Ridge augmentation with titanium mesh: A case report.

Insufficient bone volume for dental implant placement in the maxillary anterior segment is a constant challenge in oral surgery. Several techniques have been suggested to reconstruct deficient alveolar ridges and to facilitate dental implant placement. These techniques include bone splitting osteotomy, distraction osteogenesis, inlay and onlay bone grafting. Guided bone regeneration (GBR) is also a promising alternative that increases the bone volume by the use of a subperiosteal barrier. AIM: The aim of this case was to demonstrate that the use of rigid titanium occlusive barrier is a reliable alternative to perform a lateral alveolar bone augmentation and treat localized ridge deformities before reaching an ideal implant placement. OBSERVATION: A 25-year-old healthy male was referred for implant placement in the maxillary central incisor. The alveolar bone width at the implant site 21 was less than 5mm. Hard tissue augmentation was accomplished using guided bone regeneration. A rigid titanium occlusive barrier was customized to desired shape of future alveolar ridge then secured with tent and fixing screws. Autogenous bone graft harvested with an auto-chip-maker adjacent to the surgical site were mixed with a xenograft and putted under the barrier. The wound was closed using a vestibular mucoperiosteal flap. At 4 months, the rigid barrier was removed, and a 7mm crestal width transversal bone was observed. At the same time, a fixture (4×10mm) was placed. A definitive ceramometal crown was completed after full osseointegration with periodical clinical maintenance. The exposure of the titanium mesh occurred in this case and was visible with a circular flap dehiscence at 1-month follow-up visit. This exposure did not affect the successful regenerative outcomes. After removal of the titanium mesh from the grafted defects, the space beneath the membrane enclosure was seen to be almost completely filled with new hard tissue covered by a thin layer of soft tissue. The postoperative follow-ups revealed that the implant was stable with excellent osseointegration and the buccal depression of the surgical area was reconstructed. CONCLUSION: The use of rigid titanium occlusive screwed barrier with autogenous and bovine bone graft might be a reliable technique for alveolar ridge reconstruction. This approach achieve excellent final esthetic outcome of the implant-supported restoration.

[Association of renovascular hypertension and primary aldosteronism]. / Association d'une hypertension artérielle rénovasculaire et d'un hyperaldostéronisme primaire.

INTRODUCTION: Renal artery stenosis is rarely associated with Conn adenoma. CASE REPORT: We report a 27-year-old male patient who presented in 2001 with a severe high blood pressure associated with hypokaliemia. Radiologic investigations showed a left renal artery stenosis with agenesis of left kidney. A left nephrectomy was performed and blood pressure returned to normal with a single antihypertensive drug. Five years later, the patient again presented with severe high blood pressure. Laboratory studies revealed a low serum potassium level at 2.8 mmol/L associated with high urinary potassium excretion (84 mmol/24h) and a very high aldosterone/renin ratio (>462). Abdominal CT scan demonstrated a right adrenal mass. The patient underwent a right adrenalectomy (adenoma). Blood pressure returned to normal with a single antihypertensive. Serum potassium levels as well as aldosterone/renin ratio normalized. CONCLUSION: We discussed whether the association between these two entities is merely fortuitous or conversely based on a causal relationship.

[CRP and micro-albumin: new markers of cardiovascular risk in type 2 diabetes]. / CRP et micro-albuminurie : nouveaux marqueurs du risque cardiovasculaire chez les diabétiques de type 2.

INTRODUCTION: Type 2 diabetes is a chronic disease associated to the presence of multiple risk factors. Among recently studied factors we cite PCR and micro-albumin. OBJECTIVE: In the present study we intend to determine the correlation between urine albumin excretion rate, CRP levels and type of vascular complications in type 2 diabetes. PATIENTS AND METHODS: We recruited 48 type 2 diabetic subjects subdivided into three groups according to the type of vascular complications (GI: type 2 diabetics without complications, GII: type 2 diabetics with microvascular complications and GIII: type 2 diabetics with macrovascular complications). RESULTS: We found a significant elevated levels of CRP and micro-albumin (P<0.05) when we compared diabetics with vascular complications to those without any complications. Diabetics with macrovascular complications have the highest levels of CRP and micro-albumin. Significant positive correlation was found between CRP and micro-albumin levels in a total group of diabetics (r=0.32; P<0.05). CONCLUSION: The determination of CRP and microalbumin levels represents an interest in the screening of cardiovascular disease in type 2 diabetics.

[Hypopituitarism and antiphospholipid syndrome]. / Hypopituitarisme et syndrome des antiphospholipides.

Endocrine disorders seen in antiphospholipid syndrome are rare. To date, these disorders have generally involved Addison's disease. Recently reports have appeared of a few cases of primary or secondary hypopituitarism associated with primary antiphospholipid syndrome. We report the case of a young female patient who presented neuroendocrine symptoms during the postpartum period associated with an antiphospholipid syndrome. Hormone assessment showed complete anterior hypopituitarism and antiphospholipid antibodies were positive. We discuss the clinical, biological and radiological features observed in our patient and compare results with cases reported in the literature. This case illustrates the importance of screening for antiphospholipid syndrome in the etiological work-up of hypopituitarism associated with a history of recurrent thrombosis.

[Psychopathological and psychotherapeutic approach to the first psychotic episode]. / L'approche psychopathologique et psychothérapeutique d'un premier épisode psychotique.

The studies and research on the psychopathology of delusions are extremely numerous and varied and have resulted in the construction of psychoanalytic, systemic, cognitive and other explanatory models. All the theories stress the interaction between the subject and his/her environment, in particular when an initial psychotic episode emerges. In addition to their etiopathogenic interest, these models have the advantage of constituting specific therapeutic approaches, which indubitably increase the impact of treatment when associated with chemotherapy.