Chronic HBV infection in pregnant immigrants: a multicenter study of the Italian Society of Infectious and Tropical Diseases

The aims of the study were to estimate the clinical impact of HBV infection in pregnant immigrants and their family members and to identify a useful approach to managing the healthcare of HBsAg-positive immigrants. Included in this study were 143 HBsAg-positive pregnant immigrants of the 1,970 from countries with intermediate/high HBV endemicity who delivered in 8 Italian hospitals in 2012-2013. In addition, 172 family members of 96 HBsAg-positive pregnant immigrants were tested for serum HBsAg. The median age of the 143 HBsAg-positive pregnant immigrants was 31.0±12.1 years and the length of stay in Italy 5.0±4.1 years; 56.5% were unaware of their HBsAg positivity. HBV DNA was detected in 74.5% of the pregnant immigrants, i.e., 94.3% from Eastern Europe, 72.2% from East Asia and 58.1% from Sub-Saharan Africa. HBV DNA ≥2000 IU/mL was detected in 47.8% of pregnant immigrants, associated with ALT ≥1.5 times the upper normal value in 15% of cases. Anti-HDV was detected in 10% of cases. HBsAg was detected in 31.3% of the 172 family members. All HBsAg-positive immigrants received counseling on HBV infection and its prevention, and underwent a complete clinical evaluation. The findings validate the approach used for the healthcare management of the HBsAg-positive immigrant population

Preformed acrylic bone cement spacer loaded with antibiotics: Use of two-stage procedure in 10 patients because of infected hips after total replacement

In 10 patients having deep infection after total hip replacement, we used a two-stage revision procedure involving implantation of a preformed spacer with a cylindrical rod coated with acrylic cement containing antibiotics (Spacer-G). This device, which remained in situ for an average of 5 months, permitted healing of the infection in 8 cases and reimplantation of a new prosthesis (mean follow-up 35 months). During treatment, 1 dislocation occurred. The spacer maintained the gap between both bone segments and allowed a certain degree of joint mobility. Use of Spacer-G improved the quality of life of the patients during treatment and accelerated recovery of function after reimplantation

Six-year follow-up of a preformed spacer for the management of chronically infected total hip arthroplasty

Antibiotic-loaded cement spacers are currently used in two-stage revision of septic total hip arthroplasty as temporary devices. Prolonged spacer implantation in infected shoulder has been described occasionally in poor candidates for reconstruction surgery (medically compromised and/or low-physical demand patients, deficient bone stock). Few papers previously reported the use of spacers in infected hip prosthesis as a permanent solution, but limited information is available on the medium-term behaviour. We detail medium-term clinical and radiographic follow-up of a preformed spacer in the management of a chronically infected hip arthroplasty in a 50-year-old female patient who did not undergo a second-stage surgery. Normalization of inflammatory markers was detected 3 weeks after surgery and persisted over time. Six years after surgery, the patient recovered a good range of motion and was able to walk pain free with assisted weightbearing. Remarkable radiological changes of the bone stock around the spacer stem have been assessed. New bone formation developed rapidly in the femur, leading to the consolidation of transfemoral osteotomy 6 months postoperatively. Two years after implantation, spontaneous and asymptomatic fatigue fracture in the mid-part of the stem occurred. Radiographs at 6 years showed a sufficient preservation of bone stock, though a slowly progressive resorption of the cortical femur around the stem was evident in the last year. In conclusion, prolonged spacer implantation seems to be not appropriate in septic hip arthroplasty as a permanent solution. In patients not undergoing a second-stage surgery, a careful and periodic monitoring is required to rule out possible and severe complications

Late fracture of a Burch–Schneider acetabular cage: rare occurrence following polyethylene cup wear

We report a case of a 46-year-old male patient who sustained a fracture of the Burch–Schneider anti-protrusio cage (APC) that was implanted 13 years before. The fracture occurred in the transitional area to the proximal flange and was caused by direct and recurrent contact between the prosthetic metal head and the acetabular device. Late failure was related to increased wear of the polyethylene cup further aggravated by vertical orientation of the cage. Revision surgery included acetabular reconstruction using a new APC and cross-linked polyethylene cup, and replacement of the 36 mm diameter ball head. At 18 months follow-up the patient showed a complete functional recovery. When a reconstruction device is used, particularly in a young patient, special attention should be paid to the correct positioning of the cage in order to prevent accelerated polyethylene wear. Furthermore, cross-linked polyethylene cups that have become available in recent years must be used