Observational multicentric study on chronic sciatic pain: clinical data from 44 Italian centers.

OBJECTIVE: To provide information on the clinical presentation of sciatic neuropathy and its management in a real-world setting, and to analyze the effects of a multimodal approach based on the association of physical and pharmacological therapy. PATIENTS AND METHODS: A multicentric observational prospective study was conducted in 44 Italian tertiary centers specialized in Physical Medicine and Rehabilitation, Orthopedics, Neurology, Neurosurgery, and Rheumatology. To develop a shared management of LPB with sciatica, a dedicated clinical record was proposed to collect data about diagnosis, treatment, and outcomes. Pain, disability, and quality of life were recorded trough validated questionnaires at baseline and after a two-month follow-up. RESULTS: 394 patients (age, mean ± SD 55.7 ± 14.1 years, 57.1% females) with chronic LBP and sciatica were enrolled in the study. The characteristics of the selected group showed a certain variability in the clinical presentation. At baseline, patients received several different therapeutic options among physical, pharmacological and neurotrophic treatments. A subgroup of 312 patients was treated with a combination of neurotrophic agents containing alpha-lipoic acid (ALA). After a two-month follow-up, a general improvement in both perceived pain and functional disabilities was observed. A significant improvement (p < 0.001) in the Pain Numeric Rating Scale (NRS), Roland e Morris Disability Questionnaire (RMDQ) and Brief Pain Inventory (BPI) Italian short version was observed. CONCLUSIONS: Sciatic neuropathy is a multifaceted condition managed by means of a wide spectrum of therapeutic options. The results of this study suggest that a multimodal approach based on the association of ALA with physical and pharmacological therapies can be beneficial in the treatment of LBP with sciatica.

[Autologous peripheral stem cell transplantation in a patient with diffuse systemic sclerosis: our experience]. / Trapianto autologo di cellule staminali periferiche in un paziente con sclerosi sistemica diffusa: nostra esperienza.

The diffuse form of systemic sclerosis (SSc) can often lead to a rapidly progressive course with the involvement of the visceral organs which causes a severe prognosis. The 5-years cumulative mortality is between 30 and 60%, depending on the clinic form at the onset. Until now, no drug treatment has been proved to be efficacious against the progression of the disease or the regression of the fibrosis. Recently autologous peripheral blood stem cell (PBSC) transplantation has been found to be promising. We introduce the case of a patient, male, 56 years old, who came under our observation on February 2001, suffering from a SSc with a severe multisystem involvement of lungs, skin, heart and gastrointestinal tract, and a positive antibodies anti-Scl-70. The 8 months therapy, at first with iloprost and cyclophosphamide, then with bolus of cyclophosphamide, was ineffective, with a rapid worsening of the cutaneous and pulmonary involvement. Under the patient agreement we decided to carry out an autologous PBSC transplantation. On December 2001, we obtained the PBSC mobilization after the administration of cyclophosphamide and lenograstim and the PBSC recovery with two leucoaferesis procedures. On February 2002, we gave the conditioning therapy with: thiotepa, cyclophosphamide, fludarabine, rabbit antilymphocytic globulin; then we made the infusion of PBSC. The bone marrow recovery (GN >500 and PLT >20.000) arrived at the day + 10. For three months after the transplantation we made an antibacterial, antiviral and antifungin prophylaxis with valacocyclovir, co-trimoxazole and fluconazole. The one-year follow-up has shown an essentially good response with the improving of the skin involvement and of the subjective indicators of the disease, while the pulmonary involvement don't seen modified from the high dose therapy.

Current trends in conservative treatment of fractures of the proximal humerus.

Forty-nine fractures treated conservatively with 30 days of immobilization in a Desault bandage or a suspension cast (3 cases) are discussed. The diaphyseal index was used to check for correlation between the degree of osteoporosis and the extent and type of fracture. After an average follow-up of 6.7 months, 67% of the 36 patients reviewed had a satisfactory clinical and radiographic result and adequate healing, even those with a high degree of osteoporosis. There was no significant correlation between the type of fracture (location and degree of displacement) and the severity of bone resorption. We would emphasize that 33% of the unsatisfactory results were mostly due to the radiographic findings which, scored using the Neer system, were rated unsatisfactory even though the corresponding results were satisfactory as far as the clinical symptoms and signs. In our opinion, proximal humeral fractures in elderly patients should be treated conservatively, especially in cases of slight or moderate displacement.

Considerations on deformity of the foot and suprasegmental pathology in infantile cerebral palsy.

The authors conducted a clinical and CT scan study of the lower limbs of patients with infantile cerebral palsy in a search for correlations between deformities of the foot and pathological conditions in other parts of the limb. This revealed that the keystone in the system is the knee, in which flexion deformity or recurvatum associated with varus or valgus and torsional deformity of the femur and tibia leads to repercussions in the foot which are reasonably predictable and constant. This contrasts with similar situations in non-neurological deformities, where repercussions in the foot are unpredictable.

Nuclear magnetic resonance as a contribution to the choice of technique in lengthening of the Achilles tendon in a spastic equinus foot.

In the search for a more accurate surgical programme for the correction of spastic equinus foot, the authors have studied the Achilles tendon with NMR before and after surgery. The results were quite interesting. Before operation, NMR provides indications as to the best technique to be adopted based on the finding of fibrotic processes involving the peritendinous tissue, in particular the Kager triangle, while, postoperatively, it allows us to evaluate the development of adherent fibrosis in relation to the different surgical techniques of lengthening adopted.

A comparative study of the extensor force of the quadriceps between subjects with a normal patella and those with patella alta of neurological pathogenesis.

The authors examined 20 subjects with infantile cerebral palsy, 10 of whom had patella alta, in order to evaluate any difference of extensor force of the quadriceps in the various degrees of flexion of the knee as compared with normal subjects. The objective was to reveal and measure any functional differences between the two groups.