RESUMEN
OBJECTIVE: Anatomical parameters and pathologies that can affect the critical shoulder angle (CSA) are subjects of discussion. To date, we do not know if the CSA value changes in the different decades of life in a population characterized by the same ethnicity, nor if there are differences related to gender or side. This study hypothesizes that age and gender may affect the CSA. METHODS: Patients older than 15 years old affected by a shoulder trauma and who were discharged with a diagnosis of shoulder contusion were enrolled. A true AP view of the shoulder was obtained as well as data regarding age and gender of all participants. The CSA was measured by three authors, and interoperator reliability was assessed. Eight subcategories, according to decades of life, were considered. Finally, the studied population was divided into three subcategories according to CSA values (< 30°; 30-35°; ≥ 35°). RESULTS: The initial sample comprised 3587 shoulder X-rays. The interobserver reproducibility was high, with an intraclass correlation coefficient of 0.865 (95% CI 0.793-0.915). Two thousand eight hundred seventy-three radiograms were excluded. The studied group comprised 714 patients [431 females, 283 males; mean age (SD): 47.2 (20.9) years, range: 11-93 years]. The mean CSA was 33.6° (range: 24-50°; SD: 3.9°). The mean CSA values in females and males were 33.7°and 33.5°, respectively. The mean CSA values of the right and left shoulders were 33.3° and 33.9°, respectively (p > 0.05). Linear regression analysis showed a CSA increase by 0.04° every year. The mean CSA in subjects aged between 15 and 19 years was significantly lower than all the other groups, except for patients older than 80 years. No significant differences were found between CSA subcategories, gender, or side. CONCLUSIONS: In the general population, the mean CSA value was 33.6°. No significant differences were found regarding the mean CSA value according to gender or side. A significant positive linear correlation between CSA and age was detected. In each decade of life, the CSA value, which is genetically determined, shows a large variability. LEVEL OF EVIDENCE: IV.
Asunto(s)
Lesiones del Manguito de los Rotadores , Articulación del Hombro , Adolescente , Adulto , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Hombro , Articulación del Hombro/diagnóstico por imagen , Adulto JovenRESUMEN
BACKGROUND: Literature lacks data on correlations between epidemiology and clinical data of patients with distal radius fractures (DRFs). AIM: The aim of this study was to present a detailed epidemiologic survey of a large consecutive series of patient with DRFs. MATERIALS AND METHODS: This retrospective study included 827 consecutive patients (579 females, 248 men) who sustained a DRFs in the last 5 years. All fractures were radiographically evaluated. DRFs were classified according to Association of Osteosynthesis classification. Data on age, gender, side, period in which fracture occurred, and fracture mechanism were collected. Statistical analysis was performed. RESULTS: The patients' mean age was 60.23 [standard deviation (SD) 16.65] years, with the left side being most frequently involved (56.1%). The mean age of females at the time of fracture was significantly higher than that of males. The most frequent pattern of fracture was the complete articular fracture (64.3%), while the most represented fracture type was 2R3A2.2 (21.5%). Regarding the period in which the fracture occurred, 305 DRFs (37.5%) were observed in the warmer months and 272 (33.4%) in the colder months. Low-energy trauma occurring outside home was found to be the major cause of DRF throughout the year. In both genders, trauma mechanism 2 was more frequent (59.4% F; 31.9% M; p < 0.01). A bimodal distribution of fracture mechanisms was found in males when considering the patient's age with a high-energy mechanism of fracture (3 and 4), identified in 21% (n = 52) of males aged 18-45 years, and a low-energy mechanism (1 and 2) was observed in 39.9% (n = 99) of males aged > 45 years. A significant correlation between all trauma mechanisms (from 1 to 6) and different fracture patterns (complete, partial, and extraarticular) was found (p value < 0.001). The mean age of patients with extraarticular fractures (mean age 61.75 years; SD 18.18 years) was higher than that of those with complete (mean age 59.84 years; SD 15.67 years) and partial fractures (mean age 55.26 years; SD 18.31 years). Furthermore, considering different fracture patterns and patient age groups, a statistically significant difference was found (p < 0.001). CONCLUSIONS: DRFs have a higher prevalence in females, an increase in incidence with older age, and no seasonal predisposition. Low-energy trauma occurring at home is the main cause of fracture among younger males sustaining fractures after sports trauma; Complete articular is the most frequent fracture pattern, while 2R3A2.2 is most frequent fracture type. LEVEL OF EVIDENCE: Level IV; case series; descriptive epidemiology study.
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Fracturas Intraarticulares , Fracturas del Radio , Femenino , Fijación Interna de Fracturas , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Fracturas del Radio/epidemiología , Fracturas del Radio/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Laparoscopic liver resection demands expertise and a long learning curve. Resection of the posterosuperior segments is challenging, and there are no data on the learning curve. The aim of this study was to evaluate the learning curve for laparoscopic resection of the posterosuperior segments. METHODS: A cumulative sum (CUSUM) analysis of the difficulty score for resection was undertaken using patient data from four specialized centres. Risk-adjusted CUSUM analysis of duration of operation, blood loss and conversions was performed, adjusting for the difficulty score of the procedures. A receiver operating characteristic (ROC) curve was used to identify the completion of the learning curve. RESULTS: According to the CUSUM analysis of 464 patients, the learning curve showed an initial decrease in the difficulty score followed by an increase and, finally, stabilization. More patients with cirrhosis or previous surgery were operated in the latest phase of the learning curve. A smaller number of wedge resections and a larger number of anatomical resections were performed progressively. Dissection using a Cavitron ultrasonic surgical aspirator and the Pringle manoeuvre were used more frequently with time. Risk-adjusted CUSUM analysis showed a progressive decrease in operating time. Blood loss initially increased slightly, then stabilized and finally decreased over time. A similar trend was found for conversions. The learning curve was estimated to be 40 procedures for wedge and 65 for anatomical resections. CONCLUSION: The learning curve for laparoscopic liver resection of the posterosuperior segments consists of a stepwise process, during which accurate patient selection is key.
ANTECEDENTES: La resección hepática laparoscópica exige experiencia y una larga curva de aprendizaje. La resección de los segmentos posterosuperiores (PS) es un reto, y no hay datos acerca de la curva de aprendizaje (learning curve, LC). El objetivo de este estudio fue evaluar la LC de la resección laparoscópica de los segmentos PS. MÉTODOS: Se realizó un análisis CUSUM de la puntuación de dificultad (difficulty score, DS) de la resección en pacientes de 4 centros especializados. La técnica CUSUM se ajustó al riesgo (risk-adjusted CUSUM, RA-CUSUM) para el tiempo operatorio, la pérdida de sangre y las conversiones a cirugía abierta ajustando según la DS de los procedimientos. Se utilizó una curva ROC para identificar el momento en el que se consideró que la LC había sido completada. RESULTADOS: De acuerdo con el análisis CUSUM de los 464 pacientes incluidos, se observó una DS baja al inicio, que posteriormente se fue incrementando hasta llegar a una estabilización. En la última fase de la LC se operaron más pacientes con cirrosis o cirugía previa. De forma progresiva se fueron reduciendo el número de resecciones hepáticas en cuña y aumentando el de resecciones anatómicas. A lo largo del tiempo se introdujo el CUSA y la maniobra de Pringle con mayor frecuencia. El RA-CUSUM mostró una reducción progresiva del tiempo operatorio. La pérdida de sangre inicialmente aumentó ligeramente, luego se estabilizó y finalmente disminuyó con el tiempo. Una tendencia similar se observó para las conversiones. La LC se estimó en 40 casos para las resecciones en cuña y en 65 casos para las resecciones anatómicas. CONCLUSIÓN: La LC de la resección hepática laparoscópica de los segmentos PS es un proceso paso a paso durante el cual la selección del paciente es clave.
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Hepatectomía/educación , Laparoscopía/educación , Curva de Aprendizaje , Hepatopatías/cirugía , Adulto , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Conversión a Cirugía Abierta/estadística & datos numéricos , Femenino , Hepatectomía/métodos , Hepatectomía/normas , Humanos , Laparoscopía/normas , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Selección de Paciente , Curva ROCRESUMEN
OBJECTIVE: Our study analyzes the association between chemokine-ligand-2 (CCL2) serum concentrations at baseline and knee radiographic osteoarthritis (OA) (knee-rOA), knee-rOA progression, individual radiographic features and knee symptomatic OA at 5-year follow-up. DESIGN: OA outcomes were analyzed in a community-based cohort including a baseline enrollment and a 5-year follow-up. Baseline CCL2 serum concentrations were assessed by multiplex assay and associated with presence or progression of individual radiographic features at 5-year follow-up. Separate multiple logistic regression models were used to examine adjusted associations between baseline CCL2 and each of the knee OA variables at follow-up. CCL2 at baseline was modeled as an explanatory variable, whereas each of the knee OA variables at follow-up served as the response variables. Models were adjusted for age, BMI, race, and sex. Trend tests were conducted to assess any linear effect on outcomes across CCL2 tertiles. RESULTS: Participants (n = 168) had a median age of 57-years and median BMI of 29 kg/m2. About 63% of all participants were women, and 58% Caucasian (42% African American). In adjusted logistic models, continuous log-CCL2 was significantly associated with knee-rOA. For each unit increase in log CCL2, the odds of having knee-rOA at follow-up was increased by 72%. CCL2 tertiles showed significant linear associations with presence and progression of knee-rOA and medial joint space narrowing (JSN), but not with presence or progression of osteophytes, bone sclerosis, knee symptoms, or symptomatic knee-rOA. CONCLUSIONS: Serum CCL2 may help to elucidate some mechanisms of joint destruction and identify individuals with higher odds of structural knee changes.
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Quimiocina CCL2/sangre , Progresión de la Enfermedad , Osteoartritis de la Rodilla/sangre , Osteoartritis de la Rodilla/diagnóstico por imagen , Anciano , Biomarcadores/sangre , Estudios de Cohortes , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Osteoartritis de la Rodilla/fisiopatología , Pronóstico , Radiografía/métodos , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: We previously found in our embryonic studies that proper regulation of the chemokine CCL12 through its sole receptor CCR2, is critical for joint and growth plate development. In the present study, we examined the role of CCR2 in injury-induced-osteoarthritis (OA). METHOD: We used a murine model of injury-induced-OA (destabilization of medial meniscus, DMM), and systemically blocked CCR2 using a specific antagonist (RS504393) at different times during disease progression. We examined joint degeneration by assessing cartilage (cartilage loss, chondrocyte hypertrophy, MMP-13 expression) and bone lesions (bone sclerosis, osteophytes formation) with or without the CCR2 antagonist. We also performed pain behavioral studies by assessing the weight distribution between the normal and arthritic hind paws using the IITS incapacitance meter. RESULTS: Testing early vs delayed administration of the CCR2 antagonist demonstrated differential effects on joint damage. We found that OA changes in articular cartilage and bone were ameliorated by pharmacological CCR2 blockade, if given early in OA development: specifically, pharmacological targeting of CCR2 during the first 4 weeks (wks) following injury, reduced OA cartilage and bone damage, with less effectiveness with later treatments. Importantly, our pain-related behavioral studies showed that blockade of CCR2 signaling during early, 1-4 wks post-surgery or moderate, 4-8 wks post-surgery, OA was sufficient to decrease pain measures, with sustained improvement at later stages, after treatment was stopped. CONCLUSIONS: Our data highlight the potential efficacy of antagonizing CCR2 at early stages to slow the progression of post-injury OA and, in addition, improve pain symptoms.
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Benzoxazinas/farmacología , Huesos/efectos de los fármacos , Cartílago Articular/efectos de los fármacos , Condrocitos/efectos de los fármacos , Meniscos Tibiales/efectos de los fármacos , Osteoartritis/patología , Receptores CCR2/antagonistas & inhibidores , Compuestos de Espiro/farmacología , Animales , Huesos/patología , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Hipertrofia , Metaloproteinasa 13 de la Matriz/efectos de los fármacos , Metaloproteinasa 13 de la Matriz/metabolismo , Meniscos Tibiales/cirugía , Ratones , Osteoartritis/metabolismo , Osteofito , Receptores CCR2/fisiología , Esclerosis , Lesiones de Menisco TibialRESUMEN
BACKGROUND: Caustic burns are burns of third and fourth degree caused by strong acids or strong bases. Muriatic acid is often used for suicidal attempt by ingestion. We describe a case of a caustic skin lesion caused by intravenous failed attempt of suicide by injection of Muriatic acid in a woman affected with bipolar-syndrome. Generally, caustic burns are treated by cleansing, escarectomy and coverage with skin grafts. CASE REPORT: We treated the patient with a non invasive technique with collagenase and hyaluronic acid sodium salt cream (Bionect start®), hyaluronic acid-based matrix (Hyalomatrix®) and Vacuum-Assisted Closure (VAC) Therapy®. RESULTS: We obtained complete healing in 6 weeks. CONCLUSIONS: Combined use of non invasive techniques seems to ensure only advantages for both the patients and the Health System. It reduces health care costs and risks for the patients such as nosocomial infections. Patient's compliance is high, as its quality of life. Complete healing of the wound is fast and recovery of function is full.
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Quemaduras Químicas/etiología , Quemaduras Químicas/terapia , Colagenasas/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Ácido Hialurónico/administración & dosificación , Ácido Clorhídrico/efectos adversos , Terapia de Presión Negativa para Heridas , Intento de Suicidio , Administración Cutánea , Adulto , Trastorno Bipolar/psicología , Procedimientos Quirúrgicos Dermatologicos , Combinación de Medicamentos , Femenino , Humanos , Ácido Clorhídrico/administración & dosificación , Inyecciones Intradérmicas , Terapia de Presión Negativa para Heridas/métodos , Autoadministración , Crema para la Piel/administración & dosificación , Intento de Suicidio/psicología , Cicatrización de HeridasRESUMEN
BACKGROUND: Squamous-cell skin cancer is the most frequent tumor in the hand. It occurs on sun-damaged skin, especially in lightskinned individuals with a long history of chronic sun exposure. CASE REPORT: We describe a case of bilateral hand squamous-cell carcinoma in a elderly patient affected with non-Hodgkin's lymphoma, who underwent several non-successful surgical treatment, radiotherapy and at the least, amputation of right hand for rapid clinical evolution after radiotreatment. Available literature on the subject has been reviewed. RESULTS: In our case, after several non-successful treatment, elective amputation at the distal third of forearm was performed. We reviewed 56 items including books, original articles, reviews, cases report. CONCLUSIONS: Current evidence on treatment of hand squamouscells carcinoma is to perform a first radical surgical treatment in order to avoid recurrence/metastasis and to achieve a safer level of amputation thus increasing the surface area of healthy tissue available for eventually subsequent reconstruction/prosthesization.
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Amputación Quirúrgica , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Mano , Linfoma no Hodgkin/complicaciones , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Anciano de 80 o más Años , Amputación Quirúrgica/métodos , Carcinoma de Células Escamosas/radioterapia , Mano/patología , Mano/cirugía , Humanos , Masculino , Radioterapia Adyuvante/métodos , Neoplasias Cutáneas/radioterapia , Resultado del TratamientoRESUMEN
We compared the efficacy of azacitidine (AZA) and decitabine (DEC) in elderly patients with untreated AML, diagnosed according to WHO criteria. In the two groups, we evaluated complete remission (CR), overall survival (OS) and disease free survival (DFS). The AZA and DEC groups included 139 and 186 patients, respectively. To minimize the effects of treatment selection bias, adjustments were made using the propensity-score matching method, which yielded 136 patient pairs. In the AZA and DEC cohort, median age was 75 years in both, (IQR, 71-78 and 71-77), median WBCc at treatment onset 2.5 × 109/L (IQR, 1.6-5.8) and 2.9 × 109/L (IQR, 1.5-8.1), median bone marrow (BM) blast count 30% (IQR, 24-41%) and 49% (IQR, 30-67%), 59 (43%) and 63 (46%) patients had a secondary AML, respectively. Karyotype was evaluable in 115 and 120 patients: 80 (59%) and 87 (64%) had intermediate-risk, 35 (26%) and 33 (24%) an adverse risk karyotype, respectively. Median number of cycles delivered was 6 (IQR, 3.0-11.0) and 4 (IQR, 2.0-9.0), CR rate was 24% vs 29%, median OS and 2-year OS rates 11.3 (95% CI 9.5-13.8) vs 12.0 (95% CI 7.1-16.5) months and 20% vs 24%, respectively. No differences in CR and OS were found within the following subgroup: intermediate- and adverse-risk cytogenetic, frequency of WBCc at treatment ≥ 5 × 10^9 L and < 5 × 10^9/L, de novo and secondary AML, BM blast count < and ≥ 30%. Median DFS for AZA and DEC treated patients was 9.2 vs 12 months, respectively. Our analysis indicates similar outcomes with AZA compared to DEC.
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Azacitidina , Leucemia Mieloide Aguda , Humanos , Anciano , Azacitidina/uso terapéutico , Decitabina/uso terapéutico , Resultado del Tratamiento , Supervivencia sin Enfermedad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéuticoRESUMEN
BACKGROUND: Emotional writing is a short-term psychological intervention that has been successfully used in several controlled studies. OBJECTIVES: The overall objective of the study was to test the efficacy of Pennebaker's emotional writing intervention in patients with psoriasis treated with systemic therapy. METHODS: A randomized controlled trial was conducted in seven clinical centres in Italy, over a 2-year period. The main outcome measures were the psoriasis area and severity index and the Physician Global Assessment, as well as generic and dermatology-specific quality of life questionnaires. Such outcomes were measured at 4 weeks, and 6 and 12 months from baseline. The project recruitment time was 12 months, and the total follow-up time for each individual was also 12 months. RESULTS: In total, 202 patients were enrolled and assessed at baseline, 67 of whom completed all three follow-up visits. The writing exercise had little or no effect on patients with psoriasis who were undergoing systemic treatment. In the Generalized Estimating Equations models no statistically significant differences were observed in the Pennebaker intervention group vs. the control group. In subgroup analysis for health status, small effects in favour of patients assigned to the Pennebaker group were documented at the end of the study in women, in overweight individuals, in patients under treatment with biological drugs, and on the Physical Component Summary of the Short Form of the Medical Outcomes Study Questionnaire. CONCLUSIONS: The Pennebaker and control groups had similar changes over time for practically all the outcome variables, and also when considering all observations and adjusting for all the variables of interest. The longitudinal analysis confirmed that the intervention had little or no effect on the variables of interest. The implementation of writing exercises requires a careful and ad hoc organization, including dedicated spaces for the writing itself.
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Emociones , Psoriasis/psicología , Calidad de Vida/psicología , Escritura , Adulto , Escolaridad , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Psoriasis/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Clase Social , Factores Socioeconómicos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: The assessment of a patient's disease severity is an essential component in the formulation of treatment strategies. OBJECTIVES: To compare disease severity assessment by patients and by physicians, and to describe the possible discrepancies between them. METHODS: For each patient, we obtained the Physician Global Assessment (PhGA) and the Patient Global Assessment (PtGA). Data were completed for 2.578 patients. Sixty-one physicians participated in the study. We calculated the agreement between PtGA and PhGA scores using the weighted kappa statistics; a multinomial logistic regression was performed to assess the risk of disagreement considering both patient and physician variables. RESULTS: Differences in the percentages of severity level, identified by patients and by physicians, were always statistically significant (P < 0.05). Overall, the weighted Cohen's kappa was in the range of 0.09-0.34, depending on the diseases. Gender differences between patients and physicians did not influence the agreement. In the multinomial model female patients (OR = 1.38; 95% CI, 1.07-1.77), patients with higher educational levels (OR = 2.71; 95% CI, 2.12-3.46), and patients with impaired quality of life (OR = 1.56; 95% CI 1.23-1.97) had a higher risk to be underestimated for their disease severity by physicians, independently by physician gender and experience. CONCLUSIONS: Combining the subjective report with the objective severity assessment of the lesions, dermatologists may reach a better determination of how severity of disease is perceived by their patients and how they feel about the effectiveness of treatment. PtGA and PhGA might be considered in routine clinical assessments and not only for research activities.
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Pacientes Ambulatorios , Pacientes/psicología , Médicos/psicología , Enfermedades de la Piel/patología , Adulto , Actitud del Personal de Salud , Femenino , Humanos , Masculino , Autoevaluación (Psicología) , Índice de Severidad de la Enfermedad , Factores Sexuales , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Intravascular papillary endothelial hyperplasia (Masson's hemangioma or Masson's tumor) is a benign vascular disease with an exuberant endothelial proliferation in normal blood vessels. Although relatively uncommon, its correct diagnosis is important because it can clinically be like both benign lesions and malignant neoplasms. We present a case of intravascular proliferative endothelial hyperplasia simulating a tendon cyst both clinically and on ultrasound. CASE REPORT: A 74-year old Caucasian female presented with a 4-month history of soreness and swelling in the fourth finger of the right hand. Ultrasound showed an oval mass with fluid content, referred to a tendon cyst. A wide surgical excision was subsequently performed. The final histological diagnosis was Masson's tumor. DISCUSSION: The pathogenesis of intravascular papillary endothelial hyperplasia is still unclear but the exuberant endothelial cell proliferation might be stimulated by an autocrine loop of endothelial basic fibroblast growth factor (bFGF) secretion. There are three types of papillary endothelial hyperplasia: primary, or intravascular; secondary, or mixed; and extravascular. The main differential diagnosis is against pyogenic granuloma, Kaposi sarcoma, hemangioma, and angiosarcoma. CONCLUSIONS: Masson's tumor can be like both benign lesions and malignant neoplasms clinically and on ultrasound. For this reason, the right diagnosis can be made only by histology, which reveals a papillary growth composed of hyperplastic endothelial cells supported by delicate fibrous stalks entirely confined within the vascular lumen.
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Hemangioendotelioma/cirugía , Quiste Sinovial/cirugía , Tendones/cirugía , Neoplasias Vasculares/cirugía , Anciano , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Hemangioendotelioma/patología , Humanos , Quiste Sinovial/patología , Tendones/patología , Resultado del Tratamiento , Neoplasias Vasculares/patologíaRESUMEN
The complex procedures involved in the reconstructive surgery of human skin to minimize post-operative scarring are here modeled by means of an automated computational tool. A finite strain no-compression membrane model accounting for the tendency to develop wrinkling regions in the skin is presented. The constitutive behavior of the material is then described by a suitable hyperelastic incompressible potential. Transpositions of skin flaps during surgery procedures are here computationally described by a general mapping technique of the internal boundary corresponding to surgery cut. The archetypal reconstructive surgery of a Z-plasty, where a rotational transposition of the resulting triangular flaps is involved, is considered in details, along with multiple Z-plasty and rhombic flap transposition. The results are discussed in terms of optimal deformation parameters, related to stress/strain localization, displacement discontinuities and wrinkling.
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Procedimientos de Cirugía Plástica , Cicatriz , Simulación por Computador , Humanos , Procedimientos de Cirugía Plástica/métodos , Piel , Colgajos QuirúrgicosRESUMEN
PURPOSE: To study the possible association of CT-derived quantitative epicardial adipose tissue (EAT) and glycemia at the admission, with severe outcomes in patients with COVID-19. METHODS: Two hundred and twenty-nine patients consecutively hospitalized for COVID-19 from March 1st to June 30th 2020 were studied. Non contrast chest CT scans, to confirm diagnosis of pneumonia, were performed. EAT volume (cm3) and attenuation (Hounsfield units) were measured using a CT post-processing software. The primary outcome was acute respiratory distress syndrome (ARDS) or in-hospital death. RESULTS: The primary outcome occurred in 56.8% patients. Fasting blood glucose was significantly higher in the group ARDS/death than in the group with better prognosis [114 (98-144) vs. 101 (91-118) mg/dl, p = 0.001]. EAT volume was higher in patients with vs without the primary outcome [103 (69.25; 129.75) vs. 78.95 (50.7; 100.25) cm3, p < 0.001] and it was positively correlated with glycemia, PCR, fibrinogen, P/F ratio. In the multivariable logistic regression analysis, age and EAT volume were independently associated with ARDS/death. Glycemia and EAT attenuation would appear to be factors involved in ARDS/death with a trend of statistical significance. CONCLUSIONS: Our findings suggest that both blood glucose and EAT, easily measurable and modifiable targets, could be important predisposing factors for severe Covid-19 complications.
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Glucemia , COVID-19 , Tejido Adiposo/diagnóstico por imagen , Mortalidad Hospitalaria , Hospitales , Humanos , Pericardio/diagnóstico por imagen , SARS-CoV-2RESUMEN
BACKGROUND: In dermatological research and clinical practice it is important to evaluate the burden of the disease. OBJECTIVE: To assess whether the 12-item Short Form of the Medical Outcomes Study (SF-12) could yield a valid description of the health status of a large number of dermatological outpatients. METHODS: The SF-12 and the 12-item General Health Questionnaire (GHQ-12) were utilized. Questionnaires were self-completed by the outpatients in the waiting rooms. At the end of the visit the dermatologists recorded the diagnosis and the evaluation of the clinical severity. RESULTS: Data were complete for 2499 patients. We observed a reduction in the Physical Component Summary score (PCS-12) with increasing age, while the Mental Component Summary score (MCS-12) was stable. PCS-12 and MCS-12 scores were worse in women. Twenty-three per cent of patients were identified as GHQ-12 positive. GHQ-12-positive patients ('cases') had lower PCS-12 and MCS-12 scores compared with GHQ-12-negative patients (mean ± SD, PCS-12: 47·9 ± 10·8 vs. 52·2 ± 6·6; MCS-12: 35·2 ± 10·2 vs. 50·9 ± 78·3, respectively). High correlations between the MCS-12 score and the GHQ-12 were documented overall (-0·690, P < 0·001) and for single skin diseases. CONCLUSIONS: The impact of dermatological diseases is high for the mental components of health status; the mean scores for MCS-12 were low, and lower in patients identified as GHQ-12 'cases'. The picture of the general health status of patients with skin diseases given by the SF-12 allows meaningful comparisons both within dermatological conditions and with diseases in other specialties, as well as within categories of clinical severity and psychological well-being in single skin conditions.
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Atención Ambulatoria/estadística & datos numéricos , Indicadores de Salud , Estado de Salud , Enfermedades de la Piel/epidemiología , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Calidad de Vida , Adulto JovenRESUMEN
AIM: The posterior interosseous nerve palsy is a neuropathy of radial nerve interesting its deep motor branch. The neuropathy can appear with a hollow in the proximal half of the forearm without significant swelling, a complete loss of extension of the fingers with radial deviation of the wrist during extension. In some cases, PIN compression may simulate tendon rupture in rheumatologic diseases, because the pain and the paralysis occur suddenly, so often can be difficult to make a diagnosis. The palsy is caused by compression of the posterior interosseous nerve from soft tissue tumours or tumour-like masses: ganglions, lipomas, rheumatoid synovitis, synovial chondromatosis, fibromas, neurofibromas, bursitis, synovial cysts of the elbow and radioulnar proximal joints. The aim of our research was to individuate the better treatment for the posterior interosseous nerve palsy. METHODS: From 2002 to 2007 we examined 8 patients: 2 female and 6 male. Median age was 43 years. The diagnosis was made by clinical examination, ultrasound, nerve conduction studies and magnetic resonance imaging (MRI). Patients underwent to decompressing posterior interosseous nerve surgery. RESULTS: After the surgical exploration in 8 cases a globular mass of around 2.5 cm to 4.5 cm diameter was discovered. At the histological examination, a synovial cyst of the elbow joint was found in 7 out of 8 patients and an hemangioma tumor in the one remaining patient. 12 months was the median time for a complete recovery after the operation, confirmed by EMG. CONCLUSION: The surgical treatment offers a complete resolution in all cases.
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Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugía , Neuropatía Radial/etiología , Neuropatía Radial/cirugía , Quiste Sinovial/complicaciones , Quiste Sinovial/cirugía , Adulto , Articulación del Codo/inervación , Femenino , Humanos , Masculino , Procedimientos Neuroquirúrgicos , Parálisis/etiología , Parálisis/cirugía , Resultado del TratamientoRESUMEN
A rare case of simultaneous uncommon pathologies in the same patient is described: diffuse leiomyomatosis and disseminated peritoneal leiomyomatosis (DPL). The evolution and monitoring of this rare clinical case together with diagnostic and therapeutic procedures are presented.
Asunto(s)
Leiomiomatosis/patología , Neoplasias Peritoneales/patología , Neoplasias Uterinas/patología , Adulto , Femenino , Histocitoquímica , Humanos , Histerectomía , Leiomiomatosis/cirugía , Neoplasias Peritoneales/cirugía , Neoplasias Uterinas/cirugíaRESUMEN
Scaphoid fractures detected in the subacute stage require a more meticulous and prompt approach to prevent chronicity and regain wrist function. Oblique-type scaphoid fractures are potentially unstable and may result in detrimental sequelae. Aim of this study is to suggest an easy surgical approach to restoration of the oblique-type scaphoid fractures or nonunions by using of a customized mini-plate, italic-S shaped. This surgical intervention is associated with promising outcomes and at long-term follow-up showed to avoid the development of a carpal collapse with concomitant arthritis of the radiocarpal joint.
Asunto(s)
Placas Óseas , Fracturas Óseas/cirugía , Fracturas no Consolidadas/cirugía , Hueso Escafoides/lesiones , Hueso Escafoides/cirugía , Humanos , Masculino , Diseño de Prótesis , Adulto JovenRESUMEN
INTRODUCTION: Dog bites present a complex problem. Extensive facial trauma is a challenging problem to treat with priority for functional outcome. This paper describes the conservative treatment in a very difficult case of facial trauma with unusual infections due to the bites. CASE REPORT: A 45 year-old woman was admitted in hypovolaemic shock with amputation of nose, upper and lower lips, left cheek and chin caused by dog bites. After vital parameters and volaemy were stabilized, wound toilet was performed, followed by skin and mucosal rotation flaps and anterior nasal tamponade; the lesion has then been covered with a collagen/oxidized regenerated cellulose dressing and sterile gauzes. Culture test highlighted coagulase-negative Staphylococcus and Candida albicans. However after few days, the patient developed septic-undulant hyperpyrexia, retinitis, renal candidiasis, folliculitis. Systemic Candida infection resistant to fluconazole was diagnosed. Amphotericin B was given to the patient and the facial wound was managed conservatively with an active medication because of inoperability conditions. The outcome of the use of active medications was an immediate response with excessive granulation tissue followed by a rapid re-epithelization. CONCLUSION: As our case has shown, conservative treatment can be a valid alternative therapy in the treatment of large wounds with invasive candidosis and candidaemia or other major contraindications to surgery. In fact, in cases where surgical reconstruction is not a feasible option, conservative treatment can allow a rapid repair of the skin barrier.
Asunto(s)
Antifúngicos/uso terapéutico , Vendas Hidrocoloidales , Mordeduras y Picaduras/complicaciones , Candidemia/complicaciones , Celulosa/uso terapéutico , Colágeno/uso terapéutico , Perros , Traumatismos Faciales/etiología , Fluconazol/farmacología , Anfotericina B/uso terapéutico , Animales , Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Candida albicans/efectos de los fármacos , Candidemia/tratamiento farmacológico , Terapia Combinada , Contraindicaciones , Desbridamiento , Farmacorresistencia Fúngica , Traumatismos Faciales/tratamiento farmacológico , Traumatismos Faciales/cirugía , Femenino , Tejido de Granulación/patología , Humanos , Persona de Mediana Edad , Procedimientos de Cirugía Plástica , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/tratamiento farmacológico , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Palliative tendon transfer procedures for radial nerve palsy are continuing to evolve. This paper reports outcomes of 10 patients with isolated and traumatic radial nerve palsy underwent "minimal transfer". All patients improved functionally and could attend their routine activities. The flexor carpi ulnaris and palmaris longus tendon transfer has some advantages in terms of simplicity, shorter operative time, less morbidity, better wrist and finger extension and thumb extension and abduction.
Asunto(s)
Neuropatía Radial/cirugía , Transferencia Tendinosa/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuropatía Radial/etiología , Resultado del Tratamiento , Adulto JovenRESUMEN
Brain tissue is a heterogeneous material, constituted by a soft matrix filled with cerebrospinal fluid. The interactions between, and the complexity of each of these components are responsible for the non-linear rate-dependent behaviour that characterises what is one of the most complex tissue in nature. Here, we investigate the influence of the cutting rate on the fracture properties of brain, through wire cutting experiments. We also present a computational model for the rate-dependent behaviour of fracture propagation in soft materials, which comprises the effects of fluid interaction through a poro-hyperelastic formulation. The method is developed in the framework of finite strain continuum mechanics, implemented in a commercial finite element code, and applied to the case of an edge-crack remotely loaded by a controlled displacement. Experimental and numerical results both show a toughening effect with increasing rates, which is linked to the energy dissipated by the fluid-solid interactions in the region surrounding the crack tip.