Hepatocellular carcinoma and synchronous liver metastases from colorectal cancer in cirrhosis: A case report.

A 68-year-old Caucasian man with hepatitis C virus-related cirrhosis was admitted to our Unit in February 2010 for a diagnostic evaluation of three centimetric hypoechoic focal liver lesions detected by regular surveillance ultrasound. The subsequent computer tomography (CT) led to a diagnosis of unifocal hepatocellular carcinoma (HCC) in VI hepatic segment, defined the other two nodules in the VI and VII segment as suspected metastases, and showed a luminal narrowing with marked segmental circumferential thickening of the hepatic flexure of the colon. Colonoscopy detected an ulcerated, bleeding and stricturing lesion at the hepatic flexure, which was subsequently defined as adenocarcinoma with a moderate degree of differentiation at histological examination. Finally, ultrasound-guided liver biopsy of the three focal liver lesions confirmed the diagnosis of HCC for the nodule in the VI segment, and characterized the other two lesions as metastases from colorectal cancer. The patient underwent laparotomic right hemicolectomy with removal of thirty-nine regional lymph nodes (three of them tested positive for metastasis at histological examination), and simultaneous laparotomic radio-frequency ablation of both nodule of HCC and metastases. The option of adjuvant chemotherapy was excluded because of the post-surgical onset of ascites. Abdomen CT and positron emission tomography/CT scans performed after 1, 6 and 12 mo highlighted a complete response to treatments without any radiotracer accumulation. After 18 mo, the patient died due to progressive liver failure. Our experience emphasizes the potential coexistence of two different neoplasms in a cirrhotic liver and the complexity in the proper diagnosis and management of the two tumours

Antimitochondrial antibody -M2 positive autoimmune hepatitis during standard of care for chronic hepatitis C.

The current standard of care (SoC) for chronic hepatitis C, i.e. the combination of a pegylated-interferon (PEG-IFN) with ribavirin (RBV), may activate underlying autoimmune conditions. Particularly, interferon (IFN) has been known to induce or exacerbate autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) in hepatitis C virus patients. We describe a severe, acute-onset antimitochondrial antibody (AMA)-M2 positive AIH appearing during the last weeks of SoC in a woman with chronic hepatitis C and no previous history of autoimmunity, and resolving on protracted steroids. In this context, the relevance of the characterization of the immunoglobulin isotype of portal plasma cells for a more appropriate diagnosis of autoimmune liver diseases can be emphasized

Vaccinations in patients with inflammatory bowel disease.

Treatment of inflammatory bowel disease (IBD) frequently requires administration of immunosuppressive therapies, which increases susceptibility to a number of infectious pathogens. However, many infections can be prevented by correct and appropriate utilization of vaccinations. While several guidelines have been published on vaccination schedules in patients with IBD, vaccination rates remain suboptimal and even lower than those in the general population. This is due to many factors including poor awareness of the importance of vaccines by gastroenterologists and general practitioners as well as potential prejudices of patients regarding the safety and benefits of vaccines. With the aim of increasing awareness about the key role of immunization in the management of patients with IBD, the present review examines the existing literature relating to the main vaccinations and their application in these patients. We also summarize current evidence in order to provide clinicians with an easy source of reference for the principal recommendations for prevention of infectious diseases in patients with IBD. In addition, the recommendations about traveling for IBD patients are briefly explored. Lastly, since it is important for gastroenterologists to be aware of recommendations on vaccination, we recommend implementing educational programs to ensure compliance with current guidelines

La Stima dei Moduli Elastici delle Murature Secondo le Norme Tecniche: il Confronto con la Sperimentazione

Nel presente lavoro viene proposto uno studio sperimentale per la caratterizzazione meccanica di diverse tipologie di muratura. Vengono in particolare valutati i moduli elastici longitudinali e tangenziali che come è noto condizionano la risposta di sistemi murari sotto carichi laterali. I valori sperimentali sono confrontati con quelli stimabili per mezzo dei modelli proposti dalle normative tecniche italiana (DM 14/01/2008) e europea (Eurocodice 6). Lo studio prende spunto dalla questio posta dalla norma americana (MSJC 2008) che, pur proponendo l’uso di tali modelli, riconosce la poca sperimentazione eseguita a supporto della loro validazione. La campagna sperimentale ha incluso prove di compressione sui componenti (malte e blocchi), prove di compressione diagonale e prove di compressione ordinaria (in direzione ortogonale ai letti di malta) su porzioni di muratura. I risultati conseguiti hanno consentito la valutazione diretta dei moduli elastici e successivamente di ottenere le grandezze meccaniche necessarie per l’utilizzo dei succitati modelli normativi

Le musiche audiotattili: intervista a Vincenzo Caporaletti, grande musicologo

Intervista sulla Teoria delle Musiche Audiotattil

Le musiche audiotattili. Intervista a Vincenzo Caporaletti

Intervista a Vincenzo Caporaletti apparsa su L'Espresso e ripubblicat in questo volum

Definition of seismic vulnerability maps for civil protection systems: The case of lampedusa Island

The opportunity to locate and quantify the major criticalities associated to natural catastrophic events on a territory allows to plan adequate strategies and interventions by civil protection bodies involved in local and international emergencies. Seismic risk depends, most of all, on the vulnerability of buildings belonging to the urban areas. For this reason, the definition, by a deep analysis of the territory, of instruments identifying and locating vulnerability, largely favours the activities of institutions appointed to safeguard the safety of citizens. This paper proposes a procedure for the definition of vulnerability maps in terms of vulnerability indexes and critical peak ground accelerations for mid-small urban centres belonging to Mediterranean areas. The procedure, tested on the city centre of the Island of Lampedusa, is based on a preliminary historical investigation of the urban area and of the main formal and technological features of buildings involved. Moreover, the vulnerability of the constructions is evaluated by fast assessment methods (filling of evaluation forms). The vulnerability model, allowing the definition of the fragility curves, is calibrated on the basis of the results of an identification process of prototype buildings, selected to be adequately representative. Their characterizations have been provided using the results of an experimental dynamic investigation to develop high representative numerical model. Critical PGA values have been determined by pushover analyses. The results presented provided an unambiguous representation of the major criticalities with respect to seismic vulnerability and risk, of the city centre of the island, being a suitable tool for planning and handling of emergencies

Asymmetrical lower extremity loading early after ACL reconstruction is a significant predictor of asymmetrical loading at the time of return to sport

OBJECTIVES: The aim of this study was to examine whether asymmetrical lower limb loading early after anterior cruciate ligament reconstruction (1 mo) can predict asymmetrical lower limb loading at the time of return to sport (6 mos) and whether other early predictors as knee joint range of motion or maximal isometric strength affect this relationship. DESIGN: Ground reaction forces were measured during a sit-to-stand task 1 mo after anterior cruciate ligament reconstruction and a vertical countermovement jump 6 mos after anterior cruciate ligament reconstruction in 58 athletes. Other early postoperative measurements were knee joint range of motion (2 wks, 1 mo, and 2 mos after surgery) and maximal isometric strength of the knee extensor and flexor muscles (2 mos after surgery). Linear regression models were developed using side-to-side limb symmetry index (LSI) of countermovement jump as the dependent variable. RESULTS: LSI of sit-to-stand task 1 mo after surgery was a significant independent predictor of LSI of countermovement jump 6 mos after surgery. After accounting for deficits in knee joint range of motion and LSI of maximal isometric strength (ΔR² = 0.35, P < 0.01), LSI of sit-to-stand task predicted LSI of countermovement jump (ΔR² = 0.14 P < 0.01). CONCLUSIONS: Asymmetrical lower extremity loading 1 mo after anterior cruciate ligament reconstruction is an early predictor of asymmetrical lower extremity loading 6 mos after surgery

Steatosis affects the performance of liver stiffness measurement for fibrosis assessment in patients with genotype 1 chronic hepatitis C

BACKGROUND & AIMS: In Chronic Hepatitis C (CHC), the influence of steatosis on liver stiffness measurement (LSM) is still debated. We assessed the impact of steatosis and its ultrasonographical sign - bright liver echo pattern (BLEP) - on LSM values and on transient elastography (TE) accuracy for the diagnosis of liver fibrosis, in a cohort of consecutive patients with Genotype 1 (G1) CHC. METHODS: Patients (n=618) were assessed by clinical, ultrasonographic and histological (Scheuer score) features. TE was performed using the M probe. RESULTS: Male gender (p=0.04), steatosis as continuous variable (p<0.001), severity of necroinflammation (p=0.02) and stage of fibrosis (p<0.001) were associated with LSM by multivariate linear regression analysis. Among patients within the same fibrosis stages (F0-F2 and F3-F4; F0-F3 and F4), mean LSM values, expressed in kPa, were significantly higher in subjects with moderate-severe steatosis (⩾20% at liver biopsy) compared with those without, as well as in patients with BLEP on US compared with their counterpart. In subjects without severe fibrosis (F0-F2) and without cirrhosis (F0-F3), a higher rate of false-positive LSM results was observed in patients with steatosis ⩾20% compared with those without (F0-F2: 35.3% vs. 17.9%; F0-F3: 38.9% vs. 16.6%), and in patients with BLEP on US (F0-F2: 28.0% vs. 18.3%; F0-F3: 29.7% vs. 17.8%) compared with their counterpart. CONCLUSIONS: In patients with G1 CHC, the presence of moderate-severe steatosis, detected by histology or by US, should always be taken into account in order to avoid overestimations of liver fibrosis assessed by TE