Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up

Background Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up. Materials and methods Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe’s classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10–14 years). Results Average Harris Hip Score was 56 ± 9 (range 45–69) preoperatively, 90 ± 9 (range 81–100) 12 months after surgery, and 91 ± 8 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised. Conclusions Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results

Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

Piede piatto: endortesi riassorbibile

Il piede piatto \ue8 una delle deformit\ue0 ortopediche pi\uf9 frequenti nell\u2019infanzia ed \ue8 caratterizzata morfologicamente da una riduzione della volta plantare e da un valgismo del retropiede (Fig. 1) e funzionalmente da uno stato di prevalente o persistente pronazione, durante tutte le fasi del cammino. All\u2019et\ue0 di 10 anni il 4% dei bambini presenta un piede morfologicamente piatto, ma di questi solo il 10% presenta un piede funzionalmente piatto che necessita di trattamento al fine di evitare la comparsa di dolore e deformit\ue0 secondarie in et\ue0 adulta. I bambini con piede piatto funzionale raramente hanno dolore; talvolta lamentano una sensazione di stanchezza o discomfort a livello del piede dopo l\u2019attivit\ue0 fisica. In et\ue0 adulta invece il piede piatto funzionale \ue8 spesso causa di dolore, per la precoce comparsa di artrosi a livello dell\u2019articolazione sottoastragalica, e frequentemente si presenta associato a deformit\ue0 quali alluce valgo, metatarsalgia, disfunzione del tendine tibiale posteriore. Per risolvere la sensazione di discomfort o la sintomatologia dolorosa e prevenire le patologie associate, \ue8 raccomandata la correzione della deformit\ue0 durante l\u2019accrescimento. Obiettivo del trattamento \ue8 la correzione dell\u2019eccessiva pronazione dell\u2019articolazione sottoastragalica durante la crescita, in modo da promuoverne il rimodellamento e ristabilire i normali rapporti anatomici tra astragalo e calcagno

Artrorisi astragalo-calcaneare: endortesi riassorbibile

Artrorisi astragalo-calcaneare, endortesi riassorbibile, per il trattamento del piede piatto del bambin

How to perform a lumbar discectomy?

Herniated disc syndrome in the lumbar spine is the consequence of the conflict between a spinal root or cauda equina and a fragment of nucleous polpous migrated trough the annulus fibrosus. The rapid compression of one or more spinal roots produces severe pain and or sensitive or motor deficits. Lumbar discectomy is usually indicate after 6-12 weeks of conservative treatment if pain remains intractable or in case of severe sensitive or motor deficits. The aim of this video is to show the lumbar discectomy of a 36 Y/O patients suffering from 12 weeks intractable low-back pain associated with right S1 root radiculopathy. 3 cm median skin incision is made from L5 to S1. Paravertebral muscles were detached from the right lamina of L5 and S1. A little laminectomy of right L5 lamina was peformed sparing the lateral articular process and the pars interarticularis. The ligamentum flavum is removed in the interlaminal space, to expose the dural sac and the S1 exiting root. The herniated fragment is identified and carefully removed; attention should be paid to extract the disc fragments in continuity to decreasing the risk of disc herniation fragmenting and leaving residual fragments inaccessible. The herniated disc syndrome in the lumbar spine can successfully treated by discectomy; the articular facet remains intact and the bone removal is little

Use of Raman Spectroscopy, Scanning Electron Microscopy and Energy Dispersive X-ray Spectroscopy in a Multi-Technique Approach for Physical Characterization of Purple Urine Bag Syndrome

Purple urine bag syndrome (PUBS) is a rare condition characterized by purple discoloration of urine and urine bags. Although it is benign, it represents an alarming symptom to the patients and their relatives because of purple discoloration. We have physically characterized urine and urine bags belonging to a patient suffering from PUBS using an approach that combines Raman spectroscopy (RS) and scanning electron microscopy (SEM) coupled with energy dispersive X-ray (EDX). Five “blue” discolored bags and one sterile urine bag, representing the control, were cut into 1 cm2 square samples and analyzed by using RS and SEM + EDX technique. RS enabled us to identify the presence of indigo, a metabolite of tryptophan, while SEM analysis showed the biofilm deposit, probably due to the presence of microorganisms, and the EDX measurements exhibited the elemental composition of the bags. In particular, urine bags before and after the presence of PUBS urine showed an increase of ~32% of Cl, ~33% of O, ~667% of Ca, ~65% of Al and Mg, while C decreased by about 41%. Our results, to be taken as a proof-of-principle study, are promising for the aim to characterizing the urine bags in a flexible, inexpensive, and comprehensive manner

Trattamenti ortopedici nella distrofia muscolare

Le distrofie muscolari rappresentano un gruppo eterogeneo di patologie ereditarie che colpiscono la muscolatura, caratterizzate dalla progressiva compromissione dell\u2019integrit\ue0 e della funzione muscolare. L\u2019indicazione al trattamento chirurgico ortopedico nei pazienti affetti da distrofia muscolare prevede necessariamente una diagnosi precisa ed una altrettanto accurata valutazione clinica e strumentale, indirizzata in particolar modo ad identificare le risorse funzionali residue del paziente, in modo da poter prevedere un reale beneficio derivante dall\u2019intervento chirurgico, a fronte dell\u2019aumentato rischio operatorio che presentano questi pazienti. Vengono descritti alcuni dei principali trattamenti chirurgici ortopedici pi\uf9 frequentemente utilizzati in pazienti affetti da distrofia muscolare, riportati secondo un criterio di finalit\ue0 legato al beneficio per il paziente che attraverso tali metodiche si intende ottenere, a seconda delle diverse tipologie di paziente e dei diversi quadri clinici e anatomo-patologici della malattia. Tali tecniche, pur senza modificare il decorso della malattia, si sono dimostrate efficaci nel migliorare la qualit\ue0 di vita dei pazienti, consentendo loro di ottimizzare le residue risorse funzionali. Tuttavia, nei pazienti affetti da forme gravi di distrofia muscolare, il trattamento ortopedico spesso non \ue8 in grado di ottenere un beneficio significativo, pertanto \ue8 opportuno riconsiderare la strategia chirurgica a favore del trattamento medico o fisioterapico

Forecast of the demand for electric mobility for rome–fiumicino international airport

Following electrification of automotive transport, studies on the penetration of electric vehicles (EVs) are widespread, especially in defined contexts. As major transport hubs, airports fall within contexts worthy of interest. In this work, a forecast of the demand for electric mobility in an Italian international airport (Rome–Fiumicino) is presented. The main goal of the research is to build up a methodology that allows evaluating the penetration index of EVs that will access the airport parks in 2025 and 2030, to be able to have a preliminary assessment of the number of charging points necessary for serving them. In the paper, first, a wide review of proposed scenarios on the penetration of EVs at international and national level and available data on local automotive transport are presented, as a preliminary study for the definition of reference scenarios for the local context. Then, the proposed methodology is presented and applied to the specific case study. Finally, a preliminary sizing of the required charging infrastructure is reported. The results show that a significant impact on the airport electricity network can be foreseen, and it requires proper planning of adaptation/upgrading actions. The proposed approach can be considered as a reference for similar studies on electrical mobility in other airport areas around the world