The necropolis of Bolgare (Lombardy, Italy): Anthropological and paleopathological features of a Lombard population.

The mediaeval necropolis of Bolgare - St. Chierico is an important site in northern Italy, located in the Bergamo Province (about 40 km East of Milan). In order to reconstruct aspects of the demographic and health status of this Lombard population, macroscopic (morphological, metric and radiographic) and microscopic analyses were performed on over 400 skeletons for the assessments of sex (cranial and pelvic morphology, metrics), age (subadults: dental and bone development; adults: mainly pubic symphysis, auricular surface of the ilium, 4th rib) and stature, for the determination of ancestry and the identification of pathologies. Results proved the sample to be heterogeneous with males, females, adults and subadults. The sample seemed to be composed of several groups, including individuals with northern or eastern (Uralic) European features and, on the other hand, individuals with central European or Mediterranean characteristics. The first may be indicative of migrations of Lombards (suggested by tall stature estimates); the second could be considered autochthonous, bearing features more typical of northern Italian populations. Among palaeopathological finds, the study showed the presence of tuberculosis, gout, DISH and degenerative pathologies particularly on the pelvis and spinal column. The population of Bolgare constitutes one of the main sources of anthropological data on Lombards in Italy.

Metallic artefact reduction with monoenergetic dual-energy CT: systematic ex vivo evaluation of posterior spinal fusion implants from various vendors and different spine levels.

OBJECTIVES: To evaluate optimal monoenergetic dual-energy computed tomography (DECT) settings for artefact reduction of posterior spinal fusion implants of various vendors and spine levels. METHODS: Posterior spinal fusion implants of five vendors for cervical, thoracic and lumbar spine were examined ex vivo with single-energy (SE) CT (120 kVp) and DECT (140/100 kVp). Extrapolated monoenergetic DECT images at 64, 69, 88, 105 keV and individually adjusted monoenergy for optimised image quality (OPTkeV) were generated. Two independent radiologists assessed quantitative and qualitative image parameters for each device and spine level. RESULTS: Inter-reader agreements of quantitative and qualitative parameters were high (ICC = 0.81-1.00, κ = 0.54-0.77). HU values of spinal fusion implants were significantly different among vendors (P < 0.001), spine levels (P < 0.01) and among SECT, monoenergetic DECT of 64, 69, 88, 105 keV and OPTkeV (P < 0.01). Image quality was significantly (P < 0.001) different between datasets and improved with higher monoenergies of DECT compared with SECT (V = 0.58, P < 0.001). Artefacts decreased significantly (V = 0.51, P < 0.001) at higher monoenergies. OPTkeV values ranged from 123-141 keV. OPTkeV according to vendor and spine level are presented herein. CONCLUSIONS: Monoenergetic DECT provides significantly better image quality and less metallic artefacts from implants than SECT. Use of individual keV values for vendor and spine level is recommended. KEY POINTS: • Artefacts pose problems for CT following posterior spinal fusion implants. • CT images are interpreted better with monoenergetic extrapolation using dual-energy (DE) CT. • DECT extrapolation improves image quality and reduces metallic artefacts over SECT. • There were considerable differences in monoenergy values among vendors and spine levels. • Use of individualised monoenergy values is indicated for different metallic hardware devices.

Intracranial dermoid cysts: variations of radiological and clinical features.

BACKGROUND: Intracranial dermoid cysts are uncommon, and their clinical features as well as surgical management differ from patient to patient. Dermoids are generally benign lesions, but may cause spontaneous complications such as meningitis and/or hydrocephalus due to rupture and epileptic seizures depending on their location. Little has been reported about characteristic imaging findings with resulting therapeutic considerations, and only a few reports exist about associated hydrocephalus. Imaging modalities have changed and can facilitate differential diagnosis and follow-up if applied correctly. In this paper, we attempt to contribute our clinical experience with the management of dermoid cysts. PATIENTS AND METHODS: The charts of five men and two women with intracranial dermoid cysts were retrospectively reviewed. The patients were treated between September 1993 and September 2006. Selected patients are presented in detail. RESULTS: Tumour location, size and radiographic characteristics varied in each patient. Clinical presentations comprised focal neurological deficits as well as epileptic seizures, persistent headache, mental changes and psycho-organic syndromes. One patient underwent delayed ventriculo-peritoneal shunting after ruptured fatty particles caused obstructive hydrocephalus. Despite dermoid rupture into the subarachnoid space, three patients never developed hydrocephalus. Diffuse vascular supra-tentorial lesions were seen in one patient as a result of aseptic meningitis. Diffusion-weighted imaging (DWI) hyperintensity in dermoids is related to decrease of water proton diffusion and should be used for both the diagnosis and follow-up of this lesion. CONCLUSION: Although dermoid cysts are known to be benign entities per se, their rupture can cause a wide range of symptoms including aseptic meningitis and/or hydrocephalus. This may be due to intraventricular obstruction and/or paraventricular compression. While rupture does not necessarily bring about hydrocephalus, radical removal of the tumour and close monitoring of ventricular size is required. Although not widely recognised as such, DWI is considered to be a useful imaging modality in the diagnosis and follow-up of dermoids.

Decompressive hemicraniectomy in patients with subarachnoid hemorrhage and intractable intracranial hypertension.

BACKGROUND AND PURPOSE: To evaluate the outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) developing intractable intracranial hypertension and treated by decompressive hemicraniectomy (DHC). METHODS: Of 193 patients with aSAH 38 patients were treated with DHC after early aneurysm clipping. Indications for DHC were 1. Signs of brain swelling during aneurysm surgery (group 1: primary DHC). 2. Intracranial pressure- (ICP)-elevation and epidural, subdural or intracerebral hematoma after aneurysm surgery (group 2: secondary DHC due to hematoma) 3. Brain edema and elevated ICP without radiological signs of infarction (group 3: secondary DHC without infarction). 4. Brain edema and elevated ICP with radiological signs of infarction (group 4: secondary DHC with infarction). RESULTS: Thirty-one patients (81.6%) suffered from high grade aSAH Hunt & Hess 4-5. 21 belonged to group 1, five to group 2, six to group 3 and six to group 4. Of a total of 38 patients a good functional outcome according to Glasgow Outcome Score (GOS 4 & 5) could be reached in 52.6% of the cases. 26.3% survived severely disabled (GOS 3), no case suffered from a vegetative state (GOS 2) but 21.1% died (GOS 1). After 12 months good functional outcome could be achieved in 52.4% of the cases in group 1, in 60% in group 2, in 83.3% in group 3 and in 16.7% in group 4. CONCLUSIONS: In more than half of the patients with intractable intracranial hypertension after aSAH a good functional outcome could be achieved after DHC. Patients with progressive brain edema without radiological signs of infarction and those with hematoma may benefit most. The indication for DHC should be set restrictively if secondary infarcts are manifest.

[The internal mammary artery in myocardial revascularization]. / L'arteria mammaria interna nella rivascolarizzazione miocardica.

Internal mammary artery by-pass graft is a very usefull alternative to venous by-pass graft for myocardial revascularization. From February 1982 up to August 1984, 111 patients with coronarosclerosis have been operated on with left internal mammary artery. Right internal mammary artery has been also used in 2 cases. Left internal mammary artery has been used as a sequential graft 13 times. Vein grafts have been associated in more than 2/3 of the patients who had surgery with internal mammary artery and the mean of anastomoses per patient was 2.9. Five patients had a perioperative myocardial infarction and one an infarction shortly after the operation. Ten patients had immediate reoperation: 5 for postoperative bleeding, 2 for arterial graft anastomosis occlusion, 2 for sudden ST elevation and 1 for acute myocardial infarction. Only one patient died for acute myocardial infarction post-operatively, following coronary artery spasm. Eighty-six patients have been followed-up 3 to 31 months after surgery. Advantages and limits of this surgical technique are discussed.

Acute overdosage of amiodarone in a suicide attempt.

Clinical and biochemical variables and blood levels of amiodarone and its metabolite are reported after acute self-intoxication in a young woman. Despite the huge amount of drug ingested no clinical side effects were documented over the monitored period of 3 months.

[Pharmacokinetics of amiodarone in one case of acute oral intoxication]. / Farmacocinetica dell'amiodarone in un caso di intossicazione acuta (8 grammi per os).

A wealth of data about the clinical use and the therapeutic efficacy of chronic treatment with amiodarone has been reported, while the acute effects of this agent are less known. In one case of acute oral intoxication with 8 g of amiodarone for suicidal purposes, we have investigated the pharmacokinetics of amiodarone, the thyroid function and the variations of some clinical parameters, such as heart rate and QT interval. Other possible side-effects have been looked for. We have not observed substantial pharmacokinetic differences between our case and studies carried out after chronic oral or intravenous administration. Unlike chronic administration, the acute oral load was not followed by the appearance of toxic effects. The absence of toxic phenomena can be explained by the poor bioavailability of amiodarone, which is known to require long periods for a complete distribution to the tissues and target organs.