Intrusion of migrated incisors with infrabony defects in adult periodontal patients

This report describes the orthodontic treatment of 10 adult patients who had severe periodontal disease, with migration and radiological evidence of an infrabony defect on a maxillary central incisor. Orthodontic tooth movement, using light and continuous forces, was initiated 7 to 10 days after periodontal surgical therapy. Mean orthodontic treatment time was 10 months. Before surgery and at the end of orthodontic treatment, the following parameters were registered clinically and with standardized intraoral radiographs: probing depth, clinical crown length, marginal bone level, bone defect radiological dimension, and root length. Comparison of pre- and posttreatment values showed a statistically significant improvement for all parameters without a remarkable decrease of root length. The mean residual probing depth was 2.80 mm, and the mean intrusion of the incisors was 2.05 mm. Moreover, radiographs showed a reduction of the infrabony defects. These results show the efficacy of a combined orthodontic-periodontal approach. Intrusive movement, after proper periodontal surgical therapy, can positively modify both the alveolar bone and the soft periodontal tissues.

Reduction of gingival recession following orthodontic intrusion in periodontally compromised patients

OBJECTIVES

To evaluate the role of orthodontic intrusion and alignment in the reduction of gingival recession (REC) around maxillary incisors of adult periodontal patients. Design - Prospective clinical study.

SETTING AND SAMPLE POPULATION

Twenty-eight consecutively treated adult patients, suffering from severe chronic periodontitis and with one upper central incisor extruded and infrabony defect on its mesial site. All patients were seen in a private practice in Turin, Italy. At baseline, all patients presented with REC on the buccal and mesial aspects of the treated teeth.

MEASUREMENTS AND RESULTS

For each patient probing pocket depth (PPD) and REC were assessed at baseline, at the end of treatment and 1-year after the end of treatment. REC was also evaluated independently in patients with narrow (NPB) or wide periodontal biotype (WPB). All parameters showed improvement between initial and final measurements statistically, and showed no changes between final and follow-up measurements. Mean mesial PPD decrease was 4.29 mm, with a residual PPD of 2.50 mm. Mean REC reduction was 0.96 mm on the buccal sites and 1.71 mm on the mesial. No statistical difference was recorded on REC values between groups NPB and WPB.

CONCLUSION

The presented clinical protocol resulted in improvement of all parameters examined. At the end of orthodontic treatment a predictable reduction of REC was reported, both in patients with thin or wide gingiva.

Bodily tooth movement through the maxillary sinus with implant anchorage for single tooth replacement

Movement of teeth through anatomic limitations, such as the maxillary sinus, can be a reliable therapeutic protocol if suitable force systems are used. We report here the outcome of a treatment based on this concept. The patient exhibited pneumatization of the maxillary sinus resulting from earlier extractions. She was treated using an endosseous implant inserted in the retromolar region to serve as orthodontic anchorage and a T-loop appliance fabricated from TMA wire to bodily move an upper second premolar through the sinus. After 6 months, at the end of the displacement, a titanium implant was inserted in the alveolus of the moved tooth and a single crown restoration was placed. The premolar moved through the sinus maintaining its support apparatus and bone. At the end of treatment the implant used for anchorage was still osseointegrated.

[Non-cognitive symptoms and psychopharmacological treatment in demented nursing home residents]

Dementias, in particular Alzheimer's disease (AD), are the main reason for availing of nursing home care. In the course of the illness, the clinical picture is affected by cognitive decline and by other psychopathological, "non-cognitive" symptoms such as apathy, depression, delusions or agitation. Little attention has been paid to these symptoms, although they lead to an increase in strain on the patients and their relatives as well as complications in nursing care. Psychopathological symptoms were evaluated by using the Neuropsychiatric Inventory in 145 nursing home residents (age: 85 +/- 7 years, duration of stay: 35 +/- 48 months); the majority of them with moderate to severe dementia (GDS: 5 +/- 2; MMSE: 11 +/- 9). In addition, the Apathy Evaluation Scale was applied. To meet potential regional effects, residents were recruited in nursing homes in the areas around Heidelberg as well as Munster. 87% of the participants showed psychopathological symptoms of an at least moderate degree, depressive mood (52%), apathy (41%) and agitation (38%) being most frequent. General condition, nutritional status and care status were evaluated as 'good', likewise general health care. In contrast, only 27% were treated by psychiatrists. 70% received psychopharmacological treatment, mostly sedatives (44%), while antidementive drugs were used only in 11%. The findings underline the need of further information and advanced training.

[Situations of emotional significance in residents suffering from dementia]

An advanced stage of dementia implies a loss of the ability to express emotions verbally. However, this does not mean that these patients do not feel emotions anymore. Analyses of nonverbal behaviour are the only way to realise the aim of assessing emotional states in people suffering from severe dementia. In the present study, we tried to identify characteristic situations which are regularly accompanied by positive or negative emotions. Such situations should be described by members of the institutional staff. Moreover, patients' nonverbal behaviour was analysed with psychological instruments developed for analyses of mimic expressions of emotion (FACS, EMFACS). Twenty-nine female residents of nursing homes suffering from moderate or severe dementia participated in the study. Nearly all of them were perceived to show different emotional states by the staff. Most emotions seemed to occur regularly in specific situations. Measures of FACS and AMFACS suggest that predictions of the staff are highly valid. Analyses of situations which were said to be accompanied by positive emotions showed that the respective situations are often created by the residents themselves. This finding implies that even an advanced stage of dementia does not necessarily prevent people from leading a self-determined life. Concentrated and individualised attention enables the staff to shape positive emotions in residents suffering from moderate or severe dementia.

Demenzkranke Menschen in individuell bedeutsamen Alltagssituationen

First outcomes of a current intervention study focussing on emotions of nursing home residents with mild, moderate and severe dementia are discussed in the present contribution. The aim of the study was to prove the effect from an individual approach in the care of people with dementia. By promoting individual everyday situations for each resident, positive emotions should be stimulated and individual well-being should be improved. Findings show the possibility to gain such individual everyday-situations for people with mild, moderate and severe dementia, which stimulate positive reactions and may be integrated into the care process. Of particular importance are those positive situations which focus on the communication between nurses and residents or in which the residents receive personal attention from nurses.

Ultrasound transmission gel as a bolus device for skin irradiation of irregular surfaces: technical note

PURPOSE

This paper describes an uncommon radiation treatment of the external ear, with ultrasound (US) transmission gel used as bolus device to compensate for the irregularity of the target surface.

MATERIALS AND METHODS

Postoperative radiotherapy for cutaneous carcinoma was performed with a single high-energy electron beam directed over the ear auricle. Due to the irregular surface of the target, a "missing tissue" compensator was employed. Daily, after patient positioning, the concha was filled and flattened with US gel, and a dose of 54 Gy in 27 fractions was delivered.

RESULTS

Water equivalence of the gel was verified by comparing the gel's computed tomography (CT) number [Hounsfield units (HU)] and density with the corresponding values for water and another commercial bolus device. Whereas ultrasound gel and water had comparable values (HU: 0; density 1 g/cm(3) for both), the corresponding values for the commercial device were slightly higher (HU: 80; density 1.02 g/cm(3)).

CONCLUSIONS

Ultrasound gel proved to be an easy, fast and cheap compensating tool. Its water equivalence allows it to be used as an alternative to water, though easier to position and with lower risk of displacement. Thus, it is recommendable as a practical tool for most irregular sites. Further investigations are warranted to validate this solution in more complex irradiation techniques.

Astronomy and Solar Physics: X-ray Gas Scintillation Spectrometer Experiment

The payload complement on Spacelab 1 included a spectrometer for observations of the brighter cosmic x-ray sources. The primary scientific objective was to study the detailed spectral features of cosmic x-ray sources and their associated temporal variations over a wide energy range from about 2 to 80 kiloelectron volts. The instrument, based on the gas scintillation proportional counter, had a geometrical area of some 180 square centimeters with an energy resolution of about 9 percent at 7 kiloelectron volts. The results presented here show new results from two galactic binary x-ray sources, Cygnus X-3 and Centaurus X-3, and from the Perseus cluster of galaxies. The excellent energy resolution of the instrument permits line features to be identified in these sources with unprecedented quality.

Development of a subset of ICNP Nursing Diagnoses for the promotion of self-care in people with diabetes mellitus: a multi-center observational study

INTRODUCTION

Self-care is a key for people with diabetes mellitus (DM) to avoid severe complications and to maintain quality of life. Person-centered and accurate nursing care plans can help nurses to deliver effective self-care promotion interventions. Few studies focused on nursing diagnoses that are specific for diabetes self-care education, and none of them used the International Classification for Nursing Practice (ICNP). International Catalogues of ICNP nursing diagnoses are missing in this field.

AIMS

To identify the ICNP nursing diagnoses that are useful to promote self-care in people with DM; to describe the prevalence of ICNP nursing diagnoses in self-care of people with DM.

METHODS

A subset of 55 ICNP nursing diagnoses was developed based on the Middle Range Theory of Self-care of Chronic Illness, and most recent diabetes clinical guidelines. Then, the subset was tested through a multicenter cross-sectional design involving a consecutive sample of 170 adults with confirmed diagnosis of Type 1 or Type 2 DM. Data were collected by medical records, physical examinations and semi-structured interviews.

RESULTS

1343 nursing diagnoses were identified, with an average of 8 nursing diagnoses per patient. The 100% of the nursing diagnoses were described using the pre-developed subset. Overall, the five prevalent nursing diagnoses were: Body weight problem (56.4%), Non adherence to immunization regime (53.5%), Conflicting attitude toward dietary regime (41.7%), Impaired weight monitoring (39.4%), and Lack of knowledge about blood glucose diagnostic test result (32.3%). Nursing diagnoses by self-care maintenance, monitoring and management were also described.

CONCLUSIONS

A huge amount of nursing diagnoses was identified suggesting the need of intensive education. Clinicians and administrators can use this subset to improve the accuracy of the documentation of diabetes care. In Public Health, the subset can be used to assess the cost-effectiveness of diabetes healthcare services. Future research is needed to assess the effectiveness of this subset in settings that are different from the one where it was developed. Finally, this subset could be a starting point to develop and International ICNP Catalogue for diabetes care.

[Bezoar of the stomach. Clinical case report]

A clinical case of bezoar of the stomach accompanied by peptic and gastric ulcer is presented. The different types of bezoar and the reasons for their formation are described, and the clinical, laparotomic and anatomopathological picture is illustrated.

[Mixed tumor of an ectopic salivary gland. Presentation of a case]

A case of mixed tumour in an island of ectopic salivary glandular tissue at the right nostril and surrounding labial skin is reported. An anatomopathological classification of salivary neoplasias is provided and the histological picture of mixed tumours described. Stress is laid on the rarity of the finding. An extensive tissue area was removed because the neoplasia was a recurrence of a previous intervention (done by others) not followed up by histological examination.

Orthodontic treatment in periodontally compromised patients: 12-year report

This work describes the therapeutic protocol of combined orthodontic-periodontal treatment and evaluates the effectiveness of surgical and nonsurgical periodontal therapy in the maintenance of a healthy periodontal status after the orthodontic treatment. Surgical periodontal treatment was performed in 267 patients affected by severe periodontal disease, and 128 patients had nonsurgical treatment. For each patient the mean value of probing depth (mPPD) and the rate of positive bleeding on probing (%BoP) of the teeth involved in the orthodontic movement were registered before the start of the periodontal treatment, at the end of the orthodontic treatment, and 2, 4, 6, 10, and 12 years after the end of the orthodontic treatment. Comparison between pretreatment and posttreatment values and between pretreatment and follow-up values showed a decrease in mPPD and %BoP that was of statistical significance. The difference between posttreatment and follow-up values was not statistically significant. These results suggest that orthodontic treatment is no longer a contraindication in the therapy of severe adult periodontitis. In these cases orthodontics improve the possibilities of saving and restoring a deteriorated dentition.

Resin-bonded fixed partial dentures and splints in periodontally compromised patients: a 10-year follow-up

In the present study, 139 periodontally compromised patients received a complete periodontal treatment; in 104 cases this was followed by orthodontic treatment. At the end of the entire therapy, a total of 150 Maryland restorations (69 resin-bonded fixed partial dentures and 81 resin-bonded splints) was placed and then followed for a period of up to 10 years (mean 6.7 y). Thirteen fixed partial dentures and 16 splints failed during the observation period; the 10-year cumulative survival rate from lifetable analysis was 76.2% (70.6% for fixed partial dentures and 80.7% for splints).

[Treatment of acute cholecystitis. Clinico-statistical findings]

A series of 354 patients suffering from gall bladder and/or bile way conditions and who had undergone operation in the acute phase has been reviewed. The usefulness of early operation over more wait-and-see tactics is confirmed. Shortening of mean hospitalization is particularly significant. The difference in hospital mortality is insignificant. The only complication reported is the higher frequency of suppurative accidents in the surgical wound.

[A case of massive hemoperitoneum caused by spontaneous detachment of epiploic appendices]

An unusual case of spontaneous detachment of the sigmoid epiploic appendix is described. The most frequently reported pathologies of these formations are reviewed. The discussion stresses the unusual clinical picture which determined the diagnostic error. Some hypotheses are also formulated on the aetiopathogenesis of ischaemia of epiploic appendices.