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BackgroundThe presence of hypoxic cells in high-grade glioma (HGG) is one of major reasons for failure of local tumour control with radiotherapy (RT). The use of hyperbaric oxygen therapy (HBO) could help to overcome the problem of oxygen deficiency in poorly oxygenated regions of the tumour. We propose an innovative approach to improve the efficacy of hypofractionated stereotactic radiotherapy (HSRT) after HBO (HBO-RT) for the treatment of recurrent HGG (rHGG) and herein report the results of an ad interim analysis.MethodsWe enrolled a preliminary cohort of 9 adult patients (aged >18 years) with a diagnosis of rHGG. HSRT was administered in daily 5-Gy fractions for 3-5 consecutive days a week. Each fraction was delivered up to maximum of 60 minutes after HBO.ResultsMedian follow-up from re-irradiation was 11.6 months (range: 3.2-11.6 months). The disease control rate (DCR) 3 months after HBO-RT was 55.5% (5 patients). Median progression-free survival (mPFS) for all patients was 5.2 months (95%CI: 1.34-NE), while 3-month and 6-month PFS was 55.5% (95%CI: 20.4-80.4) and 27.7% (95%CI: 4.4-59.1), respectively. Median overall survival (mOS) of HBO-RT was 10.7 months (95% CI: 7.7-NE). No acute or late neurologic toxicity >grade (G)2 was observed in 88.88% of patients. One patient developed G3 radionecrosis.ConclusionsHSRT delivered after HBO appears to be effective for the treatment of rHGG, it could represent an alternative, with low toxicity, to systemic therapies for patients who cannot or refuse to undergo such treatments.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT 03411408.

Background Cervical radiculopathy (CR) is a common cervical spine disorder. Cervical traction (CT) is a frequently recommended treatment for patients with CR. Purpose The purpose of this study was to conduct a review and meta-analysis of randomized controlled trials (RCTs) on the effect of CT combined with other physical therapy procedures versus physical therapy procedures alone on pain and disability. Data Sources Data were obtained from COCHRANE Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science, and PEDro, from their inception to July 2016. Study Selection All RCTs on symptomatic adults with CR, without any restriction regarding publication time or language, were considered. Data Extraction Two reviewers selected the studies, conducted the quality assessment, and extracted the results. Meta-analysis employed a random-effects model. The evidence was assessed using GRADE criteria. Data Synthesis Five studies met the inclusion criteria. Mechanical traction had a significant effect on pain at short- and intermediate-terms (g = –0.85 [95% CI = –1.63 to –0.06] and g = –1.17 [95% CI = –2.25 to –0.10], respectively) and significant effects on disability at intermediate term (g = –1.05; 95% CI = –1.81 to –0.28). Manual traction had significant effects on pain at short- term (g = –0.85; 95% CI = –1.39 to –0.30). Limitations The most important limitation of the present work is the lack of homogeneity in CR diagnostic criteria among the included studies. Conclusions In light of these results, the current literature lends some support to the use of the mechanical and manual traction for CR in addition to other physical therapy procedures for pain reduction, but yielding lesser effects on function/disability.

Introduction The level of lymph node involvement is the most important factor in staging colorectal cancer without metastasis. Sentinel lymph node mapping identifies the node(s) that most accurately reflect the lymph node status of patients, and intensive techniques that improve staging can be focused on these nodes. The aim of this study was to assess the efficacy of ex vivo sentinel lymph node mapping in the staging of colon cancer. Materials and methods A prospective study was conducted on 125 patients from the Alava-Txagorritxu University Hospital Health Region (Alava), who were diagnosed prior to surgery with colon cancer without distant metastasis from September 2009 to December 2011. Ex vivo sentinel lymph node mapping with methylene blue was use in these patients to study the sentinel nodes with multiple slices using immunohistochemical techniques and haematoxylin–eosin staining. A comparative study was also performed based on a control group of 170 patients staged with conventional techniques, and involving a single slice and haematoxylin–eosin staining. Results The sentinel lymph node identification rate was 98%, with 5.6% false negatives. Upstaging occurred in 14.2% of cases compared to the group studied using conventional techniques (P=.006). Conclusions Ex vivo sentinel lymph node mapping with methylene blue accurately reflects the lymph node status of patients with colon cancer. This approach upstages patients classified as stages i and ii by conventional techniques to stage iii , indicating chemotherapy that may improve their prognosis.

The persistent hypoglossal artery is rare vascular anomalies. We report the case of a 50-year old man with right hypoglossal artery, ipsilateral hypoplasic internal carotid artery, associated with left proximal subclavian stenosis with subclavian steal syndrome. Power-Doppler-Ultra-Sonography spectral images obtained after the patient exercised the left arm showed mid-systolic deceleration with retrograde late-systolic velocities. A Computed Tomography Angiography demonstrated a proximal stenosis of the left SA, a mild right ICA hypoplasia and an anomalous artery arising from right ICA at C2–C3 level, entering the cranium via the hypoglossal canal and joining the basilar artery. Usually the presence of PHA may be completely asymptomatic, and detected as an incidental finding by CTA or MRA, but in our case its diagnosis is extremely important because it is often the only vessel supplying blood to the basilar trunk and posterior circulation.

Introduction The study of lymph nodes is the most important prognostic factor in colorectal cancer without metastasis. The sentinel lymph node technique identifies the lymph node that best predicts the patient's lymph node status and allows the performance of techniques of intensive study that improve staging. The aim of this study was to evaluate the efficacy of the sentinel lymph node technique in the staging of colon cancer. Methods We performed a prospective study of 45 patients preoperatively diagnosed with colon cancer in stages 0, i and ii . We carried out the sentinel lymph node technique ex vivo and with methylene blue. The sentinel lymph node was studied through multiple sections and immunohistochemical techniques in addition to hematoxylin and eosin staining. We performed a comparison with a control group of 45 patients who were studied through a single section and hematoxylin and eosin staining. Results We identified the sentinel lymph node in 98% of the patients, with a false-negative rate of 0. Overstaging was found to occur in 4.8 to 23.8% of the patients. In patients in whom less than 12 lymph nodes were studied, overstaging was between 10.5 and 36.8%. Conclusions Study of sentinel lymph nodes carried out ex vivo and with methylene blue predicts the lymph node status of patients with colon cancer. This technique overstages patients to stage iii , who will receive chemotherapy, which could improve their prognosis. The benefit of this technique is greater in patients, in whom less than 12 lymph nodes are studied.

Background: Angiotensin-converting enzyme is involved in the pathophysiology of heart failure. We hypothesized that clinical characteristics as well as survival rate in patients with heart failure of different etiologies may be modulated by functional variants DD, ID and II of the angiotensin-converting enzyme gene. Methods: We studied 333 patients with heart failure, aged 43.3±10.5 years, 262 (78.7%) men and 71 (21.3%) women. Heart failure was ascribed to idiopathic dilated cardiomyopathy in 125 patients. Heart failure was caused by ischemic heart disease in 63 patients, Chagas' disease in 58, hypertensive heart disease in 41, alcoholic cardiomyopathy in 24, and was due to other etiologies in 22 patients. Statistical analysis was performed with the χ 2 test, Student's t -test, analysis of variance, Kaplan–Meier and Cox proportional hazards methods. Results: The DD genotype was associated with increased systolic left ventricular diameter ( p =0.031). Earlier onset of symptoms was observed in patients with alcoholic cardiomyopathy and DD genotype ( p =0.033, codominant D) and in patients with hypertensive cardiomyopathy and DD genotype ( p =0.048, codominant D; p =0.024, recessive D). Mortality was higher in patients older than 50 years with DD genotype ( p =0.007, codominant D; p =0.002, recessive D). Variables independently associated with higher mortality in patients older than 50 years were age, diabetes mellitus, Chagas' disease etiology and DD genotype. Conclusions: These results add evidence for an association of the DD genotype of the angiotensin-converting enzyme gene with earlier onset of symptoms and decreased survival rate of selected patients with heart failure.

Summary objective In the present study we have performed a grey-scale quantitative analysis of thyroid echogenicity in the patients affected by Hashimoto's thyroiditis (HT), obtaining a numerical estimate of the degree of hypoecogenicity associated with the appearance of thyroid dysfunction. materials and methods The study group included 89 patients with serum positivity for thyroglobulin (TgAb) and/or peroxidase (TPOAb) antibodies. Ultrasound (US) evaluation of thyroid gland and biochemical assay of serum thyrotropin (TSH), free-thyroxine (FT4) and free-triiodiothyronyne (FT3) were performed in all patients, and in 40 healthy subjects enrolled as control group. Thyroid echogenicity was compared with that of the surrounding neck muscles, using the grey-scale histogram analysis. The echogenicity was expressed in grey-scales (GWE). results In HT patients, the mean of thyroid echogenicity was lower when compared to the normal thyroid (61·9 ± 8·3 GWE vs. 71·9 ± 3·1 GWE; P = 0·01). In all HT patients the lowest limit of thyroid echo distribution was in the echogenicity range of the surrounding muscle, the overlapping ranging between 3·4% and 95·0% (mean ± SD 48·4 ± 20·9%). The extension of like-muscle hypoechogenicity into the thyroid gland was significantly correlated with serum TSH values (r = 0·37; P

Iron depletion was suggested to be protective against the development of ischemic heart disease. Population studies have led to conflicting results, and such an association has not been addressed in patients with heart failure due to cardiomyopathy. We studied the distribution of hemochromatosis-related mutations in 319 patients with heart failure due to cardiomyopathy of different etiologies. The genotypic distribution showed a significantly higher prevalence of heterozygotes for the C282Y mutation in patients with ischemic cardiomyopathy than in patients with cardiomyopathy of nonischemic etiologies (p = 0.0036). The frequency of the D63 mutation was not significantly different between ischemic versus nonischemic groups. In multiple logistic regression models adjusted for age, sex, ethnicity, and different degrees of disease progression, there was a strong and significant association of the C282Y mutation with ischemic cardiomyopathy compared with the nonischemic group (odds ratio 6.64, 95% confidence interval 1.71 to 25.73, after adjustment). In our sample, genetic variation in the HFE gene was associated with ischemic cardiomyopathy. Such association merits further study regarding its value as a prognostic marker in patients with ischemic heart disease.

Papillary thyroid cancer (PTC) is the most common histologic type of differentiated thyroid cancer. The first site of metastasis is the cervical lymph nodes (LNs). The ultrasonography (US) is the best diagnostic method for the detection of cervical metastatic LNs. We use a new technique, B-flow imaging (BFI), recently used for evaluation of thyroid nodules, to estimate the presence of BFI twinkling signs (BFI-TS), within metastatic LNs in patients with PTC. Two hundred and fifty-two patients with known PTC were examined for preoperative evaluation with conventional US and BFI. Only 83 with at least one metastatic LN were included. All patients included underwent surgery; the final diagnosis was based on the results of histology. The following LN characteristics were evaluated: shape, abnormal echogenicity, absent hilum, calcifications, cystic appearance, peripheral vascularization, and BFI-TS. A total of 604 LNs were analyzed. Of these, 298 were metastatic, according to histopathology. The BFI-TS showed high values​​of specificity (99.7%) and sensitivity (80.9%). The combination of each conventional US sign with the BF-TS increases the specificity. Our findings suggest that BFI can be helpful in the selection of suspicious neck LNs that should be examined at cytologic examination for accurate preoperative staging and individual therapy selection.

Background Ultrasound is considered the best diagnostic method for the detection of metastatic cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC). According to current guidelines, all patients undergoing thyroidectomy for malignancy should undergo preoperative neck ultrasound of the thyroid and central and lateral neck LNs, followed by fine needle aspiration of suspicious LNs. Cervical LN involvement determenes the extent of surgery. Complete surgical resection disease at the initial operation decreases likelihood of future surgery for recurrent disease and may impact survival. We use a new technique, B-flow imaging (BFI), recently used for evaluation of thyroid nodules, to estimate the presence of BFI twinkling signs (BFI-TS), within metastatic LNs in patients with PTC. Methods Between September 2006 and December 2012, 304 patients with known PTC were examined for preoperative sonographic evaluation with gray-scale US, color Doppler US and BFI. Only 157 with at least one metastatic LN were included in our study. All patients included underwent surgery, and the final diagnosis was based on the results of histologic examination of the resected specimens. The following LN characteristics were evaluated: LN shape, abnormal echogenicity, the absent of hilum, calcifications, cystic appearance, peripheral vascularization and the presence of BFI-TS. Results A total of 767 LNs were analyzed. 329 out of 767 were metastatic, according to the histopathologic findings. BFI-TS, showed 99.5% specificity and 81,5% sensitivity. We detected BFI-TS in 6 metastatic LNs that were negative to the other conventional US features. Conclusions Our results indicate that the BFI-TS has a diagnostic accuracy higher than the other conventional sonographic signs. Our findings suggest that BFI can be helpful in the selection of suspicious neck LNs that should be examined at cytologic examination or open biopsy for accurate preoperative staging and individual therapy selection.

Background Assessment of allergic food reactions may be complicated by cross-reactivity among certain food families and seemingly unrelated allergens. Analysis can identify protein sequence and allergenic properties. Fish and its derived play an important role in nutrition, they may also be a potent food allergen. Gad-c1, Parvalbumin, the major codfish allergen, is considered as a panallergen as in seafood the Tropomyosin (muscle-derived protein) have been recently demonstrated in invertebrates such as cockroaches, mites, shrimp. The clinical symptoms related to IgE-mediated fish allergy are frequently urticaria, angioedema, mild oral symptoms, worsening atopic dermatitis, respiratory symptoms (rinitis, asthma), gastrointestinal (nausea,vomiting). Anaphylaxis may occur.

Facial injuries are common and must be radiologically evaluated to detect fractures, to determine their morphology and topography, and to assess adjacent soft-tissue damage. Spiral multislice computed tomography is progressively replacing conventional films for mandible traumatic lesions because it reveals the multiplicity of fragments, the degree of dislocation and rotation, and the extent of skull base involvement. Computed tomography is also very useful in the evaluation of condylar fractures, to determine the best choice for surgical treatment, open or close. 3-dimensional (3D) computed tomography images can display condylar fractures, but also all mandibular fractures, accurately and directly, and are very useful for surgeons to select treating methods of condylar fractures. The demonstration by imaging of the involvement of key anatomic structures is essential to classify correctly the trauma and to select the best management.

Introduction The treatment of colorectal cancer (CRC) is usually surgical and involves morbidity-mortality. The aim of this study is to quantify the postoperative mortality in our hospital and to determine their risk factors. Materials and methods Prospective observational study from 1996 to 2007 included 1017 patients who underwent surgery for CRC in our hospital. Identification of independent risk factors for postoperative mortality by multivariate analysis. Results The mean age was 67.8 years. The surgery was elective in 879 (86.5%) and was considered curative in 878 (86.1%). The postoperative mortality was 3.6% (37 patients), 2.5% in the elective surgery, and 10.9% in the urgent. The independent risk factors identified were: type of surgery (odds ratio for urgent vs elective = 2.8), American Society of Anesthesiologists (ASA) grade (odds ratio for ASA III–IV vs I–II = 2.4), age (odds ratio for age ≥85 vs ≤74 = 7.6 and age 75–84 vs ≤74 = 2.4). Conclusions We found a low postoperative mortality, which was mainly associated with age over 75 years, ASA III or IV stages, and urgent surgery.

BackgroundMicrocalcifications (aggregated with psammoma bodies), detected by ultrasound (US), are the most specific feature of papillary thyroid cancer (PTC). Using B-flow imaging (BFI), we identified a new sign (the twinkling sign; BFI-TS) in ‘suspect’ PTC nodules, which appeared to be generated by microcalcifications.ObjectiveTo evaluate whether the BFI-TS was predictive of malignancy, we correlated the BFI-TS with the results of fine needle aspiration cytology and histology.DesignCross-sectional cohort study from September 2006 to April 2008.SettingDepartment of Radiology and Endocrinology, University of Naples Federico II, and Department of Endocrinology, Second University of Naples.PatientsA total of 306 consecutive patients with 539 thyroid nodules >8 mm in diameter.Main outcome measureUS and BFI examinations were performed with the Logiq 9 system (General Electric Company, Milan, Italy); all patients underwent cytological examination.ResultsCytology revealed 455 (84.4%) benign nodules and 84 (15.6%) malignant nodules; the latter were confirmed by postsurgical histological examination (76 cases of PTC, 7 follicular carcinoma, and 1 Hürthle cell carcinoma). All suspect nodules, namely, nodules with potential predictors of thyroid malignancy (e.g., microcalcifications and intra-nodal vascularity), were analyzed by cytology or histology (or both). Of 84, 68 (80.9%) of malignant nodules had ≥4 or more BFI-TSs in at least one scan versus only 12 of 455 (2.6%) of benign lesions.ConclusionsOur results indicate that the BFI-TS could be a reliable diagnostic technique in the management of suspect thyroid nodules.

Objective. The purpose of this study was to correlate the presence and patterns of distribution of Bflow imaging (BFI) twinkling signs within thyroid nodules with the histologic evidence of microcalcifications and the results of the sonographically guided fine-needle aspiration to establish their role in predicting the risk of malignancy. Methods. Between September 2006 and December 2007, 343 consecutive patients with 479 suspected nodules (maximum diameter >9 mm) were enrolled in this prospective study. Sonographic and BFI examinations were performed with a commercially available real-time sonography system, and all patients also underwent a cytologic evaluation. Written informed consent was obtained from all patients. Patients with suspicious or malignant cytologic features underwent surgery. Results. On histologic examination, 66 of 479 nodules were malignant (59 papillary thyroid carcinoma, 1 Hurthle cell carcinoma, and 6 follicular carcinoma). All sonographic characteristics, which were potential predictors of thyroid malignancy (microcalcifications, hypoechogenicity, absence of a halo, and a predominantly solid composition), were found in different percentages in both histologically verified malignant and benign nodules. For BFI, pattern 3 (≥4 signs and distance >2 mm) was the most predictive factor for malignancy (specificity, 99.6%; sensitivity, 65.2%), whereas pattern 2 (≥4 signs and distance