Premature or early bilateral oophorectomy: a 2021 update.

In this invited review, we discuss some unresolved and controversial issues concerning premature (<40 years) or early (40-45 years) bilateral oophorectomy. First, we clarify the terminology. Second, we summarize the long-term harmful consequences of bilateral oophorectomy. Third, we discuss the restrictive indications for bilateral oophorectomy in premenopausal women to prevent ovarian cancer that are justified by the current scientific evidence. Fourth, we explain the importance of estrogen replacement therapy when bilateral oophorectomy is performed. Hormone replacement therapy is indicated after bilateral oophorectomy until the age of expected natural menopause like in premature or early primary ovarian insufficiency. Fifth, we discuss the relationship between adverse childhood experiences, adverse adult experiences, mental health, gynecologic symptoms and bilateral oophorectomy. The acceptance and popularity of bilateral oophorectomy over several decades, and its persistence even in the absence of supporting scientific evidence, suggest that non-medical factors related to sex, gender, reproduction, cultural beliefs and socioeconomic structure are involved. We discuss some of these non-medical factors and the need for more research in this area.

Treatment of Vancouver B1, C periprosthetic hip fractures with periprosthetic polyaxial locking plate system: A 3-year follow-up.

The incidence of periprosthetic fractures after primary knee and hip arthroplasty is around 2.5% and is increasing after revision surgery up to 4%. Management of these fractures is often particularly demanding and expensive. The primary aim of the presented study is to describe our experience in using a precontoured periarticular polyaxial standard plating system in a cohort of patients with homogeneous fracture type (Vancouver B1, C), comparing our experience with other surgical solutions. In stable implants, the primary strategies aim for fracture stabilization, leaving the original prosthesis in place. The results of conventional non-locking implants have been mostly poor with complication rates up to 53%. Therefore, today, monoaxial locking plates are strongly recommended. From May 2013 to December 2014, 30 "non-contact bridging plate" (NCB-PP®) were implanted. All fractures were periprosthetic Vancouver B1 or C fractures. In 24 patients, NCB-PP® plating was performed after periprosthetic femoral fracture as primary treatment, in 6 patients, it was performed as secondary fracture treatment after primary plating failure. All surgeons performed lateral femoral approach with ORIF. Average follow up was 36 months. Bony consolidation was confirmed in all patients, bar one, in an average time of 4 months; none of the patients bar one developed mechanical failure or implant breakage. The GOS at 52 weeks was back to the preoperative level in 18 patients and it did not improve at 24 months. The Harris Hip Score at 52 weeks showed a mean score of 80.14 points. Full weight bearing was allowed at mean time of 100 days. None of the patients developed complications that needed subsequent surgery. The use of NCBPP plates has given excellent results in our clinical practice, allowing early postoperative mobilization and recovery.

Efficacy, safety and acceptability of the new pen needle 33G × 4 mm. AGO 01 study.

OBJECTIVES: Adherence to insulin therapy can be threatened by pain and needle fear. This cross-over randomized non-inferiority trial evaluated a new Pic Insupen 33G × 4 mm needle vs. a 32G × 4 mm needle in terms of metabolic control, safety and acceptability in patients with diabetes treated with insulin. RESEARCH DESIGN AND METHODS: We used a centralized, permuted block randomization, stratified by center and maximum insulin dose per single injection. Subjects used the two needles in two 3 week treatment periods. The primary endpoint was the absolute percentage variation of the blood fructosamine between the two treatments (% |ΔFru|). Additional endpoints were: glycemic variability, total insulin doses, body weight, severe hypoglycemic episodes, leakage at injection sites and pain measured by visual analogue scale. Equivalent glycemic control was defined a priori as % |ΔFru| (including 95% CI) within 20%. RESULTS: Of 87 subjects randomized, 77 completed the study (median age 53.1 [IR 42.3-61.2], median BMI 24.3 Kg/m(2) [IR 21.3-28.5], median duration of insulin therapy [in months] 141.4 (IR 56.3-256.9), median baseline HbA1c 7.9% [IR 7.2-8.8]). The % |ΔFru| was 7.93% (95% CI 6.23-9.63), meeting the non-inferiority criterion. The fasting blood glucose standard deviation was 46.2 (mean 154.6) with the 33G needle and 42.8 (mean 157.3) with the 32G needle (p=0.42). Insulin daily dose and patients' weight did not show any statistically significant variation. We observed 95 episodes of symptomatic hypoglycemia with the 33G needle and 96 with the 32G needle. One episode of severe hypoglycemia was documented in the latter group. As for insulin leakage we observed 37.55 episodes per 100 patient-days with the 33G needle and 32.21 episodes per 100 patient-days with the 32G needle (p=0.31). Patients reported less pain with the 33G × 4 mm needle (p=0.05). STUDY LIMITATIONS: Study sample was mainly composed of adults with type 1 diabetes and study was not blinded. CONCLUSIONS: The 33G needle is not inferior to the 32G needle in terms of efficacy and safety, with reduced pain and no difference in insulin leakage. CLINICAL TRIAL REGISTRATION: NCT01745549.

Development and validation of the chronic hepatitis C virus treatment satisfaction (HCVTSat) instrument.

BACKGROUND: While current medications used to treat patients with chronic hepatitis C virus (HCV) effectively produce sustained viral response (SVR), postponement of therapy is often times attributed to patient perceptions of unfavourable outcomes. However, an instrument to assess patient perceptions of therapy (i.e. treatment satisfaction) has not been developed. AIM: To describe the development and validation the chronic Hepatitis C Virus Treatment Satisfaction (HCVTSat) instrument. METHODS: Focus groups, expert review and cognitive debriefing were used to develop a draft 37-item instrument (scale: 1 = not important at all; 5 = extremely important). The preliminary instrument was administered to a pre-test sample of 145 patients through Mayo Clinic, Rochester, MN. A refined HCVTSat was administered to a main sample of 333 participants with a chronic HCV diagnosis through Harris Interactive. RESULTS: The HCVTSat was completed by 333 participants with an average age of 51 (s.d. = 12.1) years, 55% male, current or previous HCV treatment experience, and a diagnosis of HCV for approximately 12 (s.d. = 8.9) years. Twelve items for the 3 dimensions, Treatment Experience (TE), Side Effects (SE) and Social Aspects (SA), were internally consistent (Cronbach's α range: 0.70-0.90), responsive and valid. Confirmatory factor analysis (goodness-of-fit indexes: χ(2) = 20.9, df = 23, P = 0.59; CFI = 1.00, GFI = 0.99, TFI = 1.00, RMSEA = 0.001) revealed a better fit with 9 items. All path coefficients were significant (P < 0.05). SE and SA were strong predictors of TE, while TE was positively associated with the 1-item global measure of TS (path coefficient = 0.12). CONCLUSIONS: The 10-item HCVTSat demonstrated valid psychometric properties and assessed patient satisfaction with HCV therapies. However, additional studies are needed to validate the HCVTSat in conjunction with SVR and in patients in underrepresented populations.

Second interlaboratory exercise on non-steroidal anti-inflammatory drug analysis in environmental aqueous samples.

Several interlaboratory exercises were organised within the framework of European FP6 project NORMAN. Among others, non-steroidal anti-inflammatory drugs were investigated in different aqueous samples in two sequential ring studies. The aim of both studies was to evaluate the state-of-art in Europe and to determine possible sources of variation, while also attempting to diminish them. In the present paper we discuss the results of the 2nd Interlaboratory study, while the results of 1st round were presented before. The main scope of the 1st exercise organised within NORMAN project was to assess the laboratory proficiency regardless of the analytical method applied, to evaluate the stability of the target compounds during sample storage, and to define possible sources of variation during sample shipment, storage and analysis. In the 2nd round we primarily aimed to diminish these sources of variation by applying two predetermined analytical protocols based on liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry. The two analytical protocols were compared in terms of their ability to determine individual analytes in matrices of different complexity, i.e. tap water, river water and wastewater. Furthermore, the 2nd exercise addressed also the filtration and compared the influence of different filter material categories on the analysis of non-steroidal anti-inflammatory drugs. Results presented herein evaluate laboratory performance using z-score, bias, proximity and Youden plots. Overall, the laboratory performances were found to be satisfactory for determining NSAIDs in aqueous samples. The two analytical protocols, LC-MS and GC-MS, are assessed according to their sensitivity and measurement uncertainty, where the GC-MS proved superior for the analysis of Ibuprofen, Ketoprofen and Naproxen in matrices with higher complexity. Finally, neither the filtration itself, nor the filter materials were shown to significantly affect the determination of NSAIDs.

Blastoid mantle cell lymphoma occurring in a patient in complete remission of chronic myelogenous leukemia.

The development of a de novo lymphoma in patients affected by chronic myelogenous leukemia (CML) is a rare event. The introduction of new molecular cytogenetic techniques, such as fluorescence in situ hybridization (FISH), allows a correct differential diagnosis between lymphoid blastic crisis and a blastoid variant of mantle cell lymphoma (MCL), which shows an aggressive behavior and some molecular characteristics detectable by cytogenetics and immunohistochemistry. We report a case of a blastoid variant of MCL that developed in a patient with CML who achieved complete cytogenetic and molecular response to imatinib mesylate treatment.

Bilateral upper and lower lid fatty herniation: an unusual presentation of non-Hodgkin's lymphoma.

We report the case of a patient presenting with eyelid hernias who required bilateral upper and lower blepharoplasty; histological examination of the excised fat revealed B-cell non-Hodgkin's lymphoma. At diagnosis, the disease was already systemically advanced, but the patient was asymptomatic. No sign of disease had been detected in the preoperative tests. The bilateral orbital presentation of a systemic lymphoma is very rare, and is usually accompanied and revealed by exophthalmos, increased tear secretion, diplopia and decreased visual acuity. To our knowledge, this is the first case in which lid hernias were the first and only clinical sign of such a systemic disease.

Study of phagocytosis of senescent erythrocytes in young and elderly individuals.

There is a decrease in the percentage contribution of a heavy density fraction of red blood cells to whole blood with increasing age. The aim of this study was to investigate in the young and elderly the interaction between monocytes and different erythrocyte suspensions: senescent red blood cells, erythrocytes stored with or without serum, and desialylated red blood cells. The results obtained with senescent red blood cells and erythrocytes stored with serum show the involvement of autologous IgG in the selective removal of erythrocytes. These values were higher in elderly individuals, indicating that this process increases with age. Our observation suggest that desialylation is not involved in the increased removal of erythrocytes observed in elderly individuals.

Function approximation--a fast-convergence neural approach based on spectral analysis.

We propose a constructive approach to building single-hidden-layer neural networks for nonlinear function approximation using frequency domain analysis. We introduce a spectrum-based learning procedure that minimizes the difference between the spectrum of the training data and the spectrum of the network's estimates. The network is built up incrementally during training and automatically determines the appropriate number of hidden units. This technique achieves similar or better approximation with faster convergence times than traditional techniques such as backpropagation.

Adenocarcinoma of the urachus: radical or conservative surgery? A report of a case and a review of the literature.

AIMS: To identify the most appropriate surgical strategy for carcinoma of the urachus. METHODS: Analysis of a case of adenocarcinoma of the urachus and an examination of the current literature were carried out. CONCLUSIONS: Partial cystectomy is considered the most appropriate surgical strategy but the need for close follow-up is underlined.

Surgical treatment of clival chordomas: the transsphenoidal approach revisited.

This is a report of 12 cases of clival chordomas that were surgically treated at the Catholic University Medical School, Rome, Italy, over a 7-year period. The study emphasizes the role of the transsphenoidal approach. The study group included seven men and five women whose ages ranged from 26 to 80 years (mean 49.8 years). Diplopia was the most common presenting symptom (eight cases). The tumor involved the upper and middle clivus in five cases, the middle clivus in five, and the lower clivus in two cases. One patient developed spinal metastasis. On histological examination, eight cases proved to be typical chordomas, three cases had a chondroid component, and one case of chordoma had atypical features. Immunohistological staining for vimentin and epithelial membrane antigen was positive in all cases. Follow-up periods ranged from 14 to 86 months (mean 40.2 months). The primary treatment consisted of surgery. Ten patients with chordomas of the upper and middle clivus underwent a total of 13 transsphenoidal procedures. Total tumor removal was achieved in seven cases, subtotal removal in two, and partial removal in one case. In the two cases of lower clival chordomas, total removal was accomplished in one and partial removal in the other. After total removal, no recurrence was noted at 14 to 86 months (mean 37.5 months). In the cases undergoing operation via a transsphenoidal approach, there was zero morbidity and one cerebrospinal fluid fistula that resolved without surgery. The tumor recurred in two patients after subtotal and partial removal, respectively. The authors opted to reoperate in cases of recurrence. Postoperative radiotherapy was administered in only two cases in which further surgery was not indicated because of medical reasons or because such a procedure was contrary to the patient's wishes. When mortality and morbidity rates of this group are compared to those of chordoma patients who were treated with extensive skull-base surgery, the results prompt a reappraisal of the transsphenoidal approach in the treatment of clival chordomas.

Rhinocerebral zygomycosis in acute lymphoblastic leukaemia.

We describe a patient with acute lymphoblastic leukaemia who developed rhinocerebral zygomycosis during the aplastic phase induced by antineoplastic chemotherapy. The patient was treated with fluconazole intravenously (400 mg daily) for 30 days and underwent surgical debridement. As a result of this treatment a complete remission of the zygomycosis-associated symptoms was observed. The possibility of treating zygomycosis with fluconazole is discussed.

Dire straits.

Orthotics, the Cinderella of the NHS, needs a radical restructuring if it is to give patients the best serviice, argue Peter Bowker and colleagues.

Granuloblastic masses in the breast: report of two cases.

Two patients with granuloblastic masses of the breast, onsetting at diagnosis and as first relapse site of acute myeloid leukemia are reported. The first case had been diagnosed initially as a carcinoma, and the patient underwent bilateral mastectomy. Acute leukemia was only revealed by histology of the surgical specimen. In the second case a second neoplasia, occurring during acute leukemia, was suspected: a fine needle aspirate of the breast mass showed a leukemic infiltrate. Involvement of breast during acute myeloid leukemia is a rare event and, in our experience, of bad prognostic significance. Mammary glands may be a sanctuary for leukemic cells, contributing to unresponsiveness to chemotherapeutic agents.

Lymph node blast crisis in chronic myeloid leukemia mimicking T-immunoblastic lymphoma.

BACKGROUND: Chronic myeloid leukemia arises from a somatic mutation in a pluripotent stem cell. It generally terminates with a blastic crisis (BC). One third of BC are lymphoid, and most have a pre-B phenotype. Few cases of T-lymphoid BC have been reported. Here we describe a lymph node blast crisis mimicking T-immunoblastic lymphoma. METHODS: Bone marrow and lymph nodes were histologically examined by standard methods and by an immunoperoxidase technique. Cytogenetic studies were also performed on lymph node and blood cells. Analysis of T-cell receptor genes and BCR rearrangements were performed on DNA extracted from both frozen bone marrow and lymph-node cells. RESULTS: Lymph-node histology showed an infiltration by large lymphoid blasts, consistent with a diagnosis of immunoblastic lymphoma. Blast cells were CD2, CD7, TDT positive, and negative for myeloid and mature lymphoid antigens. The Ph1 chromosome was found in both bone marrow and lymph-node cells. BCR rearrangement was found in the DNA from both bone marrow and lymph-node cells. TCR genes were not rearranged. DISCUSSION: The present study provides strong evidence that the lymph-node blast crisis of CML can assume the morphological appearance of immunoblastic lymphoma and may retain the immunological phenotype and genetic features of early T cells with BCR rearrangements.

[Prevalence and clinical meaning of insulin-specific IgE antibodies]. / Prevalenza e significato clinico degli anticorpi IgE specifici verso l'insulina.

Systemic and local reactions to insulins in patients affected by insulin-dependent diabetes are uncommon but may be life threatening. Both systemic and local adverse reactions to therapy may be managed by different therapeutic schemes. The availability of human (DNA recombinant) insulin raised hopes that this be the choice treatment for allergic complications. However, controlled studies showed that reaginic (IgE) antibodies are directed to common insulin determinants and not to heterologus protein contaminants. Therefore we investigated in 62 patients undergoing insulin therapy, prevalence and clinical significance of the detection of specific IgE to insulin. Furthermore, we searched for a relationship between atopic status and the presence of antiinsulin IgE. In our study prevalence of specific IgE to insulin was 16.1%. We showed a correlation between clinical symptoms and the presence of specific IgE to insulin, when these antibodies are of an elevated class (R.A.S.T. class 2 or more). When specific IgE were present we detected antibodies to all insulines (bovine, porcine and human) thus confirming that specific IgE are directed to a common antigenic determinant. Finally, we couldn't find a relationship between atopic status and the presence of reaginic antibodies to insulin.

[Effects of acute administration of nifedipine on exercise-induced microalbuminuria in normotensive patients with type 1 diabetes]. / Effetto della somministrazione acuta di nifedipina sulla microalbuminuria da sforzo in pazienti diabetici di tipo 1 normotesi.

The aim of our study was to evaluate the acute effect of nifedipine, a calcium channel blocker, on exercise-induced microalbuminuria in normotensive and normoalbuminuric type 1 diabetic patients. Fifteen normotensive diabetic patients who were normoalbuminuric at rest (8 males and 7 females; age 16-35 years) and 10 normal subjects (6 males and 4 females; age 18-40 years) performed 4 submaximal cycloergometric exercises (90% of theoretical maximum heart rate); the first two exercises were performed in basal condition and the other 2 after 24 h of therapy with nifedipine AR (20 mg/b.i.d.) or placebo (2 cps/die). One hour after exercise in basal condition the microalbuminuria was 78 +/- 17 micrograms/min in diabetic patients vs 16 +/- 4 micrograms/min in normal subjects (p less than 0.001). After placebo no significant changes with respect to basal levels were observed 1 hour after exercise in either diabetic patients (82 +/- 16 microgram/min) or normal subjects (20 +/- 5 micrograms/min). In diabetic patients after nifedipine, systolic blood pressure was reduced both at rest and after exercise (p less than 0.05) with respect to basal condition or placebo. The urinary albumin excretion rate at rest was not modified, but it was significantly reduced 1 hour after exercise: 58 +/- 15 micrograms/min (p less than 0.01 vs placebo). This reduction correlated well with the reduction of exercise blood pressure in diabetic patients (r = 0.91, p less than 0.001). Our results indicate that acute administration of nifedipine reduced exercise-induced microalbuminuria in normotensive diabetic patients, probably by means of a reduction in exercise blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Episodic angioedema with eosinophilia (Gleich syndrome).

A case of episodic angioedema with hypereosinophilia or otherwise called Gleich's syndrome is reported. The patient was a young woman with a six-year history of recurrent angioedema, itchy urticaria, rapid weight gain and hypereosinophilia. The main clinical, laboratory, and immunological findings included systemic angioedema, urticaria, 12% weight gain and leucocytosis (69.150 WBC/cu mm) with eosinophils of 75.6%. Circulating IgM, IgE, and T-helper lymphocyte were elevated. Skin biopsy showed an important perivascular eosinophil infiltration. The absence of concomitant allergic, malignant and connective disorders, and a dramatic clinical improvement with a fall of the eosinophil count to normal levels following corticosteroid therapy was the basis for our diagnosis.