Relationship between [123 I]-FP-CIT SPECT and clinical progression in Parkinson's disease.

BACKGROUND: The demonstration of presynaptic dopaminergic deficiency on [123 I]-FP-CIT SPECT imaging is a useful ancillary tool in the diagnosis of Parkinson's disease (PD). Whilst there is evidence of a cross-sectional relationship between the degree of dopaminergic deficiency and severity of bradykinesia and rigidity, longitudinal studies are rare. Moreover, the relationship between motor subtypes and their dopaminergic deficient state is not well characterized. AIM: Our primary aim was to assess the correlations between dopaminergic deficiency on baseline [123 I]-FP-CIT SPECT imaging with the progression of motor severity in patients classified by motor subtype, and the development of motor complications. Our secondary aim was to assess the correlation between UPDRS-III subscores and the time to onset of motor complications. METHODS: 42 PD patients with abnormal baseline [123 I]-FP-CIT SPECT scans and at least 3 years of clinical follow-up were classified by motor subtype: akinetic-rigid, tremor-dominant or mixed. UPDRS-III scores at baseline and at 3-year follow-up, and time to onset of motor complications were recorded. RESULTS: [123 I]-FP-CIT uptake ratios were inversely correlated with UPDRS-III scores at 3 years only in akinetic-rigid patients (r=-.51, P=.04). Time to onset of motor complications was inversely correlated with UPDRS-III subscores for bradykinesia and rigidity at baseline (r=-.52, P=.02) and at 3 years (r=-.54, P=.01). CONCLUSION: The degree of dopaminergic deficiency on baseline [123 I]-FP-CIT SPECT inversely correlates with motor severity at 3-year follow-up in akinetic-rigid patients only. Furthermore, UPDRS-III subscores for bradykinesia and rigidity at baseline show an inverse correlation with time to onset of motor complications across all PD subtypes.

Asbestos exposure in malignant mesothelioma of the pleura: a survey of 557 cases.

A series of 557 malignant mesotheliomas of the pleura diagnosed in the Trieste-Monfalcone area, Italy, in the period 1968-2000 were reviewed. The series included 492 men and 65 women, aged between 32 and 93 years (median age 69 years). Necropsy findings were available in 456 cases (82%). Occupational histories were obtained from the patients themselves or from their relatives by personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 442 cases. In 109 cases isolation and counting of asbestos bodies were performed. A majority of people had histories of working in the shipyards. Asbestos bodies were observed in lung sections in 67% of the cases. Lung asbestos body burdens after isolation ranged between 20 bodies and about 10 millions of bodies/g dried tissue. Latency periods (time intervals between first exposure to asbestos and death) ranged between 14 and 75 years (mean 48.8 years, median 51.0). Latency periods among insulators and dock workers were shorter than among the other categories. High asbestos consumption occurred in many countries in the 1960s and in the 1970s. The data on latency periods obtained in the present study suggest that a world mesothelioma epidemic has to be expected in the coming decades.

Asbestos exposure in a shipyard area, northeastern Italy.

The Monfalcone area, northeastern Italy, is a small industrial district (population 60,000), with a large shipyard. In order to monitor asbestos exposure in this area, a series of 3,640 necropsies, carried out at the Monfalcone Hospital between October 1979 and September 1998, were investigated. The thoracic cavities were examined for pleural plaques; these were classified into three classes (small, moderate, large). Routine histological sections of lung tissue were examined for asbestos bodies. Isolation and counting of asbestos bodies were performed in 1,075 cases. Lifetime occupational data were collected in 1,277 cases. Pleural plaques were observed in 70.5% among men and in 23.8% among women. The prevalences of pleural plaques did not show significant variations during the study period. Asbestos bodies were found on routine lung sections in 23.7% of men and 3.0% of women. The shipyard workers, the most numerous category in the series, were characterized by high prevalence of pleural plaques (total 86.7%, large 32.4%), high prevalence of asbestos bodies on routine lung sections (35.3%), and high amounts of lung asbestos bodies after isolation. The present data indicate that asbestos exposure may reach alarming levels in the shipyard areas.

Malignant mesothelioma in central and Eastern Europe.

To obtain data on mesothelioma incidence in Central and Eastern Europe, a short questionnaire was sent to 83 researchers from 19 countries. The questions referred to the approximate number of mesotheliomas diagnosed per year in the country, degree of asbestos consumption, and percentage of lung carcinomas attributable to asbestos. Answers were received from 12 countries. For some major asbestos producers and/or consumers, such as Russia and Ukraine, mesothelioma data were unavailable or unreliable. In various countries of Central-Eastern Europe, the crude incidence of mesothelioma appeared to be lower than in Western countries. The reported annual numbers of mesotheliomas were 120 in Poland, 133 in Romania, and 78 in Hungary. Among the countries with a population of 5 million or less, the highest incidence was observed in Croatia (46 cases per year, peritoneal tumors not included). Data on the percentage of asbestos-related lung carcinomas are lacking. The knowledge about asbestos related cancer in Central and Eastern Europe remains fragmentary. Further investigations in this relevant area of public health should be encouraged.

Asbestos exposure in lung carcinoma: a necropsy-based study of 414 cases.

BACKGROUND: The prerequisites necessary for attributing lung carcinoma to asbestos, represent a controversial issue. METHODS: Three parameters (occupational history, pleural plaques, and lung asbestos bodies) were investigated in 414 consecutive cases of lung carcinoma, examined at necropsy at the Hospital of Monfalcone, Italy. Occupational data were obtained from the patients' relatives by personal or telephone interviews. Pleural plaques were classified into three classes (small, moderate, large). Routine lung sections were examined for asbestos bodies in all cases; isolation and counting were performed in 408 cases. RESULTS: The series included 353 men, and 61 women, aged between 38 and 97 years. The male patients had worked in industries in 74% of cases (60% in shipbuilding). Men showed pleural plaques in 82% of cases (moderate or large plaques in 58.7%). Asbestos bodies were observed in routine lung sections in 34.8%, and in 31% exceeded the value of 5,000 bodies per gram of dried tissue. Among women the principal features were: history or domestic exposure to asbestos in 36% of the cases, prevalence of pleural plaques 34% (moderate or large plaques 15%), asbestos bodies in routine lung sections in 3.3% and there was no case with an asbestos body burden over 5,000/g. The fraction of asbestos-related carcinomas among male patients varied between 24.7 and 61%, depending on the criteria used for attribution. CONCLUSIONS: Different criteria indicated about 60% of the present lung carcinomas among men as plausibly attributable to asbestos.

Pleural plaques as risk indicators for malignant pleural mesothelioma: a necropsy-based study.

Pleural plaque is recognized as a reliable marker of previous exposure to asbestos. However, it is controversial whether pleural plaque is a risk indicator for asbestos-related malignancies. In the present study, the thoracic cavities were examined for pleural plaques in 3,005 necropsies performed at the Monfalcone Hospital in people aged 15 years or older. Plaques were classified into three classes: 1, small (plaques measuring 1-4 cm in major diameter); 3, large (plaques involving a major part of a hemithorax); and 2, moderate (intermediate conditions). The prevalences of pleural plaques were 70.9% among men, and 24.0% among women. The prevalences of plaques (total plaques, various classes) among subjects with pleural mesothelioma were compared with those observed in the remaining cases. The series included 92 subjects with malignant pleural mesothelioma (82 men and 10 women). Mesothelioma cases showed higher prevalences of total plaques as well as higher prevalences of classes 1, 2, and 3, when compared with controls. These differences reached the statistical significance for total plaques, and classes 2, 3. The present data are consistent with the idea that pleural plaque is a risk indicator for pleural mesothelioma.

Latency periods in asbestos-related mesothelioma of the pleura.

Latency periods (time intervals elapsing between first exposure to asbestos and death) were examined in 421 cases of malignant pleural mesothelioma, diagnosed in the Trieste-Monfalcone area, Italy. Occupational data were collected from the patients or from their relatives by personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 370 cases. Latency periods, calculated in 312 cases, ranged from 14 to 72 years (mean 48.7, median 51). Latency periods differed significantly from one occupational group to another. Mean latency periods were 29.6 among insulators, 35.4 among dock workers, 43.7 in a heterogeneous group defined as various, 46.4 in non-shipbuilding industry workers, 49.4 in shipyard workers, 51.7 among women with a history of domestic exposure to asbestos, and 56.2 in people employed in maritime trades. The ANOVA test indicated a correlation between latency periods and occupational groups. Latency periods in people with asbestos bodies visible in routine lung sections did not differ from those seen in cases with no evidence of asbestos bodies. These data suggest that intensity of exposure is a relevant, but not the only, factor in determining the duration of latency periods.

Multiple primary malignant tumors in patients with hepatocellular carcinoma. A review of 29 patients.

BACKGROUND: The study of patients with hepatocellular carcinoma (HCC) and multiple primary malignant tumors (MPMTs) is interesting from an etiopathogenetic as well as from a clinical point of view. There are few studies dealing with this topic. METHODS: Smoking habits, alcohol intake, HBsAg status, alpha-feto-protein serum concentration, presence of liver cirrhosis, type of associated cancers, treatment, and survival were evaluated in 29 patients (25 men and 4 women; median age 73 years) with histologically confirmed HCC and MPMTs. All patients were examined between January 1980 and February 1995 at the General Hospital of Monfalcone, in northeastern Italy. In the same period there were 143 patients with HCC. RESULTS: Tumors associated with HCC were located in: prostate (9 cases), colon-rectum (5), bladder (3), lung (3), stomach (2), gallbladder (2), and brain, breast, oesophagus, pancreas, thyroid, larynx, pleura, small intestine, kidney (1 each). In 25 patients there was a single, and in 4 patients two associated malignancies. A diagnosis in vita of the associated malignancy was made in 15 cases. Cirrhosis was present in 90% of patients and HBsAg was positive in 15%. Mean survival time from diagnosis was 5.5 weeks (0-150) in patients with MPMTs and 6.8 weeks (0-221) in patients with HCC only. The cause of death was HCC in 18 patients, the associated tumor in 8, and non-neoplastic diseases in 2. Treatment of the associated tumors was performed in 8 cases. CONCLUSIONS: In this study the prevalence of MPMTs in patients with HCC is high (20.3%) in accordance with other autopsy series. Mean survival time in patients with MPMTs was similar to that in patients with HCC only. From a clinical point of view, attention must be paid to the diagnosis of hepatic lesions in patients affected with cirrhosis and extrahepatic cancer.

[Dementia in Friuli-Venice Giulia: hospital diagnosis]. / Le demenze nel Friuli-Venezia Giulia: diagnosi ospedaliere.

Discharge diagnoses made in the large hospitals of Friuli-Venezia Giulia during a 3-year period (1989-91) were collected. Diagnoses with ICD-9 codes 290, 290.0-4, 290.8-9, 331, 331.0-9, and 437.0 were selected, and analyzed. Discharge diagnoses including one of the above ICD-9 codes were found in 6,647 cases. ICD-9437.0 (brain arteriosclerosis) was by far the most frequent code (4,731 cases). When the present results are examined in the light of literature data as well as of previous research performed at the Monfalcone Hospital, it emerges that in the hospitals of Friuli-Venezia Giulia, dementia is a strongly underestimated condition. In addition the present data suggest that in these hospitals most dementia cases are misdiagnosed as vascular dementias.

Asbestos-related mesothelioma in Monfalcone, Italy.

The Monfalcone area, in northeastern Italy, is a small industrial territory (population about 60,000), with a large shipyard. Between October 1979 and April 1992, ninety-two malignant mesotheliomas were diagnosed at the Monfalcone Hospital. The series included 84 men and 8 women, aged 42 to 89 years (median age 68 years). There were 89 pleural and 3 peritoneal tumors. Seventy patients (69 men and 1 woman) had worked in the shipyards; six were seamen, and four insulators. Five men had been exposed to asbestos in various industries; six women had histories of domestic exposure, and one woman had a history of possible environmental exposure. The latency periods (intervals between first exposure to asbestos and diagnosis of the tumor) ranged from 20 to 65 years (median 52 years). Latency periods among insulators were significantly lower than among shipyard workers, as well as lower than among the other categories (p < 0.01). Lung asbestos bodies were isolated after chemical digestion in 73 cases at necropsy, and in two cases at surgery. In necropsy cases, asbestos body burdens ranged between 100 and 10,000,000 bodies per gram of dried tissue (median 11,000). Pleural plaques were observed at necropsy in 62 out of 73 cases, and in two cases at surgery. In the time period we considered, the annual incidence rates for pleural mesothelioma were very high among male Monfalcone residents, being 189 per 100,000 among people aged 75 years or more. On the basis of occupational data and of objective signs (lung asbestos bodies, pleural plaques), all the cases of the present series but one (that with possible environmental exposure) were considered as asbestos-related. The role of co-factors in the development of asbestos-related mesothelioma is suggested.

Exposure to asbestos in Monfalcone, Italy. A necropsy-based study.

The Monfalcone area in north-eastern Italy (total population, about 60,000) is a small industrial district in which shipbuilding is the main industry. We examined thoracic cavities for hyaline pleural plaques and routine lung sections for asbestos bodies in 1765 necropsies performed at Monfalcone Hospital. In 553 cases, we also isolated and quantified asbestos bodies in the lungs (Smith-Naylor's method). Occupational histories were obtained from the relatives of 798 patients. The prevalence of pleural plaques was significantly higher (p less than 0.001) among residents of the Monfalcone region (73.6% of men, 26.7% of women) than among nonresidents. Similarly, asbestos bodies were found more frequently in lung sections from residents. A good correlation was observed between pleural plaques and the asbestos body content of the lung (Spearman's correlation coefficient, 0.53). Different occupational groups showed very marked differences in the prevalence of plaques in general, in the prevalence of large plaques and in the numbers of asbestos bodies in the lung. Subjects who had worked in the shipyard or in a sodium carbonate factory had the highest indices. Exposure to asbestos had occurred at work for the large majority of men for whom data on occupation had been collected and through domestic contacts for the large majority of women. In a small portion of cases, environmental exposure could not be excluded as the cause of the objective signs. Pleural plaques, the asbestos body content of the lungs and occupational history must be considered together in monitoring exposure to asbestos in a given geographical area.

[Kaposi's sarcoma in the Monfalcone area]. / Il sarcoma di Kaposi nel territorio di Monfalcone.

The Monfalcone area (Italy) is a small industrial territory (60,000 inhabitants), characterized by a high incidence of asbestos-related diseases. In a review of the biopsy and necropsy records collected at the Monfalcone Hospital during the period October 1979-September 1985 two cases of Kaposi's sarcoma were found. Of the two patients one was resident out of the Monfalcone area; the second was already affected by the disease, when he came to this country. The present data suggest that Kaposi's sarcoma is a rare condition in Monfalcone territory.

Effects of cis-Dichlorudiammineplatinum (II) and related transition metal complexes on Escherichia Coli.

A number of transition metal complexes, including the cis and trans isomers of dichlorodiammineplatinum (II), six complexes of rhodium (I), two of iridium (I), and one of ruthenium (II) have been tested for their ability to induce lambda prophage, to produce filamentous growth of Escherichia coli, and to be selectively toxic for strains with defects in the deoxyribonucleic acid repair system. Dichlorotetrakis(dimethylsulfoxide)ruthenium II [RuCl(2) (DMSO)(4)] was strictly similar to cis-dichlorodiammineplatinum II [cis PtCl(2) (NH(3))(2)] in the test for lambda induction, filamentous growth production, and selective toxicity for a recA(-) strain. [Rh COD 1,10-phenanthroline](+) Cl(-), though more toxic for recA(-) than for rec(+)E. coli, was scarcely effective in the test for filamentous growth and did not induce prophage. None of the other tested compounds showed any similarity with cis-PtCl(2)(NH(3))(2). Due to the interesting results obtained with cis-PtCl(2)(NH(3))(2) as an antitumor agent, it seems reasonable to propose RuCl(2)(DMSO)(4) as a potential antitumor substance.