The quality of life in extracorporeal life support survivors: single-center experience of a long-term follow-up

Objective: To evaluate the health-related quality of life on a very long-term follow-up in patients treated with extracorporeal membrane oxygenation (ECMO) during neonatal and pediatric age. Design: Prospective follow-up study. Setting: Pediatric Intensive Care Unit of a tertiary-care University-Hospital. Patients: Out of 20 neonates and 21 children treated with ECMO in our center, 24 patients underwent short-term neurological follow-up. Twenty of them underwent long-term neurological follow-up. Intervention: Short-term follow-up was performed at 18 months and consisted in clinical evaluation, electroencephalography, and neuroimaging. Long-term follow-up was performed in 2017, at the mean period 19.72 years from ECMO (median 20.75, range 11.50-24.08) and consisted in a standardized questionnaires self-evaluation (PedsQL 4.0 Generic Core Scale) of health-related quality of life and an interviewed about the presence of organ morbidity, school level, or work position. Measurements and main results: Sixty-one percent (25/41) of the patients survived within 30 days after ECMO treatment. Short-term follow-up was performed in 24 patients (1 patient but died before the evaluation): 21 patients (87%) showed a normal neurological status, and 3 developed severe disability. Long-term follow-up was performed in 20 long-term survivors (3 patients were not possible to be contacted and considered lost to follow-up): mean age of patients at long-term follow-up was 21.23 (median 20.96, range 13.33-35.58) years; 90% (18/20) of them have no disability with a complete normal quality of life and 95% have no cognitive impairment. Conclusions: ECMO represents a life-saving treatment for infants and children with respiratory and/or heart failure; survivors show a good quality of life comparable to healthy peers

Spazio e tempo nel "Filottete" sofocleo: tragedia e società

L'obiettivo del presente lavoro è lo studio del rapporto uomo/società in relazione al "Filottete" sofocleo. Prendendo come punto di riferimento le coordinate spaziali e temporali (spazio mitico, spazio scenico e tempo) dell'opera di riferimento, viene analizzata la complicata situazione in cui viene a trovarsi il protagonista del dramma, continuamente in bilico tra natura e cultura. Viene tenuta, inoltre, in grande considerazione l'influenza esercitata sulla tragedia e, in particolare, su Sofocle da parte della società ateniese di fine V secolo a.C., a cui la tragedia era rivolta. Si noterà, dunque, infine quanto la particolare condizione di Filottete, la quale spazia dall'assenza alla presenza di una società di riferimento, mostri dei punti di contatto con il 'quadro sociale' in cui la tragedia veniva rappresentata: una società ateniese in crisi, che stava avviandosi verso la sconfitta nella Guerra del Peloponneso

Treatment of bronchiolitis: state of the art.

Bronchiolitis is a leading cause of acute illness and hospitalization for infants and young children worldwide. It is usually a mild disease, but the few children developing severe symptoms need to be hospitalized and some will need ventilatory support. To date, the mainstay of therapy has been supportive care, i.e. assisted feeding and hydration, minimal handling, nasal suctioning and oxygen therapy. In recent years the delivery of oxygen has been improved by using a high-flow nasal cannula. At the same time, the discovery of nebulized hypertonic saline enables better airway cleaning with a benefit for respiratory function. The possible role of any pharmacological approach is still debated: many pharmacological therapies tried in the past, ranging from bronchodilators to corticosteroids, were found to offer no benefit in this disease. More recently, nebulized adrenaline demonstrated a short-term benefit. Prophylaxis and prevention, especially in children at high risk of severe infection, such as prematurely born infants and children with bronchopulmonary dysplasia, have a fundamental role in dealing with this disease. In this review, we focus on current recommendations for the management and prevention of bronchiolitis, paying particular attention to the latest literature in search of answers to the questions that remain open

Handheld Near-Infrared Device (InfrascannerTM) for Detection of Intracranial Haematoma in Children with Minor Head Injury

BACKGROUND: The use of head CT for the detection of possible intracranial haematoma in children with minor head injury (MHI) should be balanced against the risks related to radiation, as well as to sedation for uncooperative patients. Recently a handheld device using non-radiating near-infrared technology (InfrascannerTM) has shown good accuracy for detection of intracranial haematoma in adults with head injury. This device could be a useful tool to optimize the selection of children who will need to undergo a CT scan after a MHI. OBJECTIVE: This study aims to determine the feasibility of use and accuracy of InfrascannerTM in children with MHI. DESIGN/METHODS: Ongoing prospective observational study at the pediatric emergency departments in Padova and Treviso (Italy), including children at high or intermediate risk for intracranial injury according to the adapted PECARN rule in use. Completion of InfrascannerTM measurements (at 4 pre-selected pairs of locations on the head:frontal, temporal, parietal, and occipital regions) and time to completion are recorded. A positive result is defined by a difference in optical density of 0.2 between 2 symmetric regions. Decision on CT scan and CT scan reporting are performed independently and blinded to InfrascannerTM measurement results. RESULTS: 74 patients have been enrolled so far. Of these 37 (50%) were < 2 years of age. Completion of the InfrascannerTM measurement was successfully achieved without need of sedation in 72 (97%) patients, after a median of 4 minutes (interquartile range 2-6). A CT scan was performed in 12 (16%) children. A fracture was detected in 2 and no intracranial injuries were identified. InfrascannerTM measurements resulted positive in 5 (7%) patients. Of these 1 patient had a scalp haematoma overlying one of the measurement sites and 2 were infants. None of the patients who did not undergo a CT scan represented to the emergency department or had a CT scan performed at another site, as ascertained by telephone follow-up. CONCLUSIONS: InfrascannerTM seems an easy-to-use tool in the pediatric emergency department, thanks to the high completion rate and the short time to completion, with no need of sedation. Our preliminary data do not allow to assess its accuracy and its potential usefulness in guiding decision-making on CT scan. Further results are needed to evaluate its diagnostic accuracy

Effectiveness of Ball Attachment Systems in Implant Retained- and Supported-Overdentures: A Three- to Five-Year Retrospective Examination

Purpose: To evaluate implant and prosthetic survival rates, complications, patient satisfaction, and biological outcomes of patients rehabilitated with a ball attachment system for implant retained- and supported-overdentures (IOV), which was in function for 3 to 5 years. Methods: This retrospective study evaluated data collected from patients treated between April 2001 and May 2018 with IOV on splinted and non-splinted implants and a ball attachment system. Patients were followed for 36 to 206 months (mean follow-up was 128.1 &plusmn; 51.9 months). Data were collected at the 3- and 5-year follow-up examination. Outcome measures were implant and prosthetic survival rates, technical complications, marginal bone loss (MBL), oral health impact profile (OHIP), and periodontal parameters (bleeding on probing and plaque index). Results: A total of 46 patients (16 males and 30 females) with 124 implants were included in this study. Twenty-five implant-retained overdentures were delivered on 53 unsplinted implants, while the other 21 patients received an implant-supported overdentures and the implants were splinted. At the five-year follow-up examination, one implant and one prosthesis failed in the unsplinted group, resulting in a cumulative survival rate of 97.8% at the patient level. Two minor technical complications were experienced. Conclusions: Implant overdenture retained or supported by ball attachment systems showed high implant and prosthetic survival and success rates. A low number of complications, high patient satisfaction, and successful biological parameters were experienced in the mid-term follow-up. Data need to be confirmed by further randomized trials

Effect of Simultaneous Immediate Implant Placement and Guided Bone Reconstruction with Ultra-Fine Titanium Mesh Membranes on Radiographic and Clinical Parameters after 18 Months of Loading

Background: The aim of the present prospective case series study was to evaluate the implant and prosthetic survival rates, complications and marginal bone loss using ultra-fine titanium mesh membrane with simultaneous implant placement, to provide space maintenance mandatory for guided bone reconstruction of alveolar bone defects. Materials and Methods: patients were recruited and treated at a private clinic in Rome, Italy, between March 2016 and October 2017. Self-tapping tapered implants were placed through a computer-guided template-assisted approach. Autogenous bone was placed alone over the exposed implant surface, then mixed with inorganic bovine bone material. Finally, the membrane was connected and shaped in order to securely enclose the graft area, and the healing cap was connected and screwed onto the height connector. Outcome measures were: implant and prosthetic failure, biological and mechanical complications, marginal and volumetric bone level changes, esthetic evaluation performed according to the pink aesthetic score (PES). Results: in total, seven patients (five women, two men) with a mean age of 52.7 &#177; 20.3 years (range: 27&#8722;71) received 10 self-tapping tapered implants and simultaneous guided bone regeneration with ultra-fine titanium mesh membranes. No implants and no prostheses failed during the entire follow-up period. One slightly membrane exposure was observed one month after implant placement in one patient. The mean marginal bone loss (MBL) at implant loading was 0.13 &#177; 0.09 mm (95% CI 0.08&#8722;0.19). At the 18-month follow-up examination, the mean MBL was 0.28 &#177; 0.33 mm (95% CI 0.07&#8722;0.50) The difference was not statistically significant (0.15 &#177; 0.31; 95% CI 0.05&#8722;0.35; P = 0.1888). The mean horizontal alveolar ridge width was 3.72 &#177; 1.08 mm (95% CI 3.22&#8722;4.22 mm). At the II-stage surgery, the mean bone width was 8.79 &#177; 0.98 mm (95% CI 8.51&#8722;9.07 mm). The mean bone gain was 5.06 &#177; 1.13 mm (95% CI 4.68&#8722;5.44 mm; P = 0.000). The mean volume of the grafted bone calculated using the superimposition technique was 0.99 &#177; 0.38 CC (95% CI 0.75&#8722;1.23 CC). The mean PES at implant loading was 8.2 &#177; 0.8 mm (95% CI 7.7&#8722;8.7). At the 18-month follow-up examination, the mean PES was 12.0 &#177; 0.7 mm (95% CI 11.5&#8722;12.5) The difference was statistically significant (3.8 &#177; 0.4; 95% CI 3.5&#8722;4.1; P = 0.0000); Conclusion: with the limitation of the present prospective study, the guided bone reconstruction using an ultra-fine titanium mesh membrane with simultaneous implant placement seems to provide good and stable results in implant/prosthesis success. Further research with a longer follow-up and a higher sample size are needed to confirm the results from this preliminary report

Benefits of fibre retention osseous resective surgery in the treatment of shallow infrabony defects. A double-blind, randomized, clinical trial describing clinical, radiographic and patient-reported outcomes

Background The aim of this randomized clinical trial was to evaluate the efficacy of Apically Positioned Flap with Fibre Retention Osseous Resective Surgery (FibReORS) or Osseous Resective Surgery (ORS) to treat periodontal pockets associated with infrabony defect ≤3 mm at posterior natural teeth. Material and methods Thirty patients with chronic periodontitis showing persistent periodontal pockets after cause-related therapy were enrolled; 15 patients were randomly assigned to FibReORS (test group) and 15 to ORS (control group). Measurements were performed by a blind and calibrated examiner. Outcome measures included intra-operative and post-operative morbidity and root sensitivity, 1-year probing depth (PD), gingival recession (Rec) and radiographic bone changes. Results No differences in clinical and bone defect parameters were observed at baseline. Marginal bone resection was reduced by 0.9-1.6 mm in the FibReORS group. ORS was associated with patient perception of greater surgical hardship (p = 0.0264), higher 1-week pain experience (p = 0.0001) and greater dental hypersensitivity (p = 0.0002). After 1 year, shallow, maintainable PD with no difference between the two procedures (p = 0.3707) was obtained. FibReORS was associated with less final Rec (p < 0.0001) and less radiographic bone loss (p < 0.0001) than ORS. Dental hypersensitivity remained significantly higher in the ORS group (p = 0.0024). Conclusion FibReORS was similarly effective as ORS for PD reduction with less final Rec and patient morbidity. © 2012 John Wiley & Sons A/S.Link_to_subscribed_fulltex