[Self expandable metal stent as bridge-to-surgery in acute bowel obstruction]. / Le protesi colorettali come bridge to surgery nelle occlusioni intestinali acute.

AIM: Self expandable metal stent (SEMS) can be used to relieve malignant colorectal obstruction. The stent serves as a palliative measure for high-risk patients or those with unresectable tumor on subsequent workup. For low-risk patients with resectable disease, SEMS serves as a safe and effective bridge to subsequent laparoscopic surgery. METHODS: From August 2009 to April 2012 we have treated with SEMS 39 patients, 20 of whom with palliative purpose; 19 patients are treated with SEMS for bridge to surgery, out of these patients, 8 were women, 11 men with median age of 61.4 years (range 36-81 years). Technical success, defined as a successful stent placement and deployment in the stricture site, was achieved for 39/40 patients (97.5%). The average duration of the procedure was about 60 minutes (range 15-120). RESULTS: Clinical success was achieved for all the 39 patients, 19 of these could be subjected to bowel preparation and colon resection after 25 days from the positioning. No colostomy was performed. Among patients undergoing the procedure, perforation occurred in 1 case. CONCLUSION: In summary, the colonic stent placement is a complex method that needs qualified medical-nursing team, able to solve any difficult situation, such as the severe, irregular and distal obstruction. SEMS positioning guarantees a high percentage of clinical and technical success; however it is necessary to pay attention to the risk of complications like bowel perforation.

A new procedure for extraction of collagen from modern and archaeological bones for 14C dating.

Bones are potentially the best age indicators in a stratigraphic study, because they are closely related to the layer in which they are found. Collagen is the most suitable fraction and is the material normally used in radiocarbon dating. Bone contaminants can strongly alter the carbon isotopic fraction values of the samples, so chemical pretreatment for (14)C dating by accelerator mass spectrometry (AMS) is essential. The most widespread method for collagen extraction is based on the Longin procedure, which consists in HCl demineralization to dissolve the inorganic phase of the samples, followed by dissolution of collagen in a weak acid solution. In this work the possible side effects of this procedure on a modern bone are presented; the extracted collagen was analyzed by ATR-IR spectroscopy. An alternative procedure, based on use of HF instead of HCl, to minimize unwanted degradation of the organic fraction, is also given. A study by ATR-IR spectroscopic analysis of collagen collected after different demineralization times and with different acid volumes, and a study of an archaeological sample, are also presented.

Patients with profuse hair shedding may reveal anagen hair dystrophy: a diagnostic clue of alopecia areata incognita.

BACKGROUND: Several patients, especially women, seek advice because of hair loss. They may be diagnosed clinically as having telogen effluvium (TE) or androgenetic alopecia (AGA), but histopathology may reveal that a proportion of them have in fact alopecia areata incognita (AAI). OBJECTIVES: To detect dystrophic anagen hairs in such patients. METHODS: We studied 1932 patients with hair loss and no signs of classical alopecia areata. They were submitted to the modified wash test (which counts the total number of telogen hairs lost and the percentage of vellus hairs) and divided into patients having pure TE (403), patients with AGA+TE (1235) and patients with pure AGA (294). Dystrophic hairs were detected with a low magnification microscope. RESULTS: Dystrophic hairs were observed in 13 patients with TE (3.2%), in 54 with AGA+TE (4.4%) and in none with AGA. In addition, 7 patients with TE and 32 with AGA+TE developed small patches of alopecia areata in 6 to 9 weeks. No patches developed in patients with AGA. CONCLUSIONS: The presence of dystrophic hairs and the development of patches of alopecia areata (and their absence in pure AGA) provide a first evidence of the possibility that within the heterogenous condition named TE some patients have in fact AAI.

Crustal structure in the Campanian region (Southern Apennines, Italy) from potential field modelling.

We present a 3D model of the main crustal boundaries beneath the Campanian region and the onshore and offshore surrounding areas, based on high-resolution potential field data. Our main objective is the definition of the main structural interfaces in the whole Campanian region from gravity and magnetic data, thanks to their ability to define them on a regional and continuous way. The complex morphology of the Mesozoic carbonate platform, which is fundamental to constrain the top of geothermal reservoir, was reconstructed by inverting the vertical gradient of gravity. We assumed local information from seismic models and boreholes to improve the model. We modeled the deep crustal structures by spectral analysis of Bouguer gravity and magnetic data. The inferred depth estimates indicate a shallow crystalline basement below the Tyrrhenian crust and the Apulian foreland and a significant depression beneath the Bradanic foredeep. The map of the Moho boundary shows a NE-SE verging trough below the Southern Apennine chain and two pronounced uplifts beneath the foreland and the Tyrrhenian crust. We also estimated the depth to the magnetic bottom, showing a thick magnetic crust below the mountain chain and shallow depths where the crustal heat flow is high. The models were compared with seismic sections along selected profiles; a good agreement was observed, despite of some inherent lower resolution for the gravity modelling from spectral methods. The regional covering and the continuity of our estimated crustal interfaces make it a new and valid reference for further geological, geophysical and geothermal studies, especially in areas such as northern and eastern Campania, where there is an incomplete geophysical and geological information.

LABEC, the INFN ion beam laboratory of nuclear techniques for environment and cultural heritage.

The LABEC laboratory, the INFN ion beam laboratory of nuclear techniques for environment and cultural heritage, located in the Scientific and Technological Campus of the University of Florence in Sesto Fiorentino, started its operational activities in 2004, after INFN decided in 2001 to provide our applied nuclear physics group with a large laboratory dedicated to applications of accelerator-related analytical techniques, based on a new 3 MV Tandetron accelerator. The new accelerator greatly improved the performance of existing Ion Beam Analysis (IBA) applications (for which we were using since the 1980s an old single-ended Van de Graaff accelerator) and in addition allowed to start a novel activity of Accelerator Mass Spectrometry (AMS), in particular for 14C dating. Switching between IBA and AMS operation became very easy and fast, which allowed us high flexibility in programming the activities, mainly focused on studies of cultural heritage and atmospheric aerosol composition, but including also applications to biology, geology, material science and forensics, ion implantation, tests of radiation damage to components, detector performance tests and low-energy nuclear physics. This paper describes the facilities presently available in the LABEC laboratory, their technical features and some success stories of recent applications.

Crustal structure of Sicily from modelling of gravity and magnetic anomalies.

We aim at modeling the main crustal and thermal interfaces of Sicily (Italy), a key area for understanding the geological complexity at the collisional boundary between the African and European plates. To this end, we analyze the gravity and magnetic fields, integrated with information from well logs, geology, heat flow, and seismic data. In order to make the most accurate description of the crustal structure of the area, we modeled with different methodologies the carbonate and crystalline top surfaces, as well as the Moho and the Curie isotherm surface. The reconstruction of the carbonate platform is achieved using a nonlinear 3D method constrained by the available seismic and borehole data. The crystalline top, the Curie, and the Moho are instead estimated by spectral analysis of both gravity and magnetic data. The results show a complex carbonate basement and a deep crystalline crust in central Sicily, with a prominent uplift beneath the Hyblean Plateau. Maps of the Moho and the Curie isotherm surface define a variable thermal and structural setting of Sicily, with very thin crust in the southern and eastern sectors, where high heat flow is found, and deep and cold crust below the Caltanissetta Basin.

Multiridge Method for Studying Ground-Deformation Sources: Application to Volcanic Environments.

Volcanic phenomena are currently monitored by the detection of physical and chemical observations. Generally, the ground deformation field is the most relevant shallow expression of the geometric and physical parameters variations in the magmatic reservoir. In this study, we propose a novel method for the direct estimation of the geometric parameters of sources responsible for volcanic ground deformation detected via the DInSAR technique. Starting with the biharmonic properties of the deformation field, we define an approach based on the Multiridge and ScalFun methods to achieve relevant information about both the positions and shapes of active sources, such as the Mogi source. Our methodology is definitely different from the methods currently used for modeling ground-deformation sources, mainly based on forward or inverse techniques. In fact, (i) it does not require any assumptions about the source type, and (ii) it is not influenced by the distribution of medium elastic parameters or (iii) the presence of high-frequency noise in the dataset. For synthetic cases, we accurately estimate the depth to the source within a 3% error. Finally, we study the real case of the Okmok volcano ground-deformation field and achieve results compatible with those in previous works.

Gravity modeling finds a large magma body in the deep crust below the Gulf of Naples, Italy.

We analyze a wide gravity low in the Campania Active Volcanic Area and interpret it by a large and deep source distribution of partially molten, low-density material from about 8 to 30 km depth. Given the complex spatial-temporal distribution of explosive volcanism in the area, we model the gravity data consistently with several volcanological and petrological constraints. We propose two possible models: one accounts for the coexistence, within the lower/intermediate crust, of large amounts of melts and cumulates besides country rocks. It implies a layered distribution of densities and, thus, a variation with depth of percentages of silicate liquids, cumulates and country rocks. The other reflects a fractal density distribution, based on the scaling exponent estimated from the gravity data. According to this model, the gravity low would be related to a distribution of melt pockets within solid rocks. Both density distributions account for the available volcanological and seismic constraints and can be considered as end-members of possible models compatible with gravity data. Such results agree with the general views about the roots of large areas of ignimbritic volcanism worldwide. Given the prolonged history of magmatism in the Campania area since Pliocene times, we interpret the detected low-density body as a developing batholith.

Long-term efficacy and safety of piracetam in the treatment of progressive myoclonus epilepsy.

BACKGROUND: Piracetam has been proven to be effective and well tolerated in the treatment of myoclonus in short-term studies. OBJECTIVE: To assess its long-term clinical efficacy, 11 patients with disabling myoclonus due to progressive myoclonus epilepsy were treated with piracetam in an open-label study. METHODS: Neurologic outcome (at the 1st, 6th, 12th, and 18th month of treatment) was assessed by an adjusted sum score of the following 3 indices: motor impairment, functional disability, and global assessment of disability due to myoclonus. Severity of other neurologic symptoms (seizure frequency and severity, dysarthria, and gait ataxia) also was assessed. Treatment with piracetam was initiated at a dose of 3.2 g/d that was gradually increased until stable benefit was noted (maximal dose in the trial was 20 g/d). Concomitant antiepileptic drugs were maintained at their previous dose. RESULTS: Statistically significant improvement in the total rating score was observed after introduction of piracetam at the 1st, 6th, and 12th month of treatment. Severity of other neurologic symptom scores did not improve significantly. Two patients reported drowsiness during the first 2 weeks of treatment. CONCLUSIONS: Piracetam given as add-on therapy seems to be an effective, sustained, and well-tolerated treatment of myoclonus. In patients with progressive myoclonus epilepsy, the efficacy of the drug increased during the first 12 months of treatment and then stabilized.

Localizing value of alpha-methyl-L-tryptophan PET in intractable epilepsy of neocortical origin.

BACKGROUND: [(11)C] alpha-methyl-L-tryptophan (alpha-MTrp) has been developed as a tracer for the study of the synthesis of serotonin in the brain with PET. However, it has been shown that in pathologic conditions the tracer may reflect the activation of kynurenine metabolism. Increased levels of serotonin and quinolinic acid have been described in resected epileptogenic cortex, raising the possibility that alpha-MTrp can localize seizure foci in patients with intractable partial epilepsy. The authors assessed the uptake of alpha-MTrp in 18 patients (11 men, mean +/- SD age 27.1 +/- 10.1 years, range 13 to 54) with intractable partial epilepsy to correlate the PET findings with the epileptogenic area defined by electroclinical and neuroimaging data. METHOD: Seven patients with cortical dysplasia (CD) and 11 with partial epilepsy in which conventional MRI and fluorine-18-deoxyglucose ((18)FDG)-PET studies failed to detect any abnormality were studied. All underwent scalp EEG monitoring during the PET scan to exclude ictal events and estimate the interictal epileptic activity. RESULTS: In seven patients (39%; CD four and cryptogenic partial epilepsy three), PET showed focal increased uptake of alpha-MTrp corresponding to the epileptogenic area. alpha-MTrp uptake in the epileptic focus correlated with the frequency of interictal spikes (r = 0.7, p < 0.05). CONCLUSIONS: alpha-MTrp-PET may be of value in the localization of the epileptogenic area not only in patients with visible dysplastic lesions, but also in those with cryptogenic partial epilepsy.

Exceptionally long absence status: multifactorial etiology, drug interactions and complications.

To our knowledge, petit mal status lasting longer than 2-3 days has been documented only once [1]. We report a 66 year-old man with well-documented, idiopathic generalized epilepsy who developed petit mal status lasting 6 weeks. Valproate levels remained low because of interactions with phenytoin. When phenytoin was discontinued, valproate levels increased, and he progressively improved. Chronic ischemic changes in the white matter may have been an additional factor in the causation and, most likely, in the duration of his status. Exceptionally long status and stupor increase the risk of medical complications. Valproate remains the medication of choice for the treatment of petit mal status. Despite the extraordinary course in this patient, complete recovery took place, confirming the benign nature of even such a prolonged episode.

Cystic meningioangiomatosis in neurofibromatosis type 2: an MRI-pathological study.

We report cerebral cystic meningioangiomatosis in a patient with neurofibromatosis type 2. An 18-year-old woman presented with progressive hemiparesis secondary to a meningioma at the foramen magnum. Her MR examination also demonstrated three small cortical and subcortical cystic lesions. She underwent surgery for the meningioma, but died from brainstem infarction. Post-mortem histopathological examination of the cystic lesions showed enlarged subcortical perivascular spaces with overlying meningioangiomatosis. The unusual features and possible pathogenesis are discussed.

Reduced striatal D1 receptor binding in autosomal dominant nocturnal frontal lobe epilepsy.

BACKGROUND: Mutations of the neuronal nicotinic acetylcholine (nACh) receptor identified in patients with autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) lead to increased sensitivity to ACh. As activation of presynaptic nicotinic receptors augments the release of dopamine in the striatum and the prefrontal regions, we tested the hypothesis that that the alpha4-Ser248Phe mutation affects dopaminergic transmission. METHODS: We measured D(1) receptor binding using [(11)C]-SCH23390 and PET in 12 subjects with the alpha4-Ser248Phe mutation (3 men, mean age 41 +/- 16 years) and 19 controls (8 men, mean age 36 +/- 13 years) matched for gender, smoking status, and age. Parametric images were produced using the simplified reference region method. Both MRI-based regions of interest and voxel based analyses were used. RESULTS: Reduced striatal [(11)C]-SCH23390 binding occurred with the mutation (controls 1.1 +/- 0.1; ADNFLE 0.97 +/- 0.2; p < 0.01). Statistical parametric mapping confirmed a region of reduced [(11)C]-SCH23390 binding in the right putamen in alpha4-Ser248Phe subjects compared to controls (309 voxels, local maxima 20 16 -2 mm; Z(score) 3.57, p < 0.05). CONCLUSIONS: Reduced D(1) receptor binding may represent increased extracellular dopamine levels or, more likely, receptor downregulation. Alterations in mesostriatal dopaminergic circuits may contribute to nocturnal paroxysmal motor activity in autosomal dominant nocturnal frontal lobe epilepsy.

The rat mesenteric artery-intestinal loop preparation. Noradrenaline outflow and vascular responses to nerve stimulation and drugs.

A new preparation, intestine-mesenteric blood vessels of the rat, was tested for simultaneous measure of noradrenaline (NA) overflow and vasoconstrictor response (delta p) induced by electric stimulations. Control experiments showed that this preparation could be used within a wide range of frequencies and repeatedly stimulated without any important decrease of response. The effects of phenoxybenzamine, dihydroergotoxine mesylate, imipramine and pargyline were investigated. All the drugs inhibited delta p and, except for dihydroergotoxine mesylate, increased NA outflow. The results were discussed in the light of the present knowledge. It is concluded that this preparation can be profitably used to study drug effects at pre- and post-synaptic level.

In vitro comparison of pre- and postsynaptic effects of dihydroergotoxine mesylate and 1-[2-ethoxy-2-(3'-pyridyl)ethyl]-4-(2'-methoxy-phenyl) piperazine (IP-66).

The effects caused on the intestine mesenteric artery preparation by 1-[2-ethoxy-2-(3'-pyridyl)ethyl]-4-(2'-methoxy-phenyl) piperazine (IP-66), a compound having a prevailing alpha-blocking action, and by dihydroergotoxine mesylate (DHEM) were compared in normal conditions and in propranolol-induced beta-receptors block. The two drugs behaved in a completely different way both on vasoconstrictor response (delta p) and on noradrenaline (norepinephrine, NA) outflow induced by electrical stimulation of periarterial nerves. In fact IP-66 inhibited delta p much more than DHEM did but, unlike the latter, it increased NA outflow only at the lowest concentration (8.7 X 10(-9) mol/l) whereas it reduced it at the highest one (2.9 X 10(-7) mol/l). Moreover the effect of IP-6--but not that of DHEM--on NA outflow was completely abolished by propranolol. The hypothesis is put forward that IP-66 may show a strong antagonism towards postsynaptic alpha-receptors and a slight agonism towards presynaptic beta-receptors.

[Dental compromise for bite closing in patients with minimal or negative overjet]. / Compromesso dentale per la chiusura del morso in pazienti con overjet minimo o negativo.

The Authors evaluate the most common techniques to close the bite in patients with no overjet, then they suggest a method (anterior cross-bite elastics) that can obviate some of the disadvantages experienced using those techniques.

Determination of the antihypertensive drug 1-[2-ethoxy-2-(3'-pyridyl)ethyl]-4-(2'-methoxyphenyl) piperazine (IP/66) in rat and human plasma by high-performance liquid chromatography and isotope dilution mass spectrometry.

In connection with pharmacokinetic studies on the antihypertensive drug 1-[2-ethoxy-2-(3'-pyridyl)ethyl]-4-(2'-methoxyphenyl)piperazine (IP/66) (I), appropriate high-performance liquid chromatographic (HPLC) and gas chromatographic-mass spectrometric isotope dilution (GC-MS-ID) methods for its determination in rat and human plasma, respectively, were developed. In both techniques, deproteinized and basified plasma samples were extracted and purified by adsorption on an Extrelut-1 column, then the drug was eluted with dichloromethane. Quantitative HPLC analysis was performed on a C8 reversed-phase column. The mobile phase was phosphate buffer (0.02 M, pH 2.8)-acetonitrile (65:35), with UV detection at 208 nm. The internal standard was 1-[2-butoxy-2-(3'-pyridyl)ethyl]-4-(2'-methoxyphenyl)piperazine, a homologue of I. The inter-assay coefficient of variation (C.V.) was 9.9% for a drug level of 2 micrograms/ml. Quantitative GC-MS-ID analysis was performed with a DB-17 fused-silica capillary column using the selected-ion monitoring technique. The deuterated form of I, 1-[2-ethoxy-2-(3'-pyridyl)ethyl]-4-2'-trideuteromethoxyphenyl)pipe razine, utilized as internal standard, was synthesized. The inter-assay C.V. was 7.36% for a drug level of 1 ng/ml.