Acta Bio Medica Atenei Parmensis <p>Expression of the Society of Medicine and Natural Sciences of Parma and Centre on Health System's Organization, Quality and Sustainability, Parma. Acta Bio Medica is now one of the few Italian generals reviewed publications on major international databases. Divided into sections on research, case studies and updated monograph, is a training tool for broad spectrum close to the most recent advances of modern medical science.</p> Mattioli 1885 srl en-US Acta Bio Medica Atenei Parmensis 0392-4203 Contact dermatitis due to transdermal therapeutic systems: a clinical update <p class="p1">Transdermal therapeutic systems (TTS) have become a popular method of drug delivery because they allow drugs to be delivered in a rate-controlled manner, avoiding first-pass metabolism and the fluctuating plasma concentrations encountered with oral medications. Unfortunately, TTS may provoke adverse skin reactions as irritating contact dermatitis and allergic contact dermatitis: TTS seem to be ideally suited to produce sensitization because they cause occlusion, irritation, due to the repeated placement of the allergen in the same skin location. Since TTS consist of an adhesive, an active pharmaceutical drug and enhancing agents, sensitization may develop owing to one of these three agents. The purpose of this manuscript is to review known responsible allergens of contact dermatitis due to TTS.</p> Paolo Romita Caterina Foti Gianfranco Calogiuri Stefania Cantore Andrea Ballini Gianna Dipalma Francesco Inchingolo ##submission.copyrightStatement## 2018-10-26 2018-10-26 90 1 5 10 10.23750/abm.v90i1.6563 Diagnostic techniques and multidisciplinary approach in idiopathic granulomatous mastitis: a revision of the literature <p class="p1">Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast that may mimic breast cancer. It is most common in parous young fertile women, although it can occur in nulliparous women and in men. IGM is an idiopathic disease due to the influence of some environmental factors in genetically predisposed subjects. Several pathogenic hypothesis have been proposed in the last years (autoimmune, hormonal, infective genesis). IGM presents as a painful palpable mass located in one of the two udders. The skin is usually normal but could present signs of inflammation with or without lymph nodes involvement. Ultrasonography, mammography, magnetic resonance can be diagnosed an IGM, but pathognomonic radiological signs has not yet reported in literature. Biopsy findings show granulomatous lesion centered on the breast lobule, as in granulomatous mastitis induced by tuberculosis or sarcoidosis. The aim of this review of literature is to verify the development of new advanced diagnostic techniques and multidisciplinary approach for this condition. In the last years innovative approaches have modified IGM diagnosis and therapy, avoiding surgery in most of cases, introducing a more conservative medical approach based on recent etiopathological hypothesis.</p> Carolina Maione Vincenzo Davide Palumbo Angela Maffongelli Giuseppe Damiano Salvatore Buscemi Gabriele Spinelli Salvatore Fazzotta Eliana Gulotta Giuseppe Buscemi Attilio Ignazio Lo Monte ##submission.copyrightStatement## 2019-01-23 2019-01-23 90 1 11 15 10.23750/abm.v90i1.6607 Public health and burnout: a survey on lifestyle changes among workers in the healthcare sector <p class="p1">Burnout Syndrome is a condition which could most commonly be associated with negative effects on the quality of work and life. Some occupations are more likely to suffer from this syndrome, for example workers in the health sector. This survey was therefore conducted among hospital workers of the Marche Region in order to analyze levels of Burnout and any possible correlation of these levels with lifestyle changes. Methods: The survey was carried out using a self-administered, anonymous questionnaire in two sections: the first consisted of the Maslach Burnout Inventory (MBI) and the second contained questions about the healthcare operator’s lifestyle. The MBI investigates levels of Emotional Exhaustion (EE), Depersonalization (DP) and finally of Personal Accomplishment (RP) in respondents. Survey results were processed using descriptive statistics, applying the Chi-square statistic and an Odds Ratio (p&lt;0.05). <em>Results:</em> 53.4% of the questionnaire was duly completed. The scale with the highest incidence among interviewees was Depersonalization. Even though the high-level percentage for the DP and EE scale was equal to 22.3%, when adding the high-level percentage to the medium level percentage, the difference between low and medium-high level was found to be around 20% for all areas. Analyzing the correlation between lifestyle choices, and in particular the consumption of alcohol and smoking with Burnout Syndrome, a statistically significant Odds Ratio was observed in the DP scale vs alcohol (OR=4.67), the RP scale vs cigarette smoke (OR=2.50), and finally in the EE area vs cigarette smoke (OR=2.92). <em>Conclusion:</em> Our results are in line with other studies which show increasing levels of EE and DP in healthcare workers. Healthcare workers who have been in the same job for a considerable amount of time (15+ years) show the highest levels of EE and DP. Subjects with high levels of Depersonalization show a worrying exposure to alcohol abuse, while those with high levels of Emotional Exhaustion tend to make use of both alcohol and tobacco, demonstrating negative lifestyle choices; in spite of this, results for personal accomplishment being relatively low and therefore not cause for worry, subjects still show high levels of exposure to cigarette smoke.</p> Fabio Petrelli Stefania Scuri Elisabetta Tanzi Cuc Nguyen Iolanda Grappasonni ##submission.copyrightStatement## 2018-11-28 2018-11-28 90 1 24 30 10.23750/abm.v90i1.7626 Plate fixation in periprosthetic femur fractures Vancouver type B1: preliminary report of macroscopic evaluation of the cement mantle and short literature review <p class="p1">he goal of our preliminary report is to investigate hip stem stability and intra-operative cement mantle integrity after screw insertion in plate fixation of periprosthetic Vancouver B1 femur fractures. From a cohort of 50 patients with a periprosthetic femur fracture treated in our department from February 2012 until February 2017, we included in our study patients with a periprostethic Vancouver B1 femoral fracture in cemented hip arthroplasty and hemiarthroplasty, operated with ORIF using a 4.5/5.0 LCP Proximal Femoral Hook Plate ® (Synthes, Switzerland) with at least one screw perforating the cement mantle. Anteroposterior and lateral femur views and pelvis X-rays were performed preoperatively. The stability of the hip implant and the cemented mantle integrity was evaluated intra-operatively in a macroscopic way and with a post-operative X-ray in anteroposterior and lateral views. Only 7 patients satisfied the inclusion criteria; no lesion/break of the cement mantle occurred intra-operatively at any step during drilling or screw insertion, also confirmed with C-arm assessment. No cases of stem mobilization were found and cement mantle integrity was maintained in every case. Insertion of screws around a cemented stem for plate fixation in periprosthetic femur fractures Vancouver type B1 could be considered a safe procedure. However, further and more extended studies are necessary for proving additional knowledge at the evaluation of the cement mantle in osteosynthesis procedures.</p> Luigi Bibiano Grigor Stamboltsyan Georgios Touloupakis Stefano Ghirardelli Elena Biancardi Giuseppe Edoardo Giovanni Longo Guido Antonini Cornelio Crippa ##submission.copyrightStatement## 2019-01-24 2019-01-24 90 1 31 36 10.23750/abm.v90i1.6544 Evaluation of alpha-1-antitrypsin levels in blood serum of patients with chronic obstructive pulmonary disease <p class="p1"><em>Introduction:</em> Chronic obstructive pulmonary disease (COPD) is a disease that causes obstructed air flow from the lungs. The disease also has a dramatic role in increasing rate of mortality and morbidity in recent years. Air pollution, long-term exposure to particulate matter and irritating gases, especially cigarette smoke, genetic inheritance which has an impact on the initial forced expiratory volume one in second (FEV<sub>1</sub>), and alpha-1-antitrypsin (AAT) deficiency are among common COPD risk factors. The objective of this study is to evaluate parameters and serum AAT levels in COPD patients. <em>Materials and Methods: </em>Having taken the approval of local ethical committee, this cross-sectional study was performed with adult patients diagnosed with COPD, whose serum AAT levels were measured through nephelometric analysis in Kars Harakani State Hospital where secondary health care is served. The study evaluated ATT levels in patients’ serum in relation to their age, gender, body mass (BMI), exposure to cigarette smoke, FEV<sub>1 </sub>percentage, hospitalization in pulmonology or intensive care unit through a year, mortality status, white blood cell (WBC), c-reactive protein (CRP) and blood gases. <em>Results: </em>The average age of the 243 patients included in the study was 68.41±11.52 and 160 (65.8%) of them were male. The age and BMI of the female patients were higher. Of the all patients only a single patient’s serum AAT level was below the reference value. AAT levels were similar in both genders irrespective of their being exposed to cigarette smoke or being discharged or being exitus at their first admission to hospital, being exitus in the first year of disease diagnose, and being hospitalized in intensive care unit. AAT levels were reasonably correlated with WBC and CRP in a positive way (p&lt;0.001 r=0.289 for WBC; p&lt;0.001, r=0.295 for CRP). AAT levels were seen to significantly increase along with COPD stages which go up with FEV<sub>1 </sub>percentages (p&lt;0.001). CRP was watched to have increased to Stage III COPD (severe COPD). However, it was watched to have decreased in Stage IV (very severe COPD) (p =0.179). <em>Conclusion:</em> In the study, AAT serum levels of COPD patients were examined. The levels and their relations in various parameters of the patients were evaluated.</p> Gökhan Perincek Sema Avcı ##submission.copyrightStatement## 2018-10-16 2018-10-16 90 1 37 43 10.23750/abm.v90i1.6780 Proposal of a study protocol of a preliminary double-blind randomized controlled trial. Verifying effects of selenium supplementation on selenoprotein p and s genes expression in protein and mRNA levels in subjects with coronary artery disease: selenegene <p class="p1"><span class="s1"><em>Background:</em> Selenium is the component of selenocystein amino acid, which itself is the building block of selenoproteins having diverse effects on various aspects of the human health. Among these proteins, selenoprotein P is the central to the distribution and homeostasis of selenium, and selenoprotein S as a transmembrane protein is associated with a range of inflammatory markers, particularly in the context of cardiovascular disease. It is known that selenium status outside of the normal range is considered to confer different benefits or adverse cardiovascular risk factors. Therefore, for the first time, we aimed to verify effects of Selenium supplementation on Selenoprotein P and S Genes Expression in Protein and mRNA Levels in Subjects with Coronary Artery Disease (CAD). <em>Methods:</em> This is the study protocol of a double blinded randomized clinical trial on 130 subjects with angiographically documented stenosis of more than 75% in one or more coronary artery vessels. In this 60-day study, 65 patients in each group received either a 200mg selenium yeast or placebo tablets once daily. During the study, subjects were followed by phone calls and visited our clinic twice to repeat baseline measurements. We hypothesized that our finding would enable a more basic and confirmed understanding for the effect of selenium supplementation by investigating its effect on gene expression levels in people with CAD. <em>Discussion:</em> Upon confirmation of this hypothesis, the beneficial effect of inflammation regulation by supplementation with micronutrients could be considered for subjects with CVD. </span></p> Mojgan Gharipour Masoumeh Sadeghi Mehrdad Behmanesh Mansour Salehi Hamidreza Roohafza Pouya Nezafati Elham Khosravi Mohsen Hosseini Mahtab Keshvari Hojat Rouhi-Bourojeni Nizal Sarrafzadegan ##submission.copyrightStatement## 2019-01-22 2019-01-22 90 1 44 50 10.23750/abm.v90i1.6167 Topical Fisionerv® is effective in treatment of peripheral neuropathic pain <p class="p1"><span class="s1"><em>Background:</em> Management of neuropathic pain (Neu P) is complex and difficult. Although there are several therapeutic options, treatment with Neu P is often inadequate, which led to undertreated patients. Thus, it would be desirable, for Neu P treatment, further multimechanistics approaches.<em> Objective: </em>The aim of the present study was to evaluate, in Neu P management, the effectiveness of “FISIONERV, a gel for topical use. <em>Setting:</em> This study was conducted in the “Rehabilitation Unit of N. Melli’s Hospital, Brindisi, Italy”. <em>Patients and intervention:</em> In this study a double- blind randomized controlled clinical trial was conducted over 8-week treatment on 58 outpatients affected by Neu P caused by lumbar sciatica or lumbar disk herniation and/or lumbar canal stenosis (31 subjects), or with carpal tunnel syndrome (27 subjects), randomly assigned to the following two groups: Group A; n=29, received (<em>fisionerv®</em> gel, 3 times/day) added to physiotherapy (forty minutes-daily session). Group B; n=29 received a vehicle gel (placebo, 3 times/day) added to physiotherapy (forty minutes-daily session). <em>Measurements:</em> Pain was assessed by a visual analogue scale (VAS). Neuropathic symptoms frequency (pain, burning, paraesthesiae and numbness) were scored at baseline and at the end of the treatment. Treatment compliance and safety were also evaluated. <em>Results: </em>Both groups experienced a significant reduction in VAS and neuropathic symptoms after 8-treatment weeks. However, a significant (p&lt;0.05) improvement was observed in group A (VAS mean 5.3 (1.10) with respect to group B (VAS mean=6.17 (0.80), already after 4 weeks of treatment. A further VAS reduction was recorded at 8 treatment weeks, with significant difference between the treatments (group A: VAS mean=1.89 (0.77); group B: VAS mean=3.79 (1.20) (<em>p</em>&lt;0.001). In addition, more patients of the group A, than in group B, reported an improvement of their neurophatc pain (<em>p</em>&lt;0.01). No adverse drug reaction was observed. Conclusion: Use of <em>fisionerv®</em>, in combination with physiotherapy, resulted a useful approach to NP treatment. <em>Clinical rehabilitation impact: </em>These preliminary observations suggest that some interesting goals (better pain control and physical wellbeing) could be achieved by a multimodal therapy in NP patients.&nbsp;</span></p> Angelo Tarullo Antonella Tarullo Emanuela Lacatena Luigi Santacroce Angelo Michele Inchingolo Giuseppina Malcangi Salvatore Scacco Margherita Fanelli Raffaele Cagiano Francesco Inchingolo Monica Caprio Gianna Dipalma Andrea Ballini Antonietta Clemente Alessio Danilo Inchingolo Francesco Girolamo Maria Tattoli ##submission.copyrightStatement## 2019-01-24 2019-01-24 90 1 51 55 10.23750/abm.v90i1.6305 Physicians’ perception of the importance of ethical and deontological issues in a major Italian Province: pilot questionnaire and its validation <p class="p1"><span class="s1"><em>Background and aim: </em>This study aims at validating a questionnaire on physicians’ knowledge and perception of deontological and ethical rules that guide the medical profession, in a major Italian Province. <em>Methods: </em>We designed an on-line survey questionnaire. Participants (N=200) were asked to fill in information regarding their demographic features and knowledge of the deontological code. <em>Results:</em> Concerning the preliminary data, the median total score on knowledge of the deontological code was 0.50. A significant difference in the total score was observed among education groups. Specifically, the median total score among subjects with a specialist qualification was significantly lower than among those with only a medical degree. <em>Conclusions: </em>The tested instrument and methodology appear to be efficacious and reliable. Our preliminary data indicate that knowledge of the rules concerning medical deontology and the related principles of medical ethics seems to be very limited. Therefore, the authors plan to implement a second phase of the study, which will consist of the questionnaire’ distribution to a broader and more representative sample.</span></p> Rosagemma Ciliberti Ilaria Baldelli Fabio Gallo Sara Patuzzo Francesco De Stefano Alessandro Bonsignore ##submission.copyrightStatement## 2019-01-21 2019-01-21 90 1 56 67 10.23750/abm.v90i1.7647 Suicide in the elderly: a 37-years retrospective study <p class="p1"><em>Background:</em> The rates of suicide increase with age and reach their highest levels in the oldest age groupings and are sufficiently large for them to constitute a public health concern. The number of deaths due to suicides after the age of 60 years in Italy is 1,775 (41.36%) in 2013; there is a constant increase of elder population over the last ten years and elderly are almost twice of young. It is in this context that suicide arises, a risk factor during old age. <em>Method</em>: This is a retrospective study of autopsy and police reports of suicide from January 1979 through December 2015. Data about suicides after the age of 60 years was collected from the Archives of the Legal Medicine of the University of Parma, a Northern Italian city. Trend and characteristics (age, sex, marital status, pathological factors and method of suicide) were assessed. <em>Results:</em> A total of 538 cases (394 males, 144 females) were identified. Male sex correlates to a higher suicidal risk, with a male-female ratio of 2.74:1. The highest risk of suicide is observed in the age between 70 and 79 years. Pathological factors were revealed in 427 cases (physical state for 194 cases, mental state for 233 cases); mental illness was related significantly to suicidal risk. Hanging is the most common suicide method (175 cases), followed by fall from height (130 cases), drowning (101 cases) and use of firearms (56 cases); differences regarding methods employed were detected between males and females. The choice of method sometimes is indicative of a clear decision, while other times it is strictly linked to the availability of the means. <em>Conclusions:</em> Suicidal behavior seems to be the product of the interaction of many factors, such as biological or psychological diseases or painful events. The presence of chronic and debilitating diseases, often accompanied by profound psychological suffering, is a powerful stimulus for suicide among men, whereas mental state is a significant risk factor for women, with the majority suffering from depression. The psychological and the biological changes, the cognitive deficits and the common diseases facilitate the structuring of depressive characteristics.</p> Carlo Crestani Vittoria Masotti Natalia Corradi Maria Laura Schirripa Rossana Cecchi ##submission.copyrightStatement## 2019-01-22 2019-01-22 90 1 68 76 10.23750/abm.v90i1.6312 Single center evidence for the treatment of basal cell carcinoma of the head and neck <p class="p1"><em>Aim:</em> Basal Cell Carcinoma (BCC) alone accounts for 80% of cases of non-melanoma skin cancer (NMSC), which characteristically develops on sun-exposed skin. Indeed the most common site of BCC is the head and neck region (80%). The purpose of this study to review the experience of our center with BCC in the head and neck region to report the sites of occurrence and treatment. <em>Materials and method:</em> We retrospectively reviewed 77 patients with BCC of the head and neck, who revived surgical treatment within our plastic surgery division. Basic demographic data, cancer site and size, surgical treatment and histological data were collected. The mean follow-up period was 12 months. <em>Results:</em> The study population included 37 males and 40 females, with a mean age of 74.12 years. The nasal unit was the main site of BCC (31.82%), followed by the periorbital (13.64%) and cervical (12.5%) units. Primary closure was the main surgical procedure performed (72.5%), followed by local flap (26.1%) and full-thickness skin grafts (1.4%). The safety resection margin ranged from 4.5 to 9 mm, with a 98.7% complete removal rate. Neither recurrence nor any newly-developed lesions were reported during follow-up in any patient. <em>Discussion:</em> Our work reflects the shift in the incidence of BCC, which now seems to be more frequent in females. Furthermore, our data strengthens the association between UVR exposure and BCC, confirms its predilection to occur on the nasal unit and validates surgical excision as the gold standard treatment for skin cancer.</p> Nicolò Bertozzi Francesco Simonacci Michele Pio Greco Eugenio Grignaffini Edoardo Raposio ##submission.copyrightStatement## 2019-01-22 2019-01-22 90 1 77 82 10.23750/abm.v90i1.6395 European university students of pharmacy: survey on the use of pharmaceutical drugs <p class="p1"><em>Background and aim:</em> In recent years, self-medication is an increasing public health issue, also among the European young people. Only 48% of people throughout the world use prescribed medications, while the remainder admits that they self-medicate with over the counter drugs or leftover prescribed drugs. Also, the risk of antibiotic resistance, throughout the world, has doubled, due to the recourse to these drugs when they are not called for, or to failure to follow their instructions for use. <em>Methods:</em> A five-part questionnaire, translated into the national languages and validated, was given to Pharmacy students in Italy, Spain, the Czech Republic and Romania obtain anonymous information about their pharmaceutical drugs use. <em>Results:</em> Regarding the use of pharmaceutical drugs, students in Spain and Romania indicated the highest percentages of use. In Italy and Romania, the pharmacist is rarely consulted, while the advice of family members or friends is more frequently requested. In all four countries the problem of taking antibiotics without a medical prescription is significant, and 50% of Romanian students use antibiotics to treat the flu. Another important result is that, in Spain, 38.4% of the respondents admitted to using medicines with alcohol. <em>Conclusions:</em> Considering that the drug information leaflet is not read by 50% of young people interviewed, it would be important for public health entities to instruct the population, especially younger age groups such as secondary school students, about the importance of reading this information carefully. The use of mass media in such a preventive medicine campaign could be effective.</p> Stefania Scuri Fabio Petrelli Elisabetta Tanzi Cúc Nguyễn Thi Thu Iolanda Grappasonni ##submission.copyrightStatement## 2019-01-23 2019-01-23 90 1 83 91 10.23750/abm.v90i1.7572 Sleep disturbance and response to surgical decompression in patients with carpal tunnel syndrome: a prospective randomized pilot comparison of open versus endoscopic release <p class="p1"><em>Background:</em> Sleep disturbance is a common complaint of patients with carpal tunnel syndrome (CTS). While carpal tunnel release (CTR) surgery has been shown to relieve subjective sleep-related complaints, data is lacking on the global effect on sleep using validated sleep measures. Additionally, it is not known if open (OCTR) or endoscopic release (ECTR) produce differing degrees of sleep-symptom relief. <em>Methods: </em>Sixty patients were randomly allocated to undergo either OCTR (n=30) or ECTR (n=30) surgery. Forty-three (71.7%) of the patients were female, and mean age of all patients was 49.4 years (range, 35-78). Prior to surgery, patients were administered three baseline self-reported outcome measures: the Pittsburgh Sleep Quality Index (PQSI), the Insomnia Severity Scale (ISI) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) survey, which were subsequently administered at three postoperative time points: 1-2 weeks, 4-6 weeks and 6-12 months. <em>Results:</em> All 60 patients experienced significant improvements in the three outcome scores by their first postoperative visit compared to preoperatively. ECTR provided superior improvement to OCTR at the first postoperative visit for ISI (<em>P</em>=0.006) and PSQI (<em>P</em>=0.016), and at the second visit for PSQI (<em>P</em>=0.0038). There were no significant differences between the two groups for the QuickDASH at any time points, or for the ISI/PSQI at the final follow-up. <em>Conclusion:</em> Endoscopic and open CTR both improve sleep symptoms postoperatively in the short-term which is sustained for 6-12 months, although endoscopic CTR does so more rapidly.</p> Michael Patrick Gaspar Meredith N Osterman Eon K Shin Arthur Lee Osterman Patrick M Kane ##submission.copyrightStatement## 2019-01-22 2019-01-22 90 1 92 96 10.23750/abm.v90i1.6474 Prevalence and correlations of hepatorenal functions in diabetes and cardiovascular disease among stratified adults <p><strong><em>Background</em></strong>: The vulnerability of older adults to diabetes and cardiovascular complications is a global concern. Hepatorenal pathophysiology is implicated in these complications, but has yet to be clearly established, especially from rural low-mid income countries. This study investigates differences in prevalence of diabetes in aging groups and correlations of age with hepatorenal variables.</p> <p><strong><em>Methods</em></strong>: 203 participants of both sexes above the age of 18 years underwent anthropometric measurements at Catholic Hospital, Abbi, Nigeria. Questionnaires collected demographic information and medical history. Urinalysis as well as routine liver and renal function tests were performed. Data analysis included determination of levels of hepatorenal abnormalities and prevalence of diseases in age groups. Percentage of disease subpopulations made up by each age-group was also determined as well as Pearson’s correlation coefficient between age and hepatorenal variables, and comparison of average age and hepatorenal variables in disease subgroups.</p> <p><strong><em>Results</em></strong>: Percentage hepatorenal abnormalities are not significantly different between age-groups. There is no significant difference in percentage level of disease between groups, but in age-groups constituting disease sub-populations (p&lt;0.00001). The apparently healthy subpopulation comprises of younger adults compared to older adults constituting diabetes and hypertension (p &lt; 0…). Age shows moderate correlation with renal function parameters, especially urea and chloride (r = 0.42), but relatively insignificant with liver function variables.</p> <p><strong><em>Conclusion</em></strong>: This report affirms that diabetes cardiovascular co-morbidity comes with aging.&nbsp; It also indicates that renal pathophysiology may be more associated, than liver, functions in the vulnerability of adults.</p> Ezekiel Uba Nwose Joshua Obianke Ross Stuart Richards Phillip Tederera Bwitit Eunice Obiajuru Igumbor ##submission.copyrightStatement## 2019-01-22 2019-01-22 90 1 97 103 10.23750/abm.v90i1.6576 Charcot-Marie-Tooth disease with pyramidal features due to a new mutation of EGR2 gene. <p class="p1"><em>Background and aim of the work:</em> Childhood-onset peripheral neuropathies are often of genetic origin. Charcot-Marie-Tooth (CMT), is considered the commonest neuromuscular disorder. Due to its high clinical heterogeneity, especially in the pediatric age, the co-existence of central and peripheral symptoms and signs does not necessarily rule out a diagnosis of hereditary peripheral neuropathy. <em>Methods:</em> We describe the clinical, neurophysiological and genetic findings in a teen-age patient evaluated for acquired toe-walking and progressive difficulties in walking since the age of 5. Genetic testing was carried out with a targeted NGS panel. Identified variants are analyzed using Variant Studio program (Illumina). Rare variants and variants considered as pathogenic were analyzed by Sanger direct sequencing. <em>Results:</em> The coexistence of peripheral and pyramidal signs in the lower limbs, the absence of a significant pre/perinatal history, the unremarkable brain and spine MRI, together with the presence of a sensory-motor polyneuropathy in all four limbs, prompted the execution of genetic investigations with an NGS panel covering hereditary spastic paraplegias, motor neuron disease and Charcot-Marie-Tooth. We identified a previously undescribed variant (c.1142G&gt;T, p.Arg381Leu) in the <em>EGR2</em> gene. <em>Conclusions:</em> <em>ERG2</em> gene has been described as a cause of various phenotypes, including a rare autosomal dominant form of CMT (CMT type 1D) representing approximately 1% of all CMT subgroups. We describe a novel pathogenic variant in <em>EGR2</em> gene leading to the development of a complex association of peripheral and central neurological signs, underscoring the genetic and clinical heterogeneity of hereditary neuropathies of pediatric onset.</p> Carlo Fusco Carlotta Spagnoli Grazia Gabriella Salerno Elena Pavlidis Daniele Frattini Francesco Pisani Maria Teresa Bassi ##submission.copyrightStatement## 2019-01-24 2019-01-24 90 1 104 107 10.23750/abm.v90i1.6951 Spontaneous iliopsoas hematoma in a trasfusion dependent β-thalassemia patient with hypersplenism: a case report <p class="p1">A 27-year-old married man with transfusion dependent <span class="s1">β</span>-thalassemia (TDT) complaining low back pain due to a spontaneous iliopsoas hematoma is reported. A magnetic resonance imaging (MRI) confirmed the diagnosis.The patient was managed conservatively. The mechanism of spontaneous iliopsoas hematoma was unclear, although tearing of muscle fibers, unrecognized minor trauma, low platelet count, secondary to hypersplenism, and severe liver iron overload, associated to abnormalities of clotting factors synthesis, were the suspected etiologies.<span class="Apple-converted-space">&nbsp; </span>He showed a good response to treatment and was discharged home 11 days later. A new MRI, performed 7 months later, showed a complete resolution of hematoma. Although iliopsoas haematoma is an uncommon complication in patients with TDT, it should be considered in the differential diagnosis of a patient with back pain.</p> Aishwariya Padmakumari Mohammed Talat Ashraf Soliman Vincenzo De Sanctis Abdulqadir Nashwan Mohamed A Yassin ##submission.copyrightStatement## 2018-12-04 2018-12-04 90 1 107 111 10.23750/abm.v90i1.7943 Megarectosigmoid in anorectal malformations: the role of laparoscopic resection <p class="p1">Surgical treatment for anorectal malformations may lead to chronic constipation or stool incontinence. The first condition is mostly linked to an abnormal dilation of rectum and sigma and it is primarily managed with medical therapy (laxatives, diet and enemas). When medical therapy fails to improve the symptoms, a surgical resection of the dilated colon is advocated. When performing the procedure it is mandatory to consider all the previous operations the patient undergone. We present a laparoscopic left emicolectomy for an extremely dilated megarectosimoid after posterior sagittal anorectoplasty in childhood for a recto-urethral fistula.</p> Giorgio Dalmonte Maria Teresa Mita Laura Lombardi Alberto Attilio Scarpa Carmine Del Rossi Stefano Cecchini Federico Marchesi ##submission.copyrightStatement## 2019-01-24 2019-01-24 90 1 112 115 10.23750/abm.v90i1.7004 Triradiate cartilage fracture of the acetabulum treated surgically <p class="p1">Fractures of the acetabulum are rare in the pediatric age and may be complicated by the premature closure of the triradiate cartilage. We report a case of triradiate cartilage displaced fracture treated surgically. A 14 years old boy, following a high-energy road trauma, presented an hematoma in the right gluteal region with severe pain. According to radiographic Judet’s projections was highlighted a diastasis of the right acetabular triradiate cartilage.<span class="Apple-converted-space">&nbsp; </span>CT scan study with 2D-3D reconstructions confirmed as type 1 Salter-Harris epiphyseal fracture. Due to the huge diastasis of the triradiate cartilage, the patient was operated after 72 hours through a plating osteosynthesis. We decided during the preoperative study that the plates should not be removed. Two years after surgery, the patient is clinically asymptomatic; the radiographic evaluation shows a complete cartilage’s fusion and the right acetabulum is perfectly symmetrical to the contralateral. For the treatment of acetabular fractures in pediatric age should be carefully evaluated fracture’s pattern, patient’s age, skeletal maturity’s grade, acetabulum’s volume and diameter.</p> Mauro Spina Valentina Luppi Jacopo Chiappi Francesco Bagnis Guido Rocca ##submission.copyrightStatement## 2019-01-18 2019-01-18 90 1 116 121 10.23750/abm.v90i1.7263 Endovascular repair of an abdominal aortic aneurysm using bifurcated stent-graft in a patient with bilateral external iliac artery occlusion <p class="p1">Abdominal aortic aneurysm (AAA) in association with external iliac artery (EIA) occlusion is a rare entity which may limit endovascular aortic aneurysm repair (EVAR) feasibility. We describe the case of an 84-year-old man affected by a 64mm infrarenal inflammatory abdominal aortic aneurysm with complete bilateral occlusion of EIA and patency of both common and internal iliac arteries. The common femoral arteries (CFA) were patent, and the patient was asymptomatic for lower limb claudication. The treatment was performed by EVAR using a bifurcated stent-graft after the recanalization of the left EIA, achieving technical success.</p> Bilal Nabulsi Claudio Bianchini Massoni Tiziano Tecchio Alessandro Ucci Giulia Rossi Paolo Perini Matteo Azzarone Alessandro De Troia Antonio Freyrie ##submission.copyrightStatement## 2019-01-24 2019-01-24 90 1 122 126 10.23750/abm.v90i1.6605 Forty years (1978-2018) of vaccination policies in Italy <p class="p1">The paper traces the evolution of vaccination policies in Italy in the first 40 years of the National Health Service. Four phases have been identified: the first (1978-98) characterized by the eradication of smallpox, the hopes of further eradications and the introduction of hepatitis B and acellular antipertussis vaccines; the second (1999-2008) coincided with the first national vaccination plans and with the hypothesis of a progressive transition from mandatory vaccinations to nudging initiatives with the relevant experimentation in the Veneto Region; the third phase (2009-14) was characterized by the spread of health information on the web and social networks, by anti-scientific judgments and by an increasingly vaccines hesitancy that led to incorrect perceptions, falls in coverage rates and re-ignition of some epidemics; in the last phase (2015-18) there was a strong political committment that led to the approval of the National Plan (PNPV) 2017-19, to the extension of the mandatory vaccinations and to the sanctions against the anti-vaxxers doctors. This has led to a rapid rise in coverage, but also to a heated political and media debate on the ethical and social aspects linked to the admission bans and sancions of unvaccinated children in schools.</p> Carlo Signorelli ##submission.copyrightStatement## 2019-01-09 2019-01-09 90 1 127 133 10.23750/abm.v90i1.7900 The juvenile fibromyalgia syndrome (JFMS): a poorly defined disorder <p class="p1">Juvenile fibromyalgia syndrome (JFMS) is a chronic condition characterized by symptoms of chronic diffuse musculoskeletal pain and multiple painful tender points on palpation. It is often accompanied by fatigue, disorders of sleep, chronic headaches, irritable bowel syndrome, and subjective soft tissue swelling. The complexity of the presenting clinical picture in JPFS has not been sufficiently defined in the literature. Similarities to adult fibromyalgia syndrome in JFMS are often difficult to compare, because many of the symptoms are “medically unexplained” and often overlap frequently with other medical conditions. However, a valid diagnosis of JFMS often decreases parents’ anxiety, reduces unnecessary further investigations, and provides a rational framework for a management plan. The diagnostic criteria proposed by Yunus and Masi in 1985 to define JFMS were never validated or critically analyzed. In most cases, the clinical diagnosis is based on the history, the physical examination that demonstrates general tenderness (muscle, joints, tendons), the absence of other pathological conditions that could explain pain and fatigue, and the normal basic laboratory tests. <span class="s2">Research and clinical observations defined that JFMS may have a chronic course that impacts the functional status and the psychosocial development of children and adolescents.</span> This paper briefly reviews the existing knowledge on JFMS focusing on the diagnosis, clinical and the epidemiological characteristics in children and adolescents for better understanding of this disorder.</p> Vincenzo de Sanctis Vincenzo Abbasciano Ashraf T Soliman Nada Soliman Salvatore Di Maio Bernadette Fiscina Christos Kattamis ##submission.copyrightStatement## 2019-01-23 2019-01-23 90 1 134 148 10.23750/abm.v90i1.8141 Clinical manifestations, evaluation and management of hyperprolactinemia in adolescent and young girls: a brief review <p class="p1">Hyperprolactinemia (HPrl) is considered as a rare endocrinopathy in childhood. In children and adolescent girls, there are three major categories of HPrl causes; physiological, pathological and iatrogenic. Through hypogonadotropic hypogonadism, prolactin hypersecretion and production leads to the typical functional syndrome which is observed in female children and adolescents; delayed puberty, primary or secondary amenorrhea and/or galactorrhea. Regarding prolactinomas, clinical signs manifest with mass compression of the optic chiasm and anterior pituitary gland or prolactin hypersecretion. Targeted identification of HPrl is of significant importance for proper management and follow-up. The aim of this review is to focus on the evaluation of HPrl in adolescent and young girls. In addition, we aimed to summarize the current knowledge regarding the proper management of such cases.</p> Michail Matalliotakis Ioannis Koliarakis Charoula Matalliotaki Alexandra Trivli Eleftheria Hatzidaki ##submission.copyrightStatement## 2019-01-23 2019-01-23 90 1 149 157 10.23750/abm.v90i1.8142 The experience of a tertiary unit on the clinical phenotype and management of hypogonadism in female adolescents and young adults with transfusion dependent thalassemia <p class="p1"><em>Background:</em> Transfusion-dependent <span class="s1">β</span>-thalassemia (TDT) is associated with several complications necessitating a multidisciplinary approach for diagnosis, treatment and follow-up. Hypogonadism in female TDT patients is one of the most common endocrine complications, requiring hormone replacement therapy (HRT) throughout reproductive life. Little is known about the balance of benefits versus risks of treatment with sex steroids. <em>Aim: </em>The aim of this manuscript is to review the action and the associated adverse effects of HRT in hypogonadal TDT females. <em>Design:</em> Retrospective medical database records from a single centre, over a period of 38 years (January 1980 to June 2018), were reviewed. <em>Study population:</em> Forty-two cases of hypogonadism in TDT females followed in a pediatric and adolescent outpatient clinics, were in included in the study. <em>Methods:</em> Auxological, clinical, laboratory, hormonal and imaging investigations were reviewed, as well as all adverse events registered during HRT. <em>Main results:</em> In general, HRT was safe for most patients. There were few minor side effects and a couple of rare but serious adverse events. <em>Conclusions:</em> The study provides a representative clinical profile of long-term effects of HRT in hypogonadal adolescents and young adult TDT women. Our results highlight also the need for further research in other areas for which HRT may have a role.<span class="Apple-converted-space">&nbsp; </span>We hope this will contribute to a wider understanding, and potential improvement, of patient safety and quality of life.</p> Vincenzo De Sanctis Ashraf T Soliman Shahina Daar Salvatore Di Maio Mohamed A Yassin Duran Canatan Joan-Lluis Vives Corrons Heba Elsedfy Antonios Kattamis Christos Kattamis ##submission.copyrightStatement## 2019-01-23 2019-01-23 90 1 158 167 10.23750/abm.v90i1.8143 Computer-assisted surgery in total knee replacement: advantages, surgical procedure and review of the literature <p class="p1"><em>Introduction:</em> Total knee replacement (TKR) is one of the most frequent orthopaedic procedures performed every year. At the same time 20% of patients who underwent TKR are not satisfied with the outcome. The reasons are unknown; we think that a mechanical alignment beyond 3° of varus-valgus can represent the most important cause of failure of TKR and consequently patient dissatisfaction. <em>Materials and Methods:</em> Neutral mechanical alignment is the main goal in every TKR: this can be achieved through different tools, such as extramedullary and intramedullary guides, patient-specific instrumentation (PSI) and computer-assisted surgery (CAS). The aim of this review is to compare the different alignment techniques in TKR, to describe CAS procedure and CAS results in recent literature. <em>Results:</em> Regarding the intramedullary guide, there is an increased risk of fatty embolism; there are great limitations on its use, or even impossibility, in cases of bone deformity and sequelae of trauma. Regarding the extramedullary guide, it becomes more difficult to use in cases of great obesity or increased soft-tissue volume around the tibia. PSI for TKR has been introduced to improve alignment, reduce outliers, operation time and the risk of fatty embolism by avoidance of intramedullary canal violation. Recent randomized controlled trials and meta-analysis proved no advantage of PSI in improving mechanical axis and implant survivorship. <em>Discussion:</em> CAS has provided to be a useful tool in assisting the surgeon to achieve more accurate post-operative mechanical axis through precise and reproducible bone cuts and ligament balancing. Two meta-analyses definitively proved that CAS technique improves mechanical axis and implant survivorship and one recent meta-analysis demonstrated that CAS provides better mechanical alignment and higher functional scores at short-term follow-up.</p> Norberto Confalonieri Alessio Biazzo ##submission.copyrightStatement## 2019-01-22 2019-01-22 90 1 16 23 10.23750/abm.v90i1.6319 Pros and Cons in General Medicine and Geriatrics - 2018 <p>.</p> Domenico Cucinotta ##submission.copyrightStatement## 2019-02-07 2019-02-07 90 1 168 173 10.23750/abm.v90i1.8191