Epidemiology of sepsis in Internal Medicine Units of Apulia: results of SEMINA (SEpsis Management in INternal medicine Apulia) study.

Background: The prevalence and mortality of sepsis in Internal Medicine Units (IMUs) is poorly understood as most of the data derive from studies conducted in Intensive Care Units. Aim of SEpsis Management in INternal medicine Apulia (SEMINA) study was to determine the prevalence of sepsis and the characteristics and outcomes of patients with Sepsis-3 criteria admitted in Apulia's Internal Medicine Units for over six months. Methods: The SEpsis Management in INternal medicine of Apulia study was a prospective, multicentre, observational study. Adult admissions to the 13 Apulia Region's Internal Medicine Units between November 15, 2018 and May 15, 2019 were screened for sepsis according to the Sepsis-3 criteria. Medical data were collected in electronic case report form. Results: Out of 7,885 adult patients of the Internal Medicine Units, 359 (4.55%) fulfilled the inclusion criteria, and 65 of them (18.1%) met the septic shock criteria. The patients enrolled were elderly, suffering from chronic poly-pathologies and from cognitive and functional impairment. The respiratory system was the most common site of infection and the most common pathogens isolated from blood cultures were Staphylococcus spp., E. coli, Klebsiella spp., Enterococcus spp. and Acinetobacter spp. The in-hospital fatality rate was 31.2% and was significantly higher for septic shock. Sequential Organ Failure Assessment score, dementia and infections from Acinetobacter spp. were independent risk factors for mortality. Conclusions: A high prevalence of sepsis and a high fatality rate were detected in Apulia Region's Internal Medicine Units. The high fatality rate observed in our study could be related to the underlying diseases and to the vulnerability of elderly patients admitted to our Internal Medicine Units.

Intertrochanteric valgus osteotomy and sliding compression hip screw in fractures of the femoral neck.

Twenty-four patients ranging from 28 to 56 years of age with Garden grade III or IV fractures of the femoral neck are reviewed after treatment by intertrocherantic valgus osteotomy and Richards sliding compression hip screw. The rationale behind this treatment, the operative technique, and the choice of internal fixation device are all discussed. All patients were followed up after more than 2 years so that any late complications could be documented. The results were evaluated using both the Merle d'Aubigné procedure and radiographic examination: 12 (50%) were rated excellent, 5 (20.8%) good, 2 (8.4%) fair, and 5 (20.8%) poor. The unsatisfactory results are analyzed in detail, attributable to non-union in 2 cases (due to technical error), avascular necrosis in 4 cases (2 were limited and well-tolerated by the patients; 2 were early and massive and necessitated prosthetic replacement), and infection in one case. Even though valgus osteotomy and internal fixation fill a gap in the treatment of femoral neck fractures in adults by yielding good results with a conservative method, they are very demanding surgical procedures, requiring anatomical reduction, atraumatic technique, precise calculation of the valgus angle, and precise placement of the internal fixation device.

Immediate multiple osteosynthesis in polytrauma.

Thirty polytraumatized patients underwent immediate osteosynthesis of two or more long bone fractures for a total of 82 operations (plus an additional 14 for pelvis, hand, and foot fractures). Since 1983, according to the modern and rational concepts of "all at one time treatment", open fractures as well as associated closed lesions are stabilized immediately if the patient's general condition permits. This type of procedure requires adequate facilities as well as availability of and collaboration between teams of specialists, but it is inarguably advantageous for the patient (relief of pain, drastic reduction in the rate of embolism, improvement of respiratory and circulatory function, only one anesthesia), the surgeons (operation technically easier and shorter), and the ancillary medical personnel (easier nursing, rapid functional rehabilitation). The methods of osteosynthesis should be carefully selected in order to guarantee stability, rapid application, and low aggressiveness. The use of plates and screws is limited, while external fixation is employed frequently. Interlocked intramedullary nailing is adopted with increasing frequency. Review of cases treated by this method shows considerable improvement in terms of healing, functional recovery, and resumption of social and occupational activity.

Antibiotic and antithromboembolic prophylaxis in prosthetic surgery of the knee.

The prevention of deep sepsis and venous thromboembolism in knee replacement surgery is of great importance for the final success of treatment. General rules of prevention must be followed when using antimicrobial drugs (environment, surgical method, patient selection). Although it does have some negative aspects (overuse, high costs, development of resistant bacteria) the administration of antibiotics is recommended, but only when it is timely, correct, and carried out for a suitable amount of time. The prevention of thromboembolism is based first on the selection of patients who risk the occurrence of angiology-related diseases, on continuous passive postoperative movement, and, finally, on intentional normovolemic hemodilution, for which the procedures used and the advantages obtained are described.

Internal and external fixation in complex diaphyseal and metaphyseal fractures of the humerus.

The treatment of diaphyseal and metaphyseal fractures of the humerus is often controversial, especially when these fractures are complex and/or unstable (i.e. comminuted, segmental, or with a butterfly fragment). The authors review the indications, advantages, and disadvantages of various open and closed procedures, concluding that a combination of internal and external fixation is a valid treatment for these fractures. The purpose of the external fixation is immediate stabilization of the fracture, which is difficult if not impossible with intramedullary internal fixation alone. Internal fixation devices (Rush rods or "anchor" nails introduced by closed means) make it possible to align the fracture, facilitating application of the external fixator, and at the same time promote rapid healing. Fractures treated by this method healed in an average of 2 1/2 months, without residual functional limitations of the shoulder or elbow.

Cemented arthroprosthesis in femoral neck fractures.

Primary total hip replacement in femoral neck fractures is still controversial. This report presents the findings of a study of 42 femoral neck fractures treated with cemented arthroprosthesis with an average follow-up of five years. The patients were divided into two groups according to the type of prosthesis, the reaming and cementing techniques, and the type of operating room. Each group had positive results in about 80% of the cases, testifying to the fact that arthroprosthesis is a valid method of treatment provided that the following procedures are scrupulously carried out: the preparation of the patient, the choice and implantation of the prosthesis, and the functional and psychological rehabilitation of the patient.

The locked Grosse-Kempf intramedullary nail in the treatment of diaphyseal and metaphyseal fractures of the femur and tibia.

The Gross-Kempf locked intramedullary nail widens the indications for the traditional Küntscher nail in the treatment of diaphyseal and metaphyseal fractures of the lower limbs. The study includes 87 patients with a total of 93 closed fractures treated between 1981 and 1987. Osteosynthesis was carried out in 85 closed fractures and in 8 Grade 1 or 2 open fractures. Possible assemblies in relation to the level and type of fracture and the protocol for weightbearing are illustrated, with emphasis on the fact that dynamization of static assemblies is not always essential. The high percentage of positive results (86%) and the relatively small incidence of complications confirm the validity of this method. The only drawback is the fairly high dose of radiation absorbed by the surgeon during the operation.

Prolapsed intervertebral disc at the upper lumbar level. Diagnostic difficulties. A report on 12 cases.

Prolapsed intervertebral disc at the upper lumbar level causes problems in diagnosis. Compressive root syndromes at L1-L2-L3 present clinical features which are not very specific. They are frequently pluriradicular and may be referred to areas of atypical distribution. The anatomical features and the relationship between discs and nerve roots and any variations are illustrated. Based on our personal experience with 12 cases of herniation of the first two lumbar discs, we would emphasize the importance of extending myelography and CT scanning to the high lumbar metameres whenever the symptomatology is equivocal. If such a policy were adopted, the incidence of prolapsed disc at the higher lumbar levels would probably be found to be higher than is at present supposed.

Slow healing fractures: can they be prevented? (Results of electrical stimulation in fibular osteotomies in rats and in diaphyseal fractures of the tibia in humans).

The purpose of the study was to evaluate the possibility of preventing delayed union in fractures by the use of low-frequency pulsing electromagnetic fields (PEMFs). The study was conducted in two parts, both with control groups. Fibular osteotomies in rats and diaphyseal fractures of the tibia in humans were treated with and without electrical stimulation (PEMF). The rats were sacrificed on the 8th and 23rd days respectively in order to evaluate the histological picture of the repair callus and its mechanical resistance. In the human subjects, the clinical and radiological follow-up took into account various factors known to affect the rate of union in the various fracture groups. The results obtained suggest that PEMF stimulation is capable of accelerating and modulating the physiological process of union by its favourable effect on osteogenesis.

Carpal tunnel syndrome. Comparative study between normal and dialyzed patients.

The various theories of carpal tunnel syndrome (CTS) are reviewed. The clinical and other features are compared and the results of surgical decompression and neurolysis reported in two groups of patients; 65 operations in "classical" CTS and 11 operations in patients on renal dialysis ("dialytic CTS"). Relief of pain and recovery of normal sensation was achieved in a high percentage of cases in both groups. Recovery of motor function was markedly better and quicker in the "dialytic" group, probably because deterioration was more rapid and therefore surgical intervention was carried out earlier. The pathological anatomy showed no significant overall difference between the two groups, except that in two of the renal dialysis patients granular deposits of myeloid substances were observed in the flexor tendon sheaths and on the walls of the carpal tunnel.

[Proglumetacin: a flexible and broad-spectrum antirheumatic agent]. / Proglumetacina: antireumatico flessibile e ad ampio spettro.

Fifty-five patients with osteoarthritis, rheumatoid arthritis or spondyloarthritis, joint pain and other rheumatic-inflammatory disorders were treated with proglumetacin, at different doses, during 3-60 days. Assessment of therapeutic efficacy indicated 88.9% of good results. Joint pain progressively decreased during the whole period of observation. Tolerance was considered good or very good in 78% of patients.