Radiotherapy of Orbital and Ocular Adnexa Lymphoma: Literature Review and University of Catania Experience

Orbital and ocular adnexa lymphomas are rare neoplasms confined to the orbital region. The prognosis is generally favorable, with a high proportion of localized disease, indolent clinical course, prolonged disease-free intervals, and low lymphoma-related mortality rate. We report our experience on eleven patients with confirmed histological diagnosis of lymphoma stage IE-IIE, treated between 2010 and 2021 with radiotherapy alone or in association with chemotherapy or immunotherapy. Eight patients were treated with primary radiotherapy only, while three received previous systemic treatments. Six patients were treated with Proton beam therapy (PBT), and five with external beam radiotherapy (EBRT). The five-year local control rate was 98%; only one patient developed an out-of-field recurrence. We also conducted a comprehensive literature review using electronic databases (PubMed, EMBASE, and Cochrane Library). Articles were selected based on their pertinence to treatment of the ocular and adnexal lymphoma focusing on radiotherapy techniques (electron beam radiotherapy, photon beam radiotherapy, or proton beam radiotherapy), treatment total dose, fractionation schedule, early and late radio-induced toxicities, and patient's clinical outcome. Radiotherapy is an effective treatment option for orbital lymphoma, especially as standard treatment in the early stage of orbital lymphoma, with excellent local control rate and low rates of toxicity.

Hypofractionated Radiotherapy in Localized, Low-Intermediate-Risk Prostate Cancer: Current and Future Prospectives

At the time of diagnosis, the vast majority of prostate carcinoma patients have a clinically localized form of the disease, with most of them presenting with low- or intermediate-risk prostate cancer. In this setting, various curative-intent alternatives are available, including surgery, external beam radiotherapy and brachytherapy. Randomized clinical trials have demonstrated that moderate hypofractionated radiotherapy can be considered as a valid alternative strategy for localized prostate cancer. High-dose-rate brachytherapy can be administered according to different schedules. Proton beam radiotherapy represents a promising strategy, but further studies are needed to make it more affordable and accessible. At the moment, new technologies such as MRI-guided radiotherapy remain in early stages, but their potential abilities are very promising.

Beneficial effects of a program of Mindfulness by remote during COVID-19 lockdown

OBJECTIVE

In the emergency context of COVID-19 pandemic and lockdown, mindfulness relaxation techniques can provide a safe and effective strategy to obtain in a reasonably short time some degree of relief from suffering and to guarantee a greater confidence with emotional reactions in the general population.

SUBJECTS AND METHODS

The Mindfulness-Based Stress Reduction program for coping with COVID-19 emergency was designed as an 8-week program during the early phase of lockdown consisting in practice meditation exercises at least once a day guided and structured by certified instructors entered on a free online platform. At the end of the program all participants completed a survey.

RESULTS

A total of 108 surveys were completed (67.6% male; 32.4% female). Despite the difficult moment of lockdown and the fear linked to the pandemic, 61.9% of interviewed subjects declared a state of general well-being from fair to good linked to the practice of mindfulness. Female subjects (p=0.001), married subjects (p=0.05) and people taking pharmacologic therapy demonstrated (p=0.009) significant improvement in daily management of emotions and practical requests during the early phase of the COVID-19 outbreak.

CONCLUSIONS

Mindfulness meditation may be effective in helping people to regulate emotions and to support their mental health during this period of worry and uncertainty.

Adverse reactions following transfusion of blood components, with a focus on some rare reactions: reports to the International Haemovigilance Network Database (ISTARE) in 2012-2016

OBJECTIVES

The International Haemovigilance Network's (IHN) ISTARE database collects surveillance data on all adverse reactions (AR) associated with transfusion of blood and blood components, facilitating the sharing of best practice and benchmarking for improving blood safety and quality. Up to 2012 no publications discussed certain rare AR. The aim of this study is to examine ISTARE data on AR from 2012 to 2016, focusing on hypotensive reactions, post-transfusion purpura (PTP), transfusion-associated graft versus host disease (TA-GvHD), hyperkalemia and hypocalcemia.

MATERIALS AND METHODS

National Haemovigilance Systems (HVS), provided aggregate annual data on AR by type of reaction, severity, imputability to transfusion, and blood component implicated. Twenty-nine HVS provided 104 annual reports covering 107,778,290 blood units issued.

RESULTS

Among AR reported, 25% were serious, including 368 deaths. The 284 transfusion-transmitted infections included 187 bacterial infections, 84 viral and 13 parasitic or fungal; nine deaths resulted. AR related to the respiratory system transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnoea accounted for 8.3% of all AR, 20.1% of serious, and 52.2% of deaths. Of 1634 rare AR, 1565 were hypotensive, 38 PTP, 17 GvHD, 9 hyperkalemia and 5 hypercalcemia. Half were serious and 16 fatalities were recorded (13 hypotensive, 2 GvHD, one PTP). Among 14 countries that reported any hypotensive AR, incidences diverged widely.

CONCLUSIONS

ARs in this group are frequently severe or life-threatening. Hypotensive AR are the most common, but may have been overlooked and counted under allergic and other AR presenting with hypotension. Compliance with the ISBT definition may be suboptimal, thus its real incidence may be higher. Data on GvHD may contribute to clarifying the role of leukodepletion with or without irradiation. ISTARE continues to be a useful surveillance tool for all transfusion AR and provides relevant insights into overlooked and rare AR, thus offering important contributions towards maximising transfusion safety.

Prediction of early left ventricular recovery and adverse remodelling in patients with acute myocardial infarction: the role of non-invasive myocardial work evaluation

Background

Left ventricular recovery (LVR) and adverse left ventricular remodelling (aLVR) after acute myocardial infarction (AMI) play an important prognostic role.

Purpose

Our aim was to evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LVR and aLVR.

Methods

Fifty patients with AMI (mean age, 63,8±13,4 years), treated by percutaneous coronary intervention (PCI), were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 48 hours after PCI and a median of 31 days at follow-up. Myocardial work is derived from the strain-pressure relation, integrating in its calculation the non-invasive arterial pressure. Segmental LVR was defined as an absolute improvement of left ventricular ejection fraction (LVEF) ≥5% from LVEF at the baseline. The aLVR was defined as an increase of ≥20% of the LV end diastolic volume (LVEDV) at 1 month follow up.

Results

We found significant differences between the baseline and the follow-up value of LVEF (49,28 vs 52,80 p=0.001), Global Longitudinal Strain (GLS) (−13,41 vs −18,72, p=0.016), Global Work Index (GWI) (1368,68 vs 1788,08, p<0.0001), Global Work Efficiency (GWE) (86,96 vs 91,36, p=0.001), and Global Constructive Work (GCW) (1619,16 vs 2008,68, p<0.0001). The LVR at 1 month of follow-up was observed in 36% of the population enrolled, whereas aLVR was described in 18% of cases. Using ROC curve analysis, we identified a cut off value of 137 mmHg/% for baseline Global Wasted Work (Sensitivity 100%, Specificity 57,14%, AUC 0.6667, CI 95%: 0,51618- 0,81715, p<0.0001) to identify patients with aLVR at 1 month. With regards to conventional echo parameters, patients with LVR showed lower baseline Wall Motion Score Index (WMSI) than those with LVR (1,73 vs 1,38, p=0.007).

Conclusions

Baseline global wasted work can predict early adverse left ventricular remodelling at 1 months after AMI. These parameters could be used at baseline in order to predict worse outcome in AMI patients. Further larger scale studies are needed to validate these findings.

Funding Acknowledgement

Type of funding sources: None.

Monitoring the haemodynamic response to visual stimulation in glaucoma patients

In this paper, we used time-domain functional near infrared spectroscopy (TD-fNIRS) to evaluate the haemodynamic response function (HRF) in the occipital cortex following visual stimulation in glaucomatous eyes as compared to healthy eyes. A total of 98 subjects were enrolled in the study and clinically classified as healthy subjects, glaucoma patients (primary open-angle glaucoma) and mixed subjects (i.e. with a different classification for the two eyes). After quality check data were used from HRF of 73 healthy and 62 glaucomatous eyes. The amplitudes of the oxygenated and deoxygenated haemoglobin concentrations, together with their latencies with respect to the stimulus onset, were estimated by fitting their time course with a canonical HRF. Statistical analysis showed that the amplitudes of both haemodynamic parameters show a significant association with the pathology and a significant discriminating ability, while no significant result was found for latencies. Overall, our findings together with the ease of use and noninvasiveness of TD-NIRS, make this technique a promising candidate as a supporting tool for a better evaluation of the glaucoma pathology.

Web-mediated counseling to counteract the emotional impact of COVID-19 for women with interstitial cystitis/bladder pain syndrome

OBJECTIVE

Interstitial Cystitis (IC) is a chronic and rare disease, more frequent in women. Symptoms of continuous pain can produce psychological disorders, such as anxiety and depression. The spread of COVID-19 pandemic added to distress experienced by patients with IC emotions, such as fear, sadness, boredom, frustration and anger.

MATERIALS AND METHODS

A research on very recent literature outlines the necessity for patients facing the complexity of IC during the COVID-19 outbreak to prevent the temporary crisis, to broaden perspectives, to deal with confusion, to support in struggling with unpleasant and unexpected events.

CONCLUSIONS

People affected by IC have a psychological vulnerability that needs tailored support interventions, particularly in the COVID era. A multidisciplinary approach offers a personalized treatment through a web-mediated counseling intervention for patients and their caregivers: a space for continuous discussion and reflection can favour a relationship-based process of change aimed at an improvement in quality of life.

Mental health and counseling intervention for hereditary hemorrhagic telangiectasia (HHT) during the COVID-19 pandemic: perspectives from Italy

OBJECTIVE

Hereditary hemorrhagic telangiectasia (HHT) is an inherited disorder of fibrovascular tissue, transmitted as an autosomal dominant trait. This rare disease can involve one or more organs and clinical manifestations interest several medical specialties.

MATERIALS AND METHODS

A review of recent literature and our clinical experience shows that COVID-19 pandemic greatly influences the autonomy and psychic sphere of patients with HHT, causing them further distress.

RESULTS

Often patients affected by HHT experience a sense of loneliness due to the rarity of this pathology and COVID-19 pandemic adds a burden for them and their caregivers who have to face emotional experiences that interfere with personal, social and working functioning.

CONCLUSIONS

Multidisciplinary approach and web-mediated counseling intervention could offer a valid and personalized support for patients affected by HHT and their caregivers during quarantine due to COVID-19 pandemic.

SAT0090 EFFECTS OF ADHERENCE TO MEDITERRANEAN DIET ON RHEUMATOID ARTHRITIS IMPACT OF DISEASE (RAID) SCORE

Background:

Mediterranean diet (MD) is a well-balanced, nutritionally adequate and potentially anti-inflammatory diet that encompasses all food groups. Presently, there are conflicting data about the benefits of MD in rheumatoid arthritis (RA). Not enough evidence support a role of MD in the prevention and treatment of RA, and a modest impact of MD on laboratory parameters has been described. Greater effect on subjective aspects of the disease such as joint pain, morning stiffness, and fatigue was reported.

Objectives:

To investigate whether the adherence to MD affects RA perception as measured by Rheumatoid Arthritis Impact of Disease (RAID) score.

Methods:

Consecutive patients <65 years with RA attending our outpatient clinic were enrolled in this cross-sectional study. For each patient we collected: 1) RAID that consists of 7 single-item domains (pain, functional disability, fatigue, sleep, physical well-being, emotional well-being and coping), each rated by patients on an 11-point numerical rating scale from 0 (best) to 10 (worst) [1], and 2) MD score, a self-reported questionnaire that evaluates the adherence to MD through the consumption of 11 food groups, ranging from 0 (no adherence) to 55 (high adherence) [2]. Univariate analysis was performed using MD score as independent variable. Moreover, to evaluate the adjusted relationship between the single item of RAID and MD score, a multiple regression model was used.

Results:

205 RA patients were enrolled: median age at visit 53 (q1-q3: 44-59) years, female 80.5 %. The median MD and RAID score were 35 (q1-q3: 32-39) and 2.42 (q1-q3: 0.63-4.51) respectively.

RAID total score had a statistically significant negative relationship with MD score (regression coefficient -0.08; p-value=0.016). Concerning the single RAID items, a statistically significant negative association was found for pain (regression coefficient -0.08; p-value=0.025), functional disability (regression coefficient -0.13; p-value<0.001), sleep (regression coefficient -0.08; p-value=0.041), physical well-being (regression coefficient -0.08; p-value=0.027) and coping (regression coefficient -0.11; p-value=0.008).

Multiple regression analysis to evaluate the relationship between significant RAID items and MD score did not show any statistical significance as all items are strongly related to each other.

Conclusion:

To our knowledge, this is the first study addressing the relationship between the adherence to MD and the perception of RA impact. A better MD adherence was associated with lower self-reported composite total RAID score as well as lower pain, functional disability, sleep, physical well-being and coping. The effect of MD adherence on overall RAID is relevant but, at the same time, a prominent effect of one single item on the others could not be documented. This study confirmed the importance of non-pharmacological interventions, such as diet, in RA management.

References:

[1] Gossec L, et al. Ann Rheum Dis 2011;70(6):935-42.

[2] Panagiotakos DB, et al. Nutr Metab Cardiovasc Dis 2006;16(8):559-68.

Disclosure of Interests:

Francesca Ingegnoli: None declared, Isabella Scotti: None declared, Tommaso Schioppo: None declared, Tania Ubiali: None declared, Giuseppe Marano: None declared, Patrizia Boracchi: None declared, Orazio De Lucia: None declared, Antonella Murgo: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB

Socio-emotional ability, temperament and coping strategies associated with different use of Internet in Internet addiction

OBJECTIVE

The aim of the present study was to compare socio-emotional patterns, temperamental traits, and coping strategies, between a group of Internet addiction (IA) patients and a control group.

PATIENTS AND METHODS

Twenty-five IA patients and twenty-six healthy matched subjects were tested on IA, temperament, coping strategies, alexithymia and attachment dimensions. Participants reported their prevalent Internet use (online pornography, social networks, online games).

RESULTS

The IA patients using Internet for gaming online showed a greater attitude to novelty seeking and a lower tendency to use socio-emotional support and self-distraction compared to patients using Internet for social networking. Moreover, they showed a lower level of acceptance than patients using Internet for pornography. In the control group, the participants using Internet for online gaming showed higher levels of IA, emotional impairments and social alienation compared to social-networks and pornography users.

CONCLUSIONS

Findings showed a higher psychological impairment in gaming online users compared to social networking and online pornography users.

The human pegivirus: A new name for an "ancient" virus. Can transfusion medicine come up with something new?

Human pegivirus (HPgV, formerly called GB virus C/hepatitis G virus) is a poorly understood RNA virus of the Flaviviridae family. The HPgV infection is common worldwide and the virus is likely transmitted by blood products. At this time, no causal association between HPgV and human diseases has been identified. While waiting for new findings to better understand the Pegivirus genus, the aim of our narrative review is to discuss the currently available information on HPgV focusing on its prevalence in blood donors and its potential threat to transfusion safety.

Omega-3 fatty acids and schizophrenia: evidences and recommendations

Schizophrenia is a brain disease that represents a not rare condition, in fact the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100. Schizophrenia clinically manifests with acute episodes which are associated with hallucinations, delirium, behavioral disorders and a variable range of chronic persistent symptoms, which can be debilitating. The causes of schizophrenia are not clearly understood. It seems that genetic factors may produce a vulnerability to schizophrenia, along with environmental factors that contribute in a different way from individual to individual. In this context schizophrenia constitutes the outcome of a complex interaction between multiple genes and environmental risk factors, none of which on its own causes the disorder itself. Antipsychotic medications represent the first line of psychiatric treatment for schizophrenia. But there is a growing body of evidence that omega-3 fatty acids can prevent the disease or at least mitigate the course and symptoms. Probably, an appropriate dietary supplementation can play a partially therapeutic effect, even in more severe patients, improving some behavioral aspects and, mainly, reducing the cognitive deterioration. In this context the role of omega-3 fatty acids as a treatment for schizophrenia will strengthen the thrust of researchers and clinicians to the integrated approach to the prevention and cure of a disease that for more than a century challenging researchers.

The complex interplay of Depression, Inflammation and Omega-3: state of the art and progresses in research

Many epidemiological and preclinical studies have proven the potential benefit and critical role of omega-3 PUFAs in the development and management of depressive disorders. Depression may be the consequence of a complex interplay between cell-mediated-immune activation and inflammation evolving in neuroprogression. Associations between n-3 PUFAs, inflammation, oxidative stress and the risk of depression have been demonstrated and clinical and animal supplementation studies have shown the potential of PUFAs to decrease neurodegeneration and inflammation. Future research should focus on the dynamic interactions between the different cell signaling networks and oxidative and nitrosative stress pathways that cause depression.

Patologia del nervo trigemino

Scopo del nostro studio è stato quello di fornire una mappa quanto più possibile dettagliata del nervo trigemino, del suo decorso e della sua patologia. Nel percorso abbiamo preferito utilizzare come riferimento l'anatomia patologica topografica, diffidando dai singoli aspetti clinici, spesso contraddittori e non corrispondenti alla neuropatologia.

Il nervo è stato suddiviso in quattro segmenti anatomici: porzione tronco-encefalica (comprendente nuclei e vie di proiezione), radice pregangliare, ganglio di Gasser e terminazioni periferiche (sensitive e motorie).

Per ognuno di questi segmenti sono stati esaminati gli aspetti patologici su base vascolare (comprendente lesioni ischemiche, emorragiche, malformative ed il cosiddetto ‘conflitto neurovascolare»), infiammatoria (sclerosi multipla), malformativa e neoplastica.

Secondo dati statistici più frequente è l'interessamento delle terminazioni periferiche, seguite dal segmento intracisternale, dai nuclei del tronco encefalico e dal ganglio di Gasser.

Metodica neuroradiologica di scelta si è rivelata essere la risonanza magnetica in virtù del suo maggiore potere di risoluzione in alcuni distretti anatomici rispetto ad altre tecniche digitalizzate, della capacità di fornire immagini multiplanari e della maggiore sensibilità e specificità.

Psychological functioning measures in patients with primary insomnia and sleep state misperception

OBJECTIVE

Sleep state misperception (SSM) is a term used in the International Classification of Sleep Disorders to indicate people who mistakenly perceive their sleep as wakefulness. SSM is a form of primary insomnia. The aim of this study was to record psychological functioning measures (anxiety, depression, ability to feel pleasure, obsessive-compulsive traits) in a population of patients with primary insomnia and to evaluate the relationship between these measures and the patients' perception of their sleep.

MATERIALS AND METHODS

Seventy-six consecutive patients with primary insomnia were enrolled: 34 men and 42 women, mean age 53.9 ± 13.1. Sleep study included the following: Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Berlin's Questionnaire and home-based polysomnography. Psychometric evaluation included the following: Self-Administered Anxiety Scale, Beck's Depression Inventory, Maudsley's Obsessive Compulsive Inventory, Snaith-Hamilton Pleasure Scale, Eating Attitude Test.

RESULTS

All patients with insomnia had psychometric scores higher than the general population, but very few patients, in both groups, had anxiety or depression scores consistent with severe mood or anxiety disorders. Comparisons between subjective and objective scores confirmed that most sleep parameters were underestimated. Patients with SSM had lower anxiety scores as compared to patients without SSM.

CONCLUSIONS

The study did not succeed in identifying any predictor of sleep misperception. We speculate that a group of patients, rather than being extremely worried by their insomnia, may have a sort of agnosia of their sleep.

Functional neuroimaging: points of intersection between biology and psychotherapy

OBJECTIVES

In the evaluation of the biological basis of psychotherapeutic changes many researches have noticed potential effects of psychotherapeutic interventions on the neural correlates of mental illness. In a psychotherapeutic setting, modifications in individual thoughts and feelings can restore brain functioning at physiological levels. This paper gives an overview about neurobiological methods and their potential to support psychotherapy research and to examine psychotherapy effects across a number of psychiatric disorders.

METHODS

Relevant informations are identified through searches of MEDLINE and Current Contents/Clinical Medicine.

RESULTS

Studies demonstrate that it is important to consider putative neural mechanisms of psychotherapy, changes in the brain associated with psychotherapy on a global and molecular level, intervention-specific effects and prediction of outcome. Pharmacotherapy and psychotherapy converge in a common change of neuronal functions that might be detected by imaging techniques and might resemble correlates of clinical improvement.

CONCLUSIONS

Neuroimaging techniques applied to psychotherapy research are relevant for further understanding neurobiological underpinnings of psychotherapy processes and predicting treatment outcome in order to improve clinical decision-making and treatment.

Treatment of prurigo nodularis with pregabalin

WHAT IS KNOWN AND OBJECTIVE

Prurigo nodularis (PN) is a chronic skin condition that is difficult to treat. Pregabalin is one of the possible treatments for PN but its safety and efficacy are not well defined. We aimed to assess the efficacy of pregabalin in patients with PN.

METHODS

Thirty patients (10 men, 20 women; mean age 51.6 ± 9.39 years) were treated with pregabalin (75 mg/day) for 3 months. Efficacy was classified as (i) successful (disappearance of the pruritus and reduction of nodules); (ii) slight improvement/reduction of the nodules, that is, number and/or flattening, no disappearance of itching; or (iii) unsuccessful.

RESULTS

Twenty-three patients (76%) responded successfully after 3 months of treatment. There was a statistically significant difference between visual analogue scale scores before and after 1 month treatment period (8·15 ± 2·04 and 1·5 ± 1·12, respectively; P < 0·0001). Pregabalin was generally well tolerated with only six (20%) patients reporting side effects. No patient showed any renal insufficiency.

WHAT IS NEW AND CONCLUSION

In our study, pregabalin was effective for the treatment of PN. However, given the open and non-controlled study design used, a properly powered randomized controlled validation study is called for.

[Relations of the competent physician, the dependent or independent professional and the S.S.N]

The specialist who is appointed by an employer as a competent physician in an occupational medicine service, has been charged of new public legal tasks, as a result of the changes introduced by Legislative Decree No. 81/08, setting him in a direct relationship with the National Health Service; in particular the Article 40 of decree 81 assigns a strategic role for prevention of new occupational diseases and injuries to the competent physician, as a primary source of epidemiological information, able to bring out "sentinel events" in the population of workers undergoing health surveillance, by the communication to the relevant public health services of combined aggregate data as required by Annex 3B. In a second step such information shall be processed and analyzed on a national scale by Italian Workers'Compensation Authority (INAIL), in order to improve the knowledge useful to a more effective and prompt prevention. The new possibility, introduced by Legislative Decree 106/09, to carry out pre-employment visits as a part of health surveillance, allows the competent physician to establish the fitness to the work of involved persons, a task that was previously assigned by law 300/70 to public bodies only, allowing him to check for alcohol and drug addiction at such stage too, provided the involvement of public health facilities of II level (referred to State/Regions Agreement of September 18, 2008) for relevant clinical examinations for verification purposes.

P4-12-14: Pilot Study Utilizing Fluorine-18 Fluorodeoxyglucose (F-18 FDG) Positron Emission Tomography–Computed Tomography Scan (PET-CT Scan) To Investigate Brain Metabolic Changes during Treatment in Women with Breast Cancer

BACKGROUND: Approximately 25% of the patients undergoing chemotherapy develop cognitive changes. Similarly, significant neurocognitive changes in verbal memory and executive functioning have been reported in patients undergoing endocrine therapy. Though extensively studied, specific changes in the brain associated with cognitive dysfunction are still not clear. We performed an IRB-approved retrospective pilot study utilizing brain images from standard PET-CT scans in patients being treated for breast cancer. Comparison was made between patients initial and follow-up scans to look for metabolic changes.

MATERIALS AND METHODS: Thirty nine patients with a diagnosis of breast cancer were identified from radiology database of West Virginia University Hospitals, who underwent at least two PET-CT scans during their treatment for breast cancer from 2004–2009. Patients with brain metastasis were excluded. NeuroMIM® software analysis program was used to compare a comprehensive database of physiologic brain anatomy and metabolism with F-18 FDG perfusion brain images from the patients. Comparison was made in sixty-three defined brain regions. For each patient, two scans at approximately twelve month intervals were analyzed. The data sets from initial scans were compared with the follow up.

RESULTS: A total of 37 patients received cytotoxic chemotherapy, 2 patients received only endocrine therapy. Data analysis using the signed-rank test shows that the collective Z-score values change between the initial and follow up scans. When data analysis is applied to the individual brain regions, the Lingual Gyrus (p=0.012) and the Angular Gyrus (p=0.056)show statistically significant and near significant decreases in brain metabolism respectively. These regions are attributed with language, mathematics and cognition. Several additional regions such as the fusiform gyrus and the primary visual cortex show p-values between 0.05 and 0.10, which indicate “trending”. These regions may demonstrate statistically significant decrease in metabolism if the sample size is increased.

DISCUSSION: The Lingual and the Angular Gyrus show a statistically significant and near significant decrease in glucose metabolism respectively, in patients receiving treatment for breast cancer. Limitations of this study include lack of baseline brain imaging and its clinical correlation with cognitive function. Based upon these preliminary findings prospective studies are being planned.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-14.

[Diagnosis of deficit and attention/hyperactivity disorders (ADHD) in patients with bipolar or unipolar depression: an experimental study]

INTRODUCTION

The present research study starts up from the current scientific and academic interest concerning Deficit and Attention/Hyperactivity Disorders, which in this period seems to have an "epidemic" diffusion. Some authors have proved how the Deficit and Attention/Hyperactivity Disorder may predispose to the development of other psychopathological attitude in adulthood. A recent study has underlined a common comorbidity between ADHD in childhood and Bipolar Disorder. The aim of the present was to verify the existence of an ADHD diagnosis in patients with depression (Unipolar and Bipolar) and to verify if such syndrome overstays in the present psychopathological picture. Moreover there has been even the intention to investigate on a difference in ADHD symptomatology in patients with Bipolar and Unipolar Depression.

MATERIALS AND METHODS

The study has been conducted on a sample of 67 patients with depression diagnosis (35 patients with bipolar depression diagnosis, 32 patients with depression unipolar diagnosis) enrolled at the Bipolar Disorders Unit of the Clinical Psychiatry and Drug Dependence Institute of the Policlinico Universitario A. Gemelli in Rome. The evaluation has been performed through the supply of the following psychometric tests: Neo Personality Inventory (Mole-pi-R), Brown Attention Deficit Disorder Scale (Brown ADD-Scale), Adult ADHD Self-Report Staircases (ASRS-v1.1), Criteria of the Deficit and Attention / Hyperactivity Disorder for childhood according to the DSM-IV-Tr.

RESULTS

The achieved results point out that 42% of the sample has satisfied the ADHD Criterions during their childhood according to the DSM-IV-Tr and that symptomatology seems to remain in the present psychopathological picture. As to polarity of depression it has emerged that patients with Bipolar Depression diagnosis have satisfied with a greater frequency the ADHD criteria during their childhood than patients with Unipolar Depression.

CONCLUSIONS

Our results seem to confirm the hypothesis that patients with bipolar depression diagnosis have more Deficit and Attention / Hyperactivity Disorders comorbidity diagnosis than others.

Role of PET/CT scanning in detecting asymptomatic brain metastases in non-small cell lung cancer

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Background: Up to one-third of non-small cell lung cancer (NSCLC) patients are diagnosed with brain metastasis. Our study aims to evaluate the role of whole body and brain FDG-PET/CT in detecting asymptomatic brain metastasis in this population. Methods: We performed a retrospective chart review of 282 consecutive non-small cell lung cancer patients between February of 2005 and June of 2008. 60 patients with brain metastasis were identified. Information regarding tumor histology and presence of neurological symptoms at the time of discovery of brain metastasis was collected. In addition, data was acquired from brain MRI and PET/CT (with IV contrast) reports including: study date, findings and any change in staging secondary to the study. Results: The median age was 63 years (47 % women). 39 (65%) of the patients had neurological symptoms at the time of discovery of brain metastasis. PET/CT scan with IV contrast was performed in 53 patients with brain metastasis. For patients who had a PET/CT scan, the histological types were: adenocarcinoma (58.4%), unclassified (22.6%), squamous (13.2%), large cell (3.8%) and other (1.8%). PET/CT scan had a sensitivity of 97.8% in detecting CNS metastasis seen on brain MRI. 19/53 patients were found to have asymptomatic brain metastasis on PET/CT scan (2 stage I, 1 stage II, 2 stage III and 13 stage IV). Overall, PET/CT scan resulted in upstaging of 5 asymptomatic and 6 symptomatic patients or 11/53 (20.7%). Conclusions: PET/CT scan with IV contrast has a high sensitivity in detecting brain metastasis in patients with NSCLC when compared to brain MRI. It is effective in detecting asymptomatic brain metastasis in this population. Those patients, who initially were thought to have non-metastatic disease, are spared inappropriate aggressive surgery or radiation.

No significant financial relationships to disclose.

Impact of FDG-PET scan on follow-up care in nonmetastatic breast cancer

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Background: Fluorine-18-FDG positron emission tomography (FDG-PET) role in the follow up care of non-metastatic breast cancer is not defined. Methods: We retrospectively analyzed 177 patients with stage I-III breast cancer between November 2004 and June 2006. IRB approval was obtained for this study. Patients were divided into two groups. Group A consisted of patients who had one or more FDG-PET scans as part of their clinical follow up (N=68), and Group B consisted of patients who did not (N=109). Clinical, radiological and pathology data were obtained from patients’ records. Results: Median follow-up is 35 months. Mean age 53 years for group A and 57 years for group B. Group A patients were more likely to have had higher stages (29% stage I, 53% stage II, and 18% stage III) compared with group B (64 % stage I, 31% stage II and 4% stage III). The two groups did not differ significantly in ER+ status (69% vs. 78% p=0.21), or Her2neu status (19% vs. 17%; p=0.6). Group A patients had more clinic visits (18 vs. 11; p=0.009), their tumor marker was checked more often (13 vs. 9 times; p=0.0001), had more radiological studies (10 studies vs. 5; p=0.0001), and had more biopsies (0.88 vs. 0.48 biopsy per patient; p=0.05). These differences were significant even after controlling for stage and chemotherapy. 9/68 patients in group A had tumor recurrence compared to 1/109 in group B (p=0.0003). PET scan indications were as follows: 29 (43%) for asymptomatic follow up evaluation [2 recurred]; 18 (26%) concerning symptoms [0 recurred]; 10 (15%) elevated tumor marker [2 recurred]; 7 (10%) other abnormal imaging studies [1 recurred]; 4 (6%) metastatic workup. Conclusions: While FDG-PET might aid in detecting recurrence in some patients with non-metastatic breast cancer, its use was associated with more clinic visits, blood tests, biopsies, and radiological tests.

No significant financial relationships to disclose.

Subthreshold Manifestations of Bipolar Disorders as Health Care’s tool

Introdution:

Our study represents a pilot evaluation about how the MOOD-SR recognizes subthreshold manifestations that may be associated with clinical symptomatology in a group of bipolar patients.

Methods:

At Day Hospital of Psychiatry, Policlinico “A. Gemelli”, Bipolar Disorders Unit, it has been conducted an experimental study on a heterogeneous sample of 24 patients with a diagnosis of Bipolar Disorder type I. Patients have been assessed with the MOOD-SR, a clinical self-reported interview, that is specific for the spectrum of subthreshold pathology, and with the Quality of Life (QoL), that investigates the patient's quality of life.

Results:

We have found that 16 patients on 24 report a score higher than 60 (68,4%). Among these, 10 female patients on 15 have a total score higer than 61 (68.75%) while 6 male patients on 9 obtain a total score higher than 60 (62,5%). However, these results have only preliminary value, further studies are needed in order to obtain a deeper evaluation.

Conclusion:

Spectrum manifestations are both indicator of course and response to treatment and predictive for relapse. This finding may represent an important preventive instrument for maniacal relapse in patients with Bipolar Disorder, that is often underdiagnosed or confused for Unipolar Depression. By adequately recognizing the problem we will be able to refine diagnosis and individualize therapy.

Real-time contrast-enhanced ultrasound--a new simple tool for detection of peritoneal-pleural communications in hepatic hydrothorax

PURPOSE

Hepatic hydrothorax is defined as the accumulation of pleural effusion in a cirrhotic patient in the absence of pulmonary or cardiac disease. Peritoneal fluid can pass into the pleural space through diaphragmatic fenestrations. The demonstration of such passage is important to establish the diagnosis of hepatic hydrothorax and can be achieved by intraperitoneal injection of nuclear contrast agents. Our aim was to evaluate the ability of contrast enhanced ultrasound in the detection of peritoneal-pleural communications.

MATERIALS AND METHODS

Seven patients with cirrhotic ascites and pleural effusion were studied in order to make a diagnosis of hepatic hydrothorax. SonoVue was injected into the peritoneal cavity (9.8 mL), and the peritoneal and pleural cavities were monitored by ultrasound. All patients were then studied using a nuclear scan.

RESULTS

Passage of SonoVue from the peritoneal to the pleural cavities was seen in 5 patients. In 2 patients, no passage of contrast agent was detectable. Nuclear scan was consistent with contrast enhanced ultrasound in all patients.

CONCLUSION

This study shows that the presence of peritoneal-pleural communications can be demonstrated by real time contrast enhanced ultrasound, whose results are comparable to those of nuclear scan. Contrast enhanced ultrasound is cheaper and could theoretically be performed wherever ultrasound facilities are available.

Propranolol causes a paradoxical enhancement of cardiomyocyte foetal gene response to hypertrophic stimuli

BACKGROUND AND PURPOSE

Pathological cardiac hypertrophy is associated with the expression of a gene profile reminiscent of foetal development. The non selective beta-adrenoceptor antagonist propranolol is able to blunt cardiomyocyte hypertrophic response in pressure-overloaded hearts. It remains to be determined whether propranolol also attenuates the expression of hypertrophy-associated foetal genes.

EXPERIMENTAL APPROACH

To address this question, the foetal gene programme, of which atrial natriuretic peptide (ANP), the beta-isoform of myosin heavy chain (beta-MHC), and the alpha-skeletal muscle isoform of actin (skACT) are classical members, was induced by thoracic aortic coarctation (TAC) in C57BL/6 mice, or by phenylephrine, a selective alpha(1)-adrenoceptor agonist, in cultured rat neonatal cardiomyocytes.

KEY RESULTS

In TAC mice, the left ventricular weight-to-body weight (LVW/BW) ratio increased by 35% after 2 weeks. Levels of ANP, beta-MHC and skACT mRNA in the left ventricles increased 2.2-fold, 2.0-fold and 12.1-fold, respectively, whereas alpha-MHC and SERCA mRNA levels decreased by approximately 50%. Although propranolol blunted cardiomyocyte growth, with approximately an 11% increase in the LVW/BW ratio, it enhanced the expression of ANP, beta-MHC and skACT genes (10.5-fold, 27.7-fold and 22.7-fold, respectively). Propranolol also enhanced phenylephrine-stimulated ANP and beta-MHC gene expression in cultured cardiomyocytes. Similar results were obtained with metoprolol, a selective beta(1)-adrenoceptor antagonist, but not with ICI 118551, a beta(2)-adrenoceptor antagonist.

CONCLUSIONS AND IMPLICATIONS

Propranolol enhances expression of the hypertrophy-associated foetal genes mainly via the beta(1)-adrenoceptor blockade. Our results also suggest that, in pressure-overloaded hearts, cardiomyocyte growth and foetal gene expression occur as independent processes.

Correlation among [18-F] FDG-PET/CT, tumor marker CA 27.29, and circulating tumor cells in metastatic breast cancer

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Background: Both tumor marker CA 27.29 and combined [18-F]-fluorodeoxyglucose-positron emission tomography/computed tomography scan (PET/CT) are used to follow up response to treatment and disease progression in patients with metastatic breast cancer (MBC). Recently, circulating tumor cell testing (CTC) has been used in this context. It is not known if one of the three tests can be a surrogate for the other 2 tests. Methods: We analyzed the database of 35 patients with MBC. There were 173 time points (at least 6 weeks apart), when at least 2 of these tests were done. CA 27.29 test (chemiluminescent immunoassay by Bayer Advia Centaur) was either high or normal (< 38.6 U/ml). Circulating tumor cells cell test (Cell Search by Quest Diagnostics, Nichols Institute, Chantilly, VA) was either high or normal (0 cells detected). Results: PET/CT scan results were compared to CA 27.29 at 163 time points. There was statistically significant correlation between both groups (P value: 0.02), however, sensitivity of CA 27.29 to detect metastatic disease seen in PET/CT scan was 59%. The positive predictive value (PPV) of CA 27.29 was 90%, while the negative predictive value (NPV) was only 24%. PET/CT scan results were compared to CTC at 100 events, where there was statistically significant correlation between both groups (P value: 0.0002), however, sensitivity of CTC to detect metastatic disease shown in PET/CT scan was 55%. The positive predictive value of CTC was 98% while the negative predictive value was only 33%. CTC test was more specific (94% Vs 67%) than CA 27.29 to rule out metastatic disease that is seen in PET/CT scan. CA 27.29 results were also compared to CTC at 93 events, where there was statistically significant correlation between both groups (P value: 0.0002). However, only 64 % of those with high CA 27.29 had abnormal CTC. Conclusion: Our data shows correlation among PET/CT scan, CA 27.29, and CTC. However, both CA 27.29 and CTC had poor sensitivity and negative predictive value to detect metastatic disease seen in PET/CT scan. Normal CA 27.29 test or CTC has to be interpreted cautiously in patients with MBC.

No significant financial relationships to disclose.

Validating the Body Uneasiness Test (BUT) in obese patients

OBJECTIVE

To investigate the psychometric properties of the Body Uneasiness Test (BUT) in a large sample of subjects with obesity seeking treatment. BUT is a 71-item self-report questionnaire in two parts: BUT-A which measures weight phobia, body image concerns, avoidance, compulsive self-monitoring, detachment and estrangement feelings towards one's own body (depersonalization); and BUT-B, which looks at specific worries about particular body parts or functions.

METHODS

We recruited a clinical sample of 1,812 adult subjects (age range 18-65 years, females 1,411, males 401) with obesity (Body Mass Index, BMI > or = 30 kg/m2) and a normal weight (BMI value between 18.5 and 25 kg/m2) non-clinical sample of 457 adult subjects (females 248, males 209) with an Eating Attitudes Test-26 (EAT-26) score under the cut-off point 20 (scores > or = 20 indicate possible cases of eating disorders).

RESULTS

The exploratory and confirmatory analyses confirmed a structural five-factor model for BUT-A and an eight-factor model for BUT-B. Internal consistency was satisfactory. Concurrent validity with Binge Eating Scale (BES) and Three-Factor Eating Questionnaire (TFEQ) was evaluated. The authors calculated mean values for BUT scores in adult (18-65 years) patients with obesity, and evaluated the influence of gender, age and BMI. Females obtained statistically significant higher scores than males in all age groups and in all classes of obesity; patients with obesity, compared with normal weight subjects, generally obtained statistically significant higher scores, but few differences could be attributed to the influence of BMI.

CONCLUSION

The BUT can be a valuable multidimensional tool for the clinical assessment of body uneasiness in obesity; the scores of its sub-scales do not show a linear correlation with BMI values.

The Body Uneasiness Test (BUT): development and validation of a new body image assessment scale

OBJECTIVE

To investigate the psychometric properties of the Body Uneasiness Test (BUT), a 71-item self-report questionnaire that consists of two parts: BUT*A which measures weight phobia, body image concerns, avoidance, compulsive self-monitoring, detachment and estrangement feelings towards one's own body (depersonalization); and BUT*B which looks at specific worries about particular body parts or functions.

METHODS

We recruited a clinical sample of 531 subjects (491 females) suffering from eating disorders and a general population sample of 3273 subjects (2016 females) with BMI <25 and Eating Attitudes Test-26 scores under the cut-off 20.

RESULTS

The exploratory and confirmatory analyses confirmed a structural five-factor model for BUT*A and an eight-factor model for BUT*B. Internal consistency was satisfactory. The test-retest correlation coefficients were highly significant. Concurrent validity with other tests (Eating Disorder Inventory, EDI-2; Eating Attitudes Test, EAT-26; Symptom Check List, SCL-90R and Coopersmith Self-Esteem Inventory, SEI) was evaluated. Normative values for BUT scores in non-clinical samples of normal-weight non eating disordered subjects, from adolescence to old age, males and females, were calculated. The differences between males and females were highly significant, above all in the 18-39-age range. As for the comparison between women with eating disorders and controls, the results demonstrated a good predictive validity for anorexia nervosa and bulimia nervosa.

CONCLUSIONS

The BUT is psychometrically sound. It can be a valuable tool for the screening and the clinical assessment of abnormal body image attitudes and eating disorders.

Focal nodular hyperplasia after busulfan treatment

The case of a 48-year-old woman in whom focal nodular hyperplasia of the liver developed after busulfan therapy was administered for essential thrombocytosis is described. Focal nodular hyperplasia is a reactive disorder related to a circulation disorder. The close temporal relation between the haematological disease, busulfan treatment and the appearance of hyperplastic diseases of the liver in our patient supports the possibility that the association of the events might not be casual.

Gingival overgrowth with calcium-channel blockers. Treatment options

Gingival overgrowth induced by calcium channel blockers can cause significant disfigurement and functional difficulty since it interferes with eating and speech, prevents effective plaque control, and disturbs occlusal relationships. It occurs more in young and male patients. The aim of this paper is to study the physiopathology of gingival overgrowth induced by calcium channel blockers and propose different choices of treatment.

Acaricidal properties of the essential oil of Melaleuca alternifolia Cheel (tea tree oil) against nymphs of Ixodes ricinus

The aim of the study was to examine the acaricidal effect of essential oil of Melaleuca alternifolia (tea tree oil, TTO) at different doses (4, 6, 8 and 10 microl) and for different exposure times (30, 60, 90 and 120 min) on nymphs of Ixodes ricinus. A dose of 8 microl TTO was lethal for more than 70% of ticks when inhaled and this effect was enhanced when the dose was increased to 10 microl (> 80%). The effect was correlated with the duration of exposure of ticks to TTO, with a significant effect being observed after 90 min exposure. The findings show that TTO has acaricidal properties and could be extremely useful in controlling ticks that are efficient vectors of pathogens.