How will I be when I will grow up? The importance of psychological intervention in pediatric patients to prevent symptoms from becoming chronical

Psychological discomforts in pediatric patients, if not identified, and considered as personality traits can lead to abnormalities in the development. Identifying psychological problems and treating them with psychological intervention could avoid the raise of psychological disease in adulthood. The aim of this study is to evaluate the perception of self-image and interpersonal relationships of children affected by juvenile idiopathic arthritis (chronic pathology); to compare those data with those published in a previous research about enuretic children (functional pathology) and children affected by cleft palate (organic pathology). Forty children were tested using two Graphic Projective Tests: Machover test (Human Figure Drawing Test) and Corman test (Family Drawing Test) in order to assess specific disorders of their personality through the self-image perception and the emotional relationships with other members of family. Children affected by juvenile idiopathic arthritis show problems about the contact with the external world, underestimation of himself and inadequate perception of himself, exactly like children affected by enuresis and cleft lip and palate. Situation of discomfort, if not taken in consideration and seen as personality traits could easily become an emotional and behavioral chronic psychological disease

Three-dimensional morphological condylar and mandibular changes in a patient with juvenile idiopathic arthritis: Interdisciplinary treatment

Temporomandibular joint (TMJ) involvement is common but usually delayed in patients with juvenile idiopathic arthritis (JIA). We describe the case of a JIA patient with bilateral TMJ involvement, mandibular retrognathia, bone erosion, and severely restricted mouth opening. The use of cone beam computed tomography and a 3D diagnostic protocol in young patients with JIA provides reliable, accurate and precise quantitative data and images of the condylar structures and their dimensional relationships. Analgesics and conventional disease modifying antirheumatic drugs were ineffective, but interdisciplinary treatment with etanercept and a Herbst functional appliance improved functional TMJ movement and bone resorption

Temporomandibular joint involvement in juvenile idiopathic arthritis: treatment with an orthodontic appliance

Introduction and purpose: About 65% of children suffering from juvenile idiopathic arthritis (JIA) shows a more or less marked involvement of temporo-mandibular joint (TMJ) with altered mandibular growth, resorption of the condyles, occlusary instability, reduced chewing ability and facial dysmorphia. The purpose of our study is to prevent and to treat the progressive evolution of JIA on craniofacial growth and morphology with a functional appliance; surgery should be considered only in so far as the adequacy of TMJ movement is concemed. Methods: From 1992 until now 72 children with proved JIA and TMJ involvement have been treated (50 females, 22 males, aged 6 to 16 years old). TMJ involvement was bilateral in 61% and unilateral in 39% of patients. A diagnostic workup was carried out involving tomograms of TMJ and cephalometric radiograph and analysis. The authors used a bimaxillary activator in the attempt to modify the unfavourable growth pattern and provide a gradual ante-rotation of the jaw. Results: Almost all JIA patients showed satisfactory long term results, easing of pain, reduced skeletal discrepancy, increased function and good facial profile. Conclusions: The long term results of this study indicate that orthopaedic therapy might control the vicious circle of the malocclusion in children with JIA, preventing exacerbation of mandibular clockwise rotation. Surgical intervention for the improvement of TMJ function should be considered only if a severe restricted state is imminent

Late-Holocene climatic variability south of the Alps as recorded by lake-level fluctuations at Lake Ledro, Trentino, Italy

International audienceA lake-level record for the late Holocene at Lake Ledro (Trentino, northeastern Italy) is presented. It is based on the sediment and pollen analysis of a 1.75 m high stratigraphic section observed on the southern shore (site Ledro I) and a 3.2 m long sediment core taken from a littoral mire on the southeastern shore (site Ledro II). The chronology is derived from 15 radiocarbon dates and pollen stratigraphy. The late-Holocene composite record established from these two sediment sequences gives evidence of centennial-scale fluctuations with highstands at c. 3400, 2600, 1700, 1200 and 400 cal. BP, in agreement with various palaeohydro-logical records established in central and northern Italy, as well as north of the Alps. In addition, high lake-level conditions at c. 2000 cal. BP may be the equivalent of stronger river discharge observed at the same time in Central Italy's rivers. In agreement with the lake-level record of Accesa (Tuscany), the Ledro record also suggests a relatively complex palaeohydrological pattern for the period around 4000 cal. BP. On a millennial scale, sediment hiatuses observed in the lower part of the Ledro I sediment sequence indicate that, except for a high-stand occurring just after 7500 cal. BP, lower lake levels generally prevailed rather before c. 4000 cal. BP than afterwards. Finally, the lake-level data obtained at Lake Ledro indicate that the relative continuity of settlements in humid areas of northern Italy during the Bronze Age (in contrast to their general abandonment north of the Alps between c. 3450 and 3150 cal. BP), does not reflect different regional patterns of climatic and palaeohy-drological conditions. In contrast, the rise in lake level dated to c. 3400 cal. BP at Ledro appears to coincide with a worldwide climate reversal, observed in both the hemispheres, while palaeoenvironmental and archaeological data collected at Lake Ledro may suggest, as a working hypothesis, a relative emancipation of proto-historic societies from climatic conditions

Temporomandibular joint involvement in juvenile idiopathic arthritis : treatment with an orthodontic appliance

Introduction and purpose: About 65% of children suffering from juvenile idiopathic arthritis (JIA) shows a more or less marked involvement of temporo-mandibular joint (TMJ) with altered mandibular growth, resorption of the condyles, occlusary instability, reduced chewing ability and facial dysmorphia. The purpose of our study is to prevent and to treat the progressive evolution of JIA on craniofacial growth and morphology with a functional appliance; surgery should be considered only in so far as the adequacy of TMJ movement is concerned. Methods: From 1992 until now 72 children with proved JIA and TMJ involvement have been treated (50 females, 22 males, aged 6 to 16 years old). TMJ involvement was bilateral in 61% and unilateral in 39% of patients. A diagnostic workup was carried out involving tomograms of TMJ and cephalometric radiograph and analysis. The authors used a bimaxillary activator in the attempt to modify the unfavourable growth pattern and provide a gradual ante-rotation of the jaw. Results: Almost all JIA patients showed satisfactory long term results, easing of pain, reduced skeletal discrepancy, increased function and good facial profile. Conclusions: The long term results of this study indicate that orthopaedic therapy might control the vicious circle of the malocclusion in children with JIA, preventing exacerbation of mandibular clockwise rotation. Surgical intervention for the improvement of TMJ function should be considered only if a severe restricted state is imminent

Densitometria ossea: parametri ultrasonometrici in giovani sani

Background. This study was carried out in order to assess the possible changes of ultrasonometric parameters of bone (SOS, BUA, Stiffness) related to age in a normal male and female Italian population. Methods. A total of 150 healthy subjects subdivided into 2 groups (80females and 70 males) have been studied. The patients have been submitted to a careful anamnesis and clinical observation; the examination has been performed by placing the foot inside the ultrasonograph. Results. The results obtained show that there is a linear increase of SOS, BUA and Stiffness with age in the normal population and a similar pattern is observed in both sexes. Conclusions. These findings suggest that ultrasound parameters are able to detect and monitoring characteristics of bone structure. Therefore, ultrasound measurement should be considered as an alternative to radiation quantitative based methods for the assessment of the skeleton