Laparoscopic drainage of an ovarian haematoma in a Martina Franca jenny (Equus asinus)

An 11-year-old Martina Franca jenny (Equus Asinus), involved in a breed recovery programme organised by the Puglia Region, was referred to the University’s Veterinary Teaching Hospital for a mass formation detected on the surface of the right ovary. The subject had regular oestrous cycles, but gestation loss was reported in the anamnesis. The ovarian mass was monitored by transrectal palpation and ultrasonography. In the differential diagnosis, an ovarian haematoma, a haemorrhagic anovulatory follicle and a granulosa cell tumour were hypothesised; a surgical resolution with laparoscopic access was chosen. During surgery, about 750 ml of haemorrhagic fluid was drained, confirming the suspect of the ovarian haematoma. After resolution, the jenny was inseminated, eventually giving birth to a live and viable foal. Usually, an ovarian haematoma spontaneously regresses, but, in this report, the lesion remained stable for more than two months, leading to the decision of the surgical resolution. Furthermore, to the authors’ knowledge, this lesion has never been reported in donkeys

Immature ovarian teratoma in two heifers

A 15 months-old Simmental heifer (SH) and a 18 months-old Marchigiana heifer (MH) were referred to the Faculty of Veterinary Medicine of Teramo (Italy). In the first heifer, clinical examination of the vulva, vestibulum, and vagina showed no signs of disease and no discharge was detected. Palpation per rectum revealed a mass in the left portion of the abdominal cavity, closely attached to the tip of the left uterine horn. The mass was mainly firm and fibrous and its surface was slightly lobulated. The second heifer had a history of a regular cycle from the 11thto the 14thmonth of age followed by an anoestrus state. Gynecological examination revealed the presence of a large and firm mass in the caudal left region of the abdomen, soon over the edge of the pelvis floor. In both cases, the histologica examination of the mass revealed an immature ovarian teratoma

Prospective study of cetuximab and gemcitabine in combination with radiation therapy: feasibility and efficacy in locally advanced pancreatic head cancer

BACKGROUND: Radio-chemotherapy is one of the steps of multidisciplinary management in locally advanced pancreatic cancer. The Epidermal Growth Factor Receptor (EGFR) plays an important role in the disease pathway. The purpose of this prospective study is to evaluate the feasibility and the efficacy of radiotherapy in combination with gemcitabine and EGFR targeting therapy for patients with locally advanced disease. MATERIALS AND METHODS: From November 2008 through January 2012, 34 patients were included in this study. In all cases an accurate pre-treatment staging including CT scan, Endoscopic Ultra-Sonography (EUS), 18F - fluorodeoxyglucose (18F-FDG) PET-CT and laparoscopy with peritoneal washing was performed. External beam radiation was delivered with a total dose of 50.4 Gy (1.8 Gy per fraction). Patients were treated using 3D- conformal radiotherapy, and the clinical target volume was the primary tumor and involved lymph nodes. Gemcitabine 300 mg/m(2) and Cetuximab were given weekly during radiation therapy. RESULTS: Ten patients (29.4 %) were excluded from the protocol because of the evidence of metastatic disease at the pre-treatment staging. Three patients refused radiochemotherapy. Twenty-one patients completed the therapy protocol. During the combined therapy grade 3–4 toxicities observed were only haematological (leukopenia 47,6 %, trombocytopenia 4.8 %, elevated gamma-GT 23.8 %, elevated alkaline phosphatase 4,8 %). Non-haematological toxicity grade 3–4 was never reported. Post-treatment workup showed partial response in five patients (24 %), stable disease in 11 patients (52 %) and disease progression in 5 patients (24 %). Two-year Local Control was 49 % (median, 18.6 months), 2-year Metastases Free Survival was 24 % (median, 10.8 months). One and two-year Overall Survival were 66 % and 28 % respectively, with a median survival time of 15.3 months. CONCLUSIONS: The combination of cetuximab and gemcitabine with concurrent radiation therapy provides a feasible and well tolerated treatment for locally advanced pancreatic cancer. Patients’ selection is crucial in order to treat patients appropriately

The detection of anti-Trichinella antibodies in free-ranging Nebrodi Regional Park black pigs from Sicily, Italy, suggests the circulation of Trichinella britovi in the island

Abstract • Zoonotic nematodes of the genus Trichinella are known to occur in countries bordering the Mediterranean Sea. For example, Trichinella spiralis was reported in pigs and humans at the turn of the Second World War in Sicily and Trichinella britovi in pigs, red foxes and dogs from Corsica and Sardinia since 2004. Following the discovery of T. britovi in Corsica and Sardinia, a question arose as to whether this species was also present in Sicily which is located only 3.14 km from continental Italy. To address this query, we investigated the presence of anti-Trichinella antibodies in the serum of Nebrodi black pigs, a breed that is bred in the wild in the Nebrodi Regional Park, a protected area of the island rich in flora and fauna. Blood samples were collected from 112 Nebrodi black pigs from five farms. Sera were tested by ELISA and ELISA positive sera were confirmed by Western blot (Wb) using excretory/secretory antigens. Eighteen (16.1%) serum samples belonging to 17 fattening pigs and 1 boar tested positive by Wb. Positive sera tested by Wb using crude worm extract antigens (CWE), displayed a banding pattern similar to the CWE-Wb pattern of T. spiralis and T. britovi reference pig sera but different to that of T. pseudospiralis reference pig sera. No larvae were detected in muscles of serologically positive pigs by artificial digestion. The presence of anti-Trichinella antibodies in the absence of larvae in the muscles, suggests that the pigs were infected with T. britovi and not T. spiralis whose larvae survive in the muscles for at least two years. These results suggest that T. britovi is circulating in Nebrodi Regional Park in Sicily. ELISA testing may constitute a suitable tool for large-scale screening of Trichinella spp. infection in free-ranging pigs, when ELISA-positive sera are confirmed by Wb. Free-ranging animals can act as sentinels for the presence of zoonotic nematodes of the genus Trichinella in wildlife

La percezione degli infermieri della morte del paziente oncologico: uno studio qualitativo

Background: Il tema della morte è uno dei fondamentali problemi con cui gli infermieri si possono confrontare nell’agire professionale ed al quale difficilmente si è profondamente e sinceramente preparati. Le difficoltà nel gestire il carico emotivo possono indurlo a sviluppare sentimenti negativi nei confronti della vita e, nella pratica clinica tali da influenzare le capacità di caregiving e la qualità delle cure fornite.  OBIETTIVO: esplorare le percezioni dell’infermiere di fronte alla morte del paziente degente nei reparti di oncologia.  METODO: Studio qualitativo fenomenologico. Il campione di infermieri è stato reclutato presso un I.R.C.C.S. di Roma, un Hospice di Latina ed uno di Rieti. I dati sono stati raccolti mediante mediante focus group. Le interviste semi-strutturate caratterizzate da tre domande costruite ad hoc, audio-registrate, sono state poi trascritte ed analizzate utilizzando il framework analysis approach.  RISULTATI: sono stati condotti in totale 7 focus group con una partecipazione in totale di 39 infemieri. Dall’analisi qualitativa sono emersi quattro temi: “I diversi significati della morte”, “Lo strappo della morte”, “Le variabili percettive della morte”, “Le richieste di aiuto”.  CONCLUSIONI: Lo studio ha evidenziato la necessità di fornire al personale infermieristico un importante supporto psicologico ed emotivo, e di porre attenzione agli elementi organizzativi-ambientali per una migliore gestione dell’evento morte in oncologia.  PAROLE CHIAVE: Infermiere, fine vita, morte,paziente oncologico, studio qualitativo, cure palliative, psiconcologia BACKGROUND: Death is one of the basic theme with which nurses are faced, and for which it is hard for them to prepare deeply and sincerely.  The difficulties in handling the emotional burden can cause them to develop negative feelings towards life and clinical practice, so that it affects their caregiving capacity and the quality of care provided.  AIM: To explore nurses’ perceptions facing the death of a hospitalized oncology patient.  METHODS: Qualitative phenomenological study. The sample of nurses was recruited at IRCCS (Scientific Institute for Research and Healthcare) in Rome, a hospice in Latina and a hospice in Rieti. The data were collected by means of focus groups. The semi-structured interviews featuring three guiding questions constructed for this purpose, were audio-recorded, transcribed, and then analyzed using the analysis framework approach.  RESULTS: In total 7 focus groups were conducted with a total participation of 39 nurses. Four themes emerged from the qualitative analysis: “The different meanings of death”, “The rupture of death”, “The perceptual variables of death”, and “Requests for help”.  CONCLUSION: The study highlighted the need to provide nurses with substantial psychological and emotional support, and give consideration to organizational and environmental factors for better management of the event of death in oncology.  KEY WORDS: Nurse, end of life, nurses perception, death, oncology patient, qualitative study, palliative care, psycho-oncology&nbsp

Computer-assisted navigation for intramedullary nailing of intertrochanteric femur fractures: a preliminary result

Aim To demonstrate a reduction of risk factors ray-depending in proximal femur nailing of intertrochanteric femur fractures, comparing standard technique with computer-assisted navigation system. Methods One hundred patients hospitalised between October 2021 and June 2022 with intertrochanteric femur fractures type 31-A1 and 31-A2 were prospectively enrolled and divided randomly into two groups. A study group was treated with computer-assisted navigation system ATLAS (Masmec Biomed, Modugno, Bari, Italy) (20 patients), while a control group received the standard nailing technique. The same intertrochanteric nail was implanted by a single senior surgeon, Endovis BA 2 (EBA2, Citieffe, Calderara di Reno, Bologna, Italy). The following data were recorded: the setup time of operating room (STOR; minutes); surgical time (ST; minutes); radiation exposure time (ETIR; seconds) and dose area product (DAP; cGy·cm2). Results Patients underwent femur nailing with computer-assisted navigation system reported more set-up time of operating room (24.87±4.58; p<0.01), less surgical time (26.15±5.80; p<0.01), less time of radiant exposure (4.84±2.07; p<0.01) and lower dose area product (16.26±2.91; p<0.01). Conclusion The preliminary study demonstrated that computerassisted navigation allowed a better surgical technique standardization, significantly reduced exposure to ionizing radiation, including a reduction in surgical time. The ATLAS system could also play a key role in residents improving learning curve

Disability assessment using Google Maps

Objectives To evaluate the concordance between Google Maps  application (GM ) and clinical practice measurements of ambulatory function (e.g., Ambulation Score (AS) and respective Expanded Disability Status Scale (EDSS)) in people with multiple sclerosis (pwMS). Materials and methods This is a cross-sectional multicenter study. AS and EDSS were calculated using GM  and routine clinical methods; the correspondence between the two methods was assessed. A multinomial logistic model is investigated which demographic (age, sex) and clinical features (e.g., disease subtype, fatigue, depression) might have influenced discrepancies between the two methods. Results Two hundred forty-three pwMS were included; discrepancies in AS and in EDDS assessments between GM  and routine clinical methods were found in 81/243 (33.3%) and 74/243 (30.4%) pwMS, respectively. Progressive phenotype (odds ratio [OR] = 2.8; 95% confidence interval [CI] 1.1–7.11, p = 0.03), worse fatigue (OR = 1.03; 95% CI 1.01–1.06, p = 0.01), and more severe depression (OR = 1.1; 95% CI 1.04–1.17, p = 0.002) were associated with discrepancies between GM  and routine clinical scoring. Conclusion GM  could easily be used in a real-life clinical setting to calculate the AS and the related EDSS scores. GM  should be considered for validation in further clinical studies

How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations

How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient population