Post-treatment periapical periodontitis X-ray versus CBCT - a case report.

Post treatment periapical periodontitis is usually caused by residual microbes, due to poorly treated root canals and microleakage. Our clinical case proved that orthograde, single-visit endodontic re-treatment is the first choice for the clinician. Cone Beam Computed Tomography (CBCT) images detect the presence and the real extension of the periapical periodontitis and the outcome of the endodontic treatment, in terms of healing the bone defect. Compared with the limited 2-D data obtained by using the radiograph, the CBCT shows a 3-D image of the tooth, the root canal, and the surrounding tissue.

Endo-periodontal lesion--endodontic approach.

Endo-perio lesions might be interdependent because of the vascular and anatomic connections between the pulp and the periodontium. The aim of this study is to emphasise that primary endodontic lesion heals after a proper instrumentation, disinfection and sealing of the endodontic space. The primary endodontic lesion with a secondary periodontal involvement first requires an endodontic therapy and, in the second stage, a periodontal therapy. The prognosis is good, with an adequate root canal treatment; it depends on the severity of the periodontal disease, appropriate healing time and the response to the treatment. A correct diagnosis is sometimes difficult; an accurate identification of the etiologic factors is important for an adequate treatment. Primary perio-endo lesion may heal after a proper disinfection and sealing of the endodontic system, the one-year follow-up radiograph showing bonny repair. Invasive periodontal procedures should be avoided at that moment. The microorganisms and by-products from the infected root canal may cross accessory and furcal canals and determine sinus tract and loss of attachment. In both clinical cases presented in this article, successful healing was obtained after a proper disinfection and sealing of the endodontic system.

External radicular resorption: selected cases and review of the literature.

External radicular resorption is a pathological process that generates the loss of cementum, dentin and bone, almost irreversibly, involving vital and pulpless teeth. The early stage is asymptomatic and might be diagnosed by a routine radiograph or a clinical examination. Radicular resorption appears because of cementoclastic, dentinoclastic or/and osteoclastic activity. The process of resorption is associated with a damage of the periodontal ligament as a result of injury and necrosis, macrophages are the first cells that are detected, followed by multinucleated cells, odontoclasts, which affect the cementum and dentin.

Effect of cigarette smoking on the blood glucose level in normals and diabetics.

The effect of cigarette smoking on glycemia was investigated in 26 diabetic patients and 24 normal controls, all smokers. Using the method with ortho-toluidine à jeun, blood glucose levels were determined before smoking and 15, 30 and 60 minutes after the smoking of two cigarettes. Both groups showed an increase of glycemia following smoking, more marked, however, in the group of diabetics. In 16 cases the experience was repeated once more, and an even higher increase of the blood glucose values was recorded as a result of the new nicotine charge. Conversely, no glycemia rise was noted after smoking nicotine-free cigarettes nor after smoking tobacco cigarettes but without inhaling the smoke. The increase of glycemia after smoking is assumed to be due to the mobilization of catecholamines and the stimulation of STH and cortisol production. This reaction seems to be more marked in diabetics than in metabolically normal subjects.

Migration inhibition tests in penicillin allergy.

The lymphocyte blastic transformation (TTB), leucocyte and macrophage inhibition tests has been compared in 18 hypersensitive to penicillin patients and in 15 patients with hypersensitivity to PPD. It has been shown that TTB was positive in all penicillin allergy cases, due to the constantly LT sensitization, and therefore this test constitutes an efficient method for the in vitro diagnosis of penicillin hypersensitivity. Macrophage inhibitory factor (MIF) was absent in all penicillin allergic subjects. Leucocyte migration inhibition test was positive only when gamma globulin coupled penicillin was used or in the presence of autologous plasma pretreated penicillin. This suggests that leucocyte migration inhibition resulted from the specific penicillin antibodies.

Influence of deuterium on the spleen immune system.

Following administration of deuterium to white rats changes of dysimmunitary-immunitary depression occurred. At the beginning the changes involved the whole spleen parenchyma, with marked lymphocyte depopulation of the red pulp and a decrease of the lymphod follicles. After about 4 - 7 days important amorphous deposits were formed, located exclusively perifollicularly and only in the spleen. The authors suggest the dysimmunitary globulinic-paraamyloidic nature of these deposits which, in their opinion, are produced by deuterium through a chemical mechanism. The differential diagnosis was only made with Gamma-Gandy nodules, because no such changes are found in pathology. It is not known why this deposition takes place exclusively in the spleen and especially around the lymphoid follicles. The authors raise the question whether some methods could be found which might direct the immunitary blockade to certain organs.

[Participation of gonads in pulmonary silicosis]. / Zur Mitbeteiligung der Gonaden bei der Lungensilikose

A survey is given on the participation of endocrine glands in the pulmonary silicosis. At the same time a new clinical and experimental contribution to the question of the appearance of a hypogonadotropic hypogonadism is given. The frequency of this hypogonadism increases with the severity of the pulmonary silicosis. The immunological opinions as well as the neuroergonal ones concerning the pathogenesis of pulmonary silicosis gave the possibility of a better explanation of the mechanisms, by means of which also other organs may be attacked in pulmonary silicosis. The neuroendocrine system gives a defensive answer to the aggressive silicotic pulmonary process, which in general slowly progresses, but which may also be certain hormones from the group of the glucocorticosteroids in the adrenal cortex. The intervention into the axis hypothalamus-hypophysis-adrenal cortex has been provided in all defence processes of the organism against every aggression. By the functional or organic damage of the neuroendocrine system, by the immediate toxic effect of silicium dioxide or the monosilicium acid as well as by the effect of the secondary hypoxia in pulmonary silicosis an insufficiency in the stimulation and excretion of certain hormones develops. The origin of this insufficiency is found in the hypothalamo-hypophyseal centres, and the effects extend to all endocrine glands which depend on the system hypothalamus-hypophysis. This mechanism is made responsible for the appearance of a hypogonadotropic insufficiency of gonads in the course of a pulmonary silicosis and is proved clinically and experimentally in the cases investigated by the authors

Cigarette smoking as a risk factor for atherosclerosis. Study of the biologic changes consecutive to smoking in normals, in patients with coronary heart disease and in diabetics.

The atherogenic action of smoking was studied in 112 male subjects with a mean age of 48.6 years, of whom 40 healthy controls, 40 patients with compensated coronary heart disease and 32 diabetics without ketoacidosis. Sixty-two were chronic smokers consuming 19.4 cigarettes/day and the remaining 50 did not smoke. The investigations performed in all the subjects were: erythrocyte count, hemoglobin and hematocrit determination, leukocyte absolute and differential counts, coagulation time (Howell), fibrinogen assay, platelet count and aggregability, total lipids, triglycerides, uric acid, creatininemia and blood glucose determinations. In the group of smokers, these investigations were repeated 60 min after the smoking of two cigarettes. Comparison of the results obtained in smokers and non-smokers, as well as before and after smoking, in the latter group, suggests that the influence of smoking upon the serum lipoprotein fractions is of little importance in atherogenesis, while its action upon the coagulation factors and the blood glucose level seems to have a real atherogenic role.

[Immunological aspects of workers exposed to the risk of silicogenesis]. / Aspecte imunologice la muncitorii expusi riscului silicogen

Comparative studies were performed, of changes of serum proteins and IgG, IgA and IgM immunoglobulins in workers exposed to silicogenic dust. Depending on their response to tuberculin testing (2 U of PPD) these subjects were classified in negative and hyperergic. In both groups there was found a decreased albumin concentration in the serum and high alpha-2 globulin. In hyperergic subjects there was noted a slight increase of beta globulins and a significant rise in the titer of gammaglobulins. Immunoglobulins G showed a significant rise in hyperallergic subjects and slightly decreased in tuberculin negative ones, without attaining a level of immunologic deficiency. In both groups IgM immunoglobulins were significantly lowered, while IgA immunoglobulins were occasionally increased, although there was no positive correlation with tuberculin allergy. In three cases there was a slight IgA deficiency.

[Pattern of plasma lipids and insulin blood levels in male patients with non-insulin-dependent diabetes mellitus and moderate obesity]. / Patrón de lípidos plasmáticos e insulinemia en varones con diabetes mellitus no insulinodependiente y moderada obesidad.

The goal of the present work is the study of the plasmatic lipid profile in non insulin dependent diabetes mellitus (NIDDM) patients with abdominal obesity (AO), comparing them the NIDDM patients without AO and with OA persons without NIDDM. For that purpose we developed a methodology in which we have studied the body mass index (BMI: kg/m2) the hip-waist index (HWI) (0.95 = AO), lipid parameters, hydrocarbon, titers and serum insulin levels. The results are referred to four groups where we can throw into relief a statistically significant increase in triglycerides and a marked decrease in HDL cholesterol in OA and DM patients when compared to the group with AO without MD or to the group with MD without AO. Based on the results obtained the conclusions can be summarized as follows: The presence of abdominal obesity is a factor that favors the appearance of high levels of serum triglycerides and low levels of HDL-cholesterol in NIDDM. On the other hand, DM is a factor that increases the levels of triglycerides with low levels of HDL-cholesterol which already exist in AO.

[Correlation of plasma lipids and microproteinuria in diabetes mellitus]. / Correlación entre los lípidos plasmáticos y la microproteinuria en la diabetes mellitus.

Microproteinuria is an early sign of clinical diabetic nephropathy, and it also has the power to predict cardiovascular mortality in both types of diabetes. In order to investigate this last aspect, we have analyzed serum lipids in diabetes type I and II (128 male patients) with or without microproteinuria [determined using MICRAL/TEST (Boerhinguer M)]. The results revealed the following: hypertriglycerinemia and a low HDL-Cholesterol level in insulin dependent diabetes mellitus together with hypercholesterolemia in non insulin dependent diabetes mellitus. It seems that both microproteinuria as well as hyperlipidemiain diabetes mellitus reflect a generalizes vascular lesion.