Minimally Invasive Coronally Advanced Flap Techniques for Correction of Gingival Recession Defects: A Review.

For treatment of patients with isolated and/or multiple adjacent gingival recession defects, debate exists as to whether minimally invasive coronally advanced flap-based surgical techniques achieve improved root coverage compared with traditional evidence-based techniques. Correction of gingival recession defects requires mucogingival surgery utilizing tissue grafting and/or soft-tissue alternatives. Traditional mucogingival techniques for root coverage using autogenous tissue are associated with patient morbidity and discomfort. Considering the philosophical shift in daily practice from "patient-centered" to "person-centered," minimally invasive surgical procedures are warranted that provide esthetic results with reduced morbidity. This review article evaluates five minimally invasive mucogingival techniques: semilunar, tunneling, modified tunneling, vestibular incision subperiosteal tunnel access, and pinhole. These surgical procedures and their clinical application are compared and contrasted.

Swiss multicenter study evaluating the efficacy, feasibility and safety of peginterferon-alfa-2a and ribavirin in patients with chronic hepatitis C in official opiate substitution programs.

BACKGROUND: Though patients in opiate substitution programs are commonly infected with HCV, due to safety and efficacy concerns, they are rarely treated with interferon and ribavirin. METHODS: In a multicenter study, HCV-infected patients in opiate maintenance treatment programs received 180 microg pegylated interferon-alfa-2a once weekly, plus daily ribavirin for 24 weeks (genotypes 2, 3), or 48 weeks (genotypes 1, 4). RESULTS: Of the 67 patients enrolled, 31 (46%) had HCV genotypes 1 or 4, and 36 (54%) had genotypes 2 or 3. Intent-to-treat analysis showed end-of-treatment virologic response in 75% of patients (81% of genotypes 2 or 3; 65% of genotypes 1 or 4), and a sustained virologic response in 61% of patients (72% of genotypes 2 or 3; 48% of genotypes 1 or 4). Fifteen patients (22%) did not complete the study, in 5 (8%) cases because of severe adverse events. CONCLUSIONS: Drug users with chronic HCV infection, regularly attending an opiate maintenance program in which close collaboration between hepatologists/internists and addiction specialists is assured, can be treated effectively and safely with pegylated interferon-alfa-2a and ribavirin. Treatment results are very similar to those in other patient groups, and thus therapy should also be considered for this population.

Ribavirin/interferon-alpha sequential treatment of recurrent hepatitis C after liver transplantation.

Hepatitis C virus (HCV) infection invariably recurs after liver transplantation (LT), and sequels of chronic hepatitis of the graft are a significant cause of morbidity and mortality. In an uncontrolled trial, 31 patients with histologically confirmed hepatitis C after LT received, sequentially, ribavirin (10 mg/kg body weight q.d.) for 12 weeks, followed by ribavirin at the same dose q.d. plus interferon-alpha (IFN-alpha) [3 million units three times a week (3 MU TIW)] for another 48 weeks. Based on an intent-to-treat analysis, the percentages of patients with undetectable HCV RNA in their serum were 0%, 38.7% and 45.2% after 12, 36 and 60 weeks of therapy, respectively. A sustained virological response, as defined by undetectable serum HCV RNA 24 weeks after the end of treatment, was observed in 9/31 patients (29%). Sustained responders had a significant improvement of their liver inflammatory activity score (P=0.025), but not of their liver fibrosis score. The chances of sustained virological response correlated with the length of treatment, but not with the HCV genotype or baseline HCV RNA level. In conclusion, patients with recurrent hepatitis C after LT might benefit from ribavirin/IFN-alpha therapy, provided that the treatment is tolerated for a sufficient duration of time.

Proctitis and Sexually Transmissible Diseases of the Colon.

In patients with gastrointestinal symptoms and a history of anal-receptive intercourse, a careful but explicit history concerning sexual preferences and practices is required. Clinically, four infectious syndromes can be distinguished: perianal disease, proctitis, proctocolitis, and enteritis. Each of these syndromes may be caused by a certain range of pathogens. In immunocompromised patients, additional diseases must be considered. Clinical examination, a rectal swab with incubation in specific transport media, as well as a Gram stain of mucus or pus from a rectal swab, in combination with a rectosigmoidoscopy are helpful in differentiating specific diseases. Stool cultures and serologic examinations may identify specific causes of colitis or enteritis, but are of minor importance in the case of anorectal disease. Good treatments are available for most sexually transmitted anorectal diseases. An additional role for the treating physician and other healthcare providers is to educate and counsel patients and their sex partners on ways to adopt safer sexual behavior.

Detecting relationships between physiological variables using graphical models.

In intensive care physiological variables of the critically ill are measured and recorded in short time intervals. The proper extraction and interpretation of the information contained in this flood of information can hardly be done by experience alone. Intelligent alarm systems are needed to provide suitable bedside decision support. So far there is no commonly accepted standard for detecting the actual clinical state from the patient record. We use the statistical methodology of graphical models based on partial correlations for detecting time-varying relationships between physiological variables. Graphical models provide information on the relationships among physiological variables that is helpful e.g. for variable selection. Separate analyses for different pathophysiological states show that distinct clinical states are characterized by distinct partial correlation structures. Hence, this technique can provide new insights into physiological mechanisms.