fMRI-Based Effective Connectivity in Surgical Remediable Epilepsies: A Pilot Study.

Simultaneous EEG-fMRI can contribute to identify the epileptogenic zone (EZ) in focal epilepsies. However, fMRI maps related to Interictal Epileptiform Discharges (IED) commonly show multiple regions of signal change rather than focal ones. Dynamic causal modeling (DCM) can estimate effective connectivity, i.e. the causal effects exerted by one brain region over another, based on fMRI data. Here, we employed DCM on fMRI data in 10 focal epilepsy patients with multiple IED-related regions of BOLD signal change, to test whether this approach can help the localization process of EZ. For each subject, a family of competing deterministic, plausible DCM models were constructed using IED as autonomous input at each node, one at time. The DCM findings were compared to the presurgical evaluation results and classified as: "Concordant" if the node identified by DCM matches the presumed focus, "Discordant" if the node is distant from the presumed focus, or "Inconclusive" (no statistically significant result). Furthermore, patients who subsequently underwent intracranial EEG recordings or surgery were considered as having an independent validation of DCM results. The effective connectivity focus identified using DCM was Concordant in 7 patients, Discordant in two cases and Inconclusive in one. In four of the 6 patients operated, the DCM findings were validated. Notably, the two Discordant and Invalidated results were found in patients with poor surgical outcome. Our findings provide preliminary evidence to support the applicability of DCM on fMRI data to investigate the epileptic networks in focal epilepsy and, particularly, to identify the EZ in complex cases.

Observational study on adjuvant trastuzumab in HER2-positive early breast cancer patients.

AIM: This observational study investigates the use of adjuvant trastuzumab (AT) in HER2-positive breast cancer patients in a real-life setting, focusing on relapse and discontinuation rates. PATIENTS & METHODS: Data on a group of HER2-positive patients collected from 13 oncology centers of northeast Italy were analyzed. RESULTS: In total, 1245 patients were analyzed. 13.1% of patients were excluded from AT because of comorbidities, age, tumor stage, refusal or other reasons; 8.2% of patients who received AT interrupted the therapy, mainly for toxicity. Overall the relapse rate was 10.9% in the AT-treated population versus 22.6% in nontreated patients (follow-up: 37.4 and 62.1 months, respectively). Disease-free survival (DFS) was lower in AT-relapsed patients than in not-relapsed. Statistical analysis showed a correlation between DFS and estrogen receptor status in AT-treated patients. CONCLUSION: Relapse rates are lower in clinical setting compared to clinical trials. Overall, AT is effective in HER2-positive early-stage breast cancer patients.

Expression of two maize putative nitrate transporters in response to nitrate and sugar availability.

A full-length cDNA encoding a putative high-affinity nitrate transporter (ZmNrt2.2) from maize was isolated and characterised, together with another previously identified transporter (ZmNrt2.1), in terms of phylogenesis, protein structure prediction and regulation of transcript accumulation in response to nitrate and sugar availability. The expression of both genes was evaluated by quantitative and semi-quantitative RT-PCR in response to nitrate and sugar supply and the in planta localisation of mRNA was studied by in situ hybridisation. Data obtained suggested similar genetic evolution and identical transmembrane structure prediction between the two deduced proteins, and differences in both regulation of their expression and mRNA localisation in response to nitrate, leading us to hypothesise a principal role for ZmNRT2.1 in the influx activity and the major involvement of ZmNRT2.2 in the xylem loading process. Our data suggest opposing sugar regulation by ZmNrt2.1 and ZmNrt2.2 transcription in the presence or absence of nitrate and the existence of both hexokinase-dependent and hexokinase-independent transduction mechanisms for the regulation of ZmNrt2.1 and ZmNrt2.2 expression by sugars.

Chromate differentially affects the expression of a high-affinity sulfate transporter and isoforms of components of the sulfate assimilatory pathway in Zea mays (L.).

In this study the chromate accumulation and tolerance were investigated in ZEA MAYS L. in relation to sulfur availability since sulfate may interact with chromate for transport into the cells. Chromate inhibited sulfate uptake when supplied to plants for a short-term period, whereas phosphate uptake remained unchanged. Sulfate absorption was also reduced in S-starved (-S) and S-supplied (+S) plants treated for 2 d with 0.2 mM chromate and the concomitant repression of the root high-affinity sulfate root transporter ZMST1;1 transcript accumulation was observed. Conversely, the plasma membrane H (+)-ATPase MHA2 was unaffected by chromate in +S plants, allowing to exclude a general effect of chromate on the active membrane transport. As observed for sulfate uptake, chromate uptake was enhanced in -S condition and decreased in both +S and -S plants after 2 d of Cr treatment. Chromate reduced the concentration of sulfur and sulfate in +S plants to the basal level of -S plants, and maximum chromium accumulation was recorded in S-deprived plants. Analysis of transcript abundance of genes involved in sulfate assimilation revealed differential regulation by chromate, which was only partly related to sulfur availability and to the levels of thiols. This work shows for the first time that chromate specifically represses sulfate uptake, and such repression occurs without the implication of the candidate regulatory metabolites of the sulfate transport system in plants.

Role of chemotherapeutic antagonism in opportunistic infections.

The most widely-known anti-tumor drugs often induce marked immunosuppression which can give rise to one or more sepses. Anti-infection measures immediately applied can sometimes prove largely ineffective or even useless, the patient dying not as a result of the spread of the tumour but as a direct consequence of opportunistic infection. We postulate that antagonism between anti-tumour and antimicrobial drugs may also play an important part in this. By way of illustration of this hypothesis, we have studied the action of a number of known inhibitors of peptidoglycan synthesis and of DNA-gyrases on certain strains of Gram-positive and Gram-negative microorganisms cultured in medium containing various concentrations of some of the best-known anti-tumour antimetabolites. The experimental data show that antimicrobial and anti-tumour drugs can sometimes induce synergic or indifferent chemotherapeutic interactions with many bacteria, while in others the effect is antagonistic. In practice, the action of the drugs could lead to bacterial selectivity, which, in conjunction with immunosuppression and the presence of resistant strains, could favour the evolution of opportunistic infection.

Laparoscopy in routine and emergency surgery: experience with 1,720 cases.

Experience with laparoscopy in 1,720 cases performed for surgical diseases with elective or emergency indications is reported. It is hoped that laparoscopy, a simple and harmless technic of great diagnostic value, will be employed more frequently in routine and emergency surgery.

IgG antibodies to papillomavirus genus-antigens in adult men with cancer of the urinary bladder.

Forty-five sera from men with bladder cancer were examined in a micro solid-phase enzyme-linked immunosorbent assay (ELISA) and in a Western-blotting (WB) assay for the presence of IgG antibodies to papillomavirus (PV) genus-antigens of bovine origin. The ELISA detected PV antibodies in 75.6% of cancer patients. This antibody frequency was significantly higher than that found in both healthy males (22.7%) and patients with urological disorders (24%). A similar correlation among the PV antibody frequencies of the three groups was found with WB assay: 60% of the neoplastic group showed PV antibodies versus 17.3% in healthy males and 32.6% in non-neoplastic patients. Within the same group, 78% to 87% sera showed the same reactivity to both assays. Of these concordant sera, PV positive sera were 55.6% in cancer patients, 13.3% in healthy adults and 19.6% in patients with urological disorders. ELISA PV antibody level in the cancer group was higher than in each of the two control groups. The meaning of the humoral response to PV genus-antigens in men with bladder cancer is discussed.

[Captopril in heart failure in the elderly]. / Il captopril nello scompenso cardiaco dell'anziano.

The paper confirms the value of captopril in a sample group of 20 elderly patients (mean age 72.9 years) affected by overall cardiac decompensation in more or less clinically evident phases. All patients were randomly selected and received ACE-inhibition treatment for six months; doses of 25 mg or 50 mg captopril were given twice a day and all other drugs were suspended except for digitalis which was used by all patients without success. During the course of the trial the most important clinical results were the reduction of systemic blood pressure due to the diminution of peripheral resistance, the reduction of postload and ventricular filling pressure, and the consequent improvement of cardiac decompensation. All elderly patients treated in this manner experienced a stable improvement in the quality of life, with a considerable reduction in the consumption of diuretics to which they are particularly vulnerable. Following a broad ranging comparison with other reports, the Authors conclude that captopril is a geriatric drug which should be used as early as possible during the phases of latent cardiac insufficiency or at the first signs of a hypertensive crisis.

New heterocyclic structures. thiazolo[3,2-a][1,2,5] thiadiazolo[3,4-d]pyrimidine and [1,2,5]thiadiazolo[3',4':4,5] pyrimido[2,1-b][1,3]thiazine. biological assays.

6,7-Dihydro-9H-thiazolo[3,2-a][1,2,5]thiadiazolo [3,4-d]pyrimidin-9-one, 7,8-dihydro-6H,10H-[1,2,5]thiadiazolo[3',4':4,5]pyrimido [2,1-b][1,3]thiazin-10-one and its 3-methyl derivative were prepared by reacting 6,7-diamino-2,3-dihydro-5H-thiazolo[3,2-a]pyrimidin-5-one, 7,8-diamino-3,4-dihydro-2H,6H-pyrimido[2,1-b][1,3]thiazin-6-one or its 3-methyl derivative with N-thionylaniline. A reaction mechanism is proposed. The compounds and the sodium salts of (7-amino-2,3-dihydro-5H-thiazolo[3,2-a]pyrimidin-5-on-6-yl)sulfamic acid, (8-amino-3,4-dihydro-2H,6H-pyrimido[2,1-b][1,3]thiazin-6-on-7-yl) sulfamic acid and its 3-methyl derivative were tested for antimicrobial and antimycotic activity on a number of strains, namely: E. Coli, Proteus mirabilis, P. vulgaris, Pseudomonas aeruginosa, Salmonella spp, Staphylococcus spp, Streptococcus faecalis, Bacillus subtilis, Sarcina lutea, Candida albicans, and for antiviral activity on Herpes simplex virus type 1 and Vescicular stomatitis virus. None of the compounds showed antiviral activity or exhibited biological activity against gram-negative, gram-positive bacteria or against mycetes.

Synthesis and biological activity of new heterocyclic structures: [1,3]thiazino[2,3-i]purine, thiazolo[3,2-c] [1,2,3]triazolo[4,5-e]pyrimidine and [1,2,3]triazolo [4', 5': 4,5] pyrimido[6,1-b][1,3]thiazine.

Some derivatives of thiazolo[3,2-c]pyrimidine, pyrimido[6,1-b][1,3]thiazine, thiazolo[2,3-i]purine, [1,3]thiazino[2,3-i]purine, thiazolo[3,2-c][1,2,3]triazolo[4,5-e]pyrimidine and [1,2,3]triazolo[4',5':4,5]pyrimido[6,1-b][1,3]thiazine were prepared. The compounds were tested for antimicrobial and antimycotic activity on a number of strains, namely, Escherichia coli, Proteus vulgaris, P. mirabilis, Pseudomonas aeruginosa, Salmonella sp., Staphylococcus aureus, Streptococcus faecalis, Bacillus subtilis, Sarcina lutea, Candida albicans, Aspergillus sp., and for antiviral activity on Herpes simplex virus, Type 1 (HSV-1), Vesicular stomatitis virus (VSV) and Coxsackievirus B5 (CoxB5). The compounds proved to be devoid of activity against viruses, mycetes and gram-negative bacteria, while some of them exhibited a modest activity against gram-positive bacterial strains.

[Surgical therapy of Crohn's disease: observations on 63 patients]. / La terapia chirurgica della malattia di Crohn. Considerazioni su una casistica di 63 osservazioni.

AIM: The purpose of our retrospective study is to evaluate the correct indications for the surgical therapy of Crohn's disease. METHODS: Our case series consists of 63 patients admitted to our Surgery Department from January 1, 1973 to December 2002 with a diagnosis of Crohn's disease. Of the 56 operated patients, 43 patients were followed-up. For an objective evaluation of the Crohn's disease activity, the Crohn's Disease Activity Index (CDAI) was used. Surgical treatment has been carried out in 56 cases: in 29 cases of intestinal occlusion a minimal gut resection was performed; in the 26 cases of perforation a suture of the perforation was preferred, with a drainage of the peritoneal cavity and a toilette of abscess when it was present, and in 1 case an ileocolic resection was performed. RESULTS: Only 1 case showed a CDAI score >150 (153.63). This shows that in all the other cases the surgical and medical treatment has led to a satisfactory control of the disease. A relapse has been observed in 17 patients after an average period of 5 years without showing signs of disease. CONCLUSION: It is suggested that Crohn's disease therapy should be mainly of a medical nature and surgical treatment should be reserved for complicated cases.

[Acute intestinal occlusion caused by pseudo-neoplastic, endometriosic rectosigmoid stenosis]. / Occlusione intestinale acuta da stenosi rettosigmoidea endometriosica, pseudo-neoplastica.

Bilateral hysteroadnexectomy and rectosigmoid resection were successfully employed in a case of acute intestinal occlusion due to endometriotic rectosigmoid stenosis in a 36-yr-old woman. The endometriotic character of the stenosis was only made clear histopathologically. The clinical features of intestinal endometriosis are examined. Its lack of pathognomonic symptoms makes diagnosis difficult and may result in confusion with cancer, even intraoperatively. Ex tempore histological examination is thus fundamental in clinching diagnosis and hence the extent to which intestinal resection is required.

[Iatrogenic ruptures of the stomach]. / Le rotture iatrogene dello stomaco.

A case iatrogenic rupture of the stomach due to gastric wash carried out to treat a child of 5 yrs who had swallowed antineuralgic tablets is reported. This is the first reported case. It is concluded that all instrumental techniques should be carried out with maximum caution and delicacy.

[Surgical treatment of peritonitis caused by diverticulitis of the sigmoid. Apropos of 12 cases]. / Sul trattamento chirurgico delle peritoniti da diverticolite del sigma. A proposito di 12 osservazioni.

Twelve cases of peritonitis due to sigmoid diverticulitis managed by minimal surgery are reported. Morbidity involved two cases of stenosing sigmoiditis on which sigmoid resection was successfully carried out. Although it is considered that radical surgery is the optimal solution, it is also recalled that the prime objective is to cure the peritonitis, so each case must be assessed carefully on its own merits since the condition is a complication of a benign disease and the risk of emergency sigmoid resections is by no means negligible.

[The Roux-en-Y jejunal loop in extrahepatic bilio-digestive anastomoses. Technic, indications and early complications in 101 cases]. / L'ansa diguinale ad Y secondo Roux nelle anastomosi bilio-digestive extraepatiche. Tecnica, indicazioni e complicanze precoci su 101 osservazioni.

Personal experience with Roux's Y loop in 101 cases in which bilio-jejunal anastomosis was performed for mechanical icterus of malignant (66 cases) and benign (35 cases) origin is described. It is felt that this operation does not present particular technical difficulties. End-to-end anastomosis is preferable. While bilio-duodenal and bilio-jejunal anastomoses are both sound practice, Roux's Y loop offers greater possibilities of application.

[Fractures of the pelvis and associated abdominal lesions]. / Fratture del bacino e lesioni addominali associate.

106 cases of pelvic fracture and blunt abdominal trauma are reported and relationships between type of fracture, associated lesions and prognosis assessed. The presence of associated lesions, with the exception of urologic types, would appear to be correlated to the extent and prevalent application site of the trauma rather than to fracture morphology. The prognosis for patients with pelvic fractures is related to the frequency of associated lesions of intra-abdominal viscera and urological or retroperitoneal vascular structures.

[Benign solitary ulcer and acute diverticulitis of the cecum]. / L'ulcera solitaria benigna e la diverticolite acuta del ceco.

The report of diverticulosis of right colon in a patient formerly operated on for perforation of caecum single ulcer appeared to the authors as a confirmation of a common etiology between both lesions. The single ulcer would probably represent a form of manifestation for the acute phlogosis of a diverticulum.

[The clinical picture of pseudomyxoma peritonei]. / Il quadro clinico dello pseudomixoma peritoneale.

The authors describe two cases of pseudomyxoma peritonei, one of which with a lengthy clinical course and the other with a rapidly fatal outcome. The clinical picture in pseudomyxoma peritonei is associated with a variety of benign or malignant mucus-secreting tumours, mainly originating in the appendix or ovaries. Survival is generally long owing to the lack of visceral invasion or metastases. An accurate prognostic assessment can only be achieved on the basis of identification of the primary tumours and its degree of malignancy.

[Traumatic lesions of the diaphragm (experiences with 36 cases)]. / Le lesioni traumatiche del diaframma. (Esperienza su 36 casi).

The Authors report on their experience with 36 cases of traumatic lesions of the diaphragm. Such lesions should be suspected in all cases of thoraco-abdominal trauma. The possibility of a preoperative diagnosis depends entirely on thorough chest x-rays and administration of contrast medium via a nasogastric tube. In emergency surgery, lesions of the diaphragm are treated by the laparotomy route, which allows complete exploration of the abdominal cavity. The morbidity and mortality of such lesions depend on the associated lesions, on prompt diagnosis and surgery and on appropriate postoperative treatment.

[Villous adenoma of the duodenum]. / Gli adenomi villosi del duodeno.

The authors study the diagnostical problems, especially those involved in the preoperative diagnosis of malignancy, of four cases of duodenal villous adenoma. A more frequent use of endoscopy can allow the observation of this lesion in early stage, such as to ensure recovery through an intervention as scarcely demolishing as possible. However, surgeons plotting the strategy of operation should bear in mind the potential malignancy of duodenal villous adenoma.