Confocal laser endomicroscopy for the detection of mucosal changes in ileal pouch after restorative proctocolectomy

BACKGROUND

Pouchitis and dysplasia may affect the reservoir after restorative proctocolectomy.

AIMS

To assess the suitability of confocal laser endomicroscopy for the in vivo diagnosis of mucosal changes in ileal pouch for ulcerative colitis and familial adenomatous polyposis.

METHODS

Standard endoscopy and endomicroscopy were performed in 18 pouches. Confocal images were scored for the presence of villous atrophy, inflammation, ulceration, colonic metaplasia and dysplasia. Targeted biopsies were taken. Endomicroscopic and histological findings were compared.

RESULTS

At standard endoscopy, the signs of pouchitis were recorded in 7/18 (38.9%) patients. At endomicroscopy, pathological features were found in 16/18 (88.9%), villous atrophy in 15/18 (83.3%), inflammation in 13/18 (72.2%), ulceration in 3/18 (16.7%), and colonic metaplasia in 12/18 (67.7%). No dysplasia was observed. At histology, abnormalities were present in 17/18 (94.4%): villous atrophy in 15/18 (83.3%), inflammation in 17/18 (94.4%), ulceration in 6/18 (33.3%), colonic metaplasia in 15/18 (83.3%). Morphological changes of the ileal pouch could be predicted with an accuracy of 94.4% (95% CI: 74.2-99.0). The k-value for intra- and interobserver agreement was 0.93 and 0.78, respectively.

CONCLUSIONS

Endomicroscopy may be helpful in the evaluation of morphologic changes in ileal pouch. The small size of the population sample requires further studies for the results to be confirmed.

The RNA-binding protein Sam68 contributes to proliferation and survival of human prostate cancer cells

The tyrosine kinase Src is frequently activated in advanced human prostate carcinomas and its activation correlates with tyrosine phosphorylation of the RNA-binding protein Sam68. Herein, we have investigated the expression and function of Sam68 in human prostate cancer cells. Analysis of specimens obtained from 20 patients revealed that Sam68 is upregulated at the protein level in 35% of the samples. Real-time polymerase chain reaction confirmed the results at the mRNA level in most patients. Downregulation of Sam68 by RNAi in LNCaP prostate cancer cells delayed cell cycle progression and reduced the proliferation rate. Moreover, depletion of Sam68 sensitized cells to apoptosis induced by DNA-damaging agents. Similarly, stable cell lines expressing a truncated GFP-Sam68(GSG) protein displayed reduced growth rates and higher sensitivity to cisplatin-induced apoptosis. Microarray analyses revealed that a subset of genes involved in proliferation and apoptosis were altered when Sam68 was knocked down in LNCaP cells. Our results indicate that Sam68 expression supports prostate cancer cells proliferation and survival to cytotoxic agents.

Crohn's disease and Takayasu's arteritis: is this association difficult to find out?

Takayasu's arteritis is rarely reported associated with Crohn's disease in the English world literature. A case of Takayasu's arteritis type V in a young female affected by Crohn's disease is presented and the pathophysiology mechanism, and the clinical and diagnostic aspects are underlined. Surgical strategy is discussed.

Contribution of self-motion perception to acoustic target localization

CONCLUSION

The findings of this study suggest that acoustic spatial perception during head movement is achieved by the vestibular system, which is responsible for the correct dynamic of acoustic target pursuit.

OBJECTIVE

The ability to localize sounds in space during whole-body rotation relies on the auditory localization system, which recognizes the position of sound in a head-related frame, and on the sensory systems, namely the vestibular system, which perceive head and body movement. The aim of this study was to analyse the contribution of head motion cues to the spatial representation of acoustic targets in humans.

MATERIAL AND METHODS

Healthy subjects standing on a rotating platform in the dark were asked to pursue with a laser pointer an acoustic target which was horizontally rotated while the body was kept stationary or maintained stationary while the whole body was rotated. The contribution of head motion to the spatial acoustic representation could be inferred by comparing the gains and phases of the pursuit in the two experimental conditions when the frequency was varied.

RESULTS

During acoustic target rotation there was a reduction in the gain and an increase in the phase lag, while during whole-body rotations the gain tended to increase and the phase remained constant. The different contributions of the vestibular and acoustic systems were confirmed by analysing the acoustic pursuit during asymmetric body rotation. In this particular condition, in which self-motion perception gradually diminished, an increasing delay in target pursuit was observed.

Familial adenomatous polyposis. Surgical treatment: when and how

Familial adenomatous polyposis is an autosomal dominated inherited disease, caused by the mutation of the tumour suppressor gene adenomatous polyposis coli on chromosome 5. Despite being a rare disorder, accounting for some 1% of colorectal cancers, it represents an interesting model of hereditary disease, because of its intrinsic characteristics, conventionally defined by the presence of more than 100 colorectal polyps, as well as extra-colon manifestations, the attenuated form of the disease, genetic aspects, the inevitable progression to colorectal cancer and hence the correct therapy to treat or prevent the fatal evolution of the disease. Surgical treatment is based above all on two techniques: ileorectal anastomosis, which requires careful surveillance of rectal remnant, and ileal pouch-anal anastomosis, which totally eradicates the disease. The suitability of using these two techniques is discussed in view of new genetic and clinical findings, acquired from personal experience and from the literature.

On compensation of mismatched recording conditions in the Bayesian approach for forensic automatic speaker recognition

This paper deals with a procedure to compensate for mismatched recording conditions in forensic speaker recognition, using a statistical score normalization. Bayesian interpretation of the evidence in forensic automatic speaker recognition depends on three sets of recordings in order to perform forensic casework: reference (R) and control (C) recordings of the suspect, and a potential population database (P), as well as a questioned recording (QR) . The requirement of similar recording conditions between suspect control database (C) and the questioned recording (QR) is often not satisfied in real forensic cases. The aim of this paper is to investigate a procedure of normalization of scores, which is based on an adaptation of the Test-normalization (T-norm) [2] technique used in the speaker verification domain, to compensate for the mismatch. Polyphone IPSC-02 database and ASPIC (an automatic speaker recognition system developed by EPFL and IPS-UNIL in Lausanne, Switzerland) were used in order to test the normalization procedure. Experimental results for three different recording condition scenarios are presented using Tippett plots and the effect of the compensation on the evaluation of the strength of the evidence is discussed.

The effect of mismatched recording conditions on human and automatic speaker recognition in forensic applications

In this paper, we analyse mismatched technical conditions in training and testing phases of speaker recognition and their effect on forensic human and automatic speaker recognition. We use perceptual tests performed by non-experts and compare their performance with that of a baseline automatic speaker recognition system. The degradation of the accuracy of human recognition in mismatched recording conditions is contrasted with that of the automatic system under similar recording conditions. The conditions considered are of public switched telephone network (PSTN) and global system for mobile communications (GSM) transmission and background noise. The perceptual cues that the human subjects use to perceive differences in voices are studied along with their importance in different conditions. We discuss the possibility of increasing the accuracy of automatic systems using the perceptual cues that remain robust to mismatched conditions. We estimate the strength of evidence for both humans and automatic systems, calculating likelihood ratios using the perceptual scores for humans and the log-likelihood scores for automatic systems.

[The minimal bowel resection in Crohn's disease: analysis of prognostic factors on the surgical recurrence]

OBJECTIVE

To assess the effect of disease pattern and involvement of the margins on early and late results of enteric resections with hand-sewn anastomosis for Crohns disease.

BACKGROUND

Bowel sparing is one of the aims of the surgery for CD. When strictureplasties are not possible, "minimal surgery" (the resection just of the grossly involved tract of bowel) is the current choice.

METHODS

One hundred and forty-six cases of resections in 128 patients were performed in the years 1991-2001. We investigated if there is a relationship between disease pattern (perforating and non-perforating) or hystologic involvement of the margins and recurrence (reoperation for recurrent preanastomotic disease). Hand-sewn anastomosis were performed almost in all the cases; we compared the results with the main series of stapled and hand-sewn sutures.

RESULTS

Nine surgical complications occurred (7%), requiring six relaparotomies and three conservative treatments. Overall rate of recurrence (median follow-up 44 months) is 17%: 9% in patients with non perforating disease and 19% in patients with perforating disease. The rate of recurrence is 6% in the group of patients with involved margins and 23% in the group with non involved margins.

CONCLUSIONS

Limited surgery for CD doesn't increase rate of recurrence; the involvement of margins is not a risk factor for early reoperation. Hand-sewn anastomosis seem to be as safe as stapled ones.

[Intestinal carcinoma in Crohn's disease. Report of four cases and review of the literature]

BACKGROUND

Increasing numbers of intestinal carcinomas in patients affected by Crohn's disease have been reported by several authors, even if the strength of this associations (age, longstanding of the disease, its characteristics and distribution) still has to be elucidated.

METHODS

From January 1992 to July 2000, 130 patients with Crohn's disease were submitted to surgery.

RESULTS

Four patients showed an associated intestinal carcinoma at operation, in 3 cases located in the ileum, and in 1 case in the colon. Patients' mean age was 54 years. Mean duration time of the Crohn's disease was 7 years. One patient died 3 months after surgery for disseminated peritoneal carcinomatosis, whereas 3 patients are still alive with malignancy free at 5, 8, and 11 years after the tumor resection.

CONCLUSIONS

These results suggest the difficulty in recognizing patients with Crohn's disease who are at risk for intestinal carcinoma. Longstanding disease, previous intestinal exclusion surgery, enterocutaneous or other types of fistulas should be considered for the development of cancer. Therefore, the prognosis may be good if early diagnosis and treatment are made.

Synchronous isolated splenic metastasis from colon carcinoma

We report the first case known to us of a synchronous isolated splenic metastasis from colon carcinoma in a 52-year-old woman operated on splenectomy, left colectomy, and ileal resection. The patient died of diffuse carcinomatosis 1 year after the operation. Splenectomy for isolated splenic metastasis from colon carcinoma is justified, and serum tumor markers are useful to detect metastases early during the follow-up, as in our report.

Proprioceptive influence on the optokinetic nystagmus

The influence of neck and leg proprioceptive inputs on optokinetic-induced quick phases was studied in humans. Ten subjects received unidirectional horizontal optokinetic stimulation (10-20%/s) during sinusoidal neck, leg and combined neck + leg proprioceptive stimulation. The optokinetic reflex was measured by electro-oculography. Neck stimulation induced a shift in the nystagmus beating field in the opposite direction to body movement (gain 0.3 0.4, phase 140-180 degrees). The beating field shift resulted totally from the amplitude and frequency modulation of optokinetic quick phases, as slow phases were not affected. Leg proprioceptive stimulation induced a similar effect, but the phase of the response lagged by approximately 90 degrees compared with that of neck response. With combined neck + leg stimulation, the amplitude of the effect was a sum of the separate effects, but the phase coincided with that of the leg response. This suggests that neck and leg proprioceptive signals do not add linearly and that the leg signal determines the time of the response.

A light microscopic investigation of the human midpalatal suture

Biopsy samples of the human midpalatal suture, obtained from patients (age range: 10 and 30 yrs), were embedded in resin, cut with ultramicrotome and analyzed at light microscopy. The sutural connective tissue was made up of fibroblasts, collagen fibers, capillaries and nerve fibers. The sutural bone was made up of lamellar and bundle bone which alternated along both sides of the sutural connective tissue. No osteoblasts or osteoclasts were found, no signs of synostosis were ever detected. Our findings suggest that the lamellar bone replaces bundle bone when the suture is no longer involved in the growth of the palatal bones. The absence of bone remodelling shows that the sutures, at the time of sampling, were in a resting stage. Tissue architecture and cell types, so similar in samples from patients of such different ages, lead us to suppose that the sutures under examination are subject in time to very slow bone turnover.

Eye movements evoked by proprioceptive stimulation along the body axis in humans

Proprioceptive input arising from torsional body movements elicits small reflexive eye movements. The functional relevance of these eye movements is still unknown so far. We evaluated their slow components as a function of stimulus frequency and velocity. The horizontal eye movements of seven adult subjects were recorded using an infrared device, while horizontal rotations were applied at three segmental levels of the body [i.e., between head and shoulders (neck stimulus), shoulders and pelvis (trunk stimulus), and pelvis and feet (leg stimulus)]. The following results were obtained: (1) Sinusoidal leg stimulation evoked an eye response with the slow component in the direction of the movement of the feet, while the response to trunk and neck stimulation was oriented in the opposite direction (i.e., in that of the head). (2) In contrast, the gain behavior of all three responses was similar, with very low gain at mid- to high frequencies (tested up to 0.4 Hz) but increasing gain at low frequencies (down to 0.0125 Hz). We show that this gain behavior is mainly due to a gain nonlinearity for low angular velocities. (3) The responses were compatible with linear summation when an interaction series was tested in which the leg stimulus was combined with a vestibular stimulus. (4) There was good correspondence of the median gain curves when eye responses were compared with psychophysical responses (perceived body rotation in space; additionally recorded in the interaction series). However, correlation of gain values on a single-trial basis was poor. (5) During transient neck stimulation (smoothed position ramp), the neck response noticeably consisted of two components -- an initial head-directed eye shift (phasic component) followed by a shift in the opposite direction (compensatory tonic component). Both leg and neck responses can be described by one simple, dynamic model. In the model the proprioceptive input is fed into the gaze network via two pathways which differ in their dynamics and directional sign. The model simulates either leg or neck responses by selecting an appropriate weight for the gain of one of the pathways (phasic component). The interaction results can also be simulated when a vestibular path is added. This model has similarities to one we recently proposed for human self-motion perception and postural control. A major difference, though, is that the proprioceptive input to the gaze-stabilizing network is weak (restricted to low velocities), unlike that used for perception and postural control. We hold that the former undergoes involution during ontogenesis, as subjects depend on the functionally more appropriate vestibulo-ocular reflex. Yet, the weak proprioceptive eye responses that remain may have some functional relevance. Their tonic component tends to stabilize the eyes by slowly shifting them toward the primary head position relative to the body support. This applies solely to the earth-horizontal plane in which the vestibular signal has no static sensitivity.

[Surgical treatment of Crohn's disease. Indication and management in 20 patients]

MATERIALS AND METHODS

Sixty-seven patients with Crohn's disease underwent surgery in our department in the period 1989-1996. In this paper we evaluated only the first 20 patients. Ten were female and 10 male. There was single localization in 13 patients and multiple in 7. Surgery was limited to the macroscopically involved intestinal segment. Reconstruction of the intestinal tract has been carried out with a double layer polyglycolic acid end-to-end manual anastomosis.

RESULTS

We had no operative deaths and early morbidity. In the follow-up we observed 2 anastomotic recurrences respectively three and five years after the operation; none of them required surgical treatment. One patient of 20 had a colocutaneous fistula four months after operation because of the relapse of the disease at preanastomotic level.

CONCLUSIONS

The results obtained in our limited experience allow us to affirm that, when elective surgery is possible, the most reliable surgical behaviour is a limited resection of the diseased segment. Quality of life improved after surgery in all patients.

A comparative light microscopic study of human midpalatal suture and periodontal ligament

In order to provide information on the morphological features of both human midpalatal suture and periodontal ligament, bioptic samples were obtained from patients whose age was between 10 and 30 years. The samples were embedded in epoxy resin, sectioned, stained with toluidine blue and observed by light microscopy. The periodontal ligament and the midpalatal suture appeared very similar with regard to the histological characteristics of the connective tissue but differed in the nature of the bone tissue associated to it. The alveolar bone lining the periodontal ligament was a bundle bone whereas the bone lining the connective tissue of the sutures was both lamellar and bundle bone. The absence of osteoblasts, osteoclasts or undifferentiated cells in the sutures under examination suggests that they are subjected to a slow bone turnover during their life cycle. On the contrary, the presence of mesenchymal cells in the periodontal ligament supports the notion that these cells are precursors of osteogenic cells involved in the high rate of bone remodelling that characterizes the alveolar bundle bone. The present results are discussed taking into account physiologic and therapeutic aspects of the two structures under examination.

A procedure for preparing undecalcified and unembedded bone sections for light microscopy

We have developed a procedure for light microscopic investigation of undecalcified and unembedded bone sections. Biopsy samples of human metatarsus and femur and rat femur were fixed in aldehydes and sectioned with a cutting machine equipped with a diamond saw blade. Free sections 100-150 microns thick, stained with toluidine blue and von Kossa, did not show artifacts following the cutting, and the spatial relations of mineralized and nonmineralized components remained intact. Compact and trabecular bone, bone marrow and all cell types appeared well preserved and easily recognizable. Our procedure provides a simple and rapid method for preparing bone sections which undergo no chemical treatment other than fixation. This method is a useful alternative to standard histological protocols for studying bone specimens.

Assessment of the acrylic resin Technovit 7200 VLC for studying the gingival mucosa by light and electron microscopy

Technovit 7200 VLC is an acrylic resin formulated for embedding undecalcified hard tissues which are prepared for light microscopy according to a cutting-grinding technique. To employ this resin for embedding and cutting soft tissues by ultramicrotomy, we carried out a qualitative study on biopsies of canine gingival mucosa using light and transmission electron microscopy. For a critical evaluation of this resin, some biopsies were embedded in Agar 100, an epoxy resin widely used in morphological studies. At the light microscopic level the samples embedded in Technovit 7200 VLC showed good morphology and excellent toluidine blue staining of different cell types and extra cellular matrix. At the ultrastructural level, nuclei, cytoplasmic organelles, collagen fibrils and ground substance appeared well preserved and showed high electron density. The acrylic resin was stable under the electron beam and its degree of shrinkage appeared to be very low. We conclude that Technovit 7200 VLC can be employed for ultramicrotomy for both light and electron microscopic investigation of soft tissues.

[The evaluation of acrylic resins for the study of nondecalcified human teeth with the light and electronic microscopes]

Resin embedding of human teeth for light and transmission electron microscopic studies becomes difficult without previous decalcification. The limited and slow infiltration of the resin into hard tissues may cause problems during preparation and observation of the samples. Moreover the type of resin that is used may affect the morphologic preservation of both tissues and cellular elements. Recently there has been an increasing number of studies on the application of acrylic resins in light and electron microscopy, in order to overcome problems encountered with the use of epoxy resins still utilized in morphologic studies. We compared different acrylic resins (Technovit 7200 VLC, LR White, LR Gold, Bioacryl) in order to understand which one was more suitable for undecalcified human dental tissues under light and transmission electron microscope. Evaluation of such resins was performed using the following criteria: ease of cutting with ultramicrotome, soft and hard tissues infiltration, uptake of tissue stains for both light and electron microscopy, morphologic preservation and stability under electron beam. This study, carried out on the pulp area comprising predentin and dentin, showed excellent quality of Bioacryl and LR Gold, the two resins presenting, by far, the best results among all the different types tested. The optimal morphologic preservation obtained with such resins is indicated for light and electron microscopic studies, allowing their application in different fields of dental research.

[Preoperative staging of gastric carcinoma using endosonography (EUS)]

Accurate staging of gastric malignancy can only be obtained at surgery and after detailed histological examination of the resection specimen. Endoscopic ultrasonography may provide accurate detection and staging of gastric cancer because of its ability to visualize both the intramural and extramural extent of the lesion and any adjacent lymph node involvement. From february 90 to april 91, 29 patients with a gastric carcinoma were studied endosonographically before surgery. All studies were performed with an Olympus EU-M3. Preoperative TNM classification and a prediction of the resectability of gastric cancer were done in every patient. The results were matched with those obtained with the histology of resected specimens according to the TNM classification 1987. Endoscopic ultrasonography was accurate in assessing the extent and depth of tumor infiltration. The overall accuracy rate was 90.5% (19 out of 21 patients). Overstaging occurred in 9.5% of the cases (2 patients); none understaging occurred. EUS was less accurate in assessment of lymph node metastasis; the overall accuracy rate was 57.1%. Distinction between reactive lymph node and small micrometastatic lymph node involvement could be hard. Local resectability was correctly diagnosed with EUS in each of 23 patients; in two patients an intramural mass with a deep infiltration into the surrounding tissue was correctly diagnosed. In our opinion EUS is an essential diagnostic procedure in the clinical staging of the gastric cancer.

Immunochemical and immunohistochemical detection of S-100-like immunoreactivity in spinach tissues

S-100 proteins represent a group of closely related acidic, calcium binding proteins originally isolated from the mammalian nervous system and later detected in non-neural cell types and in a wide variety of vertebrate and invertebrate species. The present study used immunochemical and immunohistochemical methods to extend the investigation of S-100 during phylogenesis to plant tissues. The presence of S-100-like immunoreactive material was detected in extracts of spinach (Spinacia oleracea L.) terminal buds and young leaves by the ELISA method and by Western blotting using different anti-S-100 rabbit antisera. Using the PAP method, serial sections of young spinach leaves treated with the same antisera exhibited an immunoreaction product that was confined to the cytoplasm and nucleus (but absent from the vacuoles) in meristematic, epidermal, and parenchymal cells. The present data enlarge the field of investigation of S-100 proteins in the search of the function(s) of S-100 in biological organisms.

[Primary gastric lymphoma: our experience]

The authors report their experience with 10 cases of primary gastric lymphoma observed in 10 years. Nonspecific symptomatology and bioptic features often misleading to benign lesions (pseudolymphoma) explain why an early diagnosis is difficult to achieve. A correct surgical treatment, with careful pre- and intraoperative staging, associated to pre- and postoperative chemo- and radiotherapy, allows good results in terms of survival.

[A point about obstructive non-neoplastic pathology of the duodeno-biliary-pancreatic junction]

Various benign pathological conditions of Oddi's sphincter may give origin to clinical manifestations due to hindrances to biliary flow into the duodenum; the hypertonic dyskinesia, proper, odditis and fibrosclerotic dystrophies. Such forms develop very big problems from a diagnostic and therapeutical point of view, even if an adequate therapy permits in most cases to reach definite results. Therapy in inflammatory forms (odditis) must be first of all of medical type; only when these are changing into fibrosclerotic forms or are manifest in an acute way it is meet to proceed surgically on the sphincter. The action on the sphincter, either by means of endoscopy or surgery, is performed with caution in the forms of hypertonic dyskinesia (only when such forms are going on and have had a long duration, or even resistant to any pharmacological therapy) because of the high percentage of painful recurrences. The cutting of Oddi's sphincter is on the contrary the first therapeutical choice in the fibrosclerotic forms, with immediate success on the symptoms and the results in the long run are optimal.