Anomalie cerebellari fetali: confronto tra ecografia e risonanza magnetica prenatale e follow up a distanza

Cerebellar malformation are increasingly diagnosed in utero. To assess the effectiveness of ultrasound and fetal magnetic resonance in the antenatal prediction of long term neurodevelopmental delay. STUDY DESIGN: We collected 105 cases of cerebellum malformation in the period 2000-2010 in Bologna and Bari University. Classification included cystic anomalies of posterior fossa and cerebellar hypoplasia. RESULTS: The greater group included Blake’s pouch cysts and mega cisterna magna cases (58/105). These cases seemed to have a good prognosis with a good outcome both in association with other anomalies and isolated. In cases of Dandy Walker malformation, vermis hypoplasia and cerebellum hypoplasia there were few survivors, so it was so difficult to outline some conclusion for child outcome. Despite great neuroimaging advances, in our study, ultrasound and MR reached a similar sensitivity (62-63%) for the diagnosis of posterior fossa anomalies, but the number of MR was lower compared with ultrasonography. CONCLUSION: Ultrasonography remains the screening method of choice for evaluation of cerebellum anatomy but probably MR imaging can improve some details expecially in the third trimester. Despite the data on Dandy Walker, vermis hypoplasia and cerebellum hypoplasia were conflicting and uncertain, for Blake and mega cisterna magna we can considered a rather good outcome.

Timing per l'inserimento in lista dei pazienti affetti da fibrosi cistica che necessitano di trapianto polmonare: casistica di un centro regionale di riferimento

Timing of waiting list entrance for patients with cystic fibrosis in need of pulmonary transplant: the experience of a regional referral centre Objective: Evaluation of parameters that can predict a rapid decay of general conditions of patients affected by Cystic Fibrosis (CF) with no specific criteria to be candidate to pulmonary transplant. Material and methods: Fifteen patients with CF who died for complications and 8 who underwent lung transplantation in the 2000-2010 decade, were enrolled. Clinical data 2 years before the event (body max index, FEV1%, number of EV antibiotic treatments per year, colonization with Methicillin-resistant Staphylococcus aureus (MRSA), pseudomonas aeruginosa mucosus, burkholderia cepacia, pulmonary allergic aspergilosis) were compared among the 2 groups. Results: Mean FEV1% was significantly higher and mean number of antibiotic treatment was lower in deceased than in the transplanted patients (p<0.002 and p<0.001 respectively). Although in patients who died there were no including criteria to enter the transplant list 2 years before the exitus, suggestive findings such as low BMI (17.3), high incidence of hepatic pathology (33.3%), diabetes (50%), and infections with MRSA infection (25%), Pseudomonas aeruginosa (83.3%) and burkholderia cepacia (8.3%) were found with no statistical difference with transplanted patients, suggesting those patients were at risk of severe prognosis. In patients who died, females were double than males. Conclusion: While evaluating patients with CF, negative prognostic factors such as the ones investigated in this study, should be considered to select individuals with high mortality risk who need stricter therapeutical approach and follow up. Inclusion of those patients in the transplant waiting list should be taken into account.

Le politiche giudiziarie inglesi degli anni 2000: mutamento di paradigma e rafforzamento dell'incisività politica dei giudici

The Ph.D. dissertation analyses the reasons for which political actors (governments, legislatures and political parties) decide consciously to give away a source of power by increasing the political significance of the courts. It focuses on a single case of particular significance: the passage of the Constitutional Reform Act 2005 in the United Kingdom. This Act has deeply changed the governance and the organization of the English judicial system, has provided a much clearer separation of powers and a stronger independence of the judiciary from the executive and the legislative. What’s more, this strengthening of the judicial independence has been decided in a period in which the political role of the English judges was evidently increasing. I argue that the reform can be interpreted as a «paradigm shift» (Hall 1993), that has changed the way in which the judicial power is considered. The most diffused conceptions in the sub-system of the English judicial policies are shifted, and a new paradigm has become dominant. The new paradigm includes: (i) stronger separation of powers, (ii) collective (as well as individual) conception of the independence of the judiciary, (iii) reduction of the political accountability of the judges, (iv) formalization of the guarantees of judicial independence, (v) principle-driven (instead of pragmatic) approach to the reforms, and (vi) transformation of a non-codified constitution in a codified one. Judicialization through political decisions represent an important, but not fully explored, field of research. The literature, in particular, has focused on factors unable to explain the English case: the competitiveness of the party system (Ramseyer 1994), the political uncertainty at the time of constitutional design (Ginsburg 2003), the cultural divisions within the polity (Hirschl 2004), federal institutions and division of powers (Shapiro 2002). All these contributes link the decision to enhance the political relevance of the judges to some kind of diffusion of political power. In the contemporary England, characterized by a relative high concentration of power in the government, the reasons for such a reform should be located elsewhere. I argue that the Constitutional Reform Act 2005 can be interpreted as a result of three different kinds of reasons: (i) the social and demographical transformations of the English judiciary, which have made inefficient most of the precedent mechanism of governance, (ii) the role played by the judges in the policy process and (iii) the cognitive and normative influences originated from the European context, as a consequence of the membership of the United Kingdom to the European Union and the Council of Europe. My thesis is that only a full analysis of all these three aspects can explain the decision to reform the judicial system and the content of the Constitutional Reform Act 2005. Only the cultural influences come from the European legal complex, above all, can explain the paradigm shift previously described.