The route of Besnoitia besnoiti tachyzoites inoculation does not influence the clinical outcome of the infection in calves

In a previous attempt, an experimental model of bovine besnoitiosis was established in calves that were intravenously inoculated with different doses of Besnoitia besnoiti tachyzoites. Despite the fact that all infected calves developed the acute stage of disease, only microscopic findings characteristic of chronic besnoitiosis were reported. In the present study, calves were inoculated by subcutaneous and intradermal routes with B. besnoiti tachyzoites with the aim of developing clinical signs and macroscopic lesions characteristic of chronic besnoitiosis. Nine 3-month-old male calves were randomly distributed into three groups of three animals each. Next, 10⁶ tachyzoites were inoculated by either the subcutaneous (G1) or intradermal route (G2). The negative control group (G3) was inoculated with PBS. Daily clinical monitoring and regular blood collection were performed. At 70 days post-infection (pi), animals were euthanized, and tissues were collected to investigate lesions and parasites. Infected animals developed mild-moderate acute besnoitiosis characterized by lymphadenopathy from four days to 47 days pi, and sporadic fever peaks were only observed in one calf from G2. However, other clinical signs and macroscopic lesions characteristic of chronic besnoitiosis were not detected. Only nine tissue samples were B. besnoiti-DNA-positive, eight of which belonged to reproductive and respiratory tracts tissues from G1. Finally, the kinetics of the immune responses were similar in both infected groups. However, delayed and lower cellular and humoral immune responses were observed in G1 followed by G2 and were compared with intravenously inoculated calves. The differences observed among the three inoculation routes could be due to different effector mechanisms of the host early innate immune response against B. besnoiti. Accordingly, the inoculation route of B. besnoiti tachyzoites does not significantly influence the clinical outcome of the infection in calves. Thus, a further refinement of this experimental model of bovine besnoitiosis is needed to reproduce macroscopic lesions characteristic of chronic stage disease.

The prognostic significance of E-cadherin expression in laryngeal squamous-cell carcinoma: a systematic review

The aim of this study was to systematically review publications that investigated the prognostic role of E-cadherin immunostaining in patients affected by laryngeal squamous cell carcinoma. An appropriate string was run on PubMed to retrieve articles dealing with this topic. A double cross-check was performed on citations and full-text articles by two authors independently to analyse all manuscripts and perform a comprehensive quality assessment. Among 89 abstracts identified, 13 articles were included. These studies reported on 1,121 patients with histologically confirmed diagnosis of laryngeal squamous cell carcinoma. Overall, there were 10 studies that showed a significant correlation between E-cadherin immunohistochemical expression and at least one of the clinical and histopathological parameters considered by the authors. In particular E-cadherin expression was significantly associated with N stage (five studies), grading (four studies) and disease-free survival/disease-specific survival (six studies). In conclusion, the findings of our review appear similar to the results published by other authors on the putative role of E-cadherin in progression of malignancy. In fact, for laryngeal squamous cell carcinoma it seems that lower levels of E-cadherin correlate with increased tumoural aggressiveness and worse prognosis. Nevertheless, further high-quality prospective studies should be carried out to clarify if E-cadherin expression may be considered as an independent prognostic factor for patients affected by laryngeal cancer.

Malignant transformation of sinonasal inverted papilloma and related genetic alterations: a systematic review

Schneiderian papillomas are uncommon tumors which may develop within the nasal cavity and comprise three well-defined histological types: sinonasal inverted papilloma (SNIP), exophytic papilloma, and oncocytic papilloma. It is well known the rate of Schneiderian papilloma may also present a malignant degeneration and SNIP represents the most important subgroup in consideration of its frequency and malignant propensity. Although HPV infection is always considered the first event favoring the development of SNIP, however, it is not established as an eventual connection between viral actions and malignant transformation. In fact, different molecular mechanisms are suspected to play a crucial role in this process and, currently, many authors agree that only by improving our knowledge about these mechanisms it will be possible to achieve new and effective targeted therapies. So the aim of this study was firstly to systematically review the literature focusing on different biomarkers that could be implicated in the stages of SNIP malignant degeneration. Secondly, a systematic review with meta-analysis was performed to better define the incidence of sinonasal malignancies originating from Schneiderian papilloma (SNIP, exophytic papilloma, and oncocytic papilloma). Twenty-nine studies comprising a total of 3177 patients were statistically analyzed. Results showed a 9% (95% CI = 7-11) overall rate of malignant transformation from Schneiderian papilloma. In conclusion, this analysis confirmed that the potential malignancy of Schneiderian papilloma should not be underestimated. On the other hand, our review showed the paucity of studies investigating the molecular alterations which may be related with the malignant transformation of SNIP.

Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction

We report our experience with the endoscopic endonasal approaches (EEA) for different craniocervical junction (CCJ) disorders to analyse outcomes and demonstrate the importance and feasibility of anterior C1 arch preservation or its reconstruction. Between January 2009 and December 2013, 10 patients underwent an endoscopic endonasal approach for different CCJ pathologies at our Institution. In 8 patients we were able to preserve the anterior C1 arch, while in 2 post-traumatic cases we reconstructed it. The CCJ disorders included 4 cases of irreducible anterior bulbo-medullary compression secondary to rheumatoid arthritis or CCJ anomalies, 4 cases of inveterate fractures of C1 and/or C2 and 2 tumours. Pre- and postoperative neuroradiological evaluation was always obtained by magnetic resonance imaging (MRI), computed tomographic (CT) scanning and dynamic cranio-vertebral junction x-ray. Pre- and postoperative neurologic disability assessment was obtained by Ranawat classification for patients with rheumatoid arthritis and by Nurick classification for the others. At a mean follow-up of 31 months (range: 14-73 months), an improvement of at least one Ranawat or Nurick classification level was observed in 6 patients, while in another 4 patients neurological conditions were stable. Radiological follow-up revealed an adequate bulbo-medullary decompression in all patients and a regular bone fusion in cases of C1 and/or C2 fractures. In all patients spinal stability was preserved and none required subsequent posterior fixation. The endoscopic endonasal surgery provided adequate exposure and a low morbidity minimally invasive approach to the antero-medial located lesions of the CCJ, resulting in a safe, effective and well-tolerated procedure. This approach allowed preservation of the anterior C1 arch and the avoidance of a posterior fixation in all patients of this series, thus preserving the rotational movement at C0-C2 segment and reducing the risk of a subaxial instability development.

Clinical presentation and treatment outcomes of thyroglossal duct cysts: a systematic review

The aim of the present review was to analyze the main clinical signs and symptoms observed in patients with thyroglossal duct cysts (TGDCs). Secondarily we investigated the outcomes following the different types of treatment of TGDCs in children and adults. Three selected strings were run on the PubMed database to retrieve articles on these topics. A double cross-check was performed on citations and full-text articles were identified using the study inclusion and exclusion criteria. A meta-analysis was performed of the data obtained. Overall, 356 articles were identified; 24 (comprising a total of 1371 subjects) satisfied the inclusion and exclusion criteria. On the basis of the meta-analysis, the presence of a neck cystic mass was the main clinical presentation of TGDCs, with a mean rate of 75% (95% confidence interval 72-79%). The mean local wound infection rate was 4% (95% confidence interval 3-6%), this being the most frequent complication following treatment. The mean rate of overall recurrence was 11% (95% confidence interval 9-14%). The Sistrunk procedure appears to be the better choice for the therapy of TGDCs to avoid recurrences. Further studies on larger cohorts of patients regarding the minimally invasive treatment options would be helpful to elucidate and endorse their utilization in selected cases.

p63 and Ki-67 immunostainings in laryngeal squamous cell carcinoma are related to survival

To examine the prognostic significance of the immunohistochemical expression of p63 and Ki-67 oncoproteins in patients with laryngeal squamous cell carcinoma, a retrospective evaluation was carried out on a cohort of 108 patients with primary laryngeal squamous cell carcinoma (LSCC) treated by primary surgery. For the immunohistochemical evaluation, tissue section obtained by formalin-fixed and paraffin-embedded tissue blocks from resection of each patient was used. Clinicopathologic data were associated with the immunostaining results. The association among the considered variables was assessed by Fisher's exact test, Mann-Whitney test, non-parametric χ(2) test, and Spearman's rho rank test was used to assess the relations among them. Differences in p63 and Ki-67 immunoreactivity among the different groups were compared via Kruskal-Wallis test and post hoc tests were performed using Mann-Whitney test with Bonferroni correction. The overall survival rate was estimated via Kaplan-Meier method, and the cumulative incidence functions for different groups were compared using log-rank statistics. Cox proportional hazard model was employed in a multivariate analysis to assess the effect of prognostic factors in the overall survival rate. Furthermore, taking into account death due to other causes, we estimated LSCC-related survival and disease-free survival rates using competing risk analysis. The results of immunohistochemical examination showed a statistically significant relationship between the up-regulation of P63 and Ki-67, an increase in histological grading, and primary tumours associated with lymph node metastases. p63 and Ki-67 up-regulation was related to a shorter disease-free survival and a significant association was found between p63 and Ki-67 percentage of positive cells and patient survival. Finally, we noticed a significant relation between p63 and Ki-67 (ρ = 0.87). On the other hand, no statistically significant associations were found between p63 and Ki-67 down-regulation and clinicopathologic data. Our findings suggest that abnormal p63 and Ki-67 immunoreactivity may be involved in the early phases of laryngeal tumorigenesis and may become a significant prognostic predictor for both overall and disease-free survivals. These biomarkers could thus help in the selection of high-risk patients with LSCC who may benefit from more aggressive therapy or chemoprevention.

8 SYNCHRONIZATION OF OVULATION IN DAIRY HEIFERS USING A SHORTENED ESTRADIOL-BASED PROTOCOL THAT PROVIDES FOR A LENGTHENED PROESTRUS

Several studies, performed mainly in North America, have shown that the 5-day co-synch timed-AI (TAI) protocol results in similar or higher pregnancy rates than conventional 7-day co-synch protocols in beef cows and beef and dairy heifers. It is hypothesised that the 5-day co-synch protocol reduces the incidence of persistent follicles and provides for a longer proestrus, with increasing oestradiol concentrations due to continuous gonadotropin support for the dominant follicle (Bridges et al. 2008 Theriogenology 69, 843–851). Similar findings have been reported recently following the use of a shortened oestradiol-based protocol that also provides for a longer proestrus (named J-synch; de la Matta and Bo 2012 Taurus 55, 17–23). A study was designed to compare these 2 treatment protocols for synchronization of ovulation that allow for a prolonged proestrus with the conventional oestradiol-based protocol currently used for TAI in South America for heifers. Cycling Holstein heifers that were, on average, 17 months of age, weighting 350 to 380 kg, and with a body condition score of 2.5 to 3.5 (scale of 1 to 5), were randomly allocated to 1 of 3 treatment groups. Heifers in the 7-day estradiol benzoate (EB) group received a progesterone device (DIB 1 g of progesterone; Syntex SA, Buenos Aires, Argentina) and 2 mg EB (oestradiol benzoate, Syntex SA) on Day 0, 500 μg of cloprostenol (prostaglandin F2α; Sincronil, Proagro SA, Argentina) and DIB removal on Day 7, 1 mg of EB on Day 8, and TAI 30 h later (54 h after DIB removal). Heifers in the J-synch group received a DIB and 2 mg of EB on Day 0, PGF and DIB removal on Day 6, and 10 μg of buserelin acetate [gonadotropin-releasing hormone (GnRH); Receptal, Intervet, Millsboro, MD, USA] and TAI on Day 8 (72 h later). Heifers in the 5-day co-synch group received a DIB and GnRH on Day 0, DIB removal and prostaglandin F2α (twice, 12 h apart) on Day 5, and GnRH along with TAI on Day 8 (72 h later). Treatments were coordinated so that DIB were removed in all groups at the same time to decrease a possible time effect of follicle parameters and pregnancy rates. Two experiments were conducted; the first evaluated follicular dynamics and ovulation rates by twice daily ultrasonography (Honda 101 V, 5.0 MHz) in 20 heifers per group and the second determined pregnancy rates to TAI in 172 heifers. The mean (± standard error of the mean) interval from DIB removal to ovulation was shorter in the 7-day EB group (82.7 ± 3.1 h) than in the J-synch (103.8 ± 3.3 h) and 5-day co-synch (96.8 ± 3.3 h) groups (P = 0.01). However, the mean diameter of the dominant preovulatory follicle was smaller (P = 0.01) in the 7-day EB (12.8 ± 0.5 mm) and the J-synch (13.1 ± 0.6 mm) groups than in the 5-day co-synch group (14.9 ± 0.6 mm). Although pregnancy rates in the second experiment were numerically lower in the 7-day EB group (31/58; 53.4%) and 5-day co-synch group (30/55; 54.5%) than in the J-synch group (37/59; 62.7%), differences were not significant (P > 0.3). Preliminary results indicate that the 3 protocols evaluated result in comparable pregnancy rates to TAI in dairy heifers.

Unilateral vestibular schwannoma associated with a Jacobson's schwannoma

Coexistence of unilateral vestibular schwannoma and Jacobson's schwannoma growing in the same intracranial site is rarely observed. We present the case of 36-year-old woman with primary diagnosis of vestibular schwannoma and subsequent appearance of schwannoma to the Jacobson's nerve. Initial wait and see strategy was performed offered us the opportunity to describe Jacobson's lesion features at computed tomography over a period of 4 years. Subtotal petrosectomy with infralabyrinthine approach was subsequently executed to remove the growing mass of the temporal bone. The Jacobson's schwannoma increased its size from 0.4 cm for years whereas vestibular schwannoma size was unchanged after 7 years observation. The concomitant removal of both schwannomas is still associated with the size of the CPA lesion and to patient's symptoms.

Risks and medico-legal aspects of endoscopic sinus surgery: a review

The aim of this study was to perform a systematic literature review of risks and medico-legal aspects of endoscopic sinus surgery. The development of sophisticated technologies and instruments for endoscopic sinus surgery (ESS) has caused a dramatic increase in the number of otolaryngologists performing sinus surgery and the number of cases performed. This expansion was accompanied by an increase in malpractice lawsuits. Over the past 20 years, rhinology claims represented 70 % of the total indemnity compensation for otolaryngology claims and ESS was the surgical procedure most often involved. Only then will a careful analysis and assessment of the possible and potential risk factors of ESS, which may mislead the surgeon, allow a correct clinical risk management, with activities and procedures aimed at reducing the possibility of complications that may expose the physician to a malpractice suit.

Rotational Molding of Polyamide-6 Nanocomposites with Improved Flame Retardancy

The aim of this work was to develop polyamide-6/ organic-modified montmorillonite (omMMT) nanocomposites for the production of hollow parts by rotational molding. Particular emphasis was placed on the mechanical and flame retardancy properties needed for the fabrication of vessels for flammable liquids. The morphology of the melt compounded nanocomposites, produced by melt compounding, was investigated by X-ray diffraction measurements (WAXD), and Transmission Electron Microscopy (TEM) showed an exfoliated structure. Rheological measurements were used in order to verify whether the viscosity of materials was adequate for rotational molding. While thermomechanical analysis has revealed that neat PA6 and its nanocomposites were not suitable for rotational molding, due to the very low thermal stability of the polymer, the addition of a thermal stabilizer, shifted the onset of degradation to higher temperatures, thus widening the processing window of both PA6 and PA6 nanocomposites. Large-scale vessel prototypes were obtained by rotational molding of thermo-stabilized PA6 and its nanocomposites, and samples extracted from the rotomolded parts were characterized with respect to physical and mechanical properties. It was found that the PA6 nanocomposites exhibited significant improvements at cone calorimeter tests in comparison with neat PA6.

Nasopharyngeal mucoepidermoid carcinoma in children

Salivary gland tumours represent 1-4% of all human neoplasms and less than 5% occur in children and adolescents. Malignant salivary gland tumours only represent 0.08% of all childhood tumours and mucoepidermoid carcinoma (MEC) is the most common histological type. The majority of MECs in the paediatric group are histologically classified as low or intermediate grade of malignancy, favouring a good prognosis. Complete excision of the lesion with free surgical margins is the treatment of choice and the one that offers the best local control of the disease. Experience with minor salivary gland carcinoma arising specifically within the nasopharynx is limited because nasopharyngeal MEC is an extremely rare malignancy and there is controversy regarding its optimal treatment. We hereby report a case of mucoepidermoid carcinoma arising from the nasopharynx in a 7-year-old girl, which was managed via an endonasal endoscopic procedure. To our knowledge the case we describe is the second case of nasopharyngeal MEC in paediatric age reported in literature and is the only one occurred in the first decade of life.

p63 expression in laryngeal squamous cell carcinoma is related to tumor extension, histologic grade, lymph node involvement and clinical stage

To analyse the relationship of the immunohistochemical p63 expression with tumoral extent, histologic grade, lymph node involvement and clinical stage in laryngeal squamous cell carcinoma (LSCC), a series of 81 patients with primary LSCC treated by primary surgery was retrospectively evaluated. Immunohistochemistry was performed on formalin-fixed and paraffin-embedded tissue blocks from surgical samples. Clinicopathologic data were correlated with the p63 staining results. Differences in p63 immunoreactivity between the different groups were compared using both parametric analysis of variance (ANOVA) and non-parametric Kruskal-Wallis test. Statistical significance was set at p less than 0.05. All statistical analyses were performed using the R statistical package. We found a statistically significant association between p63 protein expression and increase of tumor extension (T1 vs T3), of histological grading, of level of lymph node involvement (N0 vs N1 and N2), and clinical stage (I vs IV). Our findings suggest that abnormal expression of p63 may be involved in the early phases of laryngeal tumorigenesis and this oncoprotein might become a useful predictor of clinical outcome.

[Sinonasal carcinoma and exposure to wood and leather dust: analysis of 36 cases]

In order to define the best strategies of prevention and diagnosis of sinonasal cancer, the aim of our study was the investigation of the etiological and prognostic factors related to 36 cases. The enrolled cases were composed mostly of men working in the footwear industry, with a mean age of 63.7 years and mean exposure of 34.6 years. The period between the start of exposure and the appearance of the neoplasm was of 44.6 years, the time between the onset of symptoms and diagnosis was of 10.8 months. Our results suggest that a diagnosis within 6 months after the onset of symptoms is associated with a lower tumor stage, a better survival and to a lower rate of recurrence. Nasal obstruction (58.3%) and epistaxis (52.7%) are the main initial symptoms. In order to obtain an early diagnosis, in addition to periodic clinical controls, a proper information of workers is required.

Neurotrophins, their receptors and KI-67 in human GH-secreting pituitary adenomas: an immunohistochemical analysis

Pituitary adenomas are a diverse group of tumors arising from the pituitary gland. Typically, they are small, slow-growing, hormonally inactive lesions that come to light as incidental findings on radiologic or postmortem examinations, although some small, slow-growing lesions with excessive hormonal activity may manifest with a clinical syndrome. The family of neurotrophins plays a key role in the development and maintenance of the pituitary endocrine cell function and in the regulation of hypothalamo-pituitary-adrenocortical axis activity. The objective of our experimental study is to investigate the localization of the neurotrophins, their relative receptors and to detect the expression level of Ki-67 to determine whether all these factors participate in the transformation and development of human pituitary adenomas. A very strong expression of Neurotrophin-3 (NT-3) and its receptor TrKC was observed in the extracellular matrix (ECM) and vessel endothelium, together with a clear/marked presence of Brain-derived neurotrophic factor (BDNF), and its receptor TrKB, thus confirming their direct involvement in the progression of pituitary adenomas. On the contrary, NGF (Nerve growth factor) and its receptor TrKA and p75NTR were weakly expressed in the epithelial gland cells and the ECM.

p53 and BCL-2 over-expression inversely correlates with histological differentiation in occupational ethmoidal intestinal-type sinonasal adenocarcinoma

Despite their histological resemblance to colorectal adenocarcinoma, there is little information on the molecular events involved in the pathogenesis of intestinal-type sinonasal adenocarcinoma (ITACs). The aim of this paper is to evaluate the possible role of TP53 and Bcl-2 gene defects in ITAC by investigating the immunohistochemical expression of TP53 and Bcl-2 gene products in a group of ethmoidal ITACs associated with occupational exposure. A retrospective study on 15 patients with pathological diagnosis of primary ethmoidal ITAC was conducted. Representative formalin-fixed, paraffin wax-embedded block from each case was selected for immunohistochemical studies using the antibodies against p53 and Bcl-2. Clinical-pathological data were also correlated with the staining results. The results of immunohistochemical examination demonstrated that poorly differentiated cases showed a higher percentage of p53 and Bcl-2 expressing cells in comparison to well-differentiated cases. No correlation was found with other clinico-pathological parameters, including T, stage and relapses. The relationship between up-regulation of p53 and Bcl-2 and poorly differentiated ethmoidal adenocarcinoma suggests a role of these genes, in combination with additional genetic events, in the pathogenesis of ITAC.

Videoendoscopic assisted curettage of central giant cell granuloma of the maxilla in pediatric age

Giant cell granuloma is an uncommon bony benign lesion that generally involves the mandible and maxilla. It may be locally aggressive and result in extensive tissue destruction in advanced cases. Surgery is the traditional and still the most accepted treatment for giant cell granuloma. We report a pediatric case of central giant cell granuloma of the maxilla treated with videoendoscopic assisted surgical excision.

Reciprocal Altered Expression of E-Cadherin and P-Cadherin in Mucous Membrane Pemphigoid

E- and P- cadherins are involved in the selective adhesion of epidermal cells. To gain insight into the role of cadherins on the acantholysis of keratinocytes and further investigate the pathogenesis of Mucous Membrane Pemphigoid, we examined the expression of P-cadherin and E-cadherin, in normal human oral mucosa, lesional and peri-lesional mucosa in MMP. Twenty-nine samples from paraffin-embedded specimens of MMP were used for the study. Five specimens of healthy oral mucosa were evaluated as control group. To evaluate the E- and P-Cadherin expression, a mean percentage of positive cells was determined from the percentage of positive cells derived from the analysis of 100 cells in ten random areas at x400 magnification. It was observed that E-cadherin was weakly and discontinuously expressed on the epithelial layers of pemphigoid mucosa, while it was intensively expressed on all keratinocytes in normal human skin. In contrast, P-cadherin was strongly expressed throughout the entire epidermal layer in MMP samples, although its expression is restricted to the basal cell layer in normal human skin. Statistical analyses showed that the percentage of E-cadherin positive cells in the epithelium of pemphigoid cases was significantly decreased compared with that in normal human mucosa. There was a significant increase in the percentage of P-cadherin positive cells in the epithelial layers of MMP compared with normal human mucosa. The present study showed that there is downregulation of E-cadherin expression and upregulation of P-cadherin expression in MMP mucosa, which may be involved in the pathogenesis of MMP.

CdS and ZnS Nanoparticles Growth in Different Reaction Media: Synthesis and Characterization

In this work we report on the growth of cadmium sulfide and zinc sulfide nanocrystals by thermolysis, starting from a metal thiolate in a (i) solventless way, (ii) by a novel route in tryoctilphosphine oxide (TOPO), and (iii) by direct synthesis in a polystyrene matrix. The x-ray diffraction (XRD) and transmission electron microscopy (TEM) show that the nanocrystals fabricated by the different methods are under optimized growth conditions single crystals of zincblende structure and of regular spherical shape. The average size was estimated to be between 2.0-3.0 nm with a size dispersion that depends on the synthesis route and is in the range between 10% and 20%. The XPS results indicate that for the nanoparticles obtained via solventless strategy the sulfur is present both as bonded to the metal atom and to the organic residue, while in the TOPO synthesized nanoparticles the sulfur signal has only one component associated to the metal-sulfide bond. The photoluminescence spectroscopy (PL) analysis of CdS crystals clearly evidences the typical emissions of nanosized zincblende CdS monocrystalline particles. Furthermore, the optical spectroscopy data indicate that the size distribution of the Cdsulfide - TOPO nanoparticles seems to be generally larger than that ones grown directly in polymer matrix. For all the CdS samples, the metal-sulfide nanocrystals exhibit a trap-related radiative transition at about 2eV that can be attributed to the hole-electron recombination at particle surface defect-center.

Non-functionalized silver nanoparticles for a localized surface plasmon resonance-based glucose sensor

The optical properties of non-functionalized silver nanoparticles in ethanol solution have been analyzed and a progressive shift of localized surface plasmon resonances caused by the adding of increasing quantities of glucose has been observed. To understand this occurrence, the interaction of glucose molecules with the silver nanoparticle surface has been investigated using Raman spectroscopy. In addition, high resolution transmission electron microscopy shows the presence of superstructures on the silver nanoparticle surface that can be imputed to the presence of glucose.

[Risk and prevention of diabetic nephropathy]

Diabetic nephropathy is one of the most frequent causes of end-stage renal disease (ESRD), and there has been a dramatic increase in the number of patients entering renal replacement therapy in the last few years. Moreover, diabetic nephropathy is associated with elevated cardiovascular morbidity and mortality. Prevention and treatment of diabetic nephropathy is based on optimal metabolic and blood pressure control, proteinuria reduction, and renin-angiotensin-aldosterone system (RAAS) inhibition. In the normoalbuminuric patient, optimal glycemic control (HbA1c below 7.0%) plays a fundamental role in the primary prevention of ESRD. Furthermore, blood pressure levels below 130/80 mmHg are strongly recommended. In the microalbuminuric stage, strict glycemic control (HbA1c below 7.0%) likely reduces the incidence of overt nephropathy, while blood pressure values less than 130/80 mmHg are recommended. Moreover, there is evidence that inhibition of RAAS, either by angiotensin-converting-enzyme inhibitors (ACE-I) or angiotensin-receptor blockers (ARB), reduces the development of overt nephropathy, regardless of the blood pressure levels. ACE-I are recommended as the drugs of choice in type 1 diabetes, while both ACE-I and ARB are considered first-choice drugs in type 2 diabetes. Once overt proteinuria has developed, it is uncertain whether glycemic control affects the progression of nephropathy, which is strongly influenced by blood pressure and proteinuria. Optimal blood pressure levels are < 130/80 mmHg in patients with proteinuria < 1 g/day and < 120/75 mmHg in patients with proteinuria > or =1 g/day. In type 1 diabetes there is consensus on the renoprotective role of ACE-I, while in type 2 diabetes, ARB have been shown to be more effective than conventional therapy or calcium-channel blockers in slowing the progression of nephropathy. Lastly, a multifactorial therapeutic approach based on optimal glycemic control, intensive antihypertensive therapy, inhibition of RAAS, statins and aspirin is pivotal in the prevention and treatment of diabetic nephropathy.

Malleostapedotomy in tympanosclerosis patients

Objectives:

To present our personal experience of a series of 10 patients suffering from tympanosclerosis with functional blocking of the stapes or footplate, who underwent malleostapedotomy surgery. The criteria for patient selection for this type of operation, and its results and complications, are discussed.

Methods:

Prospective study.

Results:

Incus and malleus dysfunction was observed in 70 per cent of cases, either alone or combined with fixation of the stapes. The post-operative hearing results were considered to be satisfactory (i.e. within 20 dB) in 80 per cent of cases. Only one patient had sensorineural hearing loss over 10 dB.

Conclusions:

Malleostapedotomy has proved its practicability in the treatment of patients with fixed footplate or stapes complicated by ankylosis of the incudomalleolar joint. This procedure can be considered a further, valid technique within the otologist's surgical armamentarium.

Surgical treatment of nasal septal perforations. Our experience

Septal perforations are difficult problems that the otolaryngologist has to solve. In fact, the otolaryngologist has to identify the cause, which in most cases is either iatrogenic or idiopathic, to decide upon the need for surgery, and select the most suitable surgical technique of those currently available, for the case under consideration. All surgical procedures, aimed at repair of nasal septal perforations, are based on two main principles, namely repair using mucosal, mucoperichondrial, and/or mucoperiosteal flaps from the nasal cavity, or with connective tissue autograft, to be interposed between the mucosal flaps. Surgical repair of septal perforation can be carried out using either the "closed technique" or "open technique". The advantage of the former is that it does not leave any external scar. However, drawbacks related to difficulties due to the narrow operating field may be encountered. Many surgeons prefer the "open" technique, as it offers a wider operating field, thus allowing better access to the superior and posterior margins of the perforation (especially in large and/or posterior perforations), and offering binocular vision. The present report focuses on a short critical examination of the various surgical procedures described in the literature, in the attempt to identify, based also on personal experience, the most suitable techniques to repair septal perforations. A novel technique is presented for the surgical treatment of some types of perforations, which has not, so far, been described in the literature.

Burkitt-like lymphoma of the sphenoid sinus: case report

Burkitt's lymphoma is a malignant endemic neoplasia with a mandibular localization, described for the first time in 1958, in African children. The World Health Organization classification recognises several variants of Burkitt's lymphoma; all are highly malignant B cell lymphomas. Besides Burkitt's sporadic, endemic lymphoma and Burkitt's lymphoma associated with AIDS, the World Health Organization classification includes an "atypical or pleomorphic" variant of Burkitt's lymphoma. This subtype includes those cases diagnosed as "Burkitt-like" lymphoma in the REAL (Revised European-American Classification of Lymphoid Neoplasm). The therapeutic protocol is similar to that used for classic Burkitt's lymphoma, with chemotherapy being standard treatment. Prognosis is extremely poor, with a mean survival of < 1 year. The case is described of a sinus-nasal "Burkitt-like lymphoma", originating within sphenoid sinus. The extremely rare localisation of this histological variant of Burkitt's lymphoma is stressed as well as the extremely aggressive nature of the neoplasm.

Giant neck neoplasm. Case report

Giant latero-cervical neoplasias usually originate in the parotid gland, as slow-growing adenomas, in subjects who take little care of their personal health. Giant adenomas of submandibular gland are very rare. These neoplasias involve prevalently male sex (male/female ratio: 2/1) and usually occur between 20 and 40 years of age. Signs of malignant transformation may be observed in the adenomatous epithelial component in a percentage ranging from 1% to 10% of cases. The case is reported of a giant malignant latero-cervical neoplasia originating from a pleomorph adenoma of the submandibular gland. The diagnostic work-up and treatment protocol are described.

Role of endoscopic CO2 laser surgery in the treatment of congenital infantile subglottic hemangioma. Experience in the Department of Otolaryngology, "Sick Children Hospital", Toronto, Canada

Subglottic hemangioma is a rare, histologically benign congenital neoplasm. The natural history is characterized by progressive obstruction of the airways during the proliferative stage, followed by gradual regression of the obstructive symptomatology in the involutional phase. After an asymptomatic neonatal period, the infant presents a characteristic biphasic stridor as the lesion progressively obstructs the subglottic space. In 80-90% of cases, these symptoms appear in the first six months of life. The involutional process generally begins at 12 months of age and continues until the subglottic hemangioma regresses completely. Due to high incidence of mortality in untreated cases, therapy should be undertaken immediately. Aim of therapy is to restore normal respiration, attempting to preserve the child's voice and alter the quality of life both of the infant and the family as little as possible. A retrospective study was carried out on all cases of infantile subglottic hemangioma treated in the Department of Otolaryngology, "Sick Children Hospital", Toronto, between 1980 and 2000. The therapeutic strategy adopted until breathing returned to normal comprised repeated endoscopic CO2 laser treatment of the lesion and perioperative administration of oral cortisone (1 mg/kg/day dexamethazone, subdivided in 3 doses) for 24-48 hours. CO2 laser was used each time the patient presented progressive worsening of obstructive respiratory symptoms. The interval between two laser treatments was > or = 6 weeks. Repeated endoscopic laser treatment, combined with other therapeutic modalities, enabled tracheotomy to be avoided in all but 4 (7.2%) cases.

[Horizontal glottectomy according to Calearo-Teatini for the treatment of tumors involving the anterior commissure of the larynx: oncological and functional results]

Among the different surgical options proposed for the treatment of glottic neoplasms involving the anterior commissure is the Horizontal Glottectomy (HG) proposed in 1978 by Calearo and Teatini. This type of laryngectomy is now included with good reason among the reconstructive horizontal laryngectomies in that it calls for the complete removal of the vocal folds and corresponding thyroid cartilage, with reconstruction of the airways by means of a thyrocricopexy. The object of our study was to describe the indications, surgical technique and oncological and functional results on the basis of the experience acquired by the Authors in 21 patients affected by laryngeal carcinoma (juxta-commissural T1a with diffuse hyperkeratosis of the contralateral cord and T1b infiltration to the anterior commissure) who underwent Horizontal Glottectomy (HG) according to the Calearo-Teatinin technique. For 3 of the 21 patients, the follow-up was under 3 years; for 11 patients it was over 5 years; and in 4 cases, it was over 10 years, with a survival rate at 5 years of 91.5%. There were 5 deaths (27.7%), 2 of which were due to non-neoplastic intervening causes, and 1 of which for a recurrence of N (5.5%) a year after surgery. In 3 patients, postoperative RT (radiotherapy) was carried out due to infiltration of the resection borders. With regard to the functional results, the naso-gastric tube was maintained for 8 days on average (min 4, max 12 days), and the tracheal cannula remained in situ an average of 11 days (min 7, max 19 days), while the average hospital stay was 9.3 days. The treatment options currently available for glottic tumors involving the anterior commissure may be divided among radiotherapy (RT), conventional surgery including vertical laryngectomies (Tucker's frontoanterior and Leroux-Robert's frontolateral laryngectomies) and horizontal laryngectomies (Calearo-Teatini's horizontal glottectomy, Majer-Piquet's crico-hyoido-epiglottopexy, and Labayle's crico-hyoidopexy), as well as endoscopic laser surgery. Each procedure is adopted on the basis of the experience and philosophy of the surgeon. For tumors involving the anterior commissure, our treatment protocol prescribes HG to be performed whenever possible, as its oncological and functional result have confirmed the validity of the procedure, as long as the indications are followed carefully. Furthermore, when compared to the frontolateral procedure, it provides similar oncological results, but being a much more economical operation on the vertical plane, it avoids stenotic complications, while, compared to the Majer-Piquet procedure, it allows easier and faster rehabilitation, even in elderly patients.

[Paralateral-nasal malignant schwannoma with rhabdomyoblastic differentiation (Triton tumor). Report of a case]

Malignant schwannoma with rhabdomyoblastic differentiation (Triton tumor) is a very rare variant of the malignant tumors arising in the peripheral nerve sheath. In 70% of the cases, the neoplasm is associated with Von Recklinghausen's neurofibromatosis; in the remaining 30% it is the sole morbid finding. Its biological behaviour is, in any case, more aggressive than that of simple malignant schwannoma; its course is rapid and its prognosis is dismal. Local recurrences are frequent, and distant metastases, preferentially situated in the lung and brain, are present in about 50% of the cases. Post-operative radiotherapy is always indicated. We report a case of a 64-year-old man who presented a right paralatero-nasal Triton tumor. Following exeresis, a cycle of high-dose radiotherapy was prescribed; the 10-year follow-up revealed no sign of recurrence or distant metastases.

[Health protection of workers in the European legislation of the Rome Treaty today]

Occupational hygiene and prevention of occupational accidents and diseases are institutional objectives of the social policy of the European Union as stated in the Treaty establishing the European Community (firstly Treaty of Rome, signed on 25 March 1957). In this report the legislative activity of the European Community aimed at the improvement of the working environment to protect workers' health and safety is considered through its historical development, up to the present situation. The first part of the report briefly describes the Institutions established by the European Community, with specific tasks relating to occupational hygiene and health and safety at work. Then European laws grouped in categories according to their subjects are considered, especially with regard to the development and progress of the legislation, to point out main features and historical trends.

Physiopathology of the renin-angiotensin system in the ovary

The present review confirms the existence of the so-called "ovarian-derived prorenin-angiotensin cascade". It also describes the physiopathology of the system and, consequently, its role in the genesis of phenomena concerning reproductive function such as ovulation, steroid synthesis and folliculogenesis. Moreover, the "ovarian-derived prorenin-angiotensin cascade" appears to play an important role in the aetiopathogenesis of diseases such as ovarian tumours, ovarian hyperstimulation syndrome and ectopic pregnancy.

[Gastrin and gastrointestinal neoplasias]

In this paper the authors focus attention on the role of gastrin as a carcinogenic factor. The aim was to bring together the numerous controversial studies on this subject, adding the authors' own personal clinical experience. Gastrin (G) is responsible for the development of carcinoids, as has been experimentally shown in Mastomys rats, and more recently in man. This hormone is regarded as a mitogen for cells in the gastroenteric tract; it acts through specific reactors and messengers, including AMPc and protein kinase A (PKA). Its role in the development of other neoplasias of the gastroenteric tract appears to be linked, but not always subordinate, to the presence of growth factors such as: EGF and TGF-alpha, and also to the possible stimulation of oncogens induced by hypergastrinemia.

High levels of HIV-1 replication show a clear correlation with downmodulation of Bcl-2 protein in peripheral blood lymphocytes of HIV-1-seropositive subjects

Peripheral blood lymphocytes (PBLs) from 51 HIV-1-seropositive subjects with different levels of HIV-1 replication and 20 healthy blood donors were examined for the expression of the antiapoptotic Bcl-2 protein. All the plasma samples from HIV-1 patients were characterized for the presence of HIV-1 p24 and HIV, RNA viral load. Bcl-2 protein expression in fresh peripheral blood lymphocytes was studied by different tests, including Western blot and indirect immunofluorescence techniques. Direct immunofluorescence staining, revealed by flow cytometry, was applied to quantify the number of specific anti-Bcl-2 antibody epitope binding sites, thus extrapolating the relative number of Bcl-2 into the cells. The results indicate that the expression of Bcl-2 protein is significantly lower in peripheral blood lymphocytes of HIV-1-seropositive patients showing high levels of viral replication, detected by means of HIV-1 p24 and RNA viral load, with respect to HIV-1 patients with low levels of virus replication and healthy blood donors. The clear-cut inverse correlation between viral replication and Bcl-2 expression reinforces the view that HIV-1-mediated apoptosis probably represents a key mechanism in AIDS pathogenesis.

Physiopathology of the renin-angiotensin system in the ovary

The present review confirms the existence of the so-called "ovarian-derived prorenin-angiotensin cascade". It also describes the physiopathology of the system and, consequently, its role in the genesis of phenomena concerning reproductive function such as ovulation, steroid synthesis and folliculogenesis. Moreover, the "ovarian-derived prorenin-angiotensin cascade" appears to play an important role in the aetiopathogenesis of diseases such as ovarian tumours, ovarian hyperstimulation syndrome and ectopic pregnancy.

Factors affecting insufficiency in activity daily living in the elderly

BACKGROUND

In a "case-control" study we investigated the correlations among twenty-four clinical signs of "functional impairment" and probability of "activity daily living insufficiency".

METHODS

The study involved 788 randomised inpatients, aged 65 years and over, of nineteen long-stay hospitals of an Italian region (Lazio, Rome). We measured self care autonomy, mobility and continence, on a modified Barthel's scale; the score on Barthel's scale, Barthel Index (BI), was correlated to twenty-four signs of "functional impairment" (explicative variables). Of these variables entered in stepwise regression only "cognitive impairment" (coef. B-22), "paralysis" (coef. B-21), "body weight reduction over 10 kg vs ideal weight" (coef. B-12), "joint deformation" (coef. B-7) and "visual impairment" (coef. B-5). Insufficiency in daily living is defined by BI < 100. The presence of these five clinical signs leads to the likelihood of "activity daily living insufficiency" to 0.996. The trend of cognitive impairment to rise with age could be responsible for the inverse regression between age and BI.

RESULTS

There was no significant correlation between BI and sex. Hearing impairment, serum creatinine level > or = 4 mg/dl, bronchospasm, obstructive and restrictive ventilation disorders, precordial pain on stress or spontaneous and dyspnea are not significantly correlated to the Barthel Index Score and to the likelihood of insufficiency in daily living activity.

Effects of Panax Ginseng C.A. Meyer saponins on male fertility

Sixty-six patients have been treated with Panax Ginseng C.A. Meyer extract, of whom 30 oligoastenospermic sine causa (group A), 16 oligoastenospermic with idiopathic varicocele (group B). Twenty age-matched volunteers were used as controls (group C). Use of Panax Ginseng extract showed an increase in spermatozoa number/ml and progressive oscillating motility, an increase in plasma total and free testosterone, DHT, FSH and LH levels, but a decrease in mean PRL. It is suggested that ginsenosides may have an effect at different levels of the hypothalamus-pituitary-testis axis.

Relationship between autoimmune thyroid disease Rand Alzheimer's disease

Alzheimer's Disease (AD) is a particular form of degenerative dementia probably due to deposit in the brain cortex of a non soluble protein called beta-A4 amyloid in senile plaque form. beta A4 is an aberrant mutant proteolytic product of Amyloid Protein Precursor (APP) codified on chromosome 21. Trisomy 21 is responsible for Down's Syndrome (DS). Down's patients have been shown to develop a form of Alzheimer's after 50 years of age, and high blood levels of antithyroid antibodies are also present in a significant percentage of these cases. In the present investigation, antithyroid antibody titres have been studied by means of RIA in group of 34 AD patients. As compared to 30 non-demented controls, AD subjects showed a significant increase in the mean values of antithyroglobulin (TgAb) and antimicrosomial (MCSAb) autoantibodies. The physiopathological relationship regarding this association is discussed.

Sexual transmission of hepatitis C virus and HIV-1 infection in female intravenous drug users

We examined the relationship between the presence of antibody to HCV and sexually transmitted diseases in 151 female, intravenous drug users aged 17-43 years. Anti-HCV was present in 49 of 66 HIV-1-negative women (74.2%), and 63 of 85 HIV-1-positive women (74.1%). Anti-HCV seropositivity was significantly related to sexually transmitted infections (Ureaplasma urealyticum infections excluded) in HIV-1-seronegative women, but not in HIV-1-positive women. Also, in HIV-1-negative subjects. Trichomonas vaginalis infections (and infections with M. hominis) were significantly related to anti-HCV seropositivity, and a positive relation between the number of sexual partners and the presence of anti-HCV was demonstrated. In HIV-1-positive subjects a shared use of needles and syringes was more likely, and an increased parenteral exposure to HCV may decrease the relative contribution by sexual transmission. However, in HIV-1-negative subjects, sexual transmission of HCV appears to be both a possible and important means of transmission.

[The risk from mixtures in the indoor air]

Indoor air is typically contaminated by complex mixtures of several pollutants at low concentrations. As a consequence, the application of methods for evaluating the effects of multiple exposure should be recommended for risk assessment of indoor air pollutants. For this purpose, criteria recommended by scientific and governmental Institutions for risk assessment of multiple indoor exposure are reported.