Pre-prosthetic surgical alterations in maxillectomy to enhance the prosthetic prognoses as part of rehabilitation of oral cancer patient.

OBJECTIVES: After maxillectomy, prosthetic restoration of the resulting defect is an essential step because it signals the beginning of patient's rehabilitation. The obturator used to restore the defect should be comfortable, restore adequate speech, deglutition, mastication, and be cosmetically acceptable, success will depend on the size and location of the defect and the quantity and integrity of the remaining structures, in addition to pre-prosthetic surgical preparation of defect site. Preoperative cooperation between the oncologist surgeon and the maxillofacial surgeon may allow obturation of a resultant defect by preservation of the premaxilla or the tuberosity on the defect side and maintaining the alveolar bone or teeth adjacent to the defect. This study evaluates the importance of pre-prosthetic surgical alterations at the time maxillectomy on the enhancement of the prosthetic prognoses as part of the rehabilitation of oral cancer patient. STUDY DESIGN: The study was carried out between 2003- 2008, on 66 cancer patients(41 male-25 female) age ranged from 33 to 72 years, at National Cancer Institute, Cairo University, whom underwent maxillectomy surgery to remove malignant tumor as a part of cancer treatment. Patients were divided in two groups. Group A: Resection of maxilla followed by preprosthetic surgical preparation. Twenty-four cancer patients (13 male - 11 female). Group B: Resection of maxilla without any preprosthetic surgical preparation. Forty-two cancer patients (28 male-14 female). RESULTS: Outcome variables measured included facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success and donor site morbidity were also studied. CONCLUSIONS: To improve the prosthetic restoration of maxillary defect resulting maxillary resection as part treatment of maxillofacial tumor depends on the close cooperation between prosthodontist and surgeon, by combination of pre-prosthetic surgery during maxillectomy and prosthodontic technique.

Migraineurs show a high prevalence of antiphospholipid antibodies.

BACKGROUND: It has been observed that migraineurs show a higher risk of thrombosis and that the most frequent symptom reported by patients with antiphospholipid syndrome is headache, especially migraine. OBJECTIVES: The aim of our research was to evaluate the prevalence of antiphospholipid antibodies (aPL) in a random cohort of migraineurs. PATIENTS/METHODS: This analytic, comparative case study was performed to evaluate the prevalence of antiphospholipid antibodies by comparing a population of migraineurs with and without aura with sex- and age-matched controls. Both the diagnosis of migraine and the laboratory diagnosis of aPL positivity were made on the basis of the most recent international guidelines. RESULTS: Between September 2008 and August 2009, we recruited 284 consecutive patients (225 women and 59 men, 203 without aura and 81 with aura) and 225 controls (174 women and 51 men). Positivity for at least one test for aPL (LAC, ACA IgG or antiß2GLP1 IgG) was detected and confirmed in 12% (n = 33) of patients and in 3% (n = 7) of controls (odds ratio, 4.08; confidence interval, 1.77-9:39; P = 0.0004). Two of the patients had triple positivity for aPL (LAC, ACA and antiß2GLP1) and one had double positivity (LAC and antiß2GLP1); none of the controls showed multiple positivity. CONCLUSIONS: Our data show that migraineurs have a significantly higher prevalence of antiphospholipid antibodies, and point towards the fact that the two conditions may be comorbid or even that migraine may be an early sign for identifying patients with aPL positivity.

Anatomical variants of the circle of willis and brain lesions in migraineurs.

BACKGROUND: Some reports demonstrated vascular alterations in brain magnetic resonance imaging (MRI) in migraineurs and a relationship between circle of Willis (Circle) variants and lacunar brain infarcts. We examined anomalies of the whole circle of Willis and their relationship with vascular brain lesions in migraineurs, to identify any possible vascular mechanism in migraine. METHODS: We studied, with a cohort controlled study, the circle of Willis in migraineurs seen consecutively in our Headache Center, and in non-headache controls, using angio-MRI of the brain. Statistical analysis used ANOVA, Scheffè's criterion, t-student test. RESULTS: We recruited 270 migraineurs (204 without aura (MWOA), 66 with aura (MWA) and 159 controls. Migraineurs presented an anatomical variant in 108 (40%) cases with 34 controls (21.4%) presenting a variant. We found a significant association between MWOA and variants (OR=2.4 CI95% [1.5 to 3.9]) and between MWA and variants (OR=3.2 CI95% [1.6 to 4.1]). Unilateral posterior variants with basilar hypoplasia are statistically associated only with MWA compared to controls (OR=9.2, CI95% [2.3 to 37.2]). Thirty-three percent of MWOA and 24% of MWA sufferers present some kind of brain lesion, included 2% of infra-tentorial lesions. We did not find any statistical association between the presence of Circle variants and ischemic lesions on MRI (OR=1.5 CI95% [0.68; 1.94]), or with infratentorial lacunar lesions (OR=1.58 CI95% [0.48 to 5.24]). CONCLUSIONS: Anatomical variants of the Circle of Willis are significantly more frequent in migraineurs; posterior anomalies are more frequent in MWA, suggesting a vascular mechanism provoking changes in cerebral blood flow, thereby stimulating cortical spreading depression.

[Approach to the study of vasculitides: general aspects and classification]. / Approccio allo studio delle vasculiti: generalità e inquadramento.

Since etiology and pathogenesis of most systemic and/or isolated vasculitides are unknown, any attempt to make a rational classification of these entities is far from being perfect. Vasculitis may be a primary disease or it may be associated with connective tissue diseases, infectious diseases, neoplasms, drug assumption, allograft rejection and so on. As secondary vasculitides constitute the majority of cases, diagnosis of primary vasculitis is made by exclusion. At the present time, the 1993 Chapel Hill Consensus Conference on Nomenclature of Primary Vasculitides provides a useful guide to clinician and pathologist for evaluating a patient with an idiopathic form of vasculitis. This classification is based on the predominant size of vessels affected and describes the main clinico-pathologic features of the various clearly defined types of systemic vasculitis. Though it suffers from omissions and contradictions, in routine practice it is of great help to distinguish diseases in this intriguing chapter of pathology.

Monitoring degradation in paper: non-invasive analysis by unilateral NMR. Part II.

High quality paper samples have been oxidized with a specific oxidant to reproduce one of the possible causes of the aging of paper. All samples have been characterized by 13C CP-MAS NMR spectroscopy. The artificial aging of paper has been monitored using a standard NMR relaxometer and the results have been compared with the corresponding data obtained using an unilateral NMR relaxometer. Experimental values obtained with both techniques are in agreement, demonstrating that unilateral NMR relaxometric measurements constitute a suitable non-invasive method for assessing the degradation process of cellulose-based materials. The sensitivity of the non-invasive NMR method allows the detection of degradation even at a very early stage. Effects due to the sample volume and to the penetration depth have been investigated.

Biological markers of the inflammatory phase of multiple sclerosis.

The search for biological markers in multiple sclerosis (MS) has been spoiled by the intrinsic nature of the disease that occurs in a secluded organ which cannot be accessed by routine sampling. Thus, markers obtained so far from the peripheral blood of MS individuals are often of little reproducibility while results obtained from the cerebrospinal fluid (CSF) are conveniently linked to the disease process but of little utility due to inaccessibility to repeated sampling. In this review we briefly discuss the biological markers available to date.

Intravenous leiomyoma with cardiac involvement.

We report a case of intravenous leiomyomatosis (IVL) in a 44-year-old woman, presenting with cardiothoracic clinical manifestations. Such a rare neoplastic condition most often arises from the uterine veins. At times it may reach the right cavities of the heart and it must be considered in the differential diagnosis with a cardiac myxoma or a thrombus.

Extraskeletal mesenchymal chondrosarcoma involving the heart: report of a case.

Extraskeletal mesenchymal chondrosarcoma is a rare tumor frequently arising in the meninges and lower limbs. We describe a case of mesenchymal chondrosarcoma involving the heart in a 39-year-old man who presented with fever, chest pain and shortness of breath. His clinical course was rapid, leaving insufficient time for a complete diagnostic work-up, and the patient died 2 months after the onset of symptoms.

[Sarcoidosis with predominant cardiac involvement]. / Sarcoidosi con prevalente interessamento cardiaco.

We present a case of predominantly myocardial sarcoidosis in a 38 year-old man. A second degree atrioventricular block was the clinical presentation, followed 2 years later by sudden cardiac arrest. Autopsy revealed large areas of myocardial scarring in the left ventricular wall unassociated with atherosclerotic coronary lesions; microscopy of these areas disclosed epithelioid granuloma with giant cells embedded in a fibrohyaline tissue. The insidious cardiac involvement in sarcoidosis often hinders an exact diagnosis in life, and prognosis without therapy is severe. Histopathologic diagnosis is made only by exclusion of other systemic granulomatous diseases.

[Coronary embolism and myocardial infarction with heat rupture during infectious endocarditis]. / Embolia coronarica ed infarto miocardico con rottura del cuore in corso di endocardite infettiva.

We report a case of transmural myocardial infarction due to coronary embolism complicating infective endocarditis in a 41 year old woman. The infarction, clinically silent, was followed by rupture of left ventricular free wall, leading to hemopericardium and cardiac tamponade. The case is an uncommon complication of infective endocarditis, at the same time an uncommon cause of myocardial infarction.

[The reactive and/or repair role of the smooth muscle cells in Horton's arteritis]. / Il ruolo reattivo e/o riparativo delle cellule muscolari lisce nell'arterite di Horton.

A recent view of atherosclerosis indicates vascular smooth muscle cell proliferation not only as a response-to-injury but also as an essential reparative process leading to plaque stabilization. To assess the role of vascular smooth muscle cell in vasculitides we studied, as a model, 10 cases of Horton's arteritis. In particular, we investigated by immunohistochemical analysis cellular population and proliferation rate in the intimal layer. As in atherosclerotic plaques, intimal thickening in arteritis is essentially due to proliferation and migration of vascular smooth muscle cells. We suppose that, whatever the vascular disease, intimal hyperplasia contributes to stability of the vessel's wall; however the reactive/reparative process is extremely slow in spontaneous atherosclerosis, accelerated in arteritis.