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Precipitation measurements by rain gauges are usually affected by a systematic underestimation, which can be larger in case of snowfall. The wind, disturbing the trajectory of the falling water droplets or snowflakes above the rain gauge, is the major source of error, but when tipping-bucket recording gauges are used, the induced evaporation due to the heating device must also be taken into account. Manual measurements of fresh snow water equivalent (SWE) were taken in Alpine areas of Valtellina and Vallecamonica, in Northern Italy, and compared with daily precipitation and melted snow measured by manual precipitation gauges and by mechanical and electronic heated tipping-bucket recording gauges without any wind-shield: all of these gauges underestimated the SWE in a range between 15% and 66%. In some experimental monitoring sites, instead, electronic weighing storage gauges with Alter-type wind-shields are coupled with snow pillows data: daily SWE measurements from these instruments are in good agreement. In order to correct the historical data series of precipitation affected by systematic errors in snowfall measurements, a simple ‘at-site’ and instrument-dependent model was first developed that applies a correction factor as a function of daily air temperature, which is an index of the solid/liquid precipitation type. The threshold air temperatures were estimated through a statistical analysis of snow field observations. The correction model applied to daily observations led to 5–37% total annual precipitation increments, growing with altitude (1740 ÷ 2190 m above sea level, a.s.l.) and wind exposure. A second ‘climatological‘ correction model based on daily air temperature and wind speed was proposed, leading to errors only slightly higher than those obtained for the at-site corrections.

Background: Achondroplasia (ACH) represents the major cause of dwarfism and is due to mutations in the fibroblast growth factor receptor 3 (FGFR3) gene. The cellular mechanisms involved in the reduced growth have been mainly described for in vitro or in vivo models, but few data have been obtained for humans. Methods: Thirteen children with ACH were enrolled in the study; the presence of FGFR3 mutations was determined by restriction fragment length polymorphism analysis and sequencing, whereas protein expression in cartilage biopsy was assessed by immunohistochemistry. Results: Chondrocytes in cartilage biopsies of ACH children were characterized by the presence of growth arrest mediated by STAT activation (both STAT1 and STAT5) and increased expression of p21 and cyclin D1, whereas no expression of either p53 or cyclin D3 could be detected. This mechanism was present in ACH children carrying the G380R mutation but also in a patient in whom no mutation could be detected in the entire coding region of the FGFR3 gene. Conclusions: These data thus demonstrate the presence of a common final mechanism involving p21 and possibly leading to a block in chondrocyte proliferation. © 2009 The Japanese Orthopaedic Association.

Treatment of long bone non-union (NU) continues to be a challenging task for the trauma surgeon often resulting in unsatisfactory results and long-term morbidity. Whilst autologous bone grafting remains the gold standard of treatment of these difficult cases, recently, due to the advances made in tissue engineering techniques, other alternatives have become available. In this study we report our preliminary results of treating long bone non-unions using either bone morphogenetic protein-7 (BMP-7) or platelet rich plasma (PRP) concentrations. Twenty-nine cases have entered this study thus far. Preliminary results indicate that BMP-7 is more efficacious that PRP as there was a significant failure rate of 6.2% versus 38.5% between BMP-7 and PRP, respectively.

Background: Gradual limb lengthening with currently used external fixation techniques can result in less than optimal outcomes, with complications including infection, stiffness of adjacent joints, and secondary axial deviation of the extremity. We describe a totally implantable lengthening device designed to provide results similar to those achieved with external fixation devices, with fewer complications and improved outcomes. Methods: Between 1993 and 1997, thirty-one patients (forty-one femora) underwent limb lengthening with a new internal fixation technique (Albizzia) to treat a congenitally short extremity (thirteen patients), post-traumatic limb-length inequality (eleven patients), or developmental problems (seven patients). Twenty-one patients (twenty-one femora) underwent unilateral surgery to equalize the limb lengths, and ten (twenty femora) underwent bilateral surgery to correct short stature. The mean age was twenty years and one month (range, twelve to thirty-nine years). After intramedullary corticotomy of the diaphysis of the femur, an intramedullary nail was inserted in an antegrade fashion. Fifteen alternating internal and external rotation maneuvers of the lower limb elongated the nail by 1 mm. The outcomes were assessed clinically and radiographically at a mean of fifty months postoperatively. Results: The gain in femoral length averaged 3.4 cm (range, 2 to 5.5 cm) after the unilateral lengthening procedures and 6.3 cm (range, 4.6 to 8.4 cm) after the bilateral procedures. Patients underwent an average of three operations on each limb; these procedures included, in addition to the nail insertion and nail removal, ratcheting under general anesthesia in thirteen limbs and eleven procedures to treat complications in nine patients. At the time of follow-up, no patient had axial deviation of the limb secondary to lengthening. Conclusions: Femoral lengthening with use of the minimally invasive Albizzia technique provides a reasonable alternative to external fixation that is well tolerated by patients and results in excellent function with little or no distortion of body image. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

This multicenter, randomized, controlled, open-label trial of 120 patients (89 men, 31 women) was conducted to compare the efficacy and safety of tramadol and diclofenac (both at 200 mg/d) in the short-term treatment (5 to 7 days) of traumatic musculoskeletal pain. The posology of the two treatments was 100 mg twice daily; however, the patients could take three doses per day. Patients were randomly assigned to either treatment. Thirty patients, with strong pain resulting from trauma to bones, joints, and/or ligaments, were admitted to each of four centers. The analgesic effect of both drugs was confirmed by the significant reduction in pain compared with baseline. The anagelsic activity of tramadol was higher than that of diclofenac, after both the first dose (between treatments at the 5th and 6th hours), and during repeated therapy (between treatments on day 2 and at the end of treatment). Patients' quality of sleep improved significantly with both drugs, on day 2 and at the end of treatment, compared with baseline. Seven patients discontinued the drugs because of moderate-to-severe adverse reactions (4 receiving tramadol and 3 receiving diclofenac). Another 6 patients had moderate-to-mild reactions (4 receiving tramadol and 2 receiving diclofenac). Final assessments of efficacy and safety were all significantly in favor of tramadol.

Background Exercise training induces cardiovascular changes that are both generalized and restricted to the microcirculation of the tissues more actively involved in the exercise itself. Whether the local effect of exercise extends to larger arteries is unknown, however. Methods In the right and left upper limb of 17 right-handed subjects performing an asymmetric training of the upper limbs (hammer throwers and baseball players) and 16 age-matched sedentary controls, we continuously measured radial artery diameter, distensibility and wall thickness by an echotracking and a beat-to-beat finger blood pressure device, Arterial distensibility was calculated by the arctangent model of Langewouters and expressed as continuous values from diastolic to systolic blood pressure. Measurements were made: (1) in baseline conditions; (2) after release from prolonged proximal ischaemia; and (3) after an increase in radial artery blood flow caused by a short (4 min) distal ischaemia to determine the endothelial involvement in the training-induced change in arterial distensibility, Results In athletes the radial artery distensibility was markedly greater in the right than in the left arm, the latter showing values slightly greater than those seen in the two arms of sedentary subjects. In both arms and groups radial artery distensibility increased markedly after prolonged ischaemia, the between arm and group differences being preserved, however. The radial artery response to distal short ischaemia was, on the other hand, similar in the two arms of the athletes, although greater in these subjects than in the sedentary ones. Radial artery wall thickness was greater in the trained than in the untrained arm of athletes, both values being greater than in sedentary subjects. Conclusions Asymmetrical training of the upper limbs is accompanied by a greater distensibility of the middle-sized arteries of the more trained side. This is not associated with asymmetrical changes in endothelial structure or function. It is associated with a greater wall thickness in the trained side, suggesting that, at least in part, a training-induced asymmetrical change in wall structure (possibly with a predominance of more distensible tissues such as elastine and smooth muscle) is responsible, (C) 2001 Lippincott Williams & Wilkins.

In this study, periprosthetic bone mineral density was measured at scheduled time intervals after surgery by dual energy x-ray absorptiometry in 21 patients to assess the history of bone density redistribution after femoral stem insertion. Measurements of changes in bone density with time were obtained for the regions of the greater trochanter, the lateral cortex, the tip, the medial cortex, and the calcar. In all regions, bone density decreased during the first 3 months after surgery; this was followed by a prolonged period of 18 to 30 months of bone gain, a subsequent period of steady state, and the final resumption of bone aging processes after the third postoperative year. The greatest loss was observed in the calcar region after 6 months (greater than 50%). The characteristic pattern of time related bone density changes obtained in this study may make it possible to compare other pathologic, design, or stiffness related patterns. This could have clinical relevance in the early diagnosis of pathologic processes and as a means of evaluating prosthetic designs.

Abstract Animal studies have suggested that arterial compliance can be modulated by adrenergic influences. Whether this adrenergic modulation also occurs in humans is still a matter of debate. In the present article we address this issue by examining the relationships between sympathetic tone and arterial compliance in a variety of physiological and pathophysiological conditions. We have found that cigarette smoking, ie, an action that produces a marked sympathetic activation, causes a significant reduction in radial artery compliance, as measured by an echotracking device capable of providing continuous beat-to-beat evaluation of this hemodynamic variable. When expressed as compliance index, ie, as the ratio between the area under the compliance-pressure curve and pulse pressure, the reduction amounted to 35.7±4.8% (mean±SEM) and was independent of the smoking-related blood pressure increase. Furthermore, pharmacological stimulation of adrenergic receptors located in the arterial wall was also shown to affect arterial compliance because the radial artery compliance index was markedly reduced (−29.5±3.9%) during phenylephrine infusion in the brachial artery at doses devoid of any systemic blood pressure effect. Evidence was also obtained that the relationship between sympathetic activation and arterial compliance has pathophysiological relevance, because in 17 patients with congestive heart failure (New York Heart Association classes II through IV) there was a significant inverse correlation ( r =.62, P

Since 1981we have operated on 113 patients ( 61 males and 52 females), afflicted with achondroplasia elongating the lower limbs.

Cabergoline is a potent dopaminergic agent that interacts with agonists and antagonists of dopamine receptors in vitro. We studied the binding of [3H]N-n-propylnorapomorphine ([3H]NPA) to dopamine receptors after i.v. and oral administration of cabergoline to determine whether cabergoline crosses the blood-brain barrier; bromocriptine was used as a reference drug. Cabergoline and/or its active metabolite(s) did cross the blood-brain barrier and reach dopamine receptors. Comparative time-course analysis of the regional inhibition of [3H]NPA binding showed that cabergoline was more potent than bromocriptine in inhibiting [3H]NPA binding and that it occupied the receptor for longer. These effects were observed in all areas of the rat brain studied (striatum, olfactory tubercles, adeno- and neurohypophysis, thalamus and hypothalamus). Further studies in the striatum and adenohypophysis showed that cabergoline receptor occupancy was dose-dependent and still detectable 72 h after i.v. administration of the drug. While cabergoline was more potent in the striatum than in the adenohypophysis when administered i.v., the reverse was observed after its oral administration. Cabergoline was equally potent in the adenohypophysis after oral and i.v. administration, as determined 1 and 8 h later.

Summary: Two rare cases of subtotal aplasia of the pectoralis major muscle, a residual anomalous formation inserted abnormally into the medial humeral condyle, are discussed