Clinical results in patients affected by moderate-severe knee osteoarthritis and treated with micro-fragmented adipose tissue: the therapeutic effects on symptomatology.

Osteoarthrosis is a degenerative musculoskeletal disease that presents a major public health problem, due to the increasing average age of the active population, as well as the increasing percentage of obesity or overweight of the general population. New therapeutic approaches have been developed, such as regenerative medicine that uses mesenchymal stromal cells taken from adipose tissue. This study analyzed the clinical potential benefits of using autologous adipose tissue to treat patients with moderate-severe knee osteoarthritis.In 2021, a total of 50 knees, affected by moderate-severe knee osteoarthritis, were treated with an intra-articular injection of micro-fragmented subcutaneous adipose tissue. Patients were submitted to the KOOS questionnaire before the operation and one year after the operation and VAS pain score at time 0, 3, 6, 12 months.Of the 50 patients treated, 2 patients were excluded from the study. Of the remaining 48 patients, improvements have been achieved in all subclasses of KOOS. In particular, VAS score proves that improvements are more considerable starting from the 3rd month after surgery.The results obtained in this study show the safety and potential benefit of the use of autologous micro-fragmented adipose on people who are affected by moderate-severe knee osteoarthritis.

Assessment of Electron Propagator Methods for the Simulation of Vibrationally Resolved Valence and Core Photoionization Spectra.

The analysis of photoelectron spectra is usually facilitated by quantum mechanical simulations. Because of the recent improvement of experimental techniques, the resolution of experimental spectra is rapidly increasing, and the inclusion of vibrational effects is usually mandatory to obtain a reliable reproduction of the spectra. With the aim of defining a robust computational protocol, a general time-independent formulation to compute different kinds of vibrationally resolved electronic spectra has been generalized to also support photoelectron spectroscopy. The electronic structure data underlying the simulation are computed using different electron propagator approaches. In addition to the more standard approaches, a new and robust implementation of the second-order self-energy approximation of the electron propagator based on a transition operator reference (TOEP2) is presented. To validate our implementation, a series of molecules has been used as test cases. The result of the simulations shows that, for ultraviolet photoionization spectra, the more accurate nondiagonal approaches are needed to obtain a reliable reproduction of vertical ionization energies but that diagonal approaches are sufficient for energy gradients and pole strengths. For X-ray photoelectron spectroscopy, the TOEP2 approach, besides being more efficient, is also the most accurate in the reproduction of both vertical ionization energies and vibrationally resolved bandshapes.

[The Hickman catheter as vascular access in bone marrow transplantation]. / Il catetere di Hickman come accesso vascolare nel trapianto di midollo osseo.

From 1984 to 1995, 522 Hickman catheters were placed in the Institute of Clinica Chirurgica B of the University of Genova to treat malignant haemathologic diseases. Aims and reasons of this choice, surgical technique, advantages and related problems are reported here.

Helical CT for the study of abdominal aortic aneurysms in patients undergoing conventional surgical repair.

OBJECTIVES: To evaluate the reliability of helical computed tomography (CT) as sole preoperative diagnostic technique for abdominal aortic aneurysms (AAA) and to compare these results with the surgical findings. MATERIALS: Thirty-three patients undergoing elective surgical repair. METHODS: Helical CT, Doppler exam of lower limbs, digital angiography, in case of peripheral vascular disease, and intraoperative evaluation. RESULTS: Helical CT correctly detected, in all cases, the proximal and distal extent of the AAA. The coeliac axis and its branches, the superior mesenteric artery and renal vessels as well as the inferior vena cava were always clearly depicted, showing anatomical variants or pathological involvement in 14 patients (42.4%). CONCLUSIONS: Helical CT can be used as the sole method for preoperative imaging of AAA. It allows a complete and precise evaluation of size, extent and relationship of the AAA, the surrounding vessels and other abdominal structures.

Screening study of abdominal aortic aneurysm in a general population: lipid parameters.

The level of blood lipids and apolipoproteins in subjects being screened for abdominal aortic aneurysms have been investigated. As part of an ultrasound screening programme in a population of 65- to 75-year-olds, blood samples were collected from 1460 of 1504 subjects with a normal aorta (97.1%) and 69 of 70 patients with an abdominal aortic aneurysm > 29 mm (99%). Samples were also taken from 22 of 27 patients (81%) with an ectatic aorta (26-29 mm). Total cholesterol, HDL-cholesterol, LDL-cholesterol, Apo-AI and Apo-B levels were significantly higher in women than in men (P < 0.01). Levels of HDL-cholesterol and Apo-AI were significantly lower in patients with an abdominal aortic aneurysm than in normal subjects (P < 0.001). The mean(s.d.) body mass index was 25.1(3.9) in women and 25.5(3.2) in men with aneurysms and not significantly greater than that of normal subjects (25.2(3.61) and 25.2(3.38) respectively).

[Preoperative imaging of aneurysms of the abdominal aorta. Role of CT scan]. / Imaging preoperatorio degli aneurismi dell'aorta addominale. Ruolo della TC spiroidea.

The reliability of helical CT as sole preoperative diagnostic technique for abdominal aortic aneurysms (AAA) and its accuracy in detecting vascular anomalies in the abdominal region was evaluated retrospectively in 42 patients with asymptomatic AAA > 40 mm. A single breath-holding helical scan was performed with 5 mm slice thickness, during a single injection of contrast medium, resulting in a 20 cm z-axis coverage. Axial images were reconstructed and used to generate high quality multiplanar reformatted images. Digital subtraction angiography (DSA) was performed in the first 18 patients and then in case of associated peripheral vascular disease (6 patients). Helical CT exactly showed, in all cases, the proximal and distal extent of the AAA. The visceral vessels as well as the inferior vena cava and renal veins were always clearly depicted, showing anatomical variants or pathological involvement in 19 patients. DSA gave sufficient details on the distal run-off but did not allow a reliable visualization of the visceral branches, venous anomalies and true extent of AAA. In our experience helical CT should be considered as the sole method for preoperative imaging of AAA. It allows a complete and precise evaluation; it is fast, with low doses of radiations and does not require hospitalization.

Screening for abdominal aortic aneurysms and associated risk factors in a general population.

OBJECTIVES: To evaluate the prevalence of abdominal aortic aneurysms (AAA) in a general population and to compare the results with those of similar studies in other countries. DESIGN: Ultrasound screening study and collection of clinical and biochemical data. SETTING: An urban Health Service District in Genoa, Italy. MATERIALS: A general population, aged 65-75 years, invited by personal letter between 1991-1994. RESULTS: 1601 subjects (741 males and 860 females) out of 2734 invited (58.5%) were evaluated. According to the ultrasound findings, 27 patients (1.7%) had an aortic dilatation of 26-29 mm; an AAA of 30-39 mm was found in 37 (2.3%) and an AAA > or = 40 mm in 33 (2.1%). The overall prevalence for AAA was 4.4% (8.8% in males and 0.6% in females respectively). The prevalence of smoking, alcohol consumption, coronary heart disease, chronic obstructive pulmonary disease and arterial disease were significantly higher in patients with AAA (p < 0.01). CONCLUSIONS: Ultrasound screening for AAA is a reliable and useful method and should be focused on men, regardless of concurrent disease.

[Prevention of vascular intimal hyperplasia in small caliber prostheses. Preliminary results]. / Controllo dell'iperplasia intimale in protesi di piccolo calibro. Risultati preliminari.

Intimal hyperplasia is one of the main risk factors for the patency of small diameter bypass grafts. The standard unfractioned heparin (UH) is able to control this phenomenon but the clinical use is not fit for long term treatment; on the other hand the antiplatelet drugs have an anti-thrombotic effect but they seem to be unable to control intimal hyperplasia. Low molecular weight heparins (LMWH) have an anti-thrombotic effect superimposable to that of UH with minimal side-effects and might inhibit intimal hyperplasia too. Based on these criteria, we carried out an experimental study on sheep with the aim of evaluating the efficacy of postoperative treatment with LMWH versus an anti-platelet drug in controlling intimal hyperplasia and growth of true endothelial cells in small prosthetic ePTFE grafts (4 mm) interposed in the carotid artery. At the operation, 30 sheep were randomly located in 3 groups: A = control group, no treatment; B = Ticlopidine hydrochloride 250 mg/bid by mouth for 4 weeks; C = LMWH 3.075 IU AXa (0.3 ml) sc preoperatively and then once a day for the same period. Complete thrombosis of the graft occurred in 7 sheep of group A, 5 in B and 2 partial in group C. The intimal hyperplasia was moderate-severe in group A, mild-moderate in group B and no-mild in group C. True endothelial cells were found mainly in the LMWH group; in the other groups and in other portions of the grafts the cellular coverage was accomplished almost completely by fibroblasts. The study is still in progress with 6 further sheep treated with LMWH.

Gemfibrozil and Mediterranean diet for patients with high plasma levels of lipoprotein [Lp(a)] and cholesterol--pilot study.

Plasma levels of lipoprotein-a [Lp(a)] > 30 mg/dl represent an independent risk factor for cardiovascular diseases with both proatherosclerotic and prothrombotic activity. The results of dietary or pharmacological treatment are not encouraging and are often controversial. We have evaluated a combination of medical treatment with Gemfibrozil (600 mg bid) and a Mediterranean diet for 2 months in 15 patients with both hypercholesterolemia (> 240 mg/dl) and high levels of Lp(a) (> 30 mg/dl). Three patients dropped out within the first 2 weeks, complaining of epigastric pain and burning; the remainder (5 females and 7 males, mean age 70 years) completed the treatment without any side effects. The median values of Lp(a) decreased from 36.5 to 8.4 mg/dl (p < 0.0002) and total cholesterol from 254.5 to 208.0 mg/dl (p < 0.0001). The small number of patients does not permit any definitive conclusion on effectiveness to be drawn, but the results indicate further randomized studies might prove worthwhile.

[Screening for abdominal aortic aneurysms in the general population. Preliminary results]. / Screening per gli aneurismi dell'aorta addominale nella popolazione generale. Risultati preliminari.

Between March 1991 and April 1993, 1188 subjects aged 65-75 years, out of 2734 invited, underwent abdominal ultrasound for screening of asymptomatic abdominal aortic aneurysms (AAA). For each patient the maximal anteroposterior and transverse diameters of the suprarenal and infrarenal aorta were measured. According to the literature data an AAA is defined as an aortic dilatation > 29 mm. AAA < 40 mm are followed by ultrasound every 6 months and the AAA > 39 mm are considered for surgical repair after complete clinical work-up. In addition any aortic dilatation ranging 26-29 mm is followed too, using the same criteria. The aorta was normal in 1112 patients (95.12%), an infrarenal aortic dilatation was found in 21 patients (1.79%), an AAA < 40 mm in 15 patients (1.28%) and an AAA > 39 mm in 21 patients (1.79%). The global prevalence of AAA > 29 mm was 3.07% (0.3% for the females and 6.8% for the males), similar to that reported by other authors. The statistically significant (p < 0.01) risk factors were: smoking, alcohol consumption, coronary disease and chronic lung obstruction. Hypertension and dyslipidaemia were not significant (but HDL-cholesterol and Apo-B), according to a different etiology of the aneurysms. In addition 38.5% of the patients had total cholesterol > 240 mg/dl but only 34.9% of these was under medical treatment and/or on a diet. Our preliminary data confirm the results of similar studies in other countries: screening for AAA is worthwhile on the general population and, looking to a better cost-benefit rate, it might be focused only on males.

[Smoking as a risk factor in arteriopathies]. / Il fumo come fattore di rischio nelle arteriopatie.

Tobacco use represents the most powerful chemical addiction, which has been defined as "the inability to discontinue smoking" and it is one of the main cardiovascular risk factors. It produces alterations in platelet activity, blood viscosity and vascular wall and clinical signs related to the different vascular districts. The probability of carotid lesions increases up to 32% for 10 years/smoking and the progression of the disease is proportional to tobacco consumption; on the contrary smoking cessation may be helpful. Furthermore the risk of PAOD increases 2 to 9-fold, irrespective the number of cigarettes and these modify significantly the long-term patency of the femoro-distal reconstructions (57% vs 78% at 2 years). Very impressive indeed the data concerning major amputations (21% vs 2%) and the mortality rate for cardiovascular diseases (83% vs 33%) between smokers and non-smokers. For the abdominal aortic aneurysm too smoking represents the main independent risk factor and the mortality rate rises 6 to 25-fold compared to the normal population. The conclusions are obvious and can be shortly summarized in the following sentence: "Stop smoking and keep walking".