Soft tissue regeneration using leukocyte-platelet rich fibrin after exeresis of hyperplastic gingival lesions: two case reports.

INTRODUCTION: Leukocyte-platelet rich fibrin belongs to a second generation of platelet concentrates that does not need biochemical blood manipulation. It is used for tissue healing and regeneration in periodontal and oral-maxillofacial surgery. We report two cases of hyperplastic gingival lesions treated by exeresis and application of leukocyte-platelet rich fibrin membranes in order to improve and accelerate tissue healing. CASE PRESENTATION: Two patients (a 78-year-old Caucasian woman and a 30-year-old Caucasian man) were treated for hyperplastic gingival lesions. They underwent to exeresis of lesions and application of leukocyte-platelet rich fibrin membranes. Tissue healing was clinically evaluated after 1, 3, 7, 14 and 30 postoperative days. No recurrences were observed after 2 years of semi-annual follow up. CONCLUSIONS: We obtained rapid and good healing of soft tissues probably due to the elevated content of leukocytes, platelets and growth factors in the leukocyte-platelet rich fibrin. Based on our results we suggest the use of leukocyte-platelet rich fibrin to cover wounds after exeresis of oral neoformations such as hyperplastic gingival lesions.

Small-bowel neoplasms in patients undergoing video capsule endoscopy: a multicenter European study.

BACKGROUND AND STUDY AIM: Small-bowel tumors account for 1% - 3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency, clinical presentation, diagnostic/therapeutic work-up, and endoscopic appearance of small-bowel tumors in a large population of patients undergoing VCE. PATIENTS AND METHODS: Identification by a questionnaire of patients with VCE findings suggesting small-bowel tumors and histological confirmation of the neoplasm seen in 29 centers of 10 European Countries. RESULTS: Of 5129 patients undergoing VCE, 124 (2.4%) had small-bowel tumors (112 primary, 12 metastatic). Among these patients, indications for VCE were: obscure gastrointestinal bleeding (108 patients), abdominal pain (9), search for primary neoplasm (6), diarrhea with malabsorption (1). The main primary small-bowel tumor type was gastrointestinal stromal tumor (GIST) (32%) followed by adenocarcinoma (20%) and carcinoid (15%); 66% of secondary small-bowel tumors were melanomas. Of the tumors, 80.6% were identified solely on the basis of VCE findings. 55 patients underwent VCE as the third procedure after negative bidirectional endoscopy. The lesions were single in 89.5% of cases, and multiple in 10.5%. Retention of the capsule occurred in 9.8% of patients with small-bowel tumors. After VCE, 54/124 patients underwent 57 other examinations before treatment; in these patients enteroscopy, when performed, showed a high diagnostic yield. Treatment was surgery in 95% of cases. CONCLUSIONS: Our data suggest that VCE detects small-bowel tumors in a small proportion of patients undergoing this examination, but the early use of this tool can shorten the diagnostic work-up and influence the subsequent management of these patients.

[Colorectal cancer screening: comparison among strategies]. / Screening del cancro del colon-retto. Metodiche a confronto.

Colorectal cancer (CCR) screening is justified since CCR is 2nd leading cause of death for malignancy: most colorectal cancers arise from preexisting adenomatous polyps that remain clinically silent until presentation, often with advanced and incurable malignant disease. The merits and cost-effectiveness of screening for colorectal cancer are evident because the detection and removal of early carcinomas and adenomatous polyps reduces colorectal cancer mortality. Several screening methods are available, each of them presenting advantages and limits. Conventional colonoscopy is considered as the gold standard for the study of colon and, at present, it is the method of screening with the highest effectiveness in reducing CCR morbidity and mortality. However, the use of colonoscopy as the most important screening strategy is limited, because it causes major complications, it has a low compliance, and there are few specialized structures and few specialists to carry out a high number of colonoscopies as screening methods. The screening strategies used at present are described and their advantages and limits are compared.

Endoscopic surveillance of Barrett's Esophagus. Personal experience.

BACKGROUND: The possible progression of Barrett's Esophagus (BE) to carcinoma is well established: the incidence of cancer in BE is about 1.9-10% or 1/52-1/441 patients/year with a risk up to 30-125 times the normal population. Endoscopic surveillance can detect esophageal adenocarcinomas when they are early and curable. The purpose of endoscopic and histologic surveillance in patients with BE is to follow its evolution in order to characterize possible affiliation to a neoplastic risk group. METHODS: From 1998 to 2000 we have endoscopically identified 12 patients with EB, histologically confirmed: 9 males and 3 females, with a M/F ratio of 3:1 and an average of 45.25 years. RESULTS: During the endoscopic and histologic follow-up have observed the sequence from intestinal metaplasia with a low-grade dysplasia in one patient, confirmed after 2 months of treatment with double-dose pump inhibitor (PPI), to intestinal metaplasia with a high-grade dysplasia on biopsy samples done after vital staining with Lugol. So the patient had an endoscopic mucosal ablation, because he rejected esophagectomy. In the other patients without dysplasia, we used prokinetic drugs and PPI and we involved them in a follow-up every 2/3 years. CONCLUSIONS: Histological grading of dysplasia is currently the most important parameter used to follow-up patients with EB: the guidelines suggest a periodic endoscopic surveillance, from six months to 2 or 5 years, according to higher or lower risk of carcinoma arising, because there is no medical or surgical therapy able to decrease cancer risk.

Infusion of large quantities of autologous blood monocyte-derived macrophages in two cancer patients did not induce increased concentration of IL-6, TNF-alpha, soluble CD14 and nitrate in blood plasma.

In an attempt to increase the number of macrophages available for reinfusion in immunotherapy trials, GM-CSF was injected in vivo to mobilize circulating blood monocytes in 2 cancer patients. Subsequently mononuclear cells were collected by apheresis, cultured in the presence of GM-CSF and activated with IFN-gamma. This procedure resulted in the harvesting of 1.3 to 3.1 x 10(9) (mean 2 x 10(9)) macrophages per apheresis, product which was very well tolerated at autologous reinfusion. These infusions did not induce increased levels of TNF-alpha, IL-6, soluble CD14 nor nitrates in blood plasma (or urine). The lack of TNF-alpha and IL-6 release in blood plasma could explain the good tolerance of these infusions. No in vivo anti-tumoural activity of these high numbers of infused macrophages could be observed.

Peripheral blood stem cell collection with a blood cell separator.

Forty-three patients with malignant nonmyeloid diseases underwent peripheral blood stem cell collections on an apheresis system (Spectra, COBE BCT, Lakewood, CO). Collections took place during the white cell (WBC) recovery phase following conditioning chemotherapy. One hundred two procedures were done after chemotherapy alone, and 72 procedures after chemotherapy plus granulocyte-colony-stimulating factor (G-CSF). Four centrifugal separation factors were tested. One and one-half patient blood volumes were processed in each procedure. The mean volume of the collected component was 158 +/- 16 mL. After chemotherapy alone, the procedures provided a mean of 0.8 x 10(8) WBCs per kg and 2.3 x 10(4) colony-forming units-granulocyte macrophage (CFU-GM) per kg of recipient body weight. The mononuclear cell percentage in the components increased with the centrifugal separation factor from 85 to 96 percent. In parallel, platelet contamination increased from 2.1 to 3.8 x 10(11). The collect hematocrit ranged from 1.0 to 2.5 percent (0.01-0.025). The collection efficiency for mononuclear cells and CFU-GM also increased with the centrifugal separation factors from 52 to 70 percent for mononuclear cells and from 55 to 68 percent for CFU-GM. Collections performed after G-CSF-stimulated mobilization were characterized by a higher neutrophil contamination independent of centrifugal separation factor, which gave a mean mononuclear cell percentage of 64 percent in the collected component. The average yield for these procedures was 2 x 10(8) WBCs per kg and 28 x 10(4) CFU-GM per kg.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endoscopic aspects of primary non-Hodgkin's lymphoma of the stomach]. / Aspetti endoscopici dei linfomi primitivi non-Hodgkin dello stomaco.

The introduction of endoscopy has led to a striking improvement in the diagnosis of primary non-Hodgkin gastric lymphomas due to the possibility of viewing the lesions directly and performing histological and cytological biopsies. Endoscopic findings are however polymorphous and may present difficulties of interpretation. The aim of this study was to re-examine the endoscopic data in 40 cases (25 M and 15 F) of gastric lymphoma observed during the period 1983-1990. There were three main endoscopic findings: ulcerated lesions (55%), infiltrating lesions (40%) and polypoid lesions (5%). In 75% of cases the biopsies carried out during the course of endoscopic examination were positive for lymphoma; in 7.5% of cases histological diagnosis was made using macrobiopsies carried out using a diathermic loop whereas in 17.5% it was made during the course of laparotomy. It may be possible to make further progress towards an early diagnosis following the introduction of echoendoscopy which will allow an in-depth evaluation of lesions and the involvement of lymph node stations and nearby organs.

Autologous lymphocytes prevent the death of monocytes in culture and promote, as do GM-CSF, IL-3 and M-CSF, their differentiation into macrophages.

Blood monocytes collected by apheresis from healthy donors were differentiated in vitro to macrophages which were subsequently activated with recombinant human interferon-gamma. 7 day cultures were established by seeding Ficoll-separated mononuclear cells or elutriation-purified monocytes under different culture conditions. The best macrophage yields required the seeding of mononuclear cells (instead of purified monocytes) in teflon bags with a high air-liquid surface interface. The effects of GM-CSF, IL-3 and M-CSF on the macrophage yield were then evaluated. GM-CSF increased the average yield by 3.6- and 2.3-fold when purified monocytes or total mononuclear cells were seeded respectively. The corresponding increases with IL-3 were 2.5- and 2.1-fold respectively and with M-CSF 1.2- and 1.4-fold respectively. Macrophages matured under these various conditions displayed similar CD14, CD64, CD71, HLA-DR and Max 1 antigen expression and similar in vitro anti-tumoral activity against U937 cells. Culturing in the presence of cytokines permits the large scale production of activated macrophages for adoptive immunotherapy trials.

[Emergency endoscopy in upper gastrointestinal hemorrhage]. / L'endoscopia d'urgenza nelle emorragie del tratto digestivo superiore.

The paper reports a series of 236 patients who underwent emergency esophagogastroduodenoscopy (EGDS) (within 48 hours of hospitalisation) due to hemorrhage of the upper digestive tract. A definitive diagnosis of the of bleeding was made in 233 (98.7%) cases. In 1.3% of cases, endoscopic tests proved negative. The most frequent cause of bleeding was duodenal ulcer, followed by esophageal varices. Hemorrhage was caused in only 46.2% of 80 cirrhotic patients by the rupture of esophageal varices, whereas in the remaining 53.8% of cases the source of hemorrhage was a lesion associated to esophageal varices. Surgery was necessary in 15 patients (6.4%). The death rate within 30 days was 5.5%. In conclusion, emergency EGDS performed within 24 hours of hospitalisation is the most precise diagnostic technique for upper gastrointestinal bleeding.

Apheresis experience with a continuous flow cell separator.

The Dideco Vivacell separator is a continuous-flow centrifugation system that has only recently been used for cytapheresis. The authors' experience with this separator in 451 plateletpheresis and 164 leukapheresis procedures is presented. Platelet collection provided high platelet yields (9.53 +/- 2.85 X 10(11) with a collection efficiency of 74 +/- 14 percent for about 6 liters of total blood processed. Functional integrity was confirmed by normal in vitro tests (aggregation and response to hypotonic stress) and good in vivo recovery (55%). In leukapheresis, white cell yields were high (3.42 +/- 1.2 X 10(10) with 85 percent polymorphonuclear neutrophil cells. Their oxidative metabolism functions (generation of free oxygen radicals), investigated by chemiluminescence, were increased over donor values. Donor reactions, all of the mild citrate type, were rare.

[Protocol of combined surgical and polychemico-immunoradiologic therapy of stage T2N2MO lung cancer]. / Protocollo di trattamento combinato, chirurgico e polichemio-immuno-radioterapico del carcinoma polmonare allo stadio T2N2M0.

Preliminary data on the use of a combined surgical-polychemical-immunoradiotherapy protocol in the treatment of 13 T2N2M0 lung cancer patients are reported. The results are compared with those obtained in a 13 patient control group, homogenous by histotype, stage and surgical treatment who were given no other therapy. At 24 months the average survival rate in the first group was 61.5% compared to 15.3% in the second. It was significant that survival at 24 months after pneumonectomy rose from 16.6% to 50% and even more significantly survival after lobectomy rose from 14.2% to 71.4%.