Visual and satisfaction results with implantation of the trifocal Panoptix® intraocular lens in cataract surgery.

PURPOSE: To assess visual results (including the Lapid-Kushlin defocus coefficient), and satisfaction, following the implantation of PanOptix® a trifocal intraocular lens. METHODS: Observational, retrospective cohort study. 130 eyes of 65 subjects with bilateral implantation were included. Binocular uncorrected visual acuities [distance (Binocular UDVA), intermediate (Binocular UIVA) and near (Binocular UNVA)] were measured. Also, the manifest refraction, binocular defocus curve and binocular contrast sensitivity were determined. The Lapid-Kushlin defocus coefficient, a new single numerical parameter based on the area under the curve of the defocus curve, was calculated. The validated Spanish CATQUEST-9SF satisfaction survey was applied. RESULTS: Postoperative visual acuity ranges were: binocular UDVA 0.18 to 0.0 LogMAR, binocular UIVA 0.30 to 0.0 LogMAR and Binocular UNVA 0.18 to 0.0 LogMAR. The levels of contrast sensitivity both in bright light conditions (with and without glare) and low light conditions with glare, remained within the limits of normality. Under scotopic conditions without glare values below normality were found at lower spatial frequencies. The binocular defocus curve showed a plateau without a clearly evident peak. The Lapid-Kushlin defocus coefficient was 0.199. Two patients (3.1%) needed glasses after the procedure for near and intermediate vision. No patient manifested great visual difficulties or was dissatisfied with the results. CONCLUSIONS: The trifocal platform showed very good results in this series of patients. 96.9% of the patients achieved independence of the glasses and expressed a high degree of satisfaction. The Lapid-Kushlin defocus coefficient was better than those calculated from literature, for other multifocal intraocular lenses.

Children with hearing impairment and early cochlear implant: A pragmatic assessment.

Extensive research has demonstrated the benefits of cochlear implants (CI) in contributing to improve the linguistic skills of children with hearing impairment; however, few studies have focused on the development of pragmatic ability and its relationship with age of implantation. Pragmatics is the ability to use language in different contexts and its development has crucial implications, e.g., social inclusion and professional attainments. In this study, we conducted a comprehensive assessment of pragmatic ability using the Language Pragmatic Abilities (APL Medea), a battery composed by five different tasks: Comprehension of Metaphors, Implicit meaning, Comics, Situations and Colors Game (a perspective taking task). Eighteen children with early CI, belonging to 3 different age groups (6; 11-7; 11, 8; 0-8; 11 and 9; 0-9; 11 years-old), and twenty-four children with typical development (Control Group) participated to the study. We also investigated how the precocity of CI, i.e., age of first implantation, may affect the pragmatic development. Globally, children with CI obtained lower scores in the APL Medea battery than typically hearing children. However, focusing on the Medea tasks separately, children with CIs differed from their hearing peers only in Comics and Colors Game tasks. Finally, age of implantation was a moderate but significant predictor of pragmatic performance.

Congenital cytomegalovirus infection and audiological follow-up: electrophysiological auditory threshold before 3 months of age as a predictor of hearing outcome at 3 years of age.

OBJECTIVE: We aimed to evaluate whether electrophysiological auditory thresholds (EATs) before 3 month of age, as assessed by the auditory brainstem responses (ABR) test and the auditory steady state responses (ASSR) test, can predict hearing outcome at 3 years of age among children born with congenital cytomegalovirus (cCMV) infection. STUDY DESIGN: Audiological assessment was performed before 3 months of age, and every 6 months thereafter until 3 years of age, in a population of 63 children (126 ears). EATs before 3 months of age and at 3 years of age were compared. RESULT: No ear with an EAT of ≤30 dBHL (i.e. normal hearing) before 3 months of age showed worsening EATs at 3 years of age. CONCLUSION: An EAT of ≤30 dBHL obtained by ABR and ASSR tests before 3 months of age is predictive of a normal hearing at 3 years of age in children born with cCMV.

Kawasaki disease triggered by parvovirus infection: an atypical case report of two siblings.

BACKGROUND: There are reports of the familial occurrence of Kawasaki disease but only a few reports described Kawasaki disease in siblings. However, the familial cases were not simultaneous. In these patients the idea of infective agents as trigger must be considered. CASE PRESENTATION: We describe two siblings with atypical presentations of Kawasaki disease; the sister was first diagnosed as having parvovirus infection with anemia and the brother was diagnosed as having myocarditis. The first patient was a 9-month-old Caucasian girl with fever, conjunctivitis, rash, and pharyngitis, and later she had cervical adenopathy, diarrhea and vomiting, leukocytosis, and anemia, which were explained by positive immunoglobulin M against parvovirus. However, coronary artery lesions with aneurysms were documented at day 26 after fever onset. An infusion of intravenous immunoglobulin and high doses of steroids were not efficacious to resolve the coronary lesions. She was treated with anakinra, despite a laboratory test not showing inflammation, with prompt and progressive improvement of coronary lesions. Her 7-year-old Caucasian brother presented vomiting and fever at the same time as she was unwell, which spontaneously resolved after 4 days. Four days later, he again presented with fever with abdominal pain, associated with tachypnea, stasis at the pulmonary bases, tachycardia, gallop rhythm, hypotension, secondary anuria, and hepatomegaly. An echocardiogram revealed a severe hypokinesia, with a severe reduction of the ejection fraction (20%). He had an increase of immunoglobulin M anti-parvovirus, tested for the index case of his sister, confirming the suspicion of viral myocarditis. He received dopamine, dobutamine, furosemide plus steroids, with a progressive increase of the ejection fraction to 50%. However, evaluating his sister's history, the brother showed a myocardial dysfunction secondary to Kawasaki shock syndrome. CONCLUSIONS: We report on familial Kawasaki disease in two siblings which had the same infectious trigger (a documented parvovirus infection). The brother was diagnosed as having post-viral myocarditis. However, in view of the two different and simultaneous evolutions, the girl showed Kawasaki disease with late coronary artery lesions and aneurysms, whereas the brother showed Kawasaki shock syndrome with myocardial dysfunction. We stress the effectiveness of anakinra in non-responder Kawasaki disease and the efficacy on coronary aneurysms.

How does reproductive strategy influence demography? A case study in the tropical, unisexual epiphyllous moss Crossomitrium patrisiae.

PREMISE OF THE STUDY: Leaf-inhabiting organisms offer an experimentally tractable model system within which to investigate the influence of alternative reproductive strategies on plant metapopulation dynamics. We conducted a field study to determine whether (1) threshold colony sizes exist for the onset of sexual and asexual expression, and (2) alternative reproductive strategies differentially influence within-patch dynamics of the tropical pleurocarpous moss Crossomitrium patrisiae. METHODS: The growth, reproduction, and fate of 2101 colonies of C. patrisiae were followed over 2 years to investigate threshold size and age for sporophyte and brood branch formation and their influence on within-patch growth rates and longevity. KEY RESULTS: Asexual expression rather than sexual onset was limited by a minimal colony size. Age was uncoupled with threshold sizes. Colonies bearing brood branches survived nearly twice as long as sterile and solely sporophytic colonies. However, no effect of reproductive strategies on colony growth rates was found. CONCLUSIONS: This study is among the few attempts to correlate life history strategies with demographic parameters of terrestrial plants. Specifically, we provide evidence for differential influence of reproductive strategies on metapopulation survivorship.

Quantitative criteria for the diagnosis of the congenital absence of pericardium by cardiac magnetic resonance.

BACKGROUND: Congenital absence of the left ventricular pericardium (LCAP) is a rare and poorly known cardiac malformation. Cardiac Magnetic Resonance (CMR) is generally used for the diagnosis of LCAP because of its high soft tissue contrast, multiplanarity and cine capability, but the diagnosis is usually made by only qualitative criteria. The aim of the present study was to establish quantitative criteria for the accurate diagnosis of LCAP on CMR. METHODS: We enrolled nine consecutive patients affected by LCAP (mean age 26±8years, 7 males), 13 healthy controls, 13 patients with dilated cardiomyopathy (DCM), 12 patients with hypertrophic cardiomyopathy (HCM) and 13 patients with right ventricular overload (RVO). All patients underwent CMR. The whole-heart volume was measured in end-systole and end-diastole. Whole-heart volume change (WHVC), was the systo-diastolic change of volume, expressed percentage of the end-diastolic volume. The angle of clockwise-rotation of the heart was also measured in the end-diastolic phase of the axial cine stack. RESULTS: The WHVC was significantly higher in LCAP (21.9±5.4), compared to healthy subjects (8.6±2.4, p<0.001), DCM (7.1±1.8, p<0.001), HCM (9.3±2.4, p<0.001) and RVO (8±2.4, p<0.001). The clockwise-rotation was significantly higher in LCAP (76±14°) than healthy controls (40±11°, p<0.001), DCM (41±5°, p<0.001), HCM (30±6°, p<0.001) and RVO (49±8°, p<0.001). WHVC had the highest sensitivity (100%) and specificity (100%) for diagnosing LCAP, using a threshold of >13%. CONCLUSIONS: In LCAP the systo-diastolic WHVC was significantly higher than controls, DCM, HCM and RVO patients and resulted an optimal quantitative criteria for the diagnosis of LCAP.

Chemotherapy-induced cardiotoxicity: role of the conventional echocardiography and the tissue Doppler.

AIM: The cardiotoxicity of anticancer drugs is an emerging problem and only an identification of the early signs of cardiotoxicity by conventional echocardiography and not (tissue Doppler imaging, TDI), will limit and contain the long-term cardiotoxicity effects. The aim of this study was to identify, through conventional echocardiography and TDI, parameters to use as early "signs" of cardiotoxicity. METHODS: A prospective study was performed using patients with breast cancer (72 women, median age 57 ± 12) treated with anticancer drugs (adjuvant chemotherapy). All patients underwent a careful cardiological evaluation before starting treatment (T0) and during follow-up at 3 months (T1), 6 months (T2) and 1 year (T3). Electrocardiography and echocardiography were performed in all patients in these times. Echocardiography evaluation considered the following parameters: systolic and diastolic diameters and volumes, LVEF, MAPSE, TAPSE, E/A TDI (Em, Am, Sm, IVCT, IVRT, ET, TEI index). On the basis of chemotherapy treatment, patients were divided into 5 groups: A=FEC (fluorouracil, epirubicin, cyclophosphamide), B=FEC+trastuzumab, C=trastuzumab, D=FEC+taxotere, E=FEC+taxolo+trastuzumab. RESULTS: A significant reduction in the echo parameters of TDI was observed. TDI appears to offer important advantages over traditional techniques in revealing the presence of early signs of cardiotoxicity. CONCLUSION: The TDI should be utilized to complement conventional echocardiography in the assessment of cardiotoxicity.

Role of magnetic resonance spectroscopic imaging ([¹H]MRSI) and dynamic contrast-enhanced MRI (DCE-MRI) in identifying prostate cancer foci in patients with negative biopsy and high levels of prostate-specific antigen (PSA).

PURPOSE: The purpose of this study was to evaluate the role of magnetic resonance spectroscopic imaging (MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in detecting tumour foci in patients with elevated prostate-specific antigen (PSA) and negative transrectal ultrasonography (TRUS)-guided biopsy. MATERIALS AND METHODS: This prospective randomised trial was conducted on 150 patients who underwent [¹H]MRSI and DCE-MRI and targeted biopsies of suspicious areas on MRI associated with random biopsies. RESULTS: After the second biopsy, the diagnosis of prostate adenocarcinoma was made in 64/150 cases. On a per-patient basis, MRSI had 82.8% sensitivity, 91.8% specificity, 88.3% positive predictive value (PPV), 87.8% negative predictive value (NPV) and 85.7% diagnostic accuracy. The sensitivity, specificity, PPV, NPV and accuracy for DCE-MRI was 76.5%, 89.5%, 84.5%, 83.7% and 82%, respectively. The combination of MRSI and DCE-MRI yielded 93.7% sensitivity, 90.7% specificity, 88.2% PPV, 95.1% NPV and 90.9% accuracy in detecting prostate carcinoma. CONCLUSIONS: The combined study with [¹H]MRSI and DCE-MRI showed promising results in guiding the biopsy of cancer foci in patients with an initial negative TRUS-guided biopsy.

64-detector row CT cystography with virtual cystoscopy in the detection of bladder carcinoma: preliminary experience in selected patients.

PURPOSE: This study was conducted to evaluate the role of computed tomography cystography (CTC) and virtual cystoscopy (VC) with 64-slice CT in diagnosing bladder lesions using flexible cystoscopy as the reference standard. MATERIALS AND METHODS: Twenty-eight patients with suspected bladder cancer and ten patients who had undergone transurethral resection of the bladder were studied by CTC and VC in both the supine and prone positions after distending the bladder with air. The patient population was divided into three groups based on lesion size at flexible cystoscopy. Results of the CT study were compared with those of flexible cystoscopy. RESULTS: Flexible cystoscopy depicted 88 bladder lesions in the 38 patients examined. Sensitivity and specificity values of CTC and VC alone were constantly lower than those of the combined-approach (group 1: 93.10% and 92.31%; group 2: 100% and 100%; group 3: 100% and 100%, respectively). Receiver operating characteristic (ROC) curve analysis showed that the combined approach decreases the lower dimensional threshold for lesion detection (1.4 mm). CONCLUSIONS: VC and CTC with 64-slice CT are promising diagnostic techniques for bladder cancers measuring 1-5 mm. Further studies on larger patient populations are required to validate our results.

Functional MRI in the evaluation of oesophageal motility: feasibility, MRI patterns of normality, and preliminary experience in subjects with motility disorders.

PURPOSE: The aim of this study was to introduce functional magnetic resonance imaging (fMRI) with T1-weighted turbo fast low-angle shot (FLASH) sequences in the evaluation of oesophageal motility and morphology, to formulate MRI patterns of normality in healthy subjects and to demonstrate the feasibility of the method by obtaining a preliminary experience in the study of subjects affected by oesophageal motility disorders. MATERIALS AND METHODS: Thirty healthy volunteers and seven patients with radiological and manometric diagnoses of oesophageal motility disorders underwent fMRI with dynamic T1- weighted turbo-FLASH (TFL) sequences during the administration of oral contrast material. RESULTS: Evaluation of oesophageal function and morphology proved possible in all subjects, as well as the formulation of normality patterns. In patients with motility disorders, fMRI correctly visualised the typical alterations in agreement with radiological and manometric findings. CONCLUSIONS: Functional MRI sequences acquired during the administration of oral contrast material can evaluate oesophageal transit, providing information on motility and morphology; furthermore, this modality can properly visualise the typical functional and morphological alterations of motility disorders.

Nasal cheek flap in ethmoidal and skull base tumour surgery: results and complications.

Surgery is the treatment of choice for the management of malignant nasal/ethmoidal tumours, followed, in most cases, by external radiotherapy. Two main procedures are adopted to resect these tumours depending upon stage and extension: ethmoidectomy and medial maxillectomy, via a transfacial approach, or craniofacial resection with a combined transcranial and transfacial approach. The nasal cheek flap technique allows complete nasal swing thus obtaining a wide access to both the nasal fossae and the ethmoidal labyrinth. Furthermore, this approach can also be used in the management of small intracranial tumours extended through the skull base to the nasal cavity, paranasal sinuses, upper and middle clivus. We have used the nasal cheek flap since 1992 with good aesthetic and functional results. Aim of the present study was to analyse personal experience, focusing on complications, aesthetic results and self-evaluation expressed by the patients.

Dysmorphism of the middle ear: case report.

Although there are numerous publications in the literature describing the wide range of diagnosis, classifications and treatment of malformations of the hearing apparatus, even more variations can be found in clinical practice. Indeed, each individual case is unique as far as concerns pathogenesis, clinical course and treatment. The case reported herein describes a 12-year-old boy affected by cranio-facial dysmorphism and monolateral conductive hearing loss in the right ear: followed from radiological diagnosis--carried out to study a malformation of the ear pinna--to surgical treatment.

EUROCARE-3: survival of cancer patients diagnosed 1990-94--results and commentary.

EUROCARE-3 analysed the survival of 1815584 adult cancer patients diagnosed from 1990 to 1994 in 22 European countries. The results are reported in tables, one per cancer site, coded according to the International Classification of Diseases (ICD)-9 classification. The main findings of the tables are summarised and commented on in this article. For most solid cancers, wide differences in survival between different European populations were found, as also reported by EUROCARE-1 and EUROCARE-2, despite a remarkable (10%) overall increase in cancer survival from 1985 to 1994. Survival was highest in northern Europe (Sweden, Norway, Finland and Iceland), and fairly good in central-southern Europe (France, Switzerland, Austria and Spain). Survival was particularly low in eastern Europe, low in Denmark and the UK, and fairly low in Portugal and Malta. The mix of tumour stage at diagnosis explains much of the survival differences for cancers of the digestive tract, female reproductive system, breast, thyroid, and also skin melanoma. For tumours of the urinary tract and prostate, the differences were explained mainly by differences in diagnostic criteria and procedures. The case mix by anatomic subsite largely explains differences in survival for head and neck cancers. For oesophagus, pancreas, liver and brain cancer, with poor prognoses, survival differences were limited. Tumours, for which highly effective treatments are available, such as testicular cancer, Hodgkin's lymphoma and some haematological malignancies, had fairly uniform survival across Europe. Survival for all tumours combined (an indicator of the overall cancer care performance of a nation's health system) was better in young than old patients, and better in women than men. The affluence of countries influenced overall cancer survival through the availability of adequate diagnostic and treatment procedures, and screening programmes.

Ultrasonography in the study of hepatocellular carcinoma in woodchucks chronically infected with WHV.

The woodchuck hepatitis virus (WHV)/woodchuck system is studied as animal model of human hepatocellular carcinoma (HCC) induced by chronic hepatitis B virus infection. The aim of the present study was the evaluation of ultrasound (US) liver examination in woodchuck as a routine method to detect HCC nodules and to follow their growth. Sixteen woodchucks were included in the study. US liver examination was carried out in all animals using a 5 MHz convex scanner. Macroscopic and microscopic examinations were performed to evaluate the US findings. The lower limit of nodule detection by US examination was a diameter of 5 mm. Macroscopic and microscopic examinations confirmed US findings in 14 of 16 animals (86.6%). No false negative results were obtained. Increase of nodule size was faster in the early phase of tumour growth. Small nodules (16 +/- 5 mm) appeared as hypoechoic lesions with well-defined margins and homogeneous structure. Large nodules (42 +/- 19 mm) appeared as hyperechoic lesions with irregular margins, heterogeneous or of mixed pattern; microscopical examination showed different degrees of necrosis, inflammation and fibrosis inside these latter neoplasms. The hepatitis reaction was conspicuously more severe around HCC nodules. No fibrosis and/or cirrhosis were found in normal liver parenchyma surrounding tumour nodules. On the whole, US appears to be helpful in the diagnosis of woodchuck HCC even at an early stage. Serial US evaluation can be used to study the growth rate of tumour nodules during natural history or experimental HCC treatments in woodchuck.

Oropharyngeal carcinoma during pregnancy: clinical and psycho-oncological aspects.

Cancer is uncommon in pregnancy, occurring in approximately one out of 1000 pregnancies, although it has been noted that one out of 118 women diagnosed with cancer is pregnant at the time of diagnosis. In the last 10 years, two oropharyngeal carcinomas, (1 squamous cell carcinoma and 1 adenoid cystic carcinoma) which developed during pregnancy, have been diagnosed and treated in our Department. No cases of oropharyngeal cancer, during pregnancy, have so far been reported in the literature with the exception of one case of oral cancer. This report focuses not only on the clinical history but also the management of oropharyngeal carcinoma during pregnancy, in terms of choice and timing of treatment. A scrupulous psycho-oncological analysis was also carried out in order to throw further light on psychological repercussions of head and neck cancer in the pregnant woman.

[Endoscopic follow-up of translaryngeal Fantoni tracheostomy]. / Follow-up endoscopico di tracheotomie translaringee sec. Fantoni.

Dilatational tracheotomy techniques are widely used in the long-term management of the respiratory tract in patients in intensive care units (ICU). The translaryngeal tracheotomy technique (TLT) was first described by Fantoni in 1993 and rapidly asserted itself, especially in Europe. This technique basically differs from the other percutaneous techniques in that it involves a progressive, retrograde, dilatation of the trachea in a single session conducted from inside the trachea, working outward, simultaneously exerting a counter-pressure on the pre-tracheal soft tissues with the fingers. The present study involves an endoscopy follow-up of 130 patients who had undergone TLT at the Intensive Care Unit of our Hospital between November 2000 and May 2001. The pre-operative oro-tracheal intubation time varied from 1 to 42 days. All patients filled out a brief questionnaire containing validated questions on their general health and quality of life with particular attention focused on respiratory conditions. Then, after receiving informed consent, the patients underwent laryngo-tracheoscopy with local anesthetic using a flexible tracheobronchoscope. All tests were recorded and viewed later by two operators in order to identify and divide the patients according to the level of execution of the tracheotomy and the presence of sequelae. The results obtained have shown that, like other percutaneous tracheotomy techniques, TLT provides some benefits including the fact that procedure can be performed at the bedside in a short time, with few post-operative complications, simpler nursing and fewer sequelae in time. Analysis of data concerning time of tracheostomy execution, tracheal level of stomia and nursing times has revealed three factors that determine severe sequelae: delay in tracheostomy execution, high level of execution with cricoid involvement and onset of problems during first tracheal cannula change.