Evaluation of the saliva cortisol levels in patients under prosthetic treatment due to functional disorders of the masticatory organ.

One of the main etiological factors of the stomatognathic system dysfunction is stress and psychoemotional disorders. During stressful situations, there is an increase in the level of cortisol, the so-called stress hormone. Literature data indicate the existence of a correlation between blood cortisol levels and its amount in the saliva. This spurred an inspiration to undertake open, non-randomised studies, the objective of which was to conduct a comparative assessment of the saliva cortisol levels in patients with functional disorders of the masticatory system and in healthy volunteers, as well as to compare the results of cortisol levels with the results of survey-based tests with the use of Endler and Parker's CISS survey. Cortisol level was assessed due to its association with stress present in the body as one of the primary etiological factors of the stomatognathic system dysfunction, and hence the association of elevated cortisol levels assessed in the morning with the occurrence of dysfunctions of the stomatognathic system. The subject of the study is a group of 30 patients, of both sexes, aged between 20 and 46, who reported to the Dental Prosthetic Out-Patient Clinic of the Institute of Dentistry, Jagiellonian University in Cracow, for prosthetic treatment due to the painful form of functional masticatory organ disorders. The control group consisted of 30 subjects, aged between 19 and 41, in whom dysfunctions of the stomatognathic system were excluded. Collection of saliva for testing was performed at a fixed hour (9 am) into plastic test tubes with a stopper. Immediately after collection, the saliva was frozen at the temperature of -18 °C. The assessment of the cortisol levels was conducted by the high performance liquid chromatography (HPLC) with UV detection at the Department of Analytical Chemistry, Faculty of Pharmacy, Department of Laboratory Medicine of the Gdansk Medical University. Moreover, a 20-minute psychological test was conducted with the use of the CISS (coping inventory for stressful situations) survey in order to assess the patients in terms of their abilities to cope with stressful situations. The results obtained were submitted to a statistical analysis based on the conventional calculation procedures. The test group revealed significantly higher cortisol levels compared with the results obtained by the control group. The findings of the CISS survey confirmed the predominance of the emotion-focused strategy of coping with stressful situations in the test group. The results support the view that the psychoemotional factor is, to a considerable extent, conducive to the development of functional disorders. The elevated cortisol levels in patients with psychological disorders concur with the findings by other authors. The results obtained confirm that psychoemotional disorders may be one of the etiological factors of the stomatognathic system dysfunctions. The CISS survey, which was not used in similar studies before, makes it possible to obtain information on the subject's method of coping with stress, thus allowing for the initiation of a relevant psychological therapy aiding the prosthetic treatment.

Auriculo-vestibular symptoms related to structural and functional disorders of stomatognatic system.

Auriculo-vestibular symptoms are otolaryngological complaints which frequently co-occur with functional disorders of masticatory organ. These symptoms include: earache, plugged ears sensation, sudden hearing impairment, burning pain of the throat, tinnitus, and dizziness. The aim of the study was assessment of co-occurrence of functional disorders of masticatory organ and auriculo-vestibular symptoms, in patients referred for otolaryngological treatment. Forty-two patients aged 24-46 years of both sexes referred for otolaryngological treatment, because of auriculo-vestibular symptoms, were qualified to our study within the framework of research project. After otolaryngological diagnostics (Department of Otolaryngology), these patients were referred for prosthetic consultation to the Department of Dental Prosthetics of Jagiellonian University Medical College. In Otolaryngology Clinic the following specialist examinations were carried out: basic clinical examinations, including otoscopy, tuning fork trials, tonal and verbal audiometry, and tympanometry. These examinations were supplemented with electronystagmometry. On prosthetic consultation, specialist functional investigations of masticatory organ, and electromyographic assessment of the activity of masseter muscles and the anterior part of the temporal muscle, were carried out. Results of the investigation revealed otolarygological causes of the reported symptoms in 30 patients, whereas in 12 patients (out of 42 patients referred for prosthetic consultation), numerous functional disorders of the stomatognathic system were observed. The investigation confirmed the occurrence of functional disorders in patients with auriculo-vestibular symptoms and appropriateness of treatment by a multi-specialist team.

Measurement of occlusal forces in the therapy of functional disorders with the use of botulinum toxin type A.

Functional disorders of the stomatognathic system include dysfunctions leading to pathological increase of the occlusal forces generated by mandibular adductors. High values of these forces are the cause of numerous disorders within the masticatory organ such as pathological abrasion of the teeth, tension headaches and pain in the region of the temporomandibular joints. The aim of this study was assessment of occlusal forces in the course of the therapy of painful types of functional disorders with the use of botulinum toxin type A - the drug causing muscle relaxation. The material for the study comprised adult patients aged 24-42 years who presented with a painful type of functional disorders in the University Hospital, Institute of Dentistry Jagiellonian University Medical College in Cracow. The patients were qualified to the study on the basis of the results of specialist functional examination of the masticatory organ in which additionally the VAS (Visual Analogue Scale) was used for pain assessment of the masseters and temporomandibular joints. The measurement of maximal occlusal forces in the examined patients was carried out in all patients in the region of the central incisors and first molars on the both side with the use of a special measuring instrument for dental examination, specially constructed (patent number P 334933). The examinations were performed before the beginning of the treatment, 10 days and 16 weeks after intramuscular administration of botulinum toxin type A at a dosage of 21 mouse units - U for one masseter. The results of the examination of maximal occlusal forces obtained in the first examination, that is, before the beginning of the treatment, markedly exceeded the physiological values. In the control examinations, significant, persistent decrease of the studied forces has been noted.

Experimental research on the possibilities of maintaining thermal conditions within the limits of the physiological conditions during intraoral preparation of dental implants.

The objective of the study was to evaluate the degree of temperature change in the bone, directly adjacent to the implant site during the abutment part of one-piece implants, during procedures involving different cutting techniques. Three different one-piece implants: Osteoplant, Nobel Direct, Q-implant were cut with air-turbine burs after insertion in fresh pig ribs. Tests were performed with a variety of cooling techniques including air and air-liquid coolant. Implants were cut on the occlusal and axial surfaces of the abutment part. The temperature changes were evaluated using thermocouple type K during and after cutting procedures. It was found that regardless of the cutting technique, the temperature of the bone always increased during the cutting procedure. The critical temperature threshold Delta T=10 degrees C (47 degrees C) was always exceeded, when only the air coolant was used, although when the air-water spray coolant was utilized during the cutting procedure, it prevented the temperature to exceed this critical level. The extent of thermal changes in the bone depends on the cutting technique. Constant air-water cooling during the cutting procedure is a recommended technique in order to avoid overheating the implant-bone interface. The dry cutting technique, using only an air coolant, should be avoided as it can induce sufficiently high thermal damage in the bone adjacent to the implant, which leads to compromise of the osteointegration process.

Application of a diagnostic-therapeutic procedure using implant-supported dental prosthesis as a preventive therapy for candidiasis of upper gastrointestinal tract in complete denture users.

Our previous studies demonstrated that the use of acrylic based prosthesis in edentulous patients had a direct impact on the increased incidence of oral mycosis and further episodes of mycosis in the digestive tract. This dependency is associated with formation of a space between the surface of the prostheses and adhering mucosal membrane, where a specific micro environment is being formed, which - as stated - creates a superior breeding ground mainly for microorganisms of the genus Candida.

Melatonin and its role in oxidative stress related diseases of oral cavity.

The role of the oral cavity in the pathogenesis of diseases of various systems such as the gastro-intestinal tract (GIT), cardiovascular and immune systems has been recently evaluated. While initially the oral cavity was considered to be mainly a source of various bacteria, their toxins and antigens, recent studies showed that it may also be a location of oxidative stress and periodontal inflammation. Accordingly, this review focuses on the involvement of melatonin (MT) in oxidative stress diseases of oral cavity as well as on potential therapeutic implications of MT in dental disorders, especially in periodontal inflammation. MT is generated and released by pineal gland and by entero-endocrine (EE) cells located in the GIT. The pattern of MT secretion from the pineal gland is controlled by an endogenous circadian timing system that conveys information about the light/dark cycle to various organs of the body, thereby organizing its seasonal and circadian rhythms. The secretion of MT from the EE cells of GIT is related mainly to feeding periods. MT is a non-toxic highly lipophilic indole, and this feature facilitates its penetration through cell membranes and its compartments. However, the most important effect of MT seems to result from its potent antioxidant, immuno-modulatory, protective and anti-cancer properties. It stimulates synthesis of type I collagen fibers and promotes bone formation. Thus, MT could be used therapeutically for instance, locally, in the oral cavity damage of mechanical, bacterial, fungal or viral origin, in post-surgical wounds caused by tooth extractions and other oral surgeries and, in helping bone formation in various auto-immunological disorders such as Sjorgen syndrome, in periodontal diseases, and in oral cancers.

Clinical evaluation of the polypropylene-polyester knit used as a cranioplasty material.

UNLABELLED: The paper presents clinical evaluation of the polypropylene-polyester knit used as a cranioplasty material. MATERIAL: Between year 1980 and 2002 275 cranioplastic procedures using the polypropylene-polyester plates Codubix were carried out in the Department of Neurosurgery of the Medical University of Lódz. There were 146 patients who primarily sustained head injuries and 129 non-traumatic patients with craniectomies carried out for various other reasons. In the majority of cases, i.e. in 158 patients, cranioplasty was performed later than 6 months after the primary surgery. The largest implant measured 430 cm2. RESULTS: Excellent and good outcome was achieved in 92% of the patients whereas the rate of local infection was 8%. CONCLUSIONS: Codubix knitted polypropylene-polyester implant proved to be useful and a safe cranioplastic material.

Tolerance of interferon-alpha therapy in children with chronic hepatitis B.

OBJECTIVE: To assess the side-effects of interferon-alpha (IFN-alpha) therapy in children with chronic hepatitis B. METHODS: This prospective study was performed on one hundred children by interviewing the patients and their parents; clinical examinations and laboratory investigations were performed during and after therapy. RESULTS: The most frequent side-effects of IFN-alpha therapy were fever, flu-like symptoms, and headaches. Lowering of the mean haemoglobin level, leukocyte and platelet count was significant, but transient during INF-alpha treatment. No increase in autoantibody titres or significant alterations in thyroid function was observed. Twelve months after treatment, hepatitis Be antigen (HBeAg) elimination and alanine aminotransferase (ALT) normalization was achieved in 46% of the children; HBeAg and hepatatis B surface antigen (HBsAg) elimination, together with ALT normalization, was achieved in 14% of the cases. CONCLUSION: The side-effects of the IFN-alpha therapy in children such as fever, flu-like symptoms and bone marrow suppression are common, but transient and mild.

Long-term evaluation of endothelial cell loss after phacoemulsification.

PURPOSE: To check whether three months' follow-up is sufficient to determine endothelial cell loss after cataract surgery and whether this value depends on preoperative central endothelial cell density. METHODS: A two-year prospective assessment of central endothelial cell density was done in 60 eyes after phacoemulsification. In 30 eyes a 3.5 mm corneal incision closed with a single crossed suture was made, and the other 30 had a 3.5 mm scleral tunnel no-stitch incision. Central endothelial cell density was measured before surgery and 1, 3, 6 months and 2 years after. RESULTS: The mean rate of endothelial cell loss even two years after surgery was significantly higher than the physiological rate, amounting to 0.9% per year. There was no correlation between preoperative central endothelial cell density and postoperative cell loss. CONCLUSIONS: Even two years' follow-up is not sufficient to establish the total endothelial cell loss after cataract surgery. The amount of cell loss does not depend on the preoperative density.

Effects of retinal detachment surgery on protein C antigen level.

BACKGROUND: The purpose of the study was to evaluate perioperative changes in protein C antigen (PC Ag) in patients undergoing retinal detachment surgery under general or local anesthesia. MATERIAL AND METHODS: Prospective study of 39 patients: 27 patients, 14 male, 13 female, age from 15 to 78 (mean: 50.8, SD=18.6), undergoing retinal detachment surgery (encirclement with scleral buckling) performed under general anesthesia (group A), and 12 patients, 5 male, 7 female, age from 25 to 78 (mean: 52.9, SD=19.2), operated under local anesthesia (group B). Patients with venous or arterial disease or other factors which could affect the evaluated parameters were excluded from the study. Blood samples were collected from the cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after the completion of the operation but before the termination of anesthesia, and after surgery (on the 1st and 4th day). The PC Ag concentration was measured in the citrate plasma of the patients studied, utilizing a commercially available enzyme-linked immunosorbent assay. RESULTS: In both groups, the pattern of changes in perioperative PC antigen was similar. A trend towards moderately lower intraoperative levels of PC Ag could be observed. In both groups, PC Ag concentration increased on the first postoperative day, but a significant change was noted only in general anesthesia group. CONCLUSIONS: Retinal detachment surgery evokes a less than statistically significant decrease in intraoperative PC antigen levels in systemic circulation, and these changes are not affected by the type of anesthesia. An increase in PC Ag was observed on the 1st postoperative day, but this was statistically significant only in the general anesthesia group.

Fibrinolytic response to retinal detachment surgery under general or local anesthesia.

PURPOSE: To evaluate perioperative changes in fibrinolysis in patients undergoing retinal detachment surgery under general or local anesthesia. PATIENTS: Prospective study of 81 patients (43 male, 38 female), aged from 15 to 82 (mean 50.7 SD = 17.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia (group A), and 14 patients (6 male, 8 female) aged from 15 to 78 (mean 52.9, SD =19.8) years, operated under local anesthesia (group B). Excluded were patients with venous or arterial disease or other factors that could change the parameters investigated. METHODS: Blood was sampled from a cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and after the operation (on days 1 and 4). In patients' citrated plasma, tissue plasminogen activator antigen (t-PA-Ag), plasminogen activator inhibitor type 1 antigen (PAI-1 Ag) and activity (PAI-1), fibrin-fibrinogen degradation products (FDP) and euglobulin lysis time (ELT) were measured. RESULTS. The pattern of changes in perioperative fibrinolytic activity was similar in both groups. Intraoperative levels of FDP were significantly higher and ELT shorter than preoperatively. In both groups t-PA Ag concentration was significantly increased on the first postoperative day. There were no changes in PAI-1 in both groups. Postoperatively, the FDP concentration was reduced and ELT prolonged. CONCLUSIONS: Retinal detachment surgery induces intraoperative activation of fibrinolysis in the systemic circulation regardless of the type of anesthesia.

Prognostic factors in the treatment of chronic hepatitis B with interferon alpha in children.

One hundred children with chronic hepatitis B, aged 1-17.3 years participated in the study. The results of treatment with interferon alpha (IFN-alpha) were evaluated. An attempt was made to define the factors predicting positive response to treatment. Three million units of IFN-alpha 2a or 2b were given by subcutaneous injections to analysed patients 3 times a week for 20 weeks. Positive treatment outcome reflected in HbeAg elimination was observed in 46% of children. High AlAT activity preceding therapy had a statistically significant effect on positive treatment outcome. The inhibition of HBV replication caused by the treatment was permanent and it coexisted with the normalisation of AlAT activity in blood serum. Full response to therapy with IFN-alpha measured with the elimination of HbeAg and HbsAg was observed in 14% of children. It was favoured by high AlAT activity before treatment and short HBV duration.

Von Willebrand factor in subretinal fluid.

PURPOSE: To measure the vWF antigen concentration (vWF Ag) in subretinal fluid (SRF) and blood plasma. METHODS: Prospective study of 30 patients, aged from 15 to 78 years (mean 52.7 years), undergoing retinal detachment surgery. Excluded were patients with venous or arterial disease or any other factors that could affect the parameters evaluated. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. VWF in plasma and in SRF and its relation to patients' age, sex, the duration and extent of retinal detachment, number of retinal tears, and cryopexy application were evaluated. RESULTS: The median level of vWFAg in 30 samples of SRF was 6.3%. The median level of vWF Ag in blood plasma was 70.34%. The levels of vWF Ag in SRF were significantly lower than in blood plasma (p<0.00001). We found no correlation between the vWF Ag concentration in plasma or in SRF and sex, the degree of myopia, the duration and extent of retinal detachment, number of retinal tears and the use of cryopexy. CONCLUSIONS: Determination of vWF Ag showed that this factor in SRF is unrelated to patients', sex, the degree of myopia, the duration and extent of retinal detachment, number of retinal tears and use of cryopexy.

[Pseudophakic retinal detachment from personal material]. / Odwarstwienie siatkówki w oczach pseudofakijnych w materiale wlasnym.

PURPOSE: To analyse retinal detachment in pseudophakic eyes. MATERIAL AND METHODS: Analysis of 23 pseudophakic patients with retinal detachment operated at the Department of Ophthalmology in Bydgoszcz in the period from 1996 to 1998. The following factors were evaluated: time interval to retinal detachment surgery from the date of cataract surgery, intraoperative complications during the cataract extraction, state of posterior capsule, type and location of retinal tears, extension of retinal detachment, anatomical and functional results and state of fellow eye. RESULTS: Retinal detachment occurred in 65.2% pseudophakic eyes in the period shorter than 3 years after cataract extraction and IOL implantation and in 34.8% more than 5 years after this operation. In 17.4% pseudophakic eyes posterior capsula was ruptured intraoperatively, in 17.4% YAG capsulotomy and in 4.3% surgical capsulotomy were performed. In 56.5% eyes posterior capsula was intact. CONCLUSIONS: Our results suggest possibility of the occurrence of delayed retinal detachment in pseudophakic eyes. The rupture of posterior capsule is not the only risk factor for this disease.

Antithrombin III activity in subretinal fluid.

PURPOSE: To evaluate antithrombin III (AT III) activity in subretinal fluid (SRF) and blood plasma. METHODS: Prospective study of 32 patients, aged from 20 to 77 years (mean 53.8 years), undergoing retinal detachment surgery. Patients with vein or arterial disease or any other factors that could affect the parameters evaluated were excluded. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. AT III activity in citrated plasma and in SRF and its relations to patients' age, sex, duration and extent of retinal detachment and degenerative changes of the retina, were evaluated. RESULTS: The median level of AT III activity in 32 SRF samples was 16.5% (lower quartile 8.5% and upper quartile 23%). The mean level of AT III activity in plasma was 105% (SD 24%). AT III levels in SRF were significantly lower than in plasma (p < 0.0001). We found no correlation between AT III activity in SRF and plasma, and age, sex, the degree of myopia, the duration and extent of retinal detachment, or retinal degenerative changes. CONCLUSIONS: In this study we detected AT III activity in all 32 SRF samples.

Alterations in antithrombin III activity and other blood coagulation parameters after retinal detachment surgery.

PURPOSE: To evaluate perioperative changes in blood coagulation in patients undergoing retinal detachment surgery. MATERIALS: Prospective study of 56 patients, aged from 19 to 82 (mean +/- S.D. 53 +/- 16.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia. Excluded were patients with venous or arterial disease and any other factors that could affect the parameters under consideration. METHODS: Blood was sampled from the cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and on days 1 and 4 after the operation. We measured antithrombin III activity (AT III), platelet count, fibrinogen concentration, activated partial thromboplastin time (aPTT) and prothrombin time (PT). RESULTS: Intraoperative AT III activity and platelet count were significantly lower, aPTT was shortened and PT prolonged, although all values remained within the normal range. These results indicate moderate activation of coagulation during retinal detachment surgery. On the first postoperative day coagulation activity was reduced, with increases in AT III activity, fibrinogen concentration and platelet count and prolongation of aPTT. CONCLUSIONS: During retinal detachment surgery there is moderate activation of coagulation in the systemic circulation.

[Thrombin-antithrombin III complexes in plasma and subretinal fluid in patients with perforated retinal detachment]. / Kompleksy trombina-antytrombina III w osoczu i plynie podsiatkówkowym u chorych z przedarciowym odwarstwieniem siatkówki.

PURPOSE: To study the thrombin generation in plasma and subretinal fluid (SRF) by evaluation of thrombin-antithrombin III complexes (TAT) and antithrombin III (AT III) activity in patients with rhegmatogenous retinal detachment. MATERIAL AND METHODS: Prospective study of 54 patients subjected to retinal detachment surgery. Patients with vein or arterial disease and with other factors which could change evaluated parameters were excluded. Subretinal fluid samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein to natrium citrate solution (9:1) immediately after induction of anaesthesia but before surgery. TAT concentration in citrate plasma and in SRF was assessed in 22 patients aged from 15 to 78 years (mean: 49.5 years). AT III activity in blood plasma and SRF was measured in 32 patients aged from 20 to 77 years (mean: 53.8). The correlations between the TAT concentration in SRF were evaluated as well as AT III activity in SRF, and age, sex of patients, the duration and extent of retinal detachment, number of retinal tears and the cryopexy application. RESULTS: The median value of TAT concentration in citrate plasma was 9.08 micrograms/l (interquartile range: 59.3 micrograms/l). In 20 cases out of 22 eyes studied TAT levels were higher than 60 micrograms/l. The mean level of AT III activity in blood plasma was 105% (SD: 24.0%). The median level of AT III activity in 32 samples of SRF was 16.5% (interquartile range: 14.5%). The levels of AT III in SRF were significantly lower than AT III values in blood plasma (p < 0.001). We found no correlation between the levels of AT III activity in plasma and AT III activity in SRF nor between TAT concentration, AT III activity in SRF and sex, age of patients, the degree of myopia, the duration and extent of retinal detachment, nor retinal degenerative changes and cryopexy application. CONCLUSION: Our study revealed high TAT concentration and AT III activity and in all studied samples of SRF disclosing the signs of thrombin generation in SRF.

Clinical and pathological importance of cagA-positive Helicobacter pylori strains in children with abdominal complaints.

BACKGROUND: The aim of this study was to assess the correlation between the prevalence of Helicobacter pylori strains possessing cytotoxin-associated gene A (cagA) in children and the intensity of clinical complaints and morphological changes of the gastric mucosa. MATERIALS AND METHODS: A group of 80 children with gastrointestinal complaints was included in this study. Pathologists examined mucosal biopsy specimens from these patients. The urease test and multiplex polymerase chain reaction (MPCR) were used to identify H. pylori strains. RESULTS: In the group of children infected with cagA-positive H. pylori strains, fourth-degree gastritis was more frequent than in the group with cagA-negative H. pylori colonization. In histopathological assessment, infection with cagA-positive H. pylori was associated also with higher grades of inflammatory intensity and activity. CONCLUSIONS: Marked inflammation of the antral mucosa was significantly more frequent in children infected with cagA-positive H. pylori than in those infected with cagA-negative H. pylori, as assessed endoscopically and histopathologically. No specific symptoms for cagA-positive and cagA-negative H. pylori infection were observed.

[Hemangioma racemosum of retina: a case report]. / Naczyniak krwionosny groniasty siatkówki--opis przypadku.

PURPOSE: To report a case of haemangioma racemosum, a rare congenital disease. PATIENT: Female patient, aged 17, with unilateral decrease of visual acuity. Examination showed retinal arteriovenous malformations. Fluorescein angiography demonstrated variably sized arteriovenous communications, tortuosity and dilatation of the malformed vessels as well as normal vessels. CONCLUSION: The reported case shows the difficulties that may be encountered in differentiating haemangioma racemosum from hemangiomas associated with other disorders. A complete physical examination and angiography are essential in distinguishing difficult cases.

[Corneal endothelial cell density and corneal thickness after laser trabeculoplasty]. / Gestosc komórek sródblonka rogówki i jej grubosc po trabekuloplastyce laserowej.

PURPOSE: The evaluation of the influence of laser trabeculoplasty on the corneal thickness and central endothelial cell density. MATERIAL AND METHODS: Corneal thickness and central endothelial cell density were measured before and 3 months after laser treatment. Patients were divided into 2 groups with different energy applied: 550-800 mW and 850-1100 mW. RESULTS: Differences of corneal thickness and central endothelial cell density were not statistically significant neither within nor between the groups. CONCLUSION: Laser trabeculoplasty performed with energy up to 1100 mW has no influence on corneal thickness and central endothelial cell density.