Platelet-rich plasma treatment and hemostasis in patients with hemorrhagic risk

AIM

Our research aimed to evaluate the risk of haemorrhage following oral surgical operations, in patients who were undergoing an anticoagulant therapy, and to test the usefulness of the autologous platelet gel in order to control haemostasis.

METHODS

A total of 208 patients (84 males/124 females) undergoing an anticoagulant therapy and submitted to oral surgery, were divided at random into 4 groups (A, B, C, D) consisting of 52 patients each, using as criterion of differentiation the kind of treatment we adopted in order to get haemostasis. The patients belonging to the first 3 groups (A, B, C), underwent a surgical operation without discontinuing the dicumarol therapy. In order to get haemostasis, we used: platelet-rich plasma (PRP) and suture, in group A; PRP, haemostatic sponges and suture, in group B; haemostatic sponges, suture and compression by means of gauzes soaked in tranexamic acid in group C. Group D, instead, consisted of patients who underwent a surgical operation, before which the dicumarol therapy had been suspended and replaced by heparincalcium.

RESULTS

Patients belonging to the groups A and B showed a very good haemostasis like the patients of group D (control group). As the coumarin therapy didn't need to be discontinued some days before the surgical operation, so the days of hospital stay were reduced and there wasn't the risk of thromboembolism. As to group C (19 males), 6 patients (i.e. 11.5%) showed a good haemostasis, both at once and in the long term, so that they could be discharged on day 2 after surgery.

CONCLUSIONS

The results obtained during our research, highly encourage using PRP regularly when carrying out surgical treatments on patients who are undergoing a coumarin therapy.

[Iris mammillations: three case reports]

INTRODUCTION

Iris mammillations are congenital abnormalities characterized by vitiliform protuberances regularly spaced on the surface of a velvety iris. They can be either isolated or associated with melanocytosis involving iris, sclera or periocular tissues, resulting in a risk for uveal melanoma. They can be complicated by ocular hypertension. We report three cases of iris mammillations in three children.

CASES REPORT

For each patient, age, circumstances of revelation, anterior and posterior segment examination, intraocular pressure, associated anomalies, and progression were noted. Patient no. 1: In a 13-month-old boy examined for a squint, bilateral iris mammillations were fortuitously discovered. Intraocular pressure remained normal over 22 months of follow-up. Patient no. 2: In an eight-year-old boy, bilateral iris mammillations with papillary excavation were fortuitously discovered. Intraocular pressure was normal and the excavation did not change over 20 months of follow-up. Patient no. 3: A five-year-old boy was examined for a scleral pigmentation in the right eye. The examination found unilateral iris mammillations and ipsilateral ocular melanocytosis. Intraocular pressure and fundus were normal and remained normal over 13 months of follow-up.

DISCUSSION

and conclusion: Iris mammillations are congenital abnormalities, generally unilateral, sometimes hereditary. The differential diagnosis includes Lisch nodules of neurofibromatosis and iris melanoma. The etiology of iris mammillations is unknown; these lesions can be complicated by ocular hypertony and, in case of associated melanocytosis of the iris, sclera or periocular tissues, by uveal melanoma. These potential complications warrant a regular clinical follow-up.

Clinical and therapeutic experience in twenty eight patients with burning mouth syndrome

AIM

Burning mouth syndrome (BMS) is a chronic painful syndrome in clinically normal oral mucosa. There are many local, systemic and/or psychogenic pathological conditions that may clinically appear as burning and painful sensation of the oral mucosa. There are essential or idiopathic BMS and organic or secondary BMS. A diagnostic and therapeutic protocol is proposed by the authors evaluating, the effectiveness of the estroprogestinic replacement therapy in post-menopausal women suffering from idiopathic BMS.

METHODS

A total of 28 patients suffering from persistent burning and painful oral sensation underwent to careful clinical and laboratory examination in order to distinguish primary forms from secondary ones. Patients suffering from primary BMS underwent to incisional biopsy for the research of estrogens receptors.

RESULTS

Only 8 out of the 28 studied patients (28.5%) were negative to the clinical oral and laboratory examinations listed in our protocol and they were diagnosed for primary BMS. All of them were females.

CONCLUSIONS

The use of a valid diagnostic and therapeutic protocol allows a better management of patients suffering from oral pain and a reduction if not a disappearance of the burning symptomatology in most of them. In post-menopausal patients suffering from idiopathic BMS good results may be obtained by an estroprogestinic replacement therapy.

Desmin-free cardiomyocytes and myocardial dysfunction in end stage heart failure

Our aim was to evaluate the desmin content in the myocardial tissue of patients with end-stage heart failure of ischaemic origin and to assess its role on cardiac function. We studied 18 explanted hearts from patients transplanted for end-stage heart failure due to ischaemic cardiomyopathy (ICM). Control myocardial tissue was obtained from the cardiac biopsies of six women with breast cancer taken prior to commencing chemotherapy with anthracyclines, four male donors for heart transplantation and two autoptic hearts from patients who died due to non-cardiac events. Myocardial tissue, obtained from the left ventricle (remote zone from infarcted area), was analyzed by light and confocal immunochemistry (desmin) microscopy. The desmin content of myocardial tissue was obtained by real-time PCR. Cardiac function was evaluated by echocardiographic and right heart catheterization data, obtained before heart transplantation. Confocal microscopy evaluation showed a significant decrease in the number of desmin-positive myocytes (P<0.01) in ICM hearts compared to controls. At real-time PCR evaluation, there was a reduction (P<0.01) in desmin content in the ICM patients compared to controls. A negative correlation was found between desmin-free cardiomyocytes and ejection fraction (EF) (r=-0.834; P<0.02) on echocardiogram. A negative relationship (r=-0.688) was also found between desmin-negative myocytes and capillary wedge pressure. In conclusion, the myocardial tissue of patients with end-stage heart failure of ischaemic origin, shows a decreased number in desmin-positive myocytes at immunochemistry evaluation compared to normal individuals. This deficiency in cytoskeletal intermediate filament content is associated with reduced cardiac function.

The glare effect and the perception of luminosity

The impression of self-luminosity in the glare effect was studied in two experiments. In experiment 1 the target (CS) was set to the highest luminance of the field and subjects were asked to adjust the luminance ramp of the inducers (R) against five backgrounds (B) to the point where they began to see CS as self-luminous. It was found that there is a linear relationship between background and luminance ramp. Another group of subjects carried out the same task in experiment 2, but this time CS and R were linked together so that CS would always have the same luminance as the highest luminance level of R, as adjustments were performed. It was found that: (i) adjustments were always lower than the highest luminance available; (ii) the linear relationship between background and luminance ramp was confirmed; (iii) observers reported a compelling impression of self-luminous grays. Data are discussed in relation to Bonato and Gilchrist's model for the perception of luminosity. The authors advance the hypothesis that luminance ramps are used at an early stage of encoding for the perception of luminosity.

[Intraocular lens implantation in the first year of life]

We evaluated 36 eyes in 23 infants between one and eleven months old who had primary posterior chamber intraocular lens implantation for congenital cataracts. All eyes had a capsulorhexis of anterior and posterior capsulae and anterior vitrectomy. In order to obtain an emmetropia at age 5 years, we chose a 35% undercorrection of lens power for infants less than six months old, and 25% for infants between seven and eleven months old. The average follow-up was 15.3 months. Nine eyes developed posterior synechiae and eight developed a posterior opacification. The average postoperative refraction was +5.81 dioptries at one month, +4.56 at four months, +1.5, at one year, and +0.19 at two years. There was a marked subjective visual improvement in 34 eyes.

Discrimination of an orientation difference in dynamic textures

We investigated whether the response of a motion sensor was related to the specificity of sensory information (orientation and direction of motion) used to compute motion energy. This was done in two ways. First, we assessed whether orientation discrimination of a target line, which segregated by an orientation difference from a textured background, was improved with two-frame apparent motion stimulation (as compared with static presentation). Second, we investigated whether the amount of improvement (in either orientation or direction of motion discrimination) depends on a particular combination of target orientation and direction of motion (either orthogonal or parallel). We found that the percentage of correct responses in the discrimination task (a) was higher for a moving target than for a static one; (b) was higher when the target was oriented more orthogonally to motion direction than background elements; (c) was little affected by background motion and (d) decreased with frame duration in the direction of motion task whereas it was largely unaffected by frame duration in the discrimination of orientation task. These results suggest that discrimination of moving texture boundaries is based on a motion sensor tuned to a particular combination of orientation and direction of motion, which is capable of signalling the orientation of a moving target more accurately than a static sensor.

Changes in myocardial cytoskeletal intermediate filaments and myocyte contractile dysfunction in dilated cardiomyopathy: an in vivo study in humans

AIM

To investigate in vivo the intermediate cytoskeletal filaments desmin and vimentin in myocardial tissues from patients with dilated cardiomyopathy, and to determine whether alterations in these proteins are associated with impaired contractility.

METHODS

Endomyocardial biopsies were performed in 12 patients with dilated cardiomyopathy and in 12 controls (six women with breast cancer before anthracycline chemotherapy and six male donors for heart transplantation). Biopsy specimens were analysed by light microscopy and immunochemistry (desmin, vimentin). Myocyte contractile protein function was evaluated by the actin-myosin in vitro motility assay. Left ventricular ejection fraction was assessed by echocardiography and radionuclide ventriculography.

RESULTS

Patients with dilated cardiomyopathy had a greater cardiomyocyte diameter than controls (p < 0.01). The increase in cell size was associated with a reduction in contractile function, as assessed by actin-myosin motility (r = -0.643; p < 0.01). Quantitative immunochemistry showed increased desmin and vimentin contents (p < 0.01), and the desmin distribution was disturbed in cardiomyopathy. There was a linear relation between desmin distribution and actin-myosin sliding in vitro (r = 0.853; p < 0.01) and an inverse correlation between desmin content and ejection fraction (r = -0.773; p < 0.02). Negative correlations were also found between myocardial vimentin content and the actin-myosin sliding rate (r = -0.74; p < 0.02) and left ventricular ejection fraction (r = -0.68; p < 0.01).

CONCLUSIONS

Compared with normal individuals, the myocardial tissue of patients with dilated cardiomyopathy shows alterations of cytoskeletal intermediate filament distribution and content associated with reduced myocyte contraction.

Positron emission tomography with f18-fluorodeoxyglucose in the staging and preoperative evaluation of malignant pleural mesothelioma

OBJECTIVES

The purpose of this study was to evaluate the utility of positron emission tomography with F18-fluorodeoxyglucose in the preoperative evaluation and staging of malignant mesothelioma in patients who were candidates for aggressive combined modality therapy.

METHODS

Eighteen consecutive patients with biopsy-proven malignant mesothelioma underwent positron emission tomographic scanning. The results of positron emission tomographic imaging were compared with results obtained by computed tomography, mediastinoscopy, thoracoscopy, and pathologic examination of surgical specimens. All patients fasted and received an average of 14.5 +/- 2.7 mCi of F18-fluorodeoxyglucose for positron emission tomographic scanning. Attenuation-corrected whole-body and regional emission images of the chest and upper abdomen were acquired and formatted into transaxial, coronal, and sagittal images.

RESULTS

All primary malignant mesotheliomas accumulated F18-fluorodeoxyglucose, and the mean standardized uptake value was 7. 6 (range, 3.33-14.85; n = 9). There were no false-negative results of positron emission tomography. Identification of occult extrathoracic metastases by positron emission tomography was the basis for excluding two patients from surgical therapy. There were two false-positive results of positron emission tomography: increased F18-fluorodeoxyglucose uptake in the contralateral chest that was negative by thoracoscopic biopsy (n = 1) and increased abdominal F18-fluorodeoxyglucose uptake after partial colectomy for diverticular disease (n = 1).

CONCLUSIONS

Positron emission tomography can identify malignant pleural mesothelioma and appears to be a useful noninvasive staging modality for patients being considered for aggressive combined modality therapy.

Investigation on cerebral hemodynamics in patients with carotid disease receiving carotid endarterectomy

100 patients (pts) receiving CEA (carotid endarterectomy) were evaluated in this study. In some of them postoperative complications were observed, characterized by TIA (transient ischemic attack) and, mostly, by cerebral hyperperfusion. In only two of the pts investigated CEA needed the implantation of a shunt, due to the emergence of intolerance signs at carotid Clamping (C) evaluated by TCD (transcranial Doppler); the preoperative cerebral angiography in the two subjects in question did not show malformations of the circle of Willis. The hyperperfusive phenomenon and the absence of intracranial compensation flows during CEA seemed to be ascribed to a more or less severe impairment of cerebral reserve. Such impairment of the autoregulatory capacity seems to be crucial to the pathogenesis of hemodynamic stroke. Thus the indication to CEA, in pts with severe carotid disease, should take into account also the cerebral reserve (CR) impairment to prevent both thromboembolic and hemodynamic stroke. The predictive and diagnostic role of TCD turns out to be crucial in assessing and selecting pts candidate to CEA.

[An analysis of the psychophysiological components in subjects with temporomandibular disorders. Myographic tension and the management of aggressiveness]

BACKGROUND

The stomatognathic literature doesn't sufficiently stress the role of aggressiveness as a modulator of muscular tensions. Our study focused on the hypothesis that 1) original psychological problems related to the modulation of aggressivity could produce 2) chronic muscular tension of the oral district 3) they can become the basis of the malocclusive phenomenon. The investigation was conducted in the laboratory of Clinical Psychophysiology of the University of Rome "La Sapienza".

METHODS

We have examined the myographic activity of the temporal and masseter muscles of both sides in 20 women with temporomandibular dysfunction and in the control group comparable by age. The myographic tension was examined in three "stimulus situations": a) closed lips without any teeth contact; b) with light teeth contact; c) with compression of the dental arcade. Moreover, we have examined the style of aggressiveness modulation through Rosenzweig's PFS test. Features of the experimental group were. 1) age between 20 and 30 yrs; 2) presence of condylomeniscal uncoordination; 3) deviation of the median line of incisors; 4) lateral deviation in the opening and/or closing mandible.

RESULTS

The experimental group showed a higher score of myographic amplitude for the above-mentioned muscles of both sides in three "stimulus situations". Moreover, it presented at the Rosenzweig's test more elevated scores for the Dominance of Obstacle (O-D); b) less elevated scores for Ego Defence (E-D).

CONCLUSIONS

Results are commented on the basis of an integrated psychophysiological model.