Gingival Thickness and Outcome of Periodontal Plastic Surgery Procedures: A Meta-regression Analysis

OBJECTIVE

To evaluate the impact of soft tissue thickness (STT) on root coverage achieved with different periodontal plastic surgery procedures.

BACKGROUND

Gingival recession has been managed successfully through various surgical approaches, with great variability in outcomes. Anatomic characteristics of the recipient site and selected technique account in part for this variability. Gingival flap thickness is one of the most critical site-related characteristics.

METHODS

An electronic search was conducted on the major databases (PubMed, Embase, Web of Science). Human prospective studies with at least 6 mo of follow-up and with a numeric baseline measurement for gingival thickness were eligible. Only studies including nonsmoking patients were considered. Variables included surgical approach, participant characteristics, local anatomic factors, and follow-up time. Primary outcome was mean percentage root coverage (%RC) achieved, and complete root coverage was a secondary outcome.

RESULTS

A total of 42 studies were included (35 randomized controlled trials, 5 case series, 1 prospective cohort study, and 1 controlled clinical trial). Across studies, the pooled %RC was 81.9% (95% CI, 79.1% to 84.7%). The %RC was not significantly associated (P = 0.267) with baseline soft tissue thickness; however there was a significant (P = 0.031) inverse relationship between STT and %RC after 12-mo follow-up. Subgroup analysis showed that for no graft, there was a significant (P = 0.025) positive relationship between STT and %RC with the exclusion of the single outlier study based on STT.

CONCLUSIONS

STT plays a limited role in predicting root coverage across all approaches; when flaps are performed with no graft, the effect of STT is most critical. The length of time following surgery appears to influence outcomes, with 12-mo follow-up offering greater insight.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can suggest to clinicians which periodontal plastic surgery technique to employ when treating challenging cases. In particular, it can be helpful when selecting the treatment approach to treat thin phenotype sites. This study could help clinicians provide a more appropriate treatment decision in such cases.

Exercise training and cytokines in breast cancer survivors

The purpose of this randomized controlled trial was to determine the effects of an 8-week (aerobic+strength) exercise training program (3 sessions/week) on the circulating cytokine levels of breast cancer survivors. We randomly allocated 16 female survivors of breast cancer (mean±SD age: 50±5 years) to an intervention or usual care (control) group (N=8 in each group). The intervention group followed an 8-week exercise program consisting of 3 sessions/week (session duration: 90 min). We measured the levels of the following cytokines before and after the intervention: beta-NGF, CTACK, eotaxin, FGF basic, G-CSF, gmCSFα, HGF, ICAM1, IFNα2, IFNγ, IL1α, IL1ß, IL1ra, IL2, IL2ra, IL3, IL4, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL16, IL17, IL18, IP10, LIF, MCS-F, MIP1α, MIP1β, MIF, MCP1, MCP3, MIG, PDGF bb, SCF, SCGFβ, SDF1α, TRAIL, TNFα, TNFβ, VCAM1, and VEGF. We only observed a significant interaction (group*time) effect for CTACK ( P=0.016), with mean values remaining stable in the intervention group but increasing over time in controls. The intervention program did not induce a significant decrease in the main breast cancer-related cytokines such as IL6 and IL8. A combined (aerobic+strength) 8-week exercise training intervention did not induce major changes in the basal cytokine levels of breast cancer survivors.

Combined aerobic and resistance training in breast cancer survivors: A randomized, controlled pilot trial

The purpose of this pilot study was to examine the effects of a combined cardiorespiratory and resistance exercise training program of short duration on the cardiorespiratory fitness, strength endurance, task specific functional muscle capacity, body composition and quality of life (QOL) in women breast cancer survivors. Sixteen subjects were randomly assigned to either a training (n = 8; age: 50 +/- 5 yrs) or control non-exercising group (n = 8; age: 51 +/- 10 yrs). The training group followed an 8-week exercise program consisting of 3 weekly sessions of 90-min duration, supervised by an experienced investigator and divided into resistance exercises and aerobic training. Before and after the intervention period, all of the subjects performed a cardiorespiratory test to measure peak oxygen uptake (VO2peak), a dynamic strength endurance test (maximum number of repetitions for chest and leg press exercise at 30 - 35 % and 100 - 110 % of body mass, respectively) and a sit-stand test. Quality of life was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC-C30) questionnaire. In response to training, QOL, VO2peak (mean 3.9 ml/kg/min; 95 % CI, 0.93, 6.90) performance in leg press (17.9 kg; 95 % CI, 12.8, 22.4) and sit-stand test (- 0.67 s; 95 % CI, - 0.52, - 1.2) improved (p < or = 0.05). We observed no significant changes in the control group. Combined cardiorespiratory and resistance training, even of very brief duration, improves the QOL and the overall physical fitness of women breast cancer survivors.

Effects of detraining on the functional capacity of previously trained breast cancer survivors

The purpose of this study was to assess the effects of a relatively short (8-weeks) period of detraining on cardiorespiratory capacity, dynamic strength endurance, task specific functional muscle capacity and quality of life (QOL) of breast cancer survivors who had previously undergone a combined supervised (aerobic and resistance) training program. Eleven women survivors of stage I - II ductal breast carcinoma (47 +/- 7 yrs) entered the study and performed a battery of tests (including anthropometric evaluation, a graded cycle ergometer test, tests of strength endurance [leg and bench press] and the sit-stand test) and completed a specific QOL questionnaire (EORTC-C30) at three time points: i) before, ii) after an exercise program (including aerobic and resistance exercises) of 8-weeks duration, and iii) after a subsequent 8-weeks period of training cessation. Training-induced improvements in strength endurance, muscle functional capacity (sit-stand test) and QOL were not significantly changed after detraining (p > 0.05 for post-training vs. detraining comparisons). The lack of significant loss in muscle strength endurance occurred despite significant losses in estimated total muscle mass after detraining (27.3 +/- 2.4 kg) compared with post-training (28.5 +/- 2.9 kg). In contrast, cardiorespiratory capacity was significantly decreased during detraining (V.O (2peak) of 29.0 +/- 4.6 vs. 22.7 +/- 3.9 ml . kg ( -1) . min (-1) at post-training vs. detraining, p < 0.01). In conclusion, cancer survivors who have participated in a combined training program can retain some of the training gains (particularly improved QOL and muscle strength endurance/functional performance) after a relatively short duration detraining period.

Ischemic Preconditioning and Kidney Transplantation: In Vivo Nitric Oxide Monitoring in a Rat Ischemia-Reperfusion Experimental Model

Direct nitric oxide measurement in live tissue would help us to understand its role in ischemia-reperfusion injury and its relationship to ischemic preconditioning (IP). We constructed four experimental groups of ischemia-reperfusion in the rat kidney: G1 were controls; G2, 1 hour of renal ischemia; G3 and G4: one or two 15/10 minute cycles, respectively, of IP prior to 1 hour of ischemia. Real-time in vivo nitric oxide measurements were compared with functional parameters of kidney damage at 24 hours. The peaks of nitric oxide production in the IP periods increased less in the rising curve of nitric oxide production during the 1 hour ischemia time. No improvement in the IP groups was observed based on serum creatinine levels at 24 hours.

Prenatal diagnosis of gastric triplication

Duplications of the intestinal tract are rare malformations, and triplications are even less common; only two cases are found in the literature. The authors describe a case of prenatal diagnosis of a gastric triplication and the surgical treatment.

[Multivalent informatics application for studies of the nutritional status of the population. Assessment of food intake]

The aim of the study is the presentation and validation of a computer program, GRUNUMUR, designed for nutritional evaluation studies in great population groups, and to describe some of the results obtained after the application of this working tool. This program includes he following types of studies: a) dietary study; b) food habits study; c) anthropometric study and d) clinical study. The main advantage of GRUNUMUR is the possibility of being periodically actualized without any important software knowledge, and to be opened to the introduction of new data bases. The software program GRUNUMUR Is one more of the multiple programs described in the literature. However, once validated, this tool has the particularity of being developed after an important experience in the nutritional field and only with a scientific purpose. The result is a reliable tool, which facilitates nutrition research.

Extensor digitorum brevis free flap: anatomic study and further clinical applications

The extensor digitorum brevis muscle flap is reliable, safe, and can be used either as a pedicle or as a free flap with minimal donor site morbidity. To increase the existing knowledge of this flap and to establish further anatomic basis for the design and elevation of the extensor digitorum brevis flap, 26 specimens from 13 fresh cadavers were dissected under 3.5x loupes. The lateral tarsal artery was found to be the main blood supply to the muscle. It has an average diameter of 1.83+/-0.35 mm and a length of 1.89+/-0.69 cm. The dorsalis pedis artery has, at the level of the lateral tarsal artery takeoff, a diameter of 3.25+/-0.62 mm. From this point to the origin of the deep plantar branch, the dorsalis pedis artery has minimal branching, and the surgeon has available an artery homogeneous in diameter that is 6.77+/-0.99 cm in length. Related neurovascular structures (anterior tibial artery and the venae comitantes, dorsalis pedis and first dorsal metatarsal artery, and deep peroneal nerve) were also studied. A safe and reliable harvesting technique and the "T interposed extensor digitorum brevis" technique for sparing the anterior tibial artery are presented, as are clinical case examples on the use of this flap as a flow-through, extensor digitorum brevis-vascularized nerve graft, a combined extensor digitorum brevis-deep peroneal nerve graft, and a bilobed extensor digitorum brevis-dorsalis pedis fasciosubcutaneous free flap.

A technique to preserve the shape of the calcaneus after massive osteomyelitis

Osteomyelitis of the os calcis challenges the reconstructive surgeon. We present the case of a patient in which massive medullary osteomyelitis of the calcaneus was treated with a technique that preserves the bone shape. The medullary cavity of the bone was first emptied, preserving the cortical shell. Then a free muscle flap was used to fill up the dead space. Three months later autologous bone grafts were packed into the cavity. Full weight-bearing was commenced 4 months after this procedure. In the latest follow-up, 2 1/2 years, the patient has had no recurrence or difficulty with walking.

Complete avulsion of the distal posterior interosseous nerve during wrist arthroscopy: a possible cause of persistent pain after arthroscopy

A case of avulsion of the distal posterior interosseous nerve during wrist arthroscopy is presented. Surgeons unaware of this entity may attribute persistent middorsal wrist pain to the underlying disease rather than to iatrogenic damage to the distal posterior interosseous nerve.

Brucellosis in patients infected with the human immunodeficiency virus

Brucellosis has been described rarely in patients infected with HIV, despite the fact that eradication of intracellular brucellae is largely dependent on cell-mediated immunity. The characteristics of all patients with HIV infection and brucellosis seen in seven Spanish hospitals are reported. Since the beginning of the AIDS epidemic, 12 HIV-infected patients were diagnosed with brucellosis (8 with cultures positive for Brucella spp., 4 with high anti-Brucella antibody titers). Most patients were male and intravenous drug users. Eleven patients had no symptoms of HIV infection when first diagnosed with brucellosis and had relatively preserved cellular immunity (median CD4 + cell count 588, range 136-1006). There was a clear epidemiologic antecedent for acquisition of brucellosis in 11 patients. Clinical symptoms included fever, arthromyalgia, and sweating in all patients; four patients presented with focal disease. All patients had high agglutinin titers, and eight of nine had cultures positive for Brucella. Therapy with doxycycline and streptomycin was curative in all cases. Two patients experienced a recurrence of symptoms after initial treatment, although no microbiological relapses were documented after a median follow-up period of 18 months. HIV infection does not seem to increase the incidence of brucellosis. Since most cases occur in asymptomatic patients with relatively preserved immunity, the epidemiology, clinical presentation, diagnosis, response to therapy, and outcome are similar to those observed in non-HIV infected patients.

Clinical significance of pneumococcal bacteraemias in a general hospital: a prospective study 1989-1993

We studied 71 patients with pneumococcal bacteraemia (PB) who were hospitalized between 1989 and 1993. The Streptococcus pneumoniae was classified as penicillin-sensitive (PS) or resistant (PR). Age, sex, underlying disease (McCabe classification), and other clinical and laboratory features were recorded on admission, at discharge and one month later. The incidence of PB was 8.1/10,000/year. PB was most frequent in men (71.9%) aged below 60 years (60%), 76% of the patients acquired the infection in the community. An underlying disease of McCabe type II or III was found in 93%. Previous treatment with beta-lactam antibiotics was considered a risk factor for PRPB. Factors related to higher mortality were age above 60 years, nosocomial PB, McCabe type I underlying disease, an initially critical clinical situation, neutropenia, and inappropriate antibiotic treatment. When appropriate treatment was given, there were no significant differences between PS and PR groups in clinical course or mortality.

Clinical comparison of desired versus actual amount of surgical crown lengthening

The actual length of clinically exposed tooth structure between planned restoration margin and alveolar crest ("biologic width") obtained during surgical crown elongation procedures was compared to the textbook goal of 3.0 mm. Sixteen (16) patients with 21 teeth requiring surgical crown lengthening for restoration placement participated. Oral hygiene instructions were given and optimal plaque control was mandatory. At each clinician's discretion, surgical techniques consisted of either gingivectomy or an apically positioned flap with and without osseous resection. Utilizing a reference stent, measurements were obtained at the facial, mesial-facial, lingual, and distal-lingual of the treated teeth both before and after osseous reduction. Parameters evaluated were gingival margin position, probing depth, mucogingival junction position, alveolar crest location, mobility, plaque index, and gingival index. These measurements were again recorded 8 weeks after surgery with the exception of alveolar crest. Statistical analysis with the paired t-test and linear correlation showed no significant change from baseline or among operators with varying experience in any of these parameters. Overall the results showed that the default objective of 3 mm between planned restoration margin and alveolar crest was not routinely achieved (mean 2.4 +/- 1.4 mm). The post-treatment distance from the planned restoration margin to the alveolar crest was greatest at the facial aspect of the teeth (mean 2.6 +/- 1.2 mm) and least at the distal-lingual (mean 2.2 +/- 1.7 mm). In addition, although more experienced periodontists removed a larger amount of bone, the amount of root surface exposed was still short of the initially desired biologic width.(ABSTRACT TRUNCATED AT 250 WORDS)

An unusual case of lightning injury: a melted silver necklace causing a full thickness linear burn

An unusual case of lightning injury is shown. Flash-over current caused the fusion of a silver necklace producing a linear full thickness burn in the neck and chest with the silver welded throughout the wound.

Thallium poisoning presenting with abdominal colic, paresthesia, and irritability

A case of acute thallium poisoning presenting with sudden abdominal pain, paraesthesiae and irritability is described. The peripheral nervous system was later affected along with loss of hair and the development of streaks (Mee's lines) on the nails of the hands and feet. The diagnosis was established by thallium assays of blood and urine. Thallium was undetectable in the blood by day 70. The manifestations cleared in six months with symptomatic treatment only. We review the characteristics and differential diagnosis of thallium poisoning and stress the importance of a high index of clinical suspicion.

Clinical significance of anaerobic bacteremias in a general hospital. A prospective study from 1988 to 1992

A prospective study was designed to investigate anaerobic bacteremias and evaluate their incidence and significance in a general hospital. One or more blood cultures positive for anaerobic microorganisms were analyzed from each of a total of 61 patients hospitalized between January 1988 and April 1992, in accordance with an established protocol. The clinical repercussions of bacteremia were also analyzed. Two percent of blood cultures were positive for anaerobes, with an incidence of 0.6 cases per 1000 hospitalized patients. The most frequently isolated anaerobes were Bacteroides fragilis and Clostridium perfringens. Intraabdominal disease was the route of entry in 50% of the patients. A death rate of 37.3% was mostly attributed to B. fragilis. Hospitalization in the surgical department, nosocomial acquisition, previous surgery, critical initial clinical status and the presence of complications were significantly associated with increased death rates. No significant differences were found in the clinical course between patients whose antibiotic treatment was judged adequate and those for whom it was considered inadequate. The frequency and incidence of anaerobic bacteremia was low in our hospital. The well-known clinical and epidemiological characteristics of these infections facilitates their prompt diagnosis and empirical treatment with antibiotics of proven effectiveness against anaerobes.

[Subglottal stenosis as the initial manifestation in Wegener's disease]

A 21-year-old man with 3-month history of hoarseness and dyspnea was suspected to have Wegener's granulomatosis with initially appearing in the trachea. In spite of unspecific biopsies, the clinicopathological picture and the high titles of anticytoplasmic autoantibodies (ACPA) confirmed the diagnosis. The early treatment with cyclophosphamide impeded the evolution to graver systemic forms of the disease.

A medium for inducing conversion of Histoplasma capsulatum var. capsulatum into its yeast-like form

Histoplasma capsulatum var. capsulatum is a dimorphic fungus that, under special conditions, converts from its more common mycelial form to a yeast-like form. Achieving this conversion, however, has been problematical for researchers. The present study tested conversion rates in ten Histoplasma capsulatum var. capsulatum strains using seven culture media, four of which were conventional and three novel. One of our novel media, MLGema, induced complete conversion of two strains within five days of incubation at 35 degrees C, and of all strains that eventually converted by the time of the second subculturing transfer, under defined experimental conditions. MLGema is also inexpensive and easy to produce.

[Amplitude of the distribution of erythrocyte size in the differential diagnosis of microcytic anemia]

A prospective study was carried out in 83 patients with microcytic anemia. 43 had iron deficiency anemia, 28 had heterozygous beta thalassemia not associated with iron deficiency (beta-THNID) and 12 had both conditions. The behavior of red blood cell volume distribution width (RDW) was evaluated in all patients. RDW was higher in patients with iron deficiency (20.62 +/- 4.64) and beta-THNID (15.76 +/- 1.41) than in controls (13.29 +/- 0.92) (p less than 0.0001 for both comparisons). There also were statistically significant differences (p less than 0.0001) between both patient groups. In patients with both heterozygous beta thalassemia and iron deficiency (beta-THID), RDW reached similar values to those from patients with only iron deficiency anemia. A significant negative correlation was also found between the transferrin saturation index and RDW (r = -0.614, p less than 0.02). In 34 patients controlled during iron replacement therapy a significant increase of RDW was found after one month of treatment, while hemoglobin concentration and mean corpuscular volume became normal. When 18 was taken as cutoff value for RDW, its positive predictive value was very high in iron deficiency (95%), while it was only 59% in beta-THNID. England's index may help to differentiate between isolated iron deficiency anemia and beta-THID: in patients with RDW higher than 18, the positive predictive value of England's index was 89% for iron deficiency and 57% for beta-THID.(ABSTRACT TRUNCATED AT 250 WORDS)