Toxoplasma gondii and Neospora caninum infection in epileptic dogs

OBJECTIVES

Studies in humans have demonstrated the role of Toxoplasma gondii, a protozoan parasite, in epileptic seizures. This study aimed to investigate the serological correlation between T. gondii and N. caninum and epilepsy in dogs.

MATERIALS AND METHODS

The medical record database of the Veterinary Teaching Hospital, University of Perugia, was searched for dogs serologically tested by IFAT for T. gondii and N. caninum and following specific inclusion criteria. Dogs were stratified by having a clinical diagnosis of epilepsy or suffering different conditions.

RESULTS

One-hundred and twenty-eight dogs were included, 64 with epilepsy and 64 without clinical signs of epilepsy. Seventeen of the 64 epileptic dogs (26.6%; 95% CI: 15.7% to 37.4%) and twenty-one of the 64 non-epileptic dogs (32.8%; 95% CI: 21.3% to 44.3%) tested positive for T. gondii. Eight of the epileptic dogs (12.5%; 95% CI: 4.4% to 20.6%) and three of the non-epileptic dogs (4.7%; 95% CI: 0% to 9.9%) tested positive for N. caninum. There was no statistically significant difference in the rate of T. gondii or N. caninum seroreactivity between epileptic and non-epileptic dogs.

CLINICAL SIGNIFICANCE

The results obtained do not seem to support the role of T. gondii and N. caninum as causative agents of dog epilepsy.

Epidemiology of Hepatocellular Carcinoma in a Province of Northern Italy: Prevalence of the Risk Factors and Incidence in the Population

Aims

Epidemiologic studies on hepatocellular carcinoma (HCC) in limited geographic areas of Italy are rare, and most of them derive from autopsies. We retrospectively analyzed the prevalence of risk factors (sex, age, HBsAg, alcoholism, cirrhosis) in 137 HCC diagnosed between 1980 and 1989 in a single centre of northern Italy (Bergamo).

Results and conclusions

One hundred and nine of the HCC (79.6%) occurred in men (M:F = 3.9:1); 35.8% were HBsAg+ and 41.4% had histories of alcoholism. There were significant differences between men and women as regards prevalence of HBsAg+ (40.4% vs 17.9%; p = 0.046) and alcoholism (47.6% vs 17.9%, p = 0.008). The mean age of the patients was 63.6 years (range, 40-82), with significant differences between men and women (62.4 ± 08 vs 68.2 ± 1.4, p = 0.001), between HCC/HBsAg + and HCC/HBsAg– (59.1 ± 1.1 vs 66.1 ± 0.8, p = 0.00001) and between alcoholics and nonalcoholics (61.6 ± 1.1 vs 64.8 ± 0.9; p = 0.03). Liver cirrhosis was associated with HCC in 104/122 cases (data not available for 15 patients) without differences in distribution of sex, age, HBsAg+ or alcoholism between HCC with cirrhosis and HCC without cirrhosis. Incidence was calculated for the surrounding territory of the hospital center (10 towns, districts 5 and 6, USSL 30). Fifty-four cases of HCC were found in this area over the 10-year period, In according with a mean standardized incidence rate (Lombardy population 1971) of 11.7/100,000 inhabitants/year (c.i. 95%, 1.49-21.86).

Etomidate anaesthesia by immersion in oriental fire-bellied toads (Bombina orientalis)

The objective of the present study was to evaluate the efficacy and the safety of etomidate anaesthesia by immersion technique in Bombina orientalis. The study comprised two phases. The first phase was carried out to identify the etomidate concentration capable of producing anaesthetic induction, as well as surgical anaesthesia, in the toads. The second phase was aimed at testing that concentration in eight additional animals. Etomidate administered via immersion at a concentration of 37.5 mg/L produced effective anaesthesia in oriental fire-bellied toads. The average duration of surgical anaesthesia was 20 min. All the toads enrolled in the study survived the anaesthesia and long-term complications did not occur. However, undesired side-effects, namely itching, myoclonus and prolonged recovery, were noticed during the perianaesthetic period. The authors concluded that etomidate anaesthesia by immersion, at a concentration of 37.5 mg/L, is suitable in oriental fire-bellied toads and produces anaesthesia of a depth and duration that is sufficient to allow the completion of various experimental procedures, without resulting in lethal complications. However, the occurrence of undesired side-effects opens a debate on the safety of this anaesthetic technique, and imposes the need for further investigation prior to proposing the latter for routine laboratory practice.

Evaluation of an aerosol emitter for mating disruption of Cydia pomonella in Italy

Some techniques have been developed to disrupt mating (MD) of codling moth (CM) by treating orchards with pheromone. Synthetic pheromone is applied to the crop as a formulation that is designed to protect these generally labile compounds from degradation while gradually releasing pheromone into the atmosphere. In Trentino South Tyrol MD has been adopted successfully (24,500 ha, i.e. 73% of the apple area) to control CM in heavily infested areas; while in areas with low pest pressure, less pesticides are usually applied (2-3 per year) and as a consequence, pheromone mating disruption is not considered economically convenient. Hand applied sealed plastic tubes and plastic ampoules are the two pheromone formulations more widely used. A new pheromone-based control technique, called Puffer, has been recently proposed. Puffers are battery-powered devices that release pheromone from pressurized aerosol cans every 15 minutes for 12 hours or 30 min for 24 hours. During each puff a quantity of 6.95 mg a.i. is emitted. The high release rate of pheromone per puff from aerosol dispensers is thought to compensate for their low application densities (2-2.5 puffer/hectare). Results of three year field trials carried out in Trentino-South Tyrol demonstrated the potential of Puffer as effective tool to control the moth.

Pesticide residue free fruits: the aim of Trentino apple production system

Chemical analyses performed in 2011 on the 575 samples of apples in Trentino (Italy), there are in average 3.24 active ingredient per sample. Moreover, in 98% of the samples with detectable residues, the level did not exceed 30% of the official MRL This result is achieved thanks to the implementation of the guide lines for integrated production by the 8000 fruit growers, to an extension service which justifies the need of the treatment and gives advice on which pesticide fit better for the time-pest combination, to the systematic check up of the sprayers, to the correct sizing of mix volumes to spray according to the size of the canopy, to the selection of active ingredients based on their residual activity in field tests, and to the systematic monitoring of the level of residues found on representative samples of the product at harvest. With these assumptions, the next goal is to eliminate all traces of insecticides and acaricides now present only in 30% of the samples. This aim could be achieved by extending the use of pheromone mating disruption to control fruit feeding Lepidoptera, as well as by promoting the use of short persistent residue products during the final part of the season. Results of some of the experimental field trials are presented and discussed.

An epidemiologic survey of celiac disease in the Terni area (Umbria, Italy) in 2002-2010

The present work is an epidemiology survey of celiac disease in the province of Terni (Umbria, Italy) in 2002-2010. Data were collected from the Local Health Unit (LHU) 4 (ASL 4), Terni database and were extrapolated from the overall population of 232,540 (as of 2010) by identifying residents with prescription charge exemptions for celiac disease-oriented drugs. Prevalence and incidence analysis over the timeframe being examined showed that prevalence (330 cases in 2010) has consistently been increasing from 2002 to 2010, whereas incidence has remained essentially the same with minor, yearly fluctuations. Both prevalence and incidence were higher in females than in males. Most patients were diagnosed as young adults, with the highest rates in the 10-14, 35-40 and 55-60 age groups. Thus, in the area of investigation, there is evidence for consistent delayed diagnosis, raising the possibility that the atypical form the disease, more difficult to recognize and more likely to escape early diagnosis, may have become increasingly commoner overtime. Because the current prevalence of the disease in the Terni area is estimated to approximate 1%, the anticipated number of cases should amount to 2325, which value contrasts with the currently reported 330 diagnoses. It is suggested that the current illness-defining criteria should be revised so to implement early diagnosis and improve the patients' quality of life and access to treatment.

The impact of eriophyoids on crops: recent issues on Aculus schlechtendali, Calepitrimerus vitis and Aculops lycopersici

The nature of the damage caused by eriophyoid mites and the assessment of yield losses still require detailed studies if appropriate control and risk mitigation strategies are to be planned. The economic importance of eriophyoid mites is increasing worldwide and a lot of species have reached a permanent pest status in certain crops, while others represent a quarantine threat for several countries. Due to their relevant role in Europe and elsewhere, three eriophyoid mites that have been frequently reported in recent research, are here considered as case studies: two of them (the apple rust mite, Aculus schlechtendali, and the grape rust mite, Calepitrimerus vitis) colonise temperate fruits, while one (the tomato russet mite, Aculops lycopersici) affects vegetables. The damage assessment related to the apple rust mite has been evaluated on different apple varieties with implications for pest control. Some factors affecting the spread and economic importance of the grape rust mite have been identified. The complexity and difficulty in controlling the tomato russet mite by chemicals enhances the interest in biological control agents. Considerations on interactions between eriophyoids and host plants (e.g. resistance, varietal susceptibility), on pest management regimes (e.g. impact of fungicides, resistance to acaricides, perspectives on biological control) are presented.

A case of primary papillary disseminated adenocarcinoma of canine lung

Primary lung tumors are rare in dogs, whereas pulmonary metastatic neoplastic involvement is common. We describe a case of a 12-year-old male, mixed-breed dog with a 3-month history of coughing and dyspnea. The investigating protocol, which also includes transcutaneous pulmonary biopsy, allowed a diagnosis of lung adenocarcinoma that necroscopic findings confirmed as a primary neoplasia. The tumor exhibited a nodular-disseminated growth, mimicking the metastatic involvement of the lung, instead of the single-mass appearance that has been observed by other authors. The present report indicates that, although the incidence of canine primary lung neoplasms is markedly low, this condition must be considered in the differential diagnosis of lung diseases that cause coughing and dyspnea in older dogs.

[Evaluation of the appropriateness of public hospital use using AEP, Disease Staging, and other DRG-based criteria (essential levels of care--Italian LEA): results and degree of agreement among the different methodologies]

Currently, more than one instrument has been found to be reliable and valid for the assessment of hospital admission appropriateness. However; data on the level of agreement among these methodologies are extremely scarce. The study was aimed at evaluating whether the percentages of organizational (in)appropriateness resulting from some of the most diffused instruments (Italian Appropriateness Evaluation Protocol--AEP/PRUO; Disease Staging; Essential Levels of Care--LEA, version 2001 and 2008) are substantially concordant, or they largely depend upon the methodology. For each public hospital of Abruzzo, Italy, the amount of inappropriateness has been computed using six indicators: inappropriate days of care (PRUO1); totally inappropriate admissions (PRU02); early admissions DRGs according to the first Law on Italian LEA (LEA01); admissions assigned to one of the 108 potentially inappropriate DRGs according to the second Law on Italian LEA, currently inactive (LEA08). The sample was composed by all ordinary admissions made in 2006 in the Region, with the exception of PRUO indicators, which were based upon the manual revision of 2% of all admissions that could be assessed using PRUO methodology. We found a good correlation among most indicators based upon administrative discharge data (DS1, DS2 and LEA01), whereas the results obtained using PRUO and new LEA (LEA08) were discordant, and marked differences were observed also between the two PRUO indicators. Although the limitations of the study permit only preliminary conclusions, in future appropriateness evaluations it may be reasonable to use more than one indicator--allowing the creation of combined scores--and rank hospitals in large categories--avoiding excessively precise scores--as such rankings might relevantly differ depending upon the used instrument.

[Evaluation of the appropriateness of public hospital use using AEP in the Abruzzo Region of Italy: results by hospital and ward, main predictors and potential implications]

In the context of a wide healthcare system reorganization, the Abruzzo Region of Italy used the Appropriateness Evaluation Protocol (AEP) to carry out a systematic evaluation of the appropriateness of the admissions performed during 2006 in all public hospitals. After specific training courses, a sample representative of all ordinary admissions was assessed twice: first by regional investigators (external assessment) then by the local personnel (internal assessment). Random-effect logistic regression was used to evaluate potential inappropriateness predictors. On a total of 13081 hospital days (2393 hospitalizations), 39.7% (95% Confidence interval: 38.9%-40.6%) were inappropriate at the regional assessment; 39.5% at the internal assessment, with high correlation between the two controls (K = 0.73). Another 10.4% of admissions, excluded by the evaluation, was assigned to DRGs at high risk of inappropriateness and should be considered. In single hospitals, the inappropriateness ranged between 17.9% and 57.9%, with large variation across wards. Additional significant predictors of inappropriateness were the day and hour of admission and hospital size, with lower inappropriateness in bigger ones. In 2006, there was a large degree of hospital misuse in public hospitals in the Abruzzo Region. The approach used in the survey may have contributed to the drastic reduction of the number of ordinary admissions observed in the Region between 2006 and 2007.

Control of Lobesia botrana (Lepidoptera: Tortricidae) by biodegradable ecodian sex pheromone dispensers

Mating disruption with a high density of sex pheromone dispensers is a new strategy recently developed for the control of the moth Lobesia botrana (Denis & Schiffermüller) (Lepidoptera: Tortricidae). Ecodian LB dispensers, made of low-cost biodegradable material, were formulated with 10 mg of (E,Z) -7,9-dodecadienyl acetate and placed at a rate of 1,600 dispensers per ha. Seasonal dispenser performances were studied using different methods. The female attractiveness disruption and the efficacy of the method were evaluated in the field. The release rates of field-aged Ecodian LB dispensers, measured directly by solid phase microextraction, was comparable with that of the standard monitoring lure after 50-60 d of field exposure and significantly lower beyond 60 d; however, at the end of the season, it was approximately 46 times higher than that of a calling L. botrana female. Electroantennographic recordings showed that dispensers of different field age strongly stimulated male antennae. In a wind tunnel test, dispensers elicited close-range approaches and direct source contacts irrespective of their age. In fields treated with Ecodian dispensers the attractiveness of traps lured with calling females and monitoring baits was significantly reduced. Our data suggest that Ecodian dispensers are active sources of pheromone throughout the season. The efficacy of Ecodian strategy for L. botrana control was comparable with standard mating disruption and curative insecticides.

Cerebellar leptomeningeal carcinomatosis in a dog

Diffuse cerebellar meningeal carcinomatosis secondary to haematogenous dissemination from an anaplastic solid mammary carcinoma was diagnosed in an old German shepherd dog suffering from seizures and rapidly progressing to stupor. A single computed tomography cerebellar scan identified an unusual homogeneous density area that was considered to be associated with a vascular disorder, in the absence of space-occupying lesions. At necropsy, nodular masses were observed in the mammary gland, lungs, tracheobronchial lymph nodes and adrenals. Cerebellar leptomeninges were affected by diffuse blood effusion. Histology showed a solid mammary tumour, characterised by anaplastic cells with a cytoplasmic keratin-positive and vimentin-negative immunoreaction. The tumour had spread to the lungs, tracheobronchial lymph nodes and adrenals. Cerebellar leptomeninges were diffusely infiltrated by the cytokeratin-positive neoplastic cells. Even though computed tomography scan gave no evidence of meningeal carcinomatosis, it was considered that a cerebellar vascular disorder might be present. This was subsequently confirmed by neuropathological investigation and seen to be associated with a cerebellar leptomeningeal carcinomatosis.

Prospective study on prognostic significance of DNA ploidy and Ki-67 expression in colorectal cancer

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Background: The prognostic value of flow cytometry DNA ploidy and Ki-67 expression in colorectal carcinomas has not been defined yet. The study tries to correlate tumoral DNA ploidy and proliferative activity (Ki-67) with therapy response, Overall Survival (OS), Disesase Specific Survival (DSS) and Disease Free Survival (DFS). Methods: From 01/09/02 to 30/06/05, 3 samples of cancer tissue and 1 sample of normal mucosa has been collected from all operating pieces of colorectal cancer. These samples were frosen and later disgregated, treated and coloured with Propidium Iodide. DNA ploidy was evaluated by FACSCalibur cytofluorimetry. Normal mucosa tissue was our internal control. Ki-67 was evaluated by immuno-histochemistry in all tumoral samples. All the patients were cured with chemo- and/or radiotherapy in our divisions. Results: 67 patients (M/F 35/32); median age was 70; staging: 19% I, 33% II, 30% III, 18% IV. We found aneuploidy in 65,7% of carcinoma and Ki-67 median expression was 55%. DNA tumoral heterogeneity was present in 27% of patients. DNA aneuploidy correlates with advanced disease stage at diagnosis (p<0,01), with high number of metastatic lymphnodes (p<0,005) and with serological markers positivity (p<0,04). After surgery and chemotherapy 35% of the patients with aneuploid carcinoma and high proliferative activity (Ki-67>55%) do not show evident disease versus 100% of patients with DNA diploidy and lower Ki-67. Tumoral aneuploidy correlates in a significative way with lower OS (48% vs 89% of diploid patients), lower DSS (tumor death happened just in patients with aneuploid DNA in every disease stages), with lower DFS (18% vs 86% of diploid patients). Univariated analysis stated that aneuploidy determinates an Odd Ratio=5,7 to develop disease progression (p=0,033). At the moment Ki-67 expression with 55% cut-off does not seem to correlate with OS, DSS and DFS. Conclusions: Preliminar results (the study is still in progress) seem to suggest that cytofluorimetric DNA-ploidy has a prognostic and predictive significance in colo-rectal carcinomas. Ki-67 expression (immuno-histochemistry) has an uncertain significance. The small number of patients and the short follow-up do not allow us to reach any definitive conclusions, but the study is worth to go on.

No significant financial relationships to disclose.

[Disease staging analysis of the timeliness and appropriateness of hospital admissions: no relevant improvements in the Abruzzo Region of Italy from 2001 to 2005]

The study was aimed at evaluating whether the degree of hospital admission inappropriateness and timeliness was improved in the Abruzzo Region of Italy between the year 2001 and 2005. All hospital admissions for the year 2001 (n = 286,924) and 2005 (n = 280,761) in the Region were analysed (SDO discharge data), and three diseases were in-depth reviewed: diabetes mellitus; cholecystitis/cholelithiasis; and bacterial pneumonia. Using Disease Staging methodology, the timeliness of hospitalisation was assessed by grouping admissions in three categories: premature or medically unnecessary, timely, and late. Overall, the rate of medically unnecessary admissions for diabetes mellitus was 72.3% in 2001 and 73.4% in 2005. The percentage of late hospitalizations for the same disease was still 20.2% in 2005, when the rate of late admissions for cholelithiasis/cholecystitis was 53.3% (+10.5% compared to 2001);for bacterial pneumonia 14.5%. The rate of early admissions did not improve for any disease, and any of the six local health units in Abruzzo showed an improvement in all the measures evaluated. In the period 2001 and 2005, in the Abruzzo Region there is no evidence of an improvement in the rates of inappropriate hospital admission, both early and late, which are still excessively high for all diseases examined excepted bacterial pneumonia. Interventions to address this issue are strongly needed.

[Drug, food, alcohol abuse and smoking in young workers. Methodology of a survey aimed at developing preventive interventions targeted to different type of workers: the Valentino Study]

Current epidemiological data suggest that the number of preventive interventions aimed at controlling alcohol, drug, food abuse and smoking achieved only partial success, especially in young individuals. In order to improve preventive action efficacy, the literature suggests the adoption of contents and communication instruments specifically targeted to different groups of individuals. The Valentino Project is a comprehensive survey on the characteristics of abuse of a representative sample of 3000 young workers (aged 18-35 years)from the Abruzzo Region of Italy. This paper describes its main methodological issues and the complete version of the questionnaire HW-80 (Healthy-Worker 80), that will be administered. HW-80 questionnaire includes 80 items on demographic characteristics, self-reported health, job-related stress, work organization, pattern of abuse, physical activity and others, and several of these items have been taken or derived from repeatedly validated questionnaires (SF-12, CAGE, Job-Strain, Effort-Reward, EU-DAP, etc.). The aims of the Valentino Project are to quantify the prevalence of obesity, alcohol use, smoking and drug addiction in diverse typologies of workers, and to describe their pattern of use. The ultimate purpose is to provide the necessary knowledge for the development of preventive strategies targeted to different professions, in order to maximize their efficacy.

Prospective study on prognostic significance of DNA ploidy and Ki-67 expression in colorectal cancer

The aim of the study was to correlate tumoral DNA ploidy and Ki-67 expression with therapy response, Overall Survival (OS), Disease Specific Survival (DSS) and Disease Free Survival (DFS). Three samples of colorectal cancer were collected from each patient. One sample of normal tissue was our internal control. DNA ploidy was evaluated by FACSCalibur cytometer and Ki-67 by immunohistochemistry. We studied 67 patients and we found aneuploidy in 65,7 percent of carcinoma with a Ki-67 median expression of 55 percent. After surgery and chemotherapy in 35 percent of the patients with aneuploid carcinoma and high proliferative activity (Ki-67 greater than 55 percent) there were no evidence of disease versus 100 percent of patients with DNA diploidy and low proliferative activity (Ki-67 less than 55 percent). Tumoral aneuploidy significantly correlated with lower OS, DSS and DFS (18 percent vs 86 percent at 30 months). Univariated analysis demonstrated a significant correlation between aneuploidy and develop disease progression (p=0,033, odd ratio=5.7), while the cut-off of 55 percent for Ki-67 expression did not correlate with OS, DSS and DFS. Preliminary results (the study is still in progress) seemed to suggest that DNA ploidy has a prognostic and predictive significance in colorectal carcinoma.

Control of Cydia pomonella L. and Cydia molesta (Busck) (Lepidoptera Tortricidae) in pome-fruit orchards with Ecodian sex pheromone dispensers

A mating disruption approach using high densities of pheromone dispensers, has been recently proposed for codling moth, Cydia pomonella (L.), and oriental fruit moth, Cydia molesta (Busck.), (Lepidoptera Tortricidae), control. Ecodian Star dispensers, made of low-cost biodegradable material and easy to apply, were formulated with 10 mg of codlemone (E8,E10-12OH) and 10 mg of grapamone (Z8-12OH) and placed at a rate of 1,400-2,000 dispensers/ha. The pheromone release rates from new and field aged dispensers were evaluated by hexane extraction of the residual attractant (indirectly) and gas-chromatographic analysis. The release rate of field-aged dispensers decreased over time with a good linearity; they released a significant amount of synthetic sex pheromones over the entire season. Dispensers elicited close-range approaches of codling moth males in wind tunnel irrespective of their age. Field trials carried out from 2003 to 2004 confirmed the efficacy of Ecodian Star dispensers for codling moth and oriental fruit moth control, regardless the size of the treated area. Our results demonstrate that Ecodian dispensers achieved a good level of activity and longevity over the season. The potential of this strategy for the control of the moths is discussed.

[Sex chromosome abnormality: report of three clinical cases of X pentasomy]

Pentasomy X cases are very few. In this study we describe three clinical cases (two newborn children and a girl in puberal age) of females showing a 49, XXXXX cariotype. The salient phenotypic characteristics of these cases (heart defects, growth deficiency, craniofacial and hand abnormalities) are compared to the clinico-pathological data described in literature.

Gershoni-Baruch syndrome: report of a new family confirming autosomal recessive inheritance

Gershoni-Baruch syndrome is a multiple congenital malformation complex characterized by omphalocele, diaphragmatic hernia, cardiovascular abnormalities, and radial ray defects. Autosomal recessive inheritance is suggested. We describe two additional cases from a single family (sister and brother) delivered through termination at 23 and 9 weeks of gestation, respectively. The first fetus showed a spectrum of schisis defects without any limb involvement while the second bore mainly malformations of hands and feet. The occurrence of two different syndromes in the same family is highly improbable, but, considering both malformation complexes as possible manifestations of the same disease, a diagnosis of Gershoni-Baruch syndrome appears the most reasonable. These new familial cases bring further support to the hypothesis of an autosomal recessive inheritance of this syndrome.

Cutaneous metastasis of neuroendocrine carcinoma of the larynx: report of a case

BACKGROUND

Cutaneous metastasis from neuroendocrine carcinomas of visceral origin is rarely described in indexed literature. The primary sites of origin include: lung (Wick et al., J Am Acad Dermatol 1985; 13: 134), larynx (Zambruno et al., Ann Dermatol Venereol 1989; 116: 855; Schmidt et al., J Laryngol Otol 1994; 108: 272; Guerzider et al., Ann Pathol 1991; 11 (4): 253), mediastinum (Yoshimasu et al., J Dermatol 2001; 28 (3): 168), uterus (Fogaca et al., J Cutan Pathol 1993; 20: 455), and thymus (Wick et al., J Am Acad Dermatol 1985; 13: 134).

METHODS

In this report, the authors present the clinical, histological, immunohistochemical, and ultrastructural characteristics of secondary skin localizations of a neuroendocrine laryngeal tumor that occurred in a 61-year-old man. The complete follow up of the case is described and a brief revision of the terminology and classification of neuroendocrine neoplasms of the larynx is discussed, since a significant relationship exists between the degree of differentiation and biological behavior.

RESULTS

On histological examination, the secondary cutaneous localization appeared to be more dedifferentiated compared to the primary tumor. The immunohistochemical patterns of reactivity were similar in both neoplasms, showing expression of neuroendocrine and epithelial markers.

CONCLUSIONS

An important issue of prognostic significance is to differentiate a cutaneous metastasis of a neuroendocrine carcinoma from the primary small cell-undifferentiated carcinoma of the skin (Merkel cell carcinoma).

Dirofilariasis due to Dirofilaria repens in Italy, an emergent zoonosis: report of 60 new cases

AIMS

Sixty new cases of human dirofilariasis due to Dirofilaria repens, occurring in Italy between 1990 and 1999, are presented. This is the most extensive case study of this zoonosis reported worldwide by a single study group. The aim is to utilize this large experience to characterize the different histopathological findings in the parasitic lesions in man.

METHODS AND RESULTS

Diagnosis was performed on histological sections of the nematode enclosed in the nodules excised at biopsy or surgery. The nematode was located in the subcutaneous tissue (49 cases), the epididymis (two cases), the spermatic cord (two cases), the lung (two cases), the breast (two cases), the omentum (two cases) and under the conjunctival tissue (one case). The majority of cases (46) were from Piedmont; the remainder were from Emilia-Romagna, Sardinia, Sicily, Tuscany, Apulia and Lombardy. The histopathological features of the lesions are described and the clinical and epidemiological aspects of the zoonosis are discussed. The prevalence in Italy in general and in the area of Piedmont in particular, comprising the provinces of Alessandria, Asti, Novara and Vercelli, which is one of the most severely affected areas of the world, is emphasized. The evident increase in the number of cases in the last few years is a clear indication that it is an emergent zoonosis.

CONCLUSIONS

We recommend that each and every case observed be recorded, to enable the true extent of human dirofilariasis in Italy to be assessed, and that a reference centre be set up in the area to collate the data. The importance of the histopathologist's role in the diagnosis is stressed.

[Bilateral pheochromocytoma associated with duodeno-jejunal GIST in patient with von Recklinghausen disease: report of a clinical case]

The authors present the case of a 60-year-old male patient suffering from von Recklinghausen's disease (neurofibromatosis type I, NF1) with bilateral pheochromocytoma and occasional intraoperative reports of duodenojejunal GIST (GastroIntestinal Stromal Tumour). Through a review of the literature the authors analyze the frequency and the features of bilateral pheochromocytoma and its rare histological variant, the so-called composite pheochromocytoma, characterized by the combination of pheochromocytoma and ganglioneuroma or ganglioneuro-blastoma. Bilaterality of pheochromocytoma is more frequent in patients with familiarity for pheochromocytoma without NF1. Composite pheochromocytoma accounts for about 3% of total pheochromocytomas. In addition, the authors summarize the present knowledge about gastrointestinal stromal tumours and investigate the possible association between them and NF1 or pheochromocytoma, concluding that any such association is purely casual, while confirming the well known, genetically determined association between NF1 and pheochromocytoma.

Prognostic value of 24-hour blood pressure in pregnancy

CONTEXT

Elevated blood pressure (BP) measured at the physician's office may reflect true hypertension or white coat hypertension (WCH). The prognostic value of WCH among pregnant women is unknown.

OBJECTIVE

To assess the prognostic value of WCH in pregnancy.

DESIGN

Prospective cohort study conducted between September 1994 and October 1997.

SETTING

Community hospital.

PATIENTS

Women without preexisting hypertension and not treated with antihypertensive drugs aid with high (n = 148) or normal (n = 106) office BP (high office BP was defined as > or =140 mm Hg systolic and/or > or =90 mm Hg diastolic) matched for gestational age during their third trimester of pregnancy. All women underwent 24-hour noninvasive BP monitoring, and women without hypertension on 24-hour monitoring (125/74 mm Hg or less for average 24-hour BP) with office hypertension were classified as having WCH. Women were followed up through the end of pregnancy.

MAIN OUTCOME MEASURES

Duration of pregnancy, gestational hypertension, preeclampsia or eclampsia, cesarean delivery, placental and neonatal weight, and length of maternal and neonatal hospital stays for those with and without elevated office BP.

RESULTS

After application of exclusion criteria, data for 7 women were removed from the analysis. For the remaining subjects, in the group with elevated BP, prevalence of WCH was 29.2% (42/144). Duration of pregnancy was similar in the normotensive and WCH groups (39.6 vs 39.8 weeks; P = .50), but shorter (38.3 weeks; P<.001) in the true hypertension group. Incidence of preeclampsia was similar in the normotensive and WCH groups (5.8% vs 7.1 %; P = .86) but higher in the true hypertension group (61.7%; P<.001). Frequency of cesarean delivery was lower in the normotensive (12.4%) than in the WCH (45.2%; P = .008) and true hypertension (41.1 %; P = .009) groups. Neonatal weight was lower (P<.001) in the true hypertension (mean, 2911 g) than in the normotensive (3336 g) and WCH groups (3435 g), which did not differ (P = .68). The duration of neonatal hospital stay did not differ between the normotensive and the WCH group (5.3 vs 6.9 days; P = .13) but was longer in the true hypertension group (12.3 days; P<.001).

CONCLUSIONS

In women with elevated BP during their third trimester of pregnancy, 24-hour BP was superior to office BP (distinguishing true hypertension from WCH) for prediction of the outcome of pregnancy. Outcomes in the normotensive and WCH group were comparable, but the increased incidence of cesarean delivery in the WCH group may reflect decision-making processes influenced by office BP.

Cancer survival from incident cases of a population-based study in the Umbria region, Italy

Survival of 12,051 cancer patients was investigated in incident cases registered in an ad hoc survey in the Umbria region for the period 1978-82. Death certificate only cases were excluded. The follow-up was carried out by an automatic link with the RENCAM (nominative register of causes of death) and verified at the Registrar's Offices of the various towns of the region. Both observed and relative survival rates according to sex and selected time periods (1, 5 and 10 years) were calculated. Generally, the relative survival rate for all tumour sites at 5 years was 0.35 in males and 0.53 in females (P < 0.01), and 0.31 and 0.49, respectively, at 10 years. 5-year relative survival rates greater than 0.50 were found for only three tumour sites in men (bladder, larynx, colon), accounting for approximately 21% of all men included in the study, but for six sites in females (breast, uterus, kidney, bladder, rectum, colon), accounting for more than 50% of the female cases. The 5-year age-adjusted relative survival rates in Umbria were higher than in other Italian and European registries for selected sites (stomach, colon, rectum, lung). High survival in Umbria could probably be related to the availability of specialist care and to the easy access to a network of oncological services.

[Amniotic fluid embolism in trial of labor. A case report]

Amniotic fluid embolism is a rare complication of pregnancy, which accounts for about 10% of all maternal deaths. A case of acute embolic episode occurred during labor in a 36-year-old patient with spontaneous rupture of membranes is described. Caesarean section was performed immediately, followed by hysterectomy; the baby survived but the mother died because of DIC and cardiorespiratory arrest.

Quantitative analysis of IgM anti-HBc in chronic hepatitis B patients using a new "gray-zone" for the evaluation of "borderline" values

BACKGROUND/METHODS

In order to define the clinical significance of borderline levels of IgM anti-HBc in chronic hepatitis B patients, we followed up 89 untreated hepatitis B patients (19 HBeAg pos and 70 anti-HBe pos) for 1 year, with monthly monitoring of IgM anti-HBc using a highly sensitive quantitative microparticle enzyme immunoassay (IMx CORE-M, Abbott). As a control group we used 304 healthy subjects: 150 HBsAg negative and anti-HBc/anti-HBs positive, and 154 without markers of HBV infection. The statistical analysis performed by Receiver Operating Characteristic curve indicated the 100% sensitivity cut-off at 0.081 IMx index and 100% specificity cut-off at 0.358 IMx index.

RESULTS

We could define the range of a chronic hepatitis B "gray-zone" between 0.100 [80.6% specificity (95% CI, 76.2%-85%), 96.6% sensitivity (95% CI, 92.8%-100%)] and 0.200 [95.7% specificity (95% CI, 93.4%-98%) and 78.7% sensitivity (95% CI, 70.2%-87.2%)] of the IgM anti-HBc-IMx index. In fact, none of the chronic hepatitis B patients had IgM anti-HBc-IMx values persistently below 0.100 during the follow-up, whereas 57.3% had values persistently higher than 0.200. In 38.2%, IgM anti-HBc values occasionally fell within the "gray-zone" limits. In the remaining four patients (4.4%), the results overlapped the "gray-zone" values.

CONCLUSIONS

These results suggest that the use of a chronic hepatitis B "gray-zone" for values of quantitative IgM anti-HBc assays helps to distinguish "true healthy carriers" from asymptomatic chronic anti-HBe positive hepatitis B patients who have been shown to have temporary remissions of liver disease and frequently undetectable serum HBV-DNA.

Biological monitoring of workers exposed to N-nitrosodiethanolamine in the metal industry

Biological monitoring of occupational hazards was performed in workers using cutting fluids containing N-nitrosodiethanolamine (NDELA). The study involved a group of 25 male subjects from some metal factories in central Italy who used cutting fluids with an NDELA content of > or = 5 mg/l (high-exposure group) and a group of 37 males exposed to cutting fluids with an NDELA content < 5 mg/l (low-exposure group). For comparison, we recruited a control group consisting of 37 subjects living in the same area. For all subjects, internal dose (urinary excretion of NDELA, mutagens, and thioethers), early biological effects (sister chromatid exchanges in blood peripheral lymphocytes), and urinary excretion of D-glucaric acid (DGA) as an endpoint product in the glucuronidation pathway were assessed. The results showed that only the workers using cutting fluids with NDELA concentrations of > or = 5 mg/l excreted trace amounts of NDELA in their urine. Urine excretion of mutagens was similar in the two exposure groups and in the controls. High-exposure subjects had a higher mean value of urinary thioethers than low-exposure and control subjects, but no differences were found in urinary DGA or lymphocyte sister chromatid exchange among the three groups. Smoking status increased the mean values of all the biomarkers, and coffee drinking was associated with urinary DGA excretion.

Cytogenetic biomonitoring of pesticide-exposed farmers in central Italy

The frequency of sister chromatid exchanges (SCE) and micronuclei in peripheral blood lymphocytes was evaluated in 48 agricultural workers and 50 control subjects living in central Italy. No difference in SCE frequency was found between the control and the exposed populations with respect to age, smoking habits, and duration of exposure, although smokers, both farmers and controls, had a higher SCE frequency than nonsmokers. However, the comparison of proliferative rate index values found in the two groups revealed a significant decrease in the activation capability of lymphocytes in the pesticide-exposed workers, probably related to the toxic properties of chemicals to which the farmers were exposed. On the contrary, the analysis of micronuclei frequency indicated that there were differences between the exposed and control subjects with respect to smoking habits, age, and duration of exposure. Our results indicate that, in the study population occupationally exposed to a complex mixture, including insecticides, fungicides, and herbicides, there is clear, although slight, evidence of clastogenic activity in peripheral blood lymphocytes but no corresponding effects on SCE induction. Moreover, our data show clear evidence of cell proliferation delay relatable to chemical compounds used in agriculture.

Twenty four-hour ambulatory blood pressure monitoring in women with pre-eclampsia

The aim of our study was to evaluate by means of ambulatory 24 h monitoring the diurnal systolic (SBP) and diastolic (DBP) blood pressure profiles in a group (n = 18) of gravid patients with pre-eclampsia compared with a group (n = 17) of healthy control subjects matched for age and week of gestation to assess whether: (i) ambulatory BP is also raised in pre-eclampsia; (ii) the increase of BP, if present, occurs to the same extent during both daytime and night; and (iii) a blunted BP pattern is consistently present in pre-eclampsia. BP was recorded at intervals of 15 min for 25 h using a TM2420 non-invasive pressurometer. The presence of a circadian rhythm of BP was assessed by cosinor analysis. SBP was higher in women with pre-eclampsia (24 h average 115 +/- 11 vs. 136 +/- 12, P = 6 x 10(-6); daytime 117 +/- 12 vs. 139 +/- 13, P = 6 x 10(-6); night 110 +/- 11 vs. 129 +/- 14, P = 5 x 10(-5) as well as DBP (24 h average 67 +/- 5 vs. 86 +/- 6, P = 8 x 10(-12); daytime 69 +/- 6 vs. 89 +/- 5, P = 2 x 10(-11); night 62 +/- 4 vs. 80 +/- 8, P = 5 x 10(-10).(ABSTRACT TRUNCATED AT 250 WORDS)

Breakthrough during recombinant interferon alfa therapy in patients with chronic hepatitis C virus infection: prevalence, etiology, and management

Recombinant interferon alfa (r-IFN alpha 2) has been shown to normalize the aminotransferase levels in approximately 50% of patients with chronic hepatitis C virus (HCV). Few patients experience a relapse during the treatment, in spite of a complete initial response (breakthrough). We studied 191 HCV Ab-positive patients with histologically proven chronic hepatitis. All of them were treated with r-IFN alpha 2 (3 MU three times a week). A complete response was seen in 54.4%. However, 12 of 104 responders experienced a breakthrough. At the time of breakthrough, neutralizing IFN antibodies were positive in 6 of 12 patients. Binding IFN antibodies were positive in all of these 12 patients. Continued treatment with r-IFN alpha 2, even at higher doses, did not restore the previous response in any patient. All of them were then switched to natural lymphoblastoid IFN, and this rapidly restored a complete response in all of the patients.

Fluctuations in viremia, aminotransferases and IgM antibody to hepatitis B core antigen in chronic hepatitis B patients with disease exacerbations

We studied the relationships between the serum levels of viremia, aminotransferases and IgM anti-HBc, measured by monthly quantitative assays, in 52 untreated chronic hepatitis B patients (41 anti-HBe+, 11 HBeAg+) followed up for 12-20 months. Forty hepatitis exacerbations were observed in 17/41 anti-HBe+ (41.5%) and in 6/11 HBeAg+ patients (54.5%) (p = NS); all but one were clinically asymptomatic. We analyzed the fluctuations in the serum levels of the three parameters before, during and after the hepatitis exacerbations and found this chronological sequence of events in 96.2% of them: HBV-DNA increase-->ALT flare-->IgM anti-HBc increase. These results suggest that both antiviral immune reactions and ALT flares were triggered by quantitative variations in viremia. HBV-DNA baseline levels before flares were lower in anti-HBe+ (3.9 +/- 1.2 pg/ml) than in HBeAg+ patients (35.3 +/- 5.4 pg/ml) (p < 0.0001) and there was an inverse correlation between basal values and viremia level increases at the time of disease exacerbations (p < 0.001). This suggests that for a hepatitis exacerbation to occur, low basal viremia needed to increase markedly, while moderate increases in HBV-DNA serum levels were sufficient to trigger ALT flares in patients with elevated basal viremia. In conclusion, asymptomatic hepatitis B exacerbations are frequent in the natural history of chronic HBV infection, and monthly monitoring of HBV-DNA, ALT and IgM anti-HBc appears to be a suitable method to evaluate their frequencies and entities. This method can be a helpful guide for clinical and therapeutic decision-making in the single patient with chronic hepatitis B.

[Aids-related cerebral lymphoma. Pathologic and immunohistochemical study of 19 cases]

We studied 19 cases of AIDS-related cerebral lymphomas, 15 of which are primary, and 4 secondary to systemic lymphoma. Eighteen cases are classified as non-Hodgkin's B cell lymphomas; in 1 case, an anaplastic large cell lymphoma coexists with systemic Hodgkin's disease. High-grade histologic types predominate (centroblastic, immunoblastic and immunoblastic plasmocytoid). One case of angiotropic lymphoma is included solely localized to the brain. We describe clinical and radiological features, gross, microscopic and immunophenotypic appearances. Other HIV-related associated diseases of the central nervous system are also considered.

Progressive multifocal leukoencephalopathy (PML) in the acquired immunodeficiency syndrome (AIDS). A neuropathological autopsy study of 21 cases

In a neuropathological autopsy study of 21 cases of AIDS-associated PML no fundamental morphological differences to non-AIDS PML were found. PML in AIDS often showed very large foci as well as necrotizing lesions. Partial involvement of cerebral cortex and deep gray matter were common findings; infratentorial lesions could be observed in more than three quarters of cases. Perivascular mononuclear infiltrates within PML foci were frequent and obviously not associated with a more benign clinical course. Possible reasons for these peculiarities of PML in AIDS are discussed. In 7 cases evidence of concomitant HIV encephalopathy was found; this may be one relevant factor contributing to severity of PML in AIDS. PML has to be regarded as a common complication of HIV infection, which may show atypical morphological and neuroradiological features.

AIDS-myelopathy. A neuropathological study

Vacuolar myelopathy belongs to the AIDS-associated diseases. It is characterized by vacuolation and infiltration of the long tracts of the spinal cord by macrophages. The clinical and morphological findings of 8 AIDS-patients with vacuolar myelopathy are reported here. The syndrome developed during the final stages of AIDS and was associated with HIV-encephalopathy in 5 cases. The vacuoles were mainly due to intramyelinic swelling and vacuolation. Vacuolated macrophages and axons contributed only to a minor degree. In one case only, HIV-antigens were detected immunohistochemically. The results are discussed in the light of modern pathogenetical concepts of HIV-related diseases.

Role of IgM antibody to hepatitis B core antigen in the diagnosis of hepatitis B exacerbations

IgM anti-HBc levels were measured by the IMx Core-M Abbott assay in 939 serum samples in order to define a specific and sensitive cut-off value for diagnosis of chronic hepatitis B. The sera used were obtained from 52 chronic HBV patients and 10 HBV carriers with HCV or HDV co-infections and 155 asymptomatic subjects without evidence of liver disease. A Youden index value of 95.4% with 98% sensitivity and 97.4% specificity was obtained for an IMx Index value of 0.204 as cut-off. A one-year follow-up study with monthly tests has shown that quantitative analysis of IgM anti-HBc can serve as a noninvasive tool for monitoring HBV infection, and provides an accurate diagnosis of hepatitis B exacerbations. Significant elevations of IgM anti-HBc levels were associated with hepatitis B exacerbations in 96.2% of the cases but with none of the ALT flare-ups observed in HCV or HDV infected individuals. These results suggest that quantitative analysis of IgM anti-HBc provides the highest degree of confidence in definition of spontaneous and therapy-induced exacerbations or remissions of hepatitis B.

Some tools for the diffusion of biomedical information using research networks

Research and academic computer networks provide e-mail and other services to all members of participating institutions. Their usage by biomedical researchers and clinicians is still limited because of several reasons, including limited awareness of the available network resources. An increased use of these networks within the biomedical community would allow fast, effective communications and convenient remote access to information sources. As an example and pilot study, we prepared two network tools to make some information services maintained by our institution also accessible through e-mail. Both tools were implemented using PMDF e-mail software on a DEC MicroVAX connected to the Italian academic and research network (GARR), which is linked to the U.S. Internet. A network server takes care of automatic distribution of documents (files) reporting results of an oncology research/education project. An information server provides for semiautomated support of a consulting service on use of drugs. The feasibility of implementing these tools, based on existing software, further illustrates the potential usefulness of research computer networks for the dissemination of biomedical information.

[The multilocular cystic nephroma in childhood. A case report]

A recently observed case of multilocular cyst of the kidney is reported. The differential diagnosis between Wilm's tumor and multilocular cyst of the kidney is pointed out.

[Immunohistochemical study of monomorphic adenoma (clear cell and basal cell) and pleomorphic adenoma of the parotid gland]

The present paper reports the results of an immunohistochemical study of 6 cases of monomorphic (2 clear cell, 4 basal cell) and 12 cases of pleomorphic adenomas in the parotid gland. The surgical specimens, embedded in paraffin, were tested by antisera vs. epithelial cell markers with epithelial membrane antigen (EMA) and cytokeratins (CK). They were also tested vs. myoepithelial and non-epithelial markers with S-100 protein and Glial Fibrillary Acidic Protein (GFAP). In pleomorphic adenomas, positive cells were found for all the tested antigens. Positive cell distribution showed a marked variability from case to case and even within each area, depending on cell morphology. In particular, areas showing tubular structures were constantly EMA-positive and CK-positive in more than 50% of the cases. In epithelioid areas EMA was negative while many cells were variably positive for CK, S-100 and GFAP. At times, the same cell proved positive to two different antigens. In those fuso-stellate (myxoid) cell areas considered to be of myoepithelial origin, cells were slightly CK-positive and widely GFAP and S-100 positive. In basal cell adenomas, widespread CK positivity was uniformly present while rare, focal positivity was evidenced for EMA and widespread non reactivity was found for S-100 and GFAP. In clear cell adenomas focal CK expression was found in the tubular lumina while clear cells, of myoepithelial origin, were steadily S-100 positive and GFAP-negative. It was noted that a sort of S-100/GFAP positive myoepithelial cell with fuso-stellate morphology was present in pleomorphic adenomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal carcinoma metastasis to the parotid gland

Metastatic tumours in major salivary glands are uncommon with a higher incidence of primary sites from the head and neck. The lungs and breast are the common primary sites, while metastases from the kidney are very rarely found. The authors describe a case of renal clear-cell carcinoma with metastasis to the parotid gland. The incidence of a metastasis in the parotid gland from a primary renal carcinoma, even if rare, should not be overlooked in making a correct differential diagnosis with acinic cell carcinoma and monomorphic clear cell adenoma.

[Apple-peel syndrome. A clinical case report and therapeutic considerations]

A recently observed case of proximal jejunal atresia with apple-peel syndrome and associated multiple ileal atresia is reported. Some clinical and anatomopathological features are pointed out. Surgical techniques and medical care are analysed.

Chemical composition and genotoxic activity of petroleum derivatives collected in two working environments

Pitch and bitumen, two complex petroleum derivative mixtures, were studied for both their chemical composition and their mutagenic/DNA damaging activity. While bitumen revealed no genotoxic effect and low polycyclic aromatic hydrocarbons (PAHs) concentration, petroleum pitch showed a high concentration of mutagenic/carcinogenic PAHs, and also an elevated mutagenic activity when assayed by the Ames test, in the presence of postmitochondrial rat liver fractions. The in vitro mutagenic activity was detectable as frameshift mutation by assaying the pitch both as an in toto mixture and after HPLC fractionation, the most polar fractions being the most active. In contrast, both derivatives showed no in vivo DNA damage in rat liver, using the DNA alkaline elution technique and the fluorometric assay of DNA unwinding.

Urinary excretion of mutagens, thioethers and D-glucaric acid in workers exposed to bitumen fumes

The authors carried out biological monitoring of the mutagenic/carcinogenic hazards associated with exposure to bitumen fumes during paving operations, analysing some biological parameters in the urine of a group of exposed workers. The urine samples were studied for mutagenicity by the Ames test and for thioethers concentration. D-Glucaric acid urine excretion was also determined to investigate the enzymatic induction potential of bitumens. Even though, in a previous environmental monitoring phase, a low content of mutagenic/carcinogenic compounds was found in bitumen and air samples, urinary mutagenicity data of exposed workers were statistically higher than those of a group of unexposed subjects. The urinary mutagenicity increased further if exposure to bitumens was associated with cigarette smoking. Thioethers were higher only in subjects exposed simultaneously to bitumens and cigarettes. D-Glucaric acid excretion did not increase significantly. The authors think that this type of coupled environmental and biological monitoring is a valid tool for a better evaluation of the mutagenic/carcinogenic exposure to bitumens or similar complex mixtures.

Thioethers, mutagens, and D-glucaric acid in urine of operating room personnel exposed to anesthetics

Mutagenic hazards related to occupational exposure to nitrous oxide and enflurane was studied in the personnel of five operating rooms using a coupled environmental and biological monitoring approach. The environmental monitoring revealed air concentrations of the two anesthetics exceedings the TLVs by 10-15-fold. These values were correlated individually with the concentrations of the two anesthetics in the expired air of the exposed subjects. The biological monitoring was carried out by determining two parameters associated with mutagen exposure (urinary mutagenicity and thioethers) and a parameter associated with the enzymatic induction (D-glucaric acid) in the urine of exposed and unexposed subjects (N = 64 and N = 37, respectively). The results showed no difference in the two groups for urine mutagenicity and D-glucaric acid, but urine thioethers were significantly increased among highly exposed subjects.