Nasal-sinus polyposis: clinical-cytological grading and prognostic index of relapse

This longitudinal and prospective study aimed at investigating the influence of some parameters,including nasal cytology and clinical findings (such as asthma, atopy, acetylsalicylic acid (ASA) sensitivity, ASA associated with asthma), as risk factor of post-surgical relapse of nasal-sinus polyps. One hundred sixty-one consecutive patients (92 males and 69 females, mean age 47 years), affected by bilateral nasal polyposis and who had undergone surgical nasal polypectomy (endoscopic FESS), were examined post-surgically at least every 6 months for a period of 10 years. Endoscopic exam and nasal cytology exam were carried out on all patients and their case histories were carefully examined. The association eosinophilic-mast cell cellularity and the contemporary presence of asthma + ASA sensitivity showed the highest level of relapse (OR 4.5). In conclusion, cytological data in association with certain clinical parameters can predict a high risk prognosis of relapse.

Genotyping of Different Pseudomonas Aeruginosa Morphotypes Arising from the Lower Respiratory Tract of a Patient Taken to an Intensive Care Unit

Pseudomonas aeruginosa is an opportunistic pathogen and an ubiquitous environmental bacterium. Fifty-seven days after hospitalization, we isolated three distinct P. aeruginosa morphotypes (smooth, rough and mucoid) from the lower respiratory tract of a patient admitted to a Cardiology Intensive Care Unit (ICU). Moreover, a group of nine colony variants, arising from the three P. aeruginosa isolates growing in laboratory growth media, were also isolated. The resulting 12 isolates were characterised for antibiotic resistance profile and subjected to genotypic analysis by fluorescent-Amplified Fragment Length Polymorphism (f-AFLP) and automated repetitive extragenic palindromic-PCR (rep-PCR) fingerprinting. The three smooth, rough and mucoid morphotypes presented different antibiotic resistance profiles and genotyping analysis showed that they belonged to distinct clones, indicating that at day 57 after the admission the patient was simultaneously colonized by three distinct P. aeruginosa isolates. On the other hand, the nine colony variants presented heterogeneous antibiotic resistance profiles and clustered together with the three parental isolates. The understanding of the link between genotype plasticity and antibiotic resistance may contribute to improving our knowledge of this life-threatening pathogen.

Non-allergic rhinitis with eosinophils and mast cells constitutes a new severe nasal disorder

Three main types of inflammatory Non-Allergic Rhinitis (NAR) have been defined: NAR infiltrated by eosinophils (NARES), by mast cells (NARMA), and by neutrophils (NARNE). A new particular type has been characterized with current infiltration by eosinophils and mast cells (NARESMA). The aim of this study is to evaluate the clinical and functional characteristics in patients with NARES, NARMA, NARNE, and NARESMA and to define the latter. One hundred and seventy-six NAR patients were prospectively and consecutively evaluated: 52 patients with NARES, 38 with NARMA, 36 with NARNE, and 50 with NARESMA. Clinical features, Quality of Life (QoL), and rhinomanometry were evaluated in all of them. QoL was significantly different in the 4 groups. NARESMA patients had the worst QoL. Nasal function and QoL in NARESMA patients were significantly correlated. Significant associations were shown with both nasal polyps and asthma in NARESMA patients. This study provides the first evidence that NARESMA constitutes a new type of NAR and is a particularly severe disorder.

Hyperhomocysteinemia is associated with cognitive impairment in multiple sclerosis

Hyperhomocysteinemia (HHcy) has been associated with cognitive impairment in various neurological diseases. Cognitive impairment occurs early in multiple sclerosis (MS). Conflicting data have been reported regarding plasma total homocysteine (tHcy) levels in MS patients, and the impact of HHcy on cognitive impairment in MS is not known. This study investigated whether plasma total homocysteine levels are increased in MS and if HHcy is associated with cognitive impairment in MS. We compared tHcy levels in 94 patients with MS and 53 healthy age-matched controls. We used a neuropsychological test battery that included the Raven's Coloured Progressive Matrices, the Visual Search Test, the Trail Making Test A and B, the Immediate and Delayed Recall of a Short Story, the 30 Paired Word Associates, the Rey-Osterrieth Complex Figure Test, and the Semantic and Verbal Fluency Tests. Clinical (sex, age, type of MS, relapse, disease duration, coexisting disease, smoking habit, and physical disability) and laboratory variables (HHcy, low serum levels of folate and vit.B12, MTHFR genotype) were evaluated for their ability to predict cognitive impairment. The mean tHcy was higher in patients (13.19 micromol/L, SD5.58) than in controls (9.81 micromol/L, SD2.53; p < 0.001). Univariate analysis determined the following factors to be associated with cognitive impairment: higher age at observation, chronic progressive course of disease, longer disease duration,moderate or severe physical disability, and frequency of HHcy. With multivariate regression analysis, there remained a significant association only between frequency of HHcy and cognitive impairment (beta 0.262, p = 0.01). We conclude that tHcy levels are increased in MS and that HHcy is associated with cognitive impairment in this disease.

Parental social contact in the work place and the risk of childhood acute lymphoblastic leukaemia

To study the possible relation between parental social contact through occupation, a marker for a child's risk of infection, and childhood acute lymphoblastic leukaemia (ALL), the parents of 294 children with ALL aged 0-14.9 years and 376 matched controls were interviewed about their jobs after their child's birth up to the age of 3 years. Job titles were assigned to a level of social contact, and an index of occupational social contact months was created using the level and the job duration. Positive interactions between this index and rural residence associated with an increased risk of childhood ALL and common ALL (c-ALL) were observed (interaction P-value=0.02 for both, using tertiles of contact months; interaction P-value=0.05 and 0.02 for ALL and c-ALL, respectively, using continuous contact months); such findings were not observed when job durations were ignored. Our data suggest that duration of parental occupation may be important when examining the association between parental social contact in the workplace and childhood leukaemia.

Increased liver mast cell recruitment in patients with chronic C virus-related hepatitis and histologically documented steatosis

Hepatitis C virus (HCV) is still one of the major causes of chronic viral infection worldwide, and hepatic steatosis is a frequent pathological finding in patients with chronic HCV-related diseases. It is unclear whether the steatosis is associated with host factors or the virus itself, although a consistent relationship has been found between steatosis and a necro-inflammatory reaction with the increased secretion of immuno-regulators. A primary sources of inflammatory mediators are mast cells (MCs) bone marrow-derived cells that are detected in both normal and diseased livers. We determined MC density and correlated it with the fibrosis, inflammatory reaction and steatosis observed in the liver biopsies of patients affected by HCV with or without steatosis. All the histological features were assessed using a computer-aided image analysis system. There was a statistically significant difference in MC density between the HCV-infected patients with and without steatosis, with the lower mean value being detected in those without (P < 0.02). Furthermore, a nonstatistically significant difference in fibrosis and inflammation between the two patient groups was found. In conclusion, this is the first study showing a significant increase in MC density in the tissues of patients with chronic HCV infection and histologically documented steatosis.

[Role of screening tests for indirect diagnosis of tuberculosis in health care workers: Mantoux and the new tests on blood ELISA]

The Tuberculosis infection in recent years has become always more a threat. The failure in the attempt to stop it (O.M.S. Millennium Global Plan) brought to the revision of the world control strategy to at least contain this disease (The Global Plan to Stop TB 2006-2015). Due to these severe facts it is even more important now to elaborate more sensitive and specific methods to find out, as fast as possible, the infected cases. As of today, the main TB infection screening test is the Skin PPD test (Mantoux). Recently new tests for the population screening are in use; these tests are based on the evaluation of immunity cell-mediated. They (QFT-G) do not have the typical limits of the Skin Test and they are more suitable as serial tests and therefore more useful, according to us, in the screening programs of the TB infection in low prevalence countries, like Italy.

Upper extremity arteriovenous dialysis fistula resulting in cavernous sinus arterialized blood flow

Arterialized blood flow in the cavernous sinus may result from carotid-cavernous fistula or dural venous fistula. We encountered an unusual case of arterialized blood flow in the cavernous sinus on MR angiography resulting from arterialized retrograde venous flow in the internal jugular vein. This abnormal flow originated from an upper extremity dialysis arteriovenous fistula in the presence of central venous occlusion. The patient's symptoms of visual disturbance resolved after the central venous occlusion was treated with stent placement.

"Conditional" neck dissection in management of laryngeal carcinoma

It is well known that malignant laryngeal tumours can extend from their site of origin into tributary lymph nodes, depending on their location and size. Management protocols almost always include concomitant surgical treatment of both the tumour and cervical nodes. When palpable lymph nodes are present, dissection is mandatory but there is no general agreement on the option of choice in clinically N0 patients. Elective neck dissection, following the current indications, is necessary in most cases of N0 laryngeal cancer, but the number of bilateral dissections may be limited. In tumours of only one hemilarynx or extending slightly beyond it, metastatic involvement is more likely to be on the same side as the lesion although there is no absolute certainty that it will be. In these cases, and especially in supraglottic tumours, occult metastatic spread may also penetrate into the contralateral lymph nodes of the neck. The present report deals with the results of a surgical strategy to limit bilateral elective dissection, based on the following criteria. In supraglottic tumours of only one hemilarynx or extending slightly beyond it, the presence of ipsilateral node metastases is highly predictive of a concomitant involvement of the contralateral nodes. In these supraglottic tumours, only in cases with post-operative serial positive histology of the uni-ipsilateral dissected cervical lymph nodes, has contralateral elective neck dissection ("conditional dissection") been performed. "Conditional dissections" led to a reduction of approximately 70% of elective bilateral neck dissections.

Conformation dependent pro-apoptotic activity of the recombinant human prion protein fragment 90-231

The transition of prion protein from a mainly alpha-structured isoform (PrPC) to a beta sheet-containing protein (PrPSc) represents a major pathogenetic mechanism in prion diseases. To study the role of PrP structural conformation in prion-dependent neurodegeneration, we analysed the neurotoxicity of PrP in alpha and beta conformations, using a recombinant protein encompassing amino acids 90-231 of the human PrP (hPrP90-231). Using controlled thermal denaturation (53 degrees C, 1h) we converted hPrP90-231 in a structural isoform displaying PrPSc-related characteristics: high beta sheet content, increased aggregability and a slight increase in the resistance to protease K. In virtue of these structural changes, hPrP90-231 powerfully affected the survival of SH-SY5Y cells, inducing a caspase-3 and p38- dependent apoptosis. Conversely, in the native alpha-helix-rich conformation, hPrP90-231 did not show significant cell toxicity. The relationship between the structural state of hPrP90-231 and its neurotoxicity was demonstrated, inducing the thermal denaturation of the peptide in the presence of Congo red that prevented both the transition of hPrP90-231 into a beta-rich isoform and the acquisition of toxic properties. In conclusion, we report that the toxicity of hPrP90-231 is dependent on its three-dimensional structure, as is supposed to occur for the pathogen PrP during TSE.