[The active search for occupational diseases in the engineering industries. Diseases associated with exposure to welding activities in optical radiation: dry eye syndrome]. / La ricerca attiva delle malattie professionali nel settore della metalmeccanica. Patologie connesse all'esposizione a R.O.A. nelle attività di saldatura: la sindrome dell'occhio secco.

In the project of active research of occupational diseases was conducted a study on 45 welders in the engineering companies, with particular attention to the hazards of exposure to the optical radiation. The protocol used involved the execution of Breack Up test, Schirmer test, corneal staining and scraping cytology. It revealed that more than half of the welders had ocular lesions referable to their work activity as well as some permanent functional damages with the characters of dry eye syndrome. None of these diseases, which could alert for medical-legal and insurance, was highlighted by the occupational health physician.

Follicular dendritic cell sarcoma of the head and neck. Literature review and report of the tonsil occurrence in a Ugandan patient.

We report a case of follicular dendritic cell sarcoma (FDCS) in a 60-year-old Ugandan female who presented with a 6-year history of a progressive left sided tonsillary mass. General systemic examination was unrevealing and the patient underwent left tonsillectomy. She was subsequently lost to follow-up. Grossly, the mass measured 6 cm in diameter and had a mottled appearance due to tissue microhaemorrhages. Markers specific for follicular dendritic cell differentiation (CD21, CD35 and CD23), p53 and EGFR were expressed on immunohistochemical analysis. Review of all of the 49 published reports of tonsil FDCS showed that this entity tended to occur at younger age (mean: 44.5 yrs) in women than in men (mean: 49.4 yrs). Tumour size ranged from 0.8 to 5 cm in maximum dimension (mean 2.9 cm). Only 12.2% of the patients presented with metastatic disease at initial diagnosis, all localised in the cervical lymph nodes. Local or distant recurrences occurred after a mean period of 72.5 months. In conclusion, although the pertinent literature suggests that FDCS should be considered at least of intermediate grade, our review indicates that FDCS of the tonsil region behaves as a low-grade sarcoma.

Predictive factors of outcome after liver transplantation in patients with cirrhosis and hepatocellular carcinoma.

Studies to define the optimal upper limits of tumor size and number as predictors of outcome after orthotopic liver transplantation (OLT) have yielded conflicting results. We analyzed 72 patients with cirrhosis and hepatocellular carcinoma (HCC) who underwent OLT over a 12-year period in a single center. Predictive factors for survival and tumor recurrence, according to the Milan criteria, were also examined. Our cohort included 60 men and 12 women of mean age 54 +/- 8 years and mean follow-up of 40 +/- 39 months. Origin of cirrhosis was postviral in 70% and Child class B or C in two thirds of patients. HCC was multifocal in 61%; about one fifth of patients had micro- or macrovascular involvement or positive nodes upon histologic examination. The cumulative size of the lesions was <3 cm in 17 patients; >3 to < or =5 cm in 28 patients; >5 to < or =8 cm in 14 patients; and >8 cm in 13 patients. According to the number and size of tumor nodules, 49 patients met the Milan criteria. During follow-up 25 patients died, 13 due to tumor recurrence. The 1- and 2-year survivals were 90% and 85% for patients who met the Milan criteria versus 57% and 51% for patients exceeding those limits (P = .006). A cumulative tumor size >8 cm was predictive of survival and tumor recurrence upon multivariate analysis. The adoption of Milan criteria for selection of cirrhotic patients has improved survival and reduced the rate of tumor recurrence. The evaluation of cumulative tumor size might further improve patient selection.

Orbital osteoclastoma of apparent extraskeletal origin in a pagetic patient: a case report.

A large mass in the right orbit, causing proptosis, ptosis of the right upper eyelid, and limitation to eye movements, was surgically removed from a 51-year-old woman suffering from Paget's bone disease (PBD). Histologically, a giant cell tumor of the bone (osteoclastoma) was diagnosed. No bony involvement was apparent either operatively, microscopically, or on preoperative computed tomographic scans. The neoplasm has not recurred in a 3-year follow-up. In addition to the fact that osteoclastoma complicating PBD is rare, the extraskeletal origin of the tumor is a matter of interest and can be tentatively explained by an unusually powerful systemic stimulus acting on circulating osteoclast precursors. HUM PATHOL 31:1527-1531.

Detection of nephrotoxicity in cyclosporine-A amyotrophic lateral sclerosis patients by means of urinary cytology.

Exfoliative urinary cytology was used for two amyotrophic lateral sclerosis patients treated with 3 mg/kg/day cyclosporine (CsA) therapy in order to detect the onset of the nephrotoxic side-effects of the drug before the apparent deterioration of the patients' clinical condition. Of the two patients, only one showed clear morphological features of drug-related damage in a one year course of cyclosporine therapy, but these followed the increase in the serum kidney and liver laboratory parameters and did not prove useful for the early detection of nephrotoxicity. However, in this patient the renal damage was hallmarked by an increasing number of tubular cells or clusters of ill-defined renal cells in the urinary specimen, suggesting an ongoing tubular injury. The slight cytological alterations may possibly be due to the low CsA dosage used for these patients. The significance of these observations is tempered by the limited number of patients and specimens studied to date and further studies in nontransplanted patients are therefore advocated, particularly when higher CsA doses are employed.

Postmortem histological survey of the ocular lesions in a British population of AIDS patients.

AIMS: To study ocular pathology and systemic correlations in a series of 73 postmortem eyes from British patients who died from AIDS before the introduction of a HAART regimen. METHODS: The eyes were studied with conventional histology, special histochemical stainings, and immunohistochemistry. RESULTS: 72.6% of the cases showed chronic uveal inflammation, caused by opportunistic agents in 37.7% of them (cytomegalovirus (CMV) in 30.1%, C neoformans in 5.6%, and Gram positive bacteria in 1.8%). Cytoid bodies were noted in 10/73 eyes, three linked to CMV retinitis. Six retinal haemorrhages, four of which were secondary to CMV, were found. 14 specimens (19. 1%) showed foci of calcification, and a further 11 (15%) calcium oxalate deposits. In no cases were the calcific deposits suspected clinically. Six eyes (8.2%) did not show any abnormality. CONCLUSIONS: CMV retinitis is the most common (28.7%, 21/73) ocular infection in this series and may occur either during or in the absence of systemic dissemination. Conversely, ocular cryptococcosis appears to be an epiphenomenon of systemic and CNS disease. No other opportunistic ocular infections were present in this series. Interesting findings were the presence of intraocular precipitates of calcium oxalate and calcium phosphate or carbonate in a significant number of cases (15% and 19%, respectively), and the high prevalence of idiopathic uveal inflammation (43.8%).

Strampelli's osteo-odonto-keratoprosthesis. Clinical and histological long-term features of three prostheses.

The histological features are reported of osteo-odonto-acrylic laminae removed from three patients who for differing underlying causes received Strampelli's osteo-odonto-keratoprostheses (OOK) 20, 16, and 12 years previously. It appears that preservation of the alveolar-dental ligament plays a definitive role in the maintenance of the prosthesis. If this tissue undergoes necrosis as a consequence of an inflammatory disease the implanted material is eventually lost. However when no such event occurs the OOK is well preserved and well tolerated even 20 years after implantation.

Tissue polypeptide antigen immunostaining in fine needle aspirates from solid breast nodules.

The purpose of this study was to determine the role of Tissue Polypeptide Antigen (TPA) immunostaining in the evaluation of aspiration smears from solid breast nodules and to discuss its possible clinical applications. Seventy-one cytologic specimens were studied; 52 were carcinomas, 15 fibroadenomas and 4 fibrocystic dysplasia. TPA was visualized with the peroxidase-antiperoxidase method, using 3-3' diaminobenzidine as chromogen and hematoxylin as counterstaining. The incidence of TPA-positive aspiration smears was 88.5% in the carcinomas and 26.7% in the fibroadenomas. The four cases of fibrocystic dysplasia showed variable behaviour. The intensity of the TPA staining varied from - to and was most frequently high in the carcinomas. The results of this research show a good correlation between a diagnosis of carcinoma and TPA positivity in fine needle aspirates of solid breast nodules.

Osteo-odonto-keratoprosthesis. Description of surgical technique with results in 85 patients.

Osteo-odonto-keratoprosthesis is a technique designed for patients with severe corneal opacification who would be at high risk of graft rejection should donor tissue transplantation be performed. Because of the isolation of the prosthetic implant from the tissues that the technique provides, the authors are of the opinion that it is the only viable option in such patients. The visual outcome and complications of the procedure in a series of 85 cases are presented.

Acquired immunodeficiency syndrome and ocular calcification.

We report the presence of peculiar nonbanded calcification of the cornea in three patients with acquired immunodeficiency syndrome, discovered on postmortem histological examination of the globes. In one patient, multiple calcium salt precipitates also affected other ocular and orbital structures. Calcium deposits were present in the corneal stroma but spared Bowman's layer, as is usually seen in primary and secondary corneal calcification. The calcified areas were positive to von Kossa, alizarin red, alcian blue, and colloidal iron stains. Electron probe analysis of the three cases showed the presence of calcium and phosphorus in a ratio characteristic for hydroxyapatite. No predisposing factors could be found. The possible role of associated alterations in the mucopolysaccharide content or composition in the calcified areas is unclear.

Inflammatory pseudotumour of the liver--evidence for malignant transformation.

A case of inflammatory pseudotumour of the liver is reported, and evidence is presented for its subsequent evolution into malignant non-Hodgkin's lymphoma. Such postulated malignant transformation challenges the assumption that hepatic inflammatory tumours are entirely benign lesions.

Co-occurrence of psoriatic arthritis with collagenous colitis: clinicopathologic findings of a case.

A 58-year-old man developed psoriatic arthritis and, after 6 months, persistent watery diarrhoea. Biopsies from the colorectal mucosa showed thickened subepithelial collagen consistent with collagenous colitis. There also was an inflammatory cell infiltration (mainly lymphocytes and monocytes) in the chorion. These findings and the parallel course of articular and bowel complaints suggest a clinicopathologic correlation between arthritis and colic involvement.

Polyp of the uterine cervix with heterologous fatty tissue

This report documents an uncommon case of choristomatous cervical polyp-containing fat tissue. The patient was a 24-year-old female who presented with irregular intermenstrual bleeding. On examination, a polypoid lesion with smooth outlines, measuring 1 cm in diameter was removed. Microscopic examination demonstrated abnormal fibrous stroma, devoid of endocervical glands, containing mature adipose tissue, and thick-walled blood vessels. The lesion was covered by a typical mature squamous cell outer lining. To the best of our knowledge, this is only the second report of an adipose tissue arising from the cervical wall. Further clinicopathologic considerations are needed to elucidate the origin of the fatty component in cervical polyps.

Ancient schwannoma of the orbit.

Schwannoma, also referred to as neurilemmoma or peripheral neurinoma, is an unusual orbital benign tumour that may pose diagnostic challenges. Awareness of the clinical features that may be associated with the tumour and prompt surgical excision with histopathologic examination enable correct diagnosis. The authors describe a progressively increasing inferolateral orbital mass in a 32-year-old patient that was demonstrated to be an orbital ancient schwannoma.

An Evaluation of 605 Endoscopic Examination in a Rural Setting, Lacor Hospital in Northern Uganda.

Introduction: The aim of this study was to evaluate the profile of esophagogastroduodenal (EGDS) diseases diagnosed by upper endoscopy in a rural area of Uganda in a retro-protective study of 605 patients. Results: The mean age of patients with digestive symptoms was 39.7yrs (SD +/-16.11) and female gender predominated by 60% compared to the male (P value 0.000). Peasant farmers were the commonest group with GI symptoms requiring EGDS compared to the rest 72.1% v 27.9%. Epigastric pain was the commonest indication (58%) for EGDS, followed by chest pain (11%), abdominal pain (8.8%), dyspahgia (7.6%) and hematemesis (7.3%). The commonest endoscopy finding was gastritis (47.9%) followed by esophagitis (14.4%), cancer esophagus (5.1%), esophageal varicose (4%), PUD (2.3%), gastric cancer (1%). However 19.5% of patients had normal EGDS. There was a significant correlation between the outpatient diagnosis and endoscopy finding (P value 0.01, r = 0.144) and between endoscopy finding and histology findings (P value 0.001, r = 0.236). H. pylori was positive in 53% of patients with gastritis. Conclusion: Gastritis is the commonest lesion (47.9%) of which 53% have H pylori and Cancer esophagus account for 5.1% of GI lesion in our setting. Cancer stomach is rare in our setting.