Enormous bi-atrial enlargement in a persistent idiopathic atrial standstill

A 62-year-old woman came to our clinical attention 21 yearsago for non-cardiac problems. The clinical evaluation discloseda persistent idiopathic atrial standstill (PIAS) with mitralincompetence. The family screening documented a     

Indexes of Surgical Quality in Gastric Cancer Surgery: Experience of an Italian Network

Background  Short-term results of gastric cancer surgery vary remarkably worldwide, and international surgical quality criteria are urgently needed. To contribute to defining these criteria, we reviewed short-term results of gastrectomy for gastric cancer in three centers of the Italian Research Group for Gastric Cancer, with an average of 24.7, 29.5, and 18 gastrectomies per year. Methods  Between 1988 and 2002, 1,032 patients underwent gastrectomy for gastric cancer in Verona, Siena, and Padua. D1, D2, and D3 lymphadenectomy were performed, respectively, in 228, 584, and 220 cases. Results  The median number of retrieved lymph nodes was 14 (interquartile range 9–18.75) after D1, 29 (21–38) after D2, and 46.5 (37–57) after D3. Fewer than 15 nodes were retrieved in 54.5%, 6.2%, and 1.4% of cases undergoing, respectively, D1, D2, and D3. Adjacent organ removal was rare during D1 (splenectomy: 6.1%, splenopancreasectomy: 1.8%), and quite common during D3 (11.4%, 11.4%). Forty patients (3.9%) died postoperatively. Neither postoperative morbidity nor mortality was significantly associated with extension of lymphadenectomy. Conclusion  We conclude that at least D2 lymphadenectomy is necessary to achieve adequate disease staging (≥15 nodes retrieved). Spleen and pancreas tail are more frequently removed during D3, but this removal is not associated with higher postoperative morbidity or mortality.     

Catecholaminergic Innervation of the Human Dura Mater Involved in Headache

The catecholaminergic innervation of cranial dura mater in humans was studied by examining several dural zones (vascular, perivascular, intervascular) in different regions (basal, calvarial, occipital, frontal, tentorial, parietal, temporal).
The results demonstrate that catecholaminergic nerve fibers are present in human cranial dura mater and that these fibers, after exposure to formaldehyde vapors, show the specific fluorescence of catecholamines.
There are more dural catecholaminergic nerve fibers in the basal region than in the calvarial region. Moreover, these nerve fibers are more abundant in the perivascular dural zone than in the intervascular zone.
We hypothesize that these catecholaminergic nerve fibers may be involved in headache.     

Evaluation of B-cell secretion and peripheral insulin resistance during pregnancy and after delivery in gestational diabetes mellitus with obesity

Summary Nine pregnant women with gestational diabetes mellitus (GDM) were studied. Six normal pregnant women and six normal nonpregnant women were evaluated as control groups. All the women underwent oral glucose tolerance test and glucose clamp during the third trimester of pregnancy and two months after delivery. During OGTT, glucose, C-peptide and insulin plasma levels were determined. C-peptide and insulin values in the late phase of OGTT were higher during pregancy than after delivery in both groups. In gestational diabetic women, the M-value in the second steady-state during glucose clamp was lower than in controls, both during pregnancy and after delivery. Nevertheless, in both groups the M-value during pregnancy was lower than after delivery. Moreover, in gestational diabetic women there was an inverse correlation between M-value in the second steady-state and ponderal excess index after delivery. In conclusion, the impaired peripheral glucose utilization and the pancreatic pattern of gestational diabetic women compared to normals suggested altered B-cell secretion response, increased peripheral resistance and overweight to be the main changes in GDM.     

The role of 9-O-acetylated ganglioside D3 (CD60) and ��4��1 (CD49d) expression in predicting the survival of patients with S��zary syndrome

Background

Sézary syndrome is a rare and very aggressive leukemic variant of cutaneous T-cell lymphoma characterized by extensive skin involvement and a malignant circulating CD4⁺ T-cell clone which homes to the skin, over-expresses CD60, and lacks CD7, CD26 and CD49d. So far prognostic markers in this disease are limited to treatment with systemic steroids, age, serum lactate dehydrogenase, and a white blood cell count of 20×10⁹/L or higher: no other biological marker with prognostic value, especially related to malignant cells, has been described.

Design and Methods

We used flow activated cell sorting analysis to compare the distribution of the T-cell receptor-Vβ repertoire and several surface molecules (CD7, CD26, CD49d and CD60) within the circulating CD4⁺ T-cell population in 62 patients with Sézary syndrome, 180 with mycosis fungoides, 6 with B-cell lymphomas, and 19 with chronic eczema. We calculated the 5-year overall survival of patients with Sézary syndrome after first hospital admission using Kaplan–Meier product–limit estimates and hazard ratios from the Cox proportional hazards model.

Results

We found that both higher number of CD60⁺ and lower number of CD49d⁺ cells within circulating CD4⁺ T cells at disease presentation were significantly associated with a lower probability of survival. An exceedingly high risk of death was observed for patients with a combination of a high proportion of CD4⁺CD60⁺ cells (≥ 0.5×10⁹/L) and low proportion of CD4⁺CD49d⁺ cells (<0.5×10⁹/L) (hazard ratio = 12.303, 95% confidence interval 1.5–95.9; P<0.02). In addition, a skewed usage of T-cell receptor-Vβ subfamilies was observed in the circulating T-cell clone for 61.9% of all patients with Sézary syndrome, T-cell receptor-Vβ 2 and 5.1 subfamilies being the most frequently represented (42.8%), followed by T-cell receptor-Vβ 12 and 13.1.

Conclusions

In this study we showed that up-regulation of CD60 and down-regulation of CD49d on circulating CD4⁺ T cells are two useful markers for predicting a very poor outcome in patients with Sézary syndrome.     

Can Hyperbaric Oxygen Therapy (HOT) have a place in the treatment of some urological diseases

HOT (Hyperbaric Oxygen Therapy) is used in urological diseases: Scrotal/perineal fasciitis and Radiation-induced cystitis (and proctopathy); in urgency and frequency syndrome and with chronic pelvic pain the use of HOT is still experimental. The basic principle of HOT is to increase oxygen dissolved in the blood when it is administered at high pressure. O2 is then distributed to the tissues through the pressure gradient; tissue hyper-oxygenation has anti-inflammatory and pain-killing effects, it increases bacterial permeability to antibiotics, strengthens neo-angiogenesis, reinforces lymphocytes and macrophages function, augments testosterone secretion (in males), and finally enhances wound healing process. We treated with HOT (integrating other treatments) 17 cases of necrotizing fasciitis, 13 radiation-induced cystitis and 4 cases of urgency and frequency syndrome. We always had good results, with a good cleansing of the dissected areas in Fournier's gangrene; in the cases of radiation-induced cystitis we had an improvement in the symptoms and hematuria, and finally in cases of urgency and frequency syndrome we had a transient reduction of symptomatology and pain. Our experiences and the specific literature on this subject suggest that HOT, sometimes associated with other medical and surgical therapies, can be an effective tool to treat urological diseases; in some cases its efficacy was well demonstrated (Fournier's gangrene and Radiation-induced cystitis), in others (urgency-frequency syndrome and chronic pelvic pain) it is a promising technique which definitely needs further research.     

Gastric Cardia Carcinoma is Associated with the Promoter -77T>C Gene Polymorphism of X-Ray Cross-Complementing Group 1 (XRCC1)

Purpose  

X-ray repair cross complementing group 1 (XRCC1) is one of the major DNA repair proteins involved in the bas-excision repair pathway. Several single-nucleotide polymorphisms in the XRCC1 gene are identified and related with increased cancer risk development. In particular, the -77T>C polymorphism located on the promoter region relates with lung cancer risk development. The aim of this study is to analyze the -77T>C allelic frequencies in a population composed of 456 primary gastric cancer patients (GC) and 507 blood donor controls.