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Acetyl-L-carnitine is a substance that occurs naturally during the course of metabolism within the mitochondria. The substance plays a role in a variety of biochemical reactions within cells, including reactions that produce phospholipids necessary for cell membranes. The substance also appears to promote the uptake of choline by cells, the synthesis of acetylcholine, and the release of acetylcholine. Since there is considerable evidence that acetylcholine systems (as well as other systems) are deficient in patients with Alzheimer's disease, there is some rationale for attempting to use acetyl-L-carnitine to treat Alzheimer's disease. Such a study was conducted with 130 Alzheimer's disease patients who were randomly assigned to receive either acetyl-L-carnitine or a placebo for one year. The patients were tested before and after the study period for performance on 14 different measures of intellectual performance. At the end of the study, both the treated group and the placebo group had deteriorated in cognitive function. However, in 13 of the 14 measures, the patients treated with acetyl-L-carnitine had deteriorated less than the patients who received only placebo treatment. In four of these performance measures, the decreased rate of decline among the treated patients was statistically significant. Furthermore, when only the patients with indications of good compliance in taking the drug were considered, less decline was observed compared with the overall group. The side effects of acetyl-L-carnitine were generally mild. (Consumer Summary produced by Reliance Medical Information, Inc.)

(1) The main goals of general anesthesia include pain management and a safe anesthetic protocol for smooth recovery. In this retrospective study, we compared two anesthetic protocols for general anesthesia with isoflurane during emergency laparotomy: sedation with xylazine and the intraoperative infusion of lidocaine (X group) versus medetomidine as a preoperative sedation and intraoperative infusion (M group). (2) The medical records of horses who underwent emergency laparotomies between 2016 and 2023 were reviewed. According to the anesthetic protocol, patients were allocated to the X or M groups. Data about the horse, signalment, history, and anesthetic variables were analyzed. (3) Group X had a significantly higher heart rate (HR), lower respiratory rate (RR) and mean and diastolic arterial pressure (MAP/DAP). A progressive increase in HR and RR was observed in both groups. Group X underwent a decrease in RR and an increase in DAP. In Group M, a decrease in MAP and DAP was observed. Group M exhibited a longer recovery time with similar recovery scores. Both protocols provided safe anesthesia for emergency laparotomy, with minor cardiovascular and respiratory depression. Minor respiratory depression was detected when xylazine was used, while recovery was longer with medetomidine.

Owner complaints of estrus-related behavior in mares are a common cause of referral for laparoscopic ovariectomy. Granulosa cell tumors are a common neoplastic condition affecting the equine ovary, causing behavioral changes at rest and reduced performance. The reported success rate of ovariectomy in treating behavioral disorders is 64-86%. The aim of this study was to retrospectively evaluate the long-term follow-up of laparoscopic ovariectomy in mares in our case series, focusing on the owner's perspective of the behavior of the mares after surgery. In addition, the histopathological features of the removed ovaries were investigated. The clinical records of mares that underwent laparoscopic ovariectomy between 2015 and 2022 were retrospectively reviewed. Owners complaining of poor behavior were interviewed about the main behavioral problem leading to referral and its eventual resolution after surgery. Eleven mares were included. The most common complaints were increased sensitivity on both flanks (10/11, 91%) and general riding problems (9/11, 82%). In 5/11 cases (45%), both ovaries were removed by laparoscopic ovariectomy. Histopathologic findings consistent with GCT/GTCT were found in five out of six examined ovaries (five granulosa theca cell tumors, GTCT). According to owner interviews, the scores assigned to each behavior improved significantly after surgery, regardless of histological findings. Although many factors can influence the behavior of horses, granulosa cell tumors (GCTs) proved to be a common cause and, as reported by the owners, ovariectomy resulted in improvement or complete resolution of the abnormal behavior.

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.)

Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure., Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes., Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT., Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer., Advances in Knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.

The oncological treatment for advanced stage head and neck cancer is based on a combination of cisplatin and cetuximab, and radiotherapy. However, very few data are available on this multimodal approach for this type of cancer in pancreas and renal recipients. We report the case of a pancreas and renal recipient being treated with combined chemoradiotherapy for a locally advanced squamous cancer of the larynx. The patient was under treatment with ciclosporin-based immunosuppressive therapy at the time of cancer diagnosis, which was then replaced by everolimus. After 4 years of follow-up, the patients is still free from disease, with a local complete response, only mild residual dysphonia, and with edema of the chin. Cetuximab plus radiation could be an adequate option for cancer treatment in solid organ transplant recipients affected by locally advanced head and neck cancer; the concomitant use of mammalian target of rapamycin pathway inhibitors may have a synergistic effect in enhancing tumor control in these patients; however, further dedicated studies are warranted.

The current Italian policy on immigration tends to force immigrants coming from non-EEC countries into an illegal position. This tendency has delayed and in many cases obstructed their benefiting from the existing services. Without proper knowledge of the users, their needs and individual cultures, the problem has been faced in terms of inclusion-exclusion from the actual system without evaluating the eventual success or coherence. This study is intended as a first step towards the analysis of the meeting point between the demand of the immigrant to lead a healthy existence and the response of the Public Health Service and the Voluntary Associations operating in the Milan area. The observational study carried out from March to June 1990 involved the casualty departments of 4 of the city hospitals, public services (family and paediatric clinics) and "NAGA", an Association of volunteers which has been operating in Milan since 1987, and which offers social and health assistance to immigrants and nomads who, for legal, economical or cultural reasons cannot benefit from the Public Health Service. 2088 cards have been compiled containing social and demographic data and characteristics, description of the health problem presented and the response of the service involved. For each case the operator registered a subjective opinion regarding the adequacy of the intervention and the difficulties incurred. The information collected, highlights the various types of users of each individual service and the legal and social differences which greatly influence the approach to these services and the subsequent usage. In particular the results seem to confirm that the Public Service tends to favour groups already having a certain privilege and delegates the more "complex" problems to the Voluntary Associations.

Forty-eight patients with mild to moderate dementia of Alzheimer's type (DAT) were tested with a generative associative naming task, a task that combines the aspects of fluency and of word association tests. The variables taken into consideration were the number of adequate and inadequate responses, conventionality, word frequency and lexical-semantic relation to the target. DAT patients' performances were compared to those of a group of control subjects matched for sex, age and educational level. As a group, the patients gave fewer adequate responses, more idiosyncratic responses and perseverations, while there was no difference in the qualitative variables. However, the analyses of the performance profiles suggest that, irrespective of the severity of the disease, two major subgroups of DAT patients may be identified: (1) a first subgroup of subjects produced words with a lower conventionality rate and these were mostly in propositional relationship to the target; they also produced a higher rate of idiosyncratic responses and perseverations. (2) A second subgroup of subjects gave more conventional responses, mostly in the hierarchical-categorical relationship. The disorders of the former subgroup seem to correspond to a disrupted access to some relatively spared semantic abilities, whereas those of the latter to a semantic breakdown.

Cardiac pacing by means of temporary wires inserted during open heart surgery is an established useful adjunct to post-operative care. Optimal rate can be imposed to the heart with transiently depressed function, arrhythmias can be suppressed by overdriving and atrioventricular synchronization sometimes can be reestablished, with a resulting improvement of cardiac output. We routinely insert wires on the right ventricle, and on the right atrium wherever excitable. Wires have been inserted in 383 consecutive patients, significantly contributing to the control of bradiarrhythmias, the suppression of PVCs, and the improvement of low cardiac output states.

Mobile coronary care units and stratified systems for coronary care have received rather poor attention in Italy up until now. To evaluate advantages and disadvantages, organizational problems, costs, etc. of a mobile unit in an Italian community provided with a reference centre for acute coronary artery disease, a study project was started in 1977. The organization of such unit was based on that of the hospital in Belfast. The covered area (200,000 inhatitants) was carefully limited to keep delays at a minimum. A program of public education, stressing the necessity for early calls for medical intervention was developed. All calls were evaluated by a physician on duty in the CCU before intervention. The results of this experience, extended to four years, are reported showing that a Mobile Coronary Care Unit is valuable from a medical point of view, is economically sound and practical in a medium size Italian city such as Udine. According to this, the Mobile Coronary Care Unit was changed from a study project to a permanent community service.

A case of myocardial infarction with severe shock, marked systemic venous congestion and transient A-V block was observed in our Coronary Care Unit four years ago; signs of pulmonary venous congestion were absent. The patient, still alive, remains seriously incapacitated, with persistent signs of right ventricular failure. Recently, coronary angiography has shown total proximal obstruction of a "dominant" right coronary artery. The left coronary artery was free from significant obstructions. Right and left ventriculography have shown severe diffuse impairment of right ventricular contractility and akinesis of the left ventricular posterobasal segment. Echocardiography has demonstrated marked paradoxical movement of the interventricular septum. The scanty literature on this rare syndrome is reviewed; diagnostic criteria, therapeutic approaches and prognosis are briefly discussed.