Minilaparotomic myomectomy for large symptomatic uterine myomas: a prospective study.

AIM: The aim of this paper was to evaluate the feasibility, morbidity, and reproductive performance of fertile women undergoing minilaparotomic myomectomy for large uterine myomas. METHODS: Ninety-nine consecutive women with symptomatic myomas underwent myomectomy through a skin incision ≤8 cm. Operative, postoperative and reproductive data were prospectively collected. RESULTS: Median (range) age and Body Mass Index (BMI) were 37 years (23-44) and 23 (18-43), respectively. Median (range) myoma diameter was 7 cm (4-20), and the median number of myomas removed was 1 (range 1-31). Myomas were intramural in 76 (76%) cases. Median incision length was 7 cm (range 4-13) and median duration of surgery was 70 min (range 40-180). Operative time and length of skin incision were not correlated with the progressive number of interventions. An incision larger than 8 cm was necessary in 7 (7%) patients and the length of incision was significantly correlated with the diameter of the largest myoma (P<0.01). The feasibility of minilaparotomy was significantly reduced when the diameter of the largest myoma was >12 cm (P<0.05). Operative time was significantly longer in patients having >1 myoma (P<0.05). Three (3%) patients underwent blood transfusion. Median (range) postoperative stay was 2 days (range 2-12). Fever occurred in 8 (8%) patients, and wound complications in 5 (5%). CONCLUSION: Myomectomy by minilaparotomy is a feasible procedure in more than 90% of unselected patients with large symptomatic myomas. Feasibility is questionable when the myoma is >12 cm. This technique is a mini-invasive option to treat patients with large and multiple myomas.

Dynamic synergy of graphitic nanoplatelets and multi-walled carbon nanotubes in polyetherimide nanocomposites.

Hybridizing graphitic nanoplatelets (GNP) with commercially functionalized multi-walled carbon nanotubes (MWCNTs) in a polyetherimide (PEI) composite at a total loading of 0.5 wt% resulted in considerable improvements in electrical conductivity, thermal conductivity and dynamic mechanical properties, compared to solely GNP or solely MWCNT composites at the same total loading. The results reveal a synergistic interaction between the GNPs and MWCNTs based on GNP protection against fragmentation of the MWCNTs during high power sonication, while still allowing full dispersion of both fillers, by providing a shielding mechanism against MWCNT damage during dispersion processing. A new process for molecular level dispersion of exfoliated GNPs in PEI is also reported. Field emission scanning electron microscopy revealed strong interactions between PEI and the flat surfaces of GNPs and effectively intercalated GNP morphology within the matrix. GNPs alone can also produce excellent electrical conductivity improvements: at 1.0 wt% of GNP, electrical conductivity of the composite increased by 11 orders of magnitude and the percolation threshold was determined to be between 0.5 and 1.0 wt% of GNP.

Detection of Coxiella burnetii in buffaloes aborted fetuses by IS111 DNA amplification: a preliminary report.

The aim of this study was to evaluate by PCR analyses the presence of Coxiella burnetii infection in fetuses of water buffalo (Bubalus bubalis) in the Campania region (Southern Italy). Samples were collected only from aborted fetuses and C. burnetii presence was evaluated by one-tube nested PCR amplification of the IS111 repetitive element. Of the 164 fetuses examined 14 (17.5%) were positive after DNA amplification, showing that C. burnetii occurs in this population of water buffaloes. However, more extensive prevalence studies need to be carried out to define the role of buffaloes as reservoirs for this pathogen and also the role of C. burnetii as an abortive agent in this animal.

Endometrial carcinoma: intraoperative evaluation of myometrial invasion. A prospective study.

AIM: The authors investigated the diagnostic value of intraoperative assessment of myometrial invasion in endometrial cancer patients. Following hysterectomy, the uterus was sectioned and macroscopically examined in order to assess the depth of myoinvasion, which was classified as <50% and >50%. In patients with macroscopic depth of invasion>30% and <50%, a frozen section of this area was carried out. The results of intraoperative evaluation were compared with the results of postoperative pathological examination. The agreement between methods was developed as generalized Kappa type statistic. Sensitivity, specificity, positive and negative predictive values for intraoperative only macro and macro/micro evaluation were calculated. METHODS: Seventy eight consecutive patients (median age 64 years, range 43-92; median Body Mass Index [BMI] 30.5, range 21.9-46.7) who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (THBSO) were included in the study. Following intraoperative macroscopic evaluation, frozen section was carried out in 15 (19%) patients. The median time to obtain the results was 16 min for macroscopic evaluation, and 29 min for the macro/micro assessment. RESULTS: Macroscopic only assessment correctly identified depth of myoinvasion in 91% of patients, while, when the frozen section was carried out, myoinvasion was correctly identified in 95% of patients. For macroscopic only and macro-micro assessment sensitivity and specificity were 76% and 98%, 86% and 98%, respectively. CONCLUSION: These data suggest that the frozen section may improve, the diagnostic value of macroscopic only intraoperative assessment of myometrial invasion in selected patients.

The role of cattle in the epidemiology of Echinococcus granulosus in an endemic area of southern Italy.

An epidemiological and molecular survey was conducted to investigate the role of cattle in the transmission chain of cystic echinococcosis (CE) in the Campania region of southern Italy. Out of a total of 434 cattle examined for CE, 45 (10.4%) were found infected. A total of 363 cysts were collected from the infected animals: 239 in the liver and 124 in the lungs. The cysts were either sterile (42.7%) or calcified/caseous (57.3%); no fertile cysts were found. Most of the cysts had sizes <3 cm (77.1%) and were unilocular (78.8%). The results of the linear regression model did not show any significant correlation between the age of infected cattle and the number of cysts. The sequencing of the mitochondrial cytochrome C oxidase subunit 1 (CO1) gene of 40 hydatid cysts produced sequences of 419 bp for each sample analyzed. Alignment of the obtained sequences with those present in GenBank showed 100% identity with the common sheep G1 (n=21 cysts), the Tasmanian sheep G2 (n=2 cysts), and the buffalo G3 (n=17 cysts) strains, which constitute the species Echinococcus granulosus sensu stricto. The findings reported in the present study show that CE is widespread in cattle bred in the Campania region of southern Italy. However, the absence of fertile cysts and of the cattle strain (G5, E. ortleppi) suggests that cattle would not have any role in the persistence of this important zoonosis but rather a role as indicators of CE infection in this endemic area.

Molecular update on cystic echinococcosis in cattle and water buffaloes of southern Italy.

Cystic echinococcosis (CE)--caused by the larval stage (hydatid cyst) of the cestode Echinococcus granulosus--is one of the most widespread zoonoses of veterinary and medical importance. Molecular techniques have allowed the identification of 10 different genotypes (G1-G10) of the parasite. The present paper is an update regarding the E. granulosus genotypes infecting water buffaloes and cattle bred in the Campania region of southern Italy. The molecular study was performed on 30 hydatid cysts (11 from water buffaloes and 19 from cattle). Two different mitochondrial DNA genes, namely the cytochrome c oxidase subunits 1 and the 12S ribosomal DNA (12S rDNA) were used as genetic markers. Three different genotypes of E. granulosus were unequivocally identified, i.e. the G1 (common sheep), G2 (Tasmanian sheep) and G3 (buffalo) genotypes, as well as some G1 and G2 variants. It should be noted that the present study demonstrated for the first time: (i) the presence of the G2 genotype in water buffaloes from a Mediterranean area; and (ii) the fact that the analysed portion of the 12S rDNA gene can not discriminate between the G2 and G3 genotypes of E. granulosus. The finding of the G1, G2 and G3 genotypes in large ruminants from southern Italy is of epidemiological relevance and immediate public health importance because of their recognized infectivity in humans.

Characterization of the 28S and the second internal transcribed spacer of ribosomal DNA of Dicrocoelium dendriticum and Dicrocoelium hospes.

Isolates of Dicrocoelium dendriticum (n=150) from sheep and cattle bred in southern Italy and isolates (n=5) of D. hospes from a Bos indicus from Senegal were characterized genetically. The 28S region and the second internal transcribed spacer (ITS-2) plus flanking 5.8S and 28S sequences (ITS-2+) of ribosomal DNA (rDNA) were amplified by polymerase chain reaction and sequenced from individual flukes. Regarding the 28S rDNA, sequences of 568 and 581 bp were obtained for D. dendriticum and D. hospes, respectively. No intraspecific variation was observed between the 28S rDNA of all the D. dendriticum specimens studied and the D. dendriticum 28S rDNA sequence present in GenBank. However, intraspecific variation was observed in the 28S rDNA of the D. hospes specimens compared to the sequence present in GenBank. Regarding the ITS2+ rDNA, sequences of 402 and 428 bp were obtained for D. dendriticum and D. hospes, respectively; both sequences were deposited in GenBank. Variations intra- and interpopulation were observed for D. dendriticum, whereas 100% identity was observed in all the ITS2+ sequences of D. hospes. With respect to the interspecific variations, the ITS-2+ of D. dendriticum and D. hospes differed in 33 positions. The findings of the present study showed an ITS2+ sequence variability (8.2-8.5%) between D. dendriticum and D. hospes, thus demonstrating the utility of this sequence to discriminate the two species.

A comparison of five methods for DNA isolation from liver and rumen flukes to perform ITS-2+ amplification.

Five different DNA isolation methods (4 commercial kits and a modification of phenol-chloroform method) were compared for the discrimination of adults of Fasciola hepatica and Dicrocoelium dendriticum (liver flukes), and Calicophoron daubneyi (rumen fluke) collected from sheep in southern Italy. The second internal transcribed spacer (ITS-2) of ribosomal DNA (rDNA) plus flanking 5.8S and 28S sequence (ITS-2+) was amplified by polymerase chain reaction (PCR) from serial diluted DNA templates (6 ng - 60 fg) of each fluke species. Overall, in terms of efficiency in detection limit, the best results were obtained either with phenol-chloroform purification or with QIAamp DNA Mini Kit (Qiagen), but using this latter method, rapid, safe and not expensive, an increased level of sensitivity sufficient to detect small amounts of target-DNA was achieved. In addition, electrophoresis analysis following PCR also showed that ITS-2+ could be useful as a genetic marker for the molecular identification of F. hepatica, D. dendriticum and C. daubneyi in definitive and intermediate hosts. Furthermore, for the first time, the ITS-2 sequence of D. dendriticum was defined.

Cystic echinococcosis in water buffaloes: epidemiological survey and molecular evidence of ovine (G1) and buffalo (G3) strains.

A survey of cystic echinococcosis (CE) in the water buffalo (Bubalus bubalis) of the Italian Mediterranean breed was carried out in Campania, a region of southern Italy. In addition, a molecular study was performed on 48 hydatid cysts coming from 48 water buffaloes in order to determine the Echinococcus granulosus strain(s) present in this host. Out of a total of 722 water buffaloes examined for CE, 76 (10.5%) were found infected. The average number of cysts per buffalo was 4.3 (minimum 1, maximum 45). Seventeen buffaloes had hydatid cysts only in the liver (with an average of 5 cysts/liver), 34 only in the lungs (with an average of 1.8 cysts/lungs), and 25 buffaloes had cysts both in the liver and in the lungs. Fertile cysts were found in 10 (13.2%) out of the 76 positive buffaloes. The sequencing of the mitochondrial cytochrome C oxidase subunit 1 (CO1) gene of the 48 hydatid cysts produced sequences of 419 bp for each sample analysed. For 33 samples, alignment of the obtained sequences with those present in GenBank showed a total homology with the common domestic sheep strain G1; for 15 samples, sequences obtained showed 100% homology with buffalo strain G3. The findings of the present survey represent the first epidemiological and molecular comprehensive studies on CE in water buffalo from an endemic area for E. granulosus.

Characterization of the second internal transcribed spacer of ribosomal DNA of Calicophoron daubneyi from various hosts and locations in southern Italy.

Isolates of the rumen fluke Calicophoron daubneyi (Digenea: Paramphistomidae) from various hosts and three locations in southern Italy were characterized genetically. The second internal transcribed spacer (ITS-2) of ribosomal DNA (rDNA) plus flanking 5.8S and 28S sequence (ITS-2+) was amplified from individual rumen flukes by PCR. PCR-linked restriction fragment length polymorphism (PCR-RFLP) analysis was performed using four different restriction endonucleases, and PCR products were sequenced. The PCR analyses from all the C. daubneyi specimens produced identical fragments, and the PCR-RFLP analyses did not show, with respect to any of the four restriction endonucleases, any differences between the C. daubneyi specimens. The sequence analyses of the ITS-2+ from each of the C. daubneyi specimens showed them all to be 428 bp, and composed of the entire ITS-2 sequence (282 bp) plus the two partial flanking conserved sequences, 5.8S (99 bp) and 28S (47 bp). No intra-specific variation was observed in the nucleotide composition of the ITS-2+ (homology=100%). There was, however, an observable inter-specific variation between the ITS-2+ of C. daubneyi and the ITS-2+ of both Calicophoron calicophorum (homology=97.2 %) and Calicophoronmicrobothrioides (homology=97.4 %), both previously deposited in the GenBank. The finding of the present study shows that, as has already demonstrated for other parasitic helminths, ITS-2 can serve as an effective genetic marker for the molecular identification of paramphistomes, and as a useful tool for developing molecular epidemiological techniques for the study of C. daubneyi transmission patterns and prevalence in definitive and intermediate hosts.

[Pathological modifications of the P wave due to probable primary changes in intra-atrial conduction]. / Modificazioni patologiche della P da probabili alterazioni primitive della conduzione intra-atriale.

Two cases of variable changes in ECG P oscillation not due, as is usually the case, to familiar cardiac or respiratory conditions suggested a review of the literature on the subject. It is concluded that these anomalies are the result of changes in the intra-atrial conduction of the stimulus through preferential ways or to aberrant atrial conduction. These are situations of no little practical interest because they may be precursors of major rhythm disturbances such as atrial flutter or atrial fibrillation.

[Echinococcal cysts of the adrenal glands. Review and diagnostic discussion]. / Le cisti da echinococco delle ghiandole surrenali. Inquadramento e discussione diagnostica.

Observation of an exceptional case of hydatid cyst of the suprarenal gland triggered an extensive review of the literature on the subject and an analysis of the disease from a historical-statistical, biological, aetiopathogenic, anatomopathological and clinical point of view. All these were analysed as an aid to diagnosis which is always difficult despite the many effective diagnostic tools now available. The difficulty derives essentially from the rarity of the condition and the fact that its clinical features often appear not to confirm or to underestimate the initial diagnostic suspicion.

Translational discrimination between embryonic and adult mouse globin mRNAs in the rabbit reticulocyte lysate system.

In the present study mouse adult (alpha, beta) and embryonic globin (x, y, z) mRNas are compared for their capacity of being translated in a micrococcus nuclease treated rabbit reticulocyte lysate. The results of these experiments indicate that: 1) alpha and beta adult RNAs are translated with a higher efficiency as compared to the alpha-like and beta-like embryonic mRNAs; 2) adult beta and embryonic beta-like messengers are translated more efficiently than their corresponding adult alpha and embryonic alpha-like messengers; 3) the alpha/beta synthetic ratio, both for adult and embryonic globins is highly dependent upon the concentration of globin mRNAs. For embryonic globins the ratio decreases from 0.21 at low mRNA concentration to 0.11 at high mRNA concentration. For adult globin mRNAs the alpha/beta chain synthetic ratio decreases from 1.4 to 0.9 within the same range of concentration.