Nuclear shadowing in the holographic framework.

The nucleon structure function F2(N) computed in a holographic framework can be used to describe nuclear deep inelastic scattering effects provided that a rescaling of the Q2 momentum and of the IR hard-wall parameter z0 is made. The ratios RA=F2(A)/F2(N) can be obtained in terms of a single rescaling parameter λA for each nucleus. The resulting ratios agree with the experiment in a wide range of the shadowing region.

Driving forces in the origins of life.

What were the physico-chemical forces that drove the origins of life? We discuss four major prebiotic 'discoveries': persistent sampling of chemical reaction space; sequence-encodable foldable catalysts; assembly of functional pathways; and encapsulation and heritability. We describe how a 'proteins-first' world gives plausible mechanisms. We note the importance of hydrophobic and polar compositions of matter in these advances.

Ultrastructural pathology of pediatric myocardium in acute ischemia: bioptic study before and after treatment with cardioplegic solution.

Protecting the myocardium from the risk of acute ischemia during heart surgery is still an unsolved problem; the problem is even more open and more pressing in pediatric heart surgery. To meet this greater risk it is advisable to use a cardioplegic solution with a composition that is better suited to the particular morphofunctional conditions of the myocardium in the child, i.e., a solution offering greater protection. To this purpose the authors experimented with Celsior cardioplegic solution during heart surgery in children to evaluate the efficacy compared to the standard St. Thomas solution. In this comparative study 15 children were treated with Celsior cardioplegic solution and 15 others with St. Thomas cardioplegic solution. Each patient underwent 2 biopsies of the myocardium, the first before cardioplegic treatment and the second immediately after reperfusion. In both groups, focal lesions involving both the cardiomyocytes and the vascular-stromal structures were randomly found. The former had undergone a necrotic-regressive process with changes in the myofibrils and the mitochondria. The vascular-stromal structures showed changes in the permeability of the capillary endothelia, with interstitial edema. The results show the lesions to be similar in the 2 groups both on a quality and quantitative level.

Desmin-free cardiomyocytes and myocardial dysfunction in end stage heart failure.

Our aim was to evaluate the desmin content in the myocardial tissue of patients with end-stage heart failure of ischaemic origin and to assess its role on cardiac function. We studied 18 explanted hearts from patients transplanted for end-stage heart failure due to ischaemic cardiomyopathy (ICM). Control myocardial tissue was obtained from the cardiac biopsies of six women with breast cancer taken prior to commencing chemotherapy with anthracyclines, four male donors for heart transplantation and two autoptic hearts from patients who died due to non-cardiac events. Myocardial tissue, obtained from the left ventricle (remote zone from infarcted area), was analyzed by light and confocal immunochemistry (desmin) microscopy. The desmin content of myocardial tissue was obtained by real-time PCR. Cardiac function was evaluated by echocardiographic and right heart catheterization data, obtained before heart transplantation. Confocal microscopy evaluation showed a significant decrease in the number of desmin-positive myocytes (P<0.01) in ICM hearts compared to controls. At real-time PCR evaluation, there was a reduction (P<0.01) in desmin content in the ICM patients compared to controls. A negative correlation was found between desmin-free cardiomyocytes and ejection fraction (EF) (r=-0.834; P<0.02) on echocardiogram. A negative relationship (r=-0.688) was also found between desmin-negative myocytes and capillary wedge pressure. In conclusion, the myocardial tissue of patients with end-stage heart failure of ischaemic origin, shows a decreased number in desmin-positive myocytes at immunochemistry evaluation compared to normal individuals. This deficiency in cytoskeletal intermediate filament content is associated with reduced cardiac function.

Causes of late failure after heart transplantation: a ten-year survey.

BACKGROUND: Little is known about the causes of death of heart transplant recipients who survive long-term. METHODS: The pathologic and clinical records of 97 patients who underwent heart transplantation in Italy from 1985 to 1995 and died (85 of 97) or underwent retransplantation (12 of 97) at least 2 years after transplantation were surveyed. Graft failures were classified as late (occurring between 2 and 5 years after transplantation) and belated (more than 5 years). RESULTS: Graft vasculopathy was the single most common cause of death (40.0%) and the only cause of late retransplantation. Tumors ranked second (23.5% of deaths), but the expected non-Hodgkin's lymphomas and Kaposi's sarcoma were accompanied by a high number of lung cancers (especially metastasizing adenocarcinomas). They were followed by the emergence or recurrence of pretransplantation diseases (9.4%), fatal infections (exclusively bacterial) (4.7%), the development of transmissible diseases (viral hepatitis and acquired immunodeficiency syndrome, 4.7%), and late acute rejection (2.3%). The distribution of failures differed in the late and belated periods: death and organ loss proportions for graft vasculopathy, respectively, fell and rose from the late to the belated period; some types of malignancy and fatal acute rejection were never observed in the belated period, whereas the emergence of pretransplantation diseases prevailed in the belated period. Graft vasculopathy was more frequent and tumors were less frequent among patients undergoing transplantation for ischemic heart disease. CONCLUSIONS: The reasons why heart transplant recipients die or undergo retransplantation, respectively, in the late and belated periods slightly differ from one another and are widely different than in short-term survivors.

Surgical pathology of the aortic valve: gross and histological findings in 1120 excised valves.

From January 1981 through December 1991, 1120 consecutive aortic valves were surgically explanted and their gross anatomy and histology studied at our university. Rheumatic disease (65%), dystrophic calcific valvular disease (23%), noninflammatory disease of the aortic root and/or floppy aortic valve (6.3%), and endocarditis (5.4%) were the causes of valve dysfunction. Among the total population the male sex predominated. The male to female ratio was 2.4 in the group with dystrophic calcific valvular disease and 1.6 in the group with bacterial endocarditis. The mean age was 37 ± 7.5 years in the group with non-inflammatory disease of the aortic root and/or aortic cusps. In the group with dystrophic calcific valvular disease, the mean age was 62 ± 6.3 years. Among the 1120 patients, 717 (64.03%) underwent surgery for aortic stenotic-incompetence, 250 (22.25%) for isolated aortic stenosis, and 153 (13.72%) for isolated aortic incompetence. In 449 cases (40.13%) a mitral pathology was associated. Chronic rheumatic aortic disease usually caused stenotic insufficiency (92.8%). Dystrophic calcific aortic disease caused pure stenosis in 84.8% of the cases. Among these, 46 patients (18.4%) had a congenitally bicuspidal aortic valve. Pure aortic incompetence was caused by noninflammatory aortic root and/or cusp disease in 44% of patients, infective endocarditis in 40%, and rheumatic disease in 16%. Patients with noninflammatory aortic root and/or cusp disease were divided into three groups: 29 patients with aortic root dilatation and normal cusps, 25 patients with aortic root dilatation and mixomatous infiltration of aortic cusps (floppy aortic valve), and 15 patients with floppy aortic valve and normal aortic root. Aortic incompetence was caused by cusp retraction caused by chronic rheumatic disease, cusp perforation or tears caused by infective endocarditis, and cusp prolapse for floppy aortic valve. Cusp diastasis has been the cause of aortic incompetence in patients with dilated aortic root. In patient with floppy aortic valve caused by the fibrous lamina disarray, the cusps prolapsed toward the left ventricle, causing valve regurgitation.

Immediate causes of death in short-term surviving heart transplant recipients.

From 1985 to 1992, 1068 cardiac transplants have been performed in the Italian units. The immediate causes of death of 142 of the 148 orthotopic cardiac transplantation recipients who died within the first 6 postoperative months were surveyed. Deaths were grouped into three periods: perioperative (⩽1 month, 68.3%), early (>1 ⩽3 months, 23.2%), and advanced (>3 ⩽6 months, 8.5%). Acute graft failure (arising from the ischemic damage to the donor heart, from surgical problems, from severe pulmonary hypertension, or from multiorgan failure) accounted for 49% of perioperative deaths and, along with noncardiac emergencies (23% of perioperative deaths), was significantly more frequent in this period than in the subsequent ones. The dissection of thoracic arteries was responsible for 4% of postoperative deaths, occurring exclusively among patients transplanted for ischemic or valvular heart disease. In the early and advanced periods, untreatable acute rejection (13%) and fatal infections (38%), mostly saprophytic, were significantly more frequent. Ischemic heart damage secondary to graft vasculopathy already caused 26% of deaths between the fourth and sixth months after transplantation. Some diseases, such as acute rejection, had the same frequency as both underlying disease and immediate cause of death. On the contrary, graft failure is more common as primary disease, leading to death also through noncardiac complications and saprophytic infections. Bacterial infections have the same frequency as both prime and immediate cause of death, viral infections are more common as primary disease, and the opposite is true for saprophytic infections.

Obstruction of mechanical mitral prostheses: analysis of pathologic findings.

BACKGROUND: The pathologic and echocardiographic findings observed in 87 patients with mitral valve obstruction were reviewed to ascertain the incidence of pannus formation versus that of thrombosis, the relationship between the two, and the time to the occurrence of pannus versus the time to thrombosis. METHODS: Pannus morphology (concentric or eccentric), its location on the valve (atrial, ventricular, atrioventricular), and the presence and relationship of associated thrombi (atrial, ventricular, atrioventricular) were analyzed. The times between valve replacement and the occurrence of obstruction were also compared. RESULTS: There were 10 caged-ball valves, 65 tilting-disc valves, and 12 bileaflet valves. Seventy-two patients underwent prosthetic replacement, and 15 underwent thrombolysis. Pannus alone was found in 27, pannus and thrombus in 39, and thrombus alone in 21. Primary thrombosis occurred earlier than pannus formation (p = 0.04); this was true for patients with bileaflet valves (p = 0.006) and those with tilting-disc valves (p = 0.04). Pannus was atrial in 19.7% (13/66), ventricular in 21.2% (14/66), and atrioventricular in 59.1% (39/66). Pannus morphology was concentric in 22.7% (15/66) and eccentric in 77.3% (51/66). Atrial secondary thrombi occur more often in patients with atrioventricular pannus (p = 0.04). Eight patients had reobstruction; this was caused by pannus formation in 5 and by thrombosis in 3. Five underwent reoperation, and 3 underwent thrombolysis. Reobstruction occurred earlier than the first event. CONCLUSIONS: The frequency of pannus formation is much higher than that of thrombus formation, but thrombosis is of earlier onset than pannus formation. Thrombosis is due to the deposition of clots on the prosthesis, and a pannus occurs as the result of an inflammatory reaction developing on both valve surfaces.

Unusual intracardiac metastasis of a testicular embryonal carcinoma.

In this report, we present a case of a metastasis of an embryonal carcinoma, unusually located in the right atrium, which was clinically revealed by a systemic paradox embolism through an atrial septal defect. The primary tumor was found in an undescended testis.

Acute thrombosis of Sorin tilting disc mitral prostheses.

We observed four cases of prosthetic thrombosis in 77 patients who had had a tilting disc valve (Sorin model) inserted in the mitral position. In all cases, the clinical findings on admission consisted of congestive heart failure, absence of prosthetic closing click and mitral regurgitation murmur. M-mode and cross-sectional echocardiography were invariably diagnostic. Surgery was performed without delay and consisted of thrombectomy in one case and valve replacement with porcine xenograft in three. Examination of the explanted prostheses disclosed fibrous tissue overgrowth surrounding the valvular ring, as well as thrombotic vegetations on the ventricular and atrial sides. The disc appeared blocked in a semiopening position at an angle of 45 degrees. Our experience suggests that the thrombosis is secondary to disc malfunction itself produced by periannular tissue growth. It is related to the porosity of the fabric which surrounds the metal ring, the valve design and its orientation. Correct anticoagulation therapy, performed in all cases, had no significant effect on tissue overgrowth. The high postoperative mortality rate depended on the severity of the preoperative clinical condition of the patients.

Bacterial endocarditis of the aortic valve associated with diaphragmatic sub-aortic stenosis--account of two operated cases.

We report two cases of subvalvular aortic stenosis associated with a postendocarditic aortic valvular insufficiency. Although the aortic valvular disease had been diagnosed preoperatively, only the direct intraoperative observation and the histological examination of the removed valve revealed evidence of the endocarditis. Because of the seriously altered condition of the valvular tissue, treatment in both cases consisted of implantation of a mechanical prosthesis. Follow-up revealed no evidence of septic relapse.

Intrapericardial teratoma in the newborn.

Two cases of intrapericardial teratomas occurring in the newborn are reported. The first was a cystic, well differentiated tumour which was totally excised. The child was alive and well with no evidence of the disease 10 months later. The second was a predominantly solid teratoma which consisted of both mature and immature tissues. It was removed but recurred 2 months later with pleural and pericardial invasion. The patient underwent reoperation but death occurred 9 days after surgical treatment. The recurrence was histologically similar to the primary tumour. The second case is probably the first malignant intrapericardial teratoma described in a neonate. Its morphology and clinical behaviour suggest that, as in ovarian and sacrococcygeal teratomas, the presence of immature neuroepithelium carries a poor prognosis. In such cases radio- or chemotherapy should be performed.

Prolapse of the "floppy" aortic valve as a cause of aortic regurgitation. A clinico-morphologic study.

A clinico-pathologic study was performed in 25 patients undergoing aortic valve replacement because of regurgitation, caused by myxoid degeneration of the valve leaflets. Associated cardiac anomalies were floppy mitral valve (2 cases), floppy mitral valve and idiopathic hypertrophic subaortic stenosis (1), left atrial myxoma (1), and aortic coarctation at the isthmus (1). Three patients died (2 immediately and 1 on the 30th postoperative day). Pathological studies of the explanted valves showed deformities characterized by redundant thin leaflets which appeared soft and gelatinous. On histologic examination the fibrous layer of the leaflets was seen to be infiltrated by myxomatous tissue. Echocardiography showed the aortic root to be dilated in 13 patients and normal in the others. In those with normal aortic root, the histological examination of aortic wall disclosed minimal cystic medial necrosis in two cases. In contrast, more severe forms of cystic medial necrosis were evident in all patients having a dilated aortic root. Aortic valve replacement was performed in all cases. It was accompanied by a Bentall procedure (1 case), repair of ascending aorta dissection (2), replacement of the ascending aorta (1), mitral valve replacement (2), mitral valve replacement and apico-ascending aorta conduit (1) and excision of a left atrial myxoma (1). Our experience suggests that prolapse of the aortic valve due to floppy leaflets is a common degenerative disease which is generally associated with noninflammatory aortic root degeneration. This, together with aortic root dilatation, contributes to valve insufficiency. Nevertheless, the disease, when isolated (with normal aortic root), is liable in itself to produce aortic regurgitation. The need for early diagnosis is stressed, so as to be able to perform valve replacement.

Non-inflammatory aortic root disease and floppy aortic valve as cause of isolated regurgitation: a clinico-morphologic study.

A clinico-morphologic study was performed on 1120 patients who underwent aortic valve replacement at the Department of Medical and Surgical Cardiology, 2nd University Medical School of Naples, Naples, Italy, from January 1981 through December 1991. In 69 cases the aortic valve was incompetent due to a non-inflammatory aortic root disease such as myxomatous infiltration of the cusps and or aortic root dilatation. Among these patients males were prevalent (male/female ratio = 2.2). The mean age was 37 +/- 7.5 years. A floppy mitral valve was diagnosed in 16 cases while in one a left atrial myxoma was found. The patients were divided into 3 groups: Group 1-29 patients with aortic root dilatation and normal cusps; Group 2-25 patients with aortic root dilatation and myxomatous infiltration of aortic cusps (floppy aortic valve); and Group 3-15 patients with floppy aortic valve and undilated aortic root. At the gross examination the cusps of the patients in Groups 2 and 3 were redundant, thin, soft and gelatinous. The histology showed myxomatous infiltration with disruption of the fibrous layer. In patients with aortic root dilatation the histology of the aortic root fragments showed a cystic medial necrosis. Deep correlation was found between the root dilatation and the grade of aortic wall cystic medial necrosis. Cusp's diastasis was the cause of aortic regurgitation in patients with aortic root dilatation, while cusp prolapse caused aortic incompetence in presence of the floppy aortic valve and undilated aortic root.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical pathology of the mitral valve: gross and histological study of 1288 surgically excised valves.

A consecutive series of 1288 mitral valves surgically excised from 1981 through 1989 were studied macroscopically and histologically. The explanted valves were affected by: chronic rheumatic disease (1179, 91.5%), floppy mitral valve (84, 6.5%), bacterial endocarditis (19, 1.5%), and post-ischemic mitral incompetence (6, 0.5%). Among 1179 post-rheumatic cases, mixed mitral stenosis and incompetence was the most frequent malfunction (747, 58%). Isolated mitral incompetence was diagnosed in 72 (6.11%) cases only, and isolated stenosis in 360 cases. In 52 valves, excised because of chronic rheumatic disease, the histology showed unexpected signs of acute rheumatism of the leaflets and the papillary muscles. In these patients clinical symptoms and blood tests were negative for rheumatic disease. Mitral incompetence, possibly due to papillary muscle dysfunction, was the prevalent lesion (61.5%). A total of 181 patients (14.05%) with pure mitral incompetence underwent surgery. In 84 patients (46.4%), the floppy mitral valve was the most frequent cause of valve dysfunction, 72 (39.8%) had rheumatic disease, 19 (10.5%) infective endocarditis, and 6 (3.4%) ischemic heart disease. In the group with floppy mitral valve, males were more prevalent than females (51:33). The mean age of the 4 patients with Marfan's syndrome and non-Marfan patients was noticeably different (17 vs 49 yr). Moreover leaflet deformation, tendinous cord elongation and annulus dilatation were the most common causes of valve incompetence. Floppy mitral valve and infective endocarditis were the cause of cordal rupture in 43.5% of the cases. This was a severe complication which always required emergency surgery.

Asymmetric medial degeneration of the intrapericardial aorta in aortic valve disease.

BACKGROUND: A geometrical and functional asymmetry in the normal aortic root has been recently demonstrated. Whether the distribution of medial degeneration (MD) within the wall of the dilated ascending aorta in adult patients reflects such asymmetry, still has to be assessed. METHODS: Nineteen patients with fibrocalcific aortic valve disease and dilatation of the intrapericardial aorta, without clinical signs and familiar history of primary elastic connective tissue disorders, underwent surgery. Biopsies (57 specimens) were taken in each patient from three areas of the ascending aortic wall distal to the three sinuses of Valsalva. MD lesions found at histology in each specimen were classified in three degrees. Comparisons were made between the three sites as to distribution of the three degrees and between one site and the other two as to incidence of the highest degree. RESULTS: A mild degree of MD was found in 26 specimens (45.6%), moderate in 14 (24.6%), severe in 17 (29.8%). The distribution of the three degrees of MD changes was significantly different between one of the three studied wall areas and the other two (P<0.001): a significantly greater incidence of the highest degree of involvement in the aortic wall distal to the non-coronary sinus than in the wall areas corresponding to the coronary sinuses was found (P<0.001). CONCLUSIONS: MD lesions in dilated intrapericardial aorta are more severe in the wall area distal to the non-coronary sinus, likely due to haemodynamic stress asymmetry.

Medial degeneration does not involve uniformly the whole ascending aorta: morphological, biochemical and clinical correlations.

OBJECTIVE: To investigate whether and how the severity of medial degeneration (MD) lesions varies along the circumference of the dilated intrapericardial aorta. METHODS: Two groups of aortic wall specimens, respectively harvested 1cm distal to the non-coronary (NC) sinus (right postero-lateral wall) and to the right coronary sinus (anterior wall) in 22 patients undergoing surgery for dilatation of the intrapericardial aorta associated with aortic valve disease, were separately sent for pathology, morphometry and ultrastructural examination. MD lesions found at histology were classified into three degrees of severity. MD mean degree and morphometric findings in postero-lateral ('NC') and anterior ('coronary') specimens were compared by paired t-test. Correlation between degree of aortic dilatation at echocardiography and severity of MD was assessed separately for each of the two groups of specimens. After the preliminary results of the morphological study, we decided to send the specimens for biochemical investigation of protein electrophoretic patterns. This was performed in the last seven patients of this series. RESULTS: At histology, MD was found in all cases. A higher mean MD degree was found in the NC group (2.59+/-0.50 versus 1.59+/-0.67 in the coronary group; P<0.001). At morphometry, normal smooth muscle cells in the NC specimens were significantly reduced (P=0.012) and the length (P=0.011) and number (P=0.015) of elastic fibres reduced and increased, respectively. Correlation between aortic ratio and MD degree was significant in the NC specimens (P<0.001), not in the coronary ones (P=0.227). Quantitative differences between coronary and NC proteins from the same patient and between coronary proteins from different patients were found at electrophoresis. However, at this stage of the study, the sample was too small to allow for the identification of proteins involved in those differences. CONCLUSIONS: MD lesions in dilated intrapericardial aorta are more severe in the right postero-lateral wall area, likely due to haemodynamic stress asymmetry.

Lipoma of the heart: a case report.

Lipomas of the heart are rare (only 0.5% according to the Armed Forces Institute of Pathology series) and their diagnosis is often difficult because they are asymptomatic; in fact, in contrast to lipomatous hypertrophy, lipomas are usually found on the epicardial surfaces of the atria or ventricles. In our case, the lipoma was located in both atria and was attached to the interatrial septum involving also the right pulmonary veins, the inferior vena cava and the right phrenic nerve. At histology, the tumor was composed only of mature adipose tissue with entrapped myocytes and vessels. The combination of computed tomography and transesophageal echocardiography allowed a precise diagnosis in terms of the localization and tissue characterization of the tumor.

[Peritoneal cystic mesothelioma. A clinical case and review of the literature]. / Mesotelioma cistico peritoneale. Caso clinico e revisione della letteratura.

Multicystic peritoneal mesothelioma is an extremely rare benign neoplastic disease with high tendency to recur locally, but no tendency to malignancy. Correct diagnosis can be made with histopathologic examination and always with immunohistochemical and ultrastructural evaluation. A case in a twenty-eight-year-old woman is reported and the anatomo-clinical characteristics of multicystic peritoneal mesothelioma from sixty-nine cases described in the literature are specified, discussing the management of this disease and emphasizing the importance of a nondemolitive approach.

[Anatomopathologic and clinical correlations of squamous carcinoma of the larynx and the hypopharynx]. / Correlazioni anatomopatologiche e cliniche nel carcinoma squamoso della laringe e dell'ipofaringe.

The most important problem in the diagnosis of neoplastic diseases is not only to identify its malignant nature but also the degree of aggressiveness since differences in prognosis and therapy exist in cancer as well. A short review of the literature regarding correlations between histologic degree of carcinoma and prognosis is presented. A total of 105 laryngectomy samples are presented taken by bilateral neck dissection following the principles employed for laryngeal or hypopharyngeal carcinoma. Reference is made to the following parameters: extension and site of primitive tumor; cellular (WHO), nuclear (Black) and structural (Carlon) gradings; histologic host response as judged by the presence and degree of lymphoid infiltration and fibrous stromal reactions around the primary tumor. Host response was related to structural grading. Regional nodes were studied for metastases. Nodal metastases were related to cellular, nuclear and structural grading. Clinical and statistical analysis proved that Carlon's grading, based on structural organization of the tumor, seen as a manifestation of its cellular cohesiveness, is a more discriminating system of malignancy than the others. The most organoid growth patterns (Structural grades 1 and 2) did not present any node metastases. They can be regarded as manifestations of "low grade malignancy tumors". The least organoid and non organoid growth patterns (Structural grades 3 and 4) showed higher levels of node metastases (Grade 3: 35.2%; Grade 4: 58%; p = 0.01). Necrosis was found only in Grades 3 and 4 and was associated with node metastases in 70%. Structural grading could be the guideline to better management of laryngeal carcinoma in terms of choice of surgical treatment (type of laryngectomy; neck dissection).