Acute treatment of medial collateral ligament tears: short to mid-term results.

The aim of this study is to describe the results of a consecutive set of patients treated in acute for the surgical repair of medial collateral ligament (MCL) tears with a mean follow up of 63.78±43.25 months (4- 136). This is a retrospective observational study. From January 2011 to December 2016, 56 patients within the average of 31.75±13.27 (13-55) years old at the time of injury underwent medial compartment repair in an acute setting. The sample size of our study is therefore made up of 26 patients. Patients have been evaluated with functional scores: IKDC (international knee documentation committee evaluation form), the KOOS (Knee injury and osteoarthritis outcome score) and clinical assessment. The Tegner Activity Score was evaluated retrospectively at the 12 months follow-up. The mean KOOS value at the final follow-up were 91.25±9.65 (72-100) for pain, 85.68 ± 12.34 (57-100) for the symptoms category, 94.5±8,07 (75-100) for the activity of daily life, 71.87±22.86 (35-100) for the sport category and 76.37±18.55 (38-100) for the quality of life. At the last follow up the mean IKCD value was 77.68±15.95 (55-98). The mean difference in the Tegner Activity Score between the preoperative time and the postoperative time was 1.06±1.12 with a 95% Confidence Interval 0.46-1.66. The functional outcomes underline how the surgical approach to the medial capsule-ligament compartment of the knee is a reliable treatment to restore excellent joint function. Level of evidence III retrospective observational study.

Painful posterior shoulder instability: Anticipating and preventing failure. A study in 25 patients.

BACKGROUND: Painful posterior shoulder instability (PPSI) is the least common of the three clinical patterns of posterior shoulder instability. PPSI is defined as pain combined with anatomical evidence of posterior instability but no instability events. MATERIAL AND METHOD: We studied a multicentre cohort of 25 patients with PPSI; 23 were identified retrospectively and had a follow-up of at least 2 years and 2 patients were included prospectively. Most patients engaged in sports. RESULTS: All 25 patients underwent surgery, which usually consisted in arthroscopic capsulo-labral reconstruction. The outcome was excellent in 43% of patients; another 43% had improvements but reported persistent pain. The pain remained unchanged or worsened in the remaining 14% of patients. Causes of failure consisted of a missed diagnosis of shoulder osteoarthritis with posterior subluxation, technical errors, and postoperative complications. The main cause of incomplete improvement with persistent pain was presence of cartilage damage. CONCLUSION: Outcomes were excellent in patients who were free of cartilage damage, bony abnormalities associated with posterior instability (reverse Hill-Sachs lesion, erosion or fracture of the posterior glenoid), technical errors, and postoperative complications.

General cooperative effects of single atom ligands on a metal: a (195)Pt NMR chemical shift as a function of coordinated halido ligands' ionic radii overall sum.

An inverse linear relationship between the experimentally observed (195)Pt NMR signals and the overall sum of coordinated halido ligands' ionic radii was discovered in Pt(ii) and Pt(iv) complexes. The reduction of (195)Pt NMR frequencies parallels the increase of coordinated halido ligands' ionic radii sum. This suggests that each halido ligand may act as a conducting ring whose induced electric current shields the (195)Pt NMR signals proportionally to the ionic radius of the coordinated halido ligand.

Vaccination of cattle using monovalent modified-live vaccine against bluetongue virus serotype 2: innocuity, immunogenicity and effect on pregnancy.

The immunogenicity, innocuity and possible teratogenic effects of the monovalent modified-live vaccine against bluetongue (BT) virus (BTV) serotype 2, manufactured by Onderstepoort Biological Products in South Africa, was evaluated in cows. Twenty-one cows, 14 of which were at different stages of gestation, were vaccinated with 2 ml of monovalent vaccine; two served as unvaccinated controls. After immunisation, 16 vaccinated and the 2 unvaccinated controls were kept in the field; the remaining 5 pregnant cows were maintained in an insect-proof stable with a controlled environment. Blood samples were taken from field cattle once a week for two months and from the stable cattle three times a week. All samples were screened for the presence of BTV and for BT antibody using the competitive enzyme-linked immunosorbent assay (c-ELISA) and the virus neutralisation (VN) test. Intravenous egg inoculation, followed by two blind passages in Vero cells, was used to isolate BTV-2 from ethylene-diaminetetra-acetic acid (EDTA) blood samples and virus titres in viraemic animals were determined. After immunisation, 9 of the cows developed a viraemia which commenced on day 7 post vaccination (pv) and lasted for three weeks. The virus titres were never higher than 10(2.8)TCID50/ml with the highest titre observed on day 14 pv. None of the vaccinated animals developed clinical symptoms that could be attributed to BTV; after three weeks all animals showed a serological response to BTV-2. In the c-ELISA, antibodies were detected from day 7 pv while in the VN test, antibodies were observed from day 21 pv. All pregnant cows completed their gestation: 13 gave birth to healthy calves, while one of those in the field group, vaccinated at the six months gestation, delivered a calf with prosencephalic hypoplasia, possibly developed during foetal organogenesis prior to vaccination. Fourteen months after immunisation the stabled cows were challenged subcutaneously by administering 2x10(6.8)TCID50 BTV-2 Italian isolate. A third group of 4 cows was also inoculated with the BTV-2 Italian field isolate, as described for the second group and was used as the unvaccinated positive control group. Vaccinated cows had a detectable viraemia only on day 14 pv and virus titres were very low. Virus titres never exceeded 10(2.3)TCID50/ml, while the unvaccinated group developed a long and intense viraemia, peaking on day 14 pv with a titre of 1.18x10(4). It is concluded that the BTV-2 modified-live vaccine used in this study was a harmless and effective immunogen that did not cross the placental membrane.

Dynamic localization and clustering of dendritic Kv2.1 voltage-dependent potassium channels in developing hippocampal neurons.

Dendritic excitability is modulated by the highly variable spatial and temporal expression pattern of voltage-dependent potassium channels. Somatodendritic Kv2.1 channels contribute a major component of delayed rectifier potassium current in cultured hippocampal neurons, where Kv2.1 is localized to large clusters on the soma and proximal dendrites. Here we found that dramatic differences exist in the clustering of endogenous Kv2.1 in cultured rat hippocampal GABAergic interneurons and glutamatergic pyramidal neurons. Studies on neurons developing in culture revealed that while a similar sequence of Kv2.1 localization and clustering occurred in both cell types, the process was temporally delayed in pyramidal cells. Localization and clustering of recombinant green fluorescent protein-tagged Kv2.1 occurred by the same sequence of events, and imaging of GFP-Kv2.1 clustering in living neurons revealed dynamic fusion events that underlie cluster formation. Overexpression of GFP-Kv2.1 accelerated the clustering program in pyramidal neurons such that the observed differences in Kv2.1 clustering in pyramidal neurons and interneurons were eliminated. Confocal imaging showed a preferential association of Kv2.1 with the basal membrane in cultured neurons, and electrophysiological recordings from neurons cultured on transistors revealed that Kv2.1 contributed the bulk of a previously described adherens junction delayed rectifier potassium conductance. Finally, Kv2.1 clusters were found spatially associated with ryanodine receptor intracellular Ca(2+) ([Ca(2+)](i)) release channels. These findings reveal a stepwise assembly of Kv2.1 potassium channels into membrane clusters during development, and an association of these clusters with Ca(2+) signaling apparatus. Together these data suggest that the restricted localization of Kv2.1 may play an important role in the previously observed contribution of this potassium channel in regulating dendritic [Ca(2+)](i) transients.

Identification of a trafficking determinant localized to the Kv1 potassium channel pore.

The repertoire of Kv1 potassium channels expressed in presynaptic terminals of mammalian central neurons is shaped by intrinsic trafficking signals that determine surface-expression efficiencies of homomeric and heteromeric Kv1 channel complexes. Here, we show that a determinant controlling surface expression of Kv1 channels is localized to the highly conserved pore region. Point-mutation analysis revealed two residues as critical for channel trafficking, one in the extracellular "turret" domain and one in the region distal to the selectivity filter. Interestingly, these same residues also form the binding sites for polypeptide neurotoxins. Our findings demonstrate a previously uncharacterized function for the channel-pore domain as a regulator of channel trafficking.

Episodic ataxia type-1 mutations in the Kv1.1 potassium channel display distinct folding and intracellular trafficking properties.

Episodic ataxia type 1 (EA-1) is a neurological disorder arising from mutations in the Kv1.1 potassium channel alpha-subunit. EA-1 patients exhibit substantial phenotypic variability resulting from at least 14 distinct EA-1 point mutations. We found that EA-1 missense mutations generate mutant Kv1.1 subunits with folding and intracellular trafficking properties indistinguishable from wild-type Kv1.1. However, the single identified EA-1 nonsense mutation exhibits intracellular aggregation and detergent insolubility. This phenotype can be transferred to co-assembled Kv1 alpha- and Kv beta-subunits associated with Kv1.1 in neurons. These results suggest that as in many neurodegenerative disorders, intracellular aggregation of misfolded Kv1.1-containing channels may contribute to the pathophysiology of EA-1.

A randomized intervention to improve ongoing participation in mammography.

OBJECTIVE: To test the effectiveness of interventions intended to increase rates of regular breast cancer screening, according to recommended guidelines. STUDY DESIGN: A randomized controlled trial of 2 outreach interventions (a mail reminder and a telephone reminder plus appointment scheduling) compared with a routine publicity campaign to encourage continued participation in mammography screening. PARTICIPANTS AND METHODS: Participants were 1908 women aged 50 to 75 years continuously enrolled in a large group-model HMO during the study who underwent a bilateral mammogram during the first quarter of 1994 and no subsequent mammogram during the next 18 to 21 months. Data were obtained from health plan administrative data files supplemented by medical chart review. Women were randomly assigned to receive (1) a mail reminder, (2) a telephone reminder, or (3) routine publicity on mammography for all women. The outcome measure was a mammogram received after the intervention period and within 2 years of the initial mammogram date. RESULTS: Bivariate and multivariate statistical analyses showed that participation was significantly higher for women contacted by telephone than through routine publicity. Mail reminders were no more effective than a routine publicity campaign. Primary care physician and gynecologist visits increased the likelihood of a subsequent mammogram for women in all intervention groups. CONCLUSIONS: Telephone contact by regular health plan staff was more successful than publicity in encouraging continued participation in mammography screening in women enrolled in a group-model managed health care plan. Because mailings did not influence participation in mammography screening, health plans should be cautious about investing in member mailings without first evaluating their effectiveness in the context of existing outreach efforts.

[Mesothelial cyst of the diaphragm. Report of a case and review of the literature]. / Le cisti mesoteliali del diaframma. Osservazione di un caso e revisione della letteratura.

A case of mesothelial cyst of the right hemidiaphragm in a 44 year old man is reported. Origin (most likely due to a recess of the primary coelomiatic cavity), topographical, histological and therapeutic features are discussed, stressing that it is now more frequently recognised thanks to progress in diagnostic imaging techniques. Complete surgical excision is mandatory to definitely differentiate such lesion from primary diaphragmatic neoplasm, not infrequently malignant.

A novel targeting signal for proximal clustering of the Kv2.1 K+ channel in hippocampal neurons.

The discrete localization of ion channels is a critical determinant of neuronal excitability. We show here that the dendritic K+ channels Kv2.1 and Kv2.2 were differentially targeted in cultured hippocampal neurons. Kv2.1 was found in high-density clusters on the soma and proximal dendrites, while Kv2.2 was uniformly distributed throughout the soma and dendrites. Chimeras revealed a proximal restriction and clustering domain on the cytoplasmic tail of Kv2.1. Truncations and internal deletions revealed a 26-amino acid targeting signal within which four residues were critical for localization. This signal is not related to other known sequences for neuronal and epithelial membrane protein targeting and represents a novel cytoplasmic signal responsible for proximal restriction and clustering.

[Optimization and diagnostic accuracy of computerized tomography with tridimensional spiral technique in the study of craniostenosis]. / Ottimizzazione e accuratezza diagnostica della Tomografia Computerizzata con tecnica spirale tridimensionale nello studio della craniostenosi.

INTRODUCTION: Conventional Computed Tomography (CT) with three-dimensional (3D) reconstructions is considered the most complete and accurate imaging modality to diagnose craniosynostosis. However, the introduction of Spiral CT (SCT) opened new possibilities for 3D studies of the skull in pediatric patients with craniosynostosis. The purpose of our study is two fold: first, to optimize the scanning and imaging parameters to obtain diagnostic images in a single spiral scan; second, to assess the diagnostic accuracy of such images in the identification of normal and abnormal cranial vault sutures. MATERIAL AND METHODS: Seventy-eight pediatric patients (age range: 1-35 months; mean: 11.8 months) with craniosynostosis were submitted to SCT of the head. The images were acquired with the following parameters: 3- and 5-mm nominal slice thickness, 5-6 mm/s table feed (pitch 1-2), 165 mAs and 120 kV. Two different algorithms and increases were used for image reconstructions. A first set of images was reconstructed with 2-mm increases and a soft tissue algorithm: these images were used for brain studies and for 3D reconstructions. A second set of slices was reconstructed with 5-mm increases and a bone algorithm to visualize the sutures of the axial plane. The 3D images were processed with the Shaded Surface Display software with threshold values ranging 120-150 HU. All images were acquired with a single spiral scan lasting less than 30 seconds. Two blinded radiologists analyzed the 3D and the planar images independently to evaluate the course and depth of each cranial suture. The sensitivity, specificity and diagnostic accuracy of both 3D and planar SCT images were evaluated. The frequency of artifacts (the Lego effect, boiled egg, pseudoforamina, movement, and chainsaw artifacts) and their influence on the final diagnosis were studied on 3D SCT images. RESULTS: The diagnostic accuracy rates of 3D SCT images, by suture, were: sagittal 90.7%, metopic 100%, left lamboid 90.9%, right lamboid 93.9%, left coronal 85.7%, right coronal 91.1%. The diagnostic accuracy rates of the axial images, by suture, were: sagittal 90.7%, metopic 95.5%, left lamboid 86.4%, right lamboid 90.9%, left coronal 83.7%, right coronal 91.1%. The interobserver agreement on 3D images was: sagittal 91.1%, metopic 100%, left lamboid 88.9%, right lamboid 91.1%, left coronal 88.9%, right coronal 84.4%. The Lego effect artifact was the most frequent one (82%) and affected image evaluation in 6.3% of cases. CONCLUSIONS: Our results prove that 3D SCT is a very accurate technique for identifying normal and abnormal sutures and presents many advantages over conventional 3D CT in the examination of pediatric patients with craniosynostosis. The quality of 3D SCT images was adequate and the artifacts did not affect the final diagnostic yield significantly.

[Reconstruction of the defect in the parotid region]. / Ricostruzione delle perdite di sostanza della regione parotidea.

The authors report their experience in the surgical management of a patient with an ulcerated tumor of the neck extending to the parotid region. The different types of reconstruction after radical surgery as well as the choice and reasons that have suggested the use of pectoralis major myocutaneous flap are discussed.

[A case of cellular neurothecoma]. / Su un caso di neurotecoma cellulare.

The Authors report a case of cellular neurothecoma, a rare benign tumor of possible nerve sheath origin. Differential diagnosis with classic neurothecoma and malignant melanoma is discussed.

[Criteria of choice in prosthetic surgery of laparocele]. / Criteri di scelta nella chirurgia protesica dei laparoceli.

The employment of prosthesis in abdominal plastic surgery for incisional hernia has contributed to a remarkable improvement in the results of this surgery. The current use of PTFEe, according to the Authors experience, proves to be effective. Both satisfactory functional results and evident aesthetic advantages are obtained. The Authors report their experience in the treatment of the median incisional hernia also by means of a polypropylene mesh. The latter was shaped in a very original way thanks to a technique borrowed from plastic surgery. The complete mobilization of the ombilicus, by a circular incision, allowed the Authors to insert this prosthesis symmetrically under the rectus abdominis muscles for the entire extension of the incisional hernia.

[Primary sarcoma of the breast: criteria for radical surgery]. / I sarcomi primitivi della mammella: criteri di radicalità chirurgica.

The experience in a case of primitive stromal sarcoma of the breast brought the Authors to study and to characterize the surgical interventions to prefer in these tumors. Criteria of radicality are considered in the light of the modern notion of "anatomical compartment" already applied to the sarcomas of the musculoskeletal or parenchymal location, from which breast sarcomas don't differ in order to the clinical behavior.

[H mesh prosthesis in the treatment of ventral hernia]. / La protesi reticolata ad "H" nel trattamento del laparocele mediano.

The Authors report their experience in the treatment of ventral hernias using a Marlex mesh moulded in an original way with a technique partially derived from plastic surgery. The complete mobilization of the umbilicus through a circular incision allows to fit this prosthesis symmetrically below the rectus abdominis muscles for the entire extension of the hernia.

[A case of myofibroblastoma]. / Su un caso di miofibroblastoma.

The Authors report a case of myofibroblastoma, a rare primitive mesenchymal tumor of the lymph node. Differential diagnosis with Kaposi sarcoma, neurilemmoma and metastatic neoplasm is discussed.

[Bednar's syndrome: a case report]. / Il tumore di Bednar: osservazioni su un caso.

The case of a tumor of Bednar, which is a rather rare form (less than 5% of cases) of dermatofibrosarcoma protuberans presenting similar biologic behavior, is reported. Therefore, the same curative procedures including a radical surgical approach and the application of the Limberg flap were adopted.

Isolation of the pigeon PMV-1 variant of Newcastle disease virus from imported pheasants (Phasianus colchicus).

Isolation of a virulent pigeon paramyxovirus 1 (PPMV-1) strain of Newcastle disease virus (NDV) from pheasants imported for release is reported. Although no clinical signs or postmortem lesions suggesting NDV infection were detected, the intestine was processed for attempted virus isolation as part of a surveillance programme on wild-bird populations. The potential role of pheasants as carriers of the disease, and the importance of developing surveillance programmes for wild bird populations is discussed.