Hyrax versus transverse sagittal maxillary expander: An assessment of arch changes on dental casts. A retrospective study.

OBJECTIVE: The aim of this study was to compare arch changes before and after maxillary expansion with Transverse Maxillary Sagittal Expander (TSME) and Hyrax Palatal Expander (HPE), in growing patients with diagnosis of maxillary hypoplasia. MATERIALS AND METHODS: The sample consisted of 40 patients' records (20 males 20 females mean age 9.2 ±â€¯2.6 years) were selected from the archive of the Orthodontic Department of the University of Milan, Italy. Patients were randomly divided in two groups: patients in group 1 were treated with HPE as they presented only transverse deficiency of the maxilla and in group 2 were treated with TSME. Plaster models have been measured with a Verniere caliper to evaluate the differences in maxillary expansion of the two devices. Measurements were performed on casts poured from impressions taken before appliance bonding (T0), immediately after appliance debonding (T1) and at 6 months follow-up (T2). The variations in the following distances have been considered: inter-molar distance, inter-canine distance, palatal depth, palatal length and arch circumference. Shapiro-Wilk test was performed to assess normality distribution. ANOVA for repeated measures with multiple paired t-test for pairwise comparisons and its non-parametric equivalent Friedman's test with multiple Wilcoxon tests for pairwise comparisons were performed to evaluate changes in time of each variable in each group. Between groups comparisons were performed for each variable at each observing time using independent t-test or Mann-Whitney test. Significance level was set at p < 0,05. RESULTS: Both the Friedman test and the rm-ANOVA test and their respective post-hoc show that within both groups the respective variables have a statistically significant increase between T0 and T1 (p < 0,05) and a slight decrease between T1 and T2 (p < 0,05) that is not clinically relevant remaining always T2 greater than T0 in a statistically and clinically relevant way (p < 0,05). The analysis between the differences of the measurements at different timing measured by the Mann-Whitney test shows that for all the variables there is no statistically significant difference between the 2 devices (p < 0,05), except for the perimeter of the arch and the length of the palate; in this case it appeared that the TSME is better statistically (p < 0,05). CONCLUSIONS: The study has shown that RPE and TSME can achieve similar results in transversal palatal expansion. Differences have been found in the palatal length and in the arch perimeter where TSME seems to be more efficient.

Lymphangioma of the tongue associated with open bite: case report.

BACKGROUND: Lymphangioma of the tongue is a rare condition related to congenital malformations of the lymphatic system. It may have different implications such as macroglossia. This condition could exacerbate in aesthetic abnormalities and functional problems such as maxillofacial structural deformities, dysphagia, airway obstruction and speech difficulties. The aim of this paper is to describe this disease by means of a case report. CASE REPORT: A 4-year-old patient was referred to our department presenting macroglossia, functional difficulty during swallowing and mastication, speech disturbances, airway obstruction, and deformities of the maxillofacial structures. Diagnosis of lymphangioma was confirmed by biopsy. After surgical removal of the lesion, the patient was treated with rapid palatal expansion, functional appliance with lingual grid and fixed multibracket appliance. After treatment, improvement in function, indicated by the gradual increase in occlusal force, could be taken as a positive sign of stability. CONCLUSION: The 3-step treatment protocol described in this article proves to be effective in controlling the malocclusion in the three planes of the space in a patient affected by lymphangioma of the tongue.

GLYOXALASE I A111E, PARAOXONASE 1 Q192R AND L55M POLYMORPHISMS IN ITALIAN PATIENTS WITH SPORADIC CEREBRAL CAVERNOUS MALFORMATIONS: A PILOT STUDY.

It is already known that the conditions of increased oxidative stress are associated to a greater susceptibility to vascular malformations including cerebral cavernous malformations (CCMs). These are vascular lesions of the CNS characterized by abnormally enlarged capillary cavities that can occur sporadically or as a familial autosomal dominant condition with incomplete penetrance and variable clinical expression attributable to mutations in three different genes: CCM1(Krit1), CCM2 (MGC4607) and CCM3 (PDCD10). Polymorphisms in the genes encoding for enzymes involved in the antioxidant systems such as glyoxalase I (GLO I) and paraoxonase I (PON I) could influence individual susceptibility to the vascular malformations. A single nucleotide polymorphism was identified in the exon 4 of GLO 1 gene that causes an amino acid substitution of Ala for Glu (Ala111Glu). Two common polymorphisms have been described in the coding region of PON1, which lead to glutamine → arginine substitution at 192 (Q192R) and a leucine → methionine substitution at 55 (L55M). The polymorphisms were characterized in 59 patients without mutations in the CCM genes versus 213 healthy controls by PCR/RFLP methods using DNA from lymphocytes. We found that the frequency of patients carrying the GLO1 A/E genotype among the case group (56%) was four-fold higher than among the controls (14.1%). In the cohort of CCM patients, an increase in the frequency of PON192 Q/R genotype was observed (39% in the CCM group versus 3.7% in the healthy controls). Similarly, an increase was observed in the proportion of individuals with the genotype R/R in the disease group (5%) in respect to the normal healthy cohort (0.5%). Finally, the frequency of the PON55 heterozygotes L/M genotype was 29% in patients with CCMs and 4% in the healthy controls. The same trend was observed in PON55 homozygous M/M genotype frequency (CCMs 20% vs controls 10%). The present study aimed to investigate the possible association of GLO1 A111E, PON1 Q192R and L55M polymorphisms with the risk of CCMs. We found that individuals with the GLO1 A /E genotype, PON192/QR-RR genotypes and PON55/LM-MM genotypes had a significantly higher risk of CCMs compared with the other genotypes. However, because CCM is a heterogeneous disease, other additional factors might be involved in the initiation and progression of CCM disease.

New category of probable invasive pulmonary aspergillosis in haematological patients.

The European Organization for Research and Treatment of Cancer and the Mycosis Study Group (EORTC-MSG) radiological definitions of invasive pulmonary aspergillosis (IPA) may lack diagnostic sensitivity. We evaluated applying less restrictive radiological criteria, when supported by specific microbiological findings, to define IPA in acute myeloid leukaemia (AML), lymphoproliferative diseases (LD) and allogeneic stem cell transplant (allo-SCT) patients. Overall, 109 consecutive episodes of proven/probable IPA in 56 AML, 31 LD and 22 allo-SCT patients diagnosed from February 2006 through to January 2011 were considered. IPA was diagnosed with EORTC-MSG criteria (control group, 76 patients) or without prespecified radiological criteria (study group, 33 patients). The latter differed from the former by the inclusion of patients with pulmonary infiltrates not fulfilling the three EORTC-MSG IPA specific findings of dense, well-circumscribed lesions with or without halo sign, air crescent sign or cavity. All the analysed clinical and mycological characteristics, 3-month response to antifungal therapy and 1- and 3-month cumulative survival were comparable in the control and study groups in AML, LD and allo-SCT patients. Seventeen of 33 (51.5%) patients of the study group fulfilled EORTC-MSG radiological criteria at subsequent imaging performed a median of 15 days (range, 6-40 days) after documentation of the pulmonary infection. Our study seems to confirm the possibility of revising the EORTC-MSG criteria by extending the radiological suspicion of IPA to less specific chest computerized tomography scan findings when supported by microbiological evidence of Aspergillus infection in high-risk haematological patients.

[Budd-Chiari syndrome and splanchnic vein thrombosis: masked myeloproliferative neoplasms and JAK2V617F]. / Sindrome di Budd-Chiari e trombosi delle vene splancniche: neoplasie mieloproliferative mascherate e mutazione di JAK2V617F.

The Budd-Chiari Syndrome (BCS) and the splanchnic vein thrombosis are characterized by hepatic venous outflow obstruction, generally due to venous thrombosis. These rare diseases are usually caused by multiple concurrent factors, including acquired and inherited thrombophilias. Since the diagnosis of myeloproliferative neoplasms (MPNs) is often difficult in patients with BCS and splanchnic vein thrombosis because of spleen enlargement, secondary pancytopenia and bleeding disorders, recent observations have included in the diagnostic work-up the analysis of the JAK2 mutation. The revision of several recent reports clarify the importance of the JAK2V617F detection in the diagnostic work-up of the BCS and splanchnic vein thrombosis, allowing the demonstration of masked MPNs among these cases that may benefit, in the near future, of target molecular therapies directed toward the JAK2 mutation.

Reverse-transcriptase polymerase chain reaction of the maspin gene in the detection of bone marrow breast carcinoma cell contamination.

BACKGROUND: Maspin is a molecular marker used for the detection of contaminating breast carcinoma (BC) cells in peripheral blood and lymph nodes. However, its specificity has been questioned recently. The objective of this study was to verify the specificity of this marker and to determine the incidence of positive bone marrow results in patients with BC who are eligible for high-dose chemotherapy (HDT) both in early and advanced disease stages and before and after treatment. METHODS: Bone marrow specimens from 41 patients with BC as well as from 35 normal volunteers and 17 patients with hematologic tumors were examined for maspin transcript expression by a modified nested reverse transcriptase-polymerase chain reaction technique. RESULTS: Maspin transcript was found in all normal and neoplastic breast tissues and in none of the 35 normal bone marrow specimens (specificity, 100%; 95% confidence interval, 90-100%). However, the transcript was found in 40% of the bone marrow samples from patients with hematologic malignancies. Thus, this marker appears very specific for discriminating between normal controls and patients with BC, but it cannot be considered disease specific. Among patients with BC, bone marrow was positive for the maspin transcript in 32% of patients with early-stage disease and in 75% of patients with metastatic disease before chemotherapy. After treatment, in 75% of patients with early-stage disease and in 50% of patients with metastatic disease, the bone marrow results became maspin negative. CONCLUSIONS: On the basis of the current data, although it is not disease specific, maspin is a reliable marker for detecting bone marrow molecular disease in patients with BC and should be considered for prospective studies as a prognostic indicator and as an assay for monitoring residual disease.

Unrelated business income tax: an update.

To meet spiraling costs, tax-exempt hospitals increasingly are operating businesses unrelated to direct patient care. Knowing which activities may be open to challenge by the Internal Revenue Service (IRS) is essential to avoid the unrelated business income (UBI) tax. Three criteria must be met for an activity to be taxable as UBI: It must constitute a trade or business; It must be regularly carried on; and It must be unrelated to the organization's exempt purpose. The Internal Revenue Code and IRS rulings clearly exclude the following areas from UBI taxation: Activities performed by unpaid volunteers (e.g., hospital auxiliaries' fund-raising dinners and bazaars and the operation of thrift stores); Operations conducted for the convenience of the organization's members, students, patients, or employees (e.g., gift shops, cafeterias, coffee shops, parking lots, lounges, vending machines, pharmaceutical sales to inpatients and emergency room outpatients, and research activities for students' benefit; The sale of merchandise that has been received by gift (e.g., flea markets, baked goods sales, book sales, and rummage sales); Investment income such as dividends, interest, annuities, royalties, certain rents, and capital gains from the sale of investment assets; Gifts or contributions made directly to the facility; and Bingo games that are conducted commercially. Areas which may be subject to UBI taxation, or in which there have been controversial or contradictory court rulings, include: Pharmaceutical sales to the public or private physicians' patients; and Laboratory services provided to private physicians for treating their patients. IRS private letter rulings, though not precedential, have excluded from UBI taxation the x-ray income from a hospital's branch facility and rental income from property leased for use as a clinic or medical office building that is substantially related to the hospital's exempt functions. Private letter rulings have subjected to UBI taxation the income for a professional standards review organization's private review activities and debt-financed income from property that is not substantially related to the organization's exempt purpose.

NY court issues 'right-to-die' guidelines.

The Eichner case may be as important as the Quinlan case for physicians who deal with irreversibly comatose patients. Physicians in New York state must now follow the guidelines set down by the court in the Eichner case, and physicians in other states should be concerned that these kinds of guidelines could be imposed in their states.