Weil osteotomy for the treatment of grade III hallux rigidus: a case series.

Hallux rigidus (HR) is one of the most common pathologies of the forefoot. The conservative treatment is indicated for early stages, while surgical treatment is required for advanced osteoarthritis and rigidity. Surgical treatment of advanced stages of HR is still controversial and includes joint-destructive procedures such as arthrodesis and arthroplasty, Weil osteotomy for decompression of the joint space may be a safe and effective procedure for the treatment of grade III HR. Twenty-four patients that underwent Weil osteotomy for Grade III HR were retrospectively reviewed. American Orthopedic Foot and Ankle Score (AOFAS), ROM and a subjective 5-point satisfaction scale were evaluated preoperatively, at 1 year, and at a minimum follow-up of 2 years. Joint space width and metatarsal length were assessed through radiographic examination preoperatively, immediately postoperatively and at 2 years follow up. AOFAS score was 45.1±3.9 preoperatively, 84.9±6.4 at 1 year and 73.7±6.2 at two years of follow up. All patients were satisfied with the procedure at 2 years follow up. Mean ROM increased from 35.1° (range, 10°- 50°) preoperatively to 80.3° (range, 60°-90°) at 1 year. Mean dorsiflexion increased from 5° (range 0° to 10°) preoperatively to 15° (range 7° to 23°) at 1 year. Both total ROM and dorsiflexion values remained constant at 2 years. The joint space was 0.5±0.9 mm preoperatively, 2.0±1.9 mm at 1 year and 1.5±1.2 mm at 2 years. The average metatarsal shortening was 2±1.4 mm. Weil osteotomy alone can be beneficial for the treatment of patients affected by advanced HR. It can improve clinical and radiological outcomes at 2 years follow up in a series of patients affected by grade III HR. Therefore, the sliding oblique osteotomy represent a valid alternative to delay more aggressive procedures.

La función de la eritropoyetina en pacientes sometidos a artroplastia articular electiva y a donación de sangre autóloga preoperatoria / Erythropoyetin in patients undergoing elective joint arthroplasty and preoperative autologous blood donation

Objetivo. El objetivo de este estudio ha sido evaluar si la suplementación con eritropoyetina (EPO) permite una apropiada donación de sangre autóloga previa a una artroplastia electiva de cadera o rodilla, incluso en pacientes con niveles límite de hematocrito (Hcto) y hemoglobina (Hb). Material y método. Desde enero de 2000 hasta diciembre de 2001 fueron incluidos en este estudio 66 pacientes que requirieron artroplastia total de cadera o rodilla, a quienes se había inscrito previamente en un programa de autotransfusión preoperatoria. Los pacientes fueron clasificados en dos grupos teniendo en cuenta sus niveles de Hb: aquéllos con un nivel de Hb < 13 g/dl (grupo 1; 37 pacientes) recibieron EPO (10.000 UI, 3 veces por semana) durante el programa de autotransfusiones, mientras que a aquéllos con un nivel de Hb > 13 g/dl (grupo 2; 29 pacientes) no se les suministró EPO ni antes ni durante el programa de autotransfusión. A los pacientes de ambos grupos se les extrajo sangre una vez por semana durante un período de entre una y tres semanas, administrándoseles además hierro por vía oral. En todos los pacientes se evaluaron los valores de Hb y Hcto antes de la primera extracción de sangre (valores basales), en el período prequirúrgico y al alta, registrándose además la cantidad de sangre recogida y transfundida para cada grupo. Durante el estudio se excluyeron 20 pacientes por no cumplir los criterios de inclusión (grupo 1, n = 12; grupo 2, n = 8). Finalmente, se analizaron estadísticamente los datos correspondientes a 46 pacientes (grupo 1, n = 25; grupo 2, n = 21). Resultados. A pesar de que los valores basales de Hb y Hcto para el grupo 2 fueron significativamente más elevados que para el grupo 1 (p < 0,001), no se observaron diferencias entre ambos grupos en cuanto a sus niveles correspondientes durante el período preoperatorio, el postoperatorio y el momento del alta hospitalaria, ni tampoco en cuanto a la cantidad de sangre recogida y transfundida. Conclusiones. La diferencia en los niveles basales de Hb y Hcto observada entre los dos grupos fue completamente corregida gracias a la administración profiláctica de EPO durante el programa de autotransfusión preoperatoria, el cual se desarrolló de forma adecuada incluso en aquellos pacientes con niveles límite de Hb y Hcto

Purpose. The aim of this study was to determine whether erythropoyetin (EPO) supplementation permits an adequate autologous blood donation prior to elective hip or knee arthroplasty in patients with boundary hematocrit and hemoglobin (Hb) levels. Materials and methods. Between January 2000 and December 2001, sixty-six patients were included in this study who required total hip or knee arthroplasty and who had also been enrolled in a preoperative transfusion program. Patients were classified into two groups, taking into account their hemoglobin levels: those with Hb < 13 g/dl (group 1, 37 patients) received EPO (10.000 IU, 3 times a week) throughout the transfusion program whereas those with Hb > 13 g/dl (group 2, 29 patients) were not given EPO before or during the self-transfusion program. Blood was extracted from patients in both groups once a week for one to three weeks; all patients received oral iron supplementation. In all patients, median hemoglobin and hematocrit values were determined before the first blood extraction (baseline values), during the preoperative period and at discharge; a record was made of the amount of blood extracted and transfused for each group. Twenty patients were excluded during the study since they did not fulfill the inclusion criteria (group 1: n = 12; group 2: n = 8). Lastly, the data corresponding to 46 patients was statistically analyzed (group 1: n = 25; group 2: n = 21). Results. Although the median baseline hemoglobin and hematocrit values for group 2 were significantly higher than those for group 1 (p < 0.001), no differences were observed between both groups regarding their median levels during the preoperative and postoperative periods or at discharge. Nor any differences were observed regarding the amount of blood extracted and transfused. Conclusions. Differences observed in the baseline hemoglobin and hematocrit levels between the two groups were fully resolved thanks to the prophylactic administration of EPO during the preoperative self-transfusion program, which was concluded appropriately even for patients with boundary hemoglobin and hematocrit levels (AU)

Hearing thresholds in patients affected by rheumatoid arthritis.

The aim of the study was to evaluate hearing thresholds in 38 patients with rheumatoid arthritis, divided according to disease activity into active (group A, n = 20) and non-active (group B, n = 18) patients. Pure tone audiometry, tympanometry and complete rheumatological assessment were performed. All patients presented poorer auditory thresholds compared with controls. Patients of group A had both air and bone conduction thresholds poorer than group B (although not statistically significant), and most patients of both groups presented an air-bone (a-b) gap. No significant difference in middle ear pressure was noticed between patients and controls. No correlation between hearing impairment and duration of the disease or patients' age was found. The high prevalence of hearing loss in autoimmune diseases supports the importance of audiometric evaluation in such patients. The auditory recovery through middle ear surgery before cranial nerve involvement could be considered in selected patients. Further investigations are needed for a better knowledge of the middle and inner ear involvement in patients with rheumatoid arthritis.

[Current trends and future perspectives in the therapy of the osteoporosis]. / Attuali orientamenti e prospettive future nella terapia dell'osteoporosi.

Osteoporosis is a pathology of considerable social impact for its high frequency in the elderly and for serious complications of the fragility fracture. Osteoporosis prevention requires high bone mass peak during growth age, adult and elder people must limit the bone loss by taking specific daily behavior and nutritional measures. The pharmacological treatment is based on drugs which are able to change bone metabolism, among which the bisphosphonates result to have a good efficacy with few collateral effects, the last generation (Alendronate and Risedronate) may be taken once a week. Promising for the next future is the Recombinante Parathormon, recently approved from the Food and Drug Administration for osteoporosis treatment. Leptin and l'Osteoprogerin are new experimental molecules under study able to act on the mechanism of central and local regulation of bone remodeling.

[Effectiveness and tolerability of celecoxib in outpatient department practice]. / Efficacia e tollerabilità del celecoxib nella pratica clinica ambulatoriale.

OBJECTIVES: Object of this work is to evaluate activity and tolerance of Celecoxib in out-patient's department practice. PATIENTS AND METHODS: In this study we enlisted 46 patients, affected by pain of inflammatory or degenerative origin; any of them ever did continued therapy with NSAIDs before. We administered 200 mg daily dose of Celecoxib for at least three months. Each patient has been evaluated by the Visual Analogic Score (VAS) Scale before and after the therapy. RESULTS: The data We obtained agree with those of multicenter studies like CLASS. Celecoxib had similar efficacy respect with traditional NSAIDs, with good control of pain in both osteoarthrosic and arthritic pain (p < 0.000). Not good results were obtained for control of acute-onset pain. In our population We didn't find side-effects different from those included in the technical-form of the drug. The only patient who complained of epigastric pain did not stop the treatment, because the symptom resolved with assumption of the drug during meals. CONCLUSIONS: By the analysis of the results We consider Celecoxib useful for the control of pain in the treatment of osteoarthrosis and autoimmune diseases like Rheumatoid Arthritis. Anyway, treatment with Celecoxib (as with all Coxib-family drugs) should be reserved for long-lasting treatments in patients at risk for gastrointestinal bleeding.

Allergy to components of total hip arthroplasty before and after surgery.

Sensitivity to a series of haptens was studied in two groups of patients by means of patch tests. The first group was made up of 66 patients with total hip replacements, 12 of whom had aseptic loosening of the implant. The second group, which was used as a control, consisted of 41 patients scheduled to undergo total hip replacement. Ten patients (15.1%) in the first group tested positive; one of these had aseptic loosening. In the control group, two patients (4.8%) tested positive. The theory that an allergy may be the cause of loosening has a biologic foundation, but it can only be used to explain a few cases. However, since considerable vanadium sensitivity was found, we suggest that this material be used as little as possible in the manufacturing of prosthetic components.