Rivalutazione critica sul trattamento delle fratture di radio e ulna nel cane

Riassunto: Le fratture di radio e ulna rappresentano dall’8,5 al 18% delle fratture nei cani e nei gatti. La consolidazione di queste fratture può risultare problematica e la presenza di complicazioni è relativamente alta. Questo a causa della limitata copertura da parte dei tessuti molli circostanti, dello scarso apporto ematico in questo distretto e della particolare configurazione anatomica. Tra le complicazioni più frequenti troviamo: unioni ritardate, non unioni, malunioni, disturbi dell’accrescimento, osteomieliti e rigidità articolari. Scopo di questo lavoro è quello di rivisitare in senso critico i risultati ottenuti nelle osteosintesi effettuate con varie tecniche, in fratture di radio e ulna nel cane. Considerando i follow up dei pazienti operati in relazione alla metodica impiegata, al tipo di frattura, all’età del soggetto ed al periodo intercorso dal trauma, abbiamo potuto constatare quanto il buon esito di un’osteosintesi in presenza di una frattura di radio e ulna possa dipendere strettamente dal protocollo impiegato. Talvolta alcune deviazioni hanno potuto causare ritardo nella guarigione con conseguente necessità di riabilitazione del paziente. Questo dimostra come, questo tipo di frattura, che per sua natura risulta apparentemente semplice, talvolta rivela delle difficoltà che possono inficiare il buon esito dell’osteosintesi. È necessario, perciò, riporre particolare attenzione sia nella scelta del tipo di osteosintesi che nel controllo postoperatorio del paziente. Abstract: Radial and ulnar fractures represent from 8,5 to 18% of all fractures in dogs and cats. Healing these fractures may be problematic, and the incidence of complications is relatively high. This is due to limited gentle tissue coverage, poor blood supply in this district and particular anatomical configuration. Major complications are: delayed union, nonunion, malunion, growth deformities, osteomyelitis and joint stiffness. The object of this study is to analyse , in a critical way, the results obtained in osteosynthesis, which have been carried out with different techniques, in radial and ulnar fractures. Considering the follow up of the operated patients in relation to the used treatment, kind of fracture, patients age and time elapsed from the trauma, we have been able to verify that the success of bone fixation in radial and ulnar fracture depends on the used protocol. Sometimes some deviations have caused delayed healing and it has been necessary to rehabilitate the patient. This suggests that this type of fracture, that seems to be easy for its nature, sometimes causes difficulties that can invalidate the outcome of osteosynthesis. So, it is necessary to pay particular attention both to the choice of surgical technique and the postoperative management of the patient

Temperature-Sensitive Inhibition of Development in Dictyostelium Due to a Point Mutation in the piaA Gene

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The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey

Background The spread of multi-resistant infections represents a continuously growing problem in cirrhosis,particularly in patients in contact with the healthcare environment. Aim Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multiresistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients. Methods All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community- Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes. Results One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections. Conclusions Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential

Laparoscopic Treatment of Gastric Duplication in a Child

Introduction: Gastric duplication is a rare congenital anomaly with an incidence of 4-8% of all gastrointestinal duplications; enteric duplications are ectopic cystic or tubular structures with a mucous and muscular tunics and they can be in contiguity/continuity with the intestinal lumen.1 Gastric duplication is often an occasional finding, associated to aspecific sintomatology for which pre-operative diagnosis is not univoque; differential diagnosis with other retroperitoneal diseases or mesenteric cysts can be difficult.1 (Run time 8min). Material and Methods: We present a case of a one-year-old child with a pre-natal ultrasound (US) finding of endo-abdominal cystic lesion. After birth, US scans showed an anechogenic-cyst of 33x28mm in the left upper quadrant, between stomach, spleen and kidney. The magnetic resonance confirmed the presence of the lesion (40x34mm), imprinting the posterior gastric wall, the spleen and the anterior side of left kidney. An esophagous-stomach-duodenum contrast study was also performed, showing the imprinting cyst on the great curvature close to the gastric fundus without communication with gastric lumen. On follow-up, the child underwent to periodic US scans and no growth or ultrasonographic changes were described. At 13-months, the diagnosis was still unclear and the patient underwent explorative laparoscopy with esophagous-gastric-duodenoscopy (EGDS). The preliminary EGDS showed a 35mm convexity on the posterior wall of gastric fundus with no evidence of orifice. A 5mm trans-umbilical trocar was placed and 5mm trocar in the epigastric region and 10-12mm trocar in the left side were positioned. At the abdominal exploration the cyst resulted to be in continuity with the posterior gastric wall on the superior third of the great curvature. The lesion was isolated from other tissues, but the postero-medial wall of neoformation appeared to be not dissociable and in continuity with the stomach; a complete resection of the cyst, using 45mm linear stapler, was performed including a small portion of the great gastric curvature. At the following intra-operative endoscopic control no more evidence of irregularity of the gastric wall was seen and the suture was assured. Results: The operative time was 140-minutes. No complications occurred and the blood loss was minimal. The patient started oral intake on 5’ post-operative-day and was discharged on 6’ post-operative-day. The histological examination confirmed the gastric nature of cyst. At 1-year of follow-up no recurrences were diagnosed and the child presents in good health with a regular growth. Conclusion: We can assume that laparoscopic surgery is the correct procedure for gastric duplication cysts, to get both definitive diagnosis and treatment, and the radical surgical excision represents the treatment of choice in order to avoid neoplastic degeneration of internal lining mucosa.2 Furthermore surgical laparoscopy appears to be a feasible and safe technique

Once-daily intrapleural urokinase treatment of complicated parapneumonic effusion in pediatric patients

In this paper, we describe our experience in the treatment of childhood empyema using urokinase. Patients' ages ranged from 2 to 12 years. Urokinase (dosage: 3,100 IU/kg/day) was diluted in normal saline to produce 1000 IU/ml (maximum dosage 100,000 IU in 100 ml of normal saline). After 2 hours, the clamped catheters were released and connected to water-seal suction at a negative pressure of 10 cm H2O. Pleural irrigations were continued once a day until thoracostomy tube output decreased to less than 10 ml/day (urokinase treatment mean duration: 11.5 days). The complete resolution of the chest effusion was assessed on chest ultrasound scan and radiographs. None of the patients experienced any side effects due to urokinase. It would now seem reasonable to advocate small chest tube thoracostomy and intrapleural urokinase as first-line treatment of pleural empyema in children, with surgery indicated as a secondaryintervention

Multicenter Evaluation of the C6 Lyme ELISA Kit for the Diagnosis of Lyme Disease

Lyme disease (LD), caused by infection with Borrelia burgdorferi, is the most common tick-borne infection in many regions of Eurasia. Antibody detection is the most frequently used laboratory test, favoring a two-step serodiagnostic algorithm; immunoenzymatic detection of antibodies to C6 has been shown to perform similarly to a standard two-step workflow. The aim of this study was the performance evaluation of the C6 Lyme ELISA kit compared to a standard two-step algorithm in three laboratories located in the northeastern region of Italy which cater to areas with different LD epidemiology. A total of 804 samples were tested, of which 695 gave concordant results between C6 testing and routine workflow (564 negative, 131 positive). Wherever available, clinical presentation and additional laboratory tests were analyzed to solve discrepancies. The C6 based method showed a good concordance with the standard two-step algorithm (Cohen's κ = 0.619), however, the distribution of discrepancies seems to point towards a slightly lower specificity of C6 testing, which is supported by literature and could impact on patient management. The C6 ELISA, therefore, is not an ideal stand-alone test; however, if integrated into a two-step algorithm, it might play a part in achieving a sensitive, specific laboratory diagnosis of LD

Aromatase and 5-alpha reductase gene expression: modulation by pain and morphine treatment in male rats

<p>Abstract</p> <p>Background</p> <p>The steroid hormone testosterone has been found to be greatly reduced by opioids in different experimental and clinical conditions. The purpose of this study on male rats was to determine the effects of a single injection of morphine (5 mg/Kg) on persistent pain (formalin test) and the single or combined effects on p450-aromatase and 5-alpha reductase type 1 mRNA expression in the brain, liver and testis. Testosterone was determined in the plasma and in the brain, morphine was assayed in the plasma.</p> <p>Results</p> <p>In the morphine-treated rats, there were increases of 5-alpha reductase mRNA expression in the liver and aromatase mRNA expression in the brain and gonads. Morphine was detected in the blood of all morphine-treated rats even though there were no clear analgesic affects in the formalin-treated animals three hours after treatment. Testosterone was greatly reduced in the plasma and brain in morphine-treated subjects.</p> <p>Conclusions</p> <p>It appears that morphine administration can induce long-lasting genomic effects in different body areas which contribute to the strong central and peripheral testosterone levels. These changes were not always accompanied by behavioral modifications.</p