Recognizing megatsunamis in Mediterranean deep sea sediments based on the massive deposits of the 365 CE Crete event.

The Mediterranean Sea hosts two subduction systems along the convergent Africa-Eurasia plate boundary that have produced strong ground shaking and generated tsunamis. Based on historical descriptions and sedimentary records, one of these events, in 365 CE, impacted a broad geographical area, including tsunami evidence for distances of 700-800 km from the source event, qualifying it as a 'megatsunami'. Understanding how megatsunamis are produced, and where they are more likely, requires a better understanding of the different secondary processes linked to these events such as massive slope failures, multiple turbidity current generation, and basin seiching. Our sedimentary records from an extensive collection of cores located in distal and disconnected basins, identify turbidites which are analyzed using granulometry, elemental (XRF), micropaleontological, and geochemical data in order to reconstruct their coastal or marine source. The results show that the 365 CE basin floor sediments are a mixture of inner shelf and slope materials. The tsunami wave produced multiple far-field slope failures that resulted in stacked basal turbidites. It also caused transport of continent-derived organic carbon and deposition over basal turbidites and into isolated basins of the deep ocean. The composition of sediment in isolated basins suggests their deposition by large-scale sheet like flows similar to what has been caused by the Tohoku earthquake associated tsunamis. This is significant for rectifying and resolving where risk is greatest and how cross-basin tsunamis are generated. Based on these results, estimates of the underlying deposits from the same locations were interpreted as possible older megatsunamis.

Italian Intersociety Recommendations on pain management in the emergency setting (SIAARTI, SIMEU, SIS 118, AISD, SIARED, SICUT, IRC).

BACKGRAUND: Pain is the primary reason for admission to the Emergency Department (ED). However, the management of pain in this setting is often inadequate because of opiophagia, fear of excessive sedation, and fear of compromising an adequate clinical assessment. METHODS: An intersociety consensus conference was held in 2010 on the assessment and treatment of pain in the emergency setting. This report is the Italian Intersociety recommendations on pain management in the emergency department setting. RESULTS: The list of level A recommendations includes: 1) use of IV acetaminophen for opioid sparing properties and reduction of opioid related adverse events; 2) ketamine-midazolam combination preferred over fentanyl-midazolam fentanyl-propofol in pediatric patients; 3) boluses of ketamine IV (particularly in the population under the age of 2 years and over the age of 13) can lead to impairment of the upper airways, including the onset of laryngospasm, requiring specific expertise and skills for administration; 4) the use of ketamine increases the potential risk of psychomotor agitation, which can happen in up to 30% of adult patients (this peculiar side effect can be significantly reduced by concomitant systemic use of benzodiazepines); 5) for shoulder dislocations and fractures of the upper limbs, the performance of brachial plexus block reduces the time spent in ED compared to sedation; 6) pain relief and the use of opioids in patients with acute abdominal pain do not increase the risk of error in the diagnostic and therapeutic pathway in adults; 7) in newborns, the administration of sucrose reduces behavioural responses to blood sampling from a heel puncture; 8) in newborns, breastfeeding or formula feeding during the procedure reduces the measures of distress; 9) in pediatric patients, non-pharmacological techniques such as distraction, hypnosis and cognitive-behavioural interventions reduce procedural pain caused by the use of needles; 10) in pediatric patients, preventive application of eutectic mixtures of prilocaine and lidocaine allows arterial and venous samples to be taken in optimum conditions; 11) in pediatric patients, the combination of hypnotics (midazolam) and N2O is effective for procedural pain, but may be accompanied by loss of consciousness. CONCLUSION: The diagnostic-therapeutic pathway of pain management in emergency should be implemented, through further interdisciplinary trials, in order to improve the EBM level of specific guidelines.

[Traumatic spondylolysis]. / Espondilolise traumática.

The authors present the results of treatment of seven cases of spondylolysis with a two years follow up. Six patients were treated with the thoracolumbosacral orthosis and one with L5-S1 fusion. At the end of the follow up all patients were pain free.

New classes of antimuscarinic agents endowed with selective antispasmodic properties. 1-Arylsulfonyl pyrrolidin-2-ones and 2-thiones, 1-arylsulfonyl piperidin-2-ones and 2-thiones and 1-arylsulfonyl hexahydro-2H-azepin-2-one.

A series of 1-arylsulfonylpyrrolidin-2-ones (and 2-thiones), 1-aryl sulfonylpiperidin-2-ones (and 2-thiones) and 1-arylsulfonyl hexahydro-2H-azepin-2-one were synthesized and submitted to a battery of binding assays. The compounds showed little or no affinity for the receptors tested other than muscarinic receptors labelled either with [3H]pirenzepine or with [3H]quinuclidinyl benzilate. When tested in the isolated guinea pig ileum, they antagonized the contractions induced by acetylcholine and behaved as competitive muscarinic antagonists. After parenteral administration in mice, most compounds inhibited carbachol-induced diarrhoea but were less effective in counteracting salivation and lacrimation and showed little or no mydriatic action, thus displaying selectivity at the intestinal level. The reference drugs tested, atropine, butyl scopolamine and cimetropium bromide were far less selective. maximal in vivo activity was obtained by introducing diethylamino or 1-piperidino or 1-hexahydroazepinyl groups in the 4-position of the phenyl ring while the enlargement of a 5- to a 6-membered lactam ring or its conversion into a thiolactam had a less marked effect. The most interesting compounds were further evaluated for their ability to antagonize carbachol-induced colonic hypermotility in the rat and arecoline-induced analgesia in mice. The effect on gastric acid secretion in the rat was also investigated. The overall in vivo data showed that compounds 14, 15, 26 and 27, i.e. those bearing a 1-hexahydroazepinyl group in the 4-position of the phenyl ring, were the most potent and selective compounds.(ABSTRACT TRUNCATED AT 250 WORDS)

Herniation of the lumbar disk in adolescents.

The authors review eight cases of lumbar intervertebral disk herniation in adolescents aged less than 16 years, with a minimum follow-up treatment of 2 years during an 18-year period. All patients presented lower back and sciatic pain, antalgic scoliosis, and a positive Lasègue sign. Nerve compression signs were present in 25+ of the cases. Seventy-five percent of the cases underwent myelography and 25% underwent computerized axial tomography. Results were good in all cases.

[Surgical treatment of idiopathic scoliosis in adolescents by the Harrington method]. / Tratamento cirúrgico das escolioses idiopáticas no adolescente pelo método de Harrington.

Forty six patients with idiopathic scoliosis were treated according the Harrington method. The surgical treatment was done with the Harrington distraction rod, and vertebral arthrodesis with autogenous iliac bone graft. The patients wore a Risser-Cotrel body-cast for nine months but started walking two days after casting. Good clinical results were obtained in all the patients. Final curve correction was 40%. In this series of patients no pseudoarthrosis occurred.

[Magnetic resonance of spinal osteoid osteoma]. / Ressonância magnética do osteoma osteóide vertebral.

The authors report one case of spinal osteoid osteoma localized in the thoracic spine that was imaged through M. R. I. They report the M. R. I. aspects of the tumor. Precise localization is necessary for the correct surgical approach.