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.

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.

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.

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.

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.

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.

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.

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.

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.

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.