Cone-Beam Computed Tomographic Assessment of the Mandibular Condylar Volume in Different Skeletal Patterns: A Retrospective Study in Adult Patients

The aim of this study was to assess the condylar volume in adult patients with different skeletal classes and vertical patterns using cone‐beam computed tomography (CBCT). CBCT scans of 146 condyles from 73 patients (mean age 30   12 years old; 49 female, 24 male) were selected from the archive of the Department of Dentistry and Maxillofacial Surgery of Fondazione IRCCS Ca’ Granda, Milan, Italy, and retrospectively analyzed. The following inclusion criteria were used: adult patients; CBCT performed with the same protocol (0.4 mm slice thickness, 16   22 cm field of view, 20 s scan time); no systemic diseases; and no previous orthodontic treatments. Three‐dimensional cephalometric tracings were performed for each patient, the mandibular condyles were segmented and the relevant volumes calculated using Mimics Materialize 20.0  software (Materialise, Leuven, Belgium). Right and left variables were analyzed together using random‐intercept linear regression models. No significant association between condylar volumes and skeletal class was found. On the other hand, in relation to vertical patterns, the mean values of the mandibular condyle volumes in hyperdivergent subjects (688 mm3) with a post‐rotation growth pattern (625 mm3) were smaller than in hypodivergent patients (812 mm3) with a horizontal growth pattern (900 mm3). Patients with an increased divergence angle had smaller condylar volumes than subjects with normal or decreased mandibular plane divergence. This relationship may help the clinician when planning orthodontic treatment

Edge-to-Edge Technique to Minimize Ovelapping of Multiple Bioresorbable Scaffolds Plus Drug Eluting Stents in Revascularization of Long Diffuse Left Anterior Descending Coronary Artery Disease

Background: Implantation of Drug Eluting Stents (DES) plus bioresorbable scaffolds (BVS) in very long diffuse left anterior descending coronary artery (LAD) disease may be problematic because of multiple devices overlapping. We sought to assess the short and mid-tern outcomes of combined implantation of DES and BVS using a novel "edge-to-edge" technique in patients with diffuse LAD disease. Methods: Patients with long diffuse LAD disease were enrolled in a prospective registry from 1st August 2014 to 1st August 2015 and treated with IVUS-aided percutaneous coronary intervention using a DES plus a single or multiple BVS using a novel "edge-to-edge" technique. Clinical follow up and invasive follow up driven by clinical justification was performed. Results: Twenty-three patients (5 females, mean age 59.1 +/- 9.1 years) were enrolled. Mean length of LAD disease was 73.1 +/- 20.6 mm. Mean number of DES and BVS implanted was 1.2 +/- 0.4 and 1.7 +/- 1.3, respectively. At a mean follow-up of 11.3 +/- 3.8 months, no stent thrombosis or MACE were observed. Angiographic and IVUS follow-up at a mean of 6.6 +/- 0.7 months showed no significant angiographic restenosis and no appreciable stent gaps. Conclusions: In revascularization of long diffuse disease of the LAD, the edge-to-edge implantation technique appears to be feasible resulting in no restenosis or thrombosis on the short-term follow-up

Primary percutaneous coronary intervention during ST elevation myocardial infarction in prosthetic valve endocarditis: a case report

Abstract Background Infective endocarditis (IE) is still a condition with high mortality and morbidity, especially in the elderly, and in patients with prosthetic valves. The concept of “time-to-therapy” plays a key role for the prompt management of IE and related complications, and the currently available multimodality imaging may play a key role in this setting. Myocardial ischemia due to extrinsic coronary compression from an aortic abscess is an extremely rare condition where the optimal therapeutic strategy has not been defined yet. We present herein the first case of a patient with ST elevation myocardial infarction caused by an aortic root abscess treated with percutaneous stent implantation. Case presentation An 82-year-old woman with a history of atrial fibrillation, chronic renal failure, anemia and a bioprosthetic aortic valve replacement performed in 2014, was admitted to hospital with profound asthenia and a pyrexia of unknown origin. Because of high clinical suspicion of endocarditis, a trans-esophageal echocardiogram was performed. Empirical broad-spectrum antimicrobial therapy was initiated, followed by targeted treatment based on the results of blood cultures (Staphylococcus aureus). The echocardiogram did not show vegetations and the patient was managed conservatively. She suddenly deteriorated, due to an acute coronary syndrome (ACS) with anterior ST segment elevation. An urgent angiogram was performed, and extrinsic compression of the left coronary system, due to an aortic root abscess, was suspected. After discussion with the surgical team, percutaneous revascularization was attempted, aiming to restore satisfactory hemodynamics, in order to plan surgery. Unfortunately, the patient rapidly developed cardiogenic shock, with multi organ failure, and died in less than 24 h. Conclusions Patients with fever, and significant risk factors for endocarditis, who develop ACS, need a prompt diagnostic work up, including trans-esophageal echocardiography. At present, the specific timing of echocardiographic follow-up and surgical intervention is still a matter of debate, and our case aims to highlight the importance of this aspect in the management of endocarditis, in order to avoid severe complications that adversely affect patient prognosis

Fluoride controlled release systems in the prevention of dental caries

Research on drug controlled release devices indicate, in particular with regards to fluoride, the utility of such formulations in dental caries prevention. With this technique, a steady and constant topical action in the mouth is achieved. The new system, called IFRD and applied on the vestibular surface of the first upper molars, is able to release and to increase the daily fluoride concentration in the saliva during 6 months with no adverse effects or intolerance by patients

Measurements of orbital protrusion from childhood to young adulthood

Ocular protrusion is usually measured as the deepest part of the lateral orbital rim to the apex of the cornea. Several studies have been carried out to propose normative data for ocular protrusion according to different age ranges. The protrusion of the eyeball seemed to increase during childhood and adolescence and become stable after the late teens during adulthood. Relationships of ocular protrusion with age are still not completely clarified. The purpose of the current retrospective study was to investigate ocular protrusion on lateral x-rays at different growth stages

Rate-Responsive Cardiac Pacing: Technological Solutions and Their Applications

Modern cardiac pacemakers are equipped with a function that allows the heart rate to adapt to the current needs of the patient in situations of increased demand related to exercise and stress ("rate-response" function). This function may be based on a variety of mechanisms, such as a built-in accelerometer responding to increased chest movement or algorithms sensing metabolic demand for oxygen, analysis of intrathoracic impedance, and analysis of the heart rhythm (Q-T interval). The latest technologies in the field of rate-response functionality relate to the use of an accelerometer in leadless endocavitary pacemakers; in these devices, the accelerometer enables mapping of the mechanical wave of the heart’s work cycle, enabling the pacemaker to correctly sense native impulses and stimulate the ventricles in synchrony with the cycles of atria and heart valves. Another modern system for synchronizing pacing rate with the patient’s real-time needs requires a closed-loop system that continuously monitors changes in the dynamics of heart contractions. This article discusses the technical details of various solutions for detecting and responding to situations related to increased oxygen demand (e.g., exercise or stress) in implantable pacemakers, and reviews the results of clinical trials regarding the use of these algorithms

Predictive variables derived from panoramic radiographs for impacted maxillary cuspids treated with easy cuspid system

The aim of the current study was to find, by means of panoramic radiographs, a viable statistical method to forecast the duration of orthodontic traction of impacted maxillary cuspids. The treatment sample consisted of 51 palatal impacted cuspids (19 unilateral and 32 bilateral) in 35 patients (aged between 10.5 and 17.5 y) with a cervical vertebral maturation between cervical stage 1 and 4. Each patient underwent the same combined surgical-orthodontic technique. Anamnestic data as well as pretreatment panoramic radiograph and cephalogram with European Board of Orthodontics analysis were recorded for each case. Eight radiographic indicators were derived from panoramic films to define the reliable position of the impacted cuspid. Multiple regression analysis was used. All cuspids were successfully treated with an average traction time of 99 days (range, 33-188 d). The pretreatment radiographic features assessed on the panoramic radiographs did not significantly affect the duration of traction. The formula based on \u3b1 angle, d1 distance, and S sector forecasted an average traction time of 123 days (range, 63-210 d), which is longer than the real time. No relevant correlations were found between orthodontic traction time and pretreatment radiograph parameters derived from panoramic film at the beginning of the treatment. The classic formula elaborated by Crescini could not be applied to the patients of this study, who were treated with the Easy Cuspid method