Unusual Intranodular Collagenase Injection: A Case of Bilateral Ledderhose Disease

Summary: Ledderhose disease (LD) is a rare plantar fibromatosis of the foot, frequently associated with Dupuytren disease. Collagenase of Clostridium hystoliticum has recently revolutionized the way to treat Dupuytren disease. Nevertheless, the literature is still critically lacking about the use of collagenase injection in LD. We report a case of a man with bilateral symptomatic LD treated with collagenase. Injections (0.58 mg of collagenase of C. hystoliticum) were performed into nodules. Forced extension after injection was not performed. The patient could walk normally immediately after procedure. The procedure was a complete success without side effects or complications on either foot. Currently, at 14 months after treatment of the right foot and 12 months after treatment of the left foot, no recurrence has been observed. Collagenase injection was only effective in treating symptomatic LD in this one patient we reported on

Allergy in total knee replacement surgery: Is it a real problem?

Total knee arthroplasty is a common procedure, with extremely good clinical results. Despite this success, it produces 20% unsatisfactory results. Among the causes of these failures is metal hypersensitivity. Metal sensitization is higher in patients with a knee arthroplasty than in the general population and is even higher in patients undergoing revision surgery. However, a clear correlation between metal sensitization and symptomatic knee after surgery has not been ascertained. Surely, patients with a clear history of metal allergy must be carefully examined through dermatological and laboratory testing before surgery. There is no globally accepted diagnostic algorithm or laboratory test to diagnose metal hypersensitivity or metal reactions. The patch test is the most common test to determine metal hypersensitivity, though presenting some limitations. Several laboratory assays have been developed, with a higher sensitivity compared to patch testing, yet their clinical availability is not widespread, due to high costs and technical complexity. Symptoms of a reaction to metal implants present across a wide spectrum, ranging from pain and cutaneous dermatitis to aseptic loosening of the arthroplasty. However, although cutaneous and systemic hypersensitivity reactions to metals have arisen, thereby increasing concern after joint arthroplasties, allergies against implant materials remain quite rare and not a well-known problem. The aim of the following paper is to provide an overview on diagnosis and management of metal hypersensitivity in patients who undergo a total knee arthroplasty in order clarify its real importance

Three-Dimensional Automated, Machine-Learning-Based Left Heart Chamber Metrics: Associations with Prevalent Vascular Risk Factors and Cardiovascular Diseases

Background. Three-dimensional transthoracic echocardiography (3DE) powered by artificial intelligence provides accurate left chamber quantification in good accordance with cardiac magnetic resonance and has the potential to revolutionize our clinical practice. Aims. To evaluate the association and the independent value of dynamic heart model (DHM)-derived left atrial (LA) and left ventricular (LV) metrics with prevalent vascular risk factors (VRFs) and cardiovascular diseases (CVDs) in a large, unselected population. Materials and Methods. We estimated the association of DHM metrics with VRFs (hypertension, diabetes) and CVDs (atrial fibrillation, stroke, ischemic heart disease, cardiomyopathies, >moderate valvular heart disease/prosthesis), stratified by prevalent disease status: participants without VRFs or CVDs (healthy), with at least one VRFs but without CVDs, and with at least one CVDs. Results. We retrospectively included 1069 subjects (median age 62 [IQR 49–74]; 50.6% women). When comparing VRFs with the healthy, significant difference in maximum and minimum indexed atrial volume (LAVi max and LAVi min), left atrial ejection fraction (LAEF), left ventricular mass/left ventricular end-diastolic volume ratio, and left ventricular global function index (LVGFI) were recorded (p < 0.05). In the adjusted logistic regression, LAVi min, LAEF, LV ejection fraction, and LVGFI showed the most robust association (OR 3.03 [95% CI 2.48–3.70], 0.45 [95% CI 0.39–0.51], 0.28 [95% CI 0.22–0.35], and 0.22 [95% CI 0.16–0.28], respectively, with CVDs. Conclusions. The present data suggested that novel 3DE left heart chamber metrics by DHM such as LAEF, LAVi min, and LVGFI can refine our echocardiographic disease discrimination capacity

Imparare una lingua straniera in famiglia e i vantaggi del bilinguismo: il progetto BilFam.

Conoscere più di una lingua è importante per i futuri cittadini europei e del mondo. La prima infanzia è il momento migliore per diventare bilingue, perché il cervello è particolarmente flessibile e l’interesse nell’apprendimento delle lingue è molto alto nei bambini. Questi possono imparare due o più lingue se hanno la possibilità di usufruire della giusta quantità di input e se viene stimolata la loro motivazione e il loro divertimento. Parlare due lingue apporta numerosi vantaggi sia di tipo sociale che di tipo cognitivo. Quando in una famiglia si parlano due lingue differenti o quando una famiglia parla una lingua diversa da quella parlata nell’ambiente sociale in cui è inserita, i bambini hanno l’opportunità di crescere bilingui, ma questa possibilità richiede qualche sforzo e l’utilizzo di strategie linguistiche sistematiche da parte dei genitori. Per la maggior parte dei genitori l’obiettivo di crescere i propri figli bilingui non si associa alla disponibilità né di una concreta base teorica di riferimento né di strumenti e materiali la cui efficacia sia provata sperimentalmente Questo è precisamente l’obiettivo del progetto Bilfam, fornire ai genitori uno strumento valido, il Modello del FN (Taeschner, 2005), per la conoscenza e l’utilizzo di due lingue da parte dei propri figli in famiglia e con gli amici. I risultati preliminari suggeriscono che i bambini apprezzano le attività del progetto Bilfam ed utilizzano la seconda lingua non solo durante le attività, ma anche nella vita quotidiana. Il supporto fornito dal tutor e dagli altri partecipanti attraverso il sito web risulta importante per le famiglie ai fini del proseguimento del progetto. Ogni famiglia ha adattato le strategie proposte alla propria situazione e la qualità di tali strategie influenza l’acquisizione della seconda lingua.The paper describes the foreign language teching and learning programme tested in the BILFAM project (funded within European LLP) where monolingual families were provided with training, teaching material and tutoring for introducing a new language in their daily routines. The paper discusses the results of the intervention in terms of learning and of families' use of the available resources