Mondani intraoral welding: historical process and main practical applications.

The intraoral welder was invented by Dr. Pierluigi Mondani during the early 70’s to weld titanium needle implants to a titanium bar in patient’s mouth and to load them immediately by means of resin prosthesis. The clinical use documented dates back to 1972. Over the years, many practical applications have been added to the initial one, which have expanded the use of this device. In this scientific work, main applications are described. The aim of the work was to trace the historical process of intra-oral welding according to Mondani and describe the main practical applications. Intra-oral welding is a process introduced by dr. Pier Luigi Mondani of Genova (Italy) which allows to firmly conjoin titanium implants of any shape by means of a titanium bar or also directly between them in the mouth during surgery. The immediate stabilization achieved by intraoral welding increases implants success rate, allows immediate loading even in situations of bone atrophy, saves implants that are running into failure, re-evaluates fractured implants, allows to stabilize submerged implants postponing prosthesis management, allows to achieve efficient rehabilitation protocols to deal with difficult cases. The 40-years’ experience with intra-oral welding described in this article, confirms the ease of use and efficiency in providing immediate stabilization of titanium implants of all types.

The efficacy of Italian guidelines in promoting oral health in children and adolescents.

AIM: The purpose of the study was to evaluate the efficacy of the guidelines on oral health published by the Italian Health Ministry. STUDY DESIGN: 1239 patients (582 girls and 657 boys) with a mean age of 4.46 (SD 2.81) years were evaluated before application of the guidelines by paediatricians (T0) for the presence of caries, gingivitis, diseases of the oral mucosa, and malocclusion. Only patients aged 6 months, 3 years, 6 years, and 9 years at T0 were taken into consideration. All patients were reevaluated after application of the ministerial guidelines (T1). METHODS: the study took place over a 3-year period. Enrolled patients referred to the outpatient clinics of three paediatricians of the Province of Genoa who strictly applied the ministerial guidelines. STATISTICS: Chi square test analysis was performed to evaluate a statistically significant decrease in the incidence of caries, gingivitis and diseases of the oral mucosa. RESULTS: After a 3-year follow-up collected data underlined a statistically significant decrease in the incidence of dental caries, gingivitis and oral mucosal diseases after implementation of the recommended ministerial guidelines. A statistically significant decrease of malocclusions was also evident in the elder patients (12 years old at T1). CONCLUSION: The accurate implementation of the Guidelines is supported. Only collaboration and increased synergy between paedodontists and paediatricians can fulfill the objectives which were the reason for publishing the "National guidelines for the promotion of oral health and the prevention of oral diseases in developmental age".

Gore external valve support for superficial saphenous vein incompetence: a 10-year, follow-up registry.

AIM: This long-term (10-year) study evaluated the safety and efficacy of expanded polytetrafluoroethylene (ePTFE) external valve support (EVS) implants used for external valvuloplasty in the treatment of incompetence of the proximal long saphenous veins. METHODS: During a 10-year follow-up, patients with superficial venous disease and venous hypertension due to pure superficial vein incompetence underwent an external valvuloplasty using an EVS with a PTFE suture. Forty-nine patients were included in the EVS group and 47 in the control group. Patients with superficial venous disease and venous hypertension due to pure superficial venous incompetence were randomised into two treatment groups. The first group was treated with what was considered "conventional treatment" (ligation or stripping) and the second with external valvuloplasty with EVS. This report deals with controls treated with ligation as only 6 cases (not mentioned in this report) were treated with stripping. There were no significant differences in the two groups concerning age, sex, or type of venous insufficiency. The procedures focused on only one single limb per patient. RESULTS: 46.9% of limbs treated with EVS developed varices in comparison with 73% in the control group. New surgical procedures (localized ligation) were needed in 32.6% of the EVS patients vs. 55.3% in controls. Sclerotherapy was used in 42% of the EVS patients vs. 72.34% in controls. At 10 years the SFJ was incompetent (reflux) in 2 EVS patients (4%); one after 5 years and one after 7 years. There was no incompetence at the level of the ligated junction in controls. There were 62 incompetent venous sites (1.26 per limb) in the EVS group vs. 96 new incompetent venous sites (2.04 per limb) in controls. In controls 10.63% of the limbs developed minor discolorations and signs due to mild CVI; none was observed in the EVS group. In all ESV implants there was full restoration of competence at 1 year. CONCLUSION: EVS implants used to correct superficial venous incompetence at 10 years were well tolerated and produced good results on incompetence and on the evolution of varicose veins.

Eruption of supernumerary permanent teeth in a sample of urban primary school population in Genoa, Italy.

AIM: The aim of this epidemiological study was to describe the incidence and distribution of hyperdontia in the primary school population in Genoa (Italy) and to check its influence on the development of orthodontic problems in children. The collected data should also help to find out what is the best age range among children to direct a program for early diagnosis and prevention of malocclusion and oral diseases related to hyperdontia. METHODS: The participating children (total number 1577, 814 males and 763 females, between 6 and 10 years of age) chosen in 19 public primary schools in Genoa have been examined by the same specialist through year 2004. Erupted permanent teeth, presence, position and form of supernumerary teeth, malocclusion presence and class, presence of orthodontic devices, age and sex have been noted down for each child. RESULTS: The global percentage of hyperdontia was 0.38%, more frequent in males (0.49%) than in females (0.26%). The most common kind of supernumerary tooth was mesiodens (83%). A significant increase of hyperdontia prevalence (from 0.64% to 1.06%) was noticed in children 9 years old. The incidence of malocclusion among children presenting hyperdontia was 83.3%, while the global incidence of malocclusion was 40%. An orthodontic treatment had been planned and started for 20% of children presenting malocclusion. CONCLUSION: The study has revealed an incidence of hyperdontia much more frequent in males than in females (2:1). The most common site of eruption of supernumerary teeth is maxillary anterior region. Hyperdontia is strictly related with dental malocclusion. The best age range to direct a program of early diagnosis and prevention of malocclusion and hyperdontia is 9 years old children.

[Pararenal aortic aneurysms: definition, classification, directions for surgery]. / Gli aneurismi dell'aorta pararenale: definizione, classificazione, indicazione al trattamento chirurgico.

The formidable impact derived by the endovascular correction (Evar) of abdominal aorta aneurysms (AAA), has risen its classification aspects. The topographical criteria has assumed importance in decisional diagnostic-therapeutic strategy especially in cases of so called pararenal aneurysms (PRAA). DEFINITION: PRAA defines aneurysm being involved underenal juxtarenal aorta (JRA), or more rarely, suprarenal aorta with normal aortic diameter at level of celiac (JRA), or more rarely, suprarenal aorta with normal aortic diameter at level of celiac trunk. CLASSIFICATION: The morphologic-topographic aspect is considered in function of selection or eligibility of patients to Evar or standard open surgery, in the need of a suprarenal clamping for the tailoring of proximal anastomosis or anchorage of endoprotesis. Various specific classifications for these aneurysms have been proposed (Schumacher, 1997; Wolf, 2000; Ayari, 2001) that considers: 1. Aneurysm collar: short/long/tortuous, 2. Relations with renal arteries, 3. Relations with the left renal vein. DIRECTIONS FOR SURGICAL TREATMENT: The choice between the technical solution to prefer either open or endovascular surgery will have to consider a series of additional variables to the standard direction common to every AAA based on dimensions and morphology. Priority will have to be given to evaluating, using shared morphologic-topographical classification criteria, real incidence of PRAA-JRA (3%-20% in literature review); greater post opening mortality (1.3%-15.3%); dimensions (AAA with diameter > or = 5.5 cm in operating risk assessment of single patient, in clinical evolution and increase in the time of the lesion); in common occurrence in AAA of steno-obstructive lesions of renal arteries and involvement of same ones in the aneurysm collar in need of reconstruction and suprarenal aortic clamping.

[Treatment of severe intermittent claudication: ORACLE-PGE1 short term study. A randomised 40-week study. Evaluation of efficacy and costs]. / Trattamento della claudicatio intermittens severa: studio ORACLE-PGE1 short term. Registry e studio randomizzato a 40 settimane, valutazione di efficacia e costi.

BACKGROUND: The efficacy and cost of prostaglandin E1 (PGE1) in severe intermittent claudication was studied comparing a long-term protocol (LTP) with a short-term protocol (STP) in a randomised 40-week study. METHODS: Phase 1 was a 2-week run-in phase (no treatment) for both protocols. In LTP, phase 2 was the main treatment phase. Treatment was performed with 2-hour infusions (60 micro g PGE1, 5 days each week for 4 weeks. In phase 3 (4-week interval period), PGE1 was administered twice a week (same dosage). In phase 4 (40 weeks), no PGE1 were used. In STP, phase 2 treatment was performed in two days by a 2-hour infusion (60 micro g PGE1 twice a day in 2 days). The same cycle was repeated every 4 weeks. A treadmill test was performed at inclusion, at the beginning of each phase and at the end of weeks 12, 16, 20 32 and 40. A progressive training plan (walking) and reduction in risk factors plan was used in both groups. RESULTS: Out of the 1276 included patients 1165 completed the study (606 in LTP group; 559 in the STP). Drop-outs were 111. The two groups were comparable in distribution, risk factors and smoking. Intention-to-treat analysis indicated an increase in pain free walking distance (PFWD). The absolute and percent increase in pain-free walking distance (PFWD) was comparable in both LTP and STP groups with a significative increase in TWD at 4 weeks. At 20 and 40 weeks increase was up to 219% in the LTP and 460% in the STP group (p<0.02). Comparable results concerning PFWD were obtained in the two groups. Both treatments were well tolerated. No side effect was observed. Local effects were observed in 8.5% of the treated subjects in the LTP and 4% in the STP. The average cost of the LTP protocol was 8786 Euro. For STP the costs was 946 (10.8% of LTP). For both protocols the cost of the infusion was 24% of the total for the LTP and 35% in the STP. Therefore 75% of the cost is not drug-related. CONCLUSIONS: In conclusion between-group-analysis favours STP considering walking distance and costs. Results indicate good efficacy and tolerability of PGE1 treatment particularly STP.

PGE(1) treatment of severe intermittent claudication (short-term versus long-term, associated with exercise)--efficacy and costs in a 20-week, randomized trial.

The efficacy, safety, and cost of prostaglandin E1 (PGE1) in the treatment of severe intermittent claudication was studied comparing a long-term treatment protocol (LTP) with a short-term treatment protocol (STP) in a randomized 20-week study. The study included 980 patients (883 completed the study) with an average total walking distance of 85.5 +/-10 m (range 22-119). Phase 1 was a 2-week run-in phase (no treatment) for both protocols. In LTP, phase 2 was the main treatment phase. In the LTP, treatment was performed with 2-hour infusions (60 microg PGE1, 5 days each week for 4 weeks. In phase 3 (4-week interval period) PGE1 was administered twice a week (same dosage). In phase 4 (monitoring lasting 3 months, from week 9 to 20) no drugs were used. In STP phase 2 treatment was performed in 2 days by a 2-hour infusion (first day: morning 20 microg, afternoon 40 microg; second day morning and afternoon 60 microg). The reduced dosage was used only at the first cycle (week 0) to evaluate tolerability or side effects. Full dosage (60 microg bid) was used for all other cycles. The same cycle was repeated at the beginning of weeks 4, 8, and 12. The observation period was between weeks 12 and 20. A treadmill test was performed at inclusion, at the beginning of each phase, and at the end of 20th week. A similar progressive physical training plan (based on walking) and a reduction in risk factors levels plan was used in both groups. Intention-to-treat analysis indicated an increase in walking distance, which improved at 4 weeks and at 20 weeks in the STP more than in the LTP group. At 4 weeks the variation (increase) in pain-free walking (PFWD) was 167.8% (of the initial value) in the LTP group and 185% in the STP group (p<0.05). At 4 weeks the variation (increase) in total walking distance (TWD) was 227.6% of the initial value in the LTP group and 289% in the STP group (p<0.05). At 20 weeks the increase in PFWD was 496% of the initial value in the LTP group vs 643% in the STP group (147% difference; p<0.02). The increase in TWD was 368% in the LTP group and 529% in the STP group (161% difference; p<0.02). In both groups there was a significant increase in PFWD and TWD at 4 and 20 weeks, but results obtained with STP are better considering both walking distances. No serious drug-related side effects were observed. Local, mild adverse reactions were seen in 6.3% of the treated subjects in the LTP and 3% in the STP. Average cost of LTP was 6,664 Euro; for STP the average costs was approximately 1,820 E. The cost to achieve an improvement in walking distance of 1 m was 45.8 E with the LTP and 8.5 E with the STP (18% of the LTP cost; p<0.02). For an average 100% increase in walking distance the LTP cost was 1,989 E vs. 421 E with STP (p<0.02). Between-group analysis favors STP considering walking distance and costs. Results indicate good efficacy and tolerability of PGE, treatment. With STP less time is spent in infusion and more in the exercise program. STP reduces costs, speeds rehabilitation, and may be easily used in a larger number of nonspecialized units.

Superficial vein valve repair with a new external valve support (EVS). The IMES (International Multicenter EVS Study).

The aim of this international multicenter trial was to evaluate the effects of a new surgical device (Gore External Valve Support-EVS) and technique for external valvuloplasty of the long saphenous vein (LSV). Patients with superficial venous disease and venous hypertension due to pure superficial venous incompetence were randomized into two treatment groups, the first treated with "conventional treatment" (ligation or stripping) and the second with external valvuloplasty with the EVS. Patients with uncomplicated varicose veins within the age range of 35-65 years were included. Incompetence with presence of functional cusps at the saphenofemoral junction (SFJ), with vein dilatation were the main inclusion criteria. The EVS comprised of a GORE-TEX patch material (including a nitinol frame) that is placed around the vein, producing a reduction in the caliber of the vein. Also the vein section becomes elliptical. These combined actions are aimed to reduce incompetence, allowing a better closure of the cusps. The EVS was placed at the SFJ after limited dissection of the vein and ligation of collaterals. The procedure was randomized as an alternative to simple ligation or stripping (according with the procedure commonly used in the center). The associated ligation of distal incompetent veins was allowed. The main outcome measures of the study were evaluated by color-duplex (morphologic findings and evaluation of reflux) and with ambulatory venous pressure (AVP) or air-plethysmography (APG). Main endpoints of the first year of the study and main subject of this report (mainly concerning safety within the first year of follow-up) were considered presence/absence of reflux; patency of the veins; mobility/function of vein cusps; occurrence of thrombosis; tolerability of the device; and increased complexity and operating time needed for the EVS. At 1 year 30 patients had been randomized (14 EVS implanted, 16 controls). Reflux was absent in all EVS patients, all treated veins were patent, and all cusps were mobile. No thrombosis had been observed and the tolerability of the device was very good. The increased complexity required by placing the EVS was limited (5-12 minutes more). In conclusion results of the first year show efficacy and tolerability of the EVS. In selected patients (superficial LSV incompetence, reflux-dilatation, functional SFJ cusps, incompetence mainly due to enlargement of the vein), the EVS could be an effective alternative to "destructive" ligation and/or stripping of the vein. Prolonged follow-up will indicate the clinical potentials of the EVS.

Optimal site for proximal and distal anastomoses in AAAs repair.

The replacement of straight graft for vascular aortic reconstruction, in the elective treatment of aortic and aorto-iliac aneurysms, is advisable and requires only two anastomoses and a low surgical risk. In our report we have tried to identify the simplest vascular reconstruction for juxtarenal involvement (15% in our experience), reducing the surgical time and the operative (or postoperative) injuries. The decision to employ the tube or the bifurcated reconstruction depends on the surgeon's assessment of the degree of common iliac dilatation, the presence of an iliac aneurysm or the concomitance of occlusive disease of the iliac-femoral district. Some authors extend the bifurcated repair to prevent the possible future occlusive events or iliac dilatation. We have much information about the natural history of aortic aneurysms but we have also to define the indications for a valuable surgical reconstruction. We have considered a consecutive series of 20 patients who underwent elective aortic and aorto-iliac aneurysm repair in S. Rita private hospital; in 13 patients (65%) the aneurysms were treated with tube grafts, the other patients received bifurcate grafts: 3 (15%) aorto-bisiliac, 2 (10%) aorto-bifemoral and 2 (10%) right aorto-iliac and left aortofemoral bypass procedure. We employed Crawford's inclusion in the juxtarenal involvements, generally without the reimplantation of renal arteries, extending the tube repair in the aorto-iliac dilatation, obtaining a simplification of the surgical procedures. The use of straight graft allows a sensible decrease of surgical operating time, a reduction of hematic loss and a very low incidence of postoperative injuries; this solution became possible also in some selected forms of aneurysmatic involvement of renal arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Double-blind comparison of nimesulide and diclofenac in the treatment of superficial thrombophlebitis with telethermographic assessment.

A total of 60 patients with acute varicophlebitis or acute superficial thrombophlebitis of the lower limbs were recruited to this randomised double-blind comparative study, which evaluated the efficacy and tolerability of oral nimesulide (100mg twice daily) with those of diclofenac (50 mg/kg twice daily) over a period of < or = 20 days (average duration 13.6 days for nimesulide and 12.6 days for diclofenac). The analgesic effect of both drugs was rapid. Spontaneous pain disappeared within 3 to 5 days of commencing therapy, and pain on palpation within 7 days. Reduced inflammation was observed after approximately 15 days, and total resolution of redness and swelling was observed by day 20. Telethermographic assessment showed a reduction in local temperature, either in absolute terms or in the extent of inflammation. Indeed, 93% of patients showed complete recovery while 7% of patients showed a partial reduction in hyperthermia. For these latter patients, medical treatment was extended, although the subjective symptoms of the disease were no longer present. The comparison between nimesulide and the reference drug, diclofenac sodium, showed no significant difference for any of the considered parameters. Both drugs were well tolerated and no patient reported an adverse event.

Nesosteine: a new mucoregulatory agent.

A new, original molecule, nesosteine, modified both the rheology and the production of tracheobronchial mucus in rabbits. The drug highly significantly reduced the viscosity of tracheobronchial mucus in animals made bronchitic by H2SO4 aerosol and markedly increased mucoproduction in healthy animals. Nesosteine was more active than the best known mucolytic/mucoregulatory drugs, such as sobrerol, N-acetylcysteine, bromexine, ambroxol, S-carboxymethylcysteine and mercaptopropionylglycine. The fluidifying activity of the drug was also demonstrated in vitro (pig's gastric mucin), although this proved to be less marked than in vivo. Nesosteine reduced the amount of total proteins of the tracheobronchial mucus, acting on albumin, alpha 1, alpha 2, beta and gamma mucoproteins.

[Digital radiography]. / Radiografia digitale.

The reliability of radiographical information may be improved by a) standardised radiography (exposure-development); b) transformation of the original image into a densitometric image and equalization with a reference wedge made of Ergal. The linear absorption coefficient of Ergal in terms of photon X energy is almost identical to the average coefficient of the bone mineral matrix; c) processing the densitometric image for additional information. An automatic image analyser controlled by a computer is used. The first osteological results showing the correspondence between the densitometric measurements provided by the analyser and the actual bone mineral content revealed by chemical analysis are presented.