Usefulness of x-ray in the detection of complications and side effects after laparoscopic sleeve gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a surgical procedure which reduces the gastric volume causing a feeling of early fullness while decreasing hunger due to a reduced secretion of ghrelin. This leads to a considerable loss of body weight. The purpose of this study was to assess the usefulness of early x-ray examination and subsequent x-ray follow-up in the detection of postoperative complications and long-term functional recovery. METHODS: From March 2010 to April 2011, 101 consecutive patients underwent LSG for morbid obesity and were subsequently included in this retrospective study. All patients were submitted to early x-ray examination 1-3 days after surgery and x-ray follow-up 3-6 months after surgery to detect the presence and persistence of surgical and functional complications. RESULTS: Early postoperative x-ray examination detected one case of suture leakage 1 day after surgery as well as one abscess and one gastric fistula in two patients who had become symptomatic 9 and 10 days after surgery. CONCLUSIONS: Early x-ray examination showed that complications were mainly functional and rarely surgical. Subsequent follow-up showed that functional disturbances were significantly reduced over time. X-ray is an easy and reliable method for detecting complications and side effects of LSG. However, in view of the extremely low incidence of surgical complications revealed at the early x-ray examination, this procedure may not be required as a routine examination in all operated patients and should be performed only in patients who become symptomatic and those considered at risk of developing more serious complications.

Contrast-enhanced ultrasonography in the diagnosis of upper urinary tract urothelial cell carcinoma: a preliminary study.

PURPOSE: The main objective was to assess the effectiveness of contrast-enhanced ultrasonography (CEUS) in the diagnosis of upper urinary tract malignancies by comparing with multidetector computed tomographic urography (MDCTU) and magnetic resonance urography (MRU). Secondary objectives were to compare the tumor size measured with CEUS, MDCTU and MRU and to assess the usefulness of CEUS in distinguishing high-grade tumors from low-grade ones. MATERIALS AND METHODS: In connection with this prospective study carried out from January 2009 to September 2011, 18 patients underwent MDCTU or MRU, grayscale ultrasonography (US), color Doppler ultrasonography and CEUS followed by surgery and histological examination of the specimen. Quantitative analysis was performed using perfusion software. Time intensity curves were extracted and the following parameters were considered: wash-in time, time-to-peak, maximum signal intensity and wash-out time. RESULTS: Grayscale US identified 15/18 lesions; color Doppler showed no flow signal in 8 lesions, low color signal in 9 lesions and an intense color signal in 1 lesion; CEUS identified 17/18 lesions with the undetected lesion being the smallest one (1.2 cm) located in the upper pelvicalyceal system. Semi-quantitative analysis produced different data for high-grade and low-grade urothelial cell carcinoma (UCC). All detected upper urinary tract masses were UCCs. MRU, MDCTU and grayscale US overestimated the tumor size, while CEUS was the most accurate. CONCLUSION: CEUS is useful for evaluating upper urinary tract masses as this method permits differentiation between high-grade and low-grade tumors as well as distinction of the tumor from the adjacent structures and accurate mass measurements.

[Micro RNA-155 expression in hemodialysis PBMC]. / Espressione del micro rna-155 nelle PBMC di pazienti in emodialisi cronica.

INTRODUCTION: MicroRNAs (miR) are fragments of non-coding RNA acting at post-transcriptional level, which modulate gene expression, and play a key role in several pathophysiological pathways. The aim of this study is to analyze the expression of miR-155 in basal Peripheral Blood Mononuclear Cells (PBMC) of chronic hemodialysis (HD) patients, before and after standard 4 -hour sessions, and after PHA stimulation compared with PBMC from healthy subjects. METHODS: miR-155 was isolated from chronic HD patients' PBMC and from PBMC derived from healthy subjects. Expression levels were quantified with Real-Time PCR; PCR reactions were performed using a specific thermocycler and cycle threshold levels were calculated using dedicated software. Blood samples were taken from HD patients after the long inter-dialytic interval. Data were expressed as MSE and statistical differences were calculated with t-test. RESULTS: Relative quantity (RQ) of pre-dialysis MiR-155 was 3.770.62 times higher than the control group (P=0,003). There was no significant difference before and after hemodialysis sessions. Pre-dialysis mir-155 RQ in PHA PBMC was 1.790.59 times higher than non stimulated PBMC (P=0.019). CONCLUSIONS: these preliminary data show a significant miR-155 up-regulation of HD PBMC when compared to PBMC from healthy individuals. An additional up-regulation was observed in HD PHA PBMC. Similar miR-155 expression was found in HD PBMC comparing pre and post-hemodialysis sessions.

Contrast-enhanced ultrasound examination of the breast: a literature review.

Angiogenesis is the basis for neoplastic growth in human tissues. Nevertheless, neovascularization may be present both in benign and malignant lesions. Although microvascular density assessment is a useful tool for the study of neoplastic vascularization, it cannot be used on a large scale because of the invasiveness of the method. When contrast-enhanced ultrasonography (CEUS) was introduced in clinical practice, the initial results in the field of breast lesions were disappointing because differentiation between benign and malignant masses was not possible. Magnetic resonance imaging (MRI) assessment of the microvascular features was therefore immediately accepted because of the higher diagnostic accuracy. However, in the last decade the sensitivity and specificity of CEUS have greatly improved due to the development of more sophisticated ultrasound (US) equipment, the introduction of second-generation contrast agents and the development of dedicated software able to perform quantitative analysis. This literature review compares the main results reported in the literature regarding the use of CEUS for the characterization of neoplastic lesions of the breast. All the authors agreed that malignant lesions show early wash-in with more intense enhancement and fast wash-out in comparison with benign masses. However, there is still no observer agreement regarding vascularization patterns, and different classifications are proposed. The conclusion of this literature review is therefore that the clinical role of CEUS in the diagnostic process and in follow-up is still to be clearly defined.

Burnout and related factors among HIV/AIDS health care workers.

A sample of 194 Italian health care-givers working in HIV/AIDS units was assessed to investigate whether there was a correlation between individual variables (socio-demographic and occupational characteristics, personality traits, anxiety, depression, attitudes and emotional reactions) and burnout and job satisfaction. For this proposal were used the Maslach Burnout Inventory (MBI), a socio-demographic and occupational characteristics schedule. Sixteen Personality Factor Questionnaire, Ipat Anxiety Scale, Ipat Depression Scale and AIDS Impact Questionnaire. A principal component analysis on frequency subscales scores of MBI extracted two independent dimensions labelled 'burnout' and 'personal accomplishment'. The results suggested important correlations among 'burnout', 'personal accomplishment', anxiety and depression. Age of care-givers was negatively correlated with 'burnout' and practical nurses were less personally accomplished. Anxiety, depression, emotional reactions, attitudes, ego strength, and the aptitude for interpersonal relationships and to team work were significant factors in outlining a profile of highly 'burned out' and 'personally accomplished' HIV/AIDS health care-givers. These results suggest the development of precise strategies of prevention, intervention and treatment of burnout considering not only the importance of occupational and institutional characteristics but also of individuals ones.

[Prostatic pathology and correlated urethral stenosis. 10 cases treated with transluminal urethroplasty]. / Patologia prostatica e stenosi uretrali correlate. Dieci casi trattati con uretroplastica transluminale.

Our study was intended to verify the efficacy and the side effects of intraluminal dilatation of the distal urinary tract with vascular balloon catheter in a group of patients with urethral stenosis. In 6 out of 10 patients, there was a significant increase in urethral diameter (by 70% to 150%). In 4 patients, the stenosis was only slightly improved (increase in urethral diameter by 10% to 20%). Only 5 patients, all belonging to the group in which dilatation was anatomically effective, have been having normal micturition and have been asymptomatic. According to data in our possession, transurethral dilatation does not seem to be very effective, since it restores adequate micturition in only 50% of cases. In view of the absence of severe side effects, however, this technique may be indicated in patients with medical problems that preclude surgery.

[Effects of flecainide in patients with non-sustained ventricular tachycardia and impaired left ventricular function]. / Effetti della flecainide in pazienti con tachicardia ventricolare non sostenuta e ridotta funzione ventricolare sinistra.

Anti-arrythmia efficacy and effects on left ventricular function of flecainide have been evaluated in 9 patients with symptomatic non sustained ventricular tachycardia (NSVT) and left ventricular ejection fraction (LVEF) lower than 30%, respectively detected by Holter monitoring and radionuclide angiocardiography in basal conditions. Seven to eleven days after starting flecainide therapy (100 mg b.i.d.), Holter and radionuclide angiocardiography were repeated. In 56% of patients a ventricular premature beats (VPB) reduction more than 70% was obtained and total VPB suppression was achieved in 33% of patients. Total suppression of NSVT was obtained in 67% of patients; LVEF did not show significant changes. Thus, antiarrhythmic efficacy of flecainide resulted in agreement with the previous reports, whereas no patient developed signs or symptoms of heart failure or pro-arrhythmia.

[Holiday heart syndrome: spontaneous reversibility of the electrocardiographic and echocardiographic alterations]. / "Holiday heart syndrome": reversibilità spontanea di alterazioni elettrocardiografiche ed ecocardiografiche.

The holiday heart syndrome is characterized by symptomatic arrhythmias more often supraventricular, elicited by alcohol ingestion, typically during the week-end period. After admission, electrocardiographic changes, which disappear in few days, are often reported. A case of an alcoholic with syncopal episodes related to alcohol ingestion is described. In this patient, remarkable changes of ventricular repolarization on the electrocardiogram associated with impairment of ventricular diastolic function on the Doppler echocardiographic study are showed. ECG and echo-Doppler data reversed to normality after few days of alcohol withdrawal.

Lidocaine, mexiletine and propafenone in the treatment of arrhythmias complicating myocardial infarction. A case report.

We describe a case of acute myocardial infarction complicated by atrial and ventricular arrhythmias in which it was possible to verify the effectiveness of lidocaine, mexiletine and propafenone. Intravenous administration of mexiletine was ineffective both on atrial and ventricular rhythm disturbances. The lidocaine therapy reduced ventricular ectopic frequency, but did not prevent the appearance of several paroxysms of atrial fibrillation. Intravenous infusion of propafenone, 11 micrograms/kg per min, after a 1 mg/kg i.v. bolus, immediately and completely suppressed atrial arrhythmias. The increase in infusion rate up to 22 micrograms/kg per min also suppressed ventricular ectopy. This dosage of propafenone did not provoke serious adverse effects in our patient.

Effects of captopril on blood pressure and renin-angiotensin-aldosterone system in hypertensive subjects after inhibition of renal vasodilative system.

The aim of this study is to contribute to the understanding of the probable role of the renin-angiotensin-aldosterone, the kallikrein-kinins and the prostaglandins systems on the various types of essential hypertension and also their contribution to the action of captopril. Nineteen patients, 7 with high and 12 with normal or low levels of plasma renin activity (PRA), have been studied. Captopril (100 mg) was administered in acute dosage, blood pressure was checked for two hours and PRA and plasma aldosterone were assayed. The same trial was repeated after inhibition of prostaglandin-synthetase with indomethacin and kallikrein with trasylol, alternatively, and then with indomethacin and trasylol, contemporaneously. Our results showed that the renal vasodilative system was probably also involved in the mechanism of action of captopril, but that this drug reduced blood pressure mainly through a block of angiotensin II production in both groups of patients. Thus the finding of a normal or low PRA does not justify the conclusion that angiotensin II is not one of the mechanisms responsible for an elevated arterial pressure.