Acute Myocarditis After Black Widow Spider Bite: A Case Report.

The black widow spider (BWS) is a venomous spider whose bite can cause various clinical conditions that range from local damage to serious systemic complications, including death. Cases of myocarditis following a BWS bite are rare but they can be fatal on occasion. However, the prognostic significance of the bite and presentation of myocarditis is unknown. Our case involved a 50-year-old man who presented with myocarditis after being bitten by a BWS and subsequently admitted to the intensive care unit for cardiac monitoring. During the hospital stay, he showed worsening signs on both the electrocardiographic and echocardiographic evaluations despite therapeutic success. Subsequent cardiac magnetic resonance and coronary angiography investigations showed no significant alterations; blood and instrumental test results slowly improved, and the patient was discharged home after 12 days of hospitalization without complications. This case illustrates that acute myocarditis, although an infrequent complication of BWS bite, has the potential to be lethal. The correct diagnosis, which is not always easy to formulate, is important to identify those patients who can benefit from careful monitoring and specific therapies aimed at reducing the risk of life.

Tantalum in type IV and V Paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery.

PURPOSE: Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures. METHOD: We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months. RESULT: Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6-18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points. CONCLUSION: Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.

Shelf-life of almond pastry cookies with different types of packaging and levels of temperature.

Almond pastries are typical cookies of the south of Italy. Introduction of new packaging for this kind of cookies requires shelf-life assessments. This study, related to different types of packaging under various storage conditions of time and temperature, identifies critical parameters, as color and texture, to track during storage studies and to extend the shelf-life. The cookies were packed in three different ways and stored at two different temperatures. The pastries were separately stored: (1) in polyvinylchloride film; (2) in aluminum foil (ALL); (3) with modified atmosphere (MAP) in plastic vessels sealed into a polyamide/ polyethylene film; and (4) in vessels without any polymeric film. The storage temperatures were 20 and 30 °C. Evolution of texture, water activity, dry matter and color was assessed. Texture was evaluated by a texture analyzer with a puncturing test. Indices for hardening were the area under the curve (N × mm) up to 10 mm of distance, and the maximum force (N) corresponding to the crust fracture. The best results were obtained with ALL packaging and MAP condition, and above all, in all the trials a temperature of 30 °C reduced the crust hardness.

Ablation of large HCCs using a new saline-enhanced expandable radiofrequency device().

PURPOSE: Evaluation of a new device designed to achieve large volumes of necrosis in hepatocellular carcinoma (HCC) nodules by application of radiofrequency ablation (RFA). MATERIALS AND METHODS: 29 consecutive patients with 31 HCC nodules ≥3 cm in diameter (range 3-7.5 cm; mean diameter 5.5 cm) underwent ultrasound (US) guided percutaneous RFA using an expandable electrode with 7 active arrays and saline injection designed to create tissue ablation in areas of up to 7 cm (Starburst XLi-enhanced RFA device). Treatment was performed in general anesthesia (6 patients) or deep sedation (23 patients). Treatment efficacy was assessed by three-phase contrast-enhanced computed tomography (CT) and bimonthly US follow-up. RESULTS: One to three electrode insertions (mean number 1.6) were performed in each patient. CT showed complete necrosis in 23/31 HCC nodules (74%) in 22 patients. Follow-up of these 22 patients ranged from 2 to 15 months (mean time 8.3 months). In 6/22 patients (28%) intrahepatic recurrence occurred within 5-10 months (mean time 8.3 months). Major complications were post-ablation syndrome in 7/29 (24%), peritoneal effusion in 4/29 (14%), pleural effusion in 2/29 (7%) and transient obstructive jaundice in 1/29 (3.4%) patients. One patient died 6 months after treatment because of tumor progression. CONCLUSIONS: In the treatment of large HCC nodules, Starburst XLi-enhanced is an effective and safe device.

[Urodynamic evaluation in children with enuresis]. / Lo studio urodinamico nei pazienti enuretici.

We performed an urodynamic study in enuretic children to evaluate the relationship between urodinamic findings and symptoms. We studied 175 patients, with age from 5 to 12 years, who presented with nocturnal enuresis: 45 monosymptomatic and 130 polysymptomatic (in association with urinary urgency, urge incontinence, etc.). Despite differences in symptoms, in 151 patients (86%) abnormal urodynamic findings were identified. Bladder instability was the most common disorder. However, mild abnormalities were found in the monosymptomatic patients. In treated patients urodinamic findings and clinical improvement were correlated. This study confirmed that most patients with nocturnal enuresis have cystometric abnormalities. Although possible etiologies of nocturnal enuresis are various, bladder dysfunction may be an underlying cause.

Ovarian cysts in newborns.

Before the introduction of ultrasonography (US), ovarian cysts in newborns were thought to be rare. With the extended use of real-time US, prenatal detection has increased. There is still considerable controversy regarding the best treatment of these neonatal findings. A total of 27 instances in 24 consecutive newborns of antenatally-diagnosed ovarian cysts were reviewed for US data, management, and outcome to assess the ante- and postnatal evolution of the cyst and establish appropriate therapy. The cysts detected during pregnancy were studied by repeated postnatal US studies. In 10 children (2 with bilateral cysts) the cyst evolved spontaneously toward regression. Fourteen patients were operated upon; 10 had complex and 4 (in 1 bilateral) had simple cysts. Cystectomy was employed when possible to preserve the ovarian parenchyma (3 cases); in the remaining cases oophorectomy was performed. Histologically, the cysts were of follicular origin or necrosis made a diagnosis impossible. US was found to be a helpful diagnostic tool for simple ovarian cysts, but could not reliably distinguish between benign and malignant tumors if a sonographically complex lesion was present. Based on our experience, surgical management of ovarian cysts should be reserved to complex masses. Simple cysts can be monitored safely by close US follow-up; surgery is indicated if the cyst fails to regress after several months or becomes symptomatic.

Isolation and characterization of the cDNA for a Ciona intestinalis RNA binding protein: spatial and temporal expression during development.

A cDNA encoding an RNA binding protein has been isolated from a cDNA library prepared from larvae of the ascidian Ciona intestinalis. The putative protein of 162 amino acids contained in the N-terminal region one copy of the consensus sequence RNA binding domain and in the C-terminal region a glycine-rich domain. The in vitro translated protein bound various RNA homopolymers, preferentially polyU, polyA, and polyG, and the binding was affected by increasing ionic strength. Northern blot analysis revealed a single transcript of about 0.7 kb in length that was present during embryonic development with two major peaks of accumulation at gastrula and larval stages. Whole-mount in situ hybridization experiments on embryos at different stages of development showed gene expression mainly in mesenchymal cells and in neural tissue.

[Ultrasound-guided ESWT in Peyronie's disease plaques]. / ESWT ecoguidata delle placche di induratio penis plastica.

The aim of the study was to check the efficiency of shock waves in the treatment of Peyronie's disease. The instrument, because of its lithotriptic power, already used in the treatment of orthopedic disease and salivary stones, can be used to break plaques in induratio penis plastica. A total of 481 patients affected with Peyronie's disease were entered into a prospective trial. Patients with big plaques or with an initial stage of degeneration were excluded. We divided the patients into three treatment groups: a) shock waves alone in 56 patients; b) a combination of shock waves and calcioantagonist (perilesional injection) in 324 patients; c) calcioantagonist alone in 101 patients. The group of 101 patients (group C) treated during the previous 2 years with a medical therapy based only on the injection of calcioantagonist, was used as a control group. Ultrasound evaluation of the treated plaques showed a reduction of size in 27/56 patients of the group A, in 159/324 patients of the group B and in 39/101 patients of group C. Painful erection improved in the 91.5% of group B, against the 45.7% of group C. Furthermore, we pointed out, with interviews to the patients, a considerable improvement of the pain and of the sexual performances. The therapeutic association of shock waves with calcioantagonist injections is an effective non-operative treatment for the stabilization of Peyronie's disease.

Cloning and characterization of a developmentally regulated sea urchin cDNA encoding glutamine synthetase.

A 2935-bp cDNA clone encoding glutamine synthetase (GS) was isolated from a cDNA library prepared from four-blastomere Paracentrotus lividus sea urchin embryos. The sequence consists of a 75-bp 5' untranslated region (5'-UTR) followed by a 1095-bp coding region corresponding to a 365-amino-acid (aa) protein, a 1747-bp 3'-UTR and a terminal 18-bp poly(A) tail. The encoded protein shows about 66% identical residues, as compared with human and lobster class-II GS. The sequence contains the Mn(2+)-binding aa and the highly conserved aa regions observed in other GS. Northern blot analyses show that the GS mRNA is present in the sea urchin egg and is developmentally regulated in the embryo.