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.

A retrospective study on mesh repair alone vs. mesh repair plus pedicle flap for large incisional hernias.

OBJECTIVE: Our experience with the treatment of large incisional hernias (IH) was reviewed comparing mesh repair alone vs. mesh repair plus pedicle flaps. MATERIALS AND METHODS: A retrospective study was performed on patients treated between 2001 and 2005 that underwent component separation technique (CST) repair with polypropylene mesh alone or with polypropylene mesh and local "pedicle" dermal flaps. The primary outcome evaluated was the recurrence rate, secondary outcomes the complication rate, hospital stay and reoperation rate. RESULTS: Forty-eight patients were reviewed. Six patients (13%) developed an IH recurrence, two of them (4%) required secondary repair. CST combined with prosthetic mesh repair and pedicle flap was performed in 19 patients (39.6%) while CST combined with mesh repair alone in 29 patients (60.4%). The duration of surgery, hospitalization, postoperative complications as well as long-term results were similar. CONCLUSIONS: Dermal pedicled flaps obtained through deepithelization of redundant skin following corrections of large incisional hernias are a safe, relatively easy and effective technique that allows reliable soft tissue coverage of the abdominal submuscular mesh.

Perniosis in association with anorexia nervosa.

Several dermatologic abnormalities have been described in anorexia nervosa, but only rare associations have been made with perniosis. We recently saw two teenage girls and one woman with anorexia nervosa who had symptoms of perniosis. We suggest that altered thermoregulation and a hyperreactive peripheral vascular response to cold in anorexia nervosa may predispose these patients to perniosis.

Effect of obesity on pulmonary function in children.

The effect of obesity on pulmonary function was studied in 13 children, aged 8-15 years, with 147-300% ideal body weight (IBW). Measurements included lung volumes, airflow rates pre- and post-bronchodilator nebulization, diffusing capacity (DLCO), maximal voluntary ventilation (MVV), minute ventilation VE), and resting energy expenditure (REE). When compared with predicted normal values for sex, height, and body surface area (BSA), decreases (mean % predicted, +/- SE) were observed in expiratory reserve volume (ERV, 36 +/- 5); forced expiratory volume in 1 second (FEV1, 73 +/- 5); forced expiratory flow between 25% and 75% of vital capacity (FEF25-75%, 70 +/- 6); DLCO, absolute (52 +/- 3) and corrected (DLCO/VA, 71 +/- 5); and MVV (62 +/- 5). Residual volume (RV), RV/total lung capacity (TLC), VE, and REE were elevated. Other lung volumes were normal. Thus, obese children have altered pulmonary function, which is characterized by reductions in DLCO and ventilatory muscle endurance and airway narrowing. These alterations may reflect extrinsic mechanical compression on the lung and thorax, and/or intrinsic changes within the lung. The reduced DLCO may result from decreases in alveolar surface area relative to lung volume.

[Bilateral renal angiomyolipoma. Operative approach in a case with Wunderlich syndrome]. / L'angiomiolipoma renale bilaterale. Tattica operatoria in un caso con sindrome di Wunderlich.

After a wide-ranging review of the literature on the topic, the case of a 33-year-old woman is reported who, after an emergency right nephrectomy performed six years earlier due to renal angiomyolipoma with Wunderlich's syndrome, was admitted with anemia and acute shock following left renal hemorrhage. Having overcome the acute stage, a number of tests were carried out (echography, urography, abdominal CT, aortography) before the patient underwent conservative surgery in the form of lower heminephrectomy. The postoperative urography is presented showing satisfactory residual renal function which enabled the patient to live normally. The Authors discuss the criteria which lead them to select conservative surgical treatment.

[Echinococcosis cyst in the pelvic cavity. Presentation of a case]. / Cisti da echinococco nello scavo pelvico. Contributo casistico.

The incidence of echinococcal cysts and their percentage occurrence in different human organs is reported. A case of hydatid cyst localisation in the pelvic cavity is reported and the pathogenesis of this infrequent localisation discussed. The various hypotheses: haematogenous and fall into the peritoneal cavity are examined; then the diagnostic approach and conservative surgical therapy employed.

Peri-operative jejunostomy-tube feeding in reconstructive spinal surgery.

Eight malnourished children with neuromuscular spinal deformity were treated with jejunostomy tubes for supplemental feeding to attain appropriate weight before reconstructive surgery. All patients had significant gastro-esophageal reflux and had failed to gain weight during an eight-month oral supplementation program. There were no complications associated with the placement or use of the jejunostomy feeding tubes and all patients gained weight in a safe and predictable fashion, had successful spinal fusion and have maintained satisfactory weight at follow-up. Jejunostomy feeding is a safe and effective method of correcting malnutrition in patients with spinal deformity which precludes gastrostomy and Nissen fundoplication.

[Diagnostic problems in pyelo-ureteral duplication. Presentation of a case]. / Problemi diagnostici nella duplicità pielo-ureterale. Presentazione di un caso.

A case of left pyeloureteral duplication with half a kidney functionally excluded is reported. After some mention of embryology to evidence the pathogenetic moments of the malformation, the clinical case is described, particular reference being made to the problems encountered in reaching diagnosis, in spite of the patient having undergone varied and repeated investigations. Superior heminephrectomy and total ureterectomy led to the clinical wellbeing of the patient.

[Synthesis and microbiologic activity of a new class of imidazole derivatives]. / Sintesi ed attività microbiologica di una nuova classe di derivati imidazolici.

The synthesis of a new class of imidazole derivatives with the structure of 1-[2-(2,4-dichlorophenyl)-2-tert.amino]ethylimidazoles is described. Preliminary data on their antimicrobial activity are reported.

Constipation presenting as respiratory distress.

This case report describes a 14-year-old boy presenting with a barrel-chested appearance and a complaint of shortness of breath on exertion. The patient had a long history of severe constipation with overflow incontinence. Physical examination suggested limited diaphragmatic excursion. Initial pulmonary function studies showed a restrictive pattern. Catharsis resulted in an 11-lb weight loss and normalization of pulmonary function. We speculate that the extrinsic upward pressure imposed on the diaphragm by a full bowel resulted in increased anteroposterior diameter, decreased lung height, and a reversible restrictive pattern on pulmonary function studies.

Possible involvement of eicosanoids in the pharmacological action of bromelain.

Bromelain, a proteolytic enzyme extracted from pineapple plants, was investigated for its capacity to interfere with arachidonic acid metabolism, since prostaglandins and other eicosanoids are well-known to be involved in the pathogenesis of inflammatory diseases. Bromelain was tested for its ability to interfere with eicosanoids generation in vivo in two experimentally-induced inflammatory reactions in the rat. Also antiplatelet aggregation activity of bromelain was studied in ex vivo rat platelets. The results seem to indicate an interference of bromelain with arachidonic acid cascade, which, however, deserves further investigation to be better assessed.