Prospective observational study of abdominal wall reconstruction with THT technique in primary midline defects with diastasis recti: clinical and functional outcomes in 110 consecutive patients.

INTRODUCTION: Surgical treatment of diastasis recti is still a matter of debate. Open approaches such as abdominoplasty, which offer the possibility to combine reparation of the diastasis with abdominal cosmetic surgery, are challenged by the emerging less-invasive laparoscopic or robotic techniques that offer shorter recovery for patients. However, evidence in favour of one of the two approaches concerning both short- and long-term complications and functional results is still lacking. In this paper, we analysed clinical and functional results of a new endo-laparoscopic technique for midline reconstruction (THT technique) in patients with primary abdominal wall defects associated with diastasis recti. METHODS: Prospective observational study on 110 consecutive patients was submitted to endo-laparoscopic reconstruction of the abdominal wall with linear staplers. Morbidity and relapse rates with clinical and radiological follow-up were recorded at 1, 6, 12, and 24 months after the operation. Data regarding the impact of surgery on patients' quality of life (EuraHSQol) on chronic low back pain (Oswestry Disability Index, ODI) and urinary stress incontinence (Incontinence Severity Index, ISI) were gathered. RESULTS: After a mean follow-up of 14 months, the morbidity rate was 9.1% and no recurrences were recorded. 6-month follow-up ultrasound showed a rectus muscles mean distance of 6.7 mm; EuraHSQol, ODI, and ISI scores significantly improved in 93%, 77%, and 63% of the cases, respectively. CONCLUSIONS: The THT technique proved to be a feasible, safe, and effective alternative for corrective surgery of primary midline hernias associated with diastasis recti. Short- and mid-term results are encouraging but need to be confirmed by further studies with longer follow-up. The achieved midline reconstruction offers a significant improvement of patients' perceived quality of life through reduction of abdominal wall pain, bulging, low back pain, and urinary stress incontinence.

Micro-CT assessment of the shaping ability of four root canal instrumentation systems in oval-shaped canals.

AIM: To compare the shaping ability of four root canal instrumentation systems in oval-shaped canals using micro-computed tomographic analysis. METHODOLOGY: Forty anatomically matched mandibular incisors were scanned and assigned to four groups (n = 10), according to the canal preparation protocol: BioRace, Reciproc, Self-Adjusting File (SAF) and TRUShape systems. After canal instrumentation, the specimens were rescanned, and the registered pre- and postoperative datasets were examined to evaluate the percentages of accumulated hard-tissue debris, untouched canal walls and dentine removed. Kruskal-Wallis and Mann-Whitney U-tests with Bonferroni correction were used to compare the variables in the groups (α = 5%). RESULTS: The preparation techniques did not affect the percentage of accumulated hard-tissue debris (P = 0.126). The percentage of untouched canal areas was significantly higher for BioRace (32.38%)compared to Reciproc (18.95%) and SAF (16.08%) systems (P < 0.05). Reciproc removed significantly more dentine (4.18%) than BioRace (2.21%) and SAF (2.56%) (P < 0.05). The TRUShape system had intermediate results for both untouched canal walls (19.20%) and dentine removed (3.77%), with no significant difference compared to BioRace, Reciproc and SAF systems. CONCLUSIONS: The preparation techniques resulted in the same level of accumulated hard-tissue debris. Compared to the other tested systems, BioRace was associated with more untouched canal walls and Reciproc produced the greatest amount of removed dentine. Although it touched more of the root canal walls, the SAF system removed less dentine, whereas TRUShape had intermediate results for these same parameters. None of the systems tested were able to provide optimal shaping ability in oval-shaped canals.

Efficacy of reciprocating and rotary techniques for removing filling material during root canal retreatment.

AIM: To compare the efficacy of reciprocating and rotary techniques with that of hand files for removing gutta-percha and sealer from root canals. METHODOLOGY: The root canals of fifty-four human extracted maxillary central incisors were cleaned and shaped using a crown-down technique to a size 40 and filled with gutta-percha and a zinc oxide-eugenol-based sealer using a lateral compaction technique. Teeth were divided into three groups according to the technique used for removing the root filling material: group I - Gates-Glidden burs and stainless steel hand files up to size 50; group II - rotary technique with NiTi Mtwo R files and additional Mtwo files to size 50, 0.04 taper; group III - reciprocating technique with the Reciproc instrument R50, size 50, 0.05 taper. Chloroform was used as a solvent in all groups. Teeth were then split longitudinally and photographed under 8× magnification. The images were transferred to a computer, and the total canal space and remaining filling material were quantified. The ratio of remaining filling material to root canal periphery was computed with the aid of Image Tool 3.0 software. The mean percentages of remaining filling material and time required to remove it were compared using the Kruskal-Wallis and Mann-Whitney tests (P < 0.05). RESULTS: The mean percentage of remaining filling material was significantly higher (P < 0.05) in group II, with Mtwo rotary files (12.17%), than in group I, with the hand file technique (7.19%), and group III, with Reciproc instruments (4.57%), which were statistically similar (P > 0.05). The time required to remove filling material was significantly shorter (P < 0.05) in group III (194 s), followed by group II (365 s) and group I (725 s) (P < 0.05). CONCLUSION: Remaining endodontic filling material was observed on the canal walls of all teeth regardless of the technique used. Hand files combined with Gates-Glidden burs (group I) and the reciprocating technique (group III) removed more filling material from the canal walls than the Mtwo R files. The reciprocating technique was the most rapid method for removing gutta-percha and sealer, followed by the rotary technique and the hand file technique.

Panbacterial real-time PCR to evaluate bacterial burden in chronic wounds treated with Cutimed™ Sorbact™.

The impact of polymicrobial bacterial infection on chronic wounds has been studied extensively, but standard bacteriological analysis is not always sensitive enough. Molecular approaches represent a promising alternative to the standard bacteriological analysis. This work aimed to assess the usefulness of a panbacterial quantitative real-time PCR reaction to quantitate the total bacterial load in chronic wounds treated with Cutimed™ Sorbact™, a novel therapeutic approach based on hydrophobic binding of bacteria to a membrane. The results obtained by panbacterial real-time PCR on conserved sequences of the bacterial 16S gene show that the bacterial burden significantly decreased in 10 out of 15 healing chronic wounds, and did not change in 5 out of 5 non-healing chronic wounds. On the contrary, classical culture for S. aureus and P. aeruginosa, and real-time PCR for Bacteroides and Fusobacterium did not show any correlation with the clinical outcome. Our study also shows that quantification of chronic wounds by panbacterial real-time PCR is to be performed on biopsies and not on swabs. These results show that panbacterial real-time PCR is a promising and quick method of determining the total bacterial load in chronic wounds, and suggest that it might be an important biomarker for the prognosis of chronic wounds under treatment.

CT scan structured report for the study of abdominal wall defects: a fast, easy and practical tool at the service of both surgeons and radiologist.

PURPOSE: The advantages offered by structured reporting have already been highlighted in the literature. However, there is still no evidence on the validity of this reporting method for the study of abdominal wall defects. This study aims to show the experience of the Trentino Hernia Team (THT) multidisciplinary group in the development and use of a structured CT scan report for the study of abdominal wall defects. METHODS: A regional multidisciplinary team (THT group) used a Delphi method to identify and select the most important CT scan parameters needed to describe and stage abdominal wall defects for correct preoperative planning. Based on the selected parameters, a CT scan structured report was worked out and collectively accepted. The first 20 structured reports obtained were individually tested for compilation speed and homogeneity of the data reported by five distinct radiologists. The reports were then evaluated by five different surgeons to test the simplicity of interpretation. RESULTS: We produced a model of a structured report for the study of the abdominal wall defects and tested it in our hospital network on the first 20 reports. The average completion time was 18 min (range 12-25). There was no heterogeneity among the reported data. The reports were analysed by five distinct surgeons to evaluate completeness and simplicity of interpretation. Each surgeon used a Likert scale from 0 to 5 to evaluate each report, producing average scores of 4.8 and 4.1 for completeness and comprehensibility respectively, with a mean combined total score of 8.9 out of 10. CONCLUSIONS: Our structured report represents a fundamental tool capable of providing the surgeon with all the measurements of the parameters necessary for correct preoperative planning. At the same time, it is of crucial help for the radiologists representing an easy and fast way to report all the needed parameters using the same standards.

CHIVA strategy in chronic venous disease treatment: instructions for users.

Along the years, scientific clinical data have been collected concerning the possible saphenous flow restoration without any ablation and according with the CHIVA strategy. Moreover, in 2013 a Cochrane review highlighted the smaller recurrence risk following a CHIVA strategy rather than a saphenous stripping. Nevertheless, the saphenous sparing strategy surely remains a not-so-worldwide-spread and accepted therapeutic option, also because considered not so immediate and easy to perform. Aim of this paper is to provide an easily accessible guide to an everyday use of a saphenous sparing strategy for chronic venous disease, highlighting how even apparently too complicated reflux patterns classifications can be fastly and successfully managed and exploited for a hemodynamic correction.

Comparison of endodontic retreatment of laterally condensed gutta-percha and Thermafil with plastic carriers.

The purpose of this study was to evaluate canal wall cleanliness in cases of retreatment using laterally condensed gutta-percha and Thermafil with plastic carriers. Forty extracted mandibular canines were prepared using a step-back flared technique and divided into two groups: group A, obturated with lateral condensation and group B, obturated with Thermafil. AH26 was the sealer used in both groups. Retreatment of all teeth was done using Gates Glidden burs and a solvent. The teeth were then split longitudinally, photographed, and projected onto a screen at x10 magnification. The total area of the canal and the area of gutta-percha/sealer were then traced on white paper. Both areas were accurately quantified using a computerized image analysis system and the ratio of remaining obturation material to root canal periphery was derived and statistically analyzed. Results showed that the average percentage of the remaining gutta-percha/sealer was 14.23 for the lateral condensation group and 15.70 for the Thermafil group with no statistically significant difference (Student's t test, p = 0.01). The plastic carrier was easily removed from the canals.

Orifice locating with a microscope.

The purpose of this study was to determine whether the use of the dental operating microscope (DOM) could increase the number of root canal orifices located in mandibular molars. Ninety-three first and 111 second extracted mandibular molars were used. With the naked eye, all access cavities were prepared and the number of canals in each root was recorded. Using a DOM with x8-x13 magnification, all teeth had the access cavity preparations again examined. With the naked eye, a total of 641 canals were seen in all teeth. After the DOM examination, 50 more canals could be visualized, representing a 7.8% increase in the total number of located canals. From these canals, 35 were located in the first molars and 15 in the second molars. The use of the DOM increases the number of root canal orifices located.

Endodontic retreatment of thermafil or lateral condensation obturations in post space prepared teeth.

The purpose of this study was to quantify the amount of remaining gutta-percha/sealer after retreatment of post space prepared teeth obturated with a lateral condensation technique or with Thermafil with plastic and metallic carrier. The time required for retreatment was also recorded. Forty-five extracted mandibular premolars were prepared using a step-back flared technique and obturated. The post space was prepared and a 5-mm obturation was left in the canal. Retreatment of all groups was done using a solvent technique. The teeth were split longitudinally and photographed. The total area of the canal and the area of gutta-percha/sealer were traced on white paper. Both areas were quantified using a computerized image analysis system and the ratio of remaining obturation material to root canal periphery was derived and statistically analyzed. Statistical analysis (analysis of variance, p = 0.01) showed no differences among the techniques when the average percentage of remaining gutta-percha/sealer was compared. Results revealed that the Thermafil metallic retreatment group consumed significantly more time than the others (analysis of variance, Scheffe p = 0.01). The metallic carriers were not easily removed from the canals, six metal carriers could not be retrieved during the retreatment routine.

Canal Master files: scanning electron microscopic evaluation of new instruments and their wear with clinical usage.

Canal Master instruments have a short, fluted cutting area and a small flexible shaft; they may be predisposed to rapid wear and breakage. This study examined new and used files as to tip, flute, and shaft design when new and with increasing time of canal preparation. One hundred files prepared 140 curved canals. Sizes #20, #40, and #60 files were examined unused and after 1, 3, 5, and 7 min of use. Evaluation was for uniformity when new and for deterioration and breakage with usage. The smaller sizes (#20 and #40) had some inconsistencies when new and were most predisposed to wear and breakage with time. Findings suggest that smaller files could have had improved quality control by the manufacturer. Also, they should be used with caution and discarded after short times of use in small, curved canals. This should minimize instrument separation and maximize cutting efficiency.

Identification of GM3 as a marker of therapy-resistant periradicular lesions.

The purpose of this study was to analyze the profile of glycosphingolipids (GSLs) in periradicular lesions refractory to endodontic treatment. Sixteen periapical lesions were removed surgically from patients (experimental group) and compared with 10 samples of periodontal ligament removed from extracted intact third molars (control group). After the GSLs extraction and purification procedures were performed the neutral and acidic GSL fractions were analyzed by high-performance thin-layer chromatography and quantified by densitometry. Data reported herein show that: (i) tissues in the experimental group presented about twice as much GSLs as the control group; (ii) lesion tissues express lactoneotetraosylceramide, and lactofucopentaosyl (IV) ceramide, whereas these neutral GSLs are absent in normal tissues; and (iii) normal tissues express GT1b, whereas lesions cells do not express this ganglioside. In contrast lesion tissues express GM3, which is conspicuously absent in normal tissues.

Instrument deterioration with usage: nickel-titanium versus stainless steel.

Nickel-titanium instruments purportedly resist deformation and loss of sharpness better than do stainless steel instruments but may be more susceptible to breakage. The processes of wear and breakage of nickel-titanium and stainless steel instruments were examined. Sixty files of five types (12 each) and three manufacturers were used. All were used repeatedly in curved canals until failure or for a maximum of 22 minutes. Each instrument was examined with scanning electron microscopy both new (control) and at spaced intervals for evidence of wear and fatigue. All new instruments were of good quality. Stainless steel instrument tended to wear the most rapidly, and next were nickel-titanium rotary instruments; the most resistant to wear were nickel-titanium hand instruments. There were few instrument separations. In general, nickel-titanium (particularly hand) instruments resisted deterioration better than did stainless steel. Nickel-titanium rotary instruments (2 of 12) had the most breakage.

Guided bone regeneration in the treatment of a large periapical lesion: a case report.

A large (19 mm x 24 mm) periapical lesion associated with tooth #10, perforating both the labial and palatal cortical plates, was treated with decalcified freeze-dried bone allograft and guided bone regeneration. The membranes were removed after a seven-month healing period. Complete osseous reconstruction of the cortical plates was noted. Biopsies demonstrated healing with mature bone and hemopoietic marrow. Few particles of decalcified freeze-dried bone could be observed. Graft particles that remained were surrounded by new bone. The learning objective of this article is to present the regeneration procedure utilized along with the histologic biopsy results to the clinician.

The reproducibility of colour Doppler in chronic cerebrospinal venous insufficiency associated with multiple sclerosis.

AIM: Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome described in multiple sclerosis (MS) patients, characterized by stenosis of the main extracranial veins with hampered cerebral venous outflow. In the original description echo-colour Doppler demonstrated to be an ideal non invasive tool for screening CCSVI patients, but the reproducibility was not assessed. Aim of this study is to assess the variability coefficient between trained and in not trained echo-colour Doppler operators. METHODS: Thirty-six (36) subjects, matched for age and gender, were subset in 3 groups (group A, 12 healthy controls, HC; group B, 12 multiple sclerosis patients, MS; group C, 12 patients with other neurological disease, OND) underwent echo-colour Doppler screening for CCSVI according to an original protocol previously described. The inter observer variability rate was assessed by comparing respectively trained vs not trained operators, and trained vs trained operators, by using the same echo-colour Doppler equipment. In addition, by scanning 15 subjects after one month from the first session, intra observer coefficient was also assessed in trained operator. RESULTS: The inter observer variability rate between trained and not trained echo-colour Doppler operators, were not completely satisfactory (K coefficient 0.47 95% CI 0.27-0.68). To the contrary the inter observer agreement between trained operators was much more reliable (K coefficient 0.80 95% CI 0.59-1.01). Finally, the intra observer variability rate in trained operators was 0.93, (95% CI 0.80-1.06) confirming a highly satisfactory agreement. CONCLUSION: Echo-colour Doppler is a powerful, non-invasive and reproducible tool for screening CCSVI-MS but it needs special training.

Ridge augmentation following extraction of replanted central incisor.

Regeneration of bone defects remains a clinically important problem in many instances. This paper reports on the use of membrane technique combined with decalcified freeze-dried bone allograft to promote bone formation after extraction of a replanted central incisor with extensive root resorption. The procedure prevented ridge reduction, both buccolingually and apicocoronally, and will facilitate prosthetic replacement of the lost tooth without esthetic problems.

Factors associated with endodontic flare-ups: a prospective study.

The purpose of this prospective study was to assess the incidence of flare-ups (a severe problem requiring an unscheduled visit and treatment) among patients who received endodontic treatment by the two authors in their respective practices during a period of one year, and also to examine the correlation with pre-operative and operative variables. The results showed an incidence of 1.58% for flare-ups from 1012 endodontically treated teeth. Statistical analysis using the chi-square test (P<0.05) indicated that flare-ups were found to be positively correlated with multiple appointments, retreatment cases, periradicular pain prior to treatment, presence of radiolucent lesions, and patients taking analgesic or anti-inflammatory drugs. In contrast, there was no correlation between flare-up, and age, sex, different arch/tooth groups and the status of the pulp.

Histologic evaluation of three endodontic instrument/preparation techniques.

33 curved canals were prepared to quantify both the increase in canal area and predentin removal in the apical region. Compared were three different file designs/instrumentation techniques, that is "stepback" with K-flex file, "balanced force" with Flex-R file, and the Canal Master system. Following canal preparation and histological processing, cross-sections at 1 and 3 mm levels were examined using the Bioquant image analysis system. Results showed that, at the 3 mm leve, the mean increase in canal area and predentin removal showed no statistically significant difference (p > 0.05) between the techniques. At 1 mm, the step-back technique (with K-flex files) resulted in a significant increase in canal area and greater predentin removal than did the "balanced forces" (with Flex-R files) or the Canal Master system. However, although there were statistical differences, the actual differences were small; these may not translate to clinically significant differences in the 3 techniques.

Prognosis in periradicular surgery: a clinical prospective study.

AIM: The purpose of this prospective study was to evaluate the prognosis of periradicular surgery using well-defined case selection and a rigorous surgical protocol. METHODOLOGY: Teeth to be treated surgically demonstrated a periradicular lesion of strictly endodontic origin with or without clinical signs and symptoms of inflammation. A total of 114 teeth were treated. Following the reflection of a full mucoperiosteal tissue flap, residual soft tissues were curetted, root ends were resected with a fine high-speed diamond bur, root-end cavities were prepared ultrasonically with diamond tips, and IRM root-end fillings were placed. Cases were followed clinically and radiographically for a period ranging from 1 to 4 years. RESULTS: The results of this study showed 91.2% success out of a total of 102 teeth available for follow-up, based on accepted parameters of evaluation. Cases were considered successful if there were no clinical signs or symptoms present and there was radiographic evidence of complete or incomplete healing (scar tissue). Factors related to case selection, parameters of healing and surgical technique are discussed in relation to the success rate identified in this prospective study. CONCLUSIONS: Adherence to a strict endodontic surgical protocol and the use of contemporary techniques and materials will result in a predictably successful outcome in a wide range of teeth.

Effectiveness of the Canal Finder and hand instrumentation in removal of gutta-percha root fillings during root canal retreatment.

The purpose of this study was to quantify the amount of remaining gutta-percha/sealer on the canal walls when the Canal Finder system, hand instrumentation and a combination of both (hybrid technique) were used to remove these materials. The amount of apically-extruded debris and the time required for removal were also recorded. Sixty extracted maxillary anterior teeth were prepared using a stepback technique and obturated with gutta-percha. Reinstrumentation of all groups was done in conjunction with a solvent, chloroform. The teeth were split longitudinally and photographed, and the total area of the root canal and the area of the debris were traced and quantified using a computerized image analysis system. The ratio of remaining obturation material to root canal surface was derived and analysed statistically. Hand instrumentation resulted in less debris remaining than did the other two techniques (P < 0.05). The differences in the amount of apically extruded debris were not significant among the techniques (P > 0.05). The hybrid technique required significantly less time for filling material removal. The Canal Finder system alone was not superior to hand instrumentation.