Giovanni Maria Fadda

Susceptibility of Acanthamoeba castellanii to contact lens disinfecting solutions.

A corneal isolate of Acanthamoeba castellanii was exposed to commercial contact lens disinfecting solutions containing hydrogen peroxide, benzalkonium chloride, polyaminopropyl biguanide, polyquaternium 1, and chlorhexidine-thimerosal. The minimum trophozoite amebicidal concentration and exposure times required to kill trophozoites and cysts were determined. Solutions containing hydrogen peroxide or chlorhexidine-thimerosal were active against both trophozoites and cysts. The benzalkonium chloride-based solution was effective only against trophozoites. Solutions containing polyaminopropyl biguanide or polyquaternium 1 were completely ineffective. The need for adequate exposure times must be stressed.

Routine second trimester ultrasound screening for prenatal detection of fetal malformations in Sassari University Hospital, Italy: 23 years of experience in 42,256 pregnancies.

OBJECTIVE To establish, for a determined period of time, the effectiveness of a program of ultrasound screening in detecting fetal malformations in prenatal time. To assess the sensitivity, the specificity, the positive and the negative predictive value of the ultrasound screening. To examine the trend of such indexes of diagnostic accuracy in a long time period. STUDY DESIGN The patients admitted to the study had effected at least one ultrasound examination within the second trimester of pregnancy (< or =23 gestational weeks). The examined pregnant women were 42,256 and the period of reference ranged from January 1981 to December 2004. All patients delivered in Gynecologic and Obstetric Clinic of Sassari University, Sassari, Italy. RESULTS In the considered period were reported 1050/42,256 (2.48%) cases of fetal malformations, of which 974 single and 76 multiple malformations. The cases of malformations diagnosed in prenatal period were 578/1050 (55.05%), of which 65/578 (11.24%) multiple anomalies. The overall sensitivity was 55.05% (95% confidence interval: 52-58%), with a variability from the 32.95% (cardiovascular system) to 81.05% (central nervous system) in relationship to the typology of the examined apparatus. The overall specificity was 99.88% (95% confidence interval: 98-99.9%), the predictive positive value 91.89% (95% confidence interval: 89-93%) and the negative predictive value 98.87% (95% confidence interval: 95-99%). CONCLUSION The sensitivity of the ultrasound screening undoubtedly appeared to be satisfactory. We believe that, for the examination of some apparatuses, as for the cardiovascular apparatus, with the extension of the standard examination (four-chamber view) to further plans of scanning, sensitivity could subsequently be improved.

Umbilical Artery Pulsatility Index in Pregnancies Complicated by Insulin-Dependent Diabetes mellitus without Hypertension

Objective: In a group of diabetic pregnant women, the umbilical artery pulsatility index (PI) was compared with both pregnancy complications and perinatal outcomes. Method: We evaluated 67 women with pregnancies complicated by insulin-dependent diabetes mellitus (IDDM), without hypertension. For the study we took the last umbilical PI value before delivery into consideration. Doppler results were not used for patient management. Umbilical artery PI was correlated with the route of delivery and the following perinatal complications: intrauterine growth retardation; cesarean sections for acute fetal distress; respiratory distress syndrome (RDS); neonatal hyperbilirubinemia; hypocalcemia; hypoglycemia; macrosomia, and neonatal intensive care unit (NICU). Results: Among the 67 diabetic patients enrolled in this study, 44 (66%) had umbilical PIs ranging from the 5th to the 95th percentile (PI mean ± SD = 1.2 ± 0.3), while 23 (34%) had PIs above the 95th percentile (PI mean ± SD = 1.6 ± 0.3). Among the group with pathologic umbilical PIs, analysis of the data revealed a significantly higher incidence of both cesarean sections for acute fetal distress and perinatal complications: RDS; hyperbilirubinemia; hypoglycemia, and the need for NICU, respectively. Conclusion: In 34% of the diabetic pregnant women without hypertension, we found increased vascular resistances. Among these patients the incidence of perinatal complications was higher, and both closer maternal metabolic control and stricter care of fetal conditions are needed.

2-phenyl-6(7)- R -substituted quinoxalines N -oxides: synthesis, structure elucidation and antimicrobial activity

A certain number of isomeric 2-phenylquinoxalines N-oxides bearing substituents at position 67 were prepared in order to investigate anti-microbial activity. The effect of some electron—withdrawing groups seem to increase an anti-Trichomonas vaginalis activity in vitro. Structure elucidation of 6-acetyl-2-phenylquinoxaline was achieved by an unambiguous synthesis. 1H NMR spectra of N-oxides were examined in detail to establish structure of parent quinoxalines.

Uterine tumors resembling ovarian sex cord tumors: a case report of conservative management in young women.

Abstract Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are distinguished into two separate groups: endometrial stromal tumors with sex cord-like elements (Group I), which have an unfavorable prognosis; and UTROSCT proper (group II), with more than 40% sex cord-like differentiation and less endometrial component, which are biologically less aggressive than the tumors of the other group. We report the case of a young woman with UTROSCT treated by minimally invasive hysteroscopic surgery. This is one of the few cases reported in the literature that have been managed conservatively.

Tufted hair folliculitis in a woman treated with lapatinib for breast cancer.

puncture skin test (0%; P < 0.001). The proportion of positive APST was in line with that found in larger groups of patients with CU. One reason why the puncture skin test was negative in all our patients might be that in this technique the concentration of autoantibodies or other histamine-releasing factors is too low to increase the permeability of the capillary wall significantly. Furthermore, Kimura et al. used a serum containing high levels of autoantibodies to perform the puncture skin test, whereas we used plasma, which may not contain autoantibodies but rather other histaminereleasing factors. Irrespective of the possible explanation, our results suggest that (at least in adult patients with CU) the APST remains the best means to detect an autoreactive status in vivo and that the puncture skin test cannot be considered a valid substitute for the intradermal test.

Advances in the Treatment of Triple-negative Early Breast Cancer.

Triple-negative breast cancer represents approximately 10-20% of all breast cancers and is associated with worse prognosis than other subtypes, with a higher risk of recurrence and death than other breast cancer types. This cancer is considered a heterogeneous disease comprising a spectrum of cancers with distinct activated biological pathways, various levels of chemosensitivity and different propensity for metastasis. Currently, chemotherapy represents the mainstay of medical treatment of these patients, because of the absence of well-defined molecular target agent, and we cannot use investigational classifications to determine appropriate systemic therapy outside of clinical trials. The specific adjuvant chemotherapy that may be most effective is still being determined but there is general consensus that regimens containing anthracyclines and taxanes are the standard approach for patient after surgery. Unfortunately, although some patients respond to treatment, other women have a high degree of intrinsic resistance to the same therapy. Moreover, in some studies, the pathological complete response was significantly higher in women treated with platinum-based regimen with respect to those treated with other chemotherapy regimen. The systematic evaluation of the predictive value of genomic alterations is critically important for a better comprehension of this entity and to develop new effective therapeutic strategies. In the future, a personalized therapeutic approach based on biology-oriented characteristics and molecular profiling may be effective for the patients.

Adjuvant Treatment of Early Breast Cancer in the Elderly

Breast cancer is common in the elderly, as more than 50% of these tumors are diagnosed in patients aged 65 years or older. Elderly women may also delay reporting or underreport to their physician suspicious symptoms and lesions, so that breast cancer is more likely to be diagnosed at a more advanced stage, with putatively inferior outcomes. Adjuvant hormonal therapy has clear benefits for all women with hormone receptor-positive early breast cancer, despite the fact that it is still under-prescribed in elderly women, but the benefits of tamoxifen are more evident than that observed in younger patients. Aromatase inhibitors significantly prolong disease-free survival, reducing the risk of metastases and contralateral cancer compared with tamoxifen, and these benefits are greater in women aged ≥65 years. However, in case of a history of pathological fractures, arthritis or chronic musculoskeletal pain syndromes, tamoxifen still represents the preferred adjuvant option. In patients with a high risk of recurrence with hormonal therapy alone, the cardiac toxicity of nonanthracycline regimens should be taken into account. Trastuzumab-based therapy should be offered to most patients with HER2-overexpressing tumors. Older patients have an increased risk of disease recurrence and cancer-related mortality, because they are usually undertreated due to their age and longevity. Thus, a multidisciplinary geriatric approach is required, but the optimal management of these patients is still not well defined.

Tamoxifen Induced Severe Hypertriglyceridemia in a Male Patient with Breast Carcinoma

To the Editor: Despite the tamoxifen is the most widely used drug in the management of the endocrine responsive male breast cancer it is difficult to obtain detailed information regarding its side-effects in men. This is probably due to the low incidence of male breast cancer, which can explain the scarcity of randomized prospective trials in those patients, added to the fact that treatment recommendations are usually inferred from female breast cancer or came from case reports or retrospectives studies. Anyway, female and male breast cancers have distinct clinical and pathologic features, especially with regards to the role of male hormones and estrogens, and so, it is interesting to note that tamoxifen related sideeffects may have a different impact in either genders. Despite in early reports the drug showed a low toxicity, as many as 25% of males discontinue the therapy because of its related toxicity. The drug interferes with the proliferation of breast cancer cells by its anti-estrogenic activity, but it has also shown to have an agonistic activity on bone, liver and endometrium. While uterine carcinogenicity, which obviously does not exist in men, is major concern among women, other problems such as hot flushes have a lower prevalence and intensity in males. Sexual dysfunctions, weight gain, mood alterations such as depression, insomnia, thromboebolic disease, are the most relevant side-effect affecting men. In October 2004, a 49-year-old Caucasian man came under our observation (B.M.I. 25.3 Kg ⁄ m), who had noted the presence of a fixed and indolent nodule of about 2 · 2 cm of size in the lower external quadrant of the right breast. General examination confirmed the presence of the breast mass and showed no other specific complaints. Laboratory findings including lipid profile were normal. Biopsy of the breast mass showed the presence of a breast carcinoma. Staging with chest X-rays, abdominal ultrasonography, and bone scintigraphy detected no metastases, so the patient underwent a radical right mastectomy with lymphadenectomy. Histological examination showed an intermediate differentiated ductal infiltrating carcinoma with pathological stage T2 N1 M0. Estrogen and progesterone receptors were both positive (60% each), Mib 1 was 9% and C-erb B2 was negative. Following surgery, on December 15th 2004, the patient was treated with six cycles of CMF adjuvant chemotherapy and subsequently underwent radiotherapy for a total amount of 50 Gy delivered to the right chest wall. After the chemotherapy completion, on June 6th 2005, hormonal therapy with tamoxifen (20 mg ⁄ day) was started. In the following time the patient underwent periodical clinical and instrumental checks, which were always negative for disease recurrence, and he did not complain any symptoms. Despite routine laboratory findings and tumour markers (Ca15–3, CEA) resulted normal, an extremely high plasma triglycerides value (7200 mg ⁄ dL) was detected on November 2005. Other lipid parameters were normal. Considering the effect of tamoxifen therapy as the possible triggering factor, as reported in female patients, we decided to discontinue the drug administration and to admit the patient to our Internal Medicine unit for further cheeks. At the admission, physical examination showed only a slight liver enlargement confirmed by a further abdomen ultrasonography which showed a fatty liver. No cutaneous and retinal signs of primary hypertrigliceridemia were detected. He had no family history of hyperlipidemia, diabetes, alcohol abuse, or other drugs able to intake the lipid profile. To exclude a genetic influence, a Address correspondence and reprint requests to: Davide Adriano Santeufemia, MD, Medical Oncology, University of Sassari, Viale San Pietro 8, Sassari 07100, Italy, or e-mail: davidesanteufemia@yahoo.it.

The use of amikacin in the treatment of primary cutaneous mycobacteriosis due to Mycobacterium fortuitum

Cutaneous and subcutaneous infections by Mycobacterium fortuitum are caused by colonisation of the tissue following accidental trauma, injection of drugs (cortisone), mesotherapy, surgical procedures or domestic animal bites. M. fortuirum is only occasionally associated with primary cutaneous infections in immunocompetent people. Rarely disseminated infection with only cutaneous manifestations can occur in immunocompromised patients or in debilitating conditions (e.g. diabetes).