Collateral Edema Research Articles

КЛИНИЧЕСКО-ИММУНОЛОГИЧЕСКИЕ АСПЕКТЫ ПРИ ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ПАЦИЕНТОВ С ГИПЕРКЕРАТОЗАМИ СЛИЗИСТОЙ ОБОЛОЧКИ РТА

Relevance. The relevance of the treatment of oral mucosa diseases is determined by their prevalence, propensity to progression and difficulties in early diagnosis. The article presents the results of surgical treatment of this category of patients using laser radiation with a wavelength of 1940 nm and determination of gene expression of immunologic factors. Purpose. To increase the efficiency of surgical treatment of oral mucosa hyperkeratosis by using the fiber laser LSP – «IRE-Polus». Materials and methods. Surgical treatment was performed on 30 patients (100%) with clinical diagnosis K13.2 Leukoplakia and other disturbances of oral epithelium, including tongue (25 patients) and L43.0 Lichen ruber planus hypertrophicus (5 patients). All patients were randomly divided into 2 groups: in the 1st group lesions were excised by fiber laser LSP – «IRE-Polus», in the 2nd group excision was performed by scalpel. Sampling for gene expression study of defensin beta 1 and IL-28B genes was performed after surgical intervention in all patients. Statistical analysis was carried out using the Mann–Whitney test. Results. The use of laser alteration leads to a decrease in pain intensity, collateral edema, and the timing of postoperative wound epithelialization. In the expression study of immunologic factors, there was no statistically significant difference in the expression of defensin beta 1 gene in both study groups, while an association was found between a high level of IL-28B gene expression and the development of inflammation when using the traditional method. Conclusion. The use of fiber lasers contributes to the improvement of treatment efficiency in patients with hyperkeratosis of the oral mucosa. When examining patients with hyperkeratosis, a significant 2.2-fold increase in IL-28B gene expression was found in the group of patients where the traditional method of treatment was applied (p < 0.05).

Modern approach to the treatment of postoperative symptoms of patients undergoing oral surgery

Introduction. Removal of wisdom teeth is always accompanied by the appearance of collateral edema of varying severity, pain, neurological dysfunction and inflammatory contracture of the masticatory muscles.Purpose. To evaluate the use of local apparatus hypothermia and the method of three-dimensional facial scanning for the treatment of patients after extraction of mandibular third molars.Materials and methods. 60 patients had their wisdom teeth removed. Depending on the group, local apparatus hypothermia (LAH) (study group of 30 patients) and local ice hypothermia (LIH) (control group of 30 patients) were performed after surgery. Evaluation criterion: three-dimensional scanning of the face on days 3, 5, 7.Results. In the control group, on the 3rd day the size of the edema was 6.31 mm (SD 0.81), on the 5th day – 4.88 mm (SD 0.73), on the 7th day – 3.44 mm (SD 0.88). In the study group, on the 3rd day the size of the edema was 5.09 mm (SD 0.80), on the 5th day – 2.73 mm (SD 0.71), on the 7th day – 1.28 mm (SD 0,62). In the control group, the size of edema on the 5th day changed by 22.67% compared to the 3rd day, on the 7th day by 30.12% compared to the 5th day and by 45.94% compared to 3rd day. In the study group, the size of edema on the 5th day changed by 46.42% compared to the 3rd day, on the 7th day by 53.16% compared to the 5th day and by 75.32% compared 3rd day. Comparison of groups 3, 5 and 7 in terms of absolute values of edema size and percentage change showed a statistically significant difference (p<0.001).Conclusion. The use of local apparatus hypothermia in the postoperative period can reduce the severity of collateral edema in a shorter period compared to standard methods of local hypothermia.

РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ КОЛЛАГЕНОВОГО МАТРИКСА ПРИ МЕНЕДЖМЕНТЕ МЯГКИХ ТКАНЕЙ В ОБЛАСТИ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ ВО ФРОНТАЛЬНОМ ОТДЕЛЕ ВЕРХНЕЙ ЧЕЛЮСТИ

The aim is to comparatively analyze the using of collagen matrix and free connective tissue graft in soft tissue thickness increase in the area of dental implants in the anterior region of the upper jaw.
 Materials and methods. 30 patients with partial absence of teeth and soft tissue thickness deficit in the anterior part of the upper jaw took part in the study. In the 1st group (n = 15) a free connective tissue graft (CTG) from the hard palate was transplanted, in the 2nd group (n = 15) a collagen matrix (CM) was used. The primary endpoint was the amount of soft tissue thickness gain 3 months after surgery. Secondary endpoints were: duration of surgery, severity of collateral edema and pain, amount of analgesic medication consumed, quality of life assessment, width of keratinized attached gingiva, and soft tissue aesthetics.
 Results. 3 months after augmentation the increase in soft tissue thickness from the vestibular surface was 0.86 ± 0.25 mm and 0.77 ± 0.26 mm (p = 0.34), from the occlusal surface - 0.46 ± 0.14 mm and 0.37 ± 0.18 mm (p = 0.137) in patients of the 1st and 2nd groups, respectively. The use of CM was characterized by less prolonged surgery (p = 0.002), less pronounced postoperative pain on the 1st and 3rd day (p = 0.007; p = 0.023), less consumption of analgesic drugs on the 1st, 3rd and 5th day (p = 0.014; p = 0.033; p = 0.002) and less reduction of patients' quality of life in the first 7 days after surgery (p = 0.023). When analyzing the "Pink Esthetics Scale" (PES) in patients, group 2 showed more pronounced inconsistencies in the assessment of the zenith level (p < 0.001), less natural soft tissue contour (p < 0.001) and more significant deficit of the alveolar ridge (p < 0.001).
 Conclusion. Collagen matrixes make it possible to obtain soft tissue augmentation comparable with the use of CTG, to reduce the time of surgical intervention and to provide a more comfortable postoperative period. The use of autogenous grafts provides better results in terms of soft tissue aesthetics.

ОПЫТ ПРИМЕНЕНИЯ ИМПЛАНТАТОВ СО СКОШЕННЫМ КРАЕМ ПЛАТФОРМЫ

Purpose: Comparative analysis of the use of implants with modified neck configuration and standard implants with additional bone grafting.
 Materials and methods: 34 patients with partial tooth loss combined with a horizontal defect of the alveolar bone were included in the study. In group 1 (n = 15) implants with sloped platform edge were placed, in group 2 (n = 19) implants of standard design with directed bone regeneration (GBR) were placed. The primary end point of the study was the level of vertical bone resorption in the implant neck area 6 months after the operation. Secondary endpoints were: pain (VAS) and oedema scores, width of attached gingiva, number of analgesics taken, quality of life and health (OHIP-14).
 Results: The level of vertical resorption after 6 months in patients in group 1 was 0.04 ± 0.04mm mesially and 0.06 ± 0.05mm distally, in patients in group 2 mesially 1.06 ± 0.35mm and distally 1.00 ± 0.39mm. The use of implants with sloped edge of the platform was characterized by lower pain intensity the first 7 days after surgery (p < 0,001), lower severity of collateral edema (p < 0,001), lower consumption of NSAIDs on 1, 3, 5, 7 days (p = 0,002, <0,001, <0,001 and 0,008, respectively), lower total OHIP-14 score (p = 0,047) on 7 days. After 4 months, the width of attached keratinized gingiva was 3.6 (3–3.8) mm in patients in group 1 and 2 (1.5–2.1) mm in group 2.
 Conclusion: The use of implants with a sloped platform edge is characterized by a lower level of vertical resorption and allows for a more comfortable postoperative period.

Local apparatus hypothermia during surgical interventions in the oral cavity

Introduction. Dry ice cryotherapy is widely used in all areas of medicine, as this method can reduce swelling, hematoma. However, there are also disadvantages inherent in this method in the form of decompensation of the vascular bed, thereby going beyond the reserve forces of the body. Because of this, it is relevant to develop and apply the method of «soft» sequential cooling of the target area, for a more consistent spastic reaction of the vascular bed. In this clinical study, the technique of local hardware hypothermia was applied, which made it possible to reduce the likelihood of undesirable local decompensatory reactions from the body. Purpose. Clinical rationale for the use of local hardware hypothermia in the postoperative period in patients after complex extractions of 3 molars.Materials and methods. We studied 60 subjects diagnosed with retention and dystopia of the third molars of the n/h (30 control, 30 experimental groups). The experimental group after surgical interventions underwent PAH for 60 minutes with a target temperature of 18°C once, the control group received cryotherapy with an ice pack for 15 minutes (3 minutes exposure, 3 minutes rest 5 times). PAH was performed using the ViTherm apparatus (TsTKh Skolkovo, Moscow). The evaluation criteria in the study were: the type of wound healing, the presence of pain, swelling, lockjaw and discomfort, the use of NSAIDs, the presence of complications. The results of the study were entered into a table, with further statistical comparative analysis. For comparison, the Chi-square test with Yates correction was used. Results. In the control group, edema was observed in 100% of cases, and in the experimental group in 87%. Discomfort was felt by 87% and 83% of patients in the control and experimental groups, respectively. There were no complications in the experimental group, and 17% of patients in the control group (p=0.06). Pain was felt by 100% of patients in the control group and only 60% in the experimental group (p=0.0004). The intake of NSAIDs was 97% and 73%, respectively, in the control and experimental groups (p=0.03). In the experimental group, 73% of patients healed according to the primary type, and in 27% according to the secondary type. In the control group, primary healing occurs in 30% of cases, and secondary in 70% (p=0.002). In the control group, complications were observed in the form of alveolitis on the 3rd day after surgery (control n=5). 3 patients did not receive an injection of DMZ in the postoperative period at the request of the patient. In 31 patients the wound healed by primary intention (control n=9, experimental n=22), in 29 patients the wound healed by secondary intention (control n=20, experimental n=9), collateral edema was visually observed in 56 patients (control n=30 , experimental n=26). 48 patients complained of pain (control n=30, experimental n=18), discomfort when eating and talking, opening the mouth in 46 (control n=25, experimental n=21); 9 patients did not take NSAIDs (control n=1, experimental n=8). Conclusion. According to the statistical analysis and the results of the study, it can be said that the use of PAH in the postoperative period in patients after complex removal of 3 molars in the lower jaw reduces the likelihood of postoperative complications in the experimental group by 100%, pain by 40%, edema by 13%, the likelihood of secondary healing by 73%, trismus and discomfort by 17%, NSAIDs by 27% compared with the control group.

Clinical effectiveness of a new collagen-based drug with lincomycin for the prevention and treatment of jaw alveolitis

BACKGROUND: Alveolitis is the most common complication that occurs after tooth extraction. Among preventive and therapeutic methods, pharmacological agents for the dry socket treatment have been proposed. However, the gold standard for the prevention and treatment of alveolitis has not been defined.
 AIM: The study aimed to conduct a comparative analysis of the effectiveness of a collagen sponge with lincomycin and an iodoform tampon for the prevention of the development and treatment of alveolitis.
 MATERIAL AND METHODS: The study included 75 patients with jaw alveolitis and patients with teething disorders and chronic periodontitis who underwent planned tooth extraction. The patients were divided into two groups: group 1 underwent a socket revision, whereas group 2 had a tooth extraction. The patients of each group were divided into two subgroups: subgroup A used a collagen sponge with lincomycin and subgroup B used an iodoform tampon. The intensity of pain syndrome, severity of mucosal hyperemia, and collateral edema were assessed, and the epithelialization time of the sockets was recorded.
 RESULTS: The clinical study of the effectiveness of a collagen sponge with lincomycin in comparison with an iodoform tampon demonstrated some advantages of a collagen sponge, including a more comfortable postoperative period, mild pain, less pronounced edema and hyperemia, epithelialization of the extracted teeth sockets 1.5 days earlier.
 CONCLUSION: For the prevention and treatment of alveolitis, especially in patients in whom the use of iodine compounds is contraindicated, the use of Alvanes collagen sponge with lincomycin is preferable to an iodoform tampon.

USE OF OSTEOPLASTIC MATERIALS TO RESTORE BONE DEFECTS FOLLOWING THE SURGICAL TREATMENT

In recent years, the number of dental surgical operations has been growing rapidly worldwide, and clinicians are facing pressing issue to select and apply osteoplastic materials, which would promote rapid repair of jaw bone defects and relieve symptoms during the post-operative period. With the advancements in the field of dentoalveolar reconstruction, it is of great importance to develop the material for bone restoration, which by its properties would be identical to autologous bone. The aim of this study is to analyze the effectiveness of osteoplastic materials used for the augmentation following sinus lift, tooth socket preservation, osteosynthesis of mandibular fractures and extraction of impacted third molars. 280 people aged from 18 to 55 with partial or complete adentia and atrophy of the alveolar arch of the jaws, with chronic periapical infection, chronic generalized periodontitis, fractures and impacted third molars were examined at the Department of Surgical Dentistry and Maxillofacial Surgery of the Chernivtsi Regional Clinical Hospital. All patients were planned to undergo prosthodontic treatment assisted by dental implants. The study has demonstrated that the patients of subgroups B of all groups of the study, where the augmentation of bone defects was performed using a combination of osteoplastic material «Colapan-L» containing multipotent mesenchymal stem cells of adipose tissue and platelet-rich plasma presented alleviating clinical symptoms including pain, collateral oedema, hyperaemia of the oral mucosa and better bone regeneration at the site of surgery, compared with subgroups A, where the augmentation was performed with osteoplastic material «Colapan-L», and sub-groups B, whose healing followed by blood clot forming. The use of osteoplastic materials containing multipotent mesenchymal stem cells of adipose tissue during dental operations improves the regenerative and reparative properties of bone tissue, facilitates the postoperative period and reduces the duration of inpatient treatment period.

EFFECTS OF BONE AUGMENTATION MATERIALS ON PECULIARITIES OF POSTOPERATIVE PERIOD IN PATIENTS AFTER IMPACTED THIRD MOLAR EXTRACTION AND THEIR CLINICAL EFFICIENCY

The article presents a comparative analysis of the clinical effectiveness of bone augmentation materials, in particular, compositions including multipotent mesenchymal stromal cells of adipose tissue and platelet-enriched plasma, used to fill bone defects during the operation of third molars extraction. The criteria for the effectiveness of treatment at the stage of the early postoperative period in the participants included the assessment of the pain intensity, collateral oedema and hyperaemia of the oral mucosa after the surgery. The aim of the study is to determine the clinical efficiency of osteoplastic materials and to determine the feasibility of using tissue equivalents of bone tissue based on multipotent mesenchymal stromal cells of adipose tissue for healing of bone defects in patients with impacted third molars. Methods and participants. The study was conducted on the basis of the Department of Surgical Dentistry and Maxillofacial Surgery of Bukovynian State Medical University, Chernivtsi, Ukraine. Extraction of impacted third molars surgery was performed on 72 patients. After the tooth extraction, 31.94% of them underwent bone augmentation by osteoplastic material “Colapan–L” (group A); 41.67% of patients had bone augmentation with a combination of multipotent mesenchymal stromal cells of adipose tissue+”Colapan–L”+platelet-rich plasma (group B), and in the rest, 26.39% of patients, wound healing occurred under a blood clot (group C). Postoperative pain syndrome was assessed using the Numerical Rating Scale (NRS) based on patients' subjective feeling of pain. Visual assessment of the severity of collateral oedema and hyperaemia of the oral mucosa after surgery was also performed. A scoring system was used to determine the severity of collateral oedema. To assess the state of the postoperative period in patients of all study groups, a protocol was completed daily during the hospital stay period that reflected the most important data of an objective and subjective nature.
 During the procedure of morning dressings, we analyzed patients' complaints and evaluated general and local status: presence of appetite, quality of sleep, wound pain, postoperative oedema, hematoma, and hyperaemia of the oral mucosa, presence of secretions from the wound, body temperature, and type of wound healing. The study has demonstrated that at the final stage of postoperative follow-up the 89.31% of patients who received a combination of “Colapan–L” with multipotent mesenchymal stromal cells of adipose tissue and platelet-rich plasma reported no pain that is 1.2 times p1<0.05 and 1.3 times p2<0.05 higher than in the patients of groups A and B. Collateral oedema was absent in 98.47% of the group B patients that exceeded 1.2 times p1<0.05 the number of such individuals in group A, where the bone defect was augmented with the osteoplastic material “Colapan–L”, and in 1.4 times higher, p1<0.01, p1>0.05 that the indicators of group B, where the healing of the bone defect developed without osteoplastic materials. The absence of hyperaemia of the oral mucosa was found in 92.37% of the patients in groups B, which was 1.3 and 1.4 times higher than the values obtained in groups A and B, p1<0.05, p2<0.01.

PATTERNS IN WOUND HEALING PROCESS AFTER BRANCIAL CLEFT CYST EXCISION IN CHILDREN

The course of the wound healing process after surgical intervention on brancial cleft cyst excision should be considered as a stereotyped inflammatory-reparative reaction of the body, characterized by staged aseptic inflammation, regeneration and fibrosis. Clinically and even morphologically, it is difficult to determine the stages of the wound healing process in the temporal aspect, since they are consistent and interconnected.
 Purpose. The paper is aimed at evaluation of the wound healing process according to clinical indicators in children after branchial cleft cyst excision.
 Methods and Material. 26 children aged from 5 to 17 years old with branchial cleft cysts have been examined and treated. In the postoperative period, the nature, amount of exudate and its cell composition has been determined; skin contact thermometry has been performed at 4 points around the wound at a distance of 1 cm.
 Results. The first manifestations of the disease coincided with the course of acute respiratory viral diseases in 8 children (30.8%); association with ENT pathology was observed in 3 (11.5%) children and the cystic masses emerged spontaneously in 15 cases (57.7%). They were localized with almost the same incidence on the left and right, but the vast majority (21 cases (80.7%)) was located anteriorly the sternocleidomastoid muscle and in 5 (19.3%) cases behind it. Ultrasound examination, made in 21 patients (80.8%), has revealed the presence of cystic masses with clear contours, hypoechoic structure and fine-grained inclusions, and the wall thickness varied from 1 to 3 mm. In 5 doubtful cases (19.2%) a puncture biopsy was performed.
 On 1st day after surgery, hyperemia around the wound was moderate in 15 children (57.7%); it was insignificant in 8 (30.8%) children and it was absent in 3 (11.5%) children. At the same time all children experienced collateral edema of various localization and painful modality. In the impression smears, a significant number of neutrophils, a moderate number of lymphocytes and erythrocytes was detected, which were prominent against the background of a loose substrate. The temperature of the wound area was 36.24 ± 0.07˚C, which was higher compared to the control group (34.71 ± 0.12˚C).
 On 3rd day, the corolla of hyperemia around the wound was not detected in 18 patients (69.2%), and its narrowing was recorded in 6 (23.1%) cases and it was persistent in 2 (7.7%) cases. On palpation, severe, moderate and weak pain on the wound area was experienced by 2 (7.7%), 15 (57.7%) and 9 (36.4%) children, respectively. The cytograms of the exudate showed a reduced quantity of neutrophils, erythrocytes and lymphocytes. Two children showed elevated quantity of destructured neutrophils and local temperature to 37.21 ± 0.16 ° C, which required medical adjustments.
 A narrow corolla of hyperemia around the wound, slight edema and moderate pain was detected on 7th day only in 2 children. In all patients, palpation revealed tissue compaction along the wound canal, onset of epithelialization, and the cytograms revealed the presence of sporadic neutrophils. The temperature of the skin around the wound reached 35.74 ± 0.11˚C, which was almost similar to controls (34.21 ± 0.08˚C). In all cases, the wounds healed with primary tension.
 Thus, the nature of the dynamics of wound healing after brancial cleft cyst extirpation in children can be successfully controlled by the prominence of the main clinical signs, the findings of the study of cellular composition of wound exudate and local temperature measuring.
 The perspectives of further research are associated with availability and simplicity of the methods in terms of their application in everyday clinical practice.

ASSESSMENT OF THE INTENSITY OF PAIN SYNDROME AND COLLATERAL SWELLING DURING THE SOCKET AUGMENTATION AFTER TOOTH EXTRAXTION WITH DIFFERENT OSTEOPLASTIC MATERIALS

The article presents a comparative analysis of the clinical effectiveness of osteoplastic materials, in particular a preparation based on multipotent mesenchymal stromal cells of adipose tissue and platelet-enriched plasma used to fill bone defects during the socket augmentation after the tooth extraction. The criteria to assess the therapy effectiveness at the stage of the early postoperative period included the intensity of pain and the amount of collateral oedema after surgery. The aim of this study is to evaluate the clinical effectiveness of osteoplastic materials to augment the volume of the alveolar bone during the operation of socket augmentation after the tooth extraction. Setting of this study: Bukovynian State Medical University, Chernivtsi, Ukraine. The study included 85 patients. The procedure of socket augmentation was performed by using "Kolapan - L" (28.57% of individuals, subgroup A), by combinations of MMSK AT + "Kolapan - L" + PRP (46.43% of individuals, subgroup B); the subgroup C included individuals (25.0%) whose wounds after tooth extraction healed by the formation a blood clot. The assessment of postoperative pain was performed by applying the digital rating scale (Numerical Rating Scale, NRS), taking into account the subjective pain in the patients. The subjects underwent visual assessment of the severity of collateral oedema after the tooth extraction surgery. To determine the dynamics of the severity of oedema we used a scoring system. The study demonstrated the patients of the subgroup B, who received the socket augmentation with "Kolapan - L" + MMSC-AT + PRP, experienced no pain at the final stage of postoperative observation (89.31% of cases) that was 1.2 times higher (p1 <0.05) than in the patients of subgroup A (p> 0, 05). At the final postoperative stages, no collateral oedema was seen in 98.47% of the participants of the subgroups B that exceed the number of cases in the subgroup A where the bone defect was augmented by "Kolapan - L", in 1.2 times (p1 <0.05).
 A comparative analysis of the clinical effectiveness of osteoplastic materials to increase the volume of the alveolar bone in the jaws during the socket augmentation after the extracted tooth convincingly proved the advantage of using the combination of "Kolapan - L" + MMSС - AT + PRP that was also confirmed by signs and symptoms in the postoperative period.

Evaluation of the Effectiveness of Laser Therapy in Complex Treatment of periodontal Diseases

Aim: The object of the study is to increase the efficiency of treatment in patients with generalized periodontitis by using a laser in complex treatment. Materials and Methods: Eighty patients underwent for instrumental and X-ray examination of the oral cavity, bacteriological studies of the microbiota of periodontal pockets, clinical analysis of peripheral blood that was taken from the ulnar vein and capillary blood that taken from the gums, as a local treatment carried lesion treatment portion of diode laser. Results: It was determined that opportunistic microflora, dominating before treatment in the contents of periodontal pockets, was not isolated in all patients, but on the 10th day of treatment, the microflora of periodontal pockets had stabilized. Both in the main group and in the comparison group, among neutrophils and monocytes, the populations of phagocytes with a low digesting ability prevailed, however, the proportions of medium- and highly active phagocytes after laser treatment were higher than after treatment with standard conservative therapy. Conclusions: The use of a laser for the therapeutic stage of the complex treatment of patients with generalized periodontitis of the I-II degree, chronic course contributes to the acceleration of reparative processes, a decrease in the degree of destruction in bone tissue, a decrease in the intensity of pain syndrome, a decrease in collateral edema, has an antibacterial effect and a longer stabilization of the periodontal condition.

PROCESSES OF LIPID PEROXIDATION AND ANTIOXIDANT PROTECTION IN ACUTE ODONOGIC OSTEOMYELITIS IN CHILDREN

The paper presented summarizes the results on the parameters of free radical lipid oxidation and antioxidant protection factors in 24 children aged from 3 to 15 years with acute odontogenic mandible osteomyelitis. In addition to standard clinical examination, peripheral blood and unstimulated oral fluid fractions were collected from all patients for 10 min at hospital admission and discharge. The samples were used to determine the components of lipid peroxidation: diene conjugates; malondialdehyde, its initial level, in 1.5 hours of incubation and its growth; antioxidant protection factors as superoxide dismutase, and catalase. It has been found out at the time of hospitalization, clinical examination showed a significant deterioration of the general condition, which was accompanied by widespread infiltrative changes and collateral oedema in the projection of the involved region of the mandible. In 12 people (50%) osteomyelitis spread from temporary molars. In other cases, permanent first and second molars were regarded as the causes. The patients demonstrated the activation of lipid peroxidation processes and reduction of antioxidant protection factors found out in peripheral blood and unstimulated oral fluid fraction. Repeated studies over the clinical recovery following the treatment conducted in accordance with the protocol of medical care enables to estimate the absence of infiltrative changes, but despite the elimination of acute inflammation, not all the studied parameters reached the level of control values. This makes it necessary to address the issue on making corrections towards the complex of therapeutic measures by including antioxidants that seems to be quiet promising and requires further in-depth investigation.

USE OF ERBIUM LASER FOR SURGICAL TREATMENT OF ROOT CYSTS OF THE JAWS

The article is devoted to investigate the efficacy of surgical treatment with Er:YAG laser of patients with root jaw cysts. An examination and surgical treatment of 55 patients with root jaw cysts of different localization were carried out: 29 patients were undertaken the traditional method of cystectomy, 16 of them - in combination with the using of Osteodet. In 26 patients we held laser cystectomy with application of Er:YAG laser, in 16 cases also Osteodent was used. According to clinical and radiological methods, the using of Er:YAG laser provides less tissue trauma during surgery, the reduction or absence of pain response, decreased postoperative collateral edema, shortening of the healing time for soft tissues, formation of soft elastic scars and reparation of bone tissue. The using of the erbium laser is effective during cystectomy of the jaws.

Radiosurgery for Large Arteriovenous Malformations as a Single-Session or Staged Treatment

Background/Objectives: The treatment of large arteriovenous malformations (AVMs) presents a challenge and the effectiveness of radiosurgery decreases with increasing treatment volume. Here, we analyzed and compared single-session treatment for AVMs >15 cm³ with staged treatment, when the volume of a large AVM was divided into 2 or more compartments, which were subsequently treated at intervals of a few months. In the event that complete obliteration was not achieved within 3 years, repeat radiosurgery was considered. Methods/Results: Between 1993 and 2011, gamma-knife radiosurgery was performed on 50 patients with large AVMs. A total of 27 of them, with volumes ranging from 15.1 to 27 cm³ (median = 17.8), were treated in a single session, with a marginal dose ranging from 10 to 17 Gy (median = 15). Complete obliteration was achieved in 7 (26%) of these; in 14 patients the treatment was repeated after a median of 38 months. The volume of AVMs subjected to repeat treatment regressed and ranged from 6.76 to 16.4 cm³ (median = 7.7), with the marginal dose ranging from 13 to 18 Gy (median = 17); 10 patients later achieved complete obliteration at a median of 79 months after the initial treatment. Overall, 63% of patients achieved complete obliteration of AVM after treatment. Rebleeding in a latent period was recorded in 3 patients (11%) and symptomatic collateral edema in 2 (7%); 23 patients were treated using the staged method, with the interval between staged treatments usually being 6 months. Their overall AVM volume ranged from 13.2 to 46.6 cm³ (median = 23.3), the volume for a single stage ranged from 4.5 to 31.3 cm³ (median 11.7), and the marginal dose ranged from 10 to 18 Gy (median = 17). Complete obliteration was achieved in 4 (17%) of them, in 8 patients the treatment was repeated at a median of 53 months after the first treatment, and a third retreatment was performed on 2 patients 98 and 102 months, respectively, after the first treatment. The volume for repeated treatment of AVMs ranged from 0.81 to 7.7 cm³ (median = 3.3), with the marginal dose ranging from 14 to 20 Gy (median 17.5). Of all the retreated patients, 5 AVMs subsequently achieved complete obliteration. Overall, 9 patients (39%) were totally cured. Rebleeding in a latent period was observed in 1 of these patients (4.3%) and symptomatic edema in another 1 (4.3%). Conclusions: Radiosurgery of large AVMs is a valuable treatment either as a single-session or staged treatment, with a reasonable chance of cure and a low risk of complications.

Morphological changes after radiosurgery for mesial temporal lobe epilepsy.

BackgroundTo review our experience with morphological developments during the long-term follow-up of patients treated by Gamma Knife radiosurgery for mesial temporal lobe epilepsy.MethodBetween 1995 and 1999, we treated 14 patients with marginal doses of 24 Gy (n = 6) and 18–20 Gy (n = 8). Nine of these were operated on for insufficient seizure control. We reviewed seizure outcome and magnetic resonance images in both operated and unoperated patients and also re-examined histopathology specimens.ResultsOf the nine operated patients, two were Engel IIIA, one was IVA, five were IVB, and one was Engel IVC prior to surgery. At their final visit, five cases had become Engel class IA, one patient was ID, and two were IIC. In one patient the follow-up was not long enough for classification. Of the five unoperated patients, one was Engel class IB, one was IIIA, one IIB and one IVB at their final visit. Radionecrosis developed in 11 patients, occurring more often and earlier in those treated with higher doses. Collateral edema reached outside the temporal lobe in six patients, caused uncal herniation in two and intracranial hypertension in three. During longer follow-up, postnecrotic pseudocysts developed in 9 patients, and postcontrast enhancement persisted for 2.5–16 years after GKRS in all 14 patients. In five of them we detected its progression between 2 and 16 years after treatment. Signs of neoangiogenesis were found in two patients and microbleeds could be seen in five. Histopathology revealed blood vessel proliferation and macrophage infiltration.ConclusionsEarly delayed complications and morphological signs suggesting a risk of development of late delayed complications are frequent after radiosurgery for mesial temporal lobe epilepsy. Together with its unproven antiseizure efficacy, these issues should be taken into account when planning future studies of this method.Electronic supplementary materialThe online version of this article (doi:10.1007/s00701-015-2525-2) contains supplementary material, which is available to authorized users.

Clinical Outcome of a Portosplenomesenteric Venous Thrombosis in Necrotizing Acute Pancreatitis with Protein C and S Deficiency Treated by Anticoagulation Therapy Alone.

Cases of splanchnic venous thrombosis have not been described in Cameroon. Their prevalence in acute pancreatitis is variable. With the emergence of acute intra-abdominal infections including typhoid fever and peritoneal tuberculosis in situations of acquired immunodeficiency syndrome, these cases will become frequent. We report the case of a portosplenomesenteric venous thrombosis related to necrotizing acute pancreatitis associated with proteins C and S deficiency, in a 46-year-old Cameroonian man, without particular past medical history. He was admitted for abdominal pain which had been evolving for 3 weeks and accompanied by vomiting. In the absence of hemorrhagic risk factor, the patient received low molecular weight heparin followed by oral warfarin. The abdominal ultrasound check on the 12th day showed a partial recanalization of venous thrombosis. The abdominal contrast-enhanced CT scanner at day 30 on oral anticoagulation therapy showed collateral vessels and small bowel edema. At the same time the upper gastrointestinal endoscopy showed grade II esophageal varices. We have maintained oral anticoagulation therapy. This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT. It is certain that the sooner the treatment is given, the better outcome will be.

The Clinical, Histopathological and Imaging Methods Characteristics of Non- Hodgkin Lymphomas in Patients with Brain Involvement

The Non- Hodgkin-lymphoma (NHL) brain infiltration carries a poor prognosis. Because of relatively rare incidence, we decided to share our experience. Retrospective analysis of patients with NHL brain infiltration dia-gnosed in 2001- 2011 at our university hospital. Twenty -seven patients with median age of 61 (range 42- 82) years were analyzed. The primary diffuse large cell B cell lymphoma of CNS was defined in 22/ 27 (81%) patients, in the others systemic NHL was present. Median positivity of the proliferative marker Ki 67 was 80%, the number of NHL lesions 1 (1- 8), diameter 28 × 30 × 29 (11 × 16 × 20 to 85 × 76 × 65) mm. The fundamental finding in brain lymphoma MRI imaging was lesion with predominantly homogenous contrast enhancement, diffusion restriction and collateral edema. Thirteen out of 27 (48%) patients underwent lumbar puncture, and lymphoma presence in fluid was detected in only two of them. The most frequent symptoms were limb paresis or hemiparesis (55%), bradypsichysm (22%), expressive aphasia (22%), cephalea (18%). Corticosteroid therapy, as a primary treatment option, was indicated in 15% of patients with a median overall survival of one month, CNS radiotherapy in 37% with a median survival of three months, and chemotherapy in 48% patients with a median overall survival 10 (2- 45) months. The brain lymphomas are rare and prognostically very unfavorable affection. When specifying brain focal lesions on MRI, it is necessary to consider this etiology and to elect imaging protocols with contrast agents and diffusion weighted sequence. Biopsy should be performed prior to start of corticosteroid therapy. Intensive chemotherapy or radiotherapy indication must be individually considered, and proposed treatment should be initiated immediately with a potential for somewhat prolonged survival.

The subthalamic microlesion story in Parkinson's disease: electrode insertion-related motor improvement with relative cortico-subcortical hypoactivation in fMRI.

Electrode implantation into the subthalamic nucleus for deep brain stimulation in Parkinson's disease (PD) is associated with a temporary motor improvement occurring prior to neurostimulation. We studied this phenomenon by functional magnetic resonance imaging (fMRI) when considering the Unified Parkinson's Disease Rating Scale (UPDRS-III) and collateral oedema. Twelve patients with PD (age 55.9± (SD)6.8 years, PD duration 9–15 years) underwent bilateral electrode implantation into the subthalamic nucleus. The fMRI was carried out after an overnight withdrawal of levodopa (OFF condition): (i) before and (ii) within three days after surgery in absence of neurostimulation. The motor task involved visually triggered finger tapping. The OFF/UPDRS-III score dropped from 33.8±8.7 before to 23.3±4.8 after the surgery (p<0.001), correlating with the postoperative oedema score (p<0.05). During the motor task, bilateral activation of the thalamus and basal ganglia, motor cortex and insula were preoperatively higher than after surgery (p<0.001). The results became more enhanced after compensation for the oedema and UPDRS-III scores. In addition, the rigidity and axial symptoms score correlated inversely with activation of the putamen and globus pallidus (p<0.0001). One month later, the OFF/UPDRS-III score had returned to the preoperative level (35.8±7.0, p = 0.4).In conclusion, motor improvement induced by insertion of an inactive electrode into the subthalamic nucleus caused an acute microlesion which was at least partially related to the collateral oedema and associated with extensive impact on the motor network. This was postoperatively manifested as lowered movement-related activation at the cortical and subcortical levels and differed from the known effects of neurostimulation or levodopa. The motor system finally adapted to the microlesion within one month as suggested by loss of motor improvement and good efficacy of deep brain stimulation.

The use of radiosurgery for the treatment of mesial temporal lobe epilepsy and long‐term results

To determine the efficacy of gamma knife radiosurgery in the treatment of mesial temporal lobe epilepsy due to mesial temporal sclerosis. Between November 1995 and May 1999, 14 patients underwent radiosurgical entorhinoamygdalohippocampectomy with a marginal dose of 18, 20, or 25 Gy to the 50% isodose following a standard preoperative epilepsy evaluation. One patient was classified as Engel Class Ib, three were Engel Class IIc, one was Engel Class IIIa, and two were Engel Class IVb in a subgroup of seven patients who were unoperated 2 years prior to the last visit and at least 8 years after irradiation (average 116 months). The insufficient effect of irradiation led us to perform epilepsy surgery on another seven patients an average of 63.5 months after radiosurgery. The average follow-up period was 43.5 months after the operation. Four patients are seizure-free; one is Engel Class IIb and one is Engel Class IId. One patient cannot be classified due to the short period of follow-up. The frequency of seizures tended to rise after irradiation in some patients. Collateral edema was observed in nine patients, which started earlier and was more frequent in those irradiated with higher doses. It had a marked expansive character in three cases and clinical signs of intracranial hypertension were present in three cases. We found partial upper lateral quadrant anopia as a permanent side effect in two patients. Repeated psychotic episodes (two patients) and status epilepticus (two patients) were also seen after treatment. No significant memory changes occurred in the group as a whole. Radiosurgery with 25, 20, or 18-Gy marginal dose levels did not lead to seizure control in our patient series, although subsequent epilepsy surgery could stop seizures. Higher doses were associated with the risk of brain edema, intracranial hypertension, and a temporary increase in seizure frequency.

Validity of primary motor area localization with fMRI versus electric cortical stimulation: A comparative study

Functional magnetic resonance imaging (fMRI) is a widely used method for research and visualization of the brain function. However, its clinical use is still limited. Our objective was to study fMRI reliability in localizing the primary hand motor cortex (M1) under pathological conditions caused by the proximity of a brain tumour. The results were then compared with standard technique of cortical function mapping-electric cortical stimulation (ECS). We compared M1 areas localized with the fMRI and ECS in 18 patients with brain tumours in fronto-parietal regions. The 1.5 T blood oxygenation-level dependent (BOLD) fMRI was performed preoperatively using a motor task involving rhythmic touching of the thumb consecutively with other fingers on the same hand contralateral to the affected hemisphere. Each individual fMRI result was displayed at the P < 0.05 significance level corrected for family wise error (more conservative approach) or at the P < 0.001 level uncorrected (less conservative approach) and projected on the T1-weighted image used for neuronavigation. In 12 patients (66.6%) we found full agreement between the fMRI and ECS. In 3 patients (16.6%) the overlap was only partial, with one ECS testing position on motor response found outside the BOLD signal cluster. In another 3 cases (16.6%) there was a discrepancy between the two methods. The fMRI sensitivity for localizing the ECS reactive M1 cortex was 71%. The fMRI/ECS consistency was within a 5-mm range in 77% of the testing positions used for ECS which complies with the inherent accuracy of the navigation system. Because the overlap between the two methods never exceeded 10-mm, we found that the fMRI method correctly guided the ECS to the M1 cortex in 83% of patients. Infiltrative growth of the tumour and collateral oedema were the reasons for the BOLD signal suppression in three patients. Our results support using ECS as a more reliable tool for M1 cortical mapping than fMRI.