AB0611 STRAIN ANALYSIS OF THE RIGHT VENTRICLE USING 2D-SPECKLE TRACKING ECHOCARDIOGRAPHY IN A COHORT OF PATIENTS WITH SYSTEMIC SCLEROSIS

Background: Systemic Sclerosis (SSc) is a rare and life-threatening connective tissue disease with multiple organ impairment. Cardio-pulmonary involvement is common: pulmonary fibrosis, pulmonary hypertension (PH), and electrical disorders are the most serious complications and causes of increased mortality. Objectives: We evaluated features related with the onset and development of PH in a cohort of SSc patients. We further studied ecocardiographic abnormalities, by means of 2D-speckle tracking echocardiography (STE) with specific reference to the right ventricular strain measure (RV-strain). Methods: We analyzed data from 50 SSc patients (pts) referred to our University-based Rheumatology Centre and SSc Unit from January 2007 to June 2019 (F/M 45/5; lc/dcSSc 45/5; mean age 59.20±14.357 years; mean disease duration 12.08±8.75 years). All pts underwent general and cardio-pulmonary

Pathology of Sentinel Lymph Nodes for Merkel Cell Carcinoma

Background: In the present work, we evaluated the possibility of introducing ultrasonographic (US) examination in association to fine needle aspiration cytology (FNAC) before sentinel lymph node biopsy (SLNB) as a useful diagnostic tool in the pre-surgical management of patients with MCC and we also assessed the negative predictive value and false negative rate of combined cytological (US+FNAC) and histological (SLNB) procedure compared to the literature values obtained from different SLNB procedures. Design: US examination was performed in 53 patients with diagnosed MCC and in 11 patients it was followed by FNAC of US suspicious lymph node. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry with a combination of anti-cytokeratin antibodies (CK 20, CAM 5.2). Results: All FNAC were informative (10 LNs were positive for metastases, 1 was negative). Of all others 42 MCC cases, with nonsuspicious lymph nodes on US, in which no FNAC examination was performed, 6 carcinomas (14.3%) turned out to be lymph node positive on histological examination. One of the 11 (9.1%) negative cytological diagnoses was false negatives since lymph node metastasis of 5 mm of diameter was found by SLNB on histology. Based on these data, US+FNAC are endowed withhigh sensitivity and accuracy (both of 90.9%) and absolute specifi city (100%) and we suggest that US examination should be performed in all patients with MCC adding immunocytochemistry-supported FNAC only on US-suspect lymph node. Besides, the negative predictive value for our combined cytological and histological procedure was 94.7% (36/38) and the false negative rates in our series was 10.5% (2/19). Conclusions: The present preoperative protocol (US+FNAC and SLNB) is reliable for screening patients with lymph node metastases, thus avoiding sentinel lymph node biopsy in 18% (10/53) of MCC cases

Nursing home staff members’ knowledge, experience and attitudes regarding advance care planning: a cross-sectional study involving 12 Italian nursing homes

Background: Advance care planning may be beneficial for nursing home residents, but its implementation is suboptimal in several countries. Aims: To investigate knowledge of, attitudes towards, and experience with advance care planning of nursing home staff members in Italy. Methods: Cross-sectional survey involving all healthcare professionals working in 12 Italian nursing homes. Statistical analyses investigated interactions between participants’ characteristics, knowledge, attitudes and frequency of advance care planning discussion with residents. Results: Of the 185 participants (80.5% female, mean age 43.6 ± 9.2 years), 29.7% reported that they had heard of advance care planning, but their actual knowledge was suboptimal. Participants had positive attitudes towards advance care planning, and most of them clearly recognized its benefits. Apprehension about upsetting the patient or their family, or that patients were not ready for these conversations were the main concerns. Only 16% of respondents discussed advance care planning at least sometimes, usually upon patient/family input. Greater knowledge was significantly correlated with more positive attitudes towards advance care planning. The issues of healthcare professionals’ knowledge and training in advance care planning, and of knowledge and awareness of advance care planning in patients, their families, and the general population were considered either main barriers or facilitators. Discussion: Nursing home staff members’ concerns towards advance care planning seemed to be related to a misconception about patient and family willingness to discuss it. Conclusions: A multifaceted strategy including educational and training programmes and the increase of public awareness is needed to implement advance care planning in Italian nursing homes

The Impact of Lymphoscintigraphy Technique on the Outcome of Sentinel Node Biopsy in 1,313 Patients with Cutaneous Melanoma: An Italian Multicentric Study (SOLISM-IMI).

An observational multicentric Italian trial on sentinel node biopsy (SNB) in melanoma patients was performed to diffuse a common SNB protocol nationwide (Italy). We report herein the results of this trial. The influence of some technical aspects on the outcome of SNB was also investigated, because a certain degree of variability was accepted in performing lymphoscintigraphy. METHODS: From January 2000 to December 2002, 1,313 consecutive patients with primary cutaneous melanoma (Breslow thickness, >1.0 mm or <1.0 mm but with ulceration, Clark level IV-V, presence of regression) were enrolled by 23 centers. One half to 1 mL of 99mTc-labeled human albumin colloid, at a suggested dosage of 5-15 or 30-70 MBq, was injected intradermally, closely around the scar, the same day or the day before SNB. Intraoperatively, Patent blue was associated when a definitive wide excision of the primary was required. A positive sentinel node (SN) was defined when containing melanoma cells detected by either hematoxylin-eosin or immunohistochemistry (S100 and HMB45 antibodies). All patients underwent regular follow-up. False-negative cases were considered when lymph node metastases occurred in the same lymphatic basin of SN biopsy (SNB) during follow-up. A quality control program has been performed for the surgical procedure and for the histologic diagnosis. RESULTS: The SN identification rate was 99.3%. The axilla was the site of the SN in 52.5% of the cases. The mean number of SNs was 2.0 (range, 1-17) and only 1 node was removed in 45.4%. The positivity and false-negative rates were 16.9% and 14.7%, respectively (median follow-up, 31 mo). On multivariate analysis (logistic and linear regression) only the number of peritumor injections was inversely associated with the number of excised SNs (P = 0.002), whereas none of the technical variables showed an independent impact on SN status when Breslow thickness was included as a control variable. CONCLUSION: The number of peritumor injections seems to influence the outcome of lymphoscintigrapy in melanoma patients undergoing SNB. If these results are confirmed in a controlled trial, 3 injections at least should be recommended

The impact of lymphoscintigraphy technique on the outcome of the sentinel node biopsy in 1,313 patients with cutaneous melanomas: an Italian multicentric study (SOLIS-IMI)

An observational multicentric Italian trial on sentinel node biopsy (SNB) in melanoma patients was performed to diffuse a common SNB protocol nationwide (Italy). We report herein the results of this trial. The influence of some technical aspects on the outcome of SNB was also investigated, because a certain degree of variability was accepted in performing lymphoscintigraphy. Methods: From January 2000 to December 2002,1,313 consecutive patients with primary cutaneous melanoma (Breslow thickness, >1.0 mm or <1.0 mm but with ulceration, Clark level IV-V, presence of regression) were enrolled by 23 centers. One half to 1 mL of Tc-99m-labeled human albumin colloid, at a suggested dosage of 5-15 or 30-70 MBq, was injected intradermally, closely around the scar, the same day or the day before SNB. Intraoperatively, Patent blue was associated when a definitive wide excision of the primary was required. A positive sentinel node (SN) was defined when containing melanoma cells detected by either hematoxylin-eosin or immunohistochemistry (S100 and HMB45 antibodies). All patients underwent regular follow-up. False-negative cases were considered when lymph node metastases occurred in the same lymphatic basin of SN biopsy (SNB) during follow-up. A quality control program has been performed for the surgical procedure and for the histologic diagnosis. Results: The SN identification rate was 99.3%. The axilla was the site of the SN in 52.5% of the cases. The mean number of SNs was 2.0 (range, 1-17) and only 1 node was removed in 45.4%. The positivity and false-negative rates were 16.9% and 14.7%, respectively (median follow-up, 31 mo). On multivariate analysis (logistic and linear regression) only the number of peritumor injections was inversely associated with the number of excised SNs (P = 0.002), whereas none of the technical variables showed an independent impact on SN status when Breslow thickness was included as a control variable. Conclusion: The number of peritumor injections seems to influence the outcome of lymphoscintigrapy in melanoma patients undergoing SNB. If these results are confirmed in a controlled trial, 3 injections at least should be recommended