What hides beneath the scar: sexuality and breast cancer what women don't say: A single-center study.

Background: Breast is a symbol of femininity, motherhood and sexuality. Breast cancer (BC) is the leading cause of cancer death in women worldwide and most frequent cancer in Italy: in 2019, 53.500 new cases were diagnosed. BC and its treatment, the disturbances of body image, and mental health problems such as anxiety and depression could influence sexuality. Very often the aspect of sexuality in BC is likely not to be fully investigated: cultural barriers may also contribute to lack of attention to these issues. In Italy, there are very few Breast Units that provide the figure of the sexologist and psycho-oncologist. Methods: We enlisted 141 BC patients (pts), mean age was 54 years afferent to Breast Unit S. Maria Goretti Hospital, Latina, from March 2019 to March 2020. All pts had undergone surgical intervention. Participants were invited to complete a structured questionnaire, which included four close-up questions regarding self-image, sexual activity, sexual satisfaction, analyzing these aspects before and after BC and its treatments. Finally the participants were asked if they needed the sexologist and psycho-oncologist. Results: Only 2/141 pts (1.41%) refused to participate in our study. Of 139 participants, 68 (48.92%) had disturbances of body image, 26 (18.7%) had sexuality greatly negatively affected, and 103 (74.1%) every kind of sexual dissatisfaction after BC. 38 pts (27.3%) would require the help of the sexologist. 135 ( 97%) would require the help of the psycho-oncologist. Despite the negative influence in their body-image and sexuality, few pts require the help of the sexologist, but nearly all pts require the help of the psycho-oncologist. Conclusion: In our study nearly all pts require the help of the psycho-oncologist, but few pts of the sexologist. Further studies will be needed to understand the reasons for this disparity: at the moment we are carrying out another project following this illustration, with the aim of understanding why this disparity.

LOX-1 and cancer: an indissoluble liaison.

Recently, a strong correlation between metabolic disorders, tumor onset, and progression has been demonstrated, directing new therapeutic strategies on metabolic targets. OLR1 gene encodes the LOX-1 receptor protein, responsible for the recognition, binding, and internalization of ox-LDL. In the past, several studied, aimed to clarify the role of LOX-1 receptor in atherosclerosis, shed light on its role in the stimulation of the expression of adhesion molecules, pro-inflammatory signaling pathways, and pro-angiogenic proteins, including NF-kB and VEGF, in vascular endothelial cells and macrophages. In recent years, LOX-1 upregulation in different tumors evidenced its involvement in cancer onset, progression and metastasis. In this review, we outline the role of LOX-1 in tumor spreading and metastasis, evidencing its function in VEGF induction, HIF-1alpha activation, and MMP-9/MMP-2 expression, pushing up the neoangiogenic and the epithelial-mesenchymal transition process in glioblastoma, osteosarcoma prostate, colon, breast, lung, and pancreatic tumors. Moreover, our studies contributed to evidence its role in interacting with WNT/APC/ß-catenin axis, highlighting new pathways in sporadic colon cancer onset. The application of volatilome analysis in high expressing LOX-1 tumor-bearing mice correlates with the tumor evolution, suggesting a closed link between LOX-1 upregulation and metabolic changes in individual volatile compounds and thus providing a viable method for a simple, non-invasive alternative monitoring of tumor progression. These findings underline the role of LOX-1 as regulator of tumor progression, migration, invasion, metastasis formation, and tumor-related neo-angiogenesis, proposing this receptor as a promising therapeutic target and thus enhancing current antineoplastic strategies.

[Peristomal laparocele: particular indications for the use of prosthetic materials]. / Il laparocele peristomale: una indicazione particolare all'utilizzazione di materiali protesici.

The authors report the case of a female patient suffering from colic neoplasm and a vast peristomal laparocele, the long-term outcome of a rectal amputation that the patient underwent at a young age. After colic resection, a vast area of surgical mesh in dacron was modelled and positioned in a retromuscular scat, thus allowing the hernia pathology to be resolved relatively simply, owing to its particular location-in correspondence with a preternatural anus-until not long ago this would have represented an absolute contraindication to the use of prosthetic materials. A precise surgical approach, marked by a scrupulous respect for aseptic conditions, is essential in these circumstances owing to the persistent risk of septic complications.

Oral iron chelating therapy. A single center interim report on deferiprone (L1) in thalassemia.

BACKGROUND AND OBJECTIVE: Deferiprone (L1) is a largely studied oral chelator in clinical setting, however, no definite conclusions concerning efficacy and toxicity still could be drawn. In an ongoing prospective trial with L1, we evaluated the efficacy and tolerance-toxicity in patients with thalassemia major previously treated by desferrioxamine (DFO); the specific aim of the study is to demonstrate that L1 could be an alternative to DFO in some patients with an acceptable toxicity. DESIGN AND METHODS: Sixty-nine patients over 13 years of age with poor compliance to DFO were considered for the study. The design included a liver biopsy before starting L1 in all patients in order to define liver siderosis either by histologic grading or by hepatic iron concentration (HIC); only patients with a minimum HIC of 4 mg/g dry weight entered the study. A repetition of the liver biopsy after one year of L1 was planned; further evaluations included serum ferritin, plasma iron, transferrin TIBC and iron urine excretion. L1 was given at 70 mg/kg/day in three divided doses. Toxicity was monitored either clinically or by controlling liver, kidney and marrow function by specific tests. Concerning clinical characteristics 52 patients showed hypogonadism (78%), 39 growth retardation (58%), 6 diabetes (9%), 4 cardiomyopathy (6%), 9 hypothyroidism (12%); 45 patients had chronic liver damage (65%). RESULTS: We focus this report on data collected in a group of 29 patients with a minimum follow-up of one year (14-33 months). The mean ferritin value was 3748 ng/mL (range: 200-10,000) and 2550 ng/mL (range: 80-14,500), before and while on L1 therapy, respectively (p = 0.001); the mean sideruria changed from 17.25 mg/dL (range: 5.4-50) to 20.98 mg/dL (range: 10-40), on DFO and L1, respectively (p = 0.078); the ratio between plasma iron (sideremia) and transferrin TIBC changed from 0.96 with DFO to 0.86 with L1 (0.014). A correlation with grade of liver siderosis and serum ferritin (p = 0.069) and iron urine excretion (p = 0.008) was recorded. The judgement of efficacy showed that L1 was effective (EF) in 9 patients, no assessable (UN) in 11 patients, not effective (NE) in 2 patients and with no advantages with respect to DFO in 7 patients. Liver biopsy was repeated in 20 patients showing a reduction of grade of liver siderosis and iron content in 7 patients. Clinical toxic effects of L1 were gastric intolerance (one patient), joint pain (three patients) and mild and temporary neutropenia (one patient). INTERPRETATION AND CONCLUSIONS: This preliminary experience shows that L1 is effective in several patients with thalassemia with poor compliance to DFO and to improve iron burden and iron excretion with generally minor side effects. L1 could be an alternative to DFO in some patients, however the recognition of neutropenia warrants a careful evaluation of patients and efforts finalized to early recognition of those to be addressed with this new and still experimental therapy.

[The use of prosthesis material in emergency surgery. Comments on a clinical case]. / L'utilizzazione di materiale protesico in chirurgia d'urgenza. Considerazioni su di una osservazione clinica.

The authors briefly report the case of a patient in whom a double Mersilene graft was used to repair a strangulated umbilical hernia. This report is interesting for various reasons. Firstly, the fact that surgery was performed under emergency conditions and secondly, the position of the graft, which was certainly not ideal--even if obligatory owing to the circumstances under which the operation was performed--in the abdominal wall. In spite of the successful results obtained, the authors feel that graft should preferably be used in elective surgery in which additional operations are not required which may further contaminate the operating field. In particular, special attention should be paid to graft position in relation to the various layers of the abdominal wall.

Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice.

OBJECTIVE: To assess the prevalence of circumcision across various social groups and examine the health and sexual outcomes of circumcision. DESIGN: An analysis of data from the National Health and Social Life Survey. PARTICIPANTS: A national probability sample of 1410 American men aged 18 to 59 years at the time of the survey. In addition, an oversample of black and Hispanic minority groups is included in comparative analyses. MAIN OUTCOME MEASURES: The contraction of sexually transmitted diseases, the experience of sexual dysfunction, and experience with a series of sexual practices. RESULTS: We find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases. However, uncircumcised men appear slightly more likely to experience sexual dysfunctions, especially later in life. Finally, we find that circumcised men engage in a more elaborated set of sexual practices. This pattern differs across ethnic groups, suggesting the influence of social factors. CONCLUSIONS: The National Health and Social Life Survey evidence indicates a slight benefit of circumcision but a negligible association with most outcomes. These findings inform existing debates on the utility of circumcision. The considerable impact of circumcision status on sexual practice represents a new finding that should further enrich such discussion. Our results support the view that physicians and parents be informed of the potential benefits and risks before circumcising newborns.

Hepatic iron overload in thalassemic patients: proposal and validation of an MRI method of assessment.

BACKGROUND: A simple, accurate, reproducible and noninvasive method of body iron overload assessment would be of great clinical use. Objective. The purpose of the study was the implementation of a 0. 5-T MRI method for liver iron overload measurement. MATERIALS AND METHODS: Thirty patients with thalassemia major took part in the study. Liver and paraspinal muscle signal intensity (SI) measurements were performed on T1-weighted images and normalized on a standard phantom, and a subjective hemochromatosis grading scale was made on both T1- and T2-weighted images. Serum ferritin levels and tissue iron from liver biopsy specimens were determined for comparison. RESULTS: A close correlation was found between bioptic liver iron and both the liver-to-phantom SI ratio (r = -0.88) and the subjective grading scale (rho = 0.89). Serum ferritin correlated poorly with liver iron deposition, whether assessed by biopsy (r = 0. 62) or MRI (r = -0.69). CONCLUSIONS: Both the subjective and the quantitative MRI methods proposed here are clinically valuable, with the former being adequate for a gross, the latter for an accurate estimation of tissue iron overload.

Iron overload in thalassemia: comparative analysis of magnetic resonance imaging, serum ferritin and iron content of the liver.

BACKGROUND: Iron overload in patients with thalassemia is a common feature which requires continuous chelation therapy and monitoring. Serum ferritin determination is widely accepted as a simple method for following iron load in patients with primary hemochromatosis; however, several reports on thalassemic patients emphasize that ferritinemia is not accurate and that other methods such as direct measurement of iron in the liver (HIC) and magnetic resonance imaging (MRI) are more precise. MATERIALS AND METHODS: In order to contribute to the general understanding of iron load in thalassemia we used liver MRI to study 33 thalassemic patients, most of whom were also evaluated for iron content by liver biopsy. The data were then compared with serum ferritin levels. RESULTS: Ferritin levels ranged between 276 and 8031 ng/mL, and liver iron content ranged from 1.6 to 31.0 mg/g dry weight; grade III or IV liver siderosis was recorded in 23/33 patients, just as 23/33 patients were found to have severe or very severe siderosis at MRI. Significant correlations with ferritin levels were recorded between grade IV and grades III, II and I (p < 0.01, p = 0.02, and p = 0.03, respectively). Ferritinemia also showed significant linearity with liver iron content (r = 0.603, p = 0.001). No significant differences of levels were recorded, however, between patients found to have severe and those with mild iron load at MRI (p = 0.073). CONCLUSIONS: Our study shows that serum ferritin levels exhibit a tendency to be significantly correlated with the true status of hemochromatosis in thalassemic patients; however, the discrepancies recorded in several patients and the scarce or total lack of correlation with MRI suggest exploring other approaches to this problem in order to make proper decisions about therapy.

[Current trends in the treatment of voluminous eventrations]. / Moderni orientamenti nella terapia delle voluminose eventrazioni.

The authors speak about their experience on the giant incisional hernias. The surgical treatment of these lesions in not always easy, especially when exist some conditions such as the loss of parietal substance and the loss of residence right. In these cases the use of prosthetic meshes and the Goni Moreno's pneumoperitoneum are very helpful. The Authors point out how important is, for a successful treatment, as well as a correct surgical procedure and opportune pre and post operative management.

[Polyps of the gallbladder. Considerations on their real clinical significance]. / I "polipi" della colecisti. Considerazioni sul loro reale significato clinico.

The authors review all the cases of polyps of the gallbladder observed during the period 1964 to 1992 at the Institutes of Pathology and General Surgery at the University of Florence. On the basis of their experience, the authors affirm that these phenomena always cause more or less evident, even if not specific clinical symptoms; moreover, since they are considered high-risk lesions for the onset of malignant tumours, the authors emphasize the need for cholecystectomy in all cases.

[Anatomic and surgical considerations regarding the recurrent laryngeal nerve in thyroidectomy]. / Considerazioni anatomo-chirurgiche sul nervo laringeo ricorrente in corso di tiroidectomia.

The majority of surgeons view the preliminary identification of the recurrent laryngeal nerve (RLN) as an essential stage in thyroidectomy in order to preserve thyroid integrity. This conviction is based on the fact that the anatomical relations of the recurrent nerve during the cervical tract with adjacent structures are highly variable. The preparation of the RLN in a series of 42 thyroidectomies performed by the 1st Department of Pathological Surgery of the University of Florence confirmed this variability above all with regard to relations with the trachea, Berry's ligament and the branches of the lower thyroid artery. As a result, it is justified to consider the identification and preliminary preparation of the RLN on both sides as a fundamental and unavoidable stage in thyroidectomy.

[Diverticular disease of the vermiform appendix. Anatomo-clinical observations]. / La malattia diverticolare dell'appendice vermiforme. Osservazioni anatomo-cliniche.

The authors describe a case of diverticular disease of the appendix. The diagnosis is intraoperative and histological while therapy is based on surgical treatment. The authors seem to be favorable to surgical treatment in case of diverticulosis of the appendix in order to avoid dangerous complications.

Dosimeter inhalation test with lysine acetylsalicylate for the detection of aspirin-induced asthma.

Inhalation challenge with lysine acetylsalicylate (L-ASA) is often used to diagnose aspirin-induced asthma. The aim of this study was to evaluate the specificity and safety of performing L-ASA inhalation challenge with a dosimeter. Twenty-four subjects entered the study: ten ASA-sensitive asthmatic patients, seven non-ASA-sensitive asthmatic patients, and seven normal control subjects. The investigation was performed on two consecutive days. On day 1 a dosimeter inhalation test with methacholine was performed to establish the provocation dose (PD20). On day 2, patients underwent the L-ASA inhalation test, whereby increasing doses of L-ASA (from 1 to 32 mg cumulative dose) were inhaled using a dosimeter and a dose response curve was constructed. In subjects negative to the top dose, an additional oral dose of 500 mg of aspirin was administered to exclude aspirin sensitivity not revealed with the inhaled drug. The ten ASA-sensitive asthmatic patients developed early reactions within 30 minutes of PD20 administration. Recovery time from induced bronchoconstriction varied from two to three hours to six hours or longer resulting in an "early prolonged reaction." The response was limited to airways. No clear late reactions were observed. There was no correlation between PD20 with methacholine and PD20 with L-ASA. The L-ASA challenge was negative in the seven non-ASA-sensitive asthmatic patients and in the seven normal control subjects. In conclusion the dosimeter method is sensitive, specific, and safe for the detection of aspirin-induced asthma.

[Progressive pneumoperitoneum in the surgical treatment of conspicuous ventral hernias. Importance of the procedure to restore a good respiratory function]. / Il pneumoperitoneo progressivo nella chirurgia delle ernie ventrali di ragguardevoli dimensioni. Importanza del procedimento per ristabilire una buona funzionalità respiratoria.

A recent clinical report regarding a patient with a voluminous laparocele treated using progressive pneumoperitoneum justifies this short paper on the use of this method as a preparatory act to reparative surgery. The paper emphasises the undoubted advantages deriving from the use of this technique, especially in the case of those subjects with a particularly poor respiratory function secondary to hernia.

[Therapeutic approach in ventral hernia]. / La tattica nella terapia dei laparoceli.

Laparoceles are diseases of the abdominal wall and their repair does not usually involve technical problems which are difficult to resolve. The use of classic surgical methods, such as direct suture and plastic surgery, enables the parietal defect to be easily repaired in most case. However, cases do occur in which the surgeon is faced with considerable technical and tactical difficulties largely due to anatomopathological causes: the "loss of the right of domicile" of herniated viscera and the loss of musculo-aponeurotic substance. In the former case it is necessary to prepare the peritoneal cavity using pneumoperitoneum. In the event of the extensive destruction of the muscular component, or when the parietal breech is located next to bone or cartilagenous structures, it is essential to use a prosthesis. The paper goes on to describe the indications for the use of various techniques and their respective methods of use under different anatomo-clinical conditions.

[Pneumoperitoneum in preparation for surgery of large ventral hernia]. / Il pneumo-peritoneo nella preparazione agli interventi dei grandi laparoceli.

Reparative surgery of ventral hernia may be relatively simple or, on the other hand, the surgeon may be confronted with a number of tactical and technical problems. Many of these are caused by the "loss of the right of domicile". In order to avoid this particular condition it is useful to resort to preoperative pneumoperitoneum. This method entails the gradual and progressive introduction of air into the peritoneal cavity. In this way abdominal capacity is increased and it is therefore possible to re-insert all the viscera into their natural cavities avoiding all the harmful consequences for respiratory and cardio-circulatory organs following forced replacement. Preoperative pneumo-peritoneum is a relatively well consolidated surgical technique in large scale eventration. The methods is simple to perform and has a low incidence of complications.

[Progressive pneumoperitoneum in the preparation for surgical intervention for voluminous ventral hernias]. / Il pneumoperitoneo progressivo nella preparazione all'intervento chirurgico per voluminose ernie ventrali.

The paper report three patients suffering from voluminous ventral hernias who were treated using progressive pneumoperitoneum as a preparative method prior to reparative surgery. On the basis of the results obtained, the authors sustain the rationality, safety and efficacy of the procedure, in particular given its ability to reestablish good respiratory and circulatory function in those cases where the latter were severely affected by hernia. Since this method needs a longer application time and therefore involves a greater economic burden, pneumoperitoneum should probably be reserved for selected cases, and alternative techniques should be used in patients where hernia is more easily resolved.

Effect of azelastine on the seasonal increase in non-specific bronchial responsiveness to methacholine in pollen allergic patients. A randomized, double-blind placebo-controlled, crossover study.

Azelastine, a phthalazinone derivative, is a new potent, long acting, orally active anti-allergic compound with particularly strong H1-histamine receptor antagonistic effects which has been proven to possess in vitro and in vivo a number of anti-inflammatory properties. The aim of the present study was to investigate whether azelastine would be able to prevent and/or reverse the seasonal increase in non-specific bronchial responsiveness to methacholine in pollen allergic patients. Twelve atopic patients (5 males, mean age 31 years), skin positive exclusively to grass and/or Parietaria pollen extract, with rhinitis and mild asthma occurring in the spring for at least two years previously, were studied. After a 2 week run-in period, oral azelastine, 4 mg twice daily, or placebo, was given for 2 weeks from the start of the pollen season, according to a randomized, double-blind design. After 2 weeks, the treatments were crossed over. During both the run-in and study periods, patients recorded rhinitis and asthma symptoms, additional antihistamine and bronchodilator drugs taken and peak expiratory flow measurements. A methacholine inhalation test was carried out on four occasions in each patient: before the run-in period, before the start of the treatment, and at the end of the two 2 week treatment periods. Azelastine significantly reduced rhinitis symptoms and the need for antihistamine drugs, whereas asthmatic symptoms, use of bronchodilator drugs, peak flow recordings and bronchial responsiveness to methacholine were unaffected by the treatment. Compliance level and adverse side-effects were not significantly different between active treatment and placebo. In the final subjective evaluation of the two treatments, eight out of 12 patients preferred azelastine.(ABSTRACT TRUNCATED AT 250 WORDS)

Dialysis efficacy and itching in renal failure.

Itching in nondialyzed uremic subjects and patients on dialysis remains incompletely explained and poorly treated. We evaluated our chronic hemo- and peritoneal dialysis patients for this symptom and synthetically reviewed previous reports on itching and renal failure. We found no biochemical correlates of itching but did find that itching was less with better dialysis as defined by urea kinetic modelling. We conclude that improved dialysis techniques will continue to reduce the prevalence of itching in end-stage renal disease patients.

[A case of anomalous outlet of the cystic duct]. / Su di un caso di sbocco anomalo del dotto cistico.

The paper reports a case of anomaly affecting the extrahepatic biliary tract. Brief comments are made regarding the practical importance of this pathology.