Interaction between chlorhexidine and fluoride in a mouthrinse solution-a 4-day and 6-week randomized clinical pilot study.

OBJECTIVE: The aim of the present investigation was to study if there is a reduced clinical effect and fluoride retention of a mouthrinse solution containing both chlorhexidine (CHX) and sodium fluoride (NaF). MATERIAL AND METHODS: Two clinical trials were designed as double-blind, randomized, cross-over studies. In study I, 16 healthy subjects were asked to rinse twice daily for 1 min during 4 days of no tooth brushing with four solutions: (1) 0.12% CHX + 0.2% NaF, (2) 0.2% NaF, (3) 0.12% CHX, and (4) placebo. In study II, another 16 healthy subjects rinsed with the same four solutions twice daily after tooth brushing during a 6-week period. Plaque formation, gingivitis, and microbiological samples from plaque and saliva, as well as fluoride retention, were analyzed. RESULTS: Both studies showed that both CHX + NaF and CHX mouthrinses had the same clinical effect with regards to plaque formation and microflora in plaque and saliva. Similarly, fluoride retention was not altered by the CHX + NaF mouthrinse compared to the NaF solution. CONCLUSION: The combination of CHX and NaF in a mouthrinse showed the same clinical effect as the CHX solution. The retention of fluoride in the oral cavity was not affected by the combination of NaF and CHX. CLINICAL RELEVANCE: A mouthrinse solution containing a mixture of CHX and NaF may be an interesting product for risk patients for caries and periodontal disease. However, this should be verified in further long-term clinical studies.

Treating Infected Non-Healing Venous Leg Ulcers with Medical-Grade Honey: A Prospective Case Series.

Venous leg ulcers (VLUs) are hard-to-heal wounds and are prone to microbial colonization. Innovative and improved therapies are thus required to resolve local infection and enhance the wound healing process. The objective of this study was to evaluate the effectiveness of medical-grade honey (MGH) for the treatment of clinically infected and non-healing VLUs. This prospective case series included nine patients with an average age of 83.4 years (range: 75-91 years) with a total of eleven VLUs, previously ineffectively treated with various products. Major risk factors for the appearance of VLUs were chronic venous insufficiency, advanced age, multiple comorbidities (particularly cardiovascular diseases), and impaired mobility. All wounds presented with local signs of infection. Upon presentation, treatment was commenced with a range of MGH-based products (L-Mesitran®). Clinical signs of infection were eliminated by MGH after 2.2 weeks on average (range: 1-4 weeks), and wounds were completely healed after 7 weeks on average (range: 3-18 weeks). No further complications or recurrences were observed. MGH has a broad-spectrum antimicrobial activity and promotes rapid healing, thus improving patients' quality of life. Moreover, MGH-based products are safe, easy to use, cost-effective, and can effectively treat VLUs alone or in combination with standard-of-care therapies.

Use of Medical-Grade Honey to Treat Clinically Infected Heel Pressure Ulcers in High-Risk Patients: A Prospective Case Series.

Management of locally infected heel-pressure ulcers (HPUs) remains challenging, and given the increasing occurrence of infections resistant to antibiotic therapy and patients' unwillingness to surgery, innovative and effective approaches must be considered. Medical-grade honey (MGH) could be an alternative therapeutic approach due to its broad-spectrum antimicrobial activity and healing properties. This study aimed to present the high effectiveness and safety of MGH for the conservative treatment of clinically infected HPUs. In this case series, we have prospectively studied nine patients with local signs of infected HPUs. In all cases, HPUs persisted for more than 4 weeks, and previous treatments with topical antibiotics or antiseptic products were ineffective. All patients were at high-risk to develop HPU infection due to their advanced age (median age of 86 years), several comorbidities, and permanent immobility. All wounds were treated with MGH products (L-Mesitran), leading to infection resolution within 3-4 weeks and complete wound healing without complication. Considering the failure of previous treatments and the chronic nature of the wounds, MGH was an effective treatment. MGH-based products are clinically and cost-effective for treating hard-to-heal pressure ulcers such as HPUs. Thus, MGH can be recommended as an alternative or complementary therapy in wound healing.

Activity of TP-6076 against carbapenem-resistant Acinetobacter baumannii isolates collected from inpatients in Greek hospitals.

TP-6076 is a synthetic fluorocycline antibiotic that inhibits bacterial protein synthesis. In this study, carbapenem-resistant Acinetobacter baumannii clinical isolates from 13 Greek hospitals were tested for susceptibility to TP-6076 and comparator antibiotics. Broth microdilution plates were used to determine minimum inhibitory concentrations (MICs). A total of 121 non-duplicate A. baumannii isolates were tested. The MIC50 and MIC90 values of TP-6076 were 0.03 mg/L and 0.06 mg/L, respectively. Tigecycline was the second most active antibiotic (MIC90, 2 mg/L), followed by minocycline (MIC90, 8 mg/L). TP-6076 exhibited MIC90 values that were one dilution lower against tigecycline- and minocycline-susceptible isolates than against resistant isolates. There was no difference in the MIC90 value for colistin-susceptible or -resistant isolates. In conclusion, TP-6076 exhibited greater antimicrobial activity in vitro against carbapenem-resistant A. baumannii than comparator antibiotics.

Clinical outcome of patients with advanced ovarian cancer after resection of liver metastases.

AIM: Hepatic resection has become the standard treatment for patients with primary or metastatic liver malignancies. The aim of our study was to evaluate the clinical outcome of hepatic resection in patients with advanced ovarian cancer (AOC). PATIENTS AND METHODS: All patients undergoing hepatic resection for AOC in our institution between 11/1991 and 02/2007 were evaluated by a validated intraoperative documentation tool. RESULTS: Seventy patients were evaluated (median age=59 years; range=29-76 years). Forty-one (58.6%) patients underwent liver resection; 29 patients had unresectable disease. Additional multivisceral procedures performed were: colic resection (51.4%), small bowel resection (32.9%), gastric resection (5.7%), pancreatic resection (4.3%), splenectomy (5.7%). The median survival of patients with R0 resection was 42 months (95% confidence interval (CI)=17-66 months), 4 months for R1, 6 months (95% CI=0-11 months) for R2, and 5 months (95% CI=0-9 months) for those without liver resection. In multivariate analysis, postoperative residual tumor mass was the strongest predictor of survival. CONCLUSION: Our data indicate that complete macroscopical tumor resection remains the strongest predictor of survival in patients with liver metastases from AOC.

First surgical experience of intraperitoneal treatment with the trifunctional antibody catumaxomab (anti-EpCam x anti-CD3) for epithelial ovarian cancer.

AIM: Intraperitoneal (i.p.) treatment with the trifunctional antibody catumaxomab is a novel promising option in the clinical management of advanced or recurrent epithelial ovarian cancer (EOC). As yet, no data exists sregarding the surgical experience after i.p. catumaxomab application. Therefore we analyzed the surgical outcome of EOC patients, previously treated with i.p. catumaxomab, with special focus on the effect on adhesion formation and morbidity. PATIENTS AND METHODS: We conducted a retrospective evaluation of patients with EOC, who were previously treated with catumaxomab, either at time of primary cytoreduction (n=6) or due to malignant ascites in the recurrent situation (n=4), and who underwent surgery due to various indications between 01/2007 and 03/2010. Surgical outcome, grade of adhesions and operative morbidity were analyzed based on surgical reports and a validated intraoperative documentation tool 'Intraoperative Mappinf of Ovarian Cancer'. RESULTS: Ten patients with EOC (FIGO stage III-IV; median age 68 years; range: 45-77 years) were evaluated. The mean time between catumaxomab treatment and surgery was 187 days (range: 8-481 days). Mean operation-time was 185 minutes (range:69-32). The indications for surgery were as follows: 3 patients due to anastomotic insufficiency after primary tumor debulking; 2 patients due to secondary tumor debulking; 4 patients due to ileus in recurrent EOC; and 2 patients for restoring intestinal continuity. At the post-catumaxomab surgery 7 patients presented massive intraoperative adhesion grade 3 (score system 0-3), while 3 patients developed repeated abscesses. Four out of the six patients operated due to recurrent EOC, presented extensive tumor load with severe peritoneal carcinosis. Nevertheless, none of the relapsed patients had at surgery ascites >500 ml. CONCLUSION: Surgery after i.p. catumaxomab appears feasible, however, larger prospective evaluations are warranted to assess its true impact on adhesion formation and postoperative morbidity.

Highly elevated serum levels of CA 19-9 in choledocholithiasis: a case report.

We present a case of a 79-year-old woman admitted to our hospital with pain in the right upper abdominal quadrate radiated to the back, jaundice, fever and chills. The laboratory tests showed serum carbohydrate antigen 19-9 levels of 99.070 U/ml (normal values: 0-37 U/ml). The rest of the biochemistry showed alkaline phosphatase of 550 IU/l, direct bilirubin: 17.5 mg/dl, total bilirubin: 28.4 mg/dl. Abdominal sonography demonstrated dilated common bile duct. Two weeks postoperatively, the carbohydrate antigen 19-9 fell to 970 U/ml and returned within normal range (31 U/ml) two months later. Furthermore, the magnetic resonance cholangiopancreatography performed postoperatively demonstrated normal configuration of the biliary tree and the common bile duct.

Ciprofloxacin induced acquired long QT syndrome in a patient under class III antiarrhythmic therapy.

We report one case of cardiac arrest related to ciprofloxacin administration. One female patient (aged 70 years old) developed a marked QTc prolongation (QTc = 0.62 s) within 24 hours of ciprofloxacin administration, with documented torsades de pointes and recurrent syncope that required defibrillation. The patient was under amiodarone and sotalol therapy for atrial fibrillation, with no obvious QT prolongation prior to ciprofloxacin therapy. QT prolongation and subsequent torsades de pointes appeared only after initiation of ciprofloxacin and normalized after drug discontinuation. Even though ciprofloxacin is thought to be safer than other agents in its class, it may cause QT prolongation and torsades de pointes, particularly in high risk patients with predisposing factors. Prolongation of the QT interval related to the effect of fluoroquinolones on rapid potassium channels (IKr) may result on potentially serious proarrhythmic effect, leading to torsades de pointes.

Prognostic factors of cutaneous melanoma in relation to metastasis at the sentinel lymph node: a case-controlled study.

BACKGROUND: The selection of patients who will undergo sentinel lymph node biopsy is primarily based on the histopathologic features of cutaneous melanoma. The purpose of this study is to identify prognostic factors that predict the sentinel lymph node metastasis in melanoma. METHODS: Sixty-nine melanoma patients underwent sentinel lymph node biopsy at Padova Plastic Surgery Institute. Univariate chi-square and multivariate logistic regression analyses were conducted to identify the relationship between prognostic factors and positive sentinel lymph node. A Receiver Operating Characteristics (ROC) Curve was performed to identify the ideal Breslow thickness cutpoint at which to perform sentinel node biopsy. RESULTS: Eleven of the 69 patients (16%) had sentinel lymph node metastases. By univariate analyses Breslow's thickness (p=0.001), ulceration (p=0.001), and lymphovascular invasion (p<0.0001) were found to be significant prognostic factors for the prediction of sentinel node micrometastases. The ROC Curve identified a Breslow thickness of 1.19 mm to be the most suitable cutpoint for sentinel lymph node positivity (p=0.003, sensibility 80%, specificity 69.6%). CONCLUSIONS: Patients with Breslow thickness >or=1.19 mm, ulceration, and lymphovascular invasion are at higher risk for occult lymph node metastases. In addition it is important to use multiple selection criteria when performing sentinel lymph node biopsy especially in patients with thin melanomas.