Pancreaticoduodenectomy for paraduodenal pancreatitis is associated with a higher incidence of diabetes but a similar quality of life and pain control when compared to medical treatment.

BACKGROUND: Paraduodenal pancreatitis is a focal form of chronic pancreatitis that affects the groove area between the duodenum and the head of the pancreas. Consensus regarding surgical or nonsurgical management as the best treatment option is still lacking. METHODS: We retrospectively evaluated all patients managed for PP at The Pancreas Institute of the University Hospital Trust of Verona from 1990 to 2017. The outcomes of surgical vs. medical treatment with regard to pain control, quality of life and pancreatic insufficiency were evaluated through specific questionnaires. RESULTS: The final study population consisted of 75 patients: 62.6% underwent surgery, and 37.4% were managed without surgery. All surgical procedures consisted of pancreaticoduodenectomy. The median follow-up from the diagnosis of paraduodenal pancreatitis was 60 (12-240) months. Patients who underwent surgery experienced a similar incidence of steatorrhea (44.7 vs. 52.6%; p = 0.4) but a significantly higher incidence of diabetes (59.6 vs. 10.7%; p < 0.01) when compared to those managed without surgery. There was no difference in terms of reported chronic pain (Graded Chronic Pain Scale, median 0 vs. 1; p = 0.1) and quality of life (Pancreatitis QoL Instrument, median 82 vs. 79; p = 0.2). However, surgical patients reported a worse level of self-care activities associated with glycemic control (Diabetes Self-Management Questionnaire, median 20 vs. 28, p = 0.02). CONCLUSION: In patients affected by paraduodenal pancreatitis, surgery and medical therapy seem to obtain similar results in terms of quality of life and pain control. However, surgery is associated with an increased prevalence of postoperative diabetes with consequent relevant issues with self-care management. Surgery should be considered only in selected patients after adequate medical treatment.

Three topographical approaches to survey soil erosion on a mountain trail affected by a forest fire. Barranc de la Manesa, Llutxent, Eastern Iberian Peninsula.

Soil erosion on mountain trails threaten the sustainability of soils and vegetation. There is a wide theoretical knowledge about the effects produced by mountain recreational activities, but particularly for soil erosion there is a shortage of field data. This is why it is necessary to properly survey the soil losses on mountain trails. The most widely applied method in scientific literature is the Cross-Section field survey as is easy-to-apply and low-cost. However, there is a doubt about its accuracy and the development of the new technologies may improve the quality and accuracy of the measurements. Aerial and terrestrial photogrammetric methods are difficult to apply when vegetation is present but, an opportunity arises to apply this method when fire takes place. This paper analyses the soil losses in a recently fire-affected land to check the accuracy of the three methodologies to assess soil loss on mountain trails. The results obtained show an average soil loss between 1287 and 1404 Mg ha-1 of trail erosion for the three methodologies applied, which implies that the Cross-Sectional-Area method, aerial photography and terrestrial photography provide very similar values. Therefore, the conventional Cross-Section field surveys method is useful and adequate to evaluate the impacts generated on mountain trails as it provides accurate measurement and can be repeated any time and below different vegetation covers. The terrestrial photogrammetric methods are accurate too, but they can only be used when there is very little vegetation cover such as in semiarid and arid landscapes or after forest fires. Moreover, they are more expensive and time consuming.

Operational functionalities of air-quality WSn metal-oxide sensors correlating semiconductor defect levels and surface potential barriers.

The comprehension of atmospheric pollution levels worldwide is a crucial issue for assessing the health consequences from human exposure to polluted air, and for identifying emission reductions that will be effective for minimizing the potential risks. Advanced interconnected sensors are required that could monitor on real-time toxic gaseous concentration. The success of these instruments depends on the reliability of these devices to quantify and disseminate the pollution levels to nearby citizens. Metal-oxide semiconductors are widely used as functional materials for gas sensing because of their chemo-resistive effect when interacting with gases. Mixed oxides are usually considered for the superior performances shown with respect to the single oxides. In this work, tungsten-tin mixed oxides with different Sn molar fraction (0.0018, 0.12, 0.33 and 0.89 named WS-1, WS-2, WS-3 and WS-4) were synthesized by sol-gel co-precipitation. The powders were characterized by ICP-OES analysis, specific surface area measurements, electron microscopy, X-ray diffraction, UV-Vis-NIR and FT-IR spectroscopies. The powders were also deposited through screen-printing technology, obtaining thick film gas sensors, on which measurements of conductance as a function of temperature, surface potential barrier and dynamical responses in the presence of oxidizing or reducing gases were carried out. Based on the studied properties, the mixed oxides can be divided into two groups: the WO3-like samples (WS-1, WS-2, WS-3) and the SnO2-like sample (WS-4). All samples present pure crystalline structures: this is a new result for the WO3-like samples. There is no literature data reporting about the introduction of so high Sn content in a WO3 structure. The combination of spectroscopic and electrical characterizations allowed the definition of an interpretative model that correlates the deepness of defect levels in the band gap of these materials to the values of the surface potential barrier in air and, as a consequence, to the electrical responses to oxidizing and reducing gases.

[High-dose CEF (cyclophosphamide, epirubicin, fluorouracil) as primary chemotherapy in locally advanced breast cancer: long-term results]. / CEF (ciclofosfamide, epirubicina, fluorouracile) ad alte dosi come chemioterapia primaria nel trattamento del carcinoma mammario localmente avanzato: risultati a lungo termine.

PURPOSE: To determine wether primary CEF is effective in locally advanced breast cancer, as measured by response, local recurrences, disease free survival (DFS) and overall survival (OS). MATERIAL AND METHODS: From 1990 to 1998, 62 patients with stage III disease were enrolled into a prospective study at Regina Elena Institute for Cancer Research, Rome. Inflammatory breast cancer (IBC) was included. Patients received three 21 days cycles of chemotherapy that consisted in epirubicin 50 mg/m2, cyclophosphamide 400 mg/m2, and fluorouracil 500 mg/m2 i.v. on days 1 and 8. G-CSF (300 microg) was given subcutaneously every other day from day 5 to day 17. After primary chemotherapy, whenever possible, mastectomy or conservative surgery was performed. Subsequently responding patients received the same regimen, while non responders were given a non cross resistant chemotherapy. In case of conservative surgery or initial T4 tumor radiation therapy was performed at the end of adjuvant chemotherapy. ER positive patients received tamoxifen 20 mg/d for five years. RESULTS: Seven IIIA patients had a median OS of 43 months (C.I. 95%, 31-55) and DFS of 42 months (C.I. 95%, 16-68), while 15 IBC patients had a median OS of 52 months (C.I. 95%, 52-79) and DFS of 27 months (C.I. 95%, 14-39). Forty IIIB non inflammatory breast cancer patients had a median DFS of 87 months (C.I. 95%, 1-175); median OS was not reached. Ten-year OS was 28.6% for stage IIIA, 50.6% for stage IIIB and 36% for IBC. CONCLUSION: Primary CEF appear to be an effective treatment. In our study we obtained a good local control and interesting long term data of disease free and overall survival.

Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness.

The aim of the study was to evaluate the efficacy of osteopathic manipulative treatment (OMT) in patients with Benign-Paroxysmal-Positional Vertigo (BPPV). Thirty-one patients with BPPV were randomly assigned into two groups: 19 patients received osteopathic treatments (TG) and 12 patients received sham therapy (SG), both in four weekly sessions. Before the first and the last treatment, those patients were evaluated using Dizziness Handicap Inventory (DHI) and stabilometric platform to assess lifestyle modification and balance functions. After the treatment session, TG compared to SG showed an improvement in DHI global (p = 0.02), functional (p = 0.03) and physical (p = 0.03) components, as well as a reduction of swinging area (p = 0.02). An association between swinging area and lifestyle measures (global [r = 0.53; p = 0.02]; functional [r = 0.50; p = 0.03]; physical [r = 0.60; p = 0.01]) changes were found in TG. These findings suggest that OMT could be a useful approach to reduce imbalance symptoms and to improve the quality of life in patients suffering from dizziness.

Recurrent acute pancreatitis in bowel malrotation.

OBJECTIVE: Recurrent acute pancreatitis is an uncommon diagnosis in teenagers. Excluded alcohol and biliary stones, more prevalent aetiologies in these group of patients are genetic pancreatitis, pancreatic duct system abnormalities, neoplasia, traumas and congenital abnormalities of the duodenum such as duodenal duplication or diverticulum. Two reported cases of recurrent pancreatitis associated to midgut malrotation were described in English literature. Bowel malrotation is a difficult diagnosis in a teenager or a young adult and a common delay is documented. Ladd's procedure is largely recognized to be the standard treatment for a symptomatic malrotation. CASE REPORT: Our Report describes in details a case of recurrent pancreatitis, where a late diagnosis of midgut malrotation was obtained and an endoscopic management was attempted. A literature review and an analysis of two previously reported cases were performed to explore a possible aetiopathogenesis of the recurrent acute pancreatitis in patients with midgut malrotation. RESULTS: 24 months of follow-up showed an asymptomatic patient on a free diet, with a mild deranged Liver Functional Tests and a normal Amylase and Lipase. The recurrence of acute pancreatitis has not been observed until the present day. CONCLUSIONS: Recurrent episodes of acute pancreatitis in young adults, without a history of alcohol abuse or evidence of gallstones, might be an atypical presentation of midgut malrotation and it should be in the differential diagnosis. In this case, a Ladd's operation is beneficial and an endoscopic procedure does not obtain advantages.

Oculodentodigital dysplasia. A case report.

This report describes a rare case of oculodentodigital (ODD) dysplasia, an autosomic-dominant disease with alteration on the gene GJA1 of connexin 43 on the human chromosome 6q22-q23, highlighting the anomalies affecting face, eyes, teeth and limbs. The case described shows bilateral microphthalmia, microcornea, syndactyly and other phenotypic alterations characteristic of this syndrome, such as: nose of reduced size with hypoplasic wings, partial stenosis of the choanae, micrognathia, ogival palate and hypoplasia of the enamel. The authors emphasize the importance to know the principal features of ODD syndrome in order to make a correct diagnosis and the role of the dentist in the treatment of this pathology.

[Molecular therapy of breast carcinoma in the advanced phase]. / Terapia molecolare del carcinoma della mammella in fase avanzata.

Conventional chemotherapy regimens for the treatment of breast cancer have limited efficacy and are associated with significant toxicity, highlighting the need for novel targeted therapies. Increased expression and activation of receptor tyrosine kinases frequently occurs in human breast carcinomas and, therefore, several clinical trials are currently evaluating therapies targeting these receptors. Therapeutic strategies include blockade of individual receptors with monoclonal antibodies (e.g., trastuzumab) and inhibition of tyrosine kinase function (e.g., gefitinib). Trastuzumab is the first agent that has been approved for patients with human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer. Other growth-factor targeted drugs are in clinical development such as STI-571, farnesyl-transferase inhibitors and antibodies directed at the insulin-like growth factor.

Paclitaxel activity in anthracycline refractory breast cancer patients.

AIMS AND BACKGROUND: We investigated the efficacy and tolerability of two doses of paclitaxel, 175 mg/m2 and 135 mg/m2, over a 3-hr infusion, without prophylactic G-CSF, in heavily pretreated patients with anthracycline-resistant breast cancer. Although paclitaxel may share with anthracyclines a common mechanism of drug resistance, there is evidence that the two drugs are not completely cross resistant. METHODS: From July 1994 to January 1996, 42 patients were treated every 3 weeks, for a maximum of 6 cycles; paclitaxel dose was established according to pretreatment extension. RESULTS: In 41 assessable patients we observed 9 partial responses, for an overall response rate of 22% (95% CI, 10-34%). There was no difference in response rate between the two dose levels. Median duration of response was 9 months, median time to progression 5 months, and median survival 9 months. The dose-limiting toxicity was neutropenia, which was grade 3-4 in 40% (135 mg/m2) and 62% (175 mg/m2) of the patients (P = 0.28); neutropenic fever occurred in 24% of the patients, without significant differences between the two dose levels. Other toxicity was mild to moderate. CONCLUSIONS: Paclitaxel at doses of 175 mg/m2 or 135 mg/m2 is active and well tolerated in advanced breast cancer patients resistant to anthracyclines. The prophylactic use of colony-stimulating factors seems appropriate in heavily pretreated patients given the higher dose level.

[Long-term survival after hepatectomy for metastatic liver cancer originating from colorectal carcinoma: presentation of two clinical cases]. / Lungo-sopravvivenza dopo metastasectomia epatica in pazienti affetti da carcinoma colorettale: presentazione di due casi clinici.

We report two case histories of long surviving patients after resection of liver methastases from colorectal cancer. In the first case the patient underwent a right hepatectomy to resect a 3 cm-lesion revealed by a CT scan three years after surgery for a rectal adenocarcinoma. Subsequently, she received two cycles of 5-day continuous infusion of fluorouracil. Four years and 11 months after hepatectomy, the patient is alive and free of disease. The second patient underwent resection of a large hepatic methastasis 3 months after left emicolectomy. The lesion substituted almost completely the right lobe and extended to the IV segment of the left lobe of the liver. After hepatectomy, the patient had a disease-free survival longer than 10 years, until a chest X-ray and a CT scan revealed a primary right lung cancer (citologically, adenocarcinoma) with a methastasis in the left lung. Surgical resection represents the only potentially curative therapy for hepatic methastases from colorectal cancer. Recent data about patient selection for hepatic methastasectomy are presented, and the opportunity of postoperative chemotherapy is discussed.

[Gemcitabine in peritoneal mesothelioma: a case report]. / Gemcitabina nel mesotelioma peritoneale: presentazione di un caso clinico.

Malignant peritoneal mesothelioma is a rare tumor whose prognosis is poor. We report a case history of a 57-year old woman with large peritoneal masses and ascites refractory to several chemotherapeutic regimens. The patient benefited of a dramatic regression of disease with symptomatic improvement during chemotherapy with gemcitabine. Serum CA-125 values declined consensually to tumor regression. The duration of response was 12 months. The activity of gemcitabine in malignant mesothelioma has been already confirmed in phase II studies. Data are also available suggesting that better results can be obtained combining this agent with cisplatin, and a multicenter phase II study is now exploring the activity of this combination.

[Phase II study of docetaxel in patients with advanced stage soft tissue sarcoma]. / Studio di fase II con docetaxel in pazienti con sarcoma dei tessuti molli in fase avanzata.

PURPOSE: To evaluate the activity and toxicity of docetaxel (TXT) as second line therapy in advanced soft-tissue sarcoma. PATIENTS AND METHODS: Adult patients (pts) with histologically proven locally advanced or metastatic soft tissue sarcoma, were treated with TXT at a dose of 100 mg/m2 in a 1-hour i.v. infusion every 21 days and steroid premedication with oral prednisone 50 mg twice a day for five days starting 24 hours prior to TXT. RESULTS: From November 1995 to May 1997, 19 pretreated pts entered the trial. Characteristics of the pts: males/females 11/8, median age 58 years (30-74), median WHO performance status 1 (0-2); histotypes: leiomyosarcoma 6 pts, malignant fibrous histiocytoma 6 pts, fibrosarcoma 2 pts, others 5 pts. No objective responses were seen. The disease remained stable in 8 pts (42%). Median time to progression was 3.5 months (range, 2-8), median survival 6 months (range, 2-20). The treatment was well-tolerated: the main side effect was hematological toxicity with G3/4 leukopenia and neutropenia in 58% of the pts; G3 anemia and thrombocytopenia occurred only in 1 case. Other toxicities were alopecia that was universal, G3 emesis in 1 pt, G3 diarrhea in 2 pts, G3 stomatitis in 1 pt. Mild fluid retention was recorded only in 2 pts. CONCLUSIONS: The results of this study do not suggest the use of TXT at this dosage and schedule in advanced soft tissue sarcoma.

[Renal carcinoma: effective modulation of low-dose interferon-alpha and interleukin-2 with medroxyprogesterone acetate and 13-cis retinoic acid]. / Carcinoma renale: efficace modulazione dell'interferone-alpha e dell'interleuchina 2 a basse dosi con medrossiprogesterone acetato e acido 13-cis retinoico.

We report a case history of a patient with clear renal carcinoma. After surgical treatment of primary tumor patient had been treated with medium-high doses IL-2 and alpha IFN for lung metastasis and paraaortic nodes, without significant response. Subsequently, low doses alpha IFN/IL-2 produced a response, and further response have been obtained by the combination of low-doses alpha IFN/IL-2 plus medroxyprogesterone acetate and cis-retinoic acid. We can therefore conclude that in immunogenic tumors, such as renal cancer, various immunologic strategies are justified, also employing in combination drugs not active as single agents, or modifying doses and schedules.

[Simultaneous infusion of vinorelbin and taxol as first-line chemotherapy in metastasized breast cancer]. / Infusione simultanea di vinorelbina e taxolo come chemioterapia di prima linea nel trattamento del carcinoma mammario metastatizzato.

PURPOSE: To evaluate the activity and toxicity of simultaneous infusion of vinorelbine (VNB) and paclitaxel (T) as first line chemotherapy in advanced breast cancer patients (pts). PATIENTS AND METHODS: 33 pts with histologically proven advanced breast cancer were treated with VNB 25 mg/m2 and T 150 mg/m2, both drugs given by i.v. infusion over 3 hours, with cycles repeated every 3 weeks. Granulocyte-colony-stimulating factor (G-CSF), 300 micrograms subcutaneously, was given on days 7 to 12 of each cycle in the first 10 patients. RESULTS: From October 1995 to July 1996, 33 untreated pts entered the study. Characteristics of the pts were the following: median age 53 years (29-71); median WHO performance status 1 (0-3); pre/postmenopausal 8/25; prior adjuvant chemotherapy 16; prior radiotherapy 8; dominant disease sites: soft tissue in 6; bone in 7, viscera in 19; number of metastatic sites: 1 in 18, 2 in 9, 3 in 6 pts. In 31 evaluable pts we observed: 1 CR (3%) and 14 PR (45%), for an overall response rate of 48%. Median time to response was 2 months; median time to progression and median survival were 7 and 22+ months, respectively. Median number of cycles was 6. Myelosuppression was the dose-limiting toxicity, with G 4 neutropenia occurring in 22% of the pts and neutropenic fever in 6% of the pts. Other toxicities were generally mild with nausea in 52% of the pts; mucositis in 15%; constipation in 12%; peripheral neuropathy in 46.5%. Alopecia was universal. CONCLUSIONS: Simultaneous infusion of VNB and T is well tolerated and active in untreated patients with advanced breast cancer. Median survival (22+ months) is similar to that reported with anthracycline-containing regimens, although response rate appears to be lower. It is likely that higher response rates may be achieved with a higher dose-intensity.

Single-agent ifosfamide in the treatment of anthracycline-refractory adult sarcomas.

OBJECTIVE: The objective of this trial was to assess the therapeutic activity and toxicity of ifosfamide (IFO) with mesna uroprotection as salvage therapy in patients (pts) with soft tissue sarcomas (STS) who had failed high-dose epirubicin treatment. PATIENTS AND METHODS: IFO was administered at a dose of 2.0 g/m2 daily for 5 consecutive days by a 2-h i.v. infusion every 3 weeks. RESULTS: Partial responses were observed in 5/31 (16%) evaluable patients, whereas in other 5 pts the disease remained stable. The median duration of response was 8 months. The median overall survival was 6.5 months. The most common toxicity was hematologic with grade 3 or 4 neutropenia occurring in 47% of the pts. Neurologic toxicity was infrequent, but in 1 patient treatment discontinuation was needed because of severe mental confusion and disorientation. CONCLUSIONS: Although IFO can be of value in a minority of pts with anthracycline-refractory STS, more active agents and new salvage cytotoxic regimens should be investigated in this disease.

[Gemcitabine in advanced stage soft tissue sarcoma: a phase II study]. / Gemcitabina nei sarcomi dei tessuti molli in fase avanzata: studio di fase II.

PURPOSE: To assess the activity and toxicity of gemcitabine in locally advanced or metastatic soft tissue sarcoma patients (pts). PATIENTS AND METHODS: Gemcitabine was administered on days 1, 8, 15 every 4 weeks at a dose of 1.000/1.250 mg/m2, respectively, in pretreated or not pretreated pts. RESULTS: Eighteen pts entered this phase II trial; sixteen had been previously treated with anthracyclines and ifosfamide. A partial response was observed in a woman with fibrous malignant istocytoma, whereas in 7 pts the disease remained stable. Median time to progression was 4 months. The treatment was well tolerated. Grade 4 toxicity was not observed. CONCLUSIONS: These results do not suggest that gemcitabine, in the dose and schedule used in this trial, may be of value in the treatment of soft tissue sarcomas.

[Chemotherapy of advanced stage melanoma using cisplatin, epirubicin and alpha-interferon]. / Chemioimmunoterapia con cisplatino, epirubicina ed alfa-interferone nel melanoma in fase avanzata.

PURPOSE: To evaluate the activity and toxicity of cisplatin (DDP), epirubicin (EPI) and interferon alfa-2a (a-IFN) in patients (pts) with metastatic melanoma. PATIENTS AND METHODS: Thirty-seven pts with histologically-proven metastatic melanoma were treated with DDP 75 mg/m2 e.v. and EPI 90 mg/m2 e.v. on day 1 + alpha-IFN 9 MUI/die s.c. on days 4 to 8 and 18 to 22. Cycles were repeated every 4 weeks. RESULTS: Characteristics of the patients were the following: median age 55 years (range, 24-75), median WHO performance status 1 (range, 0-2), prior chemotherapy 9, prior immunotherapy 16 (adjuvant/advanced 11/5), sites of disease: soft tissue only 10, lung 22, liver 11, bone 1, brain 3. In 35 evaluable patients we have obtained 3 complete and 10 partial responses, for an overall response rate of 37%. Dose-limiting toxicity was myelosuppression with grade (G) 4 neutropenia in 59.5% of patients and G4 thrombocytopenia in 11% of patients. Other toxicities were generally mild to moderate with nausea and vomiting in 67.5% of patients, flu-like syndrome in 78.5% and fatigue in 48.5% of the patients. Median time to response, median time to progression and survival were 3 (range, 2-6), 7 (range, 2-45+) and 10 months (range, 4-45+), respectively. CONCLUSION: This combination is active and well tolerated in metastatic melanoma. Toxicity was manageable and has enabled us to conduct this trial on an outpatient basis.

[Unusual case of hypercondensing malignant osteodysplasty: osteopetrosis]. / Su un raro caso di osteodispladsia ipercondensante maligna: osteopetrosi.

Osteopetrosis, known also as Albers-Schonberg disease, is a genetic disorder causing a generalized sclerosis of the bones and the reduction of the marrow. The diagnosis is often secondary to pathologic processes and its usually observed through specific X-ray researches. The principal cause of osteopetrosis is to attribute to a deficit of bone resorption and remodelling. Osteomyelitis is a complication of osteopetrosis. The purpose of this article is based on several point: 1) to know the cause of osteopetrosis, then to classify and check it; 2) to present the case who did not respond to of a patient with osteopetrosis complicated by maxillary and phalanx osteomyelitis common therapies and give an accurate analysis.

[A case of soft tissue alveolar sarcoma localized in the tongue]. / Su di un caso di sarcoma alveolare dei tessuti molli a localizzazione linguale.

Alveolar soft-part sarcoma is a rare form of malignant tumour. It is generally localized at the limb muscles, rarely in the head and neck. Its histogenesis is still uncertain but its specific cellular characters make the diagnosis easier. The case of a woman with an ASPS of the tongue is described. The morphological aspects and the immunohistochemical results seem, according to the data reported in literature, suitable with the diagnosis of alveolar soft-part sarcoma; however, it is difficult to explain the presence of local positivity to specific neuronal enolase.

[Pleomorphic adenoma of the parotid gland in childhood]. / Adenoma pleomorfo della ghiandola parotide in etá evolutiva.

BACKGROUND: The authors report the results of ten years' activity at the Pedodontic Surgery Unit in the Institute of Maxillofacial Surgery at the Second University of Naples and analyse the possibility of conservative treatment of pleomorphic adenoma in childhood. METHODS: The study includes 614 cases of salivary gland pathology. The authors illustrate the epidemiological, clinical and therapeutic characteristics of this type of lesion in childhood, emphasising that the data emerging from this study do not differ from the clinical and therapeutic management of pleomorphic adenoma in young patients reported in the literature. RESULTS: In particular, they emphasise that satisfactory therapeutic results can be achieved using conservative techniques, like conservative superficial parotidectomy. CONCLUSIONS: Conservative superficial parotidectomy has the advantage of being less radical and traumatic for a young patient, without provoking a significant increase in recidivation.