Clinical experience with hepatic resections for hepatocellular carcinoma in patients with cirrhosis

The results of 31 resections of the liver performed upon patients with cirrhosis and hepatocarcinoma are reported herein. The lesions were discovered mainly during routine echographic surveillance. Twenty-five of these patients with small tumors underwent a segmentary or subsegmentary resection. Intraoperative ultrasonography proved to be of paramount importance in these instances as it helped to recognize the lesion and outline the limits of the resection. In another 11 instances of primary tumors of the liver in patients with cirrhosis who underwent laparotomy, findings from intraoperative ultrasonography advised against exeretic operation because other intrahepatic lesions or neoplastic thrombi in portal branches were detected. The operative mortality rate in the 31 patients who underwent resection of the liver was 12.9 per cent. The actuarial three year survival rate is 58 per cent. The presence of an intact peritumoral capsule seems to be the best prognostic factor.     

Non-traumatic acute bowel disease: differential diagnosis with 64-row MDCT

To evaluate the role of 64-row multidetector computed tomography (MDCT) in the differential diagnosis of non-traumatic acute bowel disease. We retrospectively reviewed CT findings of 57 patients (29 men and 28 women; mean age, 65.5 years, range 19–99) who presented to our institutions with symptoms of acute abdomen. All patients underwent MDCT. MDCT diagnosis was compared with surgical findings and histological examinations. A total concordance between the MDCT findings and discharge diagnosis (based on surgical findings and histological examinations) was found in 47/57 cases (82.4%); partial discordance was seen in 10 of 57 cases (17.5%) and discordance in 0 of 57 (0%) cases. The overall sensitivity of MDCT was 82.4%. MDCT is a very reliable method in the diagnostic management of non-traumatic acute bowel diseases allowing a fast and precise differential diagnosis and therefore a timely treatment.     

Gliosarcoma arising in oligodendroglial tumors ("oligosarcoma"): a clinicopathologic study

Gliosarcomas are morphologically biphasic tumors composed of glial and sarcomatous elements. Only rare examples of gliosarcoma with oligodendroglial components have been reported. Seven patients with oligodendroglial tumors and a sarcomatous component were identified. Fluorescence in situ hybridization for 1p/19q was sought in glial and sarcomatous regions in all cases. Their mean age at diagnosis of gliosarcoma was 48 years (range 36 to 68) (F:M ratio=5:2). At first resection, the tumors included grade II oligodendroglioma (n=3), grade III oligodendroglioma (n=1), grade II oligoastrocytoma (n=1), and grade III oligoastrocytoma (n=2). The sarcomatous component developed in recurrent/progressive tumors in 6 cases but was a focal finding at first tumor resection in 1 and included fibrosarcoma (n=5), leiomyosarcoma (n=1), or pleomorphic myogenic sarcoma (n=1). Rhabdoid change was a focal finding in the sarcomatous component of 1 tumor. The glial component expressed both glial fibrillary acidic protein and S-100 in all cases, whereas the sarcomatous component at least focally showed smooth muscle actin (n=6), CD34 (n=4), S-100 protein (n=3), and epithelial membrane antigen (n=2) reactivity. Fluorescence in situ hybridization studies demonstrated 1p/19q codeletion in 5 cases, showed no evidence of deletion in 1 case, and technically failed in 1 case. Three of the 5 cases demonstrated 1p/19q codeletion in the sarcomatous component as well. Gliosarcomas with oligodendroglial elements are rare. The relatively frequent presence of 1p/19q codeletion in both glial and sarcomatous components supports the notion that the sarcomatous component represents a metaplastic change occurring in the glial element, the same mechanism active in classic astrocytic gliosarcomas.     

Poorly differentiated carcinomas of the thyroid with trabecular, insular, and solid patterns: a clinicopathologic study of 183 patients

BACKGROUND: The term poorly differentiated (PD) carcinoma was proposed 20 years ago to define aggressive, follicular-derived thyroid carcinomas with behavior intermediate between follicular/papillary and anaplastic carcinomas. Among the variable histologic patterns recognized in such tumors, trabecular-insular-solid (TIS) areas usually are predominant. Conversely, some authors pointed out that PD carcinomas are characterized by unequivocal, high-grade histology with atypias, high mitotic counts, and necrosis rather than by a specific growth pattern. METHODS: The clinicopathologic features of a series of 183 thyroid carcinomas with predominant (n = 165 tumors) or focal (n = 18 tumors) TIS growth patterns were studied by univariate and multivariate overall survival analyses and were compared with clinical outcomes. Subgroups included tumors with predominant oxyphilic features (n = 66 tumors) and (residual) papillary carcinoma features (n = 24 tumors). Control groups of papillary (n = 68 tumors), follicular (n = 71 tumors), and anaplastic (n = 35 tumors) carcinomas also were included for overall survival analysis. RESULTS: TIS carcinomas had an intermediate behavior between papillary/follicular and anaplastic carcinomas (P < 0.0001). Univariate and multivariate statistical analyses demonstrated that age > 45 years (P = 0.007), the presence of necrosis (P < 0.0001), and a mitotic count > 3 per 10 high-power fields (P = 0.01) were associated with poor outcome. A simplified scoring system based on statistically significant parameters allowed the identification of three prognostic subgroups (P < 0.0001). CONCLUSIONS: PD TIS carcinomas overall followed a more aggressive course compared with differentiated thyroid carcinomas, irrespective of the extent of the TIS component. However, a numeric scoring system applied to specific clinicopathologic parameters further may identify three prognostic categories of patients who have significantly different survival rates at 5 years and 10 years.     

Dopamine and somatostatin inhibition of prolactin secretion from MMQ pituitary cells: role of adenosine triphosphate-sensitive potassium channels.

The sulfonylurea glibenclamide, which is known to block ATP-sensitive potassium channels, increases, in a dose-dependent manner, the release of PRL from MMQ pituitary cells. Glibenclamide does not reduce the dopaminergic inhibition of forskolin-stimulated PRL secretion; conversely it almost completely abolishes the inhibitory effect of somatostatin (SRIF) on this parameter. The sulfonylurea dose dependently increases basal [Ca++]i, without affecting the increase in [Ca++]i induced by high concentrations of extracellular potassium. Glibenclamide does not modify dopamine-induced [Ca++]i reduction, whereas it abolishes the inhibitory effect of SRIF on basal [Ca++]i. In the presence of diazoxide, an opener of ATP-sensitive potassium channels, which lowers basal [Ca++]i, dopamine still reduces [Ca++]i whereas SRIF does not induce a further decrease. Glibenclamide induces the depolarization of the cell membrane and prevents the SRIF-evoked hyperpolarization. The hyperpolarization of the cell membrane induced by dopamine is not modified by glibenclamide. Diazoxide induces a cell membrane hyperpolarization that is enhanced by dopamine but not by SRIF. Finally, glibenclamide does not affect basal and stimulated adenylate cyclase activity. In conclusion, our findings show that, in MMQ cells, glibenclamide stimulates PRL release, suggesting an involvement of ATP-sensitive potassium channels in the regulation of PRL secretion. The reversal by glibenclamide of the effects of SRIF on calcium homeostasis, membrane potential, and PRL release suggests that this type of potassium channel participates to the somatostatinergic inhibition of PRL secretion. Conversely, we found that glibenclamide does not modify the dopaminergic inhibition of PRL secretion and second messenger systems, suggesting that ATP-sensitive potassium channels may not be involved in the inhibitory effect of dopamine on PRL release.     

Synthesis of heteroaromatic analogues of (2-aryl-1-cyclopentenyl-1-alkylidene)-(arylmethyloxy)amine COX-2 inhibitors: effects on the inhibitory activity of the replacement of the cyclopentene central core with pyrazole,thiophene or isoxazole ring

Several heteroaromatic analogues of (2-aryl-1-cyclopentenyl-1-alkylidene)-(arylmethyloxy)amine COX-2 inhibitors, in which the cyclopentene moiety was replaced by pyrazole, thiophene or isoxazole ring, were synthesized, in order to verify the influence of the different nature of the central core on the COX inhibitory properties of these kinds of molecules. Among the compounds tested, only the 3-(p-methylsulfonylphenyl) substituted thiophene derivatives 17 and 22, showed a certain COX-2 inhibitory activity, accompanied by an appreciable COX-2 versus COX-1 selectivity. Only one of the 1-(p-methylsulfonylphenyl)pyrazole compounds (16) displayed a modest inhibitory activity towards both type of isoenzymes, while the pyrazole 1-(p-aminosulfonylphenyl) substituted 12 proved to be significantly active only towards COX-1. All the isoxazole derivatives were inactive on both COX isoforms.