Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy.

STUDY OBJECTIVE: To determine the prevalence of sleep-related breathing disturbances in a large cohort of school-aged and preschool-aged children of Southern Italy. DESIGN AND SETTING: This cross-sectional prevalence study was designed in two phases: a screening phase aimed to identify symptomatic children from a cohort of 1,207 by a self-administered questionnaire, and an instrumental phase for the definition of sleep-related disorders. PATIENTS AND METHODS: One thousand two hundred seven children were screened by a self-administered questionnaire. There were 612 female children (51%) and 595 male children (mean age, 7.3 years; range, 3 to 11 years). According to answers, children were classified in three groups: nonsnorers, occasional snorers, and habitual snorers. All habitual snoring children underwent a polysomnographic home evaluation, and those with an oxygen desaturation index > 2 were considered for nocturnal polygraphic monitoring (NPM). Children with an apnea/hypopnea index > 3 received a diagnosis of obstructive sleep apnea syndrome (OSAS). RESULTS: A total of 895 questionnaires (74.2%) were returned and scored; 710 children (79.3%) were identified as nonsnorers, 141 children (15.8%) were identified as occasional snorers, and 44 children (4.9%) were identified as habitual snorers. The percentage of male children who were habitual snorers was higher than the percentage of female children who were habitual snorers (6.1% vs 3.7%, respectively; p < 0.09). OSAS was diagnosed in nine children by NPM. CONCLUSION: The lower limit of prevalence of OSAS in childhood is 1% (95% confidence interval [CI], 0.8 to 1.2). If we add the five children who underwent adenoidectomy and/or tonsillectomy because of worsening clinical condition and the two children who were shown to have evidence of OSAS on domiciliary oximetry, then the prevalence is 1.8% (higher limit of prevalence; 95% CI, 1.6 to 2.0).

Is endoscopic injection hemostasis of bleeding gastrointestinal ulcers obsolete in 1995?

Bleeding non-neoplastic lesions of the upper gastrointestinal tract, not due to portal hypertension, are a frequent cause of emergency admission. In the present paper we report our retrospective experience in hemostatic injection treatment of these lesions. From May 1990 to May 1994, 164 patients were admitted to our institution for a bleeding gastrointestinal lesion. In 124 cases an ulcer classified according Forrest's criteria was detected. Four patients underwent immediate surgery. The second group of 86 patients (FIIa/FIIb/FIII) were treated conservatively. The third group of 34 patients (FIa/FIb/FIIa) underwent perilesional injection of adrenaline 1:10,000 and polidocanol 1% saline solution during endoscopic examination; 29% (25 pts) of the second group re-bled during the first 72 h vs 8.8% (3 pts) of the third group. The postoperative morbidity in the rebleeding patients was higher in the second group: 38.4% vs 0%. The importance of immediate, inexpensive, and simple hemostatic treatment extended to Forrest IIa lesions is emphasized.

Localization of hepatitis C virus antigens in liver and skin tissues of chronic hepatitis C virus-infected patients with mixed cryoglobulinemia.

Skin and/or liver biopsy specimens were obtained from the following patients: 15 anti-hepatitis C virus (HCV), HCV RNA-positive patients and 3 anti-HCV, HCV RNA-negative patients with type II mixed cryoglobulinemia (MC); 7 anti-HCV, HCV RNA-positive patients with chronic active liver disease (CALD); 5 anti-HCV, HCV RNA-negative patients with noncryoglobulinemic vasculitis; and 7 anti-HCV, HCV RNA-negative patients with lichen ruber planus. A pool of murine monoclonal antibodies (MAbs) developed against c22-3, c33c, and c100-3 proteins was used to detect HCV-related antigens (Ags) by indirect immunohistochemistry. Acid electroelution (AEE) of tissue sections was performed to enhance the sensitivity of the immunohistochemical method. In anti-HCV-positive MC patients, specific HCV-related Ags were detected in the small vessels of the skin and in the cytoplasm of hepatocytes. Prior AEE of biopsy sections allowed detection of HCV Ags in 6 of 15 (40%) skin biopsy and in 9 of 14 (64.3%) liver biopsy specimens. HCV immunoreactive deposits in the skin displayed two immunohistochemical patterns: (1) coarse intraluminal material associated with dermal inflammatory infiltrates and intravascular deposition of eosinophilic hyaline material; and (2) reactivity confined to the vessel wall in the context of an apparently normal tissue. Immunoglobulin (Ig) G and IgM deposition in the skin showed immunohistochemical features comparable with those found for HCV Ag deposits.(ABSTRACT TRUNCATED AT 250 WORDS)

Classical Kaposi's sarcoma: a survey of 163 cases observed in Bari, south Italy.

BACKGROUND: Classical Kaposi's sarcoma (KS) is a sporadic disease that is particularly prevalent in Mediterranean countries. OBJECTIVE: The aim of the study was to update clinical information about this rare condition. METHODS: A survey of 163 cases observed in the period 1971-1990 in Bari, South Italy, was carried out. All records were reviewed and, when lost to follow-up for more than 6 months, patients were called back to update personal and family histories. The age at onset averaged 64 years (range 18-85). The male-to-female ratio was 3:1. No familiar occurrence was identified, and no significant association was found with other conditions (i.e. second primary malignancies and diabetes mellitus). Death from KS occurred in 16 cases, at the mean age of 71 years, an average of 5.7 years after the onset of the disease. To assess whether the different clinical patterns of the disease in its earlier stages may give any indication of its subsequent clinical course, all cases were re-classified into three groups (low-, moderate- and high-eruptivity group) on the basis of both the extent and the rate of spread of the disease before first admission; group-stratified survival function was evaluated using Kaplan-Meier's life table method. RESULTS: Highly significant (p < 0.0001) differences were found in survival profiles of the three study groups, also when only deaths due to KS were computed. CONCLUSION: These findings provide some support to the hypothesis that three subsets of classical KS exist that have different prognoses and, consequently, need different therapeutic approaches.

Psoriatic lesions in patients with chronic liver disease are distinct from psoriasis vulgaris lesions, as judged on basis of integrin adhesion receptors.

Psoriatic lesions are relatively frequent in patients with chronic liver disease. Furthermore, therapy with interferons tends to exacerbate the symptoms. The pathogenesis of psoriatic lesions is unclear. An important question is whether such lesions may be linked to the underlying chronic liver disease in these patients, or whether they are incidental manifestations of psoriasis vulgaris. We collected biopsy specimens from involved and uninvolved skin areas of chronic liver disease patients with psoriatic manifestations, as well as from psoriasis vulgaris patients, and investigated the patterns of integrin adhesion receptors by means of immunohistochemical methods. Integrin expression is known to be characteristically altered in psoriasis vulgaris. We found some of these changes in chronic liver disease psoriatic lesions-namely pericellular redistribution and suprabasal expression of the basement membrane receptor alpha 6 beta 4 and of the intercellular integrins alpha 2 beta 1 and alpha 3 beta 1. However, psoriasis vulgaris causes two other typical changes: One is the induction of the prototype fibronectin receptor alpha 5 beta 1, and the other is the alteration of integrin expression in areas of the epidermis that are macroscopically normal. These two changes were not found in chronic liver disease psoriasis biopsy specimens in 14 patients investigated. Thus integrin expression may be useful in differentiating chronic liver disease psoriatic lesions from psoriasis vulgaris lesions. Even though the two types of lesions are indistinguishable on inspection or by their histological features, they may be caused by distinct pathogenetic mechanisms. It remains to be seen whether the underlying chronic liver disease has a role, albeit indirect, in such mechanisms.

Melanocyte tumor progression is associated with changes in angiogenesis and expression of the 67-kilodalton laminin receptor.

BACKGROUND: A number of experimental studies have substantiated changes in angiogenesis and in laminin/laminin-receptor interactions during tumorigenesis and tumor progression. However, these observations have never been verified objectively in tissues from a well-defined model of tumor progression. METHODS: Tissues from 97 proliferative lesions of the melanocyte lineage defining distinct steps in tumor progression were investigated immunohistochemically for changes in angiogenesis and expression of the laminin receptor (67-kilodalton molecule). RESULTS: Although the microvessel number was low in common nevi, it increased significantly in nevi with architectural disorder with varying degrees of melanocytic atypia (termed "nevi with ADMA"), and these changes persisted during transformation. Progression to primary melanomas was accompanied by a high microvessel number and progression to metastases by another significant increase. The number and diameter of microvessels were significantly higher at the lesion base than at the adjacent dermis of primary melanomas and higher in the lesion than in the adjacent tissue of metastatic foci. Expression of the laminin receptor, evaluated as percentages of positive lesions and positive cells per lesion, underwent upregulation in the course of progression. Changes in expression were associated mostly with nevi with ADMA, transformation, and deepening of the tumors into the dermis. CONCLUSIONS: These in situ data suggest that more frequent interactions between melanocytic cells and their microvasculature via adhesion protein laminin occur during tumor progression.

[Cholelithiasis in advanced age]. / La colelitiasi in età avanzata.

Fifty seven patients over 65 affected with cholelithiasis underwent surgical procedures at II Patologia Chirurgica-University of Bari-Italy, from July 1987 to December 1988. Different risk factors were considered. The results, which reported a low incidence of morbidity and mortality, suggest the importance to adopt early surgery. Though 73.2% of patients had associated pathologies and 28.6% had two or more risk factors, only 5.3% of them had complications not strictly related to surgery.

[Total pericystectomy in the treatment of hepatic echinococcosis]. / La pericistectomia totale nel trattamento dell'echinococcosi epatica.

Fourteen patients, affected with hepatic echinococcosis, who underwent total pericystectomy at II Patologia Chirurgica, University of Bari-Italy, were retrospectively evaluated. The period considered was July 1987-December 1988. Immediate (low morbidity and no mortality) and late (no recurrences) results showed that total pericystectomy is the treatment of choice in hepatic hydatidosis.

[The role of lymphography in melanoma of the limbs. Personal experience]. / Ruolo della linfografia nel melanoma degli arti. Esperienza personale.

The authors report the results of the lymphographic examinations performed on 123 patients affected with melanoma of the limbs. The patients were divided into 2 groups according to the different clinical stages; they all had pathologic confirmation. The following lymphographic parameters were considered: sensitivity, specificity, efficacy and positive/negative predictive value. The results obtained in the first group of patients (clinical stage: I) demonstrated lymphography to have low sensitivity, specificity and efficacy in the staging of melanomas (37%, 50% and 45%, respectively). On the contrary, lymphography could be trusted in the study of stage II melanomas thanks to its high sensitivity. As for stage III, the methodology had a clinical indication only in the follow-up of melanomas treated with radiochemotherapy.

Skin tumors and reactive cellular infiltrate: further studies.

Twenty-two non-ulcerated basal cell carcinomas and 30 non-ulcerated squamous cell carcinomas were selected to study the reactive cellular infiltrate, utilizing histological, histoenzymatic and immunological methods. Substantial differences in cell behaviour were observed between the two tumors: advanced and metastatic squamous cell carcinoma showed prominent presence of T8+ lymphocytes, Leu 7+ cells, macrophages, mast cells and granulocytes, notably eosinophils. Degranulation of mast cells was seen both in the tumor itself and in the adjacent stroma. The basal cell carcinoma presented a low count of T4+, T8+ lymphocytes, whereas Leu 7+ cells and granulocytes were absent.

T cell subsets and soluble immune response suppressor (SIRS) factor in skin squamous cell carcinoma.

T cell subsets (theophylline-sensitive T lymphocytes and T gamma lymphocytes), and the activity of soluble immune response suppressor (SIRS) factor have been investigated in a total of 53 patients with squamous cell carcinoma (SCC) of the skin. Eight of these had metastatic regional lymph nodes. The results showed decreased values for theophylline-sensitive T lymphocytes and elevated values for T gamma cells. Suppressor function evaluated by means of SIRS factor was normal in 36 patients with non-metastatic skin SCC and decreased in 8 with metastatic skin cancer.

Macrophages in skin cancer: quantitative and functional studies.

The number of tumor-infiltrating macrophages was estimated in 43 patients with skin cancer, including 18 cases of squamous cell and 25 cases of basal cell carcinoma. Macrophages were identified in cell cultures by 2 assays, namely phagocytosis and resistance to detachment by trypsin. The average percentage of adherent cells for the 2 groups of skin tumors was 4.5 +/- 2.6 and 10.2 +/- 5.2, respectively, and the difference was statistically significant. Follow-up studies after surgical excision of the primary neoplasm showed a relatively low macrophage content in 2 of the 4 cases in which local recurrences occurred. Preliminary functional studies suggested that soluble factors may be released by neoplastic cells, accounting for the inhibitory effect of tumor cell supernatants on macrophage chemotaxis in vitro.