A suspicious dark lesion in a boy.

The presence of history of hyperpigmented crust in a patient with a history of adequate hygiene is typical of terra firma\u2010forme dermatosis. The treatment is the rubbing of the skin with isopropyl alcohol (removal of the hyperpigmented brown crust, confirming the diagnosis). Physicians should be aware because early diagnosis avoid unnecessary treatment

FROM REALITY-BASED MODEL TO GIS PLATFORM. MULTI-SCALAR MODELING FOR IRRIGATED LANDSCAPE MANAGEMENT IN THE PAVIA PLAIN

This research aims to define a low-cost replicable methodology for obtaining fast multiscale information models. The experiments carried out were conducted by researchers from Dada LAB and PLAY experimental Laboratories of the University of Pavia, Department of Civil Engineering and Architecture, on the case study of the irrigated landscape of the Pavia plain. The entire work process was developed according to a low-cost purpose, starting from fast acquisition activities with UAV instruments, to the processing of photogrammetric data, urban and detailed scale modelling with open-source software, to the census, filing, and computerisation of the model. The resulting product is configured as a multiscale reality-based information system. A census card is associated with each constituent element of the model (crops, canals, valuable hydraulic artefacts). Connection to the GIS platform allows the user to query the model. The result is a digital system oriented to facilitate the management of the agricultural and irrigation landscape, and to digitally document and preserve the heritage of historical hydraulic existing artefacts. Two different GIS platforms for structuring the information system were tested. The first involved a high-budget solution using ESRI ArcGIS Pro/ArcSCENE software, and the second involved using QGIS software, an Open-Source Geographic Information System, to develop an accessible information system without license fees, to evaluate the advantages and disadvantages of low-cost processes

Il dosaggio del lattato in neonati con distensione addominale come fattore prognostico di sindrome da compartimento addominale

L'ipertensione intraaddominale (IAH) e la risultante sindrome da compartimento addominale (ACS), caratterizzata da incremento della pressione >20 mmHg e insufficienza d’organo o multiorgano, sono state descritte in neonati con patologie addominali chirurgiche. La gestione effettiva e preventiva dell'IAH è associata a minore morbidità. In uno studio retrospettivo abbiamo analizzato 20 neonati con distensione addominale persistente per individuare fattori predittivi di IAH ed ACS. Il Gold-Standard della misurazione dell'IAH è la misurazione pressoria intravescicale ancora non standardizzata c/o le UTIN. Per definire l'IAH abbiamo quindi utilizzato il monitoraggio della saturazione di ossigeno (SpO2) prossimale e distale rispetto all’addome e 2 segni di compromissione d’organo (oliguria, ipotensione, insufficienza respiratoria, acidosi metabolica). Abbiamo riscontrato un rischio tendenzialmente elevato di disfunzione multiorgano e decesso in neonati di età gestazionale maggiore (p=0,09) e con una causa congenita di ACS (p<0,05), e in neonati in correzione con bicarbonati (p=0,05). Alti valori di lattato già al ricovero correlano con un deficit di basi maggiore nelle fasi avanzate di ACS (p<0,05) e con una distensione tardiva (p<0,05) associata, a sua volta, a valori di lattato più elevati nelle fasi di distensione ed acidosi (p<0,05) rispetto alla distensione precoce. Il lattato alla distensione è tendenzialmente più alto in chi avrà eventi più gravi (p=0,06) pur non correlando con il decesso (p=0,2). Solo nella fase successiva di acidosi i valori di lattato sono predittivi di decesso (p<0,05). In nessuna fase sono state riscontrate correlazioni con l’insufficienza respiratoria. L’unico fattore predittivo per un decorso sfavorevole è l’insulto tissutale perfusionale precoce misurato tramite il lattato che tuttavia non correla con il decesso perché probabilmente neonati, soprattutto con difetti della parete addominale, possono sopportare pressioni intraaddominali più elevate senza andare incontro ad insufficienza multiorgano. Al contrario sembra che neonati con ACS secondaria o con età gestazionale maggiore tollerino meno l’IAH sviluppando ACS a pressioni più basse poichè gli spazi intraaddominali sono già definiti

Congenital cytomegalovirus related intestinal malrotation: a case report

Background: Cytomegalovirus is the most common cause of congenital infection in the developed countries. Gastrointestinal involvement has been extensively described in both adult and paediatric immunocompromised patients but it is infrequent in congenital or perinatal CMV infection. Case presentation: We report on a case of coexistent congenital Cytomegalovirus infection with intestinal malrotation and positive intestinal Cytomegalovirus biopsy. At birth the neonate showed clinical and radiological evidence of intestinal obstruction. Meconium passed only after evacuative nursing procedures; stooling pattern was irregular; gastric residuals were bile-stained. Laparatomy revealed a complete intestinal malrotation and contextually gastrointestinal biopsy samples of the appendix confirmed the diagnosis of CMV gastrointestinal disease. Intravenous ganciclovir was initiated for 2 weeks, followed by oral valgancyclovir for 6 month. Conclusion: CMV-induced proinflammatory process may be responsible of the interruption of the normal development of the gut or could in turn lead to a disruption in the normal development of the gut potentiating the mechanism causing malrotation. We suggest the hypothesis that an inflammatory process induced by CMV congenital infection may be responsible, in the early gestation, of the intestinal end-organ disease, as the intestinal malrotation. CMV infection should always be excluded in full-term infants presenting with colonic stricture or malrotation

Management of multiple pregnancy with an affected twin

Newborns from multiple pregnancies demonstrate a higher perinatal morbidity and mortality compared to singletons. Prematurity is more frequent in twins and therefore birth weight is significantly lower compared to singletons [1]. Thus, twins are more exposed to prema- turity related diseases (respiratory, cardiovascular, infec- tious, etc.) and to long-term complications [2]. It is very difficult to estimate the increased risk of neonatal mor- bidity related to twinning independently to the increased risk of prematurity. Prematurity is the main reason for most neonatal diseases in twins, but other variables may play a role. Fetal growth restriction [3] and congenital malformationsare major issues in offspring of multiple pregnancies. Specific risks vary according tozigosity (monozygotic >dizygotic) and kind (genetic, vascular, multifactorial, etc.) and site (systems and organs involved) of malformation. Accurate risk assessment strategies and adequate obstetrical-neonatological man- agement of multiple pregnancies may reduce the increasing need for neonatal intensive care and for health resources in the long-term follow-up that has been observed over the last decades. Careful analysis of both twins for a pathological condi- tion is mandatory to address the most appropriate man- agement. Twin discordance for the presence of a severe pathological condition raises serious concern in terms of bioethical and psychological impact on the parents and medical staff[4]. Different management choices can be considered: termination of pregnancy, selective embryo reduction of the affected twin, anticipation of delivery or natural course of the pregnancy. Each choicehides difficult clinical and legal implications. Accurate clinical, laboratory and ultrasonographic evaluation together with pregnancy follow-up are essential for reaching the correct diagnosis and consider prognosis and therapeutic options [5]. The risk of intrauterine death and potential risks for the other twin and the mother must be taken into account. Some- times it is possible to wait until the natural end of preg- nancy and then provide suitable treatment to the affected twin. Other times, parents opt to terminate the pregnancy and loose both twins. A selective reduction (after accurate evaluation of placentation) of the affected twin only carries a high risk of complication for the healthy twin, especially in monochorionic pregnancies. In the late third trimester of pregnancy, the option of a preterm delivery can be con- sidered and may contribute to the increase of prematurity and prematurity related diseases in twins. The management of multiple pregnancies is a very com- plex task for medical staff and requires parental support with adequate counselling and psychological help [6]

Penile Exogenous Pigmentation Mimicking Melanoma

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Effects of clinical and laboratory variables and of pretreatment with cardiovascular drugs in acute ischaemic stroke: a retrospective chart review from the GIFA study.

Background: Few studies have examined the role of cardiovascular drugs on acute ischaemic stroke prognosis. Aims: To evaluate the relationship between a favourable outcome in patients with acute ischaemic stroke and specific demographic, clinical and laboratory variables and cardiovascular drug pretreatment. Methods: The 1096 patients enrolled in the GIFA study (who had a main discharge diagnosis of ischaemic stroke) represent the final patient sample used in this analysis. Drugs considered in the analysis included angiotensin converting enzyme (ACE)-inhibitors, angiotensin II receptor blockers, statins, calcium channel blockers, anti-platelet drugs, vitamin K antagonists and heparins. The outcomes analyzed included in-hospital mortality, cognitive function evaluated by the Hodkinson Abbreviated Mental Test (HAMT), and functional status evaluated by activities of daily living (ADL). The definition of a good outcome was no in-hospital mortality, a HAMT score of >= 6 and no ADL impairment. Results: Patients with no in-hospital mortality, a HAMT score of >6 and no ADL impairment were more likely to be younger at baseline and have a lower blood glucose level and a systolic blood pressure (SBP) between 120 and 180 mmHg, a higher plasma total cholesterol level, a lower white blood cell count, and a lower Charlson Index (CI) score, a higher rate of pretreatment with ACE-inhibitors, calcium channel blockers and a lower rate of pretreatment with heparin. Conclusions: Predictors of good outcome, in terms of in-hospital mortality and cognitive and functional performance at discharge, included higher SBP at admission between 120 and 180 mmHg, a SBP plasma total cholesterol levels, a lower CI score, and pretreatment with ACE-inhibitors, calcium channel blockers and anti-platelets. (C) 2010 Elsevier Ireland Ltd. All rights reserved