Artroplastia total no cementada en la coxartrosis secundaria a displasia y luxación congenita de cadera

Se revisan 13 prótesis no cementadas implantadas en 12 paciente s que presentaban una coxartrosis secundaria a una displasia congénita de cadera. Los paciente s han sido seguidos más de 2 años de evolución. En todos los casos se utilizó la via de abordaje postero-lateral. Se implantó siempre la prótesis tipo PCA procediéndose en 7 casos a la realización, a nivel acetabular, de un alo o autoinjerto complementario. A nivel femoral se utilizaron 7 vástagos estándar, 3 medianos y 3 largos para facilitar la restauración del centro rotatorio original de la cadera. En los pacientes que presentaban una luxación importante se llevaron a cabo osteotomías de acortamiento a nivel subtrocantérico. Los pacientes han sido evaluados pre y post-operatoriamente tanto desde el punto de vista radiográfico como clínico. Desde el punto de vista clínico, se obtuvieron 8 resultados excelentes, 3 buenos, 1 discreto y 1 malo. Todos los pacientes estaban plenamente satisfechos con el resultado de la operación habiendo aumentado drásticamente su nivel de actividad. Solamente en un caso fue necesario practicar una intervención de revisión a los 4 años de la artroplastia primitiva, a causa de una grave osificación periprotésica. Solamente se tuvo una complicación intraoperatoria consistente en una fractura de la diálisis femoral.Thirteen non-cemented hips prostheses implanted in 12 patients with an osteoartritis secundar y to congenita l dislocation and dysplasi a of the hip wer e reviewed . Patients had a more than 2 years follow-up. The postero-lateral surgical approach was employed in all cases. On the acetabular side, we always used the PCA socket type. On the femoral side we implanted a PCA standard stem in 7 cases, mid stem in 3 cases and a long stem in 3. Acetabular bone autograft was added in 7 patients. In order to restore the original center of rotacion of the hip, in patients with a severe dislocation we perfomed also a shortening sub-trochanteric osteotomy; all the patients wer e evaluated pre and post-operatively with two separate forms. The first regarding the clinical evaluation, the second for radiographic assessment. All the patients were fully satisfied with the operation increasing dramatically their activity level. We obtained 8 excellent results, 3 good, 1 fair and 1 poor. One case required a revision for a severe heterotopic bone formation about 4 years after the first implant. We had a diaphyseal femoral fracture as the sole inly an intraoperative complication

Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: A narrative literature review

Diabetes mellitus is a chronic disease characterized by high social, economic and health burden, mostly due to the high incidence and morbidity of diabetes complications. Numerous studies have shown that optimizing metabolic control may reduce the risk of micro and macrovascular complications related to the disease, and the algorithms suggest that an appropriate and timely step of care intensification should be proposed after 3 months from the failure to achieve metabolic goals. Nonetheless, many population studies show that glycemic control in diabetic patients is often inadequate. The phenomenon of clinical inertia in diabetology, defined as the failure to start a therapy or its intensification/de-intensification when appropriate, has been studied for almost 20 years, and it is not limited to diabetes care, but also affects other specialties. In the present manuscript, we have documented the issue of inertia in its complexity, assessing its dimensions, its epidemiological weight, and its burden over the effectiveness of care. Our main goal is the identification of the causes of clinical inertia in diabetology, and the quantification of its social and health-related consequences through the adoption of appropriate indicators, in an effort to advance possible solutions and proposals to fight and possibly overcome clinical inertia, thus improving health outcomes and quality of care

Early Detection of Microvascular Changes in Patients with Diabetes Mellitus without and with Diabetic Retinopathy: Comparison between Different Swept-Source OCT-A Instruments

Optical coherence tomography angiography (OCT-A) has recently improved the ability to detect subclinical and early clinically visible microvascular changes occurring in patients with diabetes mellitus (DM). The aim of the present study is to evaluate and compare early quantitative changes of macular perfusion parameters in patients with DM without DR and with mild nonproliferative DR (NPDR) evaluated by two different swept-source (SS) OCT-A instruments using two scan protocols (3 73 mm and 6 76 mm). One hundred eleven subjects/eyes were prospectively evaluated: 18 healthy controls (control group), 73 eyes with DM but no DR (no-DR group), and 20 eyes with mild NPDR (DR group). All quantitative analyses were performed using ImageJ and included vessel and perfusion density, area and circularity index of the FAZ, and vascular complexity parameters. The agreement between methods was assessed according to the method of Bland-Altman. A significant decrease in the majority of the considered parameters was found in the DR group versus the controls with both instruments. The results of Bland-Altman analysis showed the presence of a systemic bias between the two instruments with PLEX Elite providing higher values for the majority of the tested parameters when considering 6 76 mm angiocubes and a less definite difference in 3 73 mm angiocubes. In conclusion, this study documents early microvascular changes occurring in the macular region of patients at initial stages of DR, confirmed with both SS OCT-A instruments. The fact that early microvascular alterations could not be detected with one instrument does not necessarily mean that these alterations are not actually present, but this could be an intrinsic limitation of the device itself. Further, larger longitudinal studies are needed to better understand microvascular damage at very early stages of diabetic retinal disease and to define the strengths and weaknesses of different OCT-A devices

Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation

Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). The most used treatments include transarterial chemoembolization and radiofrequency ablation. Surgical resection has also been successfully used as a bridging procedure, and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function. The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation, reducing HCC recurrence after transplantation, and improving post-transplant overall survival. To date, no data from prospective randomized studies are available; however, for HCC patients listed for LT within the Milan criteria, prolonging the waiting time over 6-12 mo is a risk factor for tumor spread. Bridging treatments are useful in containing tumor progression and decreasing dropout. Furthermore, the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT. Lastly, although a definitive conclusion can not be reached, the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival. Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT. Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging. © 2013 Baishideng Publishing Group Co., Limited. All rights reserved

An integrated care pathway for cancer patients with diabetes: A proposal from the Italian experience

Diabetes and cancer frequently coexist in the same subject, often with relevant clinical effects on the management and prognosis of the comorbid patient. The existing guidelines, however, do not appropriately address many clinical issues in this setting. Although collaboration between diabetologists and oncologists should play an important role in achieving appropriate levels of care, close coordination or agreement between these specialists is seldom offered. There is an urgent need for greater interdisciplinary integration between all specialists involved in this setting, for a shared approach ensuring that organisational silos are overcome. To this end, the Italian Associations of Medical Diabetologists (AMD) and the Italian Association of Medical Oncology (AIOM) recently established a dedicated Working Group on 'Diabetes and Cancer'. The working group outlined a diagnostic and therapeutic clinical pathway dedicated to hospitalised patients with diabetes and cancer. In this article, we describe the Italian proposal including some suggested measures to assess, monitor and improve blood glucose control in the hospital setting, to integrate different specialists from both areas, as well as to ensure discharge planning and continuity of care from the hospital to the territory