Ethical issues associated with in-hospital emergency from the medical emergency team's perspective: a national survey

Medical Emergency Teams (METs) are frequently involved in ethical issues associated to in-hospital emergencies, like decisions about end-of-life care and intensive care unit (ICU) admission. MET involvement offers both advantages and disadvantages, especially when an immediate decision must be made. We performed a survey among Italian intensivists/anesthesiologists evaluating MET's perspective on the most relevant ethical aspects faced in daily practice

Use of porcine collagen matrix (Mucograft®) to promote the wound healing in the oral cavity

The aim of this study was to evaluate the use of a new collagen matrix (Mucograft®; Geistlich Pharma AG, Wol- husen, Switzerland) in the soft tissue reconstruction after excisional biopsy. The healing of soft tissues after bioptical excision tends to heal by secondary intention. To avoid this, the soft tissue grafts can be harvested from the palate, retromolar pad, or (if available) edentulous site. Disadvantages of harvesting the graft from the retromolar pad and edentulous site are minimal amount of tissue availability and thinner grafts are obtained. The use of collagen matrix is also reported in literature and could represent an optimal solution in the future. Mucograft® is a pure collagen type I and III matrix of porcine origin without further cross-linking. Mucograft® consists of pure porcine collagen obtained by standardized, controlled manufacturing processes. The product made up of porcine collagen has a bilayer structure. The compact layer consists of compact collagen fibers which has cell occlusive properties and allows tis- sue adherence as a prerequisite for favourable wound healing. This layer protects against bacterial infiltration in open healing situations and has appropriate elastic properties to accommodate suturing. A second layer consists of a thick, porous collagen spongious structure. In this paper, we report about a case of surgical site healing after biopti- cal excision proliferative verrucous leukoplakia of the hard palate

Evidence of field cancerization of oral squamous cell carcinoma: a case report

Objectives. From 1953 (1) the term “field cancerization” has been used to describe an “increased risk of cancer de- velopment in the entire upper aerodigestive tract due to multiple genetic abnormalities in the whole region after pro- longed exposure to carcinogen” (2). This phenomenon implies the occurrence of multiple primary tumors/potentially malignant disorders as results of cell-molecular aberrations in different independent sites (polyclonal theory) or from the same site through widespread expansion or later spread across the mucosa (monoclonal theory). Case report. A 63-year-old female patient referred in June of 2014 for exophytic/ulcerative lesion in the hard palate. At the same time, several teeth (1.5, 1.6 and 3.6) with poor prognosis and an incisional biopsy were per- formed. The histological examination reported a diagnosis of oral squamous cell carcinoma (G1) and the manage- ment (imaging and TNM staging) was scheduled. Unfortunately, 30 days after exodontia, one of alveolar sites (3.6) showed proliferative tissue and not healing. A new biopsy was carried out, revealing an histological diagnosis of “epithelium with marked parakeratosis, acanthosis and papillomatosis associated with areas of moderate dys- plasia (IIC: PanCK)”. Conclusions. The features described in different areas of the oral cavity led us to make a diagnosis of oral field can- cerization. This condition still must be analyzed in order to clarify the onset and development but, most importantly, a protocol for manage these patients have to be developed. Chemoprevention and cessation of smoking and alcohol may impact new tumors. Amelioration of surgery, radiotherapy, chemotherapy and gene therapy may influence the morbidity and mortality of oral cancer patients, even if a short follow up and the secondary prevention may warrant a life-long surveillance

Optical coherence tomography as a simple and non invasive tool for the diagnosis of oral disease: a case report

Introduction. Optical Coherence Tomography (OCT) is a new biomedical imaging modality that provides high reso- lution cross-sectional images of tissue. Conceptually, it has been compared with ultrasound scanning but it uses in- frared light and records reflections below the surface to produce a cross-sectional architectural image of the tissue. OCT has been applied in ophthalmology and recently in dermatology; several studies have shown the validity of the use of OCT in ex vivo oral lesions but, to date, it does not exist a bank of normative and pathological OCT data of the oral tissues to consent identification of cellular structures of normal and pathological processes. We report a case of fibroma, analyzing in vivo OCT use and comparing data with microscopic evaluation. Case report. A 44-year-old woman was referred to the Department Surgical, Oncological and Oral Sciences, Univer- sity of Palermo, with a neoformation on the apex region of the tongue, clinically compatible with the diagnosis of fi- broma or papilloma. Firstly, in vivo OCT analysis demonstrated the presence of a white area, due to the presence of hyper-reflective area for collagen storage that is strongly scattering. After, exeresis was performed and histological examination confirmed the diagnosis of fibroma. Conclusion. Optical coherence tomographic imaging can produce detailed cross-sectional images of tissue of oral cavity and it could be a new non-invasive approach that will help improve the diagnosis and the follow up of oral le- sions. The validity of OCT in ex vivo oral lesions is confirmed in literature, while in vivo OCT validity should be sup- ported by comparation of data of several oral disease: further researches are needed

Biomasa individual y poblacional de arbustos dominantes en estepas patagónicas pastoreadas

269-279Estimating aboveground biomass of vegetation is essential for population, community and ecosystem studies. In systems dominated or co-dominated by woody species, biomass estimation is difficult, and rapid and non-destructive methods are needed. In this study, we describe biomass distribution in different components (i.e., wood, leaves) and how this changes with shrub size for the three dominant species of shrubs in the Occidental District of the Patagonian steppe. We also describe the population size structure of the three species in grazed fields and estimate their contribution to total abundance and biomass through a non-destructive method. We developed allometric equations to estimate aboveground biomass components of individual shrubs from structural descriptors (i.e., diameter and height of the crown), sampling individual plants of different sizes. The variable that best predicted biomass of the three species was the sum of the height and the average diameter of the crown (calculated with the largest diameter and its perpendicular). Allometric models for each species explained more than 83 percent of the variability of individual aboveground biomass. At the individual level, species had different proportions of wood, leaves and specific wood weight. Increasing shrub size was accompanied by changes in the proportion of leaves to wood, and in some cases, the percentage of dead crown. At the population level, the three species differed in size distribution in moderately grazed fields. Development of allometric models from a population perspective is important to study demographic processes that drive community and ecosystem responses to environmental and land-use changes

Stomatitis and vR-TkI: a review of current literature in 4369 patients

the following review was performed to answer to the question \u201cWhat is the rate of incidence of oral stomatitis in patients treated with VegF tKis?\u201

ORAL LESIONS DUE TO ACINETOBACTER BAUMANNII INFECTION IN A PATIENT AFFECTED BY AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA): FIRST CLINICAL REPORT

Aim. Acinetobacter Baumannii (coming from the Greek “akinetos,” i.e. non-motile) is an opportunistic bacterial pathogen primarily associated with hospital-acquired infections. Commonly associated with aquatic environments, A. Baumannii easily contaminates the surrounding environment and it colonizes acute ill patients in which can survive for several days. Generally, A. Baumannii is able to damage mucous membranes or exposed skin after accident or injury; it may be responsible of many diseases such as pneumonia, bacteremia, meningitis, urinary tract infections, peritonitis and infections of skin and soft tissues. Tissues infected by A. Baumannii initially present “orange peel” appearance followed by sandpaper-like presentation, when there is a disruption, hemorrhagic bullae can be seen with a visible necrotizing process followed by bacteremia. Current therapy is based on intravenous administration of tigecycline 100-200 mg (first dose) and 50-100 mg every 12 h for up to 14 days, unless complications. If untreated, this infection can lead to septicemia and death. The mortality rate of this infection is high, especially in case of bacteremia (52%) and pneumonia (23–73%). A. Baumannii is resistant to many drugs and represents an important nosocomial pathogen that particularly infects critically ill patients. At the best of our knowledge, no case of oral infection has been reported. to present the first one case characterized by oral soft tissue infection due to A. Baumannii responsive to imipenem. Materials and methods. a 78 years male was hospitalized in August of 2013 at the Hematology unit of the A.O.U.P. “P. Giaccone” of Palermo with a diagnosis of autoimmune hemolytic anemia (AIHA). He was treated per os with corticosteroids (Prednisone) and immunosuppressants (Rituximab and Cyclophosphamide), also IVIG (Intra Venous Immuno-Globulin) was administreted. In November 2013, the patient was treated with piperacillin IV (Tazocin) for treating an urinary tract infection; four days after, multiple oral ulcerative bullous lesions on the lingual and buccal mucosa and crusted lesions on the lip vermilion appeared, associated with intense pain. An oral swab for bacteria research was carried out; topical therapy (chlorhexidine rinses and hyaluronic acid gel) has been prescribed and piperacillin therapy was stopped. Oral swab outcome resulted positive for A. Baumannii and Enterococcus Faecalis, both sensitive only to imipenem, that was administrated (500 mg IV every 8h) for 10 days. The patient was immediately isolated in a single room for preventing and controlling the spread of A. Baumannii. Results. From diagnosis, every 3 days clinical examination of the oral cavity was performed, revealing the progressive regression within thirty days until complete healing without leaving scars. After, a second oral swab confirmed the absence of any bacteria. Conclusions. The World Health Organization has recently identified antimicrobial resistance as one of the three most important problems facing human health and among the most common and serious pathogens, including A. Baumannii. It is an emerging potentially drug-resistant micro-organism and its isolation must alert physicians to carry on all preventive measures for avoiding contamination of other patients, especially those immunosuppressed, at risk for severe persistent infections or death. This precaution should be continued for all the duration of hospitalization and until the negativization of culture samples was obtained. It is important that physicians and dentists recognize suspicious lesions in unusual locations, such as oral mucosa, in absence of other known etiological factors in a timely manner before the diffusion among other patients in order to avoid the spread of a nosocomial outbreak

Osteoradionecrosis of the jaws due to teeth extractions during and after radiotherapy: A systematic review

Teeth extractions before or after radiotherapy (RT) could be procedures at high risk for osteoradionecrosis (ORN) onset. This systematic review was performed to investigate the ORN incidence following teeth extractions during and after RT for head and neck (H&N) cancer and to evaluate any other possible risk factor. Methods: This systematic review was conducted according to PRISMA protocol, and the PROSPERO registration number was CRD42018079986. An electronic search was performed on the following search engines: PubMed, Scopus, and Web of Science. A cumulative meta‐analysis was performed. Results: Two thousand two hundred and eighty‐one records were screened, and nine were finally included. This systematic review revealed an ORN incidence of 5.8% (41 patients out of 462, 95% CI = 2.3–9.4); 3 ORN developed in the maxilla. No other clinical risk factors were detected. Conclusion: Post‐RT teeth extractions represent a major risk factor for ORN development, especially in the mandible, with a diminishing trend in the last years. Further research on other possible risk factors might improve this evidence