Cyclists fatalities: Forensic remarks regarding 335 cases.

A retrospective study was carried out on post-mortem examination data regarding 335 cyclists involved in fatal accidents along the period 1983-2012. The following variables were considered: temporal data (year, month, day of the week and hour of the day), circumstances of the accident, vehicles involved, victims' features (sex, age), pathological and toxicological findings, cause of death. Most victims were male (77.62%), with a mean age of 58 years. In most cases vehicles other than only bicycles were involved, more frequently cars, followed by heavy motor vehicles. Head was the most frequently body region involved in lethal injuries (65.37%); low extremities were the body district most frequently involved in non-lethal injuries (63.9%). This study confirmed the importance of using helmet; head protection should be a priority for bikers.

Short-term effect of domperidone on gastroesophageal reflux in newborns assessed by combined intraluminal impedance and pH monitoring.

OBJECTIVE: Neonatal gastroesophageal reflux (GER) is primarily due to a transient motility disorder and characterized by a prevalence of weakly acid refluxes. Drug management, where necessary, must set out to reduce the number of refluxes besides correct their acidity. Prokinetics could be of assistance in this respect, though the evidence in favor of their efficacy and safety is still far from sufficient. In this randomized controlled study, the action of domperidone, a prokinetic antidopaminergic drug with little effect on the central nervous system, was evaluated in newborns with symptomatic GER. STUDY DESIGN: Combined multichannel intraluminal impedance and pH measuring for 24 h was carried out in 13 newborns receiving 0.3 mg per kg domperidone per os at the eighth and the sixteenth hour, and 13 controls. Each newborn was compared to the control nearest in postconceptional age. RESULT: GER episodes per hour increased significantly compared to the baseline in the domperidone group (4.06+/-1.16 vs 2.8+/-1.42; P=0.001) and were shorter (16.68+/-4.49 vs 20.18+/-7.83 s; P=0.043), whereas there were no differences in the maximum proximal extent reached by the refluxes (3.37+/-0.45 vs 3.34+/-0.94 channels; P=0.894) and their pH (4.72+/-0.69 vs 4.60+/-1.17; P=0.634). CONCLUSION: This paradoxical increase in the number of GER episodes could be the expression of a domperidone-induced amplification of the motor incoordination of the neonatal gastroesophageal tract. Doubt is thus cast on the efficacy of prokinetics in this age bracket, especially in view of their adverse effects as described in the literature.

Spontaneous hypoglycemia in patients with cystic fibrosis.

OBJECTIVE: Diabetes frequently complicates cystic fibrosis (CF) without fasting hyperglycemia or despite spontaneous hypoglycemia (anecdotally ascribed to malnutrition), whose prevalence, clinical meaning, and relationship with glucose tolerance and clinical/nutritional status were not previously investigated. The relationship of CF genotype with insulin secretion control is also unclear. DESIGN AND METHODS: A total of 129 CF patients without stable diabetes received 188 oral glucose tolerance tests. Distribution of fasting plasma glucose (FPG), glucose, insulin and C-peptide responses, clinical/nutritional variables, and their relationships were analyzed. RESULTS: FPG < 60 mg/dl (3.3 mmo/l) was detected in 14% of studies and reactive hypoglycemia (PG < 50 mg/dl (2.8 mmo/l)) in 15%. OGTT-based diabetes frequency was similar in the lowest quartile (Q1) and Q2-3 for FPG (10 and 8%), with higher glucose increment and area under the curve in Q1. Insulin and C-peptide levels were similar among FPG quartiles. Class I cystic fibrosis transmembrane conductance regulator mutation carriers had higher insulin concentrations than class II, especially in Q1 for FPG. Age, sex, nutritional, and anthropometric parameters including fat and lean body mass were unrelated to FPG. Lower FPG was associated with more frequent hospitalization rates (P = 0.002) and lower Shwachman scores (P = 0.041). Steroids weaning was accurately evaluated but then excluded as a possible cause of hypoglycemia. CONCLUSIONS/INTERPRETATION: Fasting asymptomatic hypoglycemia is frequent and possibly related to inappropriate insulin secretion control in class I mutation carriers. Low FPG does not exclude impaired glucose tolerance (IGT) and diabetes in CF and reflects worse clinical status.

Intraoperative fractures of the femur in prosthetic hip reimplantations.

A total of 19 cases of intraoperative fractures of the femoral diaphysis occurring during prosthetic hip reimplantation are described. Incidence, predisposing factors, treatment, and influence on long-term results are discussed. The pre-existence of osteolysis or narrowing of the femoral cortex, often associated with primary cemented implantation with a metal-polyethylene combination, constitutes a factor that predisposes the patient to fracture. Fracture consolidation occurs in most cases with minimum treatment, at times without instrumentation; fracture, however, always means a delay in weight-bearing and a slowing down in recovery times. Long-term clinical evaluation shows functional results that are worse for reimplantations complicated by fracture as compared to those where there are no complications. The differences in the radiographic results instead do not reveal statistical significance.

Computerized morphometric analysis of the femoral diaphyseal canal.

The constant increase in the use of hip arthroplasty and the continuous search for the best possible adaptation of the implant to femoral anatomy have led to the development of methods of radiographic analysis that are increasingly precise and reliable. Among these the methods that include the use of traditional radiograms-despite their limits-deserve a place of importance. In fact, these methods offer the advantage of being easy to apply and of allowing for a comparison to be made with pre-existing files. Computer science is useful in this field, in particular, computerized analysis, both morphometric and statistical, of the data acquired by digitizer. The protocol of acquisition and analysis that we applied to x-rays in anteroposterior view allowed for an evaluation to be made of some of the morphologic parameters of 354 femurs (corresponding to 264 patients), relating them with the pathologies that led to hip arthroplasty. The duration of a cementless hip prosthesis strongly depends on primary stability. For this reason, an ever-increasing number of studies tends to make a precise evaluation of the morphology of the joint, in order to obtain excellent contact between bone and prosthetic component. The methods used are essentially radiological, with the use of computerized tomography and stereophotogrammetry. Morphometric studies of the proximal femoral area have in particular considered the width of the medullary canal at various levels; the cervico-diaphyseal angle; the flare index of the femoral canal (relationship between the internal metadiaphyseal diameter and that of the isthmus) and the distance between the rotation center of the femoral head and the diaphyseal axis. The evident absence of proportion between femoral sizes and shape of the medullary canal has led to the search for parameters capable of describing in simple fashion the shape of the femoral diaphyseal canal. A good describer of femoral morphology is the flare index, that allows for classification of the various shapes of the diaphyseal canal in three families: "stove-pipe like", "normal", "champagne glass like". The distinction between these groups is not clear, as the passage from one shape to another is gradual. The idea of obtaining more knowledge on femoral morphology, also to the purpose of determining possible new criteria that may be of help in preoperative planning and in the choice of a model to be implanted, has suggested our study on modifications caused by some of the pathologies that most frequently lead to arthroplasty.

In vivo fixative effect of formocresol on pulpotomized deciduous teeth of dogs.

Formocresol was checked with respect to its in vivo fixative effect after pulpotomy, through observation of tissue resistance to necrosis. The root pulps were freed from their hard-tissue wrapping and processed for 48 hours, followed or not by capping (15 days) with zinc oxide-eugenol or with zinc oxide-eugenol-formocresol. The effect of only capping with zinc oxide-eugenol, with or without formocresol, was also recorded.