Lymph node fine needle cytology, Epstein Barr virus infection and Hodgkin Lymphoma

Epstein-Barr virus (EBV) is a double-strand DNA virus of the herpes family; it is one of the most common human viruses and it is associated with a wide spectrum of benign and malignant conditions. EBV is related to the development of several neoplasms, globally 1% of tumours, including lymphoproliferative, epithelial and mesenchymal neoplasm. Lymphoproliferative disorders include Hodgkin lymphoma (HL) and B and T cell non-Hodgkin lymphoma. HL is one of the most common lymphoma in the developed world, affecting both young people and adults. HL pathogenesis is complex and includes various and partially unknown mechanisms. EBV has been detected in some HL neoplastic cells and expresses genes with a potential oncogenic function, therefore many studies suggest that viral infections have a causative role in neoplastic transformation. Fine Needle Cytology (FNC) is extensively used in the first diagnosis of any lymph-nodal enlargement, including reactive lymphadeno - pathies and lymphoproliferative processes; therefore cytopathologists are likely to encounter EBVassociated malignancies in cytology samples, mainly HL, which is one of the most common lymphoma. This study focuses on the cytological features and ancillary studies required to diagnose EBV-related HL

Esophageal resection in the ederly

The aging of the population and longer life expectancy entails an increased number of elderly patients with esophageal cancer and benign pathologies referred for surgical treatment. Esophageal cancer is a pathology that mainly involves elderly patients. The aim of this study is to assess the effects of age on the outcome of surgery for esophageal cancer and benign pathologies in patients treated in our departmen

Increased IGF-1: IGFBP-3 ratio in patients with hepatocellular carcinoma

BACKGROUND: The development of hepatocellular carcinoma in liver cirrhosis is associated with altered synthesis and secretion of several growth factors. AIM: The aim of this prospective study was to investigate the potential implication of IGF-I and its major binding protein (IGFBP-3) in the development of hepatocellular carcinoma. PATIENTS AND METHODS: IGF-I and IGFBP-3 were measured in 150 healthy subjects, 40 patients with liver cirrhosis and 63 with liver cirrhosis and untreated hepatocellular carcinoma. The ratio between IGF-I and IGFBP-3 was also calculated. RESULTS: Serum IGF-I (70 ± 10 and 65 ± 7 vs. 185 ± 6.4 μg/l, P < 0.001) and IGFBP-3 levels (1225 ± 113 and 984 ± 67 vs. 3017 ± 80 μg/l, P < 0.001) were lower in patients with liver cirrhosis, without or with hepatocellular carcinoma, than in controls. Age was negatively correlated with IGF-I levels In patients with liver cirrhosis (r = -0.6; P = 0.0002) as well as in controls (r = -0.8, P < 0.0001), but not in patients with hepatocellular carcinoma (r = -0.2; P = 0.2). Additionally, in patients with liver cirrhosis (r = -0.54; P = 0.0003) and more weakly in those with hepatocellular carcinoma (r = -0.24; P = 0.04) IGF-I levels were negatively correlated with liver failure measured according with Child class. Despite patients with class C hepatocellular carcinoma being older than those in the same functional class with cirrhosis (64 ± 2 vs. 57 ± 2 years, P < 0.01), they had a significantly increased IGF-I : IGFBP-3 ratio (0.18 ± 0.05 vs. 0.41 ± 0.09, P = 0.04), due mostly to increased IGF-I levels (27.1 ± 5.6 vs. 42 ± 6.2 μg/l) as IGFBP-3 levels were similar to patients with cirrhosis (734 ± 81 vs. 679 ± 83 μg/l). CONCLUSIONS: Hepatocellular carcinoma is associated with a higher IGF-I : IGFBP-3 ratio than that found in patients with liver cirrhosis and a similar degree of liver failure

Thyroid surgery in geriatric patients: a literature review.

BACKGROUND: Thyroid disease is common in the elderly population. The incidence of hypothyroidism and multinodular goitre gradually increases with age. In view of a growth of aging population, we performed a literature review about the feasibility of thyroid surgery in the elderly. METHODS: We conducted a literature search in the PubMed database in September 2012 and all English-language publications on thyroidectomy in geriatric patients since 2002 were retrieved. The potential original articles mainly focusing on thyroidectomy in elderly patients were all identified and full texts were obtained and reviewed for further hand data retrieving. RESULTS: We retrieved five papers based on different primary end-point. Four were retrospective non randomized studies and one was prospective non randomized study. At last 65, 70, 75 and 80 years were used as an age cut-off. All studies evaluate the indications of thyroidectomy in geriatric patients, postoperative morbility and mortality. Only one study specifically assesses the rate of the rehospitalization after thyroidectomy among the elderly. CONCLUSIONS: Thyroid nodules are particularly important in elderly patients, as the incidence of malignancy increases and they are usually more aggressive tumors. An age of at least 70 years is an independent risk factor for complications after general surgery procedures. Thyroid surgery in patients aged 70 years or older is safe and the relatively high rate of thyroid carcinoma and toxic goiter may justify an aggressive approach. A programmed operation with a careful pre-operative evaluation and a risk stratification should make the surgical procedures less hazardous, specially in 80 years old patients with an high ASA score

Indications to total thyroidectomy for multinodular goiter in old patients

Background: In Western society, the percentage of elderly people is continually growing. The prevalence of goiter increases with the age and it is estimated that 90% of women over 60 years old and 60% of men over 80 years old have a relief of thyroid nodules. This has great importance for these patients, because the incidence of malignant transformation is higher than younger ones and these are often tumor very aggressive patterns. If thyroidectomy is indicated for patients with suspected neoplasm and severe obstructive symptoms, their surgery should not be delayed since a late urgent operation could raise morbidity and mortality risk. The main indications for young patients are due to obstructive and metabolic causes over and above suspected cancer. Total thyroidectomy is considered by many authors as the treatment of choice. Materials and methods: 75 elderly patients were submitted to thyroidectomy. The indications were metabolic (42.6%), obstructive (32%) and for suspected cancer (25.4%). Results: The most frequent complications observed with respect to young patients in different series have been cardiovascular, pulmonary or urological. Regarding the complications directly related to thyroidectomy, there were no differences compared to younger groups, except transient complications (hypoparathyroidism, seroma). In our experience, the main complication was represented by hypocalcemia (30.6%), permanent in 8% of cases. Cancer was relieved in 21.3% of cases. Prognosis has been excellent in most cases, with immediate remission of symptoms related to thyrotoxicosis and to tracheal and esophageal compression in almost all symptomatic patients. Conclusions: Age is an independent prognostic factor for cancers. It has been demonstrated that elderly patients with PTC that are operated have better prognosis and quality of life due to the resolution of dyspnea and dysphagia. In our experience, we think that age is not a contraindication to thyroid surgery

Palliative treatment of malignant esophageal-cardiac stricture in the ederly

The aging of the population and longer life expectancy entails an increased number of elderly patients with esophageal cancer and benign pathologies referred for surgical treatment. Esophageal cancer is a pathology that mainly involves elderly patients. The aim of this study is to assess the effects of age on the outcome of surgery for esophageal cancer and benign pathologies in patients treated in our department

Feasibility of inguinal hernioplasty under local anaesthesia in elderly patients.

BACKGROUND: The aim of this study is to evaluate the feasibility and the safety of hernioplasty under local anaesthesia in elderly patients with significant comorbidity. METHODS: A total of 218 patients underwent inguinal hernia repair with mesh between June 2009 and July 2012. Presence of comorbid conditions and complications were compared between patients younger and older than 70 years. RESULTS: Hernia repair in older patients were more likely associated with comorbid conditions than in their younger counterparts ( hypertension: 25% vs 8.16%; cardiovascular diseases: 50% vs 22%; benign prostatic hypertrophy 60% vs 30%). The most common postoperative complications in both groups were recurrence, wound infection, urinary retention. There was a slightly higher rate of complication in elderly group. CONCLUSIONS: Inguinal hernia repair with local anaesthesia is quite safe and results in a good success rate in elderly patients despite a higher rate of comorbidity typical of this kind of patient

New frontiers in bariatric surgery laparoscopic adjustable silicone gastric banding (LASGB)

LASGB is a minimally invasive procedure indicated for the treatment of morbid obesity. Since January 1996, six patients have successfully undergone the laparoscopic procedure. Preoperative BMI was 42 ± 3.1; range 39-46. Mean operative time was 260 ± 110, range was 160-360. Mean hospital stay was 3 ± 1 days

Peripheral blood mono-nuclear cells implantation in patients with Peripheral Arterial Disease: a pilot study for clinical and biochemical outcome of neoangiogenesis.

BACKGROUND: Substantial progresses in the management of peripheral arterial disease (PAD) have been made in the past two decades. Progress in the understanding of the endothelial-platelet interaction during health and disease state has resulted in better antiplatelet drugs that can prevent platelet aggregation, activation and thrombosis during angioplasty and stenting. A role in physiological and pathological angiogenesis in adults has been recently shown in bone marrow–derived circulating endothelial progenitors (BM-DCEPs) identified in the peripheral blood. These findings have paved the way for the development of therapeutic neovascularization techniques using endothelial progenitors. METHODS: This pilot study includes five patients, aged 60 to 75, with a history of claudication and recruited from September 2010 to February 2011 at the A.O.U. Federico II of Naples. PBMNCs have been implanted three times in the limb with the worst ABI value in all the patients included in the study. The clinical follow up was performed during the subsequent 12 months from the beginning of the treatment. RESULTS: In four patients there was a regression of ulcerative lesions. One patient’s condition improved after the first implantation but later did not respond to the further treatments. All patients achieved a pain relief as judged by the numeric pain scale. Pain relief remained satisfactory in three patients for one year. Pain gradually returned to the pre-treatment level in two patients. All patients referred an ameliorating in their quality of life expressed even by an improvement in claudication free walking distance. These improvements are reflected also by intra-arterial digital subtraction angiography (IADSA) that shows an improvement of arterial vascularization. CONCLUSIONS: The data from this study suggest an efficacy of BM-DCEPs implantation in terms of improvement of the vascularization and quality of life in patients affected by Peripheral Arterial Disease. Nevertheless a double-blind placebo-controlled study is needed to confirm our findings