Background: The therapeutic approach to chronic aspecific low back pain (CALBP) has to consider the multifactorial aetiology of the disorder. International guidelines do not agree on unequivocal treatment indications. Recommendations for fascial therapy are few and of low level evidence but several studies indicate strong correlations between fascial thickness and low back pain. This study aims at comparing the effectiveness of Fascial Manipulation® associated with a physiotherapy program following guidelines for CALBP compared to a physiotherapy program alone. Methods: 24 subjects were randomized into two groups, both received eight treatments over 4 weeks. Outcomes were measured at baseline, at the end of therapy and at a 1 month and a 3 months follow-up. Pain was measured with the visual analogue scale (VAS) and the brief pain inventory (BPI), function with the Rolland-Morris disability questionnaire (RMDQ), state of well-being with the short-form 36 health-survey (SF-36). The mean clinical important difference (MCID) was also measured. Results: Patients receiving Fascial Manipulation® showed statistically and clinically significant improvements at the end of care for all outcomes, in the short (RMDQ, VAS, BPI) and medium term for VAS and BPI compared to manual therapy. The MCID show significant improvements in the means and percentage of subjects in groups in all outcomes post-treatment, in the short and medium term. Conclusion: Fascial tissues were implicated in the aetiology of CALBP and treatment led to decreased symptomatic, improved functional and perceived well-being outcomes that were of greater amplitude compared to manual therapy alone.

KEYWORDSUltrasonography; Contrast agent; Abdominal trauma.Abstract Introduction: To evaluate the use of contrast-enhanced ultrasonography (CEUS) in patients with blunt abdominal trauma. Materials and methods: A total of 133 hemodynamically stable patients were evaluated using ultrasonography (US), CEUS and multislice Computer Tomography (CT) da eliminare. Results: In 133 patients, CT identified 84 lesions: 48 cases of splenic injury, 21 of liver injury, 13 of kidney or adrenal gland injury and 2 of pancreatic injury. US identified free fluid or parenchymal abnormalities in 59/84 patients positive at CT and free fluid in 20/49 patients negative at CT. CEUS revealed 81/84 traumatic injuries identified at CT and ruled out traumatic injuries in 48/49 negative at CT. Sensitivity, specificity, positive and negative predictive values for US were 70.2%, 59.2%, 74.7% and 53.7%, respectively; for CEUS the values were 96.4%, 98%, 98.8% and 94.1%, respectively. Conclusions: The study showed that CEUS is more accurate than US and nearly as accurate as CT, and CEUS can therefore be proposed for the initial evaluation of patients with blunt abdominal trauma.Sommario Introduzione: Descrivere l'impiego dell'ecografia con mezzo di contrasto (CEUS) nella valutazione dei pazienti con trauma chiuso dell'addome. Materiali e Metodi: 133 pazienti con trauma addominale chiuso emodinamicamente stabile sono stati esaminati con ecografia (US), CEUS e Tomografia Computerizzata multistrato (TC) da eliminare. Risultati: I 133 pazienti avevano alla TC 84 lesioni, di cui 48 spleniche, 21 epatiche, 13 renali o dei surreni e 2 del pancreas. L'US ha identificato versamento libero o alterazioni parenchimali in 59/84 pazienti positivi alla TC e versamento libero in 20/49 pazienti negativi alla TC. La CEUS ha riconosciuto 81/84 lesioni traumatiche identificate dalla TC e ha escluso lesioni traumatiche in 48/49 pazienti negativi alla TC. Sensibilità, specificità, valore predittivo positivo e negativo per l'US sono stati rispettivamente 70.2%, 59.2%, 74.7% e 53.7%; per la CEUS sono stati 96.4%, 98%, 98.8% e 94.1%. Conclusioni: Lo studio ha dimostrato che la CEUS ha una accuratezza diagnostica maggiore dell'US e quasi sovrapponibile alla TC e può quindi essere proposta nella valutazione iniziale del paziente traumatizzato. ª

KEYWORDSUltrasonography; Chest; Radiograph; Computed tomography.Abstract Diagnosis of acute lung disease is a daily challenge for radiologists working in acutecare areas. It is generally based on the results of chest radiography performed under technically unfavorable conditions. Computed tomography (CT) is undoubtedly more accurate in these cases, but it cannot always be performed on critically ill patients who need continuous care. The use of thoracic ultrasonography (US) has recently been proposed for the study of acute lung disease. It can be carried out rapidly at the bedside and does not require any particularly sophisticated equipment. This report analyzes our experience with chest sonography as a supplement to chest radiography in an Emergency Radiology Unit. We performed chest sonography e as an adjunct to chest radiography e on 168 patients with acute chest pathology. Static and dynamic US signs were analyzed in light of radiographic findings and, when possible, CT. The use of chest US improved the authors' ability to provide confident diagnoses of acute disease of the chest and lungs.Sommario La patologia polmonare acuta rappresenta una sfida quotidiana per il Radiologo d'Urgenza, al quale è richiesto di porre una diagnosi sulla base di un radiogramma del torace, eseguito spesso in condizioni tecniche precarie. La Tomografia Computerizzata (TC), pur essendo uno strumento decisivo per ovviare alla scarsa accuratezza del radiogramma del torace, non sempre è eseguibile in questi pazienti che necessitano di assistenza continua. Recentemente è stato proposto l'impiego dell'ecografia toracica per lo studio della patologia acuta. L'esame è eseguito rapidamente al letto del paziente e non necessita di apparecchiature particolari. In 168 pazienti con patologia toracica acuta è stato eseguito uno studio ecografico del torace a completamento dell'esame radiologico. Sono stati valutati i segni statici e dinamici correlandoli ai quadri radiografici e, quando possibile, di TC. Nell'esperienza riportata l'impiego dell'ecografia del torace ha permesso di migliorare la confidenza diagnostica degli autori nella diagnosi radiologica delle patologie acute del distretto toraco-polmonare. ª

Background: The therapeutic approach to chronic aspecific low back pain (CALBP) has to consider the multifactorial aetiology of the disorder. International guidelines do not agree on unequivocal treatment indications. Recommendations for fascial therapy are few and of low level evidence but several studies indicate strong correlations between fascial thickness and low back pain. This study aims at comparing the effectiveness of Fascial Manipulation® associated with a physiotherapy program following guidelines for CALBP compared to a physiotherapy program alone.Methods: 24 subjects were randomized into two groups, both received eight treatments over 4 weeks. Outcomes were measured at baseline, at the end of therapy and at a 1 month and a 3 months follow-up. Pain was measured with the visual analogue scale (VAS) and the brief pain inventory (BPI), function with the Rolland-Morris disability questionnaire (RMDQ), state of well-being with the short-form 36 health-survey (SF-36). The mean clinical important difference (MCID) was also measured.Results: Patients receiving Fascial Manipulation® showed statistically and clinically significant improvements at the end of care for all outcomes, in the short (RMDQ, VAS, BPI) and medium term for VAS and BPI compared to manual therapy. The MCID show significant improvements in the means and percentage of subjects in groups in all outcomes post-treatment, in the short and medium term.Conclusion: Fascial tissues were implicated in the aetiology of CALBP and treatment led to decreased symptomatic, improved functional and perceived well-being outcomes that were of greater amplitude compared to manual therapy alone.

II.