Medico-legal considerations in a case of splenic injury that occurred during colonoscopy

Colonoscopy has became the gold standard diagnostic and therapeutic treatment for rectum and colon diseases. The splenic injury is a rare complication of colonoscopy and relatively few cases (less than 70) have been reported in the literature so far. Here we present a case of splenic rupture identified in a 80 year-old man few hours after an apparently uneventful colonoscopy. Acknowledging a causal relationship between the lesion and the diagnostic procedures, we discuss the possible medico-legal implications with regard to professional liability considering the exceptional nature of such an event and the stance recently taken by the Italian law

Role of inosine triphosphate pyrophosphatase gene variant on fever incidence during zidovudine antiretroviral therapy

Zidovudine, the antiretroviral drug used to treat HIV infection, commonly causes adverse effects, such as systemic fever and gastrointestinal alterations. In the present study, the potential role of inosine triphosphate pyrophosphatase (ITPA) gene variant on the incidence of adverse events during antiretroviral therapy (ART) of HIV with zidovudine was discussed. Individuals from Northeastern Brazil (N = 204) receiving treatment for HIV-1 infection were recruited. Zidovudine-related adverse effects developed during the treatment were registered. The rs1127354 polymorphism in the ITPA gene was genotyped using real-time PCR to assess whether this single nucleotide polymorphism was associated with the occurrence of zidovudine-related adverse effects. We observed a significant association between the ITPA variant genotype and the reported systemic fever (odds ratio = 7.17, 95% confidence interval = 1.19-43.15; P = 0.032). Zidovudine use could indirectly lead to an increase in the levels of inosine monophosphate in an antimetabolite-like manner, which is converted to inosine triphosphate (ITP). The rs1127354 variant caused a decrease in ITPA activity, thereby leading to ITP accumulation. This in turn resulted in cytotoxicity, which was manifested by neutropenia and fever. Therefore, we hypothesized a pharmacogenetic model involving the ITPA variant genotype in multifactorial components that act together to determine the onset of zidovudine-related adverse effects

Keratin-14 Expression in Pneumocytes as a Marker of Lung Regeneration/Repair during Diffuse Alveolar Damage

letter to the Edito

Prognostic-predictive factors in breast cancer: comparison of mRNA level (Target Print) and immunohistochemistry expression

Target Print (TP) is a microarray-based gene expression test which offers a quantitative assessment of the patient'slevel of estrogen receptor (ER), progesterone receptor (PR) and HER2/neu overexpression within her breast cancer. As compared to Immunohistochemistry (IHC), TP delivers an added benefit to the diagnostic process. IHC provide a semi-quantitative positive or negative result, whereas the gene expression result provided by TP allows to integrate the absolute level of ER, PR and HER2 gene expression into treatment planning. It is known that differences in tissue fixation, choice of antibody and interpretation can severely affect IHC accuracy and reproducibility

Cyto-radiological disageement: management

In Trieste, pathologists have been actively involved in breast diagnostics working alongside radiologists in the sampling time in order to set up together the most adequate approach in case-solving basing on the clinical/radiological and rapid stain cytological findings. Based on our own experience we prefer, whenever possible, to use the fine needle aspiration sampling method (FNA), almost always under ultrasound guidance, even for palpable lesions, reserving tru-cut biopsy only for a limited number of cases and vacuum-assisted biopsy (VAB) only in not ultrasound detectable lesions (id: isolated microcalcifications). The collaboration between radiologist and pathologist is essential to correctly evaluate identified lesions: the more coincident the results of radiological and cytological exams are, the more accurate the final diagnosis will be. Nevertheless there are some cases in which radiology and cytology do not agree. We decided to reassess the entire database, focusing on the management of discrepant cases in the light of the final histological diagnosis for surgical-treated cases or referring to the follow-up exams in the cases that did not undergo surgery

Caratteristiche dei carcinomi screening-detected a 6 anni dall\u2019 avvio del programma di screening mammografico a Trieste

OBIETTIVI Questo studio si propone di confermare tale ipotesi e di estenderla anche ai carcinomi pT1c>=15 mm, suggerendo una suddivisione della categoria pT1c in pT1c=15mm per meglio monitorare tale parametro, come proposto da A. Frigerio (Atti Convegno Nazionale SIRM, Genova 2013). MATERIALI E METODI Il programma di Screening \ue8 attivo a Trieste dal 2006: escludendo il primo round di prevalenza, si confrontano i carcinomi del 2008-09 pari a 141, con quelli del 2010-2011, pari a 136. Si analizza la loro distribuzione a seconda del parametro T, proponendo la suddivisione per le lesioni pT1c in 2 gruppi. Si correlano il parametro T ed i profili molecolari delle neoplasie con la regolarit\ue0 delle pazienti nel essersi sottoposte precedentemente ai controlli mammografici. La casistica non include i carcinomi di intervallo RISULTATI Dal II al III round non solo le lesioni pT2+ si sono ridotte dal 23% al 12% (p=0.02), ma anche le lesioni pT1c>=15mm hanno registrato lo stesso decremento %. Complessivamente nei due round il 54% delle donne con cancro che non si erano controllate in passato, presentava un tumore in stadio iniziale vs il 68% delle donne che si controllavano con regolarit\ue0. Nei due gruppi l\u2019incidenza delle neoplasie con profilo molecolare aggressivo (Luminal B/Her2+/tripli negativi) non ha evidenziato variazioni significative (17.5% vs 15.9%). CONCLUSIONI La distinzione tra pT1c=15mm \ue8 un ulteriore utile indicatore per valutare l\u2019efficacia del programma di Screening, soprattutto quando questo \ue8 ben consolidato. Come prevedibile, i carcinomi a profilo molecolare aggressivo invece sono indipendenti dalla regolarit\ue0 con cui vengono effettuati gli esami mammografici

In haematopoietic SCT for acute leukemia TBI impacts on relapse but not survival: results of a multicentre observational study

The aim of this study was to determine whether parameters related to TBI impacted upon OS and relapse in patients with acute leukemia in CR who underwent haematopoietic SCT (HSCT) in 11 Italian Radiation Oncology Centres. Data were analysed from 507 patients (313 males; 194 females; median age 15 years; 318 with ALL; 188 with AML; 1 case not recorded). Besides 128 autologous transplants, donors included 192 matched siblings, 74 mismatched family members and 113 unrelated individuals. Autologous and allogeneic transplants were analysed separately. Median follow-up was 40.1 months. TBI schedules and HSCT type were closely related. Uni- and multi-variate analyses showed no parameter was significant for OS or relapse in autologous transplantation. Multivariate analysis showed type of transplant and disease impacted significantly on OS in allogeneic transplantation. Disease, GVHD and TBI dose were risk factors for relapse. This analysis illustrates that Italian Transplant Centre use of TBI is in line with international practice. Most Centres adopted a hyperfractionated schedule that is used worldwide (12 Gy in six fractions over 3 days), which appears to have become standard. TBI doses impacted significantly upon relapse rates