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The aim of this study was to compare the mechanical behavior under cyclic loading test of single-row and double-row rotator cuff repair with suture anchors in an ex-vivo animal model. For the present study, 50 fresh porcine shoulders were used. On each shoulder, a crescent-shaped full-thickness tear of the infraspinatus was performed. Width of the tendon tear was 2 cm. The lesion was repaired using metal suture anchors. Shoulders were divided in four groups, according the type of repair: single-row tension-free repair (Group 1); single-row tension repair (Group 2); double-row tension-free repair (Group 3); double-row tension repair (Group 4); and a control group. Specimens were subjected to a cyclic loading test. Number of cycles at 5 mm of elongation and at failure, and total elongation were calculated. Single-row tension repair showed significantly poorest results for all the variables considered, when compared with the other groups. Regarding the mean number of cycles at 5 mm of elongation and at failure, there was a nonsignificant difference between Groups 3 and 4, and both of them were significantly greater than Group 1. For mean total elongation, the difference between Groups 1, 3, and 4 was not significant, but all of them were significantly lower than the control group. A single-row repair is particularly weak when performed under tension. Double-row repair is significantly more resistant to cyclic displacement than single-row repair in both tension-free and tension repair. Double-row repair technique can be primarily considered for large, unstable rotator cuff tears to improve mechanical strength of primary fixation of tendons to bone.

The aim of the present study was to evaluate the structural properties of femur-patellar tendon graft complex in anterior cruciate ligament (ACL) reconstruction using different femoral fixation devices. Type of study is biomechanical testing. An ACL reconstruction was performed on 40 cadaver porcine knees, using patellar tendon (PT) graft. Specimens were divided into four groups according to the femoral fixation: interference absorbable screw (Group A), metallic setscrew (Group B), absorbable pins (Group C), and a combination of metallic setscrew and pin (Group D). Other ten knees were used as controls. On each sample, a cyclic loading test, then a load-to-failure test were performed. Elongation after 1,000 loading cycles, ultimate failure load, yield load, stiffness, deformation at the yield point, and mode of failure were recorded. Kruskal-Wallis test and Tukey test were used to compare the differences between groups. The lowest mean elongation after 1,000 load cycles was observed for Group B (1.7 +/- 1.4 mm) and D (1.2 +/- 0.3 mm). Ultimate failure load of Group D (1,021.8 +/- 199.4 N) was comparable with that of normal ACL (1,091.2 +/- 193.3 N) and PT graft (1,140.6 +/- 285.7 N). All other groups were lower than the controls. For mean stiffness, all the groups, excepting for Group D (172.8 +/- 40.4 N/mm), were significantly lower than PT control group (216 +/- 78.4 N/mm). Mode of failure was graft pullout for Groups A and B, distal pin breakage for Group C, and midsubstance graft rupture in 80% of the cases for Group D. Only combined compression and suspension fixation did not show significantly different structural properties in comparison with normal ACL and PT graft. Furthermore, it showed no risk of graft pullout or hardware breakdown in comparison with other fixation devices.

Purpose: Our purpose was to evaluate the role of subacromial decompression in the arthroscopic repair of full-thickness rotator cuff tears in a prospective randomized clinical study., Methods: Arthroscopic cuff repair was performed in 80 patients with a full-thickness rotator cuff tear. They were divided into 2 groups comprising 40 patients each. In group 1 arthroscopic rotator cuff repair was performed with subacromial decompression. In group 2 the repair was performed without decompression. Rotator cuff tears were repaired via metal suture anchors for tendon-to-bone repair, side-to-side repair, or a combination of the 2 techniques. Results were evaluated by use of the Constant score normalized for age and gender, as well as the Disabilities of the Arm, Shoulder and Hand (DASH) and Work-DASH self-administered questionnaires. On analyzing the results at 2 years' follow-up, we considered the following independent variables: age; gender; dominance; location, shape, area, retraction, and reducibility of cuff tear; fatty degeneration; involvement of subscapularis tendon; treatment of biceps tendon; rotator cuff repair technique; and type of acromion. A univariate and multivariate statistical analysis was performed to determine which variables were independently associated with the outcome., Results: Comparison between the groups did not show significant differences for each variable considered. The overall results for the Constant score were 103.6 points in group 1 and 96.1 points in group 2; those for the DASH score were 18.2 points and 23.1 points, respectively; and those for the Work-DASH score were 23.7 points and 26.2 points, respectively. Univariate and multivariate analysis showed that the following variables significantly and independently influenced the outcome: age; shape, retraction, and reducibility of cuff tear; fatty degeneration; involvement of subscapularis; and repair technique. Subacromial decompression did not influence the outcome significantly for each scoring system considered., Conclusions: At short-term follow-up, subacromial decompression did not seem to significantly affect the outcome of arthroscopic rotator cuff repair. Longer follow-up studies will be necessary to confirm the clinical relevance of these observations., Level of Evidence: Level I, randomized controlled trial with no significant difference but narrow confidence intervals.

Background: Chemohyperthermic peritoneal perfusion (CHPP) after extensive cytoreductive surgery is a possible choice as a regional treatment for peritoneal carcinomatosis (PC). The multicentric France EVOCAPE 1 study demonstrated that the median overall survival of patients with colon peritoneal carcinomatosis subjected to conventional surgical and/or chemotherapeutic treatment was 5.2 months. Historically, mitomycin C is the drug of choice in the treatment of intraperitoneal carcinomatosis from colon cancer., Methods: Twenty-five patients affected by stage IV colon cancer with only peritoneal involvement and a prior completion of at least a partial first cycle of systemic chemotherapeutic and/or surgical treatment (24 patients) were enrolled. Immediately following extensive cytoreductive surgery, early postoperative closed abdomen CHPP was performed., Results: Complete surgical cytoreduction (CC0-CC1) was obtained in 22 patients. Postoperative mortality was 1 out of 25 (4%). Major postoperative morbidity was 6 out of 25 (24%). Median overall survival estimated by Kaplan-Meier curve was 30.3 months. Locoregional progression-free survival was 17.3 months. Of all the patients 64% and 40% were alive after 1 and 2 years respectively., Conclusions: In referral centers CHPP after optimal surgical debulking is a safe procedure for peritoneal carcinomatosis from colonic cancer. Locoregional control was obtained in the majority of the pretreated patients and 1-year survival was statistically improved. A closed abdomen CHPP procedure lasting 1 hour and standard mitomycin C at a dosage of 15 mg/m(2) is probably as efficacious as other hyperthermic procedures, using higher mitomycin C dosages, with a comparable or lower number of cases of side effects. These results, as in other published phase II studies, justify future randomized trials to assess definitively the role of CHPP in the treatment of locally advanced colon neoplasms in western countries.

This study evaluates the structural properties of the femur-anterior cruciate ligament (ACL) graft-tibia complex, comparing different graft fixation techniques in sheep knees. Four fixation devices were tested both for femoral fixation (Transfix, absorbable screw, RCI screw and Linx-HT) and tibial fixation (bone plug with metal screw, absorbable screw with staple, RCI screw and cancellous screw with spiked washer). The graft used for ACL reconstruction was fresh ovine doubled Achilles tendon (DAT). Femurs and tibias were tested separately. Two mechanical test series were performed on the specimens: a load-to-failure test and a cyclic loading test. On the femoral side, transcondylar screw showed the greatest fixation strength and stiffness and the lowest elongation at cyclic loading. Tibial fixation complexes seemed to have poorer structural properties in comparison to femoral fixation. Among the tibial fixation devices, absorbable screw with staple fixation showed the greatest strength and stiffness. Spiked washer fixation showed the greatest elongation under cyclic loading.

Aims and Background: The surgical removal of lung metastases is controversial: some authors have reported good results in terms of prognosis and disease-free interval in patients affected by multiple metastases. Recently, percutaneous hyperthermic tissue ablation (HTA) has been used under CT guidance in solitary peripheral pulmonary tumors attached or close to the parietal pleura., Methods and Study Design: We report the first intraoperative HTA of a lung metastasis from colorectal carcinoma, which might pave the way for possible future application of the procedure in patients with multiple pulmonary metastases. A 64-year-old patient affected by a rectal cancer was treated by abdominal perineal amputation followed by two lines of chemotherapy. After two years two lesions appeared in the lower left pulmonary lobe and another in the lower right lobe. The patient was monitored by three-monthly thoracic and abdominal CT. The lesions were stable for one year, but in the last two months one of the suspected metastases in the left lung increased from 1 to 2 cm. This was an indication for surgical removal. A mini posterolateral thoracotomy was performed. Thanks to complete collapse of the lung with manual squeezing of the parenchyma, ultrasonography provided satisfactory visualization of the two lesions. A frozen biopsy of the larger lesion was obtained which confirmed its metastatic nature. Ultrasound-guided HTA of the larger metastasis (2 cm) was performed. Final US demonstrated the change in the metastatic pattern. The two lesions were eventually removed by wedge resection using a TA 90 stapler. Histological examination of the two lesions confirmed the coagulative necrosis of the treated metastasis. No morbidity or pulmonary problems were recorded.

The authors report a retrospective analysis of the immediate and long-term results of treatment of gastroesophageal reflux refractory to medical therapy using the insertion of Angelchik's prosthesis in a group of 26 patients operated at the Institute of Emergency Surgery of Turin University from January 1980 to December 1993. All patients underwent pre- and postoperative endoscopy and were then controlled using esophagogastric X-ray, esophagogastroscopy, esophageal manometry and pH-metry in the event of disorders of esophageal motility. Operative mortality was nil and no major surgical complications were reported. Postoperative endoscopy showed the resolution of esophagitis in 23 patients (88.4%); symptoms of slight esophagitis persisted in 2 cases, and moderate esophagitis in another. Eighteen patients were monitored over time with a minimum follow-up of more than 2 years: persistent dysphagia appeared in 3 cases (16.6%), and in one patient this led to the need for endoscopic dilatations. Two patients (11.1%) presented "gas bloat syndrome" which gradually improved. It was never necessary to remove the device. No cases were observed of erosion, migration or destruction of the prosthesis. Follow-up exceeded 10 years in 7 patients, at present asymptomatic. Angelchik's prosthesis proved to be efficacious, rapid and simple to insert, and characterised by a lower morbidity rate and shorter postoperative course. The incidence of postoperative dysphagia makes only it is use indicated only in patients with a high operative risk, obese subjects and in case of recidivation of reflux after fundoplication.

Clinical and biological data have been evaluated, using both univariate and Cox's multivariate statistical analyses, in a series of 133 Chronic Lymphocytic Leukemia (CLL) patients with a mean age of 46.6 years (range 31-50). In univariate analyses, anemia (Hb less than 13 g/dl), peripheral blood (PB) lymphocytosis (greater than 40 x 10(9)/l) and bone marrow (BM) lymphocytosis (greater than 80 per cent) were shown to be of significant prognostic value. Multivariate analysis, through a forward stepwise procedure, showed that the most important and independent variable is the BM lymphocytosis. These results are different from those obtained in previous studies and particularly in a recent identical study performed by the same Cooperative Group on 1777 patients with a mean age of 64.2 years (Mandelli et al., 1987). No significance can be demonstrated in stratifying this series of younger patients according to different staging methods (Rai et al., 1975; Binet et al., 1981b; Mandelli et al., 1987). Therefore this population of CLL patients, with less than 50 years of age, has risk factors quite different from classical CLL. The results of the present study show that the diagnostic approach to B-CLL in younger adults must be more complete: using the common diagnostic criteria, established staging systems appear to be inadequate in this series of younger patients.

Thirty-one patients with advanced stage of favorable histology non-Hodgkin's lymphomas were entered into a multicenter phase II trial with recombinant alpha A interferon as single agent. Interferon was administered intramuscular in doses of 6 x 10(6)/IU/m2 three times per week for 12 weeks. Dose escalation was applied, in the absence of toxicities greater than WHO grade II, in patients not responding after 4 weeks. In responding patients treatment was continued at the same dose with a weekly maintenance schedule for 12 additional weeks. Objective responses (4 complete, 10 partial) were obtained in 14 of the 27 evaluable patients (52%). Median time to progression was 15 months for partial responders, while none of the complete responders has relapsed up to the present time. Toxicity was generally moderate and manageable. Treatment was discontinued in three patients because of side effects, and one patient refused therapy after 3 weeks. Our study shows that recombinant alpha A interferon has antitumor activity in patients with favorable histology non-Hodgkin's lymphoma.