Maisonneuve fracture treated with suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA): Clinical and radiological evaluation in short-medium period.

The aim of this study was to estimate the time needed for patients with Maisonneuve fractures to return to routine activities, after treatment with a suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA). Methods: The study included 13 patients treated at our surgical department from January 2018 to June2022. Specific radiographical follow-up and periodic checks were performed in a short -to-medium term period, to evaluate syndesmosis evolution and tibiofibular overlap with medial clear space (MCS). Results: Progressive recovery and improvement were observed during follow-up from both radiographic and clinical perspective. Data showed that patients were able to return to full weight-bearing walking around the ninth week and to sport activities in 7.5 months. Long-term complications associated with residual joint stiffness, complex regional pain syndrome, or wound complications were observed in three patients. Conclusions: Intraoperative arthroscopy represent a valid diagnostic tool to better recognize and evaluate osteochondral lesions in case of syndesmosys. The study demonstrates the importance of intraoperative arthroscopy for recognizing and treating associated osteochondral lesions with proper syndesmosis evaluation. Plate associated to double TightRope represent valid solution to functionally fix and reduce fractures. Additionally, it imitates the normal syndesmosis's anatomy and provides elasticity and robustness, guaranteeing a rapid return to sporting activity. Data and casuistry support these findings.

Subtalar dislocation: a narrative review.

BACKGROUND: Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other involvement of the foot. Dislocation can occur medially (85%), laterally (15%), posteriorly (2.5%) and anteriorly (1%). Reduction can be performed by closed or open technique; lateral dislocations often require open reduction because of inclusion of soft tissues or bone fragments. Lateral dislocations are frequently complicated by bone exposure, risk of infection and associated soft tissues injuries. AIM OF THE STUDY: The aim of this study is to explain main characteristics and to clarify the most important pitfalls of subtalar dislocations. MATERIALS AND METHODS: We examined 47 articles published in the last thirty years (389 cases). For each dislocation we reviewed its main characteristics: direction, bone exposure, need for open reduction and for surgical stabilisation, associated injuries and method used for diagnosis. RESULTS: Medial dislocations (68.1%) has greater incidence compared to lateral ones (27.7%). Bone exposure (44.5%), associated lesions (44.5%) and need for surgical reduction (48.2%) are much more represented in lateral dislocation than in the others. CONCLUSIONS: Subtalar dislocations, especially the lateral one, represent a challenge for surgeons. Lateral subtalar dislocation occurs following high-energy trauma often involving associated injuries. Closed reduction could be unsuccessful and patients must undergo surgical reduction. After reduction CT scan is recommended. Our narrative review confirms these findings.

Tibioplasty, a new technique in the management of tibial plateau fracture: A multicentric experience review.

INTRODUCTION: The traditional methods in displaced tibial plateau fractures use metallic instrumentation. "Balloon-tibioplasty" is a novel minimally invasive technique. PURPOSE: Use of the balloon-tibioplasty show an improvement of the reduction compared to traditional methods. PATIENTS AND METHODS: We enrolled 28 patients who presented with a depression fracture of external tibial plateau divided into two treatment groups: balloon-tibioplasty (group I) and "traditional" reduction technique (group II). RESULTS: Balloon-tibioplasty is a minimally invasive treatment for tibial plateau fracture. DISCUSSION: Balloon-tibioplasty appears to have several advantages over traditional reduction techniques. CONCLUSION: Balloon-tibioplasty represents an improved and accurate modality for restoration of articular congruence.

[Effectiveness of antipsychotics in schizophrenia and related disorders. Results of a naturalistic study]. / L' "Effectiveness" degli antipsicotici nella schizofrenia e disturbi correlati. Risultati di uno studio naturalistico.

INTRODUCTION: The present study aims to evaluate effectiveness of antipsychotics in a cohort of chronic outpatients affected by schizophrenia and related disorders. MATERIALS AND METHODS: Three hundred chronic patients affected by schizophrenia (n=173), schizoaffective (n=117) and delusional (n=60) disorder who were in treament with antipsychotics on 1.3.2008 were considered in the study; effectiveness of antipsychotic treatment was evaluated by means of rates of all cause discontinuation in a 12 months period (31.3.2008-31.3.2009) and of "overall duration of treatment" (DT) (duration of treatment retrospectively evaluated on the basis of clinical records+duration of treatment prospectively evaluated during the 12-months follow up). RESULTS: Discontinuation of treatment was registered in 25% of patients (29% due to side effects, 14% due to scarce adherence, 11% due to lack of efficacy, 22% due to more causes). Clozapine (7%), Risperidon Long-acting (10%), Typical Antipsychotics depot (11%) and Olanzapine were associated to lower rates of all causes discontinuation. Overall mean duration of antipsychotic treatment was 18± 32 months, with statistically significant differences between drugs (F=4.65, p=0.000). Clozapine (65 mo), Olanzapine (50 mo), butyrophenones (49 mo), typical antipsychotics depot (48 mo), and risperidone (47.5 mo) were the antipsychotics with a longer duration of treatment. Only Clozapine showed a significantly longer DT than any other antipsychotic medication excluding buthyrrohenones. CONCLUSIONS: Rates of all cause discontinuation of antipsychotics appear to be somewhat lower than expected on the basis of pragmatic studied published in the last years; similarly overall duration of treatment seems to be longer. Clozapine is associated to a higher overall effectiveness respect to any other atypical antipsychotic.

Number of autoantibodies and HLA genotype, more than high titers of glutamic acid decarboxylase autoantibodies, predict insulin dependence in latent autoimmune diabetes of adults.

OBJECTIVE: In latent autoimmune diabetes of adults (LADA), the progression into insulin-dependent diabetes is usually faster than in type 2 diabetes (T2D) but the factors influencing this progression are not completely known. In this study, we searched for sensitive markers associated with early development of insulin dependence. DESIGN: The screening of 5568 T2D patients for glutamic acid decarboxylase autoantibodies (GAD65Ab) identified 276 LADA patients (M=131; F=145) and in 251 of them, tyrosine phosphatase-2 (IA-2Ab) and thyroperoxidase autoantibodies (TPOAbs), some clinical features and genotype variation of the main type 1 diabetes (T1D) disease susceptibility loci (HLA-DRB1 and HLA-DQB1) were analyzed. RESULTS: Four years after the diagnosis of diabetes, high GAD65Ab titer was not significantly associated with faster progression toward insulin deficiency (P=0.104). Patients with GAD65Ab and TPOAb or IA-2Ab or triple positivity for both islet and TPOAbs (GAD65Ab/IA-2Ab/TPOAb) showed a significantly faster disease progression (P=0.002). Among 104 TPOAb-positive LADA patients, 10 received replacement therapy (l-thyroxine), 43 showed high TSH levels (62.7% developed insulin dependence), and 3 had hyperthyroidism treated with methimazole. Multivariate analysis revealed a significant effect on disease progression only for TPOAb (P=0.022), female gender (P=0.036), low body mass index (BMI; P=0.001), and T1D high/intermediate risk HLA-DRB1/DQB1 genotypes grouped (P=0.020). CONCLUSIONS: High GAD65Ab titers per se are not a major risk factor for disease progression in LADA, while the number of positive autoantibodies and HLA DRB1-DQB1 genotypes at high risk for T1D are significant predictors. Moreover, clinical characteristics such as low BMI and female gender are more likely to identify patients who will require insulin therapy within 4 years of diagnosis.

[Severe hypertriglyceridemia without organ complications in an alcoholic non-diabetic patient]. / Grave ipertrigliceridemia senza complicanza d'organo in un paziente alcolista non diabetico.

A case report of a non-diabetic alcoholic patient (ethanol intake >220 g/d) who experienced severe hypertriglyceridemia (12.679 mg/dL) without pancreatitis or detectable genetic factors responsible for severe dyslipidemia is described. Following the normalization of triglyceride and cholesterol levels, through lipid-free parenteral nutrition therapy, a regimen of alcohol withdrawal and a well-balanced diet with less than 10% saturated fat maintained a normal lipid profile without requiring any lipid-lowering drug. The absence of organ damage in the patient is likely to be attributed to the short duration of the elevated triglyceride peak. The treatment of this disorder does not necessarily require LDL-apheresis but can be simply managed by parenteral therapy provided that no other risk factors are present.

[Latent autoimmune diabetes in adults]. / II diabete autoimmune latente dell'adulto (LADA).

Latent autoimmune diabetes in adults (LADA) is a disorder with onset after age 30, insulin independence for at least 6 months after diagnosis, and the presence of circulating pancreatic islet autoantibodies. The prevalence of LADA varies substantially across ethnic groups and ranges approximately from 1% to 10% among patients with type 2 diabetes. In this review we discuss the nomenclature, diagnostic criteria, immunologic and genetic markers, metabolic alterations and therapy of this form of diabetes.

Lipoprotein metabolism during normal pregnancy.

OBJECTIVE: We sought to investigate the changes in circulating serum lipids and lipoproteins, including lipoprotein (a), and low-density lipoprotein size in women during normal pregnancy. STUDY DESIGN: Twenty-two women (mean age, 31 +/- 5 years; 13 primiparous subjects) were studied during uncomplicated pregnancy with normal outcome. Twenty-four nulliparous women of similar age (31 +/- 4 years) were studied as control subjects. RESULTS: Serum triglycerides and total and low-density lipoprotein cholesterol increased significantly during pregnancy in all women. Women with changes in low-density lipoprotein during the second and third trimesters showed a more marked increase in serum triglycerides, and this effect was slightly more evident in the multiparous subjects. No other differences were evident between primiparous and multiparous women apart from high-density lipoprotein cholesterol levels, which were slightly decreased in the latter subjects. CONCLUSIONS: Our results show that during normal pregnancy, the increase in plasma triglycerides may lead to the appearance of the atherogenic dense low-density lipoproteins in a subgroup of women. We suggest that the observed changes in low-density lipoprotein patterns during pregnancy might be used to identify those women who later in life will have these atherogenic small and dense low-density lipoproteins.

Reduction of albumin excretion rate in normotensive microalbuminuric type 2 diabetic patients during long-term simvastatin treatment.

OBJECTIVE: To study the long-term effects of simvastatin on urinary albumin excretion rate (AER) in normotensive microalbuminuric type 2 diabetic patients with hypercholesterolemia. RESEARCH DESIGN AND METHODS: A total of 19 normotensive microalbuminuric hypercholesterolemic type 2 diabetic patients entered a double-blind crossover study for 2 years, receiving either simvastatin (20 mg/day) or placebo (each treatment for 1 year). RESULTS: Simvastatin significantly decreased plasma cholesterol (total and LDL) after 52 weeks of treatment. A concomitant significant decrease of AER (25% from basal) with no significant changes in creatinine clearance was observed during the same period. CONCLUSIONS: Our data are in keeping with the hypothesis that simvastatin might be used as an additional means to preserve renal function in microalbuminuric hypercholesterolemic type 2 diabetic patients.

Cyclical variation of plasma lipids, apolipoproteins, and lipoprotein(a) during menstrual cycle of normal women.

We report herein the effects of cyclical variations of endogenous sex steroids during the menstrual cycle on plasma lipids and apolipoproteins (apo) in normal women. We examined 16 normal women (age range 25-36 yr) with normal menstrual cycles of 28-31 days. The study covered the period from the 1st day of a menstrual phase (basal) until the 1st day of the following menstrual phase. During the study all women maintained a normolipidic diet (30% fat). Plasma total cholesterol and low-density-lipoprotein cholesterol were significantly higher than basal in the preovulatory phase until progesterone started to increase in the postovulatory phase [day +8 from luteinizing hormone (LH) surge]. High-density-lipoprotein cholesterol was significantly higher than basal from day -1 to the day after LH surge, whereas plasma apoAI levels were significantly higher from day -8 to day +8 (from LH surge). Plasma apo(a) increased significantly during the luteal phase in four women characterized by a single S4 band and lower basal plasma levels of apo(a). Our results indicate that endogenous female sex steroids have significant effects on the circulating levels of plasma lipids and apolipoproteins, including apo(a). More work needs to be done to elucidate the significance of the observed apo(a) changes, and the different phases of the menstrual cycle must be taken into account when evaluating the lipidic risk profile in premenopausal women.