A high-density tissue microarray from patients with clinically localized prostate cancer reveals ERG and TATI exclusivity in tumor cells.

BACKGROUND: Prostate cancer (PCa) is characterized by high tumor heterogeneity. In 2005, the fusion between the androgen-regulated gene TMPRSS2 and members of the ETS family was discovered in prostate cancer. In particular, fusion of TMPRSS2 with ERG was found in approximately 50% of prostate cancers and considered as an early event in the onset of the disease. The prognostic value of this fusion is still contradictory. Bioinformatics showed that overexpression of SPINK1 gene in a subset of fusion-gene-negative prostate cancers was associated with a poor prognosis. In theory, overexpression of the tumor-associated trypsin inhibitor (TATI) protein encoded by SPINK1 in fusion-gene-negative tumor cells opens the way to selected treatments for genotypically different cases. However, their expression has never been assessed at the cellular level in the same tissue samples. METHODS: As ERG expression has been shown to be a surrogate of fusion gene occurrence in prostate cancer, we have used double immunohistochemical staining to assess expression of ERG and TATI on a large tissue microarray comprising 4177 cases of localized prostate cancer. RESULTS: We did not detect any co-expression of ERG and TATI in the same cancer cells, which confirms previous suggestions from in silico studies. ERG was associated with Gleason score (GS), surgical margins and pathological stage, but had no prognostic value in this cohort. TATI was weakly associated with pathological stage but had no significant association with outcome. CONCLUSIONS: We here provide a morphological basis for ERG and TATI exclusivity in prostate cancer cells. Future therapies should be based on a combination of different targets in order to eradicate tumor cells with gene fusions and cells expressing other tumor-associated antigens. Further studies are needed to understand why ERG and TATI are not co-expressed in the same prostatic tumor cells.

Australian lungfish (Neoceratodus forsteri): a missing link in the evolution of complementary side biases for predator avoidance and prey capture.

Side biases in behavior, reflecting lateral specializations of the brain, are widespread amongst vertebrates. We studied laterality in the Australian lungfish (Neoceratodus forsteri) to gain insight into the evolution of the complementary specializations of predator avoidance (right hemisphere) and foraging behavior (left hemisphere). Because N. forsteri is the closest extant ancestor of the first land-dwelling vertebrates, knowledge of laterality in this species should provide a missing link in the transition from fish to tetrapods. Predator escape responses were elicited by generating pressure waves and a significant bias for C-start responses to the left side was found. This bias was unaffected by activity levels that change according to a diurnal cycle: activity is higher in the dark phase than the light phase. A complementary bias to turn to the right side was found during feeding behavior. This pattern of opposite-side specializations matches that known for fish, anurans, reptiles, birds and, as some evidence indicates, also mammals. Hence, we conclude that it is a homologous pattern of lateralization that evolved in early aquatic vertebrates and was retained as they made the transition to land-dwelling tetrapods.

[A serious complication in colorectal surgery: anastomotic leakage. Our experience]. / Una grave complicanza in chirurgia colorettale: la fistola anastomotica. Nostra esperienza.

Anastomotic leakage is a severe complication in colorectal surgery with a lot of generic and specific risk factors. There are still controversies about the possibility to prevent it or to limit its severity with the use of faecal diversions. We report our experience on 189 patients operated in five years on colon-rectum, in election and emergency, with manual or mechanical anastomoses in the last 20 cm from the anal verge. We have had 21 anastomotic leakages (11%), symptomatic in 10 cases (5.5%), and 5 deaths (2.6%), 3 directly correlated to the leakage. In the patients (n 98) with loop-ileostomy there wasn't anastomotic leakages reduction, but only of clinical impact. We prefer loop-ileostomy in cases of extraperitoneal anastomoses, always in emergency and in anastomoses at risk.

[Laparoscopic cholecystectomy for acute cholecystitis: our experience]. / La colecistectomia videolaparoscopica nella colecistite acuta: nostra esperienza.

Laparoscopic cholecystectomy (LC) is now the gold standard in the treatment of cholelithiasis. LC is safe even in patients with acute cholecystitis. In our 118 cases there was 4 major complications as bile duct injuries (3%) and 13 minor complications (11%); conversion rate was 21% (24 patients), without mortality. Our experience confirms the validity of early LC in the treatment of acute cholecystitis, but laparoscopic procedure is associated with higher conversion rate (21% versus 3%) and complication rates compared to the treatment in non-acute patients.

[Manual colonic anastomosis with continuous single layer suture. Our experience]. / Anastomosi coliche manuali con sutura continua monostrato. La nostra esperienza.

The use of staplers has produced a reduction on operative times in the colorectal surgery without reduction of anastomotic complications. We present our experience about colonic anastomoses (ileo-colic, colo-colic and colo-rectal intraperitoneal anastomoses) with extramucosal one-layer continuous suture in synthetic slow absorbable one-filament. In the period January 2000-January 2003 we performed 157 operations on the large bowel, with 113 manual colonic anastomoses. Our results are similar to the best series of literature. The hand-sewn suture actually represents our common technique for the anastomoses of the large bowel.

Lateralization of ventral fins use during object exploration in the blue gourami (Trichogaster trichopterus).

Blue gourami fish have a pair of modified ventral fins that are used to obtain tactile information about surrounding objects. Use of ventral fins by blue gourami was investigated during initial exploration of novel objects. When exposed to a sequence of novel plastic objects, varying in shape and colour, the blue gourami showed preferential use of the left fin during initial contacts. Laterality apparently depends on the nature of the stimulus: Fish exposed to a randomized series of natural objects showed preferential use of the left fin for inanimate mineral objects, but no asymmetry was apparent for investigating animate objects. This would suggest that some form of 'handedness' may have been present prior to the appearance of tetrapods. On the other hand, measurements of fish monocular viewing revealed that the fin use was strongly associated with preferential use of the ipsilateral eye before the touching of the stimulus took place, thus, suggesting that the asymmetry in fin use may also be related to lateralization of the visual system.

[A uterine pecoma: a case report]. / Pecoma uterino: descrizione di un caso.

The authors describe the first ever reported case of a malignant pecoma of the uterus infiltrating the ovary, the tube and two bowel loops. This extremely rare tumour usually shows a benign behaviour and seems to arise from the perivascular epithelioid cells (PEC).

Lateralized agonistic responses and hindlimb use in toads.

The recent discovery of forepaw preferences (handedness) in toad species has provided some insight into the evolution of brain lateralization. We tested the prediction that, as in higher vertebrates, visual lateralization and other motor preferences (footedness) also exists in toad species. During feeding periods, South American cane toads, Bufo marinus, showed a population bias to strike with the tongue at other toads occupying their left visual field. This is the first demonstration of lateralized visual behaviour in an amphibian species. Tongue striking at an individual's eyes or head may sometimes delay its approach to prey already seen by the attacker, or may dislodge prey from its mouth. In addition, we report hindlimb preferences (footedness) for contact righting in three species of toad (B. marinus, the European green toad, B. viridis, and the European common toad, B. bufo). After being fully overturned on to their back on a horizontal surface, toads initiated and completed righting using the hindlimbs and with only perfunctory use of the forepaws. Together, the findings of visual lateralization and footedness demonstrate that in toads, as in higher vertebrates, behavioural lateralization is not restricted to handedness. The hypothesis that lateralized brain functions in birds and mammals might have arisen from a common lateralized ancestor is therefore supported. Copyright 1998 The Association for the Study of Animal Behaviour.

Complementary right and left hemifield use for predatory and agonistic behaviour in toads.

Cerebral lateralization, the differing specializations of the right and left sides of the brain once thought to be unique of humans, is now well known to occur in both birds and mammals. Here we report that in toads the right hemisfield of vision guides predatory tongue-striking responses towards moving prey and the left hemisfield guides agnostic tongue-striking responses towards conspecifics. This indicates, for the first time, complementary cerebral specializations for visual processing in anurans, and strongly supports the hypothesis that lateralized brain functions in birds and mammals may have arisen from a common lateralized ancestor. Complementary specializations in visual processing may have originally evolved to avoid problem of response competition during control of medial organs such as the tongue in organisms with laterally placed eyes and, in organisms with wider binocular overlap, it appears to be retained for initial detection of stimuli in the extreme lateral fields.

Somatosensory stimulation improves imagery disorders in neglect.

A group of 9 right brain damaged patients with unilateral neglect performed a set of tasks involving mental imagery with and without a transcutaneous electrical neural stimulation (TENS) to both sides of the neck. Results showed that TENS on the left side of the neck produced significant improvements of performances on the left side of mental representations of objects (drawing, shape comparison) as well as on left side of mental images of space (description of squares). The results suggest that the modification induced by TENS may affect the imagery systems involved in objects as well as in space representation.

[Cervical neurinomas. (Considerations in five cases operated in Day-Surgery)]. / I neurinomi cervicali. (Considerazioni su 5 casi operati in Day-Surgery).

We report the experiment of five cases of neurinoma observed in the division of Day Surgery of the Third Surgery Clinic, operating in the Hematology Institute of University of Studies "La Sapienza" in Rome. The problems of the diagnosis of this neoplasia has been faced, though it is commonly unknown or confused with other cervical especially lymphonodules tumefactions, from which it is almost impossible to distinguish before the operation. In the period of six years on 775 cases of cervical neoformations have been operated only 5 patients bearers of neuromi; two originated from vago cervicale (right and left), one from simpatico cervicale on the left, another from the left spinal accessory and the last from the secondary medial trunk of the left brachial plexus. All the patients have been operated in Day-Surgery anaesthesia, locoregional and with calming of spontaneous breath. One case, that originated from the secondary medial trunk of the left brachial plexus, has been operated with microsurgical technique. On all the cases has been done a subcapsular exeresis to preserve nervous continuity. No post operating complications have been recorded; all the patients discharged in the evening. The diagnosis about the nature is left to the final histological test on the operating piece. The surgical removal remains even today the elective treatment able to exclude probable relapses and potential malignant transformation of these tumours.

[Parathyroidectomy: our school experience]. / La paratiroidectomia: esperienza di Scuola.

The Authors evaluated the results obtained in 145 patients operated on for hyperparathyroidism: 109 patients had primary hyperparathyroidism and 36 patients had secondary hyperparathyroidism. Preoperative localization by ultrasonography was assured in all cases, while only few patients were preoperatively evaluated by arteriography and selected venous sampling of the parathyroid hormone concentration. After surgical resection for primary hyperparathyroidism, transient postoperative hypoparathyroidism occurred in 30 patients (27.5%), recurrent disease occurred in 3 patients (2.7%), while 1 patient experienced persistent hypoparathyroidism (1%). In 3 patients (3%), resection of a solitary adenoma and biopsy of all parathyroid glands resulted in a permanent hypoparathyroidism which required long-term administration of vitamin D and oral calcium. Neither recurrent nor persistent hyperparathyroidism occurred in patients surgically treated for secondary hyperparathyroidism, and no postoperative hypoparathyroidism was registered. The Authors emphasize the importance of an adequate surgical strategy and accurate initial cervical exploration of the parathyroid glands as a necessary step for the correct treatment of this challenging disease.

[Surgery of differentiated cancer of the thyroid]. / La chirurgia del cancro differenziato della tiroide.

A retrospective study on patients with differentiated thyroid carcinoma operated on at the 3rd Department of General Surgery of the University "La Sapienza" of Rome from 1970 to 1996 was performed. In 709 patients total thyroidectomy was performed as the minimal procedure acceptable, while 19 patients had subtotal thyroidectomy out of necessity. A functional ipsilateral or bilateral lymphnectomy of the neck was performed in 256 cases. This wider operation is indicated in the presence of metastatic lymph nodes and on principle in patients older than forty-five years in which at least another risk factor is present. Long term follow-up (12 years) was assured in 302 patients and the survival rate was 92% independently from the histotype (papillary or follicular). The survival rate of a group of 120 patients (80 with papillary and 40 with follicular carcinoma) was analyzed in relation to the risk factors. This group analysis demonstrated a very low mortality rate in patients with low risk index and an increased rate in patients with a high risk index.

Hepatic echinococcus disease: our experience over 22 years.

BACKGROUND/AIMS: It is important to single out the indications for surgery of hydatid disease of the liver at an early stage. For this, a fully comprehensive diagnostic work up of the patient is required. Surgery represents the most effective therapy and involves resection of the cysts and their outer capsule. This must be as complete as possible. MATERIAL AND METHODS: Between 1970 and June 1992, 95 patients received this combined treatment for hydatid disease although only those presenting from 1985 were followed up. RESULTS: No serious complications were noted apart from pyrexia due to secondary cholangitis or reactive pleuritis. This responded quickly to antibiotics and there was no mortality. No cases of relapse occurred although one case did show evidence of reappearance of the disease on serological testing alone, all other tests being negative. CONCLUSION: The most effective treatment for echinococcus cystic disease of the liver is radical surgery. Results are best when surgery is combined with medical therapy of benzoimidazole drugs given pre- and post-operatively. From our experience, we are now confident that surgical treatment must always be preceded and then followed by treatment with benzoimidazole antihelminthics.

[Method of biopsy and ultrastructural study of the parathyroid gland in patients with primary hyperparathyroidism]. / Tecnica di prelievo e studio ultrastrutturale della ghiandola paratiroide nei pazienti con iperparatiroidismo primario.

The authors suggest a new method of biopsy of a seemingly normal human parathyroid gland during surgery for parathyroid adenoma. Such a method provides adequate surgical specimen to rule out a likely diffuse hyperplastic disease associated with the parathyroid adenoma, and for the ultrastructural study of the gland, without any risk of postoperative complication. In all patients, ultrastructural examination showed an abnormal cell population and signs of glandular atrophy as a consequence of the high level of serum calcium due to hormonal hyperfunction of the parathyroid adenoma.

[The treatment of benign lesions of the liver. Indications and surgical approach]. / Il trattamento delle formazioni benigne del fegato. Indicazioni e strategia chirurgica.

Benign formations in the liver constitute a heterogeneous group of pathology lesions that are rarely found clinically. In the period between January 1985 and June 1992, 81 patients, affected by benign formations of the liver, were observed at the Institute of the III Surgical Clinic of Rome "La Sapienza". Most of these lesions are asymptomatic and their diagnosis is mostly casual. Among these we found 48 cases of echinococcus cystis, 13 cases of congenital cystic formations, 2 amoebiasis cases, and 1 case the ecografic exam, which shows an hepatic formation to the fifth segment, was not in conformity with the cytologic exam which proved negative because of cellular abnormalities of any nature, therefore it's constituted by normal parenchyma. Consequently the patient was discharged. We operated on 65 patients. The complications found in the patient operated on were not important and we had the death of only 1 patient affected by hepatic abscess on the 3rd day after surgery because of septicemia and cardio-circulatory problems. The follow-up made after a certain time has resulted negative because of relapses if we exclude 1 case of echinococcus cystis wherein we found a serological relapsing. In our experience and according to most of the authors, the operation must take place always in cases such as: adenoma, cystoadenoma, hemangiomas having a diameter higher than 3 cm, echinococcus cysts, syntomatic formations and when we have complications. For all other cases we must limit ourselves to observation over a certain period both the dimensions and morphological modification of the lesions.

[Preoperative diagnosis of thyroid nodule. Ultrasonography-guided fine-needle aspiration]. / In tema di diagnosi di natura preoperatoria del nodulo tiroideo. L'FNA ecoguidata.

Nodular thyroid pathology weighs heavily for 4-5% of the general population, being the most common among the endocrinopathies. Because of this these diagnostic methods have gained more and more importance as FNA able to select already in the pre-operation phase the malignant nodules from the benign ones and to decide on the most suitable surgical intervention. In the period of time between January 1989 and June 1992 in the Institute of the III Surgical Clinic in Rome there have been performed 403 FNA. From the whole total we have extrapolated 221 patients. In this study we stressed how the FNA method has a sensibility of 80%, a specificity of 93% and afterwards an accurate diagnosis of 92%. Besides we have verified that sonography and radionuclide scanning have a truth worthiness respectively of 64% and 52%. The FNA in our opinion allows us to have in the pre-operation phase a much more accurate diagnosis as regards that obtained with only sonography and radionuclide scanning therefore the latter methods must be considered complementary to FNA.

[Autotransfusion in general surgery]. / L'autotrasfusione in chirurgia generale.

Self-transfusion represents a clinical method used for the restoration of haematic losses that, in recent years has been employed more and more widely in the surgical ambit. The utilisation of this method has become increasingly frequent because of the high diffusion of haemotransmitted diseases, and of the incidences, not negligible, of complications relative to the transfusions of homologous blood. The techniques that are currently used are: self-donation with predeposit; inter-surgery recovery; hemodilution normal blood volume. From 1989 until now 260 patients have been performed, in the Institute of III Surgical Clinic of University of Rome, to self-transfusional method with predeposit and intersurgery recovery. In practice this technique did not present any complications.