Glenoid version: the role of genetic and environmental factors on its variability. An MRI study on asymptomatic elderly twins.

BACKGROUND: Glenoid version is the most variable parameter of the shoulder joint. No authors investigated if intrinsic genetic factors or influences from extrinsic sources are responsible for its variability. AIM: We compared glenoid version between elderly monozygotic and dizygotic twins intending to separate the contributions of genetics from shared and unique environments. METHODS: Glenoid version of the dominant shoulder was assessed by MRI using Friedman's method in 30 pairs of elderly twins (16 monozygotic-14 dizygotic; mean age ± SD: 63.72 ± 3.37, 53-72). Heritability was estimated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment was calculated as the difference between monozygotic correlation coefficient and the heritability index. According to job category, one way analysis of variance was used to estimate the differences between groups in the total sample and within zygosity groups. RESULTS: Glenoid version angle in monozygotic and dizygotic twins was -2° (SD: 2°) and -3° (SD: 3°), respectively (p = 0.334). Heritability index was 0.98, while the contributions of shared and unique environment were 0 and 0.02, respectively. According to working classes, no significant differences were found between the groups (p = 0.732, F = 0.31). CONCLUSIONS: Glenoid version is mainly genetically determined and only marginally influenced by environments.Level of evidence: III.

Low complication rates in Minimally Invasive Plate Osteosynthesis (MIPO) for proximal humeral fractures at 5 years of follow-up.

INTRODUCTION: Purpose of this study was to analyse the medium term follow-up of minimally invasive plate osteosynthesis (MIPO) for proximal humeral fractures in terms of postoperative shoulder function, radiological outcome and complications. METHODS: 76 consecutive patients with unstable proximal humeral fractures were treated using locking plate with a minimally invasive antero-lateral approach in two surgical centers. Constant score and radiographic evaluation of 74 patients were available at mean follow up of 5 years (minimum 4 years). RESULTS: Mean Constant score was 74 (range to 28-100). Results were comparable in the two centers. Younger patients registered significantly higher scores (p < 0.05). 20 patients (27%) developed complications. Subacromial impingement occurred in 16,2% of cases for varus malreduction (6,7%) and for too proximal plate positioning (9,5%). Primary screws perforation (2,7%), secondary perforation due to cut-out (1,4%), avascular necrosis (AVN) of humeral head (1,4%), partial resorption of greater tuberosity (2,7%), secondary displacement of the greater tuberosity (2,7%) and stiffness (2,7%) were observed. DISCUSSION AND CONCLUSIONS: Even at a medium term follow-up, MIPO for proximal humeral fractures ensured good and reproducible results for most common pattern of fractures. Major complications were lower respect to open procedures, because of soft tissue, deltoid muscle and circumflex vessels sparing.

Arthroscopic single-row repair of massive potentially irreparable postero-superior cuff tear.

PURPOSE: We retrospectively evaluated the results of complete repair of massive potentially irreparable postero-superior tears in a consecutive cohort of patients. With the increasing and widespread use of superior capsular reconstruction, a complete repair of the superior cuff, also if not functional, may be a valuable option for irreparable cuff lesions. METHODS: A consecutive case series of massive potentially irreparable postero-superior cuff tears that underwent complete repair was included in the study. Irreparability of cuff tear was defined when on preoperative MRI images, a positive tangent sign, a Goutallier 3-4 stage of fatty infiltration, and an absent acromion-humeral distance were present. A single-row complete repair was performed using triple-loaded titanium suture anchors. Operative time was recorded, as well as intra- and postoperative complications. Patients were followed for 12 months post-op; they were clinically evaluated with the use of constant score (CS) and subjective shoulder value (SSV) at 3, 6, and 12 months; a 12-month postoperative ultrasound evaluation was obtained. RESULTS: Thirty-two patients satisfying the inclusion criteria were enrolled. The mean age was 52 years (range 41-58). The repair was completed with a mean use of 2.4 triple-loaded suture anchors (range 2-4); the mean operative time was 70 min (range 45-90). The mean preoperative CS was 55 (range 45-75, SD 17), while the SSV was 40 (range 30-70, SD 22). At the final follow-up, the mean CS and SSV were 72 (range 62-85, SD 8) and 80 (range 60-90, SD 10) (p < 0.001 with respect to the preoperative scores), respectively. At the final follow-up, sonography showed a complete healing of the cuff in 20 cases (62.5%). No intra-operative complications occurred; at the final follow-up, five patients (15, 6%) were not satisfied of the results and asked for revision surgery. CONCLUSIONS: The complete repair of massive potentially irreparable rotator cuff tear in patients younger than 60 years old yielded good results at a short-term follow-up, with a sonographic re-tear rate of about 20%. Even if it is logical to consider a tendon with severe fatty degeneration as non-functional, the superior soft tissue reconstruction we achieved may have at least the same results of a superior capsular reconstruction, with obvious lower costs. LEVEL OF EVIDENCE: Level 4, case series with no comparison group.

Immediate intensive mobilization compared with immediate conventional mobilization for the impacted osteoporotic conservatively treated proximal humeral fracture: a randomized controlled trial.

PURPOSE: To select in a 2-year survey of proximal humerus fractures accessing the emergency department, a population of osteoporotic stable impacted fractures and to randomize them into two groups, one with an immediate intensive mobilization program and the other with an immediate conventional mobilization program. METHODS: In emergency department, patients with clinical signs of shoulder girdle fracture were submitted to standard X-ray examination and CT scan. Patients with stable (absence of metaphyseal comminution or fifth fragment) osteoporotic (cortical bone thickness lower than 6 mm) impacted (Is any part of metaphysis or head impacted into the shaft? YES/NO) proximal humerus fractures were selected for randomization in one of the two groups. Group 1: early intensive mobilization; Group 2: early conventional mobilization. Functional and radiographic assessment was recorded at 3, 6 and 12 months of follow-up. RESULTS: In the considered period, 120 patients were affected by a stable impacted osteoporotic proximal humerus fracture. At the final follow-up, 36 patients in group 1 and 39 patients in group 2 were available for statistical analysis. Functional and radiographic scores were comparable, with a trend of significance in favor of group 2. No fracture in any of the group showed significant loss of reduction respect to 6 months of follow-up. 4 (10%) and 1 (2.5%) patients in groups 1 and 2 were not compliant with the rehabilitation program (p = 0.037). CONCLUSIONS: This randomized controlled trial showed that impacted osteoporotic proximal humerus fractures can be managed non-operatively with an early conventional rehabilitation program composed by 10 sessions of passive motion twice a week, followed by recovery of active range of motion for further 10 sessions thrice a week, while no advantage is given by a more aggressive rehabilitation regimen. Self-assisted exercises should be explained to patients to maximize the effects of the assisted program. LEVEL OF EVIDENCE: Level 1, randomized controlled double-blinded trial.

Retroverted glenoid reconstruction using glenoid plate in reverse shoulder arthroplasty.

PURPOSE: The objective of this study is to evaluate the clinical and radiological results of reverse shoulder arthroplasty (RSA) with glenoid plating in a consecutive series of patients affected by cuff tear glenohumeral arthropathy with glenoid retroversion >15°. We hypothesized that autologous humeral head graft may be better stabilized between the baseplate and the native glenoid surface with the use of a glenoid plate. METHODS: Twenty consecutive patients affected by cuff tear arthropathy with glenoid retroversion >15° (B2 or C according to Walch classification) were enrolled in this study. To reconstruct the glenoid, a dedicated plate was used in addition to the standard reverse shoulder baseplate and the glenosphere. Clinical and radiological assessment was performed using constant score (CS), subjective shoulder value (SSV), X-rays and CT scan at 6, 12 and 24 months of follow-up. Healing and resorption of the graft and detection of the glenoid version were assessed. RESULTS: Sixteen patients were available for final follow-up. The mean preoperative retroversion of the glenoid was 24°, while the post-op was 2° (p = 0.002). At 24 months of follow-up, mean CS and SSV were 61 and 70. Respect to preoperative scores, the results were statistically significant (p < 0.001). The last CT scan revealed: a complete healing of the graft in 100% of cases; graft resorption less than 25% in two patients (12.5%); glenoid retroversion of 4°. A negative statistically significant correlation was found between final CS and preoperative glenoid retroversion (0.039). CONCLUSIONS: The present study reports the favorable outcomes of retroverted glenoid reconstruction with glenoid plates in RSA, an alternative method to address severe glenoid deficiency. LEVEL OF EVIDENCE: Level IV, case series with no comparison group.

Bone texture analysis using CT-simulation scans to individuate risk parameters for radiation-induced insufficiency fractures.

This study deals with the role of texture analysis as a predictive factor of radiation-induced insufficiency fractures in patients undergoing pelvic radiation. INTRODUCTION: This study aims to assess the texture analysis (TA) of computed tomography (CT) simulation scans as a predictive factor of insufficiency fractures (IFs) in patients with pelvic malignancies undergoing radiation therapy (RT). METHODS: We performed an analysis of patients undergoing pelvic RT from January 2010 to December 2014, 24 of whom had developed pelvic bone IFs. We analyzed CT-simulation images using ImageJ macro software and selected two regions of interest (ROIs), which are L5 body and the femoral head. TA parameters included mean (m), standard deviation (SD), skewness (sk), kurtosis (k), entropy (e), and uniformity (u). The IFs patients were compared (1:2 ratio) with controlled patients who had not developed IFs and matched for sex, age, menopausal status, type of tumor, use of chemotherapy, and RT dose. A reliability test of intra- and inter-reader ROI TA reproducibility with the intra-class correlation coefficient (ICC) was performed. Univariate and multivariate analyses (logistic regression) were applied for TA parameters observed both in the IFs and the controlled groups. RESULTS: Inter- and intra-reader ROI TA was highly reproducible (ICC > 0.90). Significant TA parameters on paired t test included L5 m (p = 0.001), SD (p = 0.002), k (p = 0.006), e (p = 0.004), and u (p = 0.015) and femoral head m (p < 0.001) and SD (p = 0.001), whereas on logistic regression analysis, L5 e (p = 0.003) and u (p = 0.010) and femoral head m (p = 0.027), SD (p = 0.015), and sex (p = 0.044). CONCLUSIONS: In our experience, bone CT TA could be correlated to the risk of radiation-induced IFs. Studies on a large patient series and methodological refinements are warranted.

Water/cortical bone decomposition: A new approach in dual energy CT imaging for bone marrow oedema detection. A feasibility study.

INTRODUCTION: Many studies aimed at validating the application of Dual Energy Computed Tomography (DECT) in clinical practice where conventional CT is not exhaustive. An example is given by bone marrow oedema detection, in which DECT based on water/calcium (W/Ca) decomposition was applied. In this paper a new DECT approach, based on water/cortical bone (W/CB) decomposition, was investigated. MATERIALS AND METHODS: Eight patients suffering from marrow oedema were scanned with MRI and DECT. Two-materials density decomposition was performed in ROIs corresponding to normal bone marrow and oedema. These regions were drawn on DECT images using MRI informations. Both W/Ca and W/CB were considered as material basis. Scatter plots of W/Ca and W/CB concentrations were made for each ROI in order to evaluate if oedema could be distinguished from normal bone marrow. Thresholds were defined on the scatter plots in order to produce DECT images where oedema regions were highlighted through color maps. The agreement between these images and MR was scored by two expert radiologists. RESULTS: For all the patients, the best scores were obtained using W/CB density decomposition. CONCLUSIONS: In all cases, DECT color map images based on W/CB decomposition showed better agreement with MR in bone marrow oedema identification with respect to W/Ca decomposition. This result encourages further studies in order to evaluate if DECT based on W/CB decomposition could be an alternative technique to MR, which would be important when short scanning duration is relevant, as in the case of aged or traumatic patients.

Electrophysiological and morphological changes in colonic myenteric neurons from chemotherapy-treated patients: a pilot study.

BACKGROUND: Patients receiving anticancer chemotherapy experience a multitude of gastrointestinal side-effects. However, the causes of these symptoms are uncertain and whether these therapeutics directly affect the enteric nervous system is unknown. Our aim was to determine whether the function and morphology of myenteric neurons are altered in specimens of the colon from chemotherapy-treated patients. METHODS: Colon specimens were compared from chemotherapy-treated and non-treated patients following colorectal resections for removal of carcinoma. Intracellular electrophysiological recordings from myenteric neurons and immunohistochemistry were performed in whole mount preparations. KEY RESULTS: Myenteric S neurons from chemotherapy-treated patients were hyperexcitable; more action potentials (11.4 ± 9.4, p < 0.05) were fired in response to depolarising current pulses than in non-treated patients (1.4 ± 0.5). The rheobase and the threshold to evoke action potentials were significantly lower for neurons from chemotherapy-treated patients compared to neurons from non-treated patients (p < 0.01). Fast excitatory postsynaptic potential reversal potential was more positive in neurons from chemotherapy-treated patients (p < 0.05). An increase in the number of neurons with translocation of Hu protein from the cytoplasm to the nucleus was observed in specimens from chemotherapy-treated patients (103 ± 25 neurons/mm(2) , 37.2 ± 7.0%, n = 8) compared to non-treated (26 ± 5 neurons/mm(2) , 11.9 ± 2.7%, n = 12, p < 0.01). An increase in the soma size of neuronal nitric oxide synthase-immunoreactive neurons was also observed in these specimens. CONCLUSIONS & INFERENCES: This is the first study suggesting functional and structural changes in human myenteric neurons in specimens of colon from patients receiving anticancer chemotherapy. These changes may contribute to the causation of gastrointestinal symptoms experienced by chemotherapy-treated patients.

Type II congenital pulmonary airway malformation associated with intralobar pulmonary sequestration: report of a case and review of classification criteria.

Pulmonary congenital abnormalities are rare disorders including congenital pulmonary airway malformations (CPAM) and pulmonary sequestration (PS). CPAM is a lesion characterized by the presence of anomalous bronchiolar or acinar structures, variable in size, either cystic or not cystic. PS is generally defined as nonfunctioning lung tissue that is not in normal continuity with the tracheobronchial tree and that derives its blood supply from systemic vessels. We describe a case of a baby girl with a very rare association between CPAM type 2 and intralobar pulmonary sequestration (IPS) focusing on the cystic lesions typical of CPAM and on the lymphatic and blood vessels. The cells lining the cysts often were positive for D2-40 (oncofetal protein M2A). Lymphatic endothelial cells, positive for D2-40, were widely present in the lung parenchyma and dilated lymphatic vessels were present also in the inter-alveolar septa. Moreover, we discuss the pathogenesis of CPAM and its classification criteria.

The amount of impaction and loss of reduction in osteoporotic proximal humeral fractures after surgical fixation.

UNLABELLED: After surgical fixation, osteoporotic proximal humeral fractures often show high impaction and loss of reduction. This study aims at assessing the amount of impaction and loss of reduction at a short and medium follow-up. We found an alarming percentage of cases showing these complications in the first postoperative months. INTRODUCTION: This study seeks to quantify the amount of humeral head impaction and loss of reduction in a consecutive series of osteoporotic proximal humerus fractures treated with a locking plate. METHODS: A series of displaced proximal humerus fractures were prospectively treated with minimally invasive reduction and ostheosynthesis using a locking plate. Diagnosis and classification of fractures were based on X-ray examination and CT scan. Proximal humerus cortical bone thickness (CBTAVG) was studied to assess osteoporosis. Amount of loss of reduction and head fragment impaction were noted at 3 and 18 months of follow-up. Constant score was calculated at 6 and 18 months of follow-up. RESULTS: Thirty-one osteoporotic fractures were studied. Most of the fractures (21, 67.7 %) had a CBTAVG of less than 4 mm. At 3 months of follow-up, 7 cases (22.5 %) had significant loss of reduction and the mean amount of impaction was 2.8 mm. At 18 months of follow-up, only 1 additional fracture showed loss of reduction and mean impaction was 3 mm (p < 0.05). At 6 months follow-up, the mean Constant score was 58 %; while at 18 months, it was 70 % (p = 0.02). Amount of impaction was significantly correlated to age of patients (p = 0.031), female sex (p = 0.011), CBTAVG (p = 0.019), and metaphyseal comminution (p = 0.013). CONCLUSIONS: Osteoporotic proximal humerus fractures may present an important impaction and loss of reduction in the first 3 months after surgery even if treated with a rigid device and multiple head screws. Surgeons treating these osteoporotic fractures should be aware of these complications even when using a rigid device.

Exposure to a low dose of bisphenol A impairs pituitary-ovarian axis in prepubertal rats: effects on early folliculogenesis.

The research work studies the effect of providing a low dose of bisphenol A (BPA), on the reproductive axis of prepubertal female rats. Wistar mated rats were treated with either 0.1% ethanol or BPA in their drinking water until their offspring were weaned on the 21 day of birth. The estimated average dose of exposure to dams was approximately 3µg/kg/day. The pups were sacrificed at the 30th day of life. Body weight at the moment of the sacrifice was significantly higher in the group exposed to BPA; ovarian weight and its relative weight were not modified. LH and estradiol levels increased significantly, meanwhile FSH ones showed no significant changes. The number of primary, secondary and atretic follicles increased and antral ones was decreased. Our results demonstrated that early exposure to a low dose of BPA disrupts the normal function of the reproductive axis in prepubertal female rats.

Bioavailability and biological effect of engineered silver nanoparticles in a forest soil.

The extensive use of silver nanoparticles (SNPs) as antimicrobial in food, clothing and medicine, leads inevitably to a loss of such nanomaterial in soil and water. Little is known about the effects of soil contamination, in particular, on microbial cells, which play a fundamental ecological role. In this work, the impact of SNPs on forest soil has been studied, investigating eco-physiological indicators of microbial biomass and microbial diversity with culture-dependent and independent techniques. Moreover, SNPs bioavailability and uptake were assessed. Soil samples were spiked with SNPs at two different concentrations (10 and 100 µg g(-1)dw) and incubated with the relative controls for 30, 60 and 90 days. The overall parameters showed a significant influence of the SNPs on the soil microbial community, revealing a marked shift after 60 days of incubation.

Pigmented villonodular synovitis of the shoulder associated with massive rotator cuff tear treated by arthroscopic synovectomy and debridement.

PURPOSE: Pigmented villonodular synovitis (PVNS) is a rare condition. Our purpose is to describe the largest series of patients with shoulder PVNS, massive irreparable rotator cuff tear, and glenohumeral osteoarthritis treated with arthroscopic debridement and synovectomy. METHODS: We treated 9 patients with PVNS of the shoulder, irreparable rotator cuff tear, and slight glenohumeral arthropathy (group I). Patients underwent arthroscopic synovectomy and debridement. Results [constant score (CS) and subjective shoulder value (SSV)] were compared to those obtained from a control group (group II) of 20 consecutive patients undergoing arthroscopic debridement for irreparable cuff tear associated with hemorrhagic synovitis with no or slight glenohumeral arthropathy. Histologic examination was obtained in all cases to obtain the correct diagnosis. RESULTS: The preoperative shoulder function in group I was reduced with respect to group II. Upon follow-up, CS and SSV were lower in group I. Preoperatively, the differences relating to the CS value and to each item of the score were always statistically significant; instead, at follow-up, significant differences emerged in the CS, ADL, and ROM. At follow-up, significant differences emerged between CS of group I and of group II without glenohumeral arthropathy. Differences using the SSV were always statistically significant. CONCLUSIONS: The poor functional outcome of patients affected by PVNS can be attributed to the coexistence of the irreparable cuff tear and to the glenohumeral arthropathy. All patients with PVNS had shoulder osteoarthritis; it cannot be simply attributed to natural history of massive irreparable cuff tears, but to the pigmented villonodular synovitis.

The impact of aging on rotator cuff tear size.

INTRODUCTION: The aim of our study was to establish if aging influences rotator cuff tear size. PATIENTS AND METHODS: We studied 586 consecutive patients (280 M, 306 F) mean age 59 years old (range 46-73) who underwent arthroscopic rotator cuff repair. Tear size was determined during surgery. For the purpose of our study, patients were divided into two groups based on age older than 60 years. A multinomial logistic regression model was applied to explore the association between age older than 60 years and tear size. We used the ANCOVA method to determine whether the aging influences the severity of the tear. All analyses were adjusted for gender. RESULTS: Age older than 60 years was associated with a twofold higher overall risk of tear occurrence (OR = 2.12, 95 % CI 1.44-3.01). While no association was detected between age older than 60 years and the probability of a small tear (OR = 0.58, 95 % CI 0.27-1.07), subjects older than 60 years were twice more likely to experience a large tear (OR = 2.29, 95 %CI 1.51-3.27) and three times more likely to experience a massive tear (OR = 3.09, 95 % CI 2.07-5.38) as opposed to younger subjects. Mean age significantly increased from small tear (53.8 years) to large tear (66.8 years) to massive tear (69.4 years) patients (ANCOVA: F(2, 437) = 16.487, p = 1.51 × 10(-7)). DISCUSSION: We found a significantly older mean age in patients with a more severe tear. Our data provide and confirm evidence that aging is a significant risk factor for the occurrence and severity of rotator cuff tears.

Assessment of response to chemoradiation therapy in rectal cancer using MR volumetry based on diffusion-weighted data sets: a preliminary report.

PURPOSE: This study evaluated the feasibility of magnetic resonance (MR) volumetry using a diffusion-weighted data set (V(DWI)) and compared it with conventional T2-weighted volumetry (V(C)) in patients affected by rectal cancer treated with chemoradiation therapy (CHRT). MATERIALS AND METHODS: Fourteen patients with a biopsy diagnosis of rectal cancer underwent MR examination before and after CHRT. T2-weighted images were used to extrapolate V(C). A diffusion-weighted (DW) sequence was acquired [spin-echo diffusion-weighted echo-planar imaging (SE-DW-EPI)] with a b-value of 800 s/mm(2) and volume (V(DWI)) was calculated by semiautomatic segmentation of tumour hyperintensity. Two radiologists independently assessed volumes and analysed data in order to establish interobserver agreement and compare and correlate volumes to tumour regression grade (TRG), as evaluable at pathological examination of the surgical specimen. RESULTS: Interobserver agreement was 0.977 [(95% confidence interval (CI) 0.954-0.989) and 0.956 (95% CI 0.905-0.980) for V(C) and V(DWI) and 0.964 (95% CI 0.896-0.988) and 0.271 (95% CI-0.267 to 0.686) between V(C) and V(DWI) before and after CHRT. The correlation between TRG and V(C) and V(DWI) was, respectively, rho = 0.597 (p<0.05) and r(2)=0.156 (p=0.162) and rho=0.847 (p<0.001). CONCLUSIONS: V(DWI) seems to be a promising tool for assessing response to CHRT in rectal cancer. Further studies on large series of patients are needed to refine the technique and evaluate its potential predictive value.

In vitro effect of octyl - methoxycinnamate (OMC) on the release of Gn-RH and amino acid neurotransmitters by hypothalamus of adult rats.

OMC (octyl-methoxycinnamate), an endocrine disruptor having estrogenic activity, is used in sunscreen creams as UV filter. We studied its "in vitro" effects on the hypothalamic release of Gn-RH as well as on the amino acid neurotransmitter system. OMC significantly decreased Gn-RH release in normal male and female rats as well as in castrated rats with substitutive therapy. No effects were observed in castrated rats without substitutive therapy. In males OMC increases the release of GABA, decreasing the production of glutamate (GLU) while in the female decreases the excitatory amino acid aspartate (ASP) and GLU without modifications in the hypothalamic GABA release. These results suggest that OMC acting as endocrine disruptor could alter the sex hormone-neurotransmitter-Gn-RH axis relationships in adult rats.

Coracoid pain test: a new clinical sign of shoulder adhesive capsulitis.

Patients with adhesive capsulitis were clinically evaluated to establish whether pain elicited by pressure on the coracoid area may be considered a pathognomonic sign of this condition. The study group included 85 patients with primary adhesive capsulitis, 465 with rotator cuff tear, 48 with calcifying tendonitis, 16 with glenohumeral arthritis, 66 with acromioclavicular arthropathy and 150 asymptomatic subjects. The test was considered positive when pain on the coracoid region was more severe than 3 points (VAS scale) with respect to the acromioclavicular joint and the anterolateral subacromial area. The test was positive in 96.4% of patients with adhesive capsulitis and in 11.1%, 14.5%, 6.2% and 10.6% of patients with the other four conditions, respectively. A positive result was obtained in 3/150 normal subjects (2%). With respect to the other four diseases, the test had a sensitivity of 0.96 and a specificity ranging from 0.87 to 0.89. With respect to controls, the sensitivity and specificity were 0.99 and 0.98, respectively. The coracoid pain test could be considered as a pathognomonic sign in physical examination of patients with stiff and painful shoulder.

Impact of 4-methylbenzylidene-camphor (4-MBC) during embryonic and fetal development in the neuroendocrine regulation of testicular axis in prepubertal and peripubertal male rats.

4-Methylbenzylidene-camphor (4-MBC), an UV-B ray filter, belongs to the endocrine disrupters involved with alterations in the reproductive axis. Our target was to study the effect of 4-MBC on the neuroendocrine parameters that regulate reproduction in prepubertal and peripubertal male rats, which received this disrupter during embryonic and fetal development. 4-MBC was administered (sc) to female rats since pregnancy onset in doses of 20, 100 and 500 mg/kg/day. The litters were sacrificed at 15 or 30 days old to determine testicular weight, gonadotropin and prolactin serum levels and also GnRH and amino acids release from the hypothalamus. The exposure to 20 mg/kg/day only increased the LH serum levels in 30-day-old males. Doses of 100 and 500 mg/kg/day caused a decrease in testicular weight and in LH, GnRH and glutamate levels, in prepubertal rats (15-day-old specimens), and an increase in, gonadotropin (LH and FSH) con-centration and aspartate levels in peripubertal rats (30-day-old specimens), without changes in testicular weight. Prolactinaemia remained unaltered in all groups. Results obtained show that the administration of high doses of 4-MBC during embryonic and fetal stage inhibits the testicular axis in male rats during the prepubertal stage and stimulates it during peripubertad stage. On the other hand in the case of low doses no significant effects were observed.

Occult fractures of the greater tuberosity of the humerus.

We studied the highest reported number of patients with occult fracture of the greater tuberosity of the humerus and we analysed why fracture was not diagnosed, shoulder function and prevalence of eventually associated rotator cuff tear (RCT). Twenty-four patients with a missed fracture of the greater tuberosity underwent MR study for a suspect RCT. We evaluated shoulder function and self-assessed comfort with the Constant score (CS) and Simple Shoulder Test (SST). Nine patients showed evidence of cuff tendinosis, 11 of partial (p) RCT (2: subscapularis; 6: supraspinatus and 3: supraspinatus and infraspinatus). All patients with pRCT were older than 40. Initially, the mean CS and SST were 54% and 5/12; at follow-up, values increased to 36% and 5 points. MR should be performed in patients apparently negative for fracture but with painful shoulders and decreased ROM. Of our patients, 45.8% had pRCT; nevertheless function recovery was verified in 16 weeks.