Two case reports of fetal alcohol syndrome: broadening into the spectrum of cardiac disease to personalize and to improve clinical assessment

BACKGROUND

Fetal alcohol spectrum disorder (FASD) refers to a broad spectrum of disabilities, in infants and children, resulting from moderate to excessive prenatal alcohol exposure. Significant associations with alcohol exposure were already reported with congenital structural heart defects: i.e. ventricular septal defects, atrial septal defects, conotruncal defects.

CASES PRESENTATION

We describe two cases of children with FASD, both admitted to the Center for Rare Diseases and Birth Defects of Policlinico Universitario Agostino Gemelli, in whom asymptomatic cardiac rhythm alterations were detected in absence of structural cardiovascular system anomalies or cardiac channelopathies.

CONCLUSIONS

No other reports about cardiac rhythm anomalies in individuals affected by FASD are actually available from the literature. We would like to make an alert for clinician, given the possibility of finding anomalies of heart conduction and rhythm in children affected by FASD even without structural congenital heart disease.

Laser-Generated Proton Beams for High-Precision Ultra-Fast Crystal Synthesis

We present a method for the synthesis of micro-crystals and micro-structured surfaces using laser-accelerated protons. In this method, a solid surface material having a low melting temperature is irradiated with very-short laser-generated protons, provoking in the ablation process thermodynamic conditions that are between the boiling and the critical point. The intense and very quick proton energy deposition (in the ns range) induces an explosive boiling and produces microcrystals that nucleate in a plasma plume composed by ions and atoms detached from the laser-irradiated surface. The synthesized particles in the plasma plume are then deposited onto a cold neighboring, non-irradiated, solid secondary surface. We experimentally verify the synthesizing methods by depositing low-melting-material microcrystals - such as gold - onto nearby silver surfaces and modeling the proton/matter interaction via a Monte Carlo code, confirming that we are in the above described thermodynamic conditions. Morphological and crystallinity measurements indicate the formation of gold octahedral crystals with dimensions around 1.2 μm, uniformly distributed onto a silver surface with dimensions in the tens of mm2. This laser-accelerated particle based synthesis method paves the way for the development of new material synthesis using ultrashort laser-accelerated particle beams.

[Overnight surgery in proctology and anesthesia type: our experience on 320 patients]

BACKGROUND

Several evidences demonstrated that general anaesthetics associated with local anaesthesia show more advantages in comparison to spinal anaesthesia in proctological surgery. Aim of this study was to verify the efficacy of deep general anaesthesia associated with a loco-regional anesthesiological technique, in a grade population of 320 patients affected by haemorrhoidal disease and anal fissure.

PATIENTS AND METHODS

Patients with III-IV grade haemorrhoids and chronic posterior anal fissures has been eligible for this study while were excluded patients with history of allergic reaction or pharmacological hypersensibility to naropine, propofol o similar drugs. All patients (group A) were submitted to general anaesthesia associated with loco-regional anaesthesia, Control patients (group B) underwent spinal anaesthesia. At the end of all surgery procedure, it has been evaluated the presence of early and late complications according to our classification recently proposed.

RESULTS

A total of 320 patients were included, 240 submitted to haemorrhoidectomy for prolapse and 80 surgically treated for anal fissures. Anesthesia obtained has been satisfactory in the all treated patients and has not been observed permanent side-effects. Among the early post-operative complications it has been observed urinary retention in 9% of patients and pain in 30%. Among late post-operative complications it has been observed pain in 8% and urinary retention in 1% of patients. In two patients has been observed the development of abscess in correspondence of anaesthetic infiltration area. The local anaesthetical effect was present for a mean period of 4-8 hours.

CONCLUSIONS

Loco-regional anesthesiological technique with posterior block, associated to general anaesthesia, has been demonstrated efficacious for the treatment of the most frequent proctological pathologies. This method allowed a low incidence of early and late complications and a more fast resolution of clinical sequelae of the surgery.

[Proctological surgery: use of a salsobromoiodic gel solution in the post-operative period]

BACKGROUND

This study was aimed to demonstrate the advantages and the efficacy of a salsobromoiodic gel solution sponge to use in coloproctology after surgery for the most frequent pathologies of anal canal and of perineal region.

MATERIALS AND METHODS

The Authors have tested the salsobromoiodic gel solution (Fertomcidina U) in a consecutive series of patients referred to 5 coloproctological centers where they have been submitted to surgery for pathologies of anal canal and of perineal region. A total of 30 patients, 15 with clinico-instrumental diagnosis of III-IV degree haemorrhoids and 15 with diagnosis of chronic anal fissure entered in a clinical follow-up after an out-patient setting or surgery for the respective pathologies. The gel formulation is realized as a salsobromoiodic solution containing salicylic acid and magnesium biphosphate making a strong bactericide and fungicide action applicable on human skin for tissues reparation and their re-epithelization. The experimental treatment was performed on the duration of at least 10 days, with two topic applications.

RESULT

In 100% of the treated patients, the used gel has determined the prevention of infective complications, favouring a normal re-epithelization of tissue submitted to surgery or affected by previous anal mucosal lesions. The use of gel has not caused irritation and skin damage. No symptom and sign of toxicity were observed.

CONCLUSIONS

The use of salsobromoiodic gel solution has been useful to prevent infections and to contribute to the cicatrisation, healing and re-epithelization of anal mucosal lesions after surgery on a normal outpatients setting. The use of gel formulation resulted easy and satisfactory for the patients affected by the most frequent proctological pathologies which require a surgical treatment.

[Objectives of a bloodless surgery program. A comparative study (major surgery vs. minor-medium surgery) in 51 Jehova's Witnesses patients]

AIM

The purpose of this retrospective review of the charts of 51 Jehovah's Witness patients, who underwent surgery without blood transfusions, was to compare two study groups (major surgery vs minor-medium surgery).

METHODS

We compared the following variables: age, sex, length of stay, type of surgical operation, use of intraoperative red cell salvaging devices, hemodilution, number of drainages and their stay, postoperative blood loss, complications, need of reoperation and mortality rate. Between medical variables we focused on blood production therapy and nutritional support (administration of iron, folate, erythropoietin and albumin) and blood tests (at the first day of admission; intraoperative; at the first postoperative day; at the discharge).

RESULTS

In the two study groups, we detected statistically significant differences in the following variables: total of postoperative blood loss (p < 0.00001), complications rate (p = 0.0122) and in Hgb values (intraoperative: p = 0.0197; at the first postoperative day: p = 0.0028; at the discharge: p = 0.0100).

DISCUSSION

The aims of a bloodless surgery program are: 1) minimize blood loss, reducing iatrogenic anemia and intraoperative hemorrhage loss; 2) maximize blood production by administration of erythropoietin, iron and folate; 3) maximize cardiac output by alternatives to blood transfusions, as crystalloids, colloids and blood substitutes; 4) increase oxygen content; 5) decrease metabolic rate. We focused on advantages and disadvantages of the suggested procedures. Most interesting techniques are the normovolemic hemodilution and the intraoperative red cell salvaging devices, indispensable in emergency.

CONCLUSIONS

A close team-work between surgeons, anesthesiologists and hematologists is determinant in a reference center that guarantees experience, organization, professionality, respect for the patients' will and, above all, low morbidity and mortality rates, as those reported by our series.

Preliminary results of neoadjuvant paclitaxel and carboplatin in the treatment of early stage non-small cell lung cancer

The purpose of this study is to determine the feasibility of delivering neoadjuvant paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) and carboplatin to patients with clinical early stage (stage I and II) non-small cell lung cancer. Although neoadjuvant chemotherapy appears to prolong survival in patients with stage IIIA non-small cell lung cancer, several studies have demonstrated an increase in perioperative mortality associated with this approach. This study is designed to address whether three cycles of paclitaxel (200 mg/m2/3 hour, day 1) and carboplatin (area under the concentration-time curve 5, day 2) can be given preoperatively to patients with clinical stage I and II non-small cell lung cancer and to assess the associated toxicities, pathologic response rate, disease-free survival, and overall survival of this group of patients. Thus far, five patients have been enrolled. Three have successfully undergone resection, with no perioperative complications noted. One patient had a pathologic complete remission and two had pathologic partial remissions. Preliminary results indicate that this approach is well tolerated and results in major tumor response.

Interleukin 1 trials in cancer patients: a review of the toxicity, antitumor and hematopoietic effects

Clinical trials of interleukin 1 alpha (IL-1 alpha) and IL-1 beta have been completed that assess the toxicities of these cytokines as well as their hematopoietic and antitumor effects. Both forms of IL-1 recognize the same cell surface receptors and have similar toxicities and similar biological activities. Toxicities including fever, flu-like symptoms and dose-limiting hypotension can be severe yet manageable, and IL-1 can be given safely to human cancer patients. Most toxicities and biological effects appear to be dose-related. IL-1 alone has little antitumor activity against melanoma, renal cell carcinomas or other malignancies. The hematopoietic effects, including megakaryocytopoietic effects, are modest and are probably not worth the toxicity necessary to achieve them. However, IL-1 seems to endow certain progenitor cells with responsiveness to other hematopoietic cytokines including colony-stimulating factors and IL-3. One potential application of IL-1 is to help expand bone marrow ex vivo following stem cell harvest, which could allow further chemotherapy dose escalations in chemotherapy-sensitive tumors.