Surgical access and damage extent after total hip arthroplasty influence early gait pattern and guide rehabilitation treatment.

AIM: Different surgical approaches are used in total hip arthroplasty. The present study confronted two surgical techniques, analysing functional recovery in terms of activities of daily living, and ambulation using gait analysis, after a standardized rehabilitation protocol. Our hypothesis was that the increased surgical damage could modify the gait pattern and functional recovery. METHODS: Thirty patients were randomly assigned to two homogeneous groups: Group A was treated with intermuscular minimally invasive surgery (MIS); Group B was treated with standard lateral transmuscular approach. Follow up was planned at 30 and 90 days. Instrumental evaluation using gait analysis and functional evaluation using validated scales were performed at follow up. RESULTS: No differences could be found as for functional scales. At the first follow up, the MIS approach proved to be the most favourable: data showed a longer duration of the swing phase, an improved range of motion of the non-treated hip, a reduced adduction (all P<0.005) and a correct timing of activation of the gluteus medium muscle on the treated side. At the second evaluation, gait analysis demonstrated some benefits of the intermuscular approach (a better flexion of both hips, and a minor obliquity of the pelvis during the terminal stance), but also advantages in the transmuscular group (better hip extension). CONCLUSION: Gait pattern after THA seems to be strictly dependent on surgical access and on the extent and location of surgical damage. It appears important to consider these elements in order to correctly manage the rehabilitation treatment after surgery.

Screening of lung cancer with low dose spiral CT: results of a three year pilot study and design of the randomised controlled trial ''Italung-CT''.

PURPOSE: To report the results of a three-year observational pilot study of lung cancer screening with low dose computed tomography (CT) and to present the study design of a randomised clinical trial named as ''Italung-CT''. MATERIALS AND METHODS: Sixty (47 males and 13 females, mean age 64+/-4.5 years) heavy smokers (at least 20 packs-year) underwent three low-dose spiral CT screening tests one year apart on a single slice or multislice CT scanner. Indeterminate nodules were managed according to the recommendations of the Early Lung Cancer Action Project. RESULTS: and Indeterminate nodules were observed in 33 (55%) of the subjects (60% at the baseline screening test, 24% at the first annual test and 16% at the second annual test). The size of the largest indeterminate nodule was <5 mm in diameter in 20 subjects, 10 of whom showed the nodule at the baseline test. Forty-five subjects (75%) completed the first annual test and 42 (70%) the second annual test. One (1.6%) prevalent lung cancer (adenosquamous carcinoma) and one (2.2%) incident lung cancer (small cell cancer at the first annual examination) were observed, as well as a pulmonary localisation of Hodgkin's lymphoma (at the second annual test). In addition, one subject underwent lung surgery for a chondromatous hamartoma. CONCLUSIONS: The results of the pilot study are substantially in line with those of other observational studies of greater sample size. This justifies optimism about the reliability of the results in the screened arm of the ''Italung CT'' trial which has just begun.

Agrobacterium-mediated transformation of Artemisia absinthium L. (wormwood) and production of secondary metabolites.

Hairy roots were obtained after infection of Artemisia absinthium shoots with Agrobacterium rhizogenes strains 1855 and LBA 9402. The susceptibility to hairy root transformation varied between plant genotypes and bacterial strains. Hairy roots showed macroscopic differences from control root cultures. Southern blot hybridization confirmed the integration of T-DNA from both p1855 and pBin19, while polymerase chain reaction analysis indicated the presence of the neomycin phosphotransferase gene in the hairy root genome. Subcultured transformed root lines grew well in selective B5 agar-solidified medium containing kanamycin or rifampicin and without hormones. Shake-flask experiments with fast-growing root lines showed that 40 g l-1 was the best sucrose concentration for biomass production, yielding a 463-fold increase in dry weight after 28 days of culture. Great differences were found in the profiles of the essential oils isolated from normal and hairy roots. Gas chromatography/mass spectrometry analysis showed the oil produced by transformed cultures to be a mixture of 50 compounds with only one major component representing 37% of the oil content.

Poliartritis seropositiva como presentación de linfadenopatía angioinmunoblástica / Seropositive polyarthritis as a presentation of immunoblastic lymphadenopathy

Se presenta un paciente de sexo masculino de 59 años de edad con poliadenopatía febril, que habia desarrollado dos meses antes una poliartritis de tipo AR-símil, con una discreta mejória a pesar del uso de drogas analgésicas y antiinflamtorias no esteroideas. El estudio anatomopatológico de ganglio linfático mostró los criterios histológicos mayores para el diagnóstico de linfadenopatía angioinmunoblástica (LAA), según Jaffe: arquitectura normal del nódulo linfático distorsionada por infiltrados linfoplasmocíticos, acompañados por arborizaciones finas de los vasos sanguíneos y, a menudo, por depósitos intersticiales de material eosinofílico amorfo. El paciente fallece con infiltrados pulmonares. Los inofrmes sobre coexistencia de esta entidad con LES, síndrome de Sj÷gren, AR, ARJ, púrpura de Schonlein-Henoch, etc., son escasos. Si bien una poliartritis indefinida ha sido señalada, el inicio de la LAAI como una poliartritis seropositiva no se ha descripto en las principales revisiones, existiendo la posibilidad de que se trate de una manifestación de la misma o la asociación de una LAAI y una artritis reumatóide (AU)

Poliartritis seropositiva como presentación de linfadenopatía angioinmunoblástica / Seropositive polyarthritis as a presentation of immunoblastic lymphadenopathy

Se presenta un paciente de sexo masculino de 59 años de edad con poliadenopatía febril, que habia desarrollado dos meses antes una poliartritis de tipo AR-símil, con una discreta mejória a pesar del uso de drogas analgésicas y antiinflamtorias no esteroideas. El estudio anatomopatológico de ganglio linfático mostró los criterios histológicos mayores para el diagnóstico de linfadenopatía angioinmunoblástica (LAA), según Jaffe: arquitectura normal del nódulo linfático distorsionada por infiltrados linfoplasmocíticos, acompañados por arborizaciones finas de los vasos sanguíneos y, a menudo, por depósitos intersticiales de material eosinofílico amorfo. El paciente fallece con infiltrados pulmonares. Los inofrmes sobre coexistencia de esta entidad con LES, síndrome de Sjögren, AR, ARJ, púrpura de Schonlein-Henoch, etc., son escasos. Si bien una poliartritis indefinida ha sido señalada, el inicio de la LAAI como una poliartritis seropositiva no se ha descripto en las principales revisiones, existiendo la posibilidad de que se trate de una manifestación de la misma o la asociación de una LAAI y una artritis reumatóide

[Seropositive polyarthritis as a presentation form of angioimmunoblastic lymphadenopathy]. / Poliartritis seropositiva como presentación de linfadenopatía angioinmunoblástica.

We present a 59-year-old male who was admitted due to fever and generalized lymphadenopathy. The patient had polyclonal hypergammaglobulinemia, Coombs-positive anemia, positive rheumatoid factor (latex 1:1280-SCAT 1:128), hypocomplementemia, negative LE cells and FAN negative. He had a 2 months history of a rheumatoid arthritis-like polyarthritis with poor response to non-steroid antiinflammatory drugs. On physical examination a mild symmetrical polyarthritis of small and large joints was seen. A lymph node biopsy showed architectural effacement, absence of germinal centers, arborization of postcapillary venules and a polymorphonuclear infiltrate that included immunoblasts. Thus, this patient fulfills the morphologic criteria of angioimmunoblastic lymphadenopathy (AILD) (Fig. 1 and 2). Our purpose was to describe the association of seropositive polyarthritis with AILD as a presentation sign. Whether this represents a case of a rheumatoid arthritis with AILD or the polyarthritis which has been described as part of the clinical picture or AILD is difficult to say due to the short time evolution of the disease.

Poliartritis seropositiva como presentación de linfadenopatía angioinmunoblástica. / [Seropositive polyarthritis as a presentation form of angioimmunoblastic lymphadenopathy]

We present a 59-year-old male who was admitted due to fever and generalized lymphadenopathy. The patient had polyclonal hypergammaglobulinemia, Coombs-positive anemia, positive rheumatoid factor (latex 1:1280-SCAT 1:128), hypocomplementemia, negative LE cells and FAN negative. He had a 2 months history of a rheumatoid arthritis-like polyarthritis with poor response to non-steroid antiinflammatory drugs. On physical examination a mild symmetrical polyarthritis of small and large joints was seen. A lymph node biopsy showed architectural effacement, absence of germinal centers, arborization of postcapillary venules and a polymorphonuclear infiltrate that included immunoblasts. Thus, this patient fulfills the morphologic criteria of angioimmunoblastic lymphadenopathy (AILD) (Fig. 1 and 2). Our purpose was to describe the association of seropositive polyarthritis with AILD as a presentation sign. Whether this represents a case of a rheumatoid arthritis with AILD or the polyarthritis which has been described as part of the clinical picture or AILD is difficult to say due to the short time evolution of the disease.

[Indications and results of surgical treatment in gastroesophageal reflux and hiatal hernia]. / Indicazioni e risultati del trattamento chirurgico del reflusso gastro-esofageo e dell'ernia jatale.

It is well known that closure of the cardia is incomplete in about 25-30% of all infants; the GER is a direct consequence. Roughly two-thirds of these infants do not show symptoms and only one-third become symptomatic. The symptoms are mild in about 75% of the symptomatic children; no treatment or medical treatment by pediatrician is required. In the remaining 25% the symptoms are moderate or severe and the clinical treatment is necessary. About the 85% of these children are cured with conservative treatment and only 15% of this small remaining group require surgery. In the paper the diagnostic problems and indications for surgery are considered. The Authors report the results of 66 children operated on for GER without (44 children) and with (22 children) hiatus hernia. The operative technique was gastropexy according to Boerema plus retroesophageal hiatopexy in the cases of important hiatus hernia. At the follow-up 61 children (92.5%) were completely asymptomatic and three showed mild symptoms without pathological radiological findings. Clinical and radiological recurrences occurred in two patients (4.5%) with severe brain damage. Two children were reoperated on postoperatively for an ileus due to adhesion. The mortality rate has been zero. In the author's opinion, the Boerema procedure is a simple, physiologic and fast technique, associated with very few complications and no mortality rate and should be considered the elective method in the surgical treatment of GER and hiatal hernia in pediatric patients.