Immune reconstitution inflammatory syndrome (IRIS) is a recently described syndrome among human immunodeficiency virus (HIV)-infected patients attributable to the recovery of the immune system during antiretroviral therapy. A growing number of researches on this syndrome have been conducted in recent years, but IRIS in children has not been widely studied. We report the case of a 4.5 month-old, tuberculosis (TB)-HIV co-infected girl who developed IRIS two months after beginning antiretroviral and anti-TB medications. We moreover review the immunopathogenesis of TB-HIV coinfection and IRIS, with particular regard to TB-related IRIS.

SIDE EFFECTS OF THE IMMUNE SYSTEM: LESSONS FROM TUBERCULOSIS-RELATED IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME

D. BUONSENSO1, T. PIRRONTI2, O. GENOVESE3, L. GARGIULLO1, O. RANNO1

and P. VALENTINI1

1Department of Pediatrics, A. Gemelli Hospital-Catholic University of the Sacred Heart, Rome, Italy; 2Department of Bioimaging and Radiological Sciences, A. Gemelli Hospital-Catholic

University of the Sacred Heart, Rome, Italy; 3Department of Anesthesiology and Intensive Care, A. Gemelli Hospital-Catholic University of the Sacred Heart, Rome, Italy

Received August 11, 2011 – Accepted January 20, 2012

EDITORIAL DENTISTRY SECTION

Bisphosphonates (BPs) are an important class of drugs, useful in the treatment of some metabolic and oncologic skeletal diseases. BPs have shown a sure effectiveness in the treatment and in the palliative care of such pathologies; on the other hand, an avascular osteonecrosis of the jaws (B-ONJ = Bisphosphonate OsteoNecrosis of the Jaw) has recently been reported as an adverse effect not only of BP intravenous infusions, but also of their prolonged oral administration. B-ONJ normally follows a dental extraction or other surgical procedure in the oral cavity, but it also can develop spontaneously. In the latter case, some systemic risk factors, such as comorbidities and co-therapies or jaw anatomical conditions, can play a leading role in the onset of this pathologic condition. B-ONJ is an uncommon but potentially serious complication of BP therapy that can gravely affect the patient’s quality of life, producing significant morbidity. To date, no therapies are completely effective and predictable in the treatment of B-ONJ, therefore prevention should be strongly promoted by sharing knowledge in the involved medical community.

BISPHOSPHONATE AND OSTEONECROSIS OF THE JAW: THE ORAL SURGEON’S PERSPECTIVE

G. POMPA1, I. BIGNOZZI2, M.P. CRISTALLI2, A. QUARANTA3, S. DI CARLO1

and S. ANNIBALI2

1Department of Oral and Maxillofacial Sciences, Prosthodontics Unit, “Sapienza” University of Rome, Rome; 2Department of Oral and Maxillofacial Sciences, Oral Surgery Unit, “Sapienza”

University of Rome, Rome; 3Department of Clinical and Odontostomatological Sciences, Periodontics Unit, Polytechnic University of the Marche, Ancona, Italy

Received June 20, 2011 – Accepted November 17, 2011

Ethyl pyruvate (EP) has been shown to have significant anti-inflammatory activities. Here, we explore the therapeutic effects of EP administration on tumor growth and metastasis in orthotopic implantation human gastric cancer models in severe combined immunodeficiency (SCID) mice. After SCID mice were treated with EP, the tumor growth and liver metastasis from gastric cancer were investigated and its possible molecular mechanisms were further studied. As a result, it was found that EP could inhibit tumor growth and liver metastasis of gastric cancer, and reduce tumor lymphangiogenesis indicated by lymphatic microvessel density (LVD) in gastric cancer and metastatic liver tumor. Also, EP decreased the expression of high mobility group box-B1 (HMGB1), receptor for advanced glycation endproducts (RAGE), vascular endothelial growth factor (VEGF) and membrane type-1 matrix metalloprotease (MT1-MMP) in gastric cancer and metastatic liver tumor, but it exerted no effect on expression of nuclear factor-kappa B (NF-κB). Taken together, we suggest that the new application of EP could be a therapeutic option in the treatment of gastric cancer and metastatic liver tumor.

THERAPEUTIC EFFECTS OF ETHYL PYRUVATE ON TUMOR GROWTH AND METASTASIS IN A SEVERE COMBINED IMMUNODEFICIENCY MOUSE

ORTHOTOPIC IMPLANTATION MODEL

J. ZHANG, J-S. ZHU, Z. ZHOU, W-X. CHEN and N-W. CHEN

Department of Gastroenterology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China

Received November 14, 2011 – Accepted January 23, 2012

Immunological and biochemical reactions associated with inflammation are elicited in response to a physical or immunological challenge. Early in inflammation there is mobilization and infiltration of neutrophils, mast cells and macrophages to the site of inflammation. These cells release pro-inflammatory compounds icluding cytokines, vasoactive peptides (eg., histamine), and eicosanoids. The release of prostaglandin D2 (PGD2) and tryptase induced by anti-IgE, A23187 and compound 48/80 were studied using in vitro a good and valid model of human cord blood-derived mast cells (HCBDMC). Tryptase is a mast cell product and enhances vasopermeability with anticoagulant activities. In this study we measure the release of PGD2 and tryptase on mast cells activate by anti-IgE, calcium ionophore A23187, polybasic compound 48/80 (an agent containing a cationic region adjacent to a hydrophobic moiety, which works by activating G proteins) and IL-18. The generation of PGD2 was measured by radioimmunoassay. Release of PGD2 was detectable (after 12 h) following challenge with anti-IgE, A23187 and compound 48/80. Our data show that mature HCBDMC produce proinflammatory PGD2 following triggering with anti-IgE and with IgE-independent agonists, such as calcium ionophore A23187 and polybasic compound 48/80, while IL-18 was unable to stimulate the release of PGD2 or tryptase on HCBDMC. Although a great deal has been learned about the mediators produced by mast cells, the ultimate biologic function(s) of mast cells remains a mystery.

CALCIUM IONOPHORE A23187 AND COMPOUND 48/80 INDUCE PGD2 AND TRYPTASE IN HUMAN CORD BLOOD-DERIVED MAST CELLS:

LACK OF EFFECT OF IL-18

G. MACCAURO1, D. TRIPODI2, A. SAGGINI3, F. CONTI4, E. CIANCHETTI5, D. ANGELUCCI6, M. ROSATI4, E. TONIATO7, M. FULCHERI8, S. TETÈ2, V. SALINI9, A. CARAFFA10,

P. ANTINOLFI10, S. FRYDAS11, P. CONTI7 and T.C. THEOHARIDES12

1Orthopedics Division, Università Cattolica, Rome, Italy, 2Dental School, University of Chieti-Pescara, Italy; 3Department of Dermatology, University of Rome Tor Vergata, Rome, Italy;

4Gynecology Division, Pescara Hospital, Pescara, Italy; 5Ortona Hospital, University of Chieti-Pescara, Italy; 6Pathological Anatomy, Chieti Hospital, Chieti, Italy; 7Immunology Division,

University of Chieti-Pescara, Italy; 8Psychology Department, University of Chieti; 9Orthopedics Division, University of Chieti-Pescara, Italy; 10Orthopedics Division, University of Perugia,

Perugia, Italy; 11Laboratory of Parasitology, Veterinary Faculty, Aristotelian University, Thessaloniki, Greece; 12Department of Physiology and Pharmacology, Tufts University School of

Medicine, New England Medical Center, Boston, MA, USA

Received December 20, 2011 – Accepted March 6, 2012

Previous studies have demonstrated that patients affected by Oral Lichen Plauns (OLP) show lower levels of salivary fibronectin when compared with normal controls. Similarly, tissutal fibronectin expression is lost in epidermal basal layer and papillary dermis of OLP patients. To date, no data exist on the potential role of Plasma Fibronectin(PFn) in OLP pathogenesis, diagnosis and treatment. The objectives of the present study are: a) to determine the PFn levels in OLP patients; b) to evaluate a possible association between OLP clinical form and PFn levels; and c) to determine the PFn levels in relation to OLP signs and symptoms treatment. Twenty consecutive patients affected by OLP were enrolled. All patients were treated for eight weeks with topical clobetasol 0.05%. OLP signs and symptoms were scored before and after treatment. PFn level was determined by a nephelometric system. OLP signs and symptoms significantly improved after treatment. The mean levels of PFn were 31.84mg/dL at the beginning and 26.76mg/dL at the end of the study. The difference was not statistically significant (p=0.60). PFn in OLP patients remains in normal value range. OLP clinical form does not influence the PFn levels. Amelioration of symptoms and signs of atrophic-erosive and reticular OLP are induced by clobetasol treatment and the PFn seems not to interfere in the healing processes induced by topical corticosteroid. In contrast to what is observed in traumatic or diabetic wound healing, levels of PFn do not promote OLP lesion healing. PFn is not to be considered as a marker of OLP disease activity and its role in OLP pathogenesis still remains unclear.

ANALYSIS OF PLASMA FIBRONECTIN LEVELS IN PATIENTS AFFECTED BY ORAL LICHEN PLANUS

M. PETRUZZI1, G. CAMPUS2, F. PAPARUSSO1, A. LUCCHESE3, D. LAURITANO4, M. DE BENEDITTIS1 and R. SERPICO2

1Dental Clinic, University “Aldo Moro” di Bari, Italy; 2Dental Clinic University of Sassari, Italy;3Dental School, II University of Naples, Italy;

4Dental Clinic, University of Milan Bicocca, Milan, Italy

Received July 20, 2011 – Accepted December 19, 2011

The family of nuclear factor-kappaB (NF-κB) transcription factors is intimately involved in the regulation of expression of numerous genes in the setting of the inflammatory response. Inflammation, cartilage degradation, cell proliferation, angiogenesis and pannus formation are hallmarks of the pathogenesis of both collagen-induced arthritis (CIA) in rodents and rheumatoid arthritis (RA) in humans. The aim of this study is to investigate the effect of PBS-1086, a Rel inhibitor of NF-κB, on the modulation of the inflammatory response in mice subjected to CIA in comparison to the effect of etanercept. CIA was induced in mice by an intradermal injection of bovine type II collagen (CII) emulsion and complete Freund’s adjuvant (CFA) at the base of the tail. On day 21, a second injection of CII in CFA was administered. Mice developed erosive hind paw arthritis when immunised with CII in CFA. Macroscopic clinical evidence of CIA first appeared as peri-articular erythema and oedema in the hind paws. The incidence of CIA was 100% by day 28 in the CII challenged mice and the severity of CIA progressed over a 35-day period with a resorption of bone. The histopathology of CIA included erosion of the cartilage at the joint. Treatment with PBS-1086 starting at the onset of arthritis (day 21) ameliorated the clinical signs at days 21-35 and improved histological status in the joint and paw. In addition, it also reduced the neutrophil infiltration which is a key mediator of RA. In this study, we demonstrate that PBS-1086 exerts an anti-inflammatory effect during chronic inflammation and ameliorates the tissue damage associated with CIA. The anti-inflammatory activities of PBS-1086 are comparable to those of etanercept treatment.

PBS-1086, A Rel INHIBITOR OF NF-κB, AMELIORATES COLLAGEN-INDUCED ARTHRITIS IN MICE

D. IMPELLIZZERI1, E. MAZZON1,2, R. DI PAOLA1, M. GALUPPO1 P. BRAMANTI2, J. ZHANG3, K. BOBB3, D. MONIE3, J. MESHULAM3, D.R. SLISKOVIC4

and S. CUZZOCREA1

1Department of Clinical and Experimental Medicine and Pharmacology, School of Medicine, University of Messina, Messina, Italy; 2IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy;

3Profectus BioSciences, Inc., Baltimore, MD, USA; 4IDSC, Chelsea, MD, USA

Received September 8, 2011 – Accepted January 9, 2012

Delay in diagnosing oral squamous cell carcinoma (OSCC) can be still identified as a major cause of its high morbidity and mortality. To date, the early diagnosis for OSCC is mainly based on clinical oral examination and there is an urgent need for reliable markers; thus, advancements in molecular technologies has set the stage for investigating new markers, as well as new diagnostic matrices. The aim of the present study is to investigate the presence of proteomic signatures of OSCC in saliva and their use as potential biomarkers for early and non-invasive diagnosis. Saliva from 45 OSCC patients and 30 healthy controls was analysed by SELDI-TOF mass spectrometry and ProteinChip® technology. A supervised multivariate statistical analysis (Classification and Regression Tree – CART) was used to build models for discriminating between OSCC and controls, and between early (ES-OSCC) and late stage (LS-OSCC) cancers. The peptide with 8041 Da mass was 22-fold more expressed in OSCC, thus being a suitable potential biomarker. Classification and regression analysis allowed to build a model that was capable of correctly classifying all cancers and controls in an independent testing set, using the 8041 m/z peak as splitter. Eleven peaks were also differently expressed between ES-OSCCand LS-OSCC, but, basing on these differences, it was not possible to build an algorithm to predict tumour staging. These findings confirm that saliva proteome in OSCC patients is different from healthy controls and these variations might reflect different stages of disease progression and are worthy of further validation as diagnostic and prognostic biomarkers.

SALIVARY PROTEOMIC SIGNATURES OF ORAL SQUAMOUS CELL CARCINOMA

L. LO RUSSO1, M. PAPALE2, D. PERRONE1, E. RANIERI2, C. RUBINI3,G. GIANNATEMPO1, A. SANTARELLI1, G. COLELLA4 and L. LO MUZIO1

1Department of Surgical Sciences, University of Foggia, Foggia, Italy; 2Department of BIOAGROMED, University of Foggia, Foggia, Italy; 3Department of Neurosciences, Institute of Pathologic Anatomy, University of Ancona, Ancona, Italy; 4Department of Head and Neck

Pathology, Second University of Naples, Naples, Italy

Received November 2, 2011 – Accepted January 19, 2012

The aim of this prospective observational study is to assess the efficacy and safety profile of intra-articular Sinovial® Forte 1.6% administered under ultrasound-guidance in a large cohort of patients affected by symptomatic hip osteoarthritis (OA). Patients with symptomatic hip OA referred to our clinic in 2008-2010 received one 4 ml (2 vials) intra-articular injection of Sinovial® Forte 1.6% under ultrasound guidance. Patients were followed-up every 3 months for a total of 6 months and were offered an optional, additional injection at the 3-month follow-up visit if clinically justified. At each visit, pain scores [0-10 Visual Analogue Scale (pain VAS)], Lequesne index scores and NSAID intake were recorded. Adverse events (AEs) were recorded throughout the study. An effect size of 30% and 50% reduction in Lequesne index and Pain VAS scores was evaluated for each patient to ascertain the number of patients achieving partial remission of symptoms and functional impairment by the use of intra-articular hyaluronic acid in hip osteoarthritis. One hundred and fourteen patients completed the 6-month follow-up and received a total of 142 injections. A statistically significant reduction in Lequesne index scores, VAS pain scores and NSAID consumption was observed at all time-points (p < 0.05). No systemic, severe or even moderate side effects were observed. Only 7 patients reported mild local reaction at the injection site, consisting of mild pain and localized warmth, which resolved spontaneously without any additional medication. This study provides evidence of the efficacy and tolerability of Sinovial® Forte 1.6% in the treatment of patients affected by symptomatic hip OA. Sinovial® Forte may also offer economical benefits, owing to the reduction in NSAID consumption associated with this treatment. The percentage of patients achieving the effect size of 30% and 50% reduction in Lequesne index and pain VAS scores encourages the use of intra-articular hyaluronic acid in patients with hip osteoarthritis.

INTRA-ARTICULAR ULTRASOUND-GUIDED INJECTION OF SINOVIAL® FORTE 1.6% IN PATIENTS AFFECTED BY SYMPTOMATIC HIP OSTEOARTHRITIS:

EFFECTIVENESS AND SAFETY IN A LARGE COHORT OF PATIENTS

A. MIGLIORE1,2, U. MASSAFRA1, E. BIZZI1, F. GIOVANNANGELI1 and S. TORMENTA3

1U.O.S. of Rheumatology, Ospedale San Pietro Fatebenefratelli, Rome, Italy; 2Centro Ricerche, San Pietro Fatebenefratelli, Rome, Italy; 3Department of Radiology, S.Pietro Fatebenefratelli Hospital,

Rome, Italy

Received November 30, 2011 – Accepted April 18, 2012

Periodontal diseases, the major public health problem of the oral cavity, are clinically characterized by inflammation of the periodontal connective tissue that ultimately induces the destruction of periodontal tissue and the loss of alveolar bone. In chronic periodontitis, as well as aggressive periodontitis, the anaerobic gram-negative bacterium Porphyromonas gingivalis (P. gingivalis) is implicated. The pathogenicity of P. gingivalis is exerted by a wide variety of factors, including lipopolysaccharides (LPSs). LPSs activate the innate immune response during Gram-negative bacterial infections through the Toll-like receptor 4 (TLR-4)/myeloid differentiation protein 2 (MD-2) complex. In this study, the expression of TLR-4, the cell growth, the cytokine release, and the nuclear factor-KB (NF-kB) transcription factor expression in response to LPS-P.Gingivalis (LPS-G) were examined in Human Periodontal Ligament Mesenchymal Stem Cells (PDL-MSCs). The results obtained demonstrate that, in basal conditions, human PDL-MSCs express high levels of TLR-4. In inflammatory conditions mimicked by LPS-G challenge, the MTT assay carried out at different treatment times demonstrated the decrease of the cell growth. Moreover, the recognition of P. gingivalis components by TLR-4 culminated with the activation of secretion of inflammatory mediators such as: IL-6, IL-8 and CCL-20, and with the up-regulation of NF-kB, which was translocated into the nucleus. Our data intended to specify that TLR-4 expressed by PDL-MSCs is functional and plays a key role in inflammation.

TOLL-LIKE RECEPTOR 4 EXPRESSION, INTERLEUKIN-6, -8 AND CCL-20 RELEASE, AND NF-KB TRANSLOCATION IN HUMAN PERIODONTAL LIGAMENT

MESENCHYMAL STEM CELLS STIMULATED WITH LPS-P. GINGIVALIS

O. TRUBIANI1, P. BALLERINI2, G. MURMURA1, J. PIZZICANNELLA3, P. GIULIANI2,S. BUCCELLA2 and S. CAPUTI1

1Department of Medical, Oral and Biotechnological Sciences, 2Department of Biomedical Sciences, University of Chieti-Pescara, Chieti, Italy; 3Cardiovascular and Thoracic Department, San Raffaele

Hospital, Milan, Italy

Received October 28, 2011 – Accepted February 22, 2012

EUROPEAN JOURNAL OF INFLAMMATION

0393-974X (2012)Copyright © by BIOLIFE, s.a.s.

This publication and/or article is for individual use only and may not be furtherreproduced without written permission from the copyright holder.

Unauthorized reproduction may result in financial and other penaltiesDISCLOSURE: ALL AUTHORS REPORT NO CONFLICTS OF

INTEREST RELEVANT TO THIS ARTICLE.1

HISTOLOGICAL EVALUATION OF PERI-IMPLANT SOFT TISSUES IN IMMEDIATELY LOADED IMPLANTS FEATURING DIFFERENT IMPLANT-ABUTMENT

CONNECTIONS: A PRELIMINARY STUDY

M. GUERRA1, I. VOZZA2 and A. QUARANTA2

1Private Practice in Rome, Italy; 2Oral and Maxillofacial Dept, Sapienza University of Rome, Rome, Italy

Received June 26, 2011 – Accepted January 17, 2012

Nowadays dental implants are a successful method to rehabilitate edentulous jaws (1-2). Technical complications such as screw loosening, screw or implant fractures and the formation of infiltrated connective tissues at the implant-abutment connection is quite common with the adoption of screwed abutments. Among different screw-retained connections, the external screwed connection features an anti-rotation system which should prevent the rotation of the abutment although frequently high rates of screw loosening

are observed (3-4). Among the screwed connection systems those external connections provided with anti-rotation system which should stop the rotation of the abutment are distinguished. Despite the presence of an anti-rotation system, high rates are frequently observed of screw loosening in this systematic coupling implant-abutment (3-4). The internal screwed connection, however, offers a better guarantee of stability of the abutment (5) as do the tapered screwed connection (6-7) and the Morse tapered connections that show a very low

Mailing address:Iole Vozza DDs, PhDOral and Maxillo-facial Sciences Dept.,Via Caserta 6, 00161 Roma, ItalyTel/Fax: +39 06 49976619e-mail: iole.vozza@gmail.com

Key words: osseointegrated implants with conical connection, osseointegrated implants with screw connection, histology of peri-implant tissues

Vol. 10, no. 1, 0-0 (2012)

The aim of the present study is to evaluate the peri-implant soft tissues and the amount of inflammatory cells around two different implant-abutment connections (self-locking conical connection with platform switching and screwed connection with standard abutment and internal anti-rotational system). Histological analysis was made of 14 implants, 7 with self-locking Morse tapered connection (experimental group A) and 7 with screw-retained anti-rotational connection (control group B). Sixty days after non-functional immediate loading, peri-implant tissue biopsies were performed. In the samples taken from the experimental group the peri-implant connective tissue consisted of a greater density of collagen and fibroblasts compared to the connective tissue of the control group. The experimental group specimens showed less inflammatory infiltrate close to the self-locking tapered connection compared to the tissues around the screw-retained connection. The SEM observations showed less microgap in the self-locking conical connection than in the screw connections with standard abutment and internal anti-rotational system. The presence of connective tissue with few inflammatory cells and the absence of inflammatory infiltrate, in self-locking conical connection implants is due to the minimal size of the implant-abutment microgap that does not allow the passage of fluids and bacteria from the oral cavity to the implant thus preventing tissue inflammation.

DENTISTRY SECTION

1Private Practice in Rome, Italy;2Oral and Maxillofacial Department, Sapienza University of Rome, Rome Italy

Apical extrusion of infected debris to the periradicular tissues is considered one of the possible factors related to the occurrence of postoperative pain and inflammation. The goal of the present study is to evaluate and compare the incidence and intensity of postoperative pain using two different nickel-titanium instrumentation techniques: a rotary crown-down technique using TF instruments ( SybronEndo, Orange, Ca, USA) and a reciprocating single-file technique using Reciproc instruments (VDW, Munich, Germany). Sixty patients requiring endodontic treatment on permanent premolar and molar teeth with non-vital pulps preoperatively were included in the study. The patients were divided into two groups of 30 patients each, trying to make the groups very similar, concerning the number of root canals, presence of initial pain and periapical lesions. The teeth in group 1 (n = 30) were treated with a crown-down technique using TF instruments whilst those in group 2 (n = 30) were treated with a single-file technique using Reciproc 08 25. All canals were shaped, cleaned and obturated in a single-visit. The assessment of postoperative pain was carried out at 3 days by using a visual analogue scale. Chi-square tests and independent-sample t-tests to compare the incidence and intensity of postoperative pain of two groups were carried out. A statistically significant difference was found between the two techniques. When comparing patients who developed no pain, the TF instrumentation technique showed significantly better results (chi-square = 4.059 P = 0.039). When evaluating patients experiencing severe pain the incidence of symptoms was significantly higher with the Reciproc technique (chi-square = 7.246 P = 0.023). Since the incidence of preoperative pain, the type of tooth and the pulp and periodontal pathology were quite similar between the two tested groups, and all the other variables (operator, irrigation, and obturation) were identical, the difference in postoperative pain can be mainly related to the different instrumentation technique

INCIDENCE AND INTENSIVITY OF POSTOPERATIVE PAIN AND PERIAPICAL INFLAMMATION AFTER ENDODONTIC TREATMENT WITH TWO DIFFERENT

INSTRUMENTATION TECHNIQUES

G. GAMBARINI1, D. AL SUDANI2, S. DI CARLO1, G. POMPA1, A. PACIFICI1, L. PACIFICI1 and L. TESTARELLI 1

1Sapienza University of Rome, Department of Oral and Maxillo-facial Science, Rome, Italy; 2KSU University, Rijhad, Saudi Arabia

Received December 29, 2011– Accepted March 28, 2012

DENTISTRY SECTION

Biocompatibility of root canal filling materials is of great interest because they can come into permanent contact with the living periapical tissue, and induce mild or severe inflammatory responses. Usually biocompatibility tests only determine non-cytotoxic effects of dental materials, even if their functional interactions with cells also play a role in the host responses. The purpose of this study is to evaluate peripheral blood monocyte (PBM) vitality and functionality after contact with 5 different root canal filling materials: Thermafil (gutta-percha), Real Seal and Real Seal 1 (methacrylic resins), AureoSeal (MTA) and SuperSeal (EBA). Cellular vitality was determined by MTT test and cellular functionality by Chemiluminescence (CL) technique. Dishes of the materials were covered with cell culture medium (0.5 cm2/mL) and incubated for 24 h.The extracts were added to PBMs and the latter, after 2 h of incubation, were analysed by MTT and by Chemiluminescence (CL). All results are expressed as mean ± SEM. The group means were compared by analysis of variance. Results showed that SuperSeal and AuroSeal exhibited a moderate cytotoxic effect, while the toxicity induced by RealSeal, RealSeal 1 and Thermafil was lower. SuperSeal and AuroSeal induced a significant decrease of both oxidative burst and basal reactive oxygen species (ROS) production. RealSeal 1 caused a doubling of basal ROS production in respect to control. The results demonstrate that a low cytotoxic effect does not guarantee a total integrity of cellular functionality and more differences among biocompatibility of root canal materials can be detected when a functionality test is used.

BIOCOMPATIBILITY OF ROOT CANAL FILLING MATERIALS: DIFFERENCES BETWEEN VITALITY AND FUNCTIONALITY TESTS

L. TESTARELLI1, G. NOCCA2, A. LUPI3, L. PACIFICI1, G. POMPA1, I. VOZZA1

and G. GAMBARINI1

1Department of Oral Science, Sapienza University of Rome, Italy; 2Institute of Biochemistry and Clinical Biochemistry, School of Medicine, Catholic University, Rome, Italy; 3Istituto di Chimica

del Riconoscimento Molecolare, C.N.R., Rome, Italy

Received December 29, 2011 – Accepted March 30, 2012

DENTISTRY SECTION

Oral focal mucinosis (OFM) is a rare mucosal lesion of unknown etiopathogenesis. It is considered the oral counterpart of cutaneous focal mucinosis. From the anatomo-pathological point of view it is characterised by a focal degeneration of myxoid type of connective tissue. A literature survey revealed 50 reports of OFM cases worldwide. Here, we present an even more rare case with tongue involvement. Particular emphasis is placed on diagnostic-differential aspects of this kind of lesion, both from the clinical and the histopathological point of view, in respect to other manifestations of tongue mucosa.

ORAL FOCAL MUCINOSIS OF THE TONGUE: A RARE CLINICAL CASE

L. PACIFICI, D. MELEO, G. POMPA, A. PACIFICI, G. GAMBARINI and L. TESTARELLI

Department of Odontostomatological and Maxillofacial Science, Sapienza University of Rome, Rome, Italy

Received November 14, 2011 – Accepted April 5, 2012

DENTISTRY SECTION

PROOF

278 EUROPEAN JOURNAL OF INFLAMMATION Vol. 9, no. 3, 0-0 (2011)

0393-974X (2011)Copyright © by BIOLIFE, s.a.s.

This publication and/or article is for individual use only and may not be furtherreproduced without written permission from the copyright holder.

Unauthorized reproduction may result in financial and other penaltiesDISCLOSURE: ALL AUTHORS REPORT NO CONFLICTS OF

INTEREST RELEVANT TO THIS ARTICLE.279

Intratonsillar abscess is a condition rarely seen/diagnosed in clinical practice. Indeed, to our knowledge, only 11 cases have been reported in the English literature (1-4). Several years ago, we reported the first case of intratonsillar abscess indentified at our institution (1). Since then, we have diagnosed four subsequent cases. Herein we share our experiences of the diagnosis and treatment of those patients.

Case ReportsDiagnosis

Patient 1. A 22-year-old man presented with painful swallowing and tenderness on the right side of his neck. Prior to presentation, the patient had been taking oral amoxicillin for seven days without any improvement of symptoms. Physical examination and intraoral ultrasonography revealed an enlargement of the right palatine tonsil with anterior medial displacement, deviation of the left side of the

uvula, and a tender right cervical lymphadenopathy (level II/III) (Fig. 1). The diagnosis of intratonsillar abscess was confirmed by computer topographic (CT) scanning, which revealed enlargement of the right palatine tonsil with an area of central hypodensity and rim enhancement (Fig. 2).

Patient 2. A 54-year-old man presented to our clinic with painful swallowing, trismus, and a four-day history of a sore throat. The patient had been treated with high-dose oral amoxicillin for four days without success. Physical examination and intraoral ultrasonography revealed trismus and an obvious enlargement of the left palatine tonsil that obscured the oropharynx. The diagnosis of intratonsillar abscess was confirmed by CT scanning, which revealed enlargement of the left palatine tonsil with an area of central hypodensity and rim enhancement.

Patient 3. A 38-year-old woman presented following five days of progressively worsening

LETTER TO THE EDITORINTRATONSILLAR ABSCESS: DIAGNOSIS AND TREATMENT OF A RARE DISEASE

M-L. YANG1,3, J-C. LEE1, C-H. HSU1,2 and C-H. KAO1

1Department of Otolaryngology–Head and Neck Surgery, Tri-Service General Hospital,National Defense Medical Center, Taipei; 2Department of Otolaryngology–Head and Neck Surgery, Taichung Armed Forces General Hospital; 3Department of Otolaryngology-Head and Neck Surgery,

Taoyuan Armed Forced General Hospital, Taiwan

Received January 10, 2011 – Accepted July 20, 2011

Intratonsillar abscess is a condition that has rarely been described. Herein we summarize our experience diagnosing and treating four patients with intratonsillar abscess. In all cases, the diagnosis was confirmed by computer tomography (CT) scanning, which revealed enlargement of the right palatine tonsil with an area of central hypodensity and rim enhancement. Successful treatment in each case involved aspiration of the abscess using an 18G needle and post-procedural antibiotics. Our cases highlight the usefulness of CT for diagnosis and needle aspiration for treatment of intratonsillar abscess.

Mailing address: Chuan-Hsiang Kao, MDDepartment of Otolaryngology,Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Sec. 2, Cheng-Kung Rd., Taipei 114, TaiwanTel: ++886 2 87927192 Fax: ++886 2 87927193e-mail: chuanhsiang@yahoo.com.tw

Key words: diagnosis, imaging, intratonsillar abscess, needle aspiration, treatment

Insulin autoimmune syndrome (IAS) is characterized by hypoglycemic attacks, very high insulin levels and the presence of circulating autoantibodies to insulin in patients who have not been treated with exogenous insulin. Approximately half of patients with insulin autoimmune syndrome have a medication history preceding hypoglycemic events. We present the case of a young woman with premature ovarian failure who developed IAS initially after treatment with methimazole and several years later after captopril, and because of coexistent premature ovarian failure was classified as having autoimmune polyglandular syndrome (APS) type 3. Termination of methimazole and captopril treatment resulted in the disappearance of hypoglycemic episodes. We discuss diagnostic and treatment dilemmas associated with discovering and management of IAS and APS in this patient.

RECURRENT DRUG-INDUCED INSULIN AUTOIMMUNE SYNDROMEIN A PATIENT WITH PREMATURE OVARIAN FAILURE

R. KRYSIAK and B. OKOPIEN

Department of Internal Medicine and Clinical Pharmacology,Medical University of Silesia, Katowice, Poland

Received May 5, 2011 – Accepted November 30, 2011

LETTER TO THE EDITOR

Flunisolide (6α-fluorine 11β, 16α, 17α, 21-tetrahydroxypregna-1, 4-diene-3.20-dione 16.17 acetonide) is a potent inhaled corticosteroid, as demonstrated by its anti-inflammatory activities. Clinical data have widely demonstrated that inhaled flunisolide administered twice daily is effective for the treatment of bronchial asthma. However, pharmacokinetic studies suggest that the high solubility rate of flunisolde in bronchial fluid reduces the residence time of the drug in the lungs to a few minutes. The aim of this study is to determine the concentration of flunisolide in lung tissue of rats after administration by inhalation at varying time periods. Male Wistar rats weighing approximately 300 g were divided into four groups and administered a single dose of 1 mg flunisolide via inhalation. Rats were sacrificed with the exposure to CO2 either immediately or 3, 6, 12 hours after inhalation. The whole lung was then surgically removed and analysed for flunisolide concentration using gas chromatography. The mean concentration (2 standard deviation) of flunisolide detected in the lung tissue at 0, 3, 6 hours after inhalation were 66.4 (11.9), 48.6 (5.9), 42.7 (8.1) ng/mg of proteins, respectively. No flunisolide was detected after 12 hours in lung tissue. We conclude that flunisolide is retained for long duration (more than 6 hours) in lung tissue. This finding partially explains the mechanisms of action of the drug.

RETENTION OF FLUNISOLIDE IN RAT LUNGS AFTER SINGLE INHALATION

A. KANTAR1, M. CARLONI2, N. KULKARNI1,3, D. FEDELI2 and G. FALCIONI2

1High Altitude Pedriatics Asthma Centre, Pio XII Institute, Misurina, Belluno, Italy; 2School of Pharmacy and Health Products, University of Camerino, Italy; 3Department of Infection, Immunity

and Inflammation, University of Leicester, Leicester, United Kingdom

Received March 2, 2011 – Accepted December 18, 2011

LETTER TO THE EDITOR

To our knowledge, no study has evaluated N-terminal pro-brain natriuretic peptide (NTproBNP) together with interleukin-6 (IL-6) and interferon (IFN)-gamma serum levels in a large series of patients with hepatitis C virus (HCV) as possible markers of cardiac dysfunction. NTproBNP and IL-6 serum levels were valued in 55 HCV-patients, and in 55 sex- and age-matched controls. HCV-patients showed significantly higher mean NTproBNP and IL-6 levels than controls (P = 0.001); no significant difference was observed for IFN-gamma. By defining high NTproBNP level as a value higher than 300 pg/mL (that is used to rule out heart failure in patients under 75 years of age), 12% (6/49) of HCV-patients and 0 of controls had NTproBNP (χ2; P = 0.012). In conclusion, this study demonstrates high levels of circulating NTproBNP and IL-6 in HCV-patients. The increase of NTproBNP may indicate the presence of a subclinical cardiac dysfunction. Further prospective studies quantifying symptoms and correlating these with echocardiographic parameters are needed to confirm this association.

HEPATITIS C IS ASSOCIATED WITH HIGH LEVELS OF CIRCULATING N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE AND INTERLEUKIN-6

A. ANTONELLI1, C. FERRI2, S.M. FERRARI1, A. DI DOMENICANTONIO1,C. MANCUSI1, S. MARCHI1, N. DE BORTOLI1, M.R. METELLI3, F. BRUSCHI4

and P. FALLAHI1

1Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy; 2Department of Internal Medicine, Rheumatology Unit, University of Modena & Reggio E. School of Medicine, Modena, Italy; 3Department of Clinical Biochemistry and Molecular Biology, University of Pisa, Pisa, Italy; 4Department of Experimental Pathology and B.M.I.E., University of Pisa School of

Medicine, Pisa, Italy

Received February 14, 2011 – Accepted December 18, 2011

LETTER TO THE EDITOR

Cercarial dermatitis (also named Swimmer’s itch or Clam-digger’s disease) was first described about 80 years ago, but today its impact is increasing and it is considered an emerging disease. This represents a hypersensitive or allergic reaction to Trichobilharzia spp, clinically characterized by initial erythema and cutaneous itching, followed by macular or papular eruptions, itching and occasionally diffuse erythema or urticaria. We report two cases of patients affected by a cercarial dermatitis after bathing in Lake Vico (Central Italy). We highlight these cases for the rarity of this dermatitis and its increasing prevalence, also in previously non-affected geographical areas, associated to a high level of social discomfort.

TWO CASES OF CERCARIAL DERMATITIS IN AN ITALIAN LAKE

A. TAMMARO1, A. NARCISI1, C. ABRUZZESE1, G. CORTESI1, F. PERSECHINO1, F.R. PARISELLA2, C. CAPERCHI1 and S. PERSECHINO1

1U.O.C. Dermatology, NESMOS Department, Sant’Andrea hospital, Faculty of Medicine and Psychology, University of Rome “Sapienza”, Rome, Italy; 2Hospital of Towson, University of

Maryland, USA

Received March 3, 2011 – Accepted December 15, 2011

LETTER TO THE EDITOR

An aseptic abscess (AA) is an auto-inflammatory disorder characterized by necrotic lymph nodes and internal organ abscesses, most frequently located in the spleen. Described herein are two cases of aseptic abscesses; one in a patient with Behçet’s disease and the other in a patient with mesenteric panniculitis.

ASEPTIC ABSCESS: A REPORT OF TWO CASES

M. ISİK1, M. ÇALGÜNERİ1, İ. DOĞAN1, Y. YEŞİLKAYA2 and A. SHOURBAGİ3

1Division of Rheumatology, Department of Internal Medicine, Hacettepe University Hospital, Ankara, Turkey; 2Department Radiology, Hacettepe University Hospital, Ankara, Turkey; 3Division of Gastroenterology, Department of Internal Medicine, Hacettepe University Hospital, Ankara, Turkey

Received March 23, 2011 – Accepted January 12, 2012

LETTER TO THE EDITOR

THIRD MOLAR SURGICAL REMOVAL: A POSSIBLE MODEL OF HUMAN SYSTEMIC INFLAMMATION? A PRELIMINARY INVESTIGATION

S. CEI1, F. D’AIUTO2, E. DURANTI3, S. TADDEI3, M. GABRIELE1, L. GHIADONI3 and F. GRAZIANI1,2

1Department of Surgery, Section of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy; 2Periodontology Unit, UCL Eastman Dental Institute, London, UK; 3Department of Internal

Medicine, University of Pisa, Pisa, Italy

Received May 16, 2011 – Accepted February 14, 2012

The first two authors contributed equally to this article

Accumulating evidence suggests that dental treatment is associated with systemic inflammation. We aimed to preliminarily study the impact of third molar removal on biomarkers of inflammation and oxidative stress. Ten consecutive subjects underwent the removal of third molars under local anaesthesia and provided blood samples before and 1, 7 and 60 days following therapy assessed for high-sensitivity serum concentrations of C-Reactive Protein (CRP), fibrinogen, white cell counts and a number of measures of oxidative stress (MDA, LOOH and FRAP). One week inflammatory response ensued with acute increases after 24 h of CRP (P<0.01), Fibrinogen (P<0.05) and white cell counts (P<0.05). Third molar removal may represent a useful model to investigate inflammation in humans.

LETTER TO THE EDITOR

The present clinical report describes a technique for aesthetic restoration of single dental implants in the anterior area. One objective of implant therapy in anterior areas is the achievement of an aesthetic result, which is highly dependent on the condition of the peri-implant soft tissue. A 22-year-old woman presented with right maxillary lateral incisor agenesis. An implant was placed, and a transfer impression technique carried out. The model was used to construct the custom abutment, provisional crown, and metal substructure. The metal substructure was covered with a waxed collar with the same emergence profile as the provisional restoration. The abutment and the provisional crown were placed, and after soft-tissue healing, an impression was taken using the waxed metal framework as coping. This final impression also registered and transferred the architecture of the soft peri-implant tissues. This clinical report describes an impression technique that accurately duplicates the peri-implant tissue profile. The final prosthesis is therefore shaped according to the interim prosthesis, for ideal contour and soft-tissue position. This technical procedure requires minimal chair time and is cost effective, as fewer components are used during the treatment.

SOFT-TISSUE HEALING AND IMPRESSION TECHNIQUE IN IMPLANT DENTISTRY:A CASE REPORT

G. VARVARA, S. CAPUTI, C. D’ARCANGELO and G. MURMURA

Department of Oral, Nano and Biotechnological Sciences, Dental School, “G. d’Annunzio” University of Chieti–Pescara, Chieti, Italy

Received July 18, 2011 – Accepted December 13, 2011

LETTER TO THE EDITOR

Langerhans’ cell histiocytosis (LCH), formerly known as histiocytosis X, is characterized by cell proliferation. The leading clinical symptom of LCH within mandibular and maxillary bones is pain and it may resemble periodontal diseases, apical cysts, ameloblastoma, central giant cell granuloma, vascular malformation, osteomyelitys, bone metastasis and malignancies. In this paper we present the case of a mandibular histiocytosis misdiagnosed as a reparative giant cell granuloma at the first and as an aggressive giant cell tumor at the second biopsy. Definitive diagnosis was made only after examination of surgical specimens following hemimandibulectomy.

GIANT CELL LESION OR LANGERHANS’ CELL HISTIOCYTOSIS OF THE MANDIBLE? A CASE REPORT

V. VALENTINI1, V. TERENZI1, A. CASSONI1 , S. BOSCO2, E. BRAUNER1 , J. SHAHINAS1

and G. POMPA1

1Department of Oral and Maxillo-Facial Surgery, “Sapienza” University, Rome, Italy; 2Department of Molecular Medicine, “Sapienza” University, Rome, Italy

Arrived December 29, 2011 – Accepted April 11, 2012

DENTISTRY SECTION