Timing of soft tissue augmentation around implants: A clinical review and decision tree

PURPOSE

The goal of soft tissue augmentation is to improve the volume around implants and thus achieve better aesthetic and functional properties. The present review aims to make recommendations and guide clinicians in performing soft tissue augmentation procedures, focusing on the importance of timing.

OVERVIEW

Soft tissue augmentation can be performed at different time points: before or after implant placement, at implant placement (immediate/delayed), at healing abutment connection or after final restoration. Before/after implant placement or at healing abutment connection are considered the gold standard time points at which to perform soft tissue augmentation due to the possibility of achieving complete coverage of the soft tissue graft or its substitute through simple flap elevation and the easy handling of tissue. On the other hand, performing soft tissue augmentation at implant placement or after crown delivery seems to be less predictable due to the different healing approaches and the unexpected shrinkage that occurs.

CONCLUSION

Timing needs to be considered when performing soft tissue augmentation, taking into account the advantages and disadvantages related to operator experience, implant position and patient expectations. Employing a reliable approach at the appropriate time of intervention could limit complications.

Multi-Input Multi-Output Dynamic Modelling of Type 2 Diabetes Progression

Type 2 Diabetes Mellitus (T2D) is a chronic health condition that affects millions of people globally. Early identification of risk can support preventive intervention and therefore slow down disease progression. Risk characterization is also necessary to monitor the mechanisms behind the pathology through the analysis of the interrelationships between the predictors and their time course. In this work, a multi-input multi-output Gaussian Process model is proposed to describe the evolution of different biomarkers in patients who will/will not develop T2D considering the interdependencies between outputs. The preliminary results obtained suggest that the trends in biomarkers captured by the model are coherent with the literature and with real-world data, demonstrating the value of multi-input multi-output approaches. In future developments, the proposed method could be applied to assess how the biomarkers evolve and interact with each other in groups of patients having in common one or more risk factors.

Dynamics of Nucleation in Solids: A Self-Consistent Phase Field Approach

We derive a phase field method for computing rigorously the nucleation rate and the incubation time from the sole knowledge of the free energy of the system in the metastable regime. Our theoretical results are assessed against experimental data relative to demixing of an iron-chromium alloy. Our work clarifies the notions of nucleation rate and incubation time extensively used in classical nucleation theory (CNT) processes in solids. Our work thus emerges as an alternative to CNT but of more general applicability, and enables us to model the nucleation process across the whole range of condition encountered in first order phase transitions, an aspect in which CNT fails.

Proliferation and Morphological Assessment of Human Periodontal Ligament Fibroblast towards Bovine Pericardium Membranes: An In Vitro Study

Over the past decade regenerative branches of dentistry have taken on more and more importance, resulting in the development of performing scaffold materials. These should induce cell adhesion, support, and guide the tissues’ growth. Among the developed materials, we can include resorbable or non-membranes. The purpose of this study was to investigate the proliferation abilities and the attachment of human periodontal ligament fibroblasts (HPLIFs) over two bovine pericardium membranes with different thicknesses, 0.2 mm and 0.4 mm, respectively. These membranes have been decellularized by the manufacturer, preserving the three-dimensional collagen’s structure. The HPLFs were cultured in standard conditions and exposed to the tested materials. XTT was performed to assess cell proliferation, while light microscopy (LM) and scanning electron microscopy (SEM) observations assessed fibroblast morphology at different times (T1, T2, and T3). Proliferation assays have shown a statistically significant difference in growth at T1 (p < 0.05) in the cells cultured with a thicker membrane compared to the thinner one. LM analysis showed healthy fibroblasts in contact with the membranes, appearing larger and with a polygonal shape. SEM observation demonstrated thickening of the fibroblasts which continued to adhere to the membrane’s surface, with enlarged polygonal shape and developed filipodia and lamellipodia. These results showed a similar cell behavior over the two bovine pericardium membranes, demonstrating a cellular migration along and within the layers of the membrane, binding with membrane fibers by means of filopodial extensions. Knowledge of the effects of the collagen membranes derived from bovine pericardium on cellular behavior will help clinicians choose the type of scaffolds according to the required clinical situation.

The best prostate biopsy sampling system-fusion and systematic biopsy: A single center experience

BACKGROUND

Prostate cancer is the second most commonly diagnosed cancer in men. The diagnostic accuracy in prostate cancer can be increased by employing a preliminary multiparametric MRI followed by a fusion-targeted biopsy.

METHODS

To compare the diagnostic accuracy of fusion-targeted biopsy with the standard systematic biopsy in prostate cancer patients, we enrolled 139 patients on which we performed 139 prostate biopsies consisting of three targeted samples followed by 12 regular systematic samples. Based on histology, we analyzed the diagnostic performance of the two methods.

RESULTS

Both methods were equally good at detecting clinically significant cancer (83.3%, 50/60), while systematic biopsy detected more clinically insignificant cancers. However, the best diagnostic performance is obtained by combining the two methods.

CONCLUSION

The two methods are best seen as synergistic, and the addition of fusion biopsy can be used to detect more clinically significant prostate cancers than systematic biopsy alone.

Symmetry Breaking Resulting from Long-Range Interactions in Out of Equilibrium Systems: Elastic Properties of Irradiated AgCu

This work presents a consistent formulation of the phase-field approach to model the behavior of nonmiscible alloys under irradiation which includes elastic strain fields, an example of a long-range interaction. Simulations show that the spatial isotropy that is characteristic of radiation-induced patterns breaks down as a result of the elastic strain energy. The consequence of this is the emergence of superlattice structures under irradiation liable to modify macroscopic material properties. This approach is assessed against the experimental study of a AgCu alloy under irradiation: we compare our simulation results to measured solubility limits and Young moduli.

Bladder schistosomiasis in Italy: A case report

INTRODUCTION

Human schistosomiasis is a snail-borne disease caused by parasitic blood-dwelling flukes. A long-term infection can lead to the risk of liver damage, kidney failure, infertility, or bladder cancer. The most common sign is hematuria with the blood first seen in the terminal urine, but in severe cases the whole urine sample can be dark colored. We analyze the case of a healthy African child living in Italy since birth, harboring a hidden debilitating disease that was picked up during ultrasonography.

CASE REPORT

A 11-year-old African child was admitted to our emergency department with macroscopic hematuria, dysuria, and frequency for 2 months. Ultrasonography revealed a solid mass involving bladder's right wall. Non-contrast and contrast-enhanced scans of computerized tomography showed a mass of 45 mm x 15 mm on the right bladder wall. A bipolar transurethral resection of bladder was performed. The pathological examination showed findings consistent with Schistosoma haematobium.

DISCUSSION

The clinical manifestations of schistosomiasis depend on the inflammatory response to the parasitic infection. In particular, it can manifest in the bladder as painless dysuria, urinary incontinence and urinary frequency, hematuria, or even urinary retention if the trigone is involved. Utilization of ultrasonography for diagnostic evaluation of schistosomiasis is mandatory. For treatment, the World Health Organization recommends praziquantel which has an efficacy of up to 90%.

Predicting Nonequilibrium Patterns beyond Thermodynamic Concepts: Application to Radiation-Induced Microstructures

In this work, we derive an analytical model to predict the appearance of all possible radiation-induced steady states and their associated microstructures in immiscible A_{c[over ¯]}B_{1-c[over ¯]} alloys, an example of a nonequilibrium dynamical system. This model is assessed against numerical simulations and experimental results which show that different microstructures characterized by the patterning of A-rich precipitates can emerge under irradiation. We demonstrate that the steady-state microstructure is governed by irradiation conditions and also by the average initial concentration of the alloy c[over ¯]. Such a dependence offers new leverage for tailoring materials with specific microstructures overcoming limitations imposed by the equilibrium thermodynamic phase diagram.

Hepatitis C screening in the Emergency Department of a large hospital in southern Italy: results of a pilot study

Around 71 million people worldwide are chronically infected with hepatitis C. HCV prevalence among individuals born in the United States between 1945 and 1965 is estimated to be about 3%. In Italy, about 2% of the population is chronically infected with HCV. Since chronic HCV infection is often asymptomatic, many patients require access to medical care only in an advanced phase of the disease. The best strategy for bringing out hidden chronic HCV infection remains uncertain. The aim of the study was to evaluate the feasibility of an FDA-approved rapid salivary, point-of-care (POC) assay for anti-HCV, performed in patients aged between 45 and 80 years old who were referred to the emergency department of a large hospital in southern Italy and were all unaware of their HCV serostatus. In all, 966 patients were interviewed during the study period. Among them, 220 patients were enrolled. Notably, 25/588 (4%) reported to be anti-HCV positive. Of these, 19 were already being treated with direct-acting antivirals (DAA). Among the enrolled patients, two (0.9%) tested anti-HCV positive and 218 (99.1%) were negative at screening. Both patients with a positive test were male, below the age of 54, with a previous history of intravenous drug abuse, a low level of education, and who had had at least one experience of unprotected sex. We scheduled a visit for treatment evaluation for every positive patient who was not on treatment. Neither of the two de novo patients and 3/6 (50%) patients who were aware of their anti-HCV positivity came to the follow-up visit. Our study shows that a screening strategy for HCV infection in ED is feasible and that about 1% of patients attending the ED and who are unaware of their conditions are anti-HCV positive. Moreover, a non-negligible proportion of subjects, though aware of their condition, was not linked to any hepatologic center.

A model of defect cluster creation in fragmented cascades in metals based on morphological analysis

The impacts of ions and neutrons in metals cause cascades of atomic collisions that expand and shrink, leaving microstructure defect debris, i.e. interstitial or vacancy clusters or loops of different sizes. In De Backer et al (2016 Europhys. Lett. 115 26001), we described a method to detect the first morphological transition, i.e. the cascade fragmentation in subcascades, and a model of primary damage combining the binary collision approximation and molecular dynamics (MD). In this paper including W, Fe, Be, Zr and 20 other metals, we demonstrate that the fragmentation energy increases with the atomic number and decreases with the atomic density following a unique power law. Above the fragmentation energy, the cascade morphology can be characterized by the cross pair correlation functions of the multitype point pattern formed by the subcascades. We derive the numbers of pairs of subcascades and observed that they follow broken power laws. The energy where the power law breaks indicates the second morphological transition when cascades are formed by branches decorated by chaplets of small subcascades. The subcascade interaction is introduced in our model of primary damage by adding pairwise terms. Using statistics obtained on hundreds of MD cascades in Fe, we demonstrate that the interaction of subcascades increases the proportion of large clusters in the damage created by high energy cascades. Finally, we predict the primary damage of 500 keV Fe ion in Fe and obtain cluster size distributions when large statistics of MD cascades are not feasible.

Epidemiology and pathogenesis of fulminant viral hepatitis in pregnant women

INTRODUCTION

The pregnancy-associated immunological and hormonal changes may alter the immune response to infectious agents, including hepatitis viruses. Therefore, this phenomenon may affect the clinical course and the outcome of acute viral hepatitis in pregnant women.

EVIDENCE ACQUISITION

For this reason, we have focused on epidemiological and pathogenetic aspects of the fulminant liver failure caused by acute viral hepatitis reviewing PubMED in April of 2017.

EVIDENCE SYNTHESIS

Although all the viruses might cause a fulminant acute viral hepatitis in a pregnant woman, the large majority of fulminant failure reported in the literature had been related to hepatits E virus (HEV) mainly and had been concentrated in Indian subcontinent and some African areas, whereas the problem seems to be very low or absent in the remaining geographical areas. However, the rate of maternal mortality due to fulminant E hepatitis may vary inside the endemic areas of India and Africa, likely due to the circulation of HEV genotypes with different degree of virulence. The other hepatitis viruses have not been reported to cause a greater risk for fulminant hepatitis in pregnant women respect to non-pregnant ones, except Herpes simplex virus, that has been associated to some cases of fatal hepatitis in absence of a prompt antiviral therapy.

CONCLUSIONS

AVH should be considered when the pregnant woman develop fever, abdominal pain, malaise, nausea and anicteric hepatic dysfunction.

Optical properties of Ar ions irradiated nanocrystalline ZrC and ZrN thin films

Thin nanocrystalline ZrC and ZrN films (<400 nm), grown on (100) Si substrates at a substrate temperature of 500 °C by the pulsed laser deposition (PLD) technique, were irradiated by 800 keV Ar ion irradiation with fluences from 1 × 10¹⁴ at/cm² up to 2 × 10¹⁵ at/cm². Optical reflectance data, acquired from as-deposited and irradiated films, in the range of 500 - 50000 cm^-1 (0.06 - 6 eV), was used to assess the effect of irradiation on the optical and electronic properties. Both in ZrC and ZrN films we observed that irradiation affects the optical properties of the films mostly at low frequencies, which is dominated by the free carriers response. In both materials, we found a significant reduction in the free carriers scattering rate, i.e. possible increase in mobility, at higher irradiation flux. This is consistent with our previous findings that irradiation affects the crystallite size and the micro-strain, but it does not induce major structural changes.

Patterning in systems driven by nonlocal external forces

This work focuses on systems displaying domain patterns resulting from competing external and internal dynamics. To this end, we introduce a Lyapunov functional capable of describing the steady states of systems subject to external forces, by adding nonlocal terms to the Landau Ginzburg free energy of the system. Thereby, we extend the existing methodology treating long-range order interactions, to the case of external nonlocal forces. By studying the quadratic term of this Lyapunov functional, we compute the phase diagram in the temperature versus external field and we determine all possible modulated phases (domain patterns) as a function of the external forces and the temperature. Finally, we investigate patterning in chemical reactive mixtures and binary mixtures under irradiation, and we show that the last case opens the path toward micro-structural engineering of materials.

Structural Changes in the Local Environment of Uranium Atoms in the Three Phases of U4O9

The crystal structure of U4O9 remains an enigma because of its differences with U(4+) and U(5+) coordination polyhedral mixtures, as shown in the XANES experimental results. To better understand this crystal structure, its diffraction pattern was measured at seven different temperatures using neutron diffraction before being independently refined by Rietveld's method and pair distribution function analysis. The O cuboctahedron-a structural element consisting of 13 oxygen atoms-is a specific feature of the U4O9 crystal structure. The volume of the cuboctahedron decreases when the temperature increases, whereas the overall volume of the crystal cell increases. This feature can be correlated with the two U4O9 phase transitions that induce sharp changes in the cuboctahedron geometry, suggesting that this structural element has internal dynamics. In particular, these structural modifications in the γ phase suggest that the high-temperature phase can be described as a mixture of U(4+) and U(5+) coordination polyhedra, the latter having U-O distances shorter than 2.2 Å, that are absent in the former. These changes in uranium polyhedra as a function of temperature are tentatively interpreted using steric arguments. They also raise the question of charge localization on the different U ion sites in the low-temperature phases of U4O9.

Cascade fragmentation under ion beam irradiation: a fractal approach

Based on the fractal nature of collisions, the fragmentation of displacement cascades is investigated. Introducing the caliper diameter to take into account large displacements of atoms in a collision cascade, it is possible to describe this fragmentation in terms of a threshold energy Ec. From the knowledge of Ec, the number and the volume fraction of subcascades produced is then derived. This last information allows us to classify the efficiency of impinging particles to induce structural changes of solids.

Concentration profile distortion under ion beam mixing: an example of Levy flight

In order to model the evolution of concentration profiles induced by ion beam mixing in thick layers, Monte Carlo simulations were performed to study in detail the transition probability controlling the evolution of this profile within the binary collision approximation. We demonstrate that this transition probability can be factorized in two distinct functions. The first one can be understood as a scale factor. The second one controls the dynamics of ion beam mixing which can be analyzed as a Levy flight. The power law form of the tail of this function closely linked to the cross section of a collision event is responsible for long tails of concentration profiles. We demonstrate that the Levy flight nature of ion beam mixing induces an enhancement of the evolution of the initial concentration profile.

Prevalence of depression, sleep-related disturbances, and anxiety and their effect on quality of life in patients with adenocarcinoma of the pancreas

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Purpose: To evaluate the prevalence of depression, sleep related disturbances and anxiety and their effect on quality of life in patients with recently diagnosed adenocarcinoma of the pancreas who present to a multidisciplinary pancreatic cancer clinic. Methods: Cross-sectional and longitudinal psychosocial distress was assessed utilizing Personal Health Questionnaire 9 (PHQ9) to screen for depression and monitor symptoms during the course of care, the Penn State Worry Questionnaire (PSWQ) for generalized anxiety, and the Sleep Problems Questionnaire 4 (SPQ4)/ University of Michigan Sleep Questionnaire to monitor sleep symptoms. Patients were evaluated at their intake consultation and at subsequent follow up visits. Results: 24 patients (pts; mean age 66 years, 48% females) consented to participate during the 6 month pilot study with longitudinal follow up for 13. The PHQ9 scores on presentation revealed mild to moderate depressive symptoms in 54% (13 pts) of pts and moderately severe depressive symptoms in only 8% (2 pts). A minority (2 pts, 8%) had PSWQ scores characteristic of an anxiety disorder, while 33% (8 pts) had moderate anxiety scores. Only 3 pts (12.5%) scores revealed a clear sleep problem; 10 pts, (41.67%) had no sleep problem and 10 pts had a potential sleep problem. Due to the limited follow up, a statistical difference in scores over time was not observed. Conclusions: Our results indicate that mild to moderate depressive symptoms, anxiety and potential sleep problems are common in patients referred to a multidisciplinary pancreatic cancer clinic. Moderately severe depressive symptoms, severe anxiety and clear sleep problems are not as prevalent as is generally believed. To better characterize the relationship of depression (and potential causes) with pancreatic cancer, additional prospective longitudinal studies are needed.

No significant financial relationships to disclose.

Prevalence of atopy in children with chronic constipation

OBJECTIVES

To evaluate the prevalence of chronic constipation (CC) in unselected children, its association with atopy and the efficacy of a cow's milk protein (CMP) elimination diet on refractory constipation.

STUDY DESIGN

The study was conducted by six primary care paediatricians, serving a population of 5113 children aged from birth through to 12 years; only 2068 children were 6 months to 6 years. During a 3-month period, prevalence of CC was determined for the entire study population, ages 0-12 years. In the second part of the study, all patients aged 6 months to 6 years with CC, and age- and sex-matched controls, were evaluated for atopy and its association with CC. A questionnaire was completed including personal and family history of atopy and bowel-movement characteristics. Patients were tested for atopy by specific serum IgE and/or skin-prick tests. Constipated patients, refractory to osmotic laxatives, underwent a 4-week CMP elimination diet.

RESULTS

91 (1.8%) children had CC, and 69 (3.3%) of the 6 months to 6 years age group fell into the atopy study age range. All 69 constipated children (mean age 34.9 (18.0) months) and 69 controls completed the questionnaire. Twelve of the 69 constipated children (17.3%) and 13 out of the 69 control children (18.8%) had a diagnosis of atopy. Eleven out of 69 (15.9%) constipated children were refractory to constipation treatment, and three (27.3%) of these had atopy. The 4-week trial of dietary elimination did not result in improvement in any of these 11 children.

CONCLUSIONS

In our study group, prevalence of atopy among children with CC is similar to that in the general population. The level of refraction of CC does not seem to be related to cow's milk allergy.

Neutron diffraction study of the size-induced tetragonal to monoclinic phase transition in zirconia nanocrystals

Accurate neutron powder diffraction experiments at several temperatures allow one to monitor the reconstructive tetragonal to monoclinic phase transition as a function of the size of zirconia nanoparticles. The structure of the tetragonal phase observed in the nanocrystals is identical to that observed in micrometric zirconia above 1400 K. A uniaxial strain depending on grain size is observed. The phase transition occurs above a threshold crystal size. These results are analyzed within the Landau theory and can be understood as a mechanism of size-dependent phase transition where the primary order parameter is altered by the nanoparticle size.

Human pancreatic acinar cells lack functional responses to cholecystokinin and gastrin

BACKGROUND & AIMS

Pancreatic acinar cells from various species express cholecystokinin (CCK) A, CCK-B, or a combination of these CCK receptor subtypes. The presence and functional roles of CCK receptors on human acinar cells remain unclear.

METHODS

Acini isolated from human pancreas were treated with CCK receptor agonists, CCK-8 and gastrin, and an agonist for m3 muscarinic acetylcholine receptors (m3 AchR), carbachol. Functional parameters measured included intracellular [Ca(2+)], amylase secretion, and ERK phosphorylation. Binding studies were performed using (125)I-CCK-8. Expression of messenger RNAs (mRNAs) was determined using real-time quantitative reverse-transcription polymerase chain reaction (RT-PCR) and localized by in situ hybridization.

RESULTS

Human acini did not respond to CCK agonists. In contrast, they responded to carbachol with robust increases in each of the functional parameters. Moreover, the cells responded to CCK agonists after adenoviral-mediated gene transfer of CCK-A or CCK-B receptors. A low level of specific and a high level of nonspecific binding of (125)I-CCK-8 were observed. Quantitative RT-PCR indicated that the message levels for CCK-A receptors were approximately 30-fold lower than those of CCK-B receptors, which were approximately 10-fold lower than those of m3 Ach receptors. In situ hybridization indicated the presence of m3 Ach receptor and insulin mRNA but not CCK-A or CCK-B receptor mRNAs in adult human pancreas.

CONCLUSIONS

These data indicate that human pancreatic acinar cells do not respond to CCK receptor agonists in terms of expected functional parameters and show that this is due to an insufficient level of receptor expression.

Characterization of the inflammatory infiltrate in peptic oesophagitis

BACKGROUND

The diagnosis of oesophagitis is mainly based on histology, but interpretation of endoscopic biopsies is often difficult. We performed immunohistochemical studies on oesophageal biopsies to see if better characterization of the inflammatory cell infiltrate would improve the accuracy of the histologic diagnosis of gastro-oesophageal reflux disease.

METHODS

The study groups consisted of 40 consecutive children (mean age +/- SD: 79.6 +/- 5l.9 months; 20 boys) with gastro-oesophageal reflux disease and 7 symptomatic children (mean age +/- SD: 52.6 +/- 37.0 months; 3 boys) without gastro-oesophageal reflux disease. All patients underwent upper gastrointestinal endoscopy with oesophageal biopsies. The diagnosis of gastro-oesophageal reflux disease was established by conventional endoscopic and histologic criteria. In each mucosal biopsy specimen, the number of intraepithelial CD3+, CD25+ (IL2 receptor+), ICAM+, HLA-DR+ and mucosal mast cells were determined.

RESULTS

Conventional histology was in close agreement with endoscopic findings (p<0.001) and reflected the clinical score even more than endoscopic findings. Conventional histology significantly correlated with each inflammatory immunohistochemical marker (<0.05 for each), but the markers were not predictive of symptom severity. Immunohistochemical markers were always abnormal in the gastro-oesophageal reflux disease patients, even in the mildest cases of oesophagitis.

CONCLUSIONS

Although there is a good correlation between symptoms and histology, in a subset of patients, immunohistochemical studies appear useful in supporting the histological diagnosis of gastro-oesophageal reflux disease.

Effect of the dietary fiber glucomannan on chronic constipation in neurologically impaired children

OBJECTIVE

Inadequate dietary fiber intake is a widely accepted explanation for chronic constipation in children with severe brain damage. The aim of our study was to evaluate the efficacy of glucomannan, a soluble fiber, as a treatment for chronic constipation in these children.

STUDY DESIGN

Twenty children with severe brain damage and chronic constipation were randomly assigned to double-blind treatment with either glucomannan (n = 10) or placebo (n = 10) for 12 weeks. Stool habits, total and segmental gastrointestinal transit times, and anorectal motility were evaluated in all children before and after the treatment period.

RESULTS

Glucomannan significantly increased (P <.01) stool frequency, whereas the effect of placebo was not significant. Laxative or suppository use was significantly reduced (P <.01) by glucomannan but was not affected by placebo. Clinical scores of stool consistency were significantly improved and episodes of painful defecation per week were significantly reduced by glucomannan (P <.01) but not by placebo. However, neither glucomannan nor placebo had a measurable effect on total and segmental transit times.

CONCLUSIONS

In neurologically impaired children, glucomannan improves stool frequency but has no effect on colonic motility.

Treatment of childhood peptic esophagitis: a double-blind placebo-controlled trial of nizatidine

BACKGROUND

Nizatidine is an H2 histaminic receptor blocker, which acts on the oxintic cells in the stomach. The efficacy of nizatidine on acid gastric secretion has been widely studied in adults with erosive and ulcerative esophagitis, but not in children. The aim of the present study was to evaluate the therapeutic efficacy of nizatidine in children with reflux esophagitis.

METHODS

Twenty-six patients were studied; all of them underwent endoscopy with multiple esophageal biopsies and 24-h intraesophageal pH monitoring. The diagnosis of esophagitis was based on histologic features. Patients were randomly assigned to double-blind treatment with either nizatidine or a placebo (10 mg/kg/day in two doses) for 8 weeks. A symptomatic score assessment was evaluated during the study.

RESULTS

Twenty-four patients completed the 8-week protocol. After therapy, 9/13 (69%) patients on nizatidine and 2/13 (15%) patients on the placebo were healed (p < 0.007 by Fisher's exact test). Histological findings were improved in two other (16.7%) patients and unchanged in the last (8.3%) patient on nizatidine. In the placebo group there was histological improvement in three (25%) patients, no variation in six (50%), and worsening in one (8.3%). After therapy, determination of esophageal pH showed a statistically significant decrease of the total acid exposure time (p < 0.01) only in the nizatidine group. The clinical score analysis showed an improvement of symptoms only in the nizatidine group (p < 0.01), except for vomiting, which was reduced in both groups.

CONCLUSIONS

Our results show that nizatidine is effective in treating children with reflux esophagitis. The children included in this study did not have severe esophagitis, and the conclusion must be limited to those with mild to moderate degrees of disease.

Riedel's thyroiditis: treatment with tamoxifen

BACKGROUND

Riedel's thyroiditis is an often disabling disease with clinical and histologic similarity to several other fibrous inflammatory disorders. Surgical treatment alone is often unsatisfactory in permanently alleviating airway compression, dysphagia, neck immobility, pain, or chronic fatigue syndrome. Investigation of drugs shown to be of benefit in the treatment of related fibrous disorders in which hormonal factors or inflammatory deregulation appear to be important is indicated. Tamoxifen has not been previously used in the treatment of Riedel's thyroiditis.

METHODS

Four patients with clinical and histologic diagnoses of Riedel's thyroiditis were evaluated before and after treatment with tamoxifen. Each had progressive symptomatic disease of 3 to 16 years' duration despite one or more surgical procedures and steroid therapy. Subjective improvement was noted in all cases, and objective changes were confirmed by periodic physical and computed tomographic examinations.

RESULTS

Patients have been monitored for 1 to 4 years with subjective improvement in 100% and objective disease regression ranging from 50% to 100% in all patients. One patient had complete regression within 6 months, and another had more than 50% regression within 3 months. All have returned to predisease activity levels. There were no significant side effects of the therapy.

CONCLUSIONS

Tamoxifen has proved to be the most effective drug therapy available for managing Riedel's thyroiditis. Our studies suggest that this is unrelated to antiestrogen activity. Tamoxifen's effectiveness may be caused by a mechanism by which it stimulates the release of transforming growth factor-beta, which may inhibit the fibroblastic proliferation characteristic of Riedel's thyroiditis.

The radicular dentine temperature during laser irradiation: a numerical modeling

The boundary element method is well adjusted to the numerical resolution of thermal diffusion problems existing in complex volumes such as teeth. This technique is used to determine the temperatures in the bulk and on the surface of a tooth illuminated by a CO2 laser beam. The parameters taken into account in calculations include power absorbed by the tooth, laser irradiation time, and diameter of the beam on the tooth. In each case, a very fast and short heating period is observed on the tooth surface; then, the temperature decreases slowly. Inside the tooth, temperature variations are small or nonexistent. Temperature increases due to a laser beam remain concentrated at the impact region. Results are in reasonable agreement with experimental results.

Cisapride in neurologically impaired children with chronic constipation

The efficacy of cisapride as a treatment for chronic constipation in children with severe brain damage was studied in 20 children. Each subject was randomly assigned to double-blind treatment with either cisapride (N = 10) or placebo (N = 10) for 12 weeks. Stool habits, total gastrointestinal transit time, colonic segmental transit times, and anorectal motility were evaluated in all children before and at the end of the treatment period. Although cisapride significantly (P < 0.05) increased stool frequency from baseline to week 12 and no significant change was documented in the placebo group, the mean change in stool frequency per week from baseline to 12 week was not significantly different between the two treatment groups. The use of laxatives or suppositories was significantly (P < 0.05) decreased by cisapride, but remained unchanged in the placebo group. Furthermore, cisapride significantly (P < 0.05) reduced rectal compliance but had no effect on total gastrointestinal transit time and colonic segmental transit times. In summary, in neurologically impaired children with chronic constipation, cisapride increased bowel frequency but did not alter the delay in total and segmental gastrointestinal transit times.

Proximal oesophageal pH-metry in children with respiratory symptoms

Twenty-six children (mean age: 16.3 months) with vomiting and/or respiratory symptoms and 28 children (mean age 10.5 months) with vomiting and/or regurgitation underwent dual-site 24-hour oesophageal pH recording. Thirty-nine children had gastro-oesophageal reflux and in all of them, irrespective of respiratory symptoms, distal oesophageal acid exposure was significantly (p < 0.01) longer than proximal exposure. Furthermore, data from the proximal pH electrode were not significantly different between children with and without respiratory symptoms for any of the variables studied. In conclusion, no single features of reflux pattern, as determined by 24-hours pH-metry, account for respiratory symptoms in children with documented gastro-oesophageal reflux.

The radicular dentine temperature during laser irradiation: an experimental study

The detoxification and sterilization radicular surfaces that have been produced by periodontal diseases could be accomplished after polishing (root planing) using the thermal elevation resulting from CO2 laser on continuous emission. In vitro experiments reveal that thermal elevations reached on the surfaces or in the depth are proportional to the dispersed energy. The thermal elevation in the depth (0.5-1 mm from the impact point) remained moderate because of the water absorption potentials of the radiations. Energies from 2 to 4.5 J can help obtain the combination of surface temperature elevation, which allows detoxification, and of a thermal elevation in the depth, compatible with vital tissues. This energy has to be delivered at an application time under 0.6 sec in continuous mode.

Effect of low dose Amiodarone on the incidence of sudden death in elderly patients with congestive heart failure: a double-bind, placebo-controlled study

To determine if low-dose Amiodarone could reduce sudden death (SD) among patients with congestive heart failure, a prospective, double-blind, placebo-controlled study was conducted. The study group consisted of 46 patients (36 men and 10 women, mean age 71 +/- 5 years) with complex ventricular ectopy documented by 48-hour Holter monitoring. Randomization divided the patients into two treatment groups: the first group received Amiodarone (400 mg/day for 1 week and then 100 mg/day), while the second group received placebo. The drug significantly reduced ventricular arrhythmias, but then was no decrease in incidence of SD. This study demonstrates not only that low-dose Amiodarone can be safely administered to elderly patients with congestive heart failure and it will significantly suppress ventricular arrhythmias, but also that reduction in ventricular arrhythmias and the risk of SD are not linearly related.

Differentiation of cows' milk intolerance and gastro-oesophageal reflux

The aim of this study was to compare a non-invasive test of small bowel permeability with a more invasive approach involving endoscopy, mucosal biopsy, and oesophageal pH monitoring for rapidly differentiating gastro-oesophageal reflux (GOR) and cows' milk intolerance in 25 infants with persistent vomiting. Each subject underwent a cellobiose/mannitol permeability study, upper gastrointestinal endoscopy with oesophageal and small bowel biopsies, and a 24 hour pH study. Reflux disease and/or cows' milk intolerance was responsible for vomiting in 24 (96%) of the subjects. Sixteen (64%) of the infants had GOR alone, four (16%) had GOR and cows' milk intolerance, and four (16%) had cows' milk intolerance alone. Morphometric analysis of small bowel biopsies was abnormal in 19% of the patients with GOR alone and in 67% with cows' milk intolerance with or without GOR. The permeability test was abnormal in only 6% of the patients with GOR but in 100% with GOR and cows' milk intolerance and in 100% with cows' milk intolerance alone. The non-invasive permeability study aimed at rapid determination of cows' milk intolerance should pre-empt a more invasive approach in the evaluation of infants with persistent vomiting.

Cryopreserved cancellous bone allograft in periodontal intraosseous defects

The purpose of this study was to evaluate the potential of cryopreserved cancellous bone allograft (CCBA) in the treatment of intraosseous periodontal defects compared to surgical debridement alone (DEBR). Cancellous bone was procured from femur heads that had been extracted for hip prosthesis procedures and cryopreserved in liquid nitrogen (-196 degrees C) in a tissue bank. Ten patients without systemic disorders and advanced periodontal disease (at least 2 intraosseous defects) participated in this investigation. Measurements from the cemento-enamel junction were made after initial therapy for clinical attachment level; also gingival recession, probing pocket depth, plaque index, and gingival index and, at the time of surgery, alveolar crest height and osseous defect depth were measured. All measurements were repeated at 1 year-reentry. Sixteen defects were debrided and grafted (test sites) and 13 defects were debrided only (control sites). Soft tissue measurements showed no statistical differences between the 2 groups. Defect fill was significantly greater with CCBA (1.75 mm) than with DEBR (0.56 mm). Defect depth reduction was 2.06 mm for CCBA and 0.78 mm for DEBR. These values correspond to a percent-defect resolution of 60% for CCBA and 29% for DEBR. Hard tissue measurements showed significant differences between the 2 groups. CCBA seems to be effective in the short-term treatment of intraosseous periodontal defects.

[The effect of a formaldehyde-tyrothricin combination placed in periodontal pockets in association with scaling and root planing]

A solution of formaldehyde and tyrothricin was placed in periodontal pockets of 14 patients. One maxillary quadrant was used as the experimental side, while the contralateral quadrant was employed as the control. A placebo solution was placed in the pockets of the control side. Both the experimental and control sides were treated on days -3, 0, +4, +7, +11 and +14. Scaling and root planing was accomplished on day 0. Plaque and gingival indices, and gingival fluid volume were recorded on all of the treatment days, as well as on day +28. Pocket depths were noted on days -3, 0, +14 and +28. Improvements were noted in all parameters measured on both the experimental and control sides, although statistical analyses revealed that plaque and gingival indices were slightly better in the experimental side. The author concludes that placing a Formaldehyde-Tyrothricin solution in periodontal pockets offers some therapeutic gain over scaling and root planing alone.