The feasibility of contrast enhanced ultrasonography (CEUS) in the diagnosis of non-cardiac thoracic disorders of dogs and cats.

BACKGROUND: This study describes the feasibility of Contrast Enhanced Ultrasonography (CEUS) in the diagnostic work-up of non-cardiac thoracic disorders of small animals. The second aim is to assess the usefulness of CEUS as a direct guide for sample procedures. RESULTS: Forty animals, 28 dogs and 12 cats, were included in the study. Thoracic disorders included 23 pulmonary lesions [primary carcinoma (14), lymphoma (1), sarcoma (1), histiocytic sarcoma (1), abscess (1) and pneumonia (5)] and 17 mediastinal lesions [lymphoma (8), thymoma (3), mesothelioma (1), melanoma (1), carcinomatous lymphadenopathy (1), mixsosarcoma (1), lipoma (1), and abscess (1)]. The majority of neoplastic pulmonary lesions showed an inhomogeneous distribution of contrast medium, whereas inflammatory lesions had a homogenous distribution with typical pulmonary vessels ramification. The majority of mediastinal malignant lesions showed an inhomogeneous distribution pattern. The lung and mediastinal abscesses had peripheral enhancement of the wall with an avascular center. All cytological and biopsy samples obtained after CEUS were diagnostic. Quantitative analysis, performed in 19/23 pulmonary lesions, showed a statistically significant difference (P < 0.0001) between the arrival time of the malignant (7.27 s - range 4.46-13.52 s) and benign (4.52 s - range 2.87-6.06 s) pulmonary lesions. CONCLUSIONS: CEUS may be a useful tool for the evaluation of non-cardiac thoracic lesions. The contrast medium allows for the precise definition of lesion edges, the presence of necrotic areas, and the distribution of pulmonary vessels. Based on our preliminary results, the use of ultrasonographic contrast medium can be recommended for improving the diagnostic usefulness of cytology and biopsy sampling, because CEUS may help to define necrotic areas from viable tissue.

Abscisic acid and stress induced by salt: Effect on the phenylpropanoid, L-ascorbic acid and abscisic acid metabolism of strawberry fruits.

Strawberry is one of the most popular fruits because of its sensorial and functional properties. However, strawberry crop is sensitive to salt stress conditions. Despite plants have plasticity, high salt concentrations induce molecular, biochemical, and physiological responses in plants. There is evidence that the abscisic acid (ABA) hormone acts as a signaling molecule under stress conditions; however, the molecular mechanisms involved in the synthesis and homeostasis of ABA and in the induction of phytochemical antioxidant compounds under stress conditions remain unclear. In this study, the effect of stress induced by NaCl (salt stress - SS), with or without the simultaneous application of ABA, on the ABA, phenylpropanoids and L-ascorbic acid (AsA) metabolisms were evaluated. The physiological aspects (Na, Cl and proline concentration, photosynthetic variables) were also studied. The results showed that salt stress increases the Na and Cl content in the leaves, affects photosynthetic variables and triggers the production of proline, pelargonidin-3-O-glucoside, total phenolic compounds and AsA content, alongside the upregulation of several genes from the phenylpropanoid and flavonoid pathways. These effects were accompanied by the induction of compounds and transcripts related to ABA biosynthesis, conjugation and catabolism. Otherwise, the exogenous application of ABA in salt stressed plants promotes a shift in gene expression and metabolism to mitigate the stress. Therefore, salt stress affects the metabolism of ABA, phenylpropanoids and AsA in strawberry increasing phytochemical composition which is strongly associated with an ABA-dependent mechanism.

Correlations between transversal discrepancies of the upper maxilla and oral breathing.

AIM: The aim of the study was to evaluate the relationship between malocclusion with cross-bite and permeability of the upper airways, and to observe the cephalometric changes of the rhinopharyngeal space after rapid palatal expansion therapy. MATERIALS AND METHODS: The sample consisted of 17 patients (age 9-12) of which 10 were males, followed up for a period of 1 year at the Department of Paediatric Dentistry of the Dental Clinic of the University of Pisa. Clinical, radiographical and otolaryngological examinations were carried out before treatment with palatal expansor. After expansor activation, each patient underwent an otolaryngological and orthodontic evaluation followed by rhinomanometry, and, in the cooperating children, endoscopy was also performed. After 6 and 12 months from the beginning of the treatment, each patient was examined again and the radiographic examination was repeated. RESULTS AND CONCLUSION: The cephalometric analysis exhibited an increase of the rhinopharyngeal space in 16 children. Furthermore all the 17 patients showed, after therapy, an increase of the transverse dimension of the upper jaw, measured on the postero-anterior teleradiography. On the other hand, the otolaryngological examination, and in particular rhinomanometry, exhibited an improvement of the flow and of right and left nasal resistance only in 3 children, while in 6 children the graph remained unchanged, and in 8 children it worsened. The results show that the rapid palatal expansion produces an improvement of the transversal skeletal discrepancy, and an improvement of the permeability of the upper airways. To make a correct diagnosis lateral and postero-anterior teleradiography, and a cephalometric analysis are needed; instead the otolaryngological examination in our opinion it is not an essential diagnostic examination for this kind of pathology.

Adeno-tonsillar surgery in Italy.

Indications to surgery for adeno-tonsillar inflammatory disorders and analysis of the effectiveness of surgical treatment, compared with watchful waiting strategy, continue to be the subject of scientific debate. The present investigation focuses on the surgical activity of 14 Italian Otorhinolaryngological Units between 1999 and 2004. Surgical interventions (adeno-tonsillectomy, adenoidectomy, tonsillectomy) on 26915 children (age range: 2-11 years) were considered. Data on adeno-tonsillar interventions were analysed in relation to other interventions of ENT interest, performed in the same units and in the same period. Adeno-tonsillar interventions accounted for 35.4% of all operations of ENT interest. Adeno-tonsillectomy accounted for 56.6% of overall adeno-tonsillar operations, adenoidectomy 31.6%, tonsillectomy 11.8%. The percentage for the three interventions was homogeneous in the period of the study and in the recruited units. The percentage of children who underwent adeno-tonsillar surgery in paediatric units was higher as compared to general units, as far as concerns the overall number of operations performed. In southern Italy, the number of adeno-tonsillar interventions, in general, and of adeno-tonsillectomy, in particular, was higher compared to that in northern Italy. Results of the present study suggest that environmental factors, cultural issues and local health demands, may influence indications and, therefore, the different incidence of the operations under consideration in the units taking part in the investigation.

Abnormal involuntary movements (AIMs) following pulsatile dopaminergic stimulation: severe deterioration and morphological correlates following the loss of locus coeruleus neurons.

Parkinsonian patients are treated with dopamine replacement therapy (typically, intermittent administration of the dopamine precursor L-DOPA); however, this is associated with the onset of abnormal involuntary movements, which seriously impair the quality of life. The molecular mechanisms underlying abnormal involuntary movements represent an intense field of investigation in the area of neurobiology of disease, although their aetiology remains unclear. Apart from the fine cellular mechanisms, the pathways responsible for the generation of abnormal involuntary movements may involve changes in neurotransmitter systems. A potential candidate is noradrenaline, since a severe loss of this neurotransmitter characterizes Parkinson's disease, and noradrenergic drugs produce a symptomatic relief of L-DOPA-induced dyskinesia. In previous studies we found that pulsatile dopamine release, in the absence of the physiological noradrenaline innervation, produces motor alterations and ultrastructural changes within striatal neurons. In the present study we demonstrate that a unilateral damage to the noradrenaline system anticipates the onset and worsens the severity of L-DOPA-induced contralateral abnormal involuntary movements in hemi-parkinsonian rats. Similarly, ubiquitin-positive striatal ultrastructural changes occur in unilaterally dopamine-depleted, noradrenaline-deficient rats following chronic L-DOPA administration. This study confirms a significant impact of the noradrenergic system in the natural history of Parkinson's disease and extends its role to the behavioural and morphological effects taking place during pulsatile dopamine replacement therapy.

Oncocytic cyst of the larynx: an unusual occurrence.

Oncocytic cysts of the larynx are rare benign, slow growing lesions that are lined predominantly or exclusively by oncocytes, the cytoplasm of which contains a considerable number of hypertrophied mitochondria, which accounts for their eosinophilia and swollen appearance. The oncocytic change is a phenomenon of metaplasia which occurs frequently in epithelial endocrine cells with high metabolic activity and it is also associated with inflammation, degenerative process or cellular ageing. In the larynx, oncocytic metaplasia is very uncommon, but it is occasionally seen in the lining of laryngeal cysts, which are found most commonly in the ventricles or in the false vocal cords, where seromucinous glands are more abundant. Oncocytic cysts typically occur in the elderly and are usually solitary, with involvement of an isolated site, whereas diffuse involvement with multiple cysts is extremely rare. Hoarseness is the most common presenting symptom, while pain, stridor or laryngeal obstruction are unusual complaints. Management of these lesions is conservative and consists of local excision, endoscopic removal being the treatment of choice. Although oncocytic cysts are benign lesions, follow-up is recommended, as recurrence is possible, especially in the case of patients with multiple involvement, since they may show a tendency to develop new cysts. To date, approximately 150 cases of laryngeal oncocytic cysts have been published. Herein, a very unusual case is presented occurring in a 43-year-old male patient, therefore, "epidemiologically" atypical for developing oncocytic lesions. Causes of oncocytic changes and pathogenesis of laryngeal cysts are discussed.

Prevalence and pathogenesis of dental and periodontal lesions in children with X-linked hypophosphatemic rickets.

AIM: To assess the prevalence and to investigate the pathogenetic mechanisms of dental and periodontal lesions in children with X-linked hypophosphatemic rickets (XLH) examined at diagnosis or during treatment. METHODS: Nine children with XLH (age 7.2 +/- 3.3 years) were enrolled in the study (at diagnosis, n = 2; during treatment with oral inorganic phosphate salts combined with 1,25-dihydroxyvitamin D3, n = 7). Oral examination was performed according to the evidence of carious and gingival lesions. Decayed or filled teeth (dft) index for primary teeth, and the decayed, missing, or filled teeth (DMFT) index for permanent teeth was assessed. All patients with a history of spontaneous dental abscesses underwent orthopantomography examination. RESULTS: d/D ranged from 0 to 9 and f/F from 0 to 3. DMFT/dft index was 0 in the three youngest patients. One patient had enamel hypoplasia and two had enamel dyschromic alterations. Six out of nine patients (67%) had a history of spontaneous fistulae as a consequence of periapical abscesses occurring in the absence of dental decay or history of injury. In these patients, orthopantomographies showed enlarged pulp chambers associated with prominent pulp horns extending up to the dentino-enamel junction in both primary and permanent dentition. CONCLUSION: XLH patients show some peculiar dentinal abnormalities. Treatment prevents only in part dental and periodontal lesions. Genetic mechanisms have a main role in causing defective dentin mineralisation.

Papillomatosis of the larynx: treatment with CO2 laser.

OBJECTIVES: We report our experience treating papillomatosis of the larynx using CO2 laser which has a lower risk of post surgical complications. Papillomatosis has a high incidence of recurrence after surgical treatment. METHODS: We treated 42 patients (10 adults and 32 children) affected by multiple papillomatosis of the larynx. Smaller papillomas were vaporized with a 7-8 Watt CO2 laser and larger papillomas were resected at the base of their implantation. A strict follow-up during the first 3 years after surgical treatment was necessary to manage recurrences with CO2 laser endoscopy. RESULTS: All patients presented with recurrences after the first surgical treatment, but within 18-60 months all patients presented a solution of their pathology. Post-operative complications were observed in patients who did not comply with the strict follow-up protocol and presented with large lesions requiring more invasive surgery. CONCLUSIONS: CO2 laser endoscopy, although it did not prevent recurrences of papillomatosis in the larynx, is a valid surgical approach in the management of this pathology.

Outcome assessment in patients with chronic obstructive rhinitis CO2 laser treated.

Surgical lasers have been used to restore nasal flow in chronic obstructive rhinitis, with a significant improvement in symptoms having been reported in almost all cases. However, evidence supporting the efficacy at long-term, and studies on the assessment of quality of life remain limited. In the present study, efficacy at long term and improvement in the quality of life were assessed in patients with chronic obstructive rhinitis, treated with CO2 laser. A total of 308 patients with chronic obstructive rhinitis were enrolled. The primary outcome measure assessed was the change in score regarding specific and general symptoms, between baseline to 2-4.5 and 7.8 mean years follow-up. Laser turbinotomy restored nasal flow and induced a change in total score which was statistically significant, for specific and general symptoms at the first, second and third follow-up, p < 0.01. CO2 laser turbinate surgery improved symptoms and quality of life in patients with chronic obstructive rhinitis as observed at 2-4.5 and 7.8 mean years follow-up.

Submandibular gland myoepithelioma.

Benign myoepithelioma is a very rare form of salivary gland tumor, composed entirely of myoepithelial cells. It accounts for approximately 1% of all salivary gland tumors and is most frequently located in the parotid gland and in the minor salivary glands of the hard palate. We describe herein the ninth reported case of myoepithelioma of the submandibular gland. Benign myoepithelioma must be differentiated from several benign and malignant epithelial and mesenchymal tumors. Immunohistochemical staining can help differentiate between these conditions, but histopathology remains the gold standard for diagnosing this neoplastic process.

Reduced ACTH, while normal beta-endorphin CSF levels in early epileptic encephalopathies.

Since ACTH and the opioids display opposite effects on experimentally-induced seizures, cerebrospinal fluid (CSF) levels of ACTH and beta-endorphin (beta-EP) were measured in 6 children (4-8 months) affected by infantile spasms with hypsarhythmia, an idiopathic early onset encephalopathy, and in 8 age-matched controls. beta-EP levels in the patients (76.3 +/- 14.7 fmol/ml, M +/- SD) did not differ from those in controls (109.8 +/- 42.7) while babies with epileptic encephalopathy showed reduced ACTH levels in the CSF (3.8 +/- 1.5) as compared to controls (9.0 +/- 3.7, p less than 0.01). This resulted in an increased beta-EP/ACTH ratio. Another patient previously treated with ACTH showed a normal CSF level of ACTH (9.0) with a normal beta-EP/ACTH ratio while in clinical and EEG remission. These results are consistent with the hypothesis that some infantile seizures unrelated to brain injuries could originate from an ACTH deficiency at central level and/or an imbalance of neuropeptidergic pathways.

High-performance liquid chromatographic analysis of dextromethorphan, guaifenesin and benzoate in a cough syrup for stability testing.

A method has been developed for the analysis of a cough syrup containing dextromethorphan, guaifenesin, benzoic acid, saccharin and other components. Forced degradation was also studied to demonstrate that the method could be employed during a stability study of the syrup. Final conditions were phosphate buffer (25 mM, pH 2.8) with triethylamine (TEA)-acetonitrile (75:25, v/v). In such conditions, all the actives, excipients and degradation products were baseline resolved in less than 14 min, and different wavelengths were used for the different analytes and related compounds.

Capillary electrophoresis for the determination of new markers of natural latex quality.

Nowadays, increasing use of latex products in the healthcare area has also led to an increase in new scientific controls of raw material and manufactured products in order to maintain higher standards in quality control. Since field latex is a rich environment for microbial growth, in the absence of adequate preservation, the carbohydrates that it contains become microbiologically oxidised to the so-called volatile fatty acids (VFAs). Samples of natural rubber latex coming from different countries and processed in different ways have been tested by applying a capillary electrophoresis method for the measurement of the short-chain organic acids present in sera. The separation was performed with phosphate buffer at pH 6.25 and cetyltrimethylammonium bromide (CTAB) as background electrolyte in an uncoated fused-silica capillary with -10 kV of applied potential. The sample needs no other pre-treatment more than coagulation to obtain the serum. In the assayed samples, it has been shown that poorly-preserved latex presented higher amounts of succinic acid and lower amounts of malic acid. The succinic to malic acid ratio may be an important parameter because it cannot be altered by dilution or similar processes such as the traditional VFA index, used to determine the quality of latex. Ratios for succinic to malic acid <0.6 have been found for well-preserved latex and >0.6 for poorly-preserved latex.

Development and validation of a capillary electrophoresis method for the measurement of short-chain organic acids in natural rubber latex.

Short-chain organic acid contents in serum of natural latex are interesting to measure and capillary electrophoresis (CE) has proved to be a good tool for their study. In the present work a method has been developed to identify the short-chain organic acids present in sera of natural rubber latex (oxalic, formic, fumaric, aconitic, succinic, malic, glutaric, citric, acetic, glycollic, propionic and quinic acids), the separation was optimised and the quantification method validated. The separation was performed on a CE system with UV detection at 200 nm. The separation was carried out with an uncoated fused-silica capillary (57 cm x 50 microm I.D.) and was operated at -10 kV potential. The separation buffers were prepared with 0.5 M H3PO4, 0.5 mM cetyltrimethylammonium bromide and pH adjusted by adding NaOH to 6.25 except for propionic acid which was better measured at pH 7.00. Validation parameters are adequate and limits of detection range from 0.005 mM to 1.6 mM. Short-chain organic acids were measured with this method in sera of three different types of latex.

An adolescent male with multiple paraphilias successfully treated with fluoxetine.

Little is known about the psychiatric diagnosis and treatment of adolescents who sexually offend. We therefore describe an adolescent sex offender who met DSM-IV criteria for multiple paraphilias (except for the age criterion), bipolar type II disorder, and OCD, whose paraphilic urges and behaviors, depression, and violent obsessions responded to open label fluoxetine after failing to respond to long-term residential treatment. Although only a single and uncontrolled observation, this case suggests that some adolescent sex offenders may in fact have paraphilias, and that paraphilias in adolescents, like those in adults, may respond to serotonin reuptake inhibitors.

Antiepileptic drugs and puberty.

This paper investigates pubertal development in 57 epileptic subjects, ranging in age from 6 to 15 years, under anti-epileptic therapy for at least 2 years. The results were compared with those from a control group of healthy volunteers. The onset of stage II puberty was significantly earlier in both male and female treated epileptics than in healthy control subjects: at this stage serum levels of 17-beta-estradiol (E2) were found to be significantly lower in treated epileptic females than in healthy control females and the serum levels of follicle-stimulating hormone (FSH) significantly lower in treated epileptic males than in control subjects. At stage III puberty, serum levels of FSH were significantly lower both in male and female treated epileptic than in healthy control subjects.

Late febrile convulsions: a clinical follow-up.

A joint study was performed on patients from the Pediatric Clinics of Catania and Modena. Two hundred and twenty-two children who presented with febrile convulsions (FC) after the age of six years (LFC) were followed up in order to evaluate the risk of recurrence and type of convulsions. The overall results showed that 94 patients out of 222 (42.3%) had subsequent fits, both febrile and afebrile. The present study suggests that the risk of subsequent afebrile crises in LFC is higher (15.8%) than observed after "simple" FC (2-3%) and similar to that reported after "complex" FC (13-17%).

[Clinical aspects, differential diagnosis and evolution of visual epileptic seizures in children]. / Clinique, diagnostic différentiel et évolution des crises épileptiques visuelles de l'enfant.

We studied 13 boys and girls, treated for ictal visual episodes, followed-up in the Center for Epilepsy of the University of Modena. In 10 cases visual symptoms (amaurosis, hallucinations, and illusions) started between 6 and 14 years, associated with occipital EEG anomalies. In 6 cases, EEG abnormalities (sharp-waves, slow waves, spikes, spike-waves) disappeared after eyes opening. In the history of half of our cases, there was no significant antecedent. Normal intelligence and behaviour were present in all cases. Only in one case, CT demonstrated bilateral occipital calcifications. In the other 9, visual ictal symptoms disappeared after antiepileptic treatment. We think that these last cases present the characteristic features of Benign Occipital Epilepsy described by Gastaut (1982-1985). On the basis of our results, we can confirm the existence of this syndrome, even if it is rare. Nevertheless, 3 of our cases with visual symptoms, don't show the typical picture of BOE, and must be diagnostically distinguished from psychiatric disorders, basilar migraine, and other partial epilepsies.

The use of flunarizine in pediatric epilepsy.

Using the same technique as Declerk's and Wauquier's, we added flunarizine to standard therapy in 14 patients, 7 of whom were treated with the sequence flunarizine-placebo and 7 with the sequence placebo-flunarizine. Treatment averaged between 75 and 85 days, with medication administered in a single dose (orally, in drops), 5-10 mg/day. The patients comprised 7 males and 7 females, from 13 to 17 years with the following diagnoses: epileptic encephalopathy 6 cases, grand mal, myoclonic epilepsy, multifocal epilepsy, epilepsy with polymorphic seizures, 2 cases each. Age, sex and disease were distributed equally in both sequences. During treatment with flunarizine we observed the following: 7 cases--no effect on number or severity of seizures; 2 cases--moderate results; 5 cases--good results.

Montgomery thyroplasty. Case report focusing on endoscopic and functional findings.

The case is described of a 58-year-old male with cord paralysis submitted to Montgomery thyroplasty, attention being focused on the electro-acoustical findings. The usefulness is underlined of these indices which provide the opportunity to establish the phonatory advantages and results of this surgical procedure: Videolaryngostroboscopy and spectrographic analyses were carried out before and after surgery. Phonatory results were, in fact, evaluable 24 hours after surgery and found to be excellent whereas the perceptive evaluation and subjective symptoms were seen to be comparable to those in normal subjects one week after surgery.