Clinical significance of anticardiolipin antibodies in patients with systemic sclerosis.

One hundred and three patients suffering from systemic sclerosis (SSc), with different extent of skin involvement, were retrospectively examined to investigate the correlations between clinical manifestations and anticardiolipin antibodies (aCL). aCL of IgG, IgA, and IgM classes were measured in the patients' sera by enzyme linked immunosorbent assay. aCL were found in 26 patients (25.2%). A significant association was found between aCL and myocardial ischaemia or necrosis (p = 0.011). No patient showed the clinical picture of the antiphospholipid syndrome. On the basis of clinical manifestations, a protocol for disease score was drawn. Patients with IgG-aCL and with IgA-aCL showed a disease score higher than aCL negative patients (p = 0.008 and p = 0.022 respectively). Thus, the finding of aCL can be considered a useful serological index for the most severe forms of SSc.

Clinical setting of patients with systemic sclerosis by serum autoantibodies.

Associations of antinuclear (ANA) and anticardiolipin (aCL) antibodies with clinical manifestations were analyzed in patients with systemic sclerosis (SSc). We studied 105 SSc patients: 28 had limited cutaneous SSc (lcSSc) involving fingers; 36 had intermediate cutaneous SSc involving limbs and face; 33 had diffuse cutaneous SSc (dcSSc) involving the trunk; 8 had a sclerosis sine scleroderma. Clinical manifestations and instrumental and laboratory findings were considered to calculate a disease score. Serum anticentromere (ACA), anti-topoisomerase I (anti-topo I) antibodies, and aCL (of IgG/IgA/IgM classes) were investigated by conventional methods. ACA positive patients (n=18), compared to ACA negative, showed higher prevalence of IcSSc (p < 0.001), lower prevalence of restrictive ventilatory defect (p=0.006), and lower disease score (p=0.008). Anti-topo I positive patients (n= 70) showed lower prevalence of lcSSc (p =0.001) compared to anti-topo I negative. In aCL positive patients (n=27) widespread skin and visceral involvement occurred more frequently than in aCL negative. The association with myocardial ischemia or necrosis (p=0.010) was significant. Occurrence of ACA excluded the coexistence of anti-topo I (p < 0.001), and aCL (p=0.037). aCL positive patients showed higher disease score in comparison with ACA positive patients (p=0.003). In conclusion ACA recognize patients with a mild disease. aCL in contrast to ACA are better than anti-topo I in recognizing the most severe pictures of SSc.

Hip prosthesis revisions with LS stem: indications and results.

The authors present a study that includes 350 patients affected with loosening of hip arthroplasty and submitted to revision with a Wagner LS stem at the 4th Division of the Rizzoli Orthopaedic Institute. Several different types of cotyle (Fitek, Wagner, Standard Cup, cemented cotyle with support ring, Octopus system) were used depending on the anatomopathologic findings, combined with autoplastic grafts. Staging and grading of loosening were based on the four G.I.R. grades. A clinical evaluation of results was based on the Merle D'Aubigné parameters modified by Charnley. For radiographic evaluation the De Lee Charnley areas were studied for cotyle, the Gruen areas for the femoral stem. Overall, good results were obtained in 175 patients, fair in 137, poor in 38.

Hip arthroplasty in coxarthrosis secondary to Paget's disease.

A total of 5 hip arthroplasties implanted between 1997 and 2000 in 5 patients affected with coxarthrosis secondary to Paget's disease were reviewed. The quality of the pagetic bone (sclerotic and very vascularized) resulted in a slightly longer amount of time required for surgery because of the difficulty preparing prosthetic placement and intra- and postoperative blood loss exceeding the norm. Complications were not observed. Clinical results were good in 100% of cases. Radiographically, 2 stems were assembled in varus.

Autologous chondrocytes implantation: indications and results in the treatment of articular cartilage lesions of the knee.

Articular cartilage lesions of the knee constitute a frequent event and one that is difficult to treat. In time, different surgical methods have been used with results that are often contradictory. The authors report the indications and results of different methods used in the treatment of cartilage lesions: in particular, the experience initiated in 1997 with autologous chondrocytes implantation is discussed. Between 1997 and 2000, a total of 40 patients were submitted to autologous chondrocytes implantation injected in suspension under a periosteal flap. This method includes wide exposure of the joint lesion by arthrotomy. Between 1999 and 2001, a total of 30 patients were submitted to autologous chondrocytes implantation using a tridimensional matrix. The availability of biomaterial simplified the implant method and made arthroscopy possible. All of the patients were submitted to serial clinical follow-ups. MRI was also conducted for a second arthroscopic look. The results obtained in both series after a mean follow-up of 4 years (range 2 to 6 years) are good, and confirm the effectiveness of the method that allows for complete morphological and structural repair of lesions of the joint cartilage.

Systemic mastocytosis with skeletal involvement.

Systemic mastocytosis is a rare disease. The observation of one case characterized by clinical and radiographic bone involvement encouraged the authors to review the literature on the subject. The classification and most recent pathogenetic hypotheses correlated with various radiographic pictures, the different histological aspects, and most frequent differential diagnoses are reported.

Knee prosthesis in rheumatoid patients.

Total knee arthroplasty is a reliable means to improve the quality of life not only in osteoarthritis, but also in rheumatoid patients. Specific aspects, like the low mechanical quality of bone tissue, the contemporary damage of several joints and the higher risk of complications, have to be taken into account in rheumatoid arthritis. The experience with 24 prostheses in 21 rheumatoid patients is reported and confirms the efficacy of this operation. Among the technical details discussed, stress is placed on the conservation of the posterior cruciate ligament, the use of cement, the procedure of patelloplasty instead of prosthetic replacement. Careful preoperative planning is required and resections, especially in the tibia, should be economical. The evaluation of the results according to the protocol of the America Knee Society shows a satisfactory increase both of the articular score (average from 36 to 88) and the functional score (average from 34 to 68).

Bone tumors of the foot: epidemiology and diagnosis.

The authors reviewed 260 cases of bone tumors localized in the foot and treated at the Tumor Center of the Rizzoli Orthopaedic Institute: 191 were benign and 58 malignant and 11 metastasis. There was predilection for the hindfoot (57%), followed by the forefoot (33%) (prevalently the metatarsals). Localizations in the midfoot were rare (10%). Osteoid osteoma was observed in 26% of all of the tumors of the foot and in 35% of the benign forms. Among malignant neoplasms Ewing's sarcoma (27.5%) was the most frequent. Conservative surgery, which was always carried out in benign tumors, was also performed in some of the malignant ones, having an early diagnosis and a correct preoperative study. The indications and the limits of the different imaging techniques available are reported (bone scan, arteriography, CAT, MRI), and the role of biopsy in the definitive diagnosis of these neoplasms in discussed.

Supracondylar process of the humerus: four cases.

Four cases of supracondylar process of the humerus are presented. Two of the patients were asymptomatic and in one of these the supracondylar process was fractured. In a third there was median nerve compression and in the last there was ulnar nerve entrapment. The anatomical features, clinical symptoms and therapy are described. Good results were obtained after resection of the supracondylar process; neurological symptoms regressed one month after surgery.

Cartilage repair procedures associated with high tibial osteotomy in varus knees: clinical results at 11 years' follow-up.

BACKGROUND AND AIM: In this study, the authors retrospectively compared the clinical outcome of middle-aged active patients affected by a varus knee with medial unicompartmental osteoarthritis: the treatment was isolated high tibial osteotomy (HTO) for one group or HTO associated with a cartilage repair procedure, that was autologous chondrocyte implantation (ACI) for one group (HTO+ACI) and microfracture (MFX) for the other group (HTO+MFX). The purpose of this study was to analyse the clinical outcomes at long-term follow-up. The hypothesis was that a cartilage repair procedure may add some benefit to isolated axial correction. METHODS: 56 patients affected by medial osteoarthcritis in a varus knee were retrospectively investigated: 20 patients were treated by HTO, 18 by HTO+ACI and 18 by HTO+MFX. All patients underwent clinical assessment following HSS and WOMAC rating scores and a radiographic study was performed preoperatively and at follow-up. The statistical analysis confirmed that the three groups of patients were homogeneous regarding clinical, radiographical and anatomopathological patterns; differences have been reported in body mass index (BMI). RESULTS: At final follow-up, improvements in clinical and radiographical results were obtained in all patients. HTO and HTO+ACI series showed significantly higher scores compared to the HTO+MFX series. CONCLUSIONS: At more than 11 years of follow-up, isolated HTO and HTO+ACI treatments showed satisfactory results similar to those reported in the literature with no evidence of superiority of the addition of ACI to isolated HTO. MFX associated with HTO provided the worst results in the series.

New methods in arthroscopy: preliminary investigations.

The microhysteroscope, which affords direct in vivo observation of otherwise inaccessible surfaces, can be used to great advantage in arthroscopy. Although conventional arthroscopy can distinguish between 'inflammatory' and 'reactive' (post-traumatic) synovial changes, the microendoscope offers the possibility of more precise differentiation. Synovial membranes, joint cartilage, and menisci were studied at four different magnifications, including microscopic observation of vitally stained cells. Frankly pathological synovia (e.g., rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) were compared and distinguished from examples of less florid synovial changes. The fibrocartilaginous structure of the menisci and secondary undulations and tertiary depression of joint cartilage become visible in vivo with the microendoscope; these may well point to early damage to these structures. The authors believe that the three dimensional images at the magnifications provided by this microendoscope go some way towards bridging the gap between the conventional arthroscope, the light microscope, and the scanning electron microscope. This report presents preliminary findings with this new technique.