Age Assessment in Children and Adolescents by Measuring the Open Apices in Teeth: A New Sardinian Formula.

Age estimation in children is fundamental in both clinical and forensic fields. The aim of this study was to evaluate the accuracy of the Cameriere's European and Italian formulae for age estimation in Sardinian children and adolescents, a genetically isolated population. A sample of 202 orthopantomograms of healthy Sardinian children and adolescents (100 females and 102 males) aged between 6 and 17 years was retrospectively evaluated. The seven left mandibular teeth were assessed with the Cameriere's European and Italian formulae. The teeth with closed apex (N0) were counted and, in the teeth with open apex, the distance between the inner sides was calculated. All variables showed a significant and negative correlation with age except N0 and g. Sex (g), the variables s, N0, and the first-order interaction between them, contributed substantially to the age measurement (p < 0.001). Although the value of x5 had a low prediction level, it generated the following multiple linear regression formula, specific for the Sardinian sample: Age = 10.372 + 0.469 g + 0.810 N0 − 1.079 s − 0.398 s ∙ N0 − 0.326 × 5. Only the Sardinian and European formulae allowed to obtain an acceptable interclass agreement (both the lower and upper >0.7). The results showed that the European formula could be accurate for assessing age in this sample of children and adolescents.

Direct versus Indirect Techniques to Menage Uncomplicated Crown Fractures of Anterior Teeth Following Dentoalveolar Trauma.

Dental trauma are the most common reasons for dental fractures in the anterior area, they have an incidence of 5% in the population, and in permanent teeth, they are mainly caused by sports. The most involved teeth are the maxillary anterior teeth. Direct composite restorations and indirect ceramic restorations are the therapy of choice for restoring anterior teeth after fracture when is not possible to reattach the tooth fragment. The treatment options in uncomplicated coronal fractures depend on various factors such as the amount of residual dentinal enamel tissue, the relationship with the gingival profiles, and the age of the patient. The purpose of this article is to discuss the option of using direct or indirect restorative techniques in the treatment of traumatically fractured anterior teeth and to analyze the advantages and disadvantages of the two methods.

Tension-free hernioplasty of recurrent inguinal hernia under local anaesthesia: a 5-year review.

The aim of this study was to describe the tension-free hernioplasty of recurrent inguinal hernia under local anaesthesia via the anterior approach, in order to evaluate the feasibility, safety and effectiveness of local anaesthesia and its outcome in terms of hernia recurrence and chronic inguinal pain. The effects of hernia type, type of anaesthesia, comorbid disease and complications on recurrence and chronic inguinal pain were analysed. Fifty-nine procedures were performed electively on 56 adult patients. Local anaesthesia was used in all patients. In 4 patients (7%) a shift from local to general anaesthesia became necessary to conclude the procedure due to intra-operative pain. Three cases (5%) with a bilateral inguinal hernia were treated at the same time. Thirty-five (59%) recurrences were repaired with the technique proposed by Lichtenstein, 13 cases (22%) with the dynamic self-regulating (P.A.D.) system, and 11 cases (19%) with a plug repair. After a median follow-up of 96 months there was only 1 recurrence (1.6%) and 1 case of chronic inguinal pain (1.6%). We conclude that use of local anaesthesia is indicated in recurrent inguinal hernia not only for its simplicity, safety and lasting postoperative analgesia, but especially for the lack of potentially detrimental cardiovascular effects observed with general anaesthesia.

Inguinal hernia repair with the dynamic self-regulating prosthesis (PAD system). Recurrence and complications in 236 consecutive patients.

We retrospectively analysed 236 consecutive patients with primary and recurrent inguinal hernia treated with the dynamic self-regulating prosthesis (PAD system). Parameters such as hernia type, operation time, type of anaesthesia, complications, hospital stay and recurrence were evaluated. Recurrence rates were determined by clinical examination. 254 PAD procedures were performed on 236 adult male patients. Inguinal hernias were unilateral in 218 patients, bilateral in 18 patients, and recurrent in 22 patients. There were 101 patients (43%) with Nyhus type II hernia, 113 (48%) with Nyhus type III hernia, and 22 (9%) with Nyhus type IV hernia; local anaesthesia was used in 149 (63%) patients, and epidural anaesthesia in the others. Haemorrhage occurred in 2 patients (0.8%) and required re-operation. After a median follow-up of 40 months (range: 21-56), there were only 2 (0.8%) recurrences, both in the same patient. Persistent inguinal pain at 1 year occurred in 3 patients (1.2%). There was no statistical correlation between preoperative comorbid disease, Nyhus type of hernia, operative time and recurrence (p < 0.2). We conclude that the PAD system is as effective as mesh repair with an acceptable recurrence rate and fewer complications.

[Pneumoperitoneum: is exploratory laparotomy always indicated?]. / Pneumoperitoneo: è sempre indicata la laparotomia esplorativa?

Pneumoperitoneum usually indicates a surgical emergency because of visceral perforation in 85 to 95% of cases. Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma for the surgeon who is faced with this problem. Some cases of pneumoperitoneum can and should be managed conservatively. We report three cases of pneumoperitoneum and describe their outcomes. Two cases were treated conservatively, and one underwent laparotomy but no perforated viscus was found. We review the aetiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas. Furthermore, a compilation of other aetiologies of pneumoperitoneum without peritonitis as reported in the literature is presented. Pneumoperitoneum, preceded by a reasonable clinical history in a patient with an adequate abdominal examination, may warrant continued observation, thus avoiding an unnecessary laparotomy.