Immediately loaded dental implants bioactivated with platelet-rich plasma (PRP) placed in maxillary and mandibular region.

BACKGROUND AND AIM: Dental implants have today deeply changed the dental field. In fact, after almost 50 years, the permanent placement of a titanium screw with an attached tooth have, step by step, changed the society's standard toward a permanently replacement of missed or severely damaged teeth. In fact, the host of benefits born from dental implants have affected both patients and dental professionals. The aim of the present study is to report the outcomes of an implant therapy protocol supporting fixed prostheses implanted soon after extractions and loaded with flapless guided surgery by a 3D software planning. MATERIALS AND METHODS: 37 patients, requiring rehabilitation of booth dental arches with a one-to-one technique, were enrolled in a follow-up study plan which established clinical and radiological examinations on the day after surgery, seven months and one year later. Platelet Rich Plasma (PRP), in combination with autogenous bone, organic bone material and organic bone substitutes, was used before implant-prosthetic rehabilitation with an its prompt loading just before the implant insertion phase. RESULTS: Definitive restorations were delivered at 6-12 months after surgical procedure. One year after loading there were no dropouts and no failure of the definitive prosthesis. Furthermore, the feedback from patients resulted positive. CONCLUSIONS: Patients resulted satisfied both aesthetically and functionally regarding these types of prosthetic reconstructions made at the time.

Decision-making algorithm in treatment of the atrophic mandible fractures.

AIM: Closed treatment of atrophic mandible fractures often results in malunion, pseudoarthrosis and pain. Open reduction and rigid internal fixation (ORIF) is still indicated for displaced atrophic mandible fractures. The Authors report a treatment protocol that allows to gain the best results using reconstruction plates, autologous bone grafting and free fibula flap reconstruction when necessary. METHODS: Retrospective analysis of 15 patients with atrophic mandible fractures who underwent treatment between 2007 and 2011. 7 cases did not receive any treatment because of their general condition, while the others 8 were surgically managed by external approach. In all cases load-bearing osteosynthesis plates with locking screws were used; in 2 of them contextual bone grafts were performed; in 1 case mandible reconstruction needed harvesting a free fibula flap. RESULTS: In 6 out of 8 cases complete functional and morphological restoration were obtained without any major complication. In 1 case suppurative infection and necrosis of the bone graft occurred, which made necessary its removing, leaving in situ only the reconstruction plate. In another case, during the first year after surgical treatment, atrophic mandible resorption occurred from one angle to the other, resulting in loss of the anchoring reconstruction plate. CONCLUSIONS: ORIF is the gold standard procedure for the of atrophic mandible fractures, because it guarantees best morpho-functional outcomes and predictability. Nevertheless the Authors suggest contextual bone grafting in case of substance loss, or a poor quality bone or for dental implant surgery and free fibula flap in selected cases.

Extra-articular diffuse-type giant cell tumour of the temporomandibular joint.

Diffuse-type giant cell tumour (DTGCT) is a benign but destructive proliferative disorder of the synovium of joint capsules, tendons and bursae. Lesions originating from the articular synovium may grow intra-articularly or expand widely extra-articularly. Rare cases may develop only in peri-articular tissues. Temporomandibular joint (TMJ) involvement is exceptional and only two cases of purely extra-articular TMJ-DTGCT have been reported. The authors report an additional case of extra-articular TMJ-DTGCT. The clinical features, histopathological characteristics, imaging modalities and diagnostic methods for DTGCT are discussed together with a literature review based on the clinical aspects of TMJ involvement.

Cocaine-related syndrome and palatal reconstruction: report of a series of cases.

Intranasal cocaine abuse may cause significant local ischaemic necrosis and destruction of the nasal and midfacial bones and soft tissue, leading to development of a cocaine-induced midline destructive lesion. Review of the English-language literature reveals only a few case reports describing hard and/or soft palatal perforation related to cocaine inhalation. To date, among the reconstructive techniques of the palate, different surgical options have been reported such as local, regional and free flaps. Common prosthetic obturators have also been used. Presented here are six cases of cocaine abuse showing different types of cocaine-related palatal lesions treated with different surgical approaches including local and free flaps. Mean follow-up was 3 years. A surgical variation of Marshall's classic technique for insetting a free flap in such lesions is proposed.

Treatment of severe bilateral temporomandibular joint ankylosis in adults: our protocol.

AIM: In order to evaluate the reliability of interpositional gap arthroplasty with temporalis myofascial flap the authors retrospectively analysed the data of 5 patients suffering from bilateral temporomandibular ankylosis operated on with this technique. METHODS: The preoperative assessment included evaluation of pain during function, interference with eating and the maximal interincisal distance. All patients received bony ankylosis removal, interposition of a finger-shaped temporalis myofascial flap in the articular gap and coverage with temporoparietal fascial flap as a new capsule. In the postoperative period an aggressive physiotherapy was carried on for at least 6 months. RESULTS: All cases experimented release of pain (evaluated by a Visual Analogue Scale method), a return to a normal diet and a stable improvement in mouth opening during the follow-up period. CONCLUSIONS: This technique should be considered a reliable method to avoid relapse of ankylosis and to stabilize postoperative results.

Lithiasis of minor salivary glands of the upper lip. Clinico-pathological report of a case with unusual presentation.

We report a rare case of lithiasis of the minor salivary glands (LMSG) of the upper lip, with a very atypical clinical presentation, firstly as a left hemifacial cellulitis and later, after antibiotic therapy, as a solid, firm and hard intramural nodule of the retrocommissural side of the upper lip; the needs of a wide spectrum of clinical differential diagnosis with calcified angiomas, salivary tumors, soft tissue tumors, phlogistic and neoplastic pathology of the local lymphnode, foreign body lesions, is underlined. The histological aspects of the lesion are described.

Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible: case report.

The authors report a case of vertical distraction osteogenesis of a free revascularized fibula flap used to reconstruct an hemimandible lost as a result of a gunshot injury. The reconstruction procedure and the distraction protocol are described; clinical and radiological results are presented. The vertical discrepancy between the fibula and the native right hemimandible was corrected.

Cavernous sinus-carotid fistula: a complication of maxillofacial injury.

A case of traumatic carotid-cavernous sinus fistula (CCSF) is presented. The patient sustained an undisplaced fracture of his right mandibular condyle and a zygoma fracture after a motor vehicle accident. Five months later, all the classic signs and symptoms of a CCSF had appeared except ophthalmoplegia. These symptoms were preceded by a tiring auditive homolateral sensation. A carotid angiography confirmed the presence of a large CCSF. Successful management was achieved intravascularly by balloon embolization.

[Therapy of simple endometrial hyperplasia with GnRH analogs. Evaluation of a multicentric ambulatory study. Preliminary results]. / Trattamento con GnRH analoghi della iperplasia endometriale semplice. Valutazione di uno studio policentrico ambulatoriale. Risultati preliminari.

Endometrial hyperplasia is a frequent pathology during menopause and involves the risk of malignant transformation of the lesions. In an attempt to avoid radical surgery, this study proposes the use of triptorelin which was used to treat 56 patients with histologically confirmed symptoms of endometrial hyperplasia without atypia. GnRH-analog was administered using the intramuscular route every 28 days for 6 months. Histological controls were carried out 30 days after the last injection and showed the resolution of histological symptoms, confirmed after three months.

[Surgical treatment of neoplasms of the lip]. / Il trattamento chirurgico del cancro del labbro.

The authors examine the surgical treatment of lip cancer and describe the reconstructive techniques used for various tumour localisation and extensions. In addition, they illustrate the current opinions regarding the treatment of satellite lymph node areas.

Antibiotics and mucous membrane: pharmacokinetic aspects.

The penetration of chemoantibiotic agents across the mucous membrane is affected by several factors, some of which are related to the drug and others to the membrane. Molecular weight can influence the penetration of chemoantibiotic agents into mucous membranes. Liposolubility is another factor which can enhance the penetration of chemoantibiotic agents. Factors related to the membrane can affect diffusion of the antibiotic. Inflammation of the mucous membrane enhances the volume of blood circulating within tissues and, as a consequence, the rate of drug penetration into them. This condition, however, can be counterbalanced by a high binding rate of the drug to tissues. The pH affects the action of antibacterial agents. Acid pH range enhances the antibacterial activity of beta-lactams, an alkaline range that of macrolides. Besides purely physiochemical factors, there are others able to interfere with the diffusion of a chemoantibiotic agent into and through the mucous membranes. The diffusion into bronchial membrane and the penetration through the hematobronchial barrier seems to occur substantially by means of a passive transfer. There is therefore an establishment of a proportionality relationship between the concentrations in the two blood-bronchial fluid compartments. Exceptions to this rule seem to be some drugs like macrolides, even if a real active transfer mechanism has not yet been demonstrated. A precise knowledge of its pharmacokinetic parameters is an indispensable condition for the characterization of a molecule which penetrates the mucous membranes.

[Microcystic adnexal carcinoma. A case report]. / Il carcinoma microcistico annessiale. Descrizione di un caso.

Microcystic adnexal carcinoma (MAC) is a rare cutaneous neoplasm, locally aggressive, recently recognized as a clinicopathologic entity. Histologically, MAC shows both ductal and pilar differentiation. In this article we discuss a case of 52-year-old woman with MAC on the inferior lip, early recurred after initial excision.

Pathogen-host interaction.

Host defense, as it generally applies to humans, refers to the individual's ability to withstand infections. Human host defense mechanisms are numerous, diversified, complex, and often interdependent. The administration of drugs may influence some phases of immunocompetence mechanisms. The effect of several antimicrobial agents on organic defenses has been studied. The parameters considered were chemotaxis, phagocytosis, intracellular killing, superoxide-anion production, antibody production, lymphocyte subset behavior, and natural killer cell activity. Some antibacterial agents inhibit these parameters, whereas others can enhance some of these immune parameters to differing extents. Some antibacterial agents have a neutral effect on these parameters.

[Burkitt's lymphoma. A case report]. / Linfoma di Burkitt. Descrizione di un caso.

This paper presents a case of a 21 year-old female with mandibular and abdominal involved sites. Prognosis is related to an early diagnosis and chemotherapy can be started while lymphoma is still not widespread.

Ciprofloxacin: multiple-dose pharmacokinetic and clinical results in patients with hypercrinic bronchopulmonary diseases.

Ciprofloxacin, a 4-quinolone derivative with a wider spectrum of activity as compared to classic quinolones employed in the therapy of urinary tract infections, was studied in view of its possible application in the therapy of bronchopulmonary infections. An oral dose of 500 mg every 12 h was administered and both the clinical response and the pharmacokinetic profile were investigated. A complete recovery was reached in 87.5% of patients and an improvement in 12.5%; no failure was recorded. A very good penetration in sputum was confirmed by the sputum/serum area under curve ratio, providing evidence for a high bioavailability in bronchial secretion. Lung tissue concentrations confirmed the good peripheral distribution of ciprofloxacin. A twelve-hour administration schedule allows high peripheral concentrations to be obtained superior or equal to the minimum inhibitory concentrations for many pathogens.