Vertebral carcinomatosis eleven years after advanced gastric cancer resection: A case report.

Bone metastasis is an uncommon event in advanced gastric cancer patients and bone metastases are rarely detected as isolated lesions. However, eleven years after treatment for locally advanced gastric cancer, including total gastrectomy followed by adjuvant chemotherapy, a 49-year-old female was admitted to the IX Division of General Surgery of the Second University of Naples (Naples, Italy) exhibiting severe progressive neurological symptoms. Magnetic resonance imaging indicated vertebral abnormalities, with evidence of marrow infiltration in several vertebral bodies; however, a contrast-enhanced computed tomography scan did not detect disease progression to other sites. Biopsy of the soft tissue at the level of the second lumbar vertebra (L2) revealed a metastatic lesion derived from gastric mucinous adenocarcinoma. The patient was initially treated with radiotherapy directed to the L2-L4 vertebral bodies to control the pain. Subsequently, systemic chemotherapy according to a FOLFOX-4 (leucovorin, fluorouracil and oxaliplatin) regimen commenced. However, after eight cycles, pulmonary progression of the disease occurred. Thus, palliative care was administered and the patient succumbed one month later. The late relapse of gastric cancer in the current patient may be associated with the theory of tumour dormancy

Organisation of diagnosis and treatment of idiopathic pulmonary fibrosis and other interstitial lung diseases in the Nordic countries

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageDifferences in the organisation of idiopathic pulmonary fibrosis (IPF) and interstitial lung diseases (ILDs) in the Nordic countries are not well described. Diagnostic setups, treatment modalities and follow-up plans may vary due to national, cultural and epidemiological features. The aim of the present study was to describe the different organisation of diagnostics and treatment of IPF and ILD in the Nordic countries. Methods All university and regional hospitals with respiratory physicians were invited to respond to a questionnaire collecting data on the number of physicians, nurses, patients with ILD/IPF, the presence of and adherence to disease-specific national and international guidelines, diagnosis and treatment including ILD-specific palliation and rehabilitation programmes. Results Twenty-four university and 22 regional hospitals returned the questionnaire. ILD and IPF incidence varied between 1.4 and 20/100,000 and 0.4 and 10/100,000, respectively. Denmark and Estonia have official national plans for the organisation of ILD. The majority of patients are managed at the university hospitals. The regional hospitals each manage 46 (5–200) patients with ILD and 10 (0–20) patients with IPF. There are from one to four ILD centres in each country with a median of two ILD specialists employed. Specialised ILD nurses are present in nine hospitals. None of the Nordic countries have national guidelines made by health authorities. The respiratory societies in Sweden, Norway and Denmark have developed national guidelines. All hospitals except two use the ATS/ERS/JRS/ALAT IPF guidelines from 2011. The limited number of ILD specialists, ILD-specialised radiologists and pathologists and the low volume of ILD centres were perceived as bottlenecks for implementation of guidelines. Twenty of the 24 university hospitals have multidisciplinary conferences (MDCs). Pulmonologists and radiologists take part in all MDCs while pathologists only participate at 17 hospitals. Prescription of pirfenidone is performed by all university hospitals except in Estonia. Triple therapy with steroid, azathioprine and N-acetylcysteine is not used. No hospitals have specific palliation programmes for patients with ILD/IPF, but 36 hospitals have the possibility of referring patients for palliative care, mostly based on existing oncology palliative care teams; seven hospitals have rehabilitation programmes for ILD. Conclusion There are obvious differences between the organisations of ILD patients in the Nordic countries. We call for national plans that consider the challenge of cultural and geographical differences and suggest the establishment of national reference centres and satellite collaborative hospitals to enable development of common guidelines for diagnostics, therapy and palliation in this patient group

KARAKTERISTIK IBU HAMIL DI PMB KASIH IBU WONOSARI KABUPATEN GUNUNGKIDUL TAHUN 2019

Latar Belakang : Angka Kematian Ibu (AKI) sebagai salah satu indikator kesehatan ibu. Capaian AKI tahun 2015 masih tinggi yaitu 305 per 100.000 kelahiran hidup karena belum sesuai target yaitu 102 per 100.000 kelahiran hidup. Upaya untuk menurukan AKI yaitu mengoptimalkan pelayanan kesehatan dengan antenatal care. Tujuan : Untuk mengetahui karakteristik ibu hamil di PMB Kasih Ibu Wonosari Kabupaten Gunungkidul tahun 2019. Metode : Penelitian ini adalah penelitian deskriptif dengan desain penelitian observasional, populasi sebanyak 72 ibu hamil dilaksanakan pada 1-20 Februari 2020. Hasil : Hasil penelitian dari 72 ibu hamil berdasarkan tingkat pendidikan 19 orang (26%) berpendidikan dasar, 41 orang (57%) berpendidikan menengah, dan 12 orang (17%). Berdasarkan jenis pekerjaan 40 orang (56%) adalah Ibu Rumah Tangga, 3 orang (4%) bekerja sebagai pedagang, 2 orang (3%) bekerja sebagai buruh, 20 orang (28%) berkerja sebagai karyawan swasta, dan 7 orang (9%) bekerja di sector lainnya. Berdasarkan paritas 34 orang (47%) nulipara, 31 orang (43%) primipara, dan 7 orang (1%) multipara. Berdasarkan umur 59 orang (82%) berumur reproduksi sehat dan 13 orang (18%) berumur reproduksi tidak sehat. Berdasarkan status (K1) 44 orang (61%) (K1) murni dan 28 orang (18%) (K1) akses. Berdasarkan status (K4) 47 orang (65%) (K4) dan 25 orang (35%) tidak (K4). Kesimpulan : Karakteristik ibu hamil mayoritas berpendidikan menegah, berstatus ibu rumah tangga, berparitas nullipara atau kehamilan pertama, berumur reproduksi sehat, berstatus (K1) murni dan berstatus (K4). Kata Kunci : Karakteristik, Ibu hami

Inflammation and oxidative stress caused by nitric oxide synthase uncoupling might lead to left ventricular diastolic and systolic dysfunction in patients with hypertension

Objective: To investigate the role of oxidative stress, inflammation, hypercoagulability and neuroendocrine activation in the transition of hypertensive heart disease to heart failure with preserved ejection fraction (HFPEF). Methods: We performed echocardiography for 112 patients (≥ 60 years old) with normal EF (18 controls and 94 with hypertension), and determined protein carbonylation (PC), and tetrahydrobiopterin (BH4), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), fibrinogen, plasminogen activator inhibitor type-I (PAI-I), von Willebrand factor, chromogranin A (cGA) and B-type natriuretic peptide (BNP) levels from their blood samples. Results: We found that 40% (38/94) of the patients with hypertension (HT) had no diastolic dysfunction (HTDD-), and 60% (56/94) had diastolic dysfunction (HTDD+). Compared to the controls, both patient groups had increased PC and BH4, TNF-α, PAI-I and BNP levels, while the HTDD+ group had elevated cGA and CRP levels. Decreased atrial and longitudinal left ventricular (LV) systolic and diastolic myocardial deformation (strain and strain rate) was demonstrated in both patient groups versus the control. Patients whose LV diastolic function deteriorated during the follow-up had elevated PC and IL-6 level compared to their own baseline values, and to the respective values of patients whose LV diastolic function remained unchanged. Oxidative stress, inflammation, BNP and PAI-I levels inversely correlated with LV systolic, diastolic and atrial function. Conclusions: In patients with HT and normal EF, the most common HFPEF precursor condition, oxidative stress and inflammation may be responsible for LV systolic, diastolic and atrial dysfunction, which are important determinants of the transition of HT to HFPEF

Central Retina Functional Damage in Usher Syndrome Type 2: 22 Years of Focal Macular ERG Analysis in a Patient Population From Central and Southern Italy.

PURPOSE: Recent studies show that patients with Usher syndrome type 2 (USH2) have abnormal cone structure and density in the central retina. This occurs in the presence of normal acuity, opening the quest for additional sensitive functional measures of central cone function in USH. We tested here whether focal macular cone electroretinogram (fERG) could be such a tool. METHODS: This retrospective study of central cone function loss was based on data from 47 patients with USH2 from the Ophthalmology Department of the Policlinico Gemelli/Catholic University in Rome. The analysis focused on the decrease of the fERG, obtained in response to a 41-Hz sinusoidal modulation of a uniform field presented to the central 18\ub0, generated by red light-emitting diodes (LEDs) and superimposed on an equiluminant steady adapting background. fERG decrease was compared with the decrease of best-corrected visual acuity and Goldmann kinetic perimetry V4E field. RESULTS: fERG follow-up data document a severe and precocious loss of central cone function in USH2 patients, preceding losses in other measures of cone function. fERG is already reduced to 40% of control at the beginning of the second decade of life, and by 25 years of age, all USH2 patients have fERGs less than 30% of control values. CONCLUSIONS: fERG represents a sensitive tool to evaluate central cone function in USH2, anticipating the decline of other central cone function measures, such as visual acuity and Goldmann perimetry

Quasifree photoproduction of η\eta mesons off protons and neutrons

Differential and total cross sections for the quasifree reactions $\gamma p\rightarrow\eta p$ and $\gamma n\rightarrow\eta n$ have been determined at the MAMI-C electron accelerator using a liquid deuterium target. Photons were produced via bremsstrahlung from the 1.5 GeV incident electron beam and energy-tagged with the Glasgow photon tagger. Decay photons of the neutral decay modes $\eta\rightarrow 2\gamma$ and $\eta\rightarrow 3\pi^0 \rightarrow 6\gamma$ and coincident recoil nucleons were detected in a combined setup of the Crystal Ball and the TAPS calorimeters. The $\eta$-production cross sections were measured in coincidence with recoil protons, recoil neutrons, and in an inclusive mode without a condition on recoil nucleons, which allowed a check of the internal consistency of the data. The effects from nuclear Fermi motion were removed by a kinematic reconstruction of the final-state invariant mass and possible nuclear effects on the quasifree cross section were investigated by a comparison of free and quasifree proton data. The results, which represent a significant improvement in statistical quality compared to previous measurements, agree with the known neutron-to-proton cross-section ratio in the peak of the $S_{11}(1535)$ resonance and confirm a peak in the neutron cross section, which is absent for the proton, at a center-of-mass energy $W = (1670\pm 5)$ MeV with an intrinsic width of $\Gamma\approx 30$ MeV