Synthetic corticosteroids are widely used for the treatment of a variety of diseases, including pre-malignant and malignant conditions. In striking contrast, recent evidence suggests that corticosteroids can bear tumor-promoting effects in solid tumors of epithelial origin. We have recently shown that epithelial tissues, including the mucosa of the oral cavity and the skin, are able to modulate the local concentration of active corticosteroids and to produce steroids de novo. This has important clinical and physiopathological implications, because tissue-specific regulation of glucocorticoids plays a key role in the overall effect of these molecules. In the present review of the current English literature, performed using MEDLINE/PubMed/Ovid databases, we collected published evidence to demonstrate that corticosteroids induce effects that are more complex and controversial than previously acknowledged. Published studies clearly demonstrate that this class of molecules influences pathophysiological processes that are strictly related to malignancy, providing the rationale for further investigation. J. Cell. Physiol. 231: 2368-2373, 2016. © 2016 Wiley Periodicals, Inc.
Aim:To compare the incidence of complication rates as a result of third molar surgery when performed under local versus general anaesthesia. Materials and methods: Data were collected using a combination of computer database and patient records. A total of 277 patients were included in the study (130 local anaesthesia, 147 general anaesthesia). Several variables were collected and assessed including age, gender, method of anaesthesia, radiographic grading and complications. Results: Five hundred and twenty-three mandibular third molars were removed, 284 being removed under general anaesthesia and 239 under local anaesthesia. There were a total of 20 complications (3.8%), nine of those from procedures performed under local anaesthesia and 11 from procedures performed under general anaesthesia. There was a statistically significant increase of alveolar osteitis for procedures performed under LA. However, when assessing overall complication rate, there was no statistically significant difference in LA versus GA. Conclusions: Teeth more severely impacted or angulated tend to be removed under general anaesthesia for reasons such as surgical access and patient experience. Our study suggests there is an increase in alveolar osteitis when third molars are removed under LA. However, there was no significant correlation found between the method of anaesthesia and overall complication rate when combining all complications. The present study indicates that other variables, such as gender and age may be more important in determination of post-surgical complication rates after wisdom teeth removal. It is therefore reasonable for clinicians and patients to base their decision for modality of anaesthesia on patient preference, surgical difficulty, medical background and economic factors. Clinical relevance Scientific rationale for studyThere are few studies comparing the complication rates between local versus general anaesthesia in third molar surgery and have conflicting findings. Support for local or general anaesthesia may increase if it were found to have lower complication rates to the other. Principal findingsThis study found that the method of anaesthesia does not play a significant role in complication rates of third molar surgery, whilst gender and age do. Practical implicationsSupports the stance that patient preference & anxiety, surgical difficulty, medical background and Oral Surgery 12 (2019) 96--103.
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