Alcohol sclerotherapy to treat vascular malformations in the oral cavity.

OBJECTIVE: To present our experience in treating vascular malformations in the oral cavity solely by injecting ethanol into the lesions. MATERIAL AND METHODS: We treated 26 patients (12 men and 14 women) with oral malformations. The diagnosis was based on clinical findings (n=26), magnetic resonance imaging studies (n=19), angiography findings (n=5), and direct puncture venography (n=2). To achieve sclerosis, we administered absolute ethanol through direct puncture. All interventions were performed under deep sedation. RESULTS: The vascular malformations treated ranged from 7mm to 60mm (median: 24.5mm) in maximum diameter and had been present in the oral cavity for 0.2 to 54 years (mean: 13.6 years). The median age of the patients was 44.5 years (range: 12-87 years). The reason for treatment of the malformation was: an increase in size (n=8), local bleeding (n=11), risk of bleeding during dental extraction (n=5), pain (n=1), and esthetic purposes (n=3). Lesions were located in the mucosa of the cheek (n=12), in the facial gingiva (n=5), in the labial mucosa (n=6), in the tongue (n=3), in the pterygomandibular region (n=1), and in the palate (n=1). The median dose of ethanol was 3.2mL. Twenty lesions disappeared after a single injection session, five after two sessions, two after three sessions, and one after five sessions. In 20 cases all signs of the lesions disappeared, in 6 a bluish macule persisted, and in 2 a mass effect persisted. The symptoms improved in all patients. Only transient complications of sclerotherapy were observed: local inflammation, perioral paresthesia in two patients, and necrosis of the mucosa of the cheek in one. CONCLUSIONS: Alcohol sclerotherapy is an efficacious procedure for treating vascular malformations in the oral cavity.

Grade of sclerosis in the contralateral mandibular area in osteonecrosis of the jaws.

The objective of this study was to compare the grade of radiographic sclerosis between the area of osteonecrosis and the at-risk contralateral mandibular area without osteonecrosis. Three groups were studied: group 1 comprised 30 cases of medication-related osteonecrosis of the jaws (MRONJ); group 2 was the healthy contralateral area without osteonecrosis of the group 1 cases; group 3 comprised 30 healthy controls. ImageJ software was used to analyze the computed tomography images, and the grade of bone sclerosis was compared between the three groups. The grade of sclerosis was significantly higher in group 1 than in the other groups (P<0.05); the difference between groups 2 and 3 was not significant. Sclerosis was significantly greater in the area of bone necrosis than in the contralateral mandibular area in patients with MRONJ. No significant differences were found in the grade of sclerosis between the contralateral non-affected mandibular area of patients with MRONJ and the control patients.

Benefits of a rapid HIV test for evaluation of the source patient after occupational exposure of healthcare workers.

Rapid human immunodeficiency virus (HIV) testing for the management of occupational exposure of healthcare workers significantly decreased the number of anti-retroviral post-exposure prophylaxis regimens started whilst awaiting HIV test results. The study confirmed an equivalent performance of the rapid test in comparison with HIV enzyme immunoassay, and suggests it is cost-effective. In addition, two other potential benefits emerged: reducing the number of source patients who remain untested and increasing the number of occupational exposures reported.

Escherichia coli MTC, a NADPH cytochrome P450 reductase competent mutagenicity tester strain for the expression of human cytochrome P450: comparison of three types of expression systems.

Currently three different methods have been taken to develop new mutagenicity tester strains containing human cytochrome P450s (CYPs). Each of these use a single expression vector. In this paper we describe a fourth approach, i.e., the coexpression of a CYP and its electron-transfer flavoprotein, NADPH CYP reductase (RED), encoded by two different expression vectors. The Escherichia coli mutagenicity tester strain BMX100 has been expanded to a strain, MTC which stably expresses human RED. This new tester strain permits the biplasmid coexpression of human CYP1A2 and RED (MTC1A2). This novel strain can be used for the determination of the mutagenicity of chemicals known to be procarcinogens and metabolized by CYP1A2. The mutagenicity tester strain MTC1A2 was compared with: (i) BMX100 using the post-mitochondrial rat liver fraction (S9); (ii) BMX100 with expressing CYP1A2 alone (iii) or with expressing CYP1A2 fused to rat RED or (iv) with expressing CYP1A2, bicistronically coexpressed with rat RED. The biplasmid RED/CYP coexpression system generated a strain with the highest methoxy- and ethoxy-resorufin dealkylase activities and the highest mutagenic activities for the procarcinogens 2-aminoanthracene (2AA), aflatoxin B1 (AFB1) and 2-amino-3-methylimidazo(4,5-f)quinoline (IQ). Furthermore, the metabolism of 2AA and IQ was detected more efficiently using the MTC1A2 strain than with the BMX100 strain plus the standard rodent liver S9 metabolic system.

Intermediate cementum. Development, structure, composition, and potential functions.

In the roots and root analogs of mammalian teeth a narrow zone of highly calcified tissue occupies the junction between cementum and dentin. This zone is referred to as "intermediate cementum," despite evidence that it is not a product of cementogenesis (or of dentinogenesis). Studies conducted on teeth of human and nonhuman primates indicate that the intermediate cementum layer contains enamel matrix proteins and is likely a product of Hertwig's epithelial root sheath. The available evidence regarding the development (origin), structure, and composition of intermediate cementum is reviewed, and the potential functions of this layer are assessed to include a possible role in wound healing.

Epidemiological analyses on animal parasitoses: recent activity of the I.M.I.P.P.V.

The paper presents a selected review of the epidemiological analyses performed in recent years (1984-1988) in the Institute of Malattie Infettive, Profilassi e Polizia Veterinaria of the University of Bologna on animal parasitoses, with special reference to the evaluation of some risk factors of bovine, swine and canine helminthoses, and to the validity of the coprological test for some parasites of the red fox.

The combined composite resin and amalgam restoration for posterior teeth: a clinical report.

This paper presents a technique for restoring maxillary posterior teeth with a combined composite resin and amalgam restoration when the preparation extends buccally into an esthetically critical area. This technique has two major advantages over traditional combined restorations: it requires only one clinical appointment, and it provides an esthetically acceptable result while maintaining the advantages of an amalgam restoration. A clinical assessment of 12 of these restorations, in vivo for 0.8 to 6.4 years, is presented. All but one restoration received a score of excellent or acceptable.

The anatomy of local anesthesia.

The trigeminal nerve is the great sensory nerve of the facial portion of the head, and an intimate knowledge of this nerve and its surrounding structures is a prerequisite to the application of profound local anesthesia without complication. In this review article, the classic description of the relevant anatomy is described and is updated with recently published research into anatomic variations that have an impact on the induction of clinical local anesthesia. Causes of both failure and complications of traditional local anesthetic techniques are explained, and recommendations for avoiding these pitfalls are made.

An updating of the occurrence of canine heartworm disease in northern Italy.

A survey was carried out in northern Italy (Veneto and Friuli Venezia Giulia Regions) to assess the extension of canine heartworm disease close to the classic hyperendemic areas of the Po Valley. A filtration test on 275 privately owned dogs showed a mean prevalence of 44%, with a peak of 55% in the Venice province. A high prevalence (17%) of occult filariosis was discovered using a serological test. These values fall within the medium-high range previously reported from other Italian areas. The provinces of Pordenone, Udine, Trieste, Treviso and Belluno, where no cases had been previously reported, were found to be infected. The distribution of the infection did not differ significantly with the dogs' origin or sex. The prevalence seemed to be influenced significantly (p < 0.01) by the hosts' age, function and degree of outdoor activity, reflecting the different exposure risks.

The anatomy of local anesthesia.

The trigeminal nerve is the great sensory nerve of the facial portion of the head, and an intimate knowledge of this nerve and its surrounding structures is a prerequisite to the application of structures is a prerequisite to the application of profound local anesthesia without complication. In this review article, the classic description of the relevant anatomy is presented and updated with recently published research into anatomic variations that have an impact on the induction of clinical local anesthesia. Causes of both failure and complications of traditional local anesthetic techniques are explained, and recommendations for avoiding these pitfalls are made.

Root perforation repair: surgical and nonsurgical management.

Root perforation repair has historically been an unpredictable treatment modality with an unacceptably high rate of clinical failure. Recent developments in the techniques and materials utilized in root perforation repair have dramatically enhanced the prognosis of both surgical and nonsurgical procedures. This article presents a review of the literature pertaining to root perforation repair and illustrates, through clinical case presentations, the principles of extraradicular surgical repair and non-surgical internal repair of root perforation using mineral trioxide aggregate (MTA).

The anatomy of local anesthesia.

This article has attempted to present a realistic assessment of the complexities and variability of the anatomic structures related to the induction of profound clinical local anesthesia. By reviewing this material with a good atlas of anatomy (or preferably a human skull), the clinician can better visualize the important relationships described. The firm understanding of all of these relationships that will result is necessary to treating patients with maximum comfort, confidence, and safety.

PML-IRIS in patients with HIV infection: clinical manifestations and treatment with steroids.

BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection that develops in immunosuppressed patients with HIV infection. Paradoxically, some of these patients may develop PML during combined antiretroviral therapy in the setting of immune reconstitution. We describe the types of PML in relation to immune reconstitution inflammatory syndrome (IRIS) and the effects of steroid use in these patients. METHODS: We performed a retrospective review of the literature (1998 to 2007) and of all HIV-infected patients diagnosed with PML-IRIS at Johns Hopkins Hospital (2004 to 2007). We recorded information on clinical features, microbiologic and virological analysis, neuroimaging, pathology, treatment, and outcome. RESULTS: Of 54 patients with PML-IRIS, 36 developed PML and IRIS simultaneously (PML-s-IRIS) and 18 had worsening of preexisting PML (PML-d-IRIS) after the initiation of combined antiretroviral therapy. PML-IRIS developed between 1 week and 26 months after initiation of antiretroviral therapy. PML-d-IRIS patients developed IRIS earlier, had higher lesion loads on MRI of the brain, had shorter durations of survival, and had higher mortality rate compared to PML-s-IRIS patients. Twelve patients received treatment with steroids, of which five died and seven showed good neurologic recovery. Patients who survived had received steroids early after IRIS diagnosis for longer durations and had contrast enhancement on IRIS neuroimaging. CONCLUSIONS: Immune reconstitution following initiation of combined antiretroviral therapy may lead to activation of an inflammatory response to detectable or latent JC virus infection. Early and prolonged treatment with steroids may be useful in these patients but requires further investigation.

Seafood freshness determination through vapour phase Fourier transform infrared spectroscopy.

A new vapour-phase manifold has been developed to determine trimethylamine (TMA) in fish and cephalopod samples by Fourier transform infrared (FT-IR) spectroscopy. Samples were treated off-line for 1h with trichloroacetic acid (TCA), filtered and washed. The obtained extracts were aspirated and alkalinized with NaOH 2.0M, in an on-line system. TMA was separated from the solution in a gas phase separator and then transported by means of a nitrogen carrier into a home made 10 cm pathlength IR gas cell, where the corresponding FT-IR spectra were acquired by accumulating 30 scans per spectrum with 2 cm(-1) nominal resolution. The method was applied to the determination of TMA in natural samples providing concentration values statistically comparables with those obtained by a head space gas chromatography (HS-GC) reference procedure. The sample throughput by FT-IR is increased by a factor of 6 as compared with HS-GC.

Naproxen: pharmacology and dental therapeutics.

Naproxen and naproxen sodium are very commonly used and effective non-steroidal anti-inflammatory analgesics. In this paper, they are described and compared, and their pharmacokinetics and indications are discussed. Adverse reactions to these drugs and the mechanism of action of these effects on the gastrointestinal tract, central nervous system, kidneys, liver, and blood are described. A discussion of the effects of the drugs on the elderly and during pregnancy and lactation is included. Also, the allergenicity, miscellaneous rare complications and acute toxicity of the naproxen anion are described, followed by a description of the more common drug interactions. The results of several recent studies that may call into question the current recommendations on using these pharmaceuticals are cited. Until this controversy can be resolved, the practitioner should rely on the principle of "first do no harm" in choosing a course of drug treatment.

Reliability of reduced air pressure methods used to assess the apical seal.

The reliability of two commonly used methods of sealability testing, dye leakage under normal atmospheric pressure and dye leakage in a partial vacuum, was tested using a repeated studies design. Forty extracted teeth were instrumented and obturated using lateral condensation of gutta-percha and Sealapex sealer. One-half of the teeth were placed in India ink under normal atmospheric pressure and the other half underwent air evacuation before immersion in the ink. After 24 h the teeth were removed from the ink and rendered transparent for linear leakage analysis. A second study, repeated within the exact parameters of the first, was performed approximately 1 month later. Mann-Whitney U tests indicated that there was no significant difference (P>0.05) between the air and vacuum groups or within each group (air or vacuum) between trials, indicating that the methodology is repeatable and that application of reduced air pressure did not enhance reliability. A large majority of the teeth placed under partial vacuum showed evidence of vacuum-induced artefacts that may negate the value of vacuum as a research tool.

Diagnosis of canine filariosis: relative sensitivity and specificity of some haematological techniques.

Blood samples from 329 dogs of an hyperendemic area in Northern Italy were examined for filariosis. At the filter method (5 microns), taken as reference test, 163 (49.5%) were positive: 160 for Dirofilaria immitis, 2 for D. repens and 1 for both species. The direct smear test (DS), the modified Knott technique (KT) and a further modification of the Knott technique (MKT) were performed in order to assess their relative sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV). The relative SE values are of 88.3%, 91.0% and 91.8% for DS, KT and MKT, respectively. Only the DS relative SP value (99.3%) is less than 100%. Also the PPV and NPV are very high (all above 89%) as well as the values of the coefficient Kappa (all above 0.8), a measure of the concordance between the results of the FT and of the comparison tests.

[Current epidemiological and clinical features meningitis in a northern Italian area] / Attuali aspetti epidemiologici e clinici delle meningiti in un'area del nord Italia.

Objectives: To study etiological, epidemiological and clinical features of 97 cases of acute meningitis. Methods: Ninety-seven cases of acute meningitis were examined in adult HIV-negative patients admitted to the Infectious Diseases Unit of the Azienda Ospedale-Universita S. Anna in Ferrara. Demographic, etiological, epidemiological and clinical data were analyzed. Results: All cases were divided into two groups according to the macroscopic aspect of cerebrospinal fluid (CSF): purulent CSF (50 cases) or non-purulent CSF (47 cases). Purulent CSF meningitis more frequently affected male patients (64% vs 47%) and older patients (average 52 vs 44 years). The main epidemiological features in both groups were underlying bacterial diseases (i.e. otomastoiditis and/or sinusitis in 50% of pneumococcal meningitis) and iatrogenic immunodeficiency. From a clinical point of view the following alterations in the state of consciousness (stupor, confusion and coma) were most frequently found in purulent meningitis. The following non purulent forms of meningitis were diagnosed: 5 tubercular, 3 viral infections, 2 by Listeria monocytogenes, 1 by Entoameba histolytica, 1 by Cryptococcus neoformans and 35 (74,4%) unknown causes. Purulent meningitis were: 20 (40%) Streptococcus pneumoniae, 10 Neisseria meningitidis, 3 Staphylococcus aureus, 2 Escherichia coli, 1 Haemophilus influenzae and 1 Pseudomonas aeruginosa; 13 cases were unidentified. From 1989 to 1993 and from 1994-98 both groups of meningitis increased; respectively from 17 to 30 cases for non-purulent meningitis and from 18 to 32 cases for purulent meningitis. Meningitis due to Streptococcus pneumoniae increased from 27.7% to 46.8% during the period 1994-98. Conclusions: The study shows the high incidence of pneumococcal meningitis, during 1994-98, because a large number of patients with sinusitis and otomastoiditis were observed. The incidence of meningococcal meningitis appears stable. These data confirm the importance of timely diagnosis and correct therapy for such infections with reserved prognosis.

[Transverse epidemiological study of caries in a rural child population in Cuenca]. / Estudio epidemiológico transversal de caries en población rural infantil de Cuenca.

We have explored a school-children population (6-7 years old--1st of EGB--) in the Health Area of Motilla del Palancar (Cuenca). In these early age, 20% of the children show dental caries in permanent teeth; plaque index by Quigley-Hein is 2.00, finding that plaque index is superior in permanent teeth than temporary teeth. We detect cariogenic dietetic habits. Desired minimum oral hygiene level (one tooth-brush a day) appeared in 23.5% of the examined population.

The prevalence of oral leukoplakia in 138 patients with oral squamous cell carcinoma.

OBJECTIVES: To determine the relationship between oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), and to evaluate possible differences between those carcinomas with and without associated leukoplakia. MATERIAL AND METHODS: A total of 138 patients were studied at the Stomatology Service of the University General Hospital, Valencia, Spain. These patients were divided into two groups: group 1, patients with oral cancer and leukoplakia, and group 2, patients with OSCC but with no associated premalignant lesions. The relationship between this precancerous lesion and the OSCC was evaluated, as well as the possible clinical and histological differences between the tumours of the two groups. RESULTS: Leukoplakia was detected in 27 (19.56%) patients with OSCC. No differences were found between the two groups regarding age and tumour location. However, statistically significant differences were observed with respect to the form, tumour stage and the presence of adenopathies in the cancers with and without leukoplakia; in that the tumours associated with leukoplakia were diagnosed as being at a more initial stage. CONCLUSIONS: Those patients with OL associated with oral cancer presented with tumours at a less advanced stage than those where no associated leukoplakia existed.