A new and simple scoring system to predict overall survival after irradiation for metastatic spinal cord compression.

PURPOSE: To develop a model that predicts survival in patients irradiated for metastatic spinal cord compression (MSCC), hence assisting in the decision between a short and a long-course radiotherapy (RT) regimen. METHODS: 138 patients diagnosed with MSCC and treated with RT alone were included. Based on a multivariate analysis, a scoring system was developed. It included four prognostic variables: age, number of vertebrae, ECOG and histology. Total scores ranged between 14 and 24 points and patients were divided into two groups. RESULTS: The 6-month survival rate was 22% for patients with a score of 14-18 points; and 69% for patients with a score of 19-24 points (P < 0.001). The system exhibits a high specificity and positive predictive value and an appropriate discriminative ability. CONCLUSIONS: Patients with scores between 19 and 24 points were found to survive longer, thus a long-course RT appears to be more appropriate.

Return to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer.

PURPOSE: Medial displacement calcaneal osteotomy with flexor digitorum longus transfer is a common treatment for the management of the adult flatfoot associated with posterior tibial tendon dysfunction. In the literature, there is a paucity of information regarding the ability of patients to return to sport and recreational activities after this surgical procedure. The purpose of this retrospective clinical study was to assess the rate and type of athletic activities that patients participated in before and after medial displacement calcaneal osteotomy with flexor digitorum longus transfer. METHODS: A consecutive series of 42 patients with a mean age at surgery of 41 years (range 19-74 years) was evaluated with a minimum follow-up of 24 months (range 18-31 months). Pre- and post-operative sporting activities were assessed. At final follow-up, patients were asked to complete a Sports Athlete Foot and Ankle Score (SAFAS). Each patient was also evaluated with weight-bearing radiographs of the foot before surgery and at final follow-up. RESULTS: Preoperatively, 27 of 42 (64.3 %) patients were engaged in athletic activities, participating in an average of 1.4 h/week (range 0-6 h/week); post-operatively, 36/42 (85.7 %) participated in sport and recreational activities for an average of 3.5 h/week (range 0-15 h/week). Meary's angle improved significantly from 11.5 ± 6.2 degrees preoperatively to 7.0 ± 5.7 degrees at final follow-up (p < 0.01); calcaneal pitch improved significantly from 16.5 ± 4.6 degrees to 19.0 ± 5.0 degrees (p < 0.01). At final follow-up, patients demonstrated good SAFASs in symptom tolerance (86.4 %), pain tolerance (89.0 %), daily living performance (96.1 %), and sports performance (86.7 %). CONCLUSION: The majority of patients returned to sports and recreational activity after medial displacement calcaneal osteotomy and flexor digitorum longus for the treatment of adult flatfoot associated with posterior tibial tendon dysfunction. LEVEL OF EVIDENCE: III.

A prospective study for the treatment of proximal humeral fractures with the Galaxy Fixation System.

BACKGROUND: Fractures of the proximal humerus represent a common problem in clinical practice; in particular for three- or four-part fractures, there is no consensus regarding which is the best treatment. The aim of our study was to report clinical and radiological outcomes in patients treated with the Galaxy Fixation System™ for a proximal humerus fracture. MATERIALS AND METHODS: Thirty-two patients of which 18 (56.25%) women, and 14 (43.75%) men suffering from proximal humerus fractures were treated using the Galaxy Fixation System™. Fractures were classified according to Neer and only patients with a three- or four-part fracture with two-thirds of the methaphysis intact were included. Clinical examination included the Constant-Murley score, UCLA score and Quick DASH evaluated at 6, 12 and 24 months after surgery. In addition, at the final follow-up, patients were asked to complete the SF-12 questionnaire. The humeral head-shaft angle was evaluated by radiographs the day after surgery, as well as after 12 and 24 months. RESULTS: All 32 patients were available for the 6th, 12th and 24th month follow-up examination. The mean interval between trauma and surgery was 2.7 days (range 0-6 days). The period of hospital stay ranged from 2 to 8 days with an average of three days. The time of healing ranged from 4 to 10 weeks with an average of 7 weeks. The mean Constant score increased from 72.9 after 6 months to a mean of 82.8 at 12 months (p < 0.05) to 88.9 at 24 months (p < 0.05). UCLA score ranged from 27.5 at 6 months to 29.5 at 12 months (p < 0.05) and finally improved to 32.3 at final follow-up (p < 0.05). Quick DASH varied from 7.2 at 6 months after surgery to 5.2 at 12 months after surgery (p > 0.05) and reached the value of 3.1 after 24 months (p > 0.05). Mean Mental Component (MCS) resulted in a value of 48.1, while the Physical Component (PCS) was 52.7. The mean head-shaft angulation was 137.6° the day after surgery compared with 137.5° (p > 0.05) measured 12 months later, and 137.2° measured 24 months later (p > 0.05). CONCLUSIONS: Galaxy Fixation System™ is a safe and efficient procedure for the treatment of three- or four-part proximal humerus fractures, providing an excellent outcome. LEVEL OF EVIDENCE: Prospective case series, Level IV.

Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial.

BACKGROUND: Results on the effectiveness of PRP supplementation in arthroscopic rotator cuff repair are conflicting, making it difficult to draw definitive conclusions. METHODS: This was a prospective, randomized, and double-blind study with two groups of 20 patients each (PRP group and control group). Degenerative supraspinatus full-thickness tears grade C2-C3 were subjected to arthroscopic repair; PRP supplementation was given to patients in the PRP group. The outcomes were assessed by DASH, Constant scales, and ultrasound before and 6 months after surgery. Pain measured by VAS was evaluated preoperatively and 7 and 30 days after surgery. RESULTS: The two groups did not differ significantly by age, sex, and dominance of the affected side. In all surgical procedures, a long head of the biceps tenotomy and single-row repair were performed. The preoperative VAS was 5.6 ± 2.4 in PRP group and 6.4 ± 1.5 in the control group (p > 0.05). The group supplemented with PRP reported a VAS significantly better in the first week (2.5 ± 1.9 vs 5.3 ± 2.1, p < 0.05) and during the first month after surgery (1.5 ± 1.0 vs 3.2 ± 1.7, p < 0.05) compared to the control group. The preoperative Constant and DASH scores were 39.95 ± 12 and 51 ± 15.2, respectively, in the PRP group and 41 ± 11 (p > 0.05) and 45 ± 12.6 (p > 0.05) in the control group. The average Constant score improved significantly after 6 months to 81 ± 11.2 (p < 0.05) in the PRP group and 78.5 ± 9 (p < 0.05) in the control group. No differences were noted between the two groups (p > 0.05). The DASH score after 6 months was 17.4 ± 8 (p < 0.05) for the treatment group (the PRP group) and 21 ± 8.4 (p < 0.05) for the control group. No statistically significant differences were found as regards the DASH score in the two groups after 6 months (p > 0.05). The two groups showed no differences in the ultrasound evaluation after 6 months either. No re-ruptures occurred in either group. CONCLUSIONS: PRP leads to a reduction in pain during a short-term follow-up. Pain reduction allows for a more rapid recovery of mobilization and improvement in functionality. LEVEL OF EVIDENCE: Randomized controlled trial, Level of evidence, 1.

Post-Renal Transplantation Bone Health in Children Evaluated by Means of Quantitative Ultrasound and Densitometry.

BACKGROUND: Patients with end-stage renal disease develop bone mineral disease, which is not always resolved after a successful renal transplantation; moreover, some of the immunosuppressants used to prevent graft rejection may affect bone health. The aim of this study was to evaluate bone health in post-renal transplantation children with the use of quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA). METHODS: A descriptive study was performed in children >3 months after renal transplantation and with stable function of graft. Radial QUS and DXA (lumbar spine and total body less head (TBLH) were performed on the same day. RESULTS: A total of 35 patients were included. Mean age was 13.9 ± 3.9 years. Ten subjects had total bone density score <2 (28.5%), 4 a lumbar spine (L1-L4) Z-score of <2 (11.4%) as well as TBLH <2, and 6 subjects had a radial QUS Z-score of <2 (17.1%), and only 2 of them had concomitant Z-score <2 with the use of DXA. There was a positive non-significant correlation between TBLH and radial QUS Z-scores (Pearson r = 0.317; P = .016) and a positive significant correlation of DXA lumbar spine and radial QUS Z-scores (Pearson r = 0.452; P = .014). CONCLUSIONS: Despite a good correlation between TBLH and QUS Z-scores, there are subjects that can be considered normal by QUS and have osteopenia by TBLH DXA and vice versa; this could be due to the different bone areas evaluated.

Optimal glenoid component inclination in reverse shoulder arthroplasty. How to improve implant stability.

PURPOSE: The purpose of this study is to demonstrate that inferior inclination of the glenosphere is a protecting factor from joint dislocation in reverse total shoulder replacement. The hypothesis is that an average of 10° of inferior inclination of the glenoid component would determine a significant inferior rate of dislocation as compared to neutral inclination. METHODS: A retrospective case (dislocation)-control (stability of the implant) study was performed. Inclusion criteria were the homogeneity of the prosthetic model and availability of pre- and postoperative imaging of the shoulder, including antero-posterior and axillary X-ray views. Glenoid and glenosphere inclination were calculated according to standardized methods. Difference in between the angles determined the inferior tilt. RESULTS: Thirty-three cases fit the inclusion criteria. Glenoid and glenosphere inclination measured, respectively, 74.1° and 83.5°. The average tilt of the glenosphere measured 9.4°. The average tilt in stable patients was 10.2°. Tilt in patients with atraumatic dislocation measured, respectively, -6.9° (superior tilt) and 2.4°, while it was 8.3° for the patient with traumatic instability. The association between the tilt of glenosphere and atraumatic dislocation was significant. CONCLUSIONS: A 10° inferior tilt of the glenoid component in reverse shoulder arthroplasty is associated with a reduced risk of dislocation when compared to neutral tilt.

Treatment of a large postsurgical para-anastomotic aortic aneurysm using endovascular stent grafts. A case report with four-year follow-up.

This case report describes the outcome of straight endograft placement for treating a large para-anastomotic aortic aneurysm (PAA). A 43-year-old woman was admitted to the emergency department because of a vast PAA (8.7 cm in maximum transverse diameter). Since 1983, she has undergone multiple vascular operations for arterial occlusive disease. In 1990, an aortobifemoral bypass operation was performed. In this most recent intervention, we implanted three tube Excluder® endografts. The procedure was uneventful. Considering the size of the aneurysm sac, particular attention was paid to possible sequelae during the over 4-year follow-up period. No complications developed and the last computed tomography (CT) scan showed a remarkable decrease of 50 mm in aneurysm size. In conclusion, the use of straight endografts seems to be effective and lasting, even in large para-anastomotic aneurysmatic lesions.

[The best of clinical cardiovascular pharmacology in 2005]. / L'essentiel de 2005 en pharmacologie clinique cardiovasculaire.

Although the year 2005 has reinforced the therapeutic advances of 2004, with confirmation of certain concepts, the 'coxib affair' has continued to provoke arguments between pharmaceutical companies, licensing agencies as well as patients, some of whom have amalgamated into consumer groups to reject en masse placing any responsibility on the prescribers in favour of an attack on the drug licensing process itself. Among the cardiovascular drugs that will soon be licensed, only ivabradine in stable angina, and remodulin in primary pulmonary arterial hypertension are new. The therapeutic advances in 2005 regarding platelet aggregation and blood coagulation have been significant, in the human, scientific and commercial context, while hypertension has not been ignored. Another new development is the ever more precise notion of the metabolic syndrome, a target of choice for the pharmaceutical industry. The potential range of applications has been widened to include obesity, hypertension, diabetes, HDL cholesterol... The licensing authorities find themselves facing a hurdle to overcome, with novel combinations of drugs (ACE inhibitors, calcium blockers/statins, statins/aspirin, ARA2/calcium blockers...).

Effect of air cavities on the dose delivered to the lung during high-dose brachytherapy.

In the treatment of lung cancer using the radiotherapy technique of intracavitary brachytherapy with an 192Ir source, the lung is normally assumed to be entirely composed of a homogeneous mass of soft tissue. The aim of this study is to investigate whether there is the possibility that the air cavities in the lung influence the dose delivered to the lung at a prescribed distance from the source. The Monte Carlo code MCNP-4A was used to model the dose delivered by both 192Ir and 198Au as a function of treatment medium, density and composition, photon energy, and distance from the source. The suitability of MCNP-4A for this study was tested by producing depth-dose profiles for photons in water and comparing these to calculated profiles produced using well-documented methods.

[Obturator hernia]. / L'ernia otturatoria.

Obturator hernia, which is a rare cause of intestinal occlusion, generally presents non-specific signs and symptoms. Radiology may be sometimes useful for the diagnosis. Four cases of obturator hernia are described, and the possible surgical access routes are illustrated, emphasizing the use of prosthetic mesh.