HIV-1: towards understanding the nature and quantifying the latent reservoir.

The human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) pandemic constitutes one of the greatest public health issues, since 36.9 million people worldwide were living with HIV in 2017 and 940,000 died from AIDS- related illnesses in the same year. One of the main obstacles in the effort to achieve viral eradication or long-term virologic remission is the existence of the HIV-reservoir. Except for resting memory CD4+ T cells there is a plethora of innate immunity cells including macrophages, dendritic cells, follicular T helper cells and NK cells which are now considered to play a role in viral latency and persistence. Hematopoietic precursor cells and progenitor mast cells, astrocytes, fibrocytes, renal and liver epithelial cells could also contribute to the reservoir, but their role remains controversial. Tissue reservoirs, such as the central nervous system (CNS), lymphoid tissue, adipose tissue and the gut-associated-lymphoid-tissue (GALT) are usually referred to as anatomic sanctuaries, where it is difficult to achieve high concentration and efficacy of antiretroviral agents. Accurate quantification of this reservoir is of the utmost importance and multiple assays have been developed for this purpose. The role of several cell populations in viral latency needs to be clarified by further studies. Furthermore, there is an urgent need for new assays, which will accurately measure the size of the reservoir, which plays a key role in predicting the timing of viral rebound upon cessation of antiretroviral treatment, since the currently available ones either overestimate or underestimate the size and have significant limitations. Keywords: HIV-1; cellular reservoirs; tissue reservoirs; quantification.

Non small cell lung cancer metastasized to the breast and treated with modified radical mastectomy: a case report.

Breast metastasis from extra-mammary malignancy is extremely rare with an incidence from 0.4% to 1.3%. Several types of malignancies that most commonly metastasize to the breast include leukemia, lymphoma, and melanoma. AIM: We report a case of a 57-year-old male with a history of non-small cell lung cancer (NSCLC) who manifested a left breast mass, two years and four months after the initial diagnosis and treatRomament of NSCLC. METHOD: Physical examination revealed a poorly defined mass in the upper outer quadrant of the left breast, suspicious for breast cancer. After mammography results, the patient underwent Fine Needle Aspiration that was indicative of cancer. He underwent then modified radical mastectomy and axillary lymph node dissection. Histology and immunohistochemical analyses were conducted, that revealed a NSCLC that metastasized to the left breast. RESULTS: Finally, the prognosis of the patient was poor, as NSCLC relapsed from IIB to stage IV. CONCLUSIONS: An accurate differentiation of metastasis to the breast from primary breast cancer is of paramount importance because the therapeutic approach and prognosis of the two differ significantly.

Early and late complications of stapled haemorrhoidopexy: a 6-year experience from a single surgical clinic.

PURPOSE: Introduction of stapled hemorrhoidopexy (SH) brought a radical change in the treatment of haemorrhoidal disease. The aim of this study is to evaluate the results and the complications (early and late) from the use of this technique. METHODS: During the last 6 years (2005-2011), 123 patients underwent a SH in our ward. Our sample consists of 79 male and 44 female patients with an average age of 48.2 years (range 22-83 years). Of them, 83 had third-degree haemorrhoidal disease, 34 had fourth-degree and 6 had second-degree bleeding haemorrhoids. The follow-up period was 6-72 months. RESULTS: Pain was minimal or even not existent. Additional sutures or use of adrenaline 1:200.000 for haemostasis were required in 6 patients (4.8%). The bleeding has been diminished with the use of this new haemorrhoidectomy stapler PPH03. Urinary retention, which was observed in 3 patients (2.4%), was temporary and the use of catheter was not needed. As a late complication, 'faecal urgency' occurred in 8 patients (6.5%), and disappeared after some months. No recurrent haemorrhoidal disease occurred. No cases of chronic pain were reported. Average hospital stay was 1 day, except for 2 patients who remained for 2 days for bleeding observation. CONCLUSIONS: The correct application of SH reduces the possible complications. The advantages of the stapled procedure are reduced postoperative pain, the minimal hospital stay and early return to work.

Sentinel node biopsy before and after wide excision of the primary melanoma.

BACKGROUND: Initially, the technique of sentinel node biopsy involved the use of blue dye alone and was later supplemented with the use of an intraoperative probe after radiocolloid injection near the melanoma site. Ideally, it should be done before wide excision. To our knowledge, there is no information in the literature regarding the applicability or reliability of this technique after wide excision. METHODS: We conducted a retrospective review of 142 patients (1993-1999) with melanomas > or =1.0 mm or Clark's level > or =IV. Of these, 116 patients had prior biopsy only, and 26 had wide excision. The mean melanoma thickness was 2.5 mm. The location of the primary lesion was in the upper extremity in 42 patients, the lower extremity in 33, the trunk in 49, and the head and neck area in 18. RESULTS: The sentinel node was identified in 88 (93%) of 95 nodal basins using the blue dye alone and in 65 (98.5%) of 66 basins using dye plus probe. The sentinel node was positive in 35 (25%) of the 142 patients and 38 (24%) of the 161 nodal basins. In a mean follow-up of 30 months of 115 basins with negative sentinel nodes, 3 (3%) later developed a palpable positive node in the same basin. In the group of dye alone, the sentinel node was identified in 40 (100%) of 40 extremity primaries and in 48 (87%) of 55 trunk and head and neck primary lesions (P = .02). Nine (35%) of the 26 patients with previous wide excision (25 with primary closure or skin graft, 1 with flap rotation) and 10 (32%) of 31 of nodal basins had a positive node; in 8 of the 9 patients, the positive node was also the sentinel node. The only patient with a positive node incidentally removed along with a histologically negative sentinel node was the one with a previous wide excision and flap rotation. CONCLUSIONS: Previous wide excision of the melanoma does not appear to negate the reliability of sentinel node biopsy, provided that no flap rotation was used to cover the defect.