The purpose of this study was to evaluate the different behaviors of the femoral bone in patients after anterior cruciate ligament reconstruction. Twenty-two patients undergoing ACL reconstruction either by double semitendinosus and gracilis tendon graft (DTSG), or ligament advanced reinforcement system (LARS) fixed at the femur with two biodegrad-able pins (RIGID FIX), were evaluated.
In all patients a physical examination was performed and functional outcome scores were obtained at follow up. Instrumental evaluation was performed by multislice CT. The CT scan, which mainly focused on the area of the femoral tunnel, showed an increase in spongy bone out of the socket in the surgery performed with LARS, while in patients treated with DTSG, the bone retained the normal structural characteristics of density of the femoral meta-epiphysis. The CT scan also documented a higher rate of pin biodegra-dation in reconstruction with LARS. The results analysis showed different patterns of re-sponse based on the type of ligament. A bone reaction for mainly mechanical purposes, evidenced by a circumferential fibrous ring, was observed in all patients. Additionally, a bone reaction for biological purposes, characterized by an increase in the spongy tissue associated with a reduction in bone density and a faster reabsorption of pins, was found in patients treated with LARS.
Efforts in developing guidelines have to be supported by investments on their application. Medical software may have a role in these initiatives. Two computer programs have been developed: one regarding chronic kidney disease and one about chronic pain management. For six months their use by 104 general practitioners was monitored. At study conclusion, a questionnaire of 13 multiple choice questions was emailed to all participating doctors. To evaluate the clinical benefits for the patients, a GP regularly used the CKD program and provided patients’ outcomes and clinical data. The application recorded 108 accesses during 66 work sessions. In the clinical outcomes section of this study, 7 patients out of 21 were diagnosed with CKD. Our study shows a need for programs of the “expert systems” kind: sources devoted to a narrow field of competence, accessed only when needed, in a way that resembles traditional specialist consultation.
In the contemporary society an International Health Elective (IHE) represents a strategic tool in order to implement future medical doctor’s education. In Italy, in the last decade, an increasing interest of trainees and residents to IHE and opportunities was documented and supported by the reorganization of the Italian residency programs, provided by the Ministry for Education, University and Research (MIUR). Aim of the present study was to collect data on perceived need of medical residents for an IHE.
A structured questionnaire was developed and administered to medical residents of Palermo’s University who underwent their annual visit to the Occupational Health Physician Ambulatory (OHPA) of Palermo’s University Hospital, in the period between March and October 2011.
Medical residents more prone to undergo an IHE were, younger than 29 years old (p <0.01), attending the new educational system (p 0.02) and surgical residents (p= 0.0001). A negative opinion about the formative quality performances of the residency program was significantly associated with surgical residencies (p= 0.002). Future Italian surgeons are more prone to undergo an IHE and this statement is probably related to the not satisfying residency program. Residents attending the old educational system consider the IHE as a way to implement their professional perspectives possibly for their more realistic professional perspective facing an approaching future full of work uncertainties.
Considering the future competition between medical professionals working in different EU contexts, the Italian Government should implement future medical education policy in order to provide for a Healthcare “without Border” in the EU.
Many peptides are present in the nasal mucosa, but few studies have investigated the presence or absence of the oxytocin and vasopressin peptides. This immunohistochemical study on the inferior turbinates of patients affected by chronic sinusitis shows, for the first time, that these peptides are present in the epithelium of both nasal mucosa and glands. Their presence could be related to the presence of atrial natriuretic peptide (ANP), like previously demonstrated in other organs such as heart and prostate, since in some circumstances they play in antagonism.
In this article we have reviewed the main risk factors for this disease in particular: sun exposure, the use of tanning beds or sunlamps and skin phototype.
We also mention the importance of primary prevention in subjects at risk to reduce the onset of cutaneous melanoma.
Phalloplasty procedures for most men requiring penile augmentation surgery are cos-metic procedures; generally the patients have a normal-sized and fully functional penis but they think that their penis is too small. There are not well defined indications for penile enhancement surgery and, except for the treatment of "micropenis", there are not established guidelines and the outcome measures for success are still unclear. All penile enhancement techniques often do not reach the expected result and the grade of pa-tient’s satisfaction is frequently poor. Phalloplasty procedures for psychological dys-morfism are not approved by any scientific society and the majority of these procedures are performed in private settings. The ethical and medicolegal problems resulting from a penis enhancement can be various and numerous, but few of them are reported in litera-ture. After phalloplasty an attribution of professional responsibility and request of reim-bursement is not rare. In this contribution the authors summarize a panorama of several urological and medico-legal aspects related to phalloplasty procedures.
In the past few years, contributions of molecular biology assays to the investigation of sudden juvenile death have permitted to clarify some of the pathogenetic aspects of sud-den arrhythmic death, opening the way to preventive action on victims’ relatives.
We reviewed literature on the genetics of sudden juvenile death, and on molecular biol-ogy assays performed on autoptic samples.
Biological investigation permits the detection of genetic mutations underlying the suscep-tibility to sudden cardiac death of individuals with rare inherited forms of arrhythmia (Long QT Syndrome, Brugada Syndrome, Lev’s disease etc.) through the analysis of criti-cal sequences codifying for ion channel subunits (HERG, KvLQT1, MinK, Mirp1, SCN5A, KCNQ1, KCNH2, KCNE1, KCNE2).
The main objective of post-mortem investigation in sudden juvenile death is the detection of treatable monogenic inherited disorders, in order to prevent further deaths among the relatives of the deceased patient.
In this paper, the authors seek to outline the medico-legal aspects of the nursing folder and the requirement for precision in its compilation in terms of content, requirements, management and filing.
This article also discusses the importance of the introduction of the nursing folder and emphasizes its status as a public document. The passing of Law n. 42/1999 was funda-mental in empowering the nursing profession and marking the passage from "auxiliary health care profession" to "health care profession".
We analyzed the effects of working activity and working shifts on the circadian rhythmic-ity and circadian phase relations of serum cortisol level, white blood cell count, resting heart rate and systolic/diastolic blood pressure in a group of Italian fishermen.
We observed a shift-induced displacement of cortisol secretion and a change in leukocyte count. Moreover, systolic/diastolic blood pressure and resting heart rate were markedly influenced by the night shift, whereas no appreciable changes were observed after the morning and afternoon shifts, compared to pre-working values. These data suggest that the human circadian system is greatly influenced by shift work, and that serum cortisol level, leukocyte count, systolic and diastolic blood pressure as well as resting heart rate are sensitive indicators of the biological responses to a stress workload in shift workers, especially after a night shift.
Post-traumatic stress disorder (PTSD) is an anxiety disorder that results from exposure to a traumatic event, and is characterized by hypermnesia of the traumatic event with fre-quent re-experiencing of the tragic occurrence, hyperarousal, and avoidance behaviour. Depression, anxiety, sleep dysfunction and substance abuse are also commonly reported. PTSD is highly prevalent both in the general population and in certain occupations that are particularly exposed to life-threatening situations, physically and psychological de-manding activities, and physical assault, such as rescue workers, firefighters and para-medics. Recent advances in the comprehension of the epidemiology, physiopathology and clinical presentation of PTSD could push toward increased identification of this com-mon psychiatric disorder with significant reflections on the chances of successful treat-ment.
The allegation by a child victim of sexual abuse is, in many cases, the most important evidence of wrongdoing, especially in absence of medical or physical evidence or confes-sions of guilt. The Rorschach inkblot test is a projective personality assessment technique used to evaluate child witnesses.
We report a case of three girls allegedly abused by the father, in which the psychometric evaluation with the Rorschach test did not give credibility to the testimony of the chil-dren. When interrogating a minor, it is very difficult to distinguish between a true and a lie. Indeed, many different elements can affect the dialogue, such as the child’s age, the events being discussed, interrogation environment, factors linked to the interviewer, etc. Therefore, it is possible errors of evaluation, misunderstandings or confusion happen fre-quently.
The aim of this case report is to highlight that employment of methodologies and criteria recognised by the scientific community could simplify the acquisition and assessment of information from a minor.
Achilles tendon rupture is currently one of the most frequent injuries in athletes. Such rupture may be caused by a sudden dorsiflexion of the ankle, pushing off with the weight bearing forefoot while extending the knee or violent dorsiflexion of a plantar flexed foot. The treatment goal consists of restoring the normal tendon length and tension, as well as the function and strength of the gastrocnemius-soleus complex. The biological repair process can be enhanced in all stages of recovery with the use of PRP (Platelet Rich Plasma) without any side effects.
Attention Deficit Hyperactivity Disorder (ADHD) is characterised by low levels of internal-izing symptoms and self-efficacy which causes low self-esteem, while externalizing be-haviours appear to be related to high levels of stress in the parents.
The purpose of this research is to analyze the impact of ADHD on self-esteem and paren-tal stress. A multidimensional assessment of self-esteem was performed using the MSCS (Multidimensional Self-Concept Scale) in a group of 12 male patients with ADHD (age range 9-11 years). Parental stress was investigated using the Parenting Stress Index (PSI). These results were compared with a group of 12 healthy children (age 9-11 years), with both parametric statistics and correlation statistics.
The comparison between ADHD children and control subjects, performed by a calculation to rank with the Mann-Whitney, showed a high significance in two dimensional compo-nents of self-esteem: social relationships (Z -2.028 p 0.045) and academic success (Z -2.166 p 0.028). The total self-esteem score differed significantly between the two groups (Z -2.227 p 0.024). Parental stress increaseed with the level of the child‟s oppositional symptoms (p 0.790) but it did not correlate with the other scores (cognitive problems / inattention p 0.381); hyperactivity p 0.414; ADHD index p 0.324). The present study shows that self-esteem is impaired among children with ADHD.