Intrahepatic persistent fetal right umbilical vein: a retrospective study

Introduction: To appraise the incidence and value of intrahepatic persistent right umbilical vein (PRUV). Methods: This was a single-center study. Records of all women with a prenatal diagnosis of intrahepatic PRUV were reviewed. The inclusion criteria were women with gestational age greater than 13 weeks of gestation. Exclusion criteria were fetuses with situs abnormalities, due to the hepatic venous ambiguity, and extrahepatic PRUV. The primary outcome was the incidence of intrahepatic PRUV in our cohort. The secondary outcomes were associated malformations. Results: 219/57,079 cases (0.38%) of intrahepatic PRUV were recorded. The mean gestational age at diagnosis was 21.8 ± 2.9 weeks of gestations. PRUV was isolated in the 76.7%, while in 23.3% was associated with other major or minor abnormalities. The most common associated abnormalities were cardiovascular abnormalities (8.7%), followed by genitourinary abnormalities (6.4%), skeletal abnormalities (4.6%), and central nervous system abnormalities (4.1%). Within the cardiovascular abnormalities, the most common one was ventricular septal defect (six cases). Conclusion: In most cases PRUV is an isolated finding. Associated minor or major malformations are presented in the 23.3% of the cases, so this finding should prompt detailed prenatal assessment of the fetus, with particular regard to cardiovascular system

Pott disease: current diagnostic and therapeutic approaches

Spinal tuberculosis, or Pott's disease, has been known since ancient times; it was a common orthopaedic illness until 1950, but the progress of specific therapies confined it to third word countries; its resurgency in recent years in developed countries is due to drug resistance, immigration from endemic areas, and an increase in immunodeficient patients. Spinal disease is found in about 1% of all tuberculosis cases. Modern treatment consists of a diagnostic phase, based on clinical findings and imaging exams, and of a medical and surgical therapy. Our patients have been treated with a three antibiotic drugs scheme, and underwent early surgical treatment, in order to assure the curettage of the lesion and obtain spine stabilization, so as to avoid spinal deformity

Biomechanics of the conservative treatment in idiopathic scoliotic curves in surgical "grey-area"

The biomechanical behaviour of the spine significantly varies in relation to the age of the spine. Particularly, the elastic behaviour of the intervertebral discs has been proved to change during the spine growth, which changes the disc reaction to externally imparted forces. The biomechanical analysis of the G modulus of torsion rigidity of the intervertebral disc shows that the G values progressively increase through growth, which favours the progression of early scoliotic curves. At the same time, however, early structural scoliosis is more amenable to conservative treatment owing to the residual growth potential of the spine. Whereas indications to surgical treatment of scoliotic curves has been based upon the magnitude of the curves as measured according to the Cobb method, two additional factors affect the chance of correcting a scoliotic curve, The first is the residual growth potential of the vertebrae. In fact, a longer residual growth allows for external forces to be applied so as to change the growth model of the scoliotic spine, which ensures a stable correction of the deformity when these external forces are removed. The second is the magnitude of the elastic deformation of the intervertebral discs. It has been suggested that a deformation beyond the disc elastic behaviour, by producing hysteresis of the disc, renders the disc less susceptible to transferring the load to the neighbouring vertebral bodies, thus impairing remodelling. It ensues that both the age and the magnitude of rotation affects the success of conservative treatment and not only the magnitude in Cobb degrees. The curve localization adds to these two parameters, thoracic curves being stiffer than thoracolumbar and lumbar curves

Contraception with the new intrauterine systems: A winning choice if shared!

Today the rate of unexpected pregnancy is still unacceptably high; long-acting reversible contraceptives, (LARC) seem to be an effective and modern solution. Intrauterine contraception (IUC) is the main exponent of the LARC and it is living a new exponential spread in the last years. Today IUC is the most widely used reversible contraceptive method and it is recommended by the major scientific gynecological societies. This review of the literature aims to retrace the history of intrauterine contraception and to focus attention on intrauterine systems (IUS), its last and most modern form. The three systems (LNG-IUS 52 mg; LNG-IUS 13.5 mg; LNG-IUS 19.5 mg) base their extraordinary effectiveness on the same mechanism of action, however they present some important differences that can be used to enhance and customize the treatment, not just contraceptive, based on the woman's needs

Topical hemostatic agents in neurosurgery, a comprehensive review: 15 years update

: Hemostasis in neurosurgery is of utmost importance. Bleeding management is one of the crucial steps of each neurosurgical procedure. Several strategies, namely thermal, mechanical, electric, and chemical, have been advocated to face blood loss within the surgical field. Over time, countless hemostatic agents and devices have been proposed. Furthermore, the ever-growing recent technological innovation has made available several novel and interesting tools. Pursuant to their impact on surgical practice, we perceived the imperative to update our previous disclosure paper. Therefore, we reviewed the literature and analyzed technical data sheets of each product in order to provide an updated and comprehensive overview in regard to chemical properties, mechanisms of action, use, complications, tricks, and pitfalls of topical hemostatic agents

Study of vertebral morphology in Scheuermann's kyphosis before and after treatment

Variation of vertebral morphology in Scheuermann's Kyphosis before and after orthopedic treatment is usually measured by the entity of the curve, using Cobb's method, and by vertebral wedging. But the lack of correlation between these parameters and the clinical evolution of the deformity, lead to the possibility of other alterations that can explain part of the kyphosis deformities before and after the treatment. In this group of alterations the inclination of anterior and posterior walls, that express the trapezoid deformity of vertebras, seem to be more reliable indicators of curve response to ortopedic treatment

Lumbar nerve root "walled" by a calcified herniated mass in a young patient

INTRODUCTION: Discal calcification in childhood is rare. Calcifications are occasionally discovered during routine examinations, especially in the cervical spine. Generally, the calcification process is confined to the nucleus pulposus of the intervertebral disc. CASE REPORT: In this report, we describe the case of a 16-year-old girl who presented with acute low back pain, right S1 radiculopathy and a history of increasing paresthesia. The patient underwent a CT scan, which demonstrated a postero-lateral calcified disc hernia at the L5-S1 level. The surgical decompression of the lumbar nerve root was carried out; at the operation it was observed that the nerve root was "walled" into the calcified hernia. DISCUSSION: Only a few cases with evidence of calcification of the herniated portion of the disc have been previously described. In none of them was the phenomenon was so pronounced that it sealed the nerve root completely