Peek's harpoon: a new device for the treatment of laparoscopic sacropexy. Preliminary study in unembalmed cadavers.

INTRODUCTION AND HYPOTHESIS: The aim of the study is to facilitate the suture on the sacral promontory for laparoscopic sacrocolpopexy. We hypothesised that a new method of sacral anchorage using a biosynthetic material, the polyether ether ketone (PEEK) harpoon, might be adequate because of its tensile strength, might reduce complications owing to its well-known biocompatibility, and might shorten the duration of surgery. METHODS: We verified the feasibility of insertion and quantified the stress resistance of the harpoons placed in the promontory in nine fresh cadavers, using four stress tests in each case. Mean values were analysed and compared using the Wilcoxon and Fisher's exact tests. RESULTS: The harpoon resists for at least 30 s against a pulling force of 1 N, 5 N and 10 N. Maximum tensile strength is 21 N for the harpoon and 32 N for the suture. Harpoons broke in 6 % and threads in 22 % of cases. Harpoons detached owing to ligament rupture in 64 % of the cases. Regarding failures of the whole complex, the failure involves the harpoon in 92 % of cases and the thread in 56 %. The four possible placements of the harpoon in the promontory were equally safe in terms of resistance to traction. CONCLUSIONS: The PEEK harpoon can be easily anchored in the promontory. Thread is more resistant to traction than the harpoon, but the latter makes the surgical technique easier. Any of the four locations tested is feasible for anchoring the device.

Digital implant impressions by cone-beam computerized tomography: a pilot study.

OBJECTIVES: To evaluate the adjustment of structures designed from a digital impression of implants obtained by cone-beam computerized tomography (CBCT). MATERIALS AND METHODS: Thirty implants were placed in five edentulous mandibles of fresh cadaver heads, six per mandible. Special scan bodies were screwed in the implants and a CBCT was taken. DICOM images were converted to STL and digitally processed to obtain a digital model of the implants. A Cr-Co structure was designed and milled for each mandible, and the adjustment was assessed as in a real clinical situation: passivity while screwing, radiographic fitting, optical fitting, and probing. RESULTS: Good adjustment was found in three of the structures, and only slight discrepancies were found in the other two. CONCLUSION: Cone-beam computerized tomography might be a valid impression-taking method in full-mouth rehabilitations with implants. Further evaluations are needed with more implant and CBCT systems. The radiation dose might be considered when deciding to use this impression system. The types of patients appropriate for this treatment option should also be determined to fulfill the principles of the ALARA law.

Diamine oxidase (DAO) supplement reduces headache in episodic migraine patients with DAO deficiency: A randomized double-blind trial.

BACKGROUND & AIMS: Histamine intolerance is a disorder in the homeostasis of histamine due to a reduced intestinal degradation of this amine, mainly caused by a deficiency in the enzyme diamine oxidase (DAO). Among histamine related symptoms, headache is one of the most recorded. Current clinical strategies for the treatment of the symptomatology related to this disorder are based on the exclusion of foods with histamine or other bioactive amines and/or exogenous DAO supplementation. The aim of this study was to assess the efficacy of a food supplement consisting of DAO enzyme as a preventive treatment of migraine in patients with DAO deficiency through a randomized double-blind trial. METHODS: 100 patients with confirmed episodic migraine according to current International Headache Society (IHS) criteria and DAO deficiency (levels below 80 HDU/ml) were randomized in two groups. One group received DAO enzyme supplementation and the other received placebo for one month. Clinical outcomes assessed were duration and number of attacks, perception of pain intensity and adverse effects during treatment. The use of triptans was also recorded. RESULTS: Great variability was found in the duration of migraine attacks reported by placebo and DAO groups. A significant reduction (p = 0.0217) in hours of pain was achieved in patients treated with DAO supplement, with mean durations of 6.14 (±3.06) and 4.76 (±2.68) hours before and after treatment, respectively. A smaller reduction without statistical signification was also observed for this outcome in the placebo group, from 7.53 (±4.24) to 6.68 (±4.42) hours. Only in DAO group, a decrease in the percentage of patients taking triptans was observed. The number of attacks and the scores of pain intensity showed a similar reduction in both groups. No adverse effects were registered in patients treated with DAO enzyme. CONCLUSIONS: Migrainous patients supplemented with DAO enzyme during one month significantly reduced the duration of their migraine attacks by 1.4 h. No statistically significant reduction was found in placebo group before and after treatment. The reduction of pain hours observed in placebo group (0.9 h) could explain the lack of significant differences between both study groups. One month of DAO supplementation has demonstrated a positive trend in the improvement of migraine but more studies with a longer treatment period are needed to better assess the efficacy of DAO supplementation. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN10091019; www.isrctn.org.

Low serum diamine oxidase (DAO) activity levels in patients with migraine.

Histamine intolerance is a disorder in the homeostasis of histamine due to a reduced intestinal degradation of this amine, mainly caused by a deficiency in the enzyme diamine oxidase (DAO). Among the several multi-faced symptoms associated with histamine intolerance, headache is one of the most recognized and disabling consequences. The aim of this study was to determine the prevalence of DAO deficiency in patients with a confirmed migraine diagnosis according to the current International Headache Society (IHS) and in non-migraine subjects. DAO activity was assessed in a total of 198 volunteers recruited at the Headache Unit of the Hospital General de Catalunya, 137 in the migraine group and 61 as a control group. DAO enzyme activity in blood samples was determined by ELISA test. Values below 80 HDU/ml (Histamine Degrading Unit/ml) were considered as DAO deficient. Mean value of DAO activity from migraine population (64.5 ± 33.5 HDU/ml) was significantly lower (p < 0.0001) than that obtained from healthy volunteers (91.9 ± 44.3 HDU/ml). DAO deficiency was more prevalent in migraine patients than in the control group. A high incidence rate of DAO deficiency (87%) was observed in the group of patients with migraine. On the other hand, 44% of non-migranous subjects had levels of DAO activity lower than 80 HDU/ml. Despite the multifactorial aetiology of migraine, these results seem to indicate that this enzymatic deficit could be related to the onset of migraine.