26 research outputs found
Prior tuberculin skin testing does not boost QuantiFERON-TB results in paediatric contacts
No full textRecently, interferon-gamma release assays (IGRA) for specific diagnosis of Mycobacterium tuberculosis infection have become available. In recent UK tuberculosis (TB) guidelines, it has been advised to screen for latent M. tuberculosis infection using the tuberculin skin test (TST), followed by IGRA if the TST is positive. Since TST can boost immune responses to tuberculin, the present authors evaluated whether TST administration affects the result of QuantiFERON-TB Gold in-tube (QFT-GIT), a whole blood-based IGRA. QFT-GIT was performed on the day of TST administration and the day of reading in 15 TST-negative subjects, 46 TST-positive subjects with recent or remote exposure to M. tuberculosis and five cured TB patients. No systematic boosting of QFT-GIT responses from negative to positive was observed. Only in a few TST-positive persons did TST enhance pre-existing QFT-GIT responses. Screening for latent Mycobacterium tuberculosis infection using tuberculin skin testing followed by interferon-gamma release assays on the day of reading is a reliable approach, as the specificity of QuantiFERON-TB Gold in-tube is not affected by prior tuberculin skin test administration
Gingival Recessions following Invisible Aligners Treatment. A Retrospective Evaluation.
No full textA correlation between the use of fixed orthodontic appliances (FOA) and the onset of gingival recessions is now widely demonstrated. In 1999, a new type of treatment was introduced, designed, and created with invisible thermo-printed appliances.
It had great success, especially amongst adults, since it gives greater comfort, as the appliances are removed before meals and home oral hygiene practice; it also turns out to be less impactful from an aesthetic point of view, compared to FOA.
AIM of this study is to evaluate the number of gingival recession (REC) before the orthodontic treatment with aligners and compare it with the REC at the end of the treatment and after 5/10 years of a retention phase.
METHODS: 49 patients were involved, for each of whom 3 intraoral photographs were taken at 3 different time points: before treatment (T0), at the end of orthodontic therapy (T1) and after following up from a minimum of 5 to a maximum of 10 years.
Teeth from 15 to 25 showing gingival recessions in the photos between T0, T1 and T2 were recorded.
RESULTS: The data analysis showed that the gingival recessions recorded at time T2, almost doubled compared to those recorded at time T0, i.e., before treatment. In particular, the maximum possible increase in the incidence of recessions occurred between T0 and T1.
CONCLUSION: Orthodontic therapy with aligners may increase the onset of gingival recessions during the treatment or in the retention phase. In future, it will be interesting to compare the occurrence of recessions, in the same time frame, between the treated and an untreated sample
Subtrocantheric nonunion following fracture of an arthrodesed hip: a case report
No full textIn recent years in the era of successful of total hip replacement, hip arthrodesis is rarely performed. The anatomy and biomechanics of an arthrodesed hip is altered, thus influencing the treatments strategies in case of fracture or nonunions. This case report describes the management and therapeutic solution for the treatment of subtrochanteric nonunion in a patient with hip arthrodesis. Satisfactory outcomes were finally obtained after a double surgical procedure
Smooth Prosthesis: Our Experience and Current State of Art in the Use of Smooth Sub-muscular Silicone Gel Breast Implants
No full textThe objective of this clinical review is to provide an overview of the use of silicone gel-filled breast implants placed in the sub-muscular position, with a focus on complication rates reported for both smooth and textured implants. Furthermore, our experience in this field is also reviewed
Reduction Mammaplasty for Breast Symmetrisation in Implant-Based Reconstructions
No full textBACKGROUND:
Healthy breast surgery constitutes an important step to achieve symmetry in unilateral implant-based reconstructions. We analysed long-term results of breast symmetry obtained with reduction mammaplasties, and we evaluated whether different glandular pedicles may better preserve long-term stability.
METHOD:
Between 2006 and 2012, 90 patients underwent mastectomy and immediate reconstruction with tissue expanders and simultaneous contralateral reduction mammaplasty. In 30 patients, a superior nipple-areola pedicle was harvested (GROUP A), in another 30 patients a medial pedicle was performed (GROUP B), and an inferior pedicle was used in the remaining 30 women (GROUP C). An objective evaluation of the reconstructed breast and the reduced one was performed at 1 and 24 months after surgery. One-way ANOVA and Tukey's HSD tests were used for analysis. Furthermore, three independent plastic surgeons filled out a questionnaire to assess aesthetic results.
RESULTS:
Measurements of the reconstructed breasts showed similar variations between 1- and 24-month evaluations within the three groups with no significant difference (P value >0.05). Measurements of the reduced breast at the 1- and 24-month follow-up (Tukey's test) revealed significant differences among the three groups. Patients from GROUP C showed a significantly higher decrease in Δ nipple-lower clavicle margin distance and Δ nipple-inframammary fold compared to GROUP A and B (P value = 0.01). Surgeons' assessments revealed no statistically significant difference between the three groups.
CONCLUSION:
Superior or medial pedicle reduction mammaplasties seem to better preserve breast shape and position, and they maintain a more similar appearance to the contralateral prosthetic breast over time.
LEVEL OF EVIDENCE IV:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
Analisi tridimensionale del volto in soggetti con Sindrome di Moebius mediante stereofotogrammetria
No full textOBJECTIVES Moebius Syndrome (MS) is a rare disorder defined by bilateral con genital paralysis of the abducens and facial nerves in combination with various odontological, cra nio-facial, ophthalmological and orthopaedic conditions. Despite the broad spectrum of clinical manifestations, the main feature of patients with MS is due to the involvement of the VII cranial nerve and consists in the absence of movement of the facial mimic muscles with important aesthetic and functional consequences. The aim of this study is to quantify the surface facial asymmetry in two subjects affected by MS, us ing a novel stereophotogrammet ric method. MATERIALS AND METHODS A male patient (case 1, age 17.3 years) and a female patient (case 2, age 7.7 years), both affected by MS, were imaged with a ste reophotogrammetric facial scan ner. A three-dimensional (3D) elaboration was performed throughout the software View box (dHAL Software, Kiflissia, Greece) and each original image was du plicated in a mirror version. The root mean square error (RMSE) of the distances between the corre sponding points of each original photograph and its mirror copy was calculated for the whole face and for each trigeminal third, as defined by the innervation of tri geminal branches. Deviations between the original and mirror facial images were al so presented graphically as color maps and quantitatively on histo grams. RESULTS Case 1 presented incomplete bi lateral denervation of the facial nerve and had a RMSE value of 4.028, which quantified the global asymmetry; such a value progres sively increased from the upper third (RMSE = 2.277), through the middle third (RMSE = 3.675) and to the lower third of face (RMSE = 5.031). By contrast, case 2 had bilateral agenesis of facial nerve (missing facial nerves) and showed a minor global asymme try of the face (RMSE = 2.427) with a similar distribution of asym metry in all trigeminal thirds, whose RMSE values were respec tively 2.244 in the upper third, 2.023 in the middle third and 2.674 in the lower third. The evaluation of color maps confirms the data regarding the different degree and localization of the asymmetry in the two sub jects examined: in case 1 the asymmetry involves the region of the lateral and alar cartilages of the nose and the nasolabial fold, extending to the cheeks, man dibular angles and lateral areas of the chin; case 2 shows asym metrical areas mainly in corre spondence with the lateral sides of the nose, from the root to wards the apex, with a reduced involvement of the peri-labial and para-symphyseal surfaces. CONCLUSIONS The reported 3D technique provid ed an accurate topographic analy sis of the facial asymmetry and it is recommended for the quantitative and qualitative evaluation of rare cranio-facial conditions such as MS, showing a wide range of phe notypic presentations. CLINICAL SIGNIFICANCE The study of the facial morphology using methods based on stereo photogrammetry may improve both cranio-facial research and clinical practice, providing addi tional information for diagnosis, treatment planning and follow-up
Italian COVID-19 epidemic: effects on paediatric emergency attendance—a survey in the Emilia Romagna region
No full textObjective To evaluate the effect of the COVID-19
epidemic on paediatric emergency department (ED)
attendance in a region of Northern Italy.
Methods A survey was proposed to six out of nine
paediatric EDs in the Emilia Romagna region to evaluate
attendance data, distribution by age and gender, triage
code score, outcome of clinical course, number of
hospitalisations and the distribution of patients by disease.
Data were collected during March 2020 and compared
with that of March 2019.
Results A drop in paediatric ED attendance of more
than 83.8% was observed, with a higher percentage of
infants and severe triage scores. The proportion of patients
hospitalised was significantly higher in 2020 than in 2019
(p value: <0.001). The effect size for the comparison of
proportions of hospitalised patients was 0.379. Looking
at the distribution of attendance by type of disease, a
significantly different distribution was highlighted (p value:
<0.00001, Cramer’s V); there was a greater proportion
of patients presenting to paediatric EDs with poisonings
(effect size=0.07), psychiatric pathologies (effect
size=0.110), head injuries (effect size=0.167) and fever
(effect size=0.212).
Conclusions Our survey suggests that in the first
month of the COVID-19 epidemic in Italy, there has been
an increase in delayed attendance and provision of care
of potentially severe diseases in paediatric EDs. Hospital
and community paediatricians should be aware of this
phenomenon and adopt appropriate strategies to prevent
this danger, as it may affect children more seriously than
COVID-19 itself
Risks of subsequent contralateral fractures of the trochanteric region in elderly
No full textSummary. Background: Fractures in elderly are always a dramatic event and the healing is often not complete. In a context of bone fragility, repeated fractures are a growing problem in the industrialized world, in which the mean age of population is increasing. The aim of this study was to identify those general factors which may increase the risk of subsequent trochanteric fractures after an initial lesion. Materials and methods: Threehundred and thirty-one patients who underwent intramedullary fixation for trochanteric fractures between January 2012 and December 2013 were studied. Forty subjects yet alive (group 1), affected by a subsequent contralateral hip fracture, were compared with 202 patients (group 2) affected by isolated trochanteric fracture. Days of hospitalization before surgery, hospitalization, period of rehabilitation, type of discharge and comorbidities, that are reported in literature as possible risk factors for hip refracture, were analyzed. In addition, all patients were interviewed in order to assess if a therapy for osteoporosis was prescribed after the initial fracture and how their gait had been modified by fractures. Results: Days of hospitalization before surgery, hospitalization, period of rehabilitation and type of discharge were not predictive factors for subsequent fractures, as well as diabetes mellitus, hypertension and cardiac diseases. The presence of neurologic and respiratory diseases were associated to a higher risk of refractures, as well as the absence of specific medical treatment for osteoporosis. Conclusions: Neurologic and respiratory comorbidities and the absence of osteoporosis medical treatment are the variables associated to a higher risk of contralateral fractures. Physicians can do more in terms of prevention and strategies must consider these risk factors
Congenital Dermatofibrosarcoma Protuberans—An Update on the Ongoing Diagnostic Challenges
No full textDermatofibrosarcoma protuberans (DFSP) is a rare low-grade soft tissue sarcoma. Its congenital form poses distinct diagnostic and therapeutic challenges, often resembling benign entities like hemangiomas or vascular malformations, which can lead to misdiagnosis and treatment delays. This review delves into the epidemiology, clinical manifestations, and diagnostic strategies for DFSP, with an emphasis on the use of advanced molecular techniques, such as FISH and RT-PCR, for the detection of the COL1A1-PDGFB fusion gene, a definitive marker of DFSP. We also explore emerging non-invasive imaging technologies, including multispectral and optical coherence, which, while promising, still require further validation. This review underscores the importance of differential diagnosis from similar conditions, such as medallion-like dermal dendritic hamartoma (MLDDH), through an integrated approach that combines histopathology, immunohistochemistry, and molecular testing. Surgical excision, particularly using Mohs micrographic surgery, is preferred to achieve oncologic safety while preserving aesthetic and functional results in pediatric cases. Furthermore, we discuss the potential of adjuvant therapies like tyrosine kinase inhibitors in treating advanced or inoperable cases. Highlighting the critical role of early detection and a collaborative treatment strategy, this review aims to enhance diagnostic precision and access to innovative treatments, ensuring optimal management for this severe, yet rare, condition
Italian COVID-19 epidemic: effects on paediatric emergency attendance-a survey in the Emilia Romagna region
No full textObjective To evaluate the effect of the COVID-19 epidemic on paediatric emergency department (ED) attendance in a region of Northern Italy.Methods A survey was proposed to six out of nine paediatric EDs in the Emilia Romagna region to evaluate attendance data, distribution by age and gender, triage code score, outcome of clinical course, number of hospitalisations and the distribution of patients by disease. Data were collected during March 2020 and compared with that of March 2019.Results A drop in paediatric ED attendance of more than 83.8% was observed, with a higher percentage of infants and severe triage scores. The proportion of patients hospitalised was significantly higher in 2020 than in 2019 (p value: <0.001). The effect size for the comparison of proportions of hospitalised patients was 0.379. Looking at the distribution of attendance by type of disease, a significantly different distribution was highlighted (p value: <0.00001, Cramer's V); there was a greater proportion of patients presenting to paediatric EDs with poisonings (effect size=0.07), psychiatric pathologies (effect size=0.110), head injuries (effect size=0.167) and fever (effect size=0.212).Conclusions Our survey suggests that in the first month of the COVID-19 epidemic in Italy, there has been an increase in delayed attendance and provision of care of potentially severe diseases in paediatric EDs. Hospital and community paediatricians should be aware of this phenomenon and adopt appropriate strategies to prevent this danger, as it may affect children more seriously than COVID-19 itself
