Successful achievement after heterotopic transplantations of long-term stored ovarian tissue in Hodgkin's lymphoma survivor

In this case report, we describe the outcomes of two heterotopic transplantations of cryopreserved ovarian tissue performed in a patient with HL, after 11 and 15 years of storage. At the age of 30, the patient underwent laparoscopy to collect ovarian tissue for cryopreservation before chemotherapy and radiotherapy. Eleven years later she experienced premature ovarian failure (POF). As the patient was only interested in endocrine function recovery, two heterotopic ovarian tissue transplantations were performed in the abdominal wall above the rectus muscle respectively 11 and 15 years after cryopreservation. Before transplantation, ovarian samples were analyzed to assess neoplastic contamination and tissue quality. The analysis on thawed ovarian tissue did not reveal micrometastasis and it showed well-preserved follicles and stroma. After both ovarian tissue grafting, menopausal symptoms ceased. The patient had periods approximately every 30-days and hormonal levels were within the premenopausal range. The endocrine function lasted 3-years after the first heterotopic transplantation and is still ongoing after second transplantation. Cryopreservation of ovarian tissue should be proposed to HL patients, as the incidence of POF as a long-term complication is not negligible. In these patients heterotopic transplantation is a useful tool to eliminate menopausal symptoms, preventing osteoporosis and reducing cardiovascular risks.

Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States

The shortage of deceased-donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009-2012 and State Inpatient Databases (SIDs) from 2008-2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi-organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient-level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009-2012, 96,028 (3.3%) were a "possible deceased-organ donor." The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased-donors who become actual donors; range: 20.0-57.0%); and (2) organs transplanted per possible donor (range: 0.52-1.74). These metrics allow for comparisons of OPO performance and geographic-level donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.

HPV and intraepithelial neoplasia recurrent lesions of the lower genital tract: assessment of the immune system

OBJECTIVE

To evaluate the immune state in patients with genital relapse HPV and intraepithelial lesions of the lower genital tract.

METHOD

Forty-three patients were selected. Twenty-one were affected by recurrent HPV infection either alone or combined with intraepithelial neoplasia treated by laser surgery, and 22 had been previously-treated and clinically cured without recurrence during a follow-up from 18 to 24 months. The diagnostic protocol included colposcopy with eso- and endocervical cytology histologically confirmed by directed biopsy. Afterwards patients underwent a systemic immunogenic evaluation.

RESULTS

NK cell reduction was strictly related to HPV infection associated with intraepithelial lesions; B-lymphocyte reduction was percentually greater in patients affected by HPV alone; activation of R-IL2 increased in a percentage overlapping in the two groups indicating patient reaction to the virus.

CONCLUSION

Our study supports the theory that immune response directed against viral antigens is one of the most important effectors in the control of HPV infections and that HPV is the cause of a systemic rather than local lesion.

[Diagnostic evaluation of breast nodules]

Nowadays many women see a gynaecologist because of breast problems; in fact in the last years the frequency and the women's capacities to perform a breast self examination are increased. The prognosis efficacy and the improvement to detect breast nodules thanks to the mammary self palpation nowadays are still difficult to evaluate. Therefore it is important that the family doctor begin with anamnestic data, goes on with an accurate medical examination and, if necessary, sends the patients to perform assessments, clinical and instrumental ones. At the first ambulatory examination we can accurately diagnose the 90% of breast masses thanks to a diagnostic triad, consisting of: bilateral clinical evaluation; bilateral mammography (performed in antero-posterior and in latero-lateral scanning); fine needle aspiration cytology. In fact a careful mammography certainly has reduced mortality due to breast cancer. An useful approach to diagnose breast cancer in all women, especially under thirty years old, is fine needle aspiration cytology, that allows us to avoid surgical treatment in case of benign pathology. If by these approaches a mammary nodule is not definitely diagnosed (impalpable lesion but suspicious by mammography) it needs surgical excision biopsy, in any case, at any age. Another diagnostic possibility is surely ultrasound examination, that is useful to diagnose inflammatory disease and to differentiate cystic or solid lesions. Other diagnostic procedures are thermography, diaphanoscopy and galactography. Because of the multiple and increasing frequency of benign or malignant breast disease, the role of the family doctor is very important.(ABSTRACT TRUNCATED AT 250 WORDS)