[General anesthesia and cervical anesthesia. What changes in carotid surgery]. / Anestesia generale ed anestesia plessica. Cosa cambia in chirurgia carotidea.

Carotid surgery must be preventive; therefore cerebral protection procedures have been the centre of interest for a decade. Nowadays local cervical block anaesthesia seems to have changed the terms of the problem allowing achieve the aim of "no risk surgery". Therefore we considered our 16 year experience (352 carotids operated on 290 patients). Since 1990 we employed cervical block anaesthesia. In order to ratify as much as possible the two groups of comparison, considering that we adopted some exclusion criteria, we compared the results of the first hundred carotids that underwent surgery with general anaesthesia and the first hundred operated using cervical block anaesthesia. Since we adopted cervical block anaesthesia there was no need of intra-operative monitoring systems because we considered exclusively the patients' clinical answer to preclamping. The use of shunt decreased from 9% to 3%. Surgery performed in cervical block anaesthesia gives a positive impression. This is due to the fact that there is not only a significant reduction of the morbidity rate, especially from a neurologic point of view, but also a reduction of the post-operation hospital stay. Furthermore there is also a better organization of the surgical phases. Direct monitoring of the cerebral function allows a precise analysis of the peri-operatory neurological events. In conclusion our study suggests that cervical block anaesthesia allows clinical benefits for the patient as far as safety is concerned being also more convenient under the economic point of view.

The surface-specific caries pattern of participants in a school-based fluoride mouthrinsing program with implications for the use of sealants.

This paper describes the surface-specific changes in the DMFS after seven years of a school-based mouthrinsing program occurring in the elementary schools of the fluoride-deficient Three Village Central School District, Long Island, New York. The effectiveness of mouthrinsing was evaluated annually by comparing the caries prevalence of a random sample of participants to that of Three Village elementary schoolchildren examined in 1975, prior to the beginning of the program. Because sixth-grade children rinsed the longest and had the longest exposure to the caries challenge, only sixth-grade children who participated in the program are included in the analysis. Overall, they experienced a 50 percent reduction in dental caries; the reduction was not uniformly experienced by all surfaces. Proximal surface caries showed the greatest rate of change but the least absolute change, because the amount of proximal carious lesions was low initially. Occlusal surfaces showed the greatest absolute reduction in dental caries, whereas buccolingual surfaces had the lowest percentage reduction. The majority of the decayed or filled surfaces, 94 percent, involved pits or fissures. Therefore, it was concluded that the combined use of sealants and weekly fluoride rinsing could produce a virtual elimination of dental decay in elementary schoolchildren.

Supervised weekly rinsing with a 0.2% neutral NaF solution: results after 5 years.

The effect on caries prevalence of the permanent dentition was evaluated after 5 years of weekly rinsing (130 scheduled rinses) with a 0.2% neutral NaF solution. The program was conducted in the Three Village Central School District, New York, U.S.A. (F less than or equal to 0.1 part/10(6). First to sixth grade children who rinsed from 1 to 5 years respectively had a caries prevalence reduction of 45.3% (DMFT) and 47.4% (DMFS) compared to baseline scores of children who were examined before the rinsing program began. The highest caries reduction, 81.3%, was found on proximal surfaces. Two variables influenced the cariostatic benefits associated with fluoride rinsing. The younger that children entered the program and the longer that they rinsed, the greater were the accumulated benefits.

Supervised weekly rinsing with a 0.2 percent neutral NaF solution: final results of a demonstration program after six school years.

The results of a school-based fluoride mouthrinsing program in the elementary schools of a Long Island, New York community (F less than or equal to 0.1 ppm) was described. Children enrolled in this continuing program rinse once a week for 60 seconds with a 0.2 percent neutral NaF solution. Kindergarteners rinse with 5.0 ml.; children in the first through sixth grade rinse with 10 ml. Program personnel mix and distribute the rinse to the classrooms. Rinsing is supervised by homeroom teachers. A random sample of 125 children from each grade level (approximately 750 children) annually receive visual-tactile caries examinations from the same examiner. Mean caries prevalence scores after participation in the rinsing program are compared to the caries prevalence of children that were examined in 1975, before the program began. There has been 170 scheduled rinse sessions during six years. By the sixth-year examinations, first graders rinsed for one year (as kindergarteners), second graders for two years, etc. All children who were examined began participation in the program as kindergarteners. The findings after six years of the rinsing program included: 1. There was a 54.1 percent reduction in the mean DMFT caries prevalence score and a 55.2 percent reduction in the mean DMFS score. 2. The greatest percentage caries reduction, 68.8 percent, occurred for proximal surfaces, and the greatest absolute reduction occurred for occlusal surfaces. 3. The percentage of children with a caries-free permanent dentition increased from 43.5 percent to 66.3 percent. Of those children with caries, more were in the low caries category (DMFS = 1-4) compared to children who were examined before the rinsing program began.

Posttreatment benefits from participation in a school-based fluoride mouthrinsing program: II. Results after three to five years of rinsing.

The effect on caries prevalence of previous participation in a school-based 0.2 percent neutral NaF mouthrinsing program was assessed in junior-high-school students. The subjects had rinsed for three-to-five years as elementary-school students in the Three Village fluoride mouthrinsing program, Long Island, New York (F less than or equal to 0.1 ppm). The effects of rinsing were determined by comparing the caries prevalence of seventh, eighth, and ninth grade students who had previously participated in the rinsing program to the baseline caries scores of seventh through ninth grade students who were examined before the rinsing program began. The caries prevalence of the children who had participated in the rinsing program was 29.3 percent (DMFT) and 32.7 percent (DMFS) less than that of the children who had never rinsed. Preferential protection was afforded to the proximal surfaces which had a caries reduction of 56.1 percent compared to 28 percent for both the occlusal and buccolingual surfaces. The duration of the children's participation in the mouthrinsing program generally was related to the level of posttreatment benefits, although age upon entry into the program may also exert an influence. It is fortuitous that there is a persistence of mouthrinsing benefits since older children have generally been reluctant to give their full cooperation in a school-based fluoride mouthrinsing program.

Supervised weekly rinsing with a 0.2% neutral NaF solution: results of a demonstration program after four school years.

Approximately 3,900 elementary schoolchildren rinsed once a week with a 0.2% neutral NaF solution. After four school years, 109 rinses had been scheduled. The effect on caries prevalence in the permanent dentition is evaluated.

[Intralobar pulmonary sequestration in lymphoid and vascular hamartia]. / Sequestrazione polmonare intralobare in quadro di amartia linfoide e vascolare

A case of intralobar pulmonary sequestration observed in a young women subjected to right lower lobectomy is described. Reference to the relevant literature is made in outlining the anatomical and clinical picture of this form. Emphasis is laid on certain particular features: rarity, congenital origin, difficulty of interpreting the clinical picture, the need for careful angiographic examination to ensure positive diagnosis, and the indispensability of surgical management.