Optical coherence tomography angiography versus fluorescein or indocyanine green angiography: legal implications for ophthalmologists

Optical coherence tomography angiography (OCTA) is a non-invasive imaging technique able to show real-time volumetric data on chorioretinal vasculature. The most commonly used angiographic techniques in visualizing vascular changes are fluorescein (FA) or indocyanine green angiography (ICGA). Dye-based techniques require intravenous dye injection which can cause side effects. The physician has the responsibility to decide which diagnostic instrument is more appropriate. Legal implications are due to the side effects of dye injection. OCTA test can be performed without side effect

Pneumomediastinum in a smoking free-base cocaine abuser during sexual intercourse

n/

Collision of ductal adenocarcinoma and neuroendocrine tumor of the pancreas: a case report and review of the literature

Background: Simultaneous occurrence of exocrine and neuroendocrine tumors of the pancreas is very infrequent. We report a patient with an endocrine tumor in the pancreatic-duodenal area and extensive exocrine carcinoma involving the whole pancreas. Case presentation: A 69-year-old woman was hospitalized in May 2016 for epigastric pain and weight loss. Her past medical history revealed an undefined main pancreatic duct dilation that was subsequently confirmed at CT scan (23 mm) and endoscopic ultrasound. There was no evidence of pancreatic masses, but the cephalic portion of the main pancreatic duct presented hypoechoic nodules. A diagnosis of the main-duct intraductal papillary mucinous neoplasm was made, and the patient underwent total pancreatectomy. Pathological examination showed a collision tumor constituted by a ductal adenocarcinoma involving the whole pancreas and a neuroendocrine tumor located in the duodenal peripancreatic wall and the head of the pancreas. There was one peripancreatic lymph node metastasis from the ductal adenocarcinoma and eight node metastases from the neuroendocrine tumor. These findings suggested a diagnosis of collision of neuroendocrine and ductal adenocarcinomas of the pancreas. The postoperative course was uneventful. Conclusions: The coexistence of pancreatic endocrine and exocrine tumors is very uncommon. When present, problems in differential diagnosis may arise between mixed exocrine-endocrine carcinoma or the collision of separate tumors

Cysticercosis by Taenia pisiformis in Brown Hare (Lepus europaeus) in\ua0Northern Italy: Epidemiologic and pathologic features

In Northern Italy, a hastening of hare population decline was noticeable from 2008. In the same year hunters reported a sudden increase of hares infected by Taenia sp. larvae, whose morphology was consistent with T. pisiformis cysticerci. The aim of the survey was: i)to identify the parasites through morphological features and molecular techniques; ii)to quantify the prevalence and abundance of cysticerci in hunted hares; iii)to describe pathological aspects of parasite-induced lesions; iv)to evaluate the short-term trend of the infection comparing two different hunting seasons; v)to highlight possible relationship between T. pisiformis infection and hare-related variables. In 2013, 2015 the viscera of 54 and 61 hares legally hunted in agro-ecosystems of the Po Plain were collected. Peritoneum, liver and lungs were examined for cysticercosis; abundance was estimated counting superficial parasites in liver; parasites were microscopically identified by shape and measure of both large and small hooks. One cysticercus from each hare was analized by a PCR targeting Taeniid species and then sequenced. Frozen liver, lungs and gastrointestinal peritoneum were macroscopically observed and, after thawing, representative samples from the available organs were collected for histologic examination to verify parasitic cysts and the subsequent damage of the involved organs. Sex, weight and age class of the animals were recorded. Generalized linear models were used for statistical analysis. T. pisiformis was isolated in 8 hares in 2013 (prevalence 14.8%; abundance range: 0-400; mean abundance 17.8) and in 2 hares in 2015 (prevalence 3.28%; abundance range: 0-180; mean abundance 3.22). Identification was confirmed morphologically and by PCR. The DNA sequencing confirmed T. pisiformis in all samples. The sequences were all identical each-other. Infection was significantly related with adult age class, sampling year and low full-weight. Epidemiological and pathological pattern suggest both a possible role on host population health and a tendency toward host-parasite equilibrium

Pain treatment with high-dose, controlled-release oxycodone: an Italian perspective

To investigate the possible role and tolerability of high-dose (>160 mg/day) oxycodone controlled release (CR) for the treatment of cancer and non-cancer pain. 227 patients with cancer or non-cancer pain were enrolled in an open-label, multi-center, Italian study in order to assess the adequacy of their existing pain management (using a numerical rating scale [NRS]) and the possible benefit high-dose oxycodone CR may offer patients experiencing uncontrolled pain. Results: Pain was poorly controlled at baseline, with only 18.1% of patients reporting adequate pain relief (NRS <3.5). All other patients reported uncontrolled pain, with an average NRS of 7.81. At baseline assessment, 47.89% of patients had been in pain for up to 3 months, 32.82% for 3–6 months, and 19.19% for more than 6 months. After baseline assessment, patients were switched to oxycodone CR monotherapy. The starting dose was individualized to each patient and titrated up over a 3- to 4-day period until effective pain management was achieved. Treatment was continued for an average of 37.24 days during the study. Pain control (final mean NRS of 2.85) was attained with an average dose of oxycodone CR 221.84 mg/day. Standard adverse events (including constipations, nausea, and vomiting) were recorded in 39.64% of patients receiving high-dose oxycodone CR monotherapy. Side-effects tended to subside after the initial week of treatment and did not result in any participants leaving the study. High-dose oxycodone CR can achieve rapid and effective management of moderate to severe cancer and non-cancer pain with minimum side-effects

The Reef Check Mediterranean Underwater Coastal Environment Monitoring Protocol

Since 2001, trained snorkelers, freedivers, and scuba diver volunteers (collectively called EcoDivers) have been recording data on the distribution, abundance, and bathymetric range of 43 selected key marine species along the Mediterranean Sea coasts using the Reef Check Mediterranean Underwater Coastal Environment Monitoring (RCMed U-CEM) protocol. The taxa, including algae, invertebrates, and fishes, were selected by a combination of criteria, including ease of identification and being a key indicator of shifts in the Mediterranean subtidal habitats due to local pressures and climate change. The presence and abundance of gas bubbles leaching from the seabed are also recorded. The dataset collected using the RCMed U-CEM protocol is openly accessible across different platforms and allows for various uses. It has proven to be useful for several purposes, such as monitoring the ecological status of Mediterranean coastal environments, assessing the effects of human impacts and management interventions, as well as complementing scientific papers on species distribution and abundance, distribution modeling, and historical series. Also, volunteers\u2019 commitment promotes marine stewardship and environmental awareness in marine conservation. Here, we describe the RCMed U-CEM protocol, from training volunteers to recording, delivery, and sharing data, including the quality assurance and control (QA/QC) procedures

Postoperative respiratory failure in liver transplantation: Risk factors and effect on prognosis

Background :Postoperative respiratory failure (PRF, namely mechanical ventilation &gt;48 hours) significantly affects morbidity and mortality in liver transplantation (LTx). Previous studies analyzed only one or two categories of PRF risk factors (preoperative, intraoperative or postoperative ones). The aims of this study were to identify PRF predictors, to assess the length of stay (LoS) in ICU and the 90-day survival according to the PRF in LTx patients. Methods: Two classification approaches were used: systematic classification (recipient-related preoperative factors; intraoperative factors; logistic factors; donor factors; postoperative ICU factors; postoperative surgical factors) and patient/organ classification (patient-related general factors; native-liver factors; new-liver factors; kidney factors; heart factors; brain factors; lung factors). Two hundred adult non-acute patients were included. Missing analysis was performed. The competitive role of each factor was assessed. Results: PRF occurred in 36.0% of cases. Among 28 significant PRF predictors at univariate analysis, 6 were excluded because of collinearity, 22 were investigated by ROC curves and by logistic regression analysis. Recipient age (OR = 1.05; p = 0.010), female sex (OR = 2.75; p = 0.018), Model for End-Stage Liver Disease (MELD, OR = 1.09; p&lt;0.001), restrictive lung pattern (OR = 2.49; p = 0.027), intraoperative veno-venous bypass (VVBP, OR = 3.03; p = 0.008), pre-extubation PaCO 2 (OR = 1.11; p = 0.003) and Model for Early Allograft Function (MEAF, OR = 1.37; p&lt;0.001) resulted independent PRF risk factors. As compared to patients without PRF, the PRF-group had longer LoS (10 days IQR 7-18 versus 5 days IQR 4-7, respectively; p&lt;0.001) and lower day-90 survival (86.0% versus 97.6% respectively, p&lt;0.001). Conclusion: In conclusion, MELD, restrictive lung pattern, surgical complexity as captured by VVBP, pre-extubation PaCO 2 and MEAF are the main predictors of PRF in non-acute LTx patients

The Impact of Sarcopenia on Elderly Cancer Patients

Sarcopenia is a progressive loss of skeletal muscle mass and strength with consequent physical disability and negative impact on quality of life. Chemotherapy or surgery efficacy on cancer is influenced by the presence of sarcopenia. In particular, chemotherapy toxicity is influenced by genetic variability because the expression of specific muscular enzymes, i.e. dihydropyrimidine dehydrogenase (DPD), play an important role in the catabolism of anti-cancer drugs. The reduction of the total body DPD activity in muscle tissue due to sarcopenia is related to severe chemotherapy-related side effects such as nausea, vomiting, diarrhea, neutropenia, anemia, and infections. Sarcopenia and its detrimental impact on patients’ prognosis have been shown in several types of cancer, such as lung cancer, renal cancer, hepatocellular carcinoma, esophageal cancer, pancreatic cancer, breast cancer, medullary thyroid carcinoma, colorectal cancer, gastric cancer, urothelial cancer, hematologic malignancies etc. Sarcopenia may be optimally recognized by measures of muscle mass and physical performance and the diagnostic criteria. The presence of sarcopenia in elderly cancer patients should be routinely investigated by physicians in order to carry out appropriate nutritional and pharmacologic interventions.</p