Unexpected resilience to experimental gingivitis of subepithelial connective tissue grafts in gingival recession defects: a clinical-molecular evaluation.

BACKGROUND AND OBJECTIVE: The subepithelial connective tissue graft (SCTG) is the most widely used procedure for the treatment of gingival recession defects. Little is known, however, as to whether the apposed gingival flaps are more predisposed to develop plaque-related inflammation compared to healthy sites. This has salient clinical implications, as the long-term results of root coverage will depend largely on the level of inflammation of the grafted tissue. METHODS: In the present split-mouth case-control study, clinical and biomolecular parameters were used to assess the level of inflammation of periodontal sites 12 mo after treatment with SCTG (test) and healthy non-treated gingivae (control) following the induction of plaque-related gingivitis in 19 patients. RESULTS: The data showed that test sites had a significantly (P < 0.05) lower gingival index and angulated bleeding score compared to control sites (gingival index = 1.05 ± 0.23 vs. 1.34 ± 0.47; angulated bleeding score = 0.34 ± 0.37 vs. 0.61 ± 0.39) after induction of experimental gingivitis, whereas the plaque index did not differ in the two groups (P > 0.05). With regard to the biomolecular parameters, baseline levels of the proinflammatory cytokine interleukin-1ß were higher in the gingival crevicular fluid of test sites. However, control sites exhibited more pronounced increase in the levels of interleukin-1ß compared to test sites, upon plaque accumulation, so that the final concentration was similar in both groups. No changes were recorded in the gingival crevicular fluid volume. CONCLUSION: Analysis of the data demonstrates that the sites of gingival recession treated with SCTG develop a lower degree of plaque-induced inflammation compared to healthy gingivae. This strongly suggests that SCTG does not predispose to inflammation and to further gingival recession and makes it a safe technique in the treatment of gingival defects.

[Hashimoto's thyroiditis and autoimmunity parameters: descriptive study]. / Tiroidite di Hashimoto e parametri di autoimmunità. Studio descrittivo.

AIM: Aim of the study is a prospective evaluation of the simultaneous presence of antinuclear antibodies (ANA) in patients with Hashimoto's thyroiditis as a sign of a possible occurrence of another autoimmune disease. METHODS: Thirty two patients with Hashimoto's thyroiditis have been selected. No other immunological parameters have been used for the selection. All the patients have been submitted to ANA research and to thyroid colour-Doppler ultrasonography. Moreover, subgroups of patients have been submitted to the research of other autoimmunity parameters: 25 patients to AMA (anti-mitochondrial antibodies), ASMA (anti-smooth muscle antibodies), ENA (extractable nuclear antigens) and anti-double stranded-DNA; 7 patients to anti-gastric mucosa; 8 patients to ACA (anti-cardiolipin antibodies) IgM and IgG; 12 patients to rheuma-screen. Twenty five patients were under L-thyroxine therapy at the time of the samples. RESULTS: Forty-seven percent of the patients were ANA positive. Of them 60% showed a title of 1:40. The most frequent sonography picture was pseudo-nodular (66%) with predominance in ANA negative subgroups (71%) than in ANA positive one (60%). On the basis of all the autoimmune parameters evaluated in every subgroups, 72% of our patients were positive to at least one autoimmunity parameter and/or have an autoimmune disease besides Hashimoto's thyroiditis. CONCLUSION: The conclusion is drawn that the patient with Hashimoto's thyroiditis should be considered as an autoimmune patient. Thus, it is necessary to carry out an autoimmune screening with ANA in every new diagnosed patients and to study in depth the familiar and phatological history. Periodical checking of the autoimmune parameters should not be underestimated in these patients.

[Relationship between insulin secretion, and thyroid and ovary function in patients suffering from polycystic ovary]. / Relazione tra secrezione inslinemica, funzionalitá tiroidea ed ovarica, in pazienti affete da ovaio .

AIM: The present paper investigates the relationship between polycystic ovary syndrome, hypothyroidism and insulin-resistance and how, by submitting patients to a specific therapy for any one of the three pathologies, we also obtain an improvement in the other associated pathologies. METHODS: We selected 45 patients aged between 16 and 25 with problems of polycystic ovary syndrome, hypothyroidism and insulin-resistance and divided them into 3 groups. The 15 Group A patients followed a dietetic therapy. The 15 patients of Group B received hormonal therapy. The 15 Group C patients received replacement therapy with laevo-thyroxine. All patients had their thyroid and ovary function checked every six months and a glycoinsulinaemic curve was plotted after glucose loading. RESULTS: A reduction in TSH levels and an increase in the values of circulating thyroid hormones was observed in all patients. The ovary situation underwent both a hormonal and symptomatological improvement with diminution in LH and testosterone levels and an increase in progesterone. The glucose-insulin picture of our patients progressively improved in all 3 groups studied. CONCLUSIONS: The data obtained in our study enable us to support the close connection between ovary function, thyroid function and insulin-resistance. In all patients, in fact, albeit at different times, an improvement was obtained in all 3 pathologies.

[Necrotising histiocytic lymphadenitis in a patient with hypothyroidism. Aetiopatho-genesis and description of a rare clinical case]. / Linfoadenite istiocitica necrotizzante in paziente con ipotiroidismo. Eziopatogenesi e descrizione di un raro caso clinico.

Necrotising histiocytic lymphadenitis or Kikuchi-Fujimoto's disease is a rare benign disease characterised by cervical necrotising lymphadenopathy, high temperature, asthenia with complete restitutio ad integrum of the lymphnodal stations affected. A female patient A.B., aged 36, reached our clinic at the Medical Physiopathology Department of Rome's Umberto I Polyclinic in March 2001 for an endocrinological examination. The patient reported symptoms that led us to suspect hypothyroidism, a diagnosis that was later confirmed by haematochemical examinations and treated with Eutirox 100 g. After one month the patient returned to our clinic complaining of intensive asthenia, a feeling of general malaise, lack of appetite, serotin fever and painful laterocervical lymphadenopathy. Lymphnode biopsy gave an outcome of NHL. The histological finding suggested we should treat the case with anti-inflammatory drugs and after one month the symptoms had substantially retreated. To conclude, we suppose there is a possible relationship between the viral aetiology with chronic evolution of hypothyroidism in our patient and that of NHL.

[Hydatid cyst of the kidney. Case report]. / Cisti idatidea del rene. Descrizione di un caso.

The authors present a case of echinococcosis of the kidney that is interesting because of the uncommon site of localization; they illustrate their diagnostic and therapeutic approach to surgical and pharmacological management of the infection. Epidemiologically, hydatid cysts localized in the kidney occur far less often in northern Italy compared with the central-southern areas and the islands. However, echinococcosis should be suspected whenever symptoms include lumbar pain or swelling. Echography will reveal characteristic capsule and daughter cysts, while radiographic studies will often show a rim of calcification on the outline of the kidney. This information should be considered in conjunction with serologic tests (IgG-specific titers). If results to these tests are negative, abdominal computed tomography scans with contrast medium may be useful in demonstrating more details to establish diagnosis. Conservative (pericystectomy) or radical (nephrectomy) surgery is usually effective in curing the patient. Pharmacological therapy with albendazole can be a useful support in association with surgery or as an alternative single therapy in patients with other medical problems or spontaneous fistula formation that preclude surgery.

[Growth disorders in Down's syndrome: growth hormone treatment]. / Disturbo della crescita nella sindrome de Down: terapia con ormone della crescita.

BACKGROUND: The aim of the study was evaluate the short and long-term effects of growth hormone therapy in subjects affected by Trisomy 21. METHODS: The growth curves of 10 Down's syndrome patients (3 males and 7 females) aged between 21 and 35 years old were analysed. During pre- or peripuberty these subjects had received growth hormone (GH) therapy lasting an average of 3.02 years. At distance of between 10 to 15 years after the end of GH therapy, routine laboratory tests (thyroid hormones, glycemia, glycosylated hemoglobin, transaminase) were carried out together with a full hematological assay (hemochrome using leukocyte formula, morphological study of blood components). RESULTS: GH therapy resulted in an increased rate of growth among these subjects and a improvement in final stature of 5.16 cm in males and 7.35 cm in females. The long-term controls did not reveal any hematological changes or changes in HbA1c concentrations, thyroid function and hepatic function, thus confirming the absence of collateral effects of GH therapy in subjects with Down's Syndrome. CONCLUSIONS: In view of these results, we are convinced that GH therapy is extremely positive in trisomy 21, given the marked improvements in terms of growth, the absence of collateral effects and the possible psychological benefits of increased stature, in particular a better insertion in society.

[Melatonin/circadian rhythm. Is there a feedback between epiphysis and hypophysis?]. / Melatonina orologio biiologico. Esiste un feedback tra epifisi ed ipofisi?

BACKGROUND: The study evaluates the circadian rhythm of melatonin in relation to sex and age and identified contemporary alterations in the secreton of some hypophyseal hormones, suggesting that melatonin may exert a modulatory action on the latter. METHODS: The melatonin metabolite (6-hydroxymelatonin sulfate) was assayed in urine samples from 48 subjects of both sexes aged between 25 and 60 years old using the RIA method described by Arendt, modified for the ise of iodine markers. A blood sample was taken from the same subjects to assay hypophyseal hormones. RESULTS: Melatonin secretion does not remain constant over 24 hours in young subjects of both sexes, but instead is rhythmic. This rhythmic secretion is lacking in adults, revealing a daytime pineal secreton that is surprisingly higher than in younger persons. A difference in secretion levels was also found between sexes, a higher melatonin peak in females compared to males. Some young female subjects reveal a contemporary hypersecretion of the somatotropic hormone in line with the falling nocturnal peak of melatonin. Subjects with latent hypothyroidism show a diminished melatonin peak compared to that in euthyroid subjects. CONCLUSIONS: Changes in pineal secretion between the second and sixth decade of life are characterised by the loss of rhythmic secretion, linked not only to the loss of the nocturnal peak but an increased daytime secretion compared to younger subjects. The other finding that emerged from this study was the difference in secretion levels between the sexes. Lastly, we affirm that the pineal gland may exert a modulating influence on the hypophysis.

Randomized comparison of goserelin acetate versus mitomycin C plus goserelin acetate in previously untreated prostate cancer patients with bone metastases.

In a prospective trial conducted by the Gruppo Onco Urologico Piemontese, newly diagnosed prostate cancer patients with bone metastases were randomized to receive goserelin (3.6 mg subcutaneously every 4 weeks) or goserelin plus mitomycin at 14 mg/m2 i.v. every 6 weeks. Treatment was planned to be continued until progression. The study was interrupted because of inadequate accrual rate when 63 patients had been recruited. A long-term follow-up (median, 47 months), performed to counterbalance the limited number of patients included, revealed no difference in time to progression and overall survival between the study treatments. However, 56.5% of assessable patients allocated to the chemotherapy arm presented a > or =90% reduction of prostate-specific antigen levels compared with 36.3% in the goserelin group, and previously elevated levels normalized in 73.9% versus 45.4%. Non-progressing patients received 5-7 cycles of mitomycin C with acceptable toxicity, but the cytotoxic treatment was interrupted early in all cases within the first year due to cumulative myelotoxicity. In conclusion, the results, although inconclusive, fail to support a clear advantage in terms of cost/benefit of chemotherapy plus hormone therapy over hormone treatment alone in advanced prostate cancer with bone involvement.

Osteoblastic flare assessed by serum alkaline phosphatase activity is an index of short duration of response in prostate cancer patients with bone metastases submitted to systemic therapy.Gruppo Onco Urologico Piemontese (G.O.U.P).

A transient rise in serum alkaline phosphatase (ALP) activity (ALP flare) after androgen deprivation in prostate cancer patients with bone metastases has been previously correlated with both response to therapy and poor prognosis. In the present study we analyzed data coming from an Italian multicenter phase III, trial aimed to compare the efficacy of treatment with goserelin alone with that of goserelin plus mitomycin C. Sixty-seven bone metastatic patients were enrolled: 32 were treated with goserelin and 35 with and goserelin plus mitomycin. 58 cases had ALP measured every month; and were considered for flare assessment. Remarkably elevated ALP and PSA levels at baseline were significantly correlated with poor prognosis. The addition of mitomycin to goserelin resulted in a greater percent reduction of PSA values with respect to goserelin alone but did not augment the time to progression and overall survival. The monthly profile of ALP serum levels was superimposable in patients assigned to hormone therapy or chemotherapy plus hormone therapy. Patients showing a flare in ALP activity (transient rise > 15% in ALP values with respect to baseline at the first month) were classified as responders to therapy or as having stable disease upon PSA evaluation and/or at bone pain assessment, but had a shorter time to progression (median 12 months) in comparison to those showing a different ALP pattern (median 23 months). The measurement of flare in ALP activity during androgen suppression with or without concomitant mitomycin administration, may permit the early identification of patients who are likely to progress rapidly, and hence be candidate for more aggressive treatments.

[Adrenal angioma simulating pheochromocytoma]. / Angioma surrenalico simulante un feocromocitoma.

The authors report a case of adrenal angioma (a rare benign mesenchymal tumour) which was diagnosed by chance ("incidentaloma") and whose clinical and instrumental characterisation led to the hypothesis of a pheochromocytoma. The various diagnostic methods used are analysed together with results and the possible causes of their erroneous interpretation.

[Metabolism of somatotropin in severe liver diseases. Influence of the therapeutic administration of a liver extract]. / Il metabolismo dell'ormone somatotropo nelle gravi epatopatie. Influenza della somministrazione terapeutica di un estratto epatico.

Metabolic Clearance Rate (MCR) and half life of 125I Human Growth Hormone (HGH) have been studied in hepatopathic patients. A clear reduction of MCR and a prolongation of HGH half life have been found in all patients examined. After a 30 day therapy with crude liver extract (F.U. VIII ed.) both MCR and HGH half life have shown a tendency towards normalization. These findings are in agreement with the marked improvement of the clinical state of the patients and with the normalization of the laboratory indexes.

Hepatic activity in the generation of somatomedins: effects of administration of a liver extract.

The problem of the generation of growth factors (somatomedins) (SM) is at present a matter of investigation. The liver has been proposed as the primary site of production of SM. In order to verify this hypothesis, SM activity has been assayed in patients with impairment of liver function. The subjects have been divided into three groups according to the severity of the hepatic damage, assessed with conventional diagnostic tests. In every group, somatomedin A (ASM) has been assayed by means of a biological procedure, in basal conditions and after treatment with a liver extract. The results show that the ASM activity is reduced in proportion to the degree of hepatic damage. The administration of liver extract restores the production of the ASM in the first two groups of patients, i.e. in those with mild and moderate hepatic involvement.