Streptococcus agalactiae in pregnancy and the impact of recommendations on adherence to guidelines: an Italian area-based study.

INTRODUCTION: Streptococcus agalactiae, a species of ß-haemolytic streptococcus belonging to Lancefield's group B (GBS), is known as a common infecting agent transmitted to infants during childbirth, causing sepsis, meningitis, or both, with a high incidence of mortality. Following the observation of a great variability between regional laboratories both in the methodology and in the results of tests for the detection of GBS in pregnancy, with high percentages of false negative results, in 2010 the Department for Health Policies of Piedmont, Italian region, issued specific recommendations for adhere to international guidelines. Our aim was to assess whether the impact of the publication of the recommendations has been lasting over time. METHODS: We analyzed the regional birth certificate register from 2006 to 2018, to evaluate the annual number of deliveries, the number of Streptococcus agalactiae tests in pregnancy and the percentage of positive culture results. We also evaluated the consistency of the percentage of positive tests with the expectations based on the guidelines and compared the two time periods before and after introduction of regional recommendations using a multivariate regression model. RESULTS: The mean proportion of women tested for GBS vaginal-rectal swabs during pregnancy increased from 83.5% in 2006 to 90.7% in 2018 with the biggest rise in 2010, the t-test for the comparison of the two means was statistically significant (p < .001). The mean positivity rate increased from 12.7% to 19.2%, with a rise in 2010, with a significant t-test (p < .001). CONCLUSION: The results suggested a significant impact of the recommendations on the compliance and results regarding the carrying out and culture of vagino-rectal swabs for GBS, with better appropriateness of peripartum antibiotic therapy and possible reduction of GBS related neonatal sepsis.

A unique case of bilateral ovarian splenosis and review of the literature.

Splenosis is an acquired anomaly related to heterotopic auto-transplantation of splenic tissue following abdominal trauma or splenectomy. We report the first definitive bilateral ovarian case in a 65-year-old woman who underwent splenectomy following a motor vehicle accident 44 years prior to presentation. We review the literature and discuss the main differential diagnoses. Gross examination revealed a 1-cm well-circumscribed dark nodule on the surface of each ovary. Paraffin-embedded, formalin-fixed blocks were sectioned and stained with hematoxylin-eosin and immunostains (CK5/6, Calretinin, WT1, Vimentin). The histological presence of both red and white splenic pulp, delimitation from ovarian tissue and ovarian origin of blood supply, as well as medical history, led us to the correct diagnosis. The outer nodular surface was covered by mesothelium (WT1+, CK5/6+, Calretinin+, Vimentin+), which was in continuity with the ovarian surface epithelium. To our knowledge, only six previous cases of ovarian splenosis are reported. Our patient is the oldest, with a very long interval from splenectomy to presentation. Clinically, splenosis may mimic malignancy, and a correct diagnosis avoids unnecessary overtreatment. The differential diagnosis includes an accessory spleen, spleno-gonadal fusion, and splenic hamartoma: they should be excluded to come to the correct diagnosis.

Comparison of retrospective PET and MRI-DWI (PET/MRI-DWI) image fusion with PET/CT and MRI-DWI in detection of cervical and endometrial cancer lymph node metastases.

OBJECTIVES: The aim of this study was to compare the accuracy of retrospective image fusion of PET/MRI-DWI with that of PET/CT and MRI-DWI alone in detecting metastatic lymph nodes in patients with cervical and endometrial carcinoma. MATERIALS AND METHODS: Twenty-seven patients with endometrial (n = 14) and cervical (n = 13) cancer who had undergone preoperative MRI-DWI and PET/CT for staging were retrospectively evaluated. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT, MRI-DWI, and PET/MRI-DWI image fusion were calculated on a per-patient basis and on a per-node basis. Histopathological and follow-up imaging results were used as the gold standard. RESULTS: On a per-patient basis PET/MRI-DWI had the same sensitivity (87.5 %), specificity (84.2 %), diagnostic accuracy (85.1 %), PPV (70 %), and NPV (94.1 %) as PET-CT, but on a per-node basis PET/MRI-DWI showed better sensitivity (89 vs 70.2 %), specificity (91.6 vs 90.5 %), diagnostic accuracy (91.2 vs 87 %), PPV (68.7 vs 60.4 %), and NPV (97.6 vs 93.6 %) than PET-CT. Comparison of the areas under the ROC curves for the detection of metastatic lymph nodes demonstrated a non-significant difference (p = 0.055) between PET/CT and fused PET/MRI-DWI. CONCLUSION: PET/MRI-DWI may be a valuable technique for N-staging patients with endometrial and cervical cancer, but more studies are needed to investigate its potential clinical utility.

The value of imaging in standing position in preoperative breast lymphoscintigraphy.

PURPOSE: Breast lymphoscintigraphy is an accurate technique, but in a minority of cases the sentinel node (SN) visualization cannot be achieved or can be very difficult. We evaluated the potential clinical advantages and limitations of performing imaging in the standing position. The aim was to establish if this examination modality is quicker and helpful in the presence of "hidden" SN, checking also for any influence of SN skin landmarking in the upright position on the correct intraoperative SN identification. The overall objective was to verify if the standing position can be routinely used in breast lymphoscintigraphy. METHODS: A total of 144 patients underwent lymphoscintigraphy in both standing and supine positions. In both modalities, a skin landmark was set coincident with the SN orthogonal projections. The acquisition times of 2 groups (each consisting of 45 patients) examined with the standing or supine acquisition modality, were compared. RESULTS: In 6 cases with hidden SN and in 34 cases with difficult or partial visualization in one of the supine views, the standing protocol was effective and led to better and quicker visualization of lymph nodes (median examination time: 25.5 minutes standing, 35.5 minutes supine). Significant differences in skin landmark position between the 2 modalities were present only in overweight patients and in large breasts. This, however, did not have a negative impact on successful intraoperative localization of SN with the gamma probe. CONCLUSIONS: Standing acquisition resulted to be a faster, easier, and more accurate examination protocol and can be used as the routine method for SN detection in breast lymphoscintigraphy.

Arsenic trioxide and breast cancer: analysis of the apoptotic, differentiative and immunomodulatory effects.

Arsenic trioxide (As2O3) is used clinically to treat acute promyelocytic leukemia and has activity in vitro against several solid tumour cell lines, where induction of differentiation and apoptosis are the prime effects. To investigate the potential therapeutic application of As2O3 to breast cancer, we analysed the effects of As2O3 on the growth of four human breast cancer cell lines: MCF7, MDA-MB-231, T-47D and BT-20. Cells were cultured in 0.5, 2 and 5 microM AS2O3, a range of pharmacologically achievable concentrations of AS2O3. At > or = 2 microM, AS2O3 rapidly induced cell death by apoptosis in MCF7 and MDA-MB-231 while T-47D and BT-20 were partially resistant. At 0.5 microM, As2O3 was subapoptotic but induced features of differentiation consisting in upregulation of ICAM-1 (CD54), a marker of mammary epithelial differentiation, and cell cultures appeared morphologically more organized. Furthermore, we demonstrate by standard cytotoxicity assays that As2O3 treatment can augment breast cancer cell lysis by lymphokine-activated killer cells and demonstrate an important role of the ICAM-1/LFA-1 interaction in this process. This additional activity of As2O3 could translate into improved antitumour immunosurveillance in vivo. In conclusion, As2O3 induced varying degrees of differentiation, apoptosis and lysis in these model cell lines, and may be a promising adjuvant to current treatments of breast cancer by virtue of its triple apoptotic, differentiative and immunomodulatory effects.