A cost-minimization analysis of a preventive testing strategy for relatives of patients with BRCA mutated ovarian cancer

Purpose: This study aims to estimate the cost-minimization strategy of a preventive testing strategy destined to relatives of patients with BRCA mutated cancer versus a no test strategy in Italia. Methods: A BRCA testing pathway was designed by a panel of experts based on the MSTM Excel (2010) tool; the analysis was carried out considering the perspective of the Italian National Health Service. Two alternatives were considered: 1) preventive BRCA testing for relatives of patients affected by ovarian cancer carrying a BRCA1/BRCA2 mutation; 2) no test. Cost and effectiveness data, derived from literature and published sources validated by a Board of experts, were discounted using a discount factor equal to 3%. Probabilistic sensitivity analysis was performed. Results: Considering an average cost of therapy for breast and ovarian cancer major of €90,000.00 per case, the economic impact related to the preventive testing strategy are equal to –€17,814,767.25. The sensitivity analysis confirms these results in the totality of the simulations performed. Conclusions: Preventive genetic testing in relatives of patients affected by ovarian cancer is cost-effective and represents a sustainable cost for the National Healthcare System in Italia, also in the light of its reference values

Congenital myopathies: Clinical phenotypes and new diagnostic tools

Congenital myopathies are a group of genetic muscle disorders characterized clinically by hypotonia and weakness, usually from birth, and a static or slowly progressive clinical course. Historically, congenital myopathies have been classified on the basis of major morphological features seen on muscle biopsy. However, different genes have now been identified as associated with the various phenotypic and histological expressions of these disorders, and in recent years, because of their unexpectedly wide genetic and clinical heterogeneity, next-generation sequencing has increasingly been used for their diagnosis. We reviewed clinical and genetic forms of congenital myopathy and defined possible strategies to improve cost-effectiveness in histological and imaging diagnosis

Role of high tibial osteotomy in chronic injuries of posterior cruciate ligament and posterolateral corner

High tibial osteotomy (HTO) is a surgical procedure used to change the mechanical weight-bearing axis and alter the loads carried through the knee. Conventional indications for HTO are medial compartment osteoarthritis and varus malalignment of the knee causing pain and dysfunction. Traditionally, knee instability associated with varus thrust has been considered a contraindication. However, today the indications include patients with chronic ligament deficiencies and malalignment, because an HTO procedure can change not only the coronal but also the sagittal plane of the knee. The sagittal plane has generally been ignored in HTO literature, but its modification has a significant impact on biomechanics and joint stability. Indeed, decreased posterior tibial slope causes posterior tibia translation and helps the anterior cruciate ligament (ACL)-deficient knee. Vice versa, increased tibial slope causes anterior tibia translation and helps the posterior cruciate ligament (PCL)-deficient knee. A review of literature shows that soft tissue procedures alone are often unsatisfactory for chronic posterior instability if alignment is not corrected. Since limb alignment is the most important factor to consider in lower limb reconstructive surgery, diagnosis and treatment of limb malalignment should not be ignored in management of chronic ligamentous instabilities. This paper reviews the effects of chronic posterior instability and tibial slope alteration on knee and soft tissues, in addition to planning and surgical technique for chronic posterior and posterolateral instability with HTO

Infra-patellar fat pad cysts: a case report and review of the literature

Infra-patellar fat pad cysts are an uncommon type of intra-articular ganglia. We report a case of a young woman with a painful little mass in the anterior aspect of the left knee. Ultrasound revealed a multiloculate cyst, that was initially drained with a spinal needle. Four months later, she had a recurrence of symptoms and a ultrasound guided aspiration was performed. Cytological examination revealed synovial cells, synovial fluid, macrophages and debris: diagnosis was ganglion cyst. We reviewed the literature about infrapatellar fat pad cysts. Clinical diagnosis of an intraarticular cyst is very difficult, but sometimes an infrapatellar fat pad cyst could be suspected because it could be visible and palpable. MRI is the best diagnostic option in all cases. There are several treatment option, operative or conservative. In our opinion ultrasound guided aspiration is the treatment of choice in symptomatic ganglia, because it allows to drain all lacunae, preventing recurrenc

A dictionary of theatre anthropology: the secret art of the performer

Obsah (FF) |a Preface Eurasian Theatre -- Eugenio Barba 5 Eurasian theatre - Eugenio Barba -- Dawn 102; Eurasian theatre 102; Anti-tradition 102; -- Introduction Why 103; Roots 103; Village 104; To interpret a text or -- Theatre anthropology - Eugenio Barba 6 to create a context 104; Spectator -- Similar principles different performances 6; Lokadharmi Incomprehensions and inventions: from the Silk Road to -- and Natyadharmi 7; Balance in action 8; The dance of Seki Sano - Nicola Savarese -- oppositions 10; The virtue of omission 12; Intermezzo -- ; A decided body 16; A fictive body 17; A million -- Exercises -- candles 18 c -- Score and subscore: the significance or exercise in the actor s -- Anatomy dramaturgy - Eugenio Barba -- Can the sea rise above the mountain tops? - Nicola Savarese A physical action: the smallest perceptible action 112; 22 The age of exercises 112; Inner life and interpretation -- ; The complexity of emotion 114; The real relation-Apprenticeship ship 116; Sport as dance 116; The physical dialogue with -- Western examples - Eabrizio Cruciani 24 the spectators 116; The real action 117; Meyerhold’s -- Founding fathers and pedagogical theatre at the begin- theatre fission 118; The exercise: a model of organic and ning of the twentieth century 24; Creative process theatre dynamic dramaturgy 120; Form rhythm flow 120; Tacit school and theatre culture 24; Author’s pedagogy 26 knowledge -- An Indian example - Rosemary Jeanes Antze -- Guru as parent honoured preceptor 28; Guru-kula Face and eyes -- study in the guru’s home 29; Guru-dakshina gifts and Physiology and codification 122; The concrete gaze 126; fees 30; Ekalavya disciple extraordinaire 31; Guru- The action of seeing 129; Showing that one is seeing 130; shishya-parampara 31 The natural face 134; The provisional face 136; The painted -- face -- Balanc

New Solution for Massive, Irreparable Rotator Cuff Tears: The Subacromial “Biodegradable Spacer”

Massive, irreparable rotator cuff tears are a source of pain and disability. Although most rotator cuff tears can be completely repaired, a significant number are considered massive and irreparable. Numerous operative techniques have been described for the treatment of these kinds of tears including arthroscopic debridement, biceps tenotomy, tendon transfer, grafting, and reverse arthroplasty. We describe a surgical technique using a biodegradable subacromial balloon spacer (InSpace; OrthoSpace, Kfar Saba, Israel) implanted between the humeral head and acromion that permits smooth, frictionless gliding, restoring the shoulder biomechanics. The technique is easy to perform and is less invasive than the conventional surgical techniques available, and it may potentially serve as a bridging option in patients with massive, irreparable tears who are normally candidates for reverse arthroplasty

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

AbstractPurposeManagement of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1‐year follow‐up, considering different type of tears, demographic data and number of torn tendons.MethodsPatients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3–6 months and 1‐year follow‐up.ResultsA total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow‐up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow‐up (p < 0.05).ConclusionsThe use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidity and is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings.Level of EvidenceLevel IV