Treatments and overall survival in patients with Krukenberg tumor

BACKGROUND: Krukenberg tumor (KT) is a rare secondary ovarian tumor, primarily localized at the gastrointestinal tract in most cases. KT is related to severe prognosis due to its aggressiveness, diagnostic difficulties and poor treatment efficacy. Several treatments have been used, such as cytoreductive surgery (CRS), adjuvant chemotherapy (CT) and/or hyperthermic intraperitoneal chemotherapy (HIPEC). To date, it is still unclear which treatment or combination of treatments is related to better survival. OBJECTIVE: To assess the most effective therapeutic protocol in terms of overall survival (OS). METHODS: A systematic review of the literature was performed by searching MEDLINE, Scopus, EMBASE, ClinicalTrial.gov, OVID, Web of Sciences, Cochrane Library, and Google Scholar for all studies assessing the association of treatments with OS in KTs. The effectiveness of each treatment protocol was evaluated by comparing the OS between patients treated with different treatment protocols. RESULTS: Twenty retrospective studies, with a total sample size of 1533 KTs, were included in the systematic review. Therapeutic protocols used were CRS in 18 studies, CT in 13 studies, HIPEC in 7 studies, neoadjuvant CT in 2 studies, and some combinations of these in 6 studies. Seven studies showed that CRS significantly improved OS compared to other treatments or association of treatments without it. 11 studies showed that CRS without residual (R0 CRS) had a significantly better OS than CRS with residual (R + CRS). Five studies showed that CT significantly improved OS, but other five showed it did not. Two studies showed that HIPEC in association with CRS improved OS, while another study showed that efficacy of HIPEC was comparable to CT. Two studies evaluated neoadjuvant CT, but results were conflicting. CONCLUSION: CRS and in particular R0 CRS are the treatments showing the clearest results in improving OS in KT patients. Results about CT are conflicting. HIPEC appears effective both alone and in combination with CRS, and also related to fewer adverse effect than CT. The usefulness of neoadjuvant CT is still unclear. The association of R0 CRS with HIPEC seems to be the most effective and safe therapeutic protocol for KT patients

Utilization of CHROMagar MRSA in the supervision of the methicillin-resistent Staphylococcus aureus

Methicillin-resistent Staphylococcus aureus (MRSA) is one of the most common pathogen responsible for nosocomial infections. Laboratory diagnosis and assays of antimicrobial susceptibility are basic in controlling and preventing infection by MRSA. Our study was conducted for one year (May 2008-April 2009) on patients hospitalized to monitor the eventual colonization by MRSA.The use of chromogenic agar MRSA allowed us to identify pink-mauve colonies of MRSA within 24 hours and to make a timely e careful diagnosis

Acute Hepatitis HCV genotype 3h: virological baseline characterization and monitoring “On Therapy”

The Hepatitis C viral genome is highly variable and is classified into 6 genotype groups, based on phylogenetic analysis of the genomic sequence. Here we show a case of acute Hepatitis C in which a rare genotype 3h was evidenced by direct RNA sequencing.We confirm that analysis of the early kinetics of HCV RNA during antiviral therapy is an important prognostic parameter, and that a (to-t3)log10HCV RNA value is a strong predictor for Rapid Virological Response (RVR) and End Therapy Response (ETR)

Subacute bacterial endocarditis (SBE) due to Streptococcus gordonii

Endocarditis is an inflammatory state of the endothelium that promotes thrombus formation and tissue damage on the surface of heart valves. Recent studies have reported endocarditis mortality rates ranging from 12% to 46% (2008). The Streptococcus gordonii is a normal inhabitant of the human oral cavity. It is a component of the microbial communities responsible of plaque formation, associated with dental caries and also regarded as the main causative agent in the development of subacute bacterial endocarditis (SBE)

Laparotomic versus robotic surgery in elderly patients with endometrial cancer: A systematic review and meta‐analysis

BACKGROUND: Although robotics has been shown to improve outcomes in some high-difficulty surgical category patients, it is unclear if such an approach may improve outcomes in elderly patients with endometrial carcinoma (EC).OBJECTIVE: To compare robotic and laparotomic surgery in the treatment and staging of elderly EC patients.MATERIALS AND METHODS: A systematic review and meta-analysis was performed assessing the risk of overall, intra-operative, and peri-operative complications associated with the surgical approach (laparotomic vs robotic) for elderly patients with EC by relative risk (RR). Pooled means±standard deviation of length of stay were compared with the unpaired t test. Subgroup analyses for overall complications were performed based on different age cut-offs (>70, >65, and >75years) and severity of complications (minor and major). A value of P less than 0.05 was considered significant.RESULTS: Five studies with 7629 EC patients were included. Pooled RR for robotic compared with laparotomic surgery was 0.40 (P<0.001) for overall, 0.46 (P=0.18) for intra-operative, and 0.43 (P<0.001) for peri-operative complications. Pooled difference between means±standard deviation of length of stay for robotic versus laparotomic surgery was -3.34 (P<0.001). At subgroup analyses, pooled RR of overall complications for robotic surgery versus laparotomic surgery was 0.34 (P<0.001) in the >70years, 0.51 (P<0.01) in the >65years, 0.20 (P=0.12) in the >75years groups. Pooled RR was 0.50 (P=0.1) in the minor complications subgroup, and 0.42 (P=0.002) in the major complications subgroup.CONCLUSION: Robotics might be a viable alternative to the laparotomic approach for EC in elderly patients because it significantly decreases the risk of overall and peri-operative complications (mainly major complications), and the length of stay when compared with laparotomy. The decrease in risk of overall complications is greater with increasing patient age

Laparotomic versus robotic surgery in elderly patients with endometrial cancer: A systematic review and meta-analysis

BACKGROUND: Although robotics has been shown to improve outcomes in some high-difficulty surgical category patients, it is unclear if such an approach may improve outcomes in elderly patients with endometrial carcinoma (EC).OBJECTIVE: To compare robotic and laparotomic surgery in the treatment and staging of elderly EC patients.MATERIALS AND METHODS: A systematic review and meta-analysis was performed assessing the risk of overall, intra-operative, and peri-operative complications associated with the surgical approach (laparotomic vs robotic) for elderly patients with EC by relative risk (RR). Pooled means±standard deviation of length of stay were compared with the unpaired t test. Subgroup analyses for overall complications were performed based on different age cut-offs (>70, >65, and >75years) and severity of complications (minor and major). A value of P less than 0.05 was considered significant.RESULTS: Five studies with 7629 EC patients were included. Pooled RR for robotic compared with laparotomic surgery was 0.40 (P<0.001) for overall, 0.46 (P=0.18) for intra-operative, and 0.43 (P<0.001) for peri-operative complications. Pooled difference between means±standard deviation of length of stay for robotic versus laparotomic surgery was -3.34 (P<0.001). At subgroup analyses, pooled RR of overall complications for robotic surgery versus laparotomic surgery was 0.34 (P<0.001) in the >70years, 0.51 (P<0.01) in the >65years, 0.20 (P=0.12) in the >75years groups. Pooled RR was 0.50 (P=0.1) in the minor complications subgroup, and 0.42 (P=0.002) in the major complications subgroup.CONCLUSION: Robotics might be a viable alternative to the laparotomic approach for EC in elderly patients because it significantly decreases the risk of overall and peri-operative complications (mainly major complications), and the length of stay when compared with laparotomy. The decrease in risk of overall complications is greater with increasing patient age

Clinics and pathology of Krukenberg Tumor: a systematic review and meta-analysis

Background: Krukenberg tumor (KT) is defined as a secondary neoplasm of the ovary. While ovarian metastases account for about 30% of ovarian tumors, KTs are rare, accounting for about 1-2% of the total. The rarity of KT is at least in part responsible for the lack of a precise clinic-pathological characterization of these tumors. Clinically, KT may have a subtle clinical presentation, with few symptomatic manifestations and nonspecific clinical signs, even though in Literature there is disagreement about the clinical presentation of these patients; such difficulties in the diagnostic framework often leads to a delayed diagnosis with serious consequences on the patient outcome. Objectives: We aimed to provide a clinico-pathological characterization of Krukenberg Tumor (KT) through a systematic review and meta-analysis. Methods: Electronic databases were searched for all studies assessing clinicopathological features of KT series. Pooled prevalence of each clinical or pathological factor was calculated according to the random-effect model. Results: Forty-eight studies with 3025 KT patients were included; 39.7% of patients were ≥50 and 39.8% were postmenopausal. The most common primary tumor sites were stomach (42.5%), colon-rectum (26.1%), breast (9.3%), and appendix (5%); 48.7% of KTs were synchronous with the primary tumor, 64.3% were bilateral, 40.5% had a diameter ≥10 cm; 55.3% showed extraovarian extent and 49% showed peritoneal involvement. The most common presenting symptoms were ascites (51.7%), palpable mass (31.3%), pain (29.3%), abdominal distention (28.7%), irregular bleeding (9.1%), asymptomatic (11.2%); 27.5% of patients showed increased serum level of CA125, while 29.4% showed increased CEA levels. Cytokeratin-7 was positive in 34.5% of cases and cytokeratin-20 in 34.3%. Conclusions: KT shows a highly variable presentation. Understanding the prevalence of clinico-pathological factors may be helpful to improve the diagnosis and management of KT

Differences among confirmed and not-confirmed COVID-19 patients at "D.Cotugno" hospital, Naples (Italy): what we learned from first suspected cases?

: Clinical presentation of COVID-19 is common to other respiratory infections. We compared the characteristics at hospital admission of confirmed and not-confirmed COVID-19 patients, in the early phase of the epidemic. Thirty-seven suspected patients were enrolled, and COVID-19 was confirmed in 17. Confirmed patients are older, have more frequently contact with confirmed cases. Distinctive clinical characteristics among COVID-19 were the grand-glass opacities at CT scan, and a pO2/FiO2 ratio less than 250. In not-confirmed group, Influenza represented the most frequent alternative diagnosis. This study contributes to highlight the characteristics to consider at hospital admission in order to promptly suspect COVID-19

Clinical Outcome Prediction in COVID-19 Patients by Lymphocyte Subsets Analysis and Monocytes’ iTNF-α Expression

In December 2019, a novel coronavirus, “SARS-CoV-2”, was recognized as the cause of coronavirus disease 2019 (COVID-19). Several studies have explored the changes and the role of inflammatory cells and cytokines in the immunopathogenesis of the disease, but until today, the results have been controversial. Based on these premises, we conducted a retrospective assessment of monocyte intracellular TNF-α expression (iTNF-α) and on the frequencies of lymphocyte sub-populations in twenty-five patients with moderate/severe COVID-19. We found lymphopenia in all COVID-19 infected subjects compared to healthy subjects. On initial observation, in patients with favorable outcomes, we detected a high absolute eosinophil count and a high CD4+/CD8+ T lymphocytes ratio, while in the Exitus Group, we observed high neutrophil and CD8+ T lymphocyte counts. During infection, in patients with favorable outcomes, we observed a rise in the lymphocyte count, in the monocyte and in Treg lymphocyte counts, and in the CD4+ and in CD8+ T lymphocytes count but a reduction in the CD4+/CD8+ T lymphocyte ratio. Instead, in the Exitus Group, we observed a reduction in the Treg lymphocyte counts and a decrease in iTNF-α expression. Our preliminary findings point to a modulation of the different cellular mediators of the immune system, which probably play a key role in the outcomes of COVID-19