Intracranial dural based marginal zone MALT-type B-cell lymphoma: a case - Based update and literature review.

OBJECTIVES: Dural based Marginal Zone MALT-type B-Cell Lymphoma (MZBCL) is an intracranial tumor that can mimicking meningioma both from a clinical and a radiological point of view. A standard treatment protocol is still lacking. Aim of the present work is to provide an update of the present literature regarding this rare neoplasia. PATIENTS AND METHODS: We report the case of a patient with a dural-based lesion mimicking a meningioma of the tentorium. After surgical treatment, the diagnosis was of MZBCL. A literature review is performed to highlight the typical characteristics of this rare intracranial lesion and to define the best therapeutic approach. RESULTS: Literature review included 38 articles describing 126 cases of intracranial dural-based MZBCL. No clinical trial has been found. Clinical and histopathological features are properly collected to provide a guide for future cases. Different treatment options have been attempted. Combination of surgery with adjuvant radiation therapy is the most used option. CONCLUSIONS: MZBCL should be considered in differential diagnosis for dural-based intracranial lesion. Surgery followed by radiation therapy is the most reported treatment. As a consequence of the rarity of this disease, of its indolent progression and of the lack of adequate follow-up, it is not possible to define it is the best treatment option.

Trans-sulcal versus trans-parenchymal approach in supratentorial cavernomas. A multicentric experience.

OBJECTIVES: Cavernous malformations (CM) are low-flow vascular lesions that can cause significant symptoms and neurological deficits. Different intraoperative surgical approaches have been developed. Aim of the present investigation is the comparison between the trans-sulcal approach (TS) and the trans-parenchymal neuronavigation-assisted approach (TPN) in a surgical series from two neurosurgical centers. The technique and clinical outcomes are discussed, with a specific focus on seizure outcome. PATIENTS AND METHODS: Clinical and radiological data from two neurosurgical centers ("A. Gemelli" Hospital in Rome and A.O.U. Città della Salute e della Scienza in Turin) were retrospectively reviewed in order to evaluate the different outcome of TS and TPN approach for cavernous malformation treatment. RESULTS: A total of 177 patients underwent surgical intervention for supratentorial CM, 130 patients with TPN approach and 47 with TS approach. TS approach was associated with higher rate of seizure in early post-operative period both in epileptic patients (p < 0,001) and in patients without history of seizures before surgery (p = 0,002). Moreover, length of incision (p < 0,001), area of craniotomy (p < 0,001) and corticectomy (p < 0,001) were bigger in TS than in TPN approach. Brain contusion (p < 0,001) and fluid collection (p < 0,001) were more likely to be discovered after TS approach. CONCLUSIONS: TPN is a valuable approach for resection of CM. Minor complications are significantly lower in TPN approach when compared with TS approach. In addition, it is associated with lower rate of early post-operative seizure and shorter length of stay.

The post-surgical era of GBM: How molecular biology has impacted on our clinical management. A review.

Glioblastoma (GBM) is the most common glioma in adults, with incidence increasing by 3% per year. According to the World Health Organization Classification of Central Nervous System Tumors, GBM is considered a grade IV tumor due to its malignant behavior. The aim of this review is to summarize the main biological aspects of GBM. In particular, we focused our attention on those alterations which have been proven to have an impact on patients' outcome, mainly in terms of overall survival (OS), or on the tumor response to therapies. We have also analyzed the cellular biology and the interactions between GBM and the surrounding environment.

Role of Nitric Oxide in Glioblastoma Therapy: Another Step to Resolve the Terrible Puzzle ?

Glioblastoma Multiforme, the most common and aggressive primary brain tumor, remains incurable despite of the advent of modern surgical and medical treatments. This poor prognosis depends by the recurrence after surgery and intrinsic or acquired resistance to chemotherapy and radiotherapy. Nitric oxide is a small molecule that plays a key roles in glioma pathophysiology. Many researches showing that NO is involved in induction of apoptosis, radiosensitization and chemosensitization. Therefore, NO role, if clarified, may improve the knowledge about this unsolved puzzle called GBM.

Double concentric craniotomy: Safe and effective technique to achieve an en bloc resection of tumor involving both skull and duraa.

INTRODUCTION: Many tumors can involve the skull. Meningiomas are one of the most common intracranial neoplasms and invasion of the bone was described in 49% of cases. Other neoplastic lesions that can arise in bone, or involve it, are metastases, hemangiomas, aggressive cutis carcinomas and sarcomas. Radical excision is the golden standard of treatment but elevating a bone flap when the tumor involves both the skull and the dura could represent a technical challenge. PRESENTATION OF CASE: We report the technical details of our approach to remove a meningioma involving both skull and dura in a man aged 45. Patient underwent gross total excision and cranioplasty with PEEK custom made prothesis (Synthes™). DISCUSSION: We describe a double concentric craniotomy (DCC) technique where the tumor involving the bone is before left in situ, exposing normal dura, to perform afterwards en-bloc excision with minimal traction of brain surface. CONCLUSION: DCC is a safe and effective technique to remove tumor involving both skull and dural structures under direct vision.

Molecular biology of gliomas: present and future challenges.

Malignant brain tumours are one of the most relevant causes of morbidity and mortality across a wide range of individuals. Malignant glioma is the most common intra axial tumor in the adult. Many researches on this theme brought advances in the knowledge of gliomas biology and pathogenesis and to the development of new agents for targeted molecular therapy. Recent studies focused on either tumor metabolism analysis or epigenetic regulation in the pathogenesis or maintenance of brain tumors. This Review summarizes these developments analyzing molecular pathology and possible further developments for targeted therapies.

Are acute subdural hematomas possible without head trauma?

Acute subdural hematomas (ASDHs) are rarely reported in the literature. In general, it is due to head trauma, but if the traumatic event is very mild, it is inadequate to explain the ASDH occurrence. Risk factors for the development of spontaneous ASDH include hypertension, vascular abnormalities and deficit of coagulation. We present two cases of ASDH in patients with the coagulation deficit and review of the literature to understand the coagulation factors role and platelet role in the management of ASDHs.

Saccular aneurysm of graft renal artery: case report.

Repair of anatomic anomalies in a donor kidney's vascular structures requires prompt recognition of the aberrant condition and an appropriate repair technique that does not compromise transplant success. Our report describes a case of a saccular aneurysm of the donor kidney, renal artery, which was identified during harvesting and repaired on the back-table using a prosthetic patch derived from the excised lesion to cover the breach. The long-term results were good.

Endoscopic ultrasound of the upper gastrointestinal tract.

Endoscopic ultrasound (EUS) is an evolving technique used by gastroenterologists to examine lesions that are located either within or adjacent to the walls of the upper gastrointestinal (GI) tract; this topic is relatively unknown to most radiologists. Proper use of this modality is benefited by a cooperative effort between gastroenterologists and radiologists specializing in ultrasound and cross-sectional imaging. This article informs radiologists of the applications of this procedure. Most patients are examined with EUS after a biopsy of a mucosal tumor has been performed. A smaller number are performed to evaluate submucosal masses or when pancreatic disease is suspected but not diagnosed. The examinations can be performed either with dedicated flexible echoendoscopes or with catheter-based probes passed through a conventional endoscope. The exact location of abnormalities associated with the upper GI tract can be observed. Known anatomic landmarks are sought. Abnormalities of structures outside the upper GI tract will occasionally be found during these examinations. The specific layers of the walls of the gut are examined, and the T and N-classification of upper GI tumors can be determined accurately. The performance of an EUS examination requires advanced skills, and in many medical centers, it is the imaging modality of choice to stage cancers, to evaluate submucosal masses, and to investigate both malignant and benign pancreaticobiliary disease. Endoscopic ultrasound is sensitive but not specific, and biopsy is necessary to establish a diagnosis. Therapeutic applications of EUS are evolving. Specialized applications with catheter-based probes are also being developed.

Violencia sexual: un nuevo enfoque institucional / Sexual violence: a new institutional approach

Introducción: la violencia por motivos de género es una cuestión social que cobra un enorme precio en materia de salud mental y física. Es posible que la mitad de todas las mujeres estén sujetas en algún momento de su vida actos de violencia por motivos de género. Cada año, dos millones de niñas y mujeres corren riesgo de mutilación genital. La violencia puede ser evidente, como en el caso de los castigos físicos o las agresiones sexuales, o encubierta, como en el abandono o en maltrato emocional. Objetivo: Contribuir a la concientización del cuerpo profesional, a fin de hacerlo perceptivo a las necesidades de las víctimas de violaciones, pudiendo así lograr el desarrollo de un programa asistencial integral de las mismas. Material y método: Se realizó una revisión de los conceptos de definición y diagnósticos diferenciales de violación y abuso sexual. Se realizó el estudio comparativo entre distintos Códigos Penales (Españo, Argentino y su modificatoria del año 1999) de los principales artículos que reglamentan este tema. Se selecionaron las principales normativas vigentes que reglamentan los derechos humanos, la eliminación de las formas de discriminación de la mujer y los principios fundamentales de justicia para las víctimas de delitos. Resultados: Se conceptualizaron premisas profesionales, éticas y humanas que creemos fundamentales en el abordaje de esta problemática. Se plantea como necesidad una definición más abarcativa de violación de nuestro Código Penal, que permita instaurar una forma inequívoca la fellatio in ore como delito de violación. Se reseñan los principales indicadores específicos y de sospecha, así como los estudios infectológicos y la profilaxis a instaurar en caso de violación y abuso sexual. Conclusiones: No actuar para asegurar los derechos de la mujer es ponerse del lado del abuso y la violencia. Al ser indiferentes, resultaremos destructivos

Violencia sexual: un nuevo enfoque institucional / Sexual violence: a new institutional approach

Introducción: la violencia por motivos de género es una cuestión social que cobra un enorme precio en materia de salud mental y física. Es posible que la mitad de todas las mujeres estén sujetas en algún momento de su vida actos de violencia por motivos de género. Cada año, dos millones de niñas y mujeres corren riesgo de mutilación genital. La violencia puede ser evidente, como en el caso de los castigos físicos o las agresiones sexuales, o encubierta, como en el abandono o en maltrato emocional. Objetivo: Contribuir a la concientización del cuerpo profesional, a fin de hacerlo perceptivo a las necesidades de las víctimas de violaciones, pudiendo así lograr el desarrollo de un programa asistencial integral de las mismas. Material y método: Se realizó una revisión de los conceptos de definición y diagnósticos diferenciales de violación y abuso sexual. Se realizó el estudio comparativo entre distintos Códigos Penales (Españo, Argentino y su modificatoria del año 1999) de los principales artículos que reglamentan este tema. Se selecionaron las principales normativas vigentes que reglamentan los derechos humanos, la eliminación de las formas de discriminación de la mujer y los principios fundamentales de justicia para las víctimas de delitos. Resultados: Se conceptualizaron premisas profesionales, éticas y humanas que creemos fundamentales en el abordaje de esta problemática. Se plantea como necesidad una definición más abarcativa de violación de nuestro Código Penal, que permita instaurar una forma inequívoca la fellatio in ore como delito de violación. Se reseñan los principales indicadores específicos y de sospecha, así como los estudios infectológicos y la profilaxis a instaurar en caso de violación y abuso sexual. Conclusiones: No actuar para asegurar los derechos de la mujer es ponerse del lado del abuso y la violencia. Al ser indiferentes, resultaremos destructivos (AU)

Metastatic site and p53 primary tumor expression in previously untreated stage IV breast cancer patients.

p53 mutations have been reported to correlate with prognosis and response to therapy in patients with different tumor types. However, although p53 status is related to the primary tumor aggressiveness, an association between its expression and specific metastatic pattern has not yet been investigated. We immunohistochemically analyzed p53 (Pab1801) and ki67 (mib1) primary tumor expression in a series of advanced breast cancer patients presenting a selected pattern of distant metastases at the time of first diagnosis. Forty-eight percent of the overall series was classified as p53 positive while 22% as mib1 positive tumors. The overall agreement between p53 and mib1 expression was statistically significant (p = 0.03). While mib1 primary tumor expression did not show any association with the type of metastasis, p53 positivity was significantly higher in patients with soft tissue metastasis than in patients with bone or viscera metastasis (p = 0.002). No association with the probability of clinical response or different overall survival was found for patients with different p53 or mib1 status either in the overall series of patients or in subgroups of cases with different sites of distant metastasis.

Timing of breast cancer surgery within the menstrual cycle: tumor proliferative activity, receptor status and short-term clinical outcome.

We verified the variations of primary tumour steroid receptor status and proliferative activity at different times and phases (follicular vs luteal) of the menstrual cycle and their relationship with short clinical outcome in a cohort of 248 N- breast cancer patients. Steroid receptor content (ER and PgR) was evaluated by DCC assay and proliferative activity by 3H-Thymidine autoradiographic assay (TLI). Median age was 44 years, 60% of tumors were T1, and cytohistological grade was G1-2 in 54% of cases. At surgery, 57% were in the luteal phase while 43% were in the follicular phase. No significant variations were found in mean TLI or ER and PgR characteristics of the primary tumors surgically treated in different periods of the menstrual cycle; however, the ER level resulted significantly higher in 4th with respect to the 3rd week of menstrual cycle, while PgR level was higher in PgR+ cases treated during the 3rd week. The number of relapses and disease-free survival curves after 36 months median follow-up did not differ significantly for patients treated in different periods of the menstrual cycle (12% and 9% of disease relapses in luteal and follicular phases; p=n.s.). We can conclude, therefore, that TLI, ER and PgR expressions could vary significantly during menstrual cycle only in certain specific tumor subgroups.

HIV antiviral effects of hyperbaric oxygen therapy.

Researchers have speculated that hyperbaric oxygen (HBO) therapy has an antiviral effect in HIV infection. To determine HBO's antiviral effect, the authors performed ex vivo and in vivo quantitative assays on HIV-infected plasma and peripheral blood mononuclear cells (PBMCs) at baseline and after treatment. The authors also HBO-treated uninfected PBMCs and then exposed them to HIV at ambient pressure. HIV viral load was decreased in the infected cells, and few viruses entered uninfected PBMCs exposed to HBO. The results of this study support the theory that HBO has an antiviral effect.

Evaluation and management of sialorrhea of pregnancy with concomitant hyperemesis.

This article describes two gravid patients who presented with first-trimester sialorrhea and hyperemesis. Although excessive salivation, especially when accompanied by protracted nausea and vomiting, is an unusual occurrence, it can have serious consequences for both the mother and fetus when left untreated. Initially, phenothiazine was prescribed and later belladonna alkaloid was added separately to the two treatment regimens. In order to successfully treat the excessive salivation, it was necessary to control the nausea and vomiting. Eradication of sialorrhea and hyperemesis were effected 10 days posttreatment. For both patients, pregnancy, delivery, and postpartum intervals proceeded uneventfully. Mothers and infants remain in good health 2 years posttreatment.

Inappropriate breast secretions of possible bacterial etiology in the parous nonpuerperal female.

This article presents two cases of spontaneous green breast secretions of parous nonpuerperal patients. To understand the nature of these secretions, bacterial evaluations and subsequent treatment were undertaken. Case 1 culture and sensitivity studies from breast secretions were commenced within 24 hours yielding an isolate identified as Staphylococcus epidermidis, with sensitivity to cephalothin, erythromycin, and tetracycline but resistant to penicillin. Cephalothin, 500 mg four times a day for 10 days, followed by erythromycin 100 mg twice a day for 10 days and doxycycline 100 mg twice a day for 10 days, did not alter the breast secretions. Four weeks later, ciprofloxacin HCI 500 mg twice a day for 6 weeks caused a 50% decrement in breast secretion at 4 weeks but increased clinical depression. At 6 weeks, no evidence of breast secretions persisted. Mental depression decreased within 2 weeks postciprofloxacin treatment. In Case 2, a total of 35 minutes elapsed between sample collection and initiation of culture and sensitivity studies. Moraxella osloensis was identified and found sensitive to ampicillin and tetracycline but resistant to trimethoprim. Ampicillin 500 mg four times a day for 10 days and doxycycline 100 mg twice a day by mouth for 10 days were administered at 2-week intervals with no effect on breast discharge. After 4 weeks of treatment failure, ciprofloxacin HCI 500 mg twice a day for 6 weeks caused a 50% decrease in discharge at 2 weeks and total elimination at 6 weeks. Lethargy during treatment ceased with termination of therapy. These results support the importance of bacterial evaluation of breast secretions with subsequent antibiotic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

High-titer positive nontreponemal tests with negative specific treponemal serology in patients with HIV infection and/or intravenous substance use.

Nontreponemal testing is a valuable tool in screening for syphilis. False-positive reactions are uncommon and are usually at a titer less than 1:8. We describe eight intravenous substance abusers and/or HIV-positive patients with high-titer (greater than or equal to 1:16) nontreponemal and negative treponemal serologies in whom the diagnosis of syphilis is unproven and possibly false.

Contractilidad "in vitro" de los vasos coriales de la placenta humana: efecto del peróxido de hidrógeno / \"In vitro\" contractility of chorionic vase of human placenta: hydrogen peroxide effect

Según metodología descripta en trabajos anteriores, se estudia la contractilidad "in vitro" de los vasos coriales de 30 placentas humanas normales, y el efecto provocado por el aumento del PO**2 en el medio perfusor a expensas de concentraciones de H**2 O**2 de 1.25, 2.5 y 5.0 mM. El H**2 O**2 provoca una respuesta contráctil monofásica; la intensidad de la contraccíon aumenta proporcionalmente a la concentración de H**2 O**2 (F = 8.9 p > 0,01). La indometacina y la aspirina a concentraciones de 2.5 micronM y 0.25 mM respectivamente, inhiben aquella respuesta