Prenatal diagnosis of vein of Galen aneurysmal malformations

Vein of Galen aneurysmal malformations are rarely seen intracranial malformations. They represent less than 1% of the cerebral arteriovenous malformations. Prenatal diagnosis of an arteriovenous fistula malformation may be achieved by real-time and Doppler sonography with color flow imaging, by identifying dilated veins and arteriovenous shunts with turbulent flow. In addition, an elevated cardiac output may be observed and correlated with the magnitude of the cerebral arteriovenous shunt. The high incidence of cardiomegaly in neonates with arteriovenous malformations also suggests that high-output cardiac failure is already present in a significant number of cases during the 3rd trimester, and, therefore, treatment in utero may need to be considered to improve the hemodynamic status. In our case, all the above cardiovascular features were present during prenatal ultrasonography. The information on outcome compiled from the literature suggests that when an arteriovenous malformation is large enough to be detected prenatally, as in our case, it is likely to lead to cardiac failure either during the antenatal period or soon after birth. In this paper, we present the management of a case of 3rd-trimester diagnosis of a vein of Galen aneurysm associated with cardiac decompensation.     

Sexual abuse in adolescence: patient assessment,necessity and meaning of the physical examination

The objective of this paper is to report on the characteristics of sexual abuse in adolescence, on the medical evaluation and interpretation of findings and on the necessity of a multidisciplinary intervention. Sexual abuse is a common problem affecting children and adolescents, males and females of any age or socio-economic class. 10-22% of adolescents are victims of sexual abuse. They engage more frequently in risk-taking behaviours, such as early sexual activity, unprotected sexual contact with multiple partners (risk of sexually transmitted diseases, of an unwanted pregnancy), substance abuse, delinquency, school failure or suicide. Professionals who deal with adolescents should be aware of the devastating medical and psychosocial sequelae of sexual abuse and should be able to recognize it, incorporating questions regarding victimization into the psycho-social or sexual history. A medical examination, including an external anogenital inspection and in selected cases a pelvic examination, should always be performed. It is important to acknowledge that normal anogenital findings do not exclude sexual abuse and that a multidisciplinary medical-psychosocial evaluation is mandatory.     

Endothelin receptor blockade inhibits molecular effectors of Kaposi's sarcoma cell invasion and tumor growth in vivo

Endothelin-1 (ET-1) and its receptors are overexpressed in human Kaposi's sarcoma lesions. Here we show that in human KS IMM cell line ET-1 increased secretion and activation of matrix-metalloproteinase-2 (MMP-2), -3, -7, -9 and -13, as well as of membrane-type 1-MMP (MT1-MMP). ET-1 and ET-3 also enhanced the expression of tissue inhibitor of MMP-2, essential for MT1-MMP-mediated MMP-2 activation. Combined addition of both ET(B) receptor (ET(B)R) and ET(A)R antagonists completely blocked the ET-1-induced MMP activity. By immunohistochemistry, we observed that ET-1 increased MMP-2 and MT1-MMP expression and their localization at the cell surface. Treatment with both antagonists resulted also in the suppression of ET-1-induced phosphorylation of focal adhesion proteins, FAK and paxillin, which are essentials for cell motility. ET-1 induced a dose-dependent enhancement in KS IMM cell migration and MMP-dependent invasiveness that were inhibited by ET-1 receptor antagonists. The small molecule, A-182086, an orally bioavailable ET(A/B)R antagonist, completely inhibited cell proliferation and tumor growth in KS IMM xenografts. These findings demonstrate that ET-1-driven autocrine loop is crucial for enhanced invasiveness of KS IMM cells and promote tumor growth in vivo. Such activities can be blocked by the ET(A/B)R antagonists, which may be effective anti-angiogenic and anti-tumor molecules for the treatment of Kaposi's sarcoma.     

Behavioral implications of lowering cholesterol levels: a double-blind pilot study

The treatment of hypercholesterolemia may be associated with greater noncardiac mortality. This current pilot study sought to determine which behaviors, if any, are associated with decreases in cholesterol level. Twelve subjects received one of two cholesterol-reducing drugs or placebo. Cholesterol and behavioral ratings were measured at baseline, 4, and 52 weeks with standardized scales. Cholesterol levels markedly declined with concomitant significant increases in impulsivity ratings at 4 weeks. At 52 weeks, the increase in impulsivity ratings was no longer apparent, but depression ratings showed a significant improvement. This pilot study, although limited in size, raises the possibility that cholesterol-lowering drugs are associated with mild, time-limited increases in impulsivity and with mild, time-delayed improvements in depression ratings.     

Combined typical carcinoid and acinic cell tumor of the lung: a heretofore unreported occurrence

We report a primary combined typical carcinoid and acinic tumor of the lung in a 70-year-old man. Although a similar case was reported previously, to the best of our knowledge this is the first case in which the diagnosis is supported by both immunohistochemical and ultrastructural findings. We review the literature and discuss the implications of this finding.     

Vulvar carcinoma associated with lichen sclerosus. Experience at the Florence,Italy, Vulvar Clinic

OBJECTIVE: To compare demographic and clinical characteristics of patients with lichen sclerosus (LS)-associated squamous cell carcinoma (SCC) of the vulva with those of patients with tumors not histologically associated with LS in a series of patients with vulvar SCC not HPV correlated. STUDY DESIGN: We retrospectively reviewed histologic specimens and clinical files of all vulvar SCCs referred to the Vulvar Clinic, University of Florence, Florence, Italy, since 1990. RESULTS: Twenty-five out of the 72 cases in this study (34.7%) were LS associated. Among these cases, 8 (32%) were diagnosed with LS before occurrence of the cancer and received treatment for the disease. In 17 cases the diagnosis of LS was simultaneous with that of SCC; in 13 cases the diagnosis was achieved by clinical examination and confirmed afterwards histologically. In 4 cases this was confirmed only by means of histologic examination. The shared profile of patients with LS-associated vulvar SCC was a subject (mean age, 72 years) seldom with a past medical history of vitiligo (16% of cases), with invasive cancer (92% of cases), clinically characterized by an exophitic tumor (73%), seldom ulcerated (18%) or showing hyperkeratosis (9%). Labia majora (32%), labia minora (27%) and vestibule (23%) were the most frequently involved sites. In most cases (80%) the cancer was limited to 1/3 of the vulvar region. An itch was the most frequent symptom. However, for all of these variables, no overall statistically significant difference was found with patients who had SCCs not associated with LS. CONCLUSION: The experience of the Vulvar Clinic, University of Florence, confirms the suggested role of LS as a possible precursor of vulvar carcinoma since 32% of our cases not HPV related were LS associated. We demonstrated that the profile of patients with LS-associated cancer does not differ from that of patients with cancer not associated with LS, excluding HPV-related cases. The existence of accessory conditions, probably needed to promote the progression from LS to cancer in a minority of subjects remains to be established.     

Fine-needle aspiration in the evaluation of nucleated red blood cells in the human placenta

OBJECTIVE: The purpose of this study was to evaluate the correlation between placental and umbilical cord nucleated red blood cell counts. STUDY DESIGN: Eighty placentas and their matched umbilical cord blood samples were collected prospectively immediately after delivery. In vitro fine-needle aspiration biopsy specimens were used to obtain placental tissue samples. Nucleated red blood cells were counted by both manual microscopy and flow cytometry. Statistical analysis included Wilcoxon signed rank test and Spearman correlation. RESULTS: The median nucleated red blood cell counts/100 white blood cell counts for manual microscopy in umbilical cord blood; placental samples were 7.5 and 3.0, respectively (P <.0001). The median nucleated red blood cell counts for flow cytometric determination in umbilical cord blood and placental samples were 11.3 and 8.6, respectively (P <.0001). The Spearman correlation between manually counted umbilical cord blood samples and the placental tissue specimens was 0.66 (P <.0001). The Spearman correlation between flow cytometrically counted umbilical cord blood nucleated red blood cell and nucleated red blood cell counts that were obtained from the placenta was statistically significant (r = 0.74, P <.0001). The Spearman correlation between manual microscopy and flow cytometry for umbilical cord samples and their matched placental tissue specimens were 0.80 and 0.58, respectively, with all probability values at <.0001. CONCLUSION: Previous studies have reported an association between acute and chronic hypoxia and elevated nucleated red blood cells. Our results indicate that in vitro placental nucleated red blood cell counts correlate with umbilical cord nucleated red blood cell counts and suggest that antenatal evaluation of fetal nucleated red blood cells could be achieved by placental fine-needle aspiration biopsy.     

Trends in the NICU: a review of 25 years' experience

A review of 25,448 admissions was performed to evaluate the progress of neonatal intensive care at Weill Cornell Medical Center since 1978. Patients were identified by a review of admission and discharge data compiled by admitting staff. The following data were collected: birth weight, gestational age, place of birth (inborn versus outborn), discharge date, disposition. Length of stay was computed from these data. Data were organized according to year of admission. Admissions remained relatively constant with time. However the percentage of inborn infants steadily increased. Survival of the smallest infants (<600 g) remained poor, but overall survival of all infants improved over time. Length of stay for infants 1000 to 2000 g fell over time while that of other infants remained constant. These trends reflect changes in obstetric and neonatal practice over time, and include improved methods of antenatal care, neonatal pulmonary care, and nutrition, as well as changes in the distribution of neonatal and high-risk maternal care.     

Diet and risk of seromucinous benign ovarian cysts

Objective: To analyze the relation between selected dietary indicators and the risk of seromucinous benign ovarian cysts. Study design: We used data from a case–control study on risk factors for benign ovarian cysts conducted in Italy between 1984 and 1994. Cases included 225 women with a histologically confirmed diagnosis of benign seromucinous ovarian neoplasm dating back no more than 2 years. Controls were 450 women below the age of 65 years admitted for acute non-gynecological, non-hormonal, non-neoplastic conditions. Results: Women with seromucinous cysts reported more frequent consumption of beef and other red meat and cheese and less frequent consumption of green vegetables. The multivariate odds ratios (ORs) in highest versus less frequent consumption levels were 2.7 (95% confidence interval (CI) 1.8–4.3) for beef and other red meat, 0.6 (95% CI 0.3–0.9) for green vegetables and 1.4 (95% CI 1.0–2.2) for cheese. Conclusion: Seromucinous benign ovarian cysts are associated with beef and cheese consumption, whereas high intake of green vegetables seems to have a protective effect.     

Genetic Polymorphisms Influencing Therapy and Susceptibility to Rejection in Organ Allograft Recipients

Solid organ transplantation during the past 30 years has developed from an experimental procedure into routine clinical practice. The current repertoire of immunosuppressive agents has made a major contribution to transplant survival; however, problems in different areas still need to be overcome. Several gene polymorphisms are supposed to influence immunosuppressive therapy and susceptibility to rejection. Therefore, a priority of transplant biologists is to estimate individual patient risk and to characterise the genetic profile of patients in need of a transplant in order to optimise the use of a scarce resource such as organs from cadaver donors, and to avoid serious drug-induced adverse effects. Polymorphisms in genes encoding tumour necrosis factor-alpha (TNFalpha), interleukin (IL)-6, IL-10, interferon-gamma (IFNgamma), transforming growth factor-beta (TGFbeta) and thiopurine S-methyltransferase (TPMT) can have significant effects on an individual's risk of rejection, as well as their ability to tolerate immunosuppressive therapy. Genotyping of known polymorphisms in these genes may in the future contribute to our ability to individualise immunosuppressive therapy in organ transplant recipients.