Atypical Bilateral Femur Fractures in a Long-Term Bisphosphonate Therapy: A Case Report

Atypical Femur Fractures (AFF) are associated with Bisphosphonate Osteoporosis Therapy. Bisphosphonate therapy is widely used as the Gold-Standard Therapy for Osteoporosis: it increases bone density and reduce the risk of vertebral, non-vertebral and hip fractures. However, long-term alendronic acid administration can causes severely suppressed bone turnover and finally non-traumatic stress fractures. Here we present a case of Non-Traumatic stress fractures of bilateral femoral shafts in a Long-Term Alendronic Acid Therapy

Il cut-out prossimale nelle fratture pertrocanteriche di femore

The worldwide incidence of fractures of the proximal femur is increasing in parallel with the average age of the population. Pertrochanteric fractures account for about 45% of all fractures of the proximal femur.This fracture is associated with significant co-morbidity and mortality in the elderly population: about 20% of elderly patients with fracture of the proximal femur undergoes exitus to 12 months after the traumatic event.The increased incidence of this type of fracture in the elderly is related to concomitant diseases: osteoporosis,malnutrition, reduced physical activity, decreased visual acuity, neurological deficits, altered reflexes, balance disorder, and asthenia.Osteoporosis has a predominant role which explains the greater frequency of these fractures in elderly women.The study included 16 cases of Cut-out (5 males and 11 females) out of a total of 630 patients with pertrochanteric fracture treated in the Orthopaedic Clinic of Trieste from January 2003 to December 2011.The mean follow-up after the revision surgery was 18 months. It was established that it is extremely important to have a good positioning of themethod of synthesis with a "Tip-ApexDistance" (TAD) of less than 25mm

The role of antitissue transglutaminase assay for the diagnosis and monitoring of coeliac disease: A French-Italian multicentre study

Aims: Tissue transglutaminase (tTG) was recently identified as the major autoantigen in coeliac disease. The aim of this multicentre study was to evaluate the impact of a new immunoenzymatic assay for the detection of IgA anti-tGT antibodies. Methods: Seventy four Italian and French clinical laboratories participated in this study; anti-tTG IgA with an enzyme linked immunosorbent assay (ELISA) method using guinea pig liver extract as the coating antigen, anti-endomysium IgA autoantibodies (EMA), and total serum IgA were determined in 7948 patients, 1162 of whom had coeliac disease (737 untreated cases and 425 on a gluten free diet). A proportion of the sera were then sent to a reference laboratory for anti-tTG retesting with an ELISA method using recombinant human tTG antigen. Results: Seven thousand four hundred and fifty eight (93.8%) sera were EMA/antiguinea pig tTG concordant (positive or negative); 490 (6.2%) were non-concordant. The sensitivity of EMA and antiguinea pig tTG in the 737 untreated patients with coeliac disease was 92.1% and 94.8%, respectively, and the specificity was 99.8% and 99.2%, respectively. Retesting of the discordant sera showed that of the 162 sera classified as EMA negative/antiguinea pig tTG positive, only 49 were positive for human recombinant anti-tTG, and that 39 of these were also EMA positive. Furthermore, of the 36 sera classified as EMA positive/antiguinea pig tTG negative, only two were confirmed as EMA positive. Conclusions: The antiguinea pig tTG assay is more sensitive but less specific than EMA, whereas the antihuman recombinant tTG assay is far more specific and just as sensitive as antiguinea pig tTG. Testing for EMA presents considerable interpretative problems and is difficult to standardise