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Cognitive deficits occur in most stroke patients and cognitive impairment is an important predictor of adverse long term outcome. However, current screening measures, such as the Mini Mental State Examination or the Montreal Cognitive Assessment, do not provide information tuned for evaluating the impact of cognitive impairment in the early phase after stroke. The Oxford Cognitive Screen (OCS) represents an important new development in this regard. The OCS is now available for assessment of Italian individuals and the aim of this study is to standardize the OCS on a large sample of healthy Italian participants stratified for age, gender and education level. Results confirmed the influence of these factors in several of the OCS tasks. Age-, education- and gender-adjusted norms are provided for the ten sub-tests of the test. The availability of normative data represents an important prerequite for the reliable use of OCS with stroke patients.

We have analyzed the expression of Gastrokine 1 (GKN1), one of the most abundant protein of gastric mucosa, in Helicobacter pylori-related preneoplastic and neoplastic gastric lesions. The GKN1 expression was down-regulated in 36 H. pylori-positive patients with respect to 29 H. pylori-negative subjects as evaluated by Western blot, reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry, showing a progressive decrease from chronic gastritis to atrophy and intestinal metaplasia. Interestingly, in gastric cancer (GC) patients, GKN1 was undetectable in tissue tumoural areas but was instead expressed in the corresponding tissue non-tumoural areas. In conclusion our data suggests that GKN1 expression is related to the inflammatory damage of gastric mucosa and could be the related to the gastric cellular phenotype.

A 34-year-old woman with a history of malignant melanoma had no FDG uptake in a large melanoma deposit in the small bowel on a whole-body scan. However, a large metastatic lesion was identified correctly in the liver.

Since 1961, 285 cases of testicular neoplasms have been investigated by means of lymphangiography at the National Cancer Institute of Milan. Bilateral foot lymphangiography was performed in 233 cases, 46 patients had combined funicular and foot lymphangiography, and in 6 only funicular lymphangiography was performed. Lymphangiograms were probative for secondaries in the retroperitoneal lymph-nodes in 162 cases (56.8 %). The most frequent site of metastasis was the para-aortic nodes (154 cases) with bilateral involvement in 68. Funicular lymphangiograms showed metastasis in the primary testicular lymph-centre in 28/52 investigated cases, and in 6 this was the only site of metastasis. These lymph-nodes are not visualized by foot lymphangiography. Radiological investigations other than lymphangiography were performed in 236 instances. I.V.P. was unable to visualize involved but not enlarged lymphnodes, but proved to be useful in defining the extent of large metastases. G.I.T. was performed in 59 cases and in 4 instances showed retrogastric metastases, which were not visualized by lymphangiography. Also R.P.P. visualized high retroperitoneal metastases in 2 cases with negative lymphangiograms. V.I. were positive only in far advanced cases. Histological lymphographic correlation was possible in 61 cases. Sensitivity (% correct positive lymphangiograms) was 96 % and specificity (% correct negative tests) was 89 %. False negative lymphangiograms occurred only in previously operated patients. In these cases only foot lymphangiography may be performed and the primary testicular lymph-center cannot be visualized.

Seven cases of leiomyoma of the thoracic esophagus were successfully treated by simple extramucosal enucleation of the neoplasm, and one case of leiomyoma of the cardia was cured after esophago-gastric resection. The rarity of this neoplasm, which often shows a non-esophageal symptomatology, is emphasised and the diagnostic aids are described. The treatment of choice is conservative surgery, which is indicated in all cases, both because of the expanding character of the lesion and its possible malignant evolution.

Between 1966 and 1970, 23 talc pleural poudrages for neoplastic effusions were performed in 22 patients at the National Cancer Institute in Milan. No recurrence was observed in 16 cases and in another 2 the effusion recurred to a minor degree. Talc poudrage was ineffective in 2 patients and 3 died postoperatively. The median survival of the patients who had a complete remission of their pleural effusions was 8 months, with minimum of 2 months and maximum of 2 years. The best results were obtained in patients with pleural mesotheliomas or pleural metastatic carcinomas other than lung cancer. Talc pleural poudrage seemed to be more effective when performed early in patients not yet in the preterminal phase.

Gastrokine 1 (GKN1) is involved in the replenishment of the surface lumen epithelial cell layer, in maintaining the mucosal integrity, and could play a role in cell proliferation and differentiation. In fact, after injury of the gastric mucosa, restoration may occur very rapidly in the presence of GKN1. In contrast, if the protein is downregulated, the repair process may be hampered; however, application of GKN1 to gastrointestinal cells promoted epithelial restoration. Because GKN1 possesses some mitogenic effects on intestinal epithelial cells (IEC- 6) whereas this protein was also capable of inhibiting proliferation in gastric cancer cells (MKN28), we decided to study its involvement in apoptosis to understand the role of GKN1 in the modulation of inflammatory damage or tumorigenesis in gastric mucosa. We found by cytofluorimetry, Western blot and RT-PCR that the overexpression of GKN1 in gastric cancer cell lines (AGS and MKN28) stimulated the expression of Fas receptor. Moreover, compared to control cells, a significant increase of apoptosis, evaluated by TUNEL, was observed when GKN1 transfected cells were treated with a monoclonal antibody (IgM) anti-Fas. The activation of Fas expression was also observed by the overexpression of GKN1 in other cancer cell lines. Moreover, in GKN1-overexpressing gastric cancer cells exposed to FasL, the activation of caspase-3 was also observed by Western blot and fluorescence assays. Our data represent the first report for GKN1 as modulator of apoptotic signals and suggest that GKN1 might play an important role for tissue repair during the early stages of neoplastic transformation.

Mechanical ventilation in patients with bronchopleural fistula after lung resection is a major problem, as it causes increase of the air-leak, complicates the healing process and makes residual lung tissue ventilation difficult. We present two cases in which the use of a modified double lumen endobronchial tube improved ventilation and eliminated the fistula air-leak. We used a right-sided double lumen sher-i-bronch tube (Sheridan Catheter Corp., USA). This method, by blocking the airflow through the fistula, may facilitate the expansion of the residual lung parenchyma. In both the patients treated with this technique, we obtained a good expansion of the residual parenchyma. Despite the procedure, the first patient died of septic shock; in the second patient, we achieved improvement of the respiratory function, the weaning from the mechanical ventilation, and thereafter, the healing of the fistula. The use of a modified double lumen sher-i-bronch tube in mechanically ventilated patients with post-resection bronchopleural fistula allows the anaesthesiologist to suction separately the two lungs and to ventilate adequately the remaining lung tissue, thus obtaining the lung reexpansion and the consequent reduction of the residual pleural space, and facilitating the healing of the fistula.