Esthetic Challenges in Rehabilitating the Anterior Maxilla: A Case Report.

The rehabilitation of an unesthetic smile in the anterior maxilla is always a clinical challenge, especially when an improper shape and size, old restorations, and unesthetic shading are present. In addition, an irregular gingival zenith contour in the anterior maxilla can affect the smile's harmony. Thus, detailed treatment planning is needed to define a functional and esthetic prosthetic rehabilitation. This study describes a clinical case in which a 55-year-old woman was rehabilitated using Digital Smile Design planning and full ceramic crowns (metal free) in the anterior zone of the maxilla and mandible. To normalize the gingival zenith, a dynamic compression technique was performed using provisional restorations to condition the gingival tissues and harmonize the proportional length of the anterior upper teeth.

Ceramic fragments and metal-free full crowns: a conservative esthetic option for closing diastemas and rehabilitating smiles.

Dental ceramics make it possible to restore anterior teeth that have been esthetically compromised, presenting a high resistance to wear, biocompatibility, color stability, and low thermal conductivity. The development of different types of ceramic and techniques for adhesive cementation have made it possible to produce more conservative restorations without involving the healthy dental structure and with minimally invasive preparation, such as the bonding of ceramic fragments. The purpose of this article is to describe a clinical case in which diastemas were closed by using nanofluorapatite ceramic (e.max Ceram, Ivoclar-Vivadent) fragments on teeth 7 and 10 with minimal tooth preparation and metal-free ceramic crowns (e-max Ceram) reinforced with zirconia copings through a computer-aided design/computer-aided manufacturing system (Lava, 3M-ESPE) on teeth 8 and 9.

Growth hormone secretion and bone histomorphometric study in thalassaemic patients with acquired skeletal dysplasia secondary to desferrioxamine.

An auxological and endocrinological study was performed in 21 thalassaemic patients with growth retardation and skeletal dysplasia secondary to desferrioxamine. Bone metaphyseal proximal tibial or iliac crest biopsy was performed in six patients with severe genu valgum or non-traumatic vertebral compression. GH insufficiency/deficiency (GH deficiency: peak after stimulation test below 6 ng/ml) was found in 72% of our thalassaemic patients with skeletal dysplasia, but in only 41% of patients without skeletal dysplasia. Bone histology showed abnormal chondrocytes, alteration of staining pattern of cartilage, irregular columnar cartilage and lacunae in the cartilaginous tissue. The behaviour of bone tissue was unpredictable (presence of thick or thin osteoid layer). Bone microfractures were sometimes present. The bone microstructure showed scarce mineralization, which was evenly or irregularly distributed. The bone tissue apatitic phase was quantitatively reduced. The hardness of bone tissue was remarkably lower than that of normal bone in three out of six patients. In conclusion, iron chelation therapy in patients with acquired skeletal dysplasia seems to interfere with GH secretion. The early identification of clinical and radiological abnormalities of skeletal dysplasia is of paramount importance in preventing severe bone destruction.

Clinical experience using the Androderm testosterone transdermal system in hypogonadal adolescents and young men with beta-thalassemia major.

beta-Thalassemia major is associated with a high prevalence of hypogonadotropic hypogonadism affecting adolescents and young men with this disease. The pharmacokinetics of Androderm, a non-scrotal permeation-enhanced testosterone transdermal system, was previously studied in this population using three application regimens designed to mimic the nocturnal secretion and circadian patterns of testosterone production characteristics of puberty and young adulthood. In regimen I, designed for prepubertal 14 to 16 year-olds, a single Androderm patch (2.5 mg/day nominal delivery rate) is applied at night and removed 12 hours later in the morning. In regimen II, designed for partially virilized 17 to 19 year-olds, a single Androderm patch is applied nightly for 24 hours. In regimen III, intended for virilized men aged 20 years and older, two Androderm patches (total dose of 5 mg/day) are applied nightly for 24 hours. This report presents the results of a 12-month open label study using these three Androderm regimens to treat nine hypogonadal males with beta-thalassemia (ages 16.8 to 31.8 yr). Our data show that Androderm produced physiologically appropriate testosterone levels, lowered SHBG levels, promoted growth and virilization, increased bone mineral density, and was generally well tolerated in this population of hypogonadal adolescents and young men with beta-thalassemia.

Final height and endocrine function in thalassaemia intermedia.

We present data of a detailed study of endocrine function in 50 patients (21 males, 29 females) with thalassaemia intermedia, 15-46 years old (mean age 28.7 yr), with raised serum ferritin levels (mean 1540 micrograms/l). Mean haemoglobin concentration was 8.1 g/dl. Half of them had had more than 50 transfusions in their life and had received irregular intramuscular or subcutaneous chelation therapy. Delayed puberty was one of the most frequent (36%) clinical endocrine abnormalities found in our patients. Primary amenorrhea was observed in two patients and secondary amenorrhea in four patients. Two males, aged 19 and 36 years, had hypogonadism. A poor response to GnRH, found in three females and in both males tested, suggested that pituitary dysfunction was wholly or partially responsible for hypogonadism. Gonadal function was normal in all patients studied. Glucose intolerance and primary hypothyroidism were less frequent (24 and 5.7%, respectively) and milder than in thalassaemia major patients. Two patients had low T3 and T4 and normal basal and stimulated response of TSH to TRH. This condition has been found in euthyroid sick syndrome and it is likely that it represents an adaptive response by the body to minimize catabolism when undergoing major stress. As a consequence, we believe that periodic endocrine evaluation should be carried out in subjects with beta-thalassaemia intermedia, particularly in those over 14 years old, in order to detect and to treat endocrine dysfunction.

Kaposi's sarcoma-associated herpesvirus DNA sequences in prostate tissue and human semen.

BACKGROUND: Sequences of novel herpesvirus, Kaposi's sarcoma-associated herpesvirus (KSHV), have been indentified in Kaposi's sarcoma tissue, but it is not known whether the virus is transmitted by sexual contact. METHODS: Using the polymerase chain reaction (PCR), we searched for KSHV DNA sequences in ejaculates from 43 healthy men and tissue from the urogenital tract or prostate of 100 immunocompetent adults. RESULTS: In an unblinded analysis, we identified KSHV DNA sequences in 2 of 20 tissue specimens from the urinary tract (10 percent; 15 men and 5 women), 3 of 46 specimens from the female genital tract (6.5 percent), 4 of 18 specimens from the glans or foreskin (22 percent), 7 of 16 specimens from the prostate (44 percent), and 30 or 33 ejaculates (91 percent). By contrast, such sequences were present in 1 of 18 samples of normal skin (5.5 percent) and 1 of 14 samples of peripheral-blood mononuclear cells (PBMCs; 7.1 percent). Ejaculates and PBMC samples from each of 10 study subjects were analyzed in a blinded, coded fashion, along with PBMCs and biopsy specimens of normal skin from 4 and 8 other patients, respectively. This analysis confirmed the presence of KSHV DNA sequences in semen. Viral DNA was not found in the sperm heads but was present in the fraction of the ejaculates that contained urothelial and other types of cells. Point mutations were found in PCR products amplified from both prostate tissue and sperm samples. CONCLUSIONS: KSHV infects a large proportion of healthy adults and is probably transmitted by sexual contact.

Changes in intracellular magnesium concentrations during cisplatin chemotherapy.

Magnesium is mainly an intracellular cation, and its availability is not represented reliably by plasma levels. The effects of cisplatin on Mg concentrations in plasma (PMg) and erythrocytes (EMg) were investigated in 22 neoplastic patients. Assays were done before and 1, 2, 4 and 7 days after cisplatin administration; 10 patients were also checked following six courses of chemotherapy. PMg decreased progressively either day by day after a single dose of cisplatin (p < 0.001 on the 7th day) or month by month after cumulative doses (p < 0.05 after two courses and p < 0.001 after six). EMg decreased till the 4th day (p < 0.001), but recovered pretreatment levels on the 7th day; an actual depletion was manifested only after the third course of chemotherapy (p < 0.05) and became more marked after the 6th. These results suggest that, besides renal Mg wasting, Mg metabolism is influenced by cisplatin also at a cellular level. The cisplatin-induced injury on membrane transport systems, where Mg is abundant and plays an important stabilizing role, might induce an early shift of Mg from cells into the blood stream. When repair systems begin to act, Mg is taken up from plasma to recover the normal cellular content. The lack of an actual depletion of Mg body stores till the third course of chemotherapy possibly makes the early Mg supplementation commonly administered before or contemporaneously to cisplatin infusion unnecessary. Oral supplements between the courses might be sufficient to prevent Mg depletion without exposing the patients to the risk of hypermagnesemia in case of cisplatin-induced acute renal failure.

Flow cytochemical analysis of peripheral lymphocytes in chronic B-lymphocytic leukemia. Prognostic role of the blast count determined by the H*1 system and its correlation with morphologic features.

Peripheral blood samples from 148 previously untreated patients with chronic B-lymphocytic leukemia (B-CLL) were analyzed with the Technicon H*1 flow cytometer. The absolute number and the percentage values of both LUCs (large unstained cells) and blasts were correlated with survival, as well as with well-known prognostic factors including morphological subtypes of lymphoid cells. Results showed that patients at the most advanced clinical stages (Rai: III and IV; Binet: C) had the highest percentage and count of both LUCs and blasts. Furthermore, the proportion of LUC positively correlated with the following prognostic factors: peripheral lymphocytosis (greater than 50 x 10(9)/l); marked splenomegaly (greater than 10 cm UCM); % of circulating prolymphocytes, % immunoblasts, and % LGL. Our data analysis further revealed that chemotherapy produced a greater reduction of both the LUCs and of the blast count than of that of small lymphocytes. An increase in LUC count was found to coincide with deterioration of clinical status (progressive changes in the clinical stages, occurrence of prolymphocytoid transformation). A rapid increase in blast count was found to occur in concomitance with the development of Richter's syndrome, and correlated positively with the number of peripheral immunoblasts determined by light microscopy. Moreover, a blast percentage higher than 7% had the strongest predictive relation to survival rate when compared with other hematological parameters (lymphocytosis greater than 50 x 10(9)/l, % of LUCs greater than 12%, LUC to lymphocyte ratio greater than 16%, LUCs count greater than 2.2 x 10(9)/l). In the light of these findings, it may be suggested that the presence both of larger proportions of LUCs and of blasts measured with the flow cytometry may be considered unfavorable prognostic factors in B-CLL. However, based on morphological and multivariate statistical analyses, the blast count proved to be the most important prognostic parameter determined by the H*1 system in B-CLL.

Relative density of urine: methods and clinical significance.

The physical properties and chemical composition of urine are highly variable and are determined in large measure by the quantity and the type of food consumed. The specific gravity is the ratio of the density to that of water, and it is dependent on the number and weight of solute particles and on the temperature of the sample. The weight of solute particles is constituted mainly of urea (73%), chloride (5.4%), sodium (5.1%), potassium (2.4%), phosphate (2.0%), uric acid (1.7%), and sulfate (1.3%). Nevertheless, urine osmolality depends only on the number of solute particles. The renal production of maximally concentrated urine and formation of dilute urine may be reduced to two basic elements: (1) generation and maintenance of a renal medullary solute concentration hypertonic to plasma and (2) a mechanism for osmotic equilibration between the inner medulla and the collecting duct fluid. The interaction of the renal medullary countercurrent system, circulating levels of antidiuretic hormone, and thirst regulates water metabolism. Renin, aldosterone, prostaglandins, and kinins also play a role. Clinical estimation of the concentrating and diluting capacity can be performed by relatively simple provocative tests. However, urinary specific gravity after taking no fluids for 12 h overnight should be 1.025 or more, so that the second urine in the morning is a useful sample for screening purposes. Many preservation procedures affect specific gravity measurements. The concentration of solids (or water) in urine can be measured by weighing, hydrometer, refractometry, surface tension, osmolality, a reagent strip, or oscillations of a capillary tube. These measurements are interrelated, not identical. Urinary density measurement is useful to assess the disorders of water balance and to discriminate between prerenal azotemia and acute tubular necrosis. The water balance regulates the serum sodium concentration, therefore disorders are revealed by hypo- and hypernatremia. The disturbances are due to renal and nonrenal diseases, mainly liver, cardiovascular, intestinal, endocrine, and iatrogenic. Fluid management is an important topic of intensive care medicine. Moreover, the usefulness of specific gravity measurement of urine lies in interpreting other findings of urinalysis, both chemical and microscopical.

Response to RIT 4237 oral rotavirus vaccine in breast-fed and formula-fed infants.

Twenty-six full-term newborns (15 males and 11 females) were followed-up from birth to 5 months of age. During the first month of life, all of them were breast-fed. Thereafter those infants whose mothers produced enough milk continued breast-feeding (n = 16) while the remaining (n = 10) changed to an adapted milk formula supplying approximately 2 g/kg/day of protein and 100 Kcal/kg/day. At 4 months of life, all infants were vaccinated with one oral dose of RIT 4237 rotavirus vaccine of bovine origin. Before and one month after the vaccination, total protein immunoglobulin and IgM type antibodies against rotavirus were evaluated in serum. Growth, weight, length, head circumference and nutritional serum parameters were comparable in both groups of infants as well as the immune response to the RIT 4237 vaccine. Moreover, the "take" of RIT 4237 oral rotavirus vaccine was not lowered by the concomitant administration of human breast-milk which is known to contain rotavirus antibodies. Therefore, breast-feeding is probably not a contraindication for vaccination with RIT 4237, which is most important in developing countries where rotavirus infection is common in young infants and results in acute diarrhoea often leading to death.

[Rapid screening of urine cultures with a semi-automatic instrument (author's transl)]. / Screening rapido delle urinocolture con strumento semiautomatico.

The research carried out indicates that by applying an Autobac (Pfizer) system of semi-automatic reading to urine culture, it is possible to screen in 5 h about 70% of the specimens, which represent about 30-50% of the work of the microbiology section. The system experimented by us presents good correlation with a rapid system (Urotube), and can allow a saving in experimental costs. The growth of germs from infected urine in the chambers of the cuvette containing Eugonic broth, requires time comparable to that of the growth curve of inoculations of germs known as "colony-forming unit"/ml (CFU/ml). The results, read hourly during the incubation period with a calibration method, were plotted placing time of incubation in relation to the delta E of the voltage. The majority of the specimens with CFU/ml greater than or equal to 5 x 10(4) are revealed within 5 h, those with CFU/ml greater than or equal to 10(4) within 6 h, while the negative tests do not show any growth after 6 h.

[Transient bisalbuminemia induced by penicillin and gentamicin. Immunoelectrophoretic study and thorough examination of bibliography (author's transl)]. / Bisalbuminemia transitoria da penicillina piu' gentamicina. Studio immunoelettroforetico e revisione bibliografica.

The Authors report a case of transient bisalbuminemia due to the administration of large doses of penicillin and gentamicin. Cellulose acetate electrophoresis showed an abnormal fraction of normal albumin. The IEB showed a better result. Transient bisalbuminemia may indicate saturation of albumin sites with beta-lactamines, requiring interruption of therapy. The Authors point out the utility of IEB in disclosing this alteration induced by antibiotics.