Periodontal disease and chronic kidney disease

Cilj istraživanja: Parodontalna bolest (PB) jedna je od najrasprostranjenijih bolesti danas. Riječ je o stanju kronične upale niske razine koja može aktivirati sistemski upalni odgovor organizma i na taj način dodatno opteretiti bolesnika s drugim sistemskim bolestima i oslabljenim imunološkim sustavom. Istraživanja su o povezanosti parodontalne bolesti s drugim sistemskim bolestima brojna, a do sada je najbolje istražena povezanost parodontalne bolesti i dijabetesa melitusa. Cilj našeg istraživanja bio je istražiti moguću povezanost parodontalne bolesti i kronične bubrežne bolesti (KBB) preko sistemskih razina proupalnih citokina. Ispitanici i metode: U ovo presječno kohortno istraživanje uključeno je ukupno 80 bolesnika podijeljenih u dvije skupine ovisno o stupnju kronične bubrežne bolesti od kojeg boluju. U prvu skupinu uvrstili smo ispitanike s 5.stupnjem kronične bubrežne bolesti koji se liječe hemodijalizom, a u drugu ispitanike s 3.i 4.stupnjem kronične bubrežne bolesti. Svima su uzeti podatci iz anamneze i medicinske dokumentacije, učinjena je opsežna laboratorijska analiza i ELISA analiza razine citokina: interleukin 6 (IL-6), interleukin 17A (IL-17A) i tumorski faktor nekroze alfa (TNF-α) u serumu. Svim ispitanicima učinjen je kompletan parodontološki pregled i uzet kompletan parodontalni status. Podatci su međusobno analizirani i uspoređeni među skupinama. Rezultati: Rezultati su pokazali da nije bilo statistički značajne razlike u parodontalnom statusu među skupinama. Razine IL-6 bile su značajno više u skupini ispitanika koji su na hemodijalizi (P=0,004) i bile su povezane s lošijim parodontalnim statusom. Razine preostala dva citokina nisu pokazale statistički značajnu razliku. Lošiji parodontalni status također su imali i dijabetičari, te pušači. Zaključak: Povišene razine interleukina 6 u skupini ispitanika na hemodijalizi koje su i povezane s lošijim parodontalnim statusom govore da je moguće da lošiji parodontalni status svojim dodatnim upalnim opterećenjem može pogoršati stanje kronične bubrežne bolesti.Objectives: Periodontal Disease (PD) is one of the most common diseases today. It is believed that low-grade level of chronic inflammation and release of bacterial toxins and inflammatory mediators in the bloodstream aggravate a chronic systemic disease. Numerous studies have shown the association of periodontal disease and various chronic systemic diseases, such as diabetes mellitus and cardiovascular disease. The purpose of our research was to investigate the possible association of periodontal disease and chronic kidney disease (CKD) via the inflammatory cytokines path. Subjects and methods: In this cross-sectional study, we surveyed a total of 80 subjects divided into two groups. First group included subjects with CKD stages 3 and 4, and the second group included patients with CKD stage 5, who are treated with hemodialysis. We compared the periodontal status among the groups, as well as the serum levels of different cytokines: interleukin 6, interleukin 17A and tumor necrosis factor α. Results: The results showed no significant differences in the periodontal status among groups, but interleukin 6 levels were significantly higher in the hemodialysis group of patients (P=0,004) and were also associated with a poorer periodontal status. Diabetic patients and smokers also had poorer periodontal status. Conclusion: Elevated interleukin 6 levels in the hemodialysis group associated with poorer periodontal status indicate that it may be possible that a worse periodontal status can deteriorate chronic disease such as CKD with additional inflammatory burden

Frenulectomy - When and Why?

Podatci iz literature često su dijametralno suprotni što se tiče potrebe da se izvede kirurški zahvat kod perzistentnoga frenuluma, bilo da se radilo o njegovoj izravnoj povezanosti s dijastemom medijanom ili ne. Različita su mišljenja o najpovoljnijem vremenu za zahvat ili na redoslijed intervencije kirurga, odnosno ortodonta. Većina se autora slaže u tome da je zahvat potreban, ali i da se s njim ne treba žuriti. Pojedini autori smatraju kako treba pričekati da iznikne trajni očnjak, a drugi upozoravaju i na mogućnost spontanoga zatvaranja dijasteme još i u vrijeme nicanja drugoga trajnog molara. Prema navodima u literaturi frekvencija tektolabijalnoga frenuluma djece je 7,3%, a odraslih samo l,3%, što upućuje na neopravdanost ranih kirurških tretmana. Naše istraživanje pokazuje sukladne podatke, jer je najveća zastupljenost frenulektomija (80%) u dobi do 20 godina. Od svih lokalizacija koje zahvaća hipertrofični frenulum njih 90% je u području gornje usne. Upravo ta povezanost između dobi i lokalizacije govori nam da se radilo o ortodontskoj indikaciji, zapravo o dijastemi medijani. Najveći broj dijastema zatvara se u vrijeme nicanja lateralnih sjekutića, pa ako dijastema i dalje perzistira, a popraćena je hipertrofičnim frenulumom, postoje male mogućnosti kasnijeg spontanog zatvaranja. Zato operativni zahvat izvodimo ne čekajući da niknu trajni očnjaci. Sve operativne intervencije za uklanjaje abnormalno razvijenog frenuluma svode se na inciziju, eksciziju ili transpoziciju tkiva u području frenuluma, odnosno kombinaciji svih triju postupaka. Operativne metode koje se najčešće preporučuju zbog zadovoljavajućeg postoperativnog rezultata, brzine samog zahvata i jednostavnosti tehnike jesu “V” ekscizija, te horizontalna incizija interdentalnoga tkiva i dijela papile incizive. Nakon toga kirurškoga tretmana moguće je učiniti i kortikotomiju na tome području ako je to potrebno. Svrha je ovoga istraživanja prikazati indikacije za frenulektomiju, s posebnim osvrtom na vrijeme kirurškoga zahvata.Data from the literature are often diametrically contradictory with regard to the need to carry out a surgical procedure in the case of a persistent frenulum, either when it is a case of its direct connection with the diastema median or not. Opinions vary on the most suitable time to perform the operation, or on the chronology of the intervention of the surgeon or orthodontist. The majority of authors agree that the operation is necessary but that there is no need for urgency. Some authors consider that one should wait until the eruption of the permanent molar, while others warn of the possibility of spontaneous closing of the diastema at the time of the eruption of the second permanent molar. According to reports in the literature the frequency of tectolabial frenulum in children is 7.3%, and in adults only 1.3%, which indicates that early surgical treatment is unjustified. Our investigation shows consistent data, because the greatest incidence of frenulectomia (80%) occurred up to the age of 20 years. Of all the sites affected by a hypertrophic frenulum, 90% were in the area of the upper lip. The connection between age and the localisation indicates orthodontic indication, of just the diastema median. Most diastema close during eruption of the lateral incisors, but if the diastema persists, and is accompanied by hypertrophic frenulum, the possibility of later spontaneous closing is slight. Thus the operative procedure can be carried out without waiting for the eruption of the canines. All operations for removal of abnormally developed frenulum comprise incision, excision or transposition of tissue in the region of the frenulum, i.e. a combination of all three procedures. The operative methods most frequently recommended because of the satisfactory postoperative result, speed of procedure and simple technique are “V” excision and horizontal incision of the interdental tissue and part of the papilla incisiva. After such surgical treatment it is possible to carry out corticotomy in the area if necessary. The aim of this study was to present indications for frenulectomy, with special reference to the time of the surgical procedure

Debljina sloja živčanih vlakana mrežnice u glaukomskih bolesnika Liječenih multiplim intravitrealnim injekcijama anti-vegf-a (bevacizumaba)

Over the past decade, intravitreal injections of anti-VEGF agents have been widely used and intensively developed as a treatment option for many ophthalmological indications. Due to its availability and low cost, the most frequently used anti-VEGF agent is bevacizumab. This type of therapy is often indicated in patients with exudative age-related macular degeneration (ARMD) and diabetic macular edema (DME). If, in addition to these two conditions, patients have a diagnosis of primary open angle glaucoma (POAG), they also present with optic nerve head (ONH) retinal nerve fiber layer (RNFL) thinning. The aim of this prospective study was to establish whether administering bevacizumab to patients with POAG leads to additional reduction of RNFL thickness. The study included 60 patients divided into two groups. First group comprised the eyes of patients with exudative ARMD and POAG, whereas second group comprised the eyes of patients with DME and POAG, all treated with bevacizumab. Control group comprised the fellow eye of each involved patient, which was not treated with bevacizumab. In a period of one year, all patients underwent optical coherence tomography (OCT) measurements of ONH RNFL thickness. The results of all patients were compared between the two study groups and then with control group results. Study results showed a decrease of RNFL in both groups of patients. Comparison of these two groups of patients after one year revealed a statistically more significant decrease in RNFL thickness in the second group (DME + POAG).Intravitrealna aplikacija anti-VEGF agenasa za različite indikacije jedna je od najprimjenjivanijih i najbrže razvijajućih terapijskih mogućnosti posljednih godina u oftalmologiji. Najčešće se zbog svoje dostupnosti i cijene koristi bevacizumab. Eksudativna senilna makularna degeneracija (SMD) i dijabetički makularni edem (DME) među najčešćim su indikacijama za ovu vrstu terapije. Ako uz ove dijagnoze bolesnici imaju i primarni glaukom otvorenog kuta (engl. primary open angle glaucoma, POAG), imaju i stanjenje sloja živčanih vlakana PNO (lat. papilla nervi optici). U ovom prospektivnom istraživanju ispitivali smo dolazi li kod bolesnika s POAG koji moraju primati bevacizumab do dodatnog stanjenja debljine RNFL (engl. retinal nerve fi ber layer). U istraživanje je bilo uključeno 60 bolesnika podijeljenih u dvije skupine. Prvu skupinu su činile oči bolesnika koji imaju eksudativnu SMD i POAG, a drugu oni koji imaju DME i POAG te su liječeni bevacizumabom. Kontrolnu skupinu činilo je drugo oko u koje nije apliciran bevacizumab. Kod svih bolesnika mjerila se debljina sloja živčanih vlakana PNO pomoću optičke koherentne tomografi je kroz godinu dana, a dobivene vrijednosti su uspoređene s kontrolnim skupinama te međusobno. Rezultati su pokazali da su nakon godinu dana sve skupine imale stanjenje RNFL, ali dok u prvoj skupini nije bilo statistički značajne razlike između liječenog i neliječenog oka, u drugoj skupini je ta razlika ipak bila statistički značajna. Uspoređujući ove dvije skupine bolesnika dobiveno je statistički veće stanjenje RNFL nakon godinu dana u drugoj skupini bolesnika (DME + POAG)

Kirurški aspekti liječenja blefarospazma: prikaz slučaja

Blepharospasm is an idiopathic condition characterized by involuntary eyelid closure mainly caused by bilateral tonic-clonic contractions of the orbicularis oculi muscle. It results in patient inability to open their eyes, thus significantly impairing their ability to perform activities of daily living. First-line treatment for blepharospasm are primarily botulinum toxin type A injections. However, surgical procedure as a treatment option can also be taken in consideration. In this overview, we present a case of a 75-year-old female patient who received surgical treatment as per Anderson’s method after being treated with botulinum toxin type A for 3 years. This form of therapy proved to be an extremely successful permanent solution in the treatment of severe cases of refractory blepharospasm, without any long-term complications, especially ectropion and lagophthalmos.Blefarospazam je idiopatska bolest kod koje dolazi do nekontroliranog stiskanja očnih vjeđa zbog najčešće obostranih toničko kloničkih kontrakcija kružnog očnog mišića. Takvo stanje kod bolesnika rezultira nemogućnošću otvaranja očiju i znatno ograničava obavljanje svakodnevnih aktivnosti. Terapija prvog izbora su injekcije botulinum toksina A, no u obzir dolazi i kirurško liječenje. Ovaj osvrt prikazuje slučaj bolesnice u dobi od 75 godina, kirurški liječene Andersonovom metodom nakon 3 godine liječenja botulinum toksinom A. Takav oblik terapije pokazao se veoma uspješnim trajnim rješenjem u liječenju težih slučajeva refraktornog blefarospazma uz izostanak dugoročnih komplikacija, osobito ektropiona i lagoftalmusa

The Radiomorphometric Indices of the Mandible as a Screening Method for Early Detection of Osteoporosis in Postmenopausal Women

The aim of the study was to compare radiomorphometric indices measured on panoramic radiographs: mandibular cortical width (MCW), panoramic mandibular index (PMI) and mandibular cortical index (MCI) with the densitometric values of skeletons in postmenopausal women, as well as and to determine the possibilities of their use in screening for early detection of osteoporosis in risky populations. Radiomorphometric indices were measured on panoramic radiographs of 146 postmenopausal patients, mean age 66.3 (±9.7) years, mean menopausal age 16.3 (±10.6) years. By dual energy X-ray absorptiometry (DXA) method were measured bone mineral density of the femur and the lumbar vertebrae (L1–L4). The Receiver Operating Characteristic (ROC) curve analysis was used to determine the changed densitometric finding, and to distinguish osteopenia and osteoporosis. The examinees with lower densitometric values had significantly lower MCW (3.60 mm) and PMI (0.36 mm) than those with regular densitometric values (p 1 (p<0.001). For early detection of osteopenia and osteoporosis in postmenopausal women in everyday clinical practice, panoramic radiograph as a screening method can be of help

The Importance of Thorough Preoperative Diagnostics of Maxillary Ameloblastoma: Report of Three Cases

Ameloblastoma, especially maxillary, is a rare benign neoplasm of odontogenic origin. Diagnosis of significant number of lesions is usually established postoperatively, because ameloblastoma, especially the unicystic form, mimics wide range of more frequent jaw lesions. From January 1993 to December 2005, three cases of the maxillary ameloblastoma were surgically treated at our Department. The authors present clinical, radiological and pathohistological features of the ameloblastomas in this rare localization with special attention to need of accurate preoperative diagnostics

Periodontal disease and chronic kidney disease

Cilj istraživanja: Parodontalna bolest (PB) jedna je od najrasprostranjenijih bolesti danas. Riječ je o stanju kronične upale niske razine koja može aktivirati sistemski upalni odgovor organizma i na taj način dodatno opteretiti bolesnika s drugim sistemskim bolestima i oslabljenim imunološkim sustavom. Istraživanja su o povezanosti parodontalne bolesti s drugim sistemskim bolestima brojna, a do sada je najbolje istražena povezanost parodontalne bolesti i dijabetesa melitusa. Cilj našeg istraživanja bio je istražiti moguću povezanost parodontalne bolesti i kronične bubrežne bolesti (KBB) preko sistemskih razina proupalnih citokina. Ispitanici i metode: U ovo presječno kohortno istraživanje uključeno je ukupno 80 bolesnika podijeljenih u dvije skupine ovisno o stupnju kronične bubrežne bolesti od kojeg boluju. U prvu skupinu uvrstili smo ispitanike s 5.stupnjem kronične bubrežne bolesti koji se liječe hemodijalizom, a u drugu ispitanike s 3.i 4.stupnjem kronične bubrežne bolesti. Svima su uzeti podatci iz anamneze i medicinske dokumentacije, učinjena je opsežna laboratorijska analiza i ELISA analiza razine citokina: interleukin 6 (IL-6), interleukin 17A (IL-17A) i tumorski faktor nekroze alfa (TNF-α) u serumu. Svim ispitanicima učinjen je kompletan parodontološki pregled i uzet kompletan parodontalni status. Podatci su međusobno analizirani i uspoređeni među skupinama. Rezultati: Rezultati su pokazali da nije bilo statistički značajne razlike u parodontalnom statusu među skupinama. Razine IL-6 bile su značajno više u skupini ispitanika koji su na hemodijalizi (P=0,004) i bile su povezane s lošijim parodontalnim statusom. Razine preostala dva citokina nisu pokazale statistički značajnu razliku. Lošiji parodontalni status također su imali i dijabetičari, te pušači. Zaključak: Povišene razine interleukina 6 u skupini ispitanika na hemodijalizi koje su i povezane s lošijim parodontalnim statusom govore da je moguće da lošiji parodontalni status svojim dodatnim upalnim opterećenjem može pogoršati stanje kronične bubrežne bolesti.Objectives: Periodontal Disease (PD) is one of the most common diseases today. It is believed that low-grade level of chronic inflammation and release of bacterial toxins and inflammatory mediators in the bloodstream aggravate a chronic systemic disease. Numerous studies have shown the association of periodontal disease and various chronic systemic diseases, such as diabetes mellitus and cardiovascular disease. The purpose of our research was to investigate the possible association of periodontal disease and chronic kidney disease (CKD) via the inflammatory cytokines path. Subjects and methods: In this cross-sectional study, we surveyed a total of 80 subjects divided into two groups. First group included subjects with CKD stages 3 and 4, and the second group included patients with CKD stage 5, who are treated with hemodialysis. We compared the periodontal status among the groups, as well as the serum levels of different cytokines: interleukin 6, interleukin 17A and tumor necrosis factor α. Results: The results showed no significant differences in the periodontal status among groups, but interleukin 6 levels were significantly higher in the hemodialysis group of patients (P=0,004) and were also associated with a poorer periodontal status. Diabetic patients and smokers also had poorer periodontal status. Conclusion: Elevated interleukin 6 levels in the hemodialysis group associated with poorer periodontal status indicate that it may be possible that a worse periodontal status can deteriorate chronic disease such as CKD with additional inflammatory burden