Aponeurotic-Cutaneous Tract Exeresis in Patients With Persistent Lymphorrhea After Kidney Transplantation: A Valid Approach in a Day Surgery Setting

BackgroundLymphatic disorders (LDs) are the most common minor complications after kidney transplantation (KT), with an incidence rate between 0.6% and 33.9%, which appears to be related to both surgical and medical factors. LDs mostly resolve spontaneously, but occasionally a surgical approach may be required.Materials and MethodsWe report our experience with 7 KT recipients who developed persistent lymphorrhea (>150 mL/24 h) between October 2017 and March 2019. All cases were treated as outpatients with parietal fistulectomy (PF). The fibrotic aponeurotic-cutaneous tract was thoroughly excised, and the residual aponeurotic defect was closed by watertight suturing. Serial abdominal ultrasounds (US) were carried out after the procedure.ResultsA small perirenal graft lymphocele of <2 cm was detected by US in all patients after 48 to 72 hours, without any evidence of either vascular or ureteral compression. During the subsequent scheduled US follow-up, lymphoceles did not increase in size, and additional interventions were not needed. Neither superficial nor deep surgical-site infections were recorded in such patients.ConclusionsPF was found to be a safe and effective minimally invasive approach for persistent lymphorrhea after KT. It could be easily performed with local anesthesia in a day surgery setting and did not require patient hospitalization.     

Postzygotic instability of the myotonic dystrophy p[AGC]n repeat supported by larger expansions in muscle and reduced amplifications in sperm

We have analysed the [AGC] expansion in leucocytes, muscle and sperm from 17 individuals affected by myotonic dystrophy (DM). Skeletal muscle showed a larger repeat number than leucocytes in the same patient. A similar degree of expansion was detected in differently affected muscles of a single patient. The germline mutation ( 350 repeats) was expanded in somatic cells of the progeny in all patients examined. Our results provide evidence of an early postzygotic instability of the [AGC] repeat in DM.     

A comparison of iopamidol and ioxaglate in CT enhancement

We evaluated the adverse reactions (AR) rate produced in patients to see if any difference related to the diferent chemotoxicities of two low-osmolality contrast media (CM), could be detected. We compared the AR rate intravenous administration for brain or body computed tomography (CT) enhancement of either the ionic CM ioxaglate 320 mgI/ml or the non-ionic iopamidol 300 mgI/ml at a dose of 0.8 gI/kg. Three hundred and thirty patients (164 ioxaglate, 166 iopamidol) were studied according to a randomized double-blind design. AR reported by the patients (subjective) and/or observed by the radiologist (objective) were recorded by the radiologist on the patients record card. Laboratory test were performed prior to and 24 h after contrast administration.Fifty-nine mild to moderate AR occurred in 30 patients (18.3%) receiving ioxaglate, 4 mild to moderate AR occurred in 2 patients (1.2%) receiving iopamidol (P < 0.05). No severe AR occurred in either group.The results of our study are comparative to the available evidence from 16 comparative randomized trials of iopamidol versus ioxaglate both after intraarterial and intravenous administration that gave an overall odds ratio of 3.9 [confidence interval (CI) 95% = 3.1–4.9].The diagnostic efficacy of the two CM was comparable. This study showed that the non-ionic CM iopamidol was better tolerated than the ionic ioxaglate after intravenous administration. We conclude that the chemotoxicity of the molecule influences the AR when CM with comparable osmolality are administered. Correspondence to: Carlo Del Favero     

Emerging aspects of pharmacotherapy for obesity and metabolic syndrome.

Obesity is a multifactorial, chronic disorder that has reached epidemic proportions in most industrialized countries and is threatening to become a global epidemic. Obese patients are at higher risk from coronary artery disease, hypertension, hyperlipidemia, diabetes mellitus, cancers, cerebrovascular accidents, osteoarthritis, restrictive pulmonary disease, and sleep apnoea. In particular, visceral fat accumulation is usually accompanied by insulin resistance or type 2 diabetes mellitus, hypertension, hypertriglyceridemia, high uremic acid levels, low high density lipoprotein (HDL) cholesterol to define a variously named syndrome or metabolic syndrome. Metabolic syndrome is now considered a major cardiovascular risk factor in a large percentage of population in worldwide. Both obesity and metabolic syndrome are particularly challenging clinical conditions to treat because of their complex pathophysiological basis. Indeed, body weight represents the integration of many biological and environmental components and relationships among fat and glucose tolerance or blood pressure are not completely understood. Efforts to develop innovative anti-obesity drugs, with benefits for metabolic syndrome, have been recently intensified. In general two distinct strategies can be adopted: first, to reduce energy intake; second, to increase energy expenditure. Here we review some among the most promising avenues in these two fields of drug therapy of obesity and, consequently, of metabolic syndrome.     

Risk to human health associated with the environmental occurrence of cyanobacterial neurotoxic alkaloids anatoxins and saxitoxins

Cyanobacteria are ubiquitous photosynthetic micro-organisms forming blooms and scums in surface water; among them some species can produce cyanotoxins giving rise to some concern for human health and animal life. To date, more than 65 cyanobacterial neurotoxins have been described, of which the most studied are the groups of anatoxins and saxitoxins (STXs), comprising many different variants. In freshwaters, the hepatotoxic microcystins represent the most frequently detected cyanotoxin: on this basis, it could appear that neurotoxins are less relevant, but the low frequency of detection may partially reflect an a priori choice of target analytes, the low method sensitivity and the lack of certified standards. Cyanobacterial neurotoxins target cholinergic synapses or voltage-gated ion channels, blocking skeletal and respiratory muscles, thus leading to death by respiratory failure. This review reports and analyzes the available literature data on environmental occurrence of cyanobacterial neurotoxic alkaloids, namely anatoxins and STXs, their biosynthesis, toxicology and epidemiology, derivation of guidance values and action limits. These data are used as the basis to assess the risk posed to human health, identify critical exposure scenarios and highlight the major data gaps and research needs.     

Does hormone treatment added to radiotherapy improve outcome in locally advanced prostate cancer?

BACKGROUND:

To quantify the magnitude of benefit of the addition of hormone treatment (HT) to exclusive radiotherapy for locally advanced prostate cancer, a literature‐based meta‐analysis was conducted.

METHODS:

Event‐based relative risks (RR) with 95% confidence intervals (CIs) were derived through a random‐effect model. Differences in primary (biochemical failure and clinical progression‐free survival) and secondary outcomes (cancer‐specific survival, overall survival [OS], recurrence patterns, and toxicity) were explored. Absolute differences and numbers of patients needed to treat (NNT) were calculated. A heterogeneity test, a metaregression analysis with clinical predictors of outcome, and a correlation analysis for surrogate endpoints were also performed.

RESULTS:

Seven trials (4387 patients) were gathered. Hormone suppression significantly decreased both biochemical failure (RR, 0.76; 95% CI, 0.70‐0.82; P < .0001) and clinical progression‐free survival (RR, 0.81; 95% CI 0.71‐0.93; P = .002), with absolute differences of 10% and 7.7%, respectively, which translates into 10 and 13 NNT. cancer‐specific survival (RR, 0.76; 95% CI, 0.69‐0.83; P < .0001) and OS (RR, 0.86; 95% CI, 0.80‐0.93; P < .0001) were also significantly improved by the addition of HT, without significant heterogeneity, with absolute differences of 5.5% and 4.9%, respectively, which translates into 18 and 20 NNT. Local and distant relapse were significantly decreased by HT, by 36% and 28%, respectively, and no significant differences in toxicity were found. Primary and secondary efficacy outcomes were significantly correlated.

CONCLUSIONS:

Hormone suppression plus radiotherapy significantly decreases recurrence and mortality of patients with localized prostate cancer, without affecting toxicity. Cancer 2009. © 2009 American Cancer Society.     

Acute effect of whole body vibration on postural control in congenitally blind subjects: a preliminary evidence

Abstract

Purpose: The purpose of this study was to investigate the acute effects of whole body vibration at optimal frequency, on postural control in blind subjects.

Method: Twenty-four participants, 12 congenital blind males (Experimental Group), and 12 non-disabled males with no visual impairment (Control Groups) were recruited. The area of the ellipse and the total distance of the center of pressure displacements, as postural control parameters, were evaluated at baseline (T0), immediately after the vibration (T1), after 10?min (T10) and after 20?min (T20). Whole body vibration protocol consisted into 5 sets of 1?min for each vibration, with 1?min rest between each set on a vibrating platform.

Results: The total distance of center of pressure showed a significant difference (p?<?0.05) amongst groups, while the area remained constant. No significant differences were detected among times of assessments, or in the interaction group?×?time.

Conclusion: No impairments in static balance were found after an acute bout of whole body vibration at optimal frequency in blind subjects and, consequently, whole body vibration may be considered as a safe application in individuals who are blind.