CO2 laser ablation of oral leukoplakia: with or without extension of margins?

PURPOSE: The purpose is to determine the sufficient extension of margins during laser ablation of oral leukoplakia and observe its short-term recurrence rate. MATERIALS AND METHODS: The study was designed as a randomized controlled clinical trial was conducted on 33 oral leukoplakia lesions diagnosed in 30 patients (16 Females and 14 Males) with an age range between 39 and 79 years. The lesions were divided into three groups; Group A: 11 lesions in 11 patients, in which the laser ablation was done for the entire lesion without extension of margins; Group B: 11 lesions in 8 patients, in which the laser ablation was done for the lesion adding at least 3mm extension of margins; and finally the Group Control: consists of 11 untreated lesions in 11 patients, in which only "wait and see" approach was done. RESULTS: Complete healing of 13 lesions occurred in both groups A and B. Complete regression of 3 lesions occurred in Group Control. After 6 months of follow-up, 6 of 9 lesions in both groups A and B that showed the recurrence, had shown an initial recurrence after 3 weeks of the laser ablation. Patients with no history of smoking habits showed complete healing of 87.5%, while in ex-smokers complete healing was 42.8%. The statistical analysis was performed, and the averages of all groups are significantly different (p <0.00001). DISCUSSION: The primary treatment focuses on the elimination of associated risk factors (smoking, alcohol, and local irritating factors). In the literature, the recurrence rate varies between 13.6% and 40.7%, while in our study, it was 45.5% in Group A and 36.4% in Group B. CONCLUSION: The recommended extension of margins should be at least 3mm in width. Further research can be performed to evaluate the immediate re-ablation of the lesions which showed an initial recurrence after 3 weeks of laser ablation.

Leveraging Industry-Academia Collaborations in Adaptive Biomedical Innovation.

Despite the rapid pace of biomedical innovation, research and development (R&D) productivity in the pharmaceutical industry has not improved broadly. Increasingly, firms need to leverage new approaches to product development and commercial execution, while maintaining adaptability to rapid changes in the marketplace and in biomedical science. Firms are also seeking ways to capture some of the talent, infrastructure, and innovation that depends on federal R&D investment. As a result, a major transition to external innovation is taking place across the industry. One example of these external innovation initiatives is the Sanofi-MIT Partnership, which provided seed funding to MIT investigators to develop novel solutions and approaches in areas of interest to Sanofi. These projects were highly collaborative, with information and materials flowing both ways. The relatively small amount of funding and short time frame of the awards built an adaptable and flexible process to advance translational science.

Early results of synchronous carotid endarterectomy and off-pump coronary revascularization.

AIM: This study reports results of synchronous carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) in further support of the hypothesis that carotid and coronary artery revascularization can be safely performed in most patients. METHODS: The series includes 74 consecutive patients underwent synchronous CEA and off-pump CABG (group A) compared with 50 patients undergoing synchronous CEA and on-pump CABG (group B). Primary endpoint of this study are death, stroke, perioperative myocardial infarction and need for repeated revascularization within 30 days of the procedures. The secondary endpoint includes local and systemic complications. RESULTS: No stroke was observed in group A. Ipsilateral minor stroke occurred in two patients of group B (4%). Two deaths within 30 days were observed in group A (2.7%) compared with 4 deaths in group B (8%). Combined stroke/death rate at 30 days was 2.7% in group A compared with 12% in group B (P< 0.05). No significant differences in myocardial infarction, local and systemic complications were observed. CONCLUSION: Synchronous CEA and off-pump CABG may reduce the high surgical risk of patients who actually require combined carotid and coronary revascularization. This opinion has to be substantiated by larger studies and randomized trial.

Mortality and morbidity from intra-aortic balloon pumps. Risk analysis.

BACKGROUND: The purpose of this study, was to assess the incidence of and predictors for mortality and morbidity in patients who required postoperative intra-aortic balloon pump (IABP) support. METHODS: We have retrospectively estimated 116 patients and data were statistically analyzed, and significant variables were evaluated with multivariate analysis. RESULTS: Mortality rate was 57.8% (67 patients). Nineteen patients (16.3%) had major vascular complications: 12 patients (10.3%) limb ischemia, 1 patient (0.9%) aortic dissection, 6 patients (5.2%) mesenteric infarction. Thirty patients (25.8%) had minor vascular complication: 23 patients (19.8%) bleeding from insertion site, 7 (6%) patients infection of insertion site. Limb ischemia was resolved by IABP removal (10 patients), thrombectomy (2 patients). No patient required limb amputation. Sixty patients (51.7%) had renal insufficiency, of which 40 patients needed dialysis. Fifteen patients (10.3%) had neurological complications, 13 patients (11.2%) thrombocytopenia and 5 patients (4.3%) sepsis. CONCLUSIONS: The incidence of IABP insertion in our institution was 1.5%. Mortality rate is similar to mortality of other studies in which the IABP has been inserted in the postoperative period. We have found that timing of IABP insertion, thrombocytopenia, presence of peripheral vascular disease and the redo intervention are independent predictors of mortality. We also found that female sex, diabetes, history of cigarette smoking and preoperative use of antiplatelet drugs are independent predictors of limb ischemia. The following factors are instead independent predictors of renal insufficiency: postoperative ejection fraction lower than 40% and non use of dobutamine in the postoperative period.

Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques.

To facilitate mini-access for cardiac surgery, two different methods of active venous drainage are used: vacuum assisted drainage and centrifugal pump aspiration on the venous line. The aim of this study was to compare the haemolysis produced using these two techniques. From June to December 1999, 50 consecutive patients were operated on using a ministernotomy. All of these patients had valvular surgery for either valve repair or valve replacement (9 MVRepair, 11 MVR, 29 AVR, 1 AVR + MVR). They were randomized into two groups: Group A, 25 patients who underwent surgery where vacuum assisted drainage was used, and Group B, 25 patients where kinetic asssisted venous drainage with centrifugal pump venous aspiration was used. Patient characteristics of both groups were similar for age, gender, body weight, body surface area, height, cardiopulmonary bypass (CPB) time, aortic crossclamp time, priming volume, cardioplegia volume, haemoglobin concentration, haematocrit, serum creatinine, bilirubin, lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (sGOT), serum glutamic pyruvic transaminase (sGPT), aptoglobin, reticulocytes, and platelet count. We checked all these laboratory parameters preoperatively, at the end of CPB, and 2 and 24 h after operation. We also checked haemoglobinuria at these same time points. We assessed blood loss at 6, 12, and 24 h after the operation and calculated total postoperative bleeding. There was a tendency towards a greater increase in LDH, sGOT and sGPT in Group A more than in Group B, but these data did not reach statistical significance. Platelet count was always lower in Group A and aptoglobin increased in Group A more than in Group B. More patients in Group A had haemoglobinuria. These findings indicate that haemolysis is increased more in patients treated with vacuum assisted drainage, when compared to the rise in haemolysis in those treated with centrifugal pump venous drainage. Total bleeding is also greater in Group A.

Efficacy of itraconazole in treating AIDS-associated infections due to Candida krusei.

Candida krusei is an emerging pathogen, both in HIV negative immunocompromised patients and in HIV seropositive patients. Its onset appears to be due, at least in part, to the use of fluconazole. In HIV positive patients, a long term prophylactic use of fluconazole may select some less pathogenic Candida species, as C. krusei, that may determine persistent oral candidiasis and emerge as systemic pathogen. Itraconazole appears efficacious in treating AIDS-associated C. krusei infections.

Chronic cryptococcal meningitis in an intravenous drug addict without evidence of infection by HIV-1,2 in southern Italy.

Before the emergence of AIDS, extrapulmonary cryptococcosis was very rare. By contrast, meningeal cryptococcosis is a very common opportunistic infection in AIDS patients. We report an intravenous drug addict with cryptococcal meningitis, who was not infected with HIV and had no apparent predisposing conditions. This case, as those elsewhere described, supports the potential existence of viral agents, other than HIV-1,2 capable of encouraging the occurrence of unusual infections as have emerged during the AIDS pandemic.

[Computers in surgery]. / Appunti di informatica per la chirurgia.

The introduction of computers in medicine, particularly for what surgery is concerned, has many implications related to its optimal utilization. Possible applications as well as advantages and limits of such recording system in a surgical ward are examined. Emphasis is placed on the clinical data management model and the ways the different structures of the system are related. The computer processing of these data provides valid material for either clinical and surgical research or statistical studies.

[What is the best treatment in massive pulmonary embolism: anticoagulants, thrombolytics or surgical embolectomy?]. / Quale trattamento per l'embolia polmonare massiva: gli anticoagulanti, i trombolitici o l'embolectomia chirurgica?

The aim of this work was to identify the best treatment available for massive pulmonary thromboembolism which still remains a frequent and sometimes lethal complication for surgical and non-surgical patients. The Authors underline the difficulties of diagnosis and the need for therapy at the earliest possible stage. At present, clinical management involves the use of: anticoagulants, thrombolytic agents and surgical embolectomy. In conclusion, the authors state that pulmonary thromboembolism, even when massive, has been transformed into a medically interesting pathology which can be cured using heparin and thrombolytic agents. However, surgical treatment is mandatory when patients reveal adverse effects to drug therapy, when medical therapy is insuccessful, or when patients are seriously ill with recurrent cardiac arrest.

[Infectious endocarditis. Role of surgical therapy]. / Considerazioni sull'endocardite infettiva. Ruolo della terapia chirurgica.

The problem of infectious endocarditis (IE) is approached through a review of personal experience. The series examined consists of patients, 17 with active and 21 dormant infection. Furthermore 12 in the first group, 18 in the second had natural heart valves, while 5 in group I, 3 in group II had been given artificial ones. After an analysis of the aetiopathogenic, clinical and diagnostic aspects of the condition with emphasis on the fact that Staphylococcus aureus is currently more responsible for infections in natural valves and the epidermidis for acute prosthesis infections which have a higher early and late mortality rate (40% in hospital, 33.3% long-term), the paper discusses the criteria for surgical intervention. In line with opinions expressed in the literature, it is pointed out that, while the patient's haemodynamic status is certainly the main criterion for any decision, other factors such as embolism, impaired conduction, kidney failure and expansion of the infection to contiguous tissues, should not be under-estimated.