Clinical use of contrast-enhanced ultrasound beyond the liver: a focus on renal, splenic, and pancreatic applications

Contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly used, diagnostic imaging modality. In recent years, due to its safety, quickness, and repeatability, several studies have demonstrated the accuracy, specificity, and sensitivity of CEUS. The European Federation of Societies for Ultrasound in Medicine and Biology has recently updated the previous guidelines from 2012 for the use of CEUS in non-hepatic applications. This review deals with the clinical use and applications of CEUS for the evaluation of non-hepatic abdominal organs, focusing on renal, splenic, and pancreatic applications

Ectodermal dysplasia treated with one-step surgical rehabilitation: a case report.

Abstract Ectodermal dysplasia (ED) comprises a large heterogeneous group of inherited disorders that are characterized by primary defects in the skin, hair, nails, eccrine glands and teeth. The most characteristic findings are the reduced number of teeth. All rehabilitative programmes involve proper evaluation of skeletal relationships. Prosthetic-implantological treatment at the end of bony growth can be used. In this article a case of ED treated with Le Fort I for maxillary advancement, femur homografts, implants' insertion and immediate loading is described. In December 2007, a 38-year-old female was referred to the Maxillofacial Department of Galeazzi Hospital (Milan, Italy) who had a diagnosis of ED. Twelve implants were inserted in one-step surgical procedure. No implant was lost and all are stable. The occlusion is stable after 15 months of follow-up. The results indicate that the one-step oral rehabilitation can be performed in adults who are affected by ED. Also, this significantly reduces the time of oral and facial rehabilitation

Validation of decisional balance inventory test in Italian: assessment of motivation in weight loss

The decisional balance inventory (DBI) test is a valuable tool to assess motivation to change; we consider its application in enhancing motivation of losing weight. Our aim is the translation, cultural adaption and validation in Italian of this test originally designed and drafted in English. The questionnaire has been translated according to an English → Italian → Italian → English algorithm with reconciliation of the differences. Pilot study and retests were performed on 47 cases [body mass index (BMI) ≥30 kg/m2] and 15 controls (BMI value between 18.5 and 25 kg/m2). The internal consistency of the Italian version of DBI test, was satisfied (Cronbach α 0.87 on patients); test-retest shows a good concordance in pilot [Lin's concordance correlation coefficient (CCC) 0.79; 95% confidence interval (CI) 0.68-0.90] and in patient sample (Lin's CCC 0.83; 95% CI: 0.67 0.99).Our study demonstrated the trans-cultural adaptation and validation of DBI test in Italian

“Dietoterapia prescrittiva vs intervento educazionale di gruppo in soggetti sovrappeso/obesi al primo episodio di infarto del miocardio acuto: individuazione di nuovi marcatori periferici in prevenzione secondaria”

La prevalenza dell’obesità sta crescendo in modo sostanziale sia nei Paesi sviluppati sia in quelli in via di sviluppo. Negli ultimi anni si è sviluppato un vasto consenso sul fatto che una perdita di peso corporeo del 10% sia in grado di ridurre significativamente le complicanze mediche (quali le patologie cardiovascolari) e i fattori di rischio associati all’eccesso ponderale. Tuttavia, la progressiva diffusione di sovrappeso e obesità e l’assenza di una strategia di trattamento efficace costituiscono un terreno fertile per il proliferare di differenti modelli interventistici. Ad oggi, il programma di intervento più diffuso rimane la “dietoterapia prescrittiva”. La terapia di gruppo (cognitivo-comportamentale) si è dimostrata negli ultimi anni più efficace nel trattamento dell’obesità rispetto all’intervento prescrittivo. Lo studio vuole valutare l'efficacia di un intervento educazionale di gruppo (trattamento B) in un campione di soggetti con diagnosi di sovrappeso e obesità (BMI > 24,9 kg/m2) che sono incorsi in un primo episodio di infarto miocardico acuto (sia STEMI sia NSTEMI), confrontato con l'approccio dietoterapico prescrittivo classico (trattamento A). L’outcome primario dello studio è la riduzione del 5-10% del peso corporeo a 6-12 mesi dall’inizio del trattamento. Gli outcome secondari invece sono i seguenti: l’identificazione in prevenzione secondaria di nuovi biomarcatori periferici con significato prognostico-predittivo, da utilizzare in prevenzione primaria; l’identificazione di un marcatore periferico per il grasso epicardico che correli con lo spessore di EAT. Da Novembre 2013 a Settembre 2015 sono stati arruolati 90 pazienti. I pazienti che avevano dato il loro consenso scritto e che soddisfacevano le caratteristiche di inclusione sono stati randomizzati ad uno dei due trattamenti. Il trattamento educazionale di gruppo si è dimostrato essere più efficace della dietoterapia prescrittiva classica in termini di perdita di peso (in A, Δpeso T1-T6: -2,83%; in B, Δpeso T1-T6: -4,89%; in A, Δpeso T1-T12: +3,50%; in B, Δpeso T1-T12: -6,45%) e di miglioramento della composizione corporea sia nel breve che nel lungo termine. Tale intervento nutrizionale necessità tuttavia di essere perfezionato ulteriormente sulla base del costrutto della CBT, da adeguare alla condizione di cardiopatia ischemica. I risultati relativi allo spessore di EAT mostrano una riduzione dello stesso sia a sei che a 12 mesi per entrambi i trattamenti, con una percentuale di efficacia pressoché raddoppiata per i pazienti sottoposti ad intervento educazionale di gruppo (in A, ΔEAT-TS T1-T6: -5,00%; in B, ΔEAT-TS T1-T6: -18,84%; in A, ΔEAT-TS T1-T12: -11,67%; in B, ΔEAT-TS T1-T6: -30,43%), suggerendo la necessità di approfondire il ruolo del grasso epicardico nell’insorgenza della cardiomiopatia ischemica e del suo potenziale diagnostico e prognostico-predittivo utile in prevenzione primaria. Inoltre, la Serglicina si è dimostrata essere un buon marcatore di correlazione con lo spessore del grasso epicardico (p value T6 = 0,023; p value T12 = 0,002; p value andamento temporale = 0,003), da proporre eventualmente nella routine diagnostica con significato prognostico/predittivo di rischio cardiovascolare obesità viscerale-correlato. I dati ottenuti in merito ai livelli di espressione plasmatica di Chemerina e Greline suggeriscono altresì un ruolo attivo di queste molecole nei processi pro-infiammatori e cardiorigenerativi, rispettivamente. Sarebbe pertanto interessante approfondire il grado di correlazione esistente tra Chemerina e danno tissutale, nonché tra le Greline e il loro potere cardiorigenerativo, al fine di inserire i loro dosaggi nella pratica clinica con significato prognostico/predittivo di rischio cardiovascolare

Effects of a Bioavailable Arabinoxylan-enriched White Bread Flour on Postprandial Glucose Response in Normoglycemic Subjects

The beneficial effects of soluble fibers on carbohydrate metabolism are well documented. In this regard, we tested an arabinoxylan-enriched white bread flour, obtained by a patented process by which the bran extracted from the milling process is enzymatically hydrolyzed in order to separate the soluble fraction fiber from the insoluble fiber. We recruited 24 healthy normoglycemic volunteers [Age 34-61 +/- 12.5 y; Body Mass Index (BMI) 22.1 +/- 2.5 kg/m(2); Waist circumference (WC) 84.43 +/- 8.0 cm; Fat Mass (FM) 22.7 +/- 8.0%] attending the Dietetics Outpatient Clinic of the Internal Medicine Department at IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy. Subjects acutely consumed arabinoxylan-enriched white bread (weight: 100 g) or isoenergetic control breads, in a double-blind crossover study design. Plasma glucose levels were measured just before bread administration and 30 minutes afterwards. The 30-minute peak postprandial glucose concentrations after arabinoxylan-enriched meals were significantly lower than after the control meal (107+/-4.6 mg/dL vs. 121 +/- 5.2 mg/dL; p < 0.05). The here-reported results show how postprandial glucose responses were improved by ingestion of the arabinoxylan-enriched meal. Further studies are needed to clarify whether daily consumption of arabinoxylan-enriched bread will benefit patients with type 2 diabetes mellitus

A rare case of rynopharyngeal melanoma

Primary mucosal melanomas (MM) of the head and neck region constitute 0.5-2% of all malignant melanomas. The rynopharynx is a region that is less often involved by malignant melanomas. Because most of mucosal melanotic lesions are painless in their early stages, the diagnosis is unfortunately often delayed until symptoms resulting from ulceration, growth, and/or bleeding are noted. Here, we document the rare case of a malignant rynopharynx melanoma of a 43 year old woman. Its treatment and the pertinent literature are discussed. No complication was recorded in the post-operative period and no further surgery was performed. The follow up showed no recurrence in the same position and with the same characteristics, even after six years. Mucosal melanomas are aggressive tumours and the prognosis in these patients is poor. Clinicians must use treatment strategies that provide functional benefit, so as to maintain quality of life without excessive toxicity

Lymphoproliferative disease with mixed cryoglobulinemia and hyperviscosity syndrome in an HIV-infected patient: HCV is the only culprit

The availability of direct antiviral agents (DAAs) offers the possibility to treat HCV-infected patients with a high rate of efficacy and a good safety profile. Little is known about the benefit of DAAs on HCV-related hematological diseases and their complications. We describe the case of an HIV/HCV-infected patient with HCV-related chronic lymphoproliferative disease, mixed cryoglobulinemia and hyperviscosity syndrome. Treatment with direct antiviral agents (DAAs) cured HCV infection and its complications, while HCV re-infection caused recrudescence of the associated diseases

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

Introduction: An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here. Methods: Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity. Results: Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids. Conclusions: These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients. Funding: Molteni Farmaceutici, Italy