Usefulness of image guidance in the surgical treatment of petrous apex cholesterol granuloma

The petrous apex is a pyramid-shaped structure, located medial to the inner ear and the intrapetrous segment of the internal carotid artery. Lesions of the petrous apex can be surgically treated through different surgical routes. Because of the important neurovascular structures located inside the temporal bone, anatomical 3D knowledge is paramount. For this reason, image-guided surgery could represent a useful tool. We report the case of a young woman who came to our observation for a trigeminal neuralgia due to a petrous apex cholesterol granuloma. The lesion was treated through the placement of a drainage tube via an infracochlear approach, with the aid of neuronavigation and intraoperative MRI. Preoperative CT scan images and intraoperative MRI images were fused for surgical planning. The accuracy of the neuronavigation system has proved to be good, and the safety of the procedure was enhanced. Therefore, neuronavigation and intraoperative MRI, though not available in all neurootological centres, should be considered useful tools in these challenging procedures

Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study

BACKGROUND Lateral internal sphincterotomy is still the approach of choice for the treatment of chronic anal fissure (CAF) with internal anal sphincter (IAS) hypertonia, but it is burdened by high-risk postoperative faecal incontinence (FI). Sphincter saving procedures have recently been reconsidered as treatments to overcome this risk. The most employed procedure is fissurectomy with anoplasty, eventually associated with pharmacological sphincterotomy. AIM To evaluate whether fissurectomy and anoplasty with botulinum toxin injection improves the results of fissurectomy and anoplasty alone. METHODS We conducted a case-control study involving 30 male patients affected by CAF with hypertonic IAS who underwent fissurectomy and anoplasty with V-Y cutaneous flap advancement. The patients were divided into two groups: Those in group I underwent surgery alone, and those in group II underwent surgery and a botulinum toxin injection directly into the IAS. They were followed up for at least 2 years. The goals were to achieve complete healing of the patient and to assess the FI and recurrence rate along with manometry parameters. RESULTS The intensity and duration of post-defecatory pain decreased significantly in both groups of patients starting with the first defecation, and this reduction was higher in group II. Forty days after surgery, we achieved complete wound healing in all the patients in group II but only in 80% of the patients in group I (P < 0.032). We recorded 2 cases of recurrence, one in each group, and both healed with conservative therapy. We recorded one temporary and low-grade postoperative case of “de novo” FI. Manometry parameters reverted to the normal range earlier for group II patients. CONCLUSION The injection of botulinum toxin A in association with fissurectomy and anoplasty with a V-Y advancement flap improves the results of surgery alone in patients affected by CAF with IAS hypertonia

Changes of Inflammatory Mediators in Obese Patients After Laparoscopic Cholecystectomy

Background Obesity is associated with the impairment of immunological functions. The aim of this study was to analyze some inflammatory mediators in obese subjects who underwent laparoscopic cholecystectomy. Methods Seventeen consecutive female patients with a BMI ranging from 35 to 45 kg/m2 (obese) and 17 consecutive female patients with BMI ranging from 20 to 25 kg/m2 (nonobese) were included in the study. All patients were affected by symptomatic gallbladder stone disease and underwent laparoscopic cholecystectomy. Changes in levels of leukocytes, neutrophils, IL-6, IL-10, leptin, and adiponectin were evaluated. Results We observed a significant increase in leukocyte and neutrophil levels in the obese subjects compared to the nonobese subjects. The serum levels of leptin and IL-6 were higher in the postoperative period (compared to the baseline values in both groups), and always higher in the obese. Both adiponectin and IL-10 increased in the postoperative period in nonobese subjects and was always higher than in the obese. Conclusions Obese patients have a stronger acute inflammatory response than do nonobese subjects in reaction to surgical stress

Preventive hygiene protocol of University of Milan for women during pregnancy: A qualitative and quantitative bacterial plaque analysis prospective original study

Introduction: The aim of this article is to describe the preventive hygiene protocol of University of Milan for women during pregnancy analyzing the bacterial plaque quantitatively and qualitatively. Materials and methods: A sample of 35 pregnant women following a protocol of periodic visits starting from the first month of pregnancy until the childbirth and in follow up controls were analyzed. Several samples (n = 4) of bacterial plaque for quantitative and qualitative analysis were taken, from the lingual surface of the lower first molar, during the first visit (T0), during the first trimester (T1), during the second or third trimester of pregnancy (T2), and one month after childbirth (T3). Results: By performing a quantitative analysis, it was calculated that the average plaque index (Fig. 1) was n = 48.1% (T0), n = 14.7% (T1), n = 18.4% (T2) and n = 18.9% (T3). The plaque index score presents a downward trend, passing from 48.1% (T0) to 18.9% (T3). The number of total cocci (Fig. 2) was n = 205.39 (T0), n = 57.5(T1), n = 74.6 (T2) and n = 75.4(T3). The number of total bacilli (Fig. 3) was n = 62.7 (T0), n = 23.1 (T1), n = 25.3 (T2), n = 27.1(T3). The total values of cocci and bacilli were correlated and the average trend of the various samples was calculated. By performing a qualitative analysis, the value of G+ cocci (Fig. 5) was n = 2.7 (T0), n = 1.4 (T1), n = 1.4 (T2) and n = 1.5 (T3). The value of G 12 cocci (Fig. 5) was n = 2.3 (T0), n = 0.7 (T1), n = 1.1 (T2) and n = 1.1 (T3). The value of G+ bacilli (Fig. 6) was n = 1.6 (T0), n = 0.9 (T1), n = 1.2 (T2) and n = 1.2 (T3). The value of G 12 bacilli (Fig. 6) was n = 1.3 (T0), n = 0.3 (T1), n = 0.7 (T2) and n = 0.7 (T3). Conclusions: The preventive hygiene protocol used in the Dental Hygiene Department of the University of Milan, during the gestation period, is a suitable method for the control of the bacterial plaque. A considerably decrease of the plaque index and bacterial components between the first visit and the subsequent check-ups was calculated

Hyrax versus transverse sagittal maxillary expander: An assessment of arch changes on dental casts: A retrospective study

Objective: The aim of this study was to compare arch changes before and after maxillary expansion with Transverse Maxillary Sagittal Expander (TSME) and Hyrax Palatal Expander (HPE), in growing patients with diagnosis of maxillary hypoplasia. Materials and methods: The sample consisted of 40 patients\u2019 records (20 males 20 females mean age 9.2 \ub1 2.6 years) were selected from the archive of the Orthodontic Department of the University of Milan, Italy. Patients were randomly divided in two groups: patients in group 1 were treated with HPE as they presented only transverse deficiency of the maxilla and in group 2 were treated with TSME. Plaster models have been measured with a Verniere caliper to evaluate the differences in maxillary expansion of the two devices. Measurements were performed on casts poured from impressions taken before appliance bonding (T0), immediately after appliance debonding (T1) and at 6 months follow-up (T2). The variations in the following distances have been considered: inter-molar distance, inter-canine distance, palatal depth, palatal length and arch circumference. Shapiro-Wilk test was performed to assess normality distribution. ANOVA for repeated measures with multiple paired t-test for pairwise comparisons and its non-parametric equivalent Friedman's test with multiple Wilcoxon tests for pairwise comparisons were performed to evaluate changes in time of each variable in each group. Between groups comparisons were performed for each variable at each observing time using independent t-test or Mann-Whitney test. Significance level was set at p < 0,05. Results: Both the Friedman test and the rm-ANOVA test and their respective post-hoc show that within both groups the respective variables have a statistically significant increase between T0 and T1 (p < 0,05) and a slight decrease between T1 and T2 (p < 0,05) that is not clinically relevant remaining always T2 greater than T0 in a statistically and clinically relevant way (p < 0,05). The analysis between the differences of the measurements at different timing measured by the Mann-Whitney test shows that for all the variables there is no statistically significant difference between the 2 devices (p < 0,05), except for the perimeter of the arch and the length of the palate; in this case it appeared that the TSME is better statistically (p < 0,05). Conclusions: The study has shown that RPE and TSME can achieve similar results in transversal palatal expansion. Differences have been found in the palatal length and in the arch perimeter where TSME seems to be more efficient

Order statistics and heavy-tail distributions for planetary perturbations on Oort cloud comets

This paper tackles important aspects of comets dynamics from a statistical point of view. Existing methodology uses numerical integration for computing planetary perturbations for simulating such dynamics. This operation is highly computational. It is reasonable to wonder whenever statistical simulation of the perturbations can be much more easy to handle. The first step for answering such a question is to provide a statistical study of these perturbations in order to catch their main features. The statistical tools used are order statistics and heavy tail distributions. The study carried out indicated a general pattern exhibited by the perturbations around the orbits of the important planet. These characteristics were validated through statistical testing and a theoretical study based on Opik theory.Comment: 9 pages, 12 figures, submitted for publication in Astronomy and Astrophysic

COVID-19 and the impact on the cranio-oro-facial trauma care in Italy: An epidemiological retrospective cohort study

The coronavirus disease 2019 (COVID-19) has deeply modified the organization of hospitals, health care centers, and the patient’s behavior. The aim of this epidemiological retrospective cohort study is to evaluate if and how the COVID-19 pandemic has determined a modification in cranio-oro-facial traumatology service. Methods: The dataset included hospital emergency room access of a six-month pre-pandemic period and six months into pandemic outbreak. The variables collected were: patient age, gender, type of emergency access with relative color code, Glasgow Coma Scale Score, type of discharge. Results: 537 vs 237 (pre-pandemic vs pandemic) patients accessed the hospital emergency room and the mean age decreased from 60.79 ± 25.34 to 56.75 ± 24.50 year. Yellow and green code access went from 28.9% and 66.1% to 37.5% and 57.7% (pre-pandemic vs pandemic). Glasgow Coma Scale (GCS) shows an increase of 16.6% vs 27.8% of 15 grade score, a 28.7% vs 28.5% of the 14 grade score and reduction of 13 and 12 grade 40.2% and 14.5% vs 37.1 and 9.7% (pre-pandemic vs pandemic). Conclusions: Since the COVID-19 outbreak continues, epidemiological data are still necessary to perform public health intervention strategies and to appropriately predict the population needs, in order to properly manage the COVID-19 related to oral pathologies as well as the most common health problems