Current augmentation fixation techniques for the osteoporotic patient.

Osteoporosis is defined as the deterioration of microarchitecture and overall poor bone quality, which represents a risk of implant fixation failure when patients with osteoporosis are surgically treated. Fragility fractures in elderly patients, typically at the hip, spine and wrist, should be assessed by the orthopaedic surgeon prior to surgery in order to select the most appropriate technique necessary to overcome failures and other complications associated with reduced osteofixation. In this review, advanced methods of augmenting implant fixation in osteoporotic bone are described including polymethylmethacrylate (PMMA), bone grafts, calcium phosphate implants, calcium phosphate cements, calcium phosphate coatings, modified implants and pharmaceutical augmentation concepts. The indication for these techniques should be based on the quantitative assessment of the osteoporotic quality of bone evaluated by dual energy X-ray absorptiometry (DXA).

[CT in the staging of neoplasms of the gallbladder]. / La TC nello staging delle neoplasie della colecisti.

The authors report the results of 50 cases of gallbladder carcinoma studied by means of CT, which were observed since 1984. Twenty-five cases were confirmed at surgery and 25 were selected among those in which CT, clinical history, natural disease evolution and matching with other instrumental and laboratory examinations were highly suggestive of gallbladder carcinoma. The high incidence is reported of such CT signs, which may be considered typical, as the presence of soft tissue in gallbladder area (92%), liver infiltration (78%), and the presence of metastatic lymph nodes (36%); they may or may not be associated to less specific signs. CT appears as the most reliable examination for both diagnosis and staging of the disease. Unfortunately, due to the wide range of aspecific clinical signs, diagnosis is in most cases late and the disease has therefore a fatal outcome.