Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste.

OBJECTIVES: The aim of the study was to clinically and histologically evaluate the healing of human intrabony defects treated with open flap surgery (OFD) and application of a new, resorbable, fully synthetic, unsintered, nanocrystalline, phase-pure hydroxyapatite (nano-HA). MATERIALS AND METHODS: Six patients, each of them displaying very advanced intrabony defects around teeth scheduled for extraction due to advanced chronic periodontitis and further prosthodontic considerations, were included in the study. Following local anaesthesia, mucoperiosteal flaps were reflected; the granulation tissue was removed, and the roots were meticulously debrided by hand and ultrasonic instruments. A notch was placed at the most apical extent of the calculus present on the root surface or at the most apical part of the defect (if no calculus was present) in order to serve as a reference for the histological evaluation. Following defect fill with nano-HA, the flaps were sutured by means of mattress sutures to allow primary intention healing. At 7 months after regenerative surgery, the teeth were extracted together with some of their surrounding soft and hard tissues and processed for histological analysis. RESULTS: The postoperative healing was uneventful in all cases. At 7 months following surgery, mean PPD reduction and mean CAL gain measured 4.0 ± 0.8 and 2.5 ± 0.8 mm, respectively. The histological analysis revealed a healing predominantly characterized by epithelial downgrowth. Limited formation of new cementum with inserting connective tissue fibers and bone regeneration occurred in three out of the six biopsies (i.e. 0-0.86 and 0-1.33 mm, respectively). Complete resorption of the nano-HA was found in four out of the six biopsies. A few remnants of the graft particles (either surrounded by newly formed mineralized tissue or encapsulated in connective tissue) were found in two out of the six biopsies. CONCLUSION: Within their limits, the present results indicate that nano-HA has limited potential to promote periodontal regeneration in human intrabony defects. CLINICAL RELEVANCE: The clinical outcomes obtained following surgery with OFD + nano-HA may not reflect true periodontal regeneration.

[The management of a single Miller-I type gingival recession at the maxillar incisor with single tunnel technique combined with enamel matrix derivative and connective tissue graft. A case report]. / Felso metszofogat erinto Miller-I típusú inyrecessio korrekciója zománcmátrix-proteinnel kombinált subepithelialis kötoszöveti Graft-tal es Single Tooth Tunnel technikával. Esetismertetés.

Gingival recession defect in the dentition are routinely encountered in periodontal practice and presents a challenge for a periodontist. Mucogingival surgical procedures aim to restore both gingival function and aesthetics. Recently as the population is getting to be more concerned about aesthetics the aesthetical indications are more relevant. In the presented case a coronally advanced flap prepared by single tunnel technique and combined with subepithelial connective tissue graft and enamel matrix derivatives (EMD) has been employed for root coverage in a Miller's class I recession. The combined technique used resulted in approximately 100% root coverage in the treated site after 6 months. Treatment outcomes met the patient's aesthetic demands and also eliminated her root sensitivity.

[Combined conservative-surgical management of generalized aggressive periodontitis: case presentation]. / Generalizált agresszív parodontitis kombinált konzervatív-sebészi kezelése: esetismertetés.

The aggressive periodontitis is a well-defined clinical entity markedly differing from the chronic form of periodontitis. A localized and a generalized form can be distinguished. The main bacterial etiologic factor for the localized form is A. actinomycetemcomitans. It mainly starts in the first quarter of ones life. The magnitude of clinical attachment loss is not proportional to the amount of local biofilm and plaque retentive factors. The rapid, mostly vertical type of bone destruction is very characteristic. In many cases the attachment loss is localized to only a few teeth, but it may spread and progress to the generalized form, affecting practically the whole dentition. In that case a mixed Gram-negative anaerobic biofilm is present subgingivally, but the AA can also dominate the pocket flora. Its treatment is very complex and time-consuming, and needs perfect patient compliance. Predictable clinical results can only be achieved by a combined conservative-surgical therapy. The corrective phase of the comprehensive treatment and patient's rehabilitation is crucial and mainly involves certain kind of regenerative therapy. One of the most critical phases is the supportive therapy. This can give a good chance to stop the progression of attachment loss and prevent the recurrence of the active disease. The presented case is to demonstrate how time-consuming a 32-year-old female patient's comprehensive periodontal therapy was, who had suffered with active aggressive periodontitis at admittance. The extensive disease control period followed by a relatively long follow-up and finished with a series of regenerative surgery could ensure a predictable outcome that might be maintained over a long period of time with regular supportive therapy.

Oncogene and tumor suppressor gene expression changes in the peripheral blood leukocytes of patients with colorectal cancer.

AIMS AND BACKGROUND: The mortality of colorectal cancer continues to stagnate despite the development of new therapeutic approaches. Therefore, identifying high-risk population groups could contribute to the prevention of a considerable part of deaths caused by colorectal tumors. METHODS: Fifty patients with colon cancer and 50 patients with other, nonmalignant diseases were selected for the study. Expression of the c-myc, Ha-ras and p53 genes was determined in the peripheral leukocytes of the participants. RESULTS: Marked elevations of the expression of all three investigated genes were seen in the colon cancer patients when compared to the controls. CONCLUSIONS: Our investigations showed that increases in the expression of c-myc, Ha-ras and p53 genes can be demonstrated in the peripheral leukocytes of colon cancer patients. By applying our method to clinical investigations, individuals with a high risk of having developed colon cancer may be identified and early diagnosis may be established.

Tolstoy's report of five cases of chest trauma: its relevance to contemporary military surgical experience.

Fragments of the history of trauma care, an important part of our surgical heritage, can offer a relevant message to contemporary science, even at the level of statistical evaluations. A surprisingly good match of results using two distinctively different approaches for calculating survival after a chest injury is reported in a historical model. Statistical data published by French and British surgeons serving in the Crimean War (1853-1856) were found to conform with the analysis of literary observations in Leo Tolstoy's Sebastopol Sketches. The nearly complete agreement on survival probabilities from two sources so different in their nature highlights the question of the relevance of nonstatistical methods in other fields of surgery as well.

[The results of Lichtenstein operation for groin hernias--prospective multicenter study]. / Lágyéksérvek Lichtenstein mutéttel történo megoldásának eredményei. Prospektív multicentrikus tanulmány.

UNLABELLED: Authors describe the short and long term results of a prospective multicentric Lichtenstein-trial started in March 1999. For the first time in our country, the exchange of information between the participating institutes has been arranged via Internet. 1434 patients were admitted for primary hernia repair and included in the trial. However, only 714 (49.8 per cent) have attended at the last follow-up control 4 years after surgery. Premilene and Prolene meshes were used in the course of Lichtenstein's tension-free procedure. RESULTS: Wound suppuration occurred only in a very small number of the patients (0.76 per cent) and there was merely one occasion when the mesh implant had to be removed because of sepsis. The intensity of postoperative pain and demand for analgesics was very low. During the follow-up period of 4 years 16 recurrent hernias were diagnosed (2.4 per cent). A hydrocele developed in 8 patients (0.5 per cent) while necrosis of the testicle was found in 4 patients (0.27 per cent). We realised that both the attitude and practice of the institutes participating in the study has changed thoroughly and the Bassini-repair seems to be replaced by the Lichtenstein procedure in these surgical departments. CONCLUSION: The study has reached its objective in more aspects: First it helped to achieve a significant reduction in recurrence rates and it also has shown that there is no increase in wound suppuration. The great number of surgeons performing this kind of inguinal hernia repair and their good results also indicate that this operation in less depending on surgical skills and practice than the Bassini-repair. The study has largely contributed to the national spread of this operation and has doubtlessly verified the advantage of information and data processing through the Internet, ie. a prompt and correct evaluation of the data recorded

Cutting lung parenchyma using the harmonic scalpel--an animal experiment.

OBJECTIVE: Applicability of harmonic scalpel in lung surgery was investigated using an animal model. METHODS: Air tightness, control of bleeding and features of tissue regeneration were compared in a 4-week time frame of investigation in animals in which either surgical stapler or harmonic scalpel were used for pulmonary resection. RESULTS: No significant differences between the two methods were found on a clinical and histopathological basis. CONCLUSIONS: Complete lack of granuloma formation at the resection line and in its vicinity consequently restitutio ad integrum demonstrate the advantage of the harmonic scalpel over the stapler in the circumstances investigated. Overall the vibration transmission method was shown not to be inferior to the standard methods in peripheral lung tissue resection.

Improvement of air tightness of stapled lung parenchyma using fascia lata.

Postoperative air leakage, a seemingly minor complication following procedures on emphysaematosus lung parenchyma can lead to very serious consequences. It is best treated if prevented. We report a technical modification of buttressing stapled resection line using autologous fascia lata.