Variations of the perforin gene in patients with multiple sclerosis

Perforin is involved in cell-mediated cytotoxicity and mutations of its gene (PRF1) cause familial hemophagocytic lymphohistiocytosis (FLH2). PRF1 sequencing in 190 patients with multiple sclerosis and 268 controls detected two FLH2-associated variations (A91V, N252S) in both groups and six novel mutations (C999T, G1065A, G1428A, A1620G, G719A, C1069T) in patients. All together, carriers of these variations were more frequent in patients than in controls (phenotype frequency: 17 vs 9%, P=0.0166; odds ratio (OR)=2.06, 95% confidence interval (CI): 1.13-3.77). Although A91V was the most frequent variation and displayed a trend of association with multiple sclerosis (MS) in the first population of patients and controls (frequency of the 91V allele: 0.076 vs 0.043, P=0.044), we used it as a marker to confirm PRF1 involvement in MS and assessed its frequency in a second population of 966 patients and 1520 controls. Frequency of the 91V allele was significantly higher in patients than in controls also in the second population (0.075 vs 0.058%, P=0.019). In the combined cohorts of 1156 patients and 1788 controls, presence of the 91V allele in single or double dose conferred an OR=1.38 (95% CI=1.10-1.74). These data suggest that A91V and possibly other perforin variations indicate susceptibility to MS.

MDC/CCL22 intrathecal levels in patients with multiple sclerosis

MDC/CCL22 has been detected in the brain of mice with experimental autoimmune encephalomyelitis. MDC/CCL22 cerebrospinal fluid levels were evaluated in 56 patients with multiple sclerosis (MS) and in 17 controls. No significant differences were found, even when stratifying patients according to the disease subtype. Stratifying by gender, significantly increased MDC/CCL22 levels were observed in female patients when compared with female controls and male patients (109.03 versus 98.54 and 99.37 pg/mL, P = 0.034 and 0.018, respectively). Therefore, MDC/CCL22 is likely to play a role in the development of MS in females only, possibly influencing the intracerebral recruitment of Th2 cells, which produce anti-inflammatory cytokines. Multiple Sclerosis 2008; 14: 547—549. http://msj.sagepub.com

Effects of a program of hospital-supervised chest physical therapy on lung function tests in children with chronic respiratory disease: 1-year follow-up

To investigate whether a hospital-supervised program of chest physical therapy improves lung function in children with chronic pulmonary diseases, twenty-four children (4 with Kartagener?s syndrome, 12 with common variable immunodeficiency, and 8 with primary ciliary dyskinesia) average age 11.2 +/- 3.2 years, were randomly assigned to a one-month hospital-supervised program of chest physical therapy (13 patients) or to a control group (11 patients) that continued unsupervised chest physical therapy at home. Lung function was assessed before the program, and one and 12 months after. At the one-month assessment, thoracic gas volume was significantly lower in the supervised group than in the controls. At the one-year assessment, forced expiratory volume in one second was significantly higher in the supervised group than in controls. A supervised program of chest physical therapy significantly improved lung function in children with chronic pulmonary diseases.

Factors predicting incomplete recovery from relapses in multiple sclerosis: a prospective study

Objective To prospectively evaluate predictors of incomplete recovery after the first attacks in a cohort of patients with clinically isolated syndrome or relapsing—remitting multiple sclerosis.

Methods Seventy-two consecutive patients recruited from January 2001 to December 2003, evaluated every six months or at any relapse up to 31 July 2005. Relapse intervals were calculated from the date of onset, nadir, onset of improvement and maximum improvement. Predictive factors analysed were relapse-related (age at relapse onset, season and severity of the relapse, type of symptoms, speed of onset, plateau and total duration, number of affected Functional systems, preceding infections) and individual-related (gender, age at first attack, season of birth and first attack, characteristics of first brain MRI and cerebrospinal fluid oligoclonal bands, Link Index, IgG).

Results We counted 209 attacks: 44 (21%) left mild sequelae, and 27 (13%) severe. The highest probability of sequelae was associated with sphincteric symptoms (9/20; 45%), followed by sensitive (38/113; 34%), motor (20/84; 24%), visual (13/61; 21%), cerebellar (4/24; 17%), brainstem (5/44; 11%) and others (0/6) ( P 0.005). Four variables were still relevant to predict sequelae after multivariate analysis: mild, moderate or severe relapses versus very mild (Odds ratio = 17.2, 95% confidence limits = 2.2—136.4), intermediate or long relapses versus short (3.2, 1.5—6.9), age ≥ 30 at relapse onset (2.9, 1.5—5.7) and bi-polysymptomatic versus monosymptomatic (2.2, 1.1—4.3).

Conclusions Factors predicting incomplete recovery are more closely linked to the characteristics of the single relapse (extension and duration of tissue damage) than to the patient's genetic and environmental background. Multiple Sclerosis 2008; 14: 485—493. http://msj.sagepub.com

The NS3 proteins of global strains of bluetongue virus evolve into regional topotypes through negative (purifying) selection

Comparison of the deduced amino acid sequences of the genes (S10) encoding the NS3 protein of 137 strains of bluetongue virus (BTV) from Africa, the Americas, Asia, Australia and the Mediterranean Basin showed limited variation. Common to all NS3 sequences were potential glycosylation sites at amino acid residues 63 and 150 and a cysteine at residue 137, whereas a cysteine at residue 181 was not conserved. The PPXY and PS/TAP late-domain motifs were conserved in all but three of the viruses. Phylogenetic analyses of these same sequences yielded two principal clades that grouped the viruses irrespective of their serotype or year of isolation (1900-2003). All viruses from Asia and Australia were grouped in one clade, whereas those from the other regions were present in both clades. Each clade segregated into distinct subclades that included viruses from single or multiple regions, and the S10 genes of some field viruses were identical to those of live-attenuated BTV vaccines. There was no evidence of positive selection on the S10 gene as assessed by reconstruction of ancestral codon states on the phylogeny, rather the functional constraints of the NS3 protein are expressed through substantial negative (purifying) selection.

[Low back pain in VDT operators: importance of sports activities]

Video display terminal (VDT) operators are required to maintain a sitting position for extended periods of time. This transverse study assessed the prevalence of lumbar musculoskeletal disorders (low back pain, LBP) in a population of VDT operators and related results to occupational factors and other interfering variables. Data were collected using questionnaires administered to 210 public employees. LBP was defined and evaluated using the Standardized Nordic Questionnaire. The prevalence of LBP was 58.4%; it correlated significantly with the female sex, spinal disorders, sleep disturbances and stress levels. There was a significant negative correlation with exercise and sports activities and with leisure time computer use. Multiple logistic regression adjusted for age and body mass index yielded an LBP odds ratio of 0.19 (C.I.95% 0.07-0.51) for sport-practicing subjects. At least one hour of exercise weekly was the cut-off for a significant reduction in LBP prevalence. The proportion of lumbar musculoskeletal symptoms was not significantly different in VDT operators and the general population. None of the occupational variables considered correlated with development of LBP. The occupational physician should recommend VDT operators to devote some leisure time to exercise.

Lung cancer and cardiovascular diseases: occurrence, comorbidity and surgical timing

AIM

The authors discuss tumor histological type, TNM staging and time of first occurrence of lung cancer, as well as related cardiovascular diseases, underlining type of treatment, surgical timing, surgical mortality, post-surgical complications and potentially additional therapies.

METHODS

A total of 189 patients underwent surgery for non-small cell lung cancer (NSCLC) (Stage I-II), 35 (17.5%) of which presented with surgically relevant concurrent cardiovascular disease (8 coronary artery disease, 4 carotid stenosis, 8 obstructing artery disease, 15 aortic aneurysm). In most cases, surgical timing provides for cardiovascular disease treatment completion first, followed by lung resection only afterwards. Alternatively, concomitant cardiovascular and lung cancer treatment averts the need for repeated surgery, even though the intraoperative complications rate is higher, as long as patients are hemodynamically stabile.

RESULTS

No remarkable surgical mortality was observed; stay in hospital ranged from 8 to 18 days. A 5-year follow-up was carried out in only 95/189 patients; 11/18 (61%) with concurrent cardiovascular disease and 46/77 (59%) with lung cancer alone are still alive.

CONCLUSIONS

In 17% of cases, surgical treatment by the simultaneous and the differentiated approach for cancer and cardiovascular disease proved essential; comorbidity as an identifier of the strong correlation between the two diseases had a major impact on prognosis.

CXCL10 haplotypes and multiple sclerosis: association and correlation with clinical course

CXCL10 (interferon-gamma-inducible protein-10) levels are increased in cerebrospinal fluid of multiple sclerosis (MS) patients with symptomatic attacks of inflammatory demyelination, supporting a role for this molecule in MS pathogenesis. Two hundred and twenty-six patients with MS and 235 controls were genotyped for G --> C and T --> C single nucleotide polymorphisms (SNPs) in exon 4 of CXCL10 gene. Haplotypes were tested for association and correlated with clinical variables. The two SNPs studied were in complete linkage disequilibrium. None of the determined haplotypes was associated with MS. However, carriers of the GGTT haplotype (defined as wild type, according to the sequence in National Centre for Biotechnology Information (NCBI) database) had a significantly lower progression index than non-carriers (P = 0.016). Furthermore, amongst patients who had an initial relapsing remitting (RR) course of the disease, the time between onset and second episode was significantly longer in GGTT carriers (P = 0.021). Considering secondary progressive (SP)-MS patients, the time between the initial RR form and the subsequent worsening to SP was longer in this group (P = 0.08). Therefore, the GGTT haplotype of the CXCL10 gene is not a susceptibility factor for the development of MS, but is probably to influence the course of MS, possibly contributing to slow down the progression of the disease.

["Intentionally" limited pulmonary resection versus lobectomy for the treatment of peripheral stage IA non-small cell lung cancers]

BACKGROUND

The purpose of this study is to assess, through the retrospective analysis of our experience and the literature review, whether the limited pulmonary resection is comparable to lobectomy for treatment of the peripheral stage IA (T1N0M0) non-small cell lung cancers (NSCLC), in terms of oncologic radicality, survival and rate of local, regional and systemic recurrences. Moreover it has been considered the impact of the limited resections in comparison with the lobar resections on the postoperative pulmonary function.

PATIENTS AND METHODS

We have analyzed a consecutive series of 36 patients, 28 men and 8 women, of inclusive age among the 61 to 81 years (average 73 years), who underwent surgical resection from January 2000 to December 2003 for T1N0M0 peripheral NSCLC; 11 limited resections and 25 lobectomies have been performed. Comparatively survival and recurrences (follow-up period of 3-5 years) are been analyzed, as well as the pulmonary function tests at 1 year after surgery.

RESULTS

The 3-year and 5-year survivals were 88% and 82% in the patient's group underwent to limited resection , 93% and 88% in the patient's group underwent to lobectomy. Postoperative local recurrence was noted in 1 patient (9%) of the first group and in 1 patient (4%) of the second group. One year after surgery was noted a moderate decline in the forced expiratory volume in 1 second (FEV1) and in the diffusing capacity for carbon monoxide (DLCO) in the patients who underwent to lobar resection, whereas in the patient's group submitted to limited resection was observed a substantial maintenance, except for the DLCO, of the preoperative pulmonary function tests.

CONCLUSIONS

Our limited experience, according to the actual tendencies of the literature, show that the limited pulmonary resections, in selected patients with peripheral stage IA NSCLC, represents a valid alternative to lobectomy in terms of survival and recurrence's rate, also determining a lower decrement of the postoperative pulmonary function. Therefore the segmentectomy can be considered, in such cases, the gold-standard procedure even if the patient is able to bear a wider resection.

[Indications, surgical strategies and evaluation of prognostic factors in the treatment of pulmonary metastases]

Pulmonary metastases resection is a method universally accepted in selected patients. Long-term survival reaches good levels after complete resection of lung metastases independently of primary tumour histology. The Authors emphasizes literature data; they report data of their experience no statistically significant but useful for valuation of results. They discuss of advantages vs disadvantages of the surgical procedures. In conclusion they believe metastasectomy is a safe treatment of pulmonary metastases.

Differentiation between field and vaccine strain of bluetongue virus serotype 16

In August 2000, bluetongue virus (BTV) appeared for the first time in Sardinia and, since then, the infection spread across Sicily and into the mainland of Italy involving at the beginning serotypes 2 and 9 and then, from 2002, 4 and 16. To reduce direct losses due to disease and indirect losses due to new serotype circulation, the 2004 Italian vaccination campaign included the modified-live vaccines against BTV-4 and 16 produced by Onderstepoort Biological Product (OBP), South Africa. Few months after the end of the campaign, BTV-16 was reported broadly in the country and the need of differentiating field from the BTV-16 vaccine isolate became crucial. In this study, the gene segments 2, 5, 6 and 10 of both the Italian and vaccine BTV-16 strains were sequenced and their molecular relationship determined. As sequences of segment 5 were those showing the highest differences (17.3%), it was possible to develop a new diagnostic tool able to distinguish the Italian BTV-16 NS1 gene from that of the homologous vaccine strain. The procedure based on the use of a RT-PCR and the subsequent sequencing of the amplified product showed a high degree of sensitivity and specificity when samples from either BTV-16 vaccinated or infected sheep were tested.

Transcriptional regulation of major histocompatibility complex class I gene by insulin and IGF-I in FRTL-5 thyroid cells

Increased major histocompatibility complex (MHC) class I gene expression in nonimmune cell 'target tissues' involved in organ-specific diseases may be important in the pathogenesis of autoimmune diseases. This possibility in part evolves from studies of cultured thyrocytes where properties appear relevant to the development of thyroid autoimmune disease. In FRTL-5 rat thyroid cells in continuous culture, hormones and growth factors that regulate cell growth and function specifically decrease MHC class I gene expression. We hypothesized that this could reflect a mechanism to preserve self-tolerance and prevent autoimmune disease. The mechanisms of action of some of these hormones, namely TSH and hydrocortisone, have been already characterized. In this report, we show that IGF-I transcriptionally downregulates MHC class I gene expression and that its action is similar to that of insulin. The two hormones have a complex effect on the promoter of the MHC class I gene, PD1. In fact, they decrease the full promoter activity, but upregulate the activity of deleted mutants that have lost an upstream, tissue-specific regulatory region but still retain the enhancer A region. We show that insulin/IGF-I promotes the interactions of the p50/p65 subunits of NF-kappaB and AP-1 family members with these two regions, and that the tissue-specific region acts as a dominant silencer element on insulin/IGF-I regulation of promoter activity. These observations may be important to understand how MHC class I gene transcription is regulated in the cells.

[Percutaneous radio frequency thermal ablation of non-resectable lung cancer: state of the art]

BACKGROUND

Unfortunately, as of yet, most lung cancers are not operable as soon as diagnosis is available; in these situations chemo- and radio-therapy still play a key role, albeit palliative, improving survival rate moderately, but are not lacking in toxic effects, especially in case of concurrent pathology, reduced cardio-respiratory functionality or being advanced in years. Therefore thermal ablation mini-invasive techniques, already employed as ancillary treatments of hepatic cancer or in place of surgery, have been performed for these pathologies.

AIM

Aim of this work is to define the current state of the art for Radio-Frequency Ablation (RFA) to be performed on non-resectable lung cancer, also by means of a thorough review of international literature, from which to infer purposes, suggestions, methodologies, effectiveness, safety, complications and achievements, also in terms of the possible improvement of life quality and/or survival expectancy.

PATIENTS AND METHODS

Patients have been carefully selected. Pulmonary nodules have been treated with TC or echo-guided percutaneous thermal ablation and, afterwards, evaluated by radiological and clinical (sometimes histopathological) follow-up.

RESULTS

The size of the RFA-treated nodules is necessary in order to evaluate full or partial necrosis extent and, therefore, average survival rate.

CONCLUSIONS

Availability of more extensive and homogeneous case histories, as well as standard follow-up (TC and/or histopathological sampling) methodologies, is required. Nevertheless several authors agree that RFA is a safe and effective technique within the framework of a substitutive or complementary treatment of non-operable lung cancer. The best results can be achieved for cancers less than 3 cm wide; RFA, performed before chemo- and/or radio-therapy, plays a neoadjuvant role for larger cancers, decreasing cancer volume and weakening the symptoms.

VP2-segment sequence analysis of some isolates of bluetongue virus recovered in the Mediterranean basin during the 1998-2003 outbreak

The complete nucleotide sequences of the VP2 segments of bluetongue virus (BTV) isolates recovered from Italy, Greece and Israel, from 1998 to 2003, were determined. Phylogenetic analysis of these sequences, those from related viruses and the South African vaccine strains, were used to determine the probable geographic origin of BTV incursions into Italy. Results indicated that viruses from each of the four serotypes isolated in Italy (2, 4, 9 and 16) possibly had a different origin. Analysis of the bluetongue virus serotype 2 (BTV-2) isolates gave evidence that this serotype probably moved from Tunisia. BTV-4 results showed probable incursion from the southwest and not from Greece or Israel. BTV-9 isolates clearly have an eastern origin (most probably Greece), whereas BTV-16 isolates are indistinguishable from the BTV-16 live attenuated vaccine strain. The phylogenetic findings were supported by polyacrylamide gel electrophoresis (PAGE) analysis of the complete amplified genome of each isolate except for BTV-16 Italian field isolate, which showed a slightly different PAGE profile. A combination of the complete VP2 sequencing and PAGE analysis of complete genomes, allowed not only phylogenetic analysis, but also vaccine detection and assessment of reassortment events.

Studies on an inactivated vaccine against rabies virus in domestic animals

An inactivated vaccine against rabies virus was prepared from the attenuated ATCC PV-12 viral rabbit Pasteur strain. The virus was grown on Baby Hamster Kidney (BHK21) cells, and the supernatant was purified by filtration and inactivated with beta-propriolactone. The inactivated product was checked according to the NHI and European Pharmacopoeia methods. Part of the product was then lyophilised and the other part was adjuvanted with Al(OH)3. Both parts were used to vaccinate and boost groups of horses, cattle and sheep at different intervals. Their immunogenicity was compared with a similar commercial product. Blood samples were collected on a regular basis and the antibody titre was determined by the Fluorescence Antibody Virus Neutralisation (FAVN) test. No significant differences were found between species after both inoculations even though the immune response increased in intensity and duration after the booster dose in all the animals tested and was stronger and lasted longer with the adjuvanted aliquot.

Bluetongue virus isolations from midges belonging to the Obsoletus complex (Culicoides, Diptera: Ceratopogonidae) in Italy

Between July and September 2002 there were outbreaks of bluetongue on three sheep holdings in the communities of San Gregorio Magno (Salerno, Campania), Laviano (Salerno, Campania) and Carpino (Foggia, Puglia), and the involvement of bluetongue virus (btv) was confirmed serologically and virologically. The mortality rate was at least 11 per cent and involved btv serotype 2 (btv-2) and serotype 9 (btv-9). These holdings were also surveyed for the Culicoides (Diptera: Ceratopogonidae) vectors; approximately 10,000 midges belonging to 15 species were captured, but they did not include a single specimen of the classical Afro-Asiatic bluetongue vector, Culicoides imicola. Species belonging to the Obsoletus complex dominated the light-trap collections, and Culicoides obsoletus Meigen, Culicoides scoticus Downes and Kettle and Culicoides dewulfi Goetghebuer constituted 90 per cent of all the Culicoides species captured. Fifty-six pools of the Obsoletus complex (excluding C dewulfi), each containing 100 individual midges and containing only parous and gravid females, were assayed for virus. btv-2 was isolated from three pools from San Gregorio Magno and Carpino, and btv-9 was isolated from one pool from Laviano. These results indicate that a species other than C imicola is involved in the current re-emergence of bluetongue in the Mediterranean Basin, but whether it is C obsoletus sensu stricto or C scoticus, or both, is uncertain.

The structured assessment of depression in brain–damaged individuals: translation and validation study of the Italian version

The aim of this study was to translate the structured assessment of depression in brain-damaged individuals (SADBD) questionnaire into the Italian language, validate, and test reliability and validity of the Italian version. Consecutive patients with stroke were screened in the Department of Neurology, Avogadro University in Novara and the Department of Neurorehabilitation, Maugeri Foundation, Veruno, Italy. Thirty patients were included in the study. The internal consistency ranged between 0.78 and 0.87. The intra-rater test-retest reliability was 0.93 for BDIderived items and 0.82 for HRSD-derived items; while the inter-rater test-retest reliability was 0.94 for BDI-derived items and 0.93 for HRSD-derived items. Correlation between the SADBD diagnosis made by the physician and the nurse was 0.51; correlation between caregiver and physician diagnosis was 0.60. The Italian version of the SADBD was demonstrated to be acceptable, reliable and a valid measure of depression in patients with stroke.

Growth delay in Down syndrome and zinc sulphate supplementation

Children affected with Down syndrome (DS) show deficient growth, immunodeficiency--especially concerning the T-cell population--and low plasma zinc levels. New growth charts have been recently proposed, and zinc supplementation to the diet has been reported to improve transiently the efficiency of the immune system. The aim of this study was to evaluate if in DS children zinc sulphate therapy could improve the growth rate and affect some endocrine parameters. We studied 22 patients (16 males and 6 females) who received zinc sulphate for 6 to 9 months. Fifteen of 22 patients studied reached a higher centile in their growth rate, whereas the remaining seven showed no change, at least to date. The average height velocity changed from 23.84 +/- 7.98 mm/6 months to 40.80 +/- 7.68 mm/6 months. Growth hormone serum level was 5.94 +/- 4.89 ng/ml compared with 7.49 +/- 6.75 ng/ml before and after therapy, respectively. Somatomedin serum level was 160.27 +/- 68.88 mU/ml and 205 +/- 124.07 mU/ml before and after therapy, respectively. In conclusion, zinc sulphate therapy of patients with DS affects not only the immune system, as previously reported, but can also accelerate growth.

Cerebral venous thrombosis: a retrospective multicentre study of 48 patients

The objective was to describe the clinical features and management of cerebral venous thrombosis (CVT) in non-selected centres. An observational study in 11 neurological departments in NW Italy was carried out from 1995 through 1999 on 38 female and 10 male patients. Mean age: 44.8 years, SD=14.3. Onset: acute in 21 patients (44%), subacute in 17 (35%) and chronic in 10 (21%). Most frequent onset: with focal deficits and/or seizures, followed by impaired consciousness or confusion, isolated headache, isolated intracranial hypertension and cavernous syndrome. No risk factor was found in 8 patients (17%). The superior sagittal sinus was involved in 27 patients (56%) and the transverse sinus in 29 (60%). Anticoagulants were used in 45 patients (94%). Rankin Scale score at discharge: 0 (27 patients), 1 (four), 2 (five), 3 (five), 4 (none), 5 (one) and six were dead. Thirteen patients had deep CVT: age, risk factors, neurological signs and outcome differed from cortical CVT (35 patients), although not significantly. Clinical features, risk factors and outcome of CVT patients from non-selected centres are similar to those from specialised centres.

Accuracy of the ICD-9 codes for identifying TIA and stroke in an Italian automated database

The object of this study was to evaluate the sensitivity and positive predictive value (PPV) of International Classification of Diseases, 9th revision (ICD-9) codes 430-438 in the Sistema Informativo Sanitario Regionale (SISR), an Italian health care automated database. We compared the SISR with a manual search of all cases of transient ischaemic attack (TIA) and stroke discharged from the Novara Hospital, NW Italy. Results were as follows: SISR list: 1017 patients; manual list 1005. Linked: 896; false negatives: 109; false positives: 121. Sensitivity of codes 430-438: 77% at the primary position only and 89% at either the primary or secondary position; PPV: 93% and 88%. Sensitivity and PPV for specific codes vs. each subcategory (sensitivity at the primary position only/any position; PPV at the primary position only/any position): for 430, subarachnoid haemorrhage (33/35%; 46/43%); for 431, cerebral haemorrhage (57/59%; 77/75%); for 434, cerebral infarction (35/37%; 90/87%); for 436, stroke of unknown type (29/29%; 19/16%); and for 435, TIA (75/82%; 80/78%). The SISR database has a high PPV; sensitivity is high for TIA, but low for specific stroke ICD codes.

Cortical excitability in drug-naive patients with partial epilepsy: A cross-sectional study

OBJECTIVE

To use paired-pulse transcranial magnetic stimulation (TMS) to investigate cortical excitability in drug-naive patients with partial epilepsy.

METHODS

Twenty-one drug-naive patients with partial epilepsy and 15 control subjects were studied. The relaxed threshold to TMS, the central silent period, and the intracortical inhibition/facilitation were measured. Statistics implied cluster analysis methods. Also assessed were the patient interictal EEG epileptiform abnormalities (EAs) on a semiquantitative basis. Then the TMS was contrasted to the clinical and EEG findings, using chi2 or Fisher exact tests.

RESULTS

One-third of the patients made up a "pathologic" cluster with a disrupted intracortical inhibition (p < 0.01). Two-thirds had a normal inhibition. Interictal EAs predominated in the pathologic cluster, for frequency (p < 0.04), duration (p < 0.04), and focality (p < 0.02).

CONCLUSIONS

Intracortical inhibition, which was impaired in one-third of the patients, reflects gamma-aminobutyric acid (GABA) activity within cortical area 4. Defective GABA inhibition is a typical pathogenic factor in partial epilepsy. Transcranial magnetic stimulation proved able to detect it. The weaker cortical inhibition had a direct relation to the severity of interictal epileptiform abnormalities.

VP2 gene sequence analysis of some isolates of bluetongue virus recovered in the Mediterranean Basin during the 1998-2002 outbreak

Since 1998, five serotypes of bluetongue virus (BTV), BTV-1, BTV-2, BTV-4, BTV-9 and BTV-16, have been reported in countries surrounding the Mediterranean Basin. Preliminary data on the sequencing analysis of the VP2-genes of BTV isolates recovered during the 1998-2002 epizootic of BT in Italy, Greece and Israel were studied. The VP2-genes of the Italian BTV-2 and BTV-9, Greek BTV-4 and BTV-9, Israeli BTV-4 and BTV-16 and South African BTV-2, BTV-4, BTV-9 and BTV-16, together with those of their corresponding South African serotype reference and vaccine strains, were cloned and the sequences of their terminal ends determined. These sequences, as well as those of all BTV VP2-gene sequences currently available on GenBank, were used to compile a phylogenetic tree to determine the probable geographic origins of the BTV incursions into Europe. The Italian isolates included in this study were from different regions, animal hosts and years (2000-2002). The results demonstrated that sequencing of the terminal end of the VP2-gene of BTV can be used for topotyping. According to the phylogenetic analysis, the Italian BTV-2 and BTV-9 isolates were stable across all species, irrespective of geographic origin and year of isolation. The sequencing data of the Italian isolates were identical to those of a BTV-2 isolate from Corsica. There was 97% homology between the Italian and Corsican BTV-2 isolates and the BTV-2 vaccine and reference isolates from South Africa. Italian BTV-9 isolates were also identical to the Greek BTV-9 isolates (99% homology). Surprisingly these BTV-9 isolates had only 67% homology with the reference BTV-9 isolate from South Africa. Conversely, BTV-9 field isolates from Australia and elsewhere in Europe had 89% homology with the Italian isolate at the nucleic acid level. Greek and Israeli BTV-4 isolates were almost identical (98% homology) and shared a 90% homology with the BTV-4 South African reference and vaccine strains. Israeli BTV-16 and South African BTV-16 reference strains were also similar. From these results, it may be concluded that Italian and Corsican BTV-2, Israeli and Greek BTV-4, and South African and Israeli BTV-16 had a common origin. The Greek BTV-9 isolate had more than 99% homology with the isolates from Italy, indicating these isolates to have had a common origin. The European BTV-9 isolates, grouped as 'eastern isolates', were more similar to the Australian isolates than to the South African reference strains.

Field vaccination of cattle using a bivalent modified-live vaccine against bluetongue virus serotypes 2 and 9: effect on milk production

To evaluate the effect of bluetongue (BT) vaccination on milk production in cattle, 30 cows at various stages of gestation were vaccinated using a bivalent bluetongue virus serotype 2 (BTV-2) and BTV-9 modified-live vaccine produced by Onderstepoort Biological Products in South Africa. A second group of 30 pregnant cows was used unvaccinated controls. Blood samples were taken from all animals three times a week for two months. Virus titres were determined and the daily milk production of each cow was quantitatively and qualitatively evaluated. From 27 of the 30 vaccinated cows, BTV was isolated from day 4 to day 28 post vaccination. BTV vaccination had no effect on milk production, somatic cell count, pH, milk fat, protein and lactose content. It is concluded that the bivalent BTV-2/BTV-9 modified-live vaccine does not affect milk production in cows.

Monovalent modified-live vaccine against bluetongue virus serotype 2: immunity studies in cows

A challenge study was conducted to determine the efficacy of vaccination against bluetongue (BT) virus (BTV) serotype 2 in protecting cattle against infection. A group of 30 cows, vaccinated seven months previously with monovalent BTV-2 modified-live vaccine produced by Onderstepoort Biological Products in South Africa, were challenged subcutaneously with 2x 10(5.8)TCID50/ml of BTV-2 field isolate. All cattle originated from the same population in the Sardinian province of Oristano. Eight unvaccinated calves from a BTV-free herd also participated in this study; four were inoculated with BTV-2 and used as positive controls whilst the remaining four were used as negative controls to confirm that no BTV was circulating locally. Blood samples were taken from all animals three times a week for two months. Serum samples were tested for antibody against BTV using the competitive enzyme-linked immunosorbent assay (c-ELISA) and the virus neutralisation (VN) test. Virus isolation was attempted on the blood samples by intravenous egg inoculation followed by two blind passages in Vero cells. Virus titres following challenge were determined also. Of the 30 cows vaccinated, 29 were positive in the c-ELISA and demonstrated neutralising antibodies. At the time of challenge, 11 cows had no virus neutralising antibody while the remainder had low titres ranging from 1:10 (11 cows) to 1:20 (6 cows); two cows showed titres of 1:40 and 1:80, respectively. None of the cows showed signs of disease after challenge and no BTV was isolated from the blood of the 29 cows that had developed antibodies after vaccination. Commencing on day 9 post challenge, BTV-2 was isolated from the blood of the single cow that had not seroconverted following vaccination and from the blood of the unvaccinated controls. Viraemia lasted until day 21 post challenge. Neither BTV nor antibody was detected in the blood samples taken from the negative control group. These observations indicate that the monovalent BTV-2 modified-live vaccine protects most animals when challenged with field virus seven months post vaccination.

Virological and serological response of sheep following field vaccination with bivalent modified-live vaccine against bluetongue virus serotypes 2 and 9

A group of 44 sheep was vaccinated with the bivalent modified-live vaccine against bluetongue virus (BTV) serotype 2 (BTV-2) and BTV-9 to evaluate viraemia and antibody kinetics. Blood samples were taken from the sheep three times a week for two months and screened for the presence of BTV and for antibody using the competitive enzyme-linked immunosorbent assay (c-ELISA) and the virus neutralisation (VN) test. Intravenous egg inoculation, followed by two blind passages in Vero cells, was used to isolate BTV-2 and BTV-9 from the ethylene-diaminetetra-acetic acid (EDTA) blood samples; virus titres were also determined in the viraemic animals. BTV was detected in the blood of 39 sheep between day 3 and day 24 post vaccination (pv). Viraemia peaked on day 7 pv with average titres of 10(5.3)TCID50/ml. Antibodies were first detected in the c-ELISA on day 6 pv and by day 16, all sheep were seropositive. Only 36 of the 44 inoculated sheep developed virus-neutralising antibodies against both BTV-2 and BTV-9 while 4 were positive to BTV-2 only; neutralising antibodies were not detected in the 4 remaining animals. Antibody titres were very low and unstable and often bordered on the negative/positive threshold.

Serological response in cattle and sheep following infection or vaccination with bluetongue virus

Data from various experimental and field studies were compiled and analysed to evaluate the serological response in sheep and cattle against different bluetongue (BT) virus (BTV) vaccine combinations (Onderstepoort Biological Products, South Africa); the accuracy of diagnostic procedures commonly used for detecting BTV antibodies was also assessed. Using the competitive enzyme-linked immunosorbent assay (c-ELISA) (IZSA&M, Teramo, Italy) and the virus neutralisation (VN) test, antibody responses were evaluated under the following vaccination regimes: monovalent modified-live vaccine against BTV-2 in cattle and sheep, monovalent modified-live vaccine against BTV-9 in sheep, and bivalent modified-live vaccine against BTV-2 and BTV-9 in cattle and sheep. The data were compared to serological results observed in cattle and sheep infected with Italian field strains of BTV-2 or BTV-9. The c-ELISA consistently detected antibodies earlier than the VN test in both livestock species and against all BTV serotypes. The highest and most rapid antibody responses were observed in sheep infected in the field. In cattle and in sheep, high VN titres were detected using monovalent vaccines, while bivalent vaccines initiated lower antibody titres that developed more slowly.

Virological and serological response of cattle following field vaccination with bivalent modified-live vaccine against bluetongue virus serotypes 2 and 9

Following the bluetongue (BT) epidemic in Italy, the government initiated a vaccination campaign involving all domestic ruminants (cattle, sheep and goats) in the affected and adjacent areas to create a resistant population and to reduce virus circulation. Based on the serotypes circulating in the affected areas, monovalent BT virus (BTV) serotype 2 (BTV-2), or bivalent BTV-2 and BTV-9, modified-live vaccines were used. These are manufactured by Onderstepoort Biological Products in South Africa and, because they are recommended for use in sheep only, very little data exists on their use in cattle under field conditions. To evaluate duration and levels of viraemia and the antibody response following vaccination, 30 cattle in various stages of pregnancy were selected and vaccinated with a bivalent BTV-2/BTV-9 vaccine. Blood samples were taken from the animals three times a week for two months and screened using the competitive enzyme-linked immunosorbent assay (c-ELISA) and the virus neutralisation (VN) test. Intravenous egg inoculation, followed by two blind passages in Vero cells, was used to isolate BTV-2 and BTV-9 from ethylene-diaminetetra-acetic acid (EDTA) blood samples, and virus titres determined in viraemic animals. Titres against BTV were detected in 27 animals between days 4 and 35 post vaccination (pv). Viraemia peaked on day 9 pv with average viral titres of 10(4.5)TCID50/ml. From day 9 pv, the c-ELISA detected antibodies in all animals while low VN titres were observed commencing on day 18 pv. Furthermore, VN antibody to BTV-2 was detected in only 17 of the animals vaccinated and to BTV-9 in 27 animals.

Field vaccination of sheep with bivalent modified-live vaccine against bluetongue virus serotypes 2 and 9: effect on milk production

In response to complaints of the potential side-effects of the bivalent live-modified vaccine used to control the spread of bluetongue (BT) virus (BTV) serotypes 2 and 9 in Italy, a study was conducted to determine the effects of immunisation on milk production. Thirty-four Comisana cross-bred sheep were vaccinated with the bivalent BTV-2/BTV-9 modified-live vaccine produced by Onderstepoort Biological Products in South Africa; six animals served as unvaccinated controls. All animals were bled twice a week for two months and the presence and titres of BTV in the blood determined. The somatic cell count, pH, fat, protein and lactose content of the milk, as well as the quantity of the milk produced, were also measured. Vaccine virus was isolated from vaccinated animals between day 3 and day 20 post vaccination (pv) with peak titres observed on days 3 and 6 pv for BTV-2 and BTV-9, respectively. Milk production declined in the vaccinated group between days 8 and 14 pv, with the greatest decrease on day 9 pv. No differences were observed in the somatic cell count and pH, or in the milk fat, protein and lactose content.

Neutralising antibody response in cattle after vaccination with monovalent modified-live vaccine against bluetongue virus serotype 2

The antibody response following bluetongue (BT) vaccination under both field and experimental conditions, and the duration of colostral antibodies in calves born from vaccinated dams, were evaluated. To this end, 1 005 animals of various breeds and ages were selected at random from 10 herds in the Sardinian province of Oristano. During the first year of the vaccination campaign, the animals selected were vaccinated against BT virus (BTV) serotype 2 between July and August 2002. Blood samples were taken from all animals monthly for three months after vaccination and tested for the presence of BT antibodies using the competitive enzyme-linked immunosorbent assay (c-ELISA) and the virus neutralisation (VN) test. Serological results from field vaccinated animals were compared with those obtained following the vaccination of five animals under experimental conditions. Out of 1,005 animals, 994 (98.1%) developed BT antibody following vaccination whereas antibody was detected in all cows vaccinated under experimental conditions. Both groups showed the highest median titres of 1:160 after two months. To assess the duration of colostral antibodies in calves born from vaccinated dams, the sera of 47 calves were screened using the c-ELISA and VN test. Calves were divided into three age groups: Group A included 22 calves aged 1 to 25 days, Group B 13 calves aged 26 to 39 days and Group C 12 calves aged 40 to 60 days. Antibody was detected in calves in Groups A and B (68.2% and 46.1%, respectively) whereas the calves in Group C were serologically negative.

Vaccination of cattle using monovalent modified-live vaccine against bluetongue virus serotype 2: innocuity, immunogenicity and effect on pregnancy

The immunogenicity, innocuity and possible teratogenic effects of the monovalent modified-live vaccine against bluetongue (BT) virus (BTV) serotype 2, manufactured by Onderstepoort Biological Products in South Africa, was evaluated in cows. Twenty-one cows, 14 of which were at different stages of gestation, were vaccinated with 2 ml of monovalent vaccine; two served as unvaccinated controls. After immunisation, 16 vaccinated and the 2 unvaccinated controls were kept in the field; the remaining 5 pregnant cows were maintained in an insect-proof stable with a controlled environment. Blood samples were taken from field cattle once a week for two months and from the stable cattle three times a week. All samples were screened for the presence of BTV and for BT antibody using the competitive enzyme-linked immunosorbent assay (c-ELISA) and the virus neutralisation (VN) test. Intravenous egg inoculation, followed by two blind passages in Vero cells, was used to isolate BTV-2 from ethylene-diaminetetra-acetic acid (EDTA) blood samples and virus titres in viraemic animals were determined. After immunisation, 9 of the cows developed a viraemia which commenced on day 7 post vaccination (pv) and lasted for three weeks. The virus titres were never higher than 10(2.8)TCID50/ml with the highest titre observed on day 14 pv. None of the vaccinated animals developed clinical symptoms that could be attributed to BTV; after three weeks all animals showed a serological response to BTV-2. In the c-ELISA, antibodies were detected from day 7 pv while in the VN test, antibodies were observed from day 21 pv. All pregnant cows completed their gestation: 13 gave birth to healthy calves, while one of those in the field group, vaccinated at the six months gestation, delivered a calf with prosencephalic hypoplasia, possibly developed during foetal organogenesis prior to vaccination. Fourteen months after immunisation the stabled cows were challenged subcutaneously by administering 2x10(6.8)TCID50 BTV-2 Italian isolate. A third group of 4 cows was also inoculated with the BTV-2 Italian field isolate, as described for the second group and was used as the unvaccinated positive control group. Vaccinated cows had a detectable viraemia only on day 14 pv and virus titres were very low. Virus titres never exceeded 10(2.3)TCID50/ml, while the unvaccinated group developed a long and intense viraemia, peaking on day 14 pv with a titre of 1.18x10(4). It is concluded that the BTV-2 modified-live vaccine used in this study was a harmless and effective immunogen that did not cross the placental membrane.

Efficacy and safety studies on an inactivated vaccine against bluetongue virus serotype 2

An inactivated vaccine was produced from an Italian field isolate of bluetongue virus serotype 2 (BTV-2) with a titre of 10(7.8)TCID50/ml. The virus was purified through a molecular cut cassette membrane, inactivated with beta-propriolactone and emulsified with ISA 206 (Seppic) adjuvant. The vaccine was then tested for sterility, toxicity and safety in laboratory and target animals according to European Pharmacopoeia standards. Immunogenicity was assessed by inoculating subcutaneously 10 sheep and 10 goats each with 2 ml of the vaccine and 10 bovines each with 5 ml of the vaccine. A booster dose was inoculated after 14 days and no side-effects were reported following vaccination. Fourteen days after the booster dose, all vaccinated animals developed virus neutralising (VN) bluetongue (BT) antibody titres that on day 60 post vaccination ranged between 1/20 and 1/1 280. After one year, goats still had high VN antibody titres. Sheep were challenged 138 days after vaccination by subcutaneously inoculating 1 ml of 10(5.6)TCID50/ml of an Italian field isolate of BTV serotype 2; four unvaccinated animals were also inoculated and used as controls. Starting from day 6 post challenge, control animals developed a fever, with temperature ranging from 39.9 degrees C to 40.6 degrees C and lasting 48 h on average. BTV-2 was also isolated from the blood of control animals between days 4 and 20 post challenge. Conversely, neither fever nor viraemia were detected in the vaccinated animals that were challenged. A new trial with a larger number of animals, including all target species, has been planned and is in progress.

[Haemothorax and chylothorax: surgical approach]

Diseases causing blood accumulation in the pleural space (or haemothorax) are usually very demanding for diagnosis and require a multidisciplinar therapeutical approach in emergency. So, their treatment should always be immediate and should aim to restore the optimal patient's haemodynamic conditions and to find the site of bleeding. Chylothorax, a lymphatic effusion in the pleural space, is also a very important pathology, as it effects the nutritional and immunological state of the patient causing pleural involvement and respiratory insufficiency. Stabilisation of vital parameters with adequate systemic therapies (blood perfusions, fluids and pro-coagulation factors, TPN) preceeds surgery, which can be the placement of a thoracic drain or emergency thorascopy and/or thoracotomy. The Authors report the casistic of the latest three years for diagnosis and treatment of haemothorax and chylothorax stressing the advantages of a minimal invasive approach for evacuation and identification of the origin of bleeding and haemorrhage and/or lymphatic effusion control.

The isolation of bluetongue virus from field populations of the Obsoletus Complex in central Italy

Between July and September 2002, bluetongue (BT) virus (BTV) serotypes 2 and 9 caused mortalities amongst sheep in the communities of San Gregorio Magno (Salerno, Campania), Laviano (Salerno, Campania) and Carpino (Foggia, Puglia), central Italy. On three of the affected farms, approximately 10,000 specimens of Culicoides were captured, representing fifteen species. Not a single specimen of the classical Afro-Asiatic BT vector, C. imicola Kieffer, was found; species of the Obsoletus Complex dominated the light-trap collections (90%) and included C. obsoletus (Meigen), C. scoticus Downes and Kettle and C. dewulfi Goetghebuer. Fifty-eight pools of the Obsoletus Complex (excluding C. dewulfi), each numbering 100 individuals per pool, and containing only parous and gravid females, were assayed for virus. BTV serotype 2 (BTV-2) was isolated from three pools (San Gregorio and Carpino) and BTV-9 from one (Laviano). These results indicate clearly that a species other than C. imicola is involved in the current re-emergence of BT in the Mediterranean Basin, but whether this is only C. obsoletus sensu stricto, or only C. scoticus, or both together, has yet to be established.

Laboratory survival and blood feeding response of wild-caught Culicoides obsoletus Complex (Diptera: Ceratopogonidae) through natural and artificial membranes

In late summer 2002, live wild-caught midges of the Obsoletus Complex were collected using blacklight traps placed at a horse stable in Teramo (Abruzzo, Italy). For the survival study under laboratory conditions, 1,500 Obsoletus Complex midges were kept at 17 degrees C-25 degrees C and provided only with a sucrose solution. Of these, 150 (10%) survived for at least 40 days and 3 midges were still alive after 92 days. In addition, 10 midges survived 10 days at 4 degrees C. For the feeding trials, 40 blood-meals (9,440 midges) were administered, 27 of which were successful (67.5%); the feeding rate ranged from 0.3% to 16.7%, with a total of 592 engorged midges. Similar feeding rates (U Mann-Whitney test=129.5 p>0.05) were obtained when natural (day-old chicken skin) and artificial (stretched parafilm) membranes were used. To infect the insects, a field strain of bluetongue (BT) virus (BTV) serotype 2 isolated from the spleen of a sheep during the 2000 Italian outbreak was added to the blood-meal. Two different viral solutions, with titres of 10(6)TCID(50)/ml and 10(7)TCID(50)/ml, were prepared. Uninfected blood was significantly more appetising (U Mann-Whitney test=88.5 p<0.05) than the infected meal and the midges preferred (U Mann-Whitney test=48 p<0.05) to feed on blood containing BTV-2 at a lower titre. A total of 251 midges were fed on BTV-2 infected blood and were then incubated at 23 degrees C-25 degrees C and fed with a sucrose solution for 10 days. During the incubation period, the dead insects were collected daily and analysed for evidence of virus infection. Of the 251 engorged midges, 54 (21.5%) died in the feeding chambers or during sorting on the chill table, 136 died within the first 10 days and 61 survived longer. BTV was isolated only from those which died just after feeding (52.6%; 10/19) or 24 h later (47.8%; 11/23). Considering the small number of midges tested after 10 days of incubation, the prevalence of infection detected in this study (95% probability) would have been higher than 4.74%. These preliminary results appear very promising as this is the first time that midges of the Obsoletus Complex have been successfully fed under laboratory conditions.

[Bronchial arteries: anatomical and clinical studies and strategies in surgical approach]

One of the most important and controversial aspects of thoracic surgery is due to the topographical and surgical anatomy of the vascular structures involving the mediastinum. The knowledge of the so-called "vascular time", in fact, allows to face more complicated surgical situations, typical of the most specialistic thoracic surgery. The bronchial arteries represent a paradigm of what we have just stated. The study of their anatomy (number, position, origin, distribution and relationships with the mediastinal structures) is of relevant importance, not only for the interest the bronchial vascular tree arises in tracheo-bronchial surgery and in pulmonary transplantology, but also for the knowledge of the pathogenesis of some processes regarding pulmonary and pleural pathologies. The aim of this paper is to evaluate the real clinical interest of bronchial arteries, with an analytic study of the anatomy of vessels, and with the possibility to show the most frequent and characteristic anomalies involving the origin and course of these arteries.

[Surgical treatment of hydatid cysts]

Hydatidosis represents a form of helminthic zoonosis with a stronger medical, social and economic impact. It is endemic in some areas of the world including Mediterranean countries, and therefore Italy. The disease is often diagnosed in an advanced phase, due to the poor symptomatology in the early stages. The best treatment is surgery. Emergency surgery is similar to elective surgery, though in some cases is preferable only a drainage procedure until the stabilization of the genreal and local conditions of the patient allow a radical intervention. The Authors report on their five year experience of surgical treatment of compliated pulmonar hydatidosis pointing out that exeresis must be aimed at preserving pulmonar function as much as possible.

Progression of MRI abnormalities in herpes simplex encephalitis despite clinical improvement: natural history or disease progression?

Herpes simplex virus encephalitis (HSVE) is associated with a high mortality rate and a high probability of neurological sequelae. Good results are obtained when HSVE is promptly diagnosed and treated with acyclovir. We present a 71-year-old woman with clinically diagnosed HSVE, confirmed by PCR detection of HSV-1 DNA in the cerebrospinal fluid. She was treated with acyclovir (30 mg/kg day) for two weeks. Clinical and neuropsychological assessments 6 months after admission were normal; however MRI at 2, 6 and 12 months showed progressive deterioration with extensive white matter and cortical damage. Imaging studies of a cohort of patients surviving PCR-confirmed HSVE are needed to determine whether this pattern is occasional or a frequent form of progression.

Churg-Strauss syndrome associated with the leukotriene antagonist montelukast

Churg-Strauss syndrome (CSS) is a disseminated small vessel vasculitis characterized by late-onset asthma, upper airways disease, eosinophilia and late neurological manifestations such as peripheral neuropathy. Recently, several cases of CSS have been reported in patients treated with leukotriene antagonists after weaning corticosteroids. We describe a case of CSS developed while the patient was receiving montelukast for asthma treatment, after corticosteroids withdrawal. A causal relationship between montelukast therapy and CSS is hypothesized.

[Surgical treatment of celomic cysts]

Celomic cysts (pericardiopleural or serous cysts) are rare, as they account for about 30% of all the homoplastic disembryogenetic lesions of the mediastinum. There is not usually a characteristic symptomatology associated with this anomaly, which is, however, easily diagnosed by means of the most common radiologic techniques. The TC together with the MRI provides all the necessary data for an appropriate management of the patient. The Authors report on their five year experience of the surgical treatment of celomic cysts, pointing out that surgery must be aimed at preserving pulmonary function as much as possible. They finally maintain that the first surgical approach should be video-thoracoscopic with the aid of a minithoracotomy, if necessary.

[Combined video-thoracoscopic, surgical and endovascular treatment in a case of ascites and recurrent bilateral pleural effusion]

Among recurrent pleural effusions a role of remarkable importance is held by those combined with ascitis due to the difficulty of their treatment, even using widely tested techniques. The incidence of such pathology varies from 4% to 6% of patients suffering from cirrhotic pathology, reaching 10% in cases with advanced illnesses. Pleural effusions involve the right emithorax more frequently than the left one, but it can show up bilaterally too. Its etiopathogenesis is tied up to the direct passage of ascitic liquid into the chest and, during the past years, numerous theories have been described to explain this migration. The Authors report the case of a patient with interesting considerations for the diagnostic difficulties and the peculiarity of the treatment performed.

[Evaluation of lung function as a prognostic index before and after surgical resection due to NSCLC]

BACKGROUND

Although there were several studies on survival, death and morbidity rates after lung resection, considering both limited and extended resections, lung exercise capacity has been quite seldom taken into account as an index for prognosis. The aim of this study compare the consequences of three kinds of lung resections (pneumonectomy, lobectomy and wedge resection), to test pre- and post-surgery exercise capacity for patients affected by NSCLC in order to obtain more detailed prognostic indices.

METHODS

All the patients were studied by means of thorough lung static function and hemogas analytical tests before and after surgical resection, from 15 days to 12 twelve months' time past surgery.

RESULTS

In fact, in relation to lung resection due to neoplasms, several studies pointed out that zone-limited resections show an obvious anatomical benefit in terms of parenchyma spair compared to lobectomy; however, it is underlined that the functional benefits of small resections don't really prevail over post-lobectomy anatomical advantages. Furthermore local relapses are more common after small resections rather than after lobectomy.

CONCLUSIONS

Neither limited lung resection nor lobectomy alone, therefore, in accordance with nearly all the recent and still ongoing studies in this huge research field, has a significant effect on exercise capacity. Only pneumonectomy is associated with impaired exercise performance, and, nevertheless, quite below our expectations.

[Role of thymectomy in the treatment of myasthenia gravis: considerations and personal cases]

The therapeutic impact of thymectomy on the clinical course of myasthenia gravis is still very controversial. In fact, while nowadays the surgical approach is widely adopted for thymomas, its role is still debatable in patients suffering from myasthenia gravis. The surgical approach of choice for total thymectomy is represented by median sternotomy. Other surgical methodologies include cervical access and partial sternotomy. All these approaches have shown excellent results in the exeresis of the thymus. More recently video-assisted thoracoscopic thymectomy has been proposed as a less invasive and similarly effective technique for the removal of this organ and the treatment of myasthenia gravis. Aim of the present study is to report Author's experience with thymectomy, emphasizing the data available in the international literature on the surgical mortality, complications and aesthetical results of the different surgical accesses.

[Intraoperative pleural lavage for restaging of bronchogenic carcinoma]

BACKGROUND

Although lung cancer staging has been recently reviewed, a significant number of recurrences and an increased incidence of mortality is common also in the initial stages of the disease. All that is probably due to disease staging underestimation and emphasizes that an exact system of staging cannot be considered a stand-alone prognostic and therapeutic index.

METHODS

Between October 2000 and November 2001, 37 patients have undergone surgical intervention for NSCLC in our Surgical Unit; 28 of them were male (75.7%), 9 female (24.3%), aged between 55 and 70. Neither cancer-related pleural effusion, nor mediastinal lymphoadenopathy had been detected under Rx and TC inspection in any patient.

RESULTS

Pre-surgical pleural washing (PLC), which defines the positiveness of the cytological result (D+), in 17 patients (45.9%) was positive, in the remaining 20 (54.1%) negative. The positiveness of PLC was 35.3% (6/17) and 64.7% (11/17) in the initial stage of T (T1 and T2) and in the advanced stage (T3 and T4) respectively.

CONCLUSIONS

On the basis of personal experience, the authors, suggest that pre-surgical resection pleural washing searching premature microscopic pleural disseminations in NSCLC-affected patients should become an important prognostic factor for the disease outcome. Moreover, they emphasize how this procedure is easy, with a small increase in the surgical intervention time, and nearly costless.

Chronic alcohol use and first symptomatic epileptic seizures

OBJECTIVE

To establish whether chronic alcoholism and alcohol consumption are risk factors for developing a first symptomatic epileptic seizure.

METHODS

Multicentre case-control study of 293 patients (160 men, 133 women) with a first seizure symptomatic (either acute or remote) of head trauma, stroke, or brain tumour, matched to 444 hospital controls for centre, sex, age (+/-5 years), and underlying pathology.

RESULTS

The risk of first seizure in alcoholics was no higher than in non-alcoholics for men (odds ratio 1.2, 95% confidence interval 0.4 to 3.2) or women (1.5, 0.1 to 54.4). The odds ratio (both sexes) was 1.2 (0.8 to 1.7) for an average intake of absolute alcohol of 1-25 g/day, 0.9 (0.5 to 1.5) for 26-50 g/day, 1.6 (0.8 to 3.0) for 51-100 g/day, and 1.4 (0.5 to 3.5) for >100 g/day.

CONCLUSIONS

We found no evidence of an association between alcohol use or alcoholism and a first symptomatic seizure.

Cortical excitability and sleep deprivation: a transcranial magnetic stimulation study

The objective was to assess the changes in cortical excitability after sleep deprivation in normal subjects. Sleep deprivation activates EEG epileptiform activity in an unknown way. Transcranial magnetic stimulation (TMS) can inform on the excitability of the primary motor cortex. Eight healthy subjects (four men and four women) were studied. Transcranial magnetic stimulation (single and paired) was performed by a focal coil over the primary motor cortex, at the "hot spot" for the right first dorsal interosseous muscle. The following motor evoked potential features were measured: (a) active and resting threshold to stimulation; (b) duration of the silent period; (c) amount of intracortical inhibition on paired TMS at the interstimulus intervals of 2 and 3 ms and amount of facilitation at interstimulus intervals of 14 and 16 ms. The whole TMS session was repeated after a sleep deprivation of at least 24 hours. After the sleep deprivation, the threshold to stimulation (in the active and resting muscle), as well as the silent period, did not change significantly. By contrast, the paired stimulus study showed a significant (p<0.05) reduction in both intracortical inhibition and facilitation. Thus, TMS showed that sleep deprivation is associated with changes in inhibition-facilitation balance in the primary motor cortex of normal subjects. These changes might have a link with the background factors of the "activating" effects of sleep deprivation.