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Warfarin-related nephropathy (WRN) is a renal complication of warfarin treatment associated with over-anticoagulation. We describe a case of a 73-year-old man affected by chronic kidney disease, essential hypertension and atrial fibrillation treated with warfarin. The patient presented a rapid course of kidney failure after many episodes of over-anticoagulation, and renal biopsy demonstrated WRN. Interestingly, the patient's warfarin pharmacogenetic profile showed that he was warfarin sensitive. This is the first report describing the presence of gene polymorphisms affecting warfarin metabolism in a subject with a biopsy-proven WRN. The patient was treated with corticosteroids obtaining a partial clinical response.

Aims and Background: Malignant mesothelioma developing at very old ages is a rare event. The reasons for such late development were investigated., Methods: A series of 811 malignant mesothelioma of the pleura, diagnosed at the Trieste and Monfalcone Hospitals, in northeastern Italy, in the period 1968-2008 were reviewed. Eight cases regarding patients aged 90 years or more were selected. In such cases, occupational histories were re-examined, and additional data could be obtained from the patients' relatives. Routine lung sections obtained at necropsy were examined for asbestos bodies. In 2 cases, asbestos bodies had been isolated after chemical digestion of lung tissue., Results: The group included 7 men and one woman, aged between 90 and 93 years. All 8 patients had long-term histories of occupational exposure to asbestos, mostly in shipyards. Latency periods, elapsed between first exposure to asbestos and tumor manifestation, ranged between 64 and 75 years. Asbestos bodies were found on routine lung sections in 6 cases. Isolation of lung asbestos bodies showed 72,000 bodies per gram of dried tissue in a 90-year-old man, who had worked in the shipyards for 34 years, and 150 bodies per gram in a 93-year-old woman, who had worked in the shipyards for 23 years., Conclusions: In this group of cases, the late development of mesothelioma can not be attributed to mild exposure to asbestos or to unusually late exposures. Very long latency periods even in people heavily exposed suggest an individual resistance to the oncogenic effects of asbestos.

Mortality of non-operated patients suffering from necrotizing pancreatitis is very high, while at those operated is considerably less but not satisfactory. Because of in 1976 we have managed our own modified treatment which includes surgical removal of all necrotic tissue followed by the hypothermic continuous peritoneal lavage-drainage procedure for evacuation of residual devitalized dead tissue and elimination biologically active substances. Using this curative method, we succeeded to reduce mortality rate to 26 percent.

Chronic, severe reflux esophagitis can be complicated with an esophageal ulcer (EU), whose histomorphological characteristics change sensibly. Between 1983 and 1989, 18 EU were endoscopically identified in 13 (6%) out of 217 patients with chronic gastroesophageal reflux (GER). 2 groups were defined: EU and esophagitis, without columnar-lined esophagus and EU with localized columnar metaplasia or Barrett's esophagus. In the first, 4 Wolf's ulcers (WU) were present; in the second, there were 8 Barrett's ulcers (BU), 2 Savary's ulcers (SU) and 4 ulcers with intermediary characteristics (IU). The 24 h esophageal Ph monitoring demonstrated the reflux pathogenesis in all the patients (57%: alkaline reflux). The histomorphological findings of the EU could support the hypotesis that their variety is related to the different stage of the reflux disease. The EU, started as a peptic lesion on a stratified squamous mucosa (WU), due to an acid, alkaline or mixed reflux, would macroscopically turn into a BU, through intermediary entities (SU, IU), with a progressive extension of columnar metaplasia to the adjacent epithelium and walls. It's not possible to exclude the primitive development of the BU in a Barrett's mucosa, because of an alkaline reflux or because of a low mucosa's resistance (specialized columnar epithelium) to a prolonged acid exposure.

In order to assess the accuracy of CT and MRI in evaluating the local extent of rectal carcinoma, 22 patients with a rectoscopic diagnosis of rectal cancer were examined before surgery with both techniques. Tumor extent into the perirectal fat, involvement of surrounding structures and local adenopathy were evaluated on both CT and MR images. These findings were compared with the micro- and macrohistologic findings obtained from the surgical specimens. As far as perirectal fat infiltration is concerned, the diagnostic accuracy of CT was 73% and that of MRI was 71%. Sensitivity was 100% for CT and 91% for MRI, while specificity was low for both techniques (45% for CT and 50% for MRI). In evaluating local adenopathy, CT accuracy was 82% and MR accuracy was 90%, with 89% sensitivity for both techniques and 77% specificity for CT and 92% for MRI. The overall accuracy was 59% for CT and 67% for MRI. In agreement with literature data, our study shows a similar accuracy for CT and MRI in evaluating the local extent of rectal carcinomas. Moreover, our results confirm the value of macrohistology in the local staging of rectal carcinoma and its prognostic value, as well as the low specificity of both CT and MRI in evaluating lesion spread into the perirectal fat.

We report a case of carcinosarcoma and separate neuroendocrine malignant tumor of the gastric stump. The case is interesting because of its unique pathological features and it confirms the role of the gastric stump as a very important "malignancy promoter".

Schwannomas of the pancreas are rare and their number is lower than is usually reported in the literature since some were probably neurofibromas. We report a further case characterized by cystic feature, clinically mimicking a pancreatic pseudocyst. Cystic lesions of the pancreas also comprise the schwannomas, both benign or malignant, as has been previously reported and is stressed by the present case. Cyst formation characterizes many diseases of the pancreas, both neoplastic and not. Difficulties in the differential diagnosis of cysts are fortunately reduced by the preponderance of pseudocysts (i.e. non-neoplastic cysts) and, among neoplastic ones, of cystadenomas and cystadenocarcinomas. As a consequence, uncommon cystic neoplasms are neglected and very often misdiagnosed. We reported a case of solitary schwannoma mimicking a pancreatic pseudocyst, interesting both because of its rarity and because of its cystic feature which was previously reported in the literature but not emphasized.