Prognostic relevance of cell proliferation in major salivary gland carcinomas.

Several proliferation markers, such as DNA ploidy, Ki67, MiB1 and proliferating cell nuclear antigen have been shown to correlate with clinical course and prognosis in several epithelial tumours and lymphomas. In the present study, the prognostic relevance of these markers was evaluated in major salivary gland carcinomas. A sample of 36 cases out of 85 patients submitted to surgery for major salivary gland carcinomas at our institution between 1987 and 1997 were studied. The sample comprised 8 adenoid-cystic carcinomas, 6 ductal carcinomas, 11 mucoepidermoid carcinomas and 11 acinic cell carcinomas. Follow-up ranged from 1 to 12 years (mean 6.2). In some patients, DNA ploidy (euploid or aneuploid) was studied by flow cytometry. In others, proliferation activity was studied by means of monoclonal antibody MiB1, identifying cells in the proliferative cycle. In some patients, both techniques were used. Follow-up was related to these indices, TNM and stage. Even if ploidy suggested a favourable outcome in diploid cancer (13 favourable vs. 2 unfavourable) and poor outcome in aneuploid cancer (4 favourable vs. 5 unfavourable), the difference was not statistically significant with p = 0.06 in Fisher's exact test. Instead, the proliferative tumour cell fraction, evaluated by MiB1, was statistically correlated with prognosis. Comparing survival curves by Log rank Test it yielded p = 0.007 using an MiB1 cut-off of 5. Applying a cut-off of 20 yielded p = 0.001. Of particular interest were MiB1 values in acinic cell carcinomas for which grading is challenging and lacks consensus. In our group of acinic cell carcinomas, survival correlated with values of MiB1 > or < 15 with p = 0.009 in Log rank test. In conclusion, despite a trend towards correlation between ploidy and prognosis, the present study yielded p = 0.06, whereas the proliferative fraction assessed by MiB1 was significantly correlated with outcomes. Indeed, "growth fraction" in acinic cell carcinomas may stratify different classes of risk.

[Changes in the cell-mediated immune system in post-traumatic sepsis]. / Alterazioni del sistema immunitario cellulo-mediato nella sepsi post-traumatica.

OBJECTIVE: We studied the alterations of cell-mediated immunity (CMI) in polytrauma patients and its relation with sepsis. DESIGN: a prospective study. SETTING: ICU, Ospedale Maggiore, Bologna (Italy). PATIENTS: We included in the study 42 patients with at least two of following criteria: 1) Trauma Score < or = 12; 2) Abbreviated Injury Score > or = 4; 3) Arterial Pressure on admission < or = 80 mmHg; 4) Injury Severity Score > or = 16. CMI examinations were carried out at three different post-traumatic times (T0-T2). Seventeen patients developed a sepsis within the first eight days from admission. RESULTS: Sepsis caused a temporary impairment in some lymphocyte subsets at T2. The patients who developed sepsis showed a significant subset percentage difference for CD3, CD3 activated (p < 0.05) and for interleukin-2 receptor (IL-2R) (p < 0.01) in comparison with the non septic group. At T2, the seven septic patients who died, showed a marked depression of IL-2 values (0.37 +/- 0.12 UI/ml) in comparison with the values of septic patients who survived (0.66 +/- 0.25 UI/ml; p < 0.01) and with the group of non septic patients (0.83 +/- 0.5 UI/ml; p < 0.001). Septic patients who had a IL-2 value of 0.45 or lower had a mortality of 75%. IL-2 values showed a specificity of 89% and a sensibility of 75% in predicting mortality in septic trauma patients. CONCLUSION: We believe that in polytrauma patients IL-2 values monitoring could be a reliable index of the disfunction of CMI and that IL-2R sieric levels could be a diagnostic marker of impending sepsis.

Lyme disease. First reported case in Sicily.

Recently many cases of Lyme disease have been described in Italy. The patients come prevalently from Friuli Venezia Giulia and the eastern Ligurian Coast. Isolated cases have been diagnosed in other parts of northern Italy and in the central regions. We describe the first Sicilian case, concluding that Lyme borreliosis may well be widely distributed in our country.