Outcomes and risk factors for spontaneous spondylodiscitis: Case series and meta-analysis of the literature.

Despite recent improvements in surgical and antimicrobial therapies, few generally applicable guidelines exist for spondylodiscitis management. We reviewed a consecutive series of patients as well as the past 18 years of the literature and analyzed outcomes for either conservative or surgical treatment. We analyzed a consecutive series of adults with spontaneous spondylodiscitis treated at our institution over the last 6 years. We analyzed predictors for neurological deficits, vertebral collapse, and surgical treatment. We also performed a meta-analysis of the literature between 2000 and 2018, stratifying the results between surgical and conservative treatment outcomes. A younger age at diagnosis, cervical location, tubercular infection, coexistence of morbidities, and vertebral collapse were predictors of surgical intervention. Cervical spondylodiscitis, vertebral collapse, and epidural collection were associated with a higher risk of developing neurological deficits, while tubercular spondylodiscitis was associated with a higher risk of vertebral collapse. Based on the current literature, conservative treatment has success rates similar to those of surgical treatment but lower complication and mortality rates. In cases without an absolute indication for surgery, a conservative approach should be considered as the first-line treatment. A closer diagnostic and clinical follow-up should be recommended in patients with cervical tract or tubercular spondylodiscitis because of the higher risk of developing bone collapse and neurological deficits.

Surgical treatment of abdominal aortic aneurysm in association with horseshoe kidney. Three case reports and a review of technique.

Horseshoe kidney is a rare congenital anomaly that can create various technical problems during surgery for repair of abdominal aortic aneurysm. The diagnosis of this anomaly should be confirmed preoperatively in order to plan surgical strategy. Nowadays, in more than 90% of all cases, ultrasonography, contrast computerized tomography, urography, and angiography are the best instrumental methods of detecting this anomaly in association with abdominal aortic aneurysm. The transperitoneal approach assures the best exposure of the kidney, the ureters, the aneurysm, and both iliac vessels, but the renal isthmus can pose a problem in reimplanting aberrant renal arteries. When it is known preoperatively that renal revascularization should be performed, the left extraperitoneal approach is a better choice. In any event, the coexistence of horseshoe kidney and abdominal aortic aneurysm does not preclude the treatment of the latter. In elective surgery of abdominal aortic aneurysm, the morbidity and mortality rates in the presence of horseshoe kidney are much the same as those in the presence of normal kidneys. The best results in this kind of surgery are obtained by adapting one's surgical technique to each anatomical variant that is encountered.

The mechanical properties of simulated collagen fibrils.

Previous theoretical studies of the mechanical properties of tissues such as skin, bone and tendon, have used approaches based on composite materials and have tended to neglect the contribution of individual microscopic components. In this paper, we examine the relationship between the fine structure of a collagen fibril and its relative tensile strength. Collagen is a fibrous protein which provides associated tissues with the majority of their tensile strength. It is present in the form of elongated structures termed fibrils which are created by the self-assembly of rod-like collagen molecules in an entropy-driven process termed fibrillogenesis. Mutations that alter the primary structure of the collagen molecule, interfere with this assembly process and can lead to the potentially fatal brittle bone disease, osteogenesis imperfecta. Here we investigate the mechanical properties of a range of computer-generated aggregates. The aggregates, created by the diffusion limited aggregation of rods, were subjected to a simple tensile test based on local rules of damage accumulation. In the test, core samples are "extracted' from the aggregates, and the network of particles involved in the transmission of stress resolved. Increasing stress applied to the core leads to the removal of individual rods from this network; the tensile strength is determined from the force necessary to form a discontinuous network. Using this approach, we have shown that collagen fibril morphology is critical in determining its tensile strength. We suggest a possible mechanism to account for the increasing severity of osteogenesis imperfecta associated with the distance of mutation from the N-terminal of the collagen molecule.

The CSF myelin basic protein: a reliable marker of actual cerebral damage in hydrocephalus.

Raised ventricular CSF myelin basic protein (MBP) concentration has been evidenced in 17 shunted hydrocephalic patients. Contemporary evaluation both from ventricular and lumbar CSF samples showed a concentration ratio of 20:1. In all cases the raised values of ventricular CSF concentration of MBP demonstrated a significant decrease after shunt operation. This preliminary report suggests that this marker is an important index of actual brain damage in hydrocephalus and could be taken in account for the indication of shunt operation.

Immunoprophylaxis in "septic risk" patients undergoing surgery for gastrointestinal cancer. Results of a randomized, multicenter clinical trial.

The results of a randomized, multicenter clinical trial of immunoprophylaxis of post-operative infections with intravenous Immunoglobulins (IVIG) (Sandoglobulin) in "septic-risk" patients undergoing surgery for gastrointestinal cancer are presented. "Septic-risk" patients were selected by an original multiparametric test based on delayed hypersensitivity skin testing and serum protein electrophoretic sub-fractions. This screening test had shown 76% positive predictivity in a previous validation assessment. In the present study, 159 "septic-risk" patients were selected prospectively from 369 patients undergoing colo-rectal (colon) and other kinds of gastrointestinal (non-colon) oncologic surgery: 80 "septic-risk" patients were included in the colon and 79 in the non-colon group. Immunoprophylaxis with IVIG (15 g on the day prior to operation, on the 1st and 5th postoperative days) was randomly associated with antibiotic prophylaxis (cefoxitin: 2 g one hour prior to, followed by 2 g at the end of operation plus 2 g every six hours for 24 hours) in colon surgery while the prophylactic schedule in non-colon surgery was only based on random administration of IVIG, at the same dosage as in the colon group. There was a clear-cut reduction of post-operative infections both in colon and non-colon "septic-risk" patients who had IVIG prophylaxis; in the colon group, 37 and 21 infections (P < 0.004) in antibiotic (A) versus IVIG plus antibiotic (IVIG + A) subset, respectively; in the non-colon group, 33 and 19 infections (P < 0.01) in control (C) versus (IVIG) subset, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Failure of thrombin-antithrombin III complexes in the diagnosis of deep vein thrombosis.

Plasma thrombin-antithrombin III (T-AT) complexes are reputed to be an indirect manifestation of thrombin generation, and a role for their determination in the diagnosis of deep vein thrombosis (DVT) has been advocated. In order to evaluate the accuracy of T-AT complexes assay for DVT diagnosis, in 166 consecutive outpatients with clinical suspicion of the disease, plasma concentration of T-AT complexes was measured immediately before venography by means of an enzyme-linked immunosorbent assay kit. The result of the T-AT complexes assay was elevated in 29 of the 48 patients with DVT (sensitivity, 60%). The T-AT complexes levels were within the normal range in 104 of the 118 patients with normal venograms (specificity, 88%). The positive and the negative predictive value were 67% and 85%, respectively. The authors conclude that the T-AT complexes assay is of little value for the diagnosis of DVT in outpatients.

[Picotamide monohydrate prophylaxis of deep venous thrombosis in patients undergoing general surgery. Clinical experience]. / Profilassi con picotamide monoidrata della trombosi venosa profonda in pazienti sottoposti ad interventi di chirurgia generale. Esperienza clinica.

The authors report their experience with the use of picotamide monohydrate for the prophylaxis of lower limb deep vein thrombosis in patients submitted to general surgery. Thirty-two patients were treated with the drug starting with 1200 mg daily three days before surgery and tapering to 900 mg daily in the postoperative period. The efficacy of the drug was found to be comparable to that of other currently used treatments and was not beset by a significant incidence of side effects.

Study of the erythrocyte deformability in juvenile onset diabetes.

Erythrocyte filtration rate was studied in 33 subjects suffering from type I diabetes. Any significant differences were observed neither between diabetic group and a control group, nor between diabetics with and without retinopathy. Small individual differences of erythrocyte filtration rate do not seem to correlate with age, with diabetes duration or with metabolic control.

Australia antigen in diabetic subjects.

The sera of 766 diabetics and 730 blood donors have been tested for Australia surface antigen (HBsAg). Subjects with a history of an episode of jaundice were excluded from both groups. The two groups did not differ as to the frequency with which HBsAg was found 1.64% in blood donors, 1.56% in diabetics.