Apolipoprotein E genotype in sporadic early- and late-onset Alzheimer's disease

The 84 isoform of apolipoprotein E (ApoE) has been proposed as a risk factor for Alzheimer's disease (AD), while the possible role of the epsilon2 allele in AD is controversial. We have studied the ApoE genotype in 38 patients with early-onset AD (EOAD) and in 43 patients with late-onset AD (LOAD). In the EOAD group we observed a significant increase of epsilon4 allele frequency as compared with normal controls, while there was a more than 3-fold decrease of epsilon2 allele frequency that did not reach statistical significance. In the LOAD group we found a highly significant increase of epsilon4 allele frequency as compared with normal controls, while there was a significant decrease of epsilon2 allele frequency. In both the EOAD and LOAD groups, no significant difference was observed between epsilon4 carriers and epsilon4 noncarriers as for age at disease onset, disease duration, and Mini-Mental State score at observation. However, in both EOAD and LOAD groups a statistical trend towards a longer disease duration was observed in epsilon4 carriers. In both the EOAD and LOAD groups, disease severity was compared in epsilon4 carriers versus epsilon4 noncarriers by means of analyses of covariance, with disease duration as covariate. No significant difference between epsilon4 carriers and epsilon4 noncarriers was observed in both EOAD and LOAD. The results of the present study confirm that epsilon4 allele seems to be associated with an increased risk for sporadic AD, while the significant decrease of epsilon2 allele frequency in the LOAD group supports the hypothesis of a possible protective role of epsilon2 allele in AD.

Intrahepatic bile duct loss in primary sclerosing cholangitis: a quantitative study

AIMS

Intrahepatic bile duct volume density has been evaluated in four cases of primary sclerosing cholangitis (PSC) by applying a semiautomatic image analysis system to histological sections of surgical biopsies. Comparison was made between normal livers and cases of primary biliary cirrhosis.

METHODS AND RESULTS

A marked decrease in both bile duct volume density in liver (up to 50% of normal value) and bile duct volume density in portal tracts (up to 21% of normal value) was found. The analysis of correlations between the portal tract size and the portal tract volume fraction constituted by bile ducts confirms that the destruction mainly affects small and medium-sized ducts. The ratio of bile duct to arterial component volume fractions in portal tracts turned out to be inverted with respect to that determined in normal liver, showing a decrease of up to 30% of normal value.

CONCLUSIONS

The features observed in primary sclerosing cholangitis, as well as the extent of bile duct loss proved to be quite similar to what we had previously described in primary biliary cirrhosis. Thus, regardless of the causes and mechanisms leading to the bile duct loss, the quantification of ductopenia produced results which are alike for the two distinct cholestatic diseases.

Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma

BACKGROUND

Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series.

METHODS

One hundred eighty-eight cases of ACC were collected in a national registry. A complete follow-up was obtained in 179 cases. At initial diagnosis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a mean disease-free interval of 21.7 months.

RESULTS

Adjuvant chemotherapy was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 +/- 14.9 months) than in nonreoperated cases (3.2 +/- 2.9 months). Five-year actuarial survival in reoperated patients is significantly better than in nonreoperated patients (49.7% versus 8.3%, respectively).

CONCLUSIONS

Although the prognosis of this tumor is still poor, surgery is the only effective therapy; reoperation allows survival comparable to that observed in patients without recurrent disease. An aggressive strategy for recurrent ACC is advisable until prospective studies demonstrate a real effectiveness for chemotherapy.

[Simplifies case record in emergency surgery]

The Authors present an original case record simplified for urgency and emergency, with the aim to allow a quick and exact framing of the "acute" and consequently with a great saving of time. This is possible also thanks to the simple but efficacious graphic representation of the human body and his main districts. Moreover, it is possible to report data in a computerized system.

[Renal injury in childhood]

The Authors report a case of blunt renal trauma in a nine-year-old boy. Clinical and therapeutic approaches are discussed in the light of a wide review of the literature.

[Aorto-enteric fistula: current information on diagnostic and therapeutic procedures]

The Authors point out how AEFs represent a serious complication of aortic vascular surgery. Special attention is given to the diagnostic and therapeutic approach, also supported by a wide review of the literature.

[Signet ring cell adenocarcinoma of the colon (signet ring carcinoma): is it really a rare neoplasm?]

The Authors report two cases of primary carcinoma of the colon-rectum largely invasive, characterized signet ring cells. This is an uncommon neoplasm representing only 2% of primary carcinoma of the colon-rectum. The Authors discuss the diagnostic and therapeutic approach through a wide review of the literature.

[Diagnostic and therapeutic approach to kidney injuries]

The Authors report a wide review of the literature on open and blunt renal traumas. All the problems related to this pathology as well as all the instrumental and laboratory tests currently available for the correct diagnosis are illustrated. Both conservative and surgical management are also discussed.

[Surgical treatment of spontaneous rupture of the esophagus: case report]

Boerhaave's syndrome is a rare and severe syndrome, with a mortality rate around 40%. The Authors report a case recently observed and through a Literature review stress the importance of an early diagnosis and quick surgical treatment as far as quoad vitam prognosis is concerned.

Naming deficit for non-living items: neuropsychological and PET study

We report a patient with progressive left hemisphere atrophy who presented a lexical retrieval deficit more pronounced in naming non-living items than in naming living items. Word frequency and familiarity strongly influenced the performance, but the dissociation persisted when the items were controlled for these factors. In addition, the prevalent deficit for non-living items in respect to living items could be confirmed in tasks where other patients presented the opposite pattern. A PET study showed a significant hypometabolism in the left hemisphere regions suggesting that, at variance with living deficit which is observed in patients with bilateral lesions, non-living deficit is produced by unilateral left hemispheric lesions. This patient confirms that living and non-living categories may dissociate and that distinct neural systems subsume their knowledge.

[Mechanical endarterectomy: review of the literature and description of an original device]

The Authors, after a Literature review on endovascular invasive procedures used for inferior limbs obstructive arteriopathy, describe the use of a new device for mechanical endarterectomy. Through the latest acquired experience the importance of dissecting progressively the single layers of the atheroma plaque without arriving to a complete denudation of the arterial wall, so avoiding the risk of myointimal hyperplasia reactions, is outlined. The possibility of using endoarterial stents in case of more indaginous recanalization is also stressed.

[Treatment of peripheral arterial embolisms. Our case series and review of the literature]

Acute arterial obstruction of the limbs represents one of the most frequent events in Emergency Surgery. In 95% of the cases, the cause has to be searched in embolus parting from the heart in patients with rheumatic or fibrillary disease. Currently the two therapeutic methods used for peripheral arterial obstruction are thrombolytic therapy and surgical dysobstruction using Fogarty's catheter. The Authors compare the two methods on the basis of their experience in 129 cases underlying how the thrombolytic therapy (Urokinase, Streptokinase) should be instituted in the early hours from presentation of symptoms, otherwise, the possibility of revascularization will heavily drop. Better results are obtained by positioning a catheter under radiologic guide for intra-arterial infusion. The Authors also believe that up-to-date the surgical approach with Fogarty's catheter represents one of the best procedures, either for its feasibility of for the costs of the thrombolytic therapy. Furthermore, the thrombolysis may be not complete, and account for possible haemorrhagic complications.

[Foreign bodies in the gastrointestinal tract. Our cases and a review of the literature]

The ingestion or introduction of foreign bodies is a common situation in emergency surgery. The patients who usually ingest foreign bodies for different reasons are children, psychotics, alcoholics, prisoners and old people. The authors analyzed 65 cases observed in the I Institute of Surgery of the University of Rome "La Sapienza": 45 males and 20 females. Both the anal introduction and ingestion may be accidental or voluntary. The incidence of complications is estimated about 5 to 7%. The authors underline the opportunity of a conservative removal through endoscopic procedures especially for intraesophageal corps. This procedure is recommended to reduce morbidity and mortality rates, as well as hospitalization and social costs.

[Septic complications in emergency surgery: our experience and a review of the literature]

Surgical infections represent one of the main causes of postoperative morbidity and mortality, especially in emergency surgery, with negative consequences on health costs. The Authors examined 2002 cases of emergency admission for surgical pathologies at the I Surgical Department of the University of Rome ¿La Sapienza¿ from 1987 to 1992. Overall septic complications were 13,7%, with a mortality rate of 1,2%. The Authors underline the lack in Italy of either an accurate system for monitoring septic complications or a useful method for data collection. At last the attention is focused on the main causes of septic complications, their diagnosis and treatment.

Italian multicentric study on pain treatment with epidural spinal cord stimulation

A multicentric study on the treatment of nonmalignant chronic pain with epidural spinal cord stimulation (SCS) has been carried out in 32 Italian centers devoted to pain therapy. Neurosurgical and anesthesiology units participated in this retrospective study. 410 of the eligible patients were enrolled in the protocol: 48% were male, 52% female. All patients underwent a screening test period (average 21 days) and 74% underwent the definitive implant. The diagnosis was failed back surgery syndrome in 45%, reflex sympathetic dystrophy in 15%, phantom limb pain in 14%, postherpetic neuralgia in 8%, peripheral nerve injury in 5%, others 13%. 84% received noninvasive unsuccessful treatment (10 tensor acupuncture). All had previous pharmacological therapy which was not always discontinued when SCS took place. Pain assessment had been done with the visual analog scale and verbal scale both subjectively and by the physician and nurses. Neuropsychological profile with minimal mental test or MMPI was obtained in 68% of the patients. These results were favorable (i.e. excellent or good; more than 50% reduction of pain) in 87% of the patients at the 3-month follow-up, 75% at the 6-month follow-up, 69% at the 1-year follow-up, and 58% at the 2-year follow-up. Complication rate was: dislocation of the electrocatheter 4%, technical problems 3%, infections of the system 2%. The results will be discussed in correlation with the different etiologies of the nonmalignant chronic pain syndrome.

Involvement of somatically acquired ecotropic viruses in the immunogenicity of nude-transplanted NIH/3T3 transformed cell lines

Immunogenic tumor variants were previously derived after transplantation in vivo into nude mice of NIH/3T3-transformed cell lines. Nude-passaged cell lines were rejected by immunocompetent H-2q NIH mice, were recognized by specific CTL clones, and expressed new retroviral Ag. The aim of the present work was to investigate whether somatically acquired proviral sequences were present in the genome of nude-passaged cells and to test directly for a causative relationship between murine leukemia virus (MuLV) expression and immunogenicity. Southern blot analysis of PstI-digested DNA indicated that in contrast to the parental NIH/3T3 transformed cell lines (pT, T12N/5a, NS-1) all the nude-passaged immunogenic variants (pT-nude, T12N/5a-nude, NS-1-nude) contained newly acquired ecotropic-related proviruses. Immediately after in vitro establishment, these tumors displayed multiple integration sites as assessed by analysis of 3' proviral-cellular junctions. Long term in vitro culture of one of the cell lines (pT-nude) resulted in a cell line (pT-nude/vitro) that was clonal or oligo-clonal with respect to viral integration. Northern blot analysis established that the new proviruses were actively transcribed in all the immunogenic variants. To assess whether the somatically acquired ecotropic proviral sequences encode for target structures recognized by specific CTL, obtained after immunization of NIH mice with pT-nude, the parental cell line pT was transfected with plasmids containing the entire AKV MuLV genome, the cloned AKV gag or env genes. Screening of transfectants for their ability to stimulate the production of TNF by anti-pT-nude effectors indicated that cells transfected with the entire ecotropic virus or with MuLV-env gene products could be recognized by an NIH anti-pT-nude CTL line and NIH anti-pT-nude Kq-restricted CTL clones as well as the immunizing target pT-nude.

Involvement of somatically acquired ecotropic viruses in the immunogenicity of nude-transplanted NIH/3T3 transformed cell lines

Immunogenic tumor variants were previously derived after transplantation in vivo into nude mice of NIH/3T3-transformed cell lines. Nude-passaged cell lines were rejected by immunocompetent H-2q NIH mice, were recognized by specific CTL clones, and expressed new retroviral Ag. The aim of the present work was to investigate whether somatically acquired proviral sequences were present in the genome of nude-passaged cells and to test directly for a causative relationship between murine leukemia virus (MuLV) expression and immunogenicity. Southern blot analysis of PstI-digested DNA indicated that in contrast to the parental NIH/3T3 transformed cell lines (pT, T12N/5a, NS-1) all the nude-passaged immunogenic variants (pT-nude, T12N/5a-nude, NS-1-nude) contained newly acquired ecotropic-related proviruses. Immediately after in vitro establishment, these tumors displayed multiple integration sites as assessed by analysis of 3' proviral-cellular junctions. Long term in vitro culture of one of the cell lines (pT-nude) resulted in a cell line (pT-nude/vitro) that was clonal or oligo-clonal with respect to viral integration. Northern blot analysis established that the new proviruses were actively transcribed in all the immunogenic variants. To assess whether the somatically acquired ecotropic proviral sequences encode for target structures recognized by specific CTL, obtained after immunization of NIH mice with pT-nude, the parental cell line pT was transfected with plasmids containing the entire AKV MuLV genome, the cloned AKV gag or env genes. Screening of transfectants for their ability to stimulate the production of TNF by anti-pT-nude effectors indicated that cells transfected with the entire ecotropic virus or with MuLV-env gene products could be recognized by an NIH anti-pT-nude CTL line and NIH anti-pT-nude Kq-restricted CTL clones as well as the immunizing target pT-nude.

Can oncogene (RAS) activation predict susceptibility of human melanoma to activated lymphocytes and, therefore, the clinical response of such neoplasms to adoptive immunotherapy?

The expression of activated ras oncogenes was found to be associated with that of tumour-specific transplantation antigens in mouse tumours, which can be cured by adoptive immunotherapy with T lymphocytes and interleukin-2 (IL-2). A similar association is here proposed to exist between RAS oncogene activation (mutation) in human melanoma and susceptibility of these tumours to the lytic action of activated lymphocytes (both lymphokine-activated killers and cytotoxic T cells) which have been used, along with IL-2, in the adoptive immunotherapy of advanced melanomas. The limited clinical response (15-25%) of melanoma patients to different immunological therapies is, therefore, considered to be due to a similar frequency of immunogenic, RAS+ melanomas. The authors thus suggest that RAS activation might be a marker of immunogenicity and that only the subset of melanoma cells expressing activated RAS will in turn possess tumour antigens which can be the target of immunotherapeutic, activated lymphocytes. It is then predicted that RAS+ melanomas will be more susceptible to adoptive immunotherapy than RAS-counterparts.

Activation of ras oncogenes and expression of tumor-specific transplantation antigens in methylcholanthrene-induced murine fibrosarcomas

The DNA of 22 fibrosarcomas, newly induced in BALB/c mice by subcutaneous doses of 3-methylcholanthrene (3-MCA), was tested in NIH 3T3 transformation assay. Activation of K-ras and N-ras was found in 7 and 3 cases respectively. No H-ras activation was detected. Polymerase chain reaction and oligonucleotide hybridization performed on the DNA of the 22 sarcomas revealed 5 cases of K-ras mutation at codon 12, 3 at codon 13 and 1 at both codons. One case of K13 mutation was not detectable by transfection. Three cases of mutation at codon 61 of N-ras were also found, one of which was simultaneous with a K12 mutation. Tumor-specific transplantation antigens (TSTA) were assessed in the 22 original tumors. Altogether 16 sarcomas were immunogenic, with the highest frequency of TSTA+ tumors (10/11 and 5/6) in the groups given 1.0 and 0.1 mg of 3-MCA respectively, the lowest (1/5) in that with 0.01 mg of carcinogen; ras mutations occurred in the DNAs of 11 out of the 16 TSTA+ sarcomas, but none of the DNAs of the 6 TSTA- tumors showed ras mutation. The results suggest that 3-MCA-induced transformation of subcutaneous fibroblasts can involve mutations in codons 12, 13 or 61 of K- and N- but not H-ras gene and that such mutation is accompanied by the expression of TSTA.

Multiple sclerosis. Magnetic resonance imaging, evoked potentials and cerebrospinal fluid analysis

We have studied 27 patients with multiple sclerosis (22 definite, 5 probable) by magnetic resonance imaging (MRI), visual evoked potentials (VEPs), brainstem auditory evoked potentials (BAEPs), and oligoclonal bands (OBs) in cerebrospinal fluid (CSF), MRI was altered in 92.5% of the cases, the presence of OBs in CSF was revealed in 73.1% of the examined patients, the frequency of evoked potentials (EPs) alteration was VEPs = 59.3% and BAEPs = 29.6%, at least one of the two EPs occurred positive in 66.6% of the cases. Our data confirm the more sensitive value of MRI compared with OBs and EPs studies in assessing MS, and stress the utility of the combined use of these tests.

Expression of retrovirus-related, cytotoxic T lymphocyte- and transplantation-defined antigens in NIH/3T3 transfectants after a single passage in nude mice

Transfection of T24c-Ha-ras oncogene into NIH/3T3 fibroblasts resulted in the establishment of a transformed cell line (pT) that was tumorigenic when injected s.c. both into Swiss outbred nude mice and normal NIH inbred mice. The passage into nude mice, however, led to the development of a tumor variant (pT-nude) able to subsequently grow into sublethally x-irradiated but not into immunocompetent NIH mice. NIH mice immunized with this tumor variant developed a strong specific CTL response against the immunizing cell line, whereas the parental transformed pT cell line was not lysed. Clones were derived by limiting dilution from anti-pT-nude bulk population and were tested on a panel of transformed NIH/3T3 lines before and after their growth as tumor into nude mice. All of these lines were lysed by the Lyt-2+ CTL clones as a sole consequence of one in vivo passage into nude mice. The cross-reactive Ag were shown to be related to endogenous retroviral products as assessed by 1) immunoprecipitations of gp70, p15E, and p30 viral proteins in the nude variants but not in parental lines, and 2) by the ability of retroviruses from irradiated pT-nude cells to infect NIH/3T3 or pT lines making them susceptible to lysis by anti-pT-nude CTL clones. These results show that a single passage in nude mice can induce retrovirus-related, cell-surface Ag in transplanted neoplastic cells.

Expression of retrovirus-related, cytotoxic T lymphocyte- and transplantation-defined antigens in NIH/3T3 transfectants after a single passage in nude mice

Transfection of T24c-Ha-ras oncogene into NIH/3T3 fibroblasts resulted in the establishment of a transformed cell line (pT) that was tumorigenic when injected s.c. both into Swiss outbred nude mice and normal NIH inbred mice. The passage into nude mice, however, led to the development of a tumor variant (pT-nude) able to subsequently grow into sublethally x-irradiated but not into immunocompetent NIH mice. NIH mice immunized with this tumor variant developed a strong specific CTL response against the immunizing cell line, whereas the parental transformed pT cell line was not lysed. Clones were derived by limiting dilution from anti-pT-nude bulk population and were tested on a panel of transformed NIH/3T3 lines before and after their growth as tumor into nude mice. All of these lines were lysed by the Lyt-2+ CTL clones as a sole consequence of one in vivo passage into nude mice. The cross-reactive Ag were shown to be related to endogenous retroviral products as assessed by 1) immunoprecipitations of gp70, p15E, and p30 viral proteins in the nude variants but not in parental lines, and 2) by the ability of retroviruses from irradiated pT-nude cells to infect NIH/3T3 or pT lines making them susceptible to lysis by anti-pT-nude CTL clones. These results show that a single passage in nude mice can induce retrovirus-related, cell-surface Ag in transplanted neoplastic cells.