[Presacral myelolipoma: a case report]. / Mielolipoma presacrale: case report.

BACKGROUND: Presacral tumors are more frequently benign, and only occasionally malignant, showing a slow growth and an incidence of 1:40.000. They are asymptomatic in the 26-50% of the cases. When symptoms occur, these are related to the dimensions of the tumor, to its location and to the presence of infection. CASE REPORT: We report the case of a 69-year old woman with a lower abdominal pain associated with paresthesia and ipostenia of the right inferior limb. Digital rectal examination showed a fixed, mild tender and hard tumor of the posterior rectal wall. CT, MR and CT-guided biopsy sequently performed revealed a solid, dishomogeneous mass, located in the presacral region, with a connective likely origin, without pelvic lymphoadenopathy. The operation allowed to esteem a mass which was tenaciously adherent to the sacrum. We performed a total excision. Final histological diagnosis was myelolipoma. CONCLUSIONS: The Authors' opinion is that the en-bloc resection of these tumors with an anterior surgical approach allows a histological diagnosis of the nature, representing the best treatment for potentially malignant lesions, which are frequently radio and chemo-resistant.

Lipocalin 2 is required for BCR-ABL-induced tumorigenesis.

Our previous studies indicate that reduction of lipocalin 2 (mouse 24p3) expression by either anti-sense or siRNA approaches strongly reduces the overgrowth of BCR-ABL+ mouse myeloid 32D in marrow and spleen of NOD/SCID mice. In this study, we used the mouse bone marrow transplant model to further explore the role of 24p3 in BCR-ABL-induced leukemia. Consistent with our previous findings, when using non-irradiated mice as recipient, donor marrow cells expressing BCR-ABL but lacking 24p3 did not cause leukemia or any disease after 75 days, whereas all mice receiving wild type BCR-ABL donor cells died with CML-like disease. An agar clone of the BCR-ABL+ human CML cell line K562 (C5) that secretes relatively high levels of lipocalin 2 (human NGAL) induced suppression of hematopoiesis in spleen and marrow of mice, leading to early death in contrast to parental K562 or K562 clone (C6) expressing low amounts of NGAL. Compared with K562 cells, overexpressing NGAL in K562 led to a higher apoptosis rate and an atrophy phenotype in the spleen of the inoculated mice. Plasma from both leukemic mice and CML patients showed elevated lipocalin 2 levels compared with healthy individuals. Moreover, we found that a primary stable cell line from wild-type mouse marrow cells expressing BCR-ABL caused solid tumors in nude mice whereas a similar BCR-ABL+ cell line from 24p3 null mice did not. These findings demonstrate that lipocalin 2 has at least two functions related to tumorigenesis, one involving apoptosis induction of normal hematopoietic cells and the other being tissue invasion by leukemia cells.

Non-invasive three-dimensional imaging of human diaphragm in-vivo.

Three-dimensional reconstruction of human diaphragm provide useful information on the functional anatomy of the respiratory system by the analysis of its geometry. The aim of the current work is the development of a new method for the 3D analysis of diaphragm geometry by the combination of free-hand Ultrasound (US) scans with an optoelectronic system of movement analysis for the tracking of the probe. 6 healthy subjects (age=24+/-2), have been measured with a free-hand US scanning of the abdomen in supine (SP) and seated position (ST), during breath-holding at Functional Residual Capacity (FRC) and Total Lung Capacity (TLC). For one of them, measurements have been repeated in supine position in an MR scan for the validation of the method. Posture has different implications on diaphragm geometry depending on the respiratory volume. At FRC the ray of curvature (rho) in ST is 101.1+/-43.1 mm higher than in SP (p=0.006), while at TLC, posture influences the position of the diaphragm with a caudo-cranial displacement from SP to ST of 23.4+/-16.7mm (p=0.019). Diaphragm geometry at different lung volumes is influenced by the posture. In SP, rho increases of 105.9+/-48.3 mm (p=0.008) and there is a cranio-caudal displacement (Deltay) of 47.54+/-15 mm (p=0.002) shifting from FRC to TLC. In ST, Deltay=31.1+/-13.5 mm (p=0.006) while rho increases not significantly. Percentage errors between MR and US 3D reconstructions are 2.1% and 10.46% for Deltay and TLC/FRC rho ratio, respectively. US 3D reconstruction is a reliable method for the assessment of diaphragm functional anatomy. Posture directly influence diaphragm geometry and hence respiratory mechanics.

[Laparoscopic adhesiolysis in acute small bowel obstruction]. / Trattamento laparoscopico delle occlusioni del tenue.

At the beginning of the laparoscopic surgery, intestinal obstruction was considered an absolute contraindication for this approach, because of the high risk of injuring the bowel. Today laparoscopic surgery for small bowel obstruction is still under evaluation. Adhesions are the most common cause of obstruction; although an important proportion of these patients can be nonoperatively treated, some of these require immediate operation. The aim of this review was to evaluate the reliability and immediate results of laparoscopic management of small bowel obstruction by postoperative adhesions. Laparoscopic management of acute small bowel obstruction is feasible, but it is often difficult and may be hazardous. The patients with acute obstruction may be undergo laparoscopy after a careful selection. Morbidity is low if the operation is performed by skilled. The immediate benefit is rapid intestinal motility and shorter hospital stay. The long-term effect is the prevention of small bowel obstruction recurrences by new postoperative adhesions.

Isolation and characterization of new lignans from the leaves of Cestrum parqui.

Three new compounds, a sesquilignans, an oxyneolignan and a norlignan, have been isolated from the aqueous fraction of Cestrum parqui. All of the compounds have been identified on the basis of their spectroscopic properties and tested on the species Lactuca sativa and Lycopersicon esculentum to evaluate their phytotoxic activity.

Eficacia y limites de la ventilación sincronizada en el recién nacido con enfermedad de las membranas hialinas / Efficacy and limitations of synchronized ventilation in newborns with respiratory distress syndrome

Objetivos. Describir el empleo de la ventilación mecánica asistida (triggered) en una Unidad de Cuidados Intensivos Neonatales durante un periodo de cuatro años, y comparar este método con la ventilación convencional. Métodos: Se han comparado 37 recién nacidos (RN) tratados con ventilación activada por el paciente (PTV) frente a 44 RN tratados con ventilación con presión positiva intermitente (IPPV), desde enero de 1999 hasta diciembre de 2000. El estudio incluía los RN con enfermedad de las membranas hialinas y peso al nacer entre 1.000 y 2.000 g. Los dos grupos eran comparables por sexo, edad gestacional, peso al nacer y tipo de parto, y ambos fueron tratados con corticoides durante el periodo prenatal. Resultados: Se demostró una menor duración de los días de ventilación y unos valores de presión inspiratoria máxima y presión media de las vías respiratorias inferiores en el grupo tratado con PTV. Las secuelas por fallecimiento, broncodisplasia, hemorragia intraventricular, leucomalacia periventricular y neumotórax no resultaron significativamente diferentes, aunque la incidencia de neumotórax ha sido inferior en el grupo PTV. Conclusiones: El estudio demuestra que el empleo de la ventilación mecánica asistida en RN con enfermedad de membrana hialina es seguro, pues no conlleva un aumento de las complicaciones (AU)

Major ocular complications after organ transplantation.

We reviewed the existing literature on major ocular complications after organ transplantation. Disorders of the ocular surface were not considered. Published reports were selected through a computerized MEDLINE search of the literature. The incidence of cataract or increased intraocular pressure due to immunosuppressant therapy are common; although retinopathy, optic neuropathy, or central nervous system involvement are less frequent they may be related to severe and irreversible visual loss. Patients undergoing organ transplantation should receive careful and regular ocular examinations.

Potential allelochemicals from Sambucus nigra.

Twenty-four aromatic metabolites belonging to cyanogenins, lignans, flavonoids, and phenolic glycosides were obtained from Sambucus nigra. Structures were determined on the basis of their spectroscopic features. Two compounds have been isolated and identified as (2S)-2-O-beta-D-glucopyranosyl-2-hydroxyphenylacetic acid and benzyl 2-O-beta-D-glucopyranosyl-2,6-dihydroxybenzoate. All the compounds have been assayed on dicotyledons Lactuca sativa (lettuce) and Raphanus sativus (radish) and monocotyledon Allium cepa (onion) to test their stimulatory or inhibitory effects on seed germination and radicle elongation. Cyanogenins have a mainly inhibiting effect while lignans stimulate the growth. Some compounds show different effects on dicotyledons and monocotyledons.

Antialgal furano-diterpenes from Potamogeton natans L.

Six furano-ent-labdanes, 19-acetoxy-15,16-epoxy-8(17),13(16),14-ent-labdatrien-20-al, 15,16-epoxy-12-oxo-8(17),13(16),14-ent-labdatrien-20,19-olide, 12(S)-hydroxy-15,16-epoxy-8(17),13(16),14-ent-labdatrien-20,19-olide, 10alpha,19-dihydroxy-15,16-epoxy-8(17),13(16),14-nor-ent-labdatriene, 19,20-dihydroxy-15,16-epoxy-8(17),13(16),14-ent-labdatriene, 15,16-epoxy-12-oxo-8(17),13(16),14-ent-labdatrien-19,20-olide, were isolated, together with the known potamogetonin, from the aquatic plant Potamogeton natans. Their structures were determined on the basis of their chemical and spectral data. The compounds showed in vitro phytotoxicity against Raphidocelis subcapitata, a microalga used in aquatic tests.

Two new polyhydroxylated sterols from Ruppia maritima.

Two new sterols have been isolated from the aquatic plant Ruppia maritima and their structures were established as (24R) ergosta-8,22-diene-3 beta,6 beta,7 alpha-triol (1) and (24R) ergosta-8(14),22-diene-3 beta,6 beta,7 alpha-triol (2) on the basis of spectroscopic analysis.

Impact of donor-specific antibodies on chronic rejection occurrence and graft loss in renal transplantation: posttransplant analysis using flow cytometric techniques.

BACKGROUND: Improvements in immunosuppressive therapy have greatly reduced acute rejection (ARj) episodes, ensuring better short-term graft outcome, but have not modified long-term survival in renal transplantation. It is now well accepted that chronic rejection (CRj) can be determined by both immune and/or nonimmune mechanisms. The aim of this study was to evaluate the importance of the posttransplant humoral immune response towards mismatched HLA graft antigens in CRj occurrence and graft outcome. METHODS: Serum samples from 120 nonpresensitized renal transplant recipients were prospectively screened for 1 year after surgery by means of flow cytometry cross-match (FCXM) and FlowPRA beads (microbeads coated with purified HLA class I and class II antigens) assays. All transplants were followed-up for 2 years or until graft removal. RESULTS: FCXM monitoring identified donor-specific antibodies (DS-Abs) in 29 (24.2%) of 120 transplanted patients. Correlation with clinical data highlighted a higher incidence of ARj in DS-Abs-positive patients compared to negative patients (62% vs. 13%, P<0.00001). Furthermore, graft failure occurred more frequently among FCXM-positive patients than among negative patients (34% vs. 1%, P<0.00001). The deleterious effect of DS-Abs on graft function was confirmed by serum creatinine levels 2 years after transplantation. These were in fact higher in subjects producing DS-Abs than in subjects with only ARj (mean creatinine: 2.5+/-1.3 mg/dL vs.1.7+/-0.5 mg/dL, P=0.04). FlowPRA analysis of DS-Ab HLA specificity highlighted the presence of anti-HLA class I antibodies in 85% of FCXM-positive patients, who also presented with a higher incidence of HLA-B mismatches than FCXM-negative patients (1.23+/-0.66 vs. 0.92+/-0.59, P=0.02). CONCLUSIONS: Flow cytometric techniques are precious tools for investigating the activation of the humoral response against HLA antigens of the graft in renal transplantation. DS-Abs production has a worse impact on organ function and survival than ARj episodes. These findings represent further proof of the threat posed by DS-Abs on long-term graft function and draw attention to the need for a specific immunosuppressive therapy aimed at counteracting the different kinds of immune activation toward graft.

Solid-state photodimerization of cholest-4-en-3-one.

Crystalline cholest-4-en-3-one undergoes solid-state dimerization by UV radiation to give two ring A - ring A connected dimers. No dimerization occurs in solution. The first dimer, characterized by a cyclobutane ring, is formed by connection of C-2 and C-3 of a moiety with C-5' and C-6' of another moiety, respectively. The latter dimer has a six-membered ketal ring formed by connection of C-2 with C-5' and of O, linked to C-3, with C-3'. The structures have been determined by spectroscopic means. X-ray analysis of title compound evidences the proximity of the axial H-2 of a molecule to the C-4' of a molecule in the upper layer. The transfer of the hydrogen and the connection between C-2 and C-5' might be the driving force of dimerization.

Lactone diterpenes from the aquatic plant Potamogeton natans.

Four lactone diterpenes and two related glucosides with a labdane skeleton have been isolated from the aquatic plant Potamogeton natans. The structures of three new compounds were determined as 19-acetoxy-20-oxo-8(17),13-ent-labdadien-15-->16 lactone, 8(17), 13-ent-labdadien-15-->16,19-->20 dilactone and 6'-acetyl-19-glucopyranosyloxy-8(17),13-ent-labdadien-15-->16 lactone, respectively, by means of spectral analysis. Antialgal assays showed inhibitory activity for some compounds.

Synthesis and antialgal activity of dihydrophenanthrenes and phenanthrenes II: mimics of naturally occurring compounds in Juncus effusus.

9,10-Dihydrophenanthrenes and phenanthrenes, mimics of natural compounds with strong antialgal activity, have been synthesized through cross-coupling by zerovalent Ni of 1-(2-iodo-5-methoxy)-phenylethanol or 2-iodo-5-methoxyacetophenone with iodoxylenes. The synthetic compounds had a hydroxyl or a methoxyl group at C-2 and two methyls in the C ring. Assays on the green alga Selenastrum capricornutum showed that all the compounds, except 2-methoxy-5,7-dimethylphenanthrene, caused strong inhibition of algal growth at 10(-4) M. 2-Hydroxy-7,8-dimethyl-9,10-dihydrophenanthrene and 2-methoxy-5,6-dimethylphenanthrene fully inhibited growth at 10(-5) M.

Posttransplant donor-specific antibody characterization and kidney graft survival.

This study was designed to investigate the clinical relevance of donor-specific antibodies (DS-Abs) and their influence on graft survival. Among 106 patients who underwent cadaveric kidney donor transplantation and were monitored by flow cytometry crossmatch (FCXM) during the 1st posttransplantation year, 25 (23.6%) resulted positive for DS-Ab production. During a 2-year follow up only 12 of the 81 FCXM-negative patients (14.8%) suffered rejection vs 17 of 25 FCXM-positive patients (68%; P = 0.00001). Correlating graft loss to DS-Ab production, 9 FCXM-positive patients lost the graft vs only 1 among the FCXM-negative patients. A worse graft function was evidenced in FCXM-positive subjects who had also suffered rejection episodes than in those which had acute rejection but did not produce DS-Abs. A high incidence of HLA-AB mismatches was found in FCXM-positive subjects which produced anti-class I antibodies. FCXM appears useful in estimating posttransplant alloimmune response. Moreover our findings confirm the harmful effects of anti-class I DS-Abs on long-term graft survival.

Antialgal ent-labdane diterpenes from Ruppia maritima.

Seven ent-labdane diterpenes have been isolated from Ruppia maritima. The structures 15,16-epoxy-ent-labda-8(17),13(16),14-trien-19-al; 15,16-epoxy-ent-labda-8(17),13(16),14-trien-19-ol acetate; methyl 15,16-epoxy-12-oxo-ent-labda-8(17),13(16),14-trien-19-oate; 15,16-epoxy-ent-labd-8(17),13E-dien-15-ol and 13-oxo-15,16-bis-nor-ent-labd-8(17)-ene have been assigned to the five new compounds by spectroscopic means and chemical correlations. The phytotoxicity of the diterpenes has been assessed using the alga Selenastrum capricornutum as organism test.

The role of DRB1 amino acid residue differences on donor-specific antibody production and acute rejection after cadaveric renal transplant.

The correlation between DRB1 amino acid residue matching, post-transplant humoral response and acute rejection (ARj) episodes was analysed in 51 renal transplant donor-recipient pairs in order to determine new criteria for organ assignment based on the alloreactivity of the residue within the peptide binding groove. HLA class I and II compatibility was defined using serological and genomic techniques; a sequence-based typing (SBT) was used for a higher resolution of DRB1 alleles. Humoral response was monitored in the first post-transplant year using triple staining flow cytometric analysis of donor-specific antibodies (Abs). Our data showed that DRB1 residue compatibility was always correlated to the absence of ARj while the presence of one or more aminoacid differences was associated with a similar frequency of ARj. Analysis of the mismatched DRB1 amino acid residue localised in the beta-pleated sheet and the alpha-helix of the DRB 1 molecule revealed that the frequency of beta-pleated sheet residue mismatches (MMs) was higher in the ARj-positive than in the ARj-negative group. A significant increase in the alpha-helix residue MMs was observed in patients with anti-class II Ab production (p = 0.034). Furthermore, analysing in detail DRB 1 MMs at the level of single amino acid residue, we found that the frequency of the mismatches localized in codon 9 and codon 28 in the beta-pleated sheet, as well as in codon 57 in the alpha-helix, was higher in patients who experienced ARj; on the other hand, MMs in codon 58 of the alpha-helix were more frequently associated with anti-class II Ab production. The identification of the residues more involved in alloreactivity onset will make it possible to define the existence of "permissive" or immunogenic" allele combinations which could simplify and increase the chances of a successful transplant.