Policlinico Tor Vergata Research Articles

P483: Burst suppression with identical bursts: a distinct pathological EEG pattern in post anoxic coma

P484 – Figure 1 Results: Of 179 patients, 34 had bursts suppression with identical bursts. Kappa was 0.8 and disagreement resulted from sampling error. Burstsuppression with identical bursts was always bilateral synchronous, amplitudes were higher and correlation coefficients of burst shapes were higher than in burst-suppression without identical bursts. All patients with identical bursts had a poor outcome. Bifurcation analysis is ongoing. Figure 1. EEG of a comatose patient after cardiac arrest showing “burst-suppression with identical bursts”. Discussion: We confirm that “burst-suppression with identical bursts” is a distinct pathological EEG pattern after diffuse cerebral ischemia. It represents a low dimensional state of which potentially underlying mechanisms are currently explored and will be presented at the conference. Reference: [1] Hofmeijer, Tjepkema-Cloostermans, van Putten. Clin Neurophysiology 2013 (DOI 10.1016/j.clinph.2013.10.017) Poster session 28. Inflammatory diseases of CNS and PNS P484 Epidemiology and potential prognostic factors in Guillain-Barre syndrome: ten years experience of “Policlinico Tor Vergata” G. Mataluni, S. Rossi, C. Rocchi, M. Mangiardi, G.A. Marfia University of Rome “Tor Vergata”, Neuroscience, Roma, Italy Guillain Barre syndrome (GBS) is an acute immune-mediated peripheral

Preliminary experience in platelet crossmatching at Policlinico Tor Vergata SIMT – Rome

Preliminary experience in platelet crossmatching at Policlinico Tor Vergata SIMT – Rome

Automated cell processing device to eliminate DMSO: experience of Policlinico Tor Vergata

Introduction: DMSO is the most important cryoprotectant used during cryopreservation. At room temperature, DMSO is toxic for hematopoietic progenitor cells (HPCs) and its infusion during transplant is associated with mild (nausea, vomiting, flushing, rash, abdominal pain or hypotension) or severe (neurological complications, renal failure, cardiovascular disorders) adverse effects. There are several methods to reduce the amount of DMSO; we present our experience in automatic washing of DMSO in cryopreserved HPCs. Methods: From July 2013, 21 autologous HPC infusions were performed using automatic washing procedure with Sepax (Biosafe). For each procedure we evaluated: total nucleated cell (TNC) and total CD34+ cell counts; TNC and CD34+ cell viability; clonogenic assays (CFU-GM, CFU-Tot; microbial contamination of washed product; neutrophil (at least 0.5×109/L) and platelet (stable PLT counts >20×109/L) engraftment. Results: The median pre-wash counts of TNC and CD34+ cells were respectively: 48.5×109 (range 11.9–488) and 5.45×108 (range 3.24–12.2). The median post-wash count of TNC and CD34+ cells were respectively: 37.1×109 (range 10.6– 481) and 4.89×108 (range 2.59–16.5). Post-wash viability of CD34+ cells was (median value): 88% (range 32–99). Median recovery of TNC and CD34+ cells after washing procedure was respectively: 94% (range 36–105) and 97% (80–103). The median values of CFU-GM and CFU-Tot were 27.1×104/kg (range 11.9–100.8) and 57.6×104/kg (range 33.3– 200.6). Median time until neutrophil engraftment with peripheral blood neutrophils counts was 13 days (range 2–19). Median time until PLT engraftment was 16 days (range 8–35). No microbial contamination in washed product. No adverse events detected during infusion. Discussion: Our experience shows that washing of cryopreserved HPCs is a safe and effective procedure that decreases the frequency of adverse events during stem cell infusion. Automatic DMSO-depletion keeps the CD34+ cell numbers and viability as well as their engraftment potential.

Trattamento chirurgico-ortodontico degli incisivi in malposizione: protocollo terapeutico

ObjectivesThe aim of this report is to provide clinicians with useful information for immediate management of impacted maxillary incisors due to obstacles to eruption. Materials and methodsA 8-year-old boy was seen in the Operative Unit of Orthodontics of Policlinico Tor Vergata in Rome. Radiographic images showed intraosseus impaction of the maxillary left central incisor due to a compound odontoma. The treatment plan consisted of three stages: (1) removal of the odontoma and extraction of the deciduous incisors; (2) rapid maxillary expansion in order to improve the intraosseus tooth position; (3) surgical exposure and orthodontic traction of the impacted central incisor to its right position. ResultsThe impacted maxillary left central incisor was brought into proper alignment with the adjacent teeth and produced a nice smile. Two years after the treatment, the patient presented good occlusal stability, adequate width of attached gingiva, no periodontal bone loss, symmetric gingival margins for both maxillary central incisors. ConclusionsThe improvement of the intraosseus position of the unerupted incisor, obtained by removal of the odontoma and rapid maxillary expansion, has enabled a conservative surgery and the achievement of an excellent esthetics and periodontal result.

Deterioration of glucose homeostasis in type 2 diabetic patients one year after beginning of statins therapy

ObjectiveWe evaluated the long-term effects of rosuvastatin and simvastatin on insulin sensitivity and secretion in patients with well-controlled type 2 diabetes. MethodsAfter a 3 weeks run-in, 27 eligible patients were randomly assigned to receive either rosuvastatin 20 mg daily (Group 1) or simvastatin 20 mg daily (Group 2) for 6 months; thereafter they were switched to the other treatment for additional 6 months. Patients were recruited among individuals attending the outpatient service of the Diabetology Unit of the “Policlinico Tor Vergata” University Hospital, Rome, Italy. Serum lipids, glucose and insulin, glycated hemoglobin, C-reactive protein, TNF-α, leptin, adiponectin, insulin sensitivity by euglycemic–hyperinsulinemic clamp, β-cells function by HOMA-β were assessed at months 0, 6 and 12. Additionally, endothelial function was assessed by use of the brachial artery reactivity technique. ResultsBesides marked reduction in lipid levels, glycated hemoglobin significantly increased from baseline after 12 months in both Group 1 (+0.8 ± 0.2%, p < 0.001) and Group 2 (+0.9 ± 0.3%; p < 0.001). Similar trends were observed for fasting glucose in both groups. No changes in insulin sensitivity were detected throughout the study, whereas HOMA-β significantly decreased from baseline after 12 months in both Group 1 (−21.9%, p < 0.01) and Group 2 (−38.9%; p < 0.001). In addition, both treatments similarly decreased C-reactive protein and leptin, as well as improved endothelial function. No changes in anthropometric measures were observed. ConclusionsIn well-controlled type 2 diabetic patients both rosuvastatin and simvastatin significantly impaired glycemic control and insulin secretion, without affecting insulin sensitivity.

Trattamento ortodontico-chirurgico di canini mascellari inclusi. Caso clinico

ObjectivesCombined surgical-orthodontic treatment of impacted maxillary canines has advanced significantly in recent years, regarding management of both hard and soft tissues and forces of traction. The aim of this report is to describe a combined surgical-orthodontic approach used to treat an impacted maxillary canine and to evaluate the functional and esthetic results after 5 years of follow-up. Materials and methodsA 13-year-old boy was seen in the Operative Unit of Orthodontics of Policlinico Tor Vergata in Rome. Radiographic images showed intraosseous impaction of tooth no. 2.3 in a setting of late mixed dentition, and the patient was scheduled for the combined surgical-orthodontic treatment. ResultsFive years after the combined treatment, the patient presented good occlusal stability.The maxillary canine that had been orthodontically repositioned showed keratinized mucosa of adequate width on the facial side with a margin that followed the course of the enamel-cement junction. Bleeding was absent on probing, the periodontal pocket depth was <4mm, and there was no radiographically evident bone loss. ConclusionsThe combined surgical-orthodontic technique used in this case (closed eruption towards the center of the alveolar ridge associated with conservative periodontal surgery, the acid-etch technique, and controlled orthodontic traction) simulates physiological tooth eruption and results in proper alignment with good periodontal results. It should thus be regarded as the treatment of choice for impacted teeth whose eruption is not precluded by the position of the tooth and/or the presence of ankylosis.

The radioprotection management of a PET department with a cyclotron and radiopharmacy laboratory, in accordance with Italian legislation

The possibility of setting up a positron emission tomography (PET) facility with a cyclotron and radiopharmaceutical laboratory in situ, at a feasible price and in a very restricted space, has led to a steady increase both in the use of the PET technique in diagnostic clinical routine imaging and in the number of cyclotrons for drug production. Owing to the progress made in the PET procedures, it is now possible to have not only a highly innovative system of diagnostic examination, with a remarkable improvement in the diagnostic quality and patient care, but also a considerable increase in the number of daily examinations. In this paper, the authors show how the acquired know-how, with respect to radioprotection, has applied to the planning, running and management of the PET/CT unit, installed in the Imaging Diagnostic Department of the Policlinico Tor Vergata (PTV), at Tor Vergata University, Rome.

Application of Local Vibrations in Delayed and Non-Union Fractures: a Case Study

The aim of the study was to assess the efficacy of local vibration treatments (LV) in delayed-union and non-union fractures, through therapeutic exercise vibration (TEV) practice, analysing the radiological trend. The Medical Engineering Service of the Fondazione Policlinico Tor Vergata in collaboration with the Chair-Department of Rehabilitation Medicine of the University of Rome Tor Vergata and the Boscosystem company, is developing a device dedicated to LV application, to favour bone regeneration and muscle strengthening. This case report analyses the bone activity of a male patient presenting a right tibial fracture, treated with TEV. At the end of the TEV program, clinical results confirmed independent ambulation with disappearance of perimalleolar edema, while radiographic images revealed the presence of bone repair activity around the fracture line.

No evidence of family history as a risk factor for herpes zoster in patients with post‐herpetic neuralgia

Little is known about reactivation of latent varicella zoster virus as herpes zoster in individuals with no underlying immunosuppression. Risk factors include age, sex, ethnicity, exogenous boosting of immunity from varicella contacts, underlying cell-mediated immune disorders, mechanical trauma, psychological stress, and immunotoxin exposure. An association between herpes zoster and family history of zoster has been proposed. A case-control study involving patients affected by post-herpetic neuralgia, which usually follows more severe acute herpes zoster, was performed. The patients with post-herpetic neuralgia were enrolled at the Pain Clinic of the Policlinico Tor Vergata in Rome, Italy, within 1 year from the onset of acute zoster. The controls matched for sex and age were chosen among healthy subjects without a history of herpes zoster presenting at the Internal Medicine Outpatient Clinic for hypertension in the same time period. All the participants in the study gave informed consent and were interviewed by medically trained and blinded investigators using a questionnaire. Similar proportions of the patients and the controls reported a family history of herpes zoster irrespective of the degree of relationship, i.e., 17.4% and 18.2%, respectively, by analyzing only the first-degree relatives [RR 1.03 (CI 95%: 0.78-1.37)], and 28.4% and 29.6%, respectively, by analyzing the total number of relatives [RR 1.03 (CI 95%: 0.81-1.31)]. Further and larger prospective cohort studies are needed to ascertain whether a family history of herpes zoster is really an independent predictor of zoster in different geographical settings.

Photoselective Prostatic Vaporization for Bladder Outlet Obstruction: 12-Month Evaluation of Storage and Voiding Symptoms

We evaluated voiding and storage symptom evolution in patients treated with prostate photoselective vaporization by a KTP laser. Enrolled in the study were 150 consecutive patients with lower urinary tract symptoms due to benign prostatic hyperplasia and a diagnosis of bladder outlet obstruction. Patients underwent prostate photoselective vaporization with the 80 W KTP laser. Baseline parameters included prostate volume, International Prostate Symptom Score with voiding and storage symptom subscores, uroflowmetry, pressure flow study and serum prostate specific antigen. Patients were followed 1, 3, 6 and 12 months after surgery. Mean +/- SD patient age was 69.6 +/- 10 years. Mean prostate volume was 52 +/- 18 ml. Mean International Prostate Symptom Score was 22.3 +/- 4, mean maximum urine flow was 9 +/- 2.9 ml per second and mean Schäfer obstruction class was 3.6 +/- 1. An average of 190 +/- 44 kJ were delivered in a mean of 68 +/- 24 minutes with an average of 3.6 kJ/ml prostate. The mean number of fibers was 1.2 +/- 0.4. Mean catheterization time was 20 +/- 8 hours. Retrograde ejaculation was reported in 67% of patients. Prostate specific antigen was significantly decreased at 12 months (2.6 +/- 2.3 vs 0.9 +/- 0.7 ng/ml, p = 0.001). Storage symptoms decreased by 54.5%, 63.6%, 72.7% and 81.8% at 1, 3, 6 and 12 months, respectively (p <0.001). Voiding symptoms decreased 63.6%, 72.7%, 81.8% and 90.9% at 1, 3, 6 and 12 months, respectively (p <0.001). As shown by a prostate specific antigen significant decrease, proper prostate debulking may be achieved by prostate photoselective vaporization. Significant continuous improvement in storage and voiding symptoms was observed at up to 12-month followup.