Duodenal tumors: four case reports.

We report 4 cases of neuroendocrine tumors of the duodenum. Signs and symptoms were non-specific. The choice of surgery depended on the site and stage of the tumor and any concomitant diseases.

Effect of primary coronary intervention on heart rate variability and left ventricular function in patients with acute myocardial infarction.

AIM: Several studies showed that primary percutaneous coronary interventions (PCI) have a favourable impact on left ventricular remodeling and heart rate variability (HRV) both at short- and long-term follow-up in patients suffering an acute myocardial infarction (AMI). However, no previous study investigated the relationship between left ventricular remodeling and changes in HRV during follow-up in AMI patients treated by primary PCI. METHODS: We studied 28 patients with AMI (57+/-8 years, 27 men), treated by PCI within 12 hours of symptom onset. Patients underwent a 24-hour ECG Holter recording and left ventricular ejection fraction (LVEF) echocardiographic assessment before discharge, and at 1-month and 6-month follow-up. HRV was measured in the time- and frequency-domain. RESULTS: A significant improvement of both time- and frequency-domain HRV variables was observed at 1-month and at 6-month follow-up with the most significant changes being found for standard deviation of normal-normal beat intervals (SDNN) in the time-domain (95.5+/-26.1 ms vs 125.5+/-29.8 ms vs 142.8+/-28.8 ms, respectively; P<0.001) and for very low frequency (VLF) amplitude in the frequency-domain (36.7+/-9.8 ms vs 44.1+/-11.1 vs 48.9+/-12.2 ms, respectively; P<0.001). In contrast, compared to basal values, LVEF was substantially unchanged at 1-month and 6-month follow-up (48.8+/-8.5% vs 50.8+/-10% vs 49.6+/-9%, respectively; P=0.25). At 6-month follow-up 11 patients showed an improvement of >or= 5% of LVEF, whereas 17 patients did not show any improvement of LVEF. HRV variables significantly improved in a similar way in these two subgroups both at 1-month and at 6-month follow-up. CONCLUSION: Our data demonstrate that, in AMI patients treated by primary PCI, HRV improves over time, independent of changes in LVEF. The clinical implications of these findings deserve to be addressed in future studies.

[Secretory IgA of the cervical mucus in neoplastic and nonneoplastic conditions of the uterine cervix]. / IgA secretorie del muco cervicale in condizioni neoplastiche e non neoplastiche della cervice uterina.

In 39 women affected by cervical intraepithelial neoplasia (CIN) concentration of the cervical mucus secretory IgA (sIgA) was significantly higher than in 414 controls matched for age, reproductive status and smoking habit (196 healthy women; 109 with "specific" and "aspecific" cervicitis or cervico-vaginitis; 51 with benign epithelial disorders of the cervix; 40 with adenomatous cervical polyp and 18 with early invasive exocervical squamous carcinoma). CIN carried the highest proportion of cases with sIgA detectable or beyond the cut-off value and sIgA concentration was inversely related to CIN grade. Present data confirm our preliminary investigation on the cervical total IgA and explain that any increased levels of these IgA are induced by the secretory and not serum fraction of this immunoglobulin. We still don't know the exact meaning and value of the present results. It is only possible to suppose that they are the expression of a vigorous local immune activation adverse to CIN, which is elevated for as long as the architecture of cervical glandular epithelia is preserved.

Alexithymia, immunity and cervical intraepithelial neoplasia: replication.

BACKGROUND: In a previous study [Psychother Psychosom 1994;61:199-204] we investigated the relationship between alexithymia, carcinogenesis and immunity in a group of women who were unconscious sufferers from precancerous lesions of the cervix (CIN). The results of this study showed a high level of association between alexithymia and CIN and, an even more interesting fact, between alexithymia and reduced levels of immunity. METHODS: The aim of the present study is to check the results of the previous one by testing a larger group (43 women affected by cervical dysplasia and 67 healthy women) and by the use of a self-administered test for detection of alexithymia, the well-validated Twenty-Item Toronto Alexithymia Scale (TAS-20). RESULTS: The results confirm that women suffering from CIN have higher average TAS-20 ratings (55) than normal women (47.32) and that the level of alexithymia detected in the group of women suffering from dysplasia (42.5%) is higher than that of normal women (12.85%). Moreover, the present study confirms that alexithymic women have lower rates of a number of lymphocyte subsets than non-alexithymic women. CONCLUSIONS: This study fully confirms the results of our previous work and those of a number of other studies: (1) personality might be one of the factors jointly responsible for the outbreak of cancer; (2) the immune system appears to play an important part as a mediator between personality and cancer.

[Blood groups of the ABO system and survival rate in gynecologic tumors]. / Gruppi sanguigni del sistema ABO e sopravvivenza nei tumori ginecologici.

A retrospective analysis of 968 women affected by gynecological tumors was conducted to assess the existence of a difference in survival between patients with different blood groups. Data are presented on 237 cases of endometrial cancer, 92 cases of ovarian cancer and 639 cases of invasive cervix cancer, detailing their ABO blood antigenic phenotypes, the stage of neoplasia and the treatment received. With regard to endometrial cancer, a sensibly better 5-year and 10-year survival is associated with blood group 0 if compared with blood group A. This finding is more evident when 5-year survival is considered among patients affected by ovarian cancer. With regard to cervical cancer, analysis showed that a little better than 5-year survival is associated with 0 blood phenotype; on the contrary, when a 10-year or longer survival is considered, a better survival is associated with A blood phenotype. The present study confirms evidence of an association between the A blood group and gynecological tumors. Endometrial and ovarian cancer occur more frequently in women with blood type A than in those with the other blood types, moreover, in the same tumors blood group A is associated with a poor prognosis. The possible reason for these findings are discussed with detailed regard to the possible biological importance that, at present, is conferred to the ABO group system in the complex activities of the immune system.

Cervical mucus secretory IgA in adenomatous polyp, intraepithelial neoplasia and squamous cell carcinoma of the cervix.

Cervical mucus secretory IgA concentration ([sIgAc]) was significantly higher in 36 CIN (cervical intraepithelial neoplasia) patients than in 360, age, reproductive status and smoking habit-matched controls. Also, CIN ranked first compared with adenomatous polyp (29 cases), primary or secondary invasive esocervical carcinoma (IEC) (21), ectropion/erosion (49) and specific (27) or aspecific (80) cervicitis. CIN carried the highest proportion of cases with [sIgAc] detectable (86%) or beyond the cut-off value (33%) (IEC: 14% and 0%, respectively). [sIgAc] was inversely related to CIN grade and higher, though nonsignificantly, in patients with HPV-positive CIN biopsy specimens. Histologic and immunologic factors can account for the differences in [sIgAc] observed within the spectrum of neoplastic lesions of the cervix.

Alexithymia, immunity and cervical intraepithelial neoplasia: a pilot study.

Alexithymia and circulating lymphocyte subsets were studied in 62 women [36 healthy women and 26 women affected by cervical intraepithelial neoplasia (CIN I, II, III) who were not aware of their status] in order to assess a possible relationship between alexithymia, CIN and immunological lymphocytic functions. Alexithymia was estimated by the 20-item Schalling-Sifneos Personality Scale and then correlated with peripheral blood lymphocyte subsets. The results of our study report an association between alexithymia and CIN. Alexithymic women show lower rates of almost all lymphocytic subsets compared to nonalexithymic ones. The difference was also found between alexithymic women affected by CIN and alexithymic women with an unsuspicious Pap smear. On the whole, these preliminary results seem to confirm data reported by other authors who hypothesized that a certain personality trait characterized by emotional inhibition is related to a greater cancer vulnerability. Such relationships might be mediated by certain lymphocytic functions as the result of the alexithymic status. Results reported here need more extensive surveys, in order to control potentially confounding factors related to the personality assessment of the subjects in this study.

Cervical smear total IgA in adenomatous polyp, dysplasia and carcinoma of the cervix.

Cervical smear total IgA (IgAc) concentration was determined in cervicitis and proliferative disorders of the cervical epithelium. All disorders except adenomatous polyp showed increased median IgAc levels as compared with healthy controls, in both the reproductive and the postmenopausal ages. In the former age group dysplasia exhibited the highest median IgAc level, while in the latter it ranked, second following specific cervicitis. Though differences between disease groups and controls were statistically non significant, they attained percent values as large as +277% (dysplasia, postmenopausal) and +596.9% (specific cervicitis, postmenopausal). Separate quantitation of the dimeric secretory and monomeric serum-derived components of total IgAc will provide more meaningful information.