Parotid metastasis of renal cell carcinoma, mimicking primary clear cell oncocytoma: report of a case and brief review of the literature.

Malignancies of the parotid gland are relatively uncommon, accounting for only 3-6% of all head and neck cancers. Most of them are primary neoplasms, metastases are uncommon. Renal cell carcinoma (RCC) represents 3% of adult malignancies, the clear cell type comprises up to 70% of all RCC. RCC has an unpredictable behavior and the unique potential to metastasize to nearly every organ in the body. Though not as frequent, metastatic RCC to the head and neck has been identified in the thyroid, salivary glands, skull base, sinuses, pharynx, tonsils, tongue, lip and skin. Metastasis to the parotid gland is very rare. Here, we report the case of a clear cell type RCC metastatic to the parotid gland and mimicking a primary clear cell oncocytoma. Differential diagnoses and a brief review of the literature are added.

Gastric metastasis from cervix carcer: a case report.

Gastric metastasis by solid tumor cancer is a rare event. Concomitant metastases to other organs are frequent, so that this condition is often associated to a poor prognosis. Upper gastrointestinal bleeding and anemia are the most common presenting symptoms. We present the case of a 81 years old women previously treated for cervix carcinoma showing later a stomach metastasis. The patient is alive and disease free 39 months after salvage gastrectomy. A radical surgery in selected patients could be useful for symptom palliation and prolonged survival.

Alexithymia, more than depression, influences glycaemic control of type 2 diabetic patients.

PURPOSE: Psychiatric disorders could affect the patients' abilities to cope with diabetes. The objectives of this study were to assess the prevalence of depression and alexithymia among type 2 diabetic patients and investigate the possible correlations between these psychopathological phenomena and glycaemic control assessed through glycated hemoglobin (HbA1c). METHODS: All the patients were evaluated through 20-item Toronto Alexithymia Scale (TAS-20), Hamilton rating scale for depression and Quality of Life Index. HbA1c values, diabetes duration, therapy and socio-demographic characteristics were recorded. RESULTS: One hundred and twenty-eight patients (75 males and 53 female, mean age 64.7 ± 11.2 years) were enrolled. Alexithymic patients, compared to non-alexithymic ones, presented a significantly higher HbA1c (7.7 ± 1.5 vs. 7 ± 1.5, p = 0.016). No statistically significant difference was found when comparing the HbA1c of depressed versus non-depressed patients. Considering the raw values of HbA1c, the higher percentage was recorded among patients suffering from depression plus alexithymia (comorbidity group) followed by patients presenting alexithymia only, patients with neither depression nor alexithymia (control group) and, finally, those presenting depression only. The comorbidity group presented a significantly higher value of HbA1c (7.7 ± 1.2) than the control group (7 ± 1.6, p < 0.04) and the depressed patients (6.9 ± 1.3, p = 0.04). At the logistic regression, the HbA1c was found to be significantly associated only with alexithymia (TAS-20 total score) and insulin therapy. CONCLUSIONS: Alexithymia more than depression influences glycaemic control. When evaluating a diabetic patient, a rapid screening for psychopathological alterations would guarantee a more accurate management. The treatment of any associated psychiatric disorders would improve the patients' quality of life.

The role of leptin in the etiopathogenesis of anorexia nervosa and bulimia.

Leptin is an adipocyte-derived signal factor (167 amino acid protein) encoded by the ob gene in chromosome 7q31 that regulates eating behaviour via central neuroendocrine mechanisms. It has been shown that serum leptin levels correlate with weight and percentage body fat in normal and obese individuals, but the exact correlation between leptin and body weight in anorexic and bulimic patients has not yet been clarified. We investigated leptin levels in the serum of 58 female subjects aged 15-36 years: 10 with bulimia nervosa (BN); 12 with anorexia nervosa (AN); 12 overweight controls (not BN); 12 weight-reduced controls (not AN); and 12 normal weight controls. The aim of the study was to evaluate the possible correlations between leptin levels and the body mass index (BMI) in all five groups. Our results showed that the serum leptin levels of the bulimic patients were similar to those of the healthy controls, with a positive correlation between leptin and BMI. Although bulimic patients have very bad nutritional behaviour, their leptin levels do not appear altered. Serum leptin was significantly (p<0.001) reduced in the anorexic patients because of the dramatic decrease in adipose mass caused by the nutritional defect, as: is further supported by the significantly (p<0.001) low level of transferrinemia. Our data suggest that, although significantly reduced, serum leptin levels in fasting anorexic patients are non-linearly related to body weight (BMI).

[Biomorphological features of "minimal" carcinomas selected from a series of 2077 breast cancer cases]. / Caratteri biomorfologici dei carcinomi "minimi" selezionati da una serie di 2077 casi di carcinoma mammario.

Two hundred eighty nine pT1a/pT1b (less than < or = 1 cm in diameter) mammary carcinomas were selected from a series of 2077 consecutive cases of breast carcinoma. When compared with carcinomas of a larger size, they were significantly associated with a lower histological grade (SBR), a lower growth fraction (Ki-67 antigen in less than 20% of neoplastic cells) and a lower number of positive cases (more than 10% of neoplastic cells) as far as p53, c-erbB-2 oncoproteins and EGF-R, as detected by immunohistochemical methods, are concerned. Moreover, a significantly higher number of estrogen and progesterone receptors positive cases (more than 10% of positive cells), and a higher frequency of "other" histotypes with a favourable prognosis, was detected. No difference between pT1a and pT1b cases was noted so that "1 cm size" only stratifies a class with a better prognosis. It is possible that small cases, although invasive, did not undergone sufficient mytotic cycles to produce the sequence of genetic changes that characterize the "no return" phase of breast cancer. A 17% of pT1a and pT1b cases displayed lymph node metastases (mean 26 lymph node/case examined): the number is so high that cautions about simple lumpectomies and about sentinel lymphadenectomy, even in cases of small cancers, are necessary, until a larger number of studies will become available.

The use of citalopram in an integrated approach to the treatment of eating disorders: an open study.

This study investigated the efficacy and safety of citalopram in the treatment of eating disorders. Eighteen female patients gave their informed consent to enrollment in the trial: twelve with bulimia nervosa, six with anorexia nervosa according to the DSM IV criteria. They received individual systemic psychotherapy and took 20 mg/day citalopram for 8 weeks. At the beginning and end of the trial, their BMI, body fat and lean mass were checked and they completed the Eating Disorder Inventory and Binge Scale. The results showed that citalopram is effective and safe in the treatment of eating disorders: binge eating episodes and mean scores in three EDI subscales (bulimia, ineffectiveness and interoceptive awareness) significantly decreased in the bulimic patients, and mean scores in the EDI body dissatisfaction subscale significantly decreased in the anorexic patients.

[Proliferative activity of stage I testicular neoplasms: evaluation by image analysis of immunoreactive MIB-1]. / L'attività proliferativa delle neoplasie del testicolo in stadio I: valutazione mediante analisi di immagine dell'immunoreattività MIB-1.

The proliferative activity has been evaluated in 55 cases of seminoma and 36 cases of non-seminomatous germ cell tumors of the testis (NSGCT) in clinical stage I from patients alive and well within 5 years, by a semi-quantitative image analysis method of determination of the percent MIB-1 positive nuclear areas, using a Leica Quantimet 500+ analyzer. Significant differences of growth fraction have been detected between classical seminomas and seminomas showing more than 3 mitoses/1HPF (anaplastic seminoma)-mean of MIB-1 positivity in classic seminoma 23.8%, versus 43.9% in anaplastic seminoma; confirming this value of cut-off in distinguishing two classes of cases with different growth fractions, but without any difference as far as prognosis is concerned. The non seminoma- germ cell tumours (NSGCT) in toto display a growth fraction significantly higher than that of seminomas (mean value of MIB-1 positivity: 26.3% in seminoma versus 40.4% in NSGCT), but absolute values of positivity as high as those obtained by others by subjective evaluation have not been observed. A higher growth fraction in NSGCT is positively correlated with an embryonal carcinoma component as high as 80% of the tumor mass and/or with vascular invasion, but not with different histotypes. The proliferative activity doesn't stratify subgroups with different prognosis within the two groups of germinal tumours of the testis (seminomas and NSGCT) in our cases of clinical stage I testicular tumours.

[The workload in Pathological Anatomy measured on the basis of categories of services]. / I carichi di lavoro in Anatomia Patologica misurati sulla base del nomenclatore di prestazioni.

Workload measurement is one of the most reliable tools in perspective payment systems, to evaluate clerk and technical personnel needs in a Surgical Pathology Department. In 1992 Italian Government began a full-comprehensive modification of financial support in National Health Care System, and during the last four years Public Hospitals and Local Health Units modified their financial organization with the introduction of workload measurement for the personnel needs. We propose a synthetic method for the workload measurement in Surgical Pathology Departments, similar to that proposed for perspective payment of surgical pathology services. The method is reliable and simple representing the full performance to obtain pathological report.

Prognostic significance of depression occurrence in infantile autism.

Autistic children undergoing therapeutic programs, which adopt in our service (USL 3 CT) different theoretical approaches, sometimes show a marked reduction in motor activities, a lowering of tone of voice, physical expression of sadness. We observe that animation is absent in the scene they may draw and colours are no longer used in their drawings. Sleep disturbance may appear or reappearance of enuresis. Many authors consider these symptoms as signs of depression. These changes, even though they create new problems in therapeutic management, are, in our opinion, a very important index of the unblocking of autistic withdrawal and beginning of development of those emotional, relational and cognitive components which seem to be frozen in autistic children and inhibit the birth of the mind, according to the U. Frith Theory. We report in this paper the psychoanalytic, cognitive, systemic, biological viewpoint on the occurrence of depression in infantile autism. We submit three cases of patients being treated in our service with the cognitive-behavioural oriented educational program and pharmacological therapy and discuss the multidimensional approach. The temporary occurrence of depression symptoms may be an index of a change within the resisting autistic balance, which may have a biological basis, but indicates the disorganization of the autistic child's mind in view of further development.

[Multiple jejuno-ileal metastasis of malignant schwannoma from the leg. Report of a case presenting anemia symptoms and review of the literature]. / Metastasi multiple digiuno-ileali da schwannoma maligno dell'arto inferiore. Descrizione di un caso presentante sintomatologia da anemizzazione e revisione della letteratura.

A case of jejunal-ileal metastasis from a left leg malignant schwannoma in a 73 year old woman is described. The patient was affected by progressive anemization without signs of bleeding. A colonoscopy performed during hospitalization revealed an ulcerative lesion at the ileo-colonic junction which at histologic examination was suspected for sarcomatous proliferation arising in peripheral nerve tissue. At operation multiple ileal resections of numerous polypoid formations were performed. Histological examination of polypoid masses revealed the presence of malignant proliferation of spindle cells consistent with a malignant schwannoma. Differential diagnoses are discussed with a review of the literature.

[Psychopathological study of schizophrenia according to the pyramidal model]. / Studio psicopatologico della schizofrenia secondo il modello piramidale.

In this work we aimed to verify the main hypotheses of the pyramidical model where the presence in schizophrenia of four distinct but no coexclusive syndromes (positive, negative, depressive, excited) is described. The test was done by applying the PANSS (the Positive and Negative Syndrome scale) on 30 patients with a schizophrenia diagnosis according to the DSMIIIR. The PANSS was administered to 12 women and 18 men aged between 20 and 42 years old. The statistical analysis of data was done using Kendall's test and Sperman's test. The first test we checked if the four syndromes were statically independent and mutually exclusive, or if there was probability of association between them. The result proves that the four syndromes are statistically independent but not coexclusive though. Though Sperman's test we wanted to find out if there was a complete independence between positive and negative syndromes and between the latter and the depressive syndrome or if there was a probability of association between them. The results point out that the positive syndrome is independent of the negative syndrome and the latter is independent of the depressive syndrome. However, there is a significant level of association between the depressive syndrome and the negative syndrome.

Cloning and identification of mouse steroid receptor coactivator-1 (mSRC-1), as a coactivator of peroxisome proliferator-activated receptor gamma.

Peroxisome proliferator-activated receptor gamma (PPARgamma), a member of the nuclear receptor superfamily, is expressed predominantly in adipose tissue. Forced expression of the two isoforms of this receptor, PPARgamma1 and PPARgamma2, in fibroblasts initiates a transcriptional cascade that leads to the development of adipocyte phenotype. Using the yeast two-hybrid system and GAL4-PPARgamma as bait to screen mouse liver cDNA library, we isolated a mouse steroid receptor coactivator (mSRC-1) involved in nuclear hormone receptor transcriptional activity as a mPPARgamma interactive protein. mSRC-1 cDNA we isolated contains an open reading frame of 1447 amino acids and encodes a new member of the basic helix-loop-helix-PAS domain family. We show that the binding of mSRC-1 to mPPARgamma is ligand independent and coexpression of mSRC-1 with mPPARgamma increases the transcriptional activity of mPPARgamma in the presence of mPPARgamma ligand. We have identified the presence of two putative mPPARgamma binding sites in the mSRC-1, one between residues 620 and 789, and the second between residues 1231 and 1447. These two regions exhibit different degrees of binding affinity for mPPARgamma. We also show that mSRC-1 exhibits its own constitutive transcriptional activity in the yeast as well as in mammalian cells. These results suggest that mSRC-1 interacts with PPARgamma and plays a role in the PPARgamma-mediated signaling pathway.

Laparoscopically-assisted vaginal hysterectomy.

A series of 153 consecutive patients is presented in whom a laparoscopically-assisted vaginal hysterectomy was planned and was performed in 147 of them (96%). Bipolar diathermy was utilized to diathermy the upper uterine pedicles above the uterine arteries. Neither the uterine arteries nor the uterosacral ligaments were ligated laparoscopically and the remainder of the hysterectomy was performed vaginally. In the other 6 patients in whom the operation was commenced laparoscopically, it was discontinued and the operation concluded vaginally in 1 patient and abdominally in the other 5 patients. The aim of using the laparoscopic technique has been to convert a potential abdominal hysterectomy into a vaginal hysterectomy. The technique and the results are discussed.

[Atypical tricyclic neuroleptics for treatment of schizophrenia. Clothiapine and clozapine]. / Neurolettici triciclici atipici nella schizofrenia. Clotiapina e clozapina.

The main objective of the pharmacotherapy of schizophrenia has been, and still is, to obtain optimal therapeutic efficacy, which is seconded by the aim to restrict as far as possible the sometimes severe collateral effects which are acknowledged as being the major drawback to the regular use of neuroleptic agents. Tight from the start, some "atypical neuroleptics" were identified as being of interest for this reason; these included Clothiapine and Clozapine, a more recently discovered drug which is not yet commercially available in Italy. Both of these neuroleptics have been found to offer extremely interesting advantages. The authors now report data referring to the clinical use of these drugs during 1989-1990 in addition to those published in the literature on this subject.