Gonadal function in males with autoimmune Addison's disease and autoantibodies to steroidogenic enzymes.

Steroidogenic enzyme autoantibodies (SEAbs) are frequently present and are markers of autoimmune premature ovarian failure (POF) in females with autoimmune Addison's disease (AAD). The prevalence and significance of SEAbs in males with AAD have not yet been defined. We studied the prevalence of SEAbs in a large cohort of males with AAD and assessed the relationship between SEAbs positivity and testicular function. A total of 154 males with AAD (mean age 34 years) were studied. SEAbs included autoantibodies to steroid-producing cells (StCA), detected by immunofluorescence, and steroid 17α-hydroxylase (17α-OHAbs) and side chain cleavage enzyme (SCCAbs) measured by immunoprecipitation assays. Gonadal function was evaluated by measuring follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHGB), anti-müllerian hormone (AMH) and inhibin-B (I-B). Twenty-six males, 10 SEAbs((+)) and 16 SEAbs((-)), were followed-up for a mean period of 7·6 years to assess the behaviour of SEAbs and testicular function. SEAbs were found in 24·7% of males with AAD, with the highest frequency in patients with autoimmune polyendocrine syndrome type 1 (APS-1). The levels of reproductive hormones in 30 SEAbs((+)) males were in the normal range according to age and were not significantly different compared to 55 SEAbs((-)) males (P > 0·05). During follow-up, both SEAbs((+)) and SEAbs((-)) patients maintained normal testicular function. SEAbs were found with high frequency in males with AAD; however, they were not associated with testicular failure. This study suggests that the diagnostic value of SEAbs in males with AAD differs compared to females, and this may be related to the immunoprivileged status of the testis.

Proximal-type epithelioid sarcoma of the mons pubis: report of a case.

INTRODUCTION: Proximal-type epithelioid sarcoma (PES) represents an extremely rare and aggressive form of soft tissue neoplasm, typically presenting as a painless subcutaneous nodule in the trunk often located in the genital area. CASE REPORT: A 46-year-old female was subjected to the excision of a growing soft tissue mass in the mons pubis that, at histology, was identified as PES. The tumor showed an extreme aggressiveness involving subsequently adjoining structures and lymph nodes despite subsequent wide surgical resections during the following months. DISCUSSION: Gynecologists should pay careful attention to all soft tissue masses of the perineal area or external genitalia. It is important to know the possible genital localization of PES which, although rare, is an aggressive high-grade soft tissue tumor with a deceitful behavior, poorly sensitive to chemotherapy and radiotherapy. Surgery, though wide and demolitive, often fails to obtain the necessary radicality.

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome.

OBJECTIVE: To evaluate whether histological chorioamnionitis (HCA), in the setting of preterm premature rupture of membranes (PPROM), affects infant respiratory outcome. DESIGN: A prospective histological study on 287 consecutive placentas was performed in preterm infants (

Endometrial cancer: asymptomatic endometrial findings. Characteristics of postmenopausal endometrial cancer.

Endometrial cancer affects patients at every age, however it occurs more frequently in menopause (> 50) and in postmenopause (> 70). The most frequent symptoms are bleeding and vaginal discharge. When hematometra or pyometra is present the patient may feel pain. In some cases endometrial adenocarcinoma is asymptomatic and the diagnosis is casually made during ultrasound examination or by histological examination of a uterus surgically removed for other indications. In these cases the most frequent findings are polyps and abnormally increased thickness of the endometrial mucosa. In postmenopause polyps and abnormal endometrial thickness are usually limited to a small area and surrounded by atrophic mucosa. Higher incidence rates of endometrial cancer were correlated with polyps and an increased number of serous type tumors were identified in the > 65-year age group. Endometrial carcinoma may be estrogen correlated or non-estrogen associated. Patients in postmenopause are often affected by non-estrogen correlated endometrial carcinoma. According to Kurman and other authors the first type of endometrial adenocarcinoma (estrogen correlated) is characterized by low-grade malignancy. On the contrary, non-estrogen correlated neoplasia is more aggressive. In our case series including 102 women aged > 70 years with endometrial carcinoma we found that survival was correlated with stage and grading - early stages were the most frequent and the grade increased with stage. In fact all the patients with relapses had grade 2 or 3 adenocarcinomas. Thirty-one patients > 70 years (30.69%) had a non-endometrioid type of cancer.

Biochemical and morphological observations on rat liver and kidneys six months after intravenous injection of a perfluorocompound emulsion.

The histological appearance of liver and kidneys and the energy metabolism of isolated liver and kidney mitochondria were evaluated in rats 6 months after intravenous administration of 1 ml of a perfluorocompound emulsion. Both liver and kidney specimens showed neither significant histological alteration nor the presence of intracytoplasmic perfluorocompound particles. A substantial depression of the rate of ATP synthesis was observed both in liver and kidney isolated mitochondria (with respect to control mitochondria) although the magnitude of the transmembrane electrical potential was unaltered. The depression of ATP synthesis in mitochondria isolated from perfluorocompound-treated rats appeared then unrelated to the presence of perfluorocompound micelles within the cells, and might result from the interaction of either the perfluorocompound or the emulsifying agent with the mitochondrial ATP synthetase.

Transcriptional downregulation of tight junction protein ZO-1 in active coeliac disease is reversed after a gluten-free diet.

UNLABELLED: Coeliac disease is an autoimmune enteropathy characterized by an enhanced permeability of the intestinal epithelial barrier. In epithelial cells paracellular permeability is regulated by intercellular tight junction. The cytoplasmic protein ZO-1 interacts directly with F-actin and plays a pivotal role in the structural and functional organization of tight junction. AIM: The aim of this study was to investigate the expression and localization of ZO-1 in the intestinal mucosa of coeliac patients. PATIENTS AND METHODS: Twenty patients with active coeliac disease, seven of whom underwent a repeat biopsy following a gluten-free diet and 27 control subjects, were studied. In all subjects, three biopsies were obtained from distal duodenum during upper gastrointestinal endoscopy. ZO-1 protein localization and levels were detected by immunofluorescence followed by confocal microscopy analysis and immunoblotting. ZO-1 mRNA expression was assessed by RT-PCR. F-actin distribution was also investigated. RESULTS: In patients with active coeliac disease, both ZO-1 protein levels and mRNA were clearly reduced. Cytoskeletal organization was disrupted with F-actin staining concentrated at the subcortical and basal surface regions. Abnormalities in ZO-1 expression and actin organization were reversed after a gluten-free diet. CONCLUSIONS: In active coeliac disease, ZO-1 protein expression is downregulated at the transcriptional level in association with F-actin redistribution. These changes are completely reversed after a gluten-free diet and could contribute to the increased intestinal paracellular permeability observed in this disorder.

Prevalence of coeliac disease in primary biliary cirrhosis and of antimitochondrial antibodies in adult coeliac disease patients in Italy.

BACKGROUND: Although an association between primary biliary cirrhosis and coeliac disease has recently been reported in Northern Europe, there are still conflicting data concerning this issue. AIM: To evaluate both the prevalence of coeliac disease in a series of primary biliary cirrhosis patients and that of antimitochondrial antibodies in a series of adult biopsy proven coeliac disease patients from Northern Italy. PATIENTS AND METHODS: A total of 87 primary biliary cirrhosis patients (79 female, 8 male) were screened for both IgA-transglutaminase antibodies and antiendomysium antibodies and, in those with either IgA-transglutaminase antibodies or antiendomysium antibodies positivity, upper endoscopy with distal duodenum biopsy was offered. In those who refused upper endoscopy, the intestinal permeability test with lactulose/mannitol excretion was performed. RESULTS: Antiendomysium antibodies positivity was detected in 3 subjects (3.4%), all of whom had serum IgA-transglutaminase antibodies above the normal range, and fulfilled the diagnosis of coeliac disease. Of 21 other patients with serum IgA-transglutaminase antibodies above the normal range, 17 underwent upper endoscopy which revealed normal duodenum architecture. The remaining 4 patients underwent the lactulose/mannitol excretion test which was within the normal range. Sera from 108 adult coeliac disease patients were tested for antimitochondrial antibodies and positivity was found in 4 patients (3.7%): all had normal liver biochemistry tests, whereas 2 of them also presented thyroid disease. Antibodies directed to the 74-kDa polypeptide of antimitochondrial antibodies were found in 3 out of 4 antimitochondrial antibodies+ve patients. CONCLUSIONS: These results suggest an association between primary biliary cirrhosis and coeliac disease similar to that observed in the Northern European series. In conclusion, screening for coeliac disease with antiendomysium antibodies in primary biliary cirrhosis is justified, and screening for antimitochondrial antibodies is advisable in adult coeliac disease patients.

NMR determination of isosorbide dinitrate and beta-adrenergic blocking agents in tablets.

An NMR spectroscopic method for the determination of isosorbide dinitrate, alone or together with alprenolol or propranolol, is described. Spectra are determined in dimethyl sulfoxide-d6 containing maleic acid or 1,4-dinitrobenzene as internal standards. Both synthetic mixtures and commercial formulations were assayed, and the results were compared using compendial procedures.

Polyps at the site of ureterosigmoidostomy.

Anatomoclinical findings in 6 patients under long-term control of ureterosigmoidostomy, performed 5 to 26 years previously for nonneoplastic bladder pathology, are reported. Four histologically confirmed polyps are described and histopathogenetic theories are discussed. The authors suggest that these polyps arise from the ureter via glandular metaplasia due to external contact surgically created in urinary diversion.

Malignant Brenner tumor of the ovary: case report with a review of the literature.

A case of malignant Brenner tumor of the ovary is reported. From a survey of the literature some anatomo-clinical considerations are drawn and the histopathologic criteria for diagnosis are discussed.

Role of fine-needle aspiration cytology in the preoperative evaluation of smooth muscle tumors.

A preliminary study was undertaken to assess the feasibility and the diagnostic role of fine-needle aspiration cytology (FNAC) in the preoperative evaluation of eight uterine smooth muscle tumors manifesting as single large masses with signs of growth. Percutaneous FNAC was performed under echographic control with a 22-gauge needle and the material was stained according to conventional techniques. Histology of surgically resected specimens was available for final diagnosis and comparative analysis in all the cases, including five leiomyomas (LM), one smooth muscle tumor of uncertain malignant potential (TUMP), and two low-grade leiomyosarcomas (LMS). Cellularity, as indicated by the density (crowding) of nuclei reflecting the amount of cytoplasmic volume, and the cohesiveness of the tissue fragments in the smears appeared to be the most important diagnostic parameters in the distinction between LM and LMS. LM usually showed few scattered poorly cellular fragments of highly cohesive tapering cells without nuclear crowding and with abundant cytoplasm. LMS usually showed a large number of single cells and fragments of loosely arranged tapering cells with nuclear enlargement and crowding and ill-defined scanty cytoplasm. Borderline forms such as TUMP were hardly distinguishable from LMS and LM. FNAC appears to be a feasible preoperative procedure in uterine smooth muscle tumors and may play a diagnostic role, especially in distinguishing frankly benign from overtly malignant forms.

Endometrial adenocarcinoma and life expectancy in elderly women.

One hundred and six patients with endometrial adenocarcinoma, aged over 70 years, admitted to Gynaecologic Oncological department of Gynecology and Obstetrics Institute of Padua University, from 1/01/1974 to 31/12/1994, were studied. The life expectancy of these women was good, with a personalized abdominal or vaginal surgery, alone with or without lymphadenectomy, or, in advanced stages, associated with integrated therapies. In our case series an increasing frequency of this neoplasia in elderly women appears significant.

Epidermoid cyst and primary trabecular carcinoid of the ovary: case report.

In the literature and in our experience epidermoid cysts and carcinoids of the ovary are rare benign pathologies which occur more frequently in younger women. They probably are a one-sided development of a teratoma, which arise from germ cells after the first meiotic division due to either a meiosis I or a meiosis II non dysjunction. Diagnosis is possible only with histological examination and immunohistochemistry which allow us to differentiate carcinoids from sex-cord tumors and ependymomas. Prognosis is very good because the rate of malignant transformation is 1.4%-2% and the rate of complications is 14%. Thus conservative surgical therapy associated with long-term follow-up is the treatment of choice.

Epithelial ovarian tumors in young women under 35 years.

The aim of this study was to investigate the clinical-pathological pattern of primary malignant epithelial ovarian tumors in women under 35 years old. We have retrospectively analyzed data from 545 patients with these tumors, identifying 49 patients under age 35. We found a higher frequency of borderline tumors and early-stage tumors in young women than in those over 35. The influence of age as a factor in survival was evaluated by comparing the outcome in young patients and in women over 35. The 5-year survival rate, according to stage and aggressiveness factors, was significantly better in young patients. These findings support the concept of a preclinical phase of epithelial carcinoma and show that young women may be selected for conservative surgery, allowing a good quality of life.

Intraductal breast papilloma in adolescent. Case report.

Cytological and histological finding of an intraductal breast papilloma in a 14 year old girl is reported. The differential diagnosis with other adolescent breast pathology is discussed.

Anatomopathologic aspects of ovarian endometriosis.

The Authors reviewed 284 cases of endometriosis; it interested all age ranges with prevalence of four and fifth decades and showed a range of 19-68 years. Favourite sites was ovary with 271 cases, remaining were: tubes, omentum, vagina, vulva and cecum. The histological appearance is similar to normal endometrium but these foci react to hormonal stimulation variably.

Rectosigmoid endometriosis: diagnosis and surgical management.

The recurrence of endometriosis varies from 6% to 10% and, among the non-gynaecological sites, the bowel is involved in 12%-37%. Various symptoms, such as dysmenorrhea, dyspareunia, chronic pelvic pain, diarrhoea, constipation, cyclic rectal bleeding, colic-abdominal pain up to intestinal occlusion characterize this pathology. Surgery seems to be the best treatment especially for gastrointestinal symptoms; conservative surgery should be performed, particularly in young patients. Four cases of intestinal endometriosis were reevaluated.

Realdo Colombo's "De Re Anatomica": the renaissance origin of the term "placenta" and its historical background.

Over the centuries, great interest has been devoted to the placenta and to its highly symbolic significance. The Renaissance represented the age of historical and cultural transition between classical and modern scientific paradigms. In the medical setting, Realdo Colombo represents one of the protagonists of this revolution. In his masterpiece, "De Re Anatomica", he revolutionized the former medical perspective. We present a passage from this book, which carries invaluable information on the Renaissance viewpoint on pregnancy and placental biology. The connections between Colombo's theories and the previous medical tradition are also analysed.