Lateral unicompartimental knee arthroplasty: indications,technique and short-medium term results

Lateral unicompartmental knee arthroplasty (UKA) is a valid alternative treatment in the event of arthritis confined to the lateral compartment. This paper examines its indications, technique and short to medium-term results. A total of 159 Miller–Galante cemented UKA prostheses (Zimmer, Warsaw, Indiana) were implanted consecutively (131 medial and 28 lateral) by the same surgeon. This study investigates 28 lateral UKAs in 27 patients. Twenty-five implants in 24 patients (including a subject operated bilaterally) were followed up for 12–60 months. Three patients were discarded on account of to short a follow-up period. The Hospital for Special Surgery (HSS) knee score was used to compare the pre- and post-operative results of the lateral UKA patients. The HSS score improved from a pre-op mean of 59.92 (range 48–68) to 88.04 (range 71–95) at the last follow-up. There was a positive increase in the pain, function and ROM components of the score. The lateral UKA prosthesis can be regarded as a sound alternative to total knee replacement. Correct patient selection on the basis of optimum surgical indications, however, is essential. No benefits of funds were received in support of the study.     

Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study

Purpose  

Bone-patellar tendon–bone technique (BPTB) for anterior cruciate ligament injuries is associated with a higher risk of donor-site morbidity. To evaluate whether platelet-rich plasma (PRP), due to its anti-inflammatory properties and capacity to stimulate tissue regeneration, was able to reduce the anterior knee pain, the kneeling pain, and donor-site morbidity, as evidenced by evaluation of VISA and VAS scoring scales and MRI analysis of the tendon and bone defect, we performed a clinical randomized controlled study where PRP gel was applied to donor site after ACL reconstruction with BPTB.     

Changes in HDL-cholesterol and lipoprotein Lp(a) after 6-month treatment with finasteride in males affected by benign prostatic hyperplasia (BPH)

Androgen effects on lipoproteins, mainly high density lipoprotein (HDL), could be exerted by a direct interaction of testosterone (T) or dihydrotestosterone (DHT) with liver androgen receptors. To assess if T needs to be converted into DHT to affect lipid metabolism, 13 patients were studied, affected with benign prostatic hyperplasia (BPH) and treated with an inhibitor of 5 alpha-reductase (finasteride). They were compared with 15 untreated controls. At baseline and after 3 and 6 months of therapy, each patient was evaluated as for lipoprotein and hormone concentrations, as well as for nutritional status. Body composition was assessed by anthropometry and bio-impedance analysis (BIA). Treatment was associated with a significant increase of HDL-cholesterol (HDL-C), mainly HDL3 subclass, and lipoprotein(a) (Lp(a)), as well as a decline of DHT, whereas no significant changes were apparent for T, estradiol (E2), sex hormone binding hormone (SHBG) and body composition indexes. However, no significant associations between DHT and lipid relative changes were apparent at bivariate correlation analysis. This finding was confirmed by comparing patient subsets identified by cluster analysis, according to HDL subclass individual responses. Rather, a slight association with E2 for HDL2 (positive) and HDL3 (negative) was found. In conclusion, finasteride can modify HDL and Lp(a) concentrations. However, by the data, these effects cannot be definitively attributed to the changes in DHT synthesis induced by finasteride, since a direct and non-specific interference of the drug on liver metabolism cannot be excluded.     

Impact of gender–age interaction on the outcome of ischemic stroke in an Italian cohort of patients treated according to a standardized clinical pathway

BackgroundStroke outcome has been reported as worse in women, especially in terms of disability. As for mortality, the data are conflicting, with some reports suggesting a female advantage. Our objective was to explore such issues in an Italian cohort of patients managed by a standardized clinical pathway (CPW) and, as such, homogeneous in terms of clinical management.MethodsData from a cohort of 1993 patients (987 women and 1006 men) with first-ever ischemic stroke, consecutively referred to an in-hospital Clinical Pathway Program from January 1, 2001 to December 31, 2009, were retrospectively analyzed. The relationship between female gender and one-month outcome was assessed with adjustment for age, stroke severity and premorbid disability.ResultsThe outcome was worse in women in terms of disability (age-adjusted odds ratio 2.03, 95% CI 1.69–2.46), while no difference was found for mortality. In multivariate models, female gender turned out to be associated with a lower case-fatality rate (adjusted hazard ratio 0.65, 95% CI 0.48–0.89, P = 0.007), whereas the odds ratio for disability decreased but remained significant (OR 1.30; 95% CI 1.01–1.69). We found a significant interaction between gender and age in the case-fatality rate, and a female survival advantage was apparent only below 50 years.ConclusionsOur study confirms the excess risk of disability after stroke in women, although it is mostly explained by the occurrence of the most severe clinical syndromes. As for mortality, female gender seems to play a protective role, at least in the short-term and in younger patients.     

Dimensional Tolerances and Assembly Accuracy of Dental Implants and Machined Versus Cast‐On Abutments

Background: The clinical application of prosthetic components obtained by different manufacturing processes lacks technological foundation: the dimensional tolerance of individual parts and their assembly accuracy are not known. The rotational misfit (RM) of the hexagonal connection is critical in single‐tooth implant restorations, but no standard control procedures are available for its evaluation. Purpose: The research aimed at proposing a new protocol for the dimensional assessment of implant‐abutment connections, based on noncontact measurement and statistical data processing. The procedure was applied to machined‐ and cast‐on abutments, as well of the matching implants. Materials and Methods: Three groups of five abutments each were studied: machined titanium abutments, pre‐machined calcinable abutments before casting procedures and the same specimens after casting. A group of five corresponding implants was considered as well. Twice the apothem was measured on each hexagon through an optical measuring microscope. The data were processed to obtain the international tolerance (IT) grade. The RM was then calculated using the apothems of the external and the internal hexagon. Results: All the components were classified between IT8 and IT9, and the maximum RM was around 3–4° for all the assemblies, inferior to the critical limits for the screw joint stability. Conclusion: An original measuring protocol was developed, independent of parts assembly and based on ITs. An objective dimensional characterization of prosthetic components and assemblies has been achieved, which is the basis for their reliability in clinical applications.     

The role of the rehabilitation brace in restoring knee extension after anterior cruciate ligament reconstruction: a prospective controlled study

To evaluate the effects of a rehabilitation brace locked in extension for the first week on the recovery of full extension after ACL reconstruction we compared two groups of subjects who underwent ACL bone-patellar tendon-bone reconstruction. The brace was unlocked twice a day for assisted physiotherapy. In Group A, 18 male subjects wore a post-operative brace locked from 0 degrees to 90 degrees. In Group B, 18 male subjects wore the same post-op brace locked in full extension for the first week. In both groups the brace was unlocked (0 degrees -120 degrees ) at the beginning of the second postoperative week, and then removed at the beginning of the third week. All the subjects followed the same rigorous, accelerated rehabilitation protocol. Each subject was evaluated pre and post-operatively (at second, fourth and eighth week) with bubble-level heel height difference (HHD) measurements and KT 1000 arthrometric assessment at the fourth postoperative month. Preoperative bubble-level HHD measurements of the two groups were statistically similar (Group A 0.6 cm, Group B 1 cm; not significant, n.s.). At the fourth week (Group A 2.2 cm, Group B 0.6 cm) and eighth week (Group A 1.6 cm, Group B 0.1 cm) follow-ups, bubble-level HHD measurements showed that the extension of the operated knees of Group B was significantly greater than in Group A. KT 1000 arthrometric scores showed no difference between the two groups (Group A 1.8 mm, Group B 1.5; n.s.).     

Concurrent prophylactic left atrial appendage exclusion: results from a randomized controlled trial pilot study

Objective: The left atrial appendage is a significant source of cardioembolic thrombi. Open mitral valve surgery presents an opportune time to exclude this appendage from cardiovascular circulation. However, sparse randomized trial support exists for this concomitant procedure. We therefore designed a randomized controlled trial to assess the short- and long-term outcomes of concomitant left atrial appendage exclusion. This report details early outcomes of the pilot trial. Methods: Forty-three patients were randomized to either undergo concomitant suture exclusion of their left atrial appendage under direct vision or not during their open mitral valve surgery. Clinical and biochemical postoperative outcomes, including hemodynamic and hemostatic parameters, were analyzed. Results: There were no deaths in either group. The incidence of cerebrovascular events, myocardial infarction, respiratory failure, and acute renal injury were similar between groups; a composite outcome of 10 major postoperative complications occurred in 32% of the left atrial appendage exclusion group versus 38% of the control group (p = 0.75). Intensive care (median stay 2 days vs 1 day in the control group, p = 0.55) and hospital lengths of stay (median stay 9 days in both groups, p = 0.98) were also similar between groups. Specifically, no additional hemodynamic alterations (need for intra-aortic balloon pump in 1 vs 2 patients in the control group, p = 0.61) or hemostatic complications (no re-operations for bleeding in either group, need for blood product transfusion in 2 vs 1 patient in the control group, p = 1.0) were noted in the left atrial appendage exclusion group. Conclusions: This pilot trial demonstrates the safety of and feasibility of a larger trial powered to detect clinically relevant short- and long-term outcomes of concomitant left atrial appendage exclusion with open mitral valve surgery.     

Evaluation of biochemical parameters in platelet concentrates stored in glucose solution

Background

Therapeutic storage of platelet concentrate is a challenging problem for Transfusion Medicine, so that many studies have been carried out with the aim of improving the duration of storage of platelet concentrates. Little attention, however, has been given to the most appropriate biochemical methods for evaluating the quality of the stored platelet concentrates.

Material e methods

Platelet concentrates (n=10) were saved under gentle stirring at 22ºC for a total period of 8 days. Glucose 0.5% (w/v) was added either at the beginning of storage (time 0) or on the fifth day of storage. One millilitre of each concentrate was withdrawn at time 0 and after 5, 6, 7 and 8 days of storage for microbiological culture, evaluation of pH, lactate dehydrogenase (LDH), mean platelet volume, platelet haematocrit and analysis of metabolites of energy pathways (high energy phosphate derivatives, nucleosides, oxypurines and antioxidants) by high performance liquid chromatography.

Results

The addition of glucose 0.5% on day 5 did not produce significant differences in metabolites of energy pathways with respect to control platelet concentrates, whereas when the glucose was added at the beginning of storage (time 0) there was a recovery of ATP, GTP and a decrease of energetic catabolism, demonstrating a beneficial effect on energy metabolism. The changes in LDH values did not parallel those of the metabolites: indeed, only on day 7 of storage did the platelet concentrates treated with glucose on day 5 have significantly lower levels of this enzyme than those found in the other concentrates. The improvements produced by addition of glucose at time 0 were confirmed by morphological analyses (mean platelet volume, platelet haematocrit), and the pH.

Conclusions

The metabolic profile of glucose-enriched plasma concentrates on the fifth day of storage, and the different time course of increased LDH concentration, could represent valid parameters to interpret platelet vitality in the successive days of storage. These preliminary data also indicate that glucose might be a good additive for a new storage formulation.