Search

Background: Extrusion, lateral luxation, and intrusion are among the most serious types of dental trauma. Only a few studies have specifically focused on extrusion; the present one was aimed at reporting a case of domestic traumatic dental injury to primary tooth and describing the measures taken in managing the trauma in order to avoid future consequences to the underlying permanent tooth germ. Case report: A 3.5-year-old boy reported a dental injury with extrusion and root fracture of deciduous tooth 5.1. After intraoral and radiographic evaluation, the element was repositioned and stabilized by an orthodontic flexible splint attached to the adjacent teeth. Several follow-up checkups were made and showed good healing of the tissues and physiological exfoliation of the tooth, with a healthy and unaffected corresponding central permanent incisor. Conclusion: This case report strengthens the importance of well-timed diagnosis and treatment and of regular follow-up of traumatized teeth as they may affect both dentitions with a negative impact on Oral Health-Related Quality of Life. Conservative treatment should be taken into consideration when possible, being in some cases more appropriate.

Prognosis in light-chain (AL) and transthyretin (ATTR) amyloidosis is influenced by cardiac involvement. ATTR amyloidosis has better prognosis than AL amyloidosis despite more amyloid infiltration, suggesting additional mechanisms of damage in AL amyloidosis.The aim of the study was to assess the presence and prognostic significance of myocardial edema in patients with amyloidosis.The study recruited 286 patients: 100 with systemic AL amyloidosis, 163 with cardiac ATTR amyloidosis, 12 with suspected cardiac ATTR amyloidosis (grade 1 onMyocardial T2 was increased in amyloidosis with the degree of elevation being highest in untreated AL patients (untreated AL amyloidosis 56.6 ± 5.1 ms; treated AL amyloidosis 53.6 ± 3.9 ms; ATTR amyloidosis 54.2 ± 4.1 ms; each p 0.01 compared with control subjects: 48.9 ± 2.0 ms). Left ventricular (LV) mass and extracellular volume fraction were higher in ATTR amyloidosis compared with AL amyloidosis while LV ejection fraction was lower (p 0.001). Histological evidence of edema was present in 87.5% of biopsy samples ranging from 5% to 40% myocardial involvement. Using Cox regression models, myocardial T2 predicted death in AL amyloidosis (hazard ratio: 1.48; 95% confidence interval: 1.20 to 1.82) and remained significant after adjusting for extracellular volume fraction and N-terminal pro-B-type natriuretic peptide (hazard ratio: 1.32; 95% confidence interval: 1.05 to 1.67).Myocardial edema is present in cardiac amyloidosis by histology and cardiovascular magnetic resonance T2 mapping. T2 is higher in untreated AL amyloidosis compared with treated AL and ATTR amyloidosis, and is a predictor of prognosis in AL amyloidosis. This suggests mechanisms additional to amyloid infiltration contributing to mortality in amyloidosis.

Background Extracellular volume (ECV) by T1 mapping requires the contrast agent distribution to be at equilibrium. This can be achieved either definitively with a primed contrast infusion (infusion ECV), or sufficiently with a delay postbolus (bolus-only ECV). For large ECV, the bolus-only approach measures higher than the infusion ECV, causing some uncertainty in diseases such as amyloidosis. Purpose To characterize the relationship between the bolus-only and current gold-standard infusion ECV in patients with amyloidosis. Study type Bolus-only and infusion ECV were prospectively measured. Population In all, 186 subjects with systemic amyloidosis attending our clinic and 23 subjects with systemic amyloidosis who were participating in an open-label, two-part, dose-escalation, phase 1 trial. Field strength Avanto 1.5T, Siemens Medical Solutions, Erlangen, Germany. Assessment Bolus-only and infusion ECV were measured in all subjects using shortened modified Look-Locker inversion recovery (ShMOLLI) T1 mapping sequence. Statistical tests Pearson correlation coefficient (r); Bland-Altman; receiver operating characteristic (ROC) curve analysis. Linear regression model with a fractional polynomial transformation. Results The difference between the bolus-only and infusion myocardial ECV increased as the average of the two measures increased, with the bolus-ECV measuring higher. For an average ECV of 0.4, the difference was 0.013. The 95% limits of agreement for the two methods, after adjustment for the bias, were ±0.056. However, cardiac diagnostic accuracy was comparable (bolus-only vs. infusion ECV area under the curve [AUC] = 0.839 vs. 0.836), as were correlations with other clinical cardiac measures, and, in the trial patients, the ability to track changes in the liver/spleen with therapy. Data conclusion In amyloidosis, with large ECVs, the bolus-only technique reads higher than the infusion technique, but clinical performance by any measure is the same. Given the work-flow advantages, these data suggest that the bolus-only approach might be acceptable for amyloidosis, and might support its use as a surrogate endpoint in future clinical trials. Level of evidence 1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;47:1677-1684.

Background Cardiac transthyretin amyloidosis (ATTR) is an increasingly recognized cause of heart failure. Cardiac magnetic resonance (CMR), with late gadolinium enhancement (LGE) and T1 mapping, is emerging as a reference standard for diagnosis and characterization of cardiac amyloidosis. Objectives The authors used CMR with extracellular volume fraction (ECV) measurement to characterize cardiac involvement in relation to outcome in ATTR. Methods Subjects comprised 263 patients with cardiac ATTR corroborated by grade 2 to 3 99mTc-DPD (99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid) cardiac uptake, 17 with suspected cardiac ATTR (grade 1 99mTc-DPD), and 12 asymptomatic individuals with amyloidogenic transthyretin (TTR) mutations. Fifty patients with cardiac light-chain (AL) amyloidosis acted as disease comparators. Results Unlike cardiac AL amyloidosis, asymmetrical septal left ventricular hypertrophy (LVH) was present in 79% of patients with ATTR (70% sigmoid septum and 30% reverse septal contour), whereas symmetrical LVH was present in 18%, and 3% had no LVH. In patients with cardiac amyloidosis, the pattern of LGE was always typical for amyloidosis (29% subendocardial, 71% transmural), including right ventricular LGE (96%). During follow-up (19 ± 14 months), 65 patients died. ECV independently correlated with mortality and remained independent after adjustment for age, N-terminal pro-B-type natriuretic peptide, ejection fraction, E/E′, and left ventricular mass (hazard ratio: 1.164; 95% confidence interval: 1.066 to 1.271; p Conclusions Asymmetrical hypertrophy, traditionally associated with hypertrophic cardiomyopathy, was the commonest pattern of ventricular remodeling in ATTR. LGE imaging was typical in all patients with cardiac ATTR. ECV correlated with amyloid burden and was an independent prognostic factor for survival in this cohort of patients.

Multiple sclerosis (MS) is an autoimmune disease in which the immune system reacts by damaging the central nervous system, specifically myelin and oligodendrocytes. It is the most debilitating neurological disease among young adults, causing personal, familiar, social, and professional limitations. Multiple sclerosis can cause disturbances in the orofacial district, due to a demyelination process on the nerves of the head and neck district. The aim of this study was to evaluate the oral health status, dysphagia, and quality of life of patients affected by MS. For this study, 101 patients aged between 12 and 70 (47 males, 54 females) affected by MS were selected, and three questionnaires were handed out and anonymously filled in by them: An oral hygiene test, DYMUS (DYsphagia in MUltiple Sclerosis), and IOHIP-14 (Italian version Oral Health Impact Profile). Through the analysis of the questionnaires it was possible to observe pathological conditions, such as gingival inflammation, xerostomia, dysphagia, neuralgia, and dysarthria. Through the analysis it was possible to outline how the roles of a medical team, composed of a dentist, otolaryngologist, and dental hygienist, are fundamental in coping with other medical figures, during the whole development of the diseases, as well as to prevent possible complications.

Objective The study evaluated the efficacy of tea tree oil for the treatment of gingivitis. Materials and Methods The tea tree oil was administered in the form of mouthwash and then compared with a mouthwash with chlorhexidine 0.12%. Both treatments were domestic and lasted for 14 days. Patients were chosen according to random criteria, aged between 18 and 60 years, and who showed a clinically evident gingivitis. In clinical evaluation, the following clinical criteria were taken into consideration: gingival index (GI), plaque index (PI), bleeding index (BI), probing depth (PD), the presence of dental dyschromia, and the presence of taste alteration. The subjects were evaluated before (T0) and after the treatment (T1), and the data collected for each patient were recorded on a periodontal chart. Results The comparison showed that tea tree oil offered a better improvement in the evaluation of PI, BOP, and PD; furthermore, it did not cause dental dyschromia and taste alteration. In group A, treated with tea tree oil, PI decreased from 53.25 to 5.50% and BI from 38.41 to 4.22%. In group B, treated with chlorhexidine PI decreased from 47.69 to 2.37% and BI from 32.93 to 6.28%. Instead, the subjects using chlorhexidine 0.12% blamed a distaste for the product that caused a slight taste alteration; 20% of them showed iatrogenic dental dyschromia. Conclusions The collected data showed the efficacy of both treatments. Although further research works will be necessary, this study showed that tea tree oil could be an effective nontoxic substitute for the therapy of gingivitis.

Systemic light-chain (AL) amyloidosis is characterized by interstitial deposition of aggregated misfolded monoclonal immunoglobulin light chains in the form of amyloid fibrils. Cardiac involvement is the main driver of prognosis. Brain natriuretic peptides and echocardiography are currently the

This cross-sectional study aimed to describe the functional and structural cardiac abnormalities that occur across a spectrum of cardiac amyloidosis burden and to identify the strongest cardiac functional and structural prognostic predictors in amyloidosis using cardiac magnetic resonance (CMR) and echocardiography.Cardiac involvement in light chain and transthyretin amyloidosis is the main driver of prognosis and influences treatment strategies. Numerous measures of cardiac structure and function are assessed by multiple imaging modalities in amyloidosis.A total f 322 subjects (311 systemic amyloidosis and 11 transthyretin gene mutation carriers) underwent comprehensive CMR and transthoracic echocardiography. The probabilities of 11 commonly measured structural and functional cardiac parameters being abnormal with increasing cardiac amyloidosis burden were evaluated. Cardiac amyloidosis burden was quantified using CMR-derived extracellular volume. The prognostic capacities of these parameters to predict death in amyloidosis were assessed using Cox proportional hazards models.Left ventricular mass and mitral annular plane systolic excursion by CMR along with strain and E/e' by echocardiography have high probabilities of being abnormal at low cardiac amyloid burden. Reductions in biventricular ejection fractions and elevations in biatrial areas occur at high burdens of infiltration. The probabilities of indexed stroke volume, myocardial contraction fraction, and tricuspid annular plane systolic excursion (TAPSE) being abnormal occur more gradually with increasing extracellular volume. Ninety patients (28%) died during a median follow-up of 22 months (interquartile range: 10 to 38 months). Univariable analysis showed that all imaging markers studied significantly predicted outcome. Multivariable analysis showed that TAPSE (hazard ratio: 1.46; 95% confidence interval: 1.16 to 1.85; p 0.01) and indexed stroke volume (hazard ratio: 1.24; 95% confidence interval: 1.04 to 1.48; p 0.05) by CMR were the only independent predictors of mortality.Specific functional and structural abnormalities characterize different burdens of cardiac amyloid deposition. In a multimodality imaging assessment of a large cohort of amyloidosis patients, CMR-derived TAPSE and indexed stroke volume are the strongest prognostic cardiac functional markers.

Background The prognosis and treatment of the 2 main types of cardiac amyloidosis, immunoglobulin light chain (AL) and transthyretin (ATTR) amyloidosis are substantially influenced by cardiac involvement. ATTR amyloidosis has better prognosis than AL despite more amyloid infiltration. This paradox suggests additional mechanisms of damage in AL amyloidosis. The aim of this study was to assess the presence and ?prognostic significance of oedema in a large population of patients with cardiac amyloidosis and compare findings among those with TTR and AL types. Methods and results 286 patients (100 with systemic AL amyloidosis (including 49 patients scanned prior to commencing chemotherapy), 163 with cardiac ATTR amyloidosis, 12 with suspected cardiac ATTR amyloidosis (grade 1 on 99mTc-DPD) and 11 asymptomatic individuals with amyloidogenic transthyretin(TTR) mutations), and 30 healthy volunteers were recruited. All subjects underwent CMR with T1 and T2 mapping, and ECV quantification. Left ventricular(LV) mass and ECV were higher in ATTR compared to AL whilst LV ejection fraction(EF) was significantly lower(p Conclusion Patients with AL amyloidosis have a worse prognosis compared to ATTR despite having less cardiac amyloid infiltration. T2 was significantly higher in untreated AL amyloidosis consistent with oedema, and was an independent predictor of prognosis. The higher ECV in ATTR was consistent with higher amyloid infiltration. These findings highlight the unique role of CMR with multiparametric mapping for characterising the cardiac effects of systemic amyloidosis and risk stratification in this population.

Background Cardiac transthyretin amyloidosis (ATTR amyloidosis) is an increasingly recognised cause of heart failure. Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) and T1 mapping is emerging as a reference standard for diagnosis and characterisation of cardiac amyloid. Objectives We used CMR with extracellular volume fraction (ECV) measurement to characterise cardiac involvement in relation to outcome in ATTR amyloidosis. Methods Subjects comprised 263 patients with cardiac ATTR amyloidosis corroborated by grade 2–3 99mTc-DPD cardiac uptake, 17 with suspected cardiac ATTR amyloidosis (grade 1 99mTc-DPD) and 12 asymptomatic individuals with amyloidogenic transthyretin (TTR) mutations. Fifty patients with cardiac AL amyloidosis acted as disease controls. Results In contrast to AL amyloidosis, asymmetric septal hypertrophy was present in 79% of ATTR patients (70% sigmoid septum and 30% reverse septal curvature), whilst symmetric left ventricular hypertrophy (LVH) was present in only 18%; 3% of patients has no LVH. In patients with cardiac amyloidosis, the pattern of LGE was always typical for amyloidosis (29% subendocardial, 71% transmural) including right ventricular LGE (96%). 65 patients died during follow-up (19±14 months). ECV independently correlated with mortality and remained independent after adjustment for age, N-terminal pro-brain natriuretic peptide, ejection fraction, E/E’ and left ventricular mass index (hazard ratio, 1.164; 95% confidence interval, 1.066–1.271; p Conclusions Asymmetric hypertrophy, traditionally associated with hypertrophic cardiomyopathy, is the commonest pattern of ventricular remodelling in ATTR amyloidosis. LGE imaging is typical in all patients with cardiac ATTR amyloidosis. ECV correlates with amyloid burden and provides incremental information on outcome even after adjustment for known prognostic factors.

Background Cardiac involvement is the main driver of outcome in systemic amyloidosis, but the relationship between amyloid deposits and cellular injury is not well understood. The simple explanation of physical, mechanical replacement of parenchymal tissue seems insufficient, and preliminary studies support the hypothesis that myocardial hypoperfusion could contribute to cell damage in amyloidosis. The aim of this study was: 1) To assess feasibility of fully automated pixel-wise rest myocardial blood flow (MBF) mapping in cardiac amyloidosis during routine clinical scans; 2) To assess the prevalence of myocardial hypoperfusion and correlation with amyloid deposits and disease severity. Methods Patients (n=56) with systemic amyloidosis and healthy volunteers (n=16) were recruited. All subjects underwent CMR at 1.5T (Siemens) with standard SSFP cine imaging, Phase Sensitive Inversion Recovery Reconstruction Late Gadolinium Enhancement (PSIR-LGE), T1 mapping, Extracellular Volume (ECV) mapping and rest MBF mapping. Results The pixel-wise MBF maps for all slices were generated automatically in all patients within 2.5 min after image acquisition. Myocardial perfusion was globally reduced in patients with cardiac amyloidosis compared to healthy volunteers (0.66±0.26 ml/min/g vs 0.84±0.19 ml/min/g, p Conclusions Myocardial perfusion can be measured in cardiac amyloidosis during routine clinical scans with fully automated MBF mapping. Myocardial hypoperfusion at rest is highly prevalent in subjects with cardiac amyloidosis, and correlates with the degree of amyloid infiltration and disease severity.

Background Cardiac involvement in immunoglobulin light chain (AL) amyloidosis is the major determinant of survival; Cardiac response to chemotherapy is conventionally assessed by serum brain natriuretic peptide (NT-proBNP) and echocardiography, but neither quantify amyloid burden. The aim of this study was to evaluate cardiac AL amyloid serially using cardiovascular MR (CMR) including extracellular volume measurement (ECV), which is the site of the amyloid deposits. Methods 31 patients with cardiac AL amyloidosis who had chemotherapy were studied serially using ECG, echocardiography, 123I-labelled serum amyloid P component (SAP) scintigraphy, NT-proBNP measurements and CMR with T1 mapping and ECV measurements (mean interval 20±11 months). Nineteen patients achieved a complete or very good partial haematological response (CR n=10; VGPR n=9). Twelve patients attained a partial response (PR) or no response (NR). Results At follow-up (mean 20±11 months), the amyloid burden had decreased substantially in 6 of the 10 (60%) attaining a CR, 6 of the 9 (67%) in VGPR and 1 of the 8 (13%) in PR. Changes in the ECV consistent with regression of amyloid were concordant with the changes in native T1, reduction in amyloid volume and in 5 patients with changes in late gadolinium enhancement pattern (figure 1). Overall there was significant reduction in NT-proBNP concentration, LV mass, left atrial area and improvement in diastolic function in patients whose amyloid burden decreased. Regression of cardiac amyloid by CMR correlated with regression of amyloid in other organs measured by SAP scintigraphy.