TEMPus VoLA: The timed Epstein multi-pressure vessel at low accelerations

The field of planetary system formation relies extensively on our understanding of the aerodynamic interaction between gas and dust in protoplanetary disks. Of particular importance are the mechanisms triggering fluid instabilities and clumping of dust particles into aggregates, and their subsequent inclusion into planetesimals. We introduce the timed Epstein multi-pressure vessel at low accelerations, which is an experimental apparatus for the study of particle dynamics and rarefied gas under micro-gravity conditions. This facility contains three experiments dedicated to studying aerodynamic processes: (i) the development of pressure gradients due to collective particle-gas interaction, (ii) the drag coefficients of dust aggregates with variable particle-gas velocity, and (iii) the effect of dust on the profile of a shear flow and resultant onset of turbulence. The approach is innovative with respect to previous experiments because we access an untouched parameter space in terms of dust particle packing fraction, and Knudsen, Stokes, and Reynolds numbers. The mechanisms investigated are also relevant for our understanding of the emission of dust from active surfaces, such as cometary nuclei, and new experimental data will help interpreting previous datasets (Rosetta) and prepare future spacecraft observations (Comet Interceptor). We report on the performance of the experiments, which has been tested over the course of multiple flight campaigns. The project is now ready to benefit from additional flight campaigns, to cover a wide parameter space. The outcome will be a comprehensive framework to test models and numerical recipes for studying collective dust particle aerodynamics under space-like conditions.

SERENA: Particle Instrument Suite for Determining the Sun-Mercury Interaction from BepiColombo

The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.

Digital epidemiology: assessment of measles infection through Google Trends mechanism in Italy

INTRODUCTION

The primary aim of this study is to evaluate the temporal correlation between Google Trends and the data on measles infection arising from the conventional surveillance system, reported by the Istituto Superiore di Sanità's (ISS) bulletin. Moreover, this study is also aimed at forecasting the trends of the reported infectious diseases cases over time.

MATERIAL AND METHODS

The reported cases of measles were selected from January 2013 until October 2018. The data on Internet searches have been obtained from Google Trends; the research data referred to the first 48 weeks of year 2017 have been aggregated on a weekly basis. The search volume provided by Google Trends has a relative nature and is calculated as a percentage of query related to a specific term in connection with a determined place and time-frame. The statistical analyses have been performed by using the Spearman's rank correlation coefficient (rho). The statistical significance level for such analyses has been fixed in 0.05.

OUTCOMES

We have observed a strong correlation at a lag of 0 to -4 weeks (rho > 0.70) with the cases reported by ISS with the strongest correlation at a lag of -3 weeks (rho > 0.80 both for measles than for the symptoms of the measles). The database containing monthly data has shown a moderate correlation at a lag of -1 to +1 months and a strongest correlation at a lag of -1 (rho = 0.6152 for measles and rho = 0.5039 for symptoms of the measles).

CONCLUSIONS

The surveillance systems based on Google Trends have a potential role in public health in order to provide near real-time indicators of the spread of infectious diseases. Therefore the huge potential of this approach could be used in the immediate future as a support of the traditional surveillance systems.

Active immunization status against measles, mumps, rubella, hepatitis B in internationally adopted children, surveyed at the university hospital of Palermo, Sicily

INTRODUCTION

The internationally adopted child is a fragile subject who often shows an incomplete health documentation, which hinders the complete assessment of health status.

MATERIALS AND METHODS

Between January 2010 and June 2016, at the University Hospital "AOUP P. Giaccone" of Palermo, we reviewed the health documentations of 111 children recently arrived in Italy following the conclusion of the international adoption procedure. 62.2% of the children were male, of various nationalities and with an average age of 7 years (± 3.4). This study aims to detect, in the observed sample, the reliability of the vaccinal documentation and the real acquired immunization. We intend to estimate the presence of IgG against Measles, Mumps, Rubella and Hepatitis B viruses.

RESULTS

Percentages of subjects with a complete correspondence between documentation attesting the successful vaccination and the effective immunization were: 78% for measles, 66% for mumps, 84% for rubella, 71% for hepatitis B. Percentages of subjects without vaccinal documentation but with positive evidence of IgG were: 50% for measles, 38% for mumps, 71% for rubella, 50% for hepatitis B.

CONCLUSIONS

The partial correspondence found between vaccinations performed and real immune status can be attributed to several reasons: poor reliability of the received health documentation, the complex economic situation of the health services in the countries of origin, the incorrect vaccines storage or the administration beyond the expiration date, the poor immunological response due to concomitant diseases or severe malnutrition, the probable non-administration of the expected booster dose. Particular attention needs to be paid to this population, which may represent a risk group susceptible to vaccine-preventable diseases.

P2866Automated ultrasound ablation parameters predict lesion depth in a perfused thigh model

Background

The accuracy and safety of lesions created during catheter ablation of cardiac tissue rely on the user's ability to predict the size of lesions that form under variable conditions during treatment. A user-directed robotic system was developed that uses Low-Intensity Collimated Ultrasound (LICU) for cardiac imaging and to produce linear lesions without tissue contact. Molecular absorption of mechanical energy induced in the tissue by LICU causes a temperature rise resulting in thermal tissue necrosis.

Purpose

By varying the speed of the LICU beam as it traces the desired lesion path, while considering the beam intensity, distance from catheter tip to tissue, and relative motion of the target tissue, we demonstrate the capability to deposit lesions of known depth according to a predictive model.

Methods

The LICU catheter was mounted in a servo-controlled, 3 axis stage suspended above a perfused porcine thigh that simulates the thermodynamic properties of the myocardium such as acoustic attenuation, thermal conduction, and specific heat capacity. Therapy was delivered along a linear path while varying the distance to tissue, speed of the beam, and motion of the catheter relative to the tissue in 3 dimensions. Programmed relative motion was representative of typical and extreme motion in humans. Pathological analysis after necropsy was used to quantify lesion depth which was then compared to lesion depth as predicted by a mathematical model from approx. 4–12 mm.

Results

Data from 66 samples were categorized according to typical and extreme motion at 4 different distances (3, 8, 9 and 13 mm). Measured vs predicted lesion depth was well correlated (R = 0.898) with 98.5% of the samples within ±2 mm.

Assessment of LICU lesion depth

Conclusion

Lesion depth using LICU is well controlled in an animal model for the range of distances and relative motion typically encountered in a human subject. The range of acoustic beam speeds and acoustic power density with LICU predictably produces lesions up to 12 mm deep. The LICU thermal model may be useful to create lesions of known depth thus ensuring transmurality of lesions while potentially avoiding unintended extra-cardiac injury.

Therapeutic effect of RA223 in the management of breast cancer bone metastases

Radium 223 dichloride (Ra223) is the only targeted alpha therapy able to extend survival in patients with bone metastases from prostate cancer. Mechanism of action and data currently available focused mainly on osteoblastic metastases from prostate cancer. Phase 1 and 2 trials documented a clinical efficacy also in breast cancer patients with predominately bone disease, highlighting a reduction in alkaline phosphatase and other bone biomarkers. In our institution, a patient with breast cancer affected by osteolytic metastases was treated with off-label use of Ra223. Our patient had a good treatment compliance and up to now she has not been revealed the presence of SSE or hematological complications. Our preliminary experience shows that Ra223 may play a critical role to bone metastates in patients with breast cancer.

Hackathon Public Health

BACKGROUND

It is necessary to implement current teaching in the healthcare and university sector by promoting new tools for the enhancement of public health, bearing in mind that some health determinants seek to create a context in which to present their own idea of innovative Startup, can represent the opportunity to give your professional contribution to the development of another's idea or to propose an improved solution to the private business. On the other hand, networking with companies and networking between training participants will allow us to recognize the importance of demonstrating their diverse skills as a key element to create a successful Startup or to implement the activities of a reality already consolidated.

METHODS

This paper describes the research protocol of a Hackathon Public Health (HPH) teaching methodology aimed at: a) increasing public health knowledge; b) changing the proactive approach of the healthcare provider, especially by increasing the sectoral training activity; c) to promote educational and training activities in Italian regions. The subjects involved will be healthcare professionals (doctors, nurses, health professions, psychologists, biologists, assistants in training) who are selected to receive or not the intervention through the implementation of a HPH which also includes training activity.

CONCLUSIONS

HPH is an innovation in the national health landscape, with the aim of creating environments and training policies aimed at promoting proper clinical risk management as part of the continuous improvement of the quality of healthcare organizations and proper training activities.

Erratum to: Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

[This corrects the article DOI: 10.1186/s13017-016-0089-y.].

Epoxy-Montmorillonite Nanocomposites Applied to Powder Coatings

The wide range of applications associated with nanocomposites is due to their improved properties when compared to conventional composites. In this study, commercial epoxy-based powder coatings were formulated with 2 and 4% (w/w) of an organically modified montmorillonite (OMMT) by incorporation in the melt state (extrusion). These composites were characterized by thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), transmission electron microscopy (TEM) and X-ray diffraction (XDR). The thermal behavior and stability of the epoxy nanocomposites were studied by TGA and DSC. The nanoparticle structure within the polymer matrix was analyzed by XRD and TEM. A predominantly exfoliated structure was observed by TEM, which was confirmed by XDR analysis. The study demonstrated that the nanoclay increases the glass transition and crosslinking temperatures and also enhances the thermal stability of the coating.

Laparoscopic adhesiolysis: consensus conference guidelines

AIM

Laparoscopic adhesiolysis has been demonstrated to be technically feasible in small bowel obstruction and carries advantages in terms of post-surgical course. The increasing dissemination of laparoscopic surgery in the emergency setting and the lack of concrete evidence in the literature have called for a consensus conference to draw recommendations for clinical practice.

METHODS

A literature search was used to outline the evidence, and a consensus conference was held between experts in the field. A survey of international experts added expertise to the debate. A public jury of surgeons discussed and validated the statements, and the entire process was reviewed by three external experts.

RESULTS

Recommendations concern the diagnostic evaluation, the timing of the operation, the selection of patients, the induction of the pneumoperitoneum, the removal of the cause of obstructions, the criteria for conversion, the use of adhesion-preventing agents, the need for high-technology dissection instruments and behaviour in the case of misdiagnosed hernia or the need for bowel resection.

CONCLUSION

Evidence of this kind of surgery is scanty because of the absence of randomized controlled trials. Nevertheless laparoscopic skills in emergency are widespread. The recommendations given with the consensus process might be a useful tool in the hands of surgeons.

Impact of VEGF and CgA as new predictive tools in management of elderly hormone-refractory prostate cancer (HRPC) patients

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Background: Prostate cancer is one of the most frequent malignancy in men of the Western countries. The identification of new predictive factors of drug activity is crucial for elderly cancer patients, who need a particular selection according to prediction of efficacy and safety by pre-treatment parameters. Several prostate cancers show focal neuroendocrine (NE) spots and CgA seems to be associated to NE phenotype both in tissue and in circulation. VEGF expression in NE cells is corelated with clinical characteristics and disease-specific survival. Somatostatin analogues induce a decrease in plasma CgA and could have also anti-angiogenic activity by inhibition of VEGF, bFGF and GH/IGF-I axis. Methods: elderly patients, median age 75 (range: 65–83), were selected for hormone-refractory disease, previously treated with CAB. Serum PSA and plasmatic CgA and VEGF were evaluated in all pts at baseline (T0) and at 4 months (T4) and 8 months (T8) after therapy. Pts were treated with docetaxel 75 mg/m2 every 3 weeks for 6 cycles and octreotide acetate 20 mg administered intramuscularly every 4 weeks until progression. Clinical and biochemical response, progression- free survival and toxicity were also evaluated. A correlation of basal CgA and VEGF with biochemical response, clinical response and clinical benefit was also investigated. Results: Median duration of follow-up was 18 months (range: 8–32). Patients evaluable for response were 22. PSA response rate (RR) was observed in 10/22 (45%); clinical objective RR was 33% (7/22). Clinical benefit was observed in 19/22 pts (86%). Only mild toxicities was observed in both groups. CgA and VEGF were both strongly reduced after therapy. Lower CgA values correlated with clinical benefit, lower VEGF values also correlated with biochemical and clinical response. Conclusions: This combination treatment showed a good toxicity profile. The most relevant data in this study refer to the role of serum CgA and VEGF levels, for prediction of tumour response. If these findings were confirmed, it could be sufficient to measure these markers levels for identification of those HRPC patients who have more probability of obtaining clinical benefit from a docetaxel-based treatment in combination with a somatostatin analogue.

No significant financial relationships to disclose.

Herniated gravid uterus through an incisional hernia treated with the component separation technique

Herniation of a gravid uterus through an incisional hernia of the anterior abdominal wall is a rare but serious condition due to the potentially severe maternal and foetal risks. Because of the rarity of the condition, no consensus exists regarding the optimal treatment. The component separation technique (CST) has proven to be effective for the treatment of those giant abdominal hernias in which prosthetic material utilisation is not indicated. We report the case of a woman who presented at 38 weeks of gestation with non-reducible herniation of the pregnant uterus through an anterior abdominal wall incisional hernia treated with CST immediately after caesarean section. Review of the existing literature is performed to further underline the efficacy of CST and the need for the practising surgeons to be familiar with this technique and the scenarios when it may become extremely valuable.

Comparison between gemcitabine-based combination (G) and single-agent chemotherapy (S) for elderly patients (EP) with advanced non-small cell lung cancer (NSCLC): A literature-based meta-analysis

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Background: It was estimated that a quarter of all patients who have a diagnosis of NSCLC worldwide are more than 70 years old. This meta-analysis tries to shed light on the controversial results of phase III trials evaluating in NSCLC EP doublets against third generation S. Methods: We performed a literature search using MEDLINE and Cochrane Library. We selected only clinical trials responding to the question of our meta-analysis. Outcomes recorded were 1-year survival rate (1-y SR), overall response rate (ORR) and haematological toxicity (HT). Fixed-effects and random-effects models were used to calculate pooled odds ratios (OR). An OR greater than 1 indicates that doublet is more effective for 1-y SR and ORR and more toxic for HT. Results: Three published randomized controlled phase III trials (SICOG 9909; MILES; AISCAP-SICOG) were selected yielding a total of 1082 patients (G: 426; S: 655) clustered in seven comparisons. Drugs delivered to randomized patients included gemcitabine, vinorelbine and paclitaxel. EP treated with doublets showed respect to control patients a pooled estimate for 1-y SR advantage of 36%, not statistically significant (OR=1.356; 95% CI=0.925–1.990; p>0.05). The pooled estimate for ORR advantage was 57% and statistically significant (OR=1.559; 95% CI=1.220–2.015; p<0.05). However G showed not significant difference for HT (OR=1.168; 95% CI=0.685–1.992; p>0.05). Conclusions: These data confirm in EP superior efficacy and equal tolerability of G in comparison with S previously demonstrated for adult patients. Anyway G seems to not change prognosis of NSCLC EP. It is worthy to note that all the trials analysed showed some biases: early closure of the study, second-line therapy or crossover, lower dosage of drugs in combination regimen, inclusion of unfit or strongly comorbid patients. This meta-analysis doesn’t solve troubles in decision-making of treatment for EP, but suggest to design a better phase III trial including more patients and improving accrual criteria for reducing biases. An indication of a potentially active combination regimen (gemcitabine + paclitaxel) is suggested in SICOG 9909 trial.

No significant financial relationships to disclose.

Efficacy of weekly low-dose chemotherapy in elderly women with advanced ovarian cancer: is there an antiangiogenic effect?

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Background: In elderly patients decreased functionality of multiple organ systems may affect pharmacokinetics and pharmacodynamics of drugs. For this reason elderly cancer patients experience enhanced susceptibility to common chemotherapy-related adverse events. A way to prevent these effects could be metronomic chemotherapy, which is a variation of dose-dense therapy, with a cumulative dose significantly lower than maximum tolerated dose. Methods: 27 advanced ovarian cancer patients, median age 67 (range 60–86), received low dose weekly continuous chemotherapy until disease progression. All patients were treated with CBDCA AUC 2 mg/ml/min and Docetaxel 35 mg/sqm (adjusted according with Kintzel & Dorr formula) i.v. weekly. Primary endpoints were response rate (RR) and time to treatment failure (TTF). Moreover we considered as secondary endpoints toxicity profile, VEGF values and Quality of Life (QoL) score. RR and TTF were evaluated with RECIST criteria and Kaplan-Meyer formula respectively, toxicity was assessed according to the NCI-CTC. VEGF concentrations were analyzed by ELISA, QoL score was determined using the ADL/IADL and EORTC QLQ-C30 questionnaires, at baseline (T0) and at the end of therapy (T1). Results: median duration of treatment was 39 weeks. 2 Complete Responses (CR) and 5 Partial Responses (PR) were achieved for a 26% RR. Stable Disease was achieved in 18 pts (67%) with a total Clinical Benefit (CB) of 93%. Overall toxicity was very low: haematological G1/2 - 6 pts; gastrointestinal G1 - 8 pts; neurological G1/2 - 5 pts; cutaneous G3 - 1 pt; renal G1 - 1 pt. A mean TTF of 17.4 months was reached. Mean VEGF values (T0): 527 ± 35 pg/ml, (T1): 335 ± 18 pg/ml (p = 0,003). QoL score (T0): 45.2 ± 12, (T1): 47.5 ± 25 (p = 0,06). Conclusions: first results seem to be very encouraging, even if the number of responses is too small and we need to enrol more pts to reach a good statistical evaluation. Nevertheless the use of this “metronomic” schedule shows that VEGF values decrease strongly during the treatment and is maintained also when treatment is discontinued. Thus it suggests a preminent antiangiogenic role of this schedule according with the most recent preclinical and clinical studies.

No significant financial relationships to disclose.

Memory of multiple aging stages above the freezing temperature in the Relaxor ferroelectric PLZT

The dynamic dielectric susceptibility and the elastic compliance of the relaxor ferroelectric lanthanum lead zirconate titanate (PLZT) 9/65/35 have been measured under different cooling and heating protocols in order to study aging and memory. The memory of multiple aging stages at different temperatures has been found (several dips in the susceptibility curves on heating), as in spin glass systems below the glass transition. Remarkably, in PLZT the memory of several aging stages is retained also above the freezing temperature deduced from the dynamic susceptibilities. The results are discussed in light of the existing models of aging and memory in spin and dipolar glasses.

[Helicobacter pylori and gastric cancer. The incidence of infection in personal experience]

BACKGROUND

Helicobacter pylori is an identified carcinogen for gastric cancer, but the underlying mechanisms remain to be defined. The aim of this study is to analyze the incidence of Hp infection in our series of patients with gastric carcinoma.

METHODS

Between 1988 and 1998, 60 patients with diagnosis of gastric adenocarcinoma underwent partial or total gastrectomy. Forty-one were males and 19 females with an average age of 62 years (range 36-79). Twenty-seven cancers (45%) were localized in the lower third of the stomach, 17 (28%) in the middle third and eight (13%) in the upper third or cardias. In six patients (10%) the tumor was multicentric, while a recurrence on gastric stump after subtotal gastrectomy was present in two cases (3%). According to Lauren's criteria 39 cancers (65%) were of intestinal type, 16 (27%) of diffuse type and five (8%) of mixed type. The histologic preparations have been re-examined in order to verify the presence or not of Hp on gastric mucosa around neoplasm.

RESULTS

Hp was found in 35 (58%) of the analyzed specimens and therefore a significant percentage of patients was Hp-positive at the time of diagnosis and surgery. Between 35 Hp-positive samples, 24 were adenocarcinomas of intestinal type, nine of diffuse type and two of mixed type, with a prevalence of Hp in intestinal type cancer.

CONCLUSIONS

This study confirmed the high incidence of Hp infection in patients with gastric carcinoma, particularly in those with intestinal type cancer.

Primary diffuse malignant peritoneal mesothelioma: case report and update of therapy

BACKGROUND AND OBJECTIVES

Primary Diffuse Malignant Peritoneal Mesothelioma is a rare disease, with an incidence of 2.2 cases in 1. 000.000 in the USA. It occupies 10% of all mesotheliomas referred in literature.

METHODS

We describe a case of diffuse malignant peritoneal mesothelioma arising in a 54-year-old woman who presented a small bowel occlusion. A middle line laparotomy was done; multiple biopsies and an ileostomy were performed. There was not a history of exposure to asbestos. Histologic diagnosis was based on light microscopy, histochemistry, and immunohistochemistry.

RESULTS

Patient had no further treatment because of her poor general conditions. She died 4 months later.

CONCLUSIONS

Update of treatment is briefly described with particular attention to multimodality approach (surgery, chemotherapy, radiotherapy) and other new therapeutic options (iperthermochemotherapy, immunotherapy, gene therapy), currently in clinical trials.

[The immediate reconstruction of the breast after a mastectomy for carcinoma. Our experience]

The authors surgically treated 281 consecutive women with breast cancer by breast conservation techniques (45.2%) or by mastectomy (38.8%), during a four-year period. Forty-five of these 281 patients (16%) were treated in the same period of time by mastectomy and immediate reconstruction (IR) of the breast. IR of the breast was performed by inserting a submuscular tissue expander at the same time of mastectomy (first stage of reconstruction). A second operation allowed the replacement of the expander with a prosthesis (second stage of reconstruction) and the simultaneous symmetrization of the contralateral breast (not always performed, however). In some cases nipple-areola complex was eventually reconstructed with a delayed surgical procedure (third stage of reconstruction). In the present paper the authors analyze the results and outline the advantages of IR. This easy and safe technique slightly increased the average operative time of a mastectomy, did not interfere with routine oncological follow-up, did definitely reduce patient's psychological trauma following mastectomy. The authors conclude that IR of the breast undoubtedly plays a major role in the so called "onco-plastic"" surgical management of breast cancer.

[The sporadic use of intraoperative cholangiography during laparoscopic cholecystectomy]

The authors report their experience with 850 consecutive laparoscopic cholecystectomies performed from May 1990 to July 1997. In this series, despite a sporadic use of intraoperative cholangiography (IOC), there were no lesions of main biliary tract and there was only a biliary leaking cystic duct resolved with conservative treatment. The authors are satisfied with selective use of endoscopic cholangiography and sphincterotomy for the management of choledocholithiasis, and conclude that the use of IOC is not so essential to avoid iatrogenic lesions of main biliary tract, that could be avoid by applying a meticulous operative technique.

[Intracystic papillary carcinoma of the breast. Personal experience]

The Authors, on the base of three cases of intracystic papillary carcinoma of the breast, discuss about the diagnostic means and the modalities of treatment of such rare cancer. They stress the value of cytology by fine needle aspiration, which gives more detailed informations than mammography or ultrasonography. As far as the treatment concerns, the Authors, according to the data of the literature, suggest for this tumor, still at an "in situ" stage, a conservative surgical treatment such as a quadrantectomy or tumorectomy plus lymphadenectomy followed both by radiotherapy. Finally, they remark that the intracystic papillary carcinoma of the breast, mainly arising in old women (7th, 8th decade), was found within their series (two out of three) in young women in the 5th decade of life.

[A rare case of acute abdomen: perforated acute diverticulitis of the cecum]

The Authors report a rare case of perforated diverticulitis of the cecum. The patient was a 68-year-old man who was referred to the Authors attention with the classic symptoms of acute appendicitis. During laparotomy a perforated "omentum-sealed" diverticulum was found on the lateral wall of the cecum, whereas the appendix appeared to be completed unaffected. A right hemicolectomy was performed. The Authors analyse the similarities and peculiarity of the case. Special attention is drawn to the problems of differential diagnosis raised by this pathology. A preoperative diagnosis is arduous because the disease is difficult to distinguish from acute appendicitis and may be even difficult to distinguish it intraoperatively from a carcinoma of the cecum. There is no characteristic clinical pattern pointing to this diagnosis. Diagnostic maneuvers are usually unrewarding. Right hemicolectomy is a safe procedure when the diagnosis is doubtful.

[Bilateral adrenal pheochromocytoma. A clinical case and review of the literature]

The authors present a case of bilateral adrenal pheochromocytoma that occurred at their observation and surgically treated with a bilateral adrenalectomy. The authors review the literature in order to discuss the diagnostic and therapeutic option to treat these cases. They stress the importance of preoperative abdominal TC an MIBG scintigraphy and the importance of pre and intraoperative assessment to exclude extra adrenal localization of pheochromocytoma.

Cataract surgery in the patient with dementia: justified paternalism?

Paternalistic decision making for the incompetent patient involves many ethical and legal issues. In the ophthalmic surgery setting, cataract surgery on the patient with dementia is a potentially harmful act that requires justification on the part of the delegated decision maker. Does the potential outcome of improved vision outweigh the patient's right to self-determination? This discussion covers some of the moral, legal, and ethical issues to be considered in analyzing this dilemma.

A comparison of three theories of nursing used as a guide for the nursing care of an 8-year-old child with leukemia

This article evaluates three nursing theories that can be used to provide a framework for holistic pediatric oncology nursing practice: the Roy Adaptation Model, the Neuman Systems Model, and the Orem General Theory of Nursing. Each theory is compared in terms of its view of man, health, environment, nursing, and the nursing process. Critique of each theory is presented. The decision of which theorist to use as a basis for practice is left to the individual nurse. This article explicates the similarities and differences in the three theories.

The Roy Adaptation Model used as a guide for the nursing care of an 8-year-old child with leukemia

Roy's Adaptation Model provides a framework for holistic oncology nursing practice. In this article, an overview of Roy's model is provided. It is used to assess the behaviors and stimuli influencing the behaviors of an 8-year-old boy with acute lymphocytic leukemia. Planning and evaluating the nursing care of this child is based on the model. A comprehensive list of nursing diagnoses is categorized according to Roy's four adaptive modes, and a nursing care plan for two of these diagnoses is presented.

Nonanastomotic pseudoaneurysm of expanded polytetrafluoroethylene axillofemoral bypass graft

A case of nonanastomotic pseudoaneurysm of a unilateral axillofemoral bypass graft is reported. The graft material used in this particular instance was an 8 mm, reinforced, thin-walled, fluorinated ethylene-propylene-ringed, expanded polytetrafluoroethylene (ePTFE). The pseudoaneurysm occurred 1 year after insertion of the graft and was not associated with any direct trauma. It manifested with a painful tender mass at the top of the body of the axillofemoral bypass graft at the level of the nipple line. There were no symptoms of localized or diffuse sepsis. Immediate surgical exploration confirmed the diagnosis of a pseudoaneurysm of the ePTFE graft. Successful repair of the disrupted segment was accomplished by use of an interposition, nonringed, reinforced, thin-walled, 8 mm ePTFE graft. To our knowledge this is the first case of a nonanastomotic pseudoaneurysm of a ringed, ePTFE, axillofemoral bypass graft not associated with direct trauma.

Ruptured Baker's cyst causes ecchymosis of the foot. A differential clinical sign

Three consecutive patients with ruptured Baker's cysts, verified by duplex scan, were found to have ecchymosis on the dorsum of the foot. The appearance of ecchymosis can be helpful in differentiating a ruptured cyst from cellulitis or deep-vein thrombosis.

Orem's theory used as a guide for the nursing care of an eight-year-old child with leukemia

Orem's general theory of nursing provides a framework for holistic pediatric oncology nursing. In this article, an overview of Orem's theory is provided. The theory is used to assess the self-care deficits of an 8-year-old boy who has been diagnosed with leukemia, the ability of the mother to meet the son's self-care demands, and the nursing system needed to assist the mother to meet her son's self-care demands. The theory is used to plan and evaluate the nursing care of this child. A comprehensive list of nursing diagnoses and a nursing care plan for two of these diagnoses are presented.

Neuman systems model used as a guide for the nursing care of an 8-year-old child with leukemia

The Neuman Systems Model (NSM) provides a framework for holistic pediatric oncology nursing practice. In this article, an overview of NSM is given. This model is applied to an 8-year-old child with leukemia for the comprehensive assessment, planning, and evaluation of nursing care. A comprehensive list of nursing diagnoses is categorized by primary and secondary prevention.

Human monoclonal antibodies to glycolipid A that exhibit complement species-specific effector functions

Two human IgM monoclonal anti-glycolipid A antibodies (MAbs) were evaluated for their abilities to bind to various endotoxins and pathogenic gram-negative bacteria and to activate complement pathways, thereby accomplishing bactericidal and opsonic effector functions. Both MAbs cross-reacted with glycolipid A mutant lipopolysaccharides from rough colony-forming gram-negative bacteria and with selected endotoxins from smooth colony-forming bacteria. However, MAb 10235 bound to all clinical isolates of Escherichia coli and Klebsiella pneumoniae tested but only very weakly to Pseudomonas aeruginosa, whereas MAb 10058 bound to all three genera. Several strains of serum-insensitive organisms were selected for evaluation of antigen-specific, complement-mediated effector functions for the two MAbs. Assessment of bactericidal and opsonic activities showed that neither MAb was able to activate complement from nonprimate species (mouse, rat, rabbit, guinea pig, or sheep). However, both MAbs were highly effective in using primate sources of serum complement to mediate these effector functions.

Hope, social support and self-esteem of patients with spinal cord injuries

A descriptive study was conducted to determine if a relationship among the variables of hope, social support and self-esteem existed in persons with spinal cord injuries. A demographic data sheet and three instruments were used: Miller Hope Scale (MHS), Personal Resource Questionnaire Part II (PRQ) and Rosenberg Self-Esteem Scale (RSES). Of the 83 inpatients and outpatients who agreed to participate, 77 sets of questionnaires were usable. Ages of subjects ranged from 18-73 (mean 34.8) years and levels of injury ranged from C4-L3. The mean scores on the tools were: MHS-153.51 (40-200 possible range), PRQ-137.42 (25-175 possible range) and RSES-29.59 (10-40 possible range). There was a statistically significant relationship between hope and social support, hope and self-esteem and social support and self-esteem. By multiple regression analysis, the best predictors of hope in the subjects were self-esteem, social support and education.

Effects of two chest tube clearance protocols on drainage in patients after myocardial revascularization surgery

The purpose of the study was to determine the effects of two methods of clot clearance on chest tube drainage in patients undergoing myocardial revascularization. Two hundred adult patients immediately after myocardial revascularization were randomly assigned to a specific chest tube manipulation group. The dependent variables were drainage, incidence of cardiac tamponade, incidence of surgical reentry, hemodynamic values, and number of manipulation episodes. Statistical analyses revealed no difference in any of the dependent variables when milking and stripping were used. Of the 200 patients, 78 did not require any manipulation of the chest tubes in the first 8 hours after surgery. One patient had signs of cardiac tamponade and six other patients required surgical reentry. Positioning of the connecting tube in a nondependent position assisted with the removal of drainage from the chest cavity. In conclusion, patients having myocardial revascularization did not need their chest tubes manipulated the first 8 hours after surgery. Visible drainage in the chest tube did not cause a lack of patency.

[Pharmacologic treatment of migraine. Critical review of the literature]

The current aim of migraine treatment is to control attacks and reduce their frequency and intensity. Numerous drugs have been experimented in the pharmacological treatment of migraine, often with positive results. Almost always, only the main action mechanism can be hypothesised and sometimes drugs seem to act with very different mechanisms. Here mention is made of the principles, symptomatic and preventive, on which the pharmacological treatment of migraine is based. The drugs used in the two types of treatment are examined in terms of their action mechanism and their pharmacological group. Particular attention is paid to indications, contraindications and limitations of each treatment and the results reported in the literature are reviewed. For optimal treatment, prevention is considered indispensable for controlling symptomatology and preventing the pain becoming chronic. Correct preventive action also serves to avoid constant resort to symptomatic drugs, particularly analgesics, for which the risk of developing dependence or headache upon suspension of treatment is described.

The Neuman Systems Model: application to a patient with a cervical spinal cord injury

Neuman's Systems Model provides a framework for holistic neuroscience nursing practice. Utilizing Neuman's assessment format, results are presented for a patient who sustained a cervical spinal cord injury. Nursing diagnoses are identified and a sample plan of care is included.

[Plasma beta-endorphin and caffeine consumption in chronic hemicrania]

Thanks to recent biochemical and neuroendocrine findings, migraine belonging to the group of primary headaches appears as a pathology of the antinociceptive system with evolutive character. It has been demonstrated, in fact, that right at the early stage of migraine, there is a significant reduction in liquoral concentrations of beta-endorphin (beta-E), endogenous opioid peptide followed by a similar change in the plasma opioid system. The opioid system deficiency is even more evident after stimulation tests that point to reduced reactivity of the hypothalamo-hypophyseal system with respect to stimuli that in normal subjects trigger hypophyseal beta-E incretion. Caffeine, a member of the methyl-xanthine group, is an interesting molecule in the study of migraine patients because the chronic intake of this substance, contained in numerous analgesics, has been related to the chronic nature of the pain. The purpose of the present study is to assess the relationship between caffeine consumption and plasma opioid system. With the administration of a single oral dose of caffeine, normal subjects present an increase in plasma concentrations of beta-E, while in patients with chronic migraine, the response is significantly lower. These data confirm the poor reactivity of the plasma opioid system to pharmacological stimuli in migraine. Average daily consumption of caffeine has also been determined. It was not possible to establish a correlation between consumption of caffeine and plasma concentrations of beta-E whether basal or after stimulus with caffeine.

Roy's adaptation model: a guide for rehabilitation nursing practice

Roy's Adaptation Model provides a framework for holistic rehabilitation nursing practice. In this article, the model is applied to a rehabilitation patient with a spinal cord injury for the assessment of behaviors and stimuli influencing the behaviors and also for planning and evaluating nursing care.

Hope, self-esteem and social support in persons with multiple sclerosis

A descriptive study was conducted to determine if a relationship among the variables of hope, self-esteem and social support existed in persons with multiple sclerosis. A demographic data sheet and three instruments were used: Miller Hope Scale (MHS), Rosenberg Self-Esteem Scale and Part II of the Personal Resource Questionnaire (PRQ). Of 75 individuals contacted by mail asking them to participate, 40 sets of questionnaires were returned. The subjects' ages ranged from 32 to 70 with a mean of 48.2. The mean scores on the 3 instruments were: MHS--157.9 (40-200 possible range), self-esteem--29.68 (10-40 possible range), and PRQ Part II--141.13 (25-175 possible range). A statistically significant relationship was found between hope and self-esteem, hope and social support and social support and self-esteem. Additionally, findings were reported and conclusions and nursing implications identified.