One year of surgical mask testing at the University of Bologna labs: Lessons learned from data analysis

The outbreak of SARS-CoV-2 pandemic highlighted the worldwide lack of surgical masks and personal protective equipment, which represent the main defense available against respiratory diseases as COVID-19. At the time, masks shortage was dramatic in Italy, the first European country seriously hit by the pandemic: aiming to address the emergency and to support the Italian industrial reconversion to the production of surgical masks, a multidisciplinary team of the University of Bologna organized a laboratory to test surgical masks according to European regulations. The group, driven by the expertise of chemical engineers, microbiologists, and occupational physicians, set-up the test lines to perform all the functional tests required. The laboratory started its activity on late March 2020, and as of the end of December of the same year 435 surgical mask prototypes were tested, with only 42 masks compliant to the European standard. From the analysis of the materials used, as well as of the production methods, it was found that a compliant surgical mask is most likely composed of three layers, a central meltblown filtration layer and two external spunbond comfort layers. An increase in the material thickness (grammage), or in the number of layers, does not improve the filtration efficiency, but leads to poor breathability, indicating that filtration depends not only on pure size exclusion, but other mechanisms are taking place (driven by electrostatic charge). The study critically reviewed the European standard procedures, identifying the weak aspects; among the others, the control of aerosol droplet size during the bacterial filtration test results to be crucial, since it can change the classification of a mask when its performance lies near to the limiting values of 95 or 98%.

Dental Implants with Locking Taper Connection versus Screwed Connection: Microbiologic and Scanning Electron Microscope Study

The aim of this study is to carry out an analysis of the Fixture-Abutment Interfaces (FAI), comparing different connection systems, to evaluate the role of geometric discrepancy, which is present between the abutment and the fixture, in favoring the permeability to bacterial colonization. Two types of commercially available FAI were studied, 16 screwed FAI (Sweden-Martina Italia) (4 of Ø 3.8 mm diameter, 4 of Ø 4.7 mm diameter, 4 of Ø 5.7 mm diameter and 4 of Ø 6.7 mm diameter) and 4 FAI (Bicon) (Ø 3.5mm diameter). The assays were carried out in vitro, placing the different dental implants in contact with broth culture of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Streptococcus pyogenes to test the infiltration inside the FAI. Furthermore, scanning electron microscope (SEM) analysis was carried out to evaluate the gap at the fixture-abutment interface. In all the locking taper FAI and in the screwed FAI with a diameter of 3.8 mm there was no trace of bacterial infiltration of the species examined. In the screwed FAI with a diameter of 4.7 mm, 5.7 mm and 6.7 mm there was an increasing level of bacterial infiltration in relationship to the diameter. Therefore, this paper shows that there exists an important correlation between the diameter of the screwed implant and the permeability to microbic infiltration that is directly proportional to the diameter of the implant.

Neuroradiologia funzionale della ghiandola ipofisaria

Lo studio sequenziale dell'afflusso del mezzo di contrasta a carico del parenchima ipofisario è stato di recente valutato da diversi autori, utilizzando apparecchiature operanti a 1,5 T. Tutta-via, con l'eccezione di 3 casi di macroadenoma, non sono state mai valutate le possibili alterazioni di flus-so ghiandolare nelle diverse affezioni interessanti l'ipofisi. Sono stati esaminati 27 volontari non affetti da patologia ipofisaria e 47 pazienti, in età pediatrica o adulti, affetti da alterazioni ipofisarie su base congenita o acquisita. I pazienti sono stati valutati mediante apparecchiatura operante a medio campo, compa-rando i risultati, ottenuti in tempi diversi, di una valutazione ipofisaria standard versus un esame di tipo sequenziale.

Il nostro studio ha dimostrato un modello di accentuazione delle differenti componenti ghiandolari perfettamente corrispondente all'organizzazione microvascolare della ghiandola stessa, con un incremen-to dell'intensità di segnale apprezzabile prima a livello neuroipofisario, poi a carico del peduncolo e della parte prossimale dell'adenoipofisi, ed infine a carico della pars distalis adenoipofisaria. I microadenomi hanno dimostrato un modello di accentuazione di tipo <arterioso>, in rapporto alla neoangiogenesi esi-stente. I macroadenomi hanno dimostrato un modello differente, nelle aree esaminate, in dipendenza del-l'estensione. Nessuna alterazione è stata riscontrata nei pazienti affetti da sella vuota parziale. I pazienti affetti da deficit di ormone della crescita hanno dimostrato una riduzione del potenziamento del peduncolo ipofisario, in possibile relazione a danno del sistema vascolare portale.

The Efficacy of Four Ways of Administrating Dexamethasone during Surgical Extraction of Partially Impacted Lower Third Molars

Glucocorticoids are drugs noted for their potent anti-inflammatory effect and long lasting half-life. Various studies have been carried out to identify which of these molecules is best for reducing the post-operative sequelae after surgical extraction of the impacted lower third molar. This study examines four different ways of administering dexamethasone after surgical extraction of impacted lower third molars: endoalveolar application, submucous injection, intravenous administration and intramuscular injection, with the aim of identifying which method gives the least discomfort to the patient in regard to reduction of pain, edema and post-operative lock-jaw. Results show that a greater reduction of the post-operative sequelae was obtained in the group of patients treated with dexamethasone intravenously. Satisfying results were also obtained in the group treated with a topical administration of dexamethasone in powder form and in the group which was given dexamethasone through an intramuscular injection. These last two groups had similar results. Instead, the results obtained in the group that received dexamethasone through local submucous injection were not satisfactory.

The use of r-hFSH in treatment of idiopathic male factor infertility before ICSI

OBJECTIVE

To evaluate the efficacy of pre-treatment of idiopathic oligozoospermic patients with r-hFSH to improve the clinical results of ICSI.

PATIENTS AND METHODS

82 infertile couples due to male factor who attended our center were included in the study. Thirty-six were randomized to the treatment group (group A) and forty-six to the control group (group B). The male partners in group A were treated with recombinant human FSH (r-hFSH; Gonal F®) 150 IU subcutaneously three times a week for a 3-months period. The control group (group B) did not receive any treatment. After the treatment couples of both groups underwent a cycle of ICSI.

RESULTS

The fertilization rate was comparable in both groups. However, in the treatment group (group A), the clinical pregnancy rate was significantly higher (42%) compared to the control group (group B) (20%) (p < 0.02). Also, the implantation rate was significantly higher in treatment group (26%) compared to the control (15%) (p < 0.04). Miscarriage rate was lower (15.7%) in the treatment group than in the control (43.7%), and this difference was statistically significant (p < 0.05).

CONCLUSIONS

Treatment of idiopathic male factor infertility with r-hFSH before ICSI improves clinical pregnancy rate, increases implantation rate and decreases the early pregnancy loss.

[Aseptic, simultaneous and bilateral mobilisation due to an acetabular shell fracture in a 43 year-old patient]

The acetabular shell mobilization is the main long-term complication in total hip replacement. Metal-back fracture has also to be considered among the possible causes of shell mobilization. A case is presented of bilateral acetabular shell mobilization due to the trabecular covering de-soldering from the metal-back in a 43 year-old patient, 13-14 years after the first surgery.

An unconventional indication of the Sauve' - Kapandji procedure in a radial shaft pseudoarthrosis and chronic DRUJ dislocation: a case report

We present a 42-years-old male who developed a radial shaft pseudoartrosis and a chronic DRUJ dislocation/instability, following a Galeazzi fracture. He presented to our Office with a severe inability of wrist and forearm motion. A Sauve'-Kapandji procedure was adopted, performing a lateral approach to the ulna and grafting the excised ulnar block to retrieve radial length at the pseudoarthrosis level. Cancellous bone grafts from the iliac crest were also applied and mixed with autologous platelet rich plasma to promote callus formation. The goal was to create an intentional pseudoarthrosis of the distal ulna combined with a DRUJ arthrodesis, in order to resolve instability and regain forearm pronation/supination. We obtained bone healing, an excellent clinical recovery, and the patient returned to all his previous activities six months after surgery. To our knowledge, this is the first reported case of a radial shaft psudoarthrosis treated with the Sauve'-Kapandji technique.

Multidetector CT Dentascan evaluation of bone regeneration obtained with deproteinised bovine graft in residual cavity after mandibular cyst enucleation

PURPOSE

This study compared spontaneous bone healing and regeneration obtained with deproteinised bovine graft in residual cavities after mandibular cyst enucleation using computed tomography (CT) Dentascan.

MATERIALS AND METHODS

Eighty patients with a radiological diagnosis of mandibular cyst underwent surgical enucleation. Patients were divided into a control group (spontaneous healing, 40 patients) and a test group (deproteinised bovine graft, 40 patients). All patients underwent follow-up CT Dentascan 12 months after the procedure. For each residual cavity, apical-coronal and mesial-distal distance, average pixel intensity and volume were calculated and results compared between two groups using the t test.

RESULTS

The control group showed mean volume, apical-coronal and mesial-distal distance of 703.2 ± 185.3 mm(3), 28.6 ± 9.4 mm and 25 ± 2.84 mm, respectively. In the test group, values were 738.2 ± 189.2 mm(3), 27.5 ± 3.6 mm and 25.3 ± 2.97 mm, respectively. There was no statistically significant difference between groups. Average pixel intensity was 1,102.8 ± 124.3 in the test group and 624.9 ± 133.3 in the control group, with a significant difference between groups (p<0.0001).

CONCLUSIONS

The significantly higher average pixel intensity observed in the test group demonstrates the cavalue of treatment with biomaterials to obtain earlier bone regeneration.

How do biomaterials affect the biological activities and responses of cells? An in vitro study

AIM

As part of regenerative bone surgery, according to the principles of tissue engineering and GBR, the use of biomaterials aims to restore bone deficiencies by restoring both functionality and original morphology of the bone tissue. Besides being biocompatible, biofunctional and reabsorbable, the ideal scaffolding should possess an osteoinductive geometry, which depends on many physical-chemical characteristics and, in particular, on a three-dimensional morphology and the placement of molecules, which would determine pore size and interconnection between them. The purpose of this study was, therefore, to carry out an analysis with a scanning electron microscope, in order to evaluate the effect of the diameter size of the scaffold pores on the bio-molecular interaction between osteoblast-like MG63 cells and four biomaterials with different pore sizes: polylactic-co-glycolic acid, deproteinized bovine bone, equine bone, demineralized bone matrix (DBM).

METHODS

Through the observations made with SEM and X-ray microanalysis, it is possible to infer how the morphology, the proliferative ability, the modality of adhesion and the differentiation of MG63 cells are influenced in different ways by the porous structure of the various biomaterials used as a substrate for growth.

RESULTS

From among all of the biomaterials examined, DBM represented the best substrate for growth; in fact, there would be a more intense and precocious adhesion of MG-63 cells.

CONCLUSION

The strong osteoconductive effect observed in human DBM, seems to be related to the presence of the organic component, while the osteoinductive effect would be mainly attributed to the presence of BMPs.

Phlegmon of the face and neck: a case report

Deep face and neck infections are potentially life threatening if they are not diagnosed in time and then treated quickly. This report describes a case of face and deep neck infection, associated with a semi-impacted and decayed wisdom tooth in a cardiopathic, immunosuppressed patient suffering from, diabetes, hypothyroidism, osteoporosis, breathlessness, chronic bronchitis, with oral, cutaneous and vaginal erythematous lichen, Cushing's Syndrome, penicillin allergy, subjected to past hypophysectomy. The swelling was, first of all, treated in urgency, with an intravenous antibiotic therapy and, immediately afterwards, the phlegmonous infiltration linked to the avulsion of the lower third molar was surgically drained. The patient was then treated with intravenous multiple antibiotics, with the aim of eradicating the predominating bacteria that was encountered in the microbiological culture test. A complete remission of the pathological picture was obtained .

Bone regeneration: in vitro evaluation of the behaviour of osteoblast-like MG63 cells placed in contact with polylactic-co-glycolic acid, deproteinized bovine bone and demineralized freeze-dried bone allograft

Insufficient bone density of the alveolar crests, caused by loss of the dental elements, sometimes impedes the primary stability of an integrated bone implant. The techniques of bone regeneration allow to obtain a sufficient quantity of alveolar bone to permit the implant rehabilitation of the edentulous crests. Today several grafting materials are available and they have different characteristics, according to their structure, which influence the different behaviour of the grafting materials to the bone and the implant surface. The aim of this study is to evaluate the interaction between a human osteosarcoma MG63 cell line and three different biomaterials: polylactic-co-glycolic acid (PLAGA), deproteinized bovine bone and demineralised freeze-dried bone allograft (DFDBA). From this study a different behaviour emerges of the osteoblast-like MG63 cells in relation to the sublayer on which these cells were placed in culture. The results of the study, in fact, demonstrate that the most osteoconductive material of the three analysed is the DFDBA, followed by DPBB. On the contrary, the PLGA, because of its roughness, does not seem to represent a valid support for cell growth, and does not encourage any morphologic modification in tumor cells. Furthermore, deproteinized bovine bone shows a differentiating effect which could lead to hypothesise an osteoconductive capacity of this biomaterial. Further studies should be carried out with the aim of explaining the results obtained.

Mandibular osteomyelitis due to Pseudomonas aeruginosa. Case report

Osteomyelitis is a relatively frequent bacterial infection of the jaw bones. This report describes a case of mandibular osteomyelitis in a surgical site after enucleation of a follicular cyst and extraction of the associated tooth. This case is unusual because maxillary osteomyelitis generally results from polymicrobial infection. In our patient, however, laboratory analysis identified Pseudomonas aeruginosa as the etiologic agent, an opportunistic pathogen normally found on moist surfaces and vegetation. Notorious for its antibiotic multiresistance, P. aeruginosa is increasingly recognized as a serious problem in hospitalized patients. Isolation of the responsible microbe permitted specific antibiotic treatment with a 10-day course of ciprofloxacin (250 mg/12 h), which fully cleared the infection.

Mesothelial Cyst of the Kidney. A Rare Case Report of this Neoformation on the Left Kidney

The authors are hereby presenting a rare case of neoformation developing on the left kidney in a 80-year-old patient affected by left lumbar backache. The neoformation appears doubtful in nature, on ultrasonography, CT scan and MRI. The lesion is roundish and contiguous at the kidney convex edge; due to its clinical aspects, it requires a surgical management and is, therefore, easily excised. The histopathologic examination confirms it is a mesothelial cyst. The case is presented for its absolute rarity and for the preoperative diagnostic doubts it may generate.

[Mesothelial cyst of the kidney. A rare case report of this neoformation on the left kidney]

The authors are hereby presenting a rare case of neoformation developing on the left kidney in a 80-year-old patient affected by left lumbar backache. The neoformation appears doubtful in nature, on ultrasonography, CT scan and MRI. The lesion is roundish and contiguous at the kidney convex edge; due to its clinical aspects, it requires a surgical management and is, therefore, easily excised. The histopathologic examination confirms it is a mesothelial cyst. The case is presented for its absolute rarity and for the preoperative diagnostic doubts it may generate.

Antimicrobial susceptibility and beta-lactamase production of anaerobic and aerobic bacteria isolated from pus specimens from orofacial infections

Most suppurative orofacial infections are polymicrobial. Information regarding the antimicrobial susceptibility of the microorganisms involved can be useful in the choice of an effective antibiotic therapy. In this study we determined the antimicrobial susceptibility of a total 235 anaerobic and aerobic bacteria recently isolated from pus specimens of orofacial infections. All the viridans streptococci were susceptible to penicillin, cefotaxime, cefoxitin, imipenem and levofloxacin. Imipenem and levofloxacin were active against 100% of the anaerobic Gram-positive organisms isolated. Among the anaerobic Gram-negative rods beta-lactamase production was detected in all species except Campylobacter rectus. Amoxicillin-clavulanate, cefoxitin, imipenem and metronidazole were active against all the isolates of anaerobic Gram-negative species. Isolates resistant to erythromycin were found in all the species tested, however, resistance to clindamycin was only detected in Porphyromonas gingivalis and Bacteroides ureolyticus. Isolates resistant to levofloxacin were detected in P. gingivalis and Prevotella sp.

Bone substitutes in oral surgery

Osseous defects pose a clinical challenge the operator can meet with the aid of techniques that promote bone tissue regeneration. The current gold standard is autologous bone harvested from intra- and extraoral donor sites; however, autologous bone grafting requires two surgical sites (donor and recipient), resulting in greater morbidity and prolonged operating times, particularly for extraoral sites, with greater discomfort for the patient. Such disadvantages can be overcome with the use of bone substitute materials. There is a notable variety of so-called intelligent biomaterials that can modulate bone response in regeneration. Based on origin, bone substitute materials are classified as allogenic, heterologous and alloplastic materials. The first refer to bone from same-species donors, the second are obtained through processing of bone from different species, while alloplastic materials are synthetic composites. Besides different resorption rates, they possess different chemical and structural characteristics that influence the stimulation or support of bone regeneration. In daily clinical practice, before selecting from the wide variety of biomaterials, a wise step is to analyze and compare the clinical and histological results obtained with these materials. This article examines the clinical applications and osteoconductive and/or osteoinductive properties of some currently available biomaterials.

Liquid-based endometrial cytology: cyto-histological correlation in a population of 917 women

OBJECTIVE

Liquid-based cytology, because of its capacity to reduce the obscuring factors and to provide thin-layer specimens, represents an opportunity to reevaluate endometrial cytology. In order to assess the utility of the liquid-based method in endometrial diagnosis, we evaluated its accuracy in comparison with histology.

METHODS

Nine hundred and seventeen women scheduled for hysteroscopy were enrolled in the study. After providing informed consent, all the women proceeded sequentially to hysteroscopy, endometrial cytology and then biopsy endometrial sampling.

RESULTS

Cyto-histological correlations were possible in 519 cases (57%): in 361 (39%) cases the biopsy was inadequate, in 15 (2%) the cytology was inadequate, and in 22 (2%) both were inadequate. At biopsy 25 (3%) women had adenocarcinoma, 5 (1%) had adenomatous atypical hyperplasia and 21 (2%) had simple non atypical hyperplasia. At cytology two adenocarcinomas and one adenomatous atypical hyperplasia were underrated as atypical hyperplasias and as non-atypical hyperplasia; two simple non-atypical hyperplasias were reported as negative; and eight cases were false positive (non-atypical hyperplasia at cytology, negative at biopsy). In our population, the cytology provided sufficient material more often than biopsy (P < 0.04). Sensitivity was estimated at 96%, specificity at 98%, positive predictive value at 86% and negative predictive value at 99%.

CONCLUSIONS

We concluded that endometrial cytology may be an efficient diagnostic method. It could be applied to selected patients solely or in association with ultrasonography. The combination of these two noninvasive procedures may improve their diagnostic accuracy and reduce unnecessary hysteroscopies, thereby producing benefits for women and society.

Liquid-based endometrial cytology: its possible value in postmenopausal asymptomatic women

The incidence of endometrial adenocarcinoma in asymptomatic women is low. Nevertheless, some of these women might require endometrial surveillance. In this study, we evaluated the accuracy of liquid-based endometrial cytology compared to biopsy in asymptomatic postmenopausal women. Three hundred twenty women scheduled for hysteroscopy were enrolled for this study. After hysteroscopy, patients were submitted to endometrial cytology and to biopsy. Two hundred ninety-three (92%) women had sonographically thickened endometrium (>5 mm), 53 (17%) were on tamoxifen, and 16 (5%) were on hormonal substitutive treatment. The evaluation of the biopsies determined that six (2%) women had adenocarcinoma, one (<1%) had adenomatous atypical hyperplasia, and eight (3%) had simple nonatypical hyperplasia. Endometrial cytology evidenced 5 (2%) neoplastic cases, 2 (<1%) hyperplastic with atypia cases, and 25 (8%) hyperplastic without atypia cases. Two hundred twenty-two biopsies (69%) and 17 (5%) cytologies were inadequate. One adenocarcinoma and one simple nonatypical hyperplasia were underrated by cytology resulting, respectively, as atypical hyperplasia and as negative. Four cases were false positive (simple nonatypical hyperplasias on cytology, negative on biopsy). The sensitivity and specificity were estimated, respectively, at 94% and 95%; the positive and negative predictive value were estimated, respectively, at 80% and 99%. Endometrial cytology provided sufficient material more often than biopsy (P < 0.01). We suggest to introduce liquid-based endometrial cytology in the management of some subpopulations of asymptomatic postmenopausal women. Particularly, the combination of liquid-based endometrial cytology and transvaginal sonography may improve their diagnostic accuracy and reduce unnecessary more invasive and expensive procedures.

Local delivery of antimicrobial drugs in the treatment of chronic adult periodontitis

AIM

The aim of this study was to evaluate the clinical and microbiologic results of local delivery of adjunctive antimicrobials in the treatment and management of patients with periodontitis.

METHODS

The study population included 33 patients (age range, 37-49 years), with chronic adult periodontitis. Eleven of 33 received local treatment with 10% doxycycline injected directly into the periodontal pocket; 11 received local treatment with a chlorhexidine-based gel (1.5%) in situ; 11 received mechanical treatment with scaling and root planing. The crevicular fluid of the doxycycline-treated group was analyzed using high performance liquid chromatography over a period of 1 month.

RESULTS

In the 11 patients treated with an antibiotic we observed a reduction in attachment loss and a reduction in probing depth of 1.4 mm; in the 11 chlorhexidine-treated patients we observed a reduction in attachment loss and a reduction in probing depth of 0.9 mm; in the remaining 11 patients the reduction in attachment loss and probing depth was less than those measured in the other two treatment groups.

CONCLUSIONS

Our results suggest that direct delivery of antimicrobial agents to the infection site may be a useful adjunctive to conventional periodontal treatment.

Gingival overgrowth in renal transplant recipients induced by pharmacological treatment. Review of the literature

Patients who undergo a renal transplant also require a pharmacological immunosuppressor therapy with cyclosporine (CsA) as well as anti-hypertensive calcium channel-blockers (CCBs); the former suppresses interferon and interleukin-2 production thus interfering with T cell cell-mediated activity, while the latter are used in order to counteract the nephrotoxicity of CsA which causes the local release, of thromboxane A2 with vascular vasoconstriction in the kidney. The use of both these drugs, particularly if used in association, leads to the onset of a clinical picture of variable entity, characterized mainly by a hypertrophy originating usually at the level of interdental papillae, and more pronounced in the anterior maxillary areas and the vestibular surfaces of the teeth, in a more or less symptomatic manner. The therapy is above all preventive, with an appropriate oral hygiene program, both professionally as well as at home, and with the use of substitutive drugs that do not present such side effects.

The Use of Silicon Elastomer in Maxillofacial Rehabilitation as a Substitute for or in Conjunction With Resins

Maxillofacial prosthetic rehabilitation aims to restore anatomic function when serious tissue defects are present, as a result of congenital factors, trauma, or surgery. The aims are both aesthetic and functional, and results are obtained using devices that contain, reconstruct, and fill. This study introduces a technique using methods and materials that are acceptable to the patient in that they satisfy chewing, phonetic, and aesthetic functions, while respecting bone structure and restoring function to the soft tissues without causing trauma to them. Our techniques do not use innovative materials, but ones that are structurally different and that, until now, have not been connected with attachment systems. Acrylic resin, acetylic resin, and silicon are used, each in such a way as to take maximum advantage of each material's characteristics and thus give the best results.

Implant surface and osseointegration

Oral rehabilitation by means of osteointegrated implants is gaining more and more importance, in particular due to the improved characteristics of the fixture: among these, the superficial microscopical morphology plays a role of primary importance, since it can influence the evolution of the osteointegrative process. Therefore, this led to many surface treatments which can improve the quality and the speed of formation of the bony tissue. The aim of this paper is a review of the literature on this topic in order to find out which processes of characterization of the surface implant are now available and which results can be obtained.

Serum luteinizing hormone, follicle-stimulating hormone and oestradiol pattern in women undergoing pituitary suppression with different gonadotrophin-releasing hormone analogue protocols for assisted reproduction

Gonadotrophin-releasing hormone analogues (GnRH-a) are used widely in controlled ovarian stimulation (COS) cycles for assisted reproduction. At present, there is great debate about the influence of exogenous hormone activity on the hypothalamus-pituitary axis following pituitary desensitization. The objective of this comparative study was to investigate the pattern of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and oestradiol in women undergoing ovarian stimulation with different GnRH-a preparations. We retrospectively analysed 201 women, aged between 27 and 43 years, who were referred consecutively to our infertility clinic between January 2002 and January 2003. All women had no endocrinopathies or occult ovarian failure as assessed by day-3 hormone profile. Women were enrolled in one of the following COS protocols: depot triptorelin long protocol (n = 38), buserelin long protocol (n = 101) or buserelin short protocol (n = 62). Recombinant FSH was used to induce ovulation. Treatment was monitored by transvaginal ultrasound scan and serum measurement of FSH, LH and oestradiol. Among the women initially included, 30 had cancelled cycles due to poor ovarian response. Serum LH levels were significantly higher in the short-protocol group compared with the long-protocol groups (p < 0.001). The number of follicles, oocyte yield, number of grade-I embryos and fertilization rate were significantly lower in the short-protocol group than in the long-protocol groups. These findings showed that LH concentrations are significantly higher in women undergoing reversible medical hypophysectomy with a GnRH-a short protocol than in women treated with a long protocol. The hypothesis of an LH ceiling is confirmed.

[Antibacterial effect of Nd:YAG laser in periodontal pockets decontamination: a in vivo study]

AIM

Tha aim of this paper is to assess the effects in vivo of the Nd: Yag laser on gingival microflora in patients periodontally at risk.

METHODS

An investigation has been carried out on 5 patients suffering from serious periodontal disease, with a sub-gingival check-up a week after the treatment. The selected patients presented either a relapse after the raising of a traditional flap, or showed acute phenomena and were, therefore, treated with a laser with the propedeutic intention of surgery; or they refused traditional surgical therapy or presented systematic pathologies that could not be included in the appropriate protocol. Pockets were chosen that had a probe depth of between 5-8 mm, an optic fibre probe was pushed as far as possible into the probe depth, for about 1 minute per site, 5 times, at 30 second intervals. The samples, taken in order to calculate bacteria colonies, were carried out before using the laser, immediately after and, again, 1 week later.

RESULTS

All the sites showed a slight reduction in the quantity of colonies forming immediately after the Nd:Yag laser application, while a week later, only if clinical inflammation appeared to be resolved, the bacteria forming colonies seemed to be reduced.

CONCLUSION

From this study it can be concluded that the use of the Nd:Yad laser represents, in mild and average periodontitis, a therapeutic aid to scaling and root planing and, in the same way, in serious periodontitis for traditional surgical therapy.

Drugs in oral surgery. Brief guidelines for adult patients

Drugs administrable in oral surgery for adult patients are antiseptics-antibiotics, antiinflammatory-analgesics and sedative-hypnotics. Such drugs can be administered before, during or after oral surgery. Sedative-hypnotics can be administered before or during oral surgery in order to control the patient's anxiety. Anti-inflammatory-analgesics, on the other hand, can be administered before or after oral surgery to lower edema and pain. For this purpose, FANS are the most commonly used drugs but, in more traumatic oral surgery, the administration of a single pre-surgery dose of corticosteroids is suitable. As regards, antibiotics have to be given from 15 min to 1 h before oral surgery and continued or otherwise for 24-48 h depending on the dosage. post-surgery infection onset, in fact, is higher within 3 h after oral surgery.

[Alveolar ridge augmentation by means of onlay grafts harvested from mandibular symphysis]

AIM

Prosthestic-implant rehabilitation in subjects partially, or totally, endentulous is the method of choice for the considerable advantages involved from an aesthetic as well as functional point of view, besides preventing the physiological reabsorption that is established in the edentulous area. However, it is necessary to have an adequate quantity, as well as quality, of bone in order to support the fixture and the masticating load, conditions that up to now could often prove inferior for various reasons. Such a randomized research programme was proposed, in order to increase the bone volume by means of grafted onlays in the mandibular/chin area, with implant positioning 6 months after the operation, as a valid solution to the prosthestic problems found in the bone deficiency area.

METHODS

Twenty patients with partial edentulism in the incisor-canine area were chosen. They showed no signs of periodontal diseases, bruxism or parafunctions. They underwent an autogenesis bone graft with the bone being taken from the mandibular/chin area, with positioning of the implant 6 months after the first operation, thus obtaining an increased bone height of 5 to 7 mm.

RESULTS

Check ups were carried out in the 1(st) week after surgery, once a month for the first 3 months and then every 6 months and showed a minimal degree of bone reabsorption and an excellent osteo-integrative process.

CONCLUSION

The use of onlay autogenous bone, compared to the other methods for increasing bone volume, is a valid solution for prosthetic-implant rehabilitation in edentulous areas.

Use of new adjuvants in an emergency vaccine against foot-and-mouth disease virus: evaluation of conferred immunity

The ability of an emergency adjuvanted FMDV vaccine to elicit early protective immune response in mice was examined. We studied the efficacy of several adjuvants to induce such protection. The aqueous IMS1313 plus inactivated FMDV induce a higher protective immune response than the vaccine with inactivated virus alone at seven days post vaccination (dpv). Mice vaccinated with this formula showed higher lymphoproliferative index values and higher IL-2, IL-4 and IFNgamma levels than the controls.

[Role of human viruses in the pathogenesis of periodontal disease]

Human viruses play a fundamental role in the pathogenesis of periodontal disease due to their intrinsec capacity to interfere with immune system of the host. Herpesvirus maybe involved in the onset or progress of a number of periodontal diseases while HIV seems to be related to the linear gingival erythema (LGE) and necrotizing ulcerative periodontitis (NUP).

Calixarene--poly(dithiophene)-based chemically modified electrodes

The stepwise synthesis of cone and partial cone 1,3-bridged n-propoxy-calix[4]crown ethers ("monomers" 2 and 3) with an electropolymerizable 2,2'-dithiophene-3-yl-hexylene functionality at the lower rim, is described. The potential of 2 and 3 as sensing agents for alkali metal ions was investigated by 1H NMR titration experiments with NaSCN and KSCN. The results obtained have confirmed that the presence of the heterocyclic subunit does not affect the well-known size-selectivity observed with calix[4]crowns. Monomers 2 and 3 were electropolymerized (Pt as a working electrode, CH2Cl2/CH3CN, Bu4NPF6) to produce the title chemically modified electrodes (CMEs). After coating with a PVC membrane containing a lipophylic cation exchanger, CMEs based on calix[4]-crown-5 2b (cone) and 3b (partial cone) were tested for the potentiometric recognition of alkali metal ions in aqueous solution. In agreement with NMR titration studies, a satisfactory potentiometric response in terms of K+/Na+ selectivity was obtained only with CME 2b (pK(K/Na) 1.51). The amperometric responses of PVC-uncoated CMEs were studied by cyclic voltammetry (CV) experiments in CH3CN solution. High Na- selectivity was found with the CME based on partial cone calix[4]crown-4 3a, and frequency response analysis (FRA) measurements support this finding.

Older adult multiorgan donors and misdiagnosed tumor

BACKGROUND

In these last years, the increase in organ donations is mostly due to old patients died of primary vascular cerebral diseases. In this kind of patients some undiagnosed cancers can be present and can be transmitted to the receiver. Aim of this study is to carry out a research in order to identify any undiagnosed cancer which can be present during the period of encephalic death.

METHODS

Perspective study: hospitals type II and type III. Polyvalent intensive care. From January 1999 to July 2000 encephalic death has been ascertained in 16 patients. The research of tumor markers has been carried out on these patients. Further diagnostic researches have been carried out on patients who had anomalous values.

RESULTS

The organ donations have not been made by eight patients: five for family refusal, one for medical contraindications, two for the presence of undiagnosed tumor (PSA 1100 ng/ml and CEA 129.5 ng/ml) confirmed by prostatic and abdominal US imaging. A patient with CA 19-9 89.5 ng/ml has not been examined, because of the family refusal to donation. A patient with PSA of 135 ng/ml had a negative response from the anal scanner, and so the prosecution of the donation has not been interrupted. A blood sample has been taken and a biopsy of the prostate has been made to confirm the absence of neoplasm.

CONCLUSIONS

It is necessary to make a careful examination of the organ donor to check if some cancers are present. Tumor markers cannot be used to make a diagnosis of a cancer, but they can be used as guide for further researches. In spite of all the diagnostic efforts, the objective evaluation of the surgeon is still the most important factor like the biopsy of all the suspected lesions during an operation and the autopsy.

[The vertical root fracture]

Remembering the epidemiology and the possible etiologies of vertical root fractures, the authors distinguish between fractures that occur in vital teeth and vertical fractures of endodontically treated roots. They discuss predisposing factors, onset modality and follow-up. They describe the symptomatology and the few radiographic pathognomonic signs. They show the importance, prognostic and therapeutic purposes, of an exact differential diagnosis as regards periodontal problems. On the basis of personal experience and the literature they believe that the one certain resolutive therapy is extraction in the case of monorooted teeth and the root amputation of the fractured root in case of plurirooted teeth with a good periodontal supporting bone. They conclude by stressing the importance of a preventive global approach to reduce, among other things, the incidence of these unusual conditions that are difficult to diagnose, present no clear signs, and have an unfavourable prognosis.

Interactions at the outside faces of calix

Attractive pi-pi interactions between two of the four outside cavity faces of 1,3-bis-pyridylmethylcalix[4]arene (1) and both faces of 1,4-diiodotetrafluorobenzene (2a) form infinite one-dimensional non-covalent ribbons where the two modules alternate. These ribbons are cross-linked by electron donor-acceptor interactions between picolyl nitrogen atoms of calixarene 1 in one chain and iodine atoms of perfluoroarene 2a in another chain and the two-dimensional supramolecular network 3a is formed. A similar behaviour is also shown by 1,4-dibromotetrafluorobenzene (2b). The halogen bonding and the attractive pi-pi interactions occur in directions which are nearly orthogonal each other. Diiodotetrafluorobenzene, being involved in both these interactions, appears to be a particularly interesting tecton. The ability of electron-poor arenes to elicit the exo-receptor potential of calixarene module by connecting their outside faces through pi-pi interactions may be developed as a new and general binding protocol in calixarene self-assembly processes.

[Glutathione-S-transferase expression in oral squamous cell carcinoma]

BACKGROUND

A large number of oral cancer patients shows poor or partial response to chemotherapy and the mechanisms are poorly understood. Glutathione-S-transferase (GST) is one of the molecules involved in resistance to natural product-based chemotherapeutics. It is an enzyme able to conjugate several substances (metabolites, drugs) to reduct glutathione. Today several isoenzymes of GST are known: GST-alpha, GST-mu, GST-pi, GST-theta. Over-expression of glutathione S-transferase-pi class isozyme is often associated with malignant transformation. Several studies reported that GST-pi staining patterns and their distribution may be helpful in identifying high-risk oral lesions. However, GST is surely involved in resistance to alchilant agents.

OBJECTIVE

To verify the possibility of implication of GST in oral cancerogenesis and in natural chemioresistance, the authors examined the protein expression patterns by immunohistochemistry in paraffin-embedded specimens of primary untreated oral cancers (OSCC).

METHODS

GST-a and GST-pi expression in 17 cases of OSCC at different degree of cellular differentiation have been evaluated by immunohistochemistry.

RESULTS

The GST-pi expression in primary tumours predominantly varied from mild to moderate levels. The GST-a expression was often quite similar to GST-pi expression with a few exceptions.

CONCLUSIONS

Expression of GST enzymes is an important signal for multidrug resistance: positive staining for both GST-pi and GST-a could constitute a hallmark of chemoresistant groups of OSSC.

The role of apoptosis and bcl-2 protein in topical treatment of oral leukoplakia with isotretinoin

BACKGROUND

This study evaluates the role of bcl-2 protein, as well as, of apoptotic bodies in the topical treatment of oral leucoplakia with 13-cis-retinoic acid (isotretinoin). To test this role, a clinical, histological and immunohistochemical study of the treated lesions was carried out, so as to verify the role of apoptosis and its genetic control mechanism of the development, progression and therapy of preneoplastic lesions.

METHODS

A Double-blind study was carried out on 15 patients afflicted with oral leukoplakia. They were treated daily (3 topical applications) with 0.1% isotretinoin gel or a placebo for 4 months. Afterwards, the patients treated with placebo were administered the active medication for an additional 4 month period.

RESULTS

All the patients, with the exception of one patient who was lost to follow-up, who finished the treatment, showed a marked improvement of the dimension and the clinical aspect of the lesions (3 total remission, 11 improvement of the size and clinical appearance of the lesion of 50% or more). The immunohistochemical analysis for bcl-2 protein showed a weak positive reaction of the level in the basal membrane of the specimens collected before the pharmacological treatment; after the pharmacological treatment almost all the specimens with the exception of one, tested completely negative for bcl-2 protein. In the specimens collected before the pharmacological treatment only a few apoptotic bodies were observed, while after treatment the samples showed a noticeable increase of apoptotic bodies.

CONCLUSIONS

A statistical analysis showed that the difference in the positive reaction to bcl-2 protein between the 2 groups is not statistically significant (p = 0.132). On the other hand, the difference in the count of apoptotic bodies between the 2 groups is statistically significant (p = 0.0193).

[Bcl-2, p53, Ki-67 and apoptotic index in cancerous and precancerous lesions of the oral mucosa]

BACKGROUND

In this study an immunohistochemical analysis of both normal and pathological tissues was made to investigate the expression of some factors involved in genic regulation mechanisms of apoptosis.

METHODS

In normal mucosa, in leukoplakia, in mild and severe dysplasia and in high, mild and low grade cancer a bcl-2, p53, and Ki 67 evaluation was made using immunostaining techniques; also an evaluation of apoptotic index was carried out. Seventy-two biopsies were made in 12 patients with normal mucosa, 12 affected by leukoplakia, 12 by dysplasia (6 mild, 6 severe), 12 by low grade, 12 by mild grade and 12 by high grade cancer. > t

RESULTS

The immunohistochemical analysis pointed out that there was weak bcl-2 expression in normal mucosa and in preneoplastic lesions and less more in severe dysplasia while bcl-2 was discreetly detectable in oral tumors. P53 was not detectable in normal mucosa and weakly expressed in preneoplastic lesions, presenting a peak in severe dysplasia. These results showed an interesting inverse relation between bcl-2 and p53 expression in severe dysplasia. Ki 67 expression results to be weak in normal mucosa, in preneoplastic lesions and in mild dysplasia, while it reaches the maximum level in severe dysplasia and in tumors.

CONCLUSIONS

In all the samples the apoptotic index expression showed the same features of the Ki 67 protein. These results were achieved through statistically analysis carried out with the U Mann Whitney test.

[Conservative treatment of upper anterior dental discrepancy during orthodontic therapy]

The orthodontic therapeutic sequence used in cases with dento-dental discrepancy for reduced mesiodistal size and congenital absent lateral upper incisors, is described. The importance of correct conoid tooth replacement in the programmed space between the other teeth and its restorative treatment in order to obtain the best biomechanical control is stressed. The contemporaneous presence of the form and volume anomaly of the 12th and the missing 22nd due to agenesia demanded an interdisciplinary approach. For the restoration of the conoid tooth the authors used a microhybrid composite for the alloy properties with the grain size of the inorganic particles. In fact this type of composite responds well to mechanical stress and has a high shining capacity and good aesthetical rendering. Meanwhile the temporary dental prothesis solution of the 22nd in this case has suggested the application of the artificial element on the superior Hawley holding plaque.

Efficacy of corticosteroid therapy on cerebral gummas: risks and implications

Complete resolution of a cerebral gumma can take place after massive corticosteroid treatment. Such a result in patients not known as syphilitic can be misleading and hamper the identification of the true nature of the lesion.

[Augmentation of the maxillary sinus by Le Fort osteotomy in endosseous implantology. A clinical case report]

The authors present a case of sinus floor elevation using Le Fort I osteotomy. They underline that, owing to its peculiarities, this type of intervention is indicated, in their opinion, for sinus floor elevation when both the vertical dimension and possible skeletal discrepancies require modification. They briefly describe the indications, peculiarities and contraindications.

[Introduction to the study of the Willis circle with transcranial color Doppler: methodological notes and preliminary experience]

To date, adult intracranial circulation has been studied only with pulsed-wave Doppler US, which is a useful diagnostic tool even though several technical and practical limitations are related to the difficult location of intracranial vessels. Recently, dedicated color-Doppler transducers have been proposed, which can pass through the skull which makes a physiologic barrier for the US beam: this technique has been called transcranial color-Doppler (TCD). We report on our personal experience with TCD in 30 healthy volunteers (12 men and 18 women, age range: 17-75 years) submitted to TCD for Willis circle imaging. We used an ATL Ultramark 9HDI unit with a phased array transducer (3.5 MHz) and 2 MHz Doppler frequency; the PRF was 3000 Hz, with 80% color gain. 100 Hz wall filters were used. The middle cerebral artery was always shown correctly in all subjects, while the posterior one was depicted only in 7 cases (23.3%); in contrast, the anterior cerebral artery was demonstrated in 3 cases only (10%). Nowadays, TCD is mostly applied to normal intracranial circle studies, to assess normal blood speed values more accurately. To this purpose, both the direct visualization of blood vessels and the flowmetric values obtained measuring the incidence angle are useful pieces of information. TCD permits a more accurate study of intracranial local blood flow in the Willis circle and of its changes in pathologic conditions. In contrast, TCD yield is poor in characterizing intracranial tumor tissue.

X-ray evaluation of interferential femoral screw positioning in ACL reconstruction

In a total of 27 patients the authors performed reconstruction of the anterior cruciate ligament using the mid third of the free patellar tendon (bone-tendon-bone), stabilized with two interferential wires, using a mini-arthrotomic half-tunnel in-out method. X-ray examination in two orthogonal views allows for an evaluation of the orientation of the femoral screw in relation to the joint plane and the diaphyseal axis, and its relationship with the bone graft, thus obtaining useful information on its anchoring. The method used is that reported by Lemos et al. (1993). The results obtained agree with those reported by the American author and substantiate the reliability of the method.