Epidemiology of distal radius fractures: a detailed survey on a large sample of patients in a suburban area.

BACKGROUND: Literature lacks data on correlations between epidemiology and clinical data of patients with distal radius fractures (DRFs). AIM: The aim of this study was to present a detailed epidemiologic survey of a large consecutive series of patient with DRFs. MATERIALS AND METHODS: This retrospective study included 827 consecutive patients (579 females, 248 men) who sustained a DRFs in the last 5 years. All fractures were radiographically evaluated. DRFs were classified according to Association of Osteosynthesis classification. Data on age, gender, side, period in which fracture occurred, and fracture mechanism were collected. Statistical analysis was performed. RESULTS: The patients' mean age was 60.23 [standard deviation (SD) 16.65] years, with the left side being most frequently involved (56.1%). The mean age of females at the time of fracture was significantly higher than that of males. The most frequent pattern of fracture was the complete articular fracture (64.3%), while the most represented fracture type was 2R3A2.2 (21.5%). Regarding the period in which the fracture occurred, 305 DRFs (37.5%) were observed in the warmer months and 272 (33.4%) in the colder months. Low-energy trauma occurring outside home was found to be the major cause of DRF throughout the year. In both genders, trauma mechanism 2 was more frequent (59.4% F; 31.9% M; p < 0.01). A bimodal distribution of fracture mechanisms was found in males when considering the patient's age with a high-energy mechanism of fracture (3 and 4), identified in 21% (n = 52) of males aged 18-45 years, and a low-energy mechanism (1 and 2) was observed in 39.9% (n = 99) of males aged > 45 years. A significant correlation between all trauma mechanisms (from 1 to 6) and different fracture patterns (complete, partial, and extraarticular) was found (p value < 0.001). The mean age of patients with extraarticular fractures (mean age 61.75 years; SD 18.18 years) was higher than that of those with complete (mean age 59.84 years; SD 15.67 years) and partial fractures (mean age 55.26 years; SD 18.31 years). Furthermore, considering different fracture patterns and patient age groups, a statistically significant difference was found (p < 0.001). CONCLUSIONS: DRFs have a higher prevalence in females, an increase in incidence with older age, and no seasonal predisposition. Low-energy trauma occurring at home is the main cause of fracture among younger males sustaining fractures after sports trauma; Complete articular is the most frequent fracture pattern, while 2R3A2.2 is most frequent fracture type. LEVEL OF EVIDENCE: Level IV; case series; descriptive epidemiology study.

[Epidemiologic surveillance in occupational bladder cancer: a Tuscan experience]. / Intervento di ricerca attiva delle neoplasie vescicali di origine professionale: una esperienza toscana.

The percentage of bladder cancer as occupational disease in West-Europe is of 5/10%, but only a few amount of them are recognized as occupational disease from INAIL. The above mentioned research project is realized in order to decrease the gap between expected and claimed cases of occupational disease and it is conducted with the collaboration of ASL of Pisa, ASL of Empoli, Azienda Ospedaliera Universitaria Pisana and INAIL. 677 patients with bladder cancer were interviewed by phone, among them 64 subjects had a working experience compatible with neoplastic risks because had a previous occupational exposure to aromatic amines and metal working fluids. These cases were discussed into a Medical Staff and 40 cases were considered "probable" for occupational disease, 18 "possible", 3 cases are suspended for more research, 3 cases are considered "no professional disease". The research allows finding out a great number of bladder cancer, increasing the total amount of workers with occupational disease. The integrated approach with the collaboration among different institutions is surely the best way to allow and guarantee a suitable and right protection of workers with occupational disease.

[Systemic mastocytosis. A review of current diagnostic and therapeutic approaches]. / La mastocitosi sistemica. Revisione degli attuali approcci diagnostico-terapeutici.

Mastocytosis is a heterogeneous group of disorders characterized by abnormal growth and accumulation of mast cells in skin, bone marrow, bone, gastrointestinal tract, liver, spleen and lymph nodes. Today, regarding its biological features, mastocytosis (with or without myeloid accompanying disorders) is considered to be a hematologic disease. The classification proposed by Metcalfe in 1991 is the most useful in caring for patients with mastocytosis. In this classification 4 groups are described: 1) indolent mastocytosis with or without extracutaneous involvement; 2) systemic mastocytosis with an associated hematologic disorder; 3) aggressive mastocytosis; 4) mast-cell leukemia. Cutaneous mastocytosis typically presents as urticaria pigmentosa or diffuse cutaneous mastocytosis and these patients usually have a benign course. On the contrary, systemic mastocytosis is a disease with an increased risk to develop an aggressive hematologic disorder. In these patients a second hematologic process, such as myeloproliferative or myelodysplastic syndrome or acute leukemia, may occur. These patients often present without skin involvement and they have a very poor prognosis. Mast cell is a medium-sized granulated cell releasing chemical mediators (histamine, heparin, protease and cytokines). Mast cells originate from pluripotent hemopoietic progenitor cells that express the CD34 antigen. Mast cells are present in the bone marrow and are distributed throughout the connective tissues. Recently a mast-cell growth factor (MGF) has been identified. Clinical symptoms occur from the release of chemical mediators and the pathologic infiltration of cells. Although no effective therapy for patients with Mastocytosis is known, some patients may benefit from corticosteroid and interferon alpha treatment. The present article gives an overview of current knowledge about the biology, heterogeneity and treatment of human mastocytosis.

Muscle growth and myosin isoform transitions during development of a small teleost fish, Poecilia reticulata (Peters) (Atheriniformes, Poeciliidae): a histochemical, immunohistochemical, ultrastructural and morphometric study.

The myosin composition of lateral muscle in Poecilia reticulata from birth to adult was studied by ATPase histochemistry and immunostaining with myosin isoform-specific antibodies. At birth the muscle consists of two layers containing developmental isoforms of myosin. In deep layer fibres the developmental myosin is replaced by the adult fast-white isoform soon after birth. In the epaxial and hypaxial monolayer fibres the myosin composition present at birth (J1) is replaced within 3 days by another (J2). In some fibres, this J2 composition is retained in the adult, but in others it is slowly replaced by the adult slow-red muscle isoform. Close to the lateral line, all monolayer fibres are already in transition between the J2 myosin and the adult slow-red form at birth, and rapidly complete the transition to slow-red form. These fibres, together with others generated de novo in an underlying hyperplastic zone, form the red muscle layer of the adult. The pink muscle develops during the first month after birth, and by 31 days it consists of an outer, middle and inner layer. A few middle layer fibres are already present at birth, while the outer layer fibres first appear 3 days after birth. The thin inner layer is probably a transitional form between the middle pink and adult white types, and appears at about 31 days. A morphometric analysis showed that growth of the white muscle occurs principally by hypertrophy. Even at the magnification level of the electron microscope, no satellite cells or myoblasts which could give rise to new fibres were found in the white muscle, except in the far epaxial and hypaxial regions and only in the first 10 days. A zone of hyperplastic growth was also found lying just under the superficial monolayer close to the lateral line, and this presumably contributes fibres to the red and pink muscle layers.

[Preliminary observations on the behavior of serum ferritin in female patients with breast cancer at various stages of the disease]. / Osservazioni preliminari sul comportamento della ferritina serica in pazienti affette da neoplasia della mammella in diversi stadi evolutivi.

The Authors have been evaluated the behaviour of serum ferritin in 16 patients with breast cancer. In all of the cases the serum ferritin values were significantly higher, compared with those found in 11 normal control subjects. Of particular interest was the reduction of serum ferritin in most of the patients who had undergone polychemotherapy with CMF. The results agree with the observations of various Authors as far as high levels of serum ferritin in course of breast cancer are concerned. Moreover it can be pointed out that the serum ferritin evaluation can represent a monitoring marker for the evaluation of the evolution of this disease.

[The angio-immunoblastic lymphadenopathy: clinical, pathological and immunological observations on a case (author's transl)]. / La linfoadenopatia angio-immunoblastica: Osservazioni cliniche, patologiche ed immunologiche su di un caso.

The authors, after a review of the clinical pathological aspects of the angioimmunoblastic lymphadenopathy, report a case studied by means of clinical, pathological and immunological aspects. On the basis of the results a hypothesis on the pathogenesis and treatment is postulated.

[Evaluation of the proliferative activity of hematopoietic cells in preleukemic syndromes]. / Valutazione dell'attività proliferativa delle cellule emopoietiche nelle sindromi preleucemiche.

The Authors have studied bone marrow CFUc and CLFC of 8 cases affected by idiopathic myelofibrosis, 7 by chronic granulocytic leukemia, 6 by polycythemia, and 3 by sideroblastic anemia. The authors studied also C.S.F. activity in peripheral blood of 8 cases. The method of Pike and Robinson for in agar culture was utilized. The results indicated a correlation between increase of clusters/colonies fraction, growth of blasts-like clusters, reduction of C.S.F. activity in peripheral blood and transformation in acute leukemia of preleukemic syndromes.

[A case of scleroderma associated with total medullary aplasia]. / Su di un caso di sclerodermia associato ad aplasia midollare globale.

A case of scleroderma associated with pancytopenia is reported. The Authors point out that the severe haematological defect was not caused by autoimmune mechanisms and/or by iron, B12 or folic acid deficiency but it was related to bone marrow aplasia. The microangiopathy of scleroderma is taken into consideration as a possible factor responsible of the bone marrow failure.

[Asplenomegalic idiopathic myelofibrosis. Clinical observations and considerations on 5 cases]. / La mielofibrosi idiopatica asplenomegalica. Osservazioni cliniche e considerazioni su cinque casi.

The Authors, after some theoretical considerations on cell Kinetics, report five cases of Primary Asplenomegalic Myelofibrosis. Pointing out some data about the diagnosis, the Authors take into consideration the clinical course of the disease which, according to the literature, appears significantly more severe.

A preliminary study on humoral control of granulopoiesis in primary myelofibrosis and chronic granulocytic leukaemia.

The extent of the urine Colony Stimulating Factor (CSF/u), as well as the Colony Stimulating Activity (CSA) of peripheral-white blood cells (WBC) were evaluated in two groups of patients with myeloproliferative disorders, at the disease onset. The first patient group deals with Primary Myelofibrosis (PM), whereas the second group deals with Chronic Granulocytic Leukaemia (CGL). The Stanley technique was used for the above-mentioned assay, and in each group of patients either human or murine bone-marrow cell-suspensions were cultivated. In all patients with PM, a low CSF/u was detected, while patients with CGL showed a high CSF/u, regardless whether Ph1-positive or not. CSA of WBC in the PM-group was normal. In contrast, a significant low CSA in the CGL-group was noted. This fact could be of some importance in differentiating the two disorders at their onset.

Colony forming activity, density distribution and morphological features of the stem cell population in primary myelofibrosis.

In four patients with untreated primary myelofibrosis, the peripheral-blood cell growth in agar culture (frequency of clusters and colonies) was studied. As cell sources, were used either the buffy coat or the fractions obtained from an albumin discontinuous density gradient, prepared according to Dicke's technique. Besides the agar culture, also morphological features of the blasts of the granulocytic cell series of the gradient fractions were investigated, in order to relate the above-mentioned cell parameters. The results, taken as a whole, pointed out: a) increase in circulating CFUc's (expressed as the number/10(5) nucleated cells) in the patients, when compared to the controls; b) high percentage of CFUc's with an abnormal specific density (below 1.062 in 3 out of 4 patients); c) presence in 3 out of 4 patients, of two populations of blasts: one showing low specific density, small size, high N/C rate, high plating efficiency and no nucleoli; the other with a higher specific density and low plating efficiency, showing the typical morphological features of the myeloblasts.