Intact intracranial breast prosthesis: a 28-year CT follow-up after treatment of late hemispherectomy complications.

Anatomical hemispherectomy has had excellent results in treating drug-resistant seizures of infantile hemiplegia. This technique of hemispherectomy consists in the removal of a whole hemisphere, with or without the basal ganglia, the end result being a large cavity left at the end of the operation. The technique, however, is considered to be weighted by important complications, in particular intracranial hemorrhages due to vessels tearing secondary to dislodgement of the remaining hemisphere. Several techniques have been consequently proposed to reduce the volume of the residual hemicranial cavity. An alternative measure is the filling of the cavity itself. We have demonstrated that this type of procedure can be carried out using a silicone breast prosthesis. In this report, we demonstrate also that such an implant can have a surprisingly long duration in its unusual location.

Five-year outcome of bone remodelling around implants in the maxillary sinus: assessment of differences between implants placed in autogenous inlay bone blocks and in ungrafted maxilla.

The placement of implants in the posterior maxillary area is considered a reliable procedure, offering recognized rehabilitative advantages. The aim of this study was to evaluate the performance of dental implants placed in the sinus floor augmented with a block autograft by comparing the outcomes over 5 years with those of dental implants positioned in non-augmented bone. This retrospective cohort study included 16 patients who had undergone prosthetic rehabilitation supported by dental implants between 2000 and 2006. One implant per patient was included and assigned to one of two predictor groups: grafted versus ungrafted maxillary sinus. Changes in marginal bone level (MBL) and apical bone level (ABL) over time, at 1, 3, and 5 years, were the primary outcome variables. Appropriate pair-wise comparison tests were performed. No significant differences were seen with regard to ABLs and among times between the grafted group (nine implants) and the ungrafted group (seven implants). Significant marginal bone resorption was found over time, primarily at the buccal aspect, in both study groups. The bone surrounding the apex of dental implants appeared stable after sinus augmentation in the grafted area. The behaviour of the two groups with regard to loss of MBLs over time was very similar.

Volume changes of autogenous bone grafts after alveolar ridge augmentation of atrophic maxillae and mandibles.

The aim of the present retrospective chart review was to determine the relationship between nonvascularized osseous graft remodeling and the three-dimensional (3D) features of grafts and recipient sites, the anatomical recipient regions and different graft sources. 32 iliac crest or chin grafts were onlay-positioned in the mandible or maxilla of 14 patients. CT scans, taken before implant positioning and after 1 year, revealed a mean volume resorption of 35-51%. For iliac crest grafts, the average resorption was 42% when the onlay was positioned in the anterior maxilla and 59% when it was positioned in the posterior mandible. Spearman correlation and 3D interpolation analysis revealed, for both iliac crest groups, a moderate or advanced remodeling pattern depending on 3D features, namely graft thickness and shape, basal bone volume of recipient site, and the basal bone/graft volume ratio of the recipient site. No statistically significant differences were found between the recipient and donor site groups. Retrospective analysis of the data indicates that iliac crest grafts, onlay-positioned on adequate basal bone volume, may register a reduced volume remodeling when shaped thick in the anterior maxilla or rounded and convex, on the external surface, in the posterior mandible.

Clinical survey of neurosensory side-effects of mandibular parasymphyseal bone harvesting.

The aim of the present survey was to assess neurosensory disturbances and/or tooth-pulp sensitivity losses after mandibular parasymphyseal bone-harvesting procedures. Twenty-eight harvesting areas in 16 patients were surveyed. Mucosal and skin sensitivity of the chin/lower lip, divided into four regions, were determined via Pointed-Blunt and Two-Point-Discrimination Tests. Pulp sensitivity of the mandibular teeth from the left second bicuspid to the right second bicuspid was tested by cold vitality preoperatively and 12 months postoperatively. Teeth were grouped according to sensitivity alterations and distance from the harvesting defects, as measured on CT scans, and statistically significant differences sought. At 12 months, 29% of preoperatively vital cuspids overlying the harvesting defects revealed pulp-sensitivity losses; no patient reported anaesthesia or analgesia; hypoaesthesia was present in 4% (8 sites; 2 patients), hypoalgesia was present in 3% (5 sites; 2 patients) and Two-Point-Discrimination Tests yielded pathologic responses in 5% of tested areas (10 sites; 4 patients). Teeth with and without pulp sensitivity changes were statistically indistinguishable regarding distances between root apices or mental foramen and the harvesting defect. The loss of pulp sensitivity in any tooth cannot be predicted simply on the basis of the distance between its apex and the harvesting osteotomy line.

[Environmental and biological monitoring of exposure to polycyclic aromatic hydrocarbons in workers of an electric steel foundry]. / Monitoraggio ambientale e biologico dell'esposizione ad idrocarburi policiclici aromatici in lavoratori di una acciaieria elettrica.

AIMS: To assess and classify exposure to Polycyclic Aromatic Hydrocarbons (PAHs) in some specific working areas of a steel foundry operating with a continuous casting process and evaluate biomonitoring data in different job tasks. METHODS: Exposure to dusts and six PAHs classified as carcinogenic by EU directives was studied in a cohort of 35 male foundry workers (aged 41.1 +/- 6.9 years), who were examined both prior to and at the end of the work-shift (06:00 a.m.-02:00 p.m.) in two different periods. The urinary excretion of 1-hydroxypyrene (1-OH-P) was measured as a biomarker of exposure to pyrene. RESULTS: PAHs concentrations ranged from 461.8 to 935.6 ng/m3 near the continuous casting area, whereas lower values were measured near the ladle furnace. End of shift 1-OH-P values were higher in 11 non-smoking workers involved in continuous casting process as compared to those employed in mantenance and furnace areas (median of the second determination: 5.70 microg/g creatinine--range: 1.24-21.24 vs 1.17 microg/g creatinine--range: 0.23-4.49; p< 0.001). 1-OH-P excretion was significantly correlated with both the sum of six carcinogenic PAHs and pyrene airborne concentrations. In two biomonitoring sessions, 9.1% and 34.3% of the workers respectively showed end-of-shift 1-OH-P values exceeding the occupational exposure limit (OEL) (4.4 microg/g creatinine or 2.3 micromol/mol(-1) creatinine) recommended for coke-oven workers. CONCLUSIONS: 1-OH-P is a useful biomarker in assessing PAH exposure and is associated with job category at a Steelplant. Due to exposure variability, to assess risk associated with PAHs exposure, biological monitoring should be carried out periodically.

[Human muscle dirofilariasis of difficult diagnosis]. / Dirofilariasi muscolare umana di difficile diagnosi.

A case of Dirofilariasis by Dirofilaria repens localized in the left temporalis muscle, in a 43-year-old woman, is described. It was acquired in South-western Sicily but became apparent in Pisa. It is the seventh case of human Dirofilariasis reported from this area, confirming the existence of an endemic focus. In spite of the numerous investigations to identify clinically the illness (needle-aspirate, Echography, CTScan) the diagnosis was possible only upon discovery of the nematode in the histological sections of the surgically removed nodule.

[The functional and surgical rehabilitative treatment of cleft lip and cleft palate in a case of the syndrome of the deletion of the long arm of chromosome 18 diagnosed in utero]. / Trattamento riabilitativo funzionale e chirurgico della labiopalatoschisi in un caso di sindrome da delezione del braccio lungo del cromosoma 18 diagnosticata in utero.

Following an introductory illustration of the clinical characteristics of the 18q syndrome (De Grouchy syndrome), the paper describes the treatment carried out in a young patient with harelip and cleft palate in addition to chromosomopathy. Although the facial malformation and the karyotype with the deletion of a portion of the long arm of chromosome 18 were diagnosed in utero, the parents, having been correctly informed of the mental retardation usually associated with this syndrome and the possibility of surgical correction of the facial malformation, decided not to abort. The case offers an occasion for analysing the various stages and results obtained to date using a multi-specialised diagnostic approach and functional and surgical treatment of the harelip and cleft palate which have enabled much of the congenital handicap to be corrected.

[A case report of a true median cleft of the upper lip with a pedunculated median skin-mucosa mass]. / Comunicazione su di un caso di schisi mediana vera del labbro superiore con massa peduncolata mediana cutaneo-mucosa.

The Authors report an unusual case of median cleft of the upper lip with pedunculated skin and muscle contracting mass. About one hundred cases of true median cleft lip have been reported, only six showing a median pedunculated mass. As the embryogenesis of this malformation is still not completely clear, we think that any case with this characteristic has to be described. Besides the usual characteristic of the median "hare lip" this case shows a big egg-like pedunculated mass in which muscular tissue has been found well represented, and a wide incomplete maxillary cleft.

[Our experience in the correction of a short frenulum labialis by Z-plasty]. / La nostra esperienza nella correzione della brevità del frenulo labiale mediante plastica a "z".

The authors report their experience of the reconstruction by z-plasty in cases of shortness of the lip frenum. Amongst several techniques they used for this correction they got best results utilizing a z-plasty, with wide flaps, planned so that after the transposition of the flaps the medial branch of the z-plasty falls horizontally into the deeper vestibular fornix. In all cases treated by that z-plasty the A. obtained a widening of the adherent part of the gingiva, deepening of the vestibulum, no recurrence of the shortness was observed.

[A proposal for a protocol for the registration of data on cases of cleft lip and jaw]. / Proposta di un protocollo per il rilevamento dei dati inerenti i casi di cheilognatoschisi.

The Authors describe a standardized registration system applied to gnathoplasty and its follow-up. That allows both longitudinal growth study and clinical evaluations on the surgical method. If similar standardized registration systems could be adopted by several clinical teams, a comparison between different gnathoplasty methods should be possible and obviously useful.

[Hypertrophy of the concha of the auricle. Details of the technic]. / Ipertrofia della conca del padiglione auricolare. Un dettaglio di tecnica.

Ear concha hypertrophy corrected by elliptical conchal excision often resulted in deformity due to lateral deviation of the anterior part of the concha. A modification of the method allows to avoid that deviation: the conchal ellipse is left connected to the conchal floor, is weakened by half thickness incisions parallel to the edge; the conchal floor thus flattened is sutured to the lateral side of the head by non absorbable suture.

[A simple method for proposing several profiles to patients undergoing rhinoplasty or profileplasty]. / Semplice metodo per proporre vari profili ai pazienti da sottoporre a rinoplastica o profiloplastica.

The authors describe a simple mean to visualize the several profiles which is possible to perform in the patient who is undergoing rhinoplasty or profiloplasty procedure. Failure in giving a clear opportunity of choice of a profile may lead to misunderstanding between surgeon and patient.