[Lifting of the maxillary sinus: complementary use of platelet rich plasma, autologous bone deproteinised bovine bone. Case report]

The present paper describes a clinical case in which autologous bone, removed during an operation from the maxillary tuberosity, platelet rich plasma (PRP) and deproteinised bovine bone (Bio-oss, Geistlich) were used as graft material in a bilateral maxillary sinus lift procedure. During the same operating session, it was planned to carry out the lift of the maxillary sinus, employing a "combined" graft (autologous bone, PRP, deproteinised bovine bone), and to insert 6 fixtures at maxillary level, 3 in each quadrant, and 6 fixtures at mandibular level. The use of PRP, or rather of the platelet gel derived from it, represented an improvement compared to standard bone graft techniques. A graft consisting of autologous bone and PRP (with or without deproteinised bovine bone) makes it possible in fact to carry out more demanding operations, such as a major lift of the maxillary sinus, without the need for a block graft, but employing autologous bone particulate, which is easier to find. Furthermore, a "combined" graft is easily malleable and adjustable and can be adapted perfectly to the bone defect in which it is inserted. Finally, it guarantees a better quality of cure both in terms of speed and degree of mineralisation. This is very important if we consider that usually, lifting of the maxillary sinus is carried out precisely to guarantee adequate bone volume in cases where bone has been lost and to permit the insertion of osteointegrated implants.

[The principles of tissue engineering: role of growth factors in the bone regeneration]

In this article the principles of tissue engineering are analyzed. The growth factors release from platelets, TGF-beta, PDGF, IGF-I and -II, are accurately described and the structure and functions of these growth factors are reported. Then a simple model of bone regeneration is proposed. This model is used every time that bone grafts are used in oral and maxillofacial surgery. On the basis of this model of bone regeneration, the cells and biochemical indicators (pH and pO2) of bone wound where the bone graft is placed, and of surrounding tissues, are described. Then three phases of bone regeneration are analyzed: the beginning, the second (or immature bone), the third or mature bone with lamellar architecture. In each phase the importance of growth factors are evaluated. The conclusion is drawn that factors influence the bone regeneration and that their increased concentration leads to a quick bone formation and quantity. Moreover, the techniques of regeneration in vivo with autogenous bone, are better than those in vitro, since the bone structure, is also the result of the biomechanical environment, where the bone graft grows up.

[Platelet rich plasma (PRP): potentialities and techniques of extraction]

This paper describes the various techniques of platelet-rich plasma (PRP) extraction codified in recent years and their use potential is evaluated. PRP is one of the techniques with which at the moment it is attempted to modulate and facilitate the cure of a wound. The use of PRP is based on the theoretical premise that by concentrating platelets the effects of the growth factors (PDGF, TGF-beta, IGF-I and -II) so released will be increased. Marx's original technique is described above all. This prescribes the sampling of a unit of blood (450-500 ml) and the use of a cell separator. We then analysed the technique of Marx and Hannon in which the quantity of blood sampled is reduced to 150 ml, and the two simplified techniques of the Sacchi and Bellanda group. Finally, a new PRP extraction technique is described. We conclude that platelet gel allows access to autologous growth factors which by definition are neither toxic nor immunogenic and are capable of accelerating the normal processes of bone regeneration. PRP can thus be considered a useful instrument for increasing the quality and final quantity of regenerated bone in oral and maxillo-facial surgery operations.

A new p21waf1/cip1 isoform is an early event of cell response to oxidative stress

p21waf1/cip1 mRNA and protein accumulate in intact cells exposed to oxidizing agents through a p53-independent, MAPK-dependent mechanism. Treatment with oxidizing agents also yields a second form of this protein (FM p21), characterized by a faster migration on SDS-PAGE. This phenomenon depends on the modification of intracellular redox conditions induced by diethylmaleate, a glutathione-depleting agent, being prevented by the pretreatment with the glutathione precursor N-acetylcysteine. The appearance of this FM p21 form is very early, being observed 5 min after exposure to diethylmaleate, long before the already observed accumulation of p21 induced by oxidative stress. Furthermore, experiments with dominant negative mutants of MEK demonstrate that, in contrast with that observed for the oxidative stress-induced accumulation of p21 mRNA and protein, the appearance of FM p21 form is not dependent from the activation of the MAPK pathway. It was previously observed (Tchou et al, 1996) that in some lung carcinoma cells long exposure to high doses of phorbol esters also induces the appearance of a faster-migrating p21 electrophoretic band and it was suggested that this could result from a different phosphorylation or from a proteolytic processing at the C-terminus of the protein. The latter is not the case for the diethylmaleate-induced FM p21 whose C-terminus is intact, as demonstrated by the expression of a C-terminus tagged p21 cDNA. On the contrary, the observed migration shift seems to be dependent on the hypophosphorylation of the protein; in fact, a pretreatment of cells with okadaic acid, an inhibitor of (serine/threonine) phosphatases, inhibits the oxidation-dependent appearance of the FM p21 and the block of protein synthesis, caused by cycloeximide, does not affect the appearance of FM p21, that thus could derive from the dephosphorylation of preexisting protein.

Thymotrophic effect of ether lipid 1-O-octadecyl-2-O-methoxy-rac-glicero-3-phosphocholine in the mouse

1-O-octadecyl-2-O-methoxy-rac-glicero-3-phosphocholine (ET-18-OCH3) is a synthetic derivate of 2-lysophosphatidyl-choline, endowed with some immunomodulatory and anticancer effects. In the present work we report that a chronic (1 microgram/g b.w. for 2 weeks) or acute single dose injection of ET-18-OCH3 produced a recovery of thymus weight and thymocytes cellularity in two different strains of mice, C57BL6 and Swiss mice, undergoing thymus age-dependent involution. This effect was significant when the thymus weight was reduced at 50% and it was without effect on thymus lacking age dependent involution, such as young mice. The ability of ET-18-OCH3 to produce thymus weight and thymocyte cellularity recovery was also demonstrated in adult mice showing hypotrophy of thymus induced by chronic corticosterone treatment, suggesting that this compound could be effective against thymus hypotrophy induced by external stimuli. This thymotrophic effect of ET-18-OCH3 was not dependent on direct action on thymocyte proliferation, but probably it was dependent on its action on thymic epithelial cells to produce hormone thymulin, which level was found significantly increased in the plasma. These results provide further immunomodulatory propriety of ET-18-OCH3 and open the possibility to use this compound to counteract thymus hypotrophy.

Effects of ozone on some biological activities of cells in vitro

The aim of this work was to study the in vitro effect of ozone on the 70 kDa family of inducible heat shock proteins (HSPs70). We also performed tests to investigate possible toxic effects of ozone at the different doses employed. In human haematic mononucleated cells ozone at doses up to 20 micrograms/ml had no toxic effects and induced biosynthesis of the HSPs70. Biosynthesis of these proteins was greater at 40 micrograms/ml. In murine macrophages testing with tetrazolium salt (MTT), neutral red, and 2-deoxy-D-[1-3H]glucose uptake and study of the cell morphology showed a remarkable resistance or no toxic effects at a dose of 100 micrograms/ml also. Melanoma B16 murine cells assayed with the MTT test demonstrated less resistance to the toxic effects of ozone than normal cells. These results provide indications relevant to the problems of ozone therapy.

[Cardiovascular adjustments in hypertensive patients. An echocardiographic study]

Echocardiography was used to asses parameters of cardiovascular function in order to identify the main cardiac adjustment mechanisms to arterial hypertension. In addition to morphological parameters of septal and parietal thickness and diameter, telesystolic (Ses) and telediastolic (Spk) stress, EF, Vcfm, the index of left ventricular mass (ILVM), hypertrophy ratio (h/r), contractility index (Do), peripheral resistances (RPT) and Tarazi's index (SAC) were evaluated. In comparison to control subjects, higher levels of PwTs, h/r, SAC, RPT and ILVM (at the limit of significance) were found in hypertensive patients, which were reflected by higher Spk and Do values. From the further analysis of data to identify patients with signs of left ventricular hypertrophy (h/r greater than 0.40 and/or ILVM greater than 140) it was concluded that the hypertrophy ratio (h/r) is the functional parameter which most closely reveals the type of myocardial adjustment. Irrespective of absolute values of ILVM, the adequacy of myocardial hypertrophy to the dimensions of the cavity is accompanied by the normalisation of stress and the return of Do values close to normal levels. Hearts with low h/r those with the highest stress levels, as well as preesting the lowest EF and the highest Do values.

[Renal adenocarcinoma: 20 years of surgical experience, 1970-1990]

Epidemiology, diagnostics, staging, surgical procedure and survival data of 219 patients with renal cells carcinoma are reported (1970-1990). Diagnosis is based on Tc and angiography. Possibly in the future high sensitivity methods like Magnetic Resonance could limit the use of invasive techniques. 207 patients underwent radical nephrectomy and 68 of these lymphadenectomy too (para and pre aortic and/or caval). In 41 patients the tumor had involved the venous system and 9 cavatomies, 2 caval resections and 1 atriotomy have been performed. In the stage T1-T2-T3 NoMoVo the survival rate (at. 5 years) is 87%, 80%, and 75% respectively. The survival in N+MoVo patients is 17% (at 5 y.) and in V+NoMo patients 57%.

[Efficacy of long-term treatment with enalapril in patients with congestive heart failure]

Effects of enalapril on congestive heart failure and survival until 12 months have been evaluated in 60 patients with congestive heart failure (II, III, IV NYHA class) versus 60 control patients. Enalapril has been administered with digitalis and diuretic for 12 months 5 mg twice a day; in 60 control patients only digitalis and diuretic have been administered. Patients have been controlled every month during 12 months evaluating: NYHA class, time of exercise at treadmill, ejection time of left ventricle, speed index of ejection, cardiac output, systolic output, ECG, blood pressure, creatinine, BUN and electrolytes. After 12 months a significant increase (p less than 0.001) of systolic and cardiac output in patients with enalapril has been recorded. Also the increase of exercise time was more evident in patients with enalapril (p less than 0.01). The results show that long term treatment with enalapril in patients with congestive heart failure, improving cardiac performance, gives an hemodynamic and symptomatic benefit.

[Unusual anatomic coronary variants: parallel left anterior descending artery. Description of 3 cases]

Three cases with a variation of the classic anatomic left anterior descending artery pattern, encountered unexpectedly during coronary arteriography, are reported. The importance of this unusual and rare coronary artery pattern is only anatomic, and the possibility to carry out these findings by the coronary arteriography, can increase their occurrence instead of an incidental finding.

Functional voiding disturbances of the ampullo-vesicular seminal tract: a cause of male infertility

We present herein six cases of male sterility due to purely functional ampullo-vesicular tract voiding disturbances, out of a series of 94 vasovesiculographies performed on selected patients with suspected obstructive azoo-or oligozoospermia. This pathology was suspected from the particular seminal vesicle ultrasonographic pictures (anechoic areas) and the absence or marked reduction of the vesicular component in the ejaculate. The non-anatomic cause of the ampullo-vesicular voiding disturbance was demonstrated by means of the vesiculographic images and by the finding of large amounts of spermatozoa in the fluid obtained by micturition or bladder catheterism after seminal tract washout during vasovesiculography. Until now and to the best of our knowledge, only four other such cases were described in Literature, although documented in a different way (Ichijo et al., 1981). We may suppose that this new syndrome, possibly due to a local neurological defect, could be a not so rare cause of male infertility. Therapeutical attempts are also described.