Are Two Screws Enough for Fixation of Femoral Neck Fractures? A Case Series and Review of the Literature

There is still a controversy in literature regarding the treatment of subcapital fractures of the hip with internal fixation. Different methods have been tested and studies such as in cadavers mainly prejudge the three cannulated screws application. We present a series of 20 patients in which percutaneous fixation with two parallel cannulated screws under specific technical conditions has led to an uneventful fracture union. No complications were observed at a one year follow-up. Reviewing the literature we found no previous clinical studies on the subject

Cervical spondylomyelopathy in dogs

Η οπίσθια αυχενική σπονδυλομυελοπάθεια του σκύλου αποτελεί την πιο συχνή πάθηση της αυχενικής μοίρας της σπονδυλικής στήλης σε μεγαλόσωμες και γιγαντόσωμες φυλές σκύλων. Η αιτιολογία της οπίσθιας αυχενικής σπονδυλομυελοπάθειας είναι άγνωστη και οι υποκείμενοι παθοφυσιολογικοί μηχανισμοί μη πλήρως κατανοητοί. Κεντρικό ρόλο στην παθοφυσιολογία της νόσου φαίνεται ότι κατέχουν ο βαθμός συμπίεσης του νωτιαίου μυελού και η ισχαιμία/υποξία που προκαλείται. Υπάρχουν δύο κλινικές οντότητες στην οπίσθια αυχενική σπονδυλομυελοπάθεια: συμπίεση του νωτιαίου μυελού που συνδέεται με εκ- φύλιση και προβολή του μεσοσπονδυλίου δίσκου τύπου ΙΙ και συμπίεση που συνδέεται με τη δημιουργία νέου οστού. Το ιστορικό και η κλινική εικόνα είναι ενδεικτικά της νόσου, αν και τα νευρολογικά συμπτώματα ποικίλουν από αυχενικό πόνο έως τετραπληγία και έκπτωση της αναπνευστικής λειτουργίας. Η απεικονιστική διερεύνηση της αυχενικής μοίρας της σπονδυλικής στήλης είναι απαραίτητη για τη διάγνωση της οπίσθιας αυχενικής σπονδυλομυελοπάθειας, περιλαμβάνει δε τα απλά ακτινογραφήματα, τη μυελογραφία, την αξονική και τη μαγνητική τομογραφία. Επιπλέον, είναι απαραίτητη για το σχεδιασμό της χειρουργικής θεραπείας. Η τελευταία βασίζεται συνήθως στον υποκειμενικό χαρακτηρισμό των συμπιεστικών αλλοιώσεων ως δυναμικών ή στατικών. Η μαγνητική τομογραφία υπερέχει έναντι της μυελογραφίας, αλλά προς το παρόν προτείνεται οι απεικονιστικές αυτές τεχνικές να εφαρμόζονται συμπληρωματικά. Επιπρόσθετα, τονίζεται ιδιαίτερα η αναγκαιότητα ύπαρξης συμφωνίας μεταξύ των κλινικών συμπτωμάτων και των απεικονιστικών ευρημάτων της μαγνητικής τομογραφίας, προς αποφυγή ψευδώς θετικών ευρημάτων.Πριν από την ανάληψη θεραπευτικής προσπάθειας, κρίνεται σκόπιμη η διερεύνηση του ζώου για συνυπάρχουσες παθολογικές καταστάσεις, οι οποίες μπορεί να επηρεάσουν την έκβαση του περιστατικού σε βάθος χρόνου. Η οπίσθια αυχενική σπονδυλομυελοπάθεια θεωρείται χειρουργικό νόσημα, ωστόσο η συντηρητική θεραπεία, που συνίσταται στον αυστηρό περιορισμό της κινητικής δραστηριότητας και στη χρήση στεροειδών ή μη στεροειδών αντιφλεγμονωδών φαρμάκων, μπορεί να υιοθετηθεί σε επιλεγμένα περιστατικά. Η χειρουργική θεραπεία αποσκοπεί στην αποσυμπίεση του νωτιαίου μυελού. Οι συμπιεστικές αλλοιώσεις στους γειτονικούς σπονδύλους αναφέρονται ως επιπλοκή της χειρουργικής θεραπείας, χωρίς όμως η αιτιολογία τους να είναι σαφώς προσδιορισμένη. Πρόσφατα, εφαρμόστηκαν τεχνικές αντικατάστασης του μεσοσπονδύλιου δίσκου μ τεχνητό, σε περιστατικά με συμπίεση λόγω εκφυλιστικής δισκοπάθειας τύπου ΙΙ και τα πρώτα αποτελέσματα είναι ενθαρρυντικά. Τέλος, υπάρχουν σύγχρονες ενδείξεις ότι η μαγνητική τομογραφία μπορεί να χρησιμοποιηθεί για καθορισμό της πρόγνωσης σε περιστατικά μυελοπάθειας.Cervical spondylomyelopathy (CSM) is the most common disease of the cervical spine in large and giant breed dogs. Its exact aetiology is not known and the relevant pathophysiology is not clear; two clinical entities are currently recognised: disc-associated and osseous-associated spinal cord compression. History and clinical signs are indicative of cervical spondylomyelopathy, although its neurologic manifestation can vary from cervical pain only to tetraparesis and respiratory compromise. Imaging of the spine is fundamental for definitive diagnosis and includes radiography, myelography, computed tomography and magnetic resonance imaging. It is also the cornerstone of surgical planning. This is usually based on the subjective concept of dynamic or static compressive lesions. Among the advanced imaging techniques, magnetic resonance imaging is superior to myelography for diagnosis of cervical spondylomyelopathy, although, at present, these techniques can be considered complementary.Furthermore, attention is drawn to the false positive interpretations of magnetic resonance findings, which are related to clinically irrelevant spinal cord compression. Hence, the degree of agreement between neuroanatomic localization and neuroimaging is of the outmost importance. Conservative treatment consists of strict restriction of the animal and the use of steroid or non-steroid anti-inflammatory drugs. Objective of surgical treatment is to decompress the spinal cord. However, the decision-making process of surgical treatment is more complicated, because a large number of different surgical techniques have been proposed. Adjacent segment disease is a controversial complication of the surgical treatment of disk-associated cervical spondylomyelopathy and recently introduced motion-preserving techniques are targeted on reducing its occurrence. Significant prognostic information for focal parenchymal damage may derive from magnetic resonance imaging studies, but this remains to be further clarified

Comparative Susceptibility Study Against Pathogens Using Fermented Cranberry Juice and Antibiotics.

In the present study, unfermented and fermented cranberry juice in combination with the Antibiotics vancomycin and tigecycline were tested for their antimicrobial activity. Cranberry juice was fermented with a recently isolated potentially probiotic Lactobacillus paracasei K5. The tested strains selected for this purpose were Enterococcus faecalis, E. faecium, Enterobacter cloacae and Staphylococcus aureus. The methods followed were the determination of zones inhibition, Minimum Inhibitory Concentration (MIC) and Fractional Inhibitory Concentration Index (FICI). Tigecycline together with fermented juice exhibited larger Zones of Inhibition (ZOI) in strains of E. faecium (65 ± 4.8 mm) compared to the respective ZOI with tigecycline and unfermented juice (no zone). The same outcome was also obtained with E. cloacae. Vancomycin together with fermented juice exhibited larger ZOI in strains of E. faecium (28 ± 2.2 mm) compared to the respective ZOI with vancomycin and unfermented juice (24 ± 2.3 mm). The lowest MIC values were recorded when tigecycline was combined with fermented cranberry juice against S. aureus strains, followed by the same combination of juice and antibiotic against E. cloacae strains. FICI revealed synergistic effects between fermented juice and tigecycline against a strain of E. faecium (A2020) and a strain of E. faecalis (A1940). Such effects were also observed in the case of fermented juice in combination with vancomycin against a strain of S. aureus (S18), as well as between fermented juice and tigecycline against E. cloacae (E1005 and E1007) strains. The results indicate that the antibacterial activity of juice fermented with the potentially probiotic L. paracasei K5 may be due to synergistic effects between some end fermentation products and the antibiotic agents examined

Lack of effects of pioglitazone on cardiac function in patients with type 2 diabetes and evidence of left ventricular diastolic dysfunction: a tissue doppler imaging study

<p>Abstract</p> <p>Background</p> <p>Thiazolidinediones, used for the treatment of patients with type 2 diabetes mellitus (DM2), are associated with an increased incidence of heart failure. We sought to investigate the effects of pioglitazone on novel echocardiographic indices of left ventricular (LV) diastolic function in DM2 patients with LV diastolic dysfunction (LVDD).</p> <p>Methods</p> <p>Eighty-eight asymptomatic DM2 patients on metformin and/or sulfonylureas, aged 64.5 ± 7.7 years, without known cardiovascular disease, with normal LV systolic function and evidence of LVDD were randomly assigned to pioglitazone 30 mg/day (n = 42) or an increase in dose of other oral agents (n = 39) for 6 months. All patients underwent transthoracic conventional and Tissue Doppler Imaging echocardiography at baseline and follow-up. The primary end-point was change in early diastolic velocity of the mitral annulus (E').</p> <p>Results</p> <p>Improvement of glycaemic control was similar in the 2 groups. A significant difference (p < 0.05) between the 2 groups was found in the treatment-induced changes in fasting insulin, the insulin resistance index HOMA, HDL cholesterol, triglycerides, diastolic blood pressure (all in favor of pioglitazone) and in body weight (increase with pioglitazone). No significant changes were observed in any echocardiographic parameter in either group and did not differ between groups (p = NS for all). E' increased non-significantly and to a similar extent in both groups (p = NS).</p> <p>Conclusions</p> <p>In asymptomatic DM2 patients with LVDD, the addition of pioglitazone to oral conventional treatment for 6 months does not induce any adverse or favorable changes in LV diastolic or systolic function despite improvements in glycaemic control, insulin sensitivity, lipid profile, and blood pressure.</p

Muscular cystic hydatidosis: case report

BACKGROUND: Hydatidosis is a zoonosis caused by Echinococcus granulosus, and ingesting eggs released through the faeces from infected dogs infects humans. The location of the hydatid cysts is mostly hepatic and/or pulmonary, whereas musculoskeletal hydatidosis is very rare. CASE PRESENTATION: We report an unusual case of primary muscular hydatidosis in proximity of the big adductor in a young Sicilian man. The patient, 34 years old, was admitted to the Department of Infectious and Tropical Diseases for ultrasonographic detection, with successive confirmation by magnetic resonance imaging, of an ovular mass (13 × 8 cm) in the big adductor of the left thigh, cyst-like, and containing several small cystic formations. Serological tests for hydatidosis gave negative results. A second drawing of blood was done 10 days after the first one and showed an increase in the antibody titer for hydatidosis. The patient was submitted to surgical excision of the lesion with perioperatory prophylaxis with albendazole. The histopathological examination of the bioptic material was not diriment in the diagnosis, therefore further tests were performed: additional serological tests for hydatidosis for the evaluation of IgE and IgG serotype (Western Blot and REAST), and molecular analysis of the excised material. These more specific serological tests gave positive results for hydatidosis, and the sequencing of the polymerase chain reaction products from the cyst evidenced E. granulosus DNA, genotype G1. Any post-surgery complications was observed during 6 following months. CONCLUSION: Cystic hydatidosis should always be considered in the differential diagnosis of any cystic mass, regardless of its location, also in epidemiological contests less suggestive of the disease. The diagnosis should be achieved by taking into consideration the clinical aspects, the epidemiology of the disease, the imaging and immunological tests but, as demonstrated in this case, without neglecting the numerous possibilities offered by new serological devices and modern day molecular biology techniques