Prescriptions of NSAIDs to patients undergoing third molar surgery : an observational, prospective, multicentre survey

BACKGROUND AND OBJECTIVES

Surgical extraction of an impacted third molar is generally followed by acute post-operative pain that has been shown to be primarily inflammatory. Thus, use of NSAIDs in this context is appropriate and has been shown to be effective. Several drugs are employed for this purpose, but no information exists on the reasons why preference is given to one rather than another. The principal objective of this study was to evaluate the pattern of administration of NSAIDs in patients undergoing surgery for impacted third molar extraction. The study also aimed to collect information on the efficacy, onset and duration of the analgesic effect of routinely prescribed NSAIDs and to assess the duration of treatment with these drugs and their tolerability.

METHODS

This was an observational, multicentre, prospective survey. A total of 616 patients (38% male and 62% female) from the Italian Stomatology Clinics of the Universities of Bologna, Brescia, Cagliari, Chieti, Pavia, Pisa, Siena and Varese and from the Department of Oral and Maxillo-Facial Surgery of Semmelweis University, Budapest, were eligible for the study. Patients were evaluated over the 7 days following surgical extraction. NSAIDs were prescribed according to the normal prescribing habits of the centre and physician involved. The main outcomes of interest in the survey were the efficacy, onset and duration of analgesic effect, duration of therapy, and tolerability of the NSAIDs prescribed.

RESULTS

Nimesulide was the most prescribed NSAID (68%), followed by diclofenac, ketoprofen and ibuprofen. Because of the low proportion of patients receiving other NSAIDs, these patients were considered a single treatment group for evaluation purposes. Nimesulide, especially when given before patients started experiencing pain after surgery, was more effective than other NSAIDs in reducing the severity of pain on the day of surgery, in delaying the time to maximum intensity of pain, in providing complete pain relief and in prolonging the duration of analgesic effect on the day of surgery. These results are consistent with the known anti-inflammatory and analgesic actions of nimesulide and with the important role of inflammation in the onset of pain after this type of surgery.

CONCLUSION

These results confirm nimesulide as an effective reference drug for the treatment of post-operative dental pain and show that it has a positive benefit/risk profile in this setting.

Seasonal variation of air kerma rate in Sicily

Thermoluminescence dosimetry has been used to measure air kerma in 29 sites in Sicily. Four three month measurement campaigns have been carried out in order to assess seasonal variations. Average annual values between 20 and 90 nGy h(-1), after cosmic background subtraction, are reported. Average annual values are strongly dependent on site lithology, and we find that winter data are generally the highest, while spring and autumn rates are generally the lowest with very similar trends in any site. Summer values generally lay in between. Largest seasonal variations are found in sites along the southern coast of the island, probably because of stronger action of winds affecting radon, along with its progeny, concentrations at ground level.

Role of multidetector CT and FDG-PET/CT in the diagnosis of local and distant recurrence of resected rectal cancer

PURPOSE

The aim of this study was to compare the diagnostic value of multidetector computed tomography (MDCT) and F18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) for the detection of local and distant recurrence in patients operated on for rectal cancer.

MATERIALS AND METHODS

Sixty-seven patients who underwent radical surgery for rectal cancer and were followed up with FDG-PET/CT and MDCT were included in this retrospective study. The FDG-PET/CT and MDCT findings were independently compared with histological sampling or 2 years' follow-up.

RESULTS

Local recurrence occurred in 15/67 patients. MDCT diagnosed local recurrence in 15/15 cases and FDG-PET/CT in 14/15. Sensitivity and specificity were 100% and 98% for MDCT and 93% and 98% for FDG-PET/CT, respectively. Hepatic lesions were found in 17/67 patients. All hepatic metastases were detected by both techniques. Pulmonary metastases occurred in 8/67 patients: they were correctly identified in all cases by MDCT and in 6/8 by FDG-PET/CT.

CONCLUSIONS

MDCT and FDG-PET/CT showed high sensitivity and specificity for the detection of local recurrence of rectal cancer. Both techniques were equally accurate for the detection of hepatic metastases. MDCT showed slightly higher sensitivity and positive predictive value in detecting pulmonary metastases compared with FDG-PET/CT.

Comparison between gemcitabine-based combination (G) and single-agent chemotherapy (S) for elderly patients (EP) with advanced non-small cell lung cancer (NSCLC): A literature-based meta-analysis

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Background: It was estimated that a quarter of all patients who have a diagnosis of NSCLC worldwide are more than 70 years old. This meta-analysis tries to shed light on the controversial results of phase III trials evaluating in NSCLC EP doublets against third generation S. Methods: We performed a literature search using MEDLINE and Cochrane Library. We selected only clinical trials responding to the question of our meta-analysis. Outcomes recorded were 1-year survival rate (1-y SR), overall response rate (ORR) and haematological toxicity (HT). Fixed-effects and random-effects models were used to calculate pooled odds ratios (OR). An OR greater than 1 indicates that doublet is more effective for 1-y SR and ORR and more toxic for HT. Results: Three published randomized controlled phase III trials (SICOG 9909; MILES; AISCAP-SICOG) were selected yielding a total of 1082 patients (G: 426; S: 655) clustered in seven comparisons. Drugs delivered to randomized patients included gemcitabine, vinorelbine and paclitaxel. EP treated with doublets showed respect to control patients a pooled estimate for 1-y SR advantage of 36%, not statistically significant (OR=1.356; 95% CI=0.925–1.990; p>0.05). The pooled estimate for ORR advantage was 57% and statistically significant (OR=1.559; 95% CI=1.220–2.015; p<0.05). However G showed not significant difference for HT (OR=1.168; 95% CI=0.685–1.992; p>0.05). Conclusions: These data confirm in EP superior efficacy and equal tolerability of G in comparison with S previously demonstrated for adult patients. Anyway G seems to not change prognosis of NSCLC EP. It is worthy to note that all the trials analysed showed some biases: early closure of the study, second-line therapy or crossover, lower dosage of drugs in combination regimen, inclusion of unfit or strongly comorbid patients. This meta-analysis doesn’t solve troubles in decision-making of treatment for EP, but suggest to design a better phase III trial including more patients and improving accrual criteria for reducing biases. An indication of a potentially active combination regimen (gemcitabine + paclitaxel) is suggested in SICOG 9909 trial.

No significant financial relationships to disclose.

The time course of idiom processing

Recent neuropsychological and neurophysiological studies have suggested that the neural correlates of idiom processing are predominantly located in the left Brodmann's area (BA) 22 and, to some extent, in the prefrontal cortex. The present study explores the temporal dynamics of left prefrontal and temporal cortex in idiom processing by using repetitive transcranial magnetic stimulation (rTMS) in normal subjects. Forty-five opaque highly familiar idioms and 45 literal sentences were used. Forty-three subjects completed 5 blocks of 18 trials (9 idioms, 9 literal sentences) corresponding to 4 stimulation conditions (left prefrontal, left temporal, vertex, no-stimulation baseline). Each subject was assigned to one of three groups, which differed in the timing of stimulation delivery. A selective impairment in accuracy for idioms was found when rTMS was applied to the prefrontal and temporal cortex 80ms after picture presentation, confirming the role of these regions in this task. Moreover, rTMS to the prefrontal cortex, but not to the temporal cortex, continued to affect the performance with idiomatic sentences at the later time of 120ms. The results seem to suggest that the prefrontal region is involved in both the retrieval of the figurative meaning from semantic memory and the monitoring of the response by inhibiting alternative interpretations when a picture-matching task is used.

Efficacy of weekly low-dose chemotherapy in elderly women with advanced ovarian cancer: is there an antiangiogenic effect?

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Background: In elderly patients decreased functionality of multiple organ systems may affect pharmacokinetics and pharmacodynamics of drugs. For this reason elderly cancer patients experience enhanced susceptibility to common chemotherapy-related adverse events. A way to prevent these effects could be metronomic chemotherapy, which is a variation of dose-dense therapy, with a cumulative dose significantly lower than maximum tolerated dose. Methods: 27 advanced ovarian cancer patients, median age 67 (range 60–86), received low dose weekly continuous chemotherapy until disease progression. All patients were treated with CBDCA AUC 2 mg/ml/min and Docetaxel 35 mg/sqm (adjusted according with Kintzel & Dorr formula) i.v. weekly. Primary endpoints were response rate (RR) and time to treatment failure (TTF). Moreover we considered as secondary endpoints toxicity profile, VEGF values and Quality of Life (QoL) score. RR and TTF were evaluated with RECIST criteria and Kaplan-Meyer formula respectively, toxicity was assessed according to the NCI-CTC. VEGF concentrations were analyzed by ELISA, QoL score was determined using the ADL/IADL and EORTC QLQ-C30 questionnaires, at baseline (T0) and at the end of therapy (T1). Results: median duration of treatment was 39 weeks. 2 Complete Responses (CR) and 5 Partial Responses (PR) were achieved for a 26% RR. Stable Disease was achieved in 18 pts (67%) with a total Clinical Benefit (CB) of 93%. Overall toxicity was very low: haematological G1/2 - 6 pts; gastrointestinal G1 - 8 pts; neurological G1/2 - 5 pts; cutaneous G3 - 1 pt; renal G1 - 1 pt. A mean TTF of 17.4 months was reached. Mean VEGF values (T0): 527 ± 35 pg/ml, (T1): 335 ± 18 pg/ml (p = 0,003). QoL score (T0): 45.2 ± 12, (T1): 47.5 ± 25 (p = 0,06). Conclusions: first results seem to be very encouraging, even if the number of responses is too small and we need to enrol more pts to reach a good statistical evaluation. Nevertheless the use of this “metronomic” schedule shows that VEGF values decrease strongly during the treatment and is maintained also when treatment is discontinued. Thus it suggests a preminent antiangiogenic role of this schedule according with the most recent preclinical and clinical studies.

No significant financial relationships to disclose.

The methyl-CpG-binding protein MECP2 is required for prostate cancer cell growth

The incidence of prostate cancer is increasing in western countries because of population aging. Prostate cancer begins as an androgen-dependent disease, but it can become androgen independent at a later stage or in tumors recurring after an antihormonal treatment. Although many genetic events have been described to be involved in androgen-dependent and/or -independent prostate cancer growth, little is known about the contribution of epigenetic events. Here we have examined the possibility that the methyl-CpG-binding protein MECP2 might play a role in controlling the growth of prostate cancer cells. Inhibition of MECP2 expression by stable short hairpin RNA stopped the growth of both normal and cancer human prostate cells. In addition, ectopic expression of the MECP2 conferred a growth advantage to human prostate cancer cells. More importantly, this expression allowed androgen-dependent cells to grow independently of androgen stimulation and to retain tumorigenic properties in androgen-depleted conditions. Analysis of signaling pathways showed that this effect is independent of androgen receptor signaling. Instead, MECP2 appears to act by maintaining a constant c-myc level during antihormonal treatment. We further show that MECP2-expressing cells possess a functional p53 pathway and are still responsive to chemotherapeutic drugs.

Contrast enhanced ultrasound of breast cancer

The importance of ultrasound examination in the diagnosis of breast cancer has been widely demonstrated. During the last few years, the introduction of ultrasound contrast media has been considered a promising tool for studying the vascular pattern of focal lesions within the breast. Our purpose was to assess whether contrast-enhanced (CE) ultrasound examination, performed using specific contrast imaging modes, can be helpful for detection and characterization of breast lesions, and for prediction of the response of breast cancer to therapy.

Prostate epithelial stem cells

The prostate gland is the site of the most commonly diagnosed cancer in men in USA and UK, accounting for one in five of new cases of male cancer. Common with many other cancer types, prostate cancer is believed to arise from a stem cell that shares characteristics with the normal stem cell. Normal prostate epithelial stem cells were recently identified and found to have a basal cell phenotype together with expression of CD133. Preliminary data have now emerged for a prostate cancer stem cell that also expresses cell surface CD133 but lacks expression of the androgen receptor. Here we examine the evidence supporting the existence of prostate cancer stem cells and discuss possible mechanisms of stem cell maintenance.

Impact of physical training and detraining on endothelium-dependent vasodilation in patients with recent acute myocardial infarction

BACKGROUND

There is evidence that aerobic exercise improves endothelial function in healthy subjects as well as in patients with chronic heart failure. However, it is unknown whether this effect occurs in patients with recent myocardial infarction (AMI).

METHODS

Fifty-two patients with a recent first uncomplicated AMI underwent endothelial function evaluation before and after 3 months of moderate aerobic exercise training. We measured brachial artery vasomotor reactivity using flow-mediated dilation (FMD), a cold pressor (CP) test, and sublingual nitroglycerin. Patients were randomized into 2 groups: 28 patients (G1) underwent training, while 24 patients (G2) served as controls. Brachial artery vasomotor reactivity was reassessed after 1 month of detraining (DT).

RESULTS

At baseline the FMD was 1.66% +/- 4.11% in G1 and 2.04% +/- 3.4% in G2 (P = NS) and vasoconstriction was evident after a CP test. The diameter reduction was -4.1% +/- 3.89% in G1 and -4.39% +/- 5.67% in G2 (P = NS). At follow-up the FMD had increased to 9.39% +/- 4.87% in G1 (P <.01) and to 4.4% +/- 3.9% in G2 (P <.01 vs G1). Vasoconstriction during a CP test was observed only in G2. Endothelium-independent vasodilation was unchanged in both groups. Effort tolerance increased by 32% in G1 patients (P <.01 versus G2) and was correlated with FMD change (R = 0.51, P <.01). After detraining the FMD was significantly reduced in G1 (P <.01) and a further vasoconstriction was evident after CP testing.

CONCLUSIONS

Exercise training improves endothelium-dependent vasodilation in post-AMI patients. This improvement is associated with a significant increase in exercise tolerance. These benefits disappeared after detraining.

Memory and executive functions in aneurysms of the anterior communicating artery

The cognitive outcome of three groups of patients, who had undergone surgery for repair of a single ruptured intracranial aneurysm, was evaluated. We assessed performance on tests of executive functions and memory in a group of 15 patients tested at least 3 months after an aneurysm of the anterior communicating artery (ACoA) and in a group of 12 patients tested in the first month after the same pathology. Acute patients were more impaired overall than chronic ones, but the two groups significantly differed on two executive and one memory test. The performance of the ACoA patients was also compared to the performance of a group of 10 patients who had undergone surgery for an aneurysm located on the posterior communicating artery (PCoA) at least 3 months before the examination. Chronic ACoA and PCoA patients significantly differed in two memory and in two executive tests performance, with posterior patients being more impaired than anterior. An unexpected finding was the impairment of semantic memory in ACoA patients.

[Balance disorders in the elderly]

In the elderly patient, instability is a syndrome in which a loss of balance, during ambulation or while standing, can give rise to falls, with consequent disability and morbidity. Maintaining the correct static and dynamic balance is known to be the result of the synergetic functioning of different systems. In old age, however, the efficiency of these mechanisms is impaired because of the physiological process of aging, which affects all of the organs and systems of the human body. Besides that, different concomitant causes such as cardiovascular and dysmetabolic pathologies, chronic pharmacological therapies etc. contribute to the aging of our organism. The object of this study was to evaluate 40 subjects, 21 males and 19 females, aged between 70 and 86, who were referred to us with craniofacial trauma consequent to a fall. Upon hospitalization, all of the patients were asked to fill in a questionnaire evaluating the incidence of the vertigo symptom as a possible cause of the falls. All of the subjects underwent the following clinicoinstrumental examinations: standard audiometric evaluation, vestibular tests, neurological and ophthalmic examination. Careful appraisal of the results obtained enabled us to conclude that balance disorders in the elderly patient are due to the synergetic action of three factors: aging, concomitant diseases and environmental factors. In conclusion, we can affirm that balance disorders giving rise to a fall in the elderly are attributable to the concomitance of different factors that determine a clinical state of imbalance, defined by some Authors with the term "presbivertigo". It follows that a suitable diagnostic protocol must be employed, comprising a detailed medical, pharmacological and functional history, a study both of the environmental conditions in which the patient lives and the modalities according to which the traumatic event occurred. It is, last of all, indispensable that steps be taken to improve these environmental conditions, such as choosing flooring materials, light fixtures, stairs, bathroom furnishings and suitable footwear promoting proper foot placement and support on the ground.

Famous face recognition and naming test: a normative study

Tests of famous face recognition and naming, and tasks assessing semantic knowledge about famous people after presentation either of their faces or their names are often used in the neuropsychological examination of aphasic, amnesic and demented patients. A total of 187 normal subjects took part in this study. The aim was to collect normative data for a newly devised test including five subtests: famous face naming, fame judgement after face presentation and after name presentation, semantic knowledge about famous people after face presentation and after name presentation. Norms were calculated taking into account demographic variables such as age, sex and education and adjusted scores were used to determine inferential cut-off scores and to compute equivalent scores. Multiple regression analyses showed that age and education influenced significantly the performance on most subtests, but sex had no effect on any of them. Scores of the subtest evaluating fame judgements after name presentation were significantly influenced only by education. The only subtest whose scores were not influenced by any demographic variable was fame judgement after face presentation.

Eosinophilic pleuropericarditis and fasciitis. A new case

The case of a 29 year old male, non-smoker, with moderate dyspnea and subcutaneous limb swelling was reported. The final diagnosis of eosinophilic pleuropericarditis and fasciitis based on the presence of pleuropericardial effusion, painful arthromuscular swelling and peripheral eosinophilia. The particular involvement of forearms and calves furthermore differentiate the eosinophilic fasciitis from other arthromyalgic and neuromuscular syndromes.

Environmental radioactivity at Stromboli (Aeolian Islands)

HPGe gamma spectrometry, thermoluminescence dosimetry, X-ray diffractometry and fluorescence techniques have been used to analyze the natural radionuclides content of soil and rock samples, air kerma and geochemical features on the island of Stromboli, belonging to the Aeolian Islands, in the Mediterranean Sea. The 214Bi, 238Ac, and 40K contents obtained are in agreement with the magmatic evolution of the rock formation, as shown by the correlations between radionuclide and chemical elements abundacies, depending on the various magmatic differentiation mechanisms. Correlations between radiometric, lithological and geochemical data have been assessed in order to obtain some hints on the geochronology of the magmatic products.

The role of work simulation tests in a comprehensive cardiac rehabilitation program

BACKGROUND

One of the goals of a comprehensive cardiac rehabilitation (CR) program is the patient's return to his or her usual activities. The aims of this paper were to implement an occupational evaluation protocol in a CR and to assess patients' hemodynamic responses and ventricular arrhythmias during work simulation tests.

METHODS

After an 8-week outpatient CR, 132 patients performed work simulation, lifting (MH-L) and carrying (MH-C) tests. ECG, heart rate and blood pressure were constantly monitored.

RESULTS

The comparison of physiological responses during work simulation and a standard exercise testing provided the following results: 1) maximal heart rate, blood pressure and double product values during WS and MH tests were significantly lower (p < 0.001) than those measured during exercise testing; 2) higher (p < 0.001) double product values were achieved during MH-C as compared to MH-L and work simulation; 3) arrhythmias were more frequent during MH-L as compared to exercise test (p < 0.001). The increment of double product was reached much faster during work simulation and MH tests as compared to exercise testing: according to the multivariate analysis this was a predictor of a greater incidence of arrhythmias. The incidence of arrhythmias during work simulation tests and MH was significantly higher in patients with reduced tolerance to effort, valvular replacement, arrhythmias during holter monitoring, low ejection fraction and effort silent ischaemia.

CONCLUSIONS

Work simulation test provide a more personal functional assessment, complementary to the exercise testing. It appears particularly useful in patients with higher functional impairment who are at a higher risk of arrhythmias.