Madura's foot in native of the Philippines immigrant in northern Italy

Clinical case about a man, emigrated from Philippines. The patient presented a single cutaneous lesion on a foot that was thick, swollen and blackish. There were no fistulas. He remenbers a traumatic implantation of wood splinters on the sole foot 10 years ago. Radiography, Magnetic Resonance, tomographic investigation were performed. The exceptional occurrence of the mycetoma in our countries and absence of clear infectious picture were the reason for an initial clinical misinterpretation as a benign neoplasm of soft tissues.We performed surgical removal of neoplasm, with histological examination.Histopathologic exam revealed an unexpected mass of fungal hyphae; diagnosis of Madura’s foot was confirmed. We started pharmacological therapy with “itracozanole”.Our case offers opportunity to stress need for clinical suspicion of fungal infection, considering increase of immigration by the countries with endemic mycetoma, and we must prepare to observe and treat many pathologies now unknown in our practice

Frustration driven structural distortion in VOMoO4

Nuclear magnetic resonance (NMR), electron paramagnetic resonance (EPR), magnetization measurements and electronic structure calculations in VOMoO4 are presented. It is found that VOMoO4 is a frustrated two-dimensional antiferromagnet on a square lattice with competing exchange interactions along the side J1 and the diagonal J2 of the square. From magnetization measurements J1+J2 is estimated around 155 K, in satisfactory agreement with the values derived from electronic structure calculations. Around 100 K a structural distortion, possibly driven by the frustration, is evidenced. This distortion induces significant modifications in the NMR and EPR spectra which can be accounted for by valence fluctuations. The analysis of the spectra suggests that the size of the domains where the lattice is distorted progressively grows as the temperature approaches the transition to the magnetic ground state at Tc=42 K

Mesoscopic phase separation in Nax_xCoO2_2 (0.65≤x≤0.750.65\leq x\leq 0.75)

NMR, EPR and magnetization measurements in Na$_x$CoO$_2$ for $0.65\leq x\leq 0.75$ are presented. While the EPR signal arises from Co$^{4+}$ magnetic moments ordering at $T_c\simeq 26$ K, $^{59}$Co NMR signal originates from cobalt nuclei in metallic regions with no long range magnetic order and characterized by a generalized susceptibility typical of strongly correlated metallic systems. This phase separation in metallic and magnetic insulating regions is argued to occur below $T^*(x)$ ($220 - 270$ K). Above $T^*$ an anomalous decrease in the intensity of the EPR signal is observed and associated with the delocalization of the electrons which for $T<T^*$ were localized on Co$^{4+}$ $d_{z^2}$ orbitals. It is pointed out that the in-plane antiferromagnetic coupling $J\ll T^*$ cannot be the driving force for the phase separation.Comment: 14 figure

Sonography in the diagnosis of tear of the knee menisci

Goal of the study. The purpose of this study is to compare the accuracy of sonographic to radiographic measurements of subacromial space, and verify its variations in relation to acromial morphology, age, sex and rotator cuff pathologies. Materials and methods. As a result, we have compared a radiographic examination to sonographic examination, each measuring the subacromial space in 200 random shoulders, with a personal method. The sonographic examination was performed by using a HDI 5000 ultrasound scanner Sono-CT with 7.5 MHz linear array transducer. No stand-off pad was utilized. Results. The statistical analysis of the data derived from the two measurements was not sufficient to conclude that the two techniques are different (p>0.8). They also correspond with the radiographic morphology of the acromion. The size of subacromial space was related to the acromial morphology, female gender, and rotator cuff pathology, however, it was not related to age. Discussion and conclusions. Our results clearly show that sonographic measurements are very close to those obtained by X-ray (p>0.8). The Bland\u2013Altman analysis showed that for all groups, the were small enough to give us confidence that the sonographic technique may be used in place of the radiographic one for clinical purposes. One-way ANOVA showed that sonographic measurements were statistically different among the four groups (p<0.05). The sonography demonstrated precision, accuracy and carefulness in the measurement of the subacromial space

Sonographic evaluation of subacromial space

Goal of the study. The purpose of this study is to compare the accuracy of sonographic to radiographic measurements of subacromial space, and verify its variations in relation to acromial morphology, age, sex and rotator cuff pathologies. Materials and methods. As a result, we have compared a radiographic examination to sonographic examination, each measuring the subacromial space in 200 random shoulders, with a personal method. The sonographic examination was performed by using a HDI 5000 ultrasound scanner Sono-CT with 7.5 MHz linear array transducer. No stand-off pad was utilized. Results. The statistical analysis of the data derived from the two measurements was not sufficient to conclude that the two techniques are different (p>0.8). They also correspond with the radiographic morphology of the acromion. The size of subacromial space was related to the acromial morphology, female gender, and rotator cuff pathology, however, it was not related to age. Discussion and conclusions. Our results clearly show that sonographic measurements are very close to those obtained by X-ray (p>0.8). The Bland\u2013Altman analysis showed that for all groups, the were small enough to give us confidence that the sonographic technique may be used in place of the radiographic one for clinical purposes. One-way ANOVA showed that sonographic measurements were statistically different among the four groups (p<0.05). The sonography demonstrated precision, accuracy and carefulness in the measurement of the subacromial space

Endovascular balloon assistance during hip disarticulation

Objective Limb disarticulation has been widely performed since the 18th century, especially in war surgery. Actually is infrequently done in orthopaedic and vascular surgery, and it is associated with a high mortality rate because of frequent comorbidities. Disarticulation usually is reserved for patients with malignant tumours or gangrene from severe artherosclerosis. During disarticulation, hemodynamic stability can be altered by hemorrhagic events in the femoral or humeral arteries. We propose an endovascular technique for proximal control of the artery to reduce blood loss during disarticulation. Our experience today is limited at hip disarticulation. Material and methods The vascular access was percutaneous at the common femoral artery of the healthy limb. A 6 French (Fr) introducer sheath was placed using the Seldinger technique. Under fluoroscopic control, with a portable vascular C-arm capable of digitally subtracter angiogram and roadmap angiography, a 0.035 inch hydrophilic guide wire was crossed aver into the opposite side iliac artery through a 5F contra angiographic catheter placed at the aortic bifurcation. After a diagnostic angiography the guide wire was replaced with an Amplatz 0.0035 inch, 260 cm long, super stiff guide wire. Then, a 7 9 20 mm Ultra-thinTM SDS balloon catheter was placed in the external iliac artery and systemic heparinization with 2500 UI was performed. The balloon catheter was inflated and femoral pulsation ceased immediately. After proximal, endovascular occlusion, hip disarticulation was accomplished without any hemorrhagic complication. At the end of procedure, the balloon was deflated and removed. Hemostasis of the surgical field completed the procedure. The femoral access in the healthy common femoral artery was controlled with a 6 Fr Angio-seal percutaneous hemostatic system. Results and discussion In hip disarticulation, hemostatic tourniquets cannot be used of the location of the operating field. Therefore, control of bleeding is a major issue in this procedure. Various techniques have been proposed, femoral vessels and nerves were attached before the disarticulation. The use of semi-compliant balloon catheters for endovascular occlusion avoids injury to the endothelium of the vessel wall during balloon inflation. However preoperative assessment, with color-duplex scanning and plain abdominal radiographs, is mandatory; coexisting atherosclerosis often is present especially in elderly patients, and severe wall calcification can lead to vessel rupture and retroperitoneal hematoma, or even balloon catheter rupture. Moreover, color-duplex scanning and radiographs will help in choosing the landing-zone for balloon inflation. Conclusions Endovascular balloon assistance is a simple, safe and effective technique in preventing major arterial bleeding during amputation or disarticulation and can be routinely used

Poorly differentiated clusters (PDC) in colorectal cancer: Does their localization in tumor matter?

Poorly differentiated clusters (PDC) are aggregates of at least five neoplastic cells lacking evidence of glandular differentiation. By definition, they can be present at the invasive front (peripheral PDC or pPDC) and within the tumor stroma (central PDC or cPDC). In colorectal cancer (CRC), PDC are considered adverse prognosticators and seem to reflect epithelial mesenchymal transition (EMT). In this study, we have investigated the immuno-expression of two EMT-related proteins, E-cadherin and β-catenin, in PDC of primary CRCs and matched liver metastases. pPDC always showed nuclear β-catenin staining and diffusely reduced/absence of E-cadherin expression as opposed cPDC which showed nuclear β-catenin immunoreactivity and E-cadherin expression in about 50% of cases. In addition, the pattern of β-catenin and E-cadherin expression differed between PDC and the main tumor, and between primary CRC and liver metastasis (LM), in a percentage of cases. A discordant pattern of β-catenin and E-cadherin expression between pPDC and cPDC, between main tumor and cPDC, and between primary CRC and LM, confirms that EMT is a dynamic and reversible process in CRC. On the overall, this suggests that pPDC and cPDC are biologically different. We may advocate that PDC develop at the tumor center (cPDC) and then some of them migrate towards the tumor periphery while progressively completing EMT process (pPDC). Based on these results, PDC presence and counting may have different prognostic relevance if the assessment is done at the invasive front of the tumor or in the intratumor stroma

Macroeconomia dos estados e matriz interestadual de insumo-produto

This paper presents the methodology and the results ofthe estimation of a system of state accounts for Brazil. Using the available information on GDP, government revenues and expenditures, international and interstate trade for the states, estimates for consumption and private investment were produced. The system was calibrated for the year 1996. Given the state accounts and the national input-output table, an eight-sector interstate input-output table was prepared