Placement of dental implants without flap surgery: a clinical report.

Traditionally, the procedure of implant placement requires a surgical periosteal flap to be raised. In a percentage of implant cases, there is no need for flap surgery for implant placement, or for a follow-up surgical procedure for abutment connection. In this clinical investigation, 20 maxillary and mandibular implants were placed in seven adult male patients. The sites for implant placement were prepared according to an alternative surgical technique without raising a surgical flap. Patients were recalled periodically for 2 years to evaluate healing and clinical integration of implants. The results showed normal clinical healing at the first week of reexamination in all implant sites; periodontal probing of less than 2 mm circumferentially around all healing caps at 3 months and later at subsequent recall periods; no radiolucency observed in the peri-implant zone; no sign of clinical mobility during recall examination; and no persistent or irreversible sign or symptoms of pain, infection, or necrosis. This alternative surgical technique can provide several advantages over the traditional 2-step procedure.

Human pulmonary histopathological changes from marijuana smoking.

Thirteen individuals ranging in age from fifteen to forty years, who were known smokers of marijuana, all of whom died suddenly, were autopsied as coroner's cases. The pulmonary histopathologic changes revealed light to heavy infiltrations of pigmented monocytes within alveoli as well as varying degrees of monocytic and lymphocytic infiltration into the interstitium of the lungs. The intensity of the pulmonary infiltrate appears to be dose related. This report calls attention to the accelerated pathological changes in the lungs from marijuana smoking as compared to tobacco smoking leading to pulmonary scarring, emphysema, and eventual chronic obstructive pulmonary disease.

Intraoperative localization of parathyroid glands using methylthionine chloride / tetramethylthionine chloride in secondary hyperparathyroidism.

Over an 18 month interval at the University of Louisville Affiliated Hospitals, 40 patients were evaluated in a nonrandomized prospective study to determine the value of methylthionine chloride / tetramethylthionine chloride (methylene blue--MB) as an aid for the rapid intraoperative identification of parathyroid hyperplasia of end-stage renal disease (ESRD). Patients assigned to the MB infusion subgroup had infusion of 1 per cent MB (5.5 milligrams per kilogram) over a time interval of 25 to 60 minutes (mean of 43.9) prior to anesthetic induction. A total of 159 glands were identified in both the control and MB infusion groups (3.98 glands per patient) of which the predominant histopathologic diagnosis on frozen section was chief cell hyperplasia (78.3 per cent). Of 91 hyperplastic glands submitted for analysis after subtotal parathyroidectomy in those in the MB infusion group, 82 glands (90.1 per cent) were observed to have positive staining with identifiable differentiation from surrounding tissues. Analyses of the correlation of the serum calcium value and probability of MB staining or its relation to serum intact parathyroid hormone (intact-PTH) values were not statistically significant (p greater than 0.05, correlation coefficient equals 0.149). Furthermore, no relationship existed between the glandular size (millimeter to the third power) and probability of MB staining (chi-square equals 1.750, p greater than 0.05) or between hyperplastic size and serum intact-PTH value (correlation coefficient equals 0.068). Conversely, analysis of MB gland staining with regard to intact PTH concentration disclosed 59 of 59 glands stained intensely with MB when intact-PTH concentration was not less than 700 picograms per milliliter (p less than 0.01). Non-staining of hyperplastic parathyroid tissue was observed in 28.1 per cent of glands submitted for histopathologic analysis in which preoperative intact PTH values were more than 699 picograms per milliliter. Time of operation was reduced from 119.0 +/- 47.53 minutes (mean +/- S.E.M.) in control patients to 92.1 +/- 20.12 minutes (mean +/- S.E.M.) for the MB infusion group (V per cent equals 21.85, p less than 0.01). Furthermore, this technique appears to have value in the detection of ectopically located parathyroid tissue as demonstrated by the in vivo staining of seven ectopic glands in six patients of the infused group. Complications were restricted to the patients in the MB infusion group (21.7 per cent) and included: pseudo-cyanosis in three; pain in the infusion site in two, wound hematoma in one patient, pancreatitis in one and angina in one.(ABSTRACT TRUNCATED AT 400 WORDS)

Experimental and clinical observations of the effects of cytotoxic chemotherapeutic drugs on wound healing.

The administration of perioperative doxorubicin HCl (Adriamycin) had profound effects on wound healing for 5 out of 7 breast cancer patients and 5 of 5 melanoma patients following intravenous and intra-arterial infusional chemotherapy, respectively. The clinical observation of significant reduction in wound tear strength (WTS) and wound tear energy ( WTE ) in the group of patients with cutaneous melanoma initiated this experimental analysis. A study of WTS ( kNm -2) in nontumor-bearing (non-TB) and Morris Hepatoma (MH)-7777 (TB) rats treated with therapeutic doses of Adriamycin (ADR) and methotrexate (MTX) was compared with saline-treated controls. Mean tumor volume (cm3) was unaffected by MTX, while significant tumor inhibition (p less than 0.01) was evident for ADR-treated TB animals. A correlation (r = 0.516, p less than 0.01) was observed for tumor volume and WTS. Separate analysis of TB and non-TB animals identified a significant correlation (r = 0.6259, p less than 0.01) between advancing cachexia in TB rats and WTS. A 21-day analysis was done for 160 animals to determine the effect of MTX and ADR on WTS ( kNm -2) and WTE ( Ncm -1). The presence of MH-7777 significantly (p less than 0.01) reduced WTE for TB animals not treated with chemotherapy. TB animals treated with ADR had significant (p less than 0.01) improvement in WTE at day 21 compared with TB controls. This enhancement in WTE was not observed in rats treated with MTX. These clinical and experimental observations suggest significant retardation of the early phases of wound fibroplasia as determined by WTS and WTE following operative trauma and subsequent administration of therapeutic dosages of cytotoxic agents.