Massive pulmonary embolism as a rare complication of a stab in the inguinal region in a HIV-positive patient: a case report.

OBJECTIVE: Venous thromboembolism (VTE) is a severe preventable disease; HIV-infection represents a prothrombotic condition, because of specific factors due to the virus itself, the host response and the antiretroviral therapy. Our aim is to raise awareness of thromboembolic risk when dealing with HIV-positive patients presenting to the Emergency Department for treatment of injuries, even though small. CASE REPORT: We present a case of a 33-year-old woman suffering from HIV-infection who presented to the Emergency Department with two small stab wounds. Laboratory tests and radiologic examinations were normal. About 8 hours after admission the patient developed a syncopal attack: a CT scan performed after hemodynamic stabilization revealed a massive pulmonary embolism (PE); the patient was then transferred to the Intensive Care Unit and treated with systemic thrombolysis. CONCLUSIONS: This case confirms that HIV-positive patients carry a higher risk for VTE and PE compared to general population, similarly to patients suffering from cancer: emergency physicians must be aware even in case of minor wounds.

Implication of HLA-G 3' untranslated region polymorphisms in human papillomavirus infection.

Human papillomavirus (HPV) infection is involved in cervical lesion development. It interferes with host immune response and modifies the expression of human leukocyte antigen-G (HLA-G), a nonclassical HLA-I antigen with immune-inhibitory functions. We analyzed the frequencies of two HLA-G 3' untranslated region polymorphisms (14 bp ins/del, +3142C>G), involved in HLA-G modulation, in 33 condyloma acuminatum, 14 low grade squamous intraepithelial lesion and 100 invasive cervical cancer (ICC) HPV infected patients. We showed the involvement of HLA-G polymorphisms in HPV infection and lesion development, and suggested that 14 bp del allele promotes high-risk HPV infection, with del/C haplotype associated with ICC development. On the basis of these evidences, HLA-G polymorphisms could represent a risk factor in HPV positive subjects.

[Lymphadenectomy in the differentiated thyroid carcinoma]. / Linfectomia nei carcinomi differenziati della tiroide.

BACKGROUND: In this study the authors analyze the indications and the type of surgical procedure to perform on the neck lymph nodes in cases of differentiated thyroid carcinoma. METHODS: The study has been carried in a retrospective way. Between 1993 and 2001, 93 differentiated thyroid cancer were observed. There were 72 women and 21 men, with a mean age of 45.9 years (range 18-77). Patients have been divided into three groups: the first included 25 patients who underwent only thyroidectomy (24 total thyroidectomy, 1 lobectomy); the second group included 52 patients who underwent total thyroidectomy and lymphadenectomy of the central compartment. The third group included 16 patients who underwent total thyroidectomy and functional neck dissection. The median follow-up was 65.9 months. RESULTS: The postoperative complications was similar between three groups. Follow-up has shown similar survival and recurrences between groups. CONCLUSIONS: The elective lymphadenectomy of the central could be a solution for a routine treatment of differentiated thyroid cancer without lymph node involvement. The presence of cervico-lateral node metastases imposes a functional neck dissection.

[Use of mechanical staplers in the surgical treatment of rectal cancer in the elderly]. / L'utilizzo delle suturatrici meccaniche nel trattamento chirurgico del cancro del retto nell'anziano.

The aim of this study was to analyze the changes in surgical treatment of rectal cancer and in postsurgical complications as a result of the introduction of staplers in surgical practice, with particular reference to elderly patients (> or = 75 years). Since 1976, 320 patients have undergone rectal surgery in our department (207 colo-rectal or colo-anal anastomoses and 113 Miles operations have been performed). The patients were subdivided into two groups on the basis of age (> or = and < 75 years) and then further divided into subgroups operated on before and after 1983 (the year staplers were introduced). The morbidity rate (fistulas) was 16% in patients < 75 years old and 12% in elderly patients (P = n.s.); the mortality rate was 1% in patients < 75 years old and 12% in the more elderly group (P < 0.001). The utilization of staplers in surgical treatment of rectal cancer allows the surgeon to perform sphincter-sparing resections even in elderly patients without any changes in specific morbidity. Nevertheless, the complications are more severe in the elderly, with a higher mortality rate.

[Synchronous neoplasms of the colon and kidney: analysis of 2 case reports]. / Neoplasie sincrone del colon e del rene: analisi di due casi osservati.

Up until only a few decades ago synchronous renal cell carcinoma associated with primary tumors of other organs was diagnosed almost exclusively in necropsy series. Recently the widespread use of ultrasonography and CT has permitted diagnosis of clinically silent renal cell carcinoma in patients undergoing a work-up for other primary tumors. We report two cases of synchronous colon and renal cancer: 1) a 75 year old woman presented bilateral pulmonary nodules at chest X-Ray and stratigraphy. Total-body CT scan showed multiple, apparently metastatic, bilateral pulmonary lesions and two tumors in the right kidney and ascending colon. A right nephrectomy and right hemicolectomy were performed. She succumbed after 18 months as a result of metastatic spread to the liver, lungs and bone; 2) a 64 year old man was discovered to have a colon cancer during a barium enema examination and endoscopy. CT scan of the abdomen yielded an incidental diagnosis of a tumor in the left kidney. A left nephrectomy and left hemicolectomy were performed. After 6 months CT revealed no evidence of recurrence or metastases. Histology findings revealed two primary malignancies in both cases: a clear cell renal carcinoma and an adenocarcinoma of the colon.

Effect of caffeic acid on tert-butyl hydroperoxide-induced oxidative stress in U937.

Nonvitamin phenolic compounds are ubiquitous in food plants and therefore potentially present in human plasma in a diet-dependent concentration. The aim of this study was to evaluate the ability of caffeic acid, a phenolic acid with antioxidant activity, to affect cellular response in U937 human monocytic cells to t-butyl hydroperoxide-induced oxidative stress. In our experimental conditions caffeic acid was incorporated into cells without any cytotoxic effect. Caffeic acid-treated cells showed an increased resistance to oxidative challenge, as revealed by an higher percent of survival and the maintenance of an higher proliferative capacity in respect to control cells. This effect seems to be due to the ability of caffeic acid to reduce glutathione depletion and to inhibit lipid peroxidation during tBOOH treatment. It can be concluded that caffeic acid exerts an antioxidant action inside the cell, responsible for the observed modulation of the cellular response to oxidative challenge. Due to its presence in the diet, therefore, caffeic acid may play a role in the modulation of oxidative processes in vivo.

Effect of caffeic acid dietary supplementation on the antioxidant defense system in rat: an in vivo study.

Dietary supplementation of caffeic acid (0.2 and 0.8% w/w) in rats resulted in a statistically significant increase of alpha-tocopherol both in plasma and lipoprotein. While caffeic acid was not detectable in plasma under fasting conditions, in postprandial plasma it was present at micromole concentrations, doubling plasma total antioxidant capacity. Lipoproteins from caffeic acid-fed rats were more resistant than control to Cu2+-catalyzed oxidation, despite the lack of incorporation of caffeic acid in the particles. No significant effects on plasma and liver copper concentration, nor the increase in liver of Mn-superoxide dismutase reported in copper deficiency, were detected. These results demonstrate the physiological relevance of caffeic acid and its antioxidant action in vivo, through both a direct contribution to the antioxidant defense system and a sparing effect on alpha-tocopherol.

Effect of fish oil and coconut oil on antioxidant defence system and lipid peroxidation in rat liver.

Diets high in fish oil containing polyunsaturated fatty acids of the n-3 family, have been suggested to decrease the risk of cardiovascular disease. However these lipids are highly susceptible to oxidative deterioration. In order to investigate the influence of n-3 fatty acids on oxidative status, the effect of feeding rats with fish oil or coconut oil diets was studied by measuring different parameters related to an oxidative free radical challenge. Synthetic diets containing 15% (w/v) fish oil or coconut oil were used to feed growing rats for 4 weeks. As compared to control diet, the fish oil containing diet produced a significant decrease of cholesterol and triglyceride concentration in serum, however there was a significant increase in lipid peroxidation products. In addition, in fish oil fed animals, there was also a decrease in vitamin E and A concentration. Furthermore, the rate of lipid peroxidation in isolated microsomes was three fold higher in rats fed fish oil as compared to rats with coconut oil diet. No significant differences between the two experimental groups were observed in superoxide dismutase (SOD) and phospholipid hydroperoxide glutathione peroxidase (PHGPX) activities. However, there was a decrease in glutathione peroxidase (GPX) activity. These results suggest that fish oil feeding at an amount compatible with human diet, although decreasing plasma lipids, actually challenge the antioxidant defence system, thus increasing the susceptibility of tissues to free radical oxidative damage.

Influence of dietary thermally oxidized soybean oil on the oxidative status of rats of different ages.

Young and aging rats were fed for different periods (10, 90, 180 and 365 days) diets containing 15% of fresh or heated soybean oil. Thiobarbituric reactive substances (TBA-RS), lipofuscin, superoxide dismutase (SOD), vitamin A, vitamin E and microsomal and mitochondrial fatty acids in liver, brain and serum were measured. Heated oil diets induced significant increase of TBA-RS levels in liver, with earlier effects in aging rats and affected SOD activity in aging rats only after a long period of feeding. Circulating and stored vitamin A were reduced in both young and aging rats, with earlier effects in young animals. Serum and liver vitamin E was significantly reduced in all test groups. The results indicate that heated unsaturated oil produces reduction in the antioxidative defense system and that vitamin E status is the earliest indicator of the oxidative effect regardless of age.