Knee prosthesis in rheumatoid patients

Total knee arthroplasty is a reliable means to improve the quality of life not only in osteoarthritis, but also in rheumatoid patients. Specific aspects, like the low mechanical quality of bone tissue, the contemporary damage of several joints and the higher risk of complications, have to be taken into account in rheumatoid arthritis. The experience with 24 prostheses in 21 rheumatoid patients is reported and confirms the efficacy of this operation. Among the technical details discussed, stress is placed on the conservation of the posterior cruciate ligament, the use of cement, the procedure of patelloplasty instead of prosthetic replacement. Careful preoperative planning is required and resections, especially in the tibia, should be economical. The evaluation of the results according to the protocol of the America Knee Society shows a satisfactory increase both of the articular score (average from 36 to 88) and the functional score (average from 34 to 68).

The biological problems of total hip arthroplasty

Biological phenomena are the principal agents in triggering hip prosthesis aseptic loosening. The authors report the results of "in vivo" and "in vitro" and Raman-laser experimental tests, which confirm the validity of the ceramic-ceramic combination in relation to the amount of wear and biocompatibility of friction materials.

Ultrasound in the evaluation of bone fragility caused by osteoporosis: a comparison between different sites of measurement

The authors compare two different measurement sites of ultrasound transmission velocity (UTV) in discriminating between subjects with or without vertebral fracture caused by osteoporosis. To this purpose a total of 150 women in menopause, of which 50 with vertebral fracture documented radiologically, for whom UTV was measured in the distal radius and in the patella, were examined. In both sites measurement of UTV in fractured women (1531.9 m/sec in the distal radius, and 1825.1 m/sec in the patella) was significantly less than for healthy women (1557.4 m/sec in the distal radius and 1874.5 m/sec in the patella) and there was a significant inverse linear correlation with age. The logistic regression shows that in both sites ultrasound examination is capable of significantly discriminating between osteoporotic women with fracture and those without fracture (odds ratio of the distal radius = 38.857, odds ratio of the patella = 7.822). A comparison of the discriminating capacity of the two measurement sites shows that the ORC curves for the distal radius (area = 0.773) is significantly greater than that of the patella (area = 0.684). Our study confirms that UTV can discriminate healthy subjects from osteoporotic ones, and it shows that the method in question has greater diagnostic sensitivity in the distal radius than in the patella.

Different gonadotropin and leuprorelin ovulation induction regimens markedly affect follicular fluid hormone levels and folliculogenesis

OBJECTIVES

To clarify the endocrine mechanisms underlying the outcome of different ovulation induction regimens with gonadotropins and GnRH agonists (GnRH-a).

DESIGN

Prospective study.

SETTING

Reproductive Endocrinology Center, University of Bologna.

PATIENTS

Forty eumenorrheic women randomly assigned to four groups of 10 subjects each.

INTERVENTIONS

Ovulation induction regimens: group A, purified FSH only; group B, purified FSH and flare-up GnRH-a; group C, purified FSH and long GnRH-a; and group D, hMG and long GnRH-a.

MAIN OUTCOME MEASURES

Pelvic ultrasound and hormone levels in daily serum samples and in follicular fluid drawn immediately before hCG administration.

RESULTS

Exogenous gonadotropin dose did not differ among groups. Group B had fewer preovulatory follicles than group C. Group B had higher serum LH, FSH, E2, P, T, and follicular fluid LH, E2, T, and alpha-inhibin than groups C and/or D. Groups C and D did not differ.

CONCLUSIONS

Long GnRH-a regimens improved follicle yield and the endocrine milieu in spite of comparable exogenous gonadotropin dose and lower serum FSH and thus appear to be preferable in assisted reproduction. Reduced folliculogenesis found in flare-up GnRH-a regimens could be mediated by the atretic effects of high intraovarian androgens. Efficacy of purified FSH and hMG was comparable.

Recurrent posterior instability of the shoulder: surgical treatment

A total of 11 cases of posterior instability of the shoulder surgically treated by simple capsuloplasty or associated with reinforcement of the posterior wall by bone graft or muscle transposition were reviewed. Accurate selection and preoperative evaluation of the patient when choosing surgery is very important. For surgery to succeed prolonged postoperative immobilization and an intense rehabilitative program to be initiated prior to surgery are necessary. Generalized ligamentous hyperlaxity constitutes a negative factor in prognosis, so that it is important to associate capsuloplasty with posterior bone block, in an attempt to avoid the risk of recurrence as further surgery would have an unfavorable outcome.

Glomus tumor in children (description of one case)

Glomus tumor is a lesion of the soft tissues which rarely occurs in children. One case of the disease characterized by deep localization and atypical radiographic symptoms and manifestations is described.

Case report 590: Diffuse pigmented villonodular synovitis with a cartilaginous component

The authors present the case of a patient 54 years of age who developed well-defined osteolysis in the distal end of the humerus, with a slight radiodensity in the soft tissue. The radionuclide scintigram and above all the CT, were useful in defining the characteristics and expansion of the mass more precisely. Surgical intervention and histological examination demonstrated a seemingly unique case of PVNS of the elbow with diffuse cartilaginous components and erosion of the distal end of the humerus. The pathological findings in this unusual case, actually suggested the possibility of an intermediate form of PVNS associated with synovial chondromatosis.

A critical review of the surgical treatment of infantile fibrous dysplasia

A critical review of the surgical treatment of 65 cases of infantile fibrous dysplasia demonstrated that "circumscribed" forms of the disease generally do not require any type of surgical treatment, while "extended" forms, as well as Albright's syndrome, require early surgical treatment aimed at preventing the development of skeletal deformities which are difficult to correct. Prophylactic intramedullary nailing with nails of suitable calibre most effectively achieves this goal.

Brown tumor of the tibia as an early manifestation of renal osteodystrophy. A case report

A brown tumor of the tibia occurred in a 49-year-old woman on dialysis with chronic renal failure. This lesion was the first clinical or radiographic indication of bone involvement. Although serum levels of calcium and phosphorus are often well regulated by dialysis, clinical or radiologic evidence of a brown tumor may prove to be the first sign of renal osteodystrophy in patients with chronic renal failure.

Intravascular intrauterine transfusion for severe erythroblastosis fetalis using different techniques

Over a 3-year period, 44 ultrasound-guided intravascular transfusions were performed between 18 and 32 weeks on 15 patients with severe erythroblastosis fetalis due to Rh immunization. In 4 fetuses, the first transfusion was performed before 20 weeks, in 6 between 20 and 25 weeks and in the remaining 5 between 25 and 31 weeks. Eight of the 15 fetuses were hydropic at the time of referral. Five transfusions were done in the intrahepatic umbilical vein, 6 were simple transfusions via percutaneous umbilical cord puncture, and 33 were partial exchange. There were 4 intrauterine deaths before 26 weeks, despite successfully performed transfusions: 3 of these fetuses were severely hydropic, while in the remaining fetus hydrops had been reversed in utero. Following delivery by cesarean section at 32 weeks of gestation, 1 of the neonates developed respiratory distress syndrome and died 17 h after birth. The overall survival rate was 67% (10 of 15 cases): 4 of the 8 hydropic fetuses (50%) and 6 of the 7 nonhydropic fetuses (83%) were alive at birth and survived the perinatal period. Three of the 5 losses occurred among the first 4 cases, while in the last 11 cases the survival rate increased to 82% (9 of 11).

Benign fibrous histiocytoma of bone

The cases of seven patients who had a lytic lesion that was histologically similar to a metaphyseal fibrous defect (non-ossifying fibroma) of bone were studied. The patients all were adults and had pain without a fracture. These features were considered distinctive for the lesion, which has the same histological appearance as benign fibrous histiocytoma of soft tissue. The lesion is a benign tumor with fibroblastic and histiocytic differentiation. This picture may be seen in foci in other lesions of bone (aneurysmal bone cyst, fibrous dysplasia, and giant-cell tumor). Ten cases of giant-cell tumor of bone that had a large component of the same foci were also reviewed. It should be emphasized that these areas are secondary reactive tissue rather than the true neoplastic tissue of benign fibrous histiocytoma.

Sacral osteoid osteoma and osteoblastoma: a report of 13 cases

The authors present 13 cases (nine males and four females) of osteoid osteoma and osteoblastoma of the sacrum. All patients were less than 20 years old. Clinical and radiographic findings, histological features, and therapy of these rare lesions are discussed. Surgical excision with a posterior approach is considered the treatment of choice, except for tumors localized in the body of S-1, which require an anterior approach. The prognosis is good, even when the neoplasm has been incompletely removed. Nevertheless, a marginal or wide resection is the recommended surgical treatment. Radiotherapy is necessary only for inoperable tumors.

A randomized trial for the treatment of high-grade soft-tissue sarcomas of the extremities: preliminary observations

A new trial for evaluating the effectiveness of adjuvant chemotherapy in high-grade soft-tissue sarcomas of the extremities in adult patients is presented. All patients after local treatment were randomized into two arms, one without further therapy and the other to receive adjuvant chemotherapy (Adriamycin [Farmitalia-Carlo Erba, Milan, Italy], 450 mg/m2). The preliminary results of the study are reported at a median observation period of 27.6 months. Of the 59 patients who entered the study, 79.1% in the chemotherapy group are without sign of disease, whereas the corresponding figure in the nonadjuvant chemotherapy group is 54.3%. The difference between the two groups is statistically significant (P less than .005, log rank test). These preliminary observations encourage continuation of the study.

Aneurysmal bone cyst of the spine

The cases of twenty-two patients with an aneurysmal bone cyst of the spine above the sacrum were analyzed with regard to sex, age, site, symptoms, and radiographic findings. Four patients had extension of the lesion to the adjacent vertebra or rib, and twelve patients had neurological deficits. The primary treatment was either radiotherapy or surgery alone, or surgery and radiotherapy combined. No recurrences were found in patients who were treated with surgery alone or with surgery and radiotherapy, while three of the six patients who were treated with radiotherapy had a local recurrence, two of which were fatal. The patients with neurological deficits recovered after healing of the cyst.

Localized Ewing's sarcoma of bone: ten years' experience at the Istituto Ortopedico Rizzoli in 124 cases treated with multimodal therapy

The results obtained in the treatment by multimodal therapy (surgery, radiation therapy and chemotherapy) of 124 cases of Ewing's sarcoma are presented. At a medium follow-up of 65 months 48% of the patients are disease-free. One patient died of leukemia and two patients developed an irradiation-induced sarcoma. Analysing the data, three factors seem to be correlated to prognosis: location of the initial lesion outside the pelvis and sacrum, a four-drug chemotherapy protocol and the use of surgery in the treatment of the initial lesion seem to give better results.

Angiosarcoma in chronic osteomyelitis

The authors present 4 cases of angiosarcoma occurring in chronic osteomyelitis observed at the Tumour Centre of the Rizzoli Institute. The literature is reviewed.