Post-traumatic ossification of the Achilles tendon: description of a case.

The presence of small areas of ossification in the Achilles tendon is a relatively frequent finding. It is instead rare to find large, extensive ossifications for more than half of the tendon. The authors describe a case of a man aged 45 years who, in the wake of an unknown lesion of the Achilles tendon, developed clinically symptomatic ossification 9.5 cm in length and 2.3 cm in width. The patient was treated surgically by removal of the ossified portion and repair of the diastasis with a proximal Achilles flap. After 17 months, the patient is asymptomatic, there are no disorders in walking, and he exclusively shows moderate limitation in range of movement of the ankle joint associated with tricipital hyposthenia. Bone metaplasia of the Achilles tendon is a rare event, that can follow trauma or surgery. The size of the area to be removed implies considerable difficulty in repair of the continuity and in recovery of the length of the tendon.

The Mitchell bunionectomy: a prospective study of 60 consecutive cases utilizing single K-wire fixation.

The authors prospectively evaluated 45 patients (60 feet) affected by hallux valgus and treated with a distal metatarsal osteotomy. The surgical procedure consisted of a modified Mitchell osteotomy, in which fixation was achieved with a Kirschner wire that was driven into the proximal osteotomy fragment and buttressed the distal one. Early weightbearing was allowed without a cast. Follow-up averaged 25 months. The mean American Orthopedic Foot and Ankle Society clinical hallux score increased from 44.6/100 preoperatively to 83.2/100. Radiographic evaluation showed that mean metatarsophalangeal and intermetatarsal angles decreased respectively from 31.7 degrees to 16.9 degrees, and from 15.4 degrees to 8.6 degrees. Short-term loss of correction occurred in three cases (4%). Six feet (10%) had unrelieved metatarsalgia that was related to excessive shortening of the first metatarsal and/or inappropriate orientation of the metatarsal head. Stabilization of the Mitchell osteotomy with a Kirschner wire proved safe and effective for the surgical correction of mild to moderate hallux valgus.

Urinary levels of bombesin-related peptides in a population sample from northern Italy: potential role in the pathogenesis of chronic obstructive pulmonary disease.

Bombesin-related peptides (BRP) are present in the lung and have various biological functions, including modulation of lung maturation. Many recent studies have suggested that BRP have a pathogenic role in airway wall remodeling in chronic obstructive pulmonary disease. The aim of this cross-sectional survey was to evaluate the distribution of urinary BRP excretion as a indirect marker of pulmonary BRP production and to assess the prevalence of smoking, chronic respiratory symptoms, chronic obstructive pulmonary disease, and asthma in a population sample from northern Italy. Associations between urinary BRP excretion and several respiratory and nonrespiratory variables were also evaluated. The only variable tested that was significantly predictive of high urinary levels of BRP was the presence of respiratory symptoms. In contrast to previous studies, smoking per se was not significantly associated with urinary BRP levels.

Effects of seaprose on the rheology of bronchial mucus in patients with chronic bronchitis. A double-blind study vs placebo.

There are changes in the rheological characteristics of mucus (viscoelasticity) in several pulmonary pathologies, and especially in chronic bronchitis. Seaprose, a proteolytic enzyme, is one of the pharmacological possibilities for affecting the rheology of bronchial mucus to correct mucostasis and improve its clearance. The action of this drug on the viscoelasticity of bronchial mucus was assessed in a double-blind vs placebo study with 20 randomly balanced chronic bronchitis patients using a new kind of portable rheometer with special features designed for routine bronchial mucus analysis in clinical practice at the patient's bedside. It was found that in the group of patients who were given the placebo, there were no particular changes in the rheological behaviour of mucus, while in those patients who were given seaprose there were significant changes in both viscosity and elasticity at the end of treatment. Eight days after the end of treatment with seaprose, there was still a significant beneficial effect on the viscoelasticity of mucus and a sort of "post-mucolytic effect" can be postulated. Seaprose also had antiinflammatory action, and since in chronic bronchitis there are variable degrees of inflammations, its beneficial long-lasting effect could also be ascribed to this concomitant action.

[Primary volvulus of the omentum: a report of 4 cases]. / I volvoli primitivi dell'omento: presentazione di 4 casi.

The authors report their experience in the diagnosis and treatment of primary torsion of the omentum. They emphasize the clinical findings of the cases observed for a better understanding of this uncommon abdominal pathology.

Lymphocyte subsets in bronchoalveolar lavage fluid and in circulating blood in epidermoid bronchogenic carcinoma.

Alveolar macrophages, lymphocyte and granulocyte percentages, together with OKT3+, OKT4+, OKT8+ lymphocyte subsets and OKT4+/OKT8+ ratio, were evaluated in bronchoalveolar lavage (BAL) fluid and in peripheral venous blood (PVB) of neoplastic and nonneoplastic subjects, in order to assess these aspects of immunity in neoplastic disease and to find out if the modifications in the bronchoalveolar environment are correlated to the ones in the circulation blood. BAL was performed in 30 patients undergoing fiberoptic bronchoscopy to ascertain the presence of lung cancer. Twelve of them had positive findings for epidermoid bronchogenic carcinoma, while in the remaining subjects the diagnosis was not confirmed. The 30 examined subjects were then grouped according to their smoking habit. In PVB, no significant difference was seen between neoplastic and nonneoplastic subjects, whereas in BAL the neoplastic patients showed a significant increase of lymphocytes OKT3+ and OKT8+. This tends to confirm that PVB is not a good indicator of organ immunity and may justify the reduced activity of alveolar macrophages in subjects affected by bronchogenic neoplasia. Between smokers and nonsmokers, lymphocyte subsets showed more significant differences than between neoplastic and nonneoplastic subjects (decrease of T4+ lymphocytes, increase of T8+ lymphocytes and, therefore, reduction of T4/T8 ratio); there were also scalar variations in the three groups (smokers with cancer, smokers without cancer and nonsmokers without cancer). Thus, the possible autonomous role of cigarette smoke and the presence of neoplasia in the immunity alterations of the alveolar environment with final joint effects were confirmed. These data may indicate a possible correlation between cigarette smoking, immunological alterations in BAL and the onset of bronchogenic carcinoma.

Some aspects of "deep lung" cellular immunity in chronic bronchitis before and after therapy with tiopronin.

Fifteen patients suffering from obstructive chronic bronchopneumonia in a clinical steady-state phase received 0.6 g of tiopronin once a day during 10 days per os. The lymphocyte subsets (OKT3, OKT4 and OKT8) have been identified in peripheral blood and in bronchoalveolar lavage liquid (BAL) before and after treatment and phagocytosis has been evaluated in pulmonary alveolar macrophages (PAM) (phagocytosis index, phagocytosis percentage, superoxide-ion production). A highly significant improvement in the phagocytosis process has been observed in the PAM, as well as an increase in the number of lymphocytes T3 and in the T4/T8 ratio (due to an increase in T4 lymphocytes) in the BAL; while in peripheral blood T3 and T4 lymphocytes and the T4/T8 ratio only showed a nonsignificant increase after treatment. The possible mechanisms on which these variations are based have been investigated.

Pharmacokinetics and sputum levels of josamycin after single and multiple administrations in bronchopneumopathic patients.

Josamycin is a new macrolide antibiotic with low toxicity and effective therapeutic activity in many bacterial diseases, particularly bronchopulmonary infections. In the present study the pharmacokinetics of josamycin were investigated in a group of 10 patients suffering from acute exacerbation of chronic bronchitis, with purulent or mucopurulent expectoration. Patients were given one oral administration of 1 g of josamycin every 12 hours for seven days. Serum, urinary parameters and the profile of bronchial mucus diffusion were assessed after the first and the last administration.