Development and validation of a method for simultaneous analysis of hair underivatized amino acids and damage biomarkers, using liquid chromatography-tandem mass spectrometry.

The forensic and medical fields are seeing growing interest in the amino acid and damage biomarker composition of hair, in order to identify adulteration of drug hair testing and for diagnostic purposes. Therefore, there is an increased demand for quick and accurate analytical methods. This study presents the first liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for the simultaneous quantification of hair amino acids and four damage biomarkers, which also implements an isotopic dilution strategy to improve recovery and precision of the acid hydrolysis-sensitive analytes. The applied strategy enabled a recovery of the hydrolysis-sensitive amino acids between 83 and 120% (vs. 33-77%, without isotopic dilution) for two different protein standards, and a precision with a relative standard deviation (RSD) between 1.3 and 7.5% (vs. 9.0-29.4%, without isotopic dilution). All 21 analytes could be measured without interferences by matrix and sample components, thus demonstrating satisfactory selectivity of the method. For spiked samples of hair hydrolyzate, recovery was between 88 and 120%, whereas precision and intermediate precision were below 10.1%. The high sensitivity of the method made it possible to reduce sample preparation to a 10000-fold dilution of the raw hydrolyzate. The wide linear range displayed by the method allowed the simultaneous quantification of minor (0.3 µmol/g of hair) and major (up to 1000 µmol/g of hair) components of the biological fiber. This method was successfully applied to the analysis of real hair samples submitted to six different treatments. Statistical data analysis by means of t-test and principal component analysis (PCA) showed a clear discrimination of the treated from the untreated hair samples and of the different treatments. Since these hair treatments can interfere with hair drug testing, the method possesses the ability of identifying hair samples with potential for attempted drug test evasion. In addition, lanthionine emerged as a new biomarker for heat damaged hair.

[Solid pseudopapillary tumour of the pancreas. Report of a case]. / Il tumore solido pseudopapillare del pancreas. Presentazione di un caso clinico.

Solid pseudopapillary pancreatic tumour is an uncommon disease including 2.7% of exocrine malignancies of the pancreas. Its low incidence is associated with an uncertain prognosis and with difficult diagnostic and therapeutic problems, despite routine use of ultrasonography, TC and RMN. A case of solid pseudopapillary pancreatic tumour in a young woman is reported: the clinicopathologic features, diagnostic imaging and surgical treatment are discussed. Surgery is the primary option. Prognosis is however not fully known. From a review of the literature it is suggested that these tumours should be regarded as potentially malignant.

[Clinical study of aortic co-involvement in lumbo-aortic lymph node metastasis of testicular carcinoma]. / Studio clinico sul coinvolgimento aortico nelle metastasi linfonodali lombo-aortiche da carcinoma testicolare.

The Authors review the international literature about the frequency of vascular involvement (inferior vena cava and aorta) in the lymph node lumbo-aortic metastases of the testicular neoplasm. They report a case of a patient with an aortic involvement from lymph node metastases of a mixed (seminoma and germ cell) cancer of the left testis. They performed en bloc resection of the bulky metastases including the aorta involved. The literature data as well as the outcome of the operated case show a moderate survival also in patients with advanced disease.

[Clinical experience in tumors of the common bile duct]. / Esperienza clinica sui tumori della via biliare comune.

The authors, after a short review of the literature present 6 cases of cancer of the common bile duct. One was localized at the hepatic hilus, three in the middle of the c.b.d., two in the distal choledochus. In each case a c.b.d. resection was performed associated in one case to a minor hepatic resection, in two cases to a Whipple operation.

[Clinical study of the imaging validity in detecting infiltration of the mesenteric-portal axis in pancreatic carcinoma]. / Studio clinico sulla validità dell'"imaging" nel riconoscere l'infiltrazione dell'asse mesenterico-portale nei carcinomi pancreatici.

The authors examine the value of different imaging techniques (CT, MRI) in the diagnosis of the involvement of the mesenteric-portal vessels in the pancreatic cancer. In 20 jaundiced patients they obtained in all cases a correct diagnosis about the etiology of the jaundice. The correspondence of the preoperative imaging study with the involvement of the mesenteric-portal vessels was respectively 73% for the CT and 78% for the MRI. In all cases the intra-operative echography allowed a correct diagnosis of the vascular involvement.

[Surgical complications following pancreaticoduodenectomy: results of a single center experience]. / Le complicanze chirurgiche post-duodenocefalopancreasectomia: risultati di una esperienza monocentrica.

Pancreaticoduodenectomy represents the only therapeutic option for cefalo-pancreatic and periampullary cancers. Surgical and anaesthesiological techniques development over the last twenty years has granted an operative mortality decrease. However, surgical morbidity is still high, with an incidence of 30-50%. A 20 year experience of a single Centre is examined retrospectively: 121 patients underwent pancreatic resection with radical intent. Type of operation or re-operation, operative mortality within 30 days, general and surgical morbidity, postoperative hospital stay were analysed. Average recovery time was 24 days (range 12-65); operative mortality was 5.8% (7/121); general morbidity, including medical and surgical complications, was observed in 47 patients (38.8%). Pancreatic fistula occurred in 16 patients (13.2%); ten of these underwent a second operation. Patients who underwent pancreaticoduodenctomy were divided as follows: 76 pts. received a pylours-preserving pancreaticoduodenectomy and 45 a Whipple's resection. Neither surgical complications incidence nor mortality rate were significantly different between the two groups. Postoperative complications following pancreaticoduodenectomy are still frequent and severe. In particular, pancreatic fistula represents the most relevant complication following pancreaticoduodenectomy. The Authors suggest that standard and meticulous surgical procedures together with continued efforts to improve postoperative follow-up, support early detection of complications and improvement of results in most patients.

[Surgical treatment of isolated adrenal metastasis from lung carcinoma]. / Trattamento chirurgico delle metastasi surrenaliche isolate da carcinoma polmonare.

A surgical treatment of patients with lung cancer non-microcitoma and isolated adrenal metastasis has been reported in literature although limited in number and follow up. The Authors report 12 cases of patients operated for lung cancers non-microcitoma and isolated adrenal metastasis. One patients was lost in the follow up, two patients died 3 and 6 months after the adrenalectomy. The other patients are alive after 88, 39, 36, 17, 13 months after the adrenalectomy. Four of these patients are also disease free. Other 4 patients, more recently operated, are alive and disease free after 3, 3, 9 and 9 months after the adrenalectomy. The Authors believe that a surgical treatment is justified in these patients, considering the results of the series reported in literature and also their own results.

[Our experience regarding biologically inactive gastroenteropancreatic neuroendocrine tumors]. / La nostra esperienza in tema di: tumori neuroendocrini gastroenteropancreatici biologicamente inattivi (GEP-BINT).

The Authors present 9 cases of gastro-enteropancreatic neuro-endocrine biologically inactive tumors. In 5 cases the tumor site was appendicular. In 4 patients an appendectomy was performed, in one patient a right hemicolectomy and the patients after a period of 3-9 years are well and disease free. In a patient with a gastric carcinoid and a single hepatic metastasis a total gastrectomy with an hepatic metastasectomy were performed but the patient died 16 months thereafter. In a case localized to the right colon with a single hepatic metastasis a right hemicolectomy was performed with a metastasectomy but the patient died after 12 months. In a case localized to an ileal loop a segmental resection was performed followed by a medical therapy with octreotide and the patient is well and disease free after 3 years. In a case localized to the pancreas with widespread lymphatic metastasis it was performed a simple biliary diversion (coledocho-duodenostomy) followed by medical therapy with octreotide. Surprisingly after 4 years the patient is alive and a TC control shows a decrease of the pancreatic tumor and of the lympho glandular tumefactions.

[Our experience with duodenal tumors]. / La nostra esperienza in tema di tumori duodenali.

The authors report 3 cases of benign duodenal tumors and one case of duodenal cancer. In two cases the benign tumors were adenomatous polyps, in one case with signs of dysplasia. One case of benign tumor was a lipoma. All the three benign tumors were removed through a duodenotomy, in one case associated with a sphincteroplasty. The case of duodenal cancer, arisen in a patient operated since 24 years with a gastric resection, was treated with a Whipple technique but for the very old age and the bad health conditions, the patient died in 11th post-operative day for myocardium infarct.

Simultaneous measurement of soluble carcinoembryonic antigen and the tissue inhibitor of metalloproteinase TIMP1 serum levels for use as markers of pre-invasive to invasive colorectal cancer.

Matrix metalloproteinases (MMP) are members of a multigene family of zinc-dependent enzymes involved in the degradation of extracellular matrix components. Cancer research suggest that MMP and tissue inhibitors of metalloproteinases (TIMP) may be involved in disease progression; these enzymes could therefore be used as markers in cancer prevention programmes and for clinical monitoring. To establish whether MMP and TIMP can be used effectively as markers we determined serum levels of MMP1 and TIMP1, and studied the relationships between these enzymes and the stage of disease. The potential diagnostic and prognostic value of serum level measurements of MMP1 and TIMP1 was evaluated by comparing them with serum levels of soluble carcinoembryonic antigens (sCEA) and p53 antibodies. Our overall results indicate that simultaneous measurements of serum sCEA and TIMP1 in patients with colorectal cancer could be used as prognostic and diagnostic markers for disease progression from the pre-invasive nodal phase to the invasive phase (stages I, II to III, IV). In addition, serum levels of TIMP1 could be used as a selective marker for metastatic disease (stage III to IV). In fact, the 95% confidence interval of the serum levels of sCEA at stage III (18.4 < or = sCEA < or = 68.6 ng/ml) and TIMP1 at stage IV (1620 < or = TIMP1 < or = 3906 ng/ml) identified statistically significant ranges of values (sCEA P = 0.02, TIMP1 P = 0.02), which may be useful in the monitoring of patients at these disease phases. More specifically, our data suggest that, when the serum level of sCEA is below 18.4 ng/ml and the level of TIMP1 below 1620 ng/ml, there is a 95% probability that the disease is in the pre-invasive nodal phase; when the serum level of sCEA falls between 18.4 ng/ml and 68.6 ng/ml and the level of TIMP1 is below 1620 ng/ml, there is a 95% probability that the disease is in the phase when lymph node infiltration occurs; when the level of sCEA is above 68.6 ng/ml and the level of TIMP1 is at least 1620 ng/ml, there is a 95% probability that the disease is in the metastatic phase.

[A case of carcinoma arising on the duodenal stump after gastric resection]. / Su di un caso di carcinoma insorto su moncone duodenale consecutivo a gastro-resezione.

The duodenal cancers are very uncommon and the carcinomas arising on a duodenal stump following a B II gastric resection are a real rarity. The Aa. present a case of a patient with a cancer arisen on a duodenal stump 24 years after a gastric resection. The patient was operated with a Whipple D.C.P.

[Resection therapy in the treatment of intrahepatic biliary lithiasis]. / La terapia resettiva nel trattamento della litiasi biliare intraepatica.

The authors report a case of intrahepatic lithiasis in a patient already operated of cholecystectomy and without lithiasis of the common bile duct. The lithiasis was present in the left lateral bile duct, was multiple and trapped behind a very narrow stricture. The stones were associated with a marked dilatation of the involved biliary ducts, cholangitis, fibrosis and atrophy of surrounding hepatic parenchyma. It was performed a resection of the II and III hepatic segments and the patient recovered completely and is well and disease free after one year. The authors believe, also on the base of the data reported by others, that in the intrahepatic lithiasis with strictures of the bile intrahepatic ducts the hepatic resection is the treatment of choice, especially when the lithiasis is present in a sectorial or segmental bile duct, preventing any stone recurrence.

[A clinical study of the surgical treatment of liver metastases]. / Studio clinico sul trattamento chirurgico delle metastasi epatiche.

It is emphasized that currently only surgery offers a real hope of improving the prognosis of patients suffering from liver metastases and many data from the Literature supporting this contention are reported. Indications and prognostic factors for the surgical treatment of these lesions are evaluated. A series of 36 patients operated on for hepatic metastases and the relative technical procedures are presented. In 33 cases the primary tumor was a colorectal carcinoma. Two right lobectomies and 34 minor resections or segmentectomies were performed. No peroperative mortality was observed. The survival rate was 70% after 1 year, 51% after 2 years, and 27% after 3 years.

[Breast cancer. Epidemiology and other factors related to incidence in various populations]. / Carcinoma della mammella. Epidemiologia ed altri fattori connessi alla incidenza in varie popolazioni.

An extensive review of epidemiology, etiology, age, genetic factors, race, alimentary habits and hormonal patterns have been analysed in studies concerning patients with breast cancer. The role of other factors (the age of menopause, the geographic distribution, the action of reserpine and many possible causes) are also discussed. The evidences observed in many studies performed in the last years in different countries are compared but definitive data cannot be reached. The material reported in these studies is not homogeneous and this review can only indicate the problems still present in this field and the subjects we need to investigate in the next years.