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Purpose This study aims to assess the effectiveness of Microfragmented Autologous Fat Tissue (MFAT) treatment for knee osteoarthritis and to investigate whether patients’ pre-treatment clinical condition, such as synovitis, correlates with clinical outcomes, to identify potential predicting factors for the success or failure of the treatment. Methods In this prospective Cohort Study Level II multicentric trial, consecutive patients with a diagnosis of early/mild osteoarthritis and failure of previous conservative measures were enrolled to undergo diagnostic arthroscopy and a single MFAT injection. Patients were assessed with repeated scoring systems at baseline, 6 months, and 12 months after surgery. The demographic features, the arthroscopic findings, the immunophenotype of injected tissue and the histologic examination of synovia of failed patients were analyzed. Results Data from 91 patients showed a significant improvement in Lysholm, WOMAC scores at 1-year follow-up (p Age and synovitis were identified as significant factors influencing the clinical outcome (p Conclusion MFAT is effective in reducing pain when used with a single dose injection in early/mild OA of the knee, without major complications. Age over 60 and synovitis may be predictive for persistent pain at one year and should be considered before indications.

Understanding the dynamics of strongly interacting disordered quantum systems is one of the most challenging problems in modern science, due to features such as the breakdown of thermalization and the emergence of glassy phases of matter. We report on the observation of anomalous relaxation dynamics in an isolated XXZ quantum spin system realized by an ultracold gas of atoms initially prepared in a superposition of two-different Rydberg states. The total magnetization is found to exhibit sub-exponential relaxation analogous to classical glassy dynamics, but in the quantum case this relaxation originates from the build-up of non-classical correlations. In both experiment and semi-classical simulations, we find the evolution towards a randomized state is independent of the strength of disorder up to a critical value. This hints towards a unifying description of relaxation dynamics in disordered isolated quantum systems, analogous to the generalization of statistical mechanics to out-of-equilibrium scenarios in classical spin glasses.

We describe two patients with extracerebral tumours histologically diagnosed as a metastasis with focal necrosis (case 1) and a meningioma with microcystic features (case 2), examined by proton magnetic resonance spectroscopy. Tumour metabolism did not fit literature reports as lipids were not detected in the metastasis but were found in the meningioma whose in vitro spectrum also showed metabolic abnormalities. This discrepancy may be due to the technique adopted in case 1 and the small amount of tumour necrosis, but it is difficult to account for in case 2. Some explanations are offered but long-term follow-up scans will establish whether the abnormal metabolic features indicative of a negative prognosis are confirmed by the patient's evolution. The cases described do not necessarily call other literature reports into question, but warrant caution in establishing a diagnosis on the basis 1HMRS findings. Spectrum acquisition techniques need to be standardized and short TE measurements are more reliable than those made with long TE.

We describe two patients with extracerebral tumours histologically diagnosed as metastasis with focal necrosis (case 1) and a meningioma with microcystic features (case 2) examined by proton magnetic resonance spectroscopy. Tumour metabolism did not fit leterature report as lipids were not detected in the metastasis but were found in the meningioma whose in vitro spectrum also showed metabolic abnormalities. This discrepancy may be due to the technique adopted in case 1 and the small amount of tumour necrosis, but it is difficult to account for in case 2. Some explanations are offered but long term follow-up scans will establish whether the abnormal metabolic features indicative of a negative prognosis are confirmed by the patients evolution. The cases described do not necessarily call other literature reports into question, but warrant caution in establishing a diagnosis on the basis 1HMRS findings. Spectrum acquisition techniques need to be standardized and short TE measurements are more reliable than those made with long TE.

SUMMARY In a previous study, we reported an increase in the number of immunoglobulin-secreting cells and the augmentation of antibody production (IgM and IgG3) against unrelated antigens (sheep erythrocytes or bovine serum albumin (BSA)) in mice infected with the fungus Paracoccidioides brasiliensis as well as in mice inoculated with its cell wall preparation (CW). The immunomodulatory effect of the live fungus and CW preparation was dose-dependent and mainly restricted to the i.p. inoculation simultaneously to the BSA challenge by the i.v. route. In the present study, we investigated the active component of CW preparation upon the phenotype and also the degree of activation of possible target peritoneal cells involved in those phenomena. An insoluble polysaccharide fraction (F1 fraction) mainly composed of β-glucan and chitin, and the purified β-glucan (BGPb) behaved as CW in the augmentation of early antibody production. The peritoneal mononuclear inflammatory cells induced by CW, F1 fraction and BGPb were highly positive to α-naphthyl esterase staining; released low H2O2; expressed high levels of MHC-Iad molecules and produced inflammatory cytokines such as tumour necrosis factor-alpha (TNF-α) and IL-6. Phenotypic analysis by flow cytometry and immunohistochemical techniques of the inflammatory cells responding to F1 fraction showed a prevalence of (CD11b/CD18, Mac-1)+ peritoneal macrophages. In addition, s.c. inoculation of F1 fraction resulted in the formation of nodular, localized and not progressive granulomatous lesions with an accumulation of (CD11b/C18)+ macrophages. Adoptive transferred Mac-1 macrophages to immunized syngeneic recipient mice were able to cause an increase in anti-BSA antibody production. These results suggest that inflammatory (CD11b/CD18)+ macrophages may be related to immunological disturbances, caused by cell wall components of P. brasiliensis.

Nei trattamenti palliativi la chirurgia svolge un ruolo importante: l’obiettivo primario di qualsiasi chirurgia palliativa e il sollievo dei sintomi, con conservazione o miglioramento della qualita della vita [1]. Nella pratica oncologica, la chirurgia palliativa si riferisce in generale a interventi chirurgici di natura non curativa. La chirurgia palliativa coinvolge anche le procedure chirurgiche finalizzate principalmente al trattamento dei sintomi o delle complicanze associati al tumore.

Summary We report on data gathered from five European centres regarding 147 primary non-Hodgkin Lymphomas (NHLs) of the Central Nervous System (CNS) in HIV-negative patients. The results lead us to make the following considerations: i)there has been a significant and progressive increase in the frequency of observation of this pathology during the course of the last two decades; ii) the pathology lacks specific characteristic symptoms; iii) the radiological profile, as observed by CAT and/or MNR, most frequently corresponds to an isodense or slightly hyperdense lesion which has clear margins and is capable of assuming the contrast medium homogeneously; iv) the tumour most often has a single supratentorial localisation; v) high grade B-cell lymphomas account for 66 % of the observations, low grade B-cell varieties being relatively rare and cases of T-cell derivation exceptional (6/147); vi) immunohistochemistry allows the differential diagnoses with respect to primitive or secondary non-lymphoid tumours, and provides confirmation of the histogenetic assessment made on morphological grounds; vii) the course of the disease is not significantly influenced by the histotype, the phenotype, the number of lesions present or the chemotherapy regimen, but rather by the employment of combined surgery and radio- or radiochemotherapy. This study represents the largest series of CNS NHLs so far reported, and as such, provides precise clinico-pathological indications which were only partially obtainable from the relatively small previously published series. Some concluding remarks are made as to the genesis of CNS NHLs, along with some practical suggestions for reaching a better understanding of their complex biology.

Made available in DSpace on 2022-04-28T19:55:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2002-01-01 The polysaccharide fraction of Paracoccidioides brasiliensis mycelial cell wall (F1 fraction), the active component of which is composed of β-glucan, was investigated in regard to the activation of human monocytes for fungal killing. The cells were primed with interferon-γ (IFN-γ) or F1 (100 and 200 μg ml-1) or F1 (100 and 200 μg ml-1) plus IFN-γ for 24 h and then evaluated for H2O2release. In other experiments, the cells were pretreated with the same stimuli, challenged with a virulent strain of P. brasiliensis and evaluated for fungicidal activity and levels of tumor necrosis factor (TNF-α) in the supernatants. F1 increased the levels of H2O2in a similar manner to IFN-γ. However, a synergistic effect between these two activators was not detected. On the contrary, a significant fungicidal activity was only obtained after priming with IFN-γ plus F1. This higher activity was associated with high levels of TNF-α in the supernatants of the cocultures. Overall, P. brasiliensis F1 fraction induced human monocytes to release relatively high levels of TNF-α, which, in combination with IFN-γ, is responsible for the activation of human monocytes for effective killing of P. brasiliensis. Department of Microbiology and Immunology Biosciences Institute São Paulo State University-Botucatu, SP Department of Parasitology Microbiology and Immunology School of Medicine of Ribeirão Preto University of São Paulo, SP Department of Microbiology and Immunology Biosciences Institute São Paulo State University-Botucatu, SP

In brain tumors, the prognostic value of apoptosis is still debated, even though recent observations are rather negative. In 50 astrocytic gliomas, apoptotic nuclei were recognized by TUNEL technique and morphology and apoptotic index (AI), mitotic index (MI) and the MI/AI ratio were calculated in proliferative areas and in areas containing perinecrotic palisadings and hypercellular centres. In proliferative areas, a positive linear correlation between MI and AI and a MI/AI ratioI were found. The latter wasI in perinecrotic palisadings and hypercellular centres. This suggests the possibility that apoptosis is triggered respectively by cell proliferation and hypoxia. A small number of apoptotic nuclei was positive for c-Jun and JNKI, suggesting the involvement of this pathway in apoptosis as well as that of sphingomyelinase/ceramide. No relationship was found between AI and labeling indices of Bcl-2, Bcl-x, Bax, p53, APO.I/Fas. The rationale for a prognostic value of apoptosis in gliomas is thus poor.

Paget's disease of bone is a localized disorder of bony resorption. The mechanism underlying the development of the disease remains controversial. There is substantial evidence suggesting a genetic basis for Paget's disease in some patients. A viral etiology of Paget's disease has been advocated. A further hypothesis implicating an immunological mechanism for this disease is based on growing evidence reviewed in the text. The presented case showed clinical and X-ray features typical of a very aggressive form of Paget's disease. We hypothesize that the extreme local aggressiveness of this case was secondary to the patient's concomitant immunosuppression due to an extended therapy following renal transplant.

The filum terminale is an exceptional location for isolated hemangioblastoma. Only five cases are reported in literature, prior to the magnetic resonance imaging era. A 57-year-old man was referred to our Department with a prolonged history of progressive back pain, particularly severe when recumbent, and recurrent unilateral sciatalgia. Computed tomography demonstrated a non-homogeneous mass at L4 level. Magnetic resonance imaging displayed earliness and homogeneous enhancement of the mass with tortuous vessels above the rostral pole of the tumour, suggesting the diagnosis of a vascular tumour. The tumour was totally removed. Histological examination confirmed the hemangioblastoma diagnosis. The case indicates that hemangioblastoma, although uncommon, must be taken into consideration in cauda equina tumour diagnosis, and also emphasises the specificity of magnetic resonance features.

Osteoblastoma is a slow-progressing, benign bone tumor, that is not frequently observed in clinical orthopaedics (approximately 1% of all primary bone tumors). There is predilection for the vertebrae (posterior arch), the femur, the tibia, and the cranium; it affects young subjects (from 10 to 35 years), with predilection for males (males: females = 2:1). Symptoms are not very specific, characterized essentially by moderate, discontinuous pain, that is responsive to treatment by NSAIDS; it may, at times, be asymptomatic. On radiographic assessment it is viewed as a lytic area that is rounded, greater than 2 cm in size, with unclear margins, with or without peripheral bone reaction. It is not easy to diagnose osteoblastoma, particularly if it is localized in unusual sites, such as in the pelvis. The authors present a case of osteoblastoma of the acetabular bottom in a subject aged 22 years, that was not diagnosed unrecognized for about 2 years from the onset of symptoms.

We report a patient in whom the distal radius was resected for a giant cell tumour and the bone defect was replaced using a vascularized proximal fibular graft. The graft was viable and hypertrophied and normal callus formed on the distal radius. Due to chronic instability of the wrist the patient underwent revision arthrodesis 1 year after resection. Microscopic studies of the epishyseal region of the fibula showed wide necrosis of the graft with active creeping substitution. Despite the good technical result of the vascularized fibular graft, the vascularization was incomplete in the proximal epiphysis. We discuss possible reasons for this.

We describe a surgical technique for replacing the hip joint capsule using synthetic mesh after oncological resections of the proximal femur that resulted in gross intraoperative instability of the prosthetic reconstruction. The results of its use in 13 patients, 6 of whom also had pelvic resections, are described. These patients were selected from a total group of 88 patients undergoing proximal femoral replacement, 75 of whom did not require capsular replacement (none of these 75 patients have experienced dislocation). In the group requiring capsular reconstruction, 1 of 4 patients with bipolar hemiarthroplasty and 4 of 9 patients with total hip replacements experienced dislocation after operation. Of the dislocated total hip replacements, 1 remains chronically dislocated, and 3 were successfully stabilized by open reduction with further capsular augmentation. Given that the resections involved removal of most of the soft tissues stabilizing the hip joint, we believe that the technique of capsular reconstruction is useful in this difficult group of patients.

A variety of reconstructive procedures have been suggested for stabilizing the ulnar shaft following resection of the distal ulna for tumour. We present the results of a series of nine distal ulnar tumour resections in which four different stabilization techniques were employed. We based our results on an evaluation of function, pain, motion, strength and instability. We obtained good or excellent results in seven patients treated with a soft tissue stabilization of the ulnar stump. One patient did not undergo any stabilization procedure and scored fair in our system. A further patient who required a radiocarpal arthrodesis also had an inferior result. These results suggest that soft tissue stabilization of the ulnar stump should be performed whenever possible.

Primary central nervous system non-Hodgkin's malignant lymphomas (PCNSNHML) have undergone a remarkable increase in incidence in the last years. Clinically PCNSNHML may present with the symptoms that mimic many others neurological conditions. Radiologically they appear as iso or hyperdense deposits, often multiple, usually supratentorial in periventricular region. Histologically although most lesions are high grade B cell lymphomas, T cell lymphomas are being recognised with increasing frequency. Actually a substantial improvement in survival has been obtained using chemotherapy as sole treatment, eventually followed by radiotherapy for recurrences. The prognosis, however, remains poor in comparison with nodal lymphomas. It is improved by T-cell phenotype, a Karnofsky performance status more than 50%, age at onset less than 50 years and negativity for bcl-2 oncogene of neoplastic cells.

A series of 6 patients with primary T-cell lymphomas of the central nervous system (PTCLCNS) is presented. The clinical, histological and immunohistological findings are shown. The lesions were infratentorial in the 34% and sopratentorial in the 66% of the cases. Of the 5 cases with an available follow-up only one died in the first year after diagnosis and one is alive and well after 42 months. These data agree with those of others series of PTCLCNS in the literature. In conclusion our data and those of the literature suggest that immunophenotyping should routinely be carried in primary non-Hodgkin's lymphomas of the CNS (PNHLCNS), because the T-cell forms run a more favourable course than the B-cell varieties.

We report on data gathered from five European centres regarding 147 primary non-Hodgkin Lymphomas (NHLs) of the Central Nervous System (CNS) in HIV-negative patients. The results lead us to make the following considerations: i) there has been a significant and progressive increase in the frequency of observation of this pathology during the course of the last two decades; ii) the pathology lacks specific characteristic symptoms; iii) the radiological profile, as observed by CAT and/or MNR, most frequently corresponds to an isodense or slightly hyperdense lesion which has clear margins and is capable of assuming the contrast medium homogeneously; iv) the tumour most often has a single supratentorial localisation; v) high grade B-cell lymphomas account for 66% of the observations, low grade B-cell varieties being relatively rare and cases of T-cell derivation exceptional (6/147); vi) immunohistochemistry allows the differential diagnoses with respect to primitive or secondary non-lymphoid tumours, and provides confirmation of the histogenetic assessment made on morphological grounds; vii) the course of the disease is not significantly influenced by the histotype, the phenotype, the number of lesions present or the chemotherapy regimen, but rather by the employment of combined surgery and radio- or radiochemotherapy. This study represents the largest series of CNS NHLs so far reported, and as such, provides precise clinico-pathological indications which were only partially obtainable from the relatively small previously published series. Some concluding remarks are made as to the genesis of CNS NHLs, along with some practical suggestions for reaching a better understanding of their complex biology.

We report an unusual and possibly unique example of cerebral ganglioglioma with an anaplastic oligodendroglial component. The latter was documented on both morphological and immunohistochemical grounds. Immunohistochemically, the anaplastic cells were strongly positive with the monoclonal antibody anti-Leu-7, while they lacked glial fibrillary acid protein, vimentin and neurofilaments.

The authors describe an intraneural ganglion of the sural nerve at the ankle. This cause for sural neuropathy has never previously been cited. Resection of the sural nerve together with the indwelling cyst is suggested.

Several lines of evidence suggest that phosphorylation of tyrosine residue 416 (Tyr416) has a positive regulatory influence on the functional activity of the protein tyrosine kinase pp60c-src. To further examine the functional importance of phosphorylation at Tyr416, we have eliminated this phosphoacceptor site in four functionally unique mutant forms of the c-src gene product that are phosphorylated on Tyr416 in vivo. Substitution of phenylalanine for Tyr416 suppressed the biological activity of all of the mutant proteins as assayed by colony formation in soft agar and the induction of morphological alterations. However, the extent of this effect, and the degree to which the substitution affected the phosphorylation of substrates in vivo and in vitro, varied considerably in each of the mutants. These results support the notion that phosphorylation of Tyr416 has a positive regulatory effect on the biological activity of c-src; however, this effect does not directly correlate with a general effect on the total level of tyrosine kinase activity in vitro or the level of tyrosine phosphorylation of cellular proteins in vivo.

The characteristics of clear cells of an ependy-moma of the foramen of Monro have been studied by electron microscopy to precisely define its or-ganellar composition and to establish the tumor histogenesis. Our data confirm that the once-thought oligodendroglial is, in fact, an ependymal tumor. Both the scarce number of organelles, owing to the low degree of differentiation, and the abun-dance of hyaloplasmic lipid vacuoles can account for the clear appearance of these tumor cells.

We report the correlation between cytological and histological diagnoses in 101 stereotactic biopsies performed on space-occupying lesions of the CNS. Diagnostic accuracy was 89%, in line with the rates reported by other workers.

We reviewed the cases of 16 patients with primary intra-cranial lymphomas. The clinical and radiological data proved to be helpful in suggesting the diagnosis, but only tumoral biopsy provided unequivocal diagnosis. In our cases radiotherapy proved to be the most effective treatment

To assess the value of transbronchial lung biopsy in the evaluation of disease activity in pulmonary sarcoidosis, lung biopsy specimens obtained from 37 patients with this disease and their cellular patterns of bronchoalveolar lavage were studied. Morphologic analysis has showed peculiar lesions: predominant interstitial alveolitis consisting of mononuclear cells and scattered neutrophils, and eosinophils, diffuse in 13 cases and focal in 11 cases, interstitial nodular clusterings of mononuclear cells (five cases), diffuse intraalveolar infiltration of macrophages (one case), granulomas (27 cases), hyaline membranes (one case), intraalveolar (two cases) and interstitial (six cases) fibrosis, and finally cuboidal metaplasia of alveolar lining cells (eight cases). Hyaline membranes were always combined to a diffuse alveolitis consisting of some neutrophils. Only diffuse alveolitis was significantly associated with a high lymphocytosis in BAL (p less than 0.05).