Prevalence of hepatitis C virus genotypes in southern Italy

HCV is ubiquitous. In 50% of all cases it causes chronic hepatitis that often evolves into liver cirrhosis and hepatocellular carcinoma. Recently HCV has been classified in 5 genotypes by Okamoto. The purpose of this study is to evaluate the prevalence of 5 genotypes in Campania, a region of Southern Italy, where the prevalence of anti-HCV antibodies ranges from 0.87 to 4%, and to evaluate the correlation between the HCV genotypes and the severity of histological damage. One hundred and thirty-five anti-HCV positive patients were enrolled and tested by PCR to identify HCV-RNA. One hundred and twenty-four patients resulted HCV-RNA positive. Genotyping was performed as described by Okamoto et al. with minor modifications of the specific primer to type III proposed by Silini et al. Eight patients were negative for all genotypes. Eight patients were positive for type I(1a), 61 for type II(1b), 39 for type III(2a), 11 for type IV(2b) and 1 for type V(3a). In 4 cases two different genotypes were present in the same sample [II(1b)-IV(2b), III(2a)-II(1b) twice, III(2a)-IV(2b)]. Histological evaluation of liver damage showed: CPH (22 cases), minimal CAH (56), severe CAH (31) and liver cirrhosis (15). There was no statistically significant correlation between the 5 genotypes and the severity of histological damage. Data on the prevalence of genotype II(1b) in Italy are similar to those reported for other European countries. The prevalence of genotypes in Southern Italy is similar to that reported in the population of Northern Italy.     

Pathology techniques

Pathology techniques developed over the past decade may be successfully applied to the diagnosis of orbital disease. Tissue specimens may be immunophenotyped by immunohistochemical staining and flow cytometry. Immunohistochemical staining provides a qualitative analysis of localization of antigenic determinants and flow cytometry provides a quantitative analysis. The molecular biologic technique of polymerase chain reaction enables detection of minute amounts of material by amplification from DNA primers. Fine-needle aspiration biopsy is an alternative to open biopsy in select cases. The most important concept regarding these techniques is communication with the ophthalmic pathologist regarding the collection and interpretation of the specimen.     

Seasonal variation of trace metal concentrations in the digestive gland of the Mediterranean mussel Mytilus galloprovincialis: Comparison between a polluted and a non-polluted site

Seasonal changes in metal (Cu, Fe, Mn, Pb, and Zn) concentrations were observed in the digestive gland of the Mediterranean mussel, Mytilus galloprovincialis, from both a polluted and a non-polluted population. Digestive gland of mussels from the polluted site showed metal concentrations appreciably higher than in non-polluted organisms, especially for Pb (up to 160 g/g d.w.), Mn (up to 300 g/g d.w.), and Fe (up to 8,500 g/g d.w.), whereas the two populations showed maximum mean values, respectively, of 34 and 20 g/g d.w. for Cu and 170 and 120 g/g d.w. for Zn.Over 1 year (1991), differences between maximum and minimum values were moderate only in the unpolluted organisms. During gametogenesis, while the metal concentrations (expressed as g/g dry weight) decreased in the digestive gland, the tissue burden (as g) in that organ remained nearly constant or increased slightly.The apparent decrease in metal concentrations was probably due to the penetration of gonadic tissues into the digestive gland during gametogenesis, which biologically diluted metal concentrations in mussels from both the polluted and unpolluted populations. The effect of mussel size on trace metal concentrations in the digestive gland was demonstrated during different stages of the reproductive cycle. Higher concentrations were found in smaller organisms; however, during the spawning period, due to the fact that this is not a synchronous process within a population, the organisms exhibit a high variability in digestive gland weight which can mask this relationship when digestive gland weight is used as a size-index and as a parameter of the trace metal digestive gland burden.     

A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy

BACKGROUND: Despite many randomized controlled trials, the merits of laparoscopic appendectomy remain unclear. A meta-analysis may provide insights not evident from any individual studies. DATA SOURCES: Systematic literature search yielded 17 trials (1,962 subjects) of true randomized design with usable statistical data comparing laparoscopic and conventional appendectomy in adults. The effect sizes for operating time, hospitalization, postoperative pain, return to normal activity, wound infection, and intra-abdominal abscess were calculated, using the random effects model to allow for heterogeneity. An estimate of the robustness of all positive findings was also calculated. RESULTS: Modest but statistically significant effect sizes were found for four of the six outcome measures. Laparoscopic appendectomy takes 31% longer to perform, but results in less postoperative pain, faster recovery (by 35%), and lower wound infection rates (by 60%). CONCLUSION: Laparoscopic appendectomy offers significant improvement in postoperative outcomes at the cost of a longer operation.     

Predictability of PSA failure in prostate cancer by computerized cytometric assessment of tumoral cell proliferation

OBJECTIVES: To evaluate the relationship of DNA ploidy and cell proliferation (CP) with Gleason score (GS) and clinical outcome in prostate cancer. METHODS: Sixteen patients with benign prostatic hyperplasia (BPH) and 65 patients with prostate cancer classified by GS (four groups: 2 to 4, 5 to 6, 7, and 8 to 10) were studied. All patients with carcinoma underwent prostatectomy and were separated into prostate-specific antigen (PSA) failure and nonfailure groups (failure if PSA 0.1 ng/mL or more three times after surgery). Tumoral CP (Ki-67 inmunostaining and SG2M phase) and DNA ploidy were evaluated by computerized cytometry. RESULTS: BPH were diploid with low CP (8% SG2M cells or less). Carcinomas were either diploid with high CP (greater than 8% SG2M cells) or aneuploid. CP was significantly higher (P <0.001) in tumors with GS 7 or greater than in tumors with GS less than 7 (mean percent Ki-67 cells 18.3% versus 7.8%, respectively). PSA failure increased with GS (7.1% in GS 2 to 4, 21% in GS 5 to 6, 28.6% in GS 7, and 50% in GS 8 to 10), as well as with aneuploidy (18.5% in diploid tumors versus 72.7% in aneuploid tumors). Those experiencing PSA failure had significantly higher (P <0.001) CP than those not failing (mean percent Ki-67 cells 24% and mean percent SG2M 30.4% versus 8.7% and 13.5%, respectively). Cox regression analysis showed GS, DNA ploidy, Ki-67, and SG2M to each be univariately prognostic for time to PSA failure; however, Ki-67 and SG2M were more highly significant (P <0.0001 for both) than GS (P = 0.007) or DNA ploidy (P = 0.002). After adjusting for either SG2M or Ki-67 measures of CP, neither ploidy nor GS contained additional prognostic value. CONCLUSIONS: Tumor CP and DNA ploidy can be reliably determined in prostate cancer by computerized cytometry. On the basis of our preliminary results, CP correlates well with GS and predicts PSA failure better than DNA ploidy or GS.     

Leiomyoma of the testis

Testis leiomyoma is a very rare neoplasm. It is very difficult to perform an exact preoperative diagnosis; only histological examination can prove the presence of a leiomyoma. In our case radical orchidectomy was performed because of complete substitution of normal parenchyma, the extreme rarity at long-term follow-up of a reported benign intratesticular neoplasm, and the imperfect sensitivity of the extemporary histological examination.