Detection of Borrelia burgdorferi DNA and complement membrane attack complex deposits in the sural nerve of a patient with chronic polyneuropathy and tertiary Lyme disease

We report a patient who developed a chronic sensory-motor polyneuropathy and a progressive myelopathy 4 years after a tick bite. An increased serum antibody titer to Borrelia burgdorferi suggested a diagnosis of Lyme neuroborreliosis, although a concomitant cervical spondylosis probably contributed to spinal cord damage. Treatment with ceftriaxone resulted in a marked improvement of neuropathic symptoms, providing indirect evidence of spirochetal infection. Search for B. burgdorferi DNA by polymerase chain reaction amplification on sural nerve confirmed the diagnosis, demonstrating that the spirochete localized in the peripheral nervous system. The presence of complement membrane attack complex deposits and macrophage infiltrates around epineurial vessels and within the endoneurium suggests that the neuropathy in our patient was immune-mediated.

[Malignant tumors in children living in the province of Trieste, 1972-1993: descriptive epidemiology and the quality of diagnostic-therapeutic services]

The study objectives were: 1) to analyse the incidence and death rates from cancer among children aged 0-14 years resident in the north-eastern Italian province of Trieste between 1972-1993, using data from the population-based Trieste Cancer Registry; 2) to evaluate the local diagnostic facilities by analysing the accuracy of histological diagnoses, the causes of delay in the diagnosis, and the interval between onset of symptoms and diagnosis of cancer; 3) to calculate the proportion of patients treated following the most effective therapy protocols known at the time of the tumour detection, and to compute the actuarial five-year survival rates since diagnosis. We recorded 123 new cases of cancer (93% microscopically verified) corresponding to a rate, age-standardized to the world population, of 161.9 (standard error [SE] = 15.1) per million child-years. The most common diagnostic group was that of primary brain tumours: 40 cases, rate = 51.0 (SE = 8.4). In 102 cases the diagnosis was made at hospitals in the province of Trieste, with a median time of seven days (25th-75th percentile = 1-16) between admission and diagnosis. In 37 cases the length of the interval between the advancing of the diagnostic hypothesis of cancer and the microscopic diagnosis ranged from eight to 57 days: 20% of the interval was spent in the identification of the lesion, 50% elapsed between the identification and the biopsy, and 30% was spent in performing the microscopic diagnosis. Out of 123 cases, 30 were partly treated or completely treated at centres not located in our province, i.e., at seven different Italian hospitals (14 cases), nine European hospitals (15 cases), and at one North-American centre (one case). The 40 children with brain tumours were spread among 12 institutions. The five-year survival rate increased from 52.4% (SE = 6.3) for the 63 children with cancers diagnosed in 1972-1981 to 62.5% (SE = 7.0) for the 48 with malignancies detected in 1982-1990.

Cancer of the oldest old. What we have learned from autopsy studies

Cancer in the oldest old is a novel problem, due to the recent burgeoning of the population aged 85 and older. This article addresses three critical questions related to cancer in the oldest old: Does the incidence of cancer increase after age 95? Is cancer a common cause of death for the oldest old? Is cancer accurately diagnosed in the oldest old? The authors analyzed a group of 507 autopsies of elderly, divided in three age groups, 75 90 years, 95 99, and over 99 (centenarians). The prevalence of cancer was 35% among the younger persons and 20% and 16% respectively for those aged 95 99 and for the centenarians. A fourth of the patients in the younger group died from cancer but only 9.5% of the people between 95 and 98 years and 7.1% of the centenarians died from cancer. The cancer was the direct cause of death for 67% of the younger persons and 41% of patients belonging to the two oldest groups. The prevalence of metastases was 63% for tumors occurring in persons aged 75 90, 32% in persons aged 95 98, and 29% in the centenarians. Cancer had been accurately diagnosed prior to death in 67.4% of persons aged 75 90, in 38.5% of those aged 95 99, and 29.4% of the centenarian. Cancer as cause of death had been underestimated in 16% of the cases in the younger persons and in almost 50% of cases of the oldest old. This study suggests that the incidence of cancer and the importance of cancer as a cause of death may decline after age 95 and that the clinical diagnoses underestimate significantly both the incidence of cancer and the prevalence of cancer deaths in the oldest old.

Malignant tumors at very old ages

Unselected autopsy findings of nonagerians reviewed by the authors in the last 20 years, confirm a decline in malignant tumors at very old ages. Two main factors are thought to be responsible for this evidence: a less aggressive biological behavior of cancer in the oldest old; the crucial role played by comorbidity as the cause of death.

[Lung cancer in the province of Trieste]

In our study we analyzed a file of 756 males with lung cancer and an equal number of controls matched by sex, age and year of death. All the subjects were resident in the Trieste area, died between 1979-81 and 1985-86 and underwent autopsy at the Istitute of Pathological Anatomy of the University of Trieste. The aim of the research was to analyze and quantify the risk to develop lung cancer in those exposed to asbestos, and well-recognized carcinogens (list A of I.A.R.C.) or suspected (list B). We have also analyzed the relative risk (R.R.) for lung cancer among those subjects with environmental exposure to air pollution in industrial and urban areas. The study was set up in the Trieste province, a geographic area which is particularly suitable for epidemiological studies. We have demonstrated on excess of risk for males exposed to asbestos (R.R. = 1.99) and to other well known carcinogens (R.R. = 2.28). The capability in differentiating the relative risk of smoking and professional exposure to oncogenetic substances allowed us to detect an excess of risk for people living in industrial and urban areas, when compared to those living in rural and peripheral areas.

Air pollution and lung cancer in Trieste, Italy: spatial analysis of risk as a function of distance from sources

To investigate the relationship between four sources of environmental pollution (shipyard, iron foundry, incinerator, and city center) and lung cancer risk, we conducted a case-control study of decreased men in Trieste, Italy. We identified 755 cases of lung cancer and 755 controls through the local autopsy registry. Information on smoking habits, occupational history, and place of residence were obtained from the subject's next of kin. The case-control design was used to properly account for subject-specific confounders, which represent a major problem in geographical analysis. Spatial models were used to evaluate the effect of sources of pollution on lung cancer after adjustment for age, smoking habits, likelihood of exposure to occupational carcinogens, and levels of air particulate. The models are based on distance from the sources and enable estimation of the risk gradient and directional effects separately for each source. The risk of lung cancer was highly related to the city center (p = 0.0243), with an excess relative risk at zero distance of 2.2 and a smooth decrease moving away from the source (-0.015), and related to the incinerator (p = 0.0098), with an excess relative risk of 6.7 in the source and a very steep decrease (-0.176). These results are consistent with findings of previous analyses and provide further evidence that air pollution is a moderate risk factor of lung cancer.

Air pollution and lung cancer in Trieste, Italy

To investigate the relation between air pollution and histologic type of lung cancer, the authors conducted a case-control study among men who had died in Trieste, Italy, from 1979 to 1981 and from 1985 to 1986. Through the local autopsy registry, 755 cases of lung cancer and 755 controls were identified. Information on smoking habits, occupation, and place of residence was obtained from each subject's next of kin. Air pollution at the residence of each subject was estimated from the average value of total particulate at the nearest monitoring station. Logistic regression was used to evaluate the effect of residence and air pollution on lung cancer after adjustment for age, smoking habits, likelihood of exposure to occupational carcinogens, and social group. The risk of lung cancer increased with increasing level of air pollution for all types of lung cancer combined (p = 0.022), for small cell carcinoma (p = 0.016), and for large cell carcinoma (p = 0.049). Compared with inhabitants of the residential area, residents of the rural area had a relative risk (RR) of 0.6 (95% confidence interval (CI) 0.4-1.0). The RR was 1.5 (95% CI 1.0-2.2) for residents of the center of the city and 1.4 (95% CI 1.0-2.1) for residents of the industrial area. In the center of the city, the excess risk was almost completely restricted to small cell carcinoma (RR = 2.0) and to large cell carcinoma (RR = 2.6). In the industrial area, the risk was increased especially for adenocarcinoma (RR = 2.1). These results provide evidence that air pollution is a moderate risk factor for certain histologic types of lung cancer.

[Comparison of epidemiologic methods in a case-control study of lung cancer and air pollution in Trieste, Italy]

To investigate the relationship between air pollution and histologic type of lung cancer we conducted a case-control study among deceased men in Trieste, Italy. 755 cases of lung cancer and 755 controls were identified through the local autopsy registry. Information on smoking habits, occupation and place of residence was obtained from the subject's next-of-kin. Air pollution at the residence of each subject was estimated from the average value of total particulate at the nearest monitoring station. Spatial models and logistic regression were used to evaluate the effect of residence and air pollution on LC after adjustment for age, smoking habits, likelihood of exposure to occupational carcinogens and social group. The risk of lung cancer increased with increasing level of air pollution for all types of lung cancer combined (P = 0.022), for small cell carcinoma (P = 0.016) and for large cell carcinoma (P = 0.049). Compared with inhabitants of the residential area, residents of the rural area had a relative risk (RR) of 0.6 (95% confidence interval (CI): 0.4-1.0). The RR was 1.5 (1.0-2.2) for residents of the center of the city and 1.4 (1.0-2.1) for residents of the industrial area. In the center of the city the excess risk was almost completely restricted to small cell carcinoma (RR = 2.0) and to large cell carcinoma (RR = 2.6). In the industrial area the risk was increased especially for adenocarcinoma (RR = 2.1). These results provide evidence that air pollution is a moderate risk factor for certain histologic types of lung cancer.

Occupational exposure and lung cancer risk in a coastal area of northeastern Italy

A case-control study of lung cancer and occupational exposure was conducted in a coastal area of Northeastern Italy where metallurgical and mechanical industries, docks and shipyards are located. Cases comprised 756 men who died of primary lung cancer in a 5-year period. Controls comprised 756 male subjects dying from other causes during the same period. Occupational exposures to lung carcinogens were assessed according to a job title-based approach, using two separate lists of industries/occupations recognized as being causally associated (list A) or suspected of being causally associated (list B) with lung cancer in humans. Exposure to asbestos was classified as absent, possible, or definite. After adjustment for cigarette smoking and place of residence, a significant association was found between lung cancer and occupations in both list A [relative risk (RR) = 2.25, 95% confidence interval (CI) = 1.68-3.03] and list B (RR = 1.33, 95% CI = 1.03-1.71). A significant excess risk was found for workers with definite exposure to asbestos as compared to those with no exposure to lung carcinogens (RR = 1.98, 95% CI = 1.42-2.75). Among occupations with recognized exposure to lung carcinogens other than asbestos, a significant excess risk for lung cancer was observed in iron and metalware workers. In occupational groups with definite exposure to asbestos, elevated risk estimates were found for shipyard workers, dockworkers, carpenters, and electricians. The combined effect of smoking and asbestos was found to be compatible with that expected under a multiplicative model. The overall population-attributable risk (ARp) for cigarette smoking was found to be 87.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Occupation and lung cancer risk in the province of Trieste: a case-control study]

To investigate the relationship between occupation and lung cancer, a case-control study was performed in the province of Trieste, Italy, where metallurgical and mechanical industries, dock activities and shipbuilding and ship repairing are predominant. Through the local Cancer Registry, pathology records of 938 men who died of primary lung cancer (ICD 162) in a five-year period were examined. Residential, smoking and occupational histories were obtained from interviews of next of kin of 756 cases and 756 age-matched male controls (+/- 2 years). Occupational exposures to lung carcinogens were assessed according to a job-title based approach, identifying industries/occupations with well-recognized lung carcinogen exposures (list A) and industries/occupations with suspected lung carcinogen exposures (list B). Exposure to asbestos was classified as absent, possible or definite. After adjustment for cigarette smoking (four levels) and residence (three levels), a significant association was found between lung cancer and occupations in list A (RR = 2.28, 95% CI = 1.70-3.07) and in list B (RR = 1.33, 95% CI = 1.04-1.71). A significant excess risk was found for workers with definite exposure to asbestos when compared to those with no exposure to lung carcinogens (RR = 1.99, 95% CI = 1.43-2.76). A very high relative risk was observed among heavy smokers with definite exposure to asbestos (RR = 42.8). A stratified analysis showed that the combined effect of asbestos and smoking was compatible with that expected under a multiplicative model. The overall attributable risk in the population (ARp) for cigarette smoking was found to be 87.6%. The ARp fraction for occupations with well-established exposures to lung carcinogens (list A) was 16.2%. The ARp fraction increased to 25.5% (85% CI = 1.4-34.6) when occupations with suspected exposure to lung carcinogens (list B) were included. The ARp fraction for possible or definite exposure to asbestos was 20.1% (95% CI = 11.6-28.6).

Supraglottic versus glottic laryngeal cancer: epidemiological and pathological aspects

Between 1979 and 1988, 432 cases of previously untreated laryngeal cancers were histologically diagnosed at the Institute of Pathological Anatomy of the University of Trieste. Of these cases, 192 were supraglottic and 182 glottic cancers. The overall crude incidence was 31.06 0/0000 in males and 2.29 0/0000 in females, with a male/female ratio of 10.2:1 for supraglottic cancers vs. 20.4:1 for glottic cancers. Our incidence values for laryngeal cancer, and supraglottic lesions in particular, are similar to those recorded in France, Spain and other areas of Italy, i.e. in nations where wine production and consumption is very high. The 3-year adjusted survival rate was 45.7% for supraglottic and 83% for glottic cancer patients. Subjects with supraglottic cancer often had a poor prognosis because of the high frequency of cervical lymph node involvement, recurrences and visceral metastases; cancers of the aryepiglottic folds presented the worst clinical evolution.

Incidence of hepatocellular carcinoma in Italy: what could we learn from autoptic studies?

From January 1, 1968 to December 31, 1984, 31,955 autopsies were performed at the Department of Pathology of the University of Trieste. Of these 16,521 were male and 15,434 female which covered about 70% of the population who died in the area over the recent years. Hepatocellular carcinoma (HCC) associated with liver cirrhosis was encountered in 441 cases (380 males and 61 females, M:F ratio 5.8:1) with an overall occurrence of 1.4% in the autoptic population. On the contrary and in the absence of chronic liver disease HCC was only observed in 0.3% of the cases (45 males and 16 females, M:F ratio 2.7:1). Liver cirrhosis accounted for 10% of autopsies (2099 males and 1104 females, M:F ratio 1.8:1). A 15% of cirrhosis was associated with HCC, indicating that major attention should be paid to cirrhotic patients, in particular males after the 5th decade of life. The year distribution of HCC and cirrhosis was fairly constant during the period of time considered. These data suggest that: i) HCC is common in Italy; ii) in the vast majority, HCC occurs in the presence of cirrhosis; and iii) HCC appears to be a rather late disease as it does not reduce the life expectancy of cirrhotic and control populations. Since reliable, nationwide epidemiological data are not available in Italy, it is not known whether these data represent a local realty or whether they may be extrapolated to the entire country. Cooperative and prospective studies appear appropriate in investigating possible geographical differences in HCC distribution and permit a better understanding and prevention of the disease.

RNA extracted from paraffin-embedded human tissues is amenable to analysis by PCR amplification

Fixed and paraffin-embedded tissues from pathology department archives can be available for RNA expression analysis. In this report, we show that RNA isolated from surgical or autopsy tissues, routinely processed by fixation and paraffin embedding, is not completely degraded. RNA fragments around 100-200 bases in length are still present even in organs late fixed and very rich in RNase, such as the pancreas. Here we describe a general protocol to obtain RNA from single 6-8-microns tissue sections. The RNA extracted can be analyzed for the presence of specific sequences by reverse transcription and amplification with the PCR. We studied the retinoblastoma gene expression in 38 human pancreas specimens from surgical or autopsy origin.

Monoclonal antibodies define structural alterations of the thyroglobulin secreted by well-differentiated thyroid carcinomas

We have studied the sorting and alteration of the thyroglobulin (tg) secreted by well-differentiated carcinomas using a group of anti-tg monoclonal antibodies. A previously described monoclonal antibody, specific for the hormogenic iodinated epitopes, shows that in carcinomas the iodinated tg is not secreted in the colloid as in normal glands but is accumulated in the cytoplasm of the cells. Separation of tg in a concanavalin A column, to isolate the correctly glycosilated protein, reveals that hormogenesis is present only in glycosilated tg with a correct final configuration. An other monoclonal antibody, specific for an epitope connected with the carbohydrate moiety of the tg, reacts with tgs from normal glands and from any thyroid lesion except tg from carcinomas. This tg of carcinomas presents an alteration in the oligosaccharide chains that can be detected by this antibody. The alteration is specific for malignant tumors and could be connected with the missing exocytosis of the iodinated tg in carcinomas.

[Effect of hysterectomy and ovariectomy on the incidence of malignant neoplasms of the female genital tract]

The true risk population for uterine and ovary cancer have been studied, according to the prevalence of histerectomy and oophorectomy in the Trieste area female population. The calculation of the females at risk for these tumors permits to recalculate the incidence rates that are usually underestimated. This adjustment increases the rates in all genital tract tumors from 14% to 18%, but does not modify the relative frequency per age groups or the incidence in the temporal trends. An exception is represented from the uterine corpus cancer in which the correction of the population modifies the temporal trend for the age group over 60 years. The incidences tend in fact to increase significantly more after the adjustment.

Bilitranslocase localization and function in basolateral plasma membrane of renal proximal tubule in rat

Bilirubin and phthalein dyes are taken up by the liver via a carrier-mediated mechanism operated at least in part by bilitranslocase (BTL). Because they also undergo renal transport, the presence and function of BTL was investigated in rat renal tubular plasma membrane vesicles. Transport of sulfobromophthalein (BSP) was enriched in basolateral domain of plasma membrane and followed the distribution pattern of Na(+)-K(+)-ATPase but not of gamma-glutamyltransferase. BSP uptake was inhibited by addition of monospecific antibodies raised against hepatic BTL. As in liver vesicles, BSP transport was electrogenic, being greatly accelerated by addition of valinomycin in presence of an inwardly directed K+ gradient. Apparent Km of BSP transport was 17 +/- 2 microM (n = 3 expts), one order of magnitude higher than that measured in liver; however, Vmax was similar to that described in liver vesicles (429 +/- 18 nmol BSP.mg protein-1.min-1, n = 3 expts). Competitive inhibition was observed with both unconjugated bilirubin (Ki, 2.9 +/- 0.2 microM) and rifamycin SV (Ki, 76 +/- 10 microM), known competitors for hepatic BTL-mediated transport of BSP. Immunoblotting studies with anti-BTL monospecific antibodies revealed presence of a single positive band only in basolateral-enriched membrane fraction; its apparent molecular mass was 37 kDa, virtually identical to that of hepatic protein. Immunohistochemistry confined presence of BTL to renal proximal tubules (RPT) We conclude that BTL is present in basolateral plasma membrane of RPT cells. Lower affinity of renal, compared with hepatic protein, for substrates might explain the marginal role of kidney in plasma clearance of bilirubin and cholephilic dyes.

Correlation between liver cirrhosis and benign prostatic hyperplasia: a morphological study

In elderly males hormonal changes occur, that are believed to cause benign prostatic hyperplasia (BPH). These are decreased testosterone production, an increased testosterone SHBG and a slightly increased estradiol production. Liver cirrhosis in males causes similar endocrine changes. We carried out a post mortem study evaluating the prostates of 51 men who died with liver cirrhosis compared with a similar group without any hepatic disease. The occurrence of BPH in cirrhotic subjects was diminished and delayed compared to total population. Furthermore in cirrhotic men BPH is more common as early nodular hyperplasia (early stage) or stromal hyperplasia (suggesting estrogenic prevalence), while in the general population stromal and epithelial hyperplasia (androgenic stimulation), were almost equally present.

[Causes of attenuation of the sound waves in neoplasms of the breast. Histologic and echographic correlation study]

The purpose of our study was to compare the ultrasound findings in malignant breast masses (which underwent biopsy) with their histological appearance. In our activity of breast sonography, we observed that the same histological type of breast cancer often shows a different ultrasonic image. The main difference concerns the sonic attenuation or increase through the neoplastic mass. The histological examination took into account the amount of stroma and cells and the architectural pattern of the lesion. Comparing these features with the ultrasonic image, it has been shown that sonic transmission is related more to the architectural pattern than to the fibrous content of the neoplastic tissue.