right ureter. For this reason, a cystoscopy and a retrograde pielography were performed but resulted normal. A renal biopsy was carried out because of the presence of one episode of post-infective macrohaematuria, but light microscopy and immunofluorescence examinations were found to be normal. Renal ultrasonography and Color Doppler ultrasonography (CD-USG) oriented our diagnosis towards NS. An abdominal computerised tomography (CT) scan confirmed that the LRV was compressed between the aorta and the SMA. CONCLUSIONS: NS cannot be diagnosed with routine diagnostic methods. Endoscopic and radiological methods may provide some clues for the presence of NS, while CD-USG may be considered to be the first level non-invasive method for diagnosis. The sensitivity and specificity of this test for diagnosing NS is reported as being 78% and 94%, respectively. The best treatment available for this syndrome is still being debated.