Atypical swallowing: a review.

AIM: Atypical swallowing is a myofunctional problem consisting of an altered tongue position during the act of swallowing. High incidence in population, multifactorial etiology and the recurring connection with the presence of malocclusions made it a topic of strong interest and discussion in science. The purpose of this review is to illustrate the current orientation on the topic of atypical swallowing, trying in particular to answer two questions: 1) what kind of connection is there between atypical swallowing and malocclusion; 2) what kind of therapy should be used to solve it. METHODS: This review was conducted on the Medline database [www.ncbi.nim.nih.gov/pubmed] searching for the keywords "atypical swallowing" and "tongue thrust". We examined all the documents from the year 1990 onwards, excluding the ones about syndromic cases of the central motor system. RESULTS: The causal relation between the two problems seems to be biunique: some authors affirm that this oral habit starts as a compensation mechanism for a preexisting malocclusion (especially in case of open-bite); other texts show that it has a tendency to exacerbate cases of malocclusion; it is also proven that a non-physiological tongue thrust can negatively influence the progress of an ongoing orthodontic therapy. Thereby, the best therapeutic approach seems to be a multidisciplinary one: beside orthodontics, which is necessary to correct the malocclusion, it is essential to set up a myofunctional rehabilitation procedure to correct the oral habit, therefore granting long time permanent results. There is also proof of a substantial difference between the results obtained from early (deciduous or primary mixed dentition) or later treatments. CONCLUSION: The biunique causal relation between atypical swallowing and malocclusion suggests a multidisciplinary therapeutic approach, orthodontic and myofunctional, to temporarily solve both problems. An early diagnosis and a prompt intervention have a significantly positive influence on the therapy outcome.

[A case of resistant sideropenic anemia. Adult celiac disease]. / Un caso di anemia siderocarenziale resistente. Malattia celiaca dell'adulto.

We report a case of a woman affected by sideropenic anaemia (SA) for about thirty years and never restored with a therapy with iron per os. At the age of 60 years a malabsorption syndrome appears and an adult celiac disease was diagnosed (ACD). The SA was therefore and since the beginning the only symptom of the malabsorption. When SA is resistant to the iron per os therapy, we always should suspect a malabsorption due to CD often olygosymptomatic in the adult patient. We would now recommend, in presence of resistant SA, the weight of jejunum biopsy, as well as his excessive importance, when it shows an apparently not specific finding of mucosa atrophia with chronic phlogosis.

[Acute kidney failure in the patient with multiple myeloma. An analysis of the authors' personal cases]. / L'insufficienza renale acuta del paziente con mieloma multiplo. Analisi di una casistica personale.

The renal involvement in a multiple myeloma case (MM) has a frequency of 50% and causes a worsening of the disease with a survival average of about 12 months. Myeloma cast nephropathy (MCN) represents the more frequent clinic, histological form of nephropathy in course of MM and it evolves when monoclonal light free chain deposit in the renal tubules together with some other worse cases like dehydration and/or hypercalcaemia. We analyze here the clinical and renal histological features of eight patients treated for acute renal failure found in MCN in course of MM grade B. This was discovered through renal bioptic check-up. We have evaluated the Bence-Jones proteinuria, the recurrence of the condition of risk and the course of the renal failure of these patients also in order to treat the hematological illness.

[Di George's syndrome with neutropenia in an adult patient]. / Sindrome di Di George con neutropenia in un paziente adulto.

The clinical data of a thirty-nine old inpatient woman are reported, whose main complaints were non-operable vulvo-vaginal condylomata, recurrent bacterial infections, complicated chickenpox and prominent lymphopenia. The peculiar facies get us to suggest the diagnosis of a case of the Di George syndrome in an adult patient. Was probably the associated neutropenia congenital and combined with immunodeficiency syndrome?