Cinematica mandibolare in pazienti con disordini temporo-mandibolari e cefalea di tipo tensivo

Abstract: Scopo del lavoro. Rilevare aspetti clinici e strumentali statisticamente significativi per uno screening differenziale precoce di disordini temporomandibolari (TMD) e cefalea di tipo tensivo (TTH), nonché possibili fattori di rischio. Individuare l’incidenza di TTH, emicrania e cefalea a grappolo in pazienti con cefalea. Materiali e metodi. Sono stati esaminati 240 pazienti con diagnosi di sospetta TMD. Tutti sono stati sottoposti a valutazione gnatologica e ad indagini della cinematica mandibolare, mediante elettrognatografia (EGG) e risonanza magnetica (RM). 210 pazienti dei 240 iniziali presentavano anche cefalea, per cui sono stati sottoposti a valutazione neurologica. Di questi 210 pazienti, al 40% è stata fatta diagnosi di emicrania, al 27% di cefalea di tipo tensivo episodico frequente o cronico, al 2% di cefalea a grappolo, mentre il 31% risultava affetto da altre cefalee primarie o combinazioni tra le precedenti. Solo i 57 pazienti che risultavano soddisfare i criteri dell’IHS (International Headache Society) per cefalea di tipo tensivo episodico frequente o cronico sono stati ammessi allo studio. Risultati. L’iperemia della zona bilaminare riscontrata alla risonanza magnetica dell’ATM, risultava associata con TTH in modo statisticamente significativo (OR=2,18 - p-value=0,03). Dalla valutazione clinico-anamnestica e gnatologica sono risultati statisticamente significativi: presenza di interferenze in protrusione (OR=2,03 - p-value=0,03), dermatofagia periungueale (OR=1,87 - p-value=0,04), dolore facciale (OR=4,87 - p-value=0,02), all’apparato masticatorio (OR=3,64 - p-value=0,001), a livello cervicale posteriore (OR=2,15 - p-value=0,03) e cervicale antero-laterale (OR=1,86 - p-value=0,05). Conclusioni. Lo studio della cinematica mandibolare risulta imprescindibile da una corretta valutazione strumentale e clinica, che permette un’individuazione precoce di segni e sintomi predittivi di TMD e TTH

Positive surgical margins and early oncological outcomes of robotic versus open radical prostatectomy at a medium case-load institution

Background: The aim of this study was to analyze the rates of positive surgical margins (PSM) after radical prostatectomy in patients undergoing robotic surgery (robot assisted laparoscopic prostatectomy [RALP]) compared with those undergoing open surgery (radical retropubic prostatectomy [RRP]), at an institution with medium case load. Methods: Retrospective consultation of a perspectively-maintained database that stores the data of all the patients submitted to radical prostatectomy at our institution since 1/2008. The indication to RRP vs. RALP was based almost exclusively on the period of the study: RRP was the sole available option between 1/2008 and 3/2010 and afterwards RALP become the standard of treatment, once a learning curve of 50 cases was concluded. A PSM was defined as the presence of cancer at the inked surface of prostate. Aunivariate and multivariate binary logistic regression estimated which factors were related to PSMs. Results: The data of 576 patients (285 RRP, 291 RALP) were evaluated. The overall PSM rate was 28.1% (162/414 patients; 20.6% for pT2 stage, 51.8% for pT>2); overall PSM rate for RRP vs. RALP was 31.9% vs. 24.4 % (P=0.044). At multivariable analysis the factors related to the risk of PSM were stage pT>2 (RR2.979, P=0.001), Gleason Score >6 (RR1.662, P=0.026), the volume of tumor (RR1.019, P=0.008) and the surgical technique (RALP vs. RRP, RR0.647, P=0.039). Conclusions: In a series from a medium case-load institution, once data are adjusted for local staging, tumor volume and Gleason score, the risk of PSM is lower for RALP than RRP. This evidence could be of support for health-care practitioners to introduce robotic systems

Transmesenteric approach for left transperitoneal renal surgery: technique and experience

Introduction: In the last few years laparoscopic surgery has become the gold standard for the treatment of several urological diseases such as renal cancer and ureteropelvic junction obstruction (UPJO). A transmesenteric approach for left laparoscopic pyeloplasty has been recently described in order to avoid bowel manipulation and the potentially related complications. The aim of the present study is to describe the surgical technique and the advantages of the transmesenteric approach for laparoscopic pyeloplasty, pyelolithotomy, and simple nephrectomy in our experience. Subjects and Methods: From December 2007 to May 2010, 12 laparoscopic procedures for left renal diseases were performed using a transmesenteric approach. The indications were left UPJO in 9 cases, left pelvic-ureteral stones in 2 cases, and left end-stage kidney disease in one case. Results: No conversions or intraoperative complications were observed. No blood transfusions were required. Resumption of oral intake and canalization occurred in all cases within 48 hours of the procedure. All patients had an uneventful postoperative course. Conclusions: The laparoscopic transmesenteric approach represents an interesting and advantageous technical improvement of minimally invasive surgery for the treatment of left renal diseases

Alcohol and the young: How does the press face the problem?

&#x0D; Background: alcohol is an important component of the Mediterranean diet and its moderate use is protective against cardiovascular risk. Binge drinking, i.e. the heavy consumption of alcohol over a short period of time, is the main consumption pattern of young people in Western countries and may lead to severe toxic effects in many organs. Mass media often address the issue by suggesting prevention measures; however, they may also have the unintended effect of encouraging alcohol misuse. This study aims to assess how the Italian press faces excessive alcohol consumption in young people, comparing the messages given by the press with scientific recommendations.&#x0D; Methods: articles published by the 6 best-selling Italian newspapers and the 4 best-selling Italian magazines were collected from October 15th to November 14th 2009. Medline database, governmental and non-governmental sources were searched for scientific recommendations regarding primary prevention of alcohol misuse. Press articles were described and analysed by filling out a predefined form.&#x0D; Results: fourteen newspaper articles regarding alcohol were found, 79% belonging to the news section. Six quotations of scientific recommendations were found: two about drink-driving, two about raising public awareness, one about Monitoring and Evaluation, and one about community and workplace action.&#x0D; Conclusions: scientific recommendations were often inadequately reported by the Italian press. The most covered recommendations, designed driver and public educational intervention, are also the least effective according to international literature. Therefore, a further effort is needed to tackle this issue in a more scientifically sound way.&#x0D; </jats:p