In vitro comparative study on the mechanical behavior of Zirconia and Polyetheretherketone in applied dental sciences

OBJECTIVE

Recently, Zirconia and polyaryletherketone (PEEK) have attracted increasing interest as reliable and safe materials in dental applications, mainly because of their good biomechanical characteristics. The aim of this study was to investigate the response to different loads by prosthetic frameworks for supported fixed partial dentures (FPDs), thus simulating osseointegrated implants.

MATERIALS AND METHODS

The specimens were divided into two groups (n= 5 each). Group A: FDPs in zirconia-ceramic; Group B: FDPs in PEEK-composite. These 2 groups were subjected to vertical loads so to evaluate structural deformation; then, they have been analyzed by scanning electron microscopy (SEM) at different magnifications.

RESULTS

In tested samples, different types of mechanical failures have been observed. In Zirconia-specimens, chipping is the main failure noticed in this study, mostly in distal margins of the structure. Also, peek-specimens show failure and fracture.

CONCLUSIONS

Zirconia and PEEK could be considered both good materials, but several investigations are needed to use these materials as an alternative to metals for fixed partial dentures.

Periodic Bedrock Ridges at the ExoMars 2022 Landing Site: Evidence for a Changing Wind Regime

Wind-formed features are abundant in Oxia Planum (Mars), the landing site of the 2022 ExoMars mission, which shows geological evidence for a past wet environment. Studies of aeolian bedforms at the landing site were focused on assessing the risk for rover trafficability, however their potential in recording climatic fluctuations has not been explored. Here we show that the landing site experienced multiple climatic changes in the Amazonian, which are recorded by an intriguing set of ridges that we interpret as Periodic Bedrock Ridges (PBRs). Clues for a PBR origin result from ridge regularity, defect terminations, and the presence of preserved megaripples detaching from the PBRs. PBR orientation differs from superimposed transverse aeolian ridges pointing toward a major change in wind regime. Our results provide constrains on PBR formation mechanisms and offer indications on paleo winds that will be crucial for understanding the landing site geology.

Gender medicine: the impact of probiotics on male patients

PURPOSE

Numerous studies in the literature confirm the importance of the use of probiotics in inflammatory states of the prostate in humans. Our pilot study aimed to test probiotics strains ability to improve urinary bacterial load in male subjects.

METHODS

Twenty healthy men aged 55-65 years, with recurrent urinatory infections were enrolled and randomized into 2 groups. Urine culturing to detect Enterobacteriaceae (Escherichia Coli and Enterococcus faecalis) was performed at baseline and at 12 weeks after the starting of the study.

RESULTS

We found that taking the probiotic reduces the bacterial load of E. coli and E. faecalis in urine cultures. The use of the probiotic in these inflammatory states does not affect the change in weight in the tested subjects.

CONCLUSIONS

Our data confirm and improve the main results reported in the scientific literature on the importance of taking probiotics in prostatitis.

The alteration of stress-related physiological parameters after probiotics administration in oral surgeons with different degrees of surgical experience

PURPOSE

Stress is a multifactorial and complex pathway, gaining growing attention from the healthcare community. Surgeons are subjected to higher levels of stress, due to surgical procedures that are demanding and repetitive; unfortunately, high-stress levels may also cause side-effects, as surgical mistakes. This study aimed to evaluate the efficacy of specific probiotics strains formula on stress levels in oral and maxillofacial surgeons, to improve their quality of life.

METHODS

We have investigated the hormonal (salivary Cortisol; sC), immune (salivary Immunoglobulin A; sIgA) and cardiovascular (Heart rate, HR, and systolic blood pressure, SBP) responses induced by stress conditions in 40 oral surgeons, randomly selected and allocated, according to their experience level, in three categories: senior, expert, and junior.

RESULTS

The results described how the number of heartbeats/ minute and SBP are slightly raised in all surgeons at different timepoints. Such data allow us to assess that work-related stress can induce an increase in cardiovascular parameters, even if they are not significantly modified by the use of probiotics. On the other hand, our data indicate that 10 weeks of probiotic integration may induce the improvement of other stress-related physiological parameters in oral surgeons with different degrees of surgical experience, such as the salivary cortisol levels, even under stress conditions. Moreover, in the test group (probiotics administration), the immunoglobulin levels were higher than the control (placebo administration) group: this happens as a consequence of the regular use of probiotics, which may induce an increased number of IgA producing cells.

DISCUSSION

Our data indicated that 10 weeks of probiotics-enriched diet modify some stress-related physiological parameters in oral surgeons with different degrees of surgical experience, but it does not impact on the overall cardiovascular risk.

Additive manufacturing and biomimetic materials in oral and maxillofacial surgery: a topical overview

Additive manufacturing (AM) is the term used for different and complex techniques to manufacture products with complex morphology, often referred to as "custom-made". The product is made without needing to melt the material into pre-formed molds, nor to remove it from an initial mass, as happens in subtractive processes. The additive methodology gives the AM enormous potential in the widest fields of application, from aerospace to biomedical, from dental to maxillofacial. This wide range of AM technologies can be applied to different types of polymeric materials such as plastics, resins and biopolymers that are processed to obtain optimal scaffolds. The most common synthetic and biocompatible polymeric materials for the production of biocompatible scaffolds are: polylactic acid (PLA), polycaprolactone acid (PLC) and polylactic-co-glycolic acid (PLGA); such materials interact effectively with cell behavior and tissue development. These materials are degradable in the physiological environment and the degradation products do not have harmful effects. In conclusion, new biomaterials are increasingly being studied as possible therapeutic remedies. Advances in tissue engineering are leading to the development of new scaffolds useful for bone regeneration and therefore potentially valid for applications in maxillofacial surgery.

3D software scanning, processing and archiving palatal rugae: "identity base" technology

The palatal rugae, which are anatomically described as folds or wrinkles of the palate, are located on the anterior third of the palate on each side of the palatal raphe and behind the incisive papilla. The use of palatal rugae for personal identification was suggested several years ago, and attracted interest from different researchers which created different classifications, still used in scientific literature. The "identity base" (IB) system has as its object a complex information system and a personal identification protocol by means of three-dimensional palatal scans in digital format. The usefulness of this system is based on the management needs of big data. For example, in the field of forensic odontology, IB can be useful in the identification of a living or cadaver subject; and can estimate the age of a human subject. Moreover, IB stores its associated biometric data. The IB system demonstrated to overcome the issues shown by other similar systems of digital image storage. Furthermore, its high accuracy in the identification process makes IB a reliable tool for institutions in the management of immigrants, as well as in the archiving of people under restrictive measures. Finally, IB is also a system for sharing and processing clinical images, useful in dental prosthetics to reduce the number of steps from the first visit to dental prosthesis. The next generation of big-data archiving will speak the same language as IB: the route has been already set out.

Updates in regenerative medicine applied to dental sciences

Mesenchymal stem cells (MSCs) are found in high concentrations in several tissues, such as umbilical cord, adipose tissue and dental tissue. Dental stem cells reside in many areas of the oral cavity. Thanks to their abilities, dental stem cells could be used to treat diseases and to understand the basic mechanisms of developmental pathologies. There are currently numerous ongoing clinical trials evaluating a broad spectrum of conditions and situations using different stem cell populations. However, stem cell studies are raising profound ethical questions that weigh on the world of scientific research. Stem cells are always a hot topic in the scientific community. Their use is related also to their banking, as cell manipulation is also often related to medical and ethical issues. Many biomedical studies aim to treat diseases that were previously considered incurable with MSCs. All this has created the need to quickly and safely storage stem cells, usually in a stem cell biobank (SCB). Regenerative medicine is the most important approach for achieving complete tissue regeneration using stem cells isolated from adult tissues, embryonic stem cells, but also through the application of induced pluripotent stem cells (iPSC). iPSCs are non-pluripotent cells that are engineered to acquire the ability to differentiate into all different types of cells. In conclusion, the daily use of stem cells in regenerative procedures is still far from being safe and predictable, especially because of the biomedical component, often requiring experienced biologists and complex technologies for cell manipulation and cell banking. .

Digital flow in medicine and dentistry: what’s new?

The increasing requirements of standardization in medical applications have led physicians towards a deep revision of their protocols. The phenomenon of ‘digital health’ has revolutionized the way a patient accesses medical information, but it has also improved the way the doctor handles the surgical and clinical phases. In digital dentistry, the working steps are mainly reported as digital image acquisition, preparation and/or processing of data, device production and clinical application on patients; the new technologies have brought significant benefits to both the dentist and the patient. Digital processing of anatomical data uses virtual models, which represent a precise representation of the patient’s anatomy. Recent advances in digital image acquisition technologies and the enormous complexity of modern software have made intraoral scans possible to realize digital dental arch models, however, the digital model is able to report substantial information to the clinician. Therefore, both complex surgeries and less invasive local therapies can be easily planned, with an accurate analysis of biological regulators improving the regenerative procedures, to achieve the best results in a shorter treatment.

Adult or not? Accuracy of Cameriere's cut-off value for third molar in assessing 18 years of age for legal purposes

AIM

The discovery of reliable means to determine the age of an individual is a fundamental objective in forensic medicine, in consideration of the constant increase of illegal immigration into the European community. In 2008 Cameriere et al. developed a method based on the relationship between age and the third molar index (I3m), which assesses the degree of maturation of the third molar through measurements made on orthopantomography. The purpose of this work was to test the accuracy of Cameriere's cut-off for I3m as a tool to assess full age (18) on a new sample of living subjects.

METHODS

Orthopantomographs of 287 Italian living subjects aged between 13 and 22 years have been randomly selected and included in the study. Identification number, gender, date of birth and date of execution of the radiograph were recorded for each patient on a Microsoft Excel® spreadsheet. Radiographs were digitalized and analyzed using a computerized image-processing program (Adobe® Photoshop® CS4).

RESULTS

The results show that the sensitivity of the test was 84.1% and the specificity was 92.5%. The estimated post-test probability was 90.1%, with a confidence interval of 95% (83.6%, 95.2%). Thus, the probability that a person being positive to the test has 18 or more years of age was 90.1%.

CONCLUSION

The results highlight the contribution of Cameriere's cut-off value for the I3m in the assessment of full age, always remembering that the simultaneous employment of previously introduced complementary methods is essential for the purpose.

Diagnosis and treatment of a rare case of adenomatoid odontogenic tumor in a young patient affected by attenuated familial adenomatosis polyposis (aFAP): case report and 5 year follow-up

BACKGROUND

The adenomatoid odontogenic tumor (AOT) is a quite rare odontogenic tumor, with an incidence rate of approximately 12 cases/year worldwide. Attenuated familial adenomatous polyposis (aFAP) is a syndrome characterized by a significant risk to develop colon cancer. The aim of the paper is to describe a case never reported before in the literature: an AOT developed in a patient with aFAP; moreover, we want to show how it appears 5 years after surgery and after the regeneration of the eroded bone tissue, using the Platelet-Rich Fibrin (PRF) as filling material.

CASE PRESENTATION

We report the case of a female 18 years old patient, affected by aFAP; she comes to us with a swelling on the right hemi-face. We performed several radiological exams, and they showed a neoformation approximately 2 cm in diameter: this neoformation packed the upper right canine, therefore, we hypothesized a dentigerous cyst. We decided to proceed to open biopsy and enucleation of the lesion. An intra-operative endodontic treatment on the adjacent partially resorbed teeth was also performed. Finally, we performed a reconstruction of eroded bone tissue, by use of Platelet-Rich Fibrin as filling material. The samples fixed and embedded in paraffin have led to the diagnosis of AOT. After 5 years from the surgery, we did not find any clear sign of relapse, in addition, the use of PRF has favored an optimal osteogenesis at the surgical site.

CONCLUSIONS

Undoubtedly, a correct diagnosis of AOT allows to have a more performing clinical and surgical approach. Furthermore, this case could document a new manifestation of aFAP in extra-intestinal site. The onset of an AOT is quite rare in the general population, and this rarity could represent a critical point for its diagnosis; AOT onset in a patient with aFAP is a finding that could represent a new element of diagnosis and, therefore, the starting point to perform a more effective therapy.

CHARGE syndrome: an overview on dental and maxillofacial features

OBJECTIVES

CHARGE is an acronym referring to the aspects of this rare syndromic condition. Patients with CHARGE association are today considered as subjects lacking in pathognomonic dental alterations. The present study is aimed at adding to the body of evidence of the cases reported in literature and the continuous clinical research which show a clinical picture which is strongly associated with patients afflicted by this syndrome.

PATIENTS AND METHODS

We report a case-series of 8 patients with CHARGE syndrome. The dental features associated with CHARGE syndrome are from case-reports, but without a congruity that can lead to a definition of the dental condition typical of the CHARGE phenotype.

CONCLUSIONS

The systemic problems affecting these patients are predominant in compromising their quality of life: this is the reason for a frequent lack of a diagnostics and interceptive phase, relative to oral diseases. We report new oral pathological conditions affecting CHARGE patients. Knowledge of these pathological conditions may induce dentists to carry out specific diagnoses of these patients, thus, avoiding the deterioration of oral conditions.

The influence of smoking and surgical technique on the accuracy of mucosa-supported stereolithographic surgical guide in complete edentulous upper jaws

BACKGROUND

The accuracy of a stereolithographic surgical guide depends on several variables that can affect at any time from the software-planning stage to the surgical field.

AIM

The purpose of this study was to evaluate the accuracy of implants inserted using a single mucosa-supported stereolithographic surgical guide determining also the influence of surgical technique (fixed and not-fixed) and smoking on the deviation parameters.

MATERIALS AND METHODS

11 patients, totally edentate in the upper arch and needed an implant-prosthetic rehabilitation, were selected. 95 implants were planned and inserted. The pre- and post-operative CT images were compared using software.

RESULTS

Global, coronal (Mean: 1.65; Range: 3.00-0.13; SD:0.56) and apical (Mean: 2.15; Range: 4.23-0.34; SD:0.81), and angular (Mean: 4.62; Range: 15.25-0.28; SD: 2.74) deviation values were determined. The mean values of mucosa thickness in smokers and nonsmokers patients were 4.53 mm and 3.42 mm respectively (p < .05). The accuracy data showed a better result for the angular deviation when the surgical template was fixed (p = .002) and a better global apical deviation in the nonsmokers (p <. 05).

CONCLUSIONS

It is essential, especially in smoker patients, to respect a minimum safety distance of 3 mm from limiting anatomic structures.

Oral Focal Mucinosis of the Tongue: A Rare Clinical Case

Oral focal mucinosis (OFM) is a rare mucosal lesion of unknown etiopathogenesis. It is considered the oral counterpart of cutaneous focal mucinosis. From the anatomo-pathological point of view it is characterised by a focal degeneration of myxoid type of connective tissue. A literature survey revealed 50 reports of OFM cases worldwide. Here, we present an even more rare case with tongue involvement. Particular emphasis is placed on diagnostic-differential aspects of this kind of lesion, both from the clinical and the histopathological point of view, in respect to other manifestations of tongue mucosa.

Incidence and Intensivity of Postoperative Pain and Periapical Inflammation after Endodontic Treatment with Two Different Instrumentation Techniques

Apical extrusion of infected debris to the periradicular tissues is considered one of the possible factors related to the occurrence of postoperative pain and inflammation. The goal of the present study is to evaluate and compare the incidence and intensity of postoperative pain using two different nickel-titanium instrumentation techniques: a rotary crown-down technique using TF instruments (SybronEndo, Orange, Ca, USA) and a reciprocating single-file technique using Reciproc instruments (VDW, Munich, Germany). Sixty patients requiring endodontic treatment on permanent premolar and molar teeth with non-vital pulps preoperatively were included in the study. The patients were divided into two groups of 30 patients each, trying to make the groups very similar, concerning the number of root canals, presence of initial pain and periapical lesions. The teeth in group 1 (n = 30) were treated with a crown-down technique using TF instruments whilst those in group 2 (n = 30) were treated with, a single-file technique using Reciproc 08 25. All canals were shaped, cleaned and obturated in a single-visit. The assessment of postoperative pain was carried out at 3 days by using a visual analogue scale. CAi-square tests and independent-sample t-tests to compare the incidence and intensity of postoperative pain of two groups were carried out. A statistically significant difference was found between the two techniques. When comparing patients who developed no pain, the TF instrumentation technique showed significantly better results ( chi-square = 4.059 P = 0.039). When evaluating patients experiencing severe pain the incidence of symptoms was significantly higher with the Reciproc technique ( chi-square = 7.246 P = 0.023). Since the incidence of preoperative pain, the type of tooth and the pulp and periodontal pathology were quite similar between the two tested groups, and all the other variables (operator, irrigation, and obturation) were identical, the difference in postoperative pain can be mainly related to the different instrumentation technique

Anatomo-clinical study of rectus abdominis myocutaneous flap

At the Plastic and Reconstructive Surgery Department of Perugia, 52 patients were examined by color flow duplex scanning, in order to study rectus abdominis myocutaneous flap vascular supply before surgical procedures. This ultrasound technique permits a precise and accurate measurement of blood flow volume and velocity within the epigastric arteries (which represent the superior and inferior vascular pedicles of the flap) and makes it possible to detect the exact location of the perforating branches with their cutaneous distribution. This preoperative evaluation, pointing out vascular pathologies which contra-indicate the use of rectus abdominis flap, can be considered a great help for the reconstructive surgeon in the choice of the operative procedure and can surely lead to a significant decrease in postoperative complication rate.

[Use of Doppler color ultrasonography in the microsurgical treatment of idiopathic varicocele]

The aim of this paper is to evaluate the role of Doppler and echo color-Doppler in the microsurgical treatment of varicocele. Since December 1993, 87 consecutive patients underwent microsurgical treatment of varicocele. The study demonstrates that Doppler and Color-flow-Duplex scanning provide an accurate, non-invasive method to identify the position of accessory spermatic veins, evaluating at the same time the flow characteristics of the microsurgical anastomosis.

[Pre- and postoperative color Doppler ultrasonography of myocutaneous flaps in reconstructive surgery of the breast]

The authors present their experience in the study of blood supply of flaps. The machine used to study both pre and postoperatively the myocutaneous flap is the echo-color Doppler, a brand new device which has recently been used in investigating the morphology and the blood supply. The use of such method has provided us with the following information: detailed ultrasound structure of the skin, subcutaneous and muscular tissues of the examined flap; localization of vessels within the flap; size of the vessel in its whole length; quality and speed of both the arterial and venous flow. Such information is very important for the surgeon to plan in detail the reconstruction by knowing the blood supply of myocutaneous flap.

Surgery of local recurrence in rectal cancer

The local recurrence, after radical exeresis of a large intestinal cancer represents until now an extremely interesting question, taking into consideration that it represents the cause of death in 50% of operated patients. Frequency is higher after an exeresis of a rectal cancer, with a range of 2.6-83% in the different case histories, than after a surgical intervention on a colon cancer, whose incidence is lower than 5%. The early diagnosis of rectum cancer recurrence is the first step towards the favourable issue of treatment. Surgical treatment of loco-regional recurrences of rectum cancer can be curative when it is possible to perform a total resection of the recurrences and of the infiltrated structures, without microscopic residuals of disease, or palliative, aiming to reset the intestinal and urinary functions or to reduce pain. At the Department of Surgery of the University of Perugia, from January 1984 to December 1983, 153 patients with rectal cancer-79 males (52%) and 74 females (48%)-were treated. The operations, all involved total removal of the affected segment and were in 88 cases (58%) an anterior resection and in 65 cases (42%) an abdomino-perineal amputation. The analysis was made of 128 patients with a follow-up of at least five years; the local recurrence incidence was 12.5%. The authors adopted a follow-up protocol based on clinical examination, CEA antigen and routine Lab tests, chest X-rays, colonoscopy, abdominal ultrasonography, pelvic CT scan; these procedures are performed starting 3 months after operation.

[Penetrating wounds of the thorax]

From January 1989 to December 1993 at the Institute of Clinical Surgery of the University of Perugia, 5 patients were under observation for penetrating chest injuries. Two of them had show-wounds, one a slash, one a stabbing and slash and one a cutting blow. One of the patients with shot-wounds died on the operating table from a haemorrhage while the other was saved by surgery. One patient successfully underwent surgery for loss of tissue in the thorax walls. Another had a mini-thoracotomy plus lung suture which were successful. Finally, in the patient with a slash in the front region of the thorax and a slight pneumothorax, we inserted a chest thorax tube and so obtained a complete re-expansion of the lung. Total mortality was 20%. Surgical exploration of the thorax we believe is necessary wherever there is a risk of haemorrhage or possible lung damage requiring only surgery. According to many authors, video-thoracoscopy has the advantage of a reliable diagnosis and above all, enable us to repair lung wounds without opening the thorax. In one of our patients we could have avoided the mini-thoracotomy and used thoracoscopy to repair the lung damage.

Colour flow duplex scanning: an accurate, non-invasive technique for preoperative evaluation of the vascular supply of the rectus abdominis myocutaneous flap

Forty patients were examined with colour Doppler to study the vascularization of rectus abdominis myocutaneous flaps before operations. The accuracy of this non-invasive ultrasound technique allowed us to describe the characteristics of the blood flow, including volume and velocity, diameter of vessels and their transverse section area within the epigastric arteries which supply the superior and inferior vascular pedicles of the flap. Vessels are drawn on the skin surface so that the flap can be more precisely and rapidly dissected. We are now using colour Doppler to assess variations in the diameter of vessels and in other variables of blood flow within the vascular pedicle of the transferred flap. These evaluations before and after operation are a great help to the reconstructive surgeon in the choice of operation and will lead to an appreciable reduction in postoperative morbidity.

[Primary choledocholithiasis after side-to-side choledochojejunostomy]

Primary choledocholithiasis represents a quite unusual sequela of biliary tract surgery. Primary stones originate in the common bile duct and are soft, smooth, with a yellowish or brown-reddish colour, reproducing the shape of the duct in which arise. The Authors report a review of the cases observed in the division of General and Vascular Surgery-Department of Surgery and Surgical Emergencies of the University of Perugia. From January 1988 to December 1993, 577 laparotomic biliary tract operations were performed, and in 8 cases a re-operation was needed. Among the latter, particularly interesting were 2 cases of primary choledocholithiasis occurred in two patients with bilio-digestive anastomosis previously performed, i.e. two side-to-side Roux-en-Y or Braun loop choledochojejunostomies, respectively. Therefore, primary lithiasis following a choledochojejunostomy occurred when the bilio-digestive anastomoses were performed with the indication of a curative re-operation on the biliary tract. On the contrary, most choledochojejunostomies are performed as a palliative procedure in patients presenting a low survival rate not allowing to develop a Sump Syndrome and a consequent choledocholithiasis, which are long-term complications.

Preoperative and postoperative evaluation of latissimus dorsi myocutaneous flap vascularization by color flow duplex scanning

At the Plastic and Reconstructive Surgery Department of the University of Perugia, 104 patients have been examined by color flow duplex scanning in order to study latissimus dorsi vascular supply before and after surgical procedures. This noninvasive ultrasound technique provides a precise and accurate measurement of blood flow velocity (15 cm/s) and volume (27 ml/min) within the thoracodorsal artery, which represents the vascular pedicle of the flap, and it allows us to detect the exact location of the perforating branches with their cutaneous distribution. This preoperative evaluation, pointing out vascular pathologies that contraindicate use of the latissimus dorsi flap, can be considered a great help for the reconstructive surgeon in the choice of the most suitable operation, and it can surely lead to a significant decrease in postoperative graft failure rates.

[Diagnostic and therapeutic problems of "second look" in acute intestinal ischemia]

The authors present their diagnostic approach to acute intestinal ischemia. They underline the need for early specific diagnosis because the therapeutic options vary widely in relation to different types of acute intestinal ischemia. Selective arteriography preceded by an aortogram is considered the diagnostic "gold standard". Although at present mesenteric ischemia is a serious, and often lethal, disease, an aggressive therapeutic approach can improve the outcome of this group of patients.

[Intestinal obstructions caused by colorectal carcinoma in the aged]

Colorectal cancer is the second most common malignancy of the adult population in the United States. It is exceeded only by lung cancer among males and breast cancer among females. Malignancies of the colon and rectum are responsible for approximately 12 per cent of all adult cancer deaths. These tumors appear as surgical urgency by intestinal obstruction for 15-20 per cent and by perforation for 3-8 per cent of all cases. It often occurs in elderly patients; in fact, urgent surgical operations are especially performed in patients older than seventy. The mortality rate for urgent surgical operation in elderly patients is about 32-54 per cent. This high mortality is even due to concurrent pathologies and particular locoregional and/or general alterations induced by tumor. The authors studied all patients older than 75 years affected by colorectal cancer and treated by choice or by urgency at Dept. of Surgery of the University of Perugia from January 1987 to February 1993 to individualize some clinical, anatomo-pathological and therapeutical significant characteristics about colorectal cancer in geriatric age.

Preoperative evaluation of inferior vena cava involvement secondary to malignant abdominal neoplasms

The authors report their experience of different imaging techniques (US, CT, MRI, and cavography) used to evaluate inferior vena cava involvement due to abdominal malignant neoplasms. The study is a retrospective analysis of preoperative data on 15 patients of both sexes in comparison with intraoperative and/or pathological findings. All patients underwent ultrasonography, with good results in all the venous segments studied, as for the CT scan; the limitation of both techniques is the unsafe evaluation of venous wall involvement when the neoplastic tissue is confined inside the vessel. The results obtained using MRI seem to be very encouraging, but we only studied three cases with this technique, and so cannot assess the real value of the method. In nine patients we performed inferior cava phlebography: we believe this to be a very reliable exam to demonstrate vessel wall invasion, even if it is a very invasive procedure, its limits being the inability to observe proximal thrombotic extension when the vein is completely obstructed by the tumor. On the basis of their experience the authors suggest a multi-technique imaging diagnostic procedure for preoperative staging with a view to obtaining as much information as possible to correctly program surgical procedure.

[Total parenteral nutrition: a study of the microbial contamination of the bags and the infusion lines]

The authors have examined during 60 groups of patients submitted to TPN each for a period of 10-15 days. In the first group the whole infusional set became replaced after 24 h., in the second and in the third group such replacement was done, respectively, after 48 and 72 h. The bacteriological examination of the fluid in the was always sterile 6 h. after preparation except in one case of the third group. The bacteriological examination of the terminal part of the infusional set was always negative in the first group, it was positive in the 3.33% of the cases, in the second group and in the 6.66% of the cases in the third group. The authors, consequently, believe that the infusional set has to be replaced after a period no longer than 24 h. Total parenteral nutrition: study on microbial contamination of bags and infusion lines.

[Cryosurgery in the treatment of condylomatosis]

The authors report their personal experience of the treatment of condylomas in both male and female patients using cryosurgery. The temperature of -80 degrees C which can be obtained using hyperdry nitrogen monoxide equipment allow radical treatment to be performed without pain in an outpatient setting without general or loco-regional anesthesia. The characteristics of this treatment allow patients to be regularly monitored, thus eliminating all signs of recidivation of those lesions which were too small to be seen at the start of treatment. The patient is considered cured after an interval of approximately 30-40 days after the disappearance of all condylomas.

[Effects of somatostatin peridurally administered in the treatment of postoperative pain]

Somatostatin (SMS), a hormone extensively found within the CNS, has shown to have a powerful analgesic effects administered either via the epidural or subdural route. The aim of the present study was to evaluate the efficacy of SMS administered epidurally compared with placebo, for the treatment of post-operative pain in patients receiving epidural anaesthesia for surgery. Of the 86 patients observed, 58 entered the study and were randomized to receive either SMS or placebo in a double blind fashion. They were also divided into 3 groups according to the site of the operation (group A: procto-anal; group B: inguino-crural; group C: other), 28 of them receiving SMS and 30 placebo. The post-operative pain evaluation was obtained via VAS at the moment of request of treatment (basal) and after an hour. Twenty-eight of the 86 observed (32.5%) didn't complain of pain that necessitated analgesic treatment. A statistically significant difference in reduction of intensity of pain was observed in the somatostatin treated group (6.42 +/- 0.37 vs 3.64 +/- 0.59) and in the somatostatin treated subgroup A and B (6.4 +/- 0.4 vs 3.8 +/- 0.7 and 6.3 +/- 0.8 vs 3.0 +/- 0.6 respectively). No adverse reactions of any kind were observed. SMS has shown to be a safe and effective drug, reducing by 50% the intensity of pain in patients undergone procto-anal or inguino-crural surgery.

[A clinical study of prevention of stress ulcer]

The authors have studied the possibilities of preventing digestive bleedings caused by "stress ulcers" in a large number of risk-patients recovered in the Reanimation Center of St. Camillo in Rome. On 1012 patients recovered from 1985 to 1987 the authors have pointed out 69 cases of bleeding by "stress ulcer" (6.9%). The mortality was in these patients 75%. In every patient with risk factors the Authors have performed a prophylactic treatment. This treatment, achieved with randomized standards, has been performed in a group of 311 patients with ranitidine and in a second group of 170 patients with ranitidine and somatostatin joined. In the group of patients treated with ranitidine alone the incidence of digestive bleeding was of 30 patients (9.9%), in the second group treated with ranitidine and somatostatin the incidence was of 18 patients (10%). In a previous study the authors have noted an incidence of digestive bleeding by "stress ulcers" in the 16.6% of patients prophylactically treated with cimetidine and in the 8.66% in a first group of patients treated with anti-acids and in the 11.92% of a second group of patients equally treated with anti-acids. The authors point out that their results are disappointing in opposition to the good results relieved by other Authors possibly in connection with the seriousness, the number and the length of the risk factors in the patients they have treated. They believe that the results will be better when it will be possible to dispose of effective treatment able to increase the defensive powers of the gastric mucosa, seriously impaired by the stress factors.