An update on the long-term outcomes of prenatal dexamethasone treatment in congenital adrenal hyperplasia

First-trimester prenatal treatment with glucocorticoid (GC) dexamethasone (DEX) in pregnancies at risk for classic congenital adrenal hyperplasia (CAH) is associated with ethical dilemmas. Though effective in reducing virilisation in girls with CAH, it entails exposure to high doses of GC in fetuses that do not benefit from the treatment. The current paper provides an update on the literature on outcomes of prenatal DEX treatment in CAH cases and unaffected subjects. Long-term follow-up research is still needed to determine treatment safety. In addition, advances in early prenatal diagnostics for CAH and sex-typing as well as studies assessing dosing effects of DEX may avoid unnecessary treatment and improve treatment safety.

Impact of COVID-19 on hand surgery in Italy: A comparison between the Northern and the Southern regions

The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also – and paradoxically even at a higher extent – in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.

Surgically Induced Astigmatism after Manual Extracapsular Cataract Extraction or after Phacoemulsification Procedure

Astigmatic changes in three series of cataract surgical procedures were compared. The first two series comprised eyes having a manual extracapsular cataract extraction (ECCE) through a 12.0 mm or 8.0 mm incision and implant of a PMMA posterior chamber lens. The third series comprised eyes having phacoemulsification through a scleral pocket and implant of a PMMA posterior chamber lens. Preoperative keratometry measurements and corneal topography maps were compared with those obtained two days, one week, one, three and six months postoperatively. The keratometry measurements, obtained with computerized videokeratography, revealed: on day 2, 4.89 D (1st series), 3.95 D (2nd series), 2.66 D (3rd series); one week, respectively 4.46 D, 3.51 D and 2.14 D; one month, 0.65 D, 0.53 D and 0.05; three months, 1.44 D, 0.35 D and 0.36 D; six months, 1.36 D, 0.42 D and 0.48 D. The surgically-induced cylinder at three months was four times greater in the manual ECCE 12.0 mm incision series than in the phacoemulsification series. However, by six months all differences were markedly reduced. The results add to the growing evidence that the phacoemulsification procedure produces less astigmatism and more rapid visual rehabilitation than the manual ECCE procedure. Topographic analysis showed much less corneal steepening after phacoemulsification than after manual ECCE. However, all three surgical procedures offered satisfactory clinical results.

Extracorporeal shock wave therapy in pillar pain after carpal tunnel release: a preliminary study

"Pillar pain" is a relatively frequent complication after surgical release of the median nerve at the wrist. Its etiology still remains unknown although several studies highlight a neurogenic inflammation as a possible cause. Pillar pain treatment usually includes rest, bracing and physiotherapy, although a significant number of patients still complain of painful symptoms two or even three years after surgery. The aim of this study was to investigate the efficacy of low-energy, flux density-focused extracorporeal shock wave therapy (ESWT) in the treatment of pillar pain. We treated 40 consecutive patients with ESWT who had pillar pain for at least six months after carpal tunnel release surgery, and to our knowledge, this is the first study that describes the use of ESWT for treating this condition. Our results show that in all of the treated patients, there was a marked improvement: the mean visual analogue scale (VAS) score decreased from 6.18 (±1.02) to 0.44 (±0.63) 120 d after treatment, and redness and swelling of the surgical scar had also decreased significantly.

Comparison of the clinical performance of Healon 5 and Healon in phacoemulsification

PURPOSE

Healon 5 is a high-molecular-mass fraction of sodium hyaluronate. Its density endows it with a number of viscoelastic characteristics. In this prospective, randomised clinical study we compared the performance of Healon 5 and Healon in phacoemulsification.

SETTING

Institute of Ophthalmology, University of Modena and Reggio Emilia, Italy.

METHODS

Two groups of patients underwent phacoemulsification and intraocular lens (IOL) implantation. In the first 27 patients Healon 5 was used as viscoelastic substance during surgery, and in the second 27 Healon was used. The surgeons subjective comments on the performance of these viscoelastic agents were recorded at the different steps of surgery: injection, capsulorhexis, phacoemulsification, IOL implantation, removal of viscoelastic agent and trasparency throughout the operation. The surgeon's overall impression of the viscoelastics during the whole operation was noted. Tonometry and endothelial cell count were performed in all patients before and after operation.

RESULTS

There was no statistical difference between the two groups as regards visual acuity, ocular pressure and endothelial damage. Healon 5 showed excellent ability to maintain the anterior chamber during capsulorhexis, phacoemulsification and IOL implantation. Removal time with Healon 5 was not appreciably longer than Healon.

CONCLUSIONS

Healon 5 emerges as a very interesting viscoelastic substance. Visibility is better if the anterior chamber is filled completely. Removal is easier if it is aspirated while moving the irrigation aspiration tip with circular movements over the top and around the border of the IOL.

Amyloid neuropathy simulating lower motor neuron disease

We report a 57-year-old man with progressive symmetric weakness and fasciculation affecting the legs. Electromyography revealed fibrillations and neurogenic motor unit potentials in the leg muscles. Biopsy of a motor branch of the obturator nerve revealed axonal degeneration, loss of myelinated nerve fibers, and amyloidosis with deposits of lambda light chains. At 6-month follow-up, the patient manifested sensory and autonomic symptoms, and lambda light chains were first detected in the serum. In this case, diagnosis of amyloidosis remained elusive until motor nerve biopsy.

Reduction and osteosynthesis of subcapital fractures of the femoral neck: possible repercussions on post-fracture hemarthrosis of the hip

Intracapsular hip pressure was measured in undisplace or less displaced subcapital fractures of the femoral neck before and after open reduction and internal fixation with three-flanged nails. After reduction and osteosynthesis, intracapsular pressure increased in three out of five cases. The result is discussed in relation to the possible role of intracapsular pressure sustained by hemarthrosis in the pathogenesis of post-traumatic vascularity of the femoral head.

High-pressure hemarthrosis: possible consequences to the vascularization of the femoral head

The authors both detected hemarthrosis and calculated intraarticular pressure and blood supply to the femoral head using diagnostic tests (ultrasound, arthrography, manometric measurements, and bone scan tomography) in 18 patients with femoral neck fracture. The data obtained, in agreement with other reports in the literature, show a relationship between the condition of the joint capsule, the level of intraarticular pressure, and the arterial blood supply to the femoral head in cases of undisplaced or slightly displaced femoral neck fracture. The potential clinical implications are discussed.