Musculoskeletal hydatid disease: report of a rare case with primary and exclusive localization in right hemi-pelvis and femur.

Hydatid Disease (HD), also called Echinococcosis or Hydatidosis, is a parasitic infection caused by the larval stage of the tapeworm Echinococcus: E. granulosus or E. multilocularis. HD occur most frequently in liver or lungs, rarely in brain, skeletal muscles, bones, kidneys, spleen. Bone infestation of Echinococcosis hydatid cysts occurs respectively by haematogenous seeding and progressive invasion into bone by lesions in the adjacent soft tissues. Patients with musculoskeletal HD clinically show the disease in adulthood because the lesions develop very slowly. In some cases, HD is an uncommon cause of soft tissue mass, pain and neurovascular symptoms due to compression or to secondary infection. Diagnostic imaging plays an important role in the diagnosis of HD and in the differential diagnosis with soft tissue tumors. We present a rare case of male patient of 42 year-old with diagnosis of HD with primary and exclusive localization in right hemi-pelvis and femur.

Effects of losartan on left ventricular mass: a three-year follow-up in elderly hypertensives with myocardial hypertrophy despite successful conventional antihypertensive treatment.

OBJECTIVE: Reversal of left ventricular hypertrophy (LVH) in hypertensive patients appears to be a desirable goal to the reduction cardiac risk. The Renin-Angiotensin System (RAS) seems to play a major role in the establishment and maintenance of LVH through the activated systemic RAS and the Intracardiac Angiotensin System (IAS). We focused on the effects of a three-year treatment with losartan supplement in hypertensive patients with LVH not responding to eight years of an effective previous antihypertensive pharmacological treatment. PATIENTS AND METHODS: Two groups of 28 sex-, age- and therapy-matched subjects with essential hypertension and LVH were taken into consideration. The two groups were in effective pharmacological treatment (BP < 140/90) for eight years previous to their enrollment. Patients of Group A were treated for three years with a losartan (100 mg/die) on-top treatment, whereas patients of Group B continued the follow-up of the previous conventional therapy. Both groups were submitted to an echocardiographic follow-up. RESULTS: Group A, showed a significant reduction of the mean LVH since the first step at six months with a further significant trend during the whole period (variance analysis: p < 0.001). Group B showed a non-significant trend toward LVH reduction during the three-year follow-up. No significant further reduction of systolic or diastolic blood pressure values was observed in both groups. CONCLUSIONS: The effects of losartan in hypertensive and hypertrophic patients are in agreement with the results of LIFE Trial. However, the reduction of left ventricular hypertrophy in our patients seems to be related to changes inducted by losartan on the IAS, since no further hemodynamic effects were observed. Losartan induced both a significant reduction of LVH and an improvement of LV diastolic function with a subsequent expected beneficial shift on the prognosis.

Inter-observer agreement of the physician's global assessment of disease activity in children with juvenile idiopathic arthritis.

OBJECTIVE: To assess the inter-observer agreement in the physician's global assessment of overall disease activity (MD global) in a cohort of patients with juvenile idiopathic arthritis (JIA). METHODS: Forty consecutive patients with JIA, who were representative of a wide spectrum of disease activity and severity, were examined simultaneously by 4 observers. Observer 1 (who was the most experienced rheumatologist) carried out a routine rheumatologic examination of each patient including a complete articular assessment, and subsequently calculated in secrecy the MD global score on an anchored horizontal 10-cm VAS. Observers 2, 3 and 4 were present during the examination; afterwards they also scored in secrecy the MD global score for the patient. Agreement was measured by the intra-class correlation coefficient (ICC), using the score of Observer 1 as the gold standard. An ICC below 0.75 was considered unsatisfactory. RESULTS: The mean (SD) MD global scores for Observers 1, 2, 3, and 4 were 5.2 (3.4), 6.7 (3.9), 5.9 (3.5), and 5.6 (3.7), respectively. The level of agreement with Observer 1 in scoring was 0.83 for Observer 2, 0.88 for Observer 3, and 0.90 for Observer 4, indicating good agreement for all observers. CONCLUSIONS: Our study shows a good inter-observer agreement in the physician's global assessment of overall disease activity in patients with JIA. Analyses involving investigators from different countries are needed to determine whether these results can be generalized.

Cardiac effects of slow-release lanreotide, a slow-release somatostatin analog, in acromegalic patients.

Cardiac involvement, mostly characterized by left ventricular hypertrophy associated with various degrees of cardiac dysfunction, greatly contributes to the increased mortality and morbidity observed in acromegaly. Lanreotide is a new SRIF analog characterized by a slow-release (SR) formulation with the peculiarity of a 30-mg im administration every 10-14 days. In this study, 13 patients with postoperative active acromegaly (9 females, 4 males, 45.9 +/- 16.3 yr old) underwent an echo-Doppler and hormonal study before and during a 12-month period of treatment with SR-lanreotide. GH and insulin-like growth factor I plasma levels (mean +/- SD) decreased significantly throughout the study period (from 10.1 +/- 2.2 to 3.9 +/- 0.9 ng/mL for GH, P < 0.005; and from 511.0 +/- 33.0 to 305.0 +/- 34.2 ng/mL for insulin-like growth factor I, P < 0.0001). Left ventricular mass index (mean +/- SD, 137.1 +/- 7.5 g/m2 at baseline) decreased after 3 months (120.0 +/- 5.4 g/m2), 6 months (111.7 +/- 5.7 g/m2), and 12 months (110.3 +/- 5.2 g/m2) of treatment (P < 0.005 at each time-point). This reduction in left ventricular mass index was accompanied by an improvement in some indexes of left ventricular diastolic function, especially the isovolumetric relaxation time (mean +/- SD, 109.1 +/- 4.6 m/sec at baseline), which decreased after 3 months (91.9 +/- 2.8 m/sec), 6 months (92.3 +/- 3.2 m/sec), and 12 months (92.2 +/- 3.0 m/sec) of treatment (P < 0.005 at each time-point). We conclude that SR-lanreotide is able to improve cardiac morphology and functional abnormalities in acromegaly; whether such beneficial effects on cardiac parameters will contribute to improve life expectancy in these patients should be further investigated.

Unilateral destructive wrist synovitis in juvenile idiopathic arthritis.

OBJECTIVE: To describe the clinical and radiographic features of a group of juvenile idiopathic arthritis (JIA) patients who developed unilateral destructive wrist synovitis. METHODS: All wrist radiographs performed yearly between 1986 and 2002 in JIA patients who had wrist involvement were retrospectively reviewed to identify patients who had unilateral erosive wrist synovitis, defined as a difference of at least -3 units in the Poznanski score between the affected wrist and the unaffected wrist, with the Poznanski score in the unaffected wrist being > -2 units throughout the follow-up period. Clinical and radiographic data obtained during follow-up were recorded for all patients. RESULTS: Of a total of 250 patients for whom we had approximately 900 wrist radiographs, 6 patients were found to have unilateral erosive wrist synovitis. The JIA onset subtype was oligoarticular in 5 patients and polyarticular in 1 patient and the disease duration from presentation to the last follow-up visit ranged from 2 to 16 years. The arthritis course was polyarticular in all patients. Five patients had positive antinuclear antibodies (ANA) and 1 had positive rheumatoid factor (RF). At the last follow-up visit, all patients had some impairment of wrist function and 2 patients had wrist subluxation. There was a marked radiographic damage in all affected wrist, with the Poznanski ranging from -8.0 to -8.50 units in 3 patients and being -5.5, -3.1 and -2.4 units, respectively, in 3 patients. The severity of radiographic damage in the ANA-positive patients with the longest disease duration was comparable to that observed in the RF-positive patient. CONCLUSION: Unilateral erosive wrist synovitis seems to be uncommon in JIA. Patients with unilateral wrist synovitis may be at risk of a destructive course irrespective of the JIA onset subtype.

Solitary frontal sinus fracture.

Both the anterior and/or posterior wall of the frontal sinus as well as the nasofrontal duct may be injured by blunt force, commonly secondary to automobile accidents. In this group of 13 solitary frontal sinus fractures, the anterior wall was involved in all cases, and the posterior wall in 2. Antibiotic therapy was given to prevent anticipated infection. Comminuted or depressed fractures of the anterior wall were treated by elevation and/or wiring. Surgical treatment was not employed when there was a linear fracture of the anterior wall in good alignment. Posterior wall fragments were removed and periosteal flaps used to close the defect when the dura was intact. One case required neurosurgical treatment for a dural tear and necrotic frontal lobe cortex.

99mTc-sestamibi and 201-Thallium at rest: dual scintigraphic mapping of myocardial injury in infarcted patients.

UNLABELLED: 201-Thallium (Tl) and (99m)Tc-sestamibi (SM) present different biological properties and kinetics, suggesting a complementary evaluation of mitochondrial and cell membrane functions with subsequent implications regarding myocardial injury mapping. To verify the usefulness of a dual isotopic approach in Q infarcted patients, 30 subjects were submitted at rest, within 5 days, to SM imaging, 4h-delayed Tl scans and echocardiography (ECHO). Left ventricle segmental uptake and wall motion were graded on a 3 points scale (0=absent to 2=normal) and compared on the basis of an 11 segments model. RESULTS AND DISCUSSION: 1) The analysis of SM normal segments demonstrated a strong concordance (97%) with Tl and ECHO, suggesting that both mitochondrial and cell membrane functions are preserved; 2) 49% of SM graded 0 segments were scored 1 by Tl and ECHO, suggesting a worse impairment of mitochondrial function with respect to cell membrane function; 3) approximately 55% of segments showing a reduced MIBI uptake were found normal using Tl, then an impaired mitochondrial but a normal cell membrane function could be hypothesized. 4) Tl provided a better estimation of the effective infarction size with respect to SM. CONCLUSIONS: The SM and Tl dual approach, allowing scintigraphic mapping of myocardial injury, seems to provide a useful tool for a complete evaluation of infarcted patients.

Sestamibi imaging and echocardiography: a combined approach to myocardial infarction.

The resting relationship of MIBI segmental uptake to regional wall motion has been studied in 30 patients with postinfarction wall motion abnormalities. The purpose of this study was to verify whether an integrated approach using Sestamibi (MIBI) imaging (perfusion analysis) combined with echocardiography (ECHO) (wall motion analysis) could present an additive value to differentiate infarcted from viable myocardial areas with respect to MIBI imaging alone. The same 11 segments model for left ventricle was used to compare segmental wall motion scores versus segmental uptake scores using a chi 2 analysis. The global score frequency rates for MIBI and ECHO were examined and a subsequent comparative analysis score versus score on each segment was performed. Our data, based on a chi 2 analysis, indicated that MIBI imaging overestimates the effective area of necrosis, underestimating, furthermore, hypoperfused but non-necrotic myocardium. We can conclude that an integrated approach based on both segmental perfusion and wall motion analysis, seems to be clinically suitable for a correct evaluation of infarcted patients, especially in view of revascularization procedures, providing an additive value in discriminative capacity, with respect to MIBI scintigraphic analysis alone.

[Echocardiokimography and scintigraphy with Tc-MIBI in left ventricular asynergy in chronic myocardial infarct. Comparison of these methods]. / Studio ecocardiochimografico e scintigrafico con Tc-MIBI delle asinergie ventricolari sinistre nell'infarto del miocardio in fase cronica. Confronto fra le metodiche.

The study compared echocardiography, specially echocardiokimography, and myocardial scintigraphy in the evaluation of the extent of chronic myocardial infarction. Eighteen subjects were enrolled and the following examinations performed: ECG, M- and B-mode echocardiography, echocardiokimography and myocardial scintigraphy with Tc-MIBI, a new perfusion radionuclide agent. We concluded: 1) accordance between the two kinds of methods; 2) specificity of echocardiokimography; 3) advantage in using both methods, specially with MIBI scintigraphy.

[Clinical use of echo-dipyridamole test in hypertensive subjects with suspected ischemic heart disease]. / Impiego clinico del test eco-dipiridamolo in soggetti ipertesi con sospetta cardiopatia ischemica.

The aim of this study was to assess the diagnostic capacity of the dipyridamole-echocardiography test (DET) and dipyridamole myocardial scintigraphy (DMS) for coronary artery disease in mild to moderate hypertensive subjects with chest pain. A comparison was performed with exercise stress test (EST) and stress myocardial scintigraphy (SMS) in 20 subjects. Seven patients also underwent coronary angiography. To compare test results, Mc Nemar test was employed. Our results showed a statistically significant difference between DET and EST and a good agreement, in terms of dichotomy response, between DET and SMS. Any difference was further found between SMS and DMS. In conclusion, in hypertensive subjects, DET appears to provide a useful clinical noninvasive tool for coronary artery disease diagnosis and evaluation.

[Bipolar thoracic electrocardiographic derivations in non-Q myocardial infarct. Study using echocardiography and myocardial scintigraphy]. / Le derivazioni elettrocardiografiche toraciche bipolari nell'infarto miocardico non-Q. Studio con ecocardiochimografia e scintigrafia miocardica.

The Authors investigated the sensitivity of the ecg thoracic derivations of Condorelli in detecting non-Q myocardial infarction demonstrated by 2-D echocardiography and 201-TL scintigraphy. This technique showed a good reliability, allowing a useful diagnostic approach.

Multi-point accelerometric detection and principal component analysis of heart sounds.

Heart sounds are a fundamental physiological variable that provide a unique insight into cardiac semiotics. However a deterministic and unambiguous association between noises in cardiac dynamics is far from being accomplished yet due to many and different overlapping events which contribute to the acoustic emission. The current computer-based capacities in terms of signal detection and processing allow one to move from the standard cardiac auscultation, even in its improved forms like electronic stethoscopes or hi-tech phonocardiography, to the extraction of information on the cardiac activity previously unexplored. In this report, we present a new equipment for the detection of heart sounds, based on a set of accelerometric sensors placed in contact with the chest skin on the precordial area, and are able to measure simultaneously the vibration induced on the chest surface by the heart's mechanical activity. By utilizing advanced algorithms for the data treatment, such as wavelet decomposition and principal component analysis, we are able to condense the spatially extended acoustic information and to provide a synthetical representation of the heart activity. We applied our approach to 30 adults, mixed per gender, age and healthiness, and correlated our results with standard echocardiographic examinations. We obtained a 93% concordance rate with echocardiography between healthy and unhealthy hearts, including minor abnormalities such as mitral valve prolapse.