Reverse shoulder arthroplasty in older patients: is it worth it? A subjective functional outcome and quality of life survey.

BACKGROUND: Reverse shoulder arthroplasty (RSA) use has largely spread in the last decade. Doubts still exist, however, about its use in the elder population, because of high risk of complications and possibly limited cost-efficiency of the procedure. AIMS: Our work was aimed at defining the subjective outcome, complication and satisfaction rate, and perceived recovery of individual autonomy and quality of life after RSA, in a cohort of patients 79 or more years old at the time of surgery. METHODS: Between 2007 and 2012, 52 patients 79 years old or older received a RSA. In the setting of this study, 27 patients (31 shoulders) were available for clinical evaluation. The ASES score was used for subjective outcome evaluation, while the health-related quality of life was studied with the SF-12 form. An ad hoc questionnaire was used in order to evaluate the satisfaction rate and the recovery in individual autonomy. RESULTS: At 59,3 months mean follow-up, only one patient required revision due to periprosthetic fracture. ASES score attested at 78.2, and SF-12 scores showed values similar to the general age-matched population. Sensible improvement in perceived quality of life was described by 24 patients. When present, comorbidities were associated with lower results. DISCUSSION: RSA outcomes in the elderly are good in terms of function, satisfaction and quality of life recovery. Complications appear primarily linked to age-related conditions and comorbidities show critical association with lower results. CONCLUSIONS: Our study confirms that RSA represents a useful solution for end-stage shoulder disease also in the advanced age population.

Shoulder hemiarthroplasty for complex humeral fractures: a 5 to 10-year follow-up retrospective study.

BACKGROUND: Shoulder hemiarthroplasty is considered a standard treatment in case of complex proximal humeral fractures. However, great variability affects the clinical outcomes. In this work, we examined the clinical and radiographic outcomes in a series of patients treated with hemiarthroplasty for 3- and 4-part humeral fractures and focused on factors affecting the final result. MATERIALS AND METHODS: In this study, we included 27 patients who had received a shoulder hemiarthroplasty between 2001 and 2005 at our institution. These patients were evaluated at an average of 7.2 years after surgery. All patients were managed within 10 days from trauma by the same surgeon and underwent the same time-scheduled rehabilitation program. Average age at surgery was 71.9 years. RESULTS: Implant survival was 88.9 %. At the latest follow-up, mean DASH and SST-12 scores were 26.8 and 6.5, respectively. Mean Constant-Murley score was 52.4. Tuberosities complications and reduction in the acromion-humeral distance were negatively related to clinical outcome. Age at surgery displayed a negative correlation with clinical outcome, despite not reaching the statistical significance. This is mainly due to great variability in the elder group of patients. CONCLUSIONS: Shoulder hemiarthroplasty is a useful and effective solution for complex humeral fractures, with good results in the majority of patients. However, outcomes display a great variability in relation to X-ray alterations and age at surgery. A careful attention in patient selection is needed in order to standardize the clinical results associated with this kind of prosthetic implant.

Cholinergic modulation of growth hormone, prolactin and thyroid stimulating hormone responses to thyrotropin-releasing hormone in normal aging.

Endocrine changes occur during the normal aging process. These include alterations in GH, TSH and, to a lesser extent, PRL secretion. Pyrodistigmine (PD) increases basal GH secretion in a widely variable manner and partially reverses the blunted GH response to GHRH found in elderly subjects. The aims of this study were to verify the finding of a paradoxical GH response to TRH (200 micrograms iv) and to evaluate the effect of priming with PD (120 mg orally) on basal and TRH-stimulated GH, TSH and PRL secretion in 7 euthyroid subjects (aged 75-96 years). Hormonal responses after control saline and PD were also evaluated. PD did not modify TSH or PRL responses to TRH. A slight increase in GH secretion was observed after PD. A clear-cut increase in GH levels after TRH was found in 4 out of 7 subjects. TRH-induced GH secretion was significantly increased by pretreatment with PD. Functional abnormalities in the neuroendocrine control of GH secretion in aging could explain, at least in part, the appearance of GH release after TRH. Cholinergic neurotransmission, which is thought to be stimulated by PD administration, seems to be involved in the non-specific GH release after TRH administration in elderly subjects.

[Evaluation of functional periodicity of the pituitary gland by harmonic analysis.--IV) Circadian prolactin secretion in women with breast cancer]. / Valutazione della periodicita'funzionale dell'ipofisi mediante analisi armonica.--IV) La secrezione circadiana della prolattina in donne affette da carcinoma mammario.

Secretory periodicity of prolactin (PRL) is preserved in women with breast cancer in spontaneous or surgical menopause. Hormone titres occurring during the day may be occasionally significantly higher in respect to the ones observe in normal controls at the same hours. The periodicity features calculated by the Fourier's method show however normal indices, namely mesor (mean PRL titres in the 24 hours) phase, amplitude and frequency of oscillations.

[Evaluation of functional periodicity of the pituitary gland by harmonic analysis.--III Circadian prolactin secretion in subjects with prolactin-secreting adenoma]. / Valutazione della periodicita' funzionale dell'ipofisi mediante analisi armonica.--III) La secrezione circadiana di prolattina in soccetti con adenoma prolattino-secermente.

The 24-hour periodicity of PRL secretion in 7 prolactinoma subjects of both sexes has been studied by means of the Fourier's harmonic analysis. In all cases elevated PRL titres have been found, that did not show the physiological changes due to sleep and wake. In most of the cases could not be demonstrated either a significant secretory periodicity or secretory episodes occurred with a frequency higher than in the control groups. Such secretory features may depend on changes in the neoplastic cells' receptors for regulating neurotransmitters.

[The use of an immunofluorescence technic in the control of chronic HBV hepatitis]. / L'impiego della tecnica dell'immunofluorescenza nel controllo delle epatiti croniche da HBV.

The direct and indirect immunofluorescence technique has been used to study liver biopsies in children affected by different forms of chronic HBsAg positive Hepatitis. The method allows to study the long run changes of the antigens correlated to HBV and of the related immunological phenomena both in serum (autoantibodies) and in the tissue (immunoglobulins and immunocomplexes in the liver). The results obtained are satisfactory.

[Evaluation of pituitary functional periodicity by harmonic analysis. I) Circadian somatotropin secretion in acromegaly]. / Valutazione della periodicità funzionale dell'ipofisi mediaute analisi armonica. I) - La secrezione circadiana di somatotropo nell'acromegalia.

STH circadian secretion has been investigated in 11 acromegalic patients. The physiological STH nocturnal surge is not present in acromegaly, but when data are evaluated by Fourier's cosines analysis, a rhythmicity is however found also in acromegaly. The characteristics of harmonics, namely periodicity, amplitudes and phases, are largely different in respect to pattern of normal subjects, where the rhythmicity is represented by an harmonics with 24-hour periodicity.

[Evaluation of pituitary functional periodicity by harmonic analysis. II) Circadian prolactin secretion in acromegaly]. / Valutazione della periodicitià' funzionale dell'ipofisi mediante analisi armonica. - II) La secrezione circadiana di prolattina nell'acromegalia.

PRL levels over 24 hours have been studied in 9 acromegalic patients (4 men and 4 women). Hormone levels were found significantly higher than age and sex matched normal subjects in 4 cases (2 males and 2 females). PRL and STH levels were significantly correlated in men, but not in women. A 24-hour periodicity of PRL secretion was found in 4 cases, however in 2 of them the phase was anticipated in respect to the control group. In 4 of the remaining subjects the hormone secretion is made up by a succession of episodes with higher frequency than in the control group. Only in one case no significant periodicity of secretion was observed.

Neuroendocrinological and clinical data upon trazodone treatment in depressed patients.

Prolactin and somatotropin secretory rhythmicity was studied in 7 inhibited depression male patients, evaluated by the Hamilton Rating Scale for depression, before and after trazodone (400 mg i.v. once daily) treatment. The mean 24-hour hormone levels of the patients were comparable to the controls. Trazodone enhances the prolactin value, increasing chiefly the titres during sleep which were lower in respect to controls before treatment. The drug decreases the mean 24-hour somatotropin levels, mainly the values during sleep. A serotoninergic effect is possibly involved. An improvement of mood has been observed in all cases.