Baudolino Mussa

Imatinib inhibits in vitro proliferation of cells derived from a pleural solitary fibrous tumor expressing platelet-derived growth factor receptor-beta.

We examined the in vitro effects of imatinib (Novartis Pharma AG, Basel, Switzerland) as a possible inhibitor of PDGFR pathway on cells derived from a recurrence of a pleural malignant solitary fibrous tumor (SFT). Primary cell culture was characterised by immunofluorescence. SFT-derived cells were treated with imatinib at different time points. Western blotting for PDGFR-beta, phospho-PDGFR-beta or smooth muscle actin (SMA) was performed before and after 96 h of treatment with imatinib. SFT-derived cells treated with imatinib for 96 h showed a dose dependent decrease of Ki67 expression. Results were confirmed by growth curve. Western blotting showed that PDGFR-beta was highly expressed and phosphorylated in SFT-derived cells and imatinib treatment reduced PDGFR-beta phosphorylation and SMA expression. With the limit of experimental findings, our results support a possible future application of imatinib as a candidate molecule in the target therapy of malignant SFTs over-expressing wild-type PDGFR.

A simple device to secure ventricular assist device driveline and prevent exit-site infection

OBJECTIVES Driveline infections are one of the most common and important complications in patients with left ventricular assist device (LVAD). One of the causes favouring the development of this complication is the traumatism of the exit site, which occurs in response to movement of the driveline. In this work, we present a simple and feasible method to immobilize the driveline at the level of the exit site. METHODS From April 2013 until November 2013, 6 patients underwent implantation of HeartWare LVAD (HVAD) for an end-stage heart failure. When the patient has begun to mobilize after the implantation of the device, we have combined the use of two components with the aim of securing the driveline to the patients skin: a StatLock system and a silicone suture. RESULTS No case of local traumatism and no case of local infection at the driveline were observed during the follow-up. No patient reported pain or swelling at the driveline exit site. All patients were satisfied with their quality-of-life and they do not report any limitations in their daily activities. CONCLUSIONS One of the major long-term complications in patients with LVAD is the development of infections of the exit site of the driveline. The trauma of this skin region promotes the onset and maintenance of an inflammatory process and local infectious. Avoiding excessive mobilization of the driveline is likely to reduce the incidence of infections of the exit site and improve the quality-of-life.

The sentinel node in anal carcinoma.

Aims and Background Anal cancer is a rare condition. The inguinal lymph nodes are the most common site of metastasis in this neoplasm. The inguinal lymph node status is an important prognostic indicator and the presence of metastases is an independent prognostic factor for local failure and overall mortality. Depending on the primary tumor size and histological differentiation, metastasis to superficial inguinal lymph nodes occurs in 15-25% of cases. Methods and Study Design To evaluate the inguinal lymph node status we performed a search for the sentinel node in a female patient affected by squamous anal carcinoma. Results Identification and examination of the sentinel node was positive and postoperative histology showed the presence of bilateral lymph node metastases. Conclusions We suggest that examination of the sentinel node in anal cancer could be an efficient way to establish the inguinal lymph node status, which would help the clinician to plan and perform adequate treatment.

Transrectal sentinel lymph node biopsy for early rectal cancer during transanal endoscopic microsurgery.

Abstract Background: Local excision of invasive cancer by transanal endoscopic microsurgery (TEM) entails the risk of lymphnode metastases that obliges to radical surgery. A determination of metastatic lymph-nodes would avoid major surgery in the vast majority of cases. We applied the concept of sentinel lymphnode (SLN) biopsy to suspected invasive rectal cancers treated by TEM. Methods: Indocyanine green (ICG) is injected in the submucosa underneath the lesion. The tumor is dissected full-thickness until the perirectal fat. A near infra-red (NIR) optic provides a map of mesorectal lymphatics, on which guide the perirectal fat is dissected and lymph-nodes are excised. Results: The technique was tested in three patients. In all cases the pathologist confirmed presence of lymphnodes in the excised tissue, no case showed metastasis. In all cases final pathology of the rectal neoplasm did not indicate radical surgery. Conclusion: In suspected invasive cancers, SLN mapping could be a useful technique to identify the first lymph node receiving drainage from the tumour, whose accurate pathological examination could predict the status of the remaining nodes and indicate further radical surgery. An ongoing study on a prospective case series will assess sensitivity and negative predictive value of SLN biopsy.

Microcystic urothelial cell carcinoma with neuroendocrine differentiation arising in renal pelvis. Report of a case

Microcystic urothelial cell carcinoma is a rare variant of urothelial cell carcinoma which occurs in the bladder and, rarely, in the renal pelvis. Neuroendocrine differentiation is uncommon in pure urothelial carcinoma and is more frequently found in neoplasms with glandular differentiation. We report a case of microcystic urothelial cell carcinoma arising in renal pelvis and showing focal neuroendocrine differentiation. A 55-year-old man with a history of non-small cell cancer of the lung presented with abdominal pain and hematuria. Imaging studies and gross examination revealed a partially cystic mass in the left kidney. Microscopic examination disclosed invasive carcinoma with prominent microcystic features, with microcysts lined by low columnar and flat cells. Immunohistochemical analysis confirmed the urothelial histotype (positive for thrombomodulin, p63 and high-molecular-weight cytokeratins) and disclosed focal neuroendocrine differentiation.

Role of radioimmunolocalization in the staging of gastric carcinoma.

Intraoperative radioimmunolocalization is a potentially useful technique for staging gastric neoplasms without resorting to extensive surgical intervention. Before preoperative immunohistochemical typing for the presence or absence of tumor-associated glycoprotein (TAG) 72, we performed intraoperative radioimmunodetection on three patients presenting with gastric carcinoma using a whole monoclonal antibody (B72.3) marked with Indium-111 injected 1 week before operation. The results were calculated on the number of lymph node stations and yielded a high sensitivity due to a specificity of 72% and the absence of false negatives. Intraoperative radioimmunolocalization is a promising method for noninvasive staging of both early and advanced gastric carcinoma.

Peripherally Inserted Central Venous Catheters

Percutaneously inserted central venous catheters (PICCs) have become the standard of care for long-term vascular access, both for in-hospital patients and outpatients. Indeed, PICCs have gained increasing popularity in the critical care and perioperative setting in recent years. Thanks to ultrasound-guided insertion techniques, PICCs provide central venous access at a cost near to peripheral venipuncture. Current tip-tracking technology allows precise tip positioning at the bedside without the need for fluoroscopy. For these reasons, bedside PICC insertion is gaining interest within the anesthesiology community and is foreseen as soon becoming part of the anesthesiologist’s regular armamentarium. Peripherally Inserted Central Venous Catheters offers a complete state-of-the-art review on all aspects of PICC insertion and management, from the history of venous access to the psychosocial impact and medicolegal implications. The book is edited by two surgical oncologists from the University of Turin, Italy who have been leading several popular international courses and conferences on this topic. The aim of the text is to provide an in-depth analysis of each aspect of care related to PICCs, and although the final result is a rich compendium, the reader must often sort through an abundance of unprocessed information in order to reach the relevant points. That being said, the book is divided into 15 chapters assigned to a variety of international authors – mostly from Italian institutions – as well as some industry representatives. A thorough historical overview of vascular access is the topic for the opening chapter. This is followed by a very technical discussion on catheter technology and materials, including a helpful review of the biochemical basis of phlebitis. Chapter 3 is the first of a series of three chapters on indications of PICC insertion, and it offers an introduction to the ‘‘proactive’’ approach to venous access for best patient outcome, as theorized by P. Blackburn. Chapter 12 completes the block of chapters on indications and clinical decision-making. As a group, Chapters 6-8 and 11 constitute a practical handbook on PICC insertion and troubleshooting. Chapters 6 and 7 present a step-by-step guide for vein selection, ultrasound scanning, and catheter positioning using different navigational devices. Numerous diagrams and images of a complete series of real clinical scenarios and state of the art equipment complement the well-written text. Chapter 8 comprises a very practical and comprehensive guide to the diagnosis and management of PICC occlusions, though Chapter 11 is of questionable practical value. Chapters 9 and 10 provide a comprehensive review of PICC complications, including an up-to-date literature review on PICC infection and vein thrombosis. Chapter 13 is dedicated to the often underestimated aspect of psychological implications and offers a very detailed well-referenced analysis of vascular access in the oncological patient. Medicolegal concerns related to PICCs, including the need for informed consent and physician supervised vs independent nurse-led teams, are also discussed. Chapter 14 may have limited relevance for North American readers, however, as it comprises a detailed review of the theory of medical malpractice in Italy. A well-written comprehensive review of the PICC team completes this book. All relevant aspects of PICC team M. Meineri, MD (&) Toronto General Hospital, University Health Network, Toronto, ON, Canada e-mail: massimiliano.meineri@uhn.on.ca

Advantages, Disadvantages, and Indications of PICCs in Inpatients and Outpatients

Venous access is an important part of treatment in every hospitalized patient. For inpatients, open-tip power PICC lines are probably the best choice, as they have a limited cost and reliably allow to measure central venous pressure, take blood draws, and deliver contrast infusion. Open-tip PICC lines, to ensure a long operating life, require the use of good-quality neutral pressure “needle-free” connectors. The nurse’s ability to use, dress, irrigate, and maintain this type of PICC is crucial. PICC lines may be placed at the bedside in the patient’s home without any additional risk. ECG-guided tip positioning minimizes the need for checking correct catheter placement by radiological control. PICC lines need weekly maintenance, which can be easily taught to the caregiver. Well-placed PICC lines are a safe way to deliver IV therapy and take blood draws. In homecare, one of the major risks is damage to the external part of a PICC line and occlusion due to an incorrectly stopped infusion: valved PICCs can adequately meet most homecare needs.