Post-operative complications of tibial plateau fractures treated with screws or hybrid external fixation.

PURPOSE: To assess the complications and second surgeries rates at 1 year follow-up in a group of patients underwent minimally invasive fixation with screws or hybrid external fixation (HEF) for tibial plateau fractures (TPF). The hypothesis was that low Schatzker (I-IV) TPF would have shown a lower complication rate with respect to high Schatzker (V-VI) TPF. METHODS: 148 patients who underwent minimally invasive surgery with screws or HEF for TPF were included and pooled in two groups: mono-condylar (Schatzker I-IV) and bi-condylar (Schatzker V-VI). The rate of second surgeries and complications, such as stiffness, infection, wound dehiscence and malunion occurred within 1 year, were reported. RESULTS: Statistically significant difference between mono-condylar and bi-condylar groups was found in terms of stiffness (18% vs. 37%, p = 0.01), malunion (4% vs 21%, p = 0.004) and second surgeries (32% vs. 48%, p = 0.049). Associated procedures performed during TPF fixation increased risk of second surgeries (OR 2.1, p < 0.001). No differences in terms of second surgeries and complications were found in bi-condylar group treated with screws and HEF. CONCLUSION: Bi-condylar TPF treated with minimally invasive surgery developed a significantly higher rates of stiffness, malunion and second surgeries within 1 year compared to mono-condylar fractures. Moreover, when an associated procedure was performed, the risk of a reoperation was nearly doubled. Trial registration number PG 0012506 CE AVEC 620/2018/Oss/IOR.

Entero-colpo-defecography vs supine entero-MRI: which one is the best tool in the differentiation of enterocele, elytrocele and edrocele?

Pelvic floor disorders represent a significant cause of morbidity associated with a severe reduction of quality of life. It represents a very common clinical problem that afflicts women three to seven time more often than men. The purpose of this study was to assess the diagnostic tools available to define the imaging strategy in patients with pelvic floor dynamic dysfunctions and to investigate their abilities in the diagnosis of enterocele, elytrocele and edrocele. From January 2008 to May 2011, 614 patients with symptoms related to pelvic floor dynamic dysfunctions were enrolled in our retrospective study. After anamnesis and clinical examination, entero-colpo-defecography (ECD) and supine entero-magnetic resonance (SE-MR) exams were performed in all patients. This study showed that the diagnostic efficacy of ECD is higher than that of SE-MR in the detection of enterocele and edrocele. Furthermore, elytrocele can be visualized only with ECD considering the position of patient during SE-MR examination. In addition, in patients planned for surgery, SE-MR is more useful to clarify the intra-pelvic interaction of multiple organ prolapse and to better define the pelvic anatomy and functioning.

Three-dimensional anal endosonography in depicting anal-canal anatomy.

PURPOSE: This report describes the advantages of 3D anal endosonography in depicting the normal anatomy of the anal canal in relation to sex and age. MATERIALS AND METHODS: A retrospective study was performed of 85 patients, 33 men and 52 women, previously examined with 3D anal ultrasound (US) for clinically suspected anorectal disease but found to be negative. The examinations were performed with a Bruel and Kjaer US system with a 2050 transducer, scanning from the anorectal junction to the subcutaneous portion of the external anal sphincter (EAS). The 3D reconstructions provided an estimation of sphincter length in the anterior and posterior planes, and axial 2D images enabled calculation of the thickness of the internal anal sphincter (IAS) and EAS in the anterior, posterior and lateral transverse planes. RESULTS: Distribution of the sphincter complex is asymmetric in both sexes: the EAS and IAS are significantly shorter in females, especially in the anterior longitudinal plane (p=0.005 and p<0.001, respectively). EAS and IAS thickness increases with age, especially the lateral IAS (R(2)=0.37, p<0.001) and the posterior EAS (R(2)=0.29, p=0.01). CONCLUSIONS: A good knowledge of anal-canal anatomy is essential to detect sphincter abnormalities when assessing pelvic floor dysfunction.

Decreased fibrinolytic response to adrenergic stimulation in hypertensive patients.

The aim of this study was to assess the function of the fibrinolytic system at rest and in response to adrenergic stimulation in patients with stable essential hypertension as compared with normotensives. At rest, essential arterial hypertensives were characterized by increased levels of circulating tissue-plasminogen activator, associated with an increased activity of its specific inhibitor, the PAI-1. After stress, fibrinolytic response was impaired in essential arterial hypertensives despite a greater release of tissue plasminogen activator by endothelial cells. Therefore, the PAI-1 activity may be increased in essential arterial hypertensives not only at rest, but also after stress. This may represent a risk factor for hypertensive patients.

Clinical experience with ketanserin in the treatment of hypertension.

Ketanserin (K), a selective and specific S2-receptor antagonist, has been compared with metoprolol (M), a cardioselective beta-blocker, in a double-blind study in order to assess its efficacy and safety in the treatment of essential hypertension. After a placebo run-in period of 4 weeks, hypertensive patients [supine diastolic blood pressure (DBP) greater than or equal to 100 mmHg] were treated with K, 40 mg twice daily (n = 18), or with M, 100 mg twice daily (n = 14). Systolic pressure (SBP) and DBP, both supine and standing, were significantly reduced from the first month of treatment by both drugs and remained stable for the whole study period (12 weeks). About two-thirds of the patients treated with K responded to the therapy (drop in DBP of at least 10%) and half were normalized (DBP less than or equal to 90 mmHg). In the M group, 50% of patients responded and 30% were normalized. A significant decrease in the heart rate was observed with M, but not with K. Ten patients treated with K were followed for 1 year. The antihypertensive effect of K was maintained throughout the study with evidence of tolerance. No serious adverse reaction was observed.

[Juvenile hypertension. Results of a study in high school in Milan (author's transl)]. / Ipertensione giovanile. Risultati di uno studio condotto nelle scuole medie di Milano.

Blood pressure has been measured in a cohort of 2300 high school students of Milan (14-15 years old) for two years on end. The prevalence of "borderline hypertension" was 11.5% at the first examination and 8.5% at the second. The values of blood pressure were decreased, in every measurement, after a year from the initial screening especially in "borderline hypertensives". This study has confirmed that the "borderline hypertension" in subjects 14-15 aged is a transient phenomenon, but the incidence of "stable hypertension" as been found higher significantly in "borderline hypertensives" than normotensives. The results are discussed.