Adenoidal Disease and Chronic Rhinosinusitis in Children-Is there a Link?

Adenoid hypertrophy (AH) is an extremely common condition in the pediatric and adolescent populations that can lead to various medical conditions, including acute rhinosusitis, with a percentage of these progressing to chronic rhinosinusitis (CRS). The relationship between AH and pediatric CRS has been extensively studied over the past few years and clinical consensus on the treatment has now been reached, allowing this treatment to become the preferred clinical practice. The purpose of this study is to review existing literature and data on the relationship between AH and CRS and the options for treatment. A systematic literature review was performed using a search line for "(Adenoiditis or Adenoid Hypertrophy) and Sinusitis and (Pediatric or Children)". At the end of the evaluation, 36 complete texts were analyzed, 17 of which were considered eligible for the final study, dating from 1997 to 2018. The total population of children assessed in the various studies was of 2371. The studies were categorized as surgical-observational, microbiological, genetic-immunological, and radiological. The analysis of the studies confirms the relationship between AH and CRS and supports the existing consensus on medical and surgical therapy. Furthermore, these studies underline the necessity to adapt medical and surgical treatment considering age, comorbidities including asthma and, if present, the Computed Tomography (CT) score

Mini-invasive approach to preneoplastic and neoplastic endometrial lesions. Comparative study among histological, cytological and immunohistochemical diagnosis

Objective: To compare the accuracy of cytology plus immunoistochemistry vs histology in the preoperative diagnosis of endometrial malignancy. Methods: We prospectively analyzed 142 women with a proliferative endometrial lesion undergoing operative hysteroscopy (ISC): at the time of ISC, the fluid used for saline contrast sonohysterography (SCSH) was collected for cytological analysis and compared to histology. In 9 women a markers board (Notch-1+ER-\u3b1+PR-\u3b2) expression was analyzed semiquantitatively in term of presence and intensity, on both glandular and stromal samples. Results: Table 1 shows the comparison between cytological and histological diagnosis. ISC histological results Benign Lesions n=134 Malignant Lesions n=8 Endometrial Polyps n=124 Hypertrophy n=3 Typical hyperplasia n=7 Atypical hyperplasia n=4 Cancer n=4 CTM - 0 0 0 0 0 CTM + 0 0 0 0 3 SCSH cytological results Atypia - 116 3 6 1 0 Atypia + 2 0 0 3 3 Inadequate (5%) 5 (4 cervical cells) (1 scant sample) 0 1 (1 cervical cells) 0 1 (hypocellulated) Cytological sampling was inadequate in 7 cases (5%). The K value between cytology and histology was 98.4% for benign and 85.7% for malignant lesions. Notch-1 revealed a changing expression pattern: absent in benign lesions, focal and marked in atypical hyperplasia and widespread and marked in cancers. Moreover Notch-1 expression was mild and focal in originally cyto-hystologycal benign lesions which turned into atypical hyperplasia during follow up. In cancer cases, ER-\u3b1 and PR-\u3b2 were widespread and markedly expressed either in the glandular or stromal layer. Conclusions: Cytological analysis could be used as a screening test, at least for women at high surgical risk. Notch-1+ER-\u3b1+PR-\u3b2 expression could be predictive for the risk of endometrial malignancy even at an earlier stadium than hyperplasia and could be used to identify the glandular or stromal origin of cancer thus helping in identifying women at increased risk of malignancy

Neuroprotection, Recovery of Function and Endogenous Neurogenesis in Traumatic Spinal Cord Injury Following Transplantation of Activated Adipose Tissue

Spinal cord injury (SCI) is a devastating disease, which leads to paralysis and is associated to substantially high costs for the individual and society. At present, no effective therapies are available. Here, the use of mechanically-activated lipoaspirate adipose tissue (MALS) in a murine experimental model of SCI is presented. Our results show that, following acute intraspinal MALS transplantation, there is an engraftment at injury site with the acute powerful inhibition of the posttraumatic inflammatory response, followed by a significant progressive improvement in recovery of function. This is accompanied by spinal cord tissue preservation at the lesion site with the promotion of endogenous neurogenesis as indicated by the significant increase of Nestin-positive cells in perilesional areas. Cells originated from MALS infiltrate profoundly the recipient cord, while the extra-dural fat transplant is gradually impoverished in stromal cells. Altogether, these novel results suggest the potential of MALS application in the promotion of recovery in SCI

Abnormal spiral arteries modification in stillbirths : the role of maternal pre-pregnancy body mass index

Aim: to evaluate the prevalence of abnormal spiral arteries modification (ASAM) in stillbirths and its anatomo-clinical correlations. Methods: 203 placentas of stillbirth 6520 weeks of gestation were analysed. Results: ASAM was present in 69/203 cases (33.9%). The only maternal characteristic that significantly differed in ASAM versus normal spiral arteries modification (NSAM) cases was the pre-pregnancy body mass index (25.9\ub16.1 and 23.1\ub14.2 kg/m(2) respectively) with 15.9% of obesity in ASAM mothers versus 5.2% in NSAM (p=0.02). Conclusion: given the association between obesity and adverse pregnancy outcome, our data suggest that counselling obese women to lose weight before pregnancy becomes increasingly imperative

Abnormal spiral artery remodelling in the decidual segment during pregnancy : from histology to clinical correlation

INTRODUCTION: Modification of the spiral arteries with loss of the muscular vascular wall, invaded by the trophoblasts, represents the goal of the physiological vascular adaptation during human implantation. When physiological vascular changes do not occur, an unfavourable evolution of gestation may develop as suggested by uterine biopsies studies. AIMS: To evaluate the prevalence of the abnormal spiral arteries modification (ASAM) through the routine examination of placentas, to identify maternal predisposing factors and to examine the correlations between the histological lesion and pregnancy outcome. METHODS: 1534 consecutive singleton pregnancies were retrospectively analysed. An extensive histological and clinical investigation was performed. RESULTS: ASAM was present in 5.8% pregnancies. When compared with cases without ASAM, cases with ASAM exhibited a higher prevalence of pre-eclampsia (10% vs 2%), placental abruption (5.5% vs 0.3%), preterm premature rupture of membranes (7% vs 1.3%) and intrauterine fetal death (18% vs 2.2%). Multivariate analysis showed that the maternal body mass index represents the major maternal pregestational factor that can influence the prevalence of ASAM (OR=1.8, 95% CI 1.1 to 3 in cases with BMI>30 kg/m(2)). CONCLUSION: The abnormal modification of the decidual segment of the spiral arteries is identifiable at the time of the conventional histopathological placental evaluation and is associated with adverse pregnancy outcome. The identification of the cause of the unfavourable evolution of pregnancy is fundamental for parents, both for counselling and for prevention; the identification of ASAM in such pregnancies might provide additional valuable information

Thrombosis of the umbilical vessels revisited : an observational study of 317 consecutive autopsies at a single institution

Thrombosis of the umbilical vessels has been associated with conditions like fetal death, cerebral palsy, and severe fetal distress, which are common causes for litigation in today's obstetrics practice. Although different anatomical conditions of the umbilical cord as well as maternal or fetal pathologies are considered risk factors, the etiology of thrombosis of the umbilical vessels is still obscure in many cases that pathologists handle. We diagnosed 32 cases of umbilical vessel thrombosis in a series of 317 consecutive autopsies of spontaneous intrauterine fetal death selected from a file of 914 fetal and neonatal autopsies. All cases were singleton pregnancies without chromosomal abnormalities or structural malformations. Our data confirm the heterogeneous etiology and pathogenesis of umbilical vessel thrombosis and highlight a much higher incidence of this lesion than what has been previously reported. In addition, they point out the correlation between thrombosis of the umbilical vessels and specific histologic placental patterns that, in turn, might help explain the etiology and pathogenesis of thrombosis of the umbilical vessels

Identification of putative laryngeal and pharyngeal lichen planus lesions: an endoscopic preliminary evaluation in 16 patients

Lichen planus is a very common autoimmune inflammatory disease, affecting 1-3% of general population Its oral form - also known as Oral Lichen Planus - is the most common, with a prevalence between 1% and 2% in the general population. LP lesions were discovered in the esophagus in OLP patients. The malignant transformation risk of those lesions is currently unknown, but it can be equivalent to oral lesions - approximately 1-3%. Our study points towards the presence of pharyngolaryngeal lichenoid lesions with unknown neoplastic potential The clinical value of a complete, periodical, upper aerodigestive tract evaluation in lichen planus patients needs to be specifically evaluated

Gestational diabetes affects fetal autophagy

Autophagy is a catabolic process involved in the preservation of energy homeostasis and its dysregulation has been implicated in the development of metabolic disorders, including diabetes mellitus. Gestational diabetes mellitus represents a risk for fetal morbidity and mortality. The present study focuses on the autophagy process in human diabetic placenta and fetal pancreas, compared with controls. Analysis of the autophagy markers LC3, Beclin-1 and p62 suggests an impairment of the autophagy process in diabetic placentas. Results indicate an association between gestational diabetes and autophagy, emphasizing the importance of unravelling the mechanisms regulating this relationship