Comparación de dos técnicas de sección vascular en lavaricocelectomía laparoscópica. Estudio prospectivo / Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study

Introducción: El varicocele es la dilatación anormal del plexopampiniforme. Puede afectar al 15-20% de los varones preadolescentes-adultos. La importancia de su diagnóstico radica en que puede inducirhipotrofia testicular y problemas de fertilidad en la etapa adulta. El objetivo de este estudio es evaluar si existe mayor índice de complicaciones,incluyendo la recurrencia del varicocele, dependiendo de la técnica deoclusión vascular utilizada: clip y sección o sellador vascular, en latécnica de Palomo laparoscópico en nuestro centro.Material y métodos: Estudio longitudinal prospectivo que se realizade 2017 a 2021. Se crean dos grupos terapéuticos según el método deoclusión vascular utilizada durante la varicocelectomía laparoscópica:clip y sección o sellador vascular. Los pacientes son incluidos en ungrupo mediante asignación sistemática consecutiva alternante. Se realizael análisis de las variables: edad, grado de varicocele según la clasifica-ción de Dubin-Amelar, complicaciones postquirúrgicas, seguimiento yrecurrencia del varicocele, según el método empleado.Resultados: Se intervinieron un total de 37 niños, con edad mediade 12 años (10-15 años) y una media de seguimiento de 12 meses. En20 pacientes (54,1%), se utilizó clip y sección, y en los 17 restantes(45,9%), sellador vascular. El 24,3% presentaba varicocele Grado IIsintomático y el 75,7%, Grado III. El 32,4% de los niños presentó algunacomplicación postquirúrgica durante el seguimiento. El 29,7% de lospacientes presentó hidrocele tras la intervención, perteneciendo 8 niñosal grupo de sellado y 3 niños al de clipaje. El 13,5% de estos precisóreintervención por este motivo. Ningún paciente presentó recurrenciadel varicocele. Conclusiones: La técnica de Palomo laparoscópica es una técnicasegura y efectiva que presenta buenos resultados en pacientes pediátricos...(AU)

Introduction: Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males.Varicocele diagnosis is important since it can induce testicular hyper-trophy and fertility issues in adulthood. The objective of this studywas to assess whether complications, including varicocele recurrence,depend on the vascular occlusion technique used –clipping + divisionvs. vascular sealer–in the laparoscopic Palomo technique used inour institution. Materials and methods: A longitudinal, prospective study wascarried out from 2017 to 2021. Two therapeutic groups were createdaccording to the vascular occlusion method used during laparoscopicvaricocelectomy –clipping + division vs. vascular sealer. Patients wererandomly allocated to the groups in a systematic alternating consecutivemanner. Variables –age, varicocele grade according to the Dubin-Amelarclassification, postoperative complications, follow-up, and varicocelerecurrence– were analyzed according to the method employed.Results: A total of 37 boys, with a mean age of 12 years (10-15years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17(45.9%), the vascular sealer was employed. 24.3% had symptomaticGrade II varicocele and 75.7% had Grade III varicocele. 32.4% of thechildren had postoperative complications during follow-up. 29.7% ofthe patients had hydrocele following surgery –8 boys from the seal-ing group and 3 boys from the clipping group–, with 13.5% requiringre-intervention as a result of this. None of the patients had varicocelerecurrence. Conclusions: The laparoscopic Palomo technique is safe and ef-fective, with good results in pediatric patients and few postoperativecomplications, regardless of the vascular occlusion device used...(AU)

Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study. / Comparación de dos técnicas de sección vascular en la varicocelectomía laparoscópica. Estudio prospectivo.

INTRODUCTION: Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males. Varicocele diagnosis is important since it can induce testicular hypertrophy and fertility issues in adulthood. The objective of this study was to assess whether complications, including varicocele recurrence, depend on the vascular occlusion technique used -clipping + division vs. vascular sealer- in the laparoscopic Palomo technique used in our institution. MATERIALS AND METHODS: A longitudinal, prospective study was carried out from 2017 to 2021. Two therapeutic groups were created according to the vascular occlusion method used during laparoscopic varicocelectomy -clipping + division vs. vascular sealer. Patients were randomly allocated to the groups in a systematic alternating consecutive manner. Variables -age, varicocele grade according to the Dubin-Amelar classification, postoperative complications, follow-up, and varicocele recurrence- were analyzed according to the method employed. RESULTS: A total of 37 boys, with a mean age of 12 years (10-15 years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17 (45.9%), the vascular sealer was employed. 24.3% had symptomatic Grade II varicocele and 75.7% had Grade III varicocele. 32.4% of the children had postoperative complications during follow-up. 29.7% of the patients had hydrocele following surgery -8 boys from the sealing group and 3 boys from the clipping group-, with 13.5% requiring re-intervention as a result of this. None of the patients had varicocele recurrence. CONCLUSIONS: The laparoscopic Palomo technique is safe and effective, with good results in pediatric patients and few postoperative complications, regardless of the vascular occlusion device used. In our study, no statistically significant differences regarding the use of clipping or vascular sealer in this laparoscopic technique were found. However, further studies with a larger sample size are required to find potential differences.

INTRODUCCION: El varicocele es la dilatación anormal del plexo pampiniforme. Puede afectar al 15-20% de los varones preadolescentes-adultos. La importancia de su diagnóstico radica en que puede inducir hipotrofia testicular y problemas de fertilidad en la etapa adulta. El objetivo de este estudio es evaluar si existe mayor índice de complicaciones, incluyendo la recurrencia del varicocele, dependiendo de la técnica de oclusión vascular utilizada: clip y sección o sellador vascular, en la técnica de Palomo laparoscópico en nuestro centro. MATERIAL Y METODOS: Estudio longitudinal prospectivo que se realiza de 2017 a 2021. Se crean dos grupos terapéuticos según el método de oclusión vascular utilizada durante la varicocelectomía laparoscópica: clip y sección o sellador vascular. Los pacientes son incluidos en un grupo mediante asignación sistemática consecutiva alternante. Se realiza el análisis de las variables: edad, grado de varicocele según la clasificación de Dubin-Amelar, complicaciones postquirúrgicas, seguimiento y recurrencia del varicocele, según el método empleado. RESULTADOS: Se intervinieron un total de 37 niños, con edad media de 12 años (10-15 años) y una media de seguimiento de 12 meses. En 20 pacientes (54,1%), se utilizó clip y sección, y en los 17 restantes (45,9%), sellador vascular. El 24,3% presentaba varicocele Grado II sintomático y el 75,7%, Grado III. El 32,4% de los niños presentó alguna complicación postquirúrgica durante el seguimiento. El 29,7% de los pacientes presentó hidrocele tras la intervención, perteneciendo 8 niños al grupo de sellado y 3 niños al de clipaje. El 13,5% de estos precisó reintervención por este motivo. Ningún paciente presentó recurrencia del varicocele. CONCLUSIONES: La técnica de Palomo laparoscópica es una técnica segura y efectiva que presenta buenos resultados en pacientes pediátricos, ya que presenta pocas complicaciones postquirúrgicas, independientemente del dispositivo de oclusión vascular que se utilice. En nuestro estudio, no se ha demostrado que existan diferencias estadísticamente significativas en cuanto al uso de clip o sellador vascular en esta técnica laparoscópica. No obstante, es preciso realizar más estudios con mayor tamaño muestral para hallar posibles diferencias.

Congenital malformations of the urinary tract: progression to chronic renal disease. / Malformaciones congénitas del tracto urinario (CAKUT): evolución a enfermedad renal crónica.

INTRODUCTION: Congenital nephrourological abnormalities (CAKUT) are a particularly relevant group of diseases due to their high prevalence and the fact they are the main cause of chronic renal disease (CRD) in the pediatric population. Our objective was to determine the characteristics and prevalence of CAKUT in our setting, while identifying the factors associated with the occurrence of renal damage. MATERIALS AND METHODS: A retrospective, descriptive, analytical, cross-sectional study of patients seen in the Pediatric Nephrology Department of a third-level hospital from January 1 to December 31, 2018 was carried out. Epidemiological, clinical, and analytical variables were assessed, and potential risk factors associated with CRD were searched for. RESULTS: The study involved 685 patients with 827 kidney units affected by CAKUT with a mean age of 9.98 ± 5.12 years. 62.2% were male, and the mean follow-up period after diagnosis was 9.95 ± 5.09 years. 58.8% were non-obstructive dilations, followed by renal dysplasia, obstructive dilations, and number and position abnormalities. The most frequent malformation was vesicoureteral reflux (VUR). The most commonly affected side was the left (47.5%). 55% of the diagnoses were prenatal. 172 patients underwent surgery. The initially chosen treatment for VUR was endourological. Overall re-intervention rate was 20%. Of the total number of patients, glomerular filtration rate was analyzed in 383, 95 (24.8%) of whom had CRD (86% in stage 2). Male sex, bilaterality, and proteinuria were risk factors associated with CRD. CONCLUSIONS: Knowledge of the epidemiological and clinical characteristics of children with CAKUT and the factors associated with CRD helps to individualize the clinical follow-up of these patients, thus customizing diagnostic tests and healthcare resources.

INTRODUCCION: Las anomalías nefrourológicas congénitas (CAKUT), constituyen un grupo de enfermedades de gran relevancia por su alta prevalencia y por ser la principal causa de enfermedad renal crónica (ERC) en la población pediátrica. Nuestro objetivo es conocer las características y la prevalencia de CAKUT en nuestro medio, identificando los factores asociados a la aparición de daño renal. MATERIAL Y METODOS: Estudio retrospectivo, descriptivo, analítico y transversal, que incluyó los pacientes atendidos en la consulta de Nefrología Pediátrica de un hospital de tercer nivel desde el 1 de enero al 31 de diciembre de 2018. Se analizaron variables epidemiológicas, clínicas y analíticas, y se buscaron posibles factores de riesgo asociados a ERC. RESULTADOS: Se incluyeron 685 pacientes con 827 unidades renales con CAKUT con una edad media de 9,98 ± 5,12 años. El 62,2% fueron varones y el seguimiento medio desde el diagnóstico fue de 9,95 ± 5,09 años. El 58,8% fueron dilataciones no obstructivas, seguido por displasia renal, dilataciones obstructivas y anomalías de número y posición. La malformación más frecuente fue el reflujo vesicoureteral (RVU). El lado más afectado fue el izquierdo (47,5%). El 55% de los diagnósticos fueron prenatales. Fueron intervenidos 172 pacientes. El tratamiento inicial de elección en el RVU fue endourológico. La tasa de reintervención global alcanzó el 20%. Del total de pacientes, se pudo analizar el filtrado glomerular en 383 pacientes, de los cuales 95 (24,8%) tenían ERC (86% en estadio 2). El sexo masculino, la bilateralidad y la proteinuria fueron factores de riesgo asociados a la ERC. CONCLUSIONES: El conocimiento de las características epidemiológicas y clínicas de los niños con CAKUT y de los factores asociados a la ERC ayuda a individualizar el seguimiento clínico de estos pacientes adecuando las pruebas diagnósticas y los recursos sanitarios.

Malformaciones congénitas del tracto urinario(CAKUT): evolución a enfermedad renal crónica / Congenital malformations of the urinary tract: progression to chronic renal disease

Introducción: Las anomalías nefrourológicas congénitas (CAKUT),constituyen un grupo de enfermedades de gran relevancia por su altaprevalencia y por ser la principal causa de enfermedad renal crónica(ERC) en la población pediátrica. Nuestro objetivo es conocer las ca-racterísticas y la prevalencia de CAKUT en nuestro medio, identificandolos factores asociados a la aparición de daño renal. Material y métodos: Estudio retrospectivo, descriptivo, analíticoy transversal, que incluyó los pacientes atendidos en la consulta deNefrología Pediátrica de un hospital de tercer nivel desde el 1 de eneroal 31 de diciembre de 2018. Se analizaron variables epidemiológicas,clínicas y analíticas, y se buscaron posibles factores de riesgo aso-ciados a ERC.Resultados: Se incluyeron 685 pacientes con 827 unidades rena-les con CAKUT con una edad media de 9,98 ± 5,12 años. El 62,2%fueron varones y el seguimiento medio desde el diagnóstico fue de9,95 ± 5,09 años. El 58,8% fueron dilataciones no obstructivas, se-guido por displasia renal, dilataciones obstructivas y anomalías denúmero y posición. La malformación más frecuente fue el reflujovesicoureteral (RVU). El lado más afectado fue el izquierdo (47,5%).El 55% de los diagnósticos fueron prenatales. Fueron intervenidos172 pacientes. El tratamiento inicial de elección en el RVU fue en-dourológico. La tasa de reintervención global alcanzó el 20%. Deltotal de pacientes, se pudo analizar el filtrado glomerular en 383pacientes, de los cuales 95 (24,8%) tenían ERC (86% en estadio 2).El sexo masculino, la bilateralidad y la proteinuria fueron factoresde riesgo asociados a la ERC. Conclusiones: El conocimiento de las características epidemioló-gicas y clínicas de los niños con CAKUT y de los factores asociados ala ERC ayuda a individualizar el seguimiento clínico de estos pacientesadecuando las pruebas diagnósticas y los recursos sanitarios.(AU)

Introduction: Congenital nephrourological abnormalities (CAKUT)are a particularly relevant group of diseases due to their high prevalenceand the fact they are the main cause of chronic renal disease (CRD) in thepediatric population. Our objective was to determine the characteristicsand prevalence of CAKUT in our setting, while identifying the factorsassociated with the occurrence of renal damage. Materials and methods: A retrospective, descriptive, analytical, cross-sectional study of patients seen in the Pediatric NephrologyDepartment of a third-level hospital from January 1 to December 31,2018 was carried out. Epidemiological, clinical, and analytical variables were assessed, and potential risk factors associated with CRDwere searched for.Results: The study involved 685 patients with 827 kidney unitsaffected by CAKUT with a mean age of 9.98 ± 5.12 years. 62.2% weremale, and the mean follow-up period after diagnosis was 9.95 ± 5.09years. 58.8% were non-obstructive dilations, followed by renal dysplasia,obstructive dilations, and number and position abnormalities. The mostfrequent malformation was vesicoureteral reflux (VUR). The most commonly affected side was the left (47.5%). 55% of the diagnoses wereprenatal. 172 patients underwent surgery. The initially chosen treatmentfor VUR was endourological. Overall re-intervention rate was 20%. Ofthe total number of patients, glomerular filtration rate was analyzed in383, 95 (24.8%) of whom had CRD (86% in stage 2). Male sex, bilateral ity, and proteinuria were risk factors associated with CRD. Conclusions: Knowledge of the epidemiological and clinical characteristics of children with CAKUT and the factors associated withCRD helps to individualize the clinical follow-up of these patients, thuscustomizing diagnostic tests and healthcare resources.(AU)

An investigation of the bidirectional link between osteoporosis and periodontitis.

This study investigated whether periodontitis affects systemic bone status and whether FRAX® is a screening tool for periodontal disease in elderly women. The findings showed that bone density was not influenced by periodontitis and highlighted that women with FRAX® score above the intervention threshold had greater chance to present severe periodontitis. PURPOSE: This study investigated whether periodontal disease is a predictor for systemic bone loss among elderly women. The utilization of FRAX® as a screening tool for severe periodontitis was also evaluated in this population. METHODS: Current bone mineral density (BMD) for lumbar spine and proximal femur was used as an indicator of "bone status." Number of interdental sites with severe clinical attachment loss, frequency of bleeding on probing, and percentage of tooth loss due to periodontitis represented "periodontal disease" that was tested as a predictor of bone loss in a structural equation modeling analysis involving 110 participants. The intake of antiosteoporosis medication was considered in the analysis. Four other different criteria for periodontitis classification were also tested. FRAX® for major fracture was calculated without BMD, and with intervention threshold set by age. Longitudinally, BMD changes up to 10 years were also obtained and checked for possible association with periodontitis. RESULTS: Periodontal disease was not a predictor for worse systemic bone status according to the different periodontal disease classifications, and was not associated with BMD changes. Antiosteoporosis medication directly predicted periodontal disease and systemic bone status. Women with FRAX® score above the intervention threshold had higher chance for periodontitis in more advanced stages: III/IV (OR = 1.13, 95% CI [1.04 to 1.22], p = 0.03). CONCLUSION: Periodontal disease did not constitute a predictor for reduced systemic bone density in the studied population of elderly women. On the other hand, FRAX® demonstrated to be a useful tool to suggest periodontal evaluation. Antiresorptive medication showed benefits on periodontal and bone status.

Intra-alveolar epsilon-aminocaproic acid for the control of post-extraction bleeding in anticoagulated patients: randomized clinical trial.

The aim of this study was to compare the effectiveness of the intra-alveolar administration of epsilon-aminocaproic acid (EACA) and daily gentle rinsing with EACA mouthwash with that of routine postoperative procedures for the control of bleeding after tooth extraction in anticoagulated patients. A randomized clinical trial was conducted involving 52 patients submitted to 140 tooth extractions, assigned randomly to two groups. The intervention group was treated with intra-alveolar administration of EACA immediately after surgery and gentle rinsing with EACA mouthwash during the postoperative period. The control group received routine postoperative recommendations. A single episode of immediate bleeding occurred in the intervention group. Late bleeding episodes occurred in 23 procedures (16.4%): 11 (15.7%) in the intervention group and 12 (17.1%) in the control group. Among the patients with late bleeding, 18 (78.3%) events were classified as moderate and were controlled by the patient applying pressure to a gauze pack placed over the extraction socket. The remaining five cases (21.7%) required re-intervention. No statistically significant difference in the frequency of postoperative bleeding was observed between the groups. Thus, routine measures were as effective for the control of bleeding after simple tooth extractions in anticoagulated patients as the topical administration of EACA.

Effects of Bone Fragility and Antiresorptive Drugs on Periodontal Disease and Tooth Loss: A Longitudinal Study.

This longitudinal study aimed to elucidate whether systemic bone fragility predicts severe periodontal clinical attachment loss (CAL) and tooth loss over the years and to test the influence of bone medication and periodontal maintenance in these relationships. Elderly women were evaluated for bone mineral density (BMD) and for fracture risk assessment (FRAX) in a cross-sectional analysis and retrospective follow-up (6- and 10-y periods). Data on BMD and FRAX were used as indicators of bone fragility in structural equation modeling. Periodontal examination and data on postmenopausal tooth loss were recorded. Multivariate Poisson regression models with robust covariance were used to estimate relative risk (RR) and 95% CI of BMD and FRAX for sites with CAL ≥6 mm and for tooth loss. The cross-sectional analysis included 134 women aged 65 to 80 y, and from them 71 and 49 women had available data for analysis in the 6- and 10-y follow-up periods, respectively. Bone fragility predicted severe CAL over 10 y (e.g., femoral neck: 10-y analysis, ß = -0.389, P = 0.005; cross-sectional, ß = -0.190, P = 0.004); however, this association did not remain significant when the use of bone medication was evaluated. Poisson regression showed that a better skeletal condition was associated with a lower risk of severe periodontal disease and tooth loss (cross-sectional femoral neck: RR = 0.08, P < 0.001; RR = 0.03, P < 0.001, respectively) when not adjusted for bone medication and periodontal maintenance. The receiver operating characteristic curve suggested that women with osteoporosis should be referred for periodontal assessment (sensitivity = 71.0%, specificity = 70.0%). Bone fragility is a relevant longitudinal predictor of severe periodontal disease and tooth loss among elderly women. The use of bisphosphonates improved the bone condition as well as the periodontal status. Periodontal maintenance also minimized the negative impact of low BMD on teeth-supportive tissues in the studied population. Knowledge Transfer Statement: The results of this study present evidence that the management of bone fragility and osteoporosis may be important in the prevention of periodontal attachment loss and future tooth loss. Besides the antiresorptive effects of the antiosteoporosis drugs on systemic bone conditions, these medications may protect periodontal tissues. The interaction of health care professionals such as dentists and physicians represents a key role for the approach to women's health, especially in an aging world.

Bone Density and Clinical Periodontal Attachment in Postmenopausal Women: A Systematic Review and Meta-Analysis.

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and has been considered a risk factor for periodontal disease. The aim of this systematic review and meta-analysis was to verify the scientific evidence for the association of periodontal attachment loss with low BMD in postmenopausal women. A systematic search of the literature was performed in databases until August 2016, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria included studies that compared clinical attachment loss (CAL) between postmenopausal women with low and normal BMD. Studies using similar methodology, with lower and higher risk of bias, were pooled into 3 different meta-analyses to compare CAL among women with normal BMD, osteoporosis, and osteopenia. In the first meta-analysis, mean CAL was compared among groups. In the other 2 meta-analyses, the mean percentages of sites with CAL ≥4 mm and ≥6 mm were respectively compared among groups. From 792 unique citations, 26 articles were selected for the qualitative synthesis. Eleven of the studies were appraised as presenting low risk of bias, and the association between low BMD and CAL was observed in 10 of these studies. Thirteen cross-sectional articles were included in the meta-analysis for osteoporosis and 9 in the osteopenia analysis. Women with low BMD presented greater mean CAL than those with normal BMD (osteoporosis = 0.34 mm [95% confidence interval (CI), 0.20-0.49], P < 0.001; osteopenia = 0.07 mm [95% CI, 0.01-0.13], P = 0.02). Only studies with lower risk of bias were available for the analysis of CAL severity. Women with low BMD presented more severe attachment loss, represented as mean percentage of sites with CAL ≥4 mm (osteoporosis = 3.04 [95% CI, 1.23-4.85], P = 0.001; osteopenia = 1.74 [95% CI, 0.36-3.12], P = 0.01) and CAL ≥6 mm (osteoporosis = 5.07 [95% CI, 2.74-7.40], P < 0.001). This systematic review and meta-analysis indicates that postmenopausal women with osteoporosis or osteopenia may exhibit greater CAL compared with women with normal BMD.

Association of osteoporosis and bone medication with the periodontal condition in elderly women.

UNLABELLED: This study investigated whether osteoporosis and its treatment may affect periodontal condition in elderly women. The findings highlighted that women with osteoporosis had a higher chance to present severe periodontitis than women with normal bone mineral density (BMD), particularly those who were not treated for osteoporosis. INTRODUCTION: This study investigated whether osteoporosis increases the frequency and severity of chronic periodontitis in elderly women and evaluated the influence of vitamin D and osteoporosis treatment in the periodontal condition. METHODS: In this cross-sectional study, elderly women were selected among 1266 subjects evaluated for lumbar spine and proximal femur bone mineral density (BMD) using dual energy X-ray absorptiometry. Sociodemographic, clinical characteristics, and complete periodontal examination were recorded. Serum 25-hydroxyvitamin D levels were measured by chemiluminescence. RESULTS: Forty-eight elderly women with normal BMD and 86 with osteoporosis were selected. Women with osteoporosis presented higher frequency of sites with clinical attachment level ≥6 mm (p = 0.003) and gingival recession ≥3 mm (p = 0.002) than those with normal BMD and were more than twice as likely to present severe periodontitis (odds ratio (OR) = 2.49, 95 % CI [1.14 to 5.43]). Osteoporotic women who were not treated for the condition had more chance to present severe periodontitis (OR = 3.16, 95 % CI [1.28 to 7.82]) than those who did use bisphosphonates (OR = 2.04, 95 % CI [0.85 to 4.89]). Among the participants who presented low levels of vitamin D, those with osteoporosis exhibited a higher chance to present severe periodontitis than those with normal BMD (p = 0.027), but the association between vitamin D levels and osteoporosis was not statistically significant after adjustment (p = 0.198). CONCLUSIONS: Elderly women with osteoporosis have a greater chance to present periodontitis, with higher severity than those with normal BMD. Osteoporosis treatment provides protection for periodontitis.

Fractal dimension evaluation of cone beam computed tomography in patients with bisphosphonate-associated osteonecrosis.

OBJECTIVES: The aim of this study was to (1) evaluate the fractal dimension (FD) in regions of the mandible on cone beam CT (CBCT) images of patients with bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) and (2) to select the most suitable region of interest (ROI) for further study on detection of bone alterations associated with bisphosphonates. METHODS: CBCT images of patients with BP-ONJ were included with matched controls. Values of FD were compared between groups. Selected ROIs were: ROI-1 - below the mandibular foramen; ROI-2 - above the mandibular foramen; ROI-3 - anterior to the mental foramen; ROI-4 - above the mandibular canal. The area of bone exposure was included as ROI-5. The results were analysed using generalized estimating equations and conditional logistic regression. RESULTS: There were 36 patients (67% female) with a mean age of 60.7 years. The mean FDs were: ROI-1 - 1.678 for controls and 1.673 for patients (P = 0.81); ROI-2 - 1.657 for controls and 1.653 for patients (P = 0.78); ROI-3 - 1.661 for controls and 1.684 for patients (P = 0.17); and ROI-4 - 1.670 for controls and 1.698 for patients (P = 0.03). The value of the FD in the area of exposed bone was the highest (1.729). The odds of being a BP-ONJ patient vs being a control was six times as high for individuals with a higher FD score at ROI-4, although the confidence interval was quite wide owing to the small sample size. CONCLUSION: In this preliminary study, BP-ONJ patients had higher FD values than controls at regions close to the alveolar process. The results suggest that FD is a promising tool for detection of bone alterations associated with BP-ONJ.

Persistent orofacial muscle pain.

The pathophysiology of persistent orofacial myalgia has been the centre of much controversy. In this article we suggest a novel descriptive term; 'persistent orofacial muscle pain' (POMP) and review current evidence that supports the hypothesis that the induction of POMP involves the interplay between a peripheral nociceptive source in muscle, a faulty central nervous system component and decreased coping ability. In this context it is widely accepted that a complex interaction of variable intrinsic and extrinsic factors act to induce POMP and dysfunction.

Clinical aspects of Candida species carriage in saliva of xerotomic subjects.

In order to investigate the clinical factors that might influence the diversity and the degree of Candida species carriage in saliva, we conducted a cross-sectional study with 133 patients with complaints of xerostomia. Anamnesis, oral examination and collection of chewing-stimulated whole saliva were performed. The samples of saliva were kept refrigerated until they were plated onto CHROMagar Candida; cfu were counted and Candida species were identified by standard methods. There was a high prevalence of mixed Candida colonization. No relationship was found between total Candida cfu counts and variables like gender, age, place of origin, underlying diseases, exposure to medications (except antibiotics), daily habits and salivary flow rates. Oral candidiasis, antibiotic exposure and dental prosthesis wearing were associated with relatively high Candida counts in saliva. Low salivary flow rates predisposed to intense colonization by C. albicans and C. parapsilosis.

Anti-inflammatory effects of peripheral benzodiazepine receptor ligands in two mouse models of inflammation.

In vivo treatment of mice with peripheral benzodiazepine receptor ligands exerts an inhibitory effect on the inflammatory response in two models of acute inflammation. In the first model, pretreatment of the animals (24 h) with 1-(2-chlorophenyl)-N-methyl-N(1-methylpropyl)-3-isoquinoline carboxamide (PK11195) and 7-chloro-5-(4-Chlorophenyl)-1, 3-dihydro-1-methyl-2-H-1,4-benzodiazepin-2 (Ro5-4864), at different doses (0.00001-10 mg/kg, i.p.) dose dependently inhibited the formation of mouse paw oedema induced by carrageenan with mean ID(50s) of 0.009 (95% confidence limits=0.0076-0.013) and 0.04 (95% confidence limits=0.025-0.0086) mg/kg, respectively. Both ligands (0. 1 mg/kg, i.p.) inhibited in the same way the mouse paw oedema induced by carrageenan in animals with and without adrenal glands. PK11195 and Ro5-4864 (0.1 mg/kg, i.p.) inhibited the mouse paw oedema induced by several inflammatory mediators. In the second model, the pretreatment (24 h) with peripheral benzodiazepine receptor ligands (0.1 mg/kg, i.p.) exerted an inhibitory effect on neutrophil influx and produce a marked inhibition of carrageenan-produced interleukin-13 and interleukin-6 in pleural exudation. Our results extend previous findings that peripheral benzodiazepine receptor is involved in the inflammatory response, and suggest that this action may be linked to the action of different inflammatory mediators, probably mainly by the inhibition of the release of pro-inflammatory cytokines.

Chronic fatigue syndrome: sociodemographic subtypes in a community-based sample.

Most chronic fatigue syndrome (CFS) studies are based on information about patients from primary or tertiary care settings. These patients might not be typical of patients in the general population. This investigation involved examinations of individuals with CFS from a community-based study. A random sample of 18,675 in Chicago was interviewed by telephone. Individuals with chronic fatigue and at least four minor symptoms associated with CFS were given medical and psychiatric examinations. A group of physicians then diagnosed individuals with CFS, who were then subclassified based on three sociodemographic categories--gender, ethnicity, and work status. Sociodemographic subgroups were analyzed in terms of symptom severity, functional disability, coping, optimism, perceived stress, and psychiatric comorbidity. Women, minorities, and nonworking individuals with CFS reported greater levels of functional disability, symptom severity, and poorer psychosocial functioning than men, Caucasians, and working individuals, suggesting sociodemographic characteristics may be associated with poorer outcomes in urban, community-based samples of CFS individuals.

Potential role of peripheral benzodiazepine receptors in inflammatory responses.

This study investigates the anti-inflammatory effects of 1-(2-chlorophenyl)-N-methyl-N(1-methylpropyl)-3-isoquinoline carboxamide and 7-chloro-5-(4-chlorophenyl)-1, 3-dihydro-1-methyl-2-H-1,4-benzodiazepin-2-one in paw oedema induced by carrageenan in mice. Pretreatment (24 h) with both ligands inhibited oedema formation in at different doses (0.00001-10 mg/kg, i.p.) with range of inhibition of 25% to 70%, in animals with or without adrenal glands. These results demonstrate, for the first time, an in vivo anti-inflammatory property of peripheral benzodiazepine receptor ligands.