Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8-12 weeks of life

Positional plagiocephaly (PP) denotes flattening of the skull that occurs frequently in healthy infants. Aim of this study was to estimate the prevalence of positional plagiocephaly and to identify the risk factors in a cohort of healthy infants in order to help prevention of PP. In a prospective design, all healthy full-term infants, ranging from 8 to 12 weeks of age, who presented at the public immunization clinic in Ferrara, were eligible for the study. After obtaining informed consent, we interviewed the parents and examined the infants using the Argenta's assessment tool. Of 283 infants examined, 107 (37.8%) were found to have PP at 8-12 weeks of age. In 64.5%, PP was on the right side, 50.5% were male and 15% presented also with brachycephaly. Risk factors significantly associated were lower head circumference, advanced maternal age, Italian compared to African, and supine sleep position, in particular for infants born at 37 weeks, preference for one side of the head. In logistic regression, risk factors significantly associated were lower birth weight, advanced maternal age, and supine sleep position.

CONCLUSIONS

Positional plagiocephaly is a common issue faced by pediatricians; our results reinforce the need of improving prevention both of sudden infant death and positional plagiocephaly, through uniform messages provided prenatally and postnatally by different health professionals. "What is Known:" •The incidence of positional plagiocephaly varies due to population studied and measuring methods. •Different factors are considered in the literature as being associated to positional plagiocephaly (infant factors, obstetric factors, infant care practices, sociodemographic factors). "What is New:" •This is one of the few European studies quantifying positional plagiocephaly prevalence in a population of unselected healthy infants. •In this study, positional plagiocephaly is confirmed as a common issue, related to some factor (as supine sleep position and positional head prevalence) that should be addressed in pre and postnatal counseling. •The prone sleepers rate in our population highlight the need to improve parental awareness regarding SIDS prevention, in particular in borderline gestational age.

Use of the gonadotropin-releasing hormone (GnRH) stimulation test to monitor gonadal function in intact adult male cats

The gonadotropin-releasing hormone (GnRH) stimulation test is a common procedure used to investigate normality of the pituitary-gonadal axis in mammals. There is very little information on the technique, its efficacy and side effects in small animals and in particular no information for male cats. In dogs, such test is performed by intravenous (IV) administration. With cats, the number of times the animal needs to be restrained for blood sampling should be the least possible. The purpose of this study was to assess efficacy and side effects of the GnRH stimulation test in tomcats comparing the IV with the intramuscular (IM) route of administration. A GnRH stimulation test was performed in eight adult tomcats through IM or IV administration of 50 μg gonadorelin. The response of the pituitary-gonadal axis was assessed by measuring serum testosterone on blood samples collected prior to and 1 hr following treatment. When considering each single group of cats, the post-stimulation serum testosterone values were significantly higher than the pre-treatment ones (p < .05). When comparing the two groups of cats, basal testosterone concentrations did not differ, and also post-GnRH testosterone concentrations did not differ. In conclusion, in the cats of our study, the GnRH stimulation test produced the same results following the IM or the IV route of administration. Therefore, in tomcats, the IM route can be considered as effective as the IV one and should be preferred when doing a GnRH test.

IFRD1 gene polymorphisms are associated with nasal polyposis in cystic fibrosis patients

Background: Nasal polyposis (NP) is an inflammatory disease of the upper nasal airways frequently present in CF patients. Interferon-Related Developmental Regulator 1 (IFRD1) gene was reported as a possible modifier of CF lung disease severity. Three IFRD1 SNPs were analyzed to investigate a possible effect on the development of NP in CF patients. Methods and patients: The DNA of 143 patients with CF (40 with and 103 without NP) was purified from peripheral blood samples. IFRD1 SNPs (rs7817, rs3807213, rs6968084) were genotyped by restriction enzyme analysis. Results: The T allele of the common polymorphisms rs7817 and the rs7817-rs3807213 haplotype were associated with NP (p = 0.002 and 0.004, respectively). Conclusions: These results showed the association of the IFRD1-rs7817 polymorphism with NP in CF patients.

Percutaneous radiofrequency thermal ablation for hepatocellular carcinoma

BACKGROUND

Radiofrequency thermal ablation is the first therapeutic option in percutaneous treatment of hepatocellular carcinoma but data on its long-term efficacy and safety are not conclusive.

AIM

This study reports a prospective survey on radiofrequency thermal ablation in north-east Italy.

METHODS

Data were collected on 401 patients with hepatocellular carcinoma (males 301, mean age: 68 years) treated by radiofrequency thermal ablation in 13 centres. Indication to treatment was: single nodule not eligible for surgery in 77% of patients, 2-3 nodes in 18% and multiple lesions in 5%. Mean size was 3 cm (1-8 cm). Treatment response was assessed at 1 month by spiral computerized tomography and then with ultrasound examination and new spiral computerized tomography.

RESULTS

Complete response was obtained in 67% of patients and in 27% response was 75-99%. Complete response raised to 77% in lesions smaller than 3 cm. The morbidity rate was 34%; the mortality was 0.5%, seeding was observed in four patients. Ten patients presented an unexpected rapid disease progression.

CONCLUSION

The above data show that by radiofrequency thermal ablation, complete response can be achieved only in about two-third of the cases, clearly less than expected, and that, beyond seeding, unexpected progression can be observed.

Tumour staging, morphology and p53 overexpression concur in predicting survival in hepatocellular carcinoma

BACKGROUND/AIMS

The prognosis of hepatocellular carcinoma (HCC) on cirrhosis is hard to predict as it depends on tumour stage, underlying liver disease, type of treatment and, possibly, biological factors of the tumour itself.

METHODS

We prospectively evaluated the survival of 91 consecutive patients with HCC on cirrhosis, diagnosed between January 1998 and December 1999. Clinical features and histological/biological aspects, including histotype, grade, p53 overexpression, cytoproliferation and apoptotic markers were analysed.

RESULTS

Child-Pugh (P = 0.01), Okuda (P < 0.0001), Cancer of the Liver Italian Program (CLIP) staging (P < 0.0001) and type of treatment (P = 0.0001) were significantly related to survival. In the Cox model, CLIP staging was included as independent predictor of survival at step 1 (P < 0.0001) with Okuda at step 2 (P = 0.013). Amongst the biological factors, p53 overexpression and histotype were significantly related with survival (P = 0.0044 and 0.017 respectively). When clinical and biological variables were examined together in the Cox model, CLIP and Okuda were confirmed as being statistically related with survival (P < 0.0001 and =0.012) followed by histotype and p53 overexpression (P = 0.019 and 0.02).

CONCLUSIONS

CLIP, Okuda, histotype and p53 overexpression are the strongest predictors of survival in this series of patients. These data confirm that staging of the tumour and underlying liver disease are strictly related to prognosis but support the concurrent role of clinical and biological factors in upgrading our capacity of predicting the fate of HCC patients.

High Resolution Infrared Spectrum of the C-F Stretching Mode of CH2 F37 Cl

Diode laser spectra of CH2 F37 Cl (95% isotopically pure sample) have been recorded in the 9.4 μm region characterized by the nu4 fundamental. The spectral analysis allowed the assignment of more than 3700 transitions with J </= 92 and Ka </= 16 of the expected a /b -hybrid structure. The nu4 fundamental, whose origin is at 1067.7140 cm-1 , mainly interacts through a - and b -type Coriolis coupling with the nu9 fundamental located at lower wavenumbers near 1002 cm-1 . Local effects arising from Fermi resonance with nu5 + nu6 have been observed for the K a ' = 14 level. An effective set of upper state molecular constants was determined by fitting the less perturbed transitions to the Watson's A-reduction Hamiltonian in the Ir representation. Due to the second-order a -type Coriolis resonance, a number of perturbation-allowed transitions of nu9 were observed and assigned near the avoided crossing. Using a suitable program, we experienced a two band system analysis which produced the molecular constants of the v 4 = 1 and v 9 = 1 states along with the interaction parameter. From spectral simulation of nu4 , the |Deltaμa /Deltaμb | dipole moment ratio was estimated to be 1.8 +/- 0.2.

[Type I Arnold-Chiari malformation: diagnostic considerations in a case]

An 18-year-old patient with a 5-year history of periodic vertigo, headache and stiff neck is reported. Routine X-ray of the skull showed a mild form of basilar impression while the CT scan demonstrated only a tri-ventricular hydrocephalus. Without using the traditional invasive techniques, diagnosis of Chiari type I malformation was nonetheless clearly pointed out by magnetic resonance imaging of the posterior fossa and spinal cord. Diagnostic problems of this clinically ambiguous and uncharacterized syndrome are discussed.

[Convulsive episodes caused by a suspension of lorazepam]

Seven cases of convulsive seizure occurring after abrupt withdrawal of Lorazepam in non epileptic patients are reported. Five ot of them had an important cerebral damage occurred in perinatal period. All patients, before withdrawal, had been taking Lorazepam, 5-15 mg/day, for at least six months. It is stressed that in similar cases there is no need to start an anticonvulsive therapy because usually there is not a spontaneous recurrence of convulsive seizures. It is suggested that withdrawal of long term treatments with high doses of benzodiazepines be accomplished carefully and very slowly especially in patients with a previous cerebral damage.