Search

A moving tropical cyclone is an intense localized source of surface wind stress and wind stress curl that produces a significant response in the ocean environment, especially in the ocean thermal structure, the upper ocean currents, and the sea surface elevation. Such a response has been well identified in the open-ocean region, but not in the coastal ocean region. In this study we use the Princeton Ocean Model with 20 km horizontal resolution and 23 sigma levels conforming to a realistic bottom topography to identify the response of the South China Sea to Tropical Cyclone Ernie 1996. Results show strong similarities in the responses between open ocean and coastal regions, including near-surface strong asymmetric response such as divergent currents with near-inertial oscillations, significant sea surface temperature cooling, biase to the right of the storm track, sea surface depressions in the wake of the storm, and subsurface intense upwelling and cooling at the base of the mixed layer to the right of the storm track. The unique features of the SCS response to Ernie are also discussed.

CONCLUSIONS: Rivaroxaban is a cost-effective alternative to VKA and is cost-saving for the SSN in the treatment of NVAF patients at highest unmet medical need.

The purpose of this study is to heighten awareness of intestinal endometriosis, a disease that may mimic other abdominal pathologies (bowel carcinoma, intestinal inflammatory disease, diverticulitis), sometimes found in the emergency setting. The Authors report a case of acute bowel obstruction due to coecal endometriosis with appendix mucocele, peritoneal pseudomyxoma and ovarian endometrioma. The patient was operated on in the emergency setting, a right colectomy was performed and she then received pharmacological suppressive treatment with Gn-RH analogues and danatrol. We remark that preoperative diagnosis is very difficult in those cases that do not have a past history of pelvic endometriosis. An accurate anamnesis regarding the chronology of pain onset (typically only during the menstruation at first), but especially intraoperative histopathologic examination are useful for diagnosis. An increased awareness of intestinal endometriosis in reproductive age women with acute bowel obstruction, associated with an accurate anamnesis of menstrual history may allow pre- or intraoperative diagnosis, which is the clue to a less aggressive operation. Postoperative follow up and hormonal therapy are mandatory.

Radical trachelectomy was described for the first time by Dargent in 1987 as an alternative to the traditional radical hysterectomy; it led to a changed procedure in therapy for early cervical cancer in young women who want to preserve their fertility. With this technique it is possible to remove the uterine cervix and parametrius and at the same time preserve the upper part of the cervical canal and uterus. Only a low-risk subset of young patients with early cancer of the cervix are considered eligible for this treatment; to select them histological and clinical staging of the lesion are the most important criteria. We describe the cases of three patients treated with radical trachelectomy between June 1997 and March 1998 in our Institute, reporting in detail the surgical procedure and the results.

The need of foreseeing the prognosis of ovarian cancer beyond the limits of classical methods based on clinical and histopathological staging has recently caused great interest in a large number of biologic prognostic markers. Studies concern proliferation associated proteins, suppressor genes, abnormal expressions of growth factors, cytokins, and many more. Here some of the most recent and promising factors being studied are described together with their significance for future clinical application.

Preoperative chemotherapy for breast cancer has been originally proposed in the treatment of locally advanced tumors (T3b-T4) in order to allow radiotherapy or radical mastectomy. Later, it has been employed also for less advanced stages of the disease (T2-T3), to allow conservative surgery. Personal series of 45 patients that underwent preoperative chemotherapy (FAC) for breast cancer stages T2-T3 is reported. A partial response in terms of reduction of tumor volume was obtained in 80% of these patients, a complete response in 6.6% of the cases. In 48.8% a quadrantectomy has been performed, as the lesion diameter was2.5 cm after chemotherapy. The survival rate was 70% at 10 years, and 80% for initially T2 tumors, compared with 50% 10 year survival rate in a group of patients with T2 tumors treated before the introduction of neoadjuvant chemotherapy at our Department. Neoadjuvant chemotherapy allows reduction of the initial volume of breast cancer and performance of conservative instead or radical surgery, with better cosmetic results. Moreover these data suggest that they may improve the plateau of the survival curve of patients with locally advanced breast cancer.

Chemotherapy-induced emesis is one of the major problems in the treatment of oncologic patients. Recently, a novel class of compounds, the selective 5HT3 receptor antagonists, has been introduced, achieving a dramatic improvement in the control of emesis. The absence of extrapyramidal side effects adds to their safety and good tolerability. The Authors herein analyse their experience on 269 cycles of chemotherapy in 47 patients treated for gynaecological and breast malignancies, with particular regard to adverse events such as headache. Their most frequent side-effects are headache and constipation, that are usually mild and self-limiting. Nevertheless, in some cases, severe, rebel headache has been reported, leading in our experience in 6.4% of cases to discontinuation of the antiemetic regimen. A previous history of recurrent or severe headache or migraine is not correlated with the occurrence of ondansetron-induced headache, as severe headache occurred after ondansetron only in 28.4% of the patients with positive anamnesis, and 70% of the patients that experienced had never suffered from severe headache before. In those patients complaining of severe headache, the Authors suggest an antiemetic association, with a loading dose of ondansetron i.v., followed by metoclopramide i.m. orally for the following days.

Chemotherapy-induced nausea and vomiting is one of the major side effects of antiblastic treatment in cancer patients, seriously affecting both the compliance of the patient to therapy and his or her quality of life.The Authors present their experience in the use of ondansetron in 47 patients receiving 186 cycles of chemotherapy for breast or genital neoplasms.Successful control of vomiting was achieved in the first 24 hours, in 74% of the cycles containing cisplatin and 82% of the cycles without cisplatin, if ondansetron was used. On delayed vomiting the difference in results was not as striking as on acute emesis.The major side effects with ondansetron were headaches (42.4%) and constipation (48.9%). As expected, no extra-pyramidal symptoms were observed in this group, versus 13.3% of the patients treated with metoclopramide.

Invasive lobular carcinoma of the breast (ILC) is the second most common form of mammary neoplasm after ductal carcinoma. Due to its histological features, characterised by a diffuse infiltration of the tissue by malignant cells with scarce fibrotic reaction, lobular carcinoma often presents clinical and instrumental diagnostic difficulties. The Authors present a retrospective series of 28 patients with lobular carcinoma, with special regard to the diagnostic work-up. Clinical examination misdiagnosed 10 cases, in which only a mild thickening of the breast parenchyma was present. Mammographic false negatives were 21.4% (6 cases). Ultrasonography allowed correct diagnosis in 5 out of these 6 cases. Fine needle aspiration (FNA) had low sensitivity (33% false negatives). ILC constitutes a diagnostic challenge, often requiring the combination of multiple diagnostic tools.

Acephalus acardiac fetus is a rare condition due to twin reverse arterial perfusion syndrome (TRAP-sequence), affecting 1/35000 pregnancies and about 1% of monochorionic twins. In this condition the donor fetus (pump fetus) provides circulation for itself and the recipient twin, developing progressive heart failure. The acardiac twin is grossly abnormal, with severe reduction anomalies of the upper part of the body. We report a case of an acephalus acardiac fetus presenting at the third trimester scan as a small complex cystic mass. A 34-year-old woman, gravida 1, with a singleton pregnancy, was referred to our unit at 31 weeks and 6 days of gestation for a detailed scan, because of a neck/thorax fetal mass. The scan revealed an IUGR fetus (abdominal circumference at 10th centile) with no evidence of structural anomalies. The umbilical and uterine artery Doppler flow were normal (umbilical artery PI 0.97, 50th centile; RI right uterine artery 0.53; RI left uterine artery 0.45). An intramniotic complex mass, measuring 9 cm × 5 cm, was visualized, independent from fetal structures and from the uterus wall. A little and thin ‘cord-like’ structure connecting the cyst to the placenta was seen. Color and pulsed Doppler showed an umbilical artery flow. The diagnosis of acephalus acardiac twin was therefore suggested. The patient underwent weekly ultrasound examinations. At 35 weeks’ gestation a Cesarean section was performed, because of donor progressive growth restriction, giving birth to a female healthy baby, weighing 2400 g, Apgar 9. Post-mortem examination of the small cystic mass confirmed prenatal diagnosis. Our report demonstrates that TRAP-sequence could present as an intramniotic small complex mass and, regardless of the dimension, affect pump twin growth.

The authors report their considerations on the care of the oncologic childhood and their families. Various psychologic aspects are discussed, first of all the child and his cancer, how the parents and siblings face the disease, death and after. Finally they outline the role of pediatrician and the hospital staff.

not present