Comparison of early functional outcomes between two different surgical approaches for total hip arthroplasty.

Total Hip Arthroplasty (THA) is considered the most successful treatment for advanced hip osteoarthritis. Different surgical approaches for THA are available and they have shown excellent outcomes in the long-term follow-ups. However, few studies have analyzed the functional outcomes in the first days after a THA surgery. The purpose of this study was to compare the early functional outcomes between two different surgical techniques: a minimally invasive direct anterior approach (mini-DAA) and a postero-lateral approach (PL). Twelve patients for each group were analyzed. Pre- and postoperative (3, 10, 30 and 90 days after surgery) Patient-Reported Outcome Measures (PROMs) were administered: HOOS, HHS, VAS and SF-12-v2 scores. Moreover, comparison between surgical operation time and blood loss were examined. PROMs showed a significant improvement in the SF-12-v2 in the mini-DAA group compared to the PL group at 3 days after surgery: this difference was maintained also after 10 and 30 days. In addition, HOOS and HHS were significantly ameliorated in the mini-DAA group starting 10 days from surgery. In both groups, a physiological pain reduction was observed in the first days after surgery; comparing it to the pre-surgical VAS values, we found a significant improvement in the scores for the mini-DAA group after 30 days. Moreover, we demonstrated a significant reduction in blood loss for the mini-DAA group. Surgical operation times were similar in the two groups; however, the duration of the mini-DAA procedure was shorter compared with the known literature. In this preliminary study, we demonstrated that the minimally invasive direct anterior approach for THA may lead to benefits in the early postoperative time, as it allows for an improvement in functional outcomes, a reduction of postoperative pain, a reduction of hospitalization time and consequent reduction of postoperative complications; therefore, this surgical approach may consent an early return to work and daily activities.

[Functional mitral insufficiency]. / L'insufficienza mitralica funzionale.

The term "functional mitral regurgitation" is generally used to indicate the presence of mitral regurgitation in patients with left ventricular systolic dysfunction in the absence of structural abnormalities of mitral leaflets and chordal or papillary muscle rupture. Functional mitral regurgitation is commonly found in heart failure, and its presence and severity seem to contribute to exercise intolerance and poor prognosis observed in heart failure patients. Several pathogenetic mechanisms have been proposed to explain the pathophysiology of functional mitral regurgitation, in particular a) mitral annular dilation, b) geometric changes in the left ventricle from a typical ellipsoidal shape to a more spherical shape, with apical and outward displacement of papillary muscles and restriction of valve motion ("leaflet tethering hypothesis"), and c) reduction of closing force of the mitral valve ("leaflet closing force hypothesis"), as a consequence of a lower difference between left ventricular systolic pressure (reduced from left ventricular dysfunction) and left atrial pressure (increased). The relative contribution of these mechanisms to the appearance of mitral regurgitation and its severity may differ in the single patient, depending on the extent of left ventricular geometric changes and degree of systolic dysfunction. The Doppler echocardiographic examination plays an important role in assessing the presence and hemodynamic relevance of functional mitral regurgitation, allowing both a semiquantitative (color Doppler flow imaging) and a quantitative approach (PISA, regurgitant volume and fraction by Doppler). Furthermore, echocardiography may contribute to clarify the pathophysiology of mitral incompetence and to evaluate the effects of treatment, pharmacological or surgical, currently available.

Paroxysmal electroencephalographic abnormalities genetically transmitted: one family description.

A 10-year-old girl came to our observation since a general rule-out electroencephalogram (EEG) had showed, in absence of any clinical manifestation, generalized and symmetrical 3 c/s spike-and-wave bursts, whose duration was longer than 3 s. The subject, only daughter born from her mother's first marriage, had no family history of neurological diseases; her physical and neuropsychological examinations were normal. A polysomnographic recording showed, during sleep, the same abnormalities observed during wakefulness. Also on this occasion, there were no related clinical manifestations. Subsequent recordings were performed on her 33-year-old mother and on two siblings, 3 and 2 years old, respectively, born from their mother's second marriage, all normal by physical and neuropsychological examinations, with no referral about clinical seizures. Among them, the 3-year-old sister showed asymptomatic left rolandic spikes, while the 2-year-old boy, whose EEG was firstly normal, displayed, 1 year later, a burst of generalized 3 c/s spike-and-wave paroxysmal activity on a 4-7 c/s background activity. The possible unitary genetic transmission of paroxysmal EEG abnormalities is discussed.

[Multicenter trials of a new cephalosporin (ceftriaxone) in childhood]. / Sperimentazione policentrica di una nuova cefalosporina (Ceftriaxone) in pediatria.

AA. have tested a new drug (Ceftriaxone) on 40 children affected by upper and lower respiratory tract infectious diseases. As shown by results, this new drug has been remarkably effective and easy to use since it may be administered once in a day; moreover, the tested drug has not caused any kind of tissue or parenchymal involvement.

[A case of Jaffé-Lichtenstein fibrous dysplasia. Etiopathogenetic findings]. / Su di un caso di displasia fibrosa di Jaffé-Lichtenstein. Considerazioni etiopatogenetiche.

The AA. report a case of Jaffé-Lichthenstein Fibrous Dysplasy, a relatively rare syndrome whose aetiopathogenesis is still discussed. Blood laboratory data of the patient and of his family suggest a genetic background on the upon mentioned syndrome.

[The effects of verapamil on angina threshold during exercise (author's transl)]. / Effetti della somministrazione acuta di verapamil sulla soglia d'angor da sforzo

The efficacy and duration of the effects of verapamil on angina threshold during exercise were examined in five patients with proved angina pectoris, with the experimental model of a latin square 5 X 5. The effects of verapamil (0,1 mg/kg i.v.) were compared with those of a placebo (20 ml saline i.v.), of isosorbide dinitrate (5 mg, sublingual), of propranolol (0,1 mg/kg i.v.), and of dipyridamol (20 mg i.v.). All the treatments were studied within 20 minutes after administration; the efficacy of the "drugs" was checked against placebo. Verapamil and isosorbide dinitrate significantly prolonged the duration of exercise and total amount of work done before angina and EKG alteration appearance. Similar changes were observed after propranolol, but not significantly different from the effects of placebo. Dipyridamol reduced thw work performance, without significant difference from placebo. The effects of verapamil, though less marked than its peak effects, were still present 70 minutes after administration. The possible mechanism of work performance improvements induced by verapamil in angina pectoris is briefly discussed on the basis of the Triple Product changes observed during exercise.