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Aetiopathogenesis of Chronic Anal Anterior Fissure (CAAF) remains poorly understood. Some anatomical, clinical and functional features suggest that pathophysiology may be linked to a reduced anal canal pressure. LIS appear illogical as a treatment for CAAF and the employ of techniques aiming to save the integrity of the sphincterial system appears more sensible. The aim of this study was to evaluate 5 years results of fissurectomy and anoplasty with cutaneous V-Y advancement flap in patients affected by CAAF without IAS hypertonia.We enrolled 20 women, affected by idiopathic and non-recurrent CAAF without hypertonic IAS. All patients were followed up for 5 years after surgery with evaluation of anal continence, short and long term post-operative complications, recurrence rate.At 5 years follow up we did not record any new case of anal incontinence and the pre-existing ones haven't worsened. We observed 2 recurrences, which occurred within 2 years after surgery and healed after medical therapy. The manometric values were similar than those recorded prior to surgery.Our study suggests that the procedure performed allows us to preserve anal continence and avoid worsening of its pre-existing alteration.Anal canal, Anoplasty, Fissure, Fissurectomy, Proctology, Sphincterotomy.L’eziopatogenesi delle ragadi anali della commisura anteriore è ancora poco chiara. Alcune caratteristiche cliniche, anatomiche e funzionali suggerirebbero che la patofisiologia di questo disturbo sia strettamente correlata alla riduzione del tono sfinterico anale. La sfinterotomia laterale interna è un approccio poco appropriato per questa patologia, mentre, le procedure volte a garantire l’integrità del sistema sfinterico sembrerebbero più ragionevoli. L’obbiettivo del nostro studio è quello di valutare i risultati a 5 anni della fissurectomia ed anoplastica con lembo di avanzamento cutaneo a V-Y per il trattamento delle ragadi anali della commissura anteriore senza ipertono sfinterico. Al fine di condurre il nostro studio abbiamo considerato 20 pazienti donne affette da ragade anale e sottoposte al suddetto intervento chirurgico dal Gennaio 2008 al Gennaio 2015; tutte le pazienti sono state seguite per 5 anni dopo la procedura chirurgica con valutazione della continenza anale, delle complicanze post-operatorie e breve e lungo termine e del tasso di ricorrenza. Al follow up a 5 anni non abbiamo riscontrato nessun caso di incontinenza anale di nuova insorgenza, è alcun aggravamento dei casi di incontinenza anale preesistenti. Abbiamo osservato 2 recidive trattate efficacemente con terapia conservativa. Infine, il quadro manometrico a 5 anni era simile a quello pre-operatorio. In conclusione il nostro studio suggerisce che la procedura chirurgica da noi utilizzata ci permette di conservare la continenza anale in queste pazienti, senza aggravare le preesistenti alterazioni della stessa.

Leishmaniasis and rickettsial diseases are endemic and common in Mediterranean countries and so, as in humans, these diseases could be an important cause of HLH in dogs and may respond to similar medications. In conclusion, we think that the diagnosis of HLH should be considered in dogs with pancytopenia and, in selected cases, immunosuppressive treatment might be warranted.

Traumas are one of the most relevant pathological events in health care, because of clinical and prognostic relevance. Morbidity and mortality rates are strongly affected by the timely and correct approach to the patient (golden hour). The objective of this study was to investigate the possible influence of the diagnostic time and of the Injury Severity Score (ISS) on outcomes in trauma patients.Out of a total of 240,833 emergency patients, we observed, 447 polytrauma. All patients were assessed according to the Advanced Trauma Life Support (ATLS) guidelines, diagnosed by computed tomography (CT), and summarized using an adapted complex trauma card (italian version).Overall, 2.5% (11/447) of patients died during the assessment, whereas the remaining 436 patients were diagnosed at the Emergency room and afterwards hospitalised. In 76 out of 436 patients (17.43%) the outcome was poor. Particularly, the most significant complications involved the central nervous system, chest and abdomen lesions respectively, with an ISS of 41.7 ± 15.9. The mean time for the diagnostic assessment in patients with poor outcome was 115.2 ± 0.4 minutes.The immediate mortality percentage, as well as the delayed ones, was highest in patients involved in road accidents. The early management certainly plays a crucial role, reducing death rate and permanent disability.The high percentage of patients affected by haemodynamic instability (24.3%) demonstrates the existence of a criticality identifiable in the approach to the patient during the pre-hospital phase: a phase that is dramatically characterised by the exclusion of intensivists from rescue teams.Complex Trauma Card, Mortality, Multiple injuries, Polytrauma, Scores.Il Trauma rappresenta uno dei più importanti eventi patologici in sanità, in termini di rilevanza clinica e prognostica. I tassi di morbilità e mortalità sono fortemente influenzati dal pronto e corretto approccio al paziente (golden hour). Obiettivo di questo lavoro è stato analizzare la possibile influenza del tempo impiegato per la diagnosi e dell’ISS (Injury Severity Score) sull’outcome di questi pazienti.Abbiamo osservato, su un totale di 240.833 pazienti in emergenza, 447 (0,19%) politraumi. Tutti i pazienti sono stati valutati secondo le linee guida dell’Advanced Trauma Life Support (ATLS), diagnosticati mediante la tomografia computerizzata (TC), ed i dati riassunti usando la versione italiana di una Scheda del Trauma Complesso. In totale, il 2,5% (11/447) dei pazienti è morto durante tale valutazione, mentre i 436 pazienti restanti sono stati diagnosticati presso l’unità di emergenza e successivamente ospedalizzati.In 76 su 436 pazienti (17,43%) l’esito è stato sfavorevole. In particolare, le complicazioni più significative hanno coinvolto il sistema nervoso centrale (SNC), il torace e l’addome, rispettivamente, con un ISS di 41.66 ± 15.89. Il tempo medio utilizzato per la valutazioni diagnostiche nei pazienti con outcome sfavorevole è stato 115.20 ± 0,40 min.La percentuale di mortalità immediate, cosi come di quella a distanza, è stata registrata più alta tra i pazienti coinvolti in incidenti stradali. Una gestione precoce gioca certamente un ruolo cruciale nella riduzione del tasso di mortalità e di disabilità permanente.L’alta percentuale di pazienti affetti da instabilità emodinamica (24,3%), dimostra l’esistenza di una criticità identificabile nell’approccio al paziente durante la fase pre-ospedaliera: una fase che è drammaticamente caratterizza dall’esclusione quasi totale dei rianimatori dalle squadre di soccorso.

Pseudoaneurysm of the internal maxillary artery due to a traumatic event is a rare condition. Pseudoaneurysms are usually directly produced by arteries break with extravasation of blood. The compressed perivascular tissue forms the wall of aneurysmal sac. Then, this sac gradually expands and can be damaged. It is rare to see pseudoaneurysms of IMA. They are usually associated with fracture of the neck of the mandible. To the best of our knowledge the pseudoaneurysm of the internal maxillary artery related to maxillofacial trauma is an event extremely rare in the literature and if not quickly managed can lead to the patient’s death. This case underlines how the close cooperation between surgeons and radiologists results in a quick diagnosis and management of such pathological events.

Introduction Kidney and liver transplants are the most frequent transplantation procedures carried out in Italy. We report the result of an epidemiological study on kidney transplanted patients resident in the Province of Messina (Italy). Methods Seventy-five patients were enrolled between June 2010 march 2011, interviewed and evaluated using an adapted Italian version short-form 36. Socio-economic characteristics, quality of life modifications and involvement in transplant-related charities were studied. The follow-up period was ranging between 52 and 356 months. All subjects gave written informed consent and all results were analysed by chi-square test. Results No statistically significant differences were found between sexes, social and interpersonal relationship modifications. Discussion The benefits obtained on quality of life after trans- plantation is the prerogative of a small percentage of patients and is related to medium and high socio-economic conditions. The possibility of avoiding the haemodialysis represents the primary benefit for the totality of patients., Journal of Preventive Medicine and Hygiene, Vol 54, No 4 (2013)

Subtle cognitive impairment can be detected in early Parkinson's disease (PD). In a consecutive series of de novo, drug-naive PD patients, we applied stepwise regression analysis to assess which clinical, neuropsychological, and functional neuroimaging (dopamine transporter [DAT] and perfusion single photon emission computed tomography [SPECT]) characteristics at baseline was predictive of cognitive decline during an average follow-up time of about 4 years. Decline both in executive (R(2) = 0.54; p = 0.0001) and visuospatial (R(2) = 0.56; p = 0.0001) functions was predicted by the couple of Unified Parkinson's Disease Rating Scale (UPDRS)-III score and caudate dopamine transporter (DAT) uptake in the less affected hemisphere (LAH). Verbal memory and language decline was predicted instead by caudate DAT uptake and brain perfusion in a posterior parieto-temporal area of the less affected hemisphere (R(2) = 0.42; p = 0.0005). No significant effect was shown for age, baseline neuropsychological scores, and levodopa equivalent dose at follow-up. The combined use of clinical structured examination and brain functional assessment by means of dual single photon emission computed tomography imaging appears as a powerful approach to predict cognitive decline in de novo PD patients.

The neural correlates of exploration and cognitive mapping in blindness remain elusive. The role of visuo-spatial pathways in blind vs. sighted subjects is still under debate. In this preliminary study, we investigate, as a possible estimation of the activity in the visuo-spatial pathways, the EEG patterns of blind and blindfolded-sighted subjects during the active tactile construction of cognitive maps from virtual objects compared with rest and passive tactile stimulation. Ten blind and ten matched, blindfolded-sighted subjects participated in the study. Events were defined as moments when the finger was only stimulated (passive stimulation) or the contour of a virtual object was touched (during active exploration). Event-related spectral power and coherence perturbations were evaluated within the beta 1 band (14–18 Hz). They were then related to a subjective cognitive-load estimation required by the explorations [namely, perceived levels of difficulty (PLD)]. We found complementary cues for sensory substitution and spatial processing in both groups: both blind and sighted subjects showed, while exploring, late power decreases and early power increases, potentially associated with motor programming and touch, respectively. The latter involved occipital areas only for blind subjects (long-term plasticity) and only during active exploration, thus supporting tactile-to-visual sensory substitution. In both groups, coherences emerged among the fronto-central, centro-parietal, and occipito-temporal derivations associated with visuo-spatial processing. This seems in accordance with mental map construction involving spatial processing, sensory-motor processing, and working memory. The observed involvement of the occipital regions suggests that a substitution process also occurs in sighted subjects. Only during explorations did coherence correlate positively with PLD for both groups and in derivations, which can be related to visuo-spatial processing, supporting the existence of supramodal spatial processing independently of vision capabilities.

The possibility of a relation between high myopia and lens opacity was studied. For this research, the Lens Opacity Meter 701 was used. The lens opacity values measured in 91 high-myopic eyes were compared with those measured in a control group of 106 emmetropic eyes. This comparison showed that myopic had always higher lens opacity values than emmetropic ones, and this result was statistically significant after the age of 20.

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