Clinical, functional and radiological results of Achilles tenorraphy surgically treated with mini-open technique.

AIM: The aim of this paper was to report clinical, functional and radiological results of 80 patients surgically treated with a combined mini-open and percutaneous surgical repair as proposed by Kakiuchi. METHODS: All patients were evaluated with a physical examination, evaluation scales, a functional test (Ergo-jump Bosco System), and an ultrasonographic exam along with Power Doppler Ultrasonography (PDU) (S/S). RESULTS: At a mean follow-up of 58 months no cases of rerupture were detected. VISA-A evaluation scale showed an excellent score in 63 patients (78.75%), a good score in 14 patients (17.5%), a fair score in two patients (2.5%), and a poor score in one patient (1.25%). Hannover scale showed an excellent score in 63 patients (78.75%), and a good score in 17 patients (21.25%). Ergo-Jump evaluation showed a 2.07% mean deficit of the affected limb at the Squatting Jump test, a 3.26% mean deficit at the Counter Movement Jump test, and a 0.0062% mean improvement at the Repetitive Jump test. Ultrasonographic exam showed in all cases a satisfactory recovery of the integrity of the operated tendon. The mean AP and LL widths showed a significant increase of 7.13±2.97 mm (+56.1%) and of 4.01±2.36 mm (+43.81%) respectively. According to the modified Öhberg score scale, PDU exam showed a grade +1 in 16 patients (20%) and a grade +2 in seven cases (8.7%). CONCLUSION: The absence of rerupture cases, the satisfactory functional and ultrasonographic results of the patients included in this study cause us to consider this technique as reliable and effective even in young high-demand patients.

Blunt splenic injury: authors' experience and comparison to literature.

AIM: Splenic injuries, like other blunt traumatic injuries, are very frequent, especially in case of traffic accident. The purpose of this study was to present the authors' experience of blunt splenic trauma and to compare it with the studies described in literature. METHODS: Over a 5-year period 512 injured patients were admitted to the trauma center, 57 of whom presented splenic injuries, and they were retrospectively analyzed. Data review included demographic information, trauma mechanism, admitting hemodinamic parameters, Injury Severity Score. The patients were classified in two groups, one composed by immediate operated injured because their initially hemodinamic instability (27 patients) and another where patients underwent planned nonoperative management (29 patients), which included strict bed rest, frequent physical examinations, serial hematocrits and repeated diagnostic images. The patients were compared to find which factors influence the choice of surgical treatment. RESULTS: There are statistically significant differences between the groups, concerning admitting hemodinamic parameters, as blood pressure and pulse rate, and the grade of anatomic splenic injury. Four patients failed nonsurgical management and required a splenectomy, because during the third day they suddenly presented clinical deterioration. CONCLUSIONS: Comparing these results with literature the authors try to improve spleen preserving program avoiding surgery when possible and using for example splenic embolization.

[Crush syndrome]. / Sindrome da schiacciamento.

Crush injuries and crush syndrome are common after natural (e.g. earthquake, land-slide, tornadoes, tsunami) or man-made catastrophes (e.g. wars, terrorist attacks), in fact the history of this disease is well reported both in earthquake rescue reviews and in military literature. However, there are instances due to conventional causes, such as building collapses, road traffic accident, accident at work or altered level of consciousness after stroke or drug overdose. These situations of ''big or small'' catastrophes can occur at any time and anywhere, for this reason every clinician should be prepared to address issues of crush syndrome quickly and aggressively. The treatment has to manage and to predict clinical conditions before they present themselves. In particular, acute renal failure is one of the few life-threatening complications that can be reversed. This article reviews the various evidences and summarizes the treatment strategies available. Fundamental targets in crush syndrome management are early aggressive hydration, urine alkalinization and, when possible, forced diuresis. Since electrolyte imbalance may be fatal due to arrhythmias secondary to hyperkalemia (especially associated with hypocalcemia), it's necessary to correct these abnormalities using insulin-glucose solution and/or potassium binders, and if nevertheless serum potassium levels remain high this serious disease will necessitate dialysis, which is often a vital procedure.

[Valuation on prognostic factors about secondary acute peritonitis: review of 255 cases]. / Considerazioni sui fattori prognostici della peritonite acuta secondaria su di una revisione di 255 casi.

Despite advances in diagnosis, surgical treatment, antimicrobial therapy and intensive care support, severe secondary peritonitis remains a potentially fatal affliction. The purpose of this study is to present our experience of postoperative mortality in 255 patients with secondary acute peritonitis between 1998 to 2002. The Mannhein Peritonitis Index score (MPI) was calculated for each patient to predict the peritonitis related in-hospital death. Both literature reviews and our results show a strong correlation between some etiopathogenetic elements (age, origin of sepsis, organ failure, ...) and prognosis. Our patients were classified in three groups according to MPI, one with a score less than 21, another with a score between 21 and 29 and the third one with a score greater than 29. There was no mortality in the first group and there was significantly less mortality in the second group than the third one (P<0.001). While prognosis is influenced by many factors, the intervention time was the same, greater than 24 hours, for all the patients regardless of MPI score. This study suggests that intervention time may be considered the main determinant of mortality in patients with peritonitis. This observation is especially relevant since intervention time is a modifiable prognostic factor whilst many other factors are not.