Neridronate for transient osteoporosis of the hip in a child.

Transient osteoporosis of the hip (TOH) is usually reported in middle-aged men or during pregnancy as a benign self-limiting condition. Nevertheless, its impact on quality of life in terms of pain and disability is considerable. Also, it can lead to insufficiency fractures or, more rarely, evolve into osteonecrosis. This condition is anecdotally described in the pediatric age and very little is known about how it may affect the growing bone. We herein describe a case of TOH in a 10-year-old child treated at our pediatric rheumatology service and summarize the pediatric cases of TOH previously reported in literature. There are two points of interest in our case report, the first one being the unusual complication of TOH with a femoral physis fracture and the second the complete recovery after the off-label therapy with bisphosphonates. We suggest that interventional medical treatment could be considered in selected cases of juvenile TOH, to prevent any possible irreversible damage on the femoral physis. As far as we know, this is the first report of neridronate employment in children affected by TOH.

Personnel real time dosimetry in interventional radiology.

Interventional radiology and hemodynamic procedures have rapidly grown in number in the past decade, increasing the importance of personnel dosimetry not only for patients but also for medical staff. The optimization of the absorbed dose during operations is one of the goals that fostered the development of real-time dosimetric systems. Indeed, introducing proper procedure optimization, like correlating dose rate measurements with medical staff position inside the operating room, the absorbed dose could be reduced. Real-time dose measurements would greatly facilitate this task through real-time monitoring and automatic data recording. Besides real-time dose monitoring could allow automatic data recording. In this work, we will describe the calibration and validation of a wireless real-time prototype dosimeter based on a new sensor device (CMOS imager). The validation measurement campaign in clinical conditions has demonstrated the prototype capability of measuring dose-rates with a frequency in the range of few Hz, and an uncertainty smaller than 10%.

Role of alpha-synuclein in autophagy modulation of primary human T lymphocytes.

It has been demonstrated that α-synuclein can aggregate and contribute to the pathogenesis of some neurodegenerative diseases and it is capable of hindering autophagy in neuronal cells. Here, we investigated the implication of α-synuclein in the autophagy process in primary human T lymphocytes. We provide evidence that: (i) knocking down of the α-synuclein gene resulted in increased autophagy, (ii) autophagy induction by energy deprivation was associated with a significant decrease of α-synuclein levels, (iii) autophagy inhibition by 3-methyladenine or by ATG5 knocking down led to a significant increase of α-synuclein levels, and (iv) autophagy impairment, constitutive in T lymphocytes from patients with systemic lupus erythematosus, was associated with abnormal accumulation of α-synuclein aggregates. These results suggest that α-synuclein could be considered as an autophagy-related marker of peripheral blood lymphocytes, potentially suitable for use in the clinical practice.

GRB 130427A: a nearby ordinary monster.

Long-duration gamma-ray bursts (GRBs) are an extremely rare outcome of the collapse of massive stars and are typically found in the distant universe. Because of its intrinsic luminosity (L ~ 3 × 10(53) ergs per second) and its relative proximity (z = 0.34), GRB 130427A reached the highest fluence observed in the γ-ray band. Here, we present a comprehensive multiwavelength view of GRB 130427A with Swift, the 2-meter Liverpool and Faulkes telescopes, and by other ground-based facilities, highlighting the evolution of the burst emission from the prompt to the afterglow phase. The properties of GRB 130427A are similar to those of the most luminous, high-redshift GRBs, suggesting that a common central engine is responsible for producing GRBs in both the contemporary and the early universe and over the full range of GRB isotropic energies.

Malignant small-bowel neoplasms: spectrum of disease on MR imaging.

Malignant neoplasms of the small bowel are among the rarest types of cancer, accounting for only 2% of all gastrointestinal neoplasms. Owing both to the intrinsic difficulty of common radiographic and endoscopic methods in visualising the entire small bowel and the lack of typical physical findings, a delay in diagnosis is common. Recently, magnetic resonance (MR) imaging has become a widely accepted imaging modality in the study of suspected small-bowel neoplasms due to its ability to depict, without exposure to ionising radiation and with excellent soft-tissue contrast, intraluminal disorders in conjunction with mural, extraparietal and regional abnormalities. The aim of this pictorial review is to illustrate the MR appearance of malignant small-bowel neoplasms.

CT angiography versus colour-Doppler US in acute dissection of the vertebral artery.

PURPOSE: Conventional digital subtraction angiography (DSA) still represents the criterion standard for the diagnosis of vertebral artery dissection (VAD), but the main drawbacks of this technique include invasiveness, patient discomfort and risk of complications. We evaluated the potential of multidetector computed tomography angiography (CTA) as a noninvasive tool providing high-resolution images of the arterial lumen and wall by comparing the diagnostic accuracy of CTA and colour-Doppler ultrasonography (CDUS) in detecting acute VAD. MATERIALS AND METHODS: We retrospectively reviewed 15 cases of VAD in 15 patients (five men and ten women, age range 28-58 years) who came to our attention between August 2001 and September 2005. The diagnosis was made on the basis of appropriate clinical presentation, absence of atherosclerotic disease in the cerebrovascular circulation and evidence of distinctive CT features, which were subsequently confirmed by conventional angiography used as reference standard. All patients with a clinical suspicion of VAD underwent CDUS of the neck vessels prior to CTA. Accuracy, sensitivity and specificity of CDUS and CTA were expressed as percentages of agreement with the reference angiographic procedure. Interreader concordance for detection of VAD by CTA was calculated with the Cohen K value. RESULTS: The CDUS examinations revealed ten out of 15 VAD, with a sensitivity of 66%, a specificity of 60%, a positive predictive value of 55.5% and a negative predictive value of 70.5%. In five cases, CDUS revealed nonspecific wall and flow alterations; in eight patients, high resistance obstructive flow; and in two patients, intimal flap with demonstration of the true and false lumen. CTA enabled the correct identification of all 15 VAD. The reported sensitivity, specificity, positive predictive value and negative predictive value were 100%, 95%, 93.7% and 100%, respectively. With regard to localisation of VAD, CTA showed 100% correlation with DSA. The differences in CTA and CDUS sensitivity (100% vs 66%), specificity (95% vs 60%), and overall diagnostic accuracy (97% vs 62.8%), assessed by cross tabulations and compared by using the McNemar's two-sided test, were significant (p<0.05). CONCLUSIONS: Multidetector CTA is a sensitive technique for the diagnosis of VAD. Used as a complement to unenhanced brain CT, it has the advantage of being readily available and easy to perform.

Pseudo-Class III malocclusion treatment with Balters' Bionator.

The aim of this article is to show the use of the Balters' Bionator in pseudo-Class III treatment. The importance of differentiating between true Class III and pseudo-Class III is emphasized. The therapeutic results of a Balters' Bionator appliance are presented in three case reports of subjects in the mixed dentition. In this stage of development it is possible to correct an isolated problem. The use of the Bionator III in this kind of malocclusion enabled the correction of a dental malocclusion in a few months and therapeutic stability of a mesially-positioned mandible encouraging favourable skeletal growth.

Endovascular abdominal aortic aneurysm repair in high-risk patients: a single centre experience.

OBJECTIVES: to evaluate the role of endovascular repair (ER) of abdominal aortic aneurysm (AAA) repair in American Society for Anaesthesiology [ASA] class IV patients. PATIENTS AND METHODS: between April 1997 and March 2000, 266 consecutive patients underwent ER for AAA. There were 26 patients (10%) with ASA grade IV. The remaining 240 patients, ASA grade between I and III (ASA

Orthodontic correction of an ectopic mandibular first permanent molar: a case report.

Ectopic eruption of mandibular first molar is a rare clinical problem. It is one result of an improper balance in the forces of growth and eruption. A case of ectopic eruption of the mandibular first permanent molar is described and the technique for repositioning it is showed.

Predictive factors for early success of endovascular abdominal aortic aneurysm repair.

To identify predictive factors for postoperative success and potential predictors for satisfactory outcome of endovascular grafting for abdominal aortic aneurysm (AAA), we collected data from our prospective database, which includes a series of consecutive patients undergoing endovascular repair at the Vascular Surgery Unit, Policlinico Monteluce, Perugia, Italy. From April 1997 to July 1998, 202 patients were referred to our Unit for elective AAA repair; 94 patients (47%) were selected for endografting. Placement of the graft using endovascular technique without conversion to open laparotomy, in addition to no mortality, major morbidity, or endoleak at 30-day follow-up, was defined as postoperative success. The influence of anatomical features on postoperative results was analyzed by univariate and multivariate analysis. Our experience shows that endoluminal repair of AAA is safe and effective in the short term and male patients with small aneurysms are optimal candidates for successful repair.

Role of duplex scan in endoleak detection after endoluminal abdominal aortic aneurysm repair.

OBJECTIVE: to validate the role of duplex scan in endoleak detection in postoperative surveillance of endoluminal abdominal aneurysm repair (EAAR). PATIENTS AND METHODS: between April 1997 and March 1999, 103 patients were eligible for duplex and computed tomography (CT) scan after EAAR. Mean follow-up was 8 months (range 1-24 months). The study protocol comprised concurrent examination with colour-duplex and CT scan at 1, 6, and 12 months after EAAR, for a total of 198 concurrent examinations. All duplex scan examinations were performed by two vascular surgeons with the same machine (ATL HDI 3000). Interobserver agreement in endoleak detection (kappa=1) and in type of endoleak (kappa=0.7) was evaluated in 50 random duplex examinations. Endoleak detection was examined comparatively in duplex and CT scan, the latter being the gold standard. Sensitivity and specificity tests together with negative- and positive-predictive values (NPV and PPV) were calculated. RESULTS: duplex scan was not feasible in one patient. On CT scan the endoleak rate was 4% at one month, 3% at 6 months, and 4% at one year. Overall, CT scan detected 12 endoleaks. With respect to endoleak detection, duplex scan revealed a great ability in ruling out false-negative results (sensitivity 91.7%, NPV 99.4%), but overestimated the presence of endoleak (specificity 98.4%, PPV 78. 6%). Regarding type of endoleak, the ability of duplex scan to identify the source of endoleak was low (sensitivity 66.7%). CONCLUSIONS: duplex scan, if validated, appears to be a reliable means for excluding the presence of endoleak after EAAR.

Rapid palatal expansion in treatment of Class II malocclusions.

A technique which combines the use of rapid maxillary expansion and fixed appliance in growing patients, is presented. The treatment in three patients with Class II division 1 malocclusion and different skeletal patterns is described, and relative advantages highlighted.

Endoluminal repair of infrarenal abdominal aortic aneurysms using a modular stent-graft: one-year clinical results from a European multicentre trial.

This is a report of a prospective study to evaluate the safety and efficacy of the Medtronic AneuRx stent-graft. Patients with an infrarenal aneurysm with a proximal neck length of greater than 10 mm and a neck diameter not greater than 26 mm and iliac artery diameters of at least 6 mm were accepted for endovascular repair using the Medtronic AneuRx modular stent-graft. A total of 104 patients were included in the study. Transfemoral placement of the bifurcated stent-graft was successful in 102 of 104 patients. Two conversions were performed. The mean operating time was 148 min (range 75-480) and the mean blood loss was 605 ml (range 100-2900). The mean follow-up was 15 months (range 12-21). Complications were rare and no kinking or migration occurred. At follow-up, four endoleaks persisted after 12 months. The Medtronic AneuRx stent-graft is a safe and efficacious alternative to open abdominal aortic aneurysm repair with excellent early results.

Chronic iliac artery occlusion: treatment with the Strecker stent after PTA.

The purpose of this retrospective study was to evaluate the use of percutaneous transluminal angioplasty (PTA) and subsequent. Strecker stent implantation for the treatment of chronic iliac artery occlusions. A total of 39 patients were subjected to this procedure. The occluded vessels were catheterized, dilated and subjected to stenting in all patients: the length of occlusion varied from 4.5 to 10.5 cm (mean 5.9), lesions were located in common iliac arteries (25), external iliac arteries (10) and in combinations of both (4). Twenty-five patients presented stage II according to Fontaine classification, nine patients stage III and five patients stage IV. The stent was mounted on balloon catheter and introduced through a 9 French sheet (for 8-10 mm stent diameter). After this procedure, 37 out of 39 patients showed a statistically significant increase in the Doppler sonographic ankle-arm index (AAI) (P = 0.001) and improvement of clinical symptoms, while in two patients a complete occlusion resulted due to long dissection not covered by the stent in one case and to stent misplacement in the other case. After stenting, 27 patients improved to stage I, ten patients to stage IIa and two patients showed no changes. Two complications were observed: one groin hematoma and one distal embolization. At a 6-month follow-up, a 89.7% of patency was observed. This study shows that Strecker stent can be successfully employed in addition to PTA to treat occlusions of the iliac arteries.

Variation of acid-base balance, glycemia, electrolytes and ETCO2 after fast i.v. infusion of 5% fructose and/or glucose.

Intraoperative fluid infusion has precise goals and the rapid infusion of some solutions can induce important modifications of homeostatic parameters, which must be known. Rapid infusion of fructose and glucose 5% solutions has been carried out and modifications of acid-base balance, glycemia, serum electrolytes, ETCO2 have been registered. The administration of fructose 5% determines a mixed acidosis while the administration of glucose does not cause this phenomenon; the administration of both carbohydrates reduces serum chloride and sodium, while serum potassium rises only after fructose infusion and glycemia only after glucose infusion. All the variations described reach significant levels.

Laparoscopic surgery complications: pneumothorax and pneumomediastinum. Description of two cases.

After having illustrated the surgical "advantages" of laparoscopic procedures, the authors discuss the negative aspects of this technique on the anaesthesiological management of the patient. Two cases of pneumothorax during Nissen fundoplicatio are illustrated and the deranged parameters, that allow a precocious diagnosis, are extensively analyzed.

Transcutaneous ethanol injection in hepatocarcinoma: problems in analgesia and sedation.

Therapeutic ethanol injection into primitive or secondary hepatic tumours if performed in "one shot" causes a great deal of pain. For this reason an analgesic/sedation protocol was devised. This relies on the administration of ketorolac-propofol-nitrogen oxide mixture that has been used to treat patients with neoplastic hepatic diseases. A 20 patient series is described. Analgesic protocol was very effective and the only drawbacks were a residual sleepiness than in part is probably dependent on ethanol emigration into the bloodstream and consequently to the central nervous system depression.

Analgesia and sedation with propofol-NSAIDs for day-hospital extracorporeal shock wave lithotripsy (ESWL).

After a brief history of extracoporeal therapies for calculosis, with particular attention devoluted to renal calculosis and to the instruments that consent these therapeutic alternatives, the authors report the results obtained with a technique of analgesia and sedation. The drugs employed are two NSAIDs, keto-prophene and ketorolac tromethamine associated with propofol. The main advantages consist in the limited cardiovascular and respiratory depression, typical of the first minutes of administration of propofol and the rapid return of a complete functional autonomy in relative brief time intervals, with possibility of dismissing the patient after 4 hours from che end of treatment.

[The magnetic resonance imaging of abdominal aortic aneurysms]. / L'imaging con Risonanza Magnetica degli aneurismi dell'aorta addominale.

The diagnostic role of Magnetic Resonance Imaging (MRI) was investigated in the study of abdominal aortic aneurysms and compared with that of Computed Tomography (CT) and digital subtraction angiography (DSA). Magnetic Resonance angiography (MRA) was performed on 21 patients with radiologically proved abdominal aortic aneurysms, using a superconductive 1.5 T magnet (GE, Signa Advantage); the 2D TOF technique with gradient-echo sequences was used (SPGR: FA 45-60 degrees, TR/TE 33/7, ST 2 mm, 1 nex, 256 x 128 matrix, inferior presaturation and flow compensation). The images acquired on the axial plane were reconstructed according to MIP and rotated on the z-axis from +90 degrees to -90 degrees. In all cases SE 2D T1- and T2-weighted sequences were acquired on the axial plane. Twelve patients were examined with MRI, CT and DSA; 3 with MRI and CT; 2 with MRI and DSA and finally 4 with MRI only. The radiologic studies were then reviewed blind and the results of the different methods compared. In all cases MRI yielded similar information to CT and DSA as to aneurysm extent and size, vessel involvement, status of visceral, iliac and common femoral arteries and finally the conditions of perianeurysmatic tissues. The authors conclude that MRI is a useful and accurate technique for the preoperative examination of abdominal aortic aneurysm patients.