Distinct Roles of Th17 and Th1 Cells in Inflammatory Responses Associated with the Presentation of Paucibacillary Leprosy and Leprosy Reactions.

It is well established that helper T cell responses influence resistance or susceptibility to Mycobacterium leprae infection, but the role of more recently described helper T cell subsets in determining severity is less clear. To investigate the involvement of Th17 cells in the pathogenesis of leprosy, we determined the immune profile with variant presentations of leprosy. Firstly, IL-17A, IFN-γ and IL-10 were evaluated in conjunction with CD4+ T cell staining by confocal microscopy of lesion biopsies from tuberculoid (TT) and lepromatous leprosy (LL) patients. Secondly, inflammatory cytokines were measured by multiplex assay of serum samples from Multibacillary (MB, n = 28) and Paucibacillary (PB, n = 23) patients and household contacts (HHC, n = 23). Patients with leprosy were also evaluated for leprosy reaction occurrence: LR+ (n = 8) and LR- (n = 20). Finally, peripheral blood mononuclear cells were analysed by flow cytometry used to determine the phenotype of cytokine-producing cells. Lesions from TT patients were found to have more CD4+ IL-17A+ cells than those from LL patients. Higher concentrations of IL-17A and IL-1ß were observed in serum from PB than MB patients. The highest serum IFN-γ concentrations were, however, detected in sera from MB patients that developed leprosy reactions (MB LR+ ). Together, these results indicate that Th1 cells were associated with both the PB presentation and also with leprosy reactions. In contrast, Th17 cells were associated with an effective inflammatory response that is present in the PB forms but were not predictive of leprosy reactions in MB patients.

Ossifying fibromyxoid tumor with atypical histological features: a case report.

Ossifying fibromyxoid tumor of soft tissues (OFMT) is considered a rare mesenchymal neoplasm. Its main histological features are sheets and ill-defined lobules of rounded bland cells within a fibromyxoid background and a thick collagenous capsule with an incomplete rim of lamellar bone. This lesion occurs mostly in the soft tissues of the lower extremities and limb girdles. In this paper, we describe a mesenchymal tumor removed from the right thigh of a 41 year-old-woman. The neoplasm differed histologically from typical forms of OFMT for areas of moderate cellularity and atypia, nuclear enlargement and small nucleoli. Focally, stromal tongues of osteoid were centrally and irregularly located within the lesion with evident spindling of tumor cells around them. The mitotic activity was low (up to 19 per 50 HPF) and atypical figures were rarely seen. The tumor was positive to S-100 protein, vimentin, CD10, CD56, CD99, ASMA, calponin and collagen IV. Rare elements were positive for cytokeratin AE1/AE3. To the best of our knowledge, this is the first case of atypical OFMT reported to be positive for calponin. The patient is currently alive and well with no evidence of disease at 96 months following surgery. In spite of low-grade histology, OFMT has high local recurrence rate and low metastatic potential, primarily in the lungs, even several years after surgical removal. The recognition of this entity is important. In this report the authors address differential diagnosis and enigmatic histogenesis of this neoplasm.

Cognitive deterioration in Alzheimer's disease: is the early course predictive of the later stages?

This study investigated the predictive value of the early progression rate of Alzheimer's disease on that of the later stages. We retrospectively evaluated 91 patients affected by possible Alzheimer's disease; the patients had been examined twice with the Milan overall dementia assessment (MODA) scale at an interval of 12 months (53 patients) or 24 months (38 patients). At the first assessment, speed of progression was calculated for each patient dividing the MODA difference from the normality threshold by the time elapsed from the cognitive decline onset. The second assessment of speed of progression was calculated dividing the difference between the two MODA scores by the time elapsed from the first examination. Patients with a slow progression rate in the early stage were unlikely to show a subsequent fast progression rate, and vice versa for patients with a fast early progression. A tool is provided for predicting the speed of cognitive decline of patients from a single MODA assessment. We suggest that, in future clinical trials on Alzheimer's disease, a stratification of participants based on the early rate of cognitive deterioration may be considered.

How to calculate an MMSE score from a MODA score (and vice versa) in patients with Alzheimer's disease.

The aim of the present study was to provide a statistically sound way of reciprocally converting scores of the mini-mental state examination (MMSE) and the Milan overall dementia assessment (MODA). A consecutive series of 182 patients with "probable" Alzheimer's disease patients was examined with both tests. MODA and MMSE scores proved to be highly correlated. A formula for converting MODA and MMSE scores was generated.

[Surgical therapy of liver metastases secondary to colorectal neoplasms]. / Considerazioni sulla terapia chirurgica delle metastasi epatiche secondarie a neoplasia colo-rettale.

Of the therapeutic aids currently available for the treatment of liver metastases, surgical treatment, when possible, has acquired an irreplaceable role. The exact criteria needed to establish a correct indication still have to be established. Various factors have been examined so far: number, site, dimensions of the metastases and features of the primary tumour whose prognostic importance does not lend itself to unequivocable interpretation. Personal experience of a series of 11 surgically treated cases seems to confirm that of the parameters analysed, the tumour-host relationship remains the most important prognostic factor.

[Grade II and III acute pancreatitis. Diagnostic classification and surgical treatment]. / Pancreatite acuta di II e III grado. Inquadramento diagnostico e trattamento chirurgico.

Thirteen cases of acute IIIrd degree pancreatitis and 5 homogeneous cases of IInd degree, treated surgically during the first 48 hours from onset of the symptomatology, are described. The importance of careful cardiorespiratory, haemodynamic and metabolic monitoring to establish the most appropriate moment for intervention after a period of intensive therapy designed to restore the basic parameters is stressed. In the present series, total mortality was 44%. Forms with biliary aetiology have the best prognosis and justify the earliest possible surgical intervention.

Occupational contact psoriasis.

Occupational psoriasis accounts for about 1.2% of all cutaneous pathologic conditions due to work. It is especially important for subjects with slight signs of psoriasis, since patients already suffering from clear illness spontaneously avoid traumatic activities. Our interest was directed to cutaneous symptoms, signs for identifying subjects predisposed to traumatic dermatitis, also useful in vocational guidance. The necessity of official acknowledgement of such work-related dermatological pathologies is suggested.

[Evolution of coronary occlusion in a patient with past myocardial infarction (author's transl)]. / Regressione di una lesione coronarica in un paziente con esiti di infarto miocardico anteriore.

The case of a man suffering from an anterior myocardial infarction with complete occlusion of the left descendent coronary angiographically proved is reported: an angiographic control four months after aorto-coronary by-pass on right coronary, showed the recanalization of left anterior descendent coronary and occlusion of the by-pass.