Dermal substitute: a safe and effective way in surgical management of adults post-burn dorsal foot contractures.

OBJECTIVE: Neglected dorsal foοt burns may result in typical fοrefοοt defοrmities characterised by cοntractures leading tο hyperextensiοn οf the tοes and gait disturbance. These defοrmities usually cause a significant impairment in daily activities and difficulty in wearing shοes. This article presents a recοnstructiοn series οf severe fοrefοοt defοrmities by means of dermal regeneratiοn templates (also known as dermal substitutes) and split thickness skin grafts. PATIENTS AND METHODS: We retrοspectively reviewed οur institutiοnal burn database from 2010 to 2020 focusing on all those dοrsal fοοt cοntractures treated with the use οf a dermal regeneratiοn template. The patients' demοgraphics, burn injury mechanisms, depth, lοcalizatiοn, surface, treatments and fοllοw-up were described. RESULTS: Twelve patients underwent this prοcedure and the mean affected area was 75 cm2. The mean time between the dermal regeneratiοn template applicatiοn and the split thickness skin graft was 19.6 days. Just fοr one patient, an additiοnal skin grafting prοcedure was required. The mean fοllοw-up was 4.6 years. We did not register specific cοmplicatiοns at bοth the recipient (forefoot) and dοnοr sites (scalp). All patients were able tο wear shοes and walk after the procedure. Nο recurrence οf cοntractures were οbserved. All patients were satisfied with cοsmetic results, and they did not request any additiοnal prοcedure οf cοsmetic imprοvement. CONCLUSIONS: The use οf the dermal regeneratiοn template can be cοnsidered as an extremely safe and efficient treatment οf severe post-burn fοrefοοt defοrmities.

Ultrasound-guided percutaneous irreversible electroporation of hepatic and abdominal tumors not eligible for surgery or thermal ablation: a western report on safety and efficacy.

PURPOSE: To report our first results on sixteen patients affected by liver and abdominal malignant tumors, unfit for surgery or thermal ablation, treated with US-guided percutaneous irreversible electroporation (IRE). METHODS: From June 2014 to December 2016, all patients meeting the inclusion criteria (malignant hepatic or abdominal tumors not eligible for resection or thermal ablation) and not meeting the exclusion criteria (heart arrhythmia, pro-hemorrhagic hematological alterations, tumor size > 8 cm, presence of a biliary metallic stent) referred to our institutions were prospectively enrolled to undergo percutaneous US-guided irreversible electroporation (IRE). Sixteen patients (age range 59-68 years, mean 63; 7 females) with 18 tumors (diameter range 1.3-7.5 cm) fulfilled the inclusion criteria and were included in the study. Data concerning efficacy (tested by a 1-week CEUS and a 4-week enhanced CT and/or enhanced MRI) and safety were recorded during a 18-month follow up. RESULTS: All patients completed a 35-50-min procedure without complications. One patient with 6 cm Klatskin tumor also underwent a second session for 1 month. A 1-week CEUS and a 4-week e-CT and/or e-MRI arterial phase contrast enhancement analysis showed an overall reduction of arterial flow with confirmation of unenhanced lesions for seven nodules. After 1-18 months of follow up, no major complications were recorded and no tumor-related death occurred. The lesions of two patients disappeared 3 and 6 months after their treatment, respectively. CONCLUSIONS: IRE is a promising ablation modality in the treatment of malignant hepatic and abdominal tumors unsuitable for resection or thermal ablation.

Clinical outcomes of diabetic foot management with Circulat.

Major and minor lower-extremity amputation is a common complication among diabetics. Various sources indicate diabetic foot ulcer prevalence at between 2.2% and 15% in diabetics. This study evaluates the efficacy and tolerance of a standardized plant extract combination, Circulat, developed for the prevention and treatment of severe manifestations of type 2 diabetes, such as necrotic damage of the foot. Thus, a retrospective cohort study was carried out in 174 patients treated with Circulat with diabetic foot grades D1-D3, according to The University of Texas Wound Classification System, in 50 medical centers, from 2004 to 2007. Circulat obtained 50.57% complete cure of diabetic foot, significant improvement in 37.9% and prevented amputation in 88.5% of the study's total population. The treatment was well tolerated. Four patients (2.3%) had slight gastrointestinal unrest which did not warrant suspension of treatment.

Analysis of effects of the herbal preparation Circulat on gene expression levels in cultured human fibroblasts.

Circulat is a systemic standardized plant extract formulation that was developed for the prevention of severe manifestations of type 2 diabetes such as necrotic damage of the plantar foot. With the aim of revealing the molecular mechanisms underlying Circulat's biological activity, the effects of Circulat treatment on gene expression levels were examined in the cultured human fibroblast cell line MRC-5 using Affymetrix oligonucleotide microarrays. The analysis identified 187 genes, the expression levels of which underwent significant changes upon Circulat treatment. These include four genes (IL6, HMGA1, SLC19A2 and C4A) that have been implicated previously in the development of diabetes. A large proportion of the identified genes are involved in energy metabolism, protein synthesis, glucose metabolism and signaling pathways. Synergistic action of the Circulat components has also been revealed. Prospective applications of microarray analysis in phytopharmacology are discussed.

Cardiac function in congenital hypothyroidism: impairment and response to L-T4 therapy.

Electrocardiograms (heart rate, QRS voltage, QRS axis in the frontal plane. Q-Tc interval) echocardiograms [left ventricular fractional shortening (LVFS); preejection period (PEP); PEP/left ventricular ejection time (PEP/LVET) ratio; end-diastolic left ventricular free wall and interventricular septum thickness; presence of pericardial effusion], and thyrotropin (TSH), thyroxine (T4), and triiodothyronine (T3) serum levels were evaluated before and 1 week, 1 and 2 months after the start of L-thyroxine (L-T4) therapy in 11 infants with congenital hypothyroidism (CH), aged 16-59 days when first seen. Before the start of therapy, infants with CH had significantly lower QRS complexes and LVFS and significantly higher values for Q-Tc, PEP, and PEP/LVET than normal infants of the same age. The QTc interval, PEP and PEP/LVET ratio of infants with CH were significantly greater before than 1 week after L-T4 therapy, and LVFS was significantly lower before than 1 month after L-T4 therapy. Four of the infants with CH had small pericardial effusions, which disappeared within the first week of therapy. QRS axis in the frontal plane, Q-Tc interval, and PEP were negatively correlated with logT4 and logT3 serum levels. PEP/LVET ratios were negatively correlated with logT4 serum values. The QRS voltage values were positively correlated with logT4 and logT3 serum values. The frontal-plane QRS axis, Q-Tc interval, and PEP/LVET ratio were positively correlated with logTSH serum levels. The QRS voltages were negatively correlated with TSH serum levels.(ABSTRACT TRUNCATED AT 250 WORDS)

[The clinico-immunological evaluation of a bivalent vaccine against measles and rubella]. / Valutazione clinico-immunologica di un vaccino bivalente contro morbillo e rosolia.

Prevention of measles and rubella can be obtained by a single administration of bivalent vaccine which can be added to the trivalent vaccine already practice in the USA since 1970 and in the Scandinavian Countries since 1982. We evaluated the immunological response and the clinical reactions to a bivalent vaccine against measles and rubella by the study of a control group including 29 children (17 females and 12 males) aged from a minimum of 15 months to a maximum of 9 years and 4 months. All the children who resulted not to be immune to the 2 viruses by serologic tests showed a rise in the antibody titer with 100% seroconversion, whereas in those proving to be already immune to one of the 2 viruses, a persistent antibody titer or an increase was revealed in all except one. Neither general nor local clinical reactions were observed except for two children who showed feverish measles-like reactions 8 days after the vaccine administration. These results suggest that this bivalent vaccine is highly effective, without negative effects. Furthermore associated with trivalent vaccines, it offers larger immunization opportunity mainly in children who have already been affected by mumps.

[Evaluation of the effectiveness of gastro-protected proteoferrin in the therapy of sideropenic anemia in childhood]. / Valutazione dell'efficacia della proteoferrina gastroprotetta nella terapia dell'anemia sideropenica in età pediatrica.

The clinical efficacy and tolerability of gastroprotected ferritin were assessed in children affected by iron deficiency and/or sideropenic anemia. Forty-seven children with iron-deficiency and/or sideropenic anemia were included in the study and were treated with gastroprotected ferritin at a dose of 4-5 mg/kg/day per os for 4 months. Only 33 children correctly completed the entire treatment cycle, achieving a marked improvement of blood parameters (increased Hb, accompanied by higher levels of sideremia and in particular ferritin, with a contemporary decrease in erythrocytic protoporphyrin and transferrinemia) and clinical symptoms, especially pallor, anorexia, debility, somnolence, hyperactivity, disturbed sleep and excessive sweating. Of the remaining 14 children, 9 failed to present for the planned control after the 4 months of therapy, 3 abandoned therapy due to difficulties of assumption and 2 because of intolerance phenomena, such as nausea and diarrhoea. In conclusion, gastroprotected proteoferrin is efficacious and well tolerated in the treatment of iron deficiency in children.

[Clinico-immunologic evaluation of a trivalent vaccine against measles, rubella and mumps]. / Valutazione clinico-immunologica di un vaccino trivalente contro morbillo, rosolia e parotite.

Prevention of measles, mumps and rubella can be obtained by a single administration of a trivalent vaccine as it has already been practiced in the U.S.A. since 1970 in the Scandinavian Countries since 1982. The immunological response and the clinical reactions to a new trivalent vaccine (Triviraten-Berna) against measles, mumps, and rubella has been studied in a control group including 41 children (20 females and 21 males) aged from a minimum of 16 months to a maximum of 7 years and 4 months. All the children who resulted not to be immune to the 3 viruses by serologic tests showed a rise in the antibody titer with 100% seroconversion, whereas in those resulting to be already immune to one of the 3 viruses, a persistent antibody titer or an increase was revealed. Neither general nor local clinical reactions were observed. These results suggest that this trivalent vaccine is highly effective, without negative effects and helpful for a mass prevention of such viral diseases.

[Pediatric suspensions of amoxicillin and clavulanic acid in the treatment of bacterial infections of otorhinolaryngologic importance and the upper respiratory tract]. / Amoxicillina ed acido clavulanico in sospensione pediatrica nel trattamento di infezioni batteriche di pertinenza otorinolaringoiatrica e delle prime vie aeree.

Thirty children, 20 males and 10 females, aged 6.57 +/- 0.78 on the average (range: from 13 to 6 months), weighing 21.60 +/- 2.25 kg with bacterial infections of the upper respiratory tract and ear were admitted to the present trial. A chemotherapeutic agent based on amoxycillin and clavulanic acid in the suspension for children of 312.5 mg/5 ml (4:1 ratio) at the dosage of about 17 mg/kg in two daily administrations according to the weight of the patients was used. The therapy was prolonged for 8.87 +/- 0.30 days on the average, from a minimum of 3 to a maximum of 11 days. In the course of the treatment the symptom parameters and the objective signs progressively reduced until disappearance; the body temperature came promptly back to normal values, confirming the definite improvement and the regression of the infectious pictures. The microbiological data also fully confirmed the successful activity of the chemoantibiotic drug used. No side effects were found and, as regards local and general tolerance, no signs of an even slight impairment related to the administration of the drug were found. The final judgement expressed on the efficacy, on the basis of the more or less quick and complete symptom regression, evolution of the infectious picture and good tolerance were the following: excellent in 22 cases, good in 6, fair in 1 and not able to be evaluated in 1 case (a female patient who left off the trial).

[Nifedipine in hypertensive emergencies in children]. / La nifedipina nelle emergenze ipertensive pediatriche.

Nifedipine is a calcium-antagonist whose principal action is reduction of peripheral resistance. The utilization of nifedipine is still limited in infancy. We have studied the immediate effect on hypertensive blood pressure values of nifedipine administered sublingually in 10 children (3 males and 7 females; aged 6-14 years) with different clinical diagnoses: acute glomerulonephritis (6 cases), lupus erythematosus systemicus (2 cases), membrane proliferative glomerulonephritis (1 case), pyelonephritis secondary to vesico-ureteral reflux (1 case). Nifedipine (0.25-0.50 mg/Kg) lowered systolic and diastolic blood pressure values from 167.5 +/- 19.8 mmHg and 103.5 +/- 18.4 mmHg to 126 +/- 19.8 mmHg and 81.5 +/- 15.1 mmHg, respectively, 30 minutes after administration (p less than 0.001). We propose nifedipine as a simple, effective and safe alternative drug for managing hypertensive emergencies in childhood.

[Variability of arterial blood pressure readings in children following repeated measurements]. / Variabilità dei valori della pressione arteriosa nel bambino a seguito di misurazioni ripetute.

The procedures for measuring the blood pressure cause emotional reactions, which in turn influence, in a manner which is not to be disregarded, the blood pressure values. In order to evaluate the degree and type of such influence the blood pressure was determined for 3 consecutive days by the same doctor using the same technique in 242 children (150 boys and 92 girls) of a primary school in Bari. The systolic and diastolic values obtained allowed us to categorize the children in to 3 groups in accordance with their individual reactions on occasion of the second and third determination: a) children whose blood pressure went down; b) children whose blood pressure went up; c) children whose blood pressure remained unchanged. The differences of the values obtained between the first and third determination were the most evident; in particular, the PAs had an average reduction of 11.3 mmHg in 68.6% of the subjects, an average increase of 7.7 mmHg in 14.9%, whereas in the remaining 16.5% was unchanged. The PAd had un average reduction of 9.5 mmHg in 51%, an average increase of 7.6 mmHg in 19% and the remaining 30% was unchanged. The heart rate shows a statistically significant reduction of about 4 beats/min. between the first and subsequent determinations, and it is connected with the blood pressure. No correlation was found with the PAd. The variable reactions as a consequence of the repeated determinations could cause an error not to be disregarded, in view of the results obtained from the programs concerning the screening of the PA and of the identification of normal values age related.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prognostic factors in non-Hodgkin's lymphoma in childhood]. / Fattori prognostici dei linfomi non-H. nell'infanzia.

38 children with Non-Hodgkin Lymphoma (age 15 months - 17 years; 27 males and 11 females) have been treated between 1974 and 1982. They have been divided in two different groups: a Good Prognosis group for patients with complete resectable disease and a Poor Prognosis group including patients with mediastinal, bone marrow or CNS involvement or with diffuse and non completely resectable localization. In the Good Prognosis group there were 100% Complete Remission, 12.5% Local Relapses and 12.5% deaths. 88% of patients are alive at 8 1/2 years follow-up. In the Poor Prognosis group there were 83% Complete Remission, 50% Relapses (8 in the first year, 2 in the second and 5 in the third and no more in the next years) and 60% Deaths; 30% of patients are off-therapy with a survival of 40% at 8 1/2 years follow-up. Among the 19 patients with mediastinal involvement there were 84.2% Complete Remission, 68.4% Relapses, 63.1% Deaths and 26.6% off therapy patients. Among the 19 patients with mediastinal involvement there were 84.2% Complete Remission, 68.4% Relapses, 63.1% Deaths and 26.6% off therapy patients. Survival is 70% for the group without mediastinal involvement and 35% for the group with mediastinal involvement. Burkitt-type Lymphoma has a survival of 30% in contrast to the 60% survival for all the others histological types. In summary we conclude that the distinction between Good Prognosis and Poor Prognosis groups, on the basis of a clinical stage involvement and Burkitt histology have an important role for prognosis of Non-Hodgkin Lymphoma in children.

[Fetal hydrops caused by cardiac failure in utero: description of 2 cases and pathogenetic considerations]. / Idrope fetale da scompenso cardiaco in utero: descrizione di due casi e considerazioni pathogenetiche.

Two cases of congestive heart failure in utero with fetal hydrops are reported. The diagnosis was made during pregnancy by means of echography. Cardiac failure, derived from supraventricular tachycardia not associated with structural anomalies of the heart, was observed in one of the patients. By digoxin administration and vagal stimulation the rhythm reverted to sinus, one hour after birth. In the second case fetal echography showed a fetus with serious bradycardia (45/min.) and ascites. On the bases of a median located and symmetric liver and of a complex heart malformation a diagnosis of "isomeric syndrome" was supposed. One hour after vaginal delivery, the newborn dead and autopsy confirmed a left isomeric syndrome with polisplenia and complex congenital cardiopathy (left ventricle and mitral hypoplasy, double outlet right ventricle, pulmonary stenosis, anomalous systemic and pulmonary venous return).

Differential diagnosis between hepatic cirrhosis and chronic active hepatitis: specificity and sensitivity of physical and laboratory findings in a series from the Mediterranean area.

Sensitivity and specificity of physical and laboratory findings have been evaluated for the purpose of establishing a differential diagnosis between cirrhosis and chronic active hepatitis on clinicolaboratory grounds. Data from 213 patients from southern Italy with biopsy-proven chronic active hepatitis or cirrhosis have been studied retrospectively. Splenomegaly, hypocholesterolemia, and decreased sulfobromophthalein-Ki were among the most sensitive individual findings in cirrhosis, whereas decreased platelet count, jaundice, and hypoprothrombinemia were the most specific ones. The presence in the same patient of both one of the former and one of the latter findings yields a correct diagnosis of cirrhosis with at least 90% likelihood. Advantages of the proposed diagnostic technique and comparison with data from an American series are discussed.