Primary breast lymphomas: a multicentric experience

Background: The Primary Breast Lymphomas (PBL) represent 0,38-0,70% of all non-Hodgkin lymphomas (NHL), 1,7-2,2% of all extranodal NHL and only 0,04-0,5% of all breast cancer. Most frequent PBLs are the diffuse large B cell lymphomas; in any case-reports MALT lymphomas lack or are a rare occurrence. Their incidence is growing. From 1880 (first breast resection for "lymphadenoid sarcoma" carried out by Gross) to the recent past the gold standard treatment for such diseases was surgery. At present such role has lost some of its importance, and it is matter of debate. Methods: Twenty-three women affected by PBL underwent surgery. Average age was 63 years (range: 39-83). Seven suffered of hypothyroidism secondary to autoimmune thyroiditis. Fourteen patients underwent mastectomy, nine patients received quadrantectomy (average neoplasm diameter: 1,85 cm, range: 1,1-2,6 cm). In 10 cases axillary dissection was carried out. Pathologic examination revealed 16 diffuse large B cell lymphomas and 7 MALT lymphomas. Results: Seven patients in the mastectomy group had a recurrence (50%), and all of them with diffuse large B cell lymphomas at stage II. Two of these had not received chemotherapy. No patient undergoing quadrantectomy had recurrence. In the mastectomy group disease free survival (DFS) at 5 and 10 years was 57 and 50%. Overall survival (OS) at 5 and 10 years was 71.4% and 57.1% respectively. All recurrences were systemic. DFS and OS at 5 and 10 years was 100% in the quadrantectomy group. In the patients with recurrence mortality was 85.7%. For stage IE DFS and OS at 5 and 10 years were 100%. For stage II DFS at 10 years was 62.5% and 56.2% respectively; OS at 5 and 10 years was 75% and 62.5% respectively. For MALT lymphomas DFS and OS at 5 and 10 years were 100%. For diffuse large B cell lymphomas DFS at 5 and 10 years was 62.5% and 56.2% respectively; OS at 5 and 10 years was 75% and 62,5% respectively. Conclusions: The role of surgery in this disease should be limited to get a definitive diagnosis while for the staging and the treatment CT scan and chemio/radioterapy are repectively mandatory. MALT PBLs have a definitely better prognosis compared to large B cell lymphomas. The surgical treatment must always be oncologically radical (R0); mastectomy must not be carried out as a rule, but only when tissue sparing procedures are not feasible. Axillary dissection must always be performed for staging purposes, so avoiding the risk of under-staging II o IE, due to the possibility of clinically silent axillary node involvement

Recurrent differentiated thyroid cancer: to cut or burn

[No abstract available

Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric italian experience

Post-operatory wound infections are a very uncommon finding after thyroidectomy. For these reasons international guidelines do not routinely recommend systemic antibiotic prophylaxis

Neutralizing antibodies to Omicron after the fourth SARS-CoV-2 mRNA vaccine dose in immunocompromised patients highlight the need of additional boosters

IntroductionImmunocompromised patients have been shown to have an impaired immune response to COVID-19 vaccines.MethodsHere we compared the B-cell, T-cell and neutralizing antibody response to WT and Omicron BA.2 SARS-CoV-2 virus after the fourth dose of mRNA COVID-19 vaccines in patients with hematological malignancies (HM, n=71), solid tumors (ST, n=39) and immune-rheumatological (IR, n=25) diseases. The humoral and T-cell responses to SARS-CoV-2 vaccination were analyzed by quantifying the anti-RBD antibodies, their neutralization activity and the IFN-γ released after spike specific stimulation.ResultsWe show that the T-cell response is similarly boosted by the fourth dose across the different subgroups, while the antibody response is improved only in patients not receiving B-cell targeted therapies, independent on the pathology. However, 9% of patients with anti-RBD antibodies did not have neutralizing antibodies to either virus variants, while an additional 5.7% did not have neutralizing antibodies to Omicron BA.2, making these patients particularly vulnerable to SARS-CoV-2 infection. The increment of neutralizing antibodies was very similar towards Omicron BA.2 and WT virus after the third or fourth dose of vaccine, suggesting that there is no preferential skewing towards either virus variant with the booster dose. The only limited step is the amount of antibodies that are elicited after vaccination, thus increasing the probability of developing neutralizing antibodies to both variants of virus.DiscussionThese data support the recommendation of additional booster doses in frail patients to enhance the development of a B-cell response directed against Omicron and/or to enhance the T-cell response in patients treated with anti-CD20

Progettazione di uno spaziatore interspinoso regolabile

Obiettivo di questo studio è la progettazione di un dispositivo interspinoso regolabile, necessario per alleviare il dolore provocato dalla stenosi lombare. Regolabile perchè attualmente in commercio ci sono esclusivamente spaziatori modulari che non riescono a coprire intervalli fuori dal proprio modulo. Lo studio parte dal brevetto del dottor Ceccarelli, medico ortopedico dell'ospedale S.Zita di Lucca e Humanitas di Milano e dell'ingegner Carani. Per prima cosa è stata determinata, dal confronto con dispositivi presenti in commercio e da dati reperibili in letteratura, una specifica tecnica da rispettare nel progetto. Partendo da questa si è visto che il brevetto così com'era non riusciva a rispettare i requisiti richiesti e quindi si sono cercate delle possibili alternative. Determinata quella più idonea a realizzare il nuovo spaziatore si è passati al suo dimensionamento. Il dimensionamento è avvenuto con l'ausilio del software Ansys ed in particolare sono stati analizzati elementi che hanno portato a definire la geometria. Una volta definita quest'ultima sono state fatte le verifiche di resistenza statica, verifica della rigidezza e resistenza a fatica

Urgency surgical treatment for duodenal GISTs. Analysis of aged patients and review of the literature

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms (85%) of the gastrointestinal (GI) tract; duodenal GISTs constitute 3-5% of all GISTs and represent 10-30% of all malignant tumours of the duodenum. Rarely, patients present severe bowel obstruction, perforation or severe bleeding. The radical resection with complete removal of the tumour remains the main therapeutic approach. We performed a local resection in patients with suspected GIST admitted for emergency treatment for GI bleeding

Intermittent gastric outlet obstruction due to a gallstone migrated through a cholecysto-gastric fistula: A new variant of “Bouveret’s syndrome”

Bouveret’s syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made pre-surgical diagnosis possible in most cases and the death rate has dropped dramatically, “one-stage surgery” (biliary surgery carried out at the same time as the removal of the gut obstruction) should be still considered as the gold standard for the treatment of gallstone ileus.In this case, partial gastric outlet obstruction resulted in an atypical and insidious clinical presentation that allowed us to perform the conventional one-stage laparatomic procedure that completely solved the problem, thus avoiding any further complications

[Air pollution in an urban area nearby the Rome-Ciampino city airport]

OBJECTIVES: to assess air pollution spatial and temporal variability in the urban area nearby the Ciampino International Airport (Rome) and to investigate the airport-related emissions contribute. DESIGN AND SETTING: the study domain was a 64 km2 area around the airport. Two fifteen-day monitoring campaigns (late spring, winter) were carried out. Results were evaluated using several runs outputs of an airport-related sources Lagrangian particle model and a photochemical model (the Flexible Air quality Regional Model, FARM). MAIN OUTCOME MEASURES: both standard and high time resolution air pollutant concentrations measurements: CO, NO, NO2, C6H6, mass and number concentration of several PM fractions. 46 fixed points (spread over the study area) of NO2 and volatile organic compounds concentrations (fifteen days averages); deterministic models outputs. RESULTS: standard time resolution measurements, as well as model outputs, showed the airport contribution to air pollution levels being little compared to the main source in the area (i.e. vehicular traffic). However, using high time resolution measurements, peaks of particles associated with aircraft takeoff (total number concentration and soot mass concentration), and landing (coarse mass concentration) were observed, when the site measurement was downwind to the runway. CONCLUSIONS: the frequently observed transient spikes associated with aircraft movements could lead to a not negligible contribute to ultrafine, soot and coarse particles exposure of people living around the airport. Such contribute and its spatial and temporal variability should be investigated when assessing the airports air quality impact