A 10-year retrospective comparative human study on screw-retained versus cemented dental implant abutments.

The aim of this 10-year retrospective study was to evaluate the long-term reliability, survival rate and mechanical and biological complications of single-crown implant rehabilitations with two different types of fixture-abutment connections: screw-retained abutments (SRAs) with internal hexagonal connection, and cemented retained abutments (CRAs). A total of 300 single implant-supported crowns were analysed, which had been inserted between 2004 and 2007. Patients were classified according to two groups: the SRA group (n = 150) and the CRA group (n = 150). The primary outcome was marginal bone loss (MBL) on peri-apical radiographs. Bleeding on probing (BOP) and probing depth (PD) were also evaluated. Moreover, prosthetic complications were recorded. Analysis of variance (ANOVA) was used to evaluate the differences between the groups. The overall implant failure rate was 4.2%. The overall positive BOP index was 81.9% of the sites under investigation, as 83.4% for SRA and 80.4% for CRA. Moreover, >5 mm PD demonstrated a rate of 21.0% for CRA, and 13.8% for SRA. The primary outcome of mean MBL was 2.09±1.07 mm for SRA and 1.54±1.20 mm for CRA. Analysis of variance of MBL showed statistical significance for the difference between these two groups (P less than 0.001). For the mechanical aspects, an overall 12.5% of complications occurred. No implant or abutment fractures were recorded. Although complications occurred, the results from this 10-year retrospective study show that these two methods have positive long-term follow-up. With MBL significantly greater for the SRA group than the CRA group, the clinical use of CRA is encouraged in terms of the lower bone resorption rate.

Immunohistochemical study of osteopontin in oral squamous cell carcinoma allied to fractal dimension.

The aim of the study was to consider a possible correlation between the intensity of expression of osteopontin and grading established by the pathologist. Furthermore, a correlation was investigated between the increase of fractal dimension and osteopontin in order to use this marker as an early and reliable diagnostic tool for the degree of cell transformation in oral squamous carcinoma. Ten histologically healthy oral samples and sixty-four primary oral squamous cell carcinomas specimens were analysed by a single pathologist. Immunohistochemical analysis and Fulgen stain were performed in order to evaluate intensity of expression of osteopontin and fractal dimension. Data obtained were presented as mean and standard deviation and processed for the statistical analysis. Ostepontin expression revealed a statistical significance between groups (P less than 0.001). Fractal dimension in oral squamous cell carcinoma groups vs controls revealed statistically significant differences (P less than 0.001). The fractal dimension value and the osteopontin expression were compared, using two-dimensional scatter. The correlation was relevant in the G3 group. The results demonstrated a correlation between the growths of osteopontin expression and nuclear abnormality measured by fractal dimension. These results support the hypothesis that the level of osteopontin expression might be used as a marker for the evaluation of oral squamous cell carcinoma differentiation. Osteopontin and fractal dimension could support the histological grading to increase the predictability of the diagnosis, choices of treatment procedure and long-term prognosis.

Role of matrix metalloproteinases in radicular cysts and periapical granulomas.

AIM: The aim of the present study was to evaluate the expression and distribution of different classes of matrix metalloproteinases (MMPs) in radicular cysts and periapical granulomas. METHODS: Twenty consecutive specimens of radicular cysts and 20 of periapical granulomas were selected. Expression of MMP-2, -9, -8, -13, -3 was immunohistochemically evaluated. The intensity of expression of the MMPs was evaluated using a semi-quantitative analysis: low = +; intermediate = ++; high = +++. RESULTS: Positive expression of MMPs was present with different distribution. MMP-9 expressed differently in the lesions. Indeed, in periapical granulomas low expression was found in endothelial cells and fibroblasts, whilst high intensities were only detected in inflammatory cells. On the contrary, in radicular cysts the high intensities were mainly present in keratinocytes and fibroblasts. MMP-8 was mainly expressed in inflammatory cells of periapical granulomas. MMP-2 and -3 presented a low intensity of expression in both groups. MMP-13 showed a variable pattern of distribution in the different cell types of the two different lesions. CONCLUSION: The present investigation supports the role of MMPs in the inflammatory process leading to the development of radicular cysts and periapical granulomas. The results of the present study suggested that the increased enlargement of radicular cysts, compared to periapical granulomas, might be related to a higher expression of MMP-9. On the other hands, the higher intensity of expression of MMP-8 in periapical granulomas could be related to an active inflammatory process. MMP-8 could play an important role in the inflammation processes during the development of periapical lesions.

Bronchogenic cysts of the neck: a rare localization and review of the literature.

Personal experience in the diagnosis and management of two patients, one adult and one child, with pathologically proven bronchogenic cysts is described. Both patients presented with a solitary neck mass that proved to be bronchogenic cysts on histological examination. Aim of the review is to define the cytology, histopathological and clinical characteristics of bronchogenic cysts and discuss the features that distinguish them from other cervical cysts. Definitive treatment requires surgical excision.

Follicular dendritic cell tumour of the cervical lymph node: case report and brief review of literature.

Follicular dendritic cell tumour/sarcoma is a rare tumour involving lymph-node or extra-lymph-node sites; review of the literature reveals very few cases of follicular dendritic cell tumour, probably since, in the past, the disease has often been mistaken for other neoplasms: low differentiated carcinomas and fusate cell carcinomas, sarcomas, melanomas, thymic neoplasms, Castle carcinoma and other dendritic cell tumours (especially interdigital cell tumour/sarcoma). In the case described here, attention is focused on the diagnostic difficulties and on the therapeutic profile, comparing data with those reported in the international literature.

[Stomach rupture due to barotrauma (a report of the 13th case since 1969)]. / Rottura dello stomaco da barotraumatismo (descrizione del tredicesimo caso dal 1969).

The thirteenth case of rupture of the stomach after a diving accident since 1969 is reported. This rare event was caused by equipment failure and panic reaction, which induced swallowing air during diving and consequential gas expansion in gastric cavity meanwhile the rapid ascent. Peritoneal decompression by paracentesis quickly improved the patient's condition and the following surgical laparotomy revealed a gastric tear along the lesser curvature, which was closed by suturing. The patient presented a postoperative splenic abscess two months later; literature demonstrated that rupture of a filled stomach may lead to septic complications.

[Emergency surgery in inflammatory bowel disease. Experience in 26 cases]. / La chirurgia in urgenza delle malattie infiammatorie croniche intestinali. Esperienza su 26 casi.

BACKGROUND: The emergency surgical treatment of inflammatory chronic bowel diseases is closely related to the classification of patients according to their symptoms and clinical conditions, as well as possible surgical options. In our study, an actual set of criteria is proposed for the classification of the degree of seriousness of symptoms, related to patient conditions, and applicable surgical strategies. METHODS: Retrospectively evaluation of the outcome of the disease has been performed over 26 patients undergoing emergency treatment in our Hospital, and with at least 5 years of follow-up. Fourteen patients were affected by ulcerative rectocolitis and 11 underwent subtotal colectomy with ileostomy; the remaining 12 were affected by Crohn's disease and were treated with colic or ileal local resection. RESULTS: Among 11 operated patients with RCU, 6 toxic megacolon, 4 severe colitis and one perforation (postoperative death) have been diagnosed. Recanalization was possible in 8 patients. On the other hand proctectomy was necessary in the remaining 3 patients as final operation. In MC patients 6 occlusions, 4 severe colitis, one multiple perineal fistulization and one perforation of occult right colon tumor have been diagnosed. We performed 5 right colectomy, 4 jejuno-ileal resections, one Hartmann's operation, one colostomy in emergency and one multiple bypass. Because of recurrence, one right colectomy needed following total colectomy and two jejuno-ileal resections needed right colectomy soon after. Three jejuno-ileal resections were performed with a conservative purpose in patients treated by right colectomy. CONCLUSIONS: It has resulted that in ulcerative rectocolitis total colectomy actually permits an adequate control of the disease, as well as a satisfactory therapy of the rectal stump, with subsequent recanalization in the majority of cases, whereas in Crohn's disease the frequency of recidive is higher and it seems more advisable to opt for a radical resection treatment (chiefly right colectomy), but with a conservative purpose.

[Isolated hyperthermic antiblastic perfusion in recurrent melanoma of the extremities]. / La perfusione isolata ipertermico-antiblastica nel melanoma recidivo degli arti.

Twenty-two patients with recurrent melanoma of the limbs, underwent Hyperthermic Antiblastic Perfusion (HAP). HAP lasted 60 min, with maximal local temperature of 40.5-42 degrees C and melphalan 10 mg/L limb volume as antiblastic agent. Fourteen patients had in-transit metastases and 8 local recurrences. Regional nodes were involved in 6 patients. Systemic leakage monitored with 125I or 99Tc ranged between 5 and 30% (mean 19%). No operative mortality nor major complications occurred. Local toxicity scored Wieberdink grade I in 6 patients, grade II in 11 and III in 5. Response rate (UICC) in the 9 patients treated with unexcised lesions was 88% (55% complete responses). After a median follow-up of 27 months (1-92) 9 patients relapsed after a median time of 17 months, and 15 patients are currently disease free, 4 of them being re-excised and one reperfused. Actuarial 5 year survival is 67%, with 45% disease free to the first relapse. Our results are consistent with the literature indicating HAP as a safe procedure with a high evidence of clinical responses.