Classifying pain in transoral endoscopic thyroidectomy.

PURPOSES: Knowledge of visual analog scale (VAS) pain assessment for transoral endoscopic thyroidectomy vestibular approach (TOETVA) is limited. The purpose of this analysis was to classify the postoperative discomfort scores in patients undergoing TOETVA compared to open thyroidectomy. METHODS: Observational clinical study of patients who underwent thyroidectomy by VAS pain assessment from September 2016 to March 2017. Patients were stratified into two groups: patients eligible for TOETVA (Group TOETVA) and non-candidates for endoscopic intervention (open thyroidectomy approach-OTA). VAS was recorded in the recovery room, at 24 h, + 2, + 5, + 15, + 30, + 90 days, and 6 months after surgery. Pain assessment was stratified in VAS-lower lip, VAS-chin, VAS-jaw, VAS-anterior neck, VAS-cervical/back, VAS-swallowing, VAS-brushing, VAS-speaking, and VAS-shaving. Secondary outcome assessed were analgesic rescue dose, morbidity, operative notes, hospital stay, and histopathology. RESULTS: 41 TOETVA and 45 OTA constituted the analysis. There were differences between the TOETVA and OTA for age, gland volume, mean nodule diameter, coexistence thyroiditis, bilateral procedures, and use of drain. Operative time was longer in TOETVA. Results indicated that TOETVA was associated with reduced neck, cervical back, and swallowing VAS scores in the 24 h after surgery. Conversely, jaw and brushing teeth resulted in higher VAS score in TOETVA group. OTA patients never experienced lower lip or chin pain. The use of rescue analgesics did not differ between the two groups. CONCLUSIONS: VAS was used to measure treatment outcome in TOETVA. VAS scores achieved overall a minimal clinical importance difference from the two procedures. There appears to be both a short- and long-term different range of interpretations of pain between TOETVA and OTA.

Tailored-BODIPY/Amphiphilic Cyclodextrin Nanoassemblies with PDT Effectiveness.

Amphiphilic cyclodextrins (aCDs) are an intriguing class of carrier systems which, recently, have been proposed to deliver porphyrinoids and anticancer drugs or combined dose of both for dual therapeutic applications. The design of nanoassemblies based on aCD and photosensitizers (PSs) aims to preserve the photodynamic therapy (PDT) efficacy of PS, reducing the tendency of PS to self-aggregate, without affecting the quantum yield of singlet oxygen (1O2) production, and, not less importantly, minimizing dark toxicity and reducing photosensitization effects. With this idea in mind, in this paper, we focus on nanoassemblies between a non-ionic aCD (SC6OH) and halo-alkyl tailored iodinated boron-dipyrromethenes (BODIPY) dye, a class of molecules which recently have been successfully proposed as a stimulating alternative to porphyrinoids for their high photodynamic efficacy. Nanoassemblies of BODIPY/aCD (BL01I@SC6OH) were prepared in different aqueous media by evaporation of mixed organic film of aCD and BODIPY, hydration, and sonication. The nanostructures were characterized, measuring their hydrodynamic diameter and ξ-potential and also evaluating their time-stability in biological relevant media. Taking advantage of emissive properties of the not-iodinated BODIPY analogue (BL01), nanoassemblies based on aCD and BL01 were investigated as model system to get insight on entanglement of BODIPY in the amphiphile in aqueous dispersion, pointing out that BODIPY is well-entrapped in monomeric form (τ ≅ 6.5 ns) within the colloidal carriers. Also morphology and fluorescence emission properties were elucidated after casting the solution on glass. BL01@SC6OH is easily detectable in cytoplasm of HCT116 cell lines, evidencing the remarkable intracellular penetration of this nanoassembly similar to free BODIPY. On the same cell lines, the photodynamically active assembly BL01I/aCD shows toxicity upon irradiation. Despite the fact that free BL01I is more PDT active than its assembly, aCD can modulate the cell uptake of BODIPY, pointing out the potential of this system for in vivo PDT application.

Mapping of the anterior tibial profile to identify accurate reference points for sagittal alignment of tibial component in total knee arthroplasty.

BACKGROUND: Although standard instrumentation is the procedure most frequently used to implant a Total Knee Arthroplasty (TKA), high rates of malalignment of tibial component are reported using this technique. Anatomical landmarks for sagittal alignment have been little investigated and the best reference axis, which parallels the mechanical axis, is yet to be established. HYPOTHESIS: Mapping the Anterior Tibial Profile (ATP) may allow the identification of segmental zones of the ATP parallel to the mechanical axis which can be used to align the extramedullary rod. METHODS: An intramedullary rod was positioned in line with the mechanical axis in 47 dried cadaveric tibiae. The rod was connected to a cutting jig and to an extramedullary rod. Digitalized images of lateral view radiographs were taken and the distance between the ATP and the extramedullary rod was measured at 10-mm intervals and at interpolated distances corresponding to every 2% of the tibial length. RESULTS: Segmental portions of the ATP exhibit an alignment parallel to the mechanical axis between points located at 58% and 90% and at 62% and 88% of the tibial length. Points placed at 50% of tibial length and 5mm proximal to the ankle joint generate the longer axis parallel to the mechanical axis. CONCLUSION: The orientation of sagittal tibial cut may be improved by aligning the extramedullary rod parallel to the ATP at definite points. Points placed at 50% of the tibial length and 5mm proximal to the ankle joint may be preferred since they generate the longer axis parallel to the mechanical axis and are more easily identified at surgery.

Recapitulation of signals regulating embryonic bone formation during postnatal growth and in fracture repair.

A number of proteins have recently been identified which play roles in regulating bone development. One important example is Indian hedgehog (Ihh) which is secreted by the prehyprtrophic chondrocytes. Ihh acts as an activator of a second secreted factor, parathyroid hormone-related protein (PTHrP), which, in turn, negatively regulates the rate of chondrocyte differentiation. Here we examine the expression of these genes and their molecular targets during different stages of bone development. In addition to regulating PTHrP expression in the perichondrium, we find evidence that Ihh may also act on the chondrocytes themselves at particular stages. As bone growth continues postnatally in mammals and the developmental process is reactivated during fracture repair, understanding the molecular basis regulating bone development is of medical relevance. We find that the same molecules that regulate embryonic endochondral ossification are also expressed during postnatal bone growth and fracture healing, suggesting that these processes are controlled by similar mechanisms.

Quantification of chromatographic effects of vitamin B supplementation in urine and implications for hydration assessment.

Changes in body water elicit reflex adjustments at the kidney, thus maintaining fluid volume homeostasis. These renal adjustments change the concentration and color of urine, variables that can, in turn, be used as biomarkers of hydration status. It has been suggested that vitamin supplementation alters urine color; it is unclear whether any such alteration would confound hydration assessment via colorimetric evaluation. We tested the hypothesis that overnight vitamin B2 and/or B12 supplementation alters urine color as a marker of hydration status. Thirty healthy volunteers were monitored during a 3-day euhydrated baseline, confirmed via first morning nude body mass, urine specific gravity, and urine osmolality. Volunteers then randomly received B2 (n = 10), B12 (n = 10), or B2 + B12 (n = 10) at ∼200 × recommended dietary allowance. Euhydration was verified on trial days (two of the following: body mass ± 1.0% of the mean of visits 1-3, urine specific gravity < 1.02, urine osmolality < 700 mmol/kg). Vitamin purity and urinary B2 concentration ([B2]) and [B12] were quantified via ultraperformance liquid chromatography. Two independent observers assessed urine color using an eight-point standardized color chart. Following supplementation, urinary [B2] was elevated; however, urine color was not different between nonsupplemented and supplemented trials. For example, in the B2 trial, urinary [B2] increased from 8.6 × 10(4) ± 7.7 × 10(4) to 5.7 × 10(6) ± 5.3 × 10(6) nmol/l (P < 0.05), and urine color went from 4 ± 1 to 5 ± 1 (P > 0.05). Both conditions met the euhydrated color classification. We conclude that a large overnight dose of vitamins B2 and B12 does not confound assessment of euhydrated status via urine color.

Immunoradiometric analysis of circulating human glycosylated and nonglycosylated prolactin forms: spontaneous and stimulated secretions.

The monoclonal antibodies (MAbs) obtained in mice immunized with human PRL coupled to an anti-PRL MAb were screened for their ability to distinguish the glycosylated (G-) and nonglycosylated (NG-) forms of PRL. The 431-29 MAb exhibited high affinity binding for NG-PRL but little or no cross-reactivity to G-PRL. Using this antibody in conjunction with other MAbs which equally recognized both forms, we developed 2 immunoradiometric assays which were used to determine the amount of G- and NG-PRL in plasma. In 85 normal subjects, NG-PRL baseline levels averaged 6.6 +/- 3 micrograms/L, and represented 76 +/- 8% of the total PRL immunoreactivity. In 74 pregnant women, this proportion was significantly higher during the last 2 trimesters (84 +/- 4% and 85 +/- 6%), as compared to the first trimester (76 +/- 7%). In 6 healthy volunteers studied over 24 h, 79% of the NG-PRL peaks detected using the cluster algorithm occurred concomitantly to a G-PRL peak. The mean NG-PRL/PRL ratio was significantly higher during NG-PRL pulses (81 +/- 9%) than during valleys (71 +/- 12%). Similarly, this ratio was significantly increased during TRH or metoclopramide stimulated PRL secretion (to 88 +/- 7% and 86 +/- 6%, respectively). We conclude that 1) NG-PRL is the predominant immunoassayable form of PRL in plasma; 2) both G- and NG-PRL are cosecreted but NG-PRL is the main PRL form released during spontaneous or pharmacologically induced PRL secretion.

Biomechanical analysis of a chondrocyte-based repair model of articular cartilage.

The objective of this study was to evaluate the biomechanical properties of newly formed cartilaginous tissue synthesized from isolated chondrocytes. Cartilage from articular joints of lambs was either digested in collagenase to isolated chondrocytes or cut into discs that were devitalized by multiple freeze-thaw cycles. Isolated cells were incubated in suspension culture in the presence of devitalized cartilage matrix for 3 weeks. Multiple chondrocyte/matrix constructs were assembled with fibrin glue and implanted subcutaneously in nude mice for up to 6 weeks. Testing methods were devised to quantify integration of cartilage pieces and mechanical properties of constructs. These studies showed monotonic increase with time in tensile strength, fracture strain, fracture energy, and tensile modulus to values 5-10% of normal articular cartilage by 6 weeks in vivo. Histological analysis indicated that chondrocytes grown on dead cartilage matrix produced new matrix that integrated individual cartilage pieces with mechanically functional tissue.

Repopulation of laser-perforated chondroepiphyseal matrix with xenogeneic chondrocytes. An experimental model.

Growth of chondrocytes into a xenogeneic chondroepiphyseal matrix was investigated in an in vitro experimental model by combining viable calf chondrocytes with chick epiphyseal matrix devoid of viable chondrocytes. The chondrocytes were harvested from the wrist joints of newborn calves and cultured for 2 days. The epiphyses were harvested from the distal femurs and the proximal tibias of fetal chicks after development was arrested at 17 days by freezing. The epiphyseal specimens were prepared in four ways. These included femoral and tibial epiphyses without holes and femoral and tibial epiphyses with holes made by a laser. These epiphyseal specimens were co-cultured with calf chondrocytes for various periods. After digestion of the epiphyseal matrix, viable chondrocytes were counted in suspension. Chondrocyte division in the matrix was assessed by [3H]thymidine incorporation. The growth of calf chondrocytes into the xenogeneic chick matrix was evaluated by fluorescence microscopy on fresh thick epiphyseal sections. The percentage of viable chondrocytes in the xenogeneic epiphyseal matrix increased with culture time to a maximum at day 21. The addition of laser-drilled holes was found to extend a plateau of chondrocyte viability until day 29. A decrease in cell viability was detected at later observation points. This study demonstrates that xenogeneic matrix may serve as a morphogenetic scaffold for chondrocytic growth.

Meniscal repair using engineered tissue.

In this study, devitalized meniscal tissue pre-seeded with viable cultured chondrocytes was used to repair a bucket-handle incision in meniscal tissue transplanted to nude mice. Lamb knee menisci were devitalized by cyclic freezing and thawing. Chips measuring four by two by one-half millimeters were cut from this devitalized tissue to serve as scaffolds. These chips were then cultured either with or without viable allogeneic lamb chondrocytes. From the inner third of the devitalized meniscal tissue, rectangles were also cut approximately 8 x 6 mm. A 4 mm bucket-handle type incision was made in these blocks. The previously prepared chips either with (experimental group) or without viable chondrocytes (control group) were positioned into the incisions and secured with suture. Further control groups included blocks of devitalized menisci with incisions into which no chips were positioned and either closed with suture or left open with no suture. Specimens were transplanted to subcutaneous pouches of nude mice for 14 weeks. After 14 weeks, seven of eight experimental specimens (chips with viable chondrocytes) demonstrated bridging of the incision assessed by gross inspection and manual distraction. All the control groups were markedly different from the experimental group in that the incision remained grossly visible. Histological analysis was consistent with the differences apparent at the gross level. Only the experimental specimens (chips with viable chondrocytes) with gross bridging demonstrated obliteration of the interface between incision and scaffold. None of the control specimens revealed any cells or tissue filling the incision. Tissue engineering using scaffolds and viable cells may have an application in meniscal repair in vivo.

Bonding of cartilage matrices with cultured chondrocytes: an experimental model.

The capacity of isolated chondrocytes to join separate masses of cartilage matrix was investigated with composites implanted in subcutaneous pouches in nude mice. Slices of articular cartilage were harvested from lambs and were devitalized by cyclic freezing and thawing. The slices were then either co-cultured with viable allogeneic lamb chondrocytes (experimental) or cultured without such chondrocytes (control). Composites of three slices were constructed with use of fibrin glue and were implanted in nude mice for periods ranging from 7 to 42 days. Bonding of the experimental matrices with viable chondrocytes was achieved at 28 and 42 days, as assessed by direct examination, histology, thymidine uptake, and fluorescence. No bonding occurred in the control composites without viable chondrocytes. We conclude that devitalized cartilage matrix is a scaffold to which isolated chondrocytes can attach and begin to repopulate.

Audiological range in Turner's syndrome.

Turner's syndrome is generally characterised by bilateral gonadal disgenesis, short stature and inadequate sexual development secondary to anomalous karyotype. The purely otorhinolaryngoiatric pathology considerably influences the symptomatological features in Turner's subject and this is based on possible morphologically structured anomalies in the external, middle and inner ear, but also on the oral cavity and pharynx. From this there is evidence of otological emergence on a phlogistic infectious basis with remarkable long-term repercussion on the hearing process. Otofunctional evaluation in 21 Turner's syndrome patients shows predominance of conductive hearing loss (42.8%), proven through evidence of otitis media (33.3%) and chronic otitis media (9.5%). This, therefore, demands an attentive audiologic monitoring related to the possible development of chronic forms or cholesteatoma and the possible rehabilitative-prothesis procedure.

PIXE technique for calcium analysis of human bone.

The determination of calcium content in human bone tissue is very useful in metabolic diseases of bone, such as renal osteodystrophy, osteoporosis, hyperparathyroidism, and osteomalacia of diverse etiology. The PIXE technique allows calcium to be directly determined in bioptic tissue sections properly, sampled for histological optical and/or electron microscopy examination.Bone semithin sections (3 µm thick, 4×4 mm(2) dimensions), cut by ultramicrotome and deposited onto polyvinyl acetate films, underwent PIXE analysis using the CISE set-up. Histomorphometric (after standard staining), evaluation of calcified bone volume (CBV) in absolute value allows calcium density to be determined. A total of nine bone biopsies were analyzed (three sections each) obtaining values ranging between 352 and 482, with an average value of 421.5±15.3 (M±SE) µg/µL, in good agreement with literature data (obtained by AAS technique on dissected bone samples).The aim of this paper is to emphasize the usefulness, of combined PIXE and histomorphometric techniques for the study of calcium content in bone tissue in both healthy and diseased bones.

[Effectiveness of and tolerability to oral desmopressin in the treatment of central diabetes insipidus]. / Efficacia e tollerabilità della desmopressina in formulazione orale nel trattamento del diabete insipido centrale.

Intranasal desmopressin represents the treatment of choice in Central Diabetes Insipidus. Nevertheless, this route of administration bears some practical disadvantage, linked to either difficult delivering technique, or the status of nasal mucose. The antidiuretic effectiveness of oral desmopressin has been recently demonstrated, both in experimental animals and in man. In our study we compared oral vs. intranasal desmopressin efficacy in 13 patients affected by Central Diabetes Insipidus. The results show that the peroral administration of Desmopressin at a mean dose of 500-600 micrograms/die determines an antidiuretic effect comparable to that of intranasal route, without affecting body weight, arterial pressure and chemical analysis. Side effects, generally limited to the first week of treatment, were described (nausea, vomiting, headache, dizziness [corrected], bitter taste, epygastralgia, asthenia, epystassis), inducing 4/13 patients to withdrawal the trial.

Early protection to Junín virus of guinea pig with an attenuated Junín virus strain.

Inoculation of guinea pigs with attenuated XJO Junín virus (JV) strain confers protection against challenge with pathogenic XJ-JV strain starting as early as 3 days post infection (p.i.). The protection increased continuously up to 100% by 30 days p.i. Neither stimulation of non-specific cell mediated mechanisms by previous BCG sensitization nor circulating interferon (IFN) seemed essential for such protection. The early detection of the virus in guinea pig organs considered the site of primary JV multiplication suggests that early resistance phenomenon was attributed mainly to direct viral interference.

[A case of primary echinococcosis of the breast]. / Un caso di echinococcosi primitiva della mammella.

A case of hydatid cyst of the breast is reported. Stress is laid on its extreme rarity, the aspecificity of its symptomatology and the importance of considering this type of pathology in the differential diagnosis of cystic conditions of the breast.

[Burn patients in major emergencies. The preparation of air-drop kits for emergency surgical-resuscitation use]. / Pazienti ustionati nelle grandi emergenze. Confezionamento di kit per aviolancio di pronto impiego chirurgico-rianimatorio.

The kit described is for air-dropping for immediate use in the surgical treatment and resuscitation of burn victims in major emergencies when there is no direct access to the disaster area by rescue teams or vehicles. The kit can also be used to make up for deficiencies in medicines or medical materials in remote hospitals that have admitted people with severe burns who are not immediately transferable to other hospitals.

Mitotic activity in chondrocyte transplantation from the in vitro phase to the in vivo phase.

The transplantation of devitalized allogenic matrices vehiculating autologous chondrocytes, previously isoled and seeded on them could be a solution to the problem of repairing lesions of the joint cartilage. For the matrix/cell "composite" to be "graftable" the cells must continue to duplicate and produce cartilaginous matrix even after transport in vivo. The present study analyzes the mitotic activity of chondrocytes planted on devitalized allogenic cartilage and grafted in living animals. Chondrocytes of joint cartilage of lambs were isolated enzymatically and then seeded in vitro on devitalized allogenic cartilaginous matrices for 3 weeks. At the end of the co-culture period, these matrix/chondrocyte composites were transplanted in subcutaneous pockets of athymic mice. The experimental and control samples were evaluated subsequent to explantation by histological study and incorporation of tritiated thymidine. The results obtained revealed an important decrease in the values for the incorporation of thymidine beginning from experimental time 0 (pre-implant evaluation) up to day 28 after implantation, followed by a mild increase at the experimental time of 42 days. This study demonstrated the tendency of articular chondrocytes cultivated in vitro and subsequently transplanted in vivo on a support of devitalized allogenic cartilaginous matrix to modify mitotic activity from very high values for the first experimental times, typical of the in vitro phases of cellular expansion, to very low values, more similar to the behavior of articular chondrocytes in vivo.

[Immediate surgical treatment of penetrating wounds of the heart. Clinico-diagnostic and therapeutic considerations on 2 cases of suture of the myocardium]. / Il trattamento chirurgico immediato nelle ferite penetranti del cuore. Considerazioni clinico-diagnostiche e terapeutiche su due casi di sutura del miocardio.

The authors, on the basis of their experience on two cases of cardiac tamponade, and from the revision of literature, retain that immediate thoracotomy, followed by re-examination of the pericardial sac and myocardiorrhaphy, represents a treatment preferable to the evacuant pericardiocentesis, confining the latter only to diagnostic conditions and immediate decompression in cases which arrive in unequipped places.

[Gardner's syndrome in familial popyposis: clinical contribution and etiopathogenetic, therapeutic and prognostic considerations]. / La sindrome di Gardner nella poliposi familiare: contributo clinico, considerazioni etio-patogenetiche, terapeutiche e prognostiche.

Starting from one case of Gardner's syndrome of their own observation, and in light of Watne's results, the authors argue that in the syndrome just named--and in familial polyposis in a broader sense--genetic factors do not play a predominant role; rather, polyps seem to result from the prolonged action of noxious agents. At any rate, said action can be neutralized, and possibly prevented either with a surgical modification of the distal gut or by treatment with a chemical substance identified as ascorbic acid. In view of these considerations, the authors recommend preventive medical therapy.

[The prevalence of rhinopharyngeal staphylococcal carriers among those employed in the communal food services of the province of Rome]. / Prevalenza di portatori rino-faringei di stafilococchi tra gli addetti ai servizi di ristorazione collettiva della provincia di Roma.

Microbial food contamination is at present less frequent than in the past. Nevertheless, Staphylococcus aureus food poisoning is still among the most frequent ones in Italy. The authors screened nasal swabs of 112 person working in five communal feeding services in Rome province; of these, 53 were found to be positive. This percentage (48.3%) does not differ substantially from those found by other researchers in various Italian cites.