Thirty-Five-Year-Old Woman with Signet Ring Cell Gastric Carcinoma Secondary to the Chernobyl Nuclear Accident: A Case Report

The 1986 Chernobyl nuclear accident resulted in radiation exposures throughout much of Europe, with the highest exposures within the city of Pripyat, Ukraine, where the accident occurred. We report a woman who was exposed to the Chernobyl accident at age 13. Beginning in her early thirties, she experienced several years of upper abdominal pain that became progressively more severe. At age 35, she underwent upper endoscopy and gastric biopsy. Histological examination revealed a signet ring cell (SRC) gastric carcinoma. The tumor was discovered at an advanced stage and proved unresectable. She died 3 months following her diagnosis. The mean age for SRC gastric carcinoma diagnosis is about 62 years; the median survival following diagnosis is 13 months. The early appearance and aggressive clinical course of this malignancy in relation to the Chernobyl nuclear accident is discussed.Key words: Chernobyl, Signet ring cell gastric carcinoma, Malignancy, Fallout     

Care and treatment of hepatitis C among Aboriginal people in New South Wales,Australia: implications for the implementation of new treatments

Introduction. Despite Aboriginal Australians being over-represented in populations of people living with hepatitis C (HCV), there is a dearth of research to guide policy and programme development in the area of care and treatment, particularly relating to new HCV treatments.

Method. In-depth interviews were conducted with 39 people identifying as Aboriginal Australians and living with HCV in New South Wales.

Results. Participants' experiences were characterised by a lack of detailed or appropriate information provided at diagnosis, high levels of stigma associated with HCV and low overall knowledge of HCV as reported for themselves and their communities. Despite poor diagnosis experiences, participants had undertaken changes to their lifestyle, especially in relation to alcohol use, in order to promote liver health. Concerns about treatment side effects and efficacy impacted participants' decisions to undertake treatment. Eleven participants had undertaken HCV treatment in a variety of care models with a peer worker and in prison.

Conclusions. The similarities between concerns and experiences of Aboriginal people and other populations living with HCV do not suggest that services and strategies to engage these populations should also be the same. These results suggest that further engagement of the primary care sector in HCV care is important as well as increasing Aboriginal community knowledge of HCV. A variety of service models should be available to meet individuals' preferences, including those offered within Aboriginal community controlled health services emphasising holistic notions of health, and supported by information and communication programmes using principles of health literacy relevant to Aboriginal people.     

Flowable resin used as a sealant in molars affected by dental fluorosis: a comparative study

The decline in prevalence and incidence of dental caries in developed countries over the last two decades is considered to be due mainly to the widespread use of fluoride in different forms, but simultaneously with decline in caries, an increase in dental fluorosis has been reported. The aim of this study was to compare the Conventional Sealant Technique (CST) and Enameloplasty Sealant Technique (EST) using a flowable resin as sealant in molars affected by dental fluorosis. A total of 40 extracted third molars affected by dental fluorosis were divided at random into two groups of 20 teeth each, and Tetric Flow resin was used as sealant. All teeth were studied for lateral adaptation and resin penetration by direct and indirect techniques; all samples were replicated in epoxy resin and were evaluated with Scanning Electron Microscopy (SEM). The results demonstrated that EST allowed a deeper sealant penetration and a superior sealant adaptation than CST, both in direct and indirect evaluations by SEM. The most important variables being penetration-interface and penetration depth both being statistically significant (p<0.05). The CST did not flow into the bottom of the fissures, leaving spaces that can favor the fracture of the material and initiate the process of dental caries. We conclude that a flowable ceromer is an excellent material alternative to be used as sealant and that EST is quite necessary in molars affected by dental fluorosis, the combination of both being a reliable method to be used as primary prevention approach of dental caries in endemic areas of dental fluorosis.     

Delivery room management of extremely low birth weight infants in Italy: comparison between academic and non-academic birth centres

Objective: International Guidelines provide a standardised approach to newborn resuscitation in the DR and, in their most recent versions, recommendations dedicated to management of ELBWI were progressively increased. It is expected that introduction in clinical practice and dissemination of the most recent evidence should be more consistent in academic than in non-academic hospitals. The aim of the study was to compare adherence to the International Guidelines and consistency of practice in delivery room management of extremely low birth weight infants between academic and non-academic institutions.

Methods: A questionnaire was sent to the directors of all Italian level III centres between April and August 2012.

Results: There was a 92% (n?=?98/107) response rate. Apart from polyethylene wrapping to optimise thermal control, perinatal management approach was comparable between academic and non-academic centres.

Conclusions: There were minor differences in management of extremely low birth weight infants between Italian academic and non-academic institutions, apart from thermal management. Although there was a good, overall adherence to the International Guidelines for Neonatal Resuscitation, temperature management was not in accordance with official recommendations and every effort has to be done to improve this aspect.     

Detection of a novel Tet M determinant in tetracycline-resistant Neisseria gonorrhoeae from Uruguay, 1996-1999

BACKGROUND: Determination of the diversity within the tet(M) sequence from N gonorrhoeae is a useful epidemiologic tool for monitoring the movement or importation of strains within a geographic region. Only two distinct tet(M) genes in clinical gonococcal isolates have been described up to now: the Dutch and the American types. GOAL: The study involved surveillance of the tet(M) gene types in high-level-tetracycline-resistant gonococcal isolates from Uruguay during the period 1996 to 1999. STUDY DESIGN: Among 181 gonococcal isolates, those showing MICs >/=16 microg/ml to tetracycline were analyzed for detection and characterization of the tet(M) gene by a polymerase chain reaction (PCR) and further HpaII restriction fragment polymorphism methods, respectively. The plasmid content and antibiogram were determined. RESULTS: Twenty-two of 181 isolates (12%) exhibited high levels of resistance to tetracycline (MICs >/=16 microg/ml) and harbored a putative 25.2-Mda plasmid that contained the tet(M) gene. A high percentage of isolates (95%; 21/22) presented the Dutch type tet(M) gene. One isolate from 1999 revealed a new restriction pattern. Such a pattern had been previously noted in 1991. This new restriction pattern has not been described previously as occurring in isolates of N gonorrhoeae. The tet(M) amplimer sequence showed 100% identity with a previously described tet(M)-carrying plasmid from N meningitidis. CONCLUSION: A new HpaII restriction pattern of the tet(M) gene is present in low frequency. The tet(M) sequence was different from the gonococcal tet(M) sequences already known and not typable with the use of a differential PCR assay. Accordingly, with the genetic diversity already present within the tet(M) sequence of N gonorrhoeae isolates, we should be aware of the sensitivity of the PCR assays in use for tetracycline-resistant N gonorrhoeae detection.     

A child with leukocoria

Leukocoria, meaning "white pupil," describes the clinical finding of a white pupillary reflex on examination. It may be discovered through an asymmetric red reflex using direct ophthalmoscopy, or it may be seen incidentally on flash photography. It results from an abnormality of the eyeball that interferes with the normal reflective process. We report a case of a 3-year-old boy who presents with leukocoria found to be caused by a retinoblastoma and discuss the differential diagnosis of this uncommon presentation to the pediatric emergency department.     

Comparison of two wound dressings after laser skin resurfacing.

BACKGROUND: It has been reported that the final outcome of laser resurfacing still depends to a large degree on the efficiency of the post laser resurfacing wound care in promoting wound healing and preventing early and late complications. OBJECTIVE: The objective of this study was to evaluate and compare a new hydrocolloid dressing, H2460, with Flexzan(TM) for healing of an acute wound after laser skin resurfacing (LSR). METHODS: Ten volunteers received LSR of the peri-orbital area with an erbium:YAG laser. Identical parameters were used on both sides: 2 J, 5 mm spot, 8 Hz, 300 micros pulse, two passes on the upper eyelids, four passes on the lower eyelids and six passes on the crow's feet area. Soon after the LSR, one side was covered with Flexzan dressing and the other side was covered with a new hydrocolloid dressing -- H2460. The side of the dressing was randomized by alternating both dressings. All volunteers were evaluated and digitally photographed every day for a week and at 1 month after LSR. The degree of erythema, swelling, bleeding, oozing, crusting, pigmentary changes, scarring, discomfort, itching, burning, ease of application of dressings, initial adhesion, overall adhesion, leakage of fluid, maceration of surrounding skin, ease of removal and adhesive residue upon removal were documented. RESULTS: In all volunteer and investigator's evaluations, the new dressing, H2460, achieved far better results than Flexzan in each category. After a 1-week follow-up all volunteers and the investigator evaluated the H2460 side as: healed better, simple to use, and caused less discomfort in 10 out of 10 volunteers. The blinded observer's assessment showed that the Flexzan side healed better in one volunteer. CONCLUSION: The new dressing, H2460, is a better and suitable alternative to Flexzan as a post LSR dressing.     

The role of ultrasound elastographic techniques in chronic liver disease: Current status and future perspectives

This review illustrates the state of the art clinical applications and the future perspectives of ultrasound elastographic methods for the evaluation of chronic liver diseases, including the most widely used and validated technique, transient elastography, followed by shear wave elastography and strain imaging elastography. Liver ultrasound elastography allows the non-invasive evaluation of liver stiffness, providing information regarding the stage of fibrosis, comparable to liver biopsy which is still considered the gold standard; in this way, it can help physicians in managing patients, including the decision as to when to start antiviral treatment.