Evaluation of the prevalence of dental agenesis through the use of orthopantomography in a sample of subjects residing in Lombardy and Piedmont regions.

AIM: Dental agenesis is one of the most frequent dental anomalies, with a prevalence varying from 1.6% to 36.5%, depending on the populations studied. The patient's age at diagnosis, sex, and ethnic differences are considered possible influenting factors that can explain such a wide range of prevalence. The objective of the study was to define the frequency of dental agenesis in a sample of subjects living in Piedmont and Lombardy regions of Italy. MATERIALS: X-rays, already taken for other diagnostic purposes, were collected. Orthopantomographies belonging to subjects born after 1995 and aged between 7.9 and 16.9 years were selected. It was assessed the presence of each tooth, except for third molars since they are frequently absent due to their variability. If a tooth was missing and the patient had additional radiographs, the other radiographs were evaluated to confirm the diagnosis or to rule out a delayed calcification or the presence of a malposition tooth. Results: Orthopantomographies were collected from 1,020 subjects and 98 of them presented agenesis, with a prevalence of 5% for females and 4.61% for males. The most affected teeth were 35 and 45, followed by 12 and 22. The lower arch was more frequently involved by agenesis: there were 107 teeth absent in the mandibular arch and 83 in the maxillary arch.

Second order root control of self-ligating brackets and traditional brackets: a "typodont" study.

AIM: Aim of the study was to evaluate if self-ligating brackets (SLB) and conventional brackets (CB) have the same degree of second order root control in closing extraction spaces. METHODS: Two resin models, left and right sides of an upper arch, with two wells in the premolar area, were used. Wells have been filled with wax and resin premolars with anatomic root structure were placed in them. Resin premolars were bonded with CB and SLB. We performed 20 pairwise runs: CB on one side against SLB on the other side. We tested 0.018 and 0.016x0.022 stainless steel arches. Models were put in warm water to allow teeth to move in the softened wax by the force excerpted by NiTi coils. Root control in the second order was evaluated with the aid of metallic markers on the roots and digital radiographies taken before and after each run. RESULTS: On 0.018 wires CB moved 4.0 mm (SD 1.06 mm), mean root control angle was 14.8° (SD 9.15°), while SLB moved 4.1 mm (SD 1.33 mm), mean angle in the second order was 11.8° (SD 5.01°). On 0.016x0.022 wires CB moved 3.6 mm (SD 1.24 mm), mean angle in the second order was 9.7° (SD 5.48°) while SLB moved 3.4 mm (SD 1.05 mm), mean angle was 10.7° (SD 3.92°). CONCLUSION: It seems that, on typodont, CB and SLB are equally efficient in moving teeth crowns and have the same degree of second order root control, both when 0.018 and 0.016x0.022 stainless steel wires are used.

Diagnosis of dental and mandibular asymmetries in children according to Levandoski Panoramic Analysis.

AIM: The purpose of this study was to evaluate the use of the Levandoski Panoramic Analysis in the diagnosis of dental and mandibular asymmetries and its contribution to clinical patient's evaluation and treatment planning. MATERIALS AND METHODS: Thirty-one randomly selected panoramic radiographs of children from 7 to 14 year old were analysed using 10 linear measurements. Right and left values were compared with Student's paired T tests. For each value, mean and standard deviation were computed separately for each side. RESULTS: Statistics. A dominance for the left side over the right side was observed. The data obtained were not statistically significant with the exception of maxillary length: the right side length of the maxilla was shorter (p<0.05) compared to the left side. CONCLUSIONS: Levandosky Panoramic Analisys represents a useful screening method in the diagnosis of dental and mandibular asymmetries.

Premature loss of maxillary primary incisor and delayed eruption of its successor: report of a case.

BACKGROUND: Traumatic injuries to primary teeth represent one of the most common aetiologic factors of time-related eruption disturbances of permanent teeth. These include premature eruption, delayed eruption or impactions. CASE REPORT: A case of a 7.5-year-old male with delayed eruption of the maxillary permanent left incisor is presented. The case history revealed a trauma around the age of 3 involving its primary tooth predecessor and its extraction by a dentist about one year later due to frequent abscesses. The clinical examination showed an early mixed dentition and the single presence of tooth 11 in the dental arch, with an obvious aesthetic problem that affected the child's self image. The periapical x-ray ruled out any dimorphism on the impacted tooth, and it showed a root developed by two thirds. About 2 months after the examination, a simple gingivectomy was carried out, and the tooth could erupt completely 3 months later without any need for orthodontic traction. One year after surgery, a complete root development could be observed, as well as the presence of the lateral incisors with a moderate crowding.

A "typodont" study of rate of orthodontic space closure: self-ligating systems vs. conventional systems.

AIM: The aim of this study was to compare the effectiveness of space closure of two bracket systems, self-ligating and conventional ones, considering two systems with the same design and prescription. The experimental model of this study aims to identify in general if one type of system is more suitable for planning the extractive therapy, without considering the clinical aspect necessary for an adequate orthodontic approach. METHODS: A resin maxilla without the first premolars was used to test the self-ligating and conventional brackets system. Space closure was achieved on 0.016x0.022" in stainless steel wires with nickel-titanium coil springs 150 grams in strength and 10 mm in length. Two experiment settings have been prepared. The first setting was made bonding conventional bracket on the right side and self-ligating on the left; the last one was made bonding self-ligating bracket on the right side and conventional on the left. All measurements (runs) have been repeated seven times for both settings. RESULTS: During the closing phase of extraction spaces both systems are equable since there are no significant statistical differences (P=0.70). CONCLUSION: Our typodont model showed no significant difference in the efficiency of space closure between the self-ligating bracket and conventional bracket tied with stainless steel ligatures.

Sports-related dental injuries: knowledge of first aid and mouthguard use in a sample of Italian children and youngsters.

AIM: The purpose of this study was to evaluate the awareness of sports as risk factor of dental injuries, the emergency management when a tooth avulsion occurs and the compliance about mouthguards. MATERIALS AND METHODS: Two hundred children and youngsters 8- to 15-year-old (147 boys and 53 girls) attending Sports Societies in Isernia, a town in Southern Italy, participated to the investigation. The sports involved were soccer, martial arts, tennis, swimming, volleyball, basketball and cycling. The questionnaire was structured into three parts: 1) questions about age, sex, type and time of sports practice; 2) questions about dental injuries, particularly personal experience, awareness of first aid and procedure about tooth avulsion; 3) questions about knowledge and use of mouthguards. RESULTS: Sixty-five per cent of the athletes were aware of the possibility of oral injuries during sports practice and 8.5% referred an experience of dental trauma; 71.5% of the participants think that the immediate management of dental injuries by a dentist is very important to increase the rate of success; 31% know that the avulsed tooth may be reimplanted: 33.9% would reimplant the tooth within an hour and 62.9% would keep it in a wet storage medium. Finally, 80.5% of the athletes knew about mouthguards as protective devices, but only 5% actually used them; eight out of ten were provided by the dentist. CONCLUSION: Educational programs organized by the sports dentistry community are needed to inform coaches, teachers, athletes and parents about dental injuries and to promote the mouthguards use, especially in contact sports practice.

Comparative evaluation of the group of teeth with the best prediction value in the mixed dentition analysis.

AIM: Mixed dentition analysis allows the prediction of the tooth width of non erupted permanent canines and premolars (SPCP). It is an essential factor in treatment planning since it could predict a tooth-size to arch-length discrepancy. The aim of this study was to determine which group of permanent teeth presented the best prediction capability for the width sums of the unerupted canine and premolars in an Italian sample. MATERIALS AND METHODS: A total of 150 subjects with complete permanent dentition were selected. Their dental casts were measured to 0.01 mm with a digital caliper. Pearson correlation and T-test were used for the statistical analysis. RESULTS/STATISTICS: The combination of the sums of the four lower incisors and the first upper molars showed the best prediction capability for the SPCP in the Italian sample. Moreover new regression equations were formulated including sex and arch as additional predictor variables. In 80% of the cases estimated differences between the predicted and the actual values were smaller than 1 mm. CONCLUSION: It can be concluded that the new regression equations proposed seemed to show good accuracy.

[Pathogenesis and treatment of vascular calcification in CKD]. / Invecchiamento cardiovascolare nel soggetto uremico: nuove acquisizioni.

Increased vascular calcification is a major cause of cardiovascular events in patients with chronic kidney disease (CKD). It is the result of an active ossification process counteracted by ''bone'' proteins such as osteopontin, alkaline phosphatase, osteoprotegerin, and osteocalcin. Chronic kidney disease - mineral and bone disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism that occurs in CKD. In addition to abnormalities in the serum calcium and phosphate profile, CKD-MBD is characterized by abnormalities of bone turnover, mineralization, volume and growth as well as vascular calcification. Considering that the presence and extent of vascular calcification in CKD portend a poor prognosis, many efforts have been made to shed light on this complicated phenomenon to prevent vascular calcium deposition and its progression. Indeed, careful control of calcium load, serum phosphate and parathyroid hormone along with the use of calcium-free phosphate binders and vitamin D receptor activators represent a new therapeutic armamentarium to improve quality of life and reduce mortality in CKD.

Impaired brachial artery endothelial flow-mediated dilation and orthostatic stress in hemodialysis patients.

PURPOSE: Chronic kidney disease (CKD) is associated with an impaired endothelial function, which may contribute to cardiovascular events. Whether impairment in endothelial function is involved in the circulatory response to orthostatic stress is unknown. We assessed endothelial function via brachial artery flow-mediated dilation (BAFMD), an index of endothelial-dependent vasodilation. METHODS: We measured changes in brachial artery diameter (BAD) and blood flow by Doppler ultrasound in 35 CKD patients on hemodialysis, 37 young healthy controls (HC) and 50 non-uremic matched controls (MC), in the supine position and after 60 degrees head-up tilting (HUT). RESULTS: In the supine position, endothelial flow-mediated BAD was significantly increased in HC (p<0.001) and MC (p<0.01) while no significant changes were detected in CKD. Mean percent blood flow changes were HC+323.5%, MC+195.1% and CKD+158.8% (HC vs. CKD p<0.001; HC vs. MC p<0.001; MC vs. CKD p=0.04). Similarly, during HUT mean BAD and blood flow increases were significantly impaired in CKD patients. CONCLUSION: In CKD patients, an impaired response in the physiologic vascular reactivity, suggesting endothelial dysfunction, was found in the supine position and after orthostasis by BAFMD. Our results are in favor of a possible adjunctive role of uremia in the abnormal brachial artery response.

[New insights in the pathogenesis of secondary hyperparathyroidism]. / Nuove acquisizioni nella patogenesi dell'iperparatiroidismo secondario.

Parathyroid gland growth is a major cause of secondary hyperparathyroidism in renal failure. It is well known that high serum phosphate levels, low serum calcium levels and vitamin D deficiency are the three promoters of parathyroid hyperplasia in renal failure. Recent studies have investigated in depth the potential role of growth factors (transforming growth factor alpha) and their receptors (epidermal growth factor receptor) in the pathogenesis of parathyroid cell hyperplasia in chronic renal failure. The identification of molecular mechanisms involved in calcium, phosphate and vitamin D manipulations in an experimental renal failure model could help design more effective therapy for secondary hyperparathyroidism in uremic patients.

[Prevention of extraskeletal calcifications in uremia]. / Prevenzione delle calcificazioni extrascheletriche nel paziente uremico.

Secondary hyperparathyroidism (HPTH) is a common feature in end-stage renal disease (ESRD) patients. The three main factors involved in secondary HPTH pathogenesis are high phosphate levels, hypocalcemia and vitamin D deficiency. Recently, many studies demonstrated a strong association between bone disease and cardiovascular events in chronic kidney disease patients. In addition, cardiovascular events are the most frequent cause of death in patients with chronic renal failure. Increased levels of serum phosphorus and calcium-phosphate product are directly involved in the pathogenesis of extraskeletal calcifications (blood vessels, soft tissues, etc) in dialyzed patients compared to the non-uremic population. Recent studies suggested that vascular calcification is due not only to a passive calcium-phosphate deposition on atherosclerotic arteries, but also to active mechanisms regulated by bone-associated genes. In particular, fetuin and matrix Gla-protein are two 'protective' proteins associated with reduced vascular calcification and could be the regulatory keys in preventing this process in renal failure. The limitations of calcium salts as phosphate-binders in patients with advanced renal failure have been thoroughly evaluated in the last 5 yrs. New phosphate binders, which do not contain aluminum or calcium, have been developed to reduce the risk of extraskeletal calcifications in ESRD.

Primary small cell neuroendocrine carcinoma of the breast.

We report and characterize immunohistochemically a case of primary small cell neuroendocrine carcinoma of the breast. The tumor, which arose in the left side, was 18 cm in maximum diameter and microscopically was composed of patternless sheets of undifferentiated small cells with a high nuclear-to-cytoplasmic ratio, hyperchromatic nuclei with indistinct cytoplasm, inconspicuous nucleoli, numerous mitotic figures and large areas of coagulative necrosis. Tumor cells were positive for bcl-2, neuron-specific enolase, synaptophysin, CAM 5.2 and cytokeratin AE1/3, but negative for LCA, CD30, HMB-45, chromogranin A, estrogen receptor, progesterone receptor, Her-2/neu and CD99. The opposite breast harboured an intraductal carcinoma with a focus suggesting microinfiltration, a finding never reported before. In this paper we have also extensively reviewed the literature on the subject, emphasizing the variable immunohistochemical profile and the aggressiveness of mammary small cell carcinoma. The rapidly fatal clinical course of our case, which appears to have the largest dimensions described in literature, underlines the importance of an early diagnosis and treatment for long-term survival.

Placement, performance and complications of the Ash Split Cath hemodialysis catheter.

A tunneled catheter is the alternative vascular access for those patients in need of hemodialysis who cannot undergo dialysis through an arterio-venous fistula or a vascular graft. This study was undertaken to evaluate the performance of the Ash Split Cath, a 14 French chronic hemodialysis catheter with D-shaped lumens and a Dacron cuff. After tunneling through a transcutaneous portion the catheter enters the venous system, where it splits into two separate limbs. Data regarding catheter positioning, function and adequacy of dialysis were collected from two hemodialysis facilities. Twenty-eight Ash-split catheters were placed in 28 patients, with no complications, and immediate technical success was 100%. Patients were followed up for a total of 7,286 catheter days. No catheter-related infections were observed. Only one catheter failed after 15 days, with a primary catheter patency of 96% for the whole study length. Mean blood flow was 303 +/- 20 ml/min at 1 week after insertion, 306 +/- 17 ml/min at 3 months, 299 +/- 44 ml/min at 6 months, and 308 +/- 16 ml/min at 12 months. With a mean dialysis session duration of 234 +/- 25 minutes, adequate dialysis dose was observed for 96% of catheters, as reflected by a mean urea reduction ratio (URR) of 71% +/- 8 or a mean urea kinetic modeling, or Kt/V, value of 1.51 +/- 0.3 during follow up. In conclusion, compared with previous studies we report the best permanent catheter performance, confirming that the Ash-split catheter is a good alternative for vascular access in hemodialysis patients who are not candidates for surgical A-V fistula or graft placement.

Central venous catheter disruption and embolization: percutaneous retrieval. A case report.

Disruption followed by intravasal embolization is a rare (0.5%) however possible complication secondary to the insertion of a central venous catheter. The carriers of these implantable systems are patients who, for their cure and at times even for their survival, require the chronic intravenous infusion of drugs and solutions. Therefore materials that can allow long-term insertion with a minimum of complications are the most suitable. There are several causes of disruption and embolization of cannulae. The most common are represented by the pinch-off syndrome and catheter disconnection from reservoir. The literature on the subject is illustrated and a personal case treated with intravascular retrieval is reported.

[Neurinoma of the vagus nerve. Description of 2 cases and review of the literature]. / Neurinomi del nervo vago. Descrizione di due casi e revisione della letteratura.

The Authors report two rare cases of schwannoma of the cervical and thoracic portion of the vagus nerve. Schwannomas of the vagus nerve are particularly uncommon; patients suffering from these neurogenic tumors typically exhibit a paucity of symptoms and in the majority of cases they present with an asymptomatic mass noted on incidental chest X-ray. Chest pain and cough may occur with tumors arising next to and compressing the trachea or major bronchi. In the cases observed, schwannomas appeared like a mass whose size had increased during the last months without producing any clinical symptom. Clinical features of the mass, laboratory tests, ultrasound, CT scanning, magnetic resonance imaging were useful only to define its extension and relationships with the adjacent structures. Needle aspiration of these lesions is not indicated because of the paucity of the material obtained for the exact diagnosis. Surgery, with preservation of the vagus nerve when possible, is the treatment of choice also for a correct diagnosis of nature and to prevent further growth and compression on adjacent structures. When the individual fibers of the vagus nerve are displayed over the surface of the tumor within a discrete capsule nerve preservation is possible. On the contrary, when it is technically difficult to preserve the nerve trunk microsurgical procedures allow to reanastomose the cut ends. Injury of homolateral recurrent nerve often is the complication of a radical removal. Recurrence of benign lesions is not usual; malignant tumors carry a poor prognosis with patients rarely surviving beyond 1 year.

Effects of a supersulfated low molecular weight heparin (IK-SSH) on different hemostatic parameters.

In a phase I trial effects of a new supersulfated low molecular weight heparin (IK-SSH) on different hemostatic parameters were investigated in healthy volunteers. Parameters studied were activated partial thromboplastin time (aPTT), thrombin time, Heptest, anti-activated factor II (anti-FIIa) and anti-activated factor X (anti-FXa) activity, platelet adhesion, platelet count, platelet-induced thrombin generation time (PITT), bleeding time, antithrombin III, fibrinogen and several safety parameters. After single intravenous (i.v.) injections of IK-SSH (0.14, 0.33 and 0.66 mg/kg) aPTT, Heptest and PITT were strongly and dose-dependently prolonged. After ascending subcutaneous (s.c.) doses of IK-SSH (0.33, 0.66 and 1 mg/kg) aPTT, Heptest and PITT were prolonged in a dose-dependent manner. Repeat s.c. injections of 1 mg/kg IK-SSH for 5 days markedly prolonged aPTT, Heptest and PITT. No cumulative effects were observed. Anti-FIIa and anti-FXa activity were not or only slightly increased. Bleeding time, thrombin time and platelet adhesion were not significantly changed after i.v. and s.c. injections of IK-SSH. However, tissue factor pathway inhibitor (TFPI) concentration was markedly increased after each injection of IK-SSH and returned to the preinjection value 24 h later. IK-SSH prolongs aPTT, Heptest and PITT in a similar manner as other low molecular weight heparins but without significantly affecting thrombin time, FIIa and FXa activity. The release of TFPI may well be responsible for the prolongation of aPTT, Heptest and PITT. IK-SSH may be further developed as an antithrombotic agent.

A recombinant hirudin (IK-HIR02) in healthy volunteers. II. Effects on platelet adhesion and platelet-induced thrombin generation time.

The pharmacodynamic effects of different intravenous and subcutaneous doses of a new recombinant hirudin (IK-HIR02) on platelet adhesion, platelet-induced thrombin formation and on platelet count have been studied in 18 healthy volunteers in a bicenter study. Single intravenous bolus injections of 0.1, 0.2 and 0.3 mg/kg IK-HIR02 in 6 volunteers caused a significant dose-dependent prolongation of platelet-induced thrombin generation time (PITT) and a significant inhibition of platelet adhesion to glass. Single subcutaneous doses of 0.1, 0.25 and 0.5 mg/kg IK-HIR02 slightly prolonged PITT and inhibited platelet adhesion to glass for up to 8 h. Repeat subcutaneous injections of 0.3 mg/kg IK-HIR02 b.i.d. in 6 healthy volunteers led to a prolongation of PITT and also to a reduction of platelet adhesion. In platelet-rich plasma (PRP) from blood samples which had been collected using hirudin as anticoagulant (0.7 micrograms/ml), the platelet count was constantly higher than in citrate PRP which had been sampled at the same time. The recombinant hirudin IK-HIR02 inhibits platelet adhesion to glass and also PITT. Both effects which have not been described before are most likely due to a direct inhibition of thrombin-induced platelet activation. These effects may contribute to the antithrombotic action of hirudin and probably have to be considered when hirudin is used in higher doses as an antithrombotic agent together with platelet function inhibitors to avoid excessive bleeding.

A recombinant hirudin (IK-HIR02) in healthy volunteers. I. Effects on coagulation parameters and bleeding time.

The pharmacodynamic effects of different intravenous and subcutaneous doses of a recombinant hirudin (r-hirudin; IK-HIR02) on clotting parameters and bleeding time were investigated in 24 healthy volunteers in a bicenter study. Single intravenous bolus injections of 0.1, 0.2 and 0.3 mg/ kg IK-HIR02 caused a prolongation of thrombin time (TT) and aPTT in a dose-dependent manner and led to an increase in hirudin plasma levels > 6 micrograms/ml. The plasma half-life of IK-HIR02 was calculated as 1.3 h. A continuous infusion of 0.03 mg/kg/h of IK-HIR02 for 4 h significantly prolonged TT and aPTT. At the end of the hirudin infusion, a mean plasma level of 0.19 +/- 0.13 microgram/ml was measured. Single subcutaneous doses of 0.1, 0.25 and 0.5 mg/kg markedly prolonged the coagulation tests. The highest increase in hirudin plasma levels was found 2 h after injection. At this time the aPTT was doubled after 0.5 mg/kg. After repeat subcutaneous injections of 0.3 mg/kg b.i.d., aPTT was doubled, and TT increased to about 200 s, 2 h after the injections. At this time the mean plasma level was 0.5-0.6 microgram/ml. There was no cumulative effect after multiple injections. Bleeding time was not changed after the 4-hour intravenous infusion and after repeat subcutaneous injections of 0.3 mg/kg IK-HIR02. Bleeding time was moderately but significantly prolonged after the highest single intravenous and subcutaneous hirudin doses tested. Other than very minor local bleeding in some volunteers, IK-HIR02 was well tolerated. Biochemical blood and urine parameters did not change. In conclusion, r-hirudin (IK-HIR02) obtained by a new technique was well tolerated in healthy volunteers after single intravenous and subcutaneous injections, after repeat subcutaneous doses and during continuous intravenous infusion. Measurement of aPTT and anti-IIa activity, using a chromogenic substrate test, can be used to monitor hirudin effects if doses similar to those tested here are administered.

[Bladder hernia: a clinical case]. / A proposito di ernia vescicale: caso clinico.

The Authors report a case of inguinal bladder hernia and briefly refer about the different kinds of this rare pathology which is often associated to the commonest inguinal hernia. They, moreover, point out the surgical treatment which has to aim to the repositioning of the bladder and to solve the cervicovesical obstruction.

Autonomously functioning thyroid adenoma in a seven year old boy.

Hyperfunctioning thyroid adenoma is an extremely rare disorder in childhood. A case of a seven year old boy is reported. Clinical and laboratory findings were similar to those seen in adults. Recovery of thyroid function was prompt after ablative surgery and no substitutive therapy was required.