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It is not enough, because the IAP does not always answer positively; there is a certain mistrust between small and big companies. If we look at the campaign realized in England, it is a completely different story. The reports received by the Committee, if deemed substantial, will have immediate effect. The former procedure with IAP used to perform the actual withdrawal only after one month, when the campaign had already been seen.
Associations and experts who promote and monitor the complaints of sexist advertising to IAP underscore the lack of gender awareness in decisions to remove advertisements. According to an analysis of complaints, the IAP interventions is effective only when the ads are vulgar and nudity are more integral. This idle underlines the conflict of interest between the double role that cover the Italian Prime Minister, the public and political role and the private business role of entrepreneur and owner of several media, and the huge economic interests related to advertising.
The data shows a clear underrepresentation of women in the political and economic fields. It is the woman who pushed the girl under the shower. There is no analysis available on the representation of women in magazines targeting girls, teenagers and adult women. In the field of news, women are underrepresented in both aspects, quantitative and qualitative. In Italian society and in the advertising seems to be no difference between a woman and a girl: the same stereotypes interpreted and endured by an adult woman are applicable to young girls.
The girl, like the woman, must be sexy, flirtatious, beautiful and made up even in an advert for school backpacks. This is why in an advert of cheese slices, the girl cooks and washes dishes, while her brother plays and disturbs her. See also: L. The problem has not been perceived by the institutions and no specific actions have been foreseen or planned for the future. We hopes that the new Ombudsman for Children, established in , to coordinate actions to combat, prevent and protect the rights of girls and children, in television programs and advertising on all media, will work in coordination with the IAP and the Ministry of Equal Opportunities.
This gender gap becomes a very distinct trait in Italy. Women spend an average of 5 hours and 20 minutes per day on family work and care, more than all other European women. Men spend less time than men from all the other European countries on these activities. The ISTAT survey also shows that the stereotyped role of women in Italian society is increasing between the absence of sharing of roles and policies of conciliation, the rigidity of the labor market and the general disinterest. The Western society protects childhood in terms of laws against pedophilia, child pornography and abuse of on minors.
But then, when we go beyond the laws, we discover that laws are insufficient for us to hasten to say that minors are protected. Abuse of children is increasing, sexual tourism involving children is more exploited by Westerners, and in Italy, in and alone, more than one thousand children went missing. If child pornography is a crime, why is the erotisation of children allowed? Can we not also consider the images that violate childhood, that force children to become early adults and to be sexually attractive as equally damaging?
The funds are not always used to develop action with a specific gender orientation, thereby risking that these initiatives reinforce the stereotypes more than deconstructing them. Their absence is particularly relevant in the news and political programmes The results could be useful to formulate regulations and plan actions to protect and contrast these Reference to PARI programs. The Italian population, as much as the foreign one, has a naturally more balanced gender composition, made of more or less half of women and half of men.
The same is in the case of victims. If Italian women are victims of crimes in a little more than half of the cases But the difference between Italian and foreign offenders in the news is also highlighted by the rest of the details that appear in the report on the news. The image of immigrant offenders is based almost exclusively on one detail: nationality. If for the Italian equivalent persons, their profession is more frequently mentioned But what is the role of these players in the news? Often, they are simply victims of human trafficking while very rarely they are active in it, reduced to pure representation, and as such stereotyped, of the offender or of the victim, without any human connotation such as personal story, personality or ideas.
This initiative would increase the awareness and the consideration of the communication operators on the gender issues. To be effective, this action should involve many areas: it is pointless to change school times if then family welfare policies are not put in place, if advertising humiliates women and portrays them in hideous stereotypes and if institutional authorities promote a stereotyped image of the woman through their policies and their public statements.
No campaigns targeting the potential victims of exploitation were carried out to raise awareness on their own rights. Such indifference is mainly due to an outstanding decrease in the ethical tension towards the issue of trafficking of human beings for exploitation purposes. Italy has signed and ratified the Convention of the Council of Europe, but has not undertaken any initiative to foster a culture of respect towards women and to enforce art. Judges highlight that difficulties in the effective prosecution of sexual exploitation and trafficking crimes can derive from the fragmentation of the jurisdiction for trafficking and smuggling.
However, trafficking is often concealed in the aid and abet of illegal migration. A diversified jurisdiction, combined with a not always smooth relation among Public Prosecutor Offices, could determine the dispersion of useful information for the correct identification of the crime. An improvement in the international cooperation could prevent investigations from stopping at the national level, likely involving only the last links in the chain of trafficking. Such recommendation was totally disregarded.
Trafficking of human beings is a crime against human rights. There is not a prevention and protection approach that focus on victims rights. A prevention and protection policy effectively addressing the protection needs of the victims of exploitation Paragraph referred to Question no. The policies implemented from to date have focused on the prosecution of the exploiters and on the elimination of the decay related to street prostitution.
Risk that the protection envisaged by art. Despite the juridical nature of mere contravention, such a crime necessarily implies that the victim of trafficking or even of prostitution exploitation only must make declarations as a person under investigation for related crime and thus be assisted by a defending counsel in order for them to be used. Moreover, such declarations made in order to access the social protection programme as per art. The criterion of evidence evaluation ex art. It is easy to predict that the compliance to such a provision will not help the victims of trafficking in approaching the mechanism envisaged by art.
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The refusal of permit of stay by the Police Department would require, however, the woman to make a specific appeal to the Court, resulting in considerable additional cost and time for her. Even in case of formal complaint, it is not always possible for the victims to be included in the protection programmes and obtain the residence permit, since the Prosecutor Offices can consider such complaints insufficient to settle a lawsuit No protection is envisaged for the victim if the proceedings are dismissed: her presence on the territory is considered illegal and she is exposed to retaliations by the exploiters.
This determines an unmotivated diversification in protection of trafficked people. The complete social reintegration of trafficked people is hampered by access modalities to professional training courses that require the possession of a residence permit. Due to the complex procedure envisaged by art. Contrarily, for all those women the release of the permit acquires an extremely high absolute value The provision is usually interpreted in a restrictive sense and women who are trafficked in other countries and then led to Italy to be trafficked here, too are deprived of the possibility to access social protection paths Protection should be instead extended to these women, too, both because of the presence of indicators of severe and actual danger for the victim in such cases whose validation appears not to be influenced by the location of the perpetration place and because of the transnational dimension of the human trafficking crime, already acknowledged by the UN Additional Protocol on transnational crime Palermo, The advice of the State Prosecutor is compulsory for the release of the residence permit but it is not clear from the text whether it is binding, too.
Such interpretation was further confirmed by verdict no. Trafficked people must be considered as victims and, thus, penal or administrative proceedings due to their illegal status should not even be instituted against them. Incapacity to distinguish between voluntary prostitution and exploitation of prostitution. Judicial consequences art. The mass media representation of the judicial proceedings involving several politicians in indoor and outdoor prostitution affairs induced the public opinion to believe that trafficking concerns just poor foreigners women prostitutes and not other social groups.
Contrarily, street prostitution is strongly criminalized whether it is voluntary or forced, also due to political reasons of public order and territory control. Since the Parliamentary debate on prostitution was halted after the judicial proceedings involving the Premier, municipal ordinances against prostitution flourished. The repression of street prostitution determined significant difficulties in the fight against trafficking.
Street prostitutes are considered as dangerous people, subject to police controls and chased away from cities Art. The integrated service systems addressing prostitution and trafficking denounce how they have never been involved by the local institutions that decided to adopt such ordinances None of these ordinances envisages positive actions for social inclusion, conflict mediation, police officers training aimed at the identification of trafficked or exploited people.
All of them envisage sanctioning measures only. Franco Grillini presented a draft bill no. The proposal had no follow up. Oriano, These ordinances appear to be justified either by art. In both cases, the sanctioned behaviour is represented by the stopover of the vehicle to require information on the sexual performances or to negotiate or agree their price.
In order to highlight the discriminatory feature of such ordinances and of their application, we report the case of the Sovizzo municipality, where the Carabinieri halted a driver who was travelling with a coloured woman on the state highway. The driver contested the measure before the court of Vicenza that accepted the appeal verdict no. The section of the ordinance that envisages sanctions on the mere assumption of transiting or stopping by car in Sovizzo municipality while dressing or behaving in ways that could lead the traffic officers to believe prostitution is being exercised is also considered illegitimate.
Municipal ordinances were blamed by the Court of Cassation through verdicts no. Even in the absence of municipal ordinances, the associations document the criminalization of street prostitutes through all the judicial devices that could be possibly used: street prostitutes are very often subject to repeated police controls, closed in security cells, chased away from cities through the enforcement of the prevention measures ex Act no. Government seems to have not clear the distinction between voluntary prostitution, exploitation of prostitution and trafficking The draft bill text criminalizes every form of prostitution exercise in public or in places open to the public Monitoring report on the ordinances against prostitution by the Street Units, Moreover, a grave offence such as the aid and abet was often erroneously charged to the client, going as far as seizing his car, and the Highway Code notification for traffic impeding or of the state property regulation were illegitimately enforced.
It is a generic provision that demolishes the principle of sexual freedom of people ex Act no. The ratio of the law is in contrast with the current regulations on prostitution, since it introduces a different, unjustified, treatment for outdoor voluntary and forced and indoor prostitution voluntary and forced , considering outdoor prostitutes as garbage to remove from the urban streets. This would strengthen the criminal networks of the exploiters, already in close connection with the local mafias.
The situation of the victims of trafficking would thus become even more difficult, since these women would be subject to the double control of the exploiters and of the local mafia, thus making impossible for them to free themselves and for the social workers to reach them. Several researches and TV reports documented how, being promised legal job contracts, foreign girls are often induced to prostitution. These clubs are not adequately controlled. No researches are available on the correlation between the existence of such clubs and the incidence of violence against women perpetrated there.
The two pages of the illustrative report on the D. The new incrimination as per art. But also par. The figures contained in the table below show that, despite the approval of the amendment to art. In a country such as Italy, in which male dominance is widespread and the allocation of women in private and family life is part of the accepted cultural heritage, the increased female presence in the public sector requires special temporary measures, as stated in CEDAW art.
Table 1. Question no. These are the same parties that said they were favourable to increasing the presence of female candidates in elections and statutorily provide quotas or equal gender representation, and are not keeping to their promises when needed. As little or nothing has been done since then, the statements made in paragraph of the Government Report are unfounded. The only equal opportunities reform made in public administration, if it has been implemented, was only made because it was imposed by a European Directive.
Failure to implement art. Insufficient information in the Governmental Report For a brief period of time, there were gender quotas in force for administrative elections in Italy Act no. This law was then declared unconstitutional in TEGA, The figures supplied by the Ministry of Internal Affairs on the local administrators of all the local Councils in Italy elected from to show that prior to , local Councils were dominated by a significant male presence, with an average female representation of 7.
During the period in which quotas were in force, a significant increase in female representation can be observed: the percentage of seats occupied by women in local Councils increased, reaching a peak of During the period subsequent to the abolition of quotas, the percentage of women elected in local administrations in the local Councils that had voted using gender quotas The percentage of women elected in local Councils that never voted using this system reached The constitutional review was vital in overcoming the unconstitutionality claims made in the sentence and enabling the possibility of amending electoral laws for the election of the national Parliament by including the obligation of gender equality.
The failure by the Government to implement art. The worry that women will only be able to fill political roles by virtue of quotas and not in relation to their ability appears to us to be unfounded. Beyond female quotas? The Campania Region law on double preference Even without the use of quotas, is it possible to properly implement art.
This law appears to be working, but it is not enough to guarantee equality in those Bodies, such as Local Government Board, in which the components are chosen by the President. During the last regional elections, 14 women were elected thanks to this method, compared to just 2 in The electoral results from the elections obviously show the different level of effectiveness of these laws: Lazio, Abruzzo and, especially, Tuscany the region with most women on the regional council registered netter results than the other regions, with increases of 5.
In addition to the figures for local Councils, this document also includes interviews with local female administrators on their experiences and a sample investigation on the perception of citizens aimed at understanding the different views, roles and responsibilities of men and women. The women elected were also more highly educated than their male counterparts during the application of the quotas, despite the increase in female representation observed. This would appear to confirm what emerges in other contexts: women find it more difficult to achieve the results achieved by men and when they do so, it is often due to more effort.
Source: D. Some Italian Regions, such as Campania, have adopted regional laws which, in implementation of art. This has meant that not a single woman has been elected on to the regional Councils in Calabria and Basilicata, and of the 12 assessors on the Sicily Regional Government Board, only one is female. Women are not represented, or barely represented, on many local and provincial Government Boards. The only possible solution to solve this serious violation is recourse to the Regional Administrative Tribunals TAR in order for it to declare illegitimate the Local Government Boards which do not respect the criteria of gender representation.
However, not even this measure has been adequate in terms of effectively protecting the right of representation of women. The various local TAR follow different orientations. This proposal is still being examined by the Constitutional Affairs Commission of the Senate. The path taken could be to modify art. The figures provided in paragraph of the Governative Report on the political participation of women are accurate, but are presented in isolation and therefore badly interpreted by the Government.
The explanation provided by the Government as to the low level of political participation is not shared; it cannot be said that the low figures are due to a lack of interest in politics by women, and is therefore the responsibility of women themselves if they do not achieve positions of leadership in politics and in career terms. In providing such a banal and inaccurate explanation, the Government is presenting figures out of context, without taking into account the quantity of service work that is almost exclusively the responsibility of Italian women, which means that they do not all have the time and way to participate in political matters.
Contrarily, the Campania TAR, sentence no. The Puglia TAR, in sentence no. In ordinance dated It has been proposed that, independently of the voting system, the electoral laws should include, at various levels, a regulation which guarantees equal representation, on penalty of the list being inadmissible if this condition is not respected. If the method provides that electors should express nominative preferences, the regulation successfully experimented in the Campania regional election law would be preferable, in other words double preference with the obligation that the second should be of a different gender to the first, on penalty of nullity.
Incentives and disincentives on electoral reimbursements in favour of women have also been proposed, among other measures. In paragraph 7, the ISTAT Report provides figures for the last ten years, which show a significant decrease in the number of women who are totally extraneous to political participation and, at the same time, an increase in the number of women politically active.
The leadership of all the Italian political parties is almost exclusively male, in a context which rewards praise of the leader and appearance, rather than a feminist militant participation or the presence of female candidates capable of expressing independent thoughts and a gender viewpoint.
The event was a protest against the sex scandals which have led to legal proceedings investigations against the Prime Minister, from which it emerged that there was a presumed link between the sexual favours provided by certain women in his party and their candidature in or exclusion from elections. It is obvious that the expectations of the majority of Italian women have been dashed by the current climate of depreciation of the female presence in public circles, and that formal political participation is being affected by this.
Contrarily to this disaffection for formal politics, the willingness of Italian women to undertake political commitments is shown by their high level of participation in informal political life from SCOs to movements. The women involved are frequently young. In this sense, the figures presented by the Government do not distinguish those concerning academic qualifications and professional positions; the gender differences with respect to political participation decrease on the basis of academic qualifications and professional position.
Given that the level of education of young women is now better than that of young men, it is probable that their interest in politics will increase if these young women are given a real possibility of reaching positions of leadership. In general, if geographical distribution is considered, Southern Italy remains in last position as regards the pursuit of equal opportunities in the leadership of public administrations, while the local, provincial and regional Councils in the North fill the leading positions.
There are significant exceptions to this national trend, such as Palermo and Treviso, for example, which are 19th and rd in the classification of provincial capitals. This in itself prevents participation in political matters by any women who do not have their own cars, because meetings often end at times when public transport is no longer available. To increase the female presence in politics, the conditions should be imposed to allow women to actually participate. The number of women who never mention politics is decreasing from Furthermore, within the small segment of people who attend demonstrations 4.
This means that those women who manage to access these jobs are more likely to encounter a hostile working environment. This is confirmed by a very recent sentence by the Court of Cassation, which convicted a trade union representative of the prison service for giving an interview in which he criticised the recent appointment of a woman as director of the prison, stating that a man would have been more suited as director of that prison. The female presence in university management bodies is very low because there are few female faculty deans, few female heads of department and few members of Boards, etc..
These studies should become part of the training of lecturers and students, because only the understanding of relations between men and women, and also between different cultures, will lead to changes that are capable of creating a culture of equality able to affect politics and decision making processes.
When asked about the type of participation and purposes of the courses themselves, the women who coordinate these courses said that the women who participated in them only did so because they were already interested in politics, because other areas parties, local politics are not easy for women to get into, and certainly not because an institutional training course could open the doors for them to enter electoral lists no representatives of political parties has tried to recruit female candidates from these courses. Source: B. In , female representation is even lower The Ministry of Foreign Affairs does not show any will to fully enforce the current regulations on equality and equal opportunities within itself and within its foreign network.
It is not clear from the Report whether women diplomats can enjoy the same family benefits granted to men. Virtually, the exact half of women diplomats Out of a total of Embassy Councilors, women are 27 equal to Out of a total of Legation Councilors, women are 22 equal to Source: www. The Government fails to report about the increasing difficulties in accessing the citizenship caused by the amendments introduced by Act no.
If institutions do not take into account the radical changes caused by migratory flows, there will be increasingly serious phenomena of exclusion at a level of social, economic and political rights. Many women arrive in the country after their husbands, when the latter are already accepted into the social context of the host society. Husbands are therefore the first to acquire citizenship by residence and this right is only extended to their wives at a later date.
Although Act no. This situation has been confirmed by an analysis of the applications for Italian citizenship by foreign women and the enormous difference between the numerical figures concerning applications for naturalisation by marriage and those for naturalisation by residence. The amendments introduced by Act no. In this way violent husbands can blackmail their wives and prevent them in acquiring such an important right.
However, as there are no gender disaggregated data available concerning the income of the foreign population resident in Italy, it is impossible to assess whether women encounter more difficulty than men in reaching the income limits required for the acquisition of citizenship Circular of the Ministry of Interior no. In the same year, 2, applications for citizenship by residence were made by women, compared to 4, by men.
Source: XI report of the Caritas statistical bureau, Processing of data from the Ministry of Internal Affairs. Consequently, the evaluation of the income limit must be referred not only to the applicant income but also to the entire family one. Their income often remains minimal and their employment is highly precarious. This situation has a significant effect on the effective possibility of migrant women to fully exercise their citizenship rights, although they are in the country legally, employed and have been resident for a number of years. In conclusion, the procedures to obtain the permit of stay and citizenship indirectly discriminate immigrant women because place them under the authority of their husbands or their employers, preventing their emancipation and integration.
The new regulations, for example, provide for a test of Italian language and culture in order to obtain citizenship. This provision is very discriminatory for foreign women who, as they mostly originate from countries with lower female literacy rate, find additional obstacles in acquiring the needed skills and knowledge to pass the test. This will have a deep impact on the family working choices. Nevertheless this figure cannot be read separately Among the aspects negatively affecting the right to education, the policies of generalized cuts by the Government place first.
The Gelmini Reform in particular introduced several cuts that led to the decrease in the number of teachers and to the change of the primary school timetable, reduced to 24 hours per week. The rich and powerful Catholic lobbies could spread a confessional approach to research and curricula limiting equal opportunities and women rights. As a consequence, the education offer is poorer and poorer and public and secular university threatened with extinction Migrant students represent 7. Among the elderly over 65 years disabled women with a high school diploma or a degree are almost half of disabled men, respectively 6.
At the university level major developments were made with regard to the number of both enrolled and graduated women. Feminization of education is not accompanied by a feminization of the working world or, better, the working world is still structured around men and for men. Women filled the education gap that divided them from men, get better marks and graduate in a shorter time. Nevertheless, in most of careers male dominated, they still face difficulties in the access to the working world and they wait longer to get a job comparing to men graduates.
Form di ricerca
The female presence in several areas is still very low while, on the contrary, in other areas is peaking. Contrarily, with regard to the areas of technological and scientific studies, the female presence is lower: engineering cluster Maria Luigia Paciello, I numeri per dirlo, available at www.
Estimates are that the hold back rate for the remaining Roma and Sinti children of the same age is no less than three years. It is not possible to ensure the right to education to these minors, if their families are subject to reiterated evictions and evacuations from one city to another Girls face a double discrimination: because they are women and because they are Roma or Sinti.
The risk for female minors is not only related to forced mobility by their families, but also to the possibility of early marriage, even though such a practice is more and more uncommon in the settled communities. The situation is often so serious that teachers themselves intervene to demand that the right to education is granted to the Roma minors placed into their classes. Government statements are not confirmed by its recent policies that have been instead showing an increasingly racist and violent institutional attitude against the Roma Data highlight lack of regularity among foreign students already starting from 12 years old.
Causes are to be found in the scarce command of the Italian language and in social integration problems. From this story it can be inferred that Cristina, just as many other Romani children, cannot de facto exercise her right to education, being constantly engaged together with her family in the search for a house, due to the continuous evacuations by the Municipality. The Premier recalls what he said in when he entered politics. Berlusconi talked about the risk that parents could face if prevented from choosing a private school for their children as an alternative to the public one www.
Roma and Sinti children are still the most discriminated minority and data on their situation are scarce and often do not consider the high number of boys and girls who do not have access to education.
The study has the merit of focusing on the peculiar situation of each Region and school typology, but data are not disaggregated according to gender, age or citizenship. The Governative Report confirms the existence of the problem, without however identifying any strategy for action. The scarce interest for main issues linked to the reproductive health of minors in school age is also worrying. Some study would show that girls and boys learn faster and achieve better results if studying separately Since this gap still persists, it is not sufficient to acknowledge the problem, but it is needed to elaborate a strategy to invert the tendency.
In teaching Referred to para. Indicatori di base. Bullying episodes, also among girls, increasing since , are often linked to interiorized social models that are disrespectful and overbearing of other people and tend to strongly reproduce gender stereotypes. The reintroduction of the civics education in the curricula could represent a good chance to train young generations under a gender perspective, even though a structural review of the educational system is needed to achieve effective results.
Without a deep reflection on the role of the educational system in the development of the civic and social personality of the young citizens of tomorrow and in the promotion of a value system strongly anchored to the advancement of human rights, the single awareness campaigns and projects carried out by the Government definitely lose effectiveness and relevance.
Indeed, without such a reflection behind them, they themselves risk to become a vehicle for stereotypes The policies implemented by the Government to date threaten the existence of public school itself: public schools have been deprived of resources by the Government, consequently they are forced to demand parents to personally fund the purchasing of didactical materials and to offer fewer and fewer services of lower quality. According to recommendation n. In order to evaluate the vertical segregation to which women are subjected, it does not suffice to compare gender distribution in career levels Rather, different education levels must be taken into account.
Despite Italy being ranked second to last in Europe in terms of the percentage of women holding senior positions, Parliament is still discussing the Act no. In its present form, the law is overdue as well as totally insufficient to break through the glass ceiling. Pursuant to article 9, unless the companies turn their reports in by the established deadline, the regional employment inspectorate, upon warning issued by the union or the Equal Opportunities Advisor, shall request that the companies provide the report within sixty days.
In the worst case scenario, the tax benefits possibly enjoyed by the company may be suspended for one year. So far, there has been no news of companies being sanctioned for infringement pursuant to article 9 Act no. Without a doubt, the absence of any form of publicity in the reporting process of the companies along with the lack of certainty of an actual warning and subsequent sanction definitely renders this instrument, which would help women overcome the obstacles to their career advancement as well as salary pay gaps, inefficient.
The proceeds shall be used to promote the training and requalification of working women. To date, no plans have been made to introduce substantial tax reductions for employed women or incentives for companies who hire women. Particularly in the public sector, Government reform the so called Riforma Brunetta Act no. According to the data, the likelihood of women having legally unstable employment is much higher than it is for men if gender differences by age, level of education and family status are taken into consideration Survival was estimated by the product limit method of Kaplan and Meier, and differences in survival were determined by the log-rank test Mantel-Cox.
A multivariate survival analysis was conducted by the direct entry method of Cox s proportional hazards regression model. In the two survival analyses, zero time was the date of surgical resection, and censoring was cancer death. I ; however, no statistically significant differences were observed among the clinicopathological factors. No differences of PRR immunopositivity were identified from microscopic observation, among proliferating patterns or in tumor differentiation.
Univariate analyses of 5-year overall survival and 5-year disease-free survival, based on clinicopathological factors showed no statistically significant differences, regardless of decades-long separation of age, adjuvant chemotherapy or radiotherapy Tab. II, Fig. PRR immunoreactivity of non-mucinous invasive adenocarcinoma of the lung. PRR immunoreactivity might be a weak prognostic factor Hazard ratio. Cox s multivariate analysis of overall survival based on clinicopathological factors except age, location of occurrence, and adjuvant therapy, also revealed no statistically significant differences and that PRR immunoreactivity might be a weak prognostic factor Hazard ratio.
The PRR gene composed of 0 exons is mapped to chromosome 7q 9, where the spindle- and kinetochore-associated protein SKA gene lies in a head-to-head orientation with the PRR gene, only base pairs apart, on the opposite strand. The major transcript of PRR is a deduced amino acid protein with a calculated molecular mass of 40 kda, and has an N- terminal bipartite nuclear localization signal, followed by a proline-rich region, a central zinc finger domain, and a second proline-rich region.
In the present study, quantitative RT-PCR experiments revealed that PRR was ubiquitously expressed in normal human tissues; the highest expression was found in the thymus and the ovary, whereas it was modest in the lung, and such. According to human data on protein localization, respiratory epithelia, urothelium and a subset of cells in the male genital tract show strong staining 0. In this study, a majority of normal tissues displayed weak to moderate cytoplasmic positivity with additional membranous staining in some cases.
From the clinicopathological point of view, PRR protein expression is associated with aggressive phenotypes such as tumor invasion, lymph node metastasis, and advanced TNM stage, and reduced survival in cases of gastric cancer, hilar cholangiocarcinoma, and breast cancer 3.
With several coordinating genes,. PRR immunoreactivity and clinicopathological features of patients with non-mucinous invasive adenocarcinoma of the lung. In the same lobe 3 6 In the different ipsilateral lobe 0 In the contralateral lung 0 0 Pleural invasion No pleural invasion and invasion beneath the elastic layer Invasion beyond the elastic layer 6 3 Invasion to the pleural surface 9 Invasion into any component of the parietal pleura 5 7 Lymphatic invasion Yes No 8 75 Vascular invasion Yes No Adjuvant therapy Yes No 38 Univariate analyses of five-year overall and disease-free survival by PRR immunoreactivity.
Overall survival distribution by PRR immunoreactivity. Disease-free survival distribution by PRR immunoreactivity. Cox s multivariate analysis of prognostic factors by the direct entry method for non-mucinous invasive adenocarcinoma of the lung. PRR is also likely to play a critical role in both cell cycle progression and tumorigenesis in human lung cancer with other genes involved in cell cycle, tumorigenesis, and metastasis The PRR-SKA bidirectional transcription unit is essential for the accelerated proliferation and motility of lung cancer cells.
Therefore, we first evaluated the clinicopathological significance of PRR expression in primary lung cancer cases encountered in our hospitals. Surprisingly, the significance of squamous cell carcinoma of the lung could not be analyzed, despite our following the same anti-prr antibody and immunostaining method used in a previous study. I, II , although there is little statistical difference in our results, particularly as compared with gastric cancer and hilar cholangiocarcinoma.
PRR also has some effect on overall survival Hazard ratio. Conclusions Our results suggest that PRR is a weak prognostic factor of overall survival of patients with non-mucinous invasive adenocarcinoma of the lung. Further studies are needed involving a larger number of lung adenocarcinoma cases. PRR is a novel gene implicated in cell cycle progression and lung cancer.
Biochim Biophys Acta 05; Zhao Q. RNAi-mediated silencing of paraline-rich gene causes growth reduction in human lung cancer cells. International Union Against Cancer. American Joint Committee on Cancer. Cancer Staging Manual, seventh ed. New York: Springer Goldstraw P. International Association for the Study of Lung Cancer. Staging Manual in Thoracic Oncology. PRR is a prognostic marker and potential oncogene in patients with gastric cancer.
The prognostic potential and oncogenic effects of PRR expression in hilar cholangiocarcinoma. Proline-rich protein regulates epithelial-to-mesenchymal transition to promote breast cancer cell invasion. Int J Clin Exp Pathol 04; Very rarely it presented with intracranial abscesses and pleuro-parenchymal infections. We herein report a very challenging case of a year-old obese and diabetic man affected by disseminated nocardiosis with multiple brain abscesses and pleural empyema.
Despite rare, this entity should be taken into account by the pathologists and urgently communicated to clinicians in order to promptly start an effective treatment. Introduction Nocardia is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete, which are generally found in soil, water and air. It usually colonizes the respiratory tract and gastrointestinal tract causing corresponding symptoms, such as coughing, expectoration, hemoptysis and skin abscesses, which are considered as nocardiosis.
Nocardiosis is a vital, but often ignored, infectious disease in immunocompromised hosts, which is particularly serious in the absence of timely diagnosis and therapy. This infection very rarely occurs in immunocompetent patients, often affected by chronic pulmonary disease. This report describes a young patient presented with multiple brain abscesses and pleural empyema caused by multi-drug resistant Nocardia infection. Case report A year-old, obese and diabetic man presented with acute onset of left hemiplegia, fever, cough and headache.
Encephalic computed-tomography CT scan revealed multiple expansive, solid and necrotic lesions involving the frontal, temporal and parietal right lobes Fig. Thoracic CT-scan disclosed atelectasis of the left inferior lobe associated with left loculated pleural effusion suspected for empyema Fig. Blood exams revealed leucocytosis white-blood-cell:. In emergency setting, the patient underwent neurosurgical evacuation of brain abscesses; moreover, a chest tube was placed and large-broad antibiotic therapy Linezolid and Meropenem was started.
Microbiological cultures of pleural effusion and brain abscesses revealed the presence of Streptococcus intermedius. Transesophageal echocardiography was negative for endocardial vegetations. On the basis of microbiological results, specific antibiotic therapy with Ceftriaxone and Metronidazole was administered.
Three days later, a brain CT-scan revealed a severe worsening of the cerebral oedema, and, accordingly, an emergency decompressive craniotomy was performed. In the meantime, the histological and cytological examination of pleural effusion and brain abscesses evidenced Grocott methenamine silver-positive filamentous bacteria with right-angle branching and chinese-letter features, suggesting Nocardia infection Fig.
On the basis of the pathological diagnosis, specific microbiological cultures were performed confirming the presence of Nocardia. Right temporo-parietal abscess yellow arrow of 3. Considering the age of the patient, the clinical severity and the frequent multi-drug resistance of Nocardia, endovenous therapy with Linezolid and Meropenem was continued for 6 weeks. The symptoms rapidly improved along with a radiological reduction of brain lesions and resolution of pleural effusion and pulmonary atelectasis.
Discussion Nocardiosis is an opportunistic infection that mainly affects immunocompromised patients, such as patients with acquired immunodeficiency syndrome AIDS , as well as patients with long-term steroid use or transplant recipients, but can also involve immunocompetent patients; in particular, as reported in some clinical series 3, diabetic patient represent a third of the healthy population affected by Nocardia. In the present case, due to the clinical onset of left hemiplegia, fever, cough and headache, we performed a CT scan of the. Brain that revealed multiple expansive, solid and necrotic lesions involving the frontal, temporal and parietal right lobes.
The dissemination involved also the pleural cavity where a loculated pleural emphyema was observed. In this setting a timely diagnosis is pivotal to promptly start an effective treatment 5 6. Indeed, the definitive diagnosis of Nocardiosis could be challenging and a significant time lapse up to 6 weeks could be needed to establish a specific microbiological diagnosis 6.
Nocardia spp. Since pathologist could be the first and only one in facing with Nocardia filaments, an urgent communication to clinicians is mandatory to promptly start effecting treatment in this life-threatening infection. Contributors MCM made the diagnosis, took the picture and drafted the report. CL assessed the patient and drafted the report.
GR made the diagnosis and drafted the report. FL analysed imaging and drafted the report. All authors read and approved the final report. Disseminated nocardiosis caused by Nocardia otitidiscaviarum in an immunocompetent host: a case report and literature review. Nocardiosis: updates and clinical overview. Impact of immune status on the clinical characteristics and treatment outcomes of nocardiosis.
Nocardial brain abscess. Actinomycoses and nocardia pulmonary infections. Clinical and radiographic characteristics of pulmonary nocardiosis: clues to earlier diagnosis. PLoS One 04;9:e Panico, Tricase LE , Italy; Dermatology Unit, Ospedale Perrino, Brindisi, Italy Key words Vascular tumors Kaposiform hemangioendothelioms Summary This report describes a case of kaposiform hemangioendothelioma arising in an adult man during the course of rheumatoid arthritis treated with steroids and methotrexate. The vascular proliferation began in the terminal phase of the disease, which culminated in acute renal failure and death.
We discuss the possible relationship between rheumatoid arthritis, its treatment, and the onset of vascular proliferation, as well as the role of kaposiform hemangioendothelioma in aggravating the autoimmune disease and leading to its fatal outcome. Introduction Kaposiform hemangioendothelioma KHE is a rare vascular tumor of intermediate borderline malignancy that occurs mainly in infants and children. KHE is characterized by infiltrating nodules and sheets of spindle cells, affecting the skin and soft tissues of the extremities. Morphologically, it is highly similar to Kaposi s sarcoma, although the biologic behavior of KHE is not fully characterized.
KHE patients die as a result of extensive local disease or from a frequent complication called Kasabach-Merritt phenomenon thrombocytopenia, microangiopathic hemolytic anemia, and consumptive coagulopathy. KHE is even more rare in adults. The occurrence of this lesion in an adult, in association with an autoimmune disease treated with steroids and methotrexate and leading to a quick lethal outcome, makes this case worthy of interest.
Case presentation A year-old Italian man presented to the Dermatology Unit with skin rashes of purplish-brown color, mainly on the limbs, which he had had for about 6 months. He reported that, since the age of 30, he had recurrent episodes of joint pain accompanied by fever. He had been diagnosed with serum-negative rheumatoid arthritis RA and had been under treatment with steroids and methotrexate. The patient also reported that, at the age of 46 years, he had been hospitalized for glaucoma of the right eye.
Based on the features of the rash and the patient s immunosuppressive therapy, we suspected Kaposi s sarcoma. Therefore, a biopsy of skin and subcutaneous tissue 3xx cm 3 was taken from an affected area on the left leg; it was fixed in formalin and embedded in paraffin for routine and immunohistochemical analyses.
Hematoxilin-eosin staining revealed a brisk microvascular proliferation at the dermal and hypodermal levels Fig. The vascular component consisted of wellformed capillaries whose endothelium was voluminous and prominent Fig. The vascular lumen was engulfed by thrombotic material Fig. The stromal elements were globoid and spindled, arranged disorderly Fig. Mitotic activity was not seen. There was a glomeruloid pattern of capillary proliferation Fig. Gomori s silver stain also revealed glomeruloid dermal and hypodermal nodules Fig.
These observations excluded Kaposi s sarcoma. Immunohistochemical analysis showed strong positivity for CD34 Fig.
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Valerie Matarese for having made editorially acceptable their work. Panico, Tricase LE , Italy -. Diffuse proliferation of dermal capillaries a , proliferation of interstitial elements b , microthrombi in the capillary lumen c , and venular thrombosis d. Hematoxylin and eosin staining; original magnification 40x a, d or 00x b, c.
A B C D antigens. Pericytes were positive for smooth muscle actin Fig. Altogether, these findings supported a diagnosis of KHE. Three months later, the patient was hospitalized because of the collapse of several vertebral bodies due to osteoporosis. The patient died within a few hours. Testing for HIV was not carried out nor was an autopsy performed.
Discussion This report illustrates the case of a middle-aged man who developed KHE in the context of immunosuppressive treatment for RA. The diagnosis of KHE was established on the basis of the histologic and immunohistochemical findings that, together with the HHV8 negativity, excluded Kaposi s sarcoma. The patient s death Tab. Author Yr. From that date, 6 other reports have appeared in the literature.
These are mostly reports of single cases or miniseries of no more than three cases, for a total of 0 cases as indicated in Table I. In the same period, two series of 33 and 07 cases concerning childhood KHE have also been published 8 9. The appearance of KHE at an early age in association with other malformative vascular lesions e. An onset of KHE in adulthood, instead, suggests a pathogenetic mechanism of an acquired type. Indeed, several cases of KHE developed in the context of other diseases, such as osteomyelitis treated with repeated surgeries 4, lupus erythematosus disseminatus with chronic renal failure 9, hepatitis C and trauma 0, hepatitis C with cirrhosis 5, and RA this case.
Based on these observations, we suspect that even other reported cases of adult KHE may have arisen in the context of another disease, that however, was not described. The clinical presentation of KHE mimics very closely that of Kaposi s sarcoma. In contrast, the histopathology of the lesions differs substantially from classic Kaposi s sarcoma, in both architecture and cytology.
The vascular proliferation in KHE always consists of well-formed capillaries with an evident peripheral argyrophylic reticulin and a pericytic component; it can be diffuse or produce nodular aggregates that are glomeruloid and that affect the dermis and hypodermis. The differential diagnosis is also supported by immunohistochemical analyses: in KHE expression of CD34 and CD3 is restricted to endothelial cells and does not affect stromal cells, whereas in Kaposi s sarcoma the stromal cells are also positive.
In KHE, staining for smooth muscle actin highlights pericytes that are absent from classic Kaposi s sarcoma lesions. Our patient did not develop Kasabach-Merritt phenomenon, which is a frequent complication of KHE in childhood that often leads to death. In the 0 cases of adult KHE, this deadly complication was reported only once, in a patient with hepatitis C cirrhosis 5.
The HIV status of our patient was not tested. In the opinion of the authors of Fig.. Glomeruloid pattern of capillary proliferation shown with hematoxylin and eosin a, 00x and Masson s trichrome stain b, 00x. Glomeruloid dermal c and hypodermal nodules d gomori s silver stain, 40x. Immunohistochemical analyses of the biopsy specimen. Histologically, KHE presents evident similarities with juvenile hemangioma . KHE is even more similar to tufted angioma angioblastoma of Nakagawa , a benign vascular tumor that presents as a macule or nodule. Indeed, some have proposed that KHE is the disseminated form of tufted angioma and, therefore, a benign lesion itself 6 5.
In conclusion, on the basis of this case and the literature, it seems that the onset of KHE in adults, more than an autonomous phenomenon as happens in childhood, is an epiphenomenon accompanying another pathology. This etiology could explain the low incidence of Kasabach- Merritt phenomenon and the more severe course of the disease.
That the appearance of KHE may be iatrogenic, in our case, seems unlikely since the same drugs administered to patients with RA e. It is to be noted, also, that the beginning of the worsening of the underlying disease coincided with the onset of the manifestations of KHE. The present state of knowledge does not allow one to know if the appearance of KHE in the course of a morbid process is the cause or the consequence of its worsening. Kaposiform hemangioendothelioma in adults.
Clinicopathologic and immunohistochemical analysis of three cases. Kaposiform hemangioendothelioma in adult. Report of a case with amianthoid-like fibrosis and angiectases. Additional case of kaposiform hemangioendothelioma in an adult. Kaposiform hemangioendothelioma: five patients with cutaneous lesion and long followup. Kaposiform hemangioendothelioma of the external auditory canal in an adult.
Giant vascular tumour in an adult: tufted angioma or kaposiform hemangioendothelioma. Kaposiform hemangioendothelioma in an adult with an unusual presentation. Kaposiform hemangioendothelioma with distant lymphangiomatosis without an association to Kasabach-Merritt-Syndrome in a female adult. Vasc Health Risk Manag ; Kaposiform hemangioendothelioma of the tongue in an adult. Adult-onset kaposiform hemangioendothelioma in a posttraumatic site. Kaposiform hemangioendothelioma of the breast in an adult female. Clin Breast Cancer 0; Yu L, Yang SJ. Kaposiform hemangioendothelioma of the spleen in an adult: an initial case report.
Intratesticular kaposiform haemangioendothelioma in adults: a report of two cases. Expansile kaposiform hemangioendothelioma deformed thoracic cage in an adult. Kasabach-Merritt phenomenon in an adult man with a tufted angioma and cirrhosis responding to radiation, bevacizumab, and prednisone.
Kaposiform hemangioendothelioma of paranasal sinus. Cyber Knife treatment for Kaposiform Hemangioendothelioma of the ilium in an adult: case report and review of the literature. Kaposiform hemangioendothelioma: a study of 33 cases emphasizing its pathologic, immunophenotypic, and biologic uniqueness from juvenile hemangioma. Kaposiform hemangioendothelioma: atypical features and risks of Kasabach- Merritt phenomenon in 07 referrals.
Diseases associated with HIV infection: study of biopsies and surgical resection specimens at a large general hospital in Mexico City. J Ann Diagn Pathol ; Medical therapy for pediatric vascular anomalies. Semin Plast Surg 04; The patient refused to run any radiological tests, other than the periapical radiograph.
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This rendered the diagnostic dilemma more challenging. Through histochemical and immunohsitochemical stains, the case could be non-invasively diagnosed as caliber-persistent artery. All differential diagnoses were excluded based on concrete findings. Introduction Diabetes mellitus encompasses a group of genetically and clinically heterogeneous metabolic disorders characterized by hyperglycemia depletion of antioxidants, and alteration in lipid metabolism. Diabetes mellitus Type characterizes an insulin resistance which progresses into an insulin deficiency due to a secondary failure in the pancreatic beta-cells.
Given the pathophysiology of diabetes-related complications, diabetic patients develop a relatively higher vulnerability of the mucosa upon exposure to various ulcerogens, ischemia or reperfusion, stress, and nonsteroidal anti-inflammatory drugs A wide diversity of inflammatory - either fungal, viral or bacterial- and neoplastic palatal lesions may overlap complicating the diagnosis of unusual representations. Accordingly, meticulous care should be rendered to avoid unnecessary procedures and improper treatments, especially in chronic diabetic cases.
Case history A year-old female, non-smoker and non-alcoholic, has suffered a painful palatal lesion. The ulcerative palatal lesion had an insidious onset, but turned painful for two weeks without any response to placebo Antibiotics, NSAID, anti-fungal and topical gels Fig. An incisional biopsy was cut for microscopic examination. No odontogenic irritants could be blamed.
History of any concomitant tumor was negative. No running diseases in the family except for non-insulin dependent diabetes mellitus. The differential diagnosis included caliber-persistent artery with or without vasculitis, mucormycosis, lymphoma, granulomatosis polyangiitis aka Wegener s granulomatosis , and spindle cell carcinoma.
Serum ANA and C-reactive protein tests were negative. Detection of antineutrophil cytoplasmic antibodies AN- CA from indirect immunofluorescence on blood was also negative ruling out granulomatosis polyangiitis. The periapical radiograph showed no more than normal maxillary trabeculae, excluding the liability of lymphocytic malignancies Fig. Histologically, the structure of this peripheral palatal lesion revealed an arterial blood vessel wall, with dense collagen with two layers of spindle cells running in different directions, surrounded by inflammatory infiltrates Fig.
Because of the surface ulceration and acute inflammation, the ulceration was expected to be either a sign for vasculitis or inflammatory evidence. Neither granuloma formation nor malignant features could be detected Fig. Correspondence Bacem AE. Clinical picture displaying exophetic ulcerative lesion, located at the anterior palate. X-ray showing normal maxillary trabeculae. Neither dental caries nor any radicular lesion is evident. Photomicrograph of higher magnification characterizing the inflammatory infiltrates around the arterial wall.
Photomicrograph displaying no more than inflammatory infiltrates around an arterial wall. No huphae could be traced PAS stained, Original magnification: 4x. No fungal traces could be seen Fig. Immunohistologically, performing a smooth-muscle actin stain could confirm the arterial component in the lesion.
The lesion was strongly positive for smooth-muscle actin. Other tests were run to exclude any malignancy, including S, CK7, CK8,and p53, which were all negative. In 0 days, the palatal site healed up dramatically confirming the inflammatory nature of this lesion. Discussion As regards chronic diabetic complications, bone marrow-derived hematopoietic cells were recently considered proinflammatory and infiltrative to tissues inducing microvascular complications in addition to the dysregulated biochemical pathways downstream of hyperglycemia 5.
Miko et al first described, in , a developmental anomaly referred to by them as persistent caliber artery. The artery becomes superficial toward the midline, and the persistent size makes it palpable, usually a few millimeters inferior to the vermilion border. Being idiopathic in nature and rare in incidence, predisposing factors included intense sun exposure, senile atrophy of tissue associated with vascular ectasia, secondary to ageing, and injury from long term pipe smoking Although caliber-persistent artery CPA is not totally delineated in the medical literature, given the rarity of the reported cases, this case showed typical findings of CPA.
There appears a dysregulated hematopoietic element induced a low-grade irritation causing the arterial wall to thicken, which made the site liable to ulceration in the harsh oral environment. Either idiopathically induced or pathophysiologically caused by the underlying diabetic condition, the poorly vascularized anterior palate might contribute to the severity of the condition. Although CPA is a disease commonly seen in geriatric individuals, Awni and Conn 8 have interestingly to reported this rare entity in two young cases out of five cases.
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Santagata et al. In our case, other possibilities of malignancies, infection, or autoimmunity were definitely ruled out. For the deep fungal infections which are not uncommon in diabetic patients, mucormycosis was frequently seen devastating the palate and encountering the nasal cavity. Mucormycosis is ubiquitous in nature and humans usually have a strong natural resistance to the infection. Mucormycosis becomes pathogenic when the patient s general resistance has been altered by metabolic disorders, immunosuppressive therapy, malignancy or other chronic debilitating disorders.
An underlying disease, frequently diabetes mellitus, is always evident In this case, the recruitment of PAS stain, with its negative detection of hyphae, signed any deep fungal infection out. Granulomatosis polyangiitis is an uncommon immune-based inflammatory necrotizing vasculitis with no certain etiology proven. Upper respiratory signs and symptoms include ear epistaxis, sinonasal dryness, crusts, obstruction, sinonasal destruction, subglottic stenosis, hearing loss, tinnitus and vertigo.
Lower respiratory manifestations comprise parenchymal nodules, endobronchial lesions, pulmonary infiltrates, and pulmonary hemorrhage or embolism. Nothing of the above mentioned signs and symptoms was evident in our case. Malignancies were histologically and immunohistolochemically excluded. Conclusions A better understanding of the versatile pathophysiology of diabetes-related complications is mandatory. The diagnostic procedures, especially in diabetic patients, should be careful and non-invasive.
This should combine consultative efforts between medics and paramedics toward providing the best diabetic care for the patients. Skyler J, Oddo C. Diabetes trends in the USA. No authors listed. The expert committee on the diagnosis and classification of diabetes mellitus. Multiple cytokines stimulate hepatic lipid synthesis in vivo. Mechanisms underlying endothelial dysfunction in diabetes mellitus. Circulation Research 00;E Emerging roles of hematopoietic cells in the pathobiology of diabetic complications.
Simulated cancer of the lower lip attributed to a caliber persistent artery. Calibre persistent artery of the lip: an underdiagnosed entity? Caliber-persistent labial artery: a rarely recognized cause of a lower lip swelling-report of 5 cases and review of the literature. Calibre persistent labial artery: clinical features and immunohistochemistry diagnosis.
Mucormycosis of the hard palate masquerading as carcinoma. Clin Pract 0;:e8. Paranasal sinus mucormycosis: a report of two cases. Acta Otolaryngol 00;: Ottoman B. Strawberry gingivitis of wegener s granulomatosis: a clinico-pathological and immunohistochemical case study with review of literature.
J Contemp Immunol 05; It is characterized by its deceptively benign appearance. The clinical course of this uncommon variety of carcinoma is not well known and their histological and immunohistological features are not well defined. We report a case of a year-old man with a microcystic transitional cell carcinoma of the urinary bladder. He was diagnosed 4 years ago with cystitis glandularis lesions and nephrogenic adenoma. Through this observation we will try to define the clinical and pathological features of this uncommon tumor which must be differentiated from a number of proliferative lesions of the urothelium.
The poor prognosis and aggressiveness of this tumor seems to be related to a higher stage and grade at diagnosis. Introduction Invasive transitional cell carcinoma is usually composed of nests, and cords of large atypical cells. However the current WHO classification recognizes several new variants. Some of them have a deceptively benign appearance such as the nested urothelial carcinoma and the microcystic urothelial carcinoma.
These variants may cause difficulties in the differential diagnosis. The microcystic variant is rare.
Since the first description by Youn and Zukerberg in 99, few cases have been reported mainly as single case reports. More recently Antonio Lopez Beltran et al. To our knowledge, it was the largest series that analyzed this uncommon variant of urothelial carcinoma. We report a rare and new case of microcystic urothelial carcinoma of the urinary bladder developed on cystitis glandularis lesions associated with nephrogenic adenoma.
We will present the histological features of this tumor and compare our findings with the literature data. Case presentation A year-old man presented to an outside institution with a suspicion of bladder cancer. He underwent transurethral resection TUR , twice in the same year, with the diagnosis of nephrogenic adenoma developed on cystitis glandularis lesions. Four years later, he was admitted in our hospital, complaining of dysuria. Abdominal and pelvic ultrasound showed a homogenous urinary bladder with a thickened wall and two large diverticula located on both left and right side walls and measuring respectively 9 and 8 cm.
It also showed a bulging lesion over the bladder-base next to the neck, measuring 4. Uro-scan revealed an important dilation of the pyelocaliceal cavities, a hypertonic bladder with a thickened wall, two diverticula and a bulging lesion infiltrating the bladder neck Fig.
Biopsy concluded to cystitis glandularis with no signs of histological malignancy. Partial cystectomy with bladder enlargement and sampling of the bulging lesion were performed. Sfax-Tunisia - Tel Fax yahoo. The smooth detrusor muscle was not sampled. The tumor was composed of small nests and microcysts lined by a single layer of atypical flattened cells. No macrocysts were observed. Lumens were empty. Neoplastic cells had a round to oval hyperchromatic nuclei without nucleoli Fig.
There was no conventional urothelial component or urothelial carcinoma in situ. This tumor was developed on the bulging lesion in association with usual and intestinal type cystitis glandularis Fig. Regarding all these findings, the diagnosis of microcystic urothelial carcinoma was established. The patient had a second cystoscopy with bladder and urethral biopsies. At microscopic examination, specimens were free of residual tumor but they showed cystitis glandularis lesions associated with a nephrogenic adenoma.
The patient did not receive any adjuvant treatment. He was doing well with no symptoms of recurrence year later. These uncommon entities are distinct enough to be recognized separately in the current WHO classification system 4. The microcystic variant of invasive urothelial carcinoma is one of the rarest variants of urothelial carcinoma. It is characterized by the formation of microcysts, macrocysts, or tubular structures.
Lopez Beltran et al. No patient had a history of cystitis glandularis or nephrogenic metaplasia. However, in our case the patient was younger 37 years , his tumor was discovered when investigating dysuria and he has cystitis glandularis lesions. The usual radiologic examinations is useful to estimate the depth of tumor invasion and extension, they are usually inadequate to differentiate the nature of the tumor 6.
In our case, radiological examination did not reveal any muscle invasion. Microscopic features of microcystic urothelial carcinoma listed by Venyo et al. The lumina tend to be empty, but may contain granular eosinophilic debris, necrotic cells, or mucin. The cysts may be oval or round, variable in size they may be up to mm ; and. The cells are flattened cells or low columnar cells; however, they are not colonic epithelium or goblet cells.
The cysts tend to be infiltrative and they may invade the muscularis propria. The very unusual morphologic appearance could misdiagnose this tumor with benign lesions, such as cystitis glandularis, cystitis cystica, or nephrogenic metaplasia, especially in limited biopsy samples. The cytological criteria are less helpful because the atypia are often minimal with no significant mitotic activity 8. There is no true invasion 9. In our case, the tumor was associated with cystitis glandularis intestinal and usual type and nephrogenic adenoma. This association may be explained by the degeneration of the intestinal type cystitis glandularis which is considered to be a precancerous lesion.
To our knowledge, this combination has never been reported in the literature. Microcystic urothelial carcinoma can also be misdiagnosed with other neoplasic conditions like urothelial carcinoma with glandular differentiation, adenocarcinoma and nested urothelial carcinoma 7. This latter variant is also rare and can show tubular differentiation.