Search

Monika Herten,1 Giovanni B Torsello,1,2 Eva Schönefeld,3 Stefan Stahlhoff2 1Department of Vascular and Endovascular Surgery, University Hospital Münster, 2Department of Vascular Surgery, St Franziskus Hospital, Münster, 3Institute for Education and Student Affairs, University Hospital Münster, Münster, Germany Abstract: Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB) concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1) medical journals (ie, MEDLINE), 2) international registers for clinical studies (ie, www.clinicaltrials.gov), and 3) abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel –DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been contraindicated until now (ie, bifurcation, ostial lesions), and in leaving no stent scaffold behind. Reinterventions are easier to perform because DCBs leave no metal behind. Various combinations of DCBs with other treatment modalities may prove to be viable options in future. The follow-up results of clinical studies will evaluate the long-term impact of DCBs. Keywords: drug-coated balloon, critical limb ischemia, peripheral artery disease, restenosis, atherectomy, stent restenosis

While major susceptibility genes for bipolar disorder are yet to be identified, the opportunity exists to systematically ascertain the important issues and societal implications of genetic risk determination for bipolar disorder prior to these technological advances becoming widely available. This study explores, in a sample of families with a high density of bipolar disorder: (i) attitudes to predictive genetic and prenatal testing, using different risk frames; (ii) attributions for bipolar disorder, in particular the degree to which a genetic model is endorsed; and (iii) the impact of these attributions on the perceived stigma of bipolar disorder. A qualitative methodology was selected as most appropriate as no previous research has examined this issue. Participants were ascertained through a molecular genetics study of bipolar disorder. In-depth interviews were conducted with 21 members of families with a high density of bipolar disorder. Most participants reported being interested in genetic testing if it gave a definitive answer, while expressed interest in testing was lower if it gave a probable answer only. Almost all stressed that a genetic susceptibility and environmental factors interacted. Most participants felt that a genetic explanation was likely to decrease the stigma associated with bipolar disorder as it shifted the locus of control and responsibility away from the individual towards the role of heredity. Findings indicate that expressed interest in genetic testing depends on the certainty imparted by the test. Results suggest that families with bipolar disorder are likely to benefit psychologically from information about the genetic basis of bipolar disorder. Keywords: Bipolar disorder; Genetic risk; Attitudes; Genetic testing; Australia

Purpose: Because vertical ridge augmentation with autogenous bone blocks carries with it a risk of graft resorption and donor site morbidity, the aim of the present study was to compare histologically the healing following vertical ridge augmentation using screwable, xenogenous deproteinized blocks or autologous bone blocks in dogs. Materials and Methods: Standardized vertical mandibular defects were surgically created in edentulous ridges of six foxhounds. Two bone blocks (6 x 10 x 15 mm) were inserted on each mandibular side and fixed with both a titanium implant and an osteosynthetic screw. Three different therapies were tested: (1) xenogenous block alone; (2) xenogenous block, covered with a chemically cross-linked collagen membrane; and (3) autologous blocks, harvested during defect preparation. After 3 months of submerged healing, the miniscrews were removed and replaced by dental implants. Following an additional healing period of 3 months, the animals were sacrificed, and dissected blocks were prepared for histomorphometric analysis. Results: During the primary healing period, three of 12 hemimandibles (six blocks) had to be removed because of severe inflammatory reactions (two xenogenous block sites with collagen membrane, one autologous block site). In general, histologic analysis revealed that xenogenous blocks, used alone or combined with a collagen membrane, exhibited osteoconductive properties on a level equivalent to that of autologous blocks, resulting in means of 50% to 60% of ossification of the blocks. Some parts of the xenograft were encased in soft tissue, partly surrounded by multinuclear giant cells. However, all groups showed obvious signs of bone/graft resorption. Conclusions: Within the limits of the present study, it was concluded that the examined screwable xenogenous bone block might be a useful scaffold for ridge augmentation procedures. However, the combination of xenogenous blocks with a cross-linked collagen membrane did not appear to improve outcomes. INT J ORAL MAXILLOFAC IMPLANTS 2009;24:243-250 [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of the present study was to histomorphometrically investigate crestal bone changes at nonsubmerged implants (Camlog) with different machined collar lengths in a dog model. MATERIALS AND METHODS: One-stage insertion of sandblasted acid-etched screw-type implants with machined neck sizes of 1.6 mm (CAM) and 0.4 mm (CAM+) was performed in the mandibles of 4 beagle dogs. Both types of implants were inserted so that the implant shoulder (IC) exceeded the alveolar crest for 0.4 mm. Placement was followed by the connection of standard abutments. The animals were sacrificed after 2 and 12 weeks. Dissected blocks were processed for histomorphometric analysis (eg, distance between IC and the coronal extension of bone-implant contact [CBI], the distance between IC and the apical extension of the inflammatory cell infiltrate, and the percentage of bone-implant contact). RESULTS: Histomorphometric analysis revealed significantly increased mean IC-CBI (CAM: 2.4 +/- 0.3 mm; CAM+: 1.6 +/- 0.1 mm) and BIC (CAM: 77%; CAM+: 80%) values in both groups at 12 weeks. However, mean IC-CBI values were significantly higher in the CAM group (P < .01). An inflammatory cell infiltrate was localized to the implant-abutment interface of both CAM and CAM+ implants, and BC was clearly separated from alCT by a subepithelial connective tissue zone. CONCLUSIONS: Within the limits of the present study, it was concluded that (1) rough-surfaced implant necks reduced crestal bone level changes after 12 weeks of healing, and (2) microbial leakage apparently did not contribute to the marginal bone resorption in either group. [ABSTRACT FROM AUTHOR]