Acta Biomedica de l''Ateneo Parmense最新文献

Hallux rigidus (HR) is a painful condition associated with degenerative arthritis of the first metatarsophalangeal (MTP1) joint, leading to a progressive loss of dorsiflexion. The etiological factors leading to the development of the condition are not yet fully understood in the literature. When the hindfoot is aligned in excessive valgus, the medial border of the foot tends to roll over, which brings to increased stress on the medial side of the MTP1 joint, and consequently on the first ray (FR), thus potentially influencing the development of HR deformity. This state of art aims to analyze the influence of FR instability and hindfoot valgus in HR development. From the results of the analyzed studies, it appears that a FR instability may predispose the big toe to increased stress and to narrow the proximal phalanx motion on the first metatarsal, which brings to compression and ultimately degeneration of the MTP1 joint, mostly in advanced stages of disease, less in mild or moderate HR patients. A strong correlation between a pronated foot and MTP1 joint pain was found; forefoot hypermobility during the propulsion phase may promote MTP1 joint instability and increase pain. Thus, the increased moment of pronation of the foot with the overload of the medial column, when present, should be corrected conservatively or surgically; this, most likely, would be useful not only to eliminate or at least limit the painful symptoms but above all to prevent the worsening of the condition, also after the surgical treatment of HR.

Background and aim: Bone metastases are a significant prognostic factor in the history of cancer and often involve pain and a great impairment of the quality of life. The complete resection of tumor tissue is increasingly performed in patients with solitary bone metastases, to improve the survival of patients and their functional outcomes Methods: We report the case of a 65-year-old man with a painful, massive, highly perfused osteolytic lesion localized at the proximal third of the humerus, associated with extensive lesions of the rotator cuff tendons was diagnosed with keratoblastic squamous cell lung cancer metastasis.

Results: The patient underwent shoulder and proximal humerus reconstruction with inverse tumor megaprosthesis after embolization of the lesion. At 3 and 6 months FU, a nearly complete resolution of painful symptoms, a significant improvement in functional skills, and better execution of most of the activities of daily life have been reported.

Conclusions: Accordingly with the literature the inverse shoulder megaprosthesis seems able to restore a satisfactory function and the silver-coated modular tumor system appears as a safe and viable treatment option in metastases tumor of proximal humerus.

Objective: To investigate whether the use of systemic heparin could be useful for vein microvascular anastomoses in microsurgical training on rats.

Materials and methods:

Design: Femoral end-to-end venous anastomoses were performed on both thighs of 40 wistar rats by two microsurgery trainees from October 2018 to February 2019 (80 anastomoses in total). We divided the rats into 2 groups of 20 specimens (40 femoral end-to-end anastomoses) each: group A received no heparin administration; group B received subcutaneous systemic heparin administration before starting dissection. We compared both vein patency after the procedures.

Results: Patency tests showed no difference between the two groups after 5 minutes. At the delayed test after 120 minutes, vein patency was significantly better in the systemic heparin group (85,0% vs 55,0%). Even though both trainees judged practicing on both groups very instructive, they found useful performing anastomoses when heparin was administrated.

Conclusion: We suggest including the use of systemic heparin in microsurgery training programs, especially for the beginners. Systemic heparin administration in rat models is educative for trainees.

Background/Aim of the study: The periprosthetic or superficial site infections are one of the most catastrophic and difficult to manage complications following total hip arthroplasty. Recently, in addition to well know systemic markers of inflammation, the blood and synovial fluid biomarkers are focused to have a possible role in the infection diagnosis. The long Pentraxin 3 (PTX3) seems to be a sensitive biomarker of acute phase inflammation. The objectives of this prospective and multicentre study were (1) to establish the plasma trend effectiveness of PTX3 in patients undergoing primary hip replacement, and (2) to evaluate the diagnostic accuracy of blood and synovial PTX3 in patients undergoing prosthetic revision of infected hip arthroplasty.

Methods: Human PTX3 was measured by ELISA in two cohorts of patients, 10 patients undergoing primary hip replacement for osteoarthritis and 9 patients with infected hip arthroplasty.

Results: The Authors were able to demonstrate that PTX3 is a viable biomarker for acute phase inflammation.

Conclusions: An increase in PTX3 protein concentration in the synovial fluid of patients undergoing implant revision has a strong diagnostic capacity for periprosthetic joint infection, showing 97% specificity.

BACKGROUND Sarcopenia refers to a chronic loss of skeletal muscle mass, often associated with hypovitaminosis D and advanced age, which involves a greater risk of falls and fractures. The association of sarcopenia and osteoporosis defines osteo-sarcopenia. In this work, the authors analyzed the osteometabolic profile and the loco-regional muscular state of patients undergoing major orthopedic surgery, in order to define the incidence of district osteosarcopenic states, linked to a condition of disuse.   METHODS   19 patients (10M-9F), between 15 and 85 years old, underwent major orthopedic surgery (15 resection prosthesis and custom made, 2 resection and reconstruction with transplant) were evaluated, of which 9 on an oncological basis. In all patients, the phospho-calcium metabolism was assessed by blood tests and intraoperative muscle biopsy was performed at the intervention site and contralaterally; in 3 cases a densitometric comparative study of the affected/contralateral limb was performed.   RESULTS   Results shows 5 patients with hypovitaminosis D; 7 pcs with hypocalcemia; 5 with PTH rise; 4pcs with ALP increase. In 100% of cases, the biopsy revealed sarcopenic patterns exclusively on the affected limb. 2 out of 3 DEXAs (66%) showed loco-regional osteoporosis compared to the contralateral.   CONCLUSIONS   The fact that in our sample sarcopenia is unilateral affecting only the pathological limb, that it is frequently associated with osteoporosis which is also unilateral and that for the most part it is not associated with vitamin D deficiency, suggests that it is an independent condition, with etiopathogenetic mechanisms different from osteosarcopenia itself. In major orthopedic surgery, bone integration and muscle status are both essential for achieving and lasting positive results. Considering the high incidence of district osteosarcopenia, an integrated surgical, pharmacological, and rehabilitative approach is desirable for the optimization of results, as well as more studies for the definition of the etiopathogenesis of this pathological condition.

Background and aim: Fractures of the proximal femur in the elderly are probably the leading cause of death in the orthopedic patients. Furthermore, after the spread of the pandemic, the mortality rate in the elderly has certainly increased. The aim of our study is to evaluate whether the mortality following proximal femur fractures is affected by the concomitant pandemic.

Methods: We admitted to our study patients over 65 years old, who presented to our Emergency Room with a diagnosis of proximal femur fracture in the first quarter of the years 2019, the period before the development of the pandemic, of 2020 during the pandemic and of 2021 with the new wave of Covid-19. 2022 was not taken into consideration because the mortality data are not yet available and to have at least one year follow-up after surgery. All patients were divided by fracture's type and treatment; the time elapsed from trauma to surgery and from trauma to discharge was also evaluated. For each deceased patient, we considered the time elapsed from the operation to death and whether there was an episode of positivity to Covid-19 following the trauma and after discharge (all patients had a negative swab at the time of admission).

Conclusions: Fractures of the proximal femur in the elderly patient are undoubtedly an important cause leading to the death. The spreading of the Covid-19 pandemic has allowed our department to reduce the gap between trauma and intervention time and from trauma to discharge which is undoubtedly a positive prognostic factor. However, the concurrence of a positivity from the virus does not seem to influence the mortality times following the fracture.

Renal artery thrombosis is a severe and often misdiagnosed entity, that represents a true medical emergency in which renal infarction can occur. The diagnosis is often a challenge for the emergency physicians since it can mimic other more common diseases, including renal colic. We report the case of an 82-year-old man who presented to our emergency department for abdominal pain, nausea, and vomiting resulting from right renal artery thrombosis and infarction caused by misdiagnosed atrial fibrillation. Starting from our experience, we recommend to always keep renal thromboembolism in the differential diagnosis in a patient with sudden onset of flank/abdominal pain, high levels of lactate dehydrogenase and/or haematuria since early diagnosis and proper treatment are the keys to rapid recovery.

Background: Acquired ypogonadotropic hypogonadism (AHH) is the most prevalent endocrine complication in thalassemia major (TM).

Study design: Considering the detrimental effect of estrogen deficiency on glucose metabolism, the ICET-A Network promoted a retrospective study on the long-term effects of estrogen deficiency on glucose homeostasis in female β-TM patients with HH without hormonal replacement therapy (HRT).

Patients and methods: Seventeen β-TM patients with AHH (4 had arrested puberty; Tanners' breast stage 2-3), never treated with sex steroids, and 11 eugonadal β-TM patients with spontaneous menstrual cycles at the time of referral were studied. A standard 3-h OGTT was performed in the morning, after an overnight fast. Six-point plasma glucose and insulin level determinations, indices of insulin secretion and sensitivity, early-phase insulin insulinogenic index (IGI), HOMA-IR and β-cell function (HOMA-β), oral disposition index (oDI), glucose and insulin areas under the OGTT curves were evaluated.

Results: Abnormal glucose tolerance (AGT) or diabetes was observed in 15 (88.2%) of 17 patients with AHH and 6 (54.5%) of 11 patients with eumenorrhea. The difference between the two groups was statistically significant (P: 0.048). However, the group of eugonadal patients was younger compared to AHH patients (26.5 ± 4.8 years vs. 32.6 ± 6.2 years ; P: 0.010). Advanced age,  severity of iron overload, splenectomy, increased ALT levels and reduced IGF-1 levels were the main clinical and laboratory risk factors for glucose dysregulation observed in β-TM with AHH compared to eugonadal β-TM patients with spontaneous menstrual cycles.

Conclusion: These data further support the indication for an annual assessment of OGTT in patients with β-TM. We believe that a registry of subjects with hypogonadism is necessary for a better understanding of the long-term consequences of this condition and  refining treatment options.

Background and aim: Cyclops Syndrome, first described by Jackson and Schaefer in 1990, is known as a complication of anterior cruciate ligament reconstruction (ACLR). However further researches have demonstrated that cyclops can be present even without symptoms and/or in absence of ACLR, simply configuring itself as a lesion in patients with rupture of the native ligament.

Methods: This is a retrospective cohort study in which we report our experience of 13 cyclops lesions found between 126 patients during a primary arthroscopic ACLR. Preoperative examination with tests of joint stability and range of movement measurement was performed and recorded. Accurate joint examination was performed during arthroscopy and the cyclops lesions found were removed and analyzed with haematoxylin-eosin coloration. Post-operative clinical examination was performed until 6 months of follow-up.

Results: Histological analysis showed proliferation of dense fibroelastic polypoid nodules with a macroscopically histological aspects of a "blue eye", hence the name Cyclops. At 6 months of follow-up after surgery, none of the patients reported pain at terminal extension or instability and they were all able to resume their previous activities.

Conclusions: Our study confirmed that surgical reconstruction of the ACL is not the only condition in which the Cyclops Syndrome develops; in fact our histological analysis indicate that the Cyclops lesions develop like a reactive fibroproliferative process following the rupture of the native ACL fibers, as scar reaction to the trauma: for this reason an accurate arthroscopic detection of these Cyclops lesions is crucial during primary ACL reconstruction in order to obtain the best surgical outcomes.

Background and aim: Obtaining, positioning and managing intravenous access is complex but common procedure in nursing care practice. Learning the right knowledge and skills during basic nurse education is an essential goal. The use of simulators allows for a better acquisition of skills, guaranteeing safety for patients and nursing students. However, the literature is still lacking on the use of simulation for intravenous cannulation procedures and device management, presenting few conflicting results. The aim of this study was to examine the effect of simulator-based learning on vascular access management in a population of nursing students.

Methods: Using comparative observational study design we evaluated the effect of simulator learning on vascular access management in a nursing student population.

Results: The differences between the scores at t1 between the groups of students are significant for obtaining vascular access with relative management of the device and intravenous therapy (t = 3.062, p = 0.001), while at t0, albeit with strong differences in scores means (t = 0.061, p = 0.871) are not statistically significant. Early use of the simulator is also fundamental over time (t = 5.362, p = 0.001). Furthermore, the satisfaction noted by the students during the clinical simulations improves with the increase in the number of the same, as it can influence the single performance.

Conclusions: Nursing training based on the use of simulators favors a better acquisition of skills compared to traditional didactic.