Ameloblastoma plexiforme del maxilar: manejo quirúrgico y protético. A propósito de un caso

El ameloblastoma es un tumor odontógeno benigno de derivación epitelial, de elevada invasión local, crecimiento intermitente y con alta probabilidad de recidiva. Puede dividirse en los siguientes tipos histológicos: folicular, plexiforme, acantomatoso, a células basales y granulares. El ameloblastoma folicular es el subtipo histológico más común. Se manifiesta prevalentemente durante la tercera, cuarta y quinta década de vida, sin predilección para el sexo, aun así se puede encontrar en cualquier grupo de edad incluyendo niños. La mayoría de los ameloblastomas se encuentra sobretodo en mandíbula (al nivel del ángulo y rama). Las características clínicas, incluso si complementadas con radiografías y muestras histológicas, no son útiles a la hora de predeterminar el comportamiento biológico y por lo tanto el pronóstico de un ameloblastoma individual. Los autores presentan un caso localizado de ameloblastoma plexiforme localizado en la parte posterior del maxilar de un hombre de 30 años; el término "plexiforme" se refiere al aspecto de anastomosis de los islotes del epitelio odontógeno, en contraste con el tipo «folicular». En este artículo se discuten importantes aspectos de la patología, del tratamiento quirúrgico y protésico. En conclusión, es necesaria una cooperación estricta a largo plazo de un grupo de clínicos, patólogos, cirujanos y prostodoncistas, para ofrecer el mejor tratamiento individualizado en cada caso. The ameloblastoma is a clinically persistent benign tumor derived from odontogenic epithelium, locally invasive, intermittent in growth and with high a probability of recurrence. The following histologic patterns may be distinguished: follicular, plexiform, spindle cell, acanthomatous, basal cell type and granular cell. The follicular ameloblastoma is the most common histologic tipe. The majority of patients are in 3th, 4th and 5th decade, but can be found in any age group including children. The majority of ameloblastomas are observed in the mandible (mostly angle or ramus). Clinical features, even if combined with radiology or histology findings, are not useful when trying to determine the biological behaviour and therefore the prognosis of an individual ameloblastoma. The authors report a case of plexiform ameloblastoma in the posterior maxilla, in male 30 year old otherwise healthy; the term "plexiform" refers to the appearance of anastomosing islands of odontogenic epithelium in contrast to a follicular pattern. Important questions on pathology, surgical and prosthetic therapy are discussed in this paper. In conclusion, a close cooperation of clinicians, pathologists, surgeons and prosthesists is necessary and very important over a long period of time for the best management of each individual case

Multiple bound states in scissor-shaped waveguides

We study bound states of the two-dimensional Helmholtz equations with Dirichlet boundary conditions in an open geometry given by two straight leads of the same width which cross at an angle $\theta$. Such a four-terminal junction with a tunable $\theta$ can realized experimentally if a right-angle structure is filled by a ferrite. It is known that for $\theta=90^o$ there is one proper bound state and one eigenvalue embedded in the continuum. We show that the number of eigenvalues becomes larger with increasing asymmetry and the bound-state energies are increasing as functions of $\theta$ in the interval $(0,90^o)$. Moreover, states which are sufficiently strongly bent exist in pairs with a small energy difference and opposite parities. Finally, we discuss how with increasing $\theta$ the bound states transform into the quasi-bound states with a complex wave vector.Comment: 6 pages, 6 figure

The management of atrophies classified as V class according to Cawood & Howell by piezo-electric surgery

Introducción: Los casos analizados presentaban atrofias severas (V clase según Cawood y Howell) (1), que se caracterizan por presentar una densidad de la cresta transversal inferior a 4 mm y vertical inferior a 6 mm; ello hace pensar en la posibilidad de una rehabilitación implanto-soportada. Objetivo: Evaluación de la rehabilitación de pacientes afectados por severa atrofia del maxilar superior clase V según Cawood y Howell) (1) rehabilitados con elevación del seno maxilar e injerto de hueso autólogo. Materiales y métodos: Estudio longitudinal a partir de una muestra de 32 pacientes, con atrofia maxilar severa y edentulismo parcial o total. En todos los pacientes se ha colocado un injerto con técnica de reconstrucción onlay mono o bicortical y se ha adoptado la cirugía piezoeléctrica para realizar el elevación del seno, el cual podía ser mono o bilateral, de hueso autólogo procedente de la cresta ilíaca anterior. Seguimiento realizado durante 2 años. Resultados: A los dos años del control final, el 94,05% de todos los implantes colocados tras la intervención de elevación se presentan osteointegrados y cargados protésicamente. La cresta ilíaca anterior resulta ser la zona idónea para la extracción medular, necesaria para la elevación del seno. Las posibilidades de supervivencia del implante son realmente elevadas si se espera el tiempo clínico necesario para la recuperación y la integración del injerto. El éxito de todas las intervenciones de elevación del seno maxilar se debe a la adopción de la cirugía piezoeléctrica, que permite efectuar la incisión de entrada y realizar el desprendimiento de los tejidos con un traumatismo mínimo para la membrana de Schneider. La integridad de la membrana y la utilización de bone-chips de origen autólogo no ha hecho necesario recurrir a la utilización de membranas reabsorbibles, simplificando así el procedimiento quirúrgico. La utilización de la cresta ilíaca anterior como zona donante, permite disponer de abundante tejido óseo cortical, necesario para colocar los onlay y para reconstruir el defecto óseo. Introduction: Valutation of rehabilitated patients by sinus lift in upper jaw and by autologous bone graft from iliac crest. Materials and methods: Rehabilitation of 32 patients with severe atrophies of upper jaw and partial or total edentulism by positioning of mono- or bicortical onlay with piezosurgery to obtain a sinus lift mono- or bilateral by autologous bone grafts from anterior iliac crest. Results: 94.05% of successes after a two years follow-up. Conclusions: Respecting of timing surgery, a correct use of the piezosurgery technique and of the autologous bone graft from anterior iliac crest let a successful implantological rehabilitation. Moreover the iliac crest is a very good donor site of bone tissue for the management of severe atrophies in the upper jaw. An accidental laceration of Schneider's membrane was observed in filling phase in the 5.26% of cases

From Dysbiosis to Neurodegenerative Diseases through Different Communication Pathways: An Overview

The microbiome research field has rapidly evolved over the last few decades, becoming a major topic of scientific and public interest. The gut microbiota (GM) is the microbial population living in the gut. The GM has many functions, such as maintaining gut homeostasis and host health, providing defense against enteric pathogens, and involvement in immune system development. Several studies have shown that GM is implicated in dysbiosis and is presumed to contribute to neurodegeneration. This review focuses mainly on describing the connection between the intestinal microbiome alterations (dysbiosis) and the onset of neurodegenerative diseases to explore the mechanisms that link the GM to nervous system health, such as the gut-brain axis, as well as the mitochondrial, the adaptive humoral immunity, and the microvesicular pathways. The gut-brain communication depends on a continuous bidirectional flow of molecular signals exchanged through the neural and the systemic circulation. These pathways represent a possible new therapeutic target against neuroinflammation and neurodegeneration. Progress in this context is desperately needed, considering the severity of most neurodegenerative diseases and the current lack of effective treatments

Probiotics Can Cure Oral Aphthous-Like Ulcers in Inflammatory Bowel Disease Patients: A Review of the Literature and a Working Hypothesis

Dysbiosis has been associated with the onset of several chronic autoimmune or inflammatory pathologies (e.g., inflammatory bowel diseases-IBD), because of its primary role in the establishment of a chronic inflammatory process leading to tissue damage. Inflammatory bowel diseases can even involve areas far away from the gut, such as the extraintestinal manifestations involving the oral cavity with the onset of aphthous-like ulcers (ALU). Studies carried out on animal models have shown that intestinal dysbiosis may be related to the development of autoimmune diseases, even if the mechanisms involved are not yet well known. The aim of this paper is to verify the hypothesis that in inflammatory bowel diseases patients, aphthous-like ulcers are the result of the concomitance of intestinal dysbiosis and other events, e.g., the microtraumas, occurring in the oral mucosa, and that ex adiuvantibus therapy with probiotics can be employed to modify the natural course of the aphthous-like ulcers

PRENATAL DEVELOPMENT OF TEMPORO-MANDIBULAR JOINTS: STATE OF ART

The aim of this work is to analyze the state of the art of temporo-mandibular joint (MJ) to understand the varoius stage of the development of the same during embryogenesis. Various theories have been analyzed, such as the formation of apoptotic or the important role of growth factors, or the Valencia et studies in which are analyzed to numerous articular diseases in various stage of development. By the aforementioned studies show that many factors, of a different nature, are to be involved in the prenatal developlment of this important joint

POSTURE AND POSTUROLOGY, ANATOMICAL AND PHYSIOLOGICAL PROFILES: OVERVIEW AND CURRENT STATE OF ART

Background and aim of work: posture is the position of the body in the space, and is controlled by a set of anatomical structures. The maintenance and the control of posture are a set of interactions between muscle-skeletal, visual, vestibular, and skin system. Lately there are numerous studies that correlate the muscle-skeletal and the maintenance of posture. In particular, the correction of defects and obstruction of temporomandibular disorders, seem to have an impoact on posture. The aim of this work is to collect information in literature on posture and the influence of the stomatognatich system on postural system. Methods: Comparison of the literature on posture and posturology by consulting books and scientific sites. results: the results obtained from the comparison of the of the literature on posture and posturology by consulting books and scientific sites. Some studies support the correlation between stomatognatich system and posture, while others such a correlation. Conclusions: further studies are necessary to be able to confirm one or the other argument. (www.actabiomedica.it

A RARE CASE OF PERFORATED ILEAL DIVERTICULITIS IN A YOUNG MAN: A CASE REPORT AND LITERATURE REVIEW

Jejunoileal diverticulosis is a rare, often asymptomatic condition, consisting of acquired false diverticula. Diagnosis of ileal perforation is usually made incidentally or after complications, including obstruction, haemorrhage and diverticulitis. A previously healthy 17-year-old man presented to the Emergency Department with diffuse abdominal pain and fever. CT scan showed air-fluid level in the RLQ and free intraperitoneal air and fluid. The patient underwent an urgent exploratory laparotomy with an intestinal resection and primary anastomosis. We report a rare case of ileal perforation, due to diverticular disease in a healthy young man, treated an urgent surgery. Such an event requires immediate surgical intervention, especially if it presents as an acute abdomen. Although it can become a surgical emergency, jejunoileal diverticulosis remains underdiagnosed

Frequency Evaluation of the Interleukin-6 −174G>C Polymorphism and Homeostatic Iron Regulator (HFE) Mutations as Disease Modifiers in Patients Affected by Systemic Lupus Erythematosus and Rheumatoid Arthritis

Autoimmune diseases are generally characterized by a multifactorial etiology and are often associated with a genetic predisposition. Both iron metabolism and the inflammatory cytokine system have been shown to play a pivotal role in the dysregulation of the immune response in many different autoimmune conditions, rheumatologic diseases included. The purpose of this work was to analyze the frequency of mutations altering the expression of IL-6 or influencing iron metabolism in patients affected by autoimmune diseases such as Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). In this study, 144 patients were enrolled: 77 and 67 patients were affected by RA and SLE, respectively. In these cohorts, the frequency of the IL-6 polymorphism −174G>C located in the IL-6 gene promoter was tested. Moreover, the frequencies of the three HFE gene variations associated with iron overload were analyzed: p.His63Asp, p.Ser65Cys and p.Cys282Tyr. The two mutations p.His63Asp and p.Ser65Cys in the HFE gene did not reach statistical significance in any of the comparisons, regardless of the statistical model, cohorts of patients and control populations analyzed. The frequencies of the p.Cys282Tyr mutation and the IL-6 polymorphism −174G>C were found to be overall significantly decreased in RA and SLE patients when the Dominant model and Allele contrast were adopted with both the Odds Ratio and Chi-square. Although further investigation is needed, the examination of the frequencies of the −174G>C IL-6 promoter polymorphism and HFE mutations may add some valuable information on the interplay linking iron metabolism, inflammation and immunity in autoimmune diseases such as SLE and RA

Extracellular vesicles derived from gut microbiota in inflammatory bowel disease and colorectal cancer

The human gut microbiome encompasses inter alia, the myriad bacterial species that create the optimal host-micro-organism balance essential for normal metabolic and immune function. Various lines of evidence suggest that dys-regulation of the microbiota-host interaction is linked to pathologies such as inflammatory bowel disease (IBD) and colorectal cancer (CRC). Extracellular vesicles (EVs), found in virtually all body fluids and produced by both eukaryotic cells and bacteria are involved in cell-cell communication and crosstalk mechanisms, such as the immune response, barrier function and intestinal flora. This review highlights advancements in knowledge of the functional role that EVs may have in IBD and CRC, and discusses the possible use of EVs derived from intestinal microbiota in therapeutic strategies for treating these conditions