A long-time presence of a foreign body in an episiotomy scar

OBJECTIVES: The object of our study was a long-time presence of a foreign body in an episiotomy scar. STUDY DESIGN: A case of 46-year old woman with a palpable tumour in a perineal region is described. RESULTS: This false tumour was caused by a surgical needle which was left in the body of the patient 19 years ago during the episiorrhaphy after the last labour. CONCLUSION: Because of a character and localisation of the change the method of choice was surgical treatment which completely eliminated all symptoms.     

The concentration levels of airborne quartz at an urban site

The IARC has recently included crystalline silica among substances considered carcinogenic for man. This new evaluation immediately posed the need to measure the exposure levels of the general population. The paper reports the results of measurements of the concentrations of quartz (i.e., the most common form of crystalline silica) in a location in the urban area of Rome. First we studied the respirable fractions of the airborne particles (PM10) sampled in the Spring of 1996 with a cascade impactor, which were characterized using a scanning electron microscope equipped with an X-ray microprobe. Ten components were identified including total silica (crystalline and amorphous), which was present in a percentage of 3.7% on average. On the basis of these data a methodological study was undertaken of the concentration of quartz in the historic series of PM10 sampled daily at the same site by means of an AMP instrument (Airborne Particles Monitor). The filters of mixed cellulose esters on which the PM10 was collected were incinerated at low temperature in oxygen plasma to eliminate the organic component. The residue was deposited on silver filters which were read with a conventional X-ray diffractometer in order to determine the quantity of quartz. We analyzed 28 filters from four representative weeks of the four seasons of 1994, the year in which systematic sampling was initiated. The results showed a mean weekly concentration of airborne quartz of between 0.6 and 1.5 micrograms/Nmc, which gives a percentage over PM10 of 1.7 and 3.4 respectively. These data substantially agree with previous results obtained with electron microscopy and show that the levels of quartz in the urban atmosphere under study were about one hundred times lower than the TLV currently recommended by the ACGIH for working environments (100 micrograms/Nmc) and which are also in force in Italy.     

B7 costimulatory requirements of T cells at an inflammatory site

The requirement for T cell costimulation at sites of infection and inflammation is unresolved. Herpes stromal keratitis (HSK) is a CD4+ T cell-regulated inflammatory response to herpes simplex virus type 1 infection of the cornea. Our findings suggest that susceptibility to HSK is determined by the microenvironment of the infected cornea. The cornea is normally devoid of Langerhans cells (LC), but these APC are present in the surrounding conjunctiva, and migrate into the cornea following infection. The costimulatory molecule B7-2 was constitutively expressed on LC in conjunctiva, but B7-1 was not detectable until 3 days postinfection. LC were the only cells in the cornea that expressed B7-1 through 7 days postinfection. B7-1 was expressed on some, but not all, migrating LC, suggesting that LC migration and B7-1 expression can be independently regulated. The early LC migration and B7-1 expression was independent of T cells, but T cells were required for the massive accumulation of B7-1+ LC in the cornea at the onset of inflammation. Local inhibition of B7-1 function within the infected cornea prevented HSK. Locally blocking B7-2 function did not reduce HSK incidence, but markedly reduce HSK severity. This is the first direct demonstration that naturally expressed B7 is required within an inflammatory site.     

Adenocarcinoma arising at an ileostomy site: report of a case

A case is reported of a 60-year-old man, who developed an adenocarcinoma in the abdominal wall adjoining an ileostomy. Thirty-one years previously a total colectomy was performed for ulcerative colitis. Because of extensive prolapse the ileostomy was excised 6 years before the final operation, and a fresh part of the ileum, 10 cm proximal to the original stoma, was reimplanted in the abdominal wall at the same location. The pathogenesis of the malignant growth is uncertain; several possibilities as to the course of events at the ileostomy and surrounding skin are discussed.     

Neoplasms at the site of ureterocolic anastomosis

This paper discusses one of the more uncommon sequelae of ureterocolic anastomosis, namely the formation of tumours at the site of anastomosis. This is a very rare complication and until 1971 the literature recorded only 28 cases of this phenomenon. This present communication adds 2 more cases to the literature--a unilateral tumour and bilateral tumours at the site of anastomosis.     

Successful treatment with fluconazole of protothecosis developing at the site of an intralesional corticosteroid injection

We report a case of cutaneous protothecosis treated successfully with oral fluconazole. Fluconazole appears to be an effective alternative to conventional drugs for the treatment of cutaneous protothecosis. Cutaneous protothecosis is an uncommon infection due to achlorophyllic, saprophytic, algae-like unicellular organisms of the genus Prototheca that occurs mainly in immunocompromised patients. To date there is no standard treatment regimen. Surgical excision, oral ketoconazole, intravenous amphotericin B alone or in combination with oral tetracycline have been reported to be effective in the management of protothecosis. We report a 55-year-old immunocompetent woman with cutaneous protothecosis which developed at the site of intralesional triamcinolone acetonide injection, who was successfully treated with oral fluconazole.     

Endometrioma of the perineum associated with episiotomy scars

Two cases of endometrioma occurring in the perineum, associated with episiotomy scars and involving the external anal sphincter are described. Previous similar cases in the literature are reviewed and discussed. Misdiagnosis of this uncommon lesion is the rule when it is seen outside gynaecological practice. If, however, its existence is appreciated then correct diagnosis is simple and treatment is straight forward.     

Malignant mesenchymoma arising in an incisional scar of the abdominal wall

A case of malignant mesenchymoma of the anterior abdominal wall, composed of leiomyosarcoma, chondrosarcoma and osteosarcoma is described. The tumour, arising in the old scar of a previous operation, was completely removed surgically. Eleven months after the operation the patient is well with no evidence of recurrence. There have been no previous reports of malignant mesenchymoma developing in operation scars. We believe that this traumatic factor played a significant role in the aetiology of this rare soft-tissue neoplasm.     

Cytokine patterns at the site of mycobacterial infection

Distinct patterns of T cell cytokine production have been shown to influence the outcome of infection in mouse models and humans. Th1 or Type 1 cytokines, interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) are generally associated with resistance to infection, whereas Th2 or Type 2 cytokines, IL-4 and IL-10 are associated with progressive disease. Leprosy is a useful model for studying the role of cytokines in modulating T cell responses in human infectious disease. Infection by Mycobacterium leprae results in disease manifestations that encompass an immunological spectrum. Tuberculoid patients are able to restrict the growth of the pathogen and mount strong T cell responses to M. leprae. In contrast, lepromatous patients manifest disseminated infection and their T cells weakly respond to M. leprae. We have found that tuberculoid leprosy lesions have a predominance of CD4+ T cells producing the Type 1 cytokine pattern. Secondly, IL-12 mRNA was expressed at 10-fold higher levels in tuberculoid lesions as compared to lepromatous lesions and that IL-12 promotes the selective expansion of the Type 1 cytokine producing cells. In contrast, lepromatous lesions contain CD8+ IL-4-producing cells that suppress antigen-specific T cell responses and promote the outgrowth of additional suppressor T cells. IL-10, also expressed at higher levels in lepromatous as compared to tuberculoid lesions, was found to be produced by macrophages, effectively inhibiting cytokine production and macrophage activity.     

Affinity cleavage at the metal-binding site of phosphoenolpyruvate carboxykinase

Chicken liver phosphoenolpyruvate carboxykinase (PEPCK) was rapidly inactivated by micromolar concentrations of ferrous sulfate in the presence of ascorbate at pH 7.4. Omitting ascorbate or replacing the Fe2+ with Mn2+ or Mg2+ gives no inactivation. Mn2+, Mg2+, or Co2+ at 100-fold molar excess over Fe2+ offered complete protection from Fe2+/ascorbate-induced inactivation. The substrates PEP and GTP, but not OAA, GDP, or CO2, offered full protection from inactivation. The addition of 5 mM EDTA stopped further inactivation of the enzyme. Thermodynamic studies indicate that the inactive enzyme no longer binds Mn2+ but still had high affinity for GTP indicating that the inactivation process was specific for the metal site. A decrease in cysteine content was observed over time following PEPCK treatment with Fe2+ and ascorbate. The apparent first-order rate constant for free sulfhydryl loss (0.085 +/- 0.005 min-1) is similar to the apparent first-order rate constant for inactivation (0.067 +/- 0.005 min-1). Amino acid composition analysis revealed that cysteic acid was generated upon Fe2+/ascorbate addition to PEPCK. Native chicken liver PEPCK has an Mr of 67 kDa. SDS-PAGE of the inactivated enzyme showed the presence of two new bands at 31.7 and 35.3 kDa indicating that PEPCK was specifically cleaved at a single site. The rate of cleavage was slower than the rate of inactivation and fully inactivated enzyme was only 50% cleaved. The Fe2+/ascorbate-catalyzed inactivation was not solely due to protein cleavage. The protein fragments generated by cleavage were separated by C4 reverse phase HPLC. The cleavage exposed a new N-terminus which was identified to be the 35.3 kDa C-terminal half of PEPCK. Sequencing of the fragments indicated that the site of cleavage was between Asp296 and Ile297. These results indicate that Asp296 is involved in metal chelation. This agrees with previous studies [Hlavaty, J. J., & Nowak, T. (1997) Biochemistry 36, 3389-3403] that suggested that Asp295 and Asp296 are involved in metal binding.     

Factors associated with the use of episiotomy during vaginal delivery

OBJECTIVE: To examine factors associated with the performance of episiotomy. METHODS: A retrospective review was performed on 8647 deliveries during 1991 and 1992 at five medical centers. Episiotomy rates were compared based on variables involving patient demographics, obstetric condition, and physician factors for the 6458 vaginal deliveries in the sample. Logistic regression modeling using variables associated in bivariate analysis was performed to examine independent effects of each variable. RESULTS: Several characteristics of the patient, her clinical status, and physician factors were all associated with episiotomy use. The strongest independent predictors of episiotomy were nulliparity (odds ratio [OR] 4.10, 95% confidence interval [CI] 3.59-4.68) and the use of forceps (OR 5.03, 95% CI 3.39-7.46) or vacuum extraction (OR 3.78, 95% CI 2.36-6.04). Provider specialty and the site of care were also associated independently with episiotomy. Episiotomy use was also associated with major perineal lacerations and an increased length of hospital stay. CONCLUSION: Although differences in episiotomy rates mainly reflect clinical circumstances, important site-to-site variations and interspecialty differences point to potential areas where physician behaviors influence the performance of episiotomy.     

Selective episiotomy. Comparison of two suture technics

AIMS: The study aimed to highlight any differences between the sequelae of episiorrhaphy performed using the Blair-Donatti and Guilmen-Pontonnier techniques. METHODS: A total of 202 pregnant women were recruited in the Obstetrics Ward of Codogno Civic Hospital in 1994 and 1995. Subjects were randomly divided into two groups matched for socioeconomic status, age and parity (group A: Guilmen-Pontonnier suture, group B: Blair-Donatti suture). The following parameters were evaluated: pain twenty-four hours, sixty-six hours and one, two and three months after labour, pain during sexual relations, the onset of infection, hematoma, dehiscence of the wound, and lastly the cosmetic results. RESULTS: No significant differences were found between the parameters examined in both groups, barring the improved cosmetic result in group A.