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L'eradicazione dell'Epatite HCV negli utenti che afferiscono ai Ser.D dovrebbe essere incoraggiata non solo rispetto alla cura di tali pazienti ma anche per la salute globale, rappresentando oggi il principale serbatoio di infezione nei paesi industrializzati. Le esperienze sul campo e le evidenze scientifiche stanno cercando di individuare gli elementi essenziali al fine di facilitare l'accesso alle cure per la presa in carico del consumatore di sostanze con HCV. L'utilizzo dei nuovi farmaci, i DAA (antivirale ad azione diretta), in grado di curare oltre il 95% delle persone con infezione cronica da HCV, è certamente un elemento incoraggiante per il limitato tempo di cura e per gli scarsi effetti collaterali, ma l'arruolamento dei consumatori di sostanze è ancora difficile. Nel Ser.D. della provincia di Foggia è in corso una collaborazione con l'U.O.C. Malattie Infettive Policlinico Riuniti di Foggia. L'utilità di tale protocollo risiede nella sua capacità di integrare le attività svolte all'interno del Servizio per le dipendenze con quelle del Centro di cura Malattie Infettive, al quale spetta il compito di completare la diagnosi iniziale fatta dal Ser.D.e, prescrivere ai pazienti la terapia specifica. Spetta al Ser.D lo screening virologico completo, la diagnosi di attività di malattia epatica, il monitoraggio tramite esami laboratoristici in corso di terapia nonché la supervisione dell'assunzione della terapia affidata. L'esperienza fin qui svolta ha portato ai seguenti risultati: l'attività della malattia della dipendenza non ha rappresentato un fattore di non aderenza al trattamento né di non inclusione al trattamento stesso; i dipendenti afferenti al servizio risultati positivi agli Ab-HCV e con HCV-RNA positivo sono tutti dipendenti da sostanze stupefacenti con uso attivo o pregresso per via iniettiva, anche i due alcolisti positivi erano entrambi ex drug abuser; gli effetti collaterali registrati non sono risultati tali da determinare l'interruzione del trattamento antivirale in corso, eccetto per un paziente in cui è emerso una psoriasi e, comunque, quelli registrati sono legati alla terapia con interferone e ribavirina; la permanenza al servizio rappresenta un fattore protettivo non solo per la cura della dipendenza ma anche per la cura delle patologie correlate alla dipendenza, infatti ben il 72,3% di coloro che non hanno fatto il prelievo HCV-RNA aveva interrotto il trattamento per la cura della dipendenza; la percentuale di persi durante il trattamento è stata del 3,7%; rispetto alla patologia della dipendenza il 16,7% presentavano attività di malattia con positività alle sostanze stupefacenti, ma ciò non ha costituito né motivo di esclusione né d'interruzione della terapia antivirale. Il follow-up al 31 maggio 2021, post SVR-12, è stato caratterizzato da nessuna recidiva né reinfezione.

Introduzione. L'Organizzazione Mondiale della Sanità (OMS) definisce la Comorbilità o Doppia Diagnosi come la coesistenza nel medesimo individuo di un disturbo dovuto al consumo di sostanze psicoattive ed un altro disturbo psichiatrico (OMS, 1995). Per quanto piuttosto criticata tale definizione consente di individuare una popolazione di pazienti le cui caratteristiche psicopatologiche appaiono peculiari e molto spesso di difficile ed non univoca interpretazione diagnostica; da tali difficoltà discendono frequentemente diatribe ideologico culturali e reali difficoltà di intervento terapeutico che mantengono queste persone in una condizione di equilibrio precario con elevati costi in termini sanitari e di mancata produttività lavorativa. In letteratura sono presenti numerosi lavori che cercano di coniugare ipotesi etiopatogenetiche di area psichiatrica con vie neurotrasmettitoriali più tipicamente associate al mondo delle dipendenze patologiche, delineando una specifica cultura psicopatologica che cerchi di dare risposte a quesiti diagnostici di difficile soluzione. Tra i vari modelli che cercano di chiarire le associazioni etiopatogenetiche comuni a dipendenze ed altri disturbi mentali quello che forse appare più completo è l'ipotesi della "disregolazione omeostatica edonica" (la disedonia), correlato fenomenologico delle dipendenze e della malattia mentale che allo stesso momento spiegherebbe la maggiore frequenza di dipendenza nei soggetti con spettro bipolare (inteso anche come tratto temperamentale) come anche del discontrollo degli impulsi o dell'incapacità a prevedere le conseguenze dei propri agiti. In questo solco si inserisce il nostro studio con l'intento di fornire un contributo alla creazione di un linguaggio neurocomportamentale specifico per il mondo delle dipendenze. Scopo e Metodi End point primario del nostro studio è quello di identificare attraverso la frequenza nel SCL-90R, di specifiche dimensioni sintomatologiche attribuibili a specifiche popolazioni di pazienti. In seconda istanza abbiamo indagato l'eventuale esistenza di caratteristiche psicopatologiche comuni tra pazienti con patologia di spettro bipolare e dipendenza; in ultimo abbiamo valutato l'impatto della doppia diagnosi sul funzionamento globale dell'individuo. Abbiamo arruolato tre coorti di pazienti: soggetti eroinomani senza altra psicopatologia, eroinomani con disturbo bipolare, soggetti affetti da disturbo bipolare senza dipendenza, tutti provenienti dai Ser.D e DSM della provincia di (…...) La diagnosi è stata formulata attraverso il criterio dell'osservazione clinica, supportata da strumenti psicodiagnostici (MMPI-1, SCID 2) ed esami laboratoristici (esami tossicologici urinari). Le dimensioni sintomatologiche prevalenti sono state indagate con la SCL 90R. Risultati Non sono emersi dati significativi relativi ad una specifica dimensione psicopatologica per i soggetti affetti da Disturbo da uso di sostanze. Tra le sottoscale del SCL-90, l'ANX è la dimensione comune rilevata tra eroinomani bipolari (doppia diagnosi) e bipolari. Nel confronto tra i tre gruppi (eroinomani senza comorbilità, eroinomani bipolari, bipolari) valutati globalmente, il gruppo meno disfunzionale è risultato quello degli eroinomani. La ridotta estensione dei campioni esaminati non ci permette di pervenire a risultati definitivi richiedendo ulteriori studi in tal senso.

Introduction The role of thrombophilia screening and antithrombotic therapy in unselected women undergone Assisted Reproductive Technologies (ART) is largely unknown. Nonetheless, in many Countries infertile women undergo thrombophilia screening and/or antithrombotic therapy. Materials and Methods We carried out a follow-up study. The original sample (n = 1107) consisted of infertile women observed in 13 years. A cohort of 157 women with at least 1 cycle before thrombophilia test and 1 after test was investigated. All underwent thrombophilia screening; an antithrombotic treatment was prescribed in 216 out of 801 cycles. Clinical pregnancy and live birth rates were the main clinical objectives. Results Overall, 15 (9.6%) women carried thrombophilia. The Cox regression showed that LMWH alone or combined with ASA was significantly associated with the outcome "live birth" “live births” (p: 0.015, HR: 2.8, 95%CI: 1.2-6.6 for combined therapy), independently of the carriership of thrombophilia. Women with a lower number of attempts had a higher likelihood of delivering a live-born child using the combined therapy (p Conclusions A potential benefit of LMWH in improving number of live births, independently of the presence of thrombophilia, is suggested. Universal thrombophilia screening before ART is not useful to discriminate women with a worse pregnancy prognosis.

A case of a CA 19-9 producing cystadenoma with mesenchymal stroma originating from the common hepatic duct is presented, with a review of the literature. The findings of ultrasound and CT scans and the endoscopic retrograde cholangiopancreatography picture allowed the establishment of a confident pre-operative diagnosis. Although there was an elevation of CA 19-9 serum levels, the resected specimen did not show any malignant focus at pathologic examination. After surgical excision, CA 19-9 serum levels returned to normal.

Background: Triple therapy with proton pump inhibitor, clarithromycin and amoxicillin has recently been proposed in Maastricht as first-line treatment for H. pylori infection. Aim: To determine predictors of unsuccessful eradication. Methods: Two hundred and forty-eight patients underwent endoscopy with biopsies for rapid urease test, histology and culture with antibiotic susceptibility tests, and 13C-UBT. All infected patients were given pantoprazole (40 mg b.d.), clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for 1 week. Eradication was assessed by UBT at 4–6 weeks after therapy. Results: One hundred and sixty-two of 248 patients (65%) were infected. Culture was positive in 144 (89%). Prevalence rates of metronidazole, clarithromycin and amoxicillin resistance were 14, 8 and 3%, respectively. Eradication rates (95% CI) were 63% (54.7–70.6) by intention-to-treat analysis and 67% (59.4–75.4) by per protocol analysis. Drug compliance was excellent and side-effects were mild. Age ≥ 45 years (OR: 2.35, CI: 1.30–4.25), smoking (OR: 1.37, CI 1.01–1.87) and high pre-treatment UBT results (OR: 1.36, CI: 1.08–1.72) were independent predictors of eradication failure. Gender, endoscopic findings, alcohol intake, and clarithromycin and amoxicillin resistance did not predict treatment failure. Conclusion: Despite the low prevalence of primary antibiotic resistance in our geographical area, triple therapy with pantoprazole, amoxicillin and clarithromycin achieves low eradication rates. Smoking, age and pre-treatment UBT results are predictors of potential eradication failure.

Background: Triple therapy with proton pump inhibitor, clarythromycin, and amoxicillin has been proposed in Maastricht as the first-line treatment of H. pylori infection. Aim: To determine whether ranitidine bismuth citrate (RBC) based regimens may be used as second-line treatments after ‘Maastricht therapy’ failure. Methods: A total of 285 patients with H. pylori infection were given a 7-day treatment with pantoprazole 40 mg b.d., clarythromycin 500 mg b.d., and amoxicillin 1 g b.d. Patients who were still infected were randomly given one of the following 14-day treatments: RBC 400 mg b.d. plus amoxicillin 1 g b.d. and tinidazole 500 mg b.d. (RAT group), RBC 400 mg b.d. plus amoxicillin 1 g b.d. and clarythromycin 500 mg b.d. (RAC group), and RBC 400 mg b.d. plus clarythromycin 500 mg b.d. and tinidazole 500 mg b.d. (RCT group). Results: The ‘Maastricht therapy’ achieved an eradication rate of 59% (95% CI: 54–65) on intention-to-treat analysis. The RAT, RAC, and RCT regimens achieved eradication rates of 81% (95% CI: 67–94), 43% (95% CI: 26–60), and 62% (95% CI: 44–80), respectively, on intention-to-treat analysis. Patient compliance was optimal in RAT and RAC groups. Conclusion: RBC plus tinidazole and either amoxicillin or clarythromycin can be used as second-line therapies after failure of the Maastricht triple therapy.

The objective of this study was to identify clinical, biochemical, ultrasound, and/or pathologic parameters capable of predicting survival in a cohort of patients with well compensated cirrhosis and small hepatocellular carcinoma (HCC) who were treated with percutaneous ethanol injection (PEI).The study group included 111 patients with Child--Pugh Class A cirrhosis and with one (93 patients) or two (18 patients) HCC nodules measuring5 cm in greatest dimension. All patients underwent multisession PEI. The prognostic values of pretreatment and post-treatment variables were analyzed using the Kaplan-Meier method.The overall 3-year and 5-year survival rates of 62% and 41%, respectively, were not influenced by age, gender, duration of chronic hepatitis, serum albumin, prothrombin time ratio, total bilirubin, gamma-glutamyl transferase, hepatitis B surface antigen, antihepatitis C virus, HCC size, HCC ultrasound pattern, HCC histologic or cytologic grading, greatest spleen dimension, esophageal varices, or ascites. Levels of alpha-fetoprotein (AFP)14 ng/mL (P0.006), alanine aminotransferase75 IU/L (P0.04), and aspartate aminotransferase80 IU/L (P0.009) and platelet count92 x 10(9)/L (P0.02) before treatment were independent predictors of decreased survival. Among post-treatment parameters, AFP levels 6 months after PEI13.3 ng/mL (P0.003) and HCC recurrence in another segment of the liver (P0.04) were linked to decreased survival in univariate analysis.Among patients with Child--Pugh Class A cirrhosis with small uninodular or binodular HCC who are treated with multisession PEI, those with elevated serum AFP and transaminase levels and low platelet count before treatment are characterized by decreased survival. During follow-up, intrahepatic recurrence of the tumor is the main factor affecting survival.

Background : In chronic hepatitis C the schedule of interferon (IFN), 3 MU thrice weekly (tiw) plus ribavirin (1000–1200 mg/daily) needs further evaluation, as IFN dosages >3 MU achieve better responses. Aims : To compare the efficacy of 5 MU tiw of IFN with (96 patients) or without ribavirin (96 patients) for 12 months in naive patients, to evaluate the effect of baseline features on the response to therapy, and to determine a reliable point in time during treatment to predict non-response. Results : Sustained virologic response was 20.8% (95% CI 13–29) with IFN monotherapy and 54.2% (95% CI 44–64) with combination ( P =0.0001), the relapse rate 39.4% (95% CI 23–56) and 9% (95% CI 1-16) ( P =0.0007), and the combined rate of sustained biochemical and virologic response 22.7% (95% CI 14–31) and 60.5% (95% CI 50–71) ( P =0.0001), respectively. Patients given combination therapy were more likely to respond regardless of baseline features. Apart from genotype non-1, predictive factors for IFN monotherapy were ineffective in predicting response to combination therapy. Using logistic regression analysis, IFN-ribavirin was the strongest predictor of response ( χ 2 =21.3; P =0.0001). Viral persistence at month 3 of therapy was a more accurate predictor than aminotransferase values for non-response to IFN monotherapy but not to combination therapy (positive predictive values of 98 and 82%, respectively). Conclusion : In this study, 5 MU of IFN combined with a standard dose of ribavirin has yielded the highest rate of sustained response reported to date. Further dose finding studies are warranted.

A novel rifabutin-based therapy is able to cure Helicobacter pylori infection in most patients who have failed eradication after standard proton pump inhibitor (PPI)-based triple therapy. We compared this regimen with the quadruple therapy.A total of 135 patients were randomized into three groups who were treated for 10 days with pantoprazole 40 mg b.i.d., amoxycillin 1 g b.i.d., and rifabutin 150 mg o.d. (RAP50150 group), or 300 mg o.d. (RAP300 group), and pantoprazole 40 mg b.i.d., metronidazole 250 mg t.i.d., bismuth citrate 240 mg b.i.d., and tetracycline 500 mg q.i.d. (QT group). Before therapy, patients underwent endoscopy with biopsies for histology, culture and antibiotic susceptibility tests. H. pylori eradication was assessed by the 13C-urea breath test.On intention-to-treat analysis, eradication rates (with 95% confidence intervals [CI]) were 66.6% (53-80%) in the RAP150 and QT groups, respectively, and 86.6% (76-96%) in RAP300 group (p0.025). Most patients harboring metronidazole- and clarithromycin-resistant strains were eradicated at an equal rate by each of the three regimens. Side effects were observed in 9% and 11% of rifabutin-treated patients, and in 47% of those on quadruple therapy (p0.0001).In patients who failed standard eradicating treatments, a 10-day course of rifabutin with pantoprazole and amoxycillin is more effective and well tolerated than the quadruple therapy.

To evaluate damage to cirrhotic liver tissue after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).TACE was performed in 111 patients with HCC that involved less than 30% of the liver. Baseline liver function was evaluated with Child-Pugh scores and other indicators. Eighty-two patients had Child-Pugh class A disease, 27 had class B disease, and two had class C disease. All patients underwent chemotherapy followed by gelatin sponge particle embolization in the proper ("complete" embolization; n = 69) or right or left main ("partial" embolization; n = 42) hepatic artery. Liver function was assessed 4 months later, and 95 patients underwent a second TACE (complete embolization in 57, partial in 38). Liver function was again assessed 4 months later in 60 patients.No patient died. Child-Pugh scores increased in all patients from a mean 5.96 to 6.28 (not significant) and 6.51 (P =. 05) after first and second TACEs, respectively. In patients with class A disease, scores increased from a mean 5.37 to 5.73 (P =.01) and 5.89 (P =.001) after first and second TACEs, respectively; in patients with class B disease, scores changed from a mean of 7.48 to 7.67 and 7.30 after first and second TACEs, respectively (not significant).TACE does not induce significant long-term worsening of liver function in patients with class A or B cirrhosis.

Background/Aims: This study was aimed to determine whether host-dependent genetic factors modulate the outcome of HCV infection. Methods: HLA class II DRB and DQB typing was performed in 184 infected patients and 200 healthy volunteers. Among the patients, 149 subjects had persistent HCV viremia (Group 1) and 35 subjects underwent spontaneous viral clearance (Group 2). Group 1 included cirrhotic patients with transfusion-acquired infections ( n =79), asymptomatic HCV carriers ( n =42), and patients with chronic hepatitis C responsive to interferon therapy ( n =28). Results: Spontaneous viral clearance was associated with HLA DRB1*1104 ( pc =0.054, OR=4.51, 95% C.I. 2.02–10.1) and HLA DQB1*0301 ( pc =0.0039, OR=4.52, 95% C.I. 2.15–9.51). In Group 1 the haplotype DRB1*1104/DQB1*0301 was less frequent (4.8%) than in Group 2 (18.3%) ( pc =0.009, OR=7.38, 95% C.I. 2.58–21.59). At the HLA level, cirrhotic patients were not different from asymptomatic HCV carriers and patients with interferon-induced viral clearance. In cirrhotic patients infected with genotype 1b, the DQB1*0502 allele was more frequently found in those with rapidly progressive liver damage (OR=8.15, 95% C.I. 1.49–44.44), but the corrected p -value was not significant ( pc =0.09). Conclusions: The HLA haplotype DRB1*1104/DQB1*0301 appears to contribute to the spontaneous clearance of HCV infection. The predominance of the DQB1*0502 allele in cirrhotic patients with a rapidly progressive disease possibly reflects an influence of this allele on the progression of the HCV-related liver disease.

A 37-year-old man, previously submitted to colectomy for ulcerative pancolitis unresponsive to medical therapy, presented with nausea, vomiting, epigastric pain, and bloody diarrhea. An upper gastrointestinal endoscopy revealed mucosal friability, petechiae, and erosions throughout the duodenum, whereas prestomal ileum showed large ulcers and pseudopolyps. Histologically, a dense inflammation chiefly composed of lymphocytes and plasma cells with few neutrophils was detected. No bacteria, protozoa, and fungi could be detected. Despite intensive care, intra-1194 venous antibiotics and steroids, the patient died of diffuse intravascular coagulation and multiorgan failure. At post-mortem examination severe ulcerative lesions were observed scattered throughout the duodenum up to the distal ileum. The dramatic clinical presentation with fatal outcome, the widespread ulcers throughout the intestine, and the histological picture are peculiar features in our patient which can not be ascribed to any type of the ulcerative jejunoenteritis so far reported. Patients with pancolitis and diffuse ileal involvement do not necessarily have Crohn's disease but rather may have ulcerative colitis.

Uncontrolled, retrospective clinical studies have recently claimed that HCV infection could trigger the onset of diabetes mellitus (DM). We sought to verify the association between DM and liver diseases of different etiology, stage, and severity in a prospective study including gender- and age-matched controls.Two hundred forty-seven patients with liver cirrhosis (184 men, 116 with an associated hepatocellular carcinoma, 34% in Child-Pugh's class A) were evaluated (group 1). One hundred fifty-seven (63.5) of them were HCV positive, 38 (15.5%) HBV positive, 49 (19.8%) alcohol abusers, and three (1.2%) cryptogenic. Two control groups were also included. The first control group consisted of 138 patients with chronic hepatitis due to HCV infection (73.9%), HBV infection (15.9%), or alcohol abuse (10.2%) (group 2). The second control group included 494 patients with an acute osteoarticular trauma, age- and gender-matched with patients in group 1 (group 3).Diabetes mellitus was present in 32.3%, 3.6%, and 9.7% of patients in groups 1, 2, and 3, respectively. When compared with controls (group 3), DM was significantly less frequent in group 2 (p0.004) and significantly more frequent in group 1 (p0.0001). The prevalence of DM was not different among patients with HCV, HBV infection, or alcohol abuse. In group 3, the prevalence of DM appeared to increase steadily with age. On the contrary, in patients with liver cirrhosis (group 1) DM was detected in about 20-30% of cases in all decades of age. In group 2, diabetics were found only in the 7th and 8th decades of life. At multivariate analysis cirrhosis and age were the only two factors independently associated with DM; odds ratios were 12.5 (95% confidence interval [C.I.], 6.74-20.4) for cirrhosis, and 1.47 for age (95% C.I. 0.39-2.55).Our findings disprove HCV infection as a trigger factor for DM, which should not be listed among the various extrahepatic manifestations of this viral infection.

The aim of this paper is to evaluate the safety of ordinary antisepsis in `free hand' abdominal interventional ultrasound (US)-guided fine-needle punctures. A prospective series of 719 diagnostic and therapeutic procedures performed on 558 patients is reported. No puncture attachment, sterile gloves, covering or draping was used. The transducer was cleaned with water and 70% alcohol. Needle contamination during the procedure was avoided. Patients were monitored for five days in order to exclude sepsis. Subsequently, both patients and operators underwent three-month hemato-chemical checks. No patient or operating medical personnel presented fever, sepsis, viral markers turning into positive or signs of hepatitis during the six months following the puncture. The ordinary antiseptic procedure is safe for patients and operators. It allows for the reduction of the material costs and saves time. Avoiding sterilizing procedures, it allows for the prevention of possible damages to US probes.

Summary. Background: Factor (F)V Leiden and the prothrombin 20210A mutation (PTm) are associated with the occurrence of obstetric complications, including pregnancy-related venous thromboembolism (VTE). It is not known whether family members of women with FV Leiden or PTm and previous obstetric complications have a higher risk of VTE or adverse obstetric outcomes. Methods: A retrospective family study including 563 relatives of 177 women with previous adverse outcomes carrying FV Leiden or PTm, referred between April 1993 and June 2010. A history of obstetric complications and VTE was obtained. Prevalence of VTE and obstetric complications in relatives with and without inherited thrombophilias was compared. Adjusted odd ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression models that controlled for predictors (age, FV Leiden and PTm). Results: Relatives carrying FV Leiden had a significant and independent risk for obstetric complications (OR: 1.98, 95% CI 1.03–3.83); this risk was not observed in the presence of PTm (OR: 1.03, 95% CI 0.46–2.32). The presence of FV Leiden or PTm in heterozygosis was significantly and independently associated with the occurrence of VTE (OR: 5.2, 95% CI: 1.70–15.91). Severe thrombophilias were strong risk factors for VTE (OR: 23.2, 95% CI: 6.0–89.85). Male gender was a significant and independent risk factor for VTE (OR: 3.49, 95% CI: 1.51–8.05). The risk did not change when relatives of women with a previous pregnancy-related VTE were excluded (OR: 3.49, 95% CI: 1.51–8.05). Conclusions: Knowledge of thrombophilia status may help to better define the obstetric and thromboembolic risks in asymptomatic family members of women who suffered from obstetric complications.

We compared frequencies of three common prothrombotic mutations (factor V Leiden, the G20210A mutation of the prothrombin gene, and homozygosity for C677T methylenetetrahydrofolate reductase) in 219 cirrhotic patients, 43 with and 176 without portal vein thrombosis (PVT). The following variables were related to PVT: prothrombin levels, platelet count, Child-Pugh classification, previous abdominal surgery, number of decompensation events, size of varices, red markers on varices, and sclerotherapy. All patients were followed up for a mean period of 18 months (range 10-30).Prothrombotic mutations were detected in 64 of the 219 cirrhotic patients (29.2%), at equal frequency in patients with or without PVT. At univariate analysis, PVT was associated with Child-Pugh classes B and C, signs of liver decompensation, large varices with red markings, sclerotherapy, and abdominal surgery. At multivariate analysis, PVT was associated with sclerotherapy [odds ratio (OR) 4.9, 95% confidence interval (CI) 2.2-11] and previous surgery (OR 2.8, 95% CI 1.2-6.3). The combination of the two acquired factors increased the risk of PVT, whereas the combination of local with genetic defects did not. Only a single patient with genetic thrombophilia and without PVT at inclusion developed the complication during follow-up, concomitantly with the development of hepatocellular carcinoma.In cirrhotic patients prothrombotic mutations by themselves are not causative of PVT. Sclerotherapy and previous abdominal surgery favour the development of two-thirds of cases of PVT; in the remaining cases the pathogenesis remains elusive.

BACKGROUND Hepatocellular carcinoma (HCC) complicating cirrhosis has a high intrahepatic recurrence rate after treatment by surgical resection or percutaneous ethanol injection (PEI). In this study, certain clinical, biochemical, and pathologic parameters were evaluated as risk factors for intrahepatic tumor recurrence in liver segments different from that of the first neoplasm in a group of 57 cirrhotic patients with single HCC < 5 cm treated by PEI. METHODS After PEI treatment of HCC, the patients were followed for a mean period of 33 ± 16 months. The following pretreatment parameters were evaluated as predictors of tumor recurrence: age, gender, Child-Pugh score, hepatitis B virus surface antigen, hepatitis C virus antibodies, alanine aminotransferase, aspartate aminotransferase, alpha-fetoprotein (AFP) level before PEI, alcohol abuse, HCC size, HCC ultrasound pattern, HCC histologic grade, HCC capsule, and time from cirrhosis diagnosis. Furthermore, the posttreatment parameters of the AFP level 1 month after PEI and recurrence of HCC in the same liver segment were also evaluated. RESULTS The cumulative 4-year intrahepatic recurrence rate of HCC was 62%. The log rank test indicated that, among pretreatment parameters, time from cirrhosis diagnosis >6 years (P = 0.05) and AFP level before PEI of >25 ng/mL (P = 0.00005) were significantly linked to tumor recurrence. Cox's proportional hazards model showed that only AFP level before PEI was independently associated with recurrence (P 13 ng/mL was shown to be significantly related to tumor recurrence by the log rank test (P < 0.0001). CONCLUSIONS Cirrhotic patients with single HCC treated by PEI who have slightly increased serum levels of AFP before and/or after PEI treatment are at increased risk of intrahepatic tumor recurrence and should undergo a close follow-up program. Cancer 1997; 79:1501-8. © 1997 American Cancer Society.

Assisted reproductive technologies (ART) have been widely used in couples suffering from infertility. The clinical pregnancy rate is low, varying from 20 to 35% per cycle started. The role of antithrombotic drugs in improving pregnancy rate is controversial, although some Fertility Clinics have adopted different protocols either in thrombophilic and non-thrombophilic women. Between March 1998 and July 2011 we prospectively evaluated a cohort of 1107 women approaching ART (2214 cycles) consecutively referred to our Thrombosis Unit (S. Giovanni R.). All were investigated for inherited and acquired thrombophilias. Median follow-up was 34.53 months (range 2–143 months). At the enrolment, 327 women (29.5%) have experienced 946 ART cycles. One hundred twenty-two (37.3%) women obtained a clinical pregnancy (176 pregnancies), with 21 (16%) live-born children. Overall, 115 (10.4%) women carried al least one thrombophilia (45 the FVL, 57 the PTm, 13 severe thrombophilias). After screening, 595 (53.8%) underwent at least 1 attempt (1268 cycles, 27 lost to follow-up). In 424 (33.4%) cycles an antithrombotic prophylaxis (342 treated with aspirin, 66 with LMWH, 16 with aspirin+LMWH) was used. Pregnancy rate was 21.4% (265/1241 cycles) with 171 (13.8%) live-born children. Clinical pregnancies were not significantly different in treated vs untreated cycles (p: 0.42, OR: 1.1, 95% CI: 0.8–1.5). The rate of live-born was not significantly different in treated vs untreated cycles (p: 0.73, OR: 0.9, 95% CI: 0.6–1.3) prophylaxis. Overall, 7 thrombotic events (3 PE, 3 DVT, 1 arterial thrombosis; 6 of them in untreated women) were observed. Among them, 4 (0.3%, 2 DVT, 2 PE) occurred after screening, only 1 during LMWH prophylaxis. In women undergoing ART procedures, the use of antithrombotic prophylaxis is not associated with an improved pregnancy rate or live-born children. Thrombotic complications are less frequent in women receiving an antithrombotic prophylaxis

Background: The identification of therapeutic agents that can prevent the pancreatic injury after endoscopic retrograde cholangiopancreatography (ERCP) is of considerable importance. Methods: We performed a meta-analysis including 28 clinical trials on the use of somatostatin (12 studies), octreotide (10 studies), and gabexate mesilate (6 studies) after ERCP. Outcome measures evaluated were the incidence of acute pancreatitis, hyperamylasemia, and pancreatic pain. Three analyses were run separately: for all available studies, for randomized trials only, and for only those studies published as complete reports. Results: When all available studies were analyzed, somatostatin and gabexate mesilate were significantly associated with improvements in all three outcomes. Odds ratios (OR) for gabexate mesilate were 0.27 (95% CI [0.13, 0.57], p = 0.001) for acute pancreatitis, 0.66 (95% CI [0.48, –0.89], p = 0.007) for hyperamylasemia, and 0.33 (95% CI [0.18, 0.58], p = 0.0005) for post-procedural pain. Somatostatin reduced acute pancreatitis (OR 0.38: 95% CI [0.22, 0.65], p p p = 0.008). Octreotide was associated only with a reduced risk of post-ERCP hyperamylasemia (OR 0.51: 95% CI [0.31, 0.83], p = 0.007) but had no effect on acute pancreatitis and pain. The statistical significance of data did not change after analyzing randomized trials only or studies published as complete reports. For each considered outcome, the publication bias assessment and the number of patients that need to be treated to prevent one adverse effect were, respectively, higher and lower for somatostatin than for gabexate mesilate. Conclusions: The pancreatic injury after ERCP can be prevented with the administration of either somatostatin or gabexate mesilate, but the former agent is more cost-effective. Additional studies comparing the efficacy of short-term infusion of somatostatin versus gabexate mesilate in patients at high risk for post-ERCP complications seem warranted. (Gastrointest Endosc 2000;51:1-7.)

To evaluate the adequacy of ordinary antisepsis in ultrasound (US)-guided free-hand fine-needle puncture.Diagnostic and therapeutic procedures (n = 573) were performed in 456 patients. No puncture attachments, sterile gloves, or drapes or covers were used. Before each procedure the transducer was cleaned with a solution of water and 70% alcohol. No needles were contaminated. Patients were monitored for 5 days to exclude sepsis. Subsequently, the patients underwent follow-up blood and laboratory testing, including testing for for hepatitis B and C markers and human immunodeficiency virus antibodies, every 3 months for 6 months. The operators underwent the same follow-up for the first 6 months and for an additional 6 months.No patient or operator presented with fever or sepsis or with negative viral or hepatitis markers that became positive during follow-up.Use of this free-hand US-guided technique with ordinary antisepsis is safe for patients and operators, and it allows savings in time and the cost of materials.