Octogenarians Are the New Sexagenarians: Cruciate-Retaining Total Knee Arthroplasty Is Not Inferior to Posterior-Stabilized Arthroplasty in Octogenarian Patients

Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive cohorts for a total of 96 implants in patients aged 80 years or over. The first cohort consisted of 59 consecutive cemented PS cases, while the second cohort comprised 37 consecutive cemented CR cases. The decision to either perform a PS or CR arthroplasty was taken based on preoperative magnetic resonance imaging and intraoperative findings. The clinical evaluation entailed evaluating each patient’s visual analogue scale for pain (VAS), range of motion (flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated the day before surgery (T0) and at two consecutive follow-ups at least 1 (T1) and 2 (T2) years after surgery. Implant survival was calculated using the Kaplan−Meier method. Results: Both groups showed statistically significant improvements at each follow-up compared with the preoperative values (p < 0.05). The CR group showed a higher flexion degree at T1 than the PS group (116.14 ± 5.57° versus 113.16 ± 7.66°; p = 0.048). No differences were found between the two groups regarding survival rate (chi-squared test p-value = 0.789). Three failures were noted in the CR group, while there were four in the PS group. Conclusions: This prospective clinical study demonstrates that CR and PS TKA had similar clinical outcomes in octogenarians with regard to knee function, postoperative knee pain, and other complications. Prosthesis survivorship for CR and PS TKA were both satisfactory, and in selected octogenarian patients, CR TKA should always be considered because of the reduced surgical time.

[Clinico-pathologic features of occupational allergic eczema]

The Authors study the fundamental role of individual predisposition in professional eczema. They remark the relation between medicine and dermatology and, particularly, the possible interference of immediate hypersensibility.

Attitudes and knowledge about transplantation in dialyzed patients requesting a cadaveric kidney graft

AIM

Eighty-two patients answered a multiple choice questionnaire aimed at identifying their presumed and actual knowledge regarding transplantation, given immediately before evaluation by our transplant team for inclusion on our kidney transplant waiting list.

SUBJECTS, METHODS AND RESULTS

A total of 78% stated that they had no or incomplete knowledge of transplantation and 22% were very well informed. The mean score for technical knowledge of transplantation (duration, requirement for removal of native kidneys, possibility of obtaining a second transplant, duration of immunosuppressive therapy and duration of the risk of rejection) was 3.1 +/- 0.15 SEM (maximal possible score 5), that for risk knowledge (risks of infections, unpleasant side effects, hypertension, diabetes mellitus, viral infections and cancer) was 1.4 +/- 0.15 (maximal possible score 6). A total of 23% knew that the spouse could donate a kidney, 74% stated that only a blood relative could and 3% that living donation was impossible.

CONCLUSIONS

There is scarce knowledge about transplantation, especially with regard to the risks and living donation.

Influence of donor age on cadaver kidney graft function and survival: univariate and multivariate analyses

The influence of donor age on the outcome of kidney transplantation (TX) was evaluated in 169 patients who received a primary cadaver kidney transplant at our center between September 16, 1984, and December 31, 1990. All the patients received cyclosporin A as part of the immunosuppressive protocol. Patients were grouped according to donor age: low donor age (LDA; donor age range 12-25 years), medium donor age (MDA; range 26-50 years) and higher donor age (HDA; range 51-66 years). There were no differences between groups in graft and patient survival, and multivariate analysis did not show any effect of donor age on those parameters. Proteinuria/day and number of rejection episodes did not differ between groups either. Immediate diuresis was more frequent in group LDA than in the other two groups (73.8, 54.7 and 57.1%, respectively; p < 0.05) and immediate diuresis resulted as a weak positive prognostic factor for graft outcome at multivariate analysis (p = 0.05). At both univariate and multivariate analyses, donor age resulted inversely correlated with creatinine clearance (CCr) at every period after TX but the 5th year, with r2 from 0.12 to 0.23 (p < 0.01). The LDA group had significantly better CCr than the HDA group at every period after TX but for the 5th year (the MDA group behaved intermediately).(ABSTRACT TRUNCATED AT 250 WORDS)

[Dermatopathies in those engaged in domestic work and related risks]

The AA., considering the skin diseases in the subjects employed in the domestic work and similar activity, in a more ample table of general medicine, produced a contribution to the study of etiopathogenetic and nosographic problems. They have estimated the role of the individual predisposition and the etiopathogenetic, chemical, physical, biotic, complex factors. They pointed out the various nosographic, skin expressions in range of contact irritant dermatitis, of contact allergic eczema, skin abrasion, of dermatitis by physical agents, of urticaria, of dermal alterations by infectious and parasitic agents and of various dermal, morbid expressions by chemical agents. They reported the direct experience of personal casuistry and called attention on multiple aspects of preventive medicine.