Closing the knowledge gap on the composition of the asbestos bodies

Asbestos bodies (AB) form in the lungs as a result of a biomineralization process initiated by the alveolar macrophages in the attempt to remove asbestos. During this process, organic and inorganic material deposit on the foreign fibers forming a Fe-rich coating. The AB start to form in months, thus quickly becoming the actual interface between asbestos and the lung tissue. Therefore, revealing their composition, and, in particular, the chemical form of Fe, which is the major component of the AB, is essential to assess their possible role in the pathogenesis of asbestos-related diseases. In this work we report the result of the first x-ray diffraction measurements performed on single AB embedded in the lung tissue samples of former asbestos plant workers. The combination with x-ray absorption spectroscopy data allowed to unambiguously reveal that Fe is present in the AB in the form of two Fe-oxy(hydroxides): ferrihydrite and goethite. The presence of goethite, which can be explained in terms of the transformation of ferrihydrite (a metastable phase) due to the acidic conditions induced by the alveolar macrophages in their attempt to phagocytose the fibers, has toxicological implications that are discussed in the paper.

Surgical management of lip cancer

Lip cancer is the most frequent malignant neoplasm of the oral cavity. The study reported herewith refers to the clinico-pathological features and surgical treatment of lip cancer. The most frequent tumour related to the lips is squamous cell carcinoma, with the lower lip more commonly involved than the upper lip. Typically, squamous cell carcinoma originates in the red lip, whereas basal cell carcinoma involves the white lip. The management of lip cancer involves the control not only of the primary tumours with oncologically appropriate margins and subsequent reconstruction to allow oral competence during the oral phase of swallowing, but also the possible metastatic spread to the neck. Reconstruction is a surgical challenge especially for advanced and extended lesions. A successful reconstruction depends on careful pre-operative planning, knowledge of the anatomy and use of the various surgical techniques. Lymph node neck metastases significantly reduce long-term survival. Although the management of the neck is controversial in lip cancer, particularly with respect to the neck, elective or curative supra-omohyoid neck dissection is the best choice for occult or evident loco-regional metastases. Early stage tumours have good prognostic, aesthetic and functional results after surgery compared to the treatment of advanced lesions, which alter the appearance and functionality of the lip. The Authors report their experience in the treatment of lip tumours at the primary site, considering reconstructive problems, together with management of neck metastases.

An analysis of peroxisome proliferator-activated receptor gamma (PPAR-gamma 2) Pro12Ala polymorphism distribution and prevalence of type 2 diabetes mellitus (T2DM) in world populations in relation to dietary habits

BACKGROUND AND AIM

The human peroxisome proliferator-activated receptor gamma (PPAR-gamma) is involved in lipid storage, glucose homeostasis and adipocyte differentiation. The Ala allele of the Pro12Ala polymorphism has been associated with a protective effect against T2DM. Ala allele frequencies are known for many populations, but data are absent for other interesting human groups.

METHODS AND RESULTS

We examined samples from Ethiopia, Benin, Ecuador and Italy. In addition, we performed an analysis of the Pro12Ala polymorphism distribution in world populations, also in relation to T2DM prevalence and the diet lipid content. In the European populations, the Ala allele frequencies are distributed according to a latitudinal trend, with the highest in the northern and central European populations and the lowest in the Mediterranean populations. Considering the world populations, a significant inverse relationship between Ala frequency and T2DM prevalence was observed mainly in populations where energy from lipids exceeded 30% of the total energy intake.

CONCLUSION

Northern Europe's cold climate has been hypothesised to have played a role in contributing to the present pattern. Moreover our analysis appears to confirm, at a population level, the protective effect of Ala allele against T2DM, already observed in case-control studies, but only in populations with a diet rich in lipids.

Nature and extent of the exposure to fibrous amphiboles in Biancavilla

An epidemiological and environmental study in the Biancavilla area (Sicily, Italy) was recently prompted by an impressively high incidence of malignant pleural mesothelioma. Epidemiology suggested an environmental contamination by amphibole fibres rather than risks related to a specific occupational activity. The aim of this study is to describe the diffusion of fibrous amphiboles in the area and identify their source. Fibrous amphiboles were found in the products from the local quarries, which had been used for years to build houses. After sampling all around Biancavilla, three sites were detected and they were characterized by an abundant presence of mineral fibres. Fibrous amphiboles were also recovered from building materials (mortar and plasters) and airborne particulates sampled in urban sites with high dust emissions due mainly to unpaved roads. Moreover, amphibole fibres were detected in the lung tissue of a woman who died of pleural mesothelioma. The results of this study suggest that the amphibole fibre diffusion in the Biancavilla environment lasted for many years and had been maximum during the sixties and the seventies with the uncontrolled development of the local building industry. Today, the environmental situation results to be changed following both the closing of the stone quarries and the urbanization works after 2001, above all the asphalting of dusty roads. Anyway sporadic mesothelioma cases have still to be expected in the next years.

Endometriosis of the abdominal wall

Endometriosis is ectopic endometrial tissue that responds to hormonal stimulation and is found 8-15 per cent of all menstruating women. Endometrioma in/or close to a surgical scar is rare and occurs in 0.1 per cent of women who underwent cesarean section. When localized at the abdominal wall, the disease presents as a painful swelling resembling other lesions, such as hernias, post-operative ventral hernias, hematomas, granulomas, abscesses, and tumors. Endometriosis of the abdominal wall may not be considered in the differential diagnosis of masses detected in/or close cesarean scar. Three cases are reported here. All of them underwent surgery and the error of the pre-operative diagnosis was revealed by histology in two cases. Actually, only one case was suspected pre-operatively.

"Adenomatous polyps of the gallbladder" adenomas of the gallbladder

The finding of adenomatous polyps of the gallbladder is a rare occurrence and an unusual clinical problem. Among 2,145 patients who underwent cholecystectomy for gallbladder disease only 9 (0.4 per cent) presented with adenomatous polyps. There were 6 women and 3 men, aged 17 to 70 years. Preoperative ultrasonographic diagnosis was made in only 1 of 7 patients with gallstones, in contrast polypoid lesions within a gallbladder without stones were easily confirmed by both ultrasonography and oral cholecystography in the remaining 2 patients. All polyps were 1.0 cm or less in size and without histologic evidence of malignant change. The clinical significance of this rare condition is discussed, with particular reference to a possible role in development of gallbladder carcinoma. Surgical treatment should be advocated regardless of clinical manifestation when the polyp exceeds 1.0 cm in diameter or rapid growth of the lesion is seen on ultrasonographic follow-up examinations.

[Anatomo-surgical notes on transhiatal access in esophagectomy]

The Authors through an anatomic study on 20 cadavers specify the surgical procedure for transhiatal esophagectomy and describe the anatomical structures involved. The proper manoeuvres and artifices to avoid intraoperative accidents are suggested. Finally, the indications for this peculiar operation are discussed.