P03.11.A Potential role of pre-radiotherapy MRI for target delineation in high-grade gliomas: a multicenter retro-prospective cohort study

Background

The optimal timing for target identification in high-grade glioma (HGG) remains unclear due to variability in the hyper-signal T2/FLAIR between MRI performed at diagnosis, post-surgery and at radiotherapy (RT) start. The aim of this study was to retrospectively confirm that RT planned on delayed MRI might allow to spare more normal tissue without decreasing local tumour control, in order to prospectively evaluate the best standard and advanced MRI and metabolic imaging sequences for clinical tumor volume (CTV) adaptation.

Material and Methods

We analyzed a retrospective cohort of consecutive patients with HGG treated from 2017 to 2020. All patients had a diagnostic MRI and another performed immediately post-surgery or pre-RT. Target volumes were contoured, based on T2/FLAIR, on diagnostic and post-surgery MRI in group A, while in group B on pre-RT MRI. We analyzed GTV and CTV volume, and the percentage increase between them. Moreover, we compared the two groups in terms of clinical-pathological characteristics and progression-free survival (PFS) and overall survival (OS). A prospective study, started on January 2022, has enrolled patients with HGG evaluated by advanced sequences MRI at diagnosis, post-surgery and pre-RT. In addition, some selected patients have undergone diagnostic DOPA-PET and pre-RT DOPA-PET. 2 MRI-guided contours have been performed for each patient: adapted on T2/FLAIR post-surgery and CTV-adapt on pre-RT, to assess study objectives.

Results

In retrospective cohort we analyzed 54 patients (25 group A, 29 group B). The median age of patients was 61 years (IQR 17,75), 93% had an ECOG PS of 0 or 1, 51 were symptomatic at diagnosis. Patients in group B had more frequently MGMT methylation (59 % vs. 28%, p=0.01) while less frequently frontal lobe involvement (60% vs. 24%, p=0.01). The median percentage increase between GTV and CTV was higher in group A than B: 431% (range 62%-7335%) vs 385% (range 53%-3174%), respectively. No significant difference in the pattern of relapse was observed, since >90% of disease recurrences were in-field in both groups. Median PFS and OS of the overall population were 9.5 months (95% CI 7 - 12) and 18.5 months (95% CI 16 - 24), respectively. Patients in group B had a significant better PFS as compared to those in group A (p=0.03), but similar OS. Nevertheless, imbalance in MTMT methylation status between the two groups was a major driver for PFS. Overall, 37 out of 51 patients had improvement in neurological symptoms (p<0.001), with no difference between the two groups (p=0.54).

Conclusion

Our data suggest that CTV adaptation to pre-RT T2/FLAIR may allow reducing RT volume, without affecting symptoms relieving and disease control. Results from the prospective study will help identifying the best adaptation of CTV guided by T2/FLAIR, advanced MRI sequences and metabolic imaging, in order to optimize efficacy and safety of treatment planning.

New onset of AV-nodal reentrant tachycardia (AVNRT) in the elderly- an uncommon diagnosis?

Funding Acknowledgements

Type of funding sources: None.

Background

Arrhythmias in elderly patients (pat) are common. In this subset of pat, atrial fibrillation is by far the most frequent sustained arrhythmia but not the only one. Clinical, ECG and electrophysiological (EP) features of AV-nodal reentrant tachycardia (AVNRT) have rarely been described in the elderly, and this represents the aim of the current study.

Methods

At 2 EP-centres in Germany, data from all pat undergoing an EP-study (EPS) and diagnosed with AVNRT between January 2018 and May 2021 were collected and analysed. Pat > 65 years constituted the study population.

Results

During the study period AVNRT was diagnosed in a total of 329 pat. 93 pat (28%) were > 65 years and represent the study population [median age 74 (65-89) years, 48% female]. In the majority (85%), the duration of symptoms was short (< 1 year), 14 pat had symptoms of paroxysmal tachycardia for longer than 10 years. Most of the pat (n=88, 94%) had at least one ECG-documentation. In SR, the PR interval was relatively long [median 180 (120-380) ms)]. In 84% of pat, sustained AVNRT [median cycle length (CL) 400 (270-800) ms] was induced during EPS. In the remaining pat, at least 2 typical AV-nodal-echo beats were induced. Slow pathway (SP) ablation/modification was performed in all but one patient presenting with a very long baseline PR-interval, low antegrade Wenckebach-point (WP) and very slow AVNRT. In this case, the pat was treated with ß-blocker after pacemaker (PM) implantation. In 3 additional pat, PM implantation was necessary after ablation due to intermittent high-degree AV-block. In comparison to the rest of the study population, these four pat had a longer baseline PQ interval [median 275 (IQR 248- 303) ms vs. 180 (IQR 160- 192) ms], a longer baseline AH interval [median 207ms (IQR 185- 234) ms vs. 95 (IQR 80- 107) ms], a lower baseline antegrade WP CL [median 510 (IQR 435- 645) vs. 390ms (IQR 355- 470) ms], and a longer tachycardia CL [TCL 557 (IQR 454- 661) ms vs. 400 (IQR 364- 443) ms; p value <0,01 for all comparisons]. The overall complication rate (other than AV block) was low (2 pat with AV fistula treated conservatively) and comparable to the one described in younger pat.

Discussion

Elderly pat also have AVNRT, there are a slight differences in physiology (i.e. relatively long baseline PR-interval and TCL, likely due to changes of the conduction system with aging), and as in young pat, ablation is curative treatment with similar (low) complication rate. A subset of pat, characterized by longer PR- and AH-intervals, lower WP and longer TCL may be at higher risk for AV-block after SP modification. Whether this is due to pre-existing damage or to posterior location of the FP remains unknown.

SP ablation is safe and effective even in elderly pat. In pat presenting with EP characteristics presumptive of a baseline impairment of the conduction properties of the FP, ablation of the FP could be attempted to avoid postprocedural high degree AV block.

Lag3+ regulatory T lymphocytes in critical carotid artery stenosis

The aim of this study was to evaluate CD25⁺ and Lag3⁺ T regulatory subpopulations in patients with critical carotid artery stenosis (CAS) and Stanford-A acute aortic dissection (AAD). CD25⁺ and Lag3⁺ were measured in 36 patients affected by CAS and 24 patients with Stanford type A AAD. Based on neurological symptoms, patients affected by CAS were further divided in 25 asymptomatic (CAS-A) and 11 symptomatic (CAS-S) subjects. Twenty-five patients with traditional cardiovascular risk factors (RF), matched for age and sex, were used as control group. Interleukin (IL)-10, IL-6 and transforming growth factor-β-levels were also measured. CD25⁺ T cells were significantly increased in CAS-S versus CAS-A (p > 0.05), AAD (p > 0.05) and RF (p > 0.05). Moreover, a significant increase in Lag3⁺ Tregs was observed in CAS e CAS-S versus AAD (p < 0.05) and RF (p < 0.05), whereas no significant difference was observed between CAS-S and CAS-A. IL-6 was higher in AAD compared to the other groups. Patients with neurological symptoms display a peculiar expansion of CD25⁺ T cells, strongly confirming a relationship between ischemic brain damage and this regulatory subpopulation, whereas Lag3⁺ Tregs early distinguish CAS from AAD and probably exert protective actions against aortic wall rupture throughout their anti-inflammatory functions.

Exosomal HIF1α supports invasive potential of nasopharyngeal carcinoma-associated LMP1-positive exosomes

It has emerged recently that exosomes are potential carriers of pro-tumorigenic factors that participate in oncogenesis. However, whether oncogenic transcription factors are transduced by exosomes is unknown. Hypoxia-inducible factor-1α (HIF1α) transcriptionally regulates numerous key aspects of tumor development and progression by promoting a more aggressive tumor phenotype, characterized by increased proliferation and invasiveness coupled with neoangiogenesis. It has been shown that the principal oncoprotein of Epstein–Barr virus (EBV), latent membrane protein 1 (LMP1), drives oncogenic processes and tumor progression of the highly invasive EBV malignancy, nasopharyngeal carcinoma (NPC). We now demonstrate that endogenous HIF1α is detectable in exosomes and that LMP1 significantly increases levels of HIF1α in exosomes. HIF1 recovered from exosomes retains DNA-binding activity and is transcriptionally active in recipient cells after exosome uptake. We also show that treatment of EBV-negative cells with LMP1-exosomes increases migration and invasiveness of NP cell lines in functional assays, which correlates with the phenotype associated with epithelial–mesenchymal transition (EMT). In addition, we provide evidence that HIF1α itself participates in exosome-mediated pro-metastatic effects in recipient cells, as exosome-mediated delivery of active and inactive forms of HIF1α results in reciprocal changes in the expression of E- and N-cadherins associated with EMT. Further, immunohistochemical analysis of NPC tumor tissues revealed direct correlation between protein levels of LMP1 and of the endosome/exosome marker tetraspanin, CD63, which suggests an increase in exosome formation in this EBV-positive malignancy. We hypothesize that exosome-mediated transfer of functional pro-metastatic factors by LMP1-positive NPC cells to surrounding tumor cells promotes cancer progression.

Stearoyl-CoA desaturase-1 is a key factor for lung cancer-initiating cells

In recent years, studies of cancer development and recurrence have been influenced by the cancer stem cells (CSCs)/cancer-initiating cells (CICs) hypothesis. According to this, cancer is sustained by highly positioned, chemoresistant cells with extensive capacity of self renewal, which are responsible for disease relapse after chemotherapy. Growth of cancer cells as three-dimensional non-adherent spheroids is regarded as a useful methodology to enrich for cells endowed with CSC-like features. We have recently reported that cell cultures derived from malignant pleural effusions (MPEs) of patients affected by adenocarcinoma of the lung are able to efficiently form spheroids in non-adherent conditions supplemented with growth factors. By expression profiling, we were able to identify a set of genes whose expression is significantly upregulated in lung tumor spheroids versus adherent cultures. One of the most strongly upregulated gene was stearoyl-CoA desaturase (SCD1), the main enzyme responsible for the conversion of saturated into monounsaturated fatty acids. In the present study, we show both by RNA interference and through the use of a small molecule inhibitor that SCD1 is required for lung cancer spheroids propagation both in stable cell lines and in MPE-derived primary tumor cultures. Morphological examination and image analysis of the tumor spheroids formed in the presence of SCD1 inhibitors showed a different pattern of growth characterized by irregular cell aggregates. Electron microscopy revealed that the treated spheroids displayed several features of cellular damage and immunofluorescence analysis on optical serial sections showed apoptotic cells positive for the M30 marker, most of them positive also for the stemness marker ALDH1A1, thus suggesting that the SCD1 inhibitor is selectively killing cells with stem-like properties. Furthermore, SCD1-inhibited lung cancer cells were strongly impaired in their in vivo tumorigenicity and ALDH1A1 expression. These results suggest that SCD1 is a critical target in lung cancer tumor-initiating cells.

Urgent Carotid Surgery: Is It Still out of Debate?

Patients with symptomatic tight carotid stenosis have an increased short-time risk of stroke and an increased long-term risk of ischaemic vascular events compared with the general population. The aim of this study is to assess the safety, efficacy, and limitations of urgent CEA or CAS, in patients with carotid stenosis greater than 70% and clinically characterized by recurrent TIA or brain damage following a stroke (<2.5 cm). This study involved 28 patients divided into two groups. Group A consisted of sixteen patients who had undergone CEA, and group B consisted of twelve patients who had undergone CAS. Primary endpoints were mortality, neurological morbidity (by NIHSS) and postoperative hemorrhagic cerebral conversion, at 30 days. Ten patients (62.5%) of group A experienced an improvement in their initial neurological deficit while in 4 cases (26%) the deficit remained stable. Two cases of neurologic mortality are presented. At 1 month, 9 patients (75%) of group B experienced an improvement in their initial neurological deficit while 3 patients (25%) had a neurological impairment. Urgent or deferred surgical or endovascular treatment have a satisfactory outcome considering the profile in very high-risk patient population. Otherwise in selected patients CEA seems to be preferred to CAS.

Anetoderma: evidence of the relationship with autoimmune disease and a possible role of macrophages in the etiopathogenesis

Anetoderma is a benign condition characterized by round or oval macular lesions with focal loss of dermal elastic tissue resulting in localized areas of flaccid or herniated saclike skin. Often, the anetoderma is associated with immuno-mediated pathogenetic mechanism. In this article, we describe the association between anetoderma and autoimmune diseases, by underlining the role and the action of macrophages as a possible etiopathogenesis.

Development of phenotypic indexes for the description of morphological injury in breast cancer cell mitochondria

e22055

Background: Mitochondriopathy has been recently rekindled as new cancer theory. We report on structural damage of breast-infiltrating ductal carcinoma (IDC) mitochondria characterised by reduced expression levels of the oxidative phosphorylation system (OXPHOS). Methods: Mitochondria from HMC-1 (human mammary carcinoma) and HMEC (human mammary epithelial cell) cultures, traced by Mitotracker, were assayed for OXPHOS expression levels using cryo-immunoelectron microscopy (CIEM) quantitative labelling and fluorescence immunolabelling on unfractionated HMC-1 and HEMC cells. Convolution degeneration was established by transmission electron microscopy (TEM). Twenty different cell sections for both HMC-1 and HEMC cells, including 65 and 72 mitochondria, respectively, were randomly recorded and quantitatively analyzed for the percentage of area occupied by intact cristae to provide a grading of mitochondrial damage (cristae loss index). Results: Depressed expression levels were detected for all HMC-1 OXPHOS complexes by CIEM. Normalized labelling density (HEMC/HMC-1), expressed as colloidal gold particles/mitochondrial area (ρ) provided the following values: 1.77 for the NADH-ubiquinone oxidoreductase complex I NDUFS3; 1.86 for the succinate- dehydrogenase complex II SDH-B protein; 1.63 for the ubiquinol cytochrome c reductase complex III UQCRC2; 4.88 and 1.58 for the cytochrome-oxidase complex IV (CO) subunit I and IV, respectively; 2.70 for the ATP-synthase complex V F1β protein. Fluorescence immunolabelling confirmed CIEM quantitative data. MitoTracker's co-staining showed altered membrane potential and permeability. Injury grading was categorised assigning three levels of morphological damage: i) severe, ii) moderate, iii) slight, corresponding to 0 % (6.2 % and 1.4 % for HMC-1 and HMEC, respectively), 1–50 % (21.5 % and 2.8 % for HMC-1 and HMEC, respectively) and 51–75 % (44.6 % and 15.3 % for HMC-1 and HMEC, respectively) of area occupied by intact cristae (p<0.0001, χ2Test). The entire HMC-1 mitochondrial damage resulted 3.7 times higher than that observed for HMEC cells (72.3HMC-1 %/19.5HMEC %). Conclusions: New phenotypic harm indexes for IDC cell mitochondria might provide new hallmarks in breast cancer cell biology.

No significant financial relationships to disclose.

Keratinocyte growth factor receptor (KGF-R) in cholesteatoma tissue

CONCLUSION

Distribution of the receptor for epidermal growth factor (EGF-R) and of the receptor for the keratinocyte growth factor (KGF-R) in cholesteatoma was found to differ in analogy with other epithelial tissues and accordingly to epidermal differentiation and intensity of paracrine stimulation. Moreover, both EGF-R and KGF-R expression was increased, suggesting a fair correlation with aggressiveness and recurrence rate of this pathology.

OBJECTIVES

To obtain information on the biological behaviour of cholesteatoma by assessing the expression and localization of EGF-R and KGF-R and correlating their tissue distribution with that of cytokeratins as a marker of differentiation.

MATERIALS AND METHODS

Cholesteatoma tissue was taken during tympanoplasty surgery and processed for indirect immunofluorescence. Murine monoclonal antibodies were tested for the different growth factor receptors and pancytokeratins analysed. Fluorescence intensity signal was measured on randomly captured digital images, using FISH 2000/HI software, with a pseudocolours generation module.

RESULTS

EGF-R was mostly expressed at the level of keratinocytes of the basal layer, while KGF-R signal was mainly distributed on the spinous and granular suprabasal layers that were also highly positive for cytokeratins. Significant correlation between the immunofluorescence signals was found for KGF-R and cytokeratins only, demonstrating that KGF-R expression is increased in more differentiated areas of the cholesteatoma tissue, while EGF-R is associated with proliferative and migratory portions of the lesion.

Torsades de pointes in congenital long QT syndrome following low-dose orphenadrine

We report the case of a woman, affected by congenital long QT syndrome (LQTS), who experienced three syncopal episodes shortly after the assumption of a low dose of orphenadrine. The ECG revealed a QT interval of 600 ms, and the corrected QT interval (QTc) was 537 ms. No structural cardiac disease was demonstrated by echocardiography. Orphenadrine treatment was discontinued. During the first 12 h of monitoring, three short-lasting, asymptomatic episodes of torsades de pointes occurred. No other sustained ventricular arrhythmia was revealed at Holter monitoring in the following days. During the ensuing 6 months, the patient remained asymptomatic, and the QTc did not change. Orphenadrine is an analogue of diphenhydramine, an antihistaminic drug that produces sodium channel blockade similar to that caused by quinidine and other Class Ia antiarrhythmic drugs. Our case rises the suspicion that orphenadrine could cause life-threatening arrhythmias in LQTS even at a low dose, and independently from concomitant assumption of potentially QT-prolonging drugs.

Ultrastructural ciliary findings in nasal obstructive diseases

Specific ultrastructural findings have widely been described in case of obstructive nasal diseases due to congenital defects. Ciliary impairment has in particular been observed as the main pathological feature in these conditions. In this study, nasal mucosal samples from different pathologies have been collected via the "brushing" technique and analysed by transmission electron microscopy. TEM analysis was focused on specific features, such as the numerical array of peripheral and central doublets of the cilium axoneme, including eventual microtubular disarrangement; partial or total loss of inner and/or outer dynein arms; defects of radial spokes and nexin links; disorientation of the ciliary axis in closely adjacent cilia, calculating the angle between the line crossing the central microtubular core and the horizontal ciliary axis and compound cilia (CC). Statistical comparison was carried out between study and control groups. A significant incidence of organic ciliary defects was found not only in patients with inflammatory processes, but mostly in those supposed to have a long-lasting nasal respiratory disease due to mechanical stenosis in relation to septum deviation and turbinate hypertrophy. Prevalence and percentage of compound cilia were instead more related to inflammatory conditions. The "brushing" technique can be considered an easy and reliable method for the assessment of the condition of the nasal mucosa. According to the findings derived from this study, mechanical nasal obstruction seems to cause major alterations on the nasal ciliary arrangement, thus determining a functional impairment on the whole nasal function.

Immunohistochemical analysis of keratinocyte growth factor and fibroblast growth factor 10 expression in psoriasis

The pathogenic mechanism underlying the hyperproliferation of keratinocytes in psoriasis is still not completely clarified. The production of cytokines released by activated T lymphocytes infiltrating the upper dermis probably has a crucial role. Even dermal fibroblasts can participate in the process through the secretion of growth factors, and some studies have reported an increased expression of the insulin-like growth factor 1. Few studies, however, have focused on the possible involvement of the keratinocyte growth factor (KGF/FGF-7) and the fibroblast growth factor 10 (FGF-10/KGF-2), which are secreted by fibroblasts and stimulate keratinocyte proliferation acting through a receptor specifically expressed by epithelial cells. The aim of this study was to investigate the expression of KGF and FGF-10 on the skin of patients with psoriasis by immunohistochemical analysis and to evaluate the correlation with the lymphocyte infiltrate and the epidermal proliferation. Immunostaining for KGF and FGF-10 showed that both the growth factors are upregulated in the upper dermis of psoriatic skin, and that the expression is correlated with the presence of T-cell infiltrate and with keratinocyte proliferation. Our data suggest that in psoriatic lesions activated lymphocytes can stimulate fibroblasts to produce KGF and FGF-10, which in turn contribute to sustain the hyperproliferative status of the keratinocytes.

Double subepicardial aneurysm after myocardial infarction

The echocardiogram of 68-year old man, admitted with an acute myocardial re-infarction revealed the presence, in the middle-apical region of the lateral wall, of two little and contiguous subepicardial aneurysms.

Acute myocardial infarction and rescue percutaneous transluminal coronary angioplasty in a young HIV-infected patient

We report a case of acute myocardial infarction in an HIV-infected patient without significant coronary artery disease (CAD) risk factors. The patient underwent rescue percutaneous transluminal coronary angioplasty (PTCA), with a successful outcome. We presume a possible pathogenetic role of anti-retroviral therapy and/or direct viral action on ischaemic heart disease progression. We propose that the current approach to management of AIDS-affected patients needs close monitoring for CAD risk factors and symptoms, to improve prognosis and life expectancy.

[Fangotherapy in chronic degenerative rheumatic diseases]

The authors remind the historical role of the mud-therapy in the care of chronic degenerative rheumoartrhopaties, namely osteoarthritis. The main researches belong activity of muds on plasmatic hormones, cytokines, endorphins; a great deal of care is devoted to evaluation of efficacy of mud therapy and relating end points. The clinic outcomes of mud therapy, namely in osteoarthritis patients, were referred. Altogether the studies stress the employ of mud therapy in the treatment of osteoarthritis, the consequences of traumas, some dismetabolic chronic arthropaties, and fibromyalgic syndromes.

[Possibilities of thermal medicine in gastrointestinal functional disorders]

The aim of this review is that of offer an update on the real therapeutic possibility of the thermal medicine in the functional gastrointestinal disorders. The functional dyspepsia, the irritable bowel syndrome, the functional constipation and the functional disorders of the biliary tract (in accordance with Roma II criteria), are the illness for which the drinking mineral waters could give a valid therapeutic support.

[The "petit papier": a clinical sign that should not be underestimated]

The Authors report two cases in which the sign of the "petit-papier" gives interesting question for a correct management of the patients in which the somatoform disorders is often the bulklt background of an organic illness.

[Prevalence of dyspepsia in liver cirrhosis: a clinical and epidemiological investigation]

BACKGROUND

To evaluate the prevalence and severity of dyspepsia in patients with liver cirrhosis.

METHODS

A questionnaire was distributed to 33 consecutive patients suffering from liver cirrhosis (22 males and 11 females, mean age 65.5 years; 24 with post-hepatitis liver cirrhosis and 9 with alcohol- based cirrhosis) to evaluate dyspeptic symptoms. Patients receiving prolonged treatment at home with anti-acid drugs immediately prior to hospitalisation were excluded from the study.

RESULTS

Twenty-eight patients complained of dyspeptic disorders. An organic cause of symptoms could not be identified in 8 patients (24.2%), whereas the following were identified as the causes of organic dyspepsia in the remaining 20 patients, in order of frequency: gastroesophageal reflux disease (55%), congestive gastropathy (40%), gastric or duodenal ulcer (30%) and gallbladder stones (35%). Lastly, a combination of at least two of these morbid conditions was found in 10 patients (50%). The severity of dyspeptic symptoms was similar in both organic and functional forms; symptoms tend to occur with moderate intensity, worsening in parallel with the aggravation of liver disease.

CONCLUSIONS

Dyspepsia is a very frequent phenomenon in cirrhotic patients; it is normally sustained by an organic cause. The predominance of functional forms in liver cirrhosis is practically the same as that reported in the general population.

Detection and clinical evaluation of GBV-C/HGV in plasma from patients with chronic hepatitis of unknown etiology

PURPOSE

The role of GBV-C/HGV virus infection in patients with chronic hepatitis of unknown etiology has been studied. Two groups of patients have been included: a) 50 consecutive patients with chronic hepatitis (mean age 47 yrs; M/F = 35/15), negative for markers of hepatitis viruses (HBV-HCV). These patients did not show evidence of metabolic, autoimmune, alcoholic or toxic liver disease; b) 50 healthy blood donors (mean age 35 yrs; M/F = 35/15). All the subjects were HIV-seronegative.

PATIENTS AND METHODS

The detection of GBV-C/HGV RNA was performed by reverse transcription-polymerase chain reaction techniques and capillary zone electrophoresis analysis (CZE).

RESULTS

There was no difference between the two groups of patients (14% vs 6%; p = 0.18 NS).

CONCLUSIONS

The etiopathogenetic role of GBV-C/HGV in chronic hepatitis of unknown etiology is yet to be shown.

D-dimer assays in patients with carotid atherosclerosis in clinical practice

BACKGROUND

Correlate D-dimer plasma values with the presence and degree of severity of atherosclerotic carotid lesions in consecutive outpatient and hospitalized patients without cardiovascular symptoms, checking to see if such correlation, if any, may be of help in daily clinical practice.

METHODS

113 consecutive outpatient and hospitalized patients (M/F 69/44; mean age +/- SD 66 +/- 11 years).

EXCLUSION CRITERIA

acute arterial and venous thrombo-embolism, chronic venous insufficiency of lower limbs, active infections or inflammatory conditions, neoplasms, recent trauma or surgery. Ultrasonography of epiaortic vessels and quantitative assay of D-dimer using the ELFA method (Enzyme-Linked Fluorescent Assay) were carried out.

RESULTS

The patients with carotid lesions at high thrombo-embolic risk had significantly higher D-dimer concentrations than those with normal IMT or with carotid presentation at low risk (1155 +/- 1099 ng/ml vs 359 +/- 121 ng/ml and 638 +/- 468 ng/ml; ANOVA p < 0.001). Among the patients at high thrombo-embolic risk, 85% had values higher than cut-off (vs 11.5% of patients with normal IMT and vs 45.5% of patients at low thromboembolic risk).

CONCLUSIONS

D-dimer assay is a sound means for the study of angiology patients; normal D-dimer concentrations combined with modest lesions in the arterial wall are typical of patients at low thromboembolic risk. Monitoring this parameter may be useful between ultrasound tests. Significant increases over baseline values would prompt clinical intervention and justify additional diagnostic tests.

[Hepatocarcinoma: epidemiologic and clinical evaluation of 90 patients]

PURPOSE

The aim of the study was to improve the knowledge of epidemiology and clinic of primitive HCC.

PATIENTS AND METHODS

Ninety consecutive HCC patients, attending the Medical Therapy Dpt. of Rome University "La Sapienza" were examined: diagnosis of HCC was based on histologic data in 71; in the others the diagnosis derived from ultrasonographics, RMN, TC data.

RESULTS AND CONCLUSIONS

Show M/F ratio 3.7/1; in 87% HCC is associated to liver cirrhosis (HCC/CEA); the cumulative presence of HBV and HCV is 75.6%: HCV alone 33.4%, resulting the major risk factor for HCC; patients with associated alcoholism, HBV and/or HCV show evidence of earlier appearance of HCC. Significant higher presence of HBsAg is recorded in HCC without surrounding liver cirrhosis compared to HCC/CE. The cumulative survival rate of treated patients is higher compared with non treated, irrespectively to kind of therapy. The HCC/CE+ patients have significant greater presence of elevated levels of alpha-FP and portal thrombosis compared to a randomized group of patients with liver cirrhosis only. At the end we outline that over 10% of HCC has none note risk factor for hepatic diseases.

[Oral contraceptives and activated protein C resistance: a paradigmatic example of genotype and environment interaction in the development of deep venous thrombosis]

A young woman, carrying factor V Leiden, developed a deep venous thrombosis after the use of oral contraceptives. This suggests that it is appropriate to study the most frequent causes of primary thrombophilia in all of the women beginning a treatment with estrogens.

Relationships between serum hyperhomocysteinemia and carotid atherosclerosis in geriatric patients

BACKGROUND

Evaluate the relationships between serum total hyperhomocysteinemia and carotid atherosclerosis.

METHODS

The 102 consecutive patients over the age of 65 epiaortic vessels were examined by means of a high-resolution echo-Doppler and Doppler cw. Depending on the size of the atherosclerotic plaques in the carotid the patients were divided into two groups: a) patients with lesions at high thromboembolic risk (heterogeneous and/or ulcerated plaques, hemodynamically significant stenoses > 70%); b) individuals with low risk carotid involvement (IMT normal and/or thickened by > 0.8 mm and/or lumen stenosed by homogeneous plaques < 70%). The quantitative assay of serum total homocysteinemia (tHCY) was carried out by means of an immunofluorescent method (FPIA). Depending on their tHCY values, the patients were broken down into those with normal tHCY (cut-off 14 mumol/l for the women and 16 mumol/l for the men; 62 patients, M/F = 34/28, mean age 71 +/- 4); patients with mild hyperhomocysteinemia (tHCY 14-18 mumol/l for the women; 16-20 mumol/l for the men; 19 patients, M/F = 11/8; mean age 74 +/- 7); patients with moderate hyperhomocysteinemia tHCY 18 mumol/l for the women; > 20 mumol/l for the men; 21 patients, M/F = 18/3; mean age 74 +/- 7).

RESULTS

As against the individuals with normal serum concentrations of HCY (Fig. 2; chi 2: p < 0.05), the patients with mild hyperhomocysteinemia (Odds ratio: OR = 1.48) and, above all, patients with moderate hyperhomocysteinemia (OR = 4.6) were found to have a greater prevalence of carotid lesions at high thromboembolic risk. No significant differences within the three groups were found with regard to distribution by age, gender and the prevalence of the more common cardiovascular risk factors (smoking, diabetes mellitus, arterial hypertension, hyperdyslipidemia).

CONCLUSIONS

Hyperhomocysteinemia is associated with highly severe carotid lesions at higher risk for cerebrovascular events.

[Massive polycystic liver disease with rapid evolution: report of a case]

We report a case of massive polycystic liver associated to polycystic kidney disease. In a 47-year-old woman we observed liver cysts without hepatic impairment and with only a mild renal involvement.

[Hepatic steatosis: clinical-statistical study of patients diagnosed by histological or ultrasonographic methods]

PURPOSE

This study wants to document eziopathogenetic factors and clinical, instrumental and hystological characters that associate to the various types of hepatic steatosis.

PATIENTS AND METHODS

In this retrospective study have been examined two different groups of randomized patients. The "Group 1" comprehended 70 patients with hystologic diagnosis of hepatic steatosis (steatohepatitis--SH--60%; steatosis--SE--40%). The "Group 2" comprehended 70 patients with ultrasonographic pattern of fatty liver (slight degree: 70%; severe degree: 30%).

RESULTS

Analysis of results relative to the "Group 1" showed the role of HCV-infection in etiopathogenesis of the SH, significantly greater than in SE (76.2% vs 25%; p < 0.0001). SE is often associated with exogenous noxae (alcoholism: 28.6%; use of long-term medications: 14.3%) or metabolic disorders (hyperglycemia 28.6%, hyperlipidemia 42.8%, obesity 25%). Haven't seen differences of clinical data or serum liver tests between SE and SH. Histological features that predicted the development of cirrhosis and/or fibrosis are more frequent in SH (SH: 40.4% vs SE: 10.7%; p < 0.01). The analysis of "Group 2" hasn't shown differences of clinical data or serum liver tests between slight and severe degree.

CONCLUSIONS

Analysis of results relative to the two groups of patients ones has shown that SE and SH are thick asymptomatics and associated at hepatomegaly and at increase of ALT, AST, gamma GT. The increase of ALT and/or AST leads to search for the markers of HBV and HCV; when they are positive, hepatobiopsy is necessary for the diagnosis of possible SH or evolutive state to liver cirrhosis.

[Physiopathology of angiotensin II and vascular lesion]

The Authors report, in this article, about pathophysiology mechanism that is to the base of the vascular injury mediate from the Angiotensin II able of modulate the primer, the acceleration and the progression of the atherosclerosis. Afterward is considered the importance of the administration of the inhibiting of the receptors AT-1 (Losartan) in the control of the hypertension and of the atherosclerosis.

[The treatment of chronic viral hepatitis with recombinant alpha-2 interferon: meta analysis and clinical contribution]

The Authors have developed a work of meta-analysis on the employment of IFN in the virus-correlated chronic hepatitis. They have examined World literature on: virus causing chronic hepatitis, type and duration of the treatment, criteria in the choice of the observed patients, clinical effects, effects on the virus, effects on the isto-pathologic situation. Have been considered the useful actions at the end of the treatment and in the follow-ups, so to evaluate the permanence of favourable effects. Have been also reminded the main collateral effects, even about frequency and intensity, as the various Authors relate. There are quite clear data indicating: efficacy in B-correlated chronic hepatitis greater than in C-correlated ones, greater efficacy in the treatments with Interferon with duration of more then 6 months in chronic hepatitis C. Doses greater than those generally employed appear not to give better results. The Authors moreover show the results of a clinical survey they made on patients with chronic hepatitis HBsAg+/HBeAg+ (treated with IFN-alpha 2r 5 MU t.i.w. for six months) and chronic hepatitis anti-HCV+ (treated with IFN-alpha 2r 3 MU t.i.w. for six months). The results confirm the efficacy of IFN in B-correlated chronic hepatitis (50% of sustained response) and its scarce efficacy in C-correlated chronic hepatitis for treatment shorter than 12 months (9.1% of sustained response).

[Alcoholism and HCV-antibody association. Effects on the course and severity of chronic liver disease]

BACKGROUND

The authors evaluated the role of the association alcohol-hepatitis C virus on the course and severity of chronic liver disease; they also regard the researches of many authors on this subject.

MATERIALS AND METHODS

280 consecutive patients, suffering from chronic liver disease and admitted to the Department of Medical Hydrology of Rome University ''La Sapienza'' are studied. Fifty-nine of them were affected by chronic alcoholic liver disease without evidence of hepatitis virus infection (AC-), 58 were alcoholic and positive for HCV antibody (AC+), 163 positive for HCV antibody and non alcoholic (NAC+). They are divided according to the diagnosis into chronic hepatitics, cirrhotics and those affected with hepatocarcinoma; among them 193 patients, age and sex matched, are evaluated as regards the course and severity or the chronic liver disease.

RESULTS

In the total of 280 patients the hepatic damage arises significantly faster in the alcoholic and anti-HCV positive than in other patients. In the age and sex matched, in alcoholic and HCV positive patients the hepatocarcinoma significantly prevailed (AC-: 8.2%, NAC+: 9.4%, AC+: 19%; p=0.04). The three groups of cirrhotics did not show a significant difference with respect to the severity of the disease evaluated according to Child-Pugh criteria.

CONCLUSIONS

Our research confirms the role of the association of HCV virus infection and alcoholism on the severity and impairment of chronic liver disease.

[Current therapeutic methods in primary sclerosing cholangitis]

The authors synthesize the main etiopathogenetic, physiopathologic and clinic findings of CSP and describe the pharmacs employed in the treatment of disease: corticosteroids, cyclosporin, penicillamine, colchicine, tacrolimus, metotrexate, hydrophylic bile salts. They outline the poor or none therapeutic activity of the majority of these and stress the improvement of some clinical parameters after prolonged use of hydrophilic bile salts. However none of the used pharmacs can stop the pathologic course of the disease. At the end authors remember the usefulness of liposoluble vitamins to prevent carential syndromes.

[Current aspects of therapy of primary biliary cirrhosis]

The authors expose the epidemiological features of PBC and outline the role of the immunologic disorders in the disease's pathogenesis. The main clinic and laboratory features of the PBC, its course and pathology are also synthesized. The authors describe the drugs employed in the therapy of the PBC: cortisone, azathioprine, metotrexate, chlorambucil, colchicine, D-penicillamine and hydrophilic bile salts; the favourable risk-benefice rate of colchicine, azathioprine and hydrophilic bile salts is outlined, even if they are poorly active on the disease's course. The use of lyposoluble vitamins is stressed, to improve malabsorption's syndromes. At the end the role of orthotopic liver transplant is regarded.

[Epstein-Barr virus meningoencephalitis. Considerations on a very unusual clinical manifestation in adults]

The authors report a case of meningoencephalitis occurring as a complication in an adult suffering from infective mononucleosis. As well as the clinical and serological aspects of the pathology, the authors analyse the main and most recent etiopathogenetic hypotheses responsible for neurological symptoms, and pay special attention to the indirect namely immunomediated action of the virus.

[Current orientation on medical therapy of Crohn disease]

The Crohn's disease has an increasing incidence and prevalence in the western countries and also in Italy; genetic, familiar and enviromental factors, but, above all, altered immunity have pathogenetic effects for the chronic flogosis and damage of gastroenteric tract. With ulcerative rettocolitis, the Crohn's disease is part of the chronic inflammatory bowel disease. In the present paper the medical therapy of Crohn's disease is especially studied; it is based on the use of corticosteroids and SASP or its active metabolite 5-ASA. Other pharmacs are reviewed as: immunosuppressors, antibiotics, antimetabolites and symptomatic or substitutive therapy. At the end the authors pointed out therapeutic lines in relation to acute or chronic stage and gravity of the disease.

[Current orientation in medical management of ulcerative colitis]

Authors synthetically remind epidemiology, eziopathogenesis and clinic of ulcerative colitis; they after describe the drugs employed in therapy of disease, stressing the mechanism of action, efficacy, collateral effects. Authors remember the choice of cortisonic therapy in the acute and severe periods of disease and the specific activity of salazopyrine and its metabolite 5-aminosalycilic acid in the ulcerative colitis and refer about the use of drugs as immunodepressors, fatty acids omega 3, zileuton, short chain fatty acids. Practical patterns of therapy in the diverse stages and clinical forms of the disease are exposed.

[The role of the endothelium of the microcirculation in the physiopathology of critical ischemia in the lower limbs as well as other forms of ischemic pathology]

Critical ischemia of the lower limbs, the condition of decompensation of chronic obstructive arterial disease, is the upshot of a series of pathophysiologic events involving both the macrocirculatory and microcirculatory systems. It ist, however, the latter modulator of the decompensatory stage of arterial disease that conditions the severity and hence the anatomical and clinical pattern of ischemia.

[Chronic obstructive bronchopneumopathy. Epidemiologic aspects and balneotherapy potential]

The authors remember the epidemiological data of BPCO in Italy and in the world and stress the increasing incidence and prevalence of these disease, interesting above all industrial-urban areas, middle and old aged, males and smokers. The pathogenetic role of atmospheric pollution, caused by industries, heating system and motor vehicles, in exposed. At the end Auctors summarise the results of the inhalatory therapy by mineral waters in BPCO, especially of sulphureas and salso-jodic spas.