Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study.

BACKGROUND: Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. METHODS: In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. RESULTS: Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups. CONCLUSIONS: Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.

Is manual dexterity essential in the selection of dental students?

OBJECTIVE: The purpose of this study was to determine whether basic manual dexterity (BMD) could be an important parameter in selecting students for the Degree in Dentistry (CLOPD) and to assess whether initial manual dexterity in students admitted to the CLOPD can improve with training in pre-clinical and clinical practice. DESIGN: Observational study. SETTING: The study was carried out at the Catholic University of Rome, in five consecutive academic years. SUBJECTS AND METHODS: Four hundred and thirty-three subjects (262 males and 171 females) were tested (10 different exercises) in five consecutive years. Two retests were performed after three and five years respectively from the beginning of the experimentation. MAIN OUTCOME MEASURES: The scores of individual exercises were averaged for each candidate, assessing the mean value of basic manual dexterity score (BMDS). RESULTS: It was possible to observe some differences among candidates coming from different types of high schools, since those having a prior university degree or a scientific high school degree proved better than those with classical or vocational high school qualifications (p < 0.05). A statistically significant improvement of BMDS has been observed in students who attended the CLOPD for at least 32 months. CONCLUSIONS: Data obtained revealed that basic manual dexterity is not essential in the selection of dental students. Students who could follow training significantly improved in their manual ability.

Concomitant primary hyperparathyroidism, Graves' disease and vitamin D deficiency.

The simultaneous occurrence of hyperthyroidism and primary hyperparathyroidism is quite rare. A case is reported here of Graves' disease and primary hyperparathyroidism. Treatment of these concomitant diseases consists in combined thyroidectomy and parathyroidectomy. Histological examination confirmed Graves' disease and revealed the presence of a parathyroid adenoma in one gland and parathyroid hyperplasia in another one. After surgical treatment, secondary hyperparathyroidism due to 25-OH Vitamin D deficiency appeared. To our knowledge, this is the first case in which a Vitamin D absorption deficit was found in presence of hyperthyroidism and hyperparathyroidism without other intestinal absorption deficits. Diagnostic and follow-up difficulties related to these three concomitant pathological conditions are discussed.

[Post-traumatic anosmia: description of a clinical case, proposal of a standardized protocol and medico-legal comments]. / Anosmia post-traumatica: descrizione di un caso clinico, proposta di un iter valutativo standardizzato e considerazioni medico-legali.

Man's olfactory perception is considerably limited compared to that of other animals; this sense is, however, extremely important in our social lives: it helps us to "savour" our food, it enables us to appreciate perfumes and, even more important, to pick up smells that signal a danger, such as a gas leak or a fire. We describe the clinical case of a patient with anosmia and hypogeusia that appeared immediately after suffering a concussive head injury. We go through the diagnostic protocol for medico-legal assessment of hypoanosmias previously described in the literature, which includes a clinical and an imaging section. In 9% of all anosmic patients, a traumatic event precedes the onset of the disorder, with repercussions on the olfactory channels and centres of the peripherical and/or central nervous system. The overall rate of anosmia following head injury is estimated to be around 7.5%. Among the principal causes of anosmia, those of medico-legal interest constitute 35% of the total. On the basis of our personal experience and of clinical studies conducted by other Authors, we propose that a bioptic investigation of the olfactory mucosa be added to the existing protocol. The olfactory neuroepithelium of patients suffering from post-traumatic anosmia, in fact, evidences some characteristic degenerative aspects. In conclusion, we report several comments regarding the quantification of the reduction of the olfactory function in different areas of medico-legal interest.

Angina bullosa haemorrhagica: presentation of eight new cases and a review of the literature.

Angina bullosa haemorrhagica (ABH) describes the acute and sometimes painful onset of oral blood-filled vesicles and bullae not attributable to blood dyscrasia, vesiculo-bullous disorders, systemic diseases or other known causes. The haemorrhagic bullae spontaneously burst after a short time resulting in ragged, often painless, superficial erosions that heal spontaneously within 1 week without scarring. Although the pathogenesis is still unclear, ABH seems to be a multifactorial phenomenon: dental or functional trauma seems to be the major provoking factor. The lesions of ABH can be easily confused with other mucosal diseases. It is important that the presentation of this benign disorder is distinguished from other more serious disorders with similar presenting features. The aim of this paper is to report the clinical features of eight cases of ABH, in an attempt to distinguish ABH from other blistering diseases of oral mucosa and to describe their management.

Treatment of hyperacusis in Williams syndrome with bilateral conductive hearing loss.

Williams syndrome (WS) is a rather rare congenital disorder characterised by a series of cardiovascular, maxillo-facial and skeletal abnormalities. It sometimes displays otorhinolaryngological symptoms because of the relatively high incidence of secretory otitis media and hyperacusis, which may be present in up to 95% of patients. The present paper describes a case of WS associated with bilateral conductive hearing loss which was not related to secretory otitis media. Hyperacusis was, moreover, present in spite of the conductive deafness. Surgical or prosthetic treatment of hearing loss was delayed because of hyperacusis. Treatment of the hyperacusis by acoustic training, instead, yielded excellent, long-lasting remission of the symptoms.

[Unusual radiological findings in combined laryngeal mucocele]. / Aspetti radiologici peculiari in un caso di mucocele laringeo misto.

In laryngeal mucocele, Morgagni's ventricle fills with mucous resulting from proliferation of the innner glandular epithelium and simultaneous closure of the ventricular opening. In making a diagnosis, the physician must first rule out any underlying neoplasm in Morgagni's ventricle which would give rise to a secondary mucocele. The present work reports a clinical case which came under observation because of cough, dysphonia and swelling of the left ventricular band with normal motility of the true vocal cords. CT of the neck, performed with contrast medium and axial scanning, showed a solid neoformation starting from the left laryngeal ventricle; densitometry proved moderately non homogeneous and showed radiological signs of hypervascularization. On the basis of these data the patient underwent direct bioptic laryngoscopy. During the beginning of the endoscopic maneuver, the pressure exerted by the stiff laryngoscope forced out dense, sticky mucous-like material and caused the laryngeal ventricle to collapse. Subsequently, multiple bioptic samples were taken from the walls and floor of the ventricle. The histological and microbiological examination confirmed the diagnosis of laryngeal mucocele. Six months later the laryngoscopic picture was nearly normal. In the years since computerized tomography came into clinical practice, diagnosis of this pathology has become easier and quicker Computerized tomography provides radiological indication of benignness which is certainly valid for laryngocele, a tumefaction containing air and which is therefore clearly differentiated from the radiodensity of the surrounding tissues. Vice versa, the homogeneous mucous content of the laryngeal mucocele can be altered by bacterial proliferation and may not show up on the CT as a uniformly hypodense area. Phlogosis due to the presence of colonies of bacteria can lead to greater blood flow in the ventricular site, thus making it impossible to distinguish the hyperdense boundary surrounding the hypodense mass. This, in turn, creates a blurry, ambiguous area of hyperdensity typical of increased vascularization. The rarity of the lesion, the relative likelihood of a simultaneous neoplasm and the ambiguousness of the clinical diagnostic elements available justify the use of preliminary bioptic microlaryngoscopy before surgically treating laryngeal mucocele.

[Clinical observations on the nature of early caries. A study with scanning electron microscopy]. / Osservazioni cliniche sulla natura delle lesioni cariose iniziali. Studio al SEM.

BACKGROUND: Early caries lesions present a greater porosity in the deep layers than in the superficial layer of the enamel. The "white spot" lesion is a dynamic lesion which is subjected to the changes occurring in the oral cavity; it can regress, stabilize or progress. The aim of this study is to show if there are considerable morphological differences in the superficial ultrastructural aspect of early caries lesions, active or stabilized, in persons of different age. METHODS: To carry out this SEM observation, 15 patients aged from 12 to 50 presenting early caries lesions have been selected. Some of them had been recently subjected to orthodontic treatment, others several years ago. Five of these patients have been called back to examine again the demineralized area by microscope in the very same place of the first observation. The replica technique was used utilizing a silicon-based impression material, an epoxy resin for replicas casting, little steel nets to fix the silicon material. RESULTS: At the level of white spot lesions it is evident a tissural structure scattered with small overlappings and micropits with a diameter of 0.5-2 mu. The patients who removed orthodontic bands more than 10 years before show a shining white aspect, corresponding to the nearly complete loss of enamel perikymata with well defined abrasions, but without any micropits at SEM examination. CONCLUSIONS: The replica technique has shown to be useful to record the defects of active and stabilized caries lesions. However this technique can't be utilized as a diagnostic instrument because it would be too expensive, but it is certainly a valid support for in vivo research.

[Human olfactory mucosa biopsy with endoscopic technique: clinical and structural observations on neurosensory epithelium rearrangement]. / Biopsia di mucosa olfattiva con tecnica endoscopica: rilievi clinici e osservazioni strutturali sul rinnovamento tissutale.

Optical and electron microscopy have been widely used to study the structural features of olfactory epithelium in several Vertebrate species. To date, however, understanding of histopathological alterations in the human olfactory neuroepithelium has been quite limited due to the difficulty in obtaining well preserved, intact fragments of mucosa. The recent introduction of endoscopic biopsy techniques has made it possible to analyze this epithelium in greater detail. In the present work, endoscopic biopsy has been performed on samples from 10 rhinologically healthy subjects. The technique used proved quite simple and did not present any risks or complications. Moreover, all samples were well preserved, as confirmed by histology. In addition, the histological pictures suggest that normal rearrangement of neuroepithelium is not an uniform process but takes place following a zone pattern with distinct dynamics between neurosensorial and support cells. Greater diffusion of this technique would not only make it possible to use different techniques to gain more detailed knowledge of tissue structure, ultrastructure and dynamics in human neuroepithelium, but it would also provide improved diagnostic and forensic evaluation in cases of anosmia, disosmia and hyposmia.

Multifrequency multicomponent tympanometry in normal and otosclerotic ears.

A multifrequency multicomponent admittance meter was used to evaluate 70 ears of patients affected by fenestral otosclerosis (Os ears), monolateral (16 cases) or bilateral (27 cases). The 16 contralateral ears of the patients with monolateral otosclerosis who presented a pure-tone air-bone gap less than 10 dB were evaluated separately (Cos ears). A group of 48 ears belonging to 24 otologically normal subjects (N ears), with hearing thresholds better than or equal to 10dB HL in the frequencies between 250 and 8000 Hz served as a control group. The purpose of the study was to evaluate the acoustic admittance characteristics of the three groups of ears, with particular regard to the parameters represented by the resonance frequency (RF), the acoustic conductance value (G) at RF and the individual interaural differences in these two parameters in the N and Cos groups. The degree to which fenestral otosclerosis can influence variations of RF and the correlation between the value of RF and conductive hearing loss in patients with clinically confirmed pictures and in the controlateral ears in the cases where the disease was clinically unilateral were also investigated. The study reveals statistically significant differences between the RF means in the N group (1085 +/- 244Hz) vs the Os group (1264 +/- 320 Hz) (p < 0.001) and between the G means in the N group (5.33 +/- 1.72 mmhos) vs the Os group (4.46 +/- 2.54 mmhos) (p = 0.04) and N group vs Cos group (3.42 +/- 2.27 mmhos) (p < 0.001). No correlation was found between the value of RF and conductive hearing loss. This study also shows how prognostic value may also be attributed to conductance at middle-ear pressure balancement: extremely low values for this parameter at RF are indicative of initial otosclerotic involvement of the oval window.

[Videofluoroscopic study of deglutition in patients with multiple sclerosis]. / Studio videofluoroscopico della deglutizione nei pazienti affetti da sclerosi multipla.

Multiple sclerosis is a neurological disease that affects the I/II motor neurons of the CNS and its symptoms include oropharyngeal dysphagia. The onset and course of this dysphagia significantly conditions the progression of the disease. The present study evaluates the incidence on deglutition and type of alterations in a sampling of 10 multiple sclerosis patients of which 4 showed clinical signs of dysphagia. The results, obtained by combining quantitative (clinical severity) and qualitative (functional alterations) parameters showed that 9 of the 10 patients (90%) presented radiological abnormalities in the progression of the bolus. The conclusion drawn is that the high prevalence of dysphagia in multiple sclerosis, even if not always manifest clinically, justifies drawing up a standard protocol for radiological evaluation and clinical follow-up in order to screen those patients at greater risk of pulmonary complications and delay them as long as possible.

Dynamic behavior of the Provox and Staffieri prostheses for voice rehabilitation following total laryngectomy.

The present study evaluated the differences in aerodynamic behavior between the 1990 Provox and 1986 Staffieri voice prostheses for total laryngectomy patients. Both prostheses were submitted to in vitro laboratory testing to assess their aerodynamic behavior under different conditions of air flow through the valve and tracheal side pressure. In addition, six patients using the Provox and another six using the Staffieri prostheses were submitted to a dynamic study of phonation. This latter study evaluated the intratracheal pressure corresponding to the different intensities at which the vowel sound /a/ was pronounced. In vitro measurements revealed significant differences between the two prostheses, with the best results achieved with Provox. In contrast, the in vivo measurements did not reveal any significant differences between the two groups of patients in the 50-79 dBSPL range, although there was some difference at intensities equal to or greater than 80 dBSPL. Again, in this latter case the best results were achieved with the Provox. However, the ideal prosthesis has yet to be found. In some patients, the so-called low-resistance prostheses fail to maintain their aerodynamic performances, most likely because anatomic resistors interfere with the effort (i.e., pressure) required to produce a voice. At present the choice of prosthesis is best determined on an individual patient-to-patient basis.

[Analysis of qualitative voice and speech quality judgments after total laryngectomy]. / Analisi dei giudizi sulle caratteristiche qualitative della voce e del linguaggio dopo laringectomia totale.

The present work analyzes subjective judgement of the voice and speech qualities of intelligibility, pleasantness and acceptability expressed for two groups of total laryngectomy patients. The first group was composed of ten patients who had undergone esophageal voice rehabilitation. The second had nine patients with tracheo-esophageal voice rehabilitation. A group of ten listeners was set up to evaluate the voice and language parameters. These were all persons who, because of their jobs (i.e. physicians, nurses, rehabilitation therapists, etc.), had nearly daily contacts with laryngectomized patients. The listeners had to evaluate the acoustic and qualitative features of the voices reproduced on magnetic tape and score them on a specially designed sheet. This study has revealed a significant difference in the voice and speech acceptability scores for the two different groups of patients. In fact, most of the listeners found the tracheo-esophageal voice more pleasant and more acceptable than the esophageal voice.

[Effect of sulfur salt-bromine-iodine thermal waters on albumin and IgA concentrations in nasal secretions]. / Effetti indotti dalle acque termali sulfuree-salso-bromo-iodiche sulle concentrazioni di albumine e IgA secretorie del secreto nasale.

In chronic rhinopharyngotubaric phlogoses, the key pathogenic element sustaining phlogosis is a persistent modification of the biological, rheological features of the nasal mucus. For centuries sulphurous thermal waters have proved effective in clinically curing such phlogoses. In order to evaluate the effect of such sulphurous-salty-bromic-iodic thermal waters a randomized, double blind study was undertaken on a sampling of 50 patients. The effect such waters have on secretory IgA (sIgA) and albumin in the nasal secretions was tested against a placebo made of distilled water. Using the method of radial immunodiffusion, the response in the IgAs (mg/l) and albumin (mg/dl) concentrations in the nasal secretions was measured for 25 patients treated with the thermal waters and 25 patients treated with distilled water. The average concentrations were statistically compared using the Student t-test for paired samples. A significant increase (p < 0.0001) was seen in the mean IgAs concentration in the patients treated with the thermal waters. On the other hand, there was a weak, not statistically significant increase in the same data mean for the group treated with distilled water. The average increase in the albumin concentration in the nasal secretions proved significant in both cases although the significance was much more marked in the group treated with the thermal waters (p = 0.001) vs. the placebo group (p = 0.039).

Staffieri tracheo-oesophageal prosthesis for voice rehabilitation after laryngectomy: an evaluation of characteristics.

Experimental results on voice prostheses used for the rehabilitation of patients that have lost their vocal function after total laryngectomy are presented. The purpose is to evaluate the difference in aerodynamic behaviour between Staffieri voice prosthesis and other commercial valves (Groningen standard, Groningen low pressure, Panje, Provox). Two different equipments for flow-rate measurement were designed and built to compare the performance of the valves. The valves have been experimentally tested under different conditions of airflow through the valve and tracheal side pressure. The data allow calculation of the airflow resistance, the parameter usually used to compare the performance of valves. The valves have also been experimentally tested under different conditions of fluid flow through the valve and oesophageal side pressure (reverse flow). Comparing the airflow resistance of Staffieri valves of different length L and different angular extension of the razor-thin silt alpha, it has been observed that the parameter alpha has a significant influence on the characteristics, while the effect of the length L is negligible. The airflow resistance of the Provox, Groningen low pressure and Staffieri alpha = 270 degrees valves are comparable; the Panje and Staffieri alpha = 180 degrees have similar behaviour; while the Groningen Standard is comparable to the Staffieri alpha = 90 degrees. Regarding reverse flow, it is pointed out that for most of the valves (Staffieri and commercial valves), at different oesophageal pressures the fluid flow is smaller than the flow that can be tolerated by patients without giving problems.

[Saliva: clinical and diagnostic usefulness. Review of the literature]. / La saliva: utilità clinica e diagnostica. Rassegna della letteratura.

Modern clinical pathology is mainly based on the analysis of blood samples, carried out through more and more sophisticated techniques. Being the blood test an invasive technique, it certainly reduces the possibility of carrying out blood analysis, especially in patients such as children, old people, handicapped people and every person who needs continuous biochemical or pharmacological monitoring. In these cases it is very important to find other body fluids that can be easily obtained and that can offer the same reliable data as blood. Due to some of its characteristics, sometime saliva may be a good alternative to venous blood, as it presents the same features of plasma or urine. The chemical analysis of saliva provides some information that are useful for metabolic, inflammatory, neoplastic and genetic diseases; furthermore radioimmunological dosages allow to assess small concentrations of active substances. On the basis of an accurate review of literature, the aim of this study is to analyse the importance of saliva in diagnosing and monitoring certain systemic diseases, the utilization of saliva in hormonal and pharmacological dosages and the use of saliva in some epidemiological studies. Finally, it is emphasized that saliva in monitoring may help to manage several clinical conditions.

[Oxytalan fibers in the condylar cartilage. Methodologic and experimental contribution of histologic studies conducted on dogs, rabbits and rats]. / Le fibre oxytalan nella cartilagine condilare. Contributo metodologico e sperimentale nell' indagine istologica condotta su cane, coniglio e ratto.

BACKGROUND: Oxytalan fibers were identified by Fullmer and Lillie in 1958 for the first time, using the same coloring methods utilized for the elastic fibers. However, the istologic preparation had been previously treated with strong oxidation. Oxytalan fibers were found in many organs and tissues of different animal species and seem to be a type of "immature" elastic fiber in a precocious state of development. Anyway, the functional role of oxytalan fibers is still not clear. The oxytalan fibers, located in particular mechanical stress anatomic sides, seem to be connected to a more compact connective tissue in this sides. The purpose of our study is to analyze the anatomic arrangement of the oxytalan fibers in the temporomandibUlar joint of three different animal species: the rat [correction of mouse], the rabbit and the dog. MATERIALS AND METHODS: Up to now, a coloring method specific for the oxytalan fibers has not been developed. Therefore, a correct evaluation of their presence requires a systematic approach in which two contiguous sections of a sample, one heavily oxidized and the other non oxidized, are compared. RESULTS: Our results show the presence of the oxytalan fibers differently located depending of the animal species and the age of the animals.

[Septorhinoplasty in childhood]. / La rinosettoplastica in età pediatrica.

Septorhinoplasty plays an important role in childhood, particularly from the functional point of view. In fact, normal nasal respiration makes it possible to develop physical harmony throughout the entire body, particularly within the facial area. Nasal respiration serves as a defense mechanism, filtering air, thus relieving the lower respiratory tract of some work during the episodes of upper aero-digestive tract infection and inflammation so typical of childhood and early adolescence. The surgical indications should consider the central points in nasal surgery in childhood: there must be marked functional compromise; the aesthetic defect, if present, must be highly evident; the surgical treatment must be as limited and focused as possible as to prevent interfering with subsequent development of the nose, paranasal sinuses and facial structures. In those cases where the above conditions are not found, it is advisable to postpone surgery until the child has reached 16 years of age, when the development of the nasal and facial skeleton has been completed.

[The actual problems in functional and aesthetic nasal surgery]. / Le problematiche attuali nella chirurgia funzionale ed estetica del naso.

Functional and aesthetic nasal surgery has been undergoing a process of fine-tuning. The surgical approaches lean toward greater conservation-particularly aesthetic- and functional selectivity. This has been made possible by improved diagnostic methods and pre-operative programming techniques such as computerized morphometry, computerized axial tomography, rhinosinus endoscopy, rhinomanometry, acoustic rhinometry and electromyography. Another important point in functional and aesthetic nasal surgery is that a) it can be divided into different techniques for each anatomo-functional sector considered and b) these can be used together in various combinations. Experience and the literature have underscored some issues which are most pertinent to the modern methodological viewpoint. The first large-scale controversy involves a comparison of open and closed techniques for access. The advantages and disadvantages of both techniques are described, although the disadvantages can be reduced to a minimum if the right indication is chosen. In the authors' opinion, the open technique should be reserved for general revision surgery, particularly in conjunction with difficult tips, labiopalatoschisis reconstruction, septal perforation and saddle nose. The second basic point involves how to deal with the perichondrium-periostium-mucosal flaps. The two main techniques for nasal skeletizing in rhinoseptoplasty include the extra-mucosal approach which is conservative and the trans-mucosal approach which is apparently more traumatic. Curiously, however, it is the latter technique which leads to fewer medium-long term complications. The nasal tip is the crux for the neophyte to rhinoseptoplasty. Through knowledge of the indications and the risks of the various techniques makes it possible to predict the result before-hand, although with certain margin of error. Indeed, this is one of the regions of the nose where errors reap the greatest damage. In this anatomical site, the use of conservative techniques is, therefore, strongly suggested. Finally, not only has research into the field of functional nasal surgery been unable to find concrete applications in humans (for obvious ethical reasons), it has likewise been unable to provide an answer to the question most rhinosurgeons pose: why do some patients still complain of difficulty breathing, even after successful surgery? It is our conviction that the problem is due to the fact that research into the endonasal receptors has not progressed.

Spectrographic differences between tracheal-esophageal and esophageal voice.

In order to evaluate the results of voice and speech rehabilitation after total laryngectomy some acoustic parameters (fundamental frequency, waveform perturbation) were examined in 18 total laryngectomy patients. Eight of these subjects had previously been surgically rehabilitated with a tracheal-esophageal phonatory valve while 10 had been submitted to esophageal speech rehabilitation. Analysis of results has shown that tracheal-esophageal voices are more likely to provide a stable fundamental frequency; there is also a tendency toward more clearly defined harmonics; jitter and shimmer are more similar to the values of normal subjects compared with those observed in esophageal speech. Such results seem to depend on a more regular vibration pattern in the pharyngeal-esophageal segment, due to the more efficient expiratory flow in tracheal-esophageal speech. Moreover we were able to demonstrate a correlation between the objective parameters evaluated and the subjective score on speech acceptability.