Peri-implant Tissue Health and Bone Resorption in Implant- Supported Fixed Partial Rehabilitations

PURPOSE

To evaluate peri-implant tissue health and bone resorption in patients with implant-supported fixed partial rehabilitations. In particular, possible correlations between plaque accumulation and bone loss, as well as other periimplant health parameters, were investigated.

MATERIALS AND METHODS

A total of 44 patients rehabilitated with fixed implant-supported partial rehabilitations were included. The following parameters were recorded: spontaneous bleeding (SB), suppuration, bleeding on probing (BOP), plaque index (PI), and probing depth (PD). Periapical radiographs were taken to measure crestal bone loss (BL). A nonparametric test (Spearman rank coefficient; rs) was used to identify possible correlations between the clinical parameters recorded.

RESULTS

A total of 121 implants were analyzed. Global PI and BOP were 49.58% and 20.25%, respectively. There were no cases of suppuration, and only 2 implants showed spontaneous bleeding. Mean BL was 1.53 mm (SD: 0.98). No implants showed peri-implantitis. There was a weak, statistically significant correlation between PI and BL (rs = 0.27, P [2-tailed] = .99) and between PI and the other peri-implant parameters (BOP: rs = 0.14, P = .14; PD: rs = 0.04, P = .65; SB: rs = -0.08, P = .34). A very weak correlation was also found between BL and BOP (rs = 0.1, P = .2) and between BL and PD (rs = 0.02, P = .7). Correlation was found between BL and age (rs = 0.13, P = .81) and between the other peri-implant parameters and age using dichotomization (> or < 65 years; PI: rs = -0.14, P = .11; PD: rs = -0.21, P = .01; BOP: rs = -0.21, P = .01; SB: rs = 0.05, P = .53). No statistically significant correlations were found between the clinical parameters evaluated and the sex or the dental arch treated (maxilla vs mandible). In contrast, the correlation between periodontal parameters and years elapsed since surgery (follow-up) was significant.

CONCLUSIONS

The present research suggests that in implant-supported fixed partial rehabilitations, dental implants with greater plaque accumulation are more likely to present augmented probing depth, peri-implant inflammation, and bone loss, although the correlation is statistically very weak. Patient age and time of follow-up also significantly affected peri-implant health parameters.

Biomarkers from Peri-Implant Crevicular Fluid (PICF) as Predictors of Peri-Implant Bone Loss: A Systematic Review

The aim of the present systematic review is to summarize current knowledge regarding the analysis of biomarkers extracted from peri-implant crevicular fluid (PICF) as predictors of peri-implant bone loss (BL). An electronic search was conducted on three databases, PubMed/MEDLINE, Cochrane Library, and Google Scholar, to find clinical trials published until 1 December 2022 suitable to answer the following focused question: in patients with dental implants, are biomarkers harvested from PICF predictive of peri-implant BL? The initial search yielded a total of 158 entries. After a full-text review and application of the eligibility criteria, the final selection consisted of nine articles. The risk of bias in included studies was assessed using the Joanna Briggs Institute Critical Appraisal tools (JBI). According to the present systematic review, some inflammatory biomarkers harvested from PICF (collagenase-2, collagenase-3, ALP, EA, gelatinase b, NTx, procalcitonin, IL-1β, and several miRNAs) seem to be correlated with peri-implant BL and may assist in the early diagnosis of pathological BL, that characterizes peri-implantitis. MiRNA expression demonstrated a predictive potential of peri-implant BL that could be useful for host-targeted preventive and therapeutic purposes. PICF sampling may represent a promising, noninvasive, and repeatable form of liquid biopsy in implant dentistry.

Can Abutment with Novel Superlattice CrN/NbN Coatings Influence Peri-Implant Tissue Health and Implant Survival Rate Compared to Machined Abutment? 6-Month Results from a Multi-Center Split-Mouth Randomized Control Trial

Background: The aim of the present multi-center split-mouth randomized control trial was to investigate the effect on peri-implant tissue of abutment with chromium nitride/ niobium nitride (CrN/NbN) coatings (superlattice) compared to traditional machined surface. Methods: Two adjacent posterior implants were inserted in 20 patients. A machined abutment was randomly screwed on either the mesial or distal implant, while a superlattice abutment was screwed on the other one. Implant survival rate, peri-implant probing depth (PPD), plaque index (PI), and bleeding index (BI) were collected 6 months after surgery, while marginal bone loss (MBL) was evaluated at T0 and T6.; Results: Implant survival rate was 97.7%. A total MBL of 0.77 ± 0.50 mm was recorded for superlattice abutments, while a mean MBL of 0.79 ± 0.40 mm was recorded for the abutment with machined surface. A mean PPD of 1.3 ± 0.23 mm was recorded for the superlattice Group, and a mean PPD of 1.31 ± 0.3 was recorded for the machined surface Group. PI was of 0.55 ± 0.51 for superlattice Group and 0.57 ± 0.50 for machined Group, while BI was of 0.47 ± 0.49 for superlattice Group and of 0.46 ± 0.40 for the machined one. No statistically significant difference was highlighted between the two Groups (p > 0.05). Conclusions: After a 6-month observational period, no statistically significant differences were highlighted between superlattice abutment and traditional machined abutment. Further in vitro studies as well as clinical research with longer follow-ups are required to better investigate the surface properties of the novel abutments’ superlattice coating and its effect on the oral tissues.

One-stage versus two-stage technique using two splinted extra-short implants: A multicentric split-mouth study with a one-year follow-up

OBJECTIVE

To compare the clinical outcomes of extra-short implants (≤6.5 mm) inserted with one-stage versus two-stage technique in adjacent sites of the upper or lower jaw.

MATERIALS AND METHODS

In this split-mouth multicenter study, implants were randomly divided into two groups according to the healing phase: two-stage and one-stage technique. Primary outcome measures were implant survival, implant success, and prosthodontic complications. Secondary outcome measurements were: implant stability quotient (ISQ) collected at surgery time (T0), and after 3 (T3) and 12 (T12) months, marginal bone level (MBL) evaluated at T0, T3, T6, and T12, marginal bone loss evaluated at T6 and T12, plaque index (PI), probing depth (PD), bleeding on probing (BoP) evaluated at T3, T6, and T12. Significances of differences between groups were tested by linear mixed model with random intercept.

RESULTS

Nineteen patients (8 males and 11 females) were included. A total of 38 implants were inserted. At T12 implant cumulative survival and implant success rate were 100% in both groups. No statistically significant differences were recorded for any of the analyzed parameters between the two groups at any time point. ISQ values were similar at T0 (two-stage: mean 67.53 ± SD 19.47; one-stage: mean 66.53 ± 19.07 p = 0.8738) and increased in both groups at the 12-month follow-up appointment (two-stage: 81.1 ± 7.04; one-stage: 81.39 ± 0.9266). MBL values were similar in the two groups at any time point. At T12 marginal bone loss was 0.46 ± 0.41 (two-stage) and 0.45 ± 0.38 (one-stage) mm (p = 0.9417), while mean PD was 2.7 ± 0.85 (two-stage) and 2.69 ± 0.89 (one-stage) mm.

CONCLUSIONS

Within the limits of the present short-term report, extra-short implants demonstrated optimal clinical outcomes using the one-stage technique, without statistically significant differences compared with the traditional two-stage approach.

Protein and m-RNA expression of farnesyl-transferases, RhoA and RhoB in rat liver hepatocytes: action of perillyl alcohol and vitamin A in vivo

We analysed the action, in rats in vivo, of the protein isoprenylation inhibitor perillyl alcohol (POH) and that of vitamin A, alone or in association, on m-RNA and protein expression of farnesyltransferases (FTases alpha and beta subunits) and their protein substrates RhoA and RhoB, in isolated hepatocytes. Combined administration of POH and vitamin A induced a sharp decrease in FTase alpha protein after 96 h, suggesting an involvement not only of farnesyltransferases but also of geranylgeranyltransferases, which share the FTase alpha protein. FTase beta protein did not decrease. POH plus vitamin A, in contrast with POH or vitamin A alone, induced a decrease in RhoB protein, probably because of different cleavages. No modification was observed in RhoA protein. Vitamin A alone increased RhoB m-RNA and protein expression. As one of the functions of RhoB is cell polarisation, these data support our previous hypothesis of a polarised transport of vitamin A from hepatocytes to hepatic stellate cells. As the behaviours of m-RNAs and proteins in this study were often different, cytoplasmic metabolic pathways must be considered for the parameters studied. The behaviour of Rho B, which is thought to have an antioncogene function, is discussed in view of its isoprenylated forms in the membranes. These preliminary findings stress the need, when studying the association of two isoprenoids in cancer therapy, to consider normal as well as tumour-bearing animals.

Use of IgG Avidity test in case definitions of toxoplasmosis in pregnancy

A survey network for congenital toxoplasmosis (TOXO-NET) was set up in December 1996 in Piedmont (Italy). Participants were asked to classify the infections in pregnant mothers and newborns by the criteria of the European Network on Congenital Toxoplasmosis published by Lebech in 1996. Because the IgG Avidity test is largely employed as a 2nd level test in toxoplasmosis diagnosis and it could be helpful to date infection, the co-ordinators of TOXO-NET suggested including it in the "case definition" of "probable" infection and "unlikely" infection. 117 cases of toxoplasmosis in pregnancy divided into the risk categories under Lebech's criteria were re-examined using the "new" case definitions. 77 out of 117 (65.8%) Toxoplasma gondii infections during pregnancy could be defined with only one serum sample using the IgG Avidity test. The IgG Avidity test proved a useful method to classify the Toxoplasma gondii infections in pregnancy, especially when we had only one serum sample.

[The additive antiproteinuric effect of Enalapril and Losartan to normotensive patients with pathology proteinuria]

The proteinuria is frequently the initial insult to the kidney and it usually followed by a progressive decline in the glomerular filtration rate. The angiotensin II mediate by glomerular permeselective function via the opening of large pores after elevations in transmembrane pressure and by acting on the glomerular pressure, too. There is evidence that angiotensin-converting enzyme inhibitors alone or with the angiotensin receptor-blockade may improve the glomerular size-selective function and the hemodynamic intrarenal accounted output of plasma proteins. We evaluated the Enalapril action only in two progressive doses (stage 1: 0.2 mg/kg/day and stage 2: 0.4 mg/kg/per day, respectively) and then we evaluated the combinated treatment (stage 3) with Enalapril (0.2 mg/kg/per day) + Losartan (0.8 mg/kg/day) in thirteen patients (2 female/ 11 male, mean age 12 yrs, r: 10y-16y) normotensive with middle or heavy proteinuria and normal glomerular filtration rate. The study lasted six months. In the three stages occurred decrease of the urinary protein, but only the stage 2 and 3 was significant (p < 0.05). And the three stages had significant reduction of the mean blood pressure, too (p < 0.05). On the other hand there has a good correlation between the less proteinuria and the descent of the mean blood pressure in the stage I (r: 0.75, p < 0.05) and the stage 2 (r: 0.70, p < 0.05), but this did not occur in the stage 3 (r: 0.37, p < 0.1). No patient had raise serum potassium; neither did they have decrease glomerular filtration rate or anaemia.

CONCLUSION

The coadministration of Enalapril and Losartan was the most efficient treatment antiproteinuric effect. It was not only by the drug related reduction in systemic blood pressure. There weren't any adverse side effects in any patient dependent of the medication.

Thioacetamide impairs retinol storage and dolichol content in rat liver cells in vivo

The aim of this paper was to ascertain whether chronic pretreatment with thioacetamide (TAA) might alter the uptake of a load of retinol and dolichol distribution in hepatocytes (HC), hepatic stellate cells (HSC) (Ito-1 and Ito-2 subfractions), Kupffer (KC) and sinusoidal endothelial cells (SEC). The reason why retinol and dolichol content was studied is that their metabolism and transport might be interrelated and that the two isoprenoids might exert different functions in the cells of the hepatic sinusoid. Rats were treated for 2 and 4 months with TAA, a known fibrogenic hepatotoxin, at a low dosage, to produce an early stage of damage. Three days before sacrifice, the rats were given a load of vitamin A, and cells were isolated to investigate its uptake. In HC, the load of retinol was taken up and accumulated, while a decrease in dolichol preceded retinol increase. In HSC, much less of the retinol load was stored than in controls, and dolichol content also decreased. Various minor modifications were seen in KC and SEC.Collectively, the results show that the distribution of these two isoprenoids, which play important roles in cellular differentiation and proliferation, is differently altered in the multiple cell types that line the hepatic sinusoid, and that both isoprenoids seem to participate in the first steps of liver damage.

Interaction between monensin and CCl4 after chronic treatment: dolichol and retinol content of rat liver sinusoidal cells

The aim of this investigation was to study retinol, which is known to decrease in hepatic stellate cells during fibrogenesis, and dolichol, which influences membrane fluidity and decreases in liver injury, in freshly isolated liver parenchymal and nonparenchymal cells after intoxication of rats with CCl4 combined with the ionophore monensin for 3, 5 and 7 weeks. To study the interrelationship between dolichol and vitamin A transport, a load of vitamin A was given to batches of rats 3 days before sacrifice. Monensin did not modify the action of CCl4 in hepatocytes. On administration of CCl4 and CCl4-monensin, dolichol decreased independently of vitamin A load, while retinol increased, especially when a load of vitamin A was given to rats 3 days before sacrifice. Hepatocytes appeared to no longer be able to export or metabolize vitamin A. In a subfraction of hepatic stellate cells (Ito-1 cells) dolichol always decreased, while retinol was no longer stored after each treatment; dolichol and retinol showed the same behavior but the decrease was more pronounced in monensin after vitamin A load and after 3 weeks. These data support the hypothesis that by modulating membrane characteristics, dolichol might be involved in intracellular or intercellular retinol transport and that altered transport between hepatocytes and Ito-1 cells might accompany liver injury. The data regarding another subfraction, Ito-2 cells, partly resemble those for the Ito-1 fraction and are in agreement with the heterogeneity of hepatic stellate cells. In Kupffer and sinusoidal endothelial cells, dolichol and retinol content was not homogeneous and was only slightly altered after the treatments. Monensin and CCl4 are not interactive. Although both drugs alter membrane lipids, their association allows some sinusoidal cell responses to be differentiated.

Action of chronic CC14 on the retinol and dolichol content of rat liver parenchymal and non-parenchymal cells

We studied dolichol, on account of its role in membrane fluidity and fusion, and retinol, on account of its behaviour in liver fibrosis, in isolated parenchymal and sinusoidal rat liver cells after CCl4 treatment for 3, 5 and 7 weeks. Retinol uptake was also investigated by administering a load of retinol three days before sacrifice. In hepatocytes, dolichol decreased and seemed to be the preferred target of lipid peroxidation by CCl4; indeed, retinol increased especially after vitamin A load. Two subfractions of hepatic stellate cells were obtained: in the subfraction called Ito-1, dolichol decreased, while the supplemented retinol was no longer stored; in the subfraction called Ito-2, the values were intermediate. In Kupffer and endothelial cells dolichol was higher after three weeks, in agreement with fibrogenesis. Retinol increased after retinol load, in Kupffer and endothelial cells, in agreement with their scavenger function. The different behaviour of dolichol content in parenchymal and non-parenchymal cells suggests that dolichol may have different functions in liver cells. Since it has been ascertained that, in liver fibrosis, stellate cells gradually lose retinol, the inability of HCs to send retinol to Ito-1 subfraction or the inability of Ito-1 subfraction to take up and store vitamin A might induce or contribute to the transformation of these cells into a different phenotype. This behaviour is discussed regarding the role of cellular and retinol binding proteins in intracellular retinol content. Moreover a role of dolichol in membrane fluidity and retinol traffic is hypothesised.

Dolichol and retinol content of rat liver sinusoidal cells after chronic monensin treatment

Aim of this study was to ascertain whether an impairment of communication between parenchymal and non-parenchymal liver cells involves vitamin A intercellular transport. The following approach was adopted: liver cells were isolated from rats treated chronically with the hydrophobic ionophore monensin i.p. for 3, 5, and 7 weeks and their retinol and dolichol content was assessed. Monensin, which alters membrane flow, was used because it had previously been reported to induce liver steatosis, cholestasis and glycogenolysis after acute treatment and, by preliminary morphological examination, to impair vitamin A transport between stellate cells and hepatocytes. Dolichol was chosen as a biochemical marker because it is a membrane lipid that modulates the fluidity and permeability of the membranes that retinol must cross. After monensin treatment, a load of vitamin A was given to rats three days before sacrifice, to ascertain whether its uptake by sinusoidal liver cells was altered. The main result was a dolichol decrease in hepatocytes and in the Ito-1 subfraction. In this latter, monensin induced a decrease in dolichol content only after vitamin A load. Moreover, while the hepatocytes were able to take up a load of vitamin A normally, the Ito-1 subfraction was no longer able to store retinol. Therefore the polarised transport of retinol between hepatocytes and stellate cells seemed impaired. The behaviour of sinusoidal endothelial cells and Kupffer cells might be ascribed to the functions of these cells and is not significantly modified by monensin. In conclusion, the altered cross-talk between sinusoidal cells in liver pathology might involve retinol as well as cytokines. Different pools of dolichol might have a role in this membrane process in a hydrophobic environment.

Content of dolichol and retinol in isolated rat non-parenchymal liver cells

The liver sinusoids, that are considered as a functional unit, harbour four types of sinusoidal cells (Ito, Kupffer, endothelial and pit cells). Dolichol content has been determined in many tissues and subcellular compartments, alteration has been reported in many types of liver injury, but until now no data are available on its content in every type of sinusoidal non-parenchymal liver cells. Dolichol and retinol metabolism might intersect in their traffic in biological membranes. Intercellular as well as intracellular exchange of retinoids is an essential element of important processes occurring in liver cells. It has been suggested that the role of dolichol, besides being a carrier of oligosaccharides in the biosynthesis of N-linked glycoproteins, may be to modify membrane fluidity and permeability, and facilitate fusion of membranes. Dolichol in the membrane is intercalated between the two-halves of the phospholipid bilayer, but its exact disposition is not known and the movement and distribution of retinoid in membranes may vary with the geometry of the membranes. Therefore the aim of this study is to obtain a global understanding of the sinusoidal system regarding dolichol and retinol content in each type of isolated rat liver sinusoidal cell, in normal conditions and after vitamin A administration. The information that can be drawn from the present results is that with normal vitamin A status of the animal, the dolichol content is almost uniform in all liver cells. After vitamin A supplementation, a great increase of dolichol, together with the known increase of retinol, can be measured only in a subpopulation of the Ito cells, the Ito-1 subfraction. Therefore in the cells that are present in the hepatic sinusoid, different pools of dolichol may have separate functions. Because retinol traffic among cells, membranes and plasma still remains to be fully understood, roles of dolichol in the exchange of vitamin A among sinusoidal liver cells are discussed.

Monosymptomatic primary enuresis: differences between patients responding or not responding to oral desmopressin

OBJECTIVES

To evaluate the 24-h diuresis, urinary osmolality, plasma arginine vasopressin (AVP) and urinary prostaglandin E2 (PGE2) before and during desmopressin treatment in patients with monosymptomatic primary enuresis (MPE), and to investigate the possible depressor effect of desmopressin on the detrusor in such patients with urodynamically confirmed bladder instability.

PATIENTS AND METHODS

Seven healthy children (control group) and 11 consecutive patients with MPE (mean age 10.4 years, range 7-15) were assessed using laboratory tests, renal and bladder ultrasonography, and video-urodynamic investigations. A 24-h inpatient assessment with a controlled water intake of 20 mL/kg per day included determinations of diuresis, urinary osmolality, AVP and PGE2 in both normal children and those with MPE. After 30 days of treatment at optimal doses of desmopressin, all children were hospitalized and re-evaluated during desmopressin treatment; all completed 3 months of treatment at optimal doses. At the end of this period, patients whose symptoms improved by > or = 80% were defined as 'responders' while those in whom they did not were defined as 'non-responders'.

RESULTS

After treatment, six of the 11 patients with MPE were 'responders' and five 'non-responders'. Urodynamic evaluation showed bladder instability in seven of the 11 patients with MPE but in those with bladder dysfunction, urodynamic studies carried out during desmopressin treatment showed no changes in detrusor activity. There were significant differences in the morning values of AVP between normal children and responders (P < 0.03), and between responders and non-responders (P < 0.02); none of the non-responders had AVP levels of < 2.5 pg/mL, while none of the responders exceeded this value. At midnight, responders had the lowest mean AVP and non-responders the highest; this correlated with the highest PGE2 value in the nonresponders at 00.00-08.00 hours. Non-responders had an overnight mean PGE2 level greater than that in normal subjects or responders.

CONCLUSIONS

Polyuria occurred in all patients with MPE, independently of the response to desmopressin. Responders had the lowest AVP values over the 24 h; the morning AVP levels differentiated normal subjects from enuretic patients and responders from non-responders. In patients with MPE, clinically undetected bladder instability was unrelated to the results of treatment and there were no urodynamic changes during desmopressin treatment. The differences between enuretic patients suggested a different aetiology of MPE, probably related to an increase in PGE2 concentration and an antagonistic mechanism of action of AVP or desmopressin.

Dolichol and vitamin A content in rat liver Ito (perisinusoidal) cells

Dolichol has been determined in many tissues but to date no data are available on liver Ito (fat storing) cells. In this note dolichol was determined in two subpopulations of liver Ito cells isolated from rats pretreated with vitamin A: Ito-1, vitamin A enriched and Ito-2, relatively poor of vitamin A. Differences were observed in the behaviour of the two fractions after vitamin A pretreatment of rats. In fact, in Ito-1 fraction dolichol increases with the increase of vitamin A, while in Ito-2 fraction it does not change significantly with the increase of vitamin A. These results, while confirming the heterogeneity of fat storing cells, are discussed as to the possible role of dolichol and vitamin A metabolism.

Multivariate analyses of prognostic factors associated with hematopoietic recovery in autograft patients with different sources of progenitor cells. A GATMO experience. Argintine Group of Bone Marrow Transplant

OBJECTIVE

To evaluate in a multivariate analysis the prognostic factors associated with hematopoietic recovery and the supportive care requirements after autotransplant of progenitor cells (PC) from various sources: bone marrow (BMPC), BMPC & peripheral blood (PBPC), and PBPC alone.

PATIENTS AND METHODS

A total of 570 patients with hematological malignancies and solid tumors underwent high-dose therapy followed by autotransplant. PBPC were obtained after mobilization with chemotherapy and/or cytokines. One-hundred five patients received BMPC, 217 received BMPC & PBPC and 248 PBPC alone; all of the patients received G-CSF or GM-CSF after infusion.

RESULTS

In a multivariate analysis the recovery of neutrophils was adversely associated with low numbers of nucleated cells infused (P < 0.13), bone marrow progenitor cell source, and diagnosis of multiple myeloma and acute leukemia (P < 0.001). The factors that adversely affected platelet recovery were low number of nucleated cells and diagnosis of multiple myeloma and acute leukemia (P < 0.001).

CONCLUSIONS

We conclude that BMPC adversely affect neutrophil recovery while low numbers of nucleated cells and diagnosis of multiple myeloma and acute leukemia adversely affect both neutrophil and platelet recovery.

Tumor necrosis factor concentrations in hemolytic uremic syndrome patients and children with bloody diarrhea in Argentina

Hemolytic uremic syndrome (HUS) is thought to be a vascular endothelial injury disease. The mechanism of injury is unknown although verocytotoxins (Shiga-like toxins (SLTs)) are known to be associated with it. Recent evidence suggests that in vitro treatment of some endothelial cells with tumor necrosis factor alpha (TNF-alpha) dramatically increases their susceptibility to SLTs. We studied 25 children with HUS, 63 children with SLT-positive bloody diarrhea, 62 children with bloody diarrhea not associated with SLTs and 39 children admitted for elective surgery, included as an age- and season-matched control group. The TNF-alpha concentrations were found to be significantly elevated in children with HUS (range, 1 to 95 pg/ml; geometric mean, 32.2 pg/ml) compared with the healthy controls (range, 0 to 53 pg/ml; mean, 12.5 pg/ml; P < 0.001). Because it is hypothesized that TNF-alpha elevation might precede development of HUS, we also studied children with blood diarrhea. The TNF-alpha serum concentrations were significantly higher during the first 10 days after onset of bloody diarrhea than after the first 10 days (P < 0.02). Such elevation could be associated with vascular endothelial glycolipid receptor up-regulation and increased susceptibility to the effects of SLTs.

Association between severity of gastrointestinal prodrome and long-term prognosis in classic hemolytic-uremic syndrome

To determine whether severity of the prodromal gastrointestinal illness is associated with the course and complications of the extraintestinal manifestations of hemolytic-uremic syndrome, we conducted a retrospective review of children (n = 509) hospitalized with hemolytic-uremic syndrome. Those who came to the hospital with colitis and rectal prolapse associated with hemolytic-uremic syndrome (group I, n = 40) were compared with an equal number of time-matched children with hemolytic-uremic syndrome but without prolapse (group II). Children in group I had evidence of more severe colitis than children in group II had, as indicated by increased frequency of bloody diarrhea (p less than 0.001) and longer duration of diarrhea (p less than 0.001). However, they also had more severe extraintestinal manifestations during hemolytic-uremic syndrome, including edema (p less than 0.0001), severe thrombocytopenia (p less than 0.0001), prolonged anuria (p less than 0.001), and seizures (p = 0.036). Long-term prognosis for recovery of renal function was worse for group I than group II. Within group II, patients with bloody diarrhea had milder extraintestinal illness than those with prolapse but more severe extraintestinal illness than those with watery diarrhea. Analysis of Kaplan-Meier survival curves demonstrated a better prognosis for return of normal renal function in the children with watery diarrhea but without prolapse (p = 0.009) than in children with bloody diarrhea or prolapse. These data demonstrate that the severity of the gastrointestinal prodrome reflects the severity of the extraintestinal acute microangiopathic process and the resulting long-term outcome. Widespread vascular damage, often followed by permanent sequelae, is characteristic of patients with the most severe colitis.

Laryngeal flap for hypopharynx reconstruction

Hypopharynx repair following resection of a pyriform sinus carcinoma may be accomplished primarily or involve a more extensive procedure, such as a free intestinal graft. Described herein is a laryngeal flap which may be used to repair a hypopharyngeal defect when a strip of mucosa, too narrow for a primary repair, is left. This method has been used successfully in 4 patients and has saved these patients from more extensive repairs.

[Association of Wilms' tumor, pseudohermaphroditism and glomerular nephropathy. Partial and complete forms of the syndrome]

Four patients, followed at the Buenos Aires Cildren's Hospital are reported: one with a nephrotic syndrome and male pseudohermaphroditism, the second with nephrotic syndrome, male pseudohermaphroditism and Wilms' tumor, the third with pseudohermaphroditism and Wilms' tumor and the fourth with a nephrotic syndrome and Wilms' tumor. The cases presenting nephrotic syndrome, all had an early onset and a rapid and fatal course leading to death in renal failure or secondary to a related bacterial infection. The renal histology in all of the cases with nephrotic syndrome, was very similar: diffuse involvement of all glomeruli consisting in a severe increase of the mesangial matrix, with scarce mesengial proliferation.

[Bacterial antagonism of oral secretions towards staphylococci]

Bacterial antagonism may be one of the mechanism which regulates the bacterial flora of the pharynx. We have investigated the bacterial antagonism exerted in oral secretion by alpha-hemolytic streptococci against S. aureus and S. epidermidis. We cultured viridans streptococci and staphylococci in human saliva and we noted a bactericidal activity towards staphylococci. Such activity, referable to the salivary system (peroxidase-thiocyanate) activated by hydrogen peroxide produced by streptococci, was greater on S. epidermidis. The remarkable sensitivity of S. epidermidis could explain the rare presence of this species in pharynx and oral cavity.

[Staphylococcal adherence to oral mucosal cells]

The ability of Staphylococcus to adhere to human oral epithelial cells was studied. S. aureus and S. epidermidis showed remarkable attachment to cheek mucosal cells, comparable to adherence to nasal mucosal cells observed by other Authors. The same bacteria lowered consistently their ability to adhere when were previously cultured in human saliva.