Osteochondroma as a cause of scapular winging in an adolescent: a case report and review of the literature

INTRODUCTION: Winged scapula is defined as the prominence of the medial border of the scapula. The classic etiopathology of scapular winging are injuries to the spinal accessory or long thoracic nerves resulting respectively in trapezius and serratus anterior palsy. To the best of our knowledge, there are only few reports of scapular lesions being mistaken for winging of the scapula. We report a rare case of a large scapular osteochondroma arising from the medial border and causing a pseudowinging of the scapula. CASE PRESENTATION: A 17-year-old Caucasian boy came to us complaining about a winged left scapula. The patient had a complete painless range of motion, but a large hard bony swelling was palpable along the medial border of his left scapula. A grating sensation was felt when his arm was passively abducted and/or elevated causing discomfort. A lesion revealed on X-rays was diagnosed as an osteochondroma of the medial border of his scapula. After preoperative examinations, he underwent open surgery in order to remove the lesion. A histological examination confirmed the clinical diagnosis of osteochondroma. A clinical examination 3 months later showed a full and painless range of motion, the absence of the grating sensation during passive abduction and elevation and the complete disappearance of his left shoulder deformity. After 2 years of follow-up, there were no clinical or radiological signs of recurrence. CONCLUSIONS: Despite its rarity osteochondroma should be considered in the differential diagnosis for any adolescent presenting with a winging of the scapula

Early Monitoring Response to Therapy in Patients with Brain Lesions Using the Cumulative SUV Histogram

Featured Application The study proposes a methodology to evaluate the response of patients with brain lesions to Gamma Knife treatments through the use of Positron Emission Tomography imaging. Gamma Knife treatment is an alternative to traditional brain surgery and whole-brain radiation therapy for treating cancers that are inaccessible via conventional treatments. To assess the effectiveness of Gamma Knife treatments, functional imaging can play a crucial role. The aim of this study is to evaluate new prognostic indices to perform an early assessment of treatment response to therapy using positron emission tomography imaging. The parameters currently used in nuclear medicine assessments can be affected by statistical fluctuation errors and/or cannot provide information on tumor extension and heterogeneity. To overcome these limitations, the Cumulative standardized uptake value (SUV) Histogram (CSH) and Area Under the Curve (AUC) indices were evaluated to obtain additional information on treatment response. For this purpose, the absolute level of [11C]-Methionine (MET) uptake was measured and its heterogeneity distribution within lesions was evaluated by calculating the CSH and AUC indices. CSH and AUC parameters show good agreement with patient outcomes after Gamma Knife treatments. Furthermore, no relevant correlations were found between CSH and AUC indices and those usually used in the nuclear medicine environment. CSH and AUC indices could be a useful tool for assessing patient responses to therapy

West Nile virus: the Italian national transplant network reaction to an alert in the north-eastern region, Italy 2011.

We report four cases of West Nile virus (WNV) transmission following a single multiorgan donation in north-eastern Italy. The transmissions were promptly detected by local transplant centres. The donor had been tested for WNV by nucleic acid amplification test (NAT) prior to transplantation and was negative. There were no detected errors in the nationally implemented WNV safety protocols

Valorisation of typical products through characterising and promoting actions: morpho-biometric traits, sensory analysis and flavonol content in Cipolla di Giarratana

The performances of 9 accessions of Cipolla di Giarratana landrace were evaluated at 5 different sites located 2 in the area where this landrace is traditionally grown (South-Eastern Sicily, 550 m asl), 2 in the neighbor areas with similar average altitude, and one on the South East coast of Sicily (sea level). Biometric and morphological traits, flavonol content and sensory profile were all considered in the valorisation of a typical product of a marginal area of Sicily. Data on the actual yield and crop management at farm scale were also obtained involving more than half of the growers actually cultivating Cipolla di Giarratana , and measuring yield, plant density, and bulb weight directly on the farms. The Cipolla di Giarratana landrace is characterised by a large and heavy bulb (535 g), strongly flattened at the poles, with the maximum diameter at the central section, and white in colour. Significant differences in bulb weight and diameter were found among accessions and locations, but there were no interactions between them and one accession reported the highest bulb weight value in all of the locations studied. With regards to bulb weight, farm scale data confirm the results we obtained at the experimental locations. Fifty percent of registered yield at farm scale ranged between 86 and 152 t ha –1 with a median of 119 t ha –1 , and measured plant density revealed that 50% of the farmers planted 20-27 plants per square meter. Analysis of the UV-vis and mass spectra showed the presence of 10 different flavonols with Quercetin as the most represented flavonol. The sensory profile of Cipolla di Giarratana onion showed that this landrace is characterised by a high intensity of sweet, typical fresh flavour and texture perception

household transmission and disease transmissibility of a large hav outbreak in lazio italy 2016 2017

Abstract A major outbreak of Hepatitis A Virus (HAV) has swept through Europe between mid-2016 and 2017, mainly within the community of men who have sex with men (MSM). Over the same period, about 1,000 outbreak-related cases of acute Hepatitis A (AHA) were recorded in Lazio region, Italy. We calibrated a Bayesian model to reconstruct likely transmission events within all 44 households where multiple infections were recorded, representing a total of 103 cases from the HAV outbreak in Lazio. Based on information on the observed times of symptom onset, we estimated for the probability distribution function of the HAV generation time and used it to compute the effective and instantaneous reproduction numbers for the considered outbreak from the overall epidemic curve (N = 998 cases). We estimated a mean generation time of 30.2 days (95%CI: 25.2-33.0) and an effective reproduction number of about 1.63 (95% CI: 1.35-1.94). Transmissibility peaked in January 2017, shortly before targeted awareness and vaccination campaigns were put in place by health authorities; however, transmission remained above the epidemic threshold until June 2017. Within households, children (0-15) and young adults (16-30) infected preferentially individuals of the same age class, whereas transmission within older age groups was substantially homogeneous. These results suggest that the implemented interventions were able to slow down HAV transmission, but not to bring it rapidly to a halt. According to our estimates of the HAV transmissibility, about 50% of the at-risk persons should be immunized to prevent similar outbreaks in the future. Our results also indicate spillover from community transmission to household members, suggesting the opportunity of vaccinating household contacts of cases to prevent further spread of the epidemics

Immunohistochemical Analysis of Myenteric Ganglia and Interstitial Cells of Cajal in Ulcerative Colitis

Ulcerative colitis (UC) is an inflammatory bowel disease with alterations of colonic motility, which influence clinical symptoms. Although morpho-functional abnormalities in the enteric nervous system have been suggested, in UC patients scarce attention has been paid to possible changes in the cells that control colonic motility, including myenteric neurons, glial cells, and interstitial cells of Cajal (ICC). This study evaluated the neural-glial components of myenteric ganglia and ICC in the colonic neuromuscular compartment of UC patients by quantitative immunohistochemical analysis. Full-thickness archival samples of the left colon were collected from 10 patients with UC (5 M, 5 F; age range, 45-62 years) who underwent elective bowel resection. The colonic neuromuscular compartment was evaluated immunohistochemically in paraffin cross-sections. The distribution and number of neurons, glial cells and ICC were assessed by anti-HuC/D, -S100β and -c-Kit antibodies, respectively. Data were compared with findings on archival samples of normal left colon from 10 sex- and age-matched control patients, who underwent surgery for uncomplicated colon cancer. Compared to controls, patients with UC showed: (a) reduced density of myenteric HuC/D-positive neurons and S100β-positive glial cells, with a loss over 61% and 38%, respectively, and increased glial cell/neuron ratio; (b) ICC decrease in the whole neuromuscular compartment. The quantitative variations of myenteric neuro-glial cells and ICC indicate considerable alterations of the colonic neuromuscular compartment in the setting of mucosal inflammation associated with UC, and provide a morphological basis for better understanding the motor abnormalities often observed in UC patients

Recommendations of the LHC Dark Matter Working Group: Comparing LHC searches for heavy mediators of dark matter production in visible and invisible decay channels

Weakly-coupled TeV-scale particles may mediate the interactions between normal matter and dark matter. If so, the LHC would produce dark matter through these mediators, leading to the familiar "mono-X" search signatures, but the mediators would also produce signals without missing momentum via the same vertices involved in their production. This document from the LHC Dark Matter Working Group suggests how to compare searches for these two types of signals in case of vector and axial-vector mediators, based on a workshop that took place on September 19/20, 2016 and subsequent discussions. These suggestions include how to extend the spin-1 mediated simplified models already in widespread use to include lepton couplings. This document also provides analytic calculations of the relic density in the simplified models and reports an issue that arose when ATLAS and CMS first began to use preliminary numerical calculations of the dark matter relic density in these models.Comment: 19 pages, 4 figures; v2: author list and LaTeX problem fixe