Valores referenciales de posturografía basada en Nintendo Wii en población chilena

Resumen Introducción: La posturografía es un método de exploración complementario para valorar el grado de desplazamiento del centro de gravedad (COP); no debe usarse de forma aislada al evaluar equilibrio, pero se acepta para seguimiento de la respuesta a tratamiento. Es de baja disponibilidad, por su alto costo comercial. Como alternativa se documenta la plataforma Wii Balance Board (WBB) de Nintendo para registro posturográfico. Objetivo: Describir valores de normalidad en parámetros posturográficos en población chilena sin patología vestibular, usando un registro simple y accesible. Material y Método: Estudio transversal de valores referenciales en herramienta para evaluación del equilibrio. Se registraron valores posturográficos con versión adaptada del Sensory Organization Test (SOT) a adultos sanos. Mediciones con software WBB Sway Program mediante WBB. Se midieron índices somatosensorial, visual y vestibular, y patrones de control postural en ejes anteroposterior y mediolateral durante SOT-adaptado. Resultados: Se obtuvieron valores de velocidad de desplazamiento del COP, área del COP y desviaciones estándar correspondientes para 4 situaciones del SOT-adaptado de 35 sujetos entre 18-65 años, 21 mujeres, 14 hombres. Discusión: WBB permitió evaluar estos parámetros en población sana, como aproximación a determinar rangos de referencia. Esta herramienta de uso rápido y accesible constituye una alternativa útil para determinar patrones de control postural en sujetos sanos. Presentamos valores a utilizar como rango referencial en nuestra población; se sugiere utilizar estos valores como objetivo terapéutico en rehabilitación vestibular en pacientes evaluados en conjunto con otros parámetros clínico-sintomáticos.

Abstract Introduction: Posturography is a complementary method for evaluating the center of pressure (COP) displacement; it should not be used in isolation when assessing balance, but it is accepted for follow-up of the treatment response. Due to its high commercial cost and low availability, we documented the Nintendo Wii Balance Board (WBB) as an alternative for posturography. Aim: To describe the normal range of posturography parameters in the Chilean population without vestibular pathology, using a simple and accessible registry method. Material and Method: Cross-sectional study of referential values in a balance assessment tool. Posturography values were registered using an adapted version of the Sensory Organization Test (SOT) on healthy adults. Measurements with WBB Sway Program software through WBB. With adapted-SOT, somatosensory, visual and vestibular indices, as well as anterior/posterior and mediolateral axes postural control patterns, were measured. Results: Values of displacement velocity of the COP, COP area and corresponding standard deviations were obtained for 4 SOT-adapted situations from 35 subjects between 18-65 years, 21 women, 14 men. Discussion: As an approach to determine referential range values, WBB allowed to evaluate these parameters in healthy population. To determine healthy subjects postural control patterns this quick and accessible tool is a useful alternative. We present referential range values to use in our population; it is suggested to use these values as therapeutic objectives in vestibular rehabilitation in patients evaluated along with other clinical-symptomatic parameters.

Malignant triton tumor of the rectum - A case report and review of the literature.

INTRODUCTION: Malignant triton tumors (MTT) are rare but highly aggressive tumors that originate from the Schwann cells. These tumors can occur in any part of the body, mostly present late and carry poor prognosis. PRESENTATION OF CASE: We present a 24-year-old man with a rectal MTT causing non-specific abdominal pain and recurring ileus. The MRI showed a rectal mass near the urinary bladder with compression on the seminal vesical. A complete surgical resection of the tumor was performed. The immunohistological report confirmed a rectal MTT. Because of persistent ileus during the post-operative palliative chemotherapy, another tumor debulking was performed. The patient died 9 months after the diagnosis of MTT due to local recurrence under chemotherapy. DISCUSSION AND CONCLUSION: MTTs are uncommon tumors in young age with high morbidity and mortality because of local recurrence also after complete resection.

A randomized trial of intensive versus minimal surveillance of patients with resected Dukes B2-C colorectal carcinoma.

BACKGROUND: Colorectal cancer is the third most common and the third most lethal cancer in both men and women in developed countries. About 75% of cases are first diagnosed when the disease is classified as localized or regional, undergo potentially curative treatment and enter a post-treatment surveillance program. Although such programs drain significant resources from health systems, empirical evidence of their efficacy is scanty. PATIENTS AND METHODS: Dukes B2-C colorectal cancer patients who had no evidence of disease at the end of their front-line treatment (surgery and adjuvant radiochemotherapy, if indicated) were eligible for the trial and randomized to two different surveillance programs. These programs differed greatly in the frequency of diagnostic imaging. They had similar schedules of physical examinations and carcinoembryonic antigen (CEA) assessments. Patients received baseline and yearly health-related quality-of-life (HR-QoL) questionnaires. Primary outcomes were overall survival (OS) and QoL. RESULTS: From 1998 to 2006, 1228 assessable patients were randomized, 933 with colon cancer and 295 with rectal cancer. More than 90% of patients had the expected number of diagnostic procedures. Median follow-up duration was 62 months [interquartile range (IQR) 51-86] in the minimal surveillance group and 62 months (IQR 50-85) in the intensive group. At primary analysis, 250 patients had recurred and 218 had died. Intensive surveillance anticipated recurrence, as shown by a significant difference in mean disease-free survival of 5.9 months. Comparison of OS curves of the whole intention-to-treat population showed no statistically significant differences. HR-QoL of life scores did not differ between regimens. CONCLUSION: Our findings support the conclusions of other randomized clinical trials, which show that early diagnosis of cancer recurrence is not associated with OS benefit. CLINICALTRIALSGOV: NCT02409472.

SHORT VERSUS STANDARD LENGTH IMPLANTS: A CASE SERIES ANALYSIS.

The use of short implants (SIs) has had a great success, particularly in posterior jaws, because SIs avoid the need of alveolar crest reconstruction or sinus lifting. The aim of this study is to perform a retrospective study on 808 SIs to evaluate their survival rate. In the period between January 2008 and December 2013, 877 patients (498 females and 379 males) were operated at the BDD private Practice Clinic (Milan, Italy). The mean post-surgical follow-up was 30±17 months (max – min, 84 – 1). Eight hundred and eight implants (EDIERRE Implant System SpA, Genoa, Italy) were included in the present study, 119 (14.7%) 9.0 mm (i.e. short) and 689 (85.3%) 11.0 mm long. All patients underwent the same surgical protocol and agreed to participate in a post-operative check-up program. SPSS program was used for statistical analysis. Survival rate (SVR) was 97.4% since only 21 fixtures were lost from a total of 808 implants. Cross-tabulation between failures and immediate loading had a statistical significant value (p= 0.006) in respect to delayed loading. There were 10 failures out of 161 immediate loaded implants compared to 11 failures out of 626 delayed loaded fixtures. SIs are reliable devices for oral rehabilitation.

IMMEDIATE VERSUS DELAYED LOADING IMPLANTS: RATIONALE AND CONTROVERSIES.

Loading implants immediately after their position in alveolar bone crest is a procedure that has become popular in the last decade. The aim of this study is to evaluate the survival rate of 811 immediate loaded implants (ILIs). In the period between January 2008 and December 2013, 877 patients (498 females and 379 males) were operated at the BDD private Practice Clinic (Milan, Italy). The mean post-surgical follow-up was 30±17 months (max – min, 84 – 1). One thousasnd three hundred and eighty-six fixtures (EDIERRE Implant System SpA, Genoa, Italy) were evaluated in the present study, 811 immediately loaded and 575 loaded after 3 months. All patients underwent the same surgical protocol and agreed to participate in a post-operative check-up program. SPSS program was used for statistical analysis. Survival rate (SVR) was 97.3% since only 38 fixtures were lost from a total of 1,348 implants. Cross-tabulation between failures demonstrated slight but significant worse results for ILIs (p= 0.037). There were 28 failures out of 811 ILIs whereas only 10 fixtures were lost out of 565 implants loaded after 3 months. Immediate loading performed in selected cases is a reliable tool for oral rehabilitation.

COMPARISON BETWEEN LONG AND STANDARD LENGTH IMPLANTS10.

Long implants (LI, i.e. longer than 13 mm) are thought to give longer survival than standard length fixtures. The aim of this study is to evaluate the survival rate of 780 LI. In the period between January 2008 and December 2013, 877 patients (498 females and 379 males) were operated at the BDD private Practice Clinic (Milan, Italy). The mean post-surgical follow-up was 30±17 months (max – min, 84 – 1). One thousand seven hundred and fifty-three fixtures (EDIERRE Implant System SpA, Genoa, Italy) were evaluated in the present study, 780 15 mm long (LI) and 972 13 mm long (i.e. standard length implants). All patients underwent the same surgical protocol and agreed to participate in a post-operative check-up program. SPSS program was used for statistical analysis. Survival rate (SVR) was 97.8% since only 38 fixtures were lost from a total of 1,752 implants. Cross-tabulation between failures and jaws had a statistical significant value (p= 0.027) with worse results fox maxilla (23 failures out of 768 implants). Also tooth position has an impact (p= 0.027) since incisors plus canines had 18 failures out of 550 implants whereas premolars and molars had 20 lost fixtures out of 1,202. LIs give a small but significative advantage in oral rehabilitation.

IMPLANTS INSERTED IN POST EXTRACTIVE SOCKETS HAVE SURVIVAL RATES SIMILAR TO FIXTURES INSERTED IN HEALED BONE: A CASE SERIES STUDY.

Post-extractive implants (i.e. PEIs) are widely used to reduce surgical steps and improve patient compliance. The aim of this study is to perform a retrospective study on 2,273 PEIs to evaluate their survival rate. In the period between January 2008 and December 2013, 877 patients (498 females and 379 males) were operated at the BDD private Practice Clinic (Milan, Italy). The mean post-surgical follow-up was 30±17 months (max – min, 84 – 1). Two thousand two hundred and seventy-three PEIs (EDIERRE Implant System SpA, Genoa, Italy) were evaluated in the present study. All patients underwent the same surgical protocol and agreed to participate in a post-operative check-up program. SPSS program was used for statistical analysis. Survival rate (SVR) was 97.7% since only 53 fixtures were lost from a total of 2,273 implants. Cross-tabulation between failures and timing of loading demonstrated a statistically significant higher risk of failures in case of immediate loading (p= 0.013). There were 26 failures out of 761 immediate loaded implants against 27 lost fixtures out of 1,485 delayed loaded implants. PEIs is a reliable procedure, however surgeons should carefully select those cases which can be immediately loaded.

SURVIVAL RATES OF NARROW VERSUS STANDARD DIAMETER IMPLANTS IN DIFFERENT TREATMENT OPTIONS: A RETROSPECTIVE STUDY.

Implant dentistry has had a great success in the last decades for replacing missing teeth; however, implant surgery needs bone availability. The use of narrow diameter implants (NDIs) may be an alternative approach in patients with atrophic maxilla or mandible. The aim of this study is to perform a study on NDIs to evaluate their survival rate. In the period between January 2008 and December 2013, 877 patients (498 females and 379 males) were operated at the BDD private Practice Clinic (Milan, Italy). The mean post-surgical follow-up was 30±17 months (max – min, 84 – 1). One thousand three hundred and forty-six implants (EDIERRE Implant System SpA, Genoa, Italy) were included in the present study, 112 (8.3%) 3.3 mm (i.e. narrow) and 1,234 (91.7%) 3.75 mm wide. All patients underwent the same surgical protocol and agreed to participate in a post-operative check-up program. SPSS program was used for statistical analysis. Survival rate (SVR) was 97.25% since only 37 fixtures were lost from a total of 1,346 implants. Cross-tabulation between failure diameter did not demonstrate any statistical differences between narrow and standard diameter implants. NDIs are reliable devices for oral rehabilitation.

CLINICAL OUTCOME OF 2,560 IMPLANTS AFTER A MEAN OF 30-MONTH FOLLOW-UP.

The advantage of implantology is to replace dental loss with a fixed prosthesis even in cases of partial or total edentulism without damaging the natural teeth. In the period between January 2008 and December 2013, 877 patients (498 females and 379 males) were operated at the BDD private Practice Clinic (Milan, Italy). The mean post-surgical follow-up was 30±17 months (max – min, 84 – 1). Two thousand five hundred and sixty out of 2,657 implants had a complete record and were evaluated in the present study. The implants were of different diameters and length, inserted both in mandible (1,327) and in maxilla (1,233) with immediate or delayed loading, and with graft, split crest, post-extraction, osteo-condensation, small and big sinus lift techniques, respectively. Fifty-nine out of 2,560 implants were lost (i.e. SVR = 97.7%). Cross-tabulation between failures and timing of loading (p= 0.008) had a statistically significant value, with a worse result for immediate loading (28 failures out of 783). In other comparisons between lost implants and diameter (p= 0.074), length (p=0.293), jaws (i.e. maxilla vs mandible, p=0.208), replaced teeth (incisors plus cuspids vs premolars plus molars, p=0.074), insertion torque (p=0.528), surgeons (p=0.452) and additional surgical procedures (i.e. split crest, post-extraction, graft, osteo-condensation, transposition, small and big sinus lift techniques, p= 0.713) no statistically significant difference was detected. EDIERRE Implant System SpA (Genova, Italy) implants have a high SVR (97.7%) allowing more simple surgical procedures for oral rehabilitation of partially or totally edentulous jaws.

ARE WIDE DIAMETER IMPLANTS RELIABLE FOR JAW’S REHABILITATION? A RETROSPECTIVE STUDY ON 450 IMPLANTS.

The use of wide diameter implants (WDI) have had a great success, particularly in posterior jaws, because WDI can ensure an increased bone-implant contact, better withstanding occlusal forces and creating a wider platform for prosthesis. The aim of this study is to perform a study on 450 WDI to evaluate their survival rate. In the period between January 2008 and December 2013, 877 patients (498 females and 379 males) were operated at the BDD private Practice Clinic (Milan, Italy). The mean post-surgical follow-up was 30±17 months (max – min, 84 – 1). Four hundred and fifty WDI (EDIERRE Implant System SpA, Genoa, Italy) were included in the present study, 326 (72.4%) 4.5 mm and 124 (27.6%) 5 mm. All patients underwent the same surgical protocol and agreed to participate in a post-operative check-up program. SPSS program was used for statistical analysis. Survival rate (SVR) was 97.3% since only 12 fixtures were lost from a total of 450 implants. Cross-tabulation between failures and immediate loading had a statistically significant value (p= 0.009) in respect to delayed loading. There were 8 failures out of 128 immediate loaded implants in respect to 4 failures out of 315 delayed loaded fixtures. WDI are reliable devices for oral rehabilitation with high SVR.

Solitary thyroid metastasis from colon cancer: fine-needle aspiration cytology and molecular biology approach.

Thyroid gland is one of the most vascularized organs of the body, nevertheless clinical and surgical series report an incidence of secondary malignancies in this gland of only 3%. Colorectal carcinoma metastatic to the thyroid gland is not as uncommon as previously believed, infact the number of cases seems to be increased in recent years due to the more frequent use of fine-needle aspiration cytology (FNAC) guided by ultrasonography. Although kidney, breast and lung metastases to the thyroid are frequent, metastasis from colon cancer is clinically rare with 52 cases reported in the literature in the last 5 decades and three cases described as solitary thyroid metastasis from the colon cancer without any other visceral metastases. To the best of our knowledge, we report the fourth case of solitary, asymptomatic thyroid metastasis from colon cancer without involvement of other organs. We discuss the importance of FNAC to detect metastatazing process as a compulsory step of the diagnostic and therapeutic management algorithm, combined with a molecular biology approach. A review of the last 5 decades literature, to update the number of cases described to date, is also included.

5-year results of cisplatin-epirubicin-vinorelbine (PEV) combination as primary chemotherapy in T2-3, N0-2 breast cancer patients: a multicentre phase II study.

UNLABELLED: The aim this study was to assess the efficacy of cisplatin-epirubicin-vinorelbine, as primary chemotherapy, in reducing the tumour burden in T2-3 N0-2 breast carcinomas. Breast conservative surgery (BCS) rate, clinical and pathological complete response (pCR), toxicity and 5-year disease-free survival (DFS) and overall survival (OS) were evaluated. PATIENTS AND METHODS: Eighty-eight women with tumours > or =2.5 cm were treated with cisplatin (P) 50 mg/m2, epirubicin (E) 100 mg/m2 and vinorelbine (V) 25 mg/m2, every 3 weeks. RESULTS: Fifty-six out of the 88 patients (63.6%) underwent BCS, notably including 12/23 patients with initial tumours >5 cm. The overall clinical response was 72.8% (cCR=11.4%), pCR 20.5% and pTO+pNO 17%. No cardiac toxicity was observed. Grade 3/4 adverse events were leukopenia (9.4%), neutropenia (7.9%), nausea and vomiting (7.3%). After a median follow-up of 5 years, 24 patients (27.3%) had developed local or distant metastases. The mean DFS and OS were 51.7 (SE 2.38) and 57.02 (SE 1.98) months, respectively, and were significantly higher in pCR patients in comparison to the others (63.05 vs. 48.76, p<0.01 and 64.59 vs. 55.04, p<0.05, respectively). CONCLUSION: The PEV regimen was highly effective in reducing the tumour burden, especially for large tumours. The rate of pCR was similar to that obtained by other, including taxane-based regimens, and was well-tolerated. The study demonstrated the feasibility of such a regimen even in small centres, and being of low cost this combination could be of value in the application of primary therapy.

[Traumatic lesions of the diaphragm]. / Lesioni traumatiche del diaframma.

The authors report their experience of 21 cases of post-traumatic hernias of the diaphragm. On the basis of the results obtained by discussion of etiologic, diagnostic and therapeutic patterns they make at the conclusion that the high mortality, associated with diaphragmatic hernias, can be reduced only with a short time of diagnosis and a prompt surgical treatment of the associated lesions.

[Emergency surgical treatment in cancer of the colon]. / Il trattamento chirurgico d'urgenza del cancro del colon.

The diagnostic delay which accompanies the colon-rectum neoplastic desease makes that complications are often the first signal. This work means to prove, according to our experience, that the incidence of these complications is high and that only in a few patients undergoing emergency treatment is possible a one-stage procedure with radical purpose. In our survey, since Genuary 1975 to December 1993, 473 patients (255 males and 218 females) affected of colon-rectum cancer were treated: among these 54 (11.5%) underwent emergency surgery. The neoplasm was located: in the rectosigmoid junction in 25 cases (46.3%) in the caecum or in the right colon in 10 cases (18.6%), in the left colon and in the hepatic flexure in 6 cases (11.1%), in splenic flexure in 4 cases (7.4%), and in the trasversum colon in 3 cases (5.5%). According to Astler & Coller classification 22 patients (40.8%) were C2, 17 (31.5%) were D, 11 (20.4%) were B2, 3 (5.5%) were A, and only 1 patient (1.8%) was C1. 16 patients (29.7%) underwent a one-stage procedure, 8 (14.9%) had a first stage with a colostomy added together with resective procedure, and 3 (5.5%) patients had a Hartmann procedure. In 27 (50%) patients was possible only a palliative procedure. Finally, 10 patients (18.5%) had post-operative complications such as anastomotic fistula, wound's leakage or subphrenic abscess, and 11 patients (20.4%) died for cardiac insufficiency, ARDS, renal failure or cerebral stroke.

[Congenital cyst of the choledochus. A case report and review of the literature]. / Cisti congenita del coledoco. Osservazione di un caso e revisione della letteratura.

Congenital cysts of the choledochus and of the glandulae mucosae biliosae are rare anomalies generally observed in pediatric age: it is in fact exceptional to detect them in adults. There seems also to be a difference in the occurrence among the various races since the disease is more frequently seen in the Japanese and in women. In the Western world the incidence of this pathology has rated to be 1 out of 26,000 hospitalizations, consequently the personal experience and familiarity of every surgeon with this disease will be naturally limited. The authors describe the case of a women, aged 21, under observation as carrier of cystoduodenostomy after congenital cyst of the choledochus. A calculosis of the common hepatic duct as well as the stenosis of the previous cystoduodenostomy are also discovered. The abscission of the cyst and the confection of a Roux's en Y loop hepaticojejunostomy with the separation of the previous gastrojejunostomy are then performed. According to the authors, the complete abscission of the cyst and the Roux hepaticojejunostomy should be considered the surgery of choice when the local situation and the patient's general condition allow it because this treatment reduces the occurrence of late postoperative accidents such as lithiasis and cholangitis and the possibility of malignant degeneration of the cyst. Two years after the operation, the patient is in excellent health conditions.

Proctocolectomy and stapled ileo-anal anastomosis without mucosal proctectomy.

The present study compared the outcome of a small series of patients (7 cases) who underwent total proctocolectomy without mucosal proctectomy and stapled ileal pouch-anal anastomosis made at the apex of the anal transitional zone, with our previous experience (17 cases) in which the ileal pouch was anastomosed at the dentate line after mucosectomy. Though not statistically significant, our limited experience showed excellent clinical results with better continence and discriminating ability of flatus from faeces in the former group. The resting anal pressure profile was not changed postoperatively. The operation time was significantly reduced compared with our previous approach which was a time-consuming procedure. There was an indication that risk of complications (pelvic sepsis and haemorrhage) was less.

[Primary lymphomas of the gastro-intestinal tract]. / I linfomi primitivi del tratto gastro-intestinale.

The authors considered a series of 13 patients undergone surgical operation for primary malignant lymphoma of digestive system, with gastric, gastro-jejunal, jejunal, ileal and colic localization. They examined diagnostic and therapeutic features and the follow-up data. According to literature, the authors remark the importance of roentgenology and endoscopy, that together with bioptic data may reach a definite and early diagnosis; an elective and wide surgical exeresis seems useful in early stages, showing a better prognosis and epithelial malignancies. IV stage patients, however, had a very poor survival; a quick management appears today the only factor affecting long-term results in these patients.

[Non-parasitic cysts of the liver (considerations on 10 surgically treated cases)]. / Le cisti non parassitarie del fegato (considerazioni su 10 casi operati).

The Authors report their experience concerning 10 cases operated on for non-parasitic cysts of liver, among which a case of multicystic liver and a biliary pseudocyst. They emphasize the necessity, in symptomatic patients, for a selective treatment, but, where possible, with complete removal of cystic wall. The interventions performed also include six typical hepatic resections (two right hepatectomies, one of which extended to the fourth segment, and four minor resections), which revealed to be an effective therapeutical means, exempt from significant postoperative complications.