Do changes in spheno-occipital synchondrosis after rapid maxillary expansion affect the maxillomandibular complex?

AIM

This was to evaluate changes in spheno-occipital synchondrosis one year after rapid maxillary expansion (RME), in order to assess the influence that any change might have on sagittal and vertical skeletal cephalometric variables.

MATERIALS AND METHODS

Patients were selected consecutively and grouped into: Group 1 comprised 30 Caucasian patients (13 m; 17 f) undergoing RME therapy; after active expansion therapy, the Haas expander was worn as passive retainer for an average of 7 months. Group 2 as control included 14 untreated subjects (6 m, 8 f), matched by age, sex and vertebral skeletal maturity (CVM method, stages 1-3). Six cephalometric variables concerning spheno-occipital synchondrosis were studied: N-S-Ba; SOS-Ba; SOS-S; S-Ba; Ba-N; S-N; nine skeletal variables for sagittal and vertical evaluation were also checked. T-test was used for comparing the 2 groups data.

RESULTS

A statistically-significant opening of the spheno-occipital synchondrosis and increase of the posterior cranial base length (Ba-SOS) were found between group 1 and 2. After 1 year, these modifications in spheno-occipital syncondrosis produced no change in the anteroposterior or vertical skeletal parameters examined.

CONCLUSION

After RME there were statistically significant effects on spheno-occipital synchondrosis length and cranial base angle; however, these changes in the mid-term did not affect the vertical or sagittal parameters of the skeletal maxillomandibular complex.

Cancer in pregnancy: maternal and fetal implications on decision-making

BACKGROUND

Cancer complicates one out of 1,000 pregnancies. No standardized therapeutic interventions have been reported for these patients.

METHODS

Fifteen patients with cancer during pregnancy were diagnosed between 6.5 and 36 weeks of gestational age between January 1991 and December 2007.

RESULTS

Among the 15 cases one patient with early diagnosis (11 weeks) asked for interruption of pregnancy, two patients rejected chemotherapy in order to avoid fetal effects, seven patients underwent surgery during the first or second trimester, and two patients agreed to start the treatment only after delivery. Standard platinum-based chemotherapy (cisDDP) was postponed in six patients to the second trimester (administered after surgery in 2 cases). Chemotherapy was started between 18.3 and 29.6 weeks (median 22.3 weeks). One patient had pPROM (22.3 weeks) after chemotherapy with cisDDP. Ten patients were delivered by elective cesarean section and three by vaginal delivery. Mean gestational age at delivery was 33.5 weeks (range 32.1-40.0); mean weight at birth was 2,550 g (range 1,250-3,450). None of the newborns showed congenital malformations, and all had normal Apgar scores. Anemia occurred in two newborns. At a median follow-up of 56 months (range 2-198 months) all children were well and healthy. Eleven out of 15 mothers are alive and well, and one is alive with disease. An advanced neoplasm was diagnosed in three patients who died.

CONCLUSION

When platinum-based chemotherapy is administered during the 2nd-3rd trimester, adverse effects in newborns are comparable to those in the general population. Deliberate treatment delay to achieve fetal viability or to improve fetal outcome may be reasonable for patients with early-stage cancer.

Coronary flow reserve by transthoracic echocardiography predicts epicardial intimal thickening in cardiac allograft vasculopathy

Cardiac allograft vasculopathy (CAV) is the leading cause of morbidity and mortality in heart transplantation (HT). We sought to investigate the role of coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in CAV diagnosis. CAV was defined as maximal intimal thickness (MIT) assessed by intravascular ultrasound (IVUS) > or =0.5 mm. CFR was assessed in the left anterior descending coronary artery in 22 HT recipients at 6 +/- 4 years post-HT. CAV was diagnosed in 10 patients (group A), 12 had normal coronaries (group B). The mean MIT was 0.7 +/- 0.1 mm (range 0.03-1.8). MIT was higher in group A (1.16 +/- 0.3 mm vs. 0.34 +/- 0.07 mm, p < 0.0001). CFR was 3.1 +/- 0.8 in all patients and lower in group A (2.5 +/- 0.6 vs. 3.7 +/- 0.3, p < 0.0001). CFR was inversely related with MIT (r =-0.774, p < 0.0001). A cut point of < or =2.9, identified as optimal by receiver operating characteristics analysis was 100% specific and 80% sensitive (PPV = 100%, NPV = 89%, Accuracy = 91%). CFR assessment by CE-TTE is a novel noninvasive diagnostic tool in the detection of CAV defined as MIT > or =0.5 mm. CFR by CE-TTE may reduce the need for routine IVUS in HT.

Gemcitabine-induced progressive and sustained tumour response in a patient with multi-drug resistant uterine leiomyosarcoma

Background:

despite the fact that the combination of gemcitabine (GCB) and docetaxel shows an increased benefit for disease-free survival and overall survival compared to GCB alone in patients with soft-tissue sarcoma, GCB mono-chemotherapy should be considered as a preferable option with respect to the combination because of its lower toxicity profile and the possibility of it being administered continuously for a long time period.

Case report:

we report a clinical case of a woman with advanced high-grade uterine leiomyosarcoma, refractory to ifosfamide, doxorubicin and trabectedin, who experienced a sustained and progressive response to GCB alone.

Conclusions:

GCB given as mono-chemotherapy can obtain long-lasting tumour control in patients heavily pre-treated with various chemotherapeutic regimes for uterine LMS and should be considered as a possible option for this subset of patients.

Post-transplant lymphoproliferative disorders after heart or kidney transplantation at a single centre: presentation and response to treatment

Post-transplant lymphoproliferative disorders (PTLD) is a serious complication after solid organ transplantation. Reduction of immunosuppression (RI) alone is not able to control the disease. We report a prospective analysis of 30 patients with PTLD after heart or kidney transplantation. Only 5 of 30 patients, treated solely with RI, obtained a complete response. Five patients were treated heterogeneously; in the remaining 20, the efficacy and safety of a weekly anthracycline-based chemotherapy were assessed. Sixteen patients obtained a complete remission. One death was related to treatment. With a median follow-up of 36 months, 3-year overall survival was 63.3% and 57% for the entire group and the chemotherapy-treated group, respectively. Moreover, 4 second neoplasms were observed in the chemotherapeutic group. In this study, we demonstrated that most PTLD need other treatment than RI and a weekly regimen is manageable and has a favourable impact on long-term survival.

Pattern of failure and value of follow-up procedures in endometrial and cervical cancer patients

OBJECTIVE

The aim of this study was to evaluate the outcome benefit of follow-up protocols for patients with recurrent endometrial and cervical cancer.

METHODS

A retrospective review on patients primarily treated at the Division of Gynecologic Oncology, University of Brescia, was performed. We focused our attention on recurrent patients and we evaluated the pattern of relapse and the presence of symptoms or signs of disease at recurrence and evidence of disease on routine follow-up test or visits.

RESULTS

The vast majority of recurrences occurred within the first 3 years after primary treatment (78% and 87% in endometrial and cervical cancers, respectively). A better overall survival from relapse was observed when vaginal relapse was compared to other sites in endometrial cancer patients and when pelvic recurrence was compared to distant sites in cervical cancer cases. Recurrent endometrial and cervical cancer patients were symptomatic in 52% and 65% of cases, respectively. Among asymptomatic recurrent endometrial cancer cases, pelvic examination, abdominal or pelvic ultrasound and CT could detect 92% of relapses, while the vast majority of cervical cancer relapses could be diagnosed by pelvic examination and/or CT (85%).

CONCLUSION

Endometrial cancer patients showed a significantly better prognosis when the recurrence was detected during follow-up visits, thus supporting the real advantage of our surveillance programs, while no statistically significant differences were found in survival of cervical cancer patients between the symptomatic and the asymptomatic group.

Coronary flow reserve by contrast-enhanced echocardiography: a new noninvasive diagnostic tool for cardiac allograft vasculopathy

Noninvasive tests have proven unsatisfactory in cardiac allograft vasculopathy (CAV) diagnosis. We assessed coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in heart transplantation (HT). CFR was assessed in the left anterior descending coronary artery in 73 HT recipients (59 male, aged 50+/-12 years at HT), at 8+/-4.5 years post-HT. CFR measurements were taken blindly from coronary angiographies. CFR cut points were the standard value of <or=2 and those defined by receiver operating characteristics (ROC) curve analysis. CFR was lower in patients with CAV (2.3+/-0.7 vs. 3.2+/-0.5, p<0.0001). The <or=2 cut point was 100% specific and 38% sensitive. The <or=2.7 cut point, optimal by ROC analysis, was 87% specific and 82% sensitive. Accuracy rose from 71% with the standard<or=2 cut point to 85% with the optimal cut point of <or=2.7. CFR by CE-TTE may offer promise as a novel, easily repeatable and accurate noninvasive tool in CAV detection. However, further longitudinal studies in larger patient cohorts are warranted before widespread adoption can be advocated.