[Diagnostic and surgical problems of ectopic breast cancer]

Cancer of supernumerary breast or ectopic breast tissue has haigher incidence than the cancer on ortotopic breast. This finding puts some problems about the diagnosis and therapy of ectopic breast cancer. The Authors describe their personal experience in three patients surgically treated and discuss about problems and solutions of this pathology.

A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis

A sixth month phase II multicenter-pilot trial with a low dose of the opiate antagonist Naltrexone (LDN) has been carried out in 40 patients with primary progressive multiple sclerosis (PPMS). The primary end points were safety and tolerability. Secondary outcomes were efficacy on spasticity, pain, fatigue, depression, and quality of life. Clinical and biochemical evaluations were serially performed. Protein concentration of beta-endorphins (BE) and mRNA levels and allelic variants of the mu-opiod receptor gene (OPRM1) were analyzed. Five dropouts and two major adverse events occurred. The remaining adverse events did not interfere with daily living. Neurological disability progressed in only one patient. A significant reduction of spasticity was measured at the end of the trial. BE concentration increased during the trial, but no association was found between OPRM1 variants and improvement of spasticity. Our data clearly indicate that LDN is safe and well tolerated in patients with PPMS.

Tactile-Induced Ultrasonic Vocalization in the Rat: A Novel Assay to Assess Anti-Migraine Therapies in vivo

A pharmacological model of migraine is described using ultrasound vocalization (USV) of rats following central inflammation-induced sensitization to tactile stimulation. Central inflammation induced by intracerebroventricular injection of lipopolysaccharide (LPS) increased USV induced by an air current focused on the head and this was abolished by morphine and ketorolac, suggesting a nocice-ptive component. USV in naive rats were unaffected. Diazepam reduced USV in both inflamed and naive rats. The triptans, zolmitriptan and sumatriptan, both reduced USV in inflamed but not in naive rats, as did dihydroergotamine, and the calcitonin gene-related peptide (CGRP) antagonists αCGRP(8-37) and BIBN4096BS. The neurokinin-1 antagonist L-733-060 had no effect in either inflamed or naive rats when given after induction of inflammation, but when given with the LPS it prevented the augmentation of USV. This profile of activity of agents proven to be effective in the clinic suggests this model can be used to predict novel therapeutic agents for migraine.

[Cutaneous B-cell non-Hodgkin lymphoma: clinical aspects, diagnostic and surgical approach]

By clinical observation and surgical treatment of a patient with cutaneous B-cell non-Hodgkin lymphoma, the Authors describe the nosological approach, the correct diagnosis and the surgical treatment in this disease.

[Seroma in residual fibrous capsule after breast implant explantation: a case report]

The Authors present a singular case of seroma which developed in residual fibrous capsule after explantation of breast prostheses without replacement. Mammographic and sonographic findings of the seroma make difficult the diagnosis: mammograms revealed a radiopaque, well-circumscribed mass anterior to the pectoralis major muscle in the region of the prior sub-glandular implant, that was initially misinterpreted as breast implant radiographic feature. It is particularly important review and carefully correlate mammographic and sonographic findings with patient's surgical history for a correct diagnosis.

IL4 gene delivery to the CNS recruits regulatory T cells and induces clinical recovery in mouse models of multiple sclerosis

Central nervous system (CNS) delivery of anti-inflammatory cytokines, such as interleukin 4 (IL4), holds promise as treatment for multiple sclerosis (MS). We have previously shown that short-term herpes simplex virus type 1-mediated IL4 gene therapy is able to inhibit experimental autoimmune encephalomyelitis (EAE), an animal model of MS, in mice and non-human primates. Here, we show that a single administration of an IL4-expressing helper-dependent adenoviral vector (HD-Ad) into the cerebrospinal fluid (CSF) circulation of immunocompetent mice allows persistent transduction of neuroepithelial cells and long-term (up to 5 months) CNS transgene expression without toxicity. Mice affected by chronic and relapsing EAE display clinical and neurophysiological recovery from the disease once injected with the IL4-expressing HD-Ad vector. The therapeutic effect is due to the ability of IL4 to increase, in inflamed CNS areas, chemokines (CCL1, CCL17 and CCL22) capable of recruiting regulatory T cells (CD4+CD69-CD25+Foxp3+) with suppressant functions. CSF delivery of HD-Ad vectors expressing anti-inflammatory molecules might represent a valuable therapeutic option for CNS inflammatory disorders.

Preparation and characterization of calcium phosphate biomaterials

Calcium phosphate cement (CPC) samples have been prepared with a mixture of monocalciumphosphate monohydrate (MCPM) and calcium carbonate (CC) powders, in stechiometric moles ratio 1:2.5 to obtain a Ca/P ratio of about 1.67 typical of hydroxyapatite (HAp), with or without addition of HAp. All specimens are incubated at 30 degrees C in a steam saturated air environment for 3, 6 and 15 days respectively, afterwards dried and stored under nitrogen. The calcium phosphate samples have been characterized by X-ray diffraction (XRD), Vickers hardness test (HV), diametral compression (d.c.), strength compression, and porosity evaluation. MCPM/CC mixture has a 30% HAp final concentration and is characterized by higher porosity (amount 78%) and mechanical properties useful as filler in bone segments without high mechanical stress.

Stiff-person syndrome with acute recurrent peripheral vertigo: possible evidence of gamma aminobutyric acid as a neurotransmitter in the vestibular periphery

OBJECTIVE

We report a case of a 58-year-old man suffering from stiff-person syndrome and recurrent peripheral vertigo.

METHOD

A case report and a review of the recent literature on stiff-person syndrome are presented.

RESULTS

The patient presented with recurrent episodes of vertigo with a pure peripheral pattern and with concomitant episodes of burning muscle pain, muscle twitching, weight gain and fatigue, worsening with tension or stress that also occurred in periods without vertigo. Cochlear examinations only showed presbyacusis-like hearing loss. The diagnosis of stiff-person syndrome was made with electromyographic examination and from findings in the blood and cerebrospinal fluid of high titres of anti-glutamic acid decarboxylase (GAD67) autoantibodies. In a two-year follow-up period, therapy for stiff-person syndrome abolished episodes of both stiffness and vertigo.

CONCLUSION

As far as we know, no other clinical case of acute vestibular damage with a possible correlation with anti-glutamic acid decarboxylase antibodies has been described. Peripheral vertigo possibly related to a lack of gamma aminobutyric acid underlines a possible role of gamma aminobutyric acid as a neurotransmitter in the peripheral vestibular system.

[Multiple repetitive mammary fibroadenomas. Case report]

Multiple and ripetitive mammary fibroadenomas represent a rare disease. The etiology is uncertain. The diagnostic radiology is able to allow a correct diagnosis. The authors report a case of a woman 22 years old undergone a surgical treatment many times to remove multiple and ripetitive mammary fibroadenomas. The proposed management provides for periodic radiological exams; the surgical treatment is proposed only for the lesions with a rapid growth.

HSV-1-mediated IL-1 receptor antagonist gene therapy ameliorates MOG35–55-induced experimental autoimmune encephalomyelitis in C57BL/6 mice

Primary proinflammatory cytokines, such as IL-1beta, play a crucial pathogenic role in multiple sclerosis and its animal model experimental autoimmune encephalomyelitis (EAE), and may represent, therefore, a suitable therapeutic target. We have previously established the delivery of anti-inflammatory cytokine genes within the central nervous system (CNS), based on intracisternal (i.c.) injection of non-replicative HSV-1-derived vectors. Here we show the therapeutic efficacy of i.c. administration of an HSV-1-derived vector carrying the interleukin-1receptor antagonist (IL-1ra) gene, the physiological antagonist of the proinflammatory cytokine IL-1, in C57BL/6 mice affected by myelin oligodendrocyte glycoprotein-induced EAE. IL-1ra gene therapy is effective preventively, delaying EAE onset by almost 1 week (22.4+/-1.4 days post-immunization vs 15.9+/-2.1 days in control mice; P=0.0229 log-rank test), and decreasing disease severity. Amelioration of EAE course was associated with a reduced number of macrophages infiltrating the CNS and in a decreased level of proinflammatory cytokine mRNA in the CNS, suggesting an inhibitory activity of IL-1ra on effector cell recruitment, as antigen-specific peripheral T-cell activation and T-cell recruitment to the CNS is unaffected. Thus, local IL-1ra gene therapy may represent a therapeutic alternative for the inhibition of immune-mediated demyelination of the CNS.

Effect of nitric oxide release from NOR-3 on urea synthesis, viability and oxygen consumption of rat hepatocyte cultures

As nitric oxide is considered a mediator of liver oxidative metabolism during sepsis, we studied the effects of exogenous nitric oxide, produced by NO-donor, (+/-)-(E)-4-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexenamide (NOR-3), on cell viability, urea biosynthesis and oxygen consumption in rat hepatocyte cultures. Nitric oxide release from NOR-3 was studied using 4,5-diaminofluorescein diacetate. Urea levels were measured by the spectrophotometric method. Cell viability was determined by the MTT test and trypan blue exclusion test, whereas oxygen consumption was measured by a polarographic technique. After 2 h treatment, NOR-3 induced an increase in the levels of nitric oxide. After 2 h of treatment and 24 h after the end of the treatment with NOR-3, both cell viability and urea synthesis were significantly reduced in comparison to the controls for NOR-3 concentrations equal to or greater than 50 microM. A reduction in oxygen consumption was observed in hepatocytes after 40 min treatment with 100 microM NOR-3, even if the cell viability was unchanged. Reduction of oxygen consumption is an early indicator of the metabolic alterations in hepatocytes exposed to nitric oxide. These findings suggest that nitric oxide accumulation acts on hepatocyte cultures inducing cell death and reduction of urea synthesis after 2 hours.

[Endoscopic endoprosthesis insertion in the treatment of digestive diseases]

Over the last few years the use of endoscopically placed endoprostheses for benign and malignant digestive diseases has considerably developed. The endoscopic placement of prostheses is usually well tolerated by patients; it does not require anaesthesia and it is a relatively low-risk procedure. New self-expandable metallic prostheses allow to treat even very tight stenoses; they do not usually require dilatation, therefore reducing the risks involved in dilatation procedure. This study presents a review of experience with prostheses placement in digestive diseases. Indications, limits and complications will be discussed according to data reported in the international literature.

[Modern indications on the medical treatment of symptomatic diverticular disease]

Authors refer about their experience on treatment of symptomatic diverticular disease both with antibiotic and anti-inflammatory drugs. They confirm the observation of other Authors on effectiveness of this new therapeutic approach versus traditional antibiotic therapy.

[Small bowel intussusception caused by metastasis from anaplastic thyroid carcinoma: case report and literature review]

Symptomatic involvement of the small bowel by metastasis from an extra-abdominal primary malignancy is rare, most commonly resulting from malignant melanoma and lung cancer; very rarely is small bowel involvement as first metastatic site. The Authors report a case of anaplastic thyroid carcinoma with lung metastasis, brain metastasis and an isolated metastasis to the small bowel leading intestinal obstruction due to small bowel intussusception. The Authors review the international literature about frequency, etiopathogenesis, clinical and diagnostic features and therapy of small bowel metastasis by extra-abdominal malignancies, especially by primary anaplastic thyroid carcinoma. Small bowel metastasis from extra-abdominal malignancies are very unusual, especially from anaplastic thyroid carcinoma, and the etiopathogenesis is still unknown. Clinical findings are typical for abdominal urgency, especially by small bowel obstruction from anaplastic thyroid carcinoma. Computed Tomography has an important role in detecting the type of intestinal obstruction despite it is often unable to diagnose an isolated metastasis. Best therapy is surgical resection, that allows the assessment of metastasis and the definitive staging. The prognosis is poor, despite long-term survival has been occasionally reported for isolated small bowel metastasis

[Mainly abdominal "complex" polytrauma. Considerations on surgical strategy and clinical case report]

The Authors want to present un uncommon case of polytrauma managed with surgical treatment at the Trauma Center of the A. Cardarelli Hospital in Naples. Chest, abdomen, pelvis, and left lower limb have been severely injured. This case is so interesting because of the rareness of some lesions (i.e. diaphragm rupture) and the numerous lesions of internal organs (i.e. lungs, spleen, liver, pancreas, mesenterium) and of the bones (i.e. thigh-bone and pelvis). A very good outcome has been obtained for survival as well as for functionality and quality of life since we have strictly applied the rules for the management of the "complex" polytrauma.

Eosinophilic cystitis associated with urethral stricture disease from pelvic trauma. Case report and literature review

We report a case of eosinophilic cystitis (EC) in a 65-year-old man with urethral stricture disease from blunt pelvic traumatic event. EC is a rare condition characterized by eosinophilic infiltration of the bladder wall, that usually presents with irritative voiding symptoms, suprapubic pain and hematuria. Etiology is still not clear although a review of the literature suggests that pathogenetic mechanisms probably engage an altered immune response in the bladder, with the inflammatory reaction caused by factors such as exogenous allergens and previous bladder injury or surgery to the bladder or the prostate. The diagnosis of EC has to be confirmed by biopsy, since in some cases it may manifest as other inflammatory and malignant bladder disorders. A conservative medical management is indicated initially, since this disease may be self-limited, with a benign course especially in children and young patients. In adults EC is more often a chronic recurrent condition that requires close follow-up since it may lead to serious progressive bladder and/or upper urinary tract disease. More invasive therapies (including transurethral resection, partial or total cystectomy) may also be required when conservative therapy fails.

[Effect of sulphurous Bioglea on psoriasis]

OBJECTIVE

The efficacy of biological sulphurous Bioglee on psoriasis was investigated using an organic matrix derived from the metabolism of microflora growing in shallow hyper thermal waters possessing high sulphur concentrations and in thermal mud at Guardia Piemontese-Acquappesa (CS). Such a matrix forms part of the "Sulphuretum" ecological matrix which is dominated by cyanobacteria and sulfobacteria. The effect of this matrix on psoriasis was evaluated through the typical symptoms such as desquamation, cutaneous erythema and itching.

METHODS

The study was carried out on 20 patients wich gave informed consent, suffering from psoriasis. Image analysis was used to monitor the intensity of psoriasic lesions prior to and at the conclusion of the therapy which consisted of topical applications of the thermal matrices twice a day for 12 days.

RESULTS

Image analysis illustrated a reduction in the intensity of psoriasic lesions at the conclusion of the therapy with significant reductions in desquamation, erythema and itching.

CONCLUSIONS

The anti-psoriasic action of the thermal matrix used in this study may be attributable to the substances such as carotene, hydro and lipo-soluble vitamins and naturally occuring phytosterols. These substances may not only be anti-inflammatory but may also work synergistically with the mineral components of the thermal matrix to attenuate the symptoms of psoriasis.

Similar low frequency of anti-MOG IgG and IgM in MS patients and healthy subjects

The authors used a liquid-phase radiobinding assay to measure serum anti-myelin oligodendrocyte protein (MOG) immunoglobulin (Ig) G in 87 patients with multiple sclerosis (MS), in 12 patients with encephalomyelitis, and in 47 healthy subjects. Anti-MOG IgM was determined in samples obtained at onset from 40 of 87 patients with MS and in control subjects. The frequency of positive samples with low titers of anti-MOG IgG (< or =5.7%) and IgM (< or =8.3%) was similar in all the groups and subgroups. Binding competition experiments showed that these antibodies had low affinity. Anti-MOG antibodies are not disease specific.