Reliability and validity in Mexico of the Spanish version of the Children's Fear Survey Schedule - Dental Subsca.

AIM: Low attendance and abandonment of dental treatment caused by dental fear varies from 6% to 20%. Various specific scales have been used to evaluate and measure dental fear, like Children´s Fear Survey Schedule - Dental Subscale, which is considered the "gold standard", due to its efficacy and validity. However, not all the studies that have been conducted have performed the Exploratory Factorial and Confirmation Analysis to infer the validity of the scale's content, which is why this study has as its main objective to analyse the confidentiality and validation of this scale. MATERIALS AND METHODS: In a sample of 163 school age children, from 6 to 12 years old, of both genders, from a public school, a Children's Fear Survey Schedule - Dental Subscale was applied to measure dental fear. The internal consistency of the scale was estimated with the Cronbach's alpha, we also performed the Exploratory Factorial Analysis with the method of the main component with Varimax rotation and the Confirmatory Factorial Analysis to confirm the structure of the factors. RESULTS: The Cronbach's alpha was obtained with a .837 (p?.05). The adequate coefficients were determined with the Kaiser-Meyer-Olkin (KMO = .843) and the Bartlett's test of specificity (?2 = 565,325, p= .000), in which there was a good adequate data, expressing an appropriate and intercorrelation between items or strongly related. The factorial structure showed four factors extracted, 4 factors explain the 53.57% of the accumulated variation; 14 items were above the .40. The statistics of the second and third model obtained adequate values in the statistics of goodness of fit index. CONCLUSION: The Mexican version of the CFSS-DS in the present study gives us data about the adaptation and validation of the dental fear scale of CFSSS-DS by the Exploratory Factorial Analysis through a model of structural equations. This means that this instrument is a trusting and valid tool to measure dental fear in the children's population of Mexico.

[Posterior mediastinum neoplasms: a case of schwannoma]. / I tumori del mediastino posteriore: un caso di schwannoma.

The Authors report the case of a 33-year-old male affected with an asymptomatic schwannoma of the posterior mediastinum, and review the relevant Literature, discussing the difficulties in making the differential diagnosis of the posterior mediastinum lesions, particularly in the pre-clinical phase. Neurogenic tumors represent about 75 percent of all tumors of mediastinum and about one third of all tumors of the mediastinum. They can originate from the peripheral nervous system group, from the sympathetic nervous system group or, in rare cases, from the vagus nerve. In adult patients, they are usually found by chance during radiographic examination of the thorax, and they are usually asymptomatic and benign. During preoperative evaluation, a magnetic resonance examination of rachis should be done to exclude the possibility of intraspinal involvement. If there are no contraindications, the treatment of choice should be surgical resection by means of thoracoscopy or thoracotomy, when size and location of the tumors allow it in order to prevent malignant evolution.

[Day surgery in breast reconstructive surgery: our experience]. / La day surgery nella chirurgia ricostruttiva della mammella: nostra esperienza.

Breast cancer is the most common tumour in Italy in the female population, counting for about 40000 new cases every year. The psychological aspects of breast mutilation and the social and economic implications are receiving increasing attention. Despite of the diffusion of screening programs to detect pre-clinical breast cancers, 30% of patients still undergo radical interventions. Therefore, many women present serious limitations of their social-life that can lead to severe depression since, in occidental countries, the biological function of the breast is less considered than its primary role of femininity and sexuality. The gold-standard is to conceal oncological radicality and aesthetic preservation. The Authors present their experience analysing the techniques employed.

[Therapeutic strategies in neoplasms of the distal bile duct and the Vater's ampulla]. / Strategie terapeutiche nelle neoplasie della via biliare distale e dell'ampolla di vater.

Malignant periampullary and ampullary tumors represent an anatomic and clinical entity of complex surgical approach due to the difficulty in setting out an early diagnosis, for the back of symptoms at early stages. The Authors at the Department of Surgery and Medical Technology Applications "F. Durante", University of Rome "La Sapienza", since 1990 to 2001 observed 19 cases. The results of surgical treatment of these tumors are here reported. By the analysis of the cases it is evident that long-term survival if mainly conditioned by prompt diagnosis stage of the tumor, and patient status before the operation.

[Neurinoma of the brachial plexus: 2 case reports]. / Neurinoma del plesso brachiale: due casi clinici.

Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves. A small percentage of these lesions arise from the brachial plexus. The Authors report two cases of schwannoma arising from the brachial plexus. Such lesions, usually asymptomatic, may cause sensitivity alterations or, less frequently, motor deficits in the involved arm. Tumour enucleation, avoiding damage to any of the nervous fascicles, is the treatment of choice.

[Atrial fibrillation and hyperthyroidism: results after thyroidectomy]. / Fibrillazione atriale ed irpertiroidismo: risultati dopo intervento di tiroidectomia.

Hyperthyroidism patients can develop atrial fibrillation (AF) with a frequency range between 10 and 25%. The Authors consider 256 hyperthyroid patients operated in their Department, from 1985 to 2001. Before and after surgery, thyroid examination, routine blood tests and common diagnostic evaluations were performed. The follow-up has been 12 months and during this period a L-Thyroxine (50-200 mg/die) therapy has been arranged. Before surgery 59 patients (23%) showed an AF associated with palpitations (76%), asthenia (66%), tremors (54%) and dyspnea (43%). The onset of AF was less than 1 months in 18% of cases, less than 3 months in 30% and chronic in remaining 52%. The 87% of patients was already pharmacologically treated. All the patients were treated with anticoagulants, with a INR value between 2 and 3. After the surgery, 47% of patients presented a restoration of the sinusal rhythm, while the 53% showed a stronger therapeutic responsiveness to specific antiarrhythmic therapy. Treatment of FA hyperthyroid patients with FA tends to normalize the function of the thyroid gland (euthyroidism). In our experience the restoring of sinusal rhythm usually develops in patients with 50 years of age (45 +/- 5 years), while in older patients AF tends to be resistant to treatment.

Papillomatosis and breast cancer: a case report and a review of the literature.

Papillomatosis is a relatively common (22%) benign microscopic lesion in the breast and rarely seen in women less than 30 years old. It is a papillary proliferation of the ductal epithelium which partly fills up smaller ducts and to degree distends them. The histological classification of this entity is controversial because similar or identical lesions have been classified using different terms such as epitheliosis and epithelial hyperplasia, and interpretation of published series has been difficult due to imprecise definition of this term. Clinical, radiological and histological patterns of this entity are often sufficient to raise concern as to possible malignancy. Moderate or florid hyperplasia without atypia is considered to carry slight (1,5-2 times) increase in risk of later developing cancer, while in the atypical hyperplasia the risk is four to five times that of the general population. The authors describe a case of papillonlatosis recentely observed in a 67 years old female patient and, confirmed the importance to establish an accurate preoperative diagnosis. It is important that the surgeon works with the pathologist to produce clear descriptive report of epithelial changes from normal through hyperplasia to atypias in order to establish a precise surgical indication.

Achilles tendon rupture. Is casting enough?

Rupture of the Achilles tendon is relatively uncommon, but most primary care physicians are occasionally faced with evaluation and treatment of such an injury. Diagnosis is not difficult and is based almost solely on the history and physical findings. To avoid misdiagnosis, the Thompson test should be performed in any evaluation of ankle pain. The three management options are casting, open surgical repair, and percutaneous surgical repair. Incidence of rerupture is slightly higher with casting, but the greater costs and higher risk of complications with surgical treatment seem to outweigh the benefits. Because there is no conclusive evidence that functional activity is any better with surgical repair, we recommend casting for a minimum of 8 weeks. After this, the patient should wear a heel lift and begin a supervised physical rehabilitation program.