[Presacral myelolipoma: a case report]. / Mielolipoma presacrale: case report.

BACKGROUND: Presacral tumors are more frequently benign, and only occasionally malignant, showing a slow growth and an incidence of 1:40.000. They are asymptomatic in the 26-50% of the cases. When symptoms occur, these are related to the dimensions of the tumor, to its location and to the presence of infection. CASE REPORT: We report the case of a 69-year old woman with a lower abdominal pain associated with paresthesia and ipostenia of the right inferior limb. Digital rectal examination showed a fixed, mild tender and hard tumor of the posterior rectal wall. CT, MR and CT-guided biopsy sequently performed revealed a solid, dishomogeneous mass, located in the presacral region, with a connective likely origin, without pelvic lymphoadenopathy. The operation allowed to esteem a mass which was tenaciously adherent to the sacrum. We performed a total excision. Final histological diagnosis was myelolipoma. CONCLUSIONS: The Authors' opinion is that the en-bloc resection of these tumors with an anterior surgical approach allows a histological diagnosis of the nature, representing the best treatment for potentially malignant lesions, which are frequently radio and chemo-resistant.

[Laparoscopic adhesiolysis in acute small bowel obstruction]. / Trattamento laparoscopico delle occlusioni del tenue.

At the beginning of the laparoscopic surgery, intestinal obstruction was considered an absolute contraindication for this approach, because of the high risk of injuring the bowel. Today laparoscopic surgery for small bowel obstruction is still under evaluation. Adhesions are the most common cause of obstruction; although an important proportion of these patients can be nonoperatively treated, some of these require immediate operation. The aim of this review was to evaluate the reliability and immediate results of laparoscopic management of small bowel obstruction by postoperative adhesions. Laparoscopic management of acute small bowel obstruction is feasible, but it is often difficult and may be hazardous. The patients with acute obstruction may be undergo laparoscopy after a careful selection. Morbidity is low if the operation is performed by skilled. The immediate benefit is rapid intestinal motility and shorter hospital stay. The long-term effect is the prevention of small bowel obstruction recurrences by new postoperative adhesions.

Isolation and characterization of new lignans from the leaves of Cestrum parqui.

Three new compounds, a sesquilignans, an oxyneolignan and a norlignan, have been isolated from the aqueous fraction of Cestrum parqui. All of the compounds have been identified on the basis of their spectroscopic properties and tested on the species Lactuca sativa and Lycopersicon esculentum to evaluate their phytotoxic activity.

Effect of dietary cholesterol and degree of fat unsaturation on plasma lipid levels, lipoprotein composition, and fecal steroid excretion in normal young adult men.

Effect of four test diets differing in the ratio of polyunsaturated to saturated fats (P/S, 1.8 vs 0.28) and two cholesterol levels (1,000 vs 300 mg/day) for each level of the P/S ratio was determined on plasma lipid levels, lipoprotein compositions and concentrations, and fecal steroid excretion in a controlled diet study with 11 normal young men using a crossover design. Plasma cholesterol levels were significantly decreased by the diets high in P/S ratio regardless of the dietary cholesterol levels (14% decrease by high cholesterol and 20% in low cholesterol) while the diets low in P/S ratio increased cholesterol by an average of 24 and 22% in presence of high and low cholesterol, respectively. Lipids and apoproteins of lower-density lipoproteins were changed in accordance with those of plasma cholesterol but changes in high-density lipoprotein (HDL) appear to depend on both cholesterol content and P/S ratio. Dietary cholesterol level profoundly influenced the excretion of neutral sterols and diets high in P/S ratio significantly (p less than 0.05) increased fecal bile acid extraction. The present study demonstrated that dietary polyunsaturated fats, when a moderate amount was consumed, were effective and beneficial hypocholesterolemic nutrients without reducing HDL-cholesterol.

Impact of donor-specific antibodies on chronic rejection occurrence and graft loss in renal transplantation: posttransplant analysis using flow cytometric techniques.

BACKGROUND: Improvements in immunosuppressive therapy have greatly reduced acute rejection (ARj) episodes, ensuring better short-term graft outcome, but have not modified long-term survival in renal transplantation. It is now well accepted that chronic rejection (CRj) can be determined by both immune and/or nonimmune mechanisms. The aim of this study was to evaluate the importance of the posttransplant humoral immune response towards mismatched HLA graft antigens in CRj occurrence and graft outcome. METHODS: Serum samples from 120 nonpresensitized renal transplant recipients were prospectively screened for 1 year after surgery by means of flow cytometry cross-match (FCXM) and FlowPRA beads (microbeads coated with purified HLA class I and class II antigens) assays. All transplants were followed-up for 2 years or until graft removal. RESULTS: FCXM monitoring identified donor-specific antibodies (DS-Abs) in 29 (24.2%) of 120 transplanted patients. Correlation with clinical data highlighted a higher incidence of ARj in DS-Abs-positive patients compared to negative patients (62% vs. 13%, P<0.00001). Furthermore, graft failure occurred more frequently among FCXM-positive patients than among negative patients (34% vs. 1%, P<0.00001). The deleterious effect of DS-Abs on graft function was confirmed by serum creatinine levels 2 years after transplantation. These were in fact higher in subjects producing DS-Abs than in subjects with only ARj (mean creatinine: 2.5+/-1.3 mg/dL vs.1.7+/-0.5 mg/dL, P=0.04). FlowPRA analysis of DS-Ab HLA specificity highlighted the presence of anti-HLA class I antibodies in 85% of FCXM-positive patients, who also presented with a higher incidence of HLA-B mismatches than FCXM-negative patients (1.23+/-0.66 vs. 0.92+/-0.59, P=0.02). CONCLUSIONS: Flow cytometric techniques are precious tools for investigating the activation of the humoral response against HLA antigens of the graft in renal transplantation. DS-Abs production has a worse impact on organ function and survival than ARj episodes. These findings represent further proof of the threat posed by DS-Abs on long-term graft function and draw attention to the need for a specific immunosuppressive therapy aimed at counteracting the different kinds of immune activation toward graft.

Antialgal ent-labdane diterpenes from Ruppia maritima.

Seven ent-labdane diterpenes have been isolated from Ruppia maritima. The structures 15,16-epoxy-ent-labda-8(17),13(16),14-trien-19-al; 15,16-epoxy-ent-labda-8(17),13(16),14-trien-19-ol acetate; methyl 15,16-epoxy-12-oxo-ent-labda-8(17),13(16),14-trien-19-oate; 15,16-epoxy-ent-labd-8(17),13E-dien-15-ol and 13-oxo-15,16-bis-nor-ent-labd-8(17)-ene have been assigned to the five new compounds by spectroscopic means and chemical correlations. The phytotoxicity of the diterpenes has been assessed using the alga Selenastrum capricornutum as organism test.

Oleanane glycosides from Hydrocotyle ranunculoides.

Six new oleanane glycosides, ranuncosides I-VI, have been isolated from Hydrocotyle ranunculoides. Their structures have been determined on the basis of chemical and spectroscopic studies.

Lactone diterpenes from the aquatic plant Potamogeton natans.

Four lactone diterpenes and two related glucosides with a labdane skeleton have been isolated from the aquatic plant Potamogeton natans. The structures of three new compounds were determined as 19-acetoxy-20-oxo-8(17),13-ent-labdadien-15-->16 lactone, 8(17), 13-ent-labdadien-15-->16,19-->20 dilactone and 6'-acetyl-19-glucopyranosyloxy-8(17),13-ent-labdadien-15-->16 lactone, respectively, by means of spectral analysis. Antialgal assays showed inhibitory activity for some compounds.

Potential allelochemicals from Sambucus nigra.

Twenty-four aromatic metabolites belonging to cyanogenins, lignans, flavonoids, and phenolic glycosides were obtained from Sambucus nigra. Structures were determined on the basis of their spectroscopic features. Two compounds have been isolated and identified as (2S)-2-O-beta-D-glucopyranosyl-2-hydroxyphenylacetic acid and benzyl 2-O-beta-D-glucopyranosyl-2,6-dihydroxybenzoate. All the compounds have been assayed on dicotyledons Lactuca sativa (lettuce) and Raphanus sativus (radish) and monocotyledon Allium cepa (onion) to test their stimulatory or inhibitory effects on seed germination and radicle elongation. Cyanogenins have a mainly inhibiting effect while lignans stimulate the growth. Some compounds show different effects on dicotyledons and monocotyledons.

Cycloartane glucosides from Juncus effusus.

Five new cycloartane glucosides, juncosides I-V, have been isolated from Juncus effusus. The structures have been determined on the basis of chemical and spectroscopic studies.

Polysaccharides from seeds of Strychnos species.

The chemical composition of polysaccharide fractions from Strychnos nux-vomica and S. innocua seeds and comparison with those from S. potatorum seeds are reported. The structural features of the galactomannans from the three Strychnos species are also discussed.

Antialgal furano-diterpenes from Potamogeton natans L.

Six furano-ent-labdanes, 19-acetoxy-15,16-epoxy-8(17),13(16),14-ent-labdatrien-20-al, 15,16-epoxy-12-oxo-8(17),13(16),14-ent-labdatrien-20,19-olide, 12(S)-hydroxy-15,16-epoxy-8(17),13(16),14-ent-labdatrien-20,19-olide, 10alpha,19-dihydroxy-15,16-epoxy-8(17),13(16),14-nor-ent-labdatriene, 19,20-dihydroxy-15,16-epoxy-8(17),13(16),14-ent-labdatriene, 15,16-epoxy-12-oxo-8(17),13(16),14-ent-labdatrien-19,20-olide, were isolated, together with the known potamogetonin, from the aquatic plant Potamogeton natans. Their structures were determined on the basis of their chemical and spectral data. The compounds showed in vitro phytotoxicity against Raphidocelis subcapitata, a microalga used in aquatic tests.

Sialorrhea from fourth ventricle hydrocephalus. Case report.

The case of a 50-year-old man with tetraventricular hypertensive hydrocephalus is presented, remarkable for fourth ventricle dilatation. This patient showed a significant sialorrhea as the main symptom, which is quite unusual. This condition was successfully treated by cerebrospinal fluid diversion. The uncommon features of this case are summarized.

The role of DRB1 amino acid residue differences on donor-specific antibody production and acute rejection after cadaveric renal transplant.

The correlation between DRB1 amino acid residue matching, post-transplant humoral response and acute rejection (ARj) episodes was analysed in 51 renal transplant donor-recipient pairs in order to determine new criteria for organ assignment based on the alloreactivity of the residue within the peptide binding groove. HLA class I and II compatibility was defined using serological and genomic techniques; a sequence-based typing (SBT) was used for a higher resolution of DRB1 alleles. Humoral response was monitored in the first post-transplant year using triple staining flow cytometric analysis of donor-specific antibodies (Abs). Our data showed that DRB1 residue compatibility was always correlated to the absence of ARj while the presence of one or more aminoacid differences was associated with a similar frequency of ARj. Analysis of the mismatched DRB1 amino acid residue localised in the beta-pleated sheet and the alpha-helix of the DRB 1 molecule revealed that the frequency of beta-pleated sheet residue mismatches (MMs) was higher in the ARj-positive than in the ARj-negative group. A significant increase in the alpha-helix residue MMs was observed in patients with anti-class II Ab production (p = 0.034). Furthermore, analysing in detail DRB 1 MMs at the level of single amino acid residue, we found that the frequency of the mismatches localized in codon 9 and codon 28 in the beta-pleated sheet, as well as in codon 57 in the alpha-helix, was higher in patients who experienced ARj; on the other hand, MMs in codon 58 of the alpha-helix were more frequently associated with anti-class II Ab production. The identification of the residues more involved in alloreactivity onset will make it possible to define the existence of "permissive" or immunogenic" allele combinations which could simplify and increase the chances of a successful transplant.

Vitamin E supplementation in hemodialysis patients: effects on peripheral blood mononuclear cells lipid peroxidation and immune response.

Lipid peroxidation and vitamin E levels in peripheral blood mononuclear cells (PBMC) were studied in 10 patients on maintenance hemodialysis. Significant increases of PBMC malonyldialdehyde (MDA) were detected, together with low vitamin E levels. After a fifteen-day-course of parenteral vitamin E supplementation, PBMC MDA reverted to normal values, while PBMC vitamin E levels remained lower than controls. In a parallel study an immunological monitoring was performed in the same patients before and after vitamin E supplementation. NK activity and PHA blastogenesis were not influenced by treatment, while a reduction of the number of OKT8+ lymphocytes were observed after vitamin E therapy. It is tempting to speculate that peroxidative damage of PBMC cell membranes in hemodialysis patients could, by impairing their functionality, influence immune responses and expression of functionally relevant membrane determinants.

Major ocular complications after organ transplantation.

We reviewed the existing literature on major ocular complications after organ transplantation. Disorders of the ocular surface were not considered. Published reports were selected through a computerized MEDLINE search of the literature. The incidence of cataract or increased intraocular pressure due to immunosuppressant therapy are common; although retinopathy, optic neuropathy, or central nervous system involvement are less frequent they may be related to severe and irreversible visual loss. Patients undergoing organ transplantation should receive careful and regular ocular examinations.

Genetic markers of cluster headache and the links with the lithium salts therapy.

The existing relationship between genetic markers of the cluster headache and the efficacy of lithium salts therapy was described in the present study. Thirty-five patients suffering from cluster headache, who were already typed for the HLA antigens, were studied. Typing was carried out with the microlymphocytotoxicity technique used by US National Institutes of Health. The patients were treated with lithium carbonate for a period of three months. Three parameters for evaluation of the efficacy of lithium therapy was used: the percentage of improvement, the wake-sleep rhythm and the pupil diameter measurement. The parameters were statistically (Student's t-test) evaluated and it was possible to separate two subgroups of patients: "responders" and "non-responders" to the lithium therapy. The phenotypical frequencies in the two subgroups was analysed using the chi 2 test, Data emerging showed a higher frequency of antigen HLA-B18 (23.8% versus 0%; p less than 0.005 pc less than 0.06) and of antigen HLA-A9 (42.9% versus 14.3%) in the "responders" subgroup. In the "non-responders" subgroup a higher frequency of antigen HLA-A1 (35.7% versus 14.3%) was found.

[A rare case of esophageal pathology: leiomyosarcoma (author's transl)]. / Un raro caso di patologia esofagea: il leiomiosarcoma.

The AA. report a clinical case of rare oesophageal pathology: the leioomyosarcoma sole case on 200 oesophageal neoplasms that they have observed. The clinical likeness with oesophageal carcinoma and the complete superimposition of reports that have been obtained in this case with instrumental examinations respect to the oesophageal carcinoma, didn't permit to do the diagnosis of histotype, while this diagnosis could be done only after the preparation of an histopathologic preparation. The patient who was operated on for superior polar esophago-gastrectomy, after 18 months is in good general conditions. THe AA. draw their conclusions after a short discussion. We must show in these paragraphs the particular macroscopic form of neoplasm that they have observed and the great difficulty of a diagnosis of leimyosarcoma without an histopathologic preparation. Agreeing with the most part of other Authors, they point out that the best therapy for these forms is surgical therapy.

[Current trends in malignant gastric lymphoma]. / Attuali orientamenti sui linfomi gastrici maligni.

Gastric lymphomata represent an important chapter of the oncologic pathology, for both their low incidence and the difficulties for surgeons in the preoperative recognition of such disease. The authors, after a careful study about this subject, report two cases they had the opportunity to observe.