Early orthodontic treatment need in paediatric age: a prospective observational study in Italian school-children.

AIM: This study evaluates the prevalence of Interceptive Orthodontic Treatment Need (IOTN) in Italian school-children. METHODS: A prospective observational study was conducted to assess the prevalence of IOTN in patients undergoing a first visit at the Santa Chiara Hospital Paediatric Dentistry Unit in Pisa, Italy. Two thousand, one hundred ninetynine subjects met the inclusion criteria and were enrolled in the study; data on age, gender and concomitant systemic pathologies were collected from medical records. All participants were examined for individual IOTN: the presence of anterior and/or unilateral/bilateral crossbite with or without midline deviation, bad habits (finger, sucking habits, mouth breathing, and tongue thrust), overjet > 3 mm, lack of space for 1.2 and 2.2 eruption were investigated. The presence of one of the above mentioned parameters was considered positive for IOTN. Chi-square test was used to evaluate any statistically significant difference (p < 0.05). CONCLUSION: The study confirms the presence of a significant percentage of paediatric patients who need IOTN; early treatment is highly recommended to reduce malocclusion outcomes in the adult population.

Reducing dentine hypersensitivity with nano-hydroxyapatite toothpaste: a double-blind randomized controlled trial.

OBJECTIVES: The present randomized double-blind clinical trial aimed to compare the efficacy in reducing dentin hypersensitivity of a dentifrice formulation containing nano-hydroxyapatite with a fluoride dentifrice and a placebo. METHODS AND MATERIALS: One hundred and five subjects were recruited to participate in the study. A computer-generated random table with blocking to one of the three study treatments was used in order to have 35 subjects per group: (1) nano-hydroxyapatite 2% gel toothpaste fluoride free; (2) fluoride gel toothpaste; (3) placebo. Groups 1, 2, and 3 were instructed to treat their teeth for 10 min twice a day with the provided toothpaste gel. The participant's dentin hypersensitivity was evaluated at baseline and after 2 and 4 weeks using airblast and tactile tests. In addition, a subjective evaluation using a visual analogue scale was used. RESULTS: Significant lower values of cold air sensitivity and tactile sensitivity (p < 0.05) were found for the test group at 2 weeks and 4 weeks. In addition, statistically significant (p < 0.05) lower values of sensitivity were reported for group 1 compared to those for groups 2 and 3 at 2 and 4 weeks, respectively. The VAS scores were significantly lower (p < 0.05) in the test group at 2 and 4 weeks compared to those at baseline and in the control groups. CONCLUSION: The application of nano-hydroxyapatite in gel toothpaste fluoride free is an effective desensitizing agent providing relief from symptoms after 2 and 4 weeks.

Tooth bleaching with hydrogen peroxide and nano-hydroxyapatite: a 9-month follow-up randomized clinical trial.

OBJECTIVES: The aim of this study was to compare the amount of tooth colour change, rebound rate and tooth sensitivity in patients submitted to a bleaching technique with 6% hydrogen peroxide (HP) with or without 2% nano-hydroxyapatite (n-HA). METHODS: Sixty subjects were included in this examiner-blinded, randomized clinical trial using a 6% HP gel with or without 2% n-HA. Tooth colour and tooth sensitivity were analysed before and after treatment. All data were analysed statistically. RESULTS: After bleaching, both treatments demonstrated significant improvements in tooth shade (P < 0.05 for both groups). At the 9-month recall, tooth shade remained significantly lighter than at baseline (P < 0.05 for both groups). However, a relapse of the tooth shade was observed compared with the immediate post-bleaching result (P < 0.05). 6% HP with 2% n-HA produced significantly lower sensitivity (P < 0.05) than the bleaching product without n-HA. Colour change evaluation resulted in no difference between the two groups. CONCLUSION: Both treatments demonstrated significant improvements in tooth shade. The bleaching effectiveness of the tested products was comparable. The use of 6% HP with 2% n-HA reduced the incidence of sensitivity during the bleaching treatment compared to a bleaching agent that did not contain n-HA.

CODE 75: Operative protocols and a case report in preventive dental care in a department of neurorehabilitation for acquired cerebral lesions.

UNLABELLED: CODE 75 is a neurorehabilitation department at the General Hospital of Versilia, which specializes in serious acquired cerebral lesions. OBJECTIVES: The therapy and the maintenance of oral hygiene in patients with cerebral lesions are critical to the overall success of the rehabilitation therapy. The purpose of our project was to improve patients' quality of life, reducing the quantity of oral bacteria caused by the presence of layers of plaque on the tooth surfaces and in the oral mucosa. METHODS: The dental department of Versilia Hospital conducted a 1 year follow-up study to develop specific protocols designed to obtain and improve the maintenance of these patients' oral hygiene. The oral prevention project was directed primarily at the department's medical staff and carers, and focused on improving the information available to the medical team and their direct involvement. A case report is described to show an application of the protocol. Data were recorded before the start of the protocol (T0) and after 1 month (T1). RESULTS: The analysis of the periodontal parameters shows a difference in values between T0 and T1. In T1 no bleeding on probing was recorded. After the causal therapy, the gingival hypertrophy and oedema disappeared as confirmed by the absence of BOP. DISCUSSIONS: Results show that teamwork plays a fundamental role in this multi-professional approach for the rehabilitation of patients with acquired cerebral lesions. The success of this protocol depends on the cooperation between personnel with specific skills in the department.

Myocardial scarring by delayed enhancement cardiovascular magnetic resonance in thalassaemia major.

BACKGROUND: Cardiovascular magnetic resonance (CMR) by delayed enhancement (DE) enables visualisation of myocardial scarring, but no dedicated studies are available in thalassaemia major. OBJECTIVE: To investigate the prevalence, extent, clinical and instrumental correlates of myocardial fibrosis or necrosis by DE CMR in patients with thalassaemia major. PATIENTS: 115 Patients with thalassaemia major consecutively examined at an MRI laboratory. METHODS: DE images were acquired to quantify myocardial scarring. Myocardial iron overload was determined by multislice multiecho T2*. Cine images were obtained to evaluate biventricular function. RESULTS: DE areas were present in 28/115 patients (24%). The mean (SD) extent of DE was 3.9 (2.4)%. In 26 patients the location of fibrosis was not specific and patchy distribution was prevalent. Two patients showed transmural DE following coronary distribution. The DE group was significantly older than the no-DE group (31 (7.7) years vs 26 (7.7) years, p = 0.004). No significant relation with heart T2* values and biventricular function was found. A significant correlation was found between the presence of DE and changes in ECG (ECG abnormal in the DE group 22/28 patients and in the no-DE group 30/87 patients; chi(2) = 14.9; p<0.001). CONCLUSIONS: In patients with thalassaemia the significant presence of myocardial fibrosis/necrosis seems to be a time-dependent process correlating with cardiovascular risk factors and cardiac complications. Levels of HCV antibodies are significantly higher in the serum of patients with thalassaemia with myocardial fibrosis/necrosis. ECG changes showed a good accuracy in predicting myocardial scarring.

Panoramic coronary angiography.

OBJECTIVES: We describe a new imaging technique for coronary angiography. BACKGROUND: The conventional approach to coronary angiography exploits static perspective imaging over multiple cardiac cycles, using a limited number of empirically selected views. This approach entails both lack and redundancy of information and may result in suboptimal visualization of the individual lesion, contributing to diagnostic inaccuracy. METHODS: We developed a new imaging technique exploiting dynamic perspective, obtained by transverse 180 degree rotation of the C arm of a conventional angiographic unit during standard selective coronary opacification and filming. This technique yields a picture of the coronary tree isocentrically rotating around the longitudinal axis and conveying complete three-dimensional information. RESULTS: A complete diagnostic run for both coronary arteries, including two 25 degree cranial and two 25 degree caudal scans is accomplished with a total cine time of 16 s and 45 ml of contrast medium, about half of that required by conventional angiography. In a series of 129 consecutive patients studied by both the conventional and the new technique with quantitative measurements of the severity of the stenoses, the final diagnosis was identical in 65. In no case was a stenosis detected only by the conventional approach. However, in 31 patients the new technique permitted identification of 34 critical stenoses (79+/-8% [mean +/- SD]) either underestimated (61+/-3% n = 24, p < 0.001) or undetected (21+/-22%, n = 10, p < 0.001) in the standard projections. In a further 28 cases, 33 subcritical lesions (60+/-5%) were visualized in the rotational images but were insignificant (24+/-22% p < 0.001) in the standard projections. In five additional patients, distinct laminar plaques were clearly visualized only by the panoramic approach. CONCLUSIONS: This new technique can be easily implemented on conventional angiographic equipment at no additional cost. It provides complete, operator-independent exploitation of the angiographic information, resulting in enhanced diagnostic accuracy.

Atrial natriuretic peptide response is blunted in patients with acute myocardial infarction and mild left ventricular dysfunction.

Neurohumoral parameters in 45 asymptomatic patients with acute myocardial infarction were measured. In patients with mild left ventricular dysfunction (ejection fraction < or = 45% and/or left ventricular end-diastolic pressure > or = 15 mm Hg), atrial natriuretic peptide levels differed significantly from those in patients with normal left ventricular function (127 +/- 74 pg/ml vs. 79 +/- 71 pg/ml; p < 0.001). After stimulus an increase in atrial natriuretic peptide levels (79 +/- 71 to 118 +/- 86 pg/ml; p < 0.001) was found only in patients with normal hemodynamic parameters. These data show that in patients with left ventricular dysfunction, the atrial natriuretic system is activated; however, atrial natriuretic peptide response to stimulus is present only in patients with normal hemodynamics.

Selective activation of atrial natriuretic peptide in patients with myocardial infarction and mild left ventricular dysfunction.

The purpose of this study was to investigate whether neurohumoral activation occurs in asymptomatic patients with acute myocardial infarction (AMI) and without clinical signs of heart failure. During the early phase of AMI (mean 8 days), the neurohumoral profiles of 60 patients (mean age 59 range 37 to 70) were examined. Blood levels of the following humoral parameters were measured: atrial natriuretic peptide (ANP), plasma renin activity, aldosterone and vasopressin. All patients underwent cardiac catheterization during hospitalization. Baseline hemodynamic characteristics identified left ventricular dysfunction (ejection fraction < or = 45% and/or left ventricular end-diastolic pressure > or = 15 mmHg) in 32 patients; the remaining 28 patients had normal hemodynamic parameters. In patients with AMI, plasma ANP levels differed significantly from control subjects (111 +/- 74 pg/ml vs. 53 +/- 18 pg/ml; P < 0.001). In patients with AMI and mild left ventricular dysfunction ANP levels were significantly increased when compared to patients with AMI and normal left ventricular function (129 +/- 73 pg/ml vs. 82 +/- 69 pg/ml; P < 0.001). The hemodynamic data showed a significant correlation with ANP only in patients with AMI and left ventricular dysfunction (EF% r = 0.42; LVEDP r = 0.44; P < 0.001). These data show that in patients with myocardial infarction and without heart failure, the atrial natriuretic peptide is the only neurohumoral system activated out of all neurohumoral systems tested in this population and its circulating levels are strictly related to the degree of left ventricular dysfunction.

Paradoxical decrease in circulating neuropeptide Y-like immunoreactivity during mild orthostatic stress in subjects with and without congestive heart failure.

Neuropeptide Y (NPY) is thought to be co-released with catecholamines in response to major cardiovascular stresses, but its relation to the release of catecholamines in response to minor stresses has been less well described. We therefore studied the response of plasma NPY-like immunoreactivity (NPY-Li) levels to standing (10 min) in eight normal subjects and 11 patients with congestive heart failure, and to short-term (6h) vasodilator therapy in 13 patients with congestive heart failure. In both normal and heart failure patients, NPY-Li-decreased (296 +/- 73 to 233 +/- 63 pg.ml-1 and 652 +/- 36 to 516 +/- 25 pg.ml-1 (P < 0.01) respectively) in response to standing, whereas catecholamines increased in both groups (norepinephrine 203 +/- 73 to 507 +/- 165 pg.ml-1 and 493 +/- 197 to 813 +/- 336 pg.ml-1 (P < 0.001) respectively and epinephrine 23 +/- 12 to 38 +/- 12 pg.ml-1 and 46 +/- 19 to 62 +/- 28 pg.ml-1 (P < 0.001) respectively). Both basal circulating NPY-Li and catecholamine levels were markedly increased in congestive heart failure patients, but catecholamines and NPY-Li did not correlate with each other. After 6 h of nitroglycerin infusion, mean arterial pressure was decreased, but circulating neurohumoral levels remained unchanged and NPY-Li levels decreased (653 +/- 37 to 517 +/- 26 pg.ml-1, P < 0.01). It is concluded that basal circulating NPY-Li and catecholamine levels are increased in congestive heart failure and that this neurohormone could play a concomitant role in the increase in peripheral resistance in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac involvement in thalassaemia major: altered atrial natriuretic peptide levels in asymptomatic patients.

Congestive heart failure is the most common cause of death in young adults with thalassaemia major. In the present study we compared atrial natriuretic peptide levels (ANP) in 30 asymptomatic patients with thalassaemia major (aged 16.6 +/- 6.4 years), normal left ventricular diastolic cavity dimension and systolic function, with 30 aged and sex matched normal control subjects. ANP levels were significantly higher in patients with thalassaemia major compared to controls (93.9 +/- 26.3 pg.ml-1 vs 51.8 +/- 26.5 pg.ml-1; P < 0.001). Plasmatic renin activity, aldosterone, urinary sodium and catecholamine levels at basal conditions did not differ significantly in these two groups (ns). Blood volume stimulation (blood transfusion) in thalassaemic patients was followed by an increase of mean ANP values (93.9 +/- 26.3 to 109.1 +/- 40.5 pg.ml-1; P < 0.03). ANP basal levels above two standard deviations of the mean values obtained in normal control subjects were considered as abnormal and found to be in close correlation with the presence of diastolic dysfunction of the left ventricle identified by Doppler echocardiography. The method has a 57% sensitivity and a 91% specificity for revealing pre-clinical cardiac involvement (P < 0.02). Although a longer observation period is necessary in order to define the clinical and prognostic significance of these data, our results show that an increase in ANP basal values is present in asymptomatic patients with thalassaemia major. This suggests initial myocardial involvement, while ANP response to volume overload is maintained.

[A case of acute voluntary poisoning with flecainide in a suicide attempt]. / Su un caso di intossicazione acuta volontaria da flecainide a scopo suicida.

A case of acute poisoning caused by an overdose of flecainide (1.5 gr. per os), taken in order to commit suicide, is described here. With a plasmatic concentration of 5000 ng/ml the drug induced a soporose condition, shallow breathing with phases of apnea and intermittent muscular clonuses, a clinical picture of shock with a idioventricular rhythm at a rate of 40/min. and widening of the QRS (400 msec.). The infusion of orciprenaline and 5% glucose solution induced an increase in the ventricular frequency and the normalization of the circulatory condition. Twenty hours after ingestion sinus rhythm was restored. Highest therapeutic level of flecainide was reached 48 hours after ingestion. The stimulation threshold during the acute phase was 1.8 mA and came down 1.3 mA after wash-out. The outcome was favourable.