Treatment of traumatic scars using fat grafts mixed with platelet-rich plasma, and resurfacing of skin with the 1540 nm nonablative laser.

BACKGROUND: Many treatments have been proposed for cosmetic or functional improvement of scars. It is known that fat grafts and laser treatment can have beneficial effects on remodelling of scar tissue, and platelet-rich plasma (PRP) can be effective during the wound-healing process. We hypothesized that these combined treatments would be effective in improving traumatic scars, with minimal recovery time and few side-effects. AIM: The purpose of this study was to compare and evaluate the efficacy of three procedures for the treatment of traumatic scars. METHODS: We treated 60 patients affected by traumatic scars involving different body parts. All patients were randomly allocated to one of three groups (20 patients per group) and underwent one of three different procedures. Group A was treated with fat grafts mixed with PRP, group B was treated with nonablative laser, and group C was treated with both procedures. RESULTS: Comparison of the groups showed that PRP produced a significant difference in these treatments. The most effective scar treatment was the combination of fat grafts mixed with PRP plus nonablative laser resurfacing (group C). This treatment resulted in group C having an increase of 22% in wound healing compared with group A, and an increase of 11% compared with group B. CONCLUSIONS: The data confirm the efficacy of all three treatments, with the most effective scar treatment being the fat grafts mixed with PRP, followed by skin resurfacing with nonablative laser. This combined treatment appeared to be safe and effective for scar treatment. Further studies are needed to explore the potential use of this combined treatment.

Peri-implantitis fibroblasts respond to host immune factor C1q.

BACKGROUND AND OBJECTIVE: Current therapies for peri-implantitis apply the same clinical protocols as those used for the treatment of periodontitis; however, outcomes remain unpredictable. We hypothesized that resident fibroblasts of the peri-implantitis stroma and periodontitis stroma differ in their phenotype and response to host immune factors. Fibroblasts are highly heterogeneous and comprise discrete subtypes with the potential of modulating inflammatory activities. The aim of the present study was to characterize the expression of receptors for complement C1q of innate immunity on human peri-implantitis fibroblasts and investigate effects of C1q on the proinflammatory properties of the cells. MATERIAL AND METHODS: Fibroblasts were cultured from gingival tissues exhibiting peri-implantitis and periodontitis, and from healthy gingivae as a control. Expression of C1q receptors for the collagen (cC1qR) and globular domains (gC1qR) of the protein was determined by flow cytofluorometric analysis (FITC) of specific antibodies bound to the surface of the cells. Secretion of C1q-inducible proinflammatory mediators was quantified after 24 h incubation using array-based ELISAs. RESULTS: The percentage of fibroblasts FITC-positive for cC1qR was 67, 75 and 12% in peri-implantitis, healthy and periodontitis cultures, respectively, whereas the percentage of gC1qR FITC-positive fibroblasts was 5, 3 and 59%, respectively. The C1q interactions with peri-implantitis and healthy fibroblasts increased secretion of the chemokines interleukin-6 and interleukin-8 twofold, and monocyte chemoattractant protein-1 fourfold over baseline values, whereas periodontitis fibroblasts were unresponsive. Complement C1q increased levels of vascular endothelial growth factor sevenfold and transforming growth factor-ß1 12-fold over baseline values in peri-implantitis cultures, only. CONCLUSIONS: Peri-implantitis fibroblasts differ from periodontitis fibroblasts in phenotypic expression of cC1qR and function, and from healthy fibroblasts in proinflammatory, angiogenic and fibrogenic function. Peri-implantitis fibroblasts may represent a novel subtype.

Differential chemokine response of fibroblast subtypes to complement C1q.

BACKGROUND AND OBJECTIVE: The pathogenesis of periodontitis includes an inappropriate activation of the classical complement cascade (C') with accumulation of inflammatory C' products in fluids and tissues. Our hypothesis is that in vivo the C' product, C1q, may act as a regulatory component of the innate immune response of distinct matrix fibroblasts to the inflammatory environment. This study analyzed the C1q induction of pro-inflammatory cytokine secretion in fibroblast subtypes derived from distinct periodontal tissues, and identified a mechanism of the cell response. MATERIAL AND METHODS: Primary human gingival fibroblast, periodontal ligament fibroblast, and granulation tissue fibroblast cultures were treated for 24 h with C1q. Protein arrays assessed the secretory profile of constitutive and C1q-inducible pro-inflammatory cytokines, and enzyme-linked immunosorbent assays were used to quantify the kinetics of each inducible cytokine. RESULTS: Granulation tissue fibroblast cultures were unresponsive to C1q challenge. In contrast, periodontal ligament fibroblasts responded with a release of monocyte chemoattractant protein (MCP)-1, interleukin-6, interleukin-8, and macrophage inflammatory protein (MIP)-1beta higher than the basal level by 8.2-, 7.0-, 3.8-, and 7.2-fold, respectively. Human gingival fibroblast cultures increased secretion of these chemokines by 5.2-, 4.5-, 3.0-, and 9.8-fold, respectively. Inhibitor studies revealed that C1q-inducible release of chemokines by the human gingival fibroblast and periodontal ligament cultures was contingent upon p38 mitogen-activated protein kinase activity. CONCLUSION: The ability of C1q to stimulate secretion of pro-inflammatory chemokines depends upon which specific fibroblast subtype is involved. Targeting C1q-activated intracellular signaling pathways may be an effective means to inhibit the production of chemokines that promote inflammatory cell infiltration into gingival and periodontal ligament tissues.

Bile rifaximin concentration after oral administration in patients undergoing cholecystectomy.

Rifaximin, a new antibiotic derived from rifamycin SV, was measured in the cholecystic bile of 13 patients submitted to cholecystectomy, after oral administration of 1600 mg of the drug in the 48 hour preceding surgery. Rifaximin concentrations were quantified only in 6 patients and were at least five times lower than those detected with rifampicin, under similar experimental conditions. Results seem to indicate that rifaximin is virtually not absorbed through the intestinal mucosa after oral administration.

[Role of low molecular weight heparin in the prevention of postoperative deep venous thrombosis. Our experience in 88 cases]. / Il ruolo dell'eparina a basso peso molecolare nella prevenzione della trombosi venosa profonda postoperatoria. La nostra esperienza su 88 casi.

In Leriche's "maladie post-operatoire" one of the most frequent and dangerous complications is the deep vein thrombosis (DVT). In general surgery its occurrence is between 10 and 40%, closely related to factors like patient's age, postoperative immobilization, type and time of surgery. Low molecular weight heparins (LMWH) have been recently introduced as a therapy to prevent postoperative DVT in high risk patients. LMWH seem to have all advantages of classical heparin products without their side effects. Eighty eight patients who underwent general surgery were studied in a clinical controlled trial about effectiveness of a new LMWH (Fluxum) for the prevention of postoperative DVT: 44 were treated with Calcium-heparin and 44 were treated with Fluxum. Both drugs decreased significantly the percentage of DVT, but Fluxum seemed to be better tolerated for its single-daily subcutaneous administration.

A multicentre study on LMW-heparin effectiveness in preventing postsurgical thrombosis.

A multicentric study was carried out involving six italian departments of general surgery to assess the efficacy of a low molecular weight (LMW) heparin called Fluxum compared to standard calcium heparin in low doses for prevention of postoperative thromboembolic complications (deep vein thrombosis and pulmonary embolism). 610 patients were treated; 308 (50.5%) of whom were treated with Fluxum at doses of 4,000 or 8,000 I.U. Axa once a day by subcutaneous injection and 302 (49.5%) with heparin calcium at doses of 5,000 I.U. two or three times a day by subcutaneous injection. We observed a total of 29 deep vein thrombosis (4.7%); 10 (3.2%) from the group treated with LMW heparin and 19 (6.3%) from the comparative group. During the study 4 (0.65%) pulmonary embolism were found, 1 (0.32%) in the group treated with LMW heparin and 3 (1%) in the group treated with calcium heparin. None serious hemorrhagic accident was reported during the study. The antithrombotic prophy laxis carried out with Fluxum was on the whole better tolerated than the treatment of the other group, registering a lower frequency of hematomas at the injection and surgical wound sites.

Antithrombotic treatment during acute inflammatory complications of patients affected by postphlebitic syndrome: LMW-heparin versus standard heparin.

Seventy seven patients affected by postphlebitic syndrome (PPS) during acute inflammatory and/or obstructive complications were controlled. Thirty nine patients were treated with a new low molecular weight heparin (Fluxum), 16,000 I.U. AXa/day subcutaneously for 10 days and, subsequently, 8,000 I.U. AXa/day subcutaneously for up to 50 days. Thirty eight patients were treated with 20,000 I.U./day i.v. for 10 days of sodium heparin and, subsequently, with 12,500 I.U./day of calcium heparin by subcutaneous injection for up to 50 days. Clinical symptoms (pain, oedema, hyperemia, rashes, itching, dermatitis, ulceration) and instrumental patterns (Doppler) were recorded. Fluxum had an evident effect on the improvement of patient's clinical performance during acute complications of PPS.

Low molecular weight heparin prevention of post-operative deep vein thrombosis in vascular surgery.

Ninety-two patients undergoing vascular surgery took part in a controlled clinical trial to study the effectiveness of a new low molecular weight (LMW) heparin for prevention of post-operative deep vein thrombosis. Forty-six patients were treated daily, for 7 days after operation, with a single subcutaneous injection of 15,000 Anti X-activated Factor Units of the new LMW heparin; the remaining 46 patients were treated, for the same period, with 2 daily subcutaneous injections of 5,000 International Units of calcium heparin. Deep vein thrombosis detection was by the radioactive fibrinogen uptake test, performed each day during therapy in all patients. A very low incidence of sub-clinical deep vein thrombosis was observed; in 3 (6.5%) patients in the LMW heparin group and in 4 (8.6%) patients of the calcium heparin group. The results of laboratory investigation showed that the antithrombotic activity (inhibition of Factor Xa) of the LMW preparation was significantly greater than that of calcium heparin, while activated partial thromboplastin time was greater in the calcium heparin group. The new preparation also showed better local tolerance, with less pain on subcutaneous injections.

Haematological changes induced by direct contact over a coated activated charcoal: in vivo and in vitro study.

In evaluating biocompatibility, haematological changes induced by ACCM in vivo and in vitro were studied. Twenty minutes after the start of haemoperfusion a significant fall in white blood cell number was found. After 60 minutes the leucopenia still occurred. In a previous work we suggested that complement activation is at least one of the possible mechanisms responsible for these phenomena. Moreover, our data showed a significant decrease in platelet number after 60 minutes of haemoperfusion. During the in vitro study, we found, using citrated blood, a significant correlation between aggregation response to ADP and collagen, either at different ACCM doses or at various periods of incubation. Our results suggest that the fall in platelets is due to platelet aggregation. The haemocoagulation study may have clinical importance in high-risk patients when haemoperfusion is required.

Evaluation of acid-base balance and pO2 with acetate dialysis in non-uremic patients.

The aim of our work was to evaluate the immediate effects of acetate-dialysis in patients with normal renal and respiratory function. For this purpose pH, pO2, pCO2 and HCO3- were monitored in arterial blood before dialysis, after 60, 120, 180 mns and at the end of each treatment in two groups of patients on chronic hemodialysis, a first group of schizophrenic patients and a second group of uremic patients. In the first group of patients the predialytic values were in the normal range. After hemodialysis HCO3- and pCO2 significantly decreased, both these changes were associated with a stable pH. The pO2 significantly decreased after 60 mns of dialysis. At the end of dialysis the pO2 increased without significant variation compared to predialytic values. In conclusion in non-uremic hemodialysis patients metabolic acidosis due to the loss of bicarbonate through the membrane is compensated by respiratory alkalosis. This respiratory alkalosis is not due to hypoventilation secondary to respiratory centre inhibition, but is mainly due to the pCO2 loss through the dialysis membranes.

Pattern visual evoked potentials and brainstem auditory evoked responses in uremic patients.

With the improvement of dialysis therapy and subsequent increase in the average lifespan of uremic patients more interest has been directed towards neurological complications induced by chronic renal failure. Twelve uremic patients were selected on the basis of negative neurological and psychiatric examinations. Electroencephalogram, pattern visual evoked potentials (VEPs) and brainstem auditory evoked responses (BAERs) were recorded in all patients. Pathological latency increases of VEPs in six patients and of BAERs in three patients had been observed. These findings have been related by the authors to the action of toxic substances or to the presence of minimal demyelinating lesions of CNS. Since these pathological findings were observed in patients who were normal at the clinical examination, it has been suggested that the evoked potentials recording might be a sensitive index of initial early lesions of the CNS in uremic patients (Acta neurol. belg., 1982, 82, 72-79).