Search

La contaminazione dei suoli da metalli pesanti rappresenta un problema crescente in molti Paesi industrializzati del mondo. Le attivita? di caratterizzazione e di riqualificazione dei siti contaminati richiedono attente analisi finalizzate a determinare la concentrazione e la distribuzione spaziale dei contaminanti. Le analisi convenzionali sono onerose sul piano economico e temporale, per questo poco idonee per indagini su vaste aree di territorio; da cio? la necessita? di sviluppare tecniche alternative rapide e poco costose, integrative/sostitutive di quelle convenzionali. Negli ultimi anni la spettroscopia della riflettanza nel dominio visibile-infrarosso vicino (vis-NIR) si e? rivelata un metodo efficiente per l'analisi e il monitoraggio rapido e a basso costo dei predetti contaminanti, in dipendenza della specificita? del pedo- ambiente. Nell'ambito delle attivita? previste dal Commissario di Governo per gli interventi urgenti di bonifica, ambientalizzazione e riqualificazione di Taranto, e? stato condotto uno studio preliminare riguardante l'applicazione della spettroscopia vis-NIR per la caratterizzazione dei suoli dell'Area di Crisi Ambientale di Taranto, fortemente contaminata, includente il SIN di Taranto e un vasto territorio ad esso circostante (Area Vasta). In particolare, lo studio e? stato finalizzato a valutare le potenzialita? della spettroscopia vis- NIR, combinata con metodi statistici multivariati, per la predizione del contenuto di tre metalli (Berillio, Be; Vanadio, V; Tallio, Tl) che, con piu? frequenza rispetto agli altri metalli investigati, superavano la concentrazione soglia di contaminazione (CSC) stabilita dai D.Lgs 152/2006 e 46/2019. Le misure di riflettanza spettrale sono state condotte in laboratorio su 235 campioni di suolo utilizzando uno spettroradiometro ad elevata risoluzione. Per i tre metalli sono stati calibrati e validati modelli di predizione su base spettroradiometrica utilizzando il metodo statistico multivariato della Partial Least Squared Regression (PLSR) analysis. In accordo con i valori di RPD (Relative Percent Difference), sono stati prodotti modelli predittivi molto buoni per il Tl (RPD=2.15) e il Be (RPD=2.02) e buoni per il V (RPD=1.88). Stando ai risultati la spettroscopia vis-NIR, in combinazione con metodi statistici multivariati, puo? essere considerata una tecnica promettente per la predizione del contenuto di Be, V e Tl nelle specifiche condizioni pedo-ambientali dell'Area Vasta.

Il sito di interesse e? l'Area Vasta del territorio comunale di Statte (TA), in particolare le aree esterne al SIN di Taranto. L'area e? stata sottoposta ad indagini di caratterizzazione ambientale condotte nel territorio dopo la questione "diossina nel latte", che ha implicato l'abbattimento dei capi ovini. Gli esiti delle indagini hanno evidenziato, in alcune porzioni di territorio, concentrazioni di microinquinanti nel suolo superiori ai limiti normativi. Al fine di comprendere e definire lo stato di qualita? ambientale delle aree agricole, in accordo con il comune di Statte, si e? reso necessario, avvalendosi di risorse del POR Puglia 2014/2020, progettare ed eseguire un Piano di indagini nelle aree agricole in cui il suolo superficiale ha mostrato tenori di microinquinanti organici (diossine e PCB) superiori al limite di concentrazione di 4 ngTE/kg, proposto per le aree agricole da ISS-ISPRA, ed inferiori alla concentrazione soglia di contaminazione (CSC) di riferimento pari a 10 ngTE/kg. Come e? noto, in data 22 giugno 2019 e? entrato in vigore il Decreto Ministeriale n. 46 del 1 marzo 2019 recante il "Regolamento relativo agli interventi di bonifica, di ripristino ambientale e di messa in sicurezza d'emergenza, operativa e permanente, delle aree destinate alla produzione agricola e all'allevamento, ai sensi dell'articolo 241 del Decreto legislativo 3 aprile 2006, n. 152", emanato dal Ministero dell'Ambiente e della Tutela del Territorio e del Mare di concerto con il Ministero della Salute, del Ministero delle Politiche Agricole, Forestali e dello Sviluppo Economico. Il Piano di indagini integrative, che si conforma alla previsione del nuovo Decreto, rappresenta una delle prime applicazioni in campo. Lo studio approfondisce aspetti applicativi, sperimentando approcci operativi riferiti alla caratterizzazione di aree agricole, gestendo la transizione normativa e considerando opportunamente tra i bersagli della contaminazione i prodotti agroalimentari ivi coltivati, con percorsi di esposizione attivi per i residenti, per i consumatori, nonche? per i coltivatori. Attenzione e? rivolta alla potenzialita? degli organi vegetali di traslocare gli inquinanti, anche in ragione delle specie e dei fenotipi.

Patients with chronic liver disease (CLD) respond poorly to standard hepatitis B (HBV) vaccine given as sequential 20 microg IM shots because of an overall impaired immune response. Many of these patients go on to liver transplantation and are at risk of acquiring recurrent or de novo HBV infection. To evaluate the efficacy and safety of high-dose (80 microg) IM HBV vaccination in patients with CLD who had previously failed to respond to a standard three-dose schedule of 40 microg IM vaccine given monthly. A retrospective review was undertaken at our institution of 79 patients with CLD who were treated with high-dose (80 microg) HBV vaccinations. All had previously failed a three-dose course of 40 microg HBV vaccine. An HBV vaccine response was defined as an anti-HBs titer greater than 100 mIU/ml. Liver enzymes, creatinine, age, prothrombin time, total vaccine dose, and MELD score were recorded. No adverse events were reported. Seventy-two per cent (57/79) of the subjects had an adequate response after receiving a mean total dose of 220 mug vaccine (range 80-800 microg). Twenty-eight per cent (22/79) of the subjects did not respond after receiving a mean total dose of 420 microg vaccine (range 240-720 microg). Non-responders had more severe hepatic disease defined as a higher mean total bilirubin level (p = 0.003) and a lower mean albumin level (p < 0.05). Age, prothrombin time, MELD score, and creatinine were not statistically significant between the responders and non-responders. Repeated high-dose (80 microg) HBV vaccination, in patients who do not respond to standard HBV vaccine doses, is safe and effective in the majority of patients with CLD.

Functional dyspepsia, though benign, leads to deterioration of the quality of life and high costs for healthcare systems. The optimal therapy for functional dyspepsia is still to be defined because of its multifactorial pathogenesis. In an open multicentric study of patients with functional dyspepsia, we prospectively evaluated the benefit of treatment with a food supplement composed of sodium alginate, carbonate calcium, pineapple, papaya, ginger, α-galactosidase and fennel (Perdiges, Bioten Snc, Turin, Italy).Ninety-one consecutive patients were included, suffering from functional dyspepsia, who had been previously submitted to therapy to eradicate the infection from Helicobacter pylori (H. pylori) and were waiting to perform the Urea Breath Test (UBT). The primary goal was to establish the percentage of patients who continued to abstain from proton pump inhibitors (PPI) as they waited to carry out the UBT, differentiating between patients who were treated (N.=55) with Perdiges and those who were not (N.=36). Our secondary goal was to document the differences within the 2 groups in terms of symptoms perceived between the start and end of the observation period. The wellness reported, during or in absence of treatment with Perdiges, was evaluated by the use of the VAS scale (Visual Analogical Scale) completed before the start of the treatment and after 30 days.All the patients treated with Perdiges (55/55, 100%) and 31/36 (86.1%) patients who were not (P=0.008) continued to abstain from PPI in the period awaiting the UBT. The VAS scale of those who took Perdiges improved on average by 1.78 points versus a worsening of 0.08 points of those who did not take it (P0.0001). Furthermore, while among those who took Perdiges there was a statistically significant improvement (P0.0001) in the VAS scale, between the baseline and the end of treatment, a worsening of 0.08 points (P=0.78) was noticed among the patients who did not take it.Perdiges is significantly effective in the period following treatment to eradicate the infection from H. pylori in patients with functional dyspepsia. This allows to reduce the need to use antisecretive drugs. Further randomised studies, with wide ranging case histories, must assess its long-term efficacy.

Proximal humeral fractures are complex lesions with difficult management problems; therefore, they pose a challenge for orthopaedic surgeons. In the literature, numerous treatment techniques have been proposed for these kinds of fractures. In our study we reviewed 30 patients with a mean age of 75 years presenting a proximal humeral fracture (Neer 2-3) and treated at our clinic with a Polarus nail, with a mean follow-up of 7 years. We obtained 73.3% of good and excellent results in line with literature. Complications were recorded in 6 of the patients (20%) recruited in our study. In particular, 3 cases of proximal screw pull-out, 1 case of deep infection and 2 cases of acromio-clavicular joint impingement syndrome. The aim of our study was to review our case histories and compare them with the literature analysing this complex type fracture and treatment options.

The prostate cancer became for two decades the most frequent cancer in men. We describe the evolution of its incidence and mortality from 1980 to 2011 for France.Incidence data were collected from registries and national incidence estimates were based on the use of mortality as a correlate of incidence.After a very strong increase of incidence between 1980 (24.8/100,000) and 2005 (124.5/100,000), we observe a net decline since (97.7/100,000, in 2011). The reduction began earlier for the old patients. The evolution of mortality is very different. We observe a regular reduction since the end of 1990s (from 18.0/100,000 in 1990 to 10.5/100,000 in 2011). The reduction began earlier for the young patients.This pattern of evolution is observed in all the countries where the use of the PSA had caused an important increase of the diagnosis of prostate cancer.3.

Present national estimations of the incidence and mortality trends in urological cancers in France between 1980 and 2012.Francim database and French Register of Cancers.Analysis of the current data shows a regular increase of the incidence of renal cancer in men and women (7,781 cases in men and 3,792 in women in 2012). For bladder cancer, trends are divergent. There is a small reduction in incidence for men and an increase for women (9,549 cases in men and 2,416 in women in 2012). Testicular cancer is still increasing slightly (2,317 incidental cases in 2012). The incidence of prostate cancer experienced a huge increase up until 2005, and thereafter it decreased sharply, though it is difficult to discern whether this drop (which was observed up until 2008) continued at the same rate after that point (56,841 incidences in 2012 based on the rates calculated for 2009).The analyses by organ database show that there are significant variations in the incidence of urological cancers, particularly for prostate cancer, which shows that both the natural history of urological tumours and the methods of detection have an impact on incidence.

Background—CD3 and γδ cells in the rectal mucosa increase after local instillation of gluten in children with coeliac disease and in half of their siblings.Aim—To establish an in vitro system for assessing immunological changes induced by gluten in the rectum.Patients and Methods—Rectal biopsy specimens obtained from 13 treated coeliac children, nine of their siblings, and nine controls were cultured in vitro with a peptic-tryptic digest of gliadin or ovalbumin. CD3 and CD25 cells were counted, and the expression of adhesion molecules evaluated.Results—In the lamina propria of coeliac biopsy samples cultured with gliadin, but not in those from controls, the expression of vascular cell adhesion molecule 1 (VCAM-1) was enhanced, and the number of CD25 cells was significantly higher than in those cultured in medium alone; the density of intraepithelial CD3 cells was also significantly higher. No differences were noted in coeliac biopsy specimens cultured with ovalbumin. A discriminant analysis allowed correct classification of all controls and all coeliacs but one, but three of nine siblings were allocated to the coeliac group.Conclusions—Our data confirm that gliadin is able to activate cell mediated immunity in the rectal mucosa in coeliac patients and in a subset of their first degree relatives.

Combination therapies for cancer aim to exploit either additive or synergistic effects arising from the action of two species with the final goal to maximize the therapeutic efficacy. In this work, we develop multifunctional nanoparticles (NPs) for co-delivery of the conventional anticancer drug docetaxel (DTX) and the second generation photosensitizer zinc-phthalocyanine (ZnPc) as potential dual carrier system for the combination of chemotherapy and photodynamic therapy (PDT). Biodegradable and amphiphilic block copolymers based on poly(epsilon-caprolactone) (PCL=B) and poly(ethylene oxide) (PEO=A), with AB and ABA architectures, were assembled in "core-shell" NPs and loaded with both DTX and ZnPc employing the melting/sonication method. Hydrodynamic diameters within the range 60-100 nm and low polydispersity indexes were obtained. Zeta potential was negative for all the formulations and unaffected by drug encapsulation. Concerning drug loading ability of NPs, the entrapment efficiency was related to initial ZnPc/DTX ratio. Steady-stationary and time-resolved emission fluorescence measurements pointed out the embedding of monomeric ZnPc in the NPs, excluding the presence of ZnPc self-supramolecular oligomers. The release of DTX was biphasic whereas ZnPc remained mainly associated with NPs. Singlet oxygen generation was observed when ZnPc-loaded NPs were irradiated at 610 nm within a 45 min time range, despite that ZnPc was not released in the medium. Stability of NPs in the presence of serum proteins and plasma was excellent and no toxicity toward red blood cells was found. NPs cytotoxicity was evaluated in HeLa cells irradiated for 30 min with a halogen lamp. After 72 h, viability of cells treated with ZnPc/DTX-loaded NPs strongly decreased as compared to NPs loaded only with DTX, thus showing a combined effect of both DTX and ZnPc. Superior antitumor activity of ZnPc/DTX-loaded NPs as compared to DTX-loaded NPs was confirmed in an animal model of orthotopic amelanotic melanoma, thus pointing to the application of PEO-PCL NPs in the combined chemo-photodynamic therapy of cancer. (C) 2013 Elsevier B.V. All rights reserved.

The present study aims to assess the evolution of different proto-horizons as embryonic soils built by pedotechnologies for the reclamation and management of derelict and damaged lands, such as abandoned quarries. The model proto-horizons were assembled by utilizing coarse limestone gravel or zeolitized Phlegraean Yellow Tuff (PYT) as mineral components and commercial compost-amendments or a phosphorite-poultry manure mixture as organic matrices for growth of a pasture-grass under controlled conditions. The evolution of the model proto-horizons was followed by an evaluation of the stability and modification of the organic matter (OM) with reference to plant development. The results suggest that the natural carbonatic substrate occurring in limestone quarries was unable to sustain significant plant growth, while the PYT was suitable and efficient as a pedogenic substrate because it supported plant growth and induced a conspicuous accumulation of OM due to root activity. In particular, OM, including humic and non-humic components, greatly increased in the PYT treatment with the phosphorite-poultry manure mixture showing a concurrent trend toward humification. Conversely, an overall tendency toward degradation of OM was detected in the PYT model proto-horizon treated with commercial compost. Feasibility estimates show that quarry restoration costs appear reasonable where environmental impacts are high. © 2013 Elsevier Ltd.

Previous assessment of verticality by means of rod and rod and frame tests indicated that human subjects can be more (field dependent) or less (field independent) influenced by a frame placed around a tilted rod. In the present study we propose a new approach to these tests. The judgment of visual verticality (rod test) was evaluated in 50 young subjects (28 males, ranging in age from 20 to 27 years) by randomly projecting a luminous rod tilted between -18 and +18° (negative values indicating left tilts) onto a tangent screen. In the rod and frame test the rod was displayed within a luminous fixed frame tilted at +18 or -18°. Subjects were instructed to verbally indicate the rod’s inclination direction (forced choice). Visual dependency was estimated by means of a Visual Index calculated from rod and rod and frame test values. Based on this index, volunteers were classified as field dependent, intermediate and field independent. A fourth category was created within the field-independent subjects for whom the amount of correct guesses in the rod and frame test exceeded that of the rod test, thus indicating improved performance when a surrounding frame was present. In conclusion, the combined use of subjective visual vertical and the rod and frame test provides a specific and reliable form of evaluation of verticality in healthy subjects and might be of use to probe changes in brain function after central or peripheral lesions.

Sepsis of the biliary tract is a severe disease, due to its course and its significant association with relevant diseases, either benign or malignant, of the biliary tract, pancreas, hepatic hilus. In many cases it remains difficult to set the limit between medical therapy, percutaneous or endoscopic therapy and surgical treatment. Through a thorough review of the last 20 years' literature, we have studied this topic and classified cholangitis according to its etiology: Iithiasis, benign stenosis or Klatskin tumor as malignant diseases. The sequential approach, endoscopy-surgery, seems to provide the best results in lithiasic cholangitis. In patients with benign stenosis of the biliary tract, a percutaneous drainage is indicated as a first choice, meanwhile surgery is limited to unsuccessful bilioplasty and to segmental extrahepatic localization of sclerosing cholangitis. On the contrary, in Klatskin tumours preoperative percutaneous drainages are useful to obtain an accurate map, which is indispensable to perform an aggressive radical hepatic resection.

We report the observation of the exclusive decay B-s(0)-> Ds-Ds+ at the 7.5 standard deviation level using 355 pb(-1) of data collected by the CDF II detector in p (p) over bar collisions at root s =1.96 TeV at the Fermilab Tevatron. We measure the relative branching ratio B(B-s(0)-> Ds-Ds+)/B(B-0 -> D-Ds+)=1.44(-0.44)(+0.48). Using the world average value for B(B-0 -> D-Ds+), we find B(B-s(0)-> Ds-Ds+)=(9.4(-4.2)(+4.4))x10(-3). This provides a lower bound Delta Gamma(CP)(s)/Gamma(s)>= 2B(B-s(0)-> Ds-Ds+)> 1.2x10(-2) at 95% C.L.

We present a new method for studying high-pT dilepton events (e±e, μ±μ, e±μ) and simultaneously extracting the production cross sections of pp̄→tt̄, pp̄→W+W-, and pp̄→Z0→τ+τ- at a center-of-mass energy of s=1.96TeV. We perform a likelihood fit to the dilepton data in a parameter space defined by the missing transverse energy and the number of jets in the event. Our results, which use 360pb-1 of data recorded with the CDF II detector at the Fermilab Tevatron Collider, are σ(tt̄)=8.5-2.2+2.7pb, σ(W+W-)=16.3-4. 4+5.2pb, and σ(Z0→τ+τ-)=291-46+50pb. © 2008 The American Physical Society.

We present the first search for heavy, long-lived particles that decay to photons at a hadron collider. We use a sample of Î+jet+missing transverse energy events in pp collisions at s=1.96 TeV taken with the CDF II detector. Candidate events are selected based on the arrival time of the photon at the detector. Using an integrated luminosity of 570pb-1 of collision data, we observe 2 events, consistent with the background estimate of 1.3 0.7 events. While our search strategy does not rely on model-specific dynamics, we set cross section limits in a supersymmetric model with I E 10 GE and place the world-best 95% C.L. lower limit on the χ˜10 mass of 101 GeV/c2 at Ï.,χ˜10=5ns. © 2007 The American Physical Society.

Today it is expected that the great majority of patients with duodenal ulcer (DU) respond to H. pylori eradication treatment without DU recurrence. The aim of the research is to identify patients who need a different therapeutic approach and the best management of their disease.We examined retrospectively the medical history of 474 patients (326 males, mean age 61 years), followed up in 5 years in the outpatients department of a third level GI Center. From our research, 5 subgroups of patients emerged: 1) 63.5% carrying H. pylori infection, with successful eradication treatment and without DU recurrence; 2) 4% failing 3 courses of H.pylori eradication treatment; 3) 11% with DU lacking evidence of H. pylori infection or relapsing after verified eradication; 4) 8% being treated with NSAIDs; 5) 13% with DU complicated by hemorrhage or perforation.23% of patients with DU need long-term therapy after H. pylori eradication treatment. Concerning this, the percentage of ulcerous recurrences in patients receiving anti-H2 therapy is 18.5%, but decreases considerably to 2% when PPI were used.Although representing the mainstay of DU therapy, H. pylori eradication treatment may not abolish all issue in DU management. Actually, of DU patients referred to a third level GI Center, 23% need a different therapeutic approach, which results from a thorough analysis of the medical history of the patient.

Lipohyperplasia or intestinal lipomatosis is an infrequent disease characterised by anomalous infiltration of adipose tissue in the intestinal submucosa. Localised forms are generally asymptomatic, whereas diffuse forms may lead to intestinal subocclusion, digestive hemorrhage or diarrhoea. Although benign, the differential diagnosis of intestinal lipomatosis with malignant pathologies of the colon or appendix often prompts the need for surgical exploration and the histological analysis of biopsy material. Surgical exeresis of the lesion is generally associated with the normalisation of clinical symptoms. The authors report the onset and clinical evolution of two cases of intestinal lipomatosis referred to their attention.

Hepatitis C is a heterogeneous disease and is responsible for considerable mortality and morbidity. The hepatitis C virus (HCV) infects nearly 170 million people world-wide. More than 80% of infected individuals develop chronic infection; the remaining 10-20% develop spontaneous clearance with natural immunity. Acute hepatitis is icteric in only 20% of patients and is rarely severe. The majority of patients who develop chronic HCV infection are asymptomatic; but 60-80% develop chronic hepatitis as indicated by elevated alanine aminotransferase (ALT), around 30% maintain persistently normal ALT levels despite having detectable HCV-RNA in serum. One-third of chronically infected patients develop progressive liver injury, fibrosis and cirrhosis over a period of 20-30 years. The relationship between virus load, HCV genotype, quasi-species variability and progression of liver disease is controversial. Acquired infection after age 40, male sex, excessive alcohol-consumption, hepatitis B virus (HBV) or HIV co-infection, steatosis, and immunosuppressed state have been identified as co-factors associated with progression of fibrosis and development of cirrhosis. In patients with cirrhosis, the incidence of hepatocellular carcinoma is 2-5% per year. At present, HCV-related end-stage cirrhosis is the first cause of liver transplantation.

Carcinoma of the gallbladder is a gastrointestinal malignancy with a very poor prognosis. The 5-year survival rate amounts to less than 5% in most series. In this study we reviewed the results of surgical treatment for gallbladder carcinoma with special reference to extended radical procedures.Between 1995 and 2000 we enrolled 36 patients (17 males and 19 females), 24 of whom were treated with simple cholecystectomy and 12 with radical resection (partial hepatectomy, regional lymphadenectomy, and common bile duct resection). The tumours were classified by stage using the criteria of the American Joint Committee on Cancer (AJCC). Stages, operative procedures, results of pathologic examinations and the outcome of the resected cases were reviewed.There were 2 postoperative deaths (0.55%). The mean follow-up period was 19.1 months (range 1-60). For stage I and II disease extended cholecystectomy had a better result than simple cholecystectomy: the 5-year survival rates were 38.4 versus 19%, respectively. For the patients with advanced stage III or IV gallbladder carcinoma, a significant advantage of survival resulted in case of liver resection as compared to surgical treatment without liver resection: the 5-year survival rates were 20 and 0%, respectively.The survival of stage I-II patients was good. For the patients in higher stages the prognosis was significantly worse. In these cases more aggressive surgery may be needed.

Chromogranin A is a cellular marker forneuroendocrine tumors. Elevated levels of chromogranin A are also found in patients with cancers of epithelial origin when neuroendocrine differentiation occurs, which is associated with a poor prognosis. We investigated the prevalence of serum levels of chromogranin A in patients with primary liver cancer. Seventy-nine patients (65 males, mean age 67.6 years, range 48-88 years) with liver cirrhosis and hepatocellular carcinoma were studied. The etiology of cirrhosis was identified as due to hepatitis C virus infection in 47 patients, to hepatitis C virus and alcohol in 7, to alcohol alone in 14, to hepatitis C and B virus in 2, and to hepatitis B virus alone in 4. Of the remaining patients, 2 suffered from hemochromatosis and 3 had cryptogenic cirrhosis. According to the Child-Pugh's score, 54 patients belonged to class A, 22 to class B, and 3 to class C. The concentration of chromogranin A was measured in serum with a commercial solid-phase two-site immunoradiometric assay. Elevated serum levels of chromogranin A were found in 32 of 79 patients (43%). Levels over 600 ng/ml were present in 7 of 76 patients (9.2%), all of whom had very high serum levels of alpha-fetoprotein. Hence, elevated serum levels of chromogranin A are present in over one third of patients with hepatocellular carcinoma. It is therefore possible that some hepatocellular carcinomas could acquire a neuroendocrine differentiation. We propose further studies to ascertain whether serum levels of chromogranin A are useful as a prognostic marker for hepatocellular carcinoma as in prostate cancer.

The diagnosis of cholelitiasis, more and more common with the wide diffusion of abdominal ultrasound, is often a surprise for the patient as well as for the physician who is sometimes forced to take a therapeutical decision. In the case of dilatation of the biliary duct, the cholangioRM is assuming an increasingly important role, especially before a therapeutical ERCP. The best therapeutical approach seems to be the surgical ablation in laparoscopy in presence of specific signs and symptoms. Indication to surgical ablation is a symptomatic or complicated cholelithiasis, or the history of obstructive pancreatitis. A preventive cholecystectomy can be useful for precancerous lesions.

The resectability rate of hilar bile duct carcinoma is reported to be variable and to inversely correlate with the size of the associated liver resection. In an attempt to reduce the risk of postoperative liver failure, the induction of a hypertrophy of remnant liver by preoperative portal vein embolization (PVE) has been proposed. We hereby analyse the results and the technical aspects of this procedure along with our personal experience.

Hepatocellular carcinoma (HCC) is closely associated with cirrhosis, but it also develops, although much less frequently, in a non-cirrhotic liver. It is suspected that hepatocellular carcinoma has a different etiology when associated and not associated with chronic liver disease. We report two cases of patients with hepatocellular carcinoma that developed in a non-cirrhotic liver. In the first case we describe an incidental liver nodular lesion containing multiple foci of HCC including pseudogland or trabecular formation and areas of sclerosis. The non-cancerous parenchyma of the liver was histologically unremarkable except for mild fatty changes of hepatocytes and minimal dysplasia. The second case describes a combined hepatocellular carcinoma and cholangiocellular carcinoma (CCC) (mixed carcinoma) in a patient who was serologically negative for both hepatitis B and C viruses. The adjacent liver parenchyma showed mild piecemeal necrosis and mild lobular activity compatible with chronic viral hepatitis, but cirrhosis was not established. This case appears to indicate that mixed type carcinoma can develop in a non-cirrhotic liver, with CCC being far more dominant than HCC; such a finding is extremely unusual, based on previously published reports.

Many syndromes reflecting impaired metabolism have been described in association with primary neoplastic diseases. Hypercalcaemia secondary to malignancy without bone metastases and with normal parathyroid glands has been described as "pseudohyperparathyroidism". Differentiation from primary hyperparathyroidism is difficult and care should be taken to exclude an occult malignancy prior to surgical exploration for a parathyroid adenoma. Hypercalcaemia associated with hepatocellular carcinoma is not uncommon. Nevertheless, we describe a rare case of coma with persistent hypercalcaemia in a cirrhotic patient not previously known to have hepatocellular carcinoma.

The hepatitis C infection (HCV) has numerous extrahepatic manifestations owing to the systemic nature of the infection itself. HCV infects the cells that carry a CD 81 receptor and show a marked tropism for hepatocytes, bone marrow staminal cells and circulating lymphomonocytes. One consequence of this tropism is the activation of B lymphocyte clones with the consequent production of autoantibodies and cryoglobulins. The secondary event is the formation of circulating immune complexes which, having precipitated at an intravascular level, may cause part of the extrahepatic manifestations associated with these infections.This retrospective study evaluated the manifestations correlated and/or associated with HCV hepatitis and mixed cryoglobulinaemia.This analysis showed that 75% of consecutively studied patients reveal clinically important extrahepatic manifestations.This underlines the "broad spectrum" action played by the hepatitis C virus in the host organism.

The main goal of traditional treatment of idiopathic retroperitoneal fibrosis is limitation of morbidity, and surgery of already formed fibrous masses has been the main therapeutic approach. More recently, the knowledge that the disorder may be the result of an allergic reaction to atherosclerotic lipids has prompted the use of corticosteroids and cytotoxic drugs, which proved efficacious, but also toxic. On the basis of data indicating a T cell pathogenesis of idiopathic retroperitoneal fibrosis, cyclosporin, a non-cytotoxic pretranscriptional inhibitor of proinflammatory cytokines, was used to treat the case reported here. A 65 year old man with aggressive retroperitoneal fibrosis and obstructive renal failure initially received steroids, which eventually lost their efficacy and led to vertebral collapse. He responded to 5 mg/kg/day cyclosporin, with radiological reduction of tissue deposition, relief of urether compression, and reduction in acute phase reactants in the blood. Chronic disease remission required stable drug concentrations. In conclusion, progress in research into the T cell pathogenesis of idiopathic retroperitoneal fibrosis may justify attempts with drugs such as cyclosporin to block the disease at its origin rather than treating the morbidity.