Surgical treatment of a primary malignant pericardial mesothelioma: case report.

Pericardial malignant mesothelioma (MM) is a rare tumour which accounts for about 1% of all mesotheliomas, 4% of the primary heart and pericardial tumours. It carries an extremely poor prognosis, with a reported overall survival of less than 6 months. Clinical symptoms and signs are frequently nonspecific, and the diagnosis is usually made after surgery or at autopsy. We report a case of a 72 years old woman with primary pericardial malignant mesothelioma involving the right atrium. Nine months following surgery, the patient is alive with good performance status.

Allergy in adolescent population (14-18 years) living in Campania region (Southern Italy). A multicenter study.

Summary: Adolescents (Ad) constitute a difficult to manage population among individuals suffering from asthma. The aim of our study was to assess the prevalence, clinical characteristics and age of onset of allergic sensitization and clinical symptoms in a sample of atopic Ad living in the Campania region (Southern Italy). Sixteen Allergy units or Centers belonging to the Italian Association of Hospital and Territorial Allergologists (AAIITO, Campania region) participated in this cross-sectional study. A case report form (CRF) was specifically designed for this study and commercial allergen extracts used for screening SPTs were provided by ALK-Abelló Group (Milan, Italy). A total of 443 patients were examined (females, f 220, 49.6 %; males, m 223, 50.3%). Dust mites represent the most common sensitizing agents in allergic Ad living in Campania region (Dermatoph. pteronyssinus 67.4% and Dermatoph. farinae 66.5%), followed by Parietaria (58.9%), grasses (45.8%), Artemisia vulgaris (16.7%), Olea Europaea (32.2%), dog dander (17.1%), cat dander (20.0%), Alternaria alternata (8.1%), Cupressus sempervirens (4.9%), Betula pendula (4.7%), other allergens (19.4%). An interesting comparison has been made between clinical data of our Ad with data of elderly patients (E). The role of allergic sensitization is significantly higher in Ad compared to E. Dermatophagoides pteronyssinus is the first sensitizing allergen in Ad and the last in E. Parietaria constitutes the first sensitizing pollen both in Ad and E, the percentage of sensitization is higher in Ad. Another important difference is the higher prevalence of As, as only symptom, in E compared to Ad (19.7% versus 7.6%). In conclusion, our findings confirm the high prevalence and clinical significance of airway allergic sensitization in the adolescents living in Campania region.

Dog allergy: can a prevalent or exclusive sensitization to Can f 5 be considered a lucky or negative event in real life?

Summary: Recent studies have shown the increasing relevance of allergic sensitization to Can f 5 (a prostatic kallikrein), which is an androgen-regulated protein expressed in the prostate and detectable only in male dogs. Can f 5 can be a prevalent or exclusive sensitizing agent in a considerable percentage of dog-allergic patients. Its specific allergenic characteristics are able to induce possible negative as well as positive clinical effects in individuals sensitized to dogs. In the present article we pointed out the possible pros or cons of sensitization to this allergen in real life. Further studies should be carried out to correctly assess some peculiar characteristics of Can f 5, in order to support the most of positive aspects and remedy at best the negative effects.

The spine instability neoplastic score (SINS) in the assessment of response to radiotherapy for bone metastases

Background. Vertebral metastases are often causing pain and spine instability. Radiotherapy is of significant benefit for painful spine metastases but the response can be very variable. The spine instability neoplastic score (SINS) is a recent classification system for diagnosis of spinal instability caused by vertebral metastases. We analysed the degree of pain relief, the need of drug therapy and the imaging features and the SINS before and after radiotherapy. In particular, we investigated the possible correlation of spine instability defined by pre-treatment SINS with pretreatment pain and with response to radiotherapy. Material/methods. This study included 121 patients with spine metastases treated with palliative 3D conformal radiotherapy. Pain “at rest” and “breakthrough pain”, need for drug therapy in terms of "anti-inflammatory", "weak opioid", "strong opioid", imaging studies and SINS were assessed before and after radiotherapy. Statistical analysis was performed by the correlation coefficient of Spearman and Kruskal-Wallis test. Results. Pain relief after radiotherapy was observed in 50.4 and 57.8% of patients in terms of pain at rest and breakthrough pain, respectively. The correlation between pain before radiotherapy and SINS was not statistically significant for both pain at rest (p = 0.4) and breakthrough pain (p = 0.49). The correlation between pain response after radiotherapy and SINS was statistically significant for both pain at rest (p = 0.007) and breakthrough pain (p = 0.047). Discussion/conclusion. The degree of instability, classified according to SINS, resulted to be predictive factor for pain response after radiotherapy. SINS might become a valid tool to identify those patients who can benefit the most from radiotherapy (AU)

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The spine instability neoplastic score (SINS) in the assessment of response to radiotherapy for bone metastases.

BACKGROUND: Vertebral metastases are often causing pain and spine instability. Radiotherapy is of significant benefit for painful spine metastases but the response can be very variable. The spine instability neoplastic score (SINS) is a recent classification system for diagnosis of spinal instability caused by vertebral metastases. We analysed the degree of pain relief, the need of drug therapy and the imaging features and the SINS before and after radiotherapy. In particular, we investigated the possible correlation of spine instability defined by pre-treatment SINS with pretreatment pain and with response to radiotherapy. MATERIAL/METHODS: This study included 121 patients with spine metastases treated with palliative 3D conformal radiotherapy. Pain "at rest" and "breakthrough pain", need for drug therapy in terms of "anti-inflammatory", "weak opioid", "strong opioid", imaging studies and SINS were assessed before and after radiotherapy. Statistical analysis was performed by the correlation coefficient of Spearman and Kruskal-Wallis test. RESULTS: Pain relief after radiotherapy was observed in 50.4 and 57.8% of patients in terms of pain at rest and breakthrough pain, respectively. The correlation between pain before radiotherapy and SINS was not statistically significant for both pain at rest (p = 0.4) and breakthrough pain (p = 0.49). The correlation between pain response after radiotherapy and SINS was statistically significant for both pain at rest (p = 0.007) and breakthrough pain (p = 0.047). DISCUSSION/CONCLUSION: The degree of instability, classified according to SINS, resulted to be predictive factor for pain response after radiotherapy. SINS might become a valid tool to identify those patients who can benefit the most from radiotherapy.

What could the role of can f 5 allergen be in dog-sensitized patients in "Real Life"?

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Concurrent chemo-radiotherapy in elderly patients: tolerance and compliance in a series of 137 patients

Introduction: Aggressive cancer treatment is a challenge in elderly patients. The present study aims to assess tolerance in terms of acute toxicity and compliance of concurrent chemo-radiotherapy (cCRT) in a series of patients aged C70 years. Materials and methods Clinical: records of patients aged C70 years who underwent cCRT between January 2005 and December 2013 were reviewed. Concurrent CRT had curative intent in 134 patients (97.8 %) and palliative intent in 3 patients (2.2 %). Chemotherapy (CT) drugs and schedule were selected according to tumor histology. Radiotherapy median dose was 45.0 Gy (range 11-70 Gy) for curative purposes and 54 Gy (range 40-56 Gy) for palliative purposes. Incidence of acute toxicity and compliance to cCRT were analyzed and correlated with age, Karnofsky Performance Status (KPS), and Charlson Comorbidity Index (CCI). Results: Overall, 137 patients, 82 males (60 %) and 55 females (40 %), median age 74 years (range 70–90 years) were analyzed. Concurrent CRT schedule was completed by 132 patients (96.4 %). Thirty-one of these patients (23.5 %) temporarily interrupted treatment. Hematological toxicity with grade C1 was observed in 25 patients (18.2 %), gastrointestinal toxicity in 55 (40.1 %), and genitourinary in 13 (9.5 %). Mucositis with grade C1 was recorded in 19 patients (13.9 %). No statistical significant correlation between KPS, CCI, and toxicity was found. A correlation trend between mucositis and patient age (p = 0.05) was observed. Conclusion: Concurrent CRT for elderly was feasible and quite well tolerated. Great attention in prescribing CT dose should be paid to limit acute toxicity (AU)

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Concurrent chemo-radiotherapy in elderly patients: tolerance and compliance in a series of 137 patients.

INTRODUCTION: Aggressive cancer treatment is a challenge in elderly patients. The present study aims to assess tolerance in terms of acute toxicity and compliance of concurrent chemo-radiotherapy (cCRT) in a series of patients aged ≥70 years. MATERIALS AND METHODS: Clinical records of patients aged ≥70 years who underwent cCRT between January 2005 and December 2013 were reviewed. Concurrent CRT had curative intent in 134 patients (97.8 %) and palliative intent in 3 patients (2.2 %). Chemotherapy (CT) drugs and schedule were selected according to tumor histology. Radiotherapy median dose was 45.0 Gy (range 11-70 Gy) for curative purposes and 54 Gy (range 40-56 Gy) for palliative purposes. Incidence of acute toxicity and compliance to cCRT were analyzed and correlated with age, Karnofsky Performance Status (KPS), and Charlson Comorbidity Index (CCI). RESULTS: Overall, 137 patients, 82 males (60 %) and 55 females (40 %), median age 74 years (range 70-90 years) were analyzed. Concurrent CRT schedule was completed by 132 patients (96.4 %). Thirty-one of these patients (23.5 %) temporarily interrupted treatment. Hematological toxicity with grade ≥1 was observed in 25 patients (18.2 %), gastrointestinal toxicity in 55 (40.1 %), and genitourinary in 13 (9.5 %). Mucositis with grade ≥1 was recorded in 19 patients (13.9 %). No statistical significant correlation between KPS, CCI, and toxicity was found. A correlation trend between mucositis and patient age (p = 0.05) was observed. CONCLUSION: Concurrent CRT for elderly was feasible and quite well tolerated. Great attention in prescribing CT dose should be paid to limit acute toxicity.

[Aortic prosthesis infection treated by using cryogenically conserved allograft]. / Utilisation d'une allogreffe artérielle cryopréservée dans le cadre d'une infection de prothèse aorto-bifémorale.

Infections of aortic prosthesis are quite unusual. When occurring, they represent a real challenge for both medical and surgical care, and their morbidity and mortality rates are high. Initially, these infections can be treated with antibiotics, but, in case of failure, the infected prosthesis must be removed and a new aorto-iliac system has to be reconstructed surgically. We report, the case of a woman affected by infection of an aortic prosthesis and whose problem has been solved by means of a new aorto-iliac graft by using cryogenically conserved allograft. Epidemiology, potential complications and treatment will be discussed.

Les infections de prothèses aortiques sont rares. Lorsqu'elles surviennent, leur prise en charge est un défi médico-chirurgical associé à un taux de morbi-mortalité élevé. Le traitement repose en première intention sur une antibiothérapie systémique ; le choix de l'antibiotique est empirique dans un premier temps et ciblé par la suite, après identification du germe responsable par des prélèvements bactériologiques. En cas d'échec, l'exérèse de la prothèse infectée et son remplacement par une greffe biologique (veines saphènes ou fémoro-poplitées, allogreffe artérielle) pouvant résister à l'infection est le traitement idéal. En ce qui concerne le choix du greffon, la littérature scientifique ne permet pas de départager l'allogreffe artérielle de l'allo- ou autogreffe veineuse dans l'évolution à long terme. Nous rapportons le cas d'une femme ayant présenté une infection de prothèse aortique, et qui a bénéficié d'une allogreffe aorto-bifémorale cryopréservée. L'épidémiologie, les complications potentielles et la prise en charge thérapeutique sont discutées.

Sebocistomatosis / Sebocystomatosis

La sebocistomatosis es una enfermedad hereditaria, trasmitida con caracter autosomico dominate. Se caracteriza por elementos quisticos aislados o agrupados,localizados en tronco, cara, orejas, cuello, torax, miembros y cuero cabelludo. Las lesiones mas superficiales pueden mostrar coloracion amarillenta: la expresion de esos elementos hace fluir liquido aceitoso. Otros elementos se inflaman y supuran. Histologicamente se observan quistes con pared delgada formada por celulas epiteliales asociadas con epitelio sebaceo y la estructura rudimentaria de la unidad pilosa, cuyo contenido es oleoso, con sebo y lanugo.Aunque en la mayor parte de los casos se trata de un proceso aislado, en otros puede asociarse con diversas enfermedades. En los dos casos que se comunican, la sebocistomatosis acompanaba acne e hipertricosis. Se plantean los diagnosticos diferenciales con otros quistes y otras hiperplasias sebaceas. Consideramos a esta entidad como una displasia sebacea genuina desde el punto de vista histogenetico

Mucinosis cutanea focal. / Focal cutaneous mucinosis

La mucinosis cutanea focal es una lesion generalmente unica, que asienta en cara, cuello, parte superior de tronco.Se caracteriza por tener una forma redondeada, lisa y de color amarillo translucido, ocasionalmente de crecimiento verrucoso, no mayor de 15 mm. Al microscospio observamos una zona no capsulada, con degeneracion de las fibras colagenas y aumento considerable de los mucopolisacaridos acidos y fibroblastos juveniles. Nuestro caso se refiere a un hombre de 40 anos de edad, con una lesion localizada en cuello. Estudios con Alcian Blue y Naranja de acridina muestran una actividad anormal de los fibroblastos

Sebocistomatosis / Sebocystomatosis

La sebocistomatosis es una enfermedad hereditaria, trasmitida con caracter autosomico dominate. Se caracteriza por elementos quisticos aislados o agrupados,localizados en tronco, cara, orejas, cuello, torax, miembros y cuero cabelludo. Las lesiones mas superficiales pueden mostrar coloracion amarillenta: la expresion de esos elementos hace fluir liquido aceitoso. Otros elementos se inflaman y supuran. Histologicamente se observan quistes con pared delgada formada por celulas epiteliales asociadas con epitelio sebaceo y la estructura rudimentaria de la unidad pilosa, cuyo contenido es oleoso, con sebo y lanugo.Aunque en la mayor parte de los casos se trata de un proceso aislado, en otros puede asociarse con diversas enfermedades. En los dos casos que se comunican, la sebocistomatosis acompanaba acne e hipertricosis. Se plantean los diagnosticos diferenciales con otros quistes y otras hiperplasias sebaceas. Consideramos a esta entidad como una displasia sebacea genuina desde el punto de vista histogenetico

Mucinosis cutanea focal. / Focal cutaneous mucinosis

La mucinosis cutanea focal es una lesion generalmente unica, que asienta en cara, cuello, parte superior de tronco.Se caracteriza por tener una forma redondeada, lisa y de color amarillo translucido, ocasionalmente de crecimiento verrucoso, no mayor de 15 mm. Al microscospio observamos una zona no capsulada, con degeneracion de las fibras colagenas y aumento considerable de los mucopolisacaridos acidos y fibroblastos juveniles. Nuestro caso se refiere a un hombre de 40 anos de edad, con una lesion localizada en cuello. Estudios con Alcian Blue y Naranja de acridina muestran una actividad anormal de los fibroblastos