A complex proximal femoral fracture.

We present the case of a 39-year-old sportswoman who was involved in a motorcycle accident in 2012. She sustained a complex proximal femoral fracture that involved the neck and trochanteric region. We decided to preserve the natural bone stock and repair the fractures, adopting skeletal traction in the first stage and then implanting an intramedullary nail. Twenty months later the fracture was healed clinically and radiologically and the patient was able to walk and run without pain.

Clinical and functional outcomes of the PCCP study: a multi-center prospective study in Italy.

The standard surgical management of hip fractures is associated with tissue trauma and bleeding which are added to the fracture injury. The percutaneous compression plate (PCCP) is a minimally invasive device that has been demonstrated in previous studies to reduce postoperative complications and blood loss. This prospective, multi-center, observational study assessed clinical and functional outcomes with PCCP as treatment for trochanteric fractures. Patients with a stable or unstable proximal femoral fracture of type AO 31.A1 or 31.A2 were enrolled in eight hospitals in Italy. The primary outcome of interest was the recovery of the pre-fracture functional status at 1-year follow-up; secondary outcomes of interest included blood transfusions, surgical time, complications, and mortality. A total of 273 patients were enrolled. The ASA score was 3 or 4 in 72.5 % of patients. The mean surgical time was 44.1 min; the mean post-surgery blood transfusions was 0.9 units. At 1 year, 48 patients (17.6 %) died, 28 (10.2 %) were lost to follow-up, 4 patients (1.5 %) were excluded, hence 193 patients (70.3 %) were available for final evaluation. At the 1-year follow-up visit, 51.9 % of patients recovered or improved their pre-fracture modified Harris Hip Score, 49.1 % of patients improved or maintained their walking abilities, and 66.6 % of patients residing at home pre-surgery maintained their domicile. The overall mortality rate was 17.6 %. Major complications included two fracture collapses, one excessive sliding of the cephalic screw leading to a partial fracture collapse and one back-out of the diaphyseal screw. This study demonstrates that treatment of trochanteric fractures with PCCP gives good outcomes and significant advantages such as low blood loss, short surgical time, low risk of complications, and good functional recovery in the majority of the patients.

The cytotoxic effects of resin-based sealers on dental pulp stem cells.

AIM: To evaluate the effect of four current resin-based adhesives on expanded ex vivo human dental pulp mesenchymal stem cells (DP-MSCs). METHODOLOGY: Dental pulp mesenchymal stem cells were derived from dental pulps of ten donors. After in vitro isolation, dental pulp stem cells were analysed using flow cytometry. The immunophenotype of DP-MSCs disclosed the homogeneous expression of the mesenchymal-related antigens CD29, CD44, CD73, CD90, CD105, CD166. DP-MSCs were exposed to four different commercially available bonding systems (CMF Bond, Prime&Bond NT, Clearfil S(3) Bond, XP Bond), and after 24, 48 and 72 h of incubation the morphological features and the cell growth were analysed. Moreover, the cell viability was evaluated at the same times by MTT assay. Data were statistically analysed using a two-way anova and Holm-Sidak method (alpha set at 0.05). RESULTS: Significant differences were observed between the four groups when comparing DP-MSCs appearance. DP-MSCs survived and proliferated without inhibition in the presence of CMF Bond adhesive. On the contrary, microscopic evaluation of the other three groups revealed extensive cytotoxic effects from the dentine bonding agents. The MTT assay revealed no statistically significant differences in cell viability after 72 h between the control group and CMF Bond group. All the other experimental groups had statistically lower optical density values. CONCLUSIONS: CMF Bond adhesive allowed human dental pulp stem cells to survive and proliferate. All of the other dentine bonding agents had extensive cytotoxic effects.

Ex vivo expansion of umbilical cord blood CD34 cells in a closed system: a multicentric study.

BACKGROUND AND OBJECTIVES: The Dideco 'Pluricell System' is a CE-marked medical device allowing haematopoietic stem cell (HSC) expansion. It comprises a kit of cGMP cytokines and reagents, a closed-cell expansion chamber and a cell-washing set. We tested the system in a multicentric study by expanding CD34(+) cells from eight fresh umbilical cord blood (UCB) samples. MATERIALS AND METHODS: During culture, the mean nucleated cell (NC) count, the mean CD34(+) cell count, fold expansion, viability and apoptosis were measured. Clonogenic assays and immunophenotypical characterization were performed on days 0, 7 and 12. On the expanded cellular product, in three cases cell genotyping, endotoxin level and mycoplasma detection (by polymerase chain reaction) were performed. RESULTS: The mean CD34(+) cell expansion on days 7 and 12 was sevenfold and 12-fold respectively and the mean NC expansion was 69-fold and 180-fold. The mean NC viability on day 12 was 96.9% (94.4-99.1). After 12 days, granulocyte-macrophage colony-forming units (GM-CFU) showed a 20-fold increase: a slight increase in CD34(+) cell apoptosis was observed during culture. In all of three cases neither chromosomal alterations nor mycoplasma contamination was detected. No significant endotoxin levels were detected after expansion. CONCLUSIONS: The device allows the ex vivo expansion of NC and CD34(+) cells in a closed system. The expanded cellular product is a mixture of progenitors (CD34(+) cells) and differentiated (mainly myeloid and megakaryocytic) cells. To reduce cell apoptosis, more frequent cell feeding during culture should be tested.

Spontaneous dissection of coronary artery in a patient with ascending aortic aneurysm and aortic valve regurgitation.

Spontaneous coronary artery dissection is a rare cause of myocardial infarction associated with a significant high morbidity and mortality. It usually occurs in relatively young patients and it is frequently found at autopsy. We report a case of a 42-year-old woman, who underwent resection of subaortic diaphragm ten years earlier presenting with postero-lateral myocardial infarction. Coronary arteriography revealed a dissection of the left main stem extending distally to the left anterior descending artery (LAD) and circumflex artery (Cx); occlusion of the postero-lateral branch of the Cx; severe aortic valve regurgitation and ascending aortic aneurysm. She was successfully operated on in emergency and underwent myocardial revascularization and separate replacement of the aortic valve and the ascending aorta. In this specific case of coronary dissection and severe aortic regurgitation it is mandatory to perform surgery in emergency to limit infarction evolution and avert loss of life.

Hypotonically induced calcium increase and regulatory volume decrease in newborn rat cardiomyocytes.

The effect of cell swelling on intracellular calcium concentration ([Ca2+]i) was studied in newborn rat cardiomyocytes. Hypotonic cell swelling induced a fast and transient [Ca2+]i increase (hypotonically induced calcium increase, HICI; 388±47 nM, n=14). HICI was not inhibited by cyclopiazonic acid (CPA), an inhibitor of sarcoplasmic Ca2+-ATPase, nor ryanodine (an inhibitor of calcium-induced calcium release), whereas it was abolished (11±19 nM, n=5) in the absence of external calcium. Thus, HICI appeared to depend exclusively on entry of external calcium. Gadolinium ion (Gd3+), a generic inhibitor of stretch-activated cation channels (SACs), was unable to affect HICI (353±79 nM, n=6). Similarly, HICI was unaffected by internal Na+ depletion and external Na+ omission. These results suggest that neither Gd3+-sensitive SACs nor Na+-Ca2+ exchange is responsible for HICI. Conversely, HICI was inhibited by diltiazem (42±4 nM, n=3) and by membrane predepolarization (40±18 nM, n=5), suggesting an involvement of L-type voltage-activated calciumchannels. Cardiomyocyte swelling was followed by a regulatory volume decrease (RVD). The putative role of HICI in volume regulation was studied by removal of external calcium. This procedure significantly slowed RVD but did not abolish it. In conclusion, newborn rat cardiomyocytes exhibit an external-calcium-dependent HICI which contributes partially to the RVD.

Involvement of the membrane-bound Na,K ATPase in the evolution of experimental injuries of the spinal cord.

Rat spinal cords have been compressed at the region corresponding to D4-D5 by a 50 mg/cm force. After 5, 30 and 60 min this section has been dissected together with the surrounding cord. The ATPase activity of the homogenates was decreased, suggesting an involvement of this enzyme in the generation of edema.

[Dupuytren's disease and diabetes mellitus]. / Malattia di Dupuytren e diabete mellito.

The AA. study the relationship between diabetes mellitus and Dupuytren's disease. The examination of 300 patients, after a palmar aponeurectomy intervention, shows a percentage of 14.3%, equivalent to 43 patients.

[Relation between L5 sacralization and hernia of the lumbar disk]. / Studio del rapporto fra sacralizzazione di L5 ed ernia del disco lombare.

The AA. present a study on the relationship between the most common congenital malformation of the lumbosacral passage: the sacralization of L5 and lumbar disc hernia. The examination of 200 cases of lumbar disc hernia shows a sacralization incidence of 11.5%.

[Influence of osteoporosis on the morphology of proximal fractures of the femur]. / Influenza dell'osteoporosi sulla morfologia delle fratture prossimali del femore.

The authors consider 100 cases of fractures of femur proximal third with the purpose to appraise the real relations existing between degree of osteoporosis and morphology of the fractures. The data obtained confirm the strict dependence of these two phenomena on each other.

[Osseous hydatidosis: presentation of a rare localization and review of the bibliography]. / Idatidosi ossea: presentazione di una rara localizzazione e revisione della bibliografia.

The AA. present a rare case of osseus hydatidosis relapsed 27 years after the surgical treatment, located in the tibia and fibula, where the near soft tissue as well as the S.P.E. were involved. A critical revision of the bibliography is presented.

[Review of 41 cases of surgically treated acromioclavicular dislocations]. / Revisione di 41 casi di lussazione acromio-claveare di 3 tipo trattati chirurgicamente.

The authors have examined the follow-up of 41 cases of acromio- clavicular dislocation, treated by internal fixation. Statistics show a very good end result.

[Parallelism of L5-S1 in the radiological diagnosis of lumbar disk hernia]. / Il parallelismo di L5-S1 nella diagnosi radiologica di ernia discale lombare.

The authors show a study about the measuring of L5-S1 angle in 100 patients with diagnosis of L5-S1 discal prolapse, confirmed by the interoperative report. The value of the angle, in 72% of cases, resulted equal to, or lower than 10, with an aggregate average of 9.45.

[Use of the external fixator in the treatment of recent fractures of the leg]. / Uso del fissatore esterno nel trattamento delle fratture recenti di gamba.

The authors show 30 cases of recent tibial fractures treated by external fixation. They study the different types of fractures, the models of external fixation employed, the complications occurring during the treatment and the ultimate results obtained.

[A case of osteomyelitis caused by salmonella in a subject with thalassemia-drepanocytosis]. / Un caso di osteomielite da salmonella in soggetto affetto da talassodrepanocitosi.

The authors show a case of osteomyelitis due to salmonella, they had the opportunity to observe in a patient suffering from thalassemia and sickle-cells disease in heterozygote from. They describe all the clinical and instrumental ascertainments performed and the surgical treatment effected at level of the osteomyelitic focus with subsequent recovery.

[Evaluation of the aftermath of trimalleolar fractures of the tibio-tarsal joint]. / Valutazione dei postumi delle fratture trimalleolari della tibio-tarsica.

The authors have examined the follow-up of 57 cases of trimalleolar fractures treated by internal fixation. Statistics show a good end result. The Authors, moreover, report the frequent presence of synostosis tibio-fibulare distale. This condition, however, has no influence on ankle motion.

[Surgical treatment of humeral epicondylitis]. / Il trattamento chirurgico dell'epicondilite omerale.

The authors show the remote reviewing of 41 patients suffering from tenuis elbow, surgically treated from 1975 up to 1983. The results at the checking appear excellent in 67,4%, good in 20,9%, sufficient in 9,4% and, at last, poor in 2,3%.

[Osteochondritis dissecans: a rare localization]. / Osteocondrite dissecante: una rara localizzazione.

The authors show a non-frequent location of osteochondritis, occasionally diagnosed owing to a trauma. In consideration of the practically inexistent painful symptomatology, no specific therapy was performed. The clinical and radiographic checking was effected after eight months.

[Frieberg-Kohler disease. Long-term review of the surgical treatment in 20 cases]. / La malattia di Frieberg-Kohler. Revisione a distanza del trattamento chirurgico in 20 casi.

The authors show the reviewing of twenty patients suffering from Frieberg-Kohler's disease, surgically treated from 1975 up to 1980. The surgical intervention had been suggested by the important painful symptomatology, resisting to the conservative therapy. At checking, the patients were all satisfied with the results of operation, and could start again with their usual job.