Clinical results of improvement in periodontal condition by administration of oral probiotics.

Dental plaque-related diseases (cavities, gingivitis, periodontitis and halitosis) have been traditionally controlled by mechanical non-specific removal of plaque. However, many novel treatment approaches aim to inhibit the growth of pathogenic bacteria or to remove their toxins. Probiotics are viable microorganisms which, when administered in adequate amounts, provide a health benefit to the host. Recently, probiotics have been applied as new tools for the improvement of dental health. They have been used to substitute existing antibiotic treatments due to increased resistant bacteria. Probiotics not only have antibacterial activity, but they also have inhibitory effects on the reappearance of oral pathogenic bacteria. The aim of this study was to assess the clinical effect of the administration of probiotics agents in the treatment of mild to moderate periodontitis.

Do intramedullary implants improve survival in elderly patients with trochanteric fractures? A retrospective study.

BACKGROUND AND HYPOTHESIS: There is currently no consensus regarding superiority of the intramedullary fixation over the sliding hip screw. Regional variation remains high and not backed up by solid evidence. Given these premises we aimed to analyze weather implant preference can influence the postoperative survival. Secondary objectives were determining the trend for implant choice and confounding factors associated with intramedullary nails compared to sliding hip screws. PATIENTS AND METHODS: Retrospective data was obtained from patient charts with the main diagnosis of extracapsular/ trochanteric fractures, corresponding to ICD S72.1 codes. Between 2008-2012, 441 patients underwent osteosynthesis with a dynamic hip screw and 155 with intramedullary nail respectively. The living status was determined by comparing the patient identification number against the national population evidence records. RESULTS: The lifetable shows similar survival for both implants over the 5 year period. The yearly mortality was 19.4% for the dynamic hip screw and 21.8% for the intramedullary implant respectively, even though the later were used predominantly in older patients. This age difference is significant according to both parametric and non-parametric tests whereas duration of hospital stay are similar. We found a clear increase in the proportion of intramedullary implants, for a total of 11.2% over the 5 year period. There is no difference for the one year mortality and overall survival between sliding screw plates and intramedullary constructs. CONCLUSIONS: A clear increase in the use of intramedullary implants for trochanteric fractures was observed. This is even more apparent for older ages, presumably due to an higher surgeon confidence with the biomechanical stability of the intramedullary constructs.

Drain tip cultures do not predict infections in primary total knee arthroplasty.

BACKGROUND AND AIM: The possibility to predict surgical site infections development could be of high prognostic value. We aimed to investigate whether cultures obtained from the tip of the closed passive wound drain may provide early signs of progression towards periprosthetic joint infections. MATERIALS AND METHODS: We performed an observational study on consecutive primary total knee arthroplasties performed in our department over 4 years by two high volume surgeons (it means they do a lot of arthroplasties/year; it is orthopedics specific). A total of 284 knees in 257 patients were included. Follow up was available for an average of 18.7 months. There were no simultaneous procedures. RESULTS: Nineteen (6.69%) drain tips yielded positive cultures, for a mean duration, from surgery to sample collection, of 1.63 (0.5) days. None of the positive drain tip cultures developed clinical signs of infection and all knees were healed at discharge after a mean of 13.78 days (SD= 3.34; range= 8-18). None of the 7 (2.46%) cases who developed deep infections had positive drain tip cultures. A true positive value of 0 led to a positive predictive value of 0, a negative predictive value of 97.34%, sensitivity of 0% and specificity of 93.14. CONCLUSIONS: The diagnostic use of passive drain tip cultures to detect early infections after total knee replacement is therefore absolutely useless.

Carpal tunnel release: transverse or longitudinal limited-incisions?

AIMS: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy of the upper extremity. Surgical decompression through a limited open palmar incision is still the most widely used treatment. The aim of this study was to compare two different incision surgical techniques for carpal tunnel surgery. PATIENTS AND METHODS: In this retrospective study, 41 patient hands (transverse surgery) were compared with 55 controls (longitudinal surgery) using, as validated outcome instruments, the "Boston Carpal Tunnel Questionnaire" for postoperative effectiveness to measure symptoms, disability and health-related quality of life. The patients were monitored just before the CTS surgery and then 4 weeks and 3 months after surgery. RESULTS: Complications resulted few and comparable for both techniques. Results showed similar outcomes in both procedures regarding symptoms release and function, except for one month results where function was better for the transverse incision (p<0.01) which required reduced time, anyway. CONCLUSIONS: The transverse incision technique proved a suitable optimal solution for carpal tunnel release. This technique, therefore, induces to a better tolerated scar at short term follow up, compared to a standard palmar longitudinal incision.

Reconstructed ACLs have different cross-sectional areas compared to the native contralaterals on postoperative MRIs. A pilot study.

OBJECTIVE: The current trends in anterior cruciate ligament (ACL) reconstruction aim not only to restore the position and footprint of the native ACL, but also its shape and biomechanical function. The objective of our study was to determine whether the in vivo shape of the healed graft differs from the native ACL. PATIENTS AND METHODS: We performed bilateral MRI examinations on patients with successful unilateral ACL reconstruction for an average period of 3 years. The imaging acquisitions were performed using 1.5 T field strength and T2 FSE axial oblique sequence at 2 mm spacing. We than averaged the ratio between the maximum width and thickness as well as the surface area in pixels using ImageJ (National Institutes for Health) and compared it with the native ACLs using the paired t-test. RESULTS: For both quadrupled hamstrings and B-PT-B neoligaments, the mid-portion area was significantly higher (p < 0.001) than the native contralateral ACL: 41.82/31.39 mm2 and 37.05/32.08 mm2, respectively. The surface area of the neoligaments mid-portion was on average 33.23% higher than the native ACL for the quadrupled hamstrings and 15.49% for the B-PT-B, respectively. The native contralateral ACL was also significantly thinner throughout the mid-portion (p < 0.001) than both B-PT-B and quadrupled hamstrings neoligaments, with a width-thickness ratio of 2.57 vs 1.97 and 2.57 vs 1.39, respectively. CONCLUSIONS: Our study showed that, several years after successful anatomic single bundle ACL reconstruction using an ipsilateral autograft, the mid-portion shape and cross-sectional area are not restored compared to the uninjured contralateral knee. This effect was more prevalent with hamstrings and less prominent when B-PT-B were used.

Anterior cruciate ligament reconstruction and determination of tunnel size and graft obliquity.

OBJECTIVE: Increase in ACL (anterior cruciate ligament) reconstructions has led to a higher prevalence of patients with postoperative symptoms which require investigation. We aimed to investigate the utility of magnetic resonance imaging (MRI) and computer tomography (CT) in determining tunnel size and graft obliquity after single bundle ACL reconstruction. PATIENTS AND METHODS: A retrospective comparison was made on 29 symptomatic knees after anatomic single bundle (trans AM) and transtibial ACL reconstructions which had both MRI and CT scans at an average of 1.3 years postoperatively (2 months-5.7 years). We compared CT and MRI (T2 sequence) tunnel size and graft obliquity estimates using Pearson correlation and t-test. We also compared MRI's of ACL reconstructed knees with hamstrings or patellar autografts, which were confirmed by operative protocol as either antero-medial (AM) technique (n=21) or trans-tibial (TT) technique (n=19). The surgeries were performed for an average of 6.29 (4-10) years for the TT group and 1.3 (0-3) years for the AM group, respectively. The graft inclination was measured relative to the tibial plateau using DICOM software. Statistical analysis used the mean value for each case and the data were processed using the non-parametric Kruskal-Wallis test to determine the difference in graft obliquity and tunnel placement. RESULTS: Tunnel size estimates correlate well between CT and MRI on axial scans: R2=0.795 and 0.630 for femur and tibia respectively. The position of the tunnels and graft obliquity were found to differ on MRI images in both coronal and sagittal planes. Coronal graft obliquity averaged 72.38° (ranging from 69° to 76°) using the AM technique and 75.47° (ranging from 72° to 78°) with TT technique. Sagittal graft inclination angle was 54.5 (51-58.5) and 63.68 (59-69.5) respectively. MRI proves to be the most useful imaging method in determining outcome after ACL reconstruction. However, for a better revision of the ACL reconstructions, CT can offer a clearer image of tunnels and bone stock. A more anatomical graft positioning increases obliquity in coronal and sagittal planes and, thus, becomes difficult to assess both tunnels in a single slice. CONCLUSIONS: The anatomic single bundle reconstruction technique has been found to more accurately reproduce the femoral footprint and the orientation of the graft compared to the TT technique where the appropriate tibial tunnel placement resulted in a more vertical graft.

Clinical relevance of altered bone immunopathology pathways around the elbow.

Normal healing of fractures is a complex process that relies heavily on a cascade of consecutive activations of immune cells and mediators. This mechanism somewhat overlaps with all processes related to bone metabolism, from the absence of unions to heterotopic ossifications and osteoporosis. We aimed to review and describe this intricate process of bone metabolism with particular focus on abnormal function and to exemplify it with a series of clinical cases which could justify their practical importance. The elbow has great potential for fracture healing but it is very sensitive to prolonged immobilization which can easily lead to intra-articular adherences and stiffness. In addition, the interosseus membrane facilitates communication between the regenerative environments when both radius and ulna are fractured. Such extensive injuries, around the proximal forearm, can lead to heterotopic ossifications and synostosis, which decrease sagittal range of motion through impingement and even block rotational movement through bone bridges. Increased knowledge and awareness of the biological mechanism of fracture healing, will have great improvement in the pharmacological adjuvant treatment of elbow injuries.

Neurobehavioral studies, in transgenic F3/CONTACTIN (C57BL/6J × CBA) mice, on cognitive and anxiety aspects during late-adolescential period.

OBJECTIVE: Besides than in the control of developmental events, axonal adhesive glycoproteins may be also involved in functions requiring fine organization and connectivity of the nervous tissue. We previously demonstrated morphological alterations and functional cerebellar deficits in transgenic mice (TAG/F3 mice) ectopically expressing the F3/Contactin axonal glycoprotein under the control of a selected regulatory region from the Transient Axonal Glycoprotein (TAG-1) gene. In the present study, the hippocampal function was explored by evaluating the ability of TAG/F3 mice to encode spatial and non-spatial relationships between discrete stimuli and to analyze an anxiety-related behavior. MATERIALS AND METHODS: To the first end, mice were placed in an "open-Field" containing five objects and, after three sessions of habituation (S2-S4), their reactivity to objects displacement (S5-S4) and object substitution (S7-S6) was examined.To the second end, mice were placed in the "elevated zero maze", a standard test to explore the anxiety-related behavior, in order to study, in transgenic mice, the effects of F3 misexpression on emotional reactivity by measuring the avoidance of the unsheltered open sectors. RESULTS: Statistical evaluations of reactivity to object novelty, TAG-F3 mice showed a lower DO exploration with respect to wild-type mice and, regarding DOs, TAG/F3 mice interacted less than wild-type mice, showing an impaired spatial change response. Furthermore, the number of HDIPS in transgenic TAG/F3 mice resulted significantly lower with respect to the controls (wild type). CONCLUSIONS: These results indicate that the coordinated expression of axonal adhesive glycoproteins may be relevant for the functional maturation of the hippocampus.

Musculo-skeletal tumors incidence and surgical treatment - A single center 5-year retrospective.

OBJECTIVE: Muscle-skeletal tumors represent a challenging pathology for orthopedic surgeons worldwide. The extremely invasive character, the local destruction, the high recurrence rate, the high incidence in young patients and the unfavorable prognosis are all very well known. For these patients it is very important to produce an accelerated functional, social and psychological postoperative rehabilitation. We studied 121 cases of muscle-skeletal tumors which were treated in our hospital over a 5 years period. PATIENTS AND METHODS: We noticed a high prevalence in males and mainly between the 2nd-3rd and 5th-7th decades of their life. At our observation, most patients were suffering in advanced stages of malignant lesions. RESULTS: We try to manage amputations below 5%, with a significant reduction in introducing reconstructive surgical methods as a choice of treatment (10 prostheses and 12 cases of filling with acrylic cement or bone substituent increased with internal fixation). In this way we could observe an unusual ratio between benign and malignant tumors, probably caused by the patient's lack of concern for minimal symptoms. The rural citizen's addressability towards the medical system is alarmingly low, due to the big gap existing from diagnosis to treatment. CONCLUSIONS: There is still an hard effort to develop better reconstructive techniques for the treatment of muscle-skeletal tumors and more studies must be made in order to achieve this goal.

Arthroscopic debridement compared to intra-articular steroids in treating degenerative medial meniscal tears.

OBJECTIVES: Virtually all early cases of knee osteoarthritis have degenerative medial meniscus lesions accompanying the chondral defects on MRI. It is difficult to determine if the symptoms are caused by the unstable meniscus or by osteoarthritis, hence unclear guidance towards treatment. We, therefore, aimed to determine the clinical improvement following arthroscopic meniscectomy compared to intraarticular administration of corticosteroids for degenerative ruptures of the medial meniscus in the presence of early stage medial compartment knee osteoarthritis. PATIENTS AND METHODS: We included 120 consecutive cases of nontraumatic symptomatic knees which had degenerative lesions of the medial compartment (cartilage and meniscus) on MRI's. They were randomized to receive either intraarticular steroid injection or arthroscopic debridement. We also analyzed the correlation between BMI, age, gender, MRI, intraoperative aspect of the meniscus and cartilage and clinical improvement using the Oxford Knee Score up to one year. At one month there was significant improvement of the scores for all the examined cases. Also at one month, the arthroscopic group performed better in terms of symptom improvement. This was maintained for 79% of the knees in the arthroscopic group and 61% in the intraarticular steroid injection respectively, out of those available for follow up at one year. RESULTS: At one month, symptoms reappeared for 12 patients in the steroid group and 7 in the arthroscopy respectively. Gender and age did not correlate with treatment, whereas extrusion of the meniscus, bone marrow edema, duration of the clinical symptoms, obesity and a low preoperative score were negative prognostic factors. CONCLUSIONS: Degenerative medial meniscal tears, in the presence of osteoarthritis, can only marginally benefit from arthroscopic debridement over intraarticular steroid injections in short term follow up. When considering individual cases, factors become more predictive when analyzed in group.

Application of acrylic spacers for long bone defects after tumoral resections.

INTRODUCTIONS: Tumoral resections pose serious challenges because sufficient removal has to be balanced against function preservation. A particular type of resection is encountered when the tumor is located in the diaphysis. It can lead to an important gap which cannot always amend to bone grafting in the same procedure. PATIENTS AND METHODS: The aim of the paper is to evaluate the long term outcome of segmental bone loss in patients with malignant tumors removed from diaphyseal regions and treated by intramedullary nailing and polymethylmethacrylate spacer. The limb function was then evaluated using a range of motion by the Musculoskeletal Tumor Score (MSTS) and the perceived quality of life measured by the EORTC QLQ-C30. RESULTS: There were no immediate postoperative local or systemic complications and no failures of the nail/cement construct. All cases were allowed immediate weight bearing (lower limb) and none were immobilized (upper limb). The average length of the bone defect was 9 (6-14) centimeters. The average follow-up was 2.5 (1-4) years. CONCLUSIONS: Polymethylmethacrylate cement spacers, over intramedullary nailing, have statistically proved a feasible and inexpensive procedure with limited complications, low surgical stress and favorable functional outcomes. It can be a definitive therapy for advanced cases, as well as temporary solution which can be successfully converted to secondary bone grafting.

Regenerative surgery performed with platelet-rich plasma used in sinus lift elevation before dental implant surgery: an useful aid in healing and regeneration of bone tissue.

OBJECTIVES: Aim of this work is to show the effectiveness of a protocol involving the use of platelet-rich plasma (PRP) as a grafting material in bone regeneration before dental implant rehabilitation. MATERIALS AND METHODS: 127 patients, requiring maxillary sinus lift, were enrolled in a follow-up study plan, which established clinical and radiological examinations on the day after surgery and six months later. PRP, in combination with autogenous bone, an organic bone material and organic bone substitutes, was used before implant-prosthetic rehabilitation. RESULTS AND CONCLUSIONS: After implant placement, 63 patients, previously treated with PRP, reached a statistically significant improvement in implant-prosthetic rehabilitation, established by primary stability and radiographic integration criteria, in comparison with the other 64 patients receiving implant-prosthetic rehabilitation without PRP treatment.

Trial with Platelet-Rich Fibrin and Bio-Oss used as grafting materials in the treatment of the severe maxillar bone atrophy: clinical and radiological evaluations.

OBJECTIVES: The aim of the present study is to assess the implant osteointegration, as well as the course of bone regeneration and healing processes, thanks to the sinus lift procedure and by using PRF as a filling material, in association with the Bio-Oss. MATERIALS AND METHODS: 23 patients, requiring maxillary sinus lift in order to place implants into posterior maxillary region, were involved in this study. Selected cases, in which the height of the residual bone was superior to 5 mm, were adopted for surgical procedure of "one-stage sinus lift" (implant insertion concurrently occured with sinus lift resulting 6-9 months the healing and integration time). Before inserting the implant, a small quantity of filling material was placed in the cavity. For this purpose the bone fragment, stored in saline solution, was employed mixed with Bio-Oss and PRF, after being ground. RESULTS: All patients reported no pain to percussion, no sign of tissue suffering in the soft peri-implant tissues, the presence of an optimal primary stability of the inserted implants and a significant increase in the peri-implant bone density. CONCLUSIONS: In all cases included in this protocol, the Authors observed a successful implant-prosthetic rehabilitation, according with Albrektsson criteria.

Magnetic resonance angiography monitoring of streptokinase in occlusion of the middle cerebral artery.

A 77 year old woman was hospitalized one hour after the onset of right hemiplegia and aphasia. Magnetic resonance imaging (MRI) examination was negative and MRA indicated occlusion of the left middle cerebral artery. Treatment with streptokinase was instituted (a 60 minute intravenous infusion of 1.5 MU of streptokinase in 100 ml of saline solution). Two hours after infusion, the patient's motor function clearly improved. An MRA examination performed six hours later showed partial recanalization of the obstructed vessel. Our report demonstrates the potential usefulness of MRA monitoring during thrombolytic therapy.