In vivo evaluation of a metronidazole-containing gel for the adjuvant treatment of chronic periodontitis: preliminary results.

The present study developed an experimental metronidazole-based gel and evaluated its efficacy for the adjuvant treatment of chronic periodontitis. Sixteen patients were randomly allocated into two groups of eight subjects according to the following proposed treatments: (1) scaling and root planing (active control) or (2) scaling and root planing and direct periodontal intrapocket application of 15% metronidazole-based gel in two sites (≥5 mm in depth) (experimental group). Potential changes in the subgingival microbiota were assessed using a DNA Checkerboard method at three proposed times: baseline and following 7 or 30 days of drug administration. High-performance liquid chromatography (HPLC) monitored metronidazole concentrations in the crevicular fluid during treatment. The metronidazole experimental group presented lower bacterial counts than the control group at the three evaluated times (p<0.01 for baseline, p<0.001 for 7 or 30 days) when the target species were analyzed as a pool of bacteria. Samples revealed significantly lower counts 7 days after drug administration compared with baseline or after 30 days (p<0.05). HPLC analysis detected gel 1 h after application. The metronidazole-based gel significantly decreased the total bacterial count at the three evaluated times. Periodontopathogenic species were not different after gel administration.

Diametral compressive bond strength of composite resin associated with an adhesive system in incremental filling technique.

AIM: The aim of this in vitro study was to evaluate the diametral compressive bond strength between Charisma or TPH composite resin after association or not to an adhesive system in incremental filling technique. METHODS: Twenty cylinders of each composite resin brand were fabricated using a Teflon matrix and divided into four groups, according to the numbers of adhesive layers applied: group 1 Control without adhesive; group 2 one layer; group 3 two layers and group 4 three layers. The bonding system Adper Single Bond was used between composite resin increments. Diametral compression assays were carried out in an EMIC-MEM 2000 universal testing machine, adjusted at 1 mm/min. ANOVA and Tukey's test were used in the statistical analysis. RESULTS: The mean strengths and standard deviations for each group were: Charisma 1= 38.26+/-2.38; 2=46.56+/-2.38; 3=40.57+/-2.38; 4=36.87+/-2.38 (2>1=3=4; P<0.05) and TPH 1=52.17+/-2.38; 2=52.23+/-2.38; 3=44.68+/-2.38; 4=44.11+/-2.38 (1=2>3=4; P<0.05). CONCLUSIONS. It was concluded that TPH presented higher means of compressive bond strength than Charisma, and the association of an adhesive system between the increments may influence the diametral compressive bond strength of composite resins.

[Anastomosis and resection techniques in the treatment of cervical tracheal stenosis]. / Le tecniche di resezione--anastomosi ed il trattamento delle stenosi limitate alla trachea cervicale.

The author describes the most useful anastomosis and resection surgical techniques for the treatment of stenosis of cervical trachea. CO2 laser, dilatation, microsurgery, recalibration by external approach and the use of endotracheal tubes are discussed as well.

[Current issues in the endoscopic treatment of tracheobronchial foreign bodies in pediatric age: personal observations]. / Attualità in tema di trattamento endoscopico dei corpi estranei tracheobronchiali in età pediatrica: osservazioni personali.

The present paper reports some organizational hypotheses and presents personal experience in the endoscopic management of tracheobronchial foreign bodies in children. Many changes have taken place in endoscopy and anesthetic techniques over the last twenty years and these are reviewed. The present experience is based on data for 42 pediatric patients who had undergone tracheobronchial endoscopy from 1974 to 1994. Within this time lapse 3 separate periods have been identified-1974-1978, 1979-1990 and 1991-1994-for which there was a progressive improvement in endoscopic techniques. During the first period endoscopy was performed with the patient in apnea. During the second period endoscopy was able to last longer as the patient was periodically ventilated by means of the bronchoscope set in the trachea and by intermittently closing the proximal hole in the bronchoscope with a finger. During the third period endoscopy was made easier by the use of rod-lens telescopes attached to the forceps: this provided a better view when grasping the foreign body. Extractive tracheobronchial endoscopy requires close cooperation between anesthesiologist and endoscopist. As there is the risk of complications, the patient must be closely followed, not only during diagnosis and treatment but also post-operatively. For this reason parenteral administration of corticosteroids and antibiotics is advisable during the post-operative stage. Since extractive tracheobronchoscopy in pediatrics is still high risk surgery, the authors suggest three different solutions for the medical organization: a) The Pneumology-Bronchoscopy wards could be totally responsible for extracting the above-mentioned foreign bodies in children. b) An E.N.T.-Pneumological department could be set up aimed at improving rigid and flexible bronchoscope methods in both fields; this is suggested in view of the shortage of operating rooms in pneumology wards and the availability of E.N.T. specialists. c) The most important, most qualified E.N.T. wards (at least one for reach region) could be equipped with all the necessary tools. In this case the medical and paramedical staff would be kept up to date, also by attending bronchoscopy centers for adults. Hence the number of patients treated by each center would increase and the tracheobronchoscopic expertise of the E.N.T. specialists would improve. This would translate into a lowering of the risks and a better prognosis for these young patients.

Refinement of a thyroid cultured cell system used in clinically relevant bioassays.

Thyroid cultured cells are now used worldwide in clinical bioassays of TSH and of thyroid autoantibodies. Having originally developed the thyroid cell cultures (Ambesi-Impiombato et al. 1980) from rat glands in our laboratory, we now aim to improve the system, moving in two directions: a) TSH-independent mutants have been produced and characterized, which can be used in clinical bioassays without "starvation" from the hormone. b) Human cultures have been attempted using our experience with rat cells, as well as innovative strategies. Preliminary results now indicate that human normal differentiated cells may be available for clinical studies in vitro, when species-specific differences may be critical.

Refinement of a thyroid cultured cell system used in clinically relevant bioassays.

Thyroid cultured cells are now used worldwide in clinical bioassays of TSH and of thyroid autoantibodies. Having originally developed the thyroid cell cultures (Ambesi-Impiombato et al. 1980) from rat glands in our laboratory, we now aim to improve the system, moving in two directions: a) TSH-independent mutants have been produced and characterized, which can be used in clinical bioassays without "starvation" from the hormone. b) Human cultures have been attempted using our experience with rat cells, as well as innovative strategies. Preliminary results now indicate that human normal differentiated cells may be available for clinical studies in vitro, when species-specific differences may be critical.

Antibiotic prophylaxis in ear, nose and throat surgery: a comparison of a single preoperative dose with three peri-operative doses of ceftazidime.

An open prospective randomized trial was conducted in three Italian ear, nose and throat (ENT) surgery departments on 120 patients aged 10 to 84 years, to compare a single pre-operative dose vs. three peri-operative doses of ceftazidime in surgical prophylaxis. Sixty patients in group I received 1 g ceftazidime intramuscularly (im) or intravenously (iv) 1 h before surgery, and 60 in group II received three 1 g doses of ceftazidime, im or iv, 1 h before, and 6 and 12 h after surgery. Post-operative infections were observed in six group I patients (10.1%) and seven group II patients (11.6%). All infections arose in patients who had undergone 'moderate-risk' (6.7%) or 'high-risk' surgery (30.5%). We conclude that a single pre-operative 1 g dose of ceftazidime is as efficacious as multiple peri-operative doses in the prophylaxis of infectious complications following this type of surgery.

Surgical anatomy of the superior laryngeal nerve.

The authors report on their anatomic findings in 42 surgical dissections of the superior laryngeal nerve. Better knowledge of this anatomy should enable a more conservative cervical surgery and help in attempts at nervous rehabilitation of laryngeal paralysis.

Parathyroid surgery in primary hyperparathyroidism: an update.

The best approach to parathyroid removal in primary hyperparathyroidism (HPT) is still a major topic in neck surgery. The present report reviews our experiences with 71 patients operated by parathyroidectomy (PTX) between 1978 and 1987. Preoperative computed tomography, sonographic and double-tracer subtraction scanning examination allowed a precise assessment of the number and the topography of the diseased glands. Consequently, 65 patients underwent partial "selective" PTX, with removal of one or two glands, while 6 patients underwent subtotal PTX. The surgical results can be summarized as follows: full success in 67 cases (94.4%); persistent hypercalcemic syndrome in 3 cases (4.2%); recurrence of HPT in 1 case (1.4%). One case of persistent hypercalcemia was solved by reoperation. Thus, the total success rate was definitively assessed at 95.8%. As a complication of surgery a long-lasting postoperative hypocalcemic syndrome was observed in only 2 patients following subtotal parathyroidectomy. Our overall findings show that an attentive preoperative study by means of modern imaging techniques usually allows a "selective" partial PTX with good results and a low risk of complications.