Abordaje Terapéutico de Agrandamiento Gingival Influenciado por Ciclosporina y Nifedipino. Reporte de Caso / Therapeutic Approach of Gingival Enlargement Influenced by Cyclosporine and Nifedipine. Case Report

RESUMEN: Este reporte de caso muestra un paciente atendido en el Postítulo de Periodoncia de la Facultad de Odontología de la Universidad de Chile con diagnóstico de Agrandamiento Gingival influenciado por ciclosporina y nifedipino. El abordaje terapéutico consideró la fase sistémica, la fase higiénica con el tratamiento periodontal no quirúrgico para lograr la eliminación de la infección periodontal antes y después de la fase quirúrgica, y la fase de terapia de soporte periodontal. Se logró así la eliminación de los agrandamientos gingivales influenciados por ciclosporina y nifedipino.

ABSTRACT: This case report shows a patient attended in the Postgraduate Periodontics Program at the Faculty of Dentistry of the University of Chile with a diagnosis of Gingival Enlargement influenced by cyclosporine and nifedipine. The therapeutic approach considered the systemic phase, the hygienic phase with the non-surgical periodontal treatment to achieve the elimination of the periodontal infection before and after the surgical phase, and the phase of periodontal support therapy. Thus, the elimination of gingival enlargements influenced by cyclosporine and nifedipine was achieved.

Agrandamientos gingivales inducidos por fármacos / Drug-induced gingival enlargements

El término agrandamiento gingival por fármacos se refiere a un crecimiento anormal de la encía, secundario al uso de una medicación sistémica. Si bien se reporta una larga lista de medicamentos relacionados, se encontró una fuerte asociación sólo con la Fenitoína , la Nifedipina y la Ciclosporina A. La prevalencia del Agrandamiento Gingival varía ampliamente, sin embargo la prevalencia relacionada con el uso de la Fenitoína es aproximadamente del 50 por ciento. La Nifedipina y la ciclosporina producen cambios en el 25 por ciento de los pacientes tratados. Existe controversia entre la dosis y el riesgo o severidad del Agrandamiento.El grado de Agrandamiento gingival parece estar relacionado con la susceptibilidad del paciente y el grado dehigiene bucal de éste. Después de 1 a 3 meses de iniciada la medicación del fármaco los agrandamientos originadosen la papila interdental, se expande afectando otras áreas de la encía llegando a cubrir en casos extremosuna porción importante de los dientes principalmente en los segmentos anteriores por vestibular. El uso discontinuo de la medicación por el médico de cabecera y más aún la sustitución del fármaco por otroresulta en la regresión y el cese del Agrandamiento.

Nifedipine-Induced gingival overgrowth / Aumento gengival induzido por nifedipina

Objective: The objective of the present study was to evaluate gingival overgrowth induced by nifedipine and to correlate it with plaque accumulation. Material and Methods: Sixty patients were divided into a treated group (n=30) consisting of hypertensive patients long-term treated with nifedipine and a control group (n=30) consisting of patients without arterial hypertension. The following exams were performed on the first visit: anamnesis, measurement of blood pressure, weight and height, extra- and intraoral examination, and determination of the vertical and horizontal gingival overgrowth indices, plaque index, and bleeding index. The measurements were repeated after 30 days. Results: Most patients using nifedipine (60.7%) presented grade I horizontal gingival overgrowth (1 to 2 mm), with 3.6% showing minimum vertical gingival overgrowth. On the return visit, the plaque index was reduced by 8.3% and bleeding on probing was reduced by 1.5%. The individuals of control group, presented neither vertical gingival overgrowth nor horizontal, the plaque index was reduced by 7.2% and bleeding on probing was reduced by 5.3%. A significant difference in the horizontal gingival overgrowth index was observed between the treated and control groups (chi-square test, p = 0.015, p < 0.05). Conclusions: In the present study, authors conclude that the presence of dental biofilm and inflammation influences the degree of gingival overgrowth in patients using nifedipine.

Objetivo: O objetivo deste estudo foi avaliar o aumento gengival induzido por nifedipina e correlacioná-lo com o acúmulo de placa. Material e Métodos: Sessenta pacientes foram divididos em um grupo de hipertensos crônicos, sob tratamento contínuo com nifedipina, (n=30) e um grupo controle, pacientes saudáveis, sem hipertensão (n=30). Os seguintes exames foram realizados na primeira consulta: anamnese, aferição da pressão arterial, peso, altura, exame intra e extra-bucal, índices de aumento gengival vertical e horizontal, índice de placa e índice de sangramento. Os exames foram realizados novamente após 30 dias. Resultados: A maioria dos pacientes sob uso de nifedipina (60,7%) apresentou aumento gengival horizontal grau I (1 a 2 mm), e 3,6% demonstraram mínimo aumento gengival vertical. Na visita de retorno, o índice de placa foi reduzido em 8,3% e sangramento à sondagem em 1,5%. Os indivíduos do grupo controle não apresentaram aumento gengival vertical e nem horizontal, o índice de placa foi reduzido em 7,2% e sangramento à sondagem em 5,3%. Diferença significativa no índice de aumento gengival horizontal foi observada entre os grupos teste e controle (p = 0,015, p < 0,05). Conclusão: Neste estudo os autores concluíram que a presença do biofilme dental e a inflamação influenciam no grau de aumento gengival em pacientes sob tratamento com nifedipina.

Tocólisis con clorhidrato de isoxuprina o nifedipina en la amenaza de parto pretérmino / Tocolysis with isoxuprine hydrochloride or nifedipine in preterm labor

Comparar la eficacia del clorhidrato de isoxuprina o la nifedipina en la tocólisis de la amenaza de parto pretérmino. Se seleccionaron 82 pacientes con edad gestacional entre 24 y 34 semanas y diagnóstico de amenaza de parto pretérmino. Las pacientes se dividieron al azar en 2 grupos para recibir clorhidrato de isoxuprina (grupo A) o nifedipina (grupo B). Se determinaron el tiempo de cese de las contracciones, tensión arterial materna, concentraciones de glucosa y efectos adversos maternos. Maternidad "Dr. Nerio Belloso", Hospital Central "Dr. Urquinaona", Maracaibo. Estado Zulia. Se logró una tocólisis efectiva en las primeras 24 horas en 61,0 por ciento y 70,7 por ciento de las pacientes del grupo A y B, respectivamente (P = ns). Después de 7 días de tratamiento, 36,6 por ciento de las pacientes en el grupo A y 31,7 por ciento de las pacientes en el grupo B aun permanecían sin contracciones (P = ns). Se logró un retraso del parto hasta las 34 semanas o más en 26,8 por ciento y 29,3 por ciento de las pacientes de los grupos A y B, respectivamente. En el grupo de pacientes tratadas con clorhidrato de isoxuprina se observó un aumento significativo de las concentraciones séricas de glucosa (P < 0,001). Los efectos adversos maternos fueron significativamente más frecuentes en el grupo de clorhidrato de isoxuprina después de 2 y 24 horas de tratamiento (P < 0,05). La nifedipina es igual de efectiva que el clorhidrato de isoxuprina en la tocólisis de la amenaza de parto pretérmino y produce menos efectos adversos

To compare the efficacy of isoxuprine clorhidrate or nifedipine in tocolysis of threatened preterm labor. 82 patients with a gestational age between 24 and 34 weeks and threatened preterm labor diagnosis were selected. Patients were randomly divided in 2 groups to receive isoxuprine clorhidrate (group A) or nifedipine (group B). Time of cease of contractions, maternal blood pressure, glucose concentrations and maternal adverse effects were determined. Maternidad "Dr. Nerio Belloso", Hospital Central "Dr. Urquinaona", Maracaibo. Estado Zulia. An effective tocolysis was obtained within 24 hours in 61.0 percent and 70.7 percent for patients in group A and B, respectively (P = ns). After 7 days of treatment, 36.6 percent of patients in group A and 31,7 percent of patients in group B were still without contractions (P = ns). A delay in labor till 34 weeks or more was made in 26.8. percent and 29.3 percent of patients in group A and B, respectively. In the group of patients treated with isoxuprine clorhidrate a significant raise of glucose concentrations was observed (P < 0.001). Maternal adverse effects were significant more frequent in isoxuprine clorhidrate group after 2 and 24 hours of treatment (P < 0,05). Nifedipine has a similar effectivity than isoxuprine clorhidrate for tocolysis in threatened preterm labor and produces less adverse effects

Epidemiological analysis of nifedipine and phenytoin-induced gingival overgrowth in users of the Primary Health Care System / Análise epidemiológica do aumento gengival induzido por nifedipina e fenitoína em usuários da Atenção Primária à Saúde

Purposes: The aim of this study was to evaluate the prevalence of drug-induced gingival overgrowth (DIGO) in Brazilian users of nifedipine and/or phenytoin and to determine the presence of predisposing/modifying factors. Methods: Demographic, pharmacological, and periodontal data were obtained from 100 users of the Brazilian Primary Health Care System in Diamantina, Jequitinhonha Valley, Minas Gerais state, Brazil, who were taking nifedipine and/or phenytoin. Clinical evaluations including gingival overgrowth analysis were carried out by a single calibrated examiner. Bivariate analysis (Chi-square test or Student's t-test) were used to identify demographic, periodontal and drug-related significant factors associated with gingival overgrowth severity. Multivariate analysis (Poisson regression) was used to assess confounding factors. Results: The prevalence of DIGO was high (86%), but its severity was predominately mild. The prevalence of DIGO was significantly higher in phenytoin users than in nifedipine users (p=0.01). There was no association between DIGO and demographic, pharmacological or periodontal variables. Conclusion: The high occurrence of DIGO among users of nifedipine and phenytoin emphasizes the importance of the dentist as part of the public health team to provide the prevention, early diagnostic, and control of this alteration.

Objetivo: Avaliar a prevalência dos aumentos gengivais medicamentosos em usuários brasileiros de nifedipina e fenitoína e determinar a presença de fatores preditores/modificadores. Metodologia: Dados demográficos, farmacológicos e periodontais foram obtidos de 100 pacientes usuários da Atenção Primária no Vale do Jequitinhonha que usavam nifedipinae/ou fenitoína. Avaliações clínicas, incluindo a análise do aumento gengival, foram feitas por um avaliador calibrado. Análises bivariadas (teste do qui-quadrado ou teste t de Student) foram usadas para identificar fatores demográficos, periodontais e medicamentosos que apresentassem associação com a severidade do aumento gengival. Foi utilizada análise multivariada (regressão de Poisson) para estimar a razão de prevalência e intervalo de 95% de confiança para identificar os fatores de risco associados ao desenvolvimento do AG. Resultados: A prevalência do aumento gengival foi elevada (86%), mas a gravidade mais comumente observada foi a leve. A prevalência foi maior em usuários de fenitoína do que de nifedipina (P=0.01). Não houve associação entre aumento gengival e as variáveis demográficas, farmacológicas e periodontais. Conclusão: A alta prevalência do aumento gengival medicamentoso entre os usuários de nifedipina e fenitoína enfatiza a importância do cirurgião dentista no diagnóstico, prevenção e controle dessa alteração.

O impacto da saúde bucal na qualidade de vida de usuários do sistema único de saúde que fazem uso contínuo de nifedipina e fenitoína em Diamantina, Minas Gerais / The impact of oral health in the quality of life in the Unique System of Health users with continuous nifedipine and phenytoin at Diamantina, Minas Gerais

O uso continuado de alguns medicamentos, como anifedipina e fenitoína, pode acarretar o desenvolvimento de um aumento de volume gengival descrito como aumento gengival medicamentoso. Este estudo teve por objetivo a avaliação do impacto da saúde bucal na qualidade de vida de usuários do Sistema Único de Saúde (SUS) que faziam uso continuado destes medicamentos em Diamantina (MG) levando em consideração a presença/ausência de dentes e a presença do aumento gengival medicamentoso. Foram aplicados 152 questionários em indivíduos edêntulos e não-edêntulos abrangendo aspectos gerais, condição médica e odontológica e informações relacionadas ao uso de medicamentos. Avaliações clínicas, incluindo a análise do aumento gengival, foram feitas por um avaliador calibrado pelo teste-reteste. O impacto da saúde bucal na qualidade de vida foi avaliado através do OHIP-14, apresentando um valor médio de impacto de 4,49 pontos. Os resultados desta análise demonstraram que 43% dos indivíduos avaliados tinham aumento gengival. Houve correlação significativa entre o OHIP, a idade e profissão dos indivíduos avaliados, bem como com a presença de dentes e com o aumento gengival (p< 0,05). O aumento gengival apresentou correlação com 8 dos 14 itens do OHIP, demonstrando afetar 5 das 7 dimensões avaliadas. A alta ocorrência do aumento gengival entre usuários de nifedipinae fenitoína e o impacto desta alteração na qualidade devida enfatizam a importância do desenvolvimento de estratégias para avaliação e controle da saúde bucal desses pacientes.

The continuous use of some drugs such as nefidipine and phenytoin could develop a gingival enlargement calleddrug-induced gingival overgrowth. This study aimed to evaluate the oral health impact in the quality of life of the Unique Health System users who were under treatment with these drugs considering the presence/absence of teeth and gingiva lovergrowth. 152 questionnaires were applied to dentate and non dentate subjects enclosing general aspects, medical and dental condition and information related to the medicine use. Clinical evaluations, including the analysis of the gingival overgrowth was made by an appraiser calibrated for theretest-test. The impact of the oral health in the quality of life was evaluated through the OHIP-14, presenting an averagevalue of impact of 4.49 points. The results of this analysis showed that 43% of examined subjects had gingival overgrowth. It was also demonstrated a significant association between OHIP and age, and OHIP and profession of the evaluated subjects, as well as with the tooth presence and the gingival overgrowth (p< 0.05). The gingival overgrowth showed correlation with 8 of the 14 item of the OHIP, demonstrating to affect 5 of the 7 evaluated dimensions. The higher occurrence of the gingival overgrowth among users of nifedipine and phenytoin and the impact of this alteration in the quality of life emphasize the importance of the development of strategies for evaluation and controlof the oral health of these patients.

[Neurological complications of acute intermittent prophyria precipitated by prophyrinogenic drugs and efficiency of heme arginate treatment]

Acute intermittent porphyria [AlP] is a rare n disorder of heme biosynthesis characterized by enzymatic defect of porphobiligen desaminase with accumulation and s excretion of porphyrins and their precursors. Clinical picture is characterized by attacks with a triad of abdominal pain psychiatric disorder and neurological involvement [central and Peripheral nervous system manifestations, often precipitated porphyrinogenic medications are of poor outcome. We report a new cases A 13-year-old girl who: several attacks of AlP and developed acute severe axonal motor neuropathy, three weeks after porphyrinogenic [Famotidin, Phenobarbital and Nifedipine]. We stress on the importance of early diagnosis of AIP to prevent serious neurological complications often precipitated by medications and the efficiency of heme arginate treatment when administrated early during the attacks

Multidisciplinary treatment in a patient with nifedipine induced gingival enlargement

Adult patients have preexisting condition that are not seen in the adolescent population including tooth loss, severe skeletal dysplasias, periodontal disease and various forms of temporomandibular dysfunction[TMD]. Frequently, the preexisting conditions that are present in the adult patient interfere with the achievement of orthodontisc's general idealized goals. Problem-oriented synthesis of the dental needs of each case helps determine specific treatment objectives that one must establish before determining the treatment plan. A 51 years old patient approached the dental clinic to improve her smile esthetics. She was a skeletal class III high angled case with an increased lower facial height and a dentally class I with supraerupted upper right central incisor, mild spacing 4 mm of overall tooth material excess in the lower arch. Ginigival overgrowth associated with nifedipine intake was also recorded. As a more realistic treatment plan with an interdisciplinary approach was considered to be appropriate in terms of treatment efficacy and duration, a team comprising of a periodontist, an orthodontist and a restorative dentist was formed to manage the case. The importance of multidisciplinary approach in managing the case was explained. After gingivectomy, the patient was kept in a maintenance program, including oral hygiene instructions and professional tooth cleaning during the complete orthodontic treatment. Follow-up of the case for a year did not reveal any recurrence of the drug induced gingival enlargement. This case not only emphasizes the role of meticulous oral hygiene maintenance in preventing the recurrence of gingival enragement but also the ease with which adult cases would be managed efficiently with minimal endeavors by a team approach

Efeitos hemodinâmicos da nifedipina na inibição do trabalho de parto prematuro / Hemodynamics effects of nifedipine as a tocolytic agent in preterm labour

Realizou-se revisão da literatura a respeito do uso da nifedipina no trabalho de parto prematuro, descrevendo-se os principais aspectos farmacológicos, eficiência como agente de tocólise, bem como os potenciais efeitos adversos maternos e fetais, com ênfase na hemodinâmica útero-placentária. De acordo com as evidências atuais, a nifedipina é a medicação de escolha para tocólise, apresentando boa eficácia na inibição das contrações uterinas, custo mais baixo quando comparada aos demais fármacos e melhor tolerância materna por ter menos efeitos colaterais, sobretudo em relação aos betamiméticos. Os efeitos colaterais maternos mais freqüentes com o uso da medicação são a cefaléia, a fadiga e o rubor cutâneo. Os efeitos adversos fetais são pouco conhecidos. Pesquisas futuras são necessárias objetivando encontrar um regime posológico padrão que apresente boa eficácia tocolítica e nenhum ou mínimos efeitos adversos para o binômia materno-fetal.

A literature review on nifedipine in preterm labour was performed describing its pharmacological aspects, efficiency as tocolytic agent and its potential maternal-fetal side effects, emphasizing utero-placental hemodynamics. Recent evidence supports the use of nifedipine as medication of choice for tocolysis, presenting a satisfactory action to inhibit uterine contraction, lower proce when compared to other tocolytics agents and better maternal tolerance. The most frequent side effects with nifedipine for tocolysis are cutaneous flush, headache and fatigue. Fetal side effects are less known. Future research is necessary to find an ideal nifedipine posologic scheme which presents a satisfactory tocolysis performance and none or minimal maternal-fetal side effects.

Crecimiento gingival por el uso de ciclosporina A y nifedipino en un paciente con transplante renal / Gingival growth due to the use of cyclosporin A and nifedipine in a patient with renal transplant

Se presenta un paciente del sexo masculino, de 43 años de edad, con un transplante renal que inició tratamiento inmunosupresor con ciclosporina. Al interrogatorio expresa aumento de tamaño de las encías que fue empeorando progresivamente hasta impedirle cerrar la boca, le causaba molestias para comer alimentos sólidos. En el examen físico se observó engrosamiento gingival en sentido antero posterior, papilas interdentales con superficie irregular, lobulada, que cubrían las coronas clínicas de los dientes presentes. La proliferación llegó a tomar toda la encía, sin manifestación alguna en las zonas desdentadas. Es frecuente la relación entre el crecimiento gingival y el consumo de ciclosporina. Al no encontrar en la literatura médica cubana ningún reporte de caso aun cuando este medicamento es muy usado en los servicios de nefrología, motivó la presentación de este caso.

A 43-year-old male patient with a renal transplant that received immunosuppressive treatment with cyclosporin was presented. On interviewing him, he referred enlargement of the gingival size that progressively worsened until impeding him to close the mouth. It was difficult for him to eat solid food. On the physical examination, gingival thickening in anteroposterior sense, and interdental papillae with irregular and lobulated surface that covered the clinical crowns of the present teeth were observed. The proliferation reached all the gingiva with no manifestation in the edentulous zones. The relation between gingival growth and the consumption of cyclosporin is common. The fact that no case report was found in Cuban medical literature, even though this drug is used a lot in the nephrology services, motivated us to publish this paper.

Avaliação manométrica anal pré e pós tratamento da fissura anal crônica com nifedipina tópica 0,2 por cento / The role of nifedipine 0,2 percent in cronic anal fissure-manometric study pre and post treatment

No tratamento da fissura anal, novas drogas têm sido utilizadas, dentre elas os bloqueadores de canais de cálcio. O objetivo desta pesquisa foi à avaliação manométrica de pacientes com fissura anal crônica após tratamento com nifedipina tópica 0,2 por cento, correlacionando com a cicatrização e a dor. Trata-se de estudo prospectivo realizado em pacientes atendidos no ambulatório de Coloproctologia do Hospital Universitário de Taubaté. Os pacientes foram submetidos ao exame manométrico antes e após 30 dias da utilização de nifedipina tópica gel 0,2 por cento três vezes ao dia no ânus e margem anal. Para a análise estatística foi utilizado o teste de Mann-Whitney considerando significante, se p<0,05. Os dez pacientes não demonstraram nenhuma alteração manométrica provocada pelo tratamento com nifedipina, mas 50 por cento deles relataram melhora dos sintomas e 40 por cento dos pacientes apresentaram cicatrização da fissura, mostrando que a nifedipina foi efetiva no tratamento da fissura anal e segura do ponto de vista funcional, por não causar lesões esfincterianas. A avaliação manométrica demonstrou não haver alterações nas pressões anais demonstrando, entretanto, melhora da dor em 50 por cento e cicatrização em 40 por cento dos pacientes.

In the treatment of the anal fissure, calcium channel blockers are among the new drugs which have been used. The objective of this research was the manometric evaluation of patients with chronic anal fissure after topic treatment with 0.2 percent nifedipine and correlation with the healing and pain. This is a prospective study of patients from Coloproctology Clinic of the University of Taubaté Hospital. The patients had been submitted to a manometric examination before and after 30 days of the use of topic 0.2 percent nifedipine gel three times a day in the anus and anal edge. For the statistics analysis Mann-Whitney test was applied to a significance of p= 0,05. Ten patients did not exihibit manometric alteration associated with nifedipina treatment, however 50 percent of them reported improvement of the symptoms and 40 percent depicted healing of the fissure. The results demonstrated that nifedipine was effective and safe for anal fissure treatment and considering the functional point of view it did not cause injuries as well. The manometric evaluation did not demonstrate alterations in the anal pressure; however, it was observed that 50 percent of the patients had improvement in pain and 40 percent in healing.

Hiperplasia gingival por ciclosporina: A propósito de un caso / Cyclosporine-induced gingival hyperplasia: Report of one case

Gingival enlargement can be an adverse effect of ciclosporine A and nifedipine use. It has a high relapse rate if the drugs are not discontinued. There is a genetic predisposition to the development of this condition and dental biofilm can also play a role. We report a 64 years old male who received a renal allograft and was treated with cyclosporine and nifedipine. He required six surgical interventions for generalized gingival enlargement. After the sixth relapse, the patient was subjected to a periodontal treatment to eliminate the dental biofilm, which decreased the rate of recurrence of gingival enlargement.

Comparison of nifedipine with salbutamol as tocolytic agents in preterm labour

This study was carried out to evaluate the tocolytic efficacy for prolongation of pregnancy with oral nifedipine in comparison to salbutamol, and to evaluate side effects of nifedipine. It was an interventional study and was performed for a period of one year in Sir Ganga Ram hospital, and in the department of obstetrics and gynaecology, Fatima Jinnah Medical College. Sixty women were enrolled in this study. A questionnaire was filled for each patient. Once randomised the women received oral nifedipine or intravenous salbutamol in recommended dosage for acute tocolysis. Measurements of maternal pulse, blood pressure and foetal heart rate were recorded for upto 24 hours and compared over the treatment course. Outcome measures were prolongation of pregnancy as a result of tocolysis and recorded in hours and days, along with maternal and foetal side effects. Delivery was deferred for 48 hours, 3 to 7 days and more than 7 days in 30%, 6.66% and 3.33% respectively in nifedipine group compared with 26.66%, 3.33% and 3.33% of women respectively in salbutamol group [no significant difference P > 0.05]. Major maternal and foetal side effects were significantly less common in nifedipine group [0%] than in salbutamol group [13.33%] P value = 0.05. Nifedipine is almost as effective as salbutamol in suppressing preterm labour. Its use is associated with less frequent side effects

Drug related crisis in myasthenia gravis.

Myasthenia gravis is an autoimmune disorder where antibodies against the nicotinic Ach receptor resulting in impaired transmission at the NM junction. A number of drugs have been reported to cause neuromuscular blockade and/or to increase weakness in myasthenia gravis. We report a case of myasthenia gravis in which the calcium channel blocker-nifedipine caused the worsening of the symptoms.

Hipertrofia gengival em transplantados renais / Cyclosporine induced gingival hyperplasia in kidney transplants

OBJETIVO: Avaliar os fatores associados ao crescimento gengival excessivo em transplantados renais. MÉTODOS: A pesquisa foi realizada no Hospital Cajuru de Curitiba, no período de abril a outubro de 2002, com a participacão de 60 transplantados renais, em uso diário de ciclosporina e com pelo menos um segmento dentário. O protocolo de ensaio foi observacional transversal. O exame odontológico dos indivíduos consistiu da avaliacão dos segmentos dentários com verificacão do grau de crescimento da gengiva e do índice de placa bacteriana. Todos os participantes preencheram questionário com dados relacionados ao transplante renal, realizaram coleta de material para controle do nível sérico de ciclosporina e foram avaliados quanto ao peso e altura. Na comparacão dos resultados de amostras categóricas, utilizou-se o teste do Qui-quadrado e a correlacão de classes de Spearman. O teste t foi aplicado na comparacão das variáveis contínuas. RESULTADOS: Em pacientes tratados somente com ciclosporina, 47,2 por cento não apresentavam alteracões da gengiva, enquanto 52,8 por cento cursaram com crescimento gengival, sendo 30,6 por cento com grau > 2. Nos pacientes tratados com ciclosporina e nifedipina, notou-se que 29,2 por cento tinham gengiva normal e 70,8 por cento apresentaram crescimento gengival, sendo que em 45,8 por cento o comprometimento foi grau > 2. Não foi observada diferenca significativa dos resultados entre os gêneros masculino e feminino. Foi encontrada correlacão positiva entre o índice de placa bacteriana e o volume gengival (r = 0,3295; p<0,01). CONCLUSAO: Em transplantados renais, a hipertrofia gengival está associada ao uso de ciclosporina, isoladamente ou em concomitância com bloqueadores de cálcio, e apresenta uma correlacão com o índice de placa bacteriana.

Impact of one week treatment with Nitric oxide synthase inhibitor [L-NAME] and DHP-Type Calcium Channel Blocker [nifedipine] on renal Sodium and water excretion in cirrhotic rats with ascites

Arterial vasodilatation and activation of several vasoactive and neurohumoral systems may play a key role in the pathogenesis of sodium and water retention and ascites formation in cirrhosis. Strong evidence supports a role for an increased vascular production of the potent vasodilator, nitric oxide [NO], in vascular hyporeactivity of cirrhosis. Also, evidence indicated that dihydropyridine-type calcium channel blockers [DHP-CCBs] modulate the release and /or bioavailability of endothelial NO. So, it is possible that DHP-CCBs have the potential to exaggerate the hemodynamic derangements in cirrhosis. The present study was motivated to test the effect of DHP-CCBs [nifidipine] on experimental liver cirrhosis, induced in animal model by using CCI[4], either alone or in the presence of NO synthase inhibitor, N-nitro-L-arginine methyl ester [L-NAME]. Sixty four adult male albino rats were assigned into two main groups, non-cirrhotic [GI], n=32 and cirrhotic [GIl], n=32. Further classification into four subgroups was carried out for each group. GI included: Gla [non treated control], GIb [L-NAME treated], GIc [nifedipine treated] and GId [nifedipine + L-NAME treated]. While GIl included: Glla [cirrhotic untreated], GlIb [cirrhotic, L-NAME treated], GIIc [cirrhotic, nifedipine treated] and GIld [cirrhotic, nifedipine + L-NAME treated]. L-NAME and /or nifedipine administration [according to the group] was orally administrated daily for a week at a dose = 0.5mg/Kg/day for L-NAME and /or = 0.1mg/Kg/day for nifedipine. Results revealed that L-NAME treatment of healthy rats [GIb] had no significant effect on all the tested parameters including B.Wt. and plasma Na, aldosterone and NO levels. Significant elevation in plasma aldosterone and NO mean values was noted by nifedipine administration to non cirrhotic animals [GIc] compared to Gla, however, no significant difference was obtanied between GIc and Gla for each of B.Wt and plasma Na. Results also demonstrated that CCI[4] administration to rats [Glla] resulted in the appearance of ascites with a significant elevation in plasma aldosterone and NO mean values compared to Gla. Treatment of cirrhotic rats with L-NAME had nearly normalized the later two parameters with no significant difference when compared to Gla, beside reduction in ascitic fluid volume and consequently B.Wt. compared to non-treated cirrhotic group [Glla]. Our results indicated that nifedipine administration to cirrhotic rats [GIIc] significantly intensified the abnormalities associated with CCI[4] administration and resisted the normalization by L-NAME treatment [GIld]. It could be concluded that normalization of plasma NO by NO synthase inhibition is associated with improvement in renal sodium and water excretion which in turn resulted in decreased ascitic fluid volume in cirrhotic rats, while DHP-CCBs [nifedipine] by increasing the plasma NO levels exaggerate ascites in cirrhotic rats. This finding may raise the possibility of using long term NO synthase inhibition in patients with ascites and avoidance of the use of calcium channel blockers in those patients

Considerações no atendimento odontológico em pacientes sob terapia com nifedipina / Dentistry considerations in the management of patients treated with nifedipine

Diversos medicamentos apresentam, dentre seus efeitos colaterais, alterações na cavidade bucal. A hiperplasia gengival medicamentosa apresenta variável incidência, dependendo da droga utilizada, sendo normalmente relacionada à administração de ciclosporina A (agente imunosupressor para transplantados) e à fenitoína (alticonvulsivante). A nifedipina também desempenha um papel importante no desenvolvimento da hipertensão gengival. A proposta deste trabalho é de apresentar os cuidados inerentes ao atendimento odontológico ao paciente no qual é administrada a nifedipina, considerando a hiperplasia gengival medicamentosa como principal efeito colateral bucal, discutindo suas particularidades, como características clínicas e histopatológicas, incidência, prevalência, etiopatogenia e indicações terapêuticas

Conduta terapêutica e tratamento odontológico em transplantados renais com crescimento gengival / Therapeutic approach and dental treatment in patients presenting transplanted kidney and gingival growth

Os aumentos gengivais induzidos por drogas são uma resposta exacerbada do tecido gengival que causa desconforto estético, funcional e fisiológico ao paciente. Dentre os medicamentos de uso sistêmico que causam este efeito colateral estão a ciclosporina a e os bloqueadores dos canais de cálcio. Pacientes transplantados renais fazem uso concomitante da ciclosporina A(CsA) e da nifedipina (Ni), potencializando a ação da droga sobre o tecido gengival. O presente trabalho tem por objetivo relatar um caso clínico de aumento gengival e enfocar a terapia odontológica e a conduta terapêutica utilizada em transplantados renais, descrevendo os cuidados, limitações e implicações do tratamento periodontal e da terapêutica medicamentos empregada nestes pacientes.

Manejo del Síndrome de Ogilvie / Management of Ogilvie's syndrome

El Síndrome de Ogilvie es una condición caracterizada por marcada dilatación segmentaria o total de colon. Se observa en pacientes con patología médica o quirúrgica grave y en el postoperatorio de intervenciones obstétricas. El manejo es inicialmente conservador aunque puede requerir cirugía. Se revisan, retrospectivamente, las fichas clínicas de todos los enfermos tratados por un Síndrome de Ogilvie entre el 1 de julio de 1996 y el 31 de junio de 2002. La serie está constituida por 12 pacientes, el promedio de edad fue de 55 años. La patología de base que explicó el Síndrome de Ogilvie fue cardiovascular en 5 (41,7 por ciento), gíneco-obstétrica en 2 (16,6 por ciento) y otras en 5 (41,7 por ciento), además se consideró como causa desencadenante al uso de nifedipino en 2 casos. El diagnóstico fue realizado por Rx de Abdomen simple en todos los casos, el manejo se realizó con colonoscopia, sonda rectal y suspensión de nifedipino cuando correspondió. No hubo complicaciones ni mortalidad atribuibles al Síndrome de Ogilvie o a su manejo. Diez enfermos necesitaron sólo 1 colonoscopia y 2 requirieron de 2 procedimeintos. Fallecieron 5 pacientes (41,7 por ciento) debido a su patología de base.

A comparative study between nifedipine and isoxsuprine in the suppression of preterm labour.

Preterm labour and delivery remains a major cause of perinatal morbidity and mortality. Numerous drugs and interventions have been used to prevent and inhibit preterm labour but none have been found to be completely effective with the choice being further limited by troublesome side effects. This study compares in a prospective and randomised design the efficacy and safety of the calcium antagonist Nifedipine with the beta mimetic Isoxsuprine. 81.25% of patients receiving Nifedipine and 70% of those receiving Isoxsuprine achieved successful tocolysis. The mean prolongation of pregnancy with Nifedipine was 25+/-19.85 days and with Isoxsuprine it was 19.18+/-17.82 days. Maternal side effects were similar in both groups with hypotension and tachycardia being the commonest. Discontinuation rates were also similar with pulmonary oedema and severe hypotension being the reasons for foregoing tocolysis. It can be concluded that Nifedipine is a safe and effective alternative to Isoxsuprine for suppressing preterm labour.