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Background: Cerebrovascular accidents (CVA) represent a major complication in diabetes (DM). Real-life evidence as to whether modern management of CVA and DM have softened this relationship is limited. Therefore, we estimated prevalence and impact of DM on in-hospital survival and complications in a contemporary cohort of subjects with CVA. Methods: We retrospectively evaluated the records of 937 patients admitted for CVA at the Stroke Unit of Verona University Hospital during a 3-year period. Pre-existing or de novo DM was ascertained by prior diagnosis, glucose-lowering therapy at admission/discharge or admittance plasma glucose ≥ 200 mg/dL. Multiple regressions were applied to test DM as predictor of in-hospital mortality, complications (composite of infections, cardio- and cerebrovascular complications, major bleeding and pulmonary complications), duration and costs of hospitalization. Results: Diabetes prevalence was 21%, of which 22% de novo diagnoses. Compared to non-DM, diabetic individuals were older and carried an increased burden of cardiovascular risk factors. Compared to known DM, de novo DM individuals were younger, had higher admittance plasma glucose and poorer cardiovascular comorbidities. Overall, DM versus non-DM individuals did not show significantly increased risk of death (14.0 vs. 9.3%; crude-OR 1.59 95% CI 0.99–2.56). Controlling for confounders did not improve significance. DM resulted independent predictor for in-hospital complications (36.2% vs. 26.9%; adj-OR 1.49, 1.04–2.13), but not for duration and costs of hospitalization. Conclusion: DM frequently occurs in patients admitted for stroke and carries an excess burden of adverse in-hospital complications, urgently calling for strategies to anticipate DM diagnosis and tailored treatment in high-risk individuals. [ABSTRACT FROM AUTHOR]

Copyright of Giornale Italiano di Health Technology Assessment Delivery is the property of Springer Healthcare Italia Srl and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Giornale Italiano di Health Technology Assessment Delivery is the property of Springer Healthcare Italia Srl and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Latin American Society of Pediatric Infectious Diseases (SLIPE by its Spanish acronyms) is working to understand the current situation, gaps, and opportunities for traceability of the quality vaccination process in Latin America and the Caribbean. On September 24th and 25th, a Latin American forum of experts in immunization programs was held through the Zoom platform; the topics discussed included: computerized systems for recording immunizations, vaccination programs traceability, challenges, and information systems for the integrated management of vaccination. Latin American countries have transitioned from having a nominal registration system to a nominal tracking system, with many of them not migrating their platforms to new technologies; therefore, the low-quality data, fragmented databases, and slow information traffic present a challenge that must be taken on. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: The glucosuria induced by sodium–glucose cotransporter 2 (SGLT2) inhibition stimulates endogenous (hepatic) glucose production (EGP), blunting the decline in HbA1c. We hypothesised that, in response to glucosuria, a renal signal is generated and stimulates EGP. To examine the effect of acute administration of SGLT2 inhibitors on EGP, we studied non-diabetic individuals who had undergone renal transplant with and without removal of native kidneys. Methods: This was a parallel, randomised, double-blind, placebo-controlled, single-centre study, designed to evaluate the effect of a single dose of dapagliflozin or placebo on EGP determined by stable-tracer technique. We recruited non-diabetic individuals who were 30–65 years old, with a BMI of 25–35 kg/m2 and stable body weight (±2 kg) over the preceding 3 months, and HbA1c <42 mmol/mol (6.0%). Participants had undergone renal transplant with and without removal of native kidneys and were on a stable dose of immunosuppressive medications. Participants received a single dose of dapagliflozin 10 mg or placebo on two separate days, at a 5- to 14-day interval, according to randomisation performed by our hospital pharmacy, which provided dapagliflozin and matching placebo, packaged in bulk bottles that were sequentially numbered. Both participants and investigators were blinded to group assignment. Results: Twenty non-diabetic renal transplant patients (ten with residual native kidneys, ten with bilateral nephrectomy) participated in the study. Dapagliflozin induced greater glucosuria in individuals with residual native kidneys vs nephrectomised individuals (8.6 ± 1.1 vs 5.5 ± 0.5 g/6 h; p = 0.02; data not shown). During the 6 h study period, plasma glucose decreased only slightly and similarly in both groups, with no difference compared with placebo (data not shown). Following administration of placebo, there was a progressive time-related decline in EGP that was similar in both nephrectomised individuals and individuals with residual native kidneys. Following dapagliflozin administration, EGP declined in both groups, but the differences between the decrement in EGP with dapagliflozin and placebo in the group with bilateral nephrectomy (Δ = 1.11 ± 0.72 μmol min−1 kg−1) was significantly lower (p = 0.03) than in the residual native kidney group (Δ = 2.56 ± 0.33 μmol min−1 kg−1). In the population treated with dapagliflozin, urinary glucose excretion was correlated with EGP (r = 0.34, p < 0.05). Plasma insulin, C-peptide, glucagon, prehepatic insulin:glucagon ratio, lactate, alanine and pyruvate concentrations were similar following placebo and dapagliflozin treatment. β-Hydroxybutyrate increased with dapagliflozin treatment in the residual native kidney group, while a small increase was observed only at 360 min in the nephrectomy group. Plasma adrenaline (epinephrine) did not change after dapagliflozin and placebo treatment in either group. Following dapagliflozin administration, plasma noradrenaline (norepinephrine) increased slightly in the residual native kidney group and decreased in the nephrectomy group. Conclusions/interpretation: In nephrectomised individuals, the hepatic compensatory response to acute SGLT2 inhibitor-induced glucosuria was attenuated, as compared with individuals with residual native kidneys, suggesting that SGLT2 inhibitor-mediated stimulation of hepatic glucose production via efferent renal nerves occurs in an attempt to compensate for the urinary glucose loss (i.e. a renal–hepatic axis). Trial registration: ClinicalTrials.gov NCT03168295 Funding: This protocol was supported by Qatar National Research Fund (QNRF) Award No. NPRP 8-311-3-062 and NIH grant DK024092-38. Graphical abstract [ABSTRACT FROM AUTHOR]

The stochasticity of fluid and sediment parameters has been identified as a source of diffusion, particularly anomalous diffusion at different temporal and spatial scales of bed load particle trajectories. Data from two sets of flume experiments are presented, one data set has gravel particle trajectories tracked over a limited area and was used in identifying the influence of different shear stress conditions on diffusive processes. A new experiment was performed using spherical particles moving as bed load in an annular flume in order to address concerns about censorship effects caused by the size of the detection window. An annular flume allowed collection of practically uncensored particle trajectories over longer time period than has been previously possible in the laboratory. Three diffusive regimes were observed at distinct stages of particle motion: (i) ballistic regime at the local range; (ii) Fickian diffusion at the intermediate range; (iii) subdiffusion at the global range. Characteristic time scales separate the regimes and correlate with the mean traveling and resting times of particles. Fickian diffusion in the intermediate range is first recognized as a result of the balance between intermittent weak transport and near‐bed turbulence, as first predicted by Nikora et al. (2002, https://doi.org/10.1029/2001WR000513). In the global range, extreme values were observed in the distribution of particle resting times, suggesting that two types of distributions (related to surface motion and vertical mixing) were responsible for the subdiffusion at longer time scales. Diffusion was found to be anisotropic at all stages of particle motion. Key Points: The diffusive conceptual model for bed load transport is revised with two experimental data setsSubdiffusion is identified from long‐term laboratory experiment with annular flumeRanges of motion and diffusive regimes are linked to Lagrangian time‐dependent grain variables [ABSTRACT FROM AUTHOR]

In a double-blind randomized controlled trial, Xavier Saez-Llorens and colleagues examine the vaccine efficacy of PHiD-CV against community-acquired pneumonia in young children in Panama, Argentina, and Columbia. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

Objective In patients with a history of lymphoma, each lymphadenopathy should be carefully evaluated. The aims of this study were to evaluate (i) the usefulness of high-resolution ultrasonography ( US), US-guided fine-needle aspiration cytology ( FNAC) and flow cytometry phenotyping ( FCP) together in the diagnosis of recurrent lymphoma and (ii) whether these tools were independent predictors of correct results. Design Retrospective cohort study with stepwise forward logistic regression analysis of results. Setting Tertiary referral centre. Participants A total of 151 patients with a history of lymphoma who developed a cervical mass during follow-up. Methods On neck US, a lymphadenopathy was shown in 129 (85.4%) patients (median age 57 years, range 18-78 years), and US-guided FNAC combined with FCP were immediately performed. All patients had surgical excision and subsequent histological examination of the enlarged node(s), to establish lymphoma subclassification. Results Final histology confirmed recurrence in 82 (63.6%) patients. According to the logistic regression analysis, FNAC and FCP were independent predictors of correct results ( P = 0.009 and 0.028, respectively) and did not interfere with each other. The sensitivity, specificity and accuracy of the combination of all of the tools were 98.8%, 100% and 99.2%, respectively, and the area under the receiver operating characteristic curve was 0.902 (95% CI: 0.797-0.986). Conclusion This minimally invasive procedure is easily performed and should be recommended for all patients with cervical lymphadenopathy and a history of lymphoma, avoiding the need of core-biopsy or surgical excision if recurrence was excluded. [ABSTRACT FROM AUTHOR]

A complete understanding of the role of grain-scale particle-flow interaction in sediment entrainment and transport has still not been achieved in spite of recent technological advancement in measurement capabilities. In this study, the initial motion of natural sediment particles in a gravel deposit was detected and combined with simultaneous local measurements of the velocities on a horizontal plane located above the bed surface using a three-component stereoscopic PIV. A series of experimental tests with increasing low values of boundary shear stress were conducted. The acquisition system allowed coupling between streamwise and vertical near-bed velocity and the entrainment of more than 900 individual grains. Initial analysis agreed with previous observations on the predominance of sweeps (Quadrant IV), and to a lesser extent, of outward interactions (Quadrant I) in entraining gravel particles. However, the latter were found to move sediments just as efficiently as sweeps impacting on particles that had long periods of rest and so were exhibiting higher levels of stability. This behavior suggests that sweep-induced lift based on Bernoulli's principle does not entirely explain the generation of vertical forces on highly stable bed particles. Closer inspection of the data revealed that many entrainments were correlated to occasions when stable bed grains interacted with grains travelling in their close vicinity. Approximately 30% of the entrained population was observed to initiate motion in this type of situation. For this subsample of entrainment events, outward interactions were found to be comparatively more effective than for the noninterference case, whereas the relative contribution of sweeps exhibited an opposite trend. [ABSTRACT FROM AUTHOR]

Ecologically-appropriate management of natural and constructed surface water bodies has become increasingly important given the growing anthropogenic pressures, statutory regulations, and climate-change impacts on environmental quality. The development of management strategies requires that a number of knowledge gaps be addressed through interdisciplinary research efforts particularly focusing on the water-biota and water-sediment interfaces where most critical biophysical processes occur. This paper discusses the current state of affairs in this field and highlights potential paths to resolve critical issues, such as hydrodynamically-driven mass transport processes at interfaces and associated responses of organisms through the development of traits. The roles of experimental methods, theoretical modelling, statistical tools, and conceptual upscaling methods in future research are discussed from both engineering and ecological perspectives. The aim is to attract the attention of experienced and emerging hydraulic and environmental researchers to this research area, which is likely to bring new and exciting discoveries at the discipline borders. [ABSTRACT FROM AUTHOR]

Objective To compare clinical evaluation, transvaginal sonography (TVS), saline contrast sonovaginography (SCSV) and magnetic resonance imaging (MRI) in the diagnosis of posterior deep pelvic endometriosis (DPE). Methods Women suspected of having posterior DPE on the basis of subjective symptoms and clinical evaluation underwent digital vaginal and rectal examination, TVS, SCSV and MRI. Laparoscopy was performed and specimens were sent for histological examination. Sensitivity, specificity, positive and negative predictive value, as well as positive and negative likelihood ratios were analyzed for each diagnostic method. Results Fifty-four out of 102 women suspected of having posterior DPE underwent laparoscopic surgery. Among these, in 46 (85.2%) cases DPE was confirmed at laparoscopic and histological examination. SCSV correctly identified 43 (93.5%) cases, presenting higher accuracy than did the other procedures. SCSV and MRI were more accurate in diagnosing and discriminating between the different locations of endometriotic lesions, with respective sensitivities of 94.7 and 73.1% for vaginal fornix, 88.9 and 66.7% for the uterosacral ligaments and 80.6 and 83.3% for involvement of the rectovaginal septum. The specificity of SCSV and MRI, respectively, was 97.1 and 94.3% for vaginal fornix, 95.6 and 95.6% for uterosacral ligaments and 100 and 77.8% for involvement of the rectovaginal septum. In the diagnosis of rectal endometriosis, we found a sensitivity of 66.7% for both techniques and specificity of 93.8% for SCSV and 95.8% for MRI. Conclusion TVS should be used as the first-line diagnostic technique and SCSV and/or MRI as second-line methods in the diagnosis of posterior DPE. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT In this paper a modelling approach is presented to predict local scour under time varying flow conditions. The approach is validated using experimental data of unsteady scour at bed sills. The model is based on a number of hypotheses concerning the characteristics of the flow hydrograph, the temporal evolution of the scour and the geometry of the scour hole. A key assumption is that, at any time, the scour depth evolves at the same rate as in an equivalent steady flow. The assumption is supported by existing evidence of geometrical affinity and similarity of scour holes formed under different steady hydraulic conditions. Experimental data are presented that show the scour hole development downstream of bed sills due to flood hydrographs follow a predictable pattern. Numerical simulations are performed with the same input parameters used in the experimental tests but with no post-simulation calibration. Comparison between the experimental and model results indicates good correspondence, especially in the rising limb of the flow hydrograph. This suggests that the underlying assumptions used in the modelling approach are appropriate. In principle, the approach is general and can be applied to a wide range of environments (e.g. bed sills, step-pool systems) in which scouring at rapid bed elevation changes caused by time varying flows occurs, provided appropriate scaling information is available, and the scour response to steady flow conditions can be estimated. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The effect of the flood recession time on the local scour depth at bed sills in gravel deposits is examined. Experiments were carried out to study the development of scour holes under time-varying hydraulic conditions with no upstream sediment feed. Triangular-shaped hydrographs, having recession times up to three times the duration of the rising limb, were used. Traditionally, the peak water discharge in any flood event is used as a design value in estimating the final depth of scour formed by a flood. This approach is overly conservative when the flow hydrograph is steep, i.e., during the occurrence of flash floods. The actual reduction of the scour depth from this estimated value is dependent on both the characteristics of the flood event and the characteristics of the stream. The results show that the maximum potential scour depth can be achieved only for hydrographs with long recession times, while the rate of this process can be estimated as a function of the ratio between a characteristic flood time and the steady-state temporal scale of scour development. A method is proposed for the prediction of the scouring process under unsteady flows in terms of two dimensionless temporal parameters. Results obtained for clear-water boundary conditions can be extended to sediment-supply tests if specific supply input conditions hold. [ABSTRACT FROM AUTHOR]

The article presents a comparative study on the therapeutic effect of early application of lymphadenectomy against delayed lymphadenectomy in the prognosis of melanoma patients with lymph node metastases. It states that the study compared the medical records of patients with melanoma who underwent early completion lymph node dissection (CLND) versus patients who underwent delayed therapeutic lymph node dissection (TLND). It reveals that CLND provides better outcome than TLND.

Background: Diphtheria-tetanus-whole-cell pertussis (DTPw)-based combination vaccines are an attractive option to rapidly achieve high coverage and protection against other important pathogens, such as hepatitis B virus (HBV) and Haemophilus influenzae type B (Hib). To ensure adequate antigen supply, GlaxoSmithKline Biologicals has introduced a new DTPw antigen source and developed a new DTPw-HBV/Hib combination vaccine containing a reduced amount of Hib polyribosylribitol phosphate (PRP). This study was undertaken to compare the immunogenicity and reactogenicity of this new DTPw-HBV/Hib vaccine with a licensed DTPw-HBV/Hib vaccine (Tritanrix™-HBV/Hib). Methods: This was a randomized, partially-blind, multicenter study in three countries in Latin America (Argentina, Chile and Nicaragua). Healthy children received either the new DTPw-HBV/Hib vaccine (1 of 3 lots; n = 439; double-blind) or Tritanrix™-HBV/Hib (n = 146; single-blind) co-administered with oral poliovirus vaccine (OPV) at 2, 4 and 6 months, with a booster dose at 18-24 months. Results: One month after the end of the 3-dose primary vaccination course, the new DTPw-HBV/Hib vaccine was non-inferior to Tritanrix™-HBV/Hib in terms of seroprotection/vaccine response rates for all component antigens; ≥97.3% and ≥93.9% of subjects in the two groups, respectively, had seroprotective levels of antibodies against diphtheria, tetanus, hepatitis B and Hib and a vaccine response to the pertussis component. Persistence of antibodies against all vaccine antigens was comparable between groups, with marked increases in all antibody concentrations after booster administration in both groups. Both vaccines were generally well-tolerated as primary and booster doses. Conclusions: Results confirm the suitability of this new DTPw-HBV/Hib vaccine comprising antigens from a new source and a reduced PRP content for inclusion into routine childhood vaccination programs. Trial registration: http://www.clinicaltrials.gov NCT00332566. [ABSTRACT FROM AUTHOR]

In recent decades, with the widespread diffusion of the supracricoid laryngectomy in the treatment of selected advanced laryngeal neoplasm, the indications to non-conservative surgery are less frequent than in past. We report the case of a patient in whom a planned supracricoid laryngectomy was intraoperatively converted in an extended partial laryngectomy with tracheohyoidoepiglottopexy for a tumor involving the cricoid cartilage. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ultrasound is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The temporal development of clear-water local scour depth at bed sills in uniform gravel beds is considered. Experiments are presented on the development of scour holes under unsteady hydraulic conditions, with the triangular-shaped hydrographs tested being of different durations and different rates of flow variation. Based on the experimental results and a theoretical framework, a method is given for the definition and prediction of the scouring process under unsteady flows in terms of a dimensionless temporal parameter. A “flash flood” is here defined as an event for which the scour doesn’t attain its potential magnitude, i.e., the equilibrium value for the peak hydrograph flow rate. This flood nature is dependent on both the characteristics of the flood event itself and the characteristics of the stream. A quantitative measure of what constitutes a flash flood is given in terms of the identified temporal parameter. Results show that the ratio between the final scour depth and the potential scour depth at a bed sill for a given hydrograph can be estimated as a function of the identified temporal parameter. [ABSTRACT FROM AUTHOR]

Experiments were carried out using a mobile gravel bed placed in a tilting flume with a modified particle image velocimetry (PIV) system. Individual grain movements were surveyed using data from time series of images. Near-bed velocity flow field measurements were made simultaneously above the same area of the sediment surface by applying cross-correlation techniques to the collected plan view images. Statistics of grain motions were collected through a semiautomatic procedure. Significant changes in the flow field were observed in the proximity of the entrained or deposited particles. A strong correlation is shown between the changes in the local streamwise and lateral velocity and the movement of the grains. The theory of Grass is revisited and developed based on the experimental results. The probability distribution of individual grain resistance has been derived from the statistics of the near-bed velocity field and of the entrainment risk. [ABSTRACT FROM AUTHOR]

Excessive erosion of gravel bed rivers represents a hazard, which is often controlled by the construction of bed sills. Shape and volume of equilibrium local scour holes at bed sills in high-gradient streams were investigated by analyzing steady flow experimental data. Scour profiles were normalized by scaling the depths and the longitudinal distance from the upstream sill with the maximum dimensions of the scour hole. Results exhibited a universal geometrical affinity of the scour. Geometrical similarity was also found to occur, but only in a limited range of physical conditions. Evidence on the scaling nature of the scour hole shapes has important implications on the prediction of the eroded volume. In turn, a correct evaluation of the eroded volume is necessary for the optimization of the design of the intersill distance. Prediction formulae are proposed which link the eroded volume to the geometrical, hydraulic, and sediment properties. [ABSTRACT FROM AUTHOR]

This paper presents the results of an experimental study about the pattern of local scouring generated at the toe of bed sills, which are commonly built in steep, gravel bed mountain streams. The aim of this study is to evaluate the effect of upstream sediment supply on the scour depth and shape. The experiments simulated conditions of a steady upstream sediment supply which had the same grain size composition as the sediment deposit placed on the bed of the flume. The geometric characteristics of three scour holes developed under conditions of steady flow discharge and steady upstream sediment supply were measured during 48 different tests. This provided a data set containing measurements of 144 scour holes. Three different sediment feed rates were used, and tests were also performed with clear water conditions. Geometric interference between sills was not observed. A natural river gravel with a limited grain size was used. The collected data were analyzed using nondimensional groups developed in previous clear water studies. It is shown that the imposed sediment transport does not require the introduction of new dimensionless parameters into existing scour depth and length prediction formula. The effects of sediment feed are shown to be incorporated in the existing dimensionless parameters. The new data set was used to recalibrate existing scour depth formula. The influence of jet erosion on scour geometry is also discussed. Inspection of the data indicates a possible two-stage behavior, with the threshold between behaviors related to the ratio of the value of the morphological jump created at a scour hole and the flow specific energy at the bed sill. [ABSTRACT FROM AUTHOR]

This study includes all the children treated with OK-432 for lymphangioma at our institute. Twenty-nine children treated between 1999 and 2003 are reported for the first time: twelve cases regressed completely, eight cases regressed more than 50% and seven remained unchanged; two cases were lost at follow-up. The outcome was related to the size of the cysts, the larger ones having a better prognosis. The adverse reactions are discussed and the methods of treatment are described in detail. Fifteen children, treated before 1999 and already reported, are reviewed after a long-term follow-up. Four had a recurrence: one regressed spontaneously and three needed further treatment. The other 11 had no complaints. Even considering the risk of recurrence, OK-432 therapy remains our first line therapy for lymphangiomas, avoiding surgery in most cases. [ABSTRACT FROM AUTHOR]

Unlabelled: High rates of pertussis disease in adolescents suggest that additional boosting against pertussis would be beneficial. A combined acellular-pertussis-containing booster vaccine (dTpa-IPV; Boostrixtrade mark Polio, n =440) was compared to separately administered dTpa (Boostrixtrade mark) and inactivated polio virus (IPV; Imovax Polio((R)), n =219), and to DTPa-IPV (Infanrixtrade mark IPV, n =111) vaccine in a partially blind, randomised controlled trial in 10-14 year olds. One month after vaccination, seroprotection/seropositivity rates for all antigens were similar for all groups. Although pertussis and diphtheria antibody geometric mean antibody concentrations were higher after DTPa-IPV, all subjects had protective antibodies against diphtheria, tetanus and polio, and at least 97% had a vaccine response to pertussis antigens. Reactogenicity of dTpa-IPV was comparable to dTpa + IPV, but dTpa-IPV was generally better tolerated than DTPa-IPV.Conclusion: The combined reduced-antigen-content-diphtheria-tetanus-acellular-pertussis and IPV vaccine is immunogenic and well tolerated when administered to adolescents and could be used to improve the control of pertussis disease in this age group. [ABSTRACT FROM AUTHOR]

The number of women who decide to have a child after organ transplantation has increased. We determined the outcomes of 67 pregnancies of women who had undergone kidney, liver or heart transplantation. All recipients had been maintained on immunosuppressive therapy before and during pregnancy. Pregnancy complications at term were observed in 17 out of 67 women (25%), hypertension being the most frequent complication (16.17%). Two transplant rejections were reported. Sixty-eight infants were delivered (including one pair of twins); five women had two pregnancies at term. Twenty-eight miscarriages (29.2%) were recorded. Of these 68 babies (including the pair of twins), 40 (58.8%) were born at term and 28 (41.2%) before term. The babies were followed-up for 2 months to 13 years. According to our previous experience, our study shows that patients who have undergone organ transplantation can give birth to healthy infants as long as they are monitored accurately during pregnancy. [ABSTRACT FROM AUTHOR]

Nowadays, facial paralysis is an uncommon complication of acute inflammation of the middle ear, with an estimated incidence of 0.005%; it was not so rare in the pre-antibiotic era, occurring in 0.5−0.7% of middle ear inflammatory processes. We would like to highlight this complication of acute otitis media, a common paediatric complaint. We present three new cases of facial palsy in children with acute otitis media and discuss the etiological mechanisms and different approaches to the treatment; a flow chart for facial paralysis in acute otitis media is also presented. Our three patients recovered completely after mastoidectomy (first two cases) and myringotomy with antibiotic therapy (third case). Facial paralysis is an uncommon complication of otitis media which requires appropriate care. Following our experience and revision of literature on the subject, antibiotic therapy and myringotomy are the first-line procedures. Surgery should be employed in case of acute or coalescent mastoiditis, suppurative complications and lack of clinical regression. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to describe the various patterns of vascularity of the normal superficial lymph nodes detected using high-sensitivity power Doppler imaging according to the dimension and anatomic location of the nodes. Subjects and Methods: A total of 712 lymph nodes (416 in the neck, 205 in the groin, and 91 in the axilla) were studied in 118 patients with high-sensitivity Power doppler. Three categories of vascularity were defined: absence of vascularity (type 1), hilar and perihilar vascularity (type 2), and vascularity in the entire node (type 3). The 3 types of vascularity were correlated with the anatomic location and the dimension (maximum transverse diameter) of the nodes. Results: Type 3 vascularity was found in all lymph nodes with a maximum transverse diameter > 6 mm, in the 67.9% (133/196) of lymph nodes between 4 and 6 mm in diameter, and in 45.7% (42/92) of lymph nodes between 2 and 4 mm in diameter. In lymph nodes with transverse diameters of 2-6 mm, type 3 vascularity was detected in 80.7% (46/57) of the axillary nodes, in 69.0% (87/126) of the inguinal nodes, and in 40.0% (42/105) of the cervical nodes. Type 2 vascularity was seen in 14.2% (101/712) of all examined lymph nodes. The absence of vascularity (type 1) was noted in only 1.9% (8/416) of cervical and 2.0% (4/205) of inguinal nodes. Conclusions: State-of-the-art power Doppler equipment can demonstrate type 3 vascularity in a high percentage of normal superficial lymph nodes. This pattern of intense, extensive-but harmonious-vascularity must be considered as an indicator of benignity. [ABSTRACT FROM AUTHOR]

Objective --The immunosuppressive agent cyclosporin A (CsA) has contributed to the success of organ and bone marrow transplantation. CsA-related neurotoxicity is a well-known occurrence. Sensorineural hearing loss (SNHL) due to initiation of CsA treatment is an extremely rare finding. Material and Methods --A 32-year-old man who had undergone technically uneventful cadaveric renal transplantation for focal glomerulosclerosis when 25 years old was evaluated as the result of a 10-month history of bilateral hearing loss. The patient had been taking only CsA (150 mg twice daily) and methylprednisolone. Results --Progressive bilateral SNHL was confirmed by an audiological examination. Eight months after dose reduction of CsA, pure-tone audiometry excluded progression of hearing loss. Conclusions --To the best of our knowledge, only rare cases of CsA-related hearing loss have been reported, and none after long-term CsA treatment. Audiological findings confirmed the cochlear origin of SNHL in our patient. The action of CsA on the blood-inner ear barrier has recently been demonstrated but the mechanism of cochlear damage is still unknown. A prospective study to determine the incidence of CsA-induced hearing loss has been instituted in our department. [ABSTRACT FROM AUTHOR]

44 consecutive patients with confirmed primary hyperparathyroidism (HPT) undergoing surgery were prospectively enrolled in the study. There were 13 (29.5%) men and 31 (70.5%) women with an overall median age of 59 years (range 23-78 years). Prior to successful parathyroidectomy both (99)Tc(m)-sestamibi/(99)Tc(m)-pertechnetate subtraction scintigraphy (SS) and helical CT were performed, and the results of imaging studies were compared against intraoperative findings. Final histopathology showed 40 (90.9%) solitary parathyroid (PT) adenomata (median size 18 mm, range 8-40 mm), that were in an ectopic location in 13 (32.5%) patients. Moreover, 3 (6.8%) patients had multiglandular disease (one patient with two PT adenomata, two patients with PT hyperplasia), while one (2.3%) patient had a PT carcinoma. The sensitivity and positive predictive value were 86.0% and 97.4% for SS, 88.1% and 94.9% for CT, and 100% and 97.4% for the combination of SS and CT, respectively. Calcium and parathyroid hormone (PTH) serum levels, and the mean size of the removed PT glands of patients with false negative results were lower than that of those with true positive results, but the difference was not significant. Among patients with solitary PT tumours (N=41) the sensitivity was 88.1% and 90.3% for SS and CT-scan, respectively. In conclusion, our study confirms the usefulness of SS, which should be the initial test for patients undergoing parathyroidectomy. However, the strategy of performing two tests in each patient with primary HPT could be of limited utility when the initial SS is positive. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis is a potentially fatal soft-tissue infection that predominantly affects the abdominal wall, perineum and extremities. It is an uncommon clinical entity in the head and neck region and an exhaustive review of the English language literature disclosed reports on :&ap;160 cases. Dental pathology, post-traumatic or iatrogenic skin or mucosa injuries and parapharyngeal or peritonsillar infections were the most frequently described origins. We describe herein the first case of craniocervical necrotizing fasciitis (CCNF) due to a parotid gland abscess. The patient was successfully treated with i.v. broad-spectrum antibiotic therapy and an aggressive surgical approach (drainage of the parotid abscess and exploration of the neck, with drainage and debridement of necrotic tissue). Effective management of CCNF depends on a prompt diagnosis. Intravenous broad-spectrum antibiotic therapy should be instituted immediately. Antibiotic coverage can be narrowed once the culture results are obtained. Aggressive surgical intervention is necessary, involving wide incision, adequate exploration of deep neck spaces and debridement of necrotic tissue until healthy bleeding tissue is encountered. [ABSTRACT FROM AUTHOR]