Analysis of patients' needs after liver transplantation in Tuscany: a prevalence study.

BACKGROUND: The reorganization of the healthcare system in Tuscany aims at characterizing the hospitals as a place for the treatment of acute patients. This event, together with the improvement of long-term survival after orthotopic liver transplantation (OLT), calls for a management network able to ensure effective continuity of care for patient needs in the posttransplantation period. MATERIALS AND METHODS: An observational study of prevalence has been carried out with the primary objective to evaluate patients' needs and criticalities both in routine daily life and in urgency in the posttransplantation period and the capacity of the regional health system to support them. A survey, using a semi-structured questionnaire consisting of 27 questions, was administered to all patients resident in Tuscany who underwent transplantation from 2000 to 2010. The survey tool assessed the following: socio-demographic data, personal, family and social difficulties, problems emerged in the clinical routine and urgency, resolution modality, relationships with the general practitioner and the referral specialist, and services the patients would appreciate receiving in their province of residence. RESULTS: In the study, 346 patients matched the inclusion criteria of the study, 324 gave telephone consent to participate in the survey, and 225 responded (69.4%). The most frequent difficulties were as follows: depression (39.5%), difficulty in returning to work (29.3%), low income (22.6%), lack of self-sufficiency (22.6%), addictions (19.1%) (cigarette smoking 16.4%), 12.4% eating disorders, and 18.9% other difficulties (social isolation, absence of a family network, and so on). The main reasons for dissatisfaction were as follows: difficulty to obtain the required laboratory tests and lack of a reference structure at the local health facility. Few patients have a referral specialists in their area and most of them primarily refer to the Transplant Center even late after the procedure. DISCUSSION: Early diagnosis of specific conditions (depression, addiction, and eating disorders) should be implemented in the follow-up period and services such as counselling, dietary support, rehabilitation, and social services should be provided locally. An integrated management system between the transplantation center and the local facilities (hospitals, general practitioners, primary care, and laboratories) should be implemented and referral specialized centers should be identified locally.

Comparison between two methods for periodontal risk assessment.

AIM: Risk assessment is increasingly important in periodontology. The aim of this article was to propose a new objective method (UniFe) in order to simplify the risk assessment procedures. UniFe was compared with a computer-based risk assessment tool (PAT(R)). METHODS: Risk scores for both UniFe and PAT(R) were calculated for 107 patients, randomly selected among patients seeking care at a specialist periodontal clinic. For UniFe risk calculation, the ''parameter scores'' assigned to smoking status, diabetic status, number of sites with probing depth 5 mm, bleeding on probing score (BoP) and bone loss/age, were added and the sum was referred to a ''risk score'', ranging from 1 (low risk) to 5 (high risk). PAT(R) generated a risk score on a scale from 1 (lowest risk) to 5 (highest risk). RESULTS: The mean UniFe and PAT(R) risk scores were 4.5+/-0.9 and 4.6+/-0.7, respectively. Cohen k-statistics amounted to 0.7, suggesting a good agreement between methods. Difference in risk score between methods was significantly explained by the parameter scores of BoP and bone loss/age (adjusted R2=0.378). CONCLUSION: The comparison between UniFe and PAT(R) demonstrated a good level of agreement between methods in a randomly selected population referred to a periodontal clinic.

Oligodontia. Surgical treatment and implant rehabilitation. A case report.

Oligodontia is the partial loss of deciduous and permanent teeth and is rather commonly associated with a wide range of malformations in many syndromes. The treatment plan for these patients is based on a multidisciplinary approach involving maxillo-facial surgery and several branches of dentistry. The case of a young man who was diagnosed with oligodontia at the age of 11 is reported. The patient was treated with Le Fort 1 maxillary osteotomy, sagittal palatal osteotomy, mandibular widening by autogenous bone grafting, endosseus titanium implant placement and dental rehabilitation by fixed bridges.

Correlation between age and DNA damage detected by FADU in human peripheral blood lymphocytes.

Fluorometric analysis of DNA unwinding (FADU) is a fast and reliable method for detecting single strand DNA breaks as an index of DNA damage induced by clastogenic agents. A study of damage detected by FADU was conducted on DNA extracted from peripheral blood lymphocytes of 128 healthy nonsmoking regular donors (ranging in age from 19 to 67 years) and from 5 umbilical cord blood samples. DNA damage was measured as percentage of unwound DNA after alkalinization. Statistical analyses, both parametric (Pearson r correlation coefficient, b regression coefficient, ANOVA) and nonparametric (Kruskal-Wallis H test, Spearman rs rank correlation coefficient), support a significant correlation between age of donors and amount of DNA damage. The same results are found when adult donors are divided in four age classes and the ANOVA test performed among the mean percentages of unwound DNA of each class. Furthermore, donors of the same age belonging to different blood groups (A, B, AB and O) do not show any difference in DNA damage detected by FADU.

[Bone harvesting from the oral cavity]. / Prelievo di osso dalla cavita orale.

Autogenous bone grafts have been used successfully in combination with osseointegration and have shown several advantages as compared with other regenerative techniques in the restoration of bone volume for implant placement. Minor bone defects of periodontal, traumatic, and endodontic origins can easily be corrected by harvesting the bone intraorally. Also, sinus grafting procedures can be performed using inlay bone blocks from the mandibular symphysis. Mandibular and maxillary bone can be used as a whole block or can be ground into particulate size and grafted. The harvesting techniques should be as gentle as possible, and care should be taken to minimize the extracorporeal time of the graft. The use of intraoral bone donor sites, in comparison with extraoral sites, has several advantages: General anesthesia is not required; there is no need for postoperative hospitalization; and there is less morbidity in the donor sites. Patients must be informed of the benefits and limits of the autogenous bone harvesting in traditional donor sites, along with the benefits and risks in grafting from the alternative sites. A preoperative radiological study of the patient should include panoramic, lateral, and periapical radiographs. Pre- and postoperative antibiotic coverage is indicated with bone harvesting. The only disadvantage in intraoral grafting is the limited quantity of intraoral bone obtainable. While the long-term evaluations are still lacking, the intraoral grafting shows promising short-term results.

[Focal pathology and infectious dental foci. Theoretical and clinical aspects]. / Patologie focali e foci infettivi dentari. Aspetti teorici e clinici.

A relationship between bucco-dental infection and distant tissue lesions has been recognized for many years. However the pathogenesis of focal odontostomatogenous infection is still not fully understood. At the moment a special attention is paid to the auto immune pathogenesis, but, how focal infection could cause distant tissue injury remains to be investigated. The importance of prevention of infective endocarditis is underlined and prophylaxis procedures are discussed.

[Oral pathology of pscyhosomatic origin. Review of the literature]. / Patologia orale di origine psicosomatica. Rassegna della letteratura.

Emotional stress is one of the etiologic or anyway predisposing factors involved in a lot of oral pathologies. In fact, relations between stress effects and frequent diseases such as gastric ulcer or ulcerous colitis are today wellknown by everyone. Theories about a relation between this kind of etiology and tumours are only reported by some Authors and are at the level of hypotheses. Mouth is very weak in these situations, owing to its great interest as primary erogenous zone, and for this reason we find frequently oral pathologies in relation with psychosomatic medicine. In this report we tried to give a good help to the study of these diseases and to find an easy classification to use (really it is an hard work to do due to the variety of this numerous illnesses).

[Beckwith-Wiedemann syndrome. Presentation of a clinical case]. / Sindrome di Beckwith-Wiedemann. Presentazione di un caso clinico.

The interest we see in oral pathology about Beckwith-Wiedemann syndrome is not strictly related to the association with neoplasms of the syndrome but, first of all, to the high frequency of macroglossia in the patients affected. In fact this pathologic situation, setting up since birth, can strongly modify the growth of teeth and facial skeleton. Therapy consists in a partial glossectomy. After this reducing is advised a contention applied to the chin.