Paratricipital approach for distal humerus fractures.

OBJECTIVE: To report functional outcomes in a case series of distal shaft and distal humeral fractures (AO type 12 and 13) managed with open reduction and internal fixation using paratricipital approach. METHODS: Patients who were intervened between May 2006 and December 2015 were included in the analysis. The Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) score and the visual analogue scale (VAS) were used for functional assessment. RESULTS: Twelve patients were included in this case series, eight (67%) of them were women. The average age was 46 (SD 22). Regarding the type of fracture, three (25%) were classified as 12A1, two (17%) as 12B1, two (17%) as 12B2, three (25%) as 13C1 and two (17%) as 13C2. At most recent average follow-up of 3, 4 years (DS 1,62), the results were: elbow range of flexion-extension 138,3º (SD 15,18), MEPS reached 85,8 (DS 11,7), DASH of 11,8 (SD 10,6) and the mean VAS 1,3 (SD 1,1). At the final evaluation, all fractures had healed. One case presented radial nerve neuropraxia, three cases paresthesias at the ulnar nerve territory, and all of these evolved positively and spontaneously. CONCLUSIONS: In our experience, posterior paratricipital approach is useful and safe for managing the open reduction and internal fixation. It may provide preservation of the triceps and promote an earlier rehabilitation. Functional outcomes were satisfactory in this case series.

A CMOS silicon spin qubit.

Silicon, the main constituent of microprocessor chips, is emerging as a promising material for the realization of future quantum processors. Leveraging its well-established complementary metal-oxide-semiconductor (CMOS) technology would be a clear asset to the development of scalable quantum computing architectures and to their co-integration with classical control hardware. Here we report a silicon quantum bit (qubit) device made with an industry-standard fabrication process. The device consists of a two-gate, p-type transistor with an undoped channel. At low temperature, the first gate defines a quantum dot encoding a hole spin qubit, the second one a quantum dot used for the qubit read-out. All electrical, two-axis control of the spin qubit is achieved by applying a phase-tunable microwave modulation to the first gate. The demonstrated qubit functionality in a basic transistor-like device constitutes a promising step towards the elaboration of scalable spin qubit geometries in a readily exploitable CMOS platform.

[An unusual pneumomediastinum case in a child caused by spontaneous bronchial rupture]. / Un insolito caso di pneumomediastino in un bambino da rottura spontanea di bronco.

We report a case of spontaneous pneumomediastinum (SPM) in a 3 year-old child, admitted to the emergency department because he presented dyspnea for a few hours, after a paroxysm of cough. The SPM is rare in children; the term "spontaneous" is reserved for cases of pneumomediastinum that haven't a traumatic cause. SPM is seen most commonly in asthmatics and in any patient who induces a Valsalva maneuver. The clinical diagnosis is confirmed by chest radiograph. When the diagnosis is uncertain, the chest CT scan is considered the gold standard of imaging tests, capable of detecting pneumomediastinum even in patients with small amounts of mediastinal air. In this case CT images showed the cause: spontaneous bronchial rupture. The direct sign of bronchial injury is the contiguity of the luminal air with that in the mediastinum. In the literature SPM cases are very rare, at least in health patients without tracheobronchial anomalies. The SPM is generally a benign entity that requires supportive care, and resolution occurs spontaneously, such as in our patient. In this article we want to explain the main clinical, diagnostic and therapeutic aspects of SPM, because, even if it's rare in children, it must be considered in the differential diagnosis of dyspnea; then we want to demonstrate as, in this case, a TC scan was important to identifying the SPM cause: a bronchial rupture.

[A sign of the changing times: neonatal scabies]. / Un segno dei tempi che cambiano: scabbia neonatale.

Scabies is an itchy-parasitic cutaneous infection; it can spread from person to person directly or through clothing, sheets or mattresses. The incidence had fallen a lot during the last ten years, but recently it is growing up again; this is due to immigration of people coming from countries where local hygienic and social conditions are very poor. In this contest it is more frequent to observe the infection in pediatric age, sometimes also newborn. In this particular case the diagnosis can be more difficult because the clinical manifestations are different from pathognomonic lesions we usually see in adult age. We report the clinical case of a newborn, 30-day-old, born in Italy from an Indian family. When the baby was admitted in our department she looked in good physical conditions but she presented a pustular dermatitis all over the body, scalp excluded. The presence in the mother of typical skin lesion and baby's eosinophilia at blood test, induced us to suspect the diagnosis of scabies. However, both the search for acarus at optical microscope on a skin sample obtained with "scarification" and clinical response to a treatment with PAF, were unsuccessful. Moreover, we found in the baby a persistent trombopenia; this fact induced us to think of other hypothesis. Finally the child's positive response to permethrina topical treatment and normalization of the number of platelets let us confirm the initial diagnosis of scabies.

Loperamide test: a simple and highly specific screening test for hypercortisolism in children and adolescents.

The overnight dexamethasone (DXM) test can give false-positive results in a few conditions (e.g. stress, strenuous exercise, depression, anorexia, anxiety, anticonvulsive therapy) in diagnosing simple obesity and hypercortisolism (HC). The loperamide (LP; a peripheral opioid agonist) test has proven useful in such conditions in adults. Thirty-one obese subjects (age 10.0-19.7 y) were studied by both overnight DXM test and LP test (8 mg orally, samples for cortisol at 0, 90, 150, 180 and 210 min) on 2 separate days. LP suppressed cortisol (< or = 138 nmol l-1) at a dose of 0.1 mg kg-1 bw (half the minimum recommended dose for the drug's antidiarrhoea effect) in 14 subjects who had normal urinary (< 4970 nmol l-1) and serum (< 552 nmol l-1) cortisol, in the absence of signs and symptoms of HC (group A). The DXM test failed to suppress cortisol in three subjects in group A, two of whom were on anticonvulsive treatment. The LP test suppressed cortisol in all of 13 subjects with elevated urinary and/or serum cortisol and/or with signs or symptoms of HC (but in whom HC was subsequently excluded on clinical grounds) (group B), while the DXM test failed to suppress cortisol in three subjects of this group. One of these was under anticonvulsive treatment and one suffered from anxiety and depression. In four patients with Cushing's syndrome (group C) neither DXM nor LP could suppress cortisol levels. Therefore, the sensitivity was 100% for both DXM and LP, while the specificity was 84% for DXM and 100% for LP. No side-effects were observed with either drug. In conclusion, LP is a useful alternative to DXM in those particular conditions that can affect its specificity in children.