[Phlegmons of the neck: our experience with 7 cases]

Phlegmons of the neck originate from infectious diseases of head and neck. Odontogeneous inflammation of the oral cavity is most frquently primary lesion, followed by sinusitis, otitis, as well as radiation therapy and surgical procedures. Phlegmons of head and neck can drain into the spaces among the muscles, aponevrosis, organs inside the neck like sublingual space, lateral pharyngeal space, retro-pharyngeal space or pre-vertebral space. We hereby report our experience with 7 patients treated from 2001 to 2005.

Lipoma of the larynx: a case report

Lipoma is a benign tumour of mesenchymal origin with a very rare occurrence in the upper aero-digestive tract. To date, approximately 100 cases have been described in the literature. This lesion has a slow growth and, therefore, can present with various symptoms due to the mass effect with obstruction and compression on neighbouring structures, including dysphagia for liquid and solid food, dyspnoea and hoarseness. For a precise pre-operative diagnosis, indirect or direct laryngoscopy (flexible fibre-optic laryngoscopy) can be employed or, if necessary, also imaging techniques such as computed tomography scan and magnetic resonance imaging scan. These offer more useful information for better treatment planning. Surgery is the treatment of choice and includes endoscopic techniques and an external surgical approach (cervicotomy). It is very important to completely remove these benign neoplasms in order to avoid local recurrence. The present report referring to a case of laryngeal lipoma removed through an external surgical approach, aims to demonstrate that the choice of an external surgical approach is required for complete surgical removal of a large lipoma in order to prevent any possible recurrence. Furthermore, it is useful to keep in mind the possibility of recurrence of lipomas after long free intervals; therefore, it is mandatory to observe these patients at long-term follow-up.

Echocardiography and dual-energy x-ray absorptiometry in the elderly patients with metabolic syndrome: a comparison of two different tecniques to evaluate visceral fat distribution

OBJECTIVES

Metabolic syndrome (MetS) is an important risk factor for vascular diseases. Two simple and low cost measurements, the epicardial fat (EFT) obtained by echocardiography and abdominal fat (AFT) thickness evaluated by Dual-Energy X-Ray Absorptiometry (DEXA), have been validated as a markers of fat storage in young adults and elderly patients affected by MetS. At present no studies are available yet to compare the two techniques and to test their relationship with MetS. Moreover, no data exit concerning the association between hepatic steatosis, a well known indicator of intra hepatic fat storage and perivisceral fat storage. Aims of our study were: 1) to compare EFT and AFT in a group of patients with and without MetS; 2) to study whether and how these two different approaches predict MetS or risk of malnutrition in the obese elderly; 3) to evaluate the relationship between MetS occurrence, EFT, AFT and hepatic steatosis (HS).

SETTING AND PARTICIPANTS

We studied 55 elderly outpatients ( 29 males and 26 females) referred to MetS service of the IRCCS "Casa Sollievo della Sofferenza" during the year 2007.

MEASUREMENTS

Subjects underwent a complete clinical and anthropometric evaluation, laboratory tests for glycaemia and lipid profile for MetS definition. Liver ultrasound was executed to verify the occurrence of HS, a well known indicator of intraparenchymal fat storage. HS was defined as hyperechoic liver pattern in patients without liver disease or hepatic enzymes abnormalities. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Echocardiography for EFT evaluation and DEXA for AFT and fat free mass of the abdomen (FFM) measurement were also performed. Mini Nutritional Assessment (MNA) was used to test the risk of malnutrition in the elderly.

RESULTS

Patients were divided in two groups according to the absence (24 patients Group 1) or the presence (31 patients Group 2) of the MetS. HS was present in 26 (57.7%) patients. MetS patients had significantly higher AFT and EFT, and lower FFM than patients without MetS. MNA scores were not different. EFT and AFT showed a good correlation ( R 0.8 p < 0.001) but only EFT was associated with the MetS. HS was also correlated to EFT and AFT. MNA showed a risk of malnutrition in 73% of MetS patients and 23% in patients without MetS but both EFT and AFT were not correlated with MNA scores.

CONCLUSIONS

In the elderly patient with MetS, AFT and EFT are greater than in non MetS patients. Both AFT and EFT are strongly correlated to HS but only EFT was associated with MetS. In obese patients, the risk of malnutrition, as evaluated by MNA, is not associated with an increased fat tissue measured by echocardiography or DEXA.

Molecular pathology of differentiated thyroid cancer

Thyroid cancer is the most common endocrine malignancy; it accounts for approximately 1% of all new case of cancer each year, and its incidence has increased significantly over the last few decades. The majority of thyroid tumors originate from follicular epithelial cells. Among them, papillary (PTC) and follicular carcinomas (FTC) represent the most common forms of differentiated thyroid cancer and account for approximately 80% and 15% of all cases, respectively. Specific genetic lesions are associated to each thyroid tumor histotype: BRAF mutations and RET/PTC and TRK oncogenes have been detected in PTC, whereas FTC is characterized by PAX8/PPARgamma rearrangements and RAS mutations. In this review we summarize studies on the molecular biology of the differentiated thyroid tumors, with particular interest in the associated genetic lesions and their role in thyroid carcinogenesis. We also report recent findings on gene expression and miRNA profiles of PTC and FTC.

Waiting-time distributions of magnetic discontinuities: clustering or Poisson process?

Using solar wind data from the Advanced Composition Explorer spacecraft, with the support of Hall magnetohydrodynamic simulations, the waiting-time distributions of magnetic discontinuities have been analyzed. A possible phenomenon of clusterization of these discontinuities is studied in detail. We perform a local Poisson's analysis in order to establish if these intermittent events are randomly distributed or not. Possible implications about the nature of solar wind discontinuities are discussed.

Redifferentiating agents in non-radioiodine avid cancer

Thyroid cancer is the most common malignant cancer of the endocrine system. Treatment for well differentiated forms include surgery and radioactive iodine ablation. When cancer cells exhibit a less differentiated phenotype they may no longer be able to accumulate iodine, making 131-I administration ineffective. Recent studies have demonstrated the important role of therapeutic agents that have redifferentiating potential, leading to reactivation and expression of thyrocyte-specific genes, including those responsible for iodine uptake. This review will discuss the results of the most recent studies on drugs with redifferentiating properties and their application in patients with radioiodine refractory thyroid cancer.

Universal newborn hearing screening programs in Italy: survey of year 2006

CONCLUSION

Our results suggest a rapid diffusion of newborn hearing screening programs in Italy and indicate that three conditions seem to play a crucial role in the implementation of Universal Newborn Hearing Screening (UNHS) programs: the size (>800 births/year) and location (metropolitan urban areas) of the hospital, and the presence of an audiologist in the UNHS coordinating team.

OBJECTIVES

The aim of this paper is to provide data on the degree of implementation and coverage of UNHS programs in Italy.

MATERIALS AND METHODS

Data were collected through a Screening Survey Questionnaire that was sent to all birthing hospitals active in Italy in 2006 and was filled in by the chief of the hospital or by the UNHS program coordinator.

RESULTS

In Italy UNHS coverage had undergone a steep increase from 29.3% in 2003 (156,048 newborns screened) to 48.4% in 2006 (262,103 screened). The majority of UNHS programs were implemented in the two most economically developed areas, i.e. in the north-west area (79.5%, 108,200 of 136,109 births), and in the north-east area (57.2%, 52,727 of 92,133 births), while a limited diffusion still remains in some areas, typically in the islands (11.3%, 7158 of 63,460 births).

Frailty syndrome is associated with altered circulating redox balance and increased markers of oxidative stress

Frailty syndrome (FS) is a condition described in aging and characterized by physical vulnerability to stress and lack of physiological reserve. In this study we aim to define whether circulating oxidative stress correlates to frailty in terms of glutathione balance and oxidative protein damage. In 62 elderly outpatients, classified as frail patients according to Fried's criteria, evaluation of reduced glutathione (GSH), oxidized glutathione (GSSG), tumor necrosis factor-alpha, malonaldehyde-(MDA) and 4-hydroxy-2,3-nonenal-(HNE) protein plasma adducts were performed. A significant increase in the GSSG was observed in patients with FS when compared to non-frail. No difference was shown in the GSH amount, suggesting a glutathione oxidation more than impairment of the synthesis. TNF-alpha, MDA- and HNE-adducts, were significantly higher in FS as compared to non-frail patients. A logistic regression model correlating FS with redox balance showed a close relationship between glutathione ratio (OR=1.8, 95% CI=1.2-2.5) and MDA adducts (OR=2.8, 95% CI=1.6-4.7) to frailty. Our findings show an association between oxidative imbalance and Frailty Syndrome. GSSG/GSH ratio and plasma protein adducts strongly predict the frailty conditions and seem to be reliable and easily measurable markers in the context of the multidimensional analysis of elderly patients.

An open-label, multicenter, phase I/II study of AT-101 in combination with docetaxel (D) and prednisone (P) in men with castrate-resistant prostate cancer (CRPC)

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Background: Antiapoptotic Bcl-2 family proteins are overexpressed in CRPC and contribute to resistance to therapy. The oral pan-Bcl-2 inhibitor AT-101 (Bcl-2, Bcl-XL, Bcl-W, Mcl-1) is active as a single agent and in combination in in vitro and in vivo tumor models and as a single agent in CRPC. The Phase 1 portion of the study determined the recommended dose for phase II to be D (75mg/m2 q3weeks) in combination with P (5mg b.i.d. on days 1–21), and AT-101 at 40mg b.i.d. on days 1–3 of each 21-day cycle, and was previously reported. Methods: Men ≥18 years of age with chemotherapy-naïve CRPC (N = 36). Safety (NCI CTCAE v3.0) and efficacy (Bubley Criteria for PSA) were assessed at 3-wk intervals. Radiological assessments were performed at 6-wk intervals for pts with soft tissue disease and bone scans were performed after cycle 6 and at the completion of therapy. Results: 36 patients (pts) have been enrolled in the study. Twenty-four (67%) pts achieved a partial response (PR) (>50% PSA decline), and 26 (72%) pts treated had at least a 30% decrease in PSA level. Nine of 19 pts (47%) with measurable disease had a PR. One PR was unconfirmed per RECIST. Thirteen pts (36%) completed >10 cycles of therapy (range 2–24) thus far. Four pts remains active. Safety data is available for 31 pts. The most common (>20%) Adverse Events (AEs) include: fatigue (68%), nausea (52%), diarrhea (45%), alopecia (32%), constipation and dysgeusia (26%), and neutropenia and vomiting (26%). Neutropenia was the only gr. 4 event occurring in more than one pt (3pts). Serious Adverse Events (SAEs) considered related were reported in 5 pts (16%). The only SAEs reported in 2 or more pts were urinary tract infection (3 pts) and deep vein thrombosis (2 pts) and none were considered related. No ileus has been reported. Conclusions: AT-101 when given in combination with D/P is well tolerated and shows preliminary evidence of efficacy in pts with CRPC. A randomized trial is ongoing.

[Table: see text]

[A case of lymphoepithelial cyst (branchial cyst) in an elderly patient: diagnosis differential, treatment and literature review]

We present a case of lateral cervical cyst stressing the difficulties about the diagnosis. The international guidelines for the management of lateral neck cysts in the over 40s' age group are taken in consideration. Our case is a 74 years old male patient with a 6 month history of a cervical swelling. We consider this case rare for the age of patient and the absence of malignancy.

[New targets for new anti-herpes drugs]

Although infections are often subclinical, herpes simplex virus (HSV) can cause mild to severe diseases, especially in immunocompromised patients. There are few drugs licensed for the treatment of HSV infections. Most target the viral DNA polymerase, such as acyclovir that remains the reference treatment some thirty years after its discovery! Extensive clinical use of this drug has led to the emergence of resistant strains, mainly in immunocompromised patients, these infections can be managed with only two drugs, foscarnet and cidofovir, both much more toxic than acyclovir. This highlights the crucial need for the development of new anti-herpes drugs that can inhibit infection by both wild-type viruses and drug-resistant strains. Over the last few years, significant efforts have been made to set up a range of strategies for the identification of potential new antiviral drugs. One alternative is to develop drugs with different mechanisms of action. The present article reviews potential viral and cellular targets that are now known to be involved in HSV multiplication and for which specific inhibitors with anti-HSV activity, at least in cell culture, have been identified. These drugs inhibit viral proteins involved in viral replication (DNA polymerase, ribonucleotide reductase or helicase-primase complex). Other drugs acting on cellular proteins needed for viral replication have also been described; these drugs are targetting cyclin-dependent kinases or the polyamine biosynthetic pathway.

Deletion of the lifespan determinant p66(Shc) improves performance in a spatial memory task, decreases levels of oxidative stress markers in the hippocampus and increases levels of the neurotrophin BDNF in adult mice

Deletion of the p66(Shc) gene in mice results in reduced levels of oxidative stress and longer lifespan. Reactive oxygen species (ROS) can lead to tissue damage, particularly in the brain. In this study we extended previous findings on the behavioral phenotype of the p66(Shc-/-) mice. Cognitive performance of adult and old p66(Shc-/-) and p66(Shc+/+) mice was tested in a Morris water maze (MWM) task while general reactivity and pain sensitivity were assayed at adulthood, respectively, in an open field and by means of a tail flick test. Levels of brain-derived neurotrophic factor (BDNF), a neurotrophin involved in several aspects of synaptic plasticity, emotionality and pain sensitivity, were assessed in selected brain areas. P66(Shc-/-) adult subjects, compared to WT, overall showed a better performance in the MWM, lower emotionality and a higher pain threshold, in addition to increased basal levels of BDNF in the hippocampus, as well as decreased levels of oxidative stress markers in the same brain area. Although all aged subjects failed to learn the cognitive task, aged p66(Shc-/-) mice were characterized by a better physical performance. These results suggest an interaction between the p66(Shc) gene and specific signaling pathways involved in behavioral adaptation to stress and aging.

Computed-tomographic-guided biopsy of thoracic nodules: a revision of 583 lesions

OBJECTIVES

In pulmonary lesions, when bronchial or trans-bronchial biopsy is negative, thoracic Fine-Needle Aspiration Biopsy (FNAB) allows to obtain a cytological or histological diagnosis. The purpose of the current study is to investigate the usefulness of CT-guided FNAB to define the nature of pulmonary or thoracic lesions.

MATERIALS AND METHODS

Between May 1995 and September 2005, 583 patients (453 males, 133 females), with thoracic lesions, without evident intrabronchial neoplasm, underwent CT-guided FNAB of thoracic nodules. FNAB was performed with 19-20-21 gauge needles, disposable soft tissue, automatic aspiration biopsy Menghini set, 10-15 cm long.

RESULTS

In 292 patients (50%) lesions were < or = 3 cm diameter. Post biopsy pneumothorax occurred in 103 (18%) patients, with 29 patients requiring chest tube placement. Post biopsy haemoptysis occurred in 21 (4%) patients, but no patient required treatment for haemoptysis. There were 72 benign lesions (16 neoplasms) and 491 cancers (456 primary, 35 metastasis). Diagnostic accuracy was 93% and sensitivity for malignancy 93%.

CONCLUSIONS

FNAB has excellent diagnostic rates and is a suitable technique for diagnosing thoracic lesions.

Sensitivity of myxoid-round cell liposarcoma (MRCL) to trabectedin (T) may be related to a direct effect on the fusion transcript

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Background: Myxoid-round cell liposarcomas (MRCL) is a variant of liposarcoma, associated with t(12;16)(q13;p11) and the rarer t(12;22)(q13;q12) chromosomal translocation, resulting in the FUS-CHOP and EWS-CHOP fusion proteins, supposed to act as aberrant transcription factors. We reported the exceedingly high clinical efficacy of T against MRCL, which is a magnitude higher in comparison to other liposarcomas and sarcomas. Reasons thereof remain unknown, but a distinct mechanism of action of T in MRCL is suspected on clinical grounds. Methods: Tumor biopsies were taken from 9 MRCL patients (pts) before starting T, and the tumor was fully characterized by cytogenetic and molecular analysis. Primary cultures were set up, and tumor fragments were transplanted in scid mice, to develop an experimental model aimed at investigating the mechanism of action of T. Chromatin immunoprecipitation (ChIP) analysis on the 402–91 myxoid liposarcoma cell line was performed, to characterize the DNA binding capability of FUS-CHOP. Finally, in vivo ChIP analyses are currently ongoing, using tumor samples obtained before and after therapy with T. Tumor samples from 3 patients have been processed so far. Results: All patients had t(12–16) by FISH. Molecular characterization showed that 7 pts had the type II transcript, 1 had the type III, and 1 both type II and III. Primary cultures evaluated after the first 3 passages were morphologically, cytogenetically and molecularly consistent with the original tumor, as well as the 4 tumours grown in mice so far. In the myxoid liposarcoma cell line carrying the type I transcript, selective binding of FUS-CHOP to some promoters was seen. Impairment of this binding activity was observed after treatment with T at concentration 1–4 nM. Conclusions: There is in vitro evidence of a direct effect of T on the fusion protein's ability to bind to promoters. In vivo studies on the experimental model are ongoing, and results will be presented.

No significant financial relationships to disclose.

Novel targets for the development of anti-herpes compounds

Herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) are members of the Herpesviridae family. HSV infections have been known since ancient times and are one of the most common communicable diseases in humans. Although infections are often subclinical, HSV can cause mild to severe diseases, especially in immunocompromised patients. Herpes simplex viruses establish latency in the nuclei of neuronal cells and may reactivate, with or without symptoms, throughout the host's lifetime. Over one third of the world's population suffer from recurrent HSV infections several times a year and are thus capable of transmitting HSV by close personal contact. There are few drugs licensed for the treatment of HSV infections. Most target the viral DNA polymerase, and indeed acyclovir remains the reference treatment some thirty years after its discovery! Extensive clinical use of this drug has led to the emergence of resistant viral strains, mainly in immunocompromised patients. This highlights the crucial need for the development of new anti-herpes drugs that can inhibit infection by both wild-type viruses and drug-resistant strains. Over the last few years, significant efforts have been made to set up a range of strategies for the identification of potential new anti-viral drugs. One alternative is to develop drugs with different mechanisms of action. The present article reviews potential viral and cellular targets that are now known to be involved in HSV infection and for which specific inhibitors with anti-HSV activity, at least in cell culture, have been identified.

Analysis of cytomegalovirus (CMV) viremia using the pp65 antigenemia assay, the amplicor CMV test, and a semi-quantitative polymerase chain reaction test after allogeneic marrow transplantation

A pp65 antigenemia assay for polymorphonuclear leukocytes (PMNLs) (CINAkit Rapid Antigenemia), and a qualitative polymerase chain reaction (PCR) test for plasma 'PCR-P qual' (Amplicor cytomegalovirus [CMV] test) were performed for 126 samples (blood and plasma) obtained from 18 bone marrow transplant patients, over a 9-month surveillance period. Among those samples, 92 were assayed with a semi-quantitative PCR test for PMNLs 'PCR-L quant.' The number of samples with a positive CMV test for antigenemia and PCR-P qual assays was 20.63% and 12.7%, respectively, whereas the PCR-L quant assay was positive in 48 of the 92 samples assayed (52.17%). The rates of concordance of the results of PCR-P qual and antigenemia, PCR-P qual and PCR-L quant, antigenemia and PCR-L quant were 92%, 65.2% and 66.8%, respectively. The analysis of the results for the 92 specimens tested by all 3 methods showed a rate of concordance of 63% among all methods. Good agreement (kappa=0.72) was found only between pp65 Ag and PCR-P qual assays. Clinical disease correlates with an antigenemia high viral load. Three patients had CMV disease despite preemptive therapy, and all of them had graft-versus-host-disease (GVHD). PMNLs-based assays are more efficient in monitoring CMV reactivation, but for high-risk patients with GVHD, more sensitive assays (real-time PCR) must be done.

Detection of novel mRNA splice variants of human ING4 tumor suppressor gene

Inhibitor of growth (ING)4, member of a gene family encoding potential tumor suppressors, is implicated as a repressor of angiogenesis and tumor growth and suppresses loss of contact inhibition in vitro. Here, we report that ING4 undergoes alternative splicing. Expression analysis identified novel ING4 spliced variant mRNAs encoding proteins devoid of different portions. The ING4 variants were detected in both normal and tumor tissues. The existence of ING4 variants was confirmed by several approaches, including reverse transcriptase-polymerase chain reaction, real-time PCR and in silico experiments. To investigate the functional consequences of alternative splicing the ING4 variant cDNAs were expressed in mammalian cells. Our studies indicated that (i) the ING4 variants do not differ from wild-type in their nuclear localization, interaction with p53 and association to HBO1 complex; and (ii) the ING4-DeltaEx6A variant, devoid of the C-terminal portion, loses the capability to inhibit NF-kappaB. On the whole our data suggest that alternative splicing could modulate the activity of ING4 tumor suppressor protein.

Coronary flow, VO2 peak and anaerobic threshold in patients with dilated cardiomyopathy

BACKGROUND

Coronary flow is influenced by several determinants and may change according to external stimuli. In patients with dilated cardiomyopathy (DC), adaptive mechanisms could induce alterations in coronary flow, possibly related to oxygen consumption.

METHODS

In 67 consecutive patients with DC (mean age 52.06+/-13.84, 52 male gender, left ventricle ejection fraction (LVEF) 29.49%+/-8.68) and normal coronary angiography findings, coronary flow in left anterior descending (LAD), right coronary artery (RC) and left circumflex (LCx) was reported as TIMI frame count (TFC). All patients underwent a cardiopulmonary test with VO2 peak and anaerobic threshold (AT) measurement, New York Heart Association (NYHA) class stratification, two-dimensional echocardiographic evaluation including LVEF and left ventricle end-diastolic diameter (LVEDD) assessment. All patients were receiving optimal medical treatment.

RESULTS

In a multivariate analysis, a statistically significant correlation was found between VO2 peak and TFC (B 7.61, p<0.001, R2 0.61 for LAD; B 3.42, p<0.001, R2 0.33 for RC); an inverse correlation was found between AT and TFC (B -9.77, p<0.001, R2 0.61 for LAD; B -4.26, p<0.001, R2 0.33 for RC).

CONCLUSIONS

Coronary flow is related to VO2 peak and AT in patients with DC, suggesting a "compensatory" mechanism.

Opposable spines facilitate fine and gross object manipulation in fire ants

Ants inhabit diverse terrestrial biomes from the Sahara Desert to the Arctic tundra. One factor contributing to the ants' successful colonization of diverse geographical regions is their ability to manipulate objects when excavating nests, capturing, transporting and rendering prey or grooming, feeding and transporting helpless brood. This paper is the first to report the form and function of opposable spines on the foretarsi of queens and workers used during fine motor and gross motor object manipulation in the fire ant, Solenopsis invicta. In conjunction with their mandibles, queens and workers used their foretarsi to grasp and rotate eggs, push or pull thread-like objects out of their way or push excavated soil pellets behind them for disposal by other workers. Opposable spines were found on the foretarsi of workers from seven of eight other ant species suggesting that they might be a common feature in the Formicidae.