Complication analysis in acute appendicitis, results from an international multicenter study

PURPOSE

Acute appendicitis (AA) is frequent, its diagnosis is challenging, and the surgical intervention is not risk free. An accurate diagnosis will reduce unnecessary surgeries and associated risks. This study aimed to analyze the rate of appendectomies' postoperative complications.

METHODS

Multicenter, prospective, observational study conducted at three large hospitals (Pisa University Hospital, Italy; Henri Mondor University Hospital, Paris, France; and Valencia University Hospital, Spain).

RESULTS

A total of 3070 patients with a median age of 28 years (IQR 20-43) were enrolled. 1403 (45.7%) were females. Eight hundred ninety patients (29%) did not undergo preoperative imaging. Ultrasound and CT scans were performed in 1465 (47.7%) and 715 (23.3%) patients. Patients requiring CT scan were older [median 38 (IQR 26-53) vs. no imaging median 24 (IQR 16-35), Ultrasound median 28 (IQR 20-41); p < 0.0001]. Laparoscopic appendectomy was performed in 58.6%. Complications developed in 1279 (41.7%) patients: Clavien-Dindo grades I-II in 1126 (33.9%); Clavien-Dindo grades III-IV in 146 (5.2%). Overall mortality was 0.2%. Following resection of a normal appendix, 15% experienced major complications (Clavien-Dindo grades IIIb and above). Multivariable analysis revealed that age, Charlson comorbidity index, histopathology, and Alvarado score over 7 were associated with a higher risk of Clavien-Dindo complication grades IIIa and higher.

CONCLUSION

Appendectomy may be associated with serious postoperative complications. Complications were associated with older age, Charlson comorbidity index, histopathology, and high Alvarado scores. The definition of accurate diagnostic and therapeutic pathways may improve results. The association between clinical scores and radiology is recommended.

Lodovico Brunetti, the Unknown Father of Modern Crematorium

The cremation has been documented since prehistoric times and it was a common funerary custom until the advent of Catholicism. Falling into disuse, during XVII-XVIII centuries there were new movements to bring it back according to modern criteria, mainly due to hygienic reasons and cemeteries overcrowding. This also led to the prototyping of new crematory ovens to improve the ancient open-air pyre. Lodovico Brunetti was the first to carry out a crematory experimental research in the modern countries. Since Brunetti's studies were based on the study of ancient cremations, a comparison with a modern experience of reconstruction of archaeological cremation is presented to evaluate the validity of his crematorium oven. Furthermore, the social and religious aspects related to Brunetti's inventions and the revitalization of cremation shows how tools and technologies and also the cultural environment have evolved over the years, effectively accepting the cremation practice as an alternative to inhumation.

Cardiocentrism in ancient medicines

History of cardiology starts scientifically in 1628, when William Harvey (1578-1657) published his revolutionary book Extercitatio anatomica de motu cordis et sanguinis in animalibus, where he described "general" circulation, movements and functions of heart, heart valves, veins and arteries [1]. Consequently, all theories and practices of ancient medicines were reduced to superstitions. Historians relegated pre-Harveian cardiology to roughs notes, preventing a proper historical evaluation of many centuries of conceptions and practices. All the ancient civilizations shared the conviction that the heart was the biological and spiritual center of the body, the seat of emotions, mind, will, a vital energy produced by breathing and healing, and the soul. This cardiocentric view maintained a special role both in religion and in medicine across millennia from east to west, passing over cultural and scientific revolutions. Here, we will try to give a schematic account of medical beliefs on the heart from the most important pre-classic medicines. Some of them today show to have a kernel of truth. This demonstrates, at least, that history is a non-linear process and that intuitions or even truths, potentially useful for the present and scientific development, can re-emerge from the past.

Aristotle - Ἀριστοτέλης (ARISTOTÉLĒS, 384/3- 322/1 BCE) The revelation of tuberculosis in his zoological works

One of the most challenging issues with the sources of ancient medicine is to be able to identify the correspondence between the diseases we know today and those reported in ancient medical texts. Ancient diseases' definitions rarely help us, and the symptoms described often correspond to more than one disease. This is especially true about tuberculosis, a disease that historians of medicine habitually associates with the Greek words phthi(n)o (φθίνω), verb, phthisis/phthoe (φθίσις/φθόη), noun, phthinodes/phthisikos (φθινώδης/φθισικός), adjective, all etymologically linked to an Indo-European root that expresses the idea of consumption in a broad sense. This article aims to analyze a group of Greek words, branchos/branchia (βράγχος/βράγχια), krauros/kraurao (κραῦρος/κραυράω), and katarreo (καταρρέω), that appear in nosological contexts very close to the infectious disease that today we call tuberculosis. Moreover, the paper aims to focus on the transmission pathways of TB being via animal-human contact and some ancient strategies to cure it. The symptoms, transmission pathways and therapeutic approach of tuberculosis belong to a homogeneous pathological picture that emerges from a set of texts that date back to the period between the fifth century BC and the second century AD.

Paleopathology of the skull of Santorio Santorio, father of modern clinical experimental physiology

The University of Padua (Italy) preserves the skull of Santorio Santorio, father of the modern clinical experimental physiology. A recent study performed with modern anthropological methods and medical instruments (CT scan) revealed the presence of a lobular formation in the left temporal bone, with an irregular morphology, internal bone sequestrum, a well-defined non-continuous sclerosis and both internal and external thinning of the cranial plate. Three oval depressions observed in the cranial vault, edentulism and moderate osteoarthritis of the temporomandibular joint were also investigated. The lobular formation was an epidermoid cyst and the oval depressions were the result of other cysts. The edentulism was consistent with some metabolic deficiency or disease, whilst the osteoarthritis appeared to be the result of antemortem tooth loss. This study allowed to investigate a complex and peculiar palaeopathological picture, linked to a piece of the history of the University of Padua.

Leonardo Botallo (1530-1587) and his pioneering contributions to traumatology, cardiology and deontology

Leonardo Botallo (1530-c. 1587) is widely known for the eponymous "foramen Botalli" and "ductus Botalli". The first, most commonly named "foramen ovale", allows blood in the fetal heart to enter the left atrium from the right atrium. The second, named "ductus arteriosus", consists of a blood vessel in the developing fetus connecting the trunk of the pulmonary artery to the proximal descending aorta. However, Botallo was a multifaceted figure who studied many aspects of human anatomy and physiology, also making important contributions to clinical and surgical practices. Moreover, as we will see in the last section of this paper, Botallo wrote a book on medical deontology having significant features in relationship to the history of medical ethics. Botallo's multidisciplinary approach is a typical characteristic of Renaissance physicians and scientists, who contributed to making this period a fundamental prelude to the scientific revolution of the 17th century.

When self-medication goes wrong: the case of argyria at the Padua Morgagni Museum of Pathology

A unique specimen of argyria is preserved in the Morgagni Museum of Pathological Anatomy at the University of Padua (Italy). It is a stuffed head belonging to a man who decided to cure his syphilis by himself with the so-called infernal stone (silver nitrate) every day for years, thus developing argyria in the second half of the nineteenth century. Paleopathological and historical studies were performed on the specimen to confirm the diagnosis of argyria. Furthermore, a morphological investigation of the specimen was conducted with histological and ultrastructural investigations, including environmental scanning electron microscopy and electron dispersive x-ray spectroscopy, recording high presence of silver in the dermis and epidermis and also other chemical elements correlated to the "infernal stone." A comparison with actual cases may also lead to a common feature: a potential dependence on the perceived benefits brought by silver compound that may sustain a further prolonged intake.

The three fetal shunts: A story of wrong eponyms

The fetal circulatory system bypasses the lungs and liver with three shunts. The foramen ovale allows the transfer of the blood from the right to the left atrium, and the ductus arteriosus permits the transfer of the blood from the pulmonary artery to the aorta. The ductus venosus is the continuation of the umbilical vein, allowing a large part of the oxygenated blood from the placenta to join the supradiaphragmatic inferior vena cava, bypassing the fetal liver and directly connecting the right atrium. These structures are named after the physicians who are thought to have discovered them. The foramen ovale and the ductus arteriosus are called the "foramen Botalli" and the "ductus Botalli," after Leonardo Botallo (1530-c. 1587). The ductus venosus is styled "ductus Arantii" after Giulio Cesare Arantius (1530-1589). However, these eponyms have been incorrectly applied as these structures were, in fact, discovered by others earlier. Indeed, the foramen ovale and the ductus arteriosus were described by Galen of Pergamon centuries earlier (c. 129-210 AD). He understood that these structures were peculiar to the fetal heart and that they undergo closure after birth. The ductus venosus was first described by Andreas Vesalius (1514-1564) 3 years before Arantius. Therefore, the current anatomical nomenclature of the fetal cardiac shunts is historically inappropriate.

Fabrici and the functional power of the image

Hieronymus Fabricius ab Acquapendente, famous anatomist of the medical school of Padua, Italy, marked a further step not only in the morphological studies, but also in anatomical illustration and physiology. His researches were inspired by the work of Aristotle which was focused on the understanding of biological "functions" in an anatomo-comparative way. The anatomo-comparative approach of Fabrici allowed him to discover several specific features of human anatomy. His focusing on function marked the transition from a descriptive to a functional anatomy, paving the way to the birth of human physiology in the following century. To enhance the teaching and learning of anatomy, Fabrici realized the importance of the "dimension" and "color" of anatomical illustrations and introduced for first full-scale and colour painted plates. In this way, the images were closer to representing "living" parts, than previous black & white and low scale images. Moreover, Fabrici was the first to create an "anatomo-phisiological" image, namely the one representing the valves in the veins. His work was a fundamental inspiration for his students, in particular Gaspard Bauhin and William Harvey.

Exchanges and interactions between Padua and Vienna medical schools in the XIX century

It is well known that Padua Medical School, Italy, played a fundamental role in shaping modern medicine. Its golden age lasted from the late XV to the late XVIII century, thanks in particular to its extraordinary anatomical school. One of the last fundamental achievements of the Padua Medical School was the founding of the anatomo-clinical method and organ pathology by Giovanni Battista Morgagni, Professor of Theoretical Medicine in Padua from 1711 and 1715 and of Anatomy from 1715 to his death. This method, which dramatically changed the course of medical diagnosis and therapy, was immediately developed by the so-called Anatomo-Clinical School of Paris. Figures such as Jean-Nicolas Corvisart and René Laennec improved this new approach in the clinical setting with the method of auscultation and the introduction of the stethoscope. However, organ pathology probably found its most important modern expression in the so-called Viennese School of Medicine, thanks to figures such as Karl von Rokitansky, Joseph Skoda and Theodor Billroth. In that period, this school was described by the anatomist Rudolf Virchow as "the Mecca of medicine." As is well known, Padua and Venice fell under the rule of the Austro-Hungarian Empire between the end of the XVIII and the beginning of the second half of the XIX century. The most important influences and changes at the University of Padua were introduced by the Viennese School during the so-called Third Austrian Domination (1813-1866), with improvements of medical curriculum, the founding of new specialist medical institutes and a general advancement of medical science, inspired by the technical-practical approach typical of this school. In particular, the new chair and Institute of Pathological Anatomy was founded by Lodovico Brunetti, pupil of Rokitansky, who influenced his appointment at Padua. In this way, we can advance that, at the end, the Morgagni method came back to Padua through the leading role of the Vienna Medical School, which deeply influenced the University of Padua during the different phases of Austrian domination in north Italy.

Mythology and rational explanation in the history of medicine The case of molar pregnancy

OBJECTIVE

To analyse own set of molar pregnancies and to develop clinically relevant procedures.

TYPE OF STUDY

Historical article based on the analysis of Greek classic medicine.

SETTINGS

History of Medicine Unit; Department of Medico-Surgical Sciences and Biotechnologies; Sapienza-University of Rome, Italy; Unit of Medical Humanities; Department of Cardiac, Thoracic, Vascular Sciences and Public Health; University of Padua, Italy.

INTRODUCTION

Molar pregnancy is a specific kind of gestational trophoblastic disease which originates from the placenta. There are two types of molar pregnancy, complete and partial. Complete molar pregnancy derives from a defect in maternal eggs, while an incomplete one derives from a defecting fertilization by paternal sperm. Historical analysis: Molar pregnancy drawn the attention of ancient physicians from the classic period and they widely discussed maternal and paternal roles in causing this condition. Classic doctors drawn from mythology several suggestions and ideas, which indicates that the issue of normal and abnormal conception was a crucial problem since the most ancient past Conclusion: Current scientific studies on molar pregnancy are free from ancient prejudices about male and female &#8220;nature&#8221; and their reciprocal role in embryogenesis. However, an awareness of the cultural biases that could drive scientific researches, might be useful for scientists and physicians even today.

Did Antonio Vallisneri (1661-1730) really describe frontal sinus osteoma? Unexpected insights for paleo-neuroparasitology

It has been believed for a long time that the Paduan scholar Antonio Vallisneri (1661-1730) described the second historical case of the frontal sinus osteoma in 1733. By historico-medically reexamining this case, we conclude that the brain concretions he described were not a case of frontal sinus osteoma, while they appear to have been pathological outcomes of neurocysticercosis, whose larval stages would only be described by Johann Goeze (1731-1793) later, in 1784. Thus, this case becomes relevant for the history of neuroparasitology.

Ophthalmologic wax models as an educational tool for 18th-century vision scientists

The Medical Faculties of the University of Padua (Italy) and the University of Vienna (Austria) preserved two series of wax models, made by the Austrian Johann Nepomuk Hoffmayr at the beginning of the 19th century. These models were created in a period of evolution of both medical specialties and organ pathology, which brought morbid organs at the centre of medical investigation. Ceroplastic was considered a useful tool for didactic and research, as it provided a three-dimensional realistically coloured reproduction of organic lesions. The models represent the typical eye diseases of the period, in particular those affecting external parts, which could be investigated without the need for specific instruments devised for the observation of the inner and posterior anatomy of the eye, at that time not yet available. Even if the nosological categories then employed by Hoffmayr were different from those currently used, it has been possible to find a correspondence thanks to the ophthalmological literature of his period. Ceroplastic started to decline at the end of 19th century, substituted by the much less expensive method of preservation of morbid organs in formalin and by new techniques of investigation of the inner body, such as X-ray.

Phrenology between anthropology and neurology in a nineteenth-century collection of skulls

The University of Padua has many legends about its cultural heritage. One of these concerns a collection of eight skulls still preserved in the Hall of Medicine at Bo Palace, near the old anatomy theatre built in 1545. It is said that some famous professors of the University donated their bodies to medical science, and the skulls were from these bodies. From multidisciplinary research, both historical and anthropological, we have discovered that Francesco Cortese, Professor of Medicine and Rector of the University, started this personal collection of colleagues' skulls, although they had not donated their bodies to science, so that he could make his own detailed phrenology study.

Occupational markers and pathology of the castrato singer Gaspare Pacchierotti (1740-1821)

Following the birth of modern opera in Italy in 1600, the demand for soprano voices grew up and the prepuberal castration was carried out to preserve the young male voice into adult life. Among the castrati, Gaspare Pacchierotti was probably one of the most famous. The remains of Pacchierotti were exhumed for the first time in 2013, for a research in the reconstruction of his biological profile, to understand the secrets behind his sublime voice and how the castration influenced the body. All the findings discovered, through anthropological and Computed Tomography analyses, are consistent both with the occupational markers of a singer and with the hormonal effects of castration. The erosion of cervical vertebrae, the insertion of respiratory muscles and muscles of the arms can be an effect of the bodily position and exercise during singing. The hormonal effect of castration were related to osteoporosis and to the disorders of spine.

Should the annular tendon of the eye be named 'annulus of Zinn' or 'of Valsalva'?

The annular tendon is commonly named 'annulus of Zinn', from the German anatomist and botanist Johann Gottfried Zinn (1727-1759) who described this structure in his Descriptio anatomica oculi humani (Anatomical Description of the Human Eye, 1755). This structure, however, had been previously discovered not by Zinn, but by Antonio Maria Valsalva (1666-1723) some decades before the publication of Zinn, in his Dissertatio anatomica prima and Dissertatio anatomica altera (First and Second Anatomical Dissertations), inside Valsalva's Opera omnia published in 1740. We advance that this structure could be re-named such as 'annulus of Valsalva-Zinn' because Valsalva, even making a mistake in its functional interpretation, first described this anatomical structure. Likewise, Valsalva, with his discovery, advanced a revolutionary idea for that time on the usefulness of anatomy for clinic and pathology.

"Bernardino Ramazzini, three hundred years after his death", Padua (Italy), October 18th, 2014

The year 2014 has marked the tercentenary from the death of Bernardino Ramazzini (1633-1714), universally credited as the founder of Occupational Health (5, 9, 10, 11). Indeed, the renowned physician died on November 5th 1714 in Padua, where he had been appointed as Professor of Practical Medicine at the local prestigious University from the year 1700. To commemorate this anniversary, the professors of Occupational Health of the University of Padua, the Italian Society of Occupational Health and Industrial Hygiene (Società Italiana di Medicina del Lavoro eIgiene Industriale, SIMLII), the International Commission on Occupational Health (ICOH) and the University of Padua organized a conference in the wonderful location of Palazzo Bo (Main Hall) under the patronage of the Padua Municipality, the Workers' Compensation Authority (INAIL), the Venetian Region and the Societas Internationalis Historiae Medicinae.[...].

The prehistory of the cytoskeleton concept

Here we discuss how the concept and the name of cytoskeleton were generated and started to evolve over the last two centuries into what is presently a basic topic of modern biology. We also attempt to describe some facets of the emergence of cytoskeleton component characterization in which our laboratory was in part involved.

[The enigma of the "punished suicide": an anatomical preparation of Lodovico Brunetti winner of the gold medal at the Universal Exhibition in Paris in 1867]

This article reconstructs the figure of Lodovico Brunetti, the first Chair of Pathological Anatomy at the University of Padua, and Director of the homonymous Institute from 1869 to 1887. He was the inventor of a technique known as "tannization," for the conservation of animal tissue. In particular, we have reconstructed the episode related to a particularly choking anatomical preparation, created by Brunetti in 1863, called "The Punished Suicide." This composition, together with a series of 66 preparations, allowed him to win the "Gran prix" at the Universal Exposition of Paris in 1867.

The discovery of pulmonary circulation: From Imhotep to William Harvey

In his quest to comprehend his existence, Man has long been exploring his outer world (macro-cosmos), as well as his inner world (micro-cosmos). In modern times, monmental advances in the fields of physics, chemistry, and other natural sciences have reflected on how we understand the anatomy and physiology of the human body and circulation. Yet, humanity took a long and winding road to reach what we acknowledge today as solid facts of cardiovascular physiology. In this article, we will review some of the milestones along this road.

Surgery, pathology, and art in Pietro Gradenigo's ophthalmologic waxworks

Pietro Gradenigo (1831-1904) represents one of the greatest eras of cultural and scientific activity in Italian ophthalmology. Padua's Vincenzo Pinali Medico-historical Library preserves 2 series of ophthalmologic wax models. Made by Pietro Gradenigo in 1884-1889, the first consists of 18 waxes and shows different eyes diseases, such as neoplasm and tenonitis, and ophthalmologic surgical operations, such as some interesting cases of blepharoplasty. The second series from Vienna Medical School was created by Johann Hofmayer, ophthalmologist of the Josephinum in Vienna. The ideas at the foundation of wax modeling and operations represented in these series have some original and significant implications related to the role of medical imaging in didactic and research.

Situs inversus with dextrocardia in a mummy case

A mummy of a young woman, who died due to tuberculous peritonitis and salpingitis, is conserved in the Pathological Anatomy Museum of the University of Padua. It was found at autopsy to have situs inversus of viscera with dextrocardia, apparently in the absence of other congenital defects. A 64-section scanner computed tomography (CT) on the specimen was carried out to investigate the internal condition of organs. The CT revealed the presence in the heart of a muscular ventricular septal defect and of calcific deposits on visceral pericardium and aortic wall, in keeping with sequelae of previous tuberculous pericarditis.

An etymological "autopsy" of Morgagni's title: De sedibus et causis morborum per anatomen indagatis (1761)

For the Morgagnian anniversaries of 2011 to 2012, the University of Padua organized a wide research project, trying to understand Morgagni's contribution in his historical context and why he is still considered the father of a new way of thinking in medicine, based on anatomoclinical correlations. Calling his masterpiece De sedibus et causis morborum per anatomen indagatis, Morgagni placed his research in a specific tradition of medical studies: the mechanistic approach to medicine, considered new in different European contexts. This approach gave Morgagni the theoretical structure to find his anatomopathologic research and the revolutionary idea for his time: post mortem dissections could be useful to understand pathophysiologic mechanisms and clinical symptoms in the living.

[The method of "rational medicine" of Giovanni Battista Morgagni]

Giovanni Battista Morgagni is considered the father of pathological anatomy. His contribution can be contextualized within the sphere of the extraordinary development of anatomy between the seventeenth and eighteenth century, the period in which this discipline became the "queen" of the natural sciences. A new pathology based upon anatomy became possible thanks to the mechanistic perspective that had characterized this science in the seventeenth century, in particular with the work of Marcello Malpighi, whom Morgagni regarded as his master. The approach of Malpighi and of the other "iatromechanists" was the subject of an ample debate in which the advocates of mechanicism and empiricism were opposed to, and intertwined with, the supporters of the "ancient," that is to say, Galenic medicine, with respect to those of the "modern," i.e., "neoteric" one. The anatomic-clinical method of Morgagni can be fully understood only when contextualized within this debate.

[For a socio-medical iconography of Ramazzini's De Morbis: the manuscript of Giovanni Grevembroch (1731-1807)]

Since 2002, a group of historians of medicine in Padua has been working on the creation of a iconographic database related to the professions described by Ramazzini, founder of occupational medicine, in his 1700's De morbis artificum diatriba. A specific example of iconography relevant to De morbis can be found in a 17th century manuscript written and illustrated by Giovanni Grevembroch (1731-1807), Venetian painter probably from a family of Flemish origins. This manuscript describes typical Venetian dress and costumes, accompanied by commentaries made by the artist himself. Here we can find costumes related to some of the very same professions described by Ramazzini and a comparative analysis reveals interesting elements. First of all, in his commentary Grevembroch frequently invokes concepts very similar to those of Ramazzini, related both to the dangers of the environment characteristic of a given profession and to the illnesses typical to each profession. Moreover, analysis of Grevenbroch's images and text often provides supplemental insights into to the context of and risks associated with selected occupations. Finally, the Grevembroch manuscript also supplies supplemental material pertinent to the social and cultural life of the epoch that, even if not strictly linked to questions of occupational medicine.

Medicine, evolution, and natural selection: an historical overview

Contemporary Darwinian medicine is a still-expanding new discipline, one of whose principal aims is to arrive at an evolutionary understanding of those aspects of the body that leave it vulnerable to disease. Historically, there was a precedent for this research; between 1880 and 1940, several scientists tried to develop some general evolutionary theories of disease as arising from deleterious traits that escape elimination by natural selection. In contrast, contemporary Darwinian medicine uses evolutionary theory to consider all the possible reasons why selection has left humans vulnerable to disease.

Tumour-specific induction of immune complexes: DCP-IgM in hepatocellular carcinoma

BACKGROUND

In the sera of liver, colorectal and prostate cancer patients, several biomarkers may be detected as IgM immune complexes. To determine whether the presence of immune complexes was correlated to an increase of IgMs, we measured the IgM content in the sera of patients with hepatocellular carcinoma (HCC) and cirrhosis, and evaluated the occurrence of des-gamma-carboxy prothrombin (DCP) as immune complexes (DCP-IgM) compared to the levels of DCP and alpha-fetoprotein (AFP).

PATIENTS AND METHODS

Serum samples from 31 patients with cirrhosis, 33 untreated HCC patients diagnosed by ultrasound, computed tomography and/or magnetic resonance and confirmed by histopathology, when indicated, and 30 healthy controls were analysed. Concentrations of IgM and DCP-IgM were determined by ELISAs.

RESULTS

Circulating IgM in patients with HCC (median level = 1.79 mg mL(-1)) and cirrhosis (1.09 mg mL(-1)) were not significantly different (P = 0.1376) while DCP-IgM were significantly higher in HCC patients (median level = 2171.2 AU mL(-1)) than in those with cirrhosis (1152 AU mL(-1), P = 0.0047). No correlation was found between DCP-IgM and IgM in HCC (r = 0.227) and cirrhosis patients (r = 0.475). DPC-IgM was positive in 55% (18/33) of HCC patients and in 26% (8/31) of cirrhosis patients compared to 39% and 26% for DCP and 48% and 13% for AFP. DCP-IgM, DCP and AFP tests had 100% specificity in healthy controls.

CONCLUSIONS

DCP-IgM in HCC patients was not associated with an increase in IgM concentration. DCP-IgM was more frequently detected in HCC patients than DCP and AFP, strengthening the diagnostic role of IgM immune complexes for liver cancer.

High serum levels of B-lymphocyte stimulator are associated with clinical-pathological features and outcome in classical Hodgkin lymphoma

B-lymphocyte stimulator (BLyS) acts as survival factor for B lymphocytes. As Hodgkin and Reed-Sternberg (HRS) cells express receptors through which BLyS promotes their growth and chemotherapy resistance, we investgated whether this molecule was increased in sera from patients with classical Hodgkin lymphoma (cHL) and whether it correlates with clinical-pathological features and outcomes. Enzyme-linked immunosorbent assay was used to measure soluble BLyS (sBLyS) in sera from 87 patients and 33 donors; higher levels were detected in patients (mean +/- standard error 4493.9 +/- 264.9 pg/ml vs. 2687.0 +/- 200.9 pg/ml; P < 0.0001). Levels above the median value (4242.0 pg/ml) were associated with age > or = 45 years (P = 0.042), advanced stages of disease (P = 0.005), systemic symptoms (P = 0.014) and extranodal involvement (P = 0.009). Five-year failure-free survival (FFS) of patients with sBLyS below or equal to median levels was 88.6% as compared to 65.1% of those with levels above the median (P = 0.009). Statistical analyses confirmed the prognostic significance of sBLyS (P = 0.046). When patients were analysed according to variables associated with high levels, sBLyS showed an independent predictive power in terms of FFS. Our findings support the involvement of BLyS in cHL pathogenesis. The association between high serum levels and an inferior FFS indicates that sBLyS is a possible prognostic predictor with a potential significance as a therapeutic target.

Retroperitoneoscopic lumbar sympathectomy for nonreconstructable arterial occlusive disease

AIM

The aim of this study was to present our experience with video-assisted lumbar sympathectomy for non-reconstructive arterial occlusive disease in a series of 23 consecutive patients whose predominant symptoms were unilateral rest pain, limited skin ulcerations or gangrene of the toes.

METHODS

All the procedures were performed with retroperitoneal approach, dorsal position of the patient and simple digital dissection of the retroperitoneal space.

RESULTS

The operations were successfully performed in all patients except for 2, who immediately underwent open conversion. A urinoma caused by ureteral lesion was the only severe complication in this series. The mean operative time of the procedure was 55 min and the hospital stay was 2 or 3 days. No parenteral analgesics were administered postoperatively. At 1 month from operation, 20 patients out of 23 had significant relief of rest pain and improvement of ischemic lesions. After a median follow-up of 36 months, 2 patients had died, 4 underwent some type of distal amputation, 1 had recurrent rest pain and the other 16 reported persistent improvement of pain or dystrophic changes.

CONCLUSIONS

Retro-peritoneoscopic technique appears the modern and less invasive version of the lumbar surgical sympathectomy.

Giant aneurysm of the splenic artery in an elderly man short report and review of the literature

Splenic Artery Aneurysms (SAAs) are usually single and small lesions, and their size rarely exceed 3 cm. In a review of the literature from 1950 to date, only 18 aneurysms defined as "giant" were found in 15 reported papers.

CASE REPORT

A case of an 87-year-old man, successfully treated for a 7 cm wide aneurysm of the splenic artery is reported. Except for his age, the patient did not show any significant association with aneurysm-related diseases and was successfully submitted to en-bloc aneurysmectomy and splenectomy via open surgery.

HIV risk-related behaviors among injection drug users in Rome: differences between 1990 and 1992

Temporal differences in human immunodeficiency virus (HIV) risk-related behaviors among injection drug users in Rome, Italy, were analyzed in 487 drug users recruited in 1990 and 450 recruited in 1992. Sharing of syringes decreased among self-reported HIV-positive drug users between 1990 and 1992, but there was no change in their sexual behavior. Fewer HIV-seronegative drug users reported passing on used syringes in 1992 than in 1990; however, there was no change in the percentage of seronegative subjects using previously used syringes, and a reduction in condom use with primary partners. There still exists a great potential for transmission of HIV infection among injection drug users and from injection drug users to the general population.

[Behavior associated with HIV-1 infection in drug addicts in Rome, 1990-1992]

Two cross-sectional surveys have been conducted in Rome in 1990 and 1992 to investigate prevalence and temporal differences of risk behaviours among drug injectors. A total of 487 drug injectors in 1990, and 450 in 1992 have been interviewed both in the street and in treatment services. Twenty-four percent of the subjects interviewed in 1990 reported having used second-hand syringes in the preceding 6 months, as compared to 14% in 1992; in the two years 29% and 13%, respectively, reported having passed a second-hand syringe to other drug injectors. Fifty-six percent (46% in 1992) of primary partners of drug injectors interviewed were not drug users themselves, while the prevalence of non drug using occasional partners was 34% and 43% in the two surveys. In 1990 condom use with primary partner was reported by 48% of drug injectors, and by 41% in 1992; condom use with occasional partners was 56% and 64% in the two years. The differences in sharing behaviours were observed for HIV-1 positive subjects, while HIV-1 negatives reported the same prevalence of use of second-hand syringes in 1990 and 1992; no statistically significant differences have been found for sexual behaviours among the HIV-1 positives, while the HIV-1 negatives reported a lower prevalence of condom use with primary partner. The observed differences in the two years remain also adjusting for the socio-demographic characteristics of the two populations in a multiple logistic regression model. Prevalence of HIV-1 related risk behaviours among drug injectors is still too high.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis A, B, C and D in a community in Italy of immigrants from NE Africa

A total of 213 subjects from a community in Italy of immigrants from Somalia and other NE African countries were enrolled in this study to evaluate the prevalence of HAV, HBV, HCV and HDV infections and to assess their possible risk factors. Of the subjects, 45 per cent (96) were female and 24 per cent (52) were under 12 years old. The age range was from 1 to 67 years and the mean age was 24 years. Eighty-three per cent (177 subjects) were born in Somalia, 10 per cent (21 subjects) in Ethiopia, and the rest in Djibouti, Egypt or Saudi Arabia. The 213 subjects were administered a questionnaire which covered socio-demographic characteristics and risk factors resulting from Western medical practice, traditional medicine, personal behaviour and living conditions. Blood was drawn from 209 subjects to ascertain the presence of HbsAg, HBeAg, anti-HAV, anti-HBc, anti-HBs, anti-HCV and anti-HDV. The results of this study show an HAV prevalence of 96 per cent (an 87.5 per cent prevalence in children under 12), and an HBV prevalence of 32 per cent (a 3.3 per cent prevalence of HBsAg carriers). No subject under 11 was HBV positive and no woman tested positive for HBeAg, confirming the extreme unlikelihood of vertical transmission of HBV. The prevalence of HBV is closely correlated with age (ranging from 2 per cent in those under 12 to 59 per cent in subjects over 39).(ABSTRACT TRUNCATED AT 250 WORDS)