PELVIC ACTINOMYCOSIS MIMICKING A LOCALLY ADVANCED PELVIC MALIGNANCY--CASE REPORT.

We present the case of a former user of an intrauterine contraceptive device (IUD) for 10 years, diagnosed with a bulky, fixed pelvic tumor involving the internal genital organs and the recto sigmoid, causing luminal narrowing of the rectum, interpreted as locally advanced pelvic malignancy, probably of genital origin. Intraoperatively, a high index of suspicion made us collect a sample from the fibrous wall of the tumor mass, large Actinomyces colonies were thus identified. Surgery consisted in debridement, removal of a small amount of pus and appendectomy, thus avoiding a mutilating and useless surgery. Specific antibiotic therapy was administered for 3 months, with favorable postoperative and long-term outcomes. Pelvic actinomycosis should always be considered in the differential diagnosis of pelvic tumors in women using an IUD. The association of long-term antibiotic treatment is essential to eradicate the infection and prevent relapses.

Epidemiological evaluation of the outcomes after video-assisted thoracoscopic talcage in neoplastic pleurisy.

AIM: Clinical-epidemiological investigations for further assessing the importance of video-assisted thoracoscopy in the treatment y of patients with neoplastic pleurisy. MATERIALS AND METHODS: The researches included a group of 72 patients (31.9% men and 68.1% women aged 31-81 years, mean age ± 60 years) with neoplastic pleurisy who underwent pleural symphysis by video-assisted thoracoscopic talcage. For statistical-mathematical processing and interpretation the Pearson correlation index with the level of significance at p = 0.05 and highly significant at p < 0.005 was used. RESULTS: Neoplastic pleurisy prevalently affected the age groups 51-80 years (84.9%). Dyspnea was present in all cases, and patient history at the time of admission revealed 14 conditions, of which 25% were lung cancers. Macroscopically nodular and vegetative tumors were found in 66.7% of cases. An amount of 1000-2000 ml of pleural fluid was found in 44.5% of the cases and a serocitrin appearance in 50%. In 23.6% of the cases cytology results were positive for malignancy and in 13.8% suspicious. In 65.2% of the cases the pleural fluid was exudative and anatomopathology was suggestive of adenocarcinoma in 34.7% of the cases and breast cancer in 18%. The prevalence of recurrences varied from 1 month to more than 7 months, with 36.4% for 1-2 months. CONCLUSIONS: The obtained additional data support the important role of pleural symphysis by video-assisted thoracoscopic talcage in the patients with neoplastic pleurisy.

POSTOPERATIVE ARTERIAL RELAXATION AND INTRAOPERATIVE VENOUS DILATION AS INTERCONNECTED PROGNOSTIC FACTORS FOR THE MATURATION OF ARTERIOVENOUS FISTULAS.

AIM: To investigate if immediate arterial distention can be used as a predictive factor for the development of a good fistula. MATERIAL AND METHODS: Over a 5-months period (January- May 2015) all the patients who underwent an arteriovenous fistula between the radial artery and the cephalic vein of the forearm at the Second Surgical Clinic of the Iasi Regional Cancer Institute and were willing to participate were enrolled in the study. The diameters of the vessels were measured 1 hour and 8 weeks after surgery. RESULTS: We found statistically significant differences for all measured diameter variations between the calcified artery and normal artery groups (p < 0.001 for the arterial distention at 1 hour and 8 weeks after surgery and p = 0.002 for the venous distention 8 weeks after surgery). A linear regression also showed that the degree of arterial distention immediately after surgery and the venous distention 8 weeks after surgery were statistically correlated. CONCLUSIONS: Arterial distention immediately after surgery and therefore the lack of it due to the presence of arterial calcifications can be used to predict whether or not a good fistula can be achieved at a 1% statistical significance level.

Clinical-epidemiological study on the incidence of postoperative complications after pulmonary resection for lung cancer.

AIM: To determine the relationship between the characteristics of a group of lung cancer patients, lung cancer surgeries, and the incidence of early and/or late postoperative complications. MATERIAL AND METHODS: The study included a group of 115 lung cancer patients aged 40 to 85 years, 76.5% men, 60.91% living in urban areas, who received surgical treatment in the interval January 2013-August 2014. Data were collected from electronic medical records and survey sheets and processed and interpreted using Pearson correlation index (p-value of 0.05 was considered statistically significant and of <0.005 highly statistically significant), and chi2, y, 1c = 25% tests. All statistical analyses were performed using the SPSS statistical software package version 13.0. RESULTS: Of the 115 patients 7.8% were in the 40-50 years age group and 87.8% in the 51-75 years age group (p < or = 0.001). Most patients were males (76.5%, p < 0.001), and 60.9% of the patients were living in urban areas (p < or = 0.05). The difference in the prevalence of smokers (76.5%) vs. non smokers (23.5%) was highly statistically significant (p < 0.005). Active smoking of one pack of cigarettes per day for more than 10 years was recorded in 54.8%. The presence of co morbidities (17 events) and the distribution of neoplastic lesions in the five anatomical areas required the performance of lobectomies, bilobectomies or pneumectomies. The incidence of early (14 entities) and late postoperative complications (7 entities) depended on patient's general condition, nature of co morbidities, location and stage of neoplastic lesions, and surgical complexity. CONCLUSIONS: Lung cancer, in various locations and stages, most commonly affected males aged 40-85 years, from urban areas, smokers, with various co morbidities. Surgeries performed in these patients were often laborious and with a relatively low incidence of postoperative complications.

[True posttraumatic femoral artery aneurysm: a rare clinical entity]. / Anevrism adevarat posttraumatic de artera femurala. Entitate clinica rara.

Traumatic etiology in aneurysms is very rare. After arterial trauma we usually find pseudo aneurysms. True aneurysms are due to deterioration of the arterial wall in small and long-term repetitive trauma. Pseudo aneurysms are usually described on radial and cubital artery in patients who work with vibrating tools ("hypothenar and thenar hammer syndrome") and on axilar artery in those who use axilar crutches. We present a case of a woman with a true aneurysm of the femoral artery developed due to repetitive trauma of the femoral region at the work place. The patient presented as an emergency, with ruptured aneurysm and she underwent an emergency operation. The diagnosis was established late by histopathological examination. This is the first case of posttraumatic true aneurysm with this location. True aneurysms should be considered in repetitive trauma regardless of anatomical region.

[Bleeding control in stab wounds to the great vessels at the neck base]. / Controlul hemoragiei în leziunile vaselor mari de la baza gâtului produse prin arme albe.

Stab wounds of the neck are a great challenge for every surgeon. Approximately 25% of penetrating neck injuries results in a vascular lesion. Wounds being situated below the cricoid cartilage are associated with the great mortality and morbidity, having a global mortality between 12-20%. 2/3 of the vascular wounds at this level have a tragic end. We are going to present 3 cases of cervical stab wounds in zone 1 of the neck, with vascular lesions, in which we succeeded to control the hemorrhages throw a midline sternotomy combined with different extensions. After this small experience we think that in patients with wounds situated in zone 1 of the neck, who reach the hospital hemodynamically unstable or with active bleeding, urgent midline sternotomy combined with cervicotomy, or section of the clavicle, is the best way to control the hemorrhages. Using blunt digital dissection we can avoid unpleasant situations that can appear using instrumental dissection into the mediastinal hematoma.

[Cystic lymphangioma of the adrenal gland]. / Limfangiom chistic al glandei suprarenale.

Cystic lymphangioma of the adrenal gland is a rare tumor, which is often sub-clinical. Preoperative diagnosis is difficult. We present a case of a 47 year-old female in whom an incidental left cystic mass of 12 cm by 10 cm with no features of malignancy was discovered by ultrasound scan. A further computed tomography scan confirmed the ultrasound findings. Biochemical screening ruled out a secreting adrenal tumor. Because of the size of the cyst, the lesion was resected and the diagnosis of benign adrenal cystic lymphangioma was histologically confirmed. Computed tomography is the reference examination for delineating the topography and extent of the lesion, especially when it is large. Although imaging can characterize the cystic nature of a lesion, it sometimes fails to establish a specific diagnosis, so surgery or fine needle aspiration should be done for a definitive diagnosis. The characteristic features of cystic adrenal lymphangioma are discussed together with a review of the recent literature.

Unrelated allogeneic bone marrow donation: short- and long-term follow-up of 103 consecutive volunteer donors.

Between 1992 and 1999, 105 unrelated allogeneic bone marrow collections from 103 volunteer donors (65 males and 38 females; median age 33 years) were carried out in three northern Italian centers (Verona, Bolzano and Padova) affiliated with the Italian Bone Marrow Donor Registry (IBMDR). The average volume of BM collected was equivalent in both genders (1143.1 ml for males and 1054.2 ml for females; P = 0.1), although the average volume collected for unit of body weight and the average post-collection blood volume depletion was higher in females (respectively 17.1 ml/kg and 14.2% in females, 14.8 ml/kg and 12% in males; P= 0.01 and 0.03). There was no statistically significant difference between males and females in the total number of nucleated cells collected. We did not record any acute life-threatening event during or after the bone marrow collections. The most frequent complaint was pain at the collection site (77%) followed by the onset of fatigue (38%) and nausea and vomiting (25%); all of these were short-term problems. Hospitalization was short (average 20.2 h) and donors started their normal daily activities after an average of 5.4 days. We also monitored Hb, serum ferritin levels, WBC and platelet counts in the post-collection period (average follow-up 40.1 months). All donors signed a written informed consent for a further bone marrow collection, if needed. Our findings confirm the short- and long-term safety of allogeneic bone marrow collection in volunteer donors.

Presence and significance of cold agglutinins in patients with HIV infection.

BACKGROUND: HIV-infected patients may contract a variety of other concurrent infections, including Mycoplasma pneumoniae, cytomegalovirus (CMV) and Epstein-Barr virus (EBV), that are known to be causes of transient cold agglutinins (CA). The aim of this study was to search for the prevalence, the persistence and the significance of CA in HIV antibody-positive patients. METHODS: Ninety patients belonging to different risk groups (drug addicts, homosexuals and hemophiliacs), including 15 with AIDS, 20 with ARC, 25 with PGL, 30 symptom-free individuals and 100 healthy blood donors were assessed for the presence of CA for at least six months. RESULTS: In 20 cases (22%) CA were found: 3, 7, 5 and 5 respectively, in each of the above mentioned HIV-positive groups, while the group used as control was CA-negative. There were no differences between CA-negative and CA-positive patients with regard to the presence of anemia, frequency of other infections, or development of lymphatic malignancy during the follow-up period. Serological specificity of CA included 14 of type anti-I, 5 of anti-i and 1 of anti-Pr specificity. CONCLUSIONS: It appears that CA production is another immune disorder of patients with HIV infection.

[Chemotaxis deficiency in patients with HIV infection]. / Deficit della chemiotassi in pazienti con infezione da HIV.

Increased susceptibility to bacterial recurrent infection is characteristically associated with impaired B cells function but also with a defective PMN function. We studied PMN CT in 15 HIV positive drug addicts patients with persistent generalized lymphoadenopathy (PGL), in 15 symptom free HIV negative drug addicts (SFDA) and in 15 healthy blood donors to evaluate influence of HIV infection on PMN functions. CT of patients with PGL was reduced to 78% (p < 0.0001) and 75% (p < 0.00001) of CT in SFDA patients and healthy blood donors, respectively. We conclude that HIV infection causes defective PMNL CT and then it can increase susceptibility to bacterial recurrent infections in these patients.

HLA gene and phenotype data of 60 insulin-dependent diabetic patients from north-eastern Italy. A negative association with DR5 rather than DR2?

The purpose of our study was to evaluate what kind of relationships exist between HLA antigens and insulin-dependent diabetes mellitus (IDDM), in 20 families and in 40 single patients coming from and living in North Eastern Italy. The subjects studied show a strong association with HLA-DR3 and/or -DR4; at least one of these antigens is present in 88% of the diabetic subjects; this confirms that these antigens play a role in the pathogenesis of IDDM. We also noticed a negative association between IDDM and DR5 rather than DR2 and DR7. This result supports the hypothesis of a specific protective effect of DR5, at least as regards the population studied. Possibly, the gene(s) hypothetically involved in the protection against IDDM is (are) in linkage disequilibrium with DR2 and/or DR7 in some Caucasian populations and with DR5 in others. Another important result is the frequent HLA identity (75% of cases) among diabetic siblings of the same families. This result indicates that HLA identity is the main condition responsible for the susceptibility to the disease in the healthy siblings with HLA antigens identical to the diabetic siblings.

Insulin dependent diabetes mellitus epidemiology: HLA genotype study in 12 north eastern Italian families with two siblings affected by type I diabetes.

The purpose of our study was to evaluate the relationship between the histocompatibility antigens and type I diabetes mellitus in families living in the north-eastern part of Italy. In each family two siblings were affected by diabetes. HLA-antigens were determined with the lymphocytotoxicity test, utilizing antisera of the series A-B-C-DR. The phenotypic frequencies were compared with those observed in controls. We showed that diabetes has a strong association with HLA DR 3 and/or DR 4 antigens. In particular we registered high frequency of compound heterozygous DR 3 - DR 4 subjects, and this fact supports the hypothesis of the existence of two different genes for diabetes associated with these HLA antigens. Moreover we observed a particular haplotype segregation with a very high percentage of HLA identity between patients belonging to the same family, confirming the association between HLA and genetic susceptibility to insulin dependent diabetes. These results confirm data in the literature and, completed by other data from other patients' families living in our area, will be useful in providing reliable genetic counselling.

Neutrophil function and humoral immunity in children with recurrent infections of the lower respiratory tract and chronic bronchial suppuration.

Neutrophil motility and superoxide anion production and serum immunoglobulin levels were assessed in 51 children with recurrent infections of the lower respiratory tract and chronic bronchial suppuration, not due to anatomic or functional cause. In 26 children (50.9%), a significant defect of the immunologic defenses, likely to be responsible for the disease, was observed. A precocious diagnosis and an adequate therapy could result, at least in some patients, in the prevention of progressive lung damage.