A Meta-analysis of the Efficacy and Safety of Stereotactic Arrhythmia Radioablation (STAR) in Patients with Refractory Ventricular Tachycardia.

AIMS: Reports of stereotactic arrhythmia radioablation (STAR) in patients with refractory ventricular tachycardia after catheter ablation are limited to small series. Here, we carried out a systematic review and meta-analysis of studies to better determine the efficacy and toxicity of STAR for ventricular tachycardia. MATERIALS AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines, eligible studies were identified on Medline, Embase, Cochrane Library and the proceedings of annual meetings to 10 February 2023. Efficacy was defined as a ventricular tachycardia burden reduction >70% at 6 months; safety was defined as <10% of any grade ≥3 toxicity. RESULTS: Seven observational studies with a total of 61 patients treated were included. At 6 months, the ventricular tachycardia burden reduction was 92% (95% confidence interval 85-100%) and use of fewer than two anti-arrhythmic drugs was seen in 85% (95% confidence interval 50-100). Six months after STAR, an 86% reduction (95% confidence interval 80-93) in the number of implantable cardioverter-defibrillator shocks was observed. The rates for improved, unchanged and decreased cardiac ejection fraction were 10%, 84% and 6%, respectively. Overall survival at 6 and 12 months was 89% (95% confidence interval 81-97) and 82% (95% confidence interval 65-98). The cardiac-specific survival at 6 months was 87%. Late grade 3 toxicity occurred in 2% (95% confidence interval 0-5%) with no grade 4-5 toxicity. CONCLUSION: STAR demonstrated both satisfactory efficacy and safety for the management of refractory ventricular tachycardia and was also associated with a significant decline in anti-arrhythmic drugs consumption. These findings support the continued development of STAR as a treatment option.

Stereotactic radiosurgery for brain metastases from small cell lung cancer without prior whole-brain radiotherapy: A meta-analysis.

OBJECTIVES: Assess upfront Stereotactic radiosurgery (SRS) effectiveness for small cell lung cancer (SCLC) brain metastases (BM). Where possible, a comparison with whole-brain radiotherapy (WBRT) was performed. METHODS: Following PRISMA and MOOSE guidelines, eligible studies were identified on Medline, Embase, Cochrane Library, and proceedings of annual meetings between inception and July 01, 2020. RESULTS: Nine observational studies with 1638 patients were included. The median overall survival (OS) was 8.3 months (95% CI 7.1-9.5 months, I2 = 0%). OS rate at 12 months was 39% (95% CI 31-44%, I2 = 0%). The relative risk between SRS and WBRT for the OS at 12 months was 1.33 (95% CI 1.13-1.51, P = 0.0001). The projected OS for 6, 12, 18- and 24-months comparing SRS with WBRT was 67% vs. 57%, 39% vs. 29%, 22% vs. 15% and 15% vs 9%, favoring SRS (P < 0.001). The LC rate at 12 months was 93% (95% CI 91-94%, I2 = 0%). The distant brain failure rate (DBFR) at 12 months was 41% (95% CI 33-48%, I2 = 52%, P = 0.08). The SRS or WBRT as salvage treatment after upfront SRS was 32% and 19%, respectively. The freedom from neurologic death at 12 months was 87% (95% CI 84-89%). CONCLUSION: Based on the pooling of a large sample of retrospective studies our meta-analysis suggests that for high selected SCLC patients with limited BM upfront SRS produces favorable lesion control and survival outcomes. These findings support the design of randomized clinical trial to confirm the role of SRS in this clinical scenario.

Relationship between Helicobacter pylori detection and an increased risk of infection in childhood

The risk of developing gastric cancer is believed to be related to differences among Helicobacter pylori strains and the inflammatory responses mediated by host genetic factors. H. pylori infection is acquired at an early age and in the absence of appropriate antibiotic therapy, it generally persists for life. Tp53 gene regulates the transcription of several cytokines and chemokines involved in innate immunity and its action may be influenced by the presence of different H. pylori strains. The present study aimed to detect H. pylori in pediatric patients, to access Tp53 polymorphism at codon 72 and to correlate such findings with age and histopathological results. Three hundred and forty-two patients were analyzed. DNA from their gastric biopsies was extracted and the detection of H. pylori was performed through polymerase chain reaction assays, urease test and histopathologic examination. Allelic discrimination of SNP rs1042522 (Tp53) was performed by real-time polymerase chain reaction. Our results suggest a possible relationship between the presence of H. pylori and chronic gastritis in children and young patients, and showed a significant association between ageing and positivity for H. pylori. It was verified that patients aged < 10 years were 1.3 times more likely to have infection by H. pylori when compared with those aged > 10 years. Finally, no association was found between Tp53 polymorphisms and the presence of H. pylori.

[Obstructive emphysema of infant during pulmonary tuberculosis]. / Enfisema a valvola del lattante in corso di tubercolosi polmonare.

A rare complication of pulmonary tuberculosis of infant is the obstructive emphysema following to the compression by enlarged lymphadenopathy. The authors report a case of obstructive emphysema observed in a 12 month old infant affected by pulmonary tuberculosis, and debate its more important pathogenethic, clinical and differential diagnosis aspects. At last they comment upon favourable clinical course observed as results of an exclusive medical treatment (antitubercular antibiotic therapy shortly combined with moderate corticotherapy) without making use of surgical, but aggressive, treatment.

[Clinical and pathogenetic observation in a case of pulmonary hemosiderosis]. / Considerazioni clinico-patogenetiche su di un caso di emosiderosi polmonare.

Pulmonary hemosiderosis is a rare disease of unknown aetiology, whose clinical, pathogenetic and prognostic aspects are still open to discussion. The authors report a case of pulmonary hemosiderosis in a 2 years and 3 months old girl. Peculiar features of this case include antibody deficiency (which may contribute to the pathogenesis of the disease) and severe and protracted melena. Fatal outcome, despite several therapeutic trials, confirms the poor prognosis of pulmonary hemosiderosis.

[Jarcho-Levin syndrome or spondylo-costal dysostosis. Apropos of a case]. / La sindrome di Jarcho-Levin o disostosi spondilo-costale. A proposito di un'osservazione.

The Authors report a case of spondylo-costal dysostosis observed in a child 2 years and 1 month old. They recall its clinical and radiological findings and discuss genetic problems and differential diagnosis of this rare disease.

[The pseudoachondroplastic form of spondyloepiphyseal dysplasia: apropos of 2 cases]. / Forma pseudoacondroplasica della displasia spondiloepifisaria: a proposito di due osservazioni.

The Authors report two cases of pseudoachondroplasic dysplasia observed in a child aged 2 years and 5 months and in her father 31 years old. They recall the rarity of this disease, its characteristic and radiological findings and dwell upon differential diagnosis between this rare form of condrodysplasia and achondroplasia.

[Annular pancreas and neonatal duodenal occlusion. Presentation of 3 cases]. / Pancreas anulare e occlusione duodenale neonatale. Presentazione di 3 casi.

The authors report 3 cases of anular pancreas and consider the main clinical and differential diagnosis aspects of them. Afterwards they dwell upon the etiopathogenesis of this congenital malformation that is consequent not only upon extrinsic pancreatic compression but also upon a contemporary atresia or stenosis of duodenum. That however conditions the management; it will be apply to remove also the intrinsic obstruction of stenotic intestinal segment.

[Various cases of congenital lobar emphysema]. / Considerazioni su alcuni casi di enfisema lobare congenito.

The authors describe some cases of congenital lobar emphysema and after a review of literature discuss main clinical, radiological and differential diagnosis problems of this disease. At last they point out the favourable results obtained with the treatment performed (lobectomy with continuous pleural drainage and medical therapy of support).

[Presentation of a case of probably primary intestinal tuberculosis with a favorable outcome]. / Presentazione di un caso di tubercolosi intestinale verosimilmente primaria ad esito favorevole.

The authors report a case of intestinal tuberculosis observed in a 4 year old child. The more important aspects of the case are its rarity (today the intestinal tuberculosis is uncommon), its differential diagnosis because of prevalence of hematuria over other symptoms, and the favourable results obtained with specific chemotherapy alone.

[Persistent atelectasis secondary to an endobronchial tubercular granuloma in primary tuberculosis: presentation of a case with a favorable outcome]. / Atelettasia persistente secondaria a granuloma tubercolare endobronchiale in corso di tubercolosi primaria: Presentazione di un caso ad esito favorevole.

The Authors report a case of tuberculous endobronchial granuloma observed in a two years old child affected by primary tuberculosis. The more important aspects of the case are its rarity, the pathogenesis, its differential diagnosis, and the determining importance of the surgical operation for diagnosis and therapy.

[Favorable outcome of probably congenital chylothorax in a 2-month-old infant treated with continuous pleural drainage]. / Evoluzione favorevole di chilotorace verosimilmente congenito in un lattante di 2 mesi curato con drenaggio pleurico continuo.

The authors report a case of a probably congenital chylothorax observed in a 2 months old infant. The more important aspects of the case are its rarity, the delay of appearance of the clinical symptoms, theirs mild entity, and the favourable result obtained with continuous pleural drainage.