The role of surface implant treatments on the biological behavior of SaOS-2 osteoblast-like cells. An in vitro comparative study.

OBJECTIVES: The aim of this study was an in vitro comparison of osteoblast adhesion, proliferation and differentiation related to six dental implants with different surface characteristics, and to determine if the interaction between cells and implant is influenced by surface structure and chemical composition. MATERIAL AND METHODS: Six types of implants were tested, presenting four different surface treatments: turned, sandblasted, acid-etched, anodized. The implant macro- and microstructure were analyzed using SEM, and the surface chemical composition was investigated using energy-dispersive X-ray analysis. SaOS-2 osteoblasts were used for the evaluation of cell adhesion and proliferation by SEM, and cell viability in contact with the various surfaces was determined using cytotoxicity MTT assays. Alkaline phosphatase (ALP) enzymatic activity in contact with the six surfaces was evaluated. Data relative to MTT assay and ALP activity were statistically analyzed using Kruskal-Wallis not parametric test and Nemenyi-Damico-Wolfe-Dunn post hoc test. RESULTS: All the implants tested supported cell adhesion, proliferation and differentiation, revealing neither organic contaminants nor cytotoxicity effects. The industrial treatments investigated changed the implant surface microscopic aspect and SaOS-2 cell morphology appeared to be influenced by the type of surface treatment at 6, 24, and 72 h of growth. SaOS-2 cells spread more rapidly on sandblasted surfaces. Turned surfaces showed the lowest cell proliferation at SEM observation. Sandblasted surfaces showed the greatest ALP activity values per cell, followed by turned surfaces (P < 0.05). CONCLUSIONS: On the base of this in vitro investigation, differently surfaced implants affected osteoblast morphology, adhesion, proliferation, and differentiation. Sandblasted surfaces promoted the most suitable osteoblast behavior.

Immediate versus delayed loading of dental implants in edentulous maxillae: a 36-month prospective study.

PURPOSE: The aim of this study was to compare survival rates and radiographic outcomes of immediate and delayed implant loading in edentulous maxillae. MATERIALS AND METHODS: Forty-nine patients in need of maxillary full-arch treatment were randomized into two groups: test group (n = 34) treated following the Columbus Bridge Protocol with 4 to 6 implants loaded within 24 hours and a control group (n = 15) treated following the ad modum Branemark protocol with 6 to 9 implants loaded a mean 8.75 months after surgery. Two hundred sixty implants (test: n = 163, control: n = 97) were placed, and subjects were treated with screw-retained full-arch prostheses. Bone levels were measured at baseline and at 1, 2, and 3 years and analyzed using repeated-measures analysis of variance. RESULTS: All patients appeared at all scheduled recall visits. No differences in cumulative survival rates were found between groups at 36 months. Ten implants (6.1%) failed in the test group; four (4.1%) failed in the control group. At 36 months, no prosthetic failures were detected. Significantly less bone loss was found in the test group at all time intervals (P < .001). The average bone level from the implant-abutment connection was 1.3 mm in the test group and 1.9 mm in the control group at 12 months, 1.5 mm and 2.2 mm at 24 months, and 1.6 mm and 2.3 mm at 36 months, respectively. CONCLUSION: In the edentulous maxilla, the Columbus Bridge Protocol involving immediate loading of implants placed in both healed and fresh extraction sites exhibited equivalent implant survival and less marginal bone loss at 3 years compared to the conventional two-stage delayed loading protocol. Int J Prosthodont 2011;24:294-302.

Clinical evaluation of an oval-shaped prefabricated glass fiber post in endodontically treated premolars presenting an oval root canal cross-section: a retrospective cohort study.

PURPOSE: This retrospective cohort study investigated the clinical effectiveness of preformed oval-shaped glass fiber posts in combination with a dual-curing composite resin core material in endodontically treated premolars presenting an oval root canal cross-section and restored with all-ceramic crowns over up to 45 months. MATERIALS AND METHODS: The study population comprised 134 patients and 154 endodontically treated premolars, with varying degrees of hard tissue loss, restored by means of oval-shaped fiber-reinforced posts. Inclusion criteria were premolars presenting an oval-shaped root canal, symptom-free endodontic therapy, root canal treatment with a minimum apical seal of 4 mm, application of rubber dam, and the need for a post and core complex because of coronal tooth loss. Four groups were defined based on the number of preserved coronal walls after endodontic treatment and before core buildup. Survival rate of the post and core restorations was determined using Kaplan-Meier analysis, and statistical analysis was performed using the log-rank test (P < .05). RESULTS: The posts and cores were examined clinically and radiographically. The mean observation period was 42.3 ± 2.7 months. The overall survival rate was 95.45%. Comparisons revealed that the difference between premolars with no coronal wall retention and premolars that had maintained one to four coronal walls was statistically significant (P = .0006). On the contrary, comparison between premolars with one and two residual walls was found to be not significant for the overall survival rate (P = .0698). CONCLUSION: A satisfactory clinical performance was observed for preformed oval-shaped glass fiber posts. Survival was higher for teeth retaining three and four coronal walls.

CKD awareness and blood pressure control in the primary care hypertensive population.

BACKGROUND: Chronic kidney disease (CKD) is associated with poor renal and cardiovascular outcomes, and early identification largely depends on general practitioners' (GPs') awareness of it. To date, no study has evaluated CKD prevalence in patients with hypertension in primary care. STUDY DESIGN: Cross-sectional evaluation of the Italian GPs' database. SETTING & PARTICIPANTS: 39,525 patients with hypertension representative of the Italian hypertensive population followed up by GPs in 2005. FACTOR: Estimated glomerular filtration rate (eGFR); eGFR <60 mL/min/1.73 m² was defined as CKD. OUTCOMES: GPs' awareness of CKD assessed using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes for CKD, and blood pressure (BP) control. MEASUREMENTS: Data concerning serum creatinine levels, BPs, and antihypertensive medications were obtained for each patient from the GPs' database; eGFR was calculated according to the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. RESULTS: CKD prevalence was 23%, but kidney disease was diagnosed by GPs in only 3.9% of patients. BP control was inadequate in patients with CKD and those with eGFR >60 mL/min/1.73 m², with only 44% of patients reaching a BP target <140/90 mm Hg and 11% achieving <130/80 mm Hg. Patients with eGFR <60 mL/min/1.73 m² whose GPs were aware of CKD were more likely to reach recommended BP target values (OR, 1.35; 95% CI, 1.15-1.59; P < 0.001). LIMITATIONS: The prevalence of decreased eGFR may be overestimated because of the lack of creatinine calibration. Proteinuria data were not available. CONCLUSIONS: Awareness of CKD by GPs is critical for achieving the recommended guideline BP targets. However, awareness of CKD by GPs is still far too low, highlighting the need to systematically adopt eGFR for more accurate identification of CKD in high-risk populations.

Seizure frequency and sex steroids in women with partial epilepsy on antiepileptic therapy.

PURPOSE: Neuroactive sex steroids influence neuron excitability, which is enhanced by estradiol (E2) and decreased by progesterone (Pg). In epilepsy, the production, metabolism, biologic availability, and activity of sex hormones may be affected by seizures themselves or by antiepileptic drugs (AEDs). This cross-sectional observational study was aimed at evaluating the relationships between sex steroids, seizure frequency, and other clinical parameters in women with partial epilepsy (PE) on AED treatments. METHODS: Serum E2, Pg, sex hormone binding globulin (SHBG) levels, free E2 (fE2), and E2/Pg ratios were determined during the follicular and luteal phases in 72 adult women with PE, and in 30 healthy controls. Hormonal data were correlated with seizure frequency, age, body weight, body mass index (BMI), disease onset and duration, and AED therapies. RESULTS: In patients, E2, fE2, and Pg levels were lower in both ovarian phases, whereas those of SHBG were higher than in controls. No significant changes in hormone levels and in prevalence of anovulatory cycles were observed between patients grouped according to their seizure frequency. However, when compared with those in healthy controls, luteal fE2 and Pg levels were chiefly impaired in women with more frequent seizures, mostly undergoing AED polytherapies, but not in those with absent or rarer seizures. CONCLUSIONS: The actual changes in sex steroid levels and E2/Pg ratios did not explain an increased seizure frequency in adult women with AED-treated PE, but patients with more severe disease showed more relevant changes in their sex hormone profile and impaired Pg levels during the luteal phase.

The use of a masticatory robot to analyze the shock absorption capacity of different restorative materials for prosthetic implants: a preliminary report.

PURPOSE: This study was conducted to measure, in vitro, the chewing load forces transmitted through crowns made of different prosthetic restorative materials onto dental implants. MATERIALS AND METHODS: A masticatory robot capable of reproducing the mandibular movements and the forces exerted during chewing was used. The forces transmitted to the simulated peri-implant bone during the robot mastication were analyzed using four different occlusal materials: three resin composites and one glass ceramic crown. RESULTS: The ceramic crowns transmitted significantly greater forces (up to +63.06%, P < .0001) than the composite crowns tested. CONCLUSION: Composite crowns are better able to absorb shock from occlusal forces than crowns made of ceramic material.

Plaque accumulation on exposed titanium surfaces and peri-implant tissue behavior. A preliminary 1-year clinical study.

PURPOSE: The aim of this study was to evaluate plaque accumulation and peri-implant tissue response adjacent to machined and dual acid-etched (DAE) titanium implant surfaces. MATERIALS AND METHODS: Two types of implants were used-control implants with a DAE surface in their apical portion and a machined coronal part, and test implants with a DAE surface throughout their entire length. A total of 10 sets of implants were placed in the posterior quadrants of eight patients, with at least 2 implants (1 control and 1 test implant) placed in each site. Machined healing abutments were placed on the control implants and DAE-surfaced healing abutments on the test implants. Plaque Index and bleeding on probing (BOP) were recorded together with histologic and microbiologic analyses of the peri-implant tissues. The healing abutments underwent a scanning electron microscope scan at 5 months postsurgery. Standardized radiographs were also taken at the time of implant placement and 3, 6, and 12 months postsurgery. RESULTS: DAE surfaces accumulated more plaque than machined surfaces (P < .0006) and the plaque was assessed as more difficult to remove (P < .0143). No histologic abnormalities were seen and the test implants showed significantly lower crestal bone resorption than the control (P < .0174). CONCLUSION: DAE healing abutments showed an increased plaque accumulation, but no significant BOP differences or histologic analyses were found between test and control sites. The test implants showed less interproximal bone resorption than the control ones at the end of a 1-year follow-up evaluation.

Long-term survival of endodontically treated, maxillary anterior teeth restored with either tapered or parallel-sided glass-fiber posts and full-ceramic crown coverage.

OBJECTIVES: This retrospective study investigated the clinical effectiveness over up to 8 years of parallel-sided and of tapered glass-fiber posts, in combination with either hybrid composite or dual-cure composite resin core material, in endodontically treated, maxillary anterior teeth covered with full-ceramic crowns. METHODS: The study population comprised 192 patients and 526 endodontically treated teeth, with various degrees of hard-tissue loss, restored by the post-and-core technique. Four groups were defined based on post shape and core build-up materials, and within each group post-and-core restorations were assigned randomly with respect to root morphology. Inclusion criteria were symptom-free endodontic therapy, root-canal treatment with a minimum apical seal of 4mm, application of rubber dam, need for post-and-core complex because of coronal tooth loss, and tooth with at least one residual coronal wall. Survival rate of the post-and-core restorations was determined using Kaplan-Meier statistical analysis. RESULTS: The restorations were examined clinically and radiologically; mean observation period was 5.3 years. The overall survival rate of glass-fiber post-and-core restorations was 98.5%. The survival rate for parallel-sided posts was 98.6% and for tapered posts was 96.8%. Survival rates for core build-up materials were 100% for dual-cure composite and 96.8% for hybrid light-cure composite. CONCLUSIONS: For both glass-fiber post designs and for both core build-up materials, clinical performance was satisfactory. Survival was higher for teeth retaining four and three coronal walls.

Chronic kidney disease and cardiovascular risk in hypertensive type 2 diabetics: a primary care perspective.

BACKGROUND: Chronic kidney disease (CKD) is associated with poor renal and cardiovascular (CV) outcome, and early identification largely depends on the general practitioners' (GPs) awareness of it. Only a few studies have evaluated the prevalence of CKD in type 2 diabetes in primary care, and no studies are available on hypertensive diabetics. Thus, the aim of this study was to assess the prevalence of CKD and its association with CV morbidity in such a population. METHODS: On the basis of an Italian national project involving GPs and nephrologists, we retrieved demographic, laboratory and clinical data regarding 7582 hypertensive type 2 diabetics (3564 men; age 25-89 years) who were selected using the diagnostic code Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for diabetes and hypertension. Blood pressure (BP) values, serum creatinine, ECG-diagnosed left ventricular hypertrophy (LVH) and the occurrence of previous major CV events were obtained for each patient from the GPs' Health Search Database. Estimated glomerular filtration rate (GFR) was calculated according to the four-variable MDRD equation. CKD was defined as an estimated GFR < 60 mL/min/ 1.73 m2. RESULTS: CKD prevalence was 26%, although renal disease was diagnosed by GPs in only 5.4% of cases. The prevalence of both LVH and major CV events was 8%. Adequate BP control was only achieved in 10.4% of patients. Patients whose GFR was <60 mL/min/1.73 m2 were older, prevalently female, had increased pulse pressure and higher prevalence of dyslipidaemia. Moreover, the prevalence of both LVH and major CV events was higher in patients with CKD as compared to patients with normal GFR. Multivariate logistic regression analysis showed that patients with CKD had a higher risk of LVH and/or CV events adjusted for eight covariates, and this risk increased by 23% with each 21 mL/min/1.73 m2 decrease in GFR. CONCLUSIONS: This study shows that CKD is highly prevalent in hypertensive type 2 diabetic patients, where it is a strong predictor of CV adverse outcome. However, awareness of CKD by GPs is low. Equations for calculating estimated GFR should be included in the GPs' database in order to detect the presence of CKD and to improve CV outcome of such a high-risk population.

Risk factors for posterior cystoid retinal degeneration in central serous chorioretinopathy.

PURPOSE: To identify factors associated with the development of posterior cystoid retinal degeneration (PCRD) in central serous chorioretinopathy (CSC). METHODS: The authors retrospectively studied 51 eyes of 51 patients with chronic CSC and subretinal or intraretinal exudation documented by optical coherence tomography (OCT), and evaluated the association of hypertension, systemic use of corticosteroids, duration of symptoms, subretinal fibrosis, and large laser scars with the development of PCRD. RESULTS: Twenty-four eyes (47%) had PCRD and 27 eyes (53%) had serous macular detachment without cystoid retinal changes. Multivariate analysis showed that a duration of symptoms exceeding 5 years (odds ratio [OR], 25.4; 95% confidence interval [CI], 2.8-233.2; P = 0.004) and subretinal fibrosis (OR, 19.1; 95% CI, 1.8-205.1; P = 0.015) were significantly associated with PCRD. CONCLUSION: Disease duration longer than 5 years and subretinal fibrosis are associated with the development of PCRD in CSC. Prospective evaluations could substantiate the associations found in this study and further clarify their significance.

Vascular permeability, blood pressure, and organ damage in primary hypertension.

Sub-clinical organ damage is a strong independent predictor of cardiovascular mortality in primary hypertension, and its changes over time parallel those in risk of cardiovascular events. A better understanding of the pathogenetic mechanisms underlying the development of target organ damage may help us devise more effective therapeutic strategies. We therefore investigated the relationship between the presence of organ damage and some of its potential determinants, such as blood pressure severity and early atherosclerotic abnormalities. Thirty-seven untreated, non-diabetic hypertensive patients were enrolled. Target organ damage was assessed by albuminuria and left ventricular mass index; systemic vascular permeability was evaluated by transcapillary escape rate of albumin (TERalb); and blood pressure was measured by 24h ambulatory blood pressure monitoring. The albumin-to-creatinine ratio and left ventricular mass index were directly related to TERalb (r = 0.48, p = 0.003 and r = 0.39, p < 0.020, respectively) and 24-h systolic blood pressure values (r = 0.54, p < 0.001; r = 0.60, p < 0.001). The simultaneous occurrence of increased blood pressure load and TERalb was associated with higher left ventricular mass index values (p = 0.012) and entailed an increased risk of having at least one sign of damage (chi2 = 17.4; p < 0.001). Logistic regression analysis showed that the risk of presenting at least one sign of organ damage increased more than ten-fold when TERalb was above the median and more than five-fold with each 10 mmHg increase in 24-h systolic blood pressure. Blood pressure load and vascular permeability are potentially modifiable factors that are independently associated with the occurrence of sub-clinical signs of renal and cardiac damage in hypertensive patients.

Immediate function with fixed implant-supported maxillary dentures: a 12-month pilot study.

STATEMENT OF PROBLEM: Immediate occlusal loading of dental implants in the edentulous mandible has proven to be an effective, reliable, and predictable procedure. There is little long-term data available on similar treatments in the edentulous maxilla. PURPOSE: The purpose of this study was to evaluate the 12-month implant survival after immediate loading of 4 to 6 implants with fixed screw-retained prostheses in edentulous maxillae. MATERIAL AND METHODS: Twenty-one patients, edentulous or with remaining teeth to be extracted in the maxilla, received 4 to 6 implants (n=111). The patients were restored with screw-retained fixed provisional prostheses supported by palladium-alloy frameworks within 24 hours after surgery. Insertion torques for implants were at least 40 Ncm. Implants, grouped as tapered or cylindrical screws, were placed in healed bone or extraction sockets. Implants were also classified as either vertical or off-angle. Definitive prostheses were placed after a mean healing time of 18 weeks. Radiographic examinations were made at the time of placement of provisional prostheses and 12 months later. Between-groups bone resorption was compared using 2-way ANOVA (alpha=.05). RESULTS: The mean follow-up time for all of the patients was 20 months (range, 13 to 28 months). The cumulative implant survival rate at the 12-month follow-up visits (after surgery) was 92.8%; the prostheses survival rate was 100%. No significant differences were found between the survival of tapered or cylindrical screw-type implants placed in postextraction sockets versus those in healed edentulous sites or between vertical and off-angle placed implants. Eight implants failed during the first 3 months, 5 of which were the most distal implants. The mean reduction in marginal bone height over the 12-month observation period was 0.84 mm (CI 95%; 0.68-0.99 mm). CONCLUSIONS: In this study with 12-month follow-up, 4 to 6 implants were sufficient to successfully support fixed implant screw-retained prostheses in the edentulous maxillae of 21 patients.

Robotic chewing simulator for dental materials testing on a sensor-equipped implant setup.

PURPOSE: This study describes a mechanical chewing simulator that is able to reproduce mandibular movements in 3 dimensions and the forces exerted during mastication. The aim of this work was to validate the described device, which can be used to test the ability of different restorative materials to withstand stress. MATERIALS AND METHODS: To validate the masticatory robot, 5 identical samples for each of 3 different restorative materials (an acrylic resin, a composite resin, and a glass ceramic) were created. Each sample underwent 5 minutes of chewing in the robot. The forces transmitted to the simulated peri-implant bone were collected. Two-way analysis of variance was used to evaluate the results. RESULTS: There were significant differences between the materials, and internal comparisons also showed significant differences (P < .0001). CONCLUSION: The different elastic moduli of the restorative materials significantly affected stress transmission at the simulated bone-implant interface, and the masticatory robot was able to identify this difference. The very low levels of variation confirm the precision of the machine during data collection and validate the reliability of the method, showing effective repeatability of the tests.

A 4- to 6-year retrospective clinical study of cracked teeth restored with bonded indirect resin composite onlays.

PURPOSE: The purpose of this study was to retrospectively evaluate the clinical performance of bonded indirect resin composite onlays for the treatment of painful, cracked teeth over a 6-year period. MATERIALS AND METHODS: Forty-three posterior teeth diagnosed as having a crack were selected in the restorative department of the University of Genoa. Inclusion criteria were sensitivity to biting and cold and a clinically visible crack. Direct composite buildup after removal of the existing restoration was performed before definitive cavity preparation. All composite onlay restorations were cemented with an adhesive technique using a 3-step total etch system and a dual-cure composite cement. Patients were interviewed and clinically examined at 1 week, 4 weeks, and every 6 months. RESULTS: The effectiveness of bonded onlay restorations was evaluated for a mean observation time of 4.78 years. At 1 week, 38 (88.37%) restored teeth were free of pain, 3 (6.98%) still had sensitivity to cold, and 2 (4.65%) still had sensitivity to cold and chewing. At 4 weeks, 40 (93.02%) teeth were free of pain, 2 (4.65%) still had sensitivity to cold and chewing, and 1 (2.32%) needed endodontic treatment. Two other teeth (4.65%) also needed endodontic treatment, the first after 2 months and the second after 5 months. During the evaluation period, 3 restorations (6.98%) failed, and upon clinical examination, 40 (93.02%) teeth were free of symptoms with a 6-year survival rate of 93.02% (life table analysis). CONCLUSIONS: Bonded indirect resin composite onlays can be successful in treating painful, cracked teeth. From the findings of this study, it appears that cuspal protection should be incorporated into the design of coronal restorations.

Segmental resection, lymph nodes dissection and survival in patients with left colon cancer.

BACKGROUND/AIMS: To evaluate retrospectively in patients who have undergone elective surgery for left colon cancer, if extent of segmental resection may affect postoperative outcome, lymph nodes dissection and long-term survival. METHODOLOGY: With lesion localized at the sigma or descending colon, 129 patients were divided into two groups according to the length of operative specimens: group 1: 73 cases, length 8 to < or =25 cm, who were surgically treated with limited segmental resection; group 2: 56 cases, length >25 to >50 cm, who had undergone extensive segmental resection. In no patient was ligation at the root of the inferior mesenteric artery performed. Lymph node dissection of pericolic nodes (N1) and occasionally intermediate nodes (N2) in group 1 and electively of N1 and N2 nodes in group 2 was carried out. RESULTS: Median follow-up was 60 and 56 months for group 1 and 2, respectively. In group 1 a median of 8 lymph nodes were removed compared to a median of 13 nodes retrieved in group 2, where a significant prevalence of N2 nodes was found compared to group 1 (p = 0.024). The incidence of N+ cases according to the total number of nodes removed is superimposable in the two groups. Overall disease-free survival was better, but not significantly, in group 1 compared to group 2; whereas actuarial survival curves of Dukes C cases, according to two types of resection, were similar. CONCLUSIONS: This retrospective study shows that in patients with left colon cancer long-term survival does not seem to be significantly affected by the extent of segmental resection.

Reliability and diagnostic use of a test for the search of the hepatitis C virus Ag (AgHCV).

BACKGROUND/AIMS: The detection of serum HCV nucleocapsid (core) antigen, besides being a valid alternative, by virtue of its low cost, to direct analysis of the virus in everyday transfusion practice, also aims to be employed in monitoring patients subjected to antiviral therapy. The verification of strict correlation between the two tests is the presupposition for such use. METHODOLOGY: In a group of 112 HCV-positive subjects, we assessed blood transaminases, viremia (by PCR), and the circulating core antigen (by ELISA). RESULTS: Only 16 out of 112 patients were AgHCV-negative, with viremia levels in the 10(2) to 10(4) range; 96 patients were HCV-positive, as indicated both by viremia and by Ag detection (1.9 to 292.4pg/mL). Sensitivity of the ELISA test corresponds to 3.6x10(4) IU/mL of viral load. There is an evident aggregation of results in groups according to antigenemia classes and the corresponding viremia levels: <10pg/mL--10(4) IU/mL (6/96); up to 100pg/mL--10(5) IU/mL (55/96); 100-200pg/mL--10(6) IU/mL (31/96); and more than 200pg/mL--10(7) IU/mL (4/96). CONCLUSIONS: AgHCV is correlated with elevation of ALT and high or medium-high viral loads. It can discriminate between ongoing and previous infection and is suitable for monitoring the pharmacological therapy in the presence of sufficiently high viral loads and for evaluating the onset of medium-long-term relapses. Neither the genotypes nor pharmacological therapy appear to affect the comparison of viremia with antigenemia. Moreover, this analysis is cheaper as compared with molecular techniques.

Retinoids and human breast cancer: in vivo effects of an antagonist for RAR-alpha.

The aim of the present study was to evaluate the in vivo effects of the RAR-alpha selective antagonist Ro 41-5253 on a xenograft animal model for breast cancer. Our observations indicate a lack of toxic side effects of the drug, even when used at high dosages. It is interesting to note that using Ro 41-5253 at dosages of 10, 30 and 100 mg/kg/die resulted in a slight, but significant inhibition of cell growth. The data obtained in this study represents the basis for a further evaluation of Ro 41-5253 anti-neoplastic activity on transgenic breast cancer animal models.

The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy.

PURPOSE: To describe changes of the foveal photoreceptor layer using optical coherence tomography (OCT) in central serous chorioretinopathy (CSC) and evaluate the correlation with visual acuity (VA) loss. DESIGN: Observational case series. METHODS: We studied 28 eyes with acute or chronic CSC using high-resolution OCT. The tomographic findings of the detached foveal photoreceptor layer were compared with VA. Sixteen eyes also were evaluated after foveal reattachment. RESULTS: The outer photoreceptor layer (OPL) in the detached fovea was preserved in 14 eyes, of which 13 had symptoms for <1 year and atrophic in 14 eyes with symptoms for >1 year. The preserved OPL had an even profile in 7 eyes and a granulated profile in 7 eyes. Mean VA was 0.19 logMAR with a preserved OPL and 0.72 logMAR with an atrophic OPL (P <.001). Cases seen after the detachment resolved included 6 eyes with preserved even OPL, 5 eyes with preserved granulated OPL, and 5 eyes with atrophic OPL. Mean final VA was 0.06 logMAR in eyes with preserved OPL and 0.90 logMAR in eyes with atrophic OPL (P <.001). The VA improved in 73% of eyes with preserved OPL and no eyes with atrophic OPL (P = .025). The VA recovered completely in 83% of eyes with preserved even OPL and no eyes with preserved granulated OPL (P = .015). CONCLUSION: High-resolution OCT demonstrates changes in the foveal photoreceptor layer in CSC that highly correlate with VA loss and may predict visual recovery after macular reattachment.

Concomitant chemo-radiotherapy in the treatment of locally advanced and/or metastatic soft tissue sarcomas: experience of the National Cancer Institute of Genoa.

Previous in vitro and in vivo studies showed a synergistic effect of concomitant doxorubicin and radiotherapy in a variety of solid tumors. From 1988 to 2000, we have investigated in a pilot study and then in a phase II study the efficacy of a concomitant doxorubicin radiotherapy treatment in patients with advanced and/or metastatic soft tissue sarcomas (STS). We enrolled and treated a group of 115 patients with advanced STS, with metastases (61%), frequently pretreated (59%), predominantly G2/G3 (84%). Doxorubicin was administered by continuous infusion at a dose of 12 mg/m(2)/day over 5 consecutive days concomitantly with radiotherapy; treatment was given on ambulatory basis at 2-week intervals with support of granulocytes colony stimulating factors (GCSF). In the whole group of 115 patients a clinical objective response (ORs) rate of 67% was obtained, with 11% complete and 56% partial responses. No patient progressed while on therapy, except one who progressed in non-irradiated metastatic tumor. Treatment (median 3 cycles) was well tolerated with no WHO grade 3 toxicity (apart from alopecia) and no acute or chronic cardiotoxicity. Thirty-nine responder patients underwent surgery (24 primary tumors, 10 relapses, 5 relapses plus isolated lung metastases). The median survival time(s) was 29 months in the whole series and over 50 months in responder patients. A multivariate analysis showed a positive association between survival and sex (HR=1.8; CI 95%, 1.0-3.4), performance status (HR=2.1; CI 95%, 1.1-4.0), ORs (HR=7.9; CI 95%, 3.5-18.1) and surgery (HR=8.8; CI 95%, 2.1-35.9). Low toxicity, high OR rate and positive survival time trend make the concomitant chemo-radiotherapy an efficacious approach for advanced STS.

Systemic linoleic and gamma-linolenic acid therapy in dry eye syndrome with an inflammatory component.

PURPOSE: To evaluate the efficacy and anti-inflammatory activity of systemic linoleic (LA) and gamma-linolenic acid (GLA), which decrease chronic inflammation in rheumatoid arthritis, on the ocular surface of patients with keratoconjunctivitis sicca. METHODS: In a randomized clinical trial, 26 patients with aqueous-deficient keratoconjunctivitis sicca were consecutively selected from patients presenting to Department of Neurosciences, Ophthalmology and Genetics, University of Genoa. The diagnosis was based on dry eye symptom survey score, Schirmer-1 test values, positive vital staining with lissamine green, and fluorescein break-up time (FBUT). All patients had ocular surface inflammation based on HLA-DR expression, a major histocompatibility class II antigen, on epithelial bulbar conjunctiva samples. The subjects were randomly divided into two groups of 13 patients each. The study group received tablets containing LA (28.5 mg) and GLA (15 mg) twice daily for 45 days and used tears; the control group received a tear substitute and a placebo tablet for 45 days. RESULTS: Statistically significant changes in symptoms (p < 0.005), lissamine green staining (p < 0.005), and ocular surface inflammation (p < 0.05) occurred in the study group compared with controls. HLA-DR expression varied from 58.5 +/- 14.1% positive conjunctival cells to 41.3 +/- 18.9% in the treated group and from 61.4 +/- 21.9% to 58.0 +/- 13.3% in the controls. No statistically significant difference between groups was found for FBUT and the Schirmer-1 test. CONCLUSIONS: Therapy with LA and GLA and tear substitutes reduces ocular surface inflammation and improves dry eye symptoms. Long-term studies are needed to confirm the role of this new therapy for keratoconjunctivitis sicca.