The effect of orthodontic treatment on smile attractiveness: a systematic review

BACKGROUND

Smile attractiveness is a primary factor for patients to seek orthodontic treatment, however, there is yet no systematic evaluation of this topic in the literature.

OBJECTIVES

To assess the current evidence on the effect of orthodontic treatment on smile attractiveness.

SEARCH METHODS

Seven electronic databases (MEDLINE, Cochrane Library, Virtual Health Library, SCOPUS, Web of Science, Google Scholar and Embase) were searched on 14 September 2022.

SELECTION CRITERIA

Studies evaluating smile attractiveness before and after orthodontic treatment or only after completion of orthodontic treatment.

DATA COLLECTION AND ANALYSIS

Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomised studies. Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were planned a priori.

METHODS

After elimination of duplicate studies, data extraction and risk of bias assessment according to the Cochrane guidelines, an evaluation of the overall evidence was performed. The included studies were evaluated based on the characteristics of their study and control groups and based on their main research question. Also, all outcome measures were standardized into a common assessment scale (0-100), in order to obtain more easily interpretable results.

RESULTS

Ten studies were included in this review, nine of which were assessed as being at serious risk of bias and one at moderate risk of bias. The large heterogeneity between the included studies did not allow for a meta-analysis. Orthodontic treatment has a moderately positive effect on smile attractiveness. When compared to no treatment, orthodontic treatment with premolar extractions improves smile attractiveness by 22%. Also, surgical correction of Class III cases increases smile attractiveness by 7.5% more than camouflage treatment. No other significant differences were shown between different types of treatment.

CONCLUSION

Based on the available data, orthodontic treatment seems to moderately improve the attractiveness of the smile. There is significant bias in the current literature assessing the effect of orthodontics on smile attractiveness; therefore, the results cannot be accepted with certainty.

Analysis of patients attitude to undergo urgent endoscopic procedures during COVID-19 outbreak in Italy

We conducted a survey to investigate to what extent the fear of COVID-19 has influenced the patients decision to undergo or to cancel endoscopic procedures. We collected data from 847 patients from 13 centres. The main indication for endoscopy was anemia, followed by pain and unexplained weight loss. The percentage of not presenters progressively increased throughout the three weeks of study, from 15.1% at the beginning to 48.2% at the end. 37 (34.2%) upper GI endoscopies and 112 (56.3 %) colonoscopies showed an organic cause explaining the symptoms presented by the patients, respectively; 5 cases of gastric cancer (4.6%) and 16 cases of colorectal cancer (CRC) (6.0%), respectively, were detected; during the second week the percentage of organic diseases found at upper endoscopy was 19 (33.3%) with 5 cancer (8.7%), and 61 (49.1% ) at colonoscopy, with 2 CRC (1.6%); finally, during the third week the corresponding figures were 19 (48.7%) for upper GI examinations, with 3 gastric cancers (7.7%), and 43 (60.5%) with 4 (6.5%) CRC cases found.We conclude that patients weighted the fear of having a clinically relevant disease with the fear of becoming infected by coronavirus, and a relevant percentage of them (29.4%) decided not to attend the endoscopy suites at the scheduled date.

Solid-Phase Synthesis of Substrate-Based Dipeptides and Heterocyclic Pseudo-dipeptides as Potential NO Synthase Inhibitors

More than 160 arginine analogues modified on the C-terminus via either an amide bond or a heterocyclic moiety (1,2,4-oxadiazole, 1,3,4-oxadiazole and 1,2,4-triazole) were prepared as potential inhibitors of NO synthases (NOS). A methodology involving formation of a thiocitrulline intermediate linked through its side-chain on a solid support followed by modification of its carboxylate group was developed. Finally, the side-chain thiourea group was either let unchanged, S-alkylated (Me, Et) or guanidinylated (Me, Et) to yield respectively after TFA treatment the corresponding thiocitrulline, S-Me/Et-isothiocitrulline and N-Me/Et-arginine substrate analogues. They all were tested against three recombinant NOS isoforms. Several compounds containing a S-Et- or a S-Me-Itc moiety and mainly belonging to both the dipeptide-like and 1,2,4-oxadiazole series were shown to inhibit nNOS and iNOS with IC₅₀ in the 1-50 μM range. Spectral studies confirmed that these new compounds interacted at the heme active site. The more active compounds were found to inhibit intra-cellular iNOS expressed in RAW264.7 and INS-1 cells with similar efficiency than the reference compounds L-NIL and SEIT.

Effects of Sensitive Electrical Stimulation-Based Somatosensory Cueing in Parkinson's Disease Gait and Freezing of Gait Assessment

This study aims to investigate the effect of a somatosensory cueing on gait disorders in subjects with Parkinson's disease (PD). After having performed stepping in place and timed up and go assessing tasks, 13 participants with PD were equipped with an electrical stimulator and an inertial measurement unit (IMU) located under the lateral malleolus on the sagittal plane. Electrodes were positioned under the arch of the foot and electrical stimulation (ES) parameters (five 500 µs/phase charge-balanced biphasic pulses delivered at 200 Hz, repeated four times at 10 Hz) adjusted to deliver a sensitive signal. Online IMU signal was processed in order to trigger ES at heel off detection. Starting from a quiet standing posture, subjects were asked to walk at their preferred speed on a path including 5 m straight line, u-turn, and walk around tasks. Three situations were considered: no stimulation baseline precondition (C0), ES condition (C1), and no stimulation baseline post-condition (C0bis), for eliminating a learning effect possibility. In ES condition (C1) the time to execute the different tasks was globally decreased in all the subjects (n = 13). Participants' results were then grouped regarding whether they experienced freezing of gait (FOG) or not during C0 no stimulation baseline precondition. In "freezer" subjects (n = 9), the time to complete the entire path was reduced by 19%. FOG episodes occurrence was decreased by 12% compared to baseline conditions. This preliminary work showed a positive global effect on gait and FOG in PD by a somatosensory cueing based on sensitive electrical stimulation.

Effects of Sensitive Electrical Stimulation Based Cueing in Parkinson's Disease: A Preliminary Study

This study aims to investigate the effect of a sensitive cueing on Freezing of Gait (FOG) and gait disorders in subjects suffering from Parkinson's disease (PD). 13 participants with Parkinson's disease were equipped with an electrical stimulator and a foot mounted inertial measurement unit (IMU). An IMU based algorithm triggered in real time an electrical stimulus applied on the arch of foot at heel off detection. Starting from standing, subjects were asked to walk at their preferred speed on a path comprising 5m straight, u-turn and walk around tasks. Cueing globally decreased the time to achieve the different tasks in all the subjects. In "freezer" subjects, the time to complete the entire path was reduced by 19%. FOG events occurrence was lowered by 12% compared to baseline before and after cueing. This preliminary work showed a positive global effect of an electrical stimulation based cueing on gait and FOG in PD.

The earliest evidence for the use of human bone as a tool

We report on the analysis of three human cranial fragments from a Mousterian context at the site of La Quina (France), which show anthropogenic surface modifications. Macroscopic and microscopic analyses, including SEM observation, demonstrate that the modifications visible on one of these fragments are similar to those produced on bone fragments used experimentally to retouch flakes. The microscopic analysis also identified ancient scraping marks, possibly resulting from the cleaning of the skull prior to its breakage and utilisation of a resulting fragment as a tool. The traces of utilisation and the dimensions of this object are compared to those on a sample of 67 bone retouchers found in the same excavation area and layer. Results show that the tool size, as well as the dimensions and location of the utilised area, fall well within the range of variation observed on faunal shaft fragments from La Quina that were used as retouchers. This skull fragment represents the earliest known use of human bone as a raw material and the first reported use of human bone for this purpose by hominins other than modern humans. The two other skull fragments, which probably come from the same individual, also bear anthropogenic surface modifications in the form of percussion, cut, and scraping marks. The deliberate versus unintentional hypotheses for the unusual choice of the bone are presented in light of contextual information, modifications identified on the two skull fragments not used as tools, and data on bone retouchers from the same layer, the same site, and other Mousterian sites.

Improvement of functional bloating by an enterovaccine: a preliminary study

BACKGROUND

Bloating is a fastidious symptom reported by many patients who also have other gastrointestinal functional disorders. Bloating is more common in women, and it is often associated with meals and improves or disappears overnight. No specific treatments are to date available for this disturbing symptom.

AIMS

to evaluate the effects of an oral enterovaccine (Colifagina) on bloating and other abdominal symptoms in patients with prevalent complaints of functional bloating.

PATIENTS AND METHODS

One hundred and forty-eight patients with functional bloating according to Rome III criteria were recruited. Questionnaires and a VAS scale on their symptoms were administered at baseline and after four weeks of therapy with Colifagina.

RESULTS

After treatment, a significant amelioration of bloating (p < 0.0001), abdominal pain (p < 0.0001) and flatus (p < 0.0001) was observed; nausea and vomiting scores were not significantly different at the end of the treatment. Subjective wellbeing was also generally improved (p < 0.001) in treated patients.

CONCLUSION

Treatment with an enterovaccine may help improve symptoms in patients with functional bloating.

Water load test before and after PPI therapy in patients with gastro-oesophageal reflux disease

BACKGROUND

Patients with gastro-oesophageal reflux disease may complain of epigastric pain, bloating, early satiety, epigastric fullness, epigastric burning, nausea and vomiting.

AIMS

To evaluate the symptoms in response to gastric distension and its relationship to a therapeutic course in patients with gastro-oesophageal reflux disease using the water load test, compared to healthy controls.

METHODS

Thirty gastro-oesophageal reflux disease patients with grade A oesophagitis (studied before and after 4 weeks of therapy with esomeprazole, 40 mg per day) and 15 patients with reflux-related symptoms demonstrated at wireless pH monitoring (non-erosive reflux disease) were compared to 30 healthy volunteers.

RESULTS

Patients with grade A oesophagitis and with reflux-related symptoms ingested significantly lower water volumes than did controls, before onset of fullness, without statistically significant difference between erosive or non-erosive gastro-oesophageal reflux disease; this variable improved in patients after treatment. Nausea scores were higher basally in patients, pre- and post-therapy, and improved after therapy. Thirty-minute fullness and bloating scores improved after therapy in all gastro-oesophageal reflux disease patients compared to controls and pre-therapy. In all pre-treatment patients, a significant correlation was found only with epigastric fullness; after treatment, there was no significant relationship between the water load and the symptom scores.

CONCLUSIONS

In patients with reflux-related symptoms, with or without grade A oesophagitis, the water load test is frequently abnormal, suggesting an altered gastric function. This could explain the incomplete resolution of symptoms after treatment in some patients, and should lead to additional studies aimed at exploring gastric function in gastro-oesophageal reflux disease patients.

Influence of steroid drugs on orthodontically induced root resorption

OBJECTIVES

To investigate the effect of acute and chronic corticosteroid treatment on orthodontically induced root resorption.

DESIGN

'Split mouth' design performing orthodontic tooth movement in 64, 6-month-old male rats divided into three groups: acute (n = 22), chronic (n = 23) and control group (n = 19). Acute and chronic group received corticosteroid treatment (8 mg/kg/day) for 3 and 7 weeks, respectively, while no pharmacological treatment was performed in the control group. Performed at the Department of Orthodontics, School of Dentistry, University of Aarhus, Aarhus, Denmark.

EXPERIMENTAL VARIABLE

The upper left first molar was moved mesially for 21 days in all three groups with 25 g of force. Undecalcified histological sections were cut at the coronal and apical level.

OUTCOME MEASURE

The number of intersections hitting resorption lacunae (ES), defined as a scalloped surface with or without cementoclasts, over the total number of intersections hitting the root surface (RS) were recorded and expressed as percentage.

RESULTS

The acute group showed significantly more root resorption at the mesio-coronal level compared with the control and the chronic group.

CONCLUSION

This could be ascribed to the lack of balance between blastic activities (inhibited by the drug) and the clastic activities (enhanced or unchanged by drug administration) occurring in the initial phase of drug administration. As a consequence, a careful monitoring of patients undergoing acute corticosteroid treatment is suggested.

Tissue reaction to orthodontic tooth movement in acute and chronic corticosteroid treatment*

OBJECTIVES

To study tissue reaction to orthodontic loading during the course of short- and long-term corticosteroid administration.

DESIGN

'Split-mouth' design to perform orthodontic tooth movement in 64 six-month-old male rats divided into groups: no drug administration (n = 19), acute (n = 22) and chronic (n = 23) 8 mg/kg/day corticosteroid treatment. Performed in the Department of Orthodontics at Aarhus University.

EXPERIMENTAL VARIABLE

The upper left first molar was moved for 21 days. Bone markers were administered at 7 and 2 days before sacrifice. Histological sections were cut at the coronal level.

OUTCOME MEASURE

Tooth movement rate, alveolar socket area, the relative extension of alveolar wall with erosion, and the mineralizing surfaces were measured and compared in the three groups.

RESULTS

Tooth movement rate increased in the chronic group. The mechanical load induced an enlargement of the alveolar wall that was less pronounced in both medicated groups. In the acute group the drug suppressed bone resorption and formation without mechanical stimulus. Force application resulted in significant increase in the relative extension of resorption and formation in both drug groups; it was particularly pronounced in the chronic group.

CONCLUSION

Because acute corticosteroid ingestion reduces bone turnover, in these patients orthodontic treatment might best be postponed until a time the patient is free of the drug. Chronic steroid ingestion leads to an increased biological reaction to mechanical perturbation indicating that the orthodontic force level should be reduced and controlled more frequently in patients on chronic steroid treatment.

Tissue reaction to orthodontic tooth movement in different bone turnover conditions

OBJECTIVES

To study the tissue reaction to orthodontic load in normal, high, and low bone turnover states.

DESIGN

'Split mouth' design performing orthodontic tooth movement in 52, 6-month-old male rats with: normal (n = 19), high (n = 16), and low bone turnover (n = 17), the latter two being obtained by induction of hyperthyroidism and hypothyroidism, respectively. Performed at the Department of Orthodontics at Aarhus University.

EXPERIMENTAL VARIABLE

The upper left first molar was moved for 21 days. Bone markers were administered 7 and 2 days before killing. Histological sections were cut at the coronal and apical levels.

OUTCOME MEASURE

Alveolar socket area, periodontal ligament width, the relative extension of alveolar wall with erosion surfaces, and the mineralizing surfaces were measured and compared in the three groups.

RESULTS

Alveolar socket, periodontal ligament width, and erosion surface were larger on the treated than on the control side in the three groups. The normal and hypothyroid groups showed a wider periodontal ligament at the bucco-distal site at the coronal level, while the hyperthyroid group showed a widening which was not spatially oriented. The normal and hyperthyroid groups showed higher erosion at the corono-mesial site. The mineralizing surfaces were larger on the treated than on the control side in the normal and hypothyroid groups, but not in the hyperthyroid group.

CONCLUSION

In the hyperthyroid group, the widening of the periodontal ligament was not spatially oriented and the increased erosion was not accompanied by increased formation, as observed in the normal and hypothyroid groups.

The rate and the type of orthodontic tooth movement is influenced by bone turnover in a rat model

The influence of bone metabolism on both the rate and the type of orthodontic tooth movement was investigated. A rat model in which high (n = 16) and low (n = 17) bone turnover was pharmacologically induced was used. A non-pharmacologically treated group (n = 19) served as the control. A mesially directed constant single force of 25 cN was applied to the upper left first molar for a period of 3 weeks. The study was performed as a split-mouth design, the contralateral side of each animal serving as its control. The displacement of the molar crown was measured with an electronic calliper, while changes in inclination of the teeth were measured from micro-CT scans of the excised maxillae. The bone turnover significantly affected the rate of tooth movement. In the case of high turnover, the rate of tooth movement was increased while it was reduced in the case of low turnover. A controlled mesial tipping in all three groups was observed, but the actual location of the centre of rotation seemed to be influenced by the metabolic state of the bone. Based on the results it can be concluded that deviations in bone turnover influence the response to orthodontic forces, and should be taken into consideration when planning orthodontic treatment in patients with metabolic bone disease or those on chronic medication influencing bone metabolism.

Differences in static cortical bone remodeling parameters in human mandible and iliac crest

Knowledge of the baseline turnover characteristics, and of possible general and local factors influencing alveolar bone responses, is particularly important in the planning of oral rehabilitation. The conventional tool used to obtain information on bone turnover is the iliac crest biopsy, but it is not clear whether it mirrors the situation involving the jaws. The aim of this study was to compare static bone remodeling parameters in the mandible and in the iliac crest to obtain baseline values for the mandible and to test the hypothesis of site specificity of bone remodeling. Bone specimens were obtained from 50 subjects (mean age 64 +/- 17) at autopsy. Three sites were sampled: iliac crest; jaw angle; and foramen mentalis area. In addition, occlusal status was recorded. On undecalcified thin sections, cortical porosity (Ct.Po), eroded sites (ESi), formative sites (FSi), osteonal diameter (On.Dm), Haversian canal diameter (H.Ca.Dm), and wall width (W.Wi) were measured. Ct.Po in the jaw angle and in the foramen mentalis area was lower (48% and 50%, respectively) than in the iliac crest, as was ESi and FSi (80% in the jaw angle and 74% in the foramen mentalis area). In the foramen mentalis area, Ct.Po was greater in subjects with occlusion. On.Dm, H.Ca.Dm, and W.Wi were significantly larger and mutually correlated within the mandible, whereas no correlation was found between mandibular sites and iliac crest. Static cortical bone remodeling parameters are different in the mandible and the iliac crest, thus confirming the hypothesis of site specificity of bone remodeling. Within the mandible, the parameters were correlated, whereas there was no correlation between the mandible and the iliac crest. This could be ascribed to the different functional demands to the mandible and the iliac crest, which was also reflected in the observed influence of functional occlusion on bone remodeling in the mandible. It can thus be concluded that bone reaction to dental intervention is more dependent on the local environment than on general bone turnover as reflected by the iliac crest.

Histomorphometric study of bone reactions during orthodontic tooth movement in rats

The biological response to orthodontic tooth movement has generally focused on reactions within the periodontal ligament (PDL), whereas less attention has been paid to the behavior of neighboring bone. The purpose of the study was to describe the influence of orthodontic force on bone surrounding the displaced tooth and the adjacent, untreated teeth. Bone changes in relation to treatment time and different sites were investigated. A mesial tipping of the left maxillary first molar was obtained from 54 adult male Wistar rats. Oxytetracycline was injected subcutaneously 48 h before killing, which took place after 4, 7, or 14 days. The maxilla was fixed in paraformaldehyde and embedded undecalcified in methylmethacrylate. A set of thick horizontal sections was taken from the cervical, intermediate, and apical levels of the roots. The sections were microradiographed and analyzed microscopically under bright-field and fluorescent illumination. Bone fraction and PDL width was measured using a Zeiss Videoplan device equipped with an overlay system. New bone formation was detected by oxytetracycline labels. The analysis showed a consistent, significant decrease of the alveolar bone fraction around both displaced and adjacent teeth at all treatment times. Apposition, indicated by the tetracycline uptake, was found on the periosteal side of the treated hemimaxilla and, after 14 days, also on the surface toward which the tooth was moving and around the adjacent teeth. These results suggest that a time rather than a space relationship exists between bone resorption and formation and that the whole hemimaxilla reacts to the mechanical challenge, resembling the regional acceleratory phenomenon (RAP) observed in other circumstances.

Intramuscular hemangioma: a benign tumor masquerading as malignant soft tissue tumor. Report of two cases

We report two cases of intramuscular hemangiomas, one arising from the left flank region of a 33-year-old female, and another from the mid right back of a 25-year-old man. In both cases the tumor masqueraded as malignancy and required a biopsy for correct diagnosis. Intramuscular hemangioma is a benign vascular tumor. Its tendency to deep location, infiltrative border, and fixity to surrounding tissues may cause it to be confused with malignant soft tissue tumors. Preoperative biopsy of the lesion is advised, and histopathologic examination is the only way to make a definitive diagnosis. Wide excision of the lesion is the treatment of choice. Follow up is required for any late recurrences.

[Use of Valtrac in digestive surgery. Initial clinical experience]

Stapling instruments are being currently used for digestive or colorectal anastomoses with definite advantages. The authors report their initial clinical experience about BAR utilization to restore intestinal continuity after upper digestive and colorectal resections. The authors have been carried out 20 anastomoses on 18 patients: 11 males and 7 females. Eleven (61.1%) of them were affected with malignant neoplasms and in 9 cases were performed an urgency procedure. The colorectal and jejunal-jejunal anastomoses were performed, respectively, in 8 cases; gastric-jejunal and ileo-colic anastomoses, respectively, in 2. The satisfactory results obtained seem to demonstrate that the biofragmentable anastomotic ring constitutes a "safe" method of bowel junction of the whole digestive apparatus.

[Renal angiolipoma associated with bilateral double ureter. A clinical case]

Renal angiomyolipoma is a rare renal tumor usually associated with tuberous sclerosis, a syndrome characterized by adenoma sebaceum, mental insufficiency and epilepsy. The authors present a rare case of renal angio-myolipoma associated with bilateral double ureter, in a young male patient not affected by tuberous sclerosis. Histologically, the angiomyolipoma is defined by the presence of smooth muscular cells, new formed vessels and fat. Clinical diagnosis requires the utilization of various imaging techniques, like intravenous pyelogram, ultrasonic scan, CT scan, and FNA (Fine Needle Aspiration). In the histopathologic diagnosis of angiomyolipoma the use of immunohistochemical techniques with different antibodies has been helpful, for the necessity to differentiate angiomyolipoma from other epithelial tumors, as renal cell carcinoma and sarcomatous neoplasms. As for as treatment is concerned, the indication for surgery is still maintained by two factors not affected by these diagnostic improvements: tumor size and presence of symptoms. Tumor size is an important predictive growth factor of the tumor. In the absence of symptoms a close follow-up with ultrasonographic scan may be indicated, keeping in mind the possible presence of a synchronous renal cell carcinoma. Hemorrhage can be a fatal complication of renal angiomyolipoma, requiring emergency surgery or embolization.

[Computerized archives in surgery. Our experience]

In recent years, the necessity for a surgical department to obtain a wide range of clinical data in a short period is greatly increased. This necessity has been almost satisfied with widespread use of information systems in medicine using database programs and the integration of these database with other programs has allowed graphic representation of data. Anyhow, some difficulties are still present, such as low knowledge in using personal computers and lacking of a common program for all surgical departments. In the article the authors present a computerized program for the filing of medical records in a surgical department. Starting from January 1992, clinical data of all patients admitted in our department have been recorded in the described program. After three years of use, the system has shown to be easy to use, and able to give useful information for data analysis regarding the population observed, the clinical activity performed and the level of quality obtained. For these reasons, it can represent an attempt to diffuse and uniform computerized data recording in surgical departments.

[Emergency abdominal surgery in the aged]

The results of 93 elderly patients, subdivided in two age groups (> 65 < 80 years; > 80 years), undergoing abdominal surgery in immediate or delayed emergency over the past five years are reported. The overall morbility was 47.3% (48 complications in 44 patients); among the complications, sepsis was the first factor in frequency in either group (group I: 28.1%, group II: 17.2%), and was reported mostly in patients with associated diseases (group I: 61.1%, group II: 60%). Overall mortality was 16.2% (group I: 15.6%, group II: 17.2) related to 15 patients; among them, 10 had associated diseases (66.6%). The authors try to identify risk factors and their influence in prognosis and propose a multidisciplinary approach in the pre and postoperative period.

Testicular feminization syndrome diagnosed in an elderly patient at surgery. A case report

A case of Morris' syndrome in which the diagnosis has been realized only in old age is reported. A 69 year-old patient, with female external genitalia and secondary sexual characteristics, was referred to us with a diagnosis of a mass in the right inguinal region. Her personal history was based on a primary amenorrhoea, which was unsuccessfully investigated since she was adolescent. At the age of 63, during surgery for a left inguinal hernia realized in another hospital, a testis-like mass with the spermatic cord was casually found. During our hospitalization, a surgical removal of the right inguinal mass was performed, and the histologic examination showed the presence of a dominant sclerohyalin testicular tissue without evidence of seminal epithelium and sparse focuses of Leydig cells hyperplasia. Besides, the determination of gonadotropins and sex hormones yielded an increased production of LH, FSH, estradiol, testosterone and androstenedione. A cytogenetic analysis showed a 46, XY karyotype. The diagnosis realized only in old age has compelled the patient to live all her life, from sexual maturity, with indecision and doubt, and without a clinical explanation of fundamental utility even from the psychological point of view. Finally, in our patient the absence of cytologic aspect of malignant transformation in the removed testes in a six years period, seem fortuitous. It is always necessary to consider Morris' syndrome among the possible diseases causing primary amenorrhoea in the clinical evaluation of young phenotypic female patients.

[Unusual presentation of bilateral ureterocele in an adult Black male. Clinical case]

Ureterocele is a congenital urinary abnormality characterized by the presence of an intra-bladder hernia or cystic ballooning of the lower end of a ureter between the mucosa and muscle of the bladder. The abnormality leads to urinary retention and recurrent urinary tract infection which can cause irreversible damage to the kidney. Antenatal ultrasound diagnosis of ureterocele is possible but remains difficult. The disease is confirmed during radiologic examination after birth, and renal function is assessed by 99mTc-DMSA. Ureterocele, while not an uncommon pediatric urologic problem, has been reported only rarely in adults. It is bilateral in 10% of cases, is rare in black people, and requires thoughtful management decisions. A relatively uncommon case of bilateral ureterocele with single ureter, associated with left vesicoureteral reflux, in African black man is reported. The patient was investigated by ultrasonography and intravenous urography. Surgical transvesical right "osteoplasty" and excision of the left ureterocele plus ureteric reimplantation, using Politano-Leadbetter technique, were performed. The surgical approach to ureterocele is discussed and we underlined the difficulty of therapeutic decisions, especially if surgery is considered.

[Cephalometry and digital radiography. Technical note]

Conventional and digital lateral teleradiographs of the skull were performed on 6 consecutive patients (3 men and 3 women). The study was aimed at comparing the diagnostic capabilities of the two imaging techniques to measure points and angles, as derived from different cephalometric analyses (see text for details). These variables were analyzed by three different operators: for both techniques, 18 cephalometric tracings were made, including a total of 414 points and 36 angles. Correlation coefficients between the two types of measurements (points and angles) were calculated; Wilcoxon's non-parametric test was also used. This study demonstrates digital radiography to be superior to conventional radiography to detect cephalometric landmarks, which is especially evident in the evaluation of the so-called "questionable" landmarks: the latter were 15 of 23 with conventional radiography and 9 of 23 with digital radiography. On the other hand, correlation coefficients and significance of the values of the considered angles were in close agreement with the two techniques. Therefore, its simultaneous demonstration of anatomical structures of different thickness--i.e., bone and soft tissues--and its lower exposure dose make digital radiography the diagnostic procedure of choice in cephalometrics, especially in the pediatric age, as well as in monitoring the patients.

[Prevalence of caries and malocclusion in Ferrara school children]

The Authors examined 459 children for caries and malocclusion in Argenta. 77% of the whole sample had caries and 65% of children had malocclusion. Dental health education and public preventive programs should be organized to prevent caries and malocclusion. An extension and improvement of local epidemiological studies are needed to achieve this purpose.

[Radiographic screening of asymmetry and postural changes in orthodontic patients]

The role of OPM and of the teleradiography in the diagnosis of the asymmetries and of the postural problems of the orthodontic patients, is pointed out from this analysis on the group of 204 patients from mixed dentition to the adult age with different types of malocclusion. The evidence of a significant amount of patients with asymmetries and incorrected posture shows the utility of this radiological screening and gives advises for a therapeutic approach more corrected.

[Epidemiological aspects of mandibular asymmetry in the developmental period]

The prevalence of mandibular asymmetry in developmental age has been evaluated by a clinical and photographic survey. The signs of dysfunction increased with age from 14 to 34.5%. The heterogeneous predisposing or concurrent factors are discussed, with special attention for postural and breathing problems.

[Frequency of in vitro sensitivity to netilmicin and ceftizoxime on selected highly resistant flora in surgical intensive therapy]

The in vitro sensitivity of 132 gram positive and gram negative bacterial strains to Netilmycin and Ceftizoxime was assessed in order to update the statistics on the a priori efficacy of the antibacterial drugs. The flora studied were carefully selected as an extreme case of resistance to the standard antibiotics. Netilmycin was found to be effective against Staphylococci, Pseudomonas and Enterobacter, Ceftizoxime against Serratia, Acinetobacter, Proteus and Klebsiella. Both drugs were equally effective against E. coli and Citrobacter.