Reinke's crystals in an interstitial cell tumour of a rabbit (Oryctolagus cuniculus)

One case of interstitial cell tumour in the testicle of a New Zealand White rabbit was reported. The rabbit was 9-years old and had monolateral testicular lesion. There was enlargement of left testis and the lesion were seen on the cut surface. Light microscopy revealed intracytoplasmic crystals of Reinke that resembled to the features observed for this tumour in human. Immunohistochemically, this tumour was positive for vimentin.

Association between parasitic intestinal infections and acute or chronic diarrhoea in HIV-infected patients in Caracas, Venezuela

A cross sectional survey was conducted to determine the association between enteric parasites and diarrhoea in HIV-infected adults in Caracas. Three hundred and four patients were evaluated: 104 had acute diarrhoea, 113 chronic diarrhoea and 87 were controls. Isopora belli infection was associated with acute (P = 0.022) and chronic diarrhoea (P = 0.003), Entamoeba histolytica/dispar infection was also associated with both acute (P = 0.015) and chronic diarrhoea (P = 0.017). Strongyloides stercoralis (P = 0.003), and Cryptosporidium parvum (P = 0.017) infections were associated mainly with chronic episodes. Weight loss (P < 0.001), a non-infectious factor investigated, was significantly associated with diarrhoea. Eosinophilia, a laboratory parameter studied, was found to be associated with strongyloidiasis (P = 0.001), giardiasis (P = 0.001) and isoporiasis (P = 0.003). In summary, the presence of enteric parasites in HIV-infected patients from tropical urban areas with diarrhoea, with or without significant weight loss, must be considered. Similarly, eosinophilia might suggest parasitic infection in these patients.

[Renal capsuloma: description of a case with predominantly muscular differentiation]

The Authors report a case of Renal Capsuloma with a histologic biphasic pattern constituted of epithelioid and spindle cells. The lesion is observed in a nephrectomy specimen as incidental finding concurrent with a Papillary Transitional Cell Carcinoma of calices and renal pelvis. The lesion presents a distinct muscular immunophenotype (actin+, desmin+), with coexpression of the melanogenesis marker (HMB45+) in a lower cellular population. This combined immunophenotype is a characteristic feature of the Perivascular Epithelioid Cell's (PEC) lesions. Actually Renal Capsuloma is a PEC's lesion (Pecoma) closely related to Angiomyolipoma (AML). Particularly Capsuloma is thought as a variant of AML predominantly composed by muscular spindle cells (monotypic spindle cell-leiomyoma like variant of AML). In the presented case the spindle cell component is associated with an epithelioid cellular population which also shows a distinct muscular differentiation. The Authors have not found in the literature the association between Renal Capsuloma and Papillary Transitional Cell Carcinoma of the renal pelvis.

Nitric oxide attenuates platelet-activating factor induced nasal airway plasma extravasation in healthy subjects

BACKGROUND

Paranasal sinuses and the nose are important sources of nitric oxide (NO) in humans but the relevance of NO production to the control of nasal airway plasma exudation and its response to inflammatory mediators such as platelet-activating factor (PAF) in healthy subjects is not well known.

DESIGN

In this study we aimed to evaluate the effect of the nitric oxide synthase (NOS) inhibitor NG L-arginine methyl ester (L-NAME) on nasal airway plasma extravasation at baseline and after an acute challenge with PAF that induces most symptoms of rhinitis. Eleven healthy subjects were enrolled in the study. Plasma extravasation in the nasal airway was assessed by measuring the albumin content of nasal lavage.

RESULTS

PAF challenge caused a significant increase in concentrations of albumin in the nasal lavage fluid (from 0.59 +/- 0.13 mg dL(-1) to 2.46 +/- 0.45 mg dL(-1)) after placebo. Pretreatment with L-NAME significantly prevented the increase of albumin in the nasal lavage fluid induced by PAF as compared to placebo (from 0.53 +/- 0.11 mg dL(-1) to 1.70 +/- 0.28 mg dL(-1); P < 0.005).

CONCLUSION

Topical administration of a NO inhibitor is able to attenuate the nasal airway plasma extravasation induced by PAF, suggesting that NO release in vivo is involved in the nasal response to PAF.

[Authorization and accreditation: management of the conversion of hospital buildings]

The Emilia Romagna Region decided own accreditation and procedures pattern following decisions, by different levels and graduated stages: authorization, institutional accreditation and finally contractual agreements. For Emilia Romagna Health Administration, authorization step represented "the necessary minimum level of security to exercise health activity", carried out by self evaluation of general and specific requirements of health structures, outlined by specific check-list, to bring about the maximum time allowed five years realization of structure adjustment plans. Beginning from this context the Local Health Unit of Modena, introduced by an audit test of conformity levels caught up, the guide line of computer management of technical assistance, change to use or amplification of health permission of structure and installations take a census by the business administration. The method allows by operative guide lines standardization to certify the validity of innovations realized, in all Departements/Services, for own conformity of structures, plant design and installation, sanitary regulations and security for wards services, auxiliary rooms. The development of this method allow to link activity and professionality for different duties of supervision and inspection, to guarantee the maintenance of levels assurance of health structures.

[Pleomorphic adenoma in unusual anatomic sites: case reports and review of literature]

Pleomorphic adenoma is the most common neoplasm of the major salivary glands, in particular of the parotid gland. Only occasionally can it be found in the cervicofacial area outside the major and minor salivary glands of the oral cavity. The present article describes three cases of pleomorphic adenoma, respectively of the external auditory canal, the nose, and the larynx. The three tumors showed no clinical or radiological signs of malignancy and were surgically excised with a suitable margin of healthy tissue. Histologically, the typical features of pleomorphic adenoma were observed in the larynx case alone. The pleomorphic adenoma of the external auditory canal evidenced an extensive apocrine glandular component; the neoplasm of the nose was itself characterized by ample proliferation of fused cells. Immunohistochemical findings revealed focal or widespread positivity to cytokeratin, S100 protein and muscle-specific actin in both the epithelial and mesenchymal components of the neoplasm. Cases of pleomorphic adenoma in sites other than the major salivary glands show clinical and radiological signs of benignity. Their histopathological identification is, however, not always straightforward; immunohistochemistry can contribute significantly to the formulation of a definitive diagnosis and to the realization of an appropriate follow-up.

[Epidemiological study on pathology and abnormalities of the external male genitalia]

The Authors report the outcomes of an epidemiology study concerning the external genital pathologies, carried out on 2400 young males, ranging between 18 and 22 years who underwent the medical inspection for admission to the Air Force Academy. Basing on an andrologic clinical and anamnestic protocol, 229 cases with genital abnormalities, and among them 171 cases of varicocele (8.16%), were detected. The presence of varicocele in all the selected cases was confirmed with proper instrumental investigations (CW Doppler, ecocolorDoppler, telethermography). A randomized sample of 240 out of the 2400 young males, underwent the same investigations as a routine. These investigations enhanced the accuracy in detecting the varicocele, and allowed to identify 3 new cases, all classified as 1st type, in addition to the 19 previously correctly detected by the clinical and anamnestic examination.

Superficial black network: an additional dermoscopic clue for the diagnosis of pigmented spindle and/or epithelioid cell nevus

Dermoscopy is a valuable method for improving the diagnostic accuracy of pigmented skin lesions. Specific dermoscopic criteria have been described for differentiating pigmented spindle and/or epithelioid cell nevi (SECN; Spitz nevi and Reed nevi) from cutaneous melanomas. In the present study, we report an additional dermoscopic feature of SECN, namely a distinctive type of pigment network, described as superficial black network, which was observed in 10.5% of SECN. Histopathologically, this network corresponds to focal areas of pigmented parakeratosis, producing a black reticulated appearance on the horizontal plane.

Epiluminescence microscopy for port-wine stains: pretreatment evaluation

BACKGROUND

Port-wine stains (PWSs) are characterized by an increased number of ectatic vessels. The treatment of choice is the use of some lasers such as pulsed dye lasers. However, some lesions are nonresponsive to laser treatment. Perhaps the vessels' depth and diameter and the thickness of the vessel wall are important factors influencing the effectiveness of the laser treatment.

METHODS

To investigate whether epiluminescence microscopy (ELM) could be useful in determining the effectiveness of laser treatment of PWSs, we studied a group of patients with PWSs using both ELM and histological analysis.

RESULTS

A correlation existed between a gray-whitish veil seen by ELM and the vessel depth judged by histology: when the veil was absent, the vessels were always found to be located only in the upper third of the dermis.

CONCLUSION

We think that the gray-whitish veil is a distinctive dermoscopic feature that is able to differentiate between superficial vessels (absence of veil) and deeper vessels (presence of veil).

Clinical use of Levofloxacin in the long-term treatment of drug resistant tuberculosis

Multidrug-resistant (MDR) tuberculosis (TB) is a form of TB that is resistant to some of the first-line drugs used for the treatment of the disease. It is associated both with a higher incidence of treatment failures and of disease recurrence, as well as with higher mortality than forms of TB sensitive to first-line drugs. Levofloxacin (LFX) represents one of the few second-line drugs recently introduced in the therapeutic regimens for MDR TB. We report our experience concerning in vitro activity and clinical safety of LFX in long term second-line regimens for MDR TB.

IN VITRO ACTIVITY ON MYCOBACTERIA

The in vitro activity of ciprofloxacin, ofloxacin and LFX was studied on 28 strains belonging to different species of Mycobacteria. In Dubos medium, LFX inhibited the growth of both library and MDR clinical Mycobacteria strains in a range of 0.25-1 mcg/ml. In International Union Tuberculosis Medium (IUTM) the minimum inhibitory concentrations (MIC) were slightly higher, but LFX activity was not affected by the higher complexity of the medium.

CLINICAL EXPERIENCE

Four patients with MDR TB were treated with a second-line regimen comprising oral LFX 500 mg twice daily, for at least 9 months. Two isolates obtained from the patients reported here showed multi resistance to isoniazid and rifampin, one to rifampin and streptomycin and one to isoniazid and ethambutol. During therapy, no significant alteration of either liver function tests, blood tests or any other described side effect of the fluoroquinolone class was observed. The 3 patients with pulmonary MDR TB showed radiologic and clinical improvement.

CONCLUSION

We confirm the higher in vitro activity of LFX compared to older fluoroquinolones. Furthermore, in a limited number of MDR TB patients, second-line regimens comprising LFX 500 mg b.i.d. administered in a range of 9-24 months were well tolerated and safe.

Macrolides for chronic asthma

BACKGROUND

Asthma is a chronic disease of the airways in which inflammation of the respiratory mucosa plays a crucial role. The mechanisms responsible for the maintaining of this inflammatory response are only partially known and there is evidence that a role could be paid by chronic infection by intracellular pathogens (such as Chlamydia pneumoniae). Macrolides are antibiotics with both antimicrobial and anti-inflammatory activities and thus their use in asthmatic patients could lead to reduction of the airways inflammation and therefore improvement of symptoms and pulmonary function.

OBJECTIVES

To determine whether macrolides are effective in the management of patients with chronic asthma.

SEARCH STRATEGY

We searched MEDLINE, EMBASE and CINAHL up to May 2001. This was also supplemented by manually searching bibliographies of previously published reviews, conference proceedings, and contacting study authors. All languages were included in the initial search.

SELECTION CRITERIA

Randomised, controlled clinical trials involving both children and adult patients with chronic asthma treated with macrolides for more than 4 weeks, versus placebo.

DATA COLLECTION AND ANALYSIS

Two reviewers independently examined all identified articles. Two reviewers reviewed the full text of any potentially relevant article independently.

MAIN RESULTS

The initial search retrieved 95 studies. Preliminary evaluation identified 20 studies that were potentially eligible. Five (357 patients) met the entry criteria. The entry criteria for the primary trials differed, but all recruited a specific subgroup of patients (eg severe oral steroid dependent, aspirin intolerant or evidence of Chlamydia pnuemoniae infection). There was a positive effect on symptoms (Standardised Mean Difference -1.25, 95% Confidence Intervals (CI) -1.80, -0.70) and markers of eosinophilic inflammation; eg sputum eosinophils Weighted Mean difference -78.5, 95%CI -90.8, -66.1). Tests of oral corticosteroid-sparing effects have not yet been performed on the newer agents such as roxithromycin and clarithromycin.

REVIEWER'S CONCLUSIONS

Considering the small number of patients studied, there is insufficient evidence to support or to refute the use of macrolides in patients with chronic asthma. Further studies are needed in particular to clarify the potential role of macrolides in some subgroups of asthmatics such as those with evidence of chronic bacterial infection.

[Gastrointestinal stromal tumors: a case with mixed muscular-neuronal origin]

GIST have still today controversial aspects of their histogenesis that are reflected on the classification and prognosis. It's showed a particular case with mixed muscular-neuronal histogenesis that supposes totipotent cell origin of these neoplasms. Diagnosis, classification and prognosis are very difficult to evaluate; surgery at the moment is the only useful treatment modality.

Increased expression of the neuropeptide Y receptor Y(1) gene in the medial amygdala of transgenic mice induced by long-term treatment with progesterone or allopregnanolone

The neurosteroid allopregnanolone, a reduced metabolite of progesterone, induces anxiolytic effects by enhancing GABA(A) receptor function. Neuropeptide Y (NPY) and GABA are thought to interact functionally in the amygdala, and this interaction may be important in the regulation of anxiety. By using Y(1)R/LacZ transgenic mice, which harbour a fusion construct comprising the promoter of the mouse gene for the Y(1) receptor for NPY linked to the lacZ gene, we previously showed that long-term treatment with benzodiazepine receptor ligands modulates Y(1) receptor gene expression in the medial amygdala. We have now investigated the effects of prolonged treatment with progesterone or allopregnanolone on Y(1)R/LacZ transgene expression, as determined by quantitative histochemical analysis of beta-galactosidase activity. Progesterone increased both the cerebrocortical concentration of allopregnanolone and beta-galactosidase expression in the medial amygdala. Finasteride, a 5alpha-reductase inhibitor, prevented both of these effects. Long-term administration of allopregnanolone also increased both the cortical concentration of this neurosteroid and transgene expression in the medial amygdala. Treatment with neither progesterone nor allopregnanolone affected beta-galactosidase activity in the medial habenula. These data suggest that allopregnanolone regulates Y(1) receptor gene expression through modulation of GABA(A) receptor function, and they provide further support for a functional interaction between GABA and neuropeptide Y in the amygdala.

[Bilateral hernioplasty: sonographic study of prosthetic integration as a function of fixation to the hernia opening]

The Authors report in this paper the outcomes of a post-operative study based on echo and echo-color imaging in 10 patients who underwent surgery for bilateral groin hernia. On both sides the operation was performed with a "patch and plug" implantation, according to the Rutkow technique. On right sides the polypropilene mesh was fixed to the inguinal orifice with cardinal stitches, while on left sides the mesh was shaped and spreaded on the orifice without any fixation. The U.S. postoperative pictures, performed up to 30 th p.o. day, showed a better stretching of the unfixed meshs, probably owed to a better adapting capability of the free mesh inside the tissues in standing position. The Authors consider significative the correlation between images showing in 7 patient's right sides little irregularities in mesh display, with presence of thin liquid filled spaces, and the moderate postoperative pain, that occurred in the same side in 6 of them.

Aquatic humic substances inhibit clastogenic events in germinating seeds of herbaceous plants

One humic acid (HA) and two fulvic acids (FAs) of aquatic origin have been tested for their capacity to inhibit clastogenic events caused by maleic hydrazide (MH) in germinating seeds of the herbaceous plant species Allium cepa and Vicia faba. Either HA or FA at concentrations of 50 and 500 mg L(-)(1) was interacted with 10 mg L(-)(1) MH for 24 h before addition to the seeds. The evaluation of genotoxic activity was made by counting micronuclei (MN) and aberrant anatelophases (AT) in root tip cells after treatment with HA or FA alone, MH alone, and interacted HA + MH and FA + MH. Regular AT were also counted as an index of mitotic activity. In all cases HA and FA interacted with MH showed an evident anticlastogenic action indicated by the marked reduction of genetic anomalies. In A. cepa, the anticlastogenic effect of HA and FA was more significant for aberrant AT than for MN, whereas the opposite was true in the case of V. faba. The protective effect exhibited for both anomalies by HA was slightly higher than that of the corresponding FA in A. cepa, whereas no significant differences between these HA and FA treatments were observed in the case of V. faba. The two FAs generally showed similar anticlastogenic behaviors with slight quantitative differences observed as a function of the type of anomaly and the plant species. The effects of HA and FA concentration differed depending on the type of anomaly observed, the plant species, and FA origin. In V. faba, cell division, that is, the number of regular AT, was generally depressed by HA and FA at either concentration with respect to the control. In A. cepa, HA and FA produced either stimulating or inhibiting effects on regular AT depending on their nature, origin, and concentration.

Chondroid chordoma of the lateral skull base

A rare case of chondroid chordoma of the lateral skull base with laterocervical extension is reported. Clinical, radiological and pathological features of the tumor are described. This unusual location of chondroid chordoma enabled total resection of the neoplastic tissue through a combined laterocervical and far lateral transjugular approach.

Post-apopletic trigeminal trophic syndrome

Trigeminal trophic syndrome is an uncommon clinical entity in which cutaneous trophic ulceration develops with continuous manipulation of trigeminal dermatomes. Patients spontaneously refer picking, rubbing and/or scratching at the affected areas because of hypo-anaesthesia, paraesthesia and/or pain following damage of the sensory trigeminal fibres or nuclei. We herein describe a patient who developed the syndrome as a sequela of brain stem infarction. Diagnosis by scrape cytology in ruling-out basal cell carcinoma and other ulcerative skin diseases is discussed and the importance of neurological examination in disclosing hemi-anaesthesia of trigeminal dermatome(s) is emphasized.

Facial granulomatous diseases: a study of four cases tested for the presence of Mycobacterium tuberculosis DNA using nested polymerase chain reaction

The histopathologic diagnosis of cutaneous tuberculosis (CTB) is often troublesome, because there are several other entities (tuberculids, demodicidosis, granulomatous rosacea, and acne agminata) that may display granulomatous inflammation with caseation necrosis. The current study describes four cases of granulomatous disease of the face. The final diagnosis (assessed on the basis of the clinical response to therapy) was CTB in three cases and granulomatous rosacea in one case. Histologically, epithelioid granulomas were a constant feature; in one case of CTB, they displayed a palisading (granuloma annulare-like) arrangement. Caseation necrosis was a prominent feature only in the case of granulomatous rosacea. Routinely processed biopsy specimens were evaluated with nested polymerase chain reaction (nPCR) for Mycobacterium tuberculosis (MBT) DNA. The correlation between nPCR results and clinical outcome was less than optimal; in fact, one case showed an excellent clinical response to the antituberculous drug therapy despite the absence of MBT DNA amplification. In granulomatous diseases of the face, the importance of evaluating not only nPCR but the overall clinicopathologic picture so as to avoid diagnostic misinterpretations is emphasized.

Measuring contrast sensitivity in patients with Graves' ophthalmopathy complicated by ocular hypertension and suspect glaucoma or dysthyroid optic neuropathy

The present study compares contrast sensitivity functions of patients with uncomplicated Graves' ophthalmopathy, patients with ophthalmopathy and elevated intraocular pressure or suspect glaucoma, and patients with dysthyroid optic neuropathy (DON). Aim of the study was to investigate the clinical potential for the contrast sensitivity functions (CSF) in distinguish between the groups. Contrast sensitivity measurements were obtained from twenty-seven subjects with endocrine ophthalmopathy. Group I included patients with uncomplicated ophthalmopathy (n=20 eyes); group II included patients with ophthalmopathy, intraocular pressure > or = 24 mmHg with and without early visual field defects, and no evidence of apical crowding on coronal computed tomography scan (n=14 eyes); group III included patients with DON (n=12 eyes). Contrast thresholds were determined for stationary and 6.87 Hz phase-alternating gratings at eight spatial frequencies from 0.18 to 15.7 c/deg. Data from each group was compared with data from age-matched normal subjects. Observers with uncomplicated ophthalmopathy had normal CSFs. Eyes affected with DON showed contrast sensitivity disruption at overall intermediate-high spatial frequencies. Eyes with elevated intraocular pressure or suspect glaucoma had pronounced sensitivity loss in the low frequency range (0.18-0.70 c/deg) as compared to eyes with DON. This study shows that CSF detects visual function abnormalities noninvasively in patients with complicated Graves' ophthalmopathy. Results also indicate that the clinical potential for CSF in distinguish between patients suffering from ophthalmopathy complicated by ocular hypertension or suspect glaucoma and patients with DON improves when a temporal modulation of 6.87 Hz and gratings of low spatial frequency (< 1 c/deg) are used.

Intramuscular clodronate in nonresponders to oral alendronate therapy for osteoporosis

OBJECTIVE

Oral alendronate is effective in increasing bone mineral density (BMD) and in reducing fracture incidence. However, a large proportion of patients under treatment do not show significant changes in BMD, or even bone loss. Incorrect administration, low intestinal absorption, and poor compliance are among factors that may account for this effect. In this subgroup of patients we evaluated whether intramuscular (im) clodronate increased the number of responders.

METHODS

Using an open case-control design we studied 60 postmenopausal osteoporotic women (mean age 58.9 years +/- 4.8 SD) after one year of therapy with oral alendronate who had an increase in BMD that was lower than the in vivo densitometry measurement error (2%). Subjects were divided into 2 groups: the first continued aledronate treatment (AL group); the second began weekly im injections of clodronate 100 mg (CL group). BMD measurements were performed at the right femoral neck by the same operator, using dual energy x-ray absorptiometry.

RESULTS

After 12 months of therapy the prevalence of responders (increase in BMD > 2%) was 40% in the AL group and 66% in the CL group (prevalence rate ratio = 1.65; 95% CI 1.25-2.04). The treatment group was the only variable that showed a significant correlation with being a responder (beta = 1.13; p = 0.03), as analyzed by multiple logistic regression to account for the effect of confounding factors. In the CL group the difference in the mean value of BMD between time T0 and time T+12 was greater than in the AL group, but did not reach statistical significance. The mean percentage variation of BMD was significantly greater in the CL group (+3.21%) compared to the AL group (+0.98%) (p < 0.001, t test) (f value = 8.4; p < 0.01, by multiple linear regression analysis using the same covariates).

CONCLUSION

Treatment with weekly intramuscular injection of clodronate in nonresponders to oral alendronate showed a higher number of subjects with a significant increase in BMD, compared to continuation of therapy with alendronate.

Gemcitabine and cisplatin versus mitomycin, ifosfamide, and cisplatin in advanced non-small-cell lung cancer: A randomized phase III study of the Italian Lung Cancer Project

PURPOSE

To compare gemcitabine and cisplatin (GC) with mitomycin, ifosfamide, and cisplatin (MIC) chemotherapy in patients with stage IIIB (limited to T4 for pleural effusion and N3 for supraclavicular lymph nodes) or stage IV non-small-cell lung cancer (NSCLC). The end points were the evaluation of quality of life (QoL), response rates, survival, and toxicity.

PATIENTS AND METHODS

Three hundred seven patients were randomized to receive either gemcitabine 1,000 mg/m(2) on days 1, 8, and 15 plus cisplatin 100 mg/m(2) on day 2, every 28 days, or mitomycin 6 mg/m(2), ifosfamide 3,000 mg/m(2), and mesna on day 1 plus cisplatin 100 mg/m(2) on day 2, every 28 days. The whole-blood cell count was repeated on day 1 in both arms and weekly in the GC arm before each gemcitabine administration.

RESULTS

No major differences in changes in QoL were observed between the two treatment arms. The objective response rate was 38% in the GC arm compared with 26% in the MIC arm (P =.029). The median survival time was 8.6 months in the GC arm and 9.6 months in the MIC arm (P =.877, log-rank test). Grade 3 and 4 thrombocytopenia was significantly worse in the GC arm (64% v 28%, P <.001), whereas grade 3 and 4 alopecia was reported more commonly in the MIC arm (39% v 12%, P <. 001).

CONCLUSION

We report an increased response rate without changes in QoL and a similar overall survival, time to progression, and time to treatment failure for the GC when compared with the MIC regimen in the treatment of advanced NSCLC.

Typing by polymerase chain reaction of buffalo rotaviruses isolated in Italy

Six group A rotaviruses were isolated in Italy from buffaloes during different outbreaks of calf diarrhoea occurring in the same dairy herd over a 5-year period of observation. The isolates were characterized by polymerase chain reaction assay for G- and P-type antigens. G8 and P1 were the types most frequently isolated.

Optical isomer separation of potential analgesic drug candidates by using capillary electrophoresis

Using cyclodextrin capillary zone electrophoresis (CD-CZE), baseline separation of synthetic potential analgesic drug diastereoisomer candidates 6,11-dimethyl-1,2,3,4,5,6-hexahydro-3-[(2'-methoxycarbonyl-2'-phenylc yclopropyl)methyl]-2,6-methano-3-benzazocin-8-ol (MPCB) and 6,11-dimethyl-1,2,3,4,5,6-hexahydro-3-[[2'-methoxycarbonyl-2'(4-chloroph enyl)cyclopropyl]methyl]-2,6-methano-3-benzazocin-8-ol (CCB) was achieved. Among the cyclodextrins tested (hydroxypropyl-, carboxymethyl- and sulfobutyl-beta-cyclodextrin (HP-beta-CD, CM-beta-CD and SBE-beta-CD)) SBE-beta-CD was found to be the most effective complexing agent, allowing good optical isomer separation. Resolution was also influenced by the CD concentration, pH of the buffer and presence of organic modifier in the background electrolyte. The optimum experimental conditions for the separation of studied analgesic drugs were found using 25 mM borate buffer at pH 9 containing 40 mM of SBE-beta-CD and 20% v/v of methanol. Using the above-mentioned background electrolyte, it was also possible to separate, in the same run, the enantiomers of normetazocine (NMZ) as well as the optical isomers of (+/-)-cis-2-chloromethyl-1-phenyl cyclopropancarboxylic acid methyl ester (PCE) or (+/-)-cis-2-chloromethyl-1-(4-chlorophenyl)cyclopropancarboxylic acid methyl ester (CPCE) reagents used in the synthesis of the studied analgesic drugs).

Ajoene in the topical short-term treatment of tinea cruris and tinea corporis in humans. Randomized comparative study with terbinafine

Ajoene (CAS 92284-99-6), an organic trisulphur originally isolated from garlic, has an antimycotic activity which has been widely demonstrated both in vitro and in vivo. The objective of this work was to compare the safety and effectiveness of ajoene (0.6%, gel) with terbinafine (CAS 91161-71-6) (1%, cream) for the treatment of tinea corporis and tinea cruris. The patients selected were 60 soldiers with clinical and mycological diagnosis of either dermatophytosis. They were distributed at random in two treatment groups, one treated with ajoene at 0.6% and the other with terbinafine at 1%. All patients were evaluated clinically and mycologically 30 and 60 days after completion of the treatment, which was considered effective when clinical signs and symptoms had disappeared and the mycological cultures were negative. Thirty days after treatment, the percent healing rate was 77 and 75 for the groups treated with ajoene and terbinafine, respectively. Sixty days after treatment, the healing rate 73% and 71% for the groups treated with ajoene and terbinafine, respectively. These results and those obtained in previous studies confirm that ajoene is a new agent for the topic treatment of superficial mycoses, and for the first time show the therapeutic usefulness of an inhibitor of phospholipids biosynthesis in eukaryotes.

Neoplasms composed of eosinophilic polygonal cells: an overview with consideration of different cytomorphologic patterns

Neoplasms that are composed of large eosinophilic cells present a distinctive and challenging image to the diagnostic pathologist. Potential lineages for such lesions include several types of epithelial tissue, as well as melanocytic, lymphoid, germ-cell, and mesenchymal proliferations. Attention to morphological details represents a useful first step in the further evaluation of eosinophilic large-cell tumors. These tumors can usually be segregated into one of four cytological categories, including granular eosinophilic (oncocytic and oncocytoid), fibrillary eosinophilic (myoid), globular eosinophilic (rhabdoid and gemistocytic), and diffusely eosinophilic (hyaline-cell and deeply eosinophilic, not further specified). Correlation with anatomic locations, nuances of clinical presentation, and results of electron microscopic and immunohistochemical studies provides additional data that can be used for a specific interpretation, especially if it is applied in an algorithmic fashion.

Nested polymerase chain reaction on vaginal smears of tuberculous cervicitis. A case report

BACKGROUND

Tuberculous cervicitis (TC) is a rare disease the diagnosis of which is based on the microscopic and/or cultural recognition of mycobacteria. In recent years, the polymerase chain reaction (PCR), especially with double-round amplification ("nested" PCR [nPCR]), has been increasingly used for rapid detection of mycobacteria in clinical samples.

CASE

The present case is the first example of tuberculosis diagnosed with the aid of nPCR amplification of mycobacterial DNA fragments on smeared and Papanicolaou-stained cytologic material. First detected on vaginal smears, the amplicon IS6110 was subsequently identified also on paraffin-embedded tissue sections.

CONCLUSION

The technique described here could also be applied to aspiration cytology smears to give rapid and accurate information on mycobacterial infections.

Fine-needle aspiration cytology and immunohistology of low-grade adenosquamous carcinoma of the breast

Low-grade adenosquamous carcinoma of the breast (LASCB) is a relatively recently-described, rare histotype of breast cancer that has a favorable prognosis. Its principal microscopic features are the presence of "syringoid" ("tadpole"-shaped) ductal profiles of tumor cells, a bland and modestly cellular stromal background, and the variable presence of keratinizing ("epidermoid") cell groups. As such, the basic image of LASCB is quite similar to that of microcystic adnexal or adenosquamous carcinoma of the skin or "syringomatous adenoma" of the nipple. We report the fine-needle aspiration cytologic (FNA) attributes of this neoplasm, as well as its immunohistochemical characteristics and differential diagnosis.

Pure cutaneous relapsing langerhans cell histiocytosis in an adult

The histiocytic syndromes represent a group of rare diseases characterized by the proliferation of the mononuclear phagocyte system cells. We report a case of recurrent class I histiocytosis with exclusive cutaneous localization in an adult. Our patient had a 3 cm ulcerated nodule located on the right cheek. Subsequently, new lesions appeared, all having the same clinical evolution characterized by spontaneous resolution with scarring. After a five year follow up no more lesions were observed. The histopathological examination, immunohistochemical profile and electron microscopy of the lesions indicated Langerhans cell histiocytosis.

Multicenter randomized clinical trial on high-dose epirubicin plus cis-platinum versus vinorelbine plus cis-platinum in advanced non small cell lung cancer

BACKGROUND

High dose Epirubicin (HD-EPI) (>90 mg/m2) and Vinorelbine (VNR) demonstrated antitumor activity as single agent (about 20%) in the treatment of advanced NSCLC. This trial compares these two agents combined with cisplatin (CP).

PATIENTS AND METHODS

From August 1992 to February 1996, 228 patients with locally advanced or metastatic NSCLC were randomized to receive either EPI 120 mg/m2 as i.v. bolus plus Cisplatin (CP) 60 mg/m2 on day 1 (regimen A) or VNR 25 mg/m2 as i.v. bolus on day 1 and 8 plus CP 60 mg/m2 on day 1 (regimen B). Both treatments were recycled every 21 days up to a maximum cumulative dose of EPI of 840 mg/m2 or 12 cycles. Eligible patients were 212 and 198 patients were evaluable for objective response (95 in arm A and 103 in arm B). The main characteristics of eligible patients were: male/female 179/33; median age 61 (42-72); median Karnofsky PS 80 (70-100); stage IIIA 12%, stage IIIB 40%, stage IV 41%, recurrence 7%; histotype: epidermoid 48%, adenoca 36%, others 16%.

RESULTS

The following response rates were observed in regimens A and B, respectively; CR, 1 and 2%, PR, 32 and 25% (P = 0.4567). Median CR + PR duration was 9 and 8 months, respectively. Median survival was 10.5 and 9.6 months, respectively. Grade III-IV leucopenia occurred in 38 and 21% in arm A and arm B, respectively(P = 0.01), thrombocytopenia in 6 and 0% (P = 0.02), anemia in 8 and 7% (n.s.). Non-hematological toxicity was moderate and the only difference between the treatments was alopecia (88 vs. 33% in arm A and B, respectively). Supraventricular arrhythmia occurred in three patients on regimen A; a >15% LVEF absolute decrease was observed in 9 (22.5%) and three (14%) patients on arm A and arm B, respectively (n.s.). No congestive heart failure was observed.

CONCLUSION

HD-EPI+CP and VNR+CP are both active combinations in advanced NSCLC with a similar response rate, response duration and survival but regimen A was significantly more toxic (myelosuppression and alopecia).

[Endometriosis of the appendix. A case report]

The authors report a case of endometriosis of the appendix found by chance during the course of left adnexectomy owing to endometriotic cysts. Endometriosis of the appendix is usually associated with right ovarian endometriosis, which is sometimes only present at a microscopic level. A situation of acute endometriotic appendix is the result not only of the disintegration of the appendix muscles, as was thought in the past, but also recent catamenial hemorrhage within the endometriotic tissue.

Cisplatin-vindesine-mitomycin (MVP) vs cisplatin-ifosfamide-vinorelbine (PIN) vs carboplatin-vinorelbine (CaN) in patients with advanced non-small-cell lung cancer (NSCLC): a FONICAP randomized phase II study. Italian Lung Cancer Task Force (FONICAP)

In the present multicentre randomized phase II trial, the activity and toxicity of three platinum-based combination regimens for the treatment of advanced non-small-cell lung cancer (NSCLC) were evaluated. The three regimens were: MVP (mitomycin-C 6 mg m(-2) on day 1, vindesine 3 mg m(-2) on days 1 and 15, and cisplatin 80 mg m(-2) on day 1 every 28 days), PIN (cisplatin 80 mg m(-2) day 1, ifosfamide 3 g m(-2) day 1 and vinorelbine 25 mg m(-2) day 1 and 8 every 21 days) and CaN (carboplatin 350 mg m(-2) day 1 and vinorelbine 25 mg m(-2) days 1 and 8 every 28 days). A total of 140 chemotherapy-naive patients entered the study; 49 patients were treated with MVP, 48 with PIN and 43 with CaN. Sixty-seven per cent of the patients had stage IV disease. Response rates, calculated on an 'intention to treat' basis, were as follows: MVP, 14.3% (95% CI 5.94-27.2%); PIN, 16.7% (95% CI 7.4-30.2%); and CaN, 14% (95% CI 5.3-27.9%). The overall median survivals were 256, 269 and 243 days for patients treated with MVP, PIN and CaN respectively. Myelosuppression was the most frequent toxicity: grade 3-4 leucopenia was observed in 14.3%, 25% and 18.6% of patients treated with MVP, PIN and CaN respectively. This multicentre phase II randomized trial shows that MVP, PIN and CaN can be administered on an outpatient basis with acceptable toxicities. Unfortunately, the three regimens showed an activity significantly lower than that reported in previous single-institution phase II trials.

[Flow cytometry in prostate cancer. Evaluation of its feasibility for biopsy specimens and correlation with grading]

BACKGROUND

Pathologic staging and grading are the most important prognostic factors in prostatic cancer. Unfortunately, pathologic staging needs to be evaluated by surgical procedures; moreover, the proposed grading systems are largely based upon subjective histopathologic evaluations. In recent years, these problems have been approached with flow cytometry (FCM). The present study evaluates the significance of DNA ploidy of prostatic carcinoma assessed by FCM.

MATERIALS AND METHODS

Microscopic slides from 132 core needle biopsies and 22 surgical specimens of prostatic carcinoma were reviewed and classified according to Gleason's score modified by Epstein et al. Formalin-fixed, paraffin-embedded tissue samples were prepared for FCM evaluation using standard techniques. Adequate histograms were obtained from 113 biopsies (85.6%) and from all the surgical specimens (100%).

RESULTS

Among the 113 biopsy specimens, a statistically significant correlation was found between DNA ploidy and Epstein's grading, since high-grade neoplasms accounted for 40.38% of non-diploid cases and only for 21.33% of diploid cases (chi square = 5.8; p = 0.05). Moreover, tetraploid tumors were defined as a separate FCM category with an absolute prevalence (65.52%) of non-high grade neoplasms (chi square = 5.9; p = 0.05). Although not submitted to statistical analysis, data collected from surgical specimens showed similar distribution.

CONCLUSIONS

DNA ploidy assessment by FCM is a viable procedure in the majority of needle biopsy tissue samples of prostatic carcinoma; it may produce prognostic parameters with greater objectivity than conventional histologic grading.

An intronic deletion in TP53 gene causes exon 6 skipping in breast cancer

Six hundred and thirty primary breast cancer were screened for abnormalities in exons 5, 6, 7 and 8 of the TP53 tumour suppressor gene. Analysis of the structure of the TP53 gene exons was performed with the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) method and with direct sequencing of amplified DNA. In a breast tumour case from a postmenopausal patient, we found a deletion of 36 bp in intron 5 and no immunohistochemical staining for p53. We amplified and sequenced the cDNA region between exons 4 and 7 and showed that the deletion causes the skipping of exon 6. The resulting mRNA sequence had a frameshift that yields an inactive protein with a truncated C terminus. These results show the first example of intronic deletion causing exon skipping at the TP53 gene level.

Metastatic neoplasms of the breast: fine-needle aspiration cytology of two cases

Even when clinical data strongly suggest the presence of a metastatic neoplasm in the breast, this occurrence almost invariably raises great problems in diagnostic pathology. Both cases presented here had a well-recognized primitive neoplasm located elsewhere. Nonetheless, great importance was given to the application of ancillary techniques; the immunostains for "breast discriminants"--GCDFP15, HMFG1, and HMFG2--on tissue sections helped the recognition of a metastatic renal cell carcinoma; and the stains for S100 protein, smooth muscle actin, cytokeratins, and neurofilaments on cytologic material allowed the identification of a metastatic mediastinal leiomyosarcoma.

High-performance liquid chromatographic determination of some of the hydrolytic decomposition products of poly(alpha-hydroxyacid)s

An HPLC procedure is described for the separation and identification of some hydrosoluble by-products resulting from the hydrolytic degradation of poly(alpha-hydroxyacid)s having biomedical interest: poly(L-lactide), poly(DL-lactide), poly-(glycolide) and poly(lactide-co-glycolide). Peak identification was performed by comparing the respective retention times with those of pure standards. It was observed that optimum shape and separation of peaks are considerably affected by the composition of the mobile phase, consisting of acetonitrile (A) and a 0.006 M K2HPO4 buffer (B), and, in particular, its pH and A:B ratio, which had to be adjusted to around 5.8 and 75:25 (v/v), respectively. Under the investigated experimental conditions (aqueous suspension, 100 degrees C for 12 h under stirring), poly(L-lactide) is quite stable, poly(glycolide) degrades easily to glycolic acid, whereas poly(DL-lactide) and poly(DL-lactide-co-glycolide) exhibit intermediate behaviour. Upon hydrolytic decomposition, these poly(alpha-hydroxyacid)s yield not only the corresponding acids, but also their linear dimers and, possibly, trimers, tetramers and higher oligomers.

[Ambulatory phlebectomy with Müller procedure in the treatment of lower limb varices. Indications, technique and long-term results]

The authors report the results of more than five years experience of phlebectomies, according to Müller's method, performed both in general anesthesia during stripping operations and in local practice. The results confirmed the validity of this complementary surgical treatment for its radicality, execution simpleness and best respect for aesthetics.

"Pseudoneoplastic" leprosy. Leprosy revisited

A 70-year-old Italian man with a history of squamous cell carcinoma of the lung presented with a nodular skin eruption. He had traveled extensively in India and Sri Lanka. The nodules were well demarcated and measured up to 3.5 cm in diameter. Histologically, there was a proliferation of spindled and polygonal cells with focal and relatively inconspicuous cytoplasmic vacuolation. A macrophage-monocyte lineage for the cells was confirmed by paraffin section immunohistochemistry, using the monoclonal antibodies anti-CD45, MAC-387, KP-1, UCHL-1, MT-1, L26, and MB2. Infiltrating borders, extension of the lesion into the subcutis, and involvement of small dermal nerves and eccrine glands initially suggested the possibility of a "histiocytic" neoplasm of indeterminate biological potential. However, air-dried and Giemsa-stained material from a fine-needle aspirate of one cutaneous nodule showed needle-shaped intracellular "negative images," and acid-fast stains revealed a large number of intracytoplasmic bacilli in virtually all of the vacuolated lesional cells. Furthermore, a second skin nodule that was excised 3 weeks after initial presentation showed the typical morphology of lepromatous leprosy. The clinicopathologic features of this case demonstrated several similarities with those of so-called "histoid" leprosy. Unusual morphologic variants of leprosy need to be considered in the interpretation of unusual "histiocytic" infiltrates in order to avoid a mistaken diagnosis of neoplasia, regardless of the geographic locale in which the patient is evaluated.

Nodular amyloidosis of the larynx

Clinical features of laryngeal amyloidosis may suggest an erroneous diagnosis of squamous cell carcinoma. The immunohistochemical findings of monoclonal IgA-kappa positive plasma cells, together with kappa chain positive amyloid blocks suggest the definition of the present care as a localized plasmacytoma arising in mucosa-associated lymphoid tissue.

The response behaviour of LiF:Mg,Cu,P thermoluminescence dosimeters to high-energy electron beams used in radiotherapy

To ensure the effectiveness of radiation-therapy treatments, both in-phantom and in-patient reliable dose measurements are required. Thermoluminescence dosimeters are used commonly for both applications. Among the various available materials, the relatively new LiF:Mg,Cu,P phosphor is a suitable candidate for quality control of in vivo dosimetry in electron-beam therapy. The response behaviour of LiF:Mg,Cu,P chips to 6-21 MeV electron beams used in radiotherapy was studied. Batch homogeneity, dose linearity, sensitivity change after use, dose and dose-rate response, energy dependence and fading characteristics were investigated. The contribution from each factor to the overall uncertainty in dose measurement was evaluated. The results of this work show that the LiF:Mg,Cu,P chips are comparable to the commonly used LiF:Mg,Ti ones, and support their use for in vivo electron-beam dosimetry to an accuracy within +/- 10%.

L-thyroxine effects on thyreocytes and Hürthle cells in nodular hyperplastic goiter on fine needle aspiration samples. Morphometric evaluation

A morphometric study was performed on the thyreocytes and Hürthle cells in 20 cases of nodular hyperplastic goiter (NHG) and in 8 cases of Hürthle cell-rich NHG. The study was carried out on cytologic samples obtained by fine needle aspiration twice from the same nodules in a selected series of patients before and after L-thyroxine therapy with the aim of evaluating the morphometric nuclear variations induced by that therapy. Thyreocytes and Hürthle cells were evaluated for nuclear Area, Perimeter, Maximum Diameter, Form Elliptic and Form Perimeter using a planimetric instrument. A statistically significant reduction in nuclear size was observed in 18 of 20 cases of NHG after L-thyroxine therapy, but the nuclear shape factors were modified only slightly or not at all. A slight reduction in the nuclear size of Hürthle cells was observed in five and an increase in the remaining three cases, but these differences were not statistically significant. Virtually no changes in shape factors were observed in this group of lesions before or after the therapy. These data are discussed and compared to the results of other series. Our results suggest that morphometry may be useful in the follow-up of NHG to evaluate the effects of L-thyroxine and that this therapy reduces the size of thyreocytes; the therapy, however, seems to have little or no effect on Hürthle cells.

Primary cutaneous endometriosis of thoracic skin with ovarian granulosa cell tumor

A case of non-cicatricial endometriosis of the thoracic skin is described in a patient affected by an ovarian granulosa cell tumor, adult type. To the best of our knowledge, this is the first case of this type of association reported in the literature although some cases in which endometriosis was related to high estrogen levels are well documented. We suggest that in presence of an estrogen secreting neoplasm, foci of endometriosis might not be such a rare condition if clinicians and pathologists carefully looked for it.

Metastatic hepatocellular carcinoma of the breast, simulating gynecomastia: diagnosis by fine-needle aspiration biopsy

Hepatocellular carcinoma (HCC) may uncommonly present with distant metastasis in the absence of a documented neoplasm in the liver. The authors herein describe the case of a 60-year-old man with cirrhosis who developed unilateral enlargement of the breast and a subareolar mass. This problem was clinically thought to represent gynecomastia, but a mammary fine-needle aspiration biopsy demonstrated a malignant epithelial neoplasm composed of large granular amphophilic cells. Bile pigment was visualized in the tumor on aspirate smears and cell block preparations; immunostains showed reactivity for cytokeratin and alpha-fetoprotein, but there was no positivity for epithelial membrane antigen, gross cystic disease fluid protein-15, vimentin, estrogen receptors, progesterone receptors, or S100 protein. These results indicated a diagnosis of metastatic HCC, which was subsequently confirmed by computed tomography of the abdomen.

[Association between inguinal endometriosis and polycystic ovary]

A case of inguinal endometriosis is described in a patient affected by PCOD. To the best of our knowledge, this is the first case of this type of association reported in the literature although cases in which endometriosis was related to high estrogen levels are well documented. We suggest that in the presence of high estrogen levels (absolute or relative hyperestrinism), the foci of endometriosis might not prove a rare condition if clinicians and pathologists lashed for it carefully.

Tricholemmal carcinoma: a study of seven cases

Seven cases of tricholemmal carcinoma (TLC), a rarely recognized cutaneous adnexal neoplasm of external hair sheath origin, are described. Most occurred on sun-exposed skin; five involved the head and neck, one the right leg, and one the right thigh. TLC had a generally short history and all were treated by local excision. The lesions had an exophytic (3 cases) or polypoid (4 cases) gross appearance. Histologically, TLC exhibited a sharply circumscribed, lobular epithelial proliferation in continuity with the epidermis. A cytologic hallmark of these tumors was the presence of large cells with PAS-reactive, diastase-sensitive, clear or pale eosinophilic cytoplasm. High mitotic rate was a constant feature. Four tumors were infiltrative, with pushing borders, whereas three were intraepithelial. One case showed acantholysis. Immunocytochemistry revealed positivity for prekeratin and negativity for CEA and EMA, supporting the trichogenic origin of these tumors. Ultrastructural examination gave clear indication of epithelial origin for the cells but did not verify hair follicular differentiation. Despite locally aggressive growth, the clinical course of TLC appeared indolent. Moreover, there are no cases with metastases reported in the literature.