Computational Evaluation of Combined Cerebellar and Frontal Transcranial Direct Current Stimulation for Treatment-Resistant Depression

This work aimed to estimate the distribution of the electric field generated by a combined cerebellar and frontal transcranial direct current stimulation (tDCS) for treatment-resistant depression using electromagnetics computational techniques applied to a realistic head human model. Results showed that the stronger electric fields occur mainly in the cerebellum and in DLPFC areas, where the two pairs of electrodes were applied. Furthermore, the study demonstrated that the simultaneous use of the two pairs of electrodes did not imply a lower effectiveness of the tDCS technique, in fact the electric field distributions in the primarily targets of the anatomical regions (i.e., cerebellum and DLPFC) were very similar to when the pairs of electrodes were applied separately.

Cardiopulmonary predictors of mortality in patients with COVID-19: What are the findings?

BACKGROUND

Since 2019, coronavirus disease 2019 (COVID-19) has been the leading cause of mortality worldwide.

AIMS

To determine independent predictors of mortality in COVID-19, and identify any associations between pulmonary disease severity and cardiac involvement.

METHODS

Clinical, laboratory, electrocardiography and computed tomography (CT) imaging data were collected from 389 consecutive patients with COVID-19. Patients were divided into alive and deceased groups. Independent predictors of mortality were identified. Kaplan-Meier analysis was performed, based on patients having a troponin concentration>99th percentile (cardiac injury) and a CT severity score ≥18.

RESULTS

The mortality rate was 29.3%. Cardiac injury (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.14-4.18; P=0.018), CT score ≥18 (OR 2.24, 95% CI 1.15-4.34; P=0.017), localized ST depression (OR 3.77, 95% CI 1.33-10.67; P=0.012), hemiblocks (OR 3.09, 95% CI 1.47-6.48; P=0.003) and history of leukaemia/lymphoma (OR 3.76, 95% CI 1.37-10.29; P=0.010) were identified as independent predictors of mortality. Additionally, patients with cardiac injury and CT score ≥ 18 were identified to have a significantly shorter survival time (mean 14.21 days, 95% CI 10.45-17.98 days) than all other subgroups. There were no associations between CT severity score and electrocardiogram or cardiac injury in our results.

CONCLUSIONS

Our findings suggest that using CT imaging and electrocardiogram characteristics together can provide a better means of predicting mortality in patients with COVID-19. We identified cardiac injury, CT score ≥18, presence of left or right hemiblocks on initial electrocardiogram, localized ST depression and history of haematological malignancies as independent predictors of mortality in patients with COVID-19.

So-Called Nasal Glioma: Case Report with Immunohistochemical Study

The so-called nasal gliomas (nasal cerebral heterotopias) are rare, congenital, benign masses of neurogenic origin with intra or extranasal location, or both. An intranasal case is reported in a 7-month-old infant who successfully underwent surgery with the intranasal approach. The tumor had no intracranial extension and the child is free of disease after a three-year follow-up. Immunohistochemical study confirmed the glial (GFAP+) and neuronal (NSE+) nature of the cells composing the mass. In addition to the clinical behavior, the benign nature of the tumor is also indicated by the negativity of Ki67 (MIB-1) and p53 proliferation markers as well as by CD44 negativity. As far as we know, this is the first reported case of nasal glioma subjected to immunohistochemical investigation of proliferation activity.

Merkel Cell Carcinoma of the Eyelid

A case of Merkel cell carcinoma of the eyelid of an 85-year-old woman is presented. We define the essential morphological features of this much-debated neuroendocrine cutaneous tumor and its clinical and morphobiological peculiarities, with particular reference to its location in the palpebral region.

A Suggested Prototype for Assessing Bone Health

BACKGROUND

Osteoporosis is becoming a health concern worldwide. Considering the fact that prevention plays an important role in reducing the burden of this silent disease and in view of the limited resources available, many countries have adopted certain programs to fight osteoporosis through shifting their attention towards at-risk individuals. The Iranian Multicenter Osteoporosis Study (IMOS) is one of these programs. The program aims to assess bone health and the prevalence of vitamin D deficiency in different parts of Iran with various altitudes, latitudes and lifestyle habits in a way that the results could be generalized to the country.

METHOD

The present article presents the protocol used in the third phase of the study. It was designed based on the experiences gathered in the previous phases to overcome the shortcomings particularly subject loss. The questionnaire applied in this study was developed based on a thorough literature review of the risk factors and secondary causes of osteoporosis and was approved by an expert panel.

RESULTS

While the majority of the existing studies aim to study a certain aspect of osteoporosis, the present protocol provides the information needed for policy makers and researchers to study different osteoporosis-related issues.

CONCLUSION

The authors believe the protocol, to be implemented with small modifications, can help policymakers in different parts of the world, particularly developing countries, gather accurate information on different aspects of bone health at the national level.

Prevalence of osteoporosis and vitamin D receptor gene polymorphisms (FokI) in an Iranian general population based study (Kurdistan) (IMOS)

BACKGROUND

Osteoporosis, or porous bone, is a disease characterized by low bone mass density (BMD) and structural deterioration of bone tissue, leading to bone fragility and increased risk of hip, spine, and wrist fractures. There are numerous risk factors for osteoporosis. While many of these factors are non-genetic in nature, there is a definite genetic component responsible for this condition. The main aim of this study was to evaluate the association between VDR (Vitamin D receptor gene) polymorphisms (Fok1) A>G (rs2228570) and bone mineral density in an Iranian defined population.

METHODS

The study participants comprised of 1032 Iranians recruited from the city of Sanandaj during IMOS (Iranian Multi Center Osteoporosis Study). Bone mineral density measurement was performed in all the participants with and without osteoporosis. All samples were genotyped for VDR genes (Fok1) polymorphism with polymerase chain reaction, using a predesigned TaqMan allele discrimination assay.

RESULTS

There was a significant association between Fok1 polymorphism and osteoporosis in postmenopausal women, 0.138 (0.025-0.768).

CONCLUSION

It seems that cohort studies, which are more powerful than case-control studies, can be useful in evaluating the roles of genetic variants as risk or protective factors for osteoporosis.

Association between vitamin D receptor gene polymorphisms (Fok1 and Bsm1) and osteoporosis: a systematic review

Osteoporosis is a health concern characterized by reduced bone mineral density (BMD) and increased risk of fragility fractures. Many studies have investigated the association between genetic variants and osteoporosis. Polymorphism and allelic variations in the vitamin D receptor gene (VDR) have been found to be associated with bone mineral density. However, many studies have not been able to find this association. Literature review was conducted in several databases, including MEDLINE/Pubmed, Scopus, EMBASE, Ebsco, Science Citation Index Expanded, Ovid, Google Scholar, Iran Medex, Magiran and Scientific Information Database (SID) for papers published between 2000 and 2013 describing the association between Fok1 and Bsm1 polymorphisms of the VDR gene and osteoporosis risk. The majority of the revealed papers were conducted on postmenopausal women. Also, more than 50% studies reported significant relation between Fok1, Bsm1 and osteoporosis. Larger and more rigorous analytical studies with consideration of gene-gene and gene-environment interactions are needed to further dissect the mechanisms by which VDR polymorphisms influence osteoporosis.

Prevalence of vitamin D deficiency among Iranian adolescents

OBJECTIVE

Despite the high prevalence of vitamin D deficiency in adults worldwide, not many studies have evaluated the condition in adolescents. The present study was therefore conducted to assess the prevalence of vitamin D deficiency in a group of students from Shahroud, Iran.

METHODS

The cross-sectional descriptive analytical study was conducted on junior high and high school students of both genders from urban and rural areas of Shahroud, the largest city of Semnan Province in Iran, in winter 2011. The combination of stratified and cluster random sampling methods was applied in the study. A questionnaire on the demographic data, socioeconomic status, lifestyle habits (sun exposure, physical activity, dairy consumption), and drug and personal history was completed for each student. Blood samples were taken to assess vitamin D levels.

RESULTS

One thousand forty-seven students from four junior high and six high schools were recruited. From among them, 42.2% were boys and 57.8% were girls. Mean and standard deviation of vitamin D levels in the studied population were 14.7 ± 9.4 ng/mL. Only 7.2% of the boys and 3.8% of the girls had sensible sun exposure. The median of milk consumption was 3 glasses per week, ranging from 0 to 7.

CONCLUSION

It could be concluded that vitamin D deficiency is quite prevalent among the Iranian adolescents, and this is mainly because this group follows an unhealthy lifestyle due to osteoporosis.

Estimating the avoidable burden of certain modifiable risk factors in osteoporotic hip fracture using Generalized Impact Fraction (GIF) model in Iran

Backgrounds

The number of hip fractures, the most common complication of osteoporosis, has increased rapidly over the past decades. The goal of this study is to estimate the avoidable burden of certain modifiable risk factor of the condition using the Generalized Impact Fraction (GIF) model, which has been suggested and used by epidemiologists to overcome the drawbacks associated with the use of Attributable Fraction index. In addition to preventing a risk factor or the avoidable fraction of burden, this index can also calculate the change in the burden, when a risk factor is altered.

Methods

International databases were searched through PubMed, CINAHLD, Embase using OVID and Google scholar. National resources were searched through IranDoc, IranMedex, SID and Journal sites. Other resources include abstract books and articles sent to the IOF congress. The following search strategy was used: (“Osteoporotic fracture” OR “Fragility Hip fracture” OR “Calcium” OR “vitamin D” OR “BMI” OR “lean body weight” OR “Physical activity” OR “exercise” OR “Smoke”) AND (“prevalence” OR “incidence” OR “relative risk”) and limited to “humans.”

Results

With regards to different scenarios already explained in modifying the studied risk factors, the greatest impact in reducing the prevalence of risk factors on osteoporotic hip fractures, was seen in low serum vitamin D levels, low physical activity and low intake of calcium and vitamin D, respectively. According to the fact that interventions for low serum vitamin D and low intake of calcium and vitamin D, are related to each other, it can be concluded that implementing interventions to change these two risk factors, in the easy, moderate and difficult scenarios, would result in approximately a 5%, 11% and 17% decrease in the burden of osteoporotic hip fractures, respectively. The addition of interventions addressing low physical activity in the easy, moderate and difficult scenarios, an 8%, 21% and 35% reduction in the burden of osteoporotic hip fractures would be reported, respectively.

Conclusion

Improving serum vitamin D levels, recommending the consumption of calcium and vitamin D supplementations and advocating physical activity are the most effective interventions to reduce the risk of osteoporotic hip fractures.

Electronic supplementary material

The online version of this article (doi:10.1186/2251-6581-12-10) contains supplementary material, which is available to authorized users.

[Safety and health in workers employed in industry. Data from Industrial Accidents Compensation Board (INAIL) and National Social Security Institute (INPS), Veneto Region, 1994-2002]

BACKGROUND

A decreasing time trend for occupational injuries and sickness absence would be the effect of the new legislation (D.Lgs. 626/94 and successive laws) on prevention in occupational settings. Conversely, the reduction of INPS disability would reflect a health improvement due to non-occupational causes.

OBJECTIVES

The aim of the study was to investigate the efficacy of the new legislation among employees in industry (where the law was mainly applied), via the time trend of three standardized rates in the Veneto Region.

METHODS

The numerator for the rate of occupational accidents (cases occurring in industry workers in the Veneto Region, broken down for sex, age and calendar years) was supplied by INAIL. The denominator for the above rate, as well as numerators and denominators for disability and sickness absence were supplied by INPS. Data were available from 1994 to 2002 for accidents and disability, and from 1997 to 2002 for sickness absence. In every year from 1994 to 2002, the rates were standardized for age and sex with the direct method, using an internal "standard" population. The time trend of year-specific standardized rates was analyzed by Joinpoint regression software.

RESULTS

Among industrial workers in the Veneto Region, occupational accidents increased by 0.4% yearly, while disability decreased by 2.56% from 1994 to 2002. Sick absence increased up to 1999, then decreased.

CONCLUSIONS

This epidemiological pattern is difficult to explain. The increase in accidents could be due to the increase of non-European Union workers and/or to the fact that accidents on the way to or from work were recognized as occupational accidents by INAIL starting from 2000. Both these phenomena could have contributed to increase the rate that was otherwise diminishing. On the other hand, this same situation could be due to insufficient efficacy of the legislation (D.Lgs. 626/94 and successive laws) for preventing occupational accidents and diseases.

[Association between causes of lNPS compensated disability and occupational category (Veneto Region, 1994-2002): a surveillance method for occupational diseases?]

BACKGROUND

According to Italian law, workers are insured against disability through the National Social Security Institute (INPS), whose records contain information on diseases causing disability and occupational histories.

OBJECTIVES

Using the INPS data, our objective was to identify any excess risk of disabling diseases in relation to the occupational categories.

METHODS

Insurance covers all private sector employees, a small proportion of public sector employees, agricultural labourers, domestic workers, self-employed workers (craftsmen, commercial dealers,farmers), and few other occupational categories. For each insured worker, a database was created containing registry data, occupational history and, for compensated workers, the disease code, for each year from 1994 to 2002. A cohort study design was adopted, in which references were self-employed workers (with mixed exposure) to whom different categories of employees in agriculture, industry, crafts, and services were compared. Data were analyzed by means of Poisson regression, estimating the Incidence Rate Ratio (IRR) and confidence interval (CI) at 99.99%, instead of 95%, in order to set the threshold of error for the entire study at 0.05.

RESULTS

In the construction industry there were significantly high risks of disability in both industry and crafts for tumours (industry: IRR = 2.07; IC = 1. 67-2.57; crafts: 2.57; 1.89-3.18), circulatory disorders (industry: IRR = 2.24; IC = 1.65-3.04; crafts.: 3.06; 2.16-4.32), and bone and joint diseases (industry. IRR = 5.0; IC = 3.15-7.94; crafts: 6.58; 5.04-8.59).

CONCLUSIONS

The advantage of this approach is to recruit a large number of subjects at limited cost. The procedure here proposed is a mainly exploratory approach aimed at establishing new study hypotheses: disability, in fact, is acknowledged by INPS when its cause is not occupational according to the current literature.

Treatment of human immunodeficiency virus-associated facial lipoatrophy with lipofilling and submalar silicone implants

In the absence of a current therapy to prevent facial lipoatrophy in HIV+ patients treated with HAART, surgical correction of the defect still remains the best option. We evaluate two different surgical techniques for facial contour enhancing and suggest the right choice related to the lipodystrophy severity. Twelve HIV+ patients underwent surgical submalar correction: eight were treated with lipofilling following Coleman's technique and four had bilateral malar silicone implants inserted after determining their positioning with the aid of a new software. Both techniques gave long lasting results in facial contour reshaping ranging from good to very good. No complication was observed. In the mean follow-up period of 2 years no patient felt uncomfortable with his/her image. Both techniques, lipofilling and silicone implant positioning, for managing facial lipoatrophy in HIV+ patients treated with HAART had good results, but the right choice has to be related to the severity of the lipodystrophy in the patient.

Adipofascial anterolateral thigh free flap for tongue repair

With the advent of microsurgery fasciocutaneous free flaps have become a well known and accepted option for the repair of tongue defects. Many authors have tried to recover tongue function by modifying this approach. An innovative method for the repair of tongue defects using an adipofascial anterolateral thigh free flap is presented in this paper. The results are compared with those of tongue reconstructions implementing traditional fasciocutaneous free flaps performed at our institution. The histological features of the flaps were investigated postoperatively. Although this preliminary report has to be confirmed by further experience, it seems to solve many tongue-reconstruction related problems.

Median raphe cyst of the penis: a report of two cases with immunohistochemical investigation

Penile median raphe cysts are uncommon benign lesions occurring predominantly in the ventral aspect of the glans penis of young men. We observed two cases: those of a 67-year-old patient and a 22-year-old patient. The epithelial lining of the cysts was composed of pluristratified small cells that focally showed rows of columnar cells above the inner surface as well as a monolayered mucinous columnar epithelium. A columnar cell lining predominated in the younger patient. The cytokeratin (CK) immunostaining pattern of the two cysts (CK7(+++), CK13(+++), CK20(-), CAM 5.2(+)) supports the interpretation of a columnar mucinous epithelium undergoing immature urothelial metaplasia. Carcinoembryonic antigen immunostaining positivity of the columnar cells is probably related to the dysembryogenetic cloacal nature of the cysts. Neuroendocrine differentiation of sparse cells interspersed in the pluristratified epithelium was documented by immunohistochemical staining for chromogranin and synaptophysin. Cilia were not identified in the columnar cells by light microscopy or by antidynein immunohistochemistry.

Basal cell carcinoma arising from epidermoid cyst: a case report

Cutaneous epidermoid cysts are very common lesions, but neoplastic transformation of their epithelium is extremely rare. We describe a patient with basal cell carcinoma arising in the wall of an epidermoid cyst present on the back for 20 years. We emphasize the advisability of a close histologic examination of all cutaneous cysts that are seemingly benign in order to avoid incorrect diagnosis.

The use of the V-Y fasciocutaneous island advancement flap in reconstructing postsurgical defects of the leg

BACKGROUND

Soft tissue cover in the lower limb is difficult due to limited tissue mobility.

OBJECTIVE

To present the V-Y fasciocutaneous island advancement flap as an alternative for reconstructing postsurgical defects of the leg.

METHODS

Eleven patients with defects on the leg following tumor excision were reconstructed using the V-Y fasciocutaneous island advancement flap.

RESULTS

There were no major complications, except for one partial distal flap necrosis in a patient who was a smoker.

CONCLUSION

The V-Y fasciocutaneous island advancement flap is a viable alternative for reconstructing surgical defects of the leg.

Cutaneous ciliated cyst: a case report with immunohistochemical evidence for dynein in ciliated cells

Cutaneous ciliated cysts (CCCs) are rare benign lesions predominantly occurring in the lower limbs of young women. We observed such a lesion in the perineal region of a 12-year-old girl. The histogenetic interpretation of CCCs is controversial. The similarity of the epithelial lining of the cyst to the salpingeal epithelium supports the hypothesis of a Müllerian heterotopia. Strong dynein positivity observed immunohistochemically in the apical portion of CCC lining cells suggests the integrity of the ciliary apparatus. There was a marked similarity between a CCC and normal salpingeal epithelium in the mode of staining for dynein, whereas the dynein reactivity of bronchial epithelial cells showed larger cytoplasmic aggregates of positive material in proximity to the nucleus. No immunohistochemical staining for estrogen or progesterone receptors was identified in our observation, although this finding could have supported the Müllerian histogenetic hypothesis. To the best of our knowledge, this is the first time that antidynein immunohistochemistry has been applied to paraffin-embedded samples from human surgical pathology.

Proximal long saphenous vein valves in primary venous insufficiency

OBJECTIVE

To verify some of the previous findings of venous valves described in the literature, their pathophysiological significance and clinical implications.

MATERIALS AND METHODS

The elementary components of 65 proximal valves of the long saphenous vein and their interrelationships were subjected to histopathological examination. Valves were taken from patients subjected to long saphenous vein surgical removal for varicose veins of the lower limbs. Measurements and morphological evaluations were performed by optical microscopy.

RESULTS

The valvular sinus, agger and proximal portion of the cusp underwent parallel variations of thickness. Thickening of the proximal portion of cusp was related to increase in smooth muscle cells in the agger and to elastic layer dissociation. Thickening of the distal portion of cusp depended on the collagen component; sometimes it was shortened, crumpled and led to the formation of a thickened border. The vein wall in a commissural aneurysm was usually thinner than in the valvular sinus. Alterations in the intima, in the elastic membrane and in the media were found in the 98% of the valvular annulus. Ectasis and asymmetry of the venous wall were mainly related to the muscular hypoplasia of the media.

CONCLUSIONS

The development of primary venous insufficiency seems to be due to the following tissue alterations: dilatation of the valvular annulus and hypotrophy of the cusp. The hemodynamic mechanical injury increases the tissue damages of both annulus and cusps. This pathophysiologic interpretation of venous insufficiency suggests the need for detailed diagnostic procedures before reparative surgery of valves.

Efficacy of treatment with paromomycin, azithromycin, and nitazoxanide in a patient with disseminated cryptosporidiosis

A 24-year-old HIV-positive heterosexual woman with disseminated cryptosporidiosis was monitored from January 1998 to May 1999. During this period, consecutive stool, sputum, and bile examinations showed the constant presence of Cryptosporidium oocysts. Although the patient was repeatedly treated with oral paromomycin and azithromycin and, finally, nitazoxanide, her condition continued to deteriorate. In order to monitor the in vitro susceptibility of the parasite, specimens from various sites were collected periodically. When the first clinical isolate was tested, the antimicrobial agents used (azithromycin at a concentration of 8 mg/l, paromomycin at of 1 mg/ml, and nitazoxanide at 10 mg/l) produced a decrease in parasite counts of 26.5%, 63.4%, and 67.2%, respectively. Subsequent isolates of Cryptosporidium parvum showed similar susceptibilities. This case demonstrates that failure of clinical treatment corresponded to inadequate growth inhibition of the parasite in vitro.

[Metastatic brain tumors]

211 patients operated on for brain metastases have been selected through a review of specimens from the Department of Pathology of the University of Florence covering the period between 1980 to 1995. 140 patients (66%) are males and 71 (34%) are females. Average age is 59 years ranging from 33 to 79 years of age. Lung tumours (47%) and breast cancer (9%) are most frequently responsible for brain metastases. In 17% of the patients, the primary lesion was unknown. The average survival was 14 months and in 8 patients (4%) it was more 5 years. In 36 cases (17%) recurrence appeared 8 months after the first operation. Survival in these patients averaged 20 months from the diagnosis of brain metastases and 11 months after the discovery of the relapses. It is not significantly different from that of patients without evidence of relapsed metastases in the brain (13 months). Prognostically renal carcinoma behaves more favourably, average survival (27 months); on the contrary prognosis of metastatic melanoma is ominous (7 months). Metastases from unknown primaries do not have a significant different prognosis from all the other lesions.

Should scrotal calcinosis still be termed idiopathic?

We observed so-called idiopathic scrotal calcinosis in a 36-year-old man who was cured successfully by simple excision of the affected skin. Histologically, the nodular lesions consisted of calcified amorphous basophilic masses and small granules within the dermis. One rounded aggregate of calcified basophilic material showed a slight positivity on immunostaining for cytokeratin. Some intact epidermoid cysts were also present, suggesting that dystrophic calcification, and possibly inflammation and rupture of epidermoid cysts, may be the main pathogenetic mechanism of the disease in most reported cases. In our opinion, the term idiopathic should refer to the individual cases that are etiologically undefined rather than the whole category of scrotal calcinosis.

Binding of the benzodiazepine ligand [3H]-Ro 15-1788 to brain membrane of the saltwater fish Mullus surmuletus

The distribution and the pharmacological properties of the binding of the benzodiazepine receptor antagonist [3H]-Ro 15-1788 (8-fluoro-3-carboethoxy-5,6-dihydro-5-methyl-6-oxo-4H imidazol [1,5-a] 1,4 benzodiazepine) were compared in some brain membranes of the saltwater teleost fish, Mullus surmuletus: only a single population of [3H]-Ro 15-1788 binding sites was detected. The binding was saturable and reversible with a high affinity, revealing a significant population of binding sites (Kd value of 2.1 +/- 0.2 nM and Bmax value of 1400-900 fmol mg-1 of protein, depending on fish length). The highest concentration of benzodiazepine recognition sites labelled with [3H]-Ro 15-1788 was present in the optic lobe and the olfactory bulb and the lowest concentration was found in the medulla oblongata, cerebellum and spinal cord. In order to explore behavioural selectivity as a consequence of multiple receptor subtypes, six benzodiazepine receptor ligands, flunitrazepam (5-(2-fluoro-phenyl)-1,3-dihydro-1-methyl-7-nitro-2H-1, 4-benzodiazepin-2-one), alpidem, (N,N-dipropyl-6-chloro-2-(4-chlorophenyl)imidazo [1,2-a] pyridine-3- acetamide) zolpidem {N,N,6, trimethyl-2-(4-methyl-phenyl) imidazo [1,2-a] pyridine-3-acetamide hemitartrate}, methyl beta carboline-3-carboxylate (beta CCM), Ro 15-1788 and Ro 5-4864 (4'-chlorodiazepam), were tested in vitro by binding of [3H]-Ro 15-1788 to membrane preparations from various brain areas of Mullus surmuletus, Displacement studies showed a similar rank order of efficacy of various unlabelled ligands. In all regions of the brain and in the spinal cord. GABA potentiate [3H]-flunitrazepam binding in a similar order, suggesting that the BDZ recognition sites are part of the GABAA receptor structure. These results suggest that central-type benzodiazepine receptors are present in one class of benzodiazepine binding sites in the saltwater teleost fish brain of Mullus surmuletus (type I-like). Here we report initial evidence of homogeneity of subtypes of central benzodiazepine receptors in the spinal cord of the saltwater teleost fish. Mullus surmuletus.

[The reactive and/or repair role of the smooth muscle cells in Horton's arteritis]

A recent view of atherosclerosis indicates vascular smooth muscle cell proliferation not only as a response-to-injury but also as an essential reparative process leading to plaque stabilization. To assess the role of vascular smooth muscle cell in vasculitides we studied, as a model, 10 cases of Horton's arteritis. In particular, we investigated by immunohistochemical analysis cellular population and proliferation rate in the intimal layer. As in atherosclerotic plaques, intimal thickening in arteritis is essentially due to proliferation and migration of vascular smooth muscle cells. We suppose that, whatever the vascular disease, intimal hyperplasia contributes to stability of the vessel's wall; however the reactive/reparative process is extremely slow in spontaneous atherosclerosis, accelerated in arteritis.

[Malignant tumors of the peripheral nerve sheath (MPNST) after irradiation]

A case of relapsed malignant tumor of the brachial plexus and its nervous roots (MPNST) was observed in a patient treated with radiotherapy for Hodgkin's disease 24 years previously. A known risk of radiation therapy is the induction of secondary neoplasms, less commonly malignant peripheral nerve sheath tumor (MPNST). The clinico-pathological features of this rare tumor are presented and the possible relationship between radiotherapy and MPNST is discussed.

Oncocytoma of the nasal cavity: report of a case and review of the literature

The authors present a case of oncocytoma of the nasal cavity in a 60-year-old woman. The tumour shows the same histological and ultrastructural characteristics of oncocytomas arising in minor salivary glands of other sites and major salivary glands. The authors stress that the biological behaviour of oncocytomas of the nasal cavity seems related to their local growth rather than to the cytological characteristics of the tumour. The extreme rarity of this tumour in the nasal cavity is particularly emphasized. The few cases reported previously in literature are briefly reviewed.

Sapheno-femoral valves. Histopathological observations and diagnostic approach before surgery

BACKGROUND

Since the literature indicated that in the early stages of primary venous disease valves are simply dilated, some authors performed external valvuloplasty of deep and superficial venous valves with encouraging results, although some failures were observed without being sufficiently explained.

OBJECTIVE

To obtain further interpretations of the natural history of venous valve pathology, clarify methods for a correct diagnostic approach, and provide indications for the external valvuloplasty procedure.

METHODS

Forty-two proximal valves of the long saphenous vein removed for varicose veins of the lower limbs were studied with optical microscopy. The relationship between histologic alterations and age of varicose disease was investigated. Five valvuloplasties were explanted for recurrent reflux and submitted to histopathological observation. Preoperative echographic findings and histologic observations were compared. Nineteen limbs were subjected to external valvuloplasty under angioscopic control; preoperative echographic findings and angioscopic observations were compared.

RESULTS

The histologic alterations observed in venous valves were mainly hypotrophy of cusps, which seemed to be the main cause of failure after external valvuloplasty. The frequency of such hypotrophic alterations increases with the age of varicose disease but no statistically significant relationship was found. Preoperative echographic imaging of venous valves does not appear sufficiently predictive when compared with histologic and angioscopic examinations.

CONCLUSION

Hypotrophic valve damage seems to be prevalent in patients with varicose veins of the lower limbs. Valve cusp hypotrophy may be present in early disease though some normal cusps can be found in advanced disease. When preoperative echographic visualization of cusps is doubtful, intraoperative angioscopy plays the main role in the diagnosis of venous valve disease before and during external valvuloplasty.

Oxyphil cell adenoma (oncocytoma) of the lacrimal caruncle: a case report

The onset of oncocytic neoplasms in the ocular area is exceptional. A rare case of oxyphil cell adenoma of the lacrimal caruncle in an 81-year-old woman is presented. The anatomo-clinical profile of this benign small tumor is drawn up: a slowly growing tumor, generally occurring in the caruncle of elderly women, which is characterized by a uniform population of epithelial cells with eosinophilic finely-granular cytoplasm containing large numbers of mitochondria. The histogenetic problem of this tumor is briefly discussed.

Immunolocalization of extracellular matrix components in mixed tumors of the skin

Mixed tumors of the skin are characterized by a proliferation of epithelial cells embedded in a mesenchymal matrix with a wide spectrum of histologic appearances. The characterization of the extracellular matrix components of mixed tumors of the skin has so far received little attention. We performed an immunohistochemical study of type IV collagen, laminin, fibronectin, and tenascin distribution in a series of 10 mixed tumors of the skin. Laminin localized at the basement membrane around solid epithelial nests and tubulo-alveolar structures, whereas type IV collagen, fibronectin, and tenascin were also expressed in the myxoid stroma. Tenascin and fibronectin localized in the chondroid matrix. The extracellular matrix components were prominently expressed in mixed tumors of the skin, suggesting that they could play an important role in the formation and organization of myxoid and chondroid matrices and in the epithelial-mesenchymal interactions of these tumors.

Endometrial cancer in a double uterus. A report of two cases

Two cases of double uteri associated with endometrial adenocarcinoma are presented. A correct diagnosis in this situation may be difficult to make due to anatomic difficulties or the unrecognized presence of a second uterine cavity. Ultrasound imaging should be considered to look for a second uterine cavity after a negative endometrial biopsy when clinically suspecting endometrial cancer.

[SARO: a system for irradiating small intracranial tumors under the guidance of magnetic resonance imaging]

An MR-based system for the accurate irradiation of small intracranial tumors, not less than 5 cm in diameter, is described. The system uses a home-made device (a support base with millimeter scales) and a series of thin individual wood moulds. A full size-enlargement of the central sagittal and of the tumor-containing transverse MR sections is the first operative step. On these enlarged sections the intracranial isocentre, the entry position of the orthogonal laser beams and the flexion-extension degree of the patient's head are chosen. Subsequently, from the sagittal full-size section the fronto-naso-labial outline is cut-out and accurately transferred on to a thin wood plank, which is finally cut with a fine saw. On the plank two orthogonal lines are drawn, crossing at the target-volume centre and matching with both laser beams during the treatment set-up. The millimeter scale on the support base allows the accurate lateral displacements of the treatment couch, when eccentric tumors most be irradiated. By this system, called with the Italian acronym SARO, the patient needs neither to be shaved, nor to be marked on his head skin. No special shell is necessary any more. Though intrinsically simple, the system needs skillful accuracy during all its procedure steps in order to reach the desired reliability when treating small intracranial tumors (not less than 5 cm in diameter).

[The prevention of caries in Alta Val di Cecina--Volterra: a longitudinal study]

The authors present the results of three years' activity relating to "caries' prevention" in comparison with data concerning the research of previous five years. The average and standard deviations of DMFT values with regard to the permanent teeth and dmft concerning the deciduous ones, obtained from the dental visit of 222 children attending the 1st and the 3rd class of the primary school and 1st class of the secondary school, has demonstrated a statistically significant reduction of caries, compared with data concerning 749 pupils of the same standards in the period from 1984 to 1988. This fact confirms that the programme defined by U.S.L. n. 15 "Alta Val di Cecina", including sanitary education for children of primary school with their parents and teachers, besides dental examinations to the filter classes, is a valid instrument to obtain the reduction of carious' pathology in evolutive age.

[Giant cell arteritis, synonym of Horton disease?]

Giant cell arteritis: a synonym of Horton's disease? Biopsies from the temporal artery of 50 patients with Horton disease were evaluated retrospectively by light microscopy and immunohistochemical methods. All patients were adults over 60 years: 28 female, 22 male. Histopathologic study of the biopsies disclosed four main variants most likely related to different stages of temporal arteritis. Only in 22 cases the typical granulomatous giant-cell pattern was observed. However similar pathologic findings occur in several other chronic vasculitis, granulomatous giant cell inflammation being a mark of an advanced stage of the disease rather than a mark of a specific type of arteritis. Therefore <<Horton disease>> and <<giant-cell arteritis>> cannot be considered synonymous, contrary to what usually happens in clinical practice.

[The incidence of caries in a school-age population sample of U.S.L. n. 15 Alta Val di Cecina-Volterra]

It was made a screening on children of some filter classes (1st and 3d class of primary school and 1st class of secondary school) of the Volterra's schools to estimate the incidence of caries and, if necessary, to activate programs for an adequate prevention. We examined 749 children arrived to the Dental Department of the Sanitary District owing an invitation letter; a set of question was given to their parents testing mainly alimentary and oral hygienic uses of the children examined by dentists. Elaboration of data obtained from replies and demonstrated that caries incidence in our population is of 65.29%, prevailing on male sex, and that this pathology is predominant on people taking insufficient care of oral hygiene, making no use of fluoridated toothpaste and eating any of cakes (especially between meals). These data show the high incidence of caries in evolutional age and how much this is strictly connected with wrong alimentary and hygienic uses. Therefore, to reduce this phenomenon, it's necessary to operate interventions of sanitary education and dental checking examinations, at least every 6-12 months, beginning in preschool age.

Neurophysiological correlates of psychomotor activity in chronic schizophrenics

The movement-related brain macropotentials (MRBMs) of 13 chronic schizophrenics (7 paranoid and 6 hebephrenic) were recorded during a motor perceptual task and compared to those of 13 normal subjects matched by age, sex and IQ. The cerebral activity was recorded from Fpz, Fz, Cz, Pz, and right and left precentral areas and the electromyographic activities from the left and right forearm flexor muscle groups. Analysis of variance was performed to test the correlation between the MRBMs and groups, sets and performances. The results indicate that the performance considered in tests of 'performance time,' as 'performance shift' and as number of 'target performances' was poorer in chronic schizophrenics than it was in the control group. In parallel with the performance, the MRBMs of chronic schizophrenics were also significantly different in comparison to the normal subjects. In particular, the BP amplitude was reduced in all areas; the MCP and P200 were also abnormally reduced. The SPP was present but it had a small amplitude in the parietal region. These differences in chronic schizophrenics could be explained as multidimensional biopsychological deficits: the disturbed performance is the result of impairment in developing appropriate changes of set, defective inhibition of sensory information, and reduced utilization of the outcome data.

Management of intraepithelial neoplasia of the uterine cervix in the black population

The records of 2,277 patients referred to the Colposcopy Clinic at Cook County Hospital were reviewed, and those of 1,328 black patients who had a histological diagnosis of dysplasia or carcinoma in situ of the cervix were chosen for this study.Treatment modalities of intraepithelial cervical neoplasia are discussed and the conservative management of young patients is emphasized. Because of the effectiveness of outpatient management in cervical preinvasive lesions, health providers should make every attempt to motivate people particularly those at high risk, ie, black women, to undertake preventive measures.

Perinatal Herpes virus infection: report of a case indicating the paternal role

A case of perinatal Herpes simplex hominis infection with fatal neonatal outcome is reported. The significance of the paternal role is emphasized. It is important to educate sexual partners and stress the serious nature of herpetic infections, especially during the perinatal period. In the presence of active infection, sexual contact should either be totally avoided or a condom should be used.