Distinct signalling mechanisms are involved in the dissimilar myocardial and coronary effects elicited by quercetin and myricetin, two red wine flavonols.

BACKGROUND AND AIMS: Moderate red wine consumption associates with lower incidence of cardiovascular diseases. Attention to the source of this cardioprotection was focused on flavonoids, the non-alcoholic component of the red wine, whose intake inversely correlates with adverse cardiovascular events. We analysed whether two red wine flavonoids, quercetin and myricetin, affect mammalian basal myocardial and coronary function. METHODS AND RESULTS: Quercetin and myricetin effects were evaluated on isolated and Langendorff perfused rat hearts under both basal conditions and α- and ß-adrenergic stimulation. The intracellular signalling involved in the effects of these flavonoids was analysed on perfused hearts and by western blotting on cardiac and HUVEC extracts. Quercetin induced biphasic inotropic and lusitropic effects, positive at lower concentrations and negative at higher concentrations. Contrarily, Myricetin elicits coronary dilation, without affecting contractility and relaxation. Simultaneous administration of the two flavonoids only induced vasodilation. Quercetin-elicited positive inotropism and lusitropism depend on ß1/ß2-adrenergic receptors and associate with increased intracellular cAMP, while the negative inotropism and lusitropism observed at higher concentrations were α-adrenergic-dependent. NOS inhibition abolished Myricetin-elicited vasodilation, also inducing Akt, ERK1/2 and eNOS phosphorylation in both ventricles and HUVEC. Myricetin-dependent vasodilation increases intracellular cGMP and is abolished by triton X-100. CONCLUSIONS: The cardiomodulation elicited on basal mechanical performance by quercetin and the selective vasodilation induced by myricetin point to these flavonoids as potent cardioactive principles, able to protect the heart in the presence of cardiovascular diseases.

Omega 3 fatty acids: biological activity and effects on human health.

Polyunsaturated fatty acids (PUFAs) have an important role in human diet, both for the prevention and the therapy of different pathologies. In this review, a critical evaluation of PUFAs dietary sources and biological functions in human organism has been done. In particular, the efficacy of omega-3 fatty acids in the improvement of the lipidic pattern and in the excitability of myocardium has been analyzed, and, therefore, their usefulness in the prevention of cardiovascular diseases and postinfarction arrhythmias. As PUFAs are precursors of prostaglandins and leucotriens, which are involved in phlogosis and immune response, a diet rich in fish oil reduces the production of PGE2 involved in many phlogosis events. Moreover, an increase in the eicosapentaenoic acid (EPA) intake leads to a reduction in the production of inflammatory cytokines (interleukin 1, 2, 6 and tumor necrosis factor); so, it is important to use omega-3 in chronic inflammatory diseases, as the rheumatoid arthritis. It seems that omega-3 could prevent the onset of hormone-dependent tumours (i.e. breast and prostatic cancer); in vitro observations, in fact, have shown that the PG of the series 2, derived from omega-6, have a carcinogenic action; instead, the anticancer effect of omega-3 could derive from their effect in antagonizing the formation of such PG; it can be useful, therefore, to increase the dietary omega-3/omega-6 ratio. Moreover, the effects of omega-3 on the anatomic and functional central nervous system development and of their possible therapeutical use in some psychiatric pathologies were evaluated.

Prognostic factors of cirrhotic patients in extra-hepatic surgery.

BACKGROUND: The surgical approach to a cirrhotic patient is conditioned by a number of variables depending on the emergency and kind of the intervention. It is also related to the evolutionary stage of the liver pathology (evaluated following Child-Pugh score). The present study will explore the physiopathologic mechanisms which should be correlated with the preoperative risk factors responsible for the variation of morbidity and mortality of the hepatopathic patient addressed to an extrahepatic surgical intervention. METHODS: This study includes a retrospective analysis (from 1992 to 1999) of 40 patients with cirrhosis (80% HCV correlated cirrhosis, 15.5% alcoholic cirrhosis, 2.5% cryptogenic cirrhosis), who underwent such procedures as: colon resection (5), gastrectomy (4), hernioplasty (11), cholecystectomy (14), ulcorraphy (3), laparotomy (3). Patients with hepatic resection and portal shunt are excluded from this study. A pre- and postoperative evaluation of ascites, PT, APTT, albumin, bilirubin and protein value, number of leukocytes and Child-Pugh score was performed on all patients. Their follow-up was 30 days. RESULTS: The presence of tensive ascites, low albumin value, PT, APTT, together with the emergency of the operation, proved to be significant (p<0.001), in correlation with a mortality of 7.1% in Child's class A, of 23% in class B, and of 84% in class C. CONCLUSIONS: Cirrhotic patients undergoing elective or emergency surgery can incur significant preoperative risks and postoperative complications, increasing their mortality rate. An accurate preoperative predictive factor is Child's class.

Artificial nutrition for the treatment of short bowel syndrome.

BACKGROUND: In the short bowel syndromes (SBS) it is often difficult to grant a correct and sufficient alimentary supply only by ordinary natural nutrition. In the present research, we will study the prospective possibilities of integrating the nutritional supply making resort to artificial nutrition techniques in patients with SBS. METHODS: We have treated 7 patients with SBS, 6 males and 1 female, whose age was ranging from 29 and 70 years. They all underwent wide intestinal resection, 2 of them for massive infarct, 4 for Crohn's disease, 1 for bowel volvolus. An evaluation of nutritional and immunological conditions was performed on all of them, determining: albumin, transferrin, C-reactive protein, prealbumin, leukocyte count, skin test. In a second time, a protocol was implemented, based on total parenteral nutrition for the first 5 days, with scalar calorie supply up to a total of 35 kcal/kg/die; on day 6 after the operation, the parenteral caloric supply was reduced of 500 kcal/die, being compensated by the introduction of an equal caloric ration by nasointestinal tube with peristaltic pump having a flow of 20 mL/h. In the following days, the parenteral caloric supply was reduced of 500 cal each 48 hours, being substituted with an equal enteral supply in order to progressively reach a complete abandonment of parenteral nutrition. RESULTS: All the patients have a follow-up of 2 to 5 years; today they follow a high-calorie hyperglycidic, hypolipidic diet; no signs of malnutrition are shown by clinical and laboratory analysis. CONCLUSIONS: In the light of the data in our possession, it can be understood that nutritional therapy is the main treatment for SBS; parenteral subministration has to be abandoned during the postoperatory course to give way to enteral nutrition, in order to create a physiological stimulus able to make the digestive system rapidly adapt to the new situation.

Role of color flow Doppler sonography in pre-operative diagnostics of the thyroid pathology.

BACKGROUND: The aim of this work is to demonstrate the high effectiveness of preoperative diagnosis by echotomographic study of thyroid nodules through color-Doppler sonography integrated by B-mode. The authors performed both B-mode ultrasonography and color-Doppler sonography on 125 patients expecting total thyroidectomy surgical intervention, without a previous evaluation of a number of other already performed clinical and instrumental tests. After the intervention, we compared the histologic test with the data drawn from the ultrasound scan, in order to demonstrate that color-Doppler sonography is able to provide for additional diagnostic information in the preoperative period. METHODS: One hundred and twenty five patients with thyroid pathologies were examined by both B-mode and color-Doppler sonography. Two diagnoses were made for each clinical case: the first supported by B-mode data, the second based on vascularity. Our aim was to check color-Doppler's ability to provide new information in the ultrasound diagnosis. All patients underwent a total thyroidectomy surgical intervention. The data were examined by K concordance test. RESULTS: Ultrasound data were compared with the histologic test, which showed 118 (97.4%) benign and 7 (5.6%) malignant lesions. B-mode ultrasound test gave a correct diagnosis in 115 (97%) out of 118 benign lesions and in 4 (57%) out of 7 malignant lesions, while 3 (2.5%) out of 118 cases were false positive and 3 (42.8%) out of 7 were false negative. In those cases showing a wrong conventional ultrasound diagnosis, after the integration of B-mode with color-Doppler results, a decrease was recorded in both false negative and false positive. CONCLUSIONS: Even if no correspondence was found between the different aspects of blood flow and the histologic types of lesions, this experience proves that the color-Doppler test has a high predictive value of benignity in cases with pattern I II and IV, while lesions with pattern III should be more carefully examined, since both malignant and benign lesions belong to this group. From the data drawn from this study, we are able to infer that color-Doppler sonography is undoubtedly an advantage not only in terms of cutting the false negatives, but also in the aim of obtaining a higher effectiveness in the screening of goitrogenic pathology.

Breast cancer and obesity.

Epidemiological evidence links breast cancer, a typical endocrine-related tumor, with western lifestyle, in particular eating habits. Yet, it's necessary to distinguish premenopausal from postmenopausal breast cancer. Visceral obesity and body weight gain are considered responsible for the increased risk of postmenopausal breast cancer. In fact, the mammary gland is sensitive to the level of circulating estrogens, visceral obesity is usually associated with higher levels of free steroid hormones, and the adipose tissue performs important endocrine function (clearance and aromatisation of androgens, regulation of free testoterone/DHEAS molar ratio). Before menopause, ovarian polycystosis is often seen with android obesity, and breast cancer risk could arise; however, as visceral obesity is generally less frequent, genetic factors are more important than nutritional ones. Furthermore, variations have been recorded in the secretion of insulin and insulin-like growth factors, involved in the genesis of the breast cancer. High body weight and male fat distribution negatively influence prognosis of breast cancer, too; this association is linked with the presence of estrogen and progesterone receptors in tumoral cells. Links between diet quality and breast cancer risk are shown: increased use of saturated fats and animal proteins, and a consequently decreased use of vegetables, legumes and fruit, constituting the so-called Mediterranean diet, are considered responsible for the increased risk of breast cancer. Lower fat and alcohol ingestion, the use of dietary fibre and a higher use of complex carbohydrates could reduce breast cancer risk. Finally, starting from the results of our previous animal researches, we suggest using a tryptophan devoid diet for a few days for premenopausal women with male obesity and alterations to the menstrual cycle.

Lymphadenectomy in well differentiated thyroid carcinoma.

In this review, the authors analyze, in relation to the data collected in other literature, the indications and the type of surgical procedure to perform on the neck lymph nodes in cases of differentiated thyroid carcinoma. The authors stress the fact that the surgical procedure must be determined according to the stage in which the diagnosis and prognostic factors are formed and in relation to the natural history of these tumors.

Medullary thyroid carcinoma. Natural history and surgical treatment.

In the present review the Author examines the natural history, clinical aspects, diagnostic aspects and surgical treatment representing the therapy for medullary thyroid carcinoma (MTC), with particular stress on the recommendation that a meticulous total thyroidectomy is always indicated, without leaving any residual thyroid gland tissue. Lymphadenectomy of the central part of neck is also recommended, with the abstraction of the jugular chain lymph nodes. In the case of positivity of one of those lymph nodes, it is necessary to perform a functional cervico-mediastinic lymphadenectomy.

Renal hydatidosis. Discussion of a clinical case complicated by post acute pancreatitic cyst.

In this paper the authors describes a rare case of renal hydatidosis complicated by post acute pancreatitic cyst. There have been no reports up till now either of any physiopathological between the development of hydatid cysts in the vicinity of the pancreas and subsequent pancreatitis, or of any correlation between long-term albendazole therapy and acute pancreatitis. In our particular case, however, the volumetric increase of the renal cyst caused external compression of the pancreas and the consequent slowing-down of bilio-pancreatic flow, which probably led to the development of acute pancreatitis. Since, in our opinion, the pancreatic pseudocyst required surgical removal, we decided to perform the operation there and then; intraoperative examination of the cystic fluid and the presence of daughter cysts confirmed the suspected diagnosis of hydatidosis, of clear renal origin since it was closely attached to the upper pole and continued along the upper calyces renales; the cyst was easily detached from the lower and posterior edge of the liver, and was completely removed, together with its pericystium, which was detached from the lower surface of the liver and from the inferior subhepatic vein; only a tiny disk of pericystium was left in communication with a calyx, sutured to the rest of the kidney. The pancreatic cyst was drained by means of a mesocolic Roux-loop cysto-jejunostomy.

[Paget's disease of the breast]. / La malattia di Paget della mammella.

Paget's disease of the nipple is a rare lesion that is not always associated with underlying breast cancer. The authors report three cases of Paget's disease; in two of the three patients examined, the disease became evident following the appearance of an erythematous and erosive lesion on the nipple and areola, but no clinical evidence of an underlying nodule. In both cases diagnosis was made by integrating cytological tests by apposition of the nipple with mammography. In the third case the disease became manifest following the onset of a lesion on the nipple and areola with the characteristics of chronic eczema in association with a retroareolar nodule, measuring 3 cm, with the mammographic characteristics of an infiltrating carcinoma. All three patients were treated by radical mastectomy modified according to Madden.

[Ogilvie's syndrome. A clinical case report]. / La sindrome di Ogilvie. Osservazioni su un caso clinico.

Ogilvie's syndrome or acute pseudo-obstruction of the colon is characterized by a massive colonic dilatation in the absence of any mechanical obstruction. It is a particular syndrome of adynamic ileus. This case report describes a patient with Ogilvie's syndrome; he has been treated with cisapride and colonoscopic decompression.

[The role of imaging diagnosis in the study of thyroid neoplasms]. / Ruolo della diagnostica per immagine nello studio delle neoplasie tiroidee.

The aim of this paper was to evaluate the role of imaging techniques and methods in the diagnosis of thyroid tumours. The main aim was to analyse the various imaging methods and to search for an integrated diagnosis based on clinical and laboratory evaluations and techniques such as fine needle aspiration biopsy for which imaging is used as a guide. The authors stress the importance of analysing the sensitivity of the various methods in preoperative staging. The methods examined here include: scintigraphy, ultrasound, fine needle aspiration biopsy, Doppler ultrasound, color-Doppler scan, TC and magnetic resonance.

[The clinico-instrumental assessment of the vascular status of the uremic patient for the making of a vascular access for hemodialysis]. / Valutazione clinico-strumentale del patrimonio vascolare del paziente uremico per la confezione di accesso vascolare per emodialisi.

For almost twenty years the Institute of General Surgery and Organ Transplant at Palermo Polyclinic has dealt with vascular problems arising during the preparation, monitoring and search for vascular access in uremic patients. For a number of years advantage has been taken of the vascular status in uremic patients; in fact, the possibility of creating a long-lasting and efficient vascular access also depends on the optimal use of the patient's vascular resources. The authors briefly describe the clinical and instrumental diagnostic strategy for the approach to a vascular access in uremic patients which must be correct and must respect the vascular resources of a "chronic" patient by definition, for whom hemodialysis is often the only prospect of therapy.

[Preoperative instrumental diagnosis in secondary hyperparathyroidism]. / Diagnostica strumentale preoperatoria nell'iperparatiroidismo secondario.

There is a very high incidence of hyperparathyroidism secondary to chronic renal insufficiency in dialysed patients (67%). When medical therapy can no longer control the evolution of disease, an appropriate surgical strategy must be defined for the clinical case. Instrumental tests play an important role during the preoperative phase in the possible "localisation" of ectopic parathyroids (10% of cases) and the identification of those glands with a more pronounced hyperplastic appearance. The authors examine and describe the most useful tests for a preoperative study, namely ultrasonography, echo-colour Doppler, scintigraphy using a dual tracer and image subtraction, computerised xial tomography (CT), magnetic resonance (MR), digital angiography and intraoperative ultrasonography. In conclusion, it can be said that all the methods examined present similar sensitivity levels for the study of parathyroid, but the combination of more than one technique considerably improves diagnostic accuracy.

[Pseudoaneurysm in pancreatic pseudocysts. Report of a clinical case]. / Pseudoaneurisma in pseudocisti del pancreas. Descrizione di un caso clinico.

Pancreatitis in a percentage of 1.5% in a pseudocyst, 10% of which are represented as formations of the pseudoaneurysmatic type one of the visceral artery. The authors of the following study present the case of an 86 year old woman with positive anamnesis because of a chronic pancreatitis, who is affected by a symptomatology in the epigastric regione together with hematemesis and melena. An ecography shows at the head level a mass of cm 6.5 hypo ecogena, delimitated by a hyper ecogena band. A TAC, with and without contrast means and integrated by some RM and angio-RM sequences, shows that it is a vascular injury, with the characteristic area on enhancement after the infusion of the contrast means. The patients goes under surgical intervention, showing a trough supplied by a branch of the hepatic artery. The intervention is performed with the tying of the artery, with the drainage of the residual cavity plus the creation of a pancreatic, cystic and jejunum derivation.