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Odontogenic tumours are rare neoplasms whose classification is sometime controversial. Among these entities, granular cell odontogenic tumour (GCOT) is extremely rare and usually has a benign clinical behaviour. While the histogenesis of GCOT remains to be clarified, we documented the existence of a malignant counterpart of this neoplasm and proposed the name of malignant GCOT. Expression profiling by cDNA microarrays is a molecular technology that enables a global gene expression analysis. By using cDNA microarrays, we identified in malignant GCOT several genes with significantly differentially regulated genes when compared to non neoplastic tissues. These cancer specific genes include a range of functional activities: (1) transcription, (2) signaling transduction, (3) cell-cycle regulation, (4) apoptosis, (5) differentiation and (6) angiogenesis. In conclusion, we show that cDNA microarrays is a useful approach to investigate the biology of tumours. Moreover, this technology might lead to identification of gene targets for cancer therapy and to molecular classification of odontogenic tumours.

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BACKGROUND: Reactive oxygen radicals are involved in many respiratory diseases, including chronic obstructive pulmonary disease (COPD). Carbocysteine lysine salt monohydrate (CLS) is a mucoactive drug effective in the treatment of bronchopulmonary diseases characterized by mucus alterations, including COPD. In the present study, the antioxidant activity of CLS was studied in vitro in three different oxygen radical producing systems, i.e. bronchoalveolar lavages (BAL) from patients affected by COPD, ultrasound treated human serum and cultured human lung endothelial cells challenged with elastase. METHODS: BAL, exposed or not to different concentrations of CLS (1.5-30 mM), was assayed for free radical content by fluorometric analysis of DNA unwinding (FADU) or by cytochrome c reduction kinetics. Human serum was treated with ultrasound in the presence or absence of CLS (1.5, 2.5 mM) or N-acetyl cysteine (NAC; 4, 5 mM) and assayed for free radical content by FADU. Human endothelial cells cultured in vitro from pulmonary artery were incubated with elastase (0.3 IU/mL), in the presence or absence of glutathione (GSH; 0.65 mM) or CLS (0.16 mM). The supernatant was tested for cytochrome c reduction kinetics whereas cell homogenates were assessed for xanthine oxidase (XO) content by SDS-PAGE. RESULTS: Results showed that CLS is more effective as an in vitro scavenger in comparison to GSH and NAC. CLS reduced the damage of DNA from healthy donors exposed to COPD-BAL and was able to quench clastogenic activity induced in human serum by exposure to ultrasound at concentrations as low as 2.5 mM. NAC protect DNA from radical damage, starting from 5 mM. In human lung endothelial cells cultured in presence of elastase, CLS (0.16 mM) decreased xanthine oxidase activity. CONCLUSIONS: These results suggest that CLS could act by interfering with the conversion of xanthine dehydrogenase into superoxide-producing xanthine oxidase. The antioxidant activity of CLS could contribute to its therapeutic activity by reducing radical damage to different lung structures.

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INTRODUCTION: Minor head injury (MHI) is one of the most frequent causes of emergency room admission which often requires expensive, and not always non-invasive, imaging techniques to be diagnosed correctly. It is therefore necessary to follow appropriate guidelines to improve the diagnosis and reduce the risk. MATERIAL AND METHODS: A special guideline for the admission of MHI patients has been designed in agreement with other authors' reports and followed at the Emergency Department of S. Orsola-Malpighi Hospital (Bologna, Italy). The patients are classified into three groups based on the Glasgow Coma Scale (GCS) score, symptoms, clinical signs and relative medical histories. By group, the patients are then discharged, submitted to brain CT or to a short observation period. Our group 0 included the patients with GCS 15, no symptoms or risk factors and the possibility of being monitored at home. Such patients were treated and then discharged after receiving a sheet with the appropriate recommendations. Group 1 included the patients with GCS 15 and even a single symptom. Group 2 included the patients with GCS 14. All the patients in groups 1 and 2 were submitted to CT within 6 hours, as well as all the patients exhibiting any risk factors. RESULTS: Group 0 patients were not submitted to skull radiography which used to be the referral examination for CT. Thus, the number of skull radiographs was reduced about 6-fold while that of CT examinations increased by 50%, though remaining acceptable. Consequently costs have been cut down significantly, as well as the X-ray dose to the patients' thyroid, while the rate of correct diagnoses has actually increased, more lesions being detected. CONCLUSIONS: We believe it is rather useless, expensive and dangerous to perform skull radiography in adult MHI patients. Applying an appropriate guideline is the right way to make the correct diagnosis, lower costs and minimize X-ray exposure.

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A prospective study was performed on 4,262 consecutive patients who had had skull examinations for recent head trauma. Clinical signs and symptoms and patient history were correlated with skull fractures and intracranial sequelae as identified on CT studies, in order to evaluate the predictive value of each clinical finding and to identify high-yield referral criteria. Ninety-seven skull fractures (3%) and 32 intracranial sequelae (0.7%) were observed. All the intracranial complications were observed in patients with fractures and with altered consciousness of some degrees (Glasgow Coma Scale score less than 13). Most patients were asymptomatic (41%) or showed "low risk" symptoms (29%): among them, neither fractures nor complications were observed. High-risk clinical signs, mainly expressing basilar fractures (as rhinorrhea, otorrhea, focal neurologic signs, retroauricular hematoma) demonstrated high predictive value (100%) for intracranial sequelae. Other "moderate risk" findings for intracranial injury--i.e. loss of consciousness at any time, antegrade or retrograde amnesia, multiple trauma, and possible skull penetration--showed a high correlation with skull fractures and a slightly lower one with intracranial sequelae. The most predictive finding for brain injury was the depressed level of consciousness: brain injuries were never observed in fully conscious patients; in altered consciousness with GCS 15-13 we observed 4% of skull fractures with no sequelae; at GCS values 12-9, 61% of skull fractures and 20% of sequelae were present, whereas at GCS less than 8, 100% of complicated fracture were observed. The finding of skull fracture showed 33% of predictivity for brain damage, which was, however, always associated with "high or moderate risk" clinical signs. Therefore, the authors suggest some guidelines for the management of patients with recent head trauma, including referral criteria for X-rays or CT studies, based on signs and symptoms with high, intermediate and low risk of developing intracranial sequelae.

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The authors developed a series of protocols for selecting patients who need emergency radiography, based on clinical criteria that maximize the yield of abnormal radiographs. In order to test safety and reliability of the protocols and to define the reasons for requesting emergency radiographs, a prospective analysis was carried out, by means of a questionnaire, on 1000 consecutive patients referred to our Accident and Emergency Department for radiography. Seven hundred and twenty-nine patients were considered as negative according to protocol criteria: none of them was found positive on X-ray examination. Of them, 639 exams were requested for medico-legal reasons and 90 for patient reassuring. Of 271 patients considered as true positive or probably positive according to the screening criteria, all the true positive cases were such also on X-ray examinations, whereas, among the probably positives, only 31 were confirmed as positive on radiological studies. Our results demonstrate the efficacy of the suggested protocols: had these referral criteria been used for the patients in our study, only 271 examinations would have been performed with no radiographic abnormalities missed. In addition, this grid included 94 cases evaluated as "probably" positive which were subsequently found negative at X-rays, which makes a further safety margin. Our analysis also shows the low therapeutic value of emergency radiographs in both nasal bone injury and post-traumatic oblique rib views. Therefore we suggest selecting patients who need X-rays based on the clinical criteria shown in our protocols: this could result in economic saving and decreased radiation exposure, with no risks of clinical underestimation of the pattern.

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An analysis is made of the anatomofunctional features of biliojejunoduodenostomy, in comparison with different kinds of biliodigestive anastomoses; special attention is paid to roentgensemeiological problems as related to the method of investigation.

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