Recent advances in the surgical care of breast cancer patients

A tremendous improvement in every aspect of breast cancer management has occurred in the last two decades. Surgeons, once solely interested in the extipartion of the primary tumor, are now faced with the need to incorporate a great deal of information, and to manage increasingly complex tasks

Post-traumatic stress disorder, emotional processing and inappropriate implantable cardioverter-defibrillator shocks: clinical consideration by a single case report.

Introduction. Even though an overwhelming amount of evidence supports the clinical efficacy and safety of the implantable cardioverter defibrillator (ICD), inappropriate shocks for atrial arrhythmias with rapid ventricular conduction or for abnormal sensing results in multiple adverse effects Presentation. In this study we present the case of a 59- year-old woman who was admitted to hospital for ICD implantation with a past medical history that was positive for non-ischemic dilated cardiomyopathy, congestive heart failure (NYHA class III), atrial fibrillation, essential hypertension and a recent episode of syncope. Since in the 18 months follow-up the patient suffered many inappropriate shocks, we investigated the association of the presence of a PTSD (Post- Traumatic-Stress-Disorder) prior to implantation and a specific profile of cognitive processing emotions, with the effectiveness of the ICD. Emotional distress states and cognitive thoughts preceding ICD shock inappropriate episode were recorded by structured mobile diary (eMotional-ICDiary). We outlined how the presence of a highly traumatic event which had occurred 6 years previously was related to a recurrence of a combination of moderate distress and cognitive thoughts, associated with episodes of Inappropriate Shock. A psycho-diagnostic examination and the administration of the Emotional Processing Scale (EPS-25) and Emotional Regulation Questionnaire (ERQ) outlined that the patient presented a profile of cognitive processing of emotions characterized by elevated levels of unprocessed emotions, low appraisal and high suppression emotional regulation strategy. Conclusion. The observations gathered in this single case are a good starting point for further research in order to check if the post-traumatic stress disorder and a specific cognitive profile connected to the processing of emotions are associated with the presence of inappropriate ICD shocks. Further larger sample studies are required in this area

Effects of exercise training started within 2 weeks after acute myocardial infarction on myocardial perfusion and left ventricular function: a gated SPECT imaging study

Background: Several studies suggested that exercise training might improve myocardial perfusion by inducing coronary vascular adaptations or enhancing collateralization. However, these findings were obtained in patients with chronic coronary artery disease using thallium-201 myocardial perfusion scintigraphy. We evaluated whether a long-term exercise-based cardiac rehabilitation (CR) started early (9 ± 3 days) after ST elevation acute myocardial infarction (STEMI) improves myocardial perfusion and left ventricular (LV) function, evaluated by gated single-photon emission computed tomography (SPECT) imaging. Design: Randomized controlled study. Methods: Fifty patients with recent STEMI were randomized into two groups: 24 enrolled in a 6-month exercise-based CR programme (group T) and 26 discharged with generic instructions for maintaining physical activity and correct lifestyle (group C). All patients underwent cardiopulmonary exercise test and gated SPECT within 3 weeks after STEMI and at 6-month follow up. Results: At follow up, group T showed a significant reduction of stress-induced ischaemia (p < 0.01) and an improvement in resting and post-stress wall motion (both p < 0.005) and resting (p < 0.05) and post-stress wall thickness (p < 0.005) score indexes. At follow up, group T showed an improvement in peak oxygen consumption (p < 0.0001), O(2) pulse (p < 0.05), and in the slope of increase in ventilation over carbon dioxide output (p < 0.001). No changes in myocardial perfusion parameters, LV function, and cardiopulmonary indexes were observed in group C at follow up. Conclusions: Six months of exercise training early after STEMI reduces stress-induced ischaemia and improves LV wall motion and thickness. Exercise-induced changes in myocardial perfusion and function were associated with the absence of unfavourable LV remodelling and with the improvement of cardiovascular functional capacity

Imatinib-Sensitizing KIT Mutation in a Carney-Stratakis-Associated GI Stromal Tumor

no abstract availabl

Risk of Guillain-Barr\ue9 syndrome after 2010-2011 influenza vaccination

Influenza vaccination has been implicated in Guillain Barr\ue9 Syndrome (GBS) although the evidence for this link is controversial. A case-control study was conducted between October 2010 and May 2011 in seven Italian Regions to explore the relation between influenza vaccination and GBS. The study included 176 GBS incident cases aged 6518 years from 86 neurological centers. Controls were selected among patients admitted for acute conditions to the Emergency Department of the same hospital as cases. Each control was matched to a case by sex, age, Region and admission date. Two different analyses were conducted: a matched case-control analysis and a self-controlled case series analysis (SCCS). Case-control analysis included 140 cases matched to 308 controls. The adjusted matched odds ratio (OR) for GBS occurrence within 6 weeks after influenza vaccination was 3.8 (95 % CI: 1.3, 10.5). A much stronger association with gastrointestinal infections (OR = 23.8; 95 % CI 7.3, 77.6) and influenza-like illness or upper respiratory tract infections (OR = 11.5; 95 % CI 5.6, 23.5) was highlighted. The SCCS analysis included all 176 GBS cases. Influenza vaccination was associated with GBS, with a relative risk of 2.1 (95 % CI 1.1, 3.9). According to these results the attributable risk in adults ranges from two to five GBS cases per 1,000,000 vaccinations