Impact of COVID-19 on hand surgery in Italy: A comparison between the Northern and the Southern regions.

The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also - and paradoxically even at a higher extent - in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.

A simple sterile polypropylene fingernail substitute.

Traumatic nail injuries are often observed in clinical practice. Usually the fingernail can be preserved, cleaned and disinfected in order to use it in the reconstructive procedure. However, in some cases the nail can be avulsed and lost or too damaged to be used. In cases when the nail is not available it should be replaced by a substitute in order to protect nail bed and avoid adherences along the proximal nail bed and the nail fold. Furthermore the substitute serves to protect the tender nail bed from painful stimuli during the healing process. We used, as fingernail substitute, a polypropylene sheet in eight patients with fingernail avulsion or disruption. The polypropylene foil was trimmed reproducing the profile of the avulsed fingernail and thinned at the proximal edge to reduce thickness in order to ease the insertion into the nail fold. A small hole was then created in the center of the foil to allow blood drainage. The substitute was usually removed one month after the application. In our clinical experience we had not complications related to the polypropylene device. The new fingernail had good cosmetic appearance in most cases and all the patients reported a good protection of the fingertip during the healing period. The substitute used in this series is sterile, inexpensive and easily available in emergency and elective operatory theater. This polypropylene foil is flexible and can be shaped and adapted to the nail curvature radius. The substitute used in our clinical series protected the nail bed during healing until the growth of the new fingernail and respected our functional expectations.

Study of the aggregation of insulin glargine by light scattering.

Insulin glargine (Lantus, Aventis Pharma, Deutschland, GmbH) is a new long-acting human insulin analog. Structural modification of the insulin molecule at two sites alters its pH, causing insulin glargine to precipitate in the neutral environment of subcutaneous tissue and to form a depot that is slowly absorbed into the bloodstream. In this paper insulin glargine aggregation is investigated by light scattering. This study shows that, in a physiologic-like pH (even at low ionic strength) conditions, aggregation phenomena occur, giving rise to compact structures with radius of hundreds of nanometers. The aggregation of insulin glargine can be responsible for its slow in situ absorption allowing for a more controlled release.

Release from transdermal delivery systems. Application of a new non isothermic method to Trans-Ver-Sal patches.

In this paper a new non isothermic method for the determination of the release drug rate constant (k) from a transdermal delivery system is proposed. The new method was applied to transdermal patches Trans-Ver-Sal. The results obtained prove to be able to release salicylic acid of transdermal system and the effectiveness of the new method propose.

[Surgery and rehabilitation of flexor tendons injuries in zone 1 and 2]. / Chirurgia e riabilitazione delle lesioni dei tendini flessori in zona 1 e 2.

BACKGROUND: Prevention of adhesions that restrain tendon gliding is based on early mobilization techniques. Such approach, anyway, does not guarantee positive outcomes. METHODS: Seventy-five patients for a total number of 98 flexors tendons have been treated at the University Hospital of Messina between December 1993 and January 2000. Twenty-five patients, for a total number of 26 tendons, have been seen at follow-up. Seventeen lesions involved zone 2 and 9 involved zone 1. The modified Kessler suture has been generally used. All the repairs have been followed by an adequate early mobilization protocol, according to Kleinert (passive extension/active flexion) in nine patients and according to Risitano and Savage (active extension/active flexion) in 16. RESULTS: Minimum follow-up was 12 months. We present results with an assessment performed according to Strickland and to Elliot for lesion in zone 1 and according to Strickland and using Total Active Motion of the finger for lesions in zone 2. CONCLUSIONS: The suturing technique and mobilization protocol did not affect results, but we made some considerations about respective advantages and disadvantages of either method.

Fast rolitetracycline stability determination by spectrophotometer variable-temperature kinetic experiments.

The pseudo-first order rate constant for the hydrolysis of rolitetracycline as a function of temperature was obtained by performing variable-temperature kinetic experiments. The results are in agreement with those obtained at constant-parameter kinetics but saving experimental time and chemicals.

[Traumatic lesions of the hand extensor system: epidemiology and surgical considerations]. / Le lesioni traumatiche dell'apparato estensore della mano: epidemiologia e considerazioni chirurgiche.

AIMS: To investigate demographics, modalities and type of injuries among a population of isolated traumatic injuries of extensor tendons in order to evaluate the consequences on health service and on prevention. METHODS: Retrospective study of injuries treated at the divisions of Plastic Surgery and Orthopedics in a third level referral center among the years 1993-1999. MAIN RESULTS: Data from 173 patients were analyzed, a prevalence of males (81%) and injuries at home (55%) has been observed. Especially young adults (46.88%) have been involved, the thumb has been most interested finger and the middle finger the least, with two peaks of incidence in spring and autumn. The lesions, exposed through an extension of the existing wound, have been usually sutured according to Kessler, adding an early protected motion protocol. CONCLUSIONS: We discuss the possible causes and consequences of data observed, with special reference to the possibility of treating isolated extensor tendon injuries at district hospitals by non-hand surgeons, and primary actions of prevention.

Clinical results and thoughts on sensory nerve repair by autologous vein graft in emergency hand reconstruction.

Lesions of the digital and other sensory nerves in the hand are common. Based on experimental studies on vein graft as a support for peripheral nerve regeneration, the Authors have been using a simple vein graft to bridge sensory nerve gaps when treating acute hand injuries. This is a retrospective study on the results of 22 sensory nerves repaired using vein grafts in cases in which primary suture was not feasible, in emergency hand reconstruction. Patients were informed that a secondary nerve graft could possibly be necessary in the future. Patients were reviewed by two independent observers at least one year after repair and evaluated using the Highest scale as modified by MacKinnon & Dellon. Evaluation chart included influence of repair on rehabilitation program and presence of painful neuromas and scars as well as patient satisfaction. Results were classified according to Sakellarides and 20/22 were classified as very good or good. Cases classified as poor were satisfied and no secondary nerve grafting has been carried out. Rehabilitation of the associated lesions (tendon lacerations or bone and soft tissue damage) was not influenced by the nerve repair and no painful neuroma was reported in the series. In conclusion, since the literature shows unsatisfactory results in repair of digital nerves with nerve grafts, since it's been demonstrated that an unrepaired sensory nerve leads to painful scar and painful neuroma and since we are reluctant to use nerve grafts in emergency procedures, we recommend this simple method because it is easy, low-cost and effective.

Clinical signs and diagnosis of scrapie in Italy: a comparative study in sheep and goats.

This article reports the clinical signs of scrapie occurring in sheep-goat flocks in Italy. The research, carried out on over 500 goats and 550 sheep, yielded an interesting clinical picture, especially of goat scrapie. The affected animals, aged between 2 and 8 years, showed neurological signs that could be classified into three categories: changes in mental status, abnormalities of movement and changes in sensation. Some general clinical signs were also observed. The clinical suspicion was confirmed by histopathological and biochemical investigations.

Variable pH kinetics: an easy determination of pH-rate profile.

The complete pH-rate profile of the hydrolysis reaction of aspirin, requiring many experiments in the past, was obtained by a single variable-parameter kinetic experiment carried out by varying the hydrogen ion concentration. The experiment was carried out spectrophotometrically, reading automatically absorbance, pH, and temperature inside the reaction vessel. The results obtained by the fast processing of the kinetic profile are identical to those obtained under the same conditions but using traditional constant-pH kinetic runs. This method provides the possibility of reducing the amount of time and chemicals usually spent in collecting kinetic data in such mechanistic studies by nearly two orders of magnitude.

Stability study of piroxicam and cinnoxicam in solid pharmaceuticals.

The pseudo-first order rate constant for the hydrolysis of cinnoxicam as a function of temperature was obtained by variable-temperature kinetic experiments. The method used is on a generalization of non-isothermal analysis, and takes advantage of the capabilities of modern data collection and processing systems. A spectrophotometric method under non isothermal conditions was carried out. The results obtained are identical to those obtained under the same conditions by using traditional constant-temperature kinetic runs. This provides the possibility of reducing the amount of time spent and chemicals usually used in collecting kinetic data in mechanistic studies in solution by an order of magnitude.

[Biliary ileus (description of 2 clinical cases)]. / L'ileo biliare (descrizione di due casi clinici).

Biliary ileus is a rare complication of the biliary pathology, appearing through obstructive pictures of patients in advanced age. After a careful study about this subject, the authors report two cases they had he opportunity to observe.

[Cirsoid aneurysm: apropos of a clinical case]. / Gli aneurismi cirsoidei: a proposito di un caso clinico.

The authors, after mentioning the anatomopathologic, physiopathologic and clinical features of cyrsoid aneurysms, presently classed in the chapter of the congenital artero-venous fistulas, show a case, angiographically discovered, of cyrsoid aneurysm with palmar location, elsewhere already subjected twice to unsuccessful operation, and successfully operated at the Institute of Surgical Pathology of the Pavia University. The Authors think the morphologic and topographic features of such lesion, its relative local malignancy and trend to relapsing, justify why the old denomination of cyrsoid aneurysm was kept, even in the frame of the more general chapter of artero-venous fistulas.

[Sulpiride and extrahepatic bile ducts. Radioisotope study]. / Sulpiride e vie biliari extraepatiche. Ricerca con radioisotopi.

An original radioisotopic method was employed in an investigation of the effect of sulpiride on extrahepatic bile duct motility. Stress is laid on the primarily hyposthenic effect of the drug, and the influence of various factors on the functional status of the gallbladder.