Counteracting side effects of combined oral contraceptives through the administration of specific micronutrients.

OBJECTIVE: The occurrence of side effects related to the use of combined oral contraceptives (COCs) - or even the fear of them - often affects patients' compliance and their quality of life. Such adverse effects include both physical and psychological alterations. Therapies based on COCs are related to lower levels of vitamins and minerals, including vitamins B, C and E, zinc, magnesium, and selenium. This review gathers scientific evidence about the effectiveness of the administration of specific micronutrients to address nutritional needs and recover adverse conditions. MATERIALS AND METHODS: We reviewed literature searching through different databases (MEDLINE, Scopus, Google Scholar). We used different keywords, including micronutrients, COCs, side effects, B vitamins, vitamin C, vitamin E, vitamin D, zinc, magnesium, selenium and Centella Asiatica. We narrowed the search down to English literature, including both preclinical and clinical studies. The outcome of database search was to highlight beneficial effects of specific micronutrients on the evaluated side reactions. RESULTS: Based on the collected evidence, dietary supplementations of specific micronutrients, whose depletion occurs during COC treatments, have significant beneficial effects. By acting on different aspects and pathways, such supplementation prevents and counteracts discomforts and side effects related to COC treatments. CONCLUSIONS: Considering the wide use of OCs, taking appropriate dietary supplements could be an effective approach in clinical practice, tailoring therapies and improving both safety and tolerability.

Unopposed estrogens: current and future perspectives.

Estrogens and progestogens act on female reproductive tissues in opposite ways. As they counteract each other actions, the correct balance between these two classes of hormones is pivotal to avoid dangerous states. Unopposed estrogens occur when progestogen levels do not balance estrogens, primarily deriving from overproduction of estrogens via aromatase enzyme. In the endometrium, unopposed estrogens induce proliferative or invasive phenomena, which represent the first step toward different diseases. These pathologies include endometrial hyperplasia, endometrial polyps, endometriosis and adenomyosis. Endometrial hyperplasia and polyps are proliferative pathologies, while endometriosis and adenomyosis are characterized by the invasion of other tissues by endometrial cells. Current pharmacological treatments include Gonadotropin-Releasing-Hormone analogs, aromatase inhibitors and progestogens, either alone or in combination with estrogens. As these drugs usually lead to burdensome undesired effects, researchers seek to find new therapeutical molecules. Recent literature highlights the positive effects of metformin, an insulin sensitizing drug that reduces the insulin proliferative stimulus on the endometrium. d-chiro-inositol is an insulin second messenger with insulin sensitizing and mimetic properties, recently described as an aromatase down-regulator. Based on current evidence, d-chiro-inositol may be useful to treat the pathologies responsive to unopposed estrogens.

Vitamin D plus epigallocatechin gallate: a novel promising approach for uterine myomas.

OBJECTIVE: Uterine myomas are the most common benign tumors in females. Most myomas are asymptomatic and require no intervention or further investigations; however, almost a third of women with myomas will require a therapy. Treatment options include pharmacological approaches or surgery, and depend on symptomatology, size, number and desire for future pregnancy. Minimally invasive procedures or alternative medical treatments for handling myomas are preferred, when possible, to the radical abdominal surgery. Vitamin D and epigallocatechin gallate (EGCG) recently proved effective in the management of these benign tumors. Our aim was to verify the effect of combined oral vitamin D and EGCG supplementation in symptomatic women with myomas. PATIENTS AND METHODS: Symptomatic women with myomas were enrolled in this pilot study and divided in two groups: one group treated daily with two tablets of 25 µg vitamin D + 150 mg EGCG + 5 mg vitamin B6, for 4 months; the other group received no treatment (control), for the same period. Volume, number of myomas as well as severity of symptoms (SS) and quality of life (QoL) were analyzed. RESULTS: The total myoma volume significantly decreased by 34.7% in the treated group, whereas it increased by 6.9% in the control group. An improvement in the QoL of women treated with vitamin D, EGCG and vitamin B6 was reported along with a reduction of the SS. CONCLUSIONS: The combined supplementation of vitamin D and EGCG seems to be an optimal approach for the management of myomas and correlated symptoms. For the first time, we showed the cooperative effectiveness as a promising and novel treatment for myomas.

Role of mesenchymal stem cells in osteotomy sinus graft healing: a case report and a literature review.

Prosthetic rehabilitation of the edentulous posterior maxilla with implant-supported prostheses frequently presents a challenge for the oral surgeon because of the lack of bone due to alveolar ridge resorption or maxillary sinus pneumatization. To overcome these problems, different solutions were proposed over the years. Maxillary sinus membrane elevation is a common surgical technique for increasing bone height in the posterior maxilla prior to dental implant placement. However, the biological nature of bone regeneration in maxillary sinus membrane remains largely unidentified. The authors present a clinical case and literature review to understand the fundamental of bone formation in osteotomy sinus floor elevation.

Evaluation of the degree of differentiation of human mesenchimal stem cells on different titanium superfaces: a pilot study.

The aim of our study was to evaluate the properties of a laser-modified titanium surface, specifically the promotion of a faster differentiation of human Mesenchymal Stem Cells (hMSCs) into osteoblasts and a more stable connection between differentiated cells and titanium, compared to machined and sand-blasted surfaces. Furthermore, we wanted to assess if the titanium alone could be a sufficient factor in the induction of the differentiation towards the osteogenic lineage. MATERIALS AND METHODS: we harvested stem cells from an individual (under his consensus) and cultivated them into dishes containing titanium disks presenting three different surfaces: machined (M), sand-blasted (S) and laser-modified (L). In the test group, cells were cultivated in an osteogenic medium, while in the control group, cells were seeded in a standard DMEM. Evaluations of the degree of differentiation were made with Alizarin coloration after 28, 38, 42, 49, 56 and 63 days from induction. RESULTS: no signs of differentiation were evident in the control group, while in the test group there was a statistically significant differentiation, evident since the fourth week. Laser-modified and sand-blasted surfaces showed similar values, higher than the machined surface. DISCUSSION: on the laser-modified surface the differentiation reached its peak on the sixth week, while on the seventh week for the other two surfaces. After the peak, the differentiation showed a slow decrease for the laser-modified surface and a rapid decrease for the other two. CONCLUSIONS: titanium alone can't be considered enough to induce differentiation of human Mesenchymal Stem Cells into osteoblasts. Still, the laser-modified once induced a faster differentiation of stem cells and a more stable connection between osteoblasts and titanium.

Alpha Lipoic Acid (ALA) effects on subchorionic hematoma: preliminary clinical results.

OBJECTIVE: The clinic use of alpha Lipoic Acid (ALA) is linked to its capability to exert antioxidant effects and, more interestingly, to counteract the pathologic changes of complex networks of cytokines, chemokines and growth factors, restoring their physiological state. The aim of this randomized controlled clinical trial was to test the contribution of oral supplementation of ALA to the standard treatment with Progesterone vaginal suppositories, in healing subchorionic hematomas in patients with threatened miscarriage. Controls were administered only Progesterone suppositories. PATIENTS AND METHODS: Nineteen pregnant women in the first trimester of gestation, with threatened miscarriage and ultrasound evidence of subchorionic hematoma, were included in the trial and randomly divided in two groups: controls, treated with 400 mg Progesterone (200 mg 2 times per day), given by vaginal suppositories, and case study treated with the same Progesterone dosage, plus ALA, given orally at the dose of 600 mg (300 mg 2 times per day, DAV®, Lo.Li. Pharma srl, Italy). Sixteen patients completed the trial. Treatment was performed until complete resolution of the clinical picture. RESULTS: In both groups, the subjects improved significantly but, in general, a better and faster evolution in the major signs of threatened miscarriage was observed in the subjects treated with ALA and Progesterone. In these patients, the speed of resorption of subchorionic hematoma was significantly (p ≤ 0.05) superior compared to controls. The ALA and Progesterone group showed a faster decrease or disappearance of all symptoms than that observed in the control group, however the difference was not significant. CONCLUSIONS: These preliminary results suggest that ALA supplementation significantly contributes to speed up the process of restoration of physiological conditions in threatened miscarriage and ameliorates the medical conditions of both the mothers and the foetus, probably modulating the networks of cytokines, growth factors and other molecules.

Treatment of craniofacial fibrous dysplasia: a case report.

The concept of "fibro-osseous lesions" of bone has evolved over the last several years and now includes two mayor entities: the fibrous dysplasia (FD) and the cement-ossifying fibroma (COF). Fibrous dysplasia is considered to be a developmental, tumor-like (hamartomatous), fibro-osseous disease of unknown etiology. There is a maxillary predominance when craniofacial FD occurs in the jaws and the maxillary sinus is commonly involved. Differentiation of OF from FD is important because of differences in treatment and behaviour. This article report a case of 60-year-old female with a history of painless unilateral palatal swelling.

Piezolelectric surgery in dentistry: a review.

In the last ten years was observed a significant increase of publications about piezoelectric bone surgery. The purpose of this review was to define the state of art and to realize a comparison between piezoelectric devices and manual or rotating traditional techniques, analyzing advantages and disadvantages from a clinical and histological point of view for various dental procedures. The literature review has been carried out using medical databases on line: MEDLINE and COCHRANE LIBRARY. The authors selected 37 publications about dental field and consistent with inclusion criteria established. From the clinical point of view, the analysis of selected publications concerning procedures such as maxillary sinus lift, alveolar ridge expansion, samples of autologous bone, etc, showed surgical trauma reduction, especially towards to soft and nervous tissues, surgical mini-invasiveness, cut precision and selectivity and speed of learning guaranteed by piezoelectric devices compared to traditional ones. Histologically, however, the study of biology and postintervention bone tissue healing showed a lower loss of bone with piezoelectric instruments than with conventional devices, as well as a better healing quality by reducing patient's postsurgery morbidity. The use of piezoelectric devices seems thus to simplify different sinus lift surgical procedures and to allow greater predictability, although some studies reveal that there are not substantial differences in comparison of long-term results between conventional and piezoelectric instruments and also criticize their increase in operation time.

[Effectiveness of a new cervicometer in evaluating the risk of preterm delivery]. / Validità di un nuovo cervicometro per la valutazione del rischio di parto pretermine.

AIM: The ultrasound measurement of the cervix is the gold standard for assessing the risk of preterm delivery. We compared the accuracy of this technique with measurements obtained by the cervicometer Cervilenz®. The purpose was to show that this device can be used as a screening tool, low cost, in the diagnosis of preterm labor. METHODS: Fifty patients were included in the study at gestational age between 21+0 and 26 +0 or weeks. The study was blinded between the two performers utilizing the cervicometer and the transvaginal ultrasound. RESULTS: The study showed 100% concordance and a correlation between the two techniques of 0.94. CONCLUSION: The cervicometer proved to be a reliable and easy to use device to detect a normal or short cervix, with contained healthcare costs.

[Nuchal translucency and combined test: what are the implications in clinical practice?]. / La translucenza nucale e il test combinato: quali risvolti nella pratica clinica?

AIM: The aim of this study was to evaluate the performance of the combined test (nuchal translucency, NT) and maternal serum free-beta human chorionic gonadotropin (free beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A), compared to the NT measurement alone, in fetal aneuploidy screening in the general population and in pregnant women aged 35 years and over. In addition, the association between increased NT and presence of cardiac defects in fetuses with normal karyotype was evaluated. METHODS: Screening at 11-14 weeks of gestation by NT measurement and combined test was carried out in 1521 pregnant women. The estimated risk for trisomy 21 and trisomy 13+18 was calculated (risk cut-off 1/300 and 1/750 respectively) and the outcomes was evaluated. RESULTS: Ten cases of trisomies (21 and 18) occurred, seven of which among the older group of pregnant women. The detection rate (DR) for the combined test was 80% in the general population and 85.7% in older pregnant women, which resulted higher rate than NT measurements alone. Detection rate of cardiac defects using NT measurements was 66.6%. CONCLUSION: The combined test is an effective screening for aneuploidies and reduces at 14% the need of invasive testing in the older obstetric population, detecting all the trisomies occurred in this group. The association between increased NT and cardiac defects is confirmed but it seems too weak to consider NT as a single screening strategy for these abnormalities.

Manejo de las atrofias del maxilar superior clase V de Cawood y Howell mediante la adopción de la cirugíapiezo eléctrica / The management of atrophies classified as v class according to Cawood & Howell by piezo-electric surgery

Introducción: Los casos analizados presentaban atrofias severas (V clase según Cawood y Howell) (1), que se caracterizan por presentar una densidad de la cresta transversal inferior a 4 mm y vertical inferior a 6 mm; ello hace pensar en la posibilidad de una rehabilitación implanto-soportada. Objetivo: Evaluación de la rehabilitación de pacientes afectados por severa atrofia del maxilar superior clase V según Cawood y Howell) (1) rehabilitados con elevación del seno maxilar e injerto de hueso autólogo. Materiales y métodos: Estudio longitudinal a partir de una muestra de 32 pacientes, con atrofia maxilar severa y edentulismo parcial o total. En todos los pacientes se ha colocado un injerto con técnica de reconstrucción onlay mono o bicortical y se ha adoptado la cirugía piezoeléctrica para realizar el elevación del seno, el cual podía ser mono o bilateral, de hueso autólogo procedente de la cresta ilíaca anterior. Seguimiento realizado durante 2 años. Resultados: A los dos años del control final, el 94,05% de todos los implantes colocados tras la intervención de elevación se presentan osteointegrados y cargados protésicamente. La cresta ilíaca anterior resulta ser la zona idónea para la extracción medular, necesaria para la elevación del seno. Las posibilidades de supervivencia del implante son realmente elevadas si se espera el tiempo clínico necesario para la recuperación y la integración del injerto. El éxito de todas las intervenciones de elevación del seno maxilar se debe a la adopción de la cirugía piezoeléctrica, que permite efectuar la incisión de entrada y realizar el desprendimiento de los tejidos con un traumatismo mínimo para la membrana de Schneider. La integridad de la membrana y la utilización de bone-chips de origen autólogo no ha hecho necesario recurrir a la utilización de membranas reabsorbibles, simplificando así el procedimiento quirúrgico. La utilización de la cresta ilíaca anterior como zona donante, permite disponer de abundante tejido óseo cortical, necesario para colocar los onlay y para reconstruir el defecto óseo (AU)

Introduction: Valutation of rehabilitated patients by sinus lift in upper jaw and by autologous bone graft from iliac crest. Materials and methods: Rehabilitation of 32 patients with severe atrophies of upper jaw and partial or total edentulism by positioning of mono- or bicortical onlay with piezosurgery toobtain a sinus lift mono- or bilateral by autologous bone grafts from anterior iliac crest. Results: 94.05% of successes after a two years follow-up. Conclusions: Respecting of timing surgery, a correct use of the piezosurgery technique and of the autologous bone graft from anterior iliac crest let a successful implantological rehabilitation. Moreover the iliac crest is a very good donor site of bone tissue for the management of severe atrophies in the upper jaw. An accidental laceration of Schneider’s membrane was observed infilling phase in the 5.26% of cases (AU)

Reconstrucción preimplante con hueso autólogo deprocedencia sinfisaria en la rehabilitación de defectosóseos transversales de los maxilares: protocoloa realizar en la consulta / Pre-implant recostruction with autologous bone from mental symphysis during transverse maxillary bone atrophies rehabilitation: surgery protocol

Introducción: En los casos examinados, de atrofias de entidad moderada (IV clase de Cawoody Howell) (1), se ha observado un espesor transversal de la cresta inferior a 4 mm, por tanto una rehabilitación implanto soportada resulta difícil de realizar. Finalidad del trabajo: rehabilitación implanto protésica de las atrofias de entidad moderada en los maxilares. Materiales y métodos: 42 implantes realizados en 18 pacientes (8 varones y 10 mujeres, con una edad media de 47.1 años), en maxilar atrófico rehabilitado con la interposición de una muestra de hueso autólogo procedente de la sínfisis mentoniana. Los implantes han sido colocados a los 6 meses de haber aumentado transversalmente la cresta edéntula. Se han valorado: la osteointegración, con niveles de pérdida ósea correspondientes, la condición de los tejidos perimplantarios, el índice de profundidad del saco, de placa y de sangrado, así como el grado de satisfacción del paciente. Resultados: De 42 implantes no se perdió ninguno (0%), una vez finalizada la fase de seguimiento. La pérdida de hueso marginal perimplantario ha sido, en media, de 0,17 mm. Conclusiones: La utilización de muestras autólogas de zonas intraorales para el tratamiento de atrofias de entidad moderada ha demostrado ser una técnica con una predictibilidad elevada, que ha permitido efectuar implantes protésicos con un porcentaje de éxito elevado. Consecuencias clínicas: Aunque este procedimiento prevé dos zonas quirúrgicas en el mismo acto quirúrgico, necesitándose, por tanto, una elevada implicación del paciente, es indiscutible la ventaja de poder intervenir sin anestesia total, con la ayuda, exclusivamente, de anestesia lo corregional (AU)

Introduction: in the case studies the moderate atrophies (Cawood and Howell’s 4th class) is observed a transverse thickness lower than 4 mm, therefore carring out a riabilitation by prosthesis appears very difficoult. Aims: Implanto-prosthesis rehabilitation of moderate maxillary atrophies (Cawood and Howell’s4th class) (1).Materials and Methods: 42 implants in 18 patients (8 males and 10 females, of medium age of47.1 years), in an atrophic maxilla rehabilitated through interposition of autologous bone drawed from mental simphysis. The implantans were located after 6 months from the cross-sectional increase operation of edentulous crest. We have considered: the osteointegration related to bony loss, the perimplant soft tissue condition, depth index of gingival pocket, plaque and bleeding, and even patients satisfaction index. Results: at a complete follow-up no implants were lost. The mean of marginal perimplant bony loss was 0.17 mm. Conclusions: to manage moderate atrophies we have shown a technique with a good prognosis by using autologous drawings from intraoral centers, wich let successfull execution of implanto-prosthesic treatments. Clinical implications: even if the tecnique involves two simultaneous surgery sites, needing an high compliance by the patient, is unquestionable the vantage to can operate without narcosis, only availing of local anesthesia (AU)

[Use of the Dynamic Stent in the palliation of carinal and distal tracheal stenosis]. / Impiego del Dynamic Stent nella palliazione delle lesioni della carena e dell'estremo distale della trachea.

Satisfactory palliation of the lesions involving the carinal region is difficult to achieve because the stenting is conducted in an unsuitable anatomy, in highly symptomatic patients. During the period 1987-2000 we performed 785 operative rigid bronchoscopies in 524 patients, 184 of whom received a respiratory stent. The stenting of the carinal region was carried out in 27 patients with the use of the Frietag Dynamic stent. In this group of patients indication for stenting was as follows:--advanced lung cancer (22);--esophageal cancer invading the lower trachea (1);--severe tracheobronchomalacia (2);--postintubation stenosis of the lower trachea (2). No perioperative mortality was observed. All patients experienced symptomatic improvement. Follow-up ranged from 1 to 60 months: all neoplastic patients died for advanced disease without significant respiratory problems with a median survival of 5.6 months; three patients treated for benign diseases are still alive at 2, 31 and 65 months from stent deployment. No major complications were observed: in two patients the stent was removed after few days due to mucous retention; furthermore we observed symptomatic respiratory infections caused by a residual space between the tracheal wall and the prosthesis in other two patients with severe COPD. Dynamic stent is to be considered the stent of choice for palliation of the carinal region because it is effective and well tolerated with a low complications rate. The main limitations of such prosthesis are the shortness of the right bronchial branch and the size, sometimes inadequate.

[The role of surgery in the treatment of small cell lung cancer]. / Ruolo della chirurgia nel trattamento del microcitoma polmonare.

Small cell lung cancer (SCLC) is a biologically aggressive tumor with a low long-term survival rate. SCLC is highly responsive to chemotherapy and surgery has a very limited role in its treatment because the disease is usually widely disseminated at the diagnosis. Good results from surgery have been reported in the small subgroup of T1-2 N0 M0 patients. In N1 peripheral SCLC, surgery in combination with other treatments, can obtain fair results. Surgical treatment does not influence the prognosis in SCLC as stage III and IV.

[Ursodeoxycholic acid in the therapy of chronic hepatitis after treatment with interferon]. / L'acido ursodesossicolico nella terapia delle epatiti croniche virali dopo trattamento con interferone.

UNLABELLED: Interferon alfa is to day the only therapy of proven benefit for the treatment and control of chronic hepatitis C. Therefore only 25% of patients receive from it a sustained biochemical and serological response; often when the treatment is stopped there is a flare up of ALT and reappearance of HCV-RNA in the serum. The most common schedule is 6 MU t.i w. for twelve months; after this there is no codified treatment for relapse prevention. The aim of this study was to evaluate if ursodeoxycholic acid (UDCA) administration after a cycle of IFN therapy was able to prevent relapse of the disease. METHODS: We studied 36 patients whose mean age was 31.5 +/- 5.7 affected by chronic hepatitis C and treated with IFN alpha for one year. Only twenty of them received an end term therapy response and were therefore enrolled in a double blind study with two arms: Arm A treated with UDCA 300 mg b. i. d. for twelve months and Arm B treated with placebo. ALT value and HVC-RNA levels were evaluated at baseline, during and after treatment. RESULTS: Patients treated with UDCA showed a lower percentage of relapse in comparison with patients treated with placebo. CONCLUSIONS: This effect was probably due to a double mechanism: the first of biochemical type because a reduction in the intrahepatic concentration of hydrophobic biliary acids, the second immunological due to a lower expression of HLA class I and II antigens.

[Efficacy of insulin Lispro in the control of late postprandial hypoglycemia: comparison with regular human insulin]. / Efficacia dell'insulina lispro nel controllo della ipoglicemia postprandiale tardiva: confronto con la insulina umana regolare.

BACKGROUND: Lispro insulin a recently developed analogue of human insulin, is more rapidly adsorbed and has a lower duration of activity as compared with regular insulin. This implies a glycemic profile closer to the physiologic one with a reduction of early post-prandial hyperglycemic peak and of drop in late postprandial glycemia. This results in a reduction of mild or severe hypoglycemia occurring during treatment with regular human insulin. METHODS: This was designed to evaluate the efficacy of Lispro insulin in the metabolic control in subjects treated with regular insulin who were prone to late hypoglycemia. Fifteen subjects, 6 males and 9 females, range of age 18-54 years with insulin-dependent diabetes mellitus (IDDM) have been studied. These subjects were treated with regular insulin at meals plus intermediate in the evening. Regular insulin was substituted with Lispro insulin. The glycemic profile and HbA1c have been evaluated at determined intervals. Also body mass index and the number of hypoglycemic events during treatment were recorded. Significance of differences was assessed by paired Student's "t"-test. RESULTS: Lispro insulin reduced the peaks of early postprandial hyperglycemic peak and, in particular, the late glycemic drop, Lispro insulin reduced also HbA1c levels thus suggesting a better metabolic control. Moreover the number of hypoglycemic events was significantly reduced. CONCLUSIONS: In conclusion, Lispro insulin is safe and more efficient than regular human insulin.