Screening and Management of Coronary Artery Disease in Kidney Transplant Candidates.

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients and during the first year after transplantation. For these reasons, and due to the shortage of organs available for transplant, it is of utmost importance to identify patients with a good life expectancy after transplant and minimize the transplant peri-operative risk. Various conditions, such as severe pulmonary diseases, recent myocardial infarction or stroke, and severe aorto-iliac atherosclerosis, need to be ruled out before adding a patient to the transplant waiting list. The effectiveness of systematic coronary artery disease (CAD) treatment before kidney transplant is still debated, and there is no universal screening protocol, not to mention that a nontailored screening could lead to unnecessary invasive procedures and delay or exclude some patients from transplantation. Despite the different clinical guidelines on CAD screening in kidney transplant candidates that exist, up to today, there is no worldwide universal protocol. This review summarizes the key points of cardiovascular risk assessment in renal transplant candidates and faces the role of noninvasive cardiovascular imaging tools and the impact of coronary revascularization versus best medical therapy before kidney transplant on a patient's cardiovascular outcome.

Coronary Arteries Aneurysms: A Case-Based Literature Review.

Coronary artery aneurysm (CAA) is an abnormal dilatation of a coronary artery segment; those coronary artery aneurysms that are very large in size are defined as giant. However, a standardized dimension cut-off to define giant CAAs is still missing. The reported prevalence of coronary aneurysms in the population who underwent coronary angiography ranges from 0.3% to 5%, and often CAAs are found in patient with aneurysms in other sites, such as the ascending or abdominal aorta. In half of the cases an atherosclerotic etiology could be recognized; often, CAA is found in the context of acute coronary syndrome. Seldomly, CAA is found at the autopsy of patients who died due to sudden cardiac death. Currently, very few data exist about CAA management and their prognostic relevance; moreover, CAA treatment is still not clearly codified, but rather case-based. Indeed, currently there are no published dedicated studies exploring the best medical therapy, i.e., with antiplatelets or anticoagulant agents rather than an interventional approach such as an endovascular or surgical technique. In this review, through two clinical cases, the current evidence regarding diagnostic tools and treatment options of CAAs will be described.

Intraoperative sonography for nonpalpable breast lesions: Additional indications for a consolidate technique.

This prospective study evaluated the intraoperative ultrasound scan (IUSS) for nonpalpable breast lesions' detection. A total of 108 consecutive female patients underwent surgery using IUSS: Frozen sections demonstrated clear margins in 95.5% of neoplastic patients. Only four (4.5%) patients underwent local re-excision in the same operation. IUSS demonstrated to be quick, accurate, useful, effective, and safe for the intraoperative management of neoplastic nonpalpable breast lesions when performed by a surgeon who has undergone US training, particularly for people in whom alternative approaches can show some limitations due to contraindications or because of scheduling constraints, costs, and patient discomfort.

Prevalence of Ectopic Breast Tissue and Tumor: A 20-Year Single Center Experience.

BACKGROUND: Ectopic breast tissue, which includes both supernumerary breast and aberrant breast tissue, is the most common congenital breast abnormality. Ectopic breast cancers are rare neoplasms that occur in 0.3% to 0.6% of all cases of breast cancer. PATIENTS AND METHODS: We retrospectively report, using a large series of breast abnormalities diagnosed and treated, our clinical experience on the management of the ectopic breast cancer. In 2 decades, we observed 327 (2.7%) patients with ectopic breast tissue out of a total of 12,177 subjects undergoing a breast visit for lesions. All patients were classified into 8 classes, according to the classification of Kajava, and assessed by a physician examination, ultrasounds, and, when appropriate, further studies with fine needle aspiration cytology and mammography. All specimens were submitted to the anatomo-pathologist. The most frequent benign histological diagnosis was fibrocystic disease. A rare granulosa cell tumor was also found in the right anterior thoracic wall of 1 patient. Four malignancies were also diagnosed in 4 women: an infiltrating lobular cancer in 1 patient with a lesion classified as class I, and an infiltrating apocrine carcinoma, an infiltrating ductal cancer, and an infiltrating ductal cancer with tubular pattern, occurring in 3 patients with lesions classified as class IV. Only 1 recurrence was observed. We recommend an earlier surgical approach for patients with lesions from class I to IV.

[Non-lactational mastitis: our experience]. / Le lesioni infiammatorie non puerperali della mammella.

The most frequent breast inflammatory diseases are lactational and non-lactational mastitis. The diagnosis of these lesions is always difficult, as they often mimic breast cancer. The Authors report on their experience about 830 clinical cases of non-lactational mastitis, 804 were superficial abscesses and 24 were phlegmons. In 379 cases an infectious cause was found: in 249 by Streptococcus/Pseudomonas and in 30 by Staphylococcus Aureus. All patients underwent surgical treatment. Diagnosis was obtained by clinical examination, routine investigations (ultrasound, mammography and cytology) and post-operatively by histological evaluation. The non-lactational mastitis are more frequent in the postmenopausal and the menopausal period, but MDAIDS (Mammary Ducts Associated Inflammatory Diseases Sequence) are particularly interesting. MDAIDS was observed in 178 cases, these are very peculiar lesions characterized by ducts ectasia, squamous metaplasia, lymphoid infiltration and strictly correlated with heavy smoking. Sometimes, only surgical treatment clarifies the nature of these lesions. Patients with inflammatory diseases of the breast present with mastalgia and secretions, symptoms which alert patients to consult quickly a specialist. Instrumental investigations often don't clarify the diagnosis and surgical treatment by incision and drainage or excision is definitive.

[Gunshot wounds. Our experience]. / Ferite d'arma da fuoco. Nostra esperienza.

Abdominal gunshot wounds may result in elevated morbidity and mortality. The optimal management is still controversial. The authors report on their experience with treatment of 49 patients. In all patients the PATI score was used to identify trauma and all were treated surgically. Laparoscopy was employed only in one patient. The mortality was 2% and the morbidity 6%. The authors conclude that the PATI score correlated well with morbidity and mortality. Resuscitation with immediate surgical treatment may reduce the morbidity and mortality rates.

[Management of polytrauma: our experience]. / La gestione del politrauma: nostra esperienza.

In the advanced nations trauma represents the third cause of death after cardiovascular diseases and tumours. Recently, great importance has been given to the need to treat traumas as quickly as possible in order to reduce mortality and morbidity. Prompt management of is the gold standard in the emergency setting and the phrase "golden hour" is now commonly used. The authors report on their experience with the management of multiple trauma, through the study of 617 clinical cases. Patients were evaluated with the Revised Trauma Score (RTS), Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS). Of 420 (68%) cases of major trauma only one patient had ISS > 60. Patients were admitted on average after 47 +/- 18 min. Only two deaths occurred in the emergency unit. The task of the emergency unit is to stabilise the patients, anticipate the complications, including mainly shock and multiple organ failure, optimizing time, interventions and resources to reduce morbidity and mortality.