Development and Interrogation of a Transcriptomic Resource for the Giant Triton Snail (Charonia tritonis)

Gastropod molluscs are among the most abundant species that inhabit coral reef ecosystems. Many are specialist predators, along with the giant triton snail Charonia tritonis (Linnaeus, 1758) whose diet consists of Acanthaster planci (crown-of-thorns starfish), a corallivore known to consume enormous quantities of reef-building coral. C. tritonis are considered vulnerable due to overexploitation, and a decline in their populations is believed to have contributed to recurring A. planci population outbreaks. Aquaculture is considered one approach that could help restore natural populations of C. tritonis and mitigate coral loss; however, numerous questions remain unanswered regarding their life cycle, including the molecular factors that regulate their reproduction and development. In this study, we have established a reference C. tritonis transcriptome derived from developmental stages (embryo and veliger) and adult tissues. This was used to identify genes associated with cell signalling, such as neuropeptides and G protein-coupled receptors (GPCRs), involved in endocrine and olfactory signalling. A comparison of developmental stages showed that several neuropeptide precursors are exclusively expressed in post-hatch veligers and functional analysis found that FFamide stimulated a significant (20.3%) increase in larval heart rate. GPCRs unique to veligers, and a diversity of rhodopsin-like GPCRs located within adult cephalic tentacles, all represent candidate olfactory receptors. In addition, the cytochrome P450 superfamily, which participates in the biosynthesis and degradation of steroid hormones and lipids, was also found to be expanded with at least 91 genes annotated, mostly in gill tissue. These findings further progress our understanding of C. tritonis with possible application in developing aquaculture methods.

Neurogenic bladder in the settings of congenital Zika syndrome: a confirmed and unknown condition for urologists

INTRODUCTION

Congenital Zika syndrome (CZS) is a recently discovered condition that affects central nervous system structures that control the lower urinary tract. The first cases of neurogenic bladder (NB) were recently reported as a sequalae of CZS in neurologically impaired children.

OBJECTIVE

Our goal is to further evaluate NB in the setting of CZS, identifying urological risk indicators in hopes that early diagnosis will mitigate the impact of the disease.

STUDY DESIGN

Urological assessment was performed in all patients with CZS and neurological impairment who were referred to our urodynamic clinic between June 2016 and May 2018. Neurogenic bladder was confirmed by urodynamic evaluation, and urological risk was based on urodynamic results.

RESULTS

Sixty-nine patients with CZS were tested. The majority (63 patients, 91.3%) presented with overactive bladder with increased pressures and reduced capacity for age (table 1). Different urodynamic patterns were observed, and the association of reduced bladder capacity for age, high bladder-filling pressure, and increased postvoid residual were frequently observed.

DISCUSSION

NB continues to be consistently diagnosed in our cohort of CZS, mostly with high-risk indicators for renal impairment. When not intervened upon in a timely manner, NB can cause progressive damage to the urinary tract, but the lack of knowledge that CZS causes NB delays investigation and treatment. Parents and health professionals will need to be sensitized to the risks that ZIKV can pose to the urinary tract so that appropriate therapies are initiated to prevent irreversible renal damage.

CONCLUSION

NB is a common condition among our patients with CZS and microcephaly. This is a new cause of NB, unknown to urologists. While further investigation is necessary to understand long-term disease behavior and therapeutic response, increased knowledge among urologists may help to reduce morbidity related to untreated NB and to mitigate the disease burden for patients and families.

Epididymal Lymphoma. A Case Report

Primary epididymal lymphoma is an unusual observation. Only 2 cases of non-Hodgkin's lymphoma of the epididymis have been previously reported. We describe the clinical and pathologic features and management of a primary high-grade malignant lymphoma of the epididymis in which a tentative diagnosis of lymphoma was made on the basis of cytologic examination and immunochemical staining of the material obtained from an aspiration needle biopsy.

Benign Granular Cell Tumor of the Breast: A Misleading Disease

Granular cell tumor (GCT) is a relatively rare neoplasm, and almost always benign in its prognostic behavior. Location of this tumor in the breast presents serious problems for differential diagnosis, both from a clinical point of view and at gross pathological examination, because of its resemblance to carcinoma. Fine needle aspiration biopsy and intraoperative frozen section examination may not be of any further help. The histogenesis of these lesions has been widely debated in the past, but no universally accepted conclusion has been reached. Most GCTs appear to be derived from Schwann cells, but many different neoplastic and non-neoplastic lesions show granular cell changes. Therefore, GCT should not be considered as a single entity but as the result of a cytoplasmic change due to still unknown metabolic alterations that may occur in various cell types. No firm conclusions can be drawn regarding the suspected hormonal influence on the development of breast GCT.

The authors describe three typical cases of breast GCT that occurred in patients of different ages, and discuss the most important questions concerning this lesion.

Malignant Conjunctival Epibulbar Fibrous Histiocytoma with Orbital Invasion

The Authors report on a rare case of malignant conjunctival epibulbar fibrous histiocytoma with orbital invasion. Fibrous histiocytoma is a tumour of mesenchymal origin, which, although among the most common adult age soft tumours, appears very rarely at the conjunctival level. In fact the most frequent site is the orbit. So far only 15 cases concerning conjunctiva have been described in the Literature only 4 of those have been reported as malignant. We observed a male patient, who 6 years ago, at the age of 53, noticed a neoformation on the temporal portion of the bulbar conjunctiva. In June 1988, after three successive operations, with a histological diagnosis of inflammatory granuloma, he came to our Clinic, where, because of the characteristics of the orbit infiltrations, only a partial excision was carried out for a biopsy. The histological examination, associated with immunohistochemical techniques, gave the result of malignant fibrous histiocytoma. Consequently in, July 1988, the patient underwent an exenteratio orbitae. To date, the patient enjoys good health without a trace of recurrence. Besides the clinical presentation of the case, histopathological and immunohistochemical findings concerning this type of lesion are presented and discussed, with a comparison of our findings with those reported in the literature.

Light Microscopic, Immunocytochemical and Ultrastructural Study of a Case of Sertoli Cell Tumor of the Testis

A case of testicular specialized gonadal stroma tumor was evaluated by histologic, ultrastructural and immunohistochemical techniques in a young adult male patient. The neoplastic cells were organized in cords or tubular structures delimited by a basement membrane. The ultrastructural findings suggested a diagnosis of a partially differentiated Sertoli cell tumor. This was also supported by the presence of a vimentin rich cytoskeleton, which is normally present in Sertoli and Leydig cells. The tumor cells did not secrete steroid hormones, as suggested by clinical findings, as well as by hormonal, immunohistochemical, and ultrastructural observations.

Concurrence of lower jaw skeletal anomalies in triploid Atlantic salmon (Salmo salar L.) and the effect on growth in freshwater

Triploid Atlantic salmon populations are associated with higher prevalence of lower jaw skeletal anomalies affecting fish performance, welfare and value deleteriously. Anomalous lower jaw can be curved downward (LJD), shortened (SJ) or misaligned (MA). Two separate groups of triploid Atlantic salmon (~12 g) with either normal lower jaw (NOR) or SJ were visually assessed four times over three months for presence and concurrence of jaw anomalies (with severity classified) and opercular shortening to understand the relatedness of these anomalous developmental processes. The prevalence of jaw anomalies increased in both groups over time (NOR group - SJ, LJD and MA combined 0-24.5%; SJ group - LJD and MA combined 17-31%). SJ and LJD occurred both independently and concurrently whereas MA exclusively concurred with them. All three anomalies could be concurrent. Severity of both LJD and SJ increased in the SJ group only. Opercular shortening recovery was observed in both groups but at a slower rate in the SJ group. The SJ group specific growth rate (SGR) was significantly (P < 0.05) lower than the NOR group. This study demonstrated the concurrence of SJ, LJD and MA and showed possible deleterious consequences deriving from the conditions.

Skeletal anomaly assessment in diploid and triploid juvenile Atlantic salmon (Salmo salar L.) and the effect of temperature in freshwater

Triploid Atlantic salmon tend to develop a higher prevalence of skeletal anomalies. This tendency may be exacerbated by an inadequate rearing temperature. Early juvenile all-female diploid and triploid Atlantic salmon were screened for skeletal anomalies in consecutive experiments to include two size ranges: the first tested the effect of ploidy (0.2-8 g) and the second the effect of ploidy, temperature (14 °C and 18 °C) and their interaction (8-60 g). The first experiment showed that ploidy had no effect on skeletal anomaly prevalence. A high prevalence of opercular shortening was observed (average prevalence in both ploidies 85.8%) and short lower jaws were common (highest prevalence observed 11.3%). In the second experiment, ploidy, but not temperature, affected the prevalence of short lower jaw (diploids > triploids) and lower jaw deformity (triploids > diploids, highest prevalence observed 11.1% triploids and 2.7% diploids) with a trend indicating a possible developmental link between the two jaw anomalies in triploids. A radiological assessment (n = 240 individuals) showed that at both temperatures triploids had a significantly (P < 0.05) lower number of vertebrae and higher prevalence of deformed individuals. These findings (second experiment) suggest ploidy was more influential than temperature in this study.

Identification and Characterization of an Insulin-Like Receptor Involved in Crustacean Reproduction

Sexual differentiation and maintenance of masculinity in crustaceans has been suggested as being regulated by a single androgenic gland (AG) insulin-like peptide (IAG). However, downstream elements involved in the signaling cascade remain unknown. Here we identified and characterized a gene encoding an insulin-like receptor in the prawn Macrobrachium rosenbergii (Mr-IR), the first such gene detected in a decapod crustacean. In mining for IRs and other insulin signaling-related genes, we constructed a comprehensive M. rosenbergii transcriptomic library from multiple sources. In parallel we sequenced the complete Mr-IR cDNA, confirmed in the wide transcriptomic library. Mr-IR expression was detected in most tissues in both males and females, including the AG and gonads. To study Mr-IR function, we performed long-term RNA interference (RNAi) silencing in young male prawns. Although having no effect on growth, Mr-IR silencing advanced the appearance of a male-specific secondary trait. The most noted effects of Mr-IR silencing were hypertrophy of the AG and the associated increased production of Mr-IAG, with an unusual abundance of immature sperm cells being seen in the distal sperm duct. A ligand blot assay using de novo recombinant Mr-IAG confirmed the existence of a ligand-receptor interaction. Whereas these results suggest a role for Mr-IR in the regulation of the AG, we did not see any sexual shift after silencing of Mr-IR, as occurred when the ligand-encoding Mr-IAG gene was silenced. This suggests that sexual differentiation in crustaceans involve more than a single Mr-IAG receptor, emphasizing the complexity of sexual differentiation and maintenance.

Degree of cognitive impairment and mortality: a 17-year follow-up in a community study

BACKGROUND

To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment.

METHOD

A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages.

RESULTS

Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the 'mild' degree of impairment; HR: 1.29 in the 'moderate' degree; and HR: 2.08 in the 'severe' degree). The PAF of mortality due to severe cognitive impairment was 3.49%.

CONCLUSIONS

A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.

Identification of components of health complexity on internal medicine units by means of the INTERMED method

BACKGROUND

The INTERMED was developed for the early identification of biological, psychological, social and health system factors considered interacting in health complexity. This is defined as the interference with the achievement of expected or desired health and service use outcomes when patients are exposed to standard care.

OBJECTIVE

The aim of this study was to test the INTERMED's ability to identify 'case' and 'care' complexity, identifying patients that would especially benefit from integrated care.

METHODS

Observational longitudinal study of Internal medicine in patients in two National Health System hospitals in Spain using the INTERMED (patients scoring ≥ 21 were considered to be 'complex'); the Cumulative Illness Rating Scale (CIRS), a severity of illness assessment; and standard clinical variables.

RESULTS

Six hundred and fifteen consecutives were included, and the prevalence of health complexity was 27.6%. The greatest differences between patients with and without health complexity were observed in the non-biological domains. Eighty-five per cent of patients with health complexity had non-biological items considered to require timely (immediately or soon) assistance or intervention compared to 30% of those without, nearly a threefold difference. Complex patients had a significantly higher number of medical diagnoses (p = 0.002) and number of psychiatric referrals (p = 0.041), but there were no differences in CIRS scores or lengths of stay.

CONCLUSION

The INTERMED has the potential to identify a considerable subset of complex internal medicine inpatients for which timely corrective action related to non-biological risk factors not typically uncovered during standard medical evaluations would be considered beneficial.

Cortisol and anxiety response to a relaxing intervention on pregnant women awaiting amniocentesis

BACKGROUND

Stress and anxiety during pregnancy have been associated with premature and low birth weight babies, presumably through fetus over exposion to glucocorticoids. Antenatal stress also seems to have long-term effects upon infant development and adult health. However, medication for stress may carry risks to the expectant mother, therefore the efficacy of non-pharmacological interventions should be investigated.

METHODS

Pregnant women (n=154) awaiting amniocentesis, were randomly assigned in the morning and the afternoon to three groups for 30 min: (1) listening to relaxing music, (2) sitting and reading magazines, and (3) sitting in the waiting-room. Before and after that period, they completed the Spielberger's State and Trait anxiety inventory and provided blood samples for cortisol. The groups were then compared regarding change in cortisol levels and anxiety.

RESULTS

Maternal cortisol and state anxiety were correlated (r=0.25, p=0.04) in the afternoon, but not in the morning. The larger decreases in cortisol occurred in the music group (-61.8 nmol/L, ANOVA: p=0.01), followed by magazine, being differences among groups more pronounced in the morning. Women in the music group also exhibited the greater decreases in state anxiety (p<0.001). Younger mothers with less gestational age were on average the most anxious, and also the ones with greater decreases in cortisol and anxiety levels after relaxation.

CONCLUSION

A relaxing intervention as short as 30 min, especially listening to music, decreases plasma cortisol and self-reported state anxiety score. Pregnant women might benefit from the routine practice of relaxation in the imminence of clinical stressful events.

Incidence and lifetime risk of dementia and Alzheimer's disease in a Southern European population

OBJECTIVE

To calculate both the incidence rates and the lifetime risk (LTR) of dementia and Alzheimer's disease (AD).

METHODS

A two-phase case-finding procedure was implemented in a cohort of 4057 cognitively intact individuals 55+ years of age living in Zaragoza, Spain, and followed-up at 2.5 and 4.5 years. Age- and sex-specific incidence rates were calculated. A mortality-adjusted, multivariate model was used to document LTRs.

RESULTS

The incidence rate of dementia continued to rise after the age of 90 years, but was slightly lower than in North and West European studies. Only a tendency for an increased LTR with age was observed. Thus, LTR was 19.7% for a 65-year-old woman and 20.4% at the age of 85 years, the corresponding figures for AD being 16.7% and 17.6%. The LTR of AD was higher in women and was about twice as high among illiterate individuals when compared with individuals with higher educational levels.

CONCLUSIONS

The incidence rate of dementia in this Southern European city was slightly lower than in previous studies in North-West Europe. LTR of dementia and AD seems to be slightly increased with age. The association of illiteracy with higher LTR of AD is intriguing.

Isolation and characterization of a female-specific DNA marker in the giant freshwater prawn Macrobrachium rosenbergii

In this study, a female-specific DNA marker in the freshwater prawn Macrobrachium rosenbergii was identified through amplified fragment length polymorphism (AFLP). The AFLP-derived sequence-characterized amplified region (SCAR) marker was tested in over 200 individuals, giving reproducible sex identification. Further molecular characterization of the sex-marker's genomic region (∼ 3 kb long) revealed the presence of tandem and inverted repeats. The ∼ 3-kb sequence was identified both in male and female prawns, but with subtle differences: a deletion of 3 bp (present in female prawn but absent in male prawn) identified upstream of the SCAR marker sequence and two female-specific single-nucleotide polymorphisms, both indicating that male prawns are homozygous, whereas female prawns are heterozygous in this locus. Fluorescent in situ hybridization showed the ∼ 3-kb sequence to be unique: to the best of our knowledge, this is the first report of a unique sex-specific sequence observed in situ in crustaceans. The sex-specific marker identified in M. rosenbergii may have considerable applied merit for crustacean culture in that it will enable the determination of genetic sex at early developmental stages when phenotypic differences are not identifiable.

Prevalence and implications of psychopathological non-cognitive symptoms in dementia

OBJECTIVE

Clinical experience and recent population studies suggest that psychopathological, non-cognitive symptoms are both frequent and relevant in dementia.

METHOD

A representative community sample (n = 4,803 individuals, 55 + years) was interviewed in a two-phase design. The Geriatric Mental Sate (GMS) was used for assessment and cases were diagnosed according to DSM-IV-TR criteria.

RESULTS

The prevalence of non-cognitive symptoms (1 + symptoms) in cases of dementia (n = 223) was 90.1%, and negative-type symptoms were most frequently found. A GMS 'apathy-related symptom cluster' (anergia, restriction of activities and anhedonia) was significantly more frequent in the demented (55.6%) than in non-cases (0.7%; specificity = 99.2%). In both dementia of Alzheimer's type and vascular dementia, number of symptoms tended to be inversely related to severity of dementia, but psychopathological profiles differed.

CONCLUSION

Non-cognitive, negative-type symptoms are very frequent in cases of dementia living in the community. They have powerful specificity in the distinction with non-cases, and might change current concepts of dementia.

Prevalence of dementia in a southern European population in two different time periods: the ZARADEMP Project

OBJECTIVE

To compare the prevalence of dementia in two different time periods and two different studies.

METHOD

Representative, random samples of the elderly (>65 years) in the Zaragoza Study or ZARADEMP-0 (n = 1080) completed the previous decade, and now in Wave I of the ZARADEMP Project or ZARADEMP-I (n = 3715) were interviewed. Standardized measures included the Geriatric Mental State and the History and Aetiology schedule. Cases of dementia were diagnosed according to DSM-IV criteria.

RESULTS

Adjusted, global prevalence of dementia has not varied significantly: it was 5.2% (95% CI = 3.9-6.6) in ZARADEMP-0 and 3.9% (95% CI = 3.3-4.5) in ZARADEMP-I (prevalence ratio = 0.75; 95% CI = 0.56-1.02). However, the prevalence in ZARADEMP-I was significantly lower among men, particularly in all age groups between 70 and 84 years.

CONCLUSION

Stability of the global prevalence of dementia in the elderly population has been documented. However, the decreased prevalence found in elderly men stimulated environmental hypotheses.

[Can analysis of the molecular status of the p53 gene contribute to improving the therapeutic strategy for breast carcinoma?]

The occurrence of mutations in the p53 tumor suppressor gene is a specific and recurring genetic event in solid tumors. P53 plays a pivotal role in multiple cellular processes such as cell growth control, DNA repair and programmed cell death. Genotoxic damage, also induced by chemotherapy or radiotherapy, induces p53 overexpression in order to control the rate of proliferating damaged cells, thus triggering the mismatch repair or apoptotic pathways. P53 inactivation determines a condition of genetic instability, justifying the subsequent susceptibility to acquire mutations of different other genes. P53 mutations are associated with worse prognosis and with chemo/radioresistance, due to the inability to trigger p53-dependent programmed cell death. Molecular diagnostic strategies show 32% p53 mutations in breast cancer. The analysis of the p53 gene performed by FAMA (Fluorescence Assisted Mismatch Analysis) in high-risk breast cancer patients with > or = 10 involved axillary nodes may help identify a subset of very high risk BC patients (vHR-BC) with poorer prognosis and a subset with better prognosis, potentially responsive to medical treatments. The accurate evaluation of the p53 status can predict prognosis and sensitivity to chemotherapy, thus representing the first step toward better definition of therapeutic strategies according to the molecular characterization of the individual patient.

Prognostic value of p53 molecular status in high-risk primary breast cancer

BACKGROUND

Mutations in the p53 gene are the most common genetic alterations in human primary breast carcinoma and these mutations are often associated with worse prognosis and chemo/radioresistance.

PATIENTS AND METHODS

The analysis of the p53 gene was performed by fluorescence-assisted mismatch analysis in 13 consecutive high-risk primary breast cancer (HR-BC) patients with 10 or more involved axillary nodes to evaluate its prognostic value.

RESULTS

Three p53 mutations (23%) and four allelic variants were detected. After a median follow-up of 52 months the HR-BC disease-free survival (DFS) was 51% and overall survival 79%. All patients harboring a p53 mutation (p53(mut)) relapsed within 10 months of the median DFS while 67% of those showing a wild-type p53 status (p53(wt)) survive disease-free at a median follow-up of 43 months. One p53(mut) patient is still alive while all the p53(wt) patients survive at 56 months median follow-up. Two out of the four p53(wt) relapsing breast cancer patients showed the Arg72Pro allelic variant; one of these died at 75 months.

CONCLUSIONS

p53 mutations may help identify a subset of very high risk breast cancer patients (vHR-BC) with worse prognosis.

Lack of prognostic significance in Goseki grading of gastric carcinoma

The Goseki grading system, based on intracellular mucin content and tubular differentiation, was originally created to study the influence of histologic type on the mode of extension of gastric carcinoma. The prognostic value of this grading system was subsequently proposed and even recently supported, but controversies still remain about this topic. We applied the Goseki system on 114 cases of node-negative primary gastric cancer and compared Goseki groups with the other clinicopathologic features of the patients. Statistical analysis showed a significant correlation between Goseki grading and Laurèn classification, but failed to reveal any prognostic significance for this grading system. We believe that Goseki classification should not be routinely used for prognostic purposes.

[Histochemical assessment of immunoreactivity of thyroid peroxidase and its correlation with biochemical activity]

BACKGROUND

Peroxidase content has been recently evaluated in normal thyroid and in different thyroid disorders by biochemical, histochemical, ultrastructural and immunocytochemical methods Nevertheless immunocytochemical detection of thyroid peroxidase in thyroid samples conventionally processed for histology hes never been done using a commercially available antibody, neither its correlation with the biochemical activity on adjacent samples.

METHODS

In this study we have analyzed normal thyroid tissue (3 patients), follicular adenoma (2 patients) and multinodular goiter (2 patients) conventionally processed for histology and stiined by immunocytochemistry (Avidin Biotin System) using a polyclonal (rabbit) antibody for horseradish peroxidase (Serotec). Biochemical assay was performed on adjacent samples according to Hosoya method.

RESULTS

Normal thyroid showed peroxidase immunoresectivity in the majority of follicular celis; neoplastic cells of adenomas were variably stained. Biochemical assay showed positive correlation with ICC ranging from 20.4 mg/mg/prot a in multinodular goiter to 42.12 in normal thyroid, up to 122 of follicular adenoma.

CONCLUSIONS

Peroxidase content in the thyroid gland may be of clinical interest in several thyroid diseases, and in this study we have demonstrated that thyroid peroxidase can be detected by ICC in routinely processed thyroid samples using a commercially available antibody.

Agar specimen orientation technique revisited: a simple and effective method in histopathology

The agar technique represents an important method to obtain optimal orientation of small specimens during paraffin embedding and to avoid tissue loss during processing. This method is advisable for ocular, temporal artery, gastrointestinal, cervical, and skin biopsies and may be applied with formalin-fixed specimens as well as with fresh tissue. Microwave oven can be successfully used to make the small specimen orientation technique with agar quicker and easier. Ann Diagn Pathol 5:107-109, 2001.

Increased enterocyte apoptosis and Fas-Fas ligand system in celiac disease

Our aim was to evaluate whether increased enterocyte apoptosis was responsible for mucosal flattening in celiac disease (CD), and, since the mechanisms responsible for tissue injury in this condition are unknown, we studied the possibility that the Fas-Fas ligand (FasL) system may be involved. Endoscopic duodenal biopsy specimens from 12 patients with untreated and 12 with treated CD and 12 control subjects were evaluated for enterocyte apoptosis by the terminal deoxynucleotidyl transferase-mediated digoxigenin-deoxyuridine triphosphate nick-end labeling assay and for Fas and FasL expression by immunohistochemistry. A coculture of isolated enterocytes (targets) and purified lamina propria mononuclear cells (LPMCs) (effectors) was performed in the absence or presence of an antagonistic ZB4 anti-Fas antibody. We found a significant correlation between the degree of villous atrophy, morphometrically evaluated, and the level of enterocyte apoptosis, suggesting that mucosal flattening is a consequence of exaggerated epithelial cell death. Most celiac enterocytes express Fas, and LPMCs express FasL. The abolishment of enterocyte apoptosis observed in the presence of ZB4 antibody suggests that enterocytes are potential targets of lymphocyte infiltrate. These results directly demonstrate that FasL-mediated apoptosis is a major mechanism responsible for enterocyte death in CD.

[Recurrent abdominal pain and "chronic appendicitis"]

BACKGROUND

Chronic appendicitis may be the cause of recurrent abdominal pain. This hypothesis is the subject of controversy. The aim is to clarify the possible existence of a chronic inflammation of the appendix by a clinical and histopathologic study.

METHODS

The case history and the preoperative symptoms and serum findings of 269 patients with appendectomy have been studied. All the appendices have been histologically examined. Chronic appendicitis was diagnosed when at least two typical histological factors of chronic inflammation were present. The histological findings of the appendices have been correlated with preoperative clinical and serum findings of the patients. 14-46 months after the appendectomy, the patients have been examined.

RESULTS

Histological examination revealed 187 cases (69.5%) with acute appendicitis, 44 cases (16.3%) with non disease of appendix and 38 cases (14.2%) with chronic appendicitis. Recurrent abdominal pain and normal leukocyte count were closely correlated (chi 2 = 18.3, p < 0.001; chi 2 = 21.3, p < 0.001 respectively) with diagnosis of chronic appendicitis. 81.8% of 33 patients with chronic appendicitis who underwent follow-up had relief of all the symptoms after appendectomy.

CONCLUSION

Therefore, the study seems to confirm the existence of a clinico-pathological condition that can be defined as chronic appendicitis, resolvable with appendectomy.

[Revalidation and standardization of the cognition mini-exam (first Spanish version of the Mini-Mental Status Examination) in the general geriatric population]

BACKGROUND

The revalidation of the Mini Examen Cognoscitivo (MEC), first Spanish version (1978) of the Mini-Mental Status Examination (MMSE) and documentation of "population-based norms" should clarify the potential confusion induced by later versions of MMSE.

METHODS

CONTEXT

The Zaragoza Study on the prevalence of dementia and depression in a representative sample of the elderly community (N = 1,080).

INSTRUMENTS

MEC-35 and MEC-30 points, and validated, Spanish versions of Geriatric Mental State (GMS), History and Aetiology Schedule (HAS) and Social Status Schedule (SSS).

PROCEDURE

a) validation of MEC (standardized lay interviewers) against the gold standard of psychiatric diagnosis (DSM-III-R), two months later; b) "population-based norms" in the "healthy" population, and c) comparison with other MMSE versions.

RESULTS

The instrument fulfills criteria of "feasibility", "content", "procedural" and "construct validity". Test-retest reliability: weighted kappa = 0.637. MEC-30 (cut-off point 23/24), sensitivity = 89.8%, specificity = 75.1% (80.8% with the cut-off at 22/23), and ROC curve, AUC = 0.920. The coefficients of individual items were satisfactory and the specificity increases in MEC-35 (83.9%). Other MMSE Spanish versions have not improved these coefficients. "Population-based norms" confirm the hypothesized influence of age and education level. MEC-30 is the version with most comparable results with the MMSE in USA.

CONCLUSIONS

The validity of MEC is confirmed in the elderly population, with the same cut-off points recommended in the original standardization. MEC-30 is the best version for international comparisons.

N-nitroso compounds and Helicobacter pylori in the gastric remnant

AIMS AND BACKGROUND

The aims of this study were to investigate the role of N-nitroso compounds (NOC) and Helicobacter pylori (H. pylori) in gastric stump carcinogenesis.

METHODS AND STUDY DESIGN

Analyses of biochemical parameters such as pH and NOC concentration were carried out on 65 fasting gastric juice samples obtained at endoscopy from 45 patients previously submitted to partial gastrectomy for benign peptic ulcer disease (23 Billroth I, 22 Billroth II/Reichel-Polya) and 20 normal controls. Biopsy specimens were taken to determine histology and H. pylori status.

RESULTS

Significantly higher mean pH values and NOC concentrations were found in partial gastrectomies compared to normal controls. In relation to surgical methods, higher mean pH values and NOC concentrations were observed in the gastric juice of patients with Billroth II compared to Billroth I gastrectomies. Independently of the type of surgical reconstruction, higher mean NOC levels were recorded in patients with more severe histological changes and H. pylori infection.

CONCLUSIONS

All these data suggest that high levels of NOC in gastric juice and H. pylori infection could be cofactors in gastric stump carcinogenesis.

Immunohistochemical assessment of peroxidase-like immunoreactivity in the thyroid gland and its correlation with biochemical assay

BACKGROUND

Peroxidase content has been recently evaluated in normal thyroid and in different thyroid disorders by biochemical, histochemical, ultrastructural and immunocytochemical methods. Nevertheless immunocytochemical detection of thyroid peroxidase in thyroid samples conventionally processed for histology has never been done using a commercially available antibody, neither its correlation with the biochemical activity on adjacent samples.

METHODS

In this study we have analyzed normal thyroid tissue (3 patients), follicular adenoma (2 patients) and multinodular goiter (2 patients) conventionally processed for histology and stained by immunocytochemistry (Avidin Biotin System) using a polyclonal (rabbit) antibody for horseradish peroxidase (Serotec). Biochemical assay was performed on adjacent samples according to Hosoya method.

RESULTS

Normal thyroid showed peroxidase immunoreactivity in the majority of follicular cells; neoplastic cells of adenomas were variably stained. Biochemical assay showed positive correlation with ICC ranging from 20.4 micrograms/mg/prot a in multinodular goiter to 42.12 in normal thyroid, up to 122 of follicular adenoma.

CONCLUSIONS

Peroxidase content in the thyroid gland may be of clinical interest in several thyroid diseases, and in this study we have demonstrated that thyroid peroxidase can be detected by ICC in routinely processed thyroid samples using a commercially available antibody.

[Gastric carcinoma: a histopathological study of 705 cases]

We examined 705 surgical specimens of total and subtotal gastrectomy for gastric cancer, from the Surgical Pathology Department of L'Aquila, Atri and Avezzano, during the period from January 1972 to December 1991. For each case at least 15 samplings were taken, from the tumor itself and from the mucosa which appeared macroscopically normal. The cases were then classified according to the criteria proposed by Lauren and by Ming and the staging of the disease using the UICC's pTNM. Applying Ming's classification, it was evident a clear prevalence of the infiltrative (78.6%), rather than the expansive type (21.4%). Lauren's classification showed a slight prevalence of the diffuse type (56.5%), compared with the intestinal type. Intestinal metaplasia, chronic atrophic gastritis and dysplasia were found more frequently in the intestinal and expansive histotypes. These are the forms having a better prognosis and which in our results represent a minority of cases, therefore identifying the geographic area as a low risk area. With regards to the pTNM staging, T3's resulted the most numerous; T1's, or early gastric cancers (EGC), represented instead 15.7% of the total. Such a percentage is rather high in comparison with the mean percentage in western countries with low risk of disease. In reference to the macroscopic variants, a clear prevalence of the ulcerated forms (66.5%) was noted, in contrast with Ming and other Authors, that declare a slight prevalence of the fungating type. Also considering the histotypes there is a certain discrepancy between the data of Ming and ours; in fact, in our study the infiltrative type prevails, representing 78.6% against 33.6% found by Ming. Such a result can be usefully correlated to the high percentage of the ulcerated forms observed in our study and to the relative scarcity of fungating forms; these variants themselves, according to Ming, are usually related to the expansive type of gastric carcinoma. We also noted, in EGC, a remarkable age difference in regards to the diffuse type; the mean age of the 57 patients with this type classified as T1 was 52.2 years against the 63.0 years of the 341 patients with T > 1. The patients with T1 diffuse type carcinoma were not only 10.8 years younger than the patients with advanced gastric cancer of corresponding histotype, but were also 10 years younger than patients with EGC of intestinal type. Such data could support the hypothesis that EGC, diffuse type, has a peculiar biologic behavior.

Histopathological study of 110 cystectomy specimens for bladder cancer by an original mapping method

The management of cystectomy specimens represents the first and most important step in the study of bladder cancer and related lesions. We carried out a study on 110 patients, applying an original mapping protocol which allowed to determine the exact topography of lesions, recognizing even the smallest ones and putting in evidence some rare histotype. A prevalence of high-grade, high-stage tumors was noted, as well as a remarkable frequency of precancerous lesions, mostly found in Brunn's nests. This latter finding could mean that in many cases a flat carcinoma becomes invasive within a Brunn's nest rather than in surface urothelium. We were also able to accurately evaluate prostatic pathology, finding incidental malignant lesions of this gland in 24.2% of the cystectomized males. The apparently worst prognosis of the patients who underwent chemotherapy depends on the fact that they had grades and stages higher than the untreated subjects. In conclusion, we believe that a more extensive sampling of cystectomy specimens gives highly reliable prognostic data and represents an unreplaceable tool in understanding bladder neoplasms.

Ectopic adrenal tissue in the spermatic cord. Case report and review of the literature

Ectopic adrenal tissue is a not uncommon clinical finding, especially in children. These aberrant rests have been reported in various locations, such as kidney, testis and related structures, female genital tract and supradiaphragmatic region. The most common site in the male genital district is the spermatic cord. We report a case of ectopic adrenal in the spermatic cord, occasionally found in an asymptomatic 42-years-old man. No other pathologic condition of urogenital tract was present. The nodule measured 0.5 cm in diameter and was histologically arranged in three well defined layers, with predominance of the zona fasciculata. No adrenal medullary tissue was observed. The pathogenesis of this ectopic tissue near the testis can be explained by the embryologic relationship between adrenal cortex and the gonad. Finally, we reviewed the relevant literature and the main clinical implications of this condition.

[Chronic schizophrenia: validity of the study of regional cerebral blood flow through cerebral SPECT]

OBJECTIVE

To check the validity of the diagnostic test in schizophrenia.

MATERIAL AND METHODS

The cerebral blood flow (CBF) characteristics were assessed by means of single photon emission tomography (SPECT) in 24 patients with schizophrenia and 20 normal control subjects. Analysis of sensitivity, specificity and the Youden rate was made of certain RCBF patterns chosen in terms of the cerebral regions between which the greatest differences were observed according to the diagnosis, schizophrenia vs control.

RESULTS

Schizophrenia vs control: sensitivity = 58.33%; specificity = 95%; positive predictive value = 93.33% and overall efficiency = 53.33%.

CONCLUSIONS

Cerebral SPECT is valid in the discrimination between patients diagnosed with schizophrenia and control subjects, taking the diagnostic judgement of the psychiatrist as the gold standard, and the RCBF pattern that displays the best coefficient is hypoperfusion, in one or several of the regions: right frontal/left frontal/right parietal/thalamus: sensitivity = 58.33%; specificity = 95%; positive predictive value = 93.33% and overall efficiency = 53.33%.

Multiple gastric lipomas: report of an asymptomatic case found at autopsy

Gastric lipomas are uncommon lesions, usually single and located in the antrum. Common symptoms include upper digestive bleeding, anemia, and intestinal obstruction. Alternatively, they may remain asymptomatic, and detectable only at autopsy. A case of a 72-year-old man, who died of myocardial infarction, was found at autopsy to have multiple gastric lipomas of the corpus and antrum, with a single lesion measuring 10 x 6.5 x 3 cm.

Müllerian adenosarcoma of the uterus

A case of adenosarcoma of the uterus in a 59-year-old woman is here reported. Adenosarcoma is a low malignant potential tumor with a benign glandular and a malignant stromal component. The treatment is usually hysterectomy with bilateral salpingo-oophorectomy. Debated is the usefulness of adjuvant chemotherapy, while radiation treatment is not beneficial. Long term follow-up is necessary for these patients because of high recurrence risk, mostly in cases with myometrial invasion.

Association between chronic lymphocytic leukaemia and secondary tumours: unusual occurrence of a neuroendocrine (Merkell cell) carcinoma

The authors describe a case of cutaneous neuroendocrine (Merkell cell) carcinoma in a patient previously treated for Chronic Lymphocytic Leukaemia (CLL). The authors discuss some of the mechanisms concerning the increased frequency of a second tumour in patients with CLL and focus attention on the high incidence in CLL of secondary tumours, especially skin tumours, of which Merkell cell carcinoma is a rare example. The authors consider the possible therapeutic approaches, reported in the literature, for the treatment of this particular skin carcinoma, which on account of its aggressiveness and the preexistence of a leukaemic process requires a particularly careful therapeutic approach.

[Sclerotherapy of thyroid cysts with tetracycline hydrochloride]

In order to verify sclerotherapy efficiency in solitary thyroid cysts, needle aspiration of the cyst followed by instillation of tetracycline hydrochloride into the cyst cavity was performed in 110 patients; in thirty of these the aspirations was ultrasonically guided. A tight dressing on the neck was applied for 48 hours in order to maintain pressure on the cyst cavity. All patients were treated with L-T4 in TSH-suppressive doses. In a few patients (< 155), the tetracycline instillation caused local pain, lasting less than two hours. In no case, did cytological examination of the sediment of the aspirated fluid reveal any evidence of malignant cells. In 82 patients (84.54% of the 97 controlled patients), the last ultrasonic follow-up (performed at 3, 6, 9, 12 or 24 months) showed a decrease in lesion size. In particular, 16 patients (16.50%) had a complete cyst disappearance, 41 patients (42.17%) had a volume reduction of the cyst between 85 and 65%, and in 25 patients (25.77%) the reduction was more than 25%. In the remaining 15 patients (15.46%) a second treatment was performed, 3 of them also required a third treatment but in all these cases, the results seemed to be less satisfactory. The distinction in cyst size seemed to indicate that in the case of a large cyst (> 36 mm diameter), the treatment gives better results (92% success rate against 82% of the other patients). In conclusion, we are able to affirm that needle aspiration of the thyroid cyst with instillation of tetracycline hydrochloride is a simple, well tolerated and low cost technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical anatomy of the papilla of Vater and biliopancreatic ducts

The present research was aimed at defining the surgical anatomy of the biliopancreatic ducts and of Oddi's sphincter. The numerous anatomic variations of the papilla, the millimetric distribution of its muscle fibres, and any morphological detail of clinical significance have been investigated. An integrated analysis of radiographic, tridimensional (casts), and histologic findings has been carried out in 49 of 64 autoptic bilio-duodenopancreatic specimens. Exact limits of the choledocus and Wirsung sphincters were defined. A consistent accumulation of circular muscle fibres could be seen, on the choledocus duct side, up to a mean distance of 13.6 mm from the papillary pore. However, more rarefied fibres were present up to 20.5 mm. Muscle fibres were seen to stop roughly on the pancreatic duct side at 7.3 mm from the papillary pore. The beginning of the sphincter was observed 2-3 mm above the papillary pore. There was no evidence suggesting the presence of upper, middle, and lower biliary sphincters. Five anatomic diversities of the Wirsung-choledocus confluence were found. The Y type was the most frequent (61.2%), followed by the U type (22.4%), V (14.3%), and II (2.1%). Santorini's duct with a normal papilla was present in 16 per cent of the cases. These data along with other interesting observations on antireflux mechanisms (Santorini's valves) and on the ductal space orientation appear to be useful guidelines for a physiopathological understanding of bilio-pancreatic diseases and for any therapeutic procedure on these structures.

Primary adenocarcinoma arising in the jejunal limb of a Roux-en-Y esophagojejunostomy: a case report

Adenocarcinoma of the small bowel is uncommon. Due to the paucity and lack of specificity of symptoms, patients are usually seen late in the course of their illness when curative therapy, mainly represented by wide surgical resection, is unlikely. The authors report a case of primary adenocarcinoma arising in the jejunal limb transposed for a Roux-en-Y esophagojejunostomy reconstruction eight years after a total gastrectomy performed for an advanced gastric cancer (pT2N1M0), with mixed histological pattern (tubular-mucinous) and negative CEA staining of cancer cells. Evidence for excluding the possibility of a recurrence of the primitive gastric cancer was based on the different histologic pattern, positive CEA staining of cancer cells and other features of the second neoplasm. Early diagnosis of the neoplasm was made possible by its favorable anatomic location and the early onset of symptoms, which prompted effective surgical therapy (wide resection). The authors, furthermore, analyze and discuss the possible pathogenesis of the neoplasm, based on the evidence of slow jejunal limb emptying, elevated concentration of N-Nitroso compounds and contamination by N-nitrosating bacteria in the jejunal limb juice, suggesting that each of these factors could have had a role to play in the development of the jejunal malignancy.

Familial postaxial acrofacial dysostosis syndrome

Images

[Magnetic resonance in the diagnosis of thyroid diseases]

Previous clinical experience in the study of the soft tissues of the neck region has pointed out the accuracy of MRI in terms of high definition and contrast resolution. Seventy-seven patients with thyroid diseases were examined to define the possible role of MRI in the diagnosis of these conditions. In the patients affected with thyroiditis, MR findings were not specific, showing increased glandular volume and signal inhomogeneity. MR examinations of struma allowed an accurate evaluation of glandular size; furthermore, more information was obtained than with other imaging modalities in the cases with mediastinal involvement. On T2-weighted images, adenomas were always hyperintense, whereas variable signal intensity was seen on T1-weighted scans, with the exception of Hürthle cell adenomas, which were hyperintense on both T1- and T2-weighted sequences. MRI proved to be reliable in the depiction of tumor spread at both glandular and extraglandular levels. The distinction between scar fibrosis and relapse was also possible, in the cases undergoing postoperative follow-up. In conclusion, MRI emerges as a diagnostic tool complementary to other imaging techniques. However, in selected conditions--e.g., mediastinal struma and tumors--and in the postoperative follow-up, MRI can be considered the method of choice.

Isolated atrial myocardial infarction: pathological and clinical features in 10 cases

Isolated myocardial infarction of the atria is a relatively understudied and underestimated entity, rarely diagnosed in life. The pathological and clinical features in 10 cases of acute isolated atrial myocardial infarction are reported. They represent 3.5% of all myocardial necrosis out of a series of 2,704 consecutive autopsies in adults. The right atrium is more frequently involved than the left atrium (9:1). Pulmonary hypertension, with or without coronary arterial narrowing, is the major condition leading to isolated atrial infarction. Congestive heart failure, thromboembolic phenomena, and supraventricular arrhythmias are the most frequent complications of atrial infarction. The electrocardiographic findings are often non-specific and elusive and are not useful to a correct diagnosis. These observations suggest that isolated atrial myocardial infarction is a well-distinct entity with respect to ventricular myocardial infarction, since there are several differences between the 2 diseases in pathogenesis, diagnosis, clinical picture, and prognosis.