Acinic cell carcinoma of the lung with metastasis to lymph nodes.

A 64-year-old man presented with an asymptomatic left lower lobe mass. At bronchoscopy there was a tumor in the superior segment. Biopsy revealed an acinic cell carcinoma. There was no evidence of salivary gland or other site of origin. Lobectomy and lymph node staging showed involvement of interlobar (N1) nodes, while higher stations were benign. The patient remains well 20 months postoperatively. This is the only instance of primary pulmonary acinic cell carcinoma with lymph node metastasis among 15 cases in the literature. We review the clinical features, histology, and treatment of the reported cases.

Depression of CD4 T cell subsets and alteration in cytokine profile in boutonneuse fever.

Interferon (IFN)-gamma, interleukin (IL)-10, IL-6, and tumor necrosis factor (TNF)-alpha were significantly increased in sera from Sicilian patients with acute boutonneuse fever (BF) compared with those of healthy controls. IFN-gamma levels dropped sharply within the second week after infection. IL-6, IL-10, and TNF-alpha levels gradually declined; in convalescent patients only were they in the normal range. In contrast, peripheral blood mononuclear cells (PBMC) stimulated in vitro with phytohemagglutinin (PHA) produced low levels of IL-10 and IFN-gamma in acute BF that were compatible with the reduction in the levels of CD4+, CD4+/CD45RO+, and CD4+/CD45RA+ cells. In vitro production of TNF-alpha and IL-6 from PBMC stimulated with PHA was not significantly modified during the various phases of the infection compared with control PBMC, which could be due to the persistence of high levels of CD14+ monocytes compensating for the decrease in CD20+ B cells.

[Microbiological and serological study in cases of infertility with or without sterility with particular emphasis on the etiological role of Chlamydia trachomatis]. / Indagini microbiologiche e sierologiche in casi di infertilita' e/o sterilita' con particolare riguardo al ruolo svolto in essi da Chlamydia trachomatis.

Microbiological investigations were carried out on two groups of men and women--a) with genital non gonococcal pathology and--b) in infertile/sterile people of the same sex and age (mean age 28.4 y) with the aim to document in them the prevalence of various microorganisms particularly of Mycoplasma/Ureaplasma and Chlamydia trachomatis as aetiological agent of their pathology. Serum antibodies to Chlamydia trachomatis were also studied by microimmunofluorescence, immunoperoxidase and ELISA methods in the same population in comparison with apparently healthy blood donors of the same sex and age as control. Finally, 56 infertile/sterile couples were included in this study to investigate the possible role of Chl. trachomatis. Various microorganisms were isolated more frequently from women of the group b) (45.5%-22.9% respectively p less than 0.01). Mycoplasma/Ureaplasma in comparison with Chl. trachomatis were prevalent in all groups investigated (p less than 0.01). Infertile/sterile women had higher anti Chl. trachomatis antibodies than did women with genital non gonococcal pathology or women of the control group (p less than 0.01). Mycoplasma/Ureaplasma strains were isolated from infertile/sterile couples more frequently than Chl. trachomatis but the women of these couples had high titres (greater than 128) of anti Chl. trachomatis antibodies. Finally, IgA as well as IgG anti Chl. trachomatis antibodies were demonstrated in two out of nine peritoneal fluid samples obtained from women affected by PID. In one case, a pregnancy underwent after an ad hoc therapy of the two partners from whom two Ureaplasma strains were isolated.(ABSTRACT TRUNCATED AT 250 WORDS)

First trimester fetal blood sampling.

The authors report 8 diagnostic cordocentesis performed at the end of the first trimester. The indication was thalassemia (5 cases) and karyotyping (3 cases). The technique requires that the operator holds both the probe and the needle (25 G X 90 mm); the fetal blood sample ranged between 0.25 and 0.35 cc, sufficient in all cases for the diagnosis. 1 pregnancy was terminated on the basis of the diagnostic result; no complications reported at a 3-weeks follow-up in the remaining 7 patients. The first trimester cordocentesis offers several advantages if compared to CVS, especially for thalassemia prenatal diagnosis; furthermore it opens new perspectives for intrauterine transplantations. More experience is required to assess the safety of the procedure.

Clinical results and fetal biochemical data in 140 early second trimester diagnostic cordocenteses.

The authors report their experience on 140 diagnostic cordocenteses performed in the early trimester of pregnancy (technique, indications and complications). Furthermore the Authors report preliminary data concerning various fetal blood biochemical parameters (22) obtained by cordocentesis at 18-19 weeks of pregnancy (42 cases). Fetal and maternal values are compared.

Treatment of endometrial hyperplasia with levonorgestrel releasing intrauterine devices.

The effectiveness of a new levo-norgestrel releasing intrauterine device is assessed in fourteen patients with histologically confirmed hyperplastic lesions of the endometrial mucosa. The morphologic response of the hyperplastic endometria to the action of the levo-norgestrel in this study explains the regression of the cases so treated.

PIP: Levonorgestrel was inserted into the uterine cavity by means of a Nova-T device loaded with 46 mg of the drug in a study designed to assess the effectiveness of Levonorgestrel in the treatment of hyperplastic lesions of the endometrial mucosa. The device is programmed to release 3 mcg of L-norgestrel, a strong synthetic progestin, a day for a period of 5 years. The device was inserted from 60 to 27 days preceding the hysterectomy in the 1st group of patients -- 5 women ranging in age from 36-49 years who were candidates for hysterectomy because of benign uterine pathology. The 2nd group was made up of 14 patients with histologically confirmed endometrial hyperplasia. In 6 cases it was a simple form; 4 were suffering from cystic hyperplasia. The remaining 4 cases were diagnosed as adenomatous hyperplasia, 1 with and 3 without cytological atypica. In these 14 patients, the L-norgestrel-releasing device was inserted immediately after hysteroscopic examination with direct biopsy sampling to determine the condition of the endometrium before the treatment. The 1st hysteroscopic follow-up examination with direct biopsy was performed about 60 days after the beginning of the treatment. In the 1st group, the aim of the histological investigations was to determine whether the effect of the L-norgestrel was limited to the area immediately adjacent to the device or whether the whole thickness of the endometrium had been affected by the morphological changes caused by the hormone. The samples taken at different levels of the uterine cavity in the 5 hysterectomized cases show a uniform picture, i.e., without any variations due to the sampling site or nearness to the device. In all cases, the endometrial mucosa was substantially hypotrophic or even atrophic. The glands were reduced in size and morphologically atrophic. The epithelial lining was cylindrico-cubic, monostratified, and without mitosis. The effect of the hormones could be observed throughout the whole thickness of the endometrial mucosa, as far as the basal layer. In the 2nd group, all the 6 cases of simple hyperplasia of the endometrial mucosa showed a morphological picture of glandular atrophy and extensive predecidual reaction from the very 1st control performed after 2 months. After 5 months, the 4 cases of glandular-cystic hyperplasia showed that the original morphological picture had given way to the typical changes produced by L-norgestrel. In the 3 cases without cytological atypica, hysteroscopic and bioscopic examinations after 2, 5, and 8 months showed a gradual disappearance of the irregular proliferation of the endometrial mucosa, and the appearance of a morphological picture of predecidual transformation of the endometrial stroma and much atrophy of the glandular structures.

An accessory olfactory pathway in Lepidoptera: the labial pit organ and its central projections in Manduca sexta and certain other sphinx moths and silk moths.

In the hawkmoth, Manduca sexta, the third segment of each labial palp contains a pit, which houses a densely packed array of sensilla. We have named this structure the labial pit organ (LPO). The sensilla within the pit are typical of olfactory receptors, characterized by a grooved surface, wall pores, and pore tubules. Axons arising from receptor cells that innervate these sensilla project bilaterally to a single glomerulus in each antennal lobe. We have compared this central projection with that in three other species of Manduca (M. quinquemaculata, M. dilucida, and M. lanuginosa) and in the silkmoths Antheraea polyphemus and Bombyx mori. A bilateral projection to a single glomerulus in each antennal lobe is present in all cases. We suggest that the LPO serves as an accessory olfactory organ in adult Lepidoptera.

Hysteroscopic reversible tubal sterilization.

The Authors describe their experience with a new type of intratubal mechanical device to be inserted under hysteroscopic control. Up to present time, 1471 cycles without any other form of contraception have been observed. Although the promising results of this preliminary report in the field of hysteroscopic reversible tubal sterilization, the Authors underline that this new technique is still evolving and will be improved with further experience.

PIP: Techniques for hysteroscopic tubal sterilization may be divided into 3 categories: destruction of the interstitial of the bube by means of electrocoagulation or cryonecrosis; injection of sclerosing substances or silicone liquid; and mechanical devices which will occlude the interstitial section. Experience with a new type of intratubal mechanical device to be inserted under hysteroscopic control is described. The detailed and enlarged visualization possible with the aid of microhysteroscope, during an atraumatic outpatient examination, led to the invention of a device which is suitable for this method and for the anatomo-physiological conditions of the interstitial section of the tube. The device is made of surgical nylon (1 mm diameter) having an open loop at its distal end with an elastic memory so that it can be opened at varying widths and be fixed in the tube, and preventing its migration into the uterine cavity. A similarly adaptable proximal loop stops it from migrating into the peritoneum and facilitates its removal by means of a simple hook. The middle section of about 28-30 mm in length is supple so that it can be atraumatically inserted in the interstitial section. The 2 devices are placed in a supple inserting catheter (diameter 1.5 mm) and a nylon guide thread enables their progression to be followed under visual control. The microhysteroscopic technique is the same as that used for a diagnostic examination or for surgery. From march 1982 to February 1984, 166 patients who requested permanent sterilization were informed about and accepted this method. The average patient age was 33.5 years, with and average parity of 2.4. Patients less than 30 years of age or who had fewer than 2 living children were excluded. In 149 patients it was possible to effect a bilateral insertion during the 1st microhysteroscopy. In 7 patients it was necessary to make 2 attempts, either because of bleeding or unsatisfactory visualization. There was serious retroversion in 3 cases, atresic tubal orifices in 4, and in 1 case the pain felt by the patient was so violent that an hour's rest was necessary. In these 8 patients the device was not inserted. The discomfort felt during the procedure is equal to that experienced during a diagnostic microhysteroscopic examination. A microhysteroscopic examination performed 1 month after insertion showed 4 expulsions. Up to the present time, 1471 cycles without any other form of contraception have been observed. 1 intrauterine pregnancy occurred 6 months after insertion. The technique is still evolving and will be improved with experience and further study.

A sero-epidemiological survey of asymptomatic cases of Boutonneuse fever in western Sicily.

963 sera from contacts, persons from various localities, and blood donors were examined with a commercially produced kit for micro-immunofluorescence for the presence of antibodies to Rickettsia conorii. 10.6% of sera were serologically positive. The higher rates of positivity were observed in sera of contacts (19%) and persons from Mussomeli (20%) and Ustica (18.4%), the lower rates in blood donors from Palermo (3.5%). These results support the view that there is an occupational risk factor related to a rural environment.