Genotyping of different Pseudomonas aeruginosa morphotypes arising from the lower respiratory tract of a patient taken to an Intensive Care Unit.

Pseudomonas aeruginosa is an opportunistic pathogen and an ubiquitous environmental bacterium. Fifty-seven days after hospitalization, we isolated three distinct P. aeruginosa morphotypes (smooth, rough and mucoid) from the lower respiratory tract of a patient admitted to a Cardiology Intensive Care Unit (ICU). Moreover, a group of nine colony variants, arising from the three P. aeruginosa isolates growing in laboratory growth media, were also isolated. The resulting 12 isolates were characterised for antibiotic resistance profile and subjected to genotypic analysis by fluorescent-Amplified Fragment Length Polymorphism (f-AFLP) and automated repetitive extragenic palindromic-PCR (rep-PCR) fingerprinting. The three smooth, rough and mucoid morphotypes presented different antibiotic resistance profiles and genotyping analysis showed that they belonged to distinct clones, indicating that at day 57 after the admission the patient was simultaneously colonized by three distinct P. aeruginosa isolates. On the other hand, the nine colony variants presented heterogeneous antibiotic resistance profiles and clustered together with the three parental isolates. The understanding of the link between genotype plasticity and antibiotic resistance may contribute to improving our knowledge of this life-threatening pathogen.

Granular cell tumor of the hypopharynx treated by endoscopic CO(2) laser excision: report of two cases.

BACKGROUND: Granular cell tumor (GCT), or Abrikossoff's tumor, is an unusual lesion probably arising from Schwann cells. It is frequently found in the head and neck region, where the tongue is the most commonly affected site. Involvement of the hypopharynx is exceedingly rare because, to the best of our knowledge, only four cases have been reported in the literature. METHODS: We describe hypopharyngeal GCT in two women aged 29 and 52 years, respectively. RESULTS: In the first patient, preoperative diagnostic examination, including endoscopy, CT, and MRI scan, was suggestive of a benign lesion arising from the posterior wall of the hypopharynx. In the second patient, a previous biopsy of the postcricoid area performed elsewhere suggested a diagnosis of well-differentiated squamous cell carcinoma, and CT scan staged the lesion as T1 N0. In both cases, treatment included surgical excision under microlaryngoscopy with CO(2) laser. The histopathologic study of the specimens, supported by immunohistochemical techniques, determined the lesions to be a GCT. The postoperative course was uneventful, and the patients were discharged 12 and 2 days after surgery, respectively. Both patients were asymptomatic without evidence of recurrence when last seen 2 years and 4 months after surgery, respectively. CONCLUSIONS: GCT should be included in the differential diagnosis of submucosal hypopharyngeal lesions. Endoscopy and radiologic imaging do not display any typical finding suggestive of the diagnosis, which can be based only on histologic findings. Resection of the tumor, when technically feasible, should be performed under microlaryngoscopy with the CO(2) laser, which makes it possible to work in a bloodless field with minimal thermal damage and reduction of scarring and postoperative edema.

Second look laparotomy in the management of malignant epithelial ovarian neoplasias.

In the present study we examined 15 patients with malignant epithelial ovarian neoplasms who underwent primary surgery and chemotherapy at the Institute of Obstetric and Gynecologic Clinic of the University of Pisa between 1983 and 1985. At the time of diagnosis and monthly during chemotherapy plasma levels of CEA, CA 19-9, CA 125 and TPA were detected. At the end of pharmacological treatment a second-look laparotomy was performed in each patient to assess the status of cancer. At this time the clinical response was complete in 13 patients and partial in 2. These results were confirmed at second-look laparotomy in 11 of 13 cases of complete clinical remission and in 1 of the 2 cases of partial clinical remission. Two patients in complete clinical remission showed persistent disease. The other one in partial clinical remission was surgically found to have unmodified tumor. Tumoral markers, and especially CA 125, have a good correlation with the clinical course of the disease. However these tumor associated antigens cannot replace second-look laparotomy for assessing the response to cytostatic drugs. In fact patients with normal serum levels of these markers at the end of chemotherapy, were surgically found to have both complete pathological remission and persistent disease. Therefore we have come to the conclusion that the second-look laparotomy and the evaluation of tumor markers have to be performed together in the management of malignant ovarian neoplasms.