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This paper critically reviews the literature on epidemiology, risk factors, clinical evaluation and diagnostic assessment of both femoral and acetabular periprosthetic fractures (PPF). Evaluation of both National Registries and the literature shows an increase in PPF rates throughout the years. The exact rate of PPF cases appears to be underestimated, especially as regards intraoperative and acetabular PPF. There are multiple risk factors for PPF, both patient-related and implant-related. In detail, bone mechanical resistance impairment and conditions of poor alignment, loosening and implant design should all be carefully considered. A thorough radiographic assessment together with evaluation of radiographic history of the implant are paramount to diagnose the fracture condition and possible loosening. CT scans are useful for diagnosing PFF in case of negative X-rays, especially on the acetabular side. The classification systems described in the literature proved to be reliable and reproducible, especially for the femur. Hip PPFs are a growing problem because of the increase in total hip arthroplasty implants and because of population ageing. Clinical evaluation and diagnostic assessment are of primary importance in the management of these fractures. The diagnosis needs to be properly addressed by clinical suspicion, with the use of second-level exams in selected cases.

According to IASP, complex regional pain syndrome (CRPS) is defined as continuing (spontaneous and/or evoked) regional pain that is disproportionate in time or degree to the natural course of any known trauma or other lesion. Women are most commonly affected with wrist fracture being the most commonly (45%) causative event. The diagnosis is clinical and based on the recently validated "Budapest" criteria. These criteria consider the objective and subjective aspects of the diagnosis including the motor impairements of the syndrome not considered otherwise. Instrumental diagnostic methods, triphasic bone scintigraphy in particular, are useful for differential diagnosis and to confirm the diagnosis in doubt cases. Difficult diagnosis, unclear etiopathogenesis and eterogeneus studies with few patients in the literature might be responsible for the absence of a validated therapeutic algorithm. Treatment approach is multimodal, involving physical therapy, drugs and invasive procedure. Goals of treatment should be pain relief, functional restoration, and psychological stabilization. Recently, a central causative role for activated macrophages and osteoclasts has been recognized in the etiophatogenesis of the syndrome. Therefore bisphosphonates, acting as inhibitors of osteoclasts activity and macrophages activation, are being increasingly used in CRPS treatment. In particular, endovenous administration of Neridronate demonstreted to be effective.

Introduzione. Le problematiche dei tessuti molli sono state storicamente le più frequenti ed importanti complicanze delle fratture da trauma ad alta energia delle tibia prossimale. Il damage control della lesione mediante un fissatore esterno femoro-tibiale a ponte viene eseguito in queste fratture per stabilizzare le lesioni ossee e dei tessuti molli e per ripristinare la lunghezza e l’asse dell’arto. Alcuni autori hanno riportato i risultati di questa strategia di trattamento, con un decremento significativo delle complicanze dei tessuti molli e buoni risultati clinici e radiografici. Metodi. È stata valutata una popolazione di 24 casi di fratture da trauma da alta energia della tibia prossimale in 23 pazienti, trattati mediante applicazione di un fissatore esterno femoro-tibiale a ponte in urgenza seguito da una fissazione interna definitiva a distanza. I casi trattati con fissazione esterna definitiva sono stati esclusi, tra questi tutti i casi di frattura esposta oltre il grado IIIB di Gustilo-Anderson e i casi trattati mediante fasciotomie per sindrome compartimentale. Sono stati registrati il tipo di frattura e l’entità del danno dei tessuti molli, la configurazione del fissatore esterno temporaneo, il tempo di conversione a sintesi definitiva, i risultati clinici e radiografici e le complicanze. I dati ottenuti sono stati confrontati con quanto riportato in letteratura. Risultati. Le fratture erano prevalentemente a morfologia complessa, del tipo V e VI secondo Schatzker nel 70,8% dei casi e del tipo C3 secondo lo classificazione AO nel 63% dei casi. Nel 50% dei casi era presente un danno severo dei tessuti molli, per la presenza di esposizione del focolaio (25%) o di fratture chiuse tipo Tscherne II e III (25%). La configurazione anteriore per la fissazione esterna è stata la più utilizzata (66,7%) per la sua versatilità e rapidità di applicazione. Non sono state notate differenze tra i differenti montaggi in termini di risultato clinico e complicanze, le quali non sono state riscontrate. Il tempo di conversione a fissazione interna è stato in media di 6 giorni, utilizzando più frequentemente due placche contrapposte. I risultati clinici sono stati molto soddisfacenti, con pochi casi di viziosa consolidazione e nessuna pseudoartrosi. L’incidenza di complicanze dei tessuti molli è stata molto bassa, con un solo caso di infezione superficiale di ferita con deiscenza parziale (4,3%). Discussione. L’utilizzo di un fissatore esterno a ponte è un metodo sicuro ed efficace per diminuire l’incidenza di complicanze dei tessuti molli nelle fratture da trauma ad alta energia della tibia prossimale, mantenendo buoni risultati clinici e radiografici. Non vi sono differenze tra i diversi montaggi per la stabilizzazione a ponte della lesione se i principi di sicurezza sono rispettati e gli obiettivi di efficace stabilizzazione e ripristino di asse e lunghezza vengono perseguiti. Deve essere attentamente selezionata la tecnica di osteosintesi della frattura, riservando alla fissazione esterna definitiva i casi più complessi

Objective: In this study we analysed the relationship between mother and child using the Neuropsychomotor Video Analysis of parent and child interaction (NVA) (Moioli et al., 2010). This instrument was created in order to analyse and decode videotaped sequences of mother-child interactions in the first three years after birth. Two populations with atypical development were considered, with a first group consisting of children with Down syndrome and the second group of children born preterm. Video feedback meetings were arranged only for the second group and the effect of this (additional) approach was verified with a second videotape recording. Methodology: The sample included 29 children younger than 30 months divided into two subgroups: 10 children with the Down syndrome (5 females=50% and 5 males=50%; average age=16.40 months, sd=9.00) and 19 premature children (G.A.< 36 weeks) (10 females=53% and 9 males=47%; average age=11.53 months, sd=6.88) and a control group of 22 children of the same age (4 males=18% and 18 females=82%). Using the ten-minute tape-recording we filled in the report card: the program was computerized thus allowing the data processing and the visualization of the bend correlating the behaviour of the child with the mothers’. Socio-demographic data were collected with the Hollingshead’s Four Factor Index (1975). Results: The NVA allowed us to highlight specific relational modalities in both the analysed groups: in case of prematurity the bends usually showed a mirror trend, with a score decrease in participatory/sensitive categories associated with higher concentration of children’s scores in removal categories and mothers’ scores in approach categories. In the Down syndrome group we found lower scores in participatory/sensitive categories; the development retardation emerges from the score increase in the removal categories, with a maternal response balanced between children’s and mothers’ behaviour. The pre/post video feedback analysis in the preterm children subgroup showed, in the second tape recording, a score increase in participatory/sensitive categories compared with the subgroups without video feedback. Conclusions: This study shows how the NVA and Feedback can be effective tools for the analysis of mother-child interaction videotape recordings. It confirms that the birth of a premature child or of a child with development problems changes mother-child relationship modality. The use of video feedbacks proved to be a significant resource for the support of the relationship between mother and child.

At the Vittoriale degli Italiani, in the so-called «Leda’s room», Gabriele d’Annunzio’s own bedroom, there are two works by painter Astolfo de Maria, the Dogaressa (i.e. the wife of the doge) and an Erotic allegory. D’Annunzio always refused to part with the former; and he was personally involved in the peculiar framing of the second, a real tableau de chevetsince it was placed at the head of his bed. Several theories have been put forward as regards the possible sources for the subjects of the two apparently unrelated paintings, but d’Annunzio’s play Sogno d’un tramonto d’autunno (An autumn sunset dream) is the only one source that can be identified for both. The close connection between the literary work and the two paintings, and the meaning these must have had for d’Annunzio explain the role these pictures had as objects d’affection and the peculiar place they held in the poet’s bedroom since the first arrangement of the rooms of the Vittoriale., Archivio d’Annunzio, 1 | 2014

From 1922 to 1936 Carlo Sbisà is an assiduous exhibitor at the Venice Biennali. The artist begins his career precociously (he is little more than twenty), exhibiting works engraved during his Florentine period: a dry-point portrait at the 1922 Biennale and two etchings, also portraits, at the 1924 Biennale. More and more, at the following Biennali, Sbisà makes a name for himself as a painter perfectly in keeping with the character of “Novecento italiano”, not without some trace of Magic realism: from Elisabetta and Maria and Female Portrait, oil paintings exhibited in 1926, to The Astronomers, oil painting exhibited in 1936, the paintings of the Trieste-born artist – mostly painted with a steady brush-stroke, without indulging to any impressionistic suggestions – grant the human figure a central position, while perfectly setting it in an architectural or landscape context. At the 1948 Biennale Sbisà will again exhibit a couple of paintings, in a very distant style, though, from the works of his previous period: in consonance with the changes of the postwar years, they seem to definitively confirm the end of that “Novecento” of which the artist has been an exemplary representative, much appreciated by the criticism of his time.

Definire la prevalenza dei disturbi mentali in una casa circondariale italiana e descrivere i principali trattamenti psichiatrici forniti. Metodi. Studio descrittivo osservazionale dei detenuti maschi consecutivamente inviati, in 34 mesi, per una valutazione psichiatrica, tra la popolazione (N = 1683) della casa circondariale “Torre del Gallo”, Pavia; valutazione diagnostica clinica secondo il DSM-IV e analisi retrospettiva dei trattamenti psichiatrici, colloqui psichiatrici e prescrizioni farmacologiche forniti. Risultati. 320 uomini (19%) avevano uno o più disturbi mentali attuali (escludendo i disturbi correlati a sostanze): 16 (1%) psicosi; 71 (4,2%) disturbi dell’umore; 32 (1,9%) disturbi d’ansia; 46 (2,8%) disturbi dell’adattamento; 96 (5,7%) disturbi di personalità; 54 (3,2%) disturbi di personalità + disturbi dell’umore; 5 (0,3%) ritardo mentale. Si rileva comorbilità per disturbi correlati a sostanze (N = 166, 51,9%) e ad HIV (N = 49, 15,3 %). I colloqui psichiatrici sono erogati principalmente per psicosi e disturbi di personalità associati a disturbi dell’umore. Sono frequenti le prescrizioni offlabel di neurolettici. Conclusioni. La prevalenza dei disturbi mentali in questa popolazione è più elevata delle analoghe medie statunitensi ed europee e, per alcuni sottogruppi diagnostici, potrebbe essere sottostimata. La gestione psichiatrica in carcere dovrebbe essere riorganizzata secondo le linee-guida sanitarie nazionali ed europee To define the prevalence of mental disorder within an Italian local jail and to describe main psychiatric treatments provided. Methods. Cross-sectional study of consecutive male prisoners referred, over a thirty-four month period, for a clinical psychiatric assessment, among population (N = 1683) of casa Circondariale “Torre del Gallo”, Pavia; clinical DSM-IV diagnostic assessment and retrospective analysis of provided psychiatric treatments (i.e. psychiatric visits and pharmacological prescriptions). Results. 320 men (19%) had one or more current mental disorders (excluding substance misuse), including 16 (1%) psychosis; 71 (4.2%) mood disorder; 32 (1.9%) anxiety disorder; 46 (2.8%) adjustment disorder; 96 (5.7%) personality disorder; 54 (3.2%) personality disorder plus mood disorder; 5 (0.3%) mental retardation. Substance- (N = 166, 51.9%) and HIV-related (N = 49, 15.3%) disorders comorbidity is recognised. Psychiatric visits are mainly provided to psychosis and personality disorder plus mood disorder subgroups. Off-label antipsychotics prescriptions are frequent. Conclusions. The prevalence of mental disorder in this population is higher than US and EU averages, and for particular diagnostic subgroups it could be underestimated. Psychiatric management in prison should be reorganized according to national and European health guidelines