Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning.

At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. The purpose of this study was to describe the computer-assisted mandibular reconstruction procedure adopting the customized solution Synthes ProPlan CMF. The study reports five consecutive patients with benign or malignant disease requiring mandibular reconstruction using a microvascular fibular free flap, pre-operative virtual planning, construction of cutting guides and customized laser pre-bent titanium plates. The surgical technique is discussed in a step-by-step fashion. The average post-operative hospital stay was 18 ± 3 days. Ischemia time was recorded in all five cases, with an average of 75 ± 8 min. No problems were encountered in any surgical step and there were no major complications. Excellent precision of cutting guides and a good fit of pre-bent plates were found on both the mandible and fibula. There was excellent precision in bone to bone contact and position between mandible and fibula graft. Measurement data from the pre-operative and post-operative CT scans were compared. The average difference (Δ) between programed segment lengths and CT control segment lengths was 0.098 ± 0.077 cm. Microsurgical mandibular reconstruction using a virtual surgical planning yields significantly shorter ischemia times and allows more precise osteotomies. The technology is becoming increasingly recognized for its ability to optimize surgical outcomes and minimize operating time. Considering that the extent of resection can be wider than predicted, this results in safer modeling of the fibula only after frozen sections have demonstrated the radicality of resection.

[Homocysteine, folate therapy and outcome in hemodialysis: results from a prospective study]. / Omocisteina, terapia con folati e prognosi in emodialisi: domande e risposte da uno studio prospettico monocentrico.

BACKGROUND: Despite the well-known effectiveness of folate therapy on hyperhomocysteinemia in hemodialysis, its benefits on outcome are still unclear. METHODS: Sixty-five patients on thrice-weekly maintenance hemodialysis lasting more than 3 months were followed up for 1 year after stratification by predialysis homocysteine level (tHcy). Parenteral folate (25 mg quarterly) and cobalamine (1 mg quarterly) therapy was started only if the tHcy levels were > 30 uM/L at baseline or at scheduled retests (every 7 months). End points were overall mortality and new ischemic events (affecting heart, brain, or lower extremities). RESULTS: 58.5% of patients received treatment at baseline and achieved a 60% reduction of tHcy. 38.1% progressed to levels of over 30 tHcy at 6 months and were placed on treatment. No other major changes occurred until the end of the study. An excess of both overall mortality (30.8% versus 12.1%; p = 0.075) and vascular morbidity (38.5% versus 12.1%; p = 0.03) occurred in initially untreated patients,those presenting without baseline intermediate to severe hyperhomocysteinemia. CONCLUSIONS: In undertaking hemodialysis, it appears that treating intermediate to severe hyperhomocysteinemia carries better prognosis for outcome than untreated moderate or absent hyperhomocysteinemia. It is uncertain if the benefit of therapy is valid, or if it is confounded by an association between lower tHhy and hidden malnutrition or concomitant diseases.

[Insufficient correction of blood bicarbonate levels in biguanide lactic acidosis treated with CVVH and bicarbonate replacement fluids]. / Insufficiente correzione della bicarbonatemia nella acidosi lattica da biguanidi trattata con CVVH e liquido di reinfusione con bicarbonato.

BACKGROUND: In the course of Continuous Veno-Venous Hemofiltration (CVVH), bicarbonate buffer instead of lactate is suitable for the treatment of combined renal and hepatic failure and for patients suffering from lactic acidosis, type A or B, joined with acute renal failure (ARF). METHODS: We applied the CVVH buffered with bicarbonate for the treatment of two patients affected by ARF and severe lactic acidosis type B (due to biguanide intoxication) and we evaluated its ability to correct the acid-base balance. RESULTS: Clinical and laboratory data show that this technique, performed in standard conditions (plasma flow: 70 ml/min, ultrafiltration: 25 ml/min, bicarbonate concentration in the infusion fluid: 30 mEq/L), was inadequate to compensate for the high requirement of bicarbonate (approximately 280 mEq/hr during the first 6 hours of observation) and the severe metabolic acidosis, thus additional bicarbonate infusion was needed. CONCLUSIONS: In particular, from ascertained data and theoretical considerations, in the course of lactic acidosis caused by biguanide, in order to correct acidosis a positive balance of bicarbonate could be obtained only by means of a bicarbonate-based replacement fluid and of a continuous high flow hemofiltration, such as to assure an ultrafiltrate volume exceeding 150 ml/min.

[Systemic mucormycosis in dialysis: computed tomography picture and histologic lesions]. / Mucormicosi sistemica in dialisi: quadro tomografico e lesioni istologiche.

Mucormycosis (zygomycosis) is an uncommon mycosis which can be contracted from the environment and which is responsible for rhino-orbital, pulmonary, gastrointestinal, cerebral or disseminated infections. Severe immunodepression, such as that caused by leukemia, lymphomata and organ graft, or treatment by desferrioxamine, may predispose to pulmonary and systemic forms. In the present work the authors describe a case of systemic mucormycosis, with unfavourable outcome, which arose in a pediatric peritoneal dialysis patient, then transferred to hemodialysis, without evident predisposing factors. In particular they refer to the CAT reports and to lymphonodal and peritoneal histological lesions which allowed them to attain the diagnosis.

[Changes in dialysis methods. 10 years' experience]. / Cambi di metodica dialitica. Esperienza di 10 anni.

A retrospective survey has been done on 175 chronic patients who underwent dialysis in one center, between January 1982 and June 1992. The purpose of the work was to evaluate the use of the first treatment and the cause which determined a change of treatment. Diffusive haemodialysis and CAPD were the most frequent first choice techniques, respectively in extracorporeal and peritoneal dialysis, whereas changes were conditioned by the need for a more personalized treatment, especially in the filed of extracorporeal dialysis.

[Evaluation of nutritional status in a group of patients undergoing CAPD]. / Valutazione dello stato nutrizionale in un gruppo di pazienti in CAPD.

The onset of a protein-energy malnutrition represents a real risk for patients on CAPD. In order to verify the nutritional status and the effectiveness of the dietetic surveillance in preventing this complication, dietary intake, anthropometric measurements and biochemical parameters were monitored in 46 patients (27 males, 19 females, mean age: 58.7 +/- 14.8 years), suffering from ESRF and treated with CAPD, for a total observation period of 1731.67 months (mean: 37.64 +/- 25.17 months). The mean glucose concentration in the dialysate was 2.00 +/- 0.36 g/dl, the glucose reabsorption from dialysate per kg of ideal body weight (kg-IBW) was equivalent to 5.1 kcal, the mean dialysate protein loss was 13.08 +/- 5.52 g/day and the incidence of peritonitis episodes was 1 every 30.38 months-patient. The daily total caloric intake (by mouth and dialysate) was 30.8 kcal/kg-IBW with a normal subdivision for each diet component: there were not statistically significant differences in distribution according to age, sex and in the follow-up. The mean daily value of protein intake (PI) evaluated by dietary interviews was 0.99 g/kg-IBW, with a significant increase 1 year since the beginning of CAPD; the PI evaluated from urea nitrogen appearance was 1.22 g/kg-IBW. The PI remained stable later in the follow-up and in patients that made use of dietetic supplements, the mean daily increase by this way was 0.47 g/kg-IBW. Anthropometric measurements showed a statistically significant increase of %RBW after 1 year and of TS and % body fat after 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)

[The dental patient and diabetes mellitus. The practical indications to be followed in the case of minor oral surgery and extractive surgery]. / Paziente odontoiatrico e diabete mellito. Indicazioni pratiche da seguire in caso di interventi di piccola chirurgia orale e di chirurgia estrattiva.

Certain general aspects of diabetes mellitus (DM) and the diagnostic procedures for assessing metabolic compensation are reviewed. A series of indications to be followed in dental treatment in the DM patient is then reviewed in order to avoid complications.

[A case of ameloblastoma in a girl 2 years and 6 months old]. / Un caso di ameloblastoma in una bambina di due anni e sei mesi.

The paper reports a case of ameloblastoma in a patient aged two and half. The natural history of the disease is described together with therapy used.

[Presence and type of fillings found in a group of 531 school aged children]. / Presenza e tipo di otturazioni riscontrate in una popolazione di 531 bambini in età scolare.

An epidemiological investigation carried out in a population of children aged between six and twelve is reported. The relationship between caries and type of filling encountered was analysed.

[Evaluation of toothbrushing in a group of 531 school aged children]. / Valutazione dello spazzolamento dentario di una popolazione di 531 bambini in età scolare.

Data concerning the evaluation of tooth brushing collected during odontostomatological screening in Val Pellice are reported. The screening was carried out by a dental team from Turin's Mauriziano Hospital and covered a population of 531 children aged between six and twelve.

[Evaluation of the plaque-periodontal disease relation in a homogeneous group of 531 school aged children]. / Valutazione del rapporto placca-malattia parodontale su un campione omogeneo di 531 bambini di età scolare.

The data collected in a sample of 531 pupils of the primary schools of Val Pellice aged between 7 and 10 have been examined. These data suggest with sufficient reliability that periodontal disease is a threat even in this age segment.

[Computerization of an epidemiological record model. The computer in the epidemiology of dental disease]. / Computerizzazione di un modello di scheda epidemiologica. L'informatica nell'epidemiologia delle malattie dentarie.

A new method for computerized epidemiological data is proposed. Personal experience in a study of 531 children of school age from the Val Pellice is reported.