Unconventional use of Invisalign® in the treatment of ectopic palatal maxillary canines.

BACKGROUND: The proper development of the dental arches, including the eruption and correct positioning of the canines in the arch, is essential for the oral health of growing patients. Impacted canines not only give rise to functional challenges but also pose esthetic issues for patients. The aim of this article is to show if it is possible to benefit from the exclusive use of transparent aligners to guide the eruption of ectopic upper canines into the arch in the correct position. CASE REPORT: The subject of the study is the clinical case of a 13-year-old female growing patient who presented displaced upper permanent canines located in the palatal ectopic site. Following the surgical extraction of the retained deciduous elements, treatment with aligners for repositioning the ectopic canines in the arch was performed in two phases. At the end of the treatment, a Class I canine was achieved with satisfactory repositioning of the upper canines in the arch. CONCLUSION: The use of transparent aligners makes it possible, with some procedural precautions and in carefully selected cases, to reposition the ectopic palatal canines in the dental arch using a treatment that is both esthetic and effective.

Hip fractures in Italy: 2000-2005 extension study.

SUMMARY: A total of 507,671 people > or =65 experienced hip fractures between 2000 and 2005. In 2005, 94,471 people > or =65 were hospitalized due to hip fractures, corresponding to a 28.5% increase over 6 years. Most fractures occurred in patients > or =75 (82.9%; n = 420,890; +16% across 6 years), particularly in women (78.2%; n = 396,967). INTRODUCTION: We aimed to analyze incidence and costs of hip fractures in Italy over the last 6 years. METHODS: We analyzed the national hospitalization and DRG databases concerning fractures occurred in people > or =65 between 2000 and 2005. RESULTS: A total of 507,671 people > or =65 experienced hip fractures across 6 years, resulting in about 120,000 deaths. In year 2005 94,471 people aged > or =65 were hospitalized due to hip fractures, corresponding to a 28.5% increase over 6 years. The majority of hip fractures occurred in patients > or =75 (82.9%; n = 420,890; +16% across 6 years) and particularly in women (78.2%; n = 396,967). Among women, 84.2% of fractures (n = 334,223; +28.0% over 6 years) were experienced by patients > or =75, which is known to be the age group with the highest prevalence of osteoporosis, accounting for 68.6% of the overall observed increase in the total number of fractures. Hip fractures in men > or =75 increased by 33.1% (up to 16,540). Hospitalization costs increased across the six examined years (+36.1%) reaching 467 million euros in 2005, while rehabilitation costs rose up to 531 million in the same year. CONCLUSIONS: Hip fractures of the elderly are increasing and represent a major health problem in industrialized countries such as Italy.

Effect of glutathione monoethyl ester on glutathione level and cardiac energetics in reperfused pig heart.

The GSH level in myocardial tissue represents an important defense mechanism against oxygen toxicity. Since the ischemia-induced depletion of GSH might favour the cytotoxicity of oxygen-derived free radicals produced during reperfusion, we assessed the effects of the GSH donor, glutathione monoethylester, in anaesthetized pigs subjected to 90 minutes of coronary occlusion followed by 30 minutes reperfusion. The drug was infused intracoronarily at a dose of 1 mg/ml (0.5 ml/min) throughout the experimental period. After coronary occlusion and reperfusion, we found a decrease in GSH, ADP, ATP and phosphocreatine levels in reperfused compared with non-ischemic tissue. Less evident were the differences in mitochondrial function, there being only a reduction in the reperfused tissue of the respiratory control index and state 3 respiration values when pyruvate was used as substrate. The infusion with glutathione monoethylester decreased the depletion of tissue GSH and improved the GSH/GSSG ratio, particularly in the non-ischemic tissue. Moreover, the drug decreased the mitochondrial dysfunction at the level of pyruvate utilization and partially prevented the fall in ATP in the reperfused tissue. This study confirms a possible protective effect of glutathione monoethylester in the prevention of reperfusion-induced myocardial damage.

Changes in myocardial mitochondrial respiration after ligation of the coronary artery in pigs.

After ligation of the left coronary artery, porcine cardiac mitochondria were isolated by homogenizing the tissue and treating the myofibrillar pellet with nagarse. When compared with unligated controls, the ischemic myocardium showed decreases in phosphocreatine (to 41%), ATP (to 56%) and in the mitochondrial respiratory control index (to 69% and 78% as measured with glutamate and succinate respectively). No changes were found in the corresponding P/O ratios. Similar results were obtained upon separation of the mitochondria into two main fractions by a density gradient technique, though only one of these fractions showed a fall in succinate-supported respiration. The results suggest that ischemia decreases the NADH-dehydrogenase activity of cardiac mitochondria.

[Importance of metabolic disorders and endocardial viability ratio in the prognosis of open-heart operations. Experimental study of the pig heart protected by potassium cardioplegia in hypothermia]. / Importanza delle turbe metaboliche e del subendocardial viability ratio nella prognosi di interventi a cuore aperto. Studio sperimentale sul cuore di maiale protetto con cardioplegia potassica in ipotermia.

The aim of this study was to investigate the protective efficacy of potassium cardioplegia in general moderate hypothermia, in five pigs, after 90 minutes of myocardial ischemia induced by extracorporeal circulation (ECC) and aortic clamping. The behaviour of subendocardial supply demand ratio (DPTI/TTI), of CSBF (coronary sinus blood flow) and numerous hemodynamic parameters was evaluated in addition to lactate myocardial metabolism changes, at rest, after 90 minutes of total ECC and during a 60 minutes reperfusion period. The reperfusion period included two phases: during the first (15-20 minutes) the animals were in ECC with unclamped aorta; spontaneous circulation was instituted during the second one (40 minutes). A marked increase in CSBF was observed at aortic clamp removal during the first phase (post ischemic reactive hyperemia). Coronary sinus lactate release was also noted, probably due to wash-out of previously sequestered acid metabolites during aortic clamping (90 minutes). At the onset of the second phase a depressed left ventricular performance and low DPTI/TTI values were shown. A rapid return (20 minutes) to normal values of this parameter was then noted. DPTI/TTI normalization results strictly correlated to the progressive improvement in myocardial performance. Hypothermic potassium cardioplegia seems therefore to prevent the irreversible myocardial damage and favour a fast recovery of cardiac function.

[The kidney in shock. A new experimental method for the induction of controlled shock. I]. / Il rene da shock. Nuova tecnica sperimentale per l'induzione dello shock controllato. Nota I.

In this research we identify a new experimental model to study the shock-kidney, since this complication occurs with discreet frequency during high surgery operation. The model that better reproduce the surgical shock-kidney is the controlled hypovolemic shock. We used for this experiment five pigs of weight between 40 and 50 kg and were studied the following data: Ecg, arterial pressure, central venous pressure, diuresis (by incannulation of both ureters), renal arterial flow, levels of the renin in the renal vein. The measurements were made before, during and after the shock. The hypovolemic shock was induced by removing from carotid artery a sufficient quantity of blood to bring the pressure to 45-50 mmHg. This pressure level was kept constant for 120 min and then was reported to normal level by introducing the blood previously removed. During the experiment no kind of drugs were used.

[The kidney in shock. Changes of some hemodynamic and bio-humoral parameters. II]. / Il rene da shock. Andamento di alcuni parametri emodinamici e bio-umorali. Nota II.

In our experiments on 5 pigs of weight between 40-50 kg we've noticed changes of the parameters occurring precociously during the initial stage of the shock. Particularly we observed a sudden reduction of diuresis reaching total anuria in 15 min and persistence of this anuria for the entire time of the shock (120 min). Immediately after introduction of the removed blood the arterial pressure and the diuresis return to normal value. Concerning the blood flow in renal artery it was observed a gradual decreasing to 10-30 ml/min (normal value = 120-180 ml/min). After the restoration of the blood volume we did'nt notice a clean resumption of the flow although arterial pressure reached normal levels (flow value = 70% of the basal value). The hematic level of K+ undergoes a sudden increase that reaches. Maximal level compatible with animal's life. Within 45-60 min from the beginning of the shock and than decrease with restarting of the diuresis. Creatinine reaches 2 mg/ml in 60 min and remain constant during the following 120 min. The value of the plasma renin were precociously raised, reaching values particularly elevated after 90-120 min from the beginning of the shock and decreasing rapidly with the introduction of the removed blood (parallel behaviour of the arterial pressure).

[Cardiac metabolism in angina patients before and after aorto-coronary bypass]. / Il metabolismo cardiaco dell'anginoso prima e dopo by-pass aorto-coronarico.

The haemodynamic indices proposed by Buckberg et al. have been used to evaluate total coronary flow and its distribution to the subendocardial tissue. The following conclusions were drawn from the data obtained in humans and in experimental pathology: 1) in regional ischaemia (angina, myocardial infarction), the DPTI/TTI ratio expresses the degree of subendocardial hypoperfusion with fair approximation, although it has some theoretical limitations, 2) in total myocardial ischaemia, as occurs during ECC, the index provides an accurate picture of the subendocardium and a useful idea of the real effectiveness of the means of myocardial protection.

Abdominal aortic aneurysm and horseshoe kidney.

Abdominal aortic aneurysm and horseshoe kidney is an unusual association. One case successfully operated upon is presented. Embriology, clinical pattern and diagnostic approach is also discussed.

[Measurement of the stress deformation ratio in the left ventricle in systole]. / Misura del rapporto sforzo/deformazione nel ventricolo sinistro in sistole.

Thirty-three subjects, fourteen of which with normal heart, ten with aortic insufficiency and nine with myocardiopathy, were studied by echocardiography and sfigmomanometric arterial pressure measurements. The ejection fraction EF, the left ventricular equatorial wall stress sigma, the corresponding left ventricular strain epsilon and the ratio E = sigma/epsilon have been determined for all subjects. The mean values of these quantities, at the onset of ventricular systole, for normal hearts are: EF = 0.67 +/- 0.05; sigma = (2.67 +/- 0.41) . 10(5) dine/cm2; E = (0.99 +/- 0.15) . 10(6) dine/cm2; for patients with aortic insufficiency: EF = 0.51 +/- 0.09; sigma = (2.74 +/- 1.10) . 10(5) dine/cm2; E = (1.51 +/- 0.69) . 10(6) dine/cm2; for patients with miocardiopathy: EF = 0.41 +/- 0.06; sigma = (4.36 +/- 2.08) . 10(5) dine/cm2; E = (3.20 +/- 1.19) . 10(6) dine/cm2. After a discussion on the significance of sigma and E parameters, it is inferred that E may be a useful measure of ventricular function. This parameter is different for distinct cardiac diseases and, within the limits of the same disease, probably will change according to seriousness.

The surgical treatment of Kienböck's disease.

A long term follow up of thirty two patients operated on for Kienböck's disease of the semilunar bone at the Istituto Ortopedico Toscano in the last twenty eight years has been carried out. Three types of operation were performed; excision of the semilunar, lengthening of the ulna, and shortening of the radius. The best results were obtained from shortening the radius. Good results were also obtained in cases in which there was no preoperative relative shortening of the ulna at the inferior radio-ulnar joint.