Oxygen-ozone autohemotherapy in breast cancer patients suffering from fatigue and musculoskeletal pain upon aromatase inhibitors treatment: a case-series study

OBJECTIVE

In patients with breast cancer and positive hormone receptors, aromatase inhibitors are effective in reducing the risk of recurrences and are active in progressing the disease in this setting. On the other hand, fatigue and painful musculoskeletal side effects can significantly reduce treatment compliance. With no further treatment options to control these symptoms, non-pharmaceutical interventions, such as oxygen-ozone therapy, may play a role in managing rheumatologic symptomatology inasmuch. We have previously reported evidence on the effectiveness of oxygen-ozone in the treatment of pain and fatigue in chronic fatigue syndrome and fibromyalgia patients and in oncological patients as well.

PATIENTS AND METHODS

In this study, we reported 6 cases of patients (mean age 64 yrs, all Caucasian females) with breast cancer upon treatment with anastrozole (Arimidex®), suffering from musculoskeletal pain, weakness and fatigue, and therefore treated with oxygen-ozone major autohemotherapy according to the Italian Scientific Society of Oxygen Ozone Therapy (SIOOT) protocol. Pain was measured with a 10-item Numerical Rating Scale (NRS) and fatigue with a 7-item Fatigue Scoring Scale (FSS).

RESULTS

A reduction of at least 66% of pain (from 9.43 ±0.54 SD to 2.36 ±1.32 SD, p<0.001) and 66.26% of fatigue were obtained for all the cases. Pain and fatigue disappeared within one month from ozone therapy, and a healthy painless state lasted for many months following the oxygen-ozone therapy.

CONCLUSIONS

The oxygen-ozone therapy is a sound opportunity for breast cancer patients to reduce anti-aromatase-induced pain, fatigue, and musculoskeletal symptoms.

Lung cancer and COVID-19: problems and perspectives

COVID-19 pandemic generated concerns about the healthcare of patients with cancer, not simply because of the formidable impact of COVID-19 patients in the public healthcare system, but also due to the overlapping pathognomonic signs of many forms of lung cancer with lung injuries associated with COVID-19. This report tries to shed light on the issue. We evaluated the great concern of people suffering from lung cancer and also infected with SARS-CoV-2 by discussing evidence and data from current literature. Lung cancer in Italy has represented more than 1 case/4 (27%) in the latest ten years and nevertheless, even due to the concurrence of many complex interplays between COVID-19 and cancer even at the immune level, a consensus protocol and expert guidelines to diagnose and treat lung cancer upon SARS-CoV-2 infection are yet lacking. New insights and consensus panels should be therefore proposed, even at the simplistic level about if priority must be either given to COVID-19 or to cancer therapy.

Fibromyalgia treated with oxygen-ozone auto-haemotherapy (O2-O3-AHT): a case study on 200 patients with a modified 10-PI-NRS evaluation

OBJECTIVE

Fibromyalgia (FM) is a concerning chronic disease showing as widespread pain, muscle stiffness, sleep disturbances, chronic fatigue, and depressed mood, for which no sound therapy is yet available to date. In this article we assessed a wider patients' cohort the efficacy of oxygen-ozone autohemotherapy (O2-O3-AHT) previously reported.

PATIENTS AND METHODS

A number of 200 FM-patients accessed the study and were treated with 3-4 runs of O2-O3-AHT, following their signed consent. A modified 10 points-PI-NRS were used to evaluate pain intensity before and after the conclusion of the complete ozone-treatment cycle (1 month). Kruskall-Wallis' test and other statistics were used at p<0.05 level of significance.

RESULTS

A quite complete rehabilitation of the musculoskeletal function and of the overall arthralgia was observed in 76% of the patients at one month of follow-up. The number of patients having a reduction in the PI-NRS score from 10 (the maximal observed) to 3 (including 10-1 and 10-2) following only two runs of O2-O3-AHT was 23.5%, whereas only 17.5% did not show any significant improvement (ΔPI-NRS = 0 or 1), so assessing that the efficacy of O2-O3-AHT, independently from ages, encompassed at least 41% in a moderate way and 64.5% of the treated patients, as a whole.

CONCLUSIONS

Oxygen-ozone autohemotherapy represents a formidable therapeutic approach for FM, deserving further studies to be made in order to fully elucidate ozone effect of this pathology.

Biological determinants of blood-based cytokines in the Alzheimer's Disease clinical continuum

Converging translational and clinical research strongly indicates that altered immune and inflammatory homeostasis (neuroinflammation) plays a critical pathophysiological role in Alzheimer's disease (AD), across the clinical continuum. A dualistic role of neuroinflammation may account for a complex biological phenomenon, representing a potential pharmacological target. Emerging blood-based pathophysiological biomarkers, such as cytokines (Cyt) and interleukins (ILs) have been studied as indicators of neuroinflammation in AD. However, inconsistent results have been reported, probably due to lack of standardization of assays with methodological and analytical differences. We used machine-learning and a cross-validation-based statical workflow to explore and analyze the potential impact of key biological factors, such as age, sex, apolipoproteinE (APOE) genotype (the major genetic risk factor for late-onset AD) on Cyt. A set of Cyt was selected based on previous literature, and we investigated any potential association in a pooled cohort of cognitively healthy, mild cognitive impairment (MCI), and AD-like dementia patients. We also performed explorative analyses to extrapolate preliminary clinical insights. We found a robust sex effect on IL12 and an APOE-related difference in IL10, with the latter being also related to the presence of advanced cognitive decline. IL1β was the variable most significantly associated with MCI-to-dementia conversion over a 2.5 year-clinical follow-up. Albeit preliminary, our data support further clinical research to understand whether plasma Cyt may represent reliable and non-invasive tools serving the investigation of neuroimmune and inflammatory dynamics in AD and to foster biomarker-guided pathway-based therapeutic approaches, within the precision medicine development framework.

Sjögren syndrome successfully treated with oxygen-ozone auto-hemotherapy (O2-O3-AHT). a case report

OBJECTIVE

Sjögren syndrome (SS) is an autoimmune disorder, affecting about 16,000 individuals in Italy, yet lacking a standardized therapy protocol and a plain inclusion in the reimbursed healthcare services. This raises many controversial issues about how managing the SS patient, to relief pain and discomfort and improve patients' health and social life. The ozone therapy resulted successful in previous reports, and therefore, it was used in this case report.

CASE PRESENTATION

A 69-years old female outpatient, showing positivity to Schirmer's test, was previously diagnosed as a primary Sjögren syndrome, who later developed an autoimmune thyroiditis and showed the presence of rheumatoid factors. The patient suffered from a marked ocular dryness, subsequently to a purported endothelitis, alongside with fatigue and pain. Laboratory tests showed a positive ANA 1:320 in a speckled pattern with negative anti-SSA and anti-SSB tests. From December 2020 to January 2021 she underwent 2 routes of three sessions of oxygen-ozone autohemotherapy (O2-O3 AHT), as described below and improved, with only 2 sessions, her symptomatology and clinical outcome, as ocular dryness, fatigue and pain, rapidly disappeared.

CONCLUSIONS

The use of ozone in the therapy of SS is a straightforward, affordable and feasible approach to treat primary Sjögren syndrome without significant side effects.

Gamma glutamyl transferase and its fractions to predict coronary artery calcium and outcome in the general population

Background

Gamma glutamyl transferase (GGT) is a risk factor for plaque destabilization, particularly its fraction with the highest molecular weight (big-GGT, b-GGT). We explored the interplay between GGT, computed tomography (CT) findings that predict cardiovascular risk (coronary artery calcium [CAC] and epicardial fat volume [EFV]), and 10-year outcome.

Methods

Between May 2010 and October 2011, subjects aged between 45 and 75 years living in a city of Tuscany (Italy) and free from known cardiovascular disease were invited to participate to a screening including a CT scan.

Results

A subgroup of study participants (n=898, 65%) had total GGT and GGT fractions quantified (median age 65 years [25th-75th percentile: 55–70 yrs], 46% males, median 10-year risk of myocardial infarction or death based on the Framingham score 6% [2–11%]). GGT predicted CAC (Exp(B) 0.099, p=0.002) and EFV (Exp(B) 0.102, p=0.003) in a model including age, gender, diabetes, current or previous smoking status, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and aspirin therapy. Over 10.3 years (9.6–10.8), 74 individuals died (8%), and 36 (4%) experienced the composite of cardiovascular death or coronary revascularization. The risk of all-cause death and the composite endpoint increased quite steeply with GGT values, with thresholds of 19 UI and 20 IU, respectively (Figure). GGT predicted both endpoints independently from the Framingham 10-year risk (hazard ratio [HR] 1.01, 95% CI 1.01–1.02, p=0.004, and HR 1.01, 95% CI 1.01–1.02, p=0.002, respectively), as well as a model including CT findings. bGGT had the highest area under the curve value to predict the composite endpoint (0.586).

Conclusions

In a general population setting, plasma GGT independently predicts CAC and EFV, and the risk of all-cause death or a composite cardiovascular endpoint.

Funding Acknowledgement

Type of funding sources: None.

Fatigue in post-acute sequelae of SARS-CoV2 (PASC) treated with oxygen-ozone autohemotherapy - preliminary results on 100 patients

OBJECTIVE

Post-acute sequelae of SARS-CoV2 infection (PASC) are a novel terminology used to describe post-COVID persistent symptoms, mimicking somehow the previously described chronic fatigue syndrome (CFS). In this manuscript, we evaluated a therapeutical approach to address PASC-derived fatigue in a cohort of past-COVID-19 positive patients.

PATIENTS AND METHODS

A number of 100 patients, previously diagnosed as COVID-19 positive subjects and meeting our eligibility criteria, was diagnosed having PASC-related fatigue. They were recruited in the study and treated with oxygen-ozone autohemotherapy (O2-O3-AHT), according to the SIOOT protocol. Patients' response to O2-O3-AHT and changes in fatigue were measured with the 7-scoring Fatigue Severity Scale (FSS), according to previously published protocols.

RESULTS

Statistics assessed that the effects of O2-O3-AHT on fatigue reduced PASC symptoms by 67%, as a mean, in all the investigated cohort of patients (H = 148.4786 p < 0.0001) (Figure 1). Patients following O2-O3-AHT therapy, quite completely recovered for PASC-associated fatigue, a quote amounting to about two fifths (around 40%) of the whole cohort undergoing ozone treatment and despite most of patients were female subjects, the effect was not influenced by sex distribution (H = 0.7353, p = 0.39117).

CONCLUSIONS

Ozone therapy is able to recover normal functionality and to relief pain and discomfort in the form of PASC-associated fatigue in at least 67% of patients suffering from post-COVID sequelae, aside from sex and age distribution.

Correlation between gamma glutamyltransferase fractions and bone quality

Gamma-glutamyltransferase (GGT) has been recently identified as a bone-resorbing factor. The aim of this study was to investigate the association between plasma GGT fractions levels and bone quality. Plasma GGT fractions were analysed by gel-filtration chromatography. Bone quality was established quantitatively by two micro-CT derived microarchitectural parameters: the BV/TV (mineralised bone volume/total volume), and the SMI (structure model index) that describes the rod-like (low resistant) or plate-like (high-resistant) shape of bone trabeculae. We enrolled 93 patients hospitalised for elective total hip replacement (group Arthrosis, n=46) or for proximal femoral fracture (group Fracture, n=47). Patients within the first quartile of BV/TV (Q1, osteoporotic patients, n=6) showed higher levels of b-GGT fraction [median (min-max): 3.37 (1.42–6.81)] compared to patients with normal bone density (fourth quartile Q4, n=10; 1.40 (0.83–4.36); p=0.0393]. Also, according to SMI, b-GGT value was higher in the subgroup with bone fragility [Q1, n=8: 1.36 (0.43–4.36); Q4, n=8: 5.10 (1.4 –7.60); p=0.0117]. In conclusion, patients characterised by fragile bone structure showed specifically higher levels of plasma b-GGT activity thus suggesting fractional GGT analysis as a possible biomarker in the diagnosis of osteoporosis.

Ozone autohemotherapy induces long-term cerebral metabolic changes in multiple sclerosis patients

Ozone autohemotherapy is an emerging therapeutic technique that is gaining increasing importance in treating neurological disorders. A validated and standard methodology to assess the effect of such therapy on brain metabolism and circulation is however still lacking. We used a near-infrared spectroscopy (NIRS) system to monitor the cerebral metabolism and a transcranial Doppler (TCD) to monitor the blood flow velocity in the middle cerebral arteries. Fifty-four subjects (32 neurological patients and 22 controls) were tested before, during, and after ozone autohemotherapy. We monitored the concentration changes in the level of oxygenated and deoxygenated haemoglobin, and in the level of the Cytochrome-c-oxidase (CYT-c). As a primary endpoint of the work, we showed the changes in the brain metabolism and circulation of the entire population. The concentration of oxygenated haemoglobin increased after the reinjection of the ozoned blood and remained higher than the beginning for another 1.5 hours. The concentration of the deoxygenated haemoglobin decreased during the therapy and the CYT-c concentration markedly increased about 1 hour after the reinjection. No significant changes were observed on the blood flow velocity. As secondary endpoint, we compared the NIRS metabolic pattern of 20 remitting-relapsing multiple sclerosis (MS) patients against 20 controls. We showed that by using only 7 NIRS variables it was possible to characterize the metabolic brain pattern of the two groups of subjects. The MS subjects showed a marked increase of the CYT-c activity and concentration about 40 minutes after the end of the autohemotherapy, possibly revealing a reduction of the chronic oxidative stress level typical of MS sufferers. From a technical point of view, this preliminary study showed that NIRS could be useful to show the effects of ozone autohemotherapy at cerebral level, in a long-term monitoring. The clinical result of this study is the quantitative measurement of the CYT-c level changes in MS induced by ozone autohemotherapy.

Time and time-frequency analysis of near-infrared signals for the assessment of ozone autohemotherapy long-term effects in multiple sclerosis

Ozone autohemotherapy is an emerging therapeutic technique that is gaining increasing importance in treating neurological disorders. A validated and standard methodology to assess the effect of such therapy on brain metabolism and circulation is however still lacking. We used a near-infrared spectroscopy system (NIRS) to monitor the cerebral oxygenation of 9 subjects: 4 remitting-relapsing multiple sclerosis (MS) sufferers and 5 controls. Subjects were tested before, during, and after ozone autohemotherapy. We monitored the concentration changes in the level of oxygenated and deoxygenated haemoglobin, and in the level of the Cytochrome-c-oxidase (CYT-c). From the time and time-frequency analysis of the NIRS signals we extracted 128 variables, which were used to characterize the metabolic brain pattern during the therapy. We showed that by using only 7 NIRS variables out of 128 it is possible to characterize the metabolic brain pattern of the two groups of subjects. The MS subjects showed a marked increase of the CYT-c activity and concentration about 40 minutes after the end of the autohemotherapy, possibly revealing a reduction of the chronic oxidative stress level typical of MS sufferers. From a technical point of view, this preliminary study showed that NIRS could be useful to show the effects of ozone autohemotherapy at cerebral level, in a long term monitoring. The clinical result of this study is the quantitative measurement of the CYT-c level changes in MS induced by ozone autohemotherapy.

[Preliminary study to evaluate the meaning of GGT fractions analysis in a population of workers previously exposed to asbestos]

The GGT enzyme, considered for years only as a marker of liver disease and alcohol abuse, has now revealed a risk of death for many causes. Through a molecular exclusion chromatography on FPLC system (Fast Protein Liquid Chromatography), it is possible to discriminate four fractions of GGT, defined according to the molecular weight: big-GGT, medium-GGT, small-GGT and free-GGT. The objective was to study the preventing meaning of GGT fractions for asbestos-related diseases. This study was conducted on 129 workers previously exposed to asbestos, 22 patients affected by Malignant Pleural Mesothelioma and 107 healthy workers. Our data demonstrated a statistical significant correlation between the fraction free-GGT with the presence of MPM, suggesting a possible role for this molecule as a biomarker for MPM diagnosis. However, being a preliminary study, further studies are warranted to confirm our results.

Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease

BACKGROUND

Transanal haemorrhoidal dearterialisation (THD) is a nonexcisional surgical technique for the treatment of piles, consisting in the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of the haemorrhoidal plexus. The aim of this study was to assess the long-term efficacy of this treatment.

METHODS

The procedure was carried out using a proctoscope with a Doppler probe. The terminal branches were located with Doppler and then sutured.

RESULTS

From January 2000 to May 2006, we performed THD in 330 patients (180 men; mean age, 52.4 years), including 138 second-degree, 162 third-degree and 30 fourth-degree haemorrhoids. There were 23 postoperative complications (7 cases of bleeding, 5 thrombosed piles, 4 rectal haematomas, 2 anal fissures, 2 cases of dysuria, 1 of haematuria and 2 needle ruptures). The mean postoperative pain score was 1.32 on a visual analog scale. 219 patients were followed for a mean of 46 months (range, 22-79), including 100 patients with second-degree, 104 with third-degree and 15 with fourth-degree haemorrhoids. The operation completely resolved the symptoms in 132 patients (92.5%) with preoperative bleeding and in 110 patients (92%) with preoperative prolapse.

CONCLUSIONS

The efficacy and relapse rate of this procedure appears to be similar to that of traditional surgery and stapled haemorrhoidopexy. The technique was effective and safe for all degrees of haemorrhoids because of the excellent results, low complication rate and minor postoperative pain.

Antioxidant capacity and protein oxidation in cerebrospinal fluid of amyotrophic lateral sclerosis

BACKGROUND

The causes of Amyotrophic Lateral Sclerosis (ALS) are unknown. A bulk of evidence supports the hypothesis that oxidative stress and mitochondrial dysfunction can be implicated in ALS pathogenesis. METHODS =: We assessed, in cerebrospinal fluid (CSF) and in plasma of 49 ALS patients and 8 controls, the amount of oxidized proteins (AOPP, advanced oxidation protein products), the total antioxidant capacity (FRA, the ferric reducing ability), and, in CSF, two oxidation products, the 4-hydroxynonenal and the sum of nitrites plus nitrates.

RESULTS

The FRA was decreased (p = 0.003) in CSF, and AOPP were increased in both CSF (p = 0.0039) and plasma (p = 0.001) of ALS patients. The content of AOPP was differently represented in CSF of ALS clinical subsets, resulting in increase in the common and pseudopolyneuropathic forms (p < 0.001) and nearly undetectable in the bulbar form, as in controls. The sum of nitrites plus nitrates and 4-hydroxynonenal were unchanged in ALS patients compared with controls.

CONCLUSION

Our results, while confirming the occurrence of oxidative stress in ALS, indicate how its effects can be stratified and therefore implicated differently in the pathogenesis of different clinical forms of ALS.

[Gastroesophageal reflux and laryngopharyngeal disorders: pH-metric essay of the acid exposure of the proximal and distal esophagus]

AIM

The purpose of this study is to verify the role of gastroesophageal reflux as responsible for otolaryngological symptoms; it is often difficult to identify, both because of its subtle and aspecific clinical-endoscopic picture and because the traditional distal esophageal pHmetry may show readings which are still within the norm at this level. The esophageal pHmetry carried out at proximal level gives greater diagnostic accuracy.

METHODS

We use a catheter with 3 antimony electrodes, 2 of them placed at the esophageal level, respectively at 5 and 20 cm above the inferior esophageal sphincter, and 1 in the stomach. We studied 3 groups of patients: 41 asymptomatic no-refluxer patients (group I, control), 59 refluxer patients with only typical esophageal symptoms (group II) and 68 patients with laryngo-pharyngeal symptoms suffering from acid reflux (group III).

RESULTS

At both the proximal and distal esophageal levels, the reflux, with reference to control, turned out to be significantly higher in groups II and III, both as regards the number of episodes (p<0.01), the time of acid exposition (p<0.01), the length of the longer reflux (p<0.01), whereas no differences were found between groups II and III. The proximal esophageal acid refluxes in both groups II and III occurred mainly in the upright position: alone (57.2% and 62.5% respectively) or combined with supine position (23.8% and 34.0% respectively).

CONCLUSION

Our experience suggests that the esophago-gastric pHmetry with 3 electrodes represents an effective procedure for the correlation between otolaryngological symptoms and gastro-esophageal reflux.

gamma-Glutamyl transpeptidase catalyses the extracellular detoxification of cisplatin in a human cell line derived from the proximal convoluted tubule of the kidney

Nephrotoxicity is a side-effect and the main factor limiting the clinical use of cisplatin. In vivo, the administration of the cysteine-containing tripeptide glutathione (GSH) has been found to reduce nephrotoxicity, but the biochemical mechanism of this protective action is not fully understood. The present study was designed to gain insights into the mechanism by which GSH prevents cisplatin nephrotoxicity. We also wanted to verify the hypothesis of whether the protective action of GSH is mediated by products of the extracellular breakdown of GSH catalysed by gamma-glutamyl transpeptidase (GGT), an enzyme that is highly expressed in kidney tubular cells. The study was performed in HK-2 cells, derived from the immortalisation of human kidney proximal tubule cells. We investigated the influence of modulators of GGT activity and/or thiols on the antiproliferative activity of cisplatin and on the intracellular GSH content. We determined the antiproliferative activity of cisplatin, platinum cellular accumulation and DNA platination following precomplexing of the drug with thiols. The antiproliferative effect of cisplatin was minimally affected by the addition of GSH. However, when the antiproliferative assay was performed in the presence of glycyl-glycine (GlyGly), to serve as a transpeptidation acceptor and thus to stimulate GGT-mediated GSH catabolism, cisplatin-induced growth inhibition was largely prevented. This effect was not mediated through an increase of intracellular GSH levels, which were not affected by the GlyGly supplementation. The thiol dipeptide cysteinyl-glycine, i.e. the GSH catabolite generated by GGT activity, showed a higher reactivity against cisplatin in vitro than GSH, as was shown by the more rapid oxidation of its -SH groups. The cisplatin/GSH or cisplatin/cysteinyl-glycine adducts did not display an antiproliferative effect. However, 2 h precomplexing with GSH in the presence of GGT, or directly with the GSH catabolite cysteinyl-glycine, decreased the antiproliferative effect of cisplatin and drug-induced DNA platination to a greater extent than precomplexing with GSH alone. The results of the present study show that, in HK-2 cells, extracellular GSH decreases the antiproliferative effects of cisplatin only upon its hydrolysis by GGT, thereby supporting the hypothesis that the extracellular metabolism of GSH by GGT plays a role in modulating cisplatin nephrotoxicity. A primary role in the protection of HK-2 cells appears to be played by cysteinyl-glycine, the proximal product of the GGT-mediated hydrolysis of GSH, which shows a high reactivity against CDDP resulting in the rapid inactivation of the drug.

[Sclerosing peritonitis. A complication of LeVeen peritoneovenous shunt]

Sclerosing peritonitis (abdominal cocoon syndrome) is a rare chronic affection of the peritoneum; its etiology is multifactorial and it affects all ages. Capsulating membranes seem to grow from a poorly cellular connective deposition in many layers on the intestinal peritoneum and are casually detected by surgery or autopsy. The placement of the peritoneovenous shunt can favour the deposition of fibrin on the visceral peritoneum, determining the formation of sclerosing membranes. When mechanical occlusion occurs, surgery is the choice therapy in order to remove the obstacle and, if possible, the membranes as well.

[Bilateral renal oncocytoma. A clinical case and review of the literature]

Renal oncocytoma is an epithelial tumour of the kidney, originally considered benign neoplasm, but now it is thought have a limited but real malignant or metastatic potential. Usually monolateral, in 6% of cases it is bilateral in a synchronous or metachronous way. A case of bilateral renal oncocytoma in a 56-year-old woman, observed by chance during a follow-up carried out after breast cancer is described. The etiopathogenic and clinical-therapeutic aspects of this neoplasm are examined, and the conclusion is drawn that the most correct therapeutic approach must aim at both the protection of kidney function and complete removal of the tumour.

[Cholangiojejunostomy of the duct of the 3d segment. Palliative treatment of cholestatic jaundice caused by neoplastic obstruction of the hepatic hilus]

Cholangiojejunostomy of the duct of the III segment in the palliative treatment of mechanical jaundice from neoplastic obstruction of the hepatic hilus. The neoplastic obstruction of the liver hilus has an almost total absence of forewarning clinical signs and therefore results in surgery at a late stage when the patient is not susceptible to radical treatment. It is therefore necessary to use palliative treatment in order to resolve the serious jaundice, the main cause of a quick death. Among the palliative treatment the Authors report their experience of intrahepatic cholangiojejunostomy of the duct of the III segment that they consider the most suitable technique for its ease of execution, its constant anatomical situation and the peripheral position of the anastomoses in relation to the neoplastic lesion. This allows a lasting biliary decompression with a good residual life.

[Acute obstruction of the abdominal aorta]

The acute occlusion of abdominal aorta is a rare event that may have severe clinical results. Personal experience in three cases of acute thrombosis treated in emergency surgery are presented. Aorto-iliac thromboendarterectomy, aorto-bifemoral bypass and thrombectomy with Fogarty catheter were performed. In the first case, after the operation, a renal ischemia occurred. The second and the third patient died after seven days and twenty-four hours respectively.

Su di un caso di carcinoma a cellule chiare in nefroma cistico multiloculare

A case of adenocarcinoma of the kidney in a multilocular cystic disease is reported. The many diagnostic pitfalls of this rare association are underlined and the diagnostic role of selective renal artery angiography, which removed all doubt about the lesion.

[Urachal cyst. A case report and review of the literature]

The pathology of urachal disease is rarely seen. This article refers to a case of urachal cyst in a twenty-five-year-old male. In order to discuss the pathogenic, clinical and therapeutic aspects of this rare pathology, it is necessary to carry out a complete revision of the literature. Diagnosis is helped by ultrasound and CT scan of the lower abdomen, while fistulography is necessary when there is cutaneous drainage. The treatment consists of surgical approach which includes complete en-bloc excision of the cyst together with possible urachal residue. Such treatment is indispensable in order to avoid acute infection and/or malignant degeneration, frequent complications which are very serious.

Idiopathic eosinophilic pneumonia and pregnancy: report of a case

A case of chronic eosinophilic pneumonia and pregnancy is reported. In 1989, a 24-year-old woman with chronic eosinophilic pneumonia became pregnant. We decided not to stop steroid therapy. Except for premature preterm rupture of the membrane she had a uneventful pregnancy and a male infant with no distress syndrome.

[Small-cell carcinoma of the bladder: description of a case and review of the literature]

Small-cell carcinoma (also known as oat-cell carcinoma) is a rare tumor that previously concerns the lung; small-cell carcinoma of the bladder is extremely rare (0.5% of all bladder malignancies). The Authors report here the case of a 78th years old man. Fourteen months before our observation he was submitted to a partial cystectomy for a small-cell carcinoma of the bladder cupola. There was no evidence of extra-vesical location at that moment and the patient was not submitted to any adjuvant therapy. At the moment of our observation the disease was very advanced and the patient died in a few time. The Authors discuss about the therapy of bladder small-cell carcinoma in the few cases described by the literature and about the survival of those patients. A radical surgical treatment in association with an adjuvant chemo- or radiotherapy appears as a better way to treat these patients. On account of this case the Authors agree with this choice and conclude that only a combined treatment can allow a better survival.

[A high-resolution computed tomographic study of the pulmonary interstitium in systemic autoimmune diseases]

This study was aimed at assessing the diagnostic capabilities of radiologic imaging in systemic autoimmune diseases. Forty-one patients (37 women and 4 men, mean age: 57.9 years, range: 37-73) were examined: 17 of them had rheumatoid arthritis, 8 Sjögren's syndrome, 11 progressive systemic sclerosis, 3 systemic lupus erythematosus, 1 mixed connective tissue disease and 1 undifferentiated connective tissue disease. The clinical features were compared with chest X-ray and HRCT findings. Functional lung examination (spirometry) was performed in 30 patients and in 22 of them chest X-ray findings could be compared with HRCT results since the examinations were performed on the same day. Seventeen patients complained of dyspnea (41.4%) and CO diffusion was reduced in 53% of the investigated patients. Chest films showed interstitial changes in 14 of 22 patients (63.6%), while HRCT findings were abnormal in 90.2% of the patients. Significant changes in HRCT patterns were detected only in 7 of the patients complaining of dyspnea (41.1%) and in 5 of the patients with reduced CO diffusion. In conclusion, HRCT proved to be much more sensitive than plain chest films. Dyspnea and functional respiratory tests correlated poorly with HRCT findings.

Sternum resection and nephrectomy together in renal carcinoma with solitary sternal metastasis

The role of surgery and adjuvant therapy in renal tumors with metastasis is considered purely palliative. However, in cases of solitary metastasis, an aggressive surgical approach is justified by results reported in current literature, in terms of survival rate and quality of life. In bone metastasis there are additional functional problems related to the site of the lesion and to the extend of the excision. In the reported case, the tumor became evident with a serious compressive cervical-mediastinal simptomatology, due to a solitary sternal metastasis, that was resected along with the primary renal tumor.

[Surgery in aneurysms of the abdominal aorta in an outlying hospital]

Abdominal aortic aneurysms have become more frequently recognized due to an improved diagnostic approach and prolonged longevity. Therefore it can be argued that aneurysmal pathology must be entirely dealt with, including its surgical therapy, in outlying non-specialized hospitals. Elective surgical treatment of aortic aneurysms is mandatory in order to acquire the technique that will provide a satisfactory efficiency and reliability in the emergency treatment of ruptured aortic aneurysms. The basic supports of aortic aneurysm surgery in outlying hospitals are the availability of postoperative intensive therapy, a competent surgeon staff and an improved diagnostic approach in order to recognize those aneurysms which are operable by the staff and those requiring very complex reconstructive procedures such as thoraco-abdominal aortic aneurysms which must be transferred to highly specialized centres. An angiography service should be set up since it represents an important support for the operation of abdominal aneurysms; however in practice it proved to be non-essential in the present case. In contrast the intensive postoperative unit must be considered vital in view of the patient's risky conditions. The experience reported here is really positive as regards expanding aneurysms given elective surgery, in which cases there was no mortality either intra- or post-operatively. The follow-up varied from 3 to 7 years. Only one ruptured aneurysm was dealt with and the outcome was fatal owing to anuria caused by severe haemorrhagic shock. However, we cannot expect an acceptable efficiency level in emergency aneurysmectomy if the diagnostic and therapeutic approach does not guarantee full reliability in cases of elective aneurysmectomy.

Iatrogenic vascular injuries following lumbar disc surgery. Case report and review of the literature

Iatrogenic vascular injuries are unusual complications of lumbar disc surgery. The incidence of such injuries is very low but probably underestimated because clinical manifestations may be extremely variable depending on the extension of trauma whether artery or vein are injured or both. Diagnosis is suspected when early signs of retroperitoneal hemorrhage appear, but may often be delayed for weeks or years because formation of a pseudoaneurysm or an arteriovenous fistula which may be of gradual onset and produce only a few symptoms at the onset. Prompt diagnosis and aggressive treatment can hope to improve current mortality of more than 50%. A case of venous and arterial injury is reported, successfully operated on with an original technique of ilio-caval patching to avoid caval ligation. A review of the literature shows the predisposing factors and complex anatomy of such injuries, the clinical picture and the management of the emergency.