Biomedical subjects
Publications and source records attributed to L Matturri.
A 26-day-old infant dying suddenly and diagnosed as sudden infant death syndrome (SIDS). Conduction system abnormalities were found, consisting of accessory atrioventricular (AV) pathways of Mahaim type, which can be regarded as arrhythmogenic in nature.
A male sixty days old infant, dying suddenly, has been diagnosed as sudden infant death syndrome (SIDS). Autopsy visualized plurifocal haematic suffusions, typical for an asphyxial status. Abnormalities were not found in the conduction system, but aorticopulmonary paraganglia hyperplasia with mild inflammatory characters has been noted. The role of aorticopulmonary paraganglia, as baro-chemoreceptors, in the cardiovascular regulation, has been anatomical substrate for explaining a sudden infant death, according to a multifactorial theory of SIDS.
OBJECTIVES: To obtain basic information about the expression of somatostatin in the human central nervous system and, in particular, to evaluate its possible involvement in unexplained perinatal and in sudden infant death syndrome. MATERIAL: Sixty-seven brainstems from subjects aged from 30 gestational weeks to 12 postnatal months, dying of both known and unknown causes, were selected for this study. The unexplained deaths included 17 sudden intrauterine deaths, 5 sudden neonatal deaths and 28 sudden infant deaths. METHOD: All brainstems were fixed in 10% phosphate-buffered formalin, processed and embedded in paraffin, according to our protocol available on the web site: http://users.unimi.it/-pathol/sids/riscontro_diagnostico_e.html. The distribution of the somatostatin in the brainstem was studied by immunohistochemistry on serial sections. RESULTS: We observed an intense somatostatin positivity in many brainstem nuclei prevalently involved in the respiratory activity (parabrachial/Kölliker-Fuse complex, locus coeruleus, hypoglossus nucleus, dorsal vagus motor nucleus, tractus solitarii nucleus, ambiguus nucleus, reticular formation) in stillbirths. In 10 fetuses with unexplained death the neurons of the hypoglossus nucleus were somatostatin-negative. In the postnatal deaths, we observed immunopositivity in the ventrolateral and ventral subnuclei of the tractus solitarii nucleus. Besides, in 15 sudden infant death victims and in 1 control case, somatostatin-positive neurons were also present in the hypoglossus nucleus. In 10 of these 15 cases, a high apoptotic index was also reported. CONCLUSIONS: We suggest that abnormalities in the distribution of SS in the hypoglossus nucleus before and after birth may contribute to the induction of both fatal breathing in prenatal life and abnormal ventilatory control after birth leading to irreversible apnea.
Descriptive epidemiology of autopsies performed at Ospedale Maggiore in Milan 1986-87. With the aim of setting up an autopsy database we have processed and stored data relating to diagnoses from autopsies performed over the two-year period 1986-1987 at Ospedale Maggiore in Milan. We used a program developed on the basis of indications provided by a group of pathologists working in various centres in Italy. The program is designed to include the storage of personal details, clinical diagnoses, autopsy diagnoses, and a semi-automatic procedure for apposition of SNOMED codes. Using this stored material, statistical studies have been carried out on the sample of autopsy subjects and the incidence of the various types of pathology; also, a comparative evaluation has been made between the clinical diagnoses of the cause of death and those derived from autopsy. It appears that clinicians tend to overdiagnose neoplastic diseases and underestimate the significance of cardiocirculatory pathologies. Our data confirm that in spite of the advances in diagnostic technology, autopsy maintains its value and importance as a diagnostic tool, especially for its quality-control role in the public health field; moreover it can also play a significant part in epidemiological studies.
A 4-month-old infant dying suddenly is diagnosed as sudden infant death syndrome (SIDS). Important modifications of the cardiac conduction system were found, consisting of conspicuous accessory atrioventricular (AV) pathways of Mahaim and Kent type, which can be regarded as arrhythmogenic in nature.
Four cases of myocarditis from toxoplasma gondii were observed at autopsy among 18 consecutive cases of acquired immunodeficiency syndrome (AIDS). All cases showed spotty inflammatory myocardial infiltration, consisting mainly of T lymphocytes and, to a lesser extent, of B lymphocytes, histiocytes, mastocytes and eosinophilic granulocytes, with presence of toxoplasma gondii in the cytoplasm of a few myocardial cells. The incidence of toxoplasmic myocarditis in heart involvement in AIDS was 22% in our cases, manifold higher than in preceding reports from the literature. This suggests that cardiac toxoplasmosis is far from rare in patients with AIDS.
The authors describe one case of periapical cemental dysplasia, a fibro-osseous lesion of the jaws. In this case, the definition dysplasia does not have an exact histological relationship: in fact, there are no atypical cells, but mature cells with alteration of form, volume and organization, without any inclination to uncontrolled growth.
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Cardiac metastatic malignant melanoma. Secondary tumors frequently involve the heart, but the main data about incidence, rate and localization into the specialized myocardium are poor and fragmentary. Post-mortem examination of the conduction system of arrhythmic hearts was studied in two cases of malignant melanoma. In the first case signed by AV block and fibrillation, metastases involved the myocardium over atrioventricular (AV) node and the left and right bundle branch (L and RBB). The second case had not arrhythmias in the clinical picture, but a large metastatic mass involved the junctions between sinoatrial (SA) node and myocardium of the crista terminalis, the junctions between atrium and AV node and the left branch.
A 76 year old man, who had undergone tonsillectomy for non Hodgkin's malignant lymphoma, died suddenly in rapidly evolving cardiogenic shock with electrocardiographic signs of acute lateral myocardial infarction. Post mortem examination showed three cardiac lesions, two in the left ventricle and one in the right atrium, corresponding to the "crista terminalis". Histologic examination of autopsy samples confirmed the presence of lymphoma in the heart, partially affecting the sino atrial node (NSA) but excluding other sites. There was no evidence of acute myocardial infarction in spite of the clinical signs and symptoms. An infarction-type electrocardiographic pattern associated with conduction disturbances in patients with lymphoma should suggest the possibility of cardiac localization of the disease.
BACKGROUND: The different clinical evolution of gastric adenocarcinomas with the same clinico-pathologic characteristics prompted the authors to investigate the prognostic significance of different biological markers. METHODS: One hundred twenty-six preoperative cancer gastric biopsies, selected according the stage evaluated after following gastrectomy, were examined for DNA content by means the static cytometry, proliferating cell nuclear antigen (PCNA), p53 mutation, apoptosis by immunohistochemistry and karyotype using fluorescence in situ hybridization (FISH) techniques. RESULTS: The gastric cancers, ail belonging at stage III, were adenocarcinomas histologically typed as: 26 well differentiated (G1), 45 moderately differentiated (G2), 43 poorly differentiated (G3) and 12 of undifferentiated type with signet-ring cells. The tumours showed a prevalence of diploidy (68%), a mean PCNA-LI of 4.8%, trisomy of chromosome 7 in 40% of the cases, low presence of apoptosis (30%) and p53 mutation (17%). Only apoptosis was significantly correlated to histological diagnosis (p = 0.009). A multivariate analysis showed that the DNA content and PCNA-LI were the only independent prognostic markers for survival (p = 0.005 and p = 0.0002 respectively). CONCLUSIONS: The evaluation of these two biological variables, especially of the PCNA index, on gastric cancer biopsies may be useful in predicting the aggressiveness of each tumor and in identifying patients in need of additional perioperative therapies.
Involvement of the cardiovascular system in patients affected by acromegaly is an important factor in morbidity and mortality. The diagnosis in these subjects is acromegalic cardiomyopathy with cardiac decompensation, arrhythmias and sudden death. The pathologic substrate has rarely been described. The present study reports the findings in a case of sudden death in a 54-year-old man, affected by acromegaly. Subsequent diagnostic investigation revealed the characteristic aspects of acromegalic cardiomyopathy in the common myocardium and the presence of hyperacute myocardial infarct of the antero-septal wall of the left ventricle. Examination of conduction tissue revealed slight fibrolipomatosis and dispersion of the atrio-ventricular node (AVN), which extended to the His bundle and bifurcation. The right branch was prematurely intramural with sclerosis and lipomatosis. This location in atrio-ventricular conduction system has seldom been reported in the literature and if so, with different lesions from those found in the case we investigated. The results of microscopic examination convalidate the hypothesis of electrical instability in the heart, as confirmed by the subject's history of ventricular extrasystoles, left branch block and attacks of angina after effort. Death was correlated to hyperacute myocardial infarction of the anteroseptal wall of the left ventricle, in a subject with history of angina, affected by acromegalic cardiomegaly and electric instability. In this case, sudden death could also be considered arrhythmogenic in relation to the additional workload by persistent hormonal stimulation.