Improved quality of life after bariatric surgery in morbidly obese patients. Interdisciplinary group of bariatric surgery of Verona (G.I.C.O.V.).

BACKGROUND: Our aim was to evaluate the changes of health-related Quality of Life (HR-QoL) after bariatric surgery. PATIENTS AND METHODS: 110 patients, who underwent laparoscopic bariatric surgery (N=34 gastric banding; N= 69 Roux-en-Y gastric bypass, N=7 sleeve gastrectomy), were evaluated before surgery and after an average of 36±13 months with SF-36 Health Survey. RESULTS: Mean preoperative age and body mass index (BMI) were 43±12 years and 45±7 kg/m2 respectively. At follow-up, mean BMI was 33±6 kg/m2. A significant improvement was observed for all dimensions of SF-36, except for General and Mental Health dimension. Satisfaction was greater in patients with the higher reduction in weight. Only the PF (Physical Functioning) domain (F=6,349, p=0.01) resulted a significant predictor of the weight lost after surgery independently of age, sex and type of surgery. CONCLUSIONS: We confirm a beneficial effect of bariatric surgery on HR-QoL. Moreover, we found that PF domain of SF-36 is a significant predictor of weight loss.

Evaluation of temperature- and ethanol-related developmental degree variations by a new scoring system (FETAX-score) applicable to Frog Embryo Teratogenicity Assay: Xenopus.

The aim of the present work is to propose a new quantitative assessment method (FETAX-score) for determining the degree of Xenopus laevis embryo development intended for use in embryotoxicity studies. Inspired by a similar scoring system used to evaluate developmental delays (young-for-age phenotypes) in rat embryos cultured in vitro, the FETAX-score was established by considering seven morphological features (head, naris, mouth, lower jaw, tentacles, intestine, anus) that are easily evaluable in tadpoles during the late stages of development at the conclusion of the test. Given that X. laevis development is temperature-dependent and that temperatures below 14°C and above 26°C are teratogenic, the FETAX-score was tested in embryos maintained at 17, 20, 23 and 26°C. No abnormalities were observed in any group, while the total score was temperature-related, suggesting that the FETAX-score is sensitive to moderate distress that does not influence general morphology. Intestine and anus were the least sensitive structures to temperature variations. To assess the applicability of the FETAX-score in developmental toxicological studies, we evaluated FETAX-score in tadpoles exposed during the morphogenetic period to Ethanol (Eth) at concentrations of 0, 0.25, 0.5, 1, 1.5, and 2 % v/v. Gross malformations were observed only in tadpoles from the Eth 2 % group. By contrast, data analysis of the other Eth groups showed dose-related reductions in the FETAX-score. Tentacles were the most sensitive structures to Eth-related delays. These results support the use of the FETAX-score to quantitatively assess developmental deviations in FETAX embryotoxicity studies.

Teratogenic and neuro-behavioural toxic effects of bisphenol A (BPA) and B (BPB) on Xenopus laevis development.

Bisphenol A (BPA) is a plastic additive with endocrine disruptive activity, classified in 2017 by EU ECHA as substance of very high concern. A correlation between environmental exposure to BPA and congenital defects has been described in humans and in experimental species, including the amphibian Xenopus laevis. Among BPA analogues, bisphenol B (BPB) is used as alternative in different not-EU countries, including US, but seems to share with BPA its endocrine disruptor properties. Aim of the present work is the evaluation of the effects of BPB versus BPA exposure in a X. laevis developmental model. A windowed exposure (R-FETAX method) was applied covering the developmental phylotypic period (teratogenicity window), or the late tailbud stages (neuro-behavioural toxicity window, corresponding to the spontaneous swimming acquisition period). Samples were monitored for lethal effects during the full test period. External morphology evaluation and deglutition functional test were applied in any group. Abnormal tadpoles were also processed for cartilage staining. In groups exposed during neuro-behavioural toxicity window the swimming test was also applied. Lethality and malformations were obtained only in samples exposed during the teratogenicity window; these data were modelled using PROAST software and BPB relative potency resulted about 3 times higher than BPA. The day-by-day evaluation revealed that lethality was correlated to embryonic abnormal development of gills and apoptosis in gill primordia. Teratogenicity was never detected in groups exposed during the neuro-behavioural toxicity window, where some significant neuro-behavioural deficits were detected in tadpoles exposed to the highest tested concentrations of BPA and BPB.

Effects of combined exposure to two bisphenol plasticizers (BPA and BPB) on Xenopus laevis development.

Due to its endocrine disruptive activity, the plastic additive Bisphenol A (BPA) is classified as substance of very high concern (EU ECHA 2017). A correlation between environmental exposure to BPA and congenital defects has been described in humans and in experimental species including the amphibian Xenopus laevis, where severe branchial defects were associated to lethality. The exposure of X. laevis embryos to the BPA analogue bisphenol B (BPB) was recently linked to similar teratogenic effects, with BPB having relative potency about 3 times higher than BPA. The combined BPA-BPB exposure is realistic as both BPA and BPB are detected in human samples and environment. Limited experimental data are available on the combined developmental toxicity of BPA and BPB. The aim of the present work is to evaluate the effects of BPA and BPB mixture in the X. laevis development model, using R-FETAX procedure. The exposure was limited to the first day of development (corresponding to the phylotypic developmental period, common to all vertebrates). Samples were monitored for lethal effects during the full six-day test period and the external morphology was evaluated at the end of the test. Mixture effects were described by modelling, using the PROAST software package. Overall data modelling showed that dose-addiction could not be rejected, suggesting a health concern for co-exposure.

Determinants of health-related quality of life in morbid obese candidates to gastric banding.

OBJECTIVE: To analyse determinants of self reported health-related quality of life (HR-QoL) in morbid obese patients candidates to laparoscopic adjustable gastric banding (LAGB). METHODS: Determinants of HR-QoL were investigated in 383 morbid obese patients (82 M and 301 F) with BMI≥40 kg/m² (BMI≥35 kg/m² if complicated obesity) and age 18-60 years. HR-QoL was determined with the SF-36 questionnaire. Determinants of the two summary measures of SF-36 (physical component and mental component) were analysed by stepwise multiple linear regression analysis with age, BMI, physical comorbidites, mental comorbidites and eating behaviour disorders as independent variables. Physical comorbities (diabetes, hypertension, hypertriglyceridemia, low HDL, sleep apnea and osteoarthritis) were coded as present or absent on the basis of simple diagnostic clinical criteria; mental comorbidities (depression) and eating behaviour disorders (binge eating, sweet eating and nibbling) on the basis of an unstructured clinical interview. RESULTS: Mean age was 38.8±10.2 years and mean BMI was 41.5±5.4 kg/m². Scores in the eight SF-36 subscales were lower in women than in men and lower than in the general Italian population. However, 18.4-43.5% of the participants had HR-QoL levels above the normative values, depending on the scale. In both genders, low scores in the mental component of the SF-36 were associated to the presence of depression and eating behaviour disorders and not to physical comorbidities or BMI levels. Low physical self-perceived well being was associated to high BMI levels in men and to depression, hypertension and hypertriglyceridemia in women. CONCLUSION: HR-QoL was poor in morbid obese candidates to LAGB, particularly in women, and was negatively affected more by mental comorbidites and eating behaviour disorders than by physical comorbidities or BMI levels.

First report of Trypanosoma evansi in a canine in Argentina.

An Argentinian Dogo which suffered from anorexia, lymphadenopathy, cachexia and paresis of the hind limbs was diagnosed with trypanosomiasis in Argentina in 2013. In this study, we describe the clinical profile and its evolution as well as the molecular method employed to identify and quantify Trypanosoma evansi.

Comparative pharmacokinetic analysis of 5-fluorouracil and its major metabolite 5-fluoro-5,6-dihydrouracil after conventional and reduced test dose in cancer patients.

The aim of this study was to investigate the clinical pharmacokinetics of 5-fluorouracil (5-FU) and its major metabolite 5-fluoro-5,6-dihydrouracil (5-FDHU) in 20 colorectal cancer patients given two dose levels of 5-FU, 250 and 370 mg/m2, administered by i.v. bolus. A reverse-phase high-performance liquid chromatographic method was used for the simultaneous assay of 5-FU and 5-FDHU in plasma samples obtained at baseline and at multiple time points from 5 min to 4 h after 5-FU bolus as well as to assess the activity of dihydropyrimidine dehydrogenase (DPD) in peripheral blood mononuclear cells (PBMCs) before 5-FU dosing. Plasma pharmacokinetic parameters of patients given 250 mg/m2 5-FU were significantly different from those receiving 370 mg/m2; main differences were observed in the trapezoidal areas under the plasma levels-versus-time curve from to to the last measurable concentration (area under the curve, 3.77+/-0.21 versus 13.61+/-2.3 h x microg/ml), peak plasma concentration (Cmax, 18.15+/-1.35 versus 48.41+/-7.69 microg/ml), and total body clearance (CL(TB), 54.64+/-3.54 versus 25.43+/-2.3 l/h/m2). Significant differences were also observed in the main pharmacokinetic parameters of 5-FDHU after 250 and 370 mg/m2 5-FU including the area under the curve from to to 4 h (5.39+/-0.32 versus 8.75+/-1.24 h x microg/ml), Cmax (3.60+/-0.16 versus 5.26+/-0.55 microg/ml) and time to Cmax (Tmax, 0.45+/-0.03 versus 0.69+/-0.06 h). The mean DPD activity in PBMCs in this group of patients was 205.7+/-36.4 pmol of 5-FDHU/min/mg of protein and was within the normal range; however, no significant correlations were found between 5-FU or 5-FDHU pharmacokinetic parameters at two dose levels and DPD activity of PBMCs. The results of the present study provide the first detailed comparison of the distribution of 5-FU and its major metabolite 5-FDHU at the therapeutic level as well as at reduced test dose levels to obtain pharmacokinetic data to be used as reference values for the identification of patients at risk of major 5-FU toxicity due to impaired metabolism to 5-FDHU.

Isolated Meningitis and Lacrimal Gland Abscess due to Odontogenic Sinusitis: Case Report / Meningitis Aislada y Absceso de la Glándula Lagrimal debido a Sinusitis Odontogénica: Reporte de un Caso

ABSTRACT: Our objective was report an extremely rare case of isolated meningitis and suppurative dacrioadenitis as consequences of odontogenic sinusitis. We describe the diagnostic tools including imaging and culture, as well as surgical treatment and follow-up. Our final diagnosis was odontogenic sinusitis caused by Streptococcus Anginosus complicated by isolated meningitis and lacrimal gland abscess. Urgent surgical treatment to restore the paranasal sinuses and drainage of the lacrimal gland was performed. Culture from purulent material collected from maxillary sinus indicated the targeted therapy. Clinical assessment and imaging obtained 20 days after surgery demonstrated successful results. This case emphasizes the importance of evaluating intracranial complications of rinosinusitis, the need to search for a dental infection when a maxillary sinusitis is encountered, the key role of a thorough diagnostic workup in order to plan a comprehensive and effective surgical treatment, as well as targeted medical therapy.

RESUMEN: En este estudio se informa un caso extremadamente raro de meningitis aislada y dacrioadenitis supurativa, como consecuencia de sinusitis odontogénica. Describimos las herramientas de diagnóstico que incluyen imágenes y cultivo, como también el tratamiento quirúrgico y el seguimiento. El diagnóstico final fue de sinusitis odontogénica causada por estreptococo anginoso complicado por una meningitis aislada y el absceso de la glándula lagrimal. Se realizó un tratamiento quirúrgico de urgencia para restaurar los senos paranasales y drenar la glándula lagrimal. Se determinó el tratamiento de acuerdo a los resultados de cultivo del seno maxilar. La evaluación clínica y las imágenes obtenidas 20 días después de la cirugía demostraron resultados exitosos. Es importante la evaluación de las complicaciones intracraneales de la rinosinusitis además de la necesidad de considerar una infección dental frente a una sinusitis maxilar. Por otra parte, es clave una evaluación exhaustiva de diagnóstico para planificar un tratamiento quirúrgico completo y efectivo, así como el tratamiento médico.

Benign multicystic mesothelial proliferation of the peritoneum: immunohistochemical and electron microscopical study of a case and review of the literature.

We report a case of benign multicystic mesothelial proliferation (the so-called multicystic peritoneal mesothelioma) arising multifocally in the abdomen of a 46-year-old white man. His anamnesis showed an 8-year history of intermittent pain in the right lower abdominal quadrant. Mucin stains, immunohistochemistry, and electron microscopy confirmed the mesothelial origin of the lesion. Review of the available literature allowed us to find another 85 reported cases of benign multicystic mesothelial proliferations of the peritoneum. Out of these cases, eighteen only occurred in men, the majority being reported in middle-aged women mostly with complaints of abdominal pain. Electron microscopy or immunohistochemistry are needed to make a differential diagnosis towards other multicystic lesions, such as peritoneal cystic lymphangioma. Although multicystic mesothelial proliferations of the peritoneum have often been regarded as benign neoplasms, the true nature--neoplastic or hyperplastic--of these lesions still remains greatly elusive. Therefore, we believe that the unbinding term benign multicystic mesothelial proliferation (first used with regard to the unique hitherto reported case arisen in the pleural cavity) should be considered at present more appropriate to indicate even these peritoneal lesions.

[Hepatic abscess]. / Gli ascessi epatici.

The Authors review the medical records of 9 patients with liver abscess over a 15-year period from 1975 to 1989. They report on 5 pyogenic abscess, 3 amebic abscess and one case of tuberculosis of the liver. The most common initial diagnosis was fever of unknown origin, abdominal pain and hepatomegaly. The treatment consisted of 6 percutaneous transhepatic drainage, 2 open surgical drainage, and one explorative laparotomy (tbc infection). The Authors had no mortality and recommend the percutaneous transhepatic drainage as first-choice treatment.

[Epithelioid hemangioendothelioma of the liver. A case report]. / Emangioendotelioma epitelioide del fegato. Descrizione di un caso.

One case of epithelioid hemangioendothelioma (EHE) of the liver is reported. The problems of a correct diagnosis of this unusual type of vascular tumor are discussed. A final diagnosis can be established only by histologic examination of appropriate material and may be helped by immunohistochemistry and ultrastructural examination. Tumor cells are vasoformative and synthesized Factor VIII-related antigen. The accurate diagnosis of EHE of the liver is of clinical and therapeutic relevance, for the favourable prognosis, also without therapy, nevertheless liver transplantation represents in selected cases (patients exhibiting a rapidly progressive liver failure) the only possible treatment. The case studied in our Department is very interesting, because it represents a summary of knowledge regarding this type of neoplasm in a 20-year period.

Psychosexual characteristics of female university students in Brazil.

Freshmen women (N = 240) at the State University of Campinas (UNICAMP) in the state of Sao Paulo, Brazil responded to a questionnaire concerning several aspects of their sexuality from the beginning of adolescence. Topics such as body changes during puberty, menarche, menstruation, masturbation, sexual identity, virginity, sexual relations, maternity, contraceptives, abortion, and attitudes toward AIDS were investigated, as well as the level and sources of information about sex and the quality of the subjects' relationships with their parents. The majority of the subjects revealed satisfactory development in most of the aspects surveyed, as well as in their relationships with their parents except where sexual issues were concerned. Nevertheless, most of the students reported menstrual disturbances, and a significant number of the sexually active reported inappropriate behavior in relation to contraception and AIDS prevention. The results of the research are analyzed using psychodynamic theories of sexual development.

PIP: A survey of 240 randomly selected female students (average age, 19.9 years) at the State University of Campinas in Sao Paulo, Brazil, provided comprehensive information about the physical, psychological, and psychosexual dimensions of adolescence. Over half reported negative feelings or indifference to body changes associated with puberty and 54% stated they did not receive information on sexual development from their parents. The average age at menarche was 12.3 years. 79% reported persistent menstruation-related discomfort (e.g., cramps, moodiness). Virginity until marriage was considered essential by 14%; to 42%, it made no difference in the context of a loving relationship. 44% of female students had experienced intercourse; the average age at initiation of sexual relations was 17.6 years. 78% stated the idea of having a child was fundamental or agreeable. 84% of sexually active students were using contraception (including unreliable methods such as rhythm). Although 65% viewed abortion as a theoretically acceptable option, only 8% indicated they would make this choice and just 6% had had an abortion. 6% of students considered themselves at risk of AIDS. Most students characterized their relationship with their parents as good, yet they preferred to talk to friends or siblings about sexual matters. Although these students appear to have satisfactorily negotiated most of the developmental tasks of adolescence, there was some evidence of failure to resolve independence-dependence conflicts.

Psychosexual characteristics of male university students in Brazil.

Male freshmen (N = 268) at the State University of Campinas (UNICAMP) in the state of Sao Paulo in Brazil responded to a questionnaire concerning aspects of their sexuality from the onset of adolescence. Topics such as physical changes, first ejaculation, masturbation, homosexual manifestations, and sexual practices were investigated, as well as present attitudes toward virginity, intercourse, birth control, abortion, and prevention of AIDS. The quality of the relationship established with parents and the possibilities for dialogue about sex in the family circle were also surveyed. The majority of the subjects revealed satisfactory development in most areas of their sexuality, as well as a good relationship with their parents. Nevertheless, great difficulty was found in dialogue about sex within the family circle. Of these young men, 32% were still virgins at the end of their freshman year, but a considerable number of those already sexually active reported behavior which was inappropriate for the prevention of pregnancy and AIDS. The results are analyzed using psychoanalytic theories of psychosexual development.

PIP: A random sample of 268 male freshmen of mean age 19.6 years at the State University of Campinas in the state of Sao Paulo, Brazil, responded to a questionnaire in 1990 on aspects of their sexuality from the beginning of their adolescence. Topics such as physical changes, first ejaculation, masturbation, homosexual manifestations, and sexual practices were investigated, as well as present attitudes toward virginity, intercourse, birth control, abortion, and AIDS prevention. The quality of their relationships with parents was also surveyed. The sample comprised 31% of the entering students for that year. 32% were living with their parents. Most respondents reported satisfactory development in most areas of their sexuality, as well as a good relationship with their parents. However, they found it very difficult to discuss sex within their family circles. 32% were still virgins at the end of their freshman year. 28% and 20% had homosexual manifestations during childhood/early adolescence and currently, respectively, including fantasies, attraction to men/boys, physical contact with men/boys, and sexual intercourse with men/boys. 38% of the sexually active men reported taking no measures to prevent pregnancy and HIV transmission.