B-type Natriuretic Peptide as a Marker of Different Forms of Systemic Sclerosis.

BACKGROUND: Systemic sclerosis (SSc) is an autoimmune connective tissue disease which affects various tissues and organs, including skin, lungs, kidneys, gastrointestinal tract and cardiovascular system. Cardiac involvement is the most commonly recognized problem and a significant cause of morbidity. The brain natriuretic peptide (BNP) is a previously known marker of elevated cardiovascular risk in SSc, but the levels of BNP in various forms of SSc have not been investigated so far. AIM: The aim of our study was to evaluate the influence of SSc on the function of the right ventricle and the right atrium using the echocardiographic parameters. Moreover, we examined the levels of BNP in different forms of SSc as well as the association of disease severity with the plasma concentrations of BNP. METHODS: We included 42 patients with newly diagnosed SSc and patients whose disease had been diagnosed earlier. SSc patients and non-SSc control patients were examined by using echocardiography and the concentrations of BNP were determined. RESULTS: We analyzed differences in the parameters of right ventricle (RV) function and right atrium (RA) function between SSc patients and healthy controls. The two groups had similar distribution of gender, but SSc patients were significantly older than controls. RV wall thickness was increased in SSc patients (p<0.001), while right ventricular end-systolic area (RVESA; p=0.408) and right ventricular end-diastolic area (RVEDA; p=0.368) did not differ among the examinees. In contrast, RA minor-axis dimension (p=0.001) and the tricuspid annular plane systolic excursion (TAPSE) (p=0.001) were significantly higher in SSc patients. Also, we analyzed differences in brain natriuretic peptide (BNP) concentrations between diffuse cutaneous systemic sclerosis (DSSc) and limited cutaneous systemic sclerosis (LSSc) patients. DSSc patients had significantly higher concentrations of BNP. We found that levels of BNP were in significant positive correlations with age (p=0.007), disease duration (p=0.023), C reactive protein (CRP) (p=0.032), right ventricle fractional area change (FAC) (p=0.022), pulmonary vascular resistance (PVR) and Rodnan score (p=0.019). CONCLUSIONS: Given the obtained results, the laboratory determination of BNP could be useful in differentiating different forms of systemic sclerosis as well as in predicting the severity of the disease and future cardiovascular complications.

Outcome of orthograde endodontic retreatment--A two-year follow-up.

INTRODUCTION: Endodontic retreatment is a complex intervention that requires detailed analysis of possible reasons for failure, and flawless practical execution of the procedure. OBJECTIVE: The aim of the study was to assess the outcome of endodontic retreatment based on clinical and radiographic criteria after a two-year observation period. METHODS: Clinical study included 49 teeth indicated for endodontic retreatment based on periapical index (PAI). All teeth were divided into two groups. Group I comprised teeth without any periapical lesion (PAI score of 1 and 2) while Group II consisted of teeth with visible periapical radiolucency (PAI score of 3, 4, and 5). Endodontic retreatment was completed in two visits with inter-appointment medication of 2% chlorhexidine and calcium hydroxide for two weeks. Outcome of endodontic retreatment was evaluated 12-24 months after final obturation. RESULTS: Endodontic retreatment was successful in 93.3% in Group I after 24 months. In Group II, successful treatment and complete healing was found in 52.9% of teeth, whereas 14.7% of teeth showed only partial healing. However, clinical symptomatology was not present in any of the cases. Considering the absence of clinical signs and subjective symptoms, retreatment was successful in 67.6% of cases where chronic periapical inflammation was present. CONCLUSION: Endodontic retreatment was successful in high percentage in teeth with and without periapical lesions.

[Possibilities of endodontic therapy of endodonic-periodontal lesions].

INTRODUCTION: Endoperiodontal lesions are frequent in clinical practice and may require complex therapy. It is very important to determine differential diagnosis and the origin of the lesion, because the treatment plan is based on aetiology and stadium of the development of the lesion. OBJECTIVE: The aim of this clinical study was to analyze the efficacy of endodontic treatment in different types of endodontic-periodontal lesions. METHODS: Thirty patients and 42 teeth with diagnosed endoperiodontal lesions were included in the study and divided in two groups. Vital pulp therapy was applied to 18 vital teeth where the diagnosis was perio-endodontic lesions. The therapy of infected canal system was applied to 24 teeth with endodontic-periodontal or combined lesions. Standard endodontic procedure consisted of cleaning and shaping of the root canal system and between sessions filling with calcium-hydroxide paste. Obturation was made by lateral compact of the guttapercha and Apexit paste. Efficiency was evaluated clinically and radiographically three, six and twelve months later. RESULTS: Radiographic and clinical follow-up showed a significant radiographic improvement and absence of subjective symptoms in a very high percentage of the treated vital and avital teeth. The results of this study showed that in the observation period of 12 months endodontic therapy was successful in 88.89% of vital teeth, and in the group of avital teeth the percentage was 91.67%. CONCLUSION: Endodontic treatment of the endoperiodontal lesions was sufficient and it was the basic condition to achieve a complete healing of endodontic-periodontal lesions. Such therapy ensures significant improvement or even complete healing of both types of lesions, of endodontic and periodontal origin.