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Distal femoral medial closing wedge osteotomy (DFMCWO) may be a valuable treatment for arthritic valgus knees in young and active adults, with the possible aim of procrastinating knee replacement. 32 valgus knees (mean age : 41.4±11.2) treated with DFMCWO were retrospectively reviewed. All the knees had a lateral compartment osteoarthritis graded I-II-III according to Kellgren Lawrence classification. 20 knees had osteochondral lesions, treated with microfractures (8) or bone marrow derived cells transplantation (12). Patients were clinically (IKDC, KOOS, NRS, Tegner) and radiologically evaluated. A mean follow-up of 62.12±15.65 was achieved. KOOS score peaked at 24 months, showed a decremental trend, achieved a final results of 79,59±17,14. Similar trend was evident for IKDC. The final NRS score was 2.73±1.82 ; the final Tegner score was 4.81±1.56. Radiographs showed degenerative progression in 5 knees : 2 patients underwent knee replacement at the final follow-up. DFMCWO is an effective treatment to treat osteoarthritic symptomatology, delay degenerative progression and avoid knee replacement in valgus knees at mid-term follow-up.

Objective Isolated hypogonadotropic hypogonadism (IHH) is a rare disorder with pubertal delay, normal (normoosmic-IHH, nIHH) or defective sense of smell (Kallmann syndrome, KS). Other reproductive and non-reproductive anomalies might be present although information on their frequency are scanty, particularly according to the age of presentation. Design Observational cohort study carried out between January 2008 and June 2016 within a national network of academic or general hospitals. Methods We performed a detailed phenotyping of 503 IHH patients with: (1) manifestations of hypogonadism with low sex steroid hormone and low/normal gonadotropins; (2) absence of expansive hypothalamic/pituitary lesions or multiple pituitary hormone defects. Cohort was divided on IHH onset (PPO, pre-pubertal onset or AO, adult onset) and olfactory function: PPO-nIHH (n = 275), KS (n = 184), AO-nIHH (n = 36) and AO-doIHH (AO-IHH with defective olfaction, n = 8). Results 90% of patients were classified as PPO and 10% as AO. Typical midline and olfactory defects, bimanual synkinesis and familiarity for pubertal delay were also found among the AO-IHH. Mean age at diagnosis was significantly earlier and more frequently associated with congenital hypogonadism stigmata in patients with Kallmann’s syndrome (KS). Synkinesis, renal and male genital tract anomalies were enriched in KS. Overweight/obesity are significantly associated with AO-IHH rather than PPO-IHH. Conclusions Patients with KS are more prone to develop a severe and complex phenotype than nIHH. The presence of typical extra-gonadal defects and familiarity for PPO-IHH among the AO-IHH patients indicates a common predisposition with variable clinical expression. Overall, these findings improve the understanding of IHH and may have a positive impact on the management of patients and their families.

The paper describes the general characteristics of a newly developed nonconstant-flow generator for automatic ventilation of the lungs. It is known that the application of very high pressure to high internal resistance leads to a very stable flow, in that the flow itself is unaffected by external load (patient) variations. The stability of the flow means that the inspiratory process can be controlled by means of the ventilated volume, thus extending DIGIT utilization to high resistance patients. The modulation of the flow is implemented via a digital electromechanical system, which allows the ventilator functions to be accurately programmed. The desired flow waveform is obtained by means of a series of pneumatic valves, the apertures of which are digitally controlled. The design is innovative in that it allows the flow waveform in each of the ten digitalized time steps into which each inspiratory phase is divided to be both programmed and controlled. Other ventilators commercially available and currently in use do not have this functional capability, as they are all designed to model the integral flow of the inspiratory waveform without being able to modify the subunit time steps of a single inspiratory phase. The paper also discusses the results of fundamental tests concerning the performance characteristics of the ventilator.

Many international protocols related to RMI-QC program are focused on acquisition methods and analysis of several image quality parameters but rarely normality ranges or measurement frequencies are presented. To address this problem we investigated the variability of many magnetic resonance imaging (MRI) systems with the set-up of multicenter trial. The trial was set up to investigate short-and mid-term variability of two fundamental nongeometric image quality parameters: signal-to-noise (SNR) and integral percent uniformity (U%). Ten centers (12 devices) participated to data collection consisting of a three-step-protocol. First, 10 consecutive images of a phantom were collected with a spin echo sequence. As second step the series collection was repeated 24 h later. Finally a single image acquisition was performed twice a week for 5 weeks. The analysis of results allowed us to define a "physiological" variability of +/-3% of the reference level for both parameters and to conclude that a weekly measurement is adequate to detect relevant variations of device performance.

Repeated and excessive consumption of alcohol leads to pathophysiological disorders in skeletal muscles. A successful management of this syndrome requires a strict abstinence and a nutritionally adequate diet. We propose here a simple and noninvasive investigation using 31 P magnetic resonance spectroscopy (MRS) to monitor the recovery of the basal energy status of eminence thenar muscles from documented chronic alcoholic patients during a controlled 15-day period of abstinence. Cessation of alcohol abuse induced a significant recovery of the PCr(PCr + Pi) ratio otherwise depressed before the abstinence. On the contrary, the relative level of free inorganic phosphate decreased, whereas intracellular pH was not affected. These results demonstrate (a) the rapid improvement of basal muscular energy metabolism during abstinence for patients with a chronic and heavy alcohol consumption, and (b) the feasibility of a follow-up of this recovery by serial examinations using 31 P MRS.

We report a case of acute cardiac tamponade without concurrent myocardial disease occurring in a thalassemia patient early after bone marrow transplantation. The pericardial effusion was preceded by an episode of junctional tachycardia. Repeated evaluation by echocardiography was done shortly after the patient developed the arrhythmia and permitted a detailed, timed observation of the event and description of the symptoms.

A fact finding study was carried out in 58 resuscitation centres and 78 intensive care units to evaluate the current application of computerised techniques in the monitoring and processing of various parameters relating to hospitalised patients. The enquiry revealed a marked interest in the use of computerised systems, particularly in the electrophysiological and haemodynamic field. Promising results were reported from some centres. Some adverse criticisms and points of discussion still exist. International and national experiences matured so far, however, while primarily directed towards scientific research and technological development, open up significant perspectives for the future, for the rational handling of the data collected, and the extension of current knowledge on matters of physiopathology, electrophysiology, and pharmacokinetics.

In vivo 31P NMR spectroscopy was used to determine the ratios of creatine phosphate (PCr) to adenosine triphosphate (ATP) and inorganic phosphate (Pi) in leg and arm muscles of four sprinters, one marathon runner, and two sedentary subjects. Both ratios were definitely higher in the sprinters indicating that, since muscle ATP and Pi concentrations are constant, the PCr muscle content of these athletes is higher than usual. Sprinters are known to have higher percentages of fast-twitch fibers, which are richer in PCr than slow-twitch fibers. It is concluded that measurements of muscle ATP, PCr, and Pi through in vivo NMR spectroscopy could be used to determine muscle fiber composition.