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Aldo d'Alessandro,1 Sandro Mandolesi,2 Tarcisio Niglio,6 Augusto Orsini,3 Pierfrancesco Di Cello,3–5 Fabio Pelle,5 Fabio Mora,3 Alessandro d'Alessandro,4 Dimitri Mandolesi,7 Francesco Fedele2 1Department of Angiology, T Masselli–Mascia Hospital, San Severo (FG), Italy; 2Department of Cardio-vascular and Respiratory Sciences, Nephrology and Geriatric, Sapienza University, Rome, Italy; 3Department of Vascular Surgery, Gioia Hospital, Sora (FR), Italy; 4Faculty of Medicine, Catholic University "Our Lady of Good Counsel", Tirana, Albania; 5Department of Surgery, Sapienza University, Rome, Italy; 6Istituto Superiore di Sanità, Rome, Italy; 7Medicina del Lavoro, Sapienza University, Rome, Italy Objective: The aim of the present study was to assess the size of the third ventricle in a sample of patients with multiple sclerosis (MS) affected by chronic cerebrospinal venous insufficiency (CCSVI), versus size of the third ventricle in a healthy control group. Background: CCSVI, a new nosological vascular pattern, has recently been associated with MS. Methods: We enrolled 33 patients affected by MS (three in the primary progressive clinical course, 23 in the relapsing–remitting clinical course, and seven in the secondary–progressive clinical course). All patients had been affected by CCSVI and were tested using an echo color Doppler (ECD) imaging unit. The group of 33 affected by both MS and CCSVI (MS–CCSVI) was composed of 19 females and 14 males with a mean age of 40±10 years, from a minimum age of 20 years to a maximum age of 66 years, with a median of 40 years and a mode of 32 years. We compared the 33 MS–CCSVI patients with 33 healthy control subjects of similar sex and age. In the MS–CCSVI group, the MS clinical severity was expressed by expanded disability status scale (EDSS) score: light (19 patients, scoring 1, 2, or 3); medium (ten patients with a score of 4, 5, or 6), and severe (four patients with a score of 7, 8, or 9). The average duration of the MS was 10±7 years (from a minimum of 1 to a maximum of 26 years, with a median of 10 years and a mode of 1 year). Results: In the MS–CCSVI group, the third ventricle diameter was 6.2±1.7 mm (from a minimum of 2.5 mm to a maximum of 9.2 mm, with a median of 6.3 mm, and a mode of 6.0 mm). Our data showed that 29 patients (88%) had an increase in third ventricle diameter, whereas only four patients (12%) had physiological size (less than 4 mm) comparable to all healthy control group subjects (27.28%). These results show that the increase in the third ventricle diameter could represent a criterion of positivity of neurological disease in patients with CCSVI. Keywords: MS, CSSVI, increased size of the third ventricle&nbsp

Sinonasal adenocarcinoma is a tumor typically associated with exposure to occupational carcinogens. The International Agency for Research on Cancer (IARC) published several data in order to classify carcinogenic power of physical-chemical agents as far as sinonasal cancer is concerned.We report a clinical case of sinonasal adenocarcinoma observed in an 84 years old patient, without clinical history of past exposure to carcinogens, smoke and alcohol.A sinonasal adenocarcinoma in a patient without risk factors is extremely rare. It is very important to recognize this cancer at an early stage in order to give better survival rates to the patients.Carcinogens, Intestinal-type adenocarcinoma, Sinonasal cancer.L’adenocarcinoma naso sinusale è una neoplasia tipicamente associata all’esposizione di sostanze cancerogene occupazionali. Lo IARC (International Agency for Research on Cancer) ha pubblicato differenti tabelle che classificano, in base a studi e ricerche effettuate, le sostanze fisico-chimiche il base alla loro capacità di sviluppare il cancro nasosinusale. Numerosi ed approfonditi studi attribuiscono a questo tipo di neoplasia, un carattere prevalentemente occupazionale.

The improvement of the socio-economic conditions and the progress of medicine have extended the life span of the world's population and as a result, the number of patients with malignant neoplasms has increased. Gastric cancer is the third most common cancer (after lung and prostate) and the second leading cause of death caused by cancer (after lung bronchogenic cell carcinoma) in males; while it's the fifth cancer by frequency and the fourth cause of cancer death in females. It presents a peculiar geographical distribution with a lower incidence in Western Europe and North America, and higher incidence in the Far East, South America and Eastern Europe. Its incidence in Italy is 122 cases per 100000 inhabitants in males and 83 cases per 100000 inhabitants in females (in Italy). It occurs more frequently in old age, is quite rare in individuals under the age of 45. The aim of this work is to analyze the clinical and pathological characteristics of gastric carcinoma and the feasibility of curative surgery in patients over 75, identifying the factors affecting mortality, morbidity, survival and quality of life after surgery. These data have been compared with those of younger patients to assess the correct type of surgery.

Aim of this work was to investigate a possible correlation between the frequency of JCV-specific T-cells and PML occurrence in HIV-infected subjects and in liver transplant recipients. A significant decrease of JCV-specific T-cells was observed in HIV-PML subjects, highlighting a close relation between JCV-specific T-cell immune impairment and PML occurrence in HIV-subjects. Interestingly, liver-transplant recipients (LTR) showed a low frequency of JCV-specific T-cells, similar to HIV-PML subjects. Nevertheless, none of the enrolled LTR developed PML, suggesting the existence of different immunological mechanisms involved in the maintenance of a protective immune response in LTR.

Cervical radiation for head and neck cancer has been associated with an increased incidence of carotid arterial stenosis. Modern radiation therapy delivers higher doses with increasing long-term survival. In our study 50 patients with head and neck malignancies treated with radiotherapy are analized with colour Doppler ultrasonographic scanning of the carotid arteries. These patients were compared with a population of asymptomatic historical controls (40) These findings suggest that radiation has an adverse effect on large vessels. Colour Doppler follow-up may be indicated for patients receiving head and neck radiation therapy.50-70 Gy is the local dose that all patients received. during a period of about 8 weeks. The ecodoppler scan of carotid arteries was performed in all patients with estimation of Common and internal carotid artery's intimal medial thickness (IMT). Stenosis grade were divided into low (0-30%), moderate (31-49 %) and severe (=50%). In add we considered ematochimics and flogosys parameters. Patients recruited from a hospital Radiation-oncology-surgery department from April 2007 to September 2011, 90 consecutive head and neck cancer patients were enrolled in this study. 50 of these patients had previously undergone RT (RT group) and 40 had no RT (control group). All patients were screened with bilateral carotid arterial duplex ultrasonography. We defined disease as "normal or mild" if the carotid stenosis was50%, and "significant" if50%. The relationship between standard demographic risk factors and screening outcomes was then analyzed.We found that severe carotid stenosis (=50% ) was higher (41%) in patients who underwent to radiotherapy than in control group. The Eco Doppler examination demonstrated that the most affected site was Internal Carotid Arthery 's fork . There were no differences in age or gender between the two groups. The RT group had a significantly higher plaque score than the non-irradiated group. Bilateral plaque score was significantly correlated with age, hyperlipidemia, and RT. This analysis showed that in RT patients50 years old, age was inversely correlated with plaque score; however, in RT patientsor= 41 years old, age was positively correlated with plaque score.Literature evidences about this subject are few and similar to ours. Moritz et all found a severe carotid stenosis in 30% of irradiated and 5.6% in the control group. Lam found carotid stenosis in 78.9% of irradiated and 21.6% in the other group. We can conclude that radiotherapy is able to induce atherosclerotic lesions only in sites included in radiation field. Should be important to perform pre and post radiotherapy Carotid Arthery Ecodoppler of patients who are going to undergo cervical radiotherapy The prevalence of carotid arterial disease in patients with prior cervical radiation therapy is clinically significant and warrants aggressive screening as part of routine preradiation and postradiation care. Focused screening of this high-risk population may be cost effective and medically beneficial in terms of risk factor modification and stroke preventionCarotid stenosis, Cervical radiotherapy, Stroke prevention.Il trattamento radiante per il carcinoma di testa e collo è stata associata ad un’aumentata incidenza di stenosi carotidea. La moderna radioterapia offre dosi più elevate con incremento aumento della sopravvivenza a lungo termine. Nel nostro studio 50 pazienti con tumori maligni di testa e collo trattati con radioterapia sono stati analizzati con la scansione color-Doppler ultrasonografica delle arterie carotidee. Questi pazienti sono stati confrontati con una popolazione di controlli storici asintomatici (40). Questi risultati suggeriscono che la radiazione ha un effetto negativo sui grossi vasi. Un eco- Color Doppler di follow-up può essere indicato per i pazienti trattati con radioterapia della testa e del collo.50-70 Gy è la dose locale che tutti i pazienti hanno ricevuto durante un periodo di circa 8 settimane. La scansione Ecodoppler delle Arterie Carotidee è stata effettuata in tutti i pazienti con la stima dello spessore intimale mediale(IMT) dell’arteria carotide comune ed interna. Il grado di stenosi è stato diviso in: basso (0-30%), moderata (31-49%) e grave (=50%). In aggiunta abbiamo considerato parametri ematochimici e di flogosi. I pazienti sono stati reclutati da un Dipartimento ospedaliero di radiaterapia, oncologia e chirurgia dal mese di aprile 2007 a settembre 2011. Sono stati arruolati in questo studio 90 pazienti con cancro di testa e collo. Di questi pazienti, 50 erano stati precedentemente sottoposti a RT (gruppo RT) e 40 senza RT (gruppo di controllo). Tutti i pazienti sono stati sottoposti a screening con Ecografia Doppler delle Arterie Carotidee bilateralmente. Abbiamo definito la malattia come “normale o lieve” se la stenosi carotidea è stata50%, e “significativa“, se50%. La relazione tra i fattori di rischio demografici e gli esiti di screening è stata poi analizzata.Abbiamo trovato che la stenosi carotidea grave (=50%) è stata superiore (41%) nei pazienti sottoposti a radioterapia rispetto al gruppo di controllo. L’esame Eco Doppler ha dimostrato che il luogo più colpito è la biforcazione della Arteria Carotide Interna . Non ci sono state differenze di età o di genere tra i due gruppi. Il gruppo RT aveva un Punteggio di Placca significativamente più alto rispetto al gruppo non irradiato. Punteggio di Placca bilaterale è risultato significativamente correlato con l’età, iperlipidemia, e RT. Questa analisi ha mostrato che nei pazienti con RT50 anni, l’età è risultata inversamente correlata con il Punteggio di Placca, tuttavia, nei pazienti RT con età minore o uguale a 41 anni, l’età era positivamente correlata con il Punteggio di Placca.Le evidenze nella letteratura su questo argomento sono poche e simili alla nostra. Moritz et all hanno trovato una grave stenosi carotidea nel 30% dei pazienti irradiati e del 5,6% nel gruppo di controllo. Lam ha trovato una stenosi carotidea nel 78,9% dei pazienti irradiati e del 21,6% nel gruppo di controllo. Si può concludere che la radioterapia è in grado di indurre lesioni aterosclerotiche solo nei siti inclusi nel campo di radiazione.Dovrebbe essere importante effettuare una Ecografia color-Doppler delle arterie Carotidee pre e post radioterapia carotidea nei pazienti in procinto di sottoporsi a radioterapia della testa e del collo. La prevalenza della malattia arteriosa carotidea in pazienti con precedente radioterapia cervicale è clinicamente significativa e garantisce lo screening aggressivo come parte della routine e del trattamento pre e post radiazione. Lo screening mirato di questa popolazione ad alto rischio può essere efficace e medicalmente vantaggioso in termini di modificazione dei fattori di rischio e prevenzione dell’ictus.

This study is aimed at identifying the collateral circulation in case of femoral-aorta-iliac axis obstruction, with the purpose of a more correct therapeutic indication being either medical or surgical or physiotherapeutic or combined.

The IGF system has recently been shown to play an important role in the regulation of breast tumor cell proliferation. However, also breast density is currently considered as the strongest breast cancer risk factor. It is not yet clear whether these factors are interrelated and if and how they are influenced by menopausal status. The purpose of this study was to examine the possible effects of IGF-1 and IGFBP-3 and IGF-1/IGFBP-3 molar ratio on mammographic density stratified by menopausal status.A group of 341 Italian women were interviewed to collect the following data: family history of breast cancer, reproductive and menstrual factors, breast biopsies, previous administration of hormonal contraceptive therapy, hormone replacement therapy (HRT) in menopause and lifestyle information. A blood sample was drawn for determination of IGF-1, IGFBP-3 levels. IGF-1/ IGFBP-3 molar ratio was then calculated. On the basis of recent mammograms the women were divided into two groups: dense breast (DB) and non-dense breast (NDB). Student's t-test was employed to assess the association between breast density and plasma level of IGF-1, IGFBP-3 and molar ratio. To assess if this relationship was similar in subgroups of pre- and postmenopausal women, the study population was stratified by menopausal status and Student's t-test was performed. Finally, multivariate analysis was employed to evaluate if there were confounding factors that might influence the relationship between growth factors and breast density.The analysis of the relationship between mammographic density and plasma level of IGF-1, IGFBP-3 and IGF-1/ IGFBP-3 molar ratio showed that IGF-1 levels and molar ratio varied in the two groups resulting in higher mean values in the DB group (IGF-1: 109.6 versus 96.6 ng/ml; p= 0.001 and molar ratio 29.4 versus 25.5 ng/ml; p= 0.001) whereas IGFBP-3 showed similar values in both groups (DB and NDB). Analysis of plasma level of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio compared to breast density after stratification of the study population by menopausal status (premenopausal and postmenopausal) showed that there was no association between the plasma of growth factors and breast density, neither in premenopausal nor in postmenopausal patients. Multivariate analysis showed that only nulliparity, premenopausal status and body mass index (BMI) are determinants of breast density.Our study provides a strong evidence of a crude association between breast density and plasma levels of IGF-1 and molar ratio. On the basis of our results, it is reasonable to assume that the role of IGF-1 and molar ratio in the pathogenesis of breast cancer might be mediated through mammographic density. IGF-1 and molar ratio might thus increase the risk of cancer by increasing mammographic density.

To analyze clinical and laboratory findings in order to find variables predictive of severity of Biliary Peritonitis (BP).Physical findings, course of illness, imaging and laboratory data were evaluated in 22 patients with BP, and statistically analysed to assess their prognostic significance.Serious illness and worse outcome were associated with: age60 years (P= 0.034), long time between onset of symptoms and treatment (P= 0.025), fever38°C (P= 0.009), WBC count17.000 cell/mm3 (P=0.043), diffuse abdominal pain (P= 0.034), and infected bile (P= 0.048).Most patients become severely ill due to supervening infection, while early bile drainage avoids serious complications. In addition, abdominal pain, fever and WBC count are also predictive of severity of BP.

The present investigation was specifically designed to evaluate the ability of the glycerol test combined with pure-tone audiometry, distortion-product otoacoustic emissions (DPOAEs) to diagnose endolymphatic hydrops early and to identify patients who may evolve toward Meniere's disease. This investigation consisted of 43 consecutive patients with daily episodes of tinnitus with duration exceeding few hours or with continuous tinnitus who received no treatment. These were the unique symptoms reported by the patients. Each patient underwent glycerol testing measured with conventional pure tone audiometry and with distortion product otoacoustic emissions (DPOAEs). For the traditional pure-tone glycerol test a hearing improvement of at least 10 dB, at the lower two or three frequencies (125,250 and 500 Hz) was judged as positive result. For the DPOAEs glycerol testing, a smaller positive difference (5 dB) for at least three frequencies was interpreted as a significant fluctuation. Twenty four patients showed negative glycerol test both with pure tone audiometry and DPOAEs. In 7 cases the improvement was concurrently observed. In 9 patients post-glycerol changes appeared only in the DPOAEs outcomes. Finally the remaining three patients had two different patterns. Two had different ameliorations of the DPOAEs and pure-audiometry on the left and right sides respectively, and in the last one only post-glycerol, audiograms recovered. The present study re-confirms the potentiality of DPOAEs associated with glycerol test in diagnosing endolymphatic hydrops precociously. The possibility of these patients degenerating into Meniere's disease should not be underestimated.