A novel workflow for computer guided implant surgery matching digital dental casts and CBCT scan.

Nowadays computer-guided "flap-less" surgery for implant placement using stereolithographic tem-plates is gaining popularity among clinicians and patients. The advantages of this surgical protocol are its minimally invasive nature, accuracy of implant placement, predictability, less post-surgical discomfort and reduced time required for definitive rehabilitation. Aim of this work is to describe a new protocol (Smart Fusion by Nobel Biocare), thanks to which is now possible to do a mini-invasive static guided implant surgery, in partially edentulous patients with at least 6 remaining teeth, without the use of a radiographic guide. This is possible thanks to a procedure named surface mapping based on the matching between numerous points on the surface of patient's dental casts and the corresponding anatomical surface points in the CBCT data. The full protocol is examined focusing the attention on the clinical and laboratory procedures. CONCLUSIONS: Also with some critical points and needing an adequate learning curve, this protocol allows to select the ideal implant position in depth, inclination and mesio-distal distance between natural teeth and or other implants enabling a very safe and predictable rehabilitation compared with conventional surgery. It represents a good tool for the best compromise between anatomy, function and aesthetic, able to guarantee better results in all clinical situations.

Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis.

CONTEXT: Transcatheter ablation of atrial fibrillation (AF) has undergone important development, with acceptable midterm results in terms of the safety and recurrence. A meta-analysis was performed to identify the periprocedural complications, midterm success rates and predictors of recurrence after AF ablation. METHODS AND RESULTS: 4357 patients with paroxysmal AF, 1083 with persistent AF and 1777 with long standing AF were included. The pooled analysis showed that there was an in-hospital complication rate of tamponade requiring drainage of 0.99% (0.44-1.54; CI 99%), stroke with neurological persistent impairment of 0.22% (0.04-0.47; CI 99%), and stroke without of 0.36% (0.03-0.70; CI 99%) After a follow up of 22 (13-28) months and 1.23 (1.19-1.5; CI 99%) procedures per patient, the AF recurrence rate was 31.20% (24.87-34.81; CI 99%). The persistent AF patients exhibited a greater risk of recurrence after the first ablation (OR 1.78 [1.14, 2.77] CI 99%), but a trend towards non significance was present in the patients with more than one procedure (OR 1.69 [0.95, 3.00] CI 99%). The most powerful predictors of an AF ablation failure in the overall population were a recurrence within 30-days (OR 4.30; 2.00-10.80), valvular AF (OR 5.20; 2.22-9.50) and a left atrium diameter of more than 50mm (OR 5.10 2.00-12.90; all CI 95%). CONCLUSIONS: Persistent AF remains burdened from higher recurrence rates, however not so following redo-procedures. Three predictors, valvular AF, a left atrium diameter longer than 50mm and recurrence within 30 days, could be appraised to drive selection of patients and therapeutic strategy.

[Quality evaluation of audiometric findings on a sample of workers affected by probable nature of occupational hearing loss]. / La valutazione della qualità degli accertamenti audiometrici su un campione di lavoratori affetti da ipoacusia di probabile natura occupazionale.

The aim of the study is to evaluate the quality of n. 335 audiometric tests received between 2006 and 2012 in support of n. 158 reports of suspected occupational hearing loss in the companies of the Biella area by comparison with the Recommendations for the prevention of risks from noise in accordance with Title VIII-Chapter II of Decree 09.04.2008 n. 81 posted on Piedmont Region Official Gazette Part I and II number 16 of 23 April 2009. Analysis of the results showed a partial improvement in the quality of audiometric tests between before and after the publication of these recommendations.

[The surveillance of occupational risks. Problems and perspectives of the recent legislative framework after the national preliminary survey]. / I dati sanitari aggregati e di rischio dei lavoratori sottoposti a sorveglianza sanitaria. Risultati preliminari dello studio pilota nazionale sulle comunicazioni ex art. 40. D.lgs 81/2008.

BACKGROUND: Legislation in Italy concerning health, safety and prevention at the workplace recently established a new data communication standard OBJECTIVES: The findings are reported of a specific survey on 18 Local Health Units (ASL) over the entire Italian territory, aimed at identifying the critical points in data management and analyze the available information. METHODS: The occupational health physician for each company must collect and transmit information on the number of workers submitted to health surveillance protocols to the Local Health Unit. Information must be divided by risk factor and gender Local health Units then transmit the data to the Regions and finally to the Italian National Institute for Occupational Safety and Prevention (ISPESL). RESULTS: A sample of 22.977 companies was studied, providing information on about 410,009 workers undergoing health surveillance protocols. Carrying or moving heavy loads, exposure to noise, VDU and chemical substances were the most frequent risk factors. The difference between genders was significant in risk allocation, with exposures to VDU and biological agents prevalently among females. CONCLUSIONS: The information thus collected suffered from a lack of data organization and completeness in the sample under study, but nevertheless provides preliminary evidence of a map of occupational risks on a national basis, confirming the potential for the new law (D.Lgs 81/2008) to investigate health safety and prevention at the workplace.

[Carpal tunnel syndrome (CTS) in the Piedmont Region: regional incidence and prevalence of CTS based on hospital records of patients who underwent surgery]. / La sindrome del tunnel carpale in Piemonte: un esempio regionale di stima di incidenza e prevalenza di casi trattati chirurgicamente.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of the upper extremities. Despite CTS being a priority for public health, only a few studies have investigated the prevalence and incidence in the general population. In Italy, administrative data are available only for CTS cases which were judged work-related by the Workers Compensation Board. These data indicate a steady increase in CTS over the last decade. Hospital admission archives (SDO) also contain information on CTS patients who underwent surgery. OBJECTIVES: To determine: 1) the incidence and prevalence of first CTS, based on hospital records of patients who underwent surgery in the Piedmont Region; 2) to describe the geographical and temporal variation. METHODS: Crude and standardized incidence rates of CTS were computed for the period 2002-2003; geographical variation was assessed using bayesan estimators to detect spatial clusters. Crude and standardized prevalence rates of first hospitalization were calculated for every two-year period between 1996 and 2003. RESULTS AND CONCLUSIONS: The crude incidence rate was 227.2 (C.I.95% 221.9-232.7) per 100,000 women and 54.4 (C.I. 95% 51.9-57.1) per 100,000 men. The prevalence of first hospitalization was very high and varied widely by geographic area. Two possible explanations for such wide variation between areas include differences in exposure to risk factors for CTS and in the diagnostic criteria used. The increasing prevalence over time was only partly explained by an increase in work-related cases. The development of standardized diagnostic criteria would improve understanding of the effect of workplace exposures on CTS. The number of new cases per year in Piedmont was estimated at 1,500, much higher than the compensation claims related to CTS. Health education campaigns addressed to general practitioners on compensation law could improve reporting to the workers' compensation board.

[Carpal tunnel syndrome: example of assessment of the role of occupational exposure based on self-reported data]. / Sindrome del tunnel carpale: un esempio di valutazione del ruolo delle esposizioni lavorative basata su dati auto- riferiti.

BACKGROUND: The prevalence of surgical cases of carpal tunnel syndrome (CTS) tends to increase in the general population in Italy. Nevertheless, it is still unclear what percentage of CTS is attributable to occupational exposure, to ergonomic or psychosocial factors. Moreover, the problem of obtaining a reliable definition of occupational exposure in the absence of direct observation and measurement in the workplace remains unsolved. Piedmont (north-western Italy) is one of the Italian regions with the highest number of musculoskeletal disorders recognized and compensated as work-related. The aim of this study was to estimate the proportion of work-related CTS surgical cases, based on self-reported exposure data. METHODS: An interview-based questionnaire included items on medical history, workplace exposures and non-occupational risk factors for CTS. The study was carried out between June 2003 and November 2004. A total of 260 adult patients (aged 18-65 years) were interviewed. An evaluation of the questionnaires was made by 3 occupational physicians, assigning every patient a probability score of occupational aetiology. Seventy-four per cent of the sample were female; the mean age was 48.4 years. RESULTS: Seventy-one percent of the patients reported bilateral CTS. Occupational exposure preceded the onset of CTS symptoms for 184 patients. The probability that CTS was work-related was estimated as high for 66 patients (26% of the sample). Agreement among examiners, evaluated using the kappa statistic, was good. CONCLUSIONS: Despite the limitations of the study, the number of cases attributable to occupation was much higher than the number of diseases reported to INAIL (National Institute for the Insurance of Industrial Accidents), which suggests that there is substantial under-notification in Italy.

Three-year findings of an early lung cancer detection feasibility study with low-dose spiral computed tomography in heavy smokers.

BACKGROUND: Low-dose spiral computed tomography (sCT) showed a four-fold increase in the detection rate in high-risk subjects and a higher percentage of stage I lung cancer in comparison with chest X-ray. However, there is a considerable discrepancy among studies in the percentage of lung nodules, overall lung cancer and stage I detection rate. SUBJECTS AND METHODS: From April to December 2001, 520 asymptomatic volunteers aged >or=55 years with a history of cigarette smoking >or=20 pack-years and no previous cancer were enrolled to receive an annual sCT of the chest for five consecutive years. RESULTS: Seventy three per cent were male, median age was 59 years and 91% were current smokers. At baseline, nodules >or=5 mm were detected in 114 (22%) undergoing sCT; the size of lung nodules ranged from 5 to 9.9 mm in 81.5% of the cases. Five (1%) cases of lung cancer were detected. In two additional cases a pathological diagnosis of atypical adenomatous hyperplasia was made. Three new cases of lung cancer were detected in the second and third year of the study. One interval case was detected during the third year. CONCLUSIONS: Despite some promising data, convincing evidence from ongoing randomized trials is needed to support the routine use of sCT as a recommended tool for screening of lung cancer.

Maniobras para preservar continencia y potencia sexual en Prostatectomia Radical (PR) abierta y laparoscopica / Tecnical modifications to preserve continence and erectile function in open and laparoscopic radical prostactectomy (RP)

Introduccion: La incontinencia de orina y la disfuncion sexual, son las complicaciones mas frecuentes de la PR.Los abordajes anatomicos consiguieron una disminucion de su incidencia. Para mejorar estas complicaciones, se perfeccionaron algunos pasos de la tecnica basandonos en videos de PR abierta filmados con optica laparoscopica. Material y metodos: Se modifico el manejo del complejo venoso dorsal evitando involucrar fibras del esfinter en los puntos de hemostasia, el manejo de los puntos de la uretra evitando fijarla al tejido periuretral, la preservacion de los nervios erectores y la confeccion de la anastomosis vesico-uretral. Se comparo un grupo historico, analizado retrospectivamente, de 40 pacientes operados entre 10/1999 y 12/2001 con 40 pacientes operados entre 1/2002 y 12/2003, de analisis prospectivo, en quienes se implementaron las modificaciones tecnicas. Resultados: Se considero incontinencia de orina sin proteccion en 37/40 (92,5 por ciento) del grupo historico y 39/40 (97,5 por ciento) del grupo con modificaciones, continencia total en 29/40 (72,5 por ciento) y 32/40 (80 por ciento), erecciones espontaneas o con sildenafil en 22/35 (62,8 por ciento) y 27/37 (72,9 por ciento) y el tiempo para recuperacion de la ereccion 6,8 vs. 3,0 meses (P<0,05). Conclusiones: Las modificaciones introducidas disminuyeron la incidencia de la incontinencia y la disfuncion sexual, con diferencias significativas solo en el tiempo de recuperacion de la eleccion

Maniobras para preservar continencia y potencia sexual en Prostatectomia Radical (PR) abierta y laparoscopica / Tecnical modifications to preserve continence and erectile function in open and laparoscopic radical prostactectomy (RP)

Introduccion: La incontinencia de orina y la disfuncion sexual, son las complicaciones mas frecuentes de la PR.Los abordajes anatomicos consiguieron una disminucion de su incidencia. Para mejorar estas complicaciones, se perfeccionaron algunos pasos de la tecnica basandonos en videos de PR abierta filmados con optica laparoscopica. Material y metodos: Se modifico el manejo del complejo venoso dorsal evitando involucrar fibras del esfinter en los puntos de hemostasia, el manejo de los puntos de la uretra evitando fijarla al tejido periuretral, la preservacion de los nervios erectores y la confeccion de la anastomosis vesico-uretral. Se comparo un grupo historico, analizado retrospectivamente, de 40 pacientes operados entre 10/1999 y 12/2001 con 40 pacientes operados entre 1/2002 y 12/2003, de analisis prospectivo, en quienes se implementaron las modificaciones tecnicas. Resultados: Se considero incontinencia de orina sin proteccion en 37/40 (92,5 por ciento) del grupo historico y 39/40 (97,5 por ciento) del grupo con modificaciones, continencia total en 29/40 (72,5 por ciento) y 32/40 (80 por ciento), erecciones espontaneas o con sildenafil en 22/35 (62,8 por ciento) y 27/37 (72,9 por ciento) y el tiempo para recuperacion de la ereccion 6,8 vs. 3,0 meses (P<0,05). Conclusiones: Las modificaciones introducidas disminuyeron la incidencia de la incontinencia y la disfuncion sexual, con diferencias significativas solo en el tiempo de recuperacion de la eleccion(AU)

Biopsia retroperitoneoscópica de tumores retroperitoneales / Retroperitoneoscopic biopsy of retroperitoneal tumors

Objetivos: Describir la técnica de la biopsia de tumores retroperitoneales por vía retroperitoneoscópica y analizar los resultados obtenidos en nuestro servicio. Material y método: Entro los años 1996 y 2003 se han realizado 18 biopsias de tumores retroperitoneales por vía retroperitoneoscópica en 16 pacientes ( en un paciente se realizó el procedimiento en 3 oportunidades). La técnica quirúrgica fue con el paciente en decúbito lateral intermedio con elevación del flanco y abordaje retroperitoneal. Se colocaron 2 trocares de 10 y 5mm, exposición del retroperitoneo, apertura de la fascia de Gerota, disección de la masa tumoral y biopsia incisional analizada por congelación. Resultados: se diagnosticaron 12 linfomas (11 no Hodgkin y1 Enfermedad de Hodgkin), 1 mesotelioma, 1 schwannoma, 1 metástasis ganflionar de cáncer de mama y metástasis adrenal de cáncer de pulmón. Se obtuvo diagnóstico anátomo-patológico en todos los pacientes biopsiados. El material permitió efectuar estudios citológicos por impronta, evaluación histológica e inmunofenotipo por citometria de flujo. No se registraron complicaciones y el tiempo de internación fue menor de 24 horas. Conclusiones: La técnica de biopsia de tumores retroperitoneales por retroperitoneoscopia propociona buenos resultados con baja morbilidad, permitiendo obtener el diagnóstico anátomo-patológico en todos los casos. En los kinfomas posibilitó la clasificación de subtipos y repetir la biopsia en caso necesario

Biopsia retroperitoneoscópica de tumores retroperitoneales / Retroperitoneoscopic biopsy of retroperitoneal tumors

Objetivos: Describir la técnica de la biopsia de tumores retroperitoneales por vía retroperitoneoscópica y analizar los resultados obtenidos en nuestro servicio. Material y método: Entro los años 1996 y 2003 se han realizado 18 biopsias de tumores retroperitoneales por vía retroperitoneoscópica en 16 pacientes ( en un paciente se realizó el procedimiento en 3 oportunidades). La técnica quirúrgica fue con el paciente en decúbito lateral intermedio con elevación del flanco y abordaje retroperitoneal. Se colocaron 2 trocares de 10 y 5mm, exposición del retroperitoneo, apertura de la fascia de Gerota, disección de la masa tumoral y biopsia incisional analizada por congelación. Resultados: se diagnosticaron 12 linfomas (11 no Hodgkin y1 Enfermedad de Hodgkin), 1 mesotelioma, 1 schwannoma, 1 metástasis ganflionar de cáncer de mama y metástasis adrenal de cáncer de pulmón. Se obtuvo diagnóstico anátomo-patológico en todos los pacientes biopsiados. El material permitió efectuar estudios citológicos por impronta, evaluación histológica e inmunofenotipo por citometria de flujo. No se registraron complicaciones y el tiempo de internación fue menor de 24 horas. Conclusiones: La técnica de biopsia de tumores retroperitoneales por retroperitoneoscopia propociona buenos resultados con baja morbilidad, permitiendo obtener el diagnóstico anátomo-patológico en todos los casos. En los kinfomas posibilitó la clasificación de subtipos y repetir la biopsia en caso necesario(AU)

[The role of aromatase inhibitors in the treatment of breast neoplasms. An evaluation of clinical efficacy and the tolerability profile]. / Il ruolo degli inibitori dell'aromatasi nel trattamento del tumore della mammella.

Constant acquisitions regarding endocrine pathogenesis and the biology of breast neoplasms have led to the evolution of hormone manipulation as a therapeutic option in patients suffering from this disease. There has been a shift from ablative surgical procedures to the use of drugs offering greater clinical efficacy and an improved tolerability profile. Since the late 1970s tamoxifen has been regarded as the gold standard for hormone treatment in hormone-responsive breast neoplasm, but promising new endocrine agents are now being compared in random trials. Of these, the latest generation of aromatase inhibitors appears to gather the widest consensus on the basis of the results published to date. This article aims to review this new category of drugs, illustrating their rationale of use, the results obtained in the treatment of breast neoplasm and the main studies in which they are currently being investigated.

A case-control study of carcinomas of the nose and paranasal sinuses in the woolen textile manufacturing industry.

A population-based case-control study was conducted in Biella, which is located in northwestern Italy, to investigate the reported association between sinonasal carcinomas and woolen fabrics production. The study included 33 cases diagnosed during 1976-1988 (14 adenocarcinomas, 11 epidermoid carcinomas, 3 other specified carcinomas, 1 unspecified carcinoma, and 4 cases without histologic confirmation) and 131 controls. No association was found with smoking. As reported previously, excess risks were observed in wood and furniture workers (odds ratio [OR] = 4.4, 95% confidence interval [95% CI] = 1.41-13.4) and in the leather industry (OR = 3.5, 95% CI = 0.6-20.3). Odds ratios in the wood and furniture industry were 22.0 (95% CI = 4.4-124.0) for adenocarcinomas and 0.9 (95% CI = 0.4-8.3) for epidermoid carcinomas. No association was found with the woolen textile or garment industries (OR = 0.8, 95% CI = 0.2-2.8), nor with farming, construction, metal works, and transport. Odds ratios for the textile industry did not vary with length of exposure or histologic type. Power for detecting an odds ratio of 3.0 at the 95% level of significance was 40%.

[Epidemics of lung tumors in a Biella tannery]. / Epidemia di tumori polmonari in una conceria del biellese (VC).

A cluster of 7 lung cancer deaths among workers of a small tannery in Biella is reported. The major process in the plant, until the end of World War II, was chromium and vegetable tanning. A historical cohort study was carried out on a total of 353 male workers. The expected number of death was estimated on the basis of local mortality rates. An SMR for lung cancer of 449 (95% C.L. 180-925) was found for the entire cohort. Excluding workers non specifically employed in tanning operations, the SMR for lung cancer increased to 1087 (95% C.L. 352-2533). In order to control for potential confounders a nested case-control study was planned. The next-of-kin of 8 cases deceased for lung cancer and 32 controls matched by age were interviewed on smoking habits and previous jobs. Logistic regression analysis showed an O.R. of 6.94 (95% C.L. 1.18-40.73), adjusted for smoking habits and occupational history, for subjects involved in tanning operations. A registry of incident cases of cancer was established in order to avoid biased findings based on cluster cases.

A descriptive method for automatically analysing uterine forces during labor.

In recent years many authors have considered evaluation of uterine contractility by means of analysis of amniotic fluid pressure variations. The reason for this is the introduction in obstetrical management of equipment for the recording of amniotic fluid pressure variations which is a powerful facility for clinical investigation, particularly, if it is considered that previous research has been based upon clinical evaluations and measurements carried out by extra and intra-uterine manometers. Important results of these studies are the definitions of two labor indices, the Montevideo unit (defined as the sum of the maxima of the pressure signal of all uterine contractions during a time interval of ten minutes) and the Alexandria unit (which also takes into account the duration of the contraction:this unit corresponds to the Montevideo unit multiplied by the mean value of the duration of the considered contractions). It is very difficult, however, in fact almost impossible, to summarize the evaluation of labor as the only indes. Many parameters which characterize the shape, frequency and tone of contraction patterns, may be themselves important and could indicated the presence of pathological elements. At present it is not well known which parameters are useful. Since many different sets of parameters can be chosen to characterize the signal, the first point is to determine which is more important clinically. The aim of this paper is to study a procedure of intrauterine pressure signal analysis, which allows the description of uterine contraction by a set of parameters that is interesting for research purposes during labor and suitable for continuous monitoring. The set of parameters was chosen in order to repeat quantitatively the qualitative analysis which a physician can make by a simple inspection of the pressure signal oscillogram. Visual examination of the tocograph results is a clumsy means for evaluating labor performed by an experienced physician. It may appear that the pressure starts "suddenly" (or not) to increase and rises "quickly" (or "slowly"), then it maintains "high" (or "low") mean values for a "long" (or "short") time, with "smooth" (or "irregular") behaviour, then it decreases "quickly" (or slowly, until "suddenly" (or "smoothly") it reaches its basal level, whd the beginning of another uterine contraction is "long" (or "short", during this time the pressure is "almost" constant (or has a "drift" and/or presents "many irregularities"). Therefore the 25 chosen parameters replace quantitatively the above qualitative evaluations. These parameters are not put forward to indicate directly the presence of pathological facttor, but summarize all the interesting clinical aspects of the contraction waveform for research and monitoring purposes. The parameters are extracted using a pattern recognition algorithm based on a structural representation of the contraction (Tables I, II, V)...