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Carpal tunnel syndrome is the most frequent among entrapment neuropathies. It is mainly due to entrapment of the median nerve at wrist level. The authors analyze conservative treatment options, which can be useful in the early stages of the disease. Afterward, they compare various surgical techniques. The goal of surgery is to reduce the pressure on the nerve by cutting the transverse carpal ligament. Surgery can be accomplished with open carpal tunnel release or endoscopic carpal tunnel release. Open techniques can, in rare cases, cause scar problems. On the other hand, endoscopic surgery techniques can cause iatrogenic problems. [ABSTRACT FROM AUTHOR]

Negli ultimi anni, l'ergonomia di processo ha avuto un notevole sviluppo grazie alla spinta delle nuove normative europee e ai progressi fatti dalle aziende in termini di metodologie e tecniche orientate al miglioramento della sicurezza dei posti di lavoro negli stabilimenti produttivi. Il focus è stato mirato a creare nuovi metodi e strumenti di analisi ergonomica nelle prime fasi di sviluppo del processo di produzione quando è più facile e meno costoso instaurare un ciclo di ottimizzazione ergonomica, che permetta di ottenere i migliori risultati in termini di sicurezza e qualità del prodotto. Per raggiungere questi obiettivi, Fiat Group Automobiles (FGA) ha avviato un programma che punta all'ottimizzazione ergonomica delle postazioni di lavoro mediante strumenti di simulazione che operano sui modelli virtuali della vettura e della linea di produzione. Questi strumenti indagano tutti gli aspetti che tipicamente influiscono sul comfort dei lavoratori: postura, forze, modalità operative e movimentazione manuale dei carichi. Essi sono basati su metodi sviluppati a partire dalle principali norme tecniche di progettazione internazione (ISO, CEN e UNI) per cui si adeguano facilmente alle realtà globale del sistema produttivo di FGA che presenta differenze in termini di normative sulla sicurezza e sull'organizzazione del lavoro. Gli Autori presentano i principali tool realizzati per i suddetti scopi e mostrano anche le soluzioni adottate per analizzare le criticità specifiche della produzione nel settore automobilistico partendo dalle indicazioni generali presenti nelle norme di riferimento. L'implementazione dei tool presenta un'interfaccia estremamente semplificata che ne consente l'utilizzo non solo da parte di ergonomi esperti di stabilimento ma anche da parte dei progettisti fino ad oggi non dotati di elevato know-how specifico sulle tematiche dell'ergonomia. Mediante il supporto di detti strumenti, gli utenti possono specificare in input le condizioni di lavoro (informazioni sulle parti da assemblare, dimensioni, pesi, ecc.) ed ottenere, in output, indicazioni sul comfort del lavoratore secondo opportuni indici di riferimento. Gli Autori presentano infine una serie di casi studio relativi allo sviluppo di un nuovo modello vettura. [ABSTRACT FROM AUTHOR]

Negli ultimi anni, l'ergonomia di processo ha avuto un notevole sviluppo grazie alla spinta delle nuove normative europee e ai progressi fatti dalle aziende in termini di metodologie e tecniche orientate al miglioramento della sicurezza dei posti di lavoro negli stabilimenti produttivi. Il focus è stato mirato a creare nuovi metodi e strumenti di analisi ergonomica nelle prime fasi di sviluppo del processo di produzione quando è più facile e meno costoso instaurare un ciclo di ottimizzazione ergonomica, che permetta di ottenere i migliori risultati in termini di sicurezza e qualità del prodotto. Per raggiungere questi obiettivi, Fiat Group Automobiles (FGA) ha avviato un programma che punta all'ottimizzazione ergonomica delle postazioni di lavoro mediante strumenti di simulazione che operano sui modelli virtuali della vettura e della linea di produzione. Questi strumenti indagano tutti gli aspetti che tipicamente influiscono sul comfort dei lavoratori: postura, forze, modalità operative e movimentazione manuale dei carichi. Essi sono basati su metodi sviluppati a partire dalle principali norme tecniche di progettazione internazione (ISO, CEN e UNI) per cui si adeguano facilmente alle realtà globale del sistema produttivo di FGA che presenta differenze in termini di normative sulla sicurezza e sull'organizzazione del lavoro. Gli Autori presentano i principali tool realizzati per i suddetti scopi e mostrano anche le soluzioni adottate per analizzare le criticità specifiche della produzione nel settore automobilistico partendo dalle indicazioni generali presenti nelle norme di riferimento. L'implementazione dei tool presenta un'interfaccia estremamente semplificata che ne consente l'utilizzo non solo da parte di ergonomi esperti di stabilimento ma anche da parte dei progettisti fino ad oggi non dotati di elevato know-how specifico sulle tematiche dell'ergonomia. Mediante il supporto di detti strumenti, gli utenti possono specificare in input le condizioni di lavoro (informazioni sulle parti da assemblare, dimensioni, pesi, ecc.) ed ottenere, in output, indicazioni sul comfort del lavoratore secondo opportuni indici di riferimento. Gli Autori presentano infine una serie di casi studio relativi allo sviluppo di un nuovo modello vettura. [ABSTRACT FROM AUTHOR]

D.Lgs. 81/08 requires the employer to design work systems, methods and tools in accordance to the ergonomic principles. In order to check the compliance of the design with current regulation, it is appropriate and effective to make use of simulation tools since the design phase. The paper describes a tool based on multi body approach. Once the gender and the anthropometric percentile of the worker have been specified, the tool simulates the postures that the worker is likely to assume during the execution of the work task. The tool can be used in the design as well as in the re-design phase, taking into account the different percentile of workers for a proper accommodation of the same.

Thyroid surgery, one of the most common interventions in endocrine surgery, is practiced by many specialists who perform this procedure exclusively. It accounts for the bulk of work even in reference centers that treat rare endocrine tumors (e.g. adrenal and gastrointestinal tract cancer). Better results are obtained by experienced and skilled operators. Surgeons who correctly perform thyroid surgery can achieve excellent outcomes even in other areas of endocrine surgery. So it is surprising that not more is being done to teach the procedure, which has always been considered something of an art, perhaps because surgical treatment of rare endocrine tumors is more stimulating to teach than routine surgical procedures. Nonetheless, teaching correct surgical technique is essential for reducing and avoiding postoperative complications caused by inadequate experience and knowledge. Numerous studies have reported that the incidence of complications is high and that the rate is growing: 5% involve permanent injury to the recurrent laryngeal nerve after intervention for a benign tumor, despite repeated reports that the incidence could be reduced to near zero or at least to 1%. Alarmingly high is the 20% incidence of persistent hypoparathyroidism after total thyroidectomy. Here, too, accurate technique could reduce this rate to 1%. An important point is that permanent laryngeal nerve injury and persistent hypoparathyroidism are both sources of considerable discomfort for patients. One of the chief objectives of modern endocrine surgery is, therefore, to reduce the complications rate to acceptable levels by establishing adequate, uniform teaching protocols and universal guidelines that would help improve the practice of surgery.

Proximal type epithelioid sarcoma is a rare neoplasia in which morphological findings are characterized by nodular proliferation of epithelioid cells with focal rhabdoid features. It shares some histological features with other neoplasias and this gives an account of several differential diagnosis with other extrarenal rhabdoid tumors. Immunohistochemical and ultrastructural analysis are important in defining this entity: vimentin, cytokeratin, EMA and often CD34 expression of tumoral cells, moreover ultrastructurally evidence of large paranuclear whorls of intermediate filaments, are requested for diagnosis. A correct diagnostic framing is necessary because of the aggressive clinical behaviour of this tumor, that has a tendency to early spreading. We describe a case of vulvar proximal type epithelioid sarcoma in a 34 years old woman.

We studied the expression of p53 in 80 gallbladder carcinomas, 43 peritumoral mucosae, 5 adenomas and 20 mucosae of non tumoral gallbladders. Gallbladder cancers were classified according to WHO criteria. We found p53 overexpression in 51 out of the 80 gallbladder cancers (64%). p53 expression was variable in different histologic subtypes: 100% of intestinal type, 66% of papillary type, 83% of adenosquamous carcinomas and 66% of giant cells cancers showed immunoreactive cells. In well and moderately differentiated conventional gallbladder adenocarcinomas we found 60% of positive cases, while, among poorly differentiated conventional cancers, 83% were immunoreactive. All mucinous adenocarcinomas were p53-negative. In peritumoral dysplastic mucosae, p53 was expressed in 23 out 38 cases (60%), 22 (96%) of which were associated to a p53-positive adenocarcinoma. On the contrary, only 5 of the 15 p53-negative dysplastic lesions (33%) were associated to an p53-immunoreactive adenocarcinoma. Metaplastic lesions, of gastric and intestinal type, and adenomas were completely p53-negative. In conclusion, our data suggest that p53 expression is an early event, frequently involved in gallbladder carcinogenesis, and related to different histologic subtypes of gallbladder adenocarcinomas.

Introduction: Microcalcifications which do not belong to focal lesions are a difficult diagnostic problem to solve with mammography. We investigated the yield of 99mTc-Sestamibi (MIBI) scintigraphy in the assessment of the benign or malignant nature of these lesions and compared nuclear medicine with histologic and immuno-histochemical findings., Material and Methods: Twenty-seven areas of microcalcifications (0.3-5 cm in largest diameter) were considered; no solid masses or cysts were detected by mammography and sonography. The mammographic features of these microcalcifications were suggestive of malignancy in 3 cases and of benignity in 14; the diagnosis was questionable in the other 10 cases. MIBI scintigraphy was considered positive for malignancy when there was tracer uptake in the breast. Cytologic samples of all lesions were obtained with fine-needle aspiration under stereotactic guidance. Histology was performed in the 13 lesions considered malignant or dubious at mammography, independent of their cytology; histology was combined with immunohistochemical tests to assess intracellular mitochondria count and the number of vessels. The other 14 lesions, which were benign at mammography and cytology, were followed-up yearly for two years, and no change in clinical or radiological findings was demonstrated., Results: Histology diagnosed 8 ductal carcinomas (3 invasive carcinomas and 5 carcinomas in situ) and 5 benign lesions (1 sclerosing adenosis and 4 fibrocystic diseases, 3 of them associated with ductal hyperplasia). Scintigraphy was positive in 4/8 malignant lesions (3/3 invasive carcinomas, 1-3.5 cm in largest diameter; 1/5 carcinomas in situ, 5 cm in largest diameter) and negative in 4/5 benign lesions (we had one false positive in a fibrocystic disease associated with ductal hyperplasia). Tracer uptake was observed in all lesions with a high intracellular mitochondria count, except for 2 carcinomas in situ (0.3 and 0.8 cm in largest diameter, respectively); no benign or malignant lesion was well vascularized. Scintigraphy was negative also in the other 14 benign lesions with no histology., Conclusions: 99mTc-MIBI scintigraphy was able to characterize both invasive ductal carcinomas and benign lesions, which results hold even though our series was small because of the selection criteria we used. Thus, all invasive ductal carcinomas were identified and we had only one false positive (1/19) in benign lesions. In contrast, the technique was inadequate in carcinomas in situ, probably because their size and biological patterns vary greatly. Thus, scintigraphy was negative in 4/5 lesions (all < 1 cm O) and positive in only 1/5 (5 cm O). Therefore we conclude that 99mTc-MIBI scintigraphy cannot replace stereotactically-guided fine-needle aspiration in breast microcalcifications with questionable mammographic findings.

A 23-year-old white man was referred to this Odontostomatologic Service for evaluation of palatal swelling lesion. Oral inspection showed a poor oral conditions and multiple caries. A panoramic radiograph revealed 3 mandibular and 4 maxillary radiolucent lesions. No major nor minor clinical and radiographic criteria of Gorlin's syndrome were present; furthermore clinical features and laboratory blood values, ruled out a possible association with Maroteaux-Lamy, Hunter, and Hurler' syndromes and hyperparathyroidism. The 7 radiolucent lesions were surgically enucleated and the histologic study revealed that these lesions consisted in: 1 keratocyst, 1 naso-palatine cyst, 4 radicular cysts and 1 fiber-connective tissue.

Equilibrium pool scintigraphy was performed in 11 obese subjects (BMI 34 +/- 2) and in 14 normal control subjects. Temporal and spatial smoothing of the data was then performed followed by time-activity curve generation using a semiautomatic second derivative edge-detection algorithm. The increase in counts during the first third of diastole divided by the total change in number of counts during diastole was determined as the one-third filling fraction. This index of diastolic filling was significantly decreased in obese subjects as compared to the control group. These findings indicate that diastolic abnormalities may be an early finding in obesity-linked heart disease, occurring in the presence of normal systolic function (E.F. = 65 +/- 5%).

The existence of eosinophilic leukemia (EL) has been controversial since it was first described. Recently, some authors have suggested that EL is part of a spectrum of eosinophilic diseases termed hypereosinophilic syndrome (HS). EL diagnosis is very difficult, especially if abnormal chromosome are not present, because HS comprises multiple disease entities of unclear etiology with the common features of prolonged eosinophilia of undetectable cause and organ system dysfunction. We present a case of HS whose findings are consistent with a leukemic process. For two years the patient showed only sharp hypereosinophilia; his clinical course was then marked by signs and symptoms of granulocytic sarcoma (GS), an extramedullary tumor composed of granulocytic precursor cells. GS as a complication of EL was described and in some cases the diagnosis of leukemia was made only on the basis of the GS complication. The formation of eosinophilic GS also suggests a diagnosis of LE in our case of HS. Finally, we always consider HS as a potential malignant disease.

Using digitized M-mode echograms we evaluated the role of preload, afterload, inotropic state and left ventricular (LV) mass on LV systolic and diastolic function in 2 groups of hypertensive patients: Group 1: 25 subjects (18 men, mean age 48 +/- 6 years) with normal LV mass (less than 230 g); Group 2: 25 subjects (20 men, mean age 50 +/- 8 years) with LV hypertrophy (wall hypertrophy with normal LV diameter). As control group, we evaluated 50 normal subjects, matched for age, sex and body surface area with hypertensives. LV mass was significantly (p less than 0.001) higher as respect to normals also in hypertensives with normal LV mass; indexes of LV systolic and diastolic function were similar in normals and in hypertensives with normal LV mass and significantly lower in subjects with LV hypertrophy. The end-systolic wall stress was not significantly different in the 2 groups of hypertensives. We evaluated the relative role of preload (end-diastolic LV diameter), afterload (end-systolic wall stress) inotropic state (systolic arterial pressure/end-systolic LV diameter) and LV mass on LV systolic and diastolic function using multiple regression analysis. As regards LV systolic function, the major determinant was the systolic pressure/end-systolic diameter ratio in normals, the end-systolic stress in hypertensives. As regards LV diastolic function, the major determinant was end-systolic stress in normals and hypertensives with normal LV mass, LV mass in hypertensives with myocardial hypertrophy. Preload seems not to influence LV function in normals and in hypertensives with normal LV diastolic diameter. The major determinant of LV systolic function is the inotropic state in normals and the afterload in hypertensives.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of papillary cystic tumour of the pancreas in a young woman is reported. The review of the literature permits to stress the rarity of this tumour with a good prognosis.

An automatic ambulatory electrocardiogram analyzer was developed using a self-powered fast reader of FM recorded cassettes and a "general purpose" microcomputer with 640 Kbytes of RAM and 20 Mbytes of mass memory on hard-disk. Original algorithms were developed for analog to digital conversion, data storage on hard-disk, QRS detection and classification and rhythm analysis. Reliability of the system was evaluated, when appropriate, using standard databases. The relevant features of our analyzer include a favourable cost/benefit ratio, powerful interactive facilities and the typical flexibility of the non dedicated hardware.

Syncope is a relatively common clinical problem and causes 1% of hospitalizations. The clinical syndrome is characterized by a sudden reduction of the cerebral flow secondary to a number of conditions that includes benign, self-limited causes and life-threatening arrhythmias. A high percentage of these patients is discharged from hospital without an etiological diagnosis. The purpose of this short review is to present the classification of syncope and suggest the methodological approach to detect the underlying cause. The importance of patient's age and of a cardiovascular etiology as a negative prognostic index is stressed. The most valuable diagnostic tool remains a thoroughly taken clinical history.

Granulomas in the liver are identified in 3-10% of all liver biopsies. Although granulomas frequently represent a sign of either infectious or non infectious disease, 20% of the hepatic granulomas lack an identifiable etiology. These cases are defined as idiopathic granulomatous hepatitides (IG). We describe four cases of disease resembling a lymphoid malignance in which IG could be diagnosed by laboratory, radiological (XR, CT), ultrasonographic, histological and follow-up studies of the patients. We suggest that IG may be suspected in patients with granulomas in the liver, self-limited fever of unknown origin, low epatosplenomegaly, eosinophilia less than 5%, in the absence of infectious, lymphoid or sarcoid diseases. We recommend laparascopy as an important diagnostic tool.