166 Dual Mobility for Total Hip Arthroplasty Revision Surgery: A Systematic Review and Metanalysis

Dual Mobility (DM) implants provide greater stability especially in Revision Total Hip Arthroplasty (R-THA) when compared to primary THA. Aim: to identify the current evidence regarding outcomes of DM in R-THA when compared to fixed-bearing (FB) implants.

Review in accordance with PRISMA guidelines. Structured electronic searches. Primary outcome measure: dislocation rate following R-THA. Secondary outcome measures: implant survival, aseptic loosening, infection rate. Studies' methodology quality assessed using MINORS criteria.

All articles published from 2016 to December 2019 included. 1777 R-THAs were reported (49.9% with DM acetabular component, 50.1% with FB component). Sample size: 67-426 patients. Mean age: 57-73. Mean follow-up period: 12-60 months. Significant risk ratio of 1.08 [1.05, 1.12] (95% CI, I2 = 37%, P < 0.00001) with statistically significant difference between the two groups in favour of DM implant. Statistically significant difference in favour of DM group with respect to dislocation rate (risk ratio 0.22, 95% CI; P < 0.00001) and aseptic loosening (risk ratio 0.51, 95% CI; P < 0.05). No statistical difference between the groups on risk ratio for infection 0.94 (95% CI; P = 0.85).

DM implants are beneficial in R-THA when compared to FB implants. However, one needs to balance the benefits of using DM implant considering the patient’s clinical conditions and the costs involved.

169 Literature Review on Efficacy of Manual Therapy in The Conservative Treatment of Adolescent Idiopathic Scoliosis (AIS)

AIS is a common condition whose conservative options usually involve physical therapy. Manual therapy can be part of an adequate conservative strategy due to his ability to improve range of motion and decrease muscle tone and pain. However, his indications and efficacy remain controversial. What is the current evidence on indications and efficacy of manual therapy in the treatment of AIS?

Customized structured electronic searches: PubMed, Cochrane. Key terms: AIS manual therapy, AIS manipulative therapy, AIS mobilization exercises. 17 works included.

5 case reports, 3 case series, 2 group-control studies, 3 narrative reviews, 4 systematic reviews. Complications:0. Reviews suggested that manual therapy is a promising option if in adjunct to physical therapy exercises. Prevention of curve progression and better spine flexibility are often achieved. It remains unclear whether this should be attributed to physical therapy, manual therapy, or combination of both. Lacks in methodology leave room for uncertainty.

Only few papers analyse the indications and efficacy of manual therapy in treatment of AIS. The current evidence suggest that manual therapy is a promising beneficial treatment strategy for AIS with conservative indications, especially if in conjunction with physical therapy. This is further supported by absence of reported complications. Further research with better methodology is needed.

163 Audit cycle on the formal introduction of a standardised orthopaedic trauma patients’ admission pro-forma: the first Italian experience

An internationally recognised issue of general district hospitals is the accuracy and completeness of the admission documentation, particularly in a trauma setting. We built and formally introduced a Hospital Trust Wide admission pro-forma for orthopaedic trauma patients.

An Audit looking into the quality and completeness of the admission documentation for orthopaedic trauma patients was carried out at a single Hospital Trust in December 2017. This was followed by a second round Audit with formal implementation of our new clerking pro-forma.

Compliance was 94% overall. The documentation was incomplete in 7% of the cases. Delays of patients’ treatment caused by lack of documentation or written plan/instructions was recorded in only 3% of the cases. Satisfaction questionnaire: excellent 55%, good 42%, fair 7%, poor 1%.

The pro-forma provides all relevant information needed to fully assess orthopaedic trauma patients and plan the appropriate management. His utilisation facilitates completeness of documentation with a standardised approach. This is a unique work on the introduction of a standardised clerking pro-forma for the admission of orthopaedic trauma patients with excellent results in terms of compliance and improvement of patients’ care. Our study seems to be a quality improvement intervention with potentials of becoming a milestone for further improvements.

168 Interprosthetic Fractures of The Femur: A Literature Review

Increasing age expectations and number of joint replacement procedures have made interprosthetic femoral fractures (IFF) a progressively more common diagnosis and a challenge for surgeons. A gold standard and universally accepted classifications and guidelines do not exist yet.

Customized structured electronic searches performed in PubMed database. Relevant key terms: IFF, classification interprosthetic fracture, peri-implant femoral fracture, biomechanics interprosthetic femur fracture, radiographic femur fracture, risk factor IFF. 42 articles finally included (up to 2019).

High morbidity and mortality linked to IFF. Standardised classifications, management guidelines and surgical approaches are not available yet. Periprosthetic classification systems are still utilized even if not entirely appropriate. High rate of failure is related to thinner cortical bone, larger medullary canals and variable stresses depending on the distance among implants. High complication rates in all studies. Stress risers and implant stability based on fracture patterns and stress forces. Several surgical options with no uniformity. Less invasive surgical procedures are associated to reduction of metalwork failure rate, better preservation of vascularization and better functional-clinical outcomes.

Lack of specific classification systems and management guidelines. Several surgical options are available with no uniformity of results. Attention to stress risers and preservation of bone stock and vascularization are key aspects for better results.

165 A Review of The Current Literature on LMWH Administered at Different Times in Relation to MOS (Major Orthopaedic Surgery): Assessment of The Safety and Efficacy of The Different Proposed Strategies

Nowadays venous VTE represents an important perioperative and postoperative complication in patients undergoing elective Major Orthopedic Surgery (MOS). There are significant discrepancies between clinical practice, international recommendations, and published guidelines. Although thromboembolic events may be less common these days than in the past, they can still lead to serious medical complications. Therefore, most patients undergoing MOS procedures are provided with one of the thromboprophylactic treatments. The optimum timing of LMWH administrations remains debated.

Customized structured electronic searches in PubMed and Cochrane database. Meta-Analysis, Randomized Controlled Trials, Systematic Reviews on different strategies of the use of LMWH for MOS.

Studies on prophylactic regimens showed that subcutaneous LMWH plays a key role in the management of thromboprophylaxis in MOS. However, some controversies still stand. Among those most relevant, it remains unclear whether to start thromboprophylaxis before or after MOS to better balance the risks of clotting and bleeding.

With regards to different times of LMWH administration, there is no convincing evidence that starting prophylaxis 12 hours preoperatively is associated with lower risks of VTE compared to prophylaxis started 12 to 24 hours postoperatively. Furthermore, it seems that the most safe and efficient LMWH regimen is the one called “Just-in-time” (LMWH started 6 hours post-op).

Prevalence of fibrinous pericarditis in heavy pigs (170 kg) and its association with other pluck lesions at slaughter inspection

This study determined the prevalence of fibrinous pericarditis and its correlation with other pluck lesions in 658 batches of pigs from 236 intensive farms located in Northern Italy over a 12-month period. All pigs were slaughtered at 170 kg, and a total 57,943 plucks (approximately 90 pigs/batch) were individually assessed for the presence of fibrinous pericarditis, pneumonia, pleuritis, and liver milk spots. There was no seasonal variation in the prevalence of plucks with fibrinous pericarditis and annual mean prevalence was 5.6% (range, 0-26.3% at batch level; median, 4.71%). Farm of origin, evaluated as a random effect, accounted for 17.7% batch variation. Batches with a high prevalence of fibrinous pericarditis (≥7.7%) had higher prevalences of pleural, pulmonary, and liver lesions than those with low-middle prevalence of pericarditis; high prevalence of pericarditis was predictive of pluck lesions (P < 0.001). There was a highly significant association between fibrinous pericarditis and severe pleuritis, and 55% of plucks with the highest score for pleuritis also had ongoing fibrinous pericarditis, with a positive correlation at batch level (r² = 0.52; P < 0.001). The co-existence of pericarditis and pleuritis (73.5% of all pericarditis cases) suggests that pleuritis plays a role in the pathogenesis of pericarditis. Based on the prevalence fibrinous pericarditis, and the role of pleuritis as a potential comorbidity, abattoir data on pluck lesions with accompanying farm history, could aid the interpretation and management of on-farm health problems, and inform diagnostic protocols.

Neurolysis versus anterior transposition of the ulnar nerve in cubital tunnel syndrome: a 12 years single secondary specialist centre experience

BACKGROUND

Various conservative treatments and surgical techniques have been reported in the literature as efficient and feasible measures to treat the cubital tunnel syndrome. However, there has been no consensus on the best management of the syndrome, and uniform standardised guidelines have not yet been accepted or introduced. With our study, we present our experience on the clinical efficacies and outcomes of the surgical techniques of neurolysis alone and neurolysis associated with ulnar nerve anterior transposition at the elbow joint in patients with neuropathic symptoms due to cubital tunnel syndrome.

MATERIALS AND METHODS

A total of 107 patients with cubital tunnel syndrome were retrospectively enrolled, surgically treated and followed up in our study. The cohort was divided into two groups: 41 patients treated only with neurolysis of the ulnar nerve (Group 1), and 66 patients treated with neurolysis and anterior transposition (Group 2). Of the participants, 35 were women and 72 were men. The average age was 54 years. Significant comorbidities were preoperatively diagnosed in 26 patients. Conservative measures had been considered, followed by surgical management if appropriate. A pre-op electromyography was performed for all patients. All surgical procedures were performed by the same surgical team. A post-operative follow-up was carried out, and the findings were recorded. The "McGowan" and "Wilson and Krout" classifications and the DASH score were used. A satisfaction questionnaire was administered to all patients post-operatively at 2 weeks).

RESULTS

Ulnar nerve neurolysis and anterior transposition surgery were all successfully performed. Overall complications were post-operative haematoma (8%) and wound problems (5%). In 6% there was recurrence of symptoms. In 11% there was no improvement of symptoms. Pre-op McGowan classifications for groups 1 and 2 were 0% and 0% (grade 0), 21% and 24% (grade 1), 46% and 44% (grade 2), and 33% and 34% (grade 3), respectively. The post-op McGowan classifications were 34% and 37% (grade 0), 39% and 40% (grade 1), 23% and 20% (grade 2), and 4% and 3% (grade 3), respectively. The post-op Wilson and Krout classifications were 45% and 46% (excellent), 26% and 28% (good), 19% and 15% (fair), and 10% and 11% (poor), respectively. The DASH score means for groups 1 and 2 were 14.8 and 15.2, respectively. A negative Froment's sign was present in 73.2% and 71.2%, respectively. In Group 1, the post-op satisfaction questionnaire scores were 0 for one patient, 1 for four patients, 2 for seven patients, 3 for ten patients, 4 for twelve patients and 5 for seven patients. In Group 2, the post-op satisfaction questionnaire scores were 0 for three patients, 1 for nine patients, 2 for twelve patients, 3 for fifteen patients, 4 for eighteen patients and 5 for nine patients.

CONCLUSIONS

In our experience, the surgical technique to treat the cubital tunnel syndrome most efficiently and feasibly has not yet been established in terms of indications and outcomes. This is supported by the data present in the international literature. Good and similar results were obtained with neurolysis alone and neurolysis associated with anterior transposition of the ulnar nerve (in line with the international data). In conclusion, more high-quality studies of greater statistical power are needed to provide a consensus on the surgical indications and techniques to treat the cubital tunnel syndrome and to establish internationally standardised guidelines.

Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery

PURPOSE

Enhanced recovery after surgery (ERAS) protocols aim to develop peri-operative multidisciplinary programs to shorten length of hospital stay (LOS) and reduce complications, readmissions and costs for patients undergoing major surgery. The aim of this study is to evaluate the effects of an ERAS pathway for total hip (THR) and knee (TKR) replacement surgery in terms of length of stay, incidence of complications and patient satisfaction.

METHODS

Patients scheduled for hip and knee replacement were included in the study. The main aspects of this program were preoperative education/physical therapy, rational choice of the anesthetic technique, optimization of multimodal analgesia, reduction of incidence of urinary retention and catheterization, active management of risk for blood loss and deep vein thrombosis, and early mobilization of the patients. All patients had 6 months predicted and planned follow-up appointments. Primary outcomes of the study were the mean LOS, readmission and complication rates. Secondary Outcomes were percentage of Knee Injury & Osteoarthritis Outcome Score (KOOS) and Hip disability and Osteoarthritis Outcome Score (HOOS) increase and patient's satisfaction.

RESULTS

We consecutively enrolled 207 patients who underwent total joint arthroplasty, 78 hip and 129 knee joint replacements. The mean length of stay (LOS) for patients of the two groups was 4.3 days for ASA 3-4 patients subjected to TKR and THR, in ASA 1-2 patients 3.6 days for TKR and 3.9 days for THR respectively. Postoperative satisfaction level was higher than 7 (very satisfied) in 94.4% of the cases. All patients were discharged home: 61.8% continued physical therapy in complete autonomy, 23.7% supported by a home-physiotherapist and only 14.5% needed the attendance to a physiotherapy center on a daily basis. The overall incidence of major complications was 3.4%.

CONCLUSIONS

The implementation of an ERAS program for hip and knee replacement surgery allows early patient's discharge and a quick return to independency in the daily activities.

LEVEL OF EVIDENCE

IV.

Experiences of Discrimination, Harassment, and Violence in a Sample of Italian Transsexuals Who Have Undergone Sex-Reassignment Surgery

The present study aims to provide an overview of experiences of discrimination, harassment, and violence in a sample of Italian transsexuals who have undergone sex-reassignment surgery (SRS). Lack of support for gender transition from family members was also assessed, before and after SRS. Data were collected in the context of a multicentric study (Milan, Florence, and Bari) on SRS outcome. Patients who underwent SRS were contacted and asked to fill out a questionnaire concerning experiences of discrimination, harassment, violence, and crime they might have experienced in previous years. Seventy-two participants took part in the research: 46 were male-to-female (MtF; 64%) and 26 were female-to-male (FtM; 36%). Thirty-six percent of the total sample (with no differences between MtF and FtM) experienced at least one episode of harassment, violence, or discrimination. The workplace was reported to be the social area with the highest risk of discrimination and harassment (22% of participants). Reports of more than one incident of discrimination, harassment, and violence characterized the majority of participants in the MtF sample. Compared with previous studies carried out in other countries, a much larger proportion of participants could count on a supportive family environment before and after transition. Our results show that Italian society at large is prejudiced against transsexuals, but at a more "micro" level, having a trans person as a family member might result in a protective and tolerant attitude.

Surface functionalization of acrylic based photocrosslinkable resin for 3D printing applications

The limited number of resins, available for stereolithography applications, is one of the key drivers in research applied to rapid prototyping. In this work an acrylic photocrosslinkable resin based on methyl methacrylate (MMA), butyl methacrylate (BMA) and poly(ethylene glycol) dimethacrylate (PEGDA) was developed with different composition and characterized in terms of mechanical, thermal and biological behaviour. Two different systems have been developed using different amount of reagent. The influence of every components have been evaluated on the final characteristic of the resin in order to optimize the final composition for applications in bone tissue engineering. The crosslinked materials showed good mechanical properties and thermal stabilities and moreover cytotoxicity test confirms good biocompatibility with no cytotoxic effect on cells metabolism. Moreover two different treatments have been proposed, using fetal bovine serum (FBS) and methanol (MeOH), in order to improve cell recognition of the surfaces. Samples threatened with MeOH allow cell adhesion and survival, promoting spreading, elongation and fusion of C2C12 muscle myoblast cells.

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Photocrosslinkable biocompatible resin for application in tissue engineering.

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Surface treatment to improve materials wettability.

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Myoblast spreading and elongation on photocrosslinked modified surfaces.

An automated method of content analysis for psychotherapy research: A further validation

OBJECTIVE

The aim of the study is to validate the ability of ACASM (Automated Co-occurrence Analysis for Semantic Mapping) to provide a representation of the content of the therapeutic exchange that is useful for clinical analysis.

METHOD

We compared the clinical case analyses of a good outcome psychodynamic therapy performed by a group of clinicians (n = 5) based on the verbatim transcripts (transcript-based analysis) with the clinical case analyses performed by another group of clinicians (n = 5) based on the ACASM representation of the same sessions (ACASM-based analysis). Comparison concerned two levels: the descriptive level and the interpretative level of the clinical case analysis.

RESULTS

Findings showed that, inconsistently with our hypothesis, ACASM-based descriptions of the case obtained worse evaluations than transcript-based descriptions of the case (on all 3 criteria adopted). On the contrary, consistently with our hypothesis, ACASM is undistinguishable from the verbatim transcripts as regards the case interpretation (on 2 out of 3 criteria adopted).

CONCLUSIONS

ACASM provides a description of the case that, though different from the one provided by the transcripts, enables clinicians to elaborate clinical interpretations of the case which approximate those produced by clinicians working directly on verbatim transcripts.

Spontaneous metastatic angiosarcoma of the tongue in a Wistar rat: morphological and immunohistochemical characterization

A primary angiosarcoma was found in the tongue of a six-week-old female Wistar rat, sacrificed for humane reasons during the course of a four-week toxicology study. At necropsy, a nodule protruding from the dorsal part of the tongue was found. The nodule displayed microscopically, irregularly shaped vascular spaces separated by collagenous stroma. The spindle-shaped endothelial cells showed pleomorphism, hyperchromatism, and low mitotic activity; large nuclei with one or more nucleoli were present. Multiple metastases were found in the lungs, and the morphology of the cells resembled that of the primary tumor. Immunohistochemically, the primary tumor and the lung metastases were positive for von Willebrand factor and vimentin. The diagnosis of tongue angiosarcoma metastasizing to the lungs was made on the basis of microscopic and immunohistochemical findings.

Prognostic prediction ability of postoperative multifocal ERG after vitrectomy for diabetic macular edema

PURPOSE

Diabetic macular edema (DME) causes visual loss in diabetic patients. Multifocal electroretinograms (mfERGs) have been used to assess macular function pre- and postvitrectomy for DME.

METHODS

A standard three-port pars plana vitrectomy with peeling of inner limiting membrane was performed in 25 eyes of 21 patients (13 male, 8 female) with DME. For each patient, visual acuity examination, measure of retinal thickness (using optical coherence tomography), and mfERGs were performed before and 1 week, 1 month, 3 months, and 6 months after vitrectomy.

RESULTS

Mean postoperative visual acuity was significantly improved (p<0.05, t test), with mean increase of 0.17 logMAR units; mean retinal thickness was significantly (p<0.001) decreased after surgery (from 537 microm to 298 microm). The increase of normalized amplitude of central ring was not significant; the mean P1 wave-amplitude increased from 0.33 to 0.40 mV; mean P1 wave-implicit time decreased 2.88 ms. We divided the patients into two groups: Group 1 (13 eyes), in which the visual recovery was less than 0.20 logMAR, and Group 2 (12 eyes), in which the visual recovery was greater than 0.20 logMAR. ERG results were statistically significantly different between the groups (p<0.025), when we consider the response recorded from the central ring. In Group 2 there is a marked reduction in implicit time of both ERGs waves, which was statistically significant for N1 wave (p=0.01). The changes of parameters of mfERG observed 6 months after surgery were consistent with those recorded just 1 week after surgery.

CONCLUSIONS

Multifocal electroretinogram can be useful to predict functional prognosis in patients with diabetes who underwent vitrectomy for diabetic macular edema.

Parathyroid gland carcinoma in a Wistar rat

An anaplastic carcinoma was found in one of the two parathyroids of a 2-year-old male Wistar rat, which was sacrificed at the end of a carcinogenicity study. Morphologically, it was characterized by the presence of nodular areas of pleomorphic and dense cells with numerous atypical mitoses and large regions of smaller and dark monomorphic cells devoid of mitoses and forming small cystic spaces. Local invasion of the capsule and pronounced compression of the parenchyma of the thyroid gland were observed. Immunohistochemically, the tumor was markedly positive for the parathyroid hormone and negative for the thyroid transcription factor. The proliferative activity was assessed by immunostaining the endogenous cell proliferation associated-antigen Ki-67, and the proliferating cell nuclear antigen. The diagnosis of carcinoma of the parathyroid was made on the basis of microscopic and immunohistochemical findings.

Mixed pituitary adenoma-gangliocytoma in a female albino rat

A mixed intrasellar pituitary adenoma-gangliocytoma was found incidentally in an aged female Sprague-Dawley-derived rat. The animal was killed at the end of a 104-week carcinogenicity study. At necropsy, the pituitary fossa was occupied by a large, hemorrhagic nodule compressing and displacing the base of the brain. The lesion consisted of large areas of a prolactin-secreting adenoma surrounding a central island of gangliocytoma. In the latter, ganglion-like cells of varying size exhibited, occasionally, beta-tubulin and neurofilament protein immunoreactivity in their perikarya, while their cell processes expressed intense neurofilament immunoreactivity. Accompanying satellite cells in the neuropil immunostained for glial acidic and S-100 proteins. To the best of our knowledge, the presence of mixed pituitary adenoma-gangliocytoma has not been previously reported in rats.

Pulmonary vascular sclerosis in an albino rat with leukemia

The animal investigated was a two years old male control Sprague-Dawley rat which died spontaneously during a carcinogenicity study. Post-mortem examination disclosed hepatic and splenic enlargement. At microscopical examination, massive leucaemic infiltration was observed in many tissues/organs, including bone marrow, spleen, liver and renal blood vessels. A very unusual finding was observed in the lung, consisting of scattered micronodules which replaced most of the lung parenchyma. They contained collagen, displaying a somewhat circular distribution at the periphery of the lesions, fibrin, leukemic cells and fibroblasts. Immunostaining for desmin revealed the presence of smooth muscle fibers within the nodules, while staining for elastic fibers showed clearly that the internal and external elastic membranes were identifiable within the nodules. The diagnosis of pulmonary vascular sclerosis was made on the basis of microscopical and immunohistochemical findings.

Spontaneous choroid plexus carcinoma in an albino rat

Neoplasms of the choroid plexus are very rare in the rat, and few cases have been described. We report on a spontaneously occurring choroid plexus carcinoma arising from the fourth ventricle in a 2-year-old female albino rat. The infiltrative growth was observed in the adjacent brain parenchyma, in the wall of the vessels of the circle of Willis, in the perivascular space of VIRCHOW and ROBIN and in the leptomeninges. Immunohistochemical investigations demonstrated positive staining for cytokeratin (Lu-5) indicating that choroid plexus tumors in the rat express epithelial differentiation. The diagnosis was made on the basis of microscopical and immunohistochemical findings.

Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation

BACKGROUND/AIMS

The purpose of this study was to determine the effects of a high-fiber diet and fluid supplementation in patients with functional chronic constipation.

METHODOLOGY

One hundred and seventeen patients with chronic functional constipation (aged 18-50 years) were randomly divided into two treatment groups. For two months both groups consumed a standard diet providing approximately 25 g fiber per day. Group 1 (58 patients) was allowed ad libitum fluid intake, while Group 2 was instructed to drink 2 liters of mineral water per day. Compliance was monitored throughout the study and results were assessed in terms of bowel-movement frequency and laxative use.

RESULTS

Fiber intake was similar in the two groups, while total daily fluid intake in Group 2 (mean 2.1 liters) was significantly greater than that of Group 1 (1.1 liters)(p < 0.001). In both groups, there were statistically significant increases in stool frequency and decreases in laxative use during the two-month trial, but both changes were greater in Group 2 (stool frequency: p < 0.001 vs. Group 1; laxative use: p < 0.001 vs Group 1).

CONCLUSIONS

A daily fiber intake of 25 g can increase stool frequency in patients with chronic functional constipation, and this effect can be significantly enhanced by increasing fluid intake to 1.5-2.0 liters/day.

Spontaneous malignant craniopharyngioma in an albino rat

Craniopharyngioma is a rare neoplasm in the rat, and few cases have been described. These lesions are thought to originate from squamous cell remnants of Rathke's pouch, an evagination of primitive stomatodeum. This neoplasm is usually locally invasive, and neither cranial nor extracranial metastases have been described. A spontaneously occurring malignant, metastasizing craniopharyngioma arising from the neurohypophysis was detected in a 2-year-old male albino rat. The infiltrative growth was observed in the wall of the vessels of the circle of Willis, in the perivascular space of Virchow and Robin, in the submeningeal space near the hypothalamus, through the fissura chorioidea, in the medulla oblongata, and along the optic nerve into the periocular region. Metastases were detected in the thalamus and hippocampus. The diagnosis was made on the basis of microscopic, immunocytochemical and ultrastructural findings.

Use of nonsteroidal anti-inflammatory drugs in cancer

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in cancer, yet they are also responsible for many, often serious, adverse effects. This review examines the various mechanisms through which NSAIDs work. It looks at the experience built up in using NSAIDs in cancer pain in general, but then particularly examines whether the evidence available supports the claim often made that these drugs have a specific role in relief of pain from bony metastases. Criteria for choosing one NSAID over another, including adverse effect profiles, efficacy and tolerability, are considered, as are methods for improving the safe use of these drugs.

Food intolerance and allergy

Various food products can trigger disagreeable symptoms in certain people which are generally described as food intolerances. Given the complexity of the subject and the fact that a great deal remains to be learned about the mechanisms responsible for these reactions, the paper attempts to clarify the whole question. Food intolerances have been classified in various ways by different authors. The present paper considers only the three major groups: those due to enzyme deficiencies, those due to an allergic mechanism and those caused by histamine-release or histamine-releasing food products.

Spontaneous osteosarcoma of the meninges in an albino rat

A search of the rat tumor literature revealed no papers on naturally occurring primary osteosarcoma of meninges. In humans, this tumor, arising primarily from the meninges, is unusual; only two cases have been reported. We report on a spontaneously occurring osteosarcoma arising from meninges in a 2-year-old female albino rat. The diagnosis was made on the basis of gross, microscopic, and ultrastructural findings. The diagnosis of this neoplasm is supported by the fact that a primitive mesenchymal cell in the meninges is capable of giving rise to a wide variety of neoplasms.

Plasmatic values of some antioxidant vitamins on healthy children

The serum of 60 healthy children aged 1-16 years was analysed for vitamin A, vitamin E, beta-carotene and cholesterol contents. The study group consisted in 33 females and 27 males, living in the area of Rome, Italy. The mean serum values are 37.2 +/- 12.3 micrograms/dl for beta-carotene and 0.83 +/- 0.25 micrograms/dl for vitamin E. According to sex distribution, mean values of studied micronutrients levels are higher in boys than in girls, but not significantly. The cholesterol does not show alterations among the different groups in relation to sex or age. Vitamin A and vitamin E serum levels increased with age. Vitamin E level is strongly correlated with total cholesterol serum value. The beta-carotene increases significantly in the age group from 7 to 12 years and this value holds then steady until the age of 16.

The importance of vitamins in relation to the presence of heavy metals in food

Heavy metals are among the most widespread potential chemical contaminants in the environment and may be transferred to man through diet. Cadmium, mercury and lead are those which are most dangerous to human health. The nutritional status of exposed subjects is of particular interest in the study of the biochemical and morphological changes linked to heavy metal intoxication. Some vitamins play an efficacious protective role through direct or indirect mechanisms which interfere with the intestinal absorption of heavy metals by increasing urinary excretion or creating a synergic effect on the chelating element. It is important to underline the importance of an adequate vitamin intake in the prevention and treatment of cadmium, mercury and lead intoxications.

[Correlations between folic acid, human papilloma virus (HPV) and cervix neoplasms]

The study aimed to verify the probable correlation between the incidence of cervical cancer and the presence of human papilloma virus (HPV) in relation to a state of folic acid hypovitaminosis. In this context, however, it is important not to overlook the important protective role played by vitamins A and C in cancer prevention, as mentioned in the paper. Numerous authors agree that this is a real finding in cervical pathology, as shown in our research, even if folic acid therapy does not alter the course and prognosis of disease. On the contrary, low blood levels of folic acid appear to increase the risk of contracting the disease. Extensive and radical surgery therefore appears to be even more justified in order to increase the probability of recovery on the operating table in view of the irrational and inexorable progress of this pathology, especially if metastases are already present.

The role of dietary, genetic and hormonal factors in the development of breast cancer. Importance of adequate vitamin intake. Clinical and instrumental prevention

It is now recognised that inadequate diet can trigger the onset of various (cardiovascular, metabolic, neoplastic) diseases. In the field of cancer, in particular, researchers have become increasingly convinced over the years not only of the link between diet and tumour incidence, but also that there may be a hormone factor that increases the likelihood of certain conditions (e.g. breast cancer). Research is also paying increasing attention to the possibility of a genetic factor. In any event, there can be no doubt that a good, balanced diet supplemented by an adequate intake of vitamins (especially A, E, D, C, B6) combined with periodic clinical and instrumental examinations will significantly reduce the incidence of this and other conditions.

[Variations of atrial natriuretic peptide in hemodialysis]

In this study the variations of atrial natriuretic factor (ANF) in hemodialyzed patients were correlated to blood volume and atrial cavities diameter. At the end of the dialytic process we observed a significant reduction of ANF plasma levels and body weight. This data established the crucial role of blood volume in the regulation of ANF secretion-suppression. In addition the fluctuations recorded in the heart atrial diameters reveal their sensitivity to blood volume variations induced by hemodialysis.

Amino acids for dialysis patients

Calorie/protein malnutrition is a common problem among dialysis patients. A study was designed to determine the value of adding a mixture of amino acids to the diet of 36 patients (mean age, 42 years) who had been receiving triweekly hemodialysis for periods ranging from 1 to 13 years. For 1 month the patients received a mixture containing 8 essential and 9 nonessential amino acids. Before treatment, the mean levels of most amino acids were lower in the patients than in a control group of 18 healthy subjects (mean age, 43.5 years). Significant increases in most amino acids were noted in the patients after treatment, including marked increases in tryptophan, valine, leucine, isoleucine, lysine, threonine, taurine, aspartic acid, serine, histidine, tyrosine, and alanine. The essential:non-essential and tyrosine:phenylalanine ratios increased significantly during treatment. Meanwhile, serum hematocrit levels increased and phosphorus and parathormone levels decreased significantly; no changes were noted in urea, creatinine, or total protein levels. The patients reported an improvement in health and in tone and mood after treatment. The results confirm the value of dietary supplementation for dialysis patients.

Is there really any significant link between a high fat diet and breast cancer?

The possibility of a connection between a diet high in saturated fatty acids and breast cancer is examined and is found to lack conclusive proof as yet. Prevention by means of early clinical and instrumental examinations appears to offer a greater chance of success.

Concomitant ceco-appendicular and urinary tuberculosis. Description of two rare cases: physiopathological and diagnostic remarks

Two cases of specific tubercular processes in the ceco-appendicular zone and the urinary system in men aged 25 and 30 years are described. Both patients reported abdominal pain and persistent fever that did not respond to treatment. Surgery revealed ulcerated appendix, intraperitoneal serous exudate, ascitic liquid, peritoneal ulcerocaseous nodules, and fibrous adhesions. Histological sections revealed a tubercular puchet in the ceco-appendicular zone. Subsequent x-ray test in response to reports of frequent painful urination showed specific lesions in the papillae and renal ureteral ampullae, and urine cultures were positive for Koch's bacillus. Treatment with streptomycin, followed by isoniazid, rifampicin, ethambutol, and morinamid for 2 years, was effective.

[The importance of some physiopathological parameters in the development of diabetic nephropathy]

Causes contributing to diabetic nephropathy evolution are many also if the primary is the hyperglycemia. This study treats many parameters (arterial hypertension, albuminuria, etc.) but focuses primarily the importance of intraglomerular pressure, glomerular hypertrophy and anomalies of elements constituting the glomerulus in the pathogenesis of this complex pathology, which diagnostic stage of is fundamental for the institution of a correct and lasting therapeutic approach.

[Anticholinergics and cytoprotectants in gastroduodenal ulcer]

The authors evaluate the present curative indications of anticholinergic and cytoprotector drugs in the treatment of ulcer disease. They conclude that the therapeutic relevance of mucosal protective agents is limited in comparison with the major gastroactive medications especially in the treatment of peptic ulcer disease.

Few aspects of bacterial colonies in the stomach during the treatment with acidoinhibitors

On this paper are stated the reasons why a prolonged gastric-acid inhibition causes bacterial and/or mycotic colonizations in the stomach. Instead, the surgical operations, that now became obsolete, are only casual occasions of intragastric colonizations. This paper ends with some rules to be followed in order to avoid risks connected to a pH increase, and with a short hint to two important vitamins (i.e. Vitamin C and Vitamin E) for the complementary treatment of ulcerous patients.

[Evaluation of protein compliance in patients with chronic renal insufficiency undergoing hemodialysis treatment]

The majority of hemodialyzed patients manifests a proteic malnutrition. This metabolic status is a main factor in the morbidity and mortality of such subjects. It is therefore necessary to dispose of more adequate diagnostic instrumentation to offset this highly invalidating condition. The ongoing and severe evaluation of the nutritional status by means of up-to-date and sophisticated techniques such as antroproteic parameters may contribute to the maintenance of good conditions while refraining the evolution of various and often lethal complications induced by chronic renal failure.

[Omeprazole and misoprostol in acute gastroduodenal pathology. Physiopathological and therapeutic considerations in a surgical study]

In a clinical study on acute gastroduodenal pathology, the authors checked the therapeutical efficacy of Omeprazole and Misoprostol in comparison with H2-Antagonists. The study shows how Omeprazole could reduce to a half the treatment period necessary for H2-Antagonists to determine duodenal ulcer healing. Compared with these drugs, Omeprazole represents a real therapeutical progress. However, Omeprazole did not change the actual indications for surgical treatment in gastroduodenal ulcer. In drug-induced erosive gastritis treatment, Misoprostol proved to be unable to replace H2-Antagonists advantageously.

[Angiocardiographic evaluation of the left ventricular function in adult and pediatric subjects with interatrial defect of the ostium secundum type]

In order to assess left ventricular function in adults and children with ostium secundum atrial septal defect (ASD), 42 patients were examined by hemodynamic and angiocardiographic techniques. Patients were divided into three groups: Group I, 18 patients (mean age 42 years) with ASD; Group II, 14 patients (mean age 9 years) with ASD; Group III, 10 patients without cardiopathies who represented the control group. The following parameters of ventricular function were assessed: left ventricular end diastolic volume, global and regional left ventricular ejection fraction, left ventricular telediastolic pressure, mean pulmonary artery pressure, the ratio between pulmonary flow and systemic flow (QP/QS). Group I patients showed higher values of left ventricular end diastolic pressure and mean pulmonary artery pressure (16 +/- 0.6 mmHg; 33 +/- 1.5 mmHg) in relation to those of Group II (5.1 +/- 0.4 mmHg; 14 +/- 1.4 mmHg) and Group III (8.1 +/- 0.5 mmHg; 18 +/- 1.6 mmHg). In both cases the difference was statistically significant (p less than 0.001). A significant difference (p less than 0.05) was also noted in the incidence of mitral valve prolapse between patients in Group I and II. There was no significant difference (p = NS) however, between overall ejection fraction values in the three groups of patients; a lower regional ejection fraction (postero-basal segment) was recorded in Group I patients with mitral valve prolapse in comparison to patients in the other two groups (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

As regards to the immunosuppressive treatment in kidney transplant. Possibilities and limits

The Authors deal with the immunosuppressive drugs administered to kidney-transplant receiving. The point out the complexity of the utilized pharmacological schemes, underlining the metabolic and immunologic iatrogenic effects brought about by this therapeutic iter, which should not neglect the clinical conditions of the patient.

Correlation between angiographic success and functional improvement assessed by exercise test following percutaneous transluminal coronary angioplasty

Sixty-one consecutive patients with stable effort angina and single vessel disease underwent successful (reduction of coronary stenoses by greater than or equal to 20%) percutaneous transluminal coronary angioplasty (PTCA). Anatomical results were analysed on the basis of functional evaluation obtained by exercise test (ET) 1 week before (pre-PTCA) and within 1 month after (post-PTCA) PTCA. Total exercise duration and maximal double product significantly increased after PTCA (4.5 +/- 1 min vs 6.9 +/- 1.5 min, p less than 0.001 and 14.1 +/- 3.6 x 1000 mmHg x bpm vs 18 +/- 4.2 x 1000 mmHg x bpm, p less than 0.001). Pre-PTCA ET was positive in 43 patients (70%) and post-PTCA ET in 15 (24%). In patients with post-PTCA positive ET, mean stenosis diameter reduction was significantly lower than that obtained in patients with negative post-PTCA ET (29.6 +/- 8.9% vs 61.1 +/- 18.8%, p less than 0.001). In conclusion, PTCA improved exercise tolerance in the majority of patients with myocardial ischemia, however the definition of anatomical success used in this study appears to be poorly correlated with functional improvement as assessed by ET.

[Physiopathological and nutritional changes in hemodialysis patients and in those who have undergone renal transplantation]

The paper examines the complex metabolic behaviour of patients undergoing hemodialysis and renal transplantation. It underlines the importance of the metabolic and nutritional status of these patients since inadequate nutritional therapy may result in the failure of hemodialysis and/or surgery. Given the complexity of the metabolic syndrome and its bronchopulmonary, cardiovascular and septic complications, it is necessary to monitor the various chemical and clinical parameters in these patients in order to guarantee an optimal recovery and satisfactory survival rate. Fortunately today, by replacing the use of Azathioprine, Cyclosporin--irrespective of its collateral and/or secondary effects--has replaced the use of corticosteroids whose immunodepressive action made it obligatory to start simultaneous prophylactic antibiotic treatment and/or chemotherapy in order to avoid the development of other chance disease. The paper also reports the findings of a retrospective study (1976-1986) which evaluated various physiopathological and metabolic parameters and compared them to data reported in the literature.

[Importance of the genetic aspect in hypertrophic cardiomyopathy]

Hypertrophic cardiomyopathy is a disease characterised by massive ventricular hypertrophy, reduced diastolic function and excessive ventricular contraction. It involves sections of both ventricles, but in particular the left ventricle. Although it was initially thought that this pathology might depend on a modified systolic function, it is now widely held that the main alteration is of a diastolic type. The paper focuses on the importance of the genetic component in this cardiopathy, and stresses that the majority of patients affected by this disease and examined by the Authors had positive family histories, in line with previously published reports. In the majority of cases the pathology is transmitted in a dominant autosomic manner, although there are also sporadic episodes of non-hereditary transmission due to genetic mutation.