Trends in thyroid function testing, neck ultrasound, thyroid fine needle aspiration, and thyroidectomies in North-eastern Italy.

PURPOSE: Evidence of an increased diagnostic pressure on thyroid has emerged over the past decades. This study aimed to provide estimates of a wide spectrum of surveillance indicators for thyroid dysfunctions and diseases in Italy. METHODS: A population-based study was conducted in North-eastern Italy, including 11.7 million residents (20% of the total Italian population). Prescriptions for TSH testing, neck ultrasound or thyroid fine needle aspiration (FNA), surgical procedures, and drugs for hypo- or hyperthyroidism were extracted from regional health databases. Proportions and rates of selected examinations were calculated from 2010 to 2017, overall and by sex, calendar years, age, and region. RESULTS: Between 2010 and 2017 in North-eastern Italy, 24.5% of women and 9.8% of men received at least one TSH test yearly. In 2017, 7.1% of women and 1.5% of men were prescribed drugs for thyroid dysfunction, 94.6% of whom for hypothyroidism. Neck ultrasound examinations were performed yearly in 6.9% of women and 4.6% of men, with a nearly two-fold variation between areas. Thyroid FNA and thyroidectomies were three-fold more frequent in women (394 and 85 per 100,000) than in men (128 and 29 per 100,000) with a marked variation between areas. Both procedures decreased consistently after 2013. CONCLUSIONS: The results of this population-based study describe recent variations over time and between surrounding areas of indicators of 'diagnostic pressure' on thyroid in North-eastern Italy. These results emphasize the need to harmonize practices and to reduce some procedures (e.g., neck ultrasound and total thyroidectomies) in certain areas.

Post-traumatic Growth in the Italian Experience of Long-term Disease-free Cancer Survivors.

Cancer survivors often report post-traumatic growth. Since culture influences the development of post-traumatic growth, the aims of this study were to measure the prevalence of post-traumatic growth in Italian long-term disease-free and treatment-free cancer survivors (≥5 years) and explore the relationship between post-traumatic growth and sociodemographic and clinical variables. Three hundred sixty long-term disease-free and treatment-free cancer survivors were assessed with Post-traumatic Growth Inventory (PTGI), Brief COPE and Multidimensional Scale of Perceived Social Support (MSPSS). Mean age was 58.6 years, and mean survival was 11 years (range 5-32). The PTGI average total score was higher in younger survivors, in those without comorbidities, in survivors engaged in physical activity. Positive correlation between PTGI and Brief COPE and between PTGI and MSPSS were found. The variables more associated with post-traumatic growth were age, comorbidity, physical activity and two coping subscales. The prevalence of post-traumatic growth in this sample of cancer survivors was lower than previous studies. We discussed some possible explanations, including the consideration that cultural differences may affect the development of post-traumatic growth in cancer survivors. Having less comorbidities, receiving social support from friends, having the ability to adaptively cope and engaging in physical activity were found to be strongly associated with post-traumatic growth.

Patients attitudes towards sleep disturbances during chemotherapy.

Sleep disturbances are among the most distressing symptoms in cancer: they often co-occur with fatigue, pain and psychological distress. Despite the negative impact on quality of life, patients rarely seek help for managing their sleep disturbances. This paper presents the results of a multicentre observational study on patients' attitudes towards their sleep problems. The study also investigates symptom correlates. Patients responded to a semi-structured interview and completed the following questionnaires: Pittsburgh Sleep Quality Index; Brief Fatigue Inventory; Hospital Anxiety and Depression Scale; and European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life QLQ-C30 Questionnaire (QLQ-C30). Four hundred and three cancer patients were enrolled in the study. Bad sleepers constituted 66% of the sample. Thirty-eight per cent of them had not turned to any professional to solve their sleep disturbances because they had various beliefs about the importance of the problem and the possibility to be treated. The main correlates of sleep disturbances were psychological distress, reduced physical functioning and reduced overall quality of life. In conclusion, there is a need to sensitise patients to actively search for a solution to their sleep disturbances so they can be solved along with other co-occurring symptoms. Doctors could also be encouraged to dedicate more attention to routinely asking cancer patients about eventual sleep disturbances.

Is cancer-related fatigue more strongly correlated to haematological or to psychological factors in cancer patients?

GOALS OF WORK: Cancer-related fatigue is a very frequent problem in cancer, interfering with many patients' life activities. Anaemia is present in a large number of fatigued patients. The aim of this study was to evaluate cancer-related fatigue, in relation with haematic haemoglobin levels and the presence of anxiety and depression. MATERIALS AND METHODS: The Functional Assessment Of Chronic Illness Therapy-Fatigue scale was used to assess fatigue. The Hospital Anxiety and Depression Scale was administered to screen for psychological distress. Haematological values were measured by blood tests. All data were analysed using Chi-squared, and a logistic regression analysis was conducted. MAIN RESULTS: Eighty patients were enrolled in the study. Significant associations were found between fatigue and depression, fatigue and anxiety and between fatigue and haemoglobin. CONCLUSION: Anxiety and depression, other than heamoglobin levels, were found associated with fatigue. Hence, implications for a multi-dimensional treatment of fatigue are discussed.

Stop-flow perfusion with mitomycin-C as locoregional approach in the treatment of large-unresectable liver metastases.

BACKGROUND: New treatments are being investigated in patients with multiple or unresectable liver metastases, usually characterized by poor prognosis. Based on the predominant arterial blood supply of hepatic neoplasms, liver transarterial chemoembolization administers cytotoxic drugs in combination with the ischemic effect due to vascular occlusion. Mitomycin-C (MMC) is characterized by a high liver extraction rate and is potentiated by a hypoxic environment. PATIENTS AND METHODS: This technique is performed by inducing a stop-flow of the hepatic artery, obtained by the placement of a balloon-catheter and followed by the infusion of MMC; in addition, in order to prevent iatrogenic lesions of the vascular wall, caused by the inflation of the balloon-catheter, a vascular stent is placed at the beginning of the procedure. RESULTS: Thirty-one patients with liver metastases from various solid tumors were treated, while 47 sessions of treatment were performed. Toxicity was moderate; three cases of iatrogenic obstruction of the hepatic artery were observed, thus precluding further treatment. CONCLUSION: The feasibility and the good tolerability of this procedure make it an interesting option in the therapeutical strategy for patients with advanced metastatic liver disease, as well as in combination with systemic chemotherapy, ablative and cytoreductive treatments and/or free-flow liver perfusions with anticancer drugs.

Serum vascular endothelial growth factor concentrations in hepatocellular cancer patients undergoing percutaneously radiofrequency thermal ablation.

Vascular endothelial growth factor (VEGF) is known to play a central role in tumour angiogenesis. However, no data have been published with regard to the clinical-biological significance of serum (S)-VEGF in hepatocellular cancer (HCC) patients undergoing to percutaneously radiofrequency thermal ablation (PRFA). The aim of this study was to assess the modifications of S-VEGF levels in a series of 28 HCC patients in hepatitis C virus-positive cirrhosis before and after PRFA, respectively. Samples of S were taken before, 2 and 5 days after PRFA respectively and VEGF levels were assessed by ELISA. No significant difference was found between pre- and post-VEGF levels (p= n.s.; by Wilcoxon test). We suggest that S-VEGF level is not useful as early predictive marker of response to PRFA.

Radiofrequency thermal ablation of 69 lung neoplasms.

Radiofrequency thermal ablation (RFA) is a new, minimally invasive technique offered in the treatment of various neoplasms. RFA produces ionic agitation within the area to be treated, resulting in the heating of neoplastic tissue using a radiofrequency generator. Well defined areas of coagulative necrosis are formed, thereby destroying the tumor. Percutaneous CT-guided RFA was performed in 34 patients with 69 lung neoplasms. Six patients were affected by primary Non-Small Cell Lung Cancer (NSCLC), and 28 patients presented with metastatic lung nodules originating in various solid tumors. Patients were considered ineligible for surgery for the following reasons: medical comorbidities; technical reasons; severe respiratory insufficiency; refusal of surgery. Adequacy of treatment was assessed by CT-Scan and Nuclear Magnetic Resonance (NMR) with gadolinium. A median follow-up of 9 months (3-25 months) resulted in 30 patients evaluable for response with a total of 63 nodules to be treated, 58 of which achieved complete necrotic response. Relapse occurred in 5/63 treated nodules. In 2 of these patients, relapse occurred exclusively in the treated nodules, whereas in the other 3 patients, relapse occurred in the treated nodules as well as at distant sites. 9 patients are alive and disease free. Pneumothorax requiring pleural drainage was the main complication, observed in 16% of the treatment sessions. Lung RFA has shown itself to be a safe and feasible option in the treatment of lung neoplasms in patients otherwise ineligible for surgery. The high rate of complete responses obtained in our study (92%) suggests that further investigation of lung RFA, combined with chemotherapy and/or radiation therapy is warranted with the objective of improving local disease control and survival rates.

Ovarian fibroma: our experience of 34 cases.

Thirty-four cases of ovarian fibroma are reported. The early symptoms were pelvic pain and abnormal uterine bleeding. All patients were in advanced menopause, mean age 63, except for one that was normally menstruatuating and was 23 years old. In all cases an ultrasound scan TV/TA and CA 125 tests were performed, and afterwards all patients were treated with either conservative or radical surgery. In addition to the above examinations, color Doppler tests on pelvic vessels were performed in 18 cases.

Hypoxic stop-flow perfusion with mitomycin-C in the treatment of multifocal liver metastases. Usefulness of a vascular arterial stent to prevent iatrogenic lesions of the hepatic arterial wall.

13 patients affected by multifocal and/or large liver metastases from various solid tumors have been treated with stop-flow liver perfusion, to evaluate the safety and feasibility of hypoxic loco-regional infusion with Mitomycin C. The treatment was based on the hypoxic effect due to stop-flow, potentiating the cytotoxic activity of Mitomycin C, combined with the ischemic damage caused by the embolization of the vascular supply to the tumor. The schedule consisted in blocking arterial flow by an angiographic occlusion balloon catheter inflated in the hepatic artery, with previous placement of a vascular stent in order to prevent iatrogenic arterial lesions, and followed by the intraarterial administration of Mitomycin C; finally, arterial hepatic embolization was performed by a gelatine sponge. The study is ongoing with a median follow up of 8 months (range 2-12). Partial response was observed in 1/13 patients (8%), stable disease in 8/13 patients (61%), while progressive disease occurred in 4/13 patients (31%). Nine patients are still alive, and four patients died for hepatic progressive disease, three of them heavily pre-treated with multiple lines of chemotherapy for advanced disease. Toxicity was mild; main side effects were anaemia and thrombocytopenia(Grade 3 both in 1/15 treatments), while fever, nausea and vomiting and upper abdominal pain were short-lasting and easily manageable. No iatrogenic lesion of the hepatic arterial wall occurred. These preliminary data, although the small number of patients and the short follow up, show that the procedure is safe and feasible, with a interesting percentage of clinical responses. In addition, the placement of an arterial stent have demonstrated to protect vascular wall ensuring a regular blood flow, so allowing to perform repeated treatments in responsive patients. The good tolerability of this therapeutic modality suggests further investigation in order to determine its efficacy even in combination with systemic chemotherapy and other locoregional treatments such as termoablative procedures and/or intraarterial antiblastic perfusions in patients affected by metastatic liver disease.

Oral granisetron as prophylaxis for nausea and vomiting during fluorescein angiography. A multicentre, double-blind, randomised, parallel group, placebo-controlled study.

BACKGROUND: Prophylaxis with oral Granisetron was assessed in patients undergoing fluorescein angiography (FAG) in order to evaluate its efficacy in reducing patients' discomfort due to nausea and vomiting (4% > 20%) and to ensure completion of the investigation. EXPERIMENTAL PLAN: Multicentre, randomised, double-blind, placebo-controlled study, with a follow-up visit performed 24 hrs after FAG. ENVIRONMENT: Five Anaesthesia/Resuscitation and Ophthalmology operational units participated in the study. PATIENTS: 120 patients (24 from each Centre) of both sexes and aged > 18 years, suffering from retinal disorders, were enrolled after informed consent. Pregnancy, lactation, anti-neoplastic treatment, ASA status IV/V were main exclusion criteria. All recruired patients completed the study. INTERVENTIONS: Ophthalmological evaluation was performed 30 days before and the same day as FAG. Anaesthesiological assessment on the same day as FAG, recording, BP, HR, ASA status, allergic diathesis, allergy to medications and contrast media, concomitant treatments. Oral Granisetrom 1 mg or placebo was given on an empty stomach 1 hr before the injection of 5 ml 20% fluorescein in 3 sec. A follow-up examination was done 24 hrs after FAG. SURVEY: In both groups nausea, retching and vomiting were seen after fluorescein injection. RESULTS: The study demonstrated that Granisetron is more active than placebo in controlling nausea (3 cases vs 4), and retching (2 vs 6). It was significantly more effective than placebo in the prevention of vomiting (0 vs 3). Efficacy was evaluated with chi 2, p < or = 0.05). CONCLUSIONS: The results suggest that Granisetron may be indicated as prophylaxis in patients undergoing FAG in order to prevent or control emesis, improve patients' comfort and ensure successful outcome of the investigation.