Giant pleomorphic adenoma of the parotid gland: an unusual case presentation and literature review.

Pleomorphic adenoma is the most common type of all salivary gland tumours. Although uncommon, cases of giant pleomorphic adenomas have been described in the medical literature, the majority involving the parotid gland. This paper describes an unusual case of a giant adenoma arising in the parotid gland. The patient underwent surgical resection of the giant tumour, which was one of the largest pleomorphic adenoma reported in recent literature. This case has prompted us to evaluate the behaviour of those benign tumours, which suggested that aesthetic and social morbidity is sufficient to justify, when possible, early tumour excision, despite the relatively low risk of malignant transformation. Management of this unusual tumour is discussed, and the literature on giant parotid tumours is reviewed.

Head and neck cancer in elderly patients: is microsurgical free-tissue transfer a safe procedure?

The safety and success of microvascular transfer have been well documented in the general population, but the good results achieved with the use of free flaps in elderly patients have received little attention. This study sought to identify differences in complications, morbidity and functional outcomes between elderly (≥ 75 years) and younger (< 75 years) patients treated surgically for advanced head and neck cancer using the Head and Neck 35 module of the European Organisation for Research and Treatment of Cancer quality of life questionnaire. Patient treatment consisted of composite resection, including excision of the primary tumour with ipsilateral or bilateral neck dissection and microvascular reconstruction. Eighty-five microvascular tissue transfers were performed to reconstruct major surgical defects. Postoperative radiation therapy was performed when indicated. Total flap loss occurred in three cases in elderly patients and two cases in younger patients. The rates of major surgical complication were 9% in young patients and 11% in elderly patients. No significant difference was observed between the two groups in the rates of major and minor flap complications, morbidity or long-term functional outcome. The results of the present analysis indicate that free-flap microvascular reconstruction can be considered a safe procedure in elderly patients with head and neck cancer.

Periodontitis and cytokine patterns in HIV positive patients.

OBJECTIVE: Oral and dental problems are common among human immunodeficiency virus (HIV) infected individuals, particularly the periodontitis is common in HIV-infected subjects. AIM: To evaluate the cytokine patterns in HIV+ patients with periodontitis. MATERIAL AND METHODS: In this study we analysed: HIV+ patients with and without periodontitis and HIV negative patients with and without periodontitis. The clinical periodontal evaluation was based on periodontal disease index and radiographic and clinical evidence of alveolar bone loss. The CD4- and CD8-T cell counts and the plasma viral load were measured. The Interferon (IFN)-gamma, Tumor Necrosis Factor (TNF)-alpha, Interleukin (IL)-2, IL-4, IL-10 and IL-6 were evaluated by Cytometric Bead Array Assay and the IL-18 plasmatic levels were calculated by ELISA. RESULTS: The group of HIV+ with periodontitis shown levels of IL-2 and IL-18 statistically higher that the group of HIV+ without periodontitis. A positive correlation between the degree of the periodontitis and IFN-gamma, IL-2, IL-18 and CD8+ cells in the group of HIV+ with periodontitis has been shown. CONCLUSIONS: The results of the present study confirm that the IL-18, together with other cytokines, has a potential role in aetiopathogenesis of periodontitis in HIV+ patients.

The joint use of LCA and emergy evaluation for the analysis of two Italian wine farms.

The aim of this paper is to evaluate two agroindustrial productive processes in their entirety (one organic and one semi-industrial), focusing on the comparison of impacts derived from the inputs and outputs of the system (life cycle assessment, LCA), integrated with a physical evaluation of the resources and natural services, on a common basis (emergy). Methods based on the joint use of LCA and emergy evaluation are useful, as they measure the contribution of environmental services and products to the productive process thus focusing primarily on the environmental impact of emissions and non-renewable energy inputs. The complementarity of the methods used in this paper contributes important elements and information useful for the comprehension of the organization of agriculture within Siena's territory. The results show important elements and useful information: (1) for the comprehension of the two agroecosystems' organization; (2) for the use of the energy flows that determine their development. Moreover, the combined use of emergy and LCA gives a comparative thermodynamic performance evaluation between organic and semi-industrial farming.

Synovial cell sarcoma of the neck. Case report and review of the literature.

Synovial sarcoma is an uncommon neoplasm accounting between 8 and 10% of all soft tissue malignancies. Involvement of the head and neck region is rare. So far, fewer than 100 cases have been reported in the literature and only a few originated in the soft palate, tongue, larynx, hypopharynx, and cervical oesophagus. We report the case of a synovial sarcoma of the parapharyngeal space in a 72-year-old female, and experience in the behaviour and surgical treatment of this neoplasm is described. The patient has remained disease free for 28 months, with regular follow-up. Based upon this case and the others reported in the literature, synovial sarcoma does not have a good overall prognosis, and on account of its rarity and unpredictable biologic behaviour, surgical excision, and regular clinical and radiographic follow-up for at least 3 years are strongly recommended.

Human herpesvirus-6 reactivation in a longitudinal study of two HIV-1 infected patients.

After primary infection, human herpesvirus-6 (HHV-6) persists in latent form and can be reactivated in immunocompromised subjects. A longitudinal study of HHV-6 infection was carried out in two HIV-1 seropositive patients to provide in vivo evidence of HHV-6 reactivation. Concomitant with a significant rise of anti-HHV-6 IgG detected by IFA, a transient increase of HHV-6 viral load was shown in PBLs by PCR. During HHV-6 reactivation it was also identified either cell-free HHV-6 by PCR in plasma or IgM antibody titers. HHV-6 reactivation was followed by a temporary decrease in CD4+ count and by a progressive dramatic loss of CD4+ during the following 18 months. HHV-6 strain characterization by PCR demonstrated that first patient (MM) initially showed the B variant, followed by reactivation and persistence of the A variant, while in the second (SG) only the A variant was detected. The evidence of HHV-6 reactivation suggests its involvement in immunologic damage underlying the disease.

Quantitation of HCV viraemia by branched DNA signal amplification in patients treated with alpha-interferon--a longitudinal study.

Using bDNA, the plasma viral load trend of HCV-infected patients undergoing IFN therapy was analyzed. Nine patients were enrolled, each assigned to one of three groups, based on IFN response as determined by ALT and AST level trend. HCV was genotyped using DEIA. Each patient's clinical stage was determined by liver biopsy analysis. In nonresponding patients elevated viral loads and biochemical parameters were observed. These values were not influenced by IFN treatment. In relapsed patients the cessation of IFN treatment increased viral load; this was associated with a rise in ALT and AST values. In responders ALT and AST levels remained normal; viral load was low. Patients with elevated HCV viral load showed a worsening in their liver histology during the follow-up period. These results confirm that plasma viral load is a good marker of biochemical change and disease progression.

Prolonged bedtime treatment with H2-receptor antagonists (ranitidine and famotidine) does not affect blood alcohol levels after ethanol ingestion in male patients with duodenal ulcer.

OBJECTIVE: To verify whether a prolonged (therapeutic) treatment with ranitidine or famotidine may affect blood alcohol concentrations (BAC) in patients with duodenal ulcer (DU). METHODS: Sixteen male patients with DU were studied. Subjects with Helicobacter pylori-associated DU did not enter the study. Patients randomly received either 300 mg ranitidine (n = 8) or 40 mg famotidine (n = 8) at bedtime for 2 months. They had a standard lunch (1:00 PM), and 0.3 g/kg of alcohol was given 15 min after the meal. BAC were measured by head-space gas chromatography up to 150 min. RESULTS: The rate of GFPM was checked in all patients before they entered the study; we found it to be 53%, by comparing the area under the curve (AUC) of BAC after either intravenous or oral (po) administration of 0.3 g/kg ethanol. Ranitidine did not significantly modify either the mean AUCpo (5.8 +/- 1.8 vs. 6.2 +/- 1.4 mM/h, before vs. after treatment) or the peak BAC (4.6 +/- 1.1 vs. 5.3 +/- 1.7 mM) after 2 months of treatment. Famotidine failed to affect BAC in the second group of patients (AUCpo 5.0 +/- 1.4 vs. 5.6 +/- 1.7 mM/h, peak BAC 4.0 +/- 1.7 vs. 4.3 +/- 1.8 mM; before vs. after treatment). CONCLUSIONS: These findings suggest that, in males with DU, prolonged treatment with ranitidine or famotidine had no effect on BAC after administration of a small dose of postprandial alcohol.