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Este estudo trata-se de uma revisão bibliográfica, executada nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e no Portal Scientific Electronic Library Online (SciELO), no sistema on-line, no período de Agosto de 2010, utilizando-se da palavra Medicina Tradicional Chinesa, Stress e Terapias Alternativas Na seleção dos artigos utilizou-se como fatores de inclusão: texto língua portuguesa, corresponder aos objetivos deste trabalho, e estar publicado dentro dos últimos cinco anos (2005-2010). Assim, a seleção dos artigos emergiu para um no LILACS e um no SCIELO, totalizando a análise e discussão de 2 artigos científicos. Dos artigos analisados, permitiram categorizá-los em: 1) A Acupuntura, como intervenção terapêutica complementar do Enfermeiro, e da própria Equipe de Enfermagem para o tratamento do Stress; 2) A Auriculoterapia como intervenção na redução do Estresse da Equipe de Enfermagem. Os resultados mostraram que há pouca produção científica na base de dados on-line nesta temática e que mais estudos devem ser realizados para que sejam divulgados os benefícios da Medicina Tradicional Chinesa como uma terapia alternativa/complementar ao tratamento alopático. Dos artigos analisados relataram que uso da Medicina Tradicional Chinesa, pela acupuntura e a auriculoterapia, contribuiu para a diminuição de sinais e sintomas de estresse junto à equipe de enfermagem.

Objetivou-se analisar aspectos econômicos da implantação da rastreabilidade na região Centro-Sul do MT, os métodos de identificação, as reclamações, os entraves e o grau de importância dado pelos pecuaristas. De maio a julho de 2009 foram realizadas entrevistas com 13 proprietários de Estabelecimentos Rurais Aprovados no SISBOV (ERAS) e o levantamento de valores econômicos praticados por três certificadoras e um frigorífico da região. Todas as propriedades entrevistadas utilizavam brinco e botton. As principais dificuldades na implantação da rastreabilidade foram: as mudanças frequentes (46,30%), a compreensão das normativas que regem o Sistema Brasileiro de Identificação e Certificação de Origem Bovina e Bubalina (SISBOV) (30,57%) e a escolha da certificadora (23,13%). Os maiores entraves para a adoção e manutenção do SISBOV foram: (i) a demora excessiva das auditorias oficiais (53,85%); (ii) a instabilidade no valor diferencial (23,10%); (iii) a perda de elementos de identificação (15,39%); e, (iv) a demora quando da solicitação de reimpressão de brincos (7,69%). A importância atribuída à rastreabilidade está relacionada à credibilidade e agregação de valor ao produto brasileiro (84,61%). O valor individual do processo de rastreabilidade foi de R$ 4,34. A diferença do animal rastreado abatido para a União Europeia foi de R$ 10,73/@. No período analisado, a implantação do sistema de rastreabilidade apresentou viabilidade econômica, apesar da variação dos valores pagos pela carne rastreada.

http://dx.doi.org/10.5902/198464442726 As situações de violação dos direitos da criança e do adolescente são alvo de discussão de uma sociedade protetiva. É com frequência que os professores expõe suas preocupações quanto a questões que violam os direitos das crianças e adolescentes, como a violência física, sexual, psicológica, negligência que são detectadas no contexto escolar. Assim, este estudo objetivou compreender a percepção dos professores quanto à violação dos direitos das crianças e dos adolescentes. Participaram 20 professores da rede pública de Santa Maria/RS. Foram utilizados uma entrevista semi estruturada e um questionário biosociodemográfico e laboral. Entre os resultados, a violência física foi a violação mais identificada e as formas de enfrentamento mencionadas foram acionar o Conselho Tutelar e chamar os responsáveis da criança. A maioria dos professores apresentou-se engajada no problema, contudo, sentia-se despreparada e insegura para agir frente às situações de violação vivenciadas na escola. Dessa forma, sugere-se a construção de programas de capacitação de professores, fortalecendo-os no enfrentamento da violação dos direitos da criança e do adolescente. Palavras-chave: Professores, Violação dos direitos da criança de do adolescente, Escolas.

Esta pesquisa teve como objetivo realizar o levantamento das principais dificuldades encontradas pelas certificadoras credenciadas pelo Ministério da Agricultura Pecuária e Abastecimento (MAPA) na implantação da rastreabilidade, visando elaborar indicadores, sugerir propostas para sanar tais dificuldades e contribuir na formulação de políticas nacionais. Foi formulado um questionário qualitativo semi-estruturado, contendo vinte e seis questões de múltipla escolha, abertas e mistas. Este questionário foi enviado às empresas certificadoras credenciadas pelo MAPA. Os dados obtidos foram tabulados utilizando-se o programa EpiData® 3.1, com controle automático de amplitude e consistência de dados, e, posteriormente, analisados por meio de estatísticas descritivas, utilizando-se o programa estatístico SPSS for Windows® - versão 17.0. As mudanças frequentes nas normas do SISBOV, o desinteresse e a falta de conscientização dos pecuaristas para a rastreabilidade foram as principais dificuldades enfrentadas pelas certificadoras. Transformações por parte do MAPA, somadas a mobilização dos pecuaristas através de divulgação e esclarecimentos são necessários para sanar tais dificuldades. Ressalta-se ainda, a necessidade de adequações inerentes à incoerência e desatualização do banco de dados das certificadoras credenciadas no MAPA.

O objetivo desta pesquisa foi realizar o levantamento das principais dificuldades encontradas pelos técnicos de defesa sanitária animal na implantação da rastreabilidade da cadeia produtiva de bovinos de corte, visando elaborar indicadores, sugerir propostas para reduzir a incidência de tais dificuldades e contribuir na formulação de políticas nacionais. Foi elaborado um questionário qualitativo semiestruturado contendo 39 questões de múltipla escolha, abertas e mistas encaminhados a 125 veterinários do curso de pós-graduação Latu sensu em Defesa Sanitária Animal da Universidade Federal de Lavras (UFLA), Lavras, MG. Os dados obtidos foram tabulados utilizando-se o programa EpiData® 3.1, com controle automático de amplitude e consistência de dados, e posteriormente analisados por meio de estatísticas descritivas e indutivas, utilizando-se o programa estatístico PASW (Predictive Analytics SoftWare) - versão 18.0. As principais dificuldades encontradas pelos técnicos relacionaram-se diretamente com as mudanças frequentes na legislação (97,6%), a falta de compreensão das normas (86,9%) e de divulgação da rastreabilidade (62,8%). Entre as vantagens da identificação e rastreabilidade animal mencionadas pelos técnicos, incluem o maior conhecimento da quantidade do rebanho (97,5%), a abertura e manutenção dos atuais mercados consumidores (95,0%) e o controle e fiscalização do trânsito de animais (93,3%). A rastreabilidade, apesar de ser uma exigência, sobretudo do mercado consumidor importador, ainda encontra-se em evolução. A qualificação e a conscientização dos pecuaristas em relação à rastreabilidade se fazem necessárias.

Purpose: Comparative outcome data after intraoperative radiation therapy and whole breast irradiation (WBI) for breast cancer at >10 years median follow-up are rare. We present a mature, single-institution, matched-pair comparison reporting survival and relapse rates in patients treated with either modality., Methods and Materials: Complete data sets for 258 intraoperative electron radiation therapy (IOERT) patients treated between 2000 and 2010 were matched with 258 patients postoperatively treated with WBI by age/histology/tumor size, grading/lymph-node-status/hormone receptors/type of adjuvant therapy/surgical margins, and treatment date. Relapse at surgical intervention site was classified as true local recurrence (LR). All recurrences in the treated breast (any quadrant) were classified as ipsilateral recurrence (IR)., Results: Median follow-up was 157 months (12-251) for the IOERT group and 154 months (31-246) for the WBI group. Cumulative incidence of IR at 5, 10, and 15 years was 2.4%, 7.9%, and 12.7% for IOERT and 1.2%, 4.1%, and 5.0% for WBI (P = .02). Cumulative incidence of LR at 5, 10, and 15 years was 1.6%, 5.1%, and 8.3% for IOERT and 0.4%, 2.1%, and 2.5% for WBI (P = .02). No differences in overall survival, disease-free survival, second cancer incidence, or cardiac events were recorded in either treatment group. Outcome was better in the accelerated partial breast irradiation (APBI)-suitable group than in the APBI-unsuitable group (2009 criteria) (cumulative incidence of IR at 5, 10, and 15 years was 0% vs 7.3%, 6.1% vs 13.3%, and 7.3% vs 19.9% for IOERT and 0% vs 1.8%, 2.0% vs 3.9%, and 3.1% vs 3.9% for WBI) and in the revised APBI-suitable group than in the APBI-cautionary group (2017 criteria) (cumulative incidence of IR at 5, 10, and 15 years was 1.1% vs 6.4%, 6.2% vs 13.3%, and 7.8% vs 27.5% for IOERT and 1.7% vs 0%, 4.1% vs 4.4%, and 5.4% vs 4.4% for WBI)., Conclusions: The IR and LR rate were higher after IOERT than after WBI for the American Society for Radiation Oncology suitable patient group, although without reaching statistical significance. Thus, IOERT could be an alternative to WBI upon stringent patient selection, but patients should be counseled carefully about the potential for increased IR rate with IOERT. Second cancer incidence and cardiac events did not differ between IOERT and WBI., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The evaluation of the isocitrate dehydrogenase (IDH) mutation status in the glioma decision-making process has diagnostic, prognostic and therapeutic implications. The aim of this study was to evaluate whether conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) can noninvasively predict the most common IDH mutational status (R132H) in GIII-astrocytomas and the overall survival (OS). Hence, twenty-two patients (9-F, 13-M) with a histological diagnosis of GIII-astrocytoma and evaluation of IDH-mutation status (12-wild type, 10-mutant) were retrospectively evaluated. Imaging studies were reviewed for the morphological feature and mean ADC values (ADCm). Statistics included a Fisher's exact test, Student's t -test, Spearman's Test and receiver operating characteristic analysis. A p ≤ 0.05 value was considered statistically significant for all the tests. A younger age and a frontal location were more likely related to mutational status. IDH-wild type (Wt) exhibited a slight enhancement ( p = 0.039). The ADCm values in IDH-mutant (Mut) patients were higher than those of IDH-Wt patients ( p < 0.0004). The value of ADC ≥ 0.99 × 10 -3 mm 2 /s emerged as a "cut-off" to differentiate the mutation state. In the overall group, a positive relationship between the ADCm values and OS was detected ( p = 0.003; r = 0.62). Adding quantitative measures of ADC values to conventional MR imaging could be used routinely as a noninvasive marker of specific molecular patterns.

Objective: To report the initial results of a prospective study aimed at evaluating the CT perfusion parameter changes (∆PCTp) of the primary tumour after radiochemotherapy (RCT) in head and neck cancer (HNC) and to correlate with positron emission tomography (PET)/CT response., Methods: Eligibility criteria included HNC (Stage III-IV) candidates for RCT. Patients underwent perfusion CT (PCT) at baseline and at 3 weeks and 3 months after treatment. Blood volume, blood flow, mean transit time (MTT) and permeability surface (PS) product were computed. Moreover, PET/CT was performed at baseline and 3 months after treatment. The ∆PCTp were evaluated between baseline and 3-week/3-month evaluations, whereas PET/CT response was based on the maximum standardized uptake value changes according to the European Organization for Research and Treatment of Cancer criteria., Results: Between July 2012 and July 2015, 25 patients were enrolled. A significant reduction of all CT tumour perfusion parameters (PCTp) was observed from the baseline to after RCT (p < 0.001). Specifically, a significant reduction was shown at 3 weeks for all PCTp except MTT (from 6.18 to 5.14 s; p = 0.722). Differently, a significant reduction of all PCTp (p < 0.001) including MTT (from 6.18 to 2.24 s; p = 0.001) was shown at 3 months. Moreover, the reduction of PS resulted in a significant prediction of PET/CT response at 3 months (p = 0.037) with the trend also at 3 weeks (p = 0.099) at the multivariate analysis., Conclusion: Our preliminary findings seem to show that almost all PCTp are significantly reduced after RCT, whereas PS seems to come out as the strongest factor in predicting the PET/CT response., Advances in Knowledge: This article provides information on the potential useful role of PCT in evaluating tumour response after both early and late RCT.

The objective of this study is to report the initial results of a prospective trial assessing instrumental deglutition function in nasopharynx and oropharynx cancers after radio or chemoradiotherapy using intensity-modulated radiotherapy (IMRT). IMRT was delivered aiming to spare the swallowing organ at risk (SWOARs) for Stage II-IV naso- and oropharynx cancer. Objective instrumental assessment included videofluoroscopy (VFS), fiberoptic endoscopic evaluation of swallowing (FEES) and oro-pharyngeal-oesophageal scintigraphy (OPES) at baseline and at 1 month after radiotherapy. Dysphagia parameter scores were calculated at each exam after liquid (L) and semi-liquid (SL) bolus intake: pre-deglutition penetration, aspiration, pharyngeal transit time (PTT) and hypopharyngeal retention index (HPRI). Overall, 20 patients (6 nasophaynx and 14 oropharynx) completed treatment and instrumental assessment after 1 month. Comparison between pre- and post-treatment HPRI score values showed a significant worsening in both FEES-L (p = 0.021) and SL (p = 0.02) and at VFS-L (p = 0.008) and SL (p = 0.005). Moreover, a relationship between HPRI worsening at FEES-L and FEES-SL (p = 0.005) as well as at VFS-L and VFS-SL (p < 0.001) was observed. PTT was not significantly affected by radiotherapy (p > 0.2). Only a few patients experienced pre-deglutition penetration (1 patient with base of tongue cancer at FEES-L and SL) and aspiration (1 patient with nasopharynx cancer at OPES-L and FEES-SL) after radiotherapy. Our early results showed that IMRT-SWOARs sparing caused a significant increase in the post-deglutition HPRI score. Longer follow-up will be necessary to evaluate if the increase of HPRI is related to a high risk of developing late aspiration., (© Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.)

Objectives: We report a fatal case of neuroleptic malignant-like syndrome, which occurred as a consequence of paralytic bowel in a 72-year-old woman on treatment with antiparkinson medication., Case Description: Contrast enhanced computerized tomography of the chest and abdomen demonstrated the presence of paralytic bowel., Results: The patient died., Conclusions: Physicians involved in the treatment of patients affected by Parkinson's disease should take into consideration the possibility of dopaminergic drug malabsorption due to paralytic bowel as a possible cause of neuroleptic malignant-like syndrome., Learning Points: Clinical features of neuroleptic malignant-like syndrome (NMLS) in parkinsonian patients are similar to those of neuroleptic malignant syndrome (NMS), which is a potentially fatal condition associated with the withdrawal of antipsychotic medication.Paralytic bowel is a condition frequently impairing medication absorption in the absence of modifications to the normal daily intake of antiparkinson drugs.The present case report describes the fatal outcome of NMLS following paralytic bowel in a parkinsonian patient on levodopa and amantadine therapy., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests.

Background: A new entity of patients with recurrent prostate cancer limited to a small number of active metastatic lesions is having growing interest: the oligometastatic patients. Patients with oligometastatic disease could eventually be managed by treating all the active lesions with local therapy, i.e. either surgery or ablative stereotactic body radiotherapy. This study aims to assess the impact of [(18)F]Choline ([(18)F]FMCH) PET/CT and the use stereotactic body radiotherapy (SBRT) in patients (pts) with oligometastatic prostate cancer (PCa)., Methods: Twenty-nine pts with oligometastatic PCa (≤3 synchronous active lesions detected with [(18)F]FMCHPET/CT) were treated with repeated salvage SBRT until disease progression (development of > three active synchronous metastases). Primary endpoint was systemic therapy-free survival measured from the baseline [(18)F]FMCHPET/CT., Results: A total of 45 lesions were treated with SBRT. After a median follow-up of 11.5 months (range 3-40 months), 20 pts were still in the study and did not receive any systemic therapy. Nine pts started systemic therapy, and the median time of the primary endpoint was 39.7 months (CI 12.20-62.14 months). No grade 3 or 4 toxicity was recorded., Conclusions: Repeated salvage [(18)F]FMCHPET/CT-guided SBRT is well tolerated and could defer the beginning of systemic therapy in selected patients with oligometastatic PCa.

Prostate cancer (PCa) is one of the most common malignancies and main causes of cancer death in Western countries. In the presence of metastatic disease, systemic treatment remains the main clinical option. However, since the introduction of highly sensitive imaging techniques, a new clinical 'entity' of metastatic patients with a limited number of lesions has been defined: oligometastatic patients. In this patient group, the use of stereotactic body radiotherapy (SBRT) or other local therapies against all active sites of disease revealed by 18F-choline positron emission tomography/computed tomography (PET/CT) could achieve sufficient prostate-specific antigen (PSA) control. However, a clear benefit of this procedure in terms of significant endpoints is yet to be demonstrated. This case report describes our experience with treating a castration-resistant PCa patient with 18F-choline PET/CT-guided SBRT. Because of the occurrence of 5 metachronous lesions over 4 years, the pattern of recurrence was defined by the local multidisciplinary team as oligometastatic disease, and the patient was treated with 5 courses of SBRT which yielded good PSA control. He started systemic therapy with abiraterone acetate almost 5 years after the diagnosis of recurrent PCa., (© 2016 S. Karger GmbH, Freiburg.)

The efficacy of temozolomide (TMZ) plus radiation therapy (RT) in elderly patients with glioblastoma is unclear. We performed a large multicenter retrospective study to analyze prognostic factors and clinical outcome in these patients. Inclusion criteria were age ≥65 years, newly histologically confirmed glioblastoma, ECOG PS 0-2, adjuvant treatment with RT plus TMZ. We enrolled 237 patients; the average age was 71 and ECOG PS was 0-1 in 196 patients; gross total resection was performed in 174 cases. MGMT was analyzed in 151 persons and was methylated in 56 %. IDH1 was assessed in 100 patients and was mutated in 6 %. Seventy-one patients were treated with RT 40 Gy and 166 with RT 60 Gy. Progression-free survival and overall survival (OS) were 11.3 and 17.3 months, respectively. Overall survival was 19.4 vs 13.8 months for patients treated with RT 60 Gy and 40 Gy (p = 0.02); OS was 17.7 versus 16.1 months for patients treated with gross total resection vs partial surgery (p = 0.02); OS was 21.2 versus 13.6 months for methylated and unmethylated MGMT (p < 0.001). On multivariate analysis, gross total resection, RT 60 Gy, methylated MGMT and ECOG PS 0-1 were independent predictors of longer survival. Twenty-five patients (10 %) had grade 3-4 haematological toxicity during the concomitant treatment. We showed that, in elderly patients in good clinical condition treated with concomitant treatment, standard-course irradiation might be more effective than short-course irradiation. Methylated MGMT remains the most important prognostic factor.

Background: Radiotherapy (RT) with or without chemotherapy (CT) plays an important role as exclusive treatment in patients with head and neck squamous cell cancer (HNSCC). Unfortunately, in some cases, benefit for patients is not recorded and only treatment-related complications are registered., Materials and Methods: Data relating to Akt1 single nucleotide polymorphism (SNP) and response to treatment of 46 patients treated with exclusive RT or RT-CT for HNSCC were evaluated., Results: For heterozygous patients median overall survival was 28.5 months, while for the wild-type group median overall survival was 10.9 (p=0.019). Three-year survival was 85% for mutated Akt1 homozygosis and 40% for patients with a heterozygous status (p=0.019, hazard ratio (HR)=7.960)., Conclusion: SNP of rs2498804 can recognize patients resistant to RT-CT. Further studies are needed to confirm our data and to investigate the role of Akt SNPs in HNSCC patients., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: The aim of the present study was to evaluate the toxicity and clinical outcome of radio-chemotherapy with temozolomide in patients with glioblastoma aged more than 65 years., Materials and Methods: The analysis was performed in 20 male and 20 female patients with a mean age at diagnosis of 71.2 (range=65-81) years, with Karnofsky performance status greater than 70 without important comorbidities., Results: Toxicities related to temozolomide and concomitant radiochemotherapy were similar to those reported for younger patients. The median time to progression and median overall survival of the entire cohort, from the date of diagnosis, were 10.6 (range=6.7-14.4) months and 19.3 (range=17.8-20.7) months, respectively. No significant results for overall survival analysis were found for age at diagnosis and cardiovascular risk factors, as covariates, with hazard ratios of 1.00 (95% confidence interval=0.92-1.10) and 0.9 (95% confidence interval=0.43-1.88), respectively., Conclusion: Considering the relative good toxicity profile and the efficacy of treatment, our experience supports the use of radiochemotherapy with temozolomide in older patients with glioblastoma., (Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Acute low back pain (LBP) is the fifth most common reason for physician visits and about nine out of ten adults experience back pain at some point in their life. In a large number of patients LBP is associated with disc herniation (DH). Recently, oxygen-ozone (O2O3) therapy has been used successfully in the treatment of LBP, reducing pain after the failure of other conservative treatments. The aim of this study was to assess the effects of O2O3 therapy in back pain rehabilitation, comparing three groups of patients suffering from chronic back pain associated with DH submitted to three different treatments: intramuscular O2O3 infiltrations, global postural An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain re-education (GPR), or a combination of the two (O2O3+GPR). The data show that pain severity before treatment was significantly lower in the patients treated with GPR alone (VAS score 7.4) than in the O2O3+GPR patients (VAS score 8.5) and the O2O3 patients (VAS score 8.6). At the end of treatment, pain severity was lower in the O2O3 patients than in the GPR-alone patients. After some years of follow-up only the difference between O2O3+GPR and GPR-alone remained significant.

Exposure to asbestos is the predominant cause of pleural mesothelioma (PM). The PM is a tumor difficult to diagnose, chemoresistant, and with rising Incidence. The long latency periods and the lack of preventive and therapeutic strategies for the MP, suggest that asbestos will be a social and health issue in the near future. Therefore, this overview focuses on current knowledge of epigenetic alterations and on the key role of microRNAs, small RNAs that negatively regulate gene expression, as biomarkers in PM development. Dysregulated microRNA expression pattern is specific for different cancers, including MP. MicroRNA expression analysis is a promising tool for diagnosis, typing of MP than normal tissue and other lung tumors and monitoring of new therapies. However, a better knowledge of miRNA signatures in PM is still necessary to verify the contribution of specific miRNAs as diagnostic biomarkers, also compared to different asbestos forms, exposure and subject work history.

A case of long-term survivor 50-year-old man treated for advanced gastric cancer with two liver metastases is described. Patient underwent a total gastrectomy with D2 lymphadenectomy and atipic liver resection. After surgery, chemotherapy with PELF achieved a complete clinical response; six month from the fourth cycle, Ca19.9 levels slowly increased until 185 U/mL and a retro-peritoneal lymphadenopathy was detected by US. Three different chemotherapeutic combinations (FOLFOX, FOLFIRI, FOLFOX4) was administrated but two new liver recurrences spread out. From November 2007 until now, patient received 8 CDF cycles and he obtained a complete clinical response supported by persistent negativity of TC-PET scans. The radiological investigations performed after last admission in our Department for jaundice, revealed multiple liver lesions with Ca 19.9 levels of 6.766 U/mL. The patient required placement of metallic biliary endoprosthesis. He is still alive 41 month after primary surgery. We consider this case a successful example of survival increasing by integrated surgery-chemotherapy treatment but also an expression of the failure of current available therapy in the definitive cure for gastric cancer. Metastatic gastric cancer should be considered a disease treatable but not curable.

Prognosis of patients suffering from secondary central nervous system (CNS) lymphoma is dismal. Intracranial spread of a lymphoma arising in adjacent extranodal tissues is a rare event. A 32-year-old patient was diagnosed with progressive diffuse large B-cell lymphoma (DLBCL) with extra- and intracranial localization. He complained of headache, left diplopia, marked rigidity of the neck muscles, and difficulty in swallowing and articulating words, caused by bilateral palsy of the XII cranial nerve. Computed tomography (CT) and positron emission tomography (PET) scans showed disease localizations in the occipital-cervical soft tissue, and cerebellar parenchyma. Due to the severity of the clinical picture, high-dose dexamethasone was immediately administered. Mild improvement was observed during the first 2 days of treatment, but dramatic reduction of symptoms and nerve palsy was documented only in the 48 h after the first intrathecal administration of liposomal Ara-C. Systemic R-MegaCEOP chemotherapy was started 7 days later. Concomitant intrathecal liposomal Ara-C injections were continued for a total of nine administrations during the eight cycles of immunochemotherapy without any toxicity observed. Interim and post-therapy PET showed complete resolution of radionuclide accumulation in the involved sites. Consolidation radiotherapy (36 Gy) was administered in involved areas after the completion of the immunochemotherapy program. At the time of writing, no cumulative neurotoxicity is evident at follow-up of 17 months from diagnosis and 9 months after the overall therapeutic program has been accomplished.

The objective of this study was to assess the effects of subcutaneous (sc) interferon beta-1a (IFNbeta-1a) on cognition in mildly disabled patients with relapsing-remitting multiple sclerosis (RRMS). Patients aged 18-50 years with RRMS (McDonald criteria; Expanded Disability Status Scale score

Background: Cognitive impairment is a common symptom of multiple sclerosis (MS), but the association between cognitive impairment and magnetic resonance imaging (MRI) disease measures in patients with relapsing-remitting (RR) MS is unclear., Objectives: To study the prevalence of cognitive impairment and its relation with MRI disease measures in mildly disabled patients with RRMS., Methods: Patients aged 18-50 years with RRMS (McDonald criteria) and an Expanded Disability Status Scale (EDSS) score or=3 cognitive tests) was present in approximately 20% of all patients and in the subgroup who underwent MRI. T2 hyperintense and T1 hypointense lesion volumes were significantly higher in patients with cognitive impairment (defined as impaired performance on at least three tests of the Rao's battery) than those without. EDSS score was also significantly higher in cognitively impaired than in cognitively preserved patients. Disease duration, depression, and years in formal education did not differ significantly between cognitively impaired and cognitively preserved patients. T2 lesion volume, performance intelligence quotient, and age were significant predictors of cognitive impairment in this population. Weak correlations were found between performance on individual cognitive tests and specific MRI measures, with T1 and T2 lesion volumes correlating with performance on most cognitive tests., Conclusions: Cognitive impairment occurs in approximately one-fifth of mildly disabled patients with MS and is associated with specific MRI disease measures. Assessment of cognitive function at diagnosis could facilitate the identification of patients who may benefit from therapeutic intervention with disease-modifying therapies to prevent further lesion development.

After a review of literature and the report of a case with intrathoracic location, the authors consider present criteria for a correct diagnosis of low grade soft tissue sarcoma, when the possibility of nodular fasciitis is under evaluation. Nodular fasciitis is a benign pathology up to day not well characterised from the clinical and pathological point of view. The authors conclude that differential diagnosis between low grade soft tissue sarcoma and nodular fasciitis is frequently possible only on the basis of clinical course evaluation; otherwise the management may be inadequate.

The Authors report a case of great desmoid tumor of the abdominal wall with intestinal adhesions and enterocutaneous fistula, in a patient with Gardner's syndrome, who underwent total colectomy with ileorectal anastomosis. The patient was treated at first with non steroidal antiinflammatory drugs, then with local chemotherapy. The Authors performed a second surgical procedure resecting the tumor and opening a temporary ileostomy. Despite of these treatment patient showed a local recurrence. Desmoid tumor is a neoplastic benign lesion arising from aponeurotic muscle tissue. Local infiltration and post-operative recurrence are very common. Several surgical and medical treatments are proposed, but they are not totally effective. Surgical treatment might be radical, with wide resection to reduce local recurrences. Radiotherapy and chemotherapy are second choice treatments.

The Authors report a case of prostatic carcinoma in a 84 year old male, treated with cyproterone acetate (CPA), complicated by a fatal fulminant hepatitis. He was admitted with a mixed jaundice followed by a derange of all liver function tests. Serological markers for hepatitis were negative. Ultrasonography and CT revealed no hepatic abnormality but gallstones and dilatation of principal bile duct with a terminal stricture. By the endoscopic retrograde cholangiography and sphincterotomy we put an external drain tube. He died 9 days after admission. Fatal hepatis due to CPA is a very rare complication but all patients on anti-androgenic drugs should have liver function closely monitored. CPA must be discontinued immediately at the first derange of liver function tests.

Gaucher's disease is a rare metabolic disorder characterized by the lack of beta-glucocerebrosidase enzyme. In this case report a 26-year-old male patient was, first diagnosed as having splenomegaly and a huge haemangioma, therefore managed by total splenectomy. Histologic examination and specific colouring techniques using PAS and Black Sudan dyes allowed the diagnosis of Gaucher's disease. Preoperative diagnosis is hence fundamental to establish the correct management procedure, which currently may be surgical or medical and/or combined. In fact, following the diagnosis the second step includes the decision-making about splenectomy. Other therapeutic approaches are enzyme replacement therapy and genic therapy. The first may be combined to partial splenectomy, while the latter still needs further evaluations.

In this paper are described the immunological and molecular procedures that have allowed the identification and the nucleotide sequence characterization of recombinant cDNA coding for factor XII of human coagulation and have suggested the possible identification of other cDNA clones as coding for factor VII of human coagulation.