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Owing to its ease of application, noninvasive nature, and safety, echocardiography is an essential imaging modality to assess cardiac function in patients affected by ischemic heart disease (IHD). Over the past few decades, we have witnessed a continuous series of evolutions in the ultrasound field that have led to the introduction of innovative echocardiographic modalities which allowed to better understand the morphofunctional abnormalities occurring in cardiovascular diseases. This article offers an overview of some of the newest echocardiographic modalities and their promising application in IHD diagnosis, risk stratification, management, and monitoring after cardiac rehabilitation.

Aims To elucidate right ventricular (RV) function in patients with idiopathic pulmonary fibrosis (IPF) with and without pulmonary hypertension (PH) and its relation to other features of the disease. Methods and Results Clinical evaluation, standard Doppler echo, Doppler myocardial imaging (DMI), and 2D strain echocardiography (STE) of RV septal and lateral walls were performed in 52 IPF patients (66.5 ± 8.5 years; 27 males) and in 45 age- and sex-comparable controls using a commercial US system (MyLab Alpha, Esaote). Pulmonary artery mean pressure (mPAP) was estimated by standard echo Doppler. RV global longitudinal strain (RV GLS) was calculated by averaging RV local strains. The IPF patients were divided into 2 groups by noninvasive assessment of PH: no PH (mPAP

Background The anatomical complexity of the oropharynx and the difficulty in reaching its distal portion have always conditioned the surgical accessibility. Robotic surgery represents an excellent alternative in the treatment of cervico-facial oncological diseases. Methods This series comprises all patients managed for head and neck cancer by Trans Oral Robotic Surgery TORS. The staging assessment, including neck ultrasound and total body PET/CT scan, was performed in each patient according to the TNM classification. All charts were recorded with the following data: name and surname, age, gender, date of surgery intra or post-operative hemorragia, tumor site, histology, TNM stage, robot set-up time, tumor resection time, whether or not tracheotomy was performed, whether or not neck dissection was performed, insertion of a nasogastric tube or gastrostomy, time to resumption of oral feeding, surgical margins, mean length of hospital stay, adjuvant treatment and follow-up. Results From February 2013 to February 2018, TORS was performed in 67 consecutive patients affected by head and neck tumours. We divided, our sample, in 3 subsites: supraglottic larynx, parapharyngeal space and oropharynx. Pathology reports confimed malignancy in 44 cases: 8 cases lymphomas, 36 cases of Squamous cell carcinoma (SCC), 5 cases of benign salivary glands tumors and 18 miscellaneous cases. Neck dissection was performed in 12 cases. Tracheotomy was perfomed in 3/67 cases for respiratory failures. A nasogastric tube was inserted at the end of the surgical procedure in 21 patients. The mean length of hospital stay was 10 days . Major complications included post-operative bleeding in 3 patients, 1 exitus for massive bleeding 20 days post-surgery and 1 respiratory failure treated with tracheotomy and monitoring in the Intensive Care Unit (ICU) for 3 days. Conclusions Robotic surgery has been considered a valid alternative to traditional open treatment in many specializations with the advantages of an endoscopic procedure, with the same oncological and functional results and with fewer complications. The advantages of this type of surgical technique have been discussed, it is mandatory to focus on the indications and contraindications.

The aim of this study was to investigate which factors play a major role in the healing of Class II mandibular furcation defects treated with different surgical techniques. Twenty-five systemically healthy subjects with periodontitis stage III grade B and Class II buccal mandibular furcation involvement received one of the following open flap debridement approaches: Group 1 (n = 10), no further treatment; Group 2 (n = 10), piezoelectric contouring of the furcation roof; Group 3 (n = 9), piezoelectric contouring of the furcation roof and bone grafting; Group 4 (n = 10), piezoelectric contouring of the furcation roof and bone grafting with coronally positioned flap. Clinical and radiologic variables-bleeding on probing, probing depth (PPD), vertical and horizontal bone level (CAL and PH), gingival recession, root trunk length, radicular separation, and furcation perimeter (FP)-were evaluated at baseline and 180 days and 1 year after surgery. All clinical parameters were statistically analyzed. Surgical techniques caused clinical (CAL, PPD, PH) and radiographic (FP) improvements. Regenerative techniques and the coronally positioned flap yielded a major radiographic reduction of furcation areas. All therapies resulted in significant horizontal and vertical PPD reduction and CAL gain.

Pediatric non-cystic fibrosis (CF) bronchiectasis is characterized by endobronchial suppuration, airway neutrophilic inflammation and poor mucus clearance and is associated with persistent productive cough due to recurrent airway infections. Most recommendations are based on expert opinion or extrapolated from CF practice. The present narrative review aims to address some issues on the management of children or adolescents with non CF-bronchiectasis that still require attention, and analyze what available literature offers to reply to open questions. We focused on the potential offered by technological advances on lung disease assessment through novel chest imaging techniques and new or old pulmonary function tests. We also summarized the main novelties in the disease prevention and treatment. Finally, a novel diagnostic algorithm is proposed, that might help physicians in the daily clinical decision-making process. Future directions for research on pediatric non-CF bronchiectasis should include larger study populations and longer prospective clinical trials, as well as new clinical and laboratory endpoints to determine the underlying mechanisms of lung disease progression and support the role of new and existing treatments.

Defining the role of oral health evaluation in prediction of mortality in a cohort of patients admitted to an acute geriatric unit. Plaque Index and periodontal disease are independent predictors of 1-year mortality and improve accuracy of a Multidimensional Prognostic Index. Oral health evaluation, if integrated in a comprehensive assessment, adds significant information to estimate prognosis of hospitalized patients. Predicting mortality of older patients is a difficult, yet crucial task, which has lead to development of several prognostic tools. We hypothesized that the evaluation of oral health, which is often neglected, might be helpful to improve 1-year mortality prediction in a cohort of patients > 65 years admitted to an acute geriatric unit. We assessed 200 patients using the Decayed, Missing or Filled Teeth tool, the Periodontal Screening and Recording tool and the Plaque Index. A comprehensive geriatric assessment was performed to measure functional, cognitive, nutritional and comorbidity status and to calculate the Multidimensional Prognostic Index (MPI). An age- and sex-adjusted regression model was used to identify independent predictors of 1-year mortality. Area under ROC curve (AUROC) was calculated to assess predictive accuracy of MPI risk groups before and after correction for dental examination results. Plaque Index and Periodontal Screening and Recording tool were associated with 1-year mortality. Participants with periodontal disease had a fivefold higher risk of death (p

Bronchiectasis, conventionally defined as irreversible dilatation of the bronchial tree, is generally suspected on a clinical basis and confirmed by means of chest high-resolution computed tomography. Clinical manifestations, including chronic productive cough and endobronchial suppuration with persistent chest infection and inflammation, may deeply affect quality of life, both in children/adolescents and adults. Despite many cases being idiopathic or post-infectious, a number of specific aetiologies have been traditionally associated with bronchiectasis, such as cystic fibrosis (CF), primary ciliary dyskinesia or immunodeficiencies. Nevertheless, bronchiectasis may also develop in patients with bronchial asthma; chronic obstructive pulmonary disease; and, less commonly, rheumatological disorders and inflammatory bowel diseases. Available literature on the development of bronchiectasis in these conditions and on its management is limited, particularly in children. However, bronchiectasis may complicate the clinical course of the underlying condition at any age, and appropriate management requires an integration of multiple skills in a team of complementary experts to provide the most appropriate care to affected children and adolescents. The present review aims at summarizing the current knowledge and available evidence on the management of bronchiectasis in the other conditions mentioned and focuses on the new therapeutic strategies that are emerging as promising tools for improving patients' quality of life.

Head & Neck Osteomas are extremely rare osteogenic benign tumors, with unclear pathogenesis and heterogeneous clinical behavior. There are no studies in literature showing the characteristics of dimensional growth of such lesions. We report a case of a peripheral solitary osteoma of the sigmoid notch of the mandibular ramus, describing its radiographic growth in fourteen years. Measurements from OPTs (2003–6x7mm, 2008–8x12mm, 2014–17 × 24mm, 2016–19 × 25mm and 2017–21 × 28mm) and 3d cone-beam computed tomography scan (2016–19 × 15 × 21mm, 2017–21,4 × 19,2 × 22,7) were obtained. The growth of the lesion measured on OPTs was in mean 1.1 × 1.5 mm per year. This is the first case report in literature quantitatively assessing the growth of a solitary osteoma of the mandible through radiographic imaging, which seems to be more than 1 mm per dimension per year.

Respiratory syncitial virus (RSV) is the most common cause of lower respiratory tract infections (LRTI) in children worldwide and it is associated with significant childhood morbidity. Acute infection may result in respiratory failure with varying degrees of severity, and increasing evidence supports a role of RSV infection as a key determinant for the development of subsequent chronic respiratory disease. Independent predictors of RSV severity include; prematurity, congenital heart disease, cystic fibrosis, immune defects and neuromuscular disorders. Passive immunization with palivizumab has proven to be safe and effective for preventing RSV hospitalization in infants at higher risk of acquiring severe RSV infection, but its expense and cumbersome monthly intravenous delivery schedule make it inaccessible to many. Furthermore, implementing prophylaxis in 32- to 35-week-gestational age infants and the mode of its administration still represent areas of uncertainty. In this review, we describe several aspects of RSV infection and analyze recent advances in the assessment of cost-effective palivizumab prophylaxis.

Ectopic thyroid tissue (ETT) is an uncommon entity that may be found anywhere along the line of the obliterated thyroglossal duct, usually from the tongue to the diaphragm.We performed a retrospective analysis of patients undergoing surgical treatment for thyroid disease between January 2000 and December 2013, seeking for ETT All patients with prior neck surgery or trauma were excluded. The clinic-pathologic features, prevalence and diagnosis of the lesions were collected and analyzed.Out of 3092 included patients, 28 ETT were identified (0.9%). The anatomical site of ETT was as follows: lateral cervical in 6 (21.4%), along the thyroglossal duct in 6 (21.4%), mediastinal in 5 (17.9%), lingual in 5 (17.9%), sublingual in 3 (10.7%), and submandibular in 3 (10.7%). Histopathology revealed 27 benign lesions and 1 (3.6%) papillary carcinoma.ETT is found in less than 1% of patients receiving thyroid surgery. Diagnosis of ETT requires clinical imaging. Surgery is a prudent choice due to the potential of malignant evolution of ETT. Ectopic thyroid tissue (ETT) is an uncommon entity that may be found anywhere along the line of the obliterated thyroglossal duct, usually from the tongue to the diaphragm.We performed a retrospective analysis of patients undergoing surgical treatment for thyroid disease between January 2000 and December 2013, seeking for ETT All patients with prior neck surgery or trauma were excluded. The clinic-pathologic features, prevalence and diagnosis of the lesions were collected and analyzed.Out of 3092 included patients, 28 ETT were identified (0.9%). The anatomical site of ETT was as follows: lateral cervical in 6 (21.4%), along the thyroglossal duct in 6 (21.4%), mediastinal in 5 (17.9%), lingual in 5 (17.9%), sublingual in 3 (10.7%), and submandibular in 3 (10.7%). Histopathology revealed 27 benign lesions and 1 (3.6%) papillary carcinoma.ETT is found in less than 1% of patients receiving thyroid surgery. Diagnosis of ETT requires clinical imaging. Surgery is a prudent choice due to the potential of malignant evolution of ETT. (C) 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Il Calibro persistente dell'arteria labiale (CPLA) di solito si presenta come papule asintomatica sul labbro inferiore e può essere facilmente mal diagnosticato come mucocele, emangioma, venoso lago, varici o fibroma. Quando è ulcerata, la diagnosi differenziale con il carcinoma squamoso più usuale. Qui riportiamo il caso di una donna di 25 anni con nessun precedente rilevante storia medica che ha presentato in maniera asintomatica, non ulcerata, un progressivo nodulo crescente (negli ultimi 5 mesi) sulla labbro superiore. In questo caso, la diagnosi è stata fatta clinicamente e confermato mediante analisi immunoistochimica. In conclusione i medici dovrebbero essere consapevoli di CPLA e dovrebbe essere incluso nella diagnosi differenziale di papule mucose labiali. A volte, l'analisi immunoistochimica è necessaria per effettuare una diagnosi corretta. Calibre persistent labial artery (CPLA) usually presents as an asymptomatic papule on the lower lip and can be easily misdiagnosed as a mucocele, haemangioma, venous lake, varix or fibroma. When it is ulcerated, squamous cell carcinoma is the most usual differential diagnosis. Here, we report a case of a 25-year-old woman with no previous relevant medical history who presented with a complaint of an asymptomatic, non-ulcerated, progressively growing nodule (over the last 5 months) on the upper lip. In this case, the diagnosis was made clinically and confirmed by immunohistochemical analysis. We conclude that clinicians should be aware of CPLA and it should be included in the differential diagnosis of labial mucosal papules. Sometimes, the immunohistochemical analysis is necessary to make a correct diagnosis.

We report a case of migration of a surgical localization wire from the breast to the abdomen. A 41‐year‐old female underwent presurgical needle localization of a deep‐sited left‐sided breast lesion. Migration of the localization wire in the chest wall occurred during the procedure documented by imaging. Computed tomography (CT) examination showed no evidence of the wire in the left lower lung field, no peritoneal free fluid, active bleeding, or abnormalities of abdominal organ, but a metallic‐density representing the localization wire was seen for a length of 13 cm from the right diaphragmatic crus to the right psoas muscle, close to the inferior vena cava. A following CT examination showed the wire partially outside the inferior vena cava and partially inside the right iliac vein. The wire was successfully taken out by an angiographic interventional procedure.

Glycogenosis type II (Pompe disease) is a rare autosomal recessive genetic disorder caused by mutations in the gene encoding the lysosomal enzyme acid α-glucosidase. The classic form is characterized by severe cardiac involvement, generalized hypotonia and exitus early in life. Presenting symptoms and signs of the disease may be neglected or underestimated, thus delaying the diagnosis. Respiratory manifestations mainly occur because of respiratory muscle weakness. However, additional mechanisms can favor the development of pulmonary complications that result in fatal respiratory failure. We herein describe a case of an infant with glycogenosis type II presenting with hepatomegaly and hypertransaminasemia, who rapidly developed fatal lung disease.

Asthma in preschool children is common. One in three children has at least one episode of wheezing prior to their third birthday, and the cumulative prevalence of wheeze is almost 50% at the age of 6 years. The management of these patients, especially when symptoms are recurrent and severe, is a challenging task. Clinical benefits of inhaled corticosteroids in preschool asthmatic children are still controversial. Since leukotrienes are potent bronchoconstrictive agents, the leukotriene receptor antagonists (LTRAs) are used in asthmatic patients to inhibit their action in the respiratory tract. Montelukast, the only LTRA approved for young children use in several countries, is also known to have antieosinophilic properties. This review summarizes the most recent evidence on the role of LTRAs, particularly montelukast, in the treatment of preschool asthma. Montelukast seems to be effective in preschool asthma and recurrent wheezing for improving symptoms, lung function, and bronchial inflammation, and for protecting against cold air-induced bronchial hyperreactivity. The scarce data available do not allow to reach definitive conclusions on LTRAs efficacy in acute asthma or in the obese-asthma phenotype. The excellent safety profile of montelukast and the convenience of oral delivery, that entail better compliance from young children, represent the main strengths of its use in preschool children. LTRAs represent a valid alternative to inhaled corticosteroids in young children, and are suggested mainly to reduce virus-induced exacerbations, to overcome the difficulties due to the inhaled therapy, in subjects showing adverse effects related to long-term steroid therapy, or when compliance is poor.

Background Primary ciliary dyskinesia (PCD) is associated with pulmonary involvement that requires periodical assessment. Chest high-resolution computed tomography (HRCT) has become the method of choice to evaluate chronic lung disease, but entails exposure to ionizing radiation. Magnetic resonance imaging (MRI) has been proposed as a potential radiation-free technique in several chest disorders. Aim of our study is to evaluate whether high-field MRI is as effective as HRCT in identifying PCD pulmonary abnormalities. We also analyzed the relationships between the severity and extension of lung disease, and functional data. Methods Thirteen PCD patients (8 children/5 adults; median age, 15.2 yrs) underwent chest HRCT and high-field 3T MRI, spirometry, and deep throat or sputum culture. Images were scored using a modified version of the Helbich system. Results HRCT and MRI total scores were 12 (range, 6–20) and 12 (range, 5–17), respectively. Agreement between HRCT and MRI scores was good or excellent (r > 0.8). HRCT and MRI total scores were significantly related to forced vital capacity (r = -0.5, p = 0.05; and r = -0.7, p = 0.009, respectively) and forced expiratory volume at 1 second (r = -0.6, p = 0.03; and r = -0.7, p = 0.009, respectively). Conclusion Chest high-field 3T MRI appears to be as effective as HRCT in assessing the extent and severity of lung abnormalities in PCD. MRI scores might be used for longitudinal assessment and be an outcome surrogate in future studies.

The Hyper-immunoglobulin M syndromes (HIGM) are a heterogeneous group of genetic disorders resulting in defects of immunoglobulin class switch recombination. Affected patients show humoral immunodeficiency and high susceptibility to opportunistic infections. Elevated serum IgM levels are the hallmark of the disease, even though in few rare cases they may be in the normal range. Hyper IgM is associated with low to undetectable levels of serum IgG, IgA, and IgE. In some cases, alterations in different genes may be identified. Mutations in five genes have so far been associated to the disease, which can be inherited with an X-linked (CD40 ligand, and nuclear factor-kB essential modulator defects) or an autosomal recessive (CD40, activation-induced cytidine deaminase, and uracil-DNA glycosylase mutation) pattern. The patient herein described presented with recurrent upper and lower respiratory infections and evidence of suppurative lung disease at the conventional chest imaging. The presence of low serum IgG and IgA levels, elevated IgM levels, and a marked reduction of in vivo switched memory B cells led to a clinical and functional diagnosis of HIGM although the genetic cause was not identified.

We have identified new repeated interspersed DNA sequences by analysis of homologous RNA transcripts from a human teratocarcinoma cell line (NTERA-2 clone D1). The abundance of transcripts varies upon retinoic acid induced differentiation of NTERA-2/D1 cells, and it is highest when the cells display the embryonal carcinoma phenotype. The expression of these novel repeated sequences appears to be tissue specific as no detectable expression was found in various cell lines of different embryological derivation. Characterization of the RNA transcripts by analysis of recombinant cDNA clones indicated that transcripts of different genomic units are present in undifferentiated embryonal teratocarcinoma cells. Nucleotide sequencing of the cloned cDNAs reveals a complex structure composed by unique and tandemly repeated sub-elements.

Objectives: Magnetic resonance imaging (MRI) has been proposed as a radiation-free alternative to high resolution computed tomography (HRCT) for the assessment and follow-up of chest disorders. Thus far, no study has compared the efficacy of high-field MRI and HRCT in children and adults with noncystic fibrosis (CF) chronic lung disease. The aims of our study were: (1) to assess whether chest high-field MRI is as effective as chest HRCT in identifying pulmonary abnormalities; and (2) to investigate the relationships between the severity and extent of lung disease, and functional data in patients with non-CF chronic lung disease. Materials and Methods: Forty-one subjects (median age, 13.8 years; range, 5.9-29.3 years; 30 children/11 adults) with primary ciliary dyskinesia (n = 14), primary immunodeficiency (n = 14), or recurrent pneumonia (n = 13) underwent pulmonary function tests, chest HRCT (120 kV, dose-modulated mAs) and high-field 3.0-T MRI (HASTE; transversal orientation; repetition time/echo time/flip angle/acquisition time, infinite/92 milliseconds/150°/approximately 90 seconds). HRCT and MRI images were scored in consensus by 2 raters using a modified version of the Helbich scoring system. The maximal score was 25. Results: HRCT and high-field MRI total scores were 11 (range: 1-20) and 11 (range: 1-17), respectively. There was good agreement between the 2 techniques for all scores (r > 0.8). HRCT and MRI total scores, and extent of bronchiectasis scores were significantly related to pulmonary function tests (r = -0.4, P < 0.05). The MRI mucous plugging score was significantly related to pulmonary function tests (r = -0.4, P < 0.05). Conclusions: Chest high-field 3.0-T MRI appears to be as effective as HRCT in assessing the extent and severity of lung abnormalities in non-CF chronic lung diseases, and might be a reliable radiation-free option to HRCT.

Asthma is the most common chronic disease in young children. About 40% of all preschool children regularly wheeze during common cold infections. The heterogeneity of wheezing phenotypes early in life and various anatomical and emotional factors unique to young children present significant challenges in the clinical management of this problem. Anti-inflammatory therapy, mainly consisting of inhaled corticosteroids (ICS), is the cornerstone of asthma management. Since Leukotrienes (LTs) are chemical mediators of airway inflammation in asthma, the leukotriene receptor antagonists (LTRAs) are traditionally used as potent anti-inflammatory drugs in the long-term treatment of asthma in adults, adolescents, and school-age children. In particular, montelukast decreases airway inflammation, and has also a bronchoprotective effect. The main guidelines on asthma management have confirmed the clinical utility of LTRAs in children older than five years. In the present review we describe the most recent advances on the use of LTRAs in the treatment of preschool wheezing disorders. LTRAs are effective in young children with virus-induced wheeze and with multiple-trigger disease. Conflicting data do not allow to reach definitive conclusions on LTRAs efficacy in bronchiolitis or post-bronchiolitis wheeze, and in acute asthma. The excellent safety profile of montelukast and the possibility of oral administration, that entails better compliance from young children, represent the main strengths of its use in preschool children. Montelukast is a valid alternative to ICS especially in poorly compliant preschool children, or in subjects who show adverse effects related to long-term steroid therapy.