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PURPOSE: To evaluate by a clinical spectrophotometric analysis the staining side effect of a 0.2% chlorhexidine (CHX) mouthrinse containing an anti-discoloration system (ADS) compared with a 0.12% and a 0.2% CHX mouthrinse, after periodontal surgery. The efficacy of the products and the patient's opinion and acceptance were also assessed. METHODS: The study was carried out on 60 subjects scheduled for periodontal flap surgery at the Unit of Periodontology and Dental Hygiene (University of Trieste, Italy). After surgery, the subjects were randomly prescribed to rinse for 1 week with 10 ml of a 0.12% CHX (Group 1), 0.2% CHX (Group 2) or 0.2% ADS CHX (Group 3). Before surgery (TO), 7 days (T1) and 14 days (T2) after surgery, following variables were recorded: gingival parameters at the surgically treated sites (Full-Mouth Plaque Score, Full-Mouth Bleeding Score and Modified Gingival Index), tooth pigmentation measured as AE, patient perception and acceptance of the mouthrinses. RESULTS: 53 subjects completed the study. The difference among treatments related to gingival variables was not statistically significant. No statistical differences were found for dental pigmentation among the mouthrinses over time nor for discomfort at each follow-up examination. A slightly less acceptance rate was observed for 0.2% CHX. The following conclusions were drawn: (1) 0.2% CHX with ADS did not cause less brown pigmentation than the 0.2% CHX or than the 0.12% CHX; (2) 0.2% ADS CHX was as effective as CHX without ADS in reducing gingival signs of inflammation in the post-surgical early healing phase; (3) 0.2% CHX showed the lowest score in terms of taste acceptance compared with 0.12% and ADS CHX.

OBJECTIVES: Etiological periodontal therapy is effective in reducing cyclosporin A-induced gingival overgrowth, but a high variability among subjects has been observed. This study aimed to evaluate the role of polymorphisms in PAI-1 and A BCB1 genes on the course of this side effect following periodontal therapy. METHOD AND MATERIALS: Forty-five transplant patients were subjected to nonsurgical periodontal therapy and evaluated for hypertrophy index, probing depths, bleeding, and plaque scores at baseline, and after 3 and 6 months. A BCB1 (C3435T and G2677T) and PAI-1 (4G/5G) polymorphisms were studied with polymerase chain reaction-restriction fragment length polymorphism and allele-specific polymerase chain reaction respectively. RESULTS: All the monitored periodontal indexes decreased significantly during the six months. Modeling of hypertrophy index by linearmixed- effect models (allowing non-normal distribution of the outcome variable hypertrophy index) resulted in the selection as the most significant model, of the one comprising the independent variables: time, C 3435T genotype, and their interaction term. This model indicated that C 3435T-mutated patients had significantly higher baseline hypertrophy index values (90% Markov chain Monte C arlo empirical confidence intervals: 5.08, 30.00). The decrease in hypertrophy index values over time showed a trend toward being faster in mutated than nonmutated patients (interaction time: C 3435T nonmutated, 90% Markov chain Monte C arlo empirical confidence interval: -11.08, -0.40). When hypertrophy index values were normalized, the significance and trend were lost. No effect of the A BCB1 G2677T and PAI-1 4G/5G polymorphisms was observed. CONCLUSION: These preliminary results suggest that C 3435T polymorphism is a genetic factor that could influence the course of cyclosporin A-induced gingival overgrowth in transplant patients subjected to periodontal therapy.

Scopo del lavoro: L’acido ialuronico ha dimostrato di possedere effetti antinfiammatori utili nel trattamento della malattia parodontale. Lo scopo di questo studio è stato valutare l’efficacia di un gel a base di aminoacidi e sodio jaluronato applicato topicamente o intrasulcularmente e abbinato alla strumentazione meccanica ultrasonica. Materiali e metodi Sono stati selezionati 20 pazienti con diagnosi di parodontite cronica (almeno 2 siti con PPD ≥5 mm e CAL ≥5 mm) e poi suddivisi in modo randomizzato in quattro gruppi: A applicazione topica del gel; B applicazione topica di placebo; C applicazione intrasulculare del gel; D applicazione intrasulculare di placebo. Tutti i pazienti sono stati trattati in un’unica seduta di full mouth ultrasonic debridement. L’applicazione topica è stata eseguita a casa dai pazienti tre volte al giorno per una settimana. L’applicazione intrasulculare del gel è stata eseguita ambulatorialmente a baseline, il giorno 7, 15, 30 e 45. Le valutazioni parodontali (IP, BOP, PPD, CAL e GCF) sono state eseguite a baseline a 45 e 90 giorni. Conclusioni In tutti i gruppi è stato ottenuto un miglioramento dei parametri clinici parodontali (IP, BOP, PPD, CAL). La quantità del fluido crevicolare si è ridotta in modo statisticamente significativo nei siti trattati con l’applicazione topica del gel; nel gruppo trattato con applicazioni intrasulculari la riduzione del GCF è stata più graduale nel tempo. Conclusioni L’utilizzo del gel a base di aminoacidi e sodio jaluronato dopo full mouth ultrasonic debridement può migliorare la situazione parodontale di pazienti con parodontite cronica.

Objectives: Following non-surgical periodontal treatment, to assess the potential efficiency of the re-treatment of residual periodontal pockets by traditional mechanical treatment and by use of 810 nm diode laser in a clinical randomized double blind perspective study. Material and methods: Twenty systemically healthy subjects were included. The subjects had previously undergone routine periodontal therapy and in 45 days reassessment they still showed at least 8 bleeding sites (2 for each quadrant) with probing pocket depth (PPD) ≥5 mm and plaque index (PI) score ≤25%. A split mouth design was applied for the decontamination of these pockets; as two quadrants were retreated with traditional non-surgical therapy and two quadrants with 810 nm diode laser. The subjects were examined at the four experimental sessions (baseline, 15s, 30s and 90s), and at each session PI, PD, clinical attachment level (CAL) and bleeding on probing (BOP) scores were recorded. Data were statistically analysed by means of ANOVA for repeated measurements (SpSS 13.0). Results: The results demonstrated that diode laser treatment, for the residual pockets (PPD ≥5) mm with bleeding after routine therapy, provides very similar outcome compared to re-treatment with traditional therapy, both in terms of PPD and of CAL, as improvements after 15 days (CAL gain of 0.61-1,06 mm) and maintenance of these results could be observed. Conclusion: When compared to traditional non-surgical periodontal re-treatment, 810 nm diode laser does not seem to provide any additional decontaminating effect and thus any clinical benefits.

Background Breast cancer is the most frequent malignant tumour to metastasize into the gastrointestinal tract in female and is second only to malignant melanoma. Nevertheless gastrointestinal metastases arising from breast cancer are quite rare. The upper gastrointestinal tract is more frequently involved and lobular infiltrating carcinoma has a greater predilection compared to the ductal type. Case presentation The authors describe the case of a 70 years old woman with a preoperative diagnosis of gastric undifferentiated medullary – type carcinoma, which was the first manifestation of an occult breast carcinoma. The primary site of carcinoma was identified with the use of a panel of selected immunohistochemical markers. Conclusion Our goal in this case report is to increase the awareness of surgeons and clinicians to rule out the possibility of mammary origin in circumstance of gastric cancer occurring in female, even in patients without a previous or concurrent history of breast carcinoma. Although not a particularly common event, it is, nevertheless, reported in the literature. The differentiation between primary gastric carcinoma and metastatic breast carcinoma is essential for planning the correct therapeutic approach, in order to avoid the patient unnecessary surgery.

BACKGROUND AND OBJECTIVE: The aim of the present study was to determine the association between genotypes of the MDR1 gene, encoding P-glycoprotein, and gingival overgrowth in transplant patients treated with cyclosporine, and to evaluate the effect of periodontal treatment in these patients. MATERIAL AND METHODS: Fifty transplant patients receiving therapy with cyclosporine and suffering from gingival overgrowth were subjected to nonsurgical periodontal treatment and received oral hygiene instructions. Hyperplastic index, periodontal probing depths, bleeding and plaque scores were recorded at baseline and after 3 and 6 mo. Patients were dichotomized into two groups: those with a hyperplastic index of < 30% (minimal gingival overgrowth) and those with a hyperplastic index of > or = 30% (clinically significant gingival overgrowth). MDR1 C3435T and G2677T polymorphisms were evaluated in all patients and in 100 controls. RESULTS: At baseline, 32 patients (64%) had minimal gingival overgrowth and 18 patients (36%) had clinically significant gingival overgrowth. The mutated C3435T genotype was significantly more frequent in the second group (p < 0.019). The significant association between gingival overgrowth and the 3435TT genotype was confirmed by logistic regression analysis (p < 0.031). The differences in hyperplastic index, observed at baseline between patients with the TT genotype and those with the CC/CT genotype disappeared in the second and third evaluation. The mean monthly change of the square root of the gingival overgrowth scores for all patients, assessed using linear models, was significantly different from baseline (-0.17 points per month, p < 0.00001); and this was particularly evident in subjects with renal transplant (-1.62, p < 0.01). CONCLUSION: Aetiological periodontal and self-performed maintenance therapy is effective in reducing gingival overgrowth, particularly in subjects with the 3435TT genotype and in patients with renal transplant.

The routine use of intraoperative cholangiography during laparoscopic cholecystectomy remains controversial. Mirizzi was the first to recommend the use of intraoperative cholangiography in 1931 based on the high incidence of unsuspected common bile duct stones. The use of intraoperative cholangiography before common bile duct exploration reduced the incidence of unnecessary common bile duct explorations from 66% to less than 5%. With the introduction of laparoscopic cholecystectomy, an increase of incidence of bile duct injury two to four times that seen in open cholecystectomy was witnessed. The vast majority of the injuries were a direct result of the surgeon misidentifying the anatomy. The Authors report their experience in the use of intraoperative cholangiography to prevent bile duct injuries and to discover common bile duct unknown lithiasis. METHODS: From December 2002 to January 2004 in 169 patients affected to cholecystolithiasis were undergone cholecystectomy. During this operation intraoperative cholangiography was performed routinely. The patients were divided in two groups. In the Group A the patient with high risk according to a score system. and the others in the group B. RESULTS: The cholangiography was performed with success in the 97% of patients. It were discover common bile duct in the 17%, biliary anatomy anomalies in the 3.5%, bile duct injuries in the 0.5% and false positive in the 2.9%. CONCLUSION: The Authors recommended the routinely use of intraoperative cholangiography owing to its a feasible and safe technique with a success rater greater than 90%. If a bile duct injury is going to occur because of misidentification, cholangiography will not prevent the injury, but a properly performed cholangiogram will minimize the extent of the injury. Finally, the intraoperative cholangiography can discover a common unknown bile duct lithiasis and can reduce incidence of unnecessary ERCP with subsequent complication

Gastrointestinal stromal tumors (61ST) are an heterogeneous group of non epithelial tumors of the gastrointestinal tract. They are peculiar to extreme cellular variability and uncertain malignancy. Gist are rare tumors that arise from primitive mesenchymal cells located in all gastrointestinal tract. Till now they are object of discussion about their origin, diagnostic standards, prognostic factors, histopathological classification. They are more frequently in over 40 years old people without difference in two sex, but they can appear in the child too and in the young man suffering from HIV. The authors relate two cases of recent observation, and discuss on the biological behaviour of these rare tumors.

Un paziente di 24 anni si è presentato alla nostra osservazione con una sintomatologia caratterizzata da dolore addominale, febbre e ittero. L'esame ecografico dell'addome mostrava una colecisti litiasica con dilatazione della via biliare principale senza immagini da riferire a calcoli nel suo interno. La colangio-RM mostrava una stenosi del terzo distale del coledoco con dilatazione del tratto a monte. Lo stesso quadro veniva mostrato da una colangiopancreatografia endoscopica retrograda. Il paziente veniva, quindi, sottoposto a laparotomia esplorativa. La colecisti non conteneva calcoli, ma nella zona infundibolare era palpabile un nodulo duro, rotondeggiante, apparentemente indovato nello spessore della parete. Un'altra formazione di consistenza dura era palpabile nel tratto medio del coledoco. Inoltre, furono evidenziati alcuni linfonodi aumentati di dimensioni in sede mesenterica e dell'ilo epatico. Si procedeva all'esecuzione di una colangiografia: il dotto biliare principale presentava una stenosi nella sua porzione distale, il passaggio del mezzo di contrasto in duodeno, anche se ridotto, era mantenuto. Si procedette a biopsia di un linfonodo dell'ilo epatico e a colecistectomia. L'esame istologico estemporaneo del linfonodo ilare dimostrava un quadro di leucemia monocitica acuta. L'intervento fu concluso con il confezionamento di una coledoco-duodenostomia su tubo di Kehr. Il decorso postoperatorio è stato regolare e privo di complicanze e il paziente è stato sottoposto a chemioterapia. Sette anni dopo l'intervento il paziente è vivo e in assenza di malattia.

Objective: To investigate the relationship between the presence of ectopic calcification in the elongation of the styloid process (SP) and its possible clinical manifestation (Eagle syndrome) in a population of kidney-transplant patients previously treated with hemodialysis. Methods: Digital orthopantomography of 92 kidney-transplanted patients and 68 control subjects were analyzed to measure the length of SPs. Calcium, phosphate, alkaline phosphatase, and parathyroid hormone (PTH) blood levels were also available for comparison. Results: The mean length of SPs was significantly different between groups, as were phosphate and PTH values. Discussion: Renal transplant patients who have been treated with hemodialysis present elongated SPs, presumably due to alterations in phosphate balance and PTH levels. Thus, in cases of orofacial pain in patients with a history of altered bone metabolism, particularly when due to renal insufficiency, Eagle syndrome should be suspected as the main cause of symptoms.

Objectives: To analyse the possible presence of reduced cognitive efficiency in family caregivers of patients with prolonged disorders of consciousness (DOC). Subjects: The participants were 27 caregivers of 25 patients with DOC admitted to the severe brain injury units of the ICS Maugeri, Institutes of Telese Terme and Sciacca, Italy. Methods: We examined cognitive functions such as short- and long-term memory, executive functions and attention by means of standardized tests. We also assessed features of psychological distress such as anxiety, depression, psychophysiological symptoms, prolonged grief disorder, psychological burden and quality of life. All scores on neuropsychological tests were compared with those of the 15 matched control subjects. Results: Enrolled family caregivers showed high frequency of clinically relevant depressive symptoms and anxiety; half of them met the criteria for prolonged grief disorder. Caregivers achieved scores lower than the matched controls on tests for selective attention, verbal fluency and long-term spatial memory. Conclusions: Family caregivers’ burden is associated with a reduced efficiency of selected executive measures and visuospatial learning. These results emphasize the need for appropriate psychological and cognitive supporting therapies for family caregivers of patients with DOC, also considering their delicate involvement in clinical decision-making and in providing care.

I maltomi della tiroide sono rare neoplasie della ghiandola originati dalle cellule B parafollicolari, frequentemente associati a tiroidite autoimmune di Hashimoto. Gli Autori propongono un caso di linfoma tiroideo primitivo in cui nè l'evoluzione clinica, nè i dati strumentali e citologici preoperatori, nè l'esame istologico eseguito sul resecato chirurgico hanno evidenziato l'associazione con una tiroidite pregressa. Il caso appare interessante per la comparsa a circa 6 mesi dall'intervento di una grave forma di aplasia selettiva della serie rossa (pure red cell aplasia, PRCA) ub assenza di autoanticorpi o di segni di pregressa infezione virale, con remissione completa dopo trattamento corticosteroideo.

Con il termine day-surgery s’intende la possibilità clinica, organizzativa ed amministrativa di effettuare interventi chir u rgici o procedure diagnostiche e/o terapeutiche invasive e semiinvasive in regime di ricovero limitato alle sole ore del giorno, in anestesia locale, loco-regionale o generale (1) . Scopo del nostro lavoro è di valutare l’attività di daysurgery integrata nel nostro reparto di chirurgia generale

The Authors report their experience in the palliative management of malignant colorectal obstruction. Between June 2000 and April 2003 sixteen patients (11 men and 5 women, age range 63-82) were found suffering from malignant colorectal obstruction. In these patients it was not possible to perform definitive surgical treatment because of the old age, advanced neoplastic disease and poor health condition, colostomy was the only therapeutic option. Endoscopic self-expanding stents placement was performed as a definitive palliative method to treat colorectal obstructions caused by advanced and unresectable tumours. This procedure was performed under endoscopic and fluoroscopic control and neither analgesia nor sedation was administered during the procedure. Results: Stent placement was successful in 14 cases (87,5%) with relief of bowel obstruction within following 24 hours. Conclusions: It was possible to obtain a permanent intestinal canalization and other treatments weren’t necessary during the follow-up. The results obtained were similar to the data of literature.

AA. report an extremely rare case of anorectal melanoma s imul a t ing an hemor rhoida l ma s s in a s ixty- four ye a r old woman. The first symptom was anal pain attributed to an anal fissure, easily bleeding, unsuccessfully treated with ointments. It was confused with hemorrhoids andthe patient a underwent to operation. Dur ing thi s proc edur e , us ing Liga sur e™ (Va l l e y l a b , California, S.U.A.) the surgeon suspected the presence of malignancy togheter too rmorroidal mass. Extemporaneous istological exam shos the presenceof the melanoma. Instrumental examination to staging disease demonstred bilateral inguinal linfoadenectomy. The linfonodes excised veren’t metastatic.

gli autori riortano il caso di una donna obesa affetta da cistoadenoma mucinoso gigante dell'ovaio. nonostante la presenza di una massa addominale voluminosa, la paziente non accusava sintomatologia degna di rilievo.

A potentially serious complication of laparoscopic cholecystectomy is the inadvertent dissemination of unsuspected gallbladder carcinoma. There are increasing reports of seeding of tumor at the trocar sites following laparoscopic cholecystectomy in patients with unexpected or inapparent gallbladder carcinoma. Although the mechanism of the abdominal wall recurrence is still unclear, laparoscopic handling of the tumor, perforation of the gallbladder, and extraction of the specimen without an endobag may be risk factors for the spreading of malignant cells. The Authors report the case of late development of umbilical metastasis after laparoscopic cholecystectomy; the presence of an incisional hernia and the finding of a stone in subcutaneous tissue demonstrate the diffusion of tumor cells into subcutaneous tissue during the extraction of gallbladder. The patient underwent an excision of the metastases. She is disease free two years after surgical treatment.