Search

Introduction Myoclonus-dystonia is a rare syndrome typically occurring during childhood or adolescence, mainly due to SGCE pathogenic variants. Early-onset, atypical presentations of myoclonus-dystonia have recently been associated with KCTD17 variants. In these cases, laryngeal involvement was reported in the advanced stages. Methods We evaluated a 52-year-old man with myoclonus-dystonia and positive family history. He underwent an electromyographic investigation of vocal cord and forearm muscles. Whole-exome sequencing was also performed. Results Onset of symptoms was at 51 years with dysphonia and vocal tremor. Electromyography disclosed abductor spasmodic dysphonia and laryngeal myoclonus. The patient later developed writer's cramp, upper limb myoclonus, and blepharospasm. Botulinum toxin injection led to improvement of the writer's cramp and to a lesser extent of the spasmodic dysphonia. Genetic analysis identified a heterozygous missense variant in exon 2 of KCTD17: c.229 C > A (p.Leu77Ile), consistently predicted as damaging. Conclusions We suggest that the KCTD17-associated phenotypic spectrum may include late onset (even in late adulthood) as well as early and prominent laryngeal involvement.

Migraine is a highly prevalent and disabling disorder accounted among the primary headaches. It is the expression of a complex, and not yet fully understood, pathophysiology involving the sensitization of peripheral and central nociceptive pathways. In this review we succinctly illustrate the molecular, anatomical, and functional abnormalities underlying the migraine attack that are relevant for understanding in more depth the neurobiology behind the therapeutic effect of Botulinum Toxin Type A (BoNT-A). BoNT-A has proved effective in several neurological conditions and, more recently, also in chronic migraine. Its antimigraine mechanism of action was initially thought to be limited to the periphery and interpreted as an inhibitory activity on the processes associated to the local release of neuropeptides, with subsequent induction of peripheral sensitization. Increasing experimental evidence has become available to suggest that additional mechanisms are possibly involved, including the direct/indirect inhibition of sensitization processes in central nociceptive pathways.

Several surgical procedures have been described to treat hallux rigidus. Keller arthroplasty is a joint-sacrificing procedure proposed in 1904. Considering the current trends to mini-invasiveness and the debate about the technique's suitability, this review intends to state Keller arthroplasty results and the conditions where it could be still adopted in the treatment of hallux rigidus.Selected articles were reviewed to extract: population data, surgical indications, different surgical techniques, clinical and radiological outcomes, and complications.Seventeen retrospective studies were selected, counting 508 patients. Mean age at surgery was 55 years. Patients were affected by moderate-severe hallux rigidus. Three modified Keller arthroplasty were identified. Good clinical and radiological outcomes were reported. Metatarsalgia was the most frequent complication (12%).Despite for many authors KA seems a viable surgical treatment for middle aged and elderly patients affected by moderate-severe hallux rigidus, the available literature provides little evidence on the real efficacy and safety of the technique. A non-negligible percentage of complications may occur, and therefore is essential to set correct indications through an accurate patients' selection.

Case: A 56-year-old male patient sustained a traumatic cuboid medioplantar dislocation associated with a lateral cuneiform fracture. The patient was treated with open reduction and fixation using 2 temporary Kirschner wires. During surgery, the plantar ligament apparatus was found to be almost intact and the reduction was easily performed. At the last follow-up visit, the patient’s functional outcomes were excellent. Conclusions: Traumatic cuboid medioplantar dislocation associated with lateral cuneiform fracture usually requires surgical treatment. The authors conclude the integrity of the plantar ligament apparatus may play a role in facilitating the reduction.

EvoneIl successo della chirurgia laringotracheale è principalmente correlato a un’adeguata esposizione delle vie aeree, con l’utilizzo di un tubo oro-tracheale più piccolo possibile. Il primo tentativo è stato fatto introducendo la tecnologia della ventilazione a getto ad alta frequenza (VGAF) nella pratica clinica. Tuttavia, la VGAF presenta alcuni rischi legati all’alta pressione necessaria per la ventilazione. Innanzitutto, durante la VGAF, l’espirazione dell’aria dai polmoni è un riflusso passivo sulla parete della trachea, che potenzialmente causa ipercapnia e intrappolamento d’aria. In secondo luogo, la VGAF crea un sistema di ventilazione aperto che aumenta il rischio infettivo per il personale sanitario, a causa dei droplets immessi in circolo tramite aerosol. Per superare questi problemi, è stato introdotto nella pratica clinica un innovativo sistema di ventilazione a flusso controllato con catetere a cuffia stretta (EvoneThe success of laryngotracheal surgery is mainly related to adequate exposure of the airway lumen. To render airway surgery more efficient, many efforts have been made in recent decades to obtain a safe ventilation system which uses an orotracheal tube that is as small as possible. The first attempt was made by introducing the high frequency jet ventilation (HFJV) technology in clinical practice. Nonetheless, HFJV has some risks related to the high pressure needed for ventilation in the catheter. First, during HFJV, the expiration of air from the lungs is a passive backflow on the trachea wall, potentially causing hypercapnia and air trapping. Second, HFJV creates an open ventilation system that leads to aerosolisation of airborne particles with an increased infectious risk for the surgeon. To overcome these issues, an innovative flow-controlled ventilation (FCV) system with a narrow-cuffed catheter (Evone

The literature is certain regarding the multifactorial etiology of rotator cuff degeneration. However, it remains unclear if rotator cuff degeneration exclusively depends on intrinsic and extrinsic factors or if it is also genetically determined. We compared the health status of cuff tendons, evaluated with a magnetic resonance imaging (MRI) study, between elderly monozygotic and dizygotic twins with the aim of separating the contributions of genetics from shared and unique environments.The rotator cuff tendon status was assessed using the Sugaya classification by MRI. Heritability, defined as the proportion of total variance of a specific characteristic in a particular population due to a genetic cause, was calculated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment, which contributes to twin and sibling similarity, was calculated as the difference between the monozygotic correlation coefficient and the heritability index.We identified 33 pairs of elderly twins: 17 monozygotic pairs and 16 dizygotic pairs, with a mean age (and standard deviation) of 64.62 ± 3.32 years. The polychoric correlation was 0.62 in monozygotic twins and 0.53 in dizygotic twins. The calculated heritability index was 0.18 (18%), and the contribution was 0.44 (44%) for the shared environment and 0.38 (38%) for the unique environment.The role of genetics in rotator cuff degeneration is quantified by our study on elderly monozygotic and dizygotic twins; however, it is only partial with respect to the contribution of shared and unique environments.

Introduction In this open label, single-arm trial we evaluated the efficacy of onabotulinum toxin-A in the prevention of high-frequency episodic migraine (8–14 migraine days/month). Methods We enrolled 32 high-frequency episodic migraine subjects (age 44.8 ± 11.9 years, 11.0 ± 2.2 migraine days, 11.5 ± 2.1 headache days, 7 females). After a 28-day baseline period, subjects underwent 4 subsequent onabotulinum toxin-A treatments according to the phase III research evaluating migraine prophylaxis therapy (PREEMPT) paradigm, 12-weeks apart. The primary outcome was the reduction of monthly migraine days from baseline in the 12-week period following the last onabotulinum toxin-A treatment Results Onabotulinum toxin-A reduced monthly migraine days by 3.68 days (−33.1%, p Conclusions The findings suggest that, when administered according to the PREEMPT paradigm, onabotulinum toxin-A is effective in the prevention of high-frequency episodic migraine. Trial Registration: NCT04578782

Introduction/Aims Coronavirus disease 2019 (COVID‐19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, has become a global pandemic. Patients with myasthenia gravis (MG), often treated with immunosuppressants, might be at higher risk of developing COVID‐19 and of demonstrating a severe disease course. We aimed to study prevalence and describe features of COVID‐19 in MG patients. Methods In May 2020, we conducted telephonic interviews with MG patients followed at our referral center. We collected structured data regarding MG and COVID‐19, which was diagnosed as probable or confirmed according to the European Centre for Disease Prevention and Control case definition. We compared confirmed‐COVID‐19 prevalence calculated from the beginning of the pandemic in MG patients with that of the overall Pavia district. Results We interviewed 162 MG patients (median age, 66 y; interquartile range 41‐77; males 59.9%), 88 from the Pavia district. Three patients had SARS‐CoV‐2‐confirmed by polymerase chain reaction and eight had probable‐COVID‐19. In the Pavia district, the prevalence of confirmed‐COVID‐19 among MG patients (1/88, 1.14%) and overall population (4777/546 515, 0.87%) did not differ (P = .538). Higher Myasthenia Gravis Foundation of America clinicalclass and the need for recent rescue treatment, but not ongoing immunosuppressive treatments, were associated with COVID‐19 risk. Of 11 MG patients with probable/confirmed‐COVID‐19, 3 required ventilator support, and 2 elderly patients died of COVID‐19 respiratory insufficiency. Only 1 of11 patients experienced worsening MG symptoms, which improved after increasing their steroid dose. Discussion The risk of COVID‐19 in MG patients seems to be no higher than that of the general population, regardless of immunosuppressive therapies. In our cohort, COVID‐19 barely affected MG course.

INTRODUCTION/AIMS Paramyotonia congenita (PMC) is a skeletal muscle sodium channelopathy characterized by paradoxical myotonia, cold sensitivity, and exercise/cold-induced paralysis. Treatment with sodium-channel-blocking antiarrhythmic agents may expose patients to a risk of arrhythmia or may be poorly tolerated or ineffective. In this study we explored the effectiveness of non-antiarrhythmic sodium-channel blockers in two patients with PMC. METHODS Earlier treatment with mexiletine was discontinued for gastrointestinal side effects in one of the patients and lack of clinical benefit in the other. One patient received lacosamide, ranolazine, and buprenorphine, and the other was given buprenorphine only. Drug efficacy was assessed by clinical scores, timed tests, and by long and short exercise tests. RESULTS In both patients, buprenorphine improved pain scores by at least 50%, stiffness and weakness levels, and handgrip/eyelid-opening times. The fall in compound muscle action potential (CMAP) during short exercise normalized in both patients at baseline, and improved after cooling. During long exercise, one patient showed an earlier recovery of CMAP, and the other patient had a less severe decrease (

We report a Maisonneuve case of reoperation with proximal fibula fracture, diastasis of syndesmosis and parcel posterior detachment of the third malleolus.We report a case of 49- year old patient with a Maisonneuve fracture. The first surgery has failed with three-cortical screw rupture. The second surgery was based on the implantation of quadricortical screw, zip tight and fibula elongation with autograph. The results were excellent despite the patient having contracted Covid-19 virus during rehabilitation.Maisonneuve fracture is a misdiagnosed fracture. The diagnosis may be made by RX or TC of lower limb. There are many treatments provides to stabilized and reduced the ankle. We believe the gold standard is the correct realignment of syndesmosis and a strong synthesis.The Maisonneuve fracture accounts for 7% of all ankle fractures but misdiagnosed. We emphasize the importance of making good diagnosis of this fracture for an excellent surgical result and avoiding the chronic complications of incorrect treatment. In this case the physical rehabilitation is delayed by covid-19 infection so we suggest to carry out studies on post-operative period in orthopedic patients during this global pandemic.

Aim To report clinical, functional and radiographic results of oneincision distal biceps tendon repair with Toggle Loc (Zimmer-Biomet, Warsaw, Indiana, USA) at an average 4-year follow-up and to assess posterior interosseous nerve injury complications after reconstruction. Methods We conducted a retrospective review of 58 consecutive distal biceps tendon repairs performed at our department between 2010 and 2018. Disabilities of Arm, Shoulder and Hand (DASH) score, Visual Analogue Scale (VAS) scale and elbow range of motion (ROM) were recorded at each follow-up and an ultrasound examination was also performed to assess the repaired biceps brachii tendon. Results Clinical evaluation showed good and excellent results at medium- and long-term follow-up. A temporary posterior interosseous nerve (PIN) palsy developed in four (6.81%) patients and always resolved in 8 weeks. PIN palsy prevalence is in accordance with the results of the previous studies. Conclusion Distal biceps tendon repair with Toggle Loc is an effective surgical procedure. PIN injury is a relatively rare complication after one-incision anterior repair. Our complication rate did not differ significantly from other studies that have used cortical button fixation, reported in current literature. Our results confirm that accidental injury of PIN may also happen to experienced surgeons and suggest extreme care and an appropriate surgical technique to reduce this iatrogenic risk.

Background Trigeminal neuralgia (TN) is a severe, disabling form of painful cranial neuropathy. Even though TN has a typical clinical picture, diagnosis it is often missed or delayed in clinical practice. In order to investigate the occurrence of diagnostic and therapeutic errors in TN, we studied 102 patients suffering from TN recruited through a multicentric survey. Methods We performed a Pubmed database search on errors and pittfalls in TN diagnosis and management. Then, patients with TN were consecutively enrolled in the period from February 2017 to October 2019, by several European Headache Centers participating in the study, following a call of the Headache and Pain Scientific Panels of the European Academy of Neurology (EAN). Diagnosis of Classical Trigeminal Neuralgia (CTN) was made according to the International Headache Society (IHS) criteria (Tölle et al., Pain Pract 6:153-160, 2006). All the patients were evaluated using telephone/frontal interviews conducted by headache/pain specialists using an ad hoc questionnaire. Results A number of 102 patients were recruited, mostly females (F:M ratio 2.64:1). Eighty-six percent of the patients consulted a physician at the time they experienced the first pain attacks. Specialists consulted before TN diagnosis were: primary care physicians (PCP) (43.1%), dentists (in 30.4%), otorhinolaryngologists (3.9%), neurosurgeons (3.9%), neurologists or headache specialists (14.7%), others (8%). The final diagnosis was made mainly by a neurologist or headache specialist (85.3%), and the mean interval between the disease onset and the diagnosis made by a specialist was 10.8 ± 21.2 months. The “diagnostic delay” was 7.2 ± 12.5 months, and misdiagnoses at first consultation were found in 42.1% of cases. Instrumental and laboratory investigations were carried out in 93.1% of the patients before the final diagnosis of TN. Conclusion While TN has typical features and it is well defined by the available international diagnostic criteria, it is still frequently misdiagnosed and mistreated. There is a need to improve the neurological knowledge in order to promptly recognize the clinical picture of TN and properly adhere to the specific guidelines. This may result in a favorable outcome for patients, whose quality of life is usually severely impaired.

The objectives of the study were: a) to identify osteoporotic proximal humerus fractures in a large consecutive series of patients; b) to identify radiographic fracture patterns among osteoporotic and non-osteoporotic proximal humerus fractures; and c) to calculate intra- and inter-observer reliability of assessment of osteoporosis and of radiographic fracture patterns.This was a prospective observational study of patients admitted to the emergency department affected by a proximal humerus fracture between June 2014 and June 2016. Three researchers evaluated demographic data and comorbidities, x-rays and CT-scans. A new evaluation method for assessment of osteoporosis was proposed; 7 radiographic fracture patterns were studied. Reliabilities between intra- and inter-tester evaluations, and correlations between the presence of osteoporosis and the 7 radiologic fracture patterns were calculated.Two hundred twenty-five patients with a humeral fracture were recruited. Their mean (26-95, 32) age was 58. Of those, 163 (72.4%) were identified as osteoporotic. Among the three raters, the intra- and inter-observer agreement using the proposed methods were high or excellent. Significant correlations with diagnosis of osteoporosis were found with Codman-Lego type 12(p = 0.041), metaphyseal comminution(p 0.001), impaction of fragments(p = 0.023), comminution of tuberosities(p = 0.037), inferior subluxation(p = 0.029). Intra- and inter-tester reliability of evaluation of these osteoporotic fracture patterns were high.Osteoporosis of the proximal humerus was identified in 72% of patients during a two year period; most of these patients were elderly females sustaining low energy trauma. These fractures showed to have specific radiographic patterns, as comminution of metaphysis and tuberosities, impaction of fragments, and inferior subluxation of the humeral head. These patterns can be assessed with the simple observation of a 2-plan view of a radiograph, without the use of specific software.

The objectives of this study are to propose a reliable radiologic method for detecting static inferior subluxation of humeral head, to calculate the relative intra- and inter-observer reliability, and to evaluate its presence pre- and post-surgery. This is a retrospective observational study of patients surgically treated for a fracture of the proximal humerus. Fractures were classified using Codman-Lego criteria (radiographic, CT images), osteoporosis was assessed. To identify inferior subluxation, an original method is proposed. This measurement was done pre-operatively, at three and 12 month post-operatively. Clinical evaluation was recorded at final follow-up using Constant Score. One hundred fifty fractures surgically treated were studied. Intra- and inter-observer reliabilities were excellent and high, respectively. In pre-operative x-rays, a significant inferior subluxation was noted in 17/150 cases (11.3%), with significant correlation with fracture pattern (p=0.045), female sex (p=0.038), age older than 70 (p=0.003), obesity (BMI>30, p=0.03), and local osteoporosis (p=0.002). At three month of follow-up, 22 cases (14.6%) had inferior subluxation, with significant correlation with female sex (p=0.04), age older than 70 (p=0.002), obesity (p=0.02), pin or screw articular surface perforation (p

International audience; Recent findings demonstrated that a subset of papillary thyroid cancers (PTCs) is characterized by reduced expression of the von Hippel-Lindau (VHL) tumor suppressor gene, and that lowest levels associated with more aggressive PTCs. In the present study, the levels of the two VHL mRNA splicing variants, VHL-213 (V1) and VHL-172 (V2), were measured in a series of 96 PTC and corresponding normal matched tissues by means of quantitative RT-PCR. Variations in the mRNA levels were correlated with patients' clinicopathological parameters and disease-free interval (DFI). The analysis of VHL mRNA in tumor tissues, compared to normal matched tissues, revealed that its expression was either up- or down-regulated in the majority of PTC. In particular, V1 and V2 mRNA levels were altered, respectively, in 78 (81.3%) and 65 (67.7%) out of the 96 PTCs analyzed. A significant positive correlation between the two mRNA variants was observed (p

Non-resective pharyngoplasty techniques have been shown to be effective to treat oropharyngeal collapse in patients affected by obstructive sleep apnea-hypopnea syndrome (OSAHS). The aim of our study is to evaluate outcome predictors in a cohort of patients affected by OSAHS and treated with non-resective pharyngoplasty, including variation of pharyngeal measures at the end of the surgical procedure. A cohort of patients affected by OSAHS, with palatal or lateral pharyngeal wall collapse, who underwent non-resective pharyngoplasty, were enrolled between 2014 and 2017. Surgical procedures encompassed non-resective pharyngoplasty by expansion sphincter pharyngoplasty (ESP) or barbed antero-lateral pharyngoplasty with barbed reposition pharyngoplasty (BRP) or barbed suspension pharyngoplasty (BSP) techniques, eventually associated with nasal surgery. Pharyngeal measures were recorded intraoperatively and their variation at the end of the procedure was considered. Surgical success was evaluated at least 6 months after surgery with respiratory polygraphy and ESS questionnaire. Outcome predictors were examined by multivariable logistic regression and ROC curve analysis. Seventy patients met the study inclusion criteria. ESP, BRP, and BSP in a uni-/multilevel setting led to significant improvement of all respiratory polygraphic parameters and daily sleepiness (p

To define the bone's amount that should be removed during an acromioplasty has always been a challenge. We aimed to verify the correlations between scapular dimensions and acromial thickness, assess the differences between the two genders, investigate the relationship between acromial type and thickness. We examined 500 dried scapulae, measuring the major axis of the scapular body and the acromial thickness; these were also catalogued according to gender. Acromial shape was classified according to Bigliani's method. Frequencies: Type I 38.9 %, Type II 39.4 %, Type III 21.7 %. The mean acromial thickness was 0.85 cm, and it resulted wider in men. There was a direct linear relationship between scapular dimensions and acromial thickness. The range of thickness of Type III acromion was significantly different from the others. We should be aware that gender, scapular dimensions and acromial shape should be evaluated preoperatively since they influence the acromial thickness.

Background: Age and peripheral microcirculation disorders are the main causes of rotator cuff degeneration. Acromion variants may affect subacromial space width, causing a pathological narrowing of the space that may compromise the cuff integrity. However, it is not clear if the subacromial space width is genetically determined or if it changes according to loading conditions. To clarify this unresolved question, we performed an MRI (magnetic resonance imaging) study with the aim of evaluating the acromiohumeral distance in a group of elderly monozygotic and dizygotic twins, and we analyzed the obtained data using the twin design to separate the contributions of shared and unique environments. Methods: We identified twenty-nine pairs of elderly twins. On MRI scans, we evaluated the acromiohumeral distance and health status of the rotator cuff tendons. Heritability, defined as the proportion of total variance of a specific characteristic in a particular population due to a genetic cause, was estimated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment, due to environmental factors that contribute to twin and sibling similarity, was calculated as the difference between the monozygotic correlation coefficient and the heritability index. One-way ANOVA (analysis of variance) was used to estimate the differences among job categories, both in the total cohort and within zygosity groups. Results: The intraclass correlation coefficient was substantially higher for monozygotic than for dizygotic twins, indicating a high degree of concordance of the acromiohumeral distance in pairs of individuals who shared 100% of their genes. The heritability index was 0.82, and shared and unique environmental contributions were both 0.09. There were no significant differences among subjects in different job categories, either in the total cohort (p = 0.685) or within the monozygotic (p = 0.719) and dizygotic groups (p = 0.957). Conclusions: The acromiohumeral distance is mainly genetically determined and only marginally influenced by external factors. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The purpose of this study was to demonstrate the usefulness of coronal oblique multiplanar reconstruction computed tomography (MPR CT) reformation parallel to the basal turn of the cochlea in the evaluation of the retrotympanum and hypotympanum to complete the standard CT examination of the temporal bone obtained with axial and coronal images.We studied 30 patients aged 18-79 years for a total of 60 normal petrous pyramids. All examinations were performed on a multislice CT (MSCT) scanner (Sensation 16, Siemens, Erlangen, Germany) with axial volumetric acquisition and completed with reformations of coronal and coronal-oblique images. MSCT scan parameters for axial acquisition were set as follows: 0.75-mm scan collimation, FOV 300 mm, 170 mAs. Axial images were reconstructed at 0.7-mm thickness and with a reconstruction increment of 0.5 mm using a high-resolution bone algorithm.Coronal oblique MPR CT reformations provided additional information with respect to standard CT images in all cases. In particular, they enabled measurement of the craniocaudal and laterolateral diameters of the sinus tympani. In all cases, there was optimal visualisation of the ponticulus and subiculum. Analysis of the pyramidal eminence was improved thanks to its visualisation in profile. Moreover, we obtained an optimal representation of the hypotympanum, which was always exhaustively explored with only one reconstruction. Finally, in all cases, it was possible to identify the facial nerve canal and main vascular structures and to measure the distance between these and the sinus tympani, pyramidal eminence and hypotympanum. The coronal oblique CT reformation was of no advantage in the evaluation of the fossa of the oval window and the niche of the round window.Coronal oblique MPR CT reformation should not be considered an alternative to the standard CT examination, but it can represent a valid integration to provide additional information on particularly crucial districts characterised by frequent involvement of inflammatory and/or expansile disease and because of their difficult endoscopic approach. Moreover, it can represent a meaningful aid to optimise surgical planning thanks to its different perspectives of observation.

The Humerusblock is a minimally invasive device allowing fixation of proximal humeral fractures. A drawback of the device is possible K-wire perforation of the head with the need for early removal of the implant. We assessed the amount of humeral head impaction and its role in the postoperative varus/valgus deviation of the humeral head in fractures of the upper humerus treated with Humerusblock.Fractures were classified according to the Codman-Lego system. The length of the posteromedial metaphyseal extension and integrity of medial hinge were measured; metaphyseal comminution was assessed. Accuracy of fracture reduction was classified as excellent to poor. An original method of measurement of amount of postoperative impaction of the humeral head was developed. The impaction and varus/valgus inclination of the heads were measured comparing postoperative and three-month follow-up radiographs. Constant score and its relation to sintering was calculated at 12-month follow-up.Forty-three fractures were available for follow-up. The amount of humeral head impaction was 3.9 mm on average and was directly correlated with patient's age, sex, Codman-Lego classification, varus inclination and mataphyseal comminution. The postoperative cervico-diaphyseal angle was restored in 35 cases, with 81 % good results. The Humerusblock was removed in 41 % of cases because of K-wire perforation of the humeral head. A negative correlation was found between impaction and Constant score.The amount of humeral head impaction is related to patients' age, sex, and fracture patterns, being the most prone to compaction those with metaphyseal comminution. Humeral head impaction negatively affects final Constant score.

The vast majority of studies regarding rotator cuff tears (RCTs) are focused on etiopathogenesis and treatments, but information on shoulder pain characteristics needs further investigation. We analyzed the intensity and distribution of shoulder pain in patients with different sizes of RCTs.Two hundred eighty-five consecutive patients with postero-superior RCTs were enrolled for this study. Tear size was intraoperatively classified. Before surgery, all patients completed an upper limb pain map (dermatome map made by Keegan). Shoulder pain intensity was assessed with a visual analogue scale (VAS). Data were submitted to statistical analysis.Shoulder pain intensity caused by a RCT was greater in females (P = .024); it did not vary with the side nor with age. Pain intensity was less in massive tears (P.05) and in patients whose pain was distributed only to the shoulder (P = .035). Furthermore, patients whose pain persisted for more than 6 months maintained the same pain intensity. Pain was localized predominantly on dermatomes C5-C6, was more diffuse in massive tears (P.05), and rarely extended beyond the elbow. In the presence of intense shoulder pain, its precise distribution was not well-delimited.Shoulder pain characteristics in patients with RCTs may be influenced by gender and size of tear. Cuff tear pain distribution principally involves the antero-lateral aspect of the shoulder with extension down the lateral surface of the arm to the elbow. Information about pain intensity and distribution in patients with RCTs may contribute to a more accurate diagnosis.Level III, cross sectional study.

Hypothesis Smoking is an important risk factor for the development of rotator cuff tears. We hypothesized that smoking may also influence rotator cuff tear size. Materials and methods The study included 408 patients who underwent arthroscopic repair of cuff tear. Cuff tears were classified during surgery. We analyzed the percentage of smokers and the association of the amount and duration of smoking exposure with the type of tear. The average number of daily cigarettes and the total number of cigarettes in life were studied using age and gender as covariates. Results Smokers comprised 131 of 408 patients (32.1%). A type I tear affected 95 patients (23.3%), type II affected 214 (52.5%), type III affected 74 (18.1%), and type IV affected 25 (6.1%). Smokers comprised 23.2% (22 patients) of patients with type I tear, 33.6% (72 patients) of patients with type II tears, 36.5% (27 patients) of patients with type III tears and 40% (10 patients) of patients with IV tears. The frequency of smokers with at least a type II tear was 34.8% and differed significantly from the 23.2% of the type I tear patients ( P = 0.033). Total number of cigarettes was significantly higher in patients with an at least a type II tear ( F 1,127 = 4.694, P = .032). Discussion Rotator cuff has a relatively hypovascular insertion into the greater tuberosity. Cigarette smoking negatively affects vascularity of tendons. Conclusions There is a correlation between cigarette smoking habit, rotator cuff tear, and tear size. There was an increasing daily average number of cigarettes and a total number of cigarettes smoked in life across patients with increasing severity of tears.

BackgroundThis study was aimed at evaluating whether or not patients with chronic type III acromioclavicular dislocation develop cervical spine pain and degenerative changes more frequently than normal subjects.MethodsThe cervical spine of 34 patients with chronic type III AC dislocation was radiographically evaluated. Osteophytosis presence was registered and the narrowing of the intervertebral disc and cervical lordosis were evaluated. Subjective cervical symptoms were investigated using the Northwick Park Neck Pain Questionnaire (NPQ). One-hundred healthy volunteers were recruited as a control group.ResultsThe rate and distribution of osteophytosis and narrowed intervertebral disc were similar in both of the groups. Patients with chronic AC dislocation had a lower value of cervical lordosis. NPQ score was 17.3% in patients with AC separation (100% = the worst result) and 2.2% in the control group (p < 0.05). An inverse significant nonparametric correlation was found between the NPQ value and the lordosis degree in the AC dislocation group (p = 0.001) wheras results were not correlated (p = 0.27) in the control group.ConclusionsOur study shows that chronic type III AC dislocation does not interfere with osteophytes formation or intervertebral disc narrowing, but that it may predispose cervical hypolordosis. The higher average NPQ values were observed in patients with chronic AC dislocation, especially in those that developed cervical hypolordosis.

Prostaglandin E(2) (PGE(2)) belongs to a family of biologically active lipids derived from the 20-carbon essential fatty acids. Renal PGE(2) is involved in the development of the kidney; it also contributes to regulate renal perfusion and glomerular filtration rate, and controls water and electrolyte balance. Furthermore, this mediator protects the kidney against excessive functional changes during the transition from fetal to extrauterine life, when it counteracts the vasoconstrictive effects of high levels of angiotensin II and other mediators. There is evidence that PGE(2) plays an important pathophysiological role in neonatal conditions of renal stress, and in congenital or acquired nephropaties. Thus, measurement of urinary PGE(2) as an index of renal synthesis of this primary prostaglandin may represent a non-invasive and sensitive method of investigating the homeostatic function of the kidney in early life. The aim of this literature review is to examine urinary PGE(2) as a non-invasive marker of renal homeostasis in the newborn and infant under both physiological and pathological conditions, or during treatments with widely used, potentially toxic drugs.

The present study investigates the circadian rhythm (CR) of levo-carnitine (L-c) in systemic venous blood, in order to detect rhythmometric parameters that can be used for programming an eventual chronoterapy with such a molecule.The L-c CR was investigated in 10 clinically healthy subjects (5 M; 5 F; mean age: 26.02 +/- 1.11 yrs), who were diurnally active and nocturnally resting. Blood samples were taken at 06:00; 08:00; 12:00; 18:00; 20:00; 24:00, not juxtaposed to breakfast, lunch and dinner. The serum concentrations of L-c were assayed via a spectrophotometric method.A nychtohemeral variability in circulating levels of L-c was observed, with a peak in the afternoon. Such a intradiem variability was validated to have the properties of a significant CR (MESOR = 33.37 mumol/l with a SEM of 1.19 mumol/l; amplitude = 6.31 mumol/l with 95%CL ranging from 3.58 mumol/l to 9.69 mumol/l; acrophase at 15:52 h:min with 95%CL ranging from 13:28 h:min to 17:00 h:min).It is important to remark that the validation of a CR for the systemic serum levels of L-c was obtained in diurnally-active/nocturnally resting subjects. Such validated rhythmometric properties are parameters that can be used for programming an eventual chronotherapy, considering that the molecule L-c is used for treating its various types of primary and secondary deficiency.

Recent studies suggest that esophageal dysmotility occurring in systemic sclerosis might be caused by neurotransmitter levels decrease. The aim of the present study is to value VIP plasma levels, and to relate them with the pressure of the inferior esophageal sphincter (IES) and the capillaroscopy score in a group of patients affected by Systemic Sclerosis (SSc).Eleven subjects affected by SSc (eight male and three female, age from 30 to 72 years old) have been studied through esophageal manometry, capillaroscopy and VIP plasma levels evaluation. Fifteen healthy volunteers, as control group, have been enlisted.Our results show a decrease of VIP plasma levels in patients with SSc compared with control group. The difference between two groups has statistical significance (p0.01). Capillaroscopy has shown remarkable microcirculatory impairment and the esophageal manometry proved a decreased IES pressure. The scores of capillaroscopy, VIP plasma levels and pressures of IES have been compared and it has been observed that there is a relationship between VIP plasma level and pressure of IES.VIP plasma levels decrease enhances the role of the autonomic disorder in SSc and may contribute to produce the alteration of vascular tone as well as the gastroenteric musculature dysfunction.

Background Better knowledge of the suprascapular notch anatomy may help to prevent and to assess more accurately suprascapular nerve entrapment syndrome. Our purposes were to verify the reliability of the existing data, to assess the differences between the two genders, to verify the correlation between the dimensions of the scapula and the suprascapular notch, and to investigate the relationship between the suprascapular notch and the postero-superior limit of the safe zone for the suprascapular nerve. Methods We examined 500 dried scapulae, measuring seven distances related to the scapular body and suprascapular notch; they were also catalogued according to gender, age and side. Suprascapular notch was classified in accordance with Rengachary’s method. For each class, we also took into consideration the width/depth ratio. Furthermore, Pearson's correlation was calculated. Results The frequencies were: Type I 12.4%, Type II 19.8%, Type III 22.8%, Type IV 31.1%, Type V 10.2%, Type VI 3.6%. Width and depth did not demonstrate a statistical significant difference when analyzed according to gender and side; however, a significant difference was found between the depth means elaborated according to median age (73 y.o.). Correlation indexes were weak or not statistically significant. The differences among the postero-superior limits of the safe zone in the six types of notches was not statistically significant. Conclusions Patient’s characteristics (gender, age and scapular dimensions) are not related to the characteristics of the suprascapular notch (dimensions and Type); our data suggest that the entrapment syndrome is more likely to be associated with a Type III notch because of its specific features.