Results of closed subtalar dislocations.

BACKGROUND: The subtalar dislocation (SD) of the foot is an uncommon injury characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints without involvement of the tibiotalar and calcaneocuboid joints. PURPOSES: The purpose of this study was to evaluate the clinical and radiological outcome in a consecutive series of close SD. METHODS: We retrospectively evaluated a case series of patients who presented a close SD. Thirteen patients were selected for this study. There were 9 patients with a medial SD, 3 patients with a lateral dislocation and 1 patient with a posterior subtalar dislocation. RESULTS: The most frequent symptoms observed in our study included transient mild pain, swelling and decreased ankle ROM, which did not restrict patients' daily activities. However, lower AOFAS scores were observed on patients with associate peritalar osseous injuries. CONCLUSION: The results of the present study suggest that detecting and treating any associate peritalar fractures are the keys to a successful long-term outcome.

Cytogenetic analysis is non-informative for assessing the remission rate in chronic myeloid leukemia (CML) patients on interferon-alpha (IFN-alpha) therapy.

Cytogenetic analysis is considered pivotal for assessing the remission rate in CML patients on IFN therapy. On the basis of general agreement, at least 25 metaphases should be analyzed in each case. The main limitations to this approach are: 1) the small number of analyzable metaphases generally found in cytogenetic preparations from IFN-alpha-treated patients; and 2) the inability of this technique for scoring interphase cells. We compared the results of cytogenetic analysis and double-color FISH detection of bcr/abl genes fusion in 13 CML patients on IFN-alpha therapy (marrow sampling for cytogenetic and FISH analysis was carried out after 12 months in all patients and repeated after 18 months of IFN therapy in patients 4, 6, and 8). In five specimens, 20 to 25 cells were evaluable for cytogenetic examination, in another five no analyzable metaphases were scored, and in the remaining six samples two to 14 cells could be analyzed. With FISH detection at least 100 cells were easily scored in each specimen (mean number, 175). Comparing the results carried out with the two methods in different samples it emerged that cytogenetic analysis led to improper conclusions as regards the rate of Ph positivity, even in those patients where 20-25 metaphases were analyzed. Although many more cases have to be studied to establish the role of FISH analysis in Ph-positive patients, we are of the opinion that cytogenetic analysis is unfit for easily and accurately assessing the actual quality of remission in IFN-treated subjects.

Transcutaneous nerve stimulation for treatment of pain in patients with spinal cord injury.

Results of transcutaneous electrical nerve stimulation in 31 patients with spinal cord injury are presented. Success and failure are tabulated according to injury location and for type of pain perceived. Results indicate that pain at the site of injury is treated more successfully than radiating or central pain.

Cardiac risk stratification in elective non-cardiac surgery: role of NT-proBNP.

AIM: The aim of the study was to investigate the utility of NT-proBNP measurement for the stratification of presurgical cardiac risk. METHODS: Cardiac risk before elective non-cardiac surgery was evaluated in 82 consecutive patients. From each patient a venous blood sample was drawn to determinate NT-proBNP levels. Patients were followed up over three months in order to detect the occurrence of cardiac adverse events. RESULTS: NT-proBNP was positively correlated (P<0.0001) with age, days of hospitalization (P=0.001) and ASA class (P=0.001). High surgical risk (P<0.0001), diabetes (P=0.004), dyslipidemia (P=0.006) and elevated levels of NT-proBNP (P<0.0001) were significantly correlated with events. Using a logistic regression analysis we found an independent association between pre-operative elevated NT-proBNP and postoperative cardiac events (OR 1.2, 95% CI 1.0-1.4, P=0.01). CONCLUSION: Measuring NT-proBNP before non cardiac surgery in clinical practice could be useful to better stratify patients' risk.

Homecare-based Motor Rehabilitation in Musculoskeletal Chronic Graft Versus Host Disease.

Chronic graft versus host disease (cGVHD) is a frequent complication of allogeneic stem cell transplantation. Extensive musculoskeletal and skin involvement may induce severe functional impairment, disability and quality of life deterioration. Physical rehabilitation is recommended as ancillary therapy in these forms, but experiences are sparse. A 39-year-old man affected by musculoskeletal and skin chronic graft versus host disease (cGVHD) was treated with a homecare-based motor rehabilitation program during palliation for disease progression. Significant functional improvement was obtained. Motor rehabilitation should be strongly considered for patients with musculoskeletal cGVHD, both in the palliative and in the curative phase of disease.

[Tooth pastes and oral hygiene in the Roman world]. / Dentifrici e igiene orale nel mondo romano.

The trial against Apuleius frames historically and socially the subject of oral hygiene, which hides behind the semiotic paradigm full of magic, superstition, and all of the roman cultural background which stems from the ancient greek tradition. After reading carefull the latin odontic prescription written by Scribonius Largus, Celsus, Plinius, Marcellus etc., we don't want to stop at a precise list of tooth paste ingredients but we have tried to interpret the ideological procedures and practices which guided the greek and latin therapeutic practices and daily hygiene.

FISH analysis for CML monitoring?

Conventional cytogenetics is considered the gold standard for evaluating CML during interferon (IFN) treatment. Drawbacks to this approach are the small number of metaphases available during IFN therapy and the impossibility of scoring interphase cells. We applied, besides cytogenetics, double-color FISH (dc-FISH) detection of BCR-ABL gene fusion to monitor 20 CML patients on IFN. dc-FISH easily detected 200 cells per specimen, while with cytogenetic examination a mean of 16.1 mitoses per sample were scored. Though the correlation of dc-FISH and cytogenetic data was good (r = 0.77, p < 0.001), the discrepancy between the two methods as regards the proportion of leukemic cells in the marrow was often important dc-FISH detected a relevant proportion of BCR-ABL+ cells in three patients classified as complete cytogenetic responders and showed that, after 9-12 months of IFN treatment, a significant reduction of BCR-ABL+ cells was present in all the 20 patients tested. This might suggest that all CML patients are potentially responsive to IFN. Though more data are required, we think that dc-FISH is more informative than cytogenetic analysis for CML monitoring. Notably because of the simplicity of the procedure, this method could be easily standardized among different laboratories, thus permitting cross-comparison in therapeutic trials.