Surgical denervation of the thumb CMC joint: anatomy, technique.

Surgical denervation of the thumb carpometacarpal (CMC) joint is a theoretical surgical option for thumb CMC arthritis. Some authors have described the nerve branches of thumb CMC joint. We present the innervation of the thumb CMC joint (thenar - recurrent - branch of median nerve, palmar branch of median nerve, superficial branch of radial nerve, lateral cutaneous nerve of forearm, deep branch of ulnar nerve) and the surgical techniques to achieve optimal denervation of this joint. While the results have been disappointing, this technique may be combined with conservative surgical procedures (synovectomy, ligament reconstruction) and it allows more invasive surgery in the future if necessary.

Cerebral vasoreactivity and intima-media thickness in Down syndrome: A case-control study.

Subjects with Down Syndrome (DS) have high prevalence of cerebral vascular amyloidosis, cognitive decline and dementia. In Alzheimer Disease, impaired vasoreactivity has been reported as the results of vascular amyloid deposition. Aim of our study was to verify presence of impaired cerebral vasoreactivity and to study carotid intima media-thickness (IMT) by carotid and transcranial ultrasound. We studied 25 DS and compared them with 25 age- and sex-matched normal controls. Vasomotor reactivity was evaluated by means of breath-holding index (BHI) test. There was no difference in IMT, both considering the two side separately (left: 0.70±0.10 vs 0.69±0.12mm, p=0.6) (right: 0.67±0.13 vs 0.68±0.10mm, p=0.5), and considering the sum of both sides (1.38±0.22 vs 1.38±0.23mm, p=1). There was a significant difference in peak systolic velocities (PSV) (139.75±27.67 vs. 123.89±25.73cm/s, p=0.04) and in pulsatility index (PI) (0.95±0.14 vs. 0.86±0.12, p=0.02). BHI was significantly lower in DS than in controls (1.15±0.38 vs 1.88±0.72, p<0.001). In conclusion, subjects with DS have increased PSV and PI, and show a reduction of BHI, expression of impaired vasomotor reserve, possibly due to micro-vascular impairment. Larger study with longitudinal design is needed to verify our data.

Nanohydroxyapatite promotes the healing process in open-wedge high tibial osteotomy: A CT study.

BACKGROUND: The aim of this prospective and randomized study was to evaluate the effectiveness of adding nanohydroxyapatite (NHA) to heterologous bone graft in open wedge high tibial osteotomy (OWHTO) by measuring the bone density of the tibial osteotomy gap. METHODS: Twenty-seven patients (26 knees) were operated by OWHTO and randomly divided into two groups: pure graft group, in which the osteotomy gap was filled with only heterologous bone graft; nanohydroxyapatite group, in which the osteotomy gap was filled with heterologous bone graft and NHA. All patients underwent computed tomography (CT) examination within one week after operation (Time 0), and after two months (Time 1) and 12months (Time 2). CT volume acquired Hounsfield Units (HU) were calculated and the mean value of bone density on three planes was measured. RESULTS: At Time 0, the mineral density of the nanohydroxyapatite group appeared significantly higher compared with the pure graft group, due to the presence of NHA. At Time 1, the mineral density of the nanohydroxyapatite group had decreased relative to Time 0, while in the pure graft group it remained unchanged. At Time 2, the mineral density in the nanohydroxyapatite group had further decreased, reaching values close to the mineral density of normal bone. In contrast, in the pure graft group the mineral density had increased, probably due to the lack of reabsorption of the graft and the development of sclerosis in the osteotomy borders. CONCLUSIONS: The results of the present study show better osseointegration of the heterologous graft when nanohydroxyapatite is added.

Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques.

PURPOSE: The purpose of our study was to compare clinical and radiological results of two groups of patients treated for medial compartment osteoarthritis of the knee with either conventional or computer-assisted open-wedge high tibial osteotomy (HTO). Goals of surgical treatment were a correction of the mechanical axis between 2° and 6° of valgus and a modification of posterior tibial slope between -2° and +2°. METHODS: Twenty-four patients (27 knees) affected by varus knee deformity and operated with HTO were prospectively followed-up. They were randomly divided in two groups, A (11 patients, conventional treatment) and B (13 patients, navigated treatment). The American Knee Society Score and the Modified Cincinnati Rating System Questionnaire were used for clinical assessment. All patients were radiologically evaluated with a comparative lower limb weight-bearing digital radiograph, a standard digital anteroposterior, a latero-lateral radiograph of the knee, and a Rosenberg view. RESULTS: Patients were followed-up at a mean of 39 months. Clinical evaluation showed no statistical difference (n.s.) between the two groups. Radiological results showed an 86% reproducibility in achieving a mechanical axis of 182°-186° in group B compared to a 23% in group A (p = 0.0392); furthermore, in group B, we achieved a modification of posterior tibial slope between -2° and +2° in 100% of patients, while in group A, this goal was achieved only in 24% of cases (p = 0.0021). CONCLUSION: High tibial osteotomy with navigator is more accurate and reproducible in the correction of the deformity compared to standard technique. LEVEL OF EVIDENCE: Therapeutic study, Level II.

Russell body gastritis associated with Helicobacter pylori infection in an HIV-positive patient: case report and review of the literature.

In 1998 Tazawa and Tsutsumi described for the first time a case of Helicobacter pylori (HP)-related gastritis characterized by the presence of a conspicuous plasma cell infiltrate with Russell bodies, and coined the term Russell body gastritis (RBG). A 59-year-old HIV-positive man complaining of recurrent epigastric pain underwent an upper gastrointestinal endoscopy revealing in the stomach only hyperemia in the antral portion. Histology showed a moderate glandular atrophy associated with an expansion of the lamina propria due to an infiltration of monomorphous cells with eosinophilic cytoplasm inclusions and eccentric nuclei, somewhat resembling plasma cells. A diagnosis of HP-related RBG was made, after excluding, by means of histochemical, immunohistochemical stainings and molecular studies, a neoplastic process. A review of all cases of RBG previously described in the English literature is reported in order to examine the clinical, endoscopic and microscopic features of this histopathological entity and the possible pathogenetic mechanisms.

A rare association of emphysematous pyelonephritis with unrecognized diabetes and polycystic kidney.

Emphysematous pyelonephritis (EPN) is a rare, severe, gas-forming infection for which the treatment of choice is often an immediate nephrectomy, although many reports exist of conservative treatment of cases with antibiotic therapy and percutaneous drainage of abscesses. It usually occurs in diabetic patients and less frequently in subjects with an obstruction of the corresponding renoureteral unit; other predisposing factors are not common. We report here the case of a 51 year-old woman with a rare association of unrecognized diabetes and bilateral polycystic kidney disease who developed monolateral EPN. She had an emergency right nephrectomy and was admitted to Intensive Care Unit (ICU) for septic shock after surgery, requiring intensive resuscitation. The patient was managed with Coupled Plasma Filtration Adsorption (CPFA). Her clinical conditions rapidly improved and the hemofiltration was soon suspended. Urine and blood cultures were positive for the same Escherichia coli, which was susceptible to all tested antibiotics. The patient was transferred to the Nephrology Division and was discharged from the hospital without further dialysis after 34 days. This case report is somewhat unique because of the unusual association between undetected diabetes and polycystic kidney as predisposing factors of a severe infection of the urinary tract.

Evidence of dual sexual transmission of multi-resistant HIV with two years persistence of resistance to NRTI and NNRTI: a case report.

A case report of dual sexual transmission, with secondary transmission from naïve to naïve patient, of HIV harbouring K103N and L100I mutations, conferring full non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance, plus 2 nucleoside analogous reverse transcriptase inhibitor (NRTI) mutations is described. The secondary transmission of the resistant virus was confirmed by phylogenetic analysis. Data also suggest that mutations related to NRTI and NNRTI resistance may persist for a long time in naive patients, over 2 years in the present case report.

Oncolysis of pancreatic tumour cells by a gamma34.5-deleted HSV-1 does not rely upon Ras-activation, but on the PI 3-kinase pathway.

The ability of viruses to selectively target, replicate within, and destroy tumour cells without deleterious effects in normal cells (oncolysis), makes the use of viruses as an attractive tool for cancer treatment. Pancreatic adenocarcinoma, being insensitive to traditional therapy and having a rather poor prognosis, represents a suitable target to evaluate viral oncolysis as a novel therapeutic approach. Herpes simplex virus (HSV) has been reported to produce an oncolytic effect in cells overexpressing Ras. As Ras signalling is frequently aberrant in pancreatic cancer, we compared four pancreatic cell lines (which differ in the presence of mutated or wild-type ras) for their ability to support growth of gamma34.5-replication attenuated HSV-1 (R3616). Our data show that permissiveness to viral replication is neither associated with enhanced Ras signalling nor with defective PKR activity. By contrast, we provide evidence that disregulation of the PI 3-kinase signalling pathway allows conditionally replication-defective R3616 virus to overcome the cellular antiviral activity.

Immunohistochemical study of apical periodontal cysts.

Periapical lesions, as well as periodontal disease, seems to have cyclic patterns of evolution. Periods of burst may be intercalated with periods of quiescence. Because keratinocyte division must occur during cyst growth, it is presumed that epithelium status could indicate the biological activity of radicular cysts (RCs). Th1 and Th2 are important heterogeneous stages of lymphocyte differentiation. Delayed-type hypersensitivity immune reactions are mediated by Th1 lymphocytes, whereas Th2 populations mediate some types of humoral immune response. Th2 lymphocytes are characterized by high expression of CD30 glycoprotein. Th1 and Th2 lymphocytes have not been evaluated in periapical inflammatory lesions. The purpose of this study was to evaluate CD30+ cells in RCs with atrophic and hyperplastic epithelium. A biotin-streptavidin amplified system was used for identification of CD30 receptor. Results demonstrate increased proportions of Th2 cells in cysts with hyperplastic epithelium. Our results suggest that Th2 cells could be associated with RC growth.

Heroin addicts infected by HBV and HIV have a low prevalence of HBV DNA in peripheral blood mononuclear cells.

Several reports show that the prevalence of HBV (hepatitis B virus) carriers in HIV (human immunodeficiency virus) infected populations is significantly higher than in HIV seronegative individuals, independent of the risk group for HIV, that is, homosexuals or drug abusers. In this context, evaluation of the simultaneous presence of HBV and HIV in PBMCs (peripheral blood mononuclear cells) is of particular interest for at least 2 reasons: 1) the possible reciprocal influence of the 2 viruses when they infect the same cell; 2) the possibility that HIV-induced hematological disorders could indirectly influence the settling of HBV in blood cell populations. We report data on the frequency of PCR positivity for HBV DNA in PBMCs from 62 HIV infected patients, rigorously selected by risk group, that is, intravenous use of heroin for at least 3 years and syringe promiscuity. Sixty-seven HIV negative individuals who never used any drug formed the control group. The analysis of the cases positive for HBV DNA in PBMCs showed that: 1) the overall prevalence of PCR positivity found in HIV infected patients was significantly lower than that registered in the control group; 2) PCR positivity among the subjects who were HBsAg negative and anti-HBV positive was extremely low in the HIV infected patients (3.7%) but quite frequent in the HIV negative subjects (37.0%). The results support the hypothesis that, unlike the HIV negative individuals, our HIV infected patients exhibited HBV DNA in PBMCS almost exclusively when they presented with active HBV replication.

Effects of zidovudine in 30 patients with mild to end-stage AIDS dementia complex.

OBJECTIVE: Zidovudine (ZDV) is an inhibitor of HIV replication that may have a beneficial effect on patients with AIDS dementia complex (ADC). However, little is known about the association between long-term ZDV treatment and severity of ADC, ZDV dose or clinical and laboratory response to therapy. DESIGN: An open study on ZDV administration in 30 consecutive patients with ADC. SETTING: An infectious diseases hospital. PATIENTS: Thirty consecutive patients followed-up for 12 months. INTERVENTIONS: Three oral ZDV doses were used: 1000 mg (nine patients), 750 mg (eight patients) and 500 mg (13 patients) per day, depending on haematological status. MAIN OUTCOME MEASURES: Clinical and neurological examinations, neuropsychological evaluations, high-field brain magnetic resonance imaging (MRI) and 99mTc-HM-PAO single photon emission computerized tomography (SPECT). RESULTS: A favourable clinical response, defined as reversal to a less severe ADC stage (Price and Brew's criteria), was observed after 1, 3, 6, 9 and 12 months in 15, 22, 25, 19 and 14 patients, respectively. Neither severity of ADC at entry nor ZDV dose correlated with response to treatment. Seven patients died during the 12-month follow-up. The only factor associated with longer survival was ADC severity at entry (12-month survival, 0.94 and 0.53, in patients in stages 1 or 2 and in stages 3 or 4, respectively; P < 0.01). After 6-12 months of ZDV treatment six patients who initially responded to therapy showed a relapse in initial ADC stage, and two patients a less severe neurological deterioration. Neuropsychological evaluations showed significant improvement in the Wisconsin Card-Sorting test (P = 0.006 for categories, P = 0.029 for perseverative errors), which is particularly sensitive to cognitive and frontal-lobe type functions. Brain MRI revealed a reduction of the extent of white matter lesions in six out of 13 patients, who also showed clinical improvement. SPECT scanning revealed a reduction in the extent of uptake defects concomitant with clinical response in nine out of 14 patients. CONCLUSIONS: ZDV is effective in most patients with mild to end-stage ADC, although the benefit is sometimes only transient; several relapses and deaths occurred after the sixth month of treatment.

Zidovudine plus interferon alfa-2b treatment in patients with HIV and chronic active viral hepatitis.

Results are reported for a small study of 11 patients positive for HIV and with chronic active viral hepatitis. Low dose zidovudine/interferon alfa-2b combined treatment produced a general reduction in alanine aminotransferase activities and increased the CD4 lymphocyte count, hepatitis B e seroconversion, and the loss of HIV p24 antigen. The treatment was well tolerated and progression of HIV disease was not seen.

Contribuiçäo clínica e terapêutica em onze casos de cistos pleuropericárdicos / Clinical and therapeutic contribution in 11 cases of pleuro-pericardial cysts

Os autores apresentam 11 casos de cistos pleuropericárdicos observados no Serviço de Cirurgia Torácica da Universidade de Bologna, entre 1975 e 1986, tecendo algumas consideraçöes a respeito. Os cistos pleuropericárdicos têm uma etiologia disontogenética, sua descoberta geralmente é casual, por quanto a sintomatologia é quase sempre ausente e a tendência característica é de aumentar de volume. O tratamento é cirúrgico e o risco operatório é sempre reduzido, levando a um diagnóstico de certeza