Radiopacidad de Materiales Utilizados Como Sustituto Dentinario / Radiopacity of Materials Used as Dentin Substitutes

El objetivo de este estudio fue comparar la radiopacidad de distintos materiales utilizados como sustitutos de la dentina según norma ISO 6876. Se utilizaron Biodentine-Septodont (a base de silicato de calcio), Equia Forte ­ GC Corporation (ionómero vítreo convencional), Sure Fill SDR Flow ­ Dentsply Sirona (composite bulk-fill), MTA Densell Reparative - Densell (a base de silicato de calcio). Se confeccionaron 12 probetas cilíndricas, tres por cada material, siguiendo las instrucciones de los respectivos fabricantes y se colocaron en estufa a 37°C durante su fraguado. Se tomaron radiografías oclusales digitales junto a una cuña de aluminio graduada según norma ISO 6876. En cada imagen se determinaron los valores de L de la escala CieLab (negro-blanco) con el programa Photoshop (Adobe). Los resultados se analizaron estadísticamente mediante ANOVA y prueba de Tukey (AU)

Prospective evaluation of the aetiology of acute otitis media with spontaneous tympanic membrane perforation.

OBJECTIVES: To evaluate the aetiological role of the main bacterial pathogens associated with acute otitis media (AOM) in children with AOM and spontaneous tympanic membrane perforation (STMP). METHODS: Between 1 May 2015 and 30 April 2016, 177 children, aged 6 months to 7 years, with AOM complicated by STMP within 12 h were prospectively enrolled. Middle ear fluid (MEF) was tested by real-time PCR for Streptococcus pneumoniae, non-typeable Haemophilus influenzae, Streptococcus pyogenes, Moraxella catarrhalis and Staphylococcus aureus. RESULTS: Among the 177 children with AOM and STMP, 92/100 (92.0%) of those with recurrent AOM and 13/77 (16.9%) without recurrent AOM had recurrent STMP (p <0.001). A single pathogen was identified in 70 (39.5%) MEF samples, whereas two, three and four bacteria were detected in 54 (30.5%), 20 (11.3%), and 7 (4.0%) cases, respectively. Non-typeable H. influenzae was the most common and was identified in 90 children (50.8%), followed by M. catarrhalis (62 cases, 35.0%) and S. pneumoniae (48 cases, 27.1%). Non-typeable H. influenzae was the most frequent pathogen in children with co-infections. Children with co-infections, including non-typeable H. influenzae, had significantly more frequent recurrent AOM (adjusted OR 6.609, 95% CI 1.243-39.096, p 0.029). CONCLUSIONS: Recurrent AOM episodes appear to be associated with an increased risk of AOM with STMP. In AOM with STMP, non-typeable H. influenzae is detected at a high frequency, especially in children with recurrent STMP and often in association with other pathogens.

Intakes of nutrients in Italian children with celiac disease and the role of commercially available gluten-free products.

BACKGROUND: Celiac disease (CD) is a chronic gluten-sensitive enteropathy. Life-long gluten-free diet (GFD) is the only therapeutic option; however, it may contribute to the consumption of an unbalanced diet. The present study aimed to evaluate the dietary intake of CD affected children on a GFD and compare it with non-celiac children and with Italian nutritional intakes recommendations, as well as evaluate the contribution of commercially available gluten-free products (GFPs). METHODS: Eighteen celiac children, median age 7.6 years, median GFD duration 4.2 years, and 18 non-celiac controls, were enrolled in a cross-sectional age-matched study. Dietary intakes of both groups were collected using a food frequency questionnaire and a 24-hour dietary recall. Nutritional intakes were compared between the group and controls and with Italian dietary reference values. The contribution of GFPs to energy and macronutrient intakes was evaluated. RESULTS: Median energy intake was significantly higher in CD patients than in controls (8961.8 and 5761.0 kJ day(-1); P < 0.001). CD subjects showed higher carbohydrate intakes and lower fat intakes compared to controls. Protein-derived energy did not differ. By contrast to control subjects, energy derived from carbohydrate intakes in CD children met the Italian recommendations. Both children groups showed higher protein and fat intakes than recommended in Italy. GFPs consumption accounted for 36.3% of daily total energy intake. CONCLUSIONS: Intakes of simple sugars, fats and protein exceeded the National recommendations for health. Children with CD had significantly higher energy intakes than controls, although body mass index was comparable across the groups. Lack of nutritional information for GFPs prevented complete dietary analysis of subfractions of fat and micronutrient intakes. This aspect need to be addressed if studies in this field are to be meaningful in the future.

Changes of body mass index in celiac children on a gluten-free diet.

BACKGROUND AND AIM: Studies of adults and children with celiac disease (CD) performed mostly in tertiary care centers have reported an increased risk of overweight during gluten-free diet (GFD). We measured body mass index (BMI) of CD children followed by family pediatricians in order to estimate prevalence of underweight and overweight at diagnosis and to describe BMI changes during GFD. METHODS AND RESULTS: We compared 150 CD children (age range 2-16 yrs) under GFD from a median (IQR) time of 4.4 (4.2) years with 288 healthy children matched for gender and age. We also evaluated retrospectively BMI changes between CD diagnosis and the current evaluation. The median (IQR) BMI of CD patients was significantly lower than that of controls [-0.38 (1.46) vs. 0.09 (1.18) SDS, p < 0.0001, Italian reference data]. Using the International Obesity Task Force classifications, CD children were less frequently overweight or obese (12% vs. 23.3%, p = 0.014) and more frequently underweight (16% vs. 4.5%, p < 0.001) than controls. During GFD, there was a marked decrease of number of underweight subjects (13 vs. 27) and a minimal increase of number of overweight subjects (9 vs. 6) (p < 0.001). CONCLUSIONS: The frequency of overweight and obesity at diagnosis of CD and during GFD in children followed by family pediatricians is substantially lower than that reported in tertiary care centers. On the other hand, the high frequency of underweight at diagnosis confirms the need of careful personalized nutritional management.

Early onset of puberty in young girls: an Italian cross-sectional study.

BACKGROUND: International literature and clinical practice have referred to Marshall and Tanner data to define the physiological age at onset of puberty. A study in the United States (1997) showed an anticipation in pubertal onset, whereas several European studies did not confirm this trend. AIM: To describe the onset of secondary sexual characteristics in a large Italian population of girls and to compare it to reference literature data. SUBJECTS AND METHODS: A cross-sectional study on 7311 2-14-yr-old girls who spontaneously requested a clinical evaluation for routine health check-up or acute illness by family pediatrician's offices in a northern Italian region (Lombardy), between September 2005 and November 2006. Trained family pediatricians performed a complete physical examination; pubertal status was evaluated following Tanner's criteria; breast development was assessed by palpation. RESULTS: Mean age of thelarche (B2), pubarche (PH2), menarche were 9.75, 10.09, and 12.49 yr, respectively. The prevalence of B2 and PH2 at ages 7-7.99 was 5.9% and 5.6%, respectively, at ages 8-8.99 was 15.5% and 13.8%, respectively. Mean time lapse from B2 to B3 and B2 to menarche was 1.46 and 2.74 yr, respectively. Mean age at menarche of our population and their respective mothers was almost identical. CONCLUSIONS: Our population presented earlier clinical signs of pubertal development than those defined by Marshall and Tanner. Mean age of menarche was not different in comparison to the previous generation. A different progression of pubertal development was found, in which the shift to B3 may have more clinical relevance.

Safety of use, efficacy and degree of parental satisfaction with the nasal aspirator Narhinel in the treatment of nasal congestion in babies.

AIM: The aim of this study was to assess the safety, effectiveness and parental compliance with a medical device on the market in Europe for removing excess nasal secretions by aspiration in babies viral infections of the upper respiratory tract. METHODS: A prospective observational noncomparative cohort study, as part of postmarketing and customer satisfaction surveillance was specifically performed among family paediatricians in Lombardy, Italy. Two hundred and forty patients were admitted from 22 different family pediatricians belonging to the Italian Federation of Paediatricians (Federa-zione Italiana Medici Pediatri, FIMP) in Lombardy. All patients took part in the safety assessment. Two hundred and twelve patients (104 females, 108 males, average age 9.6 months, age range 1.8-27.6 months) also underwent clinical efficacy assessment (28 patients were excluded). Upon admission and at the first outpatient examination (E1), parents were taught by their family pediatrician to clean their babies' noses by nasal aspiration 3 times a day for 7 consecutive days immediately before feeding. At the end of treatment, a second outpatient examination (E2) was carried out at which parents' treatment diaries were collected and the parents answered a satisfaction questionnaire. SAFETY of use was checked using: 1) Italian Health Ministry incident/near incident report forms and 2) treatment diaries where the parents noted any events that had occurred while using the device every day. EFFICACY was assessed by analysing various clinical parameters (anterior and posterior rhinorrhea, oral respiration, noisy nasal respiration, and nasally transmitted chest sounds) measured by the pediatrician at the two examinations (E1 and E2), and the entries in the parents' treatment diary regarding quality of sleep, feeding and respiration, and use of any drugs. Parental satisfaction and compliance were assessed through a questionnaire given to the parents at E2. The device is marketed in 2007 under the name of Narhinel in Italy, Spain and Portugal; Otrisalin in Greece; Prorhinel in France; Rhinomer in the Baltic countries (Lithuania, Latvia, Estonia); Otrivin Baby in Russia and Otri-Baby in Sweden. SAFETY: no incidents were reported to the Italian Ministry of Health. There were 40 cases of mild side effects such as nose bleed (6), protracted crying (30), restlessness/irritation (2), vomiting and others (2). EFFICACY: clear improvements were seen in all the clinical parameters assessed at the post-treatment examination (E2) when compared to E1: anterior rhinorrhea (decreased by 74%), posterior rhinorrhea (decreased by 80%), oral respiration (decreased by 78%), noisy respiration (decreased by 73%), and nasally transmitted chest sounds (decreased by 82%). The entries in the treatment diaries also showed progressive improvement in the children's' conditions during the treatment period: peaceful sleep increased by 67%, quality of feeding increased by 36%, respiration improved by 76%, and the administration of drugs decreased by 41%. The P values for each item (clinicians observations and parents' observations) are statistically significative P<0.001, between the day 1 and the day 8. Satisfaction and compliance were excellent: 92% of parents were satisfied (56% very and 42.7 fairly). Seventy-eight percent reported that the device was simple to use, and 86% of parents judged Narhinel to be more effective than other similar devices. CONCLUSION: Narhinel proved to be a safe, effective and simple to use device. The parents of babies with nasal obstruction caused by upper respiratory infection were extremely satisfied.

Rheological properties and biocompatibility of endodontic sealers.

AIM: To determine the flow characteristics and subcutaneous tissue reactions to five endodontic sealers. METHODOLOGY: The materials used were Procosol, AH26, Endomethasone, Sealapex and Endion. The sealers were prepared following the manufacturers' instructions, and 0.075 mL of each material was placed on a glass surface, which was then rotated 90 degrees. The samples were stored at 37 degrees C and 95% humidity. The displacement of the sealer was recorded by measuring the difference between its original position and the position recorded at 15 and 60 min. Three samples of each material were used. Two pockets were created in the back of Wistar rats, and one silicone tube, 1 mm in diameter and 1 cm in length, was implanted in each. One was filled with one of the materials under study, and the other empty tube was implanted as a control. Fourteen days after implantation, the animals were sacrificed, and samples of the skin containing the tubes were histologically processed. Histological and histomorphometric evaluations of the tissues adjacent to the open end of the tube were carried out the volume of tissue reaction was measured histomorphometrically according to standard stereological principles. Results were statistically analysed using analysis of variance and Duncan's test. RESULTS: The highest flow values were obtained with Sealapex and AH26. Time significantly affected the flow and the material (P < (1001). Procosol and Endion produced the most severe histological reactions: these were outlined by fibrous tissue; AH26. Endomethasone and Sealapex produced reactions of smaller size and with more moderately defined limits. CONCLUSIONS: The flow did not correlate with the degree of inflammatory response. Procosol and Endion produced the most severe tissue reactions, whereas Endomethasone, Sealapex and AH26 produced only minimum reactions.

Prevalence of malnutrition assessed by bioimpedance analysis and anthropometry in children on peritoneal dialysis.

OBJECTIVE: To evaluate the sensitivity of anthropometry and bioelectrical impedance analysis (BIA) in detecting alterations in body composition of children treated with peritoneal dialysis (PD), and to determine the prevalence of malnutrition in this population, in short- and long-term PD duration, using anthropometric and BIA-derived indices. PATIENTS: Eighteen children treated with automated PD (11 males, 7 females; mean age 8.7 +/- 4.7 years). DESIGN: Eighteen patients were studied using anthropometry and BIA at the start (t0) and after 6 months (t1) of PD, 15 of these patients at 12 months (t2), and 8 at 24 months (t3) of PD. Midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA) were calculated from anthropometric measures according to Frisancho (FrisanchoAR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981; 34:2540-5.). The bioelectrical measures of resistance (R) and reactance (Xc) were obtained directly from the impedance signal; phase angle (PA) and distance (D) were calculated using mathematical formulas. Nutritional status was assessed by anthropometric measurements and BIA-derived indices, expressed as standard deviation scores (SDS), and by a score system based on BIA and anthropometric parameters. The percentage of children with values of anthropometric and BIA-derived indices below the 3rd percentile or between the 3rd and 25th percentiles, and the percentage of children with scores of 7-12 and 4-6 were calculated in order to detect patients with severe or moderate derangement of nutritional status. RESULTS: The mean SDS values of Xc, PA, and D significantly improved (p = 0.05, p = 0.001, p = 0.02) during the first 6 months of PD and remained almost stable during the following months. The SDS values of the anthropometric indices were less compromised than those of the BIA-derived indices, particularly at the start of dialysis. By 6 months, the percentages of children with values of BIA and anthropometric indices below the 3rd percentile had decreased. The percentages of patients with moderate and severe derangement of BIA and anthropometric indices remained substantially unchanged after 12 months. However, at 24 months, the percentage of patients with moderate derangement of BIA indices increased. All these findings were confirmed by the nutritional score system. CONCLUSION: BIA is more sensitive than anthropometry in detecting alterations in body composition of children on PD. The prevalence of malnutrition, high at the commencement of PD, decreases during the first year of treatment but not over the long term.

Models to assess nitrogen losses in pediatric patients on chronic peritoneal dialysis.

To develop models to estimate nitrogen (N) losses of children on chronic peritoneal dialysis (CPD) from easily measurable indexes and laboratory tests, we measured the N content and all nitrogenous compounds in dialysate (D), urine (U), and feces over 3 days in 19 pediatric patients on CPD. Total measured N losses (TNm) were 5.56+/-2.26 g/day (69.9+/-11.1% in dialysate, 16.3+/-10.6% in urine, and 13.6+/-4.6% in feces). Correlation coefficients between measured dialysate and urinary N losses and the single nitrogenous compounds indicated values of over 0.9 only for urea in dialysate and urine; fecal N losses correlated well with body surface area (BSA). Taking into account these correlations, we developed a univariate additive model and three multivariate models to predict total estimated N losses (TNe). The best prediction of TNm was obtained with model 3, which considered not only urea output in dialysate and urine but also dialysate protein loss and BSA: TNe (g/day)=0.03+/-1.138 UN urea+0.99 DN urea+1.18 BSA+0.965 DN protein. A confirmatory analysis performed on a second group of 23 pediatric patients on CPD, using all four models, showed a higher percentage of studies with a relative difference between TNm and TNe less than 10% for model 3 than for the other models. Thus, N losses of pediatric patients on CPD can be estimated from measured urea and protein losses in dialysate and urea loss in urine, together with BSA.

Dietary prescription based on estimated nitrogen balance during peritoneal dialysis.

Protein and energy requirements of children on automated peritoneal dialysis (APD) have still not been sufficiently well defined, although their adequacy is important to maintain a positive nitrogen (N) balance and prevent malnutrition. We carried out 42 studies to estimate N balance in 31 children over 3 years on APD for 19.8+/-15.7 months. Twenty metabolic studies were performed in patients dialysed for less than 1 year (7.2+/-3.3 months) and 22 in patients treated for more than 1 year (31.3+/-13.6 months). The mean estimated N balance of all metabolic studies was 57.5+/-62.8 mg/kg per day. In only 21 of 42 studies was N balance estimated to be over 50 mg/kg per day, which is considered adequate to meet N requirements for all metabolic needs and growth of uremic children. Estimated N balance correlated significantly with dietary protein intake (r=0.671, P=0.0001) and total energy intake (r=0.489, P=0.001). Using the equations of correlation, the values of dietary protein intake [=144% recommended dietary allowance (RDA)] and total energy intake (89% RDA) required to obtain an estimated N balance >50 mg/kg per day were calculated. Significantly lower estimated N balance values were obtained in the studies performed on patients on APD for over 1 year (36.09+/-54.02 mg/kg per day) than in patients treated for less than 1 year (81.11+/-64.70 mg/kg per day). In conclusion, based on the values of estimated N balance, we were able to establish adequate dietary protein and energy requirements for children on APD.

Antimicrobial effect of six endodontic sealers: an in vitro evaluation.

The aim of this study was to determine the in vitro antimicrobial effect of six endodontic sealers after 2, 20 and 40 days. The sealers studied were Apexit, Endion, AH26, AH-Plus. Procosol and Ketac Endo. The microorganisms used were Candida albicans, Staphylococcus aureus, Streptococcus mutans and Actinomyces israelii. Petri dishes were filled with sterile agar and 0.1-ml wells were prepared and filled with the sealers. The agar plates were stored for 24 h at 37 degrees C. The samples were then removed, immersed in 4.5 ml of culture medium and divided into three groups. The samples in group 1 were stored for 2 days at 37 degrees C whereas the samples of groups 2 and 3 were stored at 4 degrees C for 20 and 40 days respectively. The samples were then removed and discarded, and 0.1 ml of the culture medium was seeded on the agar plates in order to perform colony forming unit counts. Apexit, Endion and AH-Plus produced slight inhibition on Streptococcus mutans at 20 days and on Actinomyces israelii at every time interval. No effect was found on Candida albicans and Staphylococcus aureus. Ketac Endo only produced an antimicrobial effect on Actinomyces israelii at 2 and 40 days. AH26 and Procosol showed antimicrobial effect at 40 days on Candida albicans, at 20 and 40 days on Streptococcus mutans and Staphylococcus aureus, and an effective inhibition on Actinomyces israelii at every time interval. Statistical analysis revealed both sealers and microorganisms to be significant factors affecting results in groups 2 and 3. In conclusion, the sealers evaluated in this study showed different inhibitory effects depending on time span. Overall, sealers containing cugenol and formaldehyde proved to be most effective against the microorganisms at the time intervals studied.

Short-term anabolic effects of recombinant human growth hormone in young patients with a renal transplant.

Renal-transplanted children may present stunted growth, negative nitrogen balance (Nb), and alterations in body composition. Recombinant human growth hormone (rhGH) is a potent anabolic agent which improves nutritional status and Nb. In renal-transplanted children, rhGH increases growth velocity but its effect on nutritional status has not been reported. We evaluated the effect of 6 months of rhGH treatment on Nb, urea nitrogen appearance (UNA), anthropometric indexes, and growth velocity in 14 pediatric patients with a renal transplant. Nb improved significantly (P = 0.02) and was accompanied by a decrease of UNA. A significant improvement was observed also in mid-arm muscle circumference (P = 0.002), arm muscle are (P = 0.001), and arm fat are (P = 0.017). Growth velocity increased in prepubertal patients (P = 0.003). Creatinine clearance and the number of rejection episodes were not affected by rhGH treatment. In conclusion, short-term administration of rhGH improves Nb and UNA as well as the main indexes of body composition.

Changes in body composition assessed by bioimpedance analysis in the first 6 months of chronic peritoneal dialysis.

Dietary protein restriction, progressive loss of renal adaptive capacity, and uremic toxicity may contribute to the development of malnutrition and water retention in severe chronic renal failure (CRF). Malnutrition is also common in children treated with chronic peritoneal dialysis (CPD). It is not clear how the start of CPD influences body composition of children with CRF. We used a bioimpedance analysis device (BIA 101S Akern) to measure resistance and reactance in 7 children, with residual creatinine clearance of about 5 mL/min/1.73 m2 at the start of CPD (t0) and repeated the test 6 months later (t1). Distance (D), which is considered a reliable index of hydration and nutrition, was obtained from resistance (R) and reactance (Xc) by calculating phase angle (PA). BIA values of our patients were compared with those of healthy children of the same statural age from a series of 551 controls. There was an overall improvement of Xc, PA, and D after 6 months of CPD. In some cases D did not normalize, which indicates that some children with CRF on a restricted protein diet may present changes of body composition that are only partially reversed by short-term CPD. The present indications for the start of CPD should probably be reassessed, at least in some cases, to prevent malnutrition.

Prescription and assessment of tidal peritoneal dialysis delivery with a specific equilibration test.

OBJECTIVE: To propose a simplified equilibration test specific for tidal peritoneal dialysis (TPD) that will overcome the inconveniences of the measurement of TPD peritoneal solute clearances through whole dialysate collection. This will enable the prediction of peritoneal creatinine and urea clearances, the suitability of patients for TPD, and routine assessment of TPD delivery. DESIGN: In a prospective study, patients had a standardized TPD run, and dialysate-to-plasma (D/P) ratios for creatinine and urea were calculated at various TPD and peritoneal equilibration test (PET) time points and on total TPD dialysate. Solute clearances were estimated and measured, and correlation coefficients were obtained among all these variables. SETTING: Dialysis unit of a pediatric nephrology department and patients' homes. PATIENTS: Eleven pediatric patients with end-stage renal disease in stable clinical conditions treated with TPD. INTERVENTIONS: Dialysate and blood sample collections. MAIN OUTCOME MEASURES: D/P ratios for creatinine and urea at the fifth and seventh TPD exchanges, at 15-, 30-, 60-, and 120-minute PET times, and on total TPD dialysate and TPD peritoneal creatinine and urea clearances. RESULTS: Correlation coefficients between PET-derived and total TPD dialysate-derived D/P ratios, and those between PET-derived and measured creatinine and urea clearances were more significant at the 120-minute PET time point compared with the other PET time points. Best correlations were obtained at the fifth and seventh TPD exchanges. D/P ratios for creatinine and urea of the fifth and seventh TPD exchanges correlated significantly with the D/P ratios calculated from total TPD dialysate. A significant correlation was also found between peritoneal creatinine and urea clearances on total dialysate volume (measured clearances) and those derived from the dialysate collection of the fifth and seventh TPD exchanges (estimated clearances)--that based on the seventh exchange being slightly more significant. Moreover, the estimated clearances derived from the seventh exchange were within 10% of the measured value in 90.9% of patients both for creatinine and urea. CONCLUSION: The significant correlation between measured and estimated peritoneal creatinine and urea clearances and the low percentage of underestimates of measured clearances obtained using the seventh TPD exchange-derived indices confirm the accuracy of the D/P ratios for creatinine and urea derived from any exchange after the fifth (preferably the seventh) of a standardized TPD run in estimating peritoneal creatinine and urea clearances. This method could represent a simple and accurate means for prescribing TPD and routinely assessing TPD delivery.

Dialysis delivery in children on nightly intermittent and tidal peritoneal dialysis.

To achieve more adequate dialysis in a shorter treatment time, seven children, characterized as high/high average (H/HA, 5 patients) and low/low average (L/LA, 2 patients) transporters according to the peritoneal equilibration test, were treated with tidal peritoneal dialysis (TPD) for 13.7 +/- 5.7 months, after being treated with nightly intermittent peritoneal dialysis (NIPD) for a similar period. We determined the TPD prescription necessary to provide improved clearances compared with NIPD within the same or less treatment time. Dialysis flow rate was significantly higher in TPD than NIPD, due to a reduction of dwell time and an increase in the number of exchanges. Peritoneal and total clearances of urea and creatinine were higher, whereas serum creatinine and urea nitrogen levels were lower and treatment duration shorter during TPD than NIPD, notwithstanding a decrease of residual renal function. Moreover, a mean time-averaged blood urea nitrogen level as low as 48.5 +/- 11.6 mg/dl was achieved during TPD. The improvement was more significant in H/HA than in L/LA patients.

[Prevalence and severity of mitral insufficiency and arrhythmia in mitral valve prolapse]. / Prevalenza e severità dell'insufficienza mitralica e dei disturbi del ritmo nel prolasso valvolare mitralico.

OBJECTIVES: The purpose of this study was to assess, using Doppler-echocardiography and ambulatory electrocardiography in patients with mitral valve prolapse (MPV), the prevalence and severity of mitral regurgitation (MR) and arrhythmias. METHODS: Two groups of patients were compared: those with thickening and redundancy of the mitral valve leaflets, chordae lengthening and dilatation of the valvular ring (anatomic MVP; n = 40) and those with the only movement anomaly detected by 2D echocardiogram (functional MVP; n = 80). RESULTS: Significant (moderate or severe) MR was found in 4 (5%) of the 80 patients with functional MVP and in 20 (50%) of the 40 patients with anatomic MVP (p < 0.01). No significant difference in the prevalence of atrial and ventricular arrhythmias was found between patients with functional MPV without MR and 40 randomly chosen control subjects. Arrhythmias in patients with functional MVP complicated by MR were significantly more prevalent (p < 0.05) than in patients with functional MVP without MR. Patients with anatomic MVP had significantly more frequent and more complex arrhythmias than did patients with functional MVP complicated by MR (p < 0.05). There was no significant difference in the prevalence of frequent and complex ventricular arrhythmias between patients with anatomic MVP and patients with functional MVP complicated by MR of comparable hemodynamic degree. CONCLUSIONS: These results indicate that prevalence of significant (moderate or severe) MR is higher and that frequent and complex arrhythmias are significantly more prevalent in patients with anatomic MVP. The prevalence of frequent and complex arrhythmias is similar in patients with comparable MR, whether the regurgitation is related to anatomic MVP or to functional MVP or not.

[Multiplanar transesophageal echocardiography in a case of hypernephroma]. / Ecocardiografia transesofagea multiplanare in un caso di ipernefroma.

A 78-year-old man admitted to our hospital with signs and symptoms of right ventricular failure, consisting of severe edema of the scrotum and the penis, ankle edema, hepatomegaly, and a history of asthenia associated with a recent weight loss. Two-dimensional echocardiography showed an intracavitary mass in the right atrium and a moderate pericardial effusion; the remaining structures were normal. To better define the origin of this mass, transesophageal echocardiography was performed. The mass extended from the inferior vena cava with no sites of attachment to the atrial wall. The mass was elongated, mobile, with a triangular termination near the tricuspid valve, without signs of right ventricular obstruction. An abdominal-pelvic CT scan demonstrated the origin of the mass at the superior pole of the left kidney extending through the renal vein and the inferior vena cava into the right atrium. The mass was surgically removed and the pathological examination revealed a renal cell carcinoma (hypernephroma) of the clear cells subtype. After surgery, the patient did well with the resolution of the picture of right ventricular failure.