Cementless, modular, titanium stem in Vancouver B2 and B3 periprosthetic femoral fractures.

INTRODUCTION: The periprosthetic femoral fracture (PFF) is a serious complication after primary total hip arthroplasty. We conducted a retrospective study to determine whether the PRIUS® system presented similar survival to other existing implants for the treatment of Vancouver B2 or B3 PFFs. Bone consolidation rate, functional results and complications were analysed. METHOD: This is a bi-centric retrospective study between 2012 and 2017 including 39 patients with (B2/B3) PFFs treated by senior surgeons using a PRIUS® femoral implant. Implant survival, radiological outcome (fracture healing) and clinical scores (Oxford-OHS, Harris Hip Score-HHS, Postel Merle d'Aubigné-PMA, Devane and Charnley) were analysed. 10 patients had died before data collection and 5 patients were lost to follow-up. A total of 21 patients were able to undergo a clinical and radiological evaluation. The mean follow-up period was 3 years. RESULTS: The 3-year PRIUS® stem survival rate was 88.6% [95% CI, 77.2-100]. The consolidation rate was 81% (17/21). The rate of satisfied or very satisfied patients was 85.6% (18/21). Regarding the Devane score, activity level was maintained in 70.6% of cases (12/17) and decreased in 29.4% of cases (5/17), the Charnley score was stable in 94% of cases (16/17) and decreased in 6% of cases (1/17). The mean Oxford score was 28.8/48 (9.3; 16-48), the mean HHS was 67/100 (16.4; 46-91) and the mean PMA score was 12.6/18 (4.5; 2-18). CONCLUSION: The results in terms of survival rate and bone consolidation are comparable to other literature series. The PRIUS® System can be added to the surgical arsenal in the treatment of (B2/B3) PFF, subject to confirmation of these results in the longer term.

Retirada de implantes mamarios y corrección simultánea con colgajo dermoglandular inferior. Técnica de mastopexia con autoprótesis / Breast implant explantation and simultaneous correction with inferior dermoglandular flap authoprosthesis technique

Los cirujanos plásticos nos enfrentamos cada vez con más frecuencia en nuestra consulta a pacientes que desean o necesitan retirar sus implantes mamarios. Algunas de estas pacientes rechazan la idea de un reemplazo protésico, pero son exigentes con el resultado cosmético postoperatorio. Describimos la técnica empleada en 68 casos consecutivos y los resultados que hemos obtenido al tratar las secuelas en la mama tras la retirada de los implantes, fundamentalmente una disminución de volumen asociada a ptosis y excedente cutáneo. Esta técnica se basa en la extracción de los implantes y correccion mamaria simultanea con colgajo dermoglandular inferior que denominamos "autoprotesis" asociado a injerto graso simultáneo. Los resultados logran mejorar la forma, proyección y conificacion de la mama tras la retirada de los implantes, con un alto grado de satisfacción por parte de las pacientes (AU)

Plastic surgeons are frequently faced during consultation with patients who want or need breast implant explantation. Some of these patients reject the idea of a prosthetic replacement, but are demanding with the postoperative cosmetic result. We describe the technique used in 68 consecutive cases and our results to deal with breast alterations after breast implant explantation, leaving a decreased mammary volume, ptosis and a loosy cutaneous excedent. With this technique of explantation and simultaneous breast correction with de-epithelialized dermoglandular flap, "authoprosthesis", associated with simultaneous fat grafting, we can get a good result regarding the shape, projection and coning of the explanted breast, with high patient satisfaction (AU)

Adhesion of mononuclear cells from multiple sclerosis patients to cerebral vessels in cryostat sections of normal human brain.

Leukocyte extravasation across the blood-brain barrier is a critical event in the pathogenesis of multiple sclerosis (MS). This complex multistep process includes the adhesion of leukocytes to the endothelial cells of the central nervous system microvasculature. To investigate this phenomenon in MS, we developed a modified version of the frozen-section assay. Peripheral blood mononuclear cells (PBM) from 26 MS patients, 26 healthy controls and 10 patients with other inflammatory non- neurological diseases (OIND) were co-incubated with cryostat sections of normal brain white matter, immunohistochemically labelled with anti-CD45 antibody and counterstained with Giemsa stain. CD45-positive PBM adherent to transected microvasculature were counted with an automated image analyzer. MS patients showed an increased number of vessel-bound PBM (48.8 +/- 36.4) with respect to healthy controls (27.4 +/- 20.7, P = 0.01) and OIND patients (22.6 +/- 7.8, P = 0.01). Significant differences were also obtained counting the number of vessel-bound PBM as a percent of total vascular cells between MS patients (12.7 +/- 7.2%) and healthy controls (6.9 +/- 5.4%, P = 0.002) or OIND patients (7.4 +/- 4.4%, P = 0.03). We confirm that PBM from MS patients show an increased potential of binding to cerebral vessels. The frozen-section assay provides a unique tool to study in situ the molecular interactions of leukocytes with brain vascular structures.

Effects of clodronate on synovial fluid levels of some inflammatory mediators, after intra-articular administration to patients with synovitis secondary to knee osteoarthritis.

Recent studies have outlined the role of bisphosphonates, and particularly clodronate, as potential therapeutic agents for inflammatory and degenerative joint diseases. On this basis, we carried out an open, non comparative pilot trial to evaluate the effects of clodronate on synovial fluid concentration of some inflammatory mediators (prostaglandin E2, leukotriene B4 and tromboxane B2) after intra-articular, repeated administrations in 20 patients (7 males and 13 females) with synovitis secondary to knee osteoarthritis. At the end of the treatment period, statistically significant reductions (p < 0.05) of spontaneous pain and pain on active movement, evaluated by means of a 100 mm visual analogue scale (VAS), were reported. Linear regression analysis showed that the decrease of pain was correlated with the bisphosphonate induced reduction of prostaglandin E2 levels. These results, in spite of the limitation due to the open design of the trial suggest a possible role of bisphosphonates in the treatment of knee osteoarthritis.

[Proliferative activity of stage I testicular neoplasms: evaluation by image analysis of immunoreactive MIB-1]. / L'attività proliferativa delle neoplasie del testicolo in stadio I: valutazione mediante analisi di immagine dell'immunoreattività MIB-1.

The proliferative activity has been evaluated in 55 cases of seminoma and 36 cases of non-seminomatous germ cell tumors of the testis (NSGCT) in clinical stage I from patients alive and well within 5 years, by a semi-quantitative image analysis method of determination of the percent MIB-1 positive nuclear areas, using a Leica Quantimet 500+ analyzer. Significant differences of growth fraction have been detected between classical seminomas and seminomas showing more than 3 mitoses/1HPF (anaplastic seminoma)-mean of MIB-1 positivity in classic seminoma 23.8%, versus 43.9% in anaplastic seminoma; confirming this value of cut-off in distinguishing two classes of cases with different growth fractions, but without any difference as far as prognosis is concerned. The non seminoma- germ cell tumours (NSGCT) in toto display a growth fraction significantly higher than that of seminomas (mean value of MIB-1 positivity: 26.3% in seminoma versus 40.4% in NSGCT), but absolute values of positivity as high as those obtained by others by subjective evaluation have not been observed. A higher growth fraction in NSGCT is positively correlated with an embryonal carcinoma component as high as 80% of the tumor mass and/or with vascular invasion, but not with different histotypes. The proliferative activity doesn't stratify subgroups with different prognosis within the two groups of germinal tumours of the testis (seminomas and NSGCT) in our cases of clinical stage I testicular tumours.

[The workload in Pathological Anatomy measured on the basis of categories of services]. / I carichi di lavoro in Anatomia Patologica misurati sulla base del nomenclatore di prestazioni.

Workload measurement is one of the most reliable tools in perspective payment systems, to evaluate clerk and technical personnel needs in a Surgical Pathology Department. In 1992 Italian Government began a full-comprehensive modification of financial support in National Health Care System, and during the last four years Public Hospitals and Local Health Units modified their financial organization with the introduction of workload measurement for the personnel needs. We propose a synthetic method for the workload measurement in Surgical Pathology Departments, similar to that proposed for perspective payment of surgical pathology services. The method is reliable and simple representing the full performance to obtain pathological report.

A trimeric, alpha-helical, coiled coil peptide: association stoichiometry and interaction strength by analytical ultracentrifugation.

Alpha-helical coiled coils are proving to be almost ideal systems for the modelling of peptide and protein self-association processes. Stable oligomeric systems, in which the stoichiometry is well defined, can be produced by the careful selection of the appropriate amino acid sequence, although the principles behind this are still not fully understood. Here we report on a 35 residue peptide, FZ, synthesized by the solid phase method, which was originally designed to form a dimer, but which, in fact, associates to the trimeric state. A detailed characterization of the associative properties of the peptide has been performed by circular dichroism spectroscopy and, in particular, by sedimentation equilibrium in the analytical ultracentrifuge. The presence of the trimeric state, which is stable even at low peptide concentrations, has been confirmed by various independent methods of analysis for molar mass. The effects of both temperature and of guanidinium chloride on the peptide have been investigated and both found to be peptide-concentration dependent. The unfolding induced by the denaturant cannot be adequately described by a simple, two state monomer-trimer equilibrium.

[Multiple jejuno-ileal metastasis of malignant schwannoma from the leg. Report of a case presenting anemia symptoms and review of the literature]. / Metastasi multiple digiuno-ileali da schwannoma maligno dell'arto inferiore. Descrizione di un caso presentante sintomatologia da anemizzazione e revisione della letteratura.

A case of jejunal-ileal metastasis from a left leg malignant schwannoma in a 73 year old woman is described. The patient was affected by progressive anemization without signs of bleeding. A colonoscopy performed during hospitalization revealed an ulcerative lesion at the ileo-colonic junction which at histologic examination was suspected for sarcomatous proliferation arising in peripheral nerve tissue. At operation multiple ileal resections of numerous polypoid formations were performed. Histological examination of polypoid masses revealed the presence of malignant proliferation of spindle cells consistent with a malignant schwannoma. Differential diagnoses are discussed with a review of the literature.

[Correlation of the histological and cytogenetic pictures in placental tissue from early abortion. Does immunohistochemistry have a role?]. / Correlazione tra aspetti istologici e quadri citogenetici nei tessuti placentari da aborto precoce. L'immunoistochimica ha un ruolo?

Ninety-four cases of early abortion have been studied. Five histological groups of lesion have been identified by routine histological techniques on abortion materials, group I corresponding to partial hydatidiform mole. Cytogenetic analyses have revealed chromosome anomalies in near 50% of cases with a prevalence of triploidies followed by trisomies and monosomies. Normal histological findings are more often associated with normal karyotypes and group I with abnormal karyotypes but a specific correlation between histological pattern and cytogenetic anomalies is lacking. Neither some histochemical reactions nor the well preserved immunohistochemical reactivities of beta-hCG, hPL, PLAP, AFP, cytokeratin, vimentin, desmin, factor VIII, CD 68, MIB1 (growth fraction), EGF-R, p53 and c-erbB-2 oncoproteins have disclosed specific chromosome anomalies. They have only allowed a better definition of histological groups. A simple histological evaluation, although extended to immunohistochemical reaction may not substitute the cytogenetic analyses, not even for purposes of preselection.

Scarff-bloom-richardson histoprognostic grading correlates with the immunohistochemical expressions of genomic alterations in infiltrating ductal carcinomas (nos) of the breast.

The Scarff-Bloom-Richardson (SBR) multiparametric histological grading has been correlated with the immunohistochemical expression of EGF-R, c-erbB-2 and p53 oncoproteins, with the growth fraction (Ki67 antibody) and with the receptor status (ER, PgR) in 365 infiltrating ductal carcinomas of the breast (IDC-NOS). Specimens of carcinomas after surgery were sectioned and a section of each lesion was formalin-fixed and paraffin-embedded, and stained by hematoxylin-eosin in order to classify and grade cases. Another section was liquid nitrogen frozen, cryostatcut and immunostained using monoclonal antibodies against EGF-R (455 and 528 clones), c-erbB-2 (3B5 clone), p53 (Pab 1801 clone) and Ki67 antigen. An ABC-peroxidase was used after incubation with biotinylated antimouse antibody. Colour was developed using a DAB solution. ER-ICA and PgR-ICA Kits (Abbott) served to detect the hormonal receptor status. A significant direct correlation between SBR and the immuno-histochemical markers (EGF-R, c-erbB-2, p53, Ki67 growth fraction) was found. An inverse relationship of grade to ER and a weaker one to PgR was evident. An increasing histological grade was found parallel with the progressive appearance of one, two or three immunohistochemical markers in the same tumour.

Lyophilized non-denatured type-I collagen (Condress) extracted from bovine Achilles' tendon and suitable for clinical use.

On account of the biological role of collagen in wound healing, and because of its biocompatibility, the use of heterologous collagen-based devices is becoming more widespread. Here we describe the extractive procedure and properties of a lyophilized type-I collagen (Condress) suitable for clinical use. Condress is extracted from bovine Achilles' tendon through a non-denaturing procedure in the absence of proteolytic enzymes. It has not been submitted to a chemical cross-linking process before lyophilization. Chemical identification of Condress as type-I acid-insoluble collagen has been carried out by evaluation of total nitrogen and hydroxyproline contents and by chromatographic examination. Electrophoretic analysis and morphological examination by electron microscopy confirm that the procedure employed to extract collagen does not alter the polypeptidic composition of the molecule and its structure. A gamma-ray dose between 0.5 and 1.5 Mrad is quite adequate to sterilize the final product and certainly devoid of degradative effect. The finished product has a special (peculiar) absorbing capacity, immersion time, strain resistance, wrinkling temperature and enzymatic digestion time. It is a nonallergenic product suitable for clinical use. When it has been applied in chronic leg ulcers, pressure sores, or reconstructive surgery, Condress seems to substantially improve wound repair.

The Italian National Research Council and hospital infections.

In 1983 the Italian National Research Council funded a project specifically focused on Hospital infection control. The main objectives were to describe the epidemiological pattern of hospital-acquired infections; to evaluate different control measures and preventive strategies. The general frame and research issues of the project are discussed in this paper. The main research areas of the project were: urinary tract infections; infections in surgery; intensive care units/high risk patients; microbiological aspects; e) education programs.

Integrated epidemiological system for acute viral hepatitis in Italy (SEIEVA): description and preliminary results.

An integrated epidemiological system for the surveillance of acute viral hepatitis SEIEVA which linked notifications to available serology results and used a standard risk factor questionnaire is described. Results of over 1300 cases reported by 35 participating local health units (USL's) during the first 18 months of the programme are presented. Overall the annual reported incidence of acute viral hepatitis was 70 per 100,000. There were marked regional and age specific differences in the incidence of each type of viral hepatitis. The annual incidence per 100,000 of hepatitis A in southern children was 133 while in northern young adults the incidence of hepatitis B was 88 and hepatitis non-A non-B was 43. The possible roles of shellfish consumption in the transmission of non-A non-B hepatitis at all ages were highlighted.

National prevalence survey of hospital-acquired infections in Italy, 1983.

In 1983 a national prevalence survey was conducted in Italy to discover the general distribution of infection among patients in public hospitals. Thirty-four thousand, five hundred and seventy-seven acute patients were surveyed in 130 hospitals spread throughout the country: 6668 patients (19.3%) had an active infection at the time of the survey; the infection was hospital-acquired in 2361 (6.8%) and community-acquired in 4307 (12.5%). The urinary tract was the site most frequently involved in hospital infection (30.2% of patients with hospital-acquired infection). The respiratory tract was the site most often involved in community infections (35.7% for the lower tract and 9.1% for the upper). Hospital-acquired infections were more frequent in intensive care units (12.4%) and in geriatric (11.6%), orthopaedic (8.2%) and surgical wards (7.6%). The prevalence of urinary tract infection was 10.4% among the 9.4% of patients who were catheterized compared with a prevalence of 2.6% in the uncatheterized. Thirty-five point five per cent of patients were receiving an antimicrobial on the day of the survey.

Transmission of non O group 1 Vibrio cholerae by raw oyster consumption.

After having eaten dinner many customers of a restaurant in Dolo (Venice) developed gastroenteritis with diarrhoea and vomiting. Strains of non O group 1 Vibrio cholerae were isolated from rectal swabs of four customers. Epidemiological investigations revealed an association between the illness and raw oyster consumption (p = 0.008). Also, an association was found between age and illness among males (p = 0.034). As a consequence of this outbreak, a gastroenteritis surveillance programme was run for three months by health authorities in the Regione Veneto. The results indicate that, although non 0-1 V. cholerae does not account for severe pathology, it causes mild gastroenteritis and asymptomatic infections in developed countries.

Febrile illness in successive cohorts of tourists at a hotel on the Italian Adriatic coast: evidence for a persistent focus of Legionella infection.

Outbreaks of febrile illness consistent with legionellosis occurred in successive groups of vacationers at an Adriatic resort in 1980. Illness was associated with one of two hotels used by the groups. A cohort study of guests of the suspect hotel revealed 23 cases of febrile illness with pulmonary symptoms, significant antibody titers to Legionella pneumophila, or both, among 291 persons at risk. Two patients died. Attack rates ranged from 0-19% in the nine cohorts of vacationers and were highest among the most elderly. Febrile illness in the last two cohorts of the season was associated with an antibody titer greater than or equal to 128. L. pneumophila was isolated from shower heads in the suspect hotel, but no association was found between showering and illness or seropositivity. Bacteria identified as L. pneumophila by direct immunofluorescence were also found in water from an adjacent hotel and from the outflow from a common well. No cases were associated with the adjacent hotel.