The treatment of idiopathic and secondary hydrarthrosis of the knee by intra-articular Rifamycin SV

Fifty-three patients, 28 females and 25 males, aged from 21 to 68 years, affected with mono- and bilateral intermittent hydrarthrosis of the knee and of a non-inflammatory nature, were included in an open study. All of the knees involved were treated with intra-articular infiltrations with Rifamycin SV. The weekly dosage of Rifamycin SV was 500 mg; the average duration of treatment was 6 weeks. Follow-up 1 year after the end of treatment showed a decrease or regression in joint effusion in all of the knees treated.     

Osteoporotic Animal Models of Bone Healing: Advantages and Pitfalls

The aim of this review was to summarize the advantages and pitfalls of the available osteoporotic animal models of bone healing. A thorough literature search was performed in MEDLINE via OVID and EMBASE to identify animal studies investigating the effect of experimental osteoporosis on bone healing and bone regeneration. The osteotomy model in the proximal tibia is the most popular osseous defect model to study the bone healing process in osteoporotic-like conditions, although other well-characterized models, such as the post-extraction model, might be taken into consideration by future studies. The regenerative potential of osteoporotic bone and its response to biomaterials/regenerative techniques has not been clarified yet, and the critical size defect model might be an appropriate tool to serve this purpose. Since an ideal animal model for simulating osteoporosis does not exist, the type of bone remodeling, the animal lifespan, the age of peak bone mass, and the economic and ethical implications should be considered in our selection process. Furthermore, the influence of animal species, sex, age, and strain on the outcome measurement should be taken into account. In order to make future studies meaningful, standardized international guidelines for osteoporotic animal models of bone healing need to be set up.     

The Prediction of Extubation Success of Postoperative Neurosurgical Patients Using Frequency–Tidal Volume Ratios

Background  The process of discontinuing neurological patients from mechanical ventilation is still controversial. The aim of this study was to report the outcome from extubating patients undergoing elective craniotomy and correlate the result with the measured f/V _t ratio. Materials and Methods  In a cohort prospective study, all consecutive patients who required mechanical ventilation for up to 6 h after elective craniotomy were eligible for inclusion in this study. Patients passing daily screening criteria automatically received a spontaneous breathing trial (SBT). Immediately previous to the extubation, the expired minute volume (VE), breathing frequency (f), and tidal volume (V _t) were measured and the breathing frequency-to-tidal volume ratio (f/V _t) was calculated; consciousness level based on Glasgow Coma Scale (GCS) was evaluated at the same time. The extubation was considered a failure when patients needed reintubation within 48 h. Results  Ninety-two patients were extubated and failure occurred in 16%. Despite 15 patients failed extubation just one of them presented the f/V _t score over 105. The best cutoff value for f/V _t observed was 62, but with low specificity (0.53) and negative predictive values (0.29). Area under the ROC curve for the f/V _t was 0.69 ± 0.07 (P = 0.02). Patients who failed the extubation process presented higher incidence of pneumonia (80%), higher need for tracheostomy (33%) and mortality rate of 40%. Conclusion  The f/V _t ratio does not predict extubation failure in patients who have undergone elective craniotomy. Patients who fail extubation present higher incidence of pneumonia, tracheostomy and higher mortality rate.     

Measuring maternal stress and perceived support in 25 Italian NICUs

Aims: To determine the validity and reliability of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) and the Nurse Parental Support Tool (NPST) for use with Italian parents; to investigate to which extent demographic variables and/or situational factors affect NICU‐related maternal stress. Methods: Mothers (N = 156) of very preterm (VPT) infants from 25 Italian NICUs completed a socio‐demographic form, the PSS: NICU and the NPST at discharge. Psychometric properties of both tools were evaluated. Results: High internal consistency and split‐half reliability were found for both measures. The multi‐dimensional structure of the PSS:NICU was confirmed. Alteration in parental role emerged as the greatest source of NICU‐related stress. Length of stay in NICU and familiar socio‐economic status explained partial variance in the PSS: NICU scores. NPST score mitigates the stress because of the infant’s appearance and behaviour, but not that related to the parental role alteration. Conclusions: PSS: NICU and NPST demonstrated adequate psychometric properties in a large sample of Italian mothers. The need for a psychologically informed support to NICU mothers is suggested.     

Morphologic analysis of fetal stress organsin different causes of perinatal death

Complications act as stress-inducers during pregnancy so the fetus can develop functional compensatory mechanisms or morphologic changes. The cases analyzed are with congenital malformations or acute stress; chronic included cases with ascending infection (AI) and perinatal hypoxia/anoxia (PHA). The hematoxylin-eosin (H&E) was done to analyze the vacuolization, and the immunohistochemistry to the phagocytosis. The discreet standard of vacuolization was observed in 52.6% of the cases, 22.1% moderate, and 25.3% severe. The number of macrophages was higher in PHA. Changes in these organs are closely related to the cause of death and to the period during which the harmful agent.     

Macroscopic placental changes associated with fetal and maternal events in diabetes mellitus

OBJECTIVES:

The current study sought to identify macroscopic placental changes associated with clinical conditions in women with or without diabetes and their newborns.

METHODS:

The study population consisted of 62 pregnant women clinically diagnosed with diabetes and 62 healthy women (control group).

RESULTS:

Among the subjects with diabetes, 43 women (69.3%) were diagnosed with gestational diabetes mellitus, 15 had diabetes mellitus I (24.2%), and four had diabetes mellitus II (6.5%). The mean age of the women studied was 28.5±5.71 years, and the mean gestational age of the diabetic women was 38.51 weeks. Of the 62 placentas from diabetic pregnancies, 49 (79%) maternal surfaces and 59 (95.2%) fetal surfaces showed abnormalities, including calcium and fibrin deposits, placental infarction, hematoma, and fibrosis. A statistical association was found between newborn gender and fetal and maternal placental changes (p = 0.002). The mean weight of the newborns studied was 3,287±563 g for women with diabetes mellitus, 3,205±544 g for those with gestational diabetes mellitus, 3,563±696 g for those with diabetes mellitus II, and 3,095±451 g for those with diabetes mellitus I.

CONCLUSIONS:

Infarction, hematoma, calcification, and fibrin were found on the maternal and fetal placental surfaces in women with diabetes. Women with gestational diabetes and post-term infants had more calcium deposits on the maternal placental surface as compared to those with type I and type II diabetes.