Neuroendocrine Carcinoma of the Skin (Merkel Cell Carcinoma): Immunocytochemical Study of a Case

The immunocytochemical phenotype was evaluated in a case of Merkel cell carcinoma of the skin. Intermediate filaments, i.e. neurofilament, glial fibrillary acid protein, cytokeratins, keratin and panfilament as well as S-100 protein, calcitonin and epithelial membrane antigen were detected by immunoperoxidase methods. Nodular positivity for neurofilament was observed. The remaining intermediate filaments and other markers were negative. Thus the origin of Merkel cell carcinoma appears uncertain and this tumor probably has neuroendocrine activity.

Hepatitis C virus outbreak in a haemodialysis unit: learning from failures

The investigation of an outbreak of hepatitis C virus in an Italian haemodialysis (HD) centre showed that three patients acquired infection with the same strain, affecting a chronically hepatitis C virus (HCV)-infected patient receiving HD in the same room and during the same shifts. Through our observational analysis many possible modes of transmission were identified, but none could be definitively identified as the route of HCV spread in this small cluster. This outbreak confirms that repeated opportunities for nosocomial HCV transmission may occur among HD patients due to several breaches in the standard precautions for bloodborne infections by healthcare staff.

Borondifluoride complexes of hemicurcuminoids as bio-inspired push-pull dyes for bioimaging

Hemicurcuminoids are based on half of the π-conjugated backbone of curcuminoids. The synthesis of a series of such systems and their borondifluoride complexes is described. The electrochemical and photophysical properties of difluorodioxaborine species were investigated as a function of the nature of electron donor and acceptor groups appended at either terminal positions of the molecular backbone. The emissive character of these dipolar dyes was attributed to an intraligand charge transfer process, leading to fluorescence emission that is strongly dependent on solvent polarity. Quasi-quantitative quenching of fluorescence in high polarity solvents was attributed to photoinduced electron transfer. These dyes were shown to behave as versatile fluorophores. Indeed, they display efficient two-photon excited fluorescence emission leading to high two-photon brightness values. Furthermore, they form nanoparticles in water whose fluorescence emission quantum yield is less than that of the dye in solution, owing to aggregation-induced fluorescence quenching. When cos7 living cells were exposed to these weakly-emitting nanoparticles, one- and two-photon excited fluorescence spectra showed a strong emission within the cytoplasm that originated from the individual molecules. Dye uptake thus involved a disaggregation mechanism at the cell membrane which restored fluorescence emission. This off-on fluorescence switching allows a selective optical monitoring of those molecules that do enter the cell, which offers improved sensitivity and selectivity of detection for bioimaging purposes.

Maternal mortality in Italy: a record-linkage study

OBJECTIVE

To detect maternal deaths, analyse associated causes and compute absolute and specific maternal mortality ratio among five Italian regions in response to a recent ranking of Italy by the Lancet as having the lowest maternal mortality ratio among 181 countries.

DESIGN

Record-linkage study.

SETTING

Five Italian regions.

POPULATION

All women aged 15-49 years resident in the participating regions, with one or more hospitalisations for pregnancy or any pregnancy outcome between 2000 and 2007.

METHODS

Maternal deaths have been identified by record linkage between the Death Registry and the Hospital Discharge Database. Different time periods were analysed according to local data availability. Cases have been selected and causes of death have been classified according to the 10th International Classification of Diseases.

MAIN OUTCOME MEASURE

Maternal mortality ratio.

RESULTS

Underreporting of official figures based on death certification in the participating regions is 63%. A total of 118 maternal deaths have been identified resulting in a maternal mortality ratio of 11.8, compared with the official figure of 4.4, per 100,000 live births. Haemorrhage, thromboembolism, and hypertensive disorders of pregnancy are the leading causes of direct deaths.

CONCLUSIONS

This study implies that only 37% of all maternal deaths are included in the official data. Our analysis shows a predominance of direct obstetric deaths, which implies that emphasis is needed on improvements of obstetric care.

[Colon recanalization after Hartmann's procedure. A challenge for the surgeon or a strategy to be changed?]

AIM

Restoration of colorectal continuity is the second step of the procedure originally described by H. Hartmann for the treatment of sigmoid colon cancers. It is a safe, but complex procedure, that needs a meticulous surgical technique and is associated with a significant morbidity in as many as 40% of cases. For this reason, many patients are not submitted to reversal of the colostomy.

METHODS

The authors report their experience: 32 patients underwent colostomy closure after Hartmann's procedure during the last 8 years.

RESULTS

The mortality rate was nil, but post-operative complications occurred in 12 patients (37.5%), namely: wound infection (11 patients) and anastomotic leak (2 patients).

CONCLUSION

In light of this, it could be wiser to perform, in the patients affected with benign pathology, and in those affected with limited malignant pathology (T3), resection of the diseased segment of colon and primary anastomosis with temporary ileostomy, reserving Hartmann's procedure to patients unsuitable to one step treatment because of their poor general and local conditions.

Cloning and expression of a novel hepatitis B virus-binding protein from HepG2 cells

A direct involvement of the hepatitis B virus (HBV) preS1-(21-47) sequence in virus attachment to cell membrane receptor(s) and the presence on the plasma membranes of HepG2 cells of protein(s) with receptor activity for HBV have been suggested by many previous experiments. In this study, by using a tetravalent derivative of the preS1-(21-47) sequence, we have isolated by affinity chromatography from detergent-solubilized HepG2 plasma membranes a 44-kDa protein (HBV-binding protein; HBV-BP), which was found to closely correspond to the human squamous cell carcinoma antigen 1 (SCCA1), a member of the ovalbumin family of serine protease inhibitors. Comparison of SCCA1 sequence with the sequence of the corresponding HBV-BP cDNA, cloned by polymerase chain reaction starting from RNA poly(A)(+) fractions extracted from HepG2 cells, indicated the presence of only four nucleotide substitutions in the coding region, leading to three amino acid changes. Intact recombinant HBV-BP lacked inhibitory activity for serine proteases such as alpha-chymotrypsin and trypsin but inhibited with high potency cysteine proteases such as papain and cathepsin L. Direct binding experiments confirmed the interaction of recombinant HBV-BP with the HBV preS1 domain. HepG2 cells overexpressing HBV-BP after transfection of corresponding cDNA showed a virus binding capacity increased by 2 orders of magnitude compared with untransfected cells, while Chinese hamster ovary cells, which normally do not bind to HBV, acquired susceptibility to HBV binding after transfection. Native HBV particle entry was enhanced in transfected cells. Both recombinant HBV-BP and antibodies to recombinant HBV-BP blocked virus binding and internalization in transfected cells as well as in primary human hepatocytes in a dose-dependent manner. Our findings suggest that this protein plays a major role in HBV infection.

CtBP/BARS induces fission of Golgi membranes by acylating lysophosphatidic acid

Membrane fission is essential in intracellular transport. Acyl-coenzyme As (acyl-CoAs) are important in lipid remodelling and are required for fission of COPI-coated vesicles. Here we show that CtBP/BARS, a protein that functions in the dynamics of Golgi tubules, is an essential component of the fission machinery operating at Golgi tubular networks, including Golgi compartments involved in protein transport and sorting. CtBP/BARS-induced fission was preceded by the formation of constricted sites in Golgi tubules, whose extreme curvature is likely to involve local changes in the membrane lipid composition. We find that CtBP/BARS uses acyl-CoA to selectively catalyse the acylation of lysophosphatidic acid to phosphatidic acid both in pure lipidic systems and in Golgi membranes, and that this reaction is essential for fission. Our results indicate a key role for lipid metabolic pathways in membrane fission.

Tissue polypeptide antigen (TPA) in urinary bladder cancer cytology: a follow-up study

Tissue polypeptide antigen (TPA) has been detected by immunocytochemical assay on urine cytological samples from 28 asymptomatic patients, who previously had a histological diagnosis of papillary transitional cell carcinoma (PTCT) of the urinary bladder (UB), in order to evaluate its role in follow-up controls. TPA staining intensity (SI) in urothelial cells was evaluated to improve the diagnostic accuracy of cytology. Differentiated tumor cells were strongly stained for TPA, heavier than normal urothelial cells. Undifferentiated neoplastic cells were less stained for TPA with a wide range of SI. TPA detection revealed positive cytology in 21 (75%) of the considered cases. The accuracy of our cytological findings compared with both routine examinations and subsequent histopathological diagnosis was of 95.2%. Follow-up urinary cytology limits could be reduced by TPA searching in differentiated tumor cells, deriving from low-grade neoplasms.

New phenotypic aspects in a family with Lynch syndrome II

Increasing attention has been given to hereditary nonpolyposis colorectal cancer (HNPCC). This report provides medical genetic/pathologic findings on an HNPCC kindred from southern Italy that shows criteria consistent with Lynch syndrome II. An international collaborative effort led to extension of this kindred with disclosure of a potentially new spectrum of phenotypic findings: an excess of gastric carcinoma; complete intestinal metaplasia and chronic atrophic gastritis restricted to the antrum; an apparent excess of colonic mucosal macrophagia, which by special stain appeared to be positive for mucin, with a constant content of both sialo and sulfomucin, a lack of iron, and an inconstant positivity for lysozyme obtained by immunoperoxidase technique; and findings of crypt atrophy of the colonic mucosa. During the relatively short period of investigation of this family, an intensive educational and surveillance program has been mounted in the interest of improving cancer control through direct application of knowledge of natural history and the risk factor evidence through pedigree assessment.

New phenotypic aspects in a family with Lynch syndrome II

Increasing attention has been given to hereditary nonpolyposis colorectal cancer (HNPCC). This report provides medical genetic/pathologic findings on an HNPCC kindred from southern Italy that shows criteria consistent with Lynch syndrome II. An international collaborative effort led to extension of this kindred with disclosure of a potentially new spectrum of phenotypic findings: an excess of gastric carcinoma; complete intestinal metaplasia and chronic atrophic gastritis restricted to the antrum; an apparent excess of colonic mucosal macrophagia, which by special stain appeared to be positive for mucin, with a constant content of both sialo and sulfomucin, a lack of iron, and an inconstant positivity for lysozyme obtained by immunoperoxidase technique; and findings of crypt atrophy of the colonic mucosa. During the relatively short period of investigation of this family, an intensive educational and surveillance program has been mounted in the interest of improving cancer control through direct application of knowledge of natural history and the risk factor evidence through pedigree assessment.

Tissue polypeptide antigen in normal and neoplastic urinary bladder. Preliminary reports

Tissue polypeptide antigen (TPA) both in normal and neoplastic urinary bladders has been studied by immunocytochemistry. A comparison of TPA with epithelial membrane antigen (EMA), keratins and carcinoembryonic antigen (CEA) in various tumor grades and stages has been performed better to define TPA role in bladder carcinomas. Well-differentiated tumors were strongly stained for TPA with a uniform staining intensity. Undifferentiated tumors were weakly stained for TPA with an uneven staining intensity. There was no relation between TPA findings and stages of invasion. However, TPA seems to be a very helpful diagnostic tool for tumor grading and staging.

Lymphocyte Subpopulations in Lynch Syndrome Ii: An Immunocytochemical Study on Gastrointestinal Biopsies. Preliminary Report

Gastrointestinal biopsies from 18 members of a family with Lynch Syndrome II were evaluated and immunocytochemical studies were made to characterize the phenotypic expression of the tissue's immune populations. The intestinal findings suggest polyclonal B-cell activation related to the T-helper distribution. Our evaluation provides no specific information so far on the management of patients with Lynch Syndrome II.

Gastric carcinoid following gastrojejunostomy

A carcinoid tumor of the gastric body was found in a patient who had a gastrojejunostomy done for duodenal ulcer 36 years earlier. Association of gastric carcinoid with gastrojejunostomy has previously been described by Lemmer. In contrast, such tumors have never been observed when the more common surgical procedure for peptic ulcer was used, ie, gastric resection. On the basis of recent knowledge on gastric endocrine cells, the authors suggest a relationship between the gastrojejunostomy and the carcinoid tumor, probably related to an elevated gastrin release.