Effects of ZnO nanoparticles in the Caspian roach (Rutilus rutilus caspicus).

Most studies investigating the toxicity of zinc oxide nanoparticles (ZnO NPs) focused on the effect of size, whereas exposure concentration and duration remained poorly understood. In this study, the effect of acute and sub-acute exposures of ZnO NPs on Zn compartmentalization and biomarkers' expression were investigated in Rutilus rutilus caspicus (Caspian roach) considering various exposure scenarios: i) the assessment of the concentration-response curves and median lethal concentration (LC50); ii) the assessment of the effects of organisms exposed at LC50 value and one tenth of LC50 value of ZnO NPs suspensions for 4 d and 28 d, respectively; iii) the assessment of 14 d depuration period. The same concentrations of ZnSO4 were investigated. The highest Zn accumulation was detected in gill after sub-acute exposure (4.8 mg/L; 28 d) followed by liver, kidney and muscle. In gill, liver and muscle, Zn from Zn NPs accumulated higher concentrations. Depuration (14 d) decreased Zn content in each organ, but no complete removal occurred except for muscle. Biomarkers' activity was significantly over expressed after treatments, but depuration brought back their values to background levels and most effects were related to acute concentrations (48 mg/L; 4 d) and in presence of ZnSO4. Histopathological analyses showed that the exposure to ZnO NPs increased lesions in gill, liver and kidney, with a direct proportionality between alterations and Zn accumulated in the target organs. After depuration, lesions regressed for both ZnO NPs and ZnSO4, but not in a complete way. These data could contribute to increase the knowledge about ZnO NPs risk assessment in aquatic vertebrates, suggesting that the size of ZnO NPs can influence biomarker and histopathological effects.

An assessment of contamination of the Fusaro Lagoon (Campania Province, southern Italy) by trace metals.

The Fusaro Lagoon is a shallow lagoon, located in SW Italy, largely influenced in the last decades by several anthropic impacts. The study examined the pollution status of the lagoon, during year 2011-2012 at nine sampling stations with the aim to find out proper measurements of water lagoon restoration. Concentrations of heavy metals (HMs) (aluminium [Al], barium [Ba], cadmium [Cd], copper [Cu], iron [Fe], manganese [Mn], vanadium [V] and zinc [Zn]) were examined in water, sediments and specimens of the ascidian Ciona intestinalis sp. A. Low levels of dissolved oxygen concentration were detected at many stations, with mean values of 5.2-6.4 mg L(-1). The redox potential of surface waters was also low, -2.7 to 50.7 mV. Sediments possessed high organic matter content, 17.7-29.4%. In sediments, the mean Zn level, 251.4 mg kg(-1), was about sixfold higher than that recorded in year 2000 (38.5 mg kg(-1)) and considerably higher than that recorded in 2007 (191 mg kg(-1)). The mean levels of Cd were outstandingly high, with a mean value of 70.5 mg kg(-1), about 30- and 50-fold higher than those determined in 2000 and 2007, respectively. Cadmium (Cd), Cu and nickel (Ni) appeared in excess with respect to most current guidelines, reaching significant pollution levels. C. intestinalis sp. A was detected only at few stations, with metals accumulated preferentially in the body in respect to the tunic, from 1.2 times for Zn (178 mg kg(-1)) to 4.0 times for V (304 mg kg(-1)). Data suggests the necessity of an immediate action of eco-compatible interventions for environmental restoration.

Occurrence of toxigenic Clostridium difficile in edible bivalve molluscs.

Clostridium difficile is an anaerobic bacterium commonly considered to be responsible for antibiotic-associated gastrointestinal diseases, ranging from diarrhea of varying severity to pseudomembranous colitis. The aim of this study was to assess the occurrence of C. difficile in marine edible bivalve molluscs, which, as filter feeding organisms, are able to accumulate particles suspended in water, including microorganisms. Samples of Mytilus galloprovincialis, Tapes philippinarum, and Venus verrucosa were collected from mussel farms and fishmongers in the province of Naples (Southern Italy). C. difficile was found in 49% of the 53 samples investigated. Sixteen isolates were grouped in 12 known different PCR ribotypes (001, 002, 003, 010, 012, 014/020, 018, 045, 070, 078, 106, and 126), whereas 10 additional isolates were grouped in 8 new PCR riboprofiles. Two toxinotypes (0 and V) were found. Fifty eight percent of the isolates were toxigenic. These findings indicate that toxigenic C. difficile strains can be isolated in bivalve molluscs. Marine filter feeding organisms, therefore, may be considered as reservoir of toxigenic strains of C. difficile. The ingestion of raw or poorly cooked contaminated seafood and the high temperature resistance of the spore-forming C. difficile could represent an important source of exposure and pose human health concern.

Isolation and characterization of Clostridium difficile from shellfish and marine environments.

This pilot study was carried out to evaluate the occurrence of Clostridium difficile in marine environments and in edible shellfish. Samples of seawater, sediment, and zooplankton were collected at five sampling stations in the Gulf of Naples. Six samples of edible shellfish, furthermore, were obtained: two from mussel farms and four from wholesalers. The isolation and the characterization of C. difficile strains were carried out using selective media and molecular techniques, respectively. C. difficile was isolated from nine of the 21 samples investigated. Shellfish and zooplankton showed the highest prevalence of positive samples. No C. difficile was detected in marine sediment. Majority of the C. difficile isolates were toxin A/B positive. Six known different PCR ribotypes (003, 005, 009, 010, 056, and 066) were identified, whereas one strain may represent a new PCR ribotype. C. difficile may be present in the marine environment in Southern Italy, including shellfish and zooplankton. This study is reporting the isolation of C. difficile from zooplankton, clams, and mussels and pointing out a new possible route to exposure to C. difficile of healthy individuals in the community.

Dislocation of a fractured mandibular condyle into the middle cranial fossa: a case treated by an extracranial approach.

INTRODUCTION: Penetration of the mandibular condyle into the middle cranial fossa is a rare complication usually due to blunt traumas to the chin. Particular anatomical and dynamic conditions can lead to the intracranial dislocation of the condyle in spite of the fracture of the condylar neck that usually prevents this event from dissipating the kinetic force of the impact. DISCUSSION: We report the case of a 10-year-old female patient suffering from symphyseal and bilateral condilar fracture with intrusion of the left condyle into the middle cranial fossa. The diagnosis of intracranial dislocation was initially missed because of the nonspecific symptomatology and insufficient radiologic data provided by conventional investigations (plain X-rays and panoramic views). The persistence of the limitation of the mouth opening and the worsening of the preauricular pain with irradiation to the temporal region led us to perform further radiological investigations (computed tomography scan and magnetic resonance imaging) that revealed the intracranial complication. A successful removal of the displaced condyle was carried out through an extracranial approach, and at a 3-year follow-up temporomandibular joint function is satisfactory. CONCLUSION: The case is reported to emphasize the need for careful radiological investigation in case of condylar fractures and the effectiveness of the extracranial route to surgically treat these rare complications.

Submento-submandibular intubation: is the subperiosteal passage essential? Experience in 107 consecutive cases.

Adequate treatment of panfacial injuries often requires tracheostomy or alternating intubation through the nose and the mouth to keep the field free during the operation. Altemir's submental technique is an attractive option in these patients. We used the method with a slight modification in 107 operations in our unit to treat panfacial injuries. We had a low rate of complications and no increased operative time.

The Elastic Internal Traction (EIT): an effective method to reduce the displaced facial fractures.

Open reduction and rigid fixation are commonly used to treat displaced fractures of the facial skeleton. Manual reduction can be performed by means of forceps or transosseus wires to close the bone fragments. In order to reduce facial fractures, we used a technique, called Elastic Internal Traction (EIT), based on the elastic action of rubber bands stretched between screws placed on both sides of the fracture line. We have used EIT in 104 patients suffering from mandibular fractures, and 40 cases of patients with orbito-maxillary complex fractures out of the 707 patients treated for trauma between July 2000 and August 2002 at our hospital. In our opinion, this technique provides an effective reduction and a stable primary fixation of the bone before the final fixation. It also has the advantage that the surgical field is clear of the assistant's hands and surgical instruments that are usually used to lock the reduction. The resulting operative time is shortened, and the plating of the bone is simplified.

Extradural hematomas in children.

BACKGROUND: Extradural hematomas are rate complications of head injures in children often resulting from minor head traumas. Therefore the management of these ordinary traumas remains controversy since in many asymptomatic cases the intracranial bleeding is detected only by CT scan. METHODS: During the study period between January 1991 and September 1995 sixty-one patients ranging in age from 5 months to 12 years were operated on for epidural hematomas. They represent about the 3% of all patients admitted for head injury in the same period in our Division. According to the age, children were divided in three groups (G1, G2, G3). Males predominate over females in each group of age. The mechanism of injury, the clinical findings, the neurological assessment on admission, the site of hematoma and the presence of skull fracture were examined in order to identify clinical and diagnostic parameters predicting developing intracranial complications. RESULTS: The most common cause of head trauma was accidental falls in children under 5 years of age. Otherwise bicycle, pedestrian and car accidents are the main type of injury in older patients. A skull fracture was identified in 49 cases with a homogeneous distribution among the groups of age. Recurrent vomiting was found in about 70% of cases. A loss of consciousness was frequently reported (78%) in older children. Outcome mainly depended on Glasgow or Children Coma Score on admission. In our series the overall mortality rate was 4.9%. CONCLUSIONS: Our data according with the literature suggest that localized skull traumas, suspected fractures, a loss of consciousness after trauma and recurrent vomiting can be recommended as indications for intracranial complications.

Occipital remolding for correction of scaphocephaly in the young infant. Technical note.

BACKGROUND: Several surgical techniques have been described for correction of scaphocephaly. Recent advances in the field of craniofacial surgery have allowed more extensive operative procedures for the treatment of cranial vault anomalies. In general the aim of surgical treatment is to prevent early refusion of the parietal bones after the sagittal craniectomy associated with the widening of the biparietal diameter. In children older than 6 months these procedures may result unsatisfactory providing only a partial correction of the malformation. Therefore operative techniques of total cranial vault reshaping are reported in the literature. METHODS: We performed a surgical procedure of biparietal widening and occipital remolding in eight 3 month old infants with a marked deformation of the occipital prominence from sagittal synostosis. RESULTS: This technique has provided excellent cosmetic results with an immediate correction of the parieto-occipital malformation. There have not been intraoperative complications and the postoperative course was uneventful. CONCLUSIONS: The occipital remolding is useful in young infants with a marked skull deformity; this technique will produce immediate restoration of an esthetically pleasing cranial shape and a more satisfactory cosmetic result compared to less extensive procedures.

Acute cerebellar ataxia in children.

Acute cerebellar ataxia is a benign syndrome usually occurring after an acute febrile disease. In a few cases neuroradiological investigations reveal cerebellar alterations. Clinical and neuroradiological involvement of the brain stem has rarely been reported in the literature. We present five cases of acute cerebellar ataxia. In two cases the cerebellar symptomatology was associated with neurological signs of brain stem involvement. CT scans did not show any pathologic findings in three patients. MRI disclosed cerebellar or brain stem alterations in all the patients. Clinical and neuroradiological findings allow differentiation of this pathologic entity from other demyelinating or dysmyelinating diseases. The value of MRI in detection and localization of the lesions and in following their evolution is emphasized.

Effect of saline concentration, pH and growth temperature on the invasive capacity of Listeria monocytogenes.

The invasive ability of Listeria monocytogenes was monitored after treatment at different pH, temperature and salt concentrations. We found a complete loss of invasive ability in bacteria grown at pH < or = 4.5 independently of the incubation temperature (4, 22 and 30 degrees C). Increasing salt concentrations at 22 and 30 degrees C had no effect at pH 7, while drastically affecting invasive ability at pH 5. The expression of two proteins of 30 and 88 kDa, extracted from the culture supernatant and the cell wall, respectively, was detected only in cells grown under normal conditions, but not after low pH and high salt concentration treatment.

Giant intracavernous carotid aneurysm in a child. Case report.

The occurrence of intracranial aneurysm in the pediatric population is a rare phenomenon. A case of giant aneurysm of the intracavernous carotid artery in a child is reported. Clinicoradiological findings are presented and the surgical procedure is illustrated. Authors stress the value of monitoring the cerebral collateral blood flow before and during the operation.

Cerebral cavernous angiomas in critical areas. Reports of three cases in children.

Cerebral cavernous angiomas are congenital malformations usually presenting with symptomatic hemorrhages or seizures. The advent of MRI has allowed to detect asymptomatic, "cryptic" brain cavernomas. They can occur in a sporadic, isolated form and in a familial form characterized by multiple lesions. Surgical treatment is recommended by most authors in symptomatic cases when the lesion is isolated and readily accessible. Treatment is more controversial when the vascular malformation is located in critical brain region. On the other hand the increased risk of rebleeding after a prior hemorrhage and the decreased effectiveness of lesionectomy in patients with a long seizure history could lead to perform an early surgical excision also for cavernous angiomas located in those areas. We report three cases of symptomatic cerebral cavernomas located in critical areas, in children. In all cases the surgical removal of the lesions was successfully performed. The two cases presented with seizures are seizure-free in spite of the interruption of the antiepileptic therapy. The patient presented with neurological deficit due to intraparenchymal hemorrhage progressively recovered his motor function. Our experience seems to confirm the value of surgical removal regardless of where the cavernoma is located.

Eosinophilic granuloma of C4 causing spinal cord compression.

A rare case of vertebral eosinophilic granuloma (C4) causing spinal cord compression is reported. The clinical, histological and radiological features of this pathological entity are discussed. After surgery a complete neurological recovery was observed. The value, in selected cases, of surgical treatment with total removal of the tumour and reconstruction of the spine to ensure spinal stability and to prevent irreversible neurological deficit is emphasized.

Spinal intramedullary angiolipoma.

We report the case of a young patient with a thoracolumbar (T11-L3) intramedullary angiolipoma. Total removal of the tumor was possible and after operation the patient's neurological condition greatly improved. Only two previous cases of intramedullary angiolipomas have been reported, and in neither could the lesion be wholly removed. The histopathological and radiological features of these tumors are discussed and the extreme rareness of this case is emphasized.

Trigonocephaly associated with anterior basal meningocele. Case report.

Pathogenesis of craniosynostosis is poorly understood. Several different factors (primary fusion of a cranial vault suture, abnormal tensile forces acting on the cranial sutures, genetic control, fetal constraint) may be responsible for the malformation. Trigonocephaly is a relatively rare form of cranial malformation ranging from 5 to 20% of all the craniosynostotic syndromes. This form of craniosynostosis may be simple not associated with other cerebral defects or complex, associated with arhinencephaly and hypoplasia of frontal lobes; three gradations of malformation (marked, mild, incomplete) may be considered. A case of trigonocephaly associated with anterior basal meningocele is reported. The operative treatment and radiological findings are described. The pathogenetic role of the basal meningocele to determine the premature sutural fusion through tensile forces transmitted by abnormal dural attachments is evaluated.

Intramedullary haemorrhage due to AVM located within the medulla oblongata in a three year old child. Case report.

Intramedullary arteriovenous malformations are rare in childhood. Yasargil reports only two cases in children under ten years of age out of a total of forty-one cases of AVM operated on between 1967 and 1983 in which microsurgical techniques were used. The early symptoms of these lesions are those due to intramedullary or subarachnoid haemorrhage with neurological deficit, pain and/or weakness or numbness of one or more limbs. We report the case of an intramedullary haematoma due to arteriovenous malformation within the medulla oblongata in a three year old child admitted for cervical pain and right arm hypostenia. The CT scan and MRI showed an intramedullary expansive lesion with associated internal haematoma between C1-C7 level. Because of the rapid clinical deterioration upon the onset of right hemiparesis we procedeed to empty the intramedullary haematoma and to remove the intrabulbar AVM. A swift improvement of neurological deficit was observed along with a total regression of the symptomatology in a month's time. The excellent results reported in this case, very likely the only case in the literature occurring in a very small child at this spinal cord level, are mostly due to the early surgical treatment and to the exact information that MRI provided.

The operative treatment of craniosynostosis using bone plate and screw fixation (titanium micro system).

Two cases of craniosynostosis treated with the new titanium micro system for the skeletal fixation are described. Mechanical and physical characteristics of the system (biocompatibility, high strength, malleability, possibility of adequate stabilization) are discussed. Aesthetic and functional outcomes are evaluated.