Intestinal Perforation in a patient with peritoneal carcinomatosis from colon cancer treated with Regorafenib. Description of a case and review of the literature.

Regorafenib is a multikinase inhibitor approved for treatment of patients with metastatic Colo-Rectal Cancer (mCRC) and Gastro-Intestinal Stromal Tumor (GIST) progression after the administration of other tyrosine-kinase inhibitors such as imatinib and sunitinib. Only a handful of severe side effects such as intestinal perforations and fistulas have been described in the literature in patients undergoing multikinase inhibitor treatment. We report a case of a patient with peritoneal mCRC who experienced an intestinal perforation during the administration of Regorafenib and review the literature. A 48-year-old man with previously resected sigmoid colon cancer and peritoneal metastatic disease under Regorafenib treatment presented to our Emergency Department with severe abdominal pain and asthenia. Abdominal X-ray and contrast-enhanced computed tomography examination revealed an intestinal perforation. The patient underwent emergency surgery which demonstrated acute diffuse peritonitis, necrosis, and perforation of a distal ileal loop affected by peritoneal metastatic disease. The necrosis of peritoneal implants on bowel walls could be regarded as a potential factor leading to intestinal perforation in metastatic colorectal cancer patients undergoing Regorafenib treatment complaining of severe abdominal pain and asthenia. Surgeons, radiologists and oncologists should always keep in mind this rare adverse event during Regorafenib administration. Appropriate diagnostic tests and treatments should be carried out.

Prevalencia de alveolitis seca asociada a urgencias dolorosas durante el aislamiento social preventivo y obligatorio de la pandemia COVID-19 en un servicio de urgencias del área bonaerense metropolitana en la República ArgentinaPrevalence of dry socket associated with urgent dental extractions due to pain performed at an emergency service in the Buenos Aires Metropolitan Area during the mandatory preventive social isolation for the COVID-19 pandemic in Argentina / Prevalence of dry socket associated with urgent dental extractions due to pain performed at an emergency service in the Buenos Aires Metropolitan Area during the mandatory preventive social isolation for the COVID-19 pandemic in Argentina

Objective: To evaluate the prevalence of dry socket as a postoperative complication in cases where there was intense local pain in the preoperative state, during the preventive mandatory social isolation (PMSI) for the COVID-19 pandemic in Argentina. Methods: This was a descriptive study, which included 1209 walk-in patients at the emergency and orientational service at Buenos Aires University School of Dentistry during the PMSI from March 20 to June 20, 2020, with indication for dental extraction as well as intense acute pain at the surgical site. The presence of dry socket was exploratoryly associated with the variables age, sex, smoking and chronic medication use. Results: 1209 patients were operated, resulting in a total 1372 dental extractions. Average patient age was 41 years. The prevalence found in this study was 1.06%. Conclusion: The prevalence of dry socket was 1%, not being higher than other experiences where pain was not considered a condition prior to extraction.

Objetivo: Evaluar la prevalencia de alveolitis seca como complicación postquirúrgica, cuando existió dolor intenso local en el preoperatorio, durante el Aislamiento Social Preventivo y Obligatorios (ASPO) de la pandemia COVID-19 en la República Argentina. Material y Métodos: Se realizó un estudio descriptivo en el que fueron incluidos 1209 pacientes, que presentaron indicación de exodoncia y concurrieron al servicio de urgencias y orientación de pacientes de la Facultad de Odontología de la universidad de Buenos Aires, durante el ASPO en un periodo comprendido entre el 20 de marzo y el 20 de junio de 2020, con dolor agudo e intenso en el sitio quirúrgico. La presencia de alveolitis seca fue asociada de forma exploratoria con las variables edad, sexo, tabaquiamo y medicación de uso crónico. Resultados: Fueron operados 1209 pacientes a los que se les realizaron un total de 1372 exodoncias, con un promedio de edad 41 años. La prevalencia fue de 1,06%. Conclusión: La prevalencia de alveolitis seca fue del 1%, no siendo superior a otras experiencias donde no se consideró al dolor como una condición previa a la exodoncia.

Análisis de datos intra y postquirúrgicos en exodoncias unitarias realizadas por alumnos de grado de la FOUBA / Analysis of intra and post-surgical data in single extractions performed by FOUBA undergraduate studens

La exodoncia es el procedimiento odontológico más antiguo del que se tiene registro, pero pocas publi-caciones abarcan con detalle esta temática. Conocer los pormenores de esta práctica puede servir para generar políticas educativas, sanitarias, como así también sistematizarla y bajar así sus riesgos y complicaciones. El objetivo del presente estudio fue describir y analizar variables quirúrgicas asocia-das a las extracciones unitarias de piezas dentarias. Los datos se analizaron mediante las pruebas Chi-cuadrado de Pearson, exacta de Fisher y Kruskal-Wallis, según lo que correspondía (p<0,05, signifi-cativo). Concurrieron más mujeres que hombres, con una mediana de edad de 37 años (intervalo, 18 a 86), siendo los terceros molares las piezas más ex-traídas. La pieza que requirió más odontosecciones fue el primer molar superior, mientras que la pieza que requirió más alveolectomías fue el tercer mo-lar inferior, siendo esta última la pieza con mayores complicaciones intra y post quirúrgicas, incluso una alteración nerviosa. La caries penetrante fue amplia-mente el motivo más frecuente de exodoncias (79%) superando los reportes en estudios similares, La du-ración promedio (DE) de las extracciones unitarias fue de 39 minutos (21), pero difirió significativamente entre piezas dentarias (p<0,05). Las complicaciones post quirúrgicas se asociaron significativamente a cirugías más prolongadas (p<0,05). La cantidad de anestubos utilizados también difirió significativa-mente entre piezas dentarias (p<0,05), siendo el sec-tor posterior inferior el que más cantidad necesitó. Los datos aportados en el estudio pueden ser utiliza-dos para mejorar recursos en los servicios de salud odontológicos (AU)

Dental extractions are the first procedures reported in dentistry, but few articles focus on its individual details. With proper information, educational and health policies could be systematically improved, and thus reduce risks and complications. The aim of the study was to describe and analyze surgical variables associated with single tooth extractions performed by students. The practice of 500 single extractions on 500 patients who attended the Oral and Maxillofacial service of the School of Dentistry of the University of Buenos Aires, between September 2021 and September 2022, performed by fourth-year students supervised by teachers, are described. Data were analyzed using Pearson's Chi-square, Fisher's exact or Kruskal-Wallis tests, as appropriate (p<0.05, significant). More women attended than men, with a median age of 37 years (range 18 to 86), with third molars being the most extracted pieces. Decay teeth was by far the most frequent reason for extractions (79%), exceeding reports in similar studies, that may be explained by a younger sample and the multiple extractions exclusion. The tooth that required the most sections was the upper first molar, while the tooth that required the most alveolectomies was the lower third molar, the latter being the tooth with the greatest intra- and post-surgical complications, including a reported nerve damage. The average duration (SD) of single extractions was 39 minutes (21), but it differed significantly between teeth (p<0.05), for example, upper central incisors presented an average of 21 (9), and upper first premolars 47 (25), characteristics not reported to date. As other studies reported, post-surgical complications were significantly associated with longer surgeries (p<0.05). The amount of anesthesia cartridges used also differed significantly between teeth (p<0.05), being the posterior mandible the one that needed the most amount. The data provided in the study can be systematically used to improve temporal and economic resources in dental health services (AU)

Incidencia de consultas por fracturas maxilofaciales en un servicio de urgencias odontológicas del Área Metropolitana de Buenos Aires / Incidence of consultations for maxillofacial fractures in a dental emergency department in the Metropolitan Area of Buenos Aires

Objetivo: Describir la incidencia, la causa, el patrón y el tratamiento de fracturas maxilofaciales en sujetos que solici- taron atención en un Servicio de Urgencias Odontológicas del Área Metropolitana de Buenos Aires. Materiales y métodos: Se analizaron las historias clíni- cas de los individuos que concurrieron al Servicio de Urgencias y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires (SUyOP) en el período compren- dido entre marzo de 2018 y diciembre de 2019. Se registró la fre- cuencia de consultas vinculadas con diagnóstico de algún tipo de fractura del esqueleto maxilofacial y en el caso de estos pacien- tes, se registraron sexo, edad, etiología, ubicación y tratamiento. Resultados: Durante el periodo evaluado asistieron al SUyOP un total de 13.919 pacientes por algún tipo de urgen- cia odontológica, entre los cuales 47 (0,33%) se presentaron con traumatismos en la región bucomaxilofacial; 39 fueron del sexo masculino (83%). En total fueron diagnosticadas 66 frac- turas. La edad media se extendió entre los 30 y los 51 años. Las fracturas se encontraron con mayor frecuencia en la mandíbu- la (95,45%). La agresión interpersonal fue la principal causa (53,19%). El tratamiento realizado con mayor frecuencia fue el bloqueo intermaxilar en el 57,44% de los pacientes. Conclusión: Las fracturas de maxilar inferior fueron las que se registraron con mayor frecuencia. Si bien estas fracturas no ponen en riesgo la vida del paciente, la falla en el diagnóstico y el tratamiento apropiados puede derivar en la pérdida de fun- ciones del sistema estomatognático, y desarrollar deformidades secundarias que requieren de un tratamiento más complejo (AU)

Aim: To describe the incidence, etiology, pattern and treat- ment of maxillofacial fractures in a dental emergency department of the Buenos Aires Metropolitan Area. Materials and methods: A study was conducted, re- cording sex, age, etiology, location and treatment of maxillofa- cial fractures in patients who visited the Emergency and Patient Orientation Service of the School of Dentistry of the University of Buenos Aires (SUyOP) from March 2018 to December 2019. Data were obtained from dental medical records. Results: During the evaluated period, a total 13,919 pa- tients visited the SUyOP for dental emergencies, of whom 47 (0.33%) presented with trauma in the oral-maxillofacial region, and 39 were male (83%). Age range was 30 to 51 years. Over- all, 66 fractures were diagnosed. Fractures were most frequent in the mandible (95.45%). Interpersonal aggression was the most prevalent cause (53.19%). The most frequent treatment was inter- maxillary fixation, which was performed in 57.44% of the cases. Conclusion: Fractures of the lower jaw were the most fre- quently reported. Although these fractures are not life-threaten- ing, failure to diagnose and treat them properly can lead to loss of function of the stomatognathic system and development of sec- ondary deformities requiring more complex treatment (AU)

Has the COVID 19 Virus Changed Adherence to Hand Washing among Healthcare Workers?

The aim of the study was to assess adherence to hand washing by healthcare workers (HCWs) and its variations over time in hospital wards. We wanted to check whether the pandemic had changed the behavior of HCWs. The study was conducted between 1 January 2015, and 31 December 2020. The HCWs were observed to assess their compliance with the Five Moments for Hand Hygiene. We described the percentage of adherence to World Health Organization (WHO) guidelines stratified per year, per specialty areas, per different types of HCWs. We also observed the use of gloves. Descriptive data were reported as frequencies and percentages. We observed 13,494 hand hygiene opportunities. The majority of observations concerned nurses who were confirmed as the category most frequently involved with patients. Hospital's global adherence to WHO guidelines did not change in the last six years. During the pandemic, the rate of adherence to the procedure increased significantly only in Intensive Care Unit (ICU). In 2020, the use of gloves increased in pre-patient contact. The hand-washing permanent monitoring confirmed that it is very difficult to obtain the respect of correct hand hygiene in all opportunities, despite the ongoing pandemic and the fear of contagion.

Measles and Pregnancy: Immunity and Immunization-What Can Be Learned from Observing Complications during an Epidemic Year.

Measles is a highly contagious airborne disease. Unvaccinated pregnant women are not only at risk of infection but also at risk of severe pregnancy complications. As measles causes a dysregulation of the entire immune system, we describe immunological variations and how immune response mechanisms can lead to adverse pregnancy outcomes. We evaluated data during the measles outbreak reported in the province of Catania, Italy, from May 2017 to June 2018. We controlled hospital discharge records for patients admitted to hospital obstetric wards searching the measles diagnostic code. We have indicated the case as "confirmed" when the IgM was found to be positive with the ELISA method. We registered 843 cases of measles and 51% were females (430 cases). 24 patients between the ages of 17 and 40 had measles while they were pregnant. Adverse pregnancy outcomes included 2 spontaneous abortions, 1 therapeutic abortion, 1 foetal death, and 6 preterm deliveries. Respiratory complications were more prevalent in pregnant women (21%) than in nonpregnant women with measles (9%). 14 health care workers (1.7%) were infected with measles, and none of these had been previously vaccinated. Immune response mechanisms were associated with adverse pregnancy outcomes in women with measles. To reduce the rate of measles complications, gynaecologists should investigate vaccination history and antibody test results in all women of childbearing age. During a measles outbreak, gynaecologists and midwives should be active proponents of vaccination administration and counteract any vaccine hesitancy not only in patients but also among health care workers.

Hepatitis C Virus Infection in Children and Pregnant Women: An Updated Review of the Literature on Screening and Treatments.

Objective The aim of the paper is to review the current information relating to the diagnosis and treatment of hepatitis C virus (HCV) infection in pregnant women and children, particularly those infected by mother-to-child transmission. Study Design A review of published literature was performed to identify relevant articles published between January 2015 and March 2019 on: HCV infection in pregnant woman, mother-to child-transmission of HCV and HCV infection in pediatrics. The results of the evaluation of the different studies were summarized in two sections describing separately the screening and effective treatments in pregnant women and children. Results The rate of mother-to-child transmission of HCV is approximately 5%. HCV infection is strongly associated with cholestasis and preterm birth. Prenatal diagnosis of hepatitis C virus has a dual benefit for mother and child. Perinatally infected children develop cirrhosis in earlier age than those who acquire HCV as adolescents. Pregnant women with cirrhosis have a higher risk of poor maternal and neonatal outcomes than those without cirrhosis. Conclusion To improve public health, universal screening of pregnant women for HCV infection should be performed. Early identification of women and children with HCV infection is important to enable them to be included in assessment and/or treatment programs.

Are Visitors Dangerous Carriers of Pathogens in The Hospital? an Observational Study in an University Hospital in Sicily.

The hospital environment has been suggested as having an important role in the transmission of health care-associated infections. The aim of this work is to clarify the possible role of visitors in environmental contamination at our hospital. The microbial load was determined by Rodac plate contact on flat surfaces and by swabs on uneven surfaces. A total of 137 samples were taken from four different areas of the hospital unit. The results were divided into two groups according to the types of subjects that most often frequented those environments. We found that the transmission of health care-associated infections (HAIs) occurs mainly in areas where visitors are not allowed.

Physical capacity in performing daily activities is reduced in scleroderma patients with early lung involvement.

BACKGROUND AND AIMS: Patients with systemic sclerosis (SSc) often complain reduced capacity at submaximal exercise; conversely, physical capacity in performing daily duties has never been measured in SSc. The aim of this study is to evaluate this performance and its correlates, in patients with SSc compared with healthy controls, in a free-living setting. METHODS: Twenty-seven outpatients with stable SSc and 11 controls were recruited. Physical activity was assessed by portable multiple sensor device (SenseWear Armband) worn for at least 6 days. Physical activity duration (PAD; in minutes) for non-sedentary activities and physical activity level (PAL = total daily energy/resting energy expenditure) per day were calculated. Nutritional status was estimated by bioelectrical impedance analysis and pulmonary arterial hypertension excluded by echocardiography. RESULTS: Daily physical activities (243 ± 145 min per day vs 397 ± 142 min, respectively; P = 0.005) and PAL were significantly reduced in SSc compared with controls (1.5 ± 0.4 vs 2 ± 0.7, respectively; P = 0.019). Seventy-four per cent of SSc patients showed PAL < 1.70, whereas only 27% of controls were below this threshold for sedentary life style. Both PAD and PAL positively correlated with DLco. Patients and controls did not differ for spirometric parameters, body mass index, phase angle at bioelectrical impedance analysis, fat mass or fat-free mass indexes. In SSc, exercise capacity during daily activity was reduced compared with controls, and was associated with early evidence of functional decay (decreasing DLco) but not with malnutrition (undernutrition). CONCLUSIONS: A reduction of daily physical activity is already present even in early stages of lung involvement in SSc, characterized by unaltered spirometry and well-preserved nutritional status.

Airway distensibility by HRCT in asthmatics and COPD with comparable airway obstruction.

INTRODUCTION: Decreased airway distensibility (AD) in response to deep inspirations, as assessed by HRCT, has been associated with the severity of asthma and COPD. AIMS: The current study was designed to compare the magnitude of AD by HRCT in individuals with asthma and COPD with comparable degrees of bronchial obstruction, and to explore factors that may influence it. RESULTS: We enrolled a total of 12 asthmatics (M/F:7/5) and 8 COPD (7/1) with comparable degree of bronchial obstruction (FEV1% predicted mean ± SEM: 69.1 ± 5.2% and 61.2 ± 5.0%, respectively; p = 0.31). Each subject underwent chest HRCT at FRC and at TLC. A total of 701 airways (range 20 to 38 airway per subject; 2.0 to 23.1 mm in diameter) were analyzed. AD did not differ between asthmatics and COPD (mean ± SEM: 14 ± 3.5% and 17 ± 4.3%, respectively; p = 0.58). In asthmatics, AD was significantly associated with FEV1% predicted (r(2) = 0.45, p = 0.018). We found a significant correlation between the change in lung volume and the change in AD by HRCT (r(2) = 0.64, p = 0.002). In COPD, we found significant correlations between AD and the RV% predicted (r(2) = 0.51, p = 0.046) and the RV/TLC (r(2) = 0.68, p = 0.01). CONCLUSIONS: AD was primarily affected by the dynamic ability to change lung volumes in asthmatics, and by static lung volumes in COPD.

A 15-year-old boy with anterior chest pain, progressive dyspnea, and subcutaneous emphysema of the neck.

We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence.

The airway response to deep inspirations decreases with COPD severity and is associated with airway distensibility assessed by computed tomography.

In patients with mild chronic obstructive pulmonary disease (COPD), the effect of deep inspirations (DIs) to reverse methacholine-induced bronchoconstriction is largely attenuated. In this study, we tested the hypothesis that the effectiveness of DI is reduced with increasing disease severity and that this is associated with a reduction in the ability of DI to distend the airways. Fifteen subjects [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I-II: n = 7; GOLD stage III-IV: n = 8] underwent methacholine bronchoprovocation in the absence of DI, followed by DI. The effectiveness of DI was assessed by their ability to improve inspiratory vital capacity and forced expiratory volume in 1 s (FEV(1)). To evaluate airway distensibility, two sets of high-resolution computed tomography scans [at residual volume (RV) and at total lung capacity] were obtained before the challenge. In addition, mean parenchymal density was calculated on the high-resolution computed tomography scans. We found a strong correlation between the response to DI and baseline FEV(1) %predicted (r(2) = 0.70, P < 0.0001) or baseline FEV(1)/forced vital capacity (r(2) = 0.57, P = 0.001). RV %predicted and functional residual capacity %predicted correlated inversely (r(2) = 0.33, P = 0.02 and r(2) = 0.32, P = 0.03, respectively), and parenchymal density at RV correlated directly (r(2) = 0.30, P = 0.03), with the response to DI. Finally, the effect of DI correlated to the change in large airway area from RV to total lung capacity (r(2) = 0.44, P = 0.01). We conclude that loss of the effects of DI is strongly associated with COPD severity and speculate that the reduction in the effectiveness of DI is due to the failure to expand the lungs because of the hyperinflated state and/or the parenchymal damage that prevents distension of the airways with lung inflation.

Alterations of the beneficial effect of deep inspiration in scleroderma: relationships between lung function and imaging.

BACKGROUND: It has been postulated that the beneficial effects of deep inspiration are dependent on the magnitude of airway distension by virtue of airway to parenchyma interdependence. OBJECTIVE: This study was designed to examine whether the changes that occur in pulmonary fibrosis affect the beneficial effect of deep inspiration. METHODS: Thirty-one subjects with scleroderma underwent lung volume and diffusion capacity assessment as well as high-resolution computed tomography. To assess the effect of deep inspiration, each subject underwent methacholine provocations in the absence of deep breaths. When the targeted change in lung function was achieved, subjects were asked to take 4 consecutive deep inspirations after which lung function measurements were repeated. The inspiratory vital capacity (IVC) was used as primary outcome. RESULTS: Only 19 subjects attained the desired reduction in IVC in the absence of deep breaths. In those subjects, deep inspiration reversed the effect of methacholine on IVC by 48 +/- 8.4%. The effect of deep inspiration correlated with DLCO% predicted (r = 0.55, p = 0.01), but not with high-resolution computed tomography abnormalities or baseline lung function measurements. When all subjects were considered, responsiveness to methacholine in the absence of deep inspiration was progressively lower with decreasing DLCO% predicted values (r = 0.51, p = 0.003). CONCLUSIONS: In systemic scleroderma, pulmonary abnormalities resulting in mild to moderate reduction in the diffusion capacity are associated with reduced ability of deep inspiration to reverse methacholine-induced early airway closure and bronchoconstriction. When diffusion capacity is severely affected, methacholine fails to produce obstructive airway changes.

Virtual bronchoscopy in patients with central endobronchial stenosing lesions. Technique optimisation with single slice spiral CT.

PURPOSE: To describe an original protocol for single slice spiral Computed Tomography (CT) virtual bronchoscopy in the evaluation of patients with central airway stenoses and compare the results with fibreoptic bronchoscopy. MATERIALS AND METHODS: Ten patients (4 female and 6 male; age range 22-60 years; mean age 44 years) with endobronchial disease diagnosed by fibreoptic bronchoscopy (8 malignant tumours, 1 benign tumour and 1 fibroid stenosis) underwent virtual bronchoscopy with single slice spiral CT. A panoramic spiral CT scan of the whole chest was first obtained. Once the area of interest had been identified, a new contrast enhanced scan was performed, from bottom to top, with the following parameters: 2 mm slice thickness, 1 mm reconstruction index, 1.3 pitch, 120 Kvp, 80 mAs. Virtual bronchoscopy was generated with an upper threshold of -500 HU from the cross-sectional images of the second scan on a dedicated workstation. Axial, multiplanar reformations (MPR), and virtual endoscopy simulation were simultaneously visualised. Virtual CT bronchoscopy findings were compared with those of fibreoptic bronchoscopy. RESULTS: The protocol we used to perform single slice spiral CT virtual bronchoscopy enabled us to obtain virtual bronchoscopy images that correlated well with fibreoptic bronchoscopy findings in all cases, as well as allowing the visualization of the airways beyond the stenoses. Information about tissues surrounding the tracheobronchial tree was also available from axial and MPR images. Only in 1 case were motion artefacts observed. CONCLUSIONS: The set of the most appropriate parameters for performing virtual bronchoscopy by single slice spiral CT has not yet been standardized. In our opinion the appropriate selection of the protocol to adequately realize virtual bronchoscopic images is crucial when using CT devices such as the above, so as to achieve the correct balance between the quality of image definition and exposure dose.

Digital cineradiographic study of swallowing in infants with neurologic disease. Our experience.

PURPOSE: The study is aimed at proposing the use of digital cineradiography in the evaluation of swallowing disorders in children affected by severe neurological or developmental disability, in order to correctly identify these conditions and provide therapeutic approaches that could solve their feeding problem, improve their nutritional conditions and decrease the risk of infections. MATERIALS AND METHODS: In the period between March 2001 and July 2003, 12 children (8 males and 4 females), aged between 9 months and 13 years, (average 6.2 years), affected by severe neurological or psychomotor disorders were evaluated with digital cineradiography. This investigation was requested for recurrent pulmonary infections and/or dysphagia with weight loss. All the examinations were performed with radio-controlled equipment provided with a digital C arm. RESULTS: Using the above mentioned technique, in all 12 patients, it was possible to differentiate those with disorders of the oral and/or pharyngeal swallowing phase (9/12) from those without swallowing dysfunction (3/12). In 9/9 patients passage of contrast medium into the upper airways was observed during swallowing: in 2 of them this was limited to the laryngeal vestibule (sub-epiglottic penetration), while in 7/9 cases aspiration of contrast medium into the trachea (5/9) or into the right bronchus (1/9) or into both bronchi (1/9) was recorded. In one patient the aspiration decreased in the sequences acquired with hyperflexion of the head. In 3/9 patients we recorded the transition of contrast medium into the nasopharynx during swallowing caused by incomplete closing of the oropharyngeal isthmus by the soft palate. In 3/9 patients there was incomplete clearing of the pharynx with contrast medium deposition in glosso-epiglottic vallecules and in the pyriform sinuses; only in one case did this stagnation result in post-swallowing aspiration. More than one disorder was found in 5/9 patients, and one only in 4/9. CONCLUSIONS: On the basis of our preliminary data it is possible to conclude that the dynamic swallowing study with digital technique allows a clear-cut evaluation of the swallowing process with minimum discomfort for the patient. On the other hand, the technique exposes to the risk of ionizing radiation; however, in consideration of the important clinical and therapeutic implications and in agreement with the literature, we believe that the importance of the information provided by the technique outweighs the risks linked to radiations.