Recurrence of vulval intraepithelial neoplasia following treatment with cidofovir or imiquimod: results from a multicentre, randomised, phase II trial (RT3VIN).

OBJECTIVE: To compare the recurrence rates after complete response to topical treatment with either cidofovir or imiquimod for vulval intraepithelial neoplasia (VIN) 3. DESIGN: A prospective, open, randomised multicentre trial. SETTING: 32 general hospitals located in Wales and England. POPULATION OR SAMPLE: 180 patients were randomised consecutively between 21 October 2009 and 11 January 2013, 89 to cidofoovir (of whom 41 completely responded to treatment) and 91 to imiquimod (of whom 42 completely responded to treatment). METHODS: After 24 weeks of treatment, complete responders were followed up at 6-monthly intervals for 24 months. At each visit, the Common Terminology Criteria for Adverse Events (CTCAE) v3.0 was assessed and any new lesions were biopsied for histology. MAIN OUTCOME MEASURES: Time to histologically confirmed disease recurrence (any grade of VIN). RESULTS: The median length of follow up was 18.4 months. At 18 months, more participants were VIN-free in the cidofovir arm: 94% (95% CI 78.2-98.5) versus 71.6% (95% CI 52.0-84.3) [univariable hazard ratio (HR) 3.46, 95% CI 0.95-12.60, P = 0.059; multivariable HR 3.53, 95% CI 0.96-12.98, P = 0.057). The number of grade 2+ events was similar between treatment arms (imiquimod: 24/42 (57%) versus cidofovir: 27/41 (66%), χ2 = 0.665, P = 0.415), with no grade 4+. CONCLUSIONS: Long-term data indicates a trend towards response being maintained for longer following treatment with cidofovir than with imiquimod, with similar low rates of adverse events for each drug. Adverse event rates indicated acceptable safety of both drugs TWEETABLE ABSTRACT: Long-term follow up in the RT3VIN trial suggests cidofovir may maintain response for longer than imiquimod.

[Semiautomatic defibrillators at the workplace health service]. / I defibrillatori semiautomatici nel servizio sanitario aziendale.

Implementation of automated external defibrillators (AEDs) in workplace can help to revive victims of sudden cardiac arrest. The American College of Occupational and Environmental Medicine, the American Heart Association have all issued guidelines for medical management of AED programs. The School of Occupational Health-University of Bari--is currently involved in a programme to be developed with the regional 118 emergency team and the Health Department of Region Apulia aiming at establishing a well controlled use of AED in the workplace.

Ménière's disease and anxiety disorders.

Diagnosis of Menière's Disease is based upon the wellknown labyrinthic syndrome (hypoacusia, tinnitus and dizziness) which manifests with the typical abscessual, recurrent and unforeseeable course. Many Menière patients also report panic attacks, agoraphobia and anxiety which make evaluation of labyrinthic symptoms difficult, affect the onset and maintenance of vestibular compensation and require specific treatments which are very different from those for the control of endolymphatic hydrops. In order to analyse the nature and the meaning of the association of the vestibular and psychiatric symptoms, a comparison has been made between patients presenting Menière's disease, and a group of patients with dizziness resulting from other vestibular diseases. Socio-demographic data were collected and anxiety tests were used to evaluate, the depression and phobia. An interview ad hoc was also programmed for the psychiatric diagnosis. A previous psychiatric history, age, sex, marital status as well as education appear to have a variable effect upon the onset and evolution of panic-phobic symptoms, following onset of Menière's disease. These conclusions, which require confirmation with further studies, allow early characterisation of Menière's disease patients of great predictive usefulness as far as concerns the development of psychiatric sequelae of a panic-phobic nature. This evolution is far more frequent in females being enhanced by middle age, low level of education, long-standing Menière's disease and large number of attacks of dizziness. Onset of panic-phobic attacks is more rare in males in whom the condition is associated with young age, high level of education, lack of setting up of a family nucleus with children.

Asymmetrical distribution of beta-endorphin in cerebral hemispheres of suicides: preliminary data.

The assessment of beta-endorphin levels in several symmetrical brain regions of seven suicides and seven sudden death controls reveals a decreased concentration in the left temporal cortex, the left frontal cortex, and the left caudate nucleus of suicides compared to controls. Moreover, the comparisons of beta-endorphin concentrations in the symmetrical brain regions reveals an asymmetrical concentration in suicides (left less than right) in frontal cortex and caudate nucleus. These data confirm previous reports of abnormalities of neurochemical pathways in the brains of suicides and suggest that suicidal behavior might be related to the lateralized mechanisms of mood control.

[Methods of determination of stroke volume from M-mode echocardiogram of the aortic valve and aortic root. A comparative evaluation]. / Metodi di determinazione della gettata sistolica dall'ecocardiogramma M-mode della valvola aortica e della radice aortica. Una valutazione comparativa applicata.

The purpose of this study is to evaluate four methods of determining left ventricular stroke volume (SV) from aortic valve (AV) and aortic root (AR) M-mode echocardiogram (Table I, formulas 1-4); secondly, to study relations between echocardiographic aortic variables and SV. We studied 20 patients (Pts) in our Coronary Unit, 14 men and 6 women; their ages ranged from 38 to 76 (mean 53.4) years. Seventeen Pts had acute myocardial infarction; two Pts had previous myocardial infarction and heart failure; one Pt had dilated cardiomyopathy and heart failure. Three out of the twenty Pts, had mitral insufficiency (Table II, clinical and hemodynamic data). Patients were studied with high quality M-mode echocardiography. Immediately after the examination repeated measurements of cardiac output by thermodilution technique (TD) were carried out, and values of SV calculated (SV-TD). Twenty-five complete procedures were accomplished. The formulas were applied to every patient's echocardiographic data, and results (SV-ECHO) compared with SV-TD (Table III). Echocardiographic variables, whether single or multiple (terms), were also studied with regard to their relation with SV-TD (Table IV). Mean +/- SD value of SV-TD of the study group was 60.3 +/- 24.7 ml; range 22.7 to 108 ml. Mean +/- SD values of SV-ECHO were as follows: Yeh's formula, based on squared mean AV opening and LVET, 56 +/- 22.6 (ml), r = 0.8278, SEE 12.98; Jacobs' formula, based on aortic box planimetry, 68 +/- 32.5 (ml), r = 0.7129, SEE 23.31.(ABSTRACT TRUNCATED AT 250 WORDS)