Rigore metodologico nelle indagini medico legali: un caso dubbio di suicidio da impiccamento

Presentazione al convegno: Attualit\ue0 in medicina legale penalistica 20 ottobre 2017 \u2013 PARM

Dealing with pancreatic metastases from renal cell cancer: the experience of three Italian high-volume pancreatic surgical centres

Purpose: Pancreatic metastases (PM) from renal-cell carcinoma (RCC) are rare, and have a better prognosis when compared to other pancreatic malignancies. A surgical treatment may have a role for improving overall (OS) and disease-free survival (DFS). Materials and methods: Clinical records of patients with PM from RCC observed from November 2000 to February 2019 in three Italian high-volume pancreatic surgical centres were retrieved retrospectively. Clinical-pathological features, surgical management and follow-up (FU) were evaluated. FU closed in December 2019. Results: Thirty-nine patients (21 M/18 F, averaging 65 years) were enrolled. Nephrectomy for primary (23 left/16 right), was performed 73 months (up to 24 years) before detection of PM. PM were multiple in 20 (54%) of cases, mostly (72%) located in the body-tail region. Cross-sectional and functional total body imaging studies (18F-FDG-PET/CT, 68Ga-PET/CT or Octreoscan scintigraphy) were performed. Functional studies resulted positive for a pancreatic lesion in 62% of patients, and notably, 68Ga-PET/CT was positive in all cases. Preoperative diagnosis was correct in 77% of cases. Median tumour size was 3.0 (range 0.7-7.5) cm. Surgery consisted in 33 standard resections (13 distal, 12 total pancreatectomy, 8 pancreatico-duodenectomy), and 6 limited resections (other parenchyma-sparing procedures) . Median operative time was 350 (range 150-720) minutes. Median blood loss was 400 (100-1300) ml. Overall morbidity was 38.5%, including 4 grade B pancreatic fistula and 2 haemorrhage (without reoperation). Operative mortality was 2.6% (1 died from pulmonary embolism). Median hospital stay was 12 (range 6-133) days. Late exocrine insufficiency occurred in 43% and diabetes in 47% of patients. After a median DFS of 30 (range 3-201) months, 19/36 (53%) patients experienced a disease recurrence; only 5 patients had pancreatic relapse. After a median FU of 68 months (up to 17 years), 20 (56%) patients are still alive, 13 of them without evidence of disease. Conclusions: RCC metastases to the pancreas may arise late, up to 24 years after nephrectomy. 68Ga-PET/CT may play a role in the long FU of these patients, detecting PM and extra-pancreatic metastases. Surgical treatment may allow a long DFS (up to 17 years) in more than one third of cases

Comparison of 150 mg nizatidine BID or 300 mg at bedtime, and 150 mg ranitidine BID in the treatment of gastric ulcer--an 8-week randomized, double-blind multicentre study

One hundred and one active gastric ulcer patients concluded an 8-week, randomized, double-blind multicentre study, planned with the aim to compare the effectiveness of a new H2 blocker, nizatidine, with ranitidine. Thirty-three patients received 300 mg nizatidine at bedtime, 34,150 mg nizatidine b.i.d. and 34,150 mg ranitidine b.i.d. The three groups were well matched for the common clinical parameters. After 4 weeks, healing rates were 51.5% (confidence intervals 95%: 34.1-68.9%), 61.8% (41.2-82.4%), 76.5% (51-102%), respectively. At this check point ranitidine showed a significantly better outcome than did 300 mg nizatidine at bedtime (p less than 0.05). After 8 weeks, healing rates were 81.8% (54.1-109.5%), 88.2% (58.7-117.7%) and 88.2% (58.7-117.7%); these differences were not statistically significant. Age, sex, ulcer symptoms, alcohol and cigarette consumption, concomitant treatments, ulcer size and site and length of ulcer history were all found not to influence ulcer healing. Pain relief and antacid consumption were comparable in the three treatment groups. No clinically significant unwanted effects were recorded throughout the study. Nizatidine can, in our opinion, be successfully used in the treatment of active gastric ulcer