Utility of the modified 5-item frail index to predict complications and reoperations after hallux valgus percutaneous surgery. / [Artículo traducido] Utilidad del índice de fragilidad modificado de 5 items para predecir complicaciones y reoperaciones después de la cirugía percutánea de hallux valgus.

INTRODUCTION: The modified 5-item frailty index (mFI-5) has been recently proposed as a useful tool for predicting postoperative complications in orthopedic surgery. We aimed to analyze the utility of this score in predicting complications and reoperations after hallux valgus (HV) deformity surgery. METHODS: 551 patients undergoing percutaneous HV corrective surgery were retrospectively reviewed. The mFI-5 was calculated based and patients were categorized in three groups: 1) non-frail: patients without any of the 5 comorbidities, 2) pre-frail: patients with one comorbidity and 3) frail: patients with two or more comorbidities. Complications and surgical reoperations were recorded. RESULTS: In the study period 772 percutaneous surgeries were performed to correct HV deformity, 551 patients were included with a median age of 60 (IQR 48-70). Three hundred eighty-nine patients were non-frail (70.6%), 132 were pre-frail (23.9%) and 30 were frail (5.4%). 75 patients suffered complications (13.6%). Even though the rate of complications was higher in frailty patients (23.3%) compared with pre-frail (13.6%) and non frail (12.8%), no significant differences were observed among groups. 48 patients required reoperation (8.7%) but the rate of reoperations among frailty groups was not significantly different (P=.11). Frailty patients had worse AOFAS scores at final follow up (P=.011). CONCLUSION: The mFI-5 was not useful to predict postoperative complications and reoperations after hallux valgus corrective surgery. Therefore, other factors should be considered when analyzing the risk of complications after HV corrective surgery.

Utility of the modified 5-item frail index to predict complications and reoperations after hallux valgus surgery.

INTRODUCTION: The modified 5-item frailty index (mFI-5) has been recently proposed as a useful tool for predicting postoperative complications in orthopedic surgery. We aimed to analyze the utility of this score in predicting complications and reoperations after hallux valgus (HV) deformity surgery. METHODS: 551 patients undergoing percutaneous HV corrective surgery were retrospectively reviewed. The mFI-5 was calculated based and patients were categorized in three groups: (1) non-frail: patients without any of the 5 comorbidities, (2) pre-frail: patients with one comorbidity and (3) frail: patients with two or more comorbidities. Complications and surgical reoperations were recorded. RESULTS: In the study period 772 percutaneous surgeries were performed to correct hallux valgus deformity, 551 patients were included with a median age of 60 (IQR 48-70). 389 patients were non-frail (70.6%), 132 were pre-frail (23.9%) and 30 were frail (5.4%). 75 patients suffered complications (13.6%). Even though the rate of complications was higher in frailty patients (23.3%) compared with pre-frail (13.6%) and non frail (12.8%), no significant differences were observed among groups. 48 patients required reoperation (8.7%) but the rate of reoperations among frailty groups was not significantly different (p=0.11). Frailty patients had worse AOFAS scores at final follow up (p=0.011). CONCLUSION: The mFI-5 was not useful to predict postoperative complications and reoperations after hallux valgus corrective surgery. Therefore, other factors should be considered when analyzing the risk of complications after HV corrective surgery.

Prophylaxis of migraine attacks with a calcium-channel blocker: flunarizine versus methysergide.

In this study, flunarizine, a selective calcium-channel blocker, was employed in the prophylactic treatment of headache and was compared with methysergide in terms of efficacy. The trial was conducted with 104 patients (53 treated with flunarizine and 51 treated with methysergide) and lasted six months--one month of pretreatment and five months of therapy. Patients in both groups experienced a highly significant reduction in the number and duration of migraine attacks. Unlike those in the methysergide group, patients treated with flunarizine achieved a significant reduction in the intensity of attacks with very negligible side effects.

Role of magnesium in pregnancy.

The importance of magnesium in pregnancy has been emphasised by several studies. Magnesium is considered a membrane-stabilizing ion and a permeability regulator acting at an intracellular level which intervenes in the oxidative phosphorylation and oxidation reduction processes as well as in enzymatic synthesis and activity. The authors performed a double-blind study in which 15 mmol of magnesium or placebo were administered to the treatment and control groups respectively. There were more cases admitted to hospital in the control group than in that treated with magnesium. Even if there is not a large body of data which supports improved fetus development as a result of magnesium supplementation during pregnancy, the authors suggest that pregnant women with a high risk of gestosis and premature labour should receive additional magnesium.

Viral type and CD1+ cells in HPV-induced lesions.

In vivo, HPV infection can display varying symptom complexes. At present 60 types of HPV are known, and some seem to be more efficient oncogenic agents than others. In particular, HPV 16 and 18 appear the types with the greatest oncogenic potential, being frequently found in cases of intraepithelial cervical neoplasia (CIN) and/or invasive carcinoma of the cervix. Many authors suggest that they might induce cell-mediated immunodeficiency into the lesions. This investigation was conducted on 15 women aged 17 to 40 (mean, 27.8). On the basis of cytological examination, colposcopy and biopsy, HPV-induced lesions were diagnosed. Biopsies were performed periodically for six months for HPV detection and typing. In addition, the cells of Langerhans were imaged by the indirect immunoperoxidase method. Variations in their number according to the HPV type involved were observed.

Role of HPV-DNA typing in women with cytological diagnosis of squamous atypia.

The study was performed in 293 patients (mean age 36 years old). Pap tests, colposcopy and target biopsy were performed in all patients. Results showed 100 cases of cellular atypia, 53 cases of CIN (36 CIN I, 10 CIN II, 7 CIN III) and 140 normal cases. The last phase of the study consisted in the collection of exfoliated cervical cells which were then subjected to "Enzo Pathogen DNA Probe assay" using HPV-DNA 6/11, 16/18 and 31/33/51 probes. The aim of this study was to evaluate the relationship between HPV type and neoplastic evolution. The results were not sufficiently convincing to support proposing HPV/DNA typing as the sole diagnostic method in lesions of the last section of the female genital tract.

Malignant melanoma of the vagina in pregnancy: description of a clinical case.

Vaginal melanoma in pregnancy is a rare but extremely malignant tumour for which the prognosis is worsened by the fact that pregnancy increases the secretion of Melanocyte-Stimulating Hormone (MSH). The clinical case is described of a malignant vaginal melanoma in a 27 year-old woman in her 38th week of gestation, who was referred for slight vaginal bleeding. Clinical examination revealed a 3 cm pedunculate tumour on the anterior wall of the vagina. Vaginal cytology suggested a melanoma and instrumental examination failed to reveal any lymph node involvement. The vaginal tumour was removed during a caesarean section and subsequent histological examination identified it as a Breslow Stage II malignant melanoma. A 24-month follow-up showed the patient to have been completely cured.

Efficient transmit beamforming in pulse-echo ultrasonic imaging.

A high performance ultrasound imaging system requires accurate control of the amplitude of the array elements, as well as of the time delays between them, both in the transmit and receive modes. In transmission, conventional array aperture windowing implies a different driving voltage for each element of the array, an expensive solution for systems with a large number of channels. In this paper, we present a simple, versatile, and inexpensive beamforming method that operates the aperture windowing in the transmit mode, simply controlling the lengths of the electric pulses driving the array elements. Computer simulations and experimental measurements are presented for different types of arrays. They confirm that the proposed beamforming technique improves the contrast resolution of the imaging system, reducing the off-axis intensity of the radiated field pattern. Moreover, the axial resolution is slightly enhanced, because the overall length of the transmitted ultrasonic pulse is reduced.

Optimization of wide-band linear arrays.

An optimization method is proposed for linear arrays to be used in ultrasound systems under wide-band operation. A fast algorithm, the threshold accepting, has been utilized to determine the element positions and weight coefficients of a linear array that generates a desired beam pattern. To reduce the computational burden in the optimization procedure, an efficient numerical routine for the beam pattern evaluation has been implemented. We address the optimization problem of both dense and sparse wide-band arrays. In the first case, the goal is to minimize the side-lobe energy by varying the element weights; we compare the optimized beam pattern with that obtained with classical shading functions, showing that better results can be achieved with a wide-band optimization. We also consider the optimization of the layout (positions and weights) of a sparse linear array to achieve a desired beam pattern with a fixed or minimum number of array elements. The comparison of the proposed method with a narrow-band optimization algorithm is presented, showing that better performances (about -7 dB further reduction of the side-lobe level) can be achieved with a wide-band sparse array optimization. Further numerical simulations are given, showing that the proposed method yields better results than wide-band sparse random arrays and periodic arrays with the same aperture width.

Chemotherapy and cervical cancer: present trends.

A clinical case of cervical carcinoma Stage Ib is described. We treated a 48-year old woman with grade 2 carcinoma, using cisplatin at a dose of 40 mg/mq on the 1st and 4th days, bleomycin at a dose of 15 mg/mq on the 1st and 8th days, and anti-emetic for two cycles. On the basis of the low ratio T4/T8 we also administered along with chemotherapy, alpha natural interferon at a dose of 3,000,000 i.u. three times a week for four weeks. At the end of the chemotherapeutic treatment the lesion was reduced in size and the biopsy was pathognomically of a microinvasive cancer. In spite of the encouraging biopsy results, the patient was submitted to a simple hysterectomy, with random lymphoadenectomy. Today, two years after her treatment, the patient is free of disease. At present there is discussion as to the efficacy of neoadjuvant chemotherapy in the first stages of the neoplasia in relation to conventional treatment, which reserves chemotherapy to stages IV and IVb and to relapses, in the light of both the lesion and the disposability of the patient to treatment and successive follow-up.

[Behavior of blood lipids and lipoproteins in myocardial infarct]. / Atteggiamento lipido-lipoprotidemico ed infarto del miocardio

Blood lipids and lipoproteins were evaluated in male and female subjects of various ages with acute myocardial infarct. Values were within the limits of normal in less than 50%, mostly in the aged. II B (24%), IV (18%) and II A (11%) lipoprotidaemic pictures were the most common. It is felt that abnormal values are not necessarily part of the infarct picture; if present, they are mainly of the II B type.

[Lymphoblastic lymphoma of the renal cavity associated with hemorrhagic pericarditis. Description of a case]. / Linfoma linfoblastico della loggia renale associato a pericardite emorragica. Descrizione di un caso.

The authors describe a case of lymphoblastic lymphoma of the renal lodge complicated by hemorrhagic pericarditis, cardiac tamponade and quickly evolved in an unfavourable way. Lymphoblastic lymphoma is classified into lymphocytic lymphomas (or non-Hodgkin) with a higher grade of malignancy. These lymphomas have, in 40% of cases, an initially extra-lymph node localization: among these, the renal or perirenal localization is not very frequent. The concomitant presence of a pericarditis of hemorrhagic type is also less frequent. Unlike Hodgkin's lymphomas, lymphocytic lymphomas are frequently in an advanced stage at the moment of diagnosis, and their evolution is of acute-subacute, often fatal type. The case report is about a 70 year old male, who arrived at the clinical investigation for the subjective presence of asthenia, dyspnea, tachycardia and the objective evidence of jugular turgor, hepatomegaly and distal edemas, hypophonesis of right lung basis, according to a clinical picture of systemic venous congestion which instrumental examinations confirm to be of pericardial origin. The abdominal echographic examination showed an occupation of the perirenal space, so the CAT characterized as a 25 cm long formation (from the renal cavity to pelvis), with a dislocation of close structures. Unfortunately, the clinical picture had a quick evolution towards the exitus for cardiac tamponade, only permitting us a bioptic examination for the diagnosis of the case.

[Therapeutic plans for the treatment of HPV infections by systemic administration of interferon-alpha. Experience with preneoplastic pathology of the uterine cervix associated with viral cytopathic effects]. / Schemi terapeutici per il trattamento delle infezioni da HPV mediante l'uso di interferon alfa per via sistemica. Nostra esperienza nella patologia pre-neoplastica della cervice uterina associata a effetti citopatici da virus.

The principal action of IFN is anti-viral, rather than antiproliferative and immunomodulatory. All three actions are required to resolve pre-neoplastic uterine cervix pathologies, above all if they are at an early stage or associated with viral cytopathic effects.

[Adenocarcinoma of the endocervix. Clinical cases]. / Adenocarcinoma dell' endocervice. Casi clinici.

The Authors examined 8 cases of endocervical adenocarcinoma: 2 women with positive Pap-smear were colposcopically, micro-colpo-hysteroscopically (MCH) and histologically investigated and 6 with atypical bleeding were evaluated by endocervical curettage. They emphasized the role played by cytology, pointed out the necessity to find endocervical cells in the Pap-smear for catching the lesion in early stage and to save the patients a demolishing surgery.

[Vulvar dystrophies and intraepithelial neoplasms]. / Distrofie e VIN.

The ISSVD has attempted to separate dystrophic lesions from VIN in order to draw up a standard nomenclature based on histopathological characteristics so as to obtain comparable data. But the definition of the dysplastic evolutive possibilities of hyperplastic lesions is still an open problem. In this study 40% of VIN I, 100% of VIN II and 16.6% of VIN III were associated with hyperplastic lesions. 16.6% of VIN III were associated with sclerosing lichen. In this case, a hyperplastic phase could have been followed by a distrophic one since the patient was 73 years old. The overall frequency of cellular atypia in vulvar dystrophy was therefore 14.66%; it increased to 41.66% during the hyperplastic phase. The age of patients increased in parallel to the severity of lesions. No decrease in the mean age of incidence was noted except in those cases associated with HPV. The potential uncontrolled increase of hyperplastic alterations could have been produced by the absence of an inhibitory incidence stimulus, as has been noted in the resistance to topical steroid therapy in some cases of squamous hyperplasia. The localisation of cellular atypia, however, indicates surgical treatment.

[Efficacy of natural alpha interferon from normal human leukocytes in symptomatic vestibular papillomatosis]. / Efficacia dell'interferon alfa naturale da leucociti umani normali nella papillomatosi vestibolare sintomatica.

The paper discusses the genesis of vestibular papillomatosis: some researchers affirm that it is epithelio-paraphysiological whereas others maintain that it is a subclinical stage of HPV infection. In some cases "true" symptomatic papillomatosis may be remedied by human leucocyte alpha-IFN treatment.

[A new rapid method for the diagnosis of Chlamydia trachomatis in the obstetric gynecologic field]. / Nuovo metodo per diagnosi estemporanea di Chlamydia trachomatis in campo ostetrico ginecologico.

Kodak Surecell Kit, a new immunoenzymatic test for Chlamydia detection, was evaluated. The Authors compared the sensitivity, specificity and cost between the tissue culture and the immunoenzymatic test. They conclude that the immunoenzymatic test, Kodak Surecell, is sufficiently faithful. It is a rapid and cheap method.

[Thr role of histiocytes in the cytodiagnosis of endometrial adenocarcinoma]. / Ruolo degli istiociti nella diagnosi citologica di adenocarcinoma endometriale.

The Authors point out the importance of histiocytes in Papanicolaou smears. Histiocytes are associated with endometrial carcinoma on tissue sections and may be seen on cervicovaginal smears as well. Smears obtained from 120 women, with clinical signs of endometrial diseases, were evaluated to determine the correlation between the presence of histiocytes in the cervicovaginal smears and endometrial adenocarcinoma. Histiocytes were quantified as minimal [less than 5 per high-power field (hpf)], moderate (5-10 hpf) or heavy (greater than 10/hpf). The histiocytes were found in smears from 80 women. Five adenocarcinomas, 9 hyperplasias were detected in 20 patients with moderate or heavy smears. The Authors conclude that the presence of histiocytes among postmenopausal women who have cervicovaginal smears should not be ignored. The data indicate that, in the absence of endometrial cells, histiocytes on cervicovaginal smears of postmenopausal women are associated with more elevated relative risk for endometrial carcinoma.

[Anencephaly: a still unresolved problem]. / Anencefalia: un problema ancora irrisolto.

The anencephaly is a congenital malformation, characterized by the absence of the cerebral structures and of the skull. In this study we have considered 5 cases of anencephaly, occurred in the decade 1985-1994. All the pregnant women have been interviewed and underwent ultrasonographic evaluation. Four out of 5 pregnant women have voluntarily interrupted pregnancy. In only 1 case, having achieved woman the 40th week of pregnancy, the delivery has been spontaneous: the fetus has died after few hours. The results of this study suggest that, being the anencephaly the most commonly indications for the abortion, would be important to help the women bearers of anencephalic fetuses to consent taking the organs, using them for transplantations on children that necessitate them.

[Association of interleukin 2 and interferon alpha in the management of cervical condylomatosis]. / Associazione di interleuchina-2 ed interferone-alpha nel trattamento della condilomatosi della cervice uterina.

At present the therapy of cervical condylomatosis is based on the use of interferon because the HPV types responsable for condyloma inhibit the immunitary system. But many A. studying the effects of IFN have found that at high concentration it has an immunosuppressive action. The aim of the present study was to evaluate if interleukin-2 associated with IFN is useful in avoiding this negative effect by improving the efficacy of cervical condylomatosis therapy. We treated 25 women suffering from cervical condyloma with increasing doses of IL-2 injected intralesionally and associated with natural alpha-IFN injected intramuscularly. The duration of the whole therapy was six weeks. We evaluated the percentage of inflammatory cells in peripheral blood before and after treatment. The per-cent number of lymphocytes, eosinophils and lymphoblasts was increased by 27%, 88% and 40%, respectively. The clinical response to the therapy was total in 14 cases, partial in 9 cases and unsuccessful in 2 cases. These data suggested that combination therapy with interleukin-2 and alpha-IFN for the treatment of patients with cervix condylomatous is successful.