Esthetic Restoration with Artificial Gingiva in an Atrophied Alveolar Ridge: Clinical Report.

Management of the anterior maxilla is a challenge in compromised clinical situations such as loss of teeth or soft tissues, alveolar ridge defects, or loss of all three. This report shows the systematic sequence of surgical and prosthetic management in a case of Seibert Class III alveolar atrophy where the patient refused a removable prosthesis. This was resolved with a hybrid metal/porcelain prosthesis with 17-degree multiunit abutments, leading to totally satisfactory esthetic and functional results.

Effect of losartan and spironolactone on left ventricular mass and heart sympathetic activity in prehypertensive obese subjects: a 16-week randomized trial.

Obesity has been shown to be associated with increased left ventricular mass (LVM) and heart sympathetic activity even in nonhypertensive subjects. These factors are predictors of cardiovascular morbidity and mortality independent of other traditional risk factors. We evaluated the effect of losartan and spironolactone on LVM and heart sympathetic activity in prehypertensive obese subjects. A 16-week blinded randomized trial was performed in middle-aged men selected from a Health Public program. Anthropometric and clinical variables were measured at baseline and after losartan (50 mg/day; n=25) or spironolactone (25 mg/day; n=25) treatment. Heart sympathetic activity was evaluated with 60-min electrocardiograph monitoring, and spectral analysis was carried out. LVM was measured by echocardiography according to Devereux and Reicheck's formula indexed for body height (m2.7) to account for obesity. Anthropometric variables, systolic, and diastolic blood pressure levels decreased in both groups of treatment without statisticall difference between them. Losartan increased heart rate variability (from 70.0 to 82.3 ms; P=0.01), and decreased low frequency-high frequency index (from 6.6 to 4.9; P=0.001), and LVM (from 49.2 to 45.2 g; P=0.004). In the multiple regression analysis for factors associated with reduction in LVM; treatment with losartan, and decrease in SBP were the only factors included in the model (R2=0.60; P=0.003). To conclude losartan, but not spironolactone, decreased LVM and heart sympathetic overactivity in prehypertensive obese subjects after 16 weeks of treatment. Regression on LVM was associated with reduction on SBP levels.

Renal functional reserve in patients with recently diagnosed Type 2 diabetes mellitus with and without microalbuminuria.

BACKGROUND/AIMS: During the first 10 years, two thirds of the patients with type 2 diabetes mellitus (DM) have microalbuminuria (MA). Functional renal reserve (FRR) and its relationship with proteinuria and metabolic control are unknown at the early phases of disease. We investigated the frequency of MA in recently diagnosed type 2 DM patients, and its association with FRR. METHODS: We studied 181 type 2 DM patients with less than 6 months since diagnosis. Renal volume, MA, glomerular filtration rate (GFR) and renal plasma flow (ERPF) were evaluated before and after an acute oral protein load in 28 type 2 DM patients (14 with, and 14 without MA), and in 7 healthy subjects. RESULTS: A total of 10.6% of the patients had MA. MA patients had higher cholesterol and triglyceride levels than those normoalbuminuric. Twenty recently diagnosed type 2 diabetic patients showed high basal GFR. Twelve of them had MA and insulin resistance. After the acute oral protein load, the control subjects and the patients without MA increased their GFR and their ERPF. The group with MA did not. CONCLUSIONS: Seventy-five percent of the patients were hyperfiltering. Normoalbuminuric patients had larger increase in GFR and ERRPF than MB patients. We conclude that FRR measurement can be an important tool for the diagnosis of latent diabetic nephropathy.

PCR-PRINS-FISH analysis of structurally abnormal sex chromosomes in eight patients with Turner phenotype.

According to cytogenetic analysis, about 50% of Turner individuals are 45,X. The remaining cases have a structurally abnormal X chromosome or are mosaics with a second cell line containing a normal or abnormal sex chromosome. In these mosaics, approximately 20% have a sex marker chromosome whose identity cannot usually be determined by classical cytogenetic methods, requiring the use of molecular techniques. Polymerase chain reaction (PCR), primed in situ labeling (PRINS), and fluorescence in situ hybridization (FISH) analyses were performed in 8 patients with Turner syndrome and 45,X mosaic karyotypes to determine the origin and structure of the marker chromosome in the second cell line. Our data showed that markers were Y-derived in 2 patients and X-derived in the remaining 6 patients. We were also able to determine the breakpoints in the two Y chromosomes. The use of cytogenetic and molecular techniques allowed us to establish unequivocally the origin, X or Y, of the marker chromosomes in the 8 patients with Turner phenotype. This study illustrates the power of resolution and utility of combined cytogenetic and molecular approaches in some clinical cases.

[Comparison of HOMA IR with the minimal model for measuring insulin sensitivity in polycystic ovary syndrome]. / Comparación del HOMA IR con el modelo mínimo para medir sensibilidad a la insulina en el síndrome de ovarios poliquísticos.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of premenopausal women. These women have insulin resistance independent of obesity; and insulin resistance is now recognized as a risk factor for the development of type 2 diabetes mellitus, hypertension and cardiovascular disease. PURPOSE: We sought, therefore, to assess whether there was correlation between a simple fasting measure of insulin sensitivity (Homeostatic Model) and the Minimal-Model in this syndrome. METHODS: Thirty-three PCOS women (aged 22.7 +/- 6.2 years and body mass index (BMI) 29.1 +/- 5.4) underwent frequently sampled i.v. glucose tolerance test (Minimal-Model). RESULTS: Seventeen patients (51.5%) had insulin sensitivity < 1.5 x 10(-4) min.-1.microU-1.mL-1. Patients with BMI > de 27 was more resistant than the BMI < or = de 27 (p = 0.004). The correlation in PCOS between Si (insulin sensitivity) and HOMA IR was found significant for all the group (p = 0.0001; RRANK = -0.76) and those women with BMI > de 27 (RRANK = -0.77; p = 0.00006), but not significant correlation was found in those with BMI < or = de 27 (RRANK = -0.43; p = 0.13). CONCLUSIONS: We conclude that the HOMA IR may be useful as a screening test for insulin resistance in overweight and obese Mexican PCOS women but not in the lean ones.

Renal tubular acidosis in children with vesicoureteral reflux.

PURPOSE: We evaluated renal tubular acidosis in children with primary vesicoureteral reflux. MATERIALS AND METHODS: We studied 18 children 4 to 15 years old to determine age at onset, reflux intensity, and renal scars and volume as possible associated factors of renal tubular acidosis. Patients had normal glomerular filtration rates and no urinary infections for the last 12 weeks, and they had not undergone urological surgery. Urine acidification and alkalization tests were done, and the Mann-Whitney U test was used to assess differences between the groups with and without renal tubular acidosis. RESULTS: A total of 14 patients had unilateral and 4 had bilateral reflux, which varied in severity. All children except 2 had renal scarring. Bilateral renal volume was smaller in the renal tubular acidosis group. Nine patients had distal renal tubular acidosis, including 4 with short stature. CONCLUSIONS: Several patients with vesicoureteral reflux had renal tubular acidosis and some had growth failure. Grades of reflux and renal scarring were similar in patients with and without renal tubular acidosis. A single evaluation of reflux is of slight value for predicting future functional tubular impairment, and the duration of reflux and other associated factors may be more important. Renal tubular acidosis was the main explanation for growth failure in these patients.

[Single weekly dose of recombinant erythropoietin in children with chronic renal insufficiency]. / Dosis semanal única de eritropoyetina recombinante en niños con insuficiencia renal crónica.

OBJECTIVE: To study the results of a single dose weekly treatment with subcutaneous recombinant human erythropoietin in the anemia of children with end stage renal failure patients. DESIGN: We studied 19 patients 6 to 17 years old with end-stage renal failure under ambulatory peritoneal dialysis at the Centro Médico Nacional of the city of León, State of Guanajuato. All had required an average of 2.8 red blood cell transfusions during the previous 18.2 months. The criteria for inclusion were: severe normocytic normochromic anemia (Hct < 20%) without infectious or systemic illness, blood pressure under the 97th percentile for their age, normal hepatic function, and absence of convulsive crisis. The erythropoietin was subcutaneously administered once a week at a dose of 130 +/- 15 U/kg of body weight (SD). All patients received minimal daily iron and folic acid requirements. RESULTS: The initial average values for hemoglobin and hematocrit were 6.6 +/- 0.9 g/dL and 20.6 +/- 3.3% respectively. They increased to 9.4 +/- 0.9 g/dL and 28.8 +/- 2.5% after 12 weeks of treatment (p < 0.05). The patients did not receive blood transfusions during the study period and their blood pressure remained unchanged. CONCLUSIONS: The subcutaneous administration of erythropoietin in our study increased the hemoglobin and hematocrit values in our patients with a substantial reduction in secondary effects and in cost of treatment.

Hereditary hemorrhagic telangiectasia: report of 15 affected cases in a Mexican family.

We report a Mexican family with 15 members affected with hereditary hemorrhagic telangiectasia (HHT), all of them suffering from severe hemorrhagic episodes treated with multiple blood transfusions; one patient had a cerebral arteriovenous fistula that required surgical treatment and two others had severe cirrhosis of the liver. Clinical findings in this family illustrate the variable expressivity in HHT, which should be taken into account for the purpose of genetic counselling and monitoring for early detection of systemic complications.