Cerebral cortical thickness and gyrification changes in first-episode psychoses and multi-episode schizophrenia.

Cortical thickness (CT) and local gyrification index (LGI) in psychotic disorders may show modifications that relate to clinical course. This observational study aimed to analyse such variables in patients with schizophrenia, compared to healthy controls (HCs). We compared CT and LGI of 18 patients with first-episode psychosis with that of 21 with multi-episode schizophrenia and 16 HCs. CT corrected for false-positive cases (Family-Wise Error Rate) showed a reduction in the multi-episode group compared to HCs in left temporal and parietal, and right temporal, parietal, occipital, and hippocampal cortices. Family-wise corrected LGI was increased in the left inferior and middle frontal cortices, and in the right fusiform gyrus, cingulate, lingual, and parahippocampal gyri in first onset patients compared to HCs. Increased LGI was absent from later stages of psychosis, suggesting that specific CT and LGI alterations may underlie different stages of illness.

The results of the surgical treatment of 64 patients with thoracic and lumbar fracture.

A total of 64 patients surgically treated for vertebral fractures were evaluated clinically and radiographically after a mean time of 49.55 months (from 1 to 124). There were 50 males and 14 females. Mean age at the time of surgery was 40.67 years (from 17 to 71). Fractures were divided based on the Denis classification system: comminuted fractures: 45; fractures caused by flexion-distraction: 2; fracture-dislocation: 17; 31 of the fractures were localized at the lumbar level, 30 in the dorsal region, 3 at the dorsolumbar passage. Neurologic evaluation was carried out on admission and at follow-up using the Frankel classification system: type A: 22; type B: 13; type C: 7; type D: 6; type E: 16. 56.25% of the patients (36 cases) were classified as having multiple trauma. Of the 64 patients, 38 had reduction and stabilization within 6 hours of trauma, 26 were treated after a mean time of 2.7 days (from 1 to 6). Harrington-Luque stabilization was carried out in 5 patients, using the Hartshill rectangle in 59. The mean time for hospitalization was 27.68 days (from 9 to 91). Follow-up showed neurologic recovery in all of the patients operated on, with the exclusion of those classified as Frankel A, without sacral sparing. Despite the residual kyphosis and the final anatomic findings which were not always satisfactory, the methods used allowed us to obtain results that could be compared to those obtained by other means of fixation and more complex techniques.

Ilizarov external fixation in the treatment of comminuted leg fractures.

Fifty consecutive comminuted leg fractures were treated by Ilizarov external fixation. Eleven were closed fractures, 37 were Grade II, and 2 were Grade III open fractures. Forty-five fractures healed within 6 months. In 5 fractures the Ilizarov device was removed and healing occurred by intramedullary nailing (2 cases) and decortication (3 cases). The causes of failure were: rapid peroneal union or bone fragment necrosis. Subjective tolerance and fracture stability are limited by septic loosening of the wires requiring frame removal after 6 to 8 months. Excellent results may be obtained (no leg length discrepancy, no angulation, no rotation, no joint stiffness), but the time required for union is long and additional surgery is required.

Preliminary results in 167 bioceramic cemented arthroplasties with five-year follow-up in patients aged 60 years or over.

A total of 167 ceramic-ceramic cemented arthroplasties with a mean follow-up of 62.5 months were evaluated. There were no signs of loosening in the femoral components. Loosening of the acetabulum was observed in 5 patients. A statistical study conducted on the two groups (the first aged under 70 years, the second aged 70 or over) did not reveal any relationship between failure of the acetabular component and the age of the patient. An evaluation of bone density based on the DXA system in 5 cases of loosening revealed its diminution in relation to follow-up parameters. Based on our experience, implantation of the ceramic-ceramic cemented prosthesis is a reliable choice in patients with good bone trophism, in those where there is a significant reduction in bone density; it is best to use polyethylene-ceramic implants.

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).

The biological problems of total hip arthroplasty.

Biological phenomena are the principal agents in triggering hip prosthesis aseptic loosening. The authors report the results of "in vivo" and "in vitro" and Raman-laser experimental tests, which confirm the validity of the ceramic-ceramic combination in relation to the amount of wear and biocompatibility of friction materials.

Recurrent posterior instability of the shoulder: surgical treatment.

A total of 11 cases of posterior instability of the shoulder surgically treated by simple capsuloplasty or associated with reinforcement of the posterior wall by bone graft or muscle transposition were reviewed. Accurate selection and preoperative evaluation of the patient when choosing surgery is very important. For surgery to succeed prolonged postoperative immobilization and an intense rehabilitative program to be initiated prior to surgery are necessary. Generalized ligamentous hyperlaxity constitutes a negative factor in prognosis, so that it is important to associate capsuloplasty with posterior bone block, in an attempt to avoid the risk of recurrence as further surgery would have an unfavorable outcome.

Diagnostic accuracy of CT scan in intra-articular lesions of the knee (arthroscopic confirmation of 100 cases).

The results obtained for 100 CT scans of the knee confirmed by arthroscopy are analyzed in order to determine the probability of error in the various lesions and thus establish indications for the use of CT scan. This test was particularly reliable in traumatic lesions of the meniscus and in chronic breakage of the anterior cruciate ligament. It was more difficult to make an evaluation of degenerative meniscus tear or so-called "menisci at risk for tear". First and second degree chondropathies cannot be evaluated, while third and fourth degree ones may easily be evaluated on plane surfaces (tibial plate and patella), but not so easily on spherical surfaces (femoral condyles).

Total hip arthroplasty in patients dialyzed or with renal transplants.

The authors present 15 cases of hyp arthroplasty implanted in patients affected with necrosis of the femoral head, which were undergoing periodic hemodialitic treatment, or with renal transplants. Ceramic-ceramic prostheses were prevalently used and only in 1 case was a metal-polyethylene prosthesis used. Because of precarious mineralization a cemented prosthesis was implanted in dialyzed patients; in renal transplants, instead, cemented or cementless prosthesis were used depending on the state of the bone. There was a high percentage of excellent results after 2-8 years (87%), and this confirms the validity of surgical indications for the use of arthroplasty in hips affected with epiphyseal necrosis in order to favor functional recovery: considering the young age od the patients, this helps them to go back to being a part of society, and to recover psychologically.

A study of the mechanical and biological behavior of bioceramic hip arthroplasty followed-up after more than 10 years.

The authors report the results obtained in three experiments conducted on hip arthroplasty with ceramic-ceramic coupling and the evaluation of clinical follow-ups carried out on cemented bioceramic arthroplasty more than 10 years after surgery. A first test consisted in the "in vivo" study of alumina powder injected in the joints of four pigs with the purpose of verifying the biocompatibility of the compound. A second test involved the experimental evaluation of "in vitro" wear of the alumina as compared to other types of coupling, and confirmed the very low tendency of wear in alumina. A third spectroscopic study conducted using a Raman laser demonstrated the absolute biostability of the surface of bioceramic material. A retrospective clinical study was conducted in order to verify laboratory data in 83 cemented bioceramic arthroplasties followed-up more than 10 years after surgery and of which 92% obtained good clinical results.

Contracted valgus flat foot caused by tarsal synostosis in the adolescent.

Contracted valgus flat foot in the adolescent is frequently caused by tarsal synostosis or synchondrosis which are often not revealed in common radiographic views, and which may instead by clearly shown by CT scan. These synostoses are prevalently symptomatic during adolescence, when by ossifying they block the subtalar joint in valgus; they are less symptomatic between 20 and 40 years of age. Pain returns during the fifth decade due to the occurrence of secondary arthrosis of the nearby joints.

Comparison of cemented ceramic and metal-polyethylene coupling hip prostheses in ankylosing spondylitis.

Two groups of patients suffering from ankylosing spondylitis were treated by total hip arthroplasty. Twenty-one patients (37 hips) were treated with cemented metal-polyethylene prosthesis, whereas 18 patients (36 hips) had cemented ceramic coupling implants. The two groups had similar preoperative clinical data. The average follow-up period was seven to eight years for both. Each patient was graded clinically (pain, function, range of motion, deformities) and roentgenographically (radiolucent lines, etc.). Patients with metal-polyethylene implants showed important modifications of the bone around the implant. Clinical and roentgenographic results were relatively good in patients with ceramic implants. The results underline the importance of the friction coupling of the implant.

The results of the surgical treatment of breakage of the rotator cuff.

Sixteen patients affected with rotator cuff tears were treated by surgical repair and anterior acromioplasty, using superior of anteromedial approaches. The authors believe that acute and chronic massive ruptures causing significant functional failure must be surgically treated. Good results may be obtained if impingement signs of arthropathy are absent at surgery.

Arthroprosthetic reimplantation with bioceramics.

The study analyzes the results obtained in 50 cases of arthroprosthetic substitution surgery performed as a result of "aseptic detachment of the implant"; it involves a consecutive series of operations performed between 1979 and 1983. In all of the cases ceramic-ceramic cemented prostheses were implanted. The results, which were generally satisfactory, confirmed the excellent properties of alumina (low wear, elevated tolerance).

[Fracture of the tibial plateau: results of surgical treatment]. / Le fratture del piatto tibiale: risultati del trattamento chirurgico.

The different types of tibial plateau fractures have similar problems. Today most of them are treated surgically to obtain the adequate reduction. Ninety-three fractures of the tibial plateau have been reviewed. The clinical and X-ray examinations were performed from 7 to 13 years after surgery. Poor results with ligamentous instability and posttraumatic arthritis seem to be related to insufficient reduction of the fracture, loose fragments in the joint, axial angulation and insufficient repair of ligaments and menisci.

Metal ions in body fluids after arthroplasty.

We measured levels of metal ions in urine and plasma of 17 patients 7-15 years after they had a Co-Cr-Mo alloy total hip replacement. They had higher levels of cobalt and chromium than controls. No case of skin sensitivity to the investigated metals was observed. The values of cobalt and chromium in plasma and urine were considerably lower than in professionally exposed groups and do not represent a toxic hazard for the patients.

The treatment of acetabular fractures.

The results are reported of 52 acetabular fractures treated surgically and followed up for 6 to 16 years. The cases were sufficiently comparable for statistically significant analysis. Satisfactory results were obtained in 34 cases (65%), and poor in 18 (35%). The poor results were due to: epiphyseal necrosis (8%), secondary arthritis (17%), periarticular ossification (9%). The treatment of these poor results is discussed, including the indications for intertrochanteric osteotomy and, in particular, total hip replacement.