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Embj (181)

The authors describe a case of cerebral venous sinus thrombosis following subarachnoid anaesthesia, characterized by operative difficulties and lack of patient collaboration. After anaesthesia, the patient reported a positional headache and on the 5th day following surgery, he developed a frontal tensive headache with dysphoric and depressive  symptoms. On the 9th day he presented with emesis, hypostenia of the upper left limb and ipsilateral positive Babinsky. The diagnosis was made only on the 10th day.  Genetic analyses showed a homozygous mutation of methylene-tetrahydrofolate-reductase associated to hyperhomocysteinemia (21,7μM). The recurrence of post-dural puncture headaches is very frequent in patients undergoing subarachnoid anesthesia, but special attention is required in the event of headache, as well as associated clinical signs and other risk factors, in order to achieve a precocious diagnosis and allow the physician to start a suitable therapy.

Causality assessment is an algorithm proposed by WHO to identify a causal relationship between vaccines and adverse events following immunization (AEFIs), mostly for serious adverse events. It can be considered consistent, inconsistent, indeterminate or unclassifiable. This study describes AEFIs reported in Puglia from 2013 to 2016 and analyzes the differences between  the causality assessments performed on AEFI case-report information and the causality assessments performed after the examination of clinical documentation. 292 AEFI were reported: 191 (65.4%) non serious, 59 (20.2%) serious and 42 (14.4%) undefined. Causality assessment performed on the AEFI case-report information classified 59.2% (n=29/49) of serious AEFIs as consistent while assessment performed after clinical review only classified 30.6% (n=15/49) of serious AEFI as consistent (X2=65.0; p=0,000). In the first approach, inconsistent serious AEFIs were 18.6% (n=11/49) and then became 45.8% (n=27/49) after examination of clinical documentation. Indeterminate serious AEFIs were 6.8% (n=4) at first, and then 3.4% (n=2). Unclassifiables did not change.

The aim of this study was to explore the efficiency and usefulness of  tridimensional printing in plastic and reconstructive surgery for lesions of the maxillofacial region. This was comparison study between two groups of patients. Six patients underwent surgical reconstruction, using a three-dimensional model built on the basis of CT scans (group 1); and six patients underwent surgical reconstruction, without the use of a three-dimensional model (group 2). The following variables were evaluated: age, gender, histological diagnosis, cancer location, size of bone lesion, type of reconstruction, complications and surgical timing. A statistically significant difference was found in microsurgical flap survival (p = 0.019), with a survival rate higher in group 1 than in the controls.  This study provides preliminary evidence and partially confirms the validity of three-dimensional technology in plastic and reconstructive surgery. The results so far obtained, however, lead to hope for future uses of this ever-increasing technique. 

 

Genetic testing is a medical tool employed to screen changes in genes linked to cancer and other genetic diseases. Genetic tests are available for breast, ovarian, colon, thyroid, and some other cancers and they represent the main tool for early identification of the “risk” subjects. The choice to undergo genetic testing by a healthy or affected cancer patient with family history of the cancer has to be the fruit of a careful and prudent assessment of the advantages and disadvantages discussed during oncogenetic counselling. The latter, in turn, in the case of a patient's positive and informed choice, must constantly affiliate the genetic testing, in order to preserve the prediction and information role of the test as much as possible.

Allergic rhinitis is a common problem increasing greatly over the past three decades. Several studies have found a possible link between dyslipidemia and allergic disease but the relating causal mechanisms remain elusive. The aim of this study is to investigate the association between blood lipid levels and the presence of allergic rhinitis. A multicentre prospective study was carried out on 160 allergic rhinitis patients and 160 volunteers as a control according to age, gender, body mass index (BMI) values and full blood lipid profile. A possible correlation between abnormal dyslipidemia parameters and the severity of allergic rhinitis was studied too. Demographic characteristics didn’t differ between groups. While levels of LDL-C, total cholesterol, as well as TC/HDL ratio and LDL/HDL ratio, were significantly higher (p<0.001) in patients with allergic rhinitis, there was a positive correlation between abnormal dyslipidemia parameters and moderate/severe allergic rhinitis symptomatology ( p<0.001). We support the hypothesis that dyslipidemia might play a role in in the manifestation of allergic rhinitis.

The hyoid bone is the only "suspended bone" in our body, and its suspension system has an important role in posture maintenance. We studied postural modification in a group of patients affected by Obstructive Sleep Apnea Syndromewho had undergone surgical treatment including hyoid suspension.  The surgical procedure  performed was section of supra- and infrahyoid muscle and mobilization of the hyoid bone through its suspension to the thyroid cartilage. We studied the postural changes with stabilometric tests. In the early post-operative (one week) follow-up, we performed a posturography test with closed eyes and occlusal disjunction, and saw a worsening of the average parameter of the centre of pressure with antero-posterior oscillations. However, we would like to highlight that by the time of the one year follow up, a compensatory mechanism had been established which allowed for a return to normal hyoid bone kinematics.  

The aim of the study was to evaluate individual inflammatory response after inguinal hernioplasty by measuring baseline and post-operative serum IL-6 response to surgery and quantifying the variability of the serum response in a homogeneous group of patients.Patients enrolled in the study underwent inguinal hernioplasty. Blood samples were used to analyze serum IL-6, TNF-alpha, LOOH and GSH levels. To identify high and low IL-6 responders, patients were divided into 2 groups according median values of the peak levels of IL-6. Mean levels of the cytokine were comparable at baseline but reached peak at 6 h and persisted elevated at following hours among high responders whereas remained significantly lower over time among low responders.Patients identified as low responders showed not significant changes in serum IL-6 levels over the post-operative period. In contrast, high responders demonstrated a significant response reaching the peak level of IL-6 after 6 hours post operation.

During the summer of 2016, a group of students from the University of Palermo attending the second year of medicine school took part in a four week course of Whole Cadaveric Dissection at the University of Malta. Within this project, we students worked on a male cadaver by using a surgical kit, taking care to record everything with pictures and videos. In this way, every structure was isolated and studied in comparison with the anatomic atlas’ pictures. The aim of this article is to show the dissection method of the brachial plexus that we used. We started removing cutis and subcutis, then we identified the muscles’ origin and insertion; after isolating vascular-nervous structures, we finally exposed nerves, cords, trunks and roots of brachial plexus by using blunt dissection method.

In recent years, the number of contrastographic exams has increased considerably, compared to an increase in the complications related to this type of interventional approach. A number of specialists (interventional radiologists, cardiologists, vascular surgeons, cardiac surgeons, etc.) have to deal with complications related to the procedure or contrast medium (CM) used. With regard to the latter, contrast induced nephropathy (CIN) is commonly defined as an increase in serum creatinine (sCr) concentration of 0.5 mg / dL or 25% above baseline within 48 h of CM administration. It is the third most common cause of hospital - acquired renal failure, with an incidence rate that varies from 1 to 25% depending on patient comorbidities. It carries with it a lifelong dialysis therapy risk of 0.5 - 2%. CIN is a condition that can affect anyone subjected to a contrastographic exam, although there are groups at increased risk. The purpose of this article is to describe and analyze the methods used for CIN management, and detail the risk factors associated, with particular emphasis on score systems created to categorise patients according to CIN risk after procedure. The aim is also to create an easy and quick tool to guide doctors presented with a patient facing an injection of CM for diagnostic or therapeutic purposes.

The objective of this paper is to respond to the urgent need for an increase in access to HIV care among adolescents and young people in Sub-Saharan Africa. Since 2014, doctors with Africa CUAMM in collaboration with UNICEF have been supporting specific ambulatories for the youth population (between the ages of 10- 24) aiming to improve health education, specifically in relation to HIV prevention. Mozambique has the eighth highest prevalence of HIV in the world. It represents one of the six countries in which half of the adolescents living with HIV reside. Beira is Mozambique’s second largest city, and in 2009 it had the most women and men between the ages of 15-49 were living with HIV. This study retrospectively analyzes data collected between 2013 and 2014, which described the impact of a new health service in a low resource setting with high HIV prevalence. The specificity of the service, only dedicated to young people, is the basis for this paper.  We observed a significant increase in counseling in 2014 compared to 2013 (102,533 vs 63,959, p<0.01), confirming that strengthening specific youth services is an effective intervention for improving access to care of this target population. Youth ambulatories are great instruments to improve access to HIV care among young people.

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