Role of the Combination of Cyclin-Dependent Kinase Inhibitors (CDKI) and Radiotherapy (RT) in the Treatment of Metastatic Breast Cancer (MBC): Advantages and Risks in Clinical Practice

Targeting cell cycle has become the gold standard for metastatic breast cancer (MBC), being cyclin-dependent kinase inhibitors (CDKIs) cornerstones of its treatment, alongside radiotherapy (RT). To date, no definite evidence regarding safety and efficacy of the combination of CDKIs plus radiotherapy (RT) is currently available. Purpose of this review is to collect data in favor or against the feasibility of the association of CDKIs + RT, describing its potential adverse events. Our review shows how CDKI + RT allows an overall satisfying disease control, proving to be effective and causing a grade of toxicity mainly influenced by the site of irradiation, leaning to favourable outcomes for sites as liver, spine or brain and to poorer outcomes for thoracic lesions or sites close to viscera; controversial evidence is instead for bone treatment. Toxicity also varies from patient to patient. To sum up, our contribution enriches and enlightens a still indefinite field regarding the feasibility of CDKIs + RT, giving cues for innovative clinical management of hormone-responsive MBC.

[Safety and tolerability of psychotropic medications in childhood: preliminary data of a pharmacovigilance study]

AIM

The aim of this study was to evaluate adverse drug reactions (ADRs) of psychotropic medications in childhood.

METHODS

One hundred and two children and adolescents (M 82.4%, F 17.6%) followed-up at the Division of Child Neurology and Psychiatry at the University of Messina, and at the Scientific Institute Child Neurology and Psychiatry, IRCCS Stella Maris, Calambrone, Pisa, were recruited between January 2009 and December 2011. All participants met DSM-IV diagnostic criteria for psychiatric disorders. The data were collected using a recording sheet for ADRs. An electronic database was also used. The recording sheet was designed to note all relevant information about drug treatment and ADRs according to AIFA (Agenzia Italiana del Farmaco) suggestions.

RESULTS

The most prescribed drugs were: risperidone (19.6%), aripiprazole (18.4%) and valproic acid (14.8%). The ADRs more frequently recorded had been: weight gain (12.6%), sleepiness (8.4%), and irritability (6.7%). None of recorded ADRs were classified as "serious".

CONCLUSION

This study can provide a basic model to collect information on safety and tolerability of psychotropic drugs in childhood.

Aripiprazole in children with multiple-complex developmental disorder (McDD): a case series

Introduction

Multiple-complex Developmental Disorder (McDD) is a developmental disorder characterized by peculiar clinical features: affective dysregulation (anxiety, panic and aggressivity), impairment of social behaviour and hypersensitivity, impaired cognitive processing. McDD is usually included within the Pervasive Developmental Disorders not otherwise specified (PDD NOS) (Cohen et al. 1986; Towbin et al. 1993). Aripiprazole is a new atypical antipsychotic drug. Efficacy of aripiprazole in children and adolescents is supported by some studies (Findling et al. 2007, Wink at al 2010; Kim et al 2010).

Aims

The aim of our study is to describe the efficacy and safety of aripiprazole in 4 children with Multiple-complex Developmental Disorder.

Methods

Mean dosage of aripiprazole was 5 mg/day. Response was evaluated by clinical assessment and by Clinical Global Impressions Scale-Severity, Clinical Global Impressions Scale- Improvement, Children's Global Assessment Scale (CGAS) and by Brief Psychiatric Rating Scale. This assessment was administered at baseline, and at weeks 4, 12 and 24.

Results

A significant reduction of social impairments, thought disorders and affective dysregulation was observed. Drug therapy was well tolerated, even though children complained of mild and transient nausea and somnolence.

Conclusion

To date there are only a few reports on the use of aripiprazole in McDD patients. The present case series suggest that aripiprazole may be effective and well tolerated in McDD patients.

A survey on planning, expectations and factors influencing the stabilization process of migrating people in Palermo, western Sicily

BACKGROUND

Europe constitutes a major pole of attraction for the migratory fluxes. The migrating population is made up of many different individuals, carrying different projects of life and expectations. The consistence of the phenomena, in few decades, will be responsible for deep changes in the demographic structure of the European population. The purpose of this investigation was to attempt to draw an identikit of migrating people and to evaluate those factors which may be considered important to positively influence the process of stabilization. Moreover, the research tried to evaluate the differences among those migrating people who have recently arrived, still considering this country as a landing shore, and those who have definitely settled in Sicily.

METHODS

The research was carried out through a 42 items multiple choice answer questionnaire administered to two groups of individuals who were born in a non European Union (EU) country. Individuals, who were still trying to settle (group A), were chosen at random in the streets of the city, while individuals with a solid and integrated family were chosen at random from the municipality of Palermo, Sicily. To compare the two different groups of individuals Student's t and Chi square tests were used together with standard descriptive statistics and linear regression analysis.

RESULTS

Results seem to indicate that positive factors for integration are years of residence in the same place, support from the family since the very beginning of the migratory project, stable interethnic social structure. What did not seem to constitute determining factors in the territory analysed are: age, gender, country of origin, religion. Higher education levels apparently play a negative role. Child bearing indexes are higher than European levels. Birth rate was use in the attempt of modelling a projection of population growth.

DISCUSSION

The collected data brings forth the snapshot of the typical immigrant as a young strong healthy individual, longing to start a family on safe values, who accepts transitory precarious living conditions in order to improve them. The major negative factors in the migratory project are those of social nature. Governments have generally adopted a politics of control on entry and of managing the emergency. There is a need for a politics of empowerment and exploitation of the capacity of the migrants. Deep changes occurring in the demographic structure of the European population might influence the social contest. Decrease European birth rate and increasing immigration may create a melting pot, where Europeans may take a role of an endangered species.

Association of Trp53 polymorphic variants at codon 72 with nonsyndromic mental retardation

Mental retardation is the most common developmental disability affecting 2-3% of the population, a consequence of a wide range of genetic or nongenetic etiologic factors. The cause of mental retardation remains unknown in about 50% of cases. Trp53 (transformation related protein 53, also known as p53) is a tumor suppressor gene that activates the expression of genes involved in inducing growth arrest of cells in response to multiple forms of cellular stress and it plays a significant role in apoptotic cell death during the early development of the nervous system. In this study, we examined 246 children with nonsyndromic mental retardation from three Italian populations and 213 healthy children from the same populations. We observed that the Pro72/Pro72 genotype of p53 is much less represented in children with nonsyndromic mental retardation than in controls (6.5% versus 14.08%) (OR=0.42; 95% CI 0.21-0.83). These data suggest that subjects carrying the Pro allele are protected from this disease.

[Neurobiology of autism: Study of a sample of autistic children]

AIM

Recent studies on the neuroanatomic, neurofunctional and/or neurochemical features of the autistic disorder (AD) gave many evidences suggesting the hypothesis that different organic factors may lead to a disruption of the cerebral development finally expressing with an autistic pattern. The aim of this study was to study a sample of subjects with AD with a wide protocol, including neurophysiological and radiological investigations as well as laboratory investigations in order to investigate the neurobiologic basis of the syndrome.

METHODS

The patients group included 80 subjects diagnosed as having AD. All were examined with a protocol of investigations including: brain MRI; wakefulness and sleep EEG; VEP, ABR; karyotype and search of the fragile X; serum and urinary levels of serotonin, catecolamines, omovanillic acid, aminoacids, ammonium, lactic acid, creatine kinase, piruvic acid, calcium, uric acid, total proteins, antibodies against neurotrophic agents.

RESULTS

Eighty-eight percent of subjects had at least one pathologic neurobiological parameter.

CONCLUSIONS

This study highlights the different noxae involved in the etiopathogenesis of AD and the percentage that every biological factor has in the development of the autistic phenotype. Furthermore, it confirms that AD corresponds to an atypical behavioural phenotype expression of a cerebral dysfunction with heterogeneous etiology.

Tumour morphology as a predictor of outcome after local excision of rectal cancer

BACKGROUND

The aim of this study was to determine whether the morphology of rectal cancer predicts outcome following treatment by local excision, and whether morphology should therefore be added to the criteria presently used for case selection.

METHODS

The hospital notes and histological findings of 91 patients who had undergone a local surgical procedure for rectal cancer were reviewed retrospectively. Eight patient and tumour characteristics including morphology were analysed with respect to 5-year survival, local recurrence and cancer-specific death within 5 years. Morphology was divided into four types: polypoid, sessile, ulcerated and flat raised.

RESULTS

Survival and local recurrence were significantly better for patients with exophytic (polypoid and sessile) carcinomas than for those with non-exophytic (ulcerated and flat raised) lesions. Multivariate logistic regression analysis showed that age, depth of invasion, lymphatic invasion and venous invasion were significant predictors of outcome. The exophytic group included significantly more stage T1 and fewer T2 and T3 cancers, and a significantly smaller proportion of tumours that showed venous and lymphatic invasion than the non-exophytic group.

CONCLUSION

Morphology is a clinical guide to prognosis after local excision. Non-exophytic cancers are associated with high-risk histopathological features that render tumours of this type unsuitable for local excision.

Motor and perceptual-motor competence in children with Down syndrome: variation in performance with age

The aim of this study was to determine whether perceptual-motor competence in school-age children with Down syndrome was generally delayed or varied as a function of type of action. Twenty-two children with Down syndrome (13 males, 9 females), aged between 4.5 and 14 years were assessed on two standardized tests, the Movement Assessment Battery for Children (Movement ABC), a test of motor competence assessing gross and fine motor coordination, and on the Developmental Test of Visual-Motor Integration, a test focusing on shape copying. In order to obtain a profile of each child's performance on the different items contained in the Movement ABC, the test was used in its extended form. This involves testing any child who failed an item appropriate for his/her level, at progressively lower levels until a base-line measure was obtained. All the children obtained scores below the 5th percentile for their age on both tests. However, superimposed on this delay, we found distinct variation as a function of task. Whereas some aspects of gross motor function showed age development with delayed but regular acquisitions, all the aspects of fine motor skills assessed were more severely impaired and showed little development with age. Accuracy and timing of tasks requiring bimanual coordination were most impaired in our sample while balance and ball skills showed more variability. These results suggest that intervention in the motor domain should be varied according to each child's particular profile of performance.

[Transposition of the omentum to the thigh, for the vascular salvage of a limb. Apropos of 17 cases]

A new procedure to supply effective anastomotic blood supply via the omentum transpositioned to the hip in cases of impaired lower limb vascularization was proposed in 16 cases of stage III and stage IV obliterative artherosclerosis including one case of massive venous thrombosis. The results demonstrated that under rigorously controlled fundamental conditions, circulation can be established and the limb can be saved. 1--good omentum vascularization is essential: the two gastroepiploic arteries must have a large caliber and form a complete anastomotic circle. 2--After disconnecting the omentum from the stomach, while carefully protecting the gastro-epiploic arcade, one pedicle is sectioned and the other is saved depending upon the side the omentum is transpositioned. It is best to save the right pedicle which has a stronger flow even for the left limb. If the omentum is ample enough, the anatomic situation does not require a lengthening plasy. 3--If the omentum is insufficiently long, it is lengthened by a second counter-section between the two gastro-epiploic and epiploic arcades. The ends of the arcades can thus be placed in direct contact forming a unique continuous arcade. This plasty is only possible if the anastomotic circle of the gastro-epiploic arcade is complete. 4--Transposition to the hip is made by including the omentum between the rectus and its posterior sheath through a newly formed channel widening the crural canal. The omentum is thus incorporated as a bridge forming a major circulatory route between the subclavian artery and the pelvic and lower limb arteries. 5--We recommend transpositioning the omentum after lumbar sympathectomy to favour strong vasodilatation and lower flow resistance helping create favourable conditions for the new anastomotic circulation. 6--Based on these specific conditions, we have had excellent results in 80% of the cases for the entire life-span of the patients who underwent the operation. The two cases with poor results occurred after a major technical error due to a lengthening plasty on an omentum without a complete gastro-epiploic arcade.

[Biliary ileus. Our experience]

Personal surgical experience of 7 cases of typical gallstone ileus and 2 cases of Bouveret's syndrome secondary to spontaneous bilio-digestive fistula of lithiasic aetiology are reported. After analysing the problems inherent in the clinical picture and the diagnostic protocol, stress is laid on the therapeutic strategies employable in the event of typical gallstone ileus. It is concluded that single stage correction of the bilio-digestive occlusion and fistula is always preferable except in patients whose general condition is very poor. Patients should initially be submitted to treatment of intestinal occlusion alone.

Immunohistochemical localization of chondroitin sulfate in normal and pathological human muscle

The immunohistological localization of chondroitin sulfate (CS) has been studied in normal and pathological human muscle. The bovine nasal cartilage proteoglycan digested with chondroitinase ABC (BNC-PG-Ch ABC) has been utilized for the production of a rabbit polyclonal antiserum. In vitro studies showed that the antiserum binds to the unsaturated disaccharide that remains attached to the core protein after digestion of the CS chains with chondroitinase ABC (Ch ABC). As the disaccharide is created specifically by Ch ABC digestion of the CS chains, the antiserum allows the immunolocalization of CS on tissue sections digested with Ch ABC. The immunohistochemical study on normal and pathological muscle demonstrated a localization of CS in all the extracellular structures: endomysium, perimysium, muscle spindle capsule and intrafusal space. In pathological conditions, the CS was raised in all the cases with increased connective tissue, showing a pattern comparable to that obtained with fibronectin and collagen III. None of the pathological conditions displayed any peculiar character of CS distribution. This finding does not support a primary role for CS in the pathogenesis of muscular dystrophy.

Quantitative analysis of quadriceps muscle biopsy. Results in 7 definite and 45 possible carriers of Duchenne muscular dystrophy

Quadriceps muscle biopsy was performed in 7 definite and 45 possible carriers of Duchenne muscular dystrophy. Unequivocal morphological changes were observed in 8 women; all but one of them were already detected as carriers by increased serum CK. Histometric analysis of muscle biopsy was performed on two fibre types (type 1 and type 2) in all 52 women; in 38 of them the two subgroups of type 2 fibres (type 2a and type 2b) were also quantified. Results of histometric analysis were matched with control values obtained from 30 healthy females in the same age as the carriers (20-50 yr). Histometric analysis on two fibre types detected a percentage of carriers (27%) much lower than that detected by serum CK determination (44%). The detection rate of combined serum CK determination and histometric analysis of muscle biopsy was: 100% in definite carriers, 65% in mothers possible carriers, 38% in sisters and 25% in the group of cousins and aunts. The histometric parameters most frequently altered were atrophy factor and variability coefficient of mean diameter. Histometric analysis carried out on three fibre types in 38 women detected 2 more carriers showing atrophy of type 2b fibres. The results indicate that quantitative analysis of muscle biopsy may be used to detect some possible carriers with normal serum CK. However, an adequate number of controls is mandatory; in fact the detection rate of histometric analysis of muscle biopsy decreased by increasing the number of controls, resulting much lower than previously reported.

[Unusual case of urogenital anomaly]

A case of associated malformation of the urogenital apparatus, right renal aplasia associated with uterus unicornis with the second uterine duct being independent of the first and located in the corner of the right iliac vessels, in reported in a woman of 41. Three pregnancies had all terminated regularly with live foetus born from eutocic delivery. The unusual nature of the case is insisted on and it would not seem possible to include it in any of the five classes established by Musset et al.

[Intraoperative peritoneal lavage in generalized acute peritonitis. Experience with 61 cases]

After wide preface about peritoneal anatomy, pathological, physiology and physiopatology and about the physiopatology of general acute peritonitis, a case records of 61 patients is produced. All the patients were shocked and urgently operated for general acute septic peritonitis and were abundantly washed with a polisaline solution during the operation. That washing technique is described and the authors remark its abundancy (at least 10-12 litres) and its systematicity. They also remark that the washing is the true and main moment of the reanimation and it is the most important salvage action in the general acute peritonitis. The antibiotical therapy, especially the topical one, and the drainage are only complementary elements in the treatment. Among 61 patients, with an average of 54 years, there were eight deaths (13%) in old patients, with an average of 71 years and they were all caused by cardiac and circulatory disease. No patient died for peritonitis or for toxic-infections causes. The postoperative morbility (eight patients-13%) was mainly caused by the infection of the laparotomy and it only prolonged some days the stay in hospital.

[Surgery in the prevention and treatment of intestinal occlusion caused by adhesions. Reymond's method of enteropexy. (Experience with 69 cases)]

The state of the art with regard to surgical management in the prevention and treatment of intestinal occlusion caused by adhesions is described and the various operations proposed are examined. Noble's operation (folding and overcast suture of the intestinal loops)-the first to be proposed requires too much time for its execution. In addition, it restricts loop mobility and thus predisposes to recurrences and complications. The operation of Childs & Philips (folding of the intestine by accordion attachment of the mesentery with transfixing, looped wires) is quicker, but its wires result in a certain degree of vascular and enteric affection. Folding via intubation of the whole of the small intestine with a long catheter, using a nasogastric, gastrostomic or jejunostomic route, is both simple and rapid. It is particularly advisable in non-peritonitic obstruction in children and as a prophylactic measure. Reymond's operation (enteropexy with two simple and fundamental, lateral "virage" sutures) may be segmentary or total, or confined to a few loops. It is very simple and quick. It can always be used and is adaptable to the objective situation in each case. Personal experience with this operation in 69 cases (54 "therapeutic" and 15 "prophylactic") is presented. Two instances of recurrence due to poor technique were noted. It is felt that the operation is extremely satisfactory.