Histological changes in odontogenic parakeratinized keratocysts treated with marsupialization followed by enucleation.

BACKGROUND: The purpose of this study was to evaluate whether marsupialization treatment induces changes in the histology of odontogenic keratocyst epithelium and to compare our experience with the literature. MATERIAL AND METHODS: A retrospective revision of histological samples was performed. 5 patients with odontogenic keratocyst treated with marsupialization follow by enucleation were selected. Histologic evaluation analyzed the changes in the keratocyst epithelium after marsupialization in terms of type of keratinization, thickness of the epithelium and connective tissue, the presence of acanthosis, the presence and grade of fibrosis, the type and grade of inflammation and the presence and number of mitotic figures and daughter cysts. RESULTS: In our case series, a variation of para-keratinized into ortho-keratinized keratocyst was found in one case, and no significant increases were observed in the epithelium and capsule thickness, or even in the level of inflammation. However, we observed an increase in fibrosis and qualitative changes in inflammation type. CONCLUSIONS: Minor and major histological changes were associated with reduction in cyst volume, which resulted in a simpler and less invasive cystic enucleation after marsupialization.

Prognostic role and characteristics of the indeterminate response in differentiated thyroid cancer: a systematic review.

PURPOSE: The management of differentiated thyroid cancer (DTC) is actually based on a dynamic risk stratification based on classes of response to the therapy. Indeterminate response (IR) includes a heterogeneous group of patients with different characteristics, particularly different Tg and AbTg levels and/or imaging findings. The aim of systematic review (SR) is to evaluate the prognosis, diagnostic findings and other characteristics of patients in the IR class. METHODS: A wide literature search in the Scopus, PubMed/MEDLINE and Web of Science databases was performed to find published articles on patients with DTC and IR after treatment. The quality assessment of studies was carried out using QUADAS-2 evaluation. RESULTS: Eight articles were included in the systematic review. Six studies evaluated the prognosis and the prognostic factor in patients with IR, one study evaluated the role of 2-[18F]FDG PET-CT in the management of patients with IR and biochemical incomplete response and one study the risk factors for IR. CONCLUSION: Patients with DTC and IR to therapy have a probability of disease relapse < 15%. Tg value could be a predictor of disease progression. The role of 2-[18F]FDG PET-CT needs to be further investigated.

gamma-Globulin level and dietary protein intake during the first year of life.

To investigate the possible causes of relatively low blood gamma-globulin levels (less than or equal to 0.5 gm/dl) during the first year of life, 287 patients less than 1 year of age who were suffering from mild diseases were studied retrospectively. They were divided into two groups, those with a gamma-globulin level less than 0.5 gm/dl and those with a gamma-globulin level greater than 0.5 gm/dl. By reconstructing the diets given, it was found that they had been receiving isocaloric diets that differed only in protein supply: patients with lower gamma-globulin levels received 2.9 gm/kg/day of protein and patients with higher gamma-globulin levels received 4.0 gm/kg/day. Fifty-five healthy subjects were studied prospectively during the first year of life on two isocaloric diets that differed only in their protein content: the first one supplied 2.5 gm/kg/day of protein and the second supplied 4.0 gm/kg/day. At approximately 5, 7, and 10 months of age, hemoglobin, total protein, albumin, globulins, immunoglobulins, and other common blood parameters were measured. Patients on the lower protein diet had a gamma-globulin concentration of less than or equal to 0.5 gm/dl and those on the higher protein diet had a gamma-globulin concentration of greater than or equal to 0.8 gm/dl. Immunoglobulin levels, particularly IgG, were lower in patients on the lower protein diet. The subjects with lower protein intake and lower levels of gamma-globulin and immunoglobulins showed significantly higher morbidity.

Avoidable mortality in Europe 1955-1994: a plea for prevention.

OBJECTIVE: To analyse trends of avoidable mortality in Europe, emphasising causes of death amenable to primary prevention through reduction of exposures, secondary prevention through early detection and treatment, and tertiary prevention through improved treatment and medical care. DESIGN: Descriptive study of mortality from avoidable causes for the years 1955 through 1994, for ages 5-64 at time of death. Using the World Health Organisation Mortality Database, five year death rates were standardised to the world population. SETTING: 21 countries of Europe in four regions (northern, central, and southern Europe, Nordic countries). PARTICIPANTS: All causes of deaths for men and women, aged 5-64, at time of death. MAIN RESULTS: Between 1955-59 and 1990-94, the reduction in mortality was somewhat greater for avoidable causes than for all causes: 45.8% v 45.1% (women) and 39.3% v 32.6% among men. Reductions in mortality were greater for causes amenable to improved medical care: 77.9% among women and 76.3% among men. The smallest reduction in mortality was seen in women for causes amenable to secondary prevention (11.0%), and in men for causes amendable to primary prevention including tobacco related conditions (16.6%). From a geographical point of view, there were slight differences in trends between European regions, but overall the patterns were similar. CONCLUSIONS: The greatest reduction of avoidable mortality in Europe from 1955-94 came from causes amenable to improved treatment and medical care for both sexes. Further reductions of avoidable mortality can be achieved through implementation of primary and secondary prevention activities, such as tobacco control, reduction of occupational exposures, and universal access to breast and cervical cancer screening programmes.

Role of magnesium in pregnancy.

The importance of magnesium in pregnancy has been emphasised by several studies. Magnesium is considered a membrane-stabilizing ion and a permeability regulator acting at an intracellular level which intervenes in the oxidative phosphorylation and oxidation reduction processes as well as in enzymatic synthesis and activity. The authors performed a double-blind study in which 15 mmol of magnesium or placebo were administered to the treatment and control groups respectively. There were more cases admitted to hospital in the control group than in that treated with magnesium. Even if there is not a large body of data which supports improved fetus development as a result of magnesium supplementation during pregnancy, the authors suggest that pregnant women with a high risk of gestosis and premature labour should receive additional magnesium.

Viral type and CD1+ cells in HPV-induced lesions.

In vivo, HPV infection can display varying symptom complexes. At present 60 types of HPV are known, and some seem to be more efficient oncogenic agents than others. In particular, HPV 16 and 18 appear the types with the greatest oncogenic potential, being frequently found in cases of intraepithelial cervical neoplasia (CIN) and/or invasive carcinoma of the cervix. Many authors suggest that they might induce cell-mediated immunodeficiency into the lesions. This investigation was conducted on 15 women aged 17 to 40 (mean, 27.8). On the basis of cytological examination, colposcopy and biopsy, HPV-induced lesions were diagnosed. Biopsies were performed periodically for six months for HPV detection and typing. In addition, the cells of Langerhans were imaged by the indirect immunoperoxidase method. Variations in their number according to the HPV type involved were observed.

Role of HPV-DNA typing in women with cytological diagnosis of squamous atypia.

The study was performed in 293 patients (mean age 36 years old). Pap tests, colposcopy and target biopsy were performed in all patients. Results showed 100 cases of cellular atypia, 53 cases of CIN (36 CIN I, 10 CIN II, 7 CIN III) and 140 normal cases. The last phase of the study consisted in the collection of exfoliated cervical cells which were then subjected to "Enzo Pathogen DNA Probe assay" using HPV-DNA 6/11, 16/18 and 31/33/51 probes. The aim of this study was to evaluate the relationship between HPV type and neoplastic evolution. The results were not sufficiently convincing to support proposing HPV/DNA typing as the sole diagnostic method in lesions of the last section of the female genital tract.

Malignant melanoma of the vagina in pregnancy: description of a clinical case.

Vaginal melanoma in pregnancy is a rare but extremely malignant tumour for which the prognosis is worsened by the fact that pregnancy increases the secretion of Melanocyte-Stimulating Hormone (MSH). The clinical case is described of a malignant vaginal melanoma in a 27 year-old woman in her 38th week of gestation, who was referred for slight vaginal bleeding. Clinical examination revealed a 3 cm pedunculate tumour on the anterior wall of the vagina. Vaginal cytology suggested a melanoma and instrumental examination failed to reveal any lymph node involvement. The vaginal tumour was removed during a caesarean section and subsequent histological examination identified it as a Breslow Stage II malignant melanoma. A 24-month follow-up showed the patient to have been completely cured.

Study on the accuracy of official recording of nosological codes in an Italian regional hospital registry.

This paper describes an analysis of the quality of hospital discharge data stored in an Italian regional registry. Although limited in scope, this analysis sheds some light on the level of quality that users can expect in official health data and describes some factors which can influence such quality. Attention focuses on the accuracy with which official administrators code Diseases of Circulatory System (DCS) in a specified health district, using the discharge diagnosis formulated on the case-notes. Investigation of the data, a random sample of 993 medical records, shows a disturbing level of inaccuracy in the assignment of the primary diagnosis to the (DCS) group and sub-groups, especially when compared with other international experiences. Two factors, namely the type of hospital where official administrators routinely collect the data and the age of the in-patients, are found to significantly influence such inaccuracy. Explanations of these findings are suggested and proposals for the improved accuracy of hospital discharge data are presented.

Chemotherapy and cervical cancer: present trends.

A clinical case of cervical carcinoma Stage Ib is described. We treated a 48-year old woman with grade 2 carcinoma, using cisplatin at a dose of 40 mg/mq on the 1st and 4th days, bleomycin at a dose of 15 mg/mq on the 1st and 8th days, and anti-emetic for two cycles. On the basis of the low ratio T4/T8 we also administered along with chemotherapy, alpha natural interferon at a dose of 3,000,000 i.u. three times a week for four weeks. At the end of the chemotherapeutic treatment the lesion was reduced in size and the biopsy was pathognomically of a microinvasive cancer. In spite of the encouraging biopsy results, the patient was submitted to a simple hysterectomy, with random lymphoadenectomy. Today, two years after her treatment, the patient is free of disease. At present there is discussion as to the efficacy of neoadjuvant chemotherapy in the first stages of the neoplasia in relation to conventional treatment, which reserves chemotherapy to stages IV and IVb and to relapses, in the light of both the lesion and the disposability of the patient to treatment and successive follow-up.

A case of malignant melanoma of the vagina during pregnancy: immunological problems.

BACKGROUND: A clinical case of malignant melanoma of the vagina diagnosed during late pregnancy is described. Prompt histological examination showed a malignant melanoma at an early stage. The treatment of choice for malignant melanoma is surgical exicision. At present we are trying to associate immunological and chemotherapeutic treatments with surgical ones. CASE: A 27-year-old primipara was diagnosed with malignant melanoma at 38 weeks' gestation. The patient underwent a cesarean section. Careful evaluation of the immunological characteristics of the patient induced us to treat the melanoma with human leukocyte alpha interferon. The result was an increase in T4 cells with respect to T8 cells, with an enhancement in the ratio of CD4 to CD8. CONCLUSION: The results suggest the immune system plays a major role in the modification and regulation of neoplasias of the genital tract.

Role of ultrasonography in the early diagnosis of ovarian cancer.

BACKGROUND: Malign ovarian carcinomas are the main cause of death from gynaecological cancer. In fact, only in 30% of cases is it diagnosed at an early stage. In our study the possibility of an early diagnosis of the ovarian malignant neoplasia was evaluated. METHODS: One hundred and thirty-nine women with adnexal swelling were subjected to pelvic echography. The sample was selected during routine gynaecological checkups. RESULTS: All the cases showing a mass diameter exceeding 25 mm were classified as positive. Echotomography showed 129 cases of positive ovarian mass with an accurate diagnosis in 92.27%. Integrating the results of echography with those of radioimmunoassay an early diagnosis of ovarian cancer was achieved in 92.53 of the cases. CONCLUSIONS: A routine pelvic examination associated with pelvic echotomography represent an effective protocol for the diagnosis of ovarian cancer at an early stage.

[Anti-platelet aggregating drugs in the prevention of thromboembolic diseases]. / I farmaci antiaggreganti piastrinici nella prevenzione delle malattie tromboemboliche

The treatment and prevention of arterial thrombosis have been improved in recent years by the use of drugs acting on certain platelet characteristics, such as clumping capacity, adhesivity, release of factors 3 & 4, and survival. Many substances have been proposed for clinical employment. Mechanisms of action are discussed on the basis of personal experience, particularly with dipyrimadol and beta-blocking drugs. It would seem that the best results are obtainable with drugs whose effect on platelet clumping comes from stablisation of the membrane, such as the non-steroid anti-inflammatory preparations, in association with drugs than enhance intraplatelet cyclic AMP.

[Drug treatment in vulvar lichen sclerosus]. / Il trattamento medico nel lichen scleroso vulvare.

This study was made in the Oncologic Gynecology's surgery of the Department of Obstetrics and Gynecology of the University of Naples. We evaluated the efficacy of local therapy with testosterone and progesterone in Vulvar Lichen Sclerosus. We treated 65 women suffering from Vulvar Lichen Sclerosus. In the group of 38 women treated with testosterone, we observed a complete response in 26 cases (68%). In the group of 27 women treated with progesterone we observed a complete response in 18 cases (66.6%). This demonstrates the efficacy of local therapy with testosterone and Progesterone in Vulvar Lichen Sclerosus. The authors believe that medical treatment with topical testosterone and progesterone represents an effective alternative to invasive methods for the care of Vulvar Lichen Sclerosus.

[Drug therapy of condylomata acuminata]. / Trattamento farmacologico dei condilomi acuminati.

This study seeks to evaluate two candidate regimens (5-fluorouracil and interferon) as adjuvants to optimally performed laser surgery in the treatment of condylomata acuminata. Skillful laser ablation can remove any volume of human papillomavirus-associated vulvar disease but cannot prevent reactivation of the surrounding latent viral reservoir during postoperative healing. Conversely, interferon and 5-fluorouracil are relatively ineffective as primary therapies. This study involves 118 evaluable patients: 32 in the laser-CO2 group, 34 in the 5-fluorouracil group and 52 in the interferon group. At assessment of final outcome, it was found that 43 of 52 (82%) assessable patients in the adjuvant interferon arm were controlled by a single laser ablation as compared with only 17 of 34 (50%) in the 5-fluorouracil group and 13 of 32 (40%) in the laser alone group. There was no statistical difference in outcome within the 5-fluorouracil and laser only arms. Conversely, a relatively low dose of recombinant interferon, used in combination with effective surgical deleulking, can markedly reduce the risk of postoperative recurrence.

[Association of interleukin 2 and interferon alpha in the management of cervical condylomatosis]. / Associazione di interleuchina-2 ed interferone-alpha nel trattamento della condilomatosi della cervice uterina.

At present the therapy of cervical condylomatosis is based on the use of interferon because the HPV types responsable for condyloma inhibit the immunitary system. But many A. studying the effects of IFN have found that at high concentration it has an immunosuppressive action. The aim of the present study was to evaluate if interleukin-2 associated with IFN is useful in avoiding this negative effect by improving the efficacy of cervical condylomatosis therapy. We treated 25 women suffering from cervical condyloma with increasing doses of IL-2 injected intralesionally and associated with natural alpha-IFN injected intramuscularly. The duration of the whole therapy was six weeks. We evaluated the percentage of inflammatory cells in peripheral blood before and after treatment. The per-cent number of lymphocytes, eosinophils and lymphoblasts was increased by 27%, 88% and 40%, respectively. The clinical response to the therapy was total in 14 cases, partial in 9 cases and unsuccessful in 2 cases. These data suggested that combination therapy with interleukin-2 and alpha-IFN for the treatment of patients with cervix condylomatous is successful.

[Vulvo-vaginal HPV infection: immunological aspects]. / Infezione vulvo-vaginale da HPV: aspetti immunologici.

All phases of HPV infection are under the control of the immunitary system which is probably inhibited by the virus itself. We studied 65 patients (range 22-55 year). They presented an HPV vulvovaginal infection not healed after common therapy. The aim of our study was to verify the changes occurring in the immune system during HPV vulvo-vaginal infection. Using the immunohistochemical method we evaluated the number of T4,T8 and NK lymphocytes inside the lesion. Moreover we measured the immunitary cells of the hematic compartment. Inside the lesion we noted a reduction of the immune system in 69.23% of cases, while in the hematic compartment it was reduced only in 6.15% of cases. These data strongly suggested that the evaluation of the immunitary state, before starting therapy, is important in deciding when it would be useful to associate immunostimulating substances at the common treatment of vulvo-vaginal infection.

[Folic acid and cervix dysplasia]. / Acido folico e displasia cervicale.

The localized folate deficiency, which is sometimes misdiagnosed as cervical dysplasia, because of morphological similarities between the cytologic features of megaloblastosis seen with folate deficiency and the changes associated with dysplasia, could be a component of the dysplastic process. In this study we attempted the effect of oral folic in women with cervical dysplasia. A total of 154 subjects with grade 1 or 2 CIN were randomly assigned either 10 mg of folic acid or a placebo daily for 6 months. Clinical status, human papillomavirus type 16 infection and blood folate levels were monitored at 2 month intervals. After 6-months no significant differences were observed between supplemented and unsupplemented subjects regarding dysplasia status, biopsy results, or prevalence of human papillomavirus type 16 infection. Folate deficiency the initiation of cervical dysplasia, but folic acid supplements do not alter the course of established disease.