Hamartoma of mature cardiac myocytes: a cardiac tumour with preserved contractility

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Correlation between Specific Bacterial Groups in the Oral Cavity and the Severity of Halitosis: Any Possible Beneficial Role for Selected Lactobacilli?

Objective: Halitosis is a widespread problem, normally attributable to specific volatile sulphur compounds (VSC) in the breath. The aim of this study was to first relate halitosis with possible gastric infection by Helicobacter pylori and secondly to quantify specific bacterial groups in the oral cavity flora, thus correlating them with VSC concentrations and Proton Pump Inhibitors (PPIs) intake. Four selected lactobacilli were then assessed in the possible reduction of halitosis in subjects with a total salivary bacterial concentration higher than 105 CFU/ml. Methods: Specific bacterial groups, namely total bacteria, total coliforms, sulphite-reducing bacteria (SRB) and lactobacilli, were quantified in samples of saliva from 29 subjects taking PPIs compared with 36 control subjects. The amount of the three VSC hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide (CH3)2S in the breath and the presence of H. pylori were determined. Results: No significant correlation was found between H. pylori and halitosis as well as with PPIs intake. The baseline bacterial groups quantification (log10 CFU/ml of saliva, PPI group vs. control) showed: total bacteria 8.44 vs. 4.47 (p=0.001); total coliforms 4.95 vs. 2.82 (p=0.001); sulfite-reducing bacteria 5.47 vs. 2.58 (p=0.052); total lactobacilli 4.00 vs. 2.36 (p=0.016). After 15 days of lactobacilli supplementation, the same parameters (d15 vs baseline) gave: total bacteria 7.92 vs. 8.44 (p=0.019); total coliforms 3.13 vs. 4.95 (p=0.001); sulfite-reducing bacteria 4.69 vs. 5.47 (p=0.047); total lactobacilli 7.86 vs. 4.00 (p=0.048). No statistically significant differences were noted in VSC concentrations at any time. Conclusions: The intake of PPIs directly correlated with the overgrowth of specific bacterial groups in the oral cavity, but there was no correlation with H. pylori or with VSC concentration. The significant reduction in all the bacterial groups analysed after two weeks suggested the improvement of the overall oral flora in subjects chronically treated with PPIs

Use of contrast-enhanced intraoperative ultrasonography during liver surgery for colorectal cancer liver metastases - Its impact on operative outcome. Analysis of a prospective cohort study

Abstract Background Preliminary reports led to discordant conclusions concerning the use of contrast-enhanced intraoperative ultrasonography (CE-IOUS) during surgery for colorectal liver metastases (CLM). The aim of this study was to evaluate the impact of CE-IOUS in patients undergoing surgery for CLM using an advanced preoperative imaging work-up, and well-established reference standards. Materials and methods Forty-seven consecutive patients underwent liver resection using IOUS and CE-IOUS for CLM. All patients underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI) within 2 weeks prior to surgery. CE-IOUS was performed by injecting intravenously 4.8 ml of sulphur-hexafluoride microbubbles (SonoVue, Bracco, Italy). Reference standards were histology, and 6-month imaging follow-up. Results IOUS discovered 43 additional lesions in 20 patients. CE-IOUS found 10 additional lesions not seen at IOUS in four patients, and confirmed all the IOUS findings. Fourteen CLM in 10 patients appeared within 6 months after surgery. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were, respectively: 66%, 0%, 98%, 0% and 65% for CT + MRI; 88%, 100%, 100%, 8%, 88% for IOUS and 93%, 100%, 100%, 13%, 93% for IOUS + CE-IOUS. In nine patients CE-IOUS afforded better definition of tumour margins thus helping in resection guidance. Conclusions CE-IOUS improves IOUS findings both for detection and for resection guidance. The combination of IOUS and CE-IOUS should be considered routinely in patients operated for CLM

Cardiovascular magnetic resonance features of caseous calcification of the mitral annulus

We present two cases of caseous calcification of the mitral annulus studied by Cardiovascular Magnetic Resonance; the diagnostic feature of this rare cardiac mass are described