Anterior, extracanalar, cervical spine osteochondroma associated with DISH: description of a very rare tumor causing bilateral vocal cord paralysis, laryngeal compression and dysphagia. Case report and review of the literature.

INTRODUCTION: Osteochondromas are common benign bone tumors, rarely involving the spine. BACKGROUND: Osteochondroma account for about 35% of bone benign tumors and 9% of all bone tumors. Spinal involvement is described in 1%-4% of cases and their origin from the anterior surface of cervical vertebral bodies is exceedingly rare. AIM: We describe the rare case of an osteochondroma arising from the anterior surface of the C4 and C5 vertebral bodies, and not involving the spinal canal, in a 68-year-old male patient suffering from Diffuse Idiopathic Skeletal Hyperostosis (DISH). MATERIALS AND METHODS: The patient presented with acute onset of respiratory distress due to laryngeal compression exerted by the lesion, dysphagia and paralysis of left vocal cord. Imaging revealed the unusual lesion compressing and dislocating the air ways. An anterior approach to cervical spine was performed to remove the tumor. RESULTS: Postoperatively, the patient sustained a progressive improvement of respiratory function and recovery of the vocal cord paralysis. DISCUSSION: We believe that this case holds some interesting peculiarities: firstly, the anterior location of a cervical osteochondroma could be considered exceptional; yet, the resulting clinical picture should be remembered for differential diagnosis. Secondly, we hypothesized a possible correlation between the tumorigenesis of osteochondroma and the co-existence of DISH. Indeed, the abnormal bone turnover in cervical segments due to DISH could explain the unusual occurrence of osteochondromas in adult age. CONCLUSIONS: The occurrence of an osteochondroma should be considered in patients suffering from DISH and harbouring large osteophytes.

Feasibility, safety, and preliminary proof of principles of autologous neural stem cell treatment combined with T-cell vaccination for ALS patients.

Uncontrolled activation of the innate immune system promotes the deterioration of neurons in different neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS). T-cell vaccination (TCV) was developed by Irun Cohen and coworkers at the Weizmann Institute of Science (Israel) during the late 1970s and has been demonstrated to be an effective treatment for human autoimmune diseases and a regulator of macrophage activation in animal models. We treated seven ALS patients with this cell therapy and were able to slow or stop disease progression in the affected individuals. The median survival, which is 3.5 years, was extended to 6 years. They were also treated with autologous adult neural stem cells associated with effector T cells. The observed neurologic improvements after treatment lasted for at least 1 year. Clinical recovery in the treated ALS patients was confirmed by an independent, skilled neurologist using the ALS Functional Rating Scale-Revised (ALSFRS-R). TCV in conjunction with an autologous neural stem cell treatment might be a feasible, minimally invasive, safe, and effective approach to obtain enduring therapeutic effects in ALS patients.

Investigation about causes of blindness and low vision among members of Blind and Visually Impaired Italian Union (UICI).

PURPOSE: To evaluate the prevalence of the most important causes of blindness among visually impaired and blind, members of UICI (Blind and Visually Impaired Italian Union). The main aim is to get information about the most important ocular diseases which make people blind or visually impaired in Italy. Further purpose is to make our data useful to provide economical evaluations about public expense due to blindness and low vision. MATERIALS AND METHODS: A retrospective analysis was carried out on UICI database to get information about members of the most important UICI Provincial Centers. The Centers were selected depending on specific inclusion criteria. The descriptive analysis was performed with SAS System 9.1.3 and Microsoft Excel 2007. RESULTS: Data were available for 15,725 UICI members, whose 39% (n=6,133) were visually impaired and 61% (n=9.592) were blind. Pathologic myopia was responsible for low vision and blindness in 11.78%, AMD in 11%, cataract in 8.92%, glaucoma in 8.31%, diabetic retinopathy in 8.23%, retinitis pigmentosa in 6.96%. DISCUSSION: The analyzed sample allows to get only a rough, although useful, estimate of low vision and blindness in Italy. The causes of visual impairment we found are quite in line with those provided by other international studies. The main difference from previous studies concerns pathologic myopia and retinitis pigmentosa as the most important causes of low vision and blindness among working-age people. Our epidemiological study should be mixed with economical cost-effectiveness evaluations in order to provide further impulses to efficient prevention programs.

Acute Myopia: could it be the presenting symptom of a rheumatic disease? A case report

This is a case-report of a patient who came to our Eye Emergency Room for acute onset of myopia and asthenia. The purpose is to evaluate the causes of acute myopia in a 28 year old woman with a family history of rheumatic diseases and a positive antibody titer (ANA). The UBM-study showed a 360° choroidal effusion and the hematological analysis showed mild anemia, lymphocytosis and ANA antibodies were positive. All that signs could suggest a vasculitis-like onset of an autoimmune disease, involving the eye first. Although the diagnosis of Systemic Lupus Erythematosus (SLE) or other autoimmune diseases cannot be confirmed according to the rheumatologic criteria, the vasculitic ocular manifestations with positive antibodies in the young woman need further evaluation because it seems to be enough to refer the patient to a rheumatology follow-up.

[Children's eye care in Italy through data provided by "Let's see clear" campaign]. / La salute oculare nell'infanzia in Italia attraverso i dati della campagna "Vediamoci Chiaro".

PURPOSE: To know children's visual conditions and assess the actual status of ophthalmological prevention in Italy, highlighting both positive and negative aspects and its variables. MATERIALS AND METHODS: Research was carried out in nine Italian regions (Sicilia, Calabria, Campania, Lazio, Abruzzo, Molise, Emilia Romagna, Lombardia, Friuli Venezia Giulia) by means of questionnaire filled in by preschool, elementary and junior high school children's parents. A different amount of questionnaires has been got for each region. For this reason a percentage distribution is used instead of absolute value, in order to remove distortion due to the different size of samples from region to region. Statistical analysis was carried out. RESULTS: 36.744 files were collected. Most important data were about (average):Parents' schooling (37% junior high school, 46% high school, 12% degree). 2. Spread of refractive errors (23% of children wear glasses). 3. Relation between children glasses (77% accepted glasses); 4. First ophthalmological examination: age (90% <6 yrs old in Lombardia), aim (77% prevention), who take the initiative (77% parents). 5. Relation between neonatal ophthalmological examination and premature birth or stay in incubator (Friuli: examination carried out on 63% of premature babies and on 79% of babies who needed the stay in the incubator). 6. The most common ocular diseases among children (subjective disorders 60%, motility disorders 20%, annexes' disorders 8%). DISCUSSION: There are no many examples of studies about childhood health and even less frequent are the investigations about prevention and the diffusion of ophthalmological examination among children. Our data result from a pretty representative sample of Italian reality. The main feature of visual health among the children included in our research is the great spread of refractive errors, according to most economically advanced countries. Parents play a key role regarding childhood prevention, because they seem to have a high level of awareness in most included regions. Therefore, the family should represent the recipient of efforts in order to move up further the ophthalmological examination on children, preferably at birth.

QENS investigation of the dynamics of starch saccharides.

We present here quasi-elastic neutron scattering results on D20 hydrated samples of amylose, one of the main saccharide components of starch. Two different sample hydrations (h = 0.5 and 1.0 g D2O (g dry amylose)-1 have been investigated in the temperature range 170 to 350 K. Below 260 K only an elastic contribution is present in the spectra, while a quasi-elastic component shows up above this temperature. The elastic incoherent structure factor (EISF) associated with this component changes considerably with increasing temperature. For the sample with hydration h = 0.5 the confinement volume increases by a factor of four in going from 300 to 350 K, and the proportion of hydrogen involved in the confined diffusion motion increases as well from 30 to 55%. Similar effects are observed at the higher hydration investigated. The observed dynamics can be associated with the known plasticising role of water in polysaccharides.

Mean square fluctuations of hydrogen atoms and water-biopolymer interactions in hydrated saccharides.

We have used the elastic neutron scattering technique to investigate the dynamics of the two main saccharidic components of starch: amylose and amylopectin. The measurements were carried out in the temperature range of 20 to 320 K and at different hydration levels from the dry state up to 0.47 g saccharide/g D(2)O. In the dry samples, the atomic dynamics is harmonic up to approximately 300 K. In the hydrated samples a "glass-like" transition leading to an anharmonic dynamics is observed. The onset of the anharmonicity occurs at temperatures that increase from approximately 180 K to 260 K upon decreasing hydration from 0.5 to 0.1 g saccharide/g D(2)O. This behavior is qualitatively similar to that observed in hydrated globular proteins, but quantitative differences are present. Assuming a simple asymmetric double-well potential model, the temperature and hydration dependence of the transition have been described in terms of few physical parameters.

Treatment of larva migrans cutanea (creeping eruption): a comparison between albendazole and traditional therapy.

BACKGROUND: Creeping eruption (CE), which is characteristic of tropical and subtropical regions, is being increasingly frequently observed in Italy. The presence on the beaches of stray animals infected by nematodes of the Ancylostoma species favors contact between human skin and the larva-infested soil. MATERIALS AND METHODS: Our experience with 56 patients (13 cryotherapy, one thiabendazole together with cryotherapy, six thiabendazole, two albendazole with cryotherapy, and 34 albendazole) is described. RESULTS: A prompt and definitive cure was achieved in all 56 patients. The therapeutic effectiveness of the various methods used is therefore equivalent. CONCLUSIONS: We believe that albendazole should be considered the first choice for treatment. It is extremely well tolerated and patient compliance is good.

Colestasis gravídica: asociación entre la elevación de billirrubina total y peso al nacer mensor que 2.500 gramos / Cholestasis in pregnancy: association among the total bilirubin elevation and birth weight under 2500 grams

La colestais intrahepática del embarazo (CG) es la segunda causa de ictericia durante la gestación, luego de la hepatitis viral. Presenta una prevalencia variable según área geográfica y se la relaciona con potencial morbimortalidad perinatal y materna. En diversas revisiones realizadas por nuestro grupo en el Servicio de Obstetricia del Hospital Materno Infantil Ramón Sardá, hemos observado un claro rol diagnóstico para el valor de fosfatasa alcalina, pero a su vez esta enzima no aumenta su valor en asociación con complicaciones perinatales. Como contrapartida, en una revisión durante 1995 pareció observarse una relación entre complicaciones perinatales e incremento en los valores de bilirrubina total. Estas obvservaciones sugieren que la fosfatasa alcalina retiene un clave rol diagnçostico para CG, pero se insinúa una asociación entre complicaciones perinatales y elevación de los valores de bilirrubina total

Short therapy for tinea unguium with terbinafine: four different courses of treatment.

Terbinafine has partly solved the well-known problems in the treatment of dermatophyte nail infections. The aim of our study was to assess the effectiveness of very short treatment of dermatophyte nail infections with four different courses of terbinafine with or without chemical onycholysis. For this purpose, 60 patients, divided into four groups, were given different courses of treatment with oral terbinafine. Clinical, mycological and tolerability tests were performed before, during and after treatment. Clear microscopy and culture findings confirmed cure rates in the four groups of 95%, 95%, 70% and 100% without any side-effects. In conclusion, terbinafine has proved to be effective and well tolerated in the very short-term treatment of dermatophyte nail infections.

Trichophyton soudanense in Italy.

Trichophyton soudanense is an anthropophilic dermatophyte originating in Africa. Over the last 30 years sporadic cases have been reported in countries that had colonial relations with the endemic areas. In recent times, as a result of growing racial mixing linked to migratory movements, this strain has become increasingly integrated with the species most commonly responsible for dermatophytoses. This phenomenon has occurred, although only recently, in Italy too, where there has been a heavy influx of foreign immigrants over the last few years.

[Infectious endocarditis in dentistry practice: recent controversies and modes of the use of antibiotic prophylaxis]. / L'endocardite infettiva nella pratica odontostomatologica: recenti controversie e modalità di applicazione dell profilassi antibiotica.

A survey by questionnaire to assess the daily practice of the antibiotic prophylaxis of infective endocarditis by physicians attending post-graduate schools of the Institutes of Oral Surgery and Stomatology (Group A n = 83) and Cardiology (Group B n = 46) of the Second University of Naples has been conducted. They were asked about dental procedure and cardiopathies that require prophylaxis for infective endocarditis, the relationship between infective endocarditis and rheumatic disease and the provision of antibiotic. Extraction of tooth and dental and oral surgery have been reported as the most risky procedures. Moreover provision of antibiotic prophylaxis was suggested to patients not at risk (pacemaker or coronary artery bypass), and was not suggested in high risk conditions (mitral valve prolapse with regurgitation and hypertrophic cardiomyopathy). Most of the 50-60% practitioners usually start the prophylaxis 24-48 hours before the procedure and prolong it for 48-72 hours. These results underline the need for improvement of the knowledge for the antibiotic prophylaxis of infective endocarditis.

Escherichia coli chaperonins cpn60 (groEL) and cpn10 (groES) do not catalyse the refolding of mitochondrial malate dehydrogenase.

In vitro refolding of pig mitochondrial malate dehydrogenase is investigated in the presence and absence of Escherichia coli chaperonins cpn60 (groEL) and cpn10 (groES). The refolded yields of active malate dehydrogenase are increased almost 3-fold in the presence of groEL, groES, Mg2+/ATP and K+ ions. Chaperonin-assisted refolding of malate dehydrogenase does not have an absolute requirement for K+ ions but Mg2+/ATP is obligatory. When ATP is replaced by other nucleoside triphosphates, or by non-hydrolysable ATP analogues, assisted refolding is prevented. Optimal chaperonin-assisted refolding requires both groEL and groES homo-oligomers in molar excess over malate dehydrogenase. Kinetic analysis shows that the chaperonins do not catalyse the refolding of malate dehydrogenase but increase the flux of unfolded enzyme through the productive refolding pathway without altering and/or accelerating that pathway. Although not acting as refolding catalysts, the chaperonins are able to assist at least six consecutive cycles of malate dehydrogenase refolding.