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The purpose of this study was to assess concentrations of angiopoietin (Ang)-1 at various stages of gingival inflammation. Ang-1 is an anti-inflammatory mediator present in various inflammatory diseases. However, its presence during the pathogenesis of gingival inflammation has not been established in vivo.Gingiva was obtained from 110 human donors before extraction of the adjacent teeth. The tissue was grouped based on adjacent probing depth and bleeding on probing (BOP). Gingiva adjacent to aor=3-mm sulcus without BOP was classified as "normal" (N); gingiva adjacent to a 3-mm sulcus with BOP was classified as "diseased, slight" (DS); gingiva adjacent to a 4- to 6-mm sulcus featuring BOP was classified as "diseased, moderate" (DM); and gingiva adjacent to6-mm sulci was classified as "diseased, severe" (DSev). Tissues were solublized, and concentrations of interleukin (IL)-1beta and -6, tumor necrosis factor (TNF)-alpha, endothelin (ET)-1, Ang-1, vascular cell adhesion molecule (VCAM)-1, and vascular endothelial growth factor (VEGF) were assessed by enzyme-linked immunosorbent assay. Data were compared by factorial analysis of variance, the post hoc Tukey test, and the Pearson correlation test. Groups were defined as significantly different when P0.05.Gingival concentrations of IL-1beta and -6, TNF-alpha, VEGF, and ET-1 were significantly greater, and VCAM-1 and Ang-1 were significantly lower, in DSev and DM than in N and DS tissues (P0.05). In addition, gingival concentrations of IL-6, VEGF, and ET-1 were significantly greater, and VCAM-1 and Ang-1 were significantly lower, in DSev than in DM tissues (P0.05). There were significant positive correlations among sulcular depth, IL-1beta and -6, TNF-alpha, VEGF, and ET-1 and negative correlations among VCAM-1, Ang-1, sulcular depth, and the other biomarkers (P0.001).Depleted tissue concentrations of Ang-1 may allow gingival inflammation to become more severe because VEGF and ET-1 secretion become less inhibited. Thus, the tissues become edematous and more likely to develop BOP.

The presence of interleukin (IL)-23 has not been reported within inflamed gingiva, so we evaluated its concentration within gingiva from normal sites and sites of chronic periodontal disease.Gingiva was obtained prior to extraction of teeth. It was grouped based on clinical attachment loss (CAL): 0 to 2 mm (normal-slight), 3 to 4 mm (moderate), and5 mm (severe). Tissues were solubilized, and IL-12, -23, -6, -17, and -1beta; interferon-gamma (IFN-gamma); and tumor necrosis factor-alpha (TNF-alpha) concentrations were assessed by enzyme-linked immunosorbent assay. Data were compared by factorial analysis of variance, post hoc Tukey test, and Pearson correlation test. Groups were defined as significantly different when P0.05.The gingival concentrations of IL-23, -17, -1beta, and -6 and IFN-gamma were significantly greater at moderate CAL sites than at normal-slight CAL sites. Gingival concentrations of IL-23, -1beta, -17, and -6 and TNF-alpha were significantly greater at severe CAL sites than at normal-slight CAL sites. In addition, the gingival concentrations of IL-23, -17, and -6 and TNF-alpha were significantly greater and the gingival concentrations of IL-12 and IFN-gamma were significantly lower at severe CAL sites than at moderate CAL sites. Gingival concentrations of IL-23, -17, -6, and -1beta and TNF-alpha correlated positively with CAL. The IL-23 gingival concentration correlated significantly with IL-17, -1beta, and -6 and TNF-alpha concentrations and correlated negatively with IL-12 and IFN-gamma concentrations.Our results suggested the possibility that the IL-23/IL-17 immune response was present within chronically inflamed gingiva. This is a host response that had not been reported previously in periodontal disease and may be an important factor in the chronic nature of the disease.

There are no comparisons of concentrations of interleukin (IL)-13 and -15 and gingival sulcular depth within healthy or inflamed gingiva. Study of non-oral inflammations indicated that IL-15 has similar functions to IL-2, and IL-13 has similar functions to IL-4 and -10. Thus, IL-13 and -15 likely have a function in gingival inflammation.We compared the concentrations of IL-13 and -15 within healthy or inflamed human gingiva to gingival sulcular depth and the concentration of various T-helper 1 and T-helper 2 cytokines in a group of Hispanic subjects. Gingival papillae were grouped by the depth of the adjacent gingival sulcus:or=3 mm (normal); 3 to 6 mm and6 mm (diseased). The gingival concentrations of IL-2, -4, -6, -10, -13, and -15 and interferon (IFN)-gamma were assessed by enzyme-linked immunosorbent assay.IL-2, -4, -6, -10, and -13 and IFN-gamma concentrations were higher within gingiva adjacent to 3 to 6 mm diseased compared to normal; IL-15 concentrations were significantly greater within normal gingiva than within diseased gingiva (P0.001). Within gingiva adjacent to6 mm sulci, IL-6 concentrations were significantly higher than in normal gingiva, and the concentrations of the other cytokines were similar to those in normal gingiva. Gingival IL-6 concentration correlated significantly with the adjacent gingival sulcular depth, whereas the IL-15 concentration correlated inversely with the adjacent gingival sulcular depth (P0.001).IL-13, -4, and -10 had a similar concentration pattern within normal and diseased tissue; however, the concentration pattern of IL-15 was not similar to IL-2. Relatively low IL-15 concentrations within diseased gingiva suggest that IL-15 might have anti-inflammatory properties.

Variants of the opioid receptors are the obvious candidates underlying addiction. The kappa opioid receptor (KOR) system seems to play a role in stress responsivity, opiate withdrawal and responses to psycho-stimulants, inhibiting mesolimbic dopamine. KOR gene polymorphisms have been reported to contribute to predisposition to voluntary alcohol-drinking behavior in experimental animals. In humans, the 36G > T single nucleotide polymorphism (SNP) on KOR gene, that was recently identified, has been found associate with substance dependence, with inconclusive findings. In the present study, 106 heroin addicts (West European, Caucasians) and 70 healthy control subjects matched for race and gender, with no history of substance use disorder, have been genotyped. The frequency of KOR 36G > T SNP was significantly higher among heroin-dependent individuals compared with control subjects (Fisher's exact = 0.044; Pearson chi(2) = 4.2734, P = 0.039; likelihood ratio chi(2) tests = 4.6156, P = 0.032). Although KOR silent polymorphisms may apparently have no consequences on mRNA transcription, post-transcriptional mechanisms, such as mRNA stability, translation efficiency, and regulability may impair the function of kappa receptors system, with increased risk for substance use disorders. In specific, the neurobiological changes induced by mu-kappa opioid imbalance could underlie vulnerable personality traits and risk behavior.

Objective: We evaluated the efficacy of fine needle aspiration cytology (FNAC) of the thyroid in a series of 5469 lesions with histological control and studied the causes of, and the possibility of reducing the limitations of the method. Methods: FNAC was always performed by a pathologist under the guidance of a clinician, using a 22-gauge needle. Generally two aspirations were carried out, and usually four slides were obtained for each nodule; they were then stained with May–Grunwald–Giemsa and with Papanicolaou. The cytological diagnoses were classified in four groups: inadequate, benign, suspicious and malignant. Results: We obtained a complete sensitivity of 93.4%, a positive predictive value of malignancy of 98.6%, and a specificity of 74.9%. At histological control, the cytological diagnosis of Hurthle cell neoplasm corresponded to a significantly higher incidence of malignant neoplasms than the diagnosis of non-Hurthle cell follicular neoplasm (32.1% versus 15.5%). There were 66 false-negative findings, the main cause of diagnostic error (24 cases) being failure to recognize the follicular variant of papillary carcinoma. The number of inadequate FNACs was low (4.2%). Conclusion: Our study confirmed the great efficacy of thyroid FNAC. A cytological diagnosis of Hurthle cell neoplasm should be considered an indicator of high risk. Awareness that failure to recognize the follicular variant of papillary carcinoma was the main problem in the interpretation of thyroid FNAC should lead to a decrease of false-negative diagnoses. The inadequate rate was very low, as it was the pathologist personally who performed the needle aspiration.

Interleukin (IL)-11 and IL-17 are cytokines that modulate the inflammatory process and have not been assessed within normal or inflamed gingival tissues. Our purpose was to compare concentrations of human IL-11 and IL-17 within healthy and diseased human gingiva to determine their possible role in the initiation or progression of periodontal diseases.Biopsies from healthy (non-hemorrhagic gingiva adjacent to aor = 3 mm gingival sulcus) and diseased gingiva (hemorrhagic gingiva adjacent to aor = 3 mm periodontal pocket) were studied. IL-11, IL-17, RANTES, and IL-6 concentrations were assessed within solubilized gingival biopsies by enzyme-linked immunosorbent assay. Data were compared by factorial analysis of variance and a post-hoc Tukey honestly significant difference (HSD) test. Regression analysis and partial correlation analysis (adjusted for sample weight) were also used to determine correlations between the variables.Interleukin-11 concentrations were highest within gingiva adjacent to 3 mm diseased pockets (P0.001), and IL-17 concentrations were highest at 4 to 5 mm sites compared to other sites (P0.001). Gingival concentrations of both cytokines were significantly lower in gingiva adjacent to aor = 6 mm pocket. RANTES concentrations were significantly greater in gingiva adjacent toor = 6 mm pockets than in tissues derived from other sites (P0.001). IL-11, IL-6, and RANTES concentrations were significantly correlated with sulcular depth.Gingival concentrations of IL-11 and IL-17 are different in diseased gingiva adjacent to 3, 4 to 5, andor = 6 mm pockets, suggesting that their concentrations change as a consequence of the progression of gingivitis to periodontitis and that both cytokines could have a significant role in this progression. These data may be useful for the design of procedures for prevention of periodontal disease.

Celiac disease (CD) is a chronic inflammatory enteropathy of the small bowel resulting from a local TH1-mediated reaction to wheat gliadins and barley, rye and oat prolamins with the development of auto-antibodies to transglutaminases. As well as for other chronic inflammatory diseases, genetic background and environmental factors participate to pathogenesis. An increased traffic of CD34+ hemopoietic precursor and stem cells (HPC) has been reported in peripheral blood (PB) of subjects with allergic diseases that share in their pathogenesis immuno-mediated reactions, genetic and environmental factors. The aim of the present work was to investigate the CD34+ cell traffic and H2/H1 polarization of lymphoid T-cell lineage, in the peripheral blood of subjects with CD, by means of flow-cytometric techniques. Group A of control was of 20 healthy subjects, aged 5 to 58 years. Study population (Group B) was of twenty-eight patients, all females aged 13 to 70, receiving firstly a CD diagnosis at the SS Annunziata Hospital Digestive Physiopathology Out-standings' by means of clinical, serologic and small intestinal biopsy findings. Peripheral CD34+ HPCs were significantly increased in Group B (median value 0.16) when compared with Group A (median value 0.03) (p 0.0001) but did not correlate either with anti-transglutaminase (tTG) antibody levels (IgA: p 0.226; IgG: p 0.810) or with histological damage severity (p 0.41) that, on the contrary, was significantly related with anti-tTG IgA antibodies (p 0.027). Celiac circulating CD3+CD4+ lymphocytes expressed a chemokine-receptor pattern Th2-skewed in all but three patients investigated. Concluding, the CD34+ HPC highly increased peripheral traffic observed in celiac disease appears more related to a basic and emerging as common defect shared by chronic inflammatory diseases than to the gliadin-specific Th1 local reactions. Data are consistent with a potential NFkappaB deficiency and consequent prevalence of apoptotic versus survival programs leading to excessive cell-death; to replace lost cells a supplementary bone-marrow derived precursors supply, further to that physiologically provided by the gut stem cell "niches" that are cryptopatches, could be required.

Plasma cell gingivitis is a rare benign condition of the gingiva. It is marked by a dense infiltrate of normal plasma cells separated into aggregates by strands of collagen. It is a hypersensitivity reaction to some antigen, often flavorings or spices. The importance of this lesion is that it may cause severe gingival inflammation, discomfort, and bleeding and may mimic more serious conditions. Plaque control and conventional periodontal therapy alone will not cure this disease. The etiologic agent must be identified and the substance eliminated from use. This report outlines a case of plasma cell gingivitis which may have been brought on by the use of red peppers in cooking. J Periodontol 1991; 62:390–393.

Standard asbestos diagnostic protocol was applied to eleven relatives of asbestos exposure ex-workers of a cement factory in Bari. Nine wives and seventeen sons were involved as volunteers in this evaluation. In this group two pleura malignant mesotheliomas (not dose-dependent) two asbestosis and fifteen pleura plaques (dose-dependent) were detected. This situation shows high level of asbestos contamination at home. For all the test patients the contamination most probably occurred because workers carried asbestos substances home from work on their clothes.

Colorectal Kaposi's sarcoma, a human herpes virus-8 associated mesenchymal tumour, is exceedingly rare in human immunodeficiency virus-negative subjects and almost always reported in association with severe, refractory, inflammatory bowel disease. In this paper we report a case – the second from Italy – of a colorectal Kaposi's sarcoma in a human immunodeficiency virus-negative, heterosexual man with severe refractory ulcerative colitis. Kaposi's sarcoma developed after starting glucocorticosteroid therapy, supporting the theory that colorectal Kaposi's sarcoma associated with ulcerative colitis is iatrogenic.

This study compared the anti-aggressiveness effects of the atypical anti-psychotic olanzapine with that of selective serotonin reuptake inhibitors (SSRI) and benzodiazepines (BZD) among patients with heroin dependence submitted to opioid-agonists substitution treatment. Sixty-seven (67) patients who met the DSM-IV criteria for heroin dependence and showed aggressive personality traits, not affected by comorbid schizophrenia or bipolar disorder, accepted to participate in a 12-week prospective, observational trial. Patients were included into two subgroups in relationship with treatment, for the evaluation of the endpoints at week 12: group 1: substitution treatment in combination with OLA (32 patients); group 2: substitution treatment in combination with fluoxetine/paroxetine and clonazepam (35 patients). Efficacy measures were Buss Durkee Hostility Inventory (BDHI), Symptoms Check List-90 (SCL 90) anger--hostility scores, incidence rates of aggressive incidents and attacks. The rates of patients who remained in treatment at week 12 in group 1, treated with OLA, and group 2, treated with SSRI and BDZ, were not significantly different (17 = 53.1% vs 16 = 45.7%). BDHI total, direct aggressiveness, verbal aggressiveness scores, SCL 90 aggressiveness scores and aggressive incidents rates showed a significantly more consistent decrease from baseline in group 1 than in group 2 subjects, in the patients who completed the treatment (p < 0.001; p < 0.01; p < 0.05; p < 0.01; p < 0.001). Among the completers, 69.3% achieved early full substance abuse remission, while 30.7% achieved partial substance abuse remission, with no significant difference between 1 and 2 treatment subgroups. Although obtained by an observational--open clinical study, with multiple limitations, our findings suggest that OLA may be useful as an adjunctive agent in reducing aggressive/hostile behaviour in heroin addicted individuals during maintenance substitution treatment. Otherwise, atypical anti-psychotic OLA seems to be unable to improve the outcome in terms of addictive behavior and relapse risk in the addicted patients not affected by overt psychotic disorders.

Throughout July and August 2002, at the same time as a campaign on driving safety, questionnaire and breath alcohol tests was submitted to young people outside the best-frequented discotheques of the Apulia area (Italy), to describe the role of alcohol intake in the evening-time amusement and assess its influence on their attention level. 217 young people, aged between 18-30 years, accepted to fill in a questionnaire, and undergo a 'breathalizer' test and attention test, before and after having spent time in the discotheque. The score difference between entry and exit on the attention test was -1.48 points and alcohol blood level increase up to 0.14 g/l. Established the lower reference limit for the attention test to be 21 points, it was found that 9.7% had an attention score lower than the reference limit, and 61.9% of this group had a blood alcohol level higher than 0.5 g/l. A linear regression model between the difference of blood alcohol level before and after the time spent in the discotheque and attention score on exiting from it, turned out to be statistically significant. It's necessary to go on with continuous police checks and informative awareness campaigns regarding alcohol use, driving and night amusement.

An increased traffic of circulating CD34+ Hemopoietic Precursors Cells (HPC) is an important feature of systemic allergic inflammation. Bacteria and bacterial products are capable of stimulating the transcription of the maturational cytokines IL12 and IFNs through the activation of Toll-Like-Receptor and the subsequent nuclear translocation of the NF-kappaB factor. In this study the probiotics differentiation/maturational effect potential on CD34+ HPC has been investigated. Fourteen consecutive subjects, 9M and 5F, aged 6-48, with clinical symptoms of asthma and /or conjunctivitis, rhinitis, urticaria, atopic dermatitis, food allergy and irritable bowel syndrome were enrolled. Allergen-specific serum IgE were found in twelve patients. Flow-cytometric measurement of peripheral blood CD34dim/bright HPC values were assessed before and after 30 days of therapy, consisting in the oral administration of one sachet a day of ENDOLAC (UCB Pharma, Turin, Italy). Each sachet contained a mixture of Lactobacillus acidophilus, L. delbrueckii and Streptococcus thermophilus for a total of 1 x 10(9) live bacteria. Circulating CD34+ cell values significantly (p0.001) reduced after the treatment. ENDOLAC, thus, may improve the efficacy of the standard treatments of allergic diseases.

Results of an intervention of medical surveillance are reported. Medical surveillance was performed, from the Renam COR Basilicata-Puglia, in favour of 67 workers ex exposed to asbestos of the firm ex-Materit of Ferrandina that produced manufactured articles in cement-asbestos. The actual normative (art 29 DL 277/91) foresees that the competent plant physician informed the workers about the necessities to undergo to sanitary checks after the cessation of the activity, nevertheless the law doesn't establish that whom owes to make load of the medical surveillance. Cor, as Regional Reference Center, like in DPMC 308/2002, can guarantee definition of guide lines for uniform approach to regional level of all the figures involved in the management of the ex-exposed worker problem, in clinician and legal point of view and in the diffusion of the information (general practitioners, physicians operating in prevention services (SPESAL), competent plant physicians, hospital physicians and experts, labour unions).

Nuclear pleomorphism is a fundamental feature in evaluating the aggressiveness of ductal carcinoma in situ (DCIS) of the breast. In this study, pure DCIS and the in situ component (IS-comp) of invasive duct carcinoma (IDC) are compared in order to verify if these are two different entities or the same process observed at different times during its evolution. Five cases of pure DCIS and nine of IDC with extensive in situ component were selected. They were moderately and poorly differentiated. 30 nuclei for each DCIS, and 30 nuclei for both the in situ and invasive component of each IDC were studied; thus, a total of 720 nuclei were submitted to the SAM (Shape Analytical Morphometry) analysis, which enables a numerical expression not only of dimensions (area, perimeter, diameter) but also of nuclear contour irregularities and nuclear shape distortions. Univariate statistical comparisons were carried out between the nuclei of: (1) DCIS and in situ component of invasive duct carcinoma, (2) DCIS and the invasive component of infiltrating carcinoma and (3) between the in situ and invasive component of infiltrating carcinoma. Multivariate analysis was utilized to compare nuclei of DCIS with the in situ component of IDC. The in situ features of each tumor were also evaluated with the mitotic index (MI). Nuclei of pure DCIS resulted significantly larger (p0.001) and with a more regular shape (p0.001) than those of the in situ component of IDC. No differences were observed between the nuclei of the in situ and the invasive component of infiltrating carcinomas. Multivariate statistical analysis discriminated 77% of nuclei of in situ proliferation when both G2 and G3 tumors were considered, and 80% when only G3 tumors were considered. In conclusions morphological differences exist between pure DCIS and the in situ component of IDC, which may be an expression of their biological behavior; moreover, these morphological differences seem to have a better discriminating power within the same histological grade.

Despite legionellosis surveillance is active in Italy since many years, the disease notification appears still undervalued. A multicentric survey was carried out among 5 big Italian hospitals. It examined 11,435 discharge forms (1999-2001), reporting pneumonia diagnosis. Legionellosis (II class of notify system for infectious disease) was studied among pneumonia diagnosis by discharge forms. According to the ICD9-CM, there's no specific code for legionellosis (this disease is included among "others gram-negative pneumonia"). So the presumed pneumonia imputable to Legionella spp were the 2.7% of the whole number of analyzed discharge forms. Besides, the data regarding the other pneumonia showed that the etiological agent was specified only in the 11.2% of the case. This situation could be rectified both introducing adequate discharge forms codes and promoting the etiological diagnosis during the hospital stay.

To present two rare cases of malignant mesotheliomas with deciduoid features arising in the pleura, both with long survival.These two cases of deciduoid mesotheliomas were observed in adult patients (one 73-year-old male and one 23-year-old female). Only the male had a history of occupational asbestos exposure, whereas the woman had a history of familial mesothelioma. A deciduoid morphology was predominant and focal areas with tubular-papillary features were noted. The tumour cells were positive for cytokeratins, HMBE-1, calretinin, EMA and mitochondrion antibodies. The follow-up data did not suggest a particularly poor prognosis; the mean survival observed was 23 months (17 and 39 months, respectively).This deciduoid mesothelioma histological subtype does not appear to represent an unfavourable prognostic category.

Sentinel node biopsy, in breast cancer, is a promising surgical technique for predicting histological findings in the remaining axillary lymph nodes, especially in patients with clinically node-negative breast cancer. 80 patients with breast cancer were evaluated for enrollment in this study. For mapping procedure 32 patients underwent lymphoscintigraphy in combination with an injection of vital blue dye, while 48 utilized only vital dye. In all patients, after sentinel node (SLN) biopsy, a complete axillary dissection was performed. The mapping procedure was possible in 79 cases (98.7%). The SLNs were positive in 27 (34.1%), in 52 patients SLNs were negative and in 50 of these all axillary nodes were negative. There was concordance in 77/79 cases (97.4%). The false negative rate was 3.8% (2/52). The overall sensitivity of the SNL biopsy was 93.1% (27/29), with a negative predictive value of 96.1% (50/52). This study demonstrates that accurate SLN identification was obtained combining lymphoscintigraphy and blue dye. Moreover, each method requires a suitable learning curve. Further studies are needed to define an accurate patient selection and the most speedy and precise method for intraoperative histological examination of SLNs.

Cystic mesothelioma is a rare tumor of the peritoneal cavity arising from mesothelial cells. About 130 cases have been reported in the literature. The tumor is more frequent (85%) in adult women and rarely occurs in children. It is benign but recurrences are often described. The differential diagnosis with adenomatoid tumors, lymphangiomas, cystic malignant mesotheliomas and metastatic serous cystic tumors of the ovary is supported by immunohistochemistry. We describe four cases of cystic mesothelioma of the peritoneum; two of the cases occurred in pregnant women, one in a 45-year-old man and one in a 5-year-old boy. Asbestos exposure was not documented. The mesothelial origin of the neoplasms was supported by immunohistochemical analysis. Furthermore, tests for simian virus 40 (SV40 T antigen), to determine whether this virus was also present in the lesions, were negative.

Plasma leptin concentrations are reported to be elevated in patients with inflammatory diseases. There is no consensus concerning the biological mechanism for this phenomenon. To date, tissue leptin concentrations have not been assessed within normal or inflamed gingiva. The purpose of this study was to assess concentrations of human leptin within healthy and diseased gingiva to define its possible role in periodontal disease progression.Healthy (non-hemorrhagic gingiva adjacent to aor =3 mm gingival sulcus) and inflamed gingiva (hemorrhagic gingiva adjacent to aor =3 mm periodontal pocket) were studied. Leptin, vascular endothelial growth factor (VEGF; to assess potential vascular expansion), and interleukin-6 (IL-6; to assess periodontal disease activity and severity) concentrations were assessed within solubilized gingival biopsies by enzyme-linked immunosorbent assay. Data were grouped by sulcular depth and compared by factorial analysis of variance, regression analysis, and Scheffé comparisons.Leptin concentrations were highest within gingiva adjacent to aor =3 mm sulcus and progressively declined within gingiva adjacent to aor =3 mm sulcus. VEGF concentrations were highest within gingiva adjacent to 4 to 6 mm pockets and nearly equivalent in healthy (or =3 mm sulcus) and severely diseased gingiva (6 mm sulcus). IL-6 was positively correlated and leptin negatively correlated with adjacent probing depth; IL-6 concentration was significantly higher and leptin significantly lower in gingiva adjacent to6 mm pockets compared to sites adjacent to6 mm pockets (P0.001).Human leptin is present within healthy and marginally inflamed gingiva and decreases in concentration as the adjacent probing depth increases. When leptin concentrations decreased (or =3 mm sulcus), VEGF concentrations increased, suggesting that leptin could be released from gingiva coincident to vascular expansion. Thus, gingiva, in addition to adipose tissue, could be a source of circulating leptin in patients with periodontal disease. This possibility requires further investigation.

To obtain a nomogram of the clivus-supraocciput angle as a basis for the diagnosis of Chiari II malformation in fetuses with ventriculomegaly.A cross-sectional study was undertaken on 310 normal pregnant women of 16-34 weeks' gestation. A mid-sagittal section of the fetal skull was obtained and the angle between the clivus and the supraocciput was measured. Forty-four fetuses with ventriculomegaly due to various causes (13 Chiari II malformation, 12 dysgenesis of the corpus callosum, 7 aqueductal stenosis, 6 borderline ventriculomegaly, 3 Dandy-Walker malformation, 2 porencephaly, 1 schizencephaly) were also included in the study and the values of the angle found in the pathological cases were compared with those found in the normal population.The clivus-supraocciput angle did not change during gestation and was almost constant with an average value of 79.3 +/- 6 degrees. All cases of Chiari II malformation showed a value below the 5th centile of our nomogram.The evaluation of the posterior fossa and particularly the measurement of the clivus-supraocciput angle is a useful parameter to differentiate the various causes of fetal ventriculomegaly and particularly to recognize Chiari II malformation.

Between 1980 and 1998, 4272 thyroid surgical specimens with a preoperative fine needle aspirate were sent to our Anatomical Pathology Department. Among these cases there were 17 primary thyroid lymphomas, which constituted 0.3% of all the thyroid lesions and 2.3% of the thyroid malignancies. Seven cases were diffuse large B-cell (DLBC) lymphomas and 10 were MALT lymphomas. Of the DLBC lymphomas six were correctly diagnosed by fine needle aspiration cytology (FNAC) and one was diagnosed as positive for malignancy, and among MALT lymphomas four were diagnosed as lymphoma, four as suspicious for lymphoma, and three as Hashimoto's thyroiditis (HT). Our data indicate that the diagnosis of primary thyroid lymphoma of high grade is easy, and immunocytochemistry (ICC) can confirm suspicious cases. The diagnosis of MALT lymphoma is more difficult; ICC can confirm suspicious cases, and false-negative results seem to be caused by sampling error, because HT usually coexists with MALT lymphoma.

We assessed the familial aggregation of chronic lymphoproliferative diseases (CLD) in 3962 relatives of 169 patients with B-cell chronic lymphocytic leukemia (B-CLL). Data collection included a self-administered questionnaire. The "relative risk" considered the connection between a higher incidence of CLD and the degree of familial linkage with the probands. The model of logistic regression was statistically significant (p0.001), with the probability of CLD increasing in proportion to the relationship coefficient between parents, siblings and children [(relationship coefficient 0.5; probability of CLD 1.85 (C.I. 95%, range 1.1-3%)]. CLD, particularly B-CLL, were observed in first-degree relatives of the patients with B-CLL more often than in other relatives.

Sublingual immunotherapy has been recognized as an alternative to injected immunotherapy for the treatment of allergic diseases. Even if compelling clinical evidence supports such a view, few studies are available on its mechanisms of action. This study was carried out to investigate the peripheral lymphocyte Vbeta repertoire of subjects with mite-allergic respiratory allergy who were either not treated or treated for 2 years with mite-specific sublingual immunotherapy. The T-cell receptor Vbeta distribution was studied by flow-cytometric techniques in three subject groups. Group A (untreated) included 19 subjects with symptomatic, mite-allergic, low to moderate asthma and/or rhinitis. Group B (treated) was made up of 10 asymptomatic subjects treated for 2 years with mite-specific sublingual-swallow immunotherapy for low to moderate asthma and/or rhinitis. Group C (controls) included 10 healthy subjects. The Vbeta usage was investigated with monoclonal antibodies specific to the diverse beta segments V3, V5a, V5b, V5c, V6a, V8a, V8b and V12a. The comparison between the group A and group C repertoires showed a lower expression (p0.05) of the beta V8b+ T-cell subset. The group B repertoire, when compared with group A, showed a significantly greater usage of the beta V5a (p0.05), 8a (p0.05) and 12a (p0.01) segments. The significantly lower expression of beta V8b observed in the symptomatic untreated group was not present in the group that was asymptomatic after treatment. The oligoclonal expansion observed in the treated group was consistent with the development of suppressor T-cell and/or of Th1 clones but not with deletion mechanisms of induced tolerance.

allergen-specific immunotherapy has proved to be effective in selected patients with IgE-mediated respiratory allergic diseases, and alternative routes of administration are being studied. Atopic Dermatitis (AD) is currently regarded as an allergic inflammatory disease.we conducted a cohort study to evaluate the safety and effectiveness of sublingual-swallow immunotherapy (SLIT) in selected patients with allergic (extrinsic) AD. Thirty-five patients, 16 suffering from AD without respiratory allergic symptoms (Group A) and 19 with AD associated to mild asthma and/or rhinitis (Group B), were enrolled in the study. The severity of the skin lesions (eczema) was scored on a 0 to 4 scale (and subsequently related to the more recent SCORAD Index), where 0 indicated complete healing of the eczema and 4 indicated maximal spread of the lesions. Only patients with an eczema score of 1 to 3 were started on allergen-specific SLIT for 36 months. Eczema scores, symptoms and side effects were recorded every two months during the first 2 years and then after 36 months. After SLIT was completed, all patients attended 3 yearly follow-up visits to evaluate the long-term effects of the treatment. All patients followed a set of rules designed to control for identified confounding variables. All patients received ketotifen during the first 3 months of SLIT.only the complete disappearance of skin lesions (score 0) was considered to indicate effectiveness. In Group A this was observed in 12.6% of the patients after 6 months of SLIT, in 31,2% after 12 months and 68.8% after 24 months. In Group B, eczema disappeared in 0% after 6 months, in 36.8% after 12 months and 73.7% after 24 months. No patients in Group A developed asthma during SLIT, and 1 patient developed asthma 3 years after immunotherapy had ended. Three focal reactions consisting of 2 cases of mild eczema and one case of diarrhoea were recorded. One case of urticaria, due to violation of the administration schedule was the only systemic reaction observed. No life-threatening reactions appeared at any time of the study.the outcomes obtained, taken into account the limitations of the study design, suggest that sublingual allergen-specific immunotherapy for the treatment of the extrinsic form of Atopic Dermatitis is safe and well tolerated by patients, and may favourably affect the natural course of the disease.

A retrospective study of women who are delivered at the Dept. of Obstetrics and Gynecology at the University of Bari, in the period 1991-1994, was performed to evaluate if over 20 week pregnancies in women aged 35 years and over were at higher risk for maternal and neonatal complications than pregnancy in women aged 20 to 29 years. The results of these 4 years show that pregnancy in women aged 35 and over is burdened with a greater incidence of maternal complications and cesarean sections, but age is not a risk for neonatal outcomes. Moreover, most working women were obliged to delay the first birth child, but work does not increase the number of complications.

Cell kinetic data are an important adjunct to histologically based tumor classifications and provide reliable information about future tumor behaviour. The growth fraction of 62 transitional cell carcinomas was assessed using Ki-67 and PCNA (Proliferating cell nuclear antigen/cyclin) immunostainings. Ki-67 recognises an unknown nuclear antigen expressed in dividing cells and requires the use of frozen sections. PCNA, a non histone nuclear protein, identifies proliferating cells within fixed, embedded tissue sections. The percentage of labeled cells was expressed as the labeling index (LI). The median LI in normal urothelium and transitional cell carcinoma were 0.5% and 8%, respectively for Ki-67, and 1.5% and 12% for PCNA. A general agreement between indices of cell proliferation and histological grade and stage was demonstrated. Although some discrepancies were observed, there was a strong correlation between Ki-67 and PCNA Lis (r = 0.8308, P0.01). In addition, tumor EGFR positive had PCNA values greater than those found in cancer EGFR negative (P = 0.01). These findings suggest that immunohistochemical nuclear labeling with anti-PCNA on routinely processed tissue is a simple technique for the assessment of transitional cell carcinomas.

One hundred and thirteen patients with metastases from colorectal carcinoma underwent liver resection. The authors report their experience with respect to 23 repeated hepatic resections (or metastases from colorectal carcinoma). The calculated actuarial survival from the first operations is 100% at 12 months, 67% at 24 months, 48% at 36 months and 26% at 60 months. In 90 patients who underwent a single liver resection during the same period, 76% were alive at 12 months, 40% at 24 months, 27% at 36 months and 14% at 60 months (p = 0.03). Survivals calculated from the second operation were 67% at 12 months, 41% at 24 months and 11% at 35 months. There was no operative mortality with morbidity added to that of the first operation. None patients had extrahepatic disease at the second operation: this was resected. Seven patients were treated with neo adjuvant chemotherapy; six with systemic adjuvant chemotherapy; in one this was associated with loco-regional chemotherapy. The number of lesions (single versus multiple), the presence or absence of extrahepatic disease, neo-adjuvant chemotherapy and adjuvant chemotherapy did not seem to influence the prognosis. Average survival calculated from the appearance of the first metastasis in the liver is better in patients with a synchronous lesion compared to the patients with a metachronous lesion (48.1 months versus 29.3). The authors claim that surgery is indicated, when technically possible, in the hepatic recurrence of disease. The results are not as good as those obtained following the first liver resection, with a probability of earlier recurrence of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

High levels of serum beta 2-microglobulin have been associated with human immunodeficiency virus infection and beta 2-microglobulin has been used with other serological and immunological markers for monitoring disease progression. The usefulness of beta 2-microglobulin as a prognostic marker during human immunodeficiency virus infection has been demonstrated in homosexual men and hemophiliacs; few and contradictory data have been reported in intravenous drug users. We have evaluated a cohort of 160 intravenous drug users (81 seronegative and 79 seropositive for human immunodeficiency virus infection) with normal renal function to assess whether serum beta 2-microglobulin could be used as a serological marker for monitoring infection; 78 healthy subjects were used as controls. Of 79 seropositive drug users, 54 were asymptomatic or had persistent generalized lymphoadenopathy the remaining 25 had the acquired immunodeficiency syndrome. Seropositive patients were tested for CD4+ lymphocyte number, p24 antigen and anti-p24 antibodies. A significant statistical difference was found in mean serum beta 2-microglobulin levels between seronegative and seropositive drug users. Moreover, higher levels of beta 2-microglobulin were observed in acquired immunodeficiency syndrome patients compared with asymptomatic or patients with persistent lymphadenopathy. A significant relationship was also observed between increased concentration of beta 2-microglobulin and the serological and immunological markers which indicate human immunodeficiency virus disease progression.

Therapeutic choices for benign liver tumours have changed over the last 20 years. From 1975 to December 1993, we observed 145 hemangiomas (HMG) (57.2% females-mean age 47.3 years, 42.8% males-mean age 50.4 years): we resected 42 symptomatic hemangiomas: mortality rate was 2.3%. 93 HMG without symptoms were only followed-up: 5 of these increased in size and were resected. 27 symptomatic cases over 50 focal nodular hyperplasia (FNH) were resected, 7 cases were resected and 3 biopsied during laparotomy performed for other pathology. Postoperative mortality was nil. 13 cases were only followed-up after diagnosis by imaging techniques and fine needle biopsy: over a mean period of 23 months. No variations have been recorded. Increases in GGT and ALP were present respectively in 34% and 22% of FNH-cases. Scintigraphic techniques were the most diagnostically accurate (96.2%). All 16 hepatocellular adenomas (HCA) were removed (11 females, 5 males), postoperative mortality was nil: oestrogen administration was present in 36.4% of female cases, histological diagnosis v/s well differentiated hepatocellular carcinoma was difficult in 2 cases, whilst 3 cases had spontaneous rupture. We resected also 8 cases of biliary adenomas in order to determine a precise diagnosis v/s liver metastases, and 4 biliary cystadenomas for their malignant potential. Asymptomatic HMG and FNH for their low tendency to increase, can be only observed, whilst HCA must be fully resected for risk of bleeding and misdiagnosis v/s well differentiated hepatocellular carcinoma.

The influence of gender, age, body size, cholelithiasis, and obesity on fasting gallbladder volume (GBV) was investigated by real-time ultrasonography in a general population cohort of subjects whose ages were between 30 and 69 yr, living in Bari, a Southeastern Italian city. Of the 2076 subjects analyzed, 1246 (60%) were males and 830 (40%) were females (mean age 50 yr). Among them, 1703 subjects were healthy, 108 had gallstones, and 265 were obese. Fasting GBV in healthy individuals was larger in males (M) than in females (F) [M, 18.7 +/- 0.3 (SEM) ml vs. F, 17.0 +/- 0.3 ml; p less than 0.001] and obese (M, 23.4 +/- 1.5 ml vs. 19.7 +/- 0.9 ml; p less than 0.05). The trend was similar in gallstone patients, but it was not statistically significant (M, 23.0 +/- 2.0 ml vs. F, 18.8 +/- 1.5 ml; t = 1.64). Gallbladder size correlated positively with body size in the lean healthy population (p less than 0.01), increased with age in healthy nonobese males (p less than 0.01), and was smaller in healthy males than in males with gallstones (0.01 less than p less than 0.02) and obese, in both sexes (p less than 0.01). We conclude that fasting GBV 1) is larger in lean healthy and obese males than females, 2) increases with age in lean males and with body size in healthy lean females, and 3) is greater in patients with gallstones and in obese subjects, and this might partially account for the defective gallbladder motor function reported in these patients.

Vesiculoerosive disorders are often difficult to diagnose and manage. The oral cavity is often overlooked as a source of diagnostic signs of dermatologic disease. In some disorders, oral manifestations precede cutaneous signs by as much as one year. The authors describe the oral presentation and management of lichen planus, allergic stomatitis, pemphigus vulgaris, and cicatricial pemphigoid, to enable the physician to recognize, diagnose, and treat commonly encountered oral manifestations of dermatologic disease.

Clear cells with characteristic features of koilocytotic atypia (perinuclear clear zone, peripheral cytoplasmic condensation and hyperchromatic nuclei), were found in 35 out of 744 urothelial papillary tumors (UPT) of the human bladder. Using a peroxidase-antiperoxidase staining technique, papillomavirus common structural antigen was detected in six of the samples studied. The results suggests that urinary bladder tumors like some other genital cancer, may be linked to papillomavirus infection.

The authors discuss the main features of the complex pathophysiology of patients subjected to duodenocephalopancreatectomy, and particularly the difficulties inherent in clinical assessment of the digestive and metabolic impairment consequent upon the duodeno-gastro-pancreatic mutilation. Out of a total of 57 cases of this description, they singled out for recheck 23 patients who had undergone duodenocephalopancreatectomy not less than six months and not more than seven years before (chronic pancreatitis, 11 cases; various malignancies of the periampullar area, 10 cases; Zollinger-Ellison syndrome, 1 case; retroperitoneal lymphoma, 1 case). Seventy-six per cent of patients who had been gainfully employed were able to resume their jobs after surgery. Steatorrhea, assessed in terms of fecal fats, was present in all cases; notwithstanding, 70% of the patients gained weight (average increase 7 kg). All patients were on enzyme replacement therapy. Only 4% developed diabetes, and none developed postoperative peptic ulcers. Conversely there was a high incidence (65%) of bone structure reshuffling, signally osteoporosis, probably imputable to steatorrhea and vitamin D malabsorption, plus the often associated increase of serum alkaline phosphatase activity.

A case of cystic neoplasia with a cephalopancreatic localization, arising in a young woman aged 26 and derived from the beta-insular elements, is presented. The tumour had invaded the porto-mesenteric tract, and hence duodenopancreatic demolition had to be followed by venous repair by prosthesis. On the basis of the literature the biological complexity of this exceptional tumour is disscussed (especially in relation to prognosis), as well as the surgical treatment adopted in this patient, who is in excellent conditions more than three years later.

6 cases of solitary angioma of the liver, treated with major hepatic resections, are presented (2 rt hemihepatectomies - 2 lt hemihepatectomies - 1 lt lateral sect. and 1 segmentectomy of the VIth). Their anatomopathological definition (solitary angioma, multiple angiomas, hemangiomatosis) is discussed in relation to the various therapeutic possibilities. From the diagnostic standpoint, an outstanding part is played by angiography. In addition to demonstrating the presence of hepatic mass, C.A.T. can, according to their experience, also allow diagnosis of quality on the basis of demonstration of vascular lacunae. It is considered that the treatment of choice of for solitary angiomas is surgery, which must be performed by skilled surgeons and consist in hepatic resections conduced by typical route. This is especially true for the giant forms, owing to their particular tendency to growth and spontaneous rupture. For small angiomas it is considered better in principle to remove them, generally by small cuneiform resections, unless they are situated in sites difficult to attack surgically and with high risk. In this case frequent check-up is necessary since, although they are sometimes found to be stationary and even in exceptional cases regressive, personal experience (2 cases) has demonstrated a tendency to expansion.

Out of 33 cases of retroperitoneal tumours (TRP), collected throughout 11 years (1970-1981), 8 (24%) resulted benign, 25 (76%) malignant. Liposarcoma resulted the most frequent tumour. In 11 of the 25 cases of malignant TRP (44%), a radical removal of the tumour was performed; in 8 (32%), a palliative demolition, and in the remaining 6 (24%) a simple diagnostic laparotomy. In 10 of the 19 demolitive operations (53%) the removal was extended to contiguous organs: kidney, adrenal glands, colon, pancreas, spleen, bladder, stomach. The postoperative mortality was 6%. The cases of recurrence after operations considered radical were 5 (45%). Out of the 8 patients suffering from benign neoformations, 7 underwent simple removal, and result recovered. The global survival for malignant TRP was 20% after 5 years and 8% after 10 years; as related to the cases subjected to radical removal, it results 45% and 18% respectively. The Authors maintain the essential function of computerized axial tomography (TAC) in the preoperative anatomo-topographic outlining of the retroperitoneal mass and in the early recognition of the remote recurrences. An aggressive surgical behaviour seems to be presently the primary therapeutical solution; nevertheless, the encouraging results obtained through the complementary treatment (radiotherapy and chemotherapy) command the necessity of a pluridisciplinary management of the treatment of TRP as an essential condition for the improvement of the remote results.

On the basis of angiographic documentations the Authors report on 4 observations (3 men and 1 woman) of extrinsic compression of the coeliac trunk symptomatologically evidenced through abdominal pain attacks. All the patients were treated surgically by resection of the median arcuate ligament of the diaphragm. In one case distal pancreatic resection was also performed on account of accompanying chronic pancreatitis. The long-term results were excellent in 3 cases, and good in 1. The diagnosis and surgical indication were made possible after repeated biochemical and instrumental investigations in order to exclude different pathologies (vascular, biliary, pancreatic, gastrointestinal) which might account for the reported symptoms. There is still discussion on the unresolved problem of the pathogenesis of the pain, as well as on surgical tactic and the advisability of completing resection of the arcuate ligament by sympathicectomy or coeliac ganglionectomy.

A study was made at the Padua University Second Surgical Clinic--located in Verona--on four cases of digestive haemorrhage in patients with pancreatic pseudo-cysts. The psysiopatological, diagnostic and therapeutic problems inherent in this pathology are discussed. In particular, attention is drawn to the need for and difficulty of marking a correct diagnosis in good time, and the utility, for such purpose, of endoscopic examinations and selective arteriography of the coeliac tripod and the superior mesenteric artery. Lastly, the various possibilities that surgery offers in the treatment of this disease are mentioned.

In a followup study of 14 patients treated by duodeno-cephalo-pancreatectomy at least one year before, the authors detected radiological evidence of bone tissue reshuffling in 64 per cent of the cases. Of these, 70 per cent showed high serum alkaline phosphatase content not attributable to cholestasis, liver metastasis, or specific bone disease. The authors call attention to the significance of this biochemical parameter for diagnostic purposes and therapeutic guidance.