Huge Tracheal Diverticulum in a Patient with Mounier-Kuhn Syndrome

Tracheal diverticulum is a rare benign entity. Tracheobronchomegaly (TBM), also known as Mounier-Kuhn syndrome, is a rare disorder characterized by marked dilation of the trachea and main bronchi, associated with thinning or atrophy of the elastic tissue. Because of the weakened trachea and increased intraluminal pressure related to chronic cough, some patients may develop mucosal herniation leading to tracheal diverticulosis. We report the case of a patient with TBM with a huge tracheal diverticulum, diagnosed by bronchoscopy and computed tomography with three-dimensional reconstruction. To our knowledge this is the largest tracheal diameter described in a patient affected by this syndrome

A new handheld electromagnetic cortical stimulator for brain mapping during open skull neurosurgery: a feasibility study

Transcranial magnetic stimulations have provided invaluable tools for investigating nervous system functions in a preoperative context; in this paper we propose an innovative tool to extend the magnetic stimulation to an open skull context as a promising approach to map the brain cortex. The present gold standard for intraoperative functional mapping of the brain cortex, the direct brain stimulation, has a low spatial resolution and limited penetration and focusing capabilities. The magnetic stimulatory device that we present, is designed to overcome these limitations, while working with low currents and voltages. In the present work we propose an early study of feasibility, in which the possibility of exploiting a train of fast changing magnetic fields to reach the neuron's current thresholds is investigated. Measurements of electric field intensity at different distances from the coil, showed that the magnetic stimulator realized is capable of delivering an electric field on a loop of wire theoretically sufficient to evoke neuron's action potential, thus showing the approach' feasibility

Soy isoflavones, inulin, calcium, and vitamin D3 in post-menopausal hot flushes: an observational study.

Purpose of investigation To evaluate the effect of soy isoflavones and inulin (SII) on hot flushes (HF) and quality of life in a clinical setting, the authors conducted an observational study. Materials and methods The authors performed an observational, prospective, multicentric study on women in peri-/post-menopause treated or untreated with a product present on the Italian market, consisting in a mixture of calcium (500 mg), vitamin D3 (300 IU), inulin (3 g) and soy isoflavones (40 mg). Results A total of 135 patients, 75 (55.6%) in the SII group and 60 (44.4%) in the untreated group entered the study. After three months, the mean number of HF declined of 2.8 (SD 3.7) in the SII group and 0.0 in the untreated one. The corresponding values after six months were -3.7 (SD 2.7) in the SII group and -0.9 (SD 5.3) in the control group (p = 0.02). Conclusion This observational trial suggests a possible beneficial effect of a dietary soy supplement containing 40 mg of isoflavone/day plus inulin in the management of menopausal symptoms such as hot flashes

Sexual assault and abuse committed against family members: An analysis of 1342 legal outcomes and their motivations

Background Over the past years medical centres specifically addressed in gender-based violence have developed protocols for the collections of evidence useful in the courtroom, including accurate documentation of physical and psychological states of the victim and collection of samples. Previous studies showed an association between documented physical trauma and conviction but unfortunately, few studies in the recent literature analysed the factors that influence the legal outcome and final judgement. The present study focused on the elements that appeared of significance in the legal outcome, including medico-legal evaluation, source of the crime report and circumstance of the assault. Methods It was conducted a retrospective analysis of all the judgments issued by the Public Prosecutor's Office at a Court of a Metropolitan Italian city regarding sexual and domestic violence, from January 1st 2011 to 31st December 31st 2015. Examination regarded the demographic information of the victim and of the defendant, information on the crime, the circumstances of the aggression and medical information retrieved. Sentences were subsequently divided into two categories based on the legal outcome (conviction vs acquittal) and the different characteristics of the two sub-populations were compared to verify if there were variables significantly associated to the judge's final judgment. Results Over the 5 years taken into consideration, there have been 1342 verdicts regarding crimes of sexual violence (374 cases) and regarding abuses against family members or cohabitants (875): Other 93 cases regarded both sexual violence and abuse. 66.3% ended in conviction of the offender and 33.7% in acquittal of the accused. Cases of conviction were more frequent when they involved: Use of a weapon by the assailant, as well as if the assailant had a criminal record and had a history of drug abuse or other addictions; duration of proceeding less 22 months and a civil party involved; presence of clinical documentation together with other deposition in addition to victim's deposition; also frequent episodes of violence and application of precautionary measures were associated to conviction. Conclusions Many factors seem able to influence the judge's judgment, although clearly each case must be singularly evaluated. The mere presence of medical documentation, without the support of other sources of evidence, such as the victim's statement or further declarations, however, is almost always not definitive for the verdict. Despite so, in cases where there are multiple sources of evidence, clinical documentation can provide useful elements and can give clues on the consistency between the history told and injuries observed

Severe asthma: One disease and multiple definitions

Introduction There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem

Severe Asthma Network Italy Definition of Clinical Remission in Severe Asthma: A Delphi Consensus

: Severe asthma affects about 10% of the population with asthma and is characterized by low lung function and a high count of blood leukocytes, mainly eosinophils. Various definitions are used in clinical practice and in the literature to identify asthma remission: clinical remission, inflammatory remission, and complete remission. This work highlights a consensus for asthma remission using a Delphi method. In the context of the Severe Asthma Network Italy, which accounts for 57 severe asthma centers and more than 2,200 patients, a board of six experts drafted a list of candidate statements in a questionnaire, which has been revised to minimize redundancies and ensure clear and consistent wording for the first round (R1) of the analysis. Thirty-two statements were included in the R1 questionnaire and then submitted to a panel of 80 experts, which used a 5-point Likert scale to measure agreement regarding each statement. Then, an interim analysis of R1 data was performed, and items were discussed and considered to produce a consistent questionnaire for round 2 (R2) of the analysis. Then, the board set the R2 questionnaire, which included only important topics. Panelists were asked to vote on the statements in the R2 questionnaire afterward. During R2, the criteria of complete clinical remission (the absence of the need for oral corticosteroids, symptoms, exacerbations or attacks, and pulmonary function stability) and those of partial clinical remission (the absence of the need for oral corticosteroids, and two of three criteria: the absence of symptoms, exacerbations or attacks, and pulmonary stability) were confirmed. This Severe Asthma Network Italy Delphi analysis defined a valuable and independent tool that is easy to use, to test the efficacy of different treatments in patients with severe asthma enrolled into the SANI registry

Role of prenatal magnetic resonance imaging in fetuses with isolated severe ventriculomegaly at neurosonography: a multicenter study

none69siObjective: The aim of this study was to report the rate of additional anomalies detected exclusively at prenatal magnetic resonance imaging (MRI) in fetuses with isolated severe ventriculomegaly undergoing neurosonography. Method: Multicenter, retrospective, cohort study involving 20 referral fetal medicine centers in Italy, United Kingdom, Spain and Denmark. Inclusion criteria were fetuses affected by isolated severe ventriculomegaly (> 15 mm), defined as ventriculomegaly with normal karyotype and no other additional central nervous system (CNS) and extra-CNS anomalies on ultrasound. In all cases, a multiplanar assessment of fetal brain as suggested by ISUOG guidelines on fetal neurosonography had been performed. The primary outcome was the rate of additional CNS anomalies detected exclusively at fetal MRI within two weeks from neurosonography. Subgroup analyses according to gestational age at MRI (< vs 24 weeks of gestation) and the laterality of ventriculomegaly (unilateral vs bilateral) were also performed. Univariate and multivariate logistic regression analysis was used to analyze the data. Results: 187 fetuses with a prenatal diagnosis of isolated severe ventriculomegaly on neurosonography were included in the analysis. Additional structural anomalies were detected exclusively at prenatal MRI in 18.1% of cases. When considering the type of anomaly, malformations of cortical development were detected on MRI in 32.4% cases, while midline or acquired (hypoxemic/hemorrhagic) lesions were detected in 26.5% and 14.7% of cases, respectively. There was no difference in the rate of additional anomalies when stratifying the analysis according to either gestational age at MRI or laterality of the lesion. At multivariate logistic regression analysis, the presence of additional anomalies only found at MRI was significantly higher in bilateral compared versus unilateral ventriculomegaly (OR: 4.37, 95% CI 1.21-15.76; p= 0.04), while neither maternal body mass index, age, severity of ventricular dilatation, interval between ultrasound and MRI, nor gestational age at MRI were associated with the likelihood of detecting associated anomalies at MRI. Conclusion: The rate of associated anomalies detected exclusively at prenatal MRI in fetuses with isolated severe ventriculomegaly is lower than previously reported, but higher compared to isolated mild and moderate ventriculomegaly. Fetal MRI should be considered as a part of the prenatal assessment of fetuses presenting with isolated severe ventriculomegaly at neurosonography.openDi Mascio, Daniele; Khalil, Asma; Pilu, Gianluigi; Rizzo, Giuseppe; Caulo, Massimo; Liberati, Marco; Giancotti, Antonella; Lees, Christoph; Volpe, Paolo; Buca, Danilo; Oronzi, Ludovica; D'Amico, Alice; Tinari, Sara; Stampalija, Tamara; Fantasia, Ilaria; Pasquini, Lucia; Masini, Giulia; Brunelli, Roberto; D'Ambrosio, Valentina; Muzii, Ludovico; Manganaro, Lucia; Antonelli, Amanda; Ercolani, Giada; Ciulla, Sandra; Saccone, Gabriele; Maruotti, Giuseppe Maria; Carbone, Luigi; Zullo, Fulvio; Olivieri, Claudiana; Ghi, Tullio; Frusca, Tiziana; Dall'Asta, Andrea; Visentin, Silvia; Cosmi, Erich; Forlani, Francesco; Galindo, Alberto; Villalain, Cecilia; Herraiz, Ignacio; Sileo, Filomena Giulia; Quintero, Olivia Mendez; Salsi, Ginevra; Bracalente, Gabriella; Morales-Roselló, José; Loscalzo, Gabriela; Pellegrino, Marcella; De Santis, Marco; Lanzone, Antonio; Parazzini, Cecilia; Lanna, Mariano; Ormitti, Francesca; Toni, Francesco; Murru, Flora; Di Maurizio, Marco; Trincia, Elena; Garcia, Raquel; Petersen, Olav Bennike Bjørn; Neerup, Lisa; Sandager, Puk; Prefumo, Federico; Pinelli, Lorenzo; Mappa, Ilenia; Martellucci, Cecilia Acuti; Flacco, Maria Elena; Manzoli, Lamberto; Giangiordano, Ilaria; Nappi, Luigi; Scambia, Giovanni; Berghella, Vincenzo; D'Antonio, FrancescoDi Mascio, Daniele; Khalil, Asma; Pilu, Gianluigi; Rizzo, Giuseppe; Caulo, Massimo; Liberati, Marco; Giancotti, Antonella; Lees, Christoph; Volpe, Paolo; Buca, Danilo; Oronzi, Ludovica; D'Amico, Alice; Tinari, Sara; Stampalija, Tamara; Fantasia, Ilaria; Pasquini, Lucia; Masini, Giulia; Brunelli, Roberto; D'Ambrosio, Valentina; Muzii, Ludovico; Manganaro, Lucia; Antonelli, Amanda; Ercolani, Giada; Ciulla, Sandra; Saccone, Gabriele; Maruotti, Giuseppe Maria; Carbone, Luigi; Zullo, Fulvio; Olivieri, Claudiana; Ghi, Tullio; Frusca, Tiziana; Dall'Asta, Andrea; Visentin, Silvia; Cosmi, Erich; Forlani, Francesco; Galindo, Alberto; Villalain, Cecilia; Herraiz, Ignacio; Sileo, Filomena Giulia; Quintero, Olivia Mendez; Salsi, Ginevra; Bracalente, Gabriella; Morales-Roselló, José; Loscalzo, Gabriela; Pellegrino, Marcella; De Santis, Marco; Lanzone, Antonio; Parazzini, Cecilia; Lanna, Mariano; Ormitti, Francesca; Toni, Francesco; Murru, Flora; Di Maurizio, Marco; Trincia, Elena; Garcia, Raquel; Petersen, Olav Bennike Bjørn; Neerup, Lisa; Sandager, Puk; Prefumo, Federico; Pinelli, Lorenzo; Mappa, Ilenia; Martellucci, Cecilia Acuti; Flacco, Maria Elena; Manzoli, Lamberto; Giangiordano, Ilaria; Nappi, Luigi; Scambia, Giovanni; Berghella, Vincenzo; D'Antonio, Francesc