Antifungal prophylaxis with posaconazole in patients with acute myeloid leukemia: dose intensification coupled with avoidance of proton pump inhibitors is beneficial in shortening time to effective concentrations.

This study aimed to assess the influence of dose frequency and the presence or absence of cotreatment with proton pump inhibitors (PPIs) on the time to a target trough concentration (Cmin) of >700 ng/ml with posaconazole in the first 8 days of antifungal prophylaxis in hematological patients. This was a retrospective, observational study performed with 42 adult patients with acute myeloid leukemia who underwent posaconazole prophylaxis with 200 mg every 8 h (q8h) or 200 mg q6h after receiving induction chemotherapy and who had at least three subsequent therapeutic drug monitoring assessments during the first 8 days of treatment. The cohort was split into four groups (group 1, 200 mg q8h without PPI; group 2, 200 mg q8h with PPI; group 3, 200 mg q6h without PPI; group 4, 200 mg q6h with PPI).

Daptomycin underexposure in a young intravenous drug user who was affected by life-threatening Staphylococcus aureus-complicated skin and soft tissue infection associated with bacteraemia.

We describe the case of an intravenous drug user affected by life-threatening Staphylococcus aureus-complicated skin and soft tissue infection with associated bacteraemia who, while on replacement therapy with methadone, required 11 mg/kg/day daptomycin to achieve trough (Cmin) and peak (Cmax) plasma levels similar to those observed with the standard dosage of 6 mg/kg in healthy volunteers (mean ± standard deviation: Cmin 12.35 ± 0.80 mg/L, Cmax 63.

Lower lid reconstruction utilizing auricular conchal chondral-perichondral tissue in patients with neoplastic lesions.

Purpose: To assess surgical outcomes of lower lid reconstruction surgery using auricular conchal tissue.

Methods: This prospective study included 20 patients that underwent reconstructive lower lid surgery using autologous auricle chondral-perichondral graft tissue. Auricle tissue was used to provide adequate support and protection with similar conjunctiva tarsal structures on overlying soft tissues in patients with pathologic inferior lid tissue loss requiring reconstructive surgery.

Repeatability and accuracy of applanation resonance tonometry in healthy subjects and patients with glaucoma.

Purpose: To evaluate the repeatability and accuracy of the applanation resonance tonometer (ART) used in the automatic servo-controlled version, and to evaluate the influence of central corneal thickness (CCT) on the ART intraocular pressure (IOP) measurements.

Methods: This prospective, randomized, single-centre study included one eye of 153 subjects (35 healthy volunteers and 118 patients with glaucoma). All participants underwent ultrasonic CCT measurement, followed by IOP evaluation with Goldmann applanation tonometer (GAT) and ART in random order.

Prostate biopsy after abdominoperineal resection: a diagnostic challenge.

Prostate biopsy in patients who underwent abdominoperineal resection (APR) of the rectum is commonly considered a technical challenge even for experienced urologists, although tissue diagnosis is essential in prostate cancer management. Transperitoneal, transperineal and transgluteal approaches have been reported, under US, CT or MRI guidance. Transperineal biopsy seems to be the safest and most cost-effective technique.

Seeking a bridge between language and motor cortices: a PPI study.

The relation between the sensorimotor cortex and the language network has been widely discussed but still remains controversial. Two independent theories compete to explain how this area is involved during action-related verbs processing. The embodied view assumes that action word representations activate sensorimotor representations which are accessed when an action word is processed or when an action is observed.

Cognitive and anatomical underpinnings of the conceptual knowledge for common objects and familiar people: a repetitive transcranial magnetic stimulation study.

Several studies have addressed the issue of how knowledge of common objects is organized in the brain, whereas the cognitive and anatomical underpinnings of familiar people knowledge have been less explored. Here we applied repetitive transcranial magnetic stimulation (rTMS) over the left and right temporal poles before asking healthy individuals to perform a speeded word-to-picture matching task using familiar people and common objects as stimuli. We manipulated two widely used semantic variables, namely the semantic distance and the familiarity of stimuli, to assess whether the semantic organization of familiar people knowledge is similar to that of common objects.

Low-grade glioma surgery in eloquent areas: volumetric analysis of extent of resection and its impact on overall survival. A single-institution experience in 190 patients: clinical article.

Object: A growing number of published studies have recently demonstrated the role of resection in overall survival (OS) for patients with gliomas. In this retrospective study, the authors objectively investigated the role of the extent of resection (EOR) in OS in patients with low-grade gliomas (LGGs).

Methods: Between 1998 and 2011, 190 patients underwent surgery for LGGs.

Plasma pharmacokinetics of antimicrobial agents in critically ill patients.

Prompt optimal antimicrobial treatment in critically ill patients is mandatory and must be achieved not only in terms of spectrum of activity, but also in terms of exposure at the infection site. Plasma profile of antimicrobial agents may represent a valid surrogate marker of drug exposure and allow to identify the correct dosage for a given drug. However, in the critically ill patients the pharmacokinetic behavior of antimicrobials may be altered by some very peculiar pathophysiological conditions, so that dosages significantly different from those used in clinically stable patients or from those originally studied in healthy volunteers for regulatory purposes may often be needed in order to ensure optimal plasma drug exposure in such population.

Antibiotic therapy in hematological neutropenic patients: what is the news?

Bacterial infection is a very common complication in hematological neutropenic patients whose treatment is extremely challenging for several reasons. First, they are frequently caused by resistant pathogens (multidrug resistant (MDR)), and this may limit the availability of effective therapeutic weapons. Second, these patients often present peculiar pathophysiological conditions that may alter the pharmacokinetic behavior of antimicrobials, and this may explain the need for a new administration schedule and new dosing regimens of antibiotics in this setting.

Therapeutic drug monitoring may improve safety outcomes of long-term treatment with linezolid in adult patients.

Objectives: Prolonged treatment with linezolid may cause toxicity. The purpose of this study was to define pharmacodynamic thresholds for improving safety outcomes of linezolid.

Methods: We performed a retrospective study of patients who had trough (C(min)) and peak (C(max)) plasma levels measured during prolonged linezolid treatment.

Prognostic power of pre- and postoperative B-type natriuretic peptide levels in patients undergoing abdominal aortic surgery.

Objectives: The first aim of the present study was to evaluate the pre- and postoperative B-type natriuretic peptide (BNP) levels in patients undergoing surgery for repair of an infrarenal abdominal aortic aneurysm (AAA) and analyze their power as a predictor of in-hospital cardiac events. The second aim was to evaluate the association among pre- and postoperative BNP levels, postoperative patient complications, and length of hospital stay.

Design: Prospective observational study.

Magnetic resonance imaging of radial sclerosing lesions (radial scars) of the breast.

Purpose: To identify magnetic resonance (MR) imaging (MRI) features of radial sclerosing lesions (RSLs) of the breast.

Methods And Materials: The radiologic and pathologic records for 4629 consecutive patients undergoing MR examinations of the breast were retrospectively reviewed. Patients who received a pathologic diagnosis of RSL without atypia or carcinoma at surgical excision were identified.

Successful long-term treatment of cerebral nocardiosis with unexpectedly low doses of linezolid in an immunocompromised patient receiving complex polytherapy.

Cerebral nocardiosis is a severe infection that carries the highest mortality rate among all bacterial cerebral abscesses. We report on a case in an immunocompromised patient which was successfully treated with unexpectedly low doses of linezolid. Therapeutic drug monitoring was very helpful in highlighting issues of poor compliance and of drug-drug interactions.

Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI?

Objective: The purpose of this study was to investigate whether breast MRI can be used to rule out malignancy in patients with high-risk lesions diagnosed at imaging-guided core needle biopsy.

Subjects And Methods: The subjects were women consecutively registered between October 2004 and April 2010 who had high-risk lesions diagnosed at mammographically or sonographically guided core needle biopsy and subsequently underwent MRI and surgical excision. MR images were reviewed by two experienced breast radiologists.

Surgery of insular nonenhancing gliomas: volumetric analysis of tumoral resection, clinical outcome, and survival in a consecutive series of 66 cases.

Background: Despite intraoperative technical improvements, the insula remains a challenging area for surgery because of its critical relationships with vascular and neurophysiological functional structures.

Objective: To retrospectively investigate the morbidity profile in insular nonenhancing gliomas, with special emphasis on volumetric analysis of tumoral resection.

Methods: From 2000 to 2010, 66 patients underwent surgery.

Learning effect and test-retest variability of pulsar perimetry.

Purpose: To assess Pulsar Perimetry learning effect and test-retest variability (TRV) in normal (NORM), ocular hypertension (OHT), glaucomatous optic neuropathy (GON), and primary open-angle glaucoma (POAG) eyes.

Methods: This multicenter prospective study included 43 NORM, 38 OHT, 33 GON, and 36 POAG patients. All patients underwent standard automated perimetry and Pulsar Contrast Perimetry using white stimuli modulated in phase and counterphase at 30 Hz (CP-T30W test).

TDM-guided therapy with daptomycin and meropenem in a morbidly obese, critically ill patient.

Objective: To describe a case of severe cellulitis, successfully treated with high-dose daptomycin plus continuous infusion meropenem, in a patient with morbid obesity and renal failure, in whom drug exposure over time was optimized by means of real-time therapeutic drug monitoring (TDM).

Case Summary: A 63-year-old man with morbid obesity (body mass index 81.6 kg/m²) and renal failure was admitted to the emergency department because of severe cellulitis.

Intracorneal hematoma after canaloplasty in glaucoma.

Purpose: To report a case of an intracorneal hematoma after canaloplasty.

Methods: Interventional case report of a surgical method used to resolve an intracorneal hematoma complication after canaloplasty.

Results: A 45-year-old man with uncontrolled pigmentary open-angle glaucoma underwent canaloplasty for glaucoma in the left eye.

Hyperechoic lesions of the breast: not always benign.

Objective: The purposes of our study were, first, to evaluate the frequency, clinical presentation, and associated imaging findings of malignant breast lesions presenting as hyperechoic nodules in a large series of consecutive sonographically guided core needle biopsies (CNBs) and, second, to investigate sonographic features that are able to predict malignancy in hyperechoic breast lesions.

Materials And Methods: The radiologic and pathologic records for 4511 consecutive sonographically guided CNBs were retrospectively reviewed. Hyperechoic lesions were identified, and clinical notes and related mammography or MRI reports were reviewed.

Comparison of iCare tonometer and Goldmann applanation tonometry in normal corneas and in eyes with automated lamellar and penetrating keratoplasty.

Purpose: To compare intraocular pressure (IOP) measurements with Goldmann applanation tonometry (GAT) and iCare tonometry in normal and post-keratoplasty corneas and to assess the influence of central corneal thickness (CCT), corneal curvature (CC), and corneal astigmatism (CA) on IOP.

Methods: This prospective cross-sectional study included one eye of 101 subjects with normal corneas (58 healthy subjects, 43 glaucoma); and 90 post-keratoplasty patients: 34 penetrating keratoplasties (PK); 20 automated-lamellar-therapeutic keratoplasties (ALTK); 19 Descemet-stripping-automated-endothelial keratoplasties (DSAEK); 17 edematous grafts. All subjects underwent GAT and iCare IOP measurements in random order, and CCT, CC, and CA evaluation.

[Fetal and perinatal exposure to mercury and selenium: baseline evaluation of a cohort of children in Friuli Venezia Giulia, Italy].

Objective: neurotoxicity of prenatal exposure to high concentrations of mercury (Hg) is well known; however, the doseresponse relationship at low exposure levels has not been quantified yet. This article illustrates the measurement of prenatal exposure to Hg and the pathway of exposure through the diet in Friuli Venezia Giulia, Italy.

Design: description of a prospective cohort at the baseline.

The wide spectrum of hyperechoic lesions of the breast.

Although breast lesions are commonly detected because of their hypoechogenicity, some lesions may present with hyperechogenicity due to their histological components. Hyperechogenicity has been shown to be highly predictive of benignity; however, hyperechoic lesions can occasionally be malignant. This article reviews hyperechoic lesions of the breast, describes the underlying histological causes associated with hyperechogenicity, and the sonographic features useful for the differential diagnosis between benign and malignant hyperechoic lesions.

Partitioning of bronchopulmonary carcinoids in two different prognostic categories by ki-67 score.

Introduction: Histological distinction between typical and atypical bronchopulmonary carcinoids is based on mitotic activity and necrosis. Regardless of these two parameters, outcome after surgery is often unpredictable. In this study the prognostic value of different clinico-pathological factors was retrospectively analyzed in a large series of patients with bronchopulmonary carcinoid.