A proposed mathematical model to help preoperative planning between RIRS and MiniPerc for renal stones between 10 and 20 mm using holmium:Yag laser (Cyber Ho): the stone management according to size-hardness (SMASH) score.

To evaluate the performance of a mathematical model to drive preoperative planning between RIRS and MiniPerc (MP) for the treatment of renal stones between 10 and 20 mm. Patients with a renal stone between 10 and 20 mm were enrolled. A mathematical model named Stone Management According to Size-Hardness (SMASH) score was calculated: hounsfield units (HU) χ stone maximum size (cm)/100. Patients were divided into 4 groups: RIRS with score < 15 (Group A), RIRS with score ≥ 15 (Group B), MP with score < 15 (Group C), MP with score ≥ 15 (Group D). Cyber Ho device was always used. Stone free rate (SFR) was assessed after 3 months. Complication rate and need for auxiliary procedures were evaluated. Between January 2019 and December 2021, 350 patients were enrolled (87, 88, 82 and 93 in Groups A, B, C and D). Mean stone size was 13.1 vs 13.3 mm in Group A vs B (p = 0.18) and 16.2 vs 18.1 mm in Group C vs D (p = 0.12). SFR was 82%, 61%, 75% and 85% for Groups A, B, C and D. SFR was comparable between Groups C and D (p = 0.32) and Groups A and C (p = 0.22). SFR was significantly higher in Group A over B (p = 0.03) and in Group D over B (p = 0.02). Complication rate was 2.2%, 3.4%, 12.1%, 12.9% for Groups A, B, C, D. RIRS and MP are both safe and effective. The mathematical model with the proposed cut-off allowed a proper allocation of patients between endoscopic and percutaneous approaches.Registration number of the study ISRCTN55546280.

Pulsed-wave vs Continuous-wave Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP): A Comparison of Perioperative Outcomes.

OBJECTIVE: To compare intra and early postoperative outcomes between pulsed-wave and continuous-wave Thulium Fiber Laser Enucleation of the Prostate (PW-ThuFLEP vs CW-ThuFLEP) for the treatment of benign prostatic hyperplasia. METHODS: 238 patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent PW-ThuFLEP (118 patients) vs CW-ThuFLEP (120 patients). Preoperative prostate volume, adenoma volume, prostate-specific antigen (PSA), and hemoglobin values were recorded. International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual volume, and International Index of Erectile Function-5 score (IIEF-5) were assessed. Operative time, enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin drop, and postoperative complications were recorded. Micturition improvements and sexual outcomes were evaluated 3months after surgery. RESULTS: CW-ThuFLEP showed shorter operative time (61.5 vs 67.4 minutes, P = .04). Enucleation time (50.2 vs 53.3 minutes, P = .12), enucleation efficiency (0.8 vs 0.7 g/min, P = .38), catheterization time (2.2 vs 2.1days, P = .29), irrigation volume (32.9 vs 32.8L, P = .71), hospital stay (2.8 vs 2.6days, P = .29) and hemoglobin drop (0.38 vs 0.39 g/dL, P = .53) were comparable. No significant difference in complication rate was observed. At 3-month follow-up, the procedures did not show any significant difference in IPSS, Qmax, post-void residual volume, IIEF-5, and PSA value. CONCLUSION: PW-ThuFLEP and CW-ThuFLEP both relieve lower urinary tract symptoms equally, with high efficacy and safety. Operative time was significantly shorter with CW-ThuFLEP, but with a small difference with low clinical impact. Enucleation time, enucleation efficiency, catheterization time, irrigation volume, hospital stay, hemoglobin and PSA drop, complication rate, and sexual outcomes showed no differences.

Mucogingival versus guided tissue regeneration procedures in the treatment of deep recession type defects.

The objective of the study was to compare the clinical efficacy of 3 surgical approaches in the treatment of deep recession type defects. Fifty-four (54) gingival recessions > or = 5 mm were randomly assigned to 1 of the 3 treatment groups by blocking the prognostic variables. The first group was treated with a guided tissue regeneration (GTR) procedure using a bioabsorbable membrane, the second with non-resorbable membrane, and the third with a mucogingival surgical approach consisting of a connective tissue graft combined with a coronally advanced flap (bilaminar technique). No differences, in terms of baseline oral hygiene and defect characteristics, were observed among the 3 groups showing an effective blocking approach. The 1-year results indicated that 1) all treatment approaches resulted in clinically significant root coverage and attachment gain; 2) a statistically significant treatment effect (P = 0.012, ANOVA) was observed comparing the bioabsorbable (4.9+/-0.3 mm), the non-resorbable (4.5+/-0.8 mm), and the bilaminar (5.3+/-0.7 mm) groups, in terms of root coverage; 3) the difference in terms of root coverage between the bilaminar and the non-resorbable membrane groups was statistically significant while differences between the 2 GTR groups or between the bilaminar and the bioabsorbable membrane groups did not reach statistical value; 4) the 95% confidence intervals for the proportions of complete successes showed a similar pattern; 5) no statistical difference was demonstrated in the amount of attachment gain among the 3 groups (P=0.73, ANOVA). A regression model showed that the amount of root coverage was significantly affected by the initial recession depth, the procedure and smoking habits: a poorer root coverage result is expected in case of shallow recession type defects, when either bioabsorbable (P < 0.05) or non-resorbable (P < 0.001) membranes are used instead of a bilaminar technique and if the patient smokes (P < 0.01). It was concluded that the mucogingival bilaminar technique is at least as effective as GTR procedures in the treatment of gingival recession > or = 4 mm and thus recession depth is not the parameter which influences the selection of the surgical procedure.

[Oral cavity angioma treatment by cryotherapy]. / Il trattamento degli angiomi del cavo orale mediante crioterapia.

Localisations, evolutions and complications of oral cavity hemangiomas are discussed in the first part of the work. The Authors enumerate the principal clinical uses of cryosurgery showing its utility in hemangiomas therapy. The Authors report about principal cryo-units, their utilisation and working, examining literature on the argument. Description of five cases of hemangiomas treated by cryosurgery complete the work.

[Cryotherapy of precancerous lesions of the oral cavity]. / La crioterapia di alcune lesioni precancerose del cavo orale.

After a short account of principal precancerous oral lesions the Authors refer about cryosurgery principles and its effects on tissues. After an excursion on the literature about the problem, the Authors refer their experiences on seven cases of oral dyskeratosis treated by cryosurgery.

[Hyperostosis on the alveolar process margin]. / Le iperostosi del margine osseo alveolare.

Defects of the bone margin requiring ostectomy and osteoplasty include hyperostotic processes, formations which, while recalling palatine and mandibular tori, have their own nosological slot. Hyperostosis is characterized by thickening of the cervical margin and is linked by a narrow isthmus to the underlying bone plane; it occurs with greatest frequency in the vestibular region. The personal case, in a man of 52, presented two sausage-shaped protuberances located apically at the alveolar margin in the two left arches. Their removal presented no problem of surgical technique as the hyperostosis had no close links with the underlying bone planes. Histological examination of the fragments showed that the hyperostotic tissue consisted of fascicular bone with an intima vascular component. Two years after the operation, the patient presents no signs of relapse and would appear to be completely cured.

Enhanced superoxide production with no change of the antioxidant activity in gingival fluid of patients with chronic adult periodontitis.

In the gingival crevicular fluid (GCF) of control and chronic adult periodontitis (CAP) patients there is a spontaneous release of O2- radicals from polymorphonuclear leukocytes (PMN). The addition of the exogenous stimuli phorbol myristate acetate (PMA) decreased the O2-. formation in control GCF, while in CAP patients produced a marked enhancement of O2-. generation. The circulating PMN of control subjects did not show a spontaneous O2-. formation, differently from CAP patients. On the contrary, a similar O2-. production was measured when the circulating PMN were stimulated with PMA. Moreover, the antioxidant activity measured in 10 microliters of cell free gingival supernatant (GS) of control and CAP patients had the same values by inhibiting 12.6% and 18.9% respectively of the O2- formation supported by a xanthine/xanthine oxidase system. Probably, the protective or destructive effect of PMN in GCF of CAP patients depends on the variations of the rate of O2- formation in respect to the intrinsic antioxidant property of GS.

Surgical treatment and desensitization therapy of giant papillary allergic conjunctivitis.

We found that three cases of giant papillary conjunctivitis responded well to local specific desensitization therapy and transplantation of the conjunctiva with saphenous vein tissue.