A double-blind, placebo-controlled randomized trial to evaluate the efficacy of docosahexaenoic acid supplementation on hepatic fat and associated cardiovascular risk factors in overweight children with nonalcoholic fatty liver disease.

BACKGROUND AND AIMS: Very little information is available on whether docosahexaenoic acid (DHA) supplementation has a beneficial effect on liver fat and cardiovascular disease (CVD) risk factors in children with nonalcoholic fatty liver disease (NAFLD). In a double-blind, placebo-controlled randomized trial we investigated whether 6-month treatment with DHA improves hepatic fat and other fat depots, and their associated CVD risk factors in children with biopsy-proven NAFLD. METHODS AND RESULTS: Of 58 randomized children, 51 (25 DHA, 26 placebo) completed the study. The main outcome was the change in hepatic fat fraction as estimated by magnetic resonance imaging. Secondary outcomes were changes in visceral adipose tissue (VAT), epicardial adipose tissue (EAT), and left ventricular (LV) function, as well as alanine aminotransferase (ALT), triglycerides, body mass index-standard deviation score (BMI-SDS), and insulin sensitivity. At 6 months, the liver fat was reduced by 53.4% (95% CI, 33.4-73.4) in the DHA group, as compared with 22.6% (6.2-39.0) in the placebo group (P = 0.040 for the comparison between the two groups). Likewise, in the DHA group VAT and EAT were reduced by 7.8% (0-18.3) and 14.2% (0-28.2%), as compared with 2.2% (0-8.1) and 1.7% (0-6.8%) in the placebo group, respectively (P = 0.01 for both comparisons). There were no significant between-group changes for LV function as well as BMI-SDS and ALT, while fasting insulin and triglycerides significantly decreased in the DHA-treated children (P = 0.028 and P = 0.041, respectively). CONCLUSIONS: DHA supplementation decreases liver and visceral fat, and ameliorates metabolic abnormalities in children with NAFLD.

Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness, insulin resistance and nonalcoholic fatty liver disease in children and adolescents.

BACKGROUND AND AIMS: The triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C) ratio has been reported as a useful marker of atherogenic lipid abnormalities, insulin resistance, and cardiovascular disease. We evaluated in a large sample of children and adolescents the association of TG/HDL-C ratio with early signs of morphological vascular changes and cardiometabolic risk factors including nonalcoholic fatty liver disease (NAFLD). METHODS AND RESULTS: The study population, including 548 children (aged 6-16 years), of whom 157 were normal-weight, 118 overweight, and 273 obese, had anthropometric, laboratory, liver and carotid ultrasonography (carotid artery intima-media thickness-cIMT) data collected. Subjects were stratified into tertiles of TG/HDL-C. There was a progressive increase in body mass index (BMI), BMI-SD score (SDS), waist circumference, blood pressure (BP), liver enzymes, glucose, insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein (hsCRP), and cIMT values across TG/HDL-C tertiles. The odds ratios for central obesity, insulin resistance, high hsCRP, NAFLD, metabolic syndrome, and elevated cIMT increased significantly with the increasing tertile of TG/HDL-C ratio, after adjustment for age, gender, pubertal status, and BMI-SDS. In a stepwise multivariate logistic regression analysis, increased cIMT was associated with high TG/HDL-C ratio [OR, 1.81 (95% CI, 1.08-3.04); P < 0.05], elevated BP [5.13 (95% CI, 1.03-15.08); P < 0.05], insulin resistance [2.16 (95% CI, 1.30-3.39); P < 0.01], and NAFLD [2.70 (95% CI, 1.62-4.56); P < 0.01]. CONCLUSION: TG/HDL-C ratio may help identify children and adolescents at high risk for structural vascular changes and metabolic derangement.

Multicentric data analysis of the learning curve for laparoscopic Shull's repair of pelvic floor defects.

Introduction: Pelvic organs prolapse remains a significant health concern affecting millions of women worldwide. The use of native tissues to suspend the apex has acquired relevance in urogynecologic surgery. One of the most commonly used procedures performed without mesh is the technique described by Shull, consisting of suturing the vaginal apex to the uterosacral ligaments. The objective of the study is to evaluate the learning curve of laparoscopic Shull's repair for the correction of pelvic floor defects, including the surgery time and surgical outcomes. Materials and methods: This is a retrospective study conducted at the Policlinico G. Martino, University of Messina, Messina, Italy, and Policlinico Vanvitelli, Vanvitelli University, Naples, Italy. All patients affected by grade I-IV POP, consisting of apical prolapse with or without cystocele, and who underwent laparoscopic Shull's technique for prolapse correction were enrolled. The endpoints to estimate the learning curve for the procedure were the percentage of laparoscopic procedures completed, operative time, and the early complication rate. Results: A total of 31 laparoscopic Shull repairs were collected for the study. To evaluate the learning curve of the technique, we divided the 31 cases into three different groups: Procedures 0-10; 11-20; 21-31. The parameter for evaluating technique learning was the operative time. Group 21-31 demonstrated an operative time of 97 min (SD 20), compared with 121 min (SD 23) in group 0-10 and 120 min (SD 13) in group 11-20. A comparison of these means through ANOVA showed a p-value of 0.01 for the entire system, and 0.95 for the comparison between 0 and 10 and 11-20, 0.04 for 0-10 vs. 21-31, and 0.02 between 11 and 20 and 21-31. Conclusions: The rate of surgical improvement in terms of time became effective after an average of 20 procedures. However, the improvement seems to be effective case by case for surgeons skilled in basic endoscopy.

Monitoring of ochratoxin A and ochratoxin-producing fungi in traditional salami manufactured in Northern Italy.

Fungi have a crucial role in the correct maturation of salami, but special attention should be addressed to the production of the nephrotoxic, immunotoxic, and carcinogenic mycotoxin ochratoxin A (OTA). In a monitoring study conducted in Northern Italy, OTA was detected by liquid chromatography coupled with mass spectrometry in 13 out 133 samples of traditional salami (9.8% of the total count). Mycological analysis of these samples yielded 247 fungal isolates which were identified to species level. The most frequent species were Penicillium nalgiovense, P. solitum, and P. chrysogenum. P. nordicum, an OTA-producing species commonly found in proteinaceous food, was not found in these samples. Three isolates were found to be Aspergillus westerdijkiae, an OTA-producing species. In order to check the results of the microbiological identification, 19 different strains of Aspergillus and 94 of Penicillium were tested for the presence of a sequence common to OTA-producing fungi by real-time PCR. None of the studied isolates, including the three A. westerdijkiae, possessed the otanpsPN target which is common to OTA-producing strains. Two out of three isolates of the A. westerdijkiae were also PCR-negative for the otanpsPN gene and did not produce OTA in culture. Conversely, this target sequence was amplified from the DNA purified from 14 salami casings including three casings harboring A. westerdijkiae. The amplification of sequences specific for OTA-producing strains performed on total genomic DNA extracted directly from salami casings provided a more suitable approach than PCR analysis of isolates from salami for the OTA-related otanpsPN gene to evaluate the risk of OTA contamination.

Eight isolated cases of KBG syndrome: a new hypothesis of study.

We report on eight cases of patients affected by KBG syndrome (KBG stands for the initials of the affected patients in the original report), a rare genetic disease, that we find only in 40 cases mentioned in the scientific literature. In this work we present the minimum diagnostic criteria of diagnosis due to identify the syndrome and a hypothesis of study for the research of the involved factors.

Variant (8;22) translocation in lymphoblastic lymphoma.

Occasional cases with the chromosomal translocations that juxtapose the c-myc oncogene to Ig genes have been reported in large cell, small lymphocytic, immunoblastic, and follicular lymphomas. In this report, we present a 20 year-old female with lymphoblastic lymphoma of B-cell type and a translocation t(8;22), in which cytogenetic, immunologic, and molecular studies were performed. To the best of our knowledge this is the first report of this association.

Persistent esophagotrachea: description of a case.

Esophagotrachea is the most severe form of laryngo-tracheo-esophageal cleft. This congenital anomaly is due to the anomalous differentiation of the primitive cephalic gut into trachea and esophagus. We present a case of a new born female with a common tracheoesophageal canal up to the carina. Atresia ani, a vulvo-vestibular fistula, sacral ipoplasia and others associated anomalies were also present. The baby underwent surgery after a laringo-tracheoscopy and a barium study of the esophagus. The prognosis of this extremely rare malformation is generally poor and the baby died on the fifth day after surgery for a serious ipertensive pneumothorax.

[Large granular lymphocytic leukemia. Case report with scarce expression in peripheral blood]. / Leucemia de linfocitos grandes granulares. Presentación de un caso con escasa expresión en sangre periférica.

The case of a 33 year old woman with a large granular lymphocytic leukemia is presented. The main symptoms were neutropenia and recurrent respiratory bacterial infections. No enlargement of the liver, spleen or lymph nodes was noted. Circulating lymphocytes averaged 3000/microliter with 35% of large granular cells. The bone marrow biopsy showed lymphatic infiltration with both nodular and interstitial pattern. Lymphocytes bore the T suppressor phenotype (CD8+, CD45 RO+, CD20-, kappa-, lambda-). Cytogenetic studies revealed a low expression clone with 7q-: del (7)(q36). Gene rearrangements for immunoglobulins or T-cell receptors could not be demonstrated by Southern Blot. Bone marrow cultures grew normally while both normal and patient bone marrow showed marked inhibition when incubated with patients serum. Normalization of the peripheral granulocytic count was obtained with prednisone, while granulocytic-stimulating factors, chlorambucil, and cyclosporine A were partially active or inactive. We suggest that this case represents a form of the lymphoproliferative disease of granular lymphocytes. To our knowledge, the deletion of the long arm of chromosome 7 has not been described in this disease.

Hepatic steatosis and thyroid function tests in overweight and obese children.

Objectives. Associations between thyroid function and nonalcoholic fatty liver disease (NAFLD) are unknown in childhood. Thus, the aim of the present study was to investigate in 402 consecutive overweight/obese children the association between thyroid function tests and hepatic steatosis as well as metabolic variables. Methods. Hepatic steatosis was diagnosed by ultrasound after exclusion of infectious and metabolic disorders. Fasting serum samples were taken for determination of thyroid function (TSH, FT4, and FT3), along with alanine aminotransferase (ALT), lipid profile, glucose, insulin, and insulin resistance (IR). Results. Eighty-eight children (21.9%) had TSH above the normal range (>4.0 mIU/L). FT3 and FT4 were within the reference intervals in all subjects. Elevated TSH was associated with increased odds of having hepatic steatosis (OR 2.10 (95% CI, 1.22-3.60)), hepatic steatosis with elevated ALT (2.42 (95% CI, 1.29-4.51)), hypertriglyceridemia, elevated total cholesterol, and IR as well as metabolic syndrome (considered as a single clinical entity), after adjustment for age, gender, pubertal status, and body mass index-SD score (or waist circumference). Conclusions. In overweight/obese children, elevated TSH concentration is a significant predictor of hepatic steatosis and lipid and glucose dysmetabolism, independently of the degree of total and visceral obesity.

Respiratory distress in newborn: evaluation of chest X-rays.

We discuss the anatomic and pathophysiological patterns of preterm and term newborn. Particular attention is directed to technical artefacts relating to the interpretation of chest radiography. We analyze the reading of chest X-Ray of preterm with low birth weight and poor lung maturation. Are also taken into account X-Ray features relating to alveolar "recruitment" and radiographic changes after surfactant's administration. We highlight the most important paintings of bruncopulmonary dysplasia and its evolution. The most frequent neonatal pulmonary inflammation and thoraco-pulmonary malformation, that may affect more the neonatologist, are mentioned. We discuss the new diagnostic approach with non invasive techniques (ultrasound) in the neonatal distress. Some easily recognizable congenital heart disease are finally describes.

Intra-operative evaluation of the sentinel lymph node for T1-N0 breast-cancer patients: always or never? A risk/benefit and cost/benefit analysis.

AIM: To investigate whether omitting intra-operative staging of the sentinel lymph node (SLN) in T1-N0 breast-cancer patients is feasible and convenient because it could allow a more efficient management of human and logistic resources without leading to an unacceptable increase in the rate of delayed axillary lymph node dissection (ALND). METHODS: According to the experimental procedure, T1a-T1b-patients were to not receive any intra-operative SLN evaluation on frozen sections (FS). In all T1c-patients, the SLN was macroscopically examined; if the node appeared clearly free of disease, no further intra-operative assessment was performed; if the node was clearly metastatic or presented a dubious aspect, the pathologist proceeded with analysis on FS. T2-patients, enrolled in the study as reference group, were treated according to the institutional standard procedure; they all received SLN staging on FS. RESULTS: The study included 395 T1-N0-patients. Among the 118 T1a-T1b-patients whose SLN was not analyzed at surgery, 12 (10.2%) were recalled for ALND. In the group of 258 T1c-patients, 112 received SLN analysis on FS and 146 did not. An SLN falsely negative either at macroscopic or FS examination was found in 33 (12.8%) cases. Overall, the rate of recall for ALND was 11.6% as compared to 8.4% in T2-patients. Using the experimental protocol, the institution reached a 9.6% cost saving, as compared to the standard procedure. CONCLUSIONS: Omission of SLN intra-operative staging in T1-N0-patients is rather safe. It provides the institution with both management and economical advantages.

Ultrasound and psoriatic arthritis - Review of the literature and general considerations.

The authors review the recent literature on the use of ultrasonography in psoriatic arthropathy. The results are discussed in light of the authors' experience and with reference to technological advances and processes.

Cephalgia secondary to neuroma in a patient with ankylosing spondylitis: a case report.

A case is presented in which a 26-year-old male with intermittent headaches of many years duration, presents to the Arlington chiropractic Clinic for evaluation and therapy. Routine palpation of the painful area reveals a small mass in the region of the greater occipital nerve. Microscopic examination of the tumor after surgical removal suggests neuroma formation. Headaches did not recur. This patient also experienced exacerbations and remissions of vague low back pain with no radiation. A sacroiliitis was both clinically and radiographically evident. These findings, a positive HLA B27 and the consistent symptom complex allowed a diagnosis of ankylosing spondylitis to be ascertained. It is concluded that palpation of the painful area is a vital portion of the physical examination and must be included in all evaluations. This case also demonstrates that the diagnosis of one problem does not preclude the presence of others. When one condition is diagnosed and therapy is instituted, diagnostic suspicion must not be relaxed.

[Radiodiagnostic evaluation in osseointegrated dental implants]. / Iter radiodiagnostico negli imianti dentari osteointegrati.

The Authors examine the various radiological techniques indispensable to pre- and postsurgical evaluation in endosseous dental implantology. Of each technique the choice criteria and diagnostic potentialities are suggested.

Cystic lymphangioma of the spleen: US-CT-MRI correlation.

A case of a surgically confirmed cystic lymphangioma of the spleen is presented. Preoperative imaging consisted of US, contrast-enhanced CT and MRI, all showing a multiloculated lesion with small cystic cavities divided by thin septa, corresponding to dilated lymphatic spaces. Preoperative studies correlated well with the pathologic findings. Cystic lymphangioma of the spleen is a very rare condition and is usually solitary and asymptomatic. Large lymphangiomas may be an indication for splenectomy, since the risk of rupture is high even from minor abdominal trauma. Preoperative diagnosis may be achieved with correlated noninvasive imaging.

Cytogenetic study of 50 de novo cases of ANLL from Argentina.

BACKGROUND AND METHODS: Consistent and specific chromosomal aberrations have been observed in an increasing number of neoplasias. In the present report, we describe the cytogenetic findings from 50 cases of de novo ANLL in Argentina, South America, studied at diagnosis. In addition, their relation with the FAB classification is analyzed. Children with Down's syndrome and secondary ANLL were excluded from this analysis. RESULTS AND CONCLUSIONS: Out of 50 banded cases studied, 11 (22%) had normal karyotype, while the remaining 39 (78%) presented abnormal metaphases with structural alterations in the majority of them. Chromosomes 7 and 22 were most frequently involved in numerical alterations in children, while chromosomes 6, 8, 14 and 16 were the ones most often involved in adults. Consistent chromosome rearrangements were observed and they were linked to specific cytomorphologic subsets. The translocations t(8;21) and t(15;17) were seen only in M2 and M3, respectively. The inversion of chromosome 16, inv(16), was a typical finding in M4, but was not restricted to this subtype. Translocation t(2;3) was observed in three cases, all M4, each with a variable chromosome pattern. These results are in accordance with cytogenetic findings in Western Europe and the USA.

[Computed tomography evaluation of metastasis of cutaneous melanoma]. / Valutazione con Tomografia Computerizzata delle metastasi da melanoma cutaneo.

PURPOSE: To assess the value of Computed Tomography (CT) in the diagnosis and in morphologic characterization of metastatic melanoma. MATERIALS AND METHODS: The data of total body CT of 124 consecutive patients with melanoma having a Breslow index 1 mm or a positive sentinel lymph node have been retrospectively reviewed. RESULTS: The CT scan showed loco-regional and/or distant metastases in 36 patients (39%). Ten of these (28%) had metastases only to lymph nodes, whereas 26 patients (72%) had multiple metastases. Nodal, pulmonary, brain, subcutaneous, hepatic, adrenal, bone, gastrointestinal, breast and abdominal wall metastases were detected in 80.6%, 47.2%, 25%, 25%, 16.7%, 13.9%, 11.1%, 5.6%, 5.6% and 2.8% of the patients respectively. All the patients with metastases also had a positive sentinel lymph nodes and/or symptoms of metastatic disease. CONCLUSIONS: CT fails to reveal any characteristic feature of metastatic melanoma, but it is of value in the diagnosis of loco-regional and distant metastases in III stage disease.