Clinical and radiographic evaluation of single tantalum dental implants: a prospective pilot clinical study.

OBJECTIVE: The aim of this prospective pilot clinical case series report was to evaluate, through a clinical and radiographic analysis, the peri-implant bone resorption of the tantalum dental implants (TMT) (Zimmer TMT, Parsippany, NJ, USA) one year after prosthetic rehabilitation. METHODS: Twenty tantalum dental implants were placed in both maxillas and mandibles of 20 patients. Patients were asked to attend a radiographic and clinical follow-up and their previous clinical records and X-rays were assessed. Bone levels were calculated by digitally measuring the distance from the implant shoulder to the first bone-to-implant on periapical radiographs taken at surgery and after 6 and 12 months of functioning. The Pearson correlation analysis was performed to assess it there was a correlation between the measurement of the marginal bone loss (MBL). The Anova Test with a post-hoc analysis using Bonferroni's test was used to compare the three group (0, 6 months and 12 months). RESULTS: The mean total MBL for the group 0 months was 0.84 mm (SD 0.21), 6 months was 0.87 mm (SD 0.22) and for 12 months was 0.89 mm (SD 0.23). The values of the Pearson's coefficients showed that the data measurement were positively correlated. The Anova test showed a statistically significant difference between the groups. CONCLUSION: The statistically significant difference in marginal bone loss can be considered physiological. Within the limits of this study it can be concluded that TMT implants have an excellent bone crest's stability, however, to have most accurate information, will be necessary extend the sample.

Anal endosonography: a survey of equipment, technique and diagnostic criteria adopted in nine Italian centers.

BACKGROUND: Anal endosonography (AES) has become an essential part of the pre-operative diagnostic workup in both organic and functional anal diseases. METHODS: Nine Italian centres with an average volume activity of >10 exams/week each were surveyed with the aim of determining the concordance with respect to indications for the procedure and interpretation of the results. RESULTS: Overall, anal sepsis, faecal incontinence and anorectal tumours were the more common indications for AES while evacuation dysfunctions and anal pain were not always considered indications. All centres use the same diagnostic criteria for simple and complicated perirectal sepsis and sphincteric defects, but adopt different classifications for stage 1 and stage 2 anal tumours. Participants agreed in that lymph-node staging by AES is less precise than tumour staging, especially after chemoradiation therapy. CONCLUSIONS: A list of recommendations and guidelines based on the groups's experience has been produced for those radiologists and coloproctologists interested in the use of AES and accreditation of their centres.

Reinterventions after complicated or failed stapled hemorrhoidopexy.

BACKGROUND: Stapled hemorrhoidopexy has become increasingly popular over the past five years, mainly because of the assumption that it is associated with less pain. However, persistent tags and recurrence might represent a problem, because piles are not excised and severe complications requiring surgery have been occasionally reported. The aim of the present study is to analyze the causes for and the outcome of reintervention following either severely complicated or failed stapled hemorrhoidopexy. METHODS: A total of 232 primary stapled hemorrhoidopexies and 65 reinterventions after stapled hemorrhoidopexy were performed by the authors in five centers devoted to colorectal surgery. Twelve patients of the latter group had the stapled hemorrhoidopexy performed in one of these centers. Thirty-five were males and 30 were females. The mean age was 50 (range, 29-81) years. In all cases the primary indication for stapled hemorrhoidopexy was either third-degree or fourth-degree symptomatic hemorrhoids. In all patients submitted to reoperation the diagnosis of either severely complicated or failed stapled hemorrhoidopexy was made. The clinical history of all of these patients was carefully studied and all underwent inspection, digital exploration, and proctoscopy. After the reintervention, proctoscopy was performed in 61 patients (92 percent) after a median follow-up of 5.5 (range, 1-36) months. RESULTS: Our reoperation rate after stapled hemorrhoidopexy was 11 percent. The most frequent indications for reintervention were persistent, severe anal pain (visual analog pain score higher than 7) in 29 patients (45 percent), severe postoperative bleeding in 20 (31 percent), anal fissure in 16 (21 percent), prolapsing piles in 12 (18 percent), rectal polyp in 11 (16 percent), anorectal sepsis in 11 (16 percent), and fecal incontinence in 7 (11 percent). Thirteen different types of reintervention were needed. Excisional hemorrhoidectomy, removal of staples, and fissurectomy and/or internal sphincterotomy were the most frequent operation (n = 41). A decrease in anal pain, as measured by visual analog pain score, was observed one month after reintervention, compared with that measured preoperatively (from 5.6 +/- 3.6 to 3.0 +/- 2.9) (P < 0.001). Bleeding requiring treatment occurred in six cases (10 percent), anal stricture requiring dilation occurred in three (5 percent), and fecal incontinence in three (5 percent). Proctoscopy showed no recurrences in 52 cases (80 percent) after the reintervention. CONCLUSION: Pain and bleeding mostly caused by piles, fissures, and retained staples were the most frequent causes for reoperation after stapled hemorrhoidopexy. Reintervention was associated with a high bleeding and soiling rate, but was effective in treating pain and other symptoms in the majority of patients. Because of the wide spectrum of different interventions required, a failed or complicated stapled hemorrhoidopexy might be better treated by an experienced colorectal surgeon.

Sorologia anti PGL-1 e risco de ocorrencia de hanseniase em area de alta endemicidade do Estado de Sao Paulo: quatro anos de seguimento / Anti PGL-1 serological and the risk of leprosy in a highly endemic area in the State of Sao Paulo, Brazil: four-year follow-up

Os testes sorologicos para diagnostico de hanseniase, usando o glicolipideo-fenolico-1 (PGL-I), considerando antigeno especifico do M. leprae, tem aberto algumas possibilidades de estudo do comportamento epidemiologico desta doença. Algumas questoes, como tempo de latencia da doença, infecçao subiclinica e importancia do contato intra-domiciliar (contatos) no controle da endemia puderam ser melhor analisadas usando este instrumental. Este estudo teve por objetivo verificar a existencia de associaçao entre a situaçao sorologica e a ocorrencia de hanseniase. Foram seguidas durante 4 anos, 6.520 pessoas com idade igual ou superior a 5 anos, submetidas no inicio do seguimento ao teste sorologico Anti PGL-1, pertencentes ao universo de 7.416 habitantes da area urbana de um municipio paulista caracterizado por elevada endemicidade de hanseniase. Foi identificado um grupo de 590 individuos soropositivos (9.0%). Foram diagnosticados, no periodo, 82 casos novos de hanseniase, 26 no grupo de soropositivos (441 casos novos/10.000 individuos) e 48 no de soronegativos (81/10.000). Entre os que nao fizeram sorologia, surgiram 8 casos novos (89/10.000). Procurou-se controlar, na analise, a condiçao de contato, dado que a taxa de soropositivo padronizada por idade e sexo era de 9.61% no grupo de contatos e 7.65% no de nao-contatos. Tomando-se aos de nao-contatos soronegativos como o grupo de "nao espostos", foram calculados os riscos relativos de adoecimento no periodo, a partir das taxas de detecçao padronizadas por idade, resultando no seguinte: os contatos ID soropositivos apresentaram a taxa de 1.704/10.000, 27 vezes maior que a dos "nao-expostos", igual a 63/10.000, os nao-contatos soropositivos e os contatos soronegativos apresentaram taxas, respectivamente, de 274 e 198/10.000 ambas maiores que as dos "nao-expostos" e iguais entre si. A soropositividade associou-se a elevaçao de 8,6 vezes do risco de hanseniase entre os contatos de 4,4 entre os nao-contatos. Na situaçao epidemiologica estudada, caracterizada por elevada endemicidade de hanseniase, 50% dos casos novos surgiram entre os nao-contatos soronegativos, ou seja, sem fonte de infecçao conhecida. Portanto o test anti-PGL-1 usado revela-se na pratica, de pouca aplicabilidade. Resta estudar ainda o comportamento da sorologia anti-PGL-1 em areas de media e baixa endemicidade par que se possa tirar conclusoes mais consubstanciadas sobre sua utilidade no controle da endemia

[Sclerotherapy and elastic ligation of hemorrhoids]. / La scleroterapia e la legatura elastica delle emorroidi.

In the treatment of haemorrhoids all procedures may have good results, if indications are correct. Injection treatment has the best indication for I and II degree bleeding piles, the rubber band ligation for II and III degree piles; this procedure is very effective when associated to cryosurgery. All operations for haemorrhoids must be avoided in Crohn disease.