Confocal microscope analysis and tridimensional reconstruction of papillary thyroid carcinoma nuclei

Nuclei of papillary thyroid carcinoma (PTC) are characterised by diagnostic morphological features, which include optically clear nuclei, irregular nuclear profile, pseudoinclusions and grooves. In the present study, such nuclear features were analysed by means of confocal microscopy using anti-lamin B antibodies to outline the nuclear membrane. Parallel sections of the nucleus, produced by confocal microscope analysis, showed that the nuclear shape is markedly irregular with profound invaginations, clefts and tunnel-like structures, which correspond to the grooves and holes detectable using light microscopy, respectively. A tridimensional (3-D) model of the nuclei, obtained by a computer-based reconstruction of confocal microscope images, showed, in the vast majority of PTC cells, nuclei with crateriform areas, clefts and even tunnel-like structures piercing the whole nuclear thickness. By rotating these models in space, it became evident that the holes and grooves seen in light microscopy correspond to invaginations and tunnels, depending on the viewpoint. In conclusion, this is the first application of confocal microscopy and tridimensional reconstruction to the study of nuclear morphology of PTC and of tumours in general. The light microscopic appearance of PTC nuclei, so familiar to pathologists, is, therefore, due to profound remodelling of the nuclear shape with invaginations and tunnels, which appear as either grooves or holes, according to the viewpoint.     

Recurrent pain without objective evidence of disease in patients with previous idiopathic or viral acute pericarditis

Recurrent pain without clinical evidence of acute pericarditis was recorded in 27 of 275 patients (9.8%; mean age 55.6 +/- 16.0 years, female/male ratio 20/7) with previous viral or idiopathic acute pericarditis. Female gender (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.8 to 10.6), previous use of corticosteroids (OR 5.2, 95% CI 2.2 to 12.3), and previous recurrent pericarditis (OR 3.7, 95% CI 1.3 to 10.2) were identified as risk factors for this syndrome. After a mean follow-up of 40 months, a higher recurrence rate was recorded in these patients (33.3% vs 14.1%; p = 0.02) as well as a nonsignificant trend to a higher rate of constrictive pericarditis.     

Emerging imported parasitoses in Italy

In the period 1987-2001, 111 cases of imported parasitoses were diag- nosed in three Italian dermatology departments (Monza, Milan and Siena): 22 cases of tungiasis, 11 of furuncular myiasis and 78 of creeping eruption. The patients were 73 males and 38 women, who had been on trips abroad. All underwent appropriate treatment and recovered. Here we describe the geographic location of the parasites, the clinical features of the skin manifestations and differential diagnoses. Autochthonous cases of these infections, which are increasingly frequent as Europeans travel to endemic areas, have been described. Detailed knowledge of these parasitoses is necessary to enable prompt diagnosis and treatment.     

Urea percentiles in children with chronic renal failure. Data from the ItalKid project

In chronic renal failure high serum urea levels (sUrea) are correlated with the onset of uremic symptoms. Urea has generally been considered relatively non-toxic, functioning more as a surrogate for other toxic solutes; however, it has been recently reported that it can contribute to uremic toxicity. Clinically sUrea are often difficult to interpret because of the wide range of kidney functions. To obtain a practical and easily accessible tool to evaluate sUrea, we have produced percentile curves for different ranges of chronic renal failure, defined with creatinine clearance ( C(Cr)) obtained with the Schwartz formula. Data were obtained from the Italian Pediatric Registry of Chronic Renal Failure (ItalKid); its inclusion criteria are: (1) C(Cr )<75 ml/min per 1.73 m(2), (2) age <20 years at time of registration, and (3) conservative treatment. To obtain the percentiles, the following patients were excluded: patients with an underlying disease, a concomitant treatment, or a disorder that could affect urea metabolism, per se, and/or food intake, and patients aged <2 years. The study group included 690 subjects (mean age 9.56+/-4.54 years, 485 males). In total, 2,085 observations (C(Cr )and sUrea) were available for the construction of the percentile curves. A median of 258 (range 99-380) observations was obtained for each of the eight different categories of C(Cr )(intervals of 10 ml/min per 1.73 m(2)). The 10th, 25th, 50th, 75th, and 90th percentiles were calculated and a graph was produced. Patients with the highest urea percentiles showed significantly higher plasma levels of phosphorus and parathyroid hormone and significantly lower hemoglobin concentrations and bicarbonate levels. Our percentile curves may help to identify subjects with inappropriate sUrea for a given C(Cr).