Comparison of changes in dental and bone radiographic densities in the presence of different soft-tissue simulators using pixel intensity and digital subtraction analyses.

OBJECTIVES: To evaluate the influence of soft-tissue simulation materials on dental and bone tissue radiographic densities using pixel intensity (PI) and digital subtraction radiography (DSR) analyses. METHODS: 15 dry human mandibles were divided into halves. Each half was radiographed using a charge-coupled device sensor without a soft-tissue simulation material (Wm) and with 5 types of materials: acrylic (Ac), wax (Wx), water (Wt), wood (Wd) and frozen bovine tissue (Bt). Three thicknesses were tested for each material: 10 mm, 15 mm and 20 mm. The material was positioned in front of the mandible and the sensor parallel to the molar region. The radiation beam was perpendicular to the sensor at 30 cm focal spot-to-object distance. The digital images of the bone and dental tissue were captured for PI analyses. The subtracted images were marked with 14 landmark magnifications, and 2 areas of analyses were defined, forming the regions of interest. Shapiro-Wilk and Kruskal-Wallis tests followed by Dunn's post-test were used (p < 0.05). RESULTS: DSR showed that both the material type and the thickness tested influenced the gain of density in bone tissue (p < 0.05). PI analyses of the bone region did not show these differences, except for the lower density observed in the image without soft-tissue simulation material. In the dental region, both DSR and PI showed that soft-tissue simulators did not influence the density in these regions. CONCLUSIONS: This study showed that the materials evaluated and their thicknesses significantly influenced the density-level gain in alveolar bone. In dental tissues, there was no density-level gain with any soft-tissue material tested.

Efficacy of several digital radiographic imaging systems for laboratory determination of endodontic file length.

AIM: To compare the efficacy of different digital radiographic imaging systems for determining the length of endodontic files. METHODOLOGY: K-type endodontic files were introduced into the canals of 40 extracted human permanent single-rooted teeth and fixed in place at random lengths. The teeth were radiographed using Digora Optime, CygnusRay MPS and CDR Wireless digital imaging systems. Six observers measured every file length in all the images and repeated this procedure in 50% of the image samples, and assigned a score to the level of difficulty found. Analysis of variance for differences between digital systems and Tukey's test were performed. The level of intraobserver agreement was measured by intraclass correlation. The assigned scores were evaluated by Kruskal-Wallis and Dunn's tests. RESULTS: The CDR Wireless values did not differ significantly from the actual lengths and the CygnusRay MPS values. The Digora Optime system was significantly different from the others and overestimated the values (P ≤ 0.05). The Digora Optime was significantly easier to use for taking measurements and the CygnusRay MPS the most difficult (P ≤ 0.05). All digital radiographic imaging systems showed excellent agreement with the Intraclass Correlation Coefficient >0.95. CONCLUSIONS: The three digital radiographic imaging systems were precise. The CDR Wireless system was significantly more accurate in determining endodontic file lengths, and similarly to Digora Optime, was considered the least difficult to use when assessing endodontic file lengths.

Effect of alternative photostimulable phosphor plates erasing times on subjective digital image quality.

OBJECTIVE: To evaluate the influence of alternative erasing times of DenOptix(R) (Dentsply/Gendex, Chicargo, IL) digital plates on subjective image quality and the probability of double exposure image not occurring. METHODS: Human teeth were X-rayed with phosphor plates using ten different erasing times. Two observers evaluated the images for subjective image quality (sharpness, brightness, contrast, enamel definition, dentin definition and dentin-enamel junction definition) and for the presence or absence of double exposure image. Spearman's correlation analysis and ANOVA was performed to verify the existence of a linear association between the subjective image quality parameters and the alternative erasing times. A contingency table was constructed to evaluate the agreement among the observers, and a binominal logistic regression was performed to verify the correlation between the erasing time and the probability of double exposure image not occurring. RESULTS: All 6 parameters of image quality were rated high by the examiners for the erasing times between 25 s and 130 s. The same erasing time range, from 25 to 130 s, was considered a safe erasing time interval, with no probability of a double exposure image occurring. CONCLUSIONS: The alternative erasing times from 25 s to 130 s showed high image quality and no probability of double image occurrence. Thus, it is possible to reduce the operating time of the DenOptix(R) digital system without jeopardizing the diagnostic task.

[Smoking ban observance in a general hospital]. / Il rispetto del divieto di fumare in un'Azienda Ospedaliera.

Passive smoking is one of the main risk factors for severe chronic diseases. Hospitals are appropriate settings for promoting tobacco smoking cessation and preventing passive smoking. Moreover, since 2003 Italian Law (no 3/2003) forbids smoking in enclosed workplaces. The smoking ban should be strictly observed in hospitals. This study assessed smoking ban observance and exposure to ETS in a group of paramedical personnel working in a General Hospital (n=1037). Each subject answered a self-administered questionnaire. The prevalence of smokers was 31.2% in females and 31.5% in males. 83% of non-smokers and 66.6% of smokers approved the smoking ban in the hospital but 39.6% of non-smokers and 17.4% of smokers stated it was not observed. Percentages of, respectively, 57.0% and 31.1% in 2004 had dropped in 2005 and in 2006, after Law no 3/2003 was implemented. More than 90% of paramedical personnel declared that workers usually smoked in the workplace. 11.1% of non-smokers reported they were often exposed to ETS and 50% sometimes. These result show the smoking ban was not fully observed in the Hospital, where many workers reported they were exposed to ETS. Occupational Physicians should encourage health workers to stop smoking by offering appropriate counselling.

[Smoke habit in a population of apprentices in middle of Italy]. / Abitudine al fumo in una popolazione di apprendisti dell'Italia centrale.

This study assessed the smoking habit in 7,159 apprentices (females: 53.3%) in central Italy. In the period 1996-2006, each apprentice underwent a compulsory health examination to assess fitness for work carried out by specialists in Occupational Medicine. Demographic data and information on schooling, smoking habit, alcohol and coffee intake were collected by a questionnaire. Overall, 51.9% of apprentices were smokers. Smokers were fewer among female apprentices than among the males (48.3% vs 55.9%; chi-square test, p < 0.001). No decrease in the prevalence of smokers was evident during the study period. Low educational level, and daily intake of alcohol and coffee significantly increased the risk of being a smoker. Finding a high percentage of smokers among Italian apprentices with a low educational level who are employed in jobs for which few qualifications are required indicates the need for work-place activities against tobacco smoking habit. Specialists in Occupational Medicine who perform regular health surveillance of workers could play a role in the anti-smoking campaign by integrating their routine work with brief counselling sessions aimed at preventing smoking in young workers and helping smokers to stop and by collaborating in work-place health promotion programmes.

[The accidental diagnosis of a left atrial myxoma in an 80-year-old female]. / Diagnosi accidentale di mixoma atriale sinistro in ottuagenaria.

Left atrial myxoma is usually diagnosed in patients between the ages of 30 and 60 and this diagnosis follows non-specific symptoms (i.e. temperature, anemia, weakness), and obstructive or embolic episodes. There are few cases in the literature of this disease in patients older than 80. We report the case of an 80-year-old female admitted to our institute for an episode of supraventricular tachycardia. After successful treatment of the arrhythmia using verapamil i.v., a routine echocardiographic examination showed the presence of a left atrial mass, and its appearance suggested the diagnosis of a left atrial myxoma. A CT scan and a transesophageal echocardiography confirmed the diagnosis. The patient subsequently underwent cardiac catheterization and coronary angiography. In the absence of significant lesions of the coronary artery, a decision was made to remove the myxoma surgically, based on two considerations: the good clinical status of the patient and the high current risk of peripheral embolization. The operation was successful in removing the myxoma and the patient continues to be in good clinical condition.

[Physiopathology of vasovagal syncope: review of the most endorsed theories and recent findings]. / Fisiopatologia della sincope vasovagale: revisione delle teorie più accreditate e recenti acquisizioni.

Vasovagal syncope is associated with an abnormal reflex and the physiopathological mechanisms of the phenomenon overall are only partially known. Experimental and clinical studies suggest that the main factor which triggers the syncope is the brusque interruption of the alpha-adrenergic tone with marked, sudden peripheral vasodilation. Although documented, vagal hypertony, with consequent bradycardia and asystolia, is only occasional and is almost always a secondary phenomenon. The most commonly suggested cause of vasovagal syncope is a Bezold-Jarish reflex starting from the cardiac receptors in the walls of the ventricle, mediated by the paradoxical activation of afferent vagal fibres. However, recent studies are suggesting that there may be other pathogenetic mechanisms such as the paradoxical activation of the venous-atrial baroceptors and other "extracardiac" vascular receptors. The neuro-endocrine aspect of the vasovagal reaction is very complex and in spite of the many studies carried out on the catecholamine, renal-angiotensive system, arginine-vasopressin, and b-endorphine trends, there are still many points awaiting clarification. The response of the autonomous nervous system linked to age also require further research.

Intrapatient comparison between chronic VVIR and DDD pacing in patients affected by high degree AV block without heart failure.

In patients affected by high degree AV block without preexisting congestive heart failure there is no definite demonstration that DDD pacing gives real clinical advantages in respect to VVIR pacing. We performed an intrapatient, long-term study between the two pacing modes in 14 high degree AV block patients, using the Medtronic Synergyst 7027 dual chamber pacemaker, who could be programmed alternatively in DDD or VVIR mode. After a 4-week run-in period following the pacemaker implant, patients completed a randomized, double-blind, cross-over study to compare the effect of 6-week period VVIR and DDD pacing on symptoms and cardiovascular parameters. A semiquantitative score scale was used to quantify the symptoms of general well-being, palpitations, dizziness, pulsating sensation in the neck or abdomen, shortness of breath at rest and during effort, chest pain, and NYHA classification. The sum of symptom scores was 10.4 +/- 6.7 in VVIR period and 4.6 +/- 2.7 in DDD period (P less than 0.001); five patients (36%) crossed over early from VVIR to DDD because of intolerable symptoms; overall, eight patients preferred the DDD mode and no one preferred the VVIR. Cardiac output at rest (echo-Doppler method) was 4.7 +/- 1.4 versus 5.7 +/- 1.6 liter/min (P less than 0.01), body weight was 65.9 +/- 6.6 versus 64.9 +/- 6.1 kg (P less than 0.02), atrial natriuretic peptide was 236 +/- 112 versus 198 +/- 110 pg/mL (P less than 0.01), respectively, during VVIR and DDD modes. Effort tolerance was similar with the two modes of pacing (68 +/- 15 vs 70 +/- 18 watts/min).(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary angiosarcoma of the right atrium invading the pericardial cavity. Description of a case diagnosed by exploratory thoracotomy and surgically treated with success]. / Angiosarcoma primitivo dell'atrio destro ad espansione in cavità pericardica. Descrizione di un caso diagnosticato con toracotomia esplorativa e trattato chirurgicamente con successo.

The AA. report the case of a 43-year-old woman with an angiosarcoma arising from the right atrial wall and growing into the pericardial cavity. The patient presented with recurrent pericardial effusion initially responsive to medical therapy. The diagnosis was made at the exploratory thoracotomy. Repeated 2D-Echocardiograms did not help for the diagnosis in this particular case. The patient underwent surgical resection of the tumor, chemo- and radiotherapy. After 30 months there are no signs of recurrence or metastasis. In our opinion the frequent recurrence of pericardial effusion in the same patient should be regarded with special suspicion.