Management of thoracic and thoraco-abdominal aneurysms in the elderly

Repair of descending thoracic aneurysm or thoracoabdominal involves transient ischaemia of many organs with high risk of complications. The elderly patient may be more at risk depending on the presence or absence of significant comorbidity factors. Careful preoperative evaluation and patient selection considerably reduce the risk of operative mortality and morbidity. We review the management of thoracic and thoracoabdominal aneurysms in the elderly and briefly describe our surgical approach in order to minimize operative risk and improve surgical results.     

Role of chlamydia infection in the pathogenesis of atherosclerotic plaques in HIV-1-positive patients

BACKGROUND: Various authors have hypothesized a role of Chlamydia pneumoniae infection in the pathogenesis of atherosclerosis. To better understand the possible role of this infection in the pathogenesis of epi-aortic lesions in HIV-1-positive patients, the presence of anti-Chlamydia pneumoniae antibodies was evaluated in a group of individuals subjected to ultrasonography of the epi-aortic vessels. PATIENTS AND METHODS: The presence of specific antibodies in 129 subjects was determined; 59 patients were HIV-1-positive, of whom 30 had carotid plaques and 29 were without lesions. The control group was composed of 70 subjects. All were subjected to ultrasonography of the epi-aortic vessels. IgG, IgM and IgA anti-C. pneumoniae antibodies were measured with micro-immunofluorescence and positive sera were tested for C. trachomatis and C. psittaci. RESULTS: No subjects were positive for IgM. Both the IgA and IgG levels did not differ significantly in the three groups. The only highly significant variable was the use of protease inhibitors. CONCLUSION: Our data suggest that the damage to the carotid wall in HIV-1 patients was not due to C. pneumoniae.     

Efficient and nontoxic adenoviral purging method for autologous transplantation in breast cancer patients

Tumor cell contamination of clinical grafts is a major concern in autologous hematopoietic stem cell transplantation because these contaminating cells can contribute to relapse. In the present work, we use a suicide gene therapy approach that successfully accomplishes the two main goals of any purging strategy: highly efficient elimination of contaminating tumor cells and preservation of the engraftment capability of the hematopoietic progenitor cells. Human CD34(+) cells spiked with breast cancer cells were infected with an adenoviral vector encoding the cytosine deaminase transgene (Ad-CMV-CD). In vitro, transduction with Ad-CMV-CD followed by exposure to 400 micro M 5-fluorocytosine resulted in complete elimination of clonogenic contaminating tumor cells without affecting the clonogenic potential of the human hematopoietic CD34(+) cells. Transplantation of nonobese diabetic/LtSz-scid/severe combined immunodeficient (NOD/SCID) mice with nonpurged contaminated grafts and purged contaminated grafts, allowed us to test the safety and efficacy of our procedure in two independent purging experiments. Hematopoietic engraftment kinetics as well as the quantity and quality of human engraftment were not affected by the purging therapy. Results showed a significant difference in survival between the nonpurged group (28%) and the purged group (100%; P = 0.012). Moreover, highly sensitive histological and molecular analyses confirmed the absence of tumor cells in the recipients of purged marrow. In contrast, metastatic tumors were detected in animals that received nonpurged grafts. We anticipate that this strategy will result in a safe and efficacious hematopoietic graft product for autologous transplantation for patients with multiple forms of epithelial cancers.     

Tumor cells as cellular vehicles to deliver gene therapies to metastatic tumors

A long-pursued goal in cancer treatment is to deliver a therapy specifically to metastases. As a result of the disseminated nature of the metastatic disease, carrying the therapeutic agent to the sites of tumor growth represents a major step for success. We hypothesized that tumor cells injected intravenously (i.v.) into an animal with metastases would respond to many of the factors driving the metastatic process, and would target metastases. Using a model of spontaneous metastases, we report here that i.v. injected tumor cells localized on metastatic lesions. Based on this fact, we used genetically transduced tumor cells for tumor targeting of anticancer agents such as a suicide gene or an oncolytic virus, with evident antitumoral effect and negligible systemic toxicity. Therefore, autologous tumor cells may be used as cellular vehicles for systemic delivery of anticancer therapies to metastatic tumors.     

Cytologic endometrial surveillance in tamoxifen-treated women

The authors report the results of a study conducted on 136 patients affected by breast cancer under treatment with tamoxifen at a daily dose of 20 mg who underwent a strict follow-up including endometrial surveillance. The cytologic evaluation of the endometrium was performed on smears obtained by the endocyte sampling. The results were in accordance with what is reported in the literature. Forty cases presented with hyperplasia which was atypical in two cases. Only in one case did histology show a well differentiated adenocarcinoma. In 25 cases the endometrium resulted to be proliferative in accordance with the effect of tamoxifen, while the remaining 67 cases were atrophic. The investigation was not possible in four cases due to stenosis. In our study the endocyte sampler resulted to be an economic, simple and painless cytologic device, suitable for clinical use because of its low incidence of false positives.     

Duplex-doppler and cine-bmode echography of the temporal-mandibular joint. Clinical validation

We study, with the recently introduced method of analysis of the behavior of the TMJ through duplex-Doppler and cine-Bmode echography, a set of 38 patients already clinically examined. Among them we have 10 normal and 28 abnormal patients with various pathological conditions, 22 clicks of different intensities, three condylomeniscal lack of coordination and three locks. We obtained from the normal patients the typical duplex-Doppler spectra showing symmetrically alternate behavior and regular profiles during opening and closing of the mouth. In the case of clicks we obtained spectra with various irregularities of the profile and discontinuities in the worst cases. For the locks we observed a drastic and systematic reduction of the spectral amplitude.