Transvaginal contained tissue extraction after laparoscopic myomectomy: a cohort study.

OBJECTIVE: To describe the technique and report perioperative outcomes of transvaginal contained extraction of surgical specimens at laparoscopic myomectomy. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Two Italian referral centres for gynaecological minimally invasive surgery. POPULATION: Consecutive patients who underwent laparoscopic myomectomy. METHODS: Tissue extraction was accomplished following laparoscopic myomectomy in a specimen retrieval bag via a posterior colpotomy incision. If morcellation was necessary, this was performed extracorporeally, using a scalpel within the specimen retrieval pouch, whose edges were exteriorised through the vaginal introitus. MAIN OUTCOME MEASURES: Intra- and postoperative complications. RESULTS: A total of 316 women underwent transvaginal specimen retrieval with enclosed manual morcellation. The mean myomectomy specimen weight was 154 ± 128 g, and the mean operative time was 79 ± 26 minutes. No intraoperative complications occurred related to the specimen extraction or morcellation technique, or from rupture of the retrieval bag. Two (0.6%) women had a haemoperitoneum that spontaneously resolved and 16 (5.1%) had fever postoperatively. The final pathological diagnosis was benign in all cases. At the 30-day follow-up, no pelvic infection, vaginal dehiscence, or complaints of dyspareunia were recorded. CONCLUSIONS: Contained transvaginal extraction of fibroid specimens can be performed safely and efficiently in most women undergoing laparoscopic myomectomy. This technique represents a valuable minimally invasive alternative to intracorporeal morcellation. TWEETABLE ABSTRACT: Transvaginal contained morcellation at laparoscopic myomectomy is a valuable alternative to intracorporeal morcellation.

Breast metastasis from clear cell renal cell carcinoma.

In Western countries, breast cancer is the most common cancer in women, whereas metastases to the breast from extramammary malignancies are extremely rare. We present the case of a 60-year-old woman, who underwent surgery in 2007 for clear cell renal cell carcinoma and who 4 years later presented with a breast metastasis from clear cell renal cell carcinoma.

[Detection, characterization and clinical significance of circulating cancer cells in patients surgically treated for breast cancer]. / Ricerca, caratterizzazione e significato clinico di cellule tumorali circolanti in pazienti operate per cancro della mammella.

Recent technological advances have led to an increasing ability to detect isolated or groups of tumour cells in blood, lymph nodes or bone marrow in patients with different tumour types. However, the clinical evidence of these advances is unclear. The detection and the characterisation of circulating breast cancer cells and the eventually micrometastasis represent an important prognostic factor with therapeutic implications. The number of neoplastic cells being very small, these are not easily detected by using only cytomorphology, possibly associated to immunocytochemistry. In the last decade many studies have been directed in order to identify new assays. In the present review the Authors summarize advantages and disadvantages about two different technical approaches: molecular and immunomagnetic selection with cellular enrichment and immunocytochemistry.

[Is the Lauren classification an independent parameter for the prognostic evaluation of surgically treated gastric cancer patients? Analysis of a case series]. / La classificazione di Lauren può essere considerata un parametro indipendente per la valutazione prognostica di pazienti operati per cancro gastrico? Analisi di una casistica.

The Authors highlight the efficacy of the Lauren's classification in 28 surgically treated gastric cancer patients. Lauren's classification allows a prognostic evaluation corresponding to the effective gastric cancer natural history. Present histo-morphological classification criteria appear not to coincide with the clinical evolution; as a matter of fact over- or understaging is possible in gastric cancer patients. 64,28% of the Lauren's classification intestinal type patients survive after a four year follow up vs. 42,85% of the diffuse type patients. The Authors discuss about new biomolecular knowledge in gastric cancer oncogenesis.

Circadian rhythm of hunger sensation in patients affected by dysthymic disorder.

PURPOSE: The present study investigates the daily pattern of hunger sensation (HS), namely orexia, in patients affected by "Dysthymic Disorder" (DD). The aim is to detect whether there are changes in the circadian rhythm (CR) of HS, herein investigated as a "marker rhythm", that can reveal a dysfunction of the "circadian biological clock" (CBC). In such a circumstance, one could be authorised to suggest a resynchronizing therapy, via antidepressant chronizing drugs and/or morning exposure to bright light, as it is currently done in other types of human depression, having a documented dysfunction of the CBC. MATERIALS AND METHODS: Volunteered with informed consent for the study 6 women (age = 34-56 years; mean BMI = 22.7 +/- 4.8 kg/m2) affected by DD. 10 clinically healthy women (CHW, age = 21-52 years; mean BMI = 24.0 +/- 0.5 kg/m2) were recruited as the controls. Both of the dysthymic patients (DP) and CHW were asked to compile the "orexigram", which was chronobiometrically analyzed by means of the 1. conventional statistical methods; 2. rhythmometric analysis for the CR; 3. spectral analysis for the harmonic components of the orexigram. RESULTS: The DP were found to be characterized by a normal daily level of HS, with 1. the CR of the orectic stimulus to be preserved and well located in its acrophase, and 2. the spectrogram of the orexigram to be substantially well configured. CONCLUSIONS: The above-cited results suggest that the DP show no alterations in the HS marker rhythm that can be taken as an evidence for declaring that the DD is not characterized by a relevant dysfunction of the CBC. Lacking in particular a phase-shift in HS marker rhythm, it can be argued that the DD is an affective disorder for which a resynchronizing therapy (exposure to bright light or pharmacological chronizers) seems to be "a priori" not indicated.

[Identification of "presumptive risk" of hypertension crises with fractal interpolation of the 24-hour arterial pressure. III: study of normotensive subjects]. / Individuazione del "rischio presuntivo" di crisi ipertensive mediante interpolazione frattalica della pressione arteriosa di 24 ore. III: studio in soggetti normotesi.

PURPOSE: The present study is devoted to identify the normotensive subjects who are at a "presumptive risk" (PR) for hypertensive crisis, by applying the "fractal interpolation" (FI) to blood pressure 24-h pattern. MATERIALS AND METHODS: The investigation was performed on 109 ascertained cases of normotension, who underwent a non-invasive ambulatory monitoring of their 24-h blood pressure, by applying the FI to their daily mean arterial pressure. RESULTS: The study showed that the PR for hypertensive crisis can be found in 12% out of the investigated normotensives. The proportion of such a risk is not significantly higher in non-dippers as compared to dippers. Vice versa, the prevalence of cases with a PR for hypertensive crisis was found to be significantly increased in normotensives who were deprived by a significant blood pressure circadian rhythm as compared to those who showed the blood pressure circadian rhythm to be preserved. Furthermore, the cases "at risk" were found to show a different spectrum for the harmonic formants which compose the complex harmonic structure of the blood pressure 24-h variability. CONCLUSIONS: The PR for hypertensive crisis in normotensives seems to be increased by the loss of the blood pressure circadian rhythm, due to a change in the harmonic structure which confers the 24-h periodicity to the hemodynamic variable. This means that the abrogation of the blood pressure circadian rhythm in conditions of normotension promotes an adjunctive disorder for which the PR for hypertensive crisis is augmented.

[Determination of the "presumptive risk" of hypertensive crisis with fractal interpolation of 24-hour arterial pressure. II: study with secondary hypertensive patients]. / Individuazione del "rischio presuntivo" di crisi ipertensive mediante interpolazione frattalica della pressione arteriosa di 24 ore. II: Studio in ipertesi secondari.

PURPOSE: The present study applies the "fractal interpolation" (FI) to 24-h blood pressure nonivasively and ambulatorily monitored over a day-night period in secondary hypertensives. The purpose is the evaluation of the prevalence for a "presumptive risk" (PR) of hypertensive crisis. MATERIALS AND METHODS: The study was carried out in 108 cases of secondary hypertension, who were non-invasively and ambulatorily monitored for their 24-h blood pressure values. The FI was applied to the time-qualified values of the mean arterial pressure. RESULTS: The PR of hypertensive crisis was found in 11% of the investigated secondary hypertensive patients. Such a risk shows a not significant prevalence in dippers as compared to non-dippers, and in those who showed a significant blood pressure circadian rhythm as compared to those who showed the blood pressure circadian rhythm to be abolished. Additionally, a not significant difference was found between the cases "at risk" and "not at risk" as far as the spectrum of harmonic formants of the 24-h blood pressure pattern is concerned. CONCLUSIONS: The PR of hypertensive crisis is not associated with the dipping/non-dipping phenomenon as well as the circadian rhythmicity of blood pressure. Its occurrence in secondary hypertensives is essentially related to the disorder that is detectable in blood pressure non-linear variability. Therefore, such a risk may be caused by neurovegetative mechanisms which notoriously confer a non-linear chaotic variability to 24-h blood pressure pattern.

[Individualization of the "presumptive risk" of hypertensive crisis using fractals interpolation of the 24-hour arterial pressure. Study of patients with essential hypertension]. / Individuazione del "rischio presuntivo" di crisi ipertensive mediante interpolazione frattalica della pressione arteriosa di 24 ore. I: Studio in ipertesi essenziali.

PURPOSE: The present study applies the "fractal interpolation" (FI) to blood pressure that was nonivasively and ambulatorily monitored over a day-night period in essential hypertensives. The purpose is the identification of cases who are at a "presumptive risk" (PR) for hypertensive crisis. MATERIALS AND METHODS: The investigation was performed on 380 ascertained cases of essential hypertension, who underwent a non-invasive ambulatory monitoring of 24-h blood pressure. The FI was applied to the ambulatory mean arterial pressure. RESULTS: The FI showed that the PR of hypertensive crisis can be found in 14% of the investigated essential hypertensive patients. Such a risk is not significantly higher in dippers as compared to non-dippers, and in those who showed a significant blood pressure circadian rhythm as compared to those who showed the blood pressure circadian rhythm to be abolished. Furthermore, no significant difference was found between the cases "at risk" and "not at risk" as far as the spectrum of harmonic formants of the 24-h blood pressure pattern is concerned. CONCLUSIONS: The PR of hypertensive crisis is not correlated to the dipping/nondipping condition, circadian rhythmicity and complex harmonic structure of 24-h blood pressure pattern. Its occurrence depends essentially from the disorder that is detectable in 24-h blood pressure pattern. Therefore, such a PR in essential hypertensives may be attributed to the mechanisms, likely neurovegetative, which confer a non-linear chaotic variability to 24-h blood pressure values.

Circadian rhythm of hunger sensation in obese patients: effects of a short-term, moderately hypocaloric diet with a substitutive meal.

This investigation deals with the circadian rhythm (CR) of hunger sensation (HS) in obese patients before and after a four-week, moderately hypocaloric diet with a substitutive meal. The study was performed on 25 non-diabetic obese patients (5 males and 20 females, mean age: 39.7 +/- 7, mean BMI: 27.9 1.4 Kg/m2), whose obesity was not associated with impaired glucose tolerance (IGT), binge eating, nor endocrine diseases. Their daily HS profile (orexigram) was analysed chronobiometrically. The moderately hypocaloric diet with a substitutive meal reduced the daily HS by about 10% by the fourth week. This reduction was apparently due to a tonic and amplitude modulation of the HS CR and was not accompanied by its disruption. No conclusions, however, could be drawn with regard to its orectic and clinical effects beyond four weeks.

[Daily sensation of hunger, before and after phototherapy, in subjects with depression-type seasonal affective disorder]. / La sensazione giornaliera di fame, prima e dopo fototerapia, in soggetti affetti da disordine affettivo stagionale--tipo depressione.

OBJECTIVE: The present study investigates the daily pattern of hunger sensation (HS) in women affected by "seasonal affective disorder--depression type" (SAD-DT), before and after therapeutic exposure to bright light (phototherapy). The aim is to detect whether there are disorders in daily HS during the active phase of the disease which can be normalized by an effective treatment of the depressive status, via phototherapy. MATERIALS AND METHODS: Volunteered for the study 4 women affected by SAD-DT, 32-58 years old (BMI: 17.8-29.6 Kg/m2); 10 clinically healthy women (CHW), 21-52 years old (BMI: 23 e 25 Kg/m2) were recruited as controls. Both of the SAD-DT patients and CHW were asked to compile the "orexigram", which was chronobiometrically analyzed by means of the 1. conventional statistical methods; 2. rhythmometric analysis; 3. spectral analysis. RESULTS: Before phototherapy, the SAD-DT patients were found to be characterized by an increased HS (hyperorexia), with the circadian rhythm of the orectic stimulus (OS) which is shifted in its acrophase, being prone to become "free running". After phototherapy, the SAD-DT patients were found to show a little insignificant decrease in their OS, which still maintains a delayed phase in its circadian rhythm as well as the tendency to be "free running". CONCLUSIONS: The pre-treatment findings suggest that the SAD-DT patients are affected by hyperorexia associated with a "phase-shift" for the circadian periodicity of their HS, which is prone to the desynchronization. Such a dyschronism reinforces the hypothesis that the SAD-DT may be pathogenetically sustained by a mechanism of "phase-shift". The post-treatment findings suggest that both the hyperorexia and dyschronism of the orectic circadian rhythm are uncorrected by the phototherapy, even though the SAD-DT patients seem to have had beneficial antidepressive effects from the therapeutic intervention. The persisting dyschronism indicates that the photic stimulus is not able to completely reset the biological clock of the suprachiasmatic nuclei, at least for the phasic modulation of the HS circadian rhythm. The orexigram, thus, could be enclosed among the clinical tools in order to assess the complete efficacy of the phototherapy in SAD-DP patients.

[Criteria and modalities of assessment of work fitness for jobs in food industry]. / Criteri e modalità di formulazione dei giudizi di idoneità in un'azienda del comparto alimentare.

Current legislation establishes the general methods and standards of judgement concerning fitness of workers to perform particular jobs. The object of this study was to verify particular criteria and methods that, in observance of the law, allow the physician to maintain in productive activity workers with chronic disease or permanent consequences of industrial accidents in Apulia, Southern Italy. In accordance with the law, 156 workers and their work environment are regularly under surveillance. In the last few years it was possible to accurately diagnose all diseases that may be involved in particular work fitness checks. 3 workers suffered the permanent consequences of very serious labour accidents amputation of II, III, IV fingers of the right hand; a slight post-traumatic shortening (shrinkage) of the right femur; tympanic membrane perforation). 7 workers suffered from non-work related disease (substitution of aortic valve, allergic asthma, virus B chronic hepatitis, chronic glomerulonephritis, replacement of right knee, rheumatoid arthritis, thrombosis of the retinal central vein without a vision reduction). The criteria for an "fitness judgement" are: an accurate diagnosis and evaluation of residual functional ability, analysis of the original job, with an investigation in the field, and break down into the single operations in order to assess all work-related risks (concerning health, safety and physical resources), and evaluation of work organization per job. It was thus possible to define particular adjustments to the original job, so as to be compatible with the current physical conditions the workers. Workers, factory directors and union officers accepted these particular criteria and standard of "work fitness judgement, which made it possible to apply them in practice with consequent reinstatement of workers in productive activity.

Anxiety, depression, hunger and body composition: III. Their relationships in obese patients.

The present paper explores the relationships between anxiety, depression, hunger sensation and body composition in obese patients (OP). The aim is to detect whether or not there are abnormalities in these relationships in OP as compared to clinically healthy subjects (CHS). The study was performed on 22 CHS (2 M, 20 W; mean age = 24 +/- 2 years; mean body mass index = 21 +/- 2 kg/m2) and 48 OP (4 M, 44 W; mean age = 40 +/- 17 years; mean body mass index = 32 +/- 7 kg/m2). Anxiety and depression were found to be correlated, negatively, with the relative lean body mass, and, positively, with the fat body mass in OP but not in CHS. These findings corroborate the idea that anxiety and depression can reach an abnormal expression when obesity shows its worst loss in lean body mass and its highest expansion in adipocyte mass. As hunger sensation was found not to correlate with either anxiety or depression in OP, the opinion is expressed that the impairment of anxio-depressive integrity is a corollary of obesity rather than a primary affective disorder leading to obesity via an enhanced food intake.

Daily hunger sensation and body compartments: II. Their relationships in obese patients.

Hunger sensation (HS) is a signal whose levels change during the 24-h day. The daily mean level of HS was correlated with the human body compartments, as investigated by bioelectrical impedance analysis, to detect the relationship between the orectic perception and both the free fat mass (FFM) and the fat body mass (FBM) in 22 clinically healthy subjects (CHS) (2 M, 20 W, BMI: 18.5-24.0 kg/m2) and 48 obese patients (OP) (4 M, 44 W, BMI: 25.2-54.7 kg/m2). In CHS, the daily mean level of HS correlated positively with the FFM and negatively with the FBM. These correlations were not present in OP. This lack of relationships between HS and the body compartments where energy is maximally consumed (i.e., the FFM) and maximally stored (i.e., the FBM) indicates that the orectic response to energy expenditure and the orectic inhibition to fat accumulation are feedback mechanisms which are impaired in obesity.

Respiratory mucus transportability is impaired in foundry workers: a longitudinal study.

Mucus transportability impairment can prolong the permanence of occupational inhalable noxae within ciliated airways. A reliable, non-invasive indicator of mucus transportability is the Normalized Frog Palate Transport Rate (NFPTR). The aim of this 3-year prospective study was to compare NFPTR between a group of 166 foundry workers (E) and a group of 133 power plant workers (NE). In the first and third years of the study, workers underwent: clinical examination, spirometry, NFPTR, chest radiography. In both plants, environmental concentrations of respiratory irritants were well below the limits set by the American Conference of Governmental Industrial Hygienists. Both groups were homogeneous for age and smoking habits. Mean NFPTR was significantly lower in E than in NE in the first and third years of the study, and in smokers in comparison with non-smokers, at the end of the follow-up. NFPTR impairment was significantly associated with occupational exposure in the first and third years of the study. In the third year, a decline in NFPTR was associated with exposure, smoking habits, FVC and FEV1/FVC.100. At the end of the study, the means of FVC, FEV1 and PEF were significantly lower in E. No cases of pneumoconiosis were observed. In this study, low doses of foundry respiratory irritants were associated with impairment of mucus transportability; the consequent slowing of mucociliary clearance increased internal doses of foundry airborne noxae.

[Minor and major work accidents in a Puglia business in the food sector: a 10-year study]. / Infortuni sul lavoro minori e maggiori in una azienda pugliese del settore alimentare: uno studio decennale.

At present no official data are available for those occupational accidents which, according to current law, are not subject to notification to the Italian National Institute for Insurance of Occupational Accidents (INAIL) and which are conventionally called "minor" accidents. They can be divided into accidents with prognosis from 1 to 3 days (franchises) and accidents which do not cause absence from work (medications). The already mentioned lack of data, which is not confined to Italy, is reflected in the small number of articles published in Italian and international journals. Also information regarding the possible relationships between "minor" accidents and the life habits of injured workers, are rare. The aim of this study was to provide detailed data on the characteristics of the different kinds of occupational accidents occurring in a food factory in Apulia, southern Italy, from 1985 to 1994, as well as to verify whether any relationship existed between the different types of occupational accidents and the consumption of cigarettes and alcohol by injured workers. The company's accident register yielded data on injuries which caused absence from work; the nursing service register provided information about accidents which did not determine absence from work; personal health documents gave details of worker life habits; and the company pay roll showed the amount of "worked hours". "Minor" accidents represented 70% of all accidents occurring during the ten year period studied. "Blue collars" had more frequent and serious occupational injuries, in comparison with "technical employees". "Minor" accidents, and especially "medications", occurred more frequently during one-shift work than during three-shift work. As work seniority increased, the number of "major" accidents decreased and number of accidents without absence from work rose. Contusions were the most frequent lesions and were responsible for the majority of the 3 kinds of accidents. "Medications"" together with injuries notified to INAIL ("major" accidents), mostly involved upper limbs; "franchises" were mostly head interested. About 50% of all causes of occupational accidents were mainly associated with unsafe environmental and working situations, whereas the remaining 50% were mainly associated with unsafe behaviour by workers. Heavy smokers showed a higher frequency of "major" accidents. As alcohol consumption rose, she did number of accidents with absence from work. "Minor" accidents, particularly the "medicated" ones, represented the greatest part of occupational injuries. All the considered causes and circumstances contributed to determine the different kinds of accidents. Thereby, it appears necessary for prevention purposes to obtain information about any kind of injury in the different manufacturing sectors. Finally, it seems dutiful to inform workers about the relationships between life habits and occupational accidents.

[Mucociliary clearance and respiratory function in foundry workers]. / Clearance mucociliare e funzionalità respiratoria in lavoratori di fonderia.

The aim of the study was to establish whether changes occur in respiratory function, particularly mucociliary clearance, among second fusion smeltery workers. The research covered 93 male smelters employed in steel forming and casting and 116 male workers of an electric power station, considered as non-exposed. Physiological, pathological and occupational histories of all subjects under study were available. An ECCS respiratory symptoms questionnaire was administered to all subjects ad the two groups also underwent a general medical examination, a spirometry and a chest X-ray. During the medical examination sputum was collected from the subjects to measure mucus transport rate on frog palate, expressed as Normalised Frog Palate Transport Rate (NFPTR). For the environmental research, dust, fumes and gas samplings were taken either at a fixed station or by means of personal dosimeters. Environmental research revealed very low concentrations of respiratory irritants (total dust: 0.2-6.8 mg/m3; respirable dust: 0.1-4.9 mg/m3; total silica: < 2-15.5%; respirable silica: < 0.004-0.3 mg/m3; iron: 0.008-0.085 mg/m3; chromium and manganese: < 0.001 mg/m3; fumes and gases: well below the TLV. The two groups were homogeneous with regard to age and smoking habits. Exposed workers showed rales, dyspnoea and spontaneous phlegm more frequently than non-exposed workers. NFPTR alterations were checked in 49 out of 81 exposed and in 18 out of 81 non-exposed subjects (chi squared = 22.9; p < 0.001). Stratification of the results according to smoking habits further confirmed the strong association between occupational exposure and NFPTR alterations. Smelters showed significantly lower mean NFPTR values compared to non-exposed subjects; also, the mean value of NFPTR in the exposed was below 0.70, which is considered the lowest individual limit in normal subjects. The only variable which explains a large part of the variability of NFPTR is past work in a smeltery rather than in an electric power station. The spirometries showed that only the mean PEF values were significantly lower among the exposed. Stratified analysis of the results according to smoking habits in the two groups revealed a close association between smeltery work and reduction of PEF to under 80% of the ECCS 1983 theoretical values, independently of smoking habits. We also compared the mean PEF values, both as measured values and as percent values of the ECCS 1983 theoretical values, stratified for occupational exposure and smoking; the results again showed that differences between these mean values were mainly due to current or past work in the foundry.(ABSTRACT TRUNCATED AT 400 WORDS)

[Nimesulide and algo-edematous pathology of the oral cavity]. / Nimesulide e patologia algo-edemigena del cavo orale.

Nimesulide has been tested by the Authors on a group of 40 adults patients of both sexes that had undergone oral surgery. After careful clinical observation it was established that this drug has an excellent analgesic effect and is also effective as an antiedemigen and antiflogistic therapy. Furthermore the total tolerability of Nimesulide was established after noting the absence of gastroenteric or allergy symptoms.