Suicidal jumper's fracture - sacral fractures and spinopelvic instability: a case series.

BACKGROUND: Sacral fractures with spinopelvic dissociation are rare, and hard to diagnose and treat. Fractures with a H- or U-shaped line are severely unstable, due to a dissociation of the spine and of the upper body of the sacrum from the pelvis. They are commonly due to high-energy trauma events, with severe neurological injuries in 80% of cases. CASES PRESENTATION: Five polytraumatized Caucasian patients, three women and two men (mean age: 34 years old) with spinopelvic dissociation were selected. All patients underwent level I-II examinations with radiographs and computed tomography total-body scans; all patients needed damage-control procedures. Sacral fractures were classified according to Denis and Roy-Camille classifications, and neurologic injuries of cauda equina according to Gibbons classification. Patients' outcome was analyzed with the Majeed score. Definitive surgical treatment was appropriate for two patients (lumbar-pelvic fixation or transverse bar). Clinical and radiographic outcomes were analyzed periodically. Four patients survived, all of them suffered severe neurologic deficits. One case of osteomyelitis was treated with the removal of the fixation implants 23 months after the accident. CONCLUSIONS: Diagnosis of spinopelvic dissociation is frequently overlooked due to the severe associated injuries affecting these patients. In cases of a fall from high height, this lesion should be investigated with a lateral sacral radiographic view and computed tomography scan of the pelvis. If untreated, it can lead to severe and progressive neurologic deficit with muskuloskeletal deformities and persistent pain. Early decompression treatment is controversial, but an early lumbopelvic fixation is recommended. A correct diagnosis and early treatment can reduce morbidity and strongly improve the outcome of these patients.

P53, Bcl-2 expression and cell proliferation in benign breast lesions.

The role of proliferation-related markers on breast cancer pathogenesis has been only occasionally investigated. The immunocytochemical expression of P53 and Bcl-2 (using PAb1801 and anti-bcl-2 monoclonal antibodies) and cell proliferation (evaluated as the H-3-thymidine labeling index [H-3-dT LI]) were determined on 62 benign breast lesions at different risk. Accumulation of the P53 protein was never observed; Bcl-2 was detected in 50% of cases and it was unrelated to biologic and clinicopathologic features. Median H-3-dT LI was about three times lower than that observed on large series of invasive breast cancer. It was only slightly higher in lesions from patients younger than 35 years or with a positive family history than in those under 35 or with a negative family history and appeared unrelated to histology or risk classification. Such findings indicate that the investigated biomarkers fail to identify women at increased risk for breast cancer.

Schwartz-Jampel syndrome. Clinical, electrophysiological and histopathological study of a severe variant.

This report describes a child, offspring of a first cousin marriage, with a severe and progressive disorder of bone and cartilage growth associated with a myotonia-like syndrome. Clinical manifestations of this disease began at birth with marked generalized muscle hypertrophy, stiffness, myotonia and multiple skeletal deformities. Successively severe dwarfism and mental retardation were observed. Neurophysiological studies showed continuous high frequently low voltage activity at rest and myotonic discharges which did not wax and wane. These abnormalities persisted after complete curarization. Muscle biopsy showed mild dystrophic changes. Polymeric glycosaminoglycans and degradation product excretion was normal. These findings are similar to those described in Schwartz-Jampel syndrome, but since the clinical picture was fully expressed at birth and was unusually severe, it is suggested that the patient's condition may have represented a severe variant of this syndrome.

[Primary lymphoma of the thyroid gland]. / Il linfoma primitivo della tiroide.

On the basis of a case of thyroid primary lymphoma observed and in the light of the literature. The distinctive features of this rare pathology are discussed.

[Neuroendocrine carcinoma of the skin]. / Il carcinoma neuroendocrino della cute.

Merkel cell carcinoma is an unusual neuroendocrine tumour that arises in the derm. The case reported seemed to deserve the author's attention because of the clinical features, pathological findings and natural history (local recurrence, regional lymph node metachronous metastases, distant metastases). The authors believe that a differential diagnosis between Merkel cell carcinoma and other tumours located in the subcutaneous tissue is mandatory, in order to perform specific immunohistochemical and ultrastructural study.

[Sentinel lymph nodes in breast carcinoma: why, how, when]. / Lo studio del linfonodo sentinella nel carcinoma mammario: perché, come, quando.

Thanks to a retrospective analysis of the first 250 cases of sentinel lymph nodes in breast cancer assessed by the authors over the period from October 1998 to December 2000 in the light of a careful review of the literature, it has been possible to establish the importance of careful patient selection, strict compliance with the execution technique and, above all, the need for an adequate learning curve, before the procedure is used in particular protocols and/or in routine clinical practice in the near future. In particular, the training should first of all ensure that all personnel involved, i.e. surgeons, nuclear medicine specialists, and histopathologists, should attend specific courses at qualified Institutions followed by the actual management of a certain number of consecutive cases. In order to perfect the methodology and organisation, a preliminary study in a group of patients at different stages of evolution of the disease is recommended (50 cases in the study population reported). The next phase should include a group of highly selected patients, numbering at least 50-100. The training may be considered complete when in at least 20 cases, an identification rate of at least 90% is achieved with an incidence of false negatives of not more than 5%. In the authors' experience, these results were reached after 100 selected patients, and were later consistently confirmed after a further 50 cases.

[Morphological changes of the endometrium and ovary (optical and electronic microscopic observations) and their functional reversibility after prolonged use of synthetic estroprogestogens]. / Alterazioni morfologiche dell'endometrio e dell'ovaio (osservazioni al microscopio ottico ed elettronico) e loro reversibilità funzionale dopo uso prolungato di estroprogestinici di sintesi.

PIP: This study reports on the case of a 32-year-old patient who had been on OCs (oral contraceptives) for only 12 months, who was hospitalized for adnexial tumefaction. Am ovarian biopsy was done by observing with the optic and with the electronic microscope the modifications caused by the treatment on the ovary and on the endometrium. The observations revealed such serious pathological and degenerative modifications that the patient was recalled after 7 years to conduct the same kind of observations. On that occasion it was established that the patient, who has stopped hormonal contraceptive use, had resumed normal ovulatory capacity, and that hypophysary and ovaric secretions were absolutely normal. It is doubtful whether a longer period of OC use would allow the ovary to retain its ability to resume complete regular functions.^ieng

Modifying influence of fasting on liver hyperplasia induced by lead nitrate.

Previous studies by our laboratory have shown that lead nitrate when injected intravenously as a single dose to rats, induces a hyperplastic response in the liver. Liver hyperplasia was accompanied by an increase in cholesterol synthesis, an accumulation of cholesterol esters and by a stimulation of hexose-monophosphate (HMP) shunt enzyme activities. In the present report, hepatic DNA, mitotic index, cholesterol metabolism, as well as glucose-6-phosphate dehydrogenase (G6PD) and 6-phosphogluconate dehydrogenase (6PGD) activities, were investigated during liver hyperplasia induced by lead in fasted rats. Fasting was chosen as an experimental model characterized by a very strong depression of those metabolic pathways (cholesterol synthesis and HMP shunt) that we have found related to liver hyperplasia. The mitogenic response, even if at minor extent, also occurs in liver of fasted rats. A stimulation of cholesterol synthesis and HMP shunt enzyme activities, was also observed in lead-treated fasted rats, adding further support to the fact that an endogenous source of newly synthesized cholesterol together with a suitable increase of HMP shunt enzyme activities is needed during hepatic cell proliferation.

Primary T cell CD30-positive anaplastic large-cell lymphoma associated with adult-onset celiac disease and presenting with skin lesions.

We report the case of a 52-year-old woman with primary CD30+ anaplastic large-cell lymphoma of T cell phenotype with skin involvement, stage IVB, fulfilling almost all the clinical, histopathologic and immunophenotypic criteria for this disease, associated with adult-onset celiac disease. The diagnoses of malignancy and celiac disease were made during the same clinical episode. The clinical course of the patient has been extremely favorable and she is in complete remission, 15 months after finishing consolidation therapy.

Methyl-prednisolone treatment of serum HBsAg negative chronic active hepatitis occurring in transfusion-dependent thalassemia major.

We report the results of a two-year non randomized prednisolone trial carried out in 18 thalassemia major patients with chronic active hepatitis and in 16 controls. We found a beneficial effect on the biochemical remission rate and on the extent of liver inflammation with no significant side effects and no overt reactivation of possible latent HBV infection at three-year follow-up. However, a more prolonged longitudinal study is necessary in order to evaluate whether steroid treatment can impede the evolution to cirrhosis without determining long-term consequences, depending on virus-host interactions such as liver cell carcinoma.

Functional and surface phenotype study of lymphocyte subsets in peripheral blood and lymph nodes of breast cancer patients.

In an attempt to identify lymphocyte subsets possibly involved in the response to malignant cells, we have studied the lymphocyte surface phenotype by using a panel of monoclonal antibodies on both peripheral blood lymphocytes (PBL) and histologically proven metastatic and nonmetastatic (i.e., "hyperplastic") axillary lymph node lymphocytes (LNL) from eight breast cancer patients. Furthermore, we carried out a functional study by evaluating the response to polyclonal mitogens of the PBL and of the LNL of the same patients. A group of 30 healthy subjects, age and sex matched, were selected as controls for PBL. Six of them, who underwent surgery for nonneoplastic conditions, were selected as controls for LNL. The responsiveness of breast cancer patients' PBL to polyclonal mitogens phytohemagglutinin (PHA) and concanavalin A (Con A) was significantly lower as compared with the control response. The responsiveness of breast cancer patients' metastatic LNL was not different from control LNL for PHA, and it was lower than control LNL for Con A, while the responsiveness of the same metastatic LNL was higher than that of nonmetastatic (i.e., hyperplastic) LNL of patients. Furthermore, the response of hyperplastic LNL was always lower than that of control LNL. The responsiveness of patients' PBL was always lower than that of metastatic LNL, while the responsiveness of patients' PBL vs. hyperplastic LNL was at variance. Regarding the surface phenotype of PBL, there was no difference between those of breast cancer patients and controls concerning the T-cells subsets, while the Leu 7, CD 21 and DR antigens were significantly higher among the breast cancer patients. No significant differences were found between patient metastatic and hyperplastic LNL or between control LNL and patient metastatic or hyperplastic LNL, respectively; only the CD 4 antigen was higher in metastatic than in hyperplastic LNL. A comparison of this surface phenotype between PBL and either metastatic or hyperplastic LNL of breast cancer patients showed values almost constantly significantly higher for PBL vs. either metastatic or hyperplastic LNL, respectively. The results of our study suggest that there is no change in the local-regional immunocompetent cell subsets that may be related to metastasis of breast cancer to regional nodes and to the progression of disease and that circulating T cells in breast cancer include cells expressing activation markers but not showing significant changes in the proportion of entire subpopulations.