[Ionofluor + laser = prevention]. / Jonofluor + laser = prevenzione.

On the basis of experience gained in previous research, an original technique for fixing fluoride on the enamel of healthy teeth for preventive purposes is described. An apparatus of ionophoresis with which it was possible to contain fluoride in the ionic state, and later a low power laser system with double red and infrared emission mixed in optic fibre were used to achieve this result. The proposed technique is not only extremely effective, offering as it does protection for at least 3 years, but is is very simple, practical and economical.

Patients with comorbidities: what shall we do to improve the outcome.

The number of patients submitted to major surgery affected by one or more comorbidities is progressively increasing. Outcome is the final output measured as morbidity, mortality and quality of life, of diagnostic tests, procedures, therapy tools started in the preoperative period and fitted on single patients or groups of patients or typology of surgical acts. Strategies to improve outcome can be divided in some fundamental steps: preoperative evaluation; optimization and no discontinuation of preoperative drug treatments, mainly in cardiac patient; choice of adequate monitoring techniques, checking of patient metabolic state and oxidative balance; choice of the best anesthesia; postoperative care, particularly due to identify the best management of the critical patient between the different levels of assistance. In conclusion, a patient with comorbidities scheduled for major surgery needs a full anesthetist-intensivist involvement, which broadens the role of the anesthetist in the perioperative medicine. Outcome is the result of many interventions during patient course, including economic costs and the importance of an appropriate treatment.

NIV treatment for acute exacerbation in COPD patients.

The authors review the clinical applications of non invasive ventilation (NIV) in patients with chronic obstructive pulmonary disease (COPD), mostly focusing on NIV issues and possible solutions. After briefly reviewing the respiratory mechanics modification during an episode of COPD exacerbation, the authors describe the two crucial technical aspects (choice of the interface and leaks control) that are mostly involved in patient-ventilator interaction. Finally, they briefly review the most important clinical trials on NIV.