Skeletal and dento-alveolar changes obtained with customised and preformed eruption guidance appliances after 1-year treatment in early mixed dentition.

AIM: The aim of this study was to assess the skeletal and dento-alveolar changes produced by a customised eruption guidance appliance (EGA) and a preformed EGA in subjects presenting a skeletal class II pattern during early mixed dentition and to evaluate the differences between the two devices. METHODS: All subjects included in the study were randomly selected from the record's archive according to the following inclusion criteria: (1) patients presenting upper central incisor and first permanent molars fully erupted; (2) early mixed dentition with age between 7 to 9 years old; (3) Angle class I or class II malocclusion; (4) increased overjet > 4 mm;(5) deep bite with at least 2/3 overlapping of the incisors; (6) no previous orthodontic treatment apart from maxillary expansion treatment. All children belonging to the case group received treatment with a 3D printed EGA whereas the other patients belonging to the control group were treated with preformed EGA. Records consisted in digital dental models and lateral cephalogram at the beginning (T0) and after 1 year of treatment (T1). Data collected on the digital models included the dentoalveolar changes in overbite, overjet, sagittal molar relationship, and dental crowding. Cephalometric tracings were computed by a single blinded observer using Dolphin Imaging software. Statistical analysis was performed with SPSS (version 25.00; IBM Corp, Armonk, NY). Comparison regarding the cephalometric changes between T1-T2 was carried out with paired t-test. Difference in distribution regarding sagittal molar and canine relationship and anterior crowding between groups at T1 and T2 has been computed with chi-square test. The independent sample t-test was used to perform the between group comparison. CONCLUSION: In the short time, both the appliances showed to be effective in correcting class II malocclusion, anterior crowding, overjet and overbite. Custom-made appliance demonstrated to be significantly more effective in correcting anterior crowding, the dento-skeletal vertical relation and position of permanent incisor compared to the preformed appliance. Adopting a customised device, effects due to an average prescription appliance used to a specific patient can be reduced, resulting in more predictable results.

Novel Nanotube Multiquantum Dot Devices.

Addressable quantum states well isolated from the environment are of considerable interest for quantum information science and technology. Carbon nanotubes are an appealing system, since a perfect crystal can be grown without any missing atoms and its cylindrical structure prevents ill-defined atomic arrangement at the surface. Here, we develop a reliable process to fabricate compact multielectrode circuits that can sustain the harsh conditions of the nanotube growth. Nanotubes are suspended over multiple gate electrodes, which are themselves structured over narrow dielectric ridges to reduce the effect of the charge fluctuators of the substrate. We measure high-quality double- and triple-quantum dot charge stability diagrams. Transport measurements through the triple-quantum dot indicate long-range tunneling of single electrons between the left and right quantum dots. This work paves the way to the realization of a new generation of condensed-matter devices in an ultraclean environment, including spin qubits, mechanical qubits, and quantum simulators.

Oral health inequalities in Italian schoolchildren--a cross-sectional evaluation.

OBJECTIVE: To evaluate which of the following indicators of socio-economic status (SES) has the strongest association with dental caries status in a 6-year-old population: the educational level of each parent (individual-level); the mean price of housing/m2 in the area where the family resides; or the mean per capita income in the area where the family lives (area-level). MATERIAL AND METHODS: Dental caries was recorded in 2,040 schoolchildren (42.5% boys, 57.5% girls) using decayed/missed/filled surface index (d3 level) in primary dentition. Parents filled in a standardised questionnaire regarding nationality, level of education, frequency of dental check-up and perception of child's oral health and child's oral hygiene habits. RESULTS: At the individual-level of SES, mothers' educational level was associated with their children's caries severity (chi2(9) = 147.51 p < 0.01): as educational level rose the proportion of children with high numbers of carious lesions fell. The two income indicators (area-level SES) were not associated. A multinomial logistic regression model was run for caries risk factors. Caries severity was used as dependent variable and the model was stratified by mothers' educational level. Mothers' perception of child's oral health was the only covariate that was always associated in every caries severity strata and for each level of mothers' education. CONCLUSIONS: The present study shows that mothers' educational level is a useful individual SES indicator for caries in Italian children living in a low-income population.

Effect of Fluoridated Sealants on Adjacent Tooth Surfaces: A 30-mo Randomized Clinical Trial.

A double-blind randomized clinical trial was performed in 6- to 7-yr-old schoolchildren to evaluate, in a 30-mo period, whether the caries increment on the distal surface of the second primary molars adjacent to permanent first molars sealed with fluoride release compounds would be lower with respect to those adjacent to permanent first molars sealed with a nonfluoridated sealant. In sum, 2,776 subjects were enrolled and randomly divided into 3 groups receiving sealants on sound first molars: high-viscosity glass ionomer cement (GIC group); resin-based sealant with fluoride (fluoride-RB group); and a resin-based sealant without fluoride (RB group). Caries (D1 - D3 level) was recorded on the distal surface of the second primary molar, considered the unit of analysis including only sound surfaces at the baseline. At baseline, no differences in caries prevalence were recorded in the 3 groups regarding the considered surfaces. At follow-up, the prevalence of an affected unit of analysis was statistically lower (p = .03) in the GIC and fluoride-RB groups (p = .04). In the GIC group, fewer new caries were observed in the unit of analysis respect to the other 2 groups. Incidence rate ratios (IRRs) were 0.70 (95% confidence interval: 0.50, 0.86; p < .01) for GIC vs. RB and 0.79 (95% confidence interval: 0.67, 0.89; p = .005) for fluoride-RB vs. RB [Corrected]. Caries incidence was significantly associated with low socioeconomic status (IRR = 1.18; 95% confidence interval: 1.10, 1.42; p = .05). Dental sealant high-viscosity GIC and fluoride-RB demonstrated protection against dental caries, and there was evidence that these materials afforded additional protection for the tooth nearest to the sealed tooth (clinical trial registration NCT01588210).

Prevalence of halitosis in children considering oral hygiene, gender and age.

BACKGROUND: To date, few studies have addressed halitosis in the paediatric population. As such, the aim of the present study was to investigate symptoms, signs and risk factors associated with halitosis in healthy children and to present a model based on the clinical data that predicts the presence of halitosis. METHODS: A total of 101 individuals were included. All patients received a questionnaire that queried on sociodemographic characteristics, self-reported halitosis and dental treatment history. Individuals received a thorough intra-oral examination, and the volatile sulphur compounds (VSC) were measured to test the presence of halitosis with a portable sulphide monitor (Halimeter(®); Interscan Co., Chatsworth, CA, USA). The distribution of the sociodemographic characteristics, self-reported halitosis, dental treatment history and other oral features was evaluated. Finally, a statistical model was constructed with the best set of features to predict halitosis in children. RESULTS: The median age was 12.0 years (mean: 11.7 ± SD 2.7) with 54.5% males. Halitosis (VSC > 100 parts per billion, or ppb) was objectively measured in 37.6% of patients. For comparison purposes, Bayesian network was obtained using clinical and demographic data. The model consisted of four variables (sex, age, oral hygiene status and self-reported halitosis) directly related to the presence of halitosis (VSC > 100 ppb). This model achieved 76.4% area under receiver operating characteristics curve (AUROC). Overall, female patients or individuals with dental plaque on more than 25% of the dental surfaces or patients older than 13 year old were more prone to present with halitosis. CONCLUSIONS: The results suggest that halitosis in the paediatric population is related to poor oral hygiene and may be more common in females and older individuals. This specific predictive model may be useful to identify subgroups to target for intervention to treat oral halitosis.

An in vitro and in vivo comparison of the effect of Stevia rebaudiana extracts on different caries-related variables: a randomized controlled trial pilot study.

The effect of Stevia extracts on in vitro Streptococcus mutans biofilm formation and in vivo plaque pH was evaluated in this paper. Three 10% solutions containing stevioside, rebaudioside A or sucrose were prepared. MTT assay was used to evaluate microbiological counts in vitro. Twenty volunteers rinsed for 1 min with each solutions, and plaque pH was measured at 7 time points after each rinse. Higher in vitro S. mutans biofilm formation was observed in sucrose solution (p < 0.01). After 5, 10, 15 and 30 min, the sucrose in vivo rinse produced a statistically significantly lower pH value compared to the Stevia extracts (F = 99.45, p < 0.01).Stevia extracts can be considered nonacidogenic.

Fluoride concentration from dental sealants: a randomized clinical trial.

A randomized clinical trial was performed in schoolchildren (6-7 yrs) to evaluate fluoride concentration in interproximal fluid after the placement of 3 different sealants. The sample consisted of 2,776 children randomly divided: 926 in the high-viscosity Glass-ionomer Cement group (GIC group), 923 in the fluoride Resin-based group (fluoride-RB group), and 927 in the no-fluoride Resin-based group (RB group). In total, 2,640 children completed the trial. Sealants were applied following manufacturer's instructions. Interproximal fluid samples were collected at baseline and 2, 7, and 21 days after application of sealants, by insertion of a standardized paperpoint into the interproximal mesial space of the sealed tooth for 15 seconds. Fluoride concentration was evaluated by means of a fluoride ion-selective electrode. At 2 days after sealant application, fluoride concentration was significantly higher in GIC and fluoride-RB groups compared with that in the RB group (p < .01). Mean fluoride concentrations after 7 days were 2.54 (SE 0.68) ppm, 0.85 (SE 0.26) ppm, and 0.53 (SE 0.11) ppm for the three groups, respectively. After 21 days, fluoride concentration in the GIC group remained higher than that in the other two groups. High-viscosity GIC sealants increased the fluoride concentrations in interproximal fluid more than did a Resin-based sealant containing fluoride.

Development and validation of a taste sensitivity test in a group of healthy children.

AIM: This was to validate a taste test on healthy school children. A cross-sectional study was designed to perform a standardised clinical evaluation of the gustatory sensitivity. MATERIALS AND METHODS: Forty (18 males and 22 females) children were selected. Inclusion criteria were age between 5 and 12 years, absence of systemic disease and no antibiotic treatment in the last six months. The taste assessment tests were performed following a standardised protocol, repeated at two different intervals: a) tested at time 0; b) tested after 20-30 days. Tests were performed using a pipette with the sample solution: sucrose, sodium chloride, citric acid and quinine hydrochloride at different concentrations. The examiner reported in a grid the flavour perceived by the subject. A placebo (tap water) was administered in between the flavours RESULTS: The majority of the subjects detected the bitter taste at the lowest concentration (mean=1.83). The sour taste was detected with the second concentration (mean=2.56). The sweet solution was detected with the most diluted concentration (mean=1.56). The salty taste has a threshold of 2 (mean=2.04), which means that the majority of subjects detected the salty solution with the second concentration. Regarding the perceived intensity, it increases with the increasing concentrations and it reaches maximum values that are inversely proportional to the threshold, corresponding to the second concentration. Moreover, no statistically significant gender differences were detected regarding the threshold values or the perceived intensity. CONCLUSION: The proposed test allows for a controlled, reliable and standardised evaluation of the gustatory modality.

Cariogram validity in schoolchildren: a two-year follow-up study.

The validity of Cariogram in relation to caries increment over a 2-year period was evaluated. In 2007, the caries risk profile in a group of Sardinian schoolchildren (957) aged 7-9 years was assessed using the Cariogram software. A re-examination using the same criteria was performed 2 years later on 861 individuals from the original sample (drop-out 10.0%). The possible correlated variables were analyzed using the principal component analysis (PCA). The performances of Cariogram in predicting caries increment were evaluated by receiver operating characteristic (ROC) analysis. At follow-up examination, 54.4% of the sample had developed new carious lesions (mean DFS 1.6, 95% CI 1.5-1.8). The mean caries increment (ΔDFS) was 0.5, 95% CI 0.4-0.5. PCA showed that Cariogram, gingival status and dietary sugar frequency, both at baseline and at follow-up, tend to form a separate cluster (goodness of fit ≥0.75). Sensitivity and specificity measured by ROC analysis were 0.83 and 0.85, respectively, so the gain in certainty was 1.68, while the area under the ROC curve was 0.93. A strong correlation between caries risk profiles at baseline and caries incidence in the permanent teeth after 2 years was found. The validity of Cariogram was confirmed, the software fulfilling the criteria for a good risk assessment model: precision, accuracy and ease of use.

Effect of a sugar-free chewing gum containing magnolia bark extract on different variables related to caries and gingivitis: a randomized controlled intervention trial.

The effect of magnolia bark extract (MBE) on different variables related to caries and gingivitis administered daily through a sugar-free chewing gum was evaluated. The study was performed with healthy adult volunteers at high risk for caries as a randomized double-blind interventional study. 120 subjects with a salivary mutans streptococci (MS) concentration ≥10(5) CFU/ml and presence of bleeding on probing >25% were enrolled and divided into three groups: magnolia, xylitol and control. The study design included examinations at baseline, after 7 days, after 30 days of gum use and 7 days after the end of gum use. Plaque pH was assessed using the strip method following a sucrose challenge. Area under the curve (AUC(5.7) and AUC(6.2)) was recorded. Whole saliva was collected and the number of salivary MS (CFU/ml) was counted. Bleeding on probing was recorded as a proxy of dental plaque. Data were analyzed using ANOVA repeated measures. Magnolia gum significantly reduced plaque acidogenicity, MS salivary concentration and gingival bleeding compared to xylitol and control gums. Subjects from the magnolia and xylitol groups showed both MS concentration (p = 0.01 and 0.06, respectively) and AUC(5.7) (p = 0.01 and 0.04, respectively) to be significantly lower compared to baseline. Thirty-day use of a chewing gum containing MBE showed beneficial effects on oral health, including reduction of salivary MS, plaque acidogenicity and bleeding on probing.

Does smoking increase risk for caries? a cross-sectional study in an Italian military academy.

BACKGROUND/AIMS: Traditionally, tobacco is considered as part of the military culture. A cross-sectional survey was designed to clarify if smoking habit increases the caries risk in a sample of Italian adults attending a Military Academy. METHODS: Clinical examinations including dental caries and presence of bleeding at probing were carried out following WHO criteria. Related socio-behavioural factors were collected. Four calibrated examiners observed 763 subjects (men = 722; 94.6% and women = 41; 5.4%). RESULTS: One of the 763 subjects did not declare the smoking status and was excluded from the analysis. Hundred twenty-six (16.5%) subjects claimed to have never smoked, 200 (26.3%) were coded as light smokers and 436 (57.2%) as heavy tobacco users. Statistically significant linear trend across the educational level (p = 0.03), self-satisfaction with the appearance of teeth and gums (p = 0.04) and dental check-up in the past 6 months (p = 0.02) was found among the 3 subgroups. Almost the entire sample showed caries experience (84.1%). Mean DS ranged from 0.6 in the nonsmokers subgroup to 1.1 in the heavy smokers. Differences among means were statistically significant for DS, DMFS and Significant Caries Index (p = 0.01, 0.04 and 0.03, respectively). The zero-inflated regression model showed that caries severity was significantly associated with smoking habit (p = 0.02), dental check-up in the past 6 months (p = 0.01), self-satisfaction with the appearance of teeth and gums (p < 0.01) and healthy gums (p = 0.04). CONCLUSION: Heavy smokers attending a Military Academy showed a higher prevalence of caries, confirming a correlation between the disease and tobacco use.

Six months of daily high-dose xylitol in high-risk schoolchildren: a randomized clinical trial on plaque pH and salivary mutans streptococci.

A randomized clinical trial was designed to evaluate the effect of daily high-dose xylitol chewing gum on plaque pH and salivary mutans streptococci (MS) in a sample of schoolchildren at high risk of caries. The study was performed on 204 subjects (acceptance rate 88.3%). Inclusion criteria were: >1 and <4 carious lesions, and a salivary MS concentration >10(5) CFU/ml. Subjects were randomly assigned to the xylitol or control group. Study design included one examination at baseline (t(0)), one after 3 months of chewing (t(1)), one after 6 months of chewing (t(2)) and the last 3 months after the end of chewing period (t(3)). Plaque pH was assessed using the MicroTouch technique, following a sucrose challenge. The area under the curve (AUC(5.7) and AUC(6.2)) was recorded. Whole saliva was collected in sterile vials and MS CFU/ml were counted. Data were analysed using repeated-measures ANOVA. The main result was that plaque acidogenicity was reduced in both groups. The differences between treatments were statistically significant both for plaque pH and MS concentration; the interaction term for treatment and time was statistically significant (p < 0.01). At t(2), the xylitol group children with a salivary MS concentration >10(5) and those with < or =10(5) showed significantly lower AUC(5.7) and AUC(6.2) values than the control group. These results suggest that the long-term use of high-dose non-sucrose chewing gums had beneficial effects on plaque pH, and that this effect was statistically greater when using xylitol chewing gums, both on plaque pH and MS salivary concentration.

National pathfinder survey on children's oral health in Italy: pattern and severity of caries disease in 4-year-olds.

This paper describes the dental health status of Italian 4-year-olds in 2004/2005 and analyzes the association between caries in preschool children and some background characteristics in children and parents. Caries was recorded according to WHO criteria. 5,538 subjects were examined. Information on the children's and their parents' social, behavioral, ethnic and demographic status was obtained through a series of closed questions. Bivariate analysis was performed to investigate the association between caries and background characteristics. The probability of being an extra zero for the dmfs index was estimated via the zero-inflated negative binomial regression model (ZINB). 78.4% (95% CI = 77.2-79.6) of the children were caries-free. The national mean dmfs index was 1.36 (95% CI = 1.15-1.57), ranging from 1.22 (95% CI = 1.03-1.42) in the Italian North-East to 1.73 (95% CI = 0.83-2.63) in the South section. Significant bivariate associations between caries experience and risk factors were observed for parents' nationality (not Italian vs. Italian: p < 0.001), parents' educational levels (low vs. high: p < 0.001), preterm birth (yes vs. no: p = 0.011), prolonged breastfeeding (13 months: p = 0.038) and early tooth eruption (<6 months as reference: p = 0.004). Multivariable analysis (ZINB) showed that children with a low caries risk level had a higher probability of being an extra zero; in particular, children from fathers with a high educational level showed a probability of being an extra zero of 0.22. The results suggest a need to plan preventive programs to reduce oral health disparities among Italian preschool children, based on educational intervention with parents and children concerning oral health and caries prevention.

Caries prevalence and need for dental care in 13-18-year-olds in the Municipality of Milan, Italy.

OBJECTIVE: To assess the relationship between caries prevalence and toothbrushing and dietary habits in adolescents in the city of Milan (Italy). RESEARCH DESIGN: The study consisted of a cross-sectional survey using clustering samples. DMFT was recorded following the WHO guidelines by three calibrated examiners. A dental health questionnaire was completed by the subjects to assess their toothbrushing and oral hygiene habits. Univariate and multivariate analysis were performed. PARTICIPANTS: A sample of 1,333 students (age-range 13-18 years, 648 males and 685 females) was studied. The students came from three secondary schools located in different socio-economic and cultural areas of the city. RESULTS: Caries experience (DMFT>0) was 59.11%. A significant linear trend (p<0.01) was observed for DT>0 among the three different schools selected. The mean DMFT was 1.94 +/- 2.46 and difference observed in DT, FT and DMFT among the three schools was statistically significant (p<0.05). Eating snacks more than once a day provided a significantly higher odds ratio for DMFT>0 and for DT>0 (OR=5.24, p<0.001 and OR= 1.46, p=0.01 respectively). CONCLUSIONS: A significant trend between caries experience and socioeconomic status was observed: adolescents, attending school in a low-socio-economic areas, showed higher caries prevalence and higher levels of untreated caries than their counterparts attending schools located in medium-high socio-economic areas.

National Pathfinder survey of 12-year-old Children's Oral Health in Italy.

No recent data on the experience of caries among Italian 12-year-olds are available. In 2004, an epidemiological survey called 'National Pathfinder among Children's Oral Health in Italy' was promoted and carried out. This study reports the actual oral health status of Italian 12-year-olds according to gender, residence area and geographical distribution. Clinical examinations were carried out from March 2004 to April 2005, according to WHO criteria, and included dental caries (decay at the dentinal lesion level) and Community Periodontal Index (CPI). 5,342 children (2,670 males, 2,672 females) were examined by 7 ad hoc calibrated raters. Dental caries experience was found in 43.1% (95% CI 41.8-44.4%) of the study population. The mean DMFT score was 1.09 (95% CI 0.98-1.21). Significant differences (p < 0.05) were observed among geographical sections for DT, FT and DMFT. An inverse relationship was observed between mean DMFT and gross national product per capita (p < 0.001). Gingival bleeding was observed in 23.8% of children, while 28.7% had calculus. Significant differences in CPI scores among sections were found throughout the sample in both males and females (p < 0.001). Over the past two decades, mean DMFT fell from over 5 to its present level, halving every decade; consequently, the recorded level of dental caries has become aligned with that in other Western European countries. Nevertheless, differences in DMFT values remain between children from different socioeconomic backgrounds.

Caries experience and status in school-age children residing in four North Italian communities.

PURPOSE: The aim of this paper was to describe the caries experience in four North Italian areas. The areas selected were four North Italian medium-sized cities: San Remo located in western Liguria, Ferrara in Emilia, and Varese and Melegnano (Milan suburbs). MATERIALS AND METHODS: 1104 subjects (560 males and 544 females) were examined. Several dental outcomes were used: DMFT Index and SiC index following WHO recommendations; and the caries experience ratio; the percentage of children with high caries disease and with rampant caries was calculated as the percentage of subjects with DMFT > 0, DMFT > or = 4 and DMFT > or = 7. RESULTS: Mean DMFT ranged from 1.21 +/- 1.65 in the Ferrara group to 1.83 +/- 2.49 in San Remo. Among the groups, statistically significant differences were observed for DT and DMFT (p = 0.04 and p = 0.01 respectively). The SiC index was 3.75 +/- 1.87, 3 (2-5) in all samples, with significant differences among the four areas (p = 0.04). No statistical differences were observed among the four areas regarding caries experience and the proportion of children with high and rampant caries. An elevated proportion of subjects with high caries (DMFT > or = 4) was noted in the San Remo group (22.9%). The distribution of children by gender according to DMFT levels was not statistically significant either. The F/DMFT ratio was similar in the survey areas, from 0.30 in San Remo, 0.38 in Varese and Ferrara, to 0.40 in the Milan suburbs. CONCLUSION: Information drawn from this study can be helpful to describe and plan future dental prevention programmes aimed at reducing caries experience and promoting better oral health level.

[Epidemiologic survey of medical and non-medical personnel in a public dental clinic]. / Indagine epidemiologica sul personale medico e non medico di una struttura sanitaria odontoiatrica di terzo livello.

Hepatitis B and C and Mycobacterium tuberculosis infection represent an occupational problem for the dentist. Few data are available in literature about the situation in our country. An epidemiological survey was carried out to evaluate the prevalence of Hepatitis B (HbsAb) and C (HCVab) markers and the exposure to Mycobacterium tuberculosis (Tine test) of the whole population of a public dental clinic (247 dental care workers). Furthermore participants were asked to fill a questionnaire to assess their vaccination status. 67,2% of the subjects were found to be positive for HbsAb (77,4% of medical personnel and 28,8% of the auxiliary medical personnel). Only one subject was found positive for anti-HCV (0,4%). 12,5% of the population showed a positive Tine test (15,4% of medical personnel and 1,9% of the auxiliary medical personnel). Our data show a difference between the percentage of subjects who were vaccinated (2,4%) and those who were positive to the Tine test (12,5%).

[Retroperitoneal sarcomas: our experience]. / Tumori dei tessuti molli a localizzazione retroperitoneale: la nostra esperienza clinica.

BACKGROUND: Retroperitoneal soft tissues sarcomas (STS) are relatively uncommon and constitute a difficult management problem. Although surgical resection is often difficult or impossible, current chemotherapy is not effective and radiation is limited by toxicity to adjacent structures. Thus, complete surgical resection remains the most effective modality for selected primary and recurrent disease. PATIENTS AND METHODS: Fifteen patients with retroperitoneal STS were admitted and treated between January 1990 and January 2003, and prospectively followed. Nine patients underwent complete surgical resection of 8 malignant and 1 benign tumor. Two patients underwent incomplete surgical resection of 1 malignant and 1 benign tumor. Patient, tumor, and treatment variables were analyzed for disease-specific and disease-free survival. RESULTS: The patients with unresectable disease, incomplete resection, and high-grade tumors presented significantly reduced survival time. In this study, stage at presentation, high histologic grade, unresectable primary tumor, and positive gross margin are strongly associated with the tumor mortality rate. CONCLUSIONS: Patients approached with curative intent should undergo aggressive attempts at complete surgical resection. Incomplete resection should be undertaken only for symptoms relief. Because death often occurs as a result of local progression in retroperitoneal liposarcomas, it is possible that incomplete resection may be beneficial in this histologic type. Complete surgical resection is the most effective modality for the treatment of retroperitoneal sarcomas.

[Dysplastic cysts of the liver: our experience]. / Le cisti displastiche del fegato. Nostra esperienza.

AIM: Systematic surveys with advanced non-invasive imaging techniques have revealed that hepatic cysts are quite common in the general population. Therefore, we retrospectively examined our case series and compared it with the literature. METHODS: Between January 1990 and December 2000, 228 patients with non-parasitic liver cysts were referred to the outpatients section of the Department of Surgery of the University of Cagliari and 23 were submitted to treatment: 14 patients (60.8%) for solitary cyst and 9 (39.2%) for multiple simple cysts of the liver. One patient (4.5%) had right upper quadrant pain. Eleven (47.8%) patients were asymptomatic: 7 (63.7%) required treatment for other pathologies, 3 (27.3%) for a progressive enlargement of the cyst and 1 (9%) for a suspected hydatid disease. Mean diameter of the treated cysts measured by preoperative CT or US was 8.8 cm (range 7-14). Percutaneous aspiration-injection reaspiration (PAIR) was performed in 5 patients (21.7%), US-guided in 2 cases (40%) and CT-guided in 3 (60%). Twenty patients (86.9%) underwent cysts unroofing, 18 (78.2%) with open surgical fenestration and the latest 2 cases with a laparoscopic approach. Two patients had PAIR as second treatment for recurrence: CT-guided in one and US-guided in the other case. RESULTS: Four (25%) out of 16 patients treated exclusively for cystic liver disease, had fever in 3 cases and nausea and vomiting in 1 case; 8 patients (50%) had an intraperitoneal drainage for a mean of 6-7 days (range 4-11) and of 116 cc of serum-hematic liquid. CONCLUSIONS: In our opinion the choice of an adequate treatment must be based on an accurate evaluation of the clinical aspects of the patients and on the characteristics of cystic lesions such as number, size and location. These data let us to choose a surgical treatment rather than a strict US follow-up and to get the best outcome in terms of absence of recurrence, and less biological and economic costs.