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We present our experience in the treatment of fractures of the tibial plateau with arthroscopic assistance. Between January 1997 and September 2001, we evaluated 23 patients with fractures of the tibial plateau. After their clinical and radiological evaluation, we included 17 patients in this study. Fractures were classified using the Schatzker classification. 14 patients were treated with arthroscopic reduction and percutaneous fixation, while 3patients underwent open reduction and osteosynthesis with platelets under arthroscopic control. The arthroscopic technique allows for a better articular visualization, decreases dissection of the tissues, and allows for an adequate diagnosis and treatment of the associated lesions. Arthroscopic reduction and percutaneous fixation can be considered the treatment of choice in a select group of fractures of the tibial plateau (Schatzker I and III).

Currently, surgical training of physicians in Italy has limited possibilities.Surgical training can be performed on dissection of human bodies as well as in animal laboratories, but experience is very poor. We conducted a survey through an anonymous questionnaire in order to evaluate the opinions of post-graduate physicians on their need for experience training on both human and animal bodies during their medical studies. A total of 165 young Sicilian physicians responded to the survey. Only 14 of them (8.5%) declared they had specific training on a live animal, while 46 (27.9%) reported they already attended cadaver labs. Over 70% assigned the maximum score to the utility of such courses as integration of medical academic offer. Our results showed that the majority of the subjects interviewed expressed a need for training using these practices and that it might be necessary to investigate patterns to promote the opportunity for direct practice on human and animal bodies.

Little is known about the relationship between laryngopharyngeal reflux (LPR) and periodontal or dental lesions. This study investigates the association of dental and periodontal involvement in patients with LPR compared to a control group. A prospective study was carried out on 102 patients complaining of LPR symptoms. The authors used the Reflux Symptom Index (RFS), Reflux Findings Score (RSI) and 24-h ambulatory pH monitoring to diagnose LPR disease. Two study groups were established, the LPR group included patients with LPR diagnosis and a control group selected from excluded patients. All patients underwent an oral examination for the evaluation of dental and periodontal status. Plaque index, gingival index and hemorrhage index were collected too. LPR was revealed to be associated with both an increased incidence of chronic periodontitis with significantly higher values of plaque index (p=0.018), hemorrhage index (p=0.048) , gingival recession (p=0.039) and higher tooth wear scores when compared to those of  the control group. We support the view that laryngopharyngeal reflux might play a considerable role in the manifestation of periodontal and dental lesions.


This paper is a retrospective study examining 328 cadavers deceased from traffic accidents (252 drivers and 76 front seat passengers). Specifically, the skeletal injuries of the cranial, spine, chest, upper and lower limbs were examined. The purpose of the study is to ascertain whether it is possible to identify, through the skeletal injury patterns, who was driving at the time of the traffic accident. A statistical analysis was used to detect injuries that could differentiate between driver and front passenger. Drivers more frequently reported chest injuries, especially sternal injuries, due to the collision with the steering wheel. On the other hand, front passengers more frequently reported skull and spinal injuries. Furthermore, a greater incidence of pelvis fractures in front passengers was observed compared to drivers. The chest injury pattern resulted to be the most effective for distinguishing the driver from the front passenger.

Being a serious threat to physical and emotional health of children and adolescents all over the world, bullying in school represents an important public health issue. Since 2007, in Italy, the Ministry of Education (MIUR) has promoted activities to face and prevent bullying in schools of all levels while at the same time national and local Health Authorities have implemented effective social-health strategies. To date, the lack of consistent data needed to properly describe the concerning increase of this Public Health phenomenon prevents both the ability to systematically survey and measure the effectiveness of the public health strategies against bullying. The Bullying In Sicilian Schools (BIAS) pilot study’s aims: i) to estimate the prevalence of bullying in a sample of secondary first-grade schools of Palermo, the largest city in Sicily, investigating its characteristics, and  ii) to assess the feasibility of alternative methods for the detection of the prevalence of bullying in schools.  Here we present the research protocol and the questionnaires that will be used.



Humeral reconstruction post tumor resection is a challenging quest. Reconstruction strategies depend first of all on age and general conditions of the patient, tumor dimensions, local invasion and bone quality. Many kinds of surgery are described in literature, mostly megaprosthesis, hemiartoplasty or alloprosthetic composite (APC) implants or allograft, allograft arthrodesis, clavicola pro-humeri or vascolarized fibula reconstructions. One of the most important goals of this surgery is to achieve implant stability. Surgical planning varies according to deltoid muscle, rotator cuff and axillary nerve conditions. When all these structures are conserved, an allograft or composite (anatomic or reverse arthroprosthesis) reconstruction could be a more suitable option for younger patients. When deltoid muscle function is impaired due to tumoral resection or axillary nerve disfunction, especially in elderly patients, surgeons prefer to implant endoprosthesis. The purpose of this paper is to describe the surgical technique to implant humeral megaprosthesis associated with tendon transfers and tips on how to achieve implant stability.

The aims of the present study were to determine the association between IGF-1gene polymorphism with obese individuals. This case– control analysis was performed on 50 subjects ,obese (n=30) and control (n=20) groups for age ranged (20-40 year).The results showed that genotype distribution of  AA and AB in IGF-1 gene polymorphism were 83.3% and 16.7% respectively in the patients of  obese group, while it was 90.0% and 10.0% respectively in the control group .Meantime the allele frequency of A and B in IGF-1 gene polymorphism were 91.65% and 8.35% respectively in obese group, whereas it was  95.0% and 5.0% respectively in the control group. Several single nucleotide polymorphisms (SNPs), was obtained between the two resolved haplotypes and between the IGF1 gene, exon3 Primer3 plus reference of the study. The results demonstrate  that there is no association between AA and AB polymorphisms with in  obese (OR=0.87,CI[0.71-1.17]) as in comparison with control groups. 

The main aim of the study is to critically analyze the impact of defense medicine in the Italian healthcare system, considering the rapid spread of this phenomenon in the last years and its influence in the everyday medical practice. The authors use the Amenable Mortality Index (i.e. the number of premature deaths which could have been avoided in individuals younger than 74 years of age) to rate the performance status of the analyzed healthcare system and to compare different countries and Italian regions. The result of the study is that the Italian health system is valid, despite the economic difficulties of the last years, but much can be done to ameliorate its status. In fact, the authors want to promote a “no-blame culture” as an important factor for the overall improvement of the NHS, focusing only on patients’ health.

Caring of cancer patients requires special skills and knowledge that facilitates the professionals’ care during the patients' illness and palliative phases. This study was conducted to explore the nursing students' attitudes toward death and caring for dying cancer patients during their Placement. A descriptive study was conducted using the Formmelt Attitude toward Care of the Dying (FATCOD) scale and Death Attitude Profile-Revised (DAP-R) scale. Nursing students from AL-Zaytoonah University of Jordan. A sample of one hundred nursing students was recruited.   The current study showed statistically significant difference among age group in relation to total score of death scale (p-value: 0.000) and fear of death, neutral acceptance, approach acceptance, and escape- acceptance subscales. The results indicated that younger students have more negative thoughts, attitudes, and emotions toward caring for dying cancer patients. In addition the results indicated that students with higher academic levels have a more positive attitude and are more eligible to provide nursing care for dying cancer patients as compared to students with less experience. In addition, the results showed that students with less experience had a greater fear of death than students with a higher academic level. According to the study results, Nurses' attitudes toward caring for dying and dead cancer patients can be considered an important predictor of quality of life among cancer patients. 

Anal fistula has been recognized for centuries, and yet, its treatment remains a challenge for surgeons till today. In this study, a 30 year experience of treating anal fistula is being reported and discussed in light of the various recognized management methods. A total of 320 patients were treated by fistulotomy, fistulectomy, fistula plugging or seton technique. Data showed that fistula plugging carried the highest failure rate (89%) seconded by fistulectomy (37%), seton procedure (24.5%) and fistulotomy (15.6%). High transsphincteric fistulas were more likely to predict failure compared to low transsphincteric, intersphincteric and subcutaneous fistulas (37.5% versus 9.5%, 7.3% and 0%, respectively). In conclusion, the scales seem to support fistulotomy. However, no standardized algorithm exists to guide the care of patients and the choice of operation is based on patient-related factors, the patient’s surgical history, and the surgeon’s experience and familiarity with the various techniques for treating anal fistula. 

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