Management of Clinically Insignificant Residual Fragments following Shock Wave Lithotripsy

Clinically insignificant residual fragments (CIRFs) are small fragments (less than 5 mm) that are present in upper urinary tract at the time of regular post-SWL followup. The term is controversial because they may remain silent and asymptomatic or become a risk factor for stone growth and recurrence, leading to symptomatic events, and need further urologic treatment. Although a stone-free state is the desired outcome of surgical treatment of urolithiasis, the authors believe that the presence of noninfected, nonobstructive, asymptomatic residual fragments can be managed metabolically in order to prevent stone growth and recurrence. Further urologic intervention is warranted if clinical indications for stone removal are present

Scientific integrity: critical issues in environmental health research

Environmental health research is a relatively new scientific area with much interdisciplinary collaboration. Regardless of which human population is included in field studies (e.g., general population, working population, children, elderly, vulnerable sub-groups, etc.) their conduct must guarantee well acknowledged ethical principles. These principles, along with codes of conduct, are aimed at protecting study participants from research-related undesired effects and guarantee research integrity. A central role is attributed to the need for informing potential participants (i.e., recruited subjects who may be enrolled in a study), obtaining their written informed consent to participate, and making them aware of their right to refuse to participate at any time and for any reason. Data protection is also required and communication of study findings must respect participant's willingness to know or not know. This is specifically relevant for studies including biological markers and/or storing biological samples that might be analysed years later to tackle research objectives that were specified and communicated to participants at the time of recruitment or that may be formulated after consent was obtained

Inequity in the provision of and access to palliative care for cancer patients. Results from the Italian survey of the dying of cancer (ISDOC)

<p>Abstract</p> <p>Background</p> <p>The palliative services and programs have been developed with different intensity and modalities in all countries. Several studies have reported that a geographic variation in the availability and provision of palliative care services between and within countries exists, and that a number of vulnerable groups are excluded from these services. This survey estimates the distribution of places of care for Italian cancer patients during the last three months of their lives, the proportion receiving palliative care support at home and in hospital, and the factors associated with the referral to palliative care services.</p> <p>Methods</p> <p>This is a mortality follow-back survey of 2,000 cancer deaths identified with a 2-stage probability sample, representative of the whole country. Information on patients' experience was gathered from the non-professional caregiver through an interview, using an adapted version of the VOICES questionnaire. A section of the interview concerned the places of care and the palliative care services provided to patients. Multivariate logistic regression analyses were conducted to identify the determinants of palliative care service use.</p> <p>Results</p> <p>Valid interviews were obtained for 67% of the identified caregivers (n = 1,271). Most Italian cancer patients were cared for at home (91%) or in hospital (63%), but with substantial differences within the country. Only 14% of Italian cancer patients cared for at home against 20% of those admitted to hospital, received palliative care support. The principal determinants identified for receiving these service were: an extended interval between diagnosis and death (P = 0.01) and the caregiver's high educational level (P = 0.01) for patients at home; the low patient's age (P < 0.01) and the caregiver's high educational level (P = 0.01) for patients in hospital.</p> <p>Conclusion</p> <p>In Italy palliative care services are not equally available across the country. Moreover, access to the palliative care services is strongly associated with socio demographic characteristics of the patients and their caregivers. Italian Policy-makers need to equalise palliative care provision and access across the country to meet the needs of all cancer patients.</p

Survival of high grade glioma patients depends on their age at diagnosis.

Although the prognosis for malignant gliomas is normally dismal, it's not infrequent in neurooncologist's experience to find cases with unusually prolonged survival. In order to understand what factors influence survival of high grade glioma patients, a cohort of 196 high (III-IV) grade glioma patients was investigated for possible association between (1) survival and age at diagnosis; (2) survival and micronuclei in tumor tissue; (3) survival and gender; (4) micronuclei in tumor tissue and age at diagnosis.Patients diagnosed at an older age (64 years) had a significantly higher hazard as compared to younger patients (or=64 years), indicating that older patients survived shorter. On the contrary, no association was found between survival and micronuclei or gender.Survival analysis was performed by the Cox' proportional hazards regression model.Age at diagnosis, together with other established prognostic factors such as histologic characteristics, extent of surgery and Karnofsky Performance Score may to a certain extent predict survival of high grade glioma patients

Etiological Definition and Diagnostic Work-Up

Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by left ventricular or biventricular dilatation or systolic dysfunction without either pressure or volume overload or coronary artery disease sufficient to explain the dysfunction. It is pivotal to exclude possible removable causes of left ventricular dysfunction because this has prognostic implications. A comprehensive integrated approach, including third-level diagnostic tools, should be systematically implemented in clinical practice to remove every possible reversible cause through specific therapeutic interventions. This issue appears essential to promote left ventricular reverse remodeling and subsequent outcome improvement. Thus, the clinical approach to a suspected DCM requires a step-by-step work-up. In this chapter, we dissect the "red flags approach" to DCM with particular focus on easily missed diagnosis