Forty-three patients with malignant nonmyeloid diseases underwent peripheral blood stem cell collections on an apheresis system (Spectra, COBE BCT, Lakewood, CO). Collections took place during the white cell (WBC) recovery phase following conditioning chemotherapy. One hundred two procedures were done after chemotherapy alone, and 72 procedures after chemotherapy plus granulocyte-colony-stimulating factor (G-CSF). Four centrifugal separation factors were tested. One and one-half patient blood volumes were processed in each procedure. The mean volume of the collected component was 158 +/- 16 mL. After chemotherapy alone, the procedures provided a mean of 0.8 x 10(8) WBCs per kg and 2.3 x 10(4) colony-forming units-granulocyte macrophage (CFU-GM) per kg of recipient body weight. The mononuclear cell percentage in the components increased with the centrifugal separation factor from 85 to 96 percent. In parallel, platelet contamination increased from 2.1 to 3.8 x 10(11). The collect hematocrit ranged from 1.0 to 2.5 percent (0.01-0.025). The collection efficiency for mononuclear cells and CFU-GM also increased with the centrifugal separation factors from 52 to 70 percent for mononuclear cells and from 55 to 68 percent for CFU-GM. Collections performed after G-CSF-stimulated mobilization were characterized by a higher neutrophil contamination independent of centrifugal separation factor, which gave a mean mononuclear cell percentage of 64 percent in the collected component. The average yield for these procedures was 2 x 10(8) WBCs per kg and 28 x 10(4) CFU-GM per kg.(ABSTRACT TRUNCATED AT 250 WORDS)

IntroductionLeukocyte-platelet rich fibrin belongs to a second generation of platelet concentrates that does not need biochemical blood manipulation. It is used for tissue healing and regeneration in periodontal and oral-maxillofacial surgery. We report two cases of hyperplastic gingival lesions treated by exeresis and application of leukocyte-platelet rich fibrin membranes in order to improve and accelerate tissue healing.Case presentationTwo patients (a 78-year-old Caucasian woman and a 30-year-old Caucasian man) were treated for hyperplastic gingival lesions. They underwent to exeresis of lesions and application of leukocyte-platelet rich fibrin membranes. Tissue healing was clinically evaluated after 1, 3, 7, 14 and 30 postoperative days. No recurrences were observed after 2 years of semi-annual follow up.ConclusionsWe obtained rapid and good healing of soft tissues probably due to the elevated content of leukocytes, platelets and growth factors in the leukocyte-platelet rich fibrin. Based on our results we suggest the use of leukocyte-platelet rich fibrin to cover wounds after exeresis of oral neoformations such as hyperplastic gingival lesions.

When lower third molar inclusion is associated with neurosensorial complications, the treatment of choice is its surgical avulsion. One of these complications, that may be the most alarming during a first medical examination, is hemi-lip paraesthesia, that can appear in the presence of several mandibular lesions. This is a report of a rare clinical case in which paraesthesia was linked to the closeness between the root block of the dental element and the mandibular canal, which houses the neurovascular trunk of the lower mandibular nerve. A 64 year-old male Caucasian patient, presented with the chief complaint of past periodic inflammatory events in the retromolar region of the oral cavity and hemi-lip paraesthesia. Upon local clinical and radiological examination, a lower left third molar with class 3 position C inclusion was incriminated. The medical history of the patient revealed well compensated diabetes mellitus type II, and pharmacologically controlled hypertension. The tooth was surgically removed using piezoelectric instruments. Before and after surgery, three types of tests (tactile, pain and thermal sensitivity) were carried out to delimit the area affected by paraesthesia. At 7 days, the area of hypoesthesia of the hemi-lip was significantly reduced. Further improvement in tactile and thermal sensitivity occurred in subsequent follow-up, at 1 and 3 months, postoperatively. This clinical case demonstrates that the surgical intervention performed with piezoelectric instruments prevented the damage of an important structure such as the lower mandibular nerve, and promoted regression of a contingent paraesthesia.

Dear Editor,Bleeding represents the most feared complication of oral anticoagulant therapy (OAT) with vitamin K antagonists (VKA), one of the major classes of drugs used in cardiovascular medicine. Of the general population in developed countries, 1-1.5% is subject to OAT, 1 with widespread use over the last two decades. 2,3 Elderly patients represent the main group of patients treated with OAT, with a high prevalence in this group of diseases needing OAT, such as atrial fibrillation. 4 But advanced age also represents one of the main risk factors for VKA-related bleeding, together with severe liver and kidney diseases, severe thrombocytopenia, history of previous bleeding, anemia, dementia and risk of falls. 5 The incidence rate of major hemorrhage rises gradually with age from 1.5 per 100 patient-years for patients younger than 60 years to 4.2 per 100 patientyears for patients older than 80 years, yielding a hazard ratio of 2.7 (95% confidence interval, 1.7-4.4). 6 Bleeding is classified as major if it leads directly to death, it occurs in critical organs (brain, retroperitoneum, peritoneum, chest, spinal cord, joints, gastrointestinal tract), if it results in hemorrhagic shock, a decrease of 2 g/dL in hemoglobin (Hb) levels, or if it requires surgical or invasive maneuvers. The remaining bleedings are classified as minor bleedings. 7 Spontaneous and/or traumatic retroperitoneal bleedings represents a well-recognized OAT-related major complication, often related to a rupture of the iliopsoas muscle, whereas spontaneous renal hematoma (SRH) is a very uncommon example of OAT-related bleeding, diagnosis of it being often difficult and late, especially when signs such as macrohematuria are absent. Prothrombin complex concentrate (PCC) is now considered the first choice for urgent OAT reversal together with intravenous vitamin K1 (VK1) in VKA-related major bleedings. 8 The cornerstone of OAT reversal is bringing the International Normalized Ratio (INR) to a value less than 1.5, to restore normal coagulation, in association with maneuvers to stop bleedings and/or resolve hemorrhagic shock. 9,10 Recently, an 86-year-old man taking warfarin for chronic atrial fibrillation came to our attention for the abrupt onset of dyspnea and fatigue; he suffered from left sciatica for 3 days and left lumbar pain for a few hours. He denied fever, and macrohematuria was absent. Recent trauma was excluded.His past history revealed previous coronary artery bypass and prostatic cancer. Physical examination showed pallor and sweating. Systemic blood pressure (SBP) measured 75/50 mmHg, demonstrating a status of shock. Blood arterial gas analysis was substantially normal. A 12-lead electrocardiogram (ECG) revealed tachycardic atrial fibrillation (120 beats per minute) and complete right bundle branch block. Chest and abdominal radiographs and abdominal ultrasonography performed in the emergency department were unremarkable. Results of laboratory assays showed Hb levels of 10.6 g/dL, creatinine 1.41 mg/dL, normal values of brain natriuretic...

BACKGROUND: Intracranial haemorrhage represents the most feared stroke subtype. AIM: To evaluate the burden of intracranial haemorrhage in Tuscany hospitals with special reference to Livorno district. MATERIALS AND METHODS: Data of patients discharged in 2009 from Tuscan and Livorno hospitals with codes ICD-9-CM related to any type of spontaneous intracranial haemorrhage were selected and analyzed. RESULTS: 3,472 patients were discharged from Tuscan hospitals with these diagnoses. Overall mortality was 24.3%. 50% of patients were admitted in Internal Medicine wards. Incidence of intracranial haemorrhage and intracerebral haemorrhage (ICH) in population of Livorno district was 64 and 45/100,000 inhabitants/year with related mortality of 36.5% and 39.4%respectively. Intra-hospital mortality of patients admitted in Livorno hospitals for intracranial haemorrhage were 36.7%. 40% of deaths occurred in the first 48 hours. 69.6% of intracranial haemorrhage were ICHs, 16.8% subaracnoideal. Intra-hospital mortality, admissions for intracranial haemorrhage in respect of total admissions and mortality for intracranial haemorrhage in respect to total mortality increased in the last decade. 23% of patients with intracranial haemorrhage and 16% of patients with ICH underwent to surgical procedures. ICHs related to antithrombotic treatment significantly increased in the last years. Mortality in patients on antithrombotic drugs was three times over compared to that in patients not undergone these drugs (43.7% vs 12.8%, p < 0.01). CONCLUSION: There is an increasing trend in frequency, mortality and hospital burden of intracranial haemorrhage and ICH. Efforts aimed at reducing the burden and consequences of this devasting disease are warranted.