Rehabilitation and quality of life in patients undergoing surgery for esophageal cancer

The impact of esophageal cancer surgery, postoperatively as well as on quality of life (QoL) is still largely unknown. Clinical experience and the scarce existing literature concur that these patients show difficulty in returning to their original lifestyles and previous social activities, not just due to the difficulties common to all tumor pathologies but also for the specific dietary and digestive disturbances which characterize esophageal cancer therapy. As specific rehabilitation protocols are nonexistent in the literature, in this study a rehabilitation planning program, is proposed based on evaluation of postoperative and long-term problems which can be tackled with rehabilitation.     

Efficacy of homeopathic therapy in cancer treatment

Many cancer patients use homeopathic approaches to increase their body's ability to fight cancer, improve their physical and emotional well-being, and alleviate their pain resulting from the disease or conventional treatments. Homeopathy is highly controversial as there is no plausible mode of action for these highly diluted remedies. The aim of this systematic review is to summarize and critically evaluate the efficacy of homeopathic remedies used as a sole or additional therapy in cancer care. We have searched the literature using the databases: Amed (from 1985); CINHAL (from 1982); EMBASE (from 1974); Medline (from 1951); and CAMbase (from 1998). Randomised and non-randomised controlled clinical trials including patients with cancer or past experience of cancer receiving single or combined homeopathic interventions were included. The methodological quality of the trials was assessed by Jadad score. Six studies met our inclusion criteria (five were randomised clinical trials and one was a non-randomised study); but the methodological quality was variable including some high standard studies. Our analysis of published literature on homeopathy found insufficient evidence to support clinical efficacy of homeopathic therapy in cancer care.     

Acute spontaneous corneal hydrops in a patient with pellucid marginal corneal degeneration

Pellucid marginal corneal degeneration (PMCD) is an ectatic corneal disorder characterized by a peripheral, noninflammatory band of thinning of the inferior cornea. This condition often is misdiagnosed with keratoconus, with which it shares several clinical, videotopographic, and histologic aspects. Furthermore, as with keratoconus, hydrops and spontaneous corneal perforation can occur. We report the case of a 56-year-old man with confirmed PMCD, emphasizing the diagnostic approach, the disease follow-up, and its complication in spontaneous acute corneal hydrops. Finally, regarding this case, authors collect the clinical and videotopographic characteristics of PMCD and discuss the different therapeutic options.     

Cryopreservation of immature testicular tissue

An increased incidence of cancer is observed in the population of adolescents and young adults since thirty years. Major progress in cancer diagnosis and therapy is unfortunately associated to high degree of toxicity on gonad function. Cryopreservation of ovarian tissue is performed in girls and women before cancer treatment with high risk of infertility. Procedures for ejaculated or testicular extracted spermatozoa are well defined. However, for prepubertal boys or after ejaculated sperm collection failure, mature or immature testicular tissue banking should be proposed. Still, an optimal cryopreservation protocol is a prerequisite for clinical application and does not exist for the moment. Furthermore, the future applications of immature testicular tissue banking should be developed, not solely germ cell in vitro maturation but also autologous testicular tissue grafting.     

Comparison of effectiveness of carvedilol versus bisoprolol for prevention of postdischarge atrial fibrillation after coronary artery bypass grafting in patients with heart failure

Atrial fibrillation (AF) occurs frequently soon after coronary artery bypass grafting (CABG) and often results in increased mortality and morbidity, particularly in patients with heart failure. New-onset AF is also a common event in the early period after discharge from a cardiac surgery clinic. Current guidelines recommend β blockers as first-line medication for the prevention of AF after CABG. In this prospective study, we investigated the effectiveness of the highly selective β1 receptor antagonist bisoprolol compared to the less selective β blocker carvedilol in preventing postdischarge AF after CABG in patients with decreased left ventricular function. Three hundred twenty patients (231 men, 89 women, mean age 66 ± 10 years) with ejection fraction <40% who underwent CABG and were then referred to an in-hospital cardiac rehabilitation program were randomized to receive bisoprolol (n = 160) or carvedilol (n = 160) starting 4 to 5 days after surgery. Bisoprolol was started at 1.25 mg 1 time/day and carvedilol was started 3.125 mg 2 times/day. All patients underwent continuous telemetric electrocardiographic monitoring for 5 days after entry in the study and thereafter 2 times/day routinely up to hospital discharge. During follow-up, 23 patients (14.6%) in the bisoprolol group and 37 patients (23%) in the carvedilol group developed AF (relative risk 0.6, confidence interval 0.4 to 0.9, p = 0.032). Twenty-six percent of all AF episodes were asymptomatic. At the 4-week outpatient visit, those in the bisoprolol group showed a significantly greater decrease in heart rate, being in sinus rhythm or AF (-15.6 ± 3 vs -9.4 ± 3 beats/min, p = 0.021), whereas changes in systolic and diastolic blood pressures did not differ significantly. In conclusion, bisoprolol is more effective than carvedilol in decreasing the incidence of postdischarge AF after CABG in patients with decreased left ventricular function.     

AIDS-associated cryptococcosis: a comparison of epidemiology, clinical features and outcome in the pre- and post-HAART eras. Experience of a single centre in Italy

Objectives

To assess the prevalence, clinical and immunological characteristics, risk factors and survival of patients with AIDS‐related cryptococcosis in the era of highly active antiretroviral therapy (HAART).

Methods

All newly diagnosed cryptococcosis cases identified retrospectively from among a series of AIDS patients hospitalized consecutively at a single institution in Italy in 1985–1996 (pre‐HAART period, n=165) and 1997–2006 (post‐HAART period, n=40) were analysed comparatively.

Results

The prevalence of cryptococcosis decreased from 4.7% (165/3543) to 2.2% (40/1805) between the pre‐ and post‐HAART periods (P=0.0001). There were no differences in the clinical features or immunological status of the patients between the two cohorts. The variables associated with the occurrence of cryptococcosis in the post‐HAART era were older age (P<0.001), no previous diagnosis of HIV infection (P<0.001) and infection in homosexual males (P=0.004). During the post‐HAART period, immune reconstitution inflammatory syndrome associated with cryptococcosis was observed in five patients (19.3%) a median of 15 weeks after the start of HAART. Thirty‐day survival (P=0.045) and overall survival (P=0.0001) were significantly better among patients diagnosed with cryptococcosis in the post‐HAART compared to those diagnosed in the pre‐HAART era.

Conclusions

The AIDS‐associated cryptococcosis observed in Western countries in the HAART era has similar clinical and immunological characteristics to that observed in the pre‐HAART era, but a significantly better outcome.     

Italian National Survey of Blood Donors: External Quality Assessment (EQA) of Syphilis Testing

The detection of syphilis among blood donors may reveal high-risk sexual behavior, which can go unreported at the time of donor selection and compromise the safety of the donated blood. In Italy, blood is collected, tested, and distributed by transfusion services (TSs), which also perform outpatient transfusions. Although the TSs must screen for syphilis by law, there are no indications of the specific type of method to be used, generating discrepancies in the results obtained by the different TSs. To determine the proficiency of the TSs in screening for syphilis, we performed an external quality assessment (EQA). The EQA was based on two shipments of serum panels; 133 and 118 of the 326 existing TSs participated in the first and second shipments, respectively. Each panel consisted of both positive and negative serum samples. The results confirmed that the use of a single nontreponemal test (the Venereal Disease Research Laboratory [VDRL] and the rapid plasma reagin [RPR] tests) is the least sensitive means of identifying samples that are positive for syphilis antibodies. We also found that the interpretation of the results of manual techniques, such as the RPR test, the VDRL test, the Treponema pallidum hemagglutination (TPHA) assay, and the T. pallidum particle agglutination (TPPA) assay, can vary greatly among different TSs and operators. Total Ig enzyme immunoassays (EIAs) are the most sensitive. However, the determination of syphilis on the basis of the results of a single test is not sufficient for an accurate screening; and all blood units should thus be assessed by two distinct treponemal tests, that is, a total Ig EIA and the TPHA or the TPPA assay.Syphilis is a reemerging disease and is caused by the spirochete Treponema pallidum. In most cases it is sexually transmitted, although it can also be transmitted from mother to child in utero and, rarely, through blood transfusion, especially through the transfusion of fresh blood components (6, 12). Serological tests for syphilis are considered to be a milestone in syphilis control, and since as early as the 1930s they have greatly contributed to the detection of T. pallidum infection not only in the clinical setting but also in transfusional medicine. The detection of blood donors who are positive for syphilis is an important public health concern, given that testing may reveal high-risk sexual behavior, which can go unreported at the time of donor selection and compromise the safety of blood used for transfusions.In some European countries, the occurrence of T. pallidum infection in the general population has been increasing, and this increase is reflected in its growing occurrence among blood donors. In particular, a survey performed in England has indicated that since 2001 there has been a trend toward a moderate increase in the incidence of T. pallidum infection among blood donors (2). In Germany, although the incidence of infection among donors is very low, increases have been recorded since 1991 (9). The incidence of T. pallidum infection among blood donors is also increasing in Italy. In particular, according to the Transfusion Transmitted Infections Surveillance System (7), it increased from 3.8 per 100,000 donations in 1999 to 7 per 100,000 donations in 2006 (11).The data collected by the Transfusion Transmitted Infections Surveillance System in Italy are provided by the existing 326 transfusion services (TSs). These are hospital-based facilities where blood is collected, tested, and distributed and where, in most cases, outpatient transfusions are performed (10). In 2006, there were 1,539,454 donors, for a total of 2,402,267 donated units. Remarkably, 85% of the donors provided multiple donations (4). Although the TSs are required by law to screen for syphilis, there are no indications of the specific type of method that must be used, nor is there any confirmatory algorithm for testing on the basis of the different assays available. In fact, the laboratory assessment of syphilis is generally based on the detection of antibodies against T. pallidum antigens in blood by the use of either specific or nonspecific reagents. Methods based on the detection of specific Treponema antigens include passive agglutination, such as the T. pallidum hemagglutination (TPHA) assay or the T. pallidum particle agglutination (TPPA) assay, and indirect immunofluorescence, such as the fluorescent treponemal antibody absorbed (FTA-ABS) assay or the most sensitive assay, the enzyme immunoassay (EIA), for the detection of specific IgG and IgM or total Ig. Additional methods are based on nonspecific reagents, including nontreponemal lipid antigens (cardiolipin), and they most commonly rely on the flocculation technique. Of these, the Venereal Disease Research Laboratory (VDRL) and rapid plasma reagin (RPR) tests are the most commonly used.The use of different assays from such a large array could generate discrepancies in the detection of syphilis among TSs, stressing the need for quality assessment. To this end, we performed an external quality assessment (EQA) of the quality and the comparability of the results obtained by the different TSs with the aim of contributing to the development of preventive and corrective measures (1, 3).     

Characterization of shock in a hamster model of hantavirus infection

Human hantavirus cardiopulmonary syndrome (HCPS) due to Andes, sin nombre and other hantaviruses is characterized by severe pulmonary capillary leak and cardiogenic shock. Hamsters, the only animal manifesting HCPS-like disease, were instrumented with radiotelemeters that enabled ambulatory intracarotid blood pressure recording within an animal biosafety level-4 facility. Following infection with Andes virus, blood pressure and heart rate decreased slowly in a biphasic manner during the first 7 days of infection, followed by a rapid fall in pressure and rapid increase in heart rate during the 10-20 h preceding death on day 9 or 10. The preterminal narrowing of pulse pressure was consistent with a cardiogenic impairment. Heart rate variability analysis implicated increased sympathetic nervous system activity as seen in human HCPS. The hamster model of HCPS mimics not only the pulmonary capillary leak but also the hypotension characteristic of human HCPS.     

Different evolutionary rates and epidemic growth of hepatitis B virus genotypes A and D

The epidemiological history of HBV genotypes A and D and subgenotypes A2 and D3 was studied on 132 isolates drawn between 1980 and 2005 from patients living in a homogenous geographical area. Evolutionary rates and divergence dates were estimated and HBV demographic history was reconstructed by using a statistical approach based on coalescent theory. The evolutionary rate of A2 was significantly lower than that of D3. The growth rate of D3 epidemic was significantly faster than that of A2; both subgenotypes showed a decreasing growth rate from the mid-1980s. Our data suggest that the important discrepancies observed in the evolutionary rates of HBV genotypes A and D may reflect different population dynamics of their epidemics. These results show the usefulness of phylodynamic studies in reconstructing the history of epidemics due to highly variable DNA viruses, and in evaluating the long-term efficacy of prophylactic measures.