New software for cervical vertebral geometry assessment and its relationship to skeletal maturation--a pilot study.

OBJECTIVES: In the present study, we developed new software for quantitative analysis of cervical vertebrae maturation, and we evaluated its applicability through a multinomial logistic regression model (MLRM). METHODS: Digitized images of the bodies of the second (C2), third (C3) and fourth (C4) cervical vertebrae were analysed in cephalometric radiographs of 236 subjects (116 boys and 120 girls) by using a software developed for digitized vertebrae analysis. The sample was initially distributed into 11 categories according to the Fishman's skeletal maturity indicators and were then grouped into four stages for quantitative cervical maturational changes (QCMC) analysis (QCMC I, II, III and IV). Seven variables of interest were measured and analysed to identify morphologic alterations of the vertebral bodies in each QCMC category. RESULTS: Statistically significant differences (p < 0.05) were observed among all QCMC categories for the variables analysed. The MLRM used to calculate the probability that an individual belonged to each of the four cervical vertebrae maturation categories was constructed by taking into account gender, chronological age and four variables determined by digitized vertebrae analysis (Ang_C3, MP_C3, MP_C4 and SP_C4). The MLRM presented a predictability of 81.4%. The weighted κ test showed almost perfect agreement (κ = 0.832) between the categories defined initially by the method of Fishman and those allocated by the MLRM. CONCLUSIONS: Significant alterations in the morphologies of the C2, C3 and C4 vertebral bodies that were analysed through the digitized vertebrae analysis software occur during the different stages of skeletal maturation. The model that combines the four parameters measured on the vertebral bodies, the age and the gender showed an excellent prediction.

Insulin-like growth factor-I (IGF-1), IGF-binding protein-3 (IGFBP-3) and mammographic features.

INTRODUCTION: The IGF system has recently been shown to play an important role in the regulation of breast tumor cell proliferation. However, also breast density is currently considered as the strongest breast cancer risk factor. It is not yet clear whether these factors are interrelated and if and how they are influenced by menopausal status. The purpose of this study was to examine the possible effects of IGF-1 and IGFBP-3 and IGF-1/IGFBP-3 molar ratio on mammographic density stratified by menopausal status. PATIENTS AND METHODS: A group of 341 Italian women were interviewed to collect the following data: family history of breast cancer, reproductive and menstrual factors, breast biopsies, previous administration of hormonal contraceptive therapy, hormone replacement therapy (HRT) in menopause and lifestyle information. A blood sample was drawn for determination of IGF-1, IGFBP-3 levels. IGF-1/ IGFBP-3 molar ratio was then calculated. On the basis of recent mammograms the women were divided into two groups: dense breast (DB) and non-dense breast (NDB). Student's t-test was employed to assess the association between breast density and plasma level of IGF-1, IGFBP-3 and molar ratio. To assess if this relationship was similar in subgroups of pre- and postmenopausal women, the study population was stratified by menopausal status and Student's t-test was performed. Finally, multivariate analysis was employed to evaluate if there were confounding factors that might influence the relationship between growth factors and breast density. RESULTS: The analysis of the relationship between mammographic density and plasma level of IGF-1, IGFBP-3 and IGF-1/ IGFBP-3 molar ratio showed that IGF-1 levels and molar ratio varied in the two groups resulting in higher mean values in the DB group (IGF-1: 109.6 versus 96.6 ng/ml; p= 0.001 and molar ratio 29.4 versus 25.5 ng/ml; p= 0.001) whereas IGFBP-3 showed similar values in both groups (DB and NDB). Analysis of plasma level of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio compared to breast density after stratification of the study population by menopausal status (premenopausal and postmenopausal) showed that there was no association between the plasma of growth factors and breast density, neither in premenopausal nor in postmenopausal patients. Multivariate analysis showed that only nulliparity, premenopausal status and body mass index (BMI) are determinants of breast density. CONCLUSIONS: Our study provides a strong evidence of a crude association between breast density and plasma levels of IGF-1 and molar ratio. On the basis of our results, it is reasonable to assume that the role of IGF-1 and molar ratio in the pathogenesis of breast cancer might be mediated through mammographic density. IGF-1 and molar ratio might thus increase the risk of cancer by increasing mammographic density.

Severity in biliary peritonitis.

OBJECTIVE: To analyze clinical and laboratory findings in order to find variables predictive of severity of Biliary Peritonitis (BP). Patients and methods. Physical findings, course of illness, imaging and laboratory data were evaluated in 42 patients with BP, and statistically analysed to assess their prognostic significance. RESULTS: Serious illness and worse outcome were associated with: age ≥ 60 years (P=0.034), long time between onset of symptoms and treatment (P=0.025), fever > 38°C (P=0.009), WBC count > 17,000 cell/mm³ (P=0.043), diffuse abdominal pain (P=0.034), and infected bile (P=0.048). CONCLUSIONS: Most patients become severely ill due to supervening infection, while early bile drainage avoids serious complications. In addition, abdominal pain, fever and WBC count are also predictive of severity of BP.

[Phlegmons of the neck: our experience with 7 cases]. / Flemmoni del collo: nostra esperienza su 7 casi clinici.

Phlegmons of the neck originate from infectious diseases of head and neck. Odontogeneous inflammation of the oral cavity is most frquently primary lesion, followed by sinusitis, otitis, as well as radiation therapy and surgical procedures. Phlegmons of head and neck can drain into the spaces among the muscles, aponevrosis, organs inside the neck like sublingual space, lateral pharyngeal space, retro-pharyngeal space or pre-vertebral space. We hereby report our experience with 7 patients treated from 2001 to 2005.

Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis.

BACKGROUND: Sphincter-saving surgery for the treatment of middle and low rectal cancer has spread considerably when total mesorectal excision became standard treatment. In order to reduce leakage-related complications, surgeons often perform a derivative stoma, a loop ileostomy (LI), or a loop colostomy (LC), but to date, there is no evidence on which is the better technique to adopt. METHODS: We performed a systematic review and meta-analysis of all randomized controlled trials until 2007 and observational studies comparing temporary LI and LC for temporary decompression of colorectal and/or coloanal anastomoses. Clinically relevant events were grouped into four study outcomes: general outcome measures: dehydratation and wound infection GOM construction of the stoma outcome measures: parastomal hernia, stenosis, sepsis, prolapse, retraction, necrosis, and hemorrhage closure of the stoma outcome measures: anastomotic leak or fistula, wound infection COM, occlusion and hernia functioning of the stoma outcome measures: occlusion and skin irritation. RESULTS: Twelve comparative studies were included in this analysis, five randomized controlled trials and seven observational studies. Overall, the included studies reported on 1,529 patients, 894 (58.5%) undergoing defunctioning LI. LI reduced the risk of construction of the stoma outcome measure (odds ratio, OR = 0.47). Specifically, patients undergoing LI had a lower risk of prolapse (OR = 0.21) and sepsis (OR = 0.54). LI was associated with an excess risk of occlusion after stoma closure (OR = 2.13) and dehydratation (OR = 4.61). No other significant difference was found for outcomes. CONCLUSION: Our overview shows that LI is associated with a lower risk of construction of the stoma outcome measures.

Estrogens stimulate the proliferation of human cholangiocarcinoma by inducing the expression and secretion of vascular endothelial growth factor.

BACKGROUND: Estrogens may induce the proliferation of neoplastic cells by activating neo-angiogenesis. AIM: To evaluate the effect of estrogens on the expression of vascular endothelial growth factor (VEGF) and related receptors (VEGF-R) in human cholangiocarcinoma and the role played by VEGF in mediating the proliferative effects of estrogens. METHODS: Seven biopsies of intra-hepatic cholangiocarcinoma and the HuH-28 cell lines were investigated. Cell proliferation was measured by both PCNA Western blot and MTS proliferation assay. RESULTS: By immunohistochemistry, biopsies of human cholangiocarcinoma stained positively for VEGF-A and VEGF-C and related receptors. HuH-28 cells expressed VEGF-A, -C, and VEGFR-1, -2, -3 and, their protein level was enhanced by 17beta-estradiol in association with the stimulation of cell proliferation. 17beta-Estradiol-stimulated proliferation of HuH-28 cells was blocked by 70% by VEGF-TRAP, a receptor-based VEGF inhibitor. 17beta-Estradiol induced the secretion of VEGF in the supernatant of HuH-28 cells. The stimulatory effect of 17beta-estradiol on the protein expression of VEGF-A, VEGF-C and VEGFR-1, -2, -3 was blocked by antagonists of ER (Ici182,780) or insulin-like growth factor 1-receptor (alphaIR3). CONCLUSIONS: With the limitations of experiments performed in a cell line, our study indicates that VEGF plays a major role in mediating the proliferative effects of estrogens on human cholangiocarcinoma.

Hyptis pectinata essential oil: chemical composition and anti-Streptococcus mutans activity.

OBJECTIVES: The aim of the present study was to evaluate the anti-Streptococcus mutans activity of Hyptis pectinata essential oil, and present its promising potential against oral diseases. MATERIALS AND METHODS: The essential oil of H. pectinata was obtained by hydrodistillation from dried leaves and analyzed by GC / MS. The effectiveness of this essential oil regarding the antimicrobial activity against several S. mutans strains was investigated by the agar diffusion and microdilution methods, and chlorohexidine was used as a standard control. RESULTS: The H. pectinata essential oil exhibited considerable inhibitory effect against either all the clinical isolates obtained from patients' saliva or the ATCC strains tested, with minimum inhibitory and bactericidal concentrations of 200 microg ml(-1). The study also compared the efficiency of the emulsifying agents Tween 20, Tween 80, dimethyl sulfoxide and propylene glycol in H. pectinata essential oil when tested against S. mutans. The data obtained confirmed the better inhibitory effect of the oil when using all tested diluents, although Tween 80 seemed to be more suitable for emulsification. CONCLUSION: According to our results, H. pectinata essential oil can be considered a promising alternative to chlorhexidine for the control of oral bacteria-related diseases and hygiene.

[Monolateral adenopathy of the axilla due to sarcoid-type granulomata: idiopathic granulomatous disease or sarcoidosis? A case report]. / Linfoadenopatie ascellari monolaterali da granulomi di tipo sarcoidosico: malattia granulomatosa idiopatica o sarcoidosi? Caso clinico.

The presence of sarcoid-type granulomata in peripheral lymph nodes, with no evidence of other typical lesions, doesn't allow to diagnose sarcoidosis. In fact, sarcoidosis is a systemic disease and two or more organs must be affected to reach a definitive diagnosis. However this involvement could happen even several years later, thus making a correct diagnosis really difficult. In the absence of other organ involvement, an "idiopathic granulomatous disease" of peripheral lymph nodes is identified. Patients must anyway undergo a careful, long-term follow-up in order to detect clinical or radiologic variations that may confirm a diagnosis of sarcoidosis. After presenting a case-report of monolateral adenopathy of the axilla as an idiopathic granulomatous disease, the Authors review the international literature about sarcoidosis and its extra-pulmonar presentation, underlining the importance of considering sarcoidosis among possible diagnosis when peripheral adenopathies occur.

No evidence of involvement of Chlamydia pneumoniae in lung cancer by means of quantitative real-time polymerase chain reaction.

Chlamydia pneumoniae, an obligate intracellular pathogen, is well-known as etiological agent of acute respiratory infections; the repeated or prolonged exposure to chlamydial antigens may promote the persistence of C. pneumoniae in the respiratory tract leading to chronic diseases, such as chronic obstructive pulmonary disease and asthma. The predilection of C. pneumoniae to cause respiratory tract infections combined with its persistent nature suggest that it might play a role in lung cancer. The aim of our study is to evaluate the involvement of C. pneumoniae in pathogenesis of lung cancer. We therefore investigated the presence of C. pneumoniae DNA in tumor lung tissues by using real-time PCR assay. Simultaneously, tumor and healthy tissues from the same patient with primary carcinoma lung were analyzed. C. pneumoniae DNA was not detected in a single lung tumor tissue by means of an highly sensitive, and specific real-time PCR assay based on FRET hybridization probes. In conclusion, this study does not support the involvement of C. pneumoniae in the pathogenesis of lung cancer, suggesting that further investigations are needed to clarify other potential causative factors for the development of this malignancy.

[A case of lymphoepithelial cyst (branchial cyst) in an elderly patient: diagnosis differential, treatment and literature review]. / Un caso di cisti linfoepiteliale (branchiale) in un paziente anziano: diagnosi differenziale, trattamento e revisione della letteratura.

We present a case of lateral cervical cyst stressing the difficulties about the diagnosis. The international guidelines for the management of lateral neck cysts in the over 40s' age group are taken in consideration. Our case is a 74 years old male patient with a 6 month history of a cervical swelling. We consider this case rare for the age of patient and the absence of malignancy.

Urinoma and urinothorax: report of a case.

The case of a 47-year-old female who presented with urinoma and urinothorax due to left ureteral calculus obstruction is reported. The left kidney was surgically resected, while the urinothorax was evacuated by therapeutic thoracentesis, which resulted in withdrawal of 18 liters of straw-colored pleural fluid.

[Multimodal treatment complications of post-cholecystectomy intrahepatic lithiasis. Case report]. / Complicanze del trattamento multimodale della calcolosi intraepatica nel colecistectomizzato. Case report.

The Authors presents a case of post-cholecystectomy intrahepatic lithiasis. They focalized their attention to the complications of multimodal treatment.

Nanohybrids for controlled antibiotic release in topical applications.

New polymeric composite materials containing a nanohybrid to be used for the controlled release of an antibiotic molecule, chloramphenicol succinate, have been formulated, prepared and characterised. The nanohybrid consists of a layered double hydroxide of Mg-Al hydrotalcite-type, in which the nitrate anions present in the host galleries were replaced with chloramphenicol succinate anions (CFS(-)) by a simple ion-exchange reaction. Different amounts of the hybrid material were incorporated in polycaprolactone and processed as films of 0.15mm thickness. The composite materials were analysed by X-ray diffractometry and thermogravimetry and their mechanical properties were determined. They showed properties even better than those of the pristine polymer. The release process of the antibiotic molecules was found to be very interesting and promising for tuneable drug delivery. It consists of two stages: an initial stage of a very rapid burst, in which a small fraction of drug is released; and a second stage that is much slower, extending for a longer and longer time. This behaviour is profoundly different and much slower than that of a sample in which the antibiotic molecule is directly incorporated into the polymeric matrix. The parameters influencing drug release have been individuated and discussed.

Antimicrobial activity of Croton cajucara Benth linalool-rich essential oil on artificial biofilms and planktonic microorganisms.

We have previously demonstrated that a linalool-rich essential oil from Croton cajucara Benth presents leishmanicidal activity. In the present study, we demonstrate that this essential oil inhibits the growth of reference samples of Candida albicans, Lactobacillus casei, Staphylococcus aureus, Streptococcus sobrinus, Porphyromonas gingivalis and Streptococcus mutans cell suspensions, all of them associated with oral cavity disease. The purified linalool fraction was only inhibitory for C. albicans. Microbes of saliva specimens from human individuals with fixed orthodontic appliances, as well as the reference strains, were used to construct an artificial biofilm which was exposed to linalool or to the essential oil. As in microbial suspensions, the essential oil was toxic for all the microorganisms, while the purified linalool fraction mainly inhibited the growth of C. albicans. The compounds of the essential oil were separated by thin layer chromatography and exposed to the above-cited microorganisms. In this analysis, the proliferation of the bacterial cells was inhibited by still uncharacterized molecules, and linalool was confirmed as the antifungal component of the essential oil. The effects of linalool on the cell biology of C. albicans were evaluated by electron microscopy, which showed that linalool induced a reduction in cell size and abnormal germination. Neither the crude essential oil nor the purified linalool fraction is toxic to mammalian cells, which suggests that the essential oil or its purified components may be useful to control the microbial population in patients with fixed orthodontic appliances.

Anti-inflammatory drug incorporation into polymeric nano-hybrids for local controlled release.

In this paper we present the formulation, preparation and characterization of new polymeric composite materials containing a nano-hybrid to be used for the controlled molecular delivery of an anti-inflammatory molecule, Diclofenac. The nano-hybrid consists of a layer of double hydroxide of an Mg-Al hydrotalcite type, in which we replaced the chloride anions present in the host galleries with Diclofenac anions by a simple ion-exchange reaction. Different amounts of the hybrid material were incorporated in polycaprolactone and processed as films of 0.15 mm thickness. The composite materials were analyzed by X-ray diffractometry, thermogravimetry and for their mechanical properties, and showed properties even better than those for the pristine polymer. The release process of the anti-inflammatory molecules was very interesting and promising for tuneable drug delivery. It consists of two stages: a first stage, very rapid as a burst in which a small fraction of the drug is released, and of a second stage that is much slower, extending for longer and longer periods. The parameters influencing the drug release were individuated and discussed.

[Prognostic factors and results of surgical treatment of pelvic recurrence of rectal cancer]. / Fattori prognostici e risultati del trattamento chirurgico delle recidive pelviche da cancro del retto.

From 1990 to 2003 have been admitted 105 patients with pelvic recurrence from rectal cancer. Fifty-nine patients have been selected and 25 patients underwent surgery. We evaluate the prognostic factors and the 3 years disease-free survival. The 60% of the patients after R0 resection and the 20% of the patients who underwent R1-R2 resection are alive. The evaluation of the prognostic factors allows early diagnosis of recurrence with a better long time survival.

[Molecular epidemiologic analysis of the levels of metalloproteases and cyclooxygenase-2 in colorectal cancer]. / Analisi epidemiologico molecolare dei livelli di metalloproteasi e cicloossigenasi-2 nel cancro del colon/retto.

The aim of this work is the investigation of the level of expression of the vascular endothelial growth factor (VEGF) and metalloproteases (such as Cox-2) in the colon rectal cancer. The final goal is the correlation with liver metastases. Molecular biology approaches will be adopted: in particular: RT-PCR, quantitative real time PCR with fluorescent probes, immunolocalizations and Western blotting This is a proposal of research. The work is under development and results and conclusions cannot be at the moment anticipated. However, in recent publication we found human polyomavirus DNA sequences in colorectal tumors.

[Unusual localizations of hydatid cyst. Epidemiological aspects and diagnostic problems. Description of a clinical case]. / Localizzazioni inusuali delle cisti di echinococco. Aspetti epidemiologici e problematiche diagnostiche. Presentazione di un caso clinico.

A rare case of primary hydatid cyst of the mesentery is described. Though cystic echinococcosis infestation can occur in any part of the body primary peritoneal involvement is rare. The mechanism of primitive peritoneal infection by the parasite is still unclear. The hypotheses which can explain this rare primary localization, the sensitivity and the specificity of the serological and instrumental tests and the therapeutic management of this atypical lesion are discussed.

Prognostic significance of primary-tumor extension, stage and grade of nuclear differentiation in patients with renal cell carcinoma.

Surgery remains the preferred therapy for renal cell carcinoma. The various adjunctive or complementary therapies currently yield disappointing results. Identifying reliable prognostic factors could help in selecting patients most likely to benefit from postoperative adjuvant therapies. We reviewed the surgical records of 78 patients who had undergone radical nephrectomy with lymphadenectomy for renal cell carcinoma, matched for type of operation and histology. According to staging (TNM), 5.1% of the patients were classified as stage I, 51.3% as stage II, 29.5% as stage III and 14.5% as stage IV. Of the 78 patients 40 were T2N0 and 21 T3aN0. Tumor grading showed that 39.7% of the patients had well-differentiated tumors(G1), 41.1% moderately-differentiated (G2), and 19.2% poorly-differentiated tumors (G3). Overall actuarial survival at 5 and 10 years was 100% for stage 1; 91.3% at 5 years and 83.1% at 10 years for stage II; 45.5% and 34.1% for stage III; and 29.1% and nil for stage IV (stage II vs stage III p = 0.0001). Patients with tumors confined to the kidney (pT2N0) had better 5- and 10-year survival rates than patients with tumors infiltrating the perirenal fat (pT3aN0) (p = 0.000006). Survival differed according to nuclear grading (G1 vs G3 ; p = 0.000005; G2 vs G3; p = 0.0009). In conclusion our review identified tumor stage, primary-tumor extension, and the grade of nuclear differentiation as reliable prognostic factors in patients with renal cell carcinomas.

[Retroperitoneal leiomyosarcoma: clinical case]. / Il leiomiosarcoma del retroperitoneo: caso clinico.

The Authors have reported a case of retroperitoneal leiomyosarcoma. The retroperitoneal localization is quite unusual and early diagnosis is difficult. Only surgery operation and radio-chemotherapy can improve the prognosis. Tumor size is the major prognostic factor.