A case of mesonephric adenocarcinoma of the vagina with a 1-year follow-up.

Mesonephric adenocarcinoma deriving from remnants of vaginal mesonephric ducts is one of the rarest tumors of the female genital tract with only three cases reported till date in international literature. Differential diagnosis from other aggressive tumors is complex and controversies exist in the literature regarding the biological behavior, prognosis, and optimal management strategies of these tumors. A 58-year-old woman presented with a large mass extending from the right adnexal region to the perineum and labia majora. CA125 was increased. A radical excision of the lesion with pelvic and para-aortic lymphadenectomy was performed. A well-capsulated mesonephric adenocarcinoma in a background of vaginal mesonephric remnants was diagnosed. Tumor cells showed immunoreactivity for pancytokeratin, cytokeratin (CK), CD 10, epithelial membrane antigen, vimentin, and calretinin; indeed they were negative for carcinoembryonic antigen, CK 20, estrogen receptor, and progesterone receptor. No evidence of lymph node involvement or metastatic disease was observed. The patient did not receive any adjuvant therapy and is alive and clinically free of disease at 1-year follow-up. In spite of the aggressive biological behavior attributed in literature to mesonephric carcinomas, which is probably due to the complex differential diagnosis with other müllerian tumors, the favorable course of our patient further supports the hypothesis that malignant mesonephric carcinomas may not behave aggressively and that radical surgery alone may be curative.

gamma-Aminobutyric acid inhibits beta-endorphin secretion from the anterior pituitary but not the neurointermediate lobe in the rat.

We have evaluated the role of gamma-aminobutyric acid (GABA) in the neuroendocrine control of beta-endorphin (beta-EP) secretion in the rat. Plasma beta-EP and beta-lipotropin (beta-LPH) levels and beta-EP-like immunoreactivity (beta-EPLI) in the anterior pituitary (AP) and neurointermediate lobe (NIL) were determined after administration of GABA antagonist or agonist drugs in male rats under resting conditions or after potent physical stresses. Bicuculline (0.1-0.8 mg/kg BW ip), a GABA receptor antagonist, induced a dose-related rise in plasma beta-EP and beta-LPH levels and a concomitant decrease in beta-EPLI concentrations in the AP but not in the NIL. Muscimol, a potent GABA-mimetic drug, did not alter baseline plasma beta-EP and beta-LPH levels, whether given systemically (1.0-2.0 mg/kg BW ip) or intracerebroventricularly (500 ng/kg BW), but prevented the effect of bicuculline on plasma and AP-beta-EP and beta-LPH concentrations. Administration of foot shock or restraint stress induced a clear-cut activation of the AP-related beta-EP secretion, an effect that was prevented by pretreatment with muscimol. Together, these data show that GABA-ergic mechanisms, probably operating at a central nervous system level, exert an inhibitory action on resting and stimulated beta-EP and beta-LPH secretion. Since no alterations in beta-EP concentrations in the NIL occurred after manipulations with GABA-ergic drugs or stress, and these were detected only in the AP, an interaction between GABA-ergic neurons and CRF neurons is the most likely explanation for the reported findings.

Heat shock activation of NFkB in rat liver is mediated by interleukin-1.

Exposure to high temperature (heat shock) activates the transcription factor NFkB in the liver of the living rat, but is not effective in hepatoblastoma cells in culture: on the contrary, activation of the heat shock transcription factor (HSF) occurs under both conditions. Pre-treatment of the rat with IL-1 receptor antagonist suppresses the activation of NFkB, which seems to be mediated by the release of this cytokine, but does not hamper the activation of HSF and the concurrent induction of hsp 70 mRNA. IL-1 activity actually shows a strong, albeit transient, increase in the blood of heat shocked rats.

Gas chromatographic determination of galactose in milk. Example of a switching valve used for the protection of the capillary column.

Galactose, a marker of heat treatment, has been analysed in milk as pentafluorobenzyloxime acetate by gas chromatography with flame ionization detection using a simple switching valve system. The procedure did not entail any prederivatization clean-up for lactose elimination from the sample. In a short pre-column, reagent and lactose derivative excess were separated and the galactose and internal standard derivatives were transferred to the analytical column by a four-port valve. Thus, the analytical column was protected from overloading, so avoiding rapid deterioration.

Post-transcriptional control of increased hepatic catalase gene expression in response to oxidative stress.

Catalase is an important member of the antioxidant network that protects the cell against reactive oxygen species (ROS). We studied catalase gene expression in the liver of rats exposed to oxidative stress induced by the ROS-generating drug nitrofurantoin (NF). Catalase enzymatic activity and content are enhanced by NF treatment. The corresponding increase in the steady state level of the messenger ribonucleic acid (mRNA) occurs without significant changes in transcription and seems therefore controlled post-transcriptionally. Indeed, RNA band-shift assays demonstrated a reduced binding of redox-sensitive cytoplasmic protein(s) to the 3' region of catalase mRNA in NF-treated rats, thus suggesting that the redox state of protein that binds to an antioxidant enzyme mRNA may play a role in the hepatic response to oxidative stress.

Unilateral periventricular nodular heterotopia associated with diffuse areas of cerebral functional abnormalities.

A 17-year-old boy with polymorphic simple and complex partial seizures is described. Magnetic resonance imaging revealed a unilateral periventricular nodular heterotopia near the occipital ventricular right horn. Interictal and ictal electroencephalographic recordings showed bilateral specific epileptiform anomalies in the occipital region and asynchronous slow waves in frontal areas. Single photon emission computed tomography documented a reduction in regional cerebral blood flow in an area of the left occipital cortex and a symmetric increase in tracer uptake in the frontal lobes. The neuropsychologic assessment revealed a dysfunction of the frontal associative areas. Data collected led the authors to suspect a more diffuse cortical dysfunction than the nodular heterotopia revealed on magnetic resonance imaging.

Exposure to formaldehyde and cancer mortality in a cohort of workers producing resins.

The mortality of 1,332 male workers employed at least 30 days in 1959-1980 in a resins-manufacturing plant was examined. Ambient measurements taken in the plant between 1974 and 1979 documented a potential for exposure to levels of formaldehyde as high as greater than 3.0 mg/m3. Vital status was ascertained for 98.6% of the cohort members, and their mortality was compared with expected deaths drawn from the national and local population rates. A statistically significant increase in lung cancer was observed, based on 18 deaths, which was not fully accounted for by possible confounding factors linked to personal habits or sociocultural characteristics. This elevated risk, however, could not be attributed specifically to exposure to formaldehyde. Mortality from digestive cancer (14 deaths observed) and hematologic neoplasms (5 deaths observed) was not substantially higher than expected. The study was limited by information bias due to incomplete work histories, by the small number of deaths from some relevant causes, and by the possibly insufficient length of the observation period. Therefore these results do not provide sufficient grounds either to link formaldehyde exposure in the plant to the increased cancer risk noted or to exclude that formaldehyde might pose such a risk to humans under certain exposure circumstances.

Cancer mortality of an Italian cohort of workers in man-made glass-fiber production.

This study was undertaken in order to examine possible long-term effects, particularly cancer, associated with working in the man-made glass-fiber production industry in Italy (glass wool and continuous filament). All male production workers employed for a minimum of one year between 1944 and 1974 were admitted to the study (1,098 subjects), and their mortality was examined in the period 1944-1983 (21,325 person-years). The vital status ascertainment was successful for 98.9%, of the cohort members. An increased risk of cancer of the larynx was noted based, however, on only four deaths. When contrasted with the values of the local population, the increase proved to be statistically significant after 25 years since first exposure. The higher than expected larynx cancer mortality was confined to workers hired before the age of 25 years, exposed for at least 15 years, who started exposure before 1960 (main production: glass wool), and who belonged to the highest cumulative exposure categories. Known confounding factors could not completely account for the excess observed. Among the numerous studies carried out on man-made glass-fiber workers, only one incidence study in France support our findings. No other increased cancer risks have been suggested by the present study.

[Focus. An expert system for the clinical diagnosis of the location of acute neurologic events]. / Focus. Un sistema esperto per la diagnosi clinica di sede di incidenti neurologici a comparsa acuta.

Focus is an expert system developed to diagnose, by the findings on neurological examination, the anatomic location of an acute neurologic event. The inference engine uses a forward tracking algorithm and a rule based data base that includes associations of neurological signs with specific anatomic areas. Focus is linked to a data base in which all personal cases and final diagnoses confirmed by laboratory studies are stored. This makes it possible to assess the validity of the system's diagnoses and use personal cases as additional example to the revision of the rules. The program is easy to use and runs on MS-DOS microcomputer. Furthermore the diagnostic rules are accessible so Focus may furnish an interactive teaching device.

[Pyomyositis in Italy: report of a clinical case]. / Piomiosite in Italia: descrizione di un caso clinico.

Pyomyositis is an infection of the striated muscle seen frequently in Africa but rarely in Western countries with a temperate climate. Over the last few years it has been observed with increasing frequency, especially in immunocompromised hosts. An unusual case of pyomyositis in a 65-year-old immunocompetent woman is described. The disease emerged during septicemia caused by Staphylococcus aureus. It was associated with pleuropneumonia and affected two different and opposite groups of muscles. Diabetes mellitus, a known predisposing factor, was diagnosed during the infection. The diagnosis of pyomyositis was based on microbiological cultures, computed tomography, and radio-labelled granulocyte scintigraphy. Follow-up until recovery was based on computed tomography. Surgical drainage of abscesses was avoided thanks to early diagnosis and specific antibiotic therapy.

[Use of mechanical staplers in surgery of aneurysms of the abdominal aorta]. / L'impiego delle cucitrici meccaniche nella chirurgia degli aneurismi dell'aorta addominale.

This research aims to illustrate the advantages of using staplers in abdominal aorta surgery. The authors describe their experience in a personal case, of a patient suffering from aneurysmatic expansion of the abdominal aorta extending to both the common iliac arteries. The use of staplers for the closing of the distal stumps in particularly advantageous because it makes less problematic the dissection of the iliac and by hypogastric artery from their underlying veins. That involves a risk diminution of the iliac vein accidental lesions, better by hypogastric artery revascularization, shortening of any times and the perfect haemostatic holding of the mechanical suture, allowing a reduction in mortality and morbidity.

[Does arterial embolization have a role in the treatment of cavernous hemangioma of the liver in adults?]. / L'embolisation artérielle a-t-elle une place dans le traitement des hémangiomes caverneux du foie de l'adulte?

Embolization of the hepatic artery for cavernous haemangioma is discussed on the basis of 7 cases (3 giant haemangiomas, 4 medium sized or small), all symptomatic. Therapeutic embolization reduced the tumoral mass in 3 cases but had little effect on the symptoms. There was no complication. Arterial embolization is a relatively non-aggressive method, but it does not suppress the lesion. It should therefore be reserved to symptomatic or complicated cases, where reduction of the mass can be expected to result in functional improvement. Such cases are too exceptional for embolization to be performed routinely in adult patients with cavernous haemangioma of the liver.

Mortality in an area contaminated by TCDD following an industrial incident.

The mortality experience of the population, aged 20-74 years, living in an area contaminated by TCDD after an industrial accident in 1976, was examined in the period 1976-1986 and compared with the mortality of the population of the surrounding noncontaminated territory. People who left the area during the study period were followed up, and vital status was successfully ascertained for over 99% of the cohort members. An increased mortality, from chronic ischemic heart disease (males) and hypertensive disease (females), which could not be explained in terms of chance, confounding, or bias, was noted in the exposed population. The stressful experience of the population in the aftermath of the disaster was deemed relevant to the interpretation of these findings. Overall, cancer mortality was not increased. Suggestive increases, however, were seen for melanoma, brain cancer, soft tissue sarcomas and certain hematologic neoplasms, whereas mortality from breast cancer and cancer of the liver was noticeably decreased. Further research is in progress in order to thoroughly investigate the association, if any, of cancer occurrence with TCDD contamination.

[A follow-up study of 304 cases of suspected pathology caused by benzene seen in 1950-71]. / Studio a distanza di 304 casi di sospetta patologia da benzene osservati negli anni 1950-1971.

A group of 304 subjects admitted to the Institutes of Occupational Health of Milan and Pavia (Italy) between 1951 and 1970 for suspected benzene intoxication were retrieved from hospital records and their mortality experience was examined up to 31 December, 1986. The aims of the study were: 1) to estimate, in quantitative terms, the risk associated with benzene exposure in that area in the time period considered (these risks had already been reported, but merely as case reports); 2) to investigate the possibility of an increased frequency of neoplasms other than leukaemia; and 3) to further investigate the exposure history of these subjects. In the absence of data on the population at risk, mortality was analysed via the mortality odds ratio (MOR) method. A local population mortality experience was used as reference. Twenty-eight malignant neoplasms were observed (MOR = 2.2; 95% confidence interval = 1.3-3.7), 15 of which were haematologic neoplasms (MOR = 13.3; 95% confidence interval = 8.0-22.2). No odds ratio increases were observed for any of the other tumour sites or types. Eleven observed blood diseases represented a large numerical increase in the odds ratio. For all the haematologic neoplasms there had been an estimated exposure to airborne benzene concentrations above 20 ppm. However, no conclusions on dose-response relationships can be drawn from these data because of the approximate evaluation of individual exposure and, especially, because the study group most probably consisted of a highly selected sample of the exposed population.(ABSTRACT TRUNCATED AT 250 WORDS)

Tactile extinction in childhood hemiplegia.

Tactile extinction was investigated by the Quality Extinction Test (QET) of Schwartz in 39 patients, 34 of whom had congenital hemiplegia and five early-acquired hemiplegia. Extinction values were significantly higher in hemiplegia patients than in controls and usually contralateral to the side of brain damage, except for four cases with right hemiplegia. Values were also higher in males than in females. There were no significant differences between patients with left and right hemiplegia, and no correlations between extinction and IQ or the presence of epilepsy. There was a correlation between QET scores and neuroradiologically proven cerebral atrophy. The meaning of extinction in hemiplegic patients and the principal theories regarding the pathogenesis of neglect are discussed.

Differential activation of heat shock and nuclear factor kappaB transcription factors in postischemic reperfused rat liver.

The aim of this study was to investigate the behavior of the transcription factors, heat-shock factor (HSF) and nuclear factor kappaB (NF-kappaB), in postischemic reperfused liver, with particular attention paid to possible differences in the time-course and mechanism of activation, which may help in defining their role in the response of the liver to reperfusion. Ischemia was induced by clamping the hilar pedicle of the left lateral and median liver lobes; the clamp was removed after 1 hour. Some rats were treated intraperitoneally with IL-1 receptor antagonist (IL-1RA) 30 minutes before ischemia and at the time of reperfusion. Binding of NF-kappaB to the corresponding consensus sequence is activated after 30 minutes of reperfusion, and is still increased 1 hour after reperfusion. Activation is suppressed in rats treated with IL-1RA; NF-kappaB persists in the cytosol associated with the inhibitor, IkappaB, and can be artifactually activated in vitro. Super-gel shift experiments revealed that the two subunits, p50 and p65, are involved in the activation of binding. In contrast, binding of HSF to the corresponding consensus sequence, heat shock element (HSE), is already activated at the end of ischemia, shows a further increase after 30 minutes of reperfusion, but declines 1 hour after reperfusion; more importantly, it is not inhibited by pretreatment of the rat with IL-1RA. In conclusion, although both HSF and NF-kappaB are activated by ischemia-reperfusion, there are clear differences in time-course and mechanism of activation of the two transcription factors. Activation of HSF depends directly on some events occurring during ischemia; NF-kappaB is activated only after reperfusion and the concurrent oxidative stress, by an indirect mechanism that can be suppressed by IL-1RA. The possibility of dissociating the activation of these two transcription factors in postischemic reperfusion can have a prospective clinical relevance.

Differential activation of some transcription factors during rat liver ischemia, reperfusion, and heat shock.

Cells respond to external stimuli by changes in gene expression that are largely dependent on transcription factors (TFs). We studied the behavior of some TFs in rat liver during ischemia, postischemic reperfusion, and heat shock. Knowledge of the conditions at the end of ischemia is essential to understand changes occurring at reperfusion. The TFs investigated are known to be typically responsive to heat shock (HSF), hypoxia (HIF-1), pro- and antioxidant conditions (AP-1), or to various environmental changes (HNF-1 and ATF/CREB family). The most relevant new information includes the following: 1) Liver ischemia activates extremely rapidly the DNA binding capacity of HSF, soon followed by analogous activation of HIF-1 and AP-1. 2) After a certain lag time from the activation of HIF-1, mRNAs accumulate for two glycolytic enzymes, in particular Aldolase A and Heme Oxygenase 1, which contain HIF-1 sequences in their promoters. 3) Reperfusion, which is known to further increase the binding of HSF and to induce NFkappaB binding, abrogates or decreases the binding of HIF-1 and AP-1, stimulated by ischemia, and activates the binding of ATF/CREB. Later on, a second peak of AP-1 binding is induced. 4) Heat shock activates both ischemia-responsive and reperfusion-responsive TFs. 5) Preliminary experiments of supergelshift reveal that the activation of AP-1 at reperfusion or upon heat shock may result from the different involvement of the component subunits.

Differential activation of heat-shock and oxidation-specific stress genes in chemically induced oxidative stress.

Post-ischaemic reperfusion increases the level of the major heat-shock (stress) protein hsp 70 and of its mRNA by transcriptional mechanisms, and activates the binding of the heat-shock factor HSF to the consensus sequence HSE. In common with CoCl2 treatment, post-ischaemic reperfusion increases the level of haem oxygenase mRNA, an indicator of oxidative stress, but CoCl2 does not seem to induce the expression of the hsp 70 gene [Tacchini, Schiaffonati, Pappalardo, Gatti and Bernelli-Zazzera (1993) Lab. Invest. 68, 465-471]. Starting from these observations, we have now studied the expression of two genes of the hsp 70 family and of other possibly related genes under conditions of oxidative stress. Three different chemicals, which cause oxidative stress by various mechanisms and induce haem oxygenase, enhance the expression of the cognate hsc 73 gene, but do not activate the inducible hsp 70 gene. Expression of the other genes that have been studied seems to vary in intensity and/or time course, in relation to the particular mechanism of action of any single agent. The pattern of induction of the early-immediate response genes c-fos and c-jun observed during oxidative stress differs from that found in post-ischaemic reperfused livers. Oxidative-stress-inducing agents do not promote the binding of HSF to its consensus sequence HSE, such as occurs in heat-shock and post-ischaemic reperfusion, and fail to activate AP-1 (activator protein 1). With the possible exception of Phorone, the oxidative stress chemically induced in rat liver activates NFkB (nuclear factor kB) and AP-2 (activator protein 2) transcription factors.