In-patient rehabilitation in haemophilic subjects with total knee arthroplasty.

Total knee arthroplasty (TKA) is a major orthopaedic surgery intervention, indicated for severe haemophilic arthropathy. The aim of our study was to analyse rehabilitation outcome in haemophilic patients after TKA. A consecutive series of 21 patients (23 knees) was retrospectively evaluated. The mean age was 37 ± 8 years (range 22-55). Physiotherapy treatment was performed twice a day for 5 days week⁻¹, for 3 h day⁻¹. Assessment included knee range of motion (ROM), Visual Analogue Scale (VAS) for pain evaluation, Western Ontario and McMaster University (WOMAC) Score for functional outcome, Medical Research Council Scale (MRC) for quadriceps muscle strength evaluation, incidence of adverse events and a self-reported questionnaire. The patients'data were recorded before surgery (t0), at Rehabilitation Unit admission (t1), before discharge (t2) and at follow-up (t3), 11-48 months after rehabilitation. Western Ontario and McMaster University Score (ref. score: 0-96) was 56.7 ± 12 at t0 and 6.2 ± 6 at t3 (t3 vs. t0: P < 0.001). Visual Analogue Scale (ref. score: 0-10) decreased from 5.0 ± 2 at t1 to 2.1 ± 2 at t2 (t2 vs. t1: P < 0.05) and to 0.1 ± 0 at t3 (t3 vs. t2: P < 0.05). Flexion degrees increased from 43.4 ± 21° at t1 to 80.2 ± 15° at t2 (t2 vs. t1: P < 0.001) and to 95.0 ± 15° at t3 (t3 vs t2: P < 0.05). According to MRC (ref. score: 0-5), quadriceps muscle strength increased from 2.3 ± 0.6 at t1 to 3.6 ± 0.5 at t2 (t2 vs. t1: P < 0.05). Adverse events were found in four patients. Patients' satisfaction on their outcome at follow-up was referred as good by 72% of patients or excellent by 28% of patients. Postsurgical intensive rehabilitation in haemophilic patients resulted effective, safe and feasible.

Pharmacological treatment of mechanical edema: a randomized controlled trial about the effects of mesoglycan.

AIM: Mechanical edema (MO) is frequently found in a lot of the lower extremities' orthopedic diseases. In absence of deep vein thrombosis, MO is caused by the change in the dynamics of calf muscle pump with venous hypertension and by the change in capillary permeability which offsets the extra-vascular fluid balance resulting in edema formation. The correct treatment includes specific training for musculo-skeletal and gait recovery, together with medical treatment focused on venous endothelium. Little information is available about pharmacological treatment of this condition. Some studies suggest the efficacy of mesoglycan in venous pathology. Aim of this study was to evaluate the clinical efficacy of the pharmacological treatment (mesoglycan 50 mg p.o., twice a day) in patients affected by MO. METHODS: Forty-four patients with MO, aged 20-89 years, were randomized in two treatment groups: specific physiotherapy (Fkt) alone or physiotherapy plus mesoglycan 50 mg twice a day, per os. The patients were evaluated before treatment (t0), and after 1 month of treatment (t1), measuring ankle joint range of motion (degrees), calf circumference and malleolar circumference (cm), pain Borg CR10 Scale and adapted lymphedema Weiss Scale. Statistical analysis was performed by the Pearson's c2 test and the Mann-Whitney-Wilcoxon test. RESULTS: At the final evaluation of the objective and subjective parameters, the mesoglycan effect combined to the Fkt provided statistical differences on nearly all the parameters in comparison with the patients randomised to Fkt alone. CONCLUSIONS: The present study suggest that mesoglycan treatment (50 mg p.o., twice a day) can improve the recovery of MO, and it is well tolerated by the patients. Specific physiotherapy remains the first treatment for the recovery of both muscular pump and correct walking, but the optimal treatment of MO seems to be a synergic approach, including both pharmacological and mobilization programs.

Rehabilitation after primary total hip replacement. Comparison between Italian and international protocols.

AIM: In intensive rehabilitation departments (Code 56) there is a high case-load of patients with recent total hip replacement (THR). Whereas there has been a progressive standardisation and perfecting of prosthetic materials and surgical techniques, time-frames and modalities of rehabilitation programmes are still very variable. Following the Ministerial Guidelines, issued in 1998 by the Italian National Health System, and the introduction of Accreditation Requirements, methods must become more uniform and there must be increased scientific rigour in treatment so as to reduce variability and the subjective nature of the service provided. Ana-lysis of the working methods of large Rehabilitation Centres may help to focus on the problems more clearly and stimulate any improvements that may be required. The study analyses and compares rehabilitation protocols for hip replacement patients adopted in Italian and international rehabilitation centres. METHODS: Thirty-four post-THR rehabilitation protocols were analysed; 14 Italian plus 20 international. RESULTS: The analysis revealed that some factors are unanimously considered important and are therefore codified: 1) posture and positioning; 2) prevention of deep vein thrombosis; 3) rapid return to mobility; 4) education of patients to joint care. CONCLUSIONS: Weight-bearing on the operated limb is not yet a standardised aspect and thus the physiatrist's attention should be focused on this for a return to walking that is safe (for patients and for implanted prosthesis) correct (from the biomechanical and kinematic standpoints) and that plays a normal role in performing activities of daily living.

Effects of physical training on straightening-up processes in patients with Parkinson's disease.

PURPOSE: The aim of this study was to evaluate whether motor training could improve the straightening-up sequences in patients with Parkinson's disease and, consequently, could ease the capacity of the patients to change body's position. METHODS: Twenty out-patients with idiopathic Parkinson's disease (12 males, 8 females; mean age 72.9; H-Y, 1. 5-3) were enrolled in a rehabilitation programme which included exercises for the mobility of the trunk, of upper and lower limbs and of each segment of the spine, in order to improve the coordination of movement and to avoid postural disturbances. They received 1 hour of group treatment twice a week for a 5 week consecutive period. No changes were made in the pharmacological treatment received by each patient. The patients were evaluated at the beginning and at the end of the rehabilitation training. The statistical evaluation was made using the Wilcoxon test. RESULTS: Statistically significant differences were observed in all the motor parameters that were evaluated (supine to sitting and sitting to supine, supine rolling, standing from a chair). CONCLUSIONS: The observations demonstrate that physical training can be effective in improving motor performance related to changes in position which affects the simple daily activities of the patients.

[Defibrotide vs. calcium heparin in the prevention of deep vein thrombosis in gynecologic oncologic surgery]. / Defibrotide versus eparina calcica nella profilassi delle TVP in chirurgia ginecologica oncologica.

Eighty-one patients were submitted to gynaecological malignancy surgery in a randomized study aimed at the evaluation of the efficacy of defibrotide (40 patients) and calcium heparin (41 patients) in perioperative prophylaxis. They were randomly allocated to defibrotide group (400 mg bid im starting one day before surgery and continuing until the 7th postoperative day) or calcium heparin group (5000 IU bid sc starting two hours before surgery and continuing likewise for 7 days). No cases of DVT diagnosed by means of a Doppler CW were observed in either treatment group. Laboratory parameters have shown similar modifications in the two treatment groups. Three cases of bleeding were observed in the calcium heparin group while no cases of bleeding were detected in the defibrotide group. The results obtained suggest that defibrotide is at least as effective as calcium heparin in perioperative DVT prevention and that the former drug has a possibly better tolerability profile, due to a decisively lower tendency to bleeding.

[Defibrotide versus heparin in antithrombotic prophylaxis in gynecological surgery]. / Defibrotide versus eparina nella profilassi antitrombotica in chirurgia ginecologica.

Deep venous thrombosis (DVT) can be a significant complication of the postoperative course in gynaecological surgery, because of traumatism and compression to which the vascular pelvic structures are subjected. A protocol was therefore designed to evaluate the effectiveness and tolerability of defibrotide, a new antithrombotic and profibrinolytic drug, compared with low-dose heparin. The study was conducted on 102 women, undergoing major gynaecological surgery for benign and malignant affections, randomly assigned to the following two treatment groups. A) defibrotide (400 mg i.v./i.m. b.i.d., starting the day before the surgery for 8 days); B) calcium heparin (5000 IU s.c. b.i.d., starting on the day of surgery, for/days). Clinical, haematological and instrumental (Doppler ultrasound) parameters were assessed and no major events were noted in either of the two treatment groups though in the calcium heparin group, 2 patients showed clinical signs of DVT (not confirmed by Doppler ultrasound) and no side effects were noticed, except for a cutaneous rash in one defibrotide patient and an episode of bleeding on the third postoperative day in a patient treated with calcium heparin. Defibrotide proved as effective as calcium heparin in the prevention of DVT in gynaecological surgery.

[Pharmacologic prevention of deep postoperative venous thrombosis in general surgery]. / Profilassi farmacologica della trombosi venosa profonda post-operatoria in chirurgia generale.

The most commonly used pharmacological aids employed in the prevention of peroperative deep venous thrombosis in general surgery are reviewed in brief. The probable action mechanisms, recommended doses, laboratory parameters to be monitored, side-effects, contraindications and effectiveness shown in the main clinical trials carried out are illustrated.