Terapia descompresiva en el manejo no quirúrgico de lesiones perirradiculares de gran tamaño / Decompressive therapy in the non-surgical management of large periradicular lesions

Introducción: La periodontitis apical asintomática es de los diagnósticos endodónticos más comunes que se presentan en la población mundial. Consiste en la afectación del tejido periapical como resultado de la activación de mecanismos de inflamación, los que incluyen lisis y reabsorción de tejidos de soporte como cemento, ligamento y hueso alveolar. El signo patognomónico de la periodontitis apical es la presencia de radiolucidez periapical, resultado de la destrucción de los tejidos periapicales. Su principal tratamiento abarca el manejo endodóntico convencional cuyo objetivo es la eliminación de los irritantes locales dentro del conducto radicular. Sin embargo, cuando se desarrollan lesiones de gran tamaño es necesario complementar con terapias que aceleren la reparación, una de ellas la descompresión, la cual a partir de la reducción de la presión intralesión e intraósea con lo que favorece la formación de tejido fibroso, conectivo y óseo. Objetivo: Describir la técnica de descompresión intraconducto en el manejo de lesiones periapicales de gran tamaño. Presentación del caso: Paciente de 33 años de edad, con diagnóstico de periodontitis apical asintomática y evaluación tomográfica de lesión periapical de gran tamaño (67,5 UH) manejado con terapia endodóntica convencional y descomprensión intraconducto como terapia coadyuvante. Posterior a la restauración se realizaron controles clínicos y radiográficos. A los 24 meses se evidenció reparación de los tejidos involucrados con restauración del espacio del ligamento periodontal. Conclusiones: En este caso, la terapia descomprensiva fue una alternativa en el manejo de una lesión periapical de gran tamaño, que permitió regular la presión intraósea y facilitar la regeneración del tejido óseo, evitando la intervención quirúrgica siendo así más confortante para el paciente(AU)

Introduction: Asymptomatic apical periodontitis is one of the most common endodontic disorders diagnosed in the world population. It consists in damage to the periapical tissue due to activation of inflammation mechanisms, including lysis and resorption of support tissues like cementum, ligament and alveolar bone. The pathognomonic sign of apical periodontitis is the presence of periapical radiolucency due to the destruction of periapical tissue. Its main treatment includes conventional endodontic management aimed at removing local irritants from the root canal. However, when large lesions develop, it is necessary to complement the conventional treatment with therapies speeding up the repair process, such as decompression, which reduces intralesion and intraosseous pressure, fostering the formation of fibrous, connective and bone tissue. Objective: Describe the use of intracanal decompression technique in the management of large periapical lesions. Case presentation: A case is presented of a 33-year-old patient diagnosed with asymptomatic apical periodontitis and a tomographic evaluation of a large periapical lesion (67.5 UH) treated with conventional endodontic therapy and intracanal decompression as adjuvant therapy. Restoration was followed by clinical and radiographic controls. At 24 months it was observed that the tissues involved had been repaired and the periodontal ligament space restored. Conclusions: The use of decompressive therapy as an alternative in the management of a large periapical lesion, made it possible to regulate intraosseous pressure and facilitate bone tissue regeneration, relieving the patient from the discomforts of a surgical intervention(AU)

Principal components analysis of Raman spectral data for screening of Hepatitis C infection.

In the current study, Raman spectroscopy is employed for the identification of the biochemical changes taking place during the development of Hepatitis C. The Raman spectral data acquired from the human blood plasma samples of infected and healthy individuals is analysed by Principal Components Analysis and the Raman spectral markers of the Hepatitis C Virus (HCV) infection are identified. Spectral changes include those associated with nucleic acidsat720 cm-1, 1077 cm-1 1678 (CO stretching mode of dGTP of RNA), 1778 cm-1 (RNA), with proteins at 1641 cm-1(amide-I), 1721 cm-1(CC stretching of proteins) and lipids at 1738 cm-1(CO of ester group in lipids). These differences in Raman spectral features of blood plasma samples of the patients and healthy volunteers can be associated with the development of the biochemical changes during HCV infection.

Raman spectroscopy of blood plasma samples from breast cancer patients at different stages.

Raman spectroscopy was employed for the characterization of blood plasma samples from patients at different stages of breast cancer. Blood plasma samples taken from clinically diagnosed breast cancer patients were compared with healthy controls using multivariate data analysis techniques (principal components analysis - PCA) to establish Raman spectral features which can be considered spectral markers of breast cancer development. All the stages of the disease can be differentiated from normal samples. It is also found that stage 2 and 3 are biochemically similar, but can be differentiated from each other by PCA. The Raman spectral data of the stage 4 is found to be biochemically distinct, but very variable between patients. Raman spectral features associated with DNA and proteins were identified, which are exclusive to patient plasma samples. Moreover, there are several other spectral features which are strikingly different in the blood plasma samples of different stages of breast cancer. In order to further explore the potential of Raman spectroscopy as the basis of a minimally invasive screening technique for breast cancer diagnosis and staging, PCA-Factorial Discriminant Analysis (FDA) was employed to classify the Raman spectral datasets of the blood plasma samples of the breast cancer patients, according to different stages of the disease, yielding promisingly high values of sensitivity and specificity for all stages.

Raman spectral analysis for rapid screening of dengue infection.

Infection with the dengue virus is currently clinically detected according to different biomarkers in human blood plasma, commonly measured by enzyme linked immunosorbent assays, including non-structural proteins (Ns1), immunoglobulin M (IgM) and immunoglobulin G (IgG). However, there is little or no mutual correlation between the biomarkers, as demonstrated in this study by a comparison of their levels in samples from 17 patients. As an alternative, the label free, rapid screening technique, Raman spectroscopy has been used for the characterisation/diagnosis of healthy and dengue infected human blood plasma samples. In dengue positive samples, changes in specific Raman spectral bands associated with lipidic and amino acid/protein content are observed and assigned based on literature and these features can be considered as markers associated with dengue development. Based on the spectroscopic analysis of the current, albeit limited, cohort of samples, Principal Components Analysis (PCA) coupled Factorial Discriminant Analysis, yielded values of 97.95% sensitivity and 95.40% specificity for identification of dengue infection. Furthermore, in a comparison of the normal samples to the patient samples which scored low for only one of the biomarker tests, but high or medium for either or both of the other two, PCA-FDA demonstrated a sensitivity of 97.38% and specificity of 86.18%, thus providing an unambiguous screening technology.

Effects of priming volume reduction on allogeneic red blood cell transfusions and renal outcome after heart surgery.

INTRODUCTION: Excessive hemodilution during cardiopulmonary bypass (CPB) is associated with an increased rate of red blood cell (RBC) transfusion and acute kidney injury (AKI). Minimization of the oxygenator priming volume is a measure to contain hemodilution. In this study, we evaluated the new oxygenator, Sorin Inspire 6™, with respect to its ability to limit hemodilution, RBC transfusion rate and postoperative AKI rate. METHODS: A retrospective study on a consecutive series of 1,724 adult patients receiving heart surgery with CPB. Patients treated with the Inspire 6™ were assigned to the low priming volume oxygenator (LPVO) group (N=383) and patients treated with conventional oxygenators to the conventional group (N=1,341). Dynamic priming volume, time course of the hematocrit, RBC transfusions and AKI rate were compared between the groups. RESULTS: Priming volume was significantly (p=0.001) lower in the LPVO group (624±113 mL) vs. the conventional group (775±150 mL), with higher values of hematocrit during and after CPB. After correction for other confounders, patients in the LPVO group had a significantly lower RBC transfusion rate (odds ratio 0.68, 95% confidence interval 0.52-0.90, p=0.006) and AKI rate (odds ratio 0.55, 95% confidence interval 0.32-0.93, p=0.032). CONCLUSION: The Inspire 6™ oxygenator allows a significant containment of hemodilution during CPB, reducing the risk of RBC transfusions and postoperative AKI.

Transfusions during cardiopulmonary bypass: better when triggered by venous oxygen saturation and oxygen extraction rate.

During cardiopulmonary bypass (CPB), red blood cell transfusions may be required to correct dilutional anemia. The decision-making process for transfusions is usually based on the level of hemoglobin.This study investigates the hypothesis that oxygen-derived variables (mixed venous oxygen saturation, SvO(2), and oxygen extraction rate, O(2)ER) may be more reliable predictors of the efficacy of the transfusion. Thirty-six patients for 41 transfusion episodes during CPB were retrospectively analyzed. For each patient, oxygen-derived variables, including SvO(2) and O(2)ER, were measured before and after the transfusion. No changes in pump flow were allowed between the two measurements. The efficacy of transfusion was defined as an increase in SvO(2) of at least 5%. We identified 11 transfusion episodes leading to an efficacious SvO (2) increase. Factors associated with the efficacy of the transfusion were a low SvO(2) and a high O(2)ER. No association was found with hemoglobin values, unless for a trend for efficacy of transfusion in patients with very low (<6 g/dL) hemoglobin values. Cut-off values of 68% for SvO(2) and 39% for O(2)ER were predictive for the efficacy of red blood cell transfusions, with a high accuracy (c-statistics 0.856 and 0.848, respectively) and negative and positive predictive values exceeding 82%. In conclusion, SvO(2) and O(2)ER are better than the hemoglobin value for guiding the decision-making process of red blood cell transfusions to correct hemodilutional anemia during CPB.

Closed, phosphorylcholine-coated circuit and reduction of systemic heparinization for cardiopulmonary bypass: the intraoperative ECMO concept.

Cardiopulmonary bypass with heparin-bonded circuits reduces systemic heparinization which is associated to a better clinical outcome in cardiac operations. In the present study, a novel biocompatible treatment, based on a phosphorylcholine coating without heparin, has been used to reduce systemic heparinization during cardiopulmonary bypass. Sixty patients underwent coronary revascularization with a fully phosphorylcholine-coated circuit. The circuit was entirely closed; suctions from the field were separated during the cardiopulmonary bypass time. A low systemic heparinization protocol based on half the loading dose of heparin (150 IU/kg) and a target activated clotting time of 320 seconds was applied. No thrombus formation inside the extracorporeal circulation circuit occurred; in-hospital mortality was absent. One patient (1.6%) had a postoperative myocardial infarction and 2 (3.3%) were surgically revised due to bleeding. Homologous blood transfusion rate was 11.6%, postoperative bleeding was 310 +/- 136 ml. If compared to patients treated with heparin-coated circuits and low systemic heparinization, these patients have better platelet count preservation and lower postoperative bleeding. The low thrombogenicity of phosphorylcholine-treated surfaces, despite the absence of surface-immobilized heparin, allows a safe reduction of systemic heparinization in the setting of an ECMO-like intraoperative cardiopulmonary - bypass. This intraoperative ECMO approach offers promising results in terms of clinical outcome after coronary revascularization operations.

Significance of serum inhibin in female infertility.

BACKGROUND: Serum inhibin, a glycoprotein hormone is secreted from granulosa cells in females and has been shown to suppress secretions of FSH from pituitary. METHODS: A total of 45 women, 30 infertile subjects and 15 age matched fertile controls were included in this study. Blood samples from each subject were collected during follicular and luteal phases separately and were tested for serum inhibin levels using an enzyme linked immunosorbent assay (ELISA). RESULTS: Serum inhibin concentration of infertile subjects during follicular phase was 35.5 +/- 22.94 pg/ml and luteal phase was 32.4 +/- 24.2 pg/ml. Whereas serum inhibin level in follicular phase was 10.39 +/- 2.03 pg/ml and luteal phase was 12.78 +/- 6.86 pg/ml of the fertile subjects. Serum inhibin was significantly raised in the infertile subjects as compared to the fertile subjects (P < 0.05). However serum inhibin concentration during the follicular and luteal phases of the infertile subjects was not significantly different (P > 0.05). CONCLUSION: It is thus concluded that increased serum inhibin level may be treated as sensitive and early index of declining ovarian function.

Significance of thyrotrophin and thyroxine estimations in type 1 diabetes.

OBJECTIVE: To investigate whether estimation of thyrotrophin (TSH) and thyroxine (T4) is significant to assess the thyroid status of diabetic patients. MATERIALS AND METHODS: Fifty patients with type 1 diabetes (25 male and 25 female) aged 9-50 years were included. The mean duration of diabetes was 6.7 +/- 4.3 years. Clinically they were not suffering from any systemic disease or endocrine ailment. Twenty-six, age and sex matched, normal controls were also included. The TSH and and T4 were estimated in the sera of all the subjects using the commercially available ELISA kits. RESULTS: The mean +/- SD concentration of TSH was raised significantly (p < 0.001) in the patients as compared to the controls, whereas the T4 concentration was comparable. Furthermore, 30% diabetics showed significantly elevated TSH concentration than the controls. CONCLUSION: It is proposed that the estimation of TSH in the patients with type 1 diabetes may be useful in the early identification of thyroid dysfunction.

Prevalence of thyroid microsomal and thyroglobulin autoantibodies in goitrous lesions.

BACKGROUND: This prospective study was done to evaluate the serum levels of Microsomal and Thyroglobulin autoantibodies in patients with toxic diffuse goiter and nodular goitre (non-toxic) undergoing radio-iodine therapy and thyroidectomy respectively. METHODS: Forty eight patients suffering from thyroid disorders, 29 with nodular goiter and 19 with toxic diffuse goitre (TDG) and 15 age & sex-matched normal controls were studied. Thyroid microsomal (MSAb) and thyroglobulin autoantibodies (TGAb) were estimated in the sera of all the subjects using the commercially available kits based on tanned red cell haemaglutination technique. RESULTS: MSAb seropositivity in TDG and nodular goitre was found to be 78.9% and 51.7% respectively. On the other hand, TGAb seropositivity was 57.9% and 27.6% in cases of TDG and nodular goitre. 13.3% and 6.7% of the normal controls were positive for MSAb and TGAb respectively. CONCLUSION: These findings indicate that autoimmunity is implicated in the genesis of commonly occurring thyroid disorders.

Gabexate mesilate and antithrombin III for intraoperative anticoagulation in heparin pretreated patients.

Thirty patients scheduled for elective myocardial revascularization and having undergone preoperative heparin treatment have been admitted to this prospective, randomized study. The aim of the study was to test two different strategies for preserving circulating antithrombin III (AT-III) during cardiopulmonary bypass. Patients in the control group (group C, n = 10) were treated with a standard heparinization (300 IU/kg). Patients in group A (n = 10) received the same management plus two doses of purified antithrombin III (1000 IU each). Patients in group GA received 200 IU/kg heparin and a continuous infusion of heparin (100 IU/kg/h) and gabexate mesilate (2 mg/kg/h) plus the same dose of antithrombin III as group A. Both group A and group GA demonstrated a preservation of circulating AT-III when compared to group C; this effect was more pronounced in group GA. The total heparin dosage was less in group GA than in groups A and C. Purified AT-III administration is recommended in heparin pretreated patients; the addition of gabexate mesilate to this protocol decreases the heparin requirement and increases the AT-III preservation.

Normothermic perfusion and lung function after cardiopulmonary bypass: effects in pulmonary risk patients.

Fifty patients at risk for postoperative lung dysfunction and undergoing elective coronary revascularization have been randomly assigned to receive normothermic (36 degrees C) perfusion with warm heart protection (NP group) or hypothermic (28 degrees C) perfusion with cold heart protection (HP group). Lung function before and after cardiopulmonary bypass (CPB) was studied through the determination of the intrapulmonary shunt (Qs/Qt), the alveoloarterial oxygen gradient (A-a delta O2), and the artero-alveolar carbon dioxide gradient (a-A delta CO2). The Qs/Qt after CPB was significantly lower in the NP group (27.1 +/- 2.6 vs 35.7 +/- 2.3) as well as the A-a delta O2 (50.2 +/- 1.5 vs 57.6 +/- 2.4), both data returned to comparable between the groups after 3 h in the intensive care unit. The a-A delta CO2 was significantly lower after CPB in the NP group (5.2 +/- 0.74 vs 8.2 +/- 0.8). Hospital stay and mortality were comparable in the two groups; intubation time and rate of early extubation showed a trend in favour of the NP group; the rate of patients suffering hypoxia and/or hypercapnia after extubation was significantly lower in the NP group (12%) versus the HP group (44%). Normothermia seems to exert a protective effect against lung dysfunction after CPB. The absence of a rewarming injury associated with reperfusion, a limitation of the hypothermic-induced vasoconstriction due to local cooling of the lung and a better compliance of the normothermic lung are hypothesized as beneficial effects of the 'all-warm' strategy.

Beneficial effects of Duraflo II heparin-coated circuits on postperfusion lung dysfunction.

BACKGROUND: Heparin coating of the cardiopulmonary bypass circuit reduces the activation of the terminal part of the complement cascade. Conflicting data are reported concerning neutrophil activation and postoperative lung dysfunction. In this study, we compared three different types of oxygenator: a bubble oxygenator, a conventional hollow-fiber oxygenator, and a heparin-coated oxygenator and circuit. METHODS: Sixty patients undergoing myocardial revascularization were randomly assigned to one of three oxygenator groups. All the patients were free from preoperative lung dysfunction. Lung function was studied with repeated measurements of respiratory index, intrapulmonary shunt, alveolar dead space, ventilation/perfusion ratio, and static thoracopulmonary compliance. RESULTS: Immediately after cardiopulmonary bypass, the intrapulmonary shunt and respiratory index values in the bubble oxygenator and hollow-fiber oxygenator groups increased more than those in the heparin-coated oxygenator group. In the intensive care unit, the between-group difference in intrapulmonary shunt disappeared, but the within-group difference in respiratory index (from baseline) remained for the bubble oxygenator group. The other three variables did not significantly differ between groups. Intubation time and stay in the intensive care unit did not differ between groups. CONCLUSIONS: Heparin-coated circuits exert a protective effect on pulmonary function. However, their use did not modify the postoperative clinical course of patients with normal lung function preoperatively.

Renal effects of low dose aprotinin in pediatric cardiac surgery.

Two groups of 15 children aged from 15 days to 6 years, undergoing surgery on cardiopulmonary by-pass for congenital heart disease have been retrospectively analyzed. Group A received a low-dose aprotinin treatment (30,000 KIU/kg in the priming solution); group C (control group) did not receive any aprotinin. Groups were homogeneous for pathology, cardiopulmonary by-pass time, aortic cross-clamping time, cyanotic/acyanotic patients ratio, temperature during cardiopulmonary bypass. A number of postoperative data were measured: activated clotting time was without any difference between aprotinin-treated and control patients; the same went for temperatures, urine output, intubation time, stay in Intensive Care Unit, coagulation tests, platelet counts, hematocrit, survival rate, and blood loss. Serum creatinine levels were significantly higher in group A than in group C both at the arrival in Intensive Care Unit (0.81 +/- 0.27 vs 0.66 +/- 0.12, p = 0.032) and in the first postoperative day (1.01 +/- 0.5 vs 0.72 +/- 0.19, p = 0.038). BUN was significantly higher in group A vs group C in the first postoperative day (43.6 +/- 21.1 vs 33.9 +/- 16.7, p = 0.043). We conclude that low-dose aprotinin did not reduce postoperative bleeding; we cannot exclude that higher dosages could be more effective, but the evidence of a moderate tubular function impairment suggests caution in using high-dose aprotinin in children.

Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique.

We studied 316 patients undergoing cardiopulmonary bypass for coronary artery surgery in order to determine perioperative risk factors for postoperative renal dysfunction. A preliminary univariate analysis was performed by chi 2 analysis for categorical data and Mann-Whitney U-test for continuous variables to detect significant correlations between each risk factor and the occurrence of moderate or severe renal dysfunction. Subsequently, a multiple logistic regression was applied to the three risk factors identified as predictive for severe renal dysfunction. Low cardiac output syndrome and need for banked blood transfusions combined with a low haematocrit value during cardiopulmonary bypass increase the probability of severe renal dysfunction in the postoperative course.

Significance of thyroid microsomal antibody in Graves' disease.

Thyroid microsomal antibody (MsAb) was estimated in 48 patients with Graves' disease (15 newly diagnosed, 15 on drugs for about 4 weeks and 18 euthyroid with drug treatment) and twenty age and sex matched controls. The diagnosis of Graves' disease (GD) was based on clinical history, physical examination and thyroid function tests, viz. 131I uptake, thyroid scintigram and serum T3, T4 and TSH levels. MSAb was positive in 93.3% of newly diagnosed as well as hyperthyroid GD patients on drugs. Eighty-three percent euthyroid GD patients and 20% normal controls also showed MSAb positivity. The titres of newly diagnosed patients were significantly raised (P < 0.05) than those of euthyroid patients and controls indicating the diagnostic as well as prognostic significance of MSAb in Graves' disease.