Langerhans cell histiocytosis: oral/periodontal involvement in adult patients.

OBJECTIVE: Langerhans cell histiocytosis (LCH) is a clonal proliferative multisystem disease. Although bone and mucosae have been classified as non-risk organs, their involvement may increase the risk of disease progression. Oral and periodontal lesions are burdened with a significant impairment of quality of life for associated signs, symptoms and loss of function. Most of information regards paediatric disease; the disease in adults has received limited attention. SUBJECTS AND METHODS: A total of 31 adult patients affected by immuno-histopathology confirmed LCH have been prospectively examined; attention was paid to the occurrence and characterization of oral lesions. RESULTS: Twelve patients developed oral lesions. Posterior regions of jawbones were always affected; the involvement of anterior regions was not constant. Unifocal oral involvement was significantly associated with multisystemic disease while multifocal lesions were associated with unisystemic disease. Oral disease presented with soft tissue ulcers (50% of cases), gingival bleeding (66.7%), pain (83.4%), periodontal damage (50%), tooth mobility (16.7%), non-healing extraction socket (8.3%); 41.6% of patients complained of negative outcomes on quality of life. Oral lesions were easily handled with local measures. CONCLUSIONS: Posterior regions require attention; single oral lesions may be part of multisystemic disease; oral and periodontal lesions may be early signs of disease reactivation.

[AIDS and forensic medicine. I. The framework of the debate]. / AIDS: attualità intorno al dibattito etico-deontologico e medico-legale. I. Le coordinate generali.

The ethical debate regarding the AIDS is very rich both at the theoretical and practical level, but--unlike what it is happening for other sectors, e.g. the euthanasia--these two aspects are integrated, shaping a true interdisciplinary job of ethical evaluation, in which clinicians, medical examiners, ethicists, nurses, clinical psychologists, economists and politicians are met. The utilized methodology will be to identify the human act in the light of the patient's good and the common good of the society. These are strong references and broadly shared in general sense, but they become problematic if we want to identify, and we should have to do it, the contents of such "goods". The authors intend to appraise the quality of a Centre for Research and Healthcare for AIDS patients, also considering the "performance measures".

[AIDS and forensic medicine: II. the particular issues]. / AIDS: attualità intorno al dibattito etico-deontologico e medico-legale. II. Le questioni particolari.

The article deals with some issues of forensic medicine relevance, as well as ethical one, about HIV+/AIDS condition, which still represent open problems in regulations and in the case-law. Particularly, in the light of the specific Italian regulations (namely, the Law 5 June 1990 no. 135), the Authors address the juridical fundaments of the care of HIV+/AIDS patients, reaffirming the obligation for all the healthcare professionals to give care in every case of infection from HIV. Secondly, the issue of the diagnostic tests and the screenings is faced, sustaining the obligatoriness to gain an adequate previous consent by the subject and, however, only for clinical necessity and in his/her best interest. Finally, the delicate matter of the professional secrecy is examined, of the guardianship of confidentiality and of the partner notification is examined. In general, although the doctrine and jurisprudence not justify the transmission of HIV+/AIDS patient's personal data, yet the specific matter is not easily resolvable exclusively in juridical terms, because it is necessary remind also the extra-juridical--that is ethical--nature of deontological norms.

A case of mutism subsequent to cocaine abuse.

The authors report a case of mutism that was ultimately found to be associated with chronic cocaine use in an adult woman. Brain dysfunction was confirmed by SPECT scan, which revealed reduced cerebral blood perfusion and areas of infarction, presumably consequent to the cocaine addiction. This is the first reported case of such an association.

[Medical-legal evaluation of laryngeal dysfunction to determine disability]. / Valutazione medico-legale delle disfunzioni laringee in ambito di invalidità civile.

The "New Table indicating the percentage of disability resulting from injury and disabling diseases" approved by the Italian Ministerial Decree dated February 5, 1992 gives a superficial, highly disorganized handling of laryngeal pathologies. This Table only considers phonatory function disorders which are included in a special section; it totally neglects dyspnea and dysphagia of laryngeal origin. This omission cannot even be overcome on the basis of similarities since there are no analogous items listed for reference. In fact, the parameters applied to evaluate dyspnea (CV, VEMS, O2 consumption) apply to ventilation disorders of a pulmonary nature and cannot, therefore, be used in cases of laryngeal dyspnea. Moreover, the Table does not deal with dysphagia at all. In addition, the basis for the Table--the concept of permanent functional damage--is not always adhered to in giving indications for evaluation of phonatory tract damage. The purpose of the present work is not, however, to propose a different way to determine the percentages for the individual items in the tables; rather, the aim is to suggest a different, highly standardized procedure for evaluating laryngeal dysfunctions which is easy to apply.

[Removal of fractured cylindrical implants]. / Rimozione di impianti cilindrici fratturati.

The implant fracture is a rare but significative complication which requires a specific treatment for the surgical removal of the fractured fixture and the modification of the initial prosthetic plan. On the basis of the most recent studies and of a case personally observed in which both the osteointegrated supporting implants of a maxillary overdenture were fracturated, epidemiological, etiopathogenic, diagnostic and therapeutical aspects of this complication are analyzed. Clinical situations most at risk are emphasized, including implant-supported maxillary overdenture, and the major etiologic factors, represented by defects in implant design or material and physiologic or biomechanical overload. The diagnostic criteria are described along with the three therapeutical possible options: 1) removal of the fractured implant, replacement of the implant and refabrication of the prosthesis; 2) modification of the existing prosthesis leaving the fractured portion of the implant in place; 3) modification of the fractured implant and refabrication of a portion of the prosthesis. Three surgical removal technics are then illustrated (block-section, vestibular approach, occlusal approach), with the emphasis on the one choosed in the case examined, in which the ostectomy around the remaining fixture has been carried out with a trephine drill in order to contain the bone loss.

Double localization of keratoacantho-ma on the cutaneous and mucosal sides of the lower lip: report of a case.

The clinical course and histological features of keratoacanthoma (KA) are well recognized by dermatologists and pathologists, but they are less familiar to dental professionals. The aims of this report were to describe an unusual case of simultaneous intraoral and labial KA and to identify the most important aspects of the clinical management of this lesion.

Short dental implants: a systematic review.

Growing evidence has suggested the utility of short dental implants for oral reconstructive procedures in clinical situations of limited vertical bone height. The aim of this review was to systematically evaluate clinical studies of implants < 10 mm in length, to determine short implant-supported prosthesis success in the atrophic jaw. Implant survival, incidence of biological and biomechanical complications, and radiographic peri-implant marginal bone loss were evaluated. Screening of eligible studies, quality assessment, and data extraction were conducted by two reviewers independently. Meta-analyses were performed by the pooling of survival data by implant surface, surgical technique, implant location, type of edentulism, and prosthetic restoration. Two randomized controlled trials and 14 observational studies were selected and analyzed for data extraction. In total, 6193 short-implants were investigated from 3848 participants. The observational period was 3.2 ± 1.7 yrs (mean ± SD). The cumulative survival rate (CSR) was 99.1% (95%CI: 98.8-99.4). The biological success rate was 98.8% (95%CI: 97.8-99.8), and the biomechanical success rate was 99.9% (95%CI: 99.4-100.0). A higher CSR was reported for rough-surfaced implants. The provision of short implant-supported prostheses in patients with atrophic alveolar ridges appears to be a successful treatment option in the short term; however, more scientific evidence is needed for the long term.

Data protection, privacy.

The topic of data protection is referred closely to the concept of privacy--characterized by the American political philosophy in order to indicate a sphere recognized as personal, and therefore private or intimate, of the person, which exclude other individuals or society--whose protection has deep roots in the international right. The technological progress in the field of telecommunication has increased the facility of acquisition and spreading of information, the exchange of data, and the possibility of access to confidential information by other people. This made it made necessary the regulation of the management and the transfer of these information in order to protect individual rights and, on the other hand, an easy circulation of data for legitimate and useful goals.

Local complications in dental implant surgery: prevention and treatment.

There are many detailed articles regarding accidents and local complications in dental implantation. Comparison of the data they report is not always easy because different criteria have been followed in the various classifications and there is confusion between the terms accident and complication. The aim of this paper is to propose a classification that considers the timing of the events and makes a distinction between the two terms. Accidents are events that occur during surgery and complications are all the pathological conditions that appear postoperatively. The proper diagnostic procedures and surgical techniques for complications prevention and treatment are also described.

An unexpected death during oxygen-ozone therapy.

An unexpected death is described that was caused by gas embolism that occurred during oxygen-ozone (O2/O3) therapy administered by autohemotransfusion for psoriasis. This unusual complication suggests the necessity of investigating benefits and adverse effects of medical ozone application.

Death due to a leiomyosarcoma of the pulmonary artery.

Leiomyosarcomas of the pulmonary arteries are rare neoplasms seldom diagnosed during the patient's lifetime. We report a case of unexpected death in a 44-year-old man due to a leiomyosarcoma originating from the main pulmonary trunk and involving the right and left arteries as far as the lobar ramifications. The patient died after a 2-year history of bronchiectasis and chronic bronchopneumonia with weight loss and occasional episodes of syncope during the last 4 months. Immunohistochemical demonstration for alpha-smooth muscle actin was necessary to make a histological diagnosis of leiomyosarcoma. A review of pulmonary artery leiomyosarcomas is also presented.

Can steroid use be a precipitant in the development of an eating disorder?

OBJECTIVE: Corticosteroids have a wide range of clinical indications in the treatment of both acute and chronic medical illnesses, and weight gain is a well-documented side effect of their use. In this paper, we describe eight individuals with an eating disorder, which appeared following steroid administration for a medical condition. METHOD: These findings, support the possibility that the excessive weight gain resulting from steroid use can be a precipitating factor in the development of an eating disorder, particularly among female adolescents and young women who are preoccupied with their appearance and weight. RESULTS: Physicians caring for women receiving corticosteroids should therefore familiarize themselves with these patients' pre-morbid and current eating habits, as well as their weight, dieting and body image histories. DISCUSSION: The relevance of these cases for furthering our understanding of the development and treatment of eating disorder is also discussed.