Three-dimensional vision versus two-dimensional vision on laparoscopic performance of trainee surgeons: a systematic review and meta-analysis

Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane's Library and Scopus. The following words and key phrases have been searched: "Two-dimensional vision", "Three-dimensional vision", "2D and 3D laparoscopy", "Trainee surgeons". This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI - 1.17 to - 0.47; p < 0.00001), cutting (MD: - 1.09; 95% CI - 1.50 to - 0.69 p < 0.00001), suturing (MD: - 0.48; 95% CI - 0.83 to - 0.13 p = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI - 13.55 to 30.98; p = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI - 0.72 to - 4.72; p = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.

Recurrent pneumothorax after cesarean delivery in the critically ill pregnant with severe COVID-19 ARDS: a case report

OBJECTIVE

Few data are available on the ICU management and on the possible respiratory complications of invasively ventilated pregnant patients affected by COVID-19 pneumonia, especially in the early phase of pregnancy. Tension pneumothorax has been previously described as a rare cause of respiratory failure after delivery, but its occurrence in the postpartum of COVID-19 patient has not been reported yet. We hereby describe the ICU management of a 23rd gestational week pregnant woman who underwent invasive mechanical ventilation, prone positioning, and cesarean delivery during her ICU stay for COVID-19 related pneumonia. Moreover, we focused on the occurrence and management of recurrent tension pneumothorax after the cesarean delivery.

CASE REPORT

A 23rd gestational week pregnant woman was admitted to the ICU for a COVID-19 bilateral pneumonia and underwent invasive mechanical ventilation and prone positioning. Cesarean delivery was planned during the ICU stay, while the patient was receiving invasive mechanical ventilation. After delivery, the patient experienced a recurrent pneumothorax that required the positioning of multiple chest drains.

CONCLUSIONS

In pregnant critically ill COVID-19 patients, mechanical ventilation management is particularly challenging, especially in the postpartum period. Prone positioning is feasible and can improve oxygenation and respiratory system compliance, while tension pneumothorax must be suspected if the respiratory function suddenly deteriorates after delivery.

Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation

Purpose

The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement.

Methods

We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit.

Results

Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020).

Conclusion

CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.

Different impact of long-detection interval and anti-tachycardia pacing in reducing unnecessary shocks: data from the ADVANCE III trial

AIMS

A long-detection interval (LDI) (30/40 intervals) has been proved to be superior to a standard-detection interval (SDI) (18/24 intervals) in terms of reducing unnecessary implantable cardioverter defibrillator (ICD) therapies. To better evaluate the different impact of LDI and anti-tachycardia pacing (ATP) on reducing painful shocks, we assessed all treated episodes in the ADVANCE III trial.

METHODS AND RESULTS

A total of 452 fast (200 ms < cycle length ≤ 320 ms) arrhythmic episodes were recorded: 284 in 138 patients in the SDI arm and 168 in 82 patients in the LDI arm (106/452 inappropriate detections). A total of 346 fast ventricular tachycardias (FVT) were detected in 169 patients: 208 in 105 patients with SDI and 138 in 64 patients with LDI. Setting LDI determined a significant reduction in appropriate but unnecessary therapies [208 in SDI vs. 138 in LDI; incidence rate ratio (IRR): 0.61 (95% CI 0.45-0.83), P = 0.002]. Anti-tachycardia pacing determined another 52% reduction in unnecessary shocks [208 in SDI with hypothetical shock-only programming vs. 66 in LDI with ATP; IRR: 0.37 (95% CI 0.25-0.53, P < 0.001)]. The efficacy of ATP in terminating FVT was 63% in SDI and 52% in LDI (P = 0.022). No difference in the safety profile (acceleration/degeneration and death/cardiovascular hospitalizations) was observed between the two groups.

CONCLUSION

The combination of LDI and ATP during charging is extremely effective and significantly reduces appropriate but unnecessary therapies. The use of LDI alone yielded a 39% reduction in appropriate but unnecessary therapies; ATP on top of LDI determined another 52% reduction in unnecessary shocks. The strategy of associating ATP and LDI could be considered in the majority of ICD recipients.

Antimicrobial evaluation of new metallic complexes with xylitol active against P. aeruginosa and C. albicans: MIC determination, post-agent effect and Zn-uptake

Xylitol (xylH5) is metabolized via the pentose pathway in humans, but it is unsuitable as an energy source for many microorganisms where it produces a xylitol-induced growth inhibition and disturbance in protein synthesis. For this reason, xylitol is used in the prophylaxis of several infections. In the search of better antimicrobial agents, new copper and zinc complexes with xylitol were synthesized and characterized by analytical and spectrosco pic methods: Na2[Cu3(xylH−4)2]·NaCl·4.5H2O (Cu-xyl) and [Zn4(xylH−4)2(H2O)2]·NaCl·3H2O (Zn-xyl). Both copper and zinc complexes presented higher MIC against Pseudomona aeruginosa than the free xylitol while two different behaviors were found against Candida albicans depending on the complex. The growth curves showed that Cu-xyl presented lower activity than the free ligand during all the studied period. In the case of Znxyl the growth curves showed that the inhibition of the microorganism growth in the first stage was equivalent to that of xylitol but in the second stage (after 18 h) Zn-xyl inhibited more. Besides, the PAE (post agent effect)obtained for Zn-xyl and xyl showed that the recovery from the damage of microbial cells had a delay of 14 and 13 h respectively. This behavior could be useful in prophylaxis treatments for infectious diseases where it is important that the antimicrobial effect lasts longer. With the aim to understand the microbiological activities the analysis of the particle size, lipophilicity and Zn uptake was performed.

Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial

IMPORTANCE

Using more intervals to detect ventricular tachyarrhythmias has been associated with reducing unnecessary implantable cardioverter-defibrillator (ICD) therapies.

OBJECTIVE

To determine whether using 30 of 40 intervals to detect ventricular arrhythmias (VT) (long detection) during spontaneous fast VT episodes reduces antitachycardia pacing (ATP) and shock delivery more than 18 of 24 intervals (standard detection).

DESIGN, SETTING, AND PARTICIPANTS

Randomized, single-blind, parallel-group trial that enrolled 1902 primary and secondary prevention patients (mean [SD] age, 65 [11] years; 84% men; 75% primary prevention ICD) with ischemic and nonischemic etiology undergoing first ICD implant at 1 of 94 international centers (March 2008-December 2010).

INTERVENTIONS

Patients were randomized 1:1 to programming with long- (n = 948) or standard-detection (n = 954) intervals.

MAIN OUTCOMES AND MEASURES

Total number of ATPs and shocks delivered for all episodes (primary outcomes) and inappropriate shocks, mortality, and syncopal rate (secondary outcomes).

RESULTS

During a median follow-up of 12 months (interquartile range, 11-13), long-detection group had 346 delivered therapies (42 therapies per 100 person-years, 95% CI, 38-47) vs 557 in the standard-detection group (67 therapies per 100 person-years [95% CI, 62-73]; incident rate ratio [IRR], 0.63 [95% CI, 0.51-0.78]; P < .001). The long- vs the standard-detection group experienced 23 ATPs per 100 person-years (95% CI, 20-27) vs 37 ATPs per 100 person-years (95% CI, 33-41; IRR, 0.58 [95% CI, 0.47-0.72]; P < .001); 19 shocks per 100 person-years (95% CI, 16-22) vs 30 shocks per 100 person-years (95% CI, 26-34; IRR, 0.77 [95% CI, 0.59-1.01]; P = .06), with a significant difference in the probability of therapy occurrence (P < .001); and a reduction in first occurrence of inappropriate shock (5.1 per 100 patient-years [95% CI, 3.7-6.9] vs 11.6 [95% CI, 9.4-14.1]; IRR, 0.55 [95% CI, 0.36-0.85]; P = .008). Mortality (5.5 [95% CI, 4.0-7.2] vs 6.3 [95% CI, 4.8-8.2] per 100 patient-years; HR, 0.87; P = .50) and arrhythmic syncope rates (3.1 [95% CI, 2.6-4.6] vs 1.9 [95% CI, 1.1-3.1] per 100 patient-years; IRR, 1.60 [95% CI, 0.76-3.41]; P = .22) did not differ significantly between groups.

CONCLUSIONS AND RELEVANCE

Among patients receiving an ICD, the use of a long- vs standard-detection interval resulted in a lower rate of ATP and shocks, and inappropriate shocks. This programming strategy may be an appropriate alternative.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00617175.

Influence of time between last myocardial infarction and prophylactic implantable defibrillator implant on device detections and therapies. "Routine Practice" data from the SEARCH MI registry

BACKGROUND

A multicenter European Registry, SEARCH-MI, was instituted in the year 2002 in order to assess patients' outcomes and ICD interventions in patients with a previous MI and depressed LV function, treated with an ICD according to MADIT II results. In this analysis, we evaluate the influence of the time elapsed between last myocardial infarction (MI) and prophylactic cardioverter defibrillator (ICD) implant on device activations.

METHODS

643 patients with left ventricular dysfunction (mean LVEF 26 ± 5%) and NYHA class I-III were prospectively followed for 1.8 ± 1.2 years in a multicenter registry. The population was divided into 3 groups according to the time between last MI and ICD implant: [1] from 40 days to less than 1.5 years; [2] from 1.5 to less than 7 years and [3] at least 7 years.

RESULTS

The cumulative incidence of ventricular tachyarrhymias and appropriate device therapy (ATP or shock) were higher in patients implanted longer time from last MI (Gray's Test p=0.002 and p=0.013 respectively). No significant differences were seen in all cause mortality (Gray's Test p=0.618) or sudden cardiac death across the MI stratification groups (Gray's Test p=0.663).

CONCLUSIONS

Patients implanted with an ICD longer after the MI have a higher chance of presenting ventricular tachyarrhythmias and appropriate ICD therapy, while no differences were seen in overall mortality. These observations may be important for improving patient targeting in sudden death prevention.

A randomized study to compare ramp versus burst antitachycardia pacing therapies to treat fast ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators: the PITAGORA ICD trial

BACKGROUND

In patients with implantable cardioverter-defibrillators (ICDs), antitachycardia pacing (ATP) is highly effective in terminating fast ventricular tachycardias (FVTs) and lowers the use of high-energy shocks, without increasing the risk of arrhythmia acceleration or syncope.

METHODS AND RESULTS

The aim of the PITAGORA ICD trial was to randomly compare 2 ATP strategies (88% coupling interval burst versus 91% coupling interval ramp, both 8 pulses) in terms of ATP efficacy, arrhythmia acceleration, and syncope. Two hundred six ICD patients (83% male, 67+/-11 years) were enrolled. FVT episodes with cycle lengths between 240 and 320 ms were treated by 1 ATP sequence and, in the event of failure, by shocks. Over a median follow-up of 36 months, 829 spontaneous ventricular tachyarrhythmia episodes were detected in 79 patients. Episode review identified 595 episodes as true ventricular arrhythmias in 72 patients; devices classified 111 (18.7%) episodes as VF, 216 (36.3%) as FVT, and 268 (45.0%) as VT. Fifty-six patients had 214 treated FVT episodes-2 FVTs self-terminated before ATP release; 44 (79%) of these had at least 1 effective ATP intervention, and 34 (61%) were spared ICD shocks. Burst terminated 100 of 133 (75.2%) FVT episodes, whereas ramp terminated 44 of 81 (54.3%; P=0.015). Acceleration occurred in 9 of 214 (4.2%) FVT episodes treated: 6 episodes in 3 ramp patients and 3 episodes in 3 burst patients. Two patients-1 in each group-suffered 1 syncopal event associated to a nonterminated FVT episode.

CONCLUSIONS

Burst is significantly more efficacious than ramp in terminating FVT episodes. As the first therapy for FVT episodes, ATP carries a low risk of acceleration or syncopal events.

Avoid delivering therapies for nonsustained fast ventricular tachyarrhythmia in patients with implantable cardioverter/defibrillator: the ADVANCE III Trial

INTRODUCTION

The purpose of this investigation is to evaluate whether a prolonged detection interval for life threatening ventricular tachyarrhythmia (VT) is able to reduce therapies (Rx) delivered by an implantable cardioverter/defibrillator (ICD). Until now, only the PREPARE trial demonstrated a reduction of ICD Rx in a cohort of primary prevention patients.

METHODS AND RESULTS

The ADVANCE III study is a prospective, randomized, parallel trial with 2 arms evaluating different intervals to detect (NID), i.e., 18/24 (as currently used) versus 30/40. The primary endpoint is to demonstrate a 20% reduction of ICD Rx (antitachycardia pacing or shocks) delivered to terminate spontaneous VT with a cycle length < or =320 ms in patients with Class I-IIA indication for ICD therapy, regardless of cardiac resynchronization capabilities. The worldwide investigation started in spring 2008 and is expected to be finished in 2011.

CONCLUSIONS

The ADVANCE III trial is the first randomized investigation evaluating the reduction of ICD Rx for fast VT due to a prolongation of NID in a general ICD patient cohort.

Clinical and arrhythmic outcomes after implantation of a defibrillator for primary prevention of sudden death in patients with post-myocardial infarction cardiomyopathy: The Survey to Evaluate Arrhythmia Rate in High-risk MI patients (SEARCH-MI)

Aims

To evaluate clinical and arrhythmic outcomes in post-infarction cardiomyopathy patients implanted with a defibrillator (ICD) for primary prevention of sudden death.

Methods and results

The SEARCH-MI registry is a European multi-centre, prospective, observational study enrolling patients after myocardial infarction, chronic left ventricular dysfunction and an ICD implanted for primary prevention of sudden death. Data on 556 patients with at least one recorded follow-up are presented. Survey to Evaluate Arrhythmia Rate in High-risk MI (SEARCH-MI) patients were sicker than those enrolled in MADIT-II with higher New York Heart Association class and left bundle branch block. Total mortality was 10.4%. Close to one-third (30%) of patients experienced episodes of sustained ventricular arrhythmia. One-quarter (23%) received at least one appropriate therapy and 10% inappropriate therapy. Gender (25% males vs. 5% females, P = 0.0009) and history of non-sustained ventricular tachycardia (24% with vs. 18% without P = 0.037) were predictive of appropriate ventricular therapy.

Conclusion

SEARCH-MI represents the current clinical management of post-MI patients with left ventricular dysfunction indicated to defibrillator implant for primary prevention. European routine clinical practice was influenced by landmark trials and guidelines which impacted on the implantation of cardiac resynchronization therapy in over 25% of such patients. Non-sustained ventricular tachycardia identifies subjects with a higher incidence of appropriate ICD therapy.

Bacteriophage lambda display of complex cDNA libraries: a new approach to functional genomics

We describe the construction and characterization of two lambda surface displayed cDNA expression libraries derived from human brain and mouse embryo. cDNA inserts were obtained by tagged random-priming elongation of commercially available cDNA libraries and cloned into a novel lambda vector at the 3' end of the D capsid protein gene, which produced highly complex repertoires (1x10(8) and 2x10(7) phage). These libraries were affinity selected with a monoclonal antibody against the neural specific factor GAP-43 and with polyclonal antibodies that recognize the EMX1 and EMX2 homeoproteins. In both cases rapid identification of specific clones was achieved, which demonstrates the great potential of the lambda display system for generating affinity selectable cDNA libraries from complex genomes.

Distraction osteogenesis to achieve mandibular vertical bone regeneration: a case report

In this case report a surgical technique for vertical ridge augmentation is presented. The procedure, performed in a 30-year-old woman with an atrophied alveolar ridge in the anterior portion of the mandible, is based on the biologic concept of osteogenesis distraction previously introduced in orthopedic and maxillofacial surgery. After elevation of a full-thickness flap a horizontal osteotomy was performed 7 to 8 mm from the top of the ridge. Two vertical osteotomies were prepared with drills of increasing diameter (2, 2.8, and 3.25 mm), tapping was performed for the first 5 to 6 mm, and two distractor base plugs were placed at the base of the osteotomies with a repositioning tool. An intraosseous distraction implant was then inserted and 2 inward vertical cuts were made in the bone to allow proper distraction to take place. Correct functioning of the device was checked by distracting the bone fragment 1 mm using the axial distraction screw. A latency distraction healing screw was inserted in each of the distraction implants and the area was left to heal for 5 days. Once primary healing had occurred, the distraction of the newly formed bone callus was activated each day for 10 days (1 mm per day). At the end of the distraction period a final distraction screw was left in place and a final healing screw was inserted. During this time there were no complications and the patient on no occasion complained of discomfort. The distractor device was removed 30 days later, leaving the base plugs in place. One month later a vertical augmentation of 7 mm had been achieved; the base plugs were removed, 3 intraosseous implants were inserted, and a biopsy of the newly formed tissue was obtained. Histologic evaluation of the biopsy specimen showed woven bone formation approximately 75 days after the initial procedure.

Localized ridge augmentation with chin grafts and resorbable pins: case reports

Six block grafts harvested from the mandibular symphysis were used to augment partially atrophied ridges. Three maxillary defects and three mandibular defects were treated in five patients. Autologous bone grafts from the chin were stabilized in the recipient sites with resorbable pins and no membranes were used over the grafts. Healing proceeded without complications. At 3 to 4 months the external cortical surface of the grafts progressively resorbed and the profiles of the pins protruded from underneath the buccal tissue that covered the augmented areas. However, the pins never perforated the tissue and they were resorbed macroscopically within 4 to 6 months. At 6 months the areas treated showed successful ridge augmentation and when exposed for stage 2 surgery, remnants of the pin holes on the external surface of the repaired defects were detected. Radiographic evaluation of the block grafts was performed at 3 and 6 months and histologic specimens were obtained at 6 months; the specimens demonstrated incomplete pin resorption and encapsulation. A severe foreign-body reaction was detected in one case. The presence of an acellular bone matrix in certain sections and a normal bone pattern with a cellular component in others was a consistant finding. ITI endosseous Implants were placed with excellent primary stability in all treated cases.

Peripheral ossifying fibroma--literature update and clinical case

This article describes a case of peripheral ossifying fibroma. The lesion is presented with respect to its clinical, radiographic, and histologic characteristics. Recommendations for proper diagnosis and treatment are suggested.

Effect of treatment on cyclosporine- and nifedipine-induced gingival enlargement: clinical and histologic results

The clinical and histologic responses to periodontal treatment of gingival enlargements, induced when cyclosporine and nifedipine were administered singly or in combination, were evaluated. A significant correlation was noted between plaque, gingivitis, and gingival overgrowth. Severity of enlargement appeared to be greater in patients on combined therapy. All treatment approaches such as scaling, root planning, gingivectomy, and periodontal flaps, and a combination of therapies, were effective in the management of gingival overgrowth up to 1 year after completion of treatment. Adjunctive use of chlorhexidine was found to be beneficial.

[Effect of saliva on resorption time of some resorbable membranes]

Since resorbable membranes have been introduced their resorption time has been always an important topic of discussion. The current literature does not cover very accurately the contributing factors associated with this biologic process in the oral cavity. The clinical experience shows that the influence of saliva may be an important factor during the resorption of synthetic resorbable membranes. Six experiments are described in this article in which four synthetic resorbable membranes are tested (Vicryl periodontal mesh, Vicryl collagene, Guidor and Resolut). The membranes are plated in Petri dishes precoated with Agar in contact with saliva. Experiment number 1 and 2 demonstrated that saline solution and Agar do not alter the resorption time of the membranes. Experiment 3 and 4 showed that a dilution of saliva to 1:10 and a non diluted saliva accelerate their resorption time of two of the tested membranes. The Vicryl periodontal mesh and the Vicryl collagene disappeared respectively after 7 and 9 days of contact with the not diluted saliva and after 10 and 12 days of contact with the 1:10 diluted saliva. The experiment 5 and 6 indicated that both salivas (diluted and not diluted) deprived of bacteria do not alter the resorption time of the membranes. In conclusion the pattern of resorption of the synthetic membranes, in this in vitro study, is recognized in the contact between the membrane and the bacterial enzymes present in saliva, and in the mechanical structure of the membrane design.

Localized osteomyelitis following a restorative procedure

This case report describes a localized interproximal soft-tissue lesion in the anterior maxillary area that may have been caused by a composite curing light. Following clinical examination and histological analysis, the diagnosis of acute osteomyelitis was made. Palliative treatment and debridement resulted in complete resolution.

RNA transport in dendrites: a cis-acting targeting element is contained within neuronal BC1 RNA

In nerve cells, a select group of RNAs has been localized to dendritic domains. Here we have examined dendritic RNA transport in sympathetic neurons in primary culture, using a microinjection protocol with neuronal BC1 RNA and with BC1-derived sequence segments. After cytoplasmic microinjection, full-length BC1 RNA was selectively transported to dendrites; in contrast, control RNAs such as nuclear RNAs and random-sequence irrelevant RNAs remained restricted to cytoplasmic areas proximal to the injection sites. Chimeric RNAs were constructed that contained the full-length BC1 sequence inserted upstream or downstream of the coding regions of nondendritic mRNAs. After microinjection, such chimeric RNAs were specifically targeted to dendrites; microinjected corresponding nonchimeric mRNAs were not. Dendritic transport of BC1 RNA was rapid: the average dendritic delivery rate within the first hour after microinjection was 242 +/- 25 microm/hr. Whereas a 5'-BC1 segment of 62 nucleotides was transported to dendrites to extents and at levels similar to full-length BC1 RNA, a 3'-BC1 segment of 60 nucleotides did not exit injected somata to any significant degree. A cis-acting dendritic targeting element is thus contained in the 5' part of neuronal BC1 RNA. These results demonstrate that mechanisms exist in neurons for fast and specific transport of selected RNAs to dendrites.

Influence of root anatomy on periodontal disease

One of the essential elements of periodontal therapy is long-term maintenance. Anatomic factors that favor localized plaque accumulation may contribute to the progression of disease. The purpose of this investigation was to evaluate the influence of root concavities on the severity of furcation involvement. Measurements were recorded clinically at the time of surgical treatment. Statistical analysis revealed no significant association between the degree of root concavity and the severity of furcation involvement.

Regenerative periodontal therapy in mucogingival surgery for root coverage

This article illustrates the potential benefits of regenerative periodontal therapy in mucogingival surgery and esthetic dental treatment. Cases are described in which the treatment of soft-tissue recessions and root exposures are treated with surgical procedures where both clinical soft-tissue augmentation and the regeneration of periodontal attachment are obtained. Cases are also presented to illustrate the clinical application of guided tissue regeneration. Resorbable and nonresorbable barriers are placed over the root surface and bone and covered by the overlying flap, which allows the selective repopulation of the lesion by progenitor cells and the inhibition of a long junctional epithelium. Emphasis is placed on regenerative procedures in soft-tissue augmentation, particularly with respect to rationales, techniques, and indications.

The use of a resin ionomer in the regenerative treatment of an interproximal lesion: a case report

This article documents the clinical observations made in the course of a surgical procedure in which a resin ionomer was used as a barrier for guided tissue regeneration. The results indicate that this material appears to demonstrate potential in such procedures.

[Course and regression of HELLP syndrome]

The authors reported the outcome of a retrospective study of patients with HELLP syndrome to verify whether this pathology is a clinical entity with models of evolution, regression and well defined treatment. A total of 20 individual cases were reported at the Division of Obstetrics and Gynecology at the G. Gaslini Institute during the period from January 1990 to September 1995. All cases showed the normalisation of the various clinical and hematochemical parameters within a maximum of 8 days after birth. The rapid diagnosis, the immediate extraction of the fetus and appropriate medical treatment led to the prompt resolution of this severe pathology without the need for demolitive surgery frequently used in the past.

Root surface biomodification using a dentin bonding conditioner

OBJECTIVE

The purpose of this investigation was to compare by scanning electron microscopy (SEM) the surfaces of roots treated with a dentin conditioning agent and other materials that have been used routinely in periodontal therapy for root surface demineralization, namely, citric acid and tetracycline hydrochloride.

MATERIALS AND METHODS

Sixteen freshly extracted human teeth were randomly divided into four equal groups; each tooth was hand scaled and planed prior to root surface conditioning with citric acid, tetracycline hydrochloride, and a dentin bonding conditioner; Tenure Dentin Conditioner (DenMat Corporation, Santa Maria, CA). The last has been used previously in conjunction with a resin-ionomer barrier in cases involving guided tissue regeneration. Root specimens were prepared for scanning electron microscopy and representative micrographs were taken at 1000x and 2000x.

RESULTS

The results of this study indicate that there are morphological similarities between surfaces obtained with the dentin conditioning agent and the other acidic materials that are used routinely in periodontal regenerative therapy.

CONCLUSIONS

Root surface demineralization has been shown to remove the smear layer, and provides a surface which is conductive to mechanical adhesion and cellular mechanisms for growth and attachment.

Atypical frenum formation at the donor site after mucogingival flap surgery

The following case report illustrates the potential for the formation of a mucogingival problem in the form of a frenum at the donor site for a laterally positioned flap. Corrective surgery and suggestions to prevent complications at the donor site are discussed.

Surgical correction of gingival recessions associated with radicular carious lesions

In this clinical report, six cases are presented in which radicular carious lesions and gingival recessions were treated concurrently. The combined treatment included the removal of caries, radicular planing, and various surgical techniques for root coverage. Traditional procedures, as well as newer procedures, such as guided tissue regeneration, showed successful results.

Using a resin-ionomer in guided tissue regenerative procedures: technique and application--case reports

The purpose of these case reports is to introduce a potential use for a resin-ionomer in guided tissue regeneration. The resin-ionomer is used in a two-fold manner (1) to lute an e-PTFE membrane in place in furcation defects and (2) to act as a barrier itself in furcation and infrabony defects. Clinical observations made in this report indicate that a resin-ionomer barrier may be placed subgingivally without sutures. In addition, the resin-ionomer, given its ability to release fluoride, may serve as a delivery system for local antimicrobial therapy during the initial stages of wound healing. Further studies should be conducted in order to evaluate the potential of the resin-ionomer for the uses described in this article.

Use of a resin-ionomer in guided tissue regeneration: case reports

The cases presented in this report illustrate: (1) the potential for a fluoride-releasing resin-ionomer (Geristore) to be used as a sealant between an e-PTFE membrane (Gore-Tex) and tooth structure during a guided tissue regeneration, and (2) the potential for a resin-ionomer to function as a barrier in guided tissue regeneration. In the first case, the e-PTFE membrane was trimmed to only cover the area to be treated prior to its placement over the lesion. The resin-ionomer was mixed following manufacturers specifications, placed on four corners of the pre-trimmed membrane and luted into place. In the second case, the resin-ionomer alone was placed over the lesion, teased off the lesion with a curette while in a semi-set state, and luted into place with freshly mixed material after it set completely. These cases provide preliminary clinical evidence that a resin-ionomer may be used subgingivally for guided tissue regeneration.

Periodontal and prosthetic treatment of a cleft lip and palate patient: a case report

Although cleft lip and palate patients are usually treated by a multidisciplinary team involving physicians and dentists, their periodontal condition may be over-looked. Crowded or malpositioned teeth, hypertrophic gingiva, orthodontic appliances, and prosthetic replacements can impede proper plaque removal and thus perpetuate periodontal disease. It is important to incorporate periodontal treatment into the comprehensive treatment as early as possible. This case report discusses the periodontal surgical procedures involved in eliminating a residual ridge defect and the fitting of the final prosthetic reconstruction. Also, the importance of the identification and management of periodontal conditions characteristic of cleft lip and palate patients before and after surgical, orthodontic, and prosthetic rehabilitation will be emphasized.

Role of mouse polyomavirus late region in the control of viral DNA replication: a review

The genome of polyomaviruses is divided into two coding regions: the early and the late region. A relatively short regulatory sequence, encompassing the origin of viral DNA replication (ori), separates the two regions encoding the structural genes. In mouse polyomavirus (Py) in particular, the early DNA codes for three antigens: large, middle and small T-antigen (L-T, M-T and S-T, respectively). Large T antigen binds ori and thus regulates both viral DNA transcription and replication. Middle T antigen has been shown to mediate malignant transformation in non-permissive cells in vitro. No defined function has been assigned to the small T antigen although this gene product is thought to act synergistically both with L- and M-T antigens. The viral late region of Py encodes also three different genes whose products form the viral capsid during the productive infection cycle in permissive cells. Py early region was thought to be the only part of the genome necessary to code for proteins of functional and regulatory significance. The viral late region, on the other hand, was for a long time considered a simple reservoir of structural information, since it codes for capsid proteins and was supposedly devoid of functional control properties. This short review is focused on recent works from our and other laboratories, reporting evidence that in Py also the late region has a functional role since late sequences are involved in the control of viral DNA replication and in capsid assembly. Results indicating that this might be true for the cognate simian virus SV40 will be also reviewed.

Predictive factors of delayed emesis in cisplatin-treated patients and antiemetic activity and tolerability of metoclopramide or dexamethasone. A randomized single-blind study

To prevent delayed emesis induced by cisplatin (mean dose 90 mg/m2), 120 consecutive patients were randomized to receive, in a 7-day crossover design, oral metoclopramide (20 mg q.i.d.), dexamethasone (1 mg q.i.d.) or placebo (two tablets q.i.d.) starting 24 hours after the end of chemotherapy. Complete protection from nausea, but not from vomiting. was significantly increased by both dexamethasone and metoclopramide with respect to placebo. Important prognostic factors favoring the appearance of delayed emesis were incomplete protection from vomiting during the first 24 hours after cisplatin, female gender, and highest cisplatin doses. Tolerability of both drugs was good. Larger and randomized controlled trials are necessary to identify better preventive treatment of delayed emesis induced by cisplatin.

A randomized trial fo three cisplatin-containing regimens in advanced non-small-cell lung cancer (NSCLC): a study of the Umbrian Lung Cancer Group

Survival in patients with locally advanced (stage III Mo) and metastatic (Ml) non-small-cell lung cancer (NSCLC) is short. Phase II studies have reported objective responses ranging from 20% to 60% using cisplatin-based chemotherapeutic regimens, yet few have shown improvement in median survival. In our phase II pilot studies with cisplatin (CDDP) and etoposide (VP-16), we observed a 26% response rate; with CDDP, VP-16, and mitomycin-C, a 38% response rate was obtained in advanced NSCLC patients. A total of 156 consecutive patients with locally advanced and metastatic NSCLC were randomized to one of three treatment arms to determine whether the chemotherapy protocols had any effect on response rate and median survival in a large, randomized study. Arm 1 consisted of CDDP (120 mg/m2 x 3 weeks); arm 2, of CDDP (120 mg/m2) and VP-16 (100 mg/m2 given i.v. on days 1-3), repeated every 3 weeks; and arm 3, of CDDP (120 mg/m2) and VP-16 (100 mg/m2 on days 1-3) given every 3 weeks, plus mitomycin C (10 mg/m2 on days 1, 21, and 42, then every 6 weeks, for a maximal dose of 100 mg). After 71 patients had been enrolled in the study, we stopped accrual in the CDDP arm due to a lack of response [1 complete response (CR) in 24 patients; 4%] and continued enrollment in the two combination-chemotherapy arms. In the CDDP/VP-16 arm a 30% response rate [1 CR, 18 partial responses (PRs)] was obtained, and in the CDDP/VP-16 mitomycin C arm a 26% response rate (4 CRs, 11 PRs) was seen among a total of 150 evaluable patients. Responses were observed in 31% of patients with favorable performance status (PS) (ECOG 0-1) vs 14% in patients with a poor PS (ECOG 2-3). Of patients with locally advanced disease (III Mo), 17 (33%) obtained an objective response, compared with 20 patients (20%) with metastatic disease. Median survival was 18 weeks in the CDDP arm, 35 weeks in the CDDP/VP-16 arm, and 37 weeks in the CDDP/VP-16/mitomycin C arm. The median survival in the multimodal chemotherapy arms was significantly greater than that obtained with CDDP alone. Toxicity was predominantly myelosuppression in the mitomycin C-containing arm (27%, wtto grade 3-4). Our study shows that combination chemotherapy using CDDP/VP-16 is active and safe in the treatment of advanced NSCLC patients with a good performance status. The addition of mitomycin C did not improve the therapeutic response.