Pathological factors involved in local failure in squamous cell carcinoma of the oral cavity: retrospective study and proposal of a new clinical classification.

The control of local failure (LF) is essential to improve outcomes in patients with squamous cell carcinoma of the oral cavity (OSCC). In this study, LF of OSCC was classified into three clinical types: deep recurrence (type 1R), adjacent superficial recurrence (type 2R), and distant primary tumour (type 3R). LF was analyzed after surgical resection of OSCC to determine the validity and usefulness of this classification system. Of 257 patients with OSCC, 58 experienced LF; 21 had type 1R, 23 had type 2R, and 20 had type 3R. Clinical factors influencing LF were analyzed by log-rank test and Cox test. Type 1R was significantly related to the TN classification, resection margin status, and invasive pattern. Type 2R was strongly associated with the grade of epithelial dysplasia at the surgical margins. Type 1R rarely developed more than 1year after surgery, whereas type 2R did not develop within 2 years. Type 1R may be caused by residual cancer cells in the deep margins, and type 2R by precancerous cells remaining in the marginal epithelium and gradually becoming invasive cancer. Type 3R may be considered an independent tumour. The newly proposed clinical classification is convenient and roughly reflects the causes and mechanisms of relapse.

Comparison of the prognosis of bisphosphonate-related osteonecrosis of the jaw caused by oral and intravenous bisphosphonates.

Bisphosphonates (BPs) have been used in medical practice for the treatment of osteoporosis, bone metastasis, and multiple myeloma. Although many studies have been published, the treatment and prognosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) remain unclear. This study included 59 patients with BRONJ: 29 had taken oral BPs and 30 had taken intravenous (IV) BPs. All received conservative treatments. When separated sequestra were seen, a sequestrectomy was performed. Segmental mandibular resection was performed when pathological fractures were diagnosed. The outcomes of treatments were compared between groups. For patients treated with oral rinses or mandibular resection, the number in whom clinical healing was observed did not differ between the oral BP and IV BP groups. With regard to sequestrectomy, 94% of patients in the oral BP group showed improvement with this treatment compared to 50% in the IV BP group. The number of patients in whom clinical healing of BRONJ was achieved was statistically better in the oral BP group than in the IV BP group after 6 months of treatment (P<0.001). The results showed that >90% of patients treated with oral BPs could be cured. However, 50% of patients treated with IV BPs did not show an improvement. Additional research is needed to further increase the therapeutic efficacy for the resolution of BRONJ.

Effects of insulin and transferrin on the generation of lymphokine-activated killer cells in serum-free medium.

We have developed a serum-free medium designated RDSF for the generation of LAK cells based on RD6F medium, which was originally developed as a serum-free medium for the growth of myeloma and hybridoma cells. The cytotoxic activity of LAK cells generated in RDSF against Raji, K562 and oral cancer cells, is 3-4 times that of LAK cells generated in medium containing 10% human type AB serum. RDSF medium consisted of nutrient mixture supplemented with transferrin, 2-aminoethanol, 2-mercaptoethanol, sodium selenite and interleukin-2. In this study, we have found that insulin which has been shown to be the most important polypeptide hormone in serum-free media for animal cells, inhibited the generation of cytotoxic activity of LAK cells cultured from peripheral blood lymphocytes. In addition, we found that transferrin was an essential component for the growth and generation of LAK cells in serum-free culture. These results suggest that RDSF may be useful in adoptive immunotherapy for cancer as well as for studying factors involved in the growth and differentiation of LAK cells.

[Digestive Kaposi's sarcoma in patients with kidney transplantation--report of 2 cases]. / Sarcoma de Kaposi digestivo en transplantados renales--presentación de 2 casos.

Malignant tumors occur with greater frequency in patients with kidney transplants. Kaposi's sarcoma (KS), a rare vascular neoformation, represents approximately 3% of them. Its uncertain etiology appears to respond to: a chronic antigen stimulation by the transplanted tissue, to a depression of immune responsiveness, to the direct oncogenic action of the immunosuppressive agents, to the activation of oncogenic viruses or to a genetic predisposition of other possible factors. The clinical evolution is presented in two immunosuppressed kidney transplant patients with this pathology in the digestive tract. One had remission of the lesion following the suspension of the immunosuppressive agent. The relationship of this tumor with acquired immunodeficiency syndrome which occurred primarily (75%) in homosexuals shows a mortality rate of 30% due to KS. The first case showed signs of digestive hemorrhage and the typical nodule of KS was found in the esophagus on endoscopy. She also suffered a severe mixed infection due to Streptococcus faecalis and Cryptococcus neoformans with neurological complications and a new endoscopy 4 months after suspension of azathioprine showed the disappearance of the esophageal as well as the skin lesions. In the second patient, the suspicion of the digestive tract involvement could only be proved at autopsy. We insist on the importance of immunosuppression as a predisposing factor for the appearance of KS and infections in transplanted patients. It should also be remembered in cases with mucocutaneous lesions, that any digestive hemorrhage must primarily be attributed to KS and that the suspension of the immunosuppressive therapy constitutes the most effective treatment for the tumor.

[Cholestatic viral hepatitis: is it an easy diagnosis?]. / Hepatitis viral colestática: es un diagnóstico fácil?

Three cases of acute cholestatic viral hepatitis are presented. A discussion is made regarding the difficulties encountered and the methods used for certifying this not always easy diagnosis: one patient with virus A and two presumed cases of non-A, non-B virus. The most noteworthy laboratory findings are observed in the very slight transaminase changes or their abrupt descent over a short period whereas bilirubin and cholestatic parameters increase. Due to the particular characteristics observed in the first case, a doubt still exists regarding the possibility of an occult systemic disease existing even though 17 months have passed since the onset of symptoms. The possibility of Hodgkin's disease has been virtually ruled out since it seldom presents such long term hyperbilirubinemia and such high alkaline phosphatase levels.

[Hepatitis B virus in patients with renal transplant. Report of 52 cases]. / Virus de la hepatitis B en pacientes trasplantados renales. Presentación de 52 casos.

Hepatitis B virus (HBV) is a high risk factor in the frequently found liver involvement of renal transplant recipients. As in other immunosuppressed patients, these often follow a course of slight jaundice, with a progressive tendency and great replicative and infectious power. Also, in addition to an increased incidence of chronic hepatitis (CH) in transplanted when compared with hemodialized patients, specially when HBsAg is present, it is surprising the poor correlation between enzyme levels and the grade of activity of the hepatic lesion. In a retro and prospective study, we present 52 patients of the 73 transplant reviewed. There are 32 men and 20 females, with and average age of 34 years, minimum time on dialysis of 2 months and maximum of 7 years, time of renal transplant from 6 moth to 15 years (average 4.9 years). There were 31 cadaver transplants and 21 live donors. The HBsAg was + in 20 (9 seroconverted), HBeAg was + in 4 (with 2 seroconvertions), hyperbilirrubinemia in 5, hyperalkaline phosphatasemia (2 or more times) in 11 and elevated serum transaminases (SGPT) (3 times or more) in 20 cases. Positive HBsAg plus SGPT x 3 was found on 9 occasions and positive HBsAg with SGPT x 3 in 3 cases. liver biopsy (LB), in those with enzymatic changes and/or positive antigenemia, was performed in 15 instances and there were 5 autopsies. The most important histological findings were: 5 acute viral hepatitis, 2 active chronic hepatitis (CAH), 2 persistent chronic hepatitis (CPH), 5 with fat infiltration and 4 with colestasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulse oximetry during lumbar epidural anesthesia: reliability of values measured at the hand and the foot.

Pulse oximetry is dependent upon the presence of a pulsating vascular bed. The signal detection will be impaired in the presence of vasoconstriction or venous congestion, conditions which may occur readily in clinical practice. We compared the oximetric measurements (SpO2) at the hand and the foot with arterial hemoglobin saturation (SaO2) during lumbar epidural anesthesia. After administration of a crystalloid solution (20 mL/kg body weight lactated Ringer's solution), 40 adult male patients, scheduled for inguinal hernioplasty, received 15 mL of 0.50% plain bupivacaine into the lumbar epidural space. Two pulse oximeter probes were applied to the index finger and toe of the patients, and the SpO2 values were recorded continuously. Arterial hemoglobin saturation (SaO2) was measured using a co-oximeter 5 min before and 30 min after the onset of sensory block. No significant differences were detected between SaO2 (97.7%, SD 0.4%) and SpO2 basal values recorded from the hand (97.8%, SD 0.8%) and the foot (98.1%, SD 0.4%). After the onset of epidural anesthesia, a progressive decrease of SpO2 value recorded from the hand was observed: at 30 min it was 92.3% +/- 1.3% (P < 0.01 compared with baseline). At the same time, the SaO2 value was 97.5% +/- 0.9% (P < 0.01 compared with SpO2 from the hand). On the contrary, no significant difference from both basal value and SaO2 was detected in SpO2 measurements from the toe during the epidural block. In all patients intraoperative decrease of heart rate and arterial blood pressure was < or = 15% from baseline.(ABSTRACT TRUNCATED AT 250 WORDS)

Aromatization of enamines promoted by a stoichiometric amount of palladium(II) salts: a novel method for the synthesis of aromatic amines.

Enamines (1a-r) prepared from cyclohexanones, cyclohexane-1,3-diones, or tetralones led to arylamines (2a-r) in one pot when treated with a stoichiometric amount of palladium salts [PdCl2-(MeCN)2] in acetonitrile in the presence of triethylamine at room temperature or at elevated temperature, in some cases for 5 min to 2 h. The initial electrophilic attack of palladium chloride on the beta-carbon of the enamines led to a sigma-palladium species (8) which triggered a series of reactions (-->9-->10-->11-->12) destined for aromatization to give 2a-r in good yields. The intervention of such a sigma-palladium species has been attested by a trapping experiment. On the basis of this reaction mechanism, we have developed another new process capable of transforming acyclic compounds having 6-en-2-one frameworks (16, 23, 25) to arylamines (2s-u) when their enamines were treated under the similar conditions as above, featuring again the formation of sigma-palladium species such as 8 as the initial key intermediate.

Bilateral extensive skin necrosis of the lower limbs following prolonged epidural blockade.

Skin necrosis has not been described as a complication following epidural sympathetic blockade. We report a case of bilateral extensive skin necrosis of the lower limbs after a 48-hour lumbar epidural blockade in a 71-year-old patient with right hemiplegia and mitral valve regurgitation, without any preoperative clinical evidence of peripheral vascular disease or diabetes, who underwent transurethral prostatectomy.

[Intraoperative changes in aerobic and anaerobic metabolism as prognostic index in interventions of massive hepatic resection]. / Variazioni intraoperatorie del metabolismo aerobio ed anaerobio come indice prognostico negli interventi di resezione epatica massiva.

This study was conducted on 10 patients with primitive or metastatic liver tumors, scheduled for massive liver resections, in order to search for evidence of the existence of intraoperative prognostic indexes having a bearing upon postoperative survival. The following parameters were measured in every patient: HR, MAP, CVP, MPAP, WP, SVR, PVR, CI, DO2, VO2, BE, before the anhepatic period (A), during anhepatic period (B), 30' (C), and 60' (D) after liver reperfusion, holding constant Hct, body temperature, ETCO2, FiO2, anesthetic depth, and the degree of muscular relaxation. The patients were later divided into two groups: 1, nonsurvivors in the postoperative period (4 patients) due to MOF; 2, survivors (6 patients). The values of the measured parameters of the two groups were statistically evaluated at each of the above intervals, and within each group with respect to time A, taken as a control. No significant variations were found in HR, MAP, CVP, MPAP, WP, SVR, PVR, CI, and DO2. The VO2 diminished in both groups during the anhepatic period (B) (p less than 0.0025). In group 1 (nonsurvivors) the VO2 diminished after the reperfusion (p less than 0.0025), while in group 2 (survivors) VO2 rapidly resumed its initial values (n.s. 30' and 60' after the reperfusion). In the nonsurviving patients metabolic acidosis developed, with significant reductions of BE (p less than 0.0025) during times C and D, occurring simultaneously with the reduction of VO2.(ABSTRACT TRUNCATED AT 250 WORDS)

Fas ligand-induced apoptosis of hepatocytes in natural killer cell leukaemia.

Neoplastic natural killer (NK) cells overexpress Fas ligand (FasL), which may cause damage of Fas-bearing tissues. We report a patient with NK cell leukaemia who developed liver injury after pharyngitis. The NK leukaemic cells expressed functional FasL. In addition to soluble FasL, serum levels of interleukin-6 and interferon-gamma were increased dramatically when liver injury was aggravated. Moreover, hepatocytes expressed Fas and apoptotic hepatocytes were detected in the portal areas. These findings are consistent with the notion that inflammatory cytokines enhance the sensitivity to FasL and trigger apoptosis of hepatocytes in NK cell malignancies.

Phenyl-T-butyl-nitrone is active against traumatic shock in rats.

Oxygen free-radicals appear to be involved in the pathogenesis of shock; therefore trapping of these radicals would modify the evolution of experimental shock. Experiments were performed on rats submitted to 100% lethal whole body trauma (rotating drum) and their survival, pathology, acid-base status and hematocrit level observed. The spin trapping agent phenyl-t-butyl-nitrone (PBN) was administered before trauma (50, 100, 150 mg/kg i.p.) or at various intervals (30, 60 minutes) after establishment of a severe traumatic shock. It appeared that PBN administration was highly effective both in prevention and in reversion of traumatic shock in rats.

[Comparison of crystalloids and hydroxyethyl starch during normovolemic hemodilution. A study of hemodynamics and saturation measurement]. / Confronto tra cristalloidi ed amido idrossietilico in corso di emodiluizione normovolemica. Uno studio emodinamico e saturimetrico.

Normovolemic hemodilution at two different hematocrit values was performed in ten patients undergoing major surgery to evaluate changes of DO2, VO2 and CI. A Hct of 38% (low hemodilution) was reached by plasma replacement with ringer lactate infusion. A further hemodilution, a Hct of 30% (high hemodilution), was obtained by hydroxyethyl starch plus ringer lactate (1:2 ratio) infusion. A significant VO2 increase (p less than 0.01) occurred when hydroxyethyl starch plus ringer lactate infusions were employed as compared to ringer lactate alone. No changes in DO2 and CI were observed, the increase in VO2 measured during colloid infusion could suggest a better tissue perfusion and metabolic activity.

[Induction of bacterial translocation in rats with minimal doses of endotoxin]. / Induzione della translocazione batterica nel ratto mediante dosi minime di endotossina.

OBJECTIVE: To determine whether a non lethal dose of intramuscular endotoxin in rats causes a physical disruption of the mucosal barrier and promotes the translocation of bacteria from gut to visceral organs. DESIGN: Prospective randomized trial. SETTING: Experimental laboratory university medical center. EXPERIMENTS: 60 male wistar rats, weighing 250 g. INTERVENTIONS: six hours and twenty-four hours after endotoxin (8 mg/kg) or saline (control group) given intramuscularly, rats were sacrificed and mesenteric lymph nodes, spleen and some segments of the ileum were removed. Lymph nodes and spleen were cultured for translocating bacteria while ileum segments were observed by light microscopy. RESULTS: Incidence of bacterial translocation increases from 6 hours (40% p < 0.05) to 24 hours (60%, p < 0.01) after endotoxin administration. Histologic evaluation of the ileum demonstrated that a mucosal injury occurred only at the 24 an hour and that it was characterized by an evident pronounced interstitial edema with focal breaks in the basal membranes of villous and glands. CONCLUSIONS: It appears that microorganisms and microbial products contained in the gut can cross the mucosal barrier and spread into other visceral organs also after a low dose of intramuscular endotoxin.