Tumor necrosis factor-alpha as trigger of platelet activation in patients with heart failure.

The clinical history of patients with heart failure (HF) is complicated by arterial thromboembolism. Platelet activation is reported in this population, but the underlying mechanism has not been clarified. Forty-two patients with HF scored according to New York Heart Association (NYHA) classification had higher levels of collagen-induced platelet aggregation, platelet tumor necrosis factor-alpha (TNF-alpha) receptor expression, and serum thromboxane B2 and higher circulating levels of TNF-alpha than 20 healthy subjects. Coincubation of platelets from HF patients with an inhibitor of TNF-alpha receptors significantly reduced collagen-induced platelet aggregation. In vitro study demonstrated that TNF-alpha amplified the platelet response to collagen; this effect was inhibited by TNF-alpha receptor antagonist and inhibitors of arachidonic acid metabolism. This study showed that TNF-alpha behaves as a trigger of platelet activation through stimulation of the arachidonic acid pathway.

Maxillofacial traumas.

Craniofacial traumas often involve the orbital region. This report describes an unusual case of penetration of an object into the left upper oral vestibule up to the left medial-upper orbital wall. The object was an indicator switch. A multidisciplinary approach was necessary to make a correct diagnosis and to apply the best surgical treatment. The object was surgically removed, and rigid internal fixation was used to reconstruct the inferior and medial orbital walls. The aesthetic and functional results were good. One year later, the patient showed a slight enophthalmos with normal ocular motility.

Sublingual epidermoid cyst.

Dermoid and epidermoid cysts are developmental pathologies that occur in the head and neck with an incidence ranging from 1.6 to 6.9%, and they represent less than 0.01% of all oral cavity cysts. Our purpose is to report a case of sublingual epidermoid cyst of the floor of the mouth. We studied and operated on an 18-year-old white male patient showing a large swelling of oral floor. His main symptoms were difficulty breathing, swallowing, and speaking. At his birth the patient's tongue was adherent to the floor of the mouth. His father had the same problem at birth. Both father and son underwent surgical separation of tongue, during the post-neonatal period. After the surgical removal of the swelling, under general anesthesia, all the patient's symptoms were missed. Histological examination of the mass confirmed the diagnosis of an epidermoid cyst. No relapse of the lesion was present in ten months of follow-up. Many theories are proposed on the etiology of the epidermoid and dermoid cyst. In this case a traumatic event can be found, such as an operation of the tongue in neonatal age. However a multifactorial origin must be assumed for justifying the fact that the patient's father did not develop a dermoid cyst although he had the same problem of an adherent tongue and was operated on.