Linea alba 3D morphometric variability by CT scan exploration.

PURPOSE: The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature. We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics. METHODS: Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients' CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured. RESULTS: The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4 ± 1.9 cm and a larger width above the umbilicus than below. Its length was 37.5 ± 3.6 cm, which increased with body mass index (BMI) (p < 0.001), and was shorter in women (p < 0.001). The sagitta was 2.6 ± 2.2 cm, three times higher in the obese group (p < 0.001), majorated with age (p = 0.009), but was independent of gender (p = 0.212). Linea alba width increased with both age and BMI (p < 0.001-p = 0.002), being notably wider in women halfway between the umbilicus and pubis (p = 0.007). CONCLUSION: This study provides an exhaustive 3D description of Linea alba's anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.

Cytokine genotype distribution in patients with periodontal disease and rheumatoid arthritis or diabetes mellitus.

The association between oral and systemic health has highlighted the importance of periodontal health and treatment, with the consequence that dental assessment and attention to oral hygiene have assumed an increasingly important part in the clinical management of patients with diabetes mellitus and rheumatoid arthritis. The aim of this work was to assess genotype frequencies in polymorphisms of genes of IL-1α-889 and IL-1ß-511 in a case-controlled study population of patients affected by periodontal disease and rheumatoid arthritis or diabetes mellitus.

Which route of antibiotic administration should be used for third molar surgery? A split-mouth study to compare intramuscular and oral intake.

OBJECTIVE: To compare the effectiveness of two different routes of antibiotic administration in preventing septic complications in patients undergoing third molar extraction. MATERIALS AND METHODS: Twenty-four healthy patients requiring bilateral surgical removal of impacted mandibular third molars were successfully enrolled for this study. Depth of impaction, angulation, and relationship of the lower third molars with the mandibular branch had to be overlapping on both sides. A split-mouth design was chosen, so each patient underwent both the first and second surgeries, having for each extraction a different antibiotic route of administration. The second extraction was carried out 1 month later. To compare the effects of the two routes of antibiotic administration, inflammatory parameters, such as edema, trismus, pain, fever, dysphagia and lymphadenopathy were evaluated 2 and 7 days after surgery. Side effects of each therapy were evaluated 48 h after surgery. RESULTS: Oral and intramuscular antibiotic therapies overlap in preventing post-operative complications in dental surgery (p>0.05), even if the oral intake, seems to promote the onset of significant gastrointestinal disorders (p=0.003). CONCLUSIONS: This study could help dentists in their ordinary practice to choose the right route of antibiotic administration in the third molar surgery. At the same effectiveness, the higher cost and the minor compliance of the patient seem not to justify a routine antibiotic intramuscular therapy, reserving it for patients with gastrointestinal disorders.

Is cancer-related fatigue more strongly correlated to haematological or to psychological factors in cancer patients?

GOALS OF WORK: Cancer-related fatigue is a very frequent problem in cancer, interfering with many patients' life activities. Anaemia is present in a large number of fatigued patients. The aim of this study was to evaluate cancer-related fatigue, in relation with haematic haemoglobin levels and the presence of anxiety and depression. MATERIALS AND METHODS: The Functional Assessment Of Chronic Illness Therapy-Fatigue scale was used to assess fatigue. The Hospital Anxiety and Depression Scale was administered to screen for psychological distress. Haematological values were measured by blood tests. All data were analysed using Chi-squared, and a logistic regression analysis was conducted. MAIN RESULTS: Eighty patients were enrolled in the study. Significant associations were found between fatigue and depression, fatigue and anxiety and between fatigue and haemoglobin. CONCLUSION: Anxiety and depression, other than heamoglobin levels, were found associated with fatigue. Hence, implications for a multi-dimensional treatment of fatigue are discussed.

Odontoma: retrospective study and confocal laser scanning microscope analysis of 52 cases.

AIM: The aim of this study was to perform a retrospective analysis of 52 cases of odontoma treated at the Department of Dentistry and Surgery, University of Bari, in the period 1971-2005. METHODS: The odontogenic tumors were diagnosed as complex or compound odontoma following histological analysis and clinical radiological examination, and applying the 2005 WHO classification. The data analysis was conducted by considering the following factors: gender, age, site of the lesion, association with impacted teeth, aplasia, presence of supernumerary teeth as well as preoperative diagnosis by panoramic and periapical radiographs. Biopsy tissue samples were conventionally processed for histopathologic paraffin embedding and then were observed by optical microscopy and subsequently by confocal laser scanning microscopy (CLSM) in autofluorescence. RESULTS: Thirty specimens (57.6%) were from females and 22 (42.3%) were from males patients. The patients' age ranged from 5 to 75 years. Fifty-one percent of the specimens were excised from the mandible. In the maxilla, the most common location for odontomas was the anterior region. Most odontomas were associated with impacted teeth and only in one case there was an odontoma instead of a permanent tooth. CONCLUSION: Odontomas are considered hamartomatous malformations whose diagnosis is generally formulated by routinary radiographic examination. The CLSM analysis could help in diagnosis and histopathological analysis showing well-defined follicular area entrapped in hard tissues and pointing out ghost cells, otherwise not identifiable by traditional microscopy.

Chemo-hormone therapy of non-well-differentiated endocrine tumours from different anatomic sites with cisplatinum, etoposide and slow release lanreotide formulation.

We report the results of a phase II trial in patients with metastatic endocrine tumours from different sites, which aimed to evaluate the anti-tumour activity and toxicity of a cisplatinum and etoposide regimen administered in combination with the somatostatin agonist lanreotide given in slow release formulation. Between January 1999 and November 2003, 27 patients with histological diagnoses of endocrine tumours with different degrees of differentiation, excluding well differentiated carcinoid neoplasms, received intravenous (i.v.) administration of cisplatinum (30 mg m(-2)) and etoposide (100 mg m(-2)) on days 1-3 and intramuscular administration of 60 mg lanreotide on day 1, in a 21-day cycle. All of the patients were evaluable for toxicity and response. The treatment was very well tolerated as no grade 4 toxicity was observed. Four patients achieved a complete response, six a partial response, 12 experienced disease stabilisation and five disease progression. The average time to progression and to survival were 9 and 24 months respectively. These results suggest that this chemo-hormone therapy regimen is well tolerated and active in patients with non-well differentiated endocrine tumours.

[Work efficiency and lighting conditions: an experimental study]. / Efficienza lavorativa e condizioni illuminotecniche: studio sperimentale.

Thirty-two voluntary subjects were selected, not suffering either from any degenerative ophthalmic diseases or refraction and ocular motility alterations. Each subject underwent close visual task experimental sessions (e.g. PC usage), under monitored experimental conditions. Aim of the study is the assessment of working efficiency effects caused by lighting conditions characterized by "according to law" illuminations, yet in presence of high or low luminance ratios in the occupational visual field". An analysis of the data showed that high luminance ratios conditions show a decrease of the performance (decrease overall efficiency, increase in the number of errors and time of execution), which where not detected with low luminance ratios conditions. Asthenopia did not show clear differences, possibly due to the effects of the intense near work which was present in both the experimental sessions.

A novel metronomic chemotherapy regimen of weekly platinum and daily oral etoposide in high-risk non-small cell lung cancer patients.

The aim of this pilot phase II trial was to investigate the toxicity and anti-tumour activity of a novel metronomic regimen of weekly cisplatin (CDDP) and oral etoposide (VP16) in high-risk patients with advanced NSCLC. The study enrolled 31 high-risk patients (27 men and 4 women aged 16-82 years; mean, 64.3) with NSCLC (18 stage IIIB and 13 stage IV) and an ECOG performance status of < or = 3, all of whom received weekly CDDP 30 mg/m2 iv on days 1, 8, 14 and 28 of each cycle and oral daily etoposide 50 mg/m2 on 21 of the 28 days. The most frequent adverse events were grade III leukopenia and anemia; nevertheless, three patients died of pulmonary embolism after 2, 3 and 6 weeks of treatment. The objective response (OR) rate was 45.2% (2 complete and 12 partial), and the disease control rate was 58.1% (14 ORs and 4 disease stabilisations). The mean time to progression and survival were respectively nine months (95% CI, 6.3-15.8 months) and thirteen months (95% CI, 9.1-20.5 months). Pharmacological analysis showed that this metronomic regimen allows a much greater median monthly area under the curve of CDDP and VP16 than conventional treatment schedules. Our findings also suggest that this treatment schedule may affect tumour growth and neoangiogenesis by changing peripheral blood vascular-endothelial growth factor levels. These preliminary results indicate that our metronomic regimen is well tolerated and active, even in patients with a very poor prognosis.

Complex odontoma: confocal laser scanning microscopy analysis of a case.

Confocal laser scanning microscopy (CLSM) represents a recent acquisition in the study of biological samples stained for fluorescence observation. Particularly, this technique allows a bidimensional investigation of tissues and cells with the possibility to elaborate a three-dimensional model. The aim of this study is the use of this technique, as a complementary and not substitutive application of the histological examination, for the morphological and histopathological analysis in a case of mixed complex-composed odontoma. The analyzed specimen has been surgically removed in the superior frontal region in a 12 year-old boy and submitted to conventional histopathological analysis. The specimen, hematoxylin-eosin stained, has been subsequently submitted to confocal laser scanning microscopic analysis in autofluorescence by using a Nikons C1 system. This analysis has underlined not visible aspects in traditional optical microscopy, such as the mineralization of hard tissues and the morpho-structural organization of the cellular component. The presence of enamel and dentin may be observed in the different phases of odontogenesis with clear fluorescence gradients determined by the different mineralization degrees. Thus, the odontogenetic components appear strongly autofluorescent in the classical follicular configuration. Three-dimensional reconstruction is made possible by the acquisition of serial bidimensional images that are subsequently analysed by using a specific software device. This study shows the confocal laser scanning microscopy versatility in the analysis of odontogenic neoplasms with production of mineralized tissues.

A case of primary malignant hemangiopericytoma of the heart with fatal outcome.

Hemangiopericytoma is a rare, highly vascular tumor which has both malignant and benign varieties. We report a case of a 41-year-old man who underwent surgery in emergency because of cardiac tamponade. The histopathologic examination of the specimens revealed primary malignant cardiac hemangiopericytoma. The patient died 46 days from the beginning of symptoms and 13 days after surgery.

Late outcome and perioperative complications for surgery of locally recurrent bronchogenic carcinoma.

AIM: Many doubts involve a 2(nd) surgical approach for local relapse of non small cell lung cancer (NSCLC) since iterative resections represent a well-recognized treatment in second primary lung cancer (SPLC). METHODS: The medical reports of patients who underwent surgical resection, between 1988 and 2002, were reviewed. All patients submitted to 2(nd) operation were examined according to Martini and Melamed criteria to distinguish between local recurrence and second primary lung cancer. RESULTS: Complete resection for NSCLC was performed in 1 386 patients. Nineteen patients were submitted to surgery for local recurrence (17 men and 2 women) and mean age at the time of 1(st) operation was 61 years (range 41-78 years). The 1(st) operation consisted of lobectomy in 15 cases, anatomical segmentectomy in 2 and wedge resection in 2. The 2(nd) pulmonary resection was completion pneumonectomy in 16 cases, completion lobectomy in 2, wedge resection in 1. Major complications occurred in 26% and overall hospital mortality was 5%. Five-year survival after 2(nd) intervention was 31% and median survival 27 months. Survival was better when the time between 1(st) resection and cancer relapse was longer than 14 months and when recurrence was intrapulmonary. CONCLUSIONS: A new malignant lesion can be operated if it is solitary and intrapulmonary, if accurate staging is negative and if the patient is able to go through 2(nd) surgery from cardiopulmonary evaluation.

Ten year experience of bioabsorbable mesh support in pectus excavatum repair.

INTRODUCTION: We reviewed 10 years experience in the treatment of this deformity using a retro-sternal bioabsorbable mesh in place of a metallic device to lift and stabilise the sternum. Moreover, the mesh supports the thoracic and upper abdominal wall reconstruction. MATERIALS AND METHODS: From January 1990 to December 2000, in our Thoracic Surgery Unit, 65 patients with PE were assessed for surgical repair, mean age 16+/- 3.5 years, fronto sagittal thoracic index (FSTI) 0.21, ranging from 0.15-0.33. Twenty-three of them underwent surgical correction after initial assessment, 22 were deferred and sent to physiotherapy. At a subsequent assessment, five of the patients sent to physiotherapy were deemed to require surgery. RESULTS: Of the 28 patients who underwent surgery, 2 (10%) presented a mild recurrence of PE after 1 year (0.300.34), meanwhile all other patients maintained a FSTI>0.34. For all patients the improvement in FSTI was statistically significant, p = 0.001. Patients satisfaction after 24 months was thus shared: excellent 18 patients (65%), good seven patients (25%), fair one patient (3.5%) and poor two patients (7%). No major complications were observed in preoperative period. Patients mobilisation was soon achieved thanks to the postoperative pain control and the absence of retro-sternal metallic support. CONCLUSIONS: The introduction of bioabsorbable mesh in the Robicsek technique is a safe procedure related to a high percentage of success. The high tolerance of the material reduces the inflammatory reaction. Moreover, the procedure prevents patients from having complications caused by retro-sternal device dislodgment, avoiding a second intervention for device reposition and reducing the postoperative chest pain achieving an early patient mobilisation. In the end a complete reconstruction of the upper abdomen wall has been produced.

Comparison between segmentectomy and larger resection of stage IA non-small cell lung carcinoma.

AIM: Stage IA non small cell lung carcinoma (NSCLC) represents early cancer and is best treated by surgery. The frequency of recurrence and new primary cancer varies from one report to another while the role of sublobar resection is still debated. METHODS: We retrospectively reviewed 121 consecutive patients with pathological stage IA after radical surgery. RESULTS: In stage IA NSCLC 1-, 3-, 5-year survival rates were 89%, 76% and 66%. Nearly half of the deaths were unrelated to the original cancer. From statistical analysis we did not find any factor indicative of a better prognosis. We did not find any difference in survival between histologic types. Segmentectomy did not show a worse survival rate compared with larger resection. CONCLUSION: Survival is neither influenced by the type of resection nor by the histologic types in stage IA. However, we noticed a high incidence of local recurrence, segmentectomy could be a viable choice in patients with cardiopulmonary impairment.

Sudden onset of thoracic pain: neurofibroma with intracystic haemorrhage.

Intercostal nerve sheath tumors are normally benign and asymptomatic. Nevertheless surgical resection can eliminate the risk of malignant transformation and also achieve complete remission in case of symptoms.

Pneumonectomy vs lobectomy in the treatment of pathologic N1 NSCLC: could the type of surgical resection dictate survival?

AIM: To define the prognostic significance of specific types of N1 lymph node involvement in patients operated on for stage II (N1) NSCLC and to evaluate if the extent of resection affects survival. METHODS: Of 1117 patients operated on from 1985 to 1998, an homogeneous group of 124 consecutive patients with pathologic T1-T2 N1 disease who had undergone a complete resection with systematic nodal dissection were analysed. No patients received adjuvant radio- or chemotherapy. RESULTS: The overall 5-year survival rate was 48.8%. Survival was not related to pathologic T factor, histology, number, percentage or level of N1 involved, visceral pleura involvement, number of lymph nodes dissected. Patients were then divided into 3 groups depending on the level of lymph node involvement (stations 10, 11 and 12-13) and survival analysed according to the extent of resection (pneumonectomy vs lobectomy). No significant difference was found, however, in the group of level 10, patients treated by pneumonectomy showed a better 5-year survival (58%) compared to patients treated by lobectomy (33%) with a median survival of 110 against 58 months. This data was confirmed by a lower incidence of local recurrence in the pneumonectomy group than lobectomy group (0% vs 24%), whereas the same incidence of distant metastases was observed in the two groups (29% vs 23%). CONCLUSIONS: In patients with stage II (N1) NSCLC, only in case of station 10 involved, pneumonectomy could allow a better survival lowering the incidence of local recurrence. However the major part of patients with stage II (N1) NSCLC die for distant metastasis. This supports the necessity to develop a specific systemic treatment.

Results of induction chemotherapy followed by surgical resection in patients with stage IIIA (N2) non-small cell lung cancer: the importance of the nodal down-staging after chemotherapy.

OBJECTIVE: Chemotherapy of stage IIIA non-small cell lung cancer (NSCLC) using second generation, cisplatin-based combinations has shown to improve the results; however, the distant relapses remain the major problem. Encouraging results in the treatment of stage IV NSCLC with newer agents (gemcitabine, placlitaxel) has encouraged us to use them in stage III. The aim of this study was to assess feasibility and efficacy of induction chemotherapy with cisplatin and gemcitabine followed by surgery for patients with stage IIIA (N2) NSCLC. METHODS: From February 1996 to December 1999, 36 consecutive patients with mediastinoscopically staged N2 NSCLC received three cycles of cisplatin (80 mg/m(2), day 2) and gemcitabine (1200 mg/m(2), day 1+8) followed by surgery in responding patients. Patients with stable disease or even local progression received radiotherapy. All patients had clinical N2 disease (mediastinal lymph nodes metastasis) observed on CT scan. RESULTS: No major complications of the chemotherapy occurred. Twenty-five patients (70%) had a clinical partial response and were surgically explored, with 18 complete resections (70%). There were no in-hospital deaths, although four (16%) major complications: bronchopleural fistula (two), respiratory insufficiency (one), oesophagospleural fistula (one). In the total group of 36 patients, 3-year survival was 20%. So far, no patient without surgery has survived longer then 27 months; median survival was 8 months. In the group of the 25 patients who underwent surgery 3-year survival was 30%, with a median survival of 21 months. The difference is significant (P=0.0027). In the surgical group, the survival of patients with down staged disease (56%) was greater than that of patients with persistent N2 disease (44%) after chemotherapy (3-year survival of 59 and 0%, respectively; P=0.0013). CONCLUSION: induction chemotherapy with cisplatin and gemcitabine resulted in major tumour regression in a large percentage of patients with clinical N2 disease. In responding patients both the complete respectability rate and survival were higher when compared to historical controls. Survival was significantly better in patients down-staged to a mediastinal negative disease.

Assessing the prognostic value of the extent of mediastinal lymph node infiltration in surgically-treated non-small cell lung cancer (NSCLC).

Although there have been several attempts in dividing N2 patients into several subgroups on the basis of different prognoses, the correct treatment for these patients is still a moot point. Even multimodal treatment, which is the most common therapy used, does not result in a consistent outcome. The aim of our study is to assess the prognostic value of the extent of mediastinal lymph node infiltration in surgically treated non-small cell lung cancer (NSCLC). From January 1990 to December 1997, 682 patients underwent surgery for NSCLC at the Thoracic Surgery Unit, University Hospital of Siena, 87 of which (12%) had mediastinal involvement. Studies on the number of lymph node stations show that those with one station involved tend to have a better 5-year survival rate with respect to the others. We studied the number of lymph node stations by using a new critique based on the percentage of lymph node infiltration. The percentage is obtained from a ratio of the number of involved nodes to the total number of nodes removed. The result was an improved 5-year survival ratio in patients with lymph node infiltration, lower than 50% with respect to the others, and the difference was significant (P=0.0001). It appears that surgery may be the most suitable option for treating those N2 patients that we consider to be in 'early N2 phase', in view of long term survival. Although an invasive technique like mediastinoscopy seems to be the appropriate indicator in selecting N2 patients, it does not allow the calculation of the ratio a priori.

Iterative surgical resections for local recurrent and second primary bronchogenic carcinoma.

OBJECTIVE: To report our experience with repeated pulmonary resection in patients with local recurrent and second primary bronchogenic carcinoma, to assess operative mortality and late outcome. METHODS: The medical records of all patients who underwent a second lung resection for local recurrent and second primary bronchogenic carcinoma from 1978 through 1998 were reviewed. RESULTS: There were 27 patients. They constituted 2.5% of 1059 patients who had undergone lung resection for bronchogenic carcinoma in the same period. Twelve patients (1.1%) (group 1) had a local recurrence that developed at a median interval of 24 months (range 4-83). The first pulmonary resection was lobectomy in ten patients and segmentectomy in two. The second operation consisted of completion pneumonectomy in ten cases, completion lobectomy in one and wedge resection of the right lower lobe after a right upper lobectomy in one. The other 15 patients (1.4%) (group 2) had a new primary lung cancer that developed at a median interval of 45 months (range 21-188). The first pulmonary resection was lobectomy in 12 patients, bilobectomy in one and pneumonectomy in two. The second pulmonary resection was controlateral lobectomy in seven patients, controlateral sleeve lobectomy in two, controlateral pneumonectomy in 1, controlateral wedge resection in four and completion pneumonectomy in one. Overall hospital mortality was 7.4%, including one intraoperative and one postoperative death in group 1 and 2, respectively. Five-year survival after the second operation was 15.5 and 43% with a median survival of 26 and 49 months in groups 1 and 2, respectively (P=ns). CONCLUSIONS: Long-term results justify complete work-up of patients with local recurrent and second primary bronchogenic carcinoma. Treatment should be surgical, if there is no evidence of distant metastasis and the patients are in good health. Early detection of second lesions is possible with an aggressive follow-up conducted maximally at 4 months intervals for the first 2 years and 6 months intervals thereafter throughout life.

Treatment and survival after lung resection for non-small cell lung cancer in patients with microscopic residual disease at the bronchial stump.

OBJECTIVE: The aim of this study is a retrospective evaluation of survival in patients who had undergone lung resection for non-small cell lung cancer and in whose microscopic residual disease at the bronchial resection margin was found, according to the type of infiltration, histology, lymph node involvement and postoperative treatment. METHODS: A total of 1384 patients underwent lung resection for non-small cell lung cancer at the Thoracic Surgery Unit of the University of Siena from 1983 through 1998. All patients underwent complete mediastinal lymphadenectomy and this guaranteed an accurate stadiation. Staging was done according to the TNM and UICC classifications. Residual microscopic disease at the bronchial resection margin was divided in mucosal microscopic residual disease and extramucosal microscopic residual disease. Patients dying within 30 days from operation were excluded from survival analyses. Survival was analysed by the product limit method of Kaplan and Meier and curves were compared using the log-rank test. RESULTS: Microscopic residual disease was found postoperatively at the bronchial margin in 3.39% (47/1384), of all patients undergoing lung resection for non-small cell lung cancer. Thirty patients (2.16%) had extramucosal microscopic residual disease and 17 (1.22%) had mucosal microscopic residual disease. Seventeen patients received adjuvant radiotherapy after operation, two patients underwent completion pneumonectomy; no chemotherapy was given. Median survival for the whole group was 22 months. The probability of survival was not significantly (P > 0.05) correlated with the type of infiltration, nor with lymph node disease, neither with histology, although patients with squamous cell carcinoma had a median survival of 30 versus 12 months of patients with adenocarcinoma. The probability of survival could not be correlated with the administration of adjuvant radiotherapy. CONCLUSIONS: A frozen-section analysis of the bronchial resection margin and peribronchial tissue should be made in all patients with endobronchial tumour. We suggest that patients with microscopic residual tumour and stage I or II disease should undergo re-operation, if possible. In patients with documented N2 disease we don't recommend re-operation; extending the magnitude of the resection is unlikely to alter their outcome. Choice treatment for these patients is radiotherapy.