Digital work-flow.

OBJECTIVE: The project presents a clinical case in which the digital work-flow procedure was applied for a prosthetic rehabilitation in natural teeth and implants. MATERIALS: Digital work-flow uses patient's photo for the aesthetic's planning, digital smile technology for the simulation of the final restoration and real time scanning to register the two arches. Than the scanning are sent to the laboratory that proceed with CAD-CAM production. RESULTS: Digital work-flow offers the opportunities to easily speak with laboratory and patients, gives better clinical results and demonstrated to be a less invasiveness method for the patient. CONCLUSION: Intra-oral scanner, digital smile design, preview using digital wax-up, CAD-CAM production, are new predictable opportunities for prosthetic team. This work-flow, compared with traditional methods, is faster, more precise and predictable.

Implant surgery and oral anticoagulant therapy: case report.

OBJECTIVES: This work aims to assess the risks both thromboembolic that bleeding of a management protocol "non-conservative" in patients on oral anticoagulant therapy (OAT) to be undergoing implant surgery. MATERIALS AND METHODS: We decided to take a surgical "non-conservative" protocol, to insert four implants in the aesthetic zone, without using flapless surgery and the surgical template. In accordance with the hematologist, the value of INR is lowered and warfarin was replaced with heparin low molecular weight, to have a better coagulation's control. RESULTS: The modern guidelines impose a protocol of conservative management in patients with OAT, with minimally invasive surgery, flapless, and use of surgical template to reduce the risk of uncontrolled bleeding. This, thanks to the team-work between dentist and hematologist, thanks to careful adjustment of INR and the use of local haemostatic agents, were not encountered any problems with bleeding or intra or postoperative. CONCLUSION: Surgical treatment of patients with OAT is a real problem for the oral surgeon, to treat every time in association with the hematologist. Applying this type of surgical procedure, different from today's guidelines, in our experience there were no post-operative complications (bleeding or bleeding); osseointegration has not been compromised and the prosthetic rehabilitation was completed successfully.

[Pancreatic pseudocysts: a rare complication of the Warren distal splenorenal shunt]. / Pseudocisti del pancreas: rara complicazione dello shunt spleno-renale distale sec. Warren.

The authors report a case of distal splenorenal shunt with splenopancreatic disconnection complicated by a huge pancreatic pseudocyst. This complication has not been described in the literature so far. The etiology and the opportunity of the splenopancreatic disconnection are discussed.

[Angiomyolipoma of the kidney: a case of spontaneous rupture]. / L'angiomiolipoma del rene: un caso di rottura spontanea.

After reporting the general features of renal angiomyolipoma (AML), either isolated or associated to other conditions (Bourneville sclerosis, Wunderlich's syndrome), the Authors discuss a case complicated by perirenal spontaneous hematoma, undergone emergency operation (simple nephrectomy). At a 3 year follow-up the patient is in good general and local conditions (negative TC, normal renal function, preexistent hypertension disappeared). Literature is reviewed and some considerations about diagnosis and surgical tactics are reported.

Peritoneovenous shunt occlusion. Etiology, diagnosis, therapy.

Electronic pressure testing of every LeVeen valve has practically eliminated mechanical malfunction as a cause of shunt failure. Nonetheless, failures do occur and in a series of 240 cases, early or late shunt failure occurred in 29 patients. Thirty-five additional cases of failures were either referred by other physicians over a period of 6 years or information and x-rays were accumulated by direct contact. Shunt failure becomes manifest by a sudden reaccumulation of ascites in patients with a previously functioning shunt. In immediate failure, the ascites may fail to disappear after surgery or reaccumulate if removed. Ideally, caval clotting should be first excluded by x-ray visualization of the superior vena prior to injection of the shunt with contrast agent. Shuntograms are done with fine-bore needles. The venous pressure is also measured. The entry of contrast into the vena cava without pooling indicates a patent venous limb. The contrast will empty from the venous tubing with forceful inspiration if the entire system is patent. The venous tube will not clear if the valve or peritoneal collecting tubes are blocked. Only the valve and collecting tube need then be replaced if contrast enters the cava but does not leave the venous tubing. Occluded valves must not be flushed to restore patency since inflammatory exudate and cellular debris are erroneously identified as "fibrin flecks." Histology and culture are mandatory. Immediate and early failure are often caused by malposition of the venous tubing. Malplacements can often be diagnosed simply by chest x-rays. Intraoperative injection of methylene blue into the venous tubing establishes a satisfactory washout prior to wound closure. Fresh clots in the vena cava can be dissolved by the slow injection of streptokinase into the venous tubing. Other patent veins are chosen for access. Patients having repeat surgery after clotting must be heparinized to prevent a similar recurrence. Flushing blood clots from the cava can be fatal.

Radiofrequency thermotherapy, local chemotherapy, and arterial occlusion in the treatment of nonresectable cancer.

Localized radiofrequency thermotherapy (RFTT) has been effective by itself in debulking cancers but has not accomplished total eradication by itself. Occlusion of the regional artery supplying the tumor drastically reduces the arterial pressure distal to occlusion and further impairs tumor blood flow leading to an accentuation of the temperature differentiation achieved by the normal tissue and tumor. Radiofrequency thermotherapy with vascular occlusion is combined with direct injection of an effective chemotherapeutic agent into the tumor. Radiofrequency thermotherapy is performed after injection of chemotherapy using bleomycin and mitomycin C for squamous cell cancers and Adriamycin and mitomycin C for adenocarcinoma. There are no adverse systemic responses to the small dose of chemotherapy used and the combination therapy is effective in destroying the tumor.

Evaluation of peritoneovenous shunt patency with Tc-99m labeled microspheres.

The LeVeen peritoneovenous shunt (PVS) was investigated in 40 cirrhotic patients with refractory ascites. Five millicuries of Tc-99m-tagged human albumin microspheres (15-36 microns) were injected into the peritoneal cavity between the umbilicus and the left anterior superior iliac spine. The radiotracer was always detectable by scintigram in the lungs when the shunt was patent. In case of malfunction, by contrast, the radioactivity was either restricted to the venous tube or confined below the diaphragm for at least 4 hr. In the presence of complete obstruction, whereas the tube was not visualized after peritoneal injection, it was outlined by direct injection of 2 mCi of Tc-99m albumin microspheres into its subcutaneous tract, where it crossed the 12th rib, immediately above the valve. This technique sufficed to establish whether the site of obstruction was at the valve or in the tubing itself. In one patient, poor visualization of the tube and a delayed image of the lungs was caused by partial occlusion of the valve with fibrinoid debris. This radiotracer method proved simple, quick, and led to an immediate selective replacement when the shunt was not patent. Therefore, the use of this test is recommended for a definitive diagnosis, since there were neither false negatives nor false positives. No complications such as embolism or bacterial infection were encountered with Tc-99m human albumin microspheres, which are excellent tracers.

[Abscessing salpingo-oophoritis caused by Actinomyces in a woman using an IUD]. / Salpingo-ovarite ascessuale da Actinomices in donna portatrice di IUD.

PIP: Recent studies have demonstrated that there is a connection between actinomycetic genital swelling and longterm use of the Lippes Loop. After a literature review, a case of actinomycetic abscessing salpingo-ovaritis in a woman who had worn the same Lippes Loop for 12 years is reported. It is concluded that Actinomyces must be always considered a potential etiological agent in all cases where genital swelling is found in patients fitted with such loops. (author's modified)^ieng

Effects of isovolumic hemodilution on massive pulmonary emboli.

Massive pulmonary emboli obstruct the pulmonary outflow tract and release vasoactive amines that further increase vascular resistance in the pulmonary vascular bed. Lowering blood viscosity by isovolumic hemodilution has been suggested as a possible therapeutic modality to increase pulmonary blood flow. This study was performed to determine if hemodilution could affect the aberrancies caused by massive emboli. Ten pairs of mongrel dogs were instrumented and injected with autologous clot until pulmonary artery (PA) pressure rose to 40 mm Hg. One doe was then isovolumically hemodiluted to a hematocrit of two thirds of control with Ringer's lactate. Hemodynamic data, including PA, and arterial and pulmonary capillary wedge pressure (PCW), were obtained immediately following injection of the clot and one hour later. Following this, the dog was sacrificed and all clot was removed and weighed. Three dogs in the control group arrested and could not be resuscitated, while two dogs in the hemodiluted group survived arrest. The hemodynamic data was identical in the two groups. Clots in the control group weighed 9.6 +/- 7 grams while retrieved clot in the hemodiluted dogs was 3.6 +/- 2. Although the hemodynamic data was similar for both groups, the survival rate and decrease in the size of the clot was significantly favorable in the hemodiluted dogs to encourage further study on this technique.