[Organisational aspects of a donated breast milk bank: experience of the Treviso hospital]

AIM

This study analyses the organisational aspects and the volume of milk managed by the donated breast milk bank (banca del latte umano donato, BLUD) in Treviso.

METHODS

The data gathered refer to the years 2003, 2004 and 2005. In particular the hygiene methodology is described in order to obtain a high-quality product from a clinical point of view which is in line with the recent norms regarding the management of food products.

RESULTS

During the three-year study 5,647 L of milk were collected (on average: 155 L/month; 5 L/day). Seventy-two percent of breast milk collected was from mothers for their own children; the remaining 28% of milk was from ''donors for the pool''. In the same period 5,053 L of milk was pasteurised and distributed (pool=31%; frozen breast milk=61%; chilled unpasteurized breast milk =8%). Microbiological data show total effectiveness of the methods of pasteurisation used (Holder method). The tracking of the product is possible through the BLUD organisation.

CONCLUSION

We propose: 1) that scientific organisations and legislators try to optimise the control of this important product by providing guidelines, indications, microbiological parameters and legal obligations for the correct continuation of the work carried out by BLUDs; 2) that BLUDs create a network for rapid communication, integration and possible collaboration; 3) that a study be carried out regarding BLUDs and population density in order to balance costs and benefits.

Incidence and risk factors for central nervous system (CNS) metastases in HER2-positive (HER2+) metastatic breast cancer (MBC) patients (pts)

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Background: Recently, an increased incidence of CNS metastases in HER2+ MBC has been reported. Aims of the observational study were to evaluate the incidence and risk for CNS metastases in HER2+ MBC pts. Methods: We reviewed the occurrence of CNS metastases in 122 consecutive HER2+ MBC pts treated with chemotherapy (CT) and trastuzumab (T)between April 1999 and June 2005. Patient characteristics included: median age 48 yrs (28–79); G3 in 58.1%;ER- in 53.2%; DFS <24 mos in 48.3% and ≥24 mos in 51.7%. Visceral metastatic disease was dominant site of relapse in 67.2% of the pts. T+CT represented the 1st line of treatment in 54% of pts, 2nd line in 28.6% and ≥3th line in 17.2%. Results: At median follow up of 28 mos (2–167) from the occurrence of metastatic disease, 43 pts (35.2%) developed CNS metastases, confirmed by CT or MRI scanning. In 42 pts were present one or more parenchymal brain metastases and in 1 pt leptomeningeal carcinomatosis. Neurological symptoms were present in 90% of pts. Out of the 43 pts developing CNS metastases, 37.2% were in response in other metastastic sites and CNS represented the only site of progression. Median time of occurrence of CNS metastases (from diagnosis of metastatic disease) was 12 mos (0–78).Using the presence/absence of CNS metastases as dependent variable in logistic regression analysis, we obtained that age (p = 0.020) and visceral metastases (p = 0.024) were significantly associated with increased risk of CNS metastases. Panencephalic RT was given in 31 out of 43 pts; 16 pts (37.2%) received T ± further CT and 18 pts (41.8%) only cytotoxic CT. Median OS was 51.2 mos (1.9+-167.4) in the all population. Median OS was 35 mos (4–105) in pts with CNS metastases; at the present analysis median OS has not been reached in pts without CNS metastases (p = 0.002). Conclusions: CNS metastases is common, late event in the natural history of HER2-positive MBC. Age and visceral metastases were significantly associated with increased risk for CNS metastases. Clinical trials are indicated to evaluate:1) any clinical, pathological and molecular risk factors for CNS metastases; 2) if there is indication to specific treatment in a population at high risk of CNS metastases.

No significant financial relationships to disclose.

Transesophageal atrial pacing in the management of re-entry supraventricular tachyarrhythmias occurring during general anesthesia

BACKGROUND

Supraventricular tachyarrhythmias (SVTs) represent an intraoperative risk factor that should be always prevented/managed. The commonly used anti-arrhythmic drugs are accompanied by intrinsic hazards, such as pro-arrhythmic and toxic effects or unpredictable onset and duration of action. We underline the therapeutic use of transesophageal atrial pacing (TAP) for the interruption of particular re-entry SVTs occurred during surgical procedures in general anaesthesia.

METHODS

Our study was carried out in 25 patients characterized by a personal clinical history of transient tachyarrhythmic episodes, subjected to general anaesthesia obtained by midazolam, propofol, N2O e O2, sevoflurane, fentanil and vecuronium bromide. We used TAP bursts of 3-5 sec, their minimal pacing rate being equivalent to the tachyarrhythmia cycle length, with an impulse intensity ranging from 18 to 25 mA. In such conditions, the re-entry was interrupted by the induction of refractoriness of the wave-front that sustained the underlying arrhythmogenic circuit.

RESULTS

During the study, the following arrhythmias occurred in 7 out of all patients: 1 type I atrial flutter, 3 nodal tachycardias, 1 antidromic and 2 orthodromic atrioventricular tachycardias, respectively. TAP assured either atrial capture or prompt suppression of arrhythmias in all cases. Low intensity impulses did not ever allow ventricular capture.

CONCLUSIONS

TAP can be considered as a valid therapeutic device for the management of re-entry SVTs occurred during general anaesthesia, resulting it effective, safe and easy-practicable.

Gemcitabine, ifosfamide, cisplatin (GIP) for the treatment of advanced non-small cell lung cancer: a phase II study of the italian oncology group for clinical research (GOIRC)

The purpose of this study was to evaluate the activity and the toxicity of the combination of gemcitabine with ifosfamide and cisplatin (GIP) in chemonaive patients with advanced non small cell lung cancer (NSCLC). Eighty chemonaive patients with Stage IIIB-IV NSCLC were treated with the combination of gemcitabine 1 g/m(2) on Days 1 and 8, ifosfamide 2 g/m(2) on Day 1 and cisplatin 80 mg/m(2) on Day 2. Cycles were administered on an outpatient basis every 3 weeks. Hematologic toxicity was the main side effect; Grade III-IV thrombocytopenia was observed in 54 (67%) patients and Grade III-IV leucopenia in 44 (55%) patients, with 4 episodes of febrile neutropenia and 1 toxic death. Thirteen patients received platelet transfusions and 38 were transfused with packed red cells. All patients were evaluable for response. The overall response rate was 54% (95% confidence interval 43 to 65%) with 1 complete response. In patients with Stage IIIB and IV disease, response rates were 58% and 52%, respectively. Median time to progression was 40 weeks (range 0-114) and median overall survival was 12 months (16.6 months for stage IIIB and 10.4 months for stage IV). Median and minimum follow-up were 19 and 12 months, respectively. The GIP combination shows a response rate and overall survival of clinical interest. Hematologic toxicity was the main toxic effect, especially in patients with low performance status. This regimen will be tested in a Phase III randomized trial.

"Sporadic" dystrophic epidermolysis bullosa: a new dominant or mitis recessive mutation?

We describe a case of dystrophic epidermolysis bullosa which occurred in a young boy who presented thickened and dystrophic nails both in hands and feet, atrophic scars on the elbows and knees, some large bullae and milia on the hands and ankles. The parents were clinically unaffected and the family medical history was negative for blistering disease. The immunofluorescence for type VII collagen was positive, yet low in intensity and the number of anchoring fibrils was reduced, as revealed by transmission electron microscopy. The diagnosis of a "sporadic" case of dominant dystrophic epidermolysis bullosa was suggested, although a mitis case of recessive dystrophic epidermolysis bullosa cannot be excluded on the basis of clinical, immunofluorescent and ultrastructural examination. However recent studies, carried out in a series of seemingly sporadic cases, have pointed out the possibility of inheritance of two mutant alleles from unaffected parents. This implies that 'mild' recessive dystrophic epidermolysis bullosa is commoner than once thought. This information is important for genetic counselling and determination of recurrence risk in the present and future generations.

Losses of hemifield contrast sensitivity in patients with pituitary adenoma and normal visual acuity and visual field

OBJECTIVE

To detect early losses of contrast sensitivity (CS) in patients with pituitary adenomas, before the occurrence of visual acuity and visual field defects.

METHODS

CS has been evaluated in both hemifields of 28 patients with different kinds of pituitary adenoma (mainly intrasellar) and normal visual acuity and visual field, as well as in 15 age-matched controls. Two different stimuli were used: a coarse (0.3 c/deg) dynamic (10 Hz) grating and a finer (2 c/deg) static grating.

RESULTS

On average, CS and/or hemifield asymmetry were reduced in patients, whereas perimetric sensitivity was normal. CS losses were more frequent for 2 c/deg static-, as compared with 0.3 c/deg, 10 Hz stimuli. However selective losses for either stimuli were also found. CS losses did not correlate with anatomical measurements (size, chiasm involvement) of tumors as established by MRI scans.

CONCLUSIONS

CS evaluation may provide a simple and effective tool for early detection and monitoring of visual dysfunction in patients with pituitary adenoma. The lack of correlation between CS losses and chiasm involvement suggests causes different from chiasmal compression for visual dysfunction.

Minor psychiatric disorders as possible complication of mental retardation

In young adult life a large proportion of mentally retarded subjects develop psychiatric complications, both severe and mild, whose origin is undoubtedly multifactorial (biological and psychological). A series of 27 subjects (13 male, 14 female; mean age 27.6 years) with IQ ranging from 70 to 40 were studied in our Institute from 1994 to 1995 and followed up 1 and 2 years later. Paykel scale (life events), FACES III (type of family insight), MFFT and Watkin's test (cognitive styles) were used to evaluate all cases. We found that (1) minor disorders prevailed in mild and moderate mental retardation and severe disorders in profound mental retardation; (2) minor disorders were generally determined by psychological and environmental factors although biological ones may have an important role; (3) psychological factors prevailed in young adult life when the subject had to cope with relatively harder tasks, and (4) the prognosis is generally good if proper care is given.

Bolus versus 5-day continuous infusion of cisplatin with mitomycin and vindesine in the treatment of advanced non-small cell lung cancer (NSCLC): a phase III prospective randomised trial of the Italian Oncology Group for Clinical Research (GOIRC)

The aim of this randomised trial was to compare the efficacy of bolus versus continuous infusion cisplatin combined with mitomycin C and vindesine (MVP) for chemotherapy-naive patients with stage IIIB-IV non-small cell lung cancer (NSCLC). 97 patients (49 given bolus cisplatin-arm A and 48 given continuous infusion cisplatin--arm B) were evaluable for response. In arm A, 2 patients achieved a complete response (CR), 21 achieved a partial response (PR), whilst in arm B, 14 patients achieved a PR (29%) (P = 0.07). Median survival was 8 months in both arms. Myelosuppression was the most frequent and severe toxicity, with a higher incidence of grade 3-4 leucopenia in arm A when compared with arm B (44% versus 25%). In conclusion, there is no advantage for a cisplatin 5 day infusion in the MVP regimen.