Surgical synovectomy in the treatment of rheumatoid arthritis: the results obtained in a controlled study.

The authors report the long-term results obtained after 2 and 4 years in a controlled study conducted on surgical synovectomies performed in articular and extra-articular regions in rheumatoid arthritis. Out of a total of 157 patients submitted to surgery between 1977 and 1987 admitted to the study were 82 patients with bilateral symmetric localizations, but who had been submitted to synovectomy only unilaterally. The collection and interpretation of data showed that synovectomy is truly effective and that clinical improvements is not related to a spontaneous regression in the rheumatoid process. Surgery must be performed when the degree of osteocartilaginous deficit is absent or moderate. It does not avoid local recurrence, but it does obtain an antalgic effect, better joint excursion, and a slowing down in the destructive osteocartilaginous processes.     

Head and neck vascular anomalies in children

Vascular lesions are the most common congenital and neonatal abnormalities. The aim of this work is to point out differences between various vascular anomalies, in order to define accurate diagnosis, and to present different therapeutic options now used for the treatment of the vascular lesions in children.According to biological classification described by the work of Mulliken and Glowacki there are two major types of vascular abnormality: haemangioma and vascular malformation.Haemangioma is a distinct biologic tumour entity characterised by rapid endothelial proliferation shortly after birth. The lesion is absent at birth and growth in early infancy, followed by a spontaneous resolution in childhood. Vascular malformations are structural anomalies that have a normal growth rate and endothelial turnover. According to the morphology of the vessels and the flow rate we distinguish: slow-flow and fast-flow vascular malformation.The authors document their personal experience in diagnosis, clinical evaluation, treatment and follow-up of the vascular lesions.     

Osteoporosis in patients affected with thalassemia. Our experience.

The authors examine 72 patients affected with homozygous B-thalassemia; The study was conducted by clinical-hematological and radiologic examination. The Singh method is used to compare clinical data with the degree of osteoporosis. The results indicate that there is a high frequency of osteoporotic abnormalities in thalassemia. The authors postulate that osteoporotic lesions are principally caused by hyperplasia of the marrow, the overactive bone marrow widening the medullary space and the increased intramedullary pressure causing osteoporosis.     

Mean platelet volume (MPV) increase during acute non-lacunar ischemic strokes

Introduction

Mean platelet volume (MPV) has been associated with the prognosis in stroke patients. However, its spontaneous variability during the acute phase of the disease is unknown. Materials and Methods — One hundred and thirty-seven patients with ischemic stroke, aged 75.4 ± 11.0 (SD) years, were classified according to several criteria: National Institutes of Health Stroke Scale (NIHSS) score, maximum lesion diameter on CT scan, Oxfordshire Community Stroke Projects (OCSP) and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) categories. Platelet parameters were determined 1.2 days after the onset of symptoms, and after 3.0 further days.

Results

The initial MPV was higher in non-lacunar than lacunar strokes (8.30 ± 1.10 vs. 7.95 ± 0.79 fl, P = 0.04), and correlated with the sampling delay with respect to the onset of symptoms, especially in the strokes with lesions > = 4 cm (r = 0.39, P = 0.009), NIHSS > = 11 (r = 0.35, P = 0.02) and of cardioembolic origin (r = 0.35, P = 0.01). Subsequently a late MPV increment was observed in the remaining categories: from 8.20 to 8.38 fl (P = 0.02) in the strokes with lesions < 4 cm, from 8.11 to 8.31 fl (P = 0.01) in the presence of an NIHSS < 11 and from 8.20 to 8.61 fl (P = 0.03) when the occlusion of a large artery was involved.

Conclusions

Platelet volume is not stable during the acute phase in non-lacunar ischemic strokes, as it increases early in the most severe forms, and later in the remaining subtypes. The release of large and more reactive platelets may contribute to the thrombophilic state associated with ischemic events.     

Fractures in Paget's disease

After analyzing the various types of anatomical and radiographic fractures in pagetic bone, the authors explain the reason for their preference for surgical treatment if the lesion is localized in the lower limbs. This choice allows for a reduction in the duration of immobilization and a lowered incidence of local (rapid and intense osteolysis of the pagetic bone) and general complications (hypercalciuria, at times, hypercalcemia). It is best to resort to internal osteosynthesis for diaphyseal fractures and prosthetic substitution for fractures of the femoral neck where treatment with screws and plates is less reliable due to the fragility of the pagetic bone. Non-surgical treatment may be used for fractures of the upper limb as the duration of the consolidation process, which is always increased, at any rate remains restricted to acceptable limits. Nonetheless, the radiographic occurrence of repair callus is not a sure sign of healing as it may also be affected by the Paget's disease.     

The biomechanics of pelvic osteotomy according to the Chiari method

The authors analyze the biomechanical effectiveness of pelvic osteotomy according to the Chiari method. This type of operation reduces joint loading and increases the joint support surface. The authors examined 18 patients aged an average of 31 years. This series shows that the effectiveness of pelvic osteotomy according to the Chiari method is particularly observed in cases in which joint morphology is best preserved.