Post-traumatic infection of the lower limb caused by rare Enterobacteriaceae and mucorales in a young healthy male.

Summary Enterobacter amnigenus and Leclercia adecarboxylata are Gram-negative aerobic bacilli of the family Enterobacteriaceae that have been isolated from water and, rarely, from various clinical specimens. Absidia is a filamentous fungus of the class Zygomycetes that is ubiquitous in nature and can cause infection, primarily in immunocompromised hosts. Here, we describe an infection of the left lower limb caused by E. amnigenus and L. adecarboxylata with subsequent isolation of Absidia spp. in a patient with multiple traumatic injuries after a major motor vehicle accident. The severity of the clinical picture made amputation necessary, despite aggressive anti-infective therapy with both antibacterial and antifungal agents. Prompt diagnosis and management are mandatory in order to minimize morbidity and even mortality, and reduce the social and economic cost

Inferior peroneal retinaculum tear with isolated peroneus longus tendon dislocation: A case report of an extremely rare injury, with the proposal of an innovative repair technique

Peroneus longus tendon (PLT) dislocation associated with inferior peroneal retinaculum (IPR) tear is an extremely rare injury. Only 6 cases are described in English literature to date, and its diagnosis is always delayed from the initial trauma. Swelling at the lateral face of the heel and a snapping during the movement of the foot and ankle are typical signs that can induce the suspect of this injury. Operative treatment is required as it typically affects young adults with high functional demands and tendon instability causes pain and functional limitation; also, a neglected dislocated or instable PTL may eventually end up with a rupture. In the few cases reported in literature, different operative techniques have been described, all with excellent results. A case of an initially overlooked dynamic dislocation of the PLT due to IPR tear in a young professional soccer player is described. The lesion was treated with a not yet described operative technique that consists in groove deepening and subsequent IPR repair through transosseous sutures, instead of peroneal tubercle resection as mostly advocated. Final follow up at 15 months showed complete recovery, with a Foot and Ankle Outcome Score of 100%

Chronic constipation diagnosis and treatment evaluation: The "CHRO.CO.DI.T.E." study

Background: According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy. Methods: During a 2-month period, 52 Italian gastroenterologists recorded clinical data of FC, IBS-C and NRC patients, using Bristol scale, PAC-SYM and PAC-QoL questionnaires. In addition, gastroenterologists were also asked to record whether the patients were clinically assessed for CC for the first time or were in follow up. Diagnostic tests and prescribed therapies were also recorded. Results: Eight hundred seventy-eight consecutive CC patients (706 F) were enrolled (FC 62.5%, IBS-C 31.3%, NRC 6.2%). PAC-SYM and PAC-QoL scores were higher in IBS-C than in FC and NRC. 49.5% were at their first gastroenterological evaluation for CC. In 48.5% CC duration was longer than 10 years. A specialist consultation was requested in 31.6%, more frequently in IBS-C than in NRC. Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. Faecal calprotectin, thyroid tests, celiac serology, breath tests were more frequently suggested in IBS-C and anorectal manometry in FC. More than 90% had at least one treatment suggested on chronic constipation, most frequently dietary changes, macrogol and fibers. Antispasmodics and psychotherapy were more frequently prescribed in IBS-C, prucalopride and pelvic floor rehabilitation in FC. Conclusions: Patients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. Digital rectal examination was often not performed but at least one diagnostic test was prescribed to most patients. Colonoscopy and blood tests were the "first line" diagnostic tools. Macrogol was the most prescribed laxative, and prucalopride and pelvic floor rehabilitation represented a "second line" approach. Diagnostic tests and prescribed therapies increased by increasing CC severity

Femoral tunnel in revision anterior cruciate ligament reconstruction

The failure rate after anterior cruciate ligament (ACL) reconstruction performed by expert surgeons is estimated to be in the range of 10-15%, and only 60% of patients undergoing this surgery are able to resume sporting activities comparable to those they engaged in prior to the traumatic incident. Incorrect femoral tunnel placement is one of the main causes of failed ACL reconstruction and this must be remembered when undertaking revision surgery. There are various possible errors that can be committed and, to plan revision surgery correctly, it is fundamental to study the position of the existing femoral tunnel(s) both on classic anteroposterior and lateral plain radiographs and on computed tomography scans with frontal, sagittal, and coronal sections, and also using three-dimensional reconstruction. In-depth anatomical knowledge and familiarity with the various possible surgical techniques are also mandatory for a successful surgical outcome

Modified single pedicle reverse adipofascial flap for fingertip reconstruction

Homodigital adipofascial flap is a well-established method for treating a distal fingertip defect; nonetheless, its use has some limitations. Reconstruction of fingertip injuries, with radial or ulnar tissue loss, may lead to some difficulties in providing an adequate bone coverage. The standard bipedicled technique did not allow the flap to cover the bone exposure without excessive tension. In our series, the reverse adipofascial flap had a single pedicle. The modified technique, because of its improved degree of rotation, granted the flap to reach either radial or ulnar tissue losses

Freestyle Perforator Puzzle Flap for Posterior Trunk Reconstruction

Closure of extensive defects of posterior trunk can be challenging for reconstructive surgeons owing to the need of a large bulk of well-vascularized tissue to resurface the skin and the exposed hardware and to fill the dead spaces. We hypothesized that elevating multiple perforators flaps in various patterns would allow for reconstruction of large posterior trunk defects with tension-free primary closure and minimal donor site morbidity

Prognostic factors in head and neck melanoma according to facial aesthetic units

BACKGROUND: Head and neck melanoma is a clinical challenge. Indeed, cutaneous head and neck melanoma shows a worse prognosis in comparison to melanomas of other body sites. Although the emphasis on facial cosmetic preservation plays a pivotal role in comparison to other body areas, specific facial aesthetic units could also play a key role in the prognostic evaluation of the malignancy. METHODS: The aim of the current study was to evaluate the general outcome and clinicopathological features of head and neck melanoma and to detect prognostic differences according to each facial aesthetic unit. The Kaplan-Meier product was used to calculate survival curves, while Cox proportional-hazard regression was performed to evaluate the predictive value of each facial aesthetic unit. RESULTS: A total of 221 head and neck melanoma patients was included in our analysis. In the nasal facial aesthetic unit, we found a high rate of local recurrence, which affected significantly disease free survival. The worse prognosis was observed in melanoma of the scalp, which showed a greater tendency to skip metastases in internal organs. Moreover, we found that scalp showed a low incidence of non-melanoma skin cancers, if compared to other facial aesthetic unit, highlighting that the scalp local milieu might play a more prominent role in melanoma biology than chronic UV exposition. CONCLUSIONS: Although facial aesthetic units have an aesthetic function, they could also play a role in the evaluation and follow-up of melanom

Hybrid ZnO:polystyrene nanocomposite for all-polymer photonic crystals

We report on ZnO nanoparticles-polystyrene (PS) nanocomposites (NC) engineered to modify PS matrix permeability and refractive index (n), and to fabricate 1D allpolymer photonic crystals (PC) for sensing applications. The new NC can be easily processed from solutions to prepare high quality thin films by spin coating. ZnO nanoparticles (n=1.98) have been synthetized by solvothermal route and grafted with a silane to reduce phase segregation in the PS matrix (n=1.58). Such procedure led to an increase of the matrix refractive index of about 1%. By casting alternated layers of the NC and cellulose acetate (CA, n=1.46), we fabricated free-standing and flexible distributed Bragg reflectors (DBRs) of excellent optical quality. Preliminary results on the use of such DBRs as solvent vapor sensors are reported

Patient and physician views on the quality of care for inflammatory bowel disease after one-year follow-up: Results from SOLUTION-2, a prospective IG-IBD study

Background and aims Perception of quality of care is important in the management of patients with chronic diseases, particularly inflammatory bowel disease. Aims and methods This longitudinal study aimed to investigate variations of the Quality of Care through the Patients\ue2\u80\u99 Eyes (QUOTE-IBD) questionnaire scores one year after the basal evaluation in the Studio Osservazionale quaLit\uc3  cUre malatTIe crOniche intestiNali (SOLUTION-1) study. Results Of the cohort of 992 patients, 936 were evaluable. The QUOTE-IBD score overcame satisfactory levels of more than the 80%, overall and in all subdomains except for the \ue2\u80\u9cContinuity of Care\ue2\u80\u9d sub-dimension (mean, 8.3; standard deviation, 1.49), scored satisfactory only by 34% of the patients. No significant changes in satisfaction were recorded overall, or considering patients subgroups. Significant differences were found at the end of the follow-up between physicians\ue2\u80\u99 and patients\ue2\u80\u99 perceptions of quality of care, with the former over-rating their performance in \ue2\u80\u9cContinuity of Cares\ue2\u80\u9d and under-rating \ue2\u80\u9cCosts\ue2\u80\u9d, \ue2\u80\u9cCompetence\ue2\u80\u9d, and \ue2\u80\u9cAccessibility\ue2\u80\u9d sub-domains of the score (p < 0.05 for all). Conclusion Perceived quality of care in a large cohort of Italian patients with inflammatory bowel disease remains unchanged after one-year follow-up and was not significantly affected by disease activity or therapeutic interventions. Differences between physicians\ue2\u80\u99 and patients\ue2\u80\u99 perceptions of quality of care should be taken into account