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BACKGROUND: we aimed to assess whether shortness of filum terminale (FT) can represent a specific feature of fibromyalgia. Therefore we investigated benefits coming from FT section with a mini-invasive technique in patients with fibromyalgia. Filum terminale disease (FD), described firstly in 1996, is consequence of an abnormal traction exerted on spinal cord since FT is shorter than usual. Fibromyalgia syndrome (FS) is featured by chronic widespread musculoskeletal pain associated with stiffness and extra-skeletal symptoms affecting many organs and systems. Filum terminale disease and fibromyalgia syndrome share common clinical features in at least one subset of patients. METHODS: we evaluated 42 patients firstly diagnosed for FS and then re-evaluated by nuclear magnetic resonance. 38 out of 42 had also FD and 20 of them underwent surgical treatment, i.e., FT section according to Royo-Salvador technique. RESULTS: after physical therapy, surgically treated patients showed significant improvement of symptoms in terms of reduction of pain and increment of quality of life, compared to group, which refused surgery and performed physical therapy only. CONCLUSION: we suggest that FT shortness can be considered one of predisposing causes for developing FS and that FD surgical treatment in patients with FS can improve overall treatment outcome.

Acute ischemic stroke, the most frequent cause of permanent disability in adults worldwide, results from transient or permanent reduction in regional cerebral blood flow and involves oxidative stress and inflammation. Despite the success of experimental animal models of stroke in identifying anti-inflammatory/neuroprotective compounds, translation of these putative neuroprotectants to human clinical trials has failed to produce a positive outcome. Tissue injury and stress activate endogenous mechanisms which function to restore homeostatic balance and prevent further damage by upregulating the synthesis of lipid signaling molecules, including N-palmitoylethanolamine (PEA or palmitoylethanolamide). PEA exerts neuroprotection and reduces inflammatory secondary events associated with brain ischemia reperfusion injury (middle cerebral artery occlusion (MCAo)). Here, we examined the neuroprotective potential of a co-ultramicronized composite containing PEA and the antioxidant flavonoid luteolin (10:1 by mass), nominated co-ultraPEALut. The study consisted of two arms. In the first, rats subjected to MCAo and treated with co-ultraPEALut post-ischemia showed reduced edema and brain infract volume, improved neurobehavioral functions, and reduced expression of pro-inflammatory markers and astrocyte markers. In the second arm, a cohort of 250 stroke patients undergoing neurorehabilitation on either an inpatient or outpatient basis were treated for 60 days with a pharmaceutical preparation of co-ultraPEALut (Glialia®). At baseline and after 30 days of treatment, all patients underwent a battery of evaluations to assess neurological status, impairment of cognitive abilities, the degree of spasticity, pain, and independence in daily living activities. All indices showed statistically significant gains at study end. Despite its observational nature, this represents the first description of co-ultraPEALut administration to human stroke patients and clinical improvement not otherwise expected from spontaneous recovery. Further, controlled trials are warranted to confirm the utility of co-ultraPEALut to improve clinical outcome in human stroke.

Background we aimed to assess whether shortness of filum terminale (FT) can represent a specific feature of fibromyalgia. Therefore we investigated benefits coming from FT section with a mini-invasive technique in patients with fibromyalgia. Filum terminale disease (FD), described firstly in 1996, is consequence of an abnormal traction exerted on spinal cord since FT is shorter than usual. Fibromyalgia syndrome (FS) is featured by chronic widespread musculoskeletal pain associated with stiffness and extra-skeletal symptoms affecting many organs and systems. Filum terminale disease and fibromyalgia syndrome share common clinical features in at least one subset of patients. Methods we evaluated 42 patients firstly diagnosed for FS and then re-evaluated by nuclear magnetic resonance. 38 out of 42 had also FD and 20 of them underwent surgical treatment, i.e., FT section according to Royo-Salvador technique. Results after physical therapy, surgically treated patients showed significant improvement of symptoms in terms of reduction of pain and increment of quality of life, compared to group, which refused surgery and performed physical therapy only. Conclusion we suggest that FT shortness can be considered one of predisposing causes for developing FS and that FD surgical treatment in patients with FS can improve overall treatment outcome.

Main problems in the Salento peninsula are related to the increase of water table depths and to the groundwater salinization due to over abstractions and sea water intrusion, as it is shown in Figure 4.2. At several places of the Salento coastal area the electrical conductivity of the groundwater already exceeds 15,000 ?S/cm. The groundwater flows under low pressure inside karstic fractures and it is affected by withdrawals for drinking and irrigation uses, as explained above. Artificial recharge has been considered in Nardò as a pilot study to counteract saltwater intrusion and overexploitation of the aquifer, and groundwater recharge operations have started in 1991.

Per valutare il grado di diffusione nell'ambiente di batteri antibiotico resistenti, sono stati esaminati campioni di acqua superficiale e sotterranea provenienti da una zona costiera della Puglia. Ceppi di Salmonella spp. e di E. coli sono stati isolati dalle acque superficiali di un canale che convoglia a mare gli effluenti di un impianto di trattamento di reflui urbani e acque piovane. Nella stessa area sono state campionate acque sotterranee prelevate da 3 pozzi artesiani posti a diversa distanza dal mare, e che costeggiano il canale stesso. 82 ceppi batterici isolati da 24 campioni d'acqua sono stati sottoposti a test di antibiotico resistenza con due metodi: manuale, di diffusione da disco e automatizzato, VITEK ® 2 (bioMérieux, Marcy L'Etoile,France). I risultati ottenuti con le due metodiche non appaiono significativamente discordanti. I campioni di acqua superficiale sono risultati più contaminati rispetto a quelli di acqua sotterranea e con un numero più elevato di ceppi resistenti. Complessivamente lo studio mostra una notevole diffusione di batteri farmaco resistenti nell'ambiente e ciò potrebbe determinare implicazioni sulla salute dell'uomo rendendo più difficili le terapie antibiotiche.

The study investigates the fate and transport of microorganisms introduced by artificial groundwater recharge at the Nardo` fractured aquifer in Salento, Italy. Microbial indicators of faecal contamination, parasitic protozoa (Giardia and Cryptosporidium) and pathogenic bacteria (Campylobacter spp.), were monitored into injected water and groundwater to test the efficiency of the "natural disinfection" into the fractured aquifer. A remarkable decrease of microbial indicators and pathogens was observed suggesting that pathogens removal or inactivation may be possible during water flow in fractured aquifer. The recently described PNA probe CJE195 (Lehtola et al. 2005) was utilised for the rapid and specific detection of Campylobacter spp. by fluorescence in situ hybridization (FISH) after enrichment. FISH results were consistent with those of traditional cultural method (ISO 17995) applied in parallel: time required for Campylobacter identification was reduced of 4 days.

Seawater intrusion into fresh water aquifers occurs in many coastal hydrogeologic settings due to overexploitation of freshwater resources. It can be exacerbated by seawater level increases as a result of climate change on which there is wide consensus in the scientific community. Basin scale water balance deficits may be used together with hydrogeologic modelling and water quality monitoring data to track the advance of seawater intrusion. Due to the growth of population and increased exploitation of the ground water resources in coastal areas, the problem is truly global in proportion. The situation is particularly acute in the Mediterranean, the Yucatan peninsula in Mexico, the Middle East, the SE and SW United States as well as on many islands with arid to semi arid climates. Continued exploitation of limited freshwater resources can also lead to up flow of relict marine waters underlying the fresh water zone compounding the effects of seawater intrusion. This study has been designed to test the feasibility of creating a subsurface barrier to seawater intrusion by induced gypsum precipitation in fractured carbonate aquifers. The barriers design was supported by laboratory experiments and by a mathematical model which simulated sweater intrusion in a costal aquifer at Salento, in Southern Italy. The results will assist regional, national, and local water management interests to better regulate water use and protection as well as to avoid conflicts over scarce resources.

This study investigates the fate and transport of pathogens introduced by artificial groundwater recharge at the Nardò fractured aquifer in Salento, Italy. Wastewater effluents from a municipal treatment plant with known pathogen concentrations were injected into a sinkhole and the migration of pathogens in the fractured aquifer was monitored at various sampling wells. Two tracer tests using iodine and chlorophyll were carried out. The spatial variability of the mean fracture aperture was determined by well-established geostatistical procedures and local aperture measurements evaluated by pumping borehole field tests. The preliminary experimental field data suggest that the required setback distance for drinking wells should be larger than 200 m limit imposed by Italian regulations.

The Salento groundwater supplies over 70% (=4000 l/s) of drinking water requirements. The Puglia carbonate aquifer is an important water reservoir but presents also high vulnerability to wastewater injections. Under these conditions, hazardous pathogens could affect drinking water quality even at long distance from pollution sources. Recent epidemiological studies focused that the population on the Salento Coast (Puglia, Southern Italy) have an higher exposure to gastroenteritis in comparison to Italian population. The quantitative estimation of the pathogens effects on contaminated wells water has been carried out in the Nardò aquifer, where a channel (Asso) outflows raw water in a natural sinkhole. The systematic monitoring of groundwater quality in the wells was carried out during Winter 2002 and allowed the evaluation of the natural inactivation of pathogen injected in the fractured subsoil. This estimation was supported by mathematical model simulations of the groundwater flow and pathogens migration in fractures. Moreover on water samples derived from a wells affected by injected wastes at 500 m of distance, has been tested the impossibility of total inactivation of some viral indicators (Clostridi perfringens e somatic phages anti-E. coli) by hypochlorination.

In Puglia several coastal aquifers are polluted by uncontrolled discharges of domestic wastes and sea water intrusion. The Italian rule D. Lgs. 152/99 and the European Community Directive 2000/60/EC, known as the Water Frame Directive, encourage basic and supplementary measures for water resources protection such as rehabilitation projects and artificial aquifers recharge (see (xiii) and (xiv), part B annex VI). Moreover, in the semiarid environments the water derived from municipal treatment plants can conveniently be reclaimed for groundwater artificial recharge. Treated wastewater injections could improve groundwater quality by reducing the extent of seawater intrusion and increasing the groundwater storage. An experimental study has been carried out in the Salento Region where the Nardò injection sink has been used in the last 11 years as a natural way to increase groundwater replenishment. A mathematical model has been applied to simulate the effect of 140 l/s treated waste injection in the sink and to study contaminant pathways and concentrations in the fractured aquifer. Moreover water sampled in monitoring wells positioned at different distances from injection allowed the inactivation times for pathogens released in ground water to be estimated. The rates for pathogen inactivation have been also estimated by means laboratory tests carried out on horizontal pilot-plants able to reproduce waste filtration through fractures. Model results allowed two zones around the sink to be drawn by means the set back distances calculation in every direction and, the minimum distances required for virus (zone A) and fecal coliforms (zone B) inactivation in fractures were estimated in the case studied.

Background: The use of autologous platelet gel in orthopedics is effective in accelerating the healing process of osteochondral, muscle, tendon and ligament lesions. The aim of our study was to verify whether the variability in response to infiltration with platelet gel was dependent on the underlying disease treated, sex and age of the patients. During four years, 140 patients have been treated for musculoskeletal injuries by infiltration of gel platelet and lysate platelet obtained from autologous thrombin, with echo-ultrasound guided. The response to treatment was assessed at different time points T0, T1, T2 with respect to pain estimation (VAS), joint mobility (ROM scale) and echo-ultrasound evaluation. This data collection has allowed classifying the response to treated lesions in three categories: NR (no response), PR (partial response), CR (complete response). Results: The data here reported showed that the ability to physical recovery response is evident in tendon injuries, while the large joints injuries gave a poor response. Almost all patients showed a significant pain relief after the first infiltration, but in terms of echo-ultrasound evaluation and tissue repair, only the muscle and tendon injuries showed hyperechoic areas, signs or evidences of repair. Concerning the correlation between response to infiltration with platelet gel and gender/age of the patients, the clinical results appear not influenced by the age and the gender of the patient. Discussion: Our data indicate that, pain relief and ability to physical recovery of muscles, tendons and ligaments depend on tissue repair clearly visible by echo ultrasound evaluation. On the other hand tissue repair seems not occur in the large joints (hip and knee) where arthritis and /or corrosion of articular cartilage cannot be repaired and the only relief is exclusively linked to the reduction of periarticular inflammation (reduction of the inflammatory leakage and signs).

INTRODUZIONE Il dolore in regione mediale del ginocchio è una condizione di frequente riscontro nella pratica clinica. Numerose sono le strutture presenti in tale regione anatomica e le relative patologie a esse correlate che possono essere responsabili dell’insorgenza di dolore. Tra di esse, la borsite del legamento collaterale mediale di ginocchio è una condizione di non frequente riscontro ma che deve essere tenuta in considerazione in presenza della suddetta sintomatologia (1). La borsa del legamento collaterale mediale è una struttura situata tra i due strati che compongono il legamento, lo strato profondo e lo strato superficiale (2). Brantigan and Voshell per primi identificarono la presenza di una borsa nel contesto del legamento collaterale mediale (3). Nel 1988, Kerlan and Glousman individuarono le caratteristiche cliniche della borsite del legamento collaterale mediale (4). La terapia può avvalersi in prima istanza di trattamenti conservativi e mininvasivi (FANS, analgesici, iniezioni intrabursali con corticosteroidi) e successivamente, nei casi non responsivi al trattamento conservativo, si ricorre al trattamento chirurgico (4,5,6). La presenza di depositi di calcio all’interno della borsa del legamento collaterale mediale di ginocchio è una condizione di raro riscontro se paragonata ad altre sedi più frequentemente coinvolte da calcificazioni intrabursali (borsa sub acromion-deltoidea, borsa trocanterica) (7,8). Lo Scopo del nostro lavoro è di dimostrare l’efficacia del trattamento percutaneo ecoguidato (TPE) in soggetto con borsite calcifica del legamento collaterale mediale di ginocchio. CASE REPORT Nel febbraio del 2018 si presenta alla nostra osservazione uomo di 56 anni che da circa venti giorni riferiva dolore ingravescente nella regione mediale ginocchio destro con progressiva limitazione funzionale nei movimenti di flessione. In anamnesi non si documentava la presenza di patologie sistemiche (sclerosi sistemica, dermatomiosite, sarcoidosi), metaboliche o endocrine (iperparatiroidismo, gotta, insufficienza renale) né storia di precedenti traumi diretti o interventi chirurgici a carico del ginocchio destro. Il soggetto, sotto indicazione del medico curante, aveva praticato terapia farmacologica con ibuprofene 600 mg compresse per os, una compressa al giorno per dieci giorni, con scarsa riduzione della sintomatologia clinica. È stato eseguito un esame obiettivo che evidenziava: presenza di una zona dolorosa alla digitopressione in regione mediale ginocchio destro (2 cm circa prossimalmente l’interlinea articolare femoro-tibiale) in assenza di tumefazioni, arrossamenti cutanei o alterazioni di temperatura al termotatto; incremento della sintomatologia algica durante i movimenti di flessione attiva e passiva oltre i 90° con limitazione del range of motion (ROM) che risultava completo nel movimento di estensione (0°) e limitato nel movimento di flessione (90° alla mobilizzazione attiva, 110° alla mobilizzazione passiva) per l’intensa sintomatologia algica riferita dal paziente durante la mobilizzazione; positivo il test in valgo stress di ginocchio, negativi i test specifici per segni di sofferenza articolare, meniscopatia, lesione dei legamenti crociati e del legamento collaterale laterale. È stata eseguita la valutazione del dolore tramite la somministrazione della scala visuo-analogica del dolore (VAS) con rilievo di valore 8\10 della scala VAS. In considerazione dell’anamnesi e dell’esame clinico, è stato richiesto esame ecografico della regione mediale del ginocchio. L’esame ecografico, eseguito da radiologo esperto con 20 anni di esperienza in ambito di patologia muscolo-scheletrica, metteva in evidenza nel contesto del legamento collaterale mediale del ginocchio destro la presenza di una formazione ovaliforme iperecogena con sfumato cono d’ombra posteriore solo sui suoi bordi periferici (diametro trasverso: 16,7 mm). Figura 1. Pertanto, viene posta diagnosi di calcificazione nel contesto della borsa del legamento collaterale mediale di ginocchio. Inserire Figura 1. Figura 1. Asterisco: formazione ovaliforme iperecogena (diametro trasverso: 16,7 mm). Freccia: sfumato cono d’ombra posteriore. Effettuata la diagnosi e in considerazione del fallimento terapeutico della terapia con FANS per os praticata in precedenza, viene proposto al paziente il trattamento percutaneo ecoguidato (TPE) della calcificazione prendendo riferimento dai trattamenti effettuati con ottima riuscita dalla nostra équipe nel trattamento della patologia calcifica di spalla. Ricevuto il consenso al trattamento e dopo aver espletato le normative di legge previste per le procedure interventistiche ecoguidate, si è proceduto con l’esecuzione del TPE. DESCRIZIONE DELLA TECNICA Il paziente viene posto in decubito supino sul lettino con l’arto inferiore destro leggermente extraruotato. Si procede a una valutazione ecografica per individuare l’esatta sede da trattare e la via d’accesso migliore per l’introduzione dell’ago (identificazione del bersaglio e fattibilità per l’ingresso dell’ago). Dopodiché si procede alla disinfezione del campo di lavoro corrispondente al sito d’ingresso dell’ago con iodopovidone al 10% di iodio per almeno tre minuti e successivamente con clorexidina digluconato e alla disinfezione della sonda ecografica con soluzione alcolica al 70% e successivo posizionamento di coprisonda sterile in poliuretano. Dopo aver preparato il materiale necessario al trattamento: una siringa da 5 ml con 1,5 ml lidocaina cloridrato 2%; diverse siringhe da 10 ml con circa 6 ml di soluzione fisiologica; una siringa da 5 ml con 1 ml di metilprednisolone acetato 40 mg/ml; gel sterile per ultrasuoni; si procede al trattamento che presenta le seguenti fasi: 1) Anestesia locale: tramite un ago da 21 gauge (G) viene iniettata, sotto guida ecografica, la lidocaina al livello pericalcifico per anestetizzare la zona. L’ago da 21 G viene quindi rimosso. 2) Introduzione dell’ago sotto guida ecografica all’interno della calcificazione: la sonda viene posizionata in maniera tale da permettere una ottimale visualizzazione della zona da trattare. Una siringa da 10 ml riempita con soluzione fisiologica, sulla quale è montato un ago da 16 G, viene inserita lungo il lato corto della sonda. L’ago viene\è seguito lungo il suo tragitto, dalla zona di entrata fino al bersaglio, verificando che la punta dell’ago giunga all’interno della calcificazione. Per una migliore visualizzazione dell’ago è opportuno mantenere una traiettoria il più possibile parallela all’asse lungo della sonda. 3) Trattamento di aspirazione: in questa fase è applicata in maniera alternata la compressione e il rilascio dello stantuffo della siringa cosicché la soluzione fisiologica viene a essere iniettata e riaspirata all’interno della stessa. Questo impulso continuo di aspirazione e rilascio determina la frammentazione del nucleo della calcificazione e l’aspirazione dei suoi frammenti all’interno della siringa che rende la soluzione fisiologica torbida. Si procede secondariamente alla sostituzione della siringa con il contenuto calcico con un’altra che contiene soluzione fisiologica. Quest’operazione è ripetuta finché nessun altro frammento calcico viene aspirato all’interno della siringa. 4) Trattamento con cortisonico: mantenendo sempre lo stesso ago all’interno della calcificazione, si rimuove la siringa priva di frammenti e tramite una siringa da 5 ml viene iniettato 1 ml di metilprednisolone acetato. 5) Controllo ecografico post-trattamento: una volta estratto l’ago, si copre il punto d’ingresso con una garza sterile e si esegue un controllo ecografico della parte trattata al fine di escludere eventuali complicanze locali. Terminato il TPE, viene programmato un controllo clinico ed ecografico a tre settimane dal trattamento. DISCUSSIONI Il dolore in regione mediale del ginocchio è una condizione di frequente riscontro nella pratica clinica. Numerose sono le strutture presenti in tale regione anatomica e le relative patologie a esse correlate che possono essere responsabili dell’insorgenza di dolore e limitazione funzionale: osteoartrosi, lesioni meniscali, sindrome della zampa d’oca, sindrome della plica mediale, tendinite del semimembranoso, sindrome di Pellegrini-Stieda, fibromialgia, lesioni cartilaginee, fratture da stress e borsiti sono tutte condizioni che devono essere considerate nella diagnosi differenziale (4,9). Le borse sinoviali sono strutture extra-articolari la cui funzione è quella di proteggere i tessuti molli, riducendo le frizioni tra i tendini e le ossa o tra il tendine e la cute durante i movimenti. Sono costituite da una membrana sinoviale che in alcuni casi può comunicare con l’articolazione. Possono essere classificate in base alla loro formazione in native o non native (avventizie). Le borse native (borsa del legamento collaterale mediale) si formano durante lo sviluppo embrionale. Le borse avventizie si formano successivamente nel corso della vita in conseguenza della degenerazione mixoide che subisce il tessuto fibroso in relazione ad una frizione reiterata tra le ossa e i sottostanti tessuti molli (borsa intermetatarsale) (10). La borsa del legamento collaterale mediale è una struttura situata tra i due strati che compongono il legamento, lo strato profondo e lo strato superficiale (2). Di norma tale struttura non è in comunicazione con lo spazio articolare del ginocchio (11). Brantigan and Voshell per primi identificarono la presenza di una borsa nel contesto del legamento collaterale mediale (3). La borsite asettica del legamento collaterale mediale e il suo trattamento è una condizione documentata in letteratura da precedenti studi (4,5,6). Nel 1988, Kerlan and Glousman individuarono le caratteristiche cliniche della borsite del legamento collaterale mediale come un dolore isolato localizzato sulla superficie mediale dell’interlinea articolare del ginocchio riprodotto dalla digitopressione e dallo stress in valgo, in assenza di segni meccanici blocco articolare o di click udibile intrarticolare (4). La terapia può avvalersi in prima istanza di trattamenti conservativi (FANS, analgesici, iniezioni intrabursali con corticosteroidi) e successivamente, nei casi non responsivi al trattamento conservativo, si ricorre al trattamento chirurgico (4,5,6). La presenza di depositi di calcio all’interno della borsa del legamento collaterale è una condizione di raro riscontro nella pratica clinica se paragonata ad altre sedi più frequentemente coinvolte da calcificazioni intrabursali (borsa sub acromion-deltoidea, borsa trocanterica) (7,8). I soggetti maggiormente soggetti allo sviluppo di calcificazioni intrabursali sono individui di sesso femminile con un’età compresa tra i 40 e i 70 anni (12). Alcune condizioni patologiche sono correlate ad un maggiore rischio di sviluppo di calcificazioni dei tessuti molli: lesioni tissutali, condrocalcinosi, iperparatiroidismo, insufficienza renale, calcinosi, osteosarcoma con interessamento dei tessuti molli, dermatomiosite, sindrome CREST sono alcune tra di esse (13). Anche la presenza di patologie endrocrine è stata correlata ad una maggiore possibilità di sviluppare di calcificazioni intratendinee (14). È stato inoltre documentato che calcificazioni formatesi a livello dei legamenti o dei tendini del ginocchio, possano occasionalmente migrare nelle borse adiacenti (15). Quando ciò succede, il materiale calcifico e per lo più liquido ed assume aspetto nubecolare piuttosto che assumere un aspetto solido o compatto (16). L’evoluzione delle calcificazioni dei tessuti molli prevede una fase di formazione e una fase di riassorbimento dei cristalli d’idrossipatite con una sintomatologia clinica fluttuante. Dolore e relativa limitazione della funzione, sono sintomi che possono essere riscontrati con maggiore frequenza durante il processo infiammatorio reattivo della borsa che caratterizza la fase di riassorbimento del materiale calcifico. Il decorso clinico può variare dall’autorisoluzione a forme recidivanti con cronicizzazione del dolore e relativa limitazione funzionale (15). Le opzioni terapeutiche nel trattamento delle calcificazioni sintomatiche prevedono trattamenti conservativi (FANS, analgesici (16) ), trattamenti minimamente invasivi (onde d’urto, iniezioni con corticosteroidi, aspirazione della massa calcifica (16,18) ) e trattamenti chirurgici 19,20), ognuna delle quali con percentuali di successo terapeutico variabili. In considerazione del fallimento della terapia con FANS per os praticato precedentemente dal paziente e della volontà dello stesso di non sottoporsi a trattamento chirurgico, vista l’esperienza maturata dalla nostra equipe su 150 casi trattati dal gennaio 2016 al luglio 2018 con trattamento percutaneo ecoguidato (TPE) in soggetti con tendinopatia calcifica di spalla, vista la letteratura esistente sul trattamento delle calcificazioni tendinee (21) e delle calcificazioni bursali (16), si è optato per l’esecuzione del TPE della borsite calcifica del legamento collaterale mediale. Non si è ritenuto necessario l’esecuzione di ulteriori esami diagnostici (esame radiografico, tomografia computerizzata, risonanza magnetica nucleare) in relazione alla storia clinica, all’anamnesi e all’esame obiettivo. L’esame ecografico si è dimostrato esaustivo documentando la presenza della calcificazione nel contesto della borsa del legamento collaterale mediale di ginocchio (Figura 1) infatti nell’ambito delle patologie osteoarticolari rappresenta un esame di elevata affidabilità diagnostica (10,22). Inoltre, come documentato in letteratura, rappresenta un’ottima guida durante l’esecuzione di trattamenti mini-invasivi interventistici e nei controlli post trattamento (6,16,21). Nel nostro caso il paziente è stato sottoposto a controllo clinico ed ecografico post TPE a tre settimane dal trattamento. Durante tale controllo il paziente ha riferito la completa remissione della sintomatologia dolorosa sia alla digitopressione in regione mediale del ginocchio destro sia alla mobilizzazione attiva e passiva in flessione con totale recupero del ROM. Il test in valgo stress era negativo. Il paziente riferiva di non aver assunto antiinfiammatori o analgesici nel periodo post TPE. Il valore di VAS registrato al controllo era di 1/10. Il controllo ecografico documentava un’evidente riduzione volumetrica della calcificazione precedentemente osservata che manteneva ecostruttura di tipo nubecolare (diametro trasverso: 9,6 mm). Figura 2. Inserire Figura 2. Figura 3. Asterisco: area iperecogena con ecostruttura di tipo nubecolare nel contesto del legamento collaterale mediale (diametro trasverso: 9,6 mm). In relazione alla persistenza di minima calcificazione intrabursale anche se in assenza di sintomatologia clinica, è stato programmato un ulteriore controllo a 15 giorni nel corso del quale si è stato rilevato una normalizzazione del quadro clinico ed ecografico. Figura 3. Inserire Figura 3. Figura 3. Asterisco: area di maggiore ipoecogenicità del legamento collaterale mediale in sede di pregressa calcificazione che non appare più identificabile. In conclusione, in considerazione dell’efficacia di risoluzione del quadro clinico ed ecografico, possiamo affermare, seppur la nostra esperienza sia limitata a un solo caso, che il trattamento percutaneo ecoguidato in soggetti con borsite calcifica del legamento collaterale mediale può rappresentare una valida opzione terapeutica in linea con il precedente studio presente in letteratura (16). L’implementazione dell’uso dell’indagine ecografica nella pratica clinica del medico Fisiatra rappresenta un obiettivo da perseguire per le notevoli potenzialità che la metodica possiede sia da un punto di vista diagnostico che da un punto di visto terapeutico nell’esecuzione di procedure interventistiche mini-invasive. BIBLIOGRAFIA Perdikakis E, Skiadas V. MRI characteristics of cysts and cyst-like lesions in and around the knee: what the radiologist needs to know. Insights Imag. 2013;4(3):257–72. Liu F, Yue B, Gadikota HR, et al. Morphology of the medial collateral ligament of the knee. J Orthop Surg Res 2010; 5:69. Brantigan OC, Voshell AF. The tibial collateral ligament: its function, its bursae and its relation to the medial meniscus. J Bone Joint Surg 1943; 25:121–131. Kerlan RK, Glousman RE. Tibial collateral ligament bursitis. Am J Sports Med 1988; 16:344–346. Corten K, Vandenneucker H, Van Lauwe J, Bellemans J. Chronic posttraumatic bursitis of the medial collateral ligament: surgical treatment in 2 high level professional athletes. Am J Sports Med. 2009; 37: 610-13. Jose J, Schallert E, Lesniak B. Sonographically guided therapeutic injection for primary medial (tibial) collateral bursitis. J Ultrasound Med. 2011; 30: 257-61. Holt PD, Keats TE. Calcific tendinitis: a review of the usual and unusual. Skeletal Radiol 1993;22(1):1–9. Mens J, Van der Korst JK. Calcifying supracoracoid bursitis as a cause of chronic shoulder pain. Ann Rheum Dis 1984;43:758–759. Bakar Siddiq and Israt Jahan. Medial collateral ligament calcification: a rare knee pain entity with literature review. Acta Radiologica Open 6(11) 1–5 2017. DOI: 10.1177/2058460117738549. Thumanoon Ruangchaijatuporn, Kara Gaetke-Udager, Jon A. Jacobson, Corrie M. Yablon, Yoav Morag. Ultrasound evaluation of bursae: anatomy and pathological appearances. Skeletal Radiol (2017) 46:445–462 DOI 10.1007/s00256-017-2577. De Maeseneer M, Van Roy F, Lenchik L, Barbaix E, De Ridder F, Osteaux M. Medial capsular and supporting structures of the knee: MR imaging-anatomic correlation. Radiographics 2000; 20(special issue): S83– S89. Resnick D, Heung SK. Internal derangements of joints. Philadelphia: Saunders, 1997:644–655. Steewart VL, Herling P, Dalinka MK. Calcification in soft tissues. JAMA 1983;250:78–81. Harvie P, Pollard TC, Carr AJ. Calcific tendonitis: natural history and association with endocrine disorders. J Shoulder Elbow Surg 2007;16(2):169–73. Uhthoff H, Sarkar K, Maynard J. Calcifying tendinitis. Clin Orthop. 1976;118:164–8. Del Castillo-Gonzalez F, Ramos-Álvarez J. J, González-Pérez J, Jiménez-Herranz E, Rodríguez-Fabián G.Ultrasound-guided percutaneous lavage of calcific bursitis of the medial collateral ligament of the knee: a case report and review of the literature. Skeletal Radiology. DOI 10.1007/s00256-016-2442-3. Mansfield HL, Trezies A. Calcific tendonitis of the medial collateral ligament. Emerg Med J 2009;26(7):543. Kamawal Y, Steinert AF, Barthel T. Case report – calcification of the medial collateral ligament of the knee with simultaneous calciifying tendinitis of the rotator cuff. BMC Musculoskelet Disord 2016;17 :283. Muschol M, Müller I, Petersen W, Hassenpflug J. Symptomatic calcification of the medial collateral ligament of the knee joint: a report about five cases. Knee Surg Sports Traumatol Arthrosc 2005;13(7):598–602. Chang WC, Huang GS, Lee CH, Kao HW, Chen CY. Calcification of medial collateral ligament of the knee: an uncommon cause of medial knee pain. J Clin Rheumatol 2006;12(4):204–5. Lanza E, Banfi G, Serafini G, Lacelli F, Orlandi D, Bandirali M, et al. Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? a systematic review with proposals for future reporting. Eur Radiol. 2015;25(7):2176–83. Blankstein A. 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A new starch-based polymeric system, ZI1OU from Novamont, mainly composed of starch and polycaprolactone, was reprocessed several times in an extruder to investigate the recyclability of this biodegradable polymer. A previous investigation of the thermomechanical degradation in a mixer has been also done. The degradation is mostly due to the thermal stress but the presence of the mechanical stress strongly increases the degradation kinetic. During melt processing two concurrent processes take place: the first is the degradation, i.e. the breaking and shortening of polymeric chains, mostly occurring in the PCL phase; the second is the formation of some crosslinked structure in the starch phase. The rheological and mechanical properties, measured on samples subjected to repetitive extrusion operations carried out in a single screw extruder, clearly indicate that, in the adopted processing conditions, no significant modifications are observed. Only after five extrusions some decrease of these properties was measured.

The compatibilization of blends of polyamide-6 (PA6) with linear low density polyethylene (LLDPE) and of poly(ethylene terephthalate) (PET) with high density polyethylene (HDPE), by functionalization of the polyethylenes with oxazoline groups was investigated. Chemical modification of LLDPE and HDPE was carried out by melt free radical grafting with ricinoloxazoline maleinate. Blends preparation was made either with a two-steps procedure comprising functionalization and blending, and in a single step in which the chemical modification of polyethylene with the oxazoline monomer was realized in situ, during blending. The characterization of the products was carried out by FTIR spectroscopy and scanning electron microscopy (SEM). The rheological and mechanical properties of the blends were also investigated. The results show that functionalization of the polyethylenes can be achieved by melt blending with ricinoloxazoline maleinate even in the absence of free radical initiators. The compatibilization of the blends enhances the dispersion of the minor phase significantly, increases the melt viscosity, and improves the mechanical properties. The one-step preparation of the compatibilized blends was also found to be effective, and is thought to be even more promising in view of commercial application.

The aim of this study was to assess the reliability of peri-fascial oedema as a sonographic criterion for selecting the most appropriate treatment (ultrasound-guided corticosteroid injection or ultrasound-guided extracorporeal shock wave therapy) of idiopathic plantar fasciitis (IPF).Sixty-four patients with a clinical diagnosis of unilateral refractory IPF, treated conservatively for at least 8 weeks, were studied with high-resolution ultrasound (HRUS). Pain intensity was evaluated with a visual analogue scale (VAS). HRUS was used to confirm IPF and identify the presence of peri-fascial oedema. Patients with an HRUS diagnosis of IPF were grouped according to the presence (A) or absence (B) of peri-fascial oedema and then randomly allocated to treatment with corticosteroid injection (1) or extracorporeal shock wave therapy (2). Clinical and HRUS follow-up was performed 6 weeks after treatment.HRUS confirmed IPF in 68,97% of patients and identified peri-fascial oedema in 53.33%. Clinical and sonographic improvements were observed in 87.5% and 37.5% of patients in subgroups A1 and A2, respectively, and in 35.71% and 92.85% of those in subgroups B1 and B2, respectively.The presence of peri-fascial oedema may represent an effective criterion for guiding treatment decisions towards HRUS-guided corticosteroid injection.

Polyethylene-polycaprolactone graft copolymers with different chemical structures (i.e. different number and length of PCL grafts and molecular weight of PE backbone) were synthesized from various EVOH copolymers and e-caprolactone, using Aluminum isopropoxide as catalyst, and were tested for their compatibilizing capability in PE/PVC blends. PE and PCL segments in the graft copolymers were found completely immiscible, while PCL segments of the graft copolymers were found completely miscible with PVC. When graft copolymers were added to PE/PVC blends they proved to be good agents for the dispersion of PVC phase in the PE matrix. SEM showed also improved adhesion between the dispersed PVC phase and PE matrix. Moderate improvements in mechanical properties were also observed in preliminary tensile tests.

The compatibilization mechanism of some compatibilizers for blends of polyolefins with a liquid crystalline polymer (LCP) was studied. Polyethylene (PE) and polypropylene (PP) were blended with a semirigid LCP (SBH) in a batch mixer, either with and without compatibilizers. The latter were two commercially available samples of functionalized polyolefins, that is, a PE-g-MA (HDM) and a PP-g-AA (Polybond 1001) copolymer and some purposely synthesized PE-g-LCP and PP-g-LCP copolymers. Microtomed films of the binary and the ternary blends were annealed at 240 degrees C on the hot stage of a polarizing microscope and the changes undergone by their morphology were recorded as a function of time. The results indicate that the compatibilizers lower the interfacial tension, thereby providing an improvement of the minor phase dispersion. In addition to this, the rate of the coalescence caused by the high-temperature treatment is appreciably reduced in the systems compatibilized with the PE-SBH and PP-SBH graft copolymers. Among the commercial compatibilizers, only Polybond 1001 displayed an effect comparable to that of the above copolymers. HDM improved the morphology of the as-prepared PE blends, but failed to grant sufficient morphological stabilization against annealing-induced coarsening. The results are discussed with reference to the chemical structure of the different compatibilizers.

The rheology, morphology, and mechanical properties of blends of high-density polyethylene (HDPE) with a semiflexible liquid crystalline copolyester (SBH) were studied in order to assess the compatibilizing ability of added PE-g-SBH copolymers, and its dependence on the molar mass of the PE matrix, and on the technique used for blend preparation. The PE-g-SBH copolymers were synthesized as described in previous articles, either by the polycondensation of the SBH monomers in the presence of a functionalized PE sample containing free carboxyl groups, or by reactive blending of the latter polymer with preformed SBH. Two samples of HDPE having different molar masses, and two samples of SBH with different melt viscosity and different microstructure, were used for preparing the blends. The two components and the compatibilizer were either blended in a single batch or used to prepare binary master blends to which the third component was added at a later stage. The results indicate that the PE-g-SBH copolymers do, in fact, compatibilize the PE–SBH blends and that the effect is more pronounced with the lower molar mass PE matrix and with the SBH sample having lower viscosity. The experiments carried out on blends prepared with different techniques show that the compatibilizing ability of the graft copolymer is improved if the latter is first blended with either of the two main components. © 1999 John Wiley & Sons, Inc. J Appl Polym Sci 71: 603–613, 1999

The mechanical properties of blends with liquid crystalline polymers are in general poor and lower than those expected on the basis of additivity rule because of the strong incompatibility between the flexible and rigid components. Compatibilization is then necessary to enhance the adhesion between the two phases and then to improve the final properties of these blends. The addition of maleic anhydride functionalized polymers could give rise to some compatibilization because of possible reactions between the maleic anhydride group and the end groups of the liquid crystalline polymers. These reactions do not seem to occur in blends of polyethylene and a semirigid liquid crystalline polymer. The small increase of viscosity and of some mechanical properties can be ascribed to the occurrence of polar interactions, such as hydrogen bonding between the components.

Fluoroelastomers (FEs) usually have working temperatures above 150 degrees C and a great resistance to aggressive agents such as oils, fuels, aliphatic and aromatic solvents, steam, moderate acid, and basic environments. Liquid crystal polymers (LCPs) can be effective processing aids and reinforcing agents for elastomers. These characteristics are very attractive to lower melt viscosity and to stiffen and strengthen the final product through a simple blending. Among the LCPs, the semirigid LCPs seem the most appealing for blending with flexible thermoplastics (FTs) because their processing temperatures can be arranged to be in the same processing temperature range of FTs and because the presence of flexible segments can improve the compatibility with the flexible matrix. This is very important especially for FEs that are subjected not only to mechanical degradation, but also to thermal degradation. Blends of FEs with two types of semirigid LCPs show easy processability and enhanced mechanical and thermomechanical properties. These improvements were observed both for pure FEs and for filled vulcanized systems. The improvement of the mechanical properties is below that expected on the basis of the additive rule due to the incompatibility between the components; nevertheless, an impressive increase of the elastic modulus, up to 40 times, was noticed by adding 20% of LCP. In vulcanized systems, the tensile strength is also increased, whereas the elongation at break is slightly reduced. The working temperature is also drastically increased both in vulcanized and in unvulcanized systems.

Reactive blends (50/50 w/w) of a low molar mass polyethylene containing free carboxylic groups (PEox) and a semiflexible liquid crystalline polyester (SBH 1 : 1 : 2, by Eniricerche) have been prepared at 240 degrees C in a Brabender mixer, in the presence of Ti(OBu)(4) catalyst, for different mixing times (15, 60, and 120 min). In order to prove the formation of a PE-g-SBH copolymer, the blends have been fractionated by successive extractions with boiling toluene and xylene. The soluble fractions and the residues have been analyzed by Fourier transform infrared (FTIR) spectroscopy, thermogravimetry (TG and DTG), differential scanning calorimetry (DSC), and scanning electron microscopy (SEM). All analytical procedures concordantly show that PE-g-SBH copolymers with different compositions, arising from differences of either the number of PEox carboxylic groups entering the transesterification or the length of grafted SBH branches, are formed as a result of blending. Depending on the relative content of PE and SBH segments, the copolymers dissolve in the solvents, together with any unreacted PEox, or remain in the residues, together with neat SBH. Qualitative IR analyses and quantitative TG measurements have shown that the amount of copolymers increases strongly with the mixing time. Preliminary SEM observations indicate that the unfractionated products of the reactive blending carried out with long (120 min) mixing times lead to improved interfacial adhesion and phase dispersion when added to PE/SBH blends.