Divergência fenotípica entre éguas Crioulas das linhagens uruguaia "La invernada", argentina "Cardal" e chilena / [Phenotypic divergence between Criollo mares lines of the Uruguayan "La invernada", Argentine "Cardal" and Chilean]

O objetivo do presente estudo foi analisar a dissimilaridade fenotípica de amostras populacionais de três linhagens de éguas Crioulas, uruguaia (La Invernada), argentina (Cardal) e chilena, para caracteres morfológicos, apontando as características de maior variância intra e entre as diferentes linhagens que são passíveis de seleção. Foram avaliadas 22 características morfológicas de 113 éguas da linhagem uruguaia "La Invernada", 38 argentinas "Cardal" e 73 chilenas puras, totalizando 224 éguas de cria pertencentes à raça Crioula. Para determinação das variáveis lineares e de perímetro, foi utilizada fita métrica, prumo, paquímetro e hipômetro. Verificou-se variabilidade nas características morfológicas entre as três linhagens (P<0,05), incluindo as características lineares altura, perímetro de tórax e perímetro de canela (P<0,01), consideradas de caráter impositivo para fins de registro. Maior variação fenotípica foi observada nas éguas da linhagem chilena em relação aos outros dois grupos genéticos (P<0,01). As características morfológicas altura garupa, perímetro rostral pescoço, comprimento metatarso, largura garupa, profundidade do tórax, comprimento dorsal pescoço e comprimento do corpo foram passíveis de seleção entre as éguas Crioulas pertencentes às linhagens argentina (Cardal), uruguaia (La Invernada) e chilena. Em conclusão, não há homogeneidade entre as linhagens estudadas, o que identifica a diversidade entre as linhagens de éguas Crioulas estudadas.(AU)

The aim of the study was to analyze the phenotypic dissimilarity of morphological characteristics of three strains of Criollo mares, Uruguian (La Invernada), Argentine (Cardal), and Chilena, pointing to the characteristics of higher variance within and among the different strains that are selectable. We evaluated 22 morphological characteristics of 113 mares of the Uruguaian line, 38 Argentines and 73 pure Chilean, totaling 224 breeding mares belonging to the criollo breed. For the determination of the linear and perimeter variables, a metric tape, plumb, pachymeter and hypometer were used. There was variability in the morphological characteristics between the three strains (P<0.05), including the linear characteristics of height, chest circumference and perimeter of cinnamon (P<0.01), considered as taxation for registration purposes. Higher phenotypic variation was observed in the mares of the Chilean line in relation to the other two genetic groups (P<0.01). The morphological characteristics of height croup, rostral perimeter neck, metatarsal length, croup width, chest depth, dorsal neck length, and body length were the selectable characteristics among the breeding mares belonging to the Argentine (Cardal), Uruguaian (La Invernada) and Chilena strains. In conclusion, there is no homogeneity between the studied strains, which identifies the diversity among the lines of Criollo mares studied.(AU)

Delivery of selective internal radiation therapy complicated by variant hepatic vascular anatomy.

"Difficult vascular anatomy" is a challenge for Interventional Radiologists especially in liver directed therapies such as trans arterial radio embolization. Trans arterial radio embolization is a long and difficult procedure in which the basic knowledge of hepatic and gastro-enteric vascularization, with its high degree of variations, is very important in order to correctly administer the therapeutic drug selectively. In this report, we present a case of an atypical patient affected by an unresectable hepatocellular carcinoma, candidate for Radio-embolization treatment. His vascular anatomy was very difficult to manage, but the Interventional Radiologist was not only able to go over the "difficult anatomy," but also to take advantage of it.

Osteoid osteoma treated with radiofrequency ablation in non-operating room anesthesia. A different way of approaching ablative therapy on osteoid osteoma.

OBJECTIVE: The purpose of this study is to verify the effectiveness and complications occurrence of radiofrequency ablation (RFA) in the treatment of osteoid osteoma (OO) in non-operating room anesthesia (N.O.R.A.). PATIENTS AND METHODS: From 2014 to 2017, 61 patients affected by OO (40 men and 21 women) with an age of 20.7 years on average (range, 4-51 years; 12 patients aged 20 years or younger) underwent computed tomography-guided percutaneous radiofrequency ablation (RFA) in N.O.R.A. (Non-Operating Room Anesthesia). Lesion sites treated were: femur (27), tibia (22), pelvis (2), talar bone (3), distal radius (1), and humerus (6). Mean follow-up time was 36 months. In each case, anesthesiologic support followed a new protocol (N.O.R.A. protocol), approved by our Institute. Primary success rate, complications, symptom-free intervals, and follow-up results were evaluated. RESULTS: Pain relief (evaluated with Visual Analogue Scale - VAS) was significant in 97% of patients; it disappeared within 24 hours of the procedure in 44 patients, within 3 days in 10 patients, and within 7 days in 7 patients. After 6 months of observation time, 60 of 61 patients were successfully treated and had no more complaints. In 2 patients, two major complications were found: infection of the site treated, healed with antibiotics, and a nerve lesion, healed with steroid therapy. No other complications were observed. CONCLUSIONS: RFA is a highly effective, efficient, minimally invasive and safe method for the treatment of OO following N.O.R.A.

Limb saving procedure in metastatic leiomyosarcoma of the femoral vein: case report and literature review.

Primary venous leiomyosarcoma is very rare and first description was made by Perl in 1871. Most cases are from venous system and half of them are reported to originate in inferior vena cava. We report the case of a 77-year-old Caucasian man with a leiomyosarcoma of the femoral vein. A leg preservation surgery was decided. Eight months later, the patient died of tumor progression. A PubMed search using the terms "leiomyosarcoma femoral vein" and "leiomyosarcoma vein" was performed. All cases of composite iliac-femoral leiomyosarcoma were excluded, and as far as possible, only well-documented cases were included. Median age was 55 years, seven men and six women, tumor resection was performed by six authors, six others performed a vascular resection, and one preferred for a thigh excision. Prognosis remains poor if metastasis is present, and in these cases, a conservative surgery is recommended to preserve patients' quality of life.

Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases.

BACKGROUND: This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisation of patients with colorectal liver metastases (mCRC) who failed previous oxaliplatin- and irinotecan-based systemic chemotherapy regimens. METHODS: Eligible patients had adequate hepatic, haemopoietic and renal function, and an absence of major hepatic vascular anomalies and hepato-pulmonary shunting. Gastroduodenal and right gastric arteries were embolised before hepatic arterial administration of yttrium-90 resin microspheres (median activity, 1.7 GBq; range, 0.9-2.2). RESULTS: Of 50 eligible patients, 38 (76%) had received > or =4 lines of chemotherapy. Most presented with synchronous disease (72%), >4 hepatic metastases (58%), 25-50% replacement of total liver volume (60%) and bilateral spread (70%). Early and intermediate (>48 h) WHO G1-2 adverse events (mostly fever and pain) were observed in 16 and 22% of patients respectively. Two died due to renal failure at 40 days or liver failure at 60 days respectively. By intention-to-treat analysis using Response Evaluation Criteria in Solid Tumours, 1 patient (2%) had a complete response, 11 (22%) partial response, 12 (24%) stable disease, 22 (44%) progressive disease; 4 (8%) were non-evaluable. Median overall survival was 12.6 months (95% CI, 7.0-18.3); 2-year survival was 19.6%. CONCLUSION: Radioembolisation produced meaningful response and disease stabilisation in patients with advanced, unresectable and chemorefractory mCRC.

Lycopersicon esculentum lectin is a marker of transient amplifying cells in in vitro cultures of isolated limbal stem cells.

The maintenance of a healthy corneal epithelium under both normal and wound healing conditions is achieved by a population of stem cells (SCs) located in the basal epithelium at the corneoscleral limbus. In the light of the development of strategies for reconstruction of the ocular surface in patients with limbal stem cell deficiency, a major challenge in corneal SCs biology remains the ability to identify stem cells in situ and in vitro. To date, not so much markers exist for the identification of different phenotypes. CESCs (corneal epithelial stem cells) isolated from limbal biopsies were maintained in primary culture for 14 days and stained with Hoechst and a panel of FITC-conjugated lectins. All lectins, with the exception of Lycopersicon esculentum, labelled CESCs irrespective of the degree of differentiation. Lycopersicon esculentum, that binds N-acetylglucosamine oligomers, labelled intensely only the surface of TACs (single corneal epithelial stem cells better than colonial cells). These results suggest that Lycopersicon esculentum lectin is a useful and easy-to-use marker for the in vitro identification of TACs (transient amplifying cells) in cultures of isolated CESCs.

Modifications of nuclear envelope in tumour cells of human gastric carcinomas: an ultrastructural study.

BACKGROUND: Various nuclear envelope derivatives, such as the annulate lamellae, the intranuclear tubules as well as the nuclear projections and pockets may be observed electron microscopically in tumour cells. PATIENTS AND METHODS: In a series of eight gastric adenocarcinomas, ultrastructural features of nuclear envelope changes were analyzed and correlated to the biology of the tumours. RESULTS: Histologically, three tumours were intestinal-type adenocarcinomas and showed annulate lamellae in the cytoplasm of some tumor cells. Five tumors were mixed-type adenocarcinomas, with a solid growth pattern; two of these tumours were characterized by the presence of intranuclear tubules, whereas the remaining three tumours exhibited nuclear pockets and projections. Seven out of eight patients died due to metastatic disease during the follow-up period (median 31 months). CONCLUSION: Ultrastructural evaluation of pleomorphism of the nuclear envelope may be an ancillary method for the pathologist in the study of nuclear grading of gastric carcinomas.

Granulomatous inflammatory reaction in human gastric adenocarcinomas: a light and electron microscopy study.

Granuloma is a focal, compact collection of inflammatory cells in which mononuclear phagocytes predominate. The authors report 9 cases of papillary-tubular gastric adenocarcinomas characterized by mature granulomas associated with recent microhemorrhages. Mature granulomas were composed of foamy, CD68-positive histiocytes with occasional giant cells. Hemosiderin-containing macrophages were present in the tumor stroma, suggesting phagocytosis of erythrocytes. Under electron microscopy, mature (nonepithelioid) granulomas and clusters containing 1 macrophage and 1-3 eosinophils were found. This study provides morphological examples of skewed type II macrophage infiltration in gastric adenocarcinomas that is involved in scavenging activity, particularly erythrophagocytosis, formation of mature (nonepithelioid granulomas), and heterotypic aggregation with eosinophils.

Ultrastructural descriptions of pericyte/endothelium peg-socket interdigitations in the microvasculature of human gastric carcinomas.

BACKGROUND: Angiogenesis requires complex multistep signalling pathways and a high degree of spatial and temporal coordination among endothelial cells and pericytes. The two cell types exhibit numerous contacts in vivo and in vitro, including the occurrence of peg-socket junctions. MATERIALS AND METHODS: Ultrastructural findings in 9 cases of advanced gastric carcinomas were reviewed with special emphasis on endothelium/pericyte peg-socket junctions. RESULTS: The incidence of peg-socket junctions was approximately 8% in 5 out of 9 cases. The remaining 4 cases showed a very low rate, including two cases in whom interactions were totally absent. Peg-socket junctions consisted of cytoplasmic projection from the pericyte protruding into the endothelial indentation. The endothelial cells interacting with pericytes showed ultrastructural signs of partial stabilization such as continuous endothelial lining, regularly constructed interendothelial junctions, more or less integrated pericytes, and multilayered basement membrane. CONCLUSION: Our ultrastructural study confirms previous reports regarding pericyte/endothelial peg-socket interdigitations in murine and human granulation tissues and extends these findings to the microvasculature of human gastric carcinomas.

Krukenberg tumour of the ovary: a case report with light microscopy, immunohistochemistry and electron microscopy study.

A rare case of a 46-year-old woman with bilateral Krukenberg tumours is reported. Histologically, oedematous ovarian stroma was infiltrated by signet-ring cells arranged singly, in cords or in nests. Immunoreactivity for cytokeratin-7, carcinoembryonic antigen as well as histochemical positivity for mucins demonstrated the epithelial nature of the tumour. The gastric primary site was suggested by the cytoplasmic immunoreactivity for MUC-5AC and by ultrastructural evidence of gastric differentiation in signet-ring cells such as mucous granules with eccentric dense cores and intracellular microcysts, lined by sparse microvilli. Gastric biopsy, performed after pathological diagnosis, revealed a signet-ring cell carcinoma similar to that in the ovaries, confirming the gastric origin of the Krukenberg tumour. Because none of the individual immunohistochemical markers used for tissue identification is both site specific and site sensitive, electron microscopy in combination with immunohistochemistry is a valuable tool for the pathologist in the diagnosis of the tissue origin of a Krukenberg tumour.

Sonographic features of penile-gland lithiasis.

A 52-year-old man presented with a small, red, tender swelling near the penile frenulum at the lower edge of the base of the glans. Lower urinary tract symptoms were absent. Ultrasonography revealed a stone lodged in the distalmost portion of the glands of Littre. Combined with a good knowledge of penile anatomy, use of this simple imaging tool allows reliable diagnosis of even the rarest cases of penile pathology.

Percutaneous vesiculodeferentography in the diagnosis of male infertility: A review of our results and the data reported in the literature.

Vesiculodeferentography was used in the past to evaluate suspected cases of obstruction of the seminal ducts. Over the years, numerous attempts have been made to improve the technique used to perform this examination and to render it less invasive. Its use is currently indicated in selected cases, where it is combined with functional studies like seminal tract washout and followed by immediate interventions to correct the alterations revealed. Vesiculodeferentography includes collection of the contents of the seminal vesicles, which can later be used in vitro assisted fertilization procedures.

SommarioLa vesciculodeferentografia, esame utilizzato in passato nei casi di sospette ostruzioni delle vie seminali, è stato negli anni oggetto di numerosi studi allo scopo di migliorarne la tecnica di esecuzione e renderla meno invasiva. Attualmente è indicata solo in casi selezionati, in associazione a un'indagine funzionale quale il Seminal Tract Washout e prevedendo un contemporaneo ­ o in via subordinata, successivo ­ atto terapeutico.Ovviamente, peraltro, la procedura ­ ipso facto ­ prevede il prelievo di materiale dalla seminale e ciò può consentire una successiva procedura di fecondazione assistita in vitro.

5-year prospective results of trimodality treatment for malignant pleural mesothelioma.

AIM: Even though followed by a prolonged survival in highly selected patients, the promising results of Sugarbaker's trimodality treatment for malignant pleural mesothelioma (MPM) are debated and not yet uniformly replicated. The purpose of this study is to evaluate prospectively the reproducibility of the trimodality treatment results in a patient population with mesothelioma staged by the IMIG classification. METHODS: Fifty-four patients with MPM have been judged candidable to extended pleuropneumonectomy (EPP), to be followed by chemotherapy (paclitaxel+carboplatin) and radiotherapy (50 Gy). RESULTS: At thoracotomy, 44 of the 54 surgical candidates (81%) underwent EPP; 73% of the operated patients completed the entire adjuvant chemo-radiotherapy with no major toxicity. The 30-day or in-hospital operative mortality rate was 4.5% (2 deaths), the major morbidity 36%, and the overall complication rate 50%. At 5 years the projected survival of the 42 surgical survivors submitted to EPP is 19%; median survival is 20 months. The restricted group of patients with epithelial, N0-1, completely resected MPM (microscopic negative margins) exhibits a projected 50% 5-year survival. Clinical understaging has shown up to be noticeable both at the thoracotomy exploration and pathology examination. Most of the disease recurrences are loco-regional and the current insufficiency of intraoperative or postsurgical radicality needs improvement, along with earlier diagnosis, more accurate staging, and preoperative induction for the multimodality treatment of pleural mesothelioma to become an established curative option. CONCLUSIONS: This series confirms the reproducibility of the trimodality treatment for MPM,which is associated with prolonged survival for early-stage tumors at the cost of a not prohibitive treatment-related mortality rate.

A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90yttrium SIR-spheres in unresectable, colorectal liver metastases refractory to i.v. chemotherapy: preliminary results on toxicity and response rates.

BACKGROUND: In patients locally progressing after two lines of chemotherapy, some locoregional approaches showed encouraging results in terms of local control of disease. The aim of our study was to evaluate toxicity, clinical response and quality of life in 48 patients with unresectable colorectal liver metastases submitted to selective internal radiotherapy (SIRT). MATERIALS AND METHODS: Up to now 35 patients with unresectable colorectal liver metastases, refractory to two lines of chemotherapy, underwent intra-arterial infusion of resin microspheres with yttrium-90 (SIR-spheres). Pre-treatment evaluation included a CT scan, blood tests, a PET scan and arteriography of celiac trunk, hepatic and superior mesenteric artery; extrahepatic uptakes and pulmonary shunts more than 10% were excluded by a Scinti-scan. The gastroduodenal artery was embolized before the SIR-spheres injection. Other exclusion criteria were liver dysfunction and anatomical vascular anomalies. The clinical response was evaluated by CT-scan following the RECIST criteria. Median follow-up was 4 months. RESULTS: Median number of metastases was 4 (range, 1-15), 38% of cases presenting hepatic involvement < 25%. The median SIRT dose delivered was 1.7 GBq. Median pulmonary shunt was 6%. No operative mortality occurred; early toxicity (within 48 hours) was 20.6%, shown as fever, acute pain and leucocytosis. The late toxicity was 24.1% with chronic pain, jaundice and nausea being the most frequent. All the toxic events were graded 2 or 3 according to the WHO scale. Preliminary results were available in terms of clinical response after 6 weeks: 12.5% had a partial response, 75% a stable disease, while progression of disease, was observed in 12.5% of the patients. CONCLUSION: SIRT is a safe treatment in terms of acute and late toxicity. Intra-arterial microspheres could represent a good therapeutic option for patients with progressing liver metastases only, after two lines of systemic chemotherapy.

[Radiotherapy of the tonsillar region. Analysis of prognostic factors]. / Radioterapia della regione tonsillare. Analisi dei fattori prognostici.

INTRODUCTION: We report our personal experience with the treatment of tonsillar cancers at the Otorhinolaryngology-Radiotherapy Department of Umberto I Hospital, Mestre, Italy. The results were analyzed by tumor site and stage, lymph node involvement, treatment type and patient age. MATERIAL AND METHODS: January, 1987, through December, 1995, we treated a hundred and 25 patients with carcinoma of the tonsil and tonsillar region. Most patients were men (M:F = 4:1), with a mean age of 61.9 years (range: 38-87). The lesions were staged at physical examination, chest radiography, bone scintigraphy. US of the liver and neck, CT and/or MRI of the tonsillar region and neck. Eleven patients were in stage I (8.8%), 26 in stage II (20.8%), 31 in stage III (24.8%) and 57 in stage IV (45.6%). Forty-one patients were submitted to tonsillectomy and more/less massive neck dissection: surgery was not radical-in 14 of them. All patients received gamma-photon radiotherapy with a cobalt unit: the minimum dose was 50 Gy after radical surgery and 60 Gy for exclusive irradiation and after nonradical surgery. The hemiblock field technique was always used with the conventional fractionation (2 Gy/day. 1 fraction/day, 5 fractions/week); the treatment was planned with the Theraplan V05-B method on CT scans. When the tolerance dose was reached, the spinal cord was shielded and the dose compensated with 9 MeV electrons. The treatment was discontinued only when needed, and never for more than 7-10 days. RESULTS: The overall 5-year survival and the 5-year disease-free survival rates were 28% and 45%, respectively; the overall 5-year cause-specific survival rate was 39%. Disease-free survival was 81% in stage I, 52.7% in stage II, 44.2% in stage III and 35.8% in stage IV (p = .005). The 5-year disease-free survival for the patients receiving surgery and irradiation was 62.1%, versus 38.3% for irradiation alone; the rate was 37.6% when neck nodes were involved (N+). One hundred and two patients achieved complete remission (CR), while the other 23 had partial remission (PR). Twenty-eight CR patients recurred; the most common cause of death was failure in primary tumor local control. There were no complications during or after treatment. Secondary lesions were found in 13 patients (10.1%). CONCLUSIONS: Irradiation alone yields fairly good results in early tonsil carcinoma, while the surgery-irradiation combination should be preferred in large tumors. Better results are expected from kinetic and conformal irradiation techniques with 3D calculations on CT and MR images, which should permit to deliver high doses to strictly targeted areas and to reduce side-effects. Other improvements are expected from new combination therapies.

[Brachytherapy with pulsed dosage. General considerations. Radiobiological considerations. First clinical experience in Mestre (Venice)]. / Brachiterapia con rateo di dose pulsato. Considerazioni generali. Considerazioni radiobiologiche. Prime esperienze cliniche a Mestre-Venezia.

The pulsed dose rate (PDR) brachytherapy technique is analyzed and compared with the low and high dose rate (LDR and HDR, respectively) techniques relative to therapy and management, considering the advantages and pitfalls of each technique. From a radiobiological viewpoint, PDR optimization is aimed at obtaining the same therapeutic results as with LDR and HDR relative to both tumor cell killing and possible late damage. PDR permits to administer the same nominal dose rates as with LDR and HDR, but with very different pulse intervals and length. March, 1995, through March, 1996, forty-two patients were treated with microSelectron PDR at the radiotherapy Department of Umberto I Hospital in Mestre (Venice). Twenty-two patients were irradiated on the vaginal vault, 14 on the anal canal, 4 on the breast, one on the endometrium and one on the urethra (the latter patient was a man). Dose rates were 250-300 cGy/h in the vaginal vault and 90 cGy/h in the other sites. Source-dwell interval in the applicators was 2.5 mm, dwelling time for each position ranged 6.8-122 s, 3-73 pulses were applied lasting 167-1958 s. The unit was reliable and the only problem was the need to recalibrate it every 5-6 applications because of computer memory saturation. Because of the short minimum follow-up (3 months), only the early reactions to treatment have been assessed: no toxicity was found in the vaginal vault, endometrium and breast. Low-grade proctitis was observed in 11 of 14 treated anal canals and another patient complained of more severe symptoms for two weeks; the disease progressed in two anal canal patients, as in the urethra patient. In conclusion, PDR brachytherapy appears a reliable technique whose early clinical results are encouraging.

[Epistaxis in Rendu-Weber-Osler disease. The role of brachytherapy]. / L'epistassi nel morbo di Rendu-Weber-Osler. Ruolo della brachiterapia.

Rendu-Weber-Osler disease is a rare autosomic disorder. Its most common symptom is epistaxis with transitory periods of remission and of ingravescent exacerbation compromising normal daily activities and forcing the patient to give up his normal life-style for prolonged periods of time. Often it proves difficult to control the recurrent epistaxis and the treatments available today are not always totally satisfactory. The authors present the results obtained using endonasal brachytherapy in 8 patients (13 treatments) epistaxis stemming from previously diagnosed Rendu-Weber-Osler disease. Brachytherapy employs thin plastic tubes, positioned in the nostril with the heaviest epistaxis. These tubes are then filled with Iridum192. The total dose, prescribed against the reference isodose, strictly adjacent to the nasal fossae mucosa, was 30 Gy over a period ranging from two to four days (average 2.5 days). Four patients required a second treatment to the controlateral nostril as the symptoms returned after a period ranging from 36 to 60 months (average 47.1 months). Only one patient required a second treatment in the same nostril 9 years later. The episodes of epistaxis were scored by symptom severity on a scale from 0 to 5. Of the 13 treatments administered (mono and bilateral treatments), 12 can be considered satisfactory as the epistaxis was reduced from the initial pre-treatment score of 4-5 to 2 or less (5 were reduced to 0, 3 to 1 and 4 to 2). In only 1 case was the score 3. Remission of symptoms lasted for a period ranging from 11 to 108 months with an average of 51.6 months. No complications arose from the use of brachytherapy. Only one patient required embolization 3 years after the endonasal brachytherapy treatment.