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An abstract of the article "NT-proBNP assay usefulness for heart failure clinical stratification," by G. Di Tano et al., is presented.

Background : The treatment of displaced intra-articular calcaneal fractures (DIACF) is debated. This study compares open reduction and internal fixation (ORIF) with minimally invasive osteosynthesis (MIOS). Methods : We conducted a retrospective study on 70 patients with DIACF treated between January 2018 and September 2022, divided into ORIF ( n = 50) and MIOS ( n = 20) groups. Functional outcomes were assessed using the Maryland Foot Score (MFS) and the Creighton-Nebraska Health Foundation Assessment Scale (CNHFAS). Radiographic outcomes, complication rates, and reintervention rates were evaluated. A chi-square analysis examined the correlation between Sanders classification and treatment choice. Results : The chi-square analysis indicated no significant correlation between the complexity of the fracture and the type of treatment chosen (χ 2 = 0.175, p = 0.916). Additionally, the Cochran-Armitage test for trend showed no significant trend in the choice of treatment based on fracture complexity (statistic = 0.048, p = 0.826). A Kaplan-Meier analysis showed a longer time to reintervention for MIOS ( p = 0.029). Complication rates were similar, with specific complications varying between groups. Quality-of-life outcomes were comparable. Conclusions : ORIF is preferable for high-demand patients due to better anatomical outcomes, while MIOS suits high-risk patients by reducing reinterventions and complications. Further randomized trials are needed to confirm these findings.

Background: Acetabular fractures are caused by high energy injuries. The treatment aims to reconstruct the articular surface, restoring the anatomical structure. The surgical management of these fractures is difficult because it requires familiarity with the 3D anatomy of the pelvis. With the use of 3D printing technique for planning surgery, this limitation could be overcome., Hypothesis: Studies examining the use of 3D printing in pre-operative planning of acetabular fractures tend to agree on its usefulness., Methods: A systematic review of two electronic medical databases was performed by three independent authors, using the following inclusion criteria: any type of acetabular fracture and pre-operative use of 3D printing to plan the surgery., Results: Among 93 screened articles, following selection criteria, six randomised controlled human trials (hRCT) were eligible for the study; articles compare a group in which a pre-contouring plate was performed through 3D printing with a control group in which the plate was intraoperatively modelled., Conclusion: This review demonstrates the advantage of 3D printing in terms of surgical time, reduction of blood losses, quality of fracture reduction, and fixation, and reporting best clinical outcomes., Level of Evidence: II., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: Isolated ulna shaft fractures (USFs) are a relatively uncommon, but significant, injury. For unstable USF treatment, open reduction and internal fixation (ORIF) is the gold standard, while for stable USFs several procedures were described. The aim of this study is to compare the outcomes in patients with stable USFs treated by either ORIF or intramedullary nail (IMN)., Methods: According to their surgical treatment, 23 eligible USF-affected patients were divided into ORIF (14 subjects) and IMN (nine subjects) groups. The subjects underwent postoperative clinical follow-up at 1, 3, 6, and 12 months, which included calculation of the Disabilities of the Arm, Shoulder and Hand (DASH) score and radiological follow-up. Time to union, time to return to sporting and occupational activities, duration of physical therapy, and surgical complications were recorded., Results: DASH scores improved in both groups at the 6-month follow-up ( p < 0.001). The IMN cohort recorded better DASH scores at the 1- and 3-month follow-ups, while similar results were reported at the 6- and 12-month follow-ups. Earlier fracture union ( p = 0.001) and return to sporting activities and work ( p = 0.002) were seen in the IMN group, compared with the ORIF group. No complications were observed in the IMN group., Conclusions: The surgical treatment of isolated USF results in excellent functional and radiographic outcomes. IMN may be preferable, compared with ORIF, due to its faster recovery time, expedited union, and reduced likelihood of complications.

Achilles tendinopathy is a common musculoskeletal disorder. Athletes, runners and jumpers, and the sedentary are frequently affected. Numerous are the therapeutic choices to manage these kinds of disorders. The aim of this review is to analyze the available literature to document the up-to-date evidence on conservative management of Achilles tendinopathy. A systematic review of two medical electronic databases was performed by three independent authors, using the following inclusion criteria: conservative treatment consisted of pharmacologic, physical therapy without operative treatment, with more of 6 months symptoms and a minimum average of 6-months follow-up. Studies of any level of evidence, reporting clinical results, and dealing with Achilles tendinopathy and conservative treatment were searched for. A total of n = 1228 articles were found. At the end of the first screening, following the previously described selection criteria, we selected n = 94 articles eligible for full-text reading. Ultimately, after full-text reading and a reference list check, we selected n = 29 articles. Achilles tendinopathy is a frequent musculoskeletal disorder and several conservative treatments have been proposed, but no therapy is universally accepted, except for eccentric exercise training, which is the gold standard and a commonly used protocol.

Open tibial fractures represent the most frequent fractures of long bones, comprising approximately 1.9% of all fractures. Although locked intramedullary nailing is the gold standard for treating closed and unstable tibia diaphyseal fractures, for most exposed fractures, an external fixator can first be used, followed by conversion through an intramedullary nail. The present report describes the case of a 17-year-old male who presented with a complex multi-segmented displaced tibia fracture, type 42-C3, with exposure of IIIB type according to the Gustilo-Anderson classification, and with an attached disrupted fracture of peroneal malleolus, type 44-B2. External fixation was the preferred treatment method. Before the definitive surgical treatment, the patient had a second accident that caused refracture and damage to the soft tissues and external fixation system. This prolonged the time estimated for the conversion from the external fixator to the intramedullary nail. The reported case shows the use of various treatment steps with different timelines and an intervention with vacuum-assisted closure therapy for soft tissue healing as well as subsequent intramedullary nailing in order to reach the definitive healing of a non-compliant patient. These combined methods achieved an acceptable reduction and good stability of such a complex fracture.

In two studies we attempt to capture the information processing abilities underlying children's reality-status judgments. Forty 5- to 6-year-olds and 53 7- to 8-year-olds heard about novel entities (animals) that varied in their fit with children's world knowledge. After hearing about each entity, children could either guess reality status immediately or listen to testimony first. Informants varied in their expertise and in their testimony, which either supported or refuted the entities' existence. Results revealed that children were able to evaluate the fit between the new information and their existing knowledge; this information then governed their decision regarding whether to seek testimony. Testimony had the strongest effect when new information did not conflict with, but was also not representative of, children's knowledge.

In this study we assessed children's ability to use information overheard in other people's conversations to judge the reality status of a novel entity. Three- to 9-year-old children (N = 101) watched video clips in which two adults conversed casually about a novel being. Videos contained statements that either explicitly denied, explicitly affirmed, or implicitly acknowledged the entity's existence. Results indicated that children of all ages used statements of denial to discount the reality status of the novel entity, but that this ability improved with age. By age 5, children used implicit existence cues to judge a novel entity as being real. Not until age 9, however, did children begin to doubt the existence of entities whose reality status was explicitly affirmed in conversation. Overall, results indicate that the ability to use conversational cues to determine reality status is present in some children as early as age 3, but recognition of the nuanced language of belief continues to develop during the elementary-school years.

Human mirror mechanisms (MMs) respond during both performed and observed action and appear to underlie action goal recognition. We introduce a behavioral procedure for discovering and clarifying functional MM properties: blindfolded participants repeatedly move beans either toward or away from themselves to induce motor adaptation. Then, the bias for perceiving direction of ambiguous visual movement in depth is measured. Bias is affected by (a) number of beans moved, (b) movement direction, and (c) similarity of the visual stimulus to the hand used to move beans. This cross-modal adaptation pattern supports both the validity of human MMs and functionality of our testing instrument. We also discuss related work that extends the motor adaptation paradigm to investigate contributions of MMs to speech perception and language comprehension.

Antiphospholipid syndrome is a thrombotic disorder in which the clinical features are venous and/or arterial thrombosis, thrombocytopenia, and recurrent fetal loss. We describe the case of a 39-year-old woman affected by antiphospholipid syndrome and acute anterior myocardial infarction complicated by cardiogenic shock. The patient, after the failure of thrombolysis, was successfully treated by rescue angioplasty. The persistent thrombocytopenia of these patients may lead to safety problems in thrombolytic treatment; therefore, primary angioplasty may be considered the treatment of choice.

We describe the case of a middle-aged woman with massive thrombosis of the aortic bifurcation, treated with emergency surgery. The patient was later evaluated by transthoracic echocardiography, which resulted normal, and by transesophageal echocardiography, which demonstrated a huge thrombus in the lumen of the descending thoracic aorta, in the absence of gross vessel wall abnormalities. Thus, the patient underwent a second surgical intervention and the thrombus was successfully removed. The episode led us to review the medical literature about cases of thrombosis and embolization originating from macroscopically normal aortas. This review underscores the diagnostic yield of the transesophageal study of the aorta in patients with systemic embolization (particularly in the presence of risk factors for atherosclerosis) and supports a wider indication of transesophageal echocardiography in the evaluation of systemic embolizating syndromes.

BACKGROUND AND METHODS. Exercise-induced T wave normalization occurring at a low (less-than-or-equal50 watt) workload in infarct-related electrocardiographic leads was studied in 30 consecutive patients with a recent transmural anterior acute myocardial infarction. Patients underwent both ergometric stress testing (within 30 days after the infarction) and low dose dobutamine echocardiography. The T wave normalization was considered significant when it occurred in at least two infarct-related leads. A significant contractile reserve was considered present in an infarcted region when 50% or more of the dyskinetic segments functionally improved on exercise during dobutamine infusion. RESULTS. Eighteen patients showed exercise-induced T wave normalization (group 1), and 12 patients did not (group 2). Myocardial contractile reserve in the infarct area was detected in 16 patients of group 1 (88%) and in 3 patients (25%) of group 2 (p=0.004). The overall sensitivity, specificity, and diagnostic accuracy of T wave normalization, as it reflects contractile reserve in the infarct area, were 84%, 82%, and 83%, respectively. CONCLUSION. Low load exercise-induced T wave normalization in infarct-related leads appears to be an accurate marker of residual contractile reserve in the infarct area in patients with recent transmural acute anterior myocardial infarction. (c) 2000 by CHF, Inc.

Unlabelled: Cardiac PET studies in patients with left bundle branch block (LBBB) are few, and the results are conflicting. In particular, even if a reduced uptake of FDG is reported, confirmation in a large group of patients and exact understanding of the underlying cause are lacking., Methods: We selected 29 consecutive patients who had complete LBBB and no significant stenosis on coronary angiography scheduled for FDG and 13N-NH3 PET for myocardial viability evaluation at our center. Wall motion was evaluated using 2-dimensional echocardiography. Ten volunteers without coronary stenosis or LBBB served as a control group., Results: All LBBB patients had a reverse mismatch in the septum, defined as reduced uptake of FDG in comparison with 13N-NH3. The mismatch extended to the anterior and inferior walls in 17 patients. The mean (+/-SD) septal-to-lateral ratio was 0.57 +/- 0.11 for FDG (range, 0.28-0.76) and 0.99 +/- 0.12 for 13N-NH3 (range, 0.75-1.18), with P < 0.0001. In contrast, no significant differences in uptake were seen in the control group, which had a septal-to-lateral ratio of 0.95 +/- 0.13 for FDG (range, 0.78-1.15; P < 0.01 with respect to LBBB patients) and 0.94 +/- 0.11 (range, 0.85-1.20) for 13N-NH3., Conclusion: Our study suggests that in LBBB patients without significant coronary stenosis, FDG uptake in the septum changes without a correlating change in perfusion. To avoid possible overestimation of necrosis, especially in the LAD territory, this phenomenon must be considered in evaluations of myocardial viability using FDG images.

Background: Spinal cord stimulation (SCS) is an alternative therapy in patients with refractory angina pectoris when coronary revascularization cannot be performed. Several hypotheses have been given to explain the effects of SCS in reducing the number and the intensity of anginal crises. These hypotheses include possible variations in myocardial blood flow (MBF). The aim of our study was to assess regional MBF in a group of patients with spinal cord stimulator, using positron emission tomography (PET)., Methods: We studied 15 patients (9 male and 6 female), mean age 74 +/- 7 years, who were carriers of a spinal cord stimulator implanted 17 +/- 14 (range 1-48) months before. All patients had been affected with angina pectoris that was refractory to maximal tolerated pharmacological therapy. Eight patients had had a previous myocardial infarction and four patients had undergone a revascularization procedure. Every patient underwent two PETs with nitrogen-13-ammonia as the perfusion tracer. The first one was performed with the stimulator switched off for at least 20 hours, and the second one with the stimulator switched on for at least 4 hours. The quantitative evaluation of regional MBF (anterior, inferior, lateral, septal walls and apex) was performed with Patlak graphic analysis. The normal value of basal MBF in our laboratory is 0.6-1 ml/min/g., Results: The mean value of MBF increased from 0.72 +/- 0.33 ml/min/g with the stimulator off, to 0.80 +/- 0.33 ml/min/g with it on (p = 0.004). An increase in regional myocardial perfusion, with the stimulator on as opposed to off, was observed in 47 (62%) of the 75 regions studied. With the stimulator on, in comparison with off, the value of MBF increased from 0.45 +/- 0.11 ml/min/g to 0.56 +/- 0.19 (p = 0.0001) in the 35 regions with low basal MBF (< 0.6 ml/min/g), and from 0.77 +/- 0.14 ml/min/g to 0.92 +/- 0.29 ml/min/g (p = 0.013) in the 23 regions with basal MBF between 0.6 and 1 ml/min/g. Instead, in the 17 regions with high basal MBF (> 1 ml/min/g) it decreased with the stimulator on instead of off, going from 1.22 +/- 0.20 to 1.13 +/- 0.22 ml/min/g (p = 0.112)., Conclusions: Our study suggests that the beneficial effects of SCS in refractory angina may also be related to an increase in mean MBF and to a redistribution of MBF between the regions with low or normal basal flow and the regions with high basal flow.

Objectives: We investigated the sensitivity and specificity of exercise-induced T wave normalization (TWN) in infarct-related electrocardiographic leads (IRLs) for detection of residual viability in the infarct area., Background: The meaning of exercise-induced TWN on IRLs is not yet well understood. Recent reports suggest that TWN during dobutamine echocardiography could indicate the presence of viable myocardium., Methods: We evaluated 40 consecutive patients with a recent acute myocardial infarction and negative T waves in at least two IRLs. All patients underwent exercise testing; positron emission tomography (PET) with nitrogen-13 ammonia and fluorine-18 fluorodeoxyglucose; and coronary angiography., Results: Twenty-four patients showed exercise-induced TWN: 18 at a work load < or =50 W (group la) and 6 at a work load > or =75 W (group 1b); 16 patients did not show TWN (group 2). On the PET study, viability in the infarct area was present in 17 patients (94%) from group la, in only 1 (16%) from group 1b and in 4 (25%) from group 2 (p < 0.0001). The sensitivity, specificity and diagnostic accuracy of exercise-induced TWN, in comparison with residual viability, were, respectively, 82%, 67%, 75% for TWN at every work load and 77%, 94%, 85% for TWN at a work load < or =50 W. Moreover, the sensitivity and diagnostic accuracy of TWN at the low work load were higher for anterior infarctions (87% and 88%, respectively)., Conclusions: Exercise-induced TWN on IRLs at low work loads is a sensitive and specific index for the presence of residual viability in the infarct area. Sensitivity and diagnostic accuracy of this sign are higher for anterior infarctions.

The experience with control and reporting system at the "Policlinico A. Gemelli" based on the integrated use of cost and service information drawn from all applications of Hospital Information System, are described. Cost accounting for services based on about 500 operating units and monthly reporting system, inclusive of all management information communicated to all managers, is analyzed. The system design, based on the specific features of Diagnostic Imaging Service especially for internal handling, staff of operating rooms and of emergency service, is described.

Two cases of obstructive hypertrophic cardiomyopathy, in which the transthoracic echocardiography was not enough to reach the right diagnosis, are reported. The transesophageal echocardiography revealed to be the most useful technique to reach the exact diagnosis and more information about the mechanism of the left ventricular outflow tract obstruction. Moreover, this technique could be useful to direct to a surgical treatment and to monitorize the mitral valve function and the possible complications during operation.

A patient with carcinoma of the kidney and right heart metastasis is reported. Transesophageal echocardiography allowed to detect the cardiac metastasis and to control the efficacy of antineoplastic therapy. The surgical resection of the primitive tumor was subsequently possible.

We describe a case od echocardiographic visualisation of right atrial thrombus in a patient affected by pulmonary embolism. The thrombus had the characteristic aspect of embolus with venous origin. The litic treatment with rTPA, during echocardiographic monitoring, was effective with disappearance of the thrombus and quick improvement of symptoms.

Background: Aim of the present study was to compare the ability of low-dose (5-10 gamma/Kg/min) dobutamine echocardiography (DE) and of positron emission tomography (PET), performed after a thrombolized acute myocardial infarction (AMI), to predict the spontaneous functional recovery (SFR) of viable but akinetic myocardial segments., Patients and Methods: Twenty-one pts were studied by DE, 10 +/- 2 days (DE1) and 31 +/- 2 days (DE2), after a thrombolized AMI, and by PET (18F-FDS, glucose load) within 7 days after DE2; a basal echo was also performed 3 months after AMI. The left ventricle was divided in 16 segments, both in echo and PET examination. DE viability was defined as improvement in wall motion of akinetic seg; PET viability was defined as an FDG uptake > or = 40% of the maximum., Results: In the 89 akinetic segments, DE1, DE2 and PET, respectively, identified, 16, 27 and 60 viable segments; the concordance with PET, in viable and not viable segments, resulted of 50% for DE1 and of 62% for DE2. After 3 months 29/89 segments had a SFR. In comparison with SFR the sensitivity of DE1 and DE2 was lower (51% and 68%) than PET (89%); the specificity was higher for DE1 and DE2 (98% and 96%) respect to PET (43%)., Conclusions: In comparison with DE performed 10 days after a thrombolized AMI, DE performed 30 days after AMI revealed a greater extension of viable myocardium and a greater diagnostic accuracy in predicting SFR of akinetic segments. The concordance between DE and PET is high, if all myocardial segments are considered, and lower, if only akinetic segments are considered; in fact, PET identifies, as viable, a greater number of segments. In comparison with SRF, DE revealed the greatest specificity and PET the greatest sensitivity.

First, the experience with the implementation of HISs at the "Policlinico Gemelli", is reported. They were adopted since long for management support. In fact, they are playing an increasingly relevant role in health care facilities. Subsequently, operational applications are described with particular reference to the most recent ones, implemented within European projects with partial EEC financing. They are very useful to the medical and nursing personnel and for patient data management during treatment. Finally, the accounting system for cost centers, using, processing and integrating data of all used information systems, is described. It affords a low cost aggregation of all information about costs and services required for the management of four-hundred elementary operating units which constitute the structure. This system is representative of all managerial information of the "Policlinico" which is included in monthly reports, also described. They are sent to the Direction and managers of the organizational units. The system is a strategic tool of the utmost importance for rapid and effective management.

We describe a case of patient with severe angina pectoris unresponsive to medical therapy who was treated with spinal cord stimulation. The patient was studied by dynamic positron emission tomography (PET) (13-N ammonia) and with heart rate variability. Spinal cord stimulation was effective in reducing anginal attacks and PET documented an enhancement of myocardial perfusion when spinal stimulator was activated. Heart rate variability did not change during spinal cord stimulation.

An uncommon case of traumatic rupture of chordae tendineae with tricuspid regurgitation is described. The early diagnosis, in a patient with polydistrectual injuries, was done by transesophageal echocardiography. This technique allowed accurate diagnosis of the type of lesion suggesting the opportunity to perform an echocardiogram, possibly transesophageal, in all patients with blunt thoracic trauma, even in the absence or with subtle clinical manifestations of cardiovascular involvement.

Two cases of embolic infective endocarditis on bicuspid aortic valve are described. The trans-thoracic and trans-esophageal echocardiographic aspect could leave easily suppose the possibility of embolism. The prophylactic surgical treatment, during the active phase, also if the indication is debated, could have probably avoided the serious consequences of embolism.

A case of cor triatriatum in a 66-year-old man is reported. The patient died of pneumonia; ante mortem diagnosis was made with both transthoracic and transesophageal echocardiography. Autopsy finding showed a very good correlation between anatomical and echocardiographic abnormalities. Cor triatriatum is amenable to surgical correction and echocardiography is extremely helpful in the diagnosis.

Since June 1988 we have implanted 36 VDD pacemakers with single lead catheter which has floating differential sensing (Phymos). The patients were affected by 2nd and 3rd degree AV block with normal sinus node function. The reliability of the pacing system was assessed acutely and after 1 and 3 months and then every six months with ECG, Holter 24 hours monitoring, exercise stress test and nifedipine test. Two patients died during the follow-up period and two had atrial fibrillation. In the remaining patients an AV synchronization between 95 and 100% was demonstrated.

We describe two cases of cardiac tamponade following a right ventricular wall perforation, due to temporary stimulating catheter, during acute myocardial infarction. The pericardial effusion, which occurred after the catheter remotion, could have been favoured by the anticoagulant treatment.

Two cases of left ventricular bands, detected by two-dimensional echocardiography, in two young men are described. In both cases anterior negative T waves were present. Therefore, the possible presence of these structures should always be investigated, by two-dimensional echocardiography, when anterior negative T waves are present in normal young people.

Rupture of interventricular septum is an infrequent but serious complication of acute myocardial infarction. We report the cases of two patients admitted to our department for acute myocardial infarction whose clinical course was complicated by rupture of the interventricular septum. They died from cardiogenic shock on the 13th and 6th days. Two dimensional and color coded echocardiography correctly detected the presence and the site of the rupture.

The authors describe three cases of micro-Ebstein diagnosed using 2D-echocardiography in patients affected by extrasystolic cardiopalm. The most important echocardiographic criterion for diagnosis was an apical displacement of the septal cusp of the tricuspid valve of at least 8 mm/m2 BA. It is generally reported that the severity of arrhythmias is independent of the degree of tricuspid malformation. The anatomical substrates of arrhythmias are persistent anomalous muscular by-passes between the atrium and the ventricles, and intrinsic anomaly of the right ventricular myocardium. For these reasons, it is necessary to follow-up patients and monitor arrhythmias using Holter-ECG. Echocardiography is now recognised as being the most important tool for the identification of this anomaly.

A case of thrombolytic treatment with urokinase on a Sorin mitral prosthesis is described. Thrombolytic therapy, that is an alternative to valvular replacement was effective. Color-Doppler showed as a reliable method to monitor therapy effectiveness. However, a serious complication was cerebral embolism.

A case of isolated cardiac echinococcosis is reported. A 19-year-old man was hospitalized for chest pain with electrocardiographic pathological Q waves in D1, aVL, V5, V6. Two-dimensional echocardiography and chest computed tomography documented pericardial effusion and an intramyocardial cyst. Casoni's reaction and immunological tests completed the diagnosis of cardiac hydatidosis. The localization and the etiology of the cyst were confirmed during cardiac surgery.