Uso de la Fibrina Rica en Plaquetas Inyectable (i-PRF) en Defectos Infra Óseos en Terapia Periodontal no Quirúrgica. Reporte de Dos Casos / Use of Injectable Platelet-Rich Fibrin (i-PRF) in Infra Osseous Defects in Non-Surgical Periodontal Therapy. Report of Two Cases

RESUMEN: Entre los concentrados plaquetarios de segunda generación, ha suscitado creciente interés, el uso de fibrina rica en plaquetas y leucocitos inyectable (i-PRF); que se obtiene a partir de la centrifugación inmediata de sangre venosa del propio individuo, y que aporta concentraciones elevadas de factor de crecimiento vascular endotelial, factor de crecimiento transformante beta, y factor de crecimiento derivado de plaquetas, entre otras proteínas que inician y coordinan el proceso reparativo. Su nula citotoxicidad y consistencia líquida abren un nuevo campo de estudio y experimentación en el ámbito de la Cirugía Oral y de la Periodoncia, como sustancia para irrigar. El objetivo de este manuscrito fue reportar el uso del i-PRF como irrigador subgingival en el tratamiento periodontal convencional de defectos infra óseos con 6 meses de seguimiento. En ambos casos, se verificó un efecto positivo de irrigación, lo que abre el debate al uso de productos farmacéuticos tradicionales como la clorhexidina versus preparados autólogos sin efectos adversos reportados a la fecha.

ABSTRACT: Second generation platelet concentrates include the use of injectable platelet-rich fibrin (i-PRF), which has generated increasing interest because it is derived from immediate centrifugation of venous blood from the patients themselves. It provides high concentrations of vascular endothelial growth factor, transforming growth factor beta, and platelet-derived growth factor, among other proteins that initiate and coordinate the healing process. Its null cytotoxicity and liquid consistency has opened new research lines in the field of oral surgery and periodontics, as an irrigation substance. The aim of this manuscript was to report the use of i-PRF, as a subgingival irrigator in conventional periodontal treatment of infra osseous defects, with six months follow-up. In both cases, a positive effect of irrigation was confirmed. These findings, open the debate as regards the use of traditional pharmaceutical products (such as chlorhexidine), versus autonomous preparations without adverse effects reported to date.

Alpinia zerumbet (Pers.) B. L. Burtt & R. M. Sm. (Zingiberaceae): levantamento de publicações nas áreas farmacológica e química para o período de 1987 a 2008 / Alpinia zerumbet (Pers.) B. L. Burtt & R. M. Sm. (Zingiberaceae): survey of publications in pharmacological and chemical areas from 1987 to 2008

Espécie muito encontrada no nordeste do Brasil, Alpinia zerumbet (Pers.) B. L. Burtt & R. M. Sm. é conhecida popularmente como colônia. Na medicina popular é utilizada como antihipertensiva, diurética e febrífuga. Alguns estudos com óleos essenciais mostram sua atividade antimicrobiana, hipotensiva e um leve efeito diurético. Visando contribuir para o maior conhecimento da espécie realizou-se uma revisão de publicações envolvendo estudos nas áreas farmacológica e química para o período de 1987 a 2008.

Normally found in the northeast of Brazil, Alpinia zerumbet (Pers.) B. L. Burtt. & R. M. Sm. is commonly known as "colônia". In folk medicine, it has been used as antihypertensive, diuretic and febrifuge. Some studies with essential oils have shown its antimicrobial and hypotensive activities, besides a slight diuretic effect. Aimed at improving the knowledge of such species, a survey of publications involving studies in pharmacological and chemical areas was conducted from 1987 to 2008.

Osteoplastic flap for obliteration of the frontal sinus: five years' experience.

The objective of this retrospective study was to evaluate the osteoplastic flap (OPF) for the obliteration of the frontal sinus in this current era of endoscopic management of frontal sinus disease. A review of consecutive OPF procedures (n = 43) performed by the senior author (J.A.D.) from 1992 to 1997 was carried out. Data were gathered regarding chief symptom, medical history, previous sinus surgery, endoscopic findings in the office and at surgery, CT scan findings, and follow-up results (mean 19.4 months). Previous endoscopic management of frontal sinus disease had failed in 24% of patients; 97% had eventual resolution of frontal sinusitis with OPF. After OPF, 63% also had improvement or resolution of disease in other paranasal sinuses. Statistically significant, positive correlations (P < 0.05) were noted between the resolution of frontal sinusitis and improved or resolved pain, as well as the resolution of frontal sinusitis and improved or resolved infections in other paranasal sinuses. In 1998 OPF remains the standard for treating frontal sinus disease refractory to other methods. OPF can decrease the pain associated with frontal sinus infections and has a positive impact on inflammatory disease in other paranasal sinuses.

Inhibition of subglottic stenosis with mitomycin-C in the canine model.

The objective of this randomized, prospective study was to study the efficacy of topical mitomycin-C in the inhibition of subglottic stenosis in a canine model. Subglottic stenosis was elicited with the carbon dioxide laser in 10 mongrel dogs. Radial incision and serial dilation of the subglottic airway were then carried out. The animals were randomized to receive a topical solution of 1% mitomycin-C to the dilated area for a 5-minute duration or no further treatment. Weekly direct microlaryngoscopy and photodocumentation were performed during the 6-week study. Airway distress developed in 4 of the 5 control dogs, requiring early sacrifice, while all treatment group animals survived the duration of the study (p < or = .006). Morphometric analysis of the subglottic photographs confirmed a greater than 100% increase in the percentage of relative airway at sacrifice in the treatment group (p < or = .049). A statistically significant (p < or = .015) decrease in collagen formation in the subglottic scar of dogs treated with topical mitomycin-C was documented. Mitomycin-C favorably altered the clinical progression of subglottic stenosis, improved quantified airway patency, and reduced the amount of subglottic collagen formation in the canine model.

Radiofrequency tissue ablation of the inferior turbinates using a thermocouple feedback electrode.

OBJECTIVE: The objective of this clinical trial was to assess the safety and efficacy of radiofrequency (RF) tissue ablation of the inferior turbinates in the treatment of nasal obstruction using an RF energy delivery system with a thermocouple feedback electrode. METHODS: A prospective, nonrandomized study of 11 patients (mean age, 47+/-12 y) with chronic nasal obstruction was conducted. Using patient-based visual analogue scales (VAS), symptom parameters were assessed. These included degree of nasal obstruction, frequency of nasal obstruction, and pain. Physician assessment of nasal obstruction was also collected by the principal investigator. Follow-up was conducted at 24 hours, 1 week, 4 weeks, 8 weeks, and 1 year. ANOVA was carried out to determine statistically significant differences in the data. Data were fit to a regression model, and confidence intervals were determined from a 95% confidence level. RESULTS: In patient-assessed degree of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.001, P<.0001, and P<.0008, respectively). There was no difference between 8 weeks and 1 year (P<.15). The data appeared to follow an exponential decay to a constant value. The pretreatment baseline average degree of obstruction was 7.5+/-0.5 on a scale of 0 to 10. The degree of obstruction after 8 weeks was 2.7+/-0.6. The time constant for this change was 21 days to reach 90% of the final value. At 1 year, degree of obstruction was 3.3+/-0.7. For frequency of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.0001, P<.0001, and P<.0001, respectively). There was no difference between 8 weeks and 1 year (P<.15). The pretreatment baseline average frequency of obstruction was 7.8+/-0.5. The remaining frequency of obstruction after 8 weeks was 2.9+/-0.6. The time constant was 18 days. At 1 year, frequency of obstruction was 3.3+/-0.6. Physician assessment of nasal obstruction revealed statistical significance among baseline and 4 weeks, and baseline and 8 weeks (P<.0055 and P<.0056, respectively). There was no difference between 4 weeks and 8 weeks (P<.24). The average initial obstruction was 83%+/-4%. The remaining obstruction after 8 weeks was 58% +/-5%. The time constant was 14 days. Mild pain was reported by 55% of patients during the procedure; the remaining 45% reported no pain. Only one patient required pain medication consisting of acetaminophen after the procedure. There were no significant complications. CONCLUSIONS: Degree and frequency of nasal obstruction, as reported by patients, decreased following RF tissue ablation of the inferior turbinates. This improvement in symptoms was still evident after 1 year (P<.001). Physician assessment of obstruction also correlated with patient reports for the initial 8-week study period. The procedure was safe and well tolerated. Thermocouples within the active electrode provided additional feedback to the operating surgeon allowing the use of relatively lower tissue temperatures, power, and energy as compared with traditional techniques. These results support the need for continued research to evaluate this modality as a treatment for chronic nasal obstruction.

Analysis of a critical pathway in osteoplastic flap for frontal sinus obliteration.

OBJECTIVES: A critical pathway was applied to patients undergoing osteoplastic flap (OPF) for frontal sinus obliteration to determine whether efficiency could be improved. STUDY DESIGN: A retrospective review of consecutive OPF procedures (n = 51) performed between 1992 and July 1997 was conducted. METHODS: The patient groups were subdivided into those who underwent OPF alone and those who had endoscopic sinus procedures performed in addition to OPF. Comparisons were made between the precritical pathway and post-critical pathway groups, specifically noting operative time, total operating room (OR) time, estimated blood loss (EBL), length of hospital stay, and costs. We used a critical pathway that was developed for endoscopic sinus procedures at our institution through a multidisciplinary team approach. Preoperative evaluation and testing, intraoperative equipment and medications, and postoperative care including follow-up clinic visits were all standardized. An unpaired, two-tailed Student t test was used to evaluate the data. RESULTS: Statistically significant (P<.05) reductions in operative times, total OR time, EBL, and length of hospital stay were observed in the post-critical pathway group who underwent endoscopic sinus procedures as well as OPF. Costs to the OR were reduced 29% and 15% for OPF and for OPF with endoscopic surgery, respectively. Patient costs were reduced 5% and 4% in these groups, respectively. CONCLUSIONS: With implementation of effective critical pathways, significant decreases in length of stay are seen, and cost reductions can be realized through the improved efficiency, shortened OR times, and decreases in redundancy of ordering materials.

Considerations before rhinoplasty.

Patient evaluation and selection for aesthetic facial surgery and rhinoplasty in particular goes beyond assessment of anatomical indications. The selection of appropriate candidates involves an understanding of the patient's motivations for the procedure, expectations for the surgical outcome, and ego strength for tolerating the stress of operative intervention. The patient interview must be structured to give the surgeon ample information to determine the psychological and emotional stability of the candidate. Psychiatric consultation may be required if evidence is uncovered indicating psychiatric illness. Time spent informing the patient preoperatively will pay off great dividends in the postoperative period. If patient dissatisfaction does occur, validate and address the patient's concerns with a nondefensive posture.

Current options in management of head and neck cancer patients.

Head and neck cancer, particularly squamous cell carcinoma (SCC) of the upper aerodigestive tract, poses difficult diagnostic and therapeutic challenges to the clinician. A methodical approach, including complete visualization of mucosal surfaces, appropriate imaging, and tissue diagnosis whenever possible, gives patients the best opportunity for early intervention. A treatment program of surgery, radiation, or chemotherapy is best developed by a devoted head and neck oncologic team, involving surgeons, radiation and medical oncologists, and rehabilitative specialists with significant experience in the care of head and neck oncologic patients. Despite new advancements in the treatment of patients with advanced stage SCC of the head and neck, little progress has been made in overall survival. Several new avenues of investigation are currently being explored, one of which may ultimately provide the answer for this devastating disease.

SIADH after subarachnoid hemorrhage and craniotomy.

A 64-year-old woman had the syndrome of inappropriate ADH secretion (SIADH) after surgical repair of a ruptured aneurysm of the anterior communicating artery. SIADH began while the intracranial pressure was elevated, and resolved when the pressure returned to normal. Whether this syndrome was caused by direct hypothalamic lesions, local pressure on the hypothalamus secondary to enlargement of the third ventricle, or some other mechanism cannot be ascertained. The occurrence of intracranial pressure changes with SIADH is described.

Chronic cerebellar stimulation in the modulation of behavior.

From March 1976 until March 1979, 28 patients with disabling emotional symptoms were studied in the Psychiatry and Neurosurgery Departments at Tulane University, and pre-selected for cerebellar electrode implantation and subsequent cerebellar stimulation. This series include 12 patients with different types of schizophrenia; 7 epileptic patients with Grand Mal and/or psychomotor attacks, and concomitant psychiatric symptoms; 5 patients with intractable depression; and 4 patients with miscellaneous psychiatric symptoms. Follow-up results are graded as excellent, good, fair and poor. The authors conclude that significant improvement were observed in many patients, and the results, although preliminary and incomplete, are encouraging.