Increased blood pressure variability in menopause.

Blood pressure variability represents an independent risk factor for cardiovascular diseases. To detect possible blood pressure variability changes from fertile to menopausal status, we enrolled consecutively 219 women: 104 fertile women (46.6 +/- 3.4 years) and 115 menopausal women (53.9 +/- 3.98 years). We evaluated for each patient the body mass index (BMI), 24 h, daytime, night-time systolic and diastolic mean blood pressure values and blood pressure variability data by means of an Ambulatory Blood Pressure Monitoring device. We found a significant higher mean age, body mass index, systolic and diastolic 24 h, day and night-time blood pressure variability in menopausal women when compared to fertile women. Age and BMI were significantly correlated to most blood pressure variability data with the Spearman Rank test. The multivariate logistic regression with dichotomic variables showed that the menopausal status is independently correlated to 24 h systolic (p < 0.0005) and diastolic (p < 0.05) variability, systolic (p < 0.05) and diastolic (p < 0.05) daytime pressure variability and systolic night-time pressure variability (p < 0.05). Furthermore, we found independent correlations between age 24 h systolic (p < 0.05) and night-time diastolic blood pressure variability (p < 0.05), while the BMI was indepententely correlated to BMI 24h diastolic (p < 0.01), daytime systolic (p < 0.01) and diastolic (p < 0.05) blood pressure variability. These data show a significant increase of blood pressure variability in menopausal women when compared to fertile women, even after exclusion of confounding factors, such as aging and BMI. Menopausal status, aging and BMI increase may all, independently, contribute to the enhanced blood pressure variability we found in menopausal women.

Results of the multicentric Italian experience on the Gamma nail: a report on 648 cases.

In a multicentric study, the data of 628 trochanteric fractures, two non-unions, and 18 pathologic or impending fractures treated by Gamma nail in 13 Italian traumatology services were collected and analyzed. In 70% of the patients weight bearing was allowed in the first postoperative week and 78% of the controlled patients returned to their pretrauma walking ability. Complications included intraoperative (1.4%) and postoperative (1.2%) shaft fractures, "cut out" of the lag screw (2.6%), and nail failure (0.5%). There were no cases of infection. An analysis of complications showed that most of them were due to technical mistakes. The safest procedure is 2 mm diaphyseal overreaming, introduction of the nail without hammering, and distal locking; the lag screw should be placed in the lower part of the head of the femur.

A technical report reviewing the use of the 11-mm Gamma nail: interoperative femur fracture incidence.

Two years after the first large series on the Gamma nail, the authors analyze 119 surgical procedures for proximal femur fractures performed using the 11 mm Gamma nail. The study was performed by 24 surgeons (from six orthopedics departments) at different levels of learning, as in the previous study. The small-sized nail allows an easier surgical procedure and a manual introduction of the nail even in small femurs, as suggested by the previous experience. A careful operative technique and a 2 mm overreaming, which was almost always adopted, explains the decrease in interoperative and postoperative complications (evaluated in 88 cases), compared to the last case report published in 1991. No interoperative shaft fractures occurred in 119 nailings.

The role of magnetic resonance in necrosis of the femoral epiphysis as the sequelae of acetabular fracture (preliminary results).

Eleven patients surgically treated for fracture of the acetabulum were examined postoperatively by MRI in order to reveal any signs of necrosis of the femoral head at an early stage. The means of osteosynthesis used underwent preliminary testing in order to exclude magnetic or thermal phenomena. The study confirmed the usefulness of this test in the early diagnosis of this serious complication. In 3 cases the presence of the means of osteosynthesis obstructed a correct interpretation of the images.

Intramedullary osteosynthesis with Grosse-Kempf nailing for the treatment of distal fractures of the femur.

The authors report the results they obtained in a homogeneous series of fractures of the distal third of the femur treated by Grosse-Kempf nailing. Of the 67 fractures (58 closed, 9 exposed) treated with closed surgery (except for 1 case treated by nailing 35 days after trauma) non-union was never observed. The two cases of delay in consolidation (one related to an infection) did not require a change in method. Bone grafting was never necessary. Only in 3 cases (2 with multiple trauma, 1 treated by open reduction) was moderate reduction in range of movement of the knee observed.

The results of a multicenter Italian study on the use of the Gamma nail for the treatment of pertrochanteric and subtrochanteric fractures: a review of 1181 cases.

A total of 1147 pertrochanteric and subtrochanteric fractures, 10 delays in consolidation and non-union, 24 pathologic fractures and osteolysis with the risk of fracture, treated with a gamma nail in 17 Italian departments of traumatology, were collected. In 70% of the patients weight-bearing was allowed during the first week postsurgery; 77% of the patients followed-up recovered the same ability to walk that had preceded trauma. Complications included intraoperative (1.8%) and postoperative (1.1%) diaphyseal fractures, cephalic screw cut out (2.2%), and breakage of the nail (0.4%). There were two cases of infection (0.3%). Most of the complications were related to errors in technique. The safest procedure is constituted by the choice of a nail with a thinner caliber, 2 mm diaphyseal over-reaming, insertion of the nail without the use of a hammer, and distal locking; the cephalic screw must always be inserted in the lower portion of the femoral head.

Atypical indications for Ender's osteosynthesis.

On the basis of a considerable experience in the use of Ender's nails in basal and trochanteric fractures of the neck of the femur, the authors are convinced of the excellent mechanical properties of this fixation device. They have therefore used it in five atypical and complex cases of subtrochanteric fracture. They describe and discuss the clinical and radiological results obtained. Their reasons for choosing this method in preference to rigid osteosynthesis are given in each case.

The treatment of trochanteric fractures of the neck of the femur by Ender's nail.

The authors report the clinical and radiographic results obtained in the treatment of 138 patients with pertrochanteric fractures of the neck of the femur by Ender's elastic nail. This extremely simple method of treatment, which is within the scope of all surgeons, permits early recovery of function in the elderly patient and, even more important, early mobilisation in the upright stance, thereby preventing many of the surgical complications that can affect elderly patients.

The letournel lateral approach for treatment of acetabular fractures.

The authors report 9 cases of acetabular fracture, 6 recent complex and 3 inveterate, treated surgically through the lateral incision of Letournel. This approach provides excellent exposure of the acetabulum, the iliac wing, the posterior column, and the anterior column up to the iliopectineal eminence. Nevertheless, the high incidence of often serious complications makes the combined anterior-posterior approach preferable for severe inveterate fractures of the acetabulum.

Surgical treatment of infected pseudarthrosis of the humerus.

The authors report 16 cases of infected lesions of the humerus with delayed consolidation or pseudarthrosis. The treatment consisted of radical surgical debridement, freshening of the bone fragments with removal of all necrotic tissue, and stabilisation with a Hoffmann-Vidal external fixation device. Healing occurred between 3 and 6 months after operation. The one case of failure was attributable to inappropriate technique (inadequate resection of the ends of the fragments).