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Background: The aim of this study was to investigate any differences in external load indicators (ELi) between official matches (OM) and sport-specific tasks in semi-professional soccer players., Methods: Among 28 semi-professional soccer players, 1932 observations (age: 25±6 years, height: 183±6 cm, weight: 75.2±7 kg; FC Palermo, Palermo, Italy) were collected through GPS devices (Qstarz BT-Q1000EX, 10 Hz; Qstarz International Co., Ltd., Taipei, Taiwan) and the related software (LaGalaColli V: 8.6.4.3; Spinitalia Srl, Rome, Italy) during the season 2019-2020. Participants were monitored during OM, friendly matches (FM), small sided games (SSG), and match-based exercises (MBE), considering the percentage of intense accelerations (%int. acc.), percentage of intense decelerations (%int. dec.), and passive recovery time /min (PrT/m) as Eli., Results: We detected the highest mean value for PrT/m in OM and the lowest in MBE and SSG (18.36±4.38 and 13.4±5.26 and 13.4±4.29 (s/min), respectively). The lowest mean values of %int. acc. and %int. dec. were found in OM and the highest in SSG (8.64±1.52 vs. 13.02±3.14 and 9.25±1.56 vs. 15.68±3.14, for %int. acc. and %int. dec., respectively). Significant differences between the four tasks for all the ELi considered (P<0.001). The post-hoc pairwise comparisons revealed significant differences for all the ELi between all tasks (P<0.001) except for the %int. acc. between MBE vs. FM (P=0.003). No significant difference was found in PrT/m between MBE vs. FM and SSG vs. FM., Conclusions: ELi are in accordance with the performance model by achieving better values in training than OM, suggesting the fundamental role of GPS for monitoring external load in soccer.

Background: Injuries are a serious problem in soccer for the player but also for the society. It has been noted most of the injuries occurs during non-contact situations and, the soccer shoes have an important role. Unfortunately, few studies investigated the plantar distribution, argument that could help to deeply understand the causes behind the injuries. The objective was to evaluate the influence of the soccer shoes on plantar distribution in young players in a static condition., Methods: Young soccer players (range 11-18) were recruited and performed two tests on a baropodometric platform, one barefoot and one with technical soccer shoes. A student's t-test was performed to evaluate the differences between the conditions., Results: Significative results were between the left plantar surface (P<0.05) and in the total surface anterior (P<0.05) with and without the soccer shoe. Related to the pressure values, soccer shoes resulted higher than barefoot condition. Statistical significance has been found also between the forefoot and the rearfoot in the left foot, in barefoot condition (P<0.05)., Conclusions: Soccer shoes generally produce a reduction in the contact plantar surface, especially in the anterior zone and the foot load is higher in the forefoot zone.

Background: The present study aimed to describe the possible roles of cyclists' early career performance, on the transition process to elite cycling categories., Methods: Data from national and international databases, and results achieved during the UCI World Championships, were retrospectively analyzed considering the Italian national Youth-U16, Junior-U18, and U23 categories, and international Junior-U18 and UCI World-Tour categories., Results: The 15% of Youth-U16, the 38.8% of Junior-U18 and the 60% of U23 athletes who ranked top-10 between 2007 and 2013, scored points in UCI World Tour competitions between 2012 and 2018. The 1.6% of Youth-U16, the 8.3% of Junior-U18 and 25% of U23 athletes who ranked top-10 between 2007 and 2013, ranked among the Italian Top-10 in the UCI World-Tour individual classification between 2012 and 2018. Performance level in Youth-U16 category displayed a low correlation with UCI World Tour performance while the performance level in Junior-U18 category displayed a moderate correlation. The 34% of the Junior World Championship TOP-25 cyclists, participated in the elite competition. Trivial to small correlations emerged between Junior and elite World Championship performance levels., Conclusions: Early performance seems not to represent a good predictor of elite performance, while the Junior-U18 and the U23 performance level, emerged as potential indicators of future success in the elite categories.

Background: The Grooved Pegboard Test (GPT) is a widely adopted test to evaluate manual dexterity. A factor that could influence the cognitive process is physical and mental stress, which could be controlled by respiration. Stress can be monitored through heart variability. Consequently, the present study's objective was to investigate the association between the breath relaxation technique and the GPT and correlate the findings with stress parameters., Methods: One hundred fourteen participants were recruited. Stress level test, GPT, and breathing exercise for relaxation were performed. Spearman test was adopted to evaluate the correlation, while the Friedman Test and the Dunn Test and the Mann-Whitney Test were performed to detect statistical differences., Results: Correlation existed between GPT and age (r=-0.02), height (r=0.22), weight (r=0.21), and handgrip (r=0.21). The Friedman and Dunn's post-test resulted in significant differences in group 1 and 2 between GPT baseline vs. GPT rest (P<0.01) and GPT baseline vs. GPT relax in group 1 (P<0.01) and group 2 (P<0.0001)., Conclusions: A breath relaxation technique does not influence the GPT, and even not significantly, physical stress increases the time to complete the GPT. Instead, high mental stress, stress resistance, and heart frequency decrease the time to complete the GPT.

Background: To evaluate the voids percentage and the retreatability by different supplementary irrigation techniques of a matched-taper single cone and epoxy resin-based sealer., Methods: A total of 72 single-rooted premolars were prepared and filled with gutta-percha and MM-Seal. The percentage of voids in the whole root canal and each anatomical part were evaluated by Micro-CT scans. After root filling removal, the teeth were randomly allocated (N.=24) to group A, syringe irrigation; group B, Tornado Brush, and group C, ultrasonically activated irrigation and re-scanned to establish the volume of remnant root filling material. The data relative to voids and retreatment techniques were established by the Kruskal-Wallis test. Differences in retreatment time were examined using one-way ANOVA and Tukey's Test (P<0.05)., Results: No significant difference was found in the voids percentage between the different root-thirds and between the supplementary irrigation groups in the MM-Seal remnants for the whole root canal and each section. In all groups, the coronal region exhibited more remaining material than other sections., Conclusions: MM-Seal showed low voids percentage and its removal was not significantly improved by supplementary irrigation techniques.

Background: Schools constitute the ideal setting in which children's physical activity, physical fitness, and health status can improve. However, intervention protocols and their effectiveness vary considerably. The purpose of the study was to investigate the differences in physical fitness and overweight and obesity prevalence between children attending structured physical education classes held by a specialized teacher (EXP) or traditional classes of equal duration held by an ordinary teacher (TRAD)., Methods: Anthropometric and fitness parameters were assessed in a convenience sample of 12,519 1 st grade schoolchildren over 3 subsequent school years. Six field-based tests were used to assess physical fitness., Results: Physical fitness improved more in the EXP group than in the TRAD group, except for flexibility (sit and reach). At the end of the 3 rd year, the EXP children performed better than did the TRAD children (P<0.001) in Léger (girls: +34%, boys: +30%), agility shuttle (girls: -10%, boys: -9%), long jump (girls: +9%, boys: +8%), frontal basketball throw (girls: +11%, boys: +10%), and standing balance (girls: +18%, boys: +28%). The prevalence of obesity and overweight was 5% lower in the EXP than in the TRAD group at the 3-year follow-up., Conclusions: The proposed teacher-driven intervention, which was focused on the quality rather than the duration of time spent in the gym during school hours, was effective in improving children's physical fitness. Furthermore, the decrease in the prevalence of obesity and overweight suggests the intervention can improve heavier children's weight status.

Background: We compared surgical outcome of sacral colpopexy (SCP) performed with the most recent minimally invasive surgery such as 3-mm laparoscopy (Mini-LPS), percutaneous system (PSS), standard laparoscopy (LPS), and robotic surgery., Methods: This is a multicenter retrospective cohort study conducted at Urogynecological Department of the IRCCS A. Gemelli University Polyclinic Foundation in Rome and at the Gynecological Clinic of Maggiore della Carità Hospital in Novara, and of the Polyclinic of Abano. We collected data of 115 patients who underwent laparoscopic SCP for pelvic organ prolapse between June 2017 and June 2018 using PSS, Mini-LPS, standard LPS, and da Vinci Si., Results: Patients of all four groups had similar characteristics. The median operative time (OT) was significantly longer in robotic procedure compared to all other groups There were no significant differences between the four groups in terms of estimated blood loss, conversion to laparotomy, intraoperative complications and median postoperative ileus. Visual Analogue Scale (VAS) at 4 hours was significantly less for Mini-LPS compared to the other techniques. VAS at 24 hours was higher for robotic procedures than other techniques., Conclusions: Results rule out that minimize surgical invasiveness of laparoscopic techniques could bring improvements in SCP not only from a cosmetic point of view but also from a functional one without requiring longer OT and maintaining the same standard laparoscopic configuration. Even if robotic SCP is useful and safe because of its guarantee of efficiency, it cannot be considered the first choice for many women.

Introduction: Cervical cancer is currently one of the most common cancers afflicting the female population worldwide and in industrialized countries the presence of screening and a specific diagnostic and therapeutic process has favored early diagnosis of cervical cancer. In literature have found that reducing the radicality on the parametria in early cervical cancer (ECC), reduces complications without impacting oncological outcomes, but the data in the literature are not yet clear., Evidence Acquisition: Searching on PubMed, we included 1473 articles from January 1974 to 2020. We identified all the studies that compared different type of radical hysterectomy in the primary surgical treatment of ECC. 16 articles were elected for the review., Evidence Synthesis: Modified radical hysterectomy (Piver II/Querleu-Morrow Type B) in ECC, if compared to CRH (Piver III/Querleu-Morrow Type C2), is not associated with worse cancer outcome and patient survival, but it is associated with a minor operating time, lower blood loss and minor bladder dysfunction. Nerve sparing radical hysterectomy approach (NSRH/Querleu-Morrow Type C1) compared to CRH (Piver III/Type C2) in the ECC, with our data we can confirm a non-inferiority regarding the oncological outcome., Conclusions: Reduced radicality on the parametrium offers positive effects on the quality of life (sexual life and bladder function) of patients without impacting on survival, oncological outcome.

Background: The aim of the study was to evaluate how muscular performances, balance and posture were influenced applying Occlusal Splints and Taopatch ® 8 (Tao Technologies Srls, Cittadella, Padua, Italy) devices in athletes., Methods: Eighteen athletes, 7 females and 11 males, with an average age of 23.8 years, were included. Two devices were used: 1) a customized soft occlusal splint to be applied to the lower ach; 2) nanotechnological devices based on carbon nanotubules and quantum dots (Taopatch ® ) positioned on C7 and xiphoid process. Four functional tests were performed: surface electromyography (sEMG), kinesiography, the squat jump and counter movement jump and handgrip test. The tests were performed in the following order: at the baseline (no treatments), and after having applied the bite alone, the occlusal splint and Taopatch ® devices together and the Taopatch ® devices alone., Results: The sEMG showed an increased maximum clenching voltage in respect of the baseline for all treatments that included the occlusal splint. The kinesiography showed an improvement of the movements of the occlusal muscles. The squat jump increased the height of 10-14 mm, the best results registered with the bite. The handgrip showed an increased strength, that was higher with the bite and the Taopatch ® devices used alone (~5 lbs.)., Conclusions: The use of an occlusal splint and Taopatch ® devices use alone or in conjunction immediately influenced strength and balance of the occlusal postural muscles.

Background: Regular physical activity or aerobic exercise is well known to increase brain plasticity. Recent studies have reported that aerobic exercise enhances neuroplasticity and motor learning. The aim of this study was to investigate if 12 weeks' aerobic training can modify cortical excitability and motor evoked potential (MEP) responses., Methods: Fifteen untrained males were recruited. Cortical excitability was investigated using TMS. VO2max was estimated using Cooper's test. Aerobic intervention lasted 12 weeks. The subjects performed a 6-week supervised aerobic workout, 3 times a week, at 60-75% of their maximum heart rate (HRmax). Over the following 6 weeks, they performed a supervised aerobic workout 3 times a week at 70-75% of FCmax., Results: After 8 weeks of aerobic training there was a significant increase of distance covered during Cooper's test (P<0.001) and a significant increase of VO2max (P<0.001); there was also an improvement in resting motor threshold (rMT decreased from 60.5±6.6% [T0] to 55.8±5.9% [T2]; P<0.001), motor evoked potential latency decreased (from 25.3±0.8 ms [T0] to 24.1±0.8 ms [T2]; P<0.001), and motor evoked potential amplitude increased (from 0.58±0.09 mV [T0] to 0.65±0.08 mV [T2]; P<0.001). Furthermore, after 12 weeks' aerobic training there were improvements in all parameters., Conclusions: This study shows that aerobic activity seems to induce changes in cortical excitability if performed for a period longer than 4 weeks, in addition to typical cardiorespiratory benefits in previously untrained males.

Using performance-enhancing drugs concerns not only elite Olympic and Paralympic Games' athletes but also amateur athletes, who are making increasing use of substances and/or methods. Furthermore, a new frontier reached by the doping is the use of genes. World Anti-Doping Agency expressly prohibited the participation in competitive sports by the athlete in case of taking banned substances to treat disease in the event that the above assumption implies an excessive improvement of performance. This study aims to analyze and show the doping control as an essential part of the antidoping program to promote and protect the integrity of sport and athlete's health. Testing is carried out in accordance with the World Anti-Doping Code (WADC) and several international standards (ISs). The ISs were developed for laboratories, testing, the prohibited list, and for therapeutic use exemptions. It seems that the 2009 version of the WADC obliges all the healthcare professionals not to assist athletes engaged in doping behaviours; they can be removed from working with athletes. Many people do not know doping's dangerous effects on health. It is necessary, therefore, to implement the knowledge on this issue through public and sports institutions information and awareness campaigns. For this reason, local institutions and the National Olympic Committee shall give tools, in particular economic, to carry out the work of education, training, and control.

Background: Adductor longus enthesopathy-related groin pain (ALErGP) is the most common cause of groin pain in soccer players. The aim of this study was to evaluate the therapeutic utility of intratissue percutaneous electrolysis (EPI®) technique in combination with an active physical therapy (APT) program to treat ALErGP., Methods: Twenty-four non-professional male soccer players diagnosed with ALErGP were included in this study and randomly divided into two groups. Group A was treated with EPI® technique in combination with a standardized APT program. Group B only underwent the APT program. The Numeric Rating Scale (NRS) and the Patient Specific Functional Scale (PSFS) were used to assess the effectiveness of the two interventions. The follow-up covered a 6-month period., Results: Both groups significantly improved pain and functional scores after treatment and maintained this therapeutic result throughout the follow-up. The combined intervention of APT program and EPI® ensured a greater and faster reduction of pain in group A. In addition, functional recovery tended to be greater in group A than B after the treatment and throughout the follow-up by 7.8±3.8% (P=0.093)., Conclusions: EPI® treatment in association with APT ensured a greater and more rapid reduction of pain and tended to promote greater functional recovery in soccer players with ALErGP compared to APT only. This positive therapeutic result lasted for at least 6 months after the end of the treatment. These findings support the combined use of EPI® and APT to treat ALErGP.

Background: Selective mutism (SM) is a rare disease in children coded by DSM-5 as an anxiety disorder. Despite the disabling nature of the disease, there is still no specific treatment., Aim: The aims of this study were to verify the efficacy of six-month standard psychomotor treatment and the positive changes in lifestyle, in a population of children affected by SM., Design: Randomized controlled trial registered in the European Clinical Trials Registry (EuDract 2015-001161-36)., Setting: University third level Centre (Child and Adolescent Neuropsychiatry Clinic)., Population: Study population was composed by 67 children in group A (psychomotricity treatment) (35 M, mean age 7.84±1.15) and 71 children in group B (behavioral and educational counseling) (37 M, mean age 7.75±1.36)., Methods: Psychomotor treatment was administered by trained child therapists in residential settings three times per week. Each child was treated for the whole period by the same therapist and all the therapists shared the same protocol. The standard psychomotor session length is of 45 minutes. At T0 and after 6 months (T1) of treatments, patients underwent a behavioral and SM severity assessment. To verify the effects of the psychomotor management, the Child Behavior Checklist questionnaire (CBCL) and Selective Mutism Questionnaire (SMQ) were administered to the parents., Results: After 6 months of psychomotor treatment SM children showed a significant reduction among CBCL scores such as in social relations, anxious/depressed, social problems and total problems (P<0.001), Withdrawn (P=0.007) and Internalizing problems (P=0.020). Regarding SM severity according to SMQ assessment, children of group A showed a reduction of SM symptoms in all situations (school, P=0.003; family, P=0.018; and social, P=0.030 situations) and in SMQ total score (P<0.001)., Conclusions: Our preliminary results suggest the positive effect of the psychomotor treatment in rehabilitative program for children affected by selective mutism, even if further studies are needed., Clinical Rehabilitation Impact: The present study identifies in psychomotricity a safe and efficacy therapy for pediatric selective mutism.

Background: The aim of this study was to assess the frequency of GSTM1 and GSTT1 null genotype in melanoma patients and controls from Sicily and Calabria, two regions of Southern Italy never investigated on this issue before, that present a peculiar gene pool because of their geographical and historical characteristics., Methods: One hundred and twelve Caucasian melanoma patients and 150 age- and sex-matched healthy controls were examined; their GSTM1/GSTT1 genotype was defined by polymerase chain reaction on a sample of oral mucosa cells obtained by buccal swabs., Results: Odds ratio for melanoma was increased not significantly in case of fair hair/eye color, presence of many naevi or solar lentigines, or history of actinic keratosis, skin cancer or sunburns; frequencies of GSTM1 null, GSTT1 null and all their possible combinations were not significantly different between patients and controls., Conclusions: Our results, in agreement with worldwide literature, show that melanoma is apparently independent from genetic lack of GSTM1/GSTT1. However, melanoma is notoriously linked to a history of sunburns, and GSTM1/GSTT1 null are a significant risk factor for sunburns. We describe a possible explanation of this apparent contradiction, taking into account the different roles of the multiple components of human skin in photoprotection, and their variable importance in different conditions of exposure to UV radiations. Simultaneous evaluation of a larger number of components of the antioxidant system, to assess their individual contribution to protection against melanoma, is advisable and should be considered in future studies. This could allow to better define risks for each patient and possibly to tailor preventive measures.

Aim: The aim of this paper was to evaluate the influence of a challenging neck on mid-term results using the Endurant I stent-graft system in high risk patients., Methods: A retrospective study was conducted on a prospectively compiled database of 72 elective patients with challenging neck treated with the Endurant I system (Endurant Stent Graft, Medtronic AVE, Santa Rosa, CA, USA). These patients were compared to a control group (65 patients) without significant neck problems. The endpoints were mid-term 2-years technical, clinical success and the event free survival of all treated patients., Results: Mean age was 76.12 years; 76.6% of patients were males. Risk factors and preoperative variables did not differ significantly between the two groups. Only 4 (5.5%) patients of the study group vs. 2 (3.1%) in the control group developed type I endoleak during the follow-up. Three (4.1%) study group patients developed type III endoleak vs. 2 (3.1%) in the control group. All these patients required an adjunct procedure of relining with a new endograft. No type II endoleaks requiring adjunctive endovascular procedures were detected in our series. The 2-year event free survival rate did not differ statistically between the two groups (P=0.425)., Conclusion: Treatment with the Endurant stent-graft is technically feasible and safe, yielding satisfactory results even in challenging anatomies. Mid-term results are promising and challenge current opinion concerning the negative influence of challenging neck anatomy on EVAR especially after a longer follow-up.

Aim: The induction of sleep would depend on interaction between gabaergic system and the pineal gland through its main hormone melatonin. Until few years ago benzodiazepines were the only drugs effective in the treatment of insomnia. Recently, however, both melatonin and acupressure have appear to be active in sleep disorders. The aim of study was to evaluate the efficacy of HT 7 point acupressure in insomnia., Methods: The study enrolled 25 patients affected by sleep disorders, 14 of whom had a neoplastic disease. They were treated by HT 7 stimulation for al least two consecutive weeks using a medical device named H7 Insomnia Control., Results: An improvement in the quality of sleep was achieved in 15/25 (60%) patients, with a more evident efficacy in cancer patients (11/14 [79%])., Conclusion: This study confirms previous clinical data showing the efficacy of acupressure in the treatment of sleep disorders, particularly in cancer-related insomnia.

Aim: The recent rediscovery of the natural traditional medical sciences has contributed to improve the treatment of the human diseases and, in particular, it has been shown that the pharmacological approach is not the only possible strategy in the treatment of nausea and vomiting, since bioenergetic approaches, such as acupressure and acupuncture, may also counteract the onset of vomiting due to different causes. Previous preliminary clinical studies had already suggested a possible efficacy of acupressure also in the treatment of chemotherapy-induced vomiting resistant to the classical antiemetic drugs. The aim of this study was to confirm these preliminary data., Methods: The study was performed in 100 consecutive metastatic solid tumour patients, who underwent chemotherapy for their advanced neoplastic disease, and who had no benefit from the standard antiemetic agents, including corticosteroids, antidopaminergics and 5-HT 3R-antagonists. Acupressure was made by a stimulation of PC6 acupoint., Results: The emetic symptomatology was reduced by acupressure in 68/100 (68%) patients, without significant differences in relation to tumour histotype. The lowest efficacy was observed in patients treated by anthracycline-containing regimens, without, however, statistically significant differences with respect to the other chemotherapeutic combinations., Conclusion: This study confirms previous preliminary clinical results, which had already suggested the potential efficacy of acupressure in the treatment of vomiting due to cancer chemotherapy. Therefore, acupressure may be successfully included within the therapeutic strategies of cancer chemotherapy-induced vomiting.

Aim: Alopecia still remains one of the most untreatable side-effects induced by cancer chemotherapy. According to the phytotherapeutic tradition, Panicum Miliaceum has been proven to be effective in the prevention of hair loss for different reasons. At present, however, there are no data about its possible efficacy in the treatment of cancer chemotherapy-induce alopecia. The aim of this study was to analyze the efficacy of Panicum Miliaceum in cancer patients treated with the most potent chemotherapeutic drugs in terms of hair loss, consisting of cisplatin (CDDP) and anthracyclines., Methods: This case-control study included 28 cancer patients concomitantly treated with Panicum Miliaceum and 56 patients receiving the same combinations of chemotherapy alone as a control group. Panicum Miliaceum was given orally at 300 mg (daily dose) 3 times per day, every day until the end of chemotherapy. The grade of hair loss was assessed by World Health Organization (WHO) criteria., Results: The percentage of alopecia of third grade observed in patients concomitantly treated with Panicum Miliaceum in association with CDDP-containing regimens was significantly lower than that found in those who received the chemotherapy only. The percentage was also lower under anthracycline-containing schedules, without, however, statistically significant differences. Panicum Miliaceum therapy was substantially well tolerated in all patients., Results: This preliminary study would suggest that the concomitant treatment with Panicum Miliaceum may be effective in preventing hair loss induced by CDDP-containing chemotherapies, whereas the benefit was lower in patients treated with anthracyclines. Future randomized studies will be necessary to confirm these preliminary

Surgery for impacted third molar is often characterized, in the postoperative period, by pain, trismus and swelling. The study evaluates temperature variations of mucosa and skin after application of ice packs, in three different modalities, to the region overlying the surgical site. The goal was to identify any correlation between variations of temperature and postoperative clinical symptoms. For this purpose we selected 54 patients programmed for impacted third molar surgery. The patients were divided into three groups of 18. Time and frequency of application of the ice pack varied in the three groups; 5'/30' (group 1); 10'/60' (group 2); 20'/60' (group 3). During the four hours following surgery, temperatures of mucosa and of skin at the surgical site were measured with high-precision thermocouples, maximum response 5". The results indicate that application of an ice pack for 5'/30' or for 10'/60' controls the temperature of the mucosa post-surgery more effectively, and that the duration of surgery appears not to influence temperature variations. In the postoperative phase we recommend a rational application of ice packs appropriate to the constitution of each patient.

The orthodontic therapeutic sequence used in cases with dento-dental discrepancy for reduced mesiodistal size and congenital absent lateral upper incisors, is described. The importance of correct conoid tooth replacement in the programmed space between the other teeth and its restorative treatment in order to obtain the best biomechanical control is stressed. The contemporaneous presence of the form and volume anomaly of the 12th and the missing 22nd due to agenesia demanded an interdisciplinary approach. For the restoration of the conoid tooth the authors used a microhybrid composite for the alloy properties with the grain size of the inorganic particles. In fact this type of composite responds well to mechanical stress and has a high shining capacity and good aesthetical rendering. Meanwhile the temporary dental prothesis solution of the 22nd in this case has suggested the application of the artificial element on the superior Hawley holding plaque.

Acute suppurative thyroiditis is an acute disease of the thyroid gland. In this paper the authors report a case of acute suppurative thyroiditis complicated by abscessual evolution in an addict patient study with ultra-sonography and treated with fine needle aspiration and antibiotic therapy. The patient reached our observation for a swelling of the neck. Ultrasonography showed diffuse hypoechogenicity in both thyroid lobes and mixed nodule with hyperechoic trabeculas inside. This nodule underwent fine needle aspiration (FNA) for cytologic and cultural evaluation. Diagnosis was acute suppurative thyroiditis. Ultrasonography presented features similar to other thyroid pathology (sub-acute thyroiditis, haemorrhagic cyst, thyroid lymphoma and anaplastic carcinoma). In our case none of the ultrasonographic features were diagnostic except hyperechoic trabeculas inside. Ultrasonographic features of acute suppurative thyroiditis are very rare in the literature. Ultrasonography and fine needle aspiration are the only methods that confirm this diagnosis.

Ultrasound examination of the thyroid gland is widely used in the diagnosis of thyroid disease. This test is easy and rapid to perform, widely available and the results are readily interpreted. Using ultrasound the image of foci of disease within the gland are easily identified, especially using high frequency probes which enable solid nodules up to approx 3 mm to be revealed with 10 MHz probes. In non-nodular thyroid disease the ultrasonic structure guides the diagnosis (thyroiditis, Graves' disease). During the follow-up of thyroidectomised patients ultrasound can easily reveal postoperative anatomic variations and an early diagnosis can be obtained of any signs of local recurrence of the primary disease. Only hemiagenesia and hypoplasia can be accurately evaluated in congenital disease, whereas in the event of the persistence of the thyroglossal duct the latter can only be diagnosed if it presents a cystic evolution. Thyroid ectopia cannot be identified and must be studied using thyroscintigraphy, preferably performed using 131I as the isotope. The acquired pathology is classified into phlogistic processes, diffuse or nodular hyperplasia, benign and malignant neoplasia. This classification is widely accepted by virtually all authors. In thyroiditis, ultrasound may facilitate the diagnosis of De Quervain's non-suppurative sub-acute thyroiditis (TANS) and Hashimoto's chronic thyroiditis, although always in association with clinical and laboratory tests. The most frequent thyroid pathology is without doubt goitre. This disorder may occur in a non-nodular (widespread goitre with an endemic or sporadic pattern) or nodular form which may be single or multiple. The term goitre is used to indicate the increased volume of the thyroid gland independently of the causes which have provoked it. Common goitre is defined as being endemic when in some geographic area 10% of the general population or 20% of the school-aged population suffers from thyroid hyperplasia (areas of goitrogenic endemic disease). Graves' disease may be included in the group of thyroid hyperplasia diseases, although it is distinguished from the simple versions by the marked glandular hyperactivity which creates manifest hyperthyroidism. In this pathology ultrasonography must be supplemented by colour-Doppler wherever possible. Thyroid nodules are subdivided in terms of their echostructure into 5 types: liquid, mixed (prevalently solid or prevalently liquid), hyperechogenic solid, isoechogenic solid and hypoechogenic solid. The characteristics of benign nodules are: hypoechogenic structure, regular edges, complete and uniform hypoechogenic peripheral halo.(ABSTRACT TRUNCATED AT 400 WORDS)

Epidemiology has always focused attention on analysis of environmental variables, in addition to biological or physico-chemical elements, that affect the onset and development of dental pathologies. However, other environmental events, such as behavioural repertoires, that may interfere with medical treatment, reducing the chances of recovery, have never been analysed. This study, which was performed in two groups of children aged between six and ten who were examined either inside or outside to school setting, aimed to identify, in addition to the incidence of dental pathologies, the frequency of occurrence of those patterns that risk developing into non-compliant behaviour repertoires to the dentist setting. Results show a generalised response of fear and anxiety in both groups, particularly in older children. It is suggested that the prevention of biological as wall as maladaptive behavioural patterns might lead to a reduction of the social burden determined by the cost of medical care.

The authors describe an interesting case of osteoclastoma of the mandible. After the clinical and anatomy-pathologic general picture, the problem of differential diagnosis between osteoclastoma and giant cell epulis is analysed.

A case of spontaneous gallbladder-cutaneous fistula is reported with emphasis on the rarity of this lesion after the introduction of cholecystectomy.