Synchronous rectal and colon cancer caused by familial polyposis coli during pregnancy

The management of colon and rectal cancer during pregnancy is controversial and challenging. Rectal or colon cancer during pregnancy is a very rare event. A 29-year-old woman, pregnant with her second child, was diagnosed with rectal cancer causing bowel obstruction and synchronous colon cancer during the 27th week of gestation. Both cancers occurred as a result of familial polyposis. This is the first case of synchronous rectal and colon cancer caused by familial polyposis during pregnancy reported in the published literature. We discuss the therapeutic interventions and the surgical management of the cancer in relation to the gestation.     

The impact of maternal- and neonatal-associated factors on human milk's macronutrients and energy

Objectives: To test the impact of specific maternal- and neonatal-associated factors on human milk's macronutrients and energy.

Methods: This study was conducted with the use of a human milk analyzer (HMA, MIRIS, Uppsala, Sweden). Six hundred and thirty samples of raw milk and 95 samples of donor pasteurized milk were delivered from a total of 305 mothers.

Results: A significant inverse correlation of fat, protein and energy content with gestational age and birth weight was established. Fat and energy were lower in colostrum, increased in transitional milk and decreased on the 30th day's mature milk compared to transitional. The rate of protein decline from colostrum to mature milk was lower in premature deliveries compared to that of full-terms, resulting in greater contents of protein in preterm mature milk. The upmost amounts of carbohydrates were found in mature milk of preterm deliveries. A positive correlation was found between maternal age and fat contents. In women with higher post-pregnancy BMI levels greater analogies of fat and energy were presented. In women suffering diet-controlled gestational diabetes (GD), lower protein and higher fat and energy levels were found.

Conclusions: Prematurity, maternal age, diet-controlled GD and high post-pregnancy BMI levels were found to impose statistical significant effect on milk's macronutrients and energy.     

Angiogenesis in Waldenström's Macroglobulinemia

Angiogenesis represents an essential step of disease progression in several hematological malignancies. In Waldenström's macroglobulinemia (WM) the bone marrow microvessel density is increased in 30%–40% of patients but seems to have no impact on survival. Angiogenic cytokines, such as angiogenin, vascular endothelial growth factor, and basic fibroblast growth factor are increased in the serum of WM or IgM-MGUS patients, while the ratio of angiopoietin-1/angiopoietin-2 is reduced in WM but not in IgM—monoclonal gammopathy of undetermined significance (MGUS). Angiogenin and angiopoietin-1/angiopoietin-2 ratio correlates with disease activity and clinical features of WM. Macrophage and mast-cell chemoattractants, such as macrophage inflammatory protein-1 alpha are also elevated in the serum of patients with WM, while both macrophages and mast cells that are increased in the WM microenvironment have angiogenic properties and participate in the angiogenesis process in several malignancies. This review summarizes all data available by November 2008 (end of literature search) for the role of angiogenesis in the biology of WM and its correlation with clinical and laboratory features of the disease.     

Cardiac biomarkers in haemodialysis patients: the prognostic value of amino-terminal pro-B-type natriuretic peptide and cardiac troponin T

Cardiac biomarkers such as amino-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTNT) provide information on cardiovascular morbidity and mortality in patients with normal renal function. In a considerable number of chronic haemodialysis patients, both biomarkers - NT-proBNP and cTNT - are elevated despite the absence of cardiac ischaemia. The elevation of cardiac biomarkers in chronic haemodialysis patients is of prognostic value with respect to cardiovascular morbidity and mortality. They provide a useful rationale for the screening of occult cardiac disease and optimization of the dialysis procedure with respect to volume control.     

Development and validation of 3D printed virtual models for robot-assisted radical prostatectomy and partial nephrectomy: urologists’ and patients’ perception

Purpose

To test the face and content validity of 3D virtual-rendered printed models used before robot-assisted prostate cancer and nephron-sparing surgery.

Methods

Patients who underwent live surgery during an international urological meeting organized in January 2017 were enrolled. Those with organ-confined prostate cancer underwent robot-assisted radical prostatectomy. Patients with a single renal tumor underwent minimally invasive nephron-sparing surgery. High-resolution (HR) imaging was obtained for all patients. Those with kidney tumors received contrast-enhanced CT scan with angiography; those with prostate cancer underwent mp-MRI. Images in DICOM format were processed by dedicated software. The first step was the rendering of a 3D virtual model. The models were then printed. They were presented during the live surgery of the urological meeting. All the participants and the operated patients were asked to fill a questionnaire about their opinion expressed in Likert scale (1–10) about the use and application of the 3D printed models.

Results

18 patients were enrolled, including 8 undergoing robot-assisted radical prostatectomy and 10 undergoing minimally invasive partial nephrectomy. For each patient, a virtual 3D printed model was created. The attendants rated the utility of printed models in surgical planning, anatomical representation and the role of technology in surgical training as 8/10, 10/10 and 9/10, respectively. All patients reported favorable feedbacks (from 9 to 10/10) about the use of the technology during the case discussion with the surgeon.

Conclusions

In our experience, 3D printing technology has been perceived as a useful tool for the purpose of surgical planning, physician education/training and patient counseling. Further researches are expected to increase the level of evidence.

     

“Heart failure in COVID-19 patients: Critical care experience”: A letter to the editor

Coronavirus disease 2019 (COVID-19) is associated with poor cardiovascular outcomes in patients with heart failure (HF) of all categories of ejection fraction (EF), but mainly in patients with HF with reduced EF. Moreover, cardiac transplant patients exhibit worse cardiovascular prognosis, high mortality, and more admissions to the intensive care unit. In general, COVID-19 seems to de-teriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure, especially in the presence of cardiovascular comorbidities such as diabetes mellitus, kidney dysfunction, and older age. COVID-19 may induce new-onset HF with complex mechanisms that involve myocardial injury. Indeed, myocardial injury comprises a large category of detrimental effects for the myocardium, such as myocardial infarction type 1 or type 2, Takotsubo cardiomyopathy, microvascular dysfunction and myocarditis, which are not easily distinguished by HF. The pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2, cytokine storm, hypercoagulation, inflammation, and endothelial dysfunction. The proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.