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Rare genetic and non-genetic diseases are often associated with high risk of malnutrition[1]. The purpose of the study is to evaluated rare diseases among patients on Home Artificial Nutrition (HAN) and prescriptions registered at Local Health Care Unit Naples 3, Italy. Data were collected from 231 patients (M=131; F=100) recorded in 2019 (1st January-31st December). Oral Nutritional Supplements (ONS), Enteral Nutrition (HEN), Parenteral Nutrition (HPN) were included; complications of pregnancy and childbirth were excluded. Adults were 182 (78.8%), Pediatrics 49 (21.2% ). Rare diseases of the nervous system were 177 (76.7%), congenital anomalies 25 (10.8%) and inborn errors of metabolism 8 (3%). Respiratory, hematologic, immunologic, and skin diseases, primitive glomerulopathies and intestinal disorders, rare tumors were found in fewer cases (9.1%). Amyotrophic Lateral Sclerosis was the most frequent diagnosis (43.3%; 94 ALS and 6 ALS-Juvenile). Spinal Muscolar Atrophy (SMA) was found in 23.8% of pediatrics, Progressive Supranuclear Palsy (PSP) and Duchenne Muscular Dystrophy (DMD) in 8.4% and 4.5% of adult patients. ONS were 123, mainly prescribed to adults (87%); HEN were 100, administered through Percutaneous Endoscopy Gastrostomy (86%) and nasogastric tube feeding (14%), HPN were only 9 prescriptions. Nutritional impairment in patient with rare neurologic diseases is frequent. HAN could improve clinical management of symptoms worsening quality of life of patients. Further research is needed to evaluate the impact of nutritional intervention on individual clinical outcome[1].

In recent years, there has been growing interest in nutritional aspects of community patients, particularly the elderly [1]. The purpose of the study is to analyze nutrients intake in community-dwelling adult patients requiring nutritional assessment and correlations with clinical conditions. Data has been collected from 141 adult patients (M=64; F=77) registered in 2019 (1st October-31st December) at Home Artificial Nutrition (HAN) Department of Local Health Care Unit Naples 3, Italy. 24-Hour Recall Questionnaire was administered for investigating food intake. Student's t-test was used for statistical analysis. Mean age was 78 years, 89.4% were elderly (65+years) and 31.9% were aged over 85 years. The underlying disease was neurological in 56% and cancer in 29.8% of patients; 44 patients (31.2%) were bedridden with pressure sores and 76 (53.9%) referred unintentional weight loss. Patients reported dysphagia in 67.4% and loss of appetite in 43.3%. Mean energy intake was 867±328 kcal/day and proteins were 34.2±16.3 g/day. A statistically significant difference in mean energy and protein intakes was observed for older patients (85+years) (p=0.02; p=0.001), those with pressure sores (p=0.004; p=0.009) and those who reported loss of appetite (p=0.001; p=0.01). Mean fiber intake was very low in all patients (8.9±5.2 g/day). Inadequate nutrients intake is frequent in dwelling-community adult patients, particularly in the elderly. Timing of nutritional assessment and appropriate intervention could reduce chronic disease risk.

Purpose Acute toxicity in head and neck (H&N) cancer patients treated with definitive radiotherapy (RT) has a crucial role in compliance to treatments. The aim of this study was to correlate doses to swallowing-associated structures and acute dysphagia. Methods We prospectively analyzed 42 H&N cancer patients treated with RT. Dysphagia (grade ≥ 3) and indication for percutaneous endoscopic gastrostomy (PEG) insertion were classified as acute toxicity. Ten swallowing-related structures were considered for the dosimetric analysis. The correlation between clinical information and the dose absorbed by the contoured structures was analyzed. Multivariate logistic regression method using resampling methods (bootstrapping) was applied to select model order and parameters for normal tissue complication probability (NTCP) modelling. Results A strong multiple correlation between dosimetric parameters was found. A two-variable model was suggested as the optimal order by bootstrap method. The optimal model (Rs = 0.452, p  < 0.001) includes V 45 of the cervical esophagus (odds ratio [OR] = 1.016) and D mean of the cricopharyngeal muscle (OR = 1.057). The model area under the curve was 0.82 (95% confidence interval 0.69–0.95). Conclusion Our results suggested that the absorbed dose to the cricopharyngeal muscle and cervical esophagus might play a relevant role in the development of acute RT-related dysphagia.

Vitamin D deficiency rickets is a childhood osteomalacia, with impaired skeletal development and potentially skeletal deformities. The radiographic findings of rickets are many but include widening, fraying, and cupping of the metaphysis. Developmental delay and related complications of seizure and tetany have also been reported. This medical entity is often thought of as a classic medical disease of the past. However, it persists, and the recognition of rickets is on the rise. The reemergence of rickets correlates with the increase in the number of children exclusively breastfed and with the frequent use of sun block in the pediatric population. We present two cases of rickets, diagnosed through a visit to the Emergency Department made for unrelated symptoms. These two cases illustrate the importance of diagnosing rickets as an “incidental” finding. With early detection, dietary supplementation can be initiated potentially sparing the patient symptomatic disease.

To develop a new method of magnetic resonance arthrography (MRA) of the knee using an anterior approach analogous to the portals used for knee arthroscopy. An anterior approach to the knee joint was devised mimicking anterior portals used for knee arthroscopy. Seven patients scheduled for routine knee MRA were placed in a decubitus position and under fluoroscopic guidance a needle was advanced from a position adjacent to the patellar tendon into the knee joint. After confirmation of the needle tip location, a dilute gadolinium solution was injected. All the arthrograms were technically successful. The anterior approach to knee MRA has greater technical ease than the traditional approach with little patient discomfort.

To assess the impact of flip angle with gradient sequences on the \"magic angle effect\". We characterized the magic angle effect in various gradient echo sequences and compared the signal-to-noise ratios present on these sequences with the signal-to-noise ratios of spin echo sequences. Ten normal healthy volunteers were positioned such that the flexor hallucis longus tendon remained at approximately at 55 degrees to the main magnetic field (the magic angle). The tendon was imaged by a conventional spin echo T1- and T2-weighted techniques and by a series of gradient techniques. Gradient sequences were altered by both TE and flip angle. Signal-to-noise measurements were obtained at segments of the flexor hallucis longus tendon demonstrating the magic angle effect to quantify the artifact. Signal-to-noise measurements were compared and statistical analysis performed. Similar measurements were taken of the anterior tibialis tendon as an internal control. We demonstrated the magic angle effect on all the gradient sequences. The intensity of the artifact was affected by both the TE and flip angle. Low TE values and a high flip angle demonstrated the greatest magic angle effect. At TE values less than 30 ms, a high flip angle will markedly increase the magic angle effect.

We present 3 cases of small bowel diverticulitis ultimately presenting to our Emergency Department over a span of 2 years. Though the final diagnosis was the same, each patient's symptomatology was different, mimicking more common pathologies. Thus, it is important to consider this entity when confronted with signs and symptoms of acute abdomen, especially in the elderly. A missed or delayed diagnosis can lead to costly erroneous studies, incorrect treatments and delay in proper management, resulting in significant morbidity and even mortality. The variety of presentations can often be misleading; therefore, a high index of suspicion is needed on the part of the Emergency Department physician and Radiologist.

This study uses magnetic resonance (MR) imaging to delineate the types and frequencies of injuries seen in the knee after ipsilateral femoral shaft fracture. We also compare the results of the orthopedic knee examination with the MR findings. MR imaging of the ipsilateral knee was performed on 34 patients with closed femoral shaft fractures. Indications for knee MR imaging included knee pain at the time of fracture, soft tissue swelling or an effusion of the knee, or a positive knee examination under anesthesia. The patients had a mean age of 27 years and all were stabilized with intramedullary nails. Imaging was performed a mean time of 2.5 days after surgery. All patients had knee examinations done under anesthesia, and the MR results were compiled and compared with the clinical examinations. Ninety-seven percent of patients demonstrated knee effusions. Twenty-seven percent of patients demonstrated meniscal tears, with the posterior horn of the medial meniscus most frequently torn. The medial collateral ligament was the most frequent site of ligamentous injury (38%) followed by the posterior cruciate ligament (21%). Fifty percent of patients had injuries of the extensor mechanism. Bone bruises were noted in 32% of patients. Articular cartilage injuries were confined to the patella in four cases. One occult tibial plateau fracture and one meniscocapsular separation were seen. There is a common incidence of both ligamentous and meniscal injury to the knee after ipsilateral femoral shaft fracture. MR imaging can be useful in assessing the extent of injury, and may reveal findings unsuspected after clinical examination of the knee.

This work was aimed at describing the development of oral cancer and precancer in patients affected by cGVHD, thus suggesting the importance of periodical follow-up to detect premalignant or malignant lesions at an early stage. Forty patients who underwent aBMT from consanguineous and with a diagnosis of cGVHD came to our attention to the Complex Operating Unit of Odontostomatology, Policlinic of Bari; 19 of them showed 47 lesions on different oral sites which clinically appeared as: 1. leuko-erythroplastic lesions (79%), 2. ulcers (12%), and nodules (9%). All these lesions underwent incisional biopsy and histopathological analysis; specifically for neoplastic tissues, 6 prognostic factors were also evaluated: tumor thickness, invasion pattern (single cell, large front), vascular, neural, salivary glands ducts and muscle infiltration. All the surgical wounds healed without complications. The histopathological examination of the surgical samples highlighted that: 52% were oral cancers, 31% were precancerous lesions (OIN 1 and 2) and 17% were hyperkeratotic or lichenoid lesions.

Anterior dislocation of the hip is a rare phenomenon, seen in only 5-10% of all hip dislocations. These dislocations can be divided into two types: superior or subspinous and inferior or obturator dislocations. Osteochondral impaction fractures of the femoral head are a known complication of anterior dislocation, but little has been reported on the types of acetabular and pelvic fractures associated with this dislocation. Five anterior dislocations were studied with radiographs and computed tomographic (CT) imaging, and the CT findings are described. Fractures were seen in the femoral head, acetabular roof, and medial wall, as well as in the anterior inferior iliac spine. The most severe injuries occurred after a superior dislocation, but the obturator dislocations demonstrated impaction fractures of the femoral head as well as an intra-articular bone fragment. CT of the acetabuli is recommended after reduction of these dislocations to identify these complications.[PUBLICATION ABSTRACT]