Updated soil to fruit concentration ratios for radiocaesium compiled under the IAEA MODARIA II Programme.

Under the International Atomic Energy Agency (IAEA) Modelling and Data for Radiological Impact Assessments (MODARIA II) Programme, Working Group 4 activities included collating radionuclide transfer data from Japan following the Fukushima Daiichi Nuclear Power Plant accident and separately collating concentration ratio (CR) data for root uptake of radionuclides by crops grown in tropical and arid climates. In this paper, the newly compiled radiocaesium CR data for fruit from Japan, tropical and arid climates have been combined with the data originally compiled for the IAEA Technical Reports Series No. 472 (TRS 472) and additional data identified from the literature to produce an enhanced MODARIA II dataset of fruit radiocaesium CR values. Statistical analysis of the MODARIA II dataset by climate class (based on the Köppen-Geiger climate classification) indicated that the CR values for tropical climates were significantly higher (p< 0.05) than those for arid, temperate and cold climates. Statistical analysis of the MODARIA II dataset by soil group (based on soil texture) indicated that the CR values for coral sand soil (tropical climates only) and organic soil (temperate climates only) were significantly higher (p< 0.05) than those for the clay, loam and sand soil groups. Statistical analysis of the MODARIA II dataset by plant group (based on plant morphology) indicated that the CR values for non-woody trees (tropical climate bias) were significantly higher (p< 0.05) than those for herbaceous plants, shrubs and woody trees. Comparison of the MODARIA II dataset with original TRS 472 values showed only small changes in the fruit radiocaesium CR values for herbaceous plants and shrubs in temperate climates. There was a decrease in the CR values for woody trees in temperate climate across all soil groups. There was also a decrease in the CR values for tropical climates for all comparable soil groups.

The use of Argentum-Quartz® solution in primary or recurrent perianal fistulas: first experience on three cases.

Primary perianal fistulous pathology represents a painful condition often noticeable in patients affected by Crohn's disease or Ulcerative colitis. It causes difficult defecation and can evolve in perianal abscess that should be urgently ascertained and drained. The present work aims to propose Argentum-Quartz® as valid non-surgical therapeutic treatment in order to reach a more comfortable perianal fistula healing. In fact, our preliminary data allow us to consider Argentum Quartz® ideally employable for treatment of perianal fistulas associated or not with IBDs, representing a reliable sphincter-sparing solution.

Programa de seguimiento al alta de la unidad de cuidados intensivos / Follow-up program after intensive care unit discharge

Introducción: El seguimiento de pacientes al alta de la unidad de cuidados intensivos (UCI) permite el reconocimiento precoz de las complicaciones asociadas al síndrome post terapia intensiva (SPTI). El objetivo de este estudio es la estandarización de medidas básicas de resultado incluidas en un programa de seguimiento de pacientes en riesgo de presentar SPTI. Métodos: El comité de Seguimiento y Rehabilitación luego de la Enfermedad Crítica de la Sociedad Argentina de Terapia Intensiva (SATI) convocó a diferentes comités para la redacción del presente documento. Se realizó una búsqueda bibliográfica, junto con reuniones y foros de discusión. Las recomendaciones incluidas en el programa de seguimiento según el sistema GRADE son: frecuencia de seguimiento, profesionales encargados del programa, dominios básicos a evaluar, herramientas recomendadas para su evaluación validadas al español y duración del programa. Conclusión: Las medidas recomendadas para el seguimiento de pacientes permiten establecer los lineamientos básicos para la identificación y tratamiento precoz de las complicaciones asociadas al SPTI

Introduction: Patient follow-up after intensive care unit (ICU) discharge allows the early recognition of complications associated to post-intensive care syndrome (PICS). The aim of this project is to standardize outcome variables in a follow-up program for patients at risk of suffering PICS. Methods: The Rehabilitation and Patient Follow-up Committee of the Argentine Society of Intensive Care Medicine (Sociedad Argentina de Terapia Intensiva, SATI) requested the collaboration of different committees to design the present document. A thorough search of the literature on the issue, together with pre-scheduled meetings and web-based discussion encounters were carried out. After comprehensive evaluation, the recommendations according to the GRADE system included in the follow-up program were: frequency of controlled visits, appointed healthcare professionals, basic domains of assessment and recommended tools of evaluation, validated in Spanish, and entire duration of the program. Conclusion: The measures herein suggested for patient follow-up after ICU discharge will facilitate a basic approach to diagnosis and management of the long-term complications associated to PICS

Follow-up program after intensive care unit discharge. / Programa de seguimiento al alta de la unidad de cuidados intensivos.

INTRODUCTION: Patient follow-up after intensive care unit (ICU) discharge allows the early recognition of complications associated to post-intensive care syndrome (PICS). The aim of this project is to standardize outcome variables in a follow-up program for patients at risk of suffering PICS. METHODS: The Rehabilitation and Patient Follow-up Committee of the Argentine Society of Intensive Care Medicine (Sociedad Argentina de Terapia Intensiva, SATI) requested the collaboration of different committees to design the present document. A thorough search of the literature on the issue, together with pre-scheduled meetings and web-based discussion encounters were carried out. After comprehensive evaluation, the recommendations according to the GRADE system included in the follow-up program were: frequency of controlled visits, appointed healthcare professionals, basic domains of assessment and recommended tools of evaluation, validated in Spanish, and entire duration of the program. CONCLUSION: The measures herein suggested for patient follow-up after ICU discharge will facilitate a basic approach to diagnosis and management of the long-term complications associated to PICS.

Crohn’s disease and extra intestinal granulomatous lesions.

Crohn’s disease (CD) is an inflammatory bowel disease with a multifactorial etiology. Clinical features include mucosal erosion, diarrhea, weight loss and other complications such as formation of granuloma. In CD, granuloma is a non-neoplastic epithelioid lesion, formed by a compact aggregate of histiocytes with the absence of a central necrosis, however, the correlation among CD and the formation of granulomas is unknown. Many cases of granulomas in the extracellular site, related to CD, have been reported in the literature. These granulomas, at times, represented the only visible manifestation of the pathology. Extra intestinal granulomas have been found on ovaries, lungs, male genitalia, female genitalia, orofacial regions and skin. From the data in the literature it could be hypothesized that there is a cross-reaction of the immune system with similar antigenic epitopes belonging to different sites. This hypothesis, if checked, can place CD not only among inflammatory bowel disease but also among inflammatory diseases with systemic involvement.

Colorectal cancer: an update on the effects of lycopene on tumor progression and cell proliferation.

Colorectal cancer (CRC) is one of the most common cancers worldwide. Various factors, including oxidative stress, where excessive productions of reactive oxygen species (ROS) and reactive nitrogen species (RNS) occur, contribute to its pathogenesis. Numerous studies have investigated the effect of antioxidant substances derived from food such as fruits and vegetables; however, data on Lycopene are still rare. Studies on HT-29 colorectal cancer cells and on animal models have shown that lycopene has effects on cell proliferation and on the progression of the CRC by interacting with various cellular signaling pathways. This analysis of the literature focused on the antioxidant effect of lycopene, a substance that is found in the tomato.

Colorectal cancer and inflammatory bowel diseases: effects of diet and antioxidants.

It is well established that oxidative stress is common in inflammatory bowel diseases (IBDs). Accordingly, antioxidants are recommended for treatment. The aim of this study is to compare the effects of antioxidants contained in the various types of tea on symptoms and evolution of IBD and colorectal cancer (CRC). Analysis of the literature revealed that the theaflavin-3, 30-digallate (TFDG) contained in black tea, and epigallocatechin-3-O-gallate (EGCG) contained in green tea have protective effects against oxidative stress. Moreover, these substances are involved in many biochemical processes responsible for inflammation and proliferation of cancer cells. It is documented that both TFDG and EGCG are able to reduce inflammatory phenomena and symptoms associated with IBD, as well as to reduce the proliferation of CRC cells. Most studies are performed in vitro or in experimental animal models. It is, therefore, advisable to formulate studies that could be carried out on humans or human samples, in order to develop the appropriate therapeutic strategies.

Helicobacter pylori and Barrett’s esophagus: a protective factor or a real cause?

Notwithstanding the definite aetiopathogenetic path of certain diseases, the relationship between Helicobacter pylori (H. pylori) and Barrett’s esophagus (BE), a condition that increases the risk for dysplasia and consequently adenocarcinoma of the distal esophagus and esophagogastric junction, remains uncertain. This paper reviews the current scientific literature with emphasis on the protective correlation between H. pylori infection and BE and demonstrates that a causal relationship has not been disproved with certainty. Furthermore, H. pylori infection could pose a risk for the onset of gastroesophageal reflux disease (GERD), which could in turn trigger BE, a precancerous lesion, and subsequently cause cancer. By analyzing the current available data, this article tries to verify that H. pylori infection is the underlying cause of esophageal cancer.

The fingerprint of the human gastrointestinal tract microbiota: a hypothesis of molecular mapping.

The precise etiology of Inflammatory Bowel Disease (IDB) remains unclear and several factors are believed to play a role in its development and progression, including the composition of microbial communities resident in the gastrointestinal tract. Human intestinal microbiota are extensive with at least 15,000-36,000 bacterial species. However, thanks to the new development in sequencing and molecular taxonomic methodologies, our understanding of the microbiota population composition, dynamics, and ecology has greatly increased. Intestinal microbiota play a critical role in the maintenance of the host intestinal barrier homeostasis, while dysbiosis, which involves reduction in the microbiome diversity, can lead to progression of inflammatory disorders, such as IBD and colorectal cancer. It is hypothesized that fingerprinting characterization of the microbiota community composition is the first step in the study of this complex bacterial ecosystem and a crucial step in the targeted therapy. Molecular fingerprinting of human gastrointestinal tract microbiota could be performed by different techniques including the semi quantitation, 16SrRNA, the DNA- microarray as well as other relatively new methods which were developed to study many complex bacterial ecosystems. These techniques provide individual data and profiles, using fast and sensitive tools for the high taxonomic level fingerprint of the human intestinal microbiota and provide estimation of the relative presence of the microbial target groups within each individual. Such personalized information serves as a remarkable and unprecedented opportunity to improve targeted medical treatment and probably develop strategies to prevent disease.

Manejo del síndrome de abstinencia alcohólica en los pacientes críticos / Management of the syndrome of alcohol withdrawal in critical patients

El manejo del síndrome de abstinencia alcohólica es un desafío en los pacientes críticos. Con frecuencia, se desconocen los antecedentes de consumo de alcohol o este dato es incompleto, lo que limita la identificación de quienes pueden desarrollar este síndrome. El cese abrupto del consumo de alcohol coloca a estos pacientes en alto riesgo de sufrir síndrome de abstinencia alcohólica grave. Típicamente, las benzodiacepinas son consideradas las drogas de primera línea para el manejo de estos casos. Sin embargo, si el paciente progresa a un estado más grave con convulsiones o delirium tremens, puede ser necesario administrar medicación adyuvante a las benzodiacepinas, como el propofol o la dexmedetomidina, o emplear estas últimas drogas como terapias alternativas en aquellos que no responden a las benzodiacepinas. La aparición de convulsiones representa un fuerte factor de riesgo para la progresión a un síndrome de abstinencia alcohólica grave, con el desarrollo posterior de delirium tremens hasta en el 30% de los casos. El delirium tremens es el cuadro más grave y ocurre en el 5-20% de los pacientes con este síndrome, con una mortalidad hasta del 25% sin tratamiento y que se reduce al 0-1% con tratamiento. Es importante conocer el antecedente del consumo de alcohol para evitar el síndrome de abstinencia alcohólica o tratar rápidamente sus síntomas más graves, y mejorar la supervivencia de estos pacientes.(AU)

Alcohol withdrawal syndrome (AWS) is a well-known and a challenging condition occurring in critically ill patients. Frequently, history of alcohol abuse is unknown when the patient is admitted to the intensive care unit, limiting the identification of those who could develop AWS. The abrupt cessation of a heavy or constant drinking put these patients in high risk of suffering from this syndrome in its severe form. Typically, benzodiazepines are considered the first line of treatment. However, if clinical conditions progress to epileptic seizures or delirium tremens or are refractory to benzodiazepines, adjuvant drugs like propofol or dexmedetomidine might be an option to control the severe symptoms. Delirium tremens can occur in up to 30% of patients; it is the most severe picture with a mortality of 25% without treatment and that can be reduced to almost 0-1% with treatment. It is important to appropriately identify alcohol abuse in order to avoid the early clinical manifestations of AWS or rapidly treat its most severe symptoms and improve survival.(AU)

Probiotic mixture supplementation in the preventive management of trinitrobenzenesulfonic acid-induced inflammation in a murine model.

Inflammatory bowel diseases (IBD) are characterized by inflammatory conditions of the intestine. Probiotic bacteria (PB) can have beneficial effects in several gastrointestinal disorders. The objectives of this study were: (i) to provide an acute experimental IBD model induced by 2,4,6-trinitrobenzenesulfonic acid (TNBS) in CD-1 mice, and (ii) to assess the preventive effects of Citogenex (Lactobacillus casei and Bifidobacterum lactis) supplementation on intestinal tissues and microbiota. Mice were inoculated intrarectally with saline, ethanol or different TNBS solutions. 1%TNBS induced clinical signs of colitis (P less than 0.01) and histological damage (P less than 0.01). Based on these results, mice were pre-treated with Citogenex or saline for 1, 2 or 3 weeks before 1%TNBS treatment. Probiotic pre-treatment determined a reduction of clinical signs (P less than 0.05), histological alterations of colitis (P less than 0.05) and increased beneficial bacteria (P less than 0.05). This study confirms that TNBS-induced colitis in CD-1 mice is useful for studying the mechanisms involved in IBD pathogenesis, and pre-treatment with Citogenex prevents the intestinal damage induced by TNBS.

Lanzamiento de un programa de ECMO en un hospital universitario de la Argentina / Launching a program of ECMO in a hospital University of Argentina

El objetivo de este trabajo es describir el proceso para implementar un programa de ECMO en un hospital universitario de Buenos Aires, y transmitir los resultados a los tres años. Se realizó un análisis retrospectivo de 27 pacientes con ECMO desde enero de 2011: once pacientes con síndrome de dificultad respiratoria aguda y 16 postrasplante de pulmón con hipoxemia. La mediana de la edad era de 43 años (rango intercuartil 23-53); la mediana del puntaje APACHE II fue de 19 (rango intercuartil 14-21), la mediana de la PaFi, 100 (rango intercuartil 78-121) y la tasa de mortalidad, del 29%. Estos programas son factibles en la región con el entrenamiento adecuado.(AU)

The aim of this paper is to describe the process to implement an ECMO program at a university hospital in Buenos Aires, and to transmit the results after three years. A retrospective analysis of 27 patients with ECMO from January 2011 was performed, this includes patients with acute respiratory distress syndrome (n=11) and lung transplantation with hypoxemia (n=16). Patients had a median age of 43 years (IQR: 23-53), with a median APACHE II score of 19 (IQR: 14-21), a median PAFI of 100 (IQR: 78-121) and the mortality rate was 29%. These programs are feasible in the region with the right training.(AU)

Treatment of craniofacial fibrous dysplasia: a case report.

The concept of "fibro-osseous lesions" of bone has evolved over the last several years and now includes two mayor entities: the fibrous dysplasia (FD) and the cement-ossifying fibroma (COF). Fibrous dysplasia is considered to be a developmental, tumor-like (hamartomatous), fibro-osseous disease of unknown etiology. There is a maxillary predominance when craniofacial FD occurs in the jaws and the maxillary sinus is commonly involved. Differentiation of OF from FD is important because of differences in treatment and behaviour. This article report a case of 60-year-old female with a history of painless unilateral palatal swelling.

Piezolelectric surgery in dentistry: a review.

In the last ten years was observed a significant increase of publications about piezoelectric bone surgery. The purpose of this review was to define the state of art and to realize a comparison between piezoelectric devices and manual or rotating traditional techniques, analyzing advantages and disadvantages from a clinical and histological point of view for various dental procedures. The literature review has been carried out using medical databases on line: MEDLINE and COCHRANE LIBRARY. The authors selected 37 publications about dental field and consistent with inclusion criteria established. From the clinical point of view, the analysis of selected publications concerning procedures such as maxillary sinus lift, alveolar ridge expansion, samples of autologous bone, etc, showed surgical trauma reduction, especially towards to soft and nervous tissues, surgical mini-invasiveness, cut precision and selectivity and speed of learning guaranteed by piezoelectric devices compared to traditional ones. Histologically, however, the study of biology and postintervention bone tissue healing showed a lower loss of bone with piezoelectric instruments than with conventional devices, as well as a better healing quality by reducing patient's postsurgery morbidity. The use of piezoelectric devices seems thus to simplify different sinus lift surgical procedures and to allow greater predictability, although some studies reveal that there are not substantial differences in comparison of long-term results between conventional and piezoelectric instruments and also criticize their increase in operation time.

The sensitivity of different environments to radioactive contamination.

This paper describes modelling calculations carried out to determine the sensitivity of various rural and semi-natural environments to radionuclide contamination by (137)Cs, (90)Sr, and (131)I released during a major nuclear accident. Depositions of 1000 Bq/m(3) were assumed for each radionuclide. Four broad types of environments were considered: agricultural, forest or tundra, freshwater aquatic, and coastal marine. A number of different models were applied to each environment. The annual dose to a human population receiving most or all of its food and drinking water from a given environment was taken as a broad measure of sensitivity. The results demonstrated that environmental sensitivity was highly radionuclide specific, with (137)Cs generally giving the highest doses during the first year, especially for adults, in terrestrial and freshwater pathways. However, in coastal marine environments, (131)I and (239)Pu were more significant. Sensitivity was time dependent with doses for the first year dominating those for the 2nd and 10th years after deposition. In agricultural environments the ingestion dose from (137)Cs was higher for adults than other age groups, whereas for (90)Sr and (131)I, the ingestion dose was highest for infants. The dependence of sensitivity on social and economic factors such as individual living habits, food consumption preferences, and agricultural practices is discussed.

Microcirculation in the healing of surgical wounds in the oral cavity.

The aim of this research is to evaluate in vivo the characteristics of microcirculation after taking a biopsy sample from the oral mucosa. 20 patients were recruited to the study and all underwent an oral mucosa biopsy for the excision of benign neoformations. The modifications in the oral microcirculation were evaluated in vivo in correspondence to the surgical site through videocapillaroscopy at three different times: 30 min before the biopsy; 48 h after the biopsy; and 7 days after the biopsy. The statistical significance was checked with the Mann-Whitney U-test (P<0.05). The analysis of videocapillaroscopic patterns showed statistically significant variations relative to the capillary loop density; the diameter of the outgoing loop; and the length of the capillary loop. In conclusion, the study describes a simple and reproducible model for the study of wound healing from a microcirculatory point of view.

Effects of low-level laser irradiation on proliferation and osteoblastic differentiation of human mesenchymal stem cells seeded on a three-dimensional biomatrix: in vitro pilot study.

Mesenchymal stem cells (MSCs) from bone marrow are a recent source for tissue engineering. Several studies have shown that low-level laser irradiation has numerous biostimulating effects. The purpose of this trial was to evaluate the effects of Nd:Yag laser irradiation on proliferation and differentiation of MSCs induced into the osteoblastic lineage. MSCs were collected from adult human bone marrow, isolated, and cultured in complete medium (α-MEM). Subsequently, they were treated with osteogenic medium, seeded in three-dimensional collagen scaffolds, and incubated. We used six scaffolds, equally divided into three groups: two of these were irradiated with Nd:Yag laser at different power levels (15 Hz, 100 mJ, 1.5 W, and one with a power level of 15 Hz, 150 mJ, 2.25 W), and one was left untreated (control group). Evaluations with specific staining were performed at 7 and 14 days. After 7 days, proliferation was significantly increased in scaffolds treated with laser, compared with the control scaffold. After 14 days, however, laser irradiation did not appear to have any further effect on cell proliferation. As concerns differentiation, an exponential increase was observed after 14 days of laser irradiation, with respect to the control group. However, this was a pilot study with very limited sample size, we conclude, that low-level laser irradiation might lead to a reduction in healing times and potentially reduces risks of failure.

Estudio experimental sobre la utilización de células madre humanas en la terapia de los defectos periodontales: resultados preliminares / Experimental study on the use of human stem cell therapy in periodontal defects: Preliminary results

La destrucción del ligamento periodontal y de la cresta alveolar causada por la enfermedad periodontal, constituye la principal causa de pérdida dentaria en pacientes adultos. Resulta difícil que la terapia en la enfermedad periodontal avanzada lleve a una restitutio ad integrum de la estructura que se ha perdido por la imposibilidad de regenerar la correcta anatomía del sistema perdido. Este estudio tiene como objetivo evaluar el potencial y la estabilidad de la utilización de células madre mesenquimales (MSC) en la regeneración periodontal de la estructura original. Su objetivo es determinar un método de regeneración de la estructura periodontal original que se ha perdido después de la enfermedad periodontal, cerca de los elementos dentales vitales sin patologías correlacionadas. Este estudio constituye una experimentación de fase 1 aprobada por el Instituto Superior de Salud sobre un número limitado de pacientes, cuyo objetivo principal será la evaluación de la biocompatibilidad y toxicidad in vivo de las células madre mesenquimales diferenciadas en sentido osteoblástico, sostenidas por andamios de colágeno biomiméticos en pacientes afectados por periodontopatía severa. El protocolo describe el transplante de células madre mesenquimales derivadas de muestras de un aspirado percutáneo de médula ósea. Las células de la médula ósea son manipuladas ex vivo para el aislamiento de la población de células madre mesenquimales. Las células madre adultas son diferenciadas en las líneas celulares que forman el sistema periodontal, sucesivamente inducidas y cultivadas en andamios adecuados definidos en base a características propias con el fin de obtener una distribución uniforme de las líneas celulares, e injertadas en el sitio receptor estimulado adecuadamente hasta la degradación de los andamios, en un tiempo suficiente para garantizar la estabilidad de las diferentes líneas celulares y la recíproca interacción, con el fin de recrear la correcta anatomía estructural del periodonto perdido. Después de una fase de expansión celular, estas células se introducen en una estructura biomimética (andamios en colágeno), y se inducen a la diferenciación en sentido osteogénico. El producto final que consta de andamios y células mesenquimales diferenciadas en sentido osteoblástico, se instala por último en el defecto alveolar periodontal. La experimentación se basa en la posibilidad de utilizar células madre mesenquimales autólogas a partir de la médula ósea humana. La finalidad es la de estimular la regeneración de PDL cerca de la pared radicular y la formación de hueso nuevo sobre el PDL, beneficiándose de las técnicas de regeneración-reconstrucción ósea, de manera que se recree la correcta anatomía periodontal. Los resultados presentados en este trabajo conciernen el primer paciente tratado con esta metodología y afectarán los estudios siguientes para la prueba con una cobertura más amplia (AU)

Destruction of periodontal ligament and alveolar ridge rerorption caused by periodontal disease is the leading cause of tooth loss in adults. Therapy of advanced periodontal disease leads for a total recovery of the structure lost by the inability to regenerate the pristine correct anatomy system. The aim of this study is to assess the potential use of mesenchymal stem cells (MSCs) in the regeneration of original periodontal structure. This study is an experimental phase 1 approved by the Italian Institute of Health on a limited number of patients; main objective will be to assess the biocompatibility and toxicity in vivo of differentiated mesenchymal stem cells into osteoblast sense, supported by biomimetic collagen scaffolds in patients with severe periodontal disease. The protocol describes transplantation of mesenchymal stem cells derived from samples of percutaneous bone marrow aspirate. The bone marrow cells are manipulated ex vivo to isolate mesenchymal stem cell population. After a phase of cell expansion, these cells are induced to differentiate into periodontal system cell lines in a biomimetic structure (collagen scaffold). Induction and culturation in an appropriate scaffold defined on specific characteristics lead to obtain an uniform distribution of cell lines. After 28 days Scs are grafted into the defect site of the patient. Scaffold degradation time will ensure stability of the different cell lines and reciprocal interaction, in order to recreate the correct structural anatomy of periodontium lost. The purpose is to stimulate the regeneration of PDL near the root wall and new bone formation on the PDL, benefiting from the techniques of bone regeneration, reconstruction, as to recreate the pristine periodontal anatomy. The results presented in this paper concern the first patient treated with this method and will affect following studies for test for a wider coverage (AU)

Manejo de las atrofias del maxilar superior clase V de Cawood y Howell mediante la adopción de la cirugíapiezo eléctrica / The management of atrophies classified as v class according to Cawood & Howell by piezo-electric surgery

Introducción: Los casos analizados presentaban atrofias severas (V clase según Cawood y Howell) (1), que se caracterizan por presentar una densidad de la cresta transversal inferior a 4 mm y vertical inferior a 6 mm; ello hace pensar en la posibilidad de una rehabilitación implanto-soportada. Objetivo: Evaluación de la rehabilitación de pacientes afectados por severa atrofia del maxilar superior clase V según Cawood y Howell) (1) rehabilitados con elevación del seno maxilar e injerto de hueso autólogo. Materiales y métodos: Estudio longitudinal a partir de una muestra de 32 pacientes, con atrofia maxilar severa y edentulismo parcial o total. En todos los pacientes se ha colocado un injerto con técnica de reconstrucción onlay mono o bicortical y se ha adoptado la cirugía piezoeléctrica para realizar el elevación del seno, el cual podía ser mono o bilateral, de hueso autólogo procedente de la cresta ilíaca anterior. Seguimiento realizado durante 2 años. Resultados: A los dos años del control final, el 94,05% de todos los implantes colocados tras la intervención de elevación se presentan osteointegrados y cargados protésicamente. La cresta ilíaca anterior resulta ser la zona idónea para la extracción medular, necesaria para la elevación del seno. Las posibilidades de supervivencia del implante son realmente elevadas si se espera el tiempo clínico necesario para la recuperación y la integración del injerto. El éxito de todas las intervenciones de elevación del seno maxilar se debe a la adopción de la cirugía piezoeléctrica, que permite efectuar la incisión de entrada y realizar el desprendimiento de los tejidos con un traumatismo mínimo para la membrana de Schneider. La integridad de la membrana y la utilización de bone-chips de origen autólogo no ha hecho necesario recurrir a la utilización de membranas reabsorbibles, simplificando así el procedimiento quirúrgico. La utilización de la cresta ilíaca anterior como zona donante, permite disponer de abundante tejido óseo cortical, necesario para colocar los onlay y para reconstruir el defecto óseo (AU)

Introduction: Valutation of rehabilitated patients by sinus lift in upper jaw and by autologous bone graft from iliac crest. Materials and methods: Rehabilitation of 32 patients with severe atrophies of upper jaw and partial or total edentulism by positioning of mono- or bicortical onlay with piezosurgery toobtain a sinus lift mono- or bilateral by autologous bone grafts from anterior iliac crest. Results: 94.05% of successes after a two years follow-up. Conclusions: Respecting of timing surgery, a correct use of the piezosurgery technique and of the autologous bone graft from anterior iliac crest let a successful implantological rehabilitation. Moreover the iliac crest is a very good donor site of bone tissue for the management of severe atrophies in the upper jaw. An accidental laceration of Schneider’s membrane was observed infilling phase in the 5.26% of cases (AU)

Reconstrucción preimplante con hueso autólogo deprocedencia sinfisaria en la rehabilitación de defectosóseos transversales de los maxilares: protocoloa realizar en la consulta / Pre-implant recostruction with autologous bone from mental symphysis during transverse maxillary bone atrophies rehabilitation: surgery protocol

Introducción: En los casos examinados, de atrofias de entidad moderada (IV clase de Cawoody Howell) (1), se ha observado un espesor transversal de la cresta inferior a 4 mm, por tanto una rehabilitación implanto soportada resulta difícil de realizar. Finalidad del trabajo: rehabilitación implanto protésica de las atrofias de entidad moderada en los maxilares. Materiales y métodos: 42 implantes realizados en 18 pacientes (8 varones y 10 mujeres, con una edad media de 47.1 años), en maxilar atrófico rehabilitado con la interposición de una muestra de hueso autólogo procedente de la sínfisis mentoniana. Los implantes han sido colocados a los 6 meses de haber aumentado transversalmente la cresta edéntula. Se han valorado: la osteointegración, con niveles de pérdida ósea correspondientes, la condición de los tejidos perimplantarios, el índice de profundidad del saco, de placa y de sangrado, así como el grado de satisfacción del paciente. Resultados: De 42 implantes no se perdió ninguno (0%), una vez finalizada la fase de seguimiento. La pérdida de hueso marginal perimplantario ha sido, en media, de 0,17 mm. Conclusiones: La utilización de muestras autólogas de zonas intraorales para el tratamiento de atrofias de entidad moderada ha demostrado ser una técnica con una predictibilidad elevada, que ha permitido efectuar implantes protésicos con un porcentaje de éxito elevado. Consecuencias clínicas: Aunque este procedimiento prevé dos zonas quirúrgicas en el mismo acto quirúrgico, necesitándose, por tanto, una elevada implicación del paciente, es indiscutible la ventaja de poder intervenir sin anestesia total, con la ayuda, exclusivamente, de anestesia lo corregional (AU)

Introduction: in the case studies the moderate atrophies (Cawood and Howell’s 4th class) is observed a transverse thickness lower than 4 mm, therefore carring out a riabilitation by prosthesis appears very difficoult. Aims: Implanto-prosthesis rehabilitation of moderate maxillary atrophies (Cawood and Howell’s4th class) (1).Materials and Methods: 42 implants in 18 patients (8 males and 10 females, of medium age of47.1 years), in an atrophic maxilla rehabilitated through interposition of autologous bone drawed from mental simphysis. The implantans were located after 6 months from the cross-sectional increase operation of edentulous crest. We have considered: the osteointegration related to bony loss, the perimplant soft tissue condition, depth index of gingival pocket, plaque and bleeding, and even patients satisfaction index. Results: at a complete follow-up no implants were lost. The mean of marginal perimplant bony loss was 0.17 mm. Conclusions: to manage moderate atrophies we have shown a technique with a good prognosis by using autologous drawings from intraoral centers, wich let successfull execution of implanto-prosthesic treatments. Clinical implications: even if the tecnique involves two simultaneous surgery sites, needing an high compliance by the patient, is unquestionable the vantage to can operate without narcosis, only availing of local anesthesia (AU)