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Heart failure is a common and serious disease, with constantly increasing incidence. General practitioners have an essential role in its management., Aim of the Study: Describe general practitioner's practice in optimizing heart failure treatment after hospital discharge., Patients and Method: All patients admitted for heart failure with altered ejection fraction in Nanterre's hospital cardiology department between February 2014 and January 2015 and having a general practitioner were included. Demographic, clinical, biological, ultrasound data and treatments were collected. A questionnaire was submitted to general practitioners two months after discharge., Results: A total of 82 patients (age 76±12years, left ventricular ejection fraction 36±8%) were included. The target dose of angiotensin-converting-enzyme inhibitors and beta-blockers was reached for 18% of patients during hospitalization. Forty-two general practitioners answered the questionnaire, which concerned 60% of patients (n=49). None of them modified angiotensin-converting-enzyme inhibitors nor beta-blockers. The reasons were the lack of patient consultation (43%), the good tolerance (43%), the absence of habit (24%), and the attribution of this role to the cardiologist (41%). Possible improvements are: more precise hospitalization reports, alternating consultations and educational sessions., Conclusion: Patients with heart failure are under-treated at discharge and general practitioners do not optimize the treatment after hospital discharge. The main axis of improvement is to establish a better defined care pathway., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Moebius syndrome is a rare condition characterized by bilateral facial and abducens nerve paralysis. The aim of this study is to evaluate the main orthodontic features and the frequency of associated clinical characteristics in patients with Moebius syndrome (MS)., Methods: According to Terzis classifications, 58 patients with MS aged 8 months to 46 years old underwent orthodontics and clinical examination., Results: Strabismus, upper and lower limb malformations, lip and palatal cleft were frequently associated with MS. Reduced TM movements were noted (48%). Cephalometric analysis did not allow identifying a typical facies and a characteristic cephalometric pattern; we have noticed a higher prevalence of Class II (56%) with micrognathia and excessive maxillary development probably due to the lack of lip seal. Early treatment is recommended, with a multidisciplinary approach to reduce the impact of sequelae on the lives of MS patients or their families., Conclusions: Early treatment is recommended, with a multidisciplinary approach to diminish the impact of sequelae on the lives of MS patients or their families.

Introduction: Orthodontic miniscrews are an increasingly popular choice to achieve absolute anchorage. The temporary use of miniscrews and their recent introduction have limited the debate over the biological aspect of the materials to that of the surface that permeates the field of dental implants. The aim of the present study was to investigate the integration of grade 5 titanium mini-implants with machined or sand blasted acid etched surface (SAE) under mechanical load in a rabbit tibia model of implant integration., Methods: A total of 64 miniscrews (Ti6Al4V) of 1.5 mm diameter and 6.5 mm length were inserted in the proximal medial surface of each tibia in eight male rabbits aged 6 months. Each tibia received four miniscrews. A 100 g nickel-titanium coil spring (Neosentalloy) was applied between two miniscrews along the main axis while two miniscrews were left unloaded. The removal torque was measured for loaded and unloaded miniscrews after 12 weeks. Two miniscrews were harvested for histology., Results: Removal torque was significantly higher for SAE mini-implants than for machined screws, under both loading conditions. Although no difference in bone to implant contact was observed among the groups, cortical area significantly decreased with both surfaces under loading., Conclusions: Our data indicate that SAE miniscrews have higher bone retention than MA miniscrews, although the effects of mechanical loading of these devices on cortical bone require further investigations., (© The Author 2017. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com)

Objective: This study was performed to evaluate the feasibility of noninvasive measurement of the ANB angle using photographic and ultrasonographic methods., Methods: Twenty consecutive orthodontic patients were evaluated. The ANB angle and soft tissue thickness covering the N, A, and B cephalometric points were measured by lateral teleradiography; these measurements were made by two expert operators. The soft tissue thickness covering the N, A, and B cephalometric points was measured by ultrasonography; these measurements were also made by two expert operators. On a 1:1 photographic profile print on which the ultrasonographic points were marked, the ANB ultrasonographic angle was measured. The following comparisons were considered: averaged and single measurements of N, A, and B points by first versus second ultrasonographer; averaged and single ultrasonographic versus radiographic soft tissue thickness covering the N, A, B points; and averaged and single ultrasonographic versus radiographic measurements of ANB angle., Results: High correlation and concordance of the averaged and single measurements, but no significant difference, was found between the two ultrasonographers. No statistically significant difference was found between the two methods for measuring averaged soft tissue thickness, but a 20% difference was found for the single measurements. High correlation and concordance between the ultrasonographic and radiographic measurements, but no significant difference, was found between the single and averaged ANB angle measurements., Conclusion: Ultrasonography seems to be a noninvasive and reliable technique for measurement of the ANB angle and may replace radiographic measurement in some cases.

Case Report: This report describes the oral rehabilitation of a young boy with severe oligodontia of primary dentition and complete anodontia of permanent dentition, treated by complete maxillary and partial mandibular removable dentures. Since the determination of a proper occlusal vertical dimension in paediatric patients is often difficult, treatment was achieved by means of a multidisciplinary approach involving conventional prosthodontic principles combined with cephalometric analysis and growth prediction. After a follow-up of two years a second lateral cephalogram was taken to evaluate the developmental changes in craniofacial morphology and the superimpositions method was performed, showing an improvement of both sagittal and vertical relationship between basal bones. In this case, the early prosthetic treatment resulted in enhanced aesthetics and masticatory function as well as skeletal growth changes.

In Italy, advance health care directives are a subject of considerable debate in both legal theory and practice. This debate focuses in particular not only on the appropriateness of approving ad hoc statutory regulations but also on the extent to which similar advance indications of a person's wishes are applicable under the existing legal system, albeit in the absence of a law regulating them. The authors of this paper consider, in particular, guidelines relating to the possible use of the mechanism of support administration (amministrazione di sostegno) (Law No. 6/2004) as a procedure to be used for the legal recognition of advance health care directives, particularly in the light of the legal provision for the possible designation in advance of a support administrator by a beneficiary in anticipation of an eventual situation of incapacity. This underlines how the concept of health does not only exist in the abstract, but must be measured in relation to the particular patient in the particular situation and how beneficence and respect for autonomy are both essential elements in the choices aimed at promoting the health and the wellbeing of its citizens. Significance for public healthThe concept of health includes not only the physical, but also the psychosocial dimension in accordance with the will of people. The reference to the personal concept of quality of life, values, ethical and religious opinions of each subject are key components underlying the decision-making process concerning a given patient in a given clinical condition: the concept of health does not only exist in the abstract, but must be measured in relation to the specific patient in the specific situation. The authors analyse the Italian debate about the possible designation in advance of the support administrator on the part of the beneficiary in anticipation of a potential situation of incapacity, as a tool to enforce advance care directives, to show how beneficence and respect for autonomy are both essential elements in the choices of the legal system aimed at promoting the health and the wellbeing of its citizens.

Aim: Moebius syndrome is a rare condition characterised by bilateral facial and abducens nerve paralysis. In the present study, it was investigated the effect of the long term facial muscles hypoactivity on temporomandibular joint movements development., Methods: Accordingly with Terzis classification (Terzis, 2003), a wide sample of A type and B type Moebius patients was investigated for mandibular range of movements. Moebius patients were compared with a sample of healthy subjects., Results: Both type A and type B Moebius patients develop a severe articular movement reduction, especially during mouth opening. A highly significant difference was found between Moebius patients and the healthy group. No difference was found between A and B Moebius sub-samples., Conclusion: The authors stress the importance of an early adequate rehabilitation of Moebius patients, in order to avoid the limitation of TMJ movement range.

Moebius syndrome is a congenital facial palsy associated with the impairment of ocular abduction. The three-dimensional characteristics of the facial soft tissues of 12 male and 14 female subjects [3-52 yr of age (mean age + standard deviation: 17 + 14 yr)] were measured using a non-invasive, computerized system; facial volumes, areas, angles, and distances were computed and compared with those obtained in reference subjects of the same age and gender. When compared with reference subjects, patients with Moebius syndrome had a more prominent and hyperdivergent face in the sagittal plane, a smaller and more prominent upper facial third; a smaller middle facial width; a smaller nose; smaller mandibular volume, depth, corpus length, and ramus height; and a more posterior positioned mandible, with a less prominent chin. In conclusion, patients with Moebius syndrome had a tendency towards a skeletal Class II pattern. These morphological variations may be the combined effect of a general alteration of the motor and sensitive facial nerves, including the trigeminal nerve, and of a maldevelopment of the brainstem.

Aim: The aim of the study is to evaluate attention and perception of parents about children's facial aesthetics, the paediatrician's role in early diagnosis of these problems and the areas of the face considered as the most important from an aesthetic point of view., Methods: The study was carried out collecting 1214 questionnaires at paediatricians waiting room in the North of Italy., Results: Most parents showed attention toward craniofacial deformities of their children and considered the paediatrician's role as very important in early diagnosis. Profile was considered more important than the front view and face's areas felt as the most important were denture, eyes and nose., Conclusion: Despite public opinion, adults are concerned not only about the general health and growth of their children, but also about their facial aesthetics. They, in fact, not only judge aesthetics of the whole face, but also discriminate different views and specific areas of the face. They require, for early diagnosis of dentofacial problems, skilled attention from the paediatrician.

The authors report an original case of the association of three pathologies: pheochromocytoma, hyperthyroidism and cardiomyopathy with left ventricular outflow tract obstruction. This type of cardiac disease has occasionally been described in cases of pheochromocytoma and are usually induced by the endocrine disturbance because they regress with treatment of the pheochromocytoma. The associated hyperthyroidism observed in this case is very rare and may have increased the left ventricular pressure gradient. Medical treatment before surgery of the pheochromocytoma was unusual in that a triple therapy was used including betablockers, classically contra-indicated in pheochromocytoma alone. In this case, it provided excellent control of the blood pressure and decreased the left ventricular obstruction during the perioperative period.

Pericardial fluid (PF) may contain myocardial growth factors that exert paracrine actions on cardiac myocytes. The aims of this study were (1) to investigate the effects of human PF and serum, collected from patients undergoing cardiac surgery, on the growth of cultured adult rat cardiac myocytes and (2) to relate the growth activity of both fluids to the adaptive changes in overloaded human hearts. Both PF and serum increased the rate of protein synthesis, measured by [14C]phenylalanine incorporation in adult rat cardiomyocytes (PF, +71.9 +/- 8.2% [n = 17]; serum, +14.9 +/- 6.5% [n = 13]; both P < .01 versus control medium). The effects of both PF and serum on cardiomyocyte growth correlated positively with the respective left ventricular (LV) mass. However, the magnitude of change with PF was 3-fold greater than with serum (P < .01). These trophic effects of PF were mimicked by exogenous basic fibroblast growth factor (FGF2) and inhibited by anti-FGF2 antibodies and transforming growth factor-beta (TGF-beta), suggesting a relationship to FGF2. In addition, FGF2 concentration in PF was 20 times greater than in serum. On the other hand, the LV mass-dependent trophic effect, present in both fluids, was independent of FGF2 concentration or other factors, such as angiotensin II, atrial natriuretic factor, and TGF-beta. These data suggest that FGF2 in human PF is a major determining factor in normal myocyte growth, whereas unidentified LV mass-dependent factor(s), present in both PF and serum, participates in the development of ventricular hypertrophy.

We report the case of a true aneurysm of the middle meningeal artery (MMA) associated with no other pathological findings. After a review of the literature, we emphasize that this case is not associated either with skull traumas, with vascular hypertension or with Paget's disease of the skull. Histological examination and neuroradiological findings confirm the suspicion that this is a case of true aneurysm of the middle meningeal artery.

The case of a woman with absence of neurological deficits, suffering from visual and auditory hallucinosis caused by a meningioma of the lesser sphenoidal wing, is described. The authors discuss the etiology of the hallucinosis that in the reported case is caused by an impairment of the deep temporal structures.

After a short review of the literature regarding aspergillosis, the authors report a case of a 7-year-old child suffering from cerebral aspergillosis with disseminated lesions. The authors emphasize the use of amphotericin B both intraventricularly and intravenously to obtain a longer survival when surgery is impossible because of the presence of multiple abscessual lesions in central nervous system. Authors' experience shows that the intraventricular administration of amphotericin B is well tolerated and does not cause collateral effects of the parenteral way.