Manual thromboaspiration technique as a first approach for endovascular stroke treatment: A single-center experience.

BACKGROUND: For intracranial large vessel occlusion in acute ischemic stroke (AIS), a high degree of revascularization in the minimal amount of time predicts good outcomes. Recently, different studies have shown that the direct aspiration first pass technique (ADAPT technique) for AIS obtains high recanalization rates, fast interventions and low costs when it works as first attempt. This study retrospectively describes revascularization efficacy, duration of procedure, intra and post-procedural complications, early and after 90-days clinical outcome in a group of patients who underwent ADAPT as the primary endovascular approach, eventually followed by stent retriever thrombectomy, for recanalization of large vessels in the anterior circulation. MATERIALS AND METHODS: We analyzed clinical and procedural data of patients treated from April 2014 to August 2015. Recanalization was assessed according to the Thrombolysis in Cerebral Infarction score. Clinical outcome was evaluated at discharge and after 3 months (modified Rankin Scale, mRS). RESULTS: Overall, 71 patients (mean age of 69.7 years) were treated. Sites of occlusion were anterior circulation (including seven tandem extracranial-intracranial occlusions). In 39 patients i.v. rtPA was attempted. Recanalization of the target vessel was obtained in 87.3% of cases whereas direct aspiration alone was successful in 46/71cases (64.8%) with an average puncture-to-revascularization time of 43.1 minutes. Symptomatic intracranial hemorrhage occurred in 7.8% and embolization to new territories in 5.6%. In total, 38 patients (53.5%) had a good outcome at 90 days follow-up. CONCLUSIONS: In our series, the manual thromboaspiration technique has been shown as fast and safe, with good rates of vessel revascularization in 87.3% of patients and neurological outcome <3 mRS in 53.5% of patients.

Hemodynamic and Anatomic Variations Require an Adaptable Approach during Intra-Arterial Chemotherapy for Intraocular Retinoblastoma: Alternative Routes, Strategies, and Follow-Up.

BACKGROUND AND PURPOSE: Intra-arterial chemotherapy for retinoblastoma is not always a straightforward procedure, and it may require an adaptable approach. This study illustrates strategies used when the ophthalmic artery is difficult to catheterize or not visible, and it ascertains the effectiveness and safety of these strategies. MATERIALS AND METHODS: A retrospective study was performed on a series of 108 eyes affected by intraocular retinoblastoma and selected for intra-arterial chemotherapy (follow-up range, 6-82 months). We recognized 3 different patterns of drug delivery: a fixed pattern through the ophthalmic artery, a fixed pattern through branches of the external carotid artery, and a variable pattern through either the ophthalmic or the external carotid artery. RESULTS: We performed 448 sessions of intra-arterial chemotherapy, 83.70% of them through the ophthalmic artery and 16.29% via the external carotid artery. In 24.52% of eyes, the procedure was performed at least once through branches of the external carotid artery. In 73 eyes, the pattern of drug delivery was fixed through the ophthalmic artery; for 9 eyes, it was fixed through branches of the external carotid artery; and for 17 eyes, the pattern was variable. Statistical analysis did not show any significant difference in the clinical outcome of the eyes (remission versus enucleation) treated with different patterns of drug delivery. Adverse events could not be correlated with any particular pattern. CONCLUSIONS: Alternative routes of intra-arterial chemotherapy for intraocular retinoblastoma appear in the short term as effective and safe as the traditional drug infusion through the ophthalmic artery.

[Neuroimaging and definition of transient ischemic attack]. / Neuroimaging e definizione di attacco ischemico transitorio.

AIM: Transient ischemic attack (TIA) has to be considered an "alarm bell" of a more or less severe organic or systemic vasculopathy. Positive findings at neuroimaging means tissue damage. The purpose of this retrospective study was to assess the role of neuroimaging in the management of patients presenting with TIA, and to consider the relative implications. METHODS: In a consecutive series of 82 patients (53 males, 29 females, mean age: 65.9±13.1 years) admitted for TIA, it was possible to review the history and the clinical data of 66 patients, including ABCD2 score, laboratory including plasmatic D-dimer, and neuroimaging data including computed tomography (CT) and magnetic resonance imaging including diffusion-weighted with apparent diffusion coefficient measure (DWI-ADC) obtained at diagnosis and by a week later (16 by CT, and 50 by DWI-ADC). Thirty-three patients underwent DWI-ADC within 24 hours from symptoms onset. Statistical analysis has been performed by non-parametric tests (χ2 and Mann-Whitney), and logistic regression by a commercially available software. RESULTS: CT and/or DWI-ADC showed signs of acute ischemic lesions in 23/66 (35%) patients. 12 out of the 35 patients with a 24-hour DWI-ADC follow-up were positive. Statistical analysis showed that positive neuroimaging was significantly associated only with familial history of cardiovascular diseases (P<0.012) and previous TIA/stroke (P<0.046). CONCLUSION: In this patients series, at least 35% of patients with TIA had a positive neuroimaging, especially DWI-ADC. Positive neuroimaging seems an independent factor. Patients with TIA need an early assessment by neuroimaging including DWI-ADC, in order to obtain a correct classification and prognosis.

Benign orbital pseudolymphoma. Case report.

Orbital pseudolymphomas are uncommon benign tumors composed of reactive lymphocytes. The typical clinical presentation is painless onset of ptosis, proptosis, diplopia, or eyelid swelling. Virtually any adnexal structure can be affected, but lacrimal gland, orbital soft tissue, or extraocular muscles are the usual sites of involvement. Historically, treatment has been with oral corticosteroids or localized radiotherapy. We present a case of benign orbital pseudolymphoma.

Endovascular treatment of a cavernous sinus dural arteriovenous fistula by transvenous embolisation through the superior ophthalmic vein via cannulation of a frontal vein.

We describe a new approach for transvenous embolisation of cavernous sinus dural arteriovenous fistulae through the superior ophthalmic vein (SOV), i.e., via percutaneous cannulation of a frontal vein. Modern neurointerventional angiographic materials make it possible to reach the SOV in this way without puncturing it in the orbit or a surgical exposure. Orbital phlebography should still be in the repertoire of interventional neuroradiology units in large centres.

Coats disease: smaller volume of the affected globe.

PURPOSE: To determine whether a significant smaller volume of the affected globe, compared with that of the normal globe, is an additional feature of Coats disease. MATERIALS AND METHODS: Ocular globe volume was assessed in 13 children (11 boys, two girls; age range, 0.6-14 years; mean age, 4.1 years) with Coats disease and in 18 (eight boys, 10 girls; age range, 0.5-12 years; mean age, 3.6 years) with unilateral retinoblastoma. Orbital computed tomographic scans were available for all children; magnetic resonance images were available for 11 children-seven with Coats disease and four with retinoblastoma. For volume estimation, anteroposterior and equatorial diameters of ocular globes were measured. Statistical analysis was conducted with univariate and multivariate methods. RESULTS: In children with Coats disease, the mean volume of the affected globe was 4,877.03 mm(3) (range, 2,951.47-6,284.70 mm(3)) and that of the normal globe, 6,018.00 mm(3) (range, 4,062.32-7,509.26 mm(3)). In children with retinoblastoma, the mean volume of the affected globe was 4,557.06 mm(3) (range, 1,612.01-7,463.00 mm(3)) and that of the normal globe, 4,402.11 mm(3) (range, 1,360.46- 7,463.00 mm(3)). The Coats disease population had a significantly smaller volume of the affected globe (z = -3.1009; P =.002); the retinoblastoma population did not have a statistically significant trend toward a bigger affected globe volume (z = -1.7064; P =.088). The difference between the affected globe volume and the normal globe volume in children with Coats disease was the only significant independent variable (P =.005). CONCLUSION: A significantly smaller volume of the affected globe is an additional feature of Coats disease.

[Gingival hypertrophy due to cyclosporine. A clinico-statistical study in 82 patients]. / Ipertrofia gengivale da ciclosporina. Indagine clinico-statistica in 82 pazienti.

Eighty-two patients were observed at the Dental Department at Parma University. Seventy-six of them had renal transplant and 6 liver transplant. They were in immunosuppressive therapy with cyclosporina, 42 of them were also in calcium antagonist therapy. Gingival hypertrophy was observed in 52 subjects (63.4%) 25 (30%) patients underwent surgical operation, 6 of them (24%) showed a relapse about 3 months after the first operation. Clinical data were measured in accordance with 5 indicators: the level of oral hygiene, cyclosporinemia, contemporaneous use of calcium antagonist, the duration of therapy and the DMF index. By the results obtained, it's possible to suppose that the gravity of the disease is related to the contemporaneous use of calcioantagonist, but it wasn't highly significant (p < 0.05). The degree of oral hygiene was decidedly in relation to the most severe forms of gingival hyperplasia (grade 2-3), (p < 0.001). No relation was found for the duration of therapy, distribution of the DMF index and the level of drugs in the blood.

[Oral lichen planus (OLP). Therapeutic guidelines and clinical experience with 71 patients]. / Lichen planus orale (OLP). Orientamenti terapeutici ed esperienza clinica in 71 pazienti.

The authors report the results of a study performed in 71 patients suffering from lichen planus of the mucous membranes and skin. They discuss dermatological and stomatological clinical data in relation to possible basal diseases (hepatopathies, dermopathies, diabetes, hypertension, gastrointestinal diseases, etc.) and other anamnestic data (psychological aspects, drug taking, working activity, etc.). Moreover, they report the results of the clinical protocol used (betamethasone in a gel and vitamin A base) with a follow-up of 5 years and examine the other therapeutic possibilities reported in the literature.

[Gingival hypertrophy due to cyclosporine. A review of the literature]. / Ipertrofia gengivale da ciclosporina. Revisione della letteratura.

Cyclosporine is now the elective drug for immunosuppressive treatment in organ transplant patients. Compared to traditional immunosuppressants this molecule offers the therapeutic advantage that it does not act indiscriminately on all components of the immune system. In addition to the primary pharmacological action, cyclosporine also presents a number of undesirable effects, among which it is worth mentioning short and long-term nephrotoxicity and the development of neoplasia, in particular lymphomas. Other undesired effects of the drug are the possibility of overinfection, thrombosis, hypertension, hypertrichosis, hepatotoxicity and the development of the hypertrophic and hyperplastic gingival pathology.

Vallate, foliate and fungiform human papillae gustatory cells. An immunocytochemical and ultrastructural study.

We studied the classifications, topographic distribution and cellular lines of taste bud components in vallate, foliate and fungiform papillae of young, mature and old men with light microscopy, SEM, and TEM. By identifying ultrastructural and immunocytochemical characteristics, three distinct sensorial cells were identified, along with a few basal cells: dark type I cells, light type II cells and light type III cells. These cells extend from the epithelial basal lamina to the gustatory canal, where their apical cytoplasm sends long microvillous expansions. Excluding those of the fungiform papillae-which never go beyond the lower third of the gustatory canal, and are always void of dense substance-the microvillous expansions continue to the external border of the taste pore. Dark type I cells are rich in free ribosomes, tubular RER and large dense granules. Light type II cells with scarce ribosomes and RER, do not have enough peculiar ultrastructural characteristics to be considered effector or phagocyte elements. Light type III cells are characterizes by dense core vesicles whose peculiar ultrastructural characteristics in the foliate and vallate papillae, should be considered a consequence of different functional phases. After comparative evaluation the authors hypothesized on the functional value of some ultrastructural aspects and on the dense core vesicles which are immunoreactive to 5-HT. They observed that all gustatory cells are involved in taste transduction based on behaviours caused by microvilli in the gustatory canal and gustatory cell relationships with nerve endings. Moreover the authors noted that age does not seem to influence taste perception.

[11 cases of erythema multiforme. The etiological correlations and therapy]. / Undici casi di eritema multiforme. Correlazioni etiologiche e terapia.

Erythema multiforme (EM) is characterised by a polymorphous eruptive complex which many involve the cutis and oral, genital and conjunctival mucous. Its etiopathogenesis is unclear: it is thought to be associated with various viral or bacterial infective agents (herpes virus, Coxsackie virus, mycoplasmas, etc.), numerous drugs, physical therapy, systemic pathologies of various types. The authors report their experience in relation to 11 patients suffering from EM; the clinical characteristics of each case are reported, together with the course of disease, and the diagnostic and therapeutic protocol adopted. The discussion examines the possible cause of disease: in 5 patients the etiology was traced back to viral infections (4 herpes and 1 coxsackie) and to the administration of drugs in the remaining cases (4 in relation to anti-phlogistic agents and 2 regarding antibiotics).

Dimensional stability of silicone-based impression materials.

This study attempts to demonstrate that the polymerization reaction is not the only factor that affects the shrinkage of silicone-based impression materials because evaporation of the constituents also contributes to the shrinkage. These factors can be evaluated by the study of time-dependent dimensional changes. This is shown both by chemical kinetics and by experimental testing of condensation and addition polymerizing impression materials with different viscosities. Comparison of the different materials shows that the two contributions, polymerization shrinkage, and evaporation shrinkage, can be assessed separately by analysis of the time-dependent shrinkage diagrams. The instability due to the polymerization reaction is complete after a few hours, but the contribution of the constituent evaporation, if present, can have a significant long-term role.

gamma-Glutamyltransferase isoenzyme pattern in workers exposed to tetrachloroethylene.

In compliance with the mandatory medical surveillance of workers exposed to tetrachloroethylene (PCE) in Italy, isoenzyme fractioning of serum gamma-glutamyltransferase (GGT) was performed on 141 workers of both sexes and on 130 control subjects. None of the workers showed any clinical symptoms of liver disease and their enzymatic profiles, including AST, ALT, 5'-NU, ALP, and GGT, were within the normal reference limits. A statistically significant increase in total GGT serum level was found in the exposed subjects, which was associated with an increase in one of the two fractions normally present in healthy individuals (GGT-2), as well as with the appearance and progressive increase of the level of a fraction (GGT-4) considered to be an expression of hepato-biliary impairment. Further research is ongoing among these workers, which will clarify whether or not electrophoretic GGT tests may be useful in detecting liver function changes due to occupational exposure to PCE.

Influence of cigarette smoking on pituitary and sex hormone balance in healthy premenopausal women.

Plasma gonadotropin FSH and LH, PRL, sex steroids (17-beta E2, E1, and P), SBP binding capacity, and urine estrogens (E1, E2, and E3) were measured in 485 premenopausal healthy women, subdivided according to smoking habits. The aim of the study was to verify if cigarette smoking influences sex hormone balance. Baseline PRL levels were significantly lower (P less than 0.002) in smoker (n = 174) than in nonsmoker (n = 311) women. No difference was found in the other parameters of the two groups, particularly in plasma and urine estrogenic pattern. Our data suggest that smoking directly affects PRL levels by involving the hypothalamic mechanism that regulates PRL secretion.

[Functional velopalatal insufficiency. Therapeutic possibilities]. / Insufficienze funzionali velopalatine. Possibilità terapeutiche.

The function of the soft palate is complex; it takes part in speech, swallowing, and masticatory mechanisms. Its pathology ranges from morphological deficits to functional ones; these are commonly due to a central nervous system damage. The clinical analysis is based upon examination and instrumental prove, and leads to an optimum choice between surgical and prosthetic solutions. The latter is the best one in terms of quick execution, low costs and future possibilities of improvement.

[Individual cast posts for single anterior implants]. / Perni moncone individuali fusi per impianti singoli anteriori.

The Authors utilized in order to replace anterior missing teeth osseointegrated implants provided with individual angled posts. These types of abutment are used to allow a good parallel situation between implants with different angulation and also between implants and proximal teeth. The head of this abutment is thread to receive the screw that allows the crown to be fastened.

[Handicapped situations in dentistry]. / Situazione di handicap in odontoiatria.

Moving from the general definition of "handicap" "the Authors suggest a classification system based upon the most important altered function of a patient. A handicap situation happens when a patient needs special care in a dental office, both for particular oral changes due to his primary pathology or related therapy and for increased operatory risks.

[Headaches and craniofacial pains with dental involvement in the classification of the International Headache Society (1988)]. / Cefalee e algie cranio-facciali di interesse stomatologico nella classificazione della International Headache Society (1988).

Facial pain often presents complex diagnosis, requiring other specialists' consultation. The use of different terminology and protocols can affect the information exchange negatively. These problems in the field of headache, cranial neuralgias and facial pain lead the International Headache Society to introduce a new classification in 1988. The chief difference with the previous ones is the presence of strictly codified diagnostic principles. Its target is research, but it can help the general practice as well. We discuss the most interesting points to the stomatologist.

[Magnetic stimulation of the scalp: the responses of the masseter muscles. I]. / Stimolazione magnetica allo scalpo: risposte nei masseteri. Parte I.

Magnetic stimulation of nervous elements is a new neurophysiological technique. It easily succeeds in stimulating the brain motor cortex. We applied this technique to the trigeminal motor system, recording responses in masseter muscles. The magnetic stimulations at 4 cm laterally to the vertex on the biauricular line elicited responses in the contralateral masseter due to activation of motor cortex or adjacent elements along the cortico-nuclear pathway. The ipsilateral responses to the same stimuli and to more lateral ones presented shorter latencies and they were ascribed to direct stimulation of the trigeminal nerve, probably its intracisternal portion. The latency values were 6.9 +/- 0.71 ms and 3.6 +/- 0.3 ms respectively.