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Hintergrund: Pegyliertes liposomales Doxorubicin (PLD) ist ein hochwirksames Chemotherapeutikum, das jedoch bei bis zu 80% der Patienten dermale Nebenwirkungen wi

Hintergrund: Studien zum Vergleich verschiedener Haut-Prick-Test-Methoden haben unterschiedliche Ergebnisse erbracht, und uber ihre Anwendung bei Kindern ist weni

Körperpflegeprodukte, die Berichten zufolge eine allergische Kontaktdermatitis auf das darin enthaltene Formaldehyd verursachen, müssen angesichts der jüngsten chemischen Entwicklungen in unserem Verständnis des Filmbildners Toluolsulfonamid-Formaldehyd-Harz, der Konservierungsstoffe Diazolidinylharnstoff und Imidazolidinylharnstoff sowie Formalin neu bewertet werden. Der vorliegende Artikel beleuchtet diese Stoffe und die Verwendung von Formaldehyd in Rohmaterialien und formaldehydhaltigen Konservierungsstoffen in Körperpflegeprodukten.Übersetzung aus Skin Pharmacol Physiol 2012;25:236-240 (DOI: 10.1159/000338429)

Derzeit gibt es keine allgemein anerkannten Definitionen fur Wunden mit erhohtem Infektionsrisiko. In der klinischen Praxis wird bei zu vielen chronischen Wunden ein Infektionsrisiko gesehen, weshalb

Ziel: Untersuchung der Auswirkungen des chronologischen Alters auf die Permeation von Fentanyl durch die menschliche Haut in vitro mit Hilfe statischer Diffusionszellen. Es ist bekannt, dass ältere Menschen empfindlicher auf Opioide reagieren und nach dermaler Applikation von Fentanyl höhere Plasmakonzentrationen erreichen als Jüngere. Der Einfluss des Alters, als isolierter pharmakokinetischer Parameter, auf die Absorption von Fentanyl ist bislang nicht untersucht worden. Methode: Die Haut von 30 weiblichen Spendern wurde in statische Diffusionszellen eingespannt; über 48 h wurden Messungen vorgenommen. Die Spenderinnen waren in drei Altersgruppen eingeteilt: Ergebnisse: Die jüngste Gruppe zeigte eine signifikant höhere mittlere Absorption (3100 ng/cm2) als die beiden anderen Gruppen (2000 bzw. 1475 ng/cm2) und eine signifikant größere AUC (jüngere Altersgruppe: 9393 ng, mittlere und alte Altersgruppe: 5922 bzw. 4050 ng). Ferner bestanden Unterschiede in der Lag-Zeit und der Absorptionsrate zwischen den drei Gruppen, mit einer signifikant höheren Absorptionsrate bei jüngeren Teilnehmerinnen als bei älteren Teilnehmerinnen. Schlussfolgerung: Es konnte in vitro gezeigt werden, dass Fentanyl die Haut von Jüngeren in größeren Mengen und mit höherer Absorptionsrate überwindet als bei Älteren. Übersetzung aus Skin Pharmacol Physiol 2013;26:155-159 (DOI:10.1159/000348876)

Hintergrund/Ziel: Moderne Manner haben veranderte Schonheitsideale und Korperpflegegewohnheiten, was zu einer erhohten Nachfrage nach Kosmetika fur Manner gefuhrt

We report a case of diffuse malignant pleural mesothelioma (DMPM) in a 68-years-old male patient who was admitted for right sited pleural effusion. The patient was treated by multimodality approach consisting in surgical treatment with Extrapleural Pleuropneumonectomy followed by chemotherapy with Cisplatin and Pemetrexed. He had a disease free period of one year and survived for 31 months.The patient was admitted to our Institute for a right sited pleural effusion diagnosed on chest X ray. Anamnesis revealed professional asbestos exposure and the patient presented dyspnea, dry cough, right sited chest pain, low fever and loss of weight. As thoracentesis and CT scan did not reveal pathological findings except of the effusion, we performed videothoracoscopy. Several grey nodular lesions involving the costal, diaphragmatic and mediastinic parietal pleural sheets were found. Histological examination of the specimens extracted revealed the presence of epithelial malignant pleural mesothelioma with sarcomatoid areas. Further examinations staged the lesion as Butchart I. Extrapleural pleuropneumonectomy was performed followed by a chemiotherapic treatment with Cisplatin and Pemetrexed. The patient underwent a follow up program with CT scan every four months. The disease free period was of about one year and the patient died after 31 months from diagnosis for septic complications related to chronic effusion.Single treatments do not demonstrate an acceptable efficacy on the treatment of DMPM. Multimodality therapy provides good survival improvement and acceptable quality of life for the patients.

The term thyroid goiter is accepted worldwide, while the terms "substernal", "retrosternal" or "intrathoracic" are not clearly agreed on. The tendency to enlarge and to compress adjacent anatomical structures and the chance of malignancy impose the surgical excision as the principal treatment option. We present our experience on the management of substernal goiter and through this, a rapid review of the literature.The last seventeen years we treated 94 patients with substernal goiter. The mean age was 57 years and the male - female ratio was 1:5. All patients had preoperatory assessment with chest X ray, ultrasound and CT scan of the neck. We performed a total thyroidectomy through cervical access in 96.7% of cases and in 3.2% through sternotomic access.We found 95.7% cases of anterior and 4.3% cases of posterior goiters, with only one ectopic goiter. Pathologic examination reveal 72.3% colloidocystic goiters, 18% adenomas, 7.4% carcinomas and 2.3% cases of thyroiditis. The most important postoperatory complications were: 2 cases of persistent hypoparathyroidism, 3 cases of recurrent damage and 2 cases of chylothorax. No deaths were observed.It is necessary a scientific agreement on the definition of substernal goiter, in order to uniform epidemiological and clinical data. Preoperative assessment is based on chest X ray, ultrasound and CT scan of the neck. Cervicotomic access represents the most frequent approach and total thyroidectomy is the procedure recommended. Postoperative complications are almost the same as for cervical goiters and mortality is nowadays extremely low.

The treatment of colorectal cancer has changed radically in the last decades. Due to the great advances it is now often possible to subject patients to oncological radical treatments without applying to highly aggressive surgery, such as the Miles abdomino perineal resection, which requires a definitive colostomy. So nowadays we more and more apply to anterior resection of the rectum. Some recent studies about quality of life in patients who underwent anterior resection of the rectum focalized their attention on postoperative functional sequels. In particular incontinence, constipation, obstructed defecation and urgency are some of the symptoms which define the anterior resection syndrome, which can be efficiently treated by electrostimulation and biofeedback.A prospective study on 61 patients who underwent between 2002 and 2007 anterior resection of the rectum with total mesorectal excision for adenocarcinoma, has shown symptoms of anterior resection syndrome in 14 patients. Succeeding treatment with sphincter electrostimulation and biofeedback has shown improvement in all patients and complete resolution of the anterior resection syndrome in 10 patients who showed a great compliance and a steady improvement on quality of life.Rehabilitative treatment with electrostimulation and biofeedback can sensibly reduce symptoms of anterior resection syndrome. An accurate manometric functional assessment is necessary before starting treatment with electrostimulation and biofeedback.

To evaluate and compare the immediate and long-term outcomes of videothoracoscopic T2–T4 sympathectomy and T3–T4 sympathicotomy for the treatment of palmar and axillary hyperhidrosis. Between October 1993 and September 2007, we treated a total of 88 patients affected by palmar and axillary hyperhidrosis. Twenty-four patients underwent T2–T4 sympathectomy with 5–10 mm trocars (Group A), 43 T2–T4 sympathectomy with 2–5 mm trocars (Group B), 15 T3–T4 sympathicotomy with 5–10 mm trocars and 6 T3–T4 ganglion block with 2–5 mm trocars (Group C). The mean operative time, for each side, was 15 min for sympathicotomy and 28 min for sympathectomy. In September 2008, we recontacted 98% of patients (total 86), by telephone, to establish long-term results (follow-up range 1–15 years). In this series, we did not find any significant difference between T2–T4 sympathectomy and T3–T4 sympathicotomy in terms of postsurgical palmar anhidrosis or onset of compensatory hyperhidrosis, while both methods show high efficacy for remission of palmar hyperhidrosis. The slightly higher recurrence rate in our early experience (Group A) can be attributed to the learning curve. Using smaller trocars (2–5 mm), we reduced postsurgical intercostal pain and obtained better aesthetic results and a higher grade of patient’s satisfaction. Thoracoscopic approach to hyperhidrosis has evolved in the last few decades with a consequent decrease in side effects. In this series, all patients experienced an improvement in quality of life even in case of recurrence or onset of compensatory hyperhidrosis. Due to these results, the shorter operative time and easier performance of sympathicotomy, we prefer this method.

Cardiac resynchronization therapy is indicated in advanced heart failure patients with a wide QRS complex, because it restores the synchronicity of the atrioventricular, interventricular and intraventricular contractions. It is performed through endovascular implantation of one or more leads. Left cardiac lead positioning is one of the most challenging procedures in interventional cardiology; unfortunately, in up to 40% of cases no clinical improvements occur. Surgical implantation of a left ventricular lead is indicated in cases of failure or predicted unfeasibility of a transvenous positioning. Several surgical techniques have been described for implantation of left ventricular lead. Minimally invasive approaches, including video-assisted thoracic and robotic surgery, are favoured due to reduced trauma, pain and recovery time. Robotic surgery confers significant advantages for visualization and manoeuverability, which are important in patients with a history of cardiac surgery, in whom scarring and adhesions may render placement challenging. We describe here the surgical technique for robotic implantation of left ventricular leads in candidates for cardiac resynchronization therapy.

Highlights • Broncho-Esophageal Fistula (BEF) in adults is rare. • If left untreated, BEF may lead to fatal complications despite its benign nature. • The most frequent approach is thoracotomy. • Video Assisted Thoracoscopic Surgery (VATS) may be a minimally invasive approach., Introduction Broncho-esophageal fistula is a rare clinical condition which can be manifested with non-specific signs and symptoms. Presentation of a case Here, we report an adult case of a broncho-esophageal fistula in a 43-year-old man referred for chronic cough after fluid food intake and weight loss. Barium swallow, esophagogastroduodenoscopy, bronchoscopy and Computed Tomography of the chest demonstrated a broncho-esophageal fistula between the apical segmental bronchus of the lower right lobe and the middle section of the esophagus. The patient underwent video-assisted thoracoscopic surgery for resection of the fistula. No post-operative complications occurred. Discussion Broncho-esophageal fistula in adults is rare and its diagnosis is often delayed due to the frequent lack of specific symptoms. Although there is no standard protocol, the most widely used treatment is thoracotomy with identification and dissection of the fistula tract followed by repair of bronchial and esophageal defects. Conclusions Video-assisted thoracoscopic surgery appears to be an effective and minimally invasive approach for the treatment of broncho-esophageal fistulas, especially in young, healthy subjects.

Aim. We report our experience on the management of Hurthle cell neoplasms (HCNs) of the thyroid and a review of the literature in order to describe the most relevant clinical, diagnostic, biologic and therapeutic aspects. Materials and Methods. We retrospectively reviewed the clinical records of 15 consecutive patients with HCN. The male/female ratio was 1:4 and the mean age was 53.8 years. Fourteen patients underwent total thyroidectomy and one patient lobectomy. Two patients were lost to follow up. The mean follow up time was 54 months. Results. Eleven Hurthle cell adenomas and 4 carcinomas were found. At the time of initial surgical evaluation 9 patients (60%) were symptomatic, with hyperthyroidism and dysphagia being the most frequent manifestations. Only in 6 (40%) cases the diagnosis was obtained by preoperative fine needle aspiration biopsy. Among patients with Hurthle cell adenoma and carcinoma the mean age was 51 and 62 years respectively and the mean lesion size 1.6 and 3.8 cm respectively. No cases of death or recurrence were registered. Conclusions. Clinical manifestations are similar to those for other differentiated thyroid neoplasms. Patients with Hurthle cell carcinoma presented a mean age and a mean tumor size greater than those with Hurthle cell adenoma. Our data suggest that adenomas have not a malignant potential; nevertheless surgical resection is necessary to obtain a precise evaluation of eventual infiltrative events. Surgical resection is also the treatment of choice for the treatment of carcinomas with total thyroidectomy representing the best surgical option. Obiettivo. Riportiamo in questo articolo la nostra esperienza nel management delle neoplasie a cellule di Hurthle (HCNs) ed una revisione della letteratura allo scopo di sottolineare i più importanti aspetti clinici, diagnostici, biologici e terapeutici. Materiali e metodi. Abbiamo esaminato i dati clinici di 15 pazienti consecutivi con HCN. L’età media dei pazienti era di 53,8 anni e il rapporto maschi/femmine 1:4. Quattordici pazienti sono stati sottoposti a tiroidectomia totale ed uno a lobectomia. Due pazienti sono stati persi al follow up. Il tempo medio di follow up era di 54 mesi. Risultati. Undici pazienti sono stati trovati affetti da adenoma a cellule di Hurthle e 4 da carcinoma. Nove pazienti (60%) erano sintomatici, e solo in 6 (40%) casi la diagnosi è stata ottenuta tramite biopsia con ago aspirato. L’età media dei pazienti affetti da adenoma era 51 anni e di quelli con carcinoma 62. La dimensione media delle lesioni era superiore nei pazienti con carcinoma (3,8 cm verso 1,6 in quelli con adenoma). Non sono stati osservati decessi o recidive. Conclusioni. Abbiamo osservato una differenza di età e di dimensione delle lesioni tra i pazienti affetti da adenoma e quelli affetti da carcinoma. I nostri dati suggeriscono che gli adenomi a cellule di Hurthle non hanno potenziale maligno, tuttavia l’asportazione chirurgica è necessaria per la valutazione di eventuali eventi infiltrativi. Il trattamento chirurgico con tiroidectomia totale o resezioni più ampie ove necessario rappresenta il trattamento di scelta per i carcinomi.

Chronic mesenteric ischemia is a rare intestinal disorder, with a potential evolution toward intestinal infraction. The choice of the appropriate treatment is currently the most crucial issue in the management of patients with chronic mesenteric ischemia. We describe our experience with 16 cases, and we discuss the current diagnostic and therapeutic approaches. A retrospective review of the clinical records was performed, and demographic, clinical, therapeutic, and prognostic data were collected. Six patients were females (37%), and the mean age was 62 years. Postprandial pain was present in all the cases, whereas sitophobia and weight loss were detected in 87 per cent of them. Eight patients were treated with open surgery; no perioperative deaths or relevant complications occurred. One patient had a restenosis of the celiac trunk and superior mesenteric artery 10 months after surgery. No deaths or relevant complications occurred in the remaining patients, who underwent an endovascular procedure. One patient presented a restenosis distal to the vascular stent, whereas two patients died due to comorbidities. The low rates of postoperative morbidity, mortality, and restenosis obtained suggest that surgical or endovascular correction of chronic mesenteric ischemia is satisfactory when performed by experienced surgeons, with an adequate selection of the patients.

Epithelioid sarcomas (ES) are rare soft tissue tumours of obscure histogenesis. Diagnosis is often difficult as specific morphological and immunohistochemical patterns do not exist. Two distinct clinico-pathological entities have been identified: the classic or distal type and the proximal type. Recently, immunohistochemical detection of Ca 125 was described in ES, as well as loss of INI 1 expression. The authors describe in this paper the morphological and immunohistochemical features of two cases of proximal ES of the vulva. Immunoreactivity for Ca 125 and loss of INI 1 expression were present in both cases. These results confirm previous observations in Asian reports showing that these markers can be used as immunohistochemical markers for the diagnostic assessment of ES.

The aim of this study was to analyze and describe the epidemiological characteristics and trends of colorectal cancer in Sassari province (Sardinia, Italy), an area with a spontaneous surveillance program for colorectal malignancies, in the period 1992–2010. Data were obtained from the local tumor registry which makes part of a wider registry web, coordinated, today, by the Italian Association for Tumor Registries. The overall number of colorectal cancer cases registered was 4.284. The male-to-female ratio was 1:0.7 and the mean age 68.3 years for males and 69.4 years for females. The standardized incidence rates were 49.3/100,000 and 31.1/100,000 and the standardized mortality rates 20.4/100,000 and 12.4/100,000 for males and females respectively. An increasing trend in the incidence of colorectal cancer in Sassari province was evidenced. Relative survival at 5 years from diagnosis was 48.6% (52.3% for males and 44.7% for females). A slight increase in mortality rates was observed, as opposed to national figures, probably attributable to the lacking of organized screening strategies in the area.

Introduction: Pancreatic cancer can arise in the exocrine or endocrine part of the gland, and represents a relevant modern health care issue because of its extremely high mortality and increasing incidence in most developed countries, which imposes a constant epidemiological surveillance. The aim of this study was to analyse and describe the epidemiology of pancreatic cancer in North Sardinia, Italy, in the period 1992-2010. Materials and methods: Data were obtained from the tumor registry of Sassari province that makes part of a wider registry web, coordinated today by the Italian Association for Tumor Registries (AIRTUM). Results: The overall number of pancreatic cancer cases registered was 1,388. The male-to-female ratio was approximately 1:1 and the mean age 69 years for males and 73 years for females. The standardized incidence rates were 13.7/100,000 and 9.4/100,000 and the standardized mortality rates 13.3/100,000 and 8.6/100,000 for males and females respectively. The relative 5-years survival was 6.9% for males and 6.2% for females. Discussion: Incidence rates of pancreatic cancer in North Sardinia were similar to those of other countries close to the equator, confirming an inverse variation with solar exposure, and thus, vitamin D levels. Furthermore, our data showed a substantially stable trend in incidence and mortality rates of pancreatic cancer in both sexes in the last decades in the area. The relative survival rates were low, therefore efforts in all fields of research and clinical practice must be enhanced to improve outcomes in patients with pancreatic cancer.

Background The aim of this study was to analyze and describe the epidemiological characteristics and trends of lung cancer in North Sardinia, Italy, in the period 1992–2010. Methods Data were obtained from the tumor registry of Sassari province which is a part of a wider registry web, coordinated today by the Italian Association for Tumor Registries. Results The overall number of lung cancer cases registered was 4,325. The male-to-female ratio was 4.6:1 and the mean age 68.1 years for males and 67 years for females. The standardized incidence rates were 73.1/100,000 and 13.5/100,000 and the standardized mortality rates 55.7/100,000 and 9.9/100,000 for males and females, respectively. An increasing trend in incidence of lung cancer in women was evidenced. Conversely, incidence was found to decrease in males. Relative survival at 5 years from diagnosis was low (8.8% for males and 14.9% for females). Furthermore, an increase in mortality rates was observed in both sexes in the period under investigation. Conclusions Our data show an increasing trend of lung cancer incidence in women in North Sardinia in the last decades. Conversely, a reduction of incidence rates was observed in males. Furthermore, a slightly increasing trend in mortality rates was observed in both sexes, suggesting the need to enhance smoking control strategies, consider adoption of effective surveillance policies, and improve diagnosis and treatment methods.