Combination Chemotherapy (CVP or Chop)-Radiotherapy Approach in Early Stage Non-Hodgkin's Lymphomas

From January 1978 to December 1980, 42 patients with early stage non-Hodgkin's lymphoma other than of the gastrointestinal tract were treated with radiotherapy and combination chemotherapy. Eighteen patients in stage I were submitted to locally extended-field radiotherapy up to a mean dose of 48 Gy with a Co60 source and, after a 3-week rest period, to 6 cycles of combination chemotherapy. Twenty-four patients in stage II received 3 cycles of combination chemotherapy before and after irradiation, the same as for stage I. Combination chemotherapy consisted of cyclophosphamide, vincristine and prednisone (CVP) for 15 cases with favorable histology (3 NWDL, 1 NPDI, 11 DWDL), whereas it included cyclophosphamide, adriamycin, vincristine and prednisone (CHOP) for 27 cases with unfavorable histology (20 DPDL, 3 DM, 4 DH). Complete remission (CR) was achieved in 35/42 (83%) patients, with a highly significant difference between stage I (100%) and stage II (71%). After 42 months of follow-up, the probability of survival for all patients was 72%. Survival was better for stage I (88%) than for stage II (68%) and for favorable histology (87%) as compared to unfavorable histology (70%). Furthermore, survival was highly influenced by response to therapy. Indeed, actuarial survival rate for CR was 91% as compared to a median survival time of 10.2 months for the remaining patients. Four patients, all with poor histology, relapsed after 5–24 (mean 11) months of CR. Only one of them had an extension in extranodal sites and eventually died, despite the salvage treatment utilized. In our experience, locally extended-field irradiation combined with chemotherapy gave a high proportion of CR and seemed to prevent relapses, particularly in extranodal sites.

Laparoscopic pancreaticoduodenectomy for tumors of the head of pancreas; 10 cases for a single center experience

OBJECTIVE

The tumors of the head of the pancreas are one of the leading causes of cancer-related death in Western countries. The current gold standard for these tumors is a Whipple procedure. This procedure did not change in its surgical steps since when it was initially introduced in 1935. More recently, a laparoscopic approach with similar outcomes has been described. The aim of this paper is to describe the laparoscopic surgical technique performed in our unit, reporting single center postoperative outcomes.

PATIENTS AND METHODS

From the 1st January 2013 to the 31st December 2015 a database was created. Data about patients who underwent a laparoscopic pancreaticoduodenectomy (LPD) were collected prospectively. All patients were preoperatively assessed with blood samples, tumor markers, CT chest abdomen and pelvis and/or MRI pancreas. Only patients with specific characteristics were considered eligible for an LPD: performance status 0, body mass index (BMI) less than 30 kg/m2, a small neoplastic lesion (< 3.5 cm) confined to the pancreas, the absence of infiltrated organs and/or blood vessels (T1 or T2). Postoperative data and complications were recorded and described according to the Clavien-Dindo classification and the international study group of pancreatic surgery definitions.

RESULTS

In a time interval of 36 months, 31 patients with an initially considered resectable pancreatic cancer were referred. 11 patients were found to have metastasis during the preoperative workout. Only 10 patients were considered eligible for a LPD. Six of them were men (60%). The mean BMI was 25.01 kg/m2 (19.6-29.8). 5 patients, who underwent to LPD did not have any comorbidities. An overall 50% of all patients were jaundice at the time of diagnosis with a mean bilirubin level of 181.3 µmol/L (119.7-307.8). All patients with a direct bilirubin greater than 250 µmol/L underwent a preoperative percutaneous biliary drainage. In the majority of the LPD performed (50%), the histology reported a pancreatic adenocarcinoma. Other postoperative histology described were: IPMN (20%), ampullar neoplasia (20%) and neuroendocrine tumor (10%). Neo-adjuvant chemotherapy was never considered indicated. The reported postoperative complications were: 1 anastomotic bleeding, 2 pancreatic fistula, 1 infected intra-abdominal collection and 1 delay gastric emptying. The pancreatic fistulas were considered grade A and grade B. One fatality after LPD occurred because of an uncontrollable, diffuse severe hemorrhagic gastritis associated with a GJ anastomosis bleeding in the POD 25. The mean hospital stay was 12.3 days (8-25). The mean operative time was 224 min (170-310). There were no intraoperative complications. The main intraoperative blood loss was 220 ml (180-400) and intraoperative blood transfusions were not required. The resection margins were negative (R0) in 100% of cases and the mean lymph nodes harvested were 24 (18-40). The LPD is still a not common practice. Our results are comparable with those reported in literature about the open technique. These remarkable surgical outcomes are probably related to the extremely careful preoperative patient selection performed. The indication for a laparoscopic vs. an open pancreaticoduodenectomy was based on a CT scan pancreas performed less than 30 days before the planned date of surgery and a careful preoperative assessment. A low complication rate and a relative short stay in hospital were associated to a good quality of life in the early postoperative period and an early referral for postoperative chemotherapy. Good clinical outcomes were associated with outstanding oncological results.

CONCLUSIONS

Laparoscopic pancreaticoduodenectomy is a feasible surgical procedure. Remarkable oncological and surgical outcomes can be achieved with a morbidity and mortality rate in line with the data reported by the large series of open procedures.

GPX4 and GPX7 over-expression in human hepatocellular carcinoma tissues

Hepatocellular carcinoma (HCC) is the most common type of liver cancer and is still one of the most fatal cancers. Hence, it needs to identify always new putative markers to improve its diagnosis and prognosis. The selenium is an essential trace mineral implicated as a key factor in the early stage of cancer and exerts its biological function through the selenoproteins. In the last years our group has been studying the involvement of some selenoproteins in HCC. However, no many data are reported in literature about the correlation between HCC and the glutathione peroxidases (GPXs), both selenium and non selenium-containing GPXs.

In this paper we have evaluated the GPX4 and GPX7 expression in some paraffin-embedded tissues from liver biopsy of patients with hepatitis C virus (HCV)-related cirrhosis and HCC by immunohistochemistry and RT-qPCR analysis. Our results evidenced that i) GPX4 and GPX7 had a statistically significant over-expression in HCC tissues compared to cirrhotic counterparts used as non tumor tissues, and ii) their expression was higher in grade III HCC tissues with respect to grade I-II samples. Therefore, we propose to use GPX4 and GPX7 as possible markers for improving HCC diagnosis/prognosis.

S1P-induced airway smooth muscle hyperresponsiveness and lung inflammation in vivo: molecular and cellular mechanisms

BACKGROUND AND PURPOSE

Sphingosine-1-phosphate (S1P) has been shown to be involved in the asthmatic disease as well in preclinical mouse experimental models of this disease. The aim of this study was to understand the mechanism(s) underlying S1P effects on the lung.

EXPERIMENTAL APPROACH

BALB/c, mast cell-deficient and Nude mice were injected with S1P (s.c.) on days 0 and 7. Functional, molecular and cellular studies were performed.

KEY RESULTS

S1P administration to BALB/c mice increased airway smooth muscle reactivity, mucus production, PGD2 , IgE, IL-4 and IL-13 release. These features were associated to a higher recruitment of mast cells to the lung. Mast cell-deficient Kit (W) (-sh/) (W) (-sh) mice injected with S1P did not display airway smooth muscle hyper-reactivity. However, lung inflammation and IgE production were still present. Treatment in vivo with the anti-CD23 antibody B3B4, which blocks IgE production, inhibited both S1P-induced airway smooth muscle reactivity in vitro and lung inflammation. S1P administration to Nude mice did not elicit airway smooth muscle hyper-reactivity and lung inflammation. Naïve (untreated) mice subjected to the adoptive transfer of CD4+ T-cells harvested from S1P-treated mice presented all the features elicited by S1P in the lung.

CONCLUSIONS AND IMPLICATIONS

S1P triggers a cascade of events that sequentially involves T-cells, IgE and mast cells reproducing several asthma-like features. This model may represent a useful tool for defining the role of S1P in the mechanism of action of currently-used drugs as well as in the development of new therapeutic approaches for asthma-like diseases.

Assessment of the Selenoprotein M (SELM) over-expression on human hepatocellular carcinoma tissues by immunohistochemistry

Selenium is an essential trace mineral of fundamental importance to human healthy and exerts its biological function through selenoproteins. In particular, Selenoprotein M (SELM) is located in the endoplasmic reticulum and contains the common redox motif of cysteine-X-X-selenocysteine type. It attracts great attention due to its high expression in brain and its potential roles as antioxidant, neuroprotective, and cytosolic calcium regulator. Recently, our group found SELM over-expression in human hepatocellular carcinoma (HCC) cell lines. In this report some paraffin-embedded tissues from liver biopsy of patients with hepatitis C virus (HCV)-related cirrhosis and HCC were immunohistochemically stained and SELM expression scoring was evaluated. Our results evidence for the first time an increase of SELM expression in HCC liver tissues, and its gradual expression raise associated with an increased malignancy grade. Therefore, we propose to use i) SELM as putative marker for HCC as well as ii) simple immunohistochemistry technique to distinguish between the different grades of malignancy.

Small bowel obstruction caused by mesh migration. Case report

INTRODUCTION

Endoscopic hernia repair methods have become increasingly popular over the past 15 years. Nonetheless, there is no consensus regarding an optimal fixation method. Transabdominal sutures and titanium tacks or staples are the most traditional ones.

CASE REPORT

We present a case of mechanic small bowel obstruction due to mesh migration occurring one year and a half after incisional hernia repair with polytetrafluoroethylene mesh fixed by spiral tacks.

DISCUSSION

Titanium spiral tacks are dangerous because of their sharp components, which can damage organs such as the small intestine, by causing microperforations. The type of prosthesis used has also contributed to the intraluminal migration, since polytetrafluoroethylene mesh is very flexible and poorly integrates in the abdominal wall.

CONCLUSION

A prosthesis of a different material combined with a different fixation system such as absorbable tacks, biological glue, or mechanical tacks without sharp components, would have obviated mesh migration.

Characterization of metalloproteinases, oxidative status and inflammation levels in the different stages of fibrosis in HCV patients

OBJECTIVES

This study was aimed at searching noninvasive markers of the transition from mild to severe fibrosis stage in HCV patients undergoing hepatic fibrosis.

DESIGN AND METHODS

Thirty-three patients affected by chronic HCV vs. twenty healthy donors were evaluated for the serum levels of several circulating matrix metalloproteinases (MMPs), TRAIL and β-NGF by multiplex biometric ELISA based immunoassay and anti- and pro-oxidant status (d-ROMs, BAP and NO) using a Diacron automated method.

RESULTS

HCV patients displayed increased expression levels of MMP-8, MMP-9, TRAIL and β-NGF, and an imbalance between pro- and antioxidant status, that contribute to liver fibrosis.

CONCLUSIONS

Since the determination of these parameters represents a reliable and easily applicable method, these parameters are suggested as serum surrogate markers for HCV patients in the routine clinical practice.

Simultaneous evaluation of the circulating levels of both Th1 and Th2 chemokines in patients with autoimmune Addison's disease

BACKGROUND

Chemokines play a key role in the recruitment of the immune cells into the autoimmune process. Thus, the simultaneous evaluation of circulating levels of Th1-related chemokines, such as CX chemokine ligand 10 (CXCL10) and macrophage inflammatory proteins 1α (CCL3/MIP-1α), and Th2-related chemokines, such as macrophage inflammatory proteins 1 β (CCL4/MIP-1β) could be useful in the approach to some autoimmune diseases, including autoimmune Addison's disease (AAD).

AIM

To evaluate plasmatic levels of MIP-1α, MIP-1β, CXCL10 and adrenocortical antibodies in patients with AAD under treatment with corticosteroids.

PATIENTS AND METHODS

Twelve women and 5 men (group 1) were divided in 2 subgroups: 9 subjects with isolated AAD (group 1a) and 8 with AAD associated with chronic autoimmune thyroiditis (group 1b). MIP-1α, MIP- 1β and CXCL10 were evaluated in the serum of all patients and in 20 healthy controls, using a system for microarray suspension.

RESULTS

The levels of MIP-1α, MIP-1β and CXCL10 resulted significantly increased vs controls (p<0.001). An inverse significant correlation between the serum levels of MIP- 1β and the duration of the disease was observed.

CONCLUSION

High levels of MIP-1α and MIP-1β associated with increased levels of CXCL10 in AAD seem to indicate a role of these chemokines in the autoimmune pathology of adrenal gland through the recruitment in loco of Th1 and Th2 cells. The simultaneous measurement of Th1-related chemokines (CXCL10 and MIP-1α) and of Th2-related chemokine MIP-1β in the serum of patients with AAD would sustain a novel preliminary hypothesis on the immune microenvironment of chronic autoimmune inflammation within adrenal glands.

Has selenium a chemopreventive effect on hepatocellular carcinoma?

Hepatocellular carcinoma (HCC) is one of the most lethal cancers in the world. Its etiology includes chronic liver disease, viral hepatitis, alcoholism, and hepatic cirrhosis. Both oxidative stress and inflammatory mechanisms have been implicated in HCC pathophysiology. Surgical resection and liver transplants are currently used to treat HCC. Consequently, there exists a decisive requirement to explore possible alternative chemopreventive and therapeutic strategies for HCC. The use of dietary antioxidants and micronutrients has been proposed as a useful means for the HCC management. Trace elements such as selenium are involved in several major metabolic pathways as well as antioxidant defense systems. In particular, selenium is an important oligo-element that plays a central role in cellular redox processes even if the amount necessary for the cell functions is in a very narrow range. However, selenium is involved in the prevention of numerous chronic diseases and cancers. This review will examine the potential role of selenium in HCC prevention and treatment and, in detail, focus on: i) description of selenium in biological systems and in mammalian proteins, ii) involvement of selenium in HCC, iii) in vivo and in vitro effects of selenium in preclinical models of HCC and iv) potential challenges involved in the selenium use in the prevention and treatment of HCC.

Concomitant CXCR4 and CXCR7 expression predicts poor prognosis in renal cancer

CXCR4 is a chemokine receptor implicated in the metastatic process. The CXCR4 ligand, CXCL12, was shown to bind also the CXCR7 receptor, a recently deorphanized chemokine receptor whose signalling pathway and function are still controversial. This study was conducted to determine patients clinic-pathological factors and outcome according to the expressions of CXCR4 and CXCR7 in renal cell carcinoma (RCC). CXCR4 and CXCR7 expression was evaluated in 223 RCC patients through immunohistochemistry; moreover CXCR4 and CXCR7 was detected in 49 others consecutive RCC patients trough RT- PCR. CXCR4 expression was low in 42/223 RCC (18.8%), intermediate in 71/223 (31.9%) and high in 110/223 (49.3%). CXCR7 expression was low in 44/223 RCC patients (19.8%), intermediate in 65/223 (29.1%) and high in 114/223 (51.1%). High CXCR4 and high CXCR7 expression predicted shorter disease free survival. In multivariate analysis, high CXCR4 expression (p= 0.0061), high CXCR7 (p= 0.0194) expression and the concomitant high expression of CXCR4 and CXCR7 (p= 0.0235) are independent prognosis factors. Through RT-PCR, CXCR4 was overexpressed in 36/49 and CXCR7 in 33/49 samples correlating with symptoms at diagnosis and lymph nodes status. So we can hypothesize that CXCR4 and CXCR7, singularly evaluated and in combination, are valuable prognostic factors in RCC patients.

CDMS (Clinical Data Mining Software): a cytokinome data mining system for a predictive medicine of chronic inflammatory diseases

The cytokines, main players of the chronic inflammation progression leading to serious diseases such as diabetes or cancer, represent a target for better clinical prognosis and innovative therapeutic strategies. To investigate the immunopathogenetic progression of these diseases, the evaluation of serum cytokines profiles made of many different proteins is much more informative than single protein measurements. We developed a Clinical Data Mining Software to collect cytokine profiles evaluated on healthy subjects and patients by multiplex immunoassays also annotated with their clinical and laboratory data, to compare patient profiles by statistical tools and to evaluate their disease progression.

Abstract B50: Design, synthesis, and functional characterization of new cycle-peptides inhibitors for C-X-C chemokine receptor-4

Inhibition of the axis CXCR4/CXCL12 can affect tumor growth and metastases. Moreover, CXCR4 inhibition increases hematopoietic stem cell mobility in patients undergoing autologous transplantation for myeloma and non-Hodgkin lymphoma. Although several inhibitors were described neither one reached satisfactory efficacy, bioavailability and acceptable toxicity.

To develop new CXCR4 inhibitors through a rationale design approach, comparative studies were undertaken evaluating the N-terminal structure of the ligand CXCL12 and v-MIP II, an inhibitory chemokine like produced by the herpes virus 8-Kaposi associated. A common amino acidic motif (RFF) was identified in both structures although in inverted orientation. Having as a core this small domain, a new library (20 units) of cycle-peptide molecules was generated. 20 units of cycle-peptide molecules were synthesized that consists of 5 and 7 amino-acid residues cycled by a S-S bridge designed to interact with the receptor CXCR4. The peptides were characterized for functionally CXCR4 interaction through: 1. inhibition of CXCR4 binding; 2. inhibition of migration CXCL12-induced; 3. inhibition of calcium CXCL12-induced; 4. Inhibition of P-Erk CXCL12-induced. Four peptides were identified as possible CXCR4 inhibitors. These four CXCR4 inhibitory peptides were further evaluated for the in vivo efficacy through inhibition of metastasis formation. B16 mouse melanoma cells transfected with CXCR4 were injected in the vein tail in C57 Bl mice and peptide treatment followed for 10 days. Dramatic reduction in number and size of lung metastases were registered in mice peptides-treated. Moreover, xenograft of human renal cancer cells SN12C-EGFP were subcutaneously injected and systemic peptides treatment followed for 10 days. Statistically significant decrease in tumor growth was showed in peptides treated mice.

Taken together the data define three new CXCR4 inhibitory peptides, designed through innovative strategy, effective in “in vivo” deserving further development.

Citation Information: Clin Cancer Res 2010;16(7 Suppl):B50

An approach for understanding the inflammation and cancer relationship

It is well known that persistent inflammatory conditions can induce the cancer formation. In fact, cytokines and chemokines play a crucial role in the promoting of angiogenesis, metastasis, and subversion of adaptive immunity. These proteins are involved in cancer-related inflammation and can represent a target for innovative diagnostic and therapeutic strategies useful to clinical studies.

Reduction of circulating regulatory T cell (Treg) by intravenous high-dose interferon (HDI) treatment in melanoma patients

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Background: T regulatory (Treg) cells are an immunoregulatory cell type which express high levels of surface CD25, CTLA-4, and GITR. Tregs have been shown to be present in tumor and tumor-draining lymph nodes, acting as an inhibitory population blocking effector cell function. Depletion or blockade of Tregs might be able to enhance antitumor immunity. Recent evidence has been reported about the possibility of High Dose Interferon (HDI) to act through an indirect immunomodulatory mechanism (Gogas, NEJM 2006; Moschos JCO 2006). We started a study to verify if iv HDI treatment in melanoma patients could be able to reduce the number of Treg cells in peripheral blood. Methods: Analysis was performed on melanoma pts referring to the National Cancer Institute of Naples since July 2006 and who addressed to Neoadjuvant or Adjuvant treatment with iv HDI (20 MUI/m2, 5 days per week) for 4 wks. Peripheral blood mononuclear cells (PBMC) were obtained from 22 consecutive melanoma pts. Blood draw was performed at days 0, 8, 15, 22 and 29. PBMC were thawed and labeled with anti-CD4 and anti-CD25hi (BD, San Diego, CA) and anti-FoxP3 (eBioscience, San Diego, CA). Labeled cells were analyzed using a FACScalibur (Becton Dickinson). Results: Fifteen (68.2%) out of 22 pts showed a decrease of Treg cells in peripheral blood. The average value at day 0 for circulating Treg (cTreg) was 2.7%. The average percentage at day 29 was 1.4%. The average reduction was 1,4 (50% reduction in the average value of cTreg). Statistical analysis showed an average decrease of 0.29% per week of treatment. Despite of this clear trend in reducing cTreg by HDI, statistical significance was not reached (probably due to the power of the study). Moreover, it has been observed great differences between the disease status, the prognosis (recurred/not recurred pts, alive/deceased) and an increased basal percentage of cTreg. Our preliminary data are consistent for an effect of HDI on reducing cTreg, although no conclusion about the role of such reduction in terms of response to treatment or as prognostic markers of better/worse disease can be inferred. Further data are awaited in order to verify if the Treg reduction after a HDI treatment may indeed contribute to the antitumor response.

[Table: see text]

Prediction of the separation number of capillary columns in programmed temperature gas chromatographic analysis

The efficiency of capillary columns in programmed temperature analysis can be evaluated by calculation of the separation number ("Trennzahl"). A procedure for the prediction of this parameter at various initial temperatures, carrier gas pressures and heating rates, by using as the starting data the retention times and the peak widths obtained in some isobaric and isothermal runs is described. An equation is proposed that permits to obtain the values of the peak width at half height in any isothermal and linearly programmed temperature gas chromatographic run and therefore to calculate the separation number value. The effect on this parameter of the column polarity was investigated by using polar and non-polar compounds (n-alkanes and 1-alcohols).

Prediction of theoretical plate number in isothermal gas chromatographic analysis on capillary columns

A method for the prediction of the efficiency of gas chromatographic analysis in isothermal conditions by using experimental data of 1-alcohols and n-alkanes measured on capillary columns filled with polar and non-polar stationary phases in isothermal and isobaric conditions is described. The theoretical plate height trend indicates the change of separation efficiency as a function of inlet pressure and column temperature. By evaluating the variation of the diffusion coefficients of the analysed compounds into the mobile and stationary phase it is possible to predict the column efficiency and the number of theoretical plates at any temperature.

CXCR4 in melanoma: A prognostic biomarker and a target of therapy

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Background: The chemokine receptor CXCR4 was identified as an independent predictor of poor prognosis in primary melanoma. In melanoma metastases CXCR4 is also expressed and functional suggesting that CXCR4 has a role in the melanoma biology. Differential chemokine receptors expression by activated tumor specific CD8+ T cells can be associated with divergent clinical outcomes. Expression of CXCR3 by CD8+ T cells was reported to be associated with survival in melanoma patients with stage III disease. To further characterize the role of CXCR4 in the melanoma metastatization we analyzed Fine Needle Ago Biopsy (FNAB) from disease involved lymph nodes. Moreover, we are currently evaluating CD8+ subpopulation for the expression of CXCR4 during the follow up Methods: FNAB of suspicious disease involved lymphnodes. was performed and the cell suspension was analyzed by flow cytometry and .immunocytochemistry. Peripheral blood lymphocytes (PBL) was analyzed by flow cytometry Results: FNAB were performed on 25. suspicious lymphnodes. Out of 25 FNAB 19 were positive per melanoma cells (HMB45 positive). Concomitant expression of HMB45 and CXCR4 was detected in 15 out of 19 samples.with the percentage of cells CXCR4 positive being the large majority ( 40–100%) of the detected melanoma cells. Ongoing studies are further characterizing the biology of the CXCR4/HMB45 cells. The inhibition of this cells migrating through the lymphnode may interfere with the metastatization. In relation to the CD8+ subpopulation for the expression of CXCR4 during the follow up preliminary data at the time of diagnosis showed a correlation between the activated CD8 + lymphocytes (HLA-DR+) /CXCR4 + and the level of invasion of the lesion. Conclusion: Altoghether these evidences confirm a role of CXCR4 in melanoma biology and as therapeuthic target .

No significant financial relationships to disclose.

Classification and comparison of capillary columns by determination of the solution enthalpy of polar and non polar probes

The behaviour and separation characteristics of capillary columns containing different stationary phases (bonded methyl- and methylphenylsiloxanes and polyglycols, and carbon layer and porous polymer) were classified and compared by measuring the values of the solution enthalpy DeltaHs of n-alkanes and 1-alcohols at various temperatures. The difference in DeltaHs values between straight-chain 1-alcohols and n-alkanes with the same number of carbon atom (DeltaDeltaHs) does not change with changing temperature when gas-liquid partition stationary phases are used, but depends on the column composition and polarity and therefore permits to evaluate the influence of polarity on the solute-solvent interaction. The trend of the DeltaDeltaHs values is correlated with that of the DeltaC parameter and with the McReynolds' polarity constants.

Effect of injected sample amount on the shape of chromatographic peaks under condition of linear partition isotherm

In a previous paper a model function was tested in order to approximate the peak shape obtained on non-polar column by injecting different compounds. The simulation of the symmetrical or non-symmetrical shape of gas chromatographic peaks was satisfactory. In this paper, the influence of the amount of injected substance was investigated at different values of inlet pressure and carrier gas velocity, in order to evaluate the relative contribution to the total peak area and shape of the symmetrical distribution due to partition phenomena and of the non-symmetrical and tailing distribution due to adsorption-desorption kinetics. The effect of the molecular mass and of the chain length of compounds belonging to the homologous series of 1-alcohols and n-alkanes on the adsorption phenomena was evaluated.

Prediction of retention times in linear gradient temperature and pressure programmed analysis on capillary columns

The simultaneous temperature and inlet pressure programming (TPP) in gas chromatographic analysis decreases the retention time and the maximum value of temperature required for the elution of high boiling substances. Therefore, compounds sensitive to thermal degradation can be better analysed and column ageing is reduced. However, the empirical choice of proper analysis conditions requires many preliminary runs; this paper describes a procedure for the theoretical prediction of retention times in TPP using few preliminary runs carried out in isobaric and isothermal conditions. The used program permits the prediction of the retention times of the compounds analysed with any different TPP run carried out within the temperature and pressure ranges investigated with the preliminary runs. The influence of various analytical parameters on the accuracy of the prediction values was investigated. The proposed model also predicts the relative position in the chromatogram of closely eluting peaks and the possible coincidence of retention times or inversion of the elution order with changing temperature. It is also possible to foresee the analytical conditions, which offer a baseline separation of all of the peaks of the sample.

Subclavian vein stenosis following totally implantable venous access device (TIVAD) implant by percutaneous approach. Case report

Totally implantable venous access devices (TIVADs) are more and more used in oncologic patients. Early and late complications frequently occur with the techniques of implantation. Thrombosis is the most important and common late complication. On the opposite stenosis of the vessel is not frequently reported. The Authors report the case of a patient with subclavian vein stenosis after implantation of a TIVAD by percutaneous technique. On the basis of the published knowledges they try to explain this phenomenon and suggest an hypothesis for future works.

Prediction of retention times and efficiency in linear gradient programmed pressure analysis on capillary columns

A method for the prediction of the retention time and the resolution of chromatographic peaks in different experimental conditions by starting from few experimental data measured in isothermal and isobaric analyses was published previously. In this paper, the same mathematical model was implemented for calculating the retention times and the column efficiency in programmed pressure runs. Some models originated from the Golay equation and reported in the literature are compared, and a new modified equation for the calculation of the peak width at half height is proposed. The procedure for the prediction of the retention time and the peak width at half height at programmed pressure of the carrier gas and different column temperature and linear gradient by using retention data of different compounds obtained in few isobaric runs is described. The prediction of the retention time and the separation efficiency of compounds with different polarity gave good results for the programmed pressure runs with linear gradient. The effect of the variation of the initial parameters of the experimental analyses and of the mathematical model on the accuracy of the prediction has been evaluated.

Evaluation and prediction of the shape of gas chromatographic peaks

The evaluation and prediction of the shape of asymmetric gas chromatographic peaks is important as the knowledge of the amount of tailing permits to foresee the resolution between closely eluting peaks and to select the best analytical conditions for an efficient and rapid separation. A model function was tested in order to approximate the true peak shape obtained on non-polar column by injecting different compounds. The trend of the parameters involved in the used equation has been investigated as a function of column temperature and inlet pressure. The reproduction of the symmetrical or asymmetrical shape of gas chromatographic peaks is satisfactory and the method also permits to predict the shape of peaks obtained in different conditions of temperature and pressure.

Prediction of the resolution of capillary columns in different conditions of inlet pressure and temperature

A procedure previously described for the prediction of the plate height of capillary columns operated at different inlet pressure of the carrier gas and at various column temperatures by using few retention data measured under isobaric conditions was modified and improved in order to permit the prediction of the retention times and of the peak widths at various heights. It is therefore possible to calculate the ratio, delta, between the peak width at different heights and the peak width at half height, whose value is used to predict the resolution at different height of two closely eluting peaks. It was found that the delta values do not depend on temperature and inlet pressure and are a characteristic of the used column; they can therefore be used in order to calculate the resolution in any temperature and inlet pressure condition. The method was used to predict the retention time, the peak width and the resolution of polar and non-polar compounds (alkanes, alkenes, chloroalkanes, alcohols, ketones) on capillary columns of different length and polarity by using as the starting data retention and width values measured in three isobaric runs only.

Prediction of the plate height of capillary columns operated at any inlet pressure of the carrier gas by using few retention data measured under isobaric conditions

Programming inlet pressure in gas chromatography permits to decrease the analysis time without changing the elution order of compounds of different polarity whose relative retention changes with changing temperature. The choice of the best values of the inlet pressure and flow-rate of the carrier gas often requires many preliminary analyses with different parameters to be carried out. A method for the prediction of the separation by starting from few experimental data measured in isothermal and isobaric conditions decreases the time required for the optimisation of the analysis. The efficiency of the separation depends on the change of the theoretical plate height at various pressures and temperatures, due to pressure drop along the column. By calculation of the diffusion coefficients of the analysed compounds into the mobile and stationary phase it is possible to evaluate the column efficiency and predict the number of theoretical plates at any inlet pressure. A procedure for the prediction of the plate height of a capillary column at any inlet pressure of the carrier gas and column temperature by using retention data of polar and non-polar compounds (1-alcohols and linear alkanes) obtained in few isobaric runs is described.

Kaposi's sarcoma: aetiopathogenesis, histology and clinical features

Kaposi's sarcoma (KS) represents today one of the most common skin cancers in transplanted Mediterranean subjects and, since the epidemic of human immunodeficiency virus/acquired immune deficiency syndrome, in young unmarried single men. The disease has been associated with the recent identified human herpesvirus (HHV)-8 or KS herpesvirus and its incidence in the general population shows a north to south gradient that parallels the HHV-8 increasing prevalence from Nordic countries to sub-Saharan regions. The identification of the aetiopathogenetic mechanisms (viral agents and immunodeficiency) involved in the pathogenesis of KS, are relevant for identifying susceptible subjects (HHV-8 seropositive subjects), monitoring the immune levels in iatrogenic immune suppressed patients, and developing new therapeutic approaches based on antiviral and immune modulators.

LEARNING OBJECTIVE

This article should enable the reader: (i) to learn about the clinical and molecular aspects of KS in order to have a multidisciplinary approach to a tumour that shows unique features; (ii) to consider the role of viral agents and immunity; and (iii) to recognize properties of an opportunistic neoplasm. The identification of the HHV-8 role in KS pathogenesis should establish a relevant tool in the clinical management of KS patients.

Levobupivacaina, bupivacaina racemica e ropivacaina nel blocco del plesso brachiale

BACKGROUND

To compare clinical profiles of levobupivacaine, racemic bupivacaine and ropivacaine at equipotent doses in axillary brachial plexus block in the orthopaedic surgery of wrist and hand.

METHODS

For this prospective, open randomised study we took on 45 patients of both sexes, ASA I-III, subdivided into three groups in which, respectively, axillary brachial plexus block was performed, with ENS, using levobupivacaine 0.50% (1 mg/kg), racemic bupivacaine 0.50% (1 mg/kg) and ropivacaine 0.75% (1.4 mg/kg). The onset of sensory and motor block, their duration, onset of surgical block, anaesthetic plane and possible adverse events were recorded.

RESULTS

The duration of sensory block was longer in group of patients treated with levobupivacaine than in two other groups. Surgical onset was similar for levobupivacaine and ropivacaine, but it was delayed for racemic bupivacaine. In group of patients who received racemic bupivacaine, two episodes of reduction in heart rate without significant hypotension have been observed. The anaesthetic plan was satisfactory in the all three groups of patients.

CONCLUSIONS

In our experience levobupivacaine has been demonstrated to be a good substitute for racemic bupivacaine. Compared to ropivacaine, levobupivacaine induces a longer duration of postsurgery analgesia and, in our opinion, this datum seems to be the most significant.

Life-style in patients with LUTS suggestive of BPH

BACKGROUND

Owing to the existing controversy about the role of life-style in the pathogenesis of BPH, the possible associations of LUTS and prostate enlargement with alcohol intake, coffee consumption, smoking, physical activity, body mass index (BMI) and concomitant diseases were studied in the large series of patients of the QUIBUS study.

RESULTS

Among concomitant diseases, essential hypertension was the most represented. However no apparent additive or synergistic influence on symptoms was recorded in this subset of the population. Coffee consumption was not associated with prostate volume or LUTS. Alcohol consumption was associated with urgency and intermittence and with an overall higher IPSS. No major influence on symptoms was found in smokers. Physical activity was associated with a lower frequency of incomplete bladder emptying, repeated urination, intermittence and urgency. The postulated existence of an association between BMI and BPH was not confirmed in this study. When a prediction of the IPSS scores was tempted by entering the life-style factors in a multiple regression model, they were able to explain at best 5% of the variance of the dependent variable.

CONCLUSION

Life-style patterns bear a greater influence on individual symptoms than on total scores. This difference is sometimes high enough to recommend specific life-style measures to patients with LUTS and prostate enlargement.

Prognostic value of serum biological markers in patients with hepatocellular carcinoma

PURPOSE

Prognosis of patients with hepatocellular carcinoma (HCC) is assessed by using indexes based on clinical and instrumental parameters. The Cancer of the Liver Italian Program (CLIP) staging system combines the Child-Pugh classification with tumor size, portal invasion, and alpha-fetoprotein and predicts the outcome of HCC patients more precisely than the Okuda staging system. Serum levels of a number of biological variables have been found to be increased in patients with HCC and are associated with different outcomes. Our aims in this study were to test the prognostic role of the serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble interleukin-2 receptor (sIL-2R), interleukin 6 (IL-6), and anti-p53 and to assess whether the addition of any of the above serum markers could further improve the predictive ability of the CLIP score.

EXPERIMENTAL DESIGN

Serum levels of sICAM-1, sIL-2R, IL-6, and anti-p53 were assayed in 80 patients with HCC and correlated with their outcomes. Nonparametric procedures were applied to test correlations between serum sICAM-1, sIL-2R, IL-6, anti-p53, and other prognostic factors. For survival analyses, the product-limit method, log-rank test, and Cox proportional hazards model were applied.

RESULTS

Only serum levels of sIL-2R correlated with survival, which was longer for patients with lower values (< or =950 units/ml). However, with multivariate analysis sIL-2R did not confirm its predictive role when tested with the CLIP score as a covariate, with a hazard of death of 1.51 (95% confidence interval, 0.76-3.01).

CONCLUSIONS

Serum levels of sICAM-1, sIL-2R, IL-6, and anti-p53 are not useful as prognostic factors for HCC in clinical practice. They do not improve the predictive ability of the CLIP score.

Clinical significance of PCR-positive mRNA markers in peripheral blood and regional nodes of malignant melanoma patients. Melanoma Cooperative Group

Reverse-transcriptase polymerase chain reaction (RT-PCR) with multiple markers has been demonstrated to be highly sensitive in detecting metastatic cells in peripheral blood of malignant melanoma (MM) patients, and the circulating MM cells to be significantly correlated with disease stages. We further evaluated the presence of specific PCR-positive mRNA markers in peripheral blood as well as in regional nodes as an expression of tumor progression. Peripheral blood samples from 317 MM patients with either localized (n = 219) or metastatic (n = 98) disease were processed to obtain total cellular RNA. RT-PCR was performed using tyrosinase (TYR), p97, and MelanA/MART1 as mRNA markers. PCR products were analyzed by gel electrophoresis and Southern blot hybridization. In addition, paraffin-embedded samples of histologically proven tumor-negative lymph nodes from the subset of patients with localized disease were analyzed by RT-PCR, using radiolabeled primers for TYR and MelanA/MART1. The presence of mRNA markers was significantly correlated with tumor burden with a good correlation between risk of recurrence (evaluated in stage I-III patients) and increasing number of PCR-positive markers (p = 0.0002). Currently, for each patient, PCR results obtained at different times during follow-up are being analyzed, and any variation in the number of PCR-positive markers is being correlated to the clinical status. Molecular screening of histologically negative nodes for the presence of metastatic MM cells is also under evaluation. Preliminary assessment of a subset of MM patients with higher risk of recurrence will require longer follow-up in order to define the role of RT-PCR in monitoring these patients.

Detection of occult melanoma cells in paraffin-embedded histologically negative sentinel lymph nodes using a reverse transcriptase polymerase chain reaction assay

PURPOSE

Detection of occult metastasis before the development of clinical disease could allow more accurate staging, appropriate follow-up procedures, and adjuvant therapies in patients with malignant melanoma (MM). The sentinel lymph node (SLN) has been proposed as a reliable predictor of metastatic disease in the lymphatic basin draining the primary melanoma. In this study, we screened both paraffin-embedded SLNs and peripheral-blood (PB) samples from MM patients at various stage of disease using a multimarker reverse transcriptase polymerase chain reaction (RT-PCR) assay. The prognostic significance of the presence of PCR-positive markers was also evaluated.

PATIENTS AND METHODS

Total RNA was obtained from paraffin-embedded SLN sections and PB samples of 75 MM patients. RT-PCR was performed using tyrosinase and MelanA/MART1 as melanoma-associated markers. Radiolabeled PCR products were analyzed on denaturing polyacrylamide gels.

RESULTS

Good sensitivity of the RT-PCR assay on archival tissues was demonstrated after comparison of RT-PCR results on frozen and paraffin-embedded SLNs from 16 MM patients. Significant correlation between the disease stage and marker expression in both PB and SLN samples was observed; the highest value was for patients who were positive for both markers in SLN (P =.006). Progression of disease was significantly associated with the total number of PCR-positive markers in both PB (P =.034) and SLN (P =.001) samples.

CONCLUSION

Although sensitivity is lowered by the use of paraffin-embedded specimens, our data indicate that RT-PCR analysis of serial sections from archival SLNs may be helpful in improving detection of occult micrometastases, thus improving staging of patients with melanoma.

Definition of the role of chromosome 9p21 in sporadic melanoma through genetic analysis of primary tumours and their metastases. The Melanoma Cooperative Group

Malignant melanoma (MM) is thought to arise by sequential accumulation of genetic alterations in normal melanocytes. Previous cytogenetic and molecular studies indicated the 9p21 as the chromosomal region involved in MM pathogenesis. In addition to the CDKN genes (p16/CDKN2A, p15/CDKN2B and p19(ARF), frequently inactivated in familial MM), widely reported data suggested the presence within this region of other melanoma susceptibility gene(s). To clearly assess the role of the 9p21 region in sporadic melanoma, we evaluated the presence of microsatellite instability (MSI) and loss of heterozygosity (LOH) in primary tumours as well as in synchronous or asynchronous metastases obtained from the same MM patients, using 9 polymorphic markers from a 17-cM region at 9p21. LOH and MSI were found in 27 (41%) and 11 (17%), respectively, out of 66 primary tumours analysed. In corresponding 58 metastases, MSI was found at higher rate (22; 38%), whereas a quite identical pattern of allelic deletions with 27 (47%) LOH+ cases were observed. Although the CDKN locus was mostly affected by LOH, an additional region of common allelic deletion corresponding to marker D9S171 was also identified. No significant statistical correlation between any 9p21 genetic alteration (LOH, MSI or both) and clinicopathological parameters was observed.

Intermediate dose recombinant interferon-alpha as second-line treatment for patients with recurrent cutaneous melanoma who were pretreated with low dose interferon

BACKGROUND

Interferon (IFN) is widely considered the most effective agent in the adjuvant therapy of patients with cutaneous melanoma (CM). However, little is known about the effect of IFN on pretreated CM patients who experience disease recurrence. The authors conducted a Phase II study to determine whether intermediate doses of IFN could be beneficial for these patients.

METHODS

A series of 24 consecutive CM patients who had undergone surgery for local, in-transit, or lymph node disease recurrence during adjuvant therapy with low dose IFN (IFNalpha-2b, 3 million units [MU] per day, three times per week) were enrolled for second-line therapy with intermediate dose IFN (IFNalpha-2b, 10 MU per day) for one year.

RESULTS

IFN was discontinued in 7 patients (29.2%) because of toxicity. Several patients complained of impairment in their daily activities. Progression of disease was registered in 17 patients (70. 8%), with a median disease free survival of 5.5 months (95% confidence interval, 3.4-14.2). The median follow-up for the 7 patients who did not experience disease recurrence was 15 months (range, 13-22 months).

CONCLUSIONS

An increased dose of IFN as second-line adjuvant treatment was poorly tolerated and produced negative clinical outcomes in patients with CM. However, these patients probably were unresponsive to IFN regardless of the dosage level. In fact, the first adjuvant IFN treatment was ineffective in all patients. Thus, the key factor in the treatment of CM seems to be patient responsiveness to IFN rather than the total dosage achieved.

Immunological phenotype analysis of patients with Fanconi's anaemia and their family members

In contrast to patients affected with Fanconi's anaemia (FA), who are homozygotes, parental heterozygotes are generally considered normal. In this preliminary work the main immunological phenotypes of circulating mononucleated cells were studied, both in homozygous and heterozygous subjects. The statistical analysis of results showed that two sets of variables may be distinguished: (a) the first set, including CD20, CD4, CD8 cell markers and CD20/CD3 and CD4/CD8 ratios, that was able to differentiate between FA patients and the other subject groups; (b) the second set, including CD25, HLA-DR, HLA-DP, HLA-DQ cell markers, that was able to differentiate healthy subjects from the other groups. Therefore, in contrast with the literature data, immunological abnormalities may already be present in parental heterozygotes of FA patients. These subjects displayed a reduced number of cells expressing both specific (CD25) and non-specific (HLA) antigens. This defect was more severe in FA homozygous patients, who showed, in addition, a reduced total lymphocyte count, reduced levels of T helper (CD4+) and B lymphocytes (CD20+), and a reduced CD4+/CD8+ cell ratio. In conclusion, our results suggest the presence of a grading of immunological defects in FA patients and family members. Our suggestion needs to be confirmed by functional studies.