Ultrasound-guided thoracenthesis: the V-point as a site for optimal drainage positioning.

INTRODUCTION: In the latest years the use of lung ultrasound is increasing in the evaluation of pleural effusions, because it makes follow-up easier and drainage more efficient by providing guidance on the most appropriate sampling site. However, no standardized approach for ultrasound-guided thoracenthesis is actually available. AIM: To evaluate our usual ultrasonographic landmark as a possible standard site to perform thoracenthesis by assessing its value in terms of safety and efficiency (success at first attempt, drainage as complete as possible). MATERIALS AND METHODS: Hospitalized patients with non organized pleural effusion underwent thoracenthesis after ultrasound evaluation. The point showing on ultrasound the maximum thickness of the effusion ("V-point") was chosen for drainage. RESULTS: 45 ultrasound guided thoracenthesis were performed in 12 months. In 22 cases there were no complications; 16 cases of cough, 2 cases of mild dyspnea without desaturation, 4 cases of mild pain; 2 cases of complications requiring medical intervention occurred. No case of pneumothorax related to the procedure was detected. In all cases drainage was successful on the first attempt. The collected values of maximum thickness at V-point (min 3.4 cm - max 15.3 cm) and drained fluid volume (min 70 ml - max 2000 ml) showed a significative correlation (p < 0.0001). When the thickness was greater or equal to 9.9 cm, drained volume was always more than 1000 ml. CONCLUSIONS: The measure of the maximum thickness at V-point provides high efficiency to ultrasound guided thoracentesis and allows to estimate the amount of fluid in the pleural cavity. It is also an easy parameter that makes the proposed method quick to learn and apply.  

Adhesive capsulitis and ultrasound diagnosis, an inseparable pair: a novel review.

PURPOSE: Adhesive Capsulitis (AC) is a musculoskeletal disorder initially described by Codman in 1934. The disease is characterized by pain-limited restriction in active and passive glenohumeral range of motion (ROM) despite the lack of a structural deficit. In the last decades, arthroscopy and magnetic resonance imaging (MRI) has been the only diagnostic tools able to highlight the characteristic alterations of the glenohumeral capsular-ligament apparatus in AC; nevertheless, both arthroscopy and MRI are burdened by intrinsic limitations. The aim of this narrative review is to summarize the most significant evidence supporting the use of ultrasound (US) for the diagnosis of AC. METHODS: We extensively searched via PubMed library the terms "frozen-shoulder" and "adhesive capsulitis" each combined with "ultrasound". RESULTS: We found 3723 papers on PubMed and selected those inherent to AC diagnosis, US imaging, correlation with arthroscopic and MRI findings. Forty papers which were strictly related to the topic of this narrative review were initially chosen, then 20 studies which described and exploited US for AC diagnosis were finally included. Coracohumeral ligament (2.65 ± 0.4 mm) and axillary pouch thickening (3.34 ± 0.8 mm), as well as an increase in vascularity at rotator interval (78/214, 36.44%), represented the commonest US signs useful for AC diagnosis and for which the most significant cut-off values were reported. CONCLUSIONS: The evidence collected in this review testify that musculoskeletal US is as reliable as MRI for AC diagnosis, therefore we believe that in this context US should be considered a first-line imaging technique.

Inflammatory disease of the costotransverse joints: US evaluation in 15 symptomatic patients.

The costotransverse joints (CTJs) are small arthrodial joints which articulate with the costal tuberosity on the transverse process of the thoracic vertebrae. CTJs are composed of oval-shaped facets with a major axis, vertical at the upper vertebrae and almost horizontal at the lower vertebrae. This position explains the different movements of the ribs: the cranial ribs move on the sagittal plane and the caudal ribs on the transverse plane. Movements in directions other than these usual CTJ spatial planes can cause inflammation resulting in a stinging pain in the space between the scapula and thoracic spine. We studied 15 subjects with paravertebral pain compatible with CTJ pathology. Mean age was 29 years, 11 females/4 males. In 12 patients, the non-dominant limb was affected. US imaging was carried out using linear 12 MHz and 9 MHz probes. Scanning was performed following the long axis of the rib (transverse plane) and the short axis (sagittal plane). Sagittal scanning is the method of choice for detection of possible joint effusion and comparison with undamaged joints above and below. US identified joint effusion correlating with the site of pain in all patients. Thickening of the posterior costotransverse capsular ligament was detected in six patients mainly affecting the first thoracic vertebrae. Power Doppler showed intraarticular hypervascularization in four patients. US imaging should be performed as a first-line examination in the evaluation of patients with stinging pain in the paravertebral region. US evidence of effusion within the joints is a sure sign of involvement of these structures.

Ultrasound-detected synovitis with power Doppler signal is associated with severe radiographic damage and reduced cartilage thickness in hand osteoarthritis.

OBJECTIVES: To examine ultrasound (US) features of synovitis in hand osteoarthritis (OA) joints, and to evaluate their relationship with radiological damage severity and US-detected cartilage thickness. METHODS: US examination was carried out on 14 joints of both hands of 25 patients with symptomatic hand OA (HOA) and 10 age- and sex-matched control subjects. US-detected features were: synovial hypertrophy, effusion, power Doppler signal (PDS), cartilage thickness. Conventional hand radiographs were scored utilizing the Kellgren-Lawrence and Kallman systems. HOA patients were divided into two subsets: non-erosive and erosive. RESULTS: Among the three groups of subjects studied, erosive OA showed the highest values of radiological scores and the highest prevalence of US-detected synovitis. Joints positive for US synovitis features (above all PDS) had higher radiological scores and lower cartilage thickness, while joints with X-ray detected central erosions [the hallmark of erosive HOA were more likely to present PDS positivity. US measured cartilage thickness inversely correlated with radiological damage scores. CONCLUSIONS: US-detected synovitis is present in about 10% of HOA finger joints and is associated with more severe radiological damage and reduced cartilage thickness. PDS and cartilage thickness (mm) may represent two innovative additional information tools provided by ultrasonography in HOA evaluation.

Mantle cell lymphoma: from ultrasound examination to histological diagnosis.

We report the case of a 42-year-old patient referred to our department for the examination of two large, symmetrical inguinal lumps. The ultrasound examination of the swollen lymph node demonstrated a cortical echogenicity greater than the medullary echogenicity, and the vascularization stop around the cortical zone suggested a pathological pattern of mantle cell lymphoma. In this type of lymphoma, lymphocytes are localized in a mantle zone, inducing a thickening of the lumps. Therefore, for the first time, ultrasound examination detected sonographic vascular features of mantle cell lymphoma, allowing the identification of the disease and suggesting the specific histological diagnosis.

Evaluation of angiogenesis with the expression of VEGF and CD34 in human non-small cell lung cancer.

Angiogenesis is an essential process in the progression of malignant tumors and the most potent angiogenic factor is the vascular endothelial growth factor (VEGF). On the other hand, the CD34 is an endothelial antigen that has been used to highlight the microvasculature vessel density (MVD) as a direct marker of the degree of neoangiogenesis. In the present study we report the VEGF expression and its relationship with MVD, measured by CD34, in two lineages of non-small cell lung cancer (NSCL): low differentiated adenocarcinomas and epidermoid carcinomas, in order to consider the possibility of using the correlation between both antibodies as a prognostic factor. Tumor sections were stained by immunohistochemistry for CD34 and VEGF. The results showed that the mean value of VEGF for adenocarcinoma was significantly higher than the one for epidermoid carcinoma (p < 0.001). However, the mean of MVD did not show significant differences between both types of tumors. The conventional factors taken into consideration (age over 60, sex, and presence of lymph nodes) was not significantly related to the angiogenic factors examined. In conclusion, we could affirm that CD34 is a better prognostic marker of neoangiogenesis in NSCLC, because both types of tumors have the same clinical prognosis, and so we expected the same behaviour from both markers.

Pattern of drug use among preterm neonates: results from an Italian neonatal intensive care unit.

BACKGROUND: Drug use in preterm neonates admitted to Neonatal Intensive Care Unit (NICU) has been investigated, so far, in terms of unauthorized or off-label use; very little is known on the use of combinations of different active substances, which is frequently required in this population (prophylaxis of infections, treatment of concomitant diseases). The aim of this study was to describe the most common patterns of drug use in an Italian NICU, focusing on those with nephrotoxic potential. METHODS: Medical records of preterm neonates (<37 weeks of gestational age) weighing less than 1,500 g at birth and admitted to an Italian NICU were scrutinized in a 3-year retrospective investigation. Analysis included drug exposure, duration of therapies, co-administration of drugs with potential renal side effects; also daily protein supplement was calculated from parenteral nutrition. RESULTS: A cohort of 159 preterm neonates was selected; 68 were born weighing less than 1,000 g (extremely low birth weight infants, ELBW, Group A), 91 weighed between 1,000 and 1,500 g at birth (Group B). Compared to Group B, neonates of Group A were more likely to receive pharmacological treatments: the most used drugs were antibiotics (especially ampicillin and amikacin, p = .07 and p < .001, respectively), antifungals (especially fluconazole, p < .001), and diuretics (especially furosemide, p < .001). Analysis of co-administration of drugs with potential nephrotoxicity showed ampicillin and amikacin as the most reported combination (94.1% of Group A and 31.9% of Group B), the combination of furosemide with antibacterials (ampicillin or amikacin) was also frequently reported, with average period of combination shorter than 2 days. CONCLUSIONS: ELBW infants were exposed to a higher number of drugs compared to other neonates and were more likely to receive associations of drugs with nephrotoxic potential (e.g. furosemide and amikacin), though only for short cycles. Further studies should evaluate the safety profile (especially potential renal side effects) related to most commonly used combinations.

lncRNA profiling in early-stage chronic lymphocytic leukemia identifies transcriptional fingerprints with relevance in clinical outcome.

Long non-coding RNAs (lncRNAs) represent a novel class of functional RNA molecules with an important emerging role in cancer. To elucidate their potential pathogenetic role in chronic lymphocytic leukemia (CLL), a biologically and clinically heterogeneous neoplasia, we investigated lncRNAs expression in a prospective series of 217 early-stage Binet A CLL patients and 26 different subpopulations of normal B-cells, through a custom annotation pipeline of microarray data. Our study identified a 24-lncRNA-signature specifically deregulated in CLL compared with the normal B-cell counterpart. Importantly, this classifier was validated on an independent data set of CLL samples. Belonging to the lncRNA signature characterizing distinct molecular CLL subgroups, we identified lncRNAs recurrently associated with adverse prognostic markers, such as unmutated IGHV status, CD38 expression, 11q and 17p deletions, and NOTCH1 mutations. In addition, correlation analyses predicted a putative lncRNAs interplay with genes and miRNAs expression. Finally, we generated a 2-lncRNA independent risk model, based on lnc-IRF2-3 and lnc-KIAA1755-4 expression, able to distinguish three different prognostic groups in our series of early-stage patients. Overall, our study provides an important resource for future studies on the functions of lncRNAs in CLL, and contributes to the discovery of novel molecular markers with clinical relevance associated with the disease.

Silymarin and lycopene administration in periparturient dairy cows: effects on milk production and oxidative status.

AIMS: To establish during late gestation and early lactation the effects of supplementing silymarin, a natural hepatoprotective substance, combined with a powerful antioxidant, lycopene, on milk production and on serum biomarkers of oxidative status. METHODS: Italian Friesian dairy cows were given individually a supplement containing a mixture of silymarin (7.77 g/day/cow) and lycopene (1.27 g/day/cow) (n=10) or no supplement (control; n=10). Treatment was administered from 7 days before the expected calving date to the first 14 days in milk. At 7 days before the expected calving date, at calving, and 7 days postpartum, body condition score (BCS) and concentrations in serum of reactive oxygen metabolites (ROM), total antioxidant capacity (OXY) and thiobarbituric acid reactive substances (TBARS) were evaluated. Bodyweight, milk production, and somatic cell count (SCC) were determined at 7, 14 and 21 days postpartum. RESULTS: The mean time of treatment prior to calving was 6.3 (min 4, max 11) days. Compared with control cows, treatment increased energy corrected milk yield (33.3 vs. 37.8 (SEM 1.10) kg/day; p=0.006) and milk fat yield (1.14 vs. 1.32 (SEM 0.06) kg/day; p=0.05) over the first 21 days of lactation. Treated cows had lower mean log10 SCC compared to control cows (4.9 vs. 5.24 (SEM 0.11) log10 cells/mL) and had lower overall concentration of TBARS (1.47 vs. 1.59 (SEM 0.016) nM/mL; p<0.001), but similar concentrations of ROM and OXY in serum. However there was a treatment by time interaction (p=0.09) for OXY, and at calving mean OXY was higher in treated cows compared with pre-calving values (p<0.001). CONCLUSIONS: Despite the acknowledged limitation of the study, i.e. the small number of animals, our results suggest that silymarin and lycopene, as health-beneficial feed supplements, may help dairy cows in metabolic adaptation during the first stages of lactation. CLINICAL RELEVANCE: During the peripartum period dairy cows suffer moderate-to-severe fatty liver and from an overproduction of free radicals. The supplementation of a mixture of silymarin and lycopene during these stressful days may be useful to mitigate these metabolic disorders with beneficial effects on the subsequent lactation.

Ultrasonography detection of early bone erosions in the metacarpophalangeal joints of patients with rheumatoid arthritis.

OBJECTIVE: To compare ultrasonography (US) and magnetic resonance imaging (MRI) in their capability to detect bone erosions in early-advanced rheumatoid arthritis, where no erosion was evident on conventional radiography (X-ray). METHODS: Metacarpophalangeal (MCP), radiocarpal and ulnocarpal joints of 13 patients with rheumatoid arthritis, with bone erosion that was not detected by conventional X-ray, were examined by US and MRI. Ten controls underwent examination of the same joints by US. RESULTS: None of the controls showed bone erosions at US examination. No significant difference between US and MRI in detecting bone erosion was observed in wrist joints, whereas a significantly higher number of erosions was detected by US in MCP joints. CONCLUSION: US is at least as sensitive as MRI in detecting bone erosions in MCP and wrist joints. Since US examination is a more easily available and less expensive procedure than MRI, our findings justify its use as a diagnostic tool for early arthritis. In addition US may also be utilized in the follow up of patients with an established diagnosis of inflammatory arthritis.

Gamma-linolenic acid and tocopherol contents in the seed oil of 47 accessions from several Ribes species.

Gamma-linolenic acid is an essential fatty acid for humans with delta-6-desaturase deficiency; it is a precursor of prostaglandins, prostacyclins, and tromboxanes; and it has antiinflammatory and antitumoral effects. Tocopherols are natural antioxidants with biological activity, heart/vascular, and cancer protective properties. The oil, gamma-linolenic acid, and tocopherol contents, as well as tocopherol composition, were investigated in the seed oil of a collection of 47 accessions belonging to various species of the genus Ribes. Differences for oil content among species were not significant. The highest total tocopherol content was found in R. nigrum (mean, 1716 mg kg(-1) oil), followed by R. rubrum (mean, 1442 mg kg(-1) oil). R. grossularia showed the lowest values for this trait (mean, 786 mg kg(-1) oil). The three species also differed strongly for tocopherol composition. R. rubrumwas distinguished by a higher concentration of delta-tocopherol (mean, 20.2%); R. grossularia displayed the highest percentage of gamma-tocopherol (mean, 70.0%), and R. nigrum showed the highest concentration for alpha-tocopherol (mean, 34.8%), the most biologically active among the four tocopherols. Regarding gamma-linolenic acid, the highest content was found in R. nigrum, which exhibited up to 15.8% of this essential fatty acid in the oil. R. grossularia and R. rubrum showed mean gamma-linolenic acid contents of 8% and 6.2%, respectively. The present study indicated that seeds of Ribes species, especially R. nigrum, could be used as sources of gamma-linolenic acid and natural vitamin E.

Preparation and biological activity of four epiprogoitrin myrosinase-derived products.

(5R)-5-Vinyl-1,3-oxazolidine-2-thione, (2S)-1-cyano-2-hydroxy-3-butene, and two diastereoisomeric erythro-(2S)- and threo-(2S)-1-cyano-2-hydroxy-3,4-epithiobutanes were prepared in pure form starting from (2S)-2-hydroxybut-3-enyl glucosinolate (epiprogoitrin). This glucosinolate was isolated in almost pure form using ripe seeds of Crambe abyssinica and then hydrolyzed under different conditions. The hydrolysis was carried out using either myrosinase immobilized on nylon, to produce (5R)-5-vinyl-1,3-oxazolidine-2-thione, or the endogenous myrosinase contained in defatted crambe meals, to produce the other epiprogoitrin-derived products. After purification and physicochemical characterization, all four myrosinase degradation products were tested for their biological activity. A bioassay on Lactuca sativa was chosen as a simple test to determine their apparent action on living tissues. (5R)-5-Vinyl-1,3-oxazolidine-2-thione negatively affected mainly root growth, whereas (2S)-1-cyano-2-hydroxy-3-butene affected the early phase of germination, and both (2S)-1-cyano-2-hydroxy-3,4-epithiobutane diastereoisomers appeared to negatively affect both germination and root growth at doses 5-10 times lower than those of (2S)-1-cyano-2-hydroxy-3-butene or (5R)-5-vinyl-1,3-oxazolidine-2-thione.

Efficacy of silymarin-phospholipid complex in reducing the toxicity of aflatoxin B1 in broiler chicks.

Silymarin, the standardized extract of Silybum marianum, is used as a hepatoprotector in man, and is a potent antihepatotoxic agent. This study focused on the effects of a silymarin-phospholipid complex in reducing the toxic effects of aflatoxin B1 (AFB1) in broiler chickens. Twenty-one 14-d-old male commercial broilers were randomly allotted to 3 groups and treated as follows: basal diet alone [Group C (Control)]; AFB1 at 0.8 mg/kg of feed [Group B1]; AFB1 at 0.8 mg/kg of feed plus silymarin phytosome, a silymarin complexed form with phospholipids from soy, at 600 mg/kg of BW [Group B1+Sil]. Considering the whole growth cycle, BW gain and feed intake were lower in AFB1-treated birds with respect to controls (P < 0.05). In the B1+Sil group, BW gain and feed intake were higher with respect to birds receiving AFB1 alone (P < 0.05), and not different from the control birds. Serum biochemistry showed no difference among groups, except for a decrease of alanine amino transferase (ALT) in chicks treated only with AFB1. Alanine amino transferase activity in AFB1 plus silymarin phytosome treated birds was not different from the controls. No treatment differences were noted on liver weight. In conclusion, our results suggest that silymarin phytosome can provide protection against the negative effects of AFB1 on performance of broiler chicks.

Current trends in chest wall malignant tumor.

Surgery used to treat chest wall sarcomas requires preoperative evaluation in order to document their margins, and to reveal any nodules of recurrence. Because of its considerable sensitivity and specificity ultrasound was associated with routine imaging techniques. The results obtained are useful in defining superficial and lateral tumor margins, but particularly in determining micro-nodules of recurrence which would otherwise go unrecognized. Based on the data obtained using routine methods of diagnosis and ultrasound, we submitted patients to excision that each and every time proved to be wide on histological examination. A particular surgical method was used for reconstruction, involving a polypropylene mesh fixed to one or two mouldable plates. This method exploits the elasticity of polypropylene, which is indispensable for the correct respiratory dynamics of the rib cage, thus avoiding paradoxical or harmful movement. Oncological and functional results were satisfactory.

The echo-guided treatment of calcific tendinitis of the shoulder.

The authors report the results of percutaneous mini-invasive treatment of chronic calcific tendinitis of the rotator cuffs. A total of 39 patients have been treated by echo-guided injection under local anaesthesia since June 2000 with a follow-up of about 2 years. Considerable reduction in symptoms was obtained in 34 patients within a few days of treatment; improvement was moderate in 5 cases, there were no complications in any of the cases. Complete regression of calcification was observed in 21 patients, there was a more than 60% reduction in calcific deposits in 11 patients, there was little reduction in 5, and the calcification remained unchanged in 2. The method, based on our experience, proved to be simple to execute, low-cost and easily repeatable, offering good results from a symptomatological point of view as well. It is the purpose of this study to determine and maximize mini-invasive treatment that will allow for the elimination or reduction of calcifications by means of percutaneous and echo-guided access.

Patellar resurfacing in tumor endoprosthesis: a study in regard to power transmission.

Relation between quadriceps muscle mass and knee extension strength was investigated after resection of malignant bone tumor and endoprosthetic replacement of the distal femur in 19 patients with patellar resurfacing (Group A) and 16 patients without resurfacing (Group B). In all cases, a modular cementless, hinged prosthesis had been used. Age and follow-up period were comparable in the 2 groups. Muscle mass was measured ultrasonographically and strength was evaluated isokinetically. All the data on the operated side are given as percentage of the non-operated side. There was a positive correlation between muscle mass and strength in both groups. By linear regression analysis, a slightly lower value of strength was predicted in the unresurfaced group than in the resurfaced group. Analysis of covariance revealed that the influence of patellar resurfacing on strength was significant. This factor should also be considered in making a decision about patellar resurfacing with a tumor endoprosthesis.

Intraoperative ultrasonography imaging in spinal surgery (technique and indications).

Intraoperative ultrasonography was conducted in 20 patients; the technique of intraoperative ultrasonography for use in spinal surgery is described. The authors emphasize that this non-invasive method obtains real time images of considerable diagnostic importance, allowing for a significantly minor use of image intensifier, with a consequent reduction in doses for both the patient and the staff.

[Orthodontic treatment as definitive therapy in cranio-cervico-mandibular dysfunction]. / Il trattamento ortodontico come terapia definitiva nelle disfunzioni cranio-cervico-mandibolari.

After an initial review of the terminology adopted in cranio-cervico-mandibular dysfunctions the two possible forms of treatment indicated by instrumental kinesiography--coronoplasty and orthotic therapy--are described. Since the second is provisional, lasting about 6 months, definitive treatment whether prosthetic, orthodontic or mixed is then required. The concepts and techniques of definitive orthodontic treatment are described in detail with particular emphasis on the programming of the definitive occlusal plane, the biomechanics and the extrusion system. The report ends with a description of a clinical case.

[Highlights in the subject of low frequency-high intensity TENS (review)]. / Attualità in tema di TENS a bassa frequenza-alta intensità (rassegna sull'argomento).

Transcutaneous electrical neural stimulation (l.f.-h.i. TENS), employed in dentistry, allows masticatory muscles relaxation, temporary clearance of muscular and periodontal proprioceptive input and even oro-facial pain relief. The mechanisms involved in this type of stimulation are not entirely clarified. According to the most recent neurophysiological researches, the authors describe several l.f.-h.i. TENS. action modalities. Some of them are well known such as the gate control theory, the endogenous antinociceptive system activation, the metabolic recovery of the muscular tissue and the unloading reflex. Other mechanisms, instead, are less known such as hypnosis and stress analgesia, exteroceptive suppression and counterirritation (DNIC). Some hypothetical mechanisms are also considered such as endogenous inhibition and sympathetic activity reduction.