Platelet-Rich Plasma in Trauma Patients

Platelet-rich plasma (PRP) was mixed with thrombin and excess calcium resulting in activated platelets trapped within the fibrin network; within the matrix, platelets secrete bioactive substances that diffuse into the surroundings tissues. PRP is prepared from the patient’s own blood, a variety of manufacturing techniques in vastly different cell counts, and growth factor concentrations. The clinical use of PRP is treatment of soft tissue diseases and injuries, treatment of burns, hard-to-heal wounds, tissue engineering, and implantology in dentistry. An essential criterion for PRP is for it to be autologous, for the donor of the blood, and the recipient of the PRP to the same person. Most of the literatures suggest that PRP does not appreciably impact bone healing or induce bone formation. PRP might augment recruitment of osteoblast progenitors to injection sites or in sites expected to experience delayed healing. In this capacity, PRP might be utilized to initiate repair of an otherwise poorly healing bony lesion. PRP stimulates bone repair in fractures. Early through late healing process is compromised with fractures, including reduced cell proliferation, delayed chondrogenesis, and decreased biomechanical properties. In this chapter, the importance of the PRP in oral and maxillofacial surgery in trauma patients is studie

Comparison of two different labial salivary gland biopsy incision techniques: a randomized clinical trial

Objectives: To compare the reliability of two different labial salivary gland biopsy (LSGB) incision techniques (vertical versus horizontal incision techniques) and to report the related complications and discomfort. Study Design: 163 patients who underwent LSGB were included in this study. Patients were randomly divided as vertical incision group (n=81) and horizontal incision group (n=82). Demographic and clinical information of each patient were recorded. A questionnaire was prepared and applied together with Visual Analog Scale (VAS) on the subjects verbally at the 7th day, postoperatively. Intraoperative, short- term and delayed complications were evaluated. Results: The mean age of patients (117 female, 46 male) was 47.3 years (range 19-79 years). Vertical incision technique was associated with less pain (p<0.001), less swelling (p<0.05), less scar formation (p<0.05) and less difficulty in eating (p<0.05) when compared with horizontal incision technique. No statistically significant differences were observed between the 2 groups in terms of hematoma, parasthesia and speech difficulty (p>0.05). Additionally, two subjects in the horizontal incision group revealed permanent paresthesia during the follow-up period of two years. Conclusions: This prospective study demonstrated that the subjects in the vertical incision group had less complication rates and discomfort after labial salivary gland procedure than those in the horizontal incision group

An evaluation of the efficacy of a topical gel with Triester Glycerol Oxide (TGO) in the treatment of minor recurrent aphthous stomatitis in a Turkish cohort : a randomized, double-blind, placebo-controlled clinical trial

Triester glycerol oxide gel (Protefix® Queisser Pharma, Germany) is a new topical agent that has the property of adherence to the oral mucosa by forming a lipid film which protects against mechanical trauma and may help to reduce oral tissue moisture loss and inflammation. The aim of this clinical trial was to determine the efficacy of a topical TGO gel and to also compare it with triamcinolone acetonide pomade in the treatment of minor recurrent aphthous stomatitis. This study was a randomized, double-blind, placebo-controlled clinical trial and 180 patients with the complaint of minor aphthous ulcers were enrolled in this study. The sociodemographic data and clinical characteristics of the ulcer were collected by questionnaire. Ulcer size and pain level measurements were performed and the efficacy indices for ulcer pain and size were calculated at day 0,2,4,6 by the same investigator. Significant differences were not detected among the demographics and ulcer histories including age, gender, onset of ulcer, mean healing time, family RAS history and ulcer localization between three groups. The pain score in TGO group was found statistically lower at day 2,4, and 6. Efficacy index and improvement rate of TGO group, regarding pain score, was higher than the other two groups at day 2 and 4. The reduction in ulcer size was statistically higher in TGO group than the other two groups at day 4 and 6. Topical application of TGO gel could decrease pain intensity, accelerate ulcer healing without any side effects, utilizing an easy appliable and accessible procedure. Therefore TGO gel could be a well-tolerated, safe, topical therapeutic agent in the clinical practice of RAS treatment

Biomaterial Used in Trauma Patients

The development of bone tissue engineering and bone regeneration is always of interest to improve methods to reduce costs of trauma patient. Ability to use autogenous bone forming cells attached to bone morphogenetic proteins would be ideal. There are many clinical reasons to develop bone tissue engineering alternatives, for use in the reconstruction of large defects and implants. The traditional methods of bone defect management include autografting and allografting cancellous bone, vascularized grafts, and other bone transport techniques. However, these are the standard treatments. Since bone grafts are avascular and dependent on the size of the defect, the viability can limit their application. In large defects, the grafts can be resorbed by the body before osteogenesis is complete; tissue loss develops in the living organism due to infection, trauma, congenital, and physiological reasons. Placing tissue defects in the dentist and maxillofacial surgery and accelerating wound healing are an important issue. From an old Egypt, material used in treatment of different doctors with various causes. Oral surgery, periodontology, and implantology, which are surgical branches of the dentistry, need to increase bone formation in the treatment of bone defects, congenital defects, and defects around the implant. Many years of work have been done to obtain ideal biomaterials, and many materials have been used. We have prepared detailed information on biomaterials used in dentistry, oral, and maxillofacial surgeries in this book to help dentists and dental students

Limfocytarne zapalenie przysadki: zbyt rzadko rozpoznawana choroba okolicy siodła tureckiego

Hypophysitis is an inflammation of the pituitary gland and includes a heterogeneous group of diseases presenting with impaired pituitary gland function. Hundreds of cases have been reported after Goudie and Pinkerton's initial report on a young postpartum woman who died after progressive lymphocytic infiltration of the adenohypophysis in 1962. A 17-year-old woman presented with a three-year history of headache, galactorrhoea and excessive weight gain. The patient had used oral contraceptives for several years until one year previously. Her examination demonstrated only bilateral heteronymous hemianopsia. Laboratory investigation revealed elevated prolactin and decreased gonadotropin levels. Magnetic resonance imaging showed a sellar mass with suprasellar extension. Surgical removal of the lesion was performed via a transsphenoidal approach. A diagnosis of lymphocytic hypophysitis was confirmed by histopathological evaluation. Hypophysitis is an underestimated disease affecting the pituitary gland. Cases are usually diagnosed as adenomas and treated with surgical removal. This case is presented due to the extremely rare infiltration of the pituitary gland by predominantly lymphocytes.Zapalenia przysadki to niejednorodna grupa chorób manifestujących się zaburzoną czynnością przysadki. Od opublikowanego przez Goudiego i Pinkertona w 1962 r. opisu młodej kobiety, która zmarła po porodzie i u której stwierdzono limfocytarny naciek przedniego płata przysadki, opublikowano setki takich przypadków. Siedemnastoletnia kobieta zgłosiła się z powodu utrzymujących się od trzech lat bólów głowy, mlekotoku i zwiększenia masy ciała. Przez kilka lat, aż do roku poprzedzającego zgłoszenie do lekarza, stosowała hormonalne środki antykoncepcyjne. W badaniu przedmiotowym stwierdzono jedynie obustronne różnoimienne niedowidzenie połowicze. W badaniach laboratoryjnych wykryto zwiększone stężenie prolaktyny i zmniejszone stężenia gonadotropin. W badaniu za pomocą rezonansu magnetycznego uwidoczniono guz siodła tureckiego wychodzący poza obręb siodła. Zmianę usunięto chirurgicznie z dostępu przezklinowego. W badaniu histopatologicznym potwierdzono rozpoznanie limfocytarnego zapalenia przysadki. Zapalenie przysadki jest chorobą rozpoznawaną zbyt rzadko. U chorych rozpoznaje się zwykle gruczolaki i leczy się je chirurgicznie. Przypadek przedstawiono ze względu na wyjątkowo rzadko spotykany naciek przysadki, w którym dominowały limfocyty

Role of radiosynovectomy in the treatment of rheumatoid arthritis and hemophilic arthropathies

Radiosynovectomy is a novel method of treatment for several acute and chronic inflammatory joint disorders. A small amount of a beta-emitting radionuclide is injected into the affected joint delivering a radiation dose of 70 to 100 Gy to the synovia. The proliferative tissue is destroyed, secretion of fluid and accumulation of inflammation causing cellular compounds stops and the joint surfaces become fibrosed, providing long term symptom relief. The radionuclides are injected in colloidal form so that they remain in the synovium and are not transported by lymphatic vessels causing radiation exposure to other organs. Complete reduction of knee joint swelling has been seen in above 40% and pain relief in 88% of patients. Wrist, elbow, shoulder, ankle and hip joints showed significant improvement in 50-60% and restoration of normal function and long term pain relief has been achieved in about 70% of small finger joints. In hemophilic arthropathies complete cessation of bleeding in about 60% and improved mobility in 75% of patients has been reported

Neurovisceral phenotypes in the expression of psychiatric symptoms

This review explores the proposal that vulnerability to psychological symptoms, particularly anxiety, originates in constitutional differences in the control of bodily state, exemplified by a set of conditions that include Joint Hypermobility, Postural Tachycardia Syndrome and Vasovagal Syncope. Research is revealing how brainbody mechanisms underlie individual differences in psychophysiological reactivity that can be important for predicting, stratifying and treating individuals with anxiety disorders and related conditions. One common constitutional difference is Joint Hypermobility, in which there is an increased range of joint movement as a result of a variant of collagen. Joint hypermobility is over-represented in people with anxiety, mood and neurodevelopmental disorders. It is also linked to stress-sensitive medical conditions such as irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia. Structural differences in 'emotional' brain regions are reported in hypermobile individuals, and many people with joint hypermobility manifest autonomic abnormalities, typically Postural Tachycardia Syndrome. Enhanced heart rate reactivity during postural change and as recently recognised factors causing vasodilatation (as noted post prandially, post exertion and with heat) is characteristic of Postural Tachycardia Syndrome, and there is a phenomenological overlap with anxiety disorders, which may be partially accounted for by exaggerated neural reactivity within ventromedial prefrontal cortex. People who experience Vasovagal Syncope, a heritable tendency to fainting induced by emotional challenges (and needle/blood phobia), are also more vulnerable to anxiety disorders. Neuroimaging implicates brainstem differences in vulnerability to faints, yet the structural integrity of the caudate nucleus appears important for the control of fainting frequency in relation to parasympathetic tone and anxiety. Together there is clinical and neuroanatomical evidence to show that common constitutional differences affecting autonomic responsivity are linked to psychiatric symptoms, notably anxiety

Clinical and anatomical approach using Sihler's staining technique (whole mount nerve stain)

Sihler's staining allows visualization of the nerve distribution within soft tissues without extensive dissection and does not require slide preparation, unlike traditional approaches. This technique can be applied to the mucosa, muscle, and organs that contain myelinated nerve fibers. In particular, Sihler's technique may be considered the best tool for observing nerve distribution within skeletal muscles. The intramuscular distribution pattern of nerves is difficult to observe through manual manipulation due to the gradual tapering of nerves toward the terminal end of muscles, so it should be accompanied by histological studies to establish the finer branches therein. This method provides useful information not only for anatomists but also for physiologists and clinicians. Advanced knowledge of the nerve distribution patterns will be useful for developing guidelines for clinicians who perform operations such as muscle resection, tendon transplantation, and botulinum toxin injection. Furthermore, it is a useful technique to develop neurosurgical techniques and perform electrophysiological experiments. In this review, Sihler's staining technique is described in detail, covering its history, staining protocol, advantages, disadvantages, and possible applications. The application of this technique for determining the arterial distribution pattern is also described additionally in this study

Kypho-IORT - a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases

<p>Abstract</p> <p>Background</p> <p>Instable and painful vertebral metastases in patients with progressive visceral metastases present a common therapeutic dilemma. We developed a novel approach to deliver intraoperative radiotherapy (IORT) during kyphoplasty and report the first treated case.</p> <p>Methods/Results</p> <p>60 year old patient with metastasizing breast cancer under chemotherapy presented with a newly diagnosed painful metastasis in the 12^ththoracic vertebra. Under general anaesthesia, a bipedicular approach into the vertebra was chosen with insertion of specially designed metallic sleeves to guide the electron drift tube of the miniature X-ray generator (INTRABEAM, Carl Zeiss Surgical, Oberkochen, Germany). This was inserted with a novel sheet designed for this approach protecting the drift tube. A radiation dose of 8 Gy in 5 mm distance (50 kV X-rays) was delivered. The kyphoplasty balloons (KyphX, Kyphon Inc, Sunnyvale) were inflated after IORT and polymethylmethacrylate cement was injected. The whole procedure lasted less than 90 minutes.</p> <p>Conclusion</p> <p>In conclusion, this novel, minimally invasive procedure can be performed in standard operating rooms and may become a valuable option for patients with vertebral metastases providing immediate stability and local control. A phase I/II study is under way to establish the optimal dose prescription.</p