A retrospective analysis of the headache associated with temporomandibular joint disorder.

BACKGROUND: Headache is a common symptom, that can be extremely disabling, affecting 26 million of patients only in Italy. ICHD-II has reported two categories: "primary headaches" and "secondary headaches". Temporomandibular joint disorders can lead to a secondary headaches. AIM: We want to evaluate the prevalence and clinical features of headache among a series of patients having temporomandibular joint disorders and we illustrate the evolution of headache following medical treatament of temporomandibular joint (TMJ) disorders. MATERIALS AND METHODS: This is a retrospective study carried out on chart review of 426 consecutive patients with various degrees of temporomandibular disorders and treated with medical devices from 2007 to 2011. RESULTS: Headache was reported by 73 patients (17.14%). Headache was observed in 36 of 51 patients with lock and in 32 out of 130 patients with mandibular deflections (Table I). The remaining 5 patients with headache had articular noise. CONCLUSIONS: Headache is not a rare finding in a population with temporomandibular dysfunctions and is more often a tension-type rather than trigeminal headache.

Pleomorphic adenoma of the lacrimal gland: two clinical cases.

INTRODUCTION: Pleomorphic adenoma of the lacrimal gland is uncommon but it is the most common benign epithelial tumor of this gland. In the literature few cases have been reported in patients aged between 6 years and 80 years with a mean age of 39 years. A correct diagnosis and treatment is fundamental in order to avoid a relapse and sometimes their malignant transformation. An incisional biopsy is better to be avoided because it could injure the capsule, leading to dissemination of tumoral cells in the orbital tissues with a recurrence rate of 30% over 5 years. AIM: This papers want to support the use of mini-invasive surgery for the treatment of orbital lesions when it is possible. MATERIALS AND METHODS: We report two clinical cases of pleomorphic adenoma affecting the lacrimal gland treated with two different surgery approaches. The radiographic and photographic documentation of the patients was collected in the pre-and post-operatively. All patients underwent a CT scan and MRI. CONCLUSIONS: This lesions requires a well-grounded clinical and therapeutic protocol to avoid the risk of malignant transformation or disease recurrence, very dangerous at this site. CT scan and MRI scan are very important to recognize different types of lesions involving the lacrimal gland and fossa. A mini-invasive surgery reduces hospitalization, risk of complications, surgical times and bleedings and guarantees an excellent functional and esthetic result when performed by a skilled surgeon.

Primary anastomosis vs Hartmann procedure in acute complicated diverticulitis. Evolution over the last twenty years.

BACKGROUND/AIMS: Aim of this review is to assess the role and indications for primary sigmoidectomy with direct anastomosis for diverticulitis comparing it with the Hartmann's procedures. METHODS: A literature search was performed using MEDLINE (PubMed), Google Scholar and The Cochrane Library and the articles from January 1990 until June 2011 were analyzed. All patients were divided into three groups: primary anastomosis (PA), primary anastomosis and stoma protection (SP) and Hartmann's procedure (HP). Number of patients, overall mortality and morbidity, the rate of fistulization, the rate of reversal after SP (RSP) and after HP (RHP) and the Hinchey classification have been considered. RESULTS: The mortality was of 38/1010 patients (3.8%) for PA, 11/153 patients (7.2%) for SP and 139/800 patients (17.4%) for HP. The morbidity was reported in 103/325 patients (31.7%) in PA, in 23/97 patients (23.7%) in SP and in 290/586 patients (49.5%) in HP. Fistula formation was recorded in 35/625 patients (5.6%) for PA, in 10/149 patients (16.4%) for RSP and 11/426 patients (6.4%) for RHP. The intestinal continuity was restored in 82/628 patients (56.9%) who underwent SP and in 315/581 patients (54.2%) undergoing HP. A total of 790 patients (54.5%) were classified in class I-II Hinchey and total of 659 patients (45.5%) was classified in class III-IV Hinchey. CONCLUSION: The PA has a lower morbidity and mortality in relation to the HP and except some limited indications, should be used as treatment of choice in the case of diverticulitis.

Nocturnal oxygen desaturation correlates with glycemia levels in patients with coronary artery disease.

AIM: Sleep-disordered breathing (SDB) has a high occurrence in patients with coronary artery disease. The aim of the present study was to examine the relationships between the overnight oxygen desaturation index (ODI) and metabolic and anthropometric parameters in a sample of patients who underwent percutaneous transluminal coronary angioplasty (PTCA). METHODS: The overnight pulse-oximetry recording ODI (desaturation >4%, length >10 s/events per hour) was performed in 29 patients with coronary heart disease, after they underwent PTCA. All study participants performed dynamic spirometric test, echocardiography, anthropometric measurements, bio impedance analysis. Fasting blood sample was collected to measure metabolic parameters. Using ODI category, the patients were grouped as follows: group N, N.=9 (ODI= or <5 events/hour); group A, N.=14 (515 events/hour). RESULTS: Among the studied patients, 69% had a nocturnal ODI>5 and 48% had a nocturnal ODI between 5 and 15 events/hour. ODI values were correlated with body mass index (BMI) (P<0.05) but not with waist to hip ratio, or percent body fat. After adjustment for BMI values, there was a significant positive correlation of ODI values with fasting glucose serum levels (P<0.05). CONCLUSION: These data suggest that early metabolic dysfunction may occur with SDB before overt clinical manifestation of underlying disease in patients with preobesity and ischemic heart disease. Patients with ischemic heart disease should be screened for SDB by ODI, also according to fasting glucose levels.

Transurethral resection of the prostate (TURP) vs GreenLight photoselective vaporization of benign prostatic hyperplasia: analysis of BPH6 outcomes after 1 year of follow-up.

The surgical treatment of benign prostatic obstruction is changing over the time, thanks the increase evidence about the successful role of laser techniques in this surgery. We aimed to compare prostatic GreenLight photovaporization (PVP) to bipolar transurethral resection of the prostate (TURP) with regard to lower urinary tract symptoms (LUTS) improvement through the evaluation of BPH6. We enrolled 220 consecutive subjects affected by LUTS. We performed a propensity score matching using prostate volume, peak flow and International Prostate Symptoms Score (IPSS). A total of 110 (55 TURP and 55 PVP) were analyzed. We found after 1 year of follow-up that the rate of subjects resulting in greater BPH6 recovery in the PVP group vs TURP (45.6% vs 18.2%; P=0.001). The TURP treatment showed greater catheterization time (4.67 vs 1.25; P<0.01) while PVP showed greater recovery experience (82.4 vs 58.2; <0.01). Postoperative ejaculatory dysfunctions were observed in both groups, 58.8% in TURP and 34.5% in PVP group. The multivariate logistic regression analysis, adjusted for preoperative variables, showed that PVP was independently associated with BPH6 recovery end point (odds ratio=3.77; P<0.01). This study showed data in favor of PVP. Although IPSS and peak flow improvements were similar, PVP showed better clinical outcomes.

The length of telomeric G-rich strand 3'-overhang measured by oligonucleotide ligation assay.

A typical G-rich telomeric DNA strand, which runs 5'-->3' toward the chromosome ends, protrudes by several nucleotides in lower eukaryotes. In human chromosomes long G-rich 3'-overhangs have been found. Apart from the standard G-rich tail, several non-canonical terminal structures have been proposed. However, the mechanism of long-tail formation, the presence and the role of these structures in telomere maintenance or shortening are not completely understood. In a search for a simple method to accurately measure the 3'-overhang we have established a protocol based on the ligation of telomeric oligonucleotide hybridized to non-denatured DNA under stringent conditions (oligonucleotide ligation assay with telomeric repeat oligonucleotide). This method enabled us to detect a large proportion of G-rich single-stranded telomeric DNA that was as short as 24 nt. Nevertheless, we showed G-tails longer than 400 nt. In all tested cells the lengths ranging from 108 to 270 nt represented only 37% of the whole molecule population, while 56-62% were <90 nt. Our protocol provides a simple and sensitive method for measuring the length of naturally occurring unpaired repeated DNA.

The role of fillers in aesthetic medicine: medico-legal aspects.

In recent years there has been an exponential increase of fillers use in aesthetic medicine. The popularity of this anti-wrinkle product is based on their capacity to offer significant improvement in the aesthetic field, particularly to skin rejuvenating processes with non-invasive and less expensive techniques, if compared to the surgical methods (i.e. surgical lifting). The great number of fillers on the market is composed of a large heterogenic number of biomaterials. The aim of this review was to provide an overview and a classification of the filling materials that are most commonly used. A synthesis of the literature concerning fillers and related side effects was also reported. The law decree no. 23 of 1998, converted in the law no. 94 of 1998 and the principal judgments of the Italian Court of Cassation have been examined with the medico-legal issues related to fillers use in medicine. With respect to their degradation, filler materials may be classified as temporary (degradable), semi-permanent and permanent (not degradable). The temporary fillers such as hyaluronic acid and collagen are completely degraded by the surrounding tissue in a few months. The permanent fillers, such as the ones derived from silicon oil and minerals are not biodegradable and may cause serious and irreversible side effects. Their use requires a physician with a high level of specialization to perform the treatment, a deep knowledge of face anatomy and a great degree of experience.

Performance of biopsy factors in predicting unfavorable disease in patients eligible for active surveillance according to the PRIAS criteria.

BACKGROUND: To assess the added value of biopsy factors, like maximum cancer length in a core (MCL), cumulative cancer length (CCL), cumulative length of positive cores (CLPC), percentage of cancer involvement in positive cores (CIPC) and the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria in patients who underwent radical prostatectomy (RP) but eligible for active surveillance (AS). METHODS: From January 2002 to December 2007, 750 consecutive subjects underwent RP. We identified 147 (19.07%) patients who were eligible for AS based on PRIAS criteria: clinical stage T1c or T2, PSA level of ⩽ 10 ng ml(-1), Gleason score ⩽ 6, PSA-D of <0.2 ng ml(-2) and one or two positive biopsy cores. We calculated the diagnostic accuracy of biopsy factors in determining pathological confirmed unfavorable disease. Decision curve analysis (DCA) were performed. RESULTS: Of all subjects, 95 patients (66.43%) had favorable whereas 48 had (33.57%) unfavorable disease. On multivariate analyses, the inclusion of MCL, CCL, CLPC and CIPC significantly increased the accuracy of the base multivariate model in predicting unfavorable disease. The gain in predictive accuracy for MCL in a core, CCL, CLPC and CIPC ranged from 13 to 27%. The DCA shows that adding MCL, CCL, CLPC and CIPC resulted in a greater net benefit when the probability of ranges between 15 and 50%. The models can be applied at the cost of missing not more than 16.83% of unfavorable disease. CONCLUSIONS: Our findings suggested that the addition of these biopsy factors to PRIAS criteria has the potential to significantly increase the ability to detect unfavorable disease.

Predicting erectile dysfunction in sexually active patients seeking prostate health screening: proposal for a multivariable risk stratification.

To address the severity of erectile dysfunction (ED) in consecutive sexually active men seeking a prostate health screening through a multivariable risk stratification including comorbidities and lower urinary tract symptoms (LUTS). Four hundred and twenty five consecutive subjects with stable sexual relationship with normal testosterone levels were enrolled. The International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) questionnaires were collected and health-significant comorbidities were scored with the Charlson comorbidity index (CCI). All the independent predictors of ED were combined to form four different risk categories of ED: low (age⩽65 years and IPSS<8 and CCI=0), intermediate (one of the following: age>65 years, IPSS⩾8 or CCI⩾1), high (two of the following: age>65 years, IPSS⩾8 or CCI⩾1) and very high (age >65 years, IPSS⩾8 and CCI⩾1). The prevalence of ED increased with increase of CCI (χ(2) likelihood ratio: 40.85, P=0.001). The median of the IIEF-5 significantly reduced with the increase of the CCI (P<0.001) and with the worsening of our risk group stratification (P<0.001). At univariate logistic regression analysis very high risk was significantly associated with of ED (odds ratio: 26.85, P<0.001). Very high-risk group predicted ED with 88% and 56% of specificity and sensitivity, respectively. Combining these risk factors through our risk stratification may be usefulness in revealing an underling ED.

Multiple genetic lesions in solid tumors: relevance to diagnosis, prognosis, and molecular mechanisms.

In recent years, significant progress has been made in identifying characteristic chromosomal and molecular rearrangements associated with several solid tumors. Most solid tumors studied have been found to be characterized by recurrent chromosomal abnormalities that are specific to histologic types. We have studied primary specimens of malignant melanoma, gastrointestinal cancer, renal carcinoma, lung and ovarian cancer, by cytogenetic and molecular means, and we discuss the genetic alterations found. Brief descriptions of the potential clinical utility, and biological relevance changes in these disorders are also discussed.

Cytogenetic, molecular and phenotypic characterization of the newly established renal carcinoma cell line KJ29. Evidence of translocations for chromosomes 1 and 3.

The established non papillary human renal carcinoma cell line (RCC) KJ29 was submitted to a multiparametric characterization to evaluate its potential use for in vitro and in vivo studies. The cell line grows in vitro as monolayer as well as cell suspension. Cytogenetic analysis has shown a modal chromosome number of 50 with some marker chromosomes, including rearrangements of chromosomes 1 and 3. The antigenic phenotype is characterized by co-expression of cytokeratin and vimentin, as well as expression of urothelium differentiation antigens, low levels of class II MHC antigens and no class I antigens. A differential expression of the VLA-3 integrin heterodimer has been detected between the adherent and non adherent cell population. The cell line which is highly tumorigenic in athymic mice displays expression of erb B-2 and c-met oncogenes and high expression of cell-cycle related and Ha-ras 1 genes.

Evaluation of the expression of tissue DF-3 and MCA and the corresponding serum values in patients with breast carcinoma.

Two specific monoclonal antibodies for breast tissue (DF3 and MCAb-12) and the corresponding tumor markers CA15-3 and MCA in serum have been evaluated in 50 patients with breast cancer and in 15 controls. The expression of these antigens in tissue was poorly correlated with the common prognostic parameters. Their presence in serum was associated with an altered distribution of the antigens in the cell. The expression of these antigens in tissue enables us to select patients for serological follow-up and to evaluate tumor differentiation from a functional point of view.

Effects of acupuncture on immune response related to opioid-like peptides.

Experimental research has recently shown that acupuncture induces the formation of opioid-like peptides (OLPs) in animals. In order to provide further evidence, we tested the beta-endorphin levels and other parameters (VIP, lymphocyte subsets, NK cells and monocyte phagocytosis) in a group of 90 patients suffering from various painful disorders treated with acupuncture. Zusanli (St 36) and Hegu (LI 4) acupoints were selected. A homogeneous group of 30 subjects was used as control. Evaluation of the above parameters was made with 3 series of blood tests before treatment, 30 minutes and 24 hours after acupuncture treatment. In the acupuncture group, the following results were achieved: 1) A considerable increase in beta-endorphin levels remained high even 24 hours after acupuncture treatment. In addition, we demonstrated an inverted correlation between beta-endorphins and VIP; 2) 30 minutes after acupuncture session, 80% of the treated patients showed a significant increase of CD3 and CD4 values and an increase of CD8 24 hours after stimulation; 3) Monocyte phagocytosis was increased in 45% of the treated subjects 30 minutes from starting treatment, and in 100% of them after 24 hours. The percentage of NK cells was also increased in 40% of cases after 30 minutes, and in 50% after 24 hours. However, in the control group, no such significant changes in immune parameters were found.

[Neopterin and interleukin 2 soluble receptors as biochemical markers of cellular immune response to surgical trauma]. / Neopterina e recettore solubile dell'interleuchina 2 come indicatori biochimici della risposta immunitaria cellulare al trauma chirurgico.

In 67 patients submitted to surgical procedures serum neopterin (NPT) and Interleukin 2 soluble receptors (IL2R) were evaluated at the end of the operation as well as 24, 48, 72 hours later. Thirty seven of the subjects (Group B) had undergone minor surgery (average time of operation: 40 +/- 10 min.), thirty (Group A) had undergone major surgery (average time: 180 +/- 30 min.). The results showed elevated NPT and IL2R levels in the latter cases and, in particular, 48 and 72 h after surgery. Neopterin levels were positively correlated with IL2R (r = 0.548 p < 0.01). These data suggest an activation of the cellular immune response which parallels the magnitude and length of surgical trauma. Thus NPT and IL2R levels could represent biochemical markers of postoperative disorders of the immune homeostasis.

[Transdermal fentanyl: a new tool for pain therapy in pediatric oncology]. / Fentanyl Transdermico: una nuova arma nella terapia del dolore in oncologia pediatrica.

OBJECTIVES: Transdermal fentanyl delivery system (TFDS) offers advantages if oral administration of opioids is difficult because of progressive disease or poor compliance, in cancer patients (pts). The current study was conducted to assess the efficacy and safety of TFDS in a pediatric cancer population. PATIENTS AND METHODS: Twenty-one pts were enrolled between June 2004 and December 2005. TFDS was applied if pts had pain under non opioids treatment, according to our step-by-step "pain protocol". Starting dose of TFDS was decided considering the dose of the last non opioids drug used. All pts didn't receive other opioids therapy before TFDS. Degree of pain was assessed using visual and numeric scales. RESULTS: Sixteen males and 5 females were studied, median age was 8 years (range 3-14 years). They were affected by moderate to severe pain, because of progressive and/or metastatic disease. Median starting dose was 50 microg/h (range 25-100 microg/h). Highest reached dose was 200 microg/h. In 75% of pts, starting dose was adequate. In other pts, optimal dosage was found within 36 hours. Thus, pain total control was obtained in 100% of pts, with a median delay, from starting TFDS, of 24 hours (range 12-48 hours). No toxicity was observed but a moderate lethargy, within the first 12 hours, in 30% of pts. CONCLUSIONS: TFD was found to be an effective and safe system to treat pain in pediatric cancer pts. All pts and their families showed high compliance with TFDS. It could be also taken in account for outpatient therapy.

T-cell and antibody response to Parietaria judaica allergenic fractions in atopic and nonatopic individuals.

The in vitro proliferative response to separated immunologically relevant components of Parietaria judaica pollen extract (PjE) was investigated by proliferation assay and limiting dilution analysis, in peripheral blood mononuclear cells from Parietaria-allergic subjects and nonallergic controls. In the same subjects, the profile of the antibody response to the PjE fractions was also studied by immunoblotting to evaluate the functional significance of allergen-induced T-cell activation in the two groups. The estimated frequency of PjE-reactive T cells in peripheral-blood mononuclear cells was low in both groups. No difference was found between the Parietaria-allergic subjects and nonallergic controls. To assess the overall contribution to the cellular response of PjE components of different molecular weights, we separated the extract by the SDS-PAGE technique, and the fractions were blotted onto nitrocellulose and solubilized. Almost all the 14 fractions tested induced T-cell proliferation, at different degrees of magnitude. Responses were similar in the allergic subjects and nonallergic controls. Immunoblotting demonstrated specific IgG antibodies to the 14 PjE fractions not only in the allergic subjects, but also in the healthy controls, whereas IgE antibodies were found, as expected, only in the sera from atopic subjects. These findings indicate that PjE fractions elicit similar T-cell activation and IgG production in allergic and normal subjects.

[Plasma levels of beta-endorphins and ACTH in labor with continuous peridural analgesia]. / Dosaggio plasmatico di beta-endorfine e ACTH nel travaglio di parto in analgesia peridurale continua.

In order to investigate whether continuous lumbar epidural analgesia is associated with alterations of plasma levels of beta-endorphins and ACTH, we have studied a group (A) of patients under epidural analgesia and a matched group of control (B) at different stages of labour. Plasma levels of beta-endorphins and ACTH in group A did not significantly change during the labour, while in group B beta-endorphins and ACTH increased in the second stage of labour and decreased thereafter one hour after delivery. The levels of beta-endorphins and ACTH in umbilical cord mix blood were elevated in both groups.

beta2-microglobulin serum level is not a marker of disease activity in multiple sclerosis.

Beta2-microglobulin (beta2-MG) is a pharmacodynamic marker of interferon-beta activity in multiple sclerosis (MS). Its role in the natural course of the disease is not fully known. We analyzed the spontaneous fluctuation of beta2-MG in free-treatment MS patients during a short-time course to quantify beta2-MG as a marker of disease activity/progression. Thirty MS patients were clinically assessed and imaged monthly over a 3-month period. Sera were collected concomitantly for the evaluation of beta2-MG, by means of an enzyme-linked immunosorbent assay. Sera from 20 healthy individuals (HI) were drawn and used as controls. The Mann-Whitney test was used when appropriate and time effect on radiological and biological measures was assessed by means of the random effect models. Eight (26.7%) patients experienced a clinical relapse but three (10%) required steroid treatment. A reduction in the contrast-enhancing lesion load (P = 0.02) and a trend (P = 0.07) toward a decrease in brain parenchyma fraction were observed. Baseline levels of beta2-MG were similar in patients and HI. Patients' beta2-MG values increased over the 3-month time period (P = 0.05) but did not exceed those detected in HI at any time point. These results failed to demonstrate the validity of beta2-MG as a surrogate marker of disease in MS.