Outcome of pancreaticoduodenectomy in octogenarians: Single institution's experience and review of the literature.

INTRODUCTION: Pancreatic and perampullary neoplasms in patients aged 80 or older trouble the surgeons because of the risk of surgical treatment. We have reviewed our experience and literature's reports of pancreaticoduodenectomy in octogenarians, evaluating early results and long-term survival in pancreatic cancer group. METHODS: Three hundred eighty-five patients who underwent pancreaticoduodenectomy for neoplasms from 1998 to 2011 were included in the study, and were divided in two groups: group 1, patients younger than 80 years of age, and group 2, patients 80 years of age and older. Operative morbidity, mortality, disease-free and long-term survival were analysed. English literature was systematically searched for pancreatic resection's outcome in octogenarians. RESULTS: There were 385 pancreaticoduodenectomies: 362 patients were in group 1 and 23 patients in group 2. There was no significant difference regarding gender, and pathologic findings between the two groups. Complications' rate (40 vs. 43%), mortality rate (4% vs. 0%), and overall median survival for pancreatic cancer patients were not statistically different in the two groups (median 21 vs. 19 months). Literature's review showed 14 reports of pancreatic resection in octogenarians. Most of the studies (particularly in centres with high-volume pancreatic surgery) showed that outcome after pancreatectomy was not different in octogenarians or in younger patients. CONCLUSION: Pancreaticoduodenectomy is an acceptable option for elderly patients. Age alone should not be considered a contraindication to major pancreatic resection, but a careful preoperative evaluation and an accurate postoperative management are mandatory.

Modelling the rheological properties of sludge during anaerobic digestion in a batch reactor by using electrical measurements.

Anaerobic digestion is a significant process leading to biogas production and waste management. Despite this double interest, professionals still face a lack of efficient tools to monitor and manage the whole procedure. This is especially true for rheological properties of the material inside the reactor, which are of major importance for anaerobic digestion management. However, rheological properties can hardly be determined in-situ and it would be very helpful to determine indicators of their evolution. To solve this problem, this paper investigates the evolution of sewage sludge rheological and electrical properties during the anaerobic digestion in a batch reactor. We especially focus on apparent viscosity and complex impedance, measured by electrical impedance spectroscopy. Both of them can be modelled by a linear combination of raw sludge and inoculum properties, weighted by time-dependent coefficients. Thus, by determining digested sludge electrical signature, it is possible to obtain those coefficients and model sludge apparent viscosity. This work offers many theoretical and practical prospects.

Static and dynamic evaluation of pelvic floor disorders with an open low-field tilting magnet.

AIM: To assess the feasibility of magnetic resonance defaecography (MRD) in pelvic floor disorders using an open tilting magnet with a 0.25 T static field and to compare the results obtained from the same patient both in supine and orthostatic positions. MATERIALS AND METHODS: From May 2010 to November 2011, 49 symptomatic female subjects (mean age 43.5 years) were enrolled. All the patients underwent MRD in the supine and orthostatic positions using three-dimensional (3D) hybrid contrast-enhanced (HYCE) sequences and dynamic gradient echo (GE) T1-weighted sequences. All the patients underwent conventional defaecography (CD) to correlate both results. Two radiologists evaluated the examinations; inter and intra-observer concordance was measured. The results obtained in the two positions were compared between them and with CD. RESULTS: The comparison between CD and MRD found statistically significant differences in the evaluation of anterior and posterior rectocoele during defaecation in both positions and of rectal prolapse under the pubo-coccygeal line (PCL) during evacuation, only in the supine position (versus MRD orthostatic: rectal prolapse p < 0.0001; anterior rectocoele p < 0.001; posterior rectocoele p = 0.008; versus CD: rectal prolapse p < 0.0001; anterior rectocoele p < 0.001; posterior rectocoele p = 0.01). The value of intra-observer intra-class correlation coefficient (ICC) ranged from good to excellent; the interobserver ICC from moderate to excellent. CONCLUSION: MRD is feasible with an open low-field tilting magnet, and it is more accurate in the orthostatic position than in the supine position to evaluate pelvic floor disorders.

Sorafenib for the treatment of recurrent hepatocellular carcinoma after liver transplantation?

BACKGROUND: There are scarce data on the use of sorafenib for the treatment of recurrent hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). PATIENTS AND METHODS: Ten patients were treated with sorafenib after OLT following the Italian Drug Agency guidelines: they had well-compensated liver function (Child-Pugh class A in the case of cirrhosis), intermediate-or advanced-stage HCC, good general condition (performance status 0), and not suitable for loco-regional therapies. Patients with HCC recurrence after OLT were treated with sorafenib (400 mg twice daily). Adverse events (AEs) were assessed using National Cancer Institute Common Toxicity Criteria of Adverse Events (NCI-CTCAE) v3.0 with tumor responses evaluated acording to modified Response Evaluation Criteria in Select Tumors) criteria. RESULTS: Median duration of treatment was 10 months (range, 2-18). Seven patients (70%) received an additionally targeted therapy with mTOR inhibitors as part of their immunosuppressive regimen. Most common grade 3 AEs included diarrhea (50%), hand-foot skin reaction (30%), and fatigue (20%). Sorafenib had to be discontinued in 3 patients (30%) due to AEs and 4 additional patients (40%) required a dose adjustment. No deterioration of liver graft function occurred. Three patients (30%) stopped treatment due to radiological progression of HCC, whereas 3 are still using the drug. Median time to progression was 8 months (range, 2-16). Median survival from start of therapy was 18 months (range, 4- 36). CONCLUSION: Our preliminary results suggest that sorafenib is a safe effective therapy for recurrent HCC after OLT.

The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER).

BACKGROUND: While guidelines for preventing chemotherapy-induced nausea and vomiting (CINV) are widely available, clinical uptake of guidelines remains low. Our objective was to evaluate the effect of guideline-consistent CINV prophylaxis (GCCP) on patient outcomes. PATIENTS AND METHODS: This prospective, observational multicenter study enrolled chemotherapy-naive adults initiating single-day highly or moderately emetogenic chemotherapy (HEC or MEC) for cancer. Patients completed 6-day daily diaries beginning with cycle 1 for up to three chemotherapy cycles. The primary study end point, complete response (no emesis and no use of rescue therapy) during 120 h after cycle 1 chemotherapy, was compared between GCCP and guideline-inconsistent CINV prophylaxis (GICP) cohorts using multivariate logistic regression, adjusting for potential confounding factors. RESULTS: In cycle 1 (N=991), use of GCCP was 55% and 46% during acute and delayed phases, respectively, and 29 % for the overall study period (acute plus delayed phases). Complete response was recorded by 172/287 (59.9%) and 357/704 (50.7%) patients in GCCP and GICP cohorts, respectively (P=0.008). The adjusted odds ratio for complete response was 1.43 (95% confidence interval 1.04-1.97; P=0.027) for patients receiving GCCP versus GICP. CONCLUSION: GCCP reduces the incidence of CINV after single-day HEC and MEC.

Dynamic MR defecography with an open-configuration, low-field, tilting MR system in patients with pelvic floor disorders.

PURPOSE: This study was undertaken to explore the capabilities of an open-configuration, low-field, tilting, magnetic resonance (MR) system for investigating pelvic floor disorders and to compare the results obtained with the patient in the semiorthostatic and supine positions. MATERIALS AND METHODS: Eighteen female patients with a diagnosis of pelvic floor disorder (physical examination and conventional defecography) underwent dynamic MR defecography (MRD) with a 0.25-T tilting MR system (G-scan, Esaote). Images were obtained after administration of contrast agent into the rectum, bladder and vagina in both the orthostatic and supine positions. Three-dimensional T2-weighted hybrid contrast-enhanced (HYCE) sequences and dynamic T1-weighted gradient echo (GE) sequences were acquired at rest, during maximal contraction of the anal sphincter, straining and defecation. RESULTS: Good image quality was obtained in 15/18 patients; three presented severe artefacts due to motion, and three had incontinence, which hampered the functional studies. Better anatomical detail was obtained with MRD compared with conventional defecography. Three prolapses were observed in the semiorthostatic position only, and seven were found to be more severe in the orthostatic than in the supine position. CONCLUSIONS: Dynamic MRD with an open-configuration, low-field, tilting MR system is a feasible and promising tool for studying the pelvic floor. Larger series are necessary to assess its real diagnostic value.

Circulating and disseminated tumor cells in the clinical management of breast cancer patients: unanswered questions.

Breast cancer is the most common cancer in women. Although survival rates have improved with the use of new therapeutic agents, many issues remain unresolved and new predictive and prognostic factors are needed in clinical practice. Several studies have suggested a prognostic and predictive role for circulating and disseminated tumor cells in metastatic disease and adjuvant treatment. Because of recent technological advances, oncologists have gained a new perspective on this disease. Circulating tumor cells could be both a new tumor marker as well as a tool to gain novel insight into the natural history of this neoplastic disease.

Gemcitabine and liposomal doxorubicin in biliary and hepatic carcinoma (HCC) chemotherapy: preliminary results and review of the literature.

BACKGROUND: Advanced biliary tract cancers have a poor prognosis. Gemcitabine (G) as a single agent or in combination represents an active treatment option. Systemic chemotherapy in hepatocellular carcinoma represents a palliative treatment. Gemcitabine in combination with Liposomal Doxorubicin (LD) may represent an active treatment option. PATIENTS AND METHODS: Clinical trials for biliary and hepatic carcinoma have been reviewed. RESULTS: We obtained RC (1 pt), RP (4 pts), SD (8 pts) and seven pts had PD (RR 25% and SD 40%). Our chemotherapy regimen was Gemcitabine 1000 mg/m(2) d 1 and 8, Liposomal Doxorubicin 30 mg d 1, q 28. Patients were 21 (17 M), aged 44 to 78 (median 63 yrs). Only in 8 pts we observed G 3-4 haematological toxicity, thrombocytopenia and neutropenia (7 G3, 1 G4).

Dose finding of ifosfamide administered with a chronic two-week continuous infusion.

PURPOSE: Ifosfamide (IFO) is an active drug in several malignancies. A short-term 3- to 7-day (A) continuous infusion (c.i.) has been used in different tumor types. The 14-day c.i. (B) has been investigated in advanced breast cancer and in soft tissue sarcoma patients at a fixed daily dose. The tolerance and response rate (RR) of therapies A and B has been considered encouraging. AIM: To study the 14-day c.i. IFO schedule, every 28 days, with a dose-finding approach. METHODS: From January 1998 to December 2001, 34 pretreated patients with advanced malignancy and disease progression were treated with c.i. IFO (and the same dose of mesna) from 400 to 1,000 mg/m(2)/24 h for 2 consecutive weeks every 28 days. An elastomeric pumping device via an Infuse-a-Port((R)) or a Groshong((R)) catheter was used. RESULTS: A total of 159 cycles were evaluable for toxicity and results. No toxic deaths occurred. Three patients (8.8%) had a severe acute allergic cutaneous reaction with various grade 3-4 toxicities requiring hospitalization and therapy was stopped at day 6 of the first cycle, 7 and 12 of the second cycle respectively. In the other 31 patients, grade 4 neutropenia occurred in 6 (19.3%) and it represented the main toxicity. There was a positive relationship between the IFO dose step and neutropenia (p = 0.001). A positive relationship was observed between the RR and the received total IFO dose (g) (p < 0.004). Twelve patients out of 31 had progressive disease (PD) (38.7%), 8 had partial remission (PR) (25.8%), and 11 maintained a steady state (35.5%). Six of the 12 patients (50%) with PD and 2 of the 8 PRs (25%) had bone metastases. CONCLUSIONS: IFO c.i. is generally well tolerated, but acute untoward allergic reactions can occur. In chemotherapy-pretreated patients the recommended daily dose of continuously infused IFO for 14 days every 4 weeks is 900 mg/m(2)/day, together with mesna at the same dose schedule.

Folate status in Italian blood donors: relation to gender and smoking.

BACKGROUND AND OBJECTIVES: Folate deficiency in the general population is associated with a risk of cardiovascular disease and various cancers. The aim of this study was to evaluate folate status in Italian blood donors and its relationship with gender and smoking habit. DESIGN AND METHODS: A prospective study of 201 first visit donors (99 males and 102 females) was undertaken to evaluate folate status by measuring serum folate (SF) and red blood cell folate (RCF) levels and relating those with gender and smoking habit (100 smokers and 101 non-smokers). RESULTS: The rates of SF level less than 6.8 nmol/L and RCF less than 340 nmol/L were 9.9% and 25.3%, respectively in Italian blood donors. Mean RCF level was significantly lower (p<0.05) in females than in males and in smokers compared to non-smokers (p<0.001). The risk of reduced RCF levels in smokers was related to the number of cigarettes smoked per day, more than nine cigarettes increased the relative risk (RR) of low RCF level to 2.93 (95% C.I.: 1.34-6.41). INTERPRETATION AND CONCLUSIONS: This study suggests that folate deficiency, evaluated by RCF and SF levels, is widespread in Italian blood donors. Moreover, RCF values seem related to gender in non-smokers and modified by smoking habit, according to the cigarettes number smoked per day.

[Autologous transfusion technique application table]. / S.A.O.M.A. Scheda di applicazione ottimale delle metodiche di autotrasfusione.

The authors make a survey on the reasons leading to the application of different methods of autologous transfusion. They underline, incidentally, the important role played by the issues encountered in dealing with Jehovah's Witnesses as well as the discovery and spread of new transfusion transmitted diseases like AIDS and hepatitis C. They explain their experience, from which they have produced a Best Autologous Transfusion Technique Application Table (Scheda di Applicazione Ottimale delle Metodiche di Autotrasfusione, SAOMA), specific for every type, of operation, through the analysis of many parameters (surgeon, anaesthetist, transfusionist, general conditions of the patients, type of surgical operation). Moreover the authors evaluate advantages and disadvantages of the different autologous transfusion methods, including their cost efficiency aspects, and how they can be combined depending on the type of surgical operation. As a conclusion they attribute great importance to SAOMA to minimize homologous blood transfusion risks, even though at times the clinical aspect is made to prevail over the economic one.

Lyme disease seroprevalence in a region of central Italy.

The present study reports the seroprevalence of IgG antibodies to B. burgdorferi by testing sera from volunteer blood donors in Latium, a region of Central Italy. All samples were tested by ELISA and the positive samples were assayed by Western blotting as a confirmatory test. A positivity rate of 4.3% was recorded by ELISA, while after the confirmatory test by Western blotting the positivity rate decreased to 1.5%. The presence of significant antibody titers to B. burgdorferi in the sera of healthy subjects shows that further investigations are necessary to clarify the real prevalence of Lyme disease in our region.

Prognostic value of autoantibodies against erythrocytes and platelets in chronic lymphocytic leukemia (CLL).

Antiglobulin test (AT) and Dixon tests were performed in 100 patients with CLL. Thirty-five of them had Rai stages 0 or 1, 19 stage 2, 13 stage 3, and 33 stage 4. Twelve patients showed red blood cells autoantibodies (RBCAb) positivity; positivity at Dixon test (direct, indirect, or both) was observed in 74%. The presence of autoantibodies against erythrocytes and platelets did not influence survival curves, but anemia and thrombocytopenia are considered risk factors, independently of the presence of an autoimmune disorder. Nine RBCAb positive patients with positive Dixon test had the worst survival curves, 5 of these were anemic and 1 thrombocytopenic and anemic.