A topological look at human trabecular bone tissue.

Bone quality is affected by trabecular architecture at microscopic level. Various abnormalities of bone tissue lead to altered strength and to an increased susceptibility to fracture, such as Osteoporosis and Osteoarthritis, two major health burdens of our society. These are two complex musculoskeletal diseases that mainly concern bone tissue. In the last twenty years, there has been a growing interest in finding an appropriate topological model for the micro-architecture of trabecular bone tissue. In particular, we prove that these models involve general topological spaces. The appropriate notion to deal with is that of CW-complex.

Effect of subtalar arthroereisis on the tibiotalar contact characteristics in a cadaveric flatfoot model.

Previous studies reported the effect of flatfoot deformity on tibiotalar joint contact characteristics. The lateral shift of the load which occurred in flatfeet may be responsible for degenerative changes in the ankle joint. The purpose was to assess the pattern of joint contact stress of the tibiotalar joint in intact, flat, and corrected specimens with subtalar arthroereisis. Seven fresh-frozen cadaver specimens were studied in the intact and flat-footed condition after transection of ligaments which support the medial arch. Ankle joint contact stress and plantar pressure patterns were determined from a capacitive pressure sensor inserted in the tibiotalar joint and a pressure distribution platform when the specimens were axially loaded in simulated mid-stance. Contact pressure was also assessed after subtalar arthroereisis with a 12 mm Kalix implant for correction of the flatfoot deformity. A maximum contact pressure of 1414.2±319.2 kPa was recorded in the middle-medial region in intact specimens. Flatfoot caused a lateral shift in the pressure distribution (p<0.05). In the flat specimens, the maximum contact pressure of 1394.7 8±470.5 kPa was in the anterior-central region. After subtalar arthroereisis with the Kalix implant for correction of the flatfoot deformity a maximum contact pressure of 1323.3±497.5 kPa was observed in the middle-lateral region. In a cadaver model, subtalar arthroereisis with Kalix implant failed to restore a normal intraarticular ankle joint pressure pattern. Further interventions should be considered to restore a normal pressure pattern.

Chondrosarcoma of the iliac wing in Von Hippel-Lindau disease.

Von Hippel-Lindau disease is a rare autosomic dominant hereditary tumoral syndrome characterized by mutation of the VHL gene. Here follows the first reported case of a patient (20 year old male) affected by Von Hippel-Lindau (VHL) disease, was referred to our Department because of the occurrence of a hard lump at the right aspect of the pelvis, who presented a primary mildly differentiated chondrosarcoma of the right iliac wing (confirmed by CT scan). Chondrosarcoma of the iliac wing, treated by surgical resection and reconstruction of the pelvis with appropriately shaped bone allograft fixed with plates and screws. At one year follow-up, the patient shows no signs of recurrence. Conventional treatment for chondrosarcoma of the iliac wing would be either wide or radical resection (hemipelvectomy), or amputation. The described treatment is unusual in that it is dependent on patient's choice to privilege quality of life due to the awareness of being affected by a genetic disease with an inauspicious prognosis.

[Chronic osteomyelitis: one-step treatment]. / Osteomielite cronica: trattamento one-step.

PURPOSE: Chronic osteomyelitis is a surgical disease that require significant dedication from surgeons to eradicate. Osteomyelitis can result from a variety of etiologies but most often is a consequence of trauma (open fractures) to a long bone. This type includes osteomyelitis secondary to a contiguous focus of infection (after trauma and its surgical treatment: osteosynthesis). Here we are reporting one case of post-traumatic chronic osteomyelitis of the humerus. PATIENTS AND METHODS: A 34-years-old man presented with a post-traumatic chronic osteomyelitis due to an open fractur of the diaphysis humerus. We proposed a one-step surgical treatment, including fistulectomy, sequestrectomy, opening of the proximal and distal intramedullary canal. Antimicrobial therapy should be followed by close observation and treatment with appropriate antibiotics. RESULTS: A clinical control at 30 days from the intervention revealed that: no secretion; negative cultured exam; second-intention healing of the skin. CONCLUSIONS: Treatment requires isolation of the pathogens, significant debridement for removal of all infective and necrotic material, both of bone origin and soft-tissue one. Is is necessary not to close the foci: in this way we leave an external drainage, which is able to provide a tissues sterilization by secretion drainage and by the effects of the systemic antimicrobial therapy. Our results indicate that this long-term problem can be solved by a one-stage procedure that provide spontaneous second- healing of the skin defects, excluding the bony and soft tissue reconstruction.

[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.

A morphological study on femoral heads in human hip joint osteoarthrosis.

Several pathogenetical and clinical interpretation of osteoarthritic modifications are given in the literature. In this work we tried to compare in humans macroscopic, structural and ultrastructural observations on eight osteoarthritic with four femural heads from control patients. The sample for Light Microscopy and Scanning Electron Microscopy observations came from selected regions of the femural head, which included both cartilage and bone tissue of loaded and unloaded regions. The cartilage showed superficial lesions, such as erosions and fissures, and deep lesions that included matrix alterations and chondrocyte proliferation. In relation to the thickening of the subchondral bone we noticed an irregular bone-cartilage surface with signs of bone tissue proliferation. The trabeculae appeared thickened in loaded zones and rarefied in unloaded ones. Cavities were sometimes present at different depths in cancellous bone. Our observations allow us to conclude that cartilage lesions are precocious, diffusely located and relatively independent of the considered zone of the femural head, while bone tissue alterations seem evenly sited and chronologically subsequent. The cavities in the cancellous bone could produce load modifications and consequent bone deformity.