Gambling in nursing students of the University of Palermo.

INTRODUCTION: Gambling disorder is recognized as a psychiatric disorder. It is shown that the prevalence of pathological gambling is on the rise among university students, especially involving students attending the nursing degree course. The aim of the study was to estimate the prevalence of gambling's problem and to analyze the associated factors in the population of nursing students at the University of Palermo. MATERIAL AND METHODS: It's a cross-sectional study. In April 2019, a self-administered, anonymous and voluntary questionnaire was provided to students who attend daily lessons of the 3-years nursing degree course of University of Palermo, after they gave informed consent. The questionnaire investigates on socio-demographic information, year of study, the perception of the economic and health status, alcohol use disorders and gambling problems. RESULTS: The average age of the sample is 22.0 years (standard deviation ±4.3), 67.6% of the interviewees are women. The analysis shows that the risk to be "Player at risk/Moderate gambling problems/Serious game problems" is significantly associated with the following independent variables: male gender (aOR 5.15); "Do you live with your family? No" (aOR 2.98); "perceived health status: low" (aOR 2.51); "Risky consumption of alcohol: At Risk" (aOR 3.40). CONCLUSIONS: It is important to develop an effective gambling prevention program that will reduce the risk that youths will develop gambling problems. Participation in the prevention program significantly improves youths' attitudes and knowledge regarding gambling activities.

Vestibular paroxysmia: diagnostic features and medical treatment.

BACKGROUND: Vestibular paroxysmia (VP), which is attributed to neurovascular cross-compression (NVCC), leads to vertiginous spells. Although VP was described more than 30 years ago by Jannetta and colleagues, we still need more reliable data on its diagnostic features and the efficacy of medical treatment. METHODS: A follow-up study of 32 patients with recurrent short spells of vertigo and with diagnosis of VP by published criteria was performed using medical records and patient consultation (mean follow-up time 31.3 months). RESULTS: In 28% of patients the attacks occurred exclusively when at rest, whereas in 22% they were regularly precipitated by a certain action, most frequently a head turn (60%). The most common accompanying symptom was unsteadiness of stance or gait (75%). Constructive interference in steady state magnetic resonance imaging (n = 23) demonstrated at least one site of NVCC in all but one patient. Caloric testing disclosed a mild increase in vestibular deficit over time, and a hyperventilation-induced nystagmus was found in 70% of the tested patients (n = 23). The majority of patients were treated with carbamazepine (mean dose 568 mg/d) or oxcarbazepine (mean dose 870 mg/d). Treatment led to a significant reduction in the attack frequency to 10% of baseline (95% CI 6.69-14.96%), in attack intensity to 15% (95% CI 11.57-19.63%), and a reduction in attack duration to 11% (95% CI 6.72-17.40), after adjusting for time effects. CONCLUSION: This follow-up proves the usefulness of the diagnostic criteria, especially constructive interference in steady state magnetic resonance imaging, and the therapeutic efficacy of medical treatment.

Adult colocolic intussusception: demonstration by conventional MR techniques.

Intussusception is a rare condition in adults. We report a case of a 69-year-old woman referred to our institution for lower left quadrant abdominal pain, weight loss, and occasional episodes of constipation and rectal hemorrhage. The patient underwent plain radiography, ultrasonography, and magnetic resonance imaging of the pelvis. The final diagnosis was colocolic intussusception due to a neoplastic lead point.

[The value of the MR imaging in the evaluation of Müllerian duct anomalies]. / Il valore della RM nella valutazione delle anomalie dei dotti di Müller.

PURPOSE: To reaffirm the role of MRI in the assessment of the M#159;llerian duct anomalies (MDAs). MATERIAL AND METHODS: Between November 1997 and April 2001, 22 patients, age range 18-40 years (mean 29 years) were investigated with MRI and US. The MRI study was performed with a 0,5 Tesla imager (Vectra, GE Medical System) with body-coil; neither oral nor intravenous contrast was used. We obtained SE T1-weighted, fast STIR with fat suppression and FSE T2-weighted sequences. Sagittal, paracoronal and paraxial images were acquired. The paraxial images were obtained to produce true coronal images of the uterus. In evaluating MDAs, imaging the uterus in its true coronal plane is essential to assess the external fundal contour. US examination was performed with an HDI 3000, ATL, using the trans-vaginal approach. The MDAs were subdivided according to the Buttram and Gibbons classification. RESULTS: There were 22 cases of laparoscopic and hysteroscopic proved anomalies; MRI allowed correct diagnosis of 21 uterine anomalies (accuracy, 95%) whereas U.S. was correct in 20 of 22 cases (accuracy, 92%). The MRI was excellent in depicting the uterine morphology in one case of unicornuate uterus with rudimentary horn non-comunicating with the main cavity and distended by hematometra and associated hematosalpinx. Further-more evaluating composition, thickness and extension of the uterine septum and aspect of the fundal contour, MRI allowed to differentiate definitively between bicornuate uterus and septate uterus. This is a very important distinction to do because it significantly affects patient treatment: a septate uterus requires hysteroscopic septectomy, while a bicornuate uterus does not requires surgical treatment. CONCLUSIONS: Given its characteristics, MRI is a very accurate imaging modality in uterine evaluation and contributes significantly to treatment planning. Although ultrasonography remains the modality of choice for the initial study of patients who are suspected of having a MDAs, we propose, in accordance with many authors in the literature, to reserve MRI imaging for patients with a technically inadequate or indeterminate ultrasound examination.

[The role of magnetic resonance in the diagnosis of the os trigonum syndrome]. / Il ruolo della Risonanza Magnetica nella diagnosi della sindrome dell'os trigonum.

PURPOSE: We investigated the yield of Magnetic Resonance Imaging (MRI) in hindfoot conditions, particularly the os trigonum syndrome, which are very difficult to diagnose clinically. MATERIAL AND METHODS: We examined 7 consecutive patients complaining of hindfoot pain for more than 4 months (male:female = 1:6; age range 16-22 years, average 18.6). Three patients practiced competitive sports and 4 ballet. We performed conventional radiography (orthogonal projections) and then MRI with a 0.5 T superconductive unit with surface coils; MR images were acquired with T1-weighted spin-echo (SE), T2-weighted gradient-echo (GRE), and fast inversion recovery (FIR) fat-suppressed sequences with 4 mm thickness and 0 mm gap. RESULTS: In 2 cases the os trigonum had irregular margins with subchondral sclerosis and widened synchondrosis. In 3 patients we found flexor hallucis longus tenosynovitis, likely caused by tendon compression and displacement within its sheath; there were neither os trigonum marrow edema nor synchondrosis widening. One patient had os trigonum hypertrophy, mild synchondrosis widening and marrow edema, in the os trigonum and the posterior aspect of talus. One patient had the os trigonum, but no signs referable to the os trigonum syndrome. CONCLUSIONS: In the posterior impingement syndrome, our objective is to show inflammatory changes in the posterior capsule of the ankle joint, adjacent ligaments, tendons and chondrosynovial surface. In these cases, the yield of conventional radiography and CT is rather poor, while MRI provides important information on soft tissues involvement, synovial reaction, chondral and subchondral bone injuries and the association of flexor hallucis longus synovitis, if present. MRI also yields detailed information for correct therapeutic approach. In conclusion, for the (differential) diagnosis of hindfoot pain in clinically suspected os trigonum syndrome, MRI appears to be the technique of choice, after conventional radiography, thanks to its noninvasiveness, multiplanarity, and high spatial and contrast resolution.

[Magnetic resonance findings in chronic osteomyelitis fistula]. / Aspetti con Risonanza Magnetica delle fistole nell'osteomielite cronica.

INTRODUCTION: Osteomyelitis is a common inflammatory process caused by an infection which is usually from gram-positive germs. Acute, subacute and chronic forms can be distinguished both clinically and radiographically, each of them presenting different patterns but which are not always easy to recognize. Besides clinical-laboratory data, imaging methods are also useful to make the diagnosis; in chronic forms, MRI has higher sensitivity in recognizing the active foci and the presence of sinus tracts than the other techniques. MATERIAL AND METHODS: We examined nine patients with suspected chronic osteomyelitis with a sinus tract, all of them submitted to radiographic and MR examinations. MRI was performed with a .5 T magnet using a surface coil for joint studies; T1-weighted SE (TR 300-500, TE 20), T2-weighted GE (TR 500-700, TE 20, FA 35 degrees) and FIR sequences with fat suppression (TR 3000, TE 20, TI 100) were performed on the axial, sagittal and coronal planes. Three patients underwent CT too. RESULTS: Radiography showed the osteostructural changes as osteolytic and osteosclerotic areas. CT depicted not only the changes seen radiographically, but also increased bone marrow density. MRI demonstrated active foci of bone marrow appearing as low-intensity areas in T1, with increased intensity in T2 GE and fat-suppressed FIR images; it also depicted the sinus tracts as areas of decreased signal on T1 and of increased signal on FIR images. CONCLUSIONS: Based on our experience and in agreement with the literature data, we believe that MRI is more useful to diagnose the active foci of bone marrow and the sinus tracts in chronic osteomyelitis, especially with T1-weighted SE and fat-suppressed FIR sequences.

["Occult" posttraumatic lesions of the knee: can magnetic resonance substitute for diagnostic arthroscopy?]. / Lesioni "occulte" post-traumatiche del ginocchio: può la Risonanza Magnetica sostituire l'artroscopia diagnostica?

PURPOSE: We investigated the actual role of MRI versus arthroscopy in the detection and characterization of occult bone and/or cartilage injuries in patients with previous musculoskeletal trauma of the knee, pain and severe functional impairment. Occult post-traumatic osteochondral injuries of the knee are trauma-related bone and/or cartilage damage missed at plain radiography. MATERIAL AND METHODS: We retrospectively selected 70 patients (men:women = 7:3; age range: 35 +/- 7 years) with a history of acute musculoskeletal trauma, negative conventional radiographs, pain and limited joint movements. All patients were submitted to conventional radiography, arthroscopy and MRI, the latter with 0.5 T units and T1-weighted SE. T2-weighted GE and FIR sequences with fat suppression. RESULTS AND DISCUSSION: We identified three types of occult post-traumatic injuries by morpho-topographic and signal intensity patterns: bone bruises (no. 25), subchondral (no. 33) and osteochondral (no. 35) injuries. Arthroscopy depicted 45 osteochondral and 19 chondral injuries. A bone bruise was defined as a typical subcortical area of signal loss, with various shapes, on T1-weighted images and of increased signal intensity on T2-weighted and FIR images. The cortical bone and articular cartilage were normal in all cases, while osteochondral injuries exhibited associated bone and cartilage damage with the same abnormal MR signal intensity. Sprain was the mechanism of injury in 52 cases, bruise in 12 and stress in 6. In 52 sprains (30 in valgus), the injury site was the lateral compartment in 92.3% of cases (100% in valgus), associated with meniscal damage in 73% of cases (90% in valgus) and with ligament injury in 90.4% (100% in valgus). In 12 bruises, the injury site was the lateral compartment in 58.3% of cases, the knee cap in 25% and the medial compartment in 16.7%; meniscal damage was associated in 25% of cases and ligament damage in 8.3%. In 6 stress injuries, the injury site was localized in the medial tibial condyle in 80% of cases, while meniscal and ligament tears were absent. CONCLUSIONS: After comparing MR with arthroscopic findings and reviewing the available literature, we conclude that arthroscopy permits the direct visualization of even fine articular surface changes but does not depict the subchondral bone, the most frequent site of injury detected with MRI. MRI was a very useful tool in the detection and characterization of the different types of occult bone and/or cartilage injuries and showed a statistically significant correlation between site and distribution of bone and cartilage injuries and between internal damage and trauma mechanisms. Therefore, we believe that MRI can help avoid diagnostic arthroscopy in the patients with a history of post-traumatic pain, acute articular blocks and negative radiographic findings.