Biomedical subjects

C Bertoldi

Publications and source records attributed to C Bertoldi.

16 recordsLinked to original sources

PubMed2005

Release of elements from retrieved maxillofacial plates and screws.

Vitallium appliances and surrounding tissues were investigated to evaluate the release and accumulation of elements. Four microplates, sixteen screws and surrounding tissues were removed from three patients presenting inflammation 4 to 6 years after surgery and were submitted to SEM and X-ray microprobe analysis. Histology was performed on paraffin or PMMA sections of tissues.A continuous release of elements from metallic appliances into soft tissues was observed. Cobalt, chromium, and nickel were detected in soft and boney tissues in close proximity to the appliance. Aluminium, as a component of screw coatings, accumulated in soft tissues, and a remarkable amount of aluminium was detected in the dense lamella of lamellar bone. The results suggest that coatings containing aluminium should be avoided and the time these appliances are allowed to remain in patients should be shortened. Further studies on element release and the fate of aluminium in bone are warranted.

Aged↗

PubMed2001

[Metallic elements in tissues surrounding internal rigid fixation (IRF) devices].

BACKGROUND: Plates and other devices made by several alloys have been introduced to reach the stability of bone fractured fragments. Elements constituting alloys could be detected especially in organs, yet also in local tissues. Aim of the present study is the analysis of tissues surrounding IRF devices analyzing the morphology of released particles and studying the behavior of adjacent tissues to check metallic elements diffusion. METHODS: Biopsies were retrieved from 18 patients, aged 20 to 76 years. The patients received IRF by plates, screws and grids from 4 months to 9 years. They were divided into five groups according to the local phlogistic degree. Ordinary light microscopy, scanning electron microscopy and X-ray microprobe analysis (EDS system) was used to perform morphological investigations and identification of metal particles and elements. RESULTS: Metal particles or elements arising from plates, screws or grid may undergo tissular diffusion and cellular uptake. Not only Chromium, Iron or Aluminium but also Titanium may be easily released from devices and engulfed in tissues. In particular Titanium diffusion is evident in fibrous tissue surrounding IRF devices. Aluminium appears to be particularly accumulated in a persistent way in fibrous tissues and shows a characteristic embedding pattern in lamellar bone. CONCLUSIONS: The degree of local phlogosis appears to be strictly correlated to metallosis. Chromium, Iron, Aluminium and also Titanium, even if at different degree, give rise to phlogistic effects. Metallosis and phlogosis can produce a cascade process in which they are both the cause and the effect at the same time. The abundant release of Titanium, which does not normally produce clinical phlogosis as i.e. Aluminium, should be worthy of further investigations on its cellular effects.

Adult↗

PubMed2000

[Clinical evaluation, radiologic and histologic analysis in mandibular alveolar distraction procedures. Preliminary study].

BACKGROUND: Alveolar distraction osteogenesis is a process to form new alveolar bone to correct alveolar deformities in ridge height and width. Aim of this work is to study the bone processes to optimize the implantoprosthetic rehabilitation. METHODS: Alveolar distraction osteogenesis was applied in 7 patients with ridge deformities to obtain the desired ridge augmentation. Clinical and radiological evaluations were performed during the following 12 weeks, before implant insertion. Biopsies at 40, 60 and 88 days were studied after general, specific and histochemical staining of slides; microradiographs were analyzed to evaluate the trabecular bone volume. RESULTS: Forty days after the end of distraction, soft callus shows the start of ossification. Sixty days after the end of distraction, soft callus was widely converted into a network of trabecular woven bone; osteogenic activities were low; trabecular bone volume was about 50%. Eighty-eight days after the end of distraction bone amount appeared reduced, with a more ordered structure, further reduction of bone formation activity, whereas osteoclast erosion was active. CONCLUSIONS: Results show an almost steady-state bone deposition processes 60 days after the end of distraction and a regress with longer time. The results suggest the possibility of an early implant insertion to avoid bone loss due to mechanical unloading.

Adolescent↗

PubMed1997

[Treatment of the patient with a coagulation defect in oral and maxillofacial surgery. III. The management of patients in a hypocoagulative state because of a hemophilic-type primary pathology].

Hemophilia plays a particularly important role among the diseases caused by abnormal coagulation. Defective blood-clotting factor diseases have a particular importance between coagulopathies: hemophilia, among these hematic disorders, plays a principal role. In this paper the authors present the results of scientific research on hemophilic disease carried out to obtain a correct clinical and therapeutic approach for clinical and surgical Odontostomatology. The authors, after having presented in short the physiopathologic function of coagulation factors, illustrate the clinical and therapeutic aspects of Hemophilia A and Hemophilia B. The correct Odontostomatological and Maxillo-Facial Surgical approach is presented as the result of the authors' research. Also von Willebrand's disease is illustrated even if it is not exactly a hemophilic disease. This is because all hemophilias must produce a gynephoric inheritance pattern. Nevertheless clinical, therapeutic and molecular biology appearance suggests the illustration of von Willebrand's disease together with hemophilias. Von Willebrand's disease can be divided into three nosologic groups and to each one corresponds a particular clinical and therapeutic management. Such cases are illustrated and examined from an Odontostomatologic point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.

Blood Coagulation Disorders↗

PubMed1997

[The treatment of the cardiac patient in dentistry and oromaxillofacial surgery. I. The practical management of patients with arrhythmias].

Cardiac patients consist of a high incidence rate in odontostomatology, both clinical and surgical. Moreover this serious complication disease conditions odontostomatological and, particularly, surgical works. In this article the authors present the results of several years of research carried out to obtain a correct clinical and therapeutic approach for clinical and surgical dentistry. After an introduction on the clinical features of heart diseases the most important clinical cases of heart dysrhythmia are discussed: like, i.e. hypokinetic arrhythmia, hyperkinetic arrhythmia and the management of patients with pacemakers. The principal diacritic features of dysrhythmic diseases are illustrated. Anxiety is a sort of disease not directly related with dysrhythmia. Moreover a lot of clinical studies find in heart arrhythmia the principal problem caused by anxiety on heart physiology. Consequently the authors describe anxiety in the same part of pathologies commonly known as heart dysrhythmia. In the last phase the authors illustrate the most opportune therapeutic steps corresponding to the principal pathologies described above. These matters were dealt with from an odontostomatological point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.

Arrhythmias, Cardiac↗

PubMed1997

[The treatment of the cardiac patient in dentistry and oromaxillofacial surgery. II. The practical management of patients with hemodynamic pathologies].

When odontostomatological or surgical treatment is performed we suggest, in a first phase, to distinguish cardiac patients from the others. In a second phase a careful nosological diagnosis will be performed. Consequently, patients' medical history plays a fundamental role in both diagnostic phases. In this article the authors present the results of several years of research carried out to obtain a correct clinical and therapeutic approach for clinical and surgical Odontostomatology. After an introduction on the clinical features of heart hemodynamic pathologies the most important clinical cases are discussed: like, for example, acardiohemia, valvulopathies and heart decompensation. The principal diacritic features of hemodynamic diseases are illustrated. Essential hypertension (borderline and resident) is a sort of disease not directly related to hemodynamics pathology. Moreover a lot of clinical studies find in heart hemodynamic pathologies the principal problem caused by hypertension on heart physiology. Consequently the authors describe essential hypertension in the same part of pathologies commonly known as heart hemodynamic pathologies. In the last phase the authors illustrate the most opportune therapeutic steps corresponding to the principal pathologies above-described. These matters were dealt with from an odontostomatological point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.

Dental Care for Chronically Ill↗

PubMed1995

[Experimentation and clinical analysis of the interrelationships between dental damage and celiac disease].

Celiac disease is characterized by gluten-dependent atrophy of the intestinal tufts. Aetiologically the genetic "habitus" of the subject has particular importance and, as rear as the pathogenesis is concerned, many theories, among which the most accredited one is "immunopathological", exist. According to what this last one provides, the cell-mediated immunity component is to be considered the true mediator of intestinal injury, whereas the antibody-mediated component and, in particular, anti-gliadin antibodies (AGA) and anti-endomysium antibodies (EMA), has a particular and pre-eminent diagnostic role. Just from this point of view the celiac disease appeared, with the progress of the studies, to be more and more fleeting, because of growing symptomatologic diversification. It is then interesting to take into account that the celiac disease seems to be able to maintain itself asymptomatic for the greatest part of life, perhaps, forever, configuring the appearance of silent celiac disease and contributing to specify the outline of the above-mentioned celiac "habitus". Recently, besides, close associations have been found between many different diseases and celiac disease. Even for such reasons we relied upon the indication of the ESPGAN in order to achieve a sure and standardized diagnosis of celiac disease. Early diagnosis of celiac disease is very important because it allows a normal psychophysical development and it avoids the strong incidence of lymphomas and other neoplasms of the gastrointestinal tractus which can characterize the natural story of celiac patients. From a more specifically odontological point of view, interesting manifestations exist in the ambit of celiac disease. This last may in fact appear associated particular signs, such as recurrent aphthae or plainly autoimmune diseases with even oral verification. There, however, a more frequent association between celiac disease and some lesions of the tooth enamel which occur in the period of the two stages of histodifferentiation and mineralisation, and they are, respectively, hypoplasias and opacities. Alteration of the enamel, in such stages, both in deciduous and in permanent sets of teeth may be caused by different "noxae"; hence it will be necessary to know how to distinguish between the dental lesions typical of celiac disease and the others. It is helpful the fact that the dental lesion, observed in the course of celiac disease, remembers conceptually the Chronologic Hypoplasia of the enamel. This pathologic form damages the enamel which is depositing, and evolving contemporaneously to the local or systemic "noxa" which is its remote cause.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1994

[The therapy of congenital hypothyroidism].

In congenital hypothyroidism precocious diagnosis and consequent replacement therapy are necessary to prevent neurological irreversible damage caused by postnatal thyroid hormone deficiency. Synthetic L-thyroxine is the useful drug, that has to be administered in fasting condition to have the best absorption. Some points about the treatment are still discussed, such initial L-thyroxine dosage, biochemical control parameters and psycho-intellectual outcome in treated patients. The mean initial dosage in Italy increased from 7.5 +/- 2.2 micrograms/kg/day in 1987-90 period to 8.5 +/- 2.5 micrograms/kg/day in 1991, at a mean starting age of 34 and 26 days respectively. Therefore the dosage is modulated on the basis of serum levels of thyroid hormones and clinical signs. Some patients, in spite of a correct dosage of L-thyroxine, show a deficient suppression of TSH circulating level. In our experience this finding is sometimes due to the non-observance of the fasting condition when the drug is administered. Patients precociously identified by neonatal screening and correctly treated have a good mental and statural prognosis. In these patients, the psycho-intellectual development is better than in those diagnosed later clinically.

Child↗

PubMed1992

[Myelolipomatosis. A report of a case located in the mandible].

Myelolipoma is a rare benign tumour involving, in the majority of cases, the adrenal gland. Given the absolute predominance of this localisation, in this report of extra-adrenal localisations of these tumours the authors considered it worthwhile and necessary to refer to the former, relatively more complete series of data, with the exception of the supposed or real differences which exist between the two groups. Myelolipomatosis should not be considered an example of dysplasia, but on the contrary benign metaplasia/hamartoma. It is therefore obvious that, faced with an expansive process of this type, it is vital to obtain a precise diagnosis on which to base the choice of clinical and therapeutic management since this is also influenced by the anatomical site of the tumour. On the basis of a series of pathophysiological parameters, the authors have formulated a diagnostic protocol followed by a therapeutic approach since, in this context, there is no point resorting to a so-called "wait and see" strategy. In addition, the analysis of the above parameters convinced the authors of the possibility that these tumours should be regarded as bodies which should not be separated from the reaction of the organism as a whole to and appropriate stressigenic event persisting over time.

Adolescent↗

PubMedDate not supplied

Associated orthodontic, surgical and hematological management of Cooley s anemia. Report of a case.

Cooley s anaemia or b-thalassaemia or mediterranean anaemia is a blood disease characterised by malformation of the skull and long bones, which confers a typical appearance on the patient. The complete development of facial abnormalities can be prevented by an intensive blood transfusion programme or by bone-marrow-transplantation. At the present time these therapeutic strategies would be able to help these patients grow and develop, live a prolonged life and avoid bad surgical RESULTS. The aim of this study was to evaluate the feasibility of orthodontic and maxillofacial surgical corrective treatment associated with an appropriate transfusion therapy in a b-thalassemic patient. The patient enrolled in the study was affected by major b-thalassemia and diagnosis was performed as an infant. She was referred to our centre at puberty for dento-maxillofacial disorders. Clinical, haematological and radiographic evaluation permitted a complete diagnosis. She received a combined haematological, orthodontic and maxillofacial surgical treatment. Controls for evaluating the statement of results obtained were performed at different times after the end of the therapy and have shown that the therapeutic objectives had been achieved and maintained. At the present time, complete diagnostic and therapeutic haematological strategies cannot be carried out on a large scale, especially in countries where health resources are limited. This objective reason, associated with possible low patient compliance, explains why we still encounter severe facial deformities resulting from erythroid hyperplasia. Our results suggest that this facial disfigurement requires surgical and orthodontic correction by consolidated surgical-orthodontic techniques performed according to the appropriate anaemia therapy. Although this is a preliminary study, initial encouraging results show no relapse three years after the end of the therapy.

Adolescent↗

PubMedDate not supplied

[The growth hormone/somatomedin C system from the first years of life to young adulthood. Physiological aspects and physiopathologic involvement in diabetic syndrome].

The growth hormone (GH)/somatomedin-C (Sm-C) endocrine system plays a fundamental role in human anabolism. Whereas from a physiological point of view GH conforms to the classic hormone behaviour, Sm-C appears to follow a peripheral and local pattern of action with autocrine or paracrine involvement. The hormonal GH system interacts with the functional pattern of insulin and other hormones, and in addition with entire maturation process. On the basis of several reports, the puberal age seems to represent the first real "maturative-tumultuous" event managed by the operative GH/Sm-C system. It is thus possible to hypothesise that alterations to this system, as found in dysmetabolic diseases (e.g. diabetes), may either be seen as a cause or consequence of the disease process. It can therefore also be supposed that such alterations may interact with the development of the entire organism, above all when they occur during the delicate puberal phase.

Adolescent↗

PubMedDate not supplied

[Precancerous conditions of the oral cavity. Note I. General considerations. Critical review of the literature].

The authors deal with the current topic of precancerous states of the oral cavity, considering various aspects such as etiopathology, diagnosis, the clinical picture and therefore, nosological classifications. The region of the Air Passages and Superior Digestive Tract (APSDT) should be considered as a single system and it is affected by a set of genetic and environmental conditions common to the various anatomical regions of which it consists. The significance of several irritating agents, which are also habitually used (e.g. tobacco), has been demonstrated for some time, whereas, the actual harmful effects of other factors such as immunodepression in particular, are only now being evaluated and detected. The discussion concerning precancerous lesions of the oral cavity, should actually refer to lesions that do not present the histologic, biological and clinical characteristics of malignant neoplasms, but that have the objective possibility of developing them. Some lesions that traditionally belong to this pathological grouping often present dysplastic aspects, if not the actual characteristics of "carcinoma in situ". Therefore, the availability of a set of indexes is of primary importance and it should be capable of providing an orientation for diagnosis and clinical practices in a precise, standardized manner. The authors hold these indexes to be divisible into three groups as follows. The first group is composed of the "parameters of cellular kinetics" and includes the percentage of cells in phase S (LI), phase S time (Ts), cell cycle duration (Tc), and the growth fraction (GF). The second group consists in the "parameters of cellular morphology", including the nuclear content in DNA, the value of the nuclear surface and the ploidy. The third group is more specific for the existence of a pathologic mass. However, given the uncertainties of the borderlines traditionally attributed to precancerous pathology, this group is definitely useful. It is composed of the potential doubling time (Tpot) and the tumor volume doubling time (Td). Moreover, biopsy is held to be an indispensable tool and the procedure should be conducted in the various manners possible according to well-defined conditions. A correct evaluation of these parameters allows for a correct approach to precancerous pathology and the prevention of the clinical risks of "rapid proliferation" even in the diagnostic biopsy phase.

Cell Division↗

PubMedDate not supplied

[Precancerous conditions of the oral cavity. Note II--Pathology and clinical course. Critical review of the literature].

The authors examine some specific forms of precancerous states of the oral cavity, selecting them from among the 4 classes defined by the WHO Collaborating Centre for Oral Precancerous Lesions. The immunological system is given particular emphasis. In fact, as studies progress, it appears to be more and more involved not only in the increase in the incidence of such pathologies, but also in the most difficult, if not unknown, genesis of these pathologies. Highly significant examples of this involvement are: Kaposi's Sarcoma, Hairy Cell Leukoplakia, Lichen and Mycoses. Particularly significant aspects for Erythroplasia consist in the following: slow development, frequent and rapid changes in the clinical aspects and its strict connection with Bowen's Disease and Queirat's Erythroplasia. The latter lend further confirmation of its definite precancerous nature and as such, it requires radical surgical treatment. Compared to other forms, the Epidemic variety of Kaposi's sarcoma more frequently affects the oral-salivary glands and structures, the lymph nodes and the laterocervical area. Together with non-Hodgkin tumors, this represents the class of neoplasms most frequently occurring in subjects affected by AIDS. Its "atypical" aggressiveness involves the liver and pancreas and develops over much shorter time periods than the other varieties. In any case, when possible, the treatment required is the excision of the lesions. Neither radiation therapy nor polychemotherapy have yielded encouraging results as yet. In the case of Leukoplakia, it should be kept in mind that today, this pathology is defined "negatively" be exclusion that is the condition must exist that this lesion cannot be clinically or pathologically defined as another lesion. It thus follows that the clinician must maintain an extremely cautious approach in such cases. As concerns prognosis, particular attention should be given to raised, hardened, irregular and fissured forms, which manifest the greatest degenerative capacity. for the classic forms, the treatment adopted is complete exeresis, whereas the use of antiviral drugs is recommended for Hairy Cell Leukoplakia. Lichen Ruber Planus is a papuliferous eruption that is relatively common and affects the skin and mucosa often exclusively involving the oral cavity in the great majority of cases. Besides the clinical picture, the diagnosis of this disease is based on the triad consisting of hyperkeratosis, destruction of the cells of the stratum basale and subepithelial lymphocyte infiltration at distinctly low levels. In uncertain cases, however, the detection of Fluorescent Bodies grouped in large clusters near the hyaline membrane, acquires particular importance for the specification of the diagnosis.

Candidiasis, Oral↗

PubMedDate not supplied

[Management of facial pain resulting from cancer in oral and maxillofacial surgery].

Pain, which is among the most prevalent symptoms experienced by cancer patients, must absolutely be treated. The most important biologic effects of this sort of pain plays on patients' psychosociality. This is in reference to the quality of pain, the amount of pain and to the character of the patients. Actually, pain only in appearance is presented as a symptom; it is usually a disease. Patient assessment, the use of anticancer therapies and systematically administered non-opioid and opioid analgesics are pivotal. Practical aspects of cancer pain treatment include both drug selection, method of analgesic administration: selection of the appropriate route, dose titration and an understanding of the management of side effects. Pain therapy includes another series of possibilities like the use of adjuvant analgesics, psychological therapies, physiatric techniques and invasive interventions such as the use of intraspinal drugs, neural blockade and neuroablative techniques. This kind of therapy must be employed at all times, whether the case may be resolved surgically or not. So we think that pain can be effectively treated. This study was carried out to obtain the correct therapeutic approach for facial cancer pain syndrome. The research was performed on seven women and thirteen men with a mean age of 58 years. All the patients' clinical appearances were standardized with care. Study participants included odontostomatologists and anesthesiologists with experience of controlling cancer pain. The sensation of pain was quantified by means of the Visual Analogue Scale (VAS) while their psychosocial ability was assessed with the Karnofsky Performance Scale (KPS). In this way the authors hoped to obtain a good quality of standardization. The study was performed for a period of two months. The conclusions are that Trans Epidermis Nervous Stimulation (TENS) offers positive results for variable periods and only in 60% of patients with a low level of pain. The use of antiphlogistic non-steroid drugs and of opioid drugs, with a particular management requested from the personal clinical status of each patient, result as being the most effective therapeutic resource. Such therapies must be employed, whether the case may be resolved surgically or not. Nevertheless it is necessary to realize that drugs or other therapies for cancer pain are independent and propaedeutic to each surgical approach. Finally, the use of opioids is addressed in the management of patients with pain that is refractory to other interventions. This approach can provide adequate relief to the vast majority of patients. We find the morphinomania risk in cancer pain patients is not scientifically wellfounded.

Adjuvants, Pharmaceutic↗

PubMedDate not supplied

[Management of patients with coagulation defect in oral and maxillofacial surgery. I. Management of patients with drug-induced hypocoagulation].

Odontoiatric problems, clinical and surgical, connected with defective coagulation, are very frequent. Such cases can be divided into two groups: in the first we find patients with iatrogenic coagulopathy while in the second we find patients with hypocoagulative diseases. In this article the authors present the result of several years of research carried out to obtain a correct clinical and therapeutic approach for clinical and surgical Odontostomatology. After an introduction on clinical pharmacology and the use of anticoagulants, the principal clinical cases are discussed. Various laboratory tests evaluating patients with pharmacological coagulopathy are examined. The most specific and significant tests are illustrated following up the authors experiences. In the last part the authors illustrate cases corresponding to the two serious and frequent complications that can be found in patients with iatrogenic coagulopathy: hematorrhea and thromboembolism. These matters were dealt with from an Odontostomatologic point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.

Anticoagulants↗

PubMedDate not supplied

[Management of patients with coagulation disorder in oral and maxillofacial surgery. I. Management of patients with hypocoagulation caused by primary thrombocytopathy].

Any oral and maxillo-facial surgical treatment, however urgent it may be, must not include pathological states in which the patient's life may be particularly at risk as, for example, with Disseminated Intravascular Coagulation (DIC) or throm-botic thrombocytopenic purpura. In this article the authors present the result of studies carried out on the nosology of thrombocytopathy from an odontostomatological point of view. Thrombocytopathy can be divided into two groups: the first including the pathologies with a predominant defective number of thrombocytes (i.e.: thrombocytopenia, thrombocythemia, thrombocyto-sis), the second including forms with predominant qualitative defects (commonly known as thrombocytopathies). The authors, after having presented in short the physiopathologic functions of thrombocytes, illustrate the clinical and therapeutic aspects of the most important thrombocytopathies. Morbus Maculosus Werhofii, Glanzmann's disease, Bernard-Soulier syndrome, thrombocytopathies from defective reaction of release, Thrombocytopathies from defective procoagulant activity of blood plaques, thrombocytopathies in linkage to other genetic anomalies, von Willebrand's pseudodisease and a lot of acquired thrombocytopathies are identified. In the last part the authors illustrate the most opportune clinical steps corresponding to the most important thrombocytopathies. The results obtained suggest the necessity of keeping to the management that was described, Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.

Blood Loss, Surgical↗