Conservative Surgical Treatment of Infected Ulceration of the First Metatarsophalangeal Joint With Osteomyelitis in Diabetic Patients

Ulceration of the plantar aspect of the first metatarsophalangeal joint is a common localization in the diabetic foot. Conservative treatment of this lesion is a challenging problem, performed through the soft tissues and osseous debridement. The present study included a cohort of 28 patients affected by diabetes mellitus and a first ray lesion penetrating the bone. After surgical debridement with removal of the infected bone, we positioned antibiotic-loaded bone cement and stabilized the treated area with an external fixator. All patients with critical limb ischemia had their vascular disease treated before the procedure. The mean follow-up was 12.2 ± 6.9 months. Four patients developed a relapse of the ulceration after the procedure. In the postoperative period, 1 patient (3.57%) developed dehiscence of the surgical site and underwent a second procedure. In the follow-up period, 2 patients (7.14%) experienced bone cement dislocation. In 1 of these patients, a new ulceration was observed dorsally to the surgical site. The approach was surgical revision with bone cement replacement and stabilization with a new external fixator. In the other patient, given the absence of ulcerations, the cement was removed, and arthrodesis with internal stabilization using 2 cannulated screws was performed. One patient (3.57%), who had developed a relapse of ulceration after recurrent critical ischemia, underwent a percutaneous revascularization procedure and transmetatarsal amputation. During the follow-up period, no ulceration recurrences, transfer ulcerations, shoe fit problems, or gait abnormalities were detected in the other 24 patients. Our study presents the results of a technique requiring a 1-stage surgical approach to a relatively common problem, which is often difficult to solve

Metafore di un pontificato. Giulio II (1503-1513)

Il pontificato di Giulio II segna il distacco definitivo dall'età medievale e l'avvio dell'età moderna, assicurandosi un ruolo centrale rispetto alla storia del papato che vede i singoli protagonisti (dopo il rientro a Roma dall'esilio avignonese) costantemente impegnati nella costruzione dello Stato. Gli anni di Giulio II sono caratterizzati da una intensa azione religiosa, politica, culturale e sociale. Ed è in particolare intorno alla data 1508 che si concentra l'avvio di una serie di puntuali iniziative in ambito religioso, istituzionale, letterario, poetico, teatrale, musicale, artistico e architettonico. Una data centrale ed emblematica, anche ben oltre il limite temporale del pontificato del papa Della Rovere. Iniziative che si rivelano 'metafore' degli ambiziosi progetti di Giulio II e, più in generale, della politica papale precedente e successiva. Una serie di iniziative che, a cinquecento anni dalla predetta cerniera temporale, i curatori hanno inteso approfondire, rivisitare e reinterpretare nell'ambito dell'attività dell'associazione di studi e ricerche "Roma nel Rinascimento".The pontificate of Julius II marks the final separation from the Middle Ages and the beginning of the modern age, ensuring a central role with respect to the history of the papacy that sees the individual actors (after his return from exile in Avignon) constantly engaged in construction of Stato.Gli years of Julius II are characterized by an intense action religious, political, cultural and social. And it is especially around the date in 1508 that focuses the start of a series of specific initiatives in the religious sphere, institutional, literary, poetic, dramatic, musical, artistic and architectural heritage. A date central and emblematic, even well beyond the time frame of the pontificate of Pope Della Rovere. Initiatives that prove 'metaphors' of the ambitious projects of Julius II and, more generally, the next and previous papal policy. A series of initiatives that, five hundred years from the time predicted hinge, the editors have sought to deepen, to revisit and reinterpret part of the association studies and research "" Rome in the Renaissance ".

Regione Toscana, Piano di indirizzo territoriale con valenza di piano paesaggistico

Redatto tra 2012 e 2014 durante l'assessorato di Anna Marson, il Piano di indirizzo territoriale con valenza di piano paesaggistico (art. 145 del DL 42/2004) è parte del documento di indirizzo della pianificazione regionale, PIT Regione Toscana, ai sensi della LR 65/2014. Il Piano paesaggistico è approvato dal Consiglio regionale in data 27 marzo 2015