Alberto Farinetti

Mesenteric Cystic Neoformations: Report of Two Cases

The authors present two case reports of mesenteric cystic neoformations which they themselves observed and, with the help of the literature regarding this pathology, discuss the problems of both diagnosis and treatment.

Influence of coffee and caffeine consumption on atrial fibrillation in hypertensive patients

BACKGROUND AND AIMS Coffee and caffeine are widely consumed in Western countries. Little information is available on the influence of coffee and caffeine consumption on atrial fibrillation (AF) in hypertensive patients. We sought to investigate the relationship between coffee consumption and atrial fibrillation with regard to spontaneous conversion of arrhythmia. METHODS AND RESULTS A group of 600 patients presenting with a first known episode of AF was investigated, and we identified 247 hypertensive patients. The prevalence of nutritional parameters was assessed with a food frequency questionnaire. Coffee and caffeine intake were specifically estimated. Left ventricular hypertrophy was evaluated by electrocardiogram (ECG) and echocardiogram. Coffee consumption was higher in normotensive patients. High coffee consumers were more frequent in normotensive patients compared with hypertensive patients. On the other hand, the intake of caffeine was similar in hypertensive and normotensive patients, owing to a higher intake in hypertensive patients from sources other than coffee. Within normotensive patients, we report that non-habitual and low coffee consumers showed the highest probability of spontaneous conversion (OR 1.93 95%CI 0.88-3.23; p=0.001), whereas, within hypertensive patients, moderate but not high coffee consumers had the lowest probability of spontaneous conversion (OR 1.13 95%CI 0.67-1.99; p=0.05). CONCLUSION Coffee and caffeine consumption influence spontaneous conversion of atrial fibrillation. Normotensive non-habitual coffee consumers are more likely to convert arrhythmia within 48h from the onset of symptoms. Hypertensive patients showed a U-shaped relationship between coffee consumption and spontaneous conversion of AF, moderate coffee consumers were less likely to show spontaneous conversion of arrhythmia. Patients with left ventricular hypertrophy showed a reduced rate of spontaneous conversion of arrhythmia.

Hypothalamic amenorrhea: From diagnosis to therapeutical approach

Among secondary amenorrheas, hypothalamic amenorrhea (HA) is the one with no evidence of endocrine/systemic causal factors. HA is mainly related to various stressors affecting neuroendocrine control of the reproductive axis. In clinical practice, HA is mainly associated with metabolic, physical, or psychological stress. Stress is the adaptive response of our body through all its homeostatic systems, to external and/or internal stimuli that activate specific and nonspecific physiological pathways. HA occurs generally after severe stressed conditions/situations such as dieting, heavy training, or intense emotional events, all situations that can induce amenorrhea with or without body weight loss and HA is a secondary amenorrhea with a diagnosis of exclusion. In fact, the diagnosis is essentially based on a good anamnestic investigation. It has to be investigated using the clinical history of the patient: occurrence of menarche, menstrual cyclicity, time and modality of amenorrhea, and it has to be excluded any endocrine disease or any metabolic (i.e., diabetes) and systemic disorders. It is necessary to identify any stressed situation induced by loss, family or working problems, weight loss or eating disorders, or physical training or agonist activity. Peculiar, though not specific, endocrine investigations might be proposed but no absolute parameter can be proposed since HA is greatly dependent from individual response to stressors and/or the adaptive response to stress. This chapter aims to give insights into diagnosis and putative therapeutic strategies.

Mediterranean diet impact on cardiovascular diseases: A narrative review

&NA; Cardiovascular disease (CVD) accounts for more than 17 million deaths per year worldwide. It has been estimated that the influence of lifestyle on CVD mortality amounts to 13.7% for smoking, 13.2% for poor diet, and 12% for inactive lifestyle. These results deeply impact both the healthy status of individuals and their skills in working. The impact of CVD on productivity loss accounts for the 24% in total costs for CVD management. Mediterranean diet (MedD) can positively impact on natural history of CVD. It is characterized by a relatively high consumption of inexpensive and genuine food such as cereals, vegetables, legumes, nuts, fish, fresh fruits, and olive oil as the principal source of fat, low meat consumption and low-to-moderate consumption of milk, dairy products, and wine. Its effects on cardiovascular health are related to the significant improvements in arterial stiffness. Peripheral artery disease, coronary artery disease, and chronic heart failure are all positively influenced by the MedD. Furthermore, MedD lowers the risk of sudden cardiac death due to arrhythmias. The present narrative review aims to analyze the effects of MedD on CVD.

Vertical subcutaneous pedicle flaps for posterior perineal reconstruction. Report of three cases.

PURPOSE: Loss of a certain amount of cutaneous tissue of the perineal region may be remedied by first intention with creation of cutaneous flaps, thus preventing second intention healing. METHODS: We present three emblematic cases in which the posterior perineal region was reconstructed by means of vertical subcutaneous pedicle flaps, subsequent to cutaneous tissue loss after surgery for extensive condilomas or neoplastic pathologies. RESULTS: Tissue loss was repaired by means of a V-Y type vertical subcutaneous pedicle flap, constructed laterally of the extirpation zone and advanced in a median direction. In all cases, no ischemia or infection of flaps occurred; sphincteral continence and long-term aesthetic results have proved to be satisfactory. CONCLUSIONS: Vertical pedicle subcutaneous flaps are well vascularized, extremely mobile, and easy to perform and have no serious postoperative complications.

Education in anesthesia: three years of online logbook implementation in an Italian school.

BackgroundThe progress of physicians through residency training in anesthesiology can be monitored using an online logbook. The aim of this investigation was to establish how residents record clinical activities in their computerized web-based logbooks during their first years of anesthesiology training.MethodsFor this retrospective observational trial, the ESSE 3© digital registry of the University of Modena and Reggio Emilia, Italy was used to record all anesthesia-related activities performed by three consecutive year-groups of residents (Groups A, B and C) between 2009 and 2012. The ratio of activities to sessions was chosen as a surrogate measure of compliance.ResultsA total of 41,348 actions were analyzed. The ratio of activities to sessions showed a statistically significant decline for all activities concerning the perioperative management of anesthesia, with a steady reduction from the first to the last year-group (Group A 23.7, Group B 14.1 and Group C 2.2; p = 0.003).ConclusionsAn online activities logbook is a useful tool for recording and assessing the clinical activities undertaken by each resident during residency training in anesthesiology.

Lack of evidence for an association between seminoma and human papillomavirus infection using GP5+/GP6+ consensus primers

Testicular germ cell tumors account for about 1% of all cancers. The incidence of these tumors is increasing and they represent the most common solid malignancies of young men aged 15–40 years with seminoma being one of the most common histotype. Pathogenesis of testicular germ cell tumors remains unknown and, although cryptorchidism is considered the main risk factor, there is evidence of an association with environmental and genetic risk factors. Human papillomaviruses (HPV) are a family of DNA viruses and represent a major risk factor for cervical cancer. In addition, they have been associated with other human non‐malignant and malignant diseases, including breast and head and neck cancer. HPV sequences have been detected throughout the male lower genitourinary tract as well as in seminal fluid and an increased testicular tumorigenesis has been reported in HPV transgenic mice. Aim of this study was to evaluate the potential involvement of HPV in human testicular tumorigenesis. Real‐time PCR employing GP5+/GP6+ consensus HPV primers was used to examine the presence of HPV sequences in a subset of human seminoma (n = 61) and normal testicles (n = 23). None of the specimens tested displayed the presence of HPV DNA. These findings do not support an association between HPV and human seminoma and warrant further studies to assess definitively the role of these viruses in human testicular tumorigenesis. J. Med. Virol. 85:105–109, 2012.

Gender differences in adherence to Mediterranean diet and risk of atrial fibrillation

Background. Adherence to the Mediterranean Diet (MedD) is associated with a reduction of overall mortality and mortality from cardiovascular diseases and cancer. In a previous study we found a relationship between intake of antioxidant vitamins with diet and risk of atrial fibrillation (AF). The present study focuses on gender differences relative to diet and antioxidant intake in patients (pts) with a first detected episode of AF. Methods. A group of 400 pts, 205 men and 195 women, was investigated. A control group of 400 subjects, age and sex matched, was selected and compared. Nutritional parameters were assessed by a self-administered food frequency validated questionnaire (116 items) completed by an interviewer-administered 24 h diet recall. We previously constructed a MedD adherence score based on a prior scoring system developed for the Greek population. Consumption of cereals, vegetables, legumes, fruit, fish, dairy products, cups of espresso coffee, chocolate snacks, soda drinks and wine was investigated. Results. The MedD Score was higher in women compared to men (28.8 + 2.0 vs 20.1 + 2.5; p<0.001) and was higher in healthy subjects compared to patients with AF (27.9 + 5.6 vs 22.3 + 3.1; p<0.001). In pts with AF the estimated intake of total antioxidants was higher in women (19.9 ± 5.6 vs 11.2 ± 7.4 mmol/d; p<0.001), and women had higher intake of antioxidants from fruit and vegetables. Conclusions. Women showed high adherence to the MedD and higher intake of antioxidants from fruit and vegetables compared to AF men. Men had higher intake of antioxidants from coffee. Women that developed AF were older, with lower adherence to the MedD, and were more sedentary. DOI : 10.14302/issn.2329-9487.jhc-13-210 Research Article Freely Available Online www.openaccesspub.org | JHC CC-license DOI : 10.14302/issn.2329-9487.jhc-13-210 Vol-1 Issue –4 Page No5 Introduction: Several epidemiologic studies have underlined the beneficial role of the Mediterranean diet in relation to all -cause mortality, coronary heart disease mortality, lipid metabolism, blood pressure levels and body mass index (1). In 1995 a score assessing adherence to the Mediterranean diet was elaborated (2) and this score, or variants of it, has been widely used to evaluate the relation of the Mediterranean diet to cardiovascular

Radiotherapy-induced mesorectum alterations: histological evaluation of 90 consecutive cases

Abstract Objective. In order to identify the radiotherapy-induced histological modifications in the mesorectum, we reviewed the surgical specimens of 90 rectal resections comprehensive of the total mesorectal excision (23 cases radiologically classified as cT2N0M0 and 67 as cT3N0M0). All patients were preoperative treated with radiotherapy: 20 with 50 Gy, 20 with 20 Gy and 50 Gy irradiation associated to FOLFOX scheme chemotherapy. Material and methods. Routine hematoxylin and eosin stained serial slides at 5 mm of intervals were obtained from surgical specimens and included the tumor site and the adjacent irradiated mucosa, the submucosa and the muscular layers of the rectal wall and the mesorectal adipose tissue, completely removed until to the mesorectal fascia. Ten subjects (eight cT2N0M0 and two cT3N0M0), who did not received preoperative oncological treatments were adopted as controls. Results. Histologically, examination revealed fibrosis of the adipose tissue in 86 cases (95%), vascular damage including vasculities and fibrotic thickening wall of arteries and veins in 46 cases (51%), sclero-hyalinosis of lymph nodes with pericapsular fibrosis in 22 cases (23%) and perineural deposition of fibrosis in 12 (13%). These findings were ubiquitously observed in the whole mesorectum. Fibrosis of the adipose tissue and vasculitis were mainly associated to the combination of 50 Gy radiations plus chemotherapy (p < 0.05). Conclusion. The detection of histopathological alterations in the mesorectum can give reason of the well-known postoperative complications and long-term sequels.

Stem Cells Transplantation in Myocardial Tissue Induces Pro-arrhythmic Effects and Promotes Reperfusion. Comparison between Intramyocardial and Intravenous Approach

Ischemic heart disease is a life threatening condition whose prognosis remains poor as current treatments are palliative and the loss of cardiac tissue is not restored. Stem cell therapy appears to be a promising option for myocardial repair after myocardial infarction (MI). Recent experimental and clinical work has suggested that stem cell therapy contributes to cardiac regeneration and improve myocardial function. Unfortunately, there is still a lack about important issues such as mechanism of action of stem cells, dose, long-term engraftment, route of delivery and frequency of cell administration. Also, there is a concern about proarrhythmic effect of stem cell therapy. Some studies have provided basis that stem cells can show intrinsic pacemaker function and provide areas of slowed conduction that can set the stage for arrhythmias.