Effect of nonsurgical periodontal therapy on serum and gingival crevicular fluid cytokine levels during pregnancy and postpartum.

BACKGROUND AND OBJECTIVE: A low-grade systemic inflammatory status originating from periodontal infection has been proposed to explain the association between periodontal disease and systemic conditions, including adverse obstetric outcomes. The aim of this study was to evaluate the effect of periodontal therapy during pregnancy on the gingival crevicular fluid and serum levels of six cytokines associated with periodontal disease and preterm birth. MATERIAL AND METHODS: A subsample of 60 women (18-35 years of age) up to 20 gestational weeks, previously enrolled in a larger randomized clinical trial, was recruited for the present study. Participants were randomly allocated to receive either comprehensive nonsurgical periodontal therapy before 24 gestational weeks (n = 30, test group) or only one appointment for supragingival calculus removal (n = 30, control group). Clinical data, and samples of blood and gingival crevicular fluid, were collected at baseline, at 26-28 gestational weeks and 30 d after delivery. The levels of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12p70 and tumor necrosis factor-α were analyzed by flow cytometry. RESULTS: After treatment, a major reduction in periodontal inflammation was observed in the test group, with bleeding on probing decreasing from 49.62% of sites to 11.66% of sites (p < 0.001). Periodontal therapy significantly reduced the levels of IL-1ß and IL-8 in gingival crevicular fluid (p < 0.001). However, no significant effect of therapy was observed on serum cytokine levels. After delivery, the levels of IL-1ß in the gingival crevicular fluid of the test group were significantly lower than were those in the control group (p < 0.001), but there were no significant differences between test and control groups regarding serum cytokine levels. CONCLUSION: Although periodontal therapy during pregnancy successfully reduced periodontal inflammation and gingival crevicular fluid cytokine levels, it did not have a significant impact on serum biomarkers.

Resection for achalasia of the esophagus.

One hundred and twenty-two patients with advanced mega-esophagus managed by esophagectomy without thoracotomy and cervical gastroplasty were evaluated. Sixty-nine patients were followed up for periods of 6 months to 16 years. Clinical assessment included X-ray studies and endoscopy of the cervical esophagus and mobilized stomach. The most common postoperative complications were pleural effusion (22.1%) and cervical fistula (8.2%). Mortality was 4.18%. Regurgitation was the most frequent complaint in the late follow-up, followed by heartburn. Both symptoms were related to esophagitis and diffuse gastritis. Diarrhea and dumping also occurred due to vagotomy and pyloromyotomy performed at the same time as esophagectomy. The endoscopic study demonstrated esophagitis in 25.5% of the patients, and diffuse erosive gastritis in 12.7%. The symptoms and late complications were handled by clinical measures and careful endoscopic follow-up. Gastroplasty was considered a good procedure for replacing the esophagus, solving the serious problem of dysphagia and for providing nutritional improvement for the patient.