Gnathological and osteopathic treatments with digital evalua- tions before and after therapies: a case report of a patient with ehlers-danlos syndrome.

BACKGROUND: Ehlers-Danlos syndromes (EDS) are inherited connective tissue disorders, requiring specific care along with a multidisciplinary approach by an expert medical staff, as for both the diagnosis and the treatment management. Chronic generalized pain and musculoskeletal dysfunctions due to joint hypermobility are common traits. Temporomandibular disorders (TMDs) are among the most frequent complaints. The authors report the diagnostic and therapeutic management of an EDS subject. CASE PRESENTATION: A 33-year old woman with Ehlers-Danlos syndrome, hypermobile type, was clinically evalu-ated and treated. She underwent a gnathological therapy with an anterior repositioning splint and proprioception ex-ercises, and a physical rehabilitation through an osteopathic manipulation treatment (OMT). Technology - surface Elec-tromyography (sEMG) of masticatory muscles, T-scan and stabilometric platform- supported diagnostic and therapeutic phases, giving objective and quantifiable information on the patient's assessment before and after treatments. CONCLUSION: According to a targeted therapeutic strategy, both the gnathological and the osteopathic therapy proved to be effective in improving patient's symptomatology and functionality, as confirmed by digital findings.

Muscular pattern in patients with temporomandibular joint disc displacement with reduction: an electromyographical assessment.

OBJECTIVE: Surface Electromyography of masticatory muscles (sEMG) is used as a tool to support diagnosis and treatment of Temporomandibular disorders (TMDs). The study aimed at examining jaw muscles pattern in individuals with temporomandibular joint disc displacement with reduction (TMJ/DDR). This sort of subjects was supposed to have a different muscular pattern compared to the control group. MATERIALS AND METHODS: Sixty-four women with unilateral TMJ/DDR and forty TMD-free women underwent a sEMG assessment of masticatory muscles. Descriptive statistics were performed. Student T-Test assessed differences between the two groups. Statistical significance was set at ρ < 0.05. RESULT: The t-test showed statistically significant results only in BAR and SMI scores (ρ value < 0,0001). The other measurements did not differ between the two groups. BAR index values of all healthy subjects were within the reference range. Almost the entire TMJ/DDR group had BAR index out of reference range and anteriorly placed. CONCLUSION: Women with TMJ/DDR showed an altered recruitment of the jaw muscles, with significant difference between the activity of the couple of temporalis and the one of masseters, compared to the control group. A lower chewing efficiency was found in the DDR group compared to the control one.

[The use of the Kehr tube in choledochal calculi (our experience)]. / Impiego del tubo di Kehr nella calcolosi del coledoco (nostra esperienza).

Surgical therapy of the main bile duct is an important aspect of liver disease. The authors examine the advisability of using a Kehr drain in benign and malignant disease of the main bile duct, and draw the conclusion that, with precise indications, this technique still has an important role to play in the resolution of biliary tract disease.

[Intestinal occlusion due to metastases of malignant melanoma (a clinical case)]. / Occlusione intestinale da metastasi di melanoma maligno (caso clinico).

Metastases of the gastrointestinal tract from malignant melanoma are fairly frequent, though their detection during the patient's lifetime is rare. An antemortem diagnosis, however, may not necessarily be an indication for surgery, unless in the presence of an acute complication (intestinal occlusion, perforation, or severe haemorrhage), owing to the patient's degenerated general condition, the presence of secondaries in other sites and, above all, the rare occurrence of major gastrointestinal disorders. The authors describe their experience with a patient presenting acute intestinal occlusion and operated on three years previously for malignant melanoma of the scalp.

[Bilio-digestive anastomosis (our experience)]. / Le anastomosi bilio-digestive (nostra esperienza).

The authors have conducted a retrospective study of surgical therapy by bilio-digestive anastomosis of benign and malignant diseases of the common bile duct. They conclude that this procedure should only be used when the anatomical and clinical conditions do not allow other surgical techniques to be employed.

[Fournier syndrome (description of 2 clinical cases)]. / Sindrome di Fournier (descrizione di due casi clinici).

The Authors describe two cases of Fournier's syndrome, a rare disease consisting in gangrene of the scrotum, penis skin and perineum, stressing the importance of construction of an intestinal diversion for healing this unusual condition.