Acute Posterior Shoulder Dislocation with Reverse Hill-Sachs Lesion of the Epiphyseal Humeral Head

Posterior dislocation of the shoulder is an unfrequent event that often occurs as a consequence of a direct trauma or epileptic crisis. Frequently the posterior dislocations are misunderstood, so they become chronic lesions. We reported a case of an acute posterior left shoulder dislocation with lesser tuberosity fracture and reverse Hill-Sachs lesions which involved more than 25% of the articular surface of the humeral head, in a 57-old-year man with right hemiparesis. We performed a synthesis of the lesser tuberosity with a screw, and we restored the shape of the humeral head with allograft. We achieved a good result that allows the patient to be able to do his previous activities of daily living

Hybrid Funnel Technique: A Novel Approach for Implant Site Preparation: A Pilot Study.

(1) Background: Different techniques and tools have been developed for implant site preparation. In this clinical scenario, Hybrid Funnel Technique (HFT), a novel osteotomy procedure, has been proposed. (2) Aim: The aim of this retrospective observational study was to consider the different responses to compression of the histological bony compartments (cancellus and cortical). HFT involves the use of multiple drills for the cortical layer preparation and of an osteotome for the osteocompaction of the cancellous bone. (3) Materials and Methods: Following computer-supported implant planning and guided surgery, 10 osteotomies with HFT were performed and 10 implants with the same length and diameter were placed in seven healthy and no daily smoking patients. Periapical X-ray and intraoral photographs were performed at baseline and after 12 months of follow-up to evaluate marginal bone level (MBL) changes and aesthetic results obtained from implant prosthetic rehabilitation. (4) Results: At 1 year of follow-up, 100% of the implants were successfully integrated, MBL change mean value was 0.17 mm ± 0.21. No differences in terms of MBL were noted between thin and thick biotypes. Pink esthetic score (PES) and white esthetic score (WES), assessed one year after definitive restoration placement, were 7.5 ± 2.3 and 8.5 ± 1.1, respectively. (5) Conclusions: Based on the findings of this preliminary clinical study, HFT has led to stability of peri-implant tissues and could represent a reliable technique for surgical preparation of the implant site

Surgical treatment of malignant involvement of the inferior vena cava

BACKGROUND: Resection and replacement of the inferior vena cava to remove malignant disease is a formidable procedure. The purpose of this review is to describe our experience with regard to patient selection, operative technique, and early and late outcome. METHODS: The authors retrospectively reviewed a 12-year series of 11 patients; there were 10 males, with a mean age 57 ± 13 years (range 27–72) who underwent caval thrombectomy and/or resection for primary (n = 9) or recurrent (n = 2) vena cava tumours. Tumour location and type, clinical presentation, the segment of vena cava treated, graft patency, and tumour recurrence and survival data were collected. Late follow-up data were available for all patients. Graft patency was determined before hospital discharge and in follow-up by CT scan or ultrasonography. More than 80% of patients had symptoms from their caval involvement. The most common pathologic diagnosis was renal cell carcinoma (n = 6), and hepatocarcinoma (n = 2). In all but 2 patients, inferior vena cava surgical treatment was associated with multivisceral resection, including extended nephrectomy (n = 5), resection of neoplastic mass (n = 3), major hepatic resection (n = 2), and adrenal gland resection (n = 1). Prosthetic repair was performed in 5 patients (45%). RESULTS: There were no early deaths. Major complications occurred in 1 patient (9%). Mean length of stay was 16 days. Late graft thrombosis or infection did not occur. The mean follow-up was 22.7 months (range 6–60). There have been no other late graft-related complications. All late deaths were caused by the progression of malignant disease and the actuarial survival rate was 100% at 1 year. Mean survival was 31 months (median 15). CONCLUSION: Aggressive surgical management may offer the only chance for cure or palliation for patients with primary or secondary caval tumours. Our experience confirms that vena cava surgery for tumours may be performed safely with low graft-related morbidity and good patency in carefully selected patients

Problems Associated With the Assessment of Local Site Effects Through a Multidisciplinary Integrated Study: The Case of Fivizzano’s Town (Italy)

The evaluation of local site effects, by means of ground response analyses, is a very complex and difficult task, which requires a multidisciplinary approach. This is operative philosophy expressed by VEL Project (Valutazione degli Effetti Locali), sponsored by Tuscany Region, to the aim to seismic risk characterization in the main seismic areas (i.e. Garfagnana, Lunigiana, Amiata, Valtiberina and Mugello). One of the most important urban centres, involved in the multidisciplinary activity of the VEL project, is certainly the town of Fivizzano located nearby the city of Massa, which was strongly damaged during the earthquake of September 1920 (the strongest seismic event occurred in Northern Apennines in the latest centuries). Remarkably good macroseismic information is available about the destructive impact yielded at Fivizzano by this earthquake (e.g. number of casualties, level of damage of buildings, etc). The main objective of this paper is to identify the occurrence of possible local site effects in the Fivizzano’s area following the 1920 earthquake and to quantify them by means of one and two-dimensional site response analysis. The input data required for study were obtained through a comprehensive geological survey and a multi disciplinary underground exploration of the area

FLASH radiotherapy with electrons: issues related to the production, monitoring, and dosimetric characterization of the beam

Various in vivo experimental works carried out on different animals and organs have shown that it is possible to reduce the damage caused to healthy tissue still preserving the therapeutic efficacy on the tumor tissue, by drastically reducing the total time of dose delivery (<200 ms). This effect, called the FLASH effect, immediately attracted considerable attention within the radiotherapy community, due to the possibility of widening the therapeutic window and treating effectively tumors which appear radioresistant to conventional techniques. Despite the experimental evidence, the radiobiological mechanisms underlying the FLASH effect and the beam parameters contributing to its optimization are not yet known in details. In order to fully understand the FLASH effect, it might be worthy to investigate some alternatives which can further improve the tools adopted so far, in terms of both linac technology and dosimetric systems. This work investigates the problems and solutions concerning the realization of an electron accelerator dedicated to FLASH therapy and optimized for in vivo experiments. Moreover, the work discusses the saturation problems of the most common radiotherapy dosimeters when used in the very high dose-per-pulse FLASH conditions and provides some preliminary experimental data on their behavior

Knowledge of public health informatics among Italian medical residents: design and preliminary validation of a questionnaire

Background: public health requires strong information skills and competencies, as it is information-intensive and information-driven. Public health informatics has been defined as the “systematic application of information, computer science, and technology to public health practice, research, and learning”. New information and communication technologies offer unprecedented opportunities, such as linking smart-phones and mobiles devices to web based tools for data collection, enabling and enhancing participatory epidemiology. However, being an emerging discipline, despite its potential and importance, public health informatics is often neglected and overlooked, being rarely offered as course. The present study was designed as a pilot study, with the aim of designing and validating a questionnaire on the knowledge of public health informatics among medical residents in public health in Italy.  Methods and Results: thirty-two Italian residents in public health volunteered to take part into the study. Mean age of the sample was 31.44±2.23 years, most responders were males (68.8%), from northern Italy (53.1%), at the third year of residency (34.4%) and currently doing practical training at the clinical management staff/hospital directorate (34.4%). Other places of training were the Prevention Department (21.9%), the Institute of Hygiene (18.8%), the local health units and the territory (12.5%), the occupational health service (6.3%) and the Regional Health Agency (3.1%). Cronbach’s alpha coefficient yielded a value of 0.909, demonstrating excellent psychometric properties of the instrument.  Conclusion: in conclusion, the developed questionnaire seems to be an appropriate and useful tool to detect gaps concerning knowledge, education and practices of public health informatics among residents in public health.&nbsp

Tissue‐resonance interaction method for the noninvasive diagnosis of prostate cancer: analysis of a multicentre clinical evaluation

OBJECTIVETo determine, in a multicentre prospective study, the accuracy of the tissue‐resonance interaction method (TRIMprob, new technology developed for the noninvasive analysis of electromagnetic anisotropy in biological tissues) in the diagnosis of prostate cancer.PATIENTS AND METHODSTwo hundred patients (mean age 67.4 years) scheduled to have prostatic biopsies (because of a prostate‐specific, PSA, antigen level of ≥4 ng/mL or a suspicious digital rectal examination, DRE) were preliminarily examined while unaware of their clinical details using TRIMprob in five different centres. The final diagnosis obtained with TRIMprob was compared with the final histological diagnosis after extended biopsies.RESULTSOf the 188 evaluable patients (mean PSA level 9.3 ng/mL, sd 8.8; mean prostate volume 62.0 mL, sd 32.4), 61 (32.4%) had a positive biopsy for adenocarcinoma of the prostate. The overall sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy of TRIMprob were 80%, 51%, 44%, 84% and 60%, respectively. The prostate cancer detection rate after biopsy was significantly higher in patients with a positive examination (49/111, 44%) than in patients with a negative TRIMprob (12/77, 15%; P < 0.001). When TRIMprob results were combined with DRE findings the sensitivity and NPV both increased to 92%.CONCLUSIONTRIMprob seems to be a useful tool in the diagnosis of prostate cancer and can increase the accuracy of PSA or DRE results. The high NPV suggests that this new technology might be useful to reduce the indications for prostatic biopsy or repeated series of biopsies in patients suspected of having prostate cancer