We compared simultaneous measurement of aortic, direct (Dir) and of indirect (Ind) systolic (S), mean (M) and diastolic (D) arterial pressure (AP) determined by an automatic oscillometric instrument (DINAMAP) in neonates with birthweight of 1000-3680 g. DINAMAP measurements were performed with cuffs of increasing width and length, recommended by the manufacturer for increasing arm circumference, and with a Standard sized cuff (2.5 X 15 cm), previously considered as suitable for neonates of any body size. In addition, we compared simultaneous measurements of Dir SAP and of Ind SAP determined by a Doppler technique and the Standard cuff. In DINAMAP SAP measurements with the Standard cuff, a statistically significant correlation between arm circumference and delta Ind-Dir SAP values (i.e. the difference between simultaneous Ind and Dir SAP measurements) was found. In DINAMAP MAP measurements with the cuff recommended for arm circumference, a statistically significant difference of the mean delta Ind-Dir MAP values was observed in infants whose arm was or was not completely encircled by the bladder of the cuff. In SAP as well as in MAP DINAMAP determinations, the overall error of measurement with the Standard cuff was smaller than with the recommended cuff. The Doppler method was found considerably more accurate than the DINAMAP method for the determination of SAP. In spite of these limitations, the DINAMAP method with the Standard cuff was considered to be reasonably accurate for the clinical determination of SAP and MAP, provided that several consecutive measurements are performed and averaged in order to minimize the error of measurement. When considering DAP measurements the error was so unacceptably high that the DINAMAP method cannot be recommended for clinical use. The need for a careful consideration of the cuff characteristics when evaluating new methods for the indirect measurement of AP in the neonate is emphasized.

Purpose: medial opening-wedge osteotomy is a widely performed procedure used to treat moderate isolated medial knee osteoarthritis. Historically, the literature has contained reports showing satisfactory midterm results when accurate patient selection and precise surgical techniques were applied. this study was conducted to investigate the clinical and radiographic seven-to twelve-year results of opening-wedge high tibial osteotomy in a consecutive series of patients affected by varus knee malalignment with isolated medial compartment degenerative joint disease. Methods: we reviewed a case series of 147 medial opening-wedge high tibial osteotomies at an average follow-up of 9.5 years. Endpoints for evaluation included the reporting of adverse effects, radiographic evidence of bone union, radiographic changes in the correction angle during union, and clinical and functional final outcomes. Results: good or excellent results were obtained in 94% of the cases: the patients reported no major complications related to the opening-wedge high tibial osteotomy surgical technique, bone graft resorption, implant choice or postoperative rehabilitation protocol. At final follow-up, the average hip-knee angle was 4° of valgus without major loss of correction during the healing process. A statistically significant change in the patellar height was detected postoperatively, with a trend towards patella infera. Conclusions: medial opening-wedge high tibial osteotomy is still a reliable method for correcting varus deformity while producing stable fixation, thus allowing satisfactory stability, adequate bone healing and satisfactory mid-to long-term results. Level of evidence: Level iV, therapeutic cases series.

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Situs inversus viscerum is a rare congenital anomaly (incidence 1/15–20 000) in which organs are mirrored from their normal positions. It is called situs inversus viscerum totalis when there is a total transposition of abdominal and thoracic viscera. Incomplete situs inversus viscerum involves transposition only of abdominal organs and is more frequently associated with congenital cardiac defects (90%–95% vs 5%–10% in situs inversus totalis). About 25% of individuals with situs inversus have an underlying condition known as Kartagener Syndrome. As a result of benign pathology, patients with situs inversus viscerum can live normal healthy lives. Situs viscerum inversus can be associated with defects in various organ systems (respiratory, GI tract, genitourinary). In literature there’s evidence of cases of situs inversus associated with renal malformations (dysplasia, hypoplasia, ectopia, polycystic kidney, horseshoe kidney). Association with renal agenesis is rare. We report the case of S., born at 40 weeks, eutocic delivery. APGAR 8/9, weight 3350 g. Normal fetal US. In the third day of life, heart sounds better heard on the right side of the chest. Cardiac US: situs inversus viscerum, dextrocardia, subaortic stenosis, restrictive ventricular septal defect, atrial septal defect ostium secundum. In the fourth day of life, abdominal US findings were suggestive of right renal agenesis. In the 20th day of life, right reducible inguinal hernia. The little patient underwent cystography, negative for vesicoureteral reflux, and static renal scintigraphy with evidence of absent activity in right renal space. Renal function, cerebral US, audiologial assessment and karyotype were normal. No respiratory distress reported. Mucociliary clearance test and a regular follow-up are scheduled.