A case of mesonephric adenocarcinoma of the vagina with a 1-year follow-up.

Mesonephric adenocarcinoma deriving from remnants of vaginal mesonephric ducts is one of the rarest tumors of the female genital tract with only three cases reported till date in international literature. Differential diagnosis from other aggressive tumors is complex and controversies exist in the literature regarding the biological behavior, prognosis, and optimal management strategies of these tumors. A 58-year-old woman presented with a large mass extending from the right adnexal region to the perineum and labia majora. CA125 was increased. A radical excision of the lesion with pelvic and para-aortic lymphadenectomy was performed. A well-capsulated mesonephric adenocarcinoma in a background of vaginal mesonephric remnants was diagnosed. Tumor cells showed immunoreactivity for pancytokeratin, cytokeratin (CK), CD 10, epithelial membrane antigen, vimentin, and calretinin; indeed they were negative for carcinoembryonic antigen, CK 20, estrogen receptor, and progesterone receptor. No evidence of lymph node involvement or metastatic disease was observed. The patient did not receive any adjuvant therapy and is alive and clinically free of disease at 1-year follow-up. In spite of the aggressive biological behavior attributed in literature to mesonephric carcinomas, which is probably due to the complex differential diagnosis with other müllerian tumors, the favorable course of our patient further supports the hypothesis that malignant mesonephric carcinomas may not behave aggressively and that radical surgery alone may be curative.

Retrospective diagnosis of congenital cytomegalovirus infection and cortical maldevelopment.

Congenital cytomegalovirus (CMV) infection can cause malformations of cortical development (MCD). It is difficult to establish CMV as a cause of MCD several months postpartum. This can now be done by detection of CMV DNA in dried blood spots (DBS test) on Guthrie cards. The authors used DBS tests to assess 10 patients with MCD of unknown cause. Four of the 10 patients were positive for CMV.

Unilateral periventricular nodular heterotopia associated with diffuse areas of cerebral functional abnormalities.

A 17-year-old boy with polymorphic simple and complex partial seizures is described. Magnetic resonance imaging revealed a unilateral periventricular nodular heterotopia near the occipital ventricular right horn. Interictal and ictal electroencephalographic recordings showed bilateral specific epileptiform anomalies in the occipital region and asynchronous slow waves in frontal areas. Single photon emission computed tomography documented a reduction in regional cerebral blood flow in an area of the left occipital cortex and a symmetric increase in tracer uptake in the frontal lobes. The neuropsychologic assessment revealed a dysfunction of the frontal associative areas. Data collected led the authors to suspect a more diffuse cortical dysfunction than the nodular heterotopia revealed on magnetic resonance imaging.

Gas chromatographic determination of galactose in milk. Example of a switching valve used for the protection of the capillary column.

Galactose, a marker of heat treatment, has been analysed in milk as pentafluorobenzyloxime acetate by gas chromatography with flame ionization detection using a simple switching valve system. The procedure did not entail any prederivatization clean-up for lactose elimination from the sample. In a short pre-column, reagent and lactose derivative excess were separated and the galactose and internal standard derivatives were transferred to the analytical column by a four-port valve. Thus, the analytical column was protected from overloading, so avoiding rapid deterioration.

Differential activation of some transcription factors during rat liver ischemia, reperfusion, and heat shock.

Cells respond to external stimuli by changes in gene expression that are largely dependent on transcription factors (TFs). We studied the behavior of some TFs in rat liver during ischemia, postischemic reperfusion, and heat shock. Knowledge of the conditions at the end of ischemia is essential to understand changes occurring at reperfusion. The TFs investigated are known to be typically responsive to heat shock (HSF), hypoxia (HIF-1), pro- and antioxidant conditions (AP-1), or to various environmental changes (HNF-1 and ATF/CREB family). The most relevant new information includes the following: 1) Liver ischemia activates extremely rapidly the DNA binding capacity of HSF, soon followed by analogous activation of HIF-1 and AP-1. 2) After a certain lag time from the activation of HIF-1, mRNAs accumulate for two glycolytic enzymes, in particular Aldolase A and Heme Oxygenase 1, which contain HIF-1 sequences in their promoters. 3) Reperfusion, which is known to further increase the binding of HSF and to induce NFkappaB binding, abrogates or decreases the binding of HIF-1 and AP-1, stimulated by ischemia, and activates the binding of ATF/CREB. Later on, a second peak of AP-1 binding is induced. 4) Heat shock activates both ischemia-responsive and reperfusion-responsive TFs. 5) Preliminary experiments of supergelshift reveal that the activation of AP-1 at reperfusion or upon heat shock may result from the different involvement of the component subunits.

Differential activation of heat shock and nuclear factor kappaB transcription factors in postischemic reperfused rat liver.

The aim of this study was to investigate the behavior of the transcription factors, heat-shock factor (HSF) and nuclear factor kappaB (NF-kappaB), in postischemic reperfused liver, with particular attention paid to possible differences in the time-course and mechanism of activation, which may help in defining their role in the response of the liver to reperfusion. Ischemia was induced by clamping the hilar pedicle of the left lateral and median liver lobes; the clamp was removed after 1 hour. Some rats were treated intraperitoneally with IL-1 receptor antagonist (IL-1RA) 30 minutes before ischemia and at the time of reperfusion. Binding of NF-kappaB to the corresponding consensus sequence is activated after 30 minutes of reperfusion, and is still increased 1 hour after reperfusion. Activation is suppressed in rats treated with IL-1RA; NF-kappaB persists in the cytosol associated with the inhibitor, IkappaB, and can be artifactually activated in vitro. Super-gel shift experiments revealed that the two subunits, p50 and p65, are involved in the activation of binding. In contrast, binding of HSF to the corresponding consensus sequence, heat shock element (HSE), is already activated at the end of ischemia, shows a further increase after 30 minutes of reperfusion, but declines 1 hour after reperfusion; more importantly, it is not inhibited by pretreatment of the rat with IL-1RA. In conclusion, although both HSF and NF-kappaB are activated by ischemia-reperfusion, there are clear differences in time-course and mechanism of activation of the two transcription factors. Activation of HSF depends directly on some events occurring during ischemia; NF-kappaB is activated only after reperfusion and the concurrent oxidative stress, by an indirect mechanism that can be suppressed by IL-1RA. The possibility of dissociating the activation of these two transcription factors in postischemic reperfusion can have a prospective clinical relevance.

[Use of mechanical staplers in surgery of aneurysms of the abdominal aorta]. / L'impiego delle cucitrici meccaniche nella chirurgia degli aneurismi dell'aorta addominale.

This research aims to illustrate the advantages of using staplers in abdominal aorta surgery. The authors describe their experience in a personal case, of a patient suffering from aneurysmatic expansion of the abdominal aorta extending to both the common iliac arteries. The use of staplers for the closing of the distal stumps in particularly advantageous because it makes less problematic the dissection of the iliac and by hypogastric artery from their underlying veins. That involves a risk diminution of the iliac vein accidental lesions, better by hypogastric artery revascularization, shortening of any times and the perfect haemostatic holding of the mechanical suture, allowing a reduction in mortality and morbidity.

[Pyomyositis in Italy: report of a clinical case]. / Piomiosite in Italia: descrizione di un caso clinico.

Pyomyositis is an infection of the striated muscle seen frequently in Africa but rarely in Western countries with a temperate climate. Over the last few years it has been observed with increasing frequency, especially in immunocompromised hosts. An unusual case of pyomyositis in a 65-year-old immunocompetent woman is described. The disease emerged during septicemia caused by Staphylococcus aureus. It was associated with pleuropneumonia and affected two different and opposite groups of muscles. Diabetes mellitus, a known predisposing factor, was diagnosed during the infection. The diagnosis of pyomyositis was based on microbiological cultures, computed tomography, and radio-labelled granulocyte scintigraphy. Follow-up until recovery was based on computed tomography. Surgical drainage of abscesses was avoided thanks to early diagnosis and specific antibiotic therapy.

Effects of polyamine imbalance on the induction of stress genes in hepatocarcinoma cells exposed to heat shock.

The expression of hsp70-the inducible member of the corresponding heat shock gene family-of the oxidative stress marker gene heme oxygenase (HOx), and of the immediate early response genes c-fos and c-jun has been studied in FAO hepatocarcinoma cells depleted of polyamines and exposed to heat shock. Depletion of polyamines was obtained in short-term experiments (24-48 hours) by the use of alpha difluoromethylornithine (DFMO), a classical inhibitor of ornithine decarboxylase (ODC), or of the combination of the newly available inhibitors of ODC and S-adenosylmethionine decarboxylase, i.e., (2R,5R)-hept-6-yne-2,5-diamine (MAP) and 5'{[(Z)-4-aminobut-2-enyl]methylanino}-5-deoxyadeno-si ne (AbeAdo). Under our experimental conditions polyamine imbalance was realized without appreciable growth-related genes. Decreases of putrescine and spermidine 48 hours after DFMO prevented the induction of hsp70 messenger RNA (mRNA), whereas depletion spermidine and spermine obtained with MAP/AbeAdo decreased intensity and duration of post-heat shock accumulation of hsp70 mRNA. Inductions of HOx, c-jun and c-fos were also inhibited. Because MAP/AbeAdo caused also an intracelluar accumulation of putrescine, we tested the effect of exogenous putrescine, which was found to stabilize the mRNAs for hsp70 and c-jun. Hsp70 and HOx are thought to play a protective role, and the proteins of c-jun and c-fos constitute the transcription factor activator protein-1, which is involved in the transcription of many defensive products. Therefore, the integrity of polyamine pool seems to be a necessary permissive condition for an effective response of the cells to adverse environmental changes.

Post-transcriptional control of increased hepatic catalase gene expression in response to oxidative stress.

Catalase is an important member of the antioxidant network that protects the cell against reactive oxygen species (ROS). We studied catalase gene expression in the liver of rats exposed to oxidative stress induced by the ROS-generating drug nitrofurantoin (NF). Catalase enzymatic activity and content are enhanced by NF treatment. The corresponding increase in the steady state level of the messenger ribonucleic acid (mRNA) occurs without significant changes in transcription and seems therefore controlled post-transcriptionally. Indeed, RNA band-shift assays demonstrated a reduced binding of redox-sensitive cytoplasmic protein(s) to the 3' region of catalase mRNA in NF-treated rats, thus suggesting that the redox state of protein that binds to an antioxidant enzyme mRNA may play a role in the hepatic response to oxidative stress.

Heat shock activation of NFkB in rat liver is mediated by interleukin-1.

Exposure to high temperature (heat shock) activates the transcription factor NFkB in the liver of the living rat, but is not effective in hepatoblastoma cells in culture: on the contrary, activation of the heat shock transcription factor (HSF) occurs under both conditions. Pre-treatment of the rat with IL-1 receptor antagonist suppresses the activation of NFkB, which seems to be mediated by the release of this cytokine, but does not hamper the activation of HSF and the concurrent induction of hsp 70 mRNA. IL-1 activity actually shows a strong, albeit transient, increase in the blood of heat shocked rats.

Differential activation of heat-shock and oxidation-specific stress genes in chemically induced oxidative stress.

Post-ischaemic reperfusion increases the level of the major heat-shock (stress) protein hsp 70 and of its mRNA by transcriptional mechanisms, and activates the binding of the heat-shock factor HSF to the consensus sequence HSE. In common with CoCl2 treatment, post-ischaemic reperfusion increases the level of haem oxygenase mRNA, an indicator of oxidative stress, but CoCl2 does not seem to induce the expression of the hsp 70 gene [Tacchini, Schiaffonati, Pappalardo, Gatti and Bernelli-Zazzera (1993) Lab. Invest. 68, 465-471]. Starting from these observations, we have now studied the expression of two genes of the hsp 70 family and of other possibly related genes under conditions of oxidative stress. Three different chemicals, which cause oxidative stress by various mechanisms and induce haem oxygenase, enhance the expression of the cognate hsc 73 gene, but do not activate the inducible hsp 70 gene. Expression of the other genes that have been studied seems to vary in intensity and/or time course, in relation to the particular mechanism of action of any single agent. The pattern of induction of the early-immediate response genes c-fos and c-jun observed during oxidative stress differs from that found in post-ischaemic reperfused livers. Oxidative-stress-inducing agents do not promote the binding of HSF to its consensus sequence HSE, such as occurs in heat-shock and post-ischaemic reperfusion, and fail to activate AP-1 (activator protein 1). With the possible exception of Phorone, the oxidative stress chemically induced in rat liver activates NFkB (nuclear factor kB) and AP-2 (activator protein 2) transcription factors.

Prevalence of pneumonia due to Legionella pneumophila and Mycoplasma pneumoniae in a population admitted to a department of internal medicine.

We studied 177 patients with pneumonia admitted to an internal medicine department over a period of 3 years to determine the incidence of two emerging pathogens, Legionella pneumophila and Mycoplasma pneumoniae. Clinical, radiological and laboratory tests were performed and included blood cultures, serology, gram staining and sputum cultures. L. pneumophila was the agent involved in 9 patients (5.1%) and M. pneumoniae in 12 (6.8%). These prevalences were about in the middle of the range of previously published figures. Legionella pneumonia is a rare illness, which even in the absence of suggestive clinical signs must be considered because of its possibly serious course and to allow appropriate therapeutic decisions to be made.

Influence of erythrocyte aggregability and plasma fibrinogen concentration on CBF with aging.

The influence of the rheological properties of the blood on cerebral perfusion is still unresolved. Data on normal subjects are lacking and difficulties arise regarding the effect of blood viscosity owing to its close relationship with hematocrit. For these reasons we have studied the relationship between two rheological hematocrit-independent parameters and CBF in normal subjects of various ages. 36 normal volunteers, aged 20-74, free from risk factors, have been studied. CBF was measured by the Xenon inhalation method. Erythrocyte aggregability was expressed as Mean Erythrocyte Aggregation Index (MEA). Plasma fibrinogen concentration was evaluated by the coagulative method in 26 subjects. No correlation was found between CBF and MEA or fibrinogen in the subjects under the age of 45. A significant negative correlation was found between CBF and MEA (p = 0.015) and between CBF and fibrinogen (p = 0.011) in the subjects over 45. These data show that cerebral perfusion is influenced by the rheological properties of the microcirulation only with aging. We suggest that a "rheological autoregulation" exists and that it works properly in youth, only to be lost with physiological aging. This finding can be of significance in the pathogenesis of cerebrovascular disease processes in humans.

[Health surveillance of workers]. / La sorveglianza sanitaria dei lavoratori.

The main purposes of the health surveillance of workers exposed to anaesthetic gases are: a) the finding of disorders either reliable to the exposure or incompatible with the activity in the operating theatre; b) the epidemiological evaluation of the late effects. Simple and rigorous methods to estimate the previous and the current risk are suggested. The main data to be collected during the medical examination are indicated. The registration of the data of the reproductive function by a protocol of recording is proposed. For the health surveillance of workers in Health Care Institution it's advisable to establish an interdisciplinary group, referring to a specialist on occupational medicine.

[Occupational exposure to volatile anesthetics and reproductive effects: a bibliographic review of epidemiological studies]. / Esposizione professionale ad anestetici volatili ed effetti riproduttivi: rassegna bibliografica degli studi epidemiologici.

Up to the early eighties, a variety of epidemiological studies suggest that chronic exposure to low doses of anesthetic gases, as occurs in operating rooms, is an occupational risk factor for spontaneous abortion and congenital defects. Numerous and more recent epidemiologic studies are reviewed; currently it is suggested that there is inadequate evidence to conclude that occupational exposure to anesthetic gases causes increased rates of spontaneous abortion or congenital anomalies. The improvement of environmental conditions, that has reduced airborne levels of anesthetic gases in operating rooms, has been critical in reducing the risk of abortion and congenital defects. In agreement with recent epidemiological reports, we believe that the health surveillance of exposed workers must include the study of pregnancy outcome.

[Focus. An expert system for the clinical diagnosis of the location of acute neurologic events]. / Focus. Un sistema esperto per la diagnosi clinica di sede di incidenti neurologici a comparsa acuta.

Focus is an expert system developed to diagnose, by the findings on neurological examination, the anatomic location of an acute neurologic event. The inference engine uses a forward tracking algorithm and a rule based data base that includes associations of neurological signs with specific anatomic areas. Focus is linked to a data base in which all personal cases and final diagnoses confirmed by laboratory studies are stored. This makes it possible to assess the validity of the system's diagnoses and use personal cases as additional example to the revision of the rules. The program is easy to use and runs on MS-DOS microcomputer. Furthermore the diagnostic rules are accessible so Focus may furnish an interactive teaching device.

Tactile extinction in childhood hemiplegia.

Tactile extinction was investigated by the Quality Extinction Test (QET) of Schwartz in 39 patients, 34 of whom had congenital hemiplegia and five early-acquired hemiplegia. Extinction values were significantly higher in hemiplegia patients than in controls and usually contralateral to the side of brain damage, except for four cases with right hemiplegia. Values were also higher in males than in females. There were no significant differences between patients with left and right hemiplegia, and no correlations between extinction and IQ or the presence of epilepsy. There was a correlation between QET scores and neuroradiologically proven cerebral atrophy. The meaning of extinction in hemiplegic patients and the principal theories regarding the pathogenesis of neglect are discussed.