MADS-box protein complexes control carpel and ovule development in Arabidopsis

The AGAMOUS (AG) gene is necessary for stamen and carpel development and is part of a monophyletic clade of MADS-box genes that also includes SHATTERPROOF1 (SHP1), SHP2, and SEEDSTICK (STK). Here, we show that ectopic expression of either the STK or SHP gene is sufficient to induce the transformation of sepals into carpeloid organs bearing ovules. Moreover, the fact that these organ transformations occur when the STK gene is expressed ectopically in ag mutants shows that STK can promote carpel development in the absence of AG activity. We also show that STK, AG, SHP1, and SHP2 can form multimeric complexes and that these interactions require the SEPALLATA (SEP) MADS-box proteins. We provide genetic evidence for this role of the SEP proteins by showing that a reduction in SEP activity leads to the loss of normal ovule development, similar to what occurs in stk shp1 shp2 triple mutants. Together, these results indicate that the SEP proteins, which are known to form multimeric complexes in the control of flower organ identity, also form complexes to control normal ovule development.

[Post-acute long stay and extensive rehabilitation: study of the first year of work at a long stay university hospital unit]

Long stay is a new type of hospital admission geared to internal medicine patients requiring long-term stays in hospital and prolonged treatment for the purposes of stabilization or clinical rehabilitation. Given the lack of specific experience, we monitored the progress of a Long-Stay Unit with the aim to estimate the clinical and organizational impact. We studied 263 patients (59.3% females, 40.7% males; mean age 76.3 +/- 11.5 years, 42.2% all in their late eighties) coming from medical wards (75%) and from surgical wards (25%). The clinical complexity was prospectively estimated by a form divided into 3 sections: the first part was filled out at the time of transfer, the second part at set intervals throughout the period and the third at the end of the stay. Mean length of stay for medical patients was 33.2 days, for surgical patients 28.6 days (NS). Main transfer diagnosis: 50% of the patients fell into two diagnostic groups: malignant neoplasm (33.1%) and cerebral ictus (17.5%). Some data evidenced remarkable clinical complexity: 93.9% of the patients had one or more secondary diagnoses; when initially admitted 89.4% already presented with complications or serious outcomes; while in the Long-Stay Unit 83.3% required medical treatment and extensive nursing care; 87.1% had further major complications; 56.3% was totally dependent; 42.6% was totally bedridden and 35.4% died. In conclusion, the majority of long-stay patients in a medium-to-large polyclinic hospital present with several concomitant diseases, with extremely invalidating complaints, characterized over the short-to-mid term by serious clinical complications. They require a great deal of competent medical/nursing care as well as highly qualified internal medicine specialists.

Adenocarcinoma of the rete testis. Report of two cases

Adenocarcinoma of the rete testis is extremely rare and has been the subject of only sporadic case reports. Its natural history appears highly malignant even in localized forms; because of a poor response to adjuvant therapy radical orchiectomy with retroperitoneal lymph node dissection is recommended in stage A. We report our experience with two examples which arose in men of 26 and 57 years of age between 1988 and 1999. Both of them presented with a scrotal mass, and one of them had hydrocele. Neither had a history of maldescendent, infections or trauma. Microscopically the tumors were adenocarcinomas, and the one in the 26 years old patient presented with tubulopapillary formations. Immunohistochemical staining demonstrated positivity for CK and NSE in the 26 year old patient and only a weak positivity for CEA and vimentin in the 57 year old one. EMA and calretinin were always negative. Both were stage A but the young man who underwent radical orchiectomy with no lymph node dissection, developed a lymph node metastasis within one year.

Urine volume: stone risk factor and preventive measure

BACKGROUND

A high fluid intake is the oldest existing treatment for kidney stones, and, up until a few decades ago, it was the only preventive measure at the physician's disposal for stone recurrences.

METHODS

Using the data available in literature and partly unpublished personal research, we examine the role of urine volume as a stone risk factor, its impact on calcium crystallization mechanisms and its real importance as a means of prevention.

RESULTS

To sum up, the most important findings are: (1) a low urine volume must be considered as a real risk factor, both as regards the onset of renal calculi and stone relapses; (2) an increase in urine volume induced by a high water intake produces favourable effects on the crystallization of calcium oxalate and does not reduce the activity of natural inhibitors; (3) a sufficiently high intake of water and probably other fluids such as coffee, tea, beer and wine has a preventive effect on nephrolithiasis and its recurrence, and (4) the role of fruit juice is still to be defined.

CONCLUSIONS

A high intake of fluids, especially water, is still the most powerful and certainly the most economical means of prevention of nephrolithiasis, and it is often not used to advantage by stone formers.

Essential arterial hypertension and stone disease

BACKGROUND

Cross-sectional studies have shown that nephrolithiasis is more frequently found in hypertensive patients than in normotensive subjects, but the pathogenic link between hypertension and stone disease is still not clear.

METHODS

Between 1984 and 1991, we studied the baseline stone risk profile, including supersaturation of lithogenic salts, in 132 patients with stable essential hypertension (diastolic blood pressure of more than 95 mm Hg) without stone disease and 135 normotensive subjects (diastolic blood pressure less than 85 mm Hg) without stone disease who were matched for age and sex (controls). Subsequently, both controls and hypertensives were followed up for at least five years to check on the eventual formation of kidney stones.

RESULTS

Baseline urine levels in hypertensive males were different from that of normotensive males with regards to calcium (263 vs. 199 mg/day), magnesium (100 vs. 85 mg/day), uric acid (707 vs. 586 mg/day), and oxalate (34.8 vs. 26.5 mg/day). Moreover, the urine of hypertensive males was more supersaturated for calcium oxalate (8.9 vs. 6.1) and calcium phosphate (1.39 vs. 0.74). Baseline urine levels in hypertensive females were different from that of normotensive females with regards to calcium (212 vs. 154 mg/day), phosphorus (696 vs. 614 mg/day), and oxalate (26.2 vs. 21.7 mg/day), and the urine of hypertensive females was more supersaturated for calcium oxalate (7.1 vs. 4.8). These urinary alterations were only partially dependent on the greater body mass index in hypertensive patients. During the follow-up, 19 out of 132 hypertensive patients and 4 out of 135 normotensive patients had stone episodes (14.3 vs. 2.9%, chi-square 11.07, P = 0.001; odds ratio 5.5, 95% CI, 1.82 to 16.66). Of the 19 stone-former hypertensive patients, 12 formed calcium calculi, 5 formed uric acid calculi, and 2 formed nondetermined calculi. Of the urinary factors for lithogenous risk, those with the greatest predictive value were supersaturation of calcium oxalate for calcium calculi and uric acid supersaturation for uric acid calculi.

CONCLUSIONS

A significant percentage of hypertensive subjects has a greater risk of renal stone formation, especially when hypertension is associated with excessive body weight. Higher oxaluria and calciuria as well as supersaturation of calcium oxalate and uric acid appear to be the most important factors. Excessive weight and consumption of salt and animal proteins may also play an important role.

Relationship between supersaturation and calcium oxalate crystallization in normals and idiopathic calcium oxalate stone formers

BACKGROUND

In an earlier study on recurrent CaOx stone formers with no detectable abnormalities, we found that the urine of these subjects had a lower tolerance to oxalate load than controls and that the removal of urinary macromolecules with a molecular weight greater than 10,000 D improved their tolerance to oxalate.

METHODS

The effects on CaOx crystallization of reduced urinary supersaturation of calcium oxalate (CaOx), induced by night water load, were studied in 12 normal males and in 15 male OxCa stone formers who were free from urinary metabolic abnormalities. The effect of the macromolecules, purified and retrieved from the natural and diluted urine, were analyzed in a metastable solution of CaOx.

RESULTS

The water load caused an increase in urine volume (from 307 +/- 111 to 572 +/- 322 ml/8 hr, P = 0.014 in normal subjects, and from 266 +/- 92 to 518 +/- 208 ml/8 hr, P = 0.001 in the stone formers) and a concomitant reduction of the relative CaOx supersaturation (from 8.7 +/- 2.5 to 5.1 +/- 2.5 ml/8 hr, P = 0.001 in normal subjects, and from 10.4 +/- 3.5 to 5.0 +/- 2.7 ml/8 hr, P = 0.001 in the stone formers). The decrease in CaOx supersaturation was accompanied by an increase of the permissible increment in oxalate, both in normal subjects (from 43.8 +/- 10.1 to 67.2 +/- 30. 3 mg/liter, P = 0.018) and in the stone formers (from 25.7 +/- 9.4 to 43.7 +/- 17.1 mg/liter, P = 0.0001), without any significant variations of the upper limit of metastability for CaOx (from 21.6 +/- 5.3 to 20.5 +/- 4.2 mg/liter in normal subjects, and from 18.7 +/- 4.5 to 17.1 +/- 3.7 mg/liter in the stone formers). The inhibitory effect of urinary macromolecules with molecular weight greater than 10,000 Daltons did not undergo any change when the latter were recovered from concentrated or diluted urine, either in normal subjects or in the stone formers.

CONCLUSIONS

Reduced CaOx supersaturation by means of water load has a protective effect with regards to CaOx crystallization in subjects who do not present any of the common urinary stone risk factors.

Sclerosing hemangioma of the lung: a case report

A well circumscribed nodular mass discovered on routine chest ray examination, was excised from the left lung interlobar fissure of a 67 years old woman. Histologically the lesion corresponded to a typical "so called sclerosing hemangioma" according to Liebow and Hubbell's originally description. Because of the uncertain histogenesis we utilized histochemistry and immunohistochemistry to support the hypothesis of an epithelial origin.

Metastases to pineal gland as first symptom of bronchogenic carcinoma: report on an case

Metastases of malignant tumors to the pineal gland have been described by some authors but remains an uncommon manifestation of malignancy. The primary tumor appeared to be lung and breast carcinomas. A case of adenocarcinoma of the lung with isolated pineal metastases is reported.

Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study

PURPOSE

We define the role of urine volume as a stone risk factor in idiopathic calcium stone disease and test the actual preventive effectiveness of a high water intake.

MATERIALS AND METHODS

We studied 101 controls and 199 patients from the first idiopathic calcium stone episode. After a baseline study period the stone formers were divided by randomization into 2 groups (1 and 2) and they were followed prospectively for 5 years. Followup in group 1 only involved a high intake of water without any dietetic change, while followup in group 2 did not involve any treatment. Each year clinical, laboratory and radiological evaluation was obtained to determine urinary stone risk profile (including relative supersaturations of calcium oxalate, brushite and uric acid by Equil 2), recurrence rate and mean time to relapse.

RESULTS

The original urine volume was lower in male and female stone formers compared to controls (men with calcium oxalate stones 1,057 +/- 238 ml./24 hours versus normal men 1,401 +/- 562 ml./24 hours, p < 0.0001 and women calcium oxalate stones 990 +/- 230 ml./24 hours versus normal women 1,239 +/- 440 ml./24 hours, p < 0.001). During followup recurrences were noted within 5 years in 12 of 99 group 1 patients and in 27 of 100 group 2 patients (p = 0.008). The average interval for recurrences was 38.7 +/- 13.2 months in group 1 and 25.1 +/- 16.4 months in group 2 (p = 0.016). The relative supersaturations for calcium oxalate, brushite and uric acid were much greater in baseline urine of the stone patients in both groups compared to controls. During followup, baseline values decreased sharply only in group 1. Finally the baseline urine in patients with recurrences was characterized by a higher calcium excretion compared to urine of the patients without recurrences in both groups.

CONCLUSIONS

We conclude that urine volume is a real stone risk factor in nephrolithiasis and that a large intake of water is the initial therapy for prevention of stone recurrences. In cases of hypercalciuria it is suitable to prescribe adjuvant specific diets or drug therapy.

An unusual case of cytomegalovirus infection

We describe the case of a nonimmunocompromised middle age man, who presented with a history of fever, nausea, disturbance of consciousness, peripheral eosinophilia and a bone marrow eosinophilic hyperplasia. A persistent unexplained eosinophilia was initially interpreted as a sign of the hypereosinophilic syndrome because all known causes of secondary eosinophilia had been excluded and there were evidence of multiorgan dysfunction. A cervical lymph node biopsy was remarkable for malignant T cell lymphoma according to the hypothesis that patients with the hypereosinophilic syndrome should be carefully examined for an underlying proliferation of clonal T cells. The patient died of CID after 3 months of hospitalization. At autopsy he was found to have a generalized CMV infection.

Effects of urinary macromolecules on the nucleation of calcium oxalate in idiopathic stone formers and healthy controls

Urinary macromolecules have attracted great interest because of their possible role as both promoters and inhibitors of calcium oxalate (CaOx) crystallization and it remains unclear whether there is any difference, in their nucleating activity, between stone formers and controls. We selected 9 male idiopathic CaOx stone formers whose 24-h urines presented no evidence of common urinary stone risk factors such as hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia, hypomagnesiuria or low glycosaminoglycans excretion and 12 male controls (matched for age and body weight) whose 24-h urines did not differ from those of stone formers. The study of urinary CaOx nucleation was made in freshly voided overnight urines whose biochemical composition was almost identical in the two groups. In filtered (0.22 micron) and ultrafiltered (10 kDa) urine we performed an oxalate tolerance test to determine the permissible increment of oxalate, the oxalate level for nucleation and the permissible increment of CaOx relative supersaturation (CaOx RS). In filtered urine from stone formers the permissible increment of oxalate was lower than controls (30 +/- 10.2 vs. 46.7 +/- 9.7 mg/l, P = 0.001), the oxalate level for nucleation was lower (64.4 +/- 14.2 vs. 79.5 +/- 15.6 mg/l, P = 0.035) and the permissible increment of CaOx RS was also lower (9.71 +/- 2.59 vs. 13.39 +/- 3.62, P = 0.018). In ultrafiltered urine these differences disappeared because the removal of macromolecules in stone formers significantly enhanced the oxalate-tolerance values. The difference between the change of the oxalate permissible increment of filtered and ultrafiltered urine allowed a distinction to be made between stone formers and controls that was not feasible in other ways (7.6 +/- 5.3 vs. 3.3 +/- 5.9 mg/l, P < 0.0001). The study suggests that, in idiopathic CaOx stone formers free from common urinary risk factors of CaOx crystallization, there is an increased tendency for CaOx nucleation in urine, which is mediated by macromolecular components.

Undifferentiated small-cell carcinoma of the urinary bladder: report of two cases with a primary urinary cytodiagnosis

Two undifferentiated small-cell carcinomas of the urinary bladder are reported. The patients, 68- and 55-yr-old men, respectively, presented with painless hematuria. In the first case, numerous small, lymphocyte-like cells with coarse chromatin, sometimes with small nucleoli, and high nuclear/cytoplasmatic ratios were found in cytologic urine specimens. A cytodiagnosis of undifferentiated small-cell cancer was made. In the second case, urine samples showed rare aggregates of small, undifferentiated cells in association with malignant urothelial cells. The cytodiagnosis of mixed tumor composed of undifferentiated small cell and transitional carcinoma was confirmed by histologic examination. The presence of focal reactivity with anti-chromogranin antibody and neurosecretory granules via electron microscopy supports a neuroendocrine differentiation for the small neoplastic cells. The patients died 13 and 8 mo after diagnosis, respectively.

[Clear-cell sarcoma of the tendons and aponeuroses. Immunohistochemical study of 2 cases]

Two cases of clear cell sarcoma of tendons and aponeuroses are reported. Clinical setting, protracted course, and light microscopic appearance were in a agreement with the original description. In the first case the tumor required differential diagnosis from metastatic malignant melanoma because of the lack of the overlying skin and of the epithelial histological pattern. In the second case diagnosis was not too difficult; the tumor consisted of nest or fascicles of uniform pale staining cells intermingled by inconspicuous multinucleated giant cells with peripherally placed nuclei. The histologic features and immunohistochemistry are also discussed.

Metastatic renal cell carcinoma presenting as a parotid tumor: a case report

Renal cell carcinoma rarely metastasize to the parotid gland; only 16 cases have been reported in the literature. We describe a 68-year-old man presenting with a 1-year history of a painless swelling on the right parotid gland. A partial parotidectomy was performed. The histological examination revealed a clear cell neoplasm, and the tumour cells were periodic acid-Schiff positive and diastase labile. The differential diagnosis involved the primary clear cell tumors of the parotid gland and metastasis of malignant extrasalivary neoplasms. Histochemical end immunohistochemical studies for vimentin, keratins and CEA are consistent with a metastatic renal cell carcinoma.

Clear cell carcinoma simulating the "endometrioid-like variant" of yolk sac tumor

The authors report a case of clear cell carcinoma of the ovary simulating the "endometrioid-like variant" of YST only recently described by Clement. The tumor was characterized histologically by a villoglandular component intermingled with an endometrioid like glandular pattern, nuclear pleomorphism with abnormal mitotic figures, eosinophilic hyaline PAS-D resistant bodies and diffuse, typical sopranuclear and subnuclear vacuolization according to Clement's description. Clinical features as the old age of the patient and laboratory investigations, suggested the possibility of a surface epithelial origin of the neoplasia, that was substantiated by subsequent additional sections and by immunohistochemical staining for AFP, AAT and CEA.

[Laryngeal carcinoma: retrospective study of 82 cases]

Between 1988-93, 82 cases of laryngeal carcinomas were diagnosed and treated at the Hospital of Rovigo. All were retrospectively staged using the TNM system. The actuarial global and NED survival were respectively 65.85% and 58.54% for 5 years. In relation to the site the survival for 5 years was 66.04% for the supraglottic tumours, 70.83% for the glottic tumours, 50% for the subglottic tumours and 33.33% for the transglottic ones. The grade of differentiation was certified in all cases: 15 (18.3%) G1, 58 (70.7%) G2, 9 (11%) G3. The NED survival and the recurrences for 3 years were found to be 90% and 0% of G1, 64.10% and 15.38% of G2, 66.67% and 33.33% of G3. The NED survival and the recurrences for 3 years were stage I, 73.91% and 13.4%; stage II 63.64% and 18.18%; stage III 50% and 15%; stage IV 47% and 17.65%. On the basis of the results obtained from our study, we were able to formulate some considerations upon the use of therapy adopted.

Primary carcinoma of fallopian tube: experience of six cases

Between 1980 and 1993, six cases of primary carcinoma of the fallopian tube were diagnosed and treated at the Hospital of Rovigo. Median age was 64.6 years; the most frequent symptom was atypical vaginal bleeding; only one patient presented a history compatible with hydrops tubae profluens. No patient in this series had a correct preoperative diagnosis. In Papanicolau smears and endometrial currettage, one case was positive for cancer. Primary surgical treatment was performed in all cases, followed by adjuvant chemotherapy. Histologic differentiation was Grade 2 in three patients and Grade 3 in three patients. Staging was by a system analogous to the FIGO classification for ovarian carcinoma. Two patients had Stage I disease; one, Stage II; two, Stage III; and one, Stage IV. Two patients died 14 and 37 months after the initial diagnosis. Three patients without clinical evidence of disease underwent second look procedures; the patients were alive and disease free with follow up ranging from 45 to 55 months. One patient is alive 4 months after surgery. In this series survival was not associated with grade, but was dependent upon stage. In our study, the prognostic value of the second- and third-look procedures are discussed.

Nifedipine and methylprednisolone in facilitating ureteral stone passage: a randomized, double-blind, placebo-controlled study

Expulsive medical therapy of ureteral stones is not well established. To test the efficacy of a calcium antagonist (nifedipine) associated with a corticosteroid (methylprednisolone) in facilitating ureteral stone passage, we studied 86 patients with a unilateral ureteral radiopaque stone not larger than 15 mm. in maximum diameter, confirmed in each case by drop excretory urography. Patients were randomly treated for a maximum of 45 days under double-blind conditions with 16 mg. methylprednisolone plus 40 mg. nifedipine daily (group 1-13 women and 30 men, mean age 45 +/- 14 years, standard deviation) and with 16 mg. methylprednisolone plus placebo daily (group 2-18 women and 25 men, mean age 43 +/- 14 years). All patients also received 2 l. of low mineral content water daily. The average maximum diameter of the stones was 6.7 +/- 3.0 mm. in group 1 and 6.8 +/- 2.9 mm. in group 2 (not significant). Partial ureteral obstruction was present in approximately half of the patients in both groups. Four patients in group 1 and 6 in group 2 dropped out of the study. In group 1, 34 patients had successful results (stone passage without surgical manipulation) and 5 failed (success rate 87%), compared to 24 and 13, respectively, in group 2 (success rate 65%). This difference was significant (p = 0.021, Fisher's exact test). No difference was present in the maximum stone diameter among the successful cases in groups 1 and 2 (6.4 +/- 2.8 and 5.3 +/- 2.2 mm., respectively, not significant). In both groups the maximum diameter of the stone was larger in the failed than in the successful cases (group 1-10.4 +/- 3.0 versus 6.4 +/- 2.8 mm., p = 0.005, and group 2-9.3 +/- 2.5 versus 5.3 +/- 2.2 mm., p = 0.0001). In group 1 the mean interval for stone passage in the successful cases was 11.2 +/- 7.5 days, compared to 16.4 +/- 11.0 days in group 2 (p = 0.036, Student's t test). We conclude that nifedipine associated with methylprednisolone is effective in facilitating ureteral stone passage.

[Endolymphatic stromal myosis of the uterus. Report of a case]

A case of endolymphatic stromal myosis is reported, recalling the rarity of this pathology. Its relations with other mesenchymal lesions of the uterus and the most likely differential diagnoses are considered.