Doença de Gaucher e gravidez: um prognóstico favorável / Gaucher's disease and pregnancy: a favorable prognosis

Contexto: A doença de Gaucher (DG) é uma doença lisossômica de depósito, presente com maior prevalência entre judeus asquenazes, e está relacionada à mutação N370S. Apresenta-se clinicamente de três formas: não neuropática ou tipo 1, mais prevalente e com bom prognóstico; neuropática aguda ou tipo 2; neuropática crônica ou tipo 3. No tratamento, emprega-se o imiglucerase, um repositor enzimático. Descrição do caso: Paciente com 20 anos, primigesta, nulípara, com 36 semanas de idade gestacional, diagnosticada com DG tipo I aos oito anos, foi internada para acompanhamento de sua afecção de base, controle da pré-eclâmpsia e infecção do trato urinário. Devido à variação dos índices hematimétricos, foi induzido o parto com 37 semanas e 2 dias. O recém-nascido não apresentou quaisquer distúrbios e seguiu em alojamento conjunto. Discussão: Observou-se a necessidade de controle clínico ativo, mesmo com a paciente em uso regular do imiglucerase, evitando repercussões graves para o binômio materno-fetal. Conclusões: Salienta-se a necessidade de controle hematológico ativo, via de parto conforme indicação obstétrica, seja via alta ou baixa, e níveis plaquetários superiores a 50.000/mm³.

Surgical management of gingival overgrowth associated with Cowden sydrome: a case report and current understanding.

Cowden syndrome, also known as multiple hamartoma syndrome, is a rare autosomal dominant disorder characterized by multiple hamartomas and a high risk of development of malignancy. Oral findings, such as papillomatous lesions and fibromas, are common features; however, a periodontal phenotype has not been reported previously. Therefore, this report presents a case of gingival overgrowth associated with Cowden syndrome, its successful surgical management, and the 12-month follow-up results. Additionally, we discuss the implications for clinicians. A 23-year-old woman was referred to the Department of Periodontics, Piracicaba Dental School, presenting with generalized gingival overgrowth. A detailed dental and medical history and clinical examination confirmed the systemic diagnosis of Cowden syndrome. Histology, radiographs, and clinical data document the entire clinical approach and follow-up. Clinically, there were minor signs of recurrence of gingival overgrowth in a 12-month period after gingivectomy; however, papular lesions reappeared in keratinized gingiva immediately after healing. No signs of bone loss related to the systemic condition were observed radiographically. Histologically, a dense connective tissue with a moderate chronic inflammatory infiltrate and epithelial acanthosis, which is characteristic of gingival hyperplasia, were demonstrated. Gingival overgrowth may occur as an oral phenotype related to Cowden syndrome and can be successfully treated by means of external bevel gingivectomy, followed by regular maintenance therapy, contributing to the patient's well-being, both functionally and esthetically.

Clinical and laboratory evaluations of non-surgical periodontal treatment in subjects with diabetes mellitus.

BACKGROUND: The aim of this study was to evaluate the clinical and laboratory changes 3 months after full-mouth scaling and root planing in subjects with and without diabetes mellitus. METHODS: This study was performed using 10 subjects with type 2 diabetes mellitus who required insulin therapy (DM) and 10 healthy adult control subjects (NDM) with generalized chronic periodontal disease. Both groups were treated with full-mouth scaling and root planing and given oral hygiene instructions. Clinical parameters, including plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL), were measured at four sites per tooth. Subgingival plaque samples were obtained from sites with the deepest PD (> or =5 mm) and with furcations in each subject. Samples were also tested for the presence of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia (previously T. forsythensis) by polymerase chain reaction. Glycemic control (glycosylated hemoglobin [HbA1c] and fasting glucose levels) and clinical and microbiologic assessments were recorded at baseline and 3 months after periodontal treatment. RESULTS: Data revealed statistical changes (P < or =0.05; analysis of variance [ANOVA]) in clinical variables (PI, GI, PD, GR, and CAL) between baseline and 3 months in both groups. Conversely, no improvement in the fasting glucose level or glycosylated hemoglobin (P < or =0.05; ANOVA) was found after treatment. Besides some reduction in the bacterial frequency 3 months after treatment, no statistically significant difference was found between the groups. CONCLUSION: Clinical and laboratory responses were similar in DM and NDM groups 3 months after full-mouth scaling and root planing.

Thyroid hormones may influence cortical bone healing around titanium implants: a histometric study in rats.

BACKGROUND: The aim of the present study was to evaluate, by histometric analysis, the influence of the thyroid hormones, triiodothyronine (T(3)) and thyroxine (T(4)), on bone healing around titanium implants inserted in rat tibiae. METHODS: Forty-two male Wistar rats were randomly assigned to the experimental groups: G1 = healthy animals (control; N = 15); G2 = hypothyroidism (N = 13); and G3 = hyperthyroidism (N = 14). Once alterations were confirmed by total serum levels of T(3) and T(4), one screw-shaped titanium implant was placed in the rat tibiae. Sixty days later, the animals were sacrificed, and undecalcified sections were obtained. Bone-to-implant contact (BIC), bone area within the limits of the implant threads, and bone density in a 500-microm-wide zone lateral to the implant were obtained separately for the cortical (zone A) and cancellous (zone B) bone regions. RESULTS: Intergroup analysis demonstrated that thyroid hormones may significantly affect cortical bone healing around titanium implants. Hyperthyroidism significantly increased the area of newly formed bone in zone A (P <0.05), whereas hypothyroidism significantly decreased the area of newly formed bone and bone density around the implant in zone A (P <0.05) compared to the healthy group. In addition, hyperthyroidism significantly increased BIC extension in zone A compared to hypothyroidism (P <0.05). CONCLUSION: Thyroid hormones may influence the healing process in the cortical bone around titanium implants placed in rats, whereas cancellous bone seems to be less sensitive to changes in T(3) and T(4) serum levels.

Morphological and chemical analysis of bone substitutes by scanning electron microscopy and microanalysis by spectroscopy of dispersion energy.

This study evaluated the morphological and chemical composition of the following bone substitutes: cancellous and cortical organic bovine bone with macro and microparticle size ranging from 1.0 to 2.0 mm and 0.25 to 1.0 mm, respectively; inorganic bovine bone with particle size ranging from 0.25 to 1.0 mm; hydroxyapatite with particle size ranging from 0.75 to 1.0 mm; and demineralized freeze-dried bone allograft with particle size ranging from 0.25 to 0.5 mm. The samples were sputter-coated with gold in an ion coater, the morphology was observed and particle size was measured under vacuum by scanning electron microscopy (SEM). The chemical composition was evaluated by spectroscopy of dispersion energy (EDS) microanalysis using samples without coating. SEM analysis provided visual evidence that all examined materials have irregular shape and particle sizes larger than those informed by the manufacturer. EDS microanalysis detected the presence of sodium, calcium and phosphorus that are usual elements of the bone tissue. However, mineral elements were detected in all analyzed particles of organic bovine bone except for macro cancellous organic bovine bone. These results suggest that the examined organic bovine bone cannot be considered as a pure organic material.

Clinical evaluation of the use of locally delivered chlorhexidine in periodontal maintenance therapy.

BACKGROUND: The objective of this study was to evaluate clinically the effectiveness of a chlorhexidine gluconate chip in sites still showing signs of disease during periodontal maintenance therapy. METHODS: Forty-two maintenance non-smoking patients (previously treated with non-surgical scaling and root planing [SRP]), presenting at least one probing depth (PD) of 5 to 8 mm, and bleeding on probing (BOP) at single-rooted teeth were assigned randomly to two groups: treated with a chlorhexidine gluconate chip (CHIP group) and treated with SRP (SRP group). Patients were assessed for plaque index, gingival index, BOP, PD, clinical attachment level (CAL), and gingival recession at baseline, 6 weeks, and 3 and 6 months. RESULTS: Both treatments resulted in improvements in all parameters evaluated. After 6 months, a reduction in PD of 2.64 +/- 0.02 mm and 2.12 +/- 0.02 mm was observed for CHIP and SRP groups, respectively (P >0.05). The observed gain in CAL was 2.19 +/- 0.87 mm and 2.07 +/- 1.53 mm for CHIP and SRP groups, respectively (P >0.05). In deep pockets, PD reduction was 3.60 +/- 0.70 mm for CHIP group and 2.83 +/- 0.62 mm for SRP group (P = 0.01). CONCLUSIONS: Both treatments were equally effective in periodontal health reestablishment in inflamed single-root sites of maintenance patients. However, for deep pockets, the chlorhexidine gluconate chip was more effective than SRP in reducing PD.

Selective cyclooxygenase-2 inhibitor may impair bone healing around titanium implants in rats.

BACKGROUND: The aim of this study was to investigate the effect of a selective cyclooxygenase-2 inhibitor, meloxicam, on bone healing around titanium implants in rats. METHODS: Thirty-one adult male Wistar rats were included in this study, and one screw-shaped titanium implant was inserted in the tibiae of each rat. The animals were randomly assigned to one of the following groups for daily subcutaneous injections: control (N = 14): saline solution; and test (N = 17): 3 mg/kg of meloxicam, each administered daily for 60 days. After the treatment, animals were sacrificed, and undecalcified sections were obtained. Bone-to-implant contact (BIC) and bone area (BA) within the limits of implant threads and bone density (BD) in a 500 mum-wide zone lateral to the implants were obtained and arranged for cortical (zone A) and cancellous (zone B) bone regions. RESULTS: Intergroup comparisons demonstrated that meloxicam significantly reduced bone healing around implants. For zone A, significant differences were observed regarding BIC (47.01 +/- 10.48 A; 35.93 +/- 12.25 B), BA (86.42 +/- 3.66 A; 61.58 +/- 12.09 B), and BD (96.86 +/- 0.96 A; 91.06 +/- 3.05 B) for control and test groups, respectively (P <0.05). For zone B, data analysis also showed significant differences among groups for BIC (30.76 +/- 13.80 A; 16.86 +/- 11.48 B), BA (34.83 +/- 8.18 A; 25.66 +/- 9.16 B), and BD (15.76 +/- 7.05 A; 7.73 +/- 4.61 B) for control and test groups, respectively (P <0.05). CONCLUSION: Meloxicam may negatively influence bone healing in the cortical and cancellous bone around titanium implants inserted in rats after continuous administration.

Student responses to the introduction of case-based learning and practical activities into a theoretical obstetrics and gynaecology teaching programme.

BACKGROUND: The fourth-year Obstetrics and Gynaecology course at our institution had previously been taught using theory classes alone. A new teaching model was introduced to provide a better link with professional practice. We wished to evaluate the impact of the introduction of case discussions and other practical activities upon students' perceptions of the learning process. METHODS: Small-group discussions of cases and practical activities were introduced for the teaching of a fourth-year class in 2003 (Group II; 113 students). Comparisons were made with the fourth-year class of 2002 (Group I; 108 students), from before the new programme was introduced. Students were asked to rate their satisfaction with various elements of the teaching programme. Statistical differences in their ratings were analysed using the chi-square and Bonferroni tests. RESULTS: Group II gave higher ratings to the clarity of theory classes and lecturers' teaching abilities (p < 0.05) and lecturers' punctuality (p < 0.001) than did Group I. Group II had greater belief that the knowledge assessment tests were useful (p < 0.001) and that their understanding of the subject was good (p < 0.001) than did Group I. Group II gave a higher overall rating to the course (p < 0.05) than did Group I. However, there was no difference in the groups' assessments of the use made of the timetabled hours available for the subject or lecturers' concern for students' learning. CONCLUSIONS: Students were very receptive to the new teaching model.

Impact of an anti-inflammatory therapy and its withdrawal on the progression of experimental periodontitis in rats.

BACKGROUND: Anti-inflammatory agents have been reported as a bone loss mediator in periodontitis. This study aimed to investigate in rats the impact of a selective cyclooxygenase-2 inhibitor (meloxicam) on bone loss in ligature-induced periodontitis and its post-treatment effect after administration withdrawal. METHODS: Seventy-five adult male Wistar rats were included. After anesthesia, a mandibular first molar was randomly assigned to receive the cotton ligature in the sulcular position, while the contralateral tooth was left unligated. The animals were randomly assigned to one of the following five treatment groups (15 animals each), including daily subcutaneous injections: 1) saline solution for 15 days; 2) saline solution for 45 days; 3) 3 mg/kg of meloxicam for 15 days; 4) 3 mg/kg of meloxicam for 45 days; or 5) 3 mg/kg of meloxicam for 15 days followed by saline solution for 30 days. The animals were sacrificed and the specimens routinely processed. The volume of bone loss was histometrically measured and statistical analysis performed. RESULTS: Intergroup comparisons demonstrated that the drug may significantly reduce periodontitis-related bone loss (group 3: 5.83 +/- 2.04); however, this effect is less evident when the drug is administered in a short period (group 4: 3.59 +/- 1.57). Moreover, after drug withdrawal, no residual effect was observed (6.86 +/- 3.59, 6.09 +/- 2.66, groups 2 and 5, respectively) (P > 0.05). CONCLUSIONS: Within the limits of the present study, it can be concluded that selective cyclooxygenase-2 inhibitors may reduce bone loss associated with experimental periodontitis and that no remaining effect can be expected after its withdrawal.

Importance of differential diagnosis in endodontic-periodontal lesions: case reports.

Two case reports are presented in which the radiographic characteristics induced initially incorrect diagnoses. Only after combined clinical and radiographic examinations were the appropriate diagnoses achieved. This article demonstrates the need for close cooperation between periodontists and endodontists to diagnose periradicular lesions accurately.

Influence of nicotine administration on different implant surfaces: a histometric study in rabbits.

BACKGROUND: This study investigated the influence of implant surface on osseointegration around titanium implants inserted in the tibiae of rabbits administered with nicotine. METHODS: Thirty-two (32) New Zealand rabbits were included in the study. After anesthesia, the tibia surface was exposed and 2 screw-shaped commercially available pure titanium implants 7.0 mm in length and 3.75 mm in diameter were placed bilaterally. A total of 128 implants were inserted: 64 blasted with Al2O3 particles (Group 1) and 64 with a machined surface finish (Group 2). The animals were randomly assigned to 1 of 4 treatment subgroups, and daily subcutaneous injections of nicotine were administered: A) saline solution; B) 0.37 mg/kg; C) 0.57 mg/kg; and D) 0.93 mg/kg. In order to label regenerated bone, a 2% calcein green solution was administered by intramuscular injection at 0, 7, and 15 days after implant insertion. After 42 days, the animals were sacrificed and undecalcified sections were prepared. The degree of bone contact with the implant surface, the bone area, and the intensity of bone labeling were measured into the limits of the implant threads. RESULTS: Statistical analysis (2-way ANOVA) revealed no significant difference regarding the effect of nicotine on bone healing around the implants (P>0.05). However, a significant influence of the implant surface on the degree of bone-to-implant contact was detected in groups C (30.13 +/- 4.97 and 37.85 +/- 8.85, for machined and Al2O3-blasted surfaces, respectively) and D (27.79 +/- 3.93 and 33.13 +/- 8.87, for machined and Al2O3-blasted surfaces, respectively) (P<0.05). CONCLUSIONS: Although nicotine administration may not statistically influence bone healing around titanium implants, implant surface design may enhance osseointegration after nicotine administration.