ACROMORFO study: gait analysis in a cohort of acromegalic patients

PURPOSE

In acromegaly, skeletal complications resulted to be associated with low quality of life (QoL) and high risk of falls. The aim of the present study was to perform a quantitative assessment of movement through gait analysis technique in patients with acromegaly.

STUDY POPULATION

Thirty-three acromegalic patients [9 with active disease (AD), 14 with controlled disease (CD) and 10 with disease remission (RD)] and 20 healthy subjects were enrolled for the study.

MEASUREMENTS

Kinetic and kinematic data were collected with 3D-gait analysis. Kinematic data were processed to compute the Gait Profile Score (GPS), a parameter that summarizes the overall deviation of kinematic gait data relative to unaffected population.

RESULTS

The acromegalic group showed longer stance phase duration (p < 0.0001) compared to controls. The GPS and several gait variable scores resulted to be statistically higher in the acromegalic group compared to healthy controls. GPS values were significantly higher in AD compared to CD (p < 0.05) and RD groups (p = 0.001). The AD group presented significantly higher values in terms of hip rotation and ankle dorsiflexion compared to CD and RD groups and with regard to the foot progression compared to RD. Interestingly, patients with RD exhibited a more physiological gait pattern.

CONCLUSION

Acromegalic patients showed quantitative alterations of gait pattern, suggesting instability and increased risk of falls. Arthropathy, along with its associated abnormal joint loading, proprioceptive impairment and hyperkyphosis could be contributing factors. Disease control and remission appear to improve postural balance. A better knowledge on walking performance in acromegaly would help to develop specific rehabilitation programmes to reduce falls' risk and improve QoL.

Complications after gastroplasty and gastric bypass as a primary operation and as a reoperation

BACKGROUND

Since 1991 we performed vertical banded gastroplasty (VBG) as our surgical treatment of choice for morbid obesity in 680 patients, and since 1996 we also performed Roux-en-Y gastric bypass (RYGB) in 36 patients. For revisional surgery, the surgeons chose procedures based on their experience.

METHODS

We recorded early complications (0.6%) and late complications (8.5%) after the primary operations. When staple-line disruption or stenosis of the banded stoma occurred after VBG, revisional surgery was performed with re-VBG or conversion to RYGBP. Some early complications needed emergency operation for bleeding or gastric perforation.

RESULTS

Mortality was zero. Reoperation with re-VBG and RYGBP was effective in all patients, but for many, a long stay in hospital was necessary because reoperation had a high rate of early and late complications, 33.8% and 21.8% respectively.

CONCLUSION

The treatment of complications after VBG with re-VBG and RYGBP had danger. We believe that when VBG failure occurs, to avoid dangerous complications again, we should perform a biliopancreatic diversion, which does not involve a gastric restriction.

[Surgery of inguinal hernia: our experience]

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[Crohn's disease of the appendix: a rare nosological entity]

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[2 cases of chylothorax during total parenteral nutrition: the etiopathogenetic considerations]

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[Acute intermittent porphyria: a clinical case]

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[Case of mucoid hydro-adenocarcinoma of sudoriferous glands (clinical report)]

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[Esophagotracheal fistula without esophageal atresia: discussion of 2 cases (author's transl)]

The authors report two cases of esophagotracheal fistula without esophageal atresia, of their own observation, on the grounds that the anomaly is less rare than common belief would have it; in fact, available literature indicates that a good many cases go undetected. So, in the presence of clinical evidence suggesting an esophagotracheal fistula, one must do everything possible to diagnose it correctly and to take timely corrective action in view of forestalling severe respiratory complications. The predominant oblique cranial orientation of the fistular passage creates considerable difficulty in radiological detection, although this difficulty is lessened by modern roentgenocinematography. Surgical correction, at any rate, solves all extant clinical problems at the same time as it eliminates possible complications.

[Circular myotomy in the reconstructive therapy of esophageal atresia. Experimental study in the rabbit]

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