Morbidity by plating in maxillofacial surgery.

BACKGROUND: Aim of this paper is to define the behaviour of osteosynthesis plates in maxillofacial area and to determine when to remove them. METHODS: The records of 123 patients treated with osteosynthesis plates were retrospectively assessed. Each case had a follow-up of not less than 5 years. Removal as a consequence of poor surgery was excluded from the study. RESULTS: Osteosynthesis occurred in the mandible in 198 cases and in the upper maxilla in 146 cases, with a further 23 cases treated by plating in other sites. Plates were removed in 21 cases; the most frequent cause of removal was infection (13 sites) followed by nerve palsy and dehiscence. CONCLUSIONS: Infections are without doubt the main cause of plate removal. In orthognathic patients, infections occurred less frequently, nevertheless they remain the main complication. Dysesthesia, along with infections, are the most frequent cause of removal. Plate exposure very rarely are reduction and fixation lost; thus the removal of the plate can be delayed.

Surgical management of the neck in squamous cell carcinoma of the tongue.

If the nodes are involved, survival of patients with squamous cell carcinoma of the tongue is considerably reduced. Surgery remains the treatment of choice and, to define its role, we have reviewed 82 consecutive cases. Sixty-two cases (76%) were T1-2, and 46 patients (56%) had involved nodes. The cervical region II was the most often involved (n=26). Occult nodal metastases were present in 12 cases. The extent of nodal spread and prognosis varies according to whether the body or the base of the tongue is involved. Lesions of the base with involved node should be treated by a selective posterolateral neck dissection, whilst in the case of a lesion of the body of the tongue, the dissection should be selective anterolateral. In lesions of the base, when there are no nodes involved, a prophylactic selective posterolateral neck dissection is recommended, whilst in the case of the lesions of the body, selective supraomohyoid neck dissection in T2-4 lesions is recommended.

The determination of dose characteristics of ruthenium ophthalmic applicators using radiochromic film.

Ruthenium ophthalmic applicators are energetic beta ray sources, supplied in several shapes and dimensions, and used in intraocular tumor therapy. Because of their small dimensions, the determination of dosimetric characteristics represents a technical challenge. We developed a semiautomatic method to define surface dose, dose distribution, and percentage depth dose of such applicators using radiochromic dosimetric media. These detectors consist of a thin (7 microns) radiation sensitive layer on polyester base (100 microns total thickness) changing color as a function of radiation exposure. Transmission images of exposed films were then grabbed with a TV-digitizer system to obtain a gray-level image from which dosimetric characteristics such as isodose distribution, dose values, and homogeneity of nuclide distribution were derived. Good agreement between experimental results and Monte Carlo simulation performed using the GEANT 3 code, appear to be a confirmation of the validity of the method. Moreover while manufacturer specifications of absolute and relative dose rates present a standard deviation error of +/- 30% on dose rate and +/- 6% on accuracy of relative dose values, the proposed method reduces the errors to +/- 10% and +/- 4%, respectively.

Swelling of the floor of the mouth: a clinical dilemma.

Swelling of the floor of the mouth is sometime difficult to diagnose clinically. Lithiasis and neoplasm are the most frequent causes of intraoral swelling. Also after plain radiology and computed tomography the diagnosis is often dubious. A case of swelling of the floor of the mouth due to an adenoid cystic carcinoma of the sublingual gland is reported.

[Nasal patency patterns observed during working hours in a group of technicians habitually exposed to formaldehyde]. / Comportamento della pervietà nasale nell'arco di un turno lavorativo in un gruppo di soggetti professionalmente esposti a formaldeide.

Formaldehyde is a substance which is widely used in several work fields, including many medical and biological sectors. It appears that formaldehyde exposure may cause bronchial asthma. Little information is available, however, with regard to upper aereal tracts. The nose is a target organ of major importance for a large range of professional and extra-professional environmental pollutants. In particular, cases of professional rhinitis brought about by exposure to disinfectants have been reported in Literature. In the light of general knowledge related to the close correlation between upper and lower airways, and to the lack of information concerning the effects of short-term formaldehyde exposure on the upper aereal tract, the Authors decided that investigation of such exposure might prove interesting as well as worthwhile. A group of fifteen technicians who work in three different pathology departments and who had been exposed to formaldehyde for at least one year were studied. The purpose of the study was to assess possible alteration in nasal resistances at the end of a normal work shift. The subjects under study were observed according to a procedure which included several clinical, allergological, serological and functional evaluations carried out on specific days of the week. A control group, consisting of eight asymptomatic, non-atopic subjects who had never been exposed to inhalation of irritants was also monitored in the same way. Conclusions were drawn after considering some important variables such as exposure time, possible anatomical alterations of the nose, the presence of respiratory allergies and smoking habits. It was apparent that professional formaldehyde exposure typical of that experienced by technicians working in pathology departments induced a short-term irritant effect on the upper aereal tract, which, even though subclinical, is revealed by a statistically significant increase in nasal resistance. This effect seems to be favoured (at statistically not significant levels) by atopy, cigarette smoking and anatomical alterations of the nose. Our data seem to exclude a chronic cumulative effect of formaldehyde exposure.

[Nasal hyperreactivity and work environment]. / L'iperreattività nasale e l'ambiente di lavoro.

The Authors report bibliographic data concerning the effects of some substances present in the work environment of the nose and the possibility of nasal hypersensitivity to these substances. Preliminary data referring to a current study in the First ENT Clinic of the University of Turin on workers exposed to formaldehyde vapors are reported.

[A case-control study of multiple occupational risk factors in relation to laryngeal cancer]. / Studio caso-controllo sui rischi multipli lavorativi in rapporto al cancro laringeo.

In this work the A.A. present the results of a case-control study on 2,997 subjects carried out to evaluate the role of professional factors in the development of laryngeal cancer. Our analysis included only cases of laryngeal neoplasia at first diagnosis in 1990. From a statistical point of view we calculated the Odds Ratio (OR) and confidence limits at 95% following Miettinen. The analysis was made on 113 cases and 754 controls, all males smokers or ex-smokers, aged between 35-80 years. The results show a statistically significant correlation between laryngeal cancer and jobs in agriculture (OR = 3.77), in iron-steel industries (OR = 3.25), in metal-mechanic industries (OR = 1.72). Precise knowledge of such data could be very useful in promoting primary and secondary prevention campaigns in the above-mentioned work places. The A.A. stress the need to make experimental cancerogenesis studies to evaluate the effects of the association of occupational risk factors, tobacco smoke and alcohol consumption on the natural history of laryngeal cancer.

[Multiple myeloma and occupational risk factors: a case-control study]. / Mieloma multiplo e fattori di rischio occupazionali: studio caso controllo.

In order to identify possible relationships between multiple myeloma (MM) and occupational factors, a hospital-based case control type study was carried out on 94 cases of MM and on 188 controls matched for sex, age (S.D. = 2 years) and area of residence, suffering from orthopaedic trauma and free of chronic/degenerative or tumoral diseases. All jobs done for at least a year in a period of 5-30 years before diagnosis were considered. Statistical analysis showed a significant correlation between MM and agricultural work (OR 1.82; I.C. 95% 1.03-3.25), which agrees with the data in the literature. The etiopathogenetic hypotheses reported in the literature are discussed and proposals for further research are made.

B lymphocyte markers in multiple myeloma and related plasma cell dyscrasias.

Multiple myeloma and benign monoclonal gammopathies are regarded as monoclonal B cell proliferations in which B lymphocyte maturation is blocked in the final stages of the differentiation cycle. "Blocked" cells accumulate in the body and produce large quantities of immunoglobulins. These are monoclonal, because they come from a monoclonal cell stock. This study presents the results of peripheral B lymphocyte and marrow plasma cell typing designed to reveal the postulated isotypical relationship of the proliferating cells and the serum paraprotein. A good, though not absolute correlation between the two immunoglobulins was noted in most patients. The data, however, was not used in the diagnosis and treatment of these diseases. Further studies with MoAb's will, perhaps, provide a finer subclassification of the B lymphocyte proliferation diseases and assist in their diagnosis and treatment.

[Industrial accidents and hotel- and home-related pathology]. / Infortunistica e patologia alberghiera e domestica.

The authors examine the various problems regarding work-related accidents and professional illnesses in the domestic-hotel field. Faced with an ever-rising frequency in various nations, in Italy information concerning the causative agents, the modality and the severity of these problems and the preventive measures adopted, appears usually inadequate.

[Cytological study of acid phosphatase activity of plasma cells in monoclonal gammopathies]. / Zytologische Untersuchung der sauren Phosphataseaktivität in den Plasmazellen bei monoklonalen Gammopathien.

The activity of acid phosphatase in bone marrow plasma cells was investigated by a cytochemical method in 12 patients with multiple myeloma, in 12 patients with benign monoclonal gammopathy and in 5 normal controls. The activity of acid phosphatase was significantly higher in the multiple myeloma patients compared with the activity observed in controls and in benign monoclonal gammopathy patients (p less than 0.001). It is therefore suggested that this method may be a valuable adjunct in the differential diagnosis of monoclonal immunoglobulinemias .

[The osteocondensing variety of multiple myeloma. Review of the literature and description of a case]. / La varietà osteocondensante del mieloma multiplo. Rassegna della letteratura e descrizione di un caso.

A case of IgG myeloma with eburnation of the femoral and ileoischiopubic bones is described. A review of the literature confirmed the rarity of osteosclerotic myeloma, especially if other possible causes of bone eburnation or the typical contemporary existence of osteolysis are excluded. The hypothesis that osteosclerotic myeloma may constitute an autonomous form of the disease, probably related to the type and/or extent of the proliferating bone is discussed.

[Risk in welding operations. Etiopathogenetic, preventive and legislative considerations]. / Rischi nelle operazioni di saldatura. Considerazioni eziopatogenetiche, prevenzionali e legislative.

This work classifies different types of welding procedure, occasional and specific contaminating elements, both of the welding material, and of other possible substances (particularly plastic materials) used in the pre-treating phase. The authors show the risk evaluation factors of the welding operations and, moreover, suggest a diagnostic and prevention program on the exposed subjects. Finally they include a table of references on italian law concerning the contaminating substances produced by welding processes.

Multiple myeloma associated with Kaposi sarcoma: a case report.

An Italian woman affected by multiple myeloma (MM) associated with Kaposi's sarcoma (KS) has been studied. MM appeared to be at stage II, A, according to Durie & Salmon (3) (quantitative staging); KS spread out two and a half years after MM had been diagnosed, and showed only a pharyngeal involvement. The patient was still alive two and a half years after KS had been discovered, showing a benign clinical course, though several infectious complications had occurred. The observed patient is compared with the other ten cases reported in the world literature. The long lasting observed survival is thought to be related to the low MCM and the length of successful therapy.

[Routine examinations for the evaluation of thrombotic risk]. / Alcuni esami di routine per la valutazione del rischio trombotico.

The objective of our research was to align to the PAT Breddin system other routine analysis. With this procedure we intend to have, further indications on eventual pre-thrombotic situations. We have passed through examination 85 subjects: 30 as negative subjects, 55 as potential positive pre-thrombotic. The 85 subjects were passed through the PAT Breddin analysis system and the biological research of the antithrombin III, the antiplasmin and the dissolution of the coagulum. The result was satisfactory, in order to allow us to verify that utilising more research parameters we will have a more complete picture of the individual thrombosis tendency.