Transition from pediatric to adult care of children with chronic endocrine diseases: a survey on the current modalities in Italy.

We report on a survey carried out in 65 pediatric and adult endocrinological centers concerning: 1) the modalities of the transfer of children with chronic endocrine diseases from pediatricians to adult endocrinologists, 2) opinions and suggestions from physicians of the Centers, and 3) specific details regarding GH deficiency. The main results are: 1) The mean age of transfer is around 18 yr of age. 2) The reasons for the transfer are personal convincement of pediatricians in 47%, administrative reasons in 37% and patient's desire in 16% of cases 3) In the majority of cases a discharge summary is sent by the pediatrician to the endocrinologist often followed by a phone call, whereas 30% of endocrinologists do not send a report back to pediatricians. 4) Less than half of the Centers are satisfied with the modalities of the transfer and the remainder complain about the lack of communication, no common guidelines, and differences in the management of patients. However, all are willing to try to improve this important time for adolescents with chronic diseases. 5) As far as GH deficiency is concerned, the main differences between pediatric and adult endocrinological centers are the different tests used to re-evaluate the diagnosis and the higher doses of GH used by pediatricians to treat young adults. In conclusion, considering the interest and desire of physicians, a structural intervention of the scientific societies to help to overcome problems is highly desirable.

Arthrolysis in the treatment of ankylosis and severe post traumatic stiffness of the elbow.

Between 1977 and 1989 the authors performed arthrolysis on 18 patients with ankylosis or severe post traumatic elbow stiffness. After an analysis of the cases, the operative technique is described and original parameters are proposed to evaluate the consequent results. The validity of arthrolysis as a possible alternative to arthroplasty or arthroprosthesis is confirmed by the 67% positive results.

Use of the Ilizarov apparatus in one case of severe congenital dysmetria of the leg with agenesis of the foot.

The authors present one case of severe congenital dysmetria of the leg with agenesis of the foot which was treated by the Ilizarov method. After a clinical and radiographic description of the case, the type of surgery used to create a new foot and the results obtained are discussed.

Stable osteosynthesis by the AO method in comminuted intra-articular fractures of the distal humerus.

The authors report their experience between 1982 and 1986 in 16 cases of comminuted supraintercondylar fractures of the elbow treated by stable osteosynthesis using the AO method with immediate or early mobilisation. They illustrate the technical possibility of obtaining stable synthesis even in fractures with numerous fragments and analyse the long-term functional results. Because of the severity of the fracture, none of the patients recovered full flexion and extension of the elbow; nonetheless in all the patients there was recovery of at least 90 degrees of movement and, most importantly, this occurred in the most useful range of movement. These results, and the time required for healing, amply justify the use of solid synthesis in fractures where the alternative would be arthroplasty.

Transposition of the 5th to the 4th ray by osteotomy of the hamate.

The authors present 5 cases of transposition of the 5th to the 4th ray according to Le Viet's method. This is indicated for the aesthetic and functional defects that follow total or subtotal amputation of the ring finger. The technique consists of radial transposition of the whole ray and intracarpal arthrodesis after cuneiform osteotomy of the hamate bone. It is easier to perform than the traditional metacarpal osteotomy and the results were uniformly good.

Complications and technical errors in endo- and arthroprostheses of the wrist and hand. A critical reappraisal of 89 operations.

The authors analyse eighty-nine operations performed between 1969 and 1975 for the insertion of endo- and arthroprostheses is the wrist and hand, with special reference to the complications and errors of technique of this type of surgery. They have paid particular attention to possible errors of diagnosis, faulty indications, and technical operative errors. They confirm that this type of surgery, which is still in the developmental stages, should be restricted to carefully selected cases and performed only in specialist centres.

Neurovascular island flaps in the emergency reconstruction of the terminal phalanx of the thumb.

The technique of neurovascular island flaps is described applied as an emergency operation in six patients who presented with considerable loss of substance of the fleshy pulp of the thumb or total loss of the terminal phalanx. The writers consider that the reconstructive method described by them is an advance on the traditional method, since not only can the matter be resolved in a single operative session, but epicritic sensitivity is maintained, the length of the thumb remains unaltered, better aesthetic results are obtained, and there are no vasomotor or sympathetic disorders.