[Bernard-Horner syndrome after accidental lesion of carotid artery: case report]

Among the complications of internal jugular vein insertion there is the lesion of the cervical sympathetic trunk with the onset of Bernard-Horner syndrome, consisting of miosis, eyelid ptosis, enophthalmos and anhidrosis on the same side of the lesion. The neurological damage can be caused by the direct puncture of the trunk or by the irritating and compressive action of a hematoma during the puncture of the internal jugular; the clinical picture, when reversible, resolves in a few months. The case we report is about the onset of the syndrome after accidental puncture of carotid artery, followed by the total disappearance of signs in a few days.

Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management

BACKGROUND

The anterolateral thigh flap (ALT) is one of the most common flaps used in reconstructive microsurgery, due to its demonstrated lower donor-site morbidity when compared to other sites. Despite this, there are case reports of specific donor-site complications following the raising of an ALT flap. To date, there has been no systematic review of ALT-flap-related complications and overall ALT donor-site morbidity.

METHODS

A systematic review of the English-language literature was performed to identify specific donor-site complications following ALT-flap creation.

RESULTS

Fifteen articles met the study criteria and were included for analysis. ALT-flap donor-site complications were classified according to the tissue component involved (vessels/nerves, deep fascia, muscles).

CONCLUSIONS

Donor-site morbidity following raising of an ALT flap is minimal. ALT-flap versatility fulfils all of the needs of reconstruction, however we identified less common, but straightforward, complications that occurred when elevating overly large skin paddles (with widths measuring more than 10-12 cm), when sacrificing a main motor branch, when developing the pedicle too far proximally, when including too much fascia and when neglecting proper haemostasis. We suggest a basic algorithm for minimising donor-site morbidity and controlling complications, thereby reducing overall patient morbidity, shortening hospital stays and reducing costs.

The contribution of Aulus Cornelius Celsus (25 B.C.-50 A.D.) to eyelid surgery

An accurate study of ancient medicine reveals that our forebears developed a large number of surgical ideas and techniques considered to be quite modern. Although the contribution of Aulus Cornelius Celsus to the development of several branches of surgery has already been celebrated, scant attention has been focused on his description of eyelid surgery in the seventh book of his encyclopedia, De Medicina octo libri. Although the practice was quite advanced by that time, the first century A.D., Celsus was the first among the Greco-Roman authors to deal systematically with ophthalmology and oculoplastic surgery. He was a compiler, and many of his "innovations" were in fact done in principle by others. Yet it is almost certain that the surgical procedures presented were introduced more than 15 centuries before the time of Celsus by Egyptians, Indian surgeons, and Greek and Alexandrian doctors. The burning of the Ancient Library of Alexandria as well as the perishing of many writings of pioneer physicians resulted in a tragic loss of ancient knowledge for posterity. Celsus, whose work has been preserved in our time, helped to publicize this ancient knowledge, and perhaps because of the loss of so much early medical literature, became one of the most influential experts on ancient medicine. An analysis of how previous authors have influenced Celsus' description of eyelid surgery and reflections on how modern his ideas (or those of his time) were are presented in the paper.

A simple technique to improve residual skin plasticity for scrotal reconstruction in Fournier's Gangrene

A 50 years-old man developed 24 hours after hemorrhoidectomy a severe Fournier's gangrene of the scrotum necessitating surgical exeresis of more than 2/3 of scrotal skin followed by hyperbaric oxygen therapy. After the resolution of the septic phase, scrotum reconstruction was obtained by tissue expansion to avoid more invasive advanced reconstructive techniques. The procedure consisted of an enzymatic and mechanical debridement and progressive skin expansion by package of gauzes of increasing volume covered with a collagenasecloramphenicol ointment (Iruxol®- Smith and Nephew, Italy), then closing the wound edges by temporary stitches to put under tension the skin. The reestablishment of the natural elasticity of the scrotal skin was obtained in ten days and at the final closure of the wound edges an acceptable optimal aesthetic result was achieved.

Expression of β-catenin and γ-catenin in maxillary bone regeneration

β- and γ-catenin are components of catenin family involved in cadherin adhesion function. Recently it has been shown that this family is involved in other functions such as signaling and activation of transcription factors. The final goal of this study was to evaluate the role of β- and γ-catenin in bone cell physiology and bone regeneration. Formalin-fixed-paraffin embedded specimens of 15 human bone specimens after sinus lift were collected and examined by immunohistochemstry using primary antibodies against β- and γ-catenin. Staining intensity and cellular localization were evaluated. β and γ-catenin showed a very high level of expression in human bone tissues. In particular catenins were expressed in cells with morphological findings of osteoblasts in the areas of new bone formation at the junction between mineralized and unmineralized tissue, between osteoid matrix and bone. Osteoclasts showed also positivity for catenins. Osteocytes, cells located in lacunae of mature mineralized bone with function of bone vitality maintenance, showed no expression for catenins. Specimens characterized by high amount of catenins in osteoblasts at 1° month showed high grade of bone maturation at 3° month. Data demonstrated an overall involvement of catenins in human bone tissues and in particular during bone regeneration process. The presence of staining for β- and γ-catenin particularly in osteoblasts demonstrates a significant role of catenins in functions, other than in cadherin interaction, such as signaling and activation of transcription factors during differentiation of bone tissues.

Osteoplant acts on stem cells derived from peripheral blood

Objectives:

The osteoplant is an equine, flexible, heterologous, deantigenic, cortical, and spongy bone tissue, totally reabsorbable, used for implantation of bone tissue, to restore skeletal, even weight-bearing structures. However, how the osteoplant alters osteoblast activity to promote bone formation is poorly understood.

Materials and Methods:

To study how the osteoplant induces osteoblast differentiation in mesenchymal stem cells, the expression levels of bone-related genes, and mesenchymal stem cell markers are analyzed, using real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR).

Results:

The osteoplant causes induction of osteoblast transcriptional factors such as osterix (RUNX2), and of bone-related genes such as osteopontin (SPP1) and osteocalcin (BGLAP). In contrast the expression of ENG (CD105) is significantly decreased in stem cells treated with osteoplant, with respect to untreated cells, indicating the differentiation effect of this biomaterial on stem cells.

Conclusion:

The obtained results can be relevant to better understand the molecular mechanism of bone regeneration and as a model for comparing other materials with similar clinical effects.

Expansion of the Alveolar Bone Crest with Ultrasonic Surgery Device: Clinical Study in Mandible

The purpose of this paper was to document the application to the split-crest mandibular procedure in two stage in order to avoid cortical resorption due to periosteal detachment in buccal cortical bone of the alveolar crest. Twenty-two healthy patients with non-contributory past medical history (14 women and 8 men, all non-smokers, mean age 59 years, range 54–65 years) were included in this study. After buccal mucoperiosteal flap was followed by a sagittal corticotomy in the coronal area of the alveolar crest and a second sagittal corticotomy, but in a lower (basal) position and two vertical corticotomies in the buccal wall, using a ultrasonic surgery device (Surgysonic, Esacrom, Imola Italy). Adequate crest expansion was achieved without compromising cortical vascularisation by utilising a combination of scalpel, thin chisels and threaded osteotomes (Bone System, Milano, Italy). Postoperative results were assessed by panoramic and periapical radiographs. Ossification of the osteotomy lines was evident and could be observed as sites with increasing radiopacity on panoramic and periapical radiographs 3 months after implants insertion. No dehiscence of the mucosa was observed. No patient suffered from hypoaesthesia. The mean horizontal bone increase in coronal area was 5±3 mm. Mandibular ridge expansion using a split-crest technique that included grafting the implant sites with a ultrasonic surgery device is a viable therapeutic alternative for implant placement in this patient population.

Loh at PDCD4, CTNNB1, and CASP4 LOCI Contributes to Stage Progression of Oral Cancer

Squamous cell carcinoma is the most frequent malignant tumor of the oral cavity. Markers of tumor progression that could help to define diagnosis, plan treatment and implement prognosis have still to be identified. Seven candidate markers for tumor progression were investigated using a loss of heterozygosity (LOH) assay. The sample was made up of 51 squamous cell carcinoma and adjacent normal tissues from the same patients. LOH at one, or more, markers was a relatively frequent event that was observed in 53% of tumors. The number of losses detected in each tumor was significantly associated with tumor severity. Significant association between UICC stage grouping and LOH was found for 3 gene loci: programmed cell death 4 (PDCD4), catenin beta 1 (CTNNB1), and caspase 4 (CASP4). No association between allelic loss and the occurrence of lymph node metastasis was found for any of the seven investigated loci. Overall, LOH contributes to tumor progression of oral SCC. A specific role for PDCD4, CTNNB1, and CASP4 was found.

Direct visualization of oral-cavity tissue fluorescence as novel aid for early oral cancer diagnosis and potentially malignant disorders monitoring

Direct visualization of the oral tissue autofluorescence has been recently reviewed in several studies as a possible adjunctive tool for early recognition and diagnosis of potentially malignant and malignant oral disorders. The aims of this study were to assess: a) the value of a simple handheld device for tissue auto-fluorescence visualization of potentially malignant oral lesions; and b) the sensitivity, specificity and diagnostic accuracy of tested device, using histological examination as the gold standard. 175 consecutive patients, with at least one clinical oral lesion, were enrolled in the study. Clinical conventional inspections were performed for each patient by two blind operators. Then, oral biopsy and histological examination were performed. Pathologist was blind with respect to the autofluorescence results. The 175 histological assessments revealed no dysplasia, mild dysplasia, moderate/severe dysplasia and OSCC, in the 67.4%, 8.6%, 8%, 16% of cases, respectively. Oral lesions diagnosed as OSCC were found as positive under fluorescent light in the 96.4% of cases. Statistically significant correlation was observed between oral dysplastic lesions and the loss of tissue fluorescence (p-value=0.001). Low sensitivity values (60% and 71%) were recorded about the ability of the device in differentiating mild dysplasia vs. lack of dysplasia and moderate/severe dysplasia vs absence of dysplasia, respectively. The device tested in our study was found to not replace the histopathology procedure. However, we assessed its usefulness for oral tissue examination, especially within an oral medicine secondary care facility, before performing a biopsy and in monitoring oral lesions.

Study of the 12q13 Region in Nonsyndromic Cleft Lip with or without Cleft Palate

The 12q13 region has been suggested as a candidate locus for orofacial cleft by different investigators. In the present study we tested the region for linkage with non syndromic cleft lip with or without cleft palate in a collection of 39 Italian multigenerational families, using microsatellite markers. No evidence of linkage was detected between the marker map and NSCLP under different mode of inheritance nor with a nonparametric method. Formal level of linkage exclusion, were obtained for each point of the map. Genetic heterogeneity and the different impact of the candidate locus among populations could explain conflicting results obtained in different studies.

Analysis and Structural Examination of Screw Loosening in Oral Implants

Biological and technical failures of implants have already been reported. Mechanical factors are certainly of importance in implant failures, even if their exact nature has not yet been established. The abutment screw fracture or loosening represents a rare, but quite unpleasant failure. The aim of the present research is an analysis and structural examination of screw thread or abutment. In this study broken screws were excluded. A total of 58 screw thread loosening were observed, 5 Branemark, (Nobel Biocare, Gothenburg, Sweden) 4 Implant Innovation (Riverside Drive Palm Beach Gardens, FL, USA) and 7 Restore (Lifecore Biomedical, Chaska, Minnesota, USA) and 42 T.B.R. implant (Benax, Ancona, Italy). The loosened abutment screws were retrieved and analyzed under SEM. Many alterations and deformations were present in concavities and convexities of screw threads.

A case report of a difficult dissection of the iliac vessels conducted by means of the harmonic scalpel during a kidney transplantation

BACKGROUND

The "difficult" preparation of iliac vessels in the kidney transplant recipient caused by a perivascular fibrosis with satellite lymphadenopathy is sometimes burdened by post-transplant complications (lymphocele, seroma and hematoma). Both iliac vascular adhesions and satellite lymphoadenopaty are often due to reiterate femoral cannulation aimed to hemodialysis.

PATIENTS AND METHODS

The case report concerns a 60 years old female uremic patient, on dialysis for about 4 years with perivascular fibrosis and pelvic lymphadenopathy caused by bilateral femoral artery catheterization. In the course of kidney transplant, preparation of the iliac vessels was performed by ultrasonic scalpel. In the case we handled there was no incidence of immediate, medium and long term post operative complications, with a considerable reduction of the operative time in the vascular dissection performed without ligation. Often the long dialytic period, the same nephropathy, reiterative femoral catheterization determine perivascular fibrosis and/or consensual lymphadenopathy. In these cases, in light of initial experience, the use of ultrasonic scalpel enables easy dissection by the coagulative synthesis not only of vascular compartment but also of the lymphatic duct whose leakage, particularly in these cases, creates a favourable condition to hematoma and/or lymphocele formation. These complications, although rarely jeopardize patient's life, however, may affect the outcome of transplantation in terms of morbidity and survival of the organ. The use of ultrasonic scalpel ensures total control of vascular and lymphatic compartment coagulation, alongside a reduction in the time of surgical dissection.

A simple method to treat post-kydney transplantation lymphocele

To describe our experience with ultrasonic-guided instillation of povidone-iodine to treat post-kidney transplantation lymphocele. Patients and methods. We studied the safety and efficacy of this procedure for treatment of lymphocele in 6 male kidney transplanted recipients in which we assisted a progressive increase of creatinine and urinary proteins levels and color-Doppler ultrasonography demonstrated an increase (25,4%) of index of resistence (IR) Using eco-colorDoppler, the related-graft lymphocele location and the distance to the anterior abdominal wall were determined; then, a radiopaque double-lumen catheter was used to instillate 5% povidone-iodine 10 ml. Results. Percutaneous drainage achieved a resolution rate of 100%. Studying the rate of peripheral and internal vascularization of the kidney before and after treatment, eco-colorDoppler showed a significant decrease of the IR (24,6%). Conclusions. The US-guided povidone-iodine instillation for treatment of lymphocele following renal transplantation may be considered as first choice therapy in such disease.

Bilateral posterior maxillary segmental osteotomy to rehabilitate edentulous mandibular area: case report

The purpose of this work was to describe a clinical case with reduced vertical height in both the posterior sectors, due to maxillary dento-alveolar extrusion in mandibular edentulous space, as a result of some extractions which have not been promptly replaced by a prosthetic rehabilitation, eventually resolved with a bilateral posterior segmental maxillary osteotomy (PMSO). Our surgical technique was practised under general anesthesia according to Kufner's version of Schuchardt's original description. In the light of the present outcomes, in severe clinical cases of dento-alveolar extrusion, the PMSO can be considered the optimal solution, because of the quality and the stability of the final result, the short therapeutic times, the limited morbidity and the modest compliance asked to the patient.

Absence of Simian virus 40, BK, and JC polyomavirus DNA in squamous cell carcinoma limited to the oral cavity

BACKGROUND

Head and neck squamous cell carcinomas (SCCs) are among the most aggressive types of cancer. The Simian virus 40 (SV40), which is a polyomavirus known for its oncogenic potential, was found as a contaminant of oral vaccines and has been related to human pleomorphic adenoma in the parotid gland. The aim of this study was to evaluate the presence of SV40 and 2 human polyomaviruses-BK virus (BKV) and JC virus (JCV)-in a large sample of SCCs of the oral cavity.

METHODS

Quantitative real-time polymerase chain reaction (PCR) was used to evaluate virus load.

RESULTS

Overall, the prevalence of SV40, BKV, and JCV in oral SCC was negligible. Matched-pair case-control analysis indicated that prevalence among the controls did not significantly differ with respect to analyzed cases.

CONCLUSION

The results did not indicate a major role for SV40, BKV, and JCV in the etiology of oral SCC.

Risk factors for type 2 diabetes in women attending menopause clinics in Italy: a cross-sectional study

OBJECTIVE

To analyze risk factors for type 2 diabetes among women attending menopause clinics in Italy for counselling about the menopause.

SUBJECTS

Women attending a network of first-level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms.

METHODS

Cross-sectional study with no exclusion criteria. Type 2 diabetes was defined according to National Diabetes Data Groups Indications and the fasting blood glucose at an oral glucose tolerance test within the previous year.

RESULTS

Out of the 44 694 considered in this analysis, 808 had a diagnosis of diabetes type 2 (1.8%). In comparison with women aged < 50 years, the multivariate odds ratios (OR) of type 2 diabetes were 1.31 (95% confidence interval (CI), 0.99-1.74) for women aged 50-52 years, 1.66 (95% CI, 1.27-2.17) at 53-56 years and 2.84 (95% CI, 2.20-3.67) in women aged > or = 57 years. Type 2 diabetes was less frequently reported in more educated women (OR high school/university vs. primary school = 0.44 (95% CI, 0.36-0.55)). Being overweight was associated with an increased risk of type 2 diabetes. In comparison with women reporting a low level of physical activity, the multivariate OR of type 2 diabetes was 0.67 (95% CI, 0.54-0.84) for women reporting regular physical activity. In comparison with premenopausal women, the multivariate OR of type 2 diabetes was 1.38 (95% CI, 1.03-1.84) in women with natural menopause. This finding was present also after allowing for the potential confounding effect of age. The multivariate OR of diabetes for users of hormonal replacement therapy was 0.58 (95% CI, 0.46-0.73).

CONCLUSIONS

This large cross-sectional study suggests that postmenopausal women are at higher risk of type 2 diabetes after allowance for the effect of age. Other main determinants of risk of type 2 diabetes in women around menopause were low socioeconomic status and being overweight. Diabetes was found less frequently in those taking hormone replacement therapy.

Lack of association between common polymorphisms of epidermal growth factor receptors and nonsyndromic cleft lip with or without cleft palate

OBJECTIVES

Nonsyndromic cleft lip with or without cleft palate (CL/P) is a frequent craniofacial malformation with a complex aetiology. Since the first report of an association between DNA sequence variants at the transforming growth factor alpha gene (TGFA) and nonsyndromic oral clefts, several studies have been carried out, which have produced conflicting results. Overall, TGFA is considered as a genetic clefting modifier in humans. Murine models indicate that the Tgfa product (tgfalpha), as well as its receptor (Egfr), actively participates in palate development. Notably, Egfr null mice showed an increased incidence in orofacial clefts. In the present study, genes which code for subunits of epidermal growth factor receptors (EGFRs) have been considered as candidate genes for CL/P.

METHODS

A family based investigation was performed using a sample of 239 case/parent triads. The aim was to test for an allelic association between common non-synonymous polymorphisms in EGFR genes and CL/P.

RESULTS AND CONCLUSION

The results did not suggest any evidence of a link between the investigated polymorphisms and CL/P, however the involvement of different polymorphisms or mutations in such genes cannot be excluded.

Safety, efficacy, and time to clinical response with bevacizumab plus FOLFIRI regimen in metastatic colorectal cancer

e15138

Background: Bevacizumab (BEV) has shown clinical activity in metastatic colorectal cancer patients (mCRC)and randomised phase III trials have demonstrated that this agent significantly improves overall and/or progression-free survival when added to first-line irinotecan based chemotherapy (CT) regimens. We evaluated the efficacy and safety of BEV plus FOLFIRI (irinotecan, 5- fluorouracil, and leucovorin) as first line treatment in 27 consecutive metastatic colorectal cancer cases, with the primary end point to calculate the median time to clinical response with this chemotherapeutic schedule. Methods: Between October 2007 and January 2008 we collected the data on 27 patients with mCRC treated with first line chemotherapy with BEV plus FOLFIRI. Elegibility criteria had to be: mCRC; no prior CT for metastatic disease; ECOG PS 0/1, adequate organ function; no CNS metastases. The treatment consisted of a minimum of six cycles of irinotecan plus infusional 5-FU/LV according to the classical FOLFIRI schedule; BEV (5mg/kg) was given on day 1 with CT and then every 2 weeks until disease progression. Safety and response were assessed at the time of first CT and every 4 weeks thereafter. Results: 27 pts were evaluable (male 18; median age 61 years (range 45–77), ECOG PS 0: 52%, PS 1: 48%. The sites of metastases were: liver (15 pts), lung (5 pts), liver and lung (5 pts), peritoneal wall (2 pts).Median follow-up was 18 weeks. Two patients had complete response(CR) and 13 pts partial response (PR), with an overall response rate of 57.7%. Five patients had stable disease and 6 patients showed progressive disease. A clinical benefit was demonstrated in 77 % of pts. We observed a median time to clinical response of 11 weeks, evaluated with tumor markers and with CT/NMR/US examinations. A grade 3 or 4 neutropenia was detected in 39% of pts and grade 2 or 3 hypertension in 9%. We did’nt observe cases of thrombosis, bleeding and gastrointestinal perforation, sometimes related to the use of BEV. Conclusions: In this little experience the efficacy and safety of BEV associated with FOLFIRI schedule, a first line therapy in mCRC,is consistent with results from other previous studies, showing moreover a short time to clinical response with this association.

No significant financial relationships to disclose.

Biphosphonates-related osteonecrosis of the jaw: Clinical and physiopathological considerations

Since osteonecrosis of the jaw was related to biphosphonate administration by Marx, studies showing clinical symptoms, drug and surgical therapies overwhelmed the literature. Furthermore, the literature demonstrated the correlation between chronic biphosphonate adsumption and osteonecrosis of the jaw onset. Nitrogen-containing biphosphonates are widely used for the management of metastatic cancer, for prevention and treatment of osteoporosis, for the treatment of Paget's disease, and for the management of acute hypercalcemia. According to our experience, the treatment of BRON-J's lesions is difficult and prolonged. For this reason, in order to avoid these complications it is mandatory to perform a risk staging in patients who must undergo biphosphonate administration. When pharmacologic treatments with antibiotics and local antiseptics are not able to control the development of BRON-J's complications, the clinicians should perform radical surgical treatments such as the resection of the bone involved.

Retrospective study of standard-diameter implants inserted into allografts

PURPOSE

In the last decade, several investigators reported that standard-diameter implants (SDIs) achieved excellent results. However, no report is available regarding SDIs inserted into fresh-frozen bone (FFB). We conducted a retrospective study on a series of SDIs (diameter, 3.75 mm) inserted into homologous FFB to evaluate their clinical outcome.

MATERIALS AND METHODS

The SDIs inserted with FFB were analyzed. Several variables were investigated regarding patients, anatomic sites, implants, and prosthetic restoration. Implant failure and peri-implant bone resorption were considered predictors of clinical outcome. A Kaplan-Meier algorithm and Cox regression were performed to detect those variables statistically associated with clinical outcomes.

RESULTS

One hundred thirty-three SDIs were inserted in 41 patients. Implant length ranged from 10 to 15 mm. Implants were inserted to replace 6 incisors, 13 cuspids, 60 premolars, and 54 molars. The mean follow-up was 23 months. Only 1 of 133 implants was lost (ie, survival rate=99.2%), and no differences were detected among study variables. On the contrary, crestal bone resorption correlates with type of prosthetic restoration, with a better outcome for removable dentures.

CONCLUSION

The SDIs had high survival and success rates, similar to those reported in previous studies of 2-stage procedures in nongrafted bone. The SDIs inserted into FFB are reliable, although a greater marginal bone loss is to be expected if fixed prosthetic restorations are used.

[Treatment of a wide cutaneous post-traumatic loss of substance by cell cultures. Case report]

Bioengineering skin represents a successful outcome in the interdisciplinary research applied to reconstructive surgery. In this study we report our experience in the reconstruction of a wide traumatic wound by autologous engineered skin, grown on a biomaterial scaffold. Advantages were rapid reparation of the trauma and good scars.

Three dimensional finite element analysis to detect stress distribution in spiral implants and surrounding bone

BACKGROUND

The aim of research was to study spiral family implant by finite element analysis (FEA) inserted in different bone qualities connected with abutments of different angulations.

METHODS

The biomechanical behaviour of 4.2 × 13 mm dental implants, connecting screw, straight and 15° and 25° angulated abutments subjected to static loads, in contact with high and poor bone qualities was evaluated by FEA.

RESULTS

The lowest stress value was found in the system composed by implants and straight abut-ments loaded with a vertical force, while the highest stress value was found in implants with 15° angulated abutment loaded with an angulated force. In addition, we found the lower the bone quality, the higher the distribution of the stress within the bone.

CONCLUSION

Spiral family implants can be used successfully in low bone quality but applying a straight force is recommended.