Total Talar Prosthesis, Learning from Experience, Two Reports of Total Talar Prosthesis after Talar Extrusion and Literature Review

Recently, total talar prosthesis has been proposed to substitute the talus during the management of complex talar lesions such as talar extrusion, comminuted talar fractures, or avascular necrosis. Herein, we report two cases of talar extrusion treated with total talar replacement after a high-intensity trauma. Both cases subsequently required revision surgery due to degenerative changes of the tibial plafond (arthrodesis in the first case, conversion to a total ankle prosthesis in the latter). We report and analyze the literature concerning total talar replacement to discuss strategies that could help improve prosthesis survival and reduce the incidence of osteoarthritis.

How to Manage Metallosis: A Retrospective Cohort Analysis after Revision Hip Surgery

BACKGROUND

Adverse local tissue reactions to metal debris are due to a metal-on-metal bearing complication caused by micromotions at modular interfaces that induce corrosion of the protective oxide layer. This process could lead to wear, fretting, and abrasion with the release of metal ions locally and systemically, which may cause adverse local reactions in nearby tissues. The aim of this study is to describe a series of patients with painful local adverse tissue reactions secondary to corrosion at the modular neck-body interface, to document the clinical presentation, diagnostic workup, and surgical findings of our research, and to search for a possible correlation between metallosis and infection.

METHODS

A retrospective study of patients with adverse local tissue reactions due to metal surface corrosion was performed. Blood samples were collected to identify erythrocyte sedimentation rate, C reactive protein, and procalcitonin, and a magnetic resonance imaging protocol was performed.

RESULTS

Serum cobalt and chromium levels of the 43 patients tested were significantly higher on average. However, both erythrocyte sedimentation rate and C-reactive protein were significantly elevated. Magnetic resonance imaging showed adverse reactions to metal debris with large soft tissue masses and surrounding tissue damage.

CONCLUSIONS

Corrosion in hip prosthesis can lead to the release of metal ions and debris locally and systemically, resulting in local soft tissue changes. A "tumor-like" debridement can reduce this complication.

New ABO intron 1 variant alleles

Unusual and discrepant ABO phenotypes are often due to genetic variants that lead to altered levels or activity of ABO transferases and consequently to altered expression of ABO antigens. This report describes eight genetic alterations found in 15 cases with reduced or undetectable expression of ABO antigens. Forward and reverse ABO grouping was performed by standard gel or tube methods. Adsorption-heat elution and saliva testing for H and A substances followed the AABB technical manual procedures. Genomic DNA extracted from whole blood was PCR-amplified to cover the entire ABO coding sequence, splice junctions, proximal promoter, and intron 1 enhancer. Amplification products were sequenced by next-generation or Sanger dideoxy methods, either directly or after cloning into a bacterial plasmid vector. Eight unreported alleles were found in the 15 cases analyzed. Alleles ABO*A(28+1C) and ABO*A(29-5G) harbor variants that alter the consensus sequence at the intron 1 donor and acceptor splice sites, respectively. The other alleles harbor variants that alter the consensus sequence at transcription factor-binding sites in the intron 1 enhancer: specifically, ABO*A(28+5792T), ABO*A(28+5859A), and ABO*A(28+5860G) at GATA-1 sites; ABO*B(28+5877T) and ABO*B(28+5878G) at a RUNX1 site; and ABO*A(28+5843A) at or near a C/EBP site. Molecular and serologic characterization of ABO alleles can help in their future identification and in the resolution of discrepancies.

Unusual and discrepant ABO phenotypes are often due to genetic variants that lead to altered levels or activity of ABO transferases and consequently to altered expression of ABO antigens. This report describes eight genetic alterations found in 15 cases with reduced or undetectable expression of ABO antigens. Forward and reverse ABO grouping was performed by standard gel or tube methods. Adsorption-heat elution and saliva testing for H and A substances followed the AABB technical manual procedures. Genomic DNA extracted from whole blood was PCR-amplified to cover the entire ABO coding sequence, splice junctions, proximal promoter, and intron 1 enhancer. Amplification products were sequenced by next-generation or Sanger dideoxy methods, either directly or after cloning into a bacterial plasmid vector. Eight unreported alleles were found in the 15 cases analyzed. Alleles ABO*A(28+1C) and ABO*A(29–5G) harbor variants that alter the consensus sequence at the intron 1 donor and acceptor splice sites, respectively. The other alleles harbor variants that alter the consensus sequence at transcription factor–binding sites in the intron 1 enhancer: specifically, ABO*A(28+5792T), ABO*A(28+5859A), and ABO*A(28+5860G) at GATA-1 sites; ABO*B(28+5877T) and ABO*B(28+5878G) at a RUNX1 site; and ABO*A(28+5843A) at or near a C/EBP site. Molecular and serologic characterization of ABO alleles can help in their future identification and in the resolution of discrepancies.

Impact of self-ligating orthodontic brackets on dental biofilm and periodontal pathogens in adolescents

The aim of the present prospective study was to evaluate periodontal health and subgingival microbiological alterations in adolescents treated with fixed self ligating orthodontic brackets in comparison to subject without any orthodontic appliance. A total of 40 adolescents (23 females and 17 males; mean age: 13.2 ± 3.2 years) were included: 30 subjects with self ligating brackets (test group) and 10 patients without orthodontic appliances (control group). Follow-ups were as follows: T1 (1 month), T2 (3 months), T3 (6 months) from the beginning of the orthodontic therapy. Clinical parameters (plaque index, gingival index and clinical attachment level) were measured for every patient and a microbiological analysis was performed. Mann Whitney test was performed to evaluate clinical parameters between test and control group and Friedman test and Fisher test were adopted to evaluate intra group differences at different follow-ups. Student T-test was performed to compare clinical attachment level between the two groups. Significance level was set at p<0.05. No periodontal pathogens and no clinical attachment loss were found in the whole sample. A slightly higher plaque index and gingival inflammation were recorded in the test group in comparison to the controls.

Oral manifestations in paediatric patients with hepatobiliary diseases: a review

It is well known that greenish pigmentation of the teeth is seen in children following remission of severe jaundice and clinical and serum bilirubin, a degradation product of haemoglobin, may be permanently trapped in forming dental hard tissues causing discolouration and enamel and dentine hypoplasia. Neonatal jaundice is the most common cause of hyperbilirubinemia and pigmentation of the deciduous teeth is the consequence of this condition. Various hepatobiliary pathologies may have a clinical finding in the oral cavity; furthermore, oral manifestations of hepatic pathologies are not just limited to the pigmentation of the deciduous teeth but also the permanent dentition and the mucous membranes can be affected.

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.

Implant-safe test in patients with peri-implantitis

Matrix metalloproteases (MMPs) are a family of zinc-dependent endopeptidases, produced by numerous cell types including fibroblasts, endothelial cells, osteoblasts, macrophages, lymphocytes and neutrophils, and capable of degrading different components of the extracellular matrix (ECM), but also cytokines, receptors and factors that regulate cell motility (1). MMPs represent the main proteolytic enzymes involved in the remodeling and degradation of the components of the extracellular matrix, in the modifications of interactions between cells, and those between cells and the ECM that regulate, for example, the processes of cell migration (2, 3). Due to these characteristics, the MMPs are involved in numerous physiological processes (angiogenesis, apoptosis, bone remodeling, wound repair, morphogenesis, inflammation, immune response) response to incongruous conservative and endodontic treatments (29-37, 46, 47) and pathological (periodontitis, arthritis, cancer, cardiovascular diseases, neurological diseases, osteoporosis etc.) (5). Metalloproteinase-8 (MMP-8) is an important indicator of tissue decomposition and is present in case of periodontitis in the gingiva and in the sulcular fluid. The concentration of MMP-8 in the sulcular fluid of patients with chronic or aggressive periodontitis is higher than that found in healthy patients (4, 6). MMP-8 was also significantly correlated with gingivitis index, plaque index, probing and clinical attack level. For this reason, the concentration of MMP-8 in the sulcular fluid could constitute a useful index to monitor periodontitis activity and be used to predict disease progression, also because of orthodontic treatments (38-45). Patients with periodontitis had elevated concentrations of MMP-8 salivary compared to patients with gingivitis and healthy tissues. Through this experimentation we wanted to demonstrate the real effectiveness of using this test as a means of preventing peri-implant pathology.

Allergic manifestations to local anaesthetic agents for dental anaesthesia in children: a review and proposal of a new algorithm

AIM

The purpose of this review was to evaluate allergic manifestations to dental local anaesthetic (LA) in children and to propose an algorithm for the diagnosis of LA allergy, in order to minimise the number of children who are wrongly categorised as allergic.

MATERIALS AND METHODS

A comprehensive literature survey was performed on LA allergy in children before a dental treatment. In proposing a diagnostic algorithm, evidences from literature have been integrated with personal experience.

RESULTS

Data from literature showed that overall less than 1% of young patients tested for suspected LA have a positive subcutaneous test and have a positive diagnosis. A complete diagnostic procedure should include: clinical history reported by patients, objective medical records, results of skin tests and provocation test with the suspected drug. Patients with negative skin tests should perform a subcutaneous challenge, while patients with a positive skin test should be tested for a different unrelated LA.

CONCLUSION

Allergy to LA is a rare condition. A complete diagnostic algorithm will allow to identify paediatric patients correctly.

Investigation of periodontal status in type 1 diabetic adolescents

AIM

The purpose of this study was to evaluate the effects of type 1 diabetes and the possible role of metabolic control on the periodontal status of diabetic adolescents.

MATERIALS AND METHODS

Three groups of 40 patients each were examined: diabetic subjects with a good metabolic control (well controlled WC) (glycated haemoglobin HbA1c ≤ 7%) (20 males and 20 females; mean age: 14.1 ± 1.5 years); diabetic subjects with poor metabolic control (poorly controlled PC) (glycated haemoglobin HbA1c> 7%) (20 males and 20 females; mean age: 14.5 ± 1.3 years); and patients in good general health, which constituted the control group (20 males and 20 females; mean age: 14.1 ± 1.2 years). For each subject, a periodontal evaluation was performed and the following parameters were assessed: Plaque Index (PI), Gingival Index (GI), Bleeding on probing (BOP), Probing Depth (PD), Clinical Attachment Level (CAL). Chi-square was used to compare categorical variables. Kruskal-Wallis one-way ANOVA by ranks was used to compare the quantitative variables (GBI, PD) among the 3 groups. Post-hoc comparison between pairs of groups was assessed by Wilcoxon's rank sum test, with a downward adjustment of the alpha level to compensate for multiple comparisons.

RESULTS

The levels of PI in WC subjects (1.9 ± 0.8) and in PC subjects (2.1 ± 0.6) were significantly higher compared to healthy subjects in the control group (0.8 ± 0.7) (p <0.0001). Similarly, the GI in both PC (1.9 ± 0.8) and WC subjetcs (1.7 ± 0.9) was significantly higher (p <0.05) compared to controls (0.9 ± 0.8). GBI in the PC (60.2 ± 23.6%) and the WC (57.4 ± 22.5%) groups was significantly higher compared to healthy subjects (35.9 ± 18.7%) (p <0.05). The PD parameter was found significantly higher (p <0.05) in the PC group (26.7 ± 12.6) and WC group (23.5 ± 11.3%) compared with controls (8.3 ± 6.2%). Regarding the CAL, no significant differences were found between the groups (p> 0.05). In addition, the comparisons between groups PC and WC were not statistically significant (p> 0.05).

CONCLUSIONS

Adolescents affected with type 1 diabetes show a higher level of bacterial plaque, gingival inflammation with bleeding on probing and probing depth, compared to healthy subjects. There were no significant changes with regard to the accumulation of plaque and periodontal status among diabetic patients both with good control and with poor metabolic control.